Toward personalized skin cancer care: multiple skin cancer development in five cohorts.

Importance:Many patients will develop more than one skin cancer, however most research to date has examined only case status. Objective:Describe the frequency and timing of the treatment of multiple skin cancers in individual patients over time. Design:Longitudinal claims and electronic health record-based cohort study. Setting:Vanderbilt University Medical Center database called the Synthetic Derivative, VA, Medicare, Optum Clinformatics® Data Mart Database, IBM Marketscan. Participants:All patients with a Current Procedural Terminology code for the surgical management of a skin cancer in each of five cohorts. Exposures:None. Main Outcomes and Measures:The number of CPT codes for skin cancer treatment in each individual occurring on the same day as an ICD code for skin cancer over time. Results:Our cohort included 5,508,374 patients and 13,102,123 total skin cancers treated. Conclusions and Relevance:Nearly half of patients treated for skin cancer were treated for more than one skin cancer. Patients who have not developed a second skin cancer by 2 years after the first are unlikely to develop multiple skin cancers within the following 5 years. Better data formatting will allow for improved granularity in identifying individuals at high risk for multiple skin cancers and those unlikely to benefit from continued annual surveillance. Resource planning should take into account not just the number of skin cancer cases, but the individual burden of disease. Key points:Question: How many skin cancer patients are treated for more than one skin cancer and how soon after the first skin cancer do they occur?Findings: 43% of patients were treated for more than one skin cancer, the majority of which occurred within two years after the initial skin cancer. Just 3% of patients were treated for 10 or more skin cancers, but these patients accounted for 22% of all of the skin cancer treatments in the cohort Meaning: Nearly half of all skin cancer patients were treated for multiple skin cancers, while those without a second skin cancer after two years were less likely to be treated for a subsequent skin cancer within the next five years.