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Tanamas J, Chionardes MA, Handoyo T, Kholis FN, Farida, Wibisono BH, Suryanto A, Tenda ED, Singh G, Pangarsa EA, Satoto B, Septarina FR, Puspasari D. Medical thoracoscopy with cryobiopsy as diagnostic tool for pleural metastatic in cutaneous squamous cell carcinoma: a rare case report. Ann Med Surg (Lond) 2024; 86:1734-1738. [PMID: 38463096 PMCID: PMC10923346 DOI: 10.1097/ms9.0000000000001814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/11/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Distance metastasis of cutaneous squamous cell carcinoma (cSCC) to pleural is rarely reported, and meets difficulties in diagnosing due to quality of pleural biopsy sample. This case presented a novel technique by using cryobiopsy to obtain adequate sample and was first conducted in our hospital. Case presentation A 62-years-old man admitted to hospital with dyspnoea due to massive right pleural effusion. Lung multi-sliced computed tomography showed right lung pleural effusion with compression atelectasis as well as collapse of medial lobe and upper lobe, multiple solitary nodules on mediastinal, costal antero-posterior and right diaphragm pleural part. Medical thoracoscopy was performed to obtain pleural samples by using cryobiopsy and forceps biopsy. Pathological analysis with Immunohistochemistry (IHC) revealed metastatic squamous cell carcinoma. Discussion Recurrence rate of cSCC remains high even after treatment, with worse prognosis. Distant metastasis to pleural is rarely reported. Clinical approach for malignant pleural effusion by using medical thoracoscopy has 80% sensitivity with minimal complication. Pleural cryobiopsy is a novel technique used for obtaining sample from pleural biopsy with significant larger size of the specimen, less crush artefacts, fragmented and better tissue integrity, although the diagnostic yield and bleeding severity between cryobiopsy and conventional forceps biopsy are not significant. Conclusion Medical thoracoscopy with cryobiopsy should be considered as a preferrable diagnostic tool for obtaining better sample specimen, especially for pleural metastatic.
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Affiliation(s)
| | | | | | | | - Farida
- Division of Respirology and Critical Care Medicine
| | | | | | - Eric Daniel Tenda
- Division of Respirology and Critical Care Medicine, Department of Internal Medicine, Cipto Mangunkusumo National Reference Hospital, Faculty of Medicine, University of Indonesia, Kota Depok, Jawa Barat, Indonesia
| | - Gurmeet Singh
- Division of Respirology and Critical Care Medicine, Department of Internal Medicine, Cipto Mangunkusumo National Reference Hospital, Faculty of Medicine, University of Indonesia, Kota Depok, Jawa Barat, Indonesia
| | - Eko Adhi Pangarsa
- Division of Hematology and Medical Oncology, Department of Internal Medicine
| | | | - Faiza Rizky Septarina
- Anatomical Pathology, Kariadi Hospital Medical Center, Faculty of Medicine, Diponegoro University, Kota Semarang, Jawa Tengah
| | - Dik Puspasari
- Anatomical Pathology, Kariadi Hospital Medical Center, Faculty of Medicine, Diponegoro University, Kota Semarang, Jawa Tengah
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2
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Affiliation(s)
- Ashley Wysong
- From the Department of Dermatology, University of Nebraska Medical Center, Omaha
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3
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Hu M, Kim ANH, Emeto TI, Collins M, Chopping A, Lin C. Metastatic cutaneous squamous cell carcinoma to the parotid: Adjuvant radiotherapy and treatment outcomes. J Med Radiat Sci 2023. [PMID: 36790039 DOI: 10.1002/jmrs.650] [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: 08/01/2022] [Accepted: 12/29/2022] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Adjuvant radiotherapy is an established component in the management of metastatic cutaneous squamous cell carcinoma (SCC) involving the parotid gland. Radiotherapy technique, dose and volumes are seldom described sufficiently to allow close examination. We report our treatment outcomes and focus on treatment-related factors that affect outcomes in this cohort. METHODS We performed a retrospective review of patients with metastatic cutaneous SCCs who underwent parotidectomy with or without ipsilateral neck dissection. All patients received adjuvant radiotherapy. Demographics, clinical data and treatment details were collected from an intuitional electronic database. Individual patient-level radiotherapy technique, volumes and doses were reviewed. RESULTS Between July 2008 and July 2018, 60 patients met our inclusion criteria. Median follow-up duration was 32.7 months. The mean age was 66.4 years. The majority of patients (49 patients) received full neck irradiation. The 2-year and 5-year loco-regional failure-free survival was 87% (95% confidence interval (CI): 0.74-0.93) and 71% (95% CI: 0.52, 0.83), respectively. The 2-year and 5-year overall survival was 76% (95% CI: 0.62, 0.85) and 60% (95% CI: 0.45, 0.72), respectively. There were 15 cases of loco-regional failures, with 6 cases with dermal involvement. Lymphovascular invasion (LVI) was associated with higher loco-regional failure (hazard ratio: 8.43, 95% CI: 1.85-38.39, P = 0.005) and cancer-specific mortality (hazard ratio: 5.40, 95% CI: 1.40-20.87, P = 0.015). Treatment technique, intensity-modulated radiation therapy (IMRT) vs 3D conformal radiotherapy (3D CRT), bolus use, perineural invasion (PNI) and surgical margins were not significantly associated with loco-regional failure. CONCLUSION We demonstrated high loco-regional control rates with routine use of comprehensive adjuvant radiotherapy. The presence of LVI was identified as a strong predictor for recurrence. Further analysis will help to define optimal radiation dose and techniques.
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Affiliation(s)
- Marcus Hu
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Anna N H Kim
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Theophilus I Emeto
- Public Health & Tropical Medicine, College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Michael Collins
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Andrea Chopping
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Charles Lin
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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4
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Muacevic A, Adler JR, Arnouk H. Cornulin as a Prognosticator for Lymph Node Involvement in Cutaneous Squamous Cell Carcinoma. Cureus 2022; 14:e33130. [PMID: 36721574 PMCID: PMC9884428 DOI: 10.7759/cureus.33130] [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] [Accepted: 12/30/2022] [Indexed: 12/31/2022] Open
Abstract
Background Cornulin is an epidermal differentiation marker and a stress-related protein. Its expression patterns are likely to reflect the multi-step tumorigenesis process of cSCC, given its role as a tumor suppressor. The aim of this study is to evaluate the utility of Cornulin as a prognosticator for cutaneous squamous cell carcinoma (cSCC). Specifically, the correlation between Cornulin expression and the clinicopathological parameter of lymph node involvement (nodal status), which plays a major role in determining cSCC prognosis and recurrence. We predicted that Cornulin expression declines as cSCC tumors metastasize to regional lymph nodes. Methodology Tissue samples of cSCC lesions of variable nodal involvement status were stained using immunohistochemistry, and high-resolution images were acquired. Aperio ImageScope software (Leica Biosystems) equipped with a positive-pixel-counting algorithm was used to quantify the staining intensity. Subsequently, Cornulin immunoreactivity was calculated as a Histo-score (H-score) value, which is based on the staining intensity and the percentage of positively stained cells. Mean H-scores were compared between groups using an unpaired t-test. Results A significant inverse correlation was found between Cornulin expression levels and metastasis to the lymph nodes. Specifically, primary tumors with metastasis to regional lymph nodes (N1) exhibited 9.5-fold decrease in Cornulin immunoreactivity compared to the primary tumor samples without lymph node involvement (N0). Conclusion Cornulin was found to be significantly downregulated in primary tumors with lymph node metastases. Detection assays to measure Cornulin expression in cSCC primary tumors might aid in determining the nodal status in these patients and possibly help determine cases of occult lymph node metastasis or micrometastasis. Future clinical studies are needed to help establish Cornulin's role in enhancing the predictive power of histopathological examination and improving survival rates for patients suffering from this type of skin cancer.
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5
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Muacevic A, Adler JR, Arnouk H. Cornulin as a Potential Novel Biomarker for Cutaneous Squamous Cell Carcinoma. Cureus 2022; 14:e31694. [PMID: 36561600 PMCID: PMC9765330 DOI: 10.7759/cureus.31694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to evaluate the expression of an epidermal differentiation marker, cornulin, in cutaneous squamous cell carcinoma (cSCC). Cornulin has been found to be downregulated in various squamous cell carcinomas of other tissues; however, its expression in cSCC has never been studied. We predicted that cornulin expression in cSCC is reduced compared to the normal epidermis. Moreover, we hypothesized that an inverse relationship exists between cornulin expression and the loss of differentiation, as defined by histopathological grading of cSCC lesions. Methodology Samples of normal skin and cSCC lesions of variable histopathological grades were stained using immunohistochemistry. High-resolution tissue images were analyzed with Aperio ImageScope (Leica Biosystems) utilizing a positive-pixel-counting algorithm to quantify the staining intensity. Histo-score (H-score) was calculated based on staining intensity and percentage of positive cell staining. Mean H-scores were compared using an unpaired t-test. Results We documented cornulin expression in cSCC for the first time. Cornulin levels were downregulated by more than two-fold in cSCC compared to the normal epidermis. Additionally, we observed a 4.5-fold downregulation in cornulin expression in tumors with high histopathological grades when compared to low histopathological grade tumors. Conclusions Cornulin expression levels measured through immunohistochemistry staining can help distinguish among the different histopathological grades of cSCC. Therefore, we propose that cornulin detection can be an adjunct to pathological examination to evaluate the differentiation status of cSCC specimens. Longitudinal studies are needed to establish the utility of cornulin as a diagnostic and prognostic biomarker for cSCC.
