1
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Alexander MH, Cousins WJ, Ewen T, South AP, Lovat P, Stefanos N. The combined immunohistochemical expression of AMBRA1 and SQSTM1 identifies patients with poorly differentiated cutaneous squamous cell carcinoma at risk of metastasis: A proof of concept study. J Cutan Pathol 2024; 51:450-458. [PMID: 38421158 DOI: 10.1111/cup.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) incidence continues to increase globally with, as of yet, an unmet need for reliable prognostic biomarkers to identify patients at increased risk of metastasis. The aim of the present study was to test the prognostic potential of the combined immunohistochemical expression of the autophagy regulatory biomarkers, AMBRA1 and SQSTM1, to identify high-risk patient subsets. METHODS A retrospective cohort of 68 formalin-fixed paraffin-embedded primary cSCCs with known 5-year metastatic outcomes were subjected to automated immunohistochemical staining for AMBRA1 and SQSTM1. Digital images of stained slides were annotated to define four regions of interest: the normal and peritumoral epidermis, the tumor mass, and the tumor growth front. H-score analysis was used to semi-quantify AMBRA1 or SQSTM1 expression in each region of interest using Aperio ImageScope software, with receiver operator characteristics and Kaplan-Meier analysis used to assess prognostic potential. RESULTS The combined loss of expression of AMBRA1 in the tumor growth front and SQSTM1 in the peritumoral epidermis identified patients with poorly differentiated cSCCs at risk of metastasis (*p < 0.05). CONCLUSIONS Collectively, these proof of concept data suggest loss of the combined expression of AMBRA1 in the cSCC growth front and SQSTM1 in the peritumoral epidermis as a putative prognostic biomarker for poorly differentiated cSCC.
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Affiliation(s)
- Michael H Alexander
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle Helix, Newcastle upon Tyne, Newcastle upon Tyne, UK
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William J Cousins
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle Helix, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Tom Ewen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle Helix, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Andrew P South
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Penny Lovat
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle Helix, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Niki Stefanos
- Cellular Pathology, Addenbrookes Hospital, Cambridge, UK
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2
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Chang DH, Lu YD, Lin TW, Chang KC. Versatile Use of V-Y Advancement Flap for Facial Defect Reconstruction: A Case Series in Asian Patients. Aesthetic Plast Surg 2024; 48:1663-1671. [PMID: 38212544 DOI: 10.1007/s00266-023-03821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND V-Y advancement flap (VYAF) is a commonly used flap for facial reconstruction, but it is not popular in Asian society with limited aesthetic outcome evaluation. OBJECTIVE To demonstrate our experience of facial VYAF with the quantitative aesthetic outcome assessment. METHODS AND MATERIALS From January 2013 to December 2022, patients who underwent facial VYAF reconstruction were reviewed. Postoperative photographs were collected and independently graded by three plastic surgeons, three nurses, and six non-medical personnel using Manchester scar scale (MSS). The representative preoperative images were selected for surgeons' reconstruction preferences survey. RESULTS Forty-eight patients (27 females and 21 males), with a mean age of 66.8 (23-97) years, were included in this study. All flaps survived with no flap necrosis. Only six patients (12.5%) developed minor postoperative complications, and they were treated conservatively and resolved uneventfully. The total MSS score was 7.8 ± 1.9 (scale of 4 [best scar] to 24 [worst scar]) and the overall scar VAS rating was 1.9 ± 1.1 (0 [best scar] to 10 [worst scar]), indicating satisfactory postoperative scar condition. From the survey of 22 plastic surgeons and 11 scenarios, VYAF was rarely chosen among other local flaps which only accounted for 8.7%. CONCLUSION VYAF is an easy and safe method for facial reconstruction with low morbidity, but its usefulness is underappreciated. With a proper design and cautious dissection, we believe that good aesthetic and functional outcomes can be achieved with VYAF. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Dun-Hao Chang
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Information Management, Yuan Ze University, Taoyuan, Taiwan, ROC
| | - Ya-Di Lu
- Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan, ROC
| | - Tsuo-Wu Lin
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan, ROC
| | - Ke-Chung Chang
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan, ROC.
