Evaluating BCC in skin of colour: Dermoscopy is best
Superior for discerning basal cell carcinoma types compared to naked eye evaluation (1,400 words, 7 minutes)
A recent study examined the effectiveness of dermoscopy in diagnosing superficial basal cell carcinoma (BCC) in people with richly pigmented skin and found that dermoscopy was more specific than visual examination in distinguishing superficial BCC from other BCC types.
The findings were published in Advanced Biomedical Research (2024; 13:23).
In the cross-sectional study, researchers examined data on 49 patients diagnosed with BCC referred for skin biopsy between July 2020 and Sept. 2022. Data included demographic characteristics of patients, clinical attributes of lesions, and pathological sub-types of BCC.
The mean patient age was 66.22±10.41 years. Among the patients, nine (18.4%) had Fitzpatrick skin type II, 22 (44.9%) had skin type III, and 18 (36.7%) had skin type IV.
The investigators used video dermoscopy to capture comprehensive views and dermoscopic images of the lesions.
They then analyzed the data to assess the reliability of dermoscopic structures in distinguishing superficial BCC from other BCC types. They also evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of dermoscopy in differentiating superficial BCC from other BCC subtypes.
Researchers found nodular was the most prevalent pathological sub-type observed (53.1%).
Dermoscopy showed higher specificity than the naked eye in differentiating superficial BCC from other types (55% vs. 35%). Univariate analysis revealed a significant association between spoke-wheel structures and superficial BCC (p=0.02, odds ratio=7.2, 95% confidence interval=1.35–38.32).
Bottom line: Dermoscopy shows a superior specificity compared to the naked eye in differentiating superficial BCC from other BCC types in a range of Fitzpatrick skin types. Notably, the spoke-wheel structure demonstrated the most robust correlation with superficial BCC.
From the literature on non-melanoma skin cancer
Skin colour reporting in basal cell carcinoma-related randomized controlled trials in top dermatology journals: A systematic review
Researchers evaluated the rate at which skin colour is reported in randomized controlled trials (RCTs) involving basal cell carcinoma (BCC) identification and treatment in the top 10 dermatology journals. They found that less than 50% of RCTs related to BCC included skin colour within the demographic portion of their results section about study participants.
For the systematic review, researchers identified the top 10 dermatology journals based on impact factor. Articles were selected from the journals' inception to July 11, 2023. They included studies that reviewed BCC prevention, detection, and treatment, directly involved patients and classified them as RCTs. The researchers classified studies as positive for reporting skin of colour (SOC) if the demographic data in the methods or results included any of the following terms: Fitzpatrick scale, race, ethnicity, skin of colour, or sunburn tendency.
Of the 51 studies identified, only 23 articles reported data about skin colour within the results section (45.1%), while 28 mentioned skin colour somewhere within the text (54.9%). Subgroup analysis was performed, and no statistical significance was found for the study location or year of publication.
The authors note no statistically significant difference in reporting over the past four decades. They conclude that more research is needed to determine whether low reporting rates of race or skin colour in BCC-related RCTs could impact diagnostic or treatment recommendations for patient care in this group.
Outcomes of cutaneous surgery for non-melanoma skin cancer in patients with different Fitzpatrick skin types: A nationwide, multicenter, prospective study
In this prospective study, researchers examined data from 17,076 consecutive non-melanoma skin cancer cases at 22 academic and private Mohs centres, including age, sex, tumour type, Fitzpatrick skin type (FST), anatomic location of the tumour, preoperative clinically apparent tumour diameter, and postoperative defect size.
In this dataset, 91 patients identified by self-report as patients of colour, and the researchers subclassified these as FSTs III to VI based on skin tone and propensity to tan or burn. The researchers also included 202 FSTs I and II patients in an age-matched control group.
Investigators found larger clinically apparent tumours occurred in skin of colour (SOC) patients with FSTs IV to VI (95% CI: 0.98-1.38 cm; mean: 1.18) compared with SOC patients with FST III (95% CI: 0.82-1.20; mean: 1.05; p=0.022) and White patients with FSTs I and II (95% CI: 0.57-0.69; mean: 0.63; p<0.001) In SOC patients with FSTs IV to VI, squamous cell carcinomas (95% CI: 1.07-1.75; mean: 1.41) were larger than basal cell carcinomas (95% CI: 0.72-1.10; mean: 0.91; p=0.022). Among SOC patients with FSTs III to VI, increasing skin darkness was associated with larger tumour size (ρ=0.209, p=0.046).
Researchers also noted larger defect size in SOC patients with FSTs IV to VI (95% CI: 1.82-2.81; mean: 2.31) compared with SOC patients with FST III (95% CI: 1.39-1.99; mean: 1.69; p=0.026) and White patients with FSTs I and II (95% CI: 1.33-1.56; mean: 1.44; p<0 .001).
A higher percentage of tumours were located on the face in patients with SOC than in White patients (63% vs. 49%; p=0.047).
Clinicopathological spectrum of primary skin malignancies in an Indian tertiary care hospital
Researchers retrospectively reviewed patient records and histopathology sections of all patients with skin carcinomas diagnosed from Jan. 2016 to Dec. 2020 at a tertiary care teaching hospital. They analyzed and correlated the cases' clinical parameters and histopathological features for any possible association.
