Primary and secondary prevention of skin cancers

Skin neoplasms are among the more common malignant neoplasms in the human population. Due to the constantly increasing incidence of skin cancers, it is very important to diagnose them early, which at an early stage, especially in the case of malignant melanoma, gives a good therapeutic prognosis. The aim of the study was to draw attention to the need to use prophylaxis as an effective action in the fi eld of popularizing epidemiological knowledge and disseminating pro-health behaviors (primary prophylaxis). Activities enabling early diagnosis of skin cancer using clinical tests, algorithms and modern diagnostic methods such as dermatoscopy, confocal microscopy. and optical coherence tomography (secondary prophylaxis). Primary prophylaxis combined with secondary prophylaxis can reduce the incidence, morbidity and mortality of skin cancer. Control tests among people with an increased risk factor are an important element of the prophylaxis.

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Risk of Subsequent Neoplasms During the Fifth and Sixth Decades of Life in the Childhood Cancer Survivor Study Cohort

Journal of Clinical Oncology ◽

10.1200/jco.2015.60.9487 ◽

2015 ◽

Vol 33 (31) ◽

pp. 3568-3575 ◽

Cited By ~ 39

Author(s):

Lucie M. Turcotte ◽

John A. Whitton ◽

Debra L. Friedman ◽

Sue Hammond ◽

Gregory T. Armstrong ◽

...

Keyword(s):

Childhood Cancer ◽

Cumulative Incidence ◽

Absolute Risk ◽

Multivariable Analysis ◽

Malignant Neoplasms ◽

Study Cohort ◽

Skin Cancers ◽

Increased Risk ◽

Survivors Of Childhood Cancer ◽

Nonmelanoma Skin Cancers

Purpose Survivors of childhood cancer have an increased risk for subsequent neoplasms (SNs), but the incidence beyond the age of 40 years and associations with therapeutic exposures have not been well described. Patients and Methods Among 14,364 survivors of childhood cancer diagnosed between 1970 and 1986, 3,171 had an attained age of 40 years or older at the time of last contact. Cumulative incidence of SNs, standardized incidence ratios (SIRs), excess absolute risk of subsequent malignant neoplasms (SMNs), and relative risks (RRs) for SMNs and nonmelanoma skin cancers were calculated. Results In total, 679 SNs were diagnosed in patients age 40 years or older. These included 196 SMNs, 419 nonmelanoma skin cancers, 21 nonmalignant meningiomas, and 43 other benign neoplasms. At age 55 years, the cumulative incidence of new SNs and SMNs occurring after age 40 years was 34.6% (95% CI, 28.7 to 40.6) and 16.3% (95% CI, 11.7 to 20.9), respectively. Survivors were four times as likely as the general population to receive a diagnosis of SMN after age 40 years (SIR, 4.4; 95% CI 3.8 to 5.0). Among SMNs, risk was most increased for soft tissue sarcoma (SIR, 12.3; 95% CI, 7.2 to 21.0), breast cancer (SIR, 8.3; 95% CI, 6.9 to 10.0), renal cancer (SIR, 6.1; 95% CI, 3.2 to 11.6), and thyroid cancer (SIR, 5.1; 95% CI, 2.8 to 9.4). Female sex (RR, 1.5; 95% CI, 1.1 to 2.1; P = .008), platinum chemotherapy (RR, 3.4; 95% CI, 1.5 to 7.7; P = .003), epipodophyllotoxins (RR, 2.4; 95% CI, 1.0 to 5.8; P = .05), and therapeutic radiation exposure (RR, 2.0; 95% CI, 1.4 to 3.1; P < .001) were associated with higher risk for SMN in multivariable analysis. Conclusion Even after age 40 years, survivors of childhood cancer remain at increased risk for treatment-related SNs. These data suggest the need for life-long monitoring and should inform anticipatory guidance provided to survivors of childhood cancer.

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The consequences of ozone layer depletion on the health of Poles – a case study of skin melanoma

Olsztyn Economic Journal ◽

10.31648/oej.3973 ◽

2019 ◽

Vol 14 (2) ◽

pp. 223-236

Author(s):

Stanisław Wieteska ◽

Małgorzata Jabłońska

Keyword(s):

Skin Cancer ◽

Life Insurance ◽

Statistical Data ◽

Skin Neoplasms ◽

Ozone Layer ◽

Skin Melanoma ◽

Ozone Layer Depletion ◽

Skin Cancers ◽

Raising Awareness

This article presents the results of the observation of cases of skin melanomas in Poland. Dermatologists raise the problem of increased sunlight penetration and the unreasonable use of solar radiation. This causes numerous cases of skin cancer. The aim of the article is to signal the threat posed by the depletion of the ozone layer in Poland. The article uses a research method based on an analysis of statistical data on skin cancers, supported by the available research in this area. Studies show that the incidence of skin cancer in Poland in 2007-2016 nearly doubled. Women are more prone than men to skin neoplasms. The mortality rate due to skin melanoma also increased dramatically. In the article, we point to the need of raising awareness of the hazards, and consider the coverage of treatment costs by life insurance as one of the options to protect the health of insured persons. We also raise the problem of prophylaxis on the basis of sunscreen cosmetic products.

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Development of Two Types of Skin Cancer in a Patient with Systemic Sclerosis: a Case Report and Overview of the Literature

Case Reports in Oncological Medicine ◽

10.1155/2021/6628671 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Firdevs Ulutaş ◽

Erdem Çomut ◽

Veli Çobankara

Keyword(s):

Systemic Sclerosis ◽

Skin Cancer ◽

Cell Carcinoma ◽

Case Reports ◽

Pulmonary Function Tests ◽

Case Series ◽

Skin Neoplasms ◽

Skin Cancers ◽

Nonspecific Interstitial Pneumonia ◽

Diffuse Cutaneous Systemic Sclerosis

Systemic sclerosis (SSc) is an uncommon rheumatic disease in which the underlying main histopathologic feature is a thickening of the skin due to excessive accumulation of collagen in the extracellular tissue. Fibrogenesis, chronic inflammation, and ulceration may eventually promote skin neoplasms. Although nonmelanoma skin cancer (NMSC) is the most frequent type, there have been restricted case reports and case series with skin cancers in SSc patients in the literature. Herein, we describe a 78-year-old woman diagnosed with diffuse cutaneous systemic sclerosis thirteen years ago and associated nonspecific interstitial pneumonia that was successfully treated with high cumulative doses of cyclophosphamide. She developed basal cell carcinoma and squamous cell carcinoma of the skin in the follow-up. She is still on rituximab treatment with stable interstitial lung disease as indicated by pulmonary function tests and high-resolution chest computed tomography. To our knowledge and a literature search, this is the first reported patient with SSc with two types of skin cancer. In this review, we also aimed to emphasize the relationship between SSc and skin cancer, and possible risk factors for SSc-related skin cancer.

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Real-World Use of Therapeutic Anticoagulation in Patients with Paroxysmal Nocturnal Hemoglobinuria. Results of a Survey of Physicians in Australia

Blood ◽

10.1182/blood.v126.23.4537.4537 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4537-4537

Author(s):

Jeffrey Szer ◽

Cecily J Forsyth ◽

Anja Giese

Keyword(s):

Board Of Directors ◽

Paroxysmal Nocturnal Hemoglobinuria ◽

Primary Prophylaxis ◽

Secondary Prophylaxis ◽

Prior History ◽

Advisory Committees ◽

Vein Thrombosis ◽

Therapeutic Anticoagulation ◽

Increased Risk ◽

History Of

Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is a rare and life-threatening hematopoietic stem cell disorder characterized by uncontrolled complement-mediated hemolysis. Patients with PNH are at increased risk of thromboembolism and premature death. This risk is predominantly due to the effects of chronic hemolysis and platelet activation. Eculizumab, a monoclonal antibody that inhibits terminal complement activation, has been shown to reduce hemolysis and dramatically reduce the rate of thromboembolism. A previous publication (Kelly et al, 2011) suggested that cessation of therapeutic anticoagulation (TAC) in PNH patients on eculizumab with no prior history of thrombosis is safe. There are very few reports on the outcomes of cessation of TAC in PNH patients on eculizumab who have a prior history of thrombosis or on the use of non-vitamin K antagonist oral anticoagulant (NOAC) agents in PNH patients with a history of thrombosis. In Australia, patients with PNH are predominantly managed by individual hematologists rather than at a single centre and hence anticoagulation practices following the introduction of eculizumab therapy are variable. We surveyed Australian hematologists managing eculizumab-treated patients with PNH to obtain the details of anticoagulation management and incidence of thrombotic events in their patients. We received responses from 30 hematologists caring for a total of 58 patients with PNH on eculizumab (1-17 patients per hematologist) and the table summarises the results. TAC as primary prophylaxis had been ceased in 10 patients with no recurrent thrombotic events. One (1) patient remains on primary prophylaxis due to persistently high D-dimer and factor VIII levels. TAC for secondary prophylaxis had been ceased in 2 patients due to bleeding (1 patient with subdural hematoma, 1 patient with gastrointestinal bleeding) and neither of these patients had a further thrombotic event. One patient, with a prior history of thrombosis, requested cessation of TAC and subsequently developed a provoked thrombosis. Three patients not receiving TAC when eculizumab was commenced developed thrombosis; two (2) patients had provoked deep venous thromboses and one patient developed a splanchnic vein thrombosis following a cholecystectomy in association with severe sepsis. One patient had a portal vein thrombosis immediately prior to commencing eculizumab therapy but has never received TAC due to severe coexistent thrombocytopenia from myelodysplasia. This patient has not had a recurrent thrombosis. Three (3) patients with thrombotic events prior to eculizumab therapy (1 patient with pulmonary emboli, 1 patient with cerebral venous sinus thrombosis and 1 patient with inferior vena cava thrombosis) had anticoagulant therapy changed from warfarin to rivaroxaban. At a follow-up of at least twelve months for all 3 patients there have been no recurrent thrombotic events and no bleeding complications. In conclusion, these Australian data are consistent with those reported by Kelly suggesting that cessation of primary prophylaxis in PNH patients on eculizumab is safe. Cessation of TAC in PNH patients on eculizumab with a prior thrombosis can be considered if there are clear contraindications to anticoagulation. Thromboprophylaxis in situations of increased risk of venous thromboembolism remains essential for all PNH patients not on TAC, even when they are on eculizumab therapy. The three patients on rivaroxaban as secondary prophylaxis are, to our knowledge, the first reported patients with PNH treated on a NOAC. Table. Number of patients New thrombotic events Eculizumab treated 58 Ceased TAC: Total1. As 1o prophylaxis2. As 2o prophylaxis(i) Due to bleeding(ii) At patient request 1410431 -None-None1 (provoked) TE in patients not on TAC at commencement of eculizumab 3 3 (provoked) NOAC as 2o prophylaxis 3 None Disclosures Szer: Alexion: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Alexion: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Alexion Australia: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Shire: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Shire: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Forsyth:Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Giese:Alexion: Employment.

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Non-Melanoma Skin Cancer in People Living With HIV: From Epidemiology to Clinical Management

Frontiers in Oncology ◽

10.3389/fonc.2021.689789 ◽

2021 ◽

Vol 11 ◽

Author(s):

Emmanuele Venanzi Rullo ◽

Maria Grazia Maimone ◽

Francesco Fiorica ◽

Manuela Ceccarelli ◽

Claudio Guarneri ◽

...

Keyword(s):

