Chronic lymphocytic leukaemia patients are at greater risk of developing skin cancer, and haematologists can play a key role in its prevention.

This was the message delivered by consultant dermatologist Associate Professor Stephen Shumack at the CLL ARC Forum in Sydney last Sunday (July 23).

Associate Professor Shumack, a clinical associate professor at Sydney Medical School (Northern) at Sydney University, is involved in a multidisciplinary dermatology/haematology CLL clinic at Royal North Shore Hospital.

“A lot of haematologists may not know the increased risk of the development of skin cancer in patients with CLL,” he told the limbic.

This group is four to eight times more likely to develop skin cancer than the general population, he said.

Their risk of skin cancer metastasising is also higher than background risk, however this rate has not been quantified, he said.

Haematologists – or clinic nurses – should advise patients about this risk factor, ideally during an initial consult, and refer them for a skin check.

“It’s worth a review of their patient by a GP with skin cancer expertise, or dermatologist, particularly if they have a history of skin cancer.

“(These clinicians) will explain how to self-check on perhaps a three-monthly basis, particularly if they have had a skin cancer before.”

Patients with a history of skin spots or skin cancer may need to be reviewed as often as every three months, he said.

Between check-ups, it’s also important that patients report any suspect lesions to their treating haematologist to enable timely referral.

“They may well grow these (lesions) much more rapidly and the risk of it spreading is higher, so the patient should report any new lesion, particularly if it’s painful and growing rapidly.”

“The ability to fast-track an appointment if necessary is important, and dermatologists are quite happy to oblige under those circumstances.”

This population is also vulnerable to a range of other skin problems related to the disease, underlying immunosuppression or medications and other treatments.

“At our clinic we have had patients with shingles, exaggerated effects of insect bites, sun spots and solar keratosis to squamous cell carcinoma, and metastatic SCC.”

Some of the newer medications used to treat CLL can have side effects for the skin.

“Ibrutinib may cause increased bleeding or bruising, so you might want to consider stopping this before and a few days after  any significant surgical procedure.”

“Any of the medications can cause rashes as well. Some rashes don’t require the cessation of the medication, and perhaps some rashes do.”