Acta Dermato-Venereologica 99-13CompleteContent | Page 17

1266 INVESTIGATIVE REPORT Comparative Analyses of Tumour Volume Doubling Times for Periocular and Non-periocular Head and Neck Basal Cell Carcinomas Andre Boo Shern KHOO 1 , Patrick Kin Yoong GOON 2 , Holger SUDHOFF 3# Basal cell carcinomas are the commonest solid malig­ nancy in humans and thought to grow faster in the pe­ riocular region. We measured growth rates between periocular and non-periocular nodular basal cell carci­ nomas in the head and neck region from high-resolu­ tion digital photos and operative notes. The non-perio­ cular basal cell carcinomas (head and neck) showed a mean tumour volume doubling time of 129.8  ±  21.74 (n  = 79) days, and the periocular basal cell carcinoma a mean of 177.5  ±  37.21 (n  = 47) days. The unpaired t- test with Welch correction showed that this difference was not significant (p = 0.2719). The mean tumour vo­ lume doubling time was 147.59  ±  37.75 days for head and neck basal cell carcinomas overall. For the first time, tumour volume doubling times for nodular basal cell carcinomas in the periocular versus non-periocular regions for the head and neck area were analysed, with no significant differences demonstrated. Further, comparison of basal cell carcinoma growth rates with other common solid tumours confirmed that basal cell carcinomas are slow growing malignancies. Key words: periocular; non-periocular head and neck basal cell carcinoma; BCCs; tumour volume doubling time; growth rates. Accepted Sep 25, 2019; E-published Sep 25, 2019 Acta Derm Venereol 2019; 99: 1266–1269. and Peter Kin Cho GOON 1# Department of Dermatology, Addenbrooke’s Hospital, Hills Road, Cambridge, Cambridgeshire, 2 Department of Plastic Surgery, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire, UK, and 3 Department of Otorhinolaryngology and Head & Neck Surgery, Bielefeld University Hospital, Bielefeld, Germany # Co-senior author. 1 Corr: Dr Peter Goon, Department of Dermatology, Addenbrooke’s Hospi- tal, Hills Road, Cambridge CB2 2QQ, Cambridgeshire, UK. E-mail: peter. [email protected] B asal cell carcinomas (BCCs) are the most common malignant tumour in humans, especially among fair skinned humans in the developed world (1–4). Indeed the prevalence rate of BCCs far surpasses all other ma- lignancies (1–3) but since mortality from BCCs is very rare, it has long been considered more of an inconvenient nuisance, and most countries do not include them in their cancer registries. Despite the rapidly increasing incidence rates being reported and the increasing burden on healthcare sys- tems, BCCs have not been extensively researched and the amassed knowledge about the natural history of this common tumour is patchy at best. In this study, we have tested the hypotheses that there are no significant differences between the growth rates of periocular nodular BCCs compared to other head doi: 10.2340/00015555-3325 Acta Derm Venereol 2019; 99: 1266–1269 SIGNIFICANCE Basal cell carcinomas are very common skin tumours which are locally destructive. It was thought that basal cell carci- nomas around the eyes grow faster than those elsewhere based on one previous paper. We demonstrate that there is no evidence for this and also calculate tumour growth rates to show the position of basal cell carcinomas in a growth rate figure, compared to more malignant tumours. Our new data can guide clinicians as to how much time there is avail­able for removal or treatment before crucial parts of our anatomy could be affected. and neck BCCs, and also derived tumour volume dou- bling times (TVDT) for comparison with those of other malignancies. Only BCCs of the nodular histological subtype were selected as it is likely that other subtypes such as the morphoeic, infiltrative or micronodular sub- types would not be visually well represented on the skin surface for measurement, plus these other subtypes of BCC may grow in a more diffuse or tendril-like pattern rather than a generally spherical pattern. Whether these other types of BCC are biologically distinct or have dif- ferent growth rates is not known. BCCs have long been classified among the slower growing solid tumours of the skin (non-melanoma skin cancers) in contrast to the highly malignant skin tumours such as melanoma or Merkel cell carcinoma. MATERIALS AND METHODS A retrospective cohort study to study growth rates in BCCs in the periocular region (upper and lower eyelids, within the nasojugal fold, medial/lateral canthi) and non-periocular BCCs (defined as all other regions of the head and neck). The patient cohort was defined as those individuals who underwent Mohs micrographic surgery (MMS) between 1 st January 2016 and 31 st January 2018. Inclusion/exclusion criteria are detailed in Table I. Nodular BCCs selected for the study, using the above criteria, allows narrowing and focus of the study on clinically very simi- lar lesions. This is to decrease the expected biological variation found amongst different types of BCCs, and consequently their growth rates as well. The patient details were retrieved from our hospital electronic patient record system and clinical image record. We were able to utilise the unique search parameters of the electronic database and hospital administration system to find patients with BCCs from 2016 onwards. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.