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The report by Brooke and colleagues¹ on discordance between facial wrinkling and presence of basal cell carcinoma (BCC) raises some methodological issues. This small case-control study was designed to substantiate the observation made by the authors in their daily clinical practice that patients with BCC had less facial wrinkling than patients who did not have BCC. Using logistic regression analysis, they found that an increasing grade of wrinkling was associated with a progressive reduction in risk of developing a BCC, after adjusting for age, sex, and smoking history.

However, this negative association between facial wrinkles and BCC may be spurious, ie, due to confounding variables related to both the "exposure" (facial wrinkling) and the outcome of interest (BCC). The most obvious confounders in this study are sun exposure and skin type, since both may be associated with either facial wrinkling or BCC occurrence. To demonstrate a true, independent, protective effect . . . [Full Text of this Article]

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