{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:12:20Z","timestamp":1788585140602,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2021,6,27]],"date-time":"2021-06-27T00:00:00Z","timestamp":1624752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction: Basal cell carcinoma (BCC) quite frequently presents as multiple tumors in individual patients. Neoplasm\u2019s risk factors for local recurrence have a critical impact on therapeutic management. Objective: To detect risk factors for multiple BCCs (mBCC) in individual patients and to describe clinical and dermatoscopic features of low- and high-risk tumors. Materials &amp; Methods: Our study included 225 patients with 304 surgically excised primary BCCs. All patients\u2019 medical history and demographics were recorded. Clinical and dermatoscopic images of BCCs were evaluated for predefined criteria and statistical analyses were performed. Results: Grade II-III sunburns before adulthood (OR 2.146, p = 0.031) and a personal history of BCC (OR 3.403, p &lt; 0.001) were the major predisposing factors for mBCC. Clinically obvious white color (OR 3.168, p &lt; 0.001) and dermatoscopic detection of white shiny lines (OR 2.085, p = 0.025) represented strongly prognostic variables of high-risk BCC. Similarly, extensive clinico-dermatoscopic ulceration (up to 9.2-fold) and nodular morphology (3.6-fold) raise the possibility for high-risk BCC. On the contrary, dermatoscopic evidence of blue-black coloration had a negative prognostic value for high-risk neoplasms (light OR 0.269, p &lt; 0.001\/partial OR 0.198, p = 0.001). Conclusions: Profiling of mBCC patients and a thorough knowledge of high-risk tumors\u2019 clinico-dermatoscopic morphology could provide physicians with important information towards prevention of this neoplasm.<\/jats:p>","DOI":"10.3390\/cancers13133208","type":"journal-article","created":{"date-parts":[[2021,6,27]],"date-time":"2021-06-27T22:24:57Z","timestamp":1624832697000},"page":"3208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Novel Insights for Patients with Multiple Basal Cell Carcinomas and Tumors at High-Risk for Recurrence: Risk Factors, Clinical Morphology, and Dermatoscopy"],"prefix":"10.3390","volume":"13","author":[{"given":"Dimitrios","family":"Sgouros","sequence":"first","affiliation":[{"name":"2nd Department of Dermatology-Venereology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Rigopoulos","sequence":"additional","affiliation":[{"name":"1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Panayiotides","sequence":"additional","affiliation":[{"name":"2nd Department of Pathology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9255-8196","authenticated-orcid":false,"given":"Zoe","family":"Apalla","sequence":"additional","affiliation":[{"name":"State Clinic of Dermatology, Hospital for Skin and Venereal Diseases, 54643 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios K.","family":"Arvanitis","sequence":"additional","affiliation":[{"name":"2nd Department of Dermatology-Venereology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melpomeni","family":"Theofili","sequence":"additional","affiliation":[{"name":"2nd Department of Dermatology-Venereology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Theotokoglou","sequence":"additional","affiliation":[{"name":"2nd Department of Dermatology-Venereology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Syrmali","sequence":"additional","affiliation":[{"name":"2nd Department of Dermatology-Venereology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Theodoropoulos","sequence":"additional","affiliation":[{"name":"2nd Department of Dermatology-Venereology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Pappa","sequence":"additional","affiliation":[{"name":"2nd Department of Dermatology-Venereology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6584-8833","authenticated-orcid":false,"given":"Vasileia","family":"Damaskou","sequence":"additional","affiliation":[{"name":"2nd Department of Pathology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Stratigos","sequence":"additional","affiliation":[{"name":"1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Katoulis","sequence":"additional","affiliation":[{"name":"2nd Department of Dermatology-Venereology, \u201cAttikon\u201d General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,27]]},"reference":[{"key":"ref_1","first-page":"26","article-title":"Basal Cell Carcinoma","volume":"Volume 1","author":"Elder","year":"2018","journal-title":"WHO Classification of Skin Tumors"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1684\/ejd.2014.2271","article-title":"Update of the European guidelines for basal cell carcinoma management","volume":"24","author":"Trakatelli","year":"2014","journal-title":"Eur. J. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ejca.2019.06.003","article-title":"Diagnosis and treatment of basal cell carcinoma: European consensus\u2013based interdisciplinary guidelines","volume":"118","author":"Peris","year":"2019","journal-title":"Eur. J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lallas, A., Apalla, Z., Argenziano, G., Longo, C., Moscarella, E., Specchio, F., Raucci, M., and Zalaudek, I. (2014). The dermatoscopic universe of basal cell carcinoma. Dermatol. Pr. Concept., 4.","DOI":"10.5826\/dpc.0403a02"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/bjd.15321","article-title":"Epidemiology of basal cell carcinoma: Scholarly review","volume":"177","author":"Verkouteren","year":"2017","journal-title":"Br. J. Dermatol."},{"key":"ref_6","unstructured":"Schmultz, C., Blitzblau, R., Aasi, S.Z., Alam, M., Andersen, J., Baumann, B.C., Bordeaux, J., Jen, P.L., Chin, R., and Contreras, C.M. (2021, February 25). Basal Cell Skin Cancer Version 2.2021 In NCCN clinical practice guidelines in Oncology. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/nmsc.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jaad.2017.02.047","article-title":"Correlates of multiple basal cell carcinoma in a retrospective cohort study: Sex, histologic subtypes, and anatomic distribution","volume":"77","author":"Kuo","year":"2017","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1111\/1346-8138.14576","article-title":"Characteristics of multiple basal cell carcinomas: The first study on Japanese patients","volume":"45","author":"Adachi","year":"2018","journal-title":"J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1111\/j.1365-2133.2011.10488.x","article-title":"Cumulative risks and rates of subsequent basal cell carcinomas in the Netherlands","volume":"165","author":"Flohil","year":"2011","journal-title":"Br. J. