Charles Bankhead

PRAGUE — Unexplained erythema should raise suspicion about a possible underlying malignancy, according to a review of cases at one Asian institution.

In an effort to determine the clinical implications of idiopathic erythema, Dr. Steven Thng and his colleagues at the National Skin Center in Singapore reviewed the records of patients evaluated for erythema from 2001 to 2005 and compared those patients with published case series as well as with data from the Singapore Cancer Registry.

Dr. Thng and colleagues identified 218 patients evaluated for erythema during the study period—108 cases (50%) were classified as idiopathic. Among patients with an identified cause of erythema, preexisting dermatoses (30%) and drug reaction (15%) were the most common diagnoses.

On follow-up, the researchers found idiopathic erythema was associated with visceral malignancy in 18% of patients and with cutaneous T-cell lymphoma in 5%.

“We recommend close follow-up with reevaluation for malignancy even if the initial investigation had been negative,” Dr. Thng and colleagues said in a poster presented at the International Congress of Dermatology.

Few investigators have attempted to examine the natural history and potential clinical consequences of unexplained erythema, the researchers wrote. Moreover, previous studies primarily involved white populations.

Analysis of patients with idiopathic erythema showed that most were men (73%) and that idiopathic erythema tended to occur at an older age (69 years) when compared with erythema of known cause (62 years). Patients with idiopathic erythema tended to experience a slow onset of disease, which had an average duration of 22 days. They also experienced more episodes of disease (average of 1.75 episodes), compared with patients who had erythema of known cause (average of 1.32 episodes).

When compared with age-standardized cases in the cancer registry, patients with idiopathic erythema had more than a threefold greater risk of visceral malignancy. The study findings came from a review of Asian patients and may not be applicable to patients in other regions, Dr. Thng and his colleagues noted. They reported no disclosures.

PRAGUE — Unexplained erythema should raise suspicion about a possible underlying malignancy, according to a review of cases at one Asian institution.

In an effort to determine the clinical implications of idiopathic erythema, Dr. Steven Thng and his colleagues at the National Skin Center in Singapore reviewed the records of patients evaluated for erythema from 2001 to 2005 and compared those patients with published case series as well as with data from the Singapore Cancer Registry.

Dr. Thng and colleagues identified 218 patients evaluated for erythema during the study period—108 cases (50%) were classified as idiopathic. Among patients with an identified cause of erythema, preexisting dermatoses (30%) and drug reaction (15%) were the most common diagnoses.

On follow-up, the researchers found idiopathic erythema was associated with visceral malignancy in 18% of patients and with cutaneous T-cell lymphoma in 5%.

“We recommend close follow-up with reevaluation for malignancy even if the initial investigation had been negative,” Dr. Thng and colleagues said in a poster presented at the International Congress of Dermatology.

Few investigators have attempted to examine the natural history and potential clinical consequences of unexplained erythema, the researchers wrote. Moreover, previous studies primarily involved white populations.

Analysis of patients with idiopathic erythema showed that most were men (73%) and that idiopathic erythema tended to occur at an older age (69 years) when compared with erythema of known cause (62 years). Patients with idiopathic erythema tended to experience a slow onset of disease, which had an average duration of 22 days. They also experienced more episodes of disease (average of 1.75 episodes), compared with patients who had erythema of known cause (average of 1.32 episodes).

When compared with age-standardized cases in the cancer registry, patients with idiopathic erythema had more than a threefold greater risk of visceral malignancy. The study findings came from a review of Asian patients and may not be applicable to patients in other regions, Dr. Thng and his colleagues noted. They reported no disclosures.

PRAGUE — Unexplained erythema should raise suspicion about a possible underlying malignancy, according to a review of cases at one Asian institution.

In an effort to determine the clinical implications of idiopathic erythema, Dr. Steven Thng and his colleagues at the National Skin Center in Singapore reviewed the records of patients evaluated for erythema from 2001 to 2005 and compared those patients with published case series as well as with data from the Singapore Cancer Registry.

Dr. Thng and colleagues identified 218 patients evaluated for erythema during the study period—108 cases (50%) were classified as idiopathic. Among patients with an identified cause of erythema, preexisting dermatoses (30%) and drug reaction (15%) were the most common diagnoses.

On follow-up, the researchers found idiopathic erythema was associated with visceral malignancy in 18% of patients and with cutaneous T-cell lymphoma in 5%.

“We recommend close follow-up with reevaluation for malignancy even if the initial investigation had been negative,” Dr. Thng and colleagues said in a poster presented at the International Congress of Dermatology.

Few investigators have attempted to examine the natural history and potential clinical consequences of unexplained erythema, the researchers wrote. Moreover, previous studies primarily involved white populations.

