Basal Cell Carcinoma Is Most Common Skin Cancer, Chronic for Many Seniors
Study finds further confirmation that the risk of basal cell carcinoma increases with age. It's more of a chronic
disease for many. High sun exposure before age 30 was a major predictor, as was a history of eczema; what can be done for older people
Basal Cell Carcinomas - most common of cancers
July 25, 2012 - In the powerful sunlight of July, newly published results from a large study of people at high risk for
basal cell carcinoma support the emerging view of the nation’s most common cancer as a chronic ailment that often repeatedly afflicts older
people but for which the seeds may be planted in youth. The research also found a new association with eczema.
“Basal cell carcinoma is a chronic disease once people have had multiple instances of it, because they are always at risk
of getting more,” said Dr. Martin Weinstock, professor of dermatology in the Warren Alpert Medical School of Brown University, who practices
at the Providence Veterans Affairs Medical Center.
“It’s not something at the moment we can cure. It’s something that we need to monitor continually so that when these
cancers crop up we can minimize the damage.”
Dermatologists hold out hope for a medication that will help prevent recurrences of BCC. To test one such medicine,
Weinstock chaired the six-site, six-year VA Topical Tretinoin Chemoprevential Trial, which last year found that the skin medication failed to
prevent further instances of BCC in high-risk patients.
What is "Chronic" Disease?
A chronic condition
is a human health condition or disease that is persistent or otherwise long-lasting in its effects.
The term chronic is usually applied when the course of the disease lasts for more than three
months. More at
What is Eczema?
Eczema is a term
for several different types of skin swelling. Eczema is also called dermatitis. It
is not dangerous, but most types cause red, swollen and itchy skin. Factors that
can cause eczema include other diseases, irritating substances, allergies and your
genetic makeup. Eczema is not contagious.
The most common
type of eczema is atopic dermatitis. It is an allergic condition that makes your
skin dry and itchy. It is most common in babies and children.
Eczema is a
chronic disease. You can prevent some types of eczema by avoiding irritants,
stress, and the things you are allergic to. More at
Protection from sun is most important in youth.
"It was particularly UV exposure before the age of 30 that was most closely related to BCC in our study,” writes
Weinstock as the corresponding author of the new study, published online July 19 in the Journal of Investigative Dermatology.
It presents an analysis of the risk predictors of BCC recurrence found among the trial’s population of 1,131 people, all
of whom were veterans, 97 percent of whom were men, and whose median age was 72.
On average, a participant had more than three episodes of BCC or squamous cell carcinoma before entering the study.
Overall, 44 percent of study participants developed new BCCs during the study period. The biggest predictor of another
bout with BCC after three to four years of follow-up was a prior history of them.
The 129 participants who had more than five BCCs in the five years before the study had a hazard rate ratio that was
nearly four times as high as that of the 204 people who had none or one and more than twice as high that of the 200 people who had three.
Eczema was another predictor of BCC recurrence in the study’s high-risk group. Participants who acknowledged a family
history of the skin condition had a hazard rate ratio 1.54 times higher than people who did not, after statistical adjustments.
“We don’t know why this is,” Weinstock said. “The connection with eczema is something that’s new, that needs to be
Age was another predictor, and not just in providing further confirmation that the risk people face increases with age.
The study also showed that particularly intense sun exposure before the age of 30 was a strong a predictor of BCC occurrence among the
high-risk study population, even though for most of them their 30s were decades ago.
“We talk about sun protection, which is important, but that’s something for basal cell that’s most important in your
youth,” Weinstock said. “While we don’t exonerate UV exposure in one’s 40s, 50s, and 60s, it was particularly UV exposure before the age of 30
that was most closely related to BCC in our study.”
Awaiting a new trial
If limiting UV exposure is most crucial before the age of 30, what can doctors do for older people who may be headed for
multiple bouts with BCC?
“Right now we have this wait and cut approach,” he said. “We know these people are at high risk and we know that most of
them are going to get more.”
A better solution comes back to finding and testing preventive medication. Tretinoin didn’t work, but Weinstock said he
and his colleagues are testing another called 5-Fluorouracil. He said he is optimistic but has not yet seen the data from a trial that began
about three years ago.
Robert Dyer of the Providence VA Medical Center and Brown University was the study’s lead author. In addition to Dyer and
Weinstock, other authors on the paper are Tobias Cohen, Amilcar Rizzo, Stephen Brigham and the VATTC Trial Group.
The U.S. Department of Veterans Affairs Co-operative Studies Program funded the research.
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