Quality of Life, Mental Health and Executive Function in Individuals with Basal Cell Naevus Syndrome
DOI:
https://doi.org/10.2340/actadv.v106.adv-2026-0335Keywords:
Gorlin syndrome, basal cell naevus syndrome, basal cell carcinoma, health-related quality of life, executive functioning, anxietyAbstract
Basal cell naevus syndrome (BCNS) is a rare genetic disorder characteriszed by multiple basal cell carcinomas, as well as different extracutaneous tumours, cysts and abnormalities. Research on health-related quality of life (HRQoL) and mental health in BCNS is limited. This cross-sectional study included 62 individuals ≥18 years diagnosed with BCNS. Clinical and genetic data were collected, and five5 validated questionnaires were used to assess self-reported HRQoL, psychological distress, fatigue, pain and everyday executive functioning. Median regression analyses were conducted to identify factors associated with HRQoL. Independent samples t-tests and one proportion z-tests were conducted to compare the BCNS group with the general population. Individuals with BCNS reported lower HRQoL compared with the general population. Elevated anxiety symptoms were observed in 14 individuals (24%). The proportion of individuals reporting everyday executive deficits was higher in the BCNS group compared with the general population. Engagement in employment or higher education was associated with better physical and mental HRQoL, whereas symptoms of anxiety and everyday executive deficits were associated with reduced mental HRQoL. Findings highlight mental health challenges in BCNS. Routine screening for anxiety and executive functioning is suggested as essential steps in identifying those at risk and provideproviding timely psychological support.
Downloads
References
Farndon PA, Del Mastro RG, Evans DG, Kilpatrick MW. Location of gene for Gorlin syndrome. Lancet 1992; 339: 581–582. DOI: https://doi.org/10.1016/0140-6736(92)90868-4
Smith MJ, Beetz C, Williams SG, Bhaskar SS, O’Sullivan J, Anderson B, et al. Germline mutations in SUFU cause Gorlin syndrome-associated childhood medulloblastoma and redefine the risk associated with PTCH1 mutations. J Clin Oncol 2014; 32: 4155–4161. DOI: https://doi.org/10.1200/JCO.2014.58.2569
Verkouteren BJA, Cosgun B, Reinders MGHC, Kessler PAWK, Vermeulen RJ, Klaassens M, et al. A guideline for the clinical management of basal cell naevus syndrome (Gorlin-Goltz syndrome). Br J Dermatol 2022; 186: 215–226. DOI: https://doi.org/10.1111/bjd.20700
Brandtzæg KH, von der Lippe C, Vestengen IK, Holtan JP, Winge MI, Rustad CF, et al. Clinical and genetic findings in 103 individuals in Norway with basal cell naevus syndrome. Br J Dermatol 2026; 194: 264–272. DOI: https://doi.org/10.1093/bjd/ljaf413
Shah M, Mavers M, Bree A, Fosko S, Lents NH. Quality of life and depression assessment in nevoid basal cell carcinoma syndrome. Int J Dermatol 2011; 50: 268–276. DOI: https://doi.org/10.1111/j.1365-4632.2010.04658.x
Huq AJ, Bogwitz M, Gorelik A, Winship IM, White SM, Trainer AH. Cohort study of Gorlin syndrome with emphasis on standardised phenotyping and quality of life assessment. Intern Med J 2017; 47: 664–673. DOI: https://doi.org/10.1111/imj.13429
Alonso N, Cañueto J, Ciria S, Bueno E, Palacios-Alvarez I, Alegre M, et al. Novel clinical and molecular findings in Spanish patients with naevoid basal cell carcinoma syndrome. Br J Dermatol 2018; 178: 198–206. DOI: https://doi.org/10.1111/bjd.15835
Endo M, Fujii K, Sugita K, Saito K, Kohno Y, Miyashita T. Nationwide survey of nevoid basal cell carcinoma syndrome in Japan revealing the low frequency of basal cell carcinoma. Am J Med Genet A 2012; 158A: 351–357. DOI: https://doi.org/10.1002/ajmg.a.34421
Goldstein S, Naglieri JA. Introduction: A history of executive functioning. Handbook of executive functioning. New York, NY: Springer; 2014: 3–12 pp. DOI: https://doi.org/10.1007/978-1-4614-8106-5_1
Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 2007; 18: 805–835. DOI: https://doi.org/10.1097/EDE.0b013e3181577511
Ware JE. SF-36 health survey. In: Manual and interpretation guide. Vol 6. The Health Institute; 1993: p. 1–6.
Ware JE, Keller SD, Kosinski M. SF-36 Physical and mental health summary scales. Boston: Health Assessment Lab; 1994.
