LETTER
New Types of Cancer after Basal-Cell Cancer
David S. Shimm, MD
1 July 1997 | Volume 127 Issue 1 | Page 87
TO THE EDITOR:
Frisch and colleagues [1] reported an increased risk for extracutaneous cancer in patients with basal-cell cancer and refer to a similar risk in patients with squamous-cell skin cancer [2]. There is an additional piece to the puzzle of the association between cutaneous and extracutaneous cancer: the relation between keratoacanthoma and extracutaneous cancer.
Keratoacanthomas are skin lesions that histologically appear malignant, resemble squamous-cell tumors, but undergo spontaneous involution. Because this involution can be followed by scarring, keratoacanthomas located in cosmetically or functionally significant areas (such as the eyelid and nose) are sometimes treated with radiation to hasten involution and avoid scarring.
In 1983, Shimm and colleagues [3] described 13 patients with irradiated facial keratoacanthomas, 5 of whom also had extracutaneous cancer. Three patients had had cancer (gastric adenocarcinoma, malignant mixed tumor of the minor salivary glands, and epidermoid cancer of the nasal septum) before diagnosis of keratoacanthoma, 1 had a large-cell lymphoma at the same time as the diagnosis of keratoacanthoma, and 1 had transitional-cell carcinoma of the bladder 5 years after treatment of keratoacanthoma. Other researchers have also noted this association [4, 5].
As clinicians become aware of the need for vigilance in following their patients with skin cancer for extracutaneous cancers, it is important that they extend this same attention to patients with keratoacanthoma, whose risk seems even higher.
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Author and Article Information
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University of Arizona Health Sciences Center; Tucson, AZ 85724
1. Frisch M, Hjalgrim H, Olsen JH, Melbye M. Risk for subsequent cancer after diagnosis of basal-cell carcinoma. A population-based, epidemiologic study. Ann Intern Med. 1996; 125:815-1.
2. Frisch M, Melbye M. New primary cancers after squamous cell skin cancer. Am J Epidemiol. 1995; 141:916-22.
3. Shimm D, Duttenhaver J, Doucette J, Wang C. Radiation therapy of keratoacanthoma. Int J Radiat Oncol Biol Phys. 1983; 9:759-61.
4. Poleksic S. Keratoacanthoma and multiple carcinomas. Br J Dermatol. 1974; 91:461-3.
5. Caccialanza M, Sopelana N. Radiation therapy of keratoacanthomas: results in 55 patients. Int J Radiat Oncol Biol Phys. 1989; 16:475-7.
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