Epidemiology, prevention, screening and surveillance of NMSC (continued)
Risk factors for MCC are immunosuppression, older age and UV damage. The majority of tumours are associated with the Merkel cell polyomavirus.
Incidence is rising with approximately 2500 new cases per year in Europe (very rare), but its highly aggressive growth and disseminated spreading leads to a disease-specific mortality rate in the range of 25%-50%.
Screening is unwarranted due to the low incidence. Selection of immunosuppressive medication in dependant patients may be a crucial factor for prevention.
Primary cutaneous T- (CTCL) and B- (CBCL) cell lymphomas are incurable, primary extra-nodal lymphomas of major T or B cells, respectively.
The most frequent CTCL is mycosis fungoides, which is a slowly progressing, low-grade lymphoma, clinically presenting with patches, plaques, nodules, ulcerations, but also potentially organ involvement and fatal outcome.
CBCLs are a rather rare entity with an overall incidence of 3.9/1 000 000 between 2006 and 2010. They present a heterogeneous group of malignancies, varying from slowly recurring courses to those with rapid courses.
Although rare in Europe, Kaposi’s sarcoma is one of the most common neoplasms of people living with human immunodeficiency virus (HIV), with high incidences in some regions of Africa.
Overall, many patients show an immunosuppressed baseline status when developing skin cancer; this is also a risk factor for invasiveness and prognosis.
Increased awareness and regular screening of patients at risk may help to increase early diagnosis and improve outcomes in young and elderly patients.
Revision Questions
- Name three risk factors for MCC.
- From which cells do cutaneous lymphomas arise?
- What different kinds of immunosuppression are known risk factors for skin cancer development?