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Hurrell MJL, Low TH(H, Ebrahimi A, Veness M, Ashford B, Porceddu S, Clark JR. Evolution of Head and Neck Cutaneous Squamous Cell Carcinoma Nodal Staging—An Australian Perspective. Cancers (Basel) 2022; 14:cancers14205101. [PMID: 36291884 PMCID: PMC9600647 DOI: 10.3390/cancers14205101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/11/2022] [Accepted: 10/15/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Australia has the highest incidence of cutaneous squamous cell carcinoma of the head and neck (HNcSCC) in the world. Although the majority of HNcSCCs are cured by simple surgical excision, those that spread to lymph nodes require aggressive and debilitating surgery in conjunction with radiation therapy, with a significant risk of treatment failure and subsequent loss of life. Cancer staging is critical to guide prognosis, treatment (to maximise disease control and minimise morbidity), and for research. Australian institutions have been at the forefront of prognostication for HNcSCC with lymph node spread. Despite this, the search for a well performing staging system is ongoing. This review chronologically explores and summarises the Australian contribution to date and highlights the ongoing challenges. Abstract Cutaneous squamous cell carcinoma of the head and neck (HNcSCC) is one of the commonest malignancies. When patients present with regional metastatic disease, treatment escalation results in considerable morbidity and survival is markedly reduced. Owing to the high incidence, Australian institutions have been at the forefront of advocating for reliable, accurate, and clinically useful staging systems that recognise the distinct biological characteristics of HNcSCC. As a result, an extensive body of literature has been produced over the past two decades, which has defined critical prognostic factors, critiqued existing staging systems, and proposed alternative staging models. Notwithstanding, a suitable staging system has proved elusive. The goal of cancer staging is to group patients according to cancer characteristics for which survival differs between groups (distinctiveness), consistently decreases with increasing stage (monotonicity), and is similar within a group (homogeneity). Despite implementing major changes based on published data, the latest edition of the American Joint Committee on Cancer (AJCC) staging manual fails to satisfy these fundamental requirements. This review chronologically explores and summarises the Australian contribution to prognostication and nodal staging of HNcSCC and highlights the ongoing challenges.
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Affiliation(s)
- Michael J. L. Hurrell
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
- Correspondence:
| | - Tsu-Hui (Hubert) Low
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
- Department of Otolaryngology—Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW 2006, Australia
| | - Ardalan Ebrahimi
- Medical School, College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia
| | - Michael Veness
- Westmead Hospital, University of Sydney, Westmead, NSW 2006, Australia
| | - Bruce Ashford
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2500, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, NSW 2502, Australia
| | - Sandro Porceddu
- Radiation Oncology, University of Queensland, St Lucia, QLD 4072, Australia
- Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Jonathan R. Clark
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW 2006, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW 2050, Australia
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7
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Kitrell BM, Blue ED, Siller A, Lobl MB, Evans TD, Whitley MJ, Wysong A. Gene Expression Profiles in Cutaneous Oncology. Dermatol Clin 2022; 41:89-99. [DOI: 10.1016/j.det.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Cilt Kanserlerinin Ayırıcı Tanısında İnflamatuar Belirteçlerin Yeri. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1131708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim: The purpose of this study was to evaluate the role of WBC count, NLR, LMR, PLR, Systemic immune-inflammation index (SII) [(platelet count X neutrophil count) \ lymphocyte count] and platelet count (Plt)×NLR in the differential diagnosis of basal cell carcinoma, squamous cell carcinoma, and malignant melanoma and to determine the effect of tumor type, prediction of lymph node metastasis at initial diagnosis and location on these inflammatory markers.
Material and Method: Patients who underwent surgery for basal cell carcinoma, squamous cell carcinoma, or malignant melanoma were retrospectively screened. NLR, LMR, PLR, SII and Plt×NLR were calculated. Relationships between tumor type, prediction of lymph node metastasis at initial diagnosis, tumor localization and the inflammatory and hematological parameters of interest were investigated. Tumor location was classified as head and neck and others.
Results: A total of 257 patients were included in the study. No statistically significant differences in WBC, NLR, PLR, LMR, SII or Plt×NLR were detected according to tumor location. The patients with squamous cell carcinoma had higher NLR, PRL, SII and Plt×NLR values than those with basal cell carcinoma. The risk of lymph node metastasis at the time of initial diagnosis was 10.3 times higher in patients with PLR levels of 180.7 and higher. The risk of lymph node metastasis detected at initial diagnosis was 8.9 times higher in patients with Plt×NLR of 747 and higher. The risk of lymph node metastasis detected at initial diagnosis was 7.1 times higher in patients with SII of 414 and higher.
Conclusion: Inflammatory markers seem to be useful in the differential diagnosis of skin cancers and determined the risk of lymph node metastasis. However, it does not differ according to tumor localization.
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9
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Lobl MB, Clarey DD, Higgins S, Sutton A, Wysong A. Sequencing of cutaneous squamous cell carcinoma primary tumors and patient-matched metastases reveals ALK as a potential driver in metastases and low mutational concordance in immunocompromised patients. JID INNOVATIONS 2022; 2:100122. [PMID: 35620707 PMCID: PMC9127419 DOI: 10.1016/j.xjidi.2022.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Cutaneous squamous cell carcinoma is a common skin cancer that is responsible for 1,000,000 cases and up to 9,000 deaths annually in the United States. Metastases occur in 2–5% of patients and are responsible for significant morbidity and mortality. The objective of this study is to perform targeted next-generation sequencing on a cohort of squamous cell carcinoma primary tumors and patient-matched lymph node metastases. An oncology 76-gene panel was run from formalin-fixed paraffin-embedded samples of patient-matched primary squamous cell carcinomas (10) and resultant metastases (10). ALK was discovered to be a driver mutation in metastases using two different algorithms, oncoCLUSTand dNdScv. Mutational concordance between primary tumors and metastases was notably lower in immunosuppressed patients, especially among pathogenic mutations (41.7% vs. 83.3%, P = 0.01). Sequencing of matched squamous cell carcinoma primary tumors and lymph node metastases identified genes and pathways that may have clinical importance, most notably ALK as a potential driver mutation of metastasis. Sequencing of both primary tumors and metastases may improve the efficacy of targeted therapies.
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10
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LRP1B Expression Is Correlated With Age and Perineural Invasion in Metastatic Cutaneous Squamous Cell Carcinoma: A Pilot Study. Am J Dermatopathol 2022; 44:49-53. [PMID: 34889813 DOI: 10.1097/dad.0000000000002065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Rabinowits G, Migden MR, Schlesinger TE, Ferris RL, Freeman M, Guild V, Koyfman S, Pavlick AC, Swanson N, Wolf GT, Dinehart SM. Evidence-Based Consensus Recommendations for the Evolving Treatment of Patients with High-Risk and Advanced Cutaneous Squamous Cell Carcinoma. JID INNOVATIONS 2021; 1:100045. [PMID: 34909742 PMCID: PMC8659794 DOI: 10.1016/j.xjidi.2021.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/11/2023] Open
Abstract
Cutaneous squamous cell carcinoma is the second most common skin cancer in the United States. Currently, there is no standardized management approach for patients with cutaneous squamous cell carcinoma who develop metastatic or locally advanced disease and are not candidates for curative surgery or curative radiation. To address this issue, the Expert Cutaneous Squamous Cell Carcinoma Leadership program convened an expert steering committee to develop evidence-based consensus recommendations on the basis of a large, structured literature review. Consensus was achieved through modified Delphi methodology. The steering committee included five dermatologists, three medical oncologists, two head and neck surgeons, one radiation oncologist, and a patient advocacy group representative. The steering committee aligned on the following clinical topics: diagnosis and identification of patients considered not candidates for surgery; staging systems and risk stratification in cutaneous squamous cell carcinoma; the role of radiation therapy, surgery, and systemic therapy in the management of advanced disease, with a focus on immunotherapy; referral patterns; survivorship care; and inclusion of the patient’s perspective. Consensus was achieved on 34 recommendations addressing 12 key clinical questions. The Expert Cutaneous Squamous Cell Carcinoma Leadership steering committee’s evidence-based consensus recommendations may provide healthcare professionals with practically oriented guidance to help optimize outcomes for patients with advanced cutaneous squamous cell carcinoma.
