Brief Report
Increased metastasis and mortality from cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia

https://doi.org/10.1016/j.jaad.2005.08.055Get rights and content

In patients with chronic lymphocytic leukemia, squamous cell carcinoma behaves aggressively. Our purpose was to compare squamous cell carcinoma metastasis and mortality between patients with chronic lymphocytic leukemia and control subjects. Medical records were assessed retrospectively for 28 patients with chronic lymphocytic leukemia who underwent surgical excision of cutaneous squamous cell carcinoma and for 56 matched control subjects. The rate of metastasis and mortality from cutaneous squamous cell carcinoma were determined on a per-patient basis. Three of 28 patients with chronic lymphocytic leukemia had metastasis and died of metastatic disease. No metastases or deaths occurred among the 56 control subjects. Compared with control subjects, chronic lymphocytic leukemia patients with cutaneous squamous cell carcinoma were more likely to have metastasis (P = .0031) and die of metastasis (P = .0033). No significant association was detected between metastasis and history of chemotherapy administration for chronic lymphocytic leukemia. Among patients with chronic lymphocytic leukemia, surveillance for skin cancer and a decreased threshold for biopsy of suspect lesions are warranted.

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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      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.

    Reprints not available from the authors.

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