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Mathieu O, Chaine A, Benassarou M, Combes F, Debelmas A, Lanciaux S, Bertolus C, Bouaoud J. Epidemiology of facial skin cancers managed in a French ambulatory surgical center. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101726. [PMID: 38056693 DOI: 10.1016/j.jormas.2023.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Approximately 80,000 cases of skin cancer are diagnosed annually in France. The management of these cancers can occur in both university hospital centers and ambulatory surgery centers. Limited data exist regarding the epidemiology of cutaneous cancers treated through ambulatory surgery centers. The objective of our study is to describe the epidemiological characteristics of cutaneous cancers managed in a tertiary ambulatory surgery center. METHODS This is a retrospective, single-center observational study. The included patients were those who underwent surgical excision of one or more skin cancers within the maxillofacial department of a tertiary ambulatory surgery center. Clinical, therapeutic, histopathological, and follow-up data (additional surgery if margins were not clear, progression, recurrence, second cancer…) were collected. RESULTS Among the n = 1931 patients operated for a head and neck skin tumor from September 2018 to July 2022, n = 426 (22 %) were diagnosed with cancer upon histological analysis. The median age was 76 years (31-100), with a male-to-female ratio of 1/1. The most frequent locations were the nose (23 %) and cheek (20 %). Ten percent of patients had dual-site skin cancer at initial diagnosis. The most common histological types were basal cell carcinoma (77 %) and squamous cell carcinoma (18 %). Surgical treatment primarily consisted of "excision-reconstruction with local flap" (51 %) or "excision-suture" (34 %). Resection margins were mostly clear (65 %), and only six patients (2 %) experienced local recurrence or progression during follow-up. CONCLUSIONS Skin cancers are prevalent in ambulatory practice. Surgical treatment allows for effective control of the cancer. Photoprotection, particularly in immunocompromised patients, remains crucial for prevention.
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Affiliation(s)
- Olivier Mathieu
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France.
| | - André Chaine
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France; Department of Maxillofacial and Stomatology Surgery, Claude Gallien Private Hospital, Quincy-sous-Sénart, France
| | - Mourad Benassarou
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France
| | - Floriane Combes
- Department of Maxillofacial and Stomatology Surgery, Claude Gallien Private Hospital, Quincy-sous-Sénart, France
| | - Alexandre Debelmas
- Department of Maxillofacial and Stomatology Surgery, Claude Gallien Private Hospital, Quincy-sous-Sénart, France
| | - Sophie Lanciaux
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France; Department of Maxillofacial and Stomatology Surgery, Claude Gallien Private Hospital, Quincy-sous-Sénart, France
| | - Chloé Bertolus
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France
| | - Jebrane Bouaoud
- Department of Maxillofacial and Stomatology Surgery, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France
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Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, Berking C, Arenberger P, Bylaite-Bučinskiene M, Del Marmol V, Dirschka T, Dreno B, Forsea AM, Harwood CA, Hauschild A, Heerfordt IM, Kauffman R, Kelleners-Smeets N, Lallas A, Lebbe C, Leiter U, Longo C, Mijušković Ž, Pellacani G, Puig S, Saiag P, Šitum M, Stockfleth E, Salavastru C, Stratigos A, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes). J Eur Acad Dermatol Venereol 2024; 38:1024-1047. [PMID: 38451047 DOI: 10.1111/jdv.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.
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Affiliation(s)
- Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endrocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - Matilda Bylaite-Bučinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany
- CentroDerm Clinic, Wuppertal, Germany
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Ida Marie Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Roland Kauffman
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP, Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Caterina Longo
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Željko Mijušković
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Susana Puig
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mirna Šitum
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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Wheless L, Liao KP, Zheng S, Li Y, Yao L, Xu Y, Madden C, Ike J, Smith IT, Mosley D, Grossarth S, Hartman RI, Wilson O, Hung A, Wehner MR. Toward personalized skin cancer care: multiple skin cancer development in five cohorts. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.06.24306947. [PMID: 38766175 PMCID: PMC11100848 DOI: 10.1101/2024.05.06.24306947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Importance Many patients will develop more than one skin cancer, however most research to date has examined only case status. Objective Describe the frequency and timing of the treatment of multiple skin cancers in individual patients over time. Design Longitudinal claims and electronic health record-based cohort study. Setting Vanderbilt University Medical Center database called the Synthetic Derivative, VA, Medicare, Optum Clinformatics® Data Mart Database, IBM Marketscan. Participants All patients with a Current Procedural Terminology code for the surgical management of a skin cancer in each of five cohorts. Exposures None. Main Outcomes and Measures The number of CPT codes for skin cancer treatment in each individual occurring on the same day as an ICD code for skin cancer over time. Results Our cohort included 5,508,374 patients and 13,102,123 total skin cancers treated. Conclusions and Relevance Nearly half of patients treated for skin cancer were treated for more than one skin cancer. Patients who have not developed a second skin cancer by 2 years after the first are unlikely to develop multiple skin cancers within the following 5 years. Better data formatting will allow for improved granularity in identifying individuals at high risk for multiple skin cancers and those unlikely to benefit from continued annual surveillance. Resource planning should take into account not just the number of skin cancer cases, but the individual burden of disease.
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Affiliation(s)
- Lee Wheless
- Tennessee Valley Healthcare System VA Medical Center
- Vanderbilt University Medical Center Department of Medicine, Division of Epidemiology Vanderbilt University Medical Center
- Department of Dermatology, Nashville, Tennessee
| | - Kai-Ping Liao
- University of Texas MD Anderson Cancer Center, Department of Health Services Research
| | - Siwei Zheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yao Li
- University of Texas MD Anderson Cancer Center, Department of Health Services Research
| | - Lydia Yao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher Madden
- State University of New York Downstate College of Medicine, Brooklyn, New York
| | | | | | | | - Sarah Grossarth
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN
| | - Rebecca I Hartman
- VA Boston Healthcare System
- Brigham and Women's Hospital Department of Dermatology
| | - Otis Wilson
- Tennessee Valley Healthcare System VA Medical Center
| | - Adriana Hung
- Tennessee Valley Healthcare System VA Medical Center
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mackenzie R Wehner
- University of Texas MD Anderson Cancer Center, Department of Health Services Research
- University of Texas MD Anderson Cancer Center, Department of Dermatology
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Eggermont CJ, Hollestein LM, Hollatz A, Louwman M, Mooyaart AL, Nijsten T, Wakkee M. Cumulative incidence and timing of subsequent cutaneous squamous cell carcinomas stratified for patients with organ transplantation and hematologic malignancies: A nationwide cohort study. J Am Acad Dermatol 2024; 90:530-536. [PMID: 37871807 DOI: 10.1016/j.jaad.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is lack of nationwide data on the cumulative incidence and timing of subsequent cutaneous squamous cell carcinomas (cSCCs) among patients with a first cSCC. OBJECTIVE To investigate the cumulative incidence and timing of subsequent cSCCs. METHODS Patients with a first cSCC in 2007/2008 from the Netherlands Cancer Registry were linked to the Netherlands Pathology Registry for subsequent cSCCs and the Netherlands Organ Transplant Registry. Cumulative incidence function curves were calculated for subsequent cSCCs and stratified for immune status. RESULTS Among the 12,345 patients, second to sixth cSCC occurred in 4325, 2010, 1138, 739, and 501 patients, with median time intervals of 1.4, 1.2, 0.9, 0.6, and 0.5 years after the previous cSCC, respectively. The cumulative incidence of a subsequent cSCC at 5 years increased from 28% to 67% for the second to sixth cSCC. For solid organ transplant recipients, the cumulative incidences increased from 74% to 92% and from 41% to 64% for patients with hematologic malignancy. LIMITATIONS Only histopathologically confirmed cSCCs were included. CONCLUSION The risk of a subsequent cSCC steeply rises with the number of prior cSCCs and immune status, while the time interval decreases. This can support more informed decisions about follow-up management.
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Affiliation(s)
- Celeste J Eggermont
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Loes M Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Andrya Hollatz
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Marieke Louwman
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Antien L Mooyaart
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
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Gart S, Plampton K, Wysong A, Sutton A. Evaluating Disease-Specific Quality of Life and Chemoprevention Utilization in Patients With More Than One Lifetime Skin Cancer. Dermatol Surg 2024; 50:197-199. [PMID: 37962151 DOI: 10.1097/dss.0000000000004011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Sophie Gart
- All authors are affiliated with the Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
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Alkhatib B, Waler A, Welch M, McCarthy J, Nam A, Friedman HI. Clinical Observation or Further Excision: A Retrospective Review of Margin-positive Squamous and Basal Cell Carcinomas. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5473. [PMID: 38111724 PMCID: PMC10727568 DOI: 10.1097/gox.0000000000005473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 12/20/2023]
Abstract
Background Patients determined to have margin-positive nonmelanoma skin cancer (NMSC) after initial shave or punch biopsy performed by a primary care physician or dermatologist are commonly referred to extirpative surgeons for definitive removal. Not infrequently, the residual tumor is not appreciable, and the exact location of the lesion is indiscernible. The consulting surgeon must decide to excise the presumed lesion or clinically monitor for recurrence. Methods This single-center, retrospective review examined patients with squamous and basal cell carcinomas referred over a 5-year period to two senior authors. Results In total, 233 patients had a total of 312 lesions excised. Thirty-nine (12.5%) of these lesions (in 33 patients) demonstrated no residual tumor on pathologic examination. Twelve patients were managed nonoperatively (5.15%) and observed to have had no tumor recurrence with a mean observation period of 14.66 months (range 1-54 months). Thus, approximately 19.3% of all patients referred had no residual tumor. Conclusion Based on our observations and low proclivity for metastases, nonoperative monitoring of NMSC may be a reasonable option for certain lesions less than 1 cm that are undiscernible at the time of referral.
