Subsequent Basal Cell Carcinoma Research Articles

Subsequent Squamous- and Basal-Cell Carcinomas in Kidney-Transplant Recipients After the First Skin Cancer: Cumulative Incidence and Risk Factors

The risk of skin cancer is highly increased in kidney-transplant recipients (KTR), but the risk of subsequent skin cancers is less well studied. The aim of this study was to estimate the cumulative incidence of subsequent squamous- and basal-cell carcinomas (BCCs) and to analyze potential risk factors. All histologically confirmed skin cancers between 1966 and 2006 were included in the study and counted. Cumulative incidences of subsequent squamous- and BCCs were calculated using Kaplan-Meier survival analyses. For the analyses of risk factors, we used Cox proportional hazard analyses. A total of 239 (13%) of 1906 KTR developed skin cancer of whom 222 were diagnosed in our hospital. Altogether 167 (75%) of these 222 patients developed multiple skin cancers. The cumulative incidence of a second skin cancer increased from 32%, 1 year, to 59%, 3 years, and 72%, 5 years after the first skin cancer. KTR who started with squamous-cell carcinoma (SCC) mainly developed SCC and recipients who started with BCC mainly developed BCC as second skin cancer. Immunosuppression with azathioprine in combination with prednisone was associated with a significantly increased risk of subsequent SCCs but not with subsequent BCCs. Skin cancer multiplicity is common in KTR. Patients with a first skin cancer are at increased risk for more skin cancers and need to be carefully checked for subsequent skin cancers.

Association of Prediagnostic Serum Vitamin D Levels with the Development of Basal Cell Carcinoma

We investigated the association between serum 25-hydroxyvitamin D (25(OH)D) levels and basal cell carcinoma (BCC) risk in a nested case-control study at Kaiser Permanente Northern California (KPNC). A total of 220 case patients with BCC diagnosed after serum collection were matched to 220 control subjects. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression. Fully adjusted models included body mass index (BMI), smoking, education, sun-exposure variables, X-ray exposure, and personal history of cancer. For each measure of serum 25(OH)D (continuous, clinically relevant tertiles, quintiles), we found an increased risk of BCC in unadjusted models (OR=1.03, 95% CI 1.00-1.05, P<0.05; OR=3.98, 95% CI: 1.31-12.31, deficient vs. sufficient, test for trend P-value <0.01; OR=2.32, 95% CI: 1.20-4.50, 1st vs. 5th quintile, test for trend P-value 0.03). In fully adjusted models, the values attenuated slightly (OR=1.02, 95% CI 1.00-1.05, P<0.05; OR=3.61, 95% CI: 1.00-13.10, deficient vs. sufficient, t-trend P=0.03; OR=2.09 1st vs. 5th quintile, 95% CI: 0.95-4.58, t-trend P=0.11). Our findings suggest that higher prediagnostic serum 25(OH)D levels may be associated with increased risk of subsequent BCC. Further studies to evaluate the effect of sun exposure on BCC and serum 25(OH)D levels may be warranted.

C-C4-01: Statin Use and Risk of Basal Cell Carcinoma

Maryam M Asgari, MD, MPH, Jean Tang, MD, PhD, Ervin Epstein, MD, Mary-Margaret Chren, MD, Margaret Warton, MPH, Charles P Quesenberry Jr, PhD, Alan S Go, MD and Gary D Friedman, MD, MS Maryam M Asgari, MD, MPH, Kaiser Permanente Northern California; Jean Tang, MD, PhD, Kaiser Permanente Northern California; Ervin Epstein, MD, Kaiser Permanente Northern California; Mary-Margaret Chren, MD, Kaiser Permanente Northern California; Margaret Warton, MPH, Kaiser Permanente Northern California; Charles P Quesenberry Jr, PhD, Kaiser Permanente Northern California; Alan S Go, MD, Kaiser Permanente Northern California; Gary D Friedman, MD, MS, Kaiser Permanente Northern California

