BackgroundTelangiectasia or red veins are one of the main features of facial skin aging. To date there are few studies investigating risk factors for telangiectasia. We investigated environmental risk factors in a population‐based cohort study, using a digital continuous outcome measure.

MethodsTelangiectasia were quantified digitally from standardized 3‐dimensional facial photographs of 2886 North‐ European participants (56.8% female, median age 66.9) from the Rotterdam Study, a prospective population‐based cohort study. Age‐ and sex adjusted as well as fully adjusted multivariable linear regressions were performed to investigate associations between potential environmental factors and the amount of telangiectasia. Men and women were analyzed separately.

ResultsThe mean facial area covered by telangiectasia was higher in women (median area 0.95%, interquartile range 0.62‐ 1.4) than in men (median area 0.76%, interquartile range 0.48‐1.2). Besides age (men ß=0.016, P‐value<0.001; women ß=0.016, P‐value<0.001), smoking (men ß=0.29, P‐value<0.001; women ß=0.32, P‐value<0.001), a high susceptibility to sunburn (men ß=0.082, P‐value<0.001; women ß=0.076, P‐value<0.001) and light skin color (pale against olive‐colored skin in men ß=0.26, P‐value<0.001; in women ß=0.23, P‐value<0.001) were independent significant factors contributing to telangiectasia for both sexes. Additionally in men, a lower education also showed an association (medium vs. high ß=0.062, P‐value=0.008). Alcohol showed a negative association with telangiectasia (ß=‐0.028, P‐value<0.001). In women, a higher free androgen index was associated with less telangiectasia (ß=‐0.0053, P‐value<0.001).

ConclusionIn this large cohort study of facial telangiectatic photoaging, environmental factors associated with telangiectasia are described, implicating possible new prevention strategies for this form of skin aging.

A third of basal cell carcinoma (BCC) patients will develop metachronous BCCs, but information is limited on the frequency, timing and predictors of these subsequent BCCs. We aimed to develop a prediction model to assess the absolute risk of metachronous BCCs.

We observed 14,628 participants of northwestern European ancestry from a prospective population- based cohort study (Rotterdam Study). BCCs were identified using a linkage with the Dutch Pathology Registry (PALGA). Predictors for subsequent BCCs included 14 patient, lifestyle, and tumor-specific characteristics. The prediction model was developed with Fine and Gray regression analysis to account for the competing risk of death. To correct for within patient correlation, we assessed non-parametric 95% confidence intervals with bootstrapping.

Among 1,077 patients with a first BCC, second to fifth BCCs occurred in 293, 122, 58, and 36 patients, with median follow-up times of 3.0, 2.1, 1.7, and 1.8 years, respectively. The risk of a new BCC was higher for patients with more metachronous BCCs (15% within 3 years after a first BCC; 34% after a second; 45% after a third; and 67% after a fourth). Having >1 BCC at diagnosis was another strong predictor of metachronous BCCs. Discriminative ability of the model was reasonable with apparent c- indices of 0.68, 0.71, and 0.69 at 1, 3 and 5 years, respectively.

We conclude that a combination of readily available characteristics can reasonably identify patients at high risk of metachronous BCCs. After external validation the risk predictions may be used to personalize the follow-up.

BackgroundThe relationship between 25‐hydroxyvitamin D and different phenotypes of skin aging (e.g., wrinkles, pigmented spots, telangiectasia, perceived age) is unclear. We investigated the association between vitamin D levels and skin aging phenotypes in middle‐aged participants from the Rotterdam Study (RS) and Leiden Longevity Study (LLS).

MethodsStandardized facial photographs were taken of North‐European participants from the RS (N=3,831; 58.2% female, median age 66.5) and the LLS (N=661; 50.5% female, median age 63.1). Facial wrinkles, pigmented spots and telangiectasia (RS only) were quantified either digitally (RS) or by two independent dermatologists (LLS). Perceived age was graded by an average of 27 (range:20‐30) and 60 (range:59‐61) assessors in the RS and LLS respectively. The associations between vitamin D and these phenotypes (all standardized using Z‐scores) were investigated using multivariable linear regression analyses, adjusted for chronological age, sex, self‐reported UV‐exposure, season, smoking, body mass index and skin color, followed by meta‐analysis of the two cohorts.

