History of Keratinocyte Carcinoma and Risk of Melanoma: A Prospective Cohort Study

Abstract

Background: The association between history of keratinocyte carcinoma (KC, also known as nonmelanoma skin cancer) and risk of developing invasive melanoma has not been assessed comprehensively using prospective data. Methods: We followed 91 846 women in the Nurses' Health Study (NHS; 1984-2010, 114 918 women in the NHSII , and 48 946 men in the Health Professionals Follow-up Study (1986-2010 for diagnoses of KC and melanoma biennially. Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) of melanoma associated with history of KC, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). All statistical tests were two-sided. Results: We documented 1949 melanomas, 38 842 BCCs, and 7462 SCCs over 6.4 million person-years of follow-up. After adjustment for other risk factors, a personal history of KC was associated with an increased risk of melanoma (meta-analysis HR ¼ 2.22, 95% CI ¼ 1.73 to 2.85). The association was more apparent among participants with a history of both BCC and SCC (HR ¼ 3.40, 95% CI ¼ 1.60 to 7.19) than among participants with a history of BCC only (HR ¼ 2.20, 95% CI ¼ 1.80 to 2.70) or SCC only (HR ¼ 1.56, 95% CI ¼ 0.98 to 2.46), and there was a strong risk-increasing trend associated with a higher number of reported KCs removed by surgery (P trend < .001). In women, KC history was more strongly associated with head/neck melanomas (HR ¼ 4.17, 95% CI ¼ 2.77 to 6.27) than with trunk or limb melanomas (both HRs < 2.50, P heterogeneity ¼ .04). Conclusions: Our results provide novel insights for the relationship between KC history and risk of developing melanoma, which may be important for melanoma prevention.

Frequent basal cell cancer development is a clinical marker for inherited cancer susceptibility

“…Other personal history of cancers included seminoma (n = 2), bladder (n = 1), thyroid (n = 1), Kaposi (n = 1) exposure; this is consistent with previous reports of high coincidences between melanoma and keratinocyte carcinoma (15). While previous studies have not investigated malignancy risk in individuals who develop frequent BCCs, one longitudinal study of 190,000 individuals in Denmark identified an increased risk of internal malignancy after the diagnosis of one or more BCC (16).…”

Personal history of keratinocyte carcinoma is associated with reduced risk of death from invasive melanoma in men

“…We previously reported an increased risk for cancer associated with history of KC, including melanoma in men and breast cancer, lung cancer, and melanoma in women. 7 In addition, Wu et al recently reported that a personal history of KC was associated with increased risk for melanoma (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.73-2.85), 8 which is consistent with previous reports from registry-based, case-control, and prospective cohort studies. [9][10][11][12] Although the association of a personal history of KC with melanoma risk has been consistently reported, its association with melanoma mortality remains undetermined.…”

Association between Phenotypic Characteristics and Melanoma in a Large Prospective Cohort Study

“…For two of these cohorts, information on phenotype was not collected at baseline but rather in later surveys (Cho et al, 2005a;Freedman et al, 2003). None of the prospective studies examined skin phototype (burning/tanning) in relation to melanoma risk, only two studies recruited both women and men (Freedman et al, 2003;Wu et al, 2017), and none considered both in situ and invasive melanoma. Only two studies have presented estimates of effect separately for melanoma of different body sites (Cho et al, 2005a;Nielsen et al, 2012), and one of these was a cohort of women only (Nielsen et al, 2012).…”