scholarly journals Association of Advanced Leukemic Stage and Skin Cancer Tumor Stage With Poor Skin Cancer Outcomes in Patients With Chronic Lymphocytic Leukemia

2014 ◽  
Vol 150 (3) ◽  
pp. 280 ◽  
Author(s):  
Nicole F. Velez ◽  
Pritesh S. Karia ◽  
Alexander R. Vartanov ◽  
Matthew S. Davids ◽  
Jennifer R. Brown ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Tumor Stage ◽  
Lymphocytic Leukemia ◽  
Cancer Outcomes ◽  
Cancer Tumor

Prior Treatment with Chemotherapy Is Associated with Poor Outcomes of High Risk Skin Cancers in Patients with Chronic Lymphocytic Leukemia

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3920-3920
Author(s):  
Matthew S. Davids ◽  
Nicole F. Velez ◽  
Pritesh Karia ◽  
Ye Guo ◽  
Alexander R. Vartanov ◽  
...  
Keyword(s):  
High Risk ◽  
Skin Cancer ◽  
Local Recurrence ◽  
General Population ◽  
Head And Neck ◽  
Lymphocytic Leukemia ◽  
Nodal Metastases ◽  
Cancer Outcomes ◽  
Risk Of Death ◽  
Skin Cancers

Abstract Abstract 3920 The increased incidence of skin cancer in patients with chronic lymphocytic leukemia (CLL) has been well-documented; however, the outcomes for CLL patients with high risk skin cancers are not as well-characterized. Moreover, little is known about the association between outcomes of high risk skin cancers and CLL prognostic factors or exposure to prior chemotherapy. We identified 225 patients at our institutions over the last 20 years with concurrent CLL and skin cancer, and we retrospectively examined outcomes for the 139/225 (61.8%) who had high risk skin cancer as defined by a diagnosis of squamous cell carcinoma (SCC), melanoma, or Merkel cell carcinoma (MCC). Poor skin cancer outcome (defined by local recurrence, nodal metastasis, and disease specific death) was determined by review of patient medical records and verified by pathology reports. Associations between various risk factors and poor skin cancer outcomes were evaluated via chi-square statistics (STATA 12.0 College Station, TX). The study group included a representative CLL population, with 98/139 (70%) males and a median age at diagnosis of 65 years (range 35–84), with a median follow-up of 120 months (range 2–410). Over the course of the study, 76 CLL patients remained alive (55%), 16 patients died due to CLL (12%), and 42 patients died from other causes (30%), including 18 (13%) from skin cancer. Median age at time of skin cancer diagnosis was 72 years (range 44–98), and median follow-up time after skin cancer diagnosis was 41 months (range 2–182). Skin cancer diagnoses included SCC in 122 patients (81%), melanoma in 22 patients (13%), and MCC in 8 patients (6%). Sixty-three (45%) patients had more than one skin cancer diagnosed. In the 122 patients with SCC, there were a total of 353 tumors, 297 of which occurred in males (84%). Half of the SCCs were in the head and neck (n=175, 49.6%). Fifty-four SCCs (15%) were greater than 2 cm in diameter. Rates of nodal metastases and death due to SCC were 12% and 6%, respectively. In the 22 patients with melanoma, 14 occurred in men (63.6%), with the largest number of tumors again located on the head and neck (n=8, 36.4%). Breslow thickness was greater than 1 mm in 12 patients (54.5%). Local recurrence and nodal metastases each occurred in 5 patients (22.7%). The five patients (22.7%) who died due to melanoma were the same patients with nodal metastases. In the 8 patients with MCC, 5 patients (62.5%) were male, and there was no location predominance. Five tumors (62.5%) were greater than 2 cm at time of diagnosis, local recurrence occurred in 1 patient (12.5%), and 5 patients (62.5%) had nodal metastases, with 4 of these 5 dying from MCC. Interestingly, prior treatment with any CLL chemotherapy was significantly associated with poorer skin cancer outcome, with increased rates of local recurrence, metastatic disease, or death due to skin cancer (p=0.001). We also explored whether high risk CLL prognostic factors were associated with poorer skin cancer outcomes. Eleven out of 18 patients tested (61%) had unmutated IGHV, 9/69 patients tested (13%) had del(17p) or del(11q) cytogenetics, and 71 patients did not have prognostic marker data available. In this limited prognostic marker data set, neither unmutated IGHV, poor risk cytogenetics, nor advanced Rai stage was associated with skin-cancer specific outcomes. Overall, the majority of the skin cancers in our cohort occurred in males, and the most common site of disease was the head and neck, highlighting an area in need of especially close surveillance. Relative to the historical experience of high-risk skin cancer patients in the general population, we found skin cancers in our CLL population to be more aggressive. For example, 2 of the skin-cancer related deaths were in CLL patients with stage I melanoma, which is unusual in the general population. Additionally, rates of nodal metastases and death in our SCC group were 12% and 6%, respectively, compared to rates of 4% and 2% in most studies of SCC in the general population. Strikingly, the risk of death from skin cancer was equivalent to the risk of death from CLL. The poor skin cancer outcomes in patients in our study were driven by the group who had received prior chemotherapy. Outcomes were not influenced by high risk CLL prognostic markers, although this latter analysis was limited by incomplete data. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Skin Cancer Surveillance and Malignancies of the Skin in a Community-Dwelling Cohort of Patients With Newly Diagnosed Chronic Lymphocytic Leukemia

2014 ◽  
Vol 10 (1) ◽  
pp. e1-e4 ◽  
Author(s):  
Aaron S. Mansfield ◽  
Kari G. Rabe ◽  
Susan L. Slager ◽  
Susan M. Schwager ◽  
Timothy G. Call ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Community Dwelling ◽  
Lymphocytic Leukemia ◽  
Cancer Surveillance ◽  
Newly Diagnosed ◽  
Skin Malignancy

The authors documented a low compliance with guidelines to screen for skin malignancy in a community-dwelling cohort of patients with newly diagnosed chronic lymphocytic leukemia.

scholarly journals Risk Factors for the Development of Skin Cancers in Patients with Chronic Lymphocytic Leukemia: A Retrospective Cohort Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 15-16
Author(s):  
Ivan Landego ◽  
Shirley Li ◽  
Chao Xue ◽  
Vincent Poon ◽  
Robert C. Clayden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skin Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Cell Carcinoma ◽  
Lower Incidence ◽  
Research Funding ◽  
Lymphocytic Leukemia ◽  
Skin Cancers ◽  
Increased Risk

Introduction: Individuals with chronic lymphocytic leukemia (CLL) are often immunosuppressed and at increased risk of infection and secondary malignancies. The primary aim of this study was to determine the incidence of skin cancer amongst the CLL population at Kingston Health Sciences Centre (KHSC), Ontario, Canada. Secondly, we sought to identify the risk factors associated with the development of skin cancer in CLL patients. Methods: Consecutive patients seen at KHSC with a diagnosis of CLL between 2014 January 1 and 2019 December 31 formed the primary study cohort. KHSC serves a region of ~ 550,000 including a high proportion of older individuals and those living in rural areas. Approval was provided by Queen's University Research Ethics Board. Four independent reviewers conducted retrospective electronic chart review, initially in duplicate with review of any areas of discrepancy to ensure a standardized approach. Data collected included age, sex, CLL date of diagnosis, stage, genetics and treatment; histological diagnoses of other cancers (skin and other), smoking status (ever/never) and date of last follow up or death. The primary outcome was the development of the first skin cancer (squamous cell carcinoma, basal cell carcinoma, melanoma, or sarcoma) confirmed via pathology reports that are available in our local institution. All statistical analysis was performed using SAS Enterprise v. 7.15. Categorical variables were compared using chi-square or Fisher exact tests, medians using Wilcoxon and Mann-Whitney tests, and continuous variables using t-tests. Risk factors for development of skin cancer were assessed using multivarable Cox-proportional hazard models. Results: Of the total cohort of 377 individuals with CLL, 251 (67%) were male. Median age at diagnosis of CLL was 65 years (range 36 - 93 years of age). Median follow-up from the time of CLL diagnosis was 6.5 years (range 0.27 - 30.98). Of these, 80 individuals (21.2%) developed at least one skin cancer after their diagnosis of CLL, with an age-adjusted incidence of 16.96/1000 patient years (95% CI 12.5 - 23). Among the 297 who did not develop skin cancer post-CLL diagnosis, 13 individuals who had documented skin cancer pre-CLL diagnosis only, are included in the non-skin cancer group (Figure 1). Females had a lower incidence of skin cancer compared with males (63 males versus 17 females, p=0.009). There was no difference between the groups based on Rai stage at diagnosis, smoking history, or IGHV /p53 status. Individuals treated with ibrutinib had a lower incidence of skin cancer (3 versus 49, p=0.002). Development of skin cancer was associated with development of other invasive tumours including CLL transformation (p=0.001) (Table 1). Conclusion: Limitations of this study include its small size, and single institution setting. Our data likely reflect a conservative estimate as skin cancers may be diagnosed outside of the institution, and not all CLL is treated at tertiary care centres. Consistent with other studies we found that males with CLL are at increased risk of developing skin cancer, as compared to females. Individuals with CLL and skin cancer were more likely to develop another malignancy or Richter's transformation. The finding of lower incidence of skin cancer with ibrutinib treatment is novel; further investigation in larger populations is needed to determine if it may offer a protective effect. Disclosures Asai: Sanofi Canada: Honoraria, Research Funding; AllerGen NCE: Research Funding; Pfizer: Honoraria, Research Funding; Janssen: Honoraria; Leo Pharma: Honoraria; Eli Lilly: Honoraria; Novartis: Honoraria; Abbvie: Honoraria, Research Funding; Canadian Institutes of Health Research: Research Funding. Hay:Roche: Research Funding; Janssen: Research Funding.

