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skin cancer

Etiology: Risk factors: 1) sun exposure a) cumulative b) history of multiple blistering sunburn c) history of sunburns in childhood d) sun exposure in both childhood & adult life increases risk for squamous cell carcinoma of the skin & basal cell carcinoma [9] e) only early sun exposure increases cutaneous melanoma risk [9] 2) fair skin that burns easily, red or blonde hair, freckles a) blue eyes b) albinism 3) history of skin cancer or premalignant lesions a) history of melanoma b) history of non-melanoma skin cancer c) family history of skin cancer or melanoma d) actinic keratosis 4) multiple atypical nevi a) congenital nevi b) dysplastic nevi c) basal cell nevus syndrome 5) immunosuppression 6) xeroderma pigmentosum 7) history of phototherapy 8) exposure to hydrocarbons, arsenic, ionizing radiation 9) male sex 10) older age 11) alcohol consumption - especially white wine & hard liquor [6] 12) solid organ transpantation - increased risk of nonmelanoma skin cancer [2] Epidemiology: - basal cell carcinoma (BCC) most common skin cancer in whites - squamous cell carcinoma of the skin (cutaneous SCC) may be most common in blacks Genetics: see skin neoplasm & more specific types Management: Treatment: see specific skin cancer - treatment modalities used in the elderly seem to be independent of life-expectancy, functional status or comorbidities [11] Screening: see screening for skin cancer - insufficient evidence to recommend screening for skin cancer in asymptomatic adults without history of premalignant or malignant skin lesions (USPSTF) Prevention 1) sunscreen, SPF 30 or greater [2] - apply 30 minutes prior to sun exposure & every 2 hours 2) protective clothing 3) avoidance of midday sun 4) overzealous prevention strategies may result in vitamin D deficiency 5) consider vitamin D supplementation [2] 7) nicotinamide 500 mg PO BID may reduce risk of non-melanoma skin cancer (RR=0.73) [10] 8) celecoxib may reduce incidence of both cutaneous SCC & basal cell carcinoma (BCC) [4] 9) USPSTF recommends clinicians counsel fair-skinned patients aged 6 months-24 years & their caregivers about reducing exposure to ultraviolet radiation [13] 10) USPSTF recommends clinicians selectively counsel older fair-skinned patients based on their existing risk factors since the net benefit is likely small [13] Comparative biology: - strain of Staphylococcus epidermidis producing 6-N-hydroxyaminopurine on the skin of mice protected them from UV radiation-induced skin cancer [14] - same strain of Staphylococcus epidermidis common on human skin [14]

Interactions

disease interactions

Related

screening for skin cancer

Specific

basal cell carcinoma (BCC) blastic plasmacytoid dendritic cell neoplasm (BPDCN) cutaneous lymphoma cutaneous melanoma cutaneous T-cell lymphoma (CTCL) external ear cancer eyelid cancer keratinocyte carcinoma lip cancer Merkel cell carcinoma (neuroendocrine cancer of skin, trabecular cancer) nail bed cancer perianal skin cancer secondary skin cancer skin cancer, face skin cancer, genitalia skin cancer, lower extremity skin cancer, scalp/neck skin cancer, trunk skin cancer, upper extremity squamous cell carcinoma of the skin (SCCS)

