Impact of Rosacea on Keratinocyte Skin Cancers: A Prospective Case-Control Study of Basal and Squamous Cell Carcinoma Risk
Keywords:
Rosacea And Skin Cancer, Basal Cell Carcinoma, Squamous Cell Carcinoma Risk, Keratinocyte Carcinoma, Dermatological DiseasesAbstract
Introduction: The full range of cutaneous comorbidities associated with keratinocyte skin cancers remains to be elucidated.
Objectives: We aimed to examine other skin diseases in patients with keratinocyte cancer (KC) and to reveal potential associations between them.
Methods: Included in the study were 200 patients with KC and 200 disease-free controls. To identify any additional concomitant dermatological conditions, all study groups underwent examination by 2 dermatologists.
Results: In patients with KC, 87.5% were diagnosed with basal cell carcinoma and 13.5% were diagnosed with squamous cell carcinoma. There was no statistically significant difference between the two groups regarding sunscreen use habits (P =0.284). Patients with KC exhibited a significantly elevated odds ratio for the presence of rosacea (OR 5.13, 95% CI 3.2-8.3, P=0.000) and especially erythematotelangiectatic rosacea (ETR) subtype (OR 5.03, 95% CI 3.1-8.2, P=0.000). An ROC curve analysis was conducted to assess the efficacy of rosacea in differentiating between the control group and patients with KC. The sensitivity, specificity, negative predictive value and positive predictive value for rosacea were 45.5%, 86%, 61.2% and 76.5%, respectively (AUC 0.658, 95% CI 0.604-0.711, P=0.000), while for ETR it was 44%, 86.5%, 60.7% and 76.5%, respectively (AUC 0.653, 95% CI 0.599-0.706, P=0.000). The presence of rosacea demonstrated a significant efficacy in differentiating patients with KC from the control group in all localizations (P< 0.05).
Conclusion: The risk of rosacea in patients with KC, particularly those with the ETR subtype, was found to be significantly elevated, irrespective of age, gender, and localization.
References
Fahradyan A, Howell AC, Wolfswinkel EM, Tsuha M, Sheth P, Wong AK. Updates on the management of Non-Melanoma Skin Cancer (NMSC). Healthcare (Basel). 2017;5(4):82. DOI: 10.3390/healthcare5040082. PMID: 29104226
Cakir BO, Adamson P, Cingi C. Epidemiology and economic burden of nonmelanoma skin cancer. Facial Plast Surg Clin North Am. 2012;20(4):419-422. DOI: 10.1016/j.fsc.2012.07.004. PMID: 23084294
Egeberg A, Fowler JF Jr, Gislason GH, Thyssen JP. Rosacea and risk of cancer in Denmark. Cancer Epidemiol. 2017;47:76-80. DOI: 10.1016/j.fsc.2012.07.004. PMID: 28131793
Li WQ, Zhang M, Danby FW, Han J, Qureshi AA. Personal history of rosacea and risk of incident cancer among women in the US. Br J Cancer. 2015;113(3):520-523. DOI: 10.1038/bjc.2015.217. PMID: 26103573
Dupont C. Rosacea is not associated with skin cancer. Arch Dermatol. 1986;122(10):1099. PMID: 2945515
Lin EM, Qureshi AA, Wisco O, Cho E. Single-institution retrospective study evaluating personal history of rosacea and risk of basal cell carcinoma. J Am Acad Dermatol. 2023;89(2):399-401. DOI: 10.1016/j.jaad.2023.03.055. PMID: 37061134
Sanchez-Pellicer P, Eguren-Michelena C, Garcia-Gavin J, et al. Rosacea, microbiome and probiotics: the gut-skin axis. Front Microbiol. 2024;14:1323644. DOI: 10.3389/fmicb.2023.1323644. PMID: 38260914
Salzer S, Kresse S, Hirai Y, et al. Cathelicidin peptide LL-37 increases UVB-triggered inflammasome activation: possible implications for rosacea. J Dermatol Sci. 2014;76(3):173-179. DOI: 10.1016/j.jdermsci.2014.09.002. PMID: 25306296
