More evidence of skin cancer risk in CLL patients

Blood cancers

28 Sep 2016

A New Zealand study has found high rates of skin cancer, especially squamous cell carcinomas and more aggressive skin cancers, in patients with chronic lymphocytic leukaemia.

Squamous cell carcinoma rates in CLL patients were found to be 2.8 to 5.4 times that of the age-matched general population – suggesting the importance of regular skin checks in this patient group.

Dr Sean MacPherson, consultant haematologist and senior lecturer at the University of Otago Christchurch, told the limbic the findings would be equally valid in Australia.

“We know there is an increase in second malignancies in CLL patients but most of the studies are from the northern hemisphere. The background incidence of skin cancer is higher here so we expected to see more in the way of cutaneous squamous cell carcinomas due to the particular problem of UV exposure.”

The retrospective study of 371 patients, mostly male and with a median age of 67 years, found 61 squamous cell carcinomas, five melanomas, two sebaceous gland carcinomas and one Merkel cell carcinoma.

The study also found multiple skin cancers were a red flag for progression of CLL.

“Patients who had one skin cancer typically developed a second within about two years. It was a sobering observation that once they had that second occurrence, many were dying within five years,” Dr MacPherson said.

Overall about half of the patients received treatment for their CLL and 51% died during the 12-year follow-up period.

“Certainly some of the literature we cited also suggests these cancers are particularly aggressive. We hope to have a closer look at the histology of these particular skin cancers and compare what we see in CLL patients with other patients,” he said.

He said there was also some suspicion that strains of the human papilloma virus might be implicated due to the appearance of the skin lesions.

“Patients with CLL have a generally suppressed immune system so when the mechanism for cancer surveillance goes wrong we can expect to see more cancers. We have to be vigilant as the outcomes are surprisingly poor in CLL.”

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