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Bailly-Caillé B, Levard R, Kottler D, Dompmartin A, L'Orphelin JM. Long-term survival after anti-PD-1 discontinuation in advanced cutaneous squamous cell carcinoma (cSCC): a proof of concept of benefit of concomitant cemiplimab and radiotherapy. Cancer Immunol Immunother 2024; 73:118. [PMID: 38713217 PMCID: PMC11076421 DOI: 10.1007/s00262-024-03700-x] [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: 02/28/2024] [Accepted: 04/05/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND In a princeps study we conducted in patients with advanced cutaneous squamous cell carcinoma treated with concomitant anti-Programmed cell death protein 1 (PD-1) and radiotherapy, we demonstrated a clinico radiological response to cemiplimab that appeared to persist over time, 1 year after treatment discontinuation. METHOD We conducted a single-center descriptive study at Caen Hospital from September 1, 2021 to September 2023, in 14 patients with advanced carcinoma treated with cemiplimab until September 1, 2021. The aim of this update is to examine clinical and radiological follow-up 2 years after discontinuation of cemiplimab. RESULTS Of the 12 patients with a partial or complete response, we report 8 (66.7%) persistent responses 2 years after stopping cemiplimab, with only 2 patients progressing to distant disease, one lost to follow-up, and one death a priori unrelated to the disease. CONCLUSION Our study confirms a long-term and persistent effect despite discontinuation of cemiplimab at least up to 2 years later.
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MESH Headings
- Humans
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Skin Neoplasms/drug therapy
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Skin Neoplasms/radiotherapy
- Male
- Female
- Aged
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- Middle Aged
- Aged, 80 and over
- Immune Checkpoint Inhibitors/therapeutic use
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Follow-Up Studies
- Chemoradiotherapy/methods
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Affiliation(s)
| | - Romain Levard
- Department of Dermatology, Caen-Normandie University Hospital, 14000, Caen, France.
| | - Diane Kottler
- Department of Dermatology, Caen-Normandie University Hospital, 14000, Caen, France
| | - Anne Dompmartin
- Department of Dermatology, Caen-Normandie University Hospital, 14000, Caen, France
| | - Jean-Matthieu L'Orphelin
- Department of Dermatology, Caen-Normandie University Hospital, 14000, Caen, France.
- INSERM ANTICIPE UMR1086, Interdisciplinary Research Unit for Cancer Prevention and Treatment, Normandie University, Research Building F-14000 François 3 Avenue Général Harris, BP 45026, 14076, Caen Cedex, France.
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2
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Ryan MP, Winsett FT, Armenta AM, Goodwin BP, Wagner RF. Lymphovascular Invasion in Cutaneous Squamous Cell Carcinoma. Dermatol Surg 2024:00042728-990000000-00754. [PMID: 38603804 DOI: 10.1097/dss.0000000000004187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Although there is a large body of literature regarding risk stratification and outcomes for perineural invasion (PNI) in cutaneous squamous cell carcinoma (cSCC), there is a relative paucity of studies exploring the role of lymphovascular invasion (LVI) in cSCC and a lack of clear evidence-based guidelines for how to manage patients with these tumors. OBJECTIVE This article is intended to review the available literature regarding LVI in cSCC and formulate evidence-based recommendations for clinical management. METHODS AND MATERIALS A literature review was conducted using PubMed to find relevant articles relating to outcomes and management of primary cSCC with LVI. RESULTS The available literature suggests that LVI is a major risk factor for poor outcomes and increased morbidity and mortality in cSCC. CONCLUSION Lymphovascular invasion is a very high-risk feature that should place these tumors in the highest-risk category, and management of these tumors should be similar to that of squamous cell carcinoma with PNI.
