1. No distinction being made among types of basal-cell carcinoma:

Almost always, BCC is treated generically in texts that link it to UVR, including the superficial and fibroepitheliomatous types that occur on covered parts, but the actual type under discussion by nearly all authors is the noduloulcerative. What follows are but two examples of that:

"Cases were patients . . . who had histologically confirmed BCC." (Corona, 2001) [25]

"All lesions diagnosed during these examinations were excised and histologically confirmed by a single experienced dermatopathologist, though BCC subtypes were not routinely recorded . . . Grouping BCCs for analysis, irrespective of their anatomic site, may have masked important etiologic factors." (Neale, 2007) [29]

2. Speculations and suppositions predominating over hard evidence:

Despite declarations ex cathedra by various authors, hardly ever is any evidence offered on behalf of the contention that UVR is the major culprit in bringing BCC into being. Those who aver that sunlight is the single most important cause of BCC predicate that claim on speculations and suppositions punctuated by hedges and dodges, such as words and phrases such as "suggests," "implies," "is thought to," "may be," and "probably," but they present no solid evidence to support their argument. Examples are as follows:

"In our study, some association was documented with recreational sun exposure, but no clear evidence of exposure-effect relationship was found." (Naldi, 2000) [12]

"That UV radiation per se causes these cancers is mainly an indirect inference." (Armstrong, 2001) [1]

"The definite association with recreational sun exposure . . . suggests that . . . peculiar exposure to UV radiation are key independent risk factors for the development of BCC." (Corona, 2001) [25]

"Ultraviolet radiation is the major etiologic agent in the pathogenesis of BCC, but there is not a straightforward relationship between cumulative exposure and risk." (Neale, 2007) [29]

3. Contradictions abounding, even in the same article:

Urbach distanced himself from his own assertion that exposure to solar UV is the chief cause of nonmelanoma skin cancer in these words: "Effect of solar UVR is confounded by a host of variables such as: ability to tan, age, complexion . . . most of which are the result of genetic background." [23]

Armstrong et al. contradict their own conclusion by writing thus: "Only SCC is strongly related to estimated total sun exposure . . . there is little evidence for such a relationship with BCC . . .. It is not possible, on present evidence to draw any conclusion regarding the relative contributions of UVB and UVA to the production of human BCC." [1]

4. Faulty gathering of information:

Many of the studies reported on rely on questionnaires, [1,25,30] usually ones completed by persons who are elderly and no longer at the peak of their prowess intellectually. That kind of information often is unreliable, the answers being skewed by biases, as well as by being dependent on how the question was posed, to say nothing of how accurate was the memory of the responder.

Armstrong et al. acknowledged the subjectivity of the method by which they gathered data in lines such as these: " . . . none of the associations illustrated in Table 4 are very strong, possibly because of the difficulty people have in recalling past sun exposure accurately and a lack of specificity of measurements for the site of the skin cancer in most studies." [1]

Corona et al. wrote directly of the limitations of their study in sentences such as these: "The presence of potential biases . . . should be kept in mind when considering these results . . . Recall bias may arise in any study in which the subjects are asked to recall events that occurred many years before, with a potential for exposure misclassification." [25]

Hunter et al. admitted of limitations in the collection of their data by saying this: "Exposure data are self-reported . . . in one recent report the correlation was poor." [30]

5. Flawed synthesizing as a consequence of inadequate information:

Ramani et al. [21]:

"We reviewed the records of all . . . .who were referred to one of us . . . for Mohs micrographic surgery of BCC, SCC, or melanoma." (Fig. 1)

No information was provided regarding the method of diagnosis by which the cancer was identified or about the findings histopathologic themselves.

Curiously, the authors found statistical significance between SCC and sun exposure to be less than that between BCC and sun exposure.

Other known factors etiologic not mentioned by the authors are X-irradiation and arsenic that could, conceivably, have been operative in the development of BCC in veterans.

Hunter et al. [30]:

Because the authors were unable to resolve the paradox, they invoked the notion of "persons at high risk of skin cancer adopt 'preventive' behaviors," but they made no effort to justify that assertion unproven.

6. Misleading misquotations:

Several students of the subject under consideration here [31-33] quote the work of Unna [34] as proof of a link between UVR and development of BCC. This is what Unna wrote: "Carcinoma of the sailor's skin . . . this dermatosis [sailor's skin] is of great importance in the genesis of cancer of the skin . . . it presents a form of carcinoma as the last stage of a series of cancer-like, but innocent growths [presumably solar keratoses]." Almost certainly, in this context, Unna was referring to SCC, not to BCC.