The therapeutic dilemma of basal cell carcinoma in older adults: A review of the current literature

Correlation of dermoscopic and histopathological features in basal cell carcinoma using computerized image analysis

Background

Basal cell carcinoma (BCC) is the most common skin cancer, exhibiting local invasiveness despite its low metastatic potential. Dermoscopy and histopathology are essential for diagnosis, while quantitative assessments may enhance lesion characterization.

Aim of the Study

This study aims to analyze the dermoscopic and histopathological characteristics of BCC and investigate the correlation between dermoscopic pigmentation patterns and tumor depth to improve lesion classification and diagnostic accuracy.

Patients and methods

This retrospective study analyzed 41 patients with 42 histopathologically confirmed BCC lesions, evaluated at Nizip State Hospital and 25 Aralik State Hospital between April 2023 and February 2025. High-resolution dermoscopic images were analyzed alongside histopathological findings. AI-assisted computerized image analysis was employed to quantify lesion size and pigmentation percentage, while tumor depth and dermoscopic-histopathological correlations were manually assessed.

Results

BCC was more prevalent in males (56.1%) and older adults, with a mean age of 67.1 years. The most commonly affected site was the nose (42.9%), followed by the cheek (14.3%) and upper lip (11.9%). Histopathologically, nodular (28.6%) and adenoid (28.6%) BCC were the most frequent subtypes. Dermoscopic analysis revealed blue-gray ovoid nests (57.14%) and arborizing telangiectasias (71.43%) as predominant features, particularly in mixed-type BCC, while blue-gray dots and globules (57.14%) were most common in micronodular BCC. Ulceration (45.24%) and multiple erosions (57.14%) were strongly associated with infiltrative BCC. A negative correlation was observed between pigmentation percentage and tumor depth, with deeper tumors exhibiting reduced pigmentation, though this trend was not statistically significant.

Conclusion

Comprehensive characterization of the dermoscopic and histopathological features of BCC enhances lesion differentiation. AI-assisted lesion size and pigmentation analysis, combined with histopathological evaluation, improves diagnostic precision. Further studies with larger cohorts are needed to validate these findings and refine classification criteria.

Basal Cell Carcinoma in Patients over 80 Years Presenting for Surgical Excision: Clinical Characteristics and Surgical Outcomes

Background. Complete basal cell carcinoma (BCC) excision remains the most common treatment modality. However, its clinical characteristics and the surgical outcomes achieved in patients over 80 years-often with several medical comorbidities and potentially limited life expectancy-have not been thoroughly examined. This clinical study aims to investigate tumor-specific characteristics and surgical outcomes following surgical treatment of BCC in older individuals. Methods. An observational cohort study based on a prospectively maintained database was conducted in a tertiary center using a predetermined protocol. Patients who underwent BCC surgery between January 2010 and September 2024 were included and grouped by age under or over 80 years. The inclusion criterion was a histologically confirmed BCC, while patients with syndromes predisposing BCC development were excluded. Results. Among the 1396 biopsy-proven BCCs, 35% of the patients were older than 80 years. No significant differences were observed in their baseline characteristics. The pathogenic capacity was greater in elderly patients, who exhibited higher rates of multiple and concurrent skin cancers, larger BCC diameters, and routine involvement in high-risk areas. More lesions were classified as high-risk for recurrence, and the surgical treatment was accompanied by a higher frequency of positive or close margins, high-grade subtypes, and perineural invasion. Logistic regression of 1150 BCCs revealed that age > 80, advanced TNM stage, and margin status robustly predict high-risk histology and high NCCN risk of tumor recurrence. Conclusions. This study highlights that BCC in the elderly population tends to present with a more aggressive tumor status, based on the key clinical and pathology features. These findings underscore the need for tailored surgical strategies in this population.

Long-term follow up of alemtuzumab-treated patients: a retrospective study in a Belgian tertiary care center

BACKGROUND

Pivotal studies have reported a significant proportion of patients achieving no evidence of disease activity (NEDA) after 2 cycles of treatment with alemtuzumab (ATZ), that can be maintained for several years. Long-term real-world evidence regarding ATZ as well as subsequent treatment trajectories is still scarce.

OBJECTIVE

To analyze the effectiveness and safety of ATZ-treated patients in a tertiary care Belgian center.

METHODS

A retrospective cohort study including 32 patients treated with ATZ between 2015 and 2021 was performed.