scholarly journals Incidence and Implications of Skin Cancers in Cancercare Manitoba Chronic Lymphocytic Leukemia (CLL) Clinic Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4359-4359
Author(s):  
Sara Beiggi ◽  
Mohammad Pannu ◽  
Versha Banerji ◽  
Dhali H.S. Dhaliwal ◽  
Spencer B. Gibson ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Conflicts Of Interest ◽  
Lymphocytic Leukemia ◽  
P Value ◽  
Close Monitoring ◽  
Mutational Status ◽  
Skin Cancers ◽  
Increased Risk

Abstract Background:We previously conducted a population-based study on chronic lymphocytic leukemia (CLL) in Manitoba, which showed that second cancers are twice as common and skin cancers eight times as common in this disease, as compared to an age- and sex-matched control population and patients with follicular lymphoma. It is postulated that this is related to immunosuppression, secondary to the disease and chemo-immunotherapy. Here we set out to investigate rates and types of skin cancers in CLL patients and how these influence the outcome of CLL patients. Methods: Newly diagnosed CLL patients attending the CancerCare Manitoba CLL Clinic from the January 1st, 2002 until December 31st, 2012 were selected for this study. Patients were followed until December 31, 2014. Cox Proportional Hazard models were constructed to predict hazard's ratios (HR) and 95% confidence intervals (95% CI) for survival as well as risk of non-cutaneous malignancies. Association between skin cancer and CLL prognostic markers were investigated by Fisher's Exact test, Student's t-test and logistic regression analysis. P-value <0.05 was considered statistically significant. Statistical analysis was performed using SAS Studio 3.5. Results: There were 582 CLL patients in this study. The median age was 67 years (range 36-99 years) with a M:F ratio of 1.6:1. This compares with a median age of 71.5 years and a M:F ratio of 1.3:1 in the Manitoba CLL population. The median follow-up for the study was 5.8 years (range 0.1-13.0 years). There were 131 (23%) CLL patients with at least one skin cancer; 73 (56%) had their first skin cancer before the diagnosis of CLL and 58 (44%) after. Rates of first skin cancer diagnoses were constant before CLL diagnosis (5.2 per 1000 CLL cases), but began to increase three years prior to the CLL diagnosis (10.2 per 1000 CLL cases) and continued to increase after the CLL diagnosis (22.7 per 1000 CLL cases). There were a total of 368 skin cancers; 208 (57%) were basal cell carcinomas (BCC), 92 (25%) were squamous cell carcinomas (SCC), 47 (13%) were Bowen's disease, 18 (5%) were melanomas, and three (1%) were Merkel cell carcinomas. Interestingly, multiple skin cancers with varying histologies occurred in almost half the patients. When the total number of skin cancers/year was assessed, the number started to increase seven years before the CLL diagnosis and continued to increase yearly after the CLL diagnosis. Within the follow-up period, 154 (27%) patients died, with the major causes of death being CLL and second malignancies. However, the presence of skin cancers did not appear to influence survival. There were a total of three deaths due to skin cancers; two patients died of melanoma and one from BCC. However, the presence of a skin cancer, in CLL cases without a history of a solid tumor, increased the risk of a non-cutaneous malignancy by seven-fold (HR 7.55, 05% CI 3.92 - 14.53, p<0.0001). The presence of a skin cancer prior to the diagnosis of CLL did not predict CLL aggressiveness at diagnosis, as evaluated by Rai stage, Zap-70 or CD38 status, immunoglobulin levels or IGHV mutational status. However, for those patients developing their first skin cancer after the CLL diagnosis, the risk of developing a skin cancer correlated with the unmutated IGHV status (HR 1.54, 95% CI 1.01 - 2.34, p=0.0462) and baseline CD38 positivity (HR 1.58, 95% CI 1.02 - 2.44, p=0.0405). Interestingly, the risk of developing skin cancer was not increased by chemotherapy. Discussion: In summary, with a median follow-up of 5.8 years, 23% of patients had a skin cancer, half before the diagnosis of CLL and half after the CLL diagnosis. The incidence of skin cancers increased prior to the diagnosis of CLL, indicating that immunosuppression possibly preceded the diagnosis of CLL by years. The increased risk of developing skin cancers in patients with unmutated IGHV and CD38 positivity indicates that CLL patients with a more aggressive disease are more likely to develop skin cancer, probably due to a more pronounced immune deficiency. The diagnosis of skin cancer in CLL patients was associated with a seven-fold increased risk of developing a solid tumour. These results underscore the need for close monitoring and active surveillance of CLL patients for skin and other cancers throughout their disease course, by clinicians experienced in skin and other malignancies. Disclosures No relevant conflicts of interest to declare.