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3
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Song JS, Smith SP, Stucken CL. Implications of Malignancy, Radiation, and Timing of Major Nasal Reconstruction. Facial Plast Surg Clin North Am 2024; 32:189-198. [PMID: 38575277 DOI: 10.1016/j.fsc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Owing to the complex, multilayered anatomy of the nose in the central face, major nasal reconstruction can pose a significant challenge for reconstructive surgeons. It is the responsibility of reconstructive surgeons to have an understanding of the most common cutaneous malignancies and excisional techniques that may lead to complex nasal defects. The purpose of this article is to discuss these malignancies, excisional techniques, and impacts of radiation on tissue that has implications for reconstructive surgeons.
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Affiliation(s)
- Jin Soo Song
- Smith Facial Plastics, Columbus Ohio, 725 Buckles Court North #210, Gahanna, OH 43230, USA
| | - Stephen P Smith
- Smith Facial Plastics, Columbus Ohio, 725 Buckles Court North #210, Gahanna, OH 43230, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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4
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Mansilla-Polo M, Morgado-Carrasco D, Toll A. Review on the Role of Paraffin-embedded Margin-controlled Mohs Micrographic Surgery to Treat Skin Tumors. Actas Dermosifiliogr 2024:S0001-7310(24)00362-4. [PMID: 38648936 DOI: 10.1016/j.ad.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/29/2023] [Accepted: 02/06/2024] [Indexed: 04/25/2024] Open
Abstract
Paraffin-embedded margin-controlled Mohs micrographic surgery (PMMS) includes various procedures such as slow Mohs or deferred Mohs technique, the Muffin and Tübingen techniques, and staged margin excision, or the spaghetti technique. PMMS is a variation of conventional Mohs micrographic surgery (MMS) that allows histopathological examination with delayed margin control. PMMS requires minimum training and may be adopted by any hospital. The setback is that PMMS can require procedures across multiple days. PMMS lowers the rate of recurrence of basal cell carcinoma vs wide local excision in high-risk basal cell carcinoma, and improves the rates of recurrence and survival in lentigo maligna. PMMS can be very useful in high-risk squamous cell carcinoma treatment. Finally, it is a promising technique to treat infrequent skin neoplasms, such as dermatofibrosarcoma protuberans, or extramammary Paget's disease, among others. In this article, we present a literature narrative review on PMMS, describing techniques and indications, and highlighting long-term outcomes.
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Affiliation(s)
- M Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, España; Health Research Institute (IIS) La Fe, Valencia, España
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Department of Dermatology, Hospital de Figueres, Fundació Alt Empordà, España
| | - A Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
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Yoshida K, Akita K, Yoshida A, Yui M, Hirota K, Takegawa H, Anetai Y, Koike Y, Harima Y, Shiga T, Nakajima N, Kazawa N, Komemushi A, Utsunomiya K, Tanigawa N, Noborio R, Nakamura S. Single-Fraction Palliative High-Dose-Rate Brachytherapy for Symptom Management in a 97-Year-Old Patient With Dementia. J Palliat Med 2024. [PMID: 38579134 DOI: 10.1089/jpm.2023.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Background: Delivering cancer treatment to elderly patients with dementia is often challenging. We describe performing palliative surface mold brachytherapy (SMBT) in an elderly patient with advanced dementia for pain control using music therapy to assist with agitation. Case Description: The patient was a 97-year-old Japanese woman with advanced dementia. Exudate was observed from her tumor, and she complained of Grade 2 severity pain using Support team assessment schedule (STAS), especially when undergoing would dressings. Given her advanced dementia, she was not considered a candidate for radical surgery or external beam radiotherapy. We instead treated her with high-dose-rate (HDR) SMBT. Due to her advanced dementia associated with agitation, she could not maintain her position. She was able to remain calm while listening to traditional Japanese enka music, which enables our team to complete her radiation without using anesthetics or sedating analgesics. Her localized pain severity decreased ≤21 days and the exudate fluid disappeared ≤63 days after HDR-SMBT. Her tumor was locally controlled until her death from intercurrent disease 1 year after HDR-SMBT. Discussion: Single fraction palliative HDR-SMBT was useful for successful treatment of skin cancer in an elderly patient. Traditional Japanese music helped reduce her agitation to complete HDR-SMBT. For elderly patients with agitation associated with dementia, we should consider using music and music therapy to facilitate radiation therapy.