Patients with both basal and squamous cell carcinomas are at a lower risk of further basal cell carcinomas than patients with only a basal cell carcinoma

The rate of development of further basal cell carcinoma (BCC) after first presentation is highly variable. The mechanisms that determine this phenotypic difference are unclear. We assessed the risks of developing a subsequent BCC in patients who developed a BCC and a squamous cell carcinoma (SCC) and compared them with patients who developed a BCC only. In all, 1040 patients who developed BCC only were compared with 140 patients who developed BCC and SCC to see whether the latter group included a high proportion of risk phenotypes (eg, male sex and fair skin). We then compared the number of BCCs developing per year in the two groups (174 BCC only and 71 BCC/SCC) during a 5-year period after initial BCC presentation. The BCC/SCC group demonstrated a significantly lower BCC/year rate than BCC only group. The rate of development of further BCC during 5-year follow-up was lower in the BCC/SCC group because a smaller number of patients developed subsequent BCC and not because the same proportion of patients developed lesions but in smaller numbers. After 5 years of follow-up, 51.1% of BCC and 74.6% of BCC/SCC cases were free from a subsequent BCC. Logistic regression analysis corrected for age at initial presentation confirmed that patients with BCC/SCC were less likely to develop a further BCC during the 5 years after initial presentation (P = .001, odds ratio = 0.31, 95% confidence interval 0.15-0.63). Because of the large patient group and long study follow-up from the date of the index BCC or SCC, not all data were obtained. Where this is the case, the number of patients for whom the information is available is provided. Patients who develop a BCC are similar to patients who develop both a BCC and SCC, confirming the overlap of causative factors. Patients who develop both a BCC and SCC are less likely to develop BCCs compared with patients who develop BCC only.

Statin use and risk of basal cell carcinoma

We examined the association between statin use and basal cell carcinoma (BCC) risk. We identified all members of a large integrated health care delivery system with a diagnosis of a histologically proven BCC in 1997. Subsequent BCCs were identified through 2006 from health plan electronic pathology records. Longitudinal exposure to statins and other lipid-lowering agents was determined from automated pharmacy records. We used extended Cox regression to examine the independent association between receipt of statin therapy (ever vs never, cumulative duration) and risk of subsequent BCC. To minimize confounding by indication, we conducted sensitivity analyses in the subset of individuals considered eligible for lipid-lowering therapy based on national guidelines. Among 12,123 members given a diagnosis of BCC who had no prior statin exposure, 6381 developed a subsequent BCC during follow-up. Neither "ever use of statins" (adjusted hazard ratio 1.02, 95% confidence interval: 0.92-1.12) or cumulative duration of statin (adjusted hazard ratio 1.02/year, 95% confidence interval: 0.99-1.11) was associated with subsequent BCC after adjustment for age, sex, and health care use. Risk estimates did not change appreciably when the analysis was limited to the subset of individuals who met eligibility criteria for initiating statin therapy. There was also no significant association between use of non-statin antilipemics and subsequent BCC (adjusted hazard ratio 1.10, 95% confidence interval: 0.76-1.58). No information was available for BCC risk factors, such as sun sensitivity and sun exposure. Among a large cohort of individuals with BCC, statin therapy was not significantly associated with risk of subsequent BCC.

Earlier Detection of Patients' Second Primary Basal Cell Carcinomas: A Quantitative Analysis

Basal cell carcinoma (BCC) is the most common occurring cancer in humans. No studies to date have compared the size of a patient's first and second primary BCC to determine whether we are detecting and treating second primary cancers at earlier stages of development. The objective was to ascertain whether patients who have had a primary BCC are diagnosed and treated for subsequent BCC at an earlier clinical stage of development. We performed a 4-year retrospective chart review of all patients presenting for Mohs micrographic surgery for two separate primary BCC. We compared the presenting clinical size of patients' first and second primary BCC. We found a statistically significant decrease in size of the second primary BCC when compared to the first primary BCC (p<.0001). The mean difference was 116.6 mm2 and the median difference was 28.3 mm2. Our results provide important quantitative data illustrating our effectiveness in detecting subsequent BCC at an earlier stage of development. Earlier detection of skin cancers can decrease the morbidity and chance of recurrence as well as lead to smaller scars and better cosmetic outcomes and may also allow for various treatment modalities and cost containment.

