Epidemiology of Keratinocyte Carcinoma

Abstract

Purpose of the review To provide a synopsis of recent research advances in the epidemiology of keratinocyte carcinoma (KC), with a focus on indoor tanning and known risk factors for other forms of cancer such as cigarette smoking and alcohol drinking. Recent findings The evidence is strong enough to infer that use of UVR-emitting indoor tanning devices cause KC. Epidemiologic studies of cigarette smoking, alcohol drinking, and menopausal hormone therapy all show some suggestion for increased risk of KC but the evidence is not yet strong enough to determine if there is a true etiologic role. Body mass index is clearly inversely associated with KC risk but this is more likely to be due to lower UVR exposure in overweight and obese individuals than it is due to a true etiologic role. Summary The epidemic of KC continues unabated, and the causal role of indoor tanning is contributing to this unfavorable trend in KC incidence rates. Advances in understanding the etiology of KC should not divert attention away from the fact that the primary public health strategy to prevent KC is known: minimize population exposure to UVR from the sun and from UVR-emitting indoor tanning devices, particularly among those with sun-sensitive phenotypes.

Mechanisms of UV-induced mutations and skin cancer

“…The incidence of non-melanoma skin cancers derived from epidermal cells (both basal and squamous cell carcinoma) increases with age (Albert et al 2019). There has been a quite dramatic increase of these types of cancers in many parts of the world recently (Perry et al 2017). It has long been known that basal and squamous cell skin cancers are strongly linked to UV exposure from the sun.…”

Characteristics of State and Federal Malpractice Litigation of Medical Liability Claims for Keratinocyte Carcinoma, 1968 to 2018

“…23 A large proportion of cases that led to malpractice litigation occurred in the face, head, and/or neck; this finding reflects the increased incidence of KC on sunexposed areas and the cosmetic importance of facial health and appearance, which may lead to an increased likelihood of malpractice litigation for KCs that affect the face. 5,24,25 We identified more than 15 specialties involved in malpractice litigation involving KCs and found significant differences in monetary payout by health care professional specialty in cases won by the plaintiff. Although more nondermatologists are performing dermatologic procedures, increased risk of litigation has previously been associated with laser surgery by nonphysician operators compared with dermatologists.…”

Genetic and environmental factors underlying keratinocyte carcinoma risk

“…Compared with normal weight individuals, overweight and obese individuals have reduced risks of KC development (RR 0.93, 95% CI 0.89-0.99, and RR 0.86, 95% CI 0.80-0.91, respectively) (58). This inverse association between BMI and KC risk tends to be stronger in women and has not been consistently found in men (59). The pathophysiology behind the lower KC risk with obesity is unknown, but it is hypothesized that individuals with higher BMI may have reduced outdoor time and therefore less UV exposure or that higher estrogen levels due to obesity are protective against BCC and SCC, as seen in mouse models (58,60).…”