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Affiliation(s)
- Ken Yoshida
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Kohiro Akita
- Department of Radiology, Kansai Medical University Hospital, Osaka, Japan
| | - Asami Yoshida
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Midori Yui
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Kazuki Hirota
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Hideki Takegawa
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Yusuke Anetai
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Yuhei Koike
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Yoko Harima
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Toshiko Shiga
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Naomi Nakajima
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Nobukata Kazawa
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Keita Utsunomiya
- Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University Hospital, Osaka, Japan
| | - Reiko Noborio
- Department of General Medicine, Kansai Medical University Kori Hospital, Osaka, Japan
| | - Satoaki Nakamura
- Division of Radiation Oncology, Kansai Medical University Hospital, Osaka, Japan
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6
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Park JW, Kim T, Chung KY, Roh MR. Squamous cell carcinoma of lip: Clinical feature analysis and suggestion of reconstruction algorithm. J Dermatol 2024. [PMID: 38444089 DOI: 10.1111/1346-8138.17181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/28/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
Reconstruction of lips after squamous cell carcinoma (SCC) removal should restore functional and aesthetic roles; however, it remains a challenge. In this study we describe the clinical features of lip SCC and suggest a reconstruction algorithm. We retrospectively analyzed 34 patients with lip SCC who underwent reconstruction after Mohs micrographic surgery between January 2006 and March 2022. The mean age of the patients was 70.2 years. Seven tumors were on the upper lip and 27 tumors were on the lower lip. Twenty-five defects were located on the mucosal lip, eight defects involved both the mucosal and cutaneous lips, and one defect was confined to the cutaneous lip. Eighteen defects were smaller than 50% of the total lip size, and 16 were larger than 50%. Primary closure was mostly performed for defects smaller than 50% of the lip size (9/18 cases), and local flap, according to the location and size of the defects, was performed for larger defects. Thirteen patients experienced postoperative complications but improved within 1 year after surgery, except for one patient. We suggest a reconstruction algorithm with a 50% cut-off value. Defects smaller than 50% of the lip size could be reconstructed by primary closure. Even larger defects could be reconstructed by creation of a local flap from the remaining adjacent tissue with minimal postoperative complications.
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Affiliation(s)
- Jung Won Park
- Department of Dermatology, Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Taehee Kim
- Department of Dermatology, Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Yang Chung
- Department of Dermatology, Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ryung Roh
- Department of Dermatology, Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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7
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Mansilla-Polo M, Morgado-Carrasco D, Toll A. Review on the Role of Paraffin-embedded Margin-controlled Mohs Micrographic Surgery to Treat Skin Tumors. Actas Dermosifiliogr 2024:S0001-7310(24)00159-5. [PMID: 38395222 DOI: 10.1016/j.ad.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/29/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Paraffin-embedded margin-controlled Mohs micrographic surgery (PMMS) includes various procedures such as slow Mohs or deferred Mohs technique, the Muffin and Tübingen techniques, and staged margin excision, or the spaghetti technique. PMMS is a variation of conventional Mohs micrographic surgery (MMS) that allows histopathological examination with delayed margin control. PMMS requires minimum training and may be adopted by any hospital. The setback is that PMMS can require procedures across multiple days. PMMS lowers the rate of recurrence of basal cell carcinoma vs wide local excision in high-risk basal cell carcinoma, and improves the rates of recurrence and survival in lentigo maligna. PMMS can be very useful in high-risk squamous cell carcinoma treatment. Finally, it is a promising technique to treat infrequent skin neoplasms, such as dermatofibrosarcoma protuberans, or extramammary Paget's disease, among others. In this article, we present a literature narrative review on PMMS, describing techniques and indications, and highlighting long-term outcomes.
