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Nonmelanoma Skin Cancers and Infection With the Human Immunodeficiency Virus

Nonmelanoma Skin Cancers and Infection With the Human Immunodeficiency Virus Abstract • Background and Design.— Forty-eight human immunodeficiency virus-infected patients with nonmelanoma skin cancers seen during a four-year period were evaluated in a retrospective, case-control study. Patients were followed up after therapy and recurrence rates were determined. Results.— One hundred and sixteen nonmelanoma skin cancers were identified, 101 of which were basal cell carcinomas (87%), mostly superficial multicentric (67%) of the trunk (62%). There were 15 low-grade squamous cell carcinomas, most commonly of the head and neck. Half of the patients had multiple cancers. Compared with age-matched controls, the patients with skin cancer more commonly had blue/hazel eyes (89% vs 66%; odds ratio [OR] 4.1; confidence interval [CI], 1.25 to 13.44; P =.033), blond hair (42% vs 13%; OR = 4.53; CI, 1.40 to 13.74, P =.003), a family history of skin cancer (45% vs 5%; OR = 11.88; CI, 2.85 to 49.57; P =.00), and a history of regular sunbathing (92% vs 48%; OR = 11.24; CI, 3.17 to 39.83; P =.00). The number of cancers or the presence of squamous cell carcinoma did not correlate with the degree of immunosuppression. The recurrence rate for basal cell carcinomas following standard treatment methods (mostly curettage and electrodesiccation and excision) was 5.4% for those tumors followed up for longer than 12 months. Three of the 15 squamous cell carcinomas recurred, all following curettage and electrodesiccation. Conclusion.— Nonmelanoma skin cancers are a not uncommon cutaneous finding in human immunodeficiency virus-infected patients. The major risk factors for developing skin cancer in association with human immunodeficiency virus disease seem to be the same as in the normal population—fair skin, a positive family history, and sun exposure. Standard treatment methods seem to be associated with acceptable cure rates, except for squamous cell carcinomas, which had a high (20%) recurrence rate following curettage and electrodesiccation.(Arch Dermatol. 1992;128:623-627) References 1. Slazinski L, Stall JR, Mathews CR. Basal cell carcinoma in a man with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1984;11:140-141.Crossref 2. Sitz KV, Keppen M, Johnson DF. Metastatic basal cell carcinoma in acquired immunodeficiency syndrome-related complex . JAMA . 1987;257:340-343.Crossref 3. Hruza GJ, Snow SN. Basal cell carcinoma in a patient with acquired immunodeficiency syndrome: treatment with Moh's micrographic surgery fixed-tissue technique . J Dermatol Surg Oncol. 1989;15:545-551.Crossref 4. Overly WL, Jakubek DJ. Multiple squamous cell carcinomas and human immunodeficiency virus infection . Ann Intern Med. 1987;106:334.Crossref 5. Frazer IH, Medley G, Crapper RM, Brown TC. Association between anorectal dysplasia, human papillomavirus, and human immunodeficiency virus infection in homosexual men . Lancet. 1986;2:657-660.Crossref 6. Milburn PB, Brandsma JL, Goldsman CI, Teplitz ED, Heilman EI. Disseminated warts and evolving squamous cell carcinoma in a patient with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1988;19:401-405.Crossref 7. Lever WF, Schaumburg-Lever G. Tumors and cysts of the epidermis: squamous cell carcinoma . Histopathology of the Skin . 7th ed. Philadelphia, Pa: JB Lippincott Co; 1990:552-560. 8. Centers for Disease Control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome . MMWR . 1987;36( (suppl 1) ):3S = 15S. 9. Lutzner MA, Blanchet-Bardon C, Orth G. Clinical observations, virologic studies, and treatment trials in patients with epidermodysplasia verruciformis: a disease induced by specific human papillomaviruses . J Invest Dermatol. 1984;83( (suppl) ):18s-25s.Crossref 10. Barr BBB, Benton EC, McLaren K, et al. Human papillomavirus infection and skin cancer in renal allograft recipients . Lancet . 1989;1:124-128.Crossref 11. Yiannias JA, Goldberg LH, Carter-Campbell S, Reddick M, Chamberlain RM. The ratio of basal cell carcinoma to squamous cell carcinoma in Houston, Texas . J Dermatol Surg Oncol. 1988;14:886-889.Crossref 12. Pfister H, Fuchs PG. Papillomaviruses: particles, genome organisation and proteins . In: Syrjanen K, Gissmann L, Koss LG, eds. Papillomaviruses and Human Disease . New York, NY: Springer-Verlag NY Inc; 1987:1-18. 13. Mikhail GR, Nims LP, Kelly AP, Ditmars DM Jr, Eyler WR. Metastatic basal cell carcinoma . Arch Dermatol. 1977;113:1261-1269.Crossref 14. Dublin N, Kopf AW. Multivariate risk score for recurrence of cutaneous basal cell carcinomas . Arch Dermatol. 1983;119:373-377.Crossref 15. Salasche SJ. Curettage and electrodesiccation in the treatment of midfacial basal cell epithelioma . J Am Acad Dermatol. 1983;8:496-504.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Nonmelanoma Skin Cancers and Infection With the Human Immunodeficiency Virus