Prognostic factors for a subsequent basal cell carcinoma: implications for follow-up

Prognostic factors for a subsequent basal cell carcinoma: implications for follow-up

Prognostic factors for a subsequent basal cell carcinoma: implications for follow-up

Prognostic factors for a subsequent basal cell carcinoma: implications for follow-up

Repeated Occurrence of Basal Cell Carcinoma of the Skin and Multifailure Survival Analysis: Follow-up Data from the Nambour Skin Cancer Prevention Trial

The aim of this study was to apply multifailure survival methods to analyze time to multiple occurrences of basal cell carcinoma (BCC). Data from 4.5 years of follow-up in a randomized controlled trial, the Nambour Skin Cancer Prevention Trial (1992-1996), to evaluate skin cancer prevention were used to assess the influence of sunscreen application on the time to first BCC and the time to subsequent BCCs. Three different approaches of time to ordered multiple events were applied and compared: the Andersen-Gill, Wei-Lin-Weissfeld, and Prentice-Williams-Peterson models. Robust variance estimation approaches were used for all multifailure survival models. Sunscreen treatment was not associated with time to first occurrence of a BCC (hazard ratio = 1.04, 95% confidence interval: 0.79, 1.45). Time to subsequent BCC tumors using the Andersen-Gill model resulted in a lower estimated hazard among the daily sunscreen application group, although statistical significance was not reached (hazard ratio = 0.82, 95% confidence interval: 0.59, 1.15). Similarly, both the Wei-Lin-Weissfeld marginal-hazards and the Prentice-Williams-Peterson gap-time models revealed trends toward a lower risk of subsequent BCC tumors among the sunscreen intervention group. These results demonstrate the importance of conducting multiple-event analysis for recurring events, as risk factors for a single event may differ from those where repeated events are considered.

Basal cell carcinoma follow-up practices by dermatologists: a national survey.

After treatment of a basal cell carcinoma (BCC) patients are at risk of recurrence of that BCC; also, patients who have had a primary BCC are those who have an increased risk of developing a subsequent primary BCC. However, long-term hospital-based follow-up of all patients would put large strains on the U.K. health service. To investigate the follow-up intentions of U.K. dermatologists for well-defined facial BCC and to investigate the effect that variations in site and clinical indicators might have on those intentions. A self-completion questionnaire relating to BCC follow-up sent to 388 dermatology consultants and associate specialists in the U.K. had a response rate of 68%. The effects of treatment modality, tumour site, histology, multiple lesions and various patient variables that might alter the likelihood of follow-up were examined. General views on the subject of BCC follow-up were sought. Twenty-seven per cent of respondents reported that they would not review further after excision of a 'well-defined' BCC from inside a central 'T' area on the face; 37% reported that they would review on one occasion; and 36% reported that they review more than once. While it is currently not feasible to follow-up all treated BCCs, a strategy to identify and monitor high-risk patients and a system to gather long-term outcome data prospectively are necessary aspects of a national health service. This study illustrates that the first issue is being addressed to some extent, but at the currently reported level of BCC follow-up in the U.K. there is little scope for collecting comprehensive long-term data on outcomes.

Cutaneous basal cell carcinomas: distinct host factors are associated with the development of tumors on the trunk and on the head and neck.