Skin Cancer ◽

Early Stage ◽

Treatment Options ◽

Case Series ◽

Surgical Excision ◽

People Living With Hiv ◽

Skin Cancers ◽

Ablative Techniques ◽

Living With Hiv ◽

Melanoma Skin

Skin cancers represent the most common human tumors with a worldwide increasing incidence. They can be divided into melanoma and non-melanoma skin cancers (NMSCs). NMSCs include mainly squamous cell (SCC) and basal cell carcinoma (BCC) with the latest representing the 80% of the diagnosed NMSCs. The pathogenesis of NMSCs is clearly multifactorial. A growing body of literature underlies a crucial correlation between skin cancer, chronic inflammation and immunodeficiency. Intensity and duration of immunodeficiency plays an important role. In immunocompromised patients the incidence of more malignant forms or the development of multiple tumors seems to be higher than among immunocompetent patients. With regards to people living with HIV (PLWH), since the advent of combined antiretroviral therapy (cART), the incidence of non-AIDS-defining cancers (NADCs), such as NMSCs, have been increasing and now these neoplasms represent a leading cause of illness in this particular population. PLWH with NMSCs tend to be younger, to have a higher risk of local recurrence and to have an overall poorer outcome. NMSCs show an indolent clinical course if diagnosed and treated in an early stage. BCC rarely metastasizes, while SCC presents a 4% annual incidence of metastasis. Nevertheless, metastatic forms lead to poor patient outcome. NMSCs are often treated with full thickness treatments (surgical excision, Mohs micro-graphic surgery and radiotherapy) or superficial ablative techniques (such as cryotherapy, electrodesiccation and curettage). Advances in genetic landscape understanding of NMSCs have favored the establishment of novel therapeutic strategies. Concerning the therapeutic evaluation of PLWH, it’s mandatory to evaluate the risk of interactions between cART and other treatments, particularly antiblastic chemotherapy, targeted therapy and immunotherapy. Development of further treatment options for NMSCs in PLWH seems needed. We reviewed the literature after searching for clinical trials, case series, clinical cases and available databases in Embase and Pubmed. We review the incidence of NMSCs among PLWH, focusing our attention on any differences in clinicopathological features of BCC and SCC between PLWH and HIV negative persons, as well as on any differences in efficacy and safety of treatments and response to immunomodulators and finally on any differences in rates of metastatic disease and outcomes.

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A 10-Year Prospective Study of Patients with Skin Cancer

Journal of Cutaneous Medicine and Surgery ◽

10.1177/120347540200600503 ◽

2002 ◽

Vol 6 (5) ◽

pp. 427-429 ◽

Cited By ~ 6

Author(s):

D. Czarnecki ◽

Tina Sutton ◽

C. Czarnecki ◽

G. Culjak

Keyword(s):

Skin Cancer ◽

Prospective Study ◽

Nonmelanoma Skin Cancer ◽

Main Risk Factor ◽

Skin Cancers ◽

Increased Risk ◽

Male Sex ◽

A Prospective Study ◽

Logistical Regression Analysis ◽

New Skin

Background and Objective: To determine the incidence of new skin cancer formation in people who have had a nonmelanoma skin cancer (NMSC) removed. Methods: A prospective study of Australian outpatients with histologically confirmed nonmelanoma skin cancer (NMSC). Results: Four hundred eighty-one patients were entered in the study and 300 were followed for at least 10 years. Another skin cancer developed in 67.8% and multiple skin cancers (three or more) in 51.8%. A logistical regression analysis found that the main risk factors for new skin cancer formation were male sex and if the patient had multiple skin cancers. A squamous cell carcinoma (SCC) developed in 36% during the study and a melanoma in 4.7% of men and 2.1% of women. Men who had a NMSC were 8 times more likely than the general population to develop a melanoma while women with NMSC were 4 times more likely. Three patients died of metastatic SCC and one of metastatic melanoma during the followup period. A multivariate analysis showed that multiple skin cancer formation was the main risk factor for SCC or melanoma formation. Conclusion: Patients with NMSC require careful followup as they have an increased risk of new cancer formation. Those with multiple skin cancer merit particularly careful followup as all develop another NMSC within 10 years and have a significantly increased risk of developing SCC or melanoma.

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Substantiation of the value of dermatoscopy methods for medical examinations in patients working with carcinogens

Russian Journal of Occupational Health and Industrial Ecology ◽

10.31089/1026-9428-2020-60-11-760-762 ◽

2020 ◽

Vol 60 (11) ◽

pp. 760-762

Author(s):

A. V. Derevnina ◽

S. A. Avagyan

Keyword(s):

