Diagnostic challenges and influencing factors in non-melanoma skin cancers: a retrospective analysis of basal cell carcinoma and squamous cell carcinoma cases

Diagnostic challenges and influencing factors in non-melanoma skin cancers: a retrospective analysis of basal cell carcinoma and squamous cell carcinoma cases | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 17 February 2025 V1 Latest version Share on Diagnostic challenges and influencing factors in non-melanoma skin cancers: a retrospective analysis of basal cell carcinoma and squamous cell carcinoma cases Authors : Nicholas Florin Kormos 0000-0001-6277-2629 [email protected] , Ioana Daria Paval , Carina Petrenciu , Alin Stefan Vizitiu , and Adrian Lucian Baican Authors Info & Affiliations https://doi.org/10.22541/au.173980291.16554500/v1 Published Cancer Reports Version of record Peer review timeline 317 views 220 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background/Objectives: Non-melanoma skin cancers (NMSC) are the most frequent cutaneous tumors globally. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) represent the most frequently encountered representatives of this group and may represent a diagnosis challenge in some circumstances of hard to differentiate tumors. The aim of this study was to determine the factors that influence the diagnosis of NMSC and their impact. Methods: A single center, descriptive, retrospective study was performed, with a total of 866 cases from 678 patients from 2016-2022. Cases were then analyzed based on their histological diagnosis and characteristics and the available clinical data. Results: From the 866 cases, 709 were histologically diagnosed as BCC and 157 as SCC. The clinical accuracy for BCCs was 95% whereas for SCCs was 62% with both having large variations among attending dermatologists. Clinical factors that were found to influence the diagnosis were: advanced age (p<0.001), a biopsy beforehand (p=0.009), and multiple diagnosis or uncertainty (p=0.005) were predictive for a final diagnosis of SCC. Factors predicting BCCs were: the presence of multiple lesions (p=0.032), presence of ulcerations (p<0.001), age under 50 (p=0.002). BCCs were more likely to be correctly diagnosed than SCC (p<0.001). Cases with multiple BCCs were thinner compared to single-lesion excisions (p<0.001). A tumor reduction was observed after the 2020 the SARS-CoV-2 (p=0.023). Conclusions: Differentiating NMSC can be challenging, but several trends have been observed which may aide in further improving the diagnosis rates especially for SCCs. Article type: Original Research Title: Diagnostic challenges and influencing factors in non-melanoma skin cancers: a retrospective analysis of basal cell carcinoma and squamous cell carcinoma cases Running Title: Diagnostic Challenges in Skin Cancer Authors: Nicholas Florin Kormos 1 , Ioana Daria Paval 1 , Carina Maria Petrenciu 1 , Alin Stefan Vizitiu 1 , Adrian Lucian Baican 1 Author information: [1.] Dermatology Department, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400126 Cluj-Napoca, Romania ORCID numbers: Nicholas Florin Kormos https://orcid.org/0000-0001-6277-2629 Ioana Daria Paval https://orcid.org/0009-0007-1865-2428 Carina Maria Petrenciu https://orcid.org/0009-0005-2208-2937 Alin Stefan Vizitiu https://orcid.org/0009-0001-3615-8999 Adrian Lucian Baican https://orcid.org/0000-0002-4116-6459 Corresponding author: Nicholas Florin Kormos Clinica de Dermatologie, Str. Clinicilor, nr. 3-5, Cluj-Napoca, Romania. Telephone: +40 751393961 Email: [email protected] Funding sources : None Conflicts of Interest : None declared. Ethics approval statement: Approved by the Cluj Emergency County Hospital, approval no. Clinicaltrials.gov (or equivalent) listing (if applicable): - Patient consent: Not applicable Reprint requests: - Synopsis for Table of Contents: This study examines challenges in diagnosing non-melanoma skin cancers, particularly differentiating basal and squamous cell carcinoma. Clinical factors like age, biopsy history, and lesion characteristics influence accuracy. Findings highlight diagnostic trends and the need for improved squamous cell carcinoma recognition. Manuscript word count : 2950 words [excluding capsule summary, abstract, references, figures, tables] Abstract word count : 240 References : 30 Figures: 0 Tables: 4 Keywords: Non-melanoma skin cancer, basal cell carcinoma, squamous cell carcinoma, basosquamous carcinoma, SARS-CoV-2. Abstract: Background/Objectives: Non-melanoma skin cancers (NMSC) are the most frequent cutaneous tumors globally. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) represent the most frequently encountered representatives of this group and may represent a diagnosis challenge in some circumstances of hard to differentiate tumors. The aim of this study was to determine the factors that influence the diagnosis of NMSC and their impact. Methods: A single center, descriptive, retrospective study was performed, with a total of 866 cases from 678 patients from 2016-2022. Cases were then analyzed based on their histological diagnosis and characteristics and the available clinical data. Results: From the 866 cases, 709 were histologically diagnosed as BCC and 157 as SCC. The clinical accuracy for BCCs was 95% whereas for SCCs was 62% with both having large variations among attending dermatologists. Clinical factors that were found to influence the diagnosis were: advanced age (p<0.001), a biopsy beforehand (p=0.009), and multiple diagnosis or uncertainty (p=0.005) were predictive for a final diagnosis of SCC. Factors predicting BCCs were: the presence of multiple lesions (p=0.032), presence of ulcerations (p<0.001), age under 50 (p=0.002). BCCs were more likely to be correctly diagnosed than SCC (p<0.001). Cases with multiple BCCs were thinner compared to single-lesion excisions (p<0.001). A tumor reduction was observed after the 2020 the SARS-CoV-2 (p=0.023). Conclusions: Differentiating NMSC can be challenging, but several trends have been observed which may aide in further improving the diagnosis rates especially for SCCs. Body of manuscript: Introduction Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) are two of the most common skin cancers and non-melanoma skin cancers (NMSC). 1,2 Both are keratinocyte carcinomas, as they both originate from the epidermal keratinocytes. 2 Besides the genetics and epigenetic regulation, carcinogenesis can be influenced by a variety of risk factors, out of which advanced age, prolonged and cumulative exposure to ultraviolet rays (especially UVB), ionizing radiation, immunosuppression, a Fitzpatrick skin type of I and II, and carcinogenic substances (like arsenic), were the most reported ones. 4,5 Although BCC has low mortality and an insignificant chance of metastasis by blood or lymphatics, the morbidity is high, due to the ability of local tissue infiltration and destruction. 1-3 In contrast with BCC, SCC has a greater propensity to metastasize and is responsible for the majority of NMSC-related deaths. 5-8 Because the clinical profiles of BCC and SCC are widely heterogeneous in relation with the anatomical site, dimensions, definition of the margins, pigmentation, and tumor grade differentiation, NMSCs can easily mimic other benign or malignant lesions, even when they do not pose atypical features. 7,9 Therefore, an accurate diagnosis can be challenging for dermatologists, and errors might occur. 10 Clinically, BCC and SCC do not have a universal classification. BCCs can be subdivided into: nodular, superficial, fibroepithelial and morpheaform. 3,5 The clinical presentation of BCC mostly includes a translucent and smooth pearly structure (papule or nodule), with telangiectatic vessels and spontaneous bleeding, a high inclination towards ulceration, central depression and different coloration (pink, white or skin-coloured lesions), but varieties are also reported, in the form of macula or atrophic plaque appearance, and scar-like lesions. 2-4,6 Common SCC types include the superficial, nodular, plaque and flat forms. 3,4 SCC is typically seen as a solitary scaly or crusty reddish hyperkeratotic papule or plaque, with ulceration, smooth surface and firmly aspect. 2,9 Clinical features may include bleeding, pruritus, pain, paresthesia or asymptomatic lesions, depending on the perineural invasion, tumor size, depth of invasion and differentiation. 8,10 Histopathologically, BCC and SCC have numerous subtypes. BCCs are described as a relative circumscribed tumoral growth arising from the epidermis, and depending on the form, with basaloid nests. 2-4,6 SCCs have been described as low- to high-risk histological types, with common features including nests of atypical squamous epithelial cells penetrating into the dermis. 3,9 Noninvasive imaging tools including dermoscopy, reflectance confocal microscopy, ultrasonography, optical coherence tomography and cross-polarised light and fluorescence photography can provide a better accuracy, reducing the diagnostic uncertainty. 2,8,10 Dermoscopy is the most accessible form of clinical examination with hallmarks of BCC include: vascular structure (arborising vessels), network areas of melanocytic lesions, ovoidal shape of blue-gray colored nests and ulceration. 