Peripheral inflammation ratios mirror high-risk anatomic sites in basal cell carcinoma: a matched case–control study

Background Basal cell carcinoma (BCC) is the most common form of skin cancer, with increasing incidence worldwide. Although anatomical site-based risk stratification is commonly used in clinical practice, the potential role of systemic inflammatory markers in predicting tumor behavior remains unclear.Objective To compare the systemic inflammatory markers between patients with BCC and healthy controls, and to assess their association with histopathological subtypes and anatomical risk groups.Methods This retrospective analytical study included 55 patients with histopathologically confirmed BCC and 55 age- and sex-matched healthy controls. Hematological parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), were calculated from complete blood counts. Subgroup analyses were performed based on BCC subtype and anatomical risk classification. Receiver operating characteristic (ROC) analysis and logistic regression were used to evaluate predictive performance.Results Hemoglobin levels were significantly lower in BCC patients than controls (p = 0.048), but inflammatory indices did not differ between groups. Among BCC subtypes, only hemoglobin varied significantly, with higher levels in the superficial subtype. NLR and SIRI were significantly elevated in patients with high-risk tumors compared to those with low/moderate-risk lesions (p = 0.024 and p = 0.046, respectively). ROC analysis showed modest discriminatory power for NLR (AUC = 0.689) and SIRI (AUC = 0.667), but neither marker was a significant predictor of high-risk status in multivariate logistic regression.Conclusion NLR and SIRI were found to be associated with high-risk tumor localization in BCC, indicating their potential utility as supportive tools in preoperative risk assessment.