Risk of Nonmelanoma Skin Cancers and Parkinson’s Disease—Meta-Analysis and Systematic Review

Round 1

Reviewer 1 Report

Dear authors,

Please know that I enjoyed reading your manuscript and found it to be a good analysis of an important and interesting topic. Below you will find a list of my suggestions:

• The whole manuscript needs extensive language editing, perhaps by a native English speaker
• Since only BCC and SCC are analyzed, maybe the more modern term “keratinocyte carcinomas” should be used, as NMSC could be argued to also include primary cutaneous lymphomas, for example
• Line 68: issue with the flow diagram in Figure 1 - the numbers don’t add up (75 potential relevant studies - 30 excluded, but the numbers in the box to the right add to 36)
• Line 69: Table 1 - please explain abbreviations appearing in the header, in the table footer
• Line 57-59: The meaning of this “Considering that NMSCs share similar risk factors with melanoma, there is a need to understand the possible coexistence between PD and NMSCs [11].” should be made more clear - rephrase, please
• Line 165: “between January 2020 till April 2020.” should probably state “between January 2000 until April 2020”
• The finding of a higher risk of BCC among PD patients is open to interpretation, due to the high prevalence of this keratinocyte carcinoma
• The higher likeliness of discovering a NMSC after (and not before or at the same time) the diagnosis of PD could be argued, as you also elegantly mention, to be either a result of more frequent medical consults or anti-parkinsonian drugs photocarcinogenesis - maybe this could be discussed in an additional paragraph in the paper
• Your analysis clearly shows the benefits of prospective studies over retrospective studies based on medical records in which patients might have not been followed up

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

The authors perfomed a retrospective stuy evaluating the long-term survival of narrow (1-2 cm) versus wide (>2 cm) excision margins in cutaneous melanoma thicker than  2 mm. They foun no signifcant difference regarding OS and DFS.

Although the number of cases included in the study is high, the data are not so new. One major limitation is that they refer to the AJCC 6th edition but the 8th edition is currently used and therefore they should consider this and adapt their staging findings.

 

 

 

 

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

The paper by Krasowska et al. is a meta-analysis on the relationship between Parkinson's disease (PD) and non-melanoma skin cancers (NMSC). The authors found significantly higher risks of NMSCs (in particular, basal cell carcinoma) in patients with PD. As the authors mentioned, this may be the first meta-analysis to evaluate the NMSCs risk among patients with PD. I would like to raise the following concerns.

1. Please show the details of control group. How did the authors adjust the potential confounders (e.g. age)? The authors should discuss on this point. 

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 4 Report

This metanalysis analysing PD and NMSK risk is Very interesting , methods are fine and results are consistent.

I have read with pleasure the metanalysis by Krasowska and coauthors looking at the association between Parkinson disease and NMSK. At the end of the metanalysis process,   16 studies including 140291  PD patients were analysed. The authors reported a higher risk (almost 130% ) of NMSK  among the BCC group, while not in the SCC group. The authors described as well many different subgroups in the study. The association between PD and NMSK should be considered and PD patients should be screened more frequently.

The study is well performed and the methods sound. Conclusion are supported by strong evidence.

The manuscript can be accepted in the present form.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The paper is well written and informative.

Reviewer 3 Report

Thank you for the revised manuscript.　I do not have additional comments.