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Affiliation(s)
- Bailey Alkhatib
- From the University of South Carolina School of Medicine Columbia, Columbia, S.C
| | - Alexandria Waler
- Division of Plastic Surgery Prisma Health/University of South Carolina School of Medicine
| | - Madelyn Welch
- From the University of South Carolina School of Medicine Columbia, Columbia, S.C
| | - Jack McCarthy
- Division of Plastic Surgery Prisma Health/University of South Carolina School of Medicine
| | - Arthur Nam
- Division of Plastic Surgery Prisma Health/University of South Carolina School of Medicine
| | - Harold I Friedman
- From the University of South Carolina School of Medicine Columbia, Columbia, S.C
- Division of Plastic Surgery Prisma Health/University of South Carolina School of Medicine
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Guzman AK, Schmults CD, Ruiz ES. Education and Perspectives on the Use of Oral Skin Cancer Chemoprophylaxis: A Cross-Sectional Survey of Current Fellows in Mohs Micrographic Surgery & Dermatologic Oncology. Dermatol Surg 2023; 49:1072-1076. [PMID: 37962150 DOI: 10.1097/dss.0000000000003962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery & dermatologic oncology (MSDO) fellows must demonstrate competency in the use of oral skin cancer chemoprophylaxis. The current level of education in this area is unknown. OBJECTIVE To characterize oral skin cancer chemoprophylaxis education for acitretin and nicotinamide among current MSDO fellows and to compare the clinical indications felt most appropriate for prescribing to a previously published expert consensus. METHODS An electronic survey was distributed to all active MSDO fellows by the American College of Mohs Surgery. RESULTS Responses were received from 63 (69.2%) MSDO fellows. Twenty (31.7%) and 37 (58.7%) fellows reported receiving fellowship training on acitretin and nicotinamide, respectively. Fifty-seven (90.5%) intend to prescribe chemoprophylaxis after training. Sixteen (28.1%) and 43 (75.4%) report feeling very comfortable prescribing acitretin and nicotinamide, respectively. Fellow concordance with a previously published expert consensus opinion on appropriate prescribing indications is variable. Forty-one (65.1%) indicated that additional education would increase the likelihood to prescribe after training. CONCLUSION Although most MSDO fellows intend to prescribe oral skin cancer chemoprophylaxis, a standardized curriculum may promote increased use and concordance with expert consensus recommendations.
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Affiliation(s)
- Anthony K Guzman
- All authors are affiliated with the Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, Bataille V, Brochez L, Del Marmol V, Dummer R, Forsea AM, Gaudy-Marqueste C, Harwood CA, Hauschild A, Höller C, Kandolf L, Kellerners-Smeets NWJ, Lallas A, Leiter U, Malvehy J, Marinović B, Mijuskovic Z, Moreno-Ramirez D, Nagore E, Nathan P, Stratigos AJ, Stockfleth E, Tagliaferri L, Trakatelli M, Vieira R, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023. Eur J Cancer 2023; 192:113254. [PMID: 37604067 DOI: 10.1016/j.ejca.2023.113254] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.
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Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London SE1 7EH, UK
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Ana-Marie Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | | | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nicole W J Kellerners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands; Department of Dermatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, Croatia
| | - Zeljko Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - David Moreno-Ramirez
- Dermatology. Medicine School, University of Seville, University Hospital Virgen Macarena, Seville-Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Eggert Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
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9
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Mirali S, Tang E, Drucker AM, Turchin I, Gooderham M, Levell N, Beecker J, Bissonnette R, Catherall H, Lapointe McKenzie JA, Hawkins N, Hong CH, Kalia S, Papp K, Chan AW. Follow-up of Patients With Keratinocyte Carcinoma: A Systematic Review of Clinical Practice Guidelines. JAMA Dermatol 2023; 159:87-94. [PMID: 36322063 DOI: 10.1001/jamadermatol.2022.4590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Importance Patients treated for cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), collectively called keratinocyte carcinoma (KC), are at risk for recurrence, metastasis, and additional primary cutaneous malignant neoplasms. It is unclear how often patients should be seen for follow-up skin examination after initial treatment of KC. Objective To summarize the recommendations and evaluate the methodological quality of clinical practice guidelines for dermatologic follow-up of patients with BCC and invasive SCC. Evidence Review PubMed, MEDLINE, and Embase were searched for relevant articles published from January 2010 to March 2022. Search terms included guideline, squamous cell carcinoma, and basal cell carcinoma. National or international guidelines containing recommendations for follow-up frequency after a diagnosis of localized cutaneous KC were included. Quality was assessed using the 6 domains of the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool: (1) scope and purpose; (2) stakeholder development; (3) rigor of development; (4) clarity of presentation; (5) applicability; and (6) editorial independence. The Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) was used to guide study reporting. Findings Among the 14 guidelines meeting eligibility criteria, there was little consensus on the appropriate follow-up frequency after initial KC treatment. Overall duration of follow-up ranged from a single posttreatment visit to lifelong surveillance. Most guidelines stratified their recommendations by recurrence risk. For low-risk BCC and guidelines that did not stratify by risk, follow-up recommendations ranged from every 6 to 12 months. For high-risk BCC, 1 guideline suggested follow-up every 3 months, while 4 recommended every 6 months. For low-risk SCC, 5 guidelines recommended annual follow-up; 3 guidelines, every 6 months; and 1 guideline, every 3 months. For high-risk SCC, recommendations included a range of follow-up frequencies, spanning every 3 months (n = 5 guidelines), 4 months (n = 1), 6 months (n = 6), or annually (n = 4). One guideline did not use risk stratification and recommended annual screening. The highest scoring AGREE II domain was "scope and purpose," which assessed the guideline's overall objectives, and the lowest scoring was "applicability," which assessed barriers and facilitators to implementation. Conclusions and Relevance The findings of this systemic review highlight variations in follow-up recommendations for patients after initial treatment for KC. Randomized clinical trials are needed to define an optimal follow-up regimen.
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Affiliation(s)
- Sara Mirali
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
| | - Evan Tang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
| | - Aaron M Drucker
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Irina Turchin
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Brunswick Dermatology Center, Fredericton, New Brunswick, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
| | - Melinda Gooderham
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
- SKiN Centre for Dermatology, Peterborough, Ontario, Canada
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Nick Levell
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Jennifer Beecker
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Division of Dermatology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Robert Bissonnette
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Innovaderm Research, Montreal, Quebec, Canada
| | - Helen Catherall
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
| | - Jo-Ann Lapointe McKenzie
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Save Your Skin Foundation, Penticton, British Columbia, Canada
| | - Nicole Hawkins
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Peak Medical Specialty Clinic, Okotoks, Alberta, Canada
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Chih-Ho Hong
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Surrey, British Columbia, Canada
| | - Sunil Kalia
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kim Papp
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
- K Papp Clinical Research, Waterloo, Ontario, Canada
| | - An-Wen Chan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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10
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Soutou B, Massih C, Sleilaty G, Trak-Smayra V, Nasr M, Helou J, Hokayem N, Ferran F, Sleilati FH, Stéphan F, Halabi-Tawil M, Tomb R. Clinical and pathological features associated with high-risk, multiple, and recurrent basal cell carcinomas: a retrospective cohort analysis from the Levantine coast of the Mediterranean Sea. Arch Dermatol Res 2023; 315:51-59. [PMID: 35059802 DOI: 10.1007/s00403-021-02316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/17/2021] [Accepted: 12/07/2021] [Indexed: 01/07/2023]
Abstract
Basal cell carcinoma (BCC) data coming from the Levantine coast of the Mediterranean Sea are limited. The study aimed to primarily analyze the demographic, clinical, pathological, and prognostic characteristics of BCC in this region of the world and secondarily identify features associated with high-risk, recurrent, or multiple BCCs. Patients with at least one diagnosis of BCC registered in the pathology department between January 2015 and December 2019 were included in this analytical retrospective single-center cohort study. Patients with basal cell nevus syndrome were excluded. Patients' characteristics and pathological features were collected through file check for a first analysis. Risk factors and evolution were sought through a phone call interview for the second analysis. The first analysis included 506 BCCs corresponding to 365 patients with a mean age of 65 ± 15 years, twenty-two (6%) were less than 40 years old, 180 (49.3%) were women, and 85 (23.3%) had two or more BCCs. The second analysis included 279 BCCs corresponding to 205 patients. Periorificial and infiltrative BCCs were more frequent in men. Periorificial tumors were more frequently nodular or infiltrative and were associated with recurrence. Tumors with perineural involvement were histologically never nodular nor superficial. Recurrence was more frequent in BCCs having periorificial location, a size larger than 2 cm, or an infiltrative subtype. Multiple BCCs were more frequent in patients with light skin type or familial history of skin cancer. High-risk BCCs were more common in patients with low sun exposure.
