OBJECTIVES:  To assess the risk of second primary cancer in people with non-melanoma skin cancer (NMSC). METHODS:  By using data from the National Health Insurance Research Database, we conducted a population-based cohort study to assess the risk of incident second primary cancer in people affected by NMSC. RESULTS:  We identified 505 subjects with NMSC and 2,020 matched controls. After adjustment for potential confounders including age, sex, urbanization, and Charlson comorbidity index, people who had NMSC had a 1.43-fold (95% CI: 1.05-1.96) risk for the development of second primary cancer as compared with control group. Men with NMSC had a 2.99-fold (95% CI 1.00-9.10) risk for second primary cancer involving the lip, oral cavity, and pharynx and a 3.51-fold (95% CI 1.21-10.17) risk for second primary cancer involving the genitourinary organs when compared to the control group. By contrast, women with NMSC did not have an increased risk of second primary cancer. CONCLUSIONS:  This study confirmed Asians with NMSC have an increased risk of second primary cancer, but the clinical presentations are different from those in Caucasians. Our findings can be a useful reference for health care for people diagnosed with NMSC.