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Affiliation(s)
- Michael P Ryan
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Frank T Winsett
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | - Andrew M Armenta
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | - Brandon P Goodwin
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | - Richard F Wagner
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
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3
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Rampinelli V, Pinacoli A, Piazza C. Head and neck nonmelanoma skin cancers: surgical management and debated issues. Curr Opin Otolaryngol Head Neck Surg 2024; 32:62-70. [PMID: 38193646 PMCID: PMC10919275 DOI: 10.1097/moo.0000000000000960] [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] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW This review critically assesses the current literature and guidelines, aiming to clarify some of the most important factors that impact surgical strategies of head and neck nonmelanoma skin cancers (NMSCs), focusing on squamous, basal, and Merkel cell carcinomas. RECENT FINDINGS Recent developments underscore the complexity of treatment for NMSC, particularly in the head and neck region. There is a lack of high-level evidence for the management of these tumors, especially in advanced stages. The need to tailor the extent of surgical margins and parotid/neck management to different histotypes, considering the varying risk factors for recurrence, is beginning to emerge in the literature. Moreover, the role of immunotherapy and targeted therapies for locally advanced disease, alongside traditional treatment options, is progressively growing. SUMMARY NMSCs represent a heterogeneous group of malignancies with varying treatment complexities and prognoses. Management of NMSC is evolving towards an increasingly personalized strategy within a multidisciplinary therapeutic framework.
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Affiliation(s)
- Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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4
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Verdaguer-Faja J, Toll A, Boada A, Guerra-Amor Á, Ferrándiz-Pulido C, Jaka A. Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches. Cancers (Basel) 2024; 16:664. [PMID: 38339415 PMCID: PMC10854799 DOI: 10.3390/cancers16030664] [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: 12/27/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common subtype of skin cancer. The scalp is one of the most frequently affected locations and is associated with a higher rate of complications, compared to other locations. In addition, it has a characteristic thickness and anatomical structure that may influence both growth pattern and treatment of primary cSCC; while clinical peripheral margins may be easily achieved during the surgery, vertical excision of the tumor is limited by the skull. Despite having a unique anatomy, current guidelines do not contemplate specific recommendations for scalp cSCC, which leads to inconsistent decision-making in multidisciplinary committees when discussing tumors with high risk factors or with close margins. This article provides specific recommendations for the management of patients with scalp cSCC, based on current evidence, as well as those aspects in which evidence is lacking, pointing out possible future lines of research. Topics addressed include epidemiology, clinical presentation and diagnosis, imaging techniques, surgical and radiation treatments, systemic therapy for advanced cases, and follow-up. The primary focus of this review is on management of primary cSCC of the scalp with localized disease, although where relevant, some points about recurrent cSCCs or advanced disease cases are also discussed.
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Affiliation(s)
- Júlia Verdaguer-Faja
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Aram Boada
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Álvaro Guerra-Amor
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carla Ferrándiz-Pulido
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ane Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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5
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment-Update 2023. Eur J Cancer 2023; 193:113252. [PMID: 37708630 DOI: 10.1016/j.ejca.2023.113252] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/16/2023]
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 Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV), and the European Organisation of Research and Treatment of Cancer (EORTC) was formed. Recommendations were based on an 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 first-line treatment is surgical excision with postoperative margin assessment or micrographically controlled surgery. Achieving clear surgical margins is the most important treatment consideration for patients with cSCCs amenable to surgery. Regarding adjuvant radiotherapy for patients with high-risk localised cSCC with clear surgical margins, current evidence has not shown significant benefit for those with at least one high-risk factor. Radiotherapy should be considered as the primary treatment for non-surgical candidates/tumours. For cSCC with cytologically or histologically confirmed regional nodal metastasis, lymph node dissection is recommended. For patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiotherapy, anti-PD-1 agents are the first-line systemic treatment, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drugs Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC, include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiotherapy. Multidisciplinary board decisions are mandatory for all patients with advanced cSCC, considering the risks of toxicity, the age and frailty of patients, and co-morbidities, including immunosuppression. Patients should be engaged in informed, shared decision-making on management and be provided with the best supportive care to improve symptom management and quality of life. The frequency of follow-up visits and investigations for subsequent new cSCC depends on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- First 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
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital 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 Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the 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
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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6
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Huang SS, Toon CW, Harish V. The prognostic significance of lymphovascular invasion in cutaneous squamous cell carcinoma. ANZ J Surg 2023; 93:2727-2735. [PMID: 37727039 DOI: 10.1111/ans.18694] [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: 03/25/2023] [Revised: 08/12/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The majority of cutaneous squamous cell carcinomas (cSCC) have a favourable prognosis. However, a subset of cases follow an aggressive disease course with progression to metastasis and death. Several histopathological parameters are associated with poor outcomes, but lymphovascular invasion (LVI) has not been well studied. OBJECTIVE To assess the prognostic significance of LVI in cSCC and determine associations between LVI and cSCC. METHODS A retrospective review of 486 consecutive cases of cSCC over a 5-year period from a single centre was stratified by the presence or absence of LVI. Logistic regression and multivariate survival analysis were used to determine associations of LVI and prognostic significance of LVI, respectively. FINDINGS LVI was present in 41 cases (9.2%). LVI was significantly associated with increasing depth of invasion, microanatomical tumour location (subcutis vs. dermis), and tumour dimensions (P < 0.05). Univariate survival analysis revealed significantly lower 2-year overall survival rates for patients with LVI (37.1%) compared with those without (66.6%) (95% CI = 60.6-73.3, P < 0.001). LVI was also found to be an independent marker of poor disease-specific survival (HR = 0.232 (95% CI = 0.090-0.600), P = 0.003), poor overall survival (HR 0.338 (95% CI = 0.184-0.623), P < 0.001) and poor disease-free survival (HR 0.461 (95% CI = 0.230-0.923), P = 0.029) through multivariate analysis. CONCLUSIONS This study confirms that LVI is an independent poor prognosticator in cSCC, with significantly worse survival indices at 2 years. Future systems of risk stratification for cSCC should incorporate LVI.
