title: Nonmelanoma skin cancer in survivors of childhood and adolescent cancer: a report from the childhood cancer survivor study.
abstract: OBJECTIVE
  Nonmelanoma skin cancer (NMSC) has become the most common type of cancer in many populations throughout the world. Ultraviolet and ionizing radiation are known risk factors. Because NMSCs are rarely lethal and most cancer registries do not routinely report data regarding these cancers, they have received little attention in studies evaluating long-term effects of cancer therapy. This article reports on the occurrence of secondary NMSC as a long-term effect of cancer therapy in survivors of childhood cancer.
  
  
  METHODS
  The Childhood Cancer Survivor Study (CCSS) is a cohort study of 5-year survivors of childhood and adolescent cancer from 25 participating institutions in North America. NMSC patients were defined by a history of basal cell or squamous cell carcinoma of the skin after primary malignancy treatment. Demographic and treatment data were collected and analyzed.
  
  
  RESULTS
  Among the 13,132 eligible CCSS participants, 213 have reported NMSC; 99 patients (46%) have had multiple occurrences. Median age of occurrence was 31 years (range, 7 to 46 years). Location of NMSC included head and neck (43%), back (24%), chest (22%), abdomen and pelvis (5%), extremity (3%), and unknown (4%). Ninety percent of patients had previously received radiation therapy (RT); 90% of tumors occurred within the RT field. RT was associated with a 6.3-fold increase in risk (95% CI, 3.5- to 11.3-fold).
  
  
  CONCLUSIONS
  Long-term survivors of childhood and adolescent cancer who were treated with RT are at highest risk for developing NMSC. Educational efforts need to be directed to this population to facilitate early diagnosis of NMSC and reduction in sun exposure.
authors.affiliation: Children's Hospitals and Clinics, 2525 Chicago Ave S, Ste 4150, Minneapolis, MN 55404, USA. joanna.perkins@childrenshc.org
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Perkins
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.forename: Pauline A
authors.initials: PA
authors.lastname: Mitby
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Neglia
authors.forename: Sue
authors.initials: S
authors.lastname: Hammond
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Anna T
authors.initials: AT
authors.lastname: Meadows
authors.forename: Ray
authors.initials: R
authors.lastname: Hutchinson
authors.forename: Zoann E
authors.initials: ZE
authors.lastname: Dreyer
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
mesh_terms: D000293:Adolescent; D000328:Adult; D002280:Basal Cell Carcinoma / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009656:North America; D012307:Risk Factors; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D017741:Survivors