目标:非黑色素瘤皮肤癌(NMSC)患者-即,基底细胞癌(BCC)或鳞状细胞癌(SCC)-具有发展为第二皮肤癌的风险增加。这项研究的目的是描述频率,每1000人年发病率,以及接受Mohs显微手术(MMS)治疗的NMSC患者队列中第二次皮肤癌的预测因素。
方法:对2013年7月至2020年2月在西班牙22家医院接受MMS的NMSC患者全国队列进行前瞻性研究;病例数据记录在REGESMOHS注册中。研究变量包括人口统计学特征,在研究期间诊断出的每1000人年第二次皮肤癌的频率和发病率,和使用混合效应逻辑回归确定的危险因素。
结果:我们分析了4768例接受MMS的患者的数据;4397(92%)患有BCC,371(8%)患有SCC。平均随访时间为2.4年。总的来说,1201例患者(25%)在随访期间发生了第二次皮肤癌;1013例肿瘤为BCC(21%),154人是SCC(3%),20例为黑色素瘤(0.4%)。任何癌症的发病率为107/1000人年(95%CI,101-113),BCC每1000人年90(95%CI,85-96),SCC每1000人年14人(95%CI,12-16),黑色素瘤每1000人年2例(95%CI,1-3)。更多的男性比女性发展为随后的皮肤癌(738[61%]对463[39%])。主要危险因素为诊断前多发肿瘤病史(相对危险度[RR],4.6;95%CI,2.9-7.1),免疫抑制(RR,2.1;95%CI,1.4-3.1),和男性(RR,1.6;95%CI,1.4-1.9)。
结论:MMS治疗NMSC后,患者发生第二次肿瘤的风险增加。危险因素是诊断时的多发性肿瘤病史,免疫抑制,和男性。
OBJECTIVE: Patients with nonmelanoma skin cancer (NMSC)-ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)-have an increased risk of developing a second skin cancer. The aim of this
study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS).
METHODS: Prospective
study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The
study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the
study period, and risk factors identified using mixed-effects logistic regression.
RESULTS: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101-113) for any cancer, 90 per 1000 person-years (95% CI, 85-96) for BCC, 14 (95% CI, 12-16) per 1000 person-years for SCC, and 2 (95% CI, 1-3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9-7.1), immunosuppression (RR, 2.1; 95% CI, 1.4-3.1), and male sex (RR, 1.6; 95% CI, 1.4-1.9).
CONCLUSIONS: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.