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INTRODUCTION

KEY POINTS

  • Although basal cell carcinoma (BCC) occurs less commonly in patients with skin of color compared with Caucasians, it remains an important and common diagnosis in patients with skin of color.

  • BCCs classically present with a rolled border, telangiectasia, and erosions, but in patients with skin of color, the more common presentation consists of pigmented papules and nodules.

  • Because BCCs are often pigmented, they can be mistaken for seborrheic keratoses, nevocellular nevi, or malignant melanomas.

  • BCCs commonly present on the head and neck, but they may also appear in unusual locations such as the groin, scrotum, perianal region, and feet.

  • It is important to do a complete skin examination in people with skin of color to ensure that a BCC is not overlooked.

  • The approach to treating skin cancers in people with skin of color should be no different from treating patients with lighter skin.

Basal cell carcinoma (BCC) is the most common malignancy found in humans. Its growth is driven by a distinct and well-defined biochemical pathway that has led to new insights into management and treatment. Although BCC does not have significant metastatic potential, it can lead to local destruction and disfigurement and present challenges in management, if unrecognized or untreated. While BCC has been described as uncommon in patients with skin of color, it remains the most common skin cancer in Hispanic, Japanese, and Chinese patients and the second most common skin cancer in blacks and Asian Indians.1,2,3,4 Furthermore, patients with skin of color with skin cancer may be more likely to have greater morbidity and mortality associated with BCC than Caucasians.

INCIDENCE

The incidence of BCC in patients with skin of color varies with racial or ethnic group. BCC represents 65% to 75% of skin cancers in Caucasians, 20% to 30% of skin cancers in Asian Indians, 12% to 35% of skin cancers in African Americans,1,3,5,6,7 and 2% to 8% of skin cancers in African blacks.8,9 Beckenstein and Windle,10 in a series from 1995, found that 1.8% (5 of 276) of skin cancers in African Americans were BCCs. The series by Fleming et al5 noted that 12% (7 of 58) of all skin cancers in African Americans were BCCs. The study by Halder and Bang1 from Howard University showed that 28.8% (38 of 103) of African American patients with skin cancer had a BCC. Altman et al11 reported that 2.5% of all skin cancers in African Americans are BCCs.

The incidences of BCC per 100,000 population have been reported in nonblack patients as follows: Chinese men (6.4), Chinese women (5.8), Japanese (15 to 16.5), Japanese residents of Kauai, Hawaii (29.7), Japanese residents of Okinawa (26.1), New Mexican Hispanic women (113), New Mexican Hispanic men (171), southeastern Arizona Hispanic females (50), southeastern ...

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