Risk factors for skin cancer and solid tumors in newly diagnosed patients with chronic lymphocytic leukemia and the impact of skin surveillance on survival

2019 ◽  
Vol 60 (13) ◽  
pp. 3204-3213 ◽  
Author(s):  
Ganchimeg Ishdorj ◽  
Sara Beiggi ◽  
Zoann Nugent ◽  
Erin Streu ◽  
Versha Banerji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skin Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Solid Tumors ◽  
Lymphocytic Leukemia ◽  
Newly Diagnosed ◽  
The Impact

scholarly journals Prior history of non-melanoma skin cancer is associated with increased mortality in patients with chronic lymphocytic leukemia

Haematologica ◽  
2009 ◽  
Vol 94 (10) ◽  
pp. 1460-1464 ◽  
Author(s):  
J. R. Toro ◽  
P. W. Blake ◽  
M. Bjorkholm ◽  
S. Y. Kristinsson ◽  
Z. Wang ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Prior History ◽  
Non Melanoma Skin Cancer ◽  
History Of ◽  
Melanoma Skin

Increased incidence of non-melanomatous skin cancer in patients with chronic lymphocytic leukemia, an 11-year case-control study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19554-19554
Author(s):  
M. W. Schoen ◽  
P. S. Gable ◽  
A. M. Reese
Keyword(s):  
Skin Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Basal Cell ◽  
Squamous Cell Carcinomas ◽  
Lymphocytic Leukemia ◽  
Skin Cancers ◽  
Increased Risk ◽  
Malignant Lesions

19554 Background: Chronic Lymphocytic Leukemia (CLL) is a disease of B lymphocytes that affects immune tolerance and surveillance. Patients with CLL have an increased risk of basal and squamous cell skin carcinomas, which tend to be aggressive. We report the incidence of non-melanomatous (NM) in a >80% Caucasian cohort of patients with CLL and compared them to normal controls who reside in Southern California. Methods: A retrospective review was conducted of all patients in the Naval Medical Center San Diego tumor registry with CLL diagnosed between Jan 1, 1995 and Dec 31, 2005. The electronic records of 74 CLL patients and 100 control patients from the internal medicine clinic were assessed for skin biopsies performed at our institution revealing NM skin malignancies. Results: Within our CLL population, the average age at diagnosis was 72.2 years. 34% (25/74) had NM skin cancer with an incidence of 11,457 NM skin cancers per 100,000 person-years. The average number of malignant lesions was 3.7 per patient with one patient receiving 17 biopsies. 27% (7/25) of CLL patients with NM skin cancer had only squamous cell carcinoma and 23% (6/25) had only basal cell carcinoma. 42% (11/25) of patients had both squamous and basal cell cancers and one had a Merkel cell carcinoma. In the control population, the average age at diagnosis was 76.4 years. 16% (16/100) had NM skin malignancies with an incidence of 5,333 NM skin cancers per 100,000 person-years. The average number of malignant lesions was 3.7 per patient with one patient receiving 28 biopsies. 63% (10/16) had basal cell carcinomas, only 25% (4/16) had squamous cell carcinomas and 13% (2/16) had both types of cancer. Conclusions: Patients with CLL are at increased risk of developing NM skin cancers, especially squamous cell carcinomas. Patients with CLL have a 2.1 times higher risk of developing NM skin cancer than our control population, who had an incredibly high rate of skin cancer compared to prior publications. CLL patients should be closely screened for cutaneous malignancies in order to excise them before they cause further morbidity. Increased surveillance is especially prudent for elderly patients with fair skin types who have been exposed to a large amount of UV-light. No significant financial relationships to disclose.

Invasive Metastatic Skin Cancer in the Background of Chronic Lymphocytic Leukemia

2007 ◽  
Vol 86 (2) ◽  
pp. 84-85
Author(s):  
Sofia Avitia ◽  
Jason S. Hamilton ◽  
Ryan F. Osborne
Keyword(s):  
Skin Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia
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