Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
Br J Dermatol. 2014 Nov;171(5):1066-72. doi: 10.1111/bjd.13217. Epub 2014 Oct 20.
Basal cell carcinoma (BCC) is the most frequent skin cancer with increasing incidence and generally high cure rates. BCC can be quite aggressive and is difficult to treat.
To investigate BCCs with a focus on histological subtypes, treatment procedures and correlation to clinical progress to collect further information on complex BCC cases.
In this retrospective single-centre analysis the dermatopathology database, a network of cooperating dermatological surgeons, was queried for BCC cases between January 2007 and December 2011. Of 14,423 samples from a total of 9652 patients initially identified, 2938 patients were treated at the University Hospital Zurich and had corresponding local electronic patient records.
Patients (n = 2938) (with 4769 diagnoses, 2006 re-excisions with 1180 microscopically controlled surgeries) were classified based on severity estimations into 2240 simple, 640 moderate, and 58 severe cases, including one BCC-treatment-associated death and 11 patients with subsequent participation in a clinical trial. In moderate and severe cases (n = 698), there were significantly higher rates of unique histological diagnoses (n = 2·5; P < 0·0001), higher association with basosquamous carcinoma [odds ratio (OR) 3·6; P < 0·0001] and sclerosing BCC (OR 2·48; P < 0·0001). Of the patients with basosquamous carcinoma 82·6% had a previous history of BCC.
This is the first study that analyses the frequency of complicated BCCs in a tertiary referral centre. There were 6·6% moderate (640 of 9652) and 0·6% (58 of 9652) severe cases. We found significantly more varying histological diagnoses and significant association with aggressive subtypes in moderate and severe cases. These patients might especially benefit from new therapeutic options.
基底细胞癌（BCC）是最常见的皮肤癌，其发病率不断增加，且总体治愈率较高。BCC 可能极具侵袭性，且难以治疗。
本研究旨在重点关注组织学亚型、治疗程序，并分析其与临床进展的相关性，以收集有关复杂 BCC 病例的更多信息。
在这项回顾性单中心分析中，我们查询了 2007 年 1 月至 2011 年 12 月期间皮肤科医生数据库中来自苏黎世大学附属医院的患者的 BCC 病例。在最初确定的 9652 例患者的 14423 例样本中，有 2938 例在苏黎世大学附属医院接受治疗，且有相应的局部电子病历。
患者（n=2938）（有 4769 个诊断，2006 例再次切除，1180 例显微镜下控制手术）根据严重程度估计分为 2240 例简单、640 例中度和 58 例严重病例，包括 1 例 BCC 治疗相关死亡和 11 例随后参加临床试验的患者。在中度和严重病例（n=698）中，独特的组织学诊断率明显更高（n=2·5；P<0·0001），与 basosquamous 癌（优势比[OR]3·6；P<0·0001）和硬化性 BCC（OR 2·48；P<0·0001）的关联度更高。有 basosquamous 癌的患者中有 82.6%有 BCC 病史。
这是第一项在三级转诊中心分析复杂 BCC 频率的研究。中度病例（9652 例中有 640 例，6.6%）和重度病例（9652 例中有 58 例，0.6%）分别为 6.6%和 0.6%。我们发现中度和重度病例中组织学诊断明显更为多样化，且与侵袭性亚型显著相关。这些患者可能特别受益于新的治疗选择。
