Retrospective review of patients with chronic lymphocytic leukemia treated with Mohs surgery for nonmelanoma skin cancer

• DOI: 10.1016/j.jdin.2023.08.006
• Publication Date: 2023-08-19T21:25:19Z
• Authors: Annika P. Weinhammer; Kristen L. Chen; Yaohui G. Xu
• Keywords: Mohs surgery

To the Editor: There is a higher incidence of nonmelanoma skin cancer in patients with chronic lymphocytic leukemia and it seems to exhibit heightened aggressive nature rates recurrence after Mohs surgery.1Mehrany K. Weenig R.H. Pittelkow M.R. Roenigk R.K. Otley C.C. High basal cell carcinoma surgery leukemia.Arch Dermatol. 2004; 140: 985-988Crossref PubMed Scopus (61) Google Scholar,2Mehrany squamous Mohs' leukemia.Dermatol Surg. 2005; 31: 38-42Crossref (79) Scholar are many postulated reasons no well-defined pathogenesis.3Ravandi F. O'Brien S. Immune defects leukemia.Cancer Immunol Immunother. 2006; 55: 197-209Crossref (117) Interpretation histological section can often be complicated by presence dense, monomorphic infiltrates as may not clear whether infiltrate part leukemic process or reaction residual carcinoma.4Wilson M.L. Elston D.M. Tyler W.B. Marks V.J. Ferringer T. Dense associated non-melanoma Online J. 2010; 16: 4Crossref We performed an institutional review board–approved retrospective all treated at University Wisconsin Madison within past 20 years propose following: (1) demographics, (2) tumor characteristics outcomes, (3) frequency patterns peritumoral (defined dense collections mononuclear aggregates approximately 50 cells more) on slides, (4) correlation disease severity time surgery. For each patient selected, we reviewed slides tumors 10 years. Twenty (6 females, 14 males) 119 were included. for 82 The included 64 carcinomas (SCCs), 38 carcinomas, 16 situ, 1 "carcinoma." Brigham Women Hospital staging (for SCCs) 35 T1 (54.7%), 19 T2a (29.7%), 8 T2b (12.5%), 2 T3 (3.1%). Five cases had perineural invasion. Peritumoral was present 12/82 (14.6%) 6 patients. every these remaining any their tumors. diffusely focal evidence 9/12 (75%) (Fig 1) versus without 3/12 (25%) An additional layer taken 3 tumor. type, stage SCC, lymph node involvement, systemic treatment, lymphocyte count, Rai score, which prognostic indicator used (Table I).5Rai Stilgenbauer Staging Prognosis Chronic Lymphocytic Leukemia. UpToDate, 2022Google average number layers 2.7 comparison 1.9 when present. 7 recurrent (5.9%) infiltrate. known nodal metastatic disease.Table ICharacteristics infiltratePatientAgeTumor typeLocationSCC BWH staging# layersPeritumoral patternRai score∗Rai score lymphocytosis. It calculated based 5 categories including enlarged nodes, spleen, liver, anemia (Hgb <11 g/dL), thrombocytopenia (platelets <100,000/mm3)Lymphocyte countNode involvementSystemic treatment174BCCL preauricular cheekx1Diffuse present120YesNone174BCCL nasal sidewallx3Diffuse present120YesNone279SCCVertex scalpT33Diffuse present01230NoNone280BCCR sidewallx2Diffuse present01230NoNone383SCCL cheekT12Diffuse present117,914YesNone384BCCL upper lipx3Diffuse present479,442YesNone386SCCR templeT2a1Diffuse present3248,560NoNone387SCCVertex scalpT2a2Diffuse present317,990NoIbrutinib485SCCL lateral foreheadT311Diffuse present117,384NoNone576BCCL alax1Diffuse presentxUnknownUnknownUnknown679SCCMidline chestT11Diffuse present416,800NoNone679SCCR armT2a2Diffuse present416,800NoNoneBCC, Basal carcinoma; BWH, Hospital; carcinoma.∗ <100,000/mm3) Open table new tab BCC, carcinoma. SCC:basal ratio (1.7:1) general population. 10/64 (15.6%) SCCs "high risk" (Brigham higher). majority having some (75%). appeared unique individual suggests that attributable specific factors rather than association itself. Further studies support this conclusion include prospective study design collect clinical, immunologic, genetic data. None disclosed.