Does Basal Cell Carcinoma Count as Neoplastic Disease in the PORT Score?
No, basal cell carcinoma (BCC) should NOT be counted as a neoplastic disease when calculating the PORT (Postoperative Radiation Therapy) score, as it is universally excluded from cancer staging systems and risk stratification tools due to its negligible metastatic potential and excellent prognosis.
Rationale for Exclusion
Biological Behavior of BCC
BCC has an extremely low metastatic rate of less than 0.1%, making it fundamentally different from other malignancies that would warrant inclusion in prognostic scoring systems 1, 2, 3.
BCC is locally invasive but rarely life-threatening, with mortality rates that are negligible compared to other cancers 2, 4.
The prognosis of BCC is excellent due to these low metastatic rates, distinguishing it from cancers that impact survival outcomes 1.
Standard Practice in Cancer Classification
Non-melanoma skin cancers (NMSC), particularly BCC, are routinely excluded from cancer registries and prognostic scoring systems because they do not significantly impact morbidity or mortality in the same way as other malignancies 1.
BCC accounts for approximately 75% of all skin cancers but is specifically separated from other malignancies in clinical practice due to its unique behavior 2.
Even aggressive subtypes like basosquamous carcinoma, which have higher metastatic potential than typical BCC, are still managed differently than systemic malignancies 2, 3.
Clinical Context for PORT Score
The PORT score is designed to identify patients at risk for poor outcomes after surgery, where systemic disease burden and metastatic potential are critical factors. Including BCC would:
Inappropriately inflate risk scores for patients whose actual systemic cancer risk remains unchanged 1, 2.
Conflate local tissue destruction with systemic malignancy, which are fundamentally different clinical problems 1, 3.
Important Caveat
The only exception would be the extraordinarily rare metastatic BCC (occurring in <0.1% of cases), which would then be considered a systemic malignancy 1, 2. However, standard localized BCC—even high-risk or recurrent lesions—should not count as neoplastic disease for PORT score purposes.