Analysis of patients with idiopathic erythema showed that most were men (73%) and that idiopathic erythema tended to occur at an older age (69 years) when compared with erythema of known cause (62 years). Patients with idiopathic erythema tended to experience a slow onset of disease, which had an average duration of 22 days. They also experienced more episodes of disease (average of 1.75 episodes), compared with patients who had erythema of known cause (average of 1.32 episodes).

When compared with age-standardized cases in the cancer registry, patients with idiopathic erythema had more than a threefold greater risk of visceral malignancy. The study findings came from a review of Asian patients and may not be applicable to patients in other regions, Dr. Thng and his colleagues noted. They reported no disclosures.

PRAGUE — Steroid-resistant hand eczema responds almost half the time to treatment with oral alitretinoin, data from randomized clinical trials have shown.

Furthermore, 80% of patients who relapsed after alitretinoin treatment was stopped regained disease control when treated again with the agent, Dr. Uwe Hillen of University Clinic in Essen, Germany, reported at the International Congress of Dermatology.

“Alitretinoin produced improvement in all of the individual signs and symptoms of chronic hand eczema,” said Dr. Hillen. “Patients who relapse after initial treatment can be effectively retreated with alitretinoin, suggesting it is a suitable, intermittent treatment option for the long-term management of this chronic, relapsing disease.”

Hand eczema often evolves into a chronic condition, even with strict avoidance of environmental triggers. Standard therapy is topical corticosteroids, and patients have few alternatives if the combination of emollients and topical steroids doesn't work.

Dr. Hillen summarized data from three phase III clinical trials, the largest involving 1,032 patients enrolled at 111 sites in Europe and Canada. Patients in that trial were randomized to oral alitretinoin 10 mg or 30 mg once daily or placebo for 12 or 24 weeks. All patients were advised to avoid known triggers and irritants. The primary end point was the proportion of patients who had a Physician Global Assessment rating of “clear” or “almost clear” at the end of treatment.

Almost half (48%) of patients treated with 30 mg of alitretinoin had complete responses, as did 28% of patients treated with 10 mg, while just 17% of placebo-treated patients had complete or almost complete responses, Dr. Hillen reported.

The second study, a safety study, involved 249 patients from 37 centers in Europe and Canada. All had chronic hand eczema unresponsive to topical steroids, and received open-label alitretinoin 30 mg daily for as long as 24 weeks. Again, almost half (47%) of patients in the alitretinoin group had complete responses, Dr. Hillen said. When response criteria were expanded to include “mild disease,” the response rate increased to 64%.

The third trial included two groups of patients from the first study: 117 patients who initially responded to alitretinoin but relapsed within 24 weeks, and 243 patients who previously had not responded to initial treatment.

Patients in the relapse group were randomized to receive their initial dose of alitretinoin or placebo. Patients in the second group received open-label alitretinoin 30 mg. Among patients who had relapsed, 80% who were randomized a second time to alitretinoin 30 mg had clear or almost clear hands at the end of the study, compared with 8% of patients receiving placebo. Patients retreated with alitretinoin 10 mg had a response rate of 48%, compared with 10% in patients on placebo.

Topical alitretinoin gel 0.1% is approved for the treatment of cutaneous lesions in patients with AIDS-related Kaposi's sarcoma, but oral alitretinoin is not available.

Dr. Hillen reported no disclosures.

PRAGUE — Steroid-resistant hand eczema responds almost half the time to treatment with oral alitretinoin, data from randomized clinical trials have shown.

Furthermore, 80% of patients who relapsed after alitretinoin treatment was stopped regained disease control when treated again with the agent, Dr. Uwe Hillen of University Clinic in Essen, Germany, reported at the International Congress of Dermatology.

“Alitretinoin produced improvement in all of the individual signs and symptoms of chronic hand eczema,” said Dr. Hillen. “Patients who relapse after initial treatment can be effectively retreated with alitretinoin, suggesting it is a suitable, intermittent treatment option for the long-term management of this chronic, relapsing disease.”

Hand eczema often evolves into a chronic condition, even with strict avoidance of environmental triggers. Standard therapy is topical corticosteroids, and patients have few alternatives if the combination of emollients and topical steroids doesn't work.

Dr. Hillen summarized data from three phase III clinical trials, the largest involving 1,032 patients enrolled at 111 sites in Europe and Canada. Patients in that trial were randomized to oral alitretinoin 10 mg or 30 mg once daily or placebo for 12 or 24 weeks. All patients were advised to avoid known triggers and irritants. The primary end point was the proportion of patients who had a Physician Global Assessment rating of “clear” or “almost clear” at the end of treatment.