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1992.01680150053003
Publisher site
See Article on Publisher Site

Abstract

Abstract • Background and Design.— Forty-eight human immunodeficiency virus-infected patients with nonmelanoma skin cancers seen during a four-year period were evaluated in a retrospective, case-control study. Patients were followed up after therapy and recurrence rates were determined. Results.— One hundred and sixteen nonmelanoma skin cancers were identified, 101 of which were basal cell carcinomas (87%), mostly superficial multicentric (67%) of the trunk (62%). There were 15 low-grade squamous cell carcinomas, most commonly of the head and neck. Half of the patients had multiple cancers. Compared with age-matched controls, the patients with skin cancer more commonly had blue/hazel eyes (89% vs 66%; odds ratio [OR] 4.1; confidence interval [CI], 1.25 to 13.44; P =.033), blond hair (42% vs 13%; OR = 4.53; CI, 1.40 to 13.74, P =.003), a family history of skin cancer (45% vs 5%; OR = 11.88; CI, 2.85 to 49.57; P =.00), and a history of regular sunbathing (92% vs 48%; OR = 11.24; CI, 3.17 to 39.83; P =.00). The number of cancers or the presence of squamous cell carcinoma did not correlate with the degree of immunosuppression. The recurrence rate for basal cell carcinomas following standard treatment methods (mostly curettage and electrodesiccation and excision) was 5.4% for those tumors followed up for longer than 12 months. Three of the 15 squamous cell carcinomas recurred, all following curettage and electrodesiccation. Conclusion.— Nonmelanoma skin cancers are a not uncommon cutaneous finding in human immunodeficiency virus-infected patients. The major risk factors for developing skin cancer in association with human immunodeficiency virus disease seem to be the same as in the normal population—fair skin, a positive family history, and sun exposure. Standard treatment methods seem to be associated with acceptable cure rates, except for squamous cell carcinomas, which had a high (20%) recurrence rate following curettage and electrodesiccation.(Arch Dermatol. 1992;128:623-627) References 1. Slazinski L, Stall JR, Mathews CR. Basal cell carcinoma in a man with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1984;11:140-141.Crossref 2. Sitz KV, Keppen M, Johnson DF. Metastatic basal cell carcinoma in acquired immunodeficiency syndrome-related complex . JAMA . 1987;257:340-343.Crossref 3. Hruza GJ, Snow SN. Basal cell carcinoma in a patient with acquired immunodeficiency syndrome: treatment with Moh's micrographic surgery fixed-tissue technique . J Dermatol Surg Oncol. 1989;15:545-551.Crossref 4. Overly WL, Jakubek DJ. Multiple squamous cell carcinomas and human immunodeficiency virus infection . Ann Intern Med. 1987;106:334.Crossref 5. Frazer IH, Medley G, Crapper RM, Brown TC. Association between anorectal dysplasia, human papillomavirus, and human immunodeficiency virus infection in homosexual men . Lancet. 1986;2:657-660.Crossref 6. Milburn PB, Brandsma JL, Goldsman CI, Teplitz ED, Heilman EI. Disseminated warts and evolving squamous cell carcinoma in a patient with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1988;19:401-405.Crossref 7. Lever WF, Schaumburg-Lever G. Tumors and cysts of the epidermis: squamous cell carcinoma . Histopathology of the Skin . 7th ed. Philadelphia, Pa: JB Lippincott Co; 1990:552-560. 8. Centers for Disease Control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome . MMWR . 1987;36( (suppl 1) ):3S = 15S. 9. Lutzner MA, Blanchet-Bardon C, Orth G. Clinical observations, virologic studies, and treatment trials in patients with epidermodysplasia verruciformis: a disease induced by specific human papillomaviruses . J Invest Dermatol. 1984;83( (suppl) ):18s-25s.Crossref 10. Barr BBB, Benton EC, McLaren K, et al. Human papillomavirus infection and skin cancer in renal allograft recipients . Lancet . 1989;1:124-128.Crossref 11. Yiannias JA, Goldberg LH, Carter-Campbell S, Reddick M, Chamberlain RM. The ratio of basal cell carcinoma to squamous cell carcinoma in Houston, Texas . J Dermatol Surg Oncol. 1988;14:886-889.Crossref 12. Pfister H, Fuchs PG. Papillomaviruses: particles, genome organisation and proteins . In: Syrjanen K, Gissmann L, Koss LG, eds. Papillomaviruses and Human Disease . New York, NY: Springer-Verlag NY Inc; 1987:1-18. 13. Mikhail GR, Nims LP, Kelly AP, Ditmars DM Jr, Eyler WR. Metastatic basal cell carcinoma . Arch Dermatol. 1977;113:1261-1269.Crossref 14. Dublin N, Kopf AW. Multivariate risk score for recurrence of cutaneous basal cell carcinomas . Arch Dermatol. 1983;119:373-377.Crossref 15. Salasche SJ. Curettage and electrodesiccation in the treatment of midfacial basal cell epithelioma . J Am Acad Dermatol. 1983;8:496-504.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: May 1, 1992

References

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