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Affiliation(s)
- M Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Health Research Institute (IIS) La Fe, Valencia, Spain
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Dermatology, Hospital de Figueres, Fundació Alt Empordà, Spain
| | - A Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
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8
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Verdaguer-Faja J, Toll A, Boada A, Guerra-Amor Á, Ferrándiz-Pulido C, Jaka A. Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches. Cancers (Basel) 2024; 16:664. [PMID: 38339415 PMCID: PMC10854799 DOI: 10.3390/cancers16030664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common subtype of skin cancer. The scalp is one of the most frequently affected locations and is associated with a higher rate of complications, compared to other locations. In addition, it has a characteristic thickness and anatomical structure that may influence both growth pattern and treatment of primary cSCC; while clinical peripheral margins may be easily achieved during the surgery, vertical excision of the tumor is limited by the skull. Despite having a unique anatomy, current guidelines do not contemplate specific recommendations for scalp cSCC, which leads to inconsistent decision-making in multidisciplinary committees when discussing tumors with high risk factors or with close margins. This article provides specific recommendations for the management of patients with scalp cSCC, based on current evidence, as well as those aspects in which evidence is lacking, pointing out possible future lines of research. Topics addressed include epidemiology, clinical presentation and diagnosis, imaging techniques, surgical and radiation treatments, systemic therapy for advanced cases, and follow-up. The primary focus of this review is on management of primary cSCC of the scalp with localized disease, although where relevant, some points about recurrent cSCCs or advanced disease cases are also discussed.
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Affiliation(s)
- Júlia Verdaguer-Faja
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Aram Boada
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Álvaro Guerra-Amor
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carla Ferrándiz-Pulido
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ane Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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9
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Levy JJ, Davis MJ, Chacko RS, Davis MJ, Fu LJ, Goel T, Pamal A, Nafi I, Angirekula A, Suvarna A, Vempati R, Christensen BC, Hayden MS, Vaickus LJ, LeBoeuf MR. Intraoperative margin assessment for basal cell carcinoma with deep learning and histologic tumor mapping to surgical site. NPJ Precis Oncol 2024; 8:2. [PMID: 38172524 PMCID: PMC10764333 DOI: 10.1038/s41698-023-00477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
Successful treatment of solid cancers relies on complete surgical excision of the tumor either for definitive treatment or before adjuvant therapy. Intraoperative and postoperative radial sectioning, the most common form of margin assessment, can lead to incomplete excision and increase the risk of recurrence and repeat procedures. Mohs Micrographic Surgery is associated with complete removal of basal cell and squamous cell carcinoma through real-time margin assessment of 100% of the peripheral and deep margins. Real-time assessment in many tumor types is constrained by tissue size, complexity, and specimen processing / assessment time during general anesthesia. We developed an artificial intelligence platform to reduce the tissue preprocessing and histological assessment time through automated grossing recommendations, mapping and orientation of tumor to the surgical specimen. Using basal cell carcinoma as a model system, results demonstrate that this approach can address surgical laboratory efficiency bottlenecks for rapid and complete intraoperative margin assessment.
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Affiliation(s)
- Joshua J Levy
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
- Emerging Diagnostic and Investigative Technologies, Clinical Genomics and Advanced Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA.