6,8,10 Typical SCC features include red or unpigmented color, erosions or ulceration, keratotic plugs or central keratin mass, and diverse vascular structures with dotted, glomerular, linear irregular, and hairpin vessels or red starburst pattern. 6,7,10 Most BCC and SCC cases occur on photoexposed areas such as the head and neck., early detection can significantly influence the cosmetic results, which together with complete neoplasm excision and preserved functional capacity, reflect the main goals of NMSC treatment. 2,9 Surgery is the most effective treatment for BCC and SCC. Mohs micrographic surgery is considered the gold standard but is not universally available and the most common form of surgical treatment remains the wide local excision. Although, several other therapeutic options are also available for ineligible patients to first-line treatment options such as curettage and cautery, radiotherapy, immunotherapy, cryosurgery, photodynamic therapy, topical treatments and systemic therapy. 2,5,12 By mismatched or delayed diagnoses, BCCs and SCCs can be wrongfully treated, affecting the likelihood of healing and leading to a necessity of more complex or avoidable surgical interventions, thus increasing the psychological, financial and cosmetic burden of NMSCs. 8,13 The aim of our study was to determine both the clinical and histopathological accuracy of BCC and SCC cases of a large, multi-year cohort, as well as present the clinical and demographic factors that influenced the diagnostic rationale, and consequently, the therapeutic approach. Materials and methods A single center, retrospective, descriptive study was performed. The cases were selected from 3657 histopathological reports of lesions excised during 2016 and until 2022. All included cases had a complete histological and clinical report, biopsies and complete excisions were included with cases having a biopsy and a follow-up excision being considered as a singular lesion and counted once, and cases with insufficient data were excluded. There were 866 cases which were included in the final cohort. Cases were divided into two groups based on histology with the first group composed of 709 BCCs and the second one of 158 SCCs. The histological diagnosis was conclusive in all except one case and was excluded. Immunohistochemistry was performed for 39 cases in total, out of which 10 cases were SCCs and 29 BCCs. Each case was evaluated at least once in a preoperative setting and at least once when the referral for surgery or biopsy was made. The clinical evaluation included dermatoscopical evaluation in all cases performed both by the attending physician and a dermatologist in training. The excisions and biopsies were performed as a day procedure or through hospitalization in an operating room. H istopathological examination was performed in the same hospital with a clinical description of the lesion but blinded towards the clinical image of the lesion. Some of the cases evaluated in our study could not be clinically diagnosed and the surgical protocol was established as the most probable diagnosis to have a working diagnosis for the surgical excision, margins and further recommendations until the definitive diagnosis was established. Therefore, the clinical diagnosis discussed in the study may have not been the actual diagnosis the patient received before and shortly after the surgery. The following data was taken into consideration and analyzed: patients‘ personal identification data, certain and differential clinical diagnoses, the certain and differential histopathological diagnoses. A value of p<0.05 was considered statistically significant. The following statistical methods were used: Yates corrected Chi-square test (χ2), Odds Ratio (OR), Fischer’s Exact Test, and the data was described through the use of mean value (M), standard deviation (SD), standard error of the difference (SEM), 95% Confidence Interval (95% CI), number of cases (N). Results The mean age of our cohort was 69.88 years with a mean age of 68.62 years (SD=12.29, SEM=0.46, N=709) for patients with BCC’s and 75.59 years (SD=10.23, SEM=0.82, N=157) for patients with SCC. There was a statistically significant age difference between the two, with SCC cases having a more advanced age, with a mean age difference of 6.96 years, 95% CI [4.89, 9.03] was observed (p<0.001). There were 70/709 (10%) and 3/157 (3%) of BCC and SCC cases in patients aged 50 and under, the difference was statistically significant χ2(1,N=862)=9.17, p =0.002, OR=5.48 [1.76, 27.5], confirmed