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TOPLINE:

Lower-extremity (LE) lymphedema increases the risk for all types of skin cancer on the lower extremities.

METHODOLOGY:

  • In the retrospective cohort study, researchers reviewed reports at Mayo Clinic for all patients who had LE lymphedema, limiting the review to those who had an ICD code for lymphedema.

  • 4437 patients with the ICD code from 2000 to 2020 were compared with 4437 matched controls.

  • The records of patients with skin cancer diagnoses were reviewed manually to determine whether the skin cancer, its management, or both were a cause of lymphedema; cancers that caused secondary lymphedema were excluded.

  • This is the first large-scale study evaluating the association between LE lymphedema and LE skin cancer.

TAKEAWAY:

  • 211 patients (4.6%) in the LE lymphedema group had any ICD code for LE skin cancer compared with 89 (2%) in the control group.

  • Among those with LE lymphedema, the risk for skin cancer was 1.98 times the risk of having skin cancer (95% CI, 1.43-2.74; P < .001). Cases included all types of skin cancer.

  • Nineteen of 24 patients with unilateral LE lymphedema had a history of immunosuppression.

  • In the group of 24 patients with unilateral LE lymphedema, the lymphedematous LE was more likely to have one or more skin cancers than were the unaffected LE (87.5% vs 33.3%; P < .05), and skin cancer was 2.65 times more likely to develop on the affected LE than in the unaffected LE (95% CI, 1.17-5.99; P = .02).

IN PRACTICE:

“Our findings suggest the need for a relatively high degree of suspicion of skin cancer at sites with lymphedema,” senior author, Afsaneh Alavi, MD, professor of dermatology at the Mayo Clinic, said in a Mayo Clinic press release reporting the results.

SOURCE:

The study was conducted by researchers at the Mayo Clinic and Meharry Medical College, Nashville. It was published in the November 2023 Mayo Clinic Proceedings.

LIMITATIONS:

This was a single-center retrospective study, and patients with LE lymphedema may be overdiagnosed with LE skin cancer because they have a greater number of examinations.

DISCLOSURES:

Alavi reports having been a consultant for AbbVie, Boehringer Ingelheim, InflaRx, Novartis, and UCB SA, and an investigator for Processa Pharmaceuticals Inc and Boehringer Ingelheim. The other authors had no disclosures.

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