Association of Non-Melanoma Skin Cancer with Exfoliation Syndrome in Utah

Abstract

Purpose : Exfoliation syndrome (XFS) is a systemic disorder with ocular manifestations that is associated with irregularity in extracellular matrix deposition and remodeling. Given prior data suggesting an association between non-melanoma skin cancer (NMSC), i.e. basal and squamous cell cancers most often located in areas of sun exposure and XFS, a questionnaire was administered to clinic study patients to evaluate this relationship.

Methods : Participants answered a questionnaire designed to assess lifelong UV exposure, including leisure and occupational sun exposure, whether more likely to tan or burn in early life, eye and hair color, smoking behavior, vitamin D deficiency, skin cancer history, alcohol consumption and caffeine intake. The questionnaire was sent to 151 consented XFS study patients and their family members, recruited from the Moran Eye Center clinics. Of these, 53 patients completed the questionnaire and identified as non-Hispanic and white. Twelve respondents were excluded for: age (under 60y); missing birth date and basic demographic information; and unavailable electronic health records (EPIC system) to confirm absence or presence of XFS and medical history.

Results : Among these 41 eligible survey respondents ages 60y and older 31 had XFS (including 23 patients with chart-confirmed exfoliation glaucoma; XFG) and 10 respondents had no XFS diagnosis. These affected XFS and unaffected individuals did not substantively differ by gender, age, eye/hair color, or lifestyle (smoking, alcohol, caffeine consumption). XFS patients with XFG had a slightly higher frequency of NMSC (30%) compared with those unaffected by XFG (22%), and were more likely to reside at higher elevation (>5500 ft). There was an elevated proportion of XFS in those with highest quartile of sun exposure hours during young adult and adulthood (ages 21-64y) and XFS were somewhat younger at age of first sunburn.

Conclusions : Consistent with prior studies, patients with XFS/XFG appeared more likely to reside at higher elevations. Our limited, descriptive findings suggest that greater UV exposure over the adult life course may be associated with a somewhat higher risk of NMSC in XFS patients who have developed XFG. Identifying differences in UV exposure-related and other non-UV demographic and lifestyle risk factors and the development of NMSC between XFS, XFS with XFG, and unaffected individuals should be pursued in larger population-based studies.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.