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Prevalence of Actinic Skin Lesions in Patients with Basal Cell Carcinoma

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Prevalence of Actinic Skin Lesions in Patients with Basal Cell Carcinoma ARTIGO ORIGINAL PREVALÊNCIA DE LESÕES CUTÂNEAS ACTÍNICAS EM PACIENTES COM CARCINOMA BASOCELULAR DO SEGMENTO CEFÁLICO: UM ESTUDO CASO-CONTROLE Prevalência de lesões cutâneas actínicas em pacientes com INTRODUÇÃO faciais e elastose solar são comumente encontradas em O carcinoma basocelular (CBC) é a neoplasia maligna portadores dessa neoplasia, mas não foram sistematica- carcinoma basocelular do segmento cefálico: um estudo caso-controle mais comum da humanidade, principalmente entre in- mente estudadas, tampouco ponderadas quanto aos de- mais marcadores epidemiológicos de risco13,16-18. VALQUÍRIA PESSOA CHINEM1, HÉLIO AMANTE MIOT2 divíduos de pele clara. Constitui cerca de 70% a 80% dos O diagnóstico precoce é estratégia fundamental para 1 Mestre em Patologia; Dermatologista, Departamento de Dermatologia e Radioterapia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (FMB-UNESP), tumores malignos cutâneos e representa importante de- Botucatu, SP, Brasil manda e custo ao sistema de saúde1,2. Segundo casuística melhora do prognóstico, redução das sequelas (locais e pela 2 Doutor em Patologia; Professor-assistente Doutor do Departamento de Dermatologia da FMB-UNESP, Botucatu, SP, Brasil alemã, o risco cumulativo, durante toda a vida, de seu terapêutica) e dos custos para o sistema de saúde. A identi- desenvolvimento na população branca é de mais de 30%3. ficação de fenótipos de risco pode ser favorável em ações de A expectativa nacional de incidência em 2011 é de cerca saúde pública visando à prevenção primária e secundária. de 120.000 casos1, e, nos últimos 50 anos, observou-se O objetivo deste estudo é avaliar a prevalência de le- RESUMO crescimento da incidência em diversos países, com aco- sões cutâneas actínicas crônicas em pacientes portadores metimento inclusive de pacientes mais jovens4,5. de CBC sólido, primário, do segmento cefálico e compará- Objetivo: Avaliar a prevalência de lesões cutâneas actínicas em portadores de carcinoma Essa neoplasia apresenta baixos graus de malignida- la a pacientes dermatológicos sem a neoplasia, a fim de basocelular do segmento cefálico. Métodos: Foi conduzido estudo tipo caso-controle. de e mortalidade devido ao típico crescimento lento e ao identificar fenótipos cutâneos associados ao risco de CBC. Os casos, constituídos por pacientes com carcinoma basocelular sólido, primário, menor potencial reduzido de metastatização, além da precoci- que dois centímetros, no segmento cefálico; e controles, por pacientes com outras der- dade de diagnóstico, por se situar preferencialmente nas MÉTODOS matoses. Foram analisadas variáveis constitucionais, comportamentais e lesões actínicas. áreas fotoexpostas. Porém, sua morbidade é elevada em Estudo tipo caso-controle envolvendo pacientes com mais Resultados: Avaliaram-se 120 casos e 360 controles. Mílio facial (OR = 2,3), leucoder- decorrência da invasão local, destruição tecidual e pos- de 40 anos de idade, de ambos os sexos, provenientes do mia puntacta de membros superiores (OR = 2,9) e cutis romboidalis nuchae (OR = 1,8) sibilidade de recidivas, afetando a qualidade de vida dos ambulatório de dermatologia da Faculdade de Medicina associaram-se à neoplasia independentemente das demais variáveis, sugerindo um fenó- pacientes4,6-8. da UNESP – Botucatu. A pesquisa ocorreu no período en- tipo de risco. Houve ainda associação com fenótipos claros, genética familiar e exposição Em contraponto, uma menor fração das neoplasias tre março de 2007 e dezembro de 2009. solar cumulativa. Queimadura solar, tabagismo e alcoolismo não foram identificados malignas da pele (20% a 30%) é composta principal- Os casos foram definidos como pacientes portadores como fatores de risco. O uso de fotoprotetores não evidenciou proteção; porém, o grupo mente pelo carcinoma espinocelular (CEC) e melanoma, de CBC sólido (confirmado histopatologicamente), pri- controle era composto por pacientes dermatológicos, aos quais são indicados fotoprote- que são formas agressivas, com franco potencial de me- mário, com menos de dois centímetros de diâmetro, situa- tores regularmente. Conclusão: Lesões actínicas foram mais prevalentes em portadores tástase. Enquanto o CEC privilegia áreas fotoexpostas e do no segmento cefálico e diagnosticado há menos de um de carcinoma basocelular sólido do segmento cefálico que em controles, especialmente mucosas, o melanoma ocorre também em áreas menos ano da entrevista. Já o grupo de controle foi composto por mílio, cutis romboidalis nuchae e leucodermia puntacta, independentemente dos demais irradiadas, como dorso, raiz de coxas e extremidades, o pacientes portadores de outras dermatoses benignas, en- fatores de risco conhecidos. que