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Cigarette and pipe smokers have an increased risk of developing cutaneous squamous cell carcinoma, according to a study recently published in the Journal of Clinical Oncology.

Skin cancer is classified into three types: malignant melanoma, cutaneous squamous cell carcinoma and basal cell carcinoma. Cutaneous squamous cell carcinoma and basal cell carcinoma are often referred to as nonmelanoma skin cancers. Approximately 7,000 people in the U.S. die from malignant melanoma each year, whereas about 2,000 die from nonmelanoma skin cancers. Although the risk of dying from nonmelanoma skin cancers is relatively low, these cancers do present significant problems. Exposure to sunlight is one of the most important risk factors for cutaneous squamous cell carcinoma; however, increasing data supports the theory that smoking may contribute to the development of this cancer as well.

The Leiden Skin Cancer Study was performed at the Leiden University Medical Center (LUMC) in the Netherlands. The researchers interviewed 966 subjects: 580 had some form of skin cancer and 386 were control patients who did not have skin cancer. The subjects knew that they were participating in a skin cancer study, but they did not know that the study was examining the relationship between smoking and skin cancer. In addition, the individuals conducting the interviews did not know whether the subjects were from the skin cancer group or the control group.

The results revealed that smokers are three times more likely than nonsmokers to develop cutaneous squamous cell carcinoma. The risk was higher among current smokers than former smokers. The researchers observed that the risk increased with the number of cigarettes smoked and the duration (years) of smoking. Cigarette and pipe smokers appeared to have a high risk, while cigar smokers were not at a significantly increased risk. Exposure to smoking was much higher among individuals with squamous cell carcinoma compared with those with basal cell carcinoma and malignant melanoma. The researchers acknowledged that the smokers indicated more sun exposure than the nonsmokers; however this increased exposure did not appear to influence the association between smoking and skin cancer.

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The researchers are unsure just how tobacco smoke may increase the risk of developing skin cancer. They theorized that the tobacco smoke could act as a skin carcinogen, either through direct skin contact or systemically, through the bloodstream. They also suggested that smoking could lead to skin cancer by suppressing the immune system and thus, leaving smokers more susceptible to skin cancer.

More research is necessary to determine how strong the relationship is between smoking and skin cancer; however, the results of this study indicate that current and former smokers may want to consider more frequent screening tests for skin cancer. People concerned with screening for this disease or who may be interested in smoking cessation programs can consult with their physicians for more information. 

(Journal of Clinical Oncology, Vol 19, No 1, pp 231-238, 2001)