Patients with basal cell carcinoma (BCC) demonstrate marked variation in clinical phenotype, suggesting the presence of distinct subgroups. Patients with truncal lesions comprise an interesting subgroup, because, although the pathogenesis of these tumors is unclear, there is evidence to suggest that their development is mediated by different mechanisms than the mechanisms that mediate the development of BCC on other sites. The authors now speculate that some patients inherit a predisposition to truncal BCC and develop disproportionately more BCC on this site than other patients. The authors studied 100 patients who, at the time of initial presentation, had a truncal BCC lesion and 493 patients who had a lesion on the head and neck. The 493 patients with head and neck lesions included 36 patients who subsequently developed a truncal BCC and 457 patients who do not. Initial presentation with a truncal tumor was associated with significantly more subsequent BCC lesions on this site compared with patients who presented initially with a head and neck lesion. The mean truncal tumor accrual after initial presentation in patients who presented with an initial truncal BCC lesion was 0.13 BCC lesions per year compared with 0.03 BCC lesions per year in patients who presented with an initial head and neck lesion (P < 0.001). Patients with truncal lesions were significantly younger at the time of initial presentation and developed more clusters of BCC lesions (2--10 new tumors at any presentation) compared with patients who did not develop tumors on the trunk. These data suggest that the development of a truncal BCC is not random but, rather, is associated with a predisposition. In contrast, the accrual of nontruncal BCC lesions was similar in patients with and without initial truncal lesions, suggesting that different mechanisms determine the development of truncal BCC and nontruncal BCC.

Risk of Developing a Subsequent Nonmelanoma Skin Cancer in Patients With a History of Nonmelanoma Skin Cancer

To assess the risk of developing a basal cell carcinoma (BCC), and/or a squamous cell carcinoma (SCC), and/or Bowen disease (SCC in situ) after a nonmelanoma skin cancer (NMSC) of a specific type. Four electronic databases were searched from January 1, 1966, to October 21, 1999. We included all studies published in English, identified by standard search strategies, that provided original data quantifying the risk of an NMSC among persons with a previous NMSC. For each study and separate histological type of index skin tumor and subsequent skin tumor (SCC, BCC, NMSC, or Bowen disease), we determined the 3-year cumulative risk and the incidence rate of second tumors per 100 000 person-years. In cases where more than 1 study was assessing the risk of one specific tumor type after another, we undertook a formal meta-analysis. We compared the incidence of a subsequent SCC after an index SCC and of a subsequent BCC after an index BCC with the incidence of the first occurrence of such tumors in the comparable general population. We identified and reviewed 17 studies that included data for 26 tumor combinations. Overall, the 3-year cumulative risk of a subsequent SCC after an index SCC is 18%, at least a 10-fold increase in incidence compared with the incidence of first tumors in a comparable general population. For BCCs, the 3-year cumulative risk is 44%, also at least a 10-fold increase in incidence compared with the rate in a comparable general population. The risk of developing a BCC in patients with a prior SCC is about equal to that risk among persons with a prior BCC, but the risk of developing an SCC in patients with a prior BCC is low (6%). Although these studies vary in their study type, location, and biases, their results are consistent. The risk of developing a subsequent skin cancer of a specific type depends on the type of prior NMSC and number of prior skin tumors of that type. Based on these findings, follow-up strategies for patients with BCC and SCC are suggested.

Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer

Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer

Risk of Subsequent Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin Among Patients With Prior Skin Cancer