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Affiliation(s)
- Guilherme Rabinowits
- Division of Hematology Oncology, Miami Cancer Institute/Baptist Health South Florida, Miami, Florida, USA
| | - Michael R Migden
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Todd E Schlesinger
- Dermatology & Laser Center of Charleston, Summerville, South Carolina, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Morganna Freeman
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | | | - Shlomo Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna C Pavlick
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York City, New York, USA
| | - Neil Swanson
- Oregon Health & Science University, Portland, Oregon, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott M Dinehart
- Arkansas Dermatology & Skin Cancer Center, Little Rock, Arkansas, USA
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12
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Dessinioti C, Pitoulias M, Stratigos AJ. Epidemiology of advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2021; 36:39-50. [PMID: 34592000 DOI: 10.1111/jdv.17709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/02/2021] [Indexed: 12/27/2022]
Abstract
Cutaneous invasive squamous cell carcinoma (cSCC) most commonly presents as a typically indolent tumour with five-year cure rates of >90%. Advanced cSCC has been defined as locally advanced or metastatic (locoregional or distant) cSCC. The epidemiological data on advanced cSCC are rare due to underreporting or exclusion of cSCC from national cancer registries. Although the frequency of local recurrence has been reported, there is no clear evidence on the incidence or mortality of locally advanced cSCCs, e.g. locally infiltrating or locally recurrent cSCCs that are not further amenable to curative surgery or radiotherapy. This gap of knowledge on the epidemiology of locally advanced cSCC, highlights the need for standardisation in defining and reporting both locally advanced and metastatic cSCC. Even though metastatic cSCCs are a small part of cSCCs (3%-5%), their aggressive characteristics contribute to significant morbidity, higher mortality and are those likely to require systemic treatments. Locally recurrent and metastatic cSCC may occur more frequently in high-risk cSCCs (up to 35%). The site of metastasis involves in the vast majority the regional lymph nodes, with the head and neck lymph nodes or parotid most commonly affected. Metastasis occurs mostly within 2-3 years of the primary cSCC diagnosis. The knowledge of the incidence and prognosis of advanced cSCC and the risk stratification of patients, who may progress to advanced cSCC, emerge as pressing research areas with important implications for cost-efficiency planning and optimisation of patient care.
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Affiliation(s)
- C Dessinioti
- Department of Dermato-Oncology, 1st Department of Dermatology, Andreas Sygros Hospital, University of Athens, Athens, Greece
| | - M Pitoulias
- Department of Dermato-Oncology, 1st Department of Dermatology, Andreas Sygros Hospital, University of Athens, Athens, Greece
| | - A J Stratigos
- Department of Dermato-Oncology, 1st Department of Dermatology, Andreas Sygros Hospital, University of Athens, Athens, Greece
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13
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Tilden W, Saifuddin A. Soft tissue masses of the epitrochlear region. Br J Radiol 2021; 94:20210236. [PMID: 34233485 DOI: 10.1259/bjr.20210236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The epitrochlear lymph nodes (ELN) are rarely examined clinically and are difficult to identify radiologically in healthy patients. They are, therefore, generally under appreciated as a source of significant pathology. Despite this, enlargement of an ELN is almost always secondary to a pathological process, the differential for which is relatively narrow. The following pictorial review illustrates the spectrum of infectious, inflammatory and malignant conditions affecting the ELN, some of which are quite specific to this location. We also emphasise the importance of distinguishing enlarged ELNs from benign and malignant non-nodal soft tissue masses, which can have very similar clinical presentation and imaging appearances.
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Affiliation(s)
- William Tilden
- Department of Radiology, The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, The Royal National Orthopaedic Hospital, Stanmore, UK
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14
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Mutually exclusive lymphangiogenesis or perineural infiltration in human skin squamous-cell carcinoma. Oncotarget 2021; 12:638-648. [PMID: 33868585 PMCID: PMC8021034 DOI: 10.18632/oncotarget.27915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Abstract
Although tumor-associated lymphangiogenesis correlates with metastasis and poor prognosis in several cancers, it also supports T cell infiltration into the tumor and predicts favorable outcome to immunotherapy. The role of lymphatic vessels in skin squamous-cell carcinoma (sSCC), the second most common form of skin cancer, remains mostly unknown. Although anti-PD-1 therapy is beneficial for some patients with advanced sSCC, a greater understanding of disease mechanisms is still needed to develop better therapies. Using quantitative multiplex immunohistochemistry, we analyzed sSCC sections from 36 patients. CD8+ T cell infiltration showed great differences between patients, whereby these cells were mainly excluded from the tumor mass. Similar to our data in melanoma, sSCC with high density of lymphatic endothelial cells showed increased CD8+ T cell density in tumor areas. An entirely new observation is that sSCC with perineural infiltration but without metastasis was characterized by low lymphatic endothelial cell density. Since both, metastasis and perineural infiltration are known to affect tumor progression and patients’ prognosis, it is important to identify the molecular drivers, opening future options for therapeutic targeting. Our data suggest that the mechanisms underlying perineural infiltration may be linked with the biology of lymphatic vessels and thus stroma.
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15
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Lobl MB, Clarey D, Schmidt C, Wichman C, Wysong A. Analysis of mutations in cutaneous squamous cell carcinoma reveals novel genes and mutations associated with patient-specific characteristics and metastasis: a systematic review. Arch Dermatol Res 2021; 314:711-718. [PMID: 33735396 DOI: 10.1007/s00403-021-02213-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
Cutaneous squamous cell carcinoma (SCC) causes approximately 1,000,000 cases and 9000 deaths each year in the United States. While individual tumor sequencing studies have discovered driver mutations in SCC, there has yet to be a review and subsequent analysis synthesizing current studies. To conduct a comprehensive synthesis and analysis of SCC sequencing studies with individual patient-level data, a comprehensive literature search was performed. Statistical analyses were performed to identify trends. Studies meeting inclusion criteria included a total of 279 patients (189 localized SCCs, 90 metastatic SCCs). Several mutations were correlated with demographic characteristics (TP53, MLL4, BRCA2, COL4A1). TP53, TERT, SPEN, MLL3, and NOTCH2 mutations were significantly more likely to be found in metastatic versus localized SCCs even after the Bonferroni correction for multiple comparisons. Silent mutations were found more in localized SCCs than metastatic SCCs, and nonsense mutations were found more in metastatic SCCs than localized SCCs (p = 0.0003 and p = 0.04, respectively). Additional mutations were identified that have not yet been explored in SCC including AHNAK2, LRP1B, TRIO, MDN1, COL4A2, SVIL, VPS13C, DST, DMD, and DYSF. Overall, novel mutations were identified and differences between mutation patterns in localized and metastatic SCCs were found. These findings may have clinical applications.
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Affiliation(s)
- Marissa B Lobl
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Dillon Clarey
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Cynthia Schmidt
- Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
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16
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Yesensky J, Solis RN, Bewley A. Facial Nerve Sacrifice During Parotidectomy for Metastatic Cutaneous Squamous Cell Carcinoma. OTO Open 2021; 5:2473974X21996627. [PMID: 33718752 PMCID: PMC7917942 DOI: 10.1177/2473974x21996627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/08/2020] [Indexed: 12/02/2022] Open
Abstract
Objective We analyzed the incidence of facial nerve sacrifice during parotidectomy for
metastatic cutaneous squamous cell carcinoma (CSCC). Study Design We retrospectively reviewed the charts of patients with cutaneous squamous
cell carcinoma. Setting We used our CSCC institutional database, which includes patients treated at
the University of California–Davis from 2001 to 2018. Methods We evaluated patients who presented with biopsy-proven head and neck CSCC who
underwent parotidectomy as a part of surgical treatment. We assessed the
frequency of facial nerve sacrifice required in patients with normal
preoperative facial nerve function with metastatic disease to the parotid.
We evaluated the association between sacrifice and high-risk tumor variables
using multivariate analysis. Results We identified 53 patients with parotid metastasis and normal preoperative
facial nerve function. Thirteen percent of patients required sacrifice of
the main trunk of the facial nerve and 27% required sacrifice of a branch of
the facial nerve. All patients who underwent facial nerve sacrifice had
extracapsular spread (ECS). Perineural invasion (PNI) in the primary tumor
(odds ratio [OR], 9.11; P = .041) and location of
metastasis within the parotid body (OR, 6.6; P = .044) were
independently associated with facial nerve sacrifice. Conclusion Patients with regionally metastatic CSCC to the parotid gland frequently
require sacrifice of all or a component of the facial nerve despite normal
preoperative function. The likelihood of nerve sacrifice is highest for
tumors with PNI and metastatic disease within the body of the parotid.
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Affiliation(s)
- Jessica Yesensky
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Arnaud Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
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17
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Yang PF, Veness MJ, Cooper EA, Fox R, Smee RI, Lehane C, Crowe PJ, Howle JR, Thompson SR. Outcomes of patients with metastatic cutaneous squamous cell carcinoma to the axilla: a multicentre cohort study. ANZ J Surg 2021; 91:878-884. [PMID: 33506995 DOI: 10.1111/ans.16584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/02/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Metastatic cutaneous squamous cell carcinoma to the axilla is uncommon, with limited data to guide management. We sought to assess the outcomes of patients with this condition after surgery and radiotherapy. METHODS A retrospective cohort study of patients treated at two Australian hospitals from 1994 through 2016 was performed. RESULTS A total of 74 patients were identified, including 48 treated curatively with surgery-plus-radiotherapy and 15 with surgery alone. Compared with patients treated with surgery alone, a higher proportion of patients treated with surgery-plus-radiotherapy had lymph nodes larger than 6 cm (53% versus 8%, P = 0.012) and multiple adverse histopathological features (75% versus 47%, P = 0.04). The groups had similar 5-year disease-free survival (45% versus 46%) and overall survival (51% versus 48%). Presence of multiple positive lymph nodes was associated with reduced disease-free survival (hazard ratio 4.57, P = 0.01) and overall survival (hazard ratio 3.53, P = 0.02). Regional recurrence was higher in patients treated with surgery alone (38% versus 22%, P = 0.22) and patients with lymph nodes larger than 6 cm (34% versus 10%, P = 0.03). All recurrences occurred within 2 years following treatment. CONCLUSION Combined-modality therapy for metastatic cutaneous squamous cell carcinoma to the axilla is recommended for high-risk patients, although outcomes remain modest. The key period for recurrence is within 2 years following treatment.