Almost half (48%) of patients treated with 30 mg of alitretinoin had complete responses, as did 28% of patients treated with 10 mg, while just 17% of placebo-treated patients had complete or almost complete responses, Dr. Hillen reported.

The second study, a safety study, involved 249 patients from 37 centers in Europe and Canada. All had chronic hand eczema unresponsive to topical steroids, and received open-label alitretinoin 30 mg daily for as long as 24 weeks. Again, almost half (47%) of patients in the alitretinoin group had complete responses, Dr. Hillen said. When response criteria were expanded to include “mild disease,” the response rate increased to 64%.

The third trial included two groups of patients from the first study: 117 patients who initially responded to alitretinoin but relapsed within 24 weeks, and 243 patients who previously had not responded to initial treatment.

Patients in the relapse group were randomized to receive their initial dose of alitretinoin or placebo. Patients in the second group received open-label alitretinoin 30 mg. Among patients who had relapsed, 80% who were randomized a second time to alitretinoin 30 mg had clear or almost clear hands at the end of the study, compared with 8% of patients receiving placebo. Patients retreated with alitretinoin 10 mg had a response rate of 48%, compared with 10% in patients on placebo.

Topical alitretinoin gel 0.1% is approved for the treatment of cutaneous lesions in patients with AIDS-related Kaposi's sarcoma, but oral alitretinoin is not available.

Dr. Hillen reported no disclosures.

PRAGUE — Steroid-resistant hand eczema responds almost half the time to treatment with oral alitretinoin, data from randomized clinical trials have shown.

Furthermore, 80% of patients who relapsed after alitretinoin treatment was stopped regained disease control when treated again with the agent, Dr. Uwe Hillen of University Clinic in Essen, Germany, reported at the International Congress of Dermatology.

“Alitretinoin produced improvement in all of the individual signs and symptoms of chronic hand eczema,” said Dr. Hillen. “Patients who relapse after initial treatment can be effectively retreated with alitretinoin, suggesting it is a suitable, intermittent treatment option for the long-term management of this chronic, relapsing disease.”

Hand eczema often evolves into a chronic condition, even with strict avoidance of environmental triggers. Standard therapy is topical corticosteroids, and patients have few alternatives if the combination of emollients and topical steroids doesn't work.

Dr. Hillen summarized data from three phase III clinical trials, the largest involving 1,032 patients enrolled at 111 sites in Europe and Canada. Patients in that trial were randomized to oral alitretinoin 10 mg or 30 mg once daily or placebo for 12 or 24 weeks. All patients were advised to avoid known triggers and irritants. The primary end point was the proportion of patients who had a Physician Global Assessment rating of “clear” or “almost clear” at the end of treatment.

Almost half (48%) of patients treated with 30 mg of alitretinoin had complete responses, as did 28% of patients treated with 10 mg, while just 17% of placebo-treated patients had complete or almost complete responses, Dr. Hillen reported.

The second study, a safety study, involved 249 patients from 37 centers in Europe and Canada. All had chronic hand eczema unresponsive to topical steroids, and received open-label alitretinoin 30 mg daily for as long as 24 weeks. Again, almost half (47%) of patients in the alitretinoin group had complete responses, Dr. Hillen said. When response criteria were expanded to include “mild disease,” the response rate increased to 64%.

The third trial included two groups of patients from the first study: 117 patients who initially responded to alitretinoin but relapsed within 24 weeks, and 243 patients who previously had not responded to initial treatment.

Patients in the relapse group were randomized to receive their initial dose of alitretinoin or placebo. Patients in the second group received open-label alitretinoin 30 mg. Among patients who had relapsed, 80% who were randomized a second time to alitretinoin 30 mg had clear or almost clear hands at the end of the study, compared with 8% of patients receiving placebo. Patients retreated with alitretinoin 10 mg had a response rate of 48%, compared with 10% in patients on placebo.

Topical alitretinoin gel 0.1% is approved for the treatment of cutaneous lesions in patients with AIDS-related Kaposi's sarcoma, but oral alitretinoin is not available.

Dr. Hillen reported no disclosures.

PRAGUE — The diabetes drug pioglitazone significantly improved psoriasis control when added to oral acitretin, data from a small clinical trial found.

The combination led to a 64% reduction in psoriasis severity, compared with 52% for acitretin alone, Dr. Sunil Dogra of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, and colleagues reported at the International Congress of Dermatology.

“From our study results it is apparent that the addition of pioglitazone [Actos] to acitretin [Soriatane] therapy can enhance antipsoriatic efficacy,” he reported in a poster presentation. Initial worsening of disease severity occurred less often with the combination, but the difference did not achieve statistical significance.

