Survival of Childhood Cancer and Subsequent Clinical Care

To the Editor We read with interest the Review that detailed common subsequent health complications in childhood cancer survivors. The authors accurately highlighted basal cell carcinoma as an important secondary neoplasm in recipients of radiation therapy; however, childhood cancer survivors are also at risk of melanoma and squamous cell carcinoma, which, unlike basal cell carcinoma, can become invasive and metastasize. Chemotherapy alone and primary diagnoses of leukemia or lymphoma have been associated with increased risk of melanoma. Prolonged immunosuppression and chronic exposure to photosensitizing drugs such as voriconazole have been associated with increased risk of squamous cell carcinoma. Hematopoietic stem cell transplant presents unique risk factors for secondary cutaneous neoplasms, such as total body irradiation and chronic cutaneous graft vs host disease (GVHD).