Risk Factors and Outcomes of Nonmelanoma Skin Cancer in Children and Young Adults

Jennifer T. Huang, Carrie C. Coughlin, Elena B. Hawryluk, Kristen P Hook, Stephen R. Humphrey, Lacey Kruse, Leslie Lawley, Hasan Al-Sayegh, Wendy B. London, Ashfaq Marghoob, Thuy L. Phung, Elena Pope, Pedram Gerami, Birgitta Schmidt, Sarah Robinson, Diana Bartenstein, Eman Bahrani, Meera Brahmbhatt, Lily Chen, Ellen Haddock & 7 others Danny Mansour, Julie Nguyen, Tom Raisanen, Gary Tran, Kate Travis, Zachary Wolner, Lawrence F. Eichenfield

Research output: Contribution to journalArticle

Abstract

Objective: To identify risk factors associated with nonmelanoma skin cancer (NMSC) occurrence and survival in children. Study design: This was a multicenter, retrospective, case-control study of patients <20 years of age diagnosed with NMSC between 1995 and 2015 from 11 academic medical centers. The primary outcome measure was frequency of cases and controls with predisposing genetic conditions and/or iatrogenic exposures, including chemotherapy, radiation, systemic immunosuppression, and voriconazole. Results: Of the 124 children with NMSC (40 with basal cell carcinoma, 90 with squamous cell carcinoma), 70% had at least 1 identifiable risk factor. Forty-four percent of the cases had a predisposing genetic condition or skin lesion, and 29% had 1 or more iatrogenic exposures of prolonged immunosuppression, radiation therapy, chemotherapy, and/or voriconazole use. Prolonged immunosuppression and voriconazole use were associated with squamous cell carcinoma occurrence (cases vs controls; 30% vs 0%, P =.0002, and 15% vs 0%, P =.03, respectively), and radiation therapy and chemotherapy were associated with basal cell carcinoma occurrence (both 20% vs 1%, P <.0001). Forty-eight percent of initial skin cancers had been present for >12 months prior to diagnosis and 49% of patients were diagnosed with ≥2 skin cancers. At last follow-up, 5% (6 of 124) of patients with NMSC died. Voriconazole exposure was noted in 7 cases and associated with worse 3-year overall survival (P =.001). Conclusions: NMSC in children and young adults is often associated with a predisposing condition or iatrogenic exposure. High-risk patients should be identified early to provide appropriate counseling and management.

Original languageEnglish (US)
Pages (from-to)152-158
Number of pages7
JournalJournal of Pediatrics
Volume211
DOIs
StatePublished - Aug 1 2019

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Skin Neoplasms
Young Adult
Survival
Case-Control Studies
Counseling

Keywords

  • basal cell nevus syndrome
  • chemotherapy
  • genodermatosis
  • iatrogenic
  • prolonged immunosuppression
  • radiation therapy
  • voriconazole
  • xeroderma pigmentosum

Cite this

Huang, J. T., Coughlin, C. C., Hawryluk, E. B., Hook, K. P., Humphrey, S. R., Kruse, L., ... Eichenfield, L. F. (2019). Risk Factors and Outcomes of Nonmelanoma Skin Cancer in Children and Young Adults. Journal of Pediatrics, 211, 152-158. https://doi.org/10.1016/j.jpeds.2019.04.017

Risk Factors and Outcomes of Nonmelanoma Skin Cancer in Children and Young Adults. / Huang, Jennifer T.; Coughlin, Carrie C.; Hawryluk, Elena B.; Hook, Kristen P; Humphrey, Stephen R.; Kruse, Lacey; Lawley, Leslie; Al-Sayegh, Hasan; London, Wendy B.; Marghoob, Ashfaq; Phung, Thuy L.; Pope, Elena; Gerami, Pedram; Schmidt, Birgitta; Robinson, Sarah; Bartenstein, Diana; Bahrani, Eman; Brahmbhatt, Meera; Chen, Lily; Haddock, Ellen; Mansour, Danny; Nguyen, Julie; Raisanen, Tom; Tran, Gary; Travis, Kate; Wolner, Zachary; Eichenfield, Lawrence F.

In: Journal of Pediatrics, Vol. 211, 01.08.2019, p. 152-158.

