title: Increased proportion of aggressive-growth basal cell carcinoma in the Veterans Affairs population of Palo Alto, California.
abstract: BACKGROUND
  We have noted a high frequency of aggressive-growth basal cell carcinomas (BCCS) in our patient population. Subtypes observed with increased frequency include morpheaform, infiltrative, and micronodular.
  
  
  OBJECTIVE
  Our purpose was to examine the frequency of histologic subtypes of all BCCs seen in the dermatology clinics in the Veterans Affairs Palo Alto Health Care System in an 18-month period.
  
  
  METHODS
  We reviewed 432 consecutive primary BCC biopsy specimens taken from 252 patients.
  
  
  RESULTS
  Aggressive-growth BCC was observed in 20.7% of biopsy specimens, including 13.4% morpheaform, 5.7% infiltrative, and 1.6% micronodular subtypes. The mean age of the patient population was 70 years, with a standard deviation of 9.1 years.
  
  
  CONCLUSIONS
  Our observed percentage of aggressive-growth BCC is substantially higher than in most other large studies. A high frequency of aggressive-growth BCC coupled with the increasing incidence of nonmelanoma skin cancer may have significant implications for future health care resource allocation.
authors.affiliation: Dermatology Service, Veterans Affairs Palo Alto Health Care System, CA 94304, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Wrone
authors.forename: S M
authors.initials: SM
authors.lastname: Swetter
authors.forename: B M
authors.initials: BM
authors.lastname: Egbert
authors.forename: B R
authors.initials: BR
authors.lastname: Smoller
authors.forename: P A
authors.initials: PA
authors.lastname: Khavari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002140:California / Q000453:epidemiology; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology*