Risks of different skin tumour combinations after a ﬁrst
melanoma, squamous cell carcinoma and basal cell
carcinoma in Dutch population-based cohorts: 1989–2009
R.J.T. van der Leest,
* L. Liu,
E. de Vries
Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Department of Statistics, European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontiﬁcia Universidad Javeriana, Bogot
*Correspondence: L.M. Hollestein. E-mail: email@example.com
Background Skin cancer patients are primarily at increased risk of developing subsequent skin cancers of the same
type. Shared risk factors might also increase the occurrence of a different type of subsequent skin cancer.
Objective To investigate risks of different skin tumour combinations after a ﬁrst melanoma, squamous cell carcinoma
(SCC) and basal cell carcinoma (BCC).
Methods All melanoma and SCC patients included in the national Netherlands Cancer Registry (NCR) and all BCC
patients included in the regional Eindhoven Cancer Registry (ECR) between 1989 and 2009 were followed until diagnosis
of a subsequent different skin cancer (melanoma, SCC or BCC), date of death or end of study. Cumulative risks, stan-
dardized incidence ratios (SIR) and absolute excess risks (AER) of subsequent skin cancers were calculated.
Results A total of 50 510 melanoma patients and 64 054 patients with a SCC of the skin were included (national data
NCR). The regional data of the ECR consisted of 5776 melanoma patients, 5749 SCC patients and 41 485 BCC patients.
The 21-year cumulative risk for a subsequent melanoma after a ﬁrst SCC or BCC was respectively 1.7% and 1.3% for
males and 1.3% and 1.2% for females; SCC after melanoma or BCC was 4.6% and 9.3% (males) and 2.6% and 4.1%
(females); BCC after melanoma or SCC was respectively 13.2% and 27.8% (males) and 14.9% and 21.1% (females).
SIRs and AERs remained elevated up to 21 years after the ﬁrst melanoma, SCC or BCC.
Conclusion This large population-based study investigating risks of developing a different subsequent cutaneous
malignancy showed high-cumulative risks of mainly KC and markedly increased relative and absolute risks of all tumour
combinations. These estimates conﬁrm a common carcinogenesis and can serve as a base for follow-up guidelines and
patient education aiming for an early detection of the subsequent cancers.
Received: 22 May 2017; Accepted: 5 September 2017
Conﬂicts of interest
The Netherlands Organization for Health Research and Development ZonMw, VIDI 91711315.
Skin cancer patients are known to be at increased risk of devel-
oping subsequent skin cancers due to shared risk factors: large
parts of their skin have usually been exposed to mutagenic
changes as a result of exposure to UV radiation or other carcino-
gens. This so-called ﬁeld cancerization
in combination with the
generally good prognosis of adequately treated skin cancer gives
ample opportunity for new skin cancers to develop. Other
shared risk factors like genetics
and immune suppression
might further increase the occurrence of subsequent skin can-
Two meta-analyses reported pooled risks for a subsequent
melanoma or keratinocyte carcinoma (KC, including squamous
cell carcinoma [SCC] and basal cell carcinoma, [BCC]) in mela-
noma and KC patients. A previous melanoma was shown to be a
strong predictor for development of a subsequent melanoma
© 2017 European Academy of Dermatology and Venereology
2018, 32, 382–389