YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==SQUAMOUS CARCINOMA - SKIN== 2 AUTHOR Gloster HM Jr AUTHOR Brodland DG TITLE The epidemiology of skin cancer. SOURCE Dermatol Surg; VOL 22, ISS 3, 1996, P217-26 (REF: 159) ABSTRACT BACKGROUND: The incidence of skin cancer is increasing at an alarming rate. OBJECTIVE: To discuss current epidemiologic data concerning the incidence, morbidity, environmental influences, predisposing, host conditions, precursor lesions, and prevention of melanoma and nonmelanoma (basal and squamous cell) skin cancer. METHODS: The current literature was reviewed in order to provide current epidemiologic data for melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). RESULTS: Skin cancer is exceedingly common and the incidence is rising rapidly. Although the mortality rate for nonmelanoma skin cancer (NMSC) is decreasing, that of melanoma is increasing. Both NMSC and melanoma are associated with significant morbidity. Whereas chronic sun exposure is the main cause of NMSC, the development of melanoma appears to be related to intense, intermittent sun exposure. Ozone depletion has contributed to rising incidence rates of both NMSC and melanoma. In contrast to NMSC, there is not a direct relationship between ultraviolet radiation and melanoma. Genetic susceptibility significantly increases the lifetime risk of acquiring melanoma. There is no precursor lesion for BCC. Precursor lesions for invasive SCC include actinic keratoses and SCC in situ. Melanoma may arise from benign nevi and dysplastic nevi. Prevention of melanoma and NMSC is extremely important since prognosis improves with early detection. Prevention may be achieved by educating patients and physicians how to detect skin cancers early and by decreasing or eliminating exposure to ultraviolet light. CONCLUSION: The incidence of skin cancer has reached epidemic proportions. Only through heroic efforts by health care professionals and the general public to prevent the development or progression of skin cancer will this epidemic be abated. 3 AUTHOR Marks R AUTHOR Motley RJ TITLE Skin cancer. Recognition and treatment. SOURCE Drugs; VOL 50, ISS 1, 1995, P48-61 (REF: 46) ABSTRACT There is a worldwide increasing incidence of all forms of skin cancer among Whites as a result of increased sun exposure. Basal cell and squamous cell carcinomas, the most common tumours of the head and neck, are relatively benign neoplasms of elderly individuals. Malignant melanoma, however, has the potential for early metastasis and may occur in early adult life. The increase in malignant melanoma is particularly disturbing, and is a clear indication for skin screening clinics. Although surgical excision is the primary treatment of choice for skin tumours, various drugs may be of therapeutic value. Fluorouracil cream is a useful treatment for solar keratoses. Retinoids are particularly suitable for patients with large numbers of nonmelanoma skin cancer lesions and solar keratoses. For malignant melanoma, arterial limb perfusion with high concentrations of cytotoxic drugs may be performed both as an adjunctive and therapeutic manoeuvre. Treatment of metastatic melanoma with cytotoxic agents is associated with low response rates and high toxicity. However, trials with combined interferon-alpha, interleukin-2 and cytostatic drugs have produced promising preliminary results. 15 AUTHOR Urbach F TITLE Incidence of nonmelanoma skin cancer. SOURCE Dermatol Clin; VOL 9, ISS 4, 1991, P751-5 (REF: 24) ABSTRACT Nonmelanoma skin cancers are the most common malignant neoplasms of fair-skinned people, in many sunny countries exceeding the total of all other neoplasms. The evidence that the primary causal agent is chronic repeated exposure to solar ultraviolet radiation is overwhelming. The incidence of basal cell carcinoma is always greater than that of squamous cell carcinoma, varying by latitude from 10:1 to 2.5:1. The incidence of nonmelanoma skin cancer has been increasing by 2% to 3% per year, at least in the United States. Most likely, this is caused by greater outdoor exposure for leisure and social reasons. 19 AUTHOR Pollack SV TITLE Skin cancer in the elderly. SOURCE Clin Geriatr Med; VOL 3, ISS 4, 1987, P715-28 (REF: 56) ABSTRACT Skin cancer is a major concern in geriatric populations. Cumulative exposure to carcinogens and age-related factors both contribute to the high prevalence of cutaneous malignancy in the elderly. Although mortality rates from skin cancer are relatively low, morbidity can be significant, particularly if lesions are neglected. Physicians can have a major impact on the course of basal cell carcinoma, squamous cell carcinoma, and malignant melanoma by nurturing a high index of suspicion for malignancy when unexplained cutaneous lesions are encountered. 1 AUTHOR FRISCH M AUTHOR MELBYE M TITLE New primary cancers after squamous cell skin cancer. SOURCE AMERICAN JOURNAL OF EPIDEMIOLOGY; 141 (10). 1995. 