{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T16:55:49Z","timestamp":1782233749887,"version":"3.54.5"},"reference-count":62,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Erasmus Foundation and Alphatron"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Following a first cutaneous squamous cell carcinoma (cSCC), approximately one-third of patients develop new primary tumours, escalating their risk of metastasis and poor outcomes. However, current follow-up strategies lack risk stratification, representing a critical gap in patient management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To develop and validate a prognostic model to quantify individualized absolute risk of a first metachronous cSCC after an index tumour, accurately accounting for the high competing risk of mortality in this typically older population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a nationwide, population-based cohort study of 11 737 patients with a first histologically confirmed cSCC (Netherlands Cancer Registry, 2007\u20132008) with up to 10\u2005years of follow-up. Subsequent tumours were identified via linkage to the Automated National Pathological Anatomy Archive (PALGA). A Fine\u2013Gray competing-risk model was developed using routinely available clinical and pathological predictors. Model performance was assessed with 10-fold cross-validation, quantifying discrimination [time-dependent area under the receiving operator characteristic curve (AUCt)] and calibration. Clinical utility was evaluated using decision curve analysis (DCA) and tertile risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During follow-up, 3288 (28%) patients developed a first metachronous cSCC. Key predictors included markers of cumulative ultraviolet exposure (included history of actinic keratosis, \u2265 5 prior basal cell carcinomas) and chronic lymphocytic leukaemia\/small lymphocytic leukaemia. Male sex and the presence of synchronous cSCC at baseline were also associated with higher risk. While discrimination was modest (cross-validated 5-year AUCt 0.64), the model demonstrated excellent calibration across all predictor subgroups. DCA showed modest net benefit for predicted probabilities between 18% and 45%. Risk stratification into tertiles revealed a nearly fivefold acceleration: the high-risk tertile reached a 15% cumulative incidence in 1.4\u2005years compared with 6.9\u2005years for the low-risk tertile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This competing-risk model provides individualized, well-calibrated absolute risk estimates for a first metachronous cSCC. Based on routinely available clinical features, it offers insight into how established predictors shape risk in this high-susceptibility population and quantifies relative risk acceleration. External validation and the identification of novel predictors are necessary to further refine the model and support personalized surveillance strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjd\/ljag076","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T12:23:05Z","timestamp":1772454185000},"page":"48-57","source":"Crossref","is-referenced-by-count":1,"title":["Predicting a metachronous cutaneous squamous cell carcinoma: a competing-risk model based on nationwide linked registries"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9211-822X","authenticated-orcid":false,"given":"Andrya Reder","family":"Hollatz","sequence":"first","affiliation":[{"name":"Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1669-0283","authenticated-orcid":false,"given":"Celeste J","family":"Eggermont","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0073-4269","authenticated-orcid":false,"given":"Barbara","family":"Rentroia-Pacheco","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9011-6741","authenticated-orcid":false,"given":"Marieke","family":"Louwman","sequence":"additional","affiliation":[{"name":"Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL) , Utrecht ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9810-5780","authenticated-orcid":false,"given":"Antien","family":"Mooyaart","sequence":"additional","affiliation":[{"name":"Department of Pathology, Erasmus MC Cancer Institute, University Medical Center , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9940-2875","authenticated-orcid":false,"given":"Tamar","family":"Nijsten","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8578-901X","authenticated-orcid":false,"given":"Marlies","family":"Wakkee","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8922-6791","authenticated-orcid":false,"given":"Loes","family":"Hollestein","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center , Rotterdam ,","place":["the Netherlands"]},{"name":"Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL) , Utrecht ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"2026062312164929400_ljag076-B1","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1111\/j.1365-2133.2012.10830.x","article-title":"A systematic review of worldwide incidence of nonmelanoma skin cancer","volume":"166","author":"Lomas","year":"2012","journal-title":"Br 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