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Patients Who Have Multiple Skin Cancers Develop New Skin Cancers at a Constant Rate

Patients Who Have Multiple Skin Cancers Develop New Skin Cancers at a Constant Rate Research in North America and Australia has shown that people with a history of multiple nonmelanoma skin cancers (NMSCs) are at a higher risk of developing new NMSCs than the general population. In North America, it was found that up to 50% of patients with NMSC developed a new NMSC within 5 years.1 The percentage was higher in Australia, where 2 prospective studies found that 50% of women and 70% of men develop new NMSCs within 5 years.2,3 The main risk factors for new skin cancer formation were the number of skin cancers removed and male sex.1-3 In Australia, it was found that all patients who had 3 or more skin cancers (multiple skin cancers) developed another skin cancer within 6 years; however, it was uncertain whether the rate of development of new skin cancers decreased over time. We report the rate of new NMSC formation in high-risk patients who were followed up for 10 years. Patients, Methods, and Results The materials and methods have been described elsewhere.4 In brief, during a 1-year period (1988-1989), all new patients with NMSC seen by one of us (D.C.) were enrolled in the study. Patients were reviewed regularly and new skin cancers were removed. All skin cancers were histologically verified. Of 481 patients entered in the study, 361 were followed up for 10 years, and 166 of them had multiple NMSCs. The number of new NMSCs removed in the first 3 years of review (years 1-3) and in the last 3 years (years 8-10) were recorded. All NMSCs found at the site of a previously removed skin cancer were deemed to be recurrences and were not included in the study. In the first 3 years of follow-up, men had an average of 5.2 new NMSCs (range, 1-12) and women had an average of 3.5 (range, 1-12). In the last 3 years of follow-up, men had an average of 5.3 new NMSCs (range, 2-12) and women had an average of 3.6 (range, 2-10). These differences between the sexes were not statistically significant (P = .70). Comment The study found that patients at high risk of forming new skin cancers continued to develop new tumors at a constant rate, even after 10 years of review. The patients had changed their lifestyles after their NMSCs were removed and were better about protecting their skin from sun damage. They used sunscreen regularly and wore clothes that reduced exposure to sun. However, these changes did not influence the development of new NMSCs. This suggests that in this group, once enough exposure of UV light has occurred to cause a skin cancer, irrevocable damage of enough magnitude is done to ensure a constant rate of new skin cancer formation despite subsequent improvement in skin protection. One possible reason for the poor prognosis of patients with multiple skin cancers is that there is evidence that they have weaker immune systems than the normal population. Patients with multiple NMSCs have weaker cell-mediated immunity and lower lymphocyte counts than do normal controls or patients with fewer skin cancers.4,5 There was a correlation between the number of skin cancers removed and the weakness of cell-mediated immunity as measured by cutaneous reactions to recall antigens. There was also a correlation between the number of skin cancers removed and the reduction in lymphocyte counts and CD4/CD8 ratios. Women were found to have a significantly higher CD4/CD8 ratio than men, which could be one reason why women have a better prognosis than men. The results of this study indicate that careful review of patients with multiple skin cancers is needed because they all develop new cancer formation. They also underscore the need to prevent skin damage from occurring in the first place by reducing the amount of UV light that reaches the skin. Once a skin cancer develops, the patient could be in a group that develops multiple tumors, which means a lifetime of new skin cancers. There is as yet no means of predicting which patients will fall into this group. References 1. Karagas MRStukel TAGreenberg ERBaron JAMott LAStern RS Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer: Skin Cancer Prevention Study Group. JAMA. 1992;2673305- 3310Google ScholarCrossref 2. English DRKricker AHeenan PJRandell PLWinter MGArmstrong BK Incidence of non-melanocytic skin cancer in Geraldton, Western Australia. Int J Cancer. 1997;73629- 633Google ScholarCrossref 3. Czarnecki DMar AStaples MGiles GMeehan C The development of nonmelanocytic skin cancers in people with a history of skin cancer. Dermatology. 1994;189364- 367Google ScholarCrossref 4. Czarnecki DZalcberg JKuliskaya E Impaired cell-mediated immunity of apparently normal patients who have had multiple skin cancers. Cancer. 1995;76228- 231Google ScholarCrossref 5. Czarnecki DMeehan CMcColl IKulinskaya E Lymphocyte counts of patients who have had skin cancer. J Am Acad Dermatol. 1996;34772- 776Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Patients Who Have Multiple Skin Cancers Develop New Skin Cancers at a Constant Rate

