Dermatologic UV-related cancers in the head and neck region are associated with exfoliation syndrome in a New York City-based clinic population

Abstract

Purpose : Exfoliation syndrome (XFS) is a systemic disease in which extracellular matrix deposits (exfoliation material, XFM) are found in the anterior segment of the eye. Prior studies suggest that ocular UV radiation in early life is a risk factor for XFS. We performed a clinical survey study to assess the relationship between UV exposure in early life with XFS using UV-associated carcinomas [basal cell carcinoma (BCC), and squamous cell carcinoma (SCC)] history in specific regions of the body as a proxy for UV exposure.

Methods : Subjects were recruited for a one-time cross-sectional interview survey assessing age, sex, medical history, XFS diagnosis, eye color, hair color, likelihood of tanning or burning in early life, and history of BCC and/or SCC. Multivariate models adjusting for these covariates were performed.

Results : 321 subjects were recruited for the study (52.6% female, 96.2% white ethnicity, mean age: 72.6 years). 98 (30.5%) patients had XFS/XFG, 117 (36.5%) had primary open-angle glaucoma (POAG) and 106 (33.0%) were non-glaucomatous controls (Tbl. 1). After adjusting for the covariates, there was a 2-fold risk for having XFS with any history of BCC/SCC in the head and neck region versus POAG + controls (odds ratio (OR) = 2.05, 95% confidence interval (CI) = 1.04 – 3.89). Additionally, we observed a dose-response association where the chance of having XFS was higher by 67% with every BCC/SCC occurrence versus POAG + controls (OR = 1.67, 95% CI = 1.09 – 2.56). XFS versus control groups showed a 2.8-fold risk for XFS with any history of head/neck BCC/SCC (OR = 2.80, 95% CI = 1.12 – 7.02), and a 2-fold risk for each additional count of UV-related carcinomas (OR = 1.97, 95% CI = 1.09 – 3.58).

When BCC/SCC located anywhere on the body was considered, there were non-significant increased odds of XFS (OR = 1.65, 95% CI = 0.88 – 3.09).

There were no associations between head and neck BCC/SCCs and POAG compared to controls (OR = 1.15, 95% CI = 0.58 – 3.48).

Conclusions : Having BCC/SCC specifically in the head and neck region is associated with a 2-fold increase in risk for XFS/XFG. These findings support prior evidence that UV exposure may be a significant risk factor for XFS. In addition, these results provide further support for in vitro studies analyzing the effects of UV exposure in generating XFM and also strengthen recommendations for UV protection.

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