Smoking Status Predicts Worse Survival in Non-Melanoma Skin Cancer

While non-melanoma skin cancer (NMSC) generally carries an excellent prognosis, a patient's smoking history may significantly alter their long-term outlook. A recent systematic review and meta-analysis published in Cancers suggests that current or ever smoking at the time of diagnosis is a strong negative prognostic factor for overall survival in this population.

Here’s a quick overview of the findings.

Quantifying the Risk of Tobacco Exposure

Investigators pooled data from five prospective studies published between 2015 and 2022, focusing on patients with histologically confirmed basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). The studies, conducted in the US, Taiwan, and Hong Kong, included over 8,700 patients with varying follow-up periods ranging from 1.5 to 13 years. The primary outcome was overall survival, defined as the time from diagnosis to death from any cause.

The meta-analysis revealed a clear survival disadvantage for patients with a history of tobacco use:

• Being a current or ever smoker at diagnosis was associated with a more than twofold increased risk of mortality (summary HR 2.42, 95% CI 1.91-3.06).
• Overall survival was negatively affected not only by smoking status but also by the intensity of exposure. When evaluating pack-years or cigarettes per day, patients in the highest exposure category faced a 2.44-fold higher risk of death compared to those in the lowest category (95% CI 2.02-2.93).
• In the single study that evaluated disease-specific survival, ever-smokers had an over 80% increase in the risk of NMSC-specific death compared to never smokers.

Understanding the Survival Gap

The authors note that the unfavorable effect of smoking on survival in NMSC patients is likely driven by the increased risk of developing other life-threatening, smoking-related conditions rather than the skin cancer itself. However, the data underscore that a diagnosis of NMSC presents a critical window for intervention.

Addressing the Evidence Gaps

The findings are constrained by the small number of eligible studies, which limits the ability to draw firm conclusions or conduct more in-depth subgroup analyses. Additionally, smoking exposure was self-reported, and no studies tracked changes in smoking behavior post-diagnosis. This lack of longitudinal data makes it difficult to quantify the exact survival benefit of quitting smoking after an NMSC diagnosis.

Integrating Tobacco Cessation into Routine Care

Despite these limitations, the clinical implications are straightforward. For dermatologists and oncologists managing NMSC, these results highlight the importance of systematically integrating smoking cessation counseling into routine care. Treating the skin lesion is only part of the equation; addressing modifiable risk factors like smoking may be essential for improving the patient's overall long-term survival.

Reference:

Andreon C, Gaeta A, Carretti M, et al. Cigarette Smoking and Survival of Patients with Non-Melanoma Skin Cancer: A Systematic Literature Review and Meta-Analysis. Cancers (Basel). 2025;17(22):3670. Published 2025 Nov 15. doi:10.3390/cancers17223670