Survival after squamous cell and basal cell carcinoma of the skin: A retrospective cohort analysis

Abstract

A retrospective cohort analysis of survival after keratinocyte cancer (KC) was conducted using data from a large, population-based case control study of KC in New Hampshire. The original study collected detailed information during personal interviews between 1993-2002 from individuals with squamous (SCC) and basal (BCC) cell carcinoma, and controls identified through the Department of Transportation, frequency-matched on age and sex. Participants without a history of non-skin cancer at enrolment were followed as a retrospective cohort to assess survival after either SCC or BCC, or a reference date for controls. Through 2009, cancers were identified from the New Hampshire State Cancer Registry and self-report; death information was obtained from state death certificate files and the National Death Index. There were significant differences in survival between those with SCC, BCC and controls (p=0.040), with significantly greater risk of mortality after SCC compared to controls (adjusted hazard ratio [HR] 1.25; 95% confidence interval 1.01-1.54). Mortality after BCC was not significantly altered (HR 0.96; 95% CI 0.77-1.19). The excess mortality after SCC persisted after adjustment for numerous personal risk factors including time-varying non-skin cancer occurrence, age, sex and smoking. Survival from the date of the intervening cancer, however, did not vary (HR for SCC 0.98; 95% CI 0.70-1.38). Mortality also remained elevated when individuals with subsequent melanoma were excluded (HR for SCC 1.30; 95% CI 1.05-1.61). Increased mortality after SCC cannot be explained by the occurrence of intervening cancers, but may reflect a more general predisposition to life threatening illness that merits further investigation.

Risk of death from cardiovascular disease associated with low-level arsenic exposure among long-term smokers in a US population-based study

“…Such errors, however, are unlikely to have been affected by toenail arsenic levels, and thus likely, if anything, led to a bias towards the null. However, we cannot rule out the possibility that arsenic exposure and smoking behavior may be related to competing causes of death in this population [22]. Second, toenail clippings can have limitations as biomarkers due to variability in growth rate among individuals, the risk of external contamination, and protocols for collection and analysis [48], but we attempted to minimize such issues by collecting toenails immediately after bathing, washing them prior to analysis, and using standardized analytical procedures for all subjects.…”

“…Deaths that occurred prior to December 31, 2009 were secondarily confirmed with New Hampshire state death certificates, as previously described [22]. Analyses of disease-specific mortality were based on the primary cause of death as based on the International Classification of Diseases, 10th revision (ICD-10).…”

Interdisciplinary Surgical Management of Skin Cancer: the Saint Louis University Experience

“…As discussed earlier, 100 % margin examination, whether by Mohs or geometric staged excision, offers a marked cure rate advantage for Non-melanoma skin cancer (NMSC) [15,16]. Even when resection cannot be completed by the Mohs surgeon, coordination between Mohs and allied specialties can still allow for complete margin assessment.…”

“…For patients with Merkel cell cancer (MCC), up to 30 % will develop regional nodal involvement [16]. Due to the low incidence of MCC, the role of SNB for MCC has been only evaluated in various single institutional studies [25].…”

“…Local control of the primary tumor is vital to achieving cure for skin cancers, with tumor recurrence a recognized risk factor for metastatic disease for many cutaneous malignancies [15][16][17]. Mohs micrographic surgery allows for 100 % margin examination and has been shown to have cure rates superior to wide local excision for a range of skin cancers.…”