Brief ReportIncreased metastasis and mortality from cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia
Section snippets
Methods
Cases and controls in the present study were evaluated previously for the rate of SCC recurrence on a per-tumor basis. A previous study2 includes more detailed methodologic and cohort descriptions. The objectives of the present study, however, were to quantify the rate of metastasis and mortality from cutaneous SCC on a per-patient basis. We addressed regional metastasis and death separately from local recurrence because in terms of surveillance and significance, local disease and metastatic
Results
Of the 28 cases, 24 (85.7%) were men. Their mean age was 73.0 years (standard deviation [SD] ± 6.5 years; range, 60-88 years) at the time of their first procedure in our outpatient surgical unit. Three cases had metastases, which occurred at 1.0, 1.0, and 3.3 years after the procedure for the primary tumor (Table I). Among the 25 cases with no known metastases, the mean duration of follow-up was 3.9 years (median, 3.1 years; range, 0.4-13.7 years) after the time of their first tumor resection
Case 1
A 77-year-old woman with a 4-year history of CLL presented with a large, tender, well-differentiated SCC of the left cheek. Three other SCCs had been resected since CLL had been diagnosed. The left cheek tumor was excised by wide local excision. Ten months after the excision, the patient presented with a mass in the left side of the neck, paresthesia of the maxillary and mandibular nerves, and weakness of the facial nerve. A parotidectomy and left neck dissection confirmed regional metastatic
Discussion
Ours is the first controlled study to investigate the risk of metastasis and mortality from primary SCC in CLL patients. In this study, patients with CLL were significantly more likely to have metastases and subsequently die of cutaneous SCC than controls. This cohort of CLL patients had a cumulative 5-year metastasis rate of 18%. Although the numbers were small, a history of chemotherapy use was not associated with a significant increase in the risk for metastatic SCC in CLL patients.
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Immune status does not independently influence cutaneous squamous cell carcinoma metastasis and death when stratified by tumor stage: A dual-center retrospective cohort analysis of primary N0 disease
2022, Journal of the American Academy of DermatologyDelineation of clinical and biological factors associated with cutaneous squamous cell carcinoma among patients with chronic lymphocytic leukemia
2020, Journal of the American Academy of DermatologyCitation Excerpt :Therefore, our results may not be generalizable and will need further validation in other ethnicities, in particular, the PRS finding which was also based on variants discovered in White individuals, and as mentioned previously, these variants do not perform well in prediction across other races/ethnicities.37 Screening for SCC is important in newly diagnosed patients with CLL, because patients with CLL and SCC are more likely to have more frequent and more aggressive SCC and are at higher risk of death caused by metastatic SCC.48 Our data suggest that more attention to patients with CLL is particularly relevant among patients who have a prior history of skin cancer, which is the most important risk factor with the largest effect size, those with aggressive CLL according to CLL-IPI score, and those receiving T-cell immunosuppressive treatments.
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Funding sources: None.
Conflicts of interest: None identified.
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