ResultsHigher circulating 25‐hydroxyvitamin D was associated with more wrinkles (P‐value<0.0001) and a higher perceived age (P‐value<0.0001). However, there was no association between higher circulating 25‐hydroxyvitamin D and pigmented spots or telangiectasia (p‐values>0.05). Self‐reported UV‐exposure was associated with all four phenotypes. In RS, a light skin color was associated with more pigmented spots (P‐value<0.0001) and telangiectasia (P‐value<0.0001), but with less wrinkles (P‐value<0.0001).

ConclusionA higher circulating 25‐hydroxyvitamin D is associated with more facial wrinkles and a higher perceived age in middle‐aged and older individuals. However, although statistically adjusted for questionnaire‐based sun exposure, these two associations could be attributable to residual confounding.

OBJECTIVESFirst to determine the proportion of incompletely excised basal cell carcinomas (BCCs) treated by conventional excision by dermatologists, plastic surgeons and general practitioners. Second to identify characteristics of incomplete excised BCCs.

METHODSAnalysis of pathology reports of 3005 primary BCC excisions by general practitioners (31%), dermatologists (34%) and plastic surgeons (35%) from an urbanized area in the South West of the Netherlands from 2008-2014. Chi-square test and independent T-tests were used to analyze the primary outcome. Logistic regression was used to determine the odds ratio for incomplete excision in the groups corrected for patients age, patients sex, site, size, subtype and specialism.

OUTCOME MEASURESProportion of incompletely excised BCC per specialism, age and sex of patients, anatomical site, excision size (as a proxy for BCC size), and subtype.

RESULTSDermatologists had a complete excision rate of 93.24%, plastic surgeons 83.33% and general practitioners 69.61% (p<.0001). Head neck tumors we more often incompletely excised (OR 2.7; 95% CI: 2.0-3.7; p<.0001) compared to the trunk. Infiltrative BCCs were mere often incompletely excised compared to nodular BCCs (OR 3.8; 95% CI: 2.7-5.4; p<.0001). Plastic surgeons and general practitioners had a higher rate of incomplete excisions compared to dermatologists (OR 2.0; 95% CI: 1.5-2.7; p<.0001, resp. OR 6.1; 95% CI: 4.5-8.3; p<.0001).

CONCLUSIONRegardless of subtype, location and size dermatologists had a significantly higher rate of completely excised basal cell carcinomas compared to general practitioners and plastic surgeons

Health-related quality of life is increasingly important in the management of patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). A few disease-specific questionnaires exist, but all with substantial flaws. We developed and validated a quality of life questionnaire suitable for use in all BCC and SCC patients. In an extensive four-phase trajectory, as recommended by the European Organisation for Research and Treatment of Cancer (EORTC), 33 items were selected and rephrased into a preliminary questionnaire. A population-based sample of 1173 patients from the Dutch Cancer Registry were invited to complete the questionnaire. The questionnaire was reduced using exploratory factor analysis and item response theory (IRT). Subsequently, individual item performance was assessed using 8 features of the classical test theory (CTT).

The 33-item preliminary questionnaire was completed by 721 patients, of whom 15% had SCC. The number of items in the questionnaire was reduced to 16, covering five subscales: “Worries”, “Appearance”, “Behaviour”, “Diagnosis & Treatment” and “Other People”. Confirmatory factor analysis showed a good fit. Cronbach’s α (range 0.67 – 0.82) were reasonable to high and demonstrated good internal consistency. Of the 8 CTT item performance features, only 1 item was suboptimal for 6 out of 16 items and only 2 for 2 items, suggesting a valid Basal and Squamous cell carcinoma Quality of Life (BaSQoL) questionnaire.

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