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Schmitz L, Brehmer A, Falkenberg C, Gambichler T, Heppt MV, Steeb T, Gupta G, Malvehy J, Dirschka T. Treatment-resistant actinic keratoses are characterized by distinct clinical and histological features. Ital J Dermatol Venerol 2021; 156:213-219. [PMID: 33960752 DOI: 10.23736/s2784-8671.21.06892-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Actinic keratoses (AK) are generally treated to reduce the risk of progression into invasive cutaneous squamous cell carcinoma (cSCC). However, this risk of transformation is low, and rather than focusing on these lesions, current treatment studies report on complete clearance of AKs in an entire field. This study aimed to investigate treatment-resistant AKs (trAK) after field therapy compared to randomly chosen AKs prior to treatment. METHODS AKs were clinically assessed according to the grade of hyperkeratosis and pain on palpation, prior to treatment. TrAKs were biopsied and compared to AKs which were biopsied prior to any treatment. AKs were evaluated regarding histological severity (AKI-III), their basal growth grading (PROI-III), acantholysis, elastosis, follicular extension of atypical keratinocytes and accompanying infiltrate. RESULTS Two hundred eleven AKs in 171 patients were identified. TrAKs (N.=79) were significantly more painful (64.6% vs. 22.0%; P<0.0001), showing acantholysis (57.0% vs. 33.3%; P=0.0007); and with distinct basal proliferation (PROIII) (64.4% vs. 46.2%; P=0.0099) compared to the control group (N.=132). In a multivariate analysis using logistic regression, pain and PRO III graded lesions were significant independent (P<0.0001 and P=0.0179) predictors for trAKs. Focusing on individual histological features in the trAK group, AKs with grade AKIII, PROIII or follicular extension reaching the sebaceous gland were the most common findings with 51.9%, 64.6%, and 59.5% AKs demonstrating this, respectively. CONCLUSIONS TrAKs are often painful, showing a distinct basal proliferation (PROIII) and acantholysis. As these features are also seen in invasive cSCCs, trAKs may represent a subgroup of AKs and, for this reason, it requires further evaluations.
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Affiliation(s)
- Lutz Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany - .,Institute of Dermatopathology, MVZ Corius DermPathBonn, Bonn, Germany -
| | - Amrei Brehmer
- Department of Dermatology, Klinikum Dortmund gGmbH, Dortmund, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - Conrad Falkenberg
- Department of Dermatology, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Thilo Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
| | - Markus V Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Girish Gupta
- Department of Dermatology, Lauriston Building, Edinburgh, UK.,School of Medicine, University of Glasgow, Glasgow, UK
| | - Josep Malvehy
- Department of Dermatology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University Hospital of Barcelona, University of Barcelona, Barcelona, Spain
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany.,CentroDerm Clinic, Wuppertal, Germany
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Cañueto J, Tejera-Vaquerizo A, Redondo P, Botella-Estrada R, Puig S, Sanmartin O. A review of terms used to define cutaneous squamous cell carcinoma with a poor prognosis. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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3
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A review of terms used to define cutaneous squamous cell carcinoma with a poor prognosis. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:281-290. [PMID: 32359704 DOI: 10.1016/j.ad.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/10/2019] [Accepted: 06/02/2019] [Indexed: 02/01/2023] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in humans and its incidence is both underestimated and on the rise. cSCC is referred to in the literature as high-risk cSCC, locally advanced cSCC, metastatic cSCC, advanced cSCC, and aggressive cSCC. These terms can give rise to confusion and are not always well defined. In this review, we aim to clarify the concepts underlying these terms with a view to standardizing the description of this tumor, something we believe is necessary in light of the new drugs that have been approved or are in development for cSCC.
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Pyne JH, Myint E, Clark SP, Clifopoulos C, Fishburn P, Gorji M, Hou R. Squamous cell carcinoma: pain as a clue to increased tumour diameter, increased invasion depth, the grade of differentiation, acantholysis and perineural invasion. Clin Exp Dermatol 2019; 45:180-186. [DOI: 10.1111/ced.14066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- J. H. Pyne
- Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - E. Myint
- Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - S. P. Clark
- Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - C. Clifopoulos
- School of Medicine University of Queensland Brisbane Australia
| | - P. Fishburn
- School of Medicine University of Queensland Brisbane Australia
| | - M. Gorji
- Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - R. Hou
- Prince of Wales Clinical School University of New South Wales Sydney Australia
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5
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Blomberg M, He SY, Harwood C, Arron ST, Demehri S, Green A, Asgari MM. Research gaps in the management and prevention of cutaneous squamous cell carcinoma in organ transplant recipients. Br J Dermatol 2017; 177:1225-1233. [PMID: 29086412 PMCID: PMC5711582 DOI: 10.1111/bjd.15950] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 12/13/2022]
Abstract
Although tremendous progress has been made in recent years in skin cancer care for organ transplant recipients, significant gaps remain in data-driven clinical guidelines, particularly for the treatment and prevention of cutaneous squamous cell carcinoma (cSCC), the most common malignancy among this population. In this review, we aim to summarize current knowledge around the management of cSCC and highlight the most significant gaps in knowledge that continue to pose challenges in the delivery of skin cancer care for organ transplant recipients. We suggest future directions for research that will bridge existing gaps and establish evidence-driven guidelines for primary prevention, screening and treatment of cSCC in this high-risk patient population.