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Affiliation(s)
- Boutros Soutou
- Dermatology department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Hôtel-Dieu de France, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon.
| | - Carine Massih
- Dermatology department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Hôtel-Dieu de France, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon.
| | - Ghassan Sleilaty
- Statistics department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Viviane Trak-Smayra
- Pathology department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Marwan Nasr
- Plastic and Reconstructive Surgery Department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Josiane Helou
- Dermatology department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Hôtel-Dieu de France, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon
| | - Nabil Hokayem
- Plastic and Reconstructive Surgery Department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Fady Ferran
- Plastic and Reconstructive Surgery Department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Fadi H Sleilati
- Plastic and Reconstructive Surgery Department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Farid Stéphan
- Dermatology department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Hôtel-Dieu de France, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon
| | - Maya Halabi-Tawil
- Dermatology department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Hôtel-Dieu de France, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon
| | - Roland Tomb
- Dermatology department, School of Medicine, Université Saint-Joseph, and Hôtel-Dieu de France University Hospital, Hôtel-Dieu de France, Boulevard Alfred Naccache, Beirut, 16-6830, Lebanon
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11
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Hooiveld-Noeken JS, Eggen AC, Rácz E, de Vries EG, Reyners AK, Jalving M. Towards less mutilating treatments in patients with advanced non-melanoma skin cancers by earlier use of immune checkpoint inhibitors. Crit Rev Oncol Hematol 2022; 180:103855. [DOI: 10.1016/j.critrevonc.2022.103855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
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12
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Wheless L, Anand N, Hanlon A, Chren MM. Differences in Skin Cancer Rates by Transplanted Organ Type and Patient Age After Organ Transplant in White Patients. JAMA Dermatol 2022; 158:1287-1292. [PMID: 36169974 PMCID: PMC9520444 DOI: 10.1001/jamadermatol.2022.3878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022]
Abstract
Importance Although it is known that patients with thoracic organ transplants develop skin cancer more frequently than those who receive nonthoracic organ transplants, patterns of risk for subsequent skin cancers are unknown. Objective To further characterize organ transplant recipients who develop multiple skin cancers and assess for patterns of development of additional skin cancers beyond the first skin cancer diagnosis by patient age and transplanted organ type. Design, Setting, and Participants This cohort study used validated electronic health record-based data from a single tertiary care academic medical center to identify 5129 solid organ transplant recipients who underwent transplant surgery between 1992 and 2017 and were older than 18 years at the time of transplant. The cohort was limited to White patients because they have the highest skin cancer risk based on phenotype. The mean follow-up was 6.6 years. Data were analyzed June 9, 2021, to May 31, 2022. Main Outcomes and Measures Differences in rates of skin cancer development for first and subsequent skin cancers were measured using t test or analysis of variance and χ2 tests for continuous and categorical variables. Rates of skin cancer development were compared based on organ type and patient age at transplant using Fine-Gray tests and cumulative incidence plots. Results A total of 5129 organ transplant recipients (mean [SD] age, 51.3 [12.9] years; 3287 men [64.1%]) were included. Of these, 695 patients (13.6%) had development of at least 1 skin cancer, with 6842 skin cancers identified in the cohort overall. Compared with liver transplant recipients, heart, lung, or kidney recipients were more likely to develop at least 1 skin cancer (χ2 test, 25.6; df, 4; P < .001). There was no significant difference by transplanted organ type in the rate of developing a second or third skin cancer; however, the age at transplant was associated with the time to developing a second (χ2 test, 20.4; df, 4; P < .001) or third (χ2 test, 10.9; df, 4; P < .02) skin cancer. Conclusions and Relevance This cohort study found that there was no difference by organ type for development of subsequent skin cancers in organ transplant recipients, and recipients of all organ types developed additional skin cancers at high rates after the initial skin cancer.
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Affiliation(s)
- Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Nashville
| | - Nimay Anand
- Meharry Medical College, Nashville, Tennessee
| | - Allison Hanlon
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Nashville
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
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13
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Guzman AK, Schmults CD, Ruiz ES. Squamous Cell Carcinoma. Dermatol Clin 2022; 41:1-11. [DOI: 10.1016/j.det.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Basal Cell Carcinoma. Dermatol Clin 2022; 41:13-21. [DOI: 10.1016/j.det.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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Ciążyńska M, Pabianek M, Sławińska M, Reich A, Lewandowski B, Szczepaniak K, Ułańska M, Nejc D, Brodowski R, Sobjanek M, Owczarek W, Kamińska-Winciorek G, Lange D, Słowińska M, Wróbel K, Bieniek A, Woźniacka A, Pękala A, Kuncman Ł, Salińska M, Noweta M, Skibińska M, Narbutt J, Ciążyński K, Lewandowska M, Dziankowska-Zaborszczyk E, Lesiak A. Risk Factors and Clinicopathological Features for Developing a Subsequent Primary Cutaneous Squamous and Basal Cell Carcinomas. Cancers (Basel) 2022; 14:cancers14133069. [PMID: 35804841 PMCID: PMC9264931 DOI: 10.3390/cancers14133069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/04/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Patients with basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) often develop new keratinocyte carcinoma (KC), but information is limited on the frequency and timing of these subsequent tumors. This information is crucial to guide follow-up care. Given the significant clinical differences of the characteristic feature of individual skin cancer, estimation of the risk of a subsequent tumor should be estimating separately. The aim of our retrospective study was to assess risk factors for a subsequent skin cancer development. We demonstrated that patients with multiple tumors must be followed up carefully and for a long time. Moreover, we indicated the connection between the BCC subtype and increased risk for further KC development. BCC subtypes with an aggressive growth pattern predispose not only to increased risk for the recurrence but also are expected to be at an increased risk for a subsequent tumor. The non-invasive diagnosis, monitoring and follow up should be more comprehensive for those patients compared to low-risk BCC. Abstract Background: Patients with diagnosed keratinocyte carcinomas (KCs) have an increased risk of subsequent skin cancers development. Current studies indicate that patients with subsequent tumors should be followed up regularly. However, none of the studies indicate the connection between the specific subtypes and an increased risk for further KCs development. The study assesses the differences in the risk of developing a subsequent skin cancer after a previous diagnosis of KC, especially considering individual types of skin malignances, and identifies potential factors associated with an increased risk of new cutaneous tumor describing non-invasive diagnosis and monitoring. Methods: Pathology and medical records were examined to identify the characteristics of patients with multiple KCs diagnosed between 1999 and 2019. Results: The study group comprised 13,913 KCs occurring in 10,083 patients. Multiple KCs were observed in 2300 patients (22.8%). The analysis showed aggressive subtypes, multiple tumors, and male sex as significant prognostic factors. Conclusions: The most crucial risk factors for developing subsequent KC are being of a male gender, an aggressive tumor subtype, and previous history of multiple skin cancers. Basal cell carcinoma subtypes, such as infiltrative basosquamous, with aggressive growth patterns predispose not only to increased risk for the recurrence but are also expected to be at higher risk of subsequent KCs.
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Affiliation(s)
- Magdalena Ciążyńska
- Department of Proliferative Diseases, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, ul. Pabianicka 62, 93-513 Lodz, Poland; (M.P.); (K.S.); (M.U.); (A.P.)
- Department of Dermatology, Paediatric Dermatology and Oncology Clinic, Medical University of Lodz, 91-347 Lodz, Poland; (M.N.); (M.S.); (J.N.); (A.L.)
- Correspondence: ; Tel.: +48-660-726-304
| | - Marta Pabianek
- Department of Proliferative Diseases, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, ul. Pabianicka 62, 93-513 Lodz, Poland; (M.P.); (K.S.); (M.U.); (A.P.)
| | - Martyna Sławińska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland; (M.S.); (M.S.)
| | - Adam Reich
- Department of Dermatology, University of Rzeszow, 35-310 Rzeszow, Poland;
| | - Bogumił Lewandowski
- Clinical Department of Maxillo-Facial Surgery, Frederic Chopin Provincial Specialist Hospital, 35-310 Rzeszow, Poland; (B.L.); (R.B.)
| | - Katarzyna Szczepaniak
- Department of Proliferative Diseases, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, ul. Pabianicka 62, 93-513 Lodz, Poland; (M.P.); (K.S.); (M.U.); (A.P.)
| | - Małgorzata Ułańska
- Department of Proliferative Diseases, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, ul. Pabianicka 62, 93-513 Lodz, Poland; (M.P.); (K.S.); (M.U.); (A.P.)
| | - Dariusz Nejc
- Department of Surgical Oncology, Medical University in Lodz, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, 93-513 Lodz, Poland;
| | - Robert Brodowski
- Clinical Department of Maxillo-Facial Surgery, Frederic Chopin Provincial Specialist Hospital, 35-310 Rzeszow, Poland; (B.L.); (R.B.)
| | - Michał Sobjanek
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland; (M.S.); (M.S.)
| | - Witold Owczarek
- Dermatology Clinic, Military Institute of Medicine in Warsaw, 04-141 Warsaw, Poland; (W.O.); (M.S.); (K.W.)
| | - Grażyna Kamińska-Winciorek
- Department of Bone Marrow Transplantation and Hematology-Oncology, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Branch in Gliwice, 44-102 Gliwice, Poland;
| | - Dariusz Lange
- Department of Tumor Pathology, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Branch in Gliwice, 44-102 Gliwice, Poland;
| | - Monika Słowińska
- Dermatology Clinic, Military Institute of Medicine in Warsaw, 04-141 Warsaw, Poland; (W.O.); (M.S.); (K.W.)
| | - Katarzyna Wróbel
- Dermatology Clinic, Military Institute of Medicine in Warsaw, 04-141 Warsaw, Poland; (W.O.); (M.S.); (K.W.)
| | | | - Anna Woźniacka
- Department of Dermatology and Venereology, Medical University of Lodz, 90-419 Lodz, Poland; (A.W.); (M.S.)
| | - Anika Pękala
- Department of Proliferative Diseases, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, ul. Pabianicka 62, 93-513 Lodz, Poland; (M.P.); (K.S.); (M.U.); (A.P.)
| | - Łukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, 93-513 Lodz, Poland;
| | - Magdalena Salińska
- Department of Dermatology and Venereology, Medical University of Lodz, 90-419 Lodz, Poland; (A.W.); (M.S.)
| | - Marcin Noweta
- Department of Dermatology, Paediatric Dermatology and Oncology Clinic, Medical University of Lodz, 91-347 Lodz, Poland; (M.N.); (M.S.); (J.N.); (A.L.)
| | - Małgorzata Skibińska
- Department of Dermatology, Paediatric Dermatology and Oncology Clinic, Medical University of Lodz, 91-347 Lodz, Poland; (M.N.); (M.S.); (J.N.); (A.L.)
| | - Joanna Narbutt
- Department of Dermatology, Paediatric Dermatology and Oncology Clinic, Medical University of Lodz, 91-347 Lodz, Poland; (M.N.); (M.S.); (J.N.); (A.L.)
| | - Karol Ciążyński
- Institute of Applied Computer Science, Lodz University of Technology, 90-537 Lodz, Poland;
| | - Marta Lewandowska
- Department of Infectious Diseases and Hepatology for Adults, Medical University of Lodz, 93-513 Lodz, Poland;
| | | | - Aleksandra Lesiak
- Department of Dermatology, Paediatric Dermatology and Oncology Clinic, Medical University of Lodz, 91-347 Lodz, Poland; (M.N.); (M.S.); (J.N.); (A.L.)