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
- Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
| | - Matthew J Davis
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | | | - Michael J Davis
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Lucy J Fu
- Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - Tarushii Goel
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Akash Pamal
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- University of Virginia, Charlottesville, VA, 22903, USA
| | - Irfan Nafi
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- Stanford University, Palo Alto, CA, 94305, USA
| | - Abhinav Angirekula
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- University of Illinois Urbana-Champaign, Champaign, IL, 61820, USA
| | - Anish Suvarna
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
| | - Ram Vempati
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
| | - Brock C Christensen
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Matthew S Hayden
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Louis J Vaickus
- Emerging Diagnostic and Investigative Technologies, Clinical Genomics and Advanced Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Matthew R LeBoeuf
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
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10
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Lacerda PN, Lange EP, Luna NM, Miot HA, Abbade LPF. Efficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2023. [PMID: 38116955 DOI: 10.1111/jdv.19743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
The standard of care for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) involves excision by conventional surgery (CS) with a predefined safety margin of resection or micrographic surgery (MS) with microscopic margin control. Previous studies have reported the superiority of MS in reducing recurrences for high-risk BCC and SCC. This systematic review aimed to assess MS and CS recurrence rates by including randomized clinical trials (RCTs) and cohort studies. A systematic review and meta-analysis were conducted for related studies in PubMed, LILACS, Embase, Scopus, Web of Science, CINHAL and Cochrane until May 2023. RCTs and cohorts involving patients with BCC or SCC submitted to MS and CS were included. Risk of bias assessment followed Cochrane-recommended tools for RCTs and cohorts, and certainty of evidence followed the GRADE approach. Pooled estimates were used to determine the relative risk (RR) and absolute risk difference (RD) using a random-effects model. Seventeen studies were included, two RCTs and fifteen cohorts. There were 82 recurrences in 3050 tumours submitted to MS, with an overall recurrence rate of 3.1% (95% CI 2.0%-4.7%). For CS, there were 209 recurrences in 3453 tumours, with a recurrence rate of 5.3% (95% CI 2.9%-9.3%). The combined estimate of RR was 0.48 (95% CI 0.36-0.63), without heterogeneity nor evidence of publication bias (p > 0.3). The RD resulted in 2.9% (95% CI 1.0%-4.9%; NNT = 35). Regarding subgroup analysis, the RR for BBC was 0.37 (95% CI 0.25-0.54), and RD was 3.7% (95% CI 0.8%-6.5%; NNT = 28). For SCC, RR was 0.57 (95% CI 0.29-1.13), and RD was 1.9% (95% CI 0.8%-4.7%; NNT = 53). Among primary tumours, RR was 0.39 (95% CI 0.28-0.54), and for recurrent tumours was 0.67 (95% CI 0.30-1.50). There is moderate evidence based on two RCTs, and low evidence based on 15 cohort studies that MS is superior to CS in reducing recurrences of BCCs and primary tumours. The development of protocols that maximize the cost-effectiveness of each method in different clinical scenarios is paramount.
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Affiliation(s)
- Priscila Neri Lacerda
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Eloana Pasqualin Lange
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Natália Miranda Luna
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Hélio Amante Miot
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Luciana Patrícia Fernandes Abbade
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
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11
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McClure EM, Sedor G, Jin Y, Kattan MW. Image-guided superficial radiation therapy has superior 2-year recurrence probability to Mohs micrographic surgery. Clin Transl Radiat Oncol 2023; 43:100678. [PMID: 37781716 PMCID: PMC10539860 DOI: 10.1016/j.ctro.2023.100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/10/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Non-melanoma skin cancers (NMSCs) are the most common cancers in the USA, and their incidence is rising. Mohs micrographic surgery (MMS) is commonly performed to excise NMSCs. MMS replaced superficial radiotherapy (SRT) as a first line treatment, given its superior efficacy. Image-guided superficial radiation therapy (IGSRT) was invented to improve the precision of SRT. This study investigates how the 2-year recurrence probability of IGSRT-treated NMSCs compares to that of MMS-treated lesions. Methods This retrospective cohort study compared the 2-year recurrence probability of early stage NMSCs (squamous and basal cell carcinomas (SCCs and BCCs)) treated by IGSRT (2,286 lesions) to data on NMSCs treated by MMS (5,391 lesions) via one sample proportion tests. Medical Subject Headings were used to search PubMed for reports of 2-year recurrence probability rates of NMSCs treated by MMS. Seventeen studies were screened; 14 studies were excluded for lack of 2-year time to event analysis, or irrelevant patient population (non-BCC/SCC study, advanced disease), leaving 3 studies for comparison. Results IGSRT-treated NMSCs have a statistically significantly improved 2-year recurrence probability than those treated by MMS, P < 0.001 for pooled data. Conclusion The 2-year recurrence probability IGSRT-treated NMSCs is superior to MMS-treated and supports IGSRT as an effective treatment option for individuals with early stage NMSCs.
