lncidence and lmplications of Skin Cancers in Chronic Lymphocytic Leukemia (cLL)

Abstract

A recent population-based study in Manitoba showed that skin cancers are very common in chronic lymphocytic leukemia (CLL), probably as a result of immunosuppression. We have now studied 592 newly diagnosed CLL patients attending the CancerCare Manitoba CLL Clinic from 2002 until 2012. The median age at diagnosis of CLL was 67 years (range, 36-99) with a M:F ratio of 1.6.1. The median follow-up was 4.63 years (range, 0.0't-11.00 years). There were 133 (22.39o/o) patients with skin cancers, half having skin cancers before the CLL diagnosis (pre- CLL) and half following the diagnosis (post-CLL). ln the pre-CLL group, the risk of skin cancer increased 5-6 years before the CLL diagnosis indicating that immunosuppression can precede the diagnosis of CLL. For all patients, the risk of skin cancer correlated with Rai stage and duration of disease. Of 368 total skin cancers, 208 (56.520lo) were basal cell carcinomas (BCC), 92 (25.00yo) squamous cell carcinomas (SCC), 47 (12.77o/o) Bowen's disease, 18 (4.89%) melanomas, and 3 (0.82o/o) Merkel cell carcinomas (MCC). Multiple skin cancers occurred in half the patients. 22.72o/o patients died, usually from second malignancies or CLL. There were three deaths from skin cancer, two melanomas and one BCC. ln summary, one-quarter of CLL patients developed skin cancer, and this was predictive for developing a solid tumor. CLL patients, particularly those with advanced Rai stage, require regular surveillance screening for other cancers, especially those of the skin.