“In comparison to other antipsoriatic drugs used in combination with acitretin, pioglitazone may offer a safer alternative, as it has been used in patients with diabetes mellitus for several years, and most placebo-controlled trials have shown the incidence of side effects due to pioglitazone to be approximately equal to that found with placebo,” he reported.

The rationale for using a thiazolidinedione drug to treat psoriasis came from evidence that activation of peroxisome-proliferator activated receptor-gamma (PPAR-gamma) may inhibit proliferation and promote cell differentiation, according to the investigators.

Experience with troglitazone showed reduced psoriasis disease activity and normalized histologic features of psoriatic skin, Dr. Dogra noted. And, studies of pioglitazone in psoriasis have shown response rates as high as 50%.

Given that acitretin and PPAR-gamma activators decrease proliferation, induce differentiation, and have anti-inflammatory activity, the investigators combined the drugs to try and achieve therapeutic synergy. They hypothesized that pioglitazone might counter acitretin-induced lipid abnormalities.

Dr. Dogra and colleagues randomized 41 patients with plaque psoriasis requiring systemic therapy. Patients received acitretin 25 mg/day plus either pioglitazone 15 mg/day or placebo.

Patients had follow-up visits at 2, 4, 8, and 12 weeks. The primary efficacy end point was the change in Psoriasis Area and Severity Index (PASI) from baseline to 12 weeks.

The baseline PASI score averaged 19.3 in the acitretin-placebo group and 17.5 in the acitretin-pioglitazone group. The mean PASI score had worsened at 2 weeks in 37% of the acitretin-pioglitazone group and 50% of the acitretin-placebo group.

At 12 weeks, the median PASI score in the pioglitazone group was 6.0, a reduction of 11.5 from baseline. That compared with a median score of 10.0 in the placebo group and a reduction of 9.7 from baseline. The difference translated into a statistically significant advantage in favor of acitretin-pioglitazone.

No unexpected adverse effects occurred in either treatment group, and no patients had any laboratory abnormalities during the study.

The investigators acknowledged the small size of the study, that they used the lowest available dose of pioglitazone, and that women of child-bearing potential were excluded from the study.

“PPAR-gamma agonists are known to possess an array of beneficial effects, including decreased blood pressure, increased HDL, and improved fibrinolysis,” the investigators said. “Moreover, the occurrence of diabetes, hypertension, and metabolic syndrome in patients with psoriasis is not uncommon. These conditions may co-exist more often than predicted from the prevalence of either disorder alone. Pioglitazone may be particularly useful in these subsets of patients.”

The results warrant additional studies of the combination, including evaluations of the safety and efficacy combining higher doses of pioglitazone with acitretin.

The investigators declared having no relevant conflicts of interest.

PRAGUE — The diabetes drug pioglitazone significantly improved psoriasis control when added to oral acitretin, data from a small clinical trial found.

The combination led to a 64% reduction in psoriasis severity, compared with 52% for acitretin alone, Dr. Sunil Dogra of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, and colleagues reported at the International Congress of Dermatology.

“From our study results it is apparent that the addition of pioglitazone [Actos] to acitretin [Soriatane] therapy can enhance antipsoriatic efficacy,” he reported in a poster presentation. Initial worsening of disease severity occurred less often with the combination, but the difference did not achieve statistical significance.

“In comparison to other antipsoriatic drugs used in combination with acitretin, pioglitazone may offer a safer alternative, as it has been used in patients with diabetes mellitus for several years, and most placebo-controlled trials have shown the incidence of side effects due to pioglitazone to be approximately equal to that found with placebo,” he reported.

The rationale for using a thiazolidinedione drug to treat psoriasis came from evidence that activation of peroxisome-proliferator activated receptor-gamma (PPAR-gamma) may inhibit proliferation and promote cell differentiation, according to the investigators.

Experience with troglitazone showed reduced psoriasis disease activity and normalized histologic features of psoriatic skin, Dr. Dogra noted. And, studies of pioglitazone in psoriasis have shown response rates as high as 50%.

Given that acitretin and PPAR-gamma activators decrease proliferation, induce differentiation, and have anti-inflammatory activity, the investigators combined the drugs to try and achieve therapeutic synergy. They hypothesized that pioglitazone might counter acitretin-induced lipid abnormalities.

Dr. Dogra and colleagues randomized 41 patients with plaque psoriasis requiring systemic therapy. Patients received acitretin 25 mg/day plus either pioglitazone 15 mg/day or placebo.

Patients had follow-up visits at 2, 4, 8, and 12 weeks. The primary efficacy end point was the change in Psoriasis Area and Severity Index (PASI) from baseline to 12 weeks.

