Risk Factors and Outcomes of Nonmelanoma Skin Cancer in Children and Young Adults

Jennifer T. Huang, Carrie C. Coughlin, Elena B. Hawryluk, Kristen Hook, Stephen R. Humphrey, Lacey Kruse, Leslie Lawley, Hasan Al-Sayegh, Wendy B. London, Ashfaq Marghoob, Thuy L. Phung, Elena Pope, Pedram Gerami, Birgitta Schmidt, Sarah Robinson, Diana Bartenstein, Eman Bahrani, Meera Brahmbhatt, Lily Chen, Ellen HaddockDanny Mansour, Julie Nguyen, Tom Raisanen, Gary Tran, Kate Travis, Zachary Wolner, Lawrence F. Eichenfield

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objective: To identify risk factors associated with nonmelanoma skin cancer (NMSC) occurrence and survival in children. Study design: This was a multicenter, retrospective, case-control study of patients <20 years of age diagnosed with NMSC between 1995 and 2015 from 11 academic medical centers. The primary outcome measure was frequency of cases and controls with predisposing genetic conditions and/or iatrogenic exposures, including chemotherapy, radiation, systemic immunosuppression, and voriconazole. Results: Of the 124 children with NMSC (40 with basal cell carcinoma, 90 with squamous cell carcinoma), 70% had at least 1 identifiable risk factor. Forty-four percent of the cases had a predisposing genetic condition or skin lesion, and 29% had 1 or more iatrogenic exposures of prolonged immunosuppression, radiation therapy, chemotherapy, and/or voriconazole use. Prolonged immunosuppression and voriconazole use were associated with squamous cell carcinoma occurrence (cases vs controls; 30% vs 0%, P =.0002, and 15% vs 0%, P =.03, respectively), and radiation therapy and chemotherapy were associated with basal cell carcinoma occurrence (both 20% vs 1%, P <.0001). Forty-eight percent of initial skin cancers had been present for >12 months prior to diagnosis and 49% of patients were diagnosed with ≥2 skin cancers. At last follow-up, 5% (6 of 124) of patients with NMSC died. Voriconazole exposure was noted in 7 cases and associated with worse 3-year overall survival (P =.001). Conclusions: NMSC in children and young adults is often associated with a predisposing condition or iatrogenic exposure. High-risk patients should be identified early to provide appropriate counseling and management.

Original languageEnglish (US)
Pages (from-to)152-158
Number of pages7
Journaljournal of pediatrics
StatePublished - Aug 2019


  • basal cell nevus syndrome
  • chemotherapy
  • genodermatosis
  • iatrogenic
  • prolonged immunosuppression
  • radiation therapy
  • voriconazole
  • xeroderma pigmentosum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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