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16
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Potter AE, Baker C, Shumack S, Sinclair R, Curran WJ, Christie D, Wong B, Foley P, O’Brien P, Spelman L. Preliminary efficacy and safety analysis: 12-month results in 83 patients using a novel approach of widefield radiation therapy for extensive skin field cancerization with or without keratinocyte cancers. J DERMATOL TREAT 2022; 33:2634-2642. [DOI: 10.1080/09546634.2022.2067814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Christopher Baker
- Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Department of Medicine, The University Melbourne, Melbourne, Australia
| | - Stephen Shumack
- Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Australia
| | - Robert Sinclair
- Queensland Institute of Dermatology, Brisbane, Australia
- Specialist Connect Services, Brisbane, Australia
| | - Walter J. Curran
- Oncology, GenesisCare, Fort Myers, FL, USA
- Emory University, Atlanta, GA, USA
| | - David Christie
- GenesisCare, Gold Coast, QLD, Australia
- School of Medicine, Bond University, Gold Coast, QLD, Australia
| | - Bradley Wong
- GenesisCare Radiation Oncology, Buderim, QLD, Australia
| | - Peter Foley
- Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Department of Medicine, The University Melbourne, Melbourne, Australia
- Probity Medical Research, Skin Health Institute, Melbourne, Australia
| | - Peter O’Brien
- GenesisCare Radiation Oncology, Newcastle, NSW, Australia
| | - Lynda Spelman
- Queensland Institute of Dermatology, Brisbane, Australia
- Specialist Connect Services, Brisbane, Australia
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17
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Chang MS, Azin M, Demehri S. Cutaneous Squamous Cell Carcinoma: The Frontier of Cancer Immunoprevention. ANNUAL REVIEW OF PATHOLOGY 2022; 17:101-119. [PMID: 35073167 DOI: 10.1146/annurev-pathol-042320-120056] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer, with its incidence rising steeply. Immunosuppression is a well-established risk factor for cSCC, and this risk factor highlights the critical role of the immune system in regulating cSCC development and progression. Further highlighting the nature of cSCC as an immunological disorder, substantial evidence demonstrates a tight association between cSCC risk and age-related immunosenescence. Besides the proven efficacy of immune checkpoint blockade therapy for advanced cSCC, novel immunotherapy that targets cSCC precursor lesions has shown efficacy for cSCC prevention. Furthermore, the appreciation of the interplay between keratinocytes, commensal papillomaviruses, and the immune system has revealed the possibility for the development of a preventive cSCC vaccine. cSCC shares fundamental aspects of its origin and pathogenesis with mucosal SCCs. Therefore, advances in the field of cSCC immunoprevention will inform our approach to the management of mucosal SCCs and potentially other epithelial cancers.
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Affiliation(s)
| | - Marjan Azin
- Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Shadmehr Demehri
- Harvard Medical School, Boston, Massachusetts 02115, USA; .,Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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18
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Saytburkhanov RR, Kubanov AA, Kondrakhina IN, Plakhova XI. Modern understanding of the pathogenesis of basal cell skin cancer. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The incidence of basal cell skin cancer is increasing worldwide. The initiation and progression of basal cell skin cancer is due to the interaction of environmental factors and the patient's genetic characteristics. Aberrant activation of the transmission of the Hedgehog signaling pathway is the main pathogenetic pathway of carcinogenesis.
Since basal cell skin cancer is manifested by significant variability of morphological structure, aggressiveness and response to treatment, the disclosure of the molecular genetics of pathogenesis will become the basis for developing new approaches and increasing the effectiveness of treatment, as well as overcoming tumor resistance to treatment.
To search for the necessary literature, the PubMed, MedLine, Web of Science and RSCI databases were used.
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Fahy EJ, Sugrue CM, Jones D, Regan P, Hussey A, Potter S, Kerin M, McInerney NM, Kelly J. A retrospective cohort study of cutaneous squamous cell carcinoma of the scalp: features of disease and influence of sociodemographic factors on outcomes. Ir J Med Sci 2021; 191:1217-1222. [PMID: 34189657 DOI: 10.1007/s11845-021-02699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (SCC) is an increasingly prevalent and potentially fatal disease with considerable implications if not recognized early and treated promptly. Several disease features contribute to a higher risk profile and adverse outcomes in affected patients. AIMS Given the clinical observation that elderly males from rural communities often present with large SCCs of the scalp, we sought to investigate and describe features of disease and sociodemographic factors from a cohort of patients with scalp SCCs. METHODS Histology reports of scalp primary SCCs were retrospectively assessed. Disease and demographic features were recorded. Descriptive statistics were generated, and statistical analyses (Fisher's exact, Mann-Whitney U and Spearman's rank test) were utilized to examine relationships between high-risk disease features and sociodemographic features. RESULTS Ninety-three occurrences of scalp SCC in 61 patients were assessed. The average age at presentation was 78.81 years. Males were predominantly affected at a 14:1 ratio. Half of all tumours were greater than 2 cm (47/93 (50.54%)). The geographical distance from treatment was significantly associated with larger tumours at presentation. (rs = .34 P = 0.002). Recurrence and metastasis rates were determined amongst 188 patients with a primary scalp SCC, and low rates were observed (2.66% and 2.13%, respectively). CONCLUSIONS Elderly males are inordinately affected by scalp SCC compared to females. Those living further from care exhibited larger tumours at presentation. Data from this study characterize features of SCC of the scalp and provide evidence to suggest that rural isolation may act as a mediator of high-risk presentation and larger tumour size.
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Affiliation(s)
- Evan J Fahy
- Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland.
| | | | - Deirdre Jones
- Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Padraic Regan
- Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Alan Hussey
- Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Shirley Potter
- Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Michael Kerin
- Department of General Surgery, Galway University Hospital, Galway, Ireland
| | - Niall M McInerney
- Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Jack Kelly
- Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland
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20
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van Dam V, Trinh XB, An B, Julien L. Extra-anogenital giant cutaneous squamous cell carcinomas require multidisciplinary management. Cancer Treat Res Commun 2021; 28:100413. [PMID: 34126577 DOI: 10.1016/j.ctarc.2021.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/03/2021] [Accepted: 05/26/2021] [Indexed: 06/12/2023]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is a highly prevalent cancer and the majority of cSCC have a good prognosis. However, a subset of cSCC can progress to advanced disease. We present the first reported case of a giant cSCC located on the breast. In addition, a systematic literature search on extra-anogenital giant (EAG) cSCC was performed using Pubmed and MEDLINE databases. Thirty-one articles could be retained which were relevant for this review. A total of 42 well-described cases were identified. Median age at presentation was 70 years (range 9-100 years). Twenty-four (57%) patients were male, eighteen were female (43%). The estimated median delay of treatment was 12 months (range 1 to >240 months). In 27 patients (64%) the giant cSCC was localized on the neck, face or scalp, 6 on the thoracic wall or back (14%), 4 on the lower limb (10%), 2 on the hip or buttock (5%), 2 on the upper limb (5%), one (2%) on the breast. Tumor stage at presentation was T2, T3 and T4 in respectively 26 (62%), 11 (26%) and 5 (12%) cases. Lymph node metastases were identified in 1 patient (2%) and distant metastases in another patient (2%). In 34 out of 42 cases (81%) primary radical surgical excision was performed, 3 received radiotherapy, 2 chemotherapy and 3 palliative care. In the cases with reported follow-up, four patients (4/30: 13%) died of disease. The treatment of EAG cSCC poses many problems, making a multidisciplinary approach of paramount importance.
