Impact of Tobacco Smoke on Skin Cancer Survival in Florida: A Multivariate Analysis of a Population-Based Cancer Registry (1981-2009)

Background: Cigarette smoking increases the risk of developing skin cancer and may lead to worse survival outcomes in those who developed skin cancer.

Methods:  The Florida Cancer Data System (1981-2009) was linked with US census to explore overall survival (defined as the elapsed time from skin cancer diagnosis to death or last contact for living patients) by socio-demographics among SC survivors. Survival was compared by smoking status adjusting with socio-demographics, clinical characteristics and modeled with multivariate Cox regression to calculate adjusted hazard ratio (AHR) and 95% confidence interval (95%CI).

Results: Out of 80,924 SC survivors, 32,386 (40%) were never smokers, 12,788 (15.8%) were former smokers, and 9,104 (11.2%) were current smokers. For all types of skin cancer, current smokers fared worse in survival compared to never smokers (AHR=[1.24];1.18-1.31). For malignant melanoma, never smokers had better survival than current smokers ([1.25];1.18-1.33) and former smokers ([1.07];1.01-1.12). For Merkel Cell Carcinoma, current smokers had worse survival than never smokers ([1.07];0.86-1.34) but the results were not statistically significant. For UV-related skin cancers, current smokers and former smokers had significantly worse survival than never smokers ([1.36];1.21-1.53; [1.19];1.10-1.30, respectively).

Conclusions: Cigarette smoking negatively impacts survival among SC survivors. Smoking attributed the greatest risk to those with malignant melanoma. Smoking cessation efforts to enhance survivorship among skin cancer patients is highly needed.