<h3>Objective.</h3> —The primary aims of this study were to assess risk of subsequent basal and squamous cell skin cancer among patients with a prior history of these tumors and to examine these risks in relation to patient characteristics and life-style factors. <h3>Design.</h3> —Follow-up of participants in a randomized trial of betacarotene as a possible skin cancer preventive agent. <h3>Setting.</h3> —Clinical centers in Los Angeles, Calif, San Francisco, Calif, Minneapolis, Minn, and Hanover, NH. <h3>Participants.</h3> —Patients (n=1805) who were diagnosed as having a basal or squamous cell skin cancer between January 1980 and February 1986 and were free of skin cancer at study entry. <h3>Main Outcome Measure.</h3> —Time from study entry to first new occurrence of basal and squamous cell skin cancer. <h3>Results.</h3> —The estimated risk of developing one or more new skin cancers was 35% at 3 years and 50% at 5 years. New skin cancers tended to be of the same cell type as the previous skin cancers. For both basal and squamous cell skin cancer, risk was higher among patients who were male, were over the age of 60 years, had more prior skin cancers, had severe actinic skin damage, or who burned easily with sun exposure. Compared with those who had never smoked, the rate of subsequent squamous cell skin cancer was higher among current smokers (rate ratio, 2.01; 95% confidence interval,1.21 to 3.34) and former smokers (rate ratio,1.62; 95% confidence interval, 1.07 to 2.47) and increased with both duration and amount smoked. There was no clear relationship between smoking and basal cell skin cancer; the rate appeared lower among heavy smokers but was unrelated to duration of smoking. <h3>Conclusions.</h3> —Persons with a prior nonmelanoma skin cancer had a substantial 5-year risk of developing another tumor of the same histologic type. Number of previous skin cancers, solar damage, and skin sensitivity to sun exposure were particularly related to this risk. The increased risk of squamous cell skin cancer associated with cigarette smoking merits further study. (<i>JAMA</i>. 1992;267:3305-3310)

Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer. Skin Cancer Prevention Study Group

The primary aims of this study were to assess risk of subsequent basal and squamous cell skin cancer among patients with a prior history of these tumors and to examine these risks in relation to patient characteristics and life-style factors. Follow-up of participants in a randomized trial of betacarotene as a possible skin cancer preventive agent. Clinical centers in Los Angeles, Calif, San Francisco, Calif, Minneapolis, Minn, and Hanover, NH. Patients (n = 1805) who were diagnosed as having a basal or squamous cell skin cancer between January 1980 and February 1986 and were free of skin cancer at study entry. Time from study entry to first new occurrence of basal and squamous cell skin cancer. The estimated risk of developing one or more new skin cancers was 35% at 3 years and 50% at 5 years. New skin cancers tended to be of the same cell type as the previous skin cancers. For both basal and squamous cell skin cancer, risk was higher among patients who were male, were over the age of 60 years, had more prior skin cancers, had severe actinic skin damage, or who burned easily with sun exposure. Compared with those who had never smoked, the rate of subsequent squamous cell skin cancer was higher among current smokers (rate ratio, 2.01; 95% confidence interval, 1.21 to 3.34) and former smokers (rate ratio, 1.62; 95% confidence interval, 1.07 to 2.47) and increased with both duration and amount smoked. There was no clear relationship between smoking and basal cell skin cancer; the rate appeared lower among heavy smokers but was unrelated to duration of smoking. Persons with a prior nonmelanoma skin cancer had a substantial 5-year risk of developing another tumor of the same histologic type. Number of previous skin cancers, solar damage, and skin sensitivity to sun exposure were particularly related to this risk. The increased risk of squamous cell skin cancer associated with cigarette smoking merits further study.

Basal cell carcinoma: A population-based incidence study in Rochester, Minnesota

Population-based annual incidence rates for histologically proved basal cell carcinoma were derived from the records linkage system of the Rochester Epidemiology Program Project. Residents of Rochester, Minnesota, during the years 1976 to 1984, formed the observational cohort. A total of 657 first episodes of basal cell carcinoma were observed. Annual incidence rates per 100,000 persons in the Rochester population, standardized to the 1980 U.S. white population, were 175 for men, 124 for women, and 146 combined. Recurrent or subsequent basal cell carcinoma was observed among 30% of patients during an average of 4.5 years of follow-up; no metastatic lesions occurred. The rates of recurrence were similar after complete excision or treatment with curettage and cauterization in these observational data.