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Affiliation(s)
- Sarah Suruo Huang
- Department of Burns, Plastic & Maxillofacial Surgery, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Christopher W Toon
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia
- St Vincent's Clinical School, University of NSW, Sydney, Australia
| | - Varun Harish
- Department of Burns, Plastic & Maxillofacial Surgery, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
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7
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Soria Rivas A, Bea-Ardebol S, Vida Navas E, Muñoz-Arrones ÓM, Cabañas-Montero LJ, Mena-Mateos A, López-Campos F, Corral Moreno S, Pérez-Muñoz I, González Lizan F, Sanz Pascual M, Serrano Domingo JJ. Treatment of metastatic squamous cell carcinoma arising in sacrococcygeal pilonidal sinus: a case report series. Front Med (Lausanne) 2023; 10:1248894. [PMID: 37780565 PMCID: PMC10534040 DOI: 10.3389/fmed.2023.1248894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
Background Squamous cell carcinoma (SCC) arising in a sacrococcygeal pilonidal sinus is rare, with cases of metastatic disease being even rarer. Among published cases, almost none have reported on systemic treatment. Objective This disease has a poorer prognosis than other forms of cutaneous SCC; therefore, our objective is to shed some light on the treatment of metastatic disease. Methods We present a series of nine cases treated at a single center, four of whom received systemic treatment. Additionally, other previously reported cases of metastatic disease are included in an attempt to draw stronger conclusions. Results Four patients were treated under several treatment regimens, with a median progression-free survival of only 2 months and two instances of partial response (18%). The best result was achieved with cemiplimab. Across all the cases, there was a trend toward a benefit of the use of systemic treatment (HR 0.41, 95% CI 0.15-1.12, p = 0.083; median overall survival 13 vs. 8 months). Limitations Limitations include the significant lack of information on previously published cases and the extremely heterogeneous nature of the existing information. Conclusion The initial systemic treatment should be an anti-PD-1, as with other SCCs. After progression on anti-PD-1, there is no strong evidence to support the recommendation of a specific treatment or sequence: options include cetuximab and/or chemotherapy (platinum, paclitaxel, 5-fluorouracyl).
