Risk for Basal Cell Carcinoma Is Greatly Increased in Childhood Cancer Survivors

Although secondary malignancies are known to occur in childhood cancer survivors, much about the risk for subsequent skin cancers among childhood survivors remains unknown.

To examine this potential association, investigators in the Netherlands conducted a retrospective cohort study of 5843 childhood cancer survivors diagnosed between 1963 and 2001 (median age, 30.6 years) linking data from Dutch cancer and pathology registries; the follow-up time since childhood cancer diagnosis was ≥5 years (median, 23.3 years).

Results were as follows:

• 1062 basal cell carcinomas (BCCs) were identified in 259 survivors, 27 melanomas were identified in 20 survivors, and 11 squamous cell cancers (SCCs) were identified in 10 survivors.

• The risk for BCC was 30 times greater than expected in the general population; multiple BCCs occurred in 47% of BCC patients, with 13% having 10 or more BCCs.

• 92% of survivors with BCCs had received radiotherapy; the greatest risks for BCCs were when radiotherapy was combined with chemotherapy, when radiotherapy occurred in patients younger than 5 years, and in the areas receiving radiation, mostly in the head and neck.

• Risks for BCCs following radiotherapy did not appear to be increased in areas typically exposed to the sun.

• Vinca alkaloids were the only chemotherapeutic agents associated with even a minimal risk for BCC.

• Increased risks for melanomas and SCCs were modestly associated with radiation therapy; SCC risk was also was associated with total body irradiation and bone marrow transplantation.