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Advanced Rai Stage Predicts Poor Outcome of Skin Cancer in CLL

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Key Points

  • Patients were at equal risk of dying from CLL and from skin cancer.
  • Advanced Rai stage at the time of first skin cancer diagnosis and high skin cancer T stage were independent predictors of poor skin cancer outcome.

Chronic lymphocytic leukemia (CLL) is associated with increased risk of skin cancer. In a study reported in JAMA Dermatology, Velez et al attempted to determine whether progression of CLL indicated by advanced Rai stage is associated with worse skin cancer outcomes. They found that risk of death from skin cancer is equivalent to risk from CLL and that advanced Rai stage is a significant predictor of poor skin cancer outcome.  

Study Details

The study was a 20-year retrospective study involving adults with CLL and melanoma, squamous cell carcinoma, or Merkel cell carcinoma at Brigham and Women’s Hospital and Massachusetts General Hospital. The study included 133 patients with 377 primary skin cancers, with median follow-up times of 120 months from CLL diagnosis and 41 months from skin cancer diagnosis. Overall, 71% of patients were male, 79% had no history of skin cancer before CLL diagnosis, 69% had low Rai stage (0–II), and 31% had high Rai stage (III or IV); 92% had squamous cell carcinoma, 6% melanoma, and 2% Merkel cell carcinoma. Poor outcome of skin cancer was defined as local recurrence, nodal metastasis, distant metastasis, or death.

Predictors of Poor Outcome

Overall, the frequency of death from skin cancer was similar to that from CLL (12.0% and 13.5%). On univariate analysis, ≥ 5 skin cancers (P = .02), high skin cancer T stage (P < .001),  skin cancer diameter ≥ 2.0 cm (P = .004), adjuvant radiation therapy (P = .005), and high Rai stage at the time of first skin cancer diagnosis (P < .001) were significantly associated with poor skin cancer outcome. On multivariate analysis, advanced Rai stage at the time of first skin cancer diagnosis (hazard ratio [HR] = 4.5, 95% confidence interval [CI] = 2.3–8.9) and high skin cancer T stage (HR = 4.9, 95% CI = 2.2–10.8) were significant predictors of poor skin cancer outcome.

Patients with both low skin cancer T stage and low Rai stage (n = 265) had a 5.3% risk of poor skin cancer outcome, whereas risk was significantly higher in those with low skin cancer T stage and high Rai stage (n = 89; 16.9%). A relatively low proportion of patients had high skin cancer T stage (n = 23), but these patients had high risk of poor outcome, which occurred in 27.3% of those with low Rai stage (n = 11) and 50.0% of those with high Rai stage (n = 12).

The investigators concluded, “In patients with CLL and non-basal cell carcinoma skin cancer, mortality is as high from skin cancer as from CLL. The Rai stage and skin cancer T stage should be considered when risk-stratifying patients with skin cancer. Regular communication between dermatologists and oncologists will help facilitate the identification of patients with CLL who are at high risk of having poor skin cancer outcomes.”

Chrysalyne D. Schmults, MD, MSCE, of Brigham and Women’s Hospital and Harvard Medical School, is the corresponding author for the JAMA Dermatology article.

The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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