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1038\/jid.2015.244","article-title":"Predicting the Risk of a Second Basal Cell Carcinoma","volume":"135","author":"Verkouteren","year":"2015","journal-title":"J. Investig. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2975","DOI":"10.2217\/fon.15.193","article-title":"Dermoscopy in the diagnosis and management of basal cell carcinoma","volume":"11","author":"Lallas","year":"2015","journal-title":"Futur. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1016\/j.jaad.2018.12.026","article-title":"The diagnostic accuracy of dermoscopy for basal cell carcinoma: A systematic review and meta-analysis","volume":"80","author":"Reiter","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_13","unstructured":"Reiter, O., Mimouni, I., Dusza, S., Halpern, A.C., Leshem, Y.A., and Marghoob, A.A. (2019). Dermoscopic features of basal cell carcinoma and its subtypes: A systematic review. J. Am. Acad. Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1111\/jdv.12980","article-title":"Dermoscopic variability of basal cell carcinoma according to clinical type and anatomic location","volume":"29","author":"Suppa","year":"2015","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.clon.2019.08.011","article-title":"Evolving Role of Systemic Therapies in Non-melanoma Skin Cancer","volume":"31","author":"Conforti","year":"2019","journal-title":"Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jaad.2018.07.073","article-title":"Dermoscopy and dermatopathology correlates of cutaneous neoplasms","volume":"80","author":"Braun","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Pampena, R., Parisi, G., Benati, M., Borsari, S., Lai, M., Paolino, G., Cesinaro, A.M., Ciardo, S., Farnetani, F., and Bassoli, S. (2021). Clinical and Dermoscopic Factors for the Identification of Aggressive Histologic Subtypes of Basal Cell Carcinoma. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.630458"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/jdv.16597","article-title":"Sclerodermiform basal cell carcinomas vs. other histotypes: Analysis of specific demographic, clinical and dermatoscopic features","volume":"35","author":"Conforti","year":"2021","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Sgouros, D., Apalla, Z., Theofili, M., Damaskou, V., Kokkalis, G., Kitsiou, E., Lallas, A., Kanelleas, A., Stratigos, A., and Nikolaidou, C. (2021). How to spot a basosquamous carcinoma: A study on demographics, clinical\u2014Dermatoscopic features and histopathologic correlations. Eur. J. Dermatol., accepted publication.","DOI":"10.1684\/ejd.2021.4178"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.det.2013.06.005","article-title":"Pink Lesions IN Dermoscopy","volume":"31","author":"Giacomel","year":"2013","journal-title":"Dermatol. Clin."},{"key":"ref_21","unstructured":"Global Burden of Disease Study 2013 Collaborators (2015). Global, regional and national incidence, prevalence and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 386, 743\u2013800."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1001\/archdermatol.2010.155","article-title":"Risk Factors for Single and Multiple Basal Cell Carcinomas","volume":"146","author":"Kiiski","year":"2010","journal-title":"Arch. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"398","DOI":"10.4103\/0019-5154.84766","article-title":"Comparison of risk factors of single basal cell carcinoma with multiple basal cell carcinomas","volume":"56","author":"Rahimi","year":"2011","journal-title":"Indian J. Dermatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1001\/jamadermatol.2015.5731","article-title":"Association of Shiny White Blotches and Strands With Nonpigmented Basal Cell Carcinoma","volume":"152","author":"Bajaj","year":"2016","journal-title":"JAMA Dermatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"194.e1","DOI":"10.1016\/j.jaad.2011.04.039","article-title":"The significance of crystalline\/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions","volume":"67","author":"Balagula","year":"2012","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1111\/j.1468-3083.2011.04317.x","article-title":"White shiny structures: Dermoscopic features revealed under polarized light","volume":"26","author":"Liebman","year":"2011","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1001\/jamadermatol.2020.1450","article-title":"Association of Multiple Aggregated Yellow-White Globules With Nonpigmented Basal Cell Carcinoma","volume":"156","author":"Liopyris","year":"2020","journal-title":"JAMA Dermatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/bjd.12394","article-title":"Dermoscopy of basosquamous carcinoma","volume":"169","author":"Giacomel","year":"2013","journal-title":"Br. J. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/1346-8138.13563","article-title":"Basosquamous carcinoma: Dermoscopic clues to diagnosis","volume":"44","author":"Akay","year":"2017","journal-title":"J. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"608","DOI":"10.4103\/0378-6323.168343","article-title":"Dermoscopy of aggressive basal cell carcinomas","volume":"81","author":"Popadic","year":"2015","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1016\/j.jaad.2018.06.059","article-title":"Pigmentation of basal cell carcinoma is inversely associated with tumor aggressiveness in Asian patients","volume":"80","author":"Moon","year":"2019","journal-title":"J. Am. Acad. Dermatol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/13\/3208\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:25:01Z","timestamp":1760163901000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/13\/3208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,27]]},"references-count":31,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["cancers13133208"],"URL":"https:\/\/doi.org\/10.3390\/cancers13133208","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,27]]}}}