Suggested skin cancer screening protocol for chronic lymphocytic leukaemia patients

Chronic lymphocytic leukaemia (CLL) is a common malignancy in Australia. With high survival rates, concern regarding development of second cancers is a significant consideration. This increased incidence has been well documented at approximately double the general population[1]. A large population study in 2005 showed Australian CLL patients having a seven times higher risk of developing melanoma[2]. Accurate incidence rates of NMSC are difficult to obtain as they are not reported cancers in Australia, but their increased incidence can be extrapolated from mortality data; with risk of death from NMSC 17 times higher than the general population[2]. Not only are CLL patients at risk of higher rates of skin cancer, but it has been shown that skin cancers are more aggressive in this population.[2]
There are no guidelines on how to manage CLL patients and their skin cancer risks, which is particularly important given Australia’s skin cancer profile. Here we suggest a clear protocol that can be implemented in a specialist or primary care setting, adapted from the literature on CLL and organ transplant protocols. We recommend patients are educated on their risks, use UV protection, preform regular skin and lip examinations and have at least an annual skin examination by Dermatologist or medical practitioner experienced in the diagnosis of skin cancer. We recommend doctors consider the use of oral retinoids in suitable patients. Further studies on surveillance and disease pattern specific to CLL patients with skin cancer will provide the opportunity to refine these recommendations.
1. Wiernik, P.H., Second neoplasms in patients with chronic lymphocytic leukemia. Curr Treat Options Oncol, 2004. 5(3): p. 215-23.
2. Royle, J.A., et al., Second cancer incidence and cancer mortality among chronic lymphocytic leukaemia patients: a population-based study. Br J Cancer, 2011. 105(7): p. 1076-81.

Dr. Anthea Mulcahy

St George Dermatology and Skin Cancer Centre

Dr Anthea Mulcahy is a clinical research fellow to Associate Professor Stephen Shumack and Dr Adrian Lim in Sydney, NSW. Anthea gained her medical degree from the University of Tasmania and moved to Sydney in 2015 to follow her passion of Dermatology.