The baseline PASI score averaged 19.3 in the acitretin-placebo group and 17.5 in the acitretin-pioglitazone group. The mean PASI score had worsened at 2 weeks in 37% of the acitretin-pioglitazone group and 50% of the acitretin-placebo group.

At 12 weeks, the median PASI score in the pioglitazone group was 6.0, a reduction of 11.5 from baseline. That compared with a median score of 10.0 in the placebo group and a reduction of 9.7 from baseline. The difference translated into a statistically significant advantage in favor of acitretin-pioglitazone.

No unexpected adverse effects occurred in either treatment group, and no patients had any laboratory abnormalities during the study.

The investigators acknowledged the small size of the study, that they used the lowest available dose of pioglitazone, and that women of child-bearing potential were excluded from the study.

“PPAR-gamma agonists are known to possess an array of beneficial effects, including decreased blood pressure, increased HDL, and improved fibrinolysis,” the investigators said. “Moreover, the occurrence of diabetes, hypertension, and metabolic syndrome in patients with psoriasis is not uncommon. These conditions may co-exist more often than predicted from the prevalence of either disorder alone. Pioglitazone may be particularly useful in these subsets of patients.”

The results warrant additional studies of the combination, including evaluations of the safety and efficacy combining higher doses of pioglitazone with acitretin.

The investigators declared having no relevant conflicts of interest.

PRAGUE — The diabetes drug pioglitazone significantly improved psoriasis control when added to oral acitretin, data from a small clinical trial found.

The combination led to a 64% reduction in psoriasis severity, compared with 52% for acitretin alone, Dr. Sunil Dogra of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, and colleagues reported at the International Congress of Dermatology.

“From our study results it is apparent that the addition of pioglitazone [Actos] to acitretin [Soriatane] therapy can enhance antipsoriatic efficacy,” he reported in a poster presentation. Initial worsening of disease severity occurred less often with the combination, but the difference did not achieve statistical significance.

“In comparison to other antipsoriatic drugs used in combination with acitretin, pioglitazone may offer a safer alternative, as it has been used in patients with diabetes mellitus for several years, and most placebo-controlled trials have shown the incidence of side effects due to pioglitazone to be approximately equal to that found with placebo,” he reported.

The rationale for using a thiazolidinedione drug to treat psoriasis came from evidence that activation of peroxisome-proliferator activated receptor-gamma (PPAR-gamma) may inhibit proliferation and promote cell differentiation, according to the investigators.

Experience with troglitazone showed reduced psoriasis disease activity and normalized histologic features of psoriatic skin, Dr. Dogra noted. And, studies of pioglitazone in psoriasis have shown response rates as high as 50%.

Given that acitretin and PPAR-gamma activators decrease proliferation, induce differentiation, and have anti-inflammatory activity, the investigators combined the drugs to try and achieve therapeutic synergy. They hypothesized that pioglitazone might counter acitretin-induced lipid abnormalities.

Dr. Dogra and colleagues randomized 41 patients with plaque psoriasis requiring systemic therapy. Patients received acitretin 25 mg/day plus either pioglitazone 15 mg/day or placebo.

Patients had follow-up visits at 2, 4, 8, and 12 weeks. The primary efficacy end point was the change in Psoriasis Area and Severity Index (PASI) from baseline to 12 weeks.

The baseline PASI score averaged 19.3 in the acitretin-placebo group and 17.5 in the acitretin-pioglitazone group. The mean PASI score had worsened at 2 weeks in 37% of the acitretin-pioglitazone group and 50% of the acitretin-placebo group.

At 12 weeks, the median PASI score in the pioglitazone group was 6.0, a reduction of 11.5 from baseline. That compared with a median score of 10.0 in the placebo group and a reduction of 9.7 from baseline. The difference translated into a statistically significant advantage in favor of acitretin-pioglitazone.

No unexpected adverse effects occurred in either treatment group, and no patients had any laboratory abnormalities during the study.

The investigators acknowledged the small size of the study, that they used the lowest available dose of pioglitazone, and that women of child-bearing potential were excluded from the study.

“PPAR-gamma agonists are known to possess an array of beneficial effects, including decreased blood pressure, increased HDL, and improved fibrinolysis,” the investigators said. “Moreover, the occurrence of diabetes, hypertension, and metabolic syndrome in patients with psoriasis is not uncommon. These conditions may co-exist more often than predicted from the prevalence of either disorder alone. Pioglitazone may be particularly useful in these subsets of patients.”

The results warrant additional studies of the combination, including evaluations of the safety and efficacy combining higher doses of pioglitazone with acitretin.

The investigators declared having no relevant conflicts of interest.

