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Cigarette Smoking and Survival of Patients with Non-Melanoma Skin Cancer: A Systematic Literature Review and Meta-Analysis
by
, , , , , and
Chiara Andreon
1, 
Aurora Gaeta
1,2,
Maddalena Carretti
3,
Alice Graziani
3,
Giulio Tosti
4,
Chiara Doccioli
5,
Maristella Saponara
6,
Giuseppe Gorini
5,
Mariano Suppa
7,
Elisa Di Maggio
5,
Sara Gandini
1,*
and
Saverio Caini
8
1
Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
2
Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
3
Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
4
Dermato-Oncology Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
5
Clinical Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), 50139 Florence, Italy
6
Division of Melanoma and Sarcoma Medical Treatment, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
7
Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
8
Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), 50139 Florence, Italy
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(22), 3670; https://doi.org/10.3390/cancers17223670 (registering DOI)
Submission received: 28 September 2025
/
Revised: 5 November 2025
/
Accepted: 12 November 2025
/
Published: 15 November 2025
(This article belongs to the Special Issue Skin Cancer Prevention: Strategies, Challenges and Future Directions)
Simple Summary
There is still limited evidence on whether cigarette smoking may affect the prognosis of patients with non-melanoma skin cancer (NMSC). Here, we conducted a systematic review and meta-analysis of published reports in Pubmed and Embase to identify prospective studies of patients with histologically confirmed NMSC that evaluated the association between smoking habits and survival. The search was updated to February 2025. Based on five eligible articles published between 2015 and 2022, we found that the overall survival in patients with NMSC is negatively affected by current or ever smoking, as well as by the number of cigarettes smoked per day and the number of pack-years smoked in one’s lifetime. These results indicate that cigarette smoking is a negative prognostic factor in this patient population and underscore the importance of systematically integrating smoking cessation counselling into the routine management of patients with NMSC.
Abstract
Background: Non-melanoma skin cancer (NMSC) is the most frequent cancer in fair-skinned populations and represents a growing public health concern due to its impact in terms of morbidity and treatment costs. While some meta-analyses have investigated cigarette smoking as a risk factor for NMSC, less is known about its prognostic implications in patients with NMSC. This systematic review and meta-analysis aims to fill this gap by assessing the association between smoking habits and survival in patients with NMSC. Methods: A systematic search was conducted in PubMed and EMBASE up to 25 February 2025, to identify prospective studies of patients with histologically confirmed NMSC that evaluated the association between smoking habits and survival. Study-specific hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were pooled using random effects meta-analysis models. Results: A total of five studies published between 2015 and 2022 were included. The meta-analysis revealed that being a current or ever smoker at diagnosis was associated with a worse overall survival (summary HR 2.42, 95% CI 1.91–3.06). A similar result was observed when smoking exposure was assessed in terms of pack-years or number of cigarettes per day (summary HR 2.44, 95% CI 2.02–2.93). Conclusions: Our findings indicate that cigarette smoking is a negative prognostic factor in these patients, despite the generally excellent prognosis of NMSC. It is reasonable to assume that this unfavourable effect is largely due to the increased risk of developing other life-threatening conditions, in which smoking plays a causal role. These results underscore the clinical relevance of systematically integrating smoking cessation counselling into the routine management of patients with NMSC.
