All-cause mortality in patients with basal and squamous cell carcinoma: A systematic review and meta-analysis

Abstract

Background: There are varying reports of the association of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) with mortality.

Objective: To synthesize the available information on all-cause mortality after a diagnosis of BCC or SCC in the general population.

Methods: We searched PubMed (1966-present), Web of Science (1898-present), and Embase (1947-present) and hand-searched to identify additional records. All English articles that reported all-cause mortality in patients with BCC or SCC were eligible. We excluded case reports, case series, and studies in subpopulations of patients. Random effects model meta-analyses were performed separately for BCC and SCC.

Results: The searches yielded 6538 articles, and 156 were assessed in a full-text review. Twelve studies met the inclusion criteria, and 4 were included in the meta-analysis (encompassing 464,230 patients with BCC and with 175,849 SCC), yielding summary relative mortalities of 0.92 (95% confidence interval, 0.83-1.02) in BCC and 1.25 (95% confidence interval, 1.17-1.32) in SCC.

Limitations: Only a minority of studies controlled for comorbidities. There was significant heterogeneity in meta-analysis (χ²P < .001, I² > 98%), but studies of SCC were qualitatively concordant: all showed statistically significant increased relative mortality.

Conclusions: We found that patients with SCC are at higher risk for death from any cause compared with the general population.

Keywords: all-cause mortality; basal cell carcinoma; cutaneous squamous cell carcinoma; keratinocyte carcinoma; meta-analysis; systematic review.