A Model to Predict the Risk of Keratinocyte Carcinomas

Abstract

Basal cell and squamous cell carcinomas of the skin are the commonest cancers in humans, yet no validated tools exist to estimate future risks of developing keratinocyte carcinomas. To develop a prediction tool, we used baseline data from a prospective cohort study (n = 38,726) in Queensland, Australia, and used data linkage to capture all surgically excised keratinocyte carcinomas arising within the cohort. Predictive factors were identified through stepwise logistic regression models. In secondary analyses, we derived separate models within strata of prior skin cancer history, age, and sex. The primary model included terms for 10 items. Factors with the strongest effects were >20 prior skin cancers excised (odds ratio 8.57, 95% confidence interval [95% CI] 6.73-10.91), >50 skin lesions destroyed (odds ratio 3.37, 95% CI 2.85-3.99), age ≥ 70 years (odds ratio 3.47, 95% CI 2.53-4.77), and fair skin color (odds ratio 1.75, 95% CI 1.42-2.15). Discrimination in the validation dataset was high (area under the receiver operator characteristic curve 0.80, 95% CI 0.79-0.81) and the model appeared well calibrated. Among those reporting no prior history of skin cancer, a similar model with 10 factors predicted keratinocyte carcinoma events with reasonable discrimination (area under the receiver operator characteristic curve 0.72, 95% CI 0.70-0.75). Algorithms using self-reported patient data have high accuracy for predicting risks of keratinocyte carcinomas.

The incidence and multiplicity rates of keratinocyte cancers in Australia

“…Because the Medicare sample provided longitudinal historical data, we were able to calculate incidence rates separately for those with and without a prior history of skin cancer excision; we found that rates for those with a history were more than eight times as high. This accords with our previous finding that the strongest predictor of future skin cancer risk is a past history of skin cancer 11 …”

“…This accords with our previous finding that the strongest predictor of future skin cancer risk is a past history of skin cancer. 11 A notable but not unexpected finding was the geographic diversity in the incidence of keratinocyte cancers. The age-standardised rates of treatment in Queensland were nearly twice the national average and almost three times as high as in Victoria and Tasmania.…”

Bone marrow transplant recipients and their compliance with sun‐protection measures in Queensland, Australia

“…Those living in Queensland, Australia, are at greater risk, due to the already high incidence of skin cancers in the general population. 3 At the Royal Brisbane and Women's Hospital (RBWH), a tertiary referral center in Queensland where this study was undertaken, the dermatology department has a protocol for sun-safety education and skin cancer surveillance of BMT patients. Therefore, the objective of this study was to evaluate the compliance of BMT recipients with this protocol.…”

Estimating the future health service burden of keratinocyte cancers in the U.K.

“…They also emphasize the importance of skin cancer prevention and early detection programmes for the U.K. (and other) populations, as most keratinocyte cancers are attributable to excess sun exposure and are thus preventable by modifying personal sun habits . Such programmes could be targeted towards the whole population; or to susceptible population subgroups such as children, adolescents and young adults; or to those at highest risk …”

“…10 Such programmes could be targeted towards the whole population; or to susceptible population subgroups such as children, adolescents and young adults; 11 or to those at highest risk. 12…”