Thapa L, Xia J, Guo W, Usmani H, Miller D, Lozeau D. Rosacea and its association with malignancy: Systematic review. JMIR Dermatol. 2023;6:e47821. DOI: 10.2196/47821. PMID: 37938876
Chang YS, Huang YC. Role of Demodex mite infestation in rosacea: A systematic review and meta-analysis. J Am Acad Dermatol. 2017;77(3):441-447. DOI: 10.1016/j.jaad.2017.03.040. PMID: 28711190
Gerber PA, Buhren BA, Steinhoff M, Homey B. Rosacea: the cytokine and chemokine network. J Investig Dermatol Symp Proc. 2011;15(1):40-47. DOI: 10.1038/jidsymp.2011.9. PMID: 22076326
Wang Y, Wang B, Huang Yet al. Multi-transcriptomic analysis and experimental validation implicate a central role of STAT3 in skin barrier dysfunction induced aggravation of rosacea. J Inflamm Res. 2022;15:2141-2156. DOI: 10.2147/JIR.S356551. PMID: 35392024
Deng Z, Chen M, Liu Y, et al. A positive feedback loop between mTORC1 and cathelicidin promotes skin inflammation in rosacea. EMBO Mol Med. 2021;13(5):e13560. DOI: 10.15252/emmm.202013560. PMID: 33734592
Leo MS, Sivamani RK. Phytochemical modulation of the Akt/mTOR pathway and its potential use in cutaneous disease. Arch Dermatol Res. 2014;306:861-871. DOI: 10.1007/s00403-014-1480-8. PMID: 24972910
Chamcheu JC, Roy T, Uddin MB, et al. Role and therapeutic targeting of the PI3K/Akt/mTOR signaling pathway in skin cancer: A review of current status and future trends on natural and synthetic agents therapy. Cells. 2019;8:803. DOI: 10.3390/cells8080803. PMID: 31370278
Einspahr JG, Calvert V, Alberts DS, et al. Functional protein pathway activation mapping of the progression of normal skin to squamous cell carcinoma. Cancer Prev Res (Phila). 2012;5(3):403-413. DOI: 10.1158/1940-6207.CAPR-11-0427. PMID: 22389437
Brinkhuizen T, Weijzen CAH, Eben J, et al. Immunohistochemical analysis of the mechanistic target of rapamycin and hypoxia signalling pathways in basal cell carcinoma and trichoepithelioma. PLoS One. 2014;9(9):e106427. DOI: 10.1371/journal.pone.0106427. PMID: 25181405
Feehan RP, Shantz LM. Molecular signaling cascades involved in nonmelanoma skin carcinogenesis. Biochem J.2016;473(19):2973-2994. DOI: 10.1042/BCJ20160471. PMID: 27679857
Karaosmanoglu N, Ozdemir Cetinkaya P, Orenay OM. Evaluation of inflammatory status in blood in patients with rosacea. Sci Rep. 2023;13(1):9068. DOI: 10.1038/s41598-023-36247-5. PMID: 37277425
Haber R, El Gemayel M. Comorbidities in rosacea: A systematic review and update. J Am Acad Dermatol. 2018;78(4):786-792. DOI: 10.1016/j.jaad.2017.09.016. PMID: 29107339
Luo M, Wei B. Novel insights into rosacea’s role in cancer risk: A Mendelian randomization approach. Skin Res Technol. 2024;30(5):e13737. DOI: 10.1111/srt.13737. PMID: 38769705
Cho SI, Lee H, Cho S. Risk of skin cancer and actinic keratosis in patients with rosacea: A nationwide population-based cohort study. Acta Derm Venereol. 2022;102:adv00803. DOI: 10.2340/actadv.v102.2563. PMID: 36250731
Lazzeri D, Colizzi L, Licata G, et al. Malignancies within rhinophyma: report of three new cases and review of the literature. Aesthetic Plast Surg. 2012;36(2):396-405. DOI: 10.1007/s00266-011-9802-0. PMID: 218585597
Lin EM, Rajadurai S, Qureshi AA, Cho E. Prospective study evaluating the personal history of rosacea and risk of cutaneous squamous cell carcinoma among women in the United States. J Am Acad Dermatol. 2022;87(6):1389-1391. DOI: 10.1016/j.jaad.2022.09.004. PMID: 36089188
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