REPLY
New Types of Cancer after Basal-Cell Cancer
Morten Frisch, MD, PhD;
Henrik Hjalgrim, MD; and
Mads Melbye, MD, DMSc
1 July 1997 | Volume 127 Issue 1 | Pages 87-88
IN RESPONSE:
Primary care physicians, like other physicians, truly face overwhelming amounts of scientific information every day. As stated in our article, we agree with Dr. Stewart that breast and scrotal symptoms and lymph node enlargement should always prompt serious evaluation. However, we believed that, because of the substantial evidence that this applies even more so in the large group of patients with a history of basal-cell carcinoma, it was appropriate to further stress the importance of vigilance in examining noncutaneous symptoms in these patients.
The clinical impression described by Dr. Shimm-that the incidence of cancer is elevated over the background rate in patients with keratoacanthoma-may well be true. However, unlike the population-based data we and others have presented for patients with basal-cell carcinomas [1] and squamous-cell carcinomas [2, 3] and the elevated risk for subsequent extracutaneous cancer in these patients, the impression that keratoacanthoma is also followed by higher rates of extracutaneous cancer is not founded on evidence from unselected population-based follow-up studies of patients with this skin disorder. Cohort studies that distinguish sharply between cancer preceding the keratoacanthoma and those occurring after are needed to clarify whether the impression by Dr. Shimm and others is correct.
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Author and Article Information
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Danish Epidemiology Science Centre; Copenhagen, Denmark
1. Lindelof B, Sigurgeirsson B, Wallberg P, Eklund G. Occurrence of other malignancies in 1973 patients with basal cell carcinoma. J Am Acad Dermatol. 1991; 25:245-8.
2. Frisch M, Melbye M. New primary cancers after squamous cell skin cancer. Am J Epidemiol. 1995; 141:916-22.
3. Teppo L, Pukkala E, Saxen E. Multiple cancer-an epidemiologic exercise in Finland. J Natl Cancer Inst. 1985; 75:207-17.
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