916-922. ABSTRACT BIOSIS COPYRIGHT: BIOL ABS. In a search for clues to the origin of squamous cell skin cancer (SCC), the authors investigated the pattern of new cancers in a cohort of 5,100 SCC patients whose tumors were diagnosed during the years 1978-1989 and recorded in the Danish Cancer Registry. Subsequent cancer experiences in SCC patients were compared with the cancer incidence in the Danish population using ratios of observed cancers to expected cancers as a measure of the relative risk. Overall, patients with SCC were at increased risk of new malignancies (relative risk (RR) = 1.6, 95% confidence interval (CI) 1.5-1.7). Significantly elevated risks were found for cancers of the respiratory organs (RR = 1.7, 95% CI 1.4-2.0); cancers of the lip, buccal cavity, and pharynx (RR = 3.1, 95% CI 2.1-4.5); non-Hodgkin's lymphoma (RR = 2.3, 95% CI 1.4-3.5); leukemia (RR = 2.5, 95% CI 1.7-3.5); malignant melanoma (RR = 2.6, 95% CI 1.5-4.3); and cancer of the small intestine in men (RR = 4.1, 95% CI 1.1-10.6). The risk of new cancers (other than nonmelanoma skin cancers) was higher in patients diagnosed with SCC before the age of 60 years (RR = 1.9, 95% CI 1.5-2.5) than in those diagnosed with SCC at or after that age (RR = 1.3, 95% CI 1.2-1.4). The data confirmed previous strong associations between SCC and malignant melanoma and cancers of the major salivary glands. A previously undocumented significant excess of smoking-related cancers was observed after an SCC diagnosis, suggesting that smoking may be involved in the development of SCC. Since a variety of other squamous cell cancers have already been linked to smoking, the authors speculate that some general effect of smoking might act on all human squamous epithelia. The observed significant associations with lymphoma and leukemia and the high risk of subsequent malignancies in young SCC patients merit further attention. 1 AUTHOR Panizzon RG TITLE [Roentgen therapy of malignant skin tumors] SOURCE Ther Umsch; VOL 50, ISS 12, 1993, P835-40 (REF: 6) ABSTRACT In dermatologic oncology several good indications for radiotherapy are known. Precancerous lesions can be treated by grenz rays, as e.g. large senile (actinic) keratoses, lentigo maligna or large lesions of Bowen's disease or Queyrat's erythroplasia. Well-known indications are also mid-sized basal cell and squamous cell carcinomas, especially in the face of elderly patients. The lentigo-maligna melanoma should no longer be considered a radioresistant tumor, and it must be stressed that larger lesions can be successfully treated by radiotherapy. Dermato-radiotherapy shows also excellent palliative results, e.g. in cutaneous T-cell lymphomas such as mycosis fungoides, but also in Kaposi's sarcoma either of the classical type or AIDS-associated. In conclusion, radiotherapy is a good alternative treatment modality, especially in elderly patients, since it is painless and is possible on an outpatient basis with excellent functional results. 6 AUTHOR Mark RJ AUTHOR Poen J AUTHOR Tran LM AUTHOR Fu YS AUTHOR Selch MT AUTHOR Parker RG TITLE Postirradiation sarcomas. A single-institution study and review of the literature. SOURCE Cancer; VOL 73, ISS 10, 1994, P2653-62 (REF: 109) ABSTRACT BACKGROUND. With improvement in survival after cancer treatment, it is becoming increasingly important to examine treatment-related morbidity and mortality. Sarcomas can develop in the irradiated field after radiation therapy (RT). The authors undertook a study to estimate the risk, and compared the risk of postirradiation sarcoma (PIS) with other treatment modalities used against cancer. METHODS. Since 1987 the authors have reviewed the records of 1089 patients with head and neck, gynecologic, gastrointestinal, and extremity sarcomas. Of these 1089 patients, 37 had a prior history of RT. RESULTS. Conditions for which these patients received RT included: Hodgkin's disease (2 patients), retinoblastoma (3), non-Hodgkin's lymphoma (2), acne (1), astrocytoma (1), multiple recurrent mixed parotid tumor (1), laryngeal cancer (1), papillary adenocarcinoma of the thyroid (1), bony fibrous dysplasia (1), lymphangioma (1), squamous cell carcinoma of the nasopharynx (1), Ewing's sarcoma (1), choriocarcinoma (1), menorrhagia (4), cervical cancer (6), ovarian cancer (2), breast cancer (7), and hypoplasia (1). RT doses ranged from 3000 to 12,440 cGy. Latency time from RT to the development of PIS averaged 12 years. More than 15,000 patients have received RT for various conditions at our institution since 1955. CONCLUSIONS. From our data and a review of the literature, we estimate the risk of PIS with long-term follow-up to be 0.03-0.8%. From a review of the literature that compared mortality risks of chemotherapy, general surgery, and anesthesia, the risk of PIS appears no worse. Thus, given the large number of patients who can be cured or receive palliative treatment with RT, concern regarding PIS should not be a major factor influencing treatment decisions in patients with cancer.