Original article
Increased incidence and recurrence rates of nonmelanoma skin cancer in patients with non-Hodgkin lymphoma: A Rochester Epidemiology Project population-based study in Minnesota

https://doi.org/10.1016/j.jaad.2014.10.028Get rights and content

Background

Cutaneous malignancy is associated with worse outcomes in patients with chronic lymphocytic leukemia (CLL).

Objective

We sought to identify the incidence and recurrence rate of nonmelanoma skin cancer (NMSC) in patients with non-Hodgkin lymphoma (NHL).

Methods

NMSC incidence was calculated and Cox proportional hazards models were used to evaluate associations with risk of recurrence for patients with NHL between 1976 and 2005 who were in the Rochester Epidemiology Project research infrastructure.

Results

We identified 282 patients with CLL or small lymphocytic lymphoma and 435 with non-CLL NHL. The incidence of basal cell carcinoma and squamous cell carcinoma was 1829.3 (95% confidence interval [CI] 1306.7-2491.1) and 2224.9 (95% CI 1645.9-2941.6), respectively, in patients with CLL. The cumulative recurrence rate at 8 years after treatment with Mohs micrographic surgery was 8.3% (95% CI 0.0%-22.7%) for basal cell carcinoma and 13.4% (95% CI 0.0%-25.5%) for squamous cell carcinoma in patients with CLL.

Limitations

This was a retrospective cohort study.

Conclusions

After Mohs micrographic surgery and standard excision of NMSC, patients with NHL had a skin cancer recurrence rate that was higher than expected. Careful treatment and monitoring of patients with NHL and NMSC are warranted.

Section snippets

Methods

Institutional review board approval was obtained from Mayo Clinic and the Olmsted Medical Center as part of the Rochester Epidemiology Project (REP). REP resources include health care information for Olmsted County, Minnesota, residents from 1966 to the present. The medical records for a given patient are linked together across virtually all Olmsted County health care providers as a part of the REP records linkage system. This allows the health care information for an Olmsted County resident to

Results

We identified a cohort of 717 Olmsted County residents with the diagnosis of NHL established from January 1, 1976, through December 31, 2005. Although these data are from a number of decades ago to 2005, the diagnostic criteria for CLL has remained relatively stable, and the information obtained from the large amount of follow-up years is pertinent. It is possible, however, that the treatment regimens for lymphoma have changed significantly over this large amount of time, which could introduce

Discussion

In the past 30 years, investigators have suggested an increased incidence of solid tumors in the setting of CLL. In particular, the risk is significantly increased for malignant melanoma, soft-tissue sarcomas, and lung cancer.1, 10, 16, 17, 18, 19, 20, 21, 22 In 1 small study, the risk of skin cancer in the setting of CLL increased 8-fold.16 These tumors not only are more common in this clinical setting, but they also may behave more aggressively. Patients with CLL and SCC or BCC were found to

References (27)

  • D. Manusow et al.

    Subsequent neoplasia in chronic lymphocytic leukemia

    JAMA

    (1975)
  • A.M. Tsimberidou et al.

    Other malignancies in chronic lymphocytic leukemia/small lymphocytic lymphoma

    J Clin Oncol

    (2009)
  • J.L. St Sauver et al.

    Data resource profile: the Rochester Epidemiology Project (REP) medical records-linkage system

    Int J Epidemiol

    (2012)
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    Supported in part by a Dermatology Foundation Career Development Award for the study of lymphoma-associated skin cancer (Dr Brewer).

    Conflicts of interest: None declared.

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