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This population-based retrospective cohort study from Israel found that patients with a diagnosis of basal cell carcinoma (BCC) had a 2.46% incidence of melanoma, which was significantly higher than the incidence of melanoma in patients without a diagnosis of BCC (0.37%; P < .0001). The mean time to melanoma diagnosis in the BCC group was 1.7 years. Age ≥60 years and male sex were the independent risk factors for a diagnosis of melanoma.
In this population, patients with BCC had a 6.6-fold increased risk for melanoma. This risk highlights the importance of routine full-body skin examinations after a BCC diagnosis, especially for the first 2 to 3 years after diagnosis.
Basal cell carcinoma is the most prevalent cancer in Caucasians worldwide. The aim of this study was to examine the overall risk of melanoma among patients diagnosed with basal cell carcinoma. This population-based retrospective cohort study included data from January 2010 to December 2018 from the databases of the Clalit Health Maintenance Organization and 2 major pathology laboratories in North District, Israel. The incidence and hazard ratio of melanoma in patients with a diagnosis of basal cell carcinoma were determined. Of 466,700 participants, 51% were women and the mean (standard deviation) follow-up was 6.7 (2.9; range 1-9) years. A total of 3,338 patients were diagnosed with basal cell carcinoma during the study period, 82 of whom subsequently developed melanoma. Patients with basal cell carcinoma had a significantly higher incidence of melanoma than patients without basal cell carcinoma (2.46% vs 0.37%; p < 0.0001). Univariate Cox regression analysis revealed a hazard ratio of 6.6 (95% confidence interval: 3.6-12.1; p < 0.0001) for melanoma in patients with a diagnosis of basal cell carcinoma. In conclusion, a diagnosis of basal cell carcinoma confers a significant risk of melanoma.
This population-based retrospective cohort study was performed by a group of Israeli dermatologists. It included patients 18 years or older who were insured by the Clalit HMO Northern Israel District between January 1,,2010, and December 31, 2018. The Clalit HMO is the largest health insurance provider in Israel and insures 70% of the population of Israel’s Northern District. Data were extracted from the Clalit HMO databases and those of two major pathology laboratories in Northern Israel. The propensity score control group matching was accomplished 1:1 according to age, sex, place of birth, smoking status, socioeconomic status, and religious background (“greedy matching”).
A total of 466,700 individuals were included; 3338 patients were diagnosed with basal cell carcinoma (BCC) during the study period. Of those patients, 82 (2.46%) diagnosed with BCC subsequently developed melanoma.
The authors found that patients with BCC had a higher incidence of melanoma than those without BCC (2.46% vs 0.37%). Univariate Cox regression analysis revealed a hazard ratio (or increased risk) of 6.6 for melanoma in patients with a diagnosis of BCC.
The paper concluded that a diagnosis of BCC confers a significant risk of melanoma. In addition to BCC, it was also noted that male sex and age ≥60 years were independent risk factors for melanoma. The authors concluded by recommending that patients diagnosed with BCC should undergo regular screening for melanoma, especially during the first 2 to 3 years after their BCC diagnosis.
The findings of this paper are reasonable and prudent. Many types of skin cancers can be precipitated by similar carcinogens (as ultraviolet light) and genetic predispositions. Nonetheless, only 2.5% of the patients with BCC ultimately developed a melanoma versus 0.37% of those without a history of BCC. Therefore, it is this dermatologist’s opinion that all middle-aged and older adults (particularly men over 60 years) with a history of sun damage should be screened for melanoma. It is likely that those who have experienced a BCC will be more compliant, but we should still try to screen them all if possible.