TY - JOUR
T1 - Risk Factors and Outcomes of Nonmelanoma Skin Cancer in Children and Young Adults
AU - Huang, Jennifer T.
AU - Coughlin, Carrie C.
AU - Hawryluk, Elena B.
AU - Hook, Kristen
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.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/8
Y1 - 2019/8
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.
AB - 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.
KW - basal cell nevus syndrome
KW - chemotherapy
KW - genodermatosis
KW - iatrogenic
KW - prolonged immunosuppression
KW - radiation therapy
KW - voriconazole
KW - xeroderma pigmentosum
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U2 - 10.1016/j.jpeds.2019.04.017
DO - 10.1016/j.jpeds.2019.04.017
M3 - Article
C2 - 31103258
AN - SCOPUS:85065573437
SN - 0022-3476
VL - 211
SP - 152
EP - 158
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -