Skin Cancers in Patients with Actinic Keratoses Cassandra Mohr, BS 1 , Yao Li, MS 1,2 , Lucy J Navsaria, MBBCh BAO MPH 1 , Candice L Hinkston, MPH 1 , Mackenzie R Wehner, MD MPhil 1,3*
1 Department of Health Services Research, University of Texas MD Anderson Cancer Center , 2 Department of Biostatistics, University of Texas MD Anderson Cancer Center, 3 Department of Dermatology, University of Texas MD Anderson Cancer Center
INTRODUCTION
Table 1: Patient Demographics
Figure 3: Cumulative Incidence Curve- Melanoma
Characteristic Total, n (%)
AK
SK
P-value
• 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-studied
760412 (61.25%) 481024(38.75%)
Age at diagnosis, y, mean ± SD Race and ethnicity, n (%)
74.42 ±7.63
73.32±7.3 <0.0001
<0.0001
African American
2075 (0.27%) 6052 (0.8%)
12145 (2.52%) 10498 (2.18%)
Asian
Hispanic
13583 (1.79%) 16219 (3.37%) 724679 (95.3%) 431037 (89.61%)
Non-Hispanic White North American Native
1335 (0.18%)
1304 (0.27%)
Gender, n (%)
<0.0001
Female
418994 (55.1%) 348367 (72.42%) 341418 (44.9%) 132657 (27.58%) 486482 (63.98%) 335632 (69.77%) 234238 (30.8%) 123675 (25.71%) 39692 (5.22%) 21717 (4.51%)
Male
OBJECTIVE
State UV index
<0.0001
Low (5 or lower) Medium (6-7) High (8 or higher)
To examine absolute and relative risks of skin cancer in patients with AKs to guide clinical care and form the foundation for future recommendations.
Was the first AK or first SK in a dermatology visit?
<0.0001
Yes No
514924 (67.72%) 245488 (32.28%)
315905 165119
Figure 1: Cumulative Incidence Curve-Skin Cancer
RESULTS
• 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
METHODS
• 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 regressions
CONCLUSION
Figure 2: Cumulative Incidence Curve- KC
• 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
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