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Affiliation(s)
- Phillip F Yang
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael J Veness
- Department of Radiation Oncology, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Edward A Cooper
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Richard Fox
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Robert I Smee
- Department of Radiation Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Christopher Lehane
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Philip J Crowe
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Julie R Howle
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stephen R Thompson
- Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Radiation Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
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18
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Sood A, Wykes J, McGuinness J, Fowler A, Ebrahimi A. Nodal metastasis size predicts disease-free survival in cutaneous head and neck squamous cell carcinoma involving the parotid but not cervical nodes. ANZ J Surg 2020; 90:2537-2542. [PMID: 33176051 DOI: 10.1111/ans.16413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/27/2020] [Accepted: 10/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The 8th edition American Joint Committee on Cancer nodal (N) staging of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) is largely based on lymph node metastasis size, despite conflicting data in the literature. This study aimed to investigate the prognostic significance of largest node size in cSCCHN. METHODS Retrospective analysis of 94 patients undergoing curative-intent treatment for nodal cSCCHN with surgery ± radiotherapy at Liverpool Hospital, Sydney, Australia was conducted. Survival outcomes were assessed using multivariate Cox regression. The primary end point was disease-free survival (DFS). Objective measures of model performance were used in exploratory analyses to identify optimal size thresholds for predicting survival. RESULTS Nodal metastasis size significantly predicted DFS on multivariate analysis (hazard ratio 1.24; 95% confidence interval 1.06-1.46; P = 0.008). This prognostic impact occurred predominantly in parotid metastases (hazard ratio 1.27; 95% confidence interval 1.07-1.51; P = 0.006); each 1 cm increase in size increased the risk of recurrence or death by 27%, irrespective of the number of involved nodes. In parotid metastases, size thresholds of ≤3, 3-4.5 and >4.5 cm optimized prognostic discrimination. Extranodal extension (ENE) was associated with decreased DFS in nodes ≤3 cm in size (P = 0.025), but not in those >3 cm (P = 0.744). CONCLUSION Size is an important prognostic factor in cSCCHN with parotid metastases, with optimal thresholds of ≤3, >3-4.5 and >4.5 cm. The prognostic impact of ENE was seen only in nodal metastases ≤3 cm in size. These results may have important implications for node size thresholds and inclusion of ENE in the American Joint Committee on Cancer N staging categories.
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Affiliation(s)
- Ashish Sood
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - John McGuinness
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Allan Fowler
- Department of Radiation Oncology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Ardalan Ebrahimi
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
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19
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Perry J, Minaei E, Engels E, Ashford BG, McAlary L, Clark JR, Gupta R, Tehei M, Corde S, Carolan M, Ranson M. Thulium oxide nanoparticles as radioenhancers for the treatment of metastatic cutaneous squamous cell carcinoma. Phys Med Biol 2020; 65:215018. [PMID: 32726756 DOI: 10.1088/1361-6560/abaa5d] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Metastases from cutaneous squamous cell carcinoma (cSCC) occur in 2%-5% of cases. Surgery is the standard treatment, often combined with adjuvant radiotherapy. Concurrent carboplatin treatment with post-operative radiotherapy may be prescribed, although it has not shown benefit in recent clinical trials in high-risk cSCC patients. The novel high-Z nanoparticle thulium (III) oxide has been shown to enhance radiation dose delivery to brain tumors by specific uptake of these nanoparticles into the cancerous tissue. As the dose-enhancement capacity of thulium oxide nanoparticles following radiotherapy against metastatic cSCC cells is unknown, its efficacy as a radiosensitizer was evaluated, with and without carboplatin. Novel and validated human patient-derived cell lines of metastatic cSCC were used. The sensitivity of the cells to radiation was investigated using short-term proliferation assays as well as clonogenic survival as the radiobiological endpoint. Briefly, cells were irradiated with 125 kVp orthovoltage x-rays (0-6 Gy) with and without thulium oxide nanoparticles (99.9% trace metals basis; 50 µg ml-1) or low dose carboplatin pre-sensitization. Cellular uptake of the nanoparticles was first confirmed by microscopy and found to have no impact on short-term cell survival for the cSCC cells, highlighting the biocompatibility of thulium oxide nanoparticles. Clonogenic cell survival assays confirmed radio-sensitization when exposed to thulium nanoparticles, with the cell sensitivity increasing by a factor of 1.24 (calculated at the 10% survival fraction) for the irradiated cSCC cells. The combination of carboplatin with thulium oxide nanoparticles with irradiation did not result in significant further reductions in survival compared to nanoparticles alone. This is the first study to provide in vitro data demonstrating the independent radiosensitization effect of high-Z nanoparticles against metastatic cSCC with or without carboplatin. Further preclinical investigations with radiotherapy plus high-Z nanoparticles for the management of metastatic cSCC are warranted.
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Affiliation(s)
- Jay Perry
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW 2522, Australia. School of Chemistry and Molecular Bioscience, University of Wollongong, NSW 2522, Australia. Centre for Oncology Education and Research Translation (CONCERT), NSW 2170, Australia
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20
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Kawaguchi M, Kato H, Tomita H, Hara A, Suzui N, Miyazaki T, Matsuyama K, Seishima M, Matsuo M. Magnetic Resonance Imaging Findings Differentiating Cutaneous Basal Cell Carcinoma from Squamous Cell Carcinoma in the Head and Neck Region. Korean J Radiol 2020; 21:325-331. [PMID: 32090525 PMCID: PMC7039720 DOI: 10.3348/kjr.2019.0508] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/04/2019] [Indexed: 11/18/2022] Open
Abstract
Objective This study aimed to evaluate the efficacy of magnetic resonance (MR) imaging in differentiating between cutaneous basal cell carcinoma (cBCC) and cutaneous squamous cell carcinoma (cSCC) in the head and neck region. Materials and Methods Among patients with cutaneous head and neck cancers, 14 with primary cBCCs and 15 with primary cSCCs with a histologic tumor height of ≥ 4 mm underwent MR examinations; the findings were then examined for correlations. Results cBCCs (71%) occurred more frequently on the nose than cSCCs (13%) (p < 0.01). The maximum diameter (23.5 ± 7.2 mm vs. 12.7 ± 4.5 mm; p < 0.01) and diameter-to-height ratio (2.8 ± 0.9 vs. 1.7 ± 0.4; p < 0.01) were significantly greater in cSCCs than in cBCCs. Superficial ulcer formation (67% vs. 21%; p < 0.05), protrusion into the subcutaneous tissue (60% vs. 21%; p < 0.05), ill-demarcated deep tumor margins (60% vs. 7%; p < 0.01), and peritumoral fat stranding (93% vs. 7%; p < 0.01) were more frequently observed in cSCCs than in cBCCs. Intratumoral T2-hyperintense foci (57% vs. 13%; p < 0.05) were more frequently observed in cBCCs than in cSCCs. Conclusion cBCCs predominantly occurred on the nose with intratumoral T2-hyperintense foci, whereas cSCCs predominantly exhibited a flattened configuration, superficial ulcer formation, protrusion into the subcutaneous tissue, ill-demarcated deep tumor margin, and peritumoral fat stranding.
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Affiliation(s)
- Masaya Kawaguchi
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan.
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu, Japan
| | - Akira Hara
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu, Japan
| | - Natsuko Suzui
- Department of Pathology, Gifu University School of Medicine, Gifu, Japan
| | - Tatsuhiko Miyazaki
- Department of Pathology, Gifu University School of Medicine, Gifu, Japan
| | - Kanako Matsuyama
- Department of Dermatology, Gifu University School of Medicine, Gifu, Japan
| | - Mariko Seishima
- Department of Dermatology, Gifu University School of Medicine, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan.
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21
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Wysong A, Newman JG, Covington KR, Kurley SJ, Ibrahim SF, Farberg AS, Bar A, Cleaver NJ, Somani AK, Panther D, Brodland DG, Zitelli J, Toyohara J, Maher IA, Xia Y, Bibee K, Griego R, Rigel DS, Meldi Plasseraud K, Estrada S, Sholl LM, Johnson C, Cook RW, Schmults CD, Arron ST. Validation of a 40-gene expression profile test to predict metastatic risk in localized high-risk cutaneous squamous cell carcinoma. J Am Acad Dermatol 2020; 84:361-369. [PMID: 32344066 DOI: 10.1016/j.jaad.2020.04.088] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/22/2020] [Accepted: 04/15/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Current staging systems for cutaneous squamous cell carcinoma (cSCC) have limited positive predictive value for identifying patients who will experience metastasis. OBJECTIVE To develop and validate a gene expression profile (GEP) test for predicting risk for metastasis in localized, high-risk cSCC with the goal of improving risk-directed patient management. METHODS Archival formalin-fixed paraffin-embedded primary cSCC tissue and clinicopathologic data (n = 586) were collected from 23 independent centers in a prospectively designed study. A GEP signature was developed using a discovery cohort (n = 202) and validated in a separate, nonoverlapping, independent cohort (n = 324). RESULTS A prognostic 40-GEP test was developed and validated, stratifying patients with high-risk cSCC into classes based on metastasis risk: class 1 (low risk), class 2A (high risk), and class 2B (highest risk). For the validation cohort, 3-year metastasis-free survival rates were 91.4%, 80.6%, and 44.0%, respectively. A positive predictive value of 60% was achieved for the highest-risk group (class 2B), an improvement over staging systems, and negative predictive value, sensitivity, and specificity were comparable to staging systems. LIMITATIONS Potential understaging of cases could affect metastasis rate accuracy. CONCLUSION The 40-GEP test is an independent predictor of metastatic risk that can complement current staging systems for patients with high-risk cSCC.
