Increased risk of non-melanoma skin cancer with subsequent keratinocytes carcinoma

1. The risk for another non-melanoma skin cancer (NMSC) was significantly higher after a non-first NMSC diagnosis compared to the risk for another NMSC after a first-time NMSC diagnosis.

Evidence Rating Level: 2 (Good)

Study Rundown: NMSC – basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) – place tremendous burden on the US healthcare system, as more than 3.5 million tumors are treated annually. It is well understood that patients with NMSC are at increased risk for the development of subsequent new NMSCs; however few studies have compared cumulative risk after first-time vs. after multiple previous NMSCs diagnosis, which prompted this investigation. Authors found a greater magnitude of risk for subsequent tumor development after the diagnosis of multiple NMSCs, than after a first-time diagnosis (at 1 year the risk was 43.9% vs. 14.5%, respectively). While the prospective study design and large cohort strengthened the study, the demographic was restricted to a single city thereby limiting the generalizability of the findings.

Click to read the study in JAMA Dermatology

Relevant Reading: How Likely Is Another Nonmelanoma Skin Cancer?

In-Depth [prospective cohort]: This study consisted of 1284 patients who had been diagnosed with 1633 primary BCCs or SCCs at enrollment. The mean age was 67, 71.5% of the cohort was male, tumors were most commonly on the head and neck (62.2%), and most patients presented with a single NMSC. Patients were followed for a mean of 5.7 years. After first time diagnosis of NMSC, the risk of subsequent NMSC was 31.1% (95% CI, 27.3%-35.3%) at 3 years and 40.7% (95% CI, 36.5%-45.2%) at 5 years as compared to the risk after a non-first NMSC: 71.1% (95% CI, 69.1%-73.0%) at 3 years and 82.0% (95% CI, 80.2%-83.7%) at 5 years. To demonstrate the magnitude of the difference in risk between cohorts: after first life-time NMSC, the risk of developing a subsequent tumor at 10 years was 59.6% which was comparable to the risk of developing subsequent tumor within 2 years after the diagnosis of non-first lifetime NMSC (61.5%).

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Image: PD

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