Socioeconomic and demographic factors in multifocal superficial basal cell carcinoma: An NCDB analysis.
Authors: Thompson Alexander , Chin Kat , Sam Patrick , Choe Sharon , Showkat Anaum , Tran Daniel , Cronen Austin , Feerst Harrison J , Silberstein Peter T. , Lee Daniel , Demangone Michael , Rossi Anthony , Heise Craig , Hsia Beau 
Published: July 2024

e21576

Background: Multifocal superficial basal cell carcinoma (SBCC) is an uncommon clinical type of basal cell carcinoma (BCC). Usually located in the papillary dermis, it is characterized by superficial basaloid cell lobules infiltrating the dermis. This carcinoma has historically been reported to have a preference for the chest and shoulders, however, this NCDB analysis shows that the cancers reported under this code (8091) primarily appear on the vulva or scrotum. Though without significant morbidity, this lesion must be correctly identified and treated either surgically or non-invasively to achieve the best outcomes. By exploring the demographic factors of SBCC on the National Cancer Database (NCDB), important insight can be gained into its epidemiology and diagnostics, and ensure more uniform reporting of this cancer. Methods: Using retrospective cohort analysis on histologically-confirmed cases of SBCC (ICD-O-3 Code 8091) in the 2004-2020 National Cancer Database (NCDB), demographic factors such as age, sex, race, Hispanic status, insurance status, facility type, and Charlson-Deyo score were descriptively analyzed. Regression analysis was used to explore diagnostic trends of multifocal SBCC. Results: A total of 51 patients were identified in the NCDB with a diagnosis of multifocal superficial basal cell carcinoma between 2004 and 2020, and the frequency of diagnosis remained relatively constant with a rate of -0.14 (R2 = 0.11). The average age of diagnosis is 73.4 years (SD = 12.1, range = 32 - 90 years). Of the 51 patients diagnosed with multifocal superficial basal cell carcinoma, the majority were female (96%) and white (94%). The primary site of the neoplasm was the vulva in 100% of females and the scrotum in 100% of males. 50 patients underwent surgical excision at the primary site of the neoplasm, with a majority (86%) having successful excision with no residual tumor. From the data collected, 100% of patients survived after 30 and 90 days of surgery. The 2, 5, and 10-year estimated survival rates were 94%, 87%, and 57% respectively. The average survival was 11.17 years (95% CI of 9.51 - 12.84). 88% of patients had a Charles-Deyo score of 0. The patient’s primary payor at diagnosis was Medicare (73%). For valid patients, the most common treatment facilities were comprehensive community cancer programs (45%). Conclusions: This NCDB analysis helps to address the knowledge gap for multifocal SBCC with information about survival and socioeconomic data that further differentiate this diagnosis from classical BCC, and previous descriptions of multifocal SBCC. Most patients diagnosed with multifocal SBCC are white females with neoplasm of the vulva, which differs from previous reporting of the chest and shoulders as the most common site of multifocal SBCC. In light of this NCDB analysis, further research is needed to help elucidate the impact of socioeconomic factors on diagnosis in this patient population.