Introduction The risk for BCC development results from the interplay of both constitutional and environmental factors, with ultraviolet radiation (UVR) being the primary established risk factor in the development of BCC [1,2]. The epidemiologic risk factors of BCC in Mediterranean populations remain unclear.
Aim To investigate the risk associations of BCC in the Greek population.
Methods We conducted a hospital-based case-control study. We studied 199 patients with histologically confirmed BCC and 200 cancer-free controls. The following data were collected by the use of a standardized questionnaire: pigmentary traits (tanning ability, ease of sunburning), patterns of sun exposure (continuous versus intermittent), timing of sun exposure, history of severe sunburns, use of sunscreens, exposure to artificial sources of UVR, personal or family history of skin cancer, and lifestyle-related factors (smoking). A clinical examination was performed with respect to pigmentary traits (skin/hair/eye color), number of melanocytic nevi, actinic keratoses, lentigines, and the presence of elastosis.
Results In our multivariate analysis of BCC, several factors were found to be significantly associated with BCC (P<0.05), including female sex, light skin color, number of years of occupational sun exposure, number of sunburns during adulthood, no use of sunscreen, and presence of nevi and lentigines. A trend for a ‘dose-response’ effect was noted for patients who had 5 years or more, of occupational sun exposure. No association was found with skin type, exposure to non-solar UVR exposure, and lifestyle-related factors (smoking, alcohol consumption). Statistically significant risk factors for early BCC (age at diagnosis <50 years) included female sex, number of weeks per year spent at the beach before the age of 20, and the number of sunburns during childhood.
Conclusion BCC risk was associated with light skin color, occupational sun exposure, and the presence of nevi and lentigines. The association of early onset BCC with recreational sun exposure and sunburns during childhood and adolescence suggests that intense intermittent sun exposure during the early years of life may be a key risk factor for development of BCC at an early age.
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