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Affiliation(s)
- Valerie van Dam
- Department of Internal Medicine, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Xuan Bich Trinh
- Gynaecology Oncology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Bervoets An
- Dermatology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Lambert Julien
- Dermatology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
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21
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Scott JF, Brough KR, Grigoryan KV, Muzic JG, Kim GY, Conic RRZ, Hill ST, Brewer JD, Baum CL, Litzow MR, Hogan WJ, Patnaik MS, Hashmi SK, Lazarus HM, Bordeaux JS, Thompson CL, Gerstenblith MR, Lehman JS. Risk Factors for Keratinocyte Carcinoma in Recipients of Allogeneic Hematopoietic Cell Transplants. JAMA Dermatol 2021; 156:631-639. [PMID: 32267479 DOI: 10.1001/jamadermatol.2020.0559] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Allogeneic hematopoietic cell transplant (alloHCT) is known to increase the risk for keratinocyte carcinoma. The extent to which host characteristics, including pigmentary phenotype and UV radiation exposure, contribute is unknown. Objective To identify and validate independent risk factors for keratinocyte carcinoma after alloHCT, including those associated with the transplant and the host. Design, Setting, and Participants This retrospective cohort study analyzed a consecutive sample of alloHCT recipients from January 1, 2000, to December 31, 2014, at the Mayo Clinic, Rochester, Minnesota (n = 872) and University Hospitals Cleveland Medical Center, Cleveland, Ohio (n = 147). Participants from the Mayo Clinic were randomly allocated (2:1) into discovery (n = 581) and validation (n = 291) cohorts. Time to first keratinocyte carcinoma and information about transplant- and host-associated risk factors were extracted. A multivariate keratinocyte carcinoma risk model was created using a stepwise Cox proportional hazards regression model with P ≤ .05 for entry that incorporated all covariates that were individually statistically significant at α = 0.05 in the discovery cohort. The risk model was first internally validated using the Mayo Clinic validation cohort and then externally validated using the independent cohort of alloHCT recipients at University Hospitals Cleveland Medical Center. Data were analyzed from March 13, 2018, to June 12, 2019. Exposures Allogeneic hematopoietic cell transplant. Main Outcomes and Measures The primary outcome was time to development of the first cutaneous keratinocyte carcinoma after alloHCT; secondary outcome, time to development of the first individual basal and/or squamous cell carcinoma after alloHCT. Results Of the 872 alloHCT recipients identified in the Mayo Clinic cohort (520 men [59.6%]; mean [SD] age, 48.3 [12.6] years), 95 (10.9%) developed keratinocyte carcinoma after alloHCT during 5349 person-years of follow-up. Of the 147 alloHCT recipients in the exernal validation cohort (86 men [58.5%]; mean [SD] age, 47.9 [17.5] years), 18 (12.2%) developed keratinocyte carcinoma after alloHCT in 880 person-years of follow up. Risk factors independently associated with keratinocyte carcinoma after alloHCT included age (hazard ratio [HR] per 10 years, 1.72; 95% CI, 1.21-2.42), chronic lymphocytic leukemia (HR, 2.47; 95% CI, 1.20-5.09), clinically photodamaged skin (HR, 3.47; 95% CI, 1.87-6.41), and history of cutaneous squamous cell carcinoma (HR, 2.60; 95% CI, 1.41-5.91). Harrell concordance statistics were 0.81 (95% CI, 0.72-0.90) and 0.86 (95% CI, 0.74-0.98) for internal and external validation of the keratinocyte carcinoma risk model, respectively. Conclusions and Relevance This study found validated independent risk factors for keratinocyte carcinoma after alloHCT that are enriched with host- compared with transplant-associated risk factors. These findings highlight the importance of assessing host-associated risk factors for keratinocyte carcinoma in patients eligible for alloHCT. Future studies should examine whether keratinocyte carcinoma risk stratification before alloHCT may inform long-term surveillance strategies.
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Affiliation(s)
- Jeffrey F Scott
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin R Brough
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - John G Muzic
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Grace Y Kim
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rosalynn R Z Conic
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sheena T Hill
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - Mark R Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - William J Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mrinal S Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hillard M Lazarus
- Division of Hematology and Oncology, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Cheryl L Thompson
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Meg R Gerstenblith
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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22
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Keohane SG, Botting J, Budny PG, Dolan OM, Fife K, Harwood CA, Mallipeddi R, Marsden JR, Motley RJ, Newlands C, Proby C, Rembielak A, Slater DN, Smithson JA, Buckley P, Fairbrother P, Hashme M, Mohd Mustapa MF, Exton LS. British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma 2020. Br J Dermatol 2021; 184:401-414. [PMID: 33150585 DOI: 10.1111/bjd.19621] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 12/18/2022]
Affiliation(s)
- S G Keohane
- British Society for Dermatological Surgery, London, UK.,Portsmouth Hospitals University NHS Trust, Portsmouth, PO3 6AD, UK
| | - J Botting
- Royal College of General Practitioners, London, UK.,Glebe Road Surgery, Barnes, SW13 0DR, UK
| | - P G Budny
- British Association of Plastic Reconstructive and Aesthetic Surgeons, London, UK.,Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - O M Dolan
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, BT12 6BA, UK
| | - K Fife
- Royal College of Radiologists, Holborn, London, WC2A 3JW, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - C A Harwood
- Barts Health NHS Trust, Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - R Mallipeddi
- British Society for Dermatological Surgery, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - J R Marsden
- Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK
| | - R J Motley
- University Hospital of Wales, Health Park, Cardiff, CF14 4XN, UK
| | - C Newlands
- British Association of Oral & Maxillofacial Surgeons, London, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - C Proby
- University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - A Rembielak
- Royal College of Radiologists, Holborn, London, WC2A 3JW, UK.,The Christie NHS Foundation Trust, Manchester, M20 4BX, UK.,The University of Manchester, Manchester, M13 9PL, UK
| | - D N Slater
- Royal College of Pathologists, London, E1 8BB, UK
| | - J A Smithson
- British Dermatological Nursing Group, Belfast, UK.,East Sussex Healthcare NHS Trust, Eastbourne, BN21 2UD, UK
| | | | | | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
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23
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Wehner MR. Underestimation of Cutaneous Squamous Cell Carcinoma Incidence, Even in Cancer Registries. JAMA Dermatol 2020; 156:1290-1291. [PMID: 33112371 DOI: 10.1001/jamadermatol.2020.3678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mackenzie R Wehner
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston.,Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston
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24
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Fania L, Didona D, Morese R, Campana I, Coco V, Di Pietro FR, Ricci F, Pallotta S, Candi E, Abeni D, Dellambra E. Basal Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines 2020; 8:biomedicines8110449. [PMID: 33113965 PMCID: PMC7690754 DOI: 10.3390/biomedicines8110449] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/13/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common human cancer worldwide, and is a subtype of nonmelanoma skin cancer, characterized by a constantly increasing incidence due to an aging population and widespread sun exposure. Although the mortality from BCC is negligible, this tumor can be associated with significant morbidity and cost. This review presents a literature overview of BCC from pathophysiology to novel therapeutic approaches. Several histopathological BCC subtypes with different prognostic values have been described. Dermoscopy and, more recently, reflectance confocal microscopy have largely improved BCC diagnosis. Although surgery is the first-line treatment for localized BCC, other nonsurgical local treatment options are available. BCC pathogenesis depends on the interaction between environmental and genetic characteristics of the patient. Specifically, an aberrant activation of Hedgehog signaling pathway is implicated in its pathogenesis. Notably, Hedgehog signaling inhibitors, such as vismodegib and sonidegib, are successfully used as targeted treatment for advanced or metastatic BCC. Furthermore, the implementation of prevention measures has demonstrated to be useful in the patient management.
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Affiliation(s)
- Luca Fania
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
- Correspondence:
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps University, 35043 Marburg, Germany;
| | - Roberto Morese
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Irene Campana
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Valeria Coco
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Francesca Romana Di Pietro
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Francesca Ricci
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Sabatino Pallotta
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Eleonora Candi
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Damiano Abeni
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Elena Dellambra
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
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25
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Sunscreen application technique amongst patients with a history of skin cancer. Arch Dermatol Res 2020; 312:739-746. [PMID: 32929600 DOI: 10.1007/s00403-020-02131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Data on how patients with a history of skin cancer apply sunscreen are lacking. OBJECTIVE To characterize (1) gender differences in sunscreen application technique (quantity used, anatomic site coverage, and time allocated) and (2) differences in sunscreen application to unaffected skin versus previous skin cancer sites. METHODS Subjects with a history of skin cancer were asked to apply sunscreen to their head as they normally would. The amount of sunscreen used and application time were recorded. Before and after photos were taken. Using Wood's lamp lighting, an anatomic site coverage score was rated on an ordinal scale (1 = 0-25%, 2 = 26-50%, 3 = 51-75%, 4 = 76-100% coverage). RESULTS Males used 530 mg more sunscreen (p < 0.001) and applied approximately 5 mg/cm2 of sunscreen versus women, who applied 2 mg/cm2. The average coverage score was 3.27. Males were 7.61 times more likely to adequately apply sunscreen to the ears (p = 0.001). No differences were noted in application times. Coverage scores were similar for unaffected skin and previous skin cancer sites. LIMITATIONS Observations in a controlled setting may not reflect usual sunscreen application practices. CONCLUSIONS Overall, skin cancer survivors of both genders effectively applied sunscreen in line with recommended quantity guidelines, but men were significantly better at protecting their ears.
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26
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Field cancerization: Definition, epidemiology, risk factors, and outcomes. J Am Acad Dermatol 2020; 83:709-717. [PMID: 32387665 DOI: 10.1016/j.jaad.2020.03.126] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
Abstract
Field cancerization was first described in 1953 when pathologic atypia was identified in clinically normal tissue surrounding oropharyngeal carcinomas. The discovery of mutated fields surrounding primary tumors raised the question of whether the development of subsequent tumors within the field represented recurrences or additional primary tumors. Since this initial study, field cancerization has been applied to numerous other epithelial tissues, including the skin. Cutaneous field cancerization occurs in areas exposed to chronic ultraviolet radiation, which leads to clonal proliferations of p53-mutated fields and is characterized by multifocal actinic keratoses, squamous cell carcinomas in situ, and cutaneous squamous cell carcinomas. In the first article in this continuing medical education series, we define field cancerization, review the available grading systems, and discuss the epidemiology, risk factors, and outcomes associated with this disease.
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27
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Rodriguez M, Beal BT, Manmohan M, Simmons E, Varra V, Xiong D, Eversman A, Briskin IN, Knackstedt T, Vidimos AT. Risk factors and timing of subsequent cutaneous squamous cell carcinoma in patients with cutaneous squamous cell carcinoma: A retrospective cohort study. J Am Acad Dermatol 2020; 84:719-724. [PMID: 32861709 DOI: 10.1016/j.jaad.2020.08.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Information about the frequency and timing of subsequent cutaneous squamous cell carcinoma (cSCC), along with associated risk factors, is limited. However, this information is crucial to guide follow-up care for these patients. OBJECTIVE To evaluate the risk and timing of subsequent cSCC in patients who presented with an initial diagnosis of cSCC. METHODS Retrospective review of an institutional review board-approved, single-institution registry of invasive cSCC. All patients had at least 2 primary cSCCs diagnosed on 2 separate dates 2 months apart. RESULTS A total of 299 primary cSCCs were included. At 6 months from initial cSCC diagnosis, 18.06% (n = 54) of patients developed subsequent cSCC; at 1 year, 31.77% (n = 94); at 3 years, 67.56% (n = 202); and at 5 years, 87.96% (n = 263) developed subsequent cSCC. Risk factors associated with subsequent cSCC include age at initial diagnosis (hazard ratio [HR], 1.02; 95% confidence interval, 1.004-1.027; P = .008), T2 stage (HR, 1.66; 95% CI, 1.07-2.57; P = .025), and poor tumor grade. Tumor grades well, moderate, and unknown have HRs of 0.21 (P < .001), 0.16 (P .001), and 0.25 (P = .001), respectively. CONCLUSIONS Of patients who develop subsequent cSCC, 18.06% do so within 6 months, and 31.77% do so within 1 year of initial cSCC diagnosis. Patients with advanced age, poor histologic differentiation, and American Joint Committee on Cancer T2 stage are at highest risk. Close clinical follow-up after the initial diagnosis is recommended.
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Affiliation(s)
- Marla Rodriguez
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Brandon T Beal
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio; Jacksonville Skin Cancer Specialists, Jacksonville, Florida
| | | | - Elanee Simmons
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Vamsi Varra
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - David Xiong
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Anna Eversman
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Isaac N Briskin
- Cleveland Clinic Foundation, Department of Quantitative Health Sciences, Cleveland, Ohio
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28
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Korhonen N, Ylitalo L, Luukkaala T, Itkonen J, Häihälä H, Jernman J, Snellman E, Palve J. Premalignant lesions, basal cell carcinoma and melanoma in patients with cutaneous squamous cell carcinoma. Arch Dermatol Res 2020; 313:879-884. [PMID: 32772261 PMCID: PMC8528745 DOI: 10.1007/s00403-020-02114-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/23/2020] [Accepted: 07/31/2020] [Indexed: 12/02/2022]
Abstract
The incidence of keratinocyte carcinomas is increasing worldwide and currently there is no standardised strategy for the follow-up of patients with multiple tumours. The objective of this study was to assess the prevalence of premalignant lesions, i.e., actinic keratosis and Bowen’s disease, as well as basal cell carcinoma (BCC) and cutaneous melanoma (CM) among patients with cutaneous squamous cell carcinoma (cSCC). Pathology database search was performed to identify all cSCC patients diagnosed in the Pirkanmaa region of Finland in 2006–2015. Details of the patients and tumours were obtained through medical record review. The cohort consisted of 774 patients with 1131 cSCC tumours. Overall 559 patients (72%) had premalignant lesions. A total of 316 patients (41%) had BCC and 52% of these (n = 164) had more than one BCC tumour. 50 patients (6%) had CM. Overall 180 cSCC patients (23%) had no premalignant changes, BCC or CM. The median age of these patients was 6 years less than that of the patients with premalignant lesions (p < 0.001) or BCC (p < 0.001). The invasion depth of the tumours was deeper in the patients with only cSCC (median 3 mm, interquartile range 2–6) than in those with premalignant lesions or BCC (median 2 mm, interquartile range 1–3), p < 0.001. CSCC patients have a high risk of developing multiple skin cancers and need long-term follow-up.
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Affiliation(s)
- Niina Korhonen
- Department of Dermatology and Allergology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Leea Ylitalo
- Department of Dermatology and Allergology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Skin Cancer Unit, Helsinki University Central Hospital, Helsinki, Finland
| | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital and Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Julius Itkonen
- Department of Dermatology and Allergology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Henni Häihälä
- Department of Dermatology and Allergology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Jernman
- Department of Pathology, Tampere University and Fimlab Laboratories, Tampere, Finland
| | - Erna Snellman
- Department of Dermatology and Allergology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Johanna Palve
- Department of Plastic Surgery, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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29
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Abstract
Basal cell carcinoma (BCC) is the most common malignancy and the incidence is rising. BCCs have low mortality but can cause significant morbidity primarily through local destruction. The pathogenesis is linked to the interplay between environmental and patient-derived characteristics. There are multiple therapeutic modalities, and appropriate selection requires knowledge of complications, cosmetic outcomes, and recurrence rates. This article reviews the epidemiology, staging, treatment, and prevention of BCC.
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Affiliation(s)
- Dennis P Kim
- Mohs Micrographic Surgery, Brigham and Women's Faulkner Hospital, 1153 Centre Street, Suite 4J, Jamaica Plain, MA 02130-3446, USA
| | - Kylee J B Kus
- Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309-4482, USA
| | - Emily Ruiz
- High-Risk Skin Cancer Clinic, Dana Farber/Brigham and Women's Cancer Center, Mohs and Dermatologic Surgery Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, 1153 Centre Street, Suite 4J, Jamaica Plain, MA 02130-3446, USA.
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30
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Garrido PM, Borges-Costa J. Hydrochlorothiazide treatment and risk of non-melanoma skin cancer: Review of the literature. Rev Port Cardiol 2020; 39:163-170. [PMID: 32354458 DOI: 10.1016/j.repc.2019.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/02/2019] [Indexed: 01/04/2023] Open
Abstract
Non-melanoma skin cancer is the most prevalent malignancy in fair-skinned people and its incidence is increasing. Recently, studies have suggested that antihypertensive drugs may increase the risk of these tumors, particularly hydrochlorothiazide, due to its photosensitizing properties. The Portuguese National Authority for Medicines and Health Products, INFARMED, has issued an alert to healthcare professionals concerning the increased risk of non-melanoma skin cancer in patients exposed to cumulative doses of this drug. However, study results have been heterogeneous and sometimes conflicting. The high incidence of non-melanoma skin cancer and the large number of patients under chronic hydrochlorothiazide therapy may thus have important public health consequences. In this article, the authors review the published evidence and conclude that there may be an association between hydrochlorothiazide use and the risk of non-melanoma skin cancer, but also point out some limitations of the studies in the literature. It is important to promote preventive strategies against sun exposure, regular skin examinations, and individual assessment of the benefits of hydrochlorothiazide use, particularly in patients with previous skin cancer.
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Affiliation(s)
- Pedro Miguel Garrido
- Clínica Universitária de Dermatologia de Lisboa, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE (CHLN), Lisboa, Portugal.
| | - João Borges-Costa
- Clínica Universitária de Dermatologia de Lisboa, Centro Hospitalar Universitário Lisboa Norte (CHULN), EPE (CHLN), Lisboa, Portugal; Unidade de Investigação em Dermatologia da Faculdade de Medicina da Universidade de Lisboa (FMUL), Lisboa, Portugal; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
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31
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Garrido PM, Borges-Costa J. Hydrochlorothiazide treatment and risk of non-melanoma skin cancer: Review of the literature. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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32
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Lang BM, Balermpas P, Bauer A, Blum A, Brölsch GF, Dirschka T, Follmann M, Frank J, Frerich B, Fritz K, Hauschild A, Heindl LM, Howaldt HP, Ihrler S, Kakkassery V, Klumpp B, Krause-Bergmann A, Löser C, Meissner M, Sachse MM, Schlaak M, Schön MP, Tischendorf L, Tronnier M, Vordermark D, Welzel J, Weichenthal M, Wiegand S, Kaufmann R, Grabbe S. S2k Guidelines for Cutaneous Basal Cell Carcinoma - Part 2: Treatment, Prevention and Follow-up. J Dtsch Dermatol Ges 2020; 17:214-230. [PMID: 30762963 DOI: 10.1111/ddg.13755] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumor among fair-skinned individuals, and its incidence had been steadily rising in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 2 addresses issues such as proper risk stratification, the various therapeutic approaches, and prevention as well as follow-up of patients with basal cell carcinoma.
