Racial and ethnic disparities in basal cell carcinoma treated by Mohs micrographic surgery: the Columbia experience

Excerpt

There is limited literature regarding racial and ethnic disparities in basal cell carcinoma (BCC) clinical characteristics, severity, and demographic distribution [1, 2]. Here, we investigate racial and ethnic disparities in the prevalence and clinical characteristics of BCC. We performed a retrospective review of 2145 patients with BCC who underwent Mohs micrographic surgery (MMS) at Columbia University Irving Medical Center (CUIMC) between January 2017-December 2021(Supplementary Methods). Clinical tumor characteristics (pre-operative tumor size, MMS defect size, MMS stages required for tumor extirpation, anatomical tumor location) were compared between racial and ethnic groups. After excluding patients with missing race and ethnicity data, 2145 cases were included in the race comparison, 2024 cases were included in the ethnicity comparison, and 2001 cases were included in the combined comparison (Supplementary Table 1). The majority of patients (95.2%; N = 2043) identified as White, 0.89% (N = 19) identified as Black, 3.5% (N = 75) identified as Other, and 0.37% identified as Asian (N = 8). The mean defect size in White patients (3.38 cm²) was significantly larger than that in Black patients (2.29 cm²; p < 0.01) (Table 1). White patients required a significantly greater mean number of MMS stages for tumor extirpation (1.54) compared to Black patients (1.16; p < 0.001) (Table 1). There were no significant differences in clinical tumor characteristics between Hispanic and non-Hispanic patients. However, there was a significantly greater proportion of females in Hispanic compared to non-Hispanic patients with BCCs (49.5% versus 41%, p < 0.01) (Table 2). BCCs in non-Hispanic patients were equally distributed between anatomic zones 1 and 2 while BCCs in Hispanic patients were more predominantly located in zone 1 classified using the NCCN criteria (p < 0.01) (Table 2), see Supplementary Methods. When comparing differences in BCC charactersitcs utilizing the following groups: White Non-Hispanic vs. Hispanic, White Non-Hispanic vs. Black Hispanic, and White Non-Hispanic vs. Non-White Hispanic, there were no significant difference in clinical tumor characteristcs. However, there was a significantly larger relative proportion of female patients in the Hispanic, Black Hispanic, and Non-White Hispanic groups compared to the White Non-Hispanic group (p < 0.05 for all) (Table 2). Additionally, there was a larger zone 1 predominance in the Hispanic, Black Hispanic, and non-White Hispanic groups when compared to the White non-Hispanic group (p < 0.01 for all) (Table 2). This study addresses the largely unexplored issue of racial and ethnic disparities in BCC and identifies significant differences in BCC severity and demographic distribution. BCCs in White patients had larger defect sizes and required more stages for tumor extirpation compared to BCCs in Blacks. Of note, this differs from racial variations in cutaneous melanomas, in which Black patients present with significantly more advanced tumors and have poorer outcomes compared to White patients [3‐5]. Additionally, Hispanic females represent a significantly larger relative proportion of BCC cases when compared to White Non-Hispanic females, highlighting the need for enhanced patient education and screening in this population. Limitations of this study include the relatively small sample of Black and Hispanic patients. This study serves to broaden the current understanding of differences in BCC presentation across racial and ethnic groups and may aid clinicians in establishing earlier and more accurate diagnoses. …