PRAGUE — A prior diagnosis of nonmelanoma skin cancer predicts an increased mortality risk in patients with chronic lymphocytic leukemia, investigators from the National Cancer Institute reported.

Overall, chronic lymphocytic leukemia (CLL) patients with a history of nonmelanoma skin cancer had a 30% greater risk of death, which almost doubled in the subgroup of patients with a prior diagnosis of squamous cell cancer, said Patrick Blake, a medical student at the Cleveland Clinic who is on leave at the NCI.

In one-third of the CLL cases, a diagnosis of nonmelanoma skin cancer preceded the leukemia diagnosis by less than 1 year, increasing to 44% for squamous cell cancer.

"CLL patients with a previous diagnosis of nonmelanoma skin cancer have a significantly decreased survival, compared with CLL patients without nonmelanoma skin cancer," Mr. Blake and colleagues reported during a poster session at the International Congress of Dermatology.

"Our investigation has unique new findings and expands the findings of two previous studies that found increased mortality among lymphoma patients with a prior history of skin cancer," he said.

Several case reports have documented incidental identification of subclinical CLL related to excision of squamous cell or basal cell skin cancer. A Scandinavian study of patients with squamous cell skin cancer demonstrated a twofold increased risk of CLL.

Two recent studies documented increased mortality in lymphoma patients with a history of skin cancer. However, investigators in both studies included CLL patients with those who had non-Hodgkin's lymphoma.

To clarify the link between CLL and nonmelanoma skin cancer, NCI investigators analyzed data from a population-based study of more than 12,000 cases of CLL diagnosed in Sweden between 1973 and 2003.

Complete medical history was available for the CLL patients, and cause of death was ascertained by data from Sweden's national death registry.

The NCI investigators identified 236 CLL patients with a prior diagnosis of nonmelanoma skin cancer, compared with 11,805 patients with no history of skin cancer.

CLL patients with a history of nonmelanoma skin cancer were:

▸ Older (78.5 years vs. 71 years);

▸ Substantially more likely to be age 70 or older at diagnosis of CLL (80.9% vs. 54.1%);

▸ More likely to be male (69.9% vs. 62%);

▸ And diagnosed more recently (1993 vs. 1984).

Among the 236 CLL patients with a history of nonmelanoma skin cancer, investigators found that 80 (34%) had a skin cancer diagnosis less than a year before the CLL diagnosis. Of 111 patients with squamous cell skin cancer, 49 (44%) had a skin cancer diagnosis less than a year before the CLL diagnosis.

CLL patients with a prior diagnosis of nonmelanoma skin cancer had a mortality hazard ratio of 1.29, compared with CLL patients who did not have a prior skin cancer diagnosis. In the subgroup of patients who had squamous cell skin cancer, the CLL mortality hazard ratio increased to 1.86. Both of these findings differed significantly from those of the patients with no history of skin cancer (P < .0001).

The 5-year survival of CLL patients without a history of skin cancer was 43%, compared with 31% for patients with a history of nonmelanoma skin cancer and 28% for the subgroup with squamous cell cancer (P < .0001).

PRAGUE — A prior diagnosis of nonmelanoma skin cancer predicts an increased mortality risk in patients with chronic lymphocytic leukemia, investigators from the National Cancer Institute reported.

Overall, chronic lymphocytic leukemia (CLL) patients with a history of nonmelanoma skin cancer had a 30% greater risk of death, which almost doubled in the subgroup of patients with a prior diagnosis of squamous cell cancer, said Patrick Blake, a medical student at the Cleveland Clinic who is on leave at the NCI.

In one-third of the CLL cases, a diagnosis of nonmelanoma skin cancer preceded the leukemia diagnosis by less than 1 year, increasing to 44% for squamous cell cancer.

"CLL patients with a previous diagnosis of nonmelanoma skin cancer have a significantly decreased survival, compared with CLL patients without nonmelanoma skin cancer," Mr. Blake and colleagues reported during a poster session at the International Congress of Dermatology.

"Our investigation has unique new findings and expands the findings of two previous studies that found increased mortality among lymphoma patients with a prior history of skin cancer," he said.

Several case reports have documented incidental identification of subclinical CLL related to excision of squamous cell or basal cell skin cancer. A Scandinavian study of patients with squamous cell skin cancer demonstrated a twofold increased risk of CLL.

Two recent studies documented increased mortality in lymphoma patients with a history of skin cancer. However, investigators in both studies included CLL patients with those who had non-Hodgkin's lymphoma.

To clarify the link between CLL and nonmelanoma skin cancer, NCI investigators analyzed data from a population-based study of more than 12,000 cases of CLL diagnosed in Sweden between 1973 and 2003.