Archives of Dermatology , Volume 138 (1) – Jan 1, 2002

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Publisher
American Medical Association
Copyright
Copyright © 2002 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.138.1.125
Publisher site
See Article on Publisher Site

Abstract

Research in North America and Australia has shown that people with a history of multiple nonmelanoma skin cancers (NMSCs) are at a higher risk of developing new NMSCs than the general population. In North America, it was found that up to 50% of patients with NMSC developed a new NMSC within 5 years.1 The percentage was higher in Australia, where 2 prospective studies found that 50% of women and 70% of men develop new NMSCs within 5 years.2,3 The main risk factors for new skin cancer formation were the number of skin cancers removed and male sex.1-3 In Australia, it was found that all patients who had 3 or more skin cancers (multiple skin cancers) developed another skin cancer within 6 years; however, it was uncertain whether the rate of development of new skin cancers decreased over time. We report the rate of new NMSC formation in high-risk patients who were followed up for 10 years. Patients, Methods, and Results The materials and methods have been described elsewhere.4 In brief, during a 1-year period (1988-1989), all new patients with NMSC seen by one of us (D.C.) were enrolled in the study. Patients were reviewed regularly and new skin cancers were removed. All skin cancers were histologically verified. Of 481 patients entered in the study, 361 were followed up for 10 years, and 166 of them had multiple NMSCs. The number of new NMSCs removed in the first 3 years of review (years 1-3) and in the last 3 years (years 8-10) were recorded. All NMSCs found at the site of a previously removed skin cancer were deemed to be recurrences and were not included in the study. In the first 3 years of follow-up, men had an average of 5.2 new NMSCs (range, 1-12) and women had an average of 3.5 (range, 1-12). In the last 3 years of follow-up, men had an average of 5.3 new NMSCs (range, 2-12) and women had an average of 3.6 (range, 2-10). These differences between the sexes were not statistically significant (P = .70). Comment The study found that patients at high risk of forming new skin cancers continued to develop new tumors at a constant rate, even after 10 years of review. The patients had changed their lifestyles after their NMSCs were removed and were better about protecting their skin from sun damage. They used sunscreen regularly and wore clothes that reduced exposure to sun. However, these changes did not influence the development of new NMSCs. This suggests that in this group, once enough exposure of UV light has occurred to cause a skin cancer, irrevocable damage of enough magnitude is done to ensure a constant rate of new skin cancer formation despite subsequent improvement in skin protection. One possible reason for the poor prognosis of patients with multiple skin cancers is that there is evidence that they have weaker immune systems than the normal population. Patients with multiple NMSCs have weaker cell-mediated immunity and lower lymphocyte counts than do normal controls or patients with fewer skin cancers.4,5 There was a correlation between the number of skin cancers removed and the weakness of cell-mediated immunity as measured by cutaneous reactions to recall antigens. There was also a correlation between the number of skin cancers removed and the reduction in lymphocyte counts and CD4/CD8 ratios. Women were found to have a significantly higher CD4/CD8 ratio than men, which could be one reason why women have a better prognosis than men. The results of this study indicate that careful review of patients with multiple skin cancers is needed because they all develop new cancer formation. They also underscore the need to prevent skin damage from occurring in the first place by reducing the amount of UV light that reaches the skin. Once a skin cancer develops, the patient could be in a group that develops multiple tumors, which means a lifetime of new skin cancers. There is as yet no means of predicting which patients will fall into this group. References 1. Karagas MRStukel TAGreenberg ERBaron JAMott LAStern RS Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer: Skin Cancer Prevention Study Group. JAMA. 1992;2673305- 3310Google ScholarCrossref 2. English DRKricker AHeenan PJRandell PLWinter MGArmstrong BK Incidence of non-melanocytic skin cancer in Geraldton, Western Australia. Int J Cancer. 1997;73629- 633Google ScholarCrossref 3. Czarnecki DMar AStaples MGiles GMeehan C The development of nonmelanocytic skin cancers in people with a history of skin cancer. Dermatology. 1994;189364- 367Google ScholarCrossref 4. Czarnecki DZalcberg JKuliskaya E Impaired cell-mediated immunity of apparently normal patients who have had multiple skin cancers. Cancer. 1995;76228- 231Google ScholarCrossref 5. Czarnecki DMeehan CMcColl IKulinskaya E Lymphocyte counts of patients who have had skin cancer. J Am Acad Dermatol. 1996;34772- 776Google ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Jan 1, 2002

Keywords: skin cancer

References