Context.— Cancer registries have reported an increased incidence of melanoma and
certain noncutaneous cancers following nonmelanoma skin cancer (NMSC). Whether
these findings were attributable to intensified surveillance, shared risk
factors, or increased cancer susceptibility remains unclear.
Objective.— To determine whether a history of NMSC predicts cancer mortality.
Design.— Prospective cohort with 12-year mortality follow-up adjusted for multiple
Setting.— Cancer Prevention Study II, United States and Puerto Rico.
Participants.— Nearly 1.1 million adult volunteers who completed a baseline questionnaire
Main Outcome Measure.— Deaths due to all cancers and common cancers.
Results.— After adjusting for age, race, education, smoking, obesity, alcohol
use, and other conventional risk factors, a baseline history of NMSC was associated
with increased total cancer mortality (men's relative risk [RR], 1.30; 95%
confidence interval [CI], 1.23-1.36; women's RR, 1.26; 95% CI, 1.17-1.35).
Exclusion of deaths due to melanoma reduced these RRs only slightly. Mortality
was increased for the following cancers: melanoma (RR, 3.36 in men, 3.52 in
women); pharynx (RR, 2.77 in men, 2.81 in women); lung (RR, 1.37 in men, 1.46
in women); non-Hodgkin lymphoma (RR, 1.32 in men, 1.50 in women); in men only,
salivary glands (RR, 2.96), prostate (RR, 1.28), testis (RR, 12.7), urinary
bladder (RR, 1.41), and leukemia (RR, 1.37); and in women only, breast (RR,
1.34). All-cause mortality was slightly increased (adjusted men's RR, 1.03
[95% CI, 1.00-1.06]; women's RR, 1.04 [95% CI, 1.00-1.09]).
Conclusions.— Persons with a history of NMSC are at increased risk of cancer mortality.
Although the biological mechanisms are unknown, a history of NMSC should increase
the clinician's alertness for certain noncutaneous cancers as well as melanoma.