Maruish M. User’s manual for the SF-36v2 Health Survey. Lincoln: Quality Metric Incorporated; 2011: 198 p.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370. DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Bjelland I, Lie SA, Dahl AA, Mykletun A, Stordal E, Kraemer HC. A dimensional versus a categorical approach to diagnosis: anxiety and depression in the HUNT 2 study. Int J Methods Psychiatr Res 2009; 18: 128–137. DOI: https://doi.org/10.1002/mpr.284
Wu Y, Levis B, Sun Y, He C, Krishnan A, Neupane D, et al. Accuracy of the Hospital Anxiety and Depression Scale Depression subscale (HADS-D) to screen for major depression: systematic review and individual participant data meta-analysis. BMJ 2021; 373: n972. DOI: https://doi.org/10.1136/bmj.n972
Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, et al. Development of a fatigue scale. J Psychosom Res 1993; 37: 147–153. DOI: https://doi.org/10.1016/0022-3999(93)90081-P
Klepstad P, Loge JH, Borchgrevink PC, Mendoza TR, Cleeland CS, Kaasa S. The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manage 2002; 24: 517–525. DOI: https://doi.org/10.1016/S0885-3924(02)00526-2
Cleeland CS, Ryan K. The brief pain inventory. User guide. 2009.
Roth RM, Isquith PK, Gioia GA. Behavior Rating Inventory of Executive Function®--adult version. Arch Clin Neuropsychol 2005. DOI: https://doi.org/10.1037/t86244-000
Roth RM, Isquith PK, Gioia GA. Assessment of executive functioning using the Behavior Rating Inventory of Executive Function (BRIEF). In: Handbook of executive functioning. New York: Springer; 2013. DOI: https://doi.org/10.1007/978-1-4614-8106-5_18
Garratt AM, Stavem K. Measurement properties and normative data for the Norwegian SF-36: results from a general population survey. Health Qual Life Outcomes 2017; 15: 51. DOI: https://doi.org/10.1186/s12955-017-0625-9
Forskningssenter. HUNT Databank: HUNT Forskningssenter. 2024.
Loge JH, Ekeberg O, Kaasa S. Fatigue in the general Norwegian population: normative data and associations. J Psychosom Res 1998; 45: 53–65. DOI: https://doi.org/10.1016/S0022-3999(97)00291-2
Buer S, Hagen BI, Søraas A, White RA, Bø R, Ellingjord-Dale M, et al. Executive deficits after SARS-CoV-2 infection: a cross-sectional population study. Brain Behav Immun Health 2024; 41: 100857. DOI: https://doi.org/10.1016/j.bbih.2024.100857
Bryson BA, Bogart KR. Social support, stress, and life satisfaction among adults with rare diseases. Health Psychol 2020; 39: 912–920. DOI: https://doi.org/10.1037/hea0000905
Earnshaw VA, Quinn DM, Park CL. Anticipated stigma and quality of life among people living with chronic illnesses. Chronic Illn 2012; 8: 79–88. DOI: https://doi.org/10.1177/1742395311429393
Nicoloro-SantaBarbara J, Lobel M. Loneliness and its predictors in rare versus common chronic illnesses. Int J Behav Med 2024; 31: 422–432. DOI: https://doi.org/10.1007/s12529-023-10231-9
Uhlenbusch N, Swaydan J, Höller A, Löwe B, Depping MK. Affective and anxiety disorders in patients with different rare chronic diseases: a systematic review and meta-analysis. Psychol Med 2021; 51: 2731–2741. DOI: https://doi.org/10.1017/S0033291721003792
Kastner AM, Fischer-Jacobs J, Brederecke J, Hahne A, Zimmermann T. Distress, anxiety, and depression in persons with hereditary cancer syndromes: Results from a nationwide cross-sectional study in Germany. Cancer Med 2023; 12: 13701–13711. DOI: https://doi.org/10.1002/cam4.5999
Mathias SD, Chren MM, Colwell HH, Yim YM, Reyes C, Chen DM, et al. Assessing health-related quality of life for advanced basal cell carcinoma and basal cell carcinoma nevus syndrome: development of the first disease-specific patient-reported outcome questionnaires. JAMA Dermatol 2014; 150: 169–176. DOI: https://doi.org/10.1001/jamadermatol.2013.5870
Beesdo K, Jacobi F, Hoyer J, Low NCP, Höfler M, Wittchen HU. Pain associated with specific anxiety and depressive disorders in a nationally representative population sample. Soc Psychiatry Psychiatr Epidemiol 2010; 45: 89–104. DOI: https://doi.org/10.1007/s00127-009-0045-1
Løvstad M, Sigurdardottir S, Andersson S, Grane VA, Moberget T, Stubberud J, et al. Behavior Rating Inventory of Executive Function adult version in patients with neurological and neuropsychiatric conditions: symptom levels and relationship to emotional distress. J Int Neuropsychol Soc 2016; 22: 682–694. DOI: https://doi.org/10.1017/S135561771600031X
Statistics Norway. Recipients of disability benefit: Statistics Norway. 2025. [cited 2025 June 24].
Olssøn I, Mykletun A, Dahl AA. The Hospital Anxiety and Depression Rating Scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry 2005; 5: 46. DOI: https://doi.org/10.1186/1471-244X-5-46
Chren MM. The Skindex instruments to measure the effects of skin disease on quality of life. Dermatol Clin 2012; 30: 231–236. DOI: https://doi.org/10.1016/j.det.2011.11.003
Statistics Norway. Statistics on Educational attainment of the population. 2025. [cited 2025 June 11].
Additional Files
Published
How to Cite
License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.