General

malignant neoplasm of bone, connective tissue, skin, & breast skin neoplasm

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 30-31
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16. 17, American College of Physicians, Philadelphia 1998, 2009, 2012, 2015
  3. Marrett L et al Screening for Skin Cancer: A Clinical Practice Guideline A Quality Initiative of the Program in Evidence-based Care (PEBC), Cancer Care Ontario (CCO) http://www.cancercare.on.ca/pdf/pebc15-1f.pdf
  4. Elmets CA et al Chemoprevention of nonmelanoma skin cancer with celecoxib: A randomized, double-blind, placebo-controlled trial. J Natl Cancer Inst. 2010 Dec 15;102(24):1835-44. PMID: 21115882 http://dx.doi.org/10.1093/jnci/djq442 - Meyskens FL Jr and McLaren CE. Chemoprevention, risk reduction, therapeutic prevention, or preventive therapy? J Natl Cancer Inst. 2010 Dec 15;102(24):1815-7. PMID: 21115881 http://dx.doi.org/10.1093/jnci/djq466
  5. Moyer VA on behalf of the U.S. Preventive Services Task Force. Behavioral counseling to prevent skin cancer: U.S. preventive services task force recommendation statement. Ann Intern Med 2012 May 8 PMID: 22565035
  6. Kubo JT et al. Alcohol consumption and risk of melanoma and non-melanoma skin cancer in the Women's Health Initiative. Cancer Causes Control 2013 Oct 31 PMID: 24173533
  7. Ridky TW. Nonmelanoma skin cancer. J Am Acad Dermatol. 2007 Sep;57(3):484-501. Epub 2007 May 21. PMID: 17512631
  8. Gloster HM Jr, Neal K. Skin cancer in skin of color. J Am Acad Dermatol. 2006 Nov;55(5):741-60; quiz 761-4. PMID: 17052479
  9. Wu S et al. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: A cohort study. Cancer Epidemiol Biomarkers Prev 2014 Jun; 23:1080 PMID: 24876226 http://cebp.aacrjournals.org/content/23/6/1080
  10. Martin AJ et al Oral nicotinamide to reduce actinic cancer: A phase 3 double-blind randomized controlled trial. American Society of Clinical Oncology (ASCO) 2015 Annual Meeting http://abstracts.asco.org/156/AbstView_156_149209.html
  11. Linos E et al. Skin cancer in U.S. elderly adults: Does life expectancy play a role in treatment decisions? J Am Geriatr Soc 2016 Aug; 64:1610 http://onlinelibrary.wiley.com/doi/10.1111/jgs.14202/abstract
  12. Preston DS, Stern RS Nonmelanoma Cancers of the Skin. N Engl J Med 1992; 327:1649-1662. December 3, 1992 PMID: 1435901 http://www.nejm.org/doi/full/10.1056/NEJM199212033272307
  13. U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement. Oct 2017 Skin Cancer Prevention: Behavioral Counseling https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/skin-cancer-counseling2 - Draft Evidence Review. Oct 2017 Draft Evidence Review for Skin Cancer Prevention: Behavioral Counseling. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/skin-cancer-counseling2
  14. Galindo Y Beneficial Skin Bacteria Protect Against Skin Cancer. UC San Diego News Center. Feb 28, 2018 citing study Nakatsuji T, Chen TC, Butcher AM et al published in Science Advances on February 28 http://ucsdnews.ucsd.edu/pressrelease/beneficial_skin_bacteria_protect_against_skin_cancer
  15. US Preventive Services Task Force Behavioral Counseling to Prevent Skin Cancer. US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(11):1134-1142 PMID: 29558558 https://jamanetwork.com/journals/jama/fullarticle/2675556 - Henrikson NB, Morrison CC, Blasi PR et al Behavioral Counseling for Skin Cancer Prevention. Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;319(11):1143-1157 PMID: 29558557 https://jamanetwork.com/journals/jama/fullarticle/2675555 - Robinson JK, Jablonski NG Sun Protection and Skin Self-examination and the US Preventive Services Task Force Recommendation on Behavioral Counseling for Skin Cancer Prevention. JAMA. 2018;319(11):1101-1102 PMID: 29558538 https://jamanetwork.com/journals/jama/fullarticle/2675529 - Linos E, Pagoto S. USPSTF Recommendations for Behavioral Counseling for Skin Cancer Prevention. Throwing Shade on UV Radiation. JAMA Intern Med. Published online March 20, 2018 PMID: 29558531 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2675355
  16. Scott TD, Stokowski LA Nonmelanoma Skin Cancers You Need to Know. Medscape. Jam 28, 2021 https://reference.medscape.com/slideshow/nonmelanoma-skin-cancers-30455
  17. Supapannachart KJ, Chen SC, Wang Y et al Skin Cancer Risk Factors and Screening Among Asian American Individuals. JAMA Dermatol. Published online January 26, 2022 PMID: 35080583 https://jamanetwork.com/journals/jamadermatology/fullarticle/2788388
  18. National Cancer Institute Skin Cancer (Including Melanoma) - Health Professional Version https://www.cancer.gov/types/skin/hp