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Affiliation(s)
- Erin M. McClure
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, FL 33602, United States
| | - Geoffrey Sedor
- Columbia University Irving Medical Center, Vagelos College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032, United States
| | - Yuxuan Jin
- Cleveland Clinic, Dept of Quantitative Health Sciences, Mail Code JJN3, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Michael W. Kattan
- Cleveland Clinic, Dept of Quantitative Health Sciences, Mail Code JJN3, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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12
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment-Update 2023. Eur J Cancer 2023; 193:113252. [PMID: 37708630 DOI: 10.1016/j.ejca.2023.113252] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/16/2023]
Abstract
In order to update recommendations on treatment, supportive care, education, and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV), and the European Organisation of Research and Treatment of Cancer (EORTC) was formed. Recommendations were based on an evidence-based literature review, guidelines, and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable), and distant metastatic cSCC. For common primary cSCC, the first-line treatment is surgical excision with postoperative margin assessment or micrographically controlled surgery. Achieving clear surgical margins is the most important treatment consideration for patients with cSCCs amenable to surgery. Regarding adjuvant radiotherapy for patients with high-risk localised cSCC with clear surgical margins, current evidence has not shown significant benefit for those with at least one high-risk factor. Radiotherapy should be considered as the primary treatment for non-surgical candidates/tumours. For cSCC with cytologically or histologically confirmed regional nodal metastasis, lymph node dissection is recommended. For patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiotherapy, anti-PD-1 agents are the first-line systemic treatment, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drugs Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC, include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiotherapy. Multidisciplinary board decisions are mandatory for all patients with advanced cSCC, considering the risks of toxicity, the age and frailty of patients, and co-morbidities, including immunosuppression. Patients should be engaged in informed, shared decision-making on management and be provided with the best supportive care to improve symptom management and quality of life. The frequency of follow-up visits and investigations for subsequent new cSCC depends on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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13
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Navarrete-Dechent C, Mori S, Connolly K, Shah K, Dusza SW, Rossi AM, Lee EH, Busam KJ, Nehal KS. Staging System Performance and Clinical Outcomes for Cutaneous Squamous Cell Carcinoma of the Ear: A Single-Center Retrospective Study. Dermatol Surg 2023; 49:747-754. [PMID: 37235869 PMCID: PMC10524321 DOI: 10.1097/dss.0000000000003842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) of the ear is associated with poor outcomes. No studies have evaluated current staging system performance in this specific location. OBJECTIVE Describe clinicopathologic characteristics and outcomes of ear cSCC and evaluate the performance of current staging systems. METHODS Retrospective study including cases diagnosed and treated at a cancer center from January 2000 to December 2014. Demographic, clinical, and pathologic data were collected from clinical records. Biopsy slides were rereviewed and patients were staged according to the American Joint Committee on Cancer (AJCC) seventh, eighth, and Brigham Women's Hospital (BWH) staging. RESULTS Of 125 patients, the mean age at diagnosis was 71.9 years (SD 12.5), with most men (89.6%, n = 112). Median follow-up was 22.3 months. Local recurrence and survival risk factors were similar to cSCC outside the ear. The Akaike's Information Criterion (AIC) estimates showed that the BWH system better predicted outcomes than the AJCC seventh, and the AJCC eighth, with AIC values of 189.9, 270.5, and 274.1, respectively. Limitations of the study include retrospective design, single center study, and no control group. CONCLUSION Current staging systems perform well at stratifying risk in ear cSCC.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shoko Mori
