title: Increased cancer mortality following a history of nonmelanoma skin cancer.
abstract: BACKGROUND
  Cancer registries have reported an increased incidence of melanoma and certain noncutaneous cancers following nonmelanoma skin cancer (NMSC). Whether these findings were attributable to intensified surveillance, shared risk factors, or increased cancer susceptibility remains unclear.
  
  
  OBJECTIVE
  To determine whether a history of NMSC predicts cancer mortality.
  
  
  METHODS
  Prospective cohort with 12-year mortality follow-up adjusted for multiple risk factors.
  
  
  METHODS
  Cancer Prevention Study II, United States and Puerto Rico.
  
  
  METHODS
  Nearly 1.1 million adult volunteers who completed a baseline questionnaire in 1982.
  
  
  METHODS
  Deaths due to all cancers and common cancers.
  
  
  RESULTS
  After adjusting for age, race, education, smoking, obesity, alcohol use, and other conventional risk factors, a baseline history of NMSC was associated with increased total cancer mortality (men's relative risk [RR], 1.30; 95% confidence interval [CI], 1.23-1.36; women's RR, 1.26; 95% CI, 1.17-1.35). Exclusion of deaths due to melanoma reduced these RRs only slightly. Mortality was increased for the following cancers: melanoma (RR, 3.36 in men, 3.52 in women); pharynx (RR, 2.77 in men, 2.81 in women); lung (RR, 1.37 in men, 1.46 in women); non-Hodgkin lymphoma (RR, 1.32 in men, 1.50 in women); in men only, salivary glands (RR, 2.96), prostate (RR, 1.28), testis (RR, 12.7), urinary bladder (RR, 1.41), and leukemia (RR, 1.37); and in women only, breast (RR, 1.34). All-cause mortality was slightly increased (adjusted men's RR, 1.03 [95% CI, 1.00-1.06]; women's RR, 1.04 [95% CI, 1.00-1.09]).
  
  
  CONCLUSIONS
  Persons with a history of NMSC are at increased risk of cancer mortality. Although the biological mechanisms are unknown, a history of NMSC should increase the clinician's alertness for certain noncutaneous cancers as well as melanoma.
authors.affiliation: Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA. hkahn@emory.edu
authors.forename: H S
authors.initials: HS
authors.lastname: Kahn
authors.forename: L M
authors.initials: LM
authors.lastname: Tatham
authors.forename: A V
authors.initials: AV
authors.lastname: Patel
authors.forename: M J
authors.initials: MJ
authors.lastname: Thun
authors.forename: C W
authors.initials: CW
authors.lastname: Heath
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011647:Puerto Rico / Q000453:epidemiology; D012307:Risk Factors; D012878:Skin Neoplasms / Q000401:mortality*; D014481:United States / Q000453:epidemiology