RESULTS

32 patients received 2 ATZ courses with a mean follow-up (FU) duration of 5.6 years (range: 2.25-8.2). 21.75% patients were treatment naïve. 40.5% were previously treated with natalizumab or fingolimod. NEDA-3 was achieved in 61.3-85% of patients, with failure mostly attributed to recurrence of radiological disease activity. During FU, annualized relapse rates remained very low (0.06-0.14), disability improvement occurred in up to 40.5%, whereas disability worsening occurred in up to 13.5%. Retreatment risk was associated with younger age (< 45 years old, Odds Ratio 8.0, p = 0.02) and a higher number of previous DMTs (Hazard ratio 2.7, 95%CI 1.3-7.4, p = 0.02). Safety in our cohort was consistent with the known profile of ATZ. At the end of FU, 65.6% patients remained untreated after 2 or 3 courses of ATZ, while the remaining switched to anti-CD20 therapy or cladribine.

CONCLUSION

ATZ is a high efficacy therapy for active MS, providing long-term remission in a significant proportion of patients. Retreatment was more frequent in younger patients or patients having failed a higher number of previous DMTs.

The impact of basal cell carcinoma on the quality-of-life in older patients

Basal cell carcinoma (BCC) is the most frequent malignant tumour worldwide and incidences are rising rapidly. BCC grow locally, but can invade surrounding tissues. Little is known concerning their impact on the health-related quality of life (HrQoL), and limited available data reports contradicting results. Measuring HrQoL in BCC patients should be done using disease-specific questionnaires such as the Basal and Squamous cell carcinoma Quality of Life (BaSQoL) questionnaire. The aim of this study was to assess the BCC-related HrQoL by examining all relevant patient, tumour and treatment characteristics to identify the main factors for the BCC-related impact. Specific attention for older BCC patients wass brought forward because of the often complex decisions in this subgroup. Patients ≥ 18 years with a history of BCC were asked to fill in the BaSQoL questionnaire, consisting of 5 subdomains. Multivariable analyses were done using a generalized additive model (GAM) because of the need for incorporation of non-linear functions. The study obtained approval of the Ethics Committee of the Ghent University Hospital (EC/2019/1352). Informed consent was obtained from all subjects. All experiments were performed in accordance with relevant guidelines and regulations. Four hundred patients with a median age of 66 were enrolled. Mean BaSQoL subscores were 0.78 (SD 0.63) for 'behaviour', 1.01 (SD 0.73) for 'diagnosis&treatment', 0.90 (SD 0.73) for 'worries', 0.40 (SD 0.63) for 'appearance' and 1.20 (SD 0.75) for 'other people', illustrating the low to moderate impact of BCC on the HrQoL. A GAM with subsequent ANOVA testing was done for all relevant variables. In 4 out of 5 BaSQoL subdomains 'age' showed a significant correlation ('behaviour' p = 0.007; 'diagnosis&treatment' p = 0.026; 'worries' p = 0.003; 'appearance' p = 0.008). Lower BaSQoL scores were seen in older patients, meaning less BCC-impact on their HrQoL. There was a clear non-linear correlation between BaSQoL scores and age, illustrating that the impact of BCC on the HrQoL shows a rapid decrease starting around the age of 70. This study is the first to illustrate the relation between the BCC-related HrQoL and the age of patients with the use of a disease-specific HrQoL instrument. We found a lower BaSQoL score in older adults, with a specific age group of interest starting around the age of 70-75. This is an argument for a potential wait-and-see strategy for BCC in these patients.

Cutaneous Basal Cell Carcinoma In Situ: A Review of the World Literature

Cutaneous basal cell carcinoma (BCC) in situ is a recently recognized subtype of the skin neoplasm in which the abnormal cells are confined to the epidermis. BCC in situ of the skin was previously referred to as a superficial BCC. A review of the world literature has revealed 10 cutaneous BCCs in situ that have been described in nine patients but likely reflect a more general phenomenon. The neoplasm typically presents as an asymptomatic red plaque on the abdomen, upper extremity, back, and chest. Pathologic changes frequently show confluent tumor cells along the epidermal basal layer or superficial aggregates of neoplastic cells that are contiguous with the epidermis and extend into the dermis. Genomic evaluation has been performed in neoplasms from one individual with cutaneous BCC in situ and metastatic BCC; like other variants of BCC, an aberration of the PTCH1 gene was observed. In contrast to his liver metastasis, the in situ carcinoma had a lower tumor mutational burden, lacked programmed death-ligand 1 (PD-L1) and programmed death-ligand 2 (PD-L2) amplification and had a distinct PTCH1 mutation, suggesting that the in situ BCC of his skin and the metastatic BCC of his liver were derived from different clones of cells.