with the Fischer exact test (p<0.001). Biopsies were more often performed in SCCs with 21/157 (13%) vs. 48/709 (6.7%) for BCCs, χ2(1,N=866)=6.77, p =0.009, OR=2.13 [1.17, 3.75], confirmed with the Fischer exact test (p=0.013). While the average biopsied SCC was not more advanced, with an average thickness of 3.6 mm compared to a median of 3.36 mm for all SCCs (p=0.88), the mean thickness for BCCs was 1.18 mm (SD=0.64, SEM=0.11, N=30) vs a median value of 2.18 mm (SD=1.68, SEM=0.06, N=640) for all excised BCCs, the difference was statistically significant, with a mean thickness difference of 1.00 mm, 95% CI [0.41, 1.61] was observed (p=0.001). Of the biopsied tumors, 33/69 (48%) were localized on the head, out of which 8/33 (24%) were SCCs and 25/33 (76%) were BCCs. In the 709 BCC cohort there were 675/709 (95%) clinically correct diagnosed tumors, with 655/675 (97%) having a single or certain diagnosis and 20/675 (3%) having a multiple or uncertain diagnosis, and 34/709 (5%) with a mismatch, out of which 31/34 (91%) having a single or certain diagnosis and 3/34 (9%) having a multiple or uncertain diagnosis. The 157 SCCs were 97/157 (62%) clinically correct diagnosed, 88/97 (90%) were certainly diagnosed as SCC and 9/97 (10%) presented uncertainty. 60/157 (38%) had a clinical-histopathological mismatch, with 57/60 (95%) had a certain diagnosis, and 3/60 (5%) had an uncertain diagnosis (Table 1). Comparing the correct diagnosis and false diagnosis among BCC’s and SCC’s there was a statistically significant difference between the rates of correct diagnosis of the two χ2(1,N=866)=144.9, p<0.001, OR=12.28 [7.66, 19.68], confirmed with the Fischer exact test (p<0.001). Out of the 772 correctly diagnosed BCCs and SCCs, 743 (96%) had a certain diagnosis with 655/743 (88%) BCCs and 88/743 (12%) SCCs, and 29 (4%) had a clinically uncertain diagnosis out of which 20/29 (69%) were BCCs and 9/29 (31%) were SCCs. The difference between BCCs and SCCs being statistically significant χ2(1,N=772)=7.69, p =0.005, OR=3.35 [1.48, 7.59], confirmed with the Fischer exact test (p=0.012). The clinical accuracy varied among physicians from 97% to 81%, and for BCCs and from 100% to 12% for SCCs (Table 2). During the 2020 SARS-CoV-2 pandemic the number of patients decreased by 41% from an average number of 169 for the previous two years to 99 patients in 2020. The mean thickness of excised tumors was significantly lower in 2021 and 2022 (M=2.42, SD=1.88, SEM=0.11, N=284) vs the two years prior the pandemic (M= 2.04, SD=1.49, SEM=0.11, N=182). The observed mean thickness difference was 0.38 mm, 95% CI [0.05, 0.70] (p=0.023). The most frequent location for both BCCs and SCCs with 551/866 (64%) was on the head (Table 3). Tumors located on the head were correctly diagnosed more often. Out of the 97 correctly diagnosed, 75 (74%) were located on the head, compared to 33/60 (55%) for misdiagnosed SCCs, the observed difference was statistically significant χ2(1,N=157)=7.59, p=0.005, OR=2.79 [1.39, 5.59], confirmed with the Fischer exact test (p=0.006). Of the correctly diagnosed BCCs, 429/675 (64%) were localized on the face while 14/34 (42%) of the misdiagnosed BCCs were localized on the face, χ2(1,N=709)=5.99, p=0.014, OR=2.49 [1.24, 5.02], confirmed with the Fischer exact test (p=0.016). There were 137/678 (20%) patients with two or more lesions and 541/678 (80%) with a single excised lesion. 102/137 (74%) had two or more BCCs, 22/137 (16%) had a single SCC and one or more BCCs, and 13 (10%) had multiple SCCs. The average tumor thickness was higher when a single lesion (M=2.45, SD=1.91, SEM=0.08, N=501) was excised vs when two or more lesions (M=2.16, SD=1.59, SEM=0.13, N=141) were excised, regardless of the nature of the second lesion, but without statistical significance (p=0.092). The difference was larger when three or more lesions (M=1.69, SD=1.70, SEM=0.19, N=78) were excised. The difference was statistically significant, with a mean thickness difference of 0.77 mm, 95% CI [0.32, 1.22] was observed (p<0.001). The presence of more than three lesion was significantly specific for the presence of multiple BCCs than multiple SCCs or BBCs accompanied by an SCC χ2(1,N=866)=4.61, p=0.032, OR=2.16 [1.01, 4.78], confirmed with the Fischer exact test (p=0.024). However, when single lesions versus two or more lesions, the statistical significance was narrowly missed (p=0.064). There were 423 ulcerated lesions in our cohort. There was no observed difference between correctly 31/97 (31%) and falsely 22/60 (37%) diagnosed SCC (p=0.665), or between correctly 370/675 (55%) and falsely 18/34 (53%) diagnosed BCCs (p=0.932). But ulcerations were more commonly found in BCCs than in SCCs χ2(1,N=866)=16.74, p<0.001, OR=2.14 [1.49, 3.08], confirmed with the Fischer exact test (p<0.001). Of the 157 SCCs 50/157 (32%) were well differentiated, 25/157 (16%) were moderately differentiated, and 3/157 (2%) were poorly differentiated. The remaining 79/157 (50%) had no specification in regards to differentiation. 