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Affiliation(s)
- Ashley Wysong
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | | | | | - Aaron S Farberg
- Icahn School of Medicine at Mount Sinai, New York, New York; Arkansas Dermatology Skin Cancer Center, Little Rock, Arkansas
| | - Anna Bar
- Oregon Health & Science University, Portland, Oregon
| | | | | | - David Panther
- Zitelli and Brodland, P.C. Skin Cancer Center, Pittsburgh, Pennsylvania
| | - David G Brodland
- Zitelli and Brodland, P.C. Skin Cancer Center, Pittsburgh, Pennsylvania
| | - John Zitelli
- Zitelli and Brodland, P.C. Skin Cancer Center, Pittsburgh, Pennsylvania
| | | | - Ian A Maher
- University of Minnesota, Minneapolis, Minnesota
| | - Yang Xia
- Brooke Army Medical Center, San Antonio, Texas
| | - Kristin Bibee
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Sarah Estrada
- Castle Biosciences, Inc, Phoenix, Arizona; Affiliated Dermatology, Scottsdale, Arizona
| | | | | | | | | | - Sarah T Arron
- University of California San Francisco, San Francisco, California.
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22
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Bachar G, Mizrachi A, Rabinovics N, Guttman D, Shpitzer T, Ad-El D, Hadar T. Prognostic Factors in Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/0145561316095010-1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck poses a significant therapeutic challengedue to its aggressive biologic behavior. We conducted a retrospective study of71 patients—58 men and 13 women, aged 28 to 88 years (mean: 71)—who had been treated atour university-affiliated tertiary care medical center for metastatic cutaneous SCCover a 15-year period. In addition to demographic data, we compiled and analyzed information on tumor characteristics, the site and extent of metastasis, treatment, follow-up, and outcome. Among the tumor factors, poorly differentiated carcinoma was an independent predictor of poorer disease-free survival, and olderage was found to be an independent predictor of poorer overall survival. We found no significant difference in disease-free or disease-specific survival among patients with parotid involvement, neck involvement, or both. In our series, the site of nodal involvement appeared to have no prognostic significance in patients with metastatic cutaneous SCC of the head and neck.
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Affiliation(s)
- Gideon Bachar
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Rabinovics
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Guttman
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Shpitzer
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dean Ad-El
- Department of Plastic and Reconstructive Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Hadar
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Mortality Associated With Development of Squamous Cell Cancer in Patients With Inflammatory Bowel Diseases Receiving Treatment With Thiopurines. Clin Gastroenterol Hepatol 2019; 17:2262-2268. [PMID: 30853615 DOI: 10.1016/j.cgh.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Treatment with thiopurines is associated with an increased risk of squamous cell carcinoma of the skin (SCC) in patients with inflammatory bowel diseases (IBD). We studied outcomes of patients with IBD who developed SCC while receiving thiopurine therapy. METHODS We conducted a retrospective cohort study of 54,919 patients with IBD followed in the nationwide Veterans Affairs Healthcare System from January 1, 2000, through May 23, 2018. From this cohort, we created a sub-cohort of patients with an incident diagnosis of SCC, confirmed by review of patients' medical records; we identified those who had received treatment with thiopurines (exposed group) vs those treated with mesalamine and no prior exposure to thiopurines or tumor necrosis factor antagonists (unexposed group). The primary outcome was death associated with SCC (SCC mortality). We collected data on baseline demographic features, exposure to ultraviolet light, Charlson comorbidity index, smoking status, and environmental exposures. Follow up began at the time of incident SCC diagnosis and ended at death or last recorded date in the health system. Cause-specific hazard models were used to estimate the adjusted and unadjusted hazard ratio (HRs), with 95% CIs, for SCC mortality. RESULTS We identified 467 patients with incident SCC and included 449 patients (161 exposed and 288 unexposed) in our final analysis. Eleven patients from complications of SCC (8 in the exposed group and 3 in the unexposed group). The estimated 5- and 10-year cumulative mortality values were 2.9% and 2.9% in the exposed group and 0.4% and 0.9% in the unexposed group, respectively. The unadjusted and adjusted cause-specific HRs for SCC mortality associated with exposure were 7.0 (95% CI, 1.8-28.0; P = .006) and 8.0 (95% CI, 2.0-32.8; P = .004), respectively. CONCLUSIONS Although the cause-specific mortality is relatively low, patients with IBD exposed to thiopurines who develop SCC have an increased risk of SCC-associated death compared to patients exposed to only mesalamine.
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24
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Lee KA, Cioni M, Robson A, Bataille V. Metastatic porocarcinoma achieving complete radiological and clinical response with pembrolizumab. BMJ Case Rep 2019; 12:12/9/e228917. [PMID: 31492726 DOI: 10.1136/bcr-2018-228917] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 67-year-old woman presented in 2012 with a crusty nodule on the left lower limb. Histopathological examination at this time reported a poorly differentiated squamous cell carcinoma (SCC). Two years later, she underwent lymphadenectomy and radiotherapy due to unilateral inguinal and pelvic sidewall nodal metastases. The following year she required excision of two subcutaneous lesions, reported pathologically to be SCC metastases. Further imaging following cyberknife radiotherapy to new brain metastases demonstrated widespread metastatic visceral disease. Twelve cycles of carboplatin and capecitabine failed to halt disease progression. In February 2017, she commenced pembrolizumab, achieving an excellent response and currently has no clinical or radiological evidence of disease. Given the unusual behaviour of her cancer, a histopathological review was requested. The diagnosis was revised to that of porocarcinoma (PC). This represents the first documented case of PC treated with immunotherapy. As of March 2019, the patient remains free of disease.
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Affiliation(s)
- Karla A Lee
- Department of Twin Research, King's College London, London, UK.,The Royal Marsden NHS Foundation Trust, London, UK
| | - Margherita Cioni
- Department of Dermatology, San Martino Policlinic Hospital, Genoa, Italy
| | - Alistair Robson
- LD Path Group, London, UK.,Department of Pathology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Veronique Bataille
- Kings College, London, UK.,Dermatology, West Herts NHS Trust, Hemel Hempstead, UK
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25
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Pang G, Look Hong NJ, Paull G, Dobransky J, Kupper S, Hurton S, Kagedan DJ, Quan ML, Helyer L, Nessim C, Wright FC. Squamous Cell Carcinoma with Regional Metastasis to Axilla or Groin Lymph Nodes: a Multicenter Outcome Analysis. Ann Surg Oncol 2019; 26:4642-4650. [PMID: 31440926 DOI: 10.1245/s10434-019-07743-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) of the trunk/extremities with nodal metastasis represents a rare but significant clinical challenge. Treatment patterns and outcomes are poorly described. PATIENTS AND METHODS Patients with cSCC who developed axilla/groin lymph node metastasis and underwent curative-intent surgery between 2005 and 2015 were identified at four Canadian academic centers. Demographics, tumor characteristics, treatment patterns, recurrence rates, and mortality were described. Overall survival (OS) and disease-free survival (DFS) were calculated using Kaplan-Meier analysis. Predictors of survival and any recurrence were explored using Cox regression and logistic regression models, respectively. RESULTS Of 43 patients, 70% were male (median age 74 years). Median follow-up was 38 months. Median time to nodal metastasis was 11.3 months. Thirty-one and 12 patients had nodal metastasis to the axilla and groin, respectively. A total of 72% and 7% received adjuvant and neoadjuvant radiation, respectively, while 5% received adjuvant chemotherapy. Following surgery, 26% patients developed nodal and/or distant disease recurrence. Crude mortality rate was 39.5%. Mean OS was 5.3 years [95% confidence interval (CI) 3.9-6.8 years], and 5-year OS was 55.1%. Mean DFS was 4.8 years (95% CI 3.3-6.2 years), and five-year DFS was 49.3%. Any recurrence was the only independent predictor of death [p = 0.036, odds ratio (OR) = 29.5], and extracapsular extension (p = 0.028, OR = 189) and age (p = 0.017, OR = 0.823) were independent predictors of recurrence. CONCLUSIONS This represents the largest contemporary series to date of outcomes for patients with axilla/groin nodal metastases from cSCC. Despite aggressive treatment, outcomes remain modest, indicating the need for a continued multidisciplinary approach and integration of new systemic agents.
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Affiliation(s)
- George Pang
- Department of Surgery, Western University, London, ON, Canada.
| | | | - Gabrielle Paull
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Suzana Kupper
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Scott Hurton
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Daniel J Kagedan
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - May Lynn Quan
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lucy Helyer
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Carolyn Nessim
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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26
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A Retrospective Cohort Study of Cutaneous Squamous Cell Carcinoma With Lymph Node Metastasis: Risk Factors and Clinical Course. Dermatol Surg 2019; 45:772-781. [DOI: 10.1097/dss.0000000000001828] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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27
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Mc Ternan J, Mitchell O, Ilankovan V. Bilateral retro-orbital metastases arising from primary squamous cell carcinoma of the anterior scalp. Br J Oral Maxillofac Surg 2019; 57:386-387. [PMID: 30930033 DOI: 10.1016/j.bjoms.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/01/2019] [Indexed: 11/26/2022]
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28
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Genders RE, Weijns ME, Dekkers OM, Plasmeijer EI. Metastasis of cutaneous squamous cell carcinoma in organ transplant recipients and the immunocompetent population: is there a difference? a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2019; 33:828-841. [PMID: 30793804 DOI: 10.1111/jdv.15396] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/14/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Organ transplant recipients (OTR) have a higher risk of developing cutaneous squamous cell carcinoma (cSCC) compared to the immunocompetent population. Immunosuppression is often stated as a risk factor for metastasis. However, evidence for this is scarce. OBJECTIVES To investigate the cSCC metastasis risk in OTR and the immunocompetent population by systematically reviewing the literature. METHODS A systematic review of the literature was performed up to January 2018 using: Medline; Embase; Web of Science and ISI Science Citation Index. Studies assessing cSCC metastasis risk in ORT or immunocompetent cohorts were considered. A pooled risk estimate for metastasis was calculated for the immunocompetent population and OTR separately. RESULTS The pooled metastasis risk estimate for OTR was, respectively, 7.3% (95% CI 6.2-8.4) for cSCC on total body, and 11.0% (95% CI 7.7-14.8) for cSCC of the head neck area. For the immunocompetent population reported risk estimate analysis showed a pooled metastatic risk of 3.1% (95% CI 2.8-3.4) in total body cSCC and of 8.5% (95% CI 7.3-9.8) in cSCC of the head and neck area. Pooled risk estimate per single cSCC in OTR was 1.3% (95% CI 1.0-1.7) in total body cSCC and 4.0% (95% CI 2.7-5.5) in cSCC of the head and neck area. In the immunocompetent population, these pooled risk estimates were, respectively, 2.4% (95% CI 2.1-2.6) and 6.7% (95% CI 5.7-7.8). CONCLUSIONS Organ transplant recipients show a higher overall risk of cSCC metastasis compared to the immunocompetent population. Metastasis risks per single cSCC were substantially lower in both groups. However, due to heterogeneity and differences between studies, comparisons are difficult. Comprehensive follow-up studies with defined cohorts are necessary to adequately asses the risk for cSCC metastasis.
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Affiliation(s)
- R E Genders
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - M E Weijns
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - O M Dekkers
- Department of clinical epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - E I Plasmeijer
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands
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The Role of Sentinel Lymph Node Biopsy in the Management of Cutaneous Malignancies. Facial Plast Surg Clin North Am 2019; 27:119-129. [DOI: 10.1016/j.fsc.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Voiculescu VM, Lisievici CV, Lupu M, Vajaitu C, Draghici CC, Popa AV, Solomon I, Sebe TI, Constantin MM, Caruntu C. Mediators of Inflammation in Topical Therapy of Skin Cancers. Mediators Inflamm 2019; 2019:8369690. [PMID: 30766448 PMCID: PMC6350587 DOI: 10.1155/2019/8369690] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/28/2018] [Accepted: 11/26/2018] [Indexed: 12/24/2022] Open
Abstract
Taking into consideration that the immune system plays a very important role in the development of melanoma and non-melanoma skin cancers, which have a high prevalence in immunosuppressed patients and after prolonged ultraviolet radiation, the interest in developing novel therapies, in particular targeting the inflammation in cancer, has increased in the past years. The latest data suggest that therapies such as imiquimod (IMQ), ingenol mebutate (IM), 5-fluorouracil (5-FU), retinoids, and nonsteroidal anti-inflammatory drugs (NSAIDs) have been used with success in the topical treatment of some cancers. Herein, we review the topical treatment targeting the inflammation in skin cancer and the mechanisms involved in these processes. Currently, various associations have shown a superior success rate than monotherapy, such as systemic acitretin and topical IMQ, topical 5-FU with tretinoin cream, or IMQ with checkpoint inhibitor cytotoxic T lymphocyte antigen 4. Novel therapies targeting Toll-like receptor-7 (TLR-7) with higher selectivity than IMQ are also of great interest.
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Affiliation(s)
- Vlad Mihai Voiculescu
- Department of Dermatology, “ELIAS” University Emergency Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
| | | | - Mihai Lupu
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
- Dermatology Clinic, MedAs Medical Center, Bucharest, Romania
| | - Cristina Vajaitu
- Department of Dermatology, “ELIAS” University Emergency Hospital, Bucharest, Romania
| | | | | | - Iulia Solomon
- Department of Dermatology, “ELIAS” University Emergency Hospital, Bucharest, Romania
| | - Teona Ioana Sebe
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
- The Clinic of Plastic Surgery Reconstructive Microsurgery, Emergency Hospital Bucharest, Romania
| | - Maria Magdalena Constantin
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
- 2nd Department of Dermatology, “Colentina” Clinical Hospital, Bucharest, Romania
| | - Constantin Caruntu
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
- Department of Dermatology, Prof. “N Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
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Nodal staging of high-risk cutaneous squamous cell carcinoma. J Am Acad Dermatol 2018; 81:548-557. [PMID: 30227190 DOI: 10.1016/j.jaad.2018.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/03/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND While progress has been made in defining the clinical and histopathologic features of high-risk cutaneous squamous cell carcinoma (HRcSCC), optimal staging guidelines remain elusive. OBJECTIVE We seek to guide clinical practice regarding nodal staging options for patients with HRcSCC via review of evolving definitions of HRcSCC, nodal staging options, and how nodal staging may impact treatment and affect outcomes. METHODS This was a retrospective review of the published peer-reviewed literature regarding risk stratification, nodal staging, and treatment and outcomes for patients with HRcSCC via PubMed. RESULTS For patients without clinical lymphadenopathy, based on literature from head and neck SCC, preoperative nodal staging with ultrasonography may be more useful than computed tomography or magnetic resonance imaging. Early nodal disease is usually curable, and therefore obtaining a sentinel lymph node biopsy specimen may be considered in those with negative imaging while we await studies of nodal staging outcomes. LIMITATIONS More data are needed to validate the relationships between primary tumor stage and sentinel lymph node biopsy status and to determine if early detection of nodal disease impacts survival for patients with HRcSCC. CONCLUSION It is reasonable to consider nodal staging for patients with HRcSCC (Brigham and Women's Hospital stage T2b and T3) in the absence of clinically palpable lymphadenopathy via radiographic imaging and, if negative, sentinel lymph node biopsy.
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Hutting KH, Bos PG, Kibbelaar RE, Veeger NJGM, Marck KW, Mouës CM. Effective excision of cutaneous squamous cell carcinoma of the face using analysis of intra-operative frozen sections from the whole specimen. J Surg Oncol 2017; 117:473-478. [DOI: 10.1002/jso.24870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/08/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Kor H. Hutting
- Department of Plastic Surgery; Medisch Centrum Leeuwarden; Leeuwarden The Netherlands
| | - Paul G. Bos
- Department of Plastic Surgery; Medisch Centrum Leeuwarden; Leeuwarden The Netherlands
| | | | - Nic J. G. M. Veeger
- Department of Epidemiology; Medisch Centrum Leeuwarden; Leeuwarden The Netherlands
| | - Klaas W. Marck
- Department of Plastic Surgery; Medisch Centrum Leeuwarden; Leeuwarden The Netherlands
| | - Chantal M. Mouës
- Department of Plastic Surgery; Medisch Centrum Leeuwarden; Leeuwarden The Netherlands
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McLaughlin EJ, Miller L, Shin TM, Sobanko JF, Cannady SB, Miller CJ, Newman JG. Rate of regional nodal metastases of cutaneous squamous cell carcinoma in the immunosuppressed patient. Am J Otolaryngol 2017; 38:325-328. [PMID: 28202188 DOI: 10.1016/j.amjoto.2017.01.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/31/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Immunosuppressed solid organ transplant recipients (SOTRs) have an increased risk of developing cutaneous squamous cell carcinomas (cSCCs) with metastatic potential. This study sought to determine the rate of regional lymph node involvement in a large cohort of solid organ transplant patients with cutaneous head and neck squamous cell carcinoma. MATERIALS AND METHODS A retrospective chart review was performed on solid organ transplant patients with head and neck cutaneous squamous cell carcinoma treated at a tertiary academic medical center from 2005 to 2015. RESULTS 130 solid organ transplant patients underwent resection of 383 head and neck cutaneous squamous cell carcinomas. The average age of the patient was 63. Seven patients (5%) developed regional lymph node metastases (3 parotid, 4 cervical lymph nodes). The mean time from primary tumor resection to diagnosis of regional lymphatic disease was 6.7months. Six of these patients underwent definitive surgical resection followed by adjuvant radiation; one patient underwent definitive chemoradiation. 6 of the 7 patients died of disease progression with a mean survival of 15months. The average follow up time was 3years (minimum 6months). CONCLUSIONS Solid organ transplant recipients with cutaneous squamous cell carcinoma of the head and neck develop regional lymph node metastasis at a rate of 5%. Regional lymph node metastasis in this population has a poor prognosis and requires aggressive management and surveillance.
