Skin Cancers Observed More Frequently in Patients With CLL Than in General Population: Presented at ASH
By Ed Susman
NEW ORLEANS -- December 10, 2009 -- Researchers reported here at the American Society of Hematology (ASH) 51st Annual Meeting and Exposition that skin cancer appears to occur more frequently in patients with chronic lymphocytic leukaemia (CLL) -- but even when the skin cancer is dangerous, melanoma occurrence does not seem to impact survival.
“We find in our cohort of chronic lymphocytic leukaemia patients a higher prevalence -- an 8-fold higher rate -- of melanoma than the general public,” said Timothy G. Call, MD, Mayo Clinic School of Medicine, Rochester, Minnesota, in his poster presentation on December 5.
“However, the diagnosis of melanoma and nonmelanoma skin cancer … does not appear to be a risk factor for adverse chronic lymphocytic leukaemia outcomes or for shorter outcomes,” he said.
Dr. Call and colleagues combed the Mayo Clinic database and identified 2,240 patients in a 15-year period who were diagnosed with CLL. Of this cohort, 293 patients (13.1% of the total) had also been diagnosed with nonmelanoma skin cancer, and 57 patients had been diagnosed with melanoma.
The prevalence of melanoma in patients with CLL was 2.5% compared with that of the age-adjusted prevalence for individuals in the Iowa Surveillance, Epidemiology, and End Results (SEER) registry of .03% (P < .001).
About 60% of the patients were diagnosed with skin cancer following or around the time of their initial diagnosis of chronic lymphocytic leukaemia.
“Since the presence of skin cancer could be a marker of immune dysregulation, we hypothesised skin cancer may be associated with the clinical outcome of chronic lymphocytic leukaemia,” said Dr. Call. “Accordingly, we evaluated the relationship between nonmelanoma skin cancer and melanoma skin cancer and time to first treatment and overall survival.”
Among those with melanoma, there was no difference in time to first treatment or overall survival compared with those who were not diagnosed with the aggressive form of skin cancer.
However, when it came to nonmelanoma skin cancer, the researchers found a surprising inverse relationship. Time to first treatment for CLL was longer in those with nonmelanoma skin cancer -- about 6 years -- compared with those patients who did not have skin cancer, 4.9 years (P = .04).
Similarly, among those patients with nonmelanoma skin cancer, median overall survival was 10.8 years compared with 9.7 years for those who did not have skin cancer (P = .02).
Dr. Call said that patients with CLL diagnosed with nonmelanoma skin cancer were older with a median age of 67 years compared with 63 years for those patients without skin cancer (P < .001). The same was true for melanoma patients whose median age was 70 years compared with 64 years for those without a melanoma diagnosis (P = .002).
“Skin cancer prevalence in these patients appears to be elevated when compared with the general public and may be related to the fact that people with chronic lymphocytic leukaemia have an altered immune system in general,” said Ephraim Hochberg, MD, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
He said that the prevalence of nonmelanoma skin cancer in the Mayo cohort is about 3 times that seen in the general population.
[Presentation title: Melanoma and Non-Melanoma Skin Cancer in Patients With Chronic Lymphocytic Leukemia. Abstract 1268]
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