Actinic keratosis-related signs predictive of squamous cell carcinoma in renal transplant recipients: a nested case-control study

Jiyad, Z., O'Rourke, P., Soyer, H.P. and Green, A.C. (2017) Actinic keratosis-related signs predictive of squamous cell carcinoma in renal transplant recipients: a nested case-control study. British Journal of Dermatology, 176 4: 965-970. doi:10.1111/bjd.15019

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Author Jiyad, Z.
O'Rourke, P.
Soyer, H.P.
Green, A.C.
Title Actinic keratosis-related signs predictive of squamous cell carcinoma in renal transplant recipients: a nested case-control study
Journal name British Journal of Dermatology   Check publisher's open access policy
ISSN 0007-0963
1365-2133
Publication date 2017-04-01
Year available 2017
Sub-type Article (original research)
DOI 10.1111/bjd.15019
Open Access Status File (Author Post-print)
Volume 176
Issue 4
Start page 965
End page 970
Total pages 6
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Subject 2708 Dermatology
Abstract Background: Squamous cell carcinoma (SCC) and intraepidermal carcinoma (IEC) commonly arise in actinically damaged skin. Objectives: To identify clinical features of actinic change that correlate with an increased risk of SCC or IEC in the short-to-medium term as guidance for prioritizing field treatment. Methods: In a nested case–control study, cases were renal transplant recipients who developed an incident SCC or IEC within 18 months following baseline examination and photography. Controls without SCC or IEC were matched to cases on age, sex and duration of immunosuppression. Predefined skin sites on the head, neck and upper limbs were examined using baseline photographs to assess objectively the following features of actinic damage: presence of actinic keratosis (AK) patch (defined as AK > 1 cm), number of AK patches, number of AKs and area affected by AK. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using McNemar's test to identify differences in SCC/IEC risk combined and SCC risk alone between case and control skin sites. Results: Thirty-nine cases were matched to 39 controls. Significant associations with the presence of an AK patch, number of AK patches, number of AKs and area affected by AKs were identified. The presence of an AK patch conferred an 18-fold increased risk of SCC (OR 18·00, 95% CI 2·84–750) and more than a sixfold increased risk of SCC/IEC combined (OR 6·60, 95% CI 2·56–21·66). Conclusions: AK patches are predictive of SCC/IEC development within 18 months. This can be used to guide site selection for field treatment in patients with widespread actinic damage.
Formatted abstract
Background
Squamous cell carcinoma (SCC) and intraepidermal carcinoma (IEC) commonly arise in actinically damaged skin.

Objective
To identify clinical features of actinic change that correlate with an increased risk of SCC or IEC in the short-medium term as guidance for prioritising field treatment.

Methods
In a nested case-control study, cases were renal transplant recipients (RTRs) who developed an incident SCC or IEC within 18 months following baseline examination and photography. Controls without SCC/IEC were matched to cases on age, sex and duration of immunosuppression. Pre-defined skin sites on head, neck and upper limbs were examined using baseline photographs to objectively assess the following features of actinic damage: presence of actinic keratosis (AK) patch (defined as AK >1cm2), number of AK patches, number of AKs and area affected by AK. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using McNemar's test to identify differences in SCC/IEC risk combined and SCC risk alone between case and control skin sites.

Results
39 cases were matched to 39 controls. Significant associations with the presence of an AK patch, number of AK patches, number of AKs and area affected by AKs were identified. The presence of an AK patch conferred an 18-fold increased risk of SCC (OR 18.00, 95% CI 2.84-750) and a 7-fold increased risk of SCC/IEC combined (OR 6.6, 95% CI 2.56-21.66).

Conclusion
AK patches are predictive of SCC/IEC development within 18 months. This can be used to guide site selection for field treatment in patients with widespread actinic damage.
Keyword Actinic keratosis
Actinic keratosis patch
Field change
Intraepidermal carcinoma
Squamous cell carcinoma
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID 1073898
552429
Institutional Status UQ

 
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Created: Tue, 06 Sep 2016, 22:19:38 EST by Professor Peter Soyer on behalf of School of Medicine