Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA.
Division of Dermatology, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO.
J Pediatr. 2019 Aug;211:152-158. doi: 10.1016/j.jpeds.2019.04.017. Epub 2019 May 15.
To identify risk factors associated with nonmelanoma skin cancer (NMSC) occurrence and survival in children.
This was a multicenter, retrospective, case-control study of patients <20 years of age diagnosed with NMSC between 1995 and 2015 from 11 academic medical centers. The primary outcome measure was frequency of cases and controls with predisposing genetic conditions and/or iatrogenic exposures, including chemotherapy, radiation, systemic immunosuppression, and voriconazole.
Of the 124 children with NMSC (40 with basal cell carcinoma, 90 with squamous cell carcinoma), 70% had at least 1 identifiable risk factor. Forty-four percent of the cases had a predisposing genetic condition or skin lesion, and 29% had 1 or more iatrogenic exposures of prolonged immunosuppression, radiation therapy, chemotherapy, and/or voriconazole use. Prolonged immunosuppression and voriconazole use were associated with squamous cell carcinoma occurrence (cases vs controls; 30% vs 0%, P = .0002, and 15% vs 0%, P = .03, respectively), and radiation therapy and chemotherapy were associated with basal cell carcinoma occurrence (both 20% vs 1%, P < .0001). Forty-eight percent of initial skin cancers had been present for >12 months prior to diagnosis and 49% of patients were diagnosed with ≥2 skin cancers. At last follow-up, 5% (6 of 124) of patients with NMSC died. Voriconazole exposure was noted in 7 cases and associated with worse 3-year overall survival (P = .001).
NMSC in children and young adults is often associated with a predisposing condition or iatrogenic exposure. High-risk patients should be identified early to provide appropriate counseling and management.
确定与儿童非黑色素瘤皮肤癌（NMSC）发生和生存相关的危险因素。
这是一项多中心、回顾性、病例对照研究，纳入了 1995 年至 2015 年期间在 11 个学术医疗中心诊断为 NMSC 的年龄<20 岁的患者。主要观察指标为易患遗传条件和/或医源性暴露（包括化疗、放疗、全身免疫抑制和伏立康唑）的病例和对照的发生频率。
在 124 例患有 NMSC 的儿童中（40 例基底细胞癌，90 例鳞状细胞癌），70%的儿童至少有 1 种可识别的危险因素。44%的病例存在易患遗传条件或皮肤病变，29%的病例有 1 种或多种医源性长期免疫抑制、放疗、化疗和/或伏立康唑使用的暴露史。长期免疫抑制和伏立康唑的使用与鳞状细胞癌的发生相关（病例组 vs 对照组；30% vs 0%，P=0.0002 和 15% vs 0%，P=0.03），放疗和化疗与基底细胞癌的发生相关（均为 20% vs 1%，P<0.0001）。48%的初始皮肤癌在诊断前已存在>12 个月，49%的患者被诊断患有≥2 种皮肤癌。在最后一次随访时，有 5%（124 例患者中的 6 例）患有 NMSC 的患者死亡。在 7 例病例中发现了伏立康唑暴露，且与 3 年总生存率较差相关（P=0.001）。
儿童和年轻成人的 NMSC 常与易患条件或医源性暴露相关。应尽早识别高危患者，以便提供适当的咨询和管理。
