Tobacco smoking as a risk for cutaneous squamous cell carcinoma in skin of color.

9589 Background: Ultraviolet radiation (UVR) along with immunosuppression, tobacco smoking and age are the major risk factor cutaneous squamous cell carcinoma (cSCC) in White individuals. However, the risk factors for cSCC in skin of color (SOC), where UVR may be less important, remain inadequately explored. Methods: A retrospective cohort study of real-world aggregate patient data from the TriNetX global federated research network was used to identify patients with cSCC. Cohorts were created for Asian, Black/African American, White/Caucasian, and Hispanic patients with ICD-10 codes for cSCC. These cohorts were then 1:1 propensity matched with a control group of the same race/ethnicity with ICD-10 codes for benign skin lesions. Propensity matching was performed for age at cSCC diagnosis and patients’ sex. The number of patients in the smokers in the cSCC group was then compared to the number of smokers in the control group. Results: We identified 2122 Asian subjects, 5237 Black subjects, 4256 Hispanic subjects and 227,683 White subjects with cSCC. We also identified a control cohort of each race/ethnicity with a diagnosis of benign neoplasm of the skin. After propensity matching for age at diagnosis and sex, White subjects diagnosed with cSCC were 2.3 fold more likely to have a previous history of cigarette smoking than White subjects with the control diagnosis (P<0.001). When looking at SOC, Black subjects were 3.3 fold (p<0.001), Asians 3.6 were fold (p<0.001), and Hispanics were 2.5 fold (p<0.001) more likely to have a cigarette smoking diagnosis than subjects of the same race with the control diagnosis. Conclusions: This study suggests that smoking is a major risk factor in for cSCC in SOC. These findings emphasize this importance of tailored preventative strategies to address disparities in tobacco smoking behaviors. Future research should seek to further elucidate the underlying socioeconomic, cultural, and healthcare access factors contributing to differences for optimization of equitable care.