Long-Term Risk of Skin Cancer Among Childhood Cancer Survivors: A DCOG-LATER Cohort Study

Abstract

Background Skin cancer is common after radiotherapy among childhood cancer survivors (CCSs). We studied risks and risk factors for subsequent skin cancers, with emphasis on radiation dose, exposed skin surface area, and chemotherapeutic agents. Methods The DCOG-LATER cohort study includes 5-year Dutch CCSs diagnosed 1963–2001. Subsequent skin cancers were identified from record linkages with the Netherlands Cancer Registry and Dutch Pathology Registry. Incidence rates were compared with general population rates. Multivariable Cox regression models were used, applying a novel method of case-control sampling enabling use of tumor location in cohort analyses. All statistical tests were two-sided. Results Among 5843 CCSs, 259 developed 1061 basal cell carcinomas (BCCs) (standardized incidence ratio [SIR] = 29.8, 95% confidence interval [CI] = 26.3 to 33.6; excess absolute risk per 10 000 person-years (EAR) = 24.6), 20 had melanoma (SIR = 2.3, 95% CI = 1.4 to 3.5; EAR = 1.1), and 10 had squamous cell carcinoma (SIR = 7.5, 95% CI = 3.6 to 13.8; EAR = 0.8). Cumulative incidence of BCC 40 years after childhood cancer was 19.1% (95% CI = 16.6 to 21.8%) after radiotherapy vs 0.6% expected based on general population rates. After a first BCC, 46.7% had more BCCs later. BCC risk was associated with any radiotherapy to the skin compartment of interest (hazard ratio [HR] = 14.32, 95% CI = 10.10 to 20.29) and with estimated percentage in-field skin surface area (26–75%: HR = 1.99, 95% CI = 1.24 to 3.20; 76–100%: HR = 2.16, 95% CI = 1.33 to 3.53, vs 1–25% exposed; Ptrend among exposed = .002), but not with prescribed radiation dose and likelihood of sun-exposed skin-area. Of all chemotherapy groups examined, only vinca alkaloids increased BCC risk (HR = 1.54, 95% CI = 1.04 to 2.27). Conclusion CCSs have a strongly, 30-fold increased BCC risk. BCC risk appears to increase with increasing skin surface area exposed. This knowledge underscores the need for awareness by survivors and their health care providers.

Clinical characteristics and survival patterns of subsequent sarcoma, breast cancer, and melanoma after childhood cancer in the DCOG-LATER cohort

“…Keegan et al did find a slight significantly worse overall survival in melanoma-SMN compared to melanoma-FMN [14]. Previous studies have shown that childhood cancer survivors are at increased risk of skin cancers, mainly basal cell carcinomas, occurring mainly in skin surface areas that had received radiation [33,34]. Survivors who received radiotherapy should be educated to be on alert for local skin changes in order to timely seek medical attention for skin lesions that may be potentially malignant.…”

The Time Has Come to Enhance Skin Cancer Screening for Adult Childhood Cancer Survivors

“…In contrast, young survivors, primarily treated with radiation, face an epidemic proportion of skin cancer, primarily BCCs. In this study of 5843 Dutch survivors, Teepen et al document standardized incidence ratios of 29.8 for basal cell cancer, 2.3 for melanoma, and 7.5 for squamous cell cancer (5). The median age of the sample was only 30.6 years.…”

“…The median age of the sample was only 30.6 years. Strikingly, nearly 50% of those who had a first BCC had more BCCs later, averaging 4.1 BCCs per individual (5) Furthermore, BCC risk was elevated when increasing skin surface area WAS exposed to radiation (5).…”

<p>SASH1 Suppresses the Proliferation and Invasion of Human Skin Squamous Cell Carcinoma Cells via Inhibiting Akt Cascade</p>

“…1 Epidemiological survey has reported that more than 20% of population worldwide could potential occur skin tumor in the life time. 2 Furthermore, the prevalence of cSCC has been increasing at an amazing rate in the last decade. 3 The present clinical therapy for cSCC mainly depend on the combinations of surgery, radiotherapy, and/or chemotherapy.…”