HISTOLOGIC PATTERNS OF BASAL-CELL CARCINOMA BASED UPON PATIENT IMMUNOSTATUS

BACKGROUND. The biologic behavior of basal cell carcinoma (BCC) seems to be dictated by the histologic subtype. Moreover, BCCs in immunosupp ressed patients appear to show a more aggressive biologic behavior. OB JECTIVE. The purpose of this study was to retrospectively investigate different histologic subtypes of BCC to determine whether a particular subtype would predominate in immunosuppressed patients. METHODS. The histologic patterns of 112 primary BCCs from 77 immunosuppressed patie nts and 60 primary BCCs from 46 patients who are endogenously immunoco mpromised, clue to diabetes mellitus and/or chronic renal failure, wer e examined. The results were compared with 488 primary BCCs of 318 imm mnocompetent patients. RESULTS. The nodular subtype teas the predomina nt pattern among all patients. However, a statistical difference was f ound in the immunosuppressed patients in that there was a lower percen tage of nodular pattern (P = .0038), and a higher percentage of infilt rative pattern (P = .0002). The higher frequency of the infiltrative p attern in the immunosuppressed group was particularly prominent among chronic alcoholics. CONCLUSION. In immunosuppressed patients, the high er frequency of the infiltrative subtype of BCC, particularly among ch ronic alcoholics, may have a predictive role in the management of thes e cases.