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Abstract

Basal cell carcinoma (BCC) is the most common malignancy, typically arising on sun-exposed skin. BCCs occurring in sun-protected sites are rare, and those involving the male anogenital region are poorly characterized. We present 20 cases of male anogenital BCCs diagnosed at a single institution over a 20-year period. Of these, 50% were perianal, 30% inguinal and 20% scrotal in origin. The mean age at diagnosis was 74 years and 95% exhibited a nodular growth pattern. Fifty-five percent of patients had a smoking history (mean pack years = 28), 50% had a history of other skin cancers and 60% had a history of a non-dermatologic malignancy. Notably, 25% of all patients and 42% of those with a history of non-dermatologic malignancy had undergone ionizing radiation therapy to the pelvis during prior cancer treatment. Ten percent of patients were immunosuppressed, due to heart/kidney transplant (5%) or concomitant prostate cancer therapy (5%). In available cases, immunohistochemistry for p16 demonstrated patchy expression. To our knowledge, this is one of the largest case series of male anogenital BCCs to date. These findings suggest an association between smoking and ionizing radiation to the pelvis and the subsequent development of anogenital BCCs. Within the limitations of this dataset, p16 does not appear to represent a major oncogenic driver for BCCs in this anatomic region. Clinical examination of the anogenital region in patients with a smoking history, prior pelvic radiation history or immunosuppression should be strongly considered to identify this rare presentation of a common malignancy.