Pigmented Basal Cell Carcinoma in Skin of Color: A Systematic Review of the Literature.

Though basal cell carcinoma (BCC) is most often studied in Fitzpatrick Skin Types (FST) I-III, BCC in skin of color (SOC) is characterized by unique clinical features and a propensity toward pigmentation. While cutaneous malignancy occurs with decreased frequency in FST IV - VI, the diagnosis is generally associated with disproportionately increased morbidity and mortality. Accordingly, it is increasingly vital for dermatologists to recognize clinical presentations of skin cancer in individuals with SOC to improve outcomes and mitigate gaps in care. We systematically reviewed the literature regarding pigmented basal cell carcinoma (pBCC) in individuals with SOC. The keywords “pigmented basal cell carcinoma” and “pBCC” were independently combined with “Asian,” “Black,” “Hispanic,” “Latinx,” “skin of color,” and “SOC” to perform a PubMed/MEDLINE search. Based on the selected search terms, 26 unique articles were identified. Of these, 16 articles met the inclusion criteria for full-text screening. Pigmented BCC is more common in those with SOC and can be clinically challenging to diagnose. As evidence suggests that pBCC confers a favorable prognosis, efforts to standardize reporting and formalize sub-classification should be considered. Furthermore, as the existing literature is primarily retrospective with small sample sizes, larger prospective studies would be valuable additions to the literature and aid in shedding light on disparate outcomes associated with cutaneous malignancy in skin of color.