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Karen Connolly
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kalee Shah
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen W. Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony M. Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erica H. Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kishwer S. Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Müller CSL, Hauer N, Kofler K, Kofler L. [Micrographic controlled surgery in everyday dermatosurgery]. Dermatologie (Heidelb) 2023:10.1007/s00105-023-05158-x. [PMID: 37249657 DOI: 10.1007/s00105-023-05158-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/31/2023]
Abstract
Micrographic controlled surgery (MCS) has become established in dermatosurgery in recent years and includes various methods to enable the histologically proven complete resection of malignant cutaneous tumors, while at the same time sparing tumor-free tissue in the immediate vicinity as much as possible. MCS is of great importance in the surgical treatment of cutaneous malignancies in so-called problem locations and aggressive tumor subtypes. Indications for MCS include basal cell carcinoma, cutaneous squamous cell carcinoma, Bowen's disease and Bowen's carcinoma, melanoma in chronic light-damaged skin with acral lentiginous melanoma, dermatofibrosarcoma protuberans (DFSP), and Merkel cell carcinoma. However, other tumor entities are also treated using MCS, such as extramammary Paget's disease and various cutaneous sarcomas. All procedures subsumed under MCS have in common the marking of the surgical specimen for topographical orientation, which provides assignment of remaining tumor remnants. Various methods of MCS (3D histology, the horizontal method or Mohs surgery) are presented in this article. Furthermore, this article aims to raise awareness of the possibilities and limitations of micrographically controlled surgery.
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Affiliation(s)
- Cornelia Sigrid Lissi Müller
- MVZ für Histologie, Zytologie und molekulare Diagnostik Trier GmbH, Wissenschaftspark Trier, Max-Planck-Str. 5 und 17, 54296, Trier, Deutschland.
- Medizinische Fakultät, Universität des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
| | - Nina Hauer
- MVZ für Histologie, Zytologie und molekulare Diagnostik Trier GmbH, Wissenschaftspark Trier, Max-Planck-Str. 5 und 17, 54296, Trier, Deutschland
| | - Katrin Kofler
- Universitätshautklinik, Studienzentrum Operative Dermatologie, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- skin + more MVZ GmbH, Holzmarkt 6, 88400, Biberach, Deutschland
| | - Lukas Kofler
- Universitätshautklinik, Studienzentrum Operative Dermatologie, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- skin + more MVZ GmbH, Holzmarkt 6, 88400, Biberach, Deutschland
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15
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Abstract
Skin cancer is the most common malignancy in the world, and the majority of cases affect the skin of the head and neck. The face is a particularly emotive area for patients who often present with a lesion that is causing them concern. This article reviews the identification, diagnosis and principles of management of non-melanoma skin cancer of the head and neck. There are many lesions of the skin which are benign and mimic skin cancer. The differential of head and neck skin lesions and how to determine their nature is discussed. The vast majority of non-melanoma skin cancer are basal cell carcinoma, followed by squamous cell carcinoma. These and the other types of non-melanoma skin cancer are described and illustrated. Current methods of clinical identification, diagnosis and evaluation of skin cancers are clarified, and contemporary treatment paradigms are presented.
