Basal cell carcinoma (BCC) is the most common cancer worldwide. In the United States, the lifetime risk of developing BCC is estimated to be around 20%, and 30% in whites. It is the most common skin cancer seen by most dermatologists. Although many things in life are out of our control, there are some risk factors for basal cell carcinoma that can be avoided, and others that cannot.
What Are The Main Associations With Developing Basal Cell Carcinoma?
- Sun exposure. Sun damage is highly correlated with the risk of developing basal cell carcinoma. Intense intermittent sun exposure is especially a risk factor. This means the periodic sunburn you get on vacation or at the beach. Dermatologists say it a lot, but cover up, wear sunscreen, don’t get burned. You can’t change who you are, but the risk is greatest in people with very fair skin and an inability to tan, red or blond hair, tendency to freckle, and light eye color. Although intermittent sun burn is particularly risky, long-term cumulative sun exposure is also correlated with an increased risk of developing basal cell carcinoma.
- Tanning. Tanning bed use is is highly correlated with skin cancer risk, including basal cell carcinoma. Don’t do it!
- Age. You can’t avoid getting old, but you can be sure to be more vigilant about skin checks as you get older. The incidence of basal cell carcinoma is double in those 70 years of age versus those 40 years of age.
- Immunosuppression. The incidence of basal cell carcinoma is 5- 10-fold higher in organ transplant patients receiving immunosuppression (and the risk of squamous cell carcinoma is around 100X higher!) All transplant patient on immunosuppressive medications should be seen for annual skin cancer screenings.
- Oral contraceptive use. The use of oral contraceptives may also be associated with a higher risk of basal cell carcinoma.
- Genetic syndromes. There are several genetic syndromes with an increased rick of basal carcinoma, such as nevoid basal cell carcinoma syndrome, also known as Gorlin syndrome.
- Rheumatoid arthritis. Patients with rheumatoid arthritis have a slight increase in the risk of developing basal cell carcinoma.
- History of posralen plus ultraviolet A light phototherapy (PUVA). A history of PUVA therapy increases the risk of developing basal cell carcinoma.
- Ionizing radiation. Ionizing radiation increases the risk of developing basal cell carcinoma within the treatment area.
Many of these risk factors are outside of one’s control, such as age and complexion, and of course genetic syndromes. But some choices, such as tanning bed use, practicing prudent sun protection, and routine surveillance with an annual skin check, especially if you have risk factors, are within your control.