Characteristic of Basal Cell Carcinoma in Tertiary Health Care

Radema Maradong, Yulia Farida Yahya, and Theresia Lumban Toruan

Department of Dermatology and Venereology Faculty of Medicine Sriwijaya University/ Dr. Moh. Hoesin General Hospital

Palembang, Indonesia

Keywords: nail changes, Characteristic, BCC, risk factor sun exposure, occupation farmer

Abstract: Basal cell carcinoma (BCC) is cutaneous non melanoma cancer usually found in Caucasian with incidence

rate 70%-80% from all cutaneous malignant, in Asia 10-100x lower than Europe and America. The purpose

of this study is to know the characteristic of BCC such as incidence, sex, age, occupation, location and

clinicohistopathology feature. Study method is retrospective descriptive study, the data was taken from

medical record of BCC patient in Department of Dermatology and Venereology, Department of Surgery,

Department of Ophtamology and Department of Ear, Nose, and Throat in Dr. Mohammad Hoesin General

Hospital from January 2014 – December 2016. The result from 193 medical records of four Departments

found 104 cases (53.9%) affected inmaleand 89 cases (46.1%) in female. Male to female ratio is 1.2:1,

mostly occur in age 55-64 years old (37.8%).We found 92 cases (47.7%) in a farmer, which 98 cases

(50.8%) occur on thenasalis region, and 172 cases (89.2%) are nodular type. In conclusion, male are often

affected than female in elderly, with the nasalis region is the most common site of BCC and mostly

occupation as a farmer. The Sun exposure to UV radiation is undoubtely of great factor. The

clinicohistophatology features are nodular type. These characteristicsof BCC were similar to other Asian

studies.

1 INTRODUCTION

Basal cell carcinoma (BCC) or Rodent ulcer is the

most common skin cancer, derived from immature

pluripotent cell of interfollicular epidermis (Kumar

et al., 2004; Saldanha & Upadhaya, 2015). The

population of BCC between 70-80% from all types

of skin cancer (Saldanha & Upadhaya, 2015; LeBoit

et al., 2006).

The etiology of BCC is still unclear,

some investigator believe that the main risk factor

associated with UV radiation exposure. There is a

correlation between an outdoor occupational

especially a farmer (Kumar et al., 2004; Saldanha &

Upadhaya, 2015; LeBoit et al., 2006).Basal cell

carcinoma usually found in chronic UV expose area

such as face and neck (LeBoit et al., 2006;

Verkouteren et al., 2017).

Male more often affected

than female (Verkouteren et al., 2017; Yahya et al.,

2011). The incidence of BCC increase with age,

especially in elderly between 50-80 years old

(Kumar et al., 2004; Saldanha & Upadhaya, 2015).

2 METHODS

This is a descriptive retrospective study in General

Hospital of Dr. Moh. Hoesin Palembang, between

January 2014 and December 2016 based on

demographic and clinicohistophatology data of BCC

patients. The statistical analysis were done using

software package (SPSS) 22.0 version.

3 RESULTS

In this study, we found 193 cases of BCC (0,02%)

from January 2014 - December 2016 (Figure 1).

Predominantly affected male in 104 cases (53.9%)

and 89 cases (46.1%) in female (Figure 2). In this

tudy, we found 73 cases (37,8%) with age 55-64

years old, ≥ 65 years old in 59 cases (30.6%), 45-54

years old in 34 cases (17.6%), 35-44 years old in 9

cases (9.8%), 25-34 years old in 6 cases(3.1%), 18-

24 years old in 2 cases (1%) (Table 1).

Maradong, R., Yahya, Y. and Toruan, T.

Characteristic of Basal Cell Carcinoma in Tertiary Health Care.

DOI: 10.5220/0008149500050008

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 5-8

ISBN: 978-989-758-494-7

Figure 1: Total of BCC patients from January 2014 and December 2016.

Figure 2: Sex distribution of BCC patients

The mean age of BCC is 61.74±11.76 (mean±

SD). Occupations are farmer in 92 cases (47.7%), 52

cases (27%) of housewives, 40 cases (20.6%) of

civil servant, and 9 cases (4.6%) of retired (Table 1).

Distribution of location respectively are facialis

predominantly on nasalis region around 98 cases

(50.8%), 11 cases (5.7%) on the colli, 2 cases (1%)

on the truncus, and 3 cases (1.5%) on extremities

(Table 1). Clinicohistophatology features are

nodular around 172 cases (89.1%), 10 cases (5.2%)

micronodular, 9 cases (4.7%) infiltrative, 1 case

(0.5%) superficial, and 1 case (0.5%) basosquamous.

4 DISCUSSION

In this tertiary health care study (2016), incidence of

BCC is 0,02%. BCC more often occur in male than

female, with ratio 1,2:1. Toruan, et all. (2000) found

incidence of BCC in Palembang was 0,042%.

Yahya, et al.(2011) found the incidence of BCC in

palembang was 0,3% with the ratio of male:female

is 1:1.

Lomas, et al. (2012) in England found the

incidence of BCC was increased approximately 5%

over recent decades.

