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Current national and European guidelines recommend distinct management approaches for basal cell carcinoma (BCC) based on tumor location, size, and histopathological subtype. In vivo reflectance confocal microscopy (RCM) is a non-invasive skin imaging technique which may change the diagnostic pathway for BCC patients. This study aimed to determine the sensitivity and specificity of RCM for BCC diagnosis, assess the predictive values of several confocal criteria in correctly classifying BCC subtypes, and evaluate the intraobserver reliability of RCM diagnosis for BCC. We conducted a retrospective study in two tertiary care centers in Bucharest, Romania. We included adults with clinically and dermoscopic suspect BCCs who underwent RCM and histopathological examination of excision specimens. For RCM examinations, we used the VivaScope 1500 and histopathology of the surgical excision specimen was the reference standard. Of the 123 cases included in the analysis, BCC was confirmed in 104 and excluded in 19 cases. RCM showed both high sensitivity (97.1%, 95% CI (91.80, 99.40)) and specificity (78.95%, 95% CI (54.43, 93.95)) for detecting BCC. Several RCM criteria were highly predictive for BCC subtypes: cords connected to the epidermis for superficial BCC, big tumor islands, peritumoral collagen bundles and increased vascularization for nodular BCC, and hyporefractile silhouettes for aggressive BCC. Excellent intraobserver agreement (κ = 0.909, p < 0.001) was observed. This data suggests that RCM could be used for preoperative diagnosis and BCC subtype classification in patients with suspected BCCs seen in tertiary care centers. [ABSTRACT FROM AUTHOR]

Background: Non-melanoma skin cancer (NMSC) represents the most frequently diagnosed cancer in humans. Occupational solar UV radiation exposure is associated with a higher-risk of developing NMSC, but still Romania does not acknowledge this affliction as an occupational disease. The study aims to determine if occupationally-induced NMSC is associated with more aggressive clinical and histopathological features compared to sporadic NMSC. Material and methods: A retrospective, analytical, comparative study was conducted during 2017-2019 in a University Department of Dermato-venereology in Bucharest, Romania, with focus on patients presenting with NMSC who underwent surgical excision of lesions followed by histopathological examination, classified as outdoor or indoor workers. High-risk clinical and histopathological characteristics were analysed and correlated with outdoor UV exposure. Outcomes: The study included 51 consecutive patients diagnosed with NMSC, of which 25 outdoor workers (OW) and 26 controls as indoor workers with no occupational UV exposure background. OW presented with 21 BCC and four SCC, while controls with 22 BCC and four SCC. Males were predominant in both groups and most patients came from urban environment. The mean age value was lower for the OW group compared to controls. OW had a 4.66 times higher risk of developing NMSC with aggressive location and size χ2 (1, N=51) = 6.246, p=0.013, OR=4.66 (95% CI: 1.34, 16.23) and a 24-fold risk of developing NMSC with clinically poorly defined margins χ2 (1, N=51) = 21.697, p<0.001, OR=24.44 (95% CI: 5.38,110.92). The risk of developing a high-risk histopathological subtype was 15 times greater for OW χ2 (1, N=51) = 13.814, p<0.001, OR=15.27 (95% CI: 2.94,79.08). Moderate to severe desmoplastic reaction was 8.57 more frequent in controls χ2 (1, N=51) = 12.244, p=0.001, OR=8.57 (95% CI: 2.42, 30.30). Grades 2 and 3 of actinic elastosis were significantly associated with outdoor work (χ2 (1, N=51) = 33.382, p<0.001, OR=131.25 (95% CI: 13.60, 1266.37). The presence of ulceration and pigment association of tumors on the histopathological report were not significantly associated with outdoor working. Conclusions: 1. Occupational NMSC in Romania is associated with high-risk clinical features; 2. Poorly defined borders is a significant clinical high-risk factor associated with occupational UV exposure in NMSC; 3. High-risk histopathological subtypes are more frequently encountered in outdoor workers diagnosed with NMSC compared to indoor workers with no occupational UV exposure background; 4. Occupational NMSC is associated with significantly higher grades of desmoplastic reaction and of actinic elastosis compared to indoor workers. [ABSTRACT FROM AUTHOR]

Objectives. Non-melanoma skin cancer (NMSC) is the most common human malignancy and is strongly related to solar ultraviolet (UV) radiation exposure. Occupational UV exposure is associated with a two-fold increased risk of developing NMSC, but still only few European countries recognize NMSC as an occupational disease. The study aims to analyze the clinical and histopathological features of NMSC with regard to personal cumulative occupational UV exposure doses. Material and methods. A retrospective, analytical, comparative study was conducted during 2017-2019 with focus on outdoor workers presenting with NMSC. Occupational solar UV exposure dose was calculated based on the Wittlich algorithm and cumulative lifetime exposure of the general population of the same age was estimated according to German Standards of 130 SED/year. Subjects were divided in two groups (OW1 and OW2) according to differences between occupational exposure and estimated cumulative lifetime exposure of the general population. High-risk clinical and histopathological characteristics were compared between groups. Outcomes. The study included 25 consecutive outdoor workers diagnosed with BCC (N=21) and SCC (N=4). Occupational solar UV exposure doses were calculated for Romanian workers and identified mean values of 17695 SED two times higher than estimative leisure cumulative lifetime solar UV exposure for a person of the same age from the general population according to German standards of 130 SED/year. Subjects were classified in two groups: group 1 (OW1) included subjects who were exposed to an additional occupational UV dose less than 50% of the cumulative lifetime exposure dose of a person of the same age from the general population according to German standards and group 2 (OW2) included subjects exposed to additional professional UV doses higher than 50%. 12 subjects were included in OW 1 and 13 subjects in OW2. Data analysis between groups identified significant statistical differences with regard to high-risk body locations and tumour size, present in 100% of OW2 and 58.3% of OW1 (÷2 (1, N=51) = 6.771, p=0.015) and to high-risk histopathological subtypes, present in 56% OW2 and 33.3% OW1 (÷2 (1, N=51) = 4.812, p=0.036). Ulceration was present on the histopathological report of all subjects in OW2. OW2 was associated with higher percentages of moderate to severe grades of actinic elastosis and of desmoplastic reaction and a more rapid evolution of lesions. Conclusions: Outdoor workers in Romania are exposed to an occupational solar UV dose two times higher than the cumulative lifetime exposure dose of the general population of the same age which may receive up to 130 SED/year according to German standards and they bear an increased risk of NMSC. Occupational NMSC induced by UV exposure should be recognized as an occupational disease if the subject received more than 50% additional UV exposure at the workplace. [ABSTRACT FROM AUTHOR]