275 Personal history of rosacea and risk of head and neck squamous cell carcinoma among women in the US

Abstract

Rosacea is a chronic cutaneous inflammatory disease that presents primarily in the central face. Its pathophysiology may be partially explained by a dysregulation in immune response, as well as factors including UV radiation. This study prospectively evaluates the relationship between personal history of rosacea with risks of squamous cell carcinoma (SCC) based on body site using the all-female Nurses’ Health Study II (NHSII) cohort. In the NHSII, participants completed biennial questionnaires that gathered medical history, including clinician-diagnosed rosacea and SCC. Our study was comprised of 90,238 white participants with no skin cancer history at baseline that were followed for 20 years (1991-2011). Cox proportional hazard models were applied to estimate the associations between history of rosacea and SCC risk. Multivariate models were adjusted for age and other skin cancer risk factors. During the follow-up period, 525 SCC cases were documented. Rosacea was associated with an increased SCC risk; relative risks (RR) and 95% confidence intervals were 1.33 (0.94, 1.87). When the SCCs were grouped by head and neck (HN) vs. non head and neck (non-HN) sites, there was a significantly increased risk of HN SCC (n=245; RR= 1.83 [1.15, 2.92]), but no significant associations with non-HN SCC (n=280; RR= 0.97 [0.57, 1.63]). When evaluating HN SCCs further to compare face versus non-face HN SCC, participants with a history of rosacea were at a significantly increased risk of non-face HN SCC; RR was 3.12 (1.30, 7.51). There were no significant associations between history of rosacea and risk of HN SCC of the face; RR was 1.67 (0.96, 2.89). These results suggest that history of rosacea is significantly associated with head and neck SCC, particularly in non-face regions. Inflammation plays a significant role in SCC development. The associations found in this study could be attributed to the inflammatory nature of rosacea. The resulting inflammation may lead to immunologic and neurovascular changes in the region that promote development of SCC.