Rogers, et al. (2015) in the

Table 1. Characteristic features of BCC patients

Characteristics Male Female

Age

 18-24

 25-34

 35-44

1 (0.5%)

3 (1.6%)

6 (3.1%)

1 (0.5%)

3 (1.6%)

13 (6.7%)

RCD 2018 - The 23rd Regional Conference of Dermatology 2018

 45-54

 55-64

 > 65

16 (8.3%)

42 (21.7%)

36 (18.7%)

18 (9.3%)

31 (16.1%)

23 (11.9%)

Occupation

 Farmer

 Housewives

 Civil servants

 Retired

65 (33.7%)

0 (0%)

30 (15.5%)

9 (4.7%)

27 (14%)

52 (27%)

10 (5.1%)

0 (0%)

Location

 Facialis

 Colli

 Truncus

 Extremities

91(47.2%)

9 (4.7%)

2 (1%)

86 (44.6%)

2 (1%)

0 (0%)

1 (0.5%)

Clinicohistophatology

 Nodular

 Micronodular

 Infiltratives

 Superficial

 Basosquamous

94 (48.7%)

4 (2.1%)

5 (2.6%)

0 (0%)

1 (0.5%)

78 (40.4%)

6 (3.1%)

4 (2.1%)

1 (0.5%)

0 (0%)

United States reported the incidence of BCC was

increased 2% every year (Rogers et al., 2015). The

precentage of skin cancer in Asia about 2-4%.

found incidence of BCC in this study is lower than

the Caucasian population about 35 -40%. This study

is a hospital based study, and others are population

based study.

In this study, the mean age is 61.74±11.76

(mean± SD) with onset of BCC often occur in age

55-64 years old in 73 cases (37,8%) followed by ≥

65 years old in 59 cases (30.6%), 45-54 years old in

34 cases (17.6%), 35-44 years old in 9 cases (9.8%),

25-34 years old in 6 cases (3.1%), and 18-24 years

old in 2 cases (1%). This study is similar with

Goldenberg, et al. (2016) in United States and

Trakatelli, et al. (2016) in Europe which reported the

mean age are 60 and 66,5 years old respectively,

especially in fifth decade (Goldenberg et al., 2016;

Trakatelli et al., 2016). The reason of this findings

related to the accumulation of UV exposure and

decreasing the ability of DNA repair in elderly

people (Verkouteren et al., 2017).

The location of BCC commonly on the face,

predominantly on the nasalis region 98 cases

(50.8%), followed by 11 cases (5.7%) on the colli, 2

cases (1%) on the truncus, and 3 cases (1.5%) on the

extremities. This findings is similar with study by

Tan, et al. (2014) in Singapore and Kumar, et al.

(2014) in India which reported the most common

location of BCC is the nasalis region (Tan et al.,

2015).The nasalis region is an area that often

exposed to UV radiation and sometimes it lack of

any UV protection (Trakatelli et al., 2016).

We found 92 cases (47.7%) are farmer and

followed by housewives 52 cases (27%), 40 cases

(20.6%) of civil servants, and 9 cases (4.6%) of

retired. This study is similar with Kumar, et al.

(2014) in India, where outdoor occupation have a

correlation with prolonged exposure which an

intermitten or intense sun exposure increase the risk

of BCC (Verkouteren et al., 2017).

Corona et al.

(2001) showed a tedency of increased incidence of

BCC only if an outdoor accupation had been carried

out for more than 8 years (Corona et al., 2001).

Vlajinac et al. (2000) found this correlation only for

outdoor work during summer time (Vlajinac et al.,

2000) . Zak Perlich et al. (2004) suggested that

occupational factor have been connected with

development of BCC. They include organic and

nonorganic solvent and organophosphatic

compounds (Zak Perlich et al., 2004)

In this study, the most common

clinicohistophatology features is nodular (89,1%),

then micronodular (5,2%), infiltrative (4,7%),

basosquamous (0,5%), and superficial (0,5%). These

result is similar with other studies in Asia such as

Tan, et al. (2014) in Singapore, and Kumar, et al.

(2014) in India, both reported that nodular type are

the most common clinicohistophatology features

BCC (Kumar et al., 2014; Tan et al., 2015). These

results could indicate that could indicate that the

different types of clinicohistophatology features

related to UV exposure and the interaction between

constitutional characteristics and other

environmental risk factors (Verkouteren et al.,

2017).

Characteristic of Basal Cell Carcinoma in Tertiary Health Care

5 CONCLUSIONS

Male are often affected than female,age 55-64 years

old often suffer BCC which a farmer is the most

common occupation related to BCC development.

The nasalis region is the main site of BCC. There is

correlation an outdoor working, occupational factor

with sun exposure of development BCC. The

clinicohistophatology features are nodular type.

These characteristics of BCC were similar to other

Asian studies.

ACKNOWLEDGEMENT

We are grateful to Pathology Anatomy Department

of Dr. Mohammad Hoesin General Hospital

Palembang, for submitting pathology examination

data of BCC.

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