Work Experience ◽

Digital Camera ◽

Skin Neoplasms ◽

Diagnostic Methods ◽

Skin Tumor ◽

Professional Activity ◽

Malignant Neoplasms ◽

Epithelial Neoplasms ◽

Special Assessment ◽

Medical Examinations

Introduction. Industrial carcinogens are one of the causes leading to malignancy of epithelial neoplasms of the skin. The aim of study to assess the importance of conducting dermatoscopic research methods during periodic medical examinations of workers with industrial carcinogens. Materials and methods. 108 employees of the enterprise of Moscow were examined at periodic medical examinations of KPO FSBSI Izmerov Research Institute of Occupational Health. According to the special assessment of working conditions for harmful factors and types of work, a contingent of 60 people who had contact with industrial carcinogens and 48 people who did not have contact with industrial factors was identified. A complex of clinical-anamnestic and diagnostic methods was performed. Clinical research-interview of the patient, study of the patient's medical history, complaints, heredity, Constitution, professional activity, skin type and harmful effects; duration of existence and dynamics of changes in the size of the neoplasm. Visual examination of the patient's skin under natural and side lighting using a magnifying glass with 7x magnification. Physical examination of the primary skin tumor: the shape, color, size, and boundaries of the neoplasm were preliminarily evaluated. Epiluminescent surface microscopy (dermatoscopy) of each suspected pigmented neoplasm was performed using a Heine Delta 20 Dermatoscope (Heine Optotechnik, Germany). During dermatoscopy, in order to make the surface layers of the skin more transparent, oil was applied to the surface of the neoplasm. Digital photos during dermatoscopy were taken using a Nikon D 3100 18-55 II Kit digital camera, which was connected to the Dermatoscope by a Nikon UR-E15 adapter ring. Industrial carcinogens are one of the causes leading to malignancy of epithelial neoplasms of the skin. Results. According to the results of the study in a group of patients, it was found that workers who had contact with industrial carcinogens, epithelial skin neoplasms were much more common and more common at a young age (from 18 to 39 years), compared with patients who did not have contact with carcinogens at work. It was also revealed that epithelial neoplasms of the skin are most often diagnosed with longer work experience. It is noted that in patients who have contact with industrial carcinogens, even with work experience of up to 10 years, epithelial skin neoplasms are more often detected. Conclusions. There are good reasons to believe that exposure to industrial carcinogenic factors significantly increases the risk of developing skin neoplasms. The use of dermatoscopic diagnostic methods will allow timely detection of benign skin neoplasms in persons who have contact with industrial carcinogens during preventive medical examinations and thereby reduce the risk of malignant neoplasms.

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Inflammatory Bowel Disease Risk Variants Are Associated with an Increased Risk of Skin Cancer

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab336 ◽

2022 ◽

Author(s):

Kelly C Cushing ◽

Xiaomeng Du ◽

Yanhua Chen ◽

L C Stetson ◽

Annapurna Kuppa ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Skin Cancer ◽

Bowel Disease ◽

Validation Cohort ◽

Effect Modification ◽

Discovery Cohort ◽

Risk Variants ◽

Skin Cancers ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background Inflammatory bowel disease is associated with an increased risk of skin cancer. The aims of this study were to determine whether IBD susceptibility variants are also associated with skin cancer susceptibility and if such risk is augmented by use of immune-suppressive therapy. Methods The discovery cohort included participants in the UK Biobank. The validation cohort included participants in the Michigan Genomics Initiative. The primary outcome of interest was skin cancer, subgrouped into nonmelanoma skin cancers (NMSC) and melanoma skin cancers (MSC). Multivariable logistic regression with matched controls (3 controls:1 case) was performed to identify genomic predictors of skin malignancy in the discovery cohort. Variants with P < .05 were tested for replication in the validation cohort. Validated Single nucleotide polymorphisms were then evaluated for effect modification by immune-suppressive medications. Results The discovery cohort included 10,247 cases of NMSC and 1883 cases of MSC. The validation cohort included 7334 cases of NMSC and 3304 cases of MSC. Twenty-nine variants were associated with risk of NMSC in the discovery cohort, of which 5 replicated in the validation cohort (increased risk, rs7773324-A [DUSP22; IRF4], rs2476601-G [PTPN22], rs1847472-C [BACH2], rs72810983-A [CPEB4]; decreased risk, rs6088765-G [PROCR; MMP24]). Twelve variants were associated with risk of MSC in the discovery cohort, of which 4 were replicated in the validation cohort (increased risk, rs61839660-T [IL2RA]; decreased risk, rs17391694-C [GIPC2; MGC27382], rs6088765-G [PROCR; MMP24], and rs1728785-C [ZFP90]). No effect modification was observed. Conclusions The results of this study highlight shared genetic susceptibility across IBD and skin cancer, with increased risk of NMSC in those who carry risk variants in IRF4, PTPN22, CPEB4, and BACH2 and increased risk of MSC in those who carry a risk variant in IL2RA.

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

Blood ◽

10.1182/blood-2020-138961 ◽

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.

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

Blood ◽

10.1182/blood.v128.22.4359.4359 ◽

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.

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