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J Pediatr. 2019 May 15. pii: S0022-3476(19)30437-8. doi: 10.1016/j.jpeds.2019.04.017. [Epub ahead of print]

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

Author information

1
Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA.
2
Division of Dermatology, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO.
3
Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Dermatology, Massachusetts General Hospital, Boston, MA.
4
Department of Dermatology, University of Minnesota, Minneapolis, MN.
5
Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI.
6
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
7
Department of Dermatology, Emory University School of Medicine, Atlanta, GA.
8
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA.
9
Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA.
10
Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY.
11
Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX.
12
Section of Dermatology, The Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
13
Harvard Medical School, Boston, MA; Department of Pathology, Boston Children's Hospital, Boston, MA.
14
Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, MA.
15
Department of Dermatology, Massachusetts General Hospital, Boston, MA.
16
Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.
17
Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA; Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego, CA.

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.

KEYWORDS:

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

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