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Affiliation(s)
- Berenice M Lang
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Andrea Bauer
- Department of Dermatology, Carl Gustav Carus University Medical Center, Dresden, Germany
| | - Andreas Blum
- Dermatology and Teaching Practice, Konstanz, Germany
| | - G Felix Brölsch
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hanover Medical School, Hanover, Germany
| | - Thomas Dirschka
- CentroDerm Clinic, Wuppertal, Germany.,Faculty of Health, Witten-Herdecke University, Witten, Germany
| | | | - Jorge Frank
- Department of Dermatology, Venereology and Allergology, Göttingen University Medical Center, Göttingen, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Plastic Surgery, Rostock University Medical Center, Rostock, Germany
| | - Klaus Fritz
- Dermatology and Laser Center, Landau, Germany
| | - Axel Hauschild
- Department of Dermatology, Venereology and Allergology, Schleswig-Holstein University Medical Center, Kiel, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Cologne University Medical Center, Cologne, Germany
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Gießen University Medical Center, Gießen, Germany
| | - Stephan Ihrler
- Laboratory for Dermatohistology and Oral Pathology, Munich, Germany
| | - Vinodh Kakkassery
- Department of Ophthalmology, Schleswig-Holstein University Medical Center, Lübeck, Germany.,Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Bernhard Klumpp
- Department of Diagnostic and Interventional Radiology, Tübingen University Medical Center, Tübingen, Germany.,Department of Radiology, Rems-Murr Medical Center, Winnenden, Germany
| | | | - Christoph Löser
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Michael M Sachse
- Department of Dermatology, Allergology and Phlebology, Bremerhaven Medical Center, Bremerhaven, Germany
| | - Max Schlaak
- Department of Dermatology and Allergology, Munich University Medical Center, Munich, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, Göttingen University Medical Center, Göttingen, Germany
| | | | - Michael Tronnier
- Department of Dermatology, Venereology and Allergology, Helios Medical Center, Hildesheim, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Halle University Medical Center, Martin Luther University, Halle, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, Augsburg Medical Center, Augsburg, Germany
| | - Michael Weichenthal
- Department of Dermatology, Venereology and Allergology, Schleswig-Holstein University Medical Center, Kiel, Germany
| | - Susanne Wiegand
- Department of Otolaryngology, Leipzig University Medical Center, Leipzig, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
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33
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, Dreno B, Concetta Fargnoli M, Forsea AM, Frenard C, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NWJ, Malvehy J, Del Marmol V, Middleton MR, Moreno-Ramirez D, Pellecani G, Peris K, Saiag P, van den Beuken-van Everdingen MHJ, Vieira R, Zalaudek I, Eggermont AMM, Grob JJ. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer 2020; 128:83-102. [PMID: 32113942 DOI: 10.1016/j.ejca.2020.01.008] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 01/11/2023]
Abstract
In order to update recommendations on treatment, supportive care, education and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer was formed. Recommendations were based on evidence-based literature review, guidelines and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable) and distant metastatic cSCC. For common primary cSCC (the most frequent cSCC type), first-line treatment is surgical excision with postoperative margin assessment or microscopically controlled sugery. Safety margins containing clinical normal-appearing tissue around the tumour during surgical excision and negative margins as reported in the pathology report are necessary to minimise the risk of local recurrence and metastasis. In case of positive margins, a re-excision shall be done, for operable cases. Lymph node dissection is recommended for cSCC with cytologically or histologically confirmed regional nodal involvement. Radiotherapy should be considered as curative treatment for inoperable cSCC, or for non-surgical candidates. Anti-PD-1 antibodies are the first-line systemic treatment for patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiation, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drug Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiation therapy. Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Patients should be engaged with informed decisions on management and be provided with best supportive care to optimise symptom management and improve quality of life. Frequency of follow-up visits and investigations for subsequent new cSCC depend on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université de Paris, INSERM U976, AP-HP, Dermatology Department, Saint Louis Hospital, Paris, France
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Dermatology Department, CHU Nantes, Université Nantes, CIC 1413, CRCINA Inserm U1232, Nantes, France
| | - Maria Concetta Fargnoli
- Dermatology - Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana M Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Romania
| | - Cecille Frenard
- Dermatology Department, CHU Nantes, Université Nantes, CIC 1413, CRCINA Inserm U1232, Nantes, France
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | | | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+, GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Belgium
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - David Moreno-Ramirez
- Department of Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, APHP, EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Marieke H J van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Italy
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34
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Furdova A, Kapitanova K, Kollarova A, Sekac J. Periocular basal cell carcinoma - clinical perspectives. Oncol Rev 2020; 14:420. [PMID: 32395200 PMCID: PMC7204832 DOI: 10.4081/oncol.2020.420] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/20/2020] [Indexed: 01/15/2023] Open
Abstract
Basal cell carcinoma (BCC) as a non-melanoma skin cancer type is the most common malignant tumor throughout the world. The incidence is higher in age over 60. The intense of exposure to ultraviolet radiation is one of the known risk factors. Over 50% of BCC of the periocular region initially occur on the lower lid and inner angle. Literature review of treatment options for basal cell carcinoma, which consist of surgery, or combined techniques plus vismodegib, radiotherapy and imiquimod. The first consideration for treatment of periocular BCC is radical surgical excision using Mohs micrographic technique. Functional and esthetic outcome in patients are important after clear excisions and reconstruction should be carefully considered. Radical exenteration is considered in the case of orbital invasion of high-risk aggressive BCC.
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Affiliation(s)
- Alena Furdova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Karolina Kapitanova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Alexandra Kollarova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Juraj Sekac
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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35
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Gonzalez JL, Reddy ND, Cunningham K, Silverman R, Madan E, Nguyen BM. Multiple Cutaneous Squamous Cell Carcinoma in Immunosuppressed vs Immunocompetent Patients. JAMA Dermatol 2020; 155:625-627. [PMID: 30865240 DOI: 10.1001/jamadermatol.2018.5595] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jessica L Gonzalez
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Nithin D Reddy
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Kiera Cunningham
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Rebecca Silverman
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Elena Madan
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Bichchau Michelle Nguyen
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
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36
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Greywal T, Goldenberg A, Eimpunth S, Jiang S. Key characteristics of basal cell carcinoma with large subclinical extension. J Eur Acad Dermatol Venereol 2019; 34:485-490. [DOI: 10.1111/jdv.15884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 07/16/2019] [Indexed: 12/23/2022]
Affiliation(s)
- T. Greywal
- Department of Dermatology University of California, San Diego San Diego CA USA
| | - A. Goldenberg
- Department of Dermatology University of California, San Diego San Diego CA USA
| | - S. Eimpunth
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - S.B. Jiang
- Department of Dermatology University of California, San Diego San Diego CA USA
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37
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Morgan HJ, Benketah A, Olivero C, Rees E, Ziaj S, Mukhtar A, Lanfredini S, Patel GK. Hair follicle differentiation‐specific keratin expression in human basal cell carcinoma. Clin Exp Dermatol 2019; 45:417-425. [DOI: 10.1111/ced.14113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 12/16/2022]
Affiliation(s)
- H. J. Morgan
- European Cancer Stem Cell Research Institute School of Biosciences Cardiff University Maindy Road Cardiff UK
| | - A. Benketah
- European Cancer Stem Cell Research Institute School of Biosciences Cardiff University Maindy Road Cardiff UK
| | - C. Olivero
- European Cancer Stem Cell Research Institute School of Biosciences Cardiff University Maindy Road Cardiff UK
| | - E. Rees
- European Cancer Stem Cell Research Institute School of Biosciences Cardiff University Maindy Road Cardiff UK
| | - S. Ziaj
- European Cancer Stem Cell Research Institute School of Biosciences Cardiff University Maindy Road Cardiff UK
| | - A. Mukhtar
- European Cancer Stem Cell Research Institute School of Biosciences Cardiff University Maindy Road Cardiff UK
| | - S. Lanfredini
- European Cancer Stem Cell Research Institute School of Biosciences Cardiff University Maindy Road Cardiff UK
| | - G. K. Patel
- European Cancer Stem Cell Research Institute School of Biosciences Cardiff University Maindy Road Cardiff UK
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38
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Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, Bataille V, Marmol VD, Dummer R, Harwood CA, Hauschild A, Höller C, Haedersdal M, Malvehy J, Middleton MR, Morton CA, Nagore E, Stratigos AJ, Szeimies RM, Tagliaferri L, Trakatelli M, Zalaudek I, Eggermont A, Grob JJ. Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines. Eur J Cancer 2019; 118:10-34. [DOI: 10.1016/j.ejca.2019.06.003] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
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39
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Kim Y, Su KA, Asgari MM. Correlates of multiple cutaneous squamous cell carcinoma: A retrospective cohort study. J Am Acad Dermatol 2019; 82:497-499. [PMID: 31401039 DOI: 10.1016/j.jaad.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/20/2019] [Accepted: 08/02/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Yuhree Kim
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Katherine A Su
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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40
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Dessinioti C, Plaka M, Soura E, Mortaki D, Papaxoinis G, Gogas H, Stratigos AJ. A Practical Guide for the Follow-Up of Patients with Advanced Basal Cell Carcinoma During Treatment with Hedgehog Pathway Inhibitors. Oncologist 2019; 24:e755-e764. [PMID: 31073024 DOI: 10.1634/theoncologist.2018-0924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 12/23/2022] Open
Abstract
The Hedgehog pathway inhibitors (HPIs), vismodegib and sonidegib, are increasingly employed in the treatment of patients with advanced basal cell carcinoma (BCC). The aim of this review is to create a synthesis of available information in the literature regarding the follow-up of patients with advanced BCC treated with HPIs and to provide the treating physician with a structured practical guide to standardize clinical practice. Several challenges during treatment are addressed: to optimally evaluate tumor responses, to differentiate between resistance (HPI rechallenge not possible) and recurrence (HPI rechallenge may be possible) in case of BCC regrowth, to readily assess for toxicity and tolerability issues, to provide patients with practical ways and behaviors to effectively cope with adverse events, and to improve patient adherence and quality of life. IMPLICATIONS FOR PRACTICE: This is a practical guide for clinical practice regarding the monitoring and follow-up of patients with advanced basal cell carcinoma (BCC) during treatment with the Hedgehog pathway inhibitors (HPIs) vismodegib and sonidegib. This review aims to bridge the gap in knowledge of assessing tumor response for BCC with both an externally visible component and an infiltrating component measurable with imaging. Furthermore, it addresses the follow-up for adverse events as a challenging multistep process involving practices aiming to readily assess new-onset symptoms of HPI toxicity, perform total-body skin examination, and improve patient adherence and quality of life.
