COMMENTARY

How Common Is a Subsequent Keratinocyte Carcinoma Diagnosis?

Graeme M. Lipper, MD

Disclosures

June 26, 2015

Timing of Subsequent New Tumors in Patients Who Present With Basal Cell Carcinoma or Cutaneous Squamous Cell Carcinoma

Wehner MR, Linos E, Parvataneni R, Stuart SE, Boscardin WJ, Chren MM
JAMA Dermatol. 2015;151:382-388

Study Summary

Keratinocyte carcinomas (KCs; basal cell carcinoma [BCC], squamous cell carcinoma [SCC]; also termed nonmelanoma skin cancers or NMSCs) are the most common malignancies, with roughly 3.5 million lesions being diagnosed annually in the United States alone.[1] As such, KCs pose a significant health and financial burden. Established risk factors for KCs include light skin pigmentation, heavy sun exposure, and a history of blistering sunburns.[2,3] In addition, one 17-study meta-analysis showed that people diagnosed with a KC are 10 times more likely to develop an additional KC than the general population over 3 years of follow-up.[4] In this context, Wehner and colleagues asked the important question of whether or not all individuals diagnosed with one or multiple new KCs carry a higher risk of developing subsequent BCCs or SCCs. Their goal was to look at the timing and pattern of subsequent KCs in patients diagnosed with their first KC vs multiple prior lesions.

To this end, Wehner and colleagues did a prospective observational cohort study of 1426 patients with a newly diagnosed KC, then excluded all those with immunocompromise or basal cell nevus syndrome, both strong independent risk factors for multiple KCs. This left 1284 patients (923 with BCC only; 296 with SCC only; 65 with both BCC and SCC). Key findings in this cohort were as follows:

  1. Patients who developed their first KC were much less likely to develop a subsequent KC when compared with patients with a history of prior KCs (single or multiple).

  2. These differences were significant: roughly 15% vs 44% at 1 year; 31 vs 71% at 3 years; 41% vs 82% at 5 years.

  3. Secondary analysis showed similar risk differentials for BCCs and SCCs (ie, the risk for an additional BCC or SCC was much greater after the second lesion than after the first lesion).

  4. The relative risk of developing another KC increased with each additional lesion.

  5. Even at 10 years of follow-up, up to 40% of patients diagnosed with their first KC will not have developed another KC.

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