26/709 (3.7%) of BCCs had a squamous differentiation and 22/26 (85%) were located on the head and neck area. They (M=3.15, SD=2.25, SEM=0.45, N=24) were characterized by a significantly increased tumor thickness of 1.01 mm 95% CI [0.33, 1.69] compared to the rest of the BCCs (M=2.14, SD=1.63, SEM=0.06, N=616), (p=0.004). Leucocytic infiltrate was the most common immune cell present in 445/866 (51%), and an immune infiltrate was observed in 506/866 (58%) of cases. A rich infiltrate was observed predominantly in cases where a single lesion was excised compared No statistically significant relationship was found regarding the immune infiltrate. Discussions The mean age of our cohort was 69.88 years, with the mean age for BCC cases at 68.62 and 75.59 years for SCCs. In line with other studies such as Lee et al., showing NMSCs were more frequent in patients over 40, with a peak in 50-69 years old. 15 Another study estimated t he median and mean age at approximately 71 and 70.1 years for BCCs and 79 and 77.1 years for SCCs in the UK. 16,17 According to Leman et al., 20% of all BCC cases occur in patients under 50 years old., significantly higher than the 10% rate observed in our cohort. 18 Although skin biopsies are not regularly performed in our department and the lesions are usually excised as a first intent, 13% of SCCs and 6.7% of BCCs were initially biopsied followed by an excision. The average thickness of biopsied SCCs was similar to that of all SCCs but there was an observed difference in BCC cases. An article by 19. Christensen et al., described a mean thickness of 1.53mm and 1.67 for biopsied and excised BCCs. An explanation could be the larger number of cases in our cohort, compared to the previous studies. 19 Not all lesions were precisely diagnosed before the surgery but all lesions were excised based on a surgical protocol for a specific diagnosis, which represents the basis of our considerations for this article. The diagnosis accuracy for BCCs was significantly higher than that of SCCs and significantly more likely to be correctly diagnosed than SCC. Ryu et al, had similar observations as to our study that SCCs have a higher tendency to be clinically misdiagnosed as BCCs than the opposite. 20 And also found that the diagnostic accuracy for BCC was higher than that of SCC. U lceration, telangiectasia and translucency were significant confusion factors. Another possible reason could be the fact that BCCs are more common than SCCs; therefore, physicians may have a tendency diagnose an uncertain lesion as a BCC rather than a SCC. A 41% decrease was observed in 2020 due to the SarsCoV-19 pandemic. A retrospective study by Abbassi et al. reported a 158% increase of NMSC compared to the previous year. The increase was generated by an increased number of telemedicine consultations and reduced non-urgent and non-cancer elective surgeries. 21 In a meta-analysis by Wall J. et al., a decrease incidence in NMSC rates was observed, reported by all articles published in 2020-2021, compared to 2019. Only the incidence for BCC was diminished and not for SCC, mostly attribute to a delay in presentation, diagnosis or treatment. 22 A peculiar observation observed in our study was the reduced thickness pf tumors after the year 2020, which may be interpreted as a greater awareness for the need of medical care among patients or an increase in addressability. However, the trend would require more studies to confirm the trend. The most frequent localization for both BCC and SCC was the head and neck with 64% of cases. This being a common localization reported in literature as well, the main risk factor for developing a BCC being sun exposure during childhood and/or adolescence. 23-26 According to Neale et al., there is a modest correlation between sun exposure and the risk of developing a BCC but SCCs are directly correlated with the quantity of sun exposure. 