A 2001 report (Harris et al 2001
) on trends in the incidence of nonmelanoma skin cancers in southeastern Arizona found that non-Hispanic whites were 11 times more likely than Hispanics to develop either basal or squamous cell carcinoma. Similarly, a 1982 report on the incidence of basal cell carcinoma and melanoma in New Mexico found that these cancers occurred seven times less often in Hispanics than in non-Hispanics (Pathak et al 1982
Although both basal and squamous cell carcinoma, as well as melanoma, occur with less frequency in the Hispanic population than in the non-Hispanic population, it has been shown that PBCC occurs more often in Hispanics. In one prospective series (Bigler et al 1996
), for BCC at any site, 66% of all BCCs in Hispanics were found to be PBCC, whereas only 11% of all BCCs in non-Hispanic patients were PBCC. Pigmented basal cell carcinoma has also been shown to occur with higher frequency in patients with darker skin color (Smith et al 1960
; Kalter et al 1984
; Abreo and Sanusi 1991
Histologic studies have shown that the pigment in PBCC originates from the surrounding skin (Bleehan 1975
Hornblass and Stefano (1981)
described pigmented basal cell carcinoma specific to the eyelid in white patients. Haye and Dufier (1976)
reported a relative frequency of 1% for PBCC of the eyelid in the population in Paris, which increased to 45% in Mediterranean ethnic groups. After careful review of the literature, to the best of the authors’ knowledge, eyelid PBCC specific to the Hispanic population has not been reported. Just as eyelid PBCC is more frequent in the darker skinned Mediterranean population, it is likely that PBCC of the eyelid also occurs more commonly in Hispanics than in non-Hispanics.
Because PBCC is not commonly considered in the differential of eyelid pigmented lesions of general ophthalmologists, these lesions are often misdiagnosed as melanoma. Both lesions can have irregular borders and dark pigment. However, some features of PBCC can help differentiate it from melanoma. Pigmented basal cell carcinoma is more likely to have mottled appearance since the pigment is often located superficially in the dermis (Bigler et al 1996
). Melanoma, on the other hand, tends to have intense or masking pigment (Haye and Dufier 1976
). Other features that help differentiate PBCC from melanoma include a translucent or pearly sheen, firm or indurated lesions, areas of ulceration, and raised edges (Hornblass and Stefano 1981
; Bigler et al 1996
Clinicians should be aware that PBCC of the eyelid occurs more frequently in Hispanics, a population less frequently affected by other skin carcinomas, and consider PBCC on their differential diagnosis of all pigmented eyelid lesions.