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Affiliation(s)
- Clio Dessinioti
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mikaella Plaka
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Soura
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Mortaki
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papaxoinis
- 1st Department of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Gogas
- 1st Department of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander J Stratigos
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
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41
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Lang BM, Balermpas P, Bauer A, Blum A, Brölsch GF, Dirschka T, Follmann M, Frank J, Frerich B, Fritz K, Hauschild A, Heindl LM, Howaldt HP, Ihrler S, Kakkassery V, Klumpp B, Krause-Bergmann A, Löser C, Meissner M, Sachse MM, Schlaak M, Schön MP, Tischendorf L, Tronnier M, Vordermark D, Welzel J, Weichenthal M, Wiegand S, Kaufmann R, Grabbe S. S2k-Leitlinie Basalzellkarzinom der Haut - Teil 2: Therapie, Prävention und Nachsorge. J Dtsch Dermatol Ges 2019; 17:214-231. [PMID: 30762951 DOI: 10.1111/ddg.13755_g] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus Dresden
| | | | - G Felix Brölsch
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover
| | - Thomas Dirschka
- CentroDerm, Wuppertal.,Fakultät für Gesundheit, Universität Witten-Herdecke
| | | | - Jorge Frank
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Bernhard Frerich
- Klinik und Poliklinik für Mund-, Kiefer- und plastische Gesichtschirurgie, Universitätsmedizin Rostock
| | | | - Axel Hauschild
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | - Hans-Peter Howaldt
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Gießen
| | | | - Vinodh Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck.,Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock
| | - Bernhard Klumpp
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen.,Radiologie, Rems-Murr-Klinikum Winnenden
| | | | | | - Markus Meissner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt
| | - Michael M Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven
| | - Max Schlaak
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München
| | - Michael P Schön
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | | | - Michael Tronnier
- Klinik für Dermatologie, Venerologie und Allergologie, Helios Klinikum Hildesheim
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Klinikum Augsburg
| | - Michael Weichenthal
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Roland Kaufmann
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt
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Risk factors for development of new skin neoplasms in patients with past history of skin cancer: A survival analysis. Sci Rep 2018; 8:15744. [PMID: 30356134 PMCID: PMC6200724 DOI: 10.1038/s41598-018-33763-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/27/2018] [Indexed: 11/08/2022] Open
Abstract
We conducted a retrospective study aiming to assess the risk, and associated risk factors, of developing subsequent skin cancers after having a first diagnosis of skin cancer. We included all patients with biopsy-proven skin cancer attending a dermatology clinic between July 2007 and July 2017. We assessed the frequency of new skin cancers, as well as potential demographic and clinical factors significantly associated with occurrence of such neoplasms, that were identified by means of a survival analysis. We analyzed 969 patients with a total of 1584 skin neoplasms (1122 basal cell carcinomas (BCC), 310 squamous cell carcinomas (SCC), 143 melanomas and 9 other neoplasms). 165 patients (17.0%) developed subsequent skin neoplasms. Factors identified in multivariable models to be significantly associated with development of new skin cancers included older age (adjusted HR = 1.04 per year; 95%CI = 1.02-1.05; p < 0.001), and presence of synchronous neoplasms (adjusted HR = 2.25; 95%CI = 1.61-3.14; p < 0.001). Having a history of a BCC was significantly associated with development of new BCC (adjusted HR = 1.63; 95%CI = 1.05-2.54; p = 0.030), while having a previous SCC was associated with occurrence of subsequent SCC (adjusted HR = 3.60; 95%CI = 1.93-6.72; p < 0.001). These findings point to the importance of careful follow-up (e.g., skin self-examination and full body examination) of skin cancer patients.
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Carcinoma, Basal Cell/etiology
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/prevention & control
- Carcinoma, Basal Cell/therapy
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/prevention & control
- Carcinoma, Squamous Cell/therapy
- Female
- Humans
- Incidence
- Life Expectancy
- Male
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Quality of Life
- Radiotherapy, Adjuvant
- Risk Factors
- Skin Neoplasms/etiology
- Skin Neoplasms/pathology
- Skin Neoplasms/prevention & control
- Skin Neoplasms/therapy
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Affiliation(s)
- Kishwer S Nehal
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (K.S.N.); and Michigan Medicine, University of Michigan, Ann Arbor (C.K.B.)
| | - Christopher K Bichakjian
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (K.S.N.); and Michigan Medicine, University of Michigan, Ann Arbor (C.K.B.)
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Christensen SR. Recent advances in field cancerization and management of multiple cutaneous squamous cell carcinomas. F1000Res 2018; 7. [PMID: 29904586 PMCID: PMC5989149 DOI: 10.12688/f1000research.12837.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 12/31/2022] Open
Abstract
Cutaneous squamous cell carcinoma (SCC) is among the most common cancers in humans, and many patients with SCC will develop multiple tumors within their lifetime. The field cancerization concept, originally proposed over 60 years ago, hypothesized that multiple primary cancers may arise simultaneously and coexist with subclinical precursor lesions within a defined field. Genetic sequencing of SCC and precursor lesions has identified what may be the earliest clonal proliferations in SCC development and confirmed that field cancerization in the skin is mediated by ultraviolet radiation. For patients with multiple SCCs and severe actinic damage, treatment of precursor lesions within a cancerized field can decrease the risk of subsequent cancer development. Sunblock is an effective intervention for field cancerization, even in patients with established disease. There is now direct evidence that field therapy with topical 5-fluorouracil is effective in reducing the incidence of subsequent SCC, and there is indirect evidence suggesting that topical imiquimod, topical ingenol mebutate, and photodynamic therapy are similarly effective. There is limited direct evidence to show that systemic acitretin or nicotinamide can decrease incident SCC in patients with field cancerization. In this review, an approach to the management of patients with multiple SCCs and field cancerization is presented along with the rationale to support field-directed therapy.
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Affiliation(s)
- Sean R Christensen
- Section of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology, Yale University, New Haven, CT, USA
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Linos E, Pagoto S. USPSTF Recommendations for Behavioral Counseling for Skin Cancer Prevention: Throwing Shade on UV Radiation. JAMA Intern Med 2018; 178:609-611. [PMID: 29558531 PMCID: PMC5971005 DOI: 10.1001/jamainternmed.2018.0846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Eleni Linos
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs
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Kim JY, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P, Bichakjian C, Armstrong A, Baum C, Bordeaux JS, Brown M, Busam KJ, Eisen DB, Iyengar V, Lober C, Margolis DJ, Messina J, Miller A, Miller S, Mostow E, Mowad C, Nehal K, Schmitt-Burr K, Sekulic A, Storrs P, Teng J, Yu S, Huang C, Boyer K, Begolka WS, Alam M. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol 2018; 78:540-559. [DOI: 10.1016/j.jaad.2017.10.006] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 01/05/2023]
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Kim JYS, Kozlow JH, Mittal B, Moyer J, Olenecki T, Rodgers P. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol 2018; 78:560-578. [PMID: 29331386 DOI: 10.1016/j.jaad.2017.10.007] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common form of human cancer and has an increasing annual incidence. Although most cSCC is cured with office-based therapy, advanced cSCC poses a significant risk for morbidity, impact on quality of life, and death. This document provides evidence-based recommendations for the management of patients with cSCC. Topics addressed include biopsy techniques and histopathologic assessment, tumor staging, surgical and nonsurgical management, follow-up and prevention of recurrence, and management of advanced disease. The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cSCC is noted, as is general information on the management of patients with metastatic disease.
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Affiliation(s)
| | | | - John Y S Kim
- Department of Plastic and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Jeffrey H Kozlow
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, Michigan
| | - Bharat Mittal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - Jeffrey Moyer
- Department of Otolaryngology, Plastic/Head/Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Thomas Olenecki
- Department of Internal Medicine, Ohio State University, Columbus, Ohio
| | - Phillip Rodgers
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
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Villani R, Khosrotehrani K. Oncogenes and morphogens: intricacies of targeted therapy in cutaneous basal cell carcinoma. Br J Dermatol 2018; 177:1472-1473. [PMID: 29313924 DOI: 10.1111/bjd.15988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Villani
- The University of Queensland, UQ Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, 4102, Australia
| | - K Khosrotehrani
- The University of Queensland, UQ Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba, 4102, Australia
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van der Leest R, Hollestein L, Liu L, Nijsten T, de Vries E. Risks of different skin tumour combinations after a first melanoma, squamous cell carcinoma and basal cell carcinoma in Dutch population-based cohorts: 1989-2009. J Eur Acad Dermatol Venereol 2017; 32:382-389. [DOI: 10.1111/jdv.14587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
Affiliation(s)
- R.J.T. van der Leest
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - L.M. Hollestein
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
- Department of Research; Netherlands Comprehensive Cancer Organisation (IKNL); Utrecht The Netherlands
| | - L. Liu
- Department of Public Health; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Statistics; European Organization for Research and Treatment of Cancer (EORTC); Brussels Belgium
| | - T. Nijsten
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - E. de Vries
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
- Department of Public Health; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Clinical Epidemiology and Biostatistics; Faculty of Medicine; Pontificia Universidad Javeriana; Bogotá Colombia
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Hollestein L, Weinstock M, Le Roux E, Olsen C. More Than Many: How to Manage the Most Frequent Cancer? J Invest Dermatol 2017; 137:1823-1826. [PMID: 28843292 DOI: 10.1016/j.jid.2017.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
Leiter et al. report on the increasing incidence of keratinocyte cancers in Germany. The true population burden is even larger then reported, because many of these new patients will develop multiple keratinocyte cancers. Keratinocyte cancer puts a large burden on health care systems worldwide. Prevention and management strategies are needed to maintain high quality of care for all patients.
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Affiliation(s)
- Loes Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands.
| | - Martin Weinstock
- Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA; Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Emma Le Roux
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Catherine Olsen
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia; School of Public Health, University of Queensland, Queensland, Australia
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