title: Basal cell carcinoma in Singapore: a prospective study on epidemiology and clinicopathological characteristics with a secondary comparative analysis between Singaporean Chinese and Caucasian patients.
abstract: OBJECTIVE
  Susceptibility to and clinical presentation of basal cell carcinoma (BCC) differ in Asian and Caucasian populations. This study aims to evaluate the epidemiological and clinicopathological characteristics of BCC in a multiracial Singaporean population, with a secondary comparative analysis between Chinese and Caucasian patients.
  
  
  METHODS
  We prospectively studied patients with newly diagnosed, histologically confirmed BCC at the National Skin Centre, Singapore from 2004 to 2008.
  
  
  RESULTS
  In total, 274 BCC from 260 patients were studied, with 19 patients having two or more tumours. Their mean age was 67.5 years and 54% were male. Chinese comprised 80% and Caucasians 14%. The Chinese were 1.8-fold as likely as Caucasians to be older than 60 years, and experienced itch thrice more frequently. Caucasians developed multiple BCC threefold and truncal or upper limb BCC 2.9-fold more frequently than the Chinese. In terms of tumour subtype, morphoeic BCC was 2.7-fold more common in Caucasians. Pigmented BCC occurred 2.7-fold more often in the Chinese, most frequently on the head and neck of elderly Chinese.
  
  
  CONCLUSIONS
  Compared to the Chinese, BCC occurred more often in younger Caucasians, with a predilection for the trunk and upper limb, suggesting a greater role for recreational sun exposure as a risk factor. Pigmented BCC more commonly occurred on the head and neck of elderly Chinese and may be reflective of cumulative sun exposure as a risk factor. Aggressive morphoeic BCC was more common in Caucasians than in Singaporean Chinese patients.
authors.affiliation: National Skin Centre, Singapore.
authors.forename: Eugene St
authors.initials: ES
authors.lastname: Tan
authors.affiliation: Dermatology & Surgery Clinic, National University Health System, Singapore.
authors.forename: Melvin
authors.initials: M
authors.lastname: Ee
authors.affiliation: Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore.
authors.forename: Liang
authors.initials: L
authors.lastname: Shen
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.
authors.forename: Hilary
authors.initials: H
authors.lastname: Chua
authors.affiliation: Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore.
authors.forename: Yiong-Huak
authors.initials: YH
authors.lastname: Chan
authors.affiliation: National Skin Centre, Singapore.
authors.forename: Suat-Hoon
authors.initials: SH
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000208:ethnology* / Q000473:pathology; D002681:China / Q000208:ethnology; D005260:Female; D006257:Head; D006801:Humans; D017495:Hyperpigmentation / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009333:Neck; D009378:Neoplasms, Multiple Primary / Q000208:ethnology*; D011446:Prospective Studies; D011537:Pruritus / Q000208:ethnology; D012846:Singapore / Q000453:epidemiology*; D012878:Skin Neoplasms / Q000208:ethnology* / Q000473:pathology; D060726:Torso; D034941:Upper Extremity; D044465:White People / Q000208:ethnology
keywords: Asia; Caucasian; Chinese; Singapore; basal cell carcinoma; epidemiology