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Original Investigation
November 23, 2016

Anatomical Distributions of Basal Cell Carcinoma and Squamous Cell Carcinoma in a Population-Based Study in Queensland, Australia

Author Affiliations
  • 1Department of Population Health, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Queensland, Australia
  • 2Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
  • 3National Health and Medical Research Council Centre for Research Excellence in Sun and Health, Queensland University of Technology, Queensland, Australia
  • 4School of Public Health, University of Queensland, Queensland, Australia
JAMA Dermatol. Published online November 23, 2016. doi:10.1001/jamadermatol.2016.4070
Key Points

Question  How great are the differences in anatomical distributions of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)?

Findings  In this population-based study, the anatomical distribution of 3398 keratinocyte cancers arising during 2 years of follow-up of 37 103 Australians consisted of BCCs primarily on the head and neck and trunk and SCCs predominantly on the upper limbs and head and neck. Sites with the greatest discrepancy in relative tumor densities between BCC and SCC were the hand and back and buttocks.

Meaning  Basal cell carcinoma and SCC have high relative tumor densities on the head, consistent with sun exposure as the primary etiologic factor; however, for BCC, the low relative tumor densities on the hand and high relative tumor densities on less sun-exposed sites suggest a complex association with sun exposure.

Abstract

Importance  Keratinocyte cancers (KCs), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common cancers among fair-skinned populations worldwide. Although studies have indicated that the anatomical distribution of BCC and SCC differ, few have compared them directly in well-defined population samples.

Objectives  To describe and compare the anatomical distribution of BCC and SCC in a population-based sample in Queensland, Australia.

Design, Setting, and Participants  This study was nested within the population-based QSkin Sun and Health Study in Queensland, Australia. Of 37 103 study participants linked to national medical insurance records, 3398 diagnosed with KCs from September 1, 2010, to September 30, 2012, were identified, and information about their KCs was extracted from pathology reports. Data were analyzed from January 1, 2013, to March 30, 2016.

Main Outcomes and Measures  The relative tumor densities (RTDs) on defined body sites, calculated by dividing the proportion of tumors occurring at a specified site by the proportion of skin area of that site.

Results  A total of 5150 KCs with complete data were identified in 2374 study participants (1339 men [56.4%] and 1035 women [43.6%]; mean [SD] age, 59.7 [7.4] years). Of these, 3846 KCs (74.7%) were BCCs. Most BCCs were on the head and/or neck (1547 [40.2%]) and the trunk (1305 [33.9%]); most SCCs were on the head and/or neck (435 [33.4%]) and upper limbs (455 [34.9%]). The greatest differences in RTDs between BCC and SCC were on the hand (BCC:SCC ratio, 1:14) and the back and/or buttocks (BCC:SCC ratio, 8:1). Relative tumor densities of KCs were higher on the scalp and ear in men compared with women, and on the upper arm in women compared with men. The pattern of RTDs did not differ with age for BCC. Compared with younger adults (40-54 years), the RTDs in older adults (55-69 years) were 2-fold higher for SCC on the scalp (0.38 [95% CI, 0.00-0.81] vs 1.07 [95% CI, 0.75-1.38]) and the back and/or buttocks (0.05 [95% CI, 0.00-0.12] vs 0.12 [95% CI, 0.07-0.16]).

Conclusions and Relevance  The high RTDs on sun-exposed body sites for BCC and SCC are in keeping with sun exposure as the primary etiologic factor for both tumors. However, for BCC, the low RTD on the hand and high RTDs on less sun-exposed sites suggest a complex association between sun exposure and occurrence of BCC. Knowledge about the anatomical distribution of BCC and SCC may provide insight into their diagnoses and causes.

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