27 A retrospective study by Sgouros et al. reported 23% having multiple BCCs, a higher number than our observations. They concluded that patients with multiple BCCs had a rich history of sun exposure and sunburns. And significantly lower than a 2019 review which summarized the role of genetic susceptibility and the greater prevalence of the superficial variant of BCC. 28 Ulcerations were more commonly found in correctly diagnosed BCC, when examined clinically through dermoscopy and confirmed histopathologically. This finding is consistent with the study published by Hyung Ryu T. et. al., together with other dermoscopic common traits of cBCC: blue-gray nests and globules, arborizing vessels; the sensitivity of its diagnostic being greater than 95%. 29 The presence of ulceration in a cBCC lesion can also aid in its subtype differentiation, therefore, this trait is less consistent with a superficial BCC, as opposed to other clinical traits found when performing dermoscopy, which suggest a more likely diagnosis of sBCC (short-line superficial telangiectasias, maple-leaf like areas). 30 BCCs with a squamous differentiation, or basosquamous carcinoma (BSC), are an aggressive type of basal cell carcinoma. One of its similarities with the basal cell carcinoma is the localization: a higher tendency to be localized in the head and neck area. 31 We observed a 3.7% incidence, significantly higher than historical reports. Schuller et al. reported an incidence of 1.2% in a cohort of 2565 NMSCs cases. 32 Similar to the 1.4% from another cohort from the University of Louisville between 1985-1988, with 31 lesions out of a total of 2075 cases. 33 With a higher incidence of 2.7% in the early 00’, and a 4.8% incidence in the early 10’. 34 These results may suggest an increase incidence of BSC to over double the historical data. Conclusion Diagnosing NMSC can be a real challenge, especially when differentiating the two main representatives. With the increasing incidence of BSC several questions need to be answered regarding the physiopathological mechanisms that lead to this variant of BCC. Several factors have been shown to influence the clinical diagnostic and probability of either one of the two NMSC. Patients under 50 rarely have an SCC which in general are harder to diagnose and are determined as unknown lesions, and have a misdiagnosis more often. While BCCs are more likely to be associated with other skin lesions, younger age, ulcerations, and a higher risk towards developing further lesions. Lesions on the head are less likely to be misdiagnosed. Acknowledgments : We would like to thank Dr. Judit Kiss for her help in reviewing and practical insights. Publication of this paper was supported by the Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, through the institutional Open access program Data Availability Statement The data that support the findings of this study are available from the corresponding author upon reasonable request. REFERENCES Zambrano-Román M, Padilla-Gutiérrez JR, Valle Y, Muñoz-Valle JF, Valdés-Alvarado E. Non-melanoma skin cancer: A genetic update and future perspectives. Cancers (Basel) [Internet]. 2022 [cited 2024 Oct 23];14(10):2371. Available from: http://dx.doi.org/10.3390/cancers14102371 Firnhaber JM. Basal cell and cutaneous squamous cell carcinomas: Diagnosis and treatment. 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Cells , 12 (23), 2737. https://doi.org/10.3390/cells12232737 Supplementary Material File (table 1.docx) Download 14.73 KB File (table 2.docx) Download 13.84 KB File (table 3.docx) Download 12.79 KB File (table 4.docx) Download 13.63 KB Information & Authors Information Version history V1 Version 1 17 February 2025 Peer review timeline Published Cancer Reports Version of Record 4 Sep 2025 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords basal cell carcinoma basosquamous carcinoma non-melanoma skin cancer sars-cov-2 squamous cell carcinoma Authors Affiliations Nicholas Florin Kormos 0000-0001-6277-2629 [email protected] Universitatea de Medicina si Farmacie Iuliu Hatieganu Facultatea de Farmacie View all articles by this author Ioana Daria Paval Universitatea de Medicina si Farmacie Iuliu Hatieganu Facultatea de Farmacie View all articles by this author Carina Petrenciu Universitatea de Medicina si Farmacie Iuliu Hatieganu Facultatea de Farmacie View all articles by this author Alin Stefan Vizitiu Universitatea de Medicina si Farmacie Iuliu Hatieganu Facultatea de Farmacie View all articles by this author Adrian Lucian Baican Universitatea de Medicina si Farmacie Iuliu Hatieganu Facultatea de Farmacie View all articles by this author Metrics & Citations Metrics Article Usage 317 views 220 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Nicholas Florin Kormos, Ioana Daria Paval, Carina Petrenciu, et al. 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