Research output: Contribution to journalArticle

Huang, JT, Coughlin, CC, Hawryluk, EB, Hook, KP, Humphrey, SR, Kruse, L, Lawley, L, Al-Sayegh, H, London, WB, Marghoob, A, Phung, TL, Pope, E, Gerami, P, Schmidt, B, Robinson, S, Bartenstein, D, Bahrani, E, Brahmbhatt, M, Chen, L, Haddock, E, Mansour, D, Nguyen, J, Raisanen, T, Tran, G, Travis, K, Wolner, Z & Eichenfield, LF 2019, 'Risk Factors and Outcomes of Nonmelanoma Skin Cancer in Children and Young Adults', Journal of Pediatrics, vol. 211, pp. 152-158. https://doi.org/10.1016/j.jpeds.2019.04.017
Huang, Jennifer T. ; Coughlin, Carrie C. ; Hawryluk, Elena B. ; Hook, Kristen P ; Humphrey, Stephen R. ; Kruse, Lacey ; Lawley, Leslie ; Al-Sayegh, Hasan ; London, Wendy B. ; Marghoob, Ashfaq ; Phung, Thuy L. ; Pope, Elena ; Gerami, Pedram ; Schmidt, Birgitta ; Robinson, Sarah ; Bartenstein, Diana ; Bahrani, Eman ; Brahmbhatt, Meera ; Chen, Lily ; Haddock, Ellen ; Mansour, Danny ; Nguyen, Julie ; Raisanen, Tom ; Tran, Gary ; Travis, Kate ; Wolner, Zachary ; Eichenfield, Lawrence F. / Risk Factors and Outcomes of Nonmelanoma Skin Cancer in Children and Young Adults. In: Journal of Pediatrics. 2019 ; Vol. 211. pp. 152-158.
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AU - Huang, Jennifer T.

AU - Coughlin, Carrie C.

AU - Hawryluk, Elena B.

AU - Hook, Kristen P

AU - Humphrey, Stephen R.

AU - Kruse, Lacey

AU - Lawley, Leslie

AU - Al-Sayegh, Hasan

AU - London, Wendy B.

AU - Marghoob, Ashfaq

AU - Phung, Thuy L.

AU - Pope, Elena

AU - Gerami, Pedram

AU - Schmidt, Birgitta

AU - Robinson, Sarah

AU - Bartenstein, Diana

AU - Bahrani, Eman

AU - Brahmbhatt, Meera

AU - Chen, Lily

AU - Haddock, Ellen

AU - Mansour, Danny

AU - Nguyen, Julie

AU - Raisanen, Tom

AU - Tran, Gary

AU - Travis, Kate

AU - Wolner, Zachary

AU - Eichenfield, Lawrence F.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Objective: To identify risk factors associated with nonmelanoma skin cancer (NMSC) occurrence and survival in children. Study design: This was a multicenter, retrospective, case-control study of patients <20 years of age diagnosed with NMSC between 1995 and 2015 from 11 academic medical centers. The primary outcome measure was frequency of cases and controls with predisposing genetic conditions and/or iatrogenic exposures, including chemotherapy, radiation, systemic immunosuppression, and voriconazole. Results: Of the 124 children with NMSC (40 with basal cell carcinoma, 90 with squamous cell carcinoma), 70% had at least 1 identifiable risk factor. Forty-four percent of the cases had a predisposing genetic condition or skin lesion, and 29% had 1 or more iatrogenic exposures of prolonged immunosuppression, radiation therapy, chemotherapy, and/or voriconazole use. Prolonged immunosuppression and voriconazole use were associated with squamous cell carcinoma occurrence (cases vs controls; 30% vs 0%, P =.0002, and 15% vs 0%, P =.03, respectively), and radiation therapy and chemotherapy were associated with basal cell carcinoma occurrence (both 20% vs 1%, P <.0001). Forty-eight percent of initial skin cancers had been present for >12 months prior to diagnosis and 49% of patients were diagnosed with ≥2 skin cancers. At last follow-up, 5% (6 of 124) of patients with NMSC died. Voriconazole exposure was noted in 7 cases and associated with worse 3-year overall survival (P =.001). Conclusions: NMSC in children and young adults is often associated with a predisposing condition or iatrogenic exposure. High-risk patients should be identified early to provide appropriate counseling and management.

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