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Margaret R. Karagas, PhD; Thérèse A. Stukel, PhD; E. Robert Greenberg, MD; John A. Baron, MD; Leila A. Mott, MS; Robert S. Stern, MD; the Skin Cancer Prevention Study Group

JAMA. 1992;267(24):3305-3310.

Abstract
Objective.
—The primary aims of this study were to assess risk of subsequent basal and squamous cell skin cancer among patients with a prior history of these tumors and to examine these risks in relation to patient characteristics and life-style factors.

Design.
—Follow-up of participants in a randomized trial of betacarotene as a possible skin cancer preventive agent.

Setting.
—Clinical centers in Los Angeles, Calif, San Francisco, Calif, Minneapolis, Minn, and Hanover, NH.

Participants.
—Patients (n=1805) who were diagnosed as having a basal or squamous cell skin cancer between January 1980 and February 1986 and were free of skin cancer at study entry.

Main Outcome Measure.
—Time from study entry to first new occurrence of basal and squamous cell skin cancer.

Results.
—The estimated risk of developing one or more new skin cancers was 35% at 3 years and 50% at 5 years. New skin cancers tended to be of the same cell type as the previous skin cancers. For both basal and squamous cell skin cancer, risk was higher among patients who were male, were over the age of 60 years, had more prior skin cancers, had severe actinic skin damage, or who burned easily with sun exposure. Compared with those who had never smoked, the rate of subsequent squamous cell skin cancer was higher among current smokers (rate ratio, 2.01; 95% confidence interval,1.21 to 3.34) and former smokers (rate ratio,1.62; 95% confidence interval, 1.07 to 2.47) and increased with both duration and amount smoked. There was no clear relationship between smoking and basal cell skin cancer; the rate appeared lower among heavy smokers but was unrelated to duration of smoking.

Conclusions.
—Persons with a prior nonmelanoma skin cancer had a substantial 5-year risk of developing another tumor of the same histologic type. Number of previous skin cancers, solar damage, and skin sensitivity to sun exposure were particularly related to this risk. The increased risk of squamous cell skin cancer associated with cigarette smoking merits further study.

(JAMA. 1992;267:3305-3310)

Author Affiliations
From the Department of Community and Family Medicine (Drs Karagas, Stukel, Greenberg, and Baron and Ms Mott), Department of Medicine (Dr Baron), and the Norris Cotton Cancer Center (Drs Karagas, Stukel, Greenberg, and Baron and Ms Mott), Dartmouth Medical School, Hanover, NH, and the Department of Dermatology, Beth Israel Hospital, Harvard Medical School, Boston, Mass (Dr Stern).

Footnotes
A complete list of the members of the Skin Cancer Prevention Study Group and their affiliations appears at the end of the article.

Reprint requests to Dartmouth Medical School, Hinman Box 7927, Hanover, NH 03755-3861 (Dr Karagas).

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