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Humphreys TR, Shah K, Wysong A, Lexa F, MacFarlane D. The role of imaging in the management of patients with nonmelanoma skin cancer. J Am Acad Dermatol 2017; 76:591-607. [DOI: 10.1016/j.jaad.2015.10.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 10/12/2015] [Accepted: 10/17/2015] [Indexed: 11/17/2022]
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Smith JA, Virk S, Palme CE, Low THH, Ch'ng S, Gupta R, Gao K, Clark J. Age is not a predictor of prognosis in metastatic cutaneous squamous cell carcinoma of the head and neck. ANZ J Surg 2016; 88:E273-E277. [DOI: 10.1111/ans.13757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/18/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Joel A. Smith
- Sydney Head and Neck Cancer Institute (SHNCI); Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Sohaib Virk
- Sydney Head and Neck Cancer Institute (SHNCI); Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Carsten E. Palme
- Sydney Head and Neck Cancer Institute (SHNCI); Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute (SHNCI); Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute (SHNCI); Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Ruta Gupta
- Sydney Head and Neck Cancer Institute (SHNCI); Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute (SHNCI); Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute (SHNCI); Chris O'Brien Lifehouse; Sydney New South Wales Australia
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Abstract
Non-melanoma skin cancer represents one-third of all malignancies and its incidence is expected to rise until the year 2040. Cutaneous squamous cell carcinoma (cSCC) represents 20 % of all non-melanoma skin cancer and is a deadly threat owing to its ability to metastasize to any organ in the body. Therefore, a better understanding of cSCC is essential to strengthen preventative measures and curable treatment options. Currently, research demonstrates that cSCC is diagnosed at a rate of 15-35 per 100,000 people and is expected to increase 2-4 % per year. With respect to metastatic cSCC, this disease is more common in men; people over the age of 75 years; and inhabitants of the south and mid-west USA. In 2010, the American Joint Committee on Cancer updated the Cancer Staging Manual's primary tumor designation to now include high-risk factors; however, factors such as immunosuppression and tumor recurrence were not included. Other staging systems such as Brigham and Women's Hospital have allowed for increased stratification of cSCC. High-risk cSCC is defined as a cSCC that is staged as N0, extends beyond basement membrane, and has high-risk features associated with sub-clinical metastasis. High-risk features are depth of invasion (>2 mm), poor histological differentiation, high-risk anatomic location (face, ear, pre/post auricular, genitalia, hands, and feet), perineural involvement, recurrence, multiple cSCC tumors, and immunosuppression. Epidermal growth factor receptor and nuclear active IκB kinase (IKK) expression are also predictive of metastatic capabilities. Clinically, the initial lesions of a cSCC tumor can present as a painless plaque-like or verrucous tumor that can ultimately progress to being large, necrotic, and infected. Tumors can also present with paresthesias or lymphadenopathy depending on the location involved. With respect to prognosis, metastatic cSCC is lethal, with several large studies demonstrating a mortality rate of >70 %. Therefore, treatment of metastatic cSCC is difficult and depends on the location involved and extent of metastasis. Treatment options include surgery, radiation therapy, chemotherapy, and any combination of the above. Surgery alone can be used for metastatic cSCC treatment, but is not as effective as surgery in conjunction with radiation therapy. Radiation therapy has some success as a monotherapy in low-risk or cosmetically sensitive areas such as the external ear, eyelid or nose. According to the 2013 National Comprehensive Cancer Network Guidelines, cisplatin as a single agent or combined with 5-fluorouracil hold the strongest support for the treatment of metastatic cSCC; however, the supporting evidence is inconsistent and a curative chemotherapeutic approach is still lacking. Epidermal growth factor receptor inhibitors are a newer class of agents being used in metastatic cSCC and hold some promise as a therapy for this disease. Other areas of interest in finding curative treatments for metastatic cSCC include p53, hypermethylation of specific genes, chromatin remodeling genes, and the RAS/RTK/PI3K pathway. This review addresses the epidemiology, staging, risk factors, clinical presentation, management, and new trends in the treatment of high-risk and metastatic cSCC.
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Immune Checkpoint Inhibitor Therapy as a Novel and Effective Therapy for Aggressive Cutaneous Squamous-cell Carcinoma. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.clsc.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Small J, Barton V, Peterson B, Alberg AJ. Keratinocyte Carcinoma as a Marker of a High Cancer-Risk Phenotype. Adv Cancer Res 2016; 130:257-91. [PMID: 27037755 DOI: 10.1016/bs.acr.2016.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Keratinocyte carcinoma (KC) (also referred to as nonmelanoma skin cancer) is by far the most common form of human cancer. A personal history of KC is well established to be associated with increased risk of recurrent KC and malignant melanoma, a less common yet more fatal form of skin cancer. More surprising is that a substantial body of epidemiologic evidence now indicates that a personal history of KC is significantly associated with an overall elevated risk of noncutaneous malignancies. This association is not limited to one or a few types of cancer but applies across many different types of malignancy. This association has been consistently observed in prospective studies across genders for both major histologic types of KC, basal cell carcinoma and squamous cell carcinoma. The risk of other cancers has been even stronger in those with younger compared with older age of onset of KC. A robust body of evidence lends support to the notion that KC may be a marker of a high cancer-risk phenotype. The underlying mechanisms for this association remain to be elucidated, but the cross-cutting nature of this association across numerous malignancies suggests that research to uncover these mechanisms is a promising line of inquiry that could potentially yield valuable insight into human carcinogenesis.
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Affiliation(s)
- J Small
- Medical University of South Carolina, Charleston, SC, United States
| | - V Barton
- Medical University of South Carolina, Charleston, SC, United States
| | - B Peterson
- Medical University of South Carolina, Charleston, SC, United States
| | - A J Alberg
- Medical University of South Carolina, Charleston, SC, United States.
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Gleich T, Chiticariu E, Huber M, Hohl D. Keratoacanthoma: a distinct entity? Exp Dermatol 2015; 25:85-91. [DOI: 10.1111/exd.12880] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Tobias Gleich
- Service of Dermatology; University Hospital Center and University of Lausanne; Lausanne Switzerland
| | - Elena Chiticariu
- Service of Dermatology; University Hospital Center and University of Lausanne; Lausanne Switzerland
| | - Marcel Huber
- Service of Dermatology; University Hospital Center and University of Lausanne; Lausanne Switzerland
| | - Daniel Hohl
- Service of Dermatology; University Hospital Center and University of Lausanne; Lausanne Switzerland
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Metterle L, Nelson C, Patel N. Intralesional 5-fluorouracil (FU) as a treatment for nonmelanoma skin cancer (NMSC): A review. J Am Acad Dermatol 2015; 74:552-7. [PMID: 26577512 DOI: 10.1016/j.jaad.2015.09.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 01/30/2023]
Abstract
The treatment paradigm for nonmelanoma skin cancer remains surgical. This fact combined with its remarkably high incidence positions it as the fifth most costly cancer to treat in the Medicare population. To address this, consideration of alternative medical therapeutics is warranted. Intralesional 5-fluorouracil is a potentially affordable option that may demand further investigation. This literature review examines current data on its efficacy and adverse effects.
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Affiliation(s)
- Lauren Metterle
- University of South Florida College of Medicine, Tampa, Florida
| | | | - Nishit Patel
- University of South Florida College of Medicine, Tampa, Florida.
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Yu J, Cao XF, Zheng Y, Zhao RC, Yan LQ, Zhao L, Wang JW. Anti-VEGF Therapy with Bevacizumab--limited cardiovascular toxicity. Asian Pac J Cancer Prev 2015; 15:10769-72. [PMID: 25605173 DOI: 10.7314/apjcp.2014.15.24.10769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This analysis was conducted to evaluate cardiovascular toxicity of commonly used anti-VEGF therapeutic agent, bevacizumab, in treating patients with cancer. METHODS Clinical studies evaluating the efficacy and safety of bevacizumab-based regimens on response and safety for patients with cancer were identified using a predefined search strategy, allowing cardiovascular toxicity and other side effects of treatment to be estimated. RESULTS In bevacizumab based regimens, 4 clinical studies including 282 patients with advanced cancer (including gliomas, cervical, breast and ovarian cancer) were considered eligible for inclusion. These bevacizumab-based regimens included docetaxel, irinitecan and carboplatin. Systematic analysis suggested that, of 282 patients treated by bevacizumab based regimens, hypertension and thrombo-embolism occurred in 2.5% (7/282), while only 3 patients reported cardiovascular events (1.1%). No treatment related death occurred in bevacizumab based treatment. CONCLUSION This systemic analysis suggests that bevacizumab based regimens are associated with reasonable and accepted cardiovascular toxicity when treating patients with gliomas, cervical, breast and ovarian cancer.