Complete medical history was available for the CLL patients, and cause of death was ascertained by data from Sweden's national death registry.

The NCI investigators identified 236 CLL patients with a prior diagnosis of nonmelanoma skin cancer, compared with 11,805 patients with no history of skin cancer.

CLL patients with a history of nonmelanoma skin cancer were:

▸ Older (78.5 years vs. 71 years);

▸ Substantially more likely to be age 70 or older at diagnosis of CLL (80.9% vs. 54.1%);

▸ More likely to be male (69.9% vs. 62%);

▸ And diagnosed more recently (1993 vs. 1984).

Among the 236 CLL patients with a history of nonmelanoma skin cancer, investigators found that 80 (34%) had a skin cancer diagnosis less than a year before the CLL diagnosis. Of 111 patients with squamous cell skin cancer, 49 (44%) had a skin cancer diagnosis less than a year before the CLL diagnosis.

CLL patients with a prior diagnosis of nonmelanoma skin cancer had a mortality hazard ratio of 1.29, compared with CLL patients who did not have a prior skin cancer diagnosis. In the subgroup of patients who had squamous cell skin cancer, the CLL mortality hazard ratio increased to 1.86. Both of these findings differed significantly from those of the patients with no history of skin cancer (P < .0001).

The 5-year survival of CLL patients without a history of skin cancer was 43%, compared with 31% for patients with a history of nonmelanoma skin cancer and 28% for the subgroup with squamous cell cancer (P < .0001).

PRAGUE — A prior diagnosis of nonmelanoma skin cancer predicts an increased mortality risk in patients with chronic lymphocytic leukemia, investigators from the National Cancer Institute reported.

Overall, chronic lymphocytic leukemia (CLL) patients with a history of nonmelanoma skin cancer had a 30% greater risk of death, which almost doubled in the subgroup of patients with a prior diagnosis of squamous cell cancer, said Patrick Blake, a medical student at the Cleveland Clinic who is on leave at the NCI.

In one-third of the CLL cases, a diagnosis of nonmelanoma skin cancer preceded the leukemia diagnosis by less than 1 year, increasing to 44% for squamous cell cancer.

"CLL patients with a previous diagnosis of nonmelanoma skin cancer have a significantly decreased survival, compared with CLL patients without nonmelanoma skin cancer," Mr. Blake and colleagues reported during a poster session at the International Congress of Dermatology.

"Our investigation has unique new findings and expands the findings of two previous studies that found increased mortality among lymphoma patients with a prior history of skin cancer," he said.

Several case reports have documented incidental identification of subclinical CLL related to excision of squamous cell or basal cell skin cancer. A Scandinavian study of patients with squamous cell skin cancer demonstrated a twofold increased risk of CLL.

Two recent studies documented increased mortality in lymphoma patients with a history of skin cancer. However, investigators in both studies included CLL patients with those who had non-Hodgkin's lymphoma.

To clarify the link between CLL and nonmelanoma skin cancer, NCI investigators analyzed data from a population-based study of more than 12,000 cases of CLL diagnosed in Sweden between 1973 and 2003.

Complete medical history was available for the CLL patients, and cause of death was ascertained by data from Sweden's national death registry.

The NCI investigators identified 236 CLL patients with a prior diagnosis of nonmelanoma skin cancer, compared with 11,805 patients with no history of skin cancer.

CLL patients with a history of nonmelanoma skin cancer were:

▸ Older (78.5 years vs. 71 years);

▸ Substantially more likely to be age 70 or older at diagnosis of CLL (80.9% vs. 54.1%);

▸ More likely to be male (69.9% vs. 62%);

▸ And diagnosed more recently (1993 vs. 1984).

Among the 236 CLL patients with a history of nonmelanoma skin cancer, investigators found that 80 (34%) had a skin cancer diagnosis less than a year before the CLL diagnosis. Of 111 patients with squamous cell skin cancer, 49 (44%) had a skin cancer diagnosis less than a year before the CLL diagnosis.

CLL patients with a prior diagnosis of nonmelanoma skin cancer had a mortality hazard ratio of 1.29, compared with CLL patients who did not have a prior skin cancer diagnosis. In the subgroup of patients who had squamous cell skin cancer, the CLL mortality hazard ratio increased to 1.86. Both of these findings differed significantly from those of the patients with no history of skin cancer (P < .0001).

The 5-year survival of CLL patients without a history of skin cancer was 43%, compared with 31% for patients with a history of nonmelanoma skin cancer and 28% for the subgroup with squamous cell cancer (P < .0001).

PRAGUE — Unexplained erythema should raise suspicion about a possible underlying malignancy, according to a review of cases as one Asian institution.

