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Nonmelanoma Skin Cancer
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Nonmelanoma Skin Cancer
, Keratinocyte Carcinoma, Nonmelanoma Skin Cancer Risk Factors
See Also
Basal Cell Carcinoma
Squamous Cell Carcinoma
Actinic Keratoses
Melanoma
Types
Basal Cell Carcinoma
Actinic Keratoses
(
Squamous Cell Carcinoma
precursor)
Squamous Cell Carcinoma
Represents 30% of Nonmelanoma Skin Cancer cases (related to cummulative UV light exposure)
Epidemiology
Lifetime Risk >20% (>30% in white patients)
Risk Factors
Both
Basal Cell Carcinoma
and
Squamous Cell Carcinoma
Very High Risk (10 fold or greater
Relative Risk
)
Current immunosuppressive therapy after organ
Transplantation
(especially related to SCC)
Personal history of skin cancer
Melanoma
in 2 or more first degree relatives
Nevi
numbering 100 or more, or 5 or more atypical or
Dysplastic Nevi
Basal Cell Skin Cancer
risk increases 40% with >15 extremity nevi
Nan (2019) J Am Acad Dermatol 80(4): 970-8 [PubMed]
PUVA therapy for
Psoriasis
for more than 250 treatments
Radiation exposure and other local skin damage
Cummulative
Sun Exposure
Gamma radiation for
Psoriasis
or malignancy
Ultraviolet Radiation
exposure (esp. before age <14, esp. childhood
Sunburn
s)
Prior burn scars
Tanning device use
Increases SCC risk by 2.5 fold and BCC risk by 1.5 fold
Risk increases with younger age of first tanning device exposure
Genitourinary skin
Human papilloma virus (HPV) infection
Uncircumcised male
Miscellaneous
Tobacco Abuse
Prior Nonmelanoma Skin Cancer
Signs
See
Sun Damaged Skin
See
Basal Cell Carcinoma
See
Squamous Cell Carcinoma
See
Actinic Keratoses
Prognosis
Metastasis risk
Basal Cell Carcinoma
does not metastasize
Squamous Cell Carcinoma
metastasizes in 3-4% of cases
Recurrence or metastases occur in first 2 years in >70% of cases and first 5 years in 95% of cases
Subsequent skin cancer risk (new skin cancer following previously treated skin cancer)
Prior Nonmelanoma Skin Cancer increases risk of subsequent skin cancer by factor of 10 over general population
Three year risk: 35%
Five year risk: 40% after first diagnosis (82% after more than one diagnosis)
Malignant
Melanoma
risk doubles after non-
Melanoma
skin cancer diagnosis
Risk factors for subsequent skin cancer
Male gender
Age over 60 years
Higher number of prior skin cancers
Severe
Actinic Keratosis
involvement
Tobacco Abuse
Increases
Squamous Cell Carcinoma
risk by 2.0x for current smokers and 1.6x for prior smokers
Prevention
See
Sun Exposure
(lists general preventive measures)
See
Sunscreen
See Self-skin examination
Minimize significant
Sun Exposure
in age <24 years esp. with fair skin (and light eye color, red or blond hair,
Freckles
)
Whole body skin examination
USPTF: Not enough evidence
ACS: Every 3 years for age 20 to 40 and every 1 year as of age 40 years
Niacinamide
500 mg twice daily
May be indicated in high risk patients with a history of Nonmelanoma Skin Cancer
One fewer Nonmelanoma Skin Cancer lesion developed per year while on
Niacinamide
Chen (2014) Australas J Dermatol 55(3):169-75 +PMID:24635573 [PubMed]
References
Tavelli in Noble (2001) Primary Care, p. 771-2
Firnhaber (2020) Am Fam Physician 102(6): 339-46 [PubMed]
Firnhaber (2012) Am Fam Physician 86(2): 161-8 [PubMed]
Nguyen (2002) Curr Treat Options Oncol 3:193-203 [PubMed]
Stulberg (2004) Am Fam Physician 70:1481-8 [PubMed]
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