pode levar ao atraso do diagnóstico1. trevistados na proporção de três para cada caso de forma Unitermos: Neoplasias de cabeça e pescoço; carcinoma basocelular; epidemiologia; es- A radiação ultravioleta (RUV) é o principal fator de não pareada, para permitir a estimativa do risco e análi- tudos de casos e controles; raios ultravioleta; fatores de risco. risco ambiental associado à gênese do CBC, o que se se estratificada de variáveis constitucionais como gênero, evidencia pela maior ocorrência de lesões em áreas fo- idade e fototipo (classificação de Fitzpatrick)19. ©2012 Elsevier Editora Ltda. Todos os direitos reservados toexpostas. Além da ação imunossupressora na pele, Excluíram-se pacientes com indícios de imunossu- SUMMARY comprometendo a atividade de vigilância antitumoral pressão medicamentosa ou doenças crônicas associadas à Trabalho realizado no Departamento 2-4,9 de Dermatologia, Faculdade de Prevalence of actinic skin lesions in patients with basal cell local , a radiação UVB gera fotoprodutos mutagêni- importante redução da resposta imune, portadores de sín- Medicina de Botucatu, Universidade carcinoma of the head: a case-control study cos no DNA, que promovem mutações em genes como dromes genéticas predisponentes a neoplasias, com der- Estadual Paulista (UNESP), Botucatu, SP, Brasil Objective: To evaluate the prevalence of actinic skin lesions in patients with basal cell car- PTCH e p53. Por sua vez, a UVA apresenta principal- matoses difusas do tegumento, fototipo VI, portadores de cinoma of the head. Methods: A case-control study was carried out. Cases were patients mente efeitos indiretos, gerando radicais livres citotóxi- mais de uma lesão de CBC ou qualquer outra neoplasia with primary, solid basal cell carcinoma of the head, less than two centimeters in diam- cos e mutagênicos9-12. maligna cutânea, em qualquer tempo. Artigo recebido: 27/09/2011 Aceito para publicação: 19/12/2011 eter; and as controls, patients with other dermatoses. Constitutional and behavioral vari- Os fatores de risco constitucionais mais importantes As informações demográficas e comportamentais fo- ables were analyzed, as well as actinic lesions. Results: One hundred twenty cases and 360 são: pele clara (com dificuldade de bronzear e predispo- ram obtidas a partir de formulário padronizado e as lesões controls were evaluated. Facial milia (OR = 2.3), leukoderma punctata of the upper limbs sição para queimaduras solares), olhos e cabelos claros, cutâneas actínicas foram examinadas por dermatologista. (OR = 2.9), and cutis rhomboidalis nuchae (OR = 1.8) were associated with neoplasms re- história familiar de CBC e sardas na infância. Entre os Não foi adotada sistematização na amostragem dos pa- Correspondência para: gardless of other variables, suggesting a risk phenotype. There was also association with fatores comportamentais destacam-se: exercício profis- cientes, incluindo todos os consecutivamente disponíveis. Hélio Amante Miot light hair and eye color phenotypes, family genetics, and cumulative sun exposure. Sun- sional desprotegido da RUV, atividade rural e queimadu- A principal variável dependente foi o acometimento Universidade Estadual Paulista 7,13 Faculdade de Medicina burn, smoking, and alcoholism were not identified as risk factors. The use of sunscreens ras solares na juventude . A respeito deste, é importan- por CBC esporádico, sólido, menor que dois centímetros, de Botucatu te ressaltar que, apesar de a maioria dos autores apontar situado no segmento cefálico. As variáveis independentes Departamento de Dermatologia showed no evidence of protection; however, the control group consisted of dermatology e Radioterapia patients who are often prescribed sunscreens. Conclusion: Actinic lesions were more para maior participação de exposição solar intermitente, foram: idade, gênero, fototipo, características constitu- Campus Universitário prevalent in patients with solid basal cell carcinoma of the head than in controls, espe- principalmente na juventude, na gênese do CBC, alguns cionais, queimaduras solares, medidas de fotoenvelheci- Distrito de Rubião Júnior estudos recentes sugerem que o CBC nodular estaria mento, dermatoses associadas à exposição solar crônica, CEP: 18618-000 cially milia, cutis rhomboidalis nuchae, and leukoderma punctata, regardless of other Botucatu, SP, Brasil mais relacionado à exposição crônica14,15. tabagismo, uso de álcool, ocorrência de CBC familiar, ex- Tel/Fax: (14) 3882-4922 known risk factors. [email protected] Devido à gênese associada à exposição à RUV, lesões posição solar, ocupacional ou lazer, e uso de filtro solar. Keywords: Head and neck neoplasias; basal cell carcinoma; epidemiology; case-control cutâneas actínicas crônicas podem ser indicadores de ris- Inicialmente foi realizada análise bivariada para es- studies; UV rays; risk factors. Conflito de interesse:
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