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Nonmelanoma Skin Cancer in Survivors of Childhood and Adolescent Cancer: A Report From the Childhood Cancer Survivor Study

From the Children's Hospitals and Clinics, Minneapolis; Department of Pediatrics, University of Minnesota Medical School and Cancer Center, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Columbus Children's Hospital, Columbus, OH; University of Texas M.D. Anderson Cancer Center; Baylor College of Medicine, Houston, TX; Children's Hospital of Philadelphia, Philadelphia, PA; and University of Michigan, Ann Arbor, MI

Address reprint requests to Joanna L. Perkins, MD, Children's Hospitals and Clinics, 2525 Chicago Ave S, Ste 4150, Minneapolis, MN 55404; e-mail: joanna.perkins{at}childrenshc.org

PURPOSE: Nonmelanoma skin cancer (NMSC) has become the most common type of cancer in many populations throughout the world. Ultraviolet and ionizing radiation are known risk factors. Because NMSCs are rarely lethal and most cancer registries do not routinely report data regarding these cancers, they have received little attention in studies evaluating long-term effects of cancer therapy. This article reports on the occurrence of secondary NMSC as a long-term effect of cancer therapy in survivors of childhood cancer.

PATIENTS AND METHODS: The Childhood Cancer Survivor Study (CCSS) is a cohort study of 5-year survivors of childhood and adolescent cancer from 25 participating institutions in North America. NMSC patients were defined by a history of basal cell or squamous cell carcinoma of the skin after primary malignancy treatment. Demographic and treatment data were collected and analyzed.

RESULTS: Among the 13,132 eligible CCSS participants, 213 have reported NMSC; 99 patients (46%) have had multiple occurrences. Median age of occurrence was 31 years (range, 7 to 46 years). Location of NMSC included head and neck (43%), back (24%), chest (22%), abdomen and pelvis (5%), extremity (3%), and unknown (4%). Ninety percent of patients had previously received radiation therapy (RT); 90% of tumors occurred within the RT field. RT was associated with a 6.3-fold increase in risk (95% CI, 3.5- to 11.3-fold).

CONCLUSION: Long-term survivors of childhood and adolescent cancer who were treated with RT are at highest risk for developing NMSC. Educational efforts need to be directed to this population to facilitate early diagnosis of NMSC and reduction in sun exposure.

Supported by grant No. CA 55727 from the National Cancer Institute, Bethesda, MD, and the Children's Cancer Research Fund, Minneapolis, MN.

Abstract presented at the 39th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 30-June 3, 2003.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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