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Affiliation(s)
- Ainara Soria Rivas
- Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Sonia Bea-Ardebol
- Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Elena Vida Navas
- Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | | | | | | | | | - Israel Pérez-Muñoz
- Orthopedics and Orthopedic Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Fausto González Lizan
- Orthopedics and Orthopedic Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - María Sanz Pascual
- Orthopedics and Orthopedic Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
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8
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Blumenthal SR, Chen HW, Maher I, Nijhawan RI. Management of Scalp Squamous Cell Carcinoma Involving Bone: A Survey of the American College of Mohs Surgery. Dermatol Surg 2023; 49:620-621. [PMID: 37000967 DOI: 10.1097/dss.0000000000003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Affiliation(s)
| | - Henry W Chen
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
| | - Ian Maher
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Rajiv I Nijhawan
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas
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9
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Dessinioti C, Stratigos AJ. Recent Advances in the Diagnosis and Management of High-Risk Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14143556. [PMID: 35884616 PMCID: PMC9323313 DOI: 10.3390/cancers14143556] [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: 06/29/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer. Although most cSCCs are effectively treated with surgery, there are some tumors at higher risk for relapse, progression to nodal metastasis, or, rarely, death. An important issue concerns the early diagnosis and appropriate treatment of these few high-risk cSCCs, as they are associated with poorer prognosis and may more frequently progress to advanced cSCCs. This review discusses the characteristics of high-risk cSCC and how to identify and manage patients with these tumors. Abstract High-risk cSCC is defined as invasive cSCC staged as N0 (without detectable regional lymph nodes) and M0 (without distant metastasis), that has features associated with a higher risk of poorer prognosis. The focus of this review is on the recent advances in the diagnosis and management of high-risk cSCC. The interest in high-risk cSCC relies on its higher risk of progression to advanced cSCC, as it represents the main pool of cSCCs that give rise to advanced tumors. Assessment of the risk is thus particularly relevant for common cSCC to identify the few with a high-risk risk of local recurrence, metastasis, or disease-specific death among all other low-risk tumors. The timely diagnosis and effective treatment of high-risk cSCCs may halt their further progression and aim to prevent and lower the incidence of advanced cSCCs. Clearance of the tumor with negative surgical margins is the main goal of surgery, which is the primary treatment of cSCC. It seems that it is difficult to discern the group of high-risk cSCCs that may benefit from adjuvant RT, as a universal beneficial effect for a cSCC with any high-risk factor which was resected with clear surgical margins has not been established. In the case of a high-risk cSCC with positive margins after surgery, and re-excision not feasible, post-operative radiotherapy is performed when possible. Recommendations on further management are discussed. Regarding the follow-up of patients diagnosed with high-risk cSCC, factors to consider regarding the frequency and intensity of the follow-up schedule include the risk and possible time of occurrence of metastasis from cSCC.
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10
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Benkhaled S, Van Gestel D, Gomes da Silveira Cauduro C, Palumbo S, del Marmol V, Desmet A. The State of the Art of Radiotherapy for Non-melanoma Skin Cancer: A Review of the Literature. Front Med (Lausanne) 2022; 9:913269. [PMID: 35833108 PMCID: PMC9272768 DOI: 10.3389/fmed.2022.913269] [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: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Due to the general aging population and the fashion trend of sun exposure, non-melanoma skin cancer (NMSC) is rising. The management of NMSC is difficult and necessitates a multidisciplinary team (i.e., pathologists, dermatologists, medical oncologists, surgeons, and radiation oncologists). When surgery is not an option or will cause unacceptably functional morbidity, radiation therapy (RT) may be a preferable tissue-preserving option. Whether used alone or in conjunction with other treatments, RT has been shown to be quite effective in terms of cosmetic results and local control. Contact hypofractionated RT, brachytherapy, and electronic brachytherapy are all promising new treatments. However, rigorous, randomized trials are missing, explaining the disparity in dose, fractionation, and technique recommendations. Therefore, it is essential that interdisciplinary teams better understand RT modalities, benefits, and drawbacks. Our review will provide the role and indications for RT in patients with NMSC.
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Affiliation(s)
- Sofian Benkhaled
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
- *Correspondence: Sofian Benkhaled
| | - Dirk Van Gestel
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | | | - Samuel Palumbo
- Department of Radiation-Oncology, Jolimont Hospital, La Louvière, Belgium
| | - Veronique del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Desmet
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
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11
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Nwolise C, Rembielak A, Fitzpatrick R, Jenkinson C, Marsden J, Fairbrother P, Proby CM, Harwood CA, Matin RN. Adjuvant radiotherapy in patients with high-risk cutaneous Squamous Cell Carcinoma After surgery (SCC-AFTER): Patient and carer views regarding a proposed clinical trial. Clin Exp Dermatol 2022; 47:1875-1876. [PMID: 35722934 DOI: 10.1111/ced.15300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Chidiebere Nwolise
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Agata Rembielak
- Clinical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
| | | | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jerry Marsden
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Charlotte M Proby
- Division of Molecular and Clinical Medicine, Ninewells Hospital & Medical School, University of Dundee, UK
| | - 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
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