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Affiliation(s)
- Jing Yu
- Department of Cardiology, Cangzhou Central Hospital of HeBei, CangZhou, China E-mail :
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Suárez AL, Louis P, Kitts J, Busam K, Myskowski PL, Wong RJ, Chen CSJ, Spencer P, Lacouture M, Pulitzer MP. Clinical and dermoscopic features of combined cutaneous squamous cell carcinoma (SCC)/neuroendocrine [Merkel cell] carcinoma (MCC). J Am Acad Dermatol 2015; 73:968-75. [PMID: 26433246 DOI: 10.1016/j.jaad.2015.08.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a neuroendocrine carcinoma, associated with Merkel cell polyomavirus. MCC admixed with squamous cell carcinoma (SCC) is unassociated with polyomavirus, and is genetically distinct. OBJECTIVE We sought to distinguish clinically and dermoscopically between MCC and SCC/MCC. METHODS We compared patient data for SCC/MCC (n = 26) and MCC (n = 20), and reviewed clinical and dermoscopic images (n = 9) of SCC/MCC. RESULTS Patients with SCC/MCC were older (median 76.5 vs 69 years) and more often male (77% vs 60%), and had more nonmelanoma skin cancer (85% vs 25%), malignant extracutaneous tumors (25% vs 5%), lymphoproliferative disorders (23% vs 10%), and immunodeficient/proinflammatory states (77% vs 35%). In all, 58% of SCC/MCC versus 10% of MCC were clinically diagnosed nonmelanoma skin cancer. Patients with SCC/MCC had more metastases (77% vs 40%), more treatment failures (53% vs 45%), shorter survival (41 vs 54 months), and more death from disease (50% vs 40%). SCC/MCC demonstrated marked scale (7/9), and telangiectasia (1/9). Dermoscopically, small dotted and short linear irregular peripheral vessels and central milky-red areas with large-diameter arborizing vessels were seen. LIMITATIONS The rarity of SCC/MCC limits available data. CONCLUSIONS SCC/MCC is aggressive, arising within elderly patients' chronically ultraviolet-exposed skin, often in the setting of immunosuppression or inflammation. Dermoscopically, polymorphous vessels in lesions suspicious for nonmelanoma skin cancer are suggestive.
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Affiliation(s)
- Andrea Luísa Suárez
- Department of Dermatology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Peter Louis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jasmine Kitts
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Klaus Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chih-Shan Jason Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Philip Spencer
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mario Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa P Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Li YY, Hanna GJ, Laga AC, Haddad RI, Lorch JH, Hammerman PS. Genomic analysis of metastatic cutaneous squamous cell carcinoma. Clin Cancer Res 2015; 21:1447-56. [PMID: 25589618 DOI: 10.1158/1078-0432.ccr-14-1773] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE A rare 5% of cutaneous squamous cell carcinomas (cSCC) metastasize, lack FDA-approved therapies, and carry a poor prognosis. Our aim was to identify recurrent genomic alterations in this little-studied population of metastatic cSCCs. EXPERIMENTAL DESIGN We performed targeted sequencing of 504 cancer-associated genes on lymph node metastases in 29 patients with cSCC and identified mutations and somatic copy-number alterations associated with metastatic cSCC. We determined significantly mutated, deleted, and amplified genes and associated genomic alterations with clinical variables. RESULTS The cSCC genome is heterogeneous with widely varying numbers of genomic alterations and does not appear to be associated with human papillomavirus. We found previously identified recurrently altered genes (TP53, CDKN2A, NOTCH1/2) but also a wide spectrum of oncogenic mutations affecting RAS/RTK/PI3K, squamous differentiation, cell cycle, and chromatin remodeling pathway genes. Specific mutations in known oncogenic drivers and pathways were correlated with inferior patient outcomes. Our results suggest potential therapeutic targets in metastatic cSCC, including PIK3CA, FGFR3, BRAF, and EGFR, similar to those reported in SCCs of the lung and head and neck, suggesting that clinical trials could be developed to accrue patients with SCCs from multiple sites of origin. CONCLUSIONS We have genomically characterized a rare cohort of 29 metastatic cSCCs and identified a diverse array of oncogenic alterations that can guide future studies of this disease.
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Affiliation(s)
- Yvonne Y Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Broad Institute, Cambridge, Massachusetts
| | - Glenn J Hanna
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alvaro C Laga
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Peter S Hammerman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Medicine, Harvard Medical School, Boston, Massachusetts.
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Shao XH, Xu YS, Zhang XQ, Li WF. Evidence Based Analysis of Cisplatin for Treating Patients with Cutaneous Squamous Cell Carcinoma. Asian Pac J Cancer Prev 2014; 15:9813-5. [DOI: 10.7314/apjcp.2014.15.22.9813] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Drug delivery nanoparticles in skin cancers. BIOMED RESEARCH INTERNATIONAL 2014; 2014:895986. [PMID: 25101298 PMCID: PMC4102061 DOI: 10.1155/2014/895986] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/28/2014] [Indexed: 12/17/2022]
Abstract
Nanotechnology involves the engineering of functional systems at nanoscale, thus being attractive for disciplines ranging from materials science to biomedicine. One of the most active research areas of the nanotechnology is nanomedicine, which applies nanotechnology to highly specific medical interventions for prevention, diagnosis, and treatment of diseases, including cancer disease. Over the past two decades, the rapid developments in nanotechnology have allowed the incorporation of multiple therapeutic, sensing, and targeting agents into nanoparticles, for detection, prevention, and treatment of cancer diseases. Nanoparticles offer many advantages as drug carrier systems since they can improve the solubility of poorly water-soluble drugs, modify pharmacokinetics, increase drug half-life by reducing immunogenicity, improve bioavailability, and diminish drug metabolism. They can also enable a tunable release of therapeutic compounds and the simultaneous delivery of two or more drugs for combination therapy. In this review, we discuss the recent advances in the use of different types of nanoparticles for systemic and topical drug delivery in the treatment of skin cancer. In particular, the progress in the treatment with nanocarriers of basal cell carcinoma, squamous cell carcinoma, and melanoma has been reported.
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Supriya M, Suat-Chin N, Sizeland A. Use of positron emission tomography scanning in metastatic head and neck cutaneous squamous cell cancer: does it add to patient management? Am J Otolaryngol 2014; 35:347-52. [PMID: 24503246 DOI: 10.1016/j.amjoto.2014.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/04/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the impact of whole-body positron emission tomography in comparison to staging by conventional methods alone in management of patients with head and neck cutaneous squamous cell cancer (cSCC) with confirmed regional nodal metastasis. MATERIALS AND METHODS This is a retrospective case cohort study carried out at a tertiary referral cancer centre. The participants were thirty-one adults with head and neck cSCC and regional nodal metastasis. The original treatment plan based on conventional cross-sectional imaging and clinical examination was compared to the final treatment plan after additional PET staging to evaluate the impact of 18F-FDG PET-CT on patient management. RESULTS Addition of 18F-FDG PET-CT did not change the management in 24/31 (77%) of patients. In four cases the 18F-FDG PET-CT failed to pick up biopsy proven metastatic disease. Two patients who had reduced extent of surgery have shown no features of regional failure after one year of follow-up. CONCLUSION Overall the management in majority of head and neck cSCC patients with regional metastasis does not change by addition of 18F-FDG PET-CT over conventional imaging.
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Head and Neck Cutaneous Squamous Cell Carcinoma Requiring Parotidectomy. Otolaryngol Head Neck Surg 2014; 150:610-7. [DOI: 10.1177/0194599814520686] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective Evaluate characteristics and risk factors for patients with advanced cutaneous squamous cell carcinoma (cSCC). Study Design Retrospective case series. Setting Tertiary care center. Patients and Methods Chart review of patients with cSCC undergoing a parotidectomy (2003-2012). Results Of 218 patients identified, 49% presented with a new primary lesion (n = 107) and 51% with a recurrence (n = 111). Parotid lymph nodes were positive in 52% of patients; 81% had a concurrent neck dissection, and 28% had cervical lymph node metastases. In 18% of patients, both parotid and cervical nodes were positive, while 44% were both parotid and cervical node negative; 33% had positive parotid and negative cervical nodes, and only 5% had negative parotid and positive cervical nodes. The overall 2- and 5-year survival rates were 0.71 and 0.58. Overall 5-year survival was lower for patients presenting with recurrent (0.49) versus new primary disease (0.69; P = .04). In addition, decreased overall 5-year survival rates were associated with cervical lymph node involvement (0.47 vs. 0.62; P = .01). There was no difference in overall survival when stratified by parotid lymph node involvement ( P = .85), margin status ( P = .67), perineural invasion ( P = .42), facial nerve sacrifice ( P = .92), or type of parotid operation performed ( P = .51). Conclusions In this study, cervical, but not parotid, lymph node involvement was associated with poor outcomes in patients with advanced cSCC requiring a parotidectomy. In patients without evidence of cervical or parotid lymph node involvement, a neck dissection may be spared, given there is a 5% chance of occult disease.
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Perioperative Management of High Risk Primary Cutaneous Squamous Cell Carcinoma: Role of Radiologic Imaging, Elective Lymph Node Dissection, Sentinel Lymph Node Biopsy, and Adjuvant Radiotherapy. CURRENT DERMATOLOGY REPORTS 2013. [DOI: 10.1007/s13671-013-0041-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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