Is There a Connection Between CLL and Melanoma?

Risk of Melanoma Skin Cancer in Patients with CLL

The following article includes highlights from the CLL Answers Now series.

When Cathy Hamilton was diagnosed with chronic lymphocytic leukemia (CLL) in February 2018, she was not thinking about skin cancer. She spent the first few weeks learning everything she could about CLL and trying to understand why she did not need treatment right away.

“I didn’t hear everything [my doctor said],” Hamilton told Patient Power co-founder Andrew Schorr in 2019. “I did hear that there would be no treatment, and that was confusing to me. Anytime you hear the word cancer, you think, ‘Let’s get it. Let’s attack it. Let’s throw everything we can at it.’ But in this case, it was, ‘No, we’re just going to sit back and see what happens.’ For my personality type, that was a little hard to take.”

Hamilton, who is still on watch and wait more than three years after her diagnosis, has learned a lot about CLL since then, including that she is at increased risk of developing melanoma and other cancers. Hamilton recently hosted a CLL Answers Now program to discuss those risks with experts Nicole Lamanna, MD, a hematologist-oncologist at the Columbia University Herbert Irving Comprehensive Cancer Center in New York City, and Gregory Bociek, MD, an oncologist at the University of Nebraska Medical Center in Omaha.

Why Are Patients With CLL at Risk for Second Cancers?

“One of the most fascinating things for me about CLL is how much of an immunosuppressive illness it is,” Dr. Bociek told Hamilton during the program. At the point of diagnosis, a patient with CLL has measurable damage to their immune system. It is likely disease-related and often progresses over time, even without cancer therapy (which can also damage the immune system).

“We think of second cancers as an additional malignancy that more often than not would not be associated with the first cancer in a way that we can clearly, directly understand,” he said. “The assumption is, there is an underlying abnormality in the immune system that makes certain types of cancers a little bit more likely to arise.”

What is the Connection Between Melanoma Skin Cancer and CLL?

CLL affects the blood and bone marrow, and melanoma develops when skin cells are damaged. What does one have to do with the other? Seemingly nothing — and yet, according to a 2019 study published in Blood Cancer Journal, a correlation exists.

Using Surveillance, Epidemiology, and End Results (SEER) data from 38,754 patients who were diagnosed with CLL between 1973 and 2015, researchers found that patients with CLL in the United States had a 20% higher risk of developing a new cancer than the general population. When looking at solid tumors, the risk was most elevated compared to the general population for developing Kaposi sarcoma, salivary gland tumors, melanoma, and other skin cancers.

Dr. Bociek theorized that one connection between CLL and melanoma could be age — most people diagnosed with CLL are age 70 or older — and the fact that skin cancer prevention years ago was not what it is now.

“It used to be the era of Coppertone and baby oil and go out until we get as brown as possible,” he said. “Our kids’ skin looks nothing like our skin, and they have grown up with a completely different sense of sun safety. I would like to believe that if our kids’ generation and beyond continue to be smart, maybe we’ll see a dramatic decrease in the incidence of skin cancer.”

Experts agree that the immune system is likely at the root of the elevated risk of melanoma in people with CLL. A healthy immune system can detect and destroy melanoma cells before they are a problem, while a compromised immune system cannot.

Can Patients with CLL Reduce their Melanoma Risks?

There is no surefire way to prevent a second cancer, but you can take steps to reduce your risk of developing melanoma.

1. Protect your skin. Everyone should practice good sun safety, but skin cancer prevention is even more critical if you are immunocompromised. Stay in the shade, wear a broad-brimmed hat, wear sunscreen with an SPF of 15 or higher, and reapply sunscreen every two hours and after swimming or excessive sweating.

“We know that sun is still the main driver of [skin cancer], even perhaps in the setting of a disorder of the immune system,” said Dr. Bociek. “You have to be super thoughtful about being outdoors in the summer and wearing the right clothing. I think people forget things as simple as putting on sunscreen every couple of hours.”

2. Get screened for skin cancer. Dr. Lamanna recommends seeing a dermatologist at least once a year for a skin cancer screening. Your dermatologist may want to see you more frequently if you have a history of skin cancer or they need to monitor a suspicious mole, but Dr. Lamanna said to make sure you get screened annually at a minimum.

“I often sound like a broken record because I ask my patients the same questions every time they come in,” she said. “We document that they saw the dermatologist here, and they went and had their colonoscopy here. We go through that as a routine practice to remind them what they’re due for and to be proactive about their health screenings so that we can potentially pick up other cancers early.”

Dr. Lamanna reminds patients that while CLL is chronic and can usually be managed, some secondary cancers like melanoma are not always so manageable if they progress to metastatic disease. Early detection leads to better outcomes.

To learn more, watch Secondary Cancers in CLL Patients. For questions about your health and personal risk factors, make an appointment with a CLL specialist.