Out of the 230 skin malignancies the authors studied, squamous cell carcinoma constituted the most common type (n=148), followed by basal cell carcinoma (n=70) and malignant melanoma (n=12). The tumour commonly presented in the 6th decade of life with slightly higher male preponderance (M:F=1.6:1). Sun-exposed areas were the most common sites, and the common presentations included non-healing ulcer, fungating/cauliflower/polypoidal growth, and hyperpigmented or nodular plaque. In squamous cell carcinoma, a previous history of diabetes and burns was noted in 10% and 3.4% of the patients, respectively.
VIDEO: Are skin cancers different in skin of colour?
Dermatologist Dr. Valerie M. Harvey (Newport, Va.) describes how basal cell carcinoma, squamous cell carcinoma, and melanoma can present differently in darker skin types. She emphasizes the importance of self-examination, as early detection and treatment are crucial for successful outcomes.
Nominations for the 2024 Women in Dermatology Honour Roll closing soon
The 2024 Women in Dermatology Honour Roll nomination deadline is July 26, 2024.
This Honour Roll acknowledges the leadership of a select group of Canadian physicians. It recognizes female dermatologists in Canada who have made significant contributions to the specialty, inspire others and serve as mentors and role models.
The 2024 honourees will be profiled in the upcoming Third Edition of Women in Dermatology, from the publishers of The Chronicle of Skin & Allergy.
Nominees should be female dermatologists who, throughout their careers, have made a lasting impact on others in the field of dermatology, served as a source of inspiration to residents, colleagues, and patients, and demonstrated extraordinary dedication, leadership, and commitment to the principles of dermatologic care.
To learn more or to obtain a nomination form, please go to the following link:
At the intersection of skin and society
A new scoping paper, Beyond Sustainability: The Power of Indigenous Healthy Energy Homes, shows that current approaches to housing in Indigenous communities have resulted in unhealthy housing conditions that include poor ventilation, overcrowding, and homes that are unsuitable for their location or environment. According to a press release, the unhealthy housing conditions, in turn, have led to a variety of severe health challenges, including respiratory, cardiovascular, and mental illnesses that are either aggravated or directly caused by inadequate and unsafe housing.
The paper was a collaborative project between the Canadian Climate Institute’s Indigenous Research stream and Indigenous Clean Energy.
As noted in a press release from the Canadian Climate Institute, investing in energy-efficient, climate-resilient homes and supporting the well-being of inhabitants could address many of these challenges and unlock multiple benefits, including reduced healthcare costs, emissions reductions, and household savings. This investment will require an approach in which housing strategies and funding decisions “take a holistic view of housing issues and are developed in partnership with Indigenous communities.”
This scoping paper is the first part of a larger collaboration between the two bodies. It focuses on policy changes to unlock positive interconnections between Indigenous housing, energy, and health.
“This collaborative paper has brought together experts from across sectors and communities to work together to show how interconnected Indigenous housing and health outcomes are,” said Janna Wale, Policy Advisor, Indigenous Research at the Canadian Climate Institute, in the release. “Building Healthy Energy Homes for communities could deliver nested benefits that help address poor health outcomes in Indigenous communities, reducing emissions, and building climate resilience.”
Registration is open for the 2024 Colloquium on the Black Patient
In recognition of persistent gaps in dermatologic training concerning skin of colour, the Colloquium on the Black Patient will discuss topics in dermatology specific to Black patients and recent progress in advancing the inclusion of diverse skin tones in research and medical education.
This live discussion will be held virtually via Zoom Webinar on Saturday, Aug. 17, 2024, from 10 a.m. to 1:30 p.m. ET.
The Colloquium will cover the state of therapies, research, and education in dermatology for skin of colour, focusing on progress in Canada.
This non-accredited program will be available to attend at no charge, thanks to the support of our sponsors.
More details are available at this link.
This week
July is Hyperpigmentation/Melasma Awareness Month
July 17 is Black Leaders Awareness Day in the U.K.
July 18 is Nelson Mandela International Day
Something to think about in the week ahead . . .
—Robert Collier, U.S. author (1885-1950)
Next week
In a presentation at the 2023 Indigenous Skin Spectrum Summit, rheumatologist Dr. Cheryl Barnabe provided advice for researchers seeking to work with Indigenous populations respectfully and culturally sensitively.
Dr. Barnabe is a professor in the departments of medicine and community health sciences at the Cumming School of Medicine, University of Calgary, and a member of the Otipemisiwak Métis Government.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Jerry Tan (Windsor, Ont.) shares his thoughts on recent findings showing that benzoyl peroxide in acne products can break down into benzene when stored in high-temperature conditions.
Drs. Andrei Metelitsa (Calgary), Geeta Yadav (Toronto), and Rahul Shukla (Hamilton, Ont.) review several current innovations in cosmetic dermatology.
Drs. Jason Rivers (Vancouver), Cheryl Rosen (Toronto), Peter Hull (Halifax), and Jennifer Beecker (Ottawa) provide an overview of essential news in melanoma, including the use of artificial intelligence to support screening.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.