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Affiliation(s)
- M Blomberg
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, U.S.A
| | - S Y He
- Department of Dermatology, Weill Cornell Medical College, New York, NY, U.S.A
| | - C 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, U.K
| | - S T Arron
- Department of Dermatology, University of California, San Francisco, CA, U.S.A
| | - S Demehri
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A
| | - A Green
- QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
- Cancer Research UK Manchester Institute, University of Manchester, Manchester, U.K
| | - M M Asgari
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, U.S.A
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6
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Oh C, Hofbauer G, Serra A, Harwood C, Mitchell L, Proby C, Olasz E, Mosel D, Piaserico S, Fortina A, Geusau A, Jahn-Bassler K, Gerritsen M, Seçkin D, Güleç A, Cetkovská P, Ricar J, Imko-Walczuk B, Dębska-Ślizień A, Bouwes Bavinck J. Painful skin lesions and squamous cell carcinoma predict overall mortality risk in organ transplant recipients: a cohort study. Br J Dermatol 2017; 176:1179-1186. [DOI: 10.1111/bjd.15269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- C.C. Oh
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - G.F.L. Hofbauer
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - A.L. Serra
- Epidemiology, Biostatistics and Prevention Institute; University of Zürich; Zürich Switzerland
| | - C.A. Harwood
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London U.K
| | - L. Mitchell
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London U.K
| | - C.M. Proby
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London U.K
- Division of Cancer Research; University of Dundee; Ninewells Hospital and Medical School; Dundee U.K
| | - E.B. Olasz
- Medical College of Wisconsin; Milwaukee WI U.S.A
| | - D.D. Mosel
- Medical College of Wisconsin; Milwaukee WI U.S.A
| | - S. Piaserico
- Department of Medicine; University of Padua; Padua Italy
| | - A.B. Fortina
- Department of Medicine; University of Padua; Padua Italy
| | - A. Geusau
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - K. Jahn-Bassler
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | | | - D. Seçkin
- Başkent University Faculty of Medicine; Ankara Turkey
| | - A.T. Güleç
- Başkent University Faculty of Medicine; Ankara Turkey
| | - P. Cetkovská
- University Hospital Pilsen; Pilsen Czech Republic
| | - J. Ricar
- University Hospital Pilsen; Pilsen Czech Republic
| | | | - A. Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
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Lowenstein SE, Garrett GL, He SY, Mansh M, Arron ST. Management of Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Tufaro AP, Azoury SC, Crompton JG, Straughan DM, Reddy S, Prasad NB, Shi G, Fischer AC. Rising incidence and aggressive nature of cutaneous malignancies after transplantation: An update on epidemiology, risk factors, management and surveillance. Surg Oncol 2015; 24:345-52. [DOI: 10.1016/j.suronc.2015.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/16/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023]
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Abstract
Cancer pain sends a message. It is frightening to the patient. It heralds progression or recurrence to the oncologist. It is a biological readout of the cancer-nerve interaction for the scientist. Nerves have been considered bystanders within the cancer microenvironment. However, emerging information suggests that nerves are recruited and participate in the carcinogenic process. These newly formed fibers respond to mediators secreted by constituents of the cancer microenvironment. In this manner, these nerves serve as bellwethers and sensors embedded within the cancer. When we rigorously assess patients' cancer pain, we gain insight into the action of cancer. An enhanced understanding of cancer pain offers biological questions that if answered might not only provide relief from cancer pain but might also improve survival.
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Skin Cancer in the Crosshairs: Highlights from the Biennial Scientific Retreat of International Transplant Skin Cancer Collaborative and Skin Care in Organ Transplant Recipients Europe. Transplant Direct 2015; 1:e26. [PMID: 27500228 PMCID: PMC4946475 DOI: 10.1097/txd.0000000000000535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The International Transplant Skin Cancer Collaborative (ITSCC) is an organization comprising of physicians; transplant surgeons and basic science research scientists dedicated in providing optimal care and ongoing research advancements in solid organ transplant recipients to improve patient outcome and quality of life. As medical advances occur, it is anticipated that the sheer number of solid organ transplantations occurring worldwide will continue to increase. The long-term medication associated immunosuppression improves graft survival, but as a consequence, these individuals become increasingly susceptible to various cutaneous malignancies, lymphoproliferative disorders and infections. Squamous cell carcinoma is the most frequently encountered skin cancer and increases 65- to 250-fold [Jensen et al., Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. J Am Acad Dermatol. 1999;40:177-186; Lindelöf et al., Incidence of skin cancer in 5356 patients following organ transplantation. Br J Dermatol. 2000; 143:513-519]. However, the rates of basal cell carcinoma, Merkel cell carcinoma and melanoma also increase in organ transplant recipients leading to significant morbidity as well as mortality [Berg and Otley. Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol. 2002; 47:1-20]. In October 2014, the International Transplant Skin Cancer Collaborative and its equivalent European counterpart, Skin Care in Organ Transplant Recipients Europe held its 10th biennial meeting in Essex, MA to discuss the clinical conundrums and the evolving research pertinent to the field. This meeting report provides a synthesis of all the clinical and research data presented at the 4-day meeting.
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