Re: "Laterality of periocular basal cell carcinomas in relation to driving practices in Philadelphia, PA, U.S.A.".

Basal cell carcinoma (BCC) is the most common malignant tumor of the eyelids, and the link between ultraviolet light in sun exposure and BCC has been well described. A study in the United Kingdom further suggested a relationship between driving habits and laterality of periocular tumors in men, because men in the United Kingdom are more likely to be the driver and thus be exposed to greater ultraviolet rays on the right side of the face. (Jones CA, Adams MW. Why you should let your wife drive: the distribution of periocular basal cell carcinomas. Paper presented at: the Thirty-Fourth Annual Scientific Symposium of the American Society of Ophthalmic Plastic and Reconstructive Surgery; 2004; New Orleans, LA.) In the United States, it would be expected that periocular tumors are more likely to occur on the left side of the face, since it is presumably exposed to greater solar damage. We examined this relationship through a retrospective analysis of 131 patients who were diagnosed with BCC at a tertiary care center in Philadelphia, between 2000 and 2005. Variables such as sex, laterality of the eyelid tumor, location of the tumor, and age at diagnosis were analyzed. The diagnosis of periocular BCC was made in 131 patients, of which 54 were male and 77 were female (Table). The most frequent site of periocular BCC in males or females was the lower eyelid, a finding consistent with previous epidemiologic studies. Basal cell lesions in males occurred on the right side in 31 patients and on the left in 23 patients. Similarly, females had 41 lesions on the right and 36 lesions on the left. Regardless of sex, there was no significant difference in laterality of BCC (chi-square, p 0.222). Our findings do not support the conclusion that driving habits have a causal relationship with laterality of BCC in the U.S.A. Studies have shown that the development of facial BCC is poorly correlated to the cumulative affects of ultraviolet radiation alone, and that episodic ultraviolet exposure may be more harmful than cumulative sun exposure. The fact that this relationship is found among males in the United Kingdom suggests there may be differences in driving patterns among males and females within these populations. It would be interesting to repeat this study using a specialized subset of patients, such as those with driving-related occupations.