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Some patients with keratinocyte carcinoma may have lower risk for subsequent tumors
A subset of patients who develop keratinocyte carcinoma may not be at risk for subsequent tumors, study results suggest.
Mary-Margaret Chren, MD, of the department of dermatology at the University of California, San Francisco, and colleagues evaluated data on 1,426 patients with biopsy-proven keratinocyte carcinomas, which include basal cell carcinoma and cutaneous squamous cell carcinoma.
Mary-Margaret Chren
All patients were treated at a university dermatology practice and affiliated Department of Veterans Affairs dermatology service from Jan. 1, 1999, through Dec. 31, 2000.
Researchers excluded patients with basal cell nevus syndrome, as well as those who were immunocompromised. The remaining 1,284 patients were followed prospectively for a mean 5.7 years (range, 0-12.3).
Chren and colleagues used single-failure and multiple-failure models to evaluate risks for subsequent keratinocyte carcinomas over time.
They assessed outcomes after patients experienced first lifetime keratinocyte carcinomas, as well as outcomes of those who experienced second or subsequent keratinocyte carcinomas.
The risk for subsequent keratinocyte carcinomas increased with time. However, the risk was significantly lower for those with one lifetime diagnosis compared with those who had second or subsequent diagnoses. The reduced risk was observed at 1 year (14.5% vs. 43.9%), 3 years (31.1% vs. 71.1%) and 5 years (40.7% vs. 82%).
In secondary analyses, researchers assessed risks for subsequent basal cell carcinoma among those with a prior diagnosis. They also evaluated risk for subsequent squamous cell carcinoma risk among those with a prior diagnosis. Results were consistent with the analyses of the entire cohort, researchers wrote.
“Although all patients with keratinocyte carcinoma are assumed to be at high risk for subsequent tumors, a subset may not develop another keratinocyte carcinoma,” Chren and colleagues wrote. “Whether these findings are related to biological or behavioral differences or to differences in health care services should be investigated further to inform and improve care.”
The ability to identify patients which patients with a history of nonmelanoma skin cancer who are at the greatest risk for subsequent diagnoses — specifically those likely to lead to substantial morbidity — would allow for more efficient screening and counseling strategies, Peggy A. Wu, MD, MPH, and Robert S. Stern, MD, both of the department of dermatology at Beth Israel Deaconess Medical Center and Harvard Medical School, wrote in an accompanying editorial.
“Further studies are needed to more precisely define the risk, site, and type of subsequent tumors in relation to the location and characteristics of the index tumor, sun exposure history, and age, sex, phenotype and other characteristics of the patient,” Wu and Stern wrote. “Armed with this information, we can provide rational and efficient follow-up care for those with a history of nonmelanoma skin cancer.”
Disclosure: Chren reports a consultant role with Genentech. The other researchers report no relevant financial disclosures. Wu and Stern report no relevant financial disclosures.