In an effort to determine the clinical implications of idiopathic erythema, Dr. Steven Thng and colleagues at the National Skin Center in Singapore reviewed the records of patients evaluated for erythema from 2001 to 2005 and compared those patients with published cases series as well as with data from the Singapore Cancer Registry.

Dr. Thng and colleagues identified 218 patients evaluated for erythema during the study period—108 cases (50%) were classified as idiopathic. Among patients with an identified cause of erythema, preexisting dermatoses (30%) and drug reaction (15%) were the most common diagnoses.

On follow-up, the researchers found idiopathic erythema was associated with visceral malignancy in 18% of patients and with cutaneous T-cell lymphoma in 5%.

“We recommend close follow-up with re-evaluation for malignancy even if the initial investigation had been negative,” they said in a poster at the International Congress of Dermatology.

Few investigators have attempted to examine the natural history and potential clinical consequences of unexplained erythema, the researchers wrote. Moreover, previous studies primarily involved white populations.

Most patients with idiopathic erythema were men (73%) and idiopathic erythema tended to occur at an older age (69 years) when compared with erythema of known cause (62 years). Patients with idiopathic erythema tended to experience a slow onset of disease and an average duration of 22 days. They also experienced more episodes of disease (average of 1.75 episodes), compared with patients who had erythema of known cause (average of 1.32 episodes).

When compared with age-standardized cases, patients with idiopathic erythema had more than a threefold greater risk of visceral malignancy. Dr. Thng and colleagues reported no disclosures.

PRAGUE — Unexplained erythema should raise suspicion about a possible underlying malignancy, according to a review of cases as one Asian institution.

In an effort to determine the clinical implications of idiopathic erythema, Dr. Steven Thng and colleagues at the National Skin Center in Singapore reviewed the records of patients evaluated for erythema from 2001 to 2005 and compared those patients with published cases series as well as with data from the Singapore Cancer Registry.

Dr. Thng and colleagues identified 218 patients evaluated for erythema during the study period—108 cases (50%) were classified as idiopathic. Among patients with an identified cause of erythema, preexisting dermatoses (30%) and drug reaction (15%) were the most common diagnoses.

On follow-up, the researchers found idiopathic erythema was associated with visceral malignancy in 18% of patients and with cutaneous T-cell lymphoma in 5%.

“We recommend close follow-up with re-evaluation for malignancy even if the initial investigation had been negative,” they said in a poster at the International Congress of Dermatology.

Few investigators have attempted to examine the natural history and potential clinical consequences of unexplained erythema, the researchers wrote. Moreover, previous studies primarily involved white populations.

Most patients with idiopathic erythema were men (73%) and idiopathic erythema tended to occur at an older age (69 years) when compared with erythema of known cause (62 years). Patients with idiopathic erythema tended to experience a slow onset of disease and an average duration of 22 days. They also experienced more episodes of disease (average of 1.75 episodes), compared with patients who had erythema of known cause (average of 1.32 episodes).

When compared with age-standardized cases, patients with idiopathic erythema had more than a threefold greater risk of visceral malignancy. Dr. Thng and colleagues reported no disclosures.

PRAGUE — Unexplained erythema should raise suspicion about a possible underlying malignancy, according to a review of cases as one Asian institution.

In an effort to determine the clinical implications of idiopathic erythema, Dr. Steven Thng and colleagues at the National Skin Center in Singapore reviewed the records of patients evaluated for erythema from 2001 to 2005 and compared those patients with published cases series as well as with data from the Singapore Cancer Registry.

Dr. Thng and colleagues identified 218 patients evaluated for erythema during the study period—108 cases (50%) were classified as idiopathic. Among patients with an identified cause of erythema, preexisting dermatoses (30%) and drug reaction (15%) were the most common diagnoses.

On follow-up, the researchers found idiopathic erythema was associated with visceral malignancy in 18% of patients and with cutaneous T-cell lymphoma in 5%.

“We recommend close follow-up with re-evaluation for malignancy even if the initial investigation had been negative,” they said in a poster at the International Congress of Dermatology.

Few investigators have attempted to examine the natural history and potential clinical consequences of unexplained erythema, the researchers wrote. Moreover, previous studies primarily involved white populations.

Most patients with idiopathic erythema were men (73%) and idiopathic erythema tended to occur at an older age (69 years) when compared with erythema of known cause (62 years). Patients with idiopathic erythema tended to experience a slow onset of disease and an average duration of 22 days. They also experienced more episodes of disease (average of 1.75 episodes), compared with patients who had erythema of known cause (average of 1.32 episodes).

When compared with age-standardized cases, patients with idiopathic erythema had more than a threefold greater risk of visceral malignancy. Dr. Thng and colleagues reported no disclosures.