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Hinkston, Candice L

Li, Yao

Mohr, Cassandra

Navsaria, Lucy J

Wehner, Mackenzie R

English

OpenWorks @ MD Anderson

Skin Cancers in Patients with Actinic KeratosesCassandra Mohr, BS1, Yao Li, MS1,2, Lucy J Navsaria, MBBCh BAO MPH1, Candice L Hinkston, MPH1, Mackenzie R Wehner, MD MPhil1,3*1Department of Health Services Research, University of Texas MD Anderson Cancer Center , 2Department of Biostatistics, University of Texas MD Anderson Cancer Center, 3Department of Dermatology, University of Texas MD Anderson Cancer CenterINTRODUCTIONRESULTSOBJECTIVEMETHODSCONCLUSION• Actinic keratoses (AKs) are premalignant skin lesions often diagnosed in older, Caucasian adults • AKs are exceptionally common• Individual AKs have a low risk of progression to SCC• The overall skin cancer risk of AK patients is not well-studiedTo examine absolute and relative risks of skin cancer in patients with AKs to guide clinical care and form the foundation for future recommendations.• Retrospective cohort study of 4,999,999 de-identified Medicare beneficiaries (2009-2018)• Inclusion Criteria: • AK cohort: AK diagnosis with treatment (cryotherapy, PDT, or medication)• SK cohort: SK diagnosis without history of AK diagnosis• Exclusion criteria: • History of skin cancer• HIV/AIDS• Solid organ transplant• Primary outcome: any surgically treated skin cancer• Analysis: • Absolute risk of skin cancer in patients with AK using cumulative incidence curves• Relative risk of skin cancer in AK patients vs. SK patients using hazard ratios and competing risk regressionsFigure 1: Cumulative Incidence Curve-Skin Cancer Figure 2: Cumulative Incidence Curve- KC Characteristic AK SK P-valueTotal, n (%) 760412 (61.25%) 481024(38.75%)Age at diagnosis, y, mean ±SD74.42 ±7.63 73.32±7.3 <0.0001Race and ethnicity, n (%) <0.0001African American 2075 (0.27%) 12145 (2.52%)Asian 6052 (0.8%) 10498 (2.18%)Hispanic 13583 (1.79%) 16219 (3.37%)Non-Hispanic White 724679 (95.3%) 431037 (89.61%)North American Native 1335 (0.18%) 1304 (0.27%)Gender, n (%) <0.0001Female 418994 (55.1%) 348367 (72.42%)Male 341418 (44.9%) 132657 (27.58%)State UV index <0.0001Low (5 or lower) 486482 (63.98%) 335632 (69.77%)Medium (6-7) 234238 (30.8%) 123675 (25.71%)High (8 or higher) 39692 (5.22%) 21717 (4.51%)Was the first AK or first SK in a dermatology visit?<0.0001Yes 514924 (67.72%) 315905No 245488 (32.28%) 165119Table 1: Patient Demographics Figure 3: Cumulative Incidence Curve- Melanoma• A total of 555,945 patients (53.61%) patients had AKs and 481,024 (46.39%) had SKs• Patients had a mean follow-up of 5.63 (SD 2.75) years for patients with AKs and 4.55 (SD 2.74) years for patients with SKs• Absolute risk of skin cancer after a first AK was: • 1-year: 6.30% (95% CI 6.27%-6.40%)• 2-year: 12.70% (95% CI 12.60%-12.79%)• 3-year: 18.40% (95% CI 18.25-18.47%)• 4-year: 23.60% (95% CI 23.48%-23.73%)• Patients with AKs had a significantly increased risk for future skin cancer compared with patients with SKs (adjusted for age, race, gender, and UV index): • Hazard ratio: 2.17, 95% CI 2.15-2.19• Patients with AKs are at significantly increased risk of skin cancer, with nearly 1 out of 4 having a skin cancer within 4 years• Patients with AKs require heightened attention, and efforts to create guidelines for skin cancer surveillance for these patients is paramount

Skin Cancers in Patients with Actinic Keratoses

https://openworks.mdanderson.org/cgi/viewcontent.cgi?article=1034&context=leading-edge

Skin Cancers in Patients with Actinic Keratoses

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