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Affiliation(s)
- Nick Roland
- Department of Otolaryngology/Head and Neck Surgery, Liverpool University Hospital Trust, Liverpool, UK
| | - Aamir Memon
- Department of Dermatology, Ramsay Renacres Hall Hospital, Halsall, Ormskirk, UK
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16
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Singh G, Tolkachjov SN, Farberg AS. Incorporation of the 40-Gene Expression Profile (40-GEP) Test to Improve Treatment Decisions in High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients: Case Series and Algorithm. Clin Cosmet Investig Dermatol 2023; 16:925-935. [PMID: 37051586 PMCID: PMC10083143 DOI: 10.2147/ccid.s403330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
Cutaneous squamous cell carcinoma (cSCC) has become a significant public health issue due to its rapidly rising incidence and an estimated 1.8 million newly diagnosed cases annually. As with other cancers, treatment decisions for patients with cSCC are based primarily on a patient's risk for poor outcomes. There has been improvement in clinicopathologic factor-based risk assessment approaches, either through informal methods or ever evolving staging approaches. However, these approaches misidentify patients who will eventually have disease progression as low-risk and conversely, over classify patients as high-risk who do not experience relapse. To improve the accuracy of risk assessment for patients with cSCC, the 40-gene expression profile (40-GEP) test has been validated to show statistically significant stratification of a high-risk cSCC patient's risk of nodal or distant metastasis, independent of currently available risk-assessment methods. The 40-GEP test allows for a more accurate classification of metastatic risk for high-risk cSCC patients, with the aim to influence appropriate allocation of clinician time and therapeutic resources to those patients who will most benefit. The objective of this article is to present a treatment algorithm in which clinicians can easily integrate the results of the 40-GEP test into their current treatment approaches to tailor patient care based on individual tumor biology. The following modalities were considered: surveillance imaging, sentinel lymph node biopsy (SLNB), adjuvant radiation therapy (ART), and clinical follow-up. The authors have contributed their own cases for discussion as to how they have seen the beneficial impact of 40-GEP test results in their own practice. Overall, clinicians can identify risk-aligned treatment pathway improvements with the use of the 40-GEP test for challenging to manage, high-risk cSCC patients.
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Affiliation(s)
| | - Stanislav N Tolkachjov
- Epiphany Dermatology, Dallas, TX, USA
- University of Texas at Southwestern, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
- Texas A&M College of Medicine, Dallas, TX, USA
| | - Aaron S Farberg
- Texas A&M College of Medicine, Dallas, TX, USA
- Bare Dermatology, Dallas, TX, USA
- Baylor Scott & White Health System, Dallas, TX, USA
- Correspondence: Aaron S Farberg, Bare Dermatology, 2110 Research Row, Dallas, TX, 75235, USA, Tel +1 847-721-2725, Email
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17
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Brewer CF, Chawla R, Patel AJK. Galea vs periosteum: impact of excision depth on outcomes for cutaneous squamous cell carcinoma of the scalp. J Plast Surg Hand Surg 2023; 57:253-256. [PMID: 35412400 DOI: 10.1080/2000656x.2022.2060993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cutaneous squamous-cell carcinoma (cSCC) is the second most common skin cancer, with local recurrence rates of up to 10% in the scalp. To date there have been no direct comparisons of recurrence rates or deep margin involvement for surgical excision to different anatomical layers of the scalp. A multi-centre retrospective study of all cSCC excised from the scalp from 2015 to 2020 was conducted. Two hundred and seventy nine patients (17-female, 262-male) met the inclusion criteria (median age 82.2 years), incorporating a total of 302 cSCC's. Primary excision depth was galea in 80 cases and periosteum in 222 (26.5% and 73.5% respectively). A significantly greater proportion of lesions excised to galea had involved or close (<1mm) deep margins (n = 27, 33.8% galea vs n = 50, 22.5% periosteum, OR 2.74 [95% CI 1.38-5.45], p = .004). Local recurrence rates were also significantly higher for lesions excised to galea vs periosteum (n = 13, 16.3% vs n = 18, 8.1% respectively, p = .039), although this trend was lost after adjusting for deep margin status. To our knowledge, this study is the first to compare local recurrence rates and margin involvement for cSCC of the scalp excised to different depths. Our findings demonstrate a higher incidence of involved/close deep margins for lesions excised to galea, imposing a higher treatment burden and risk of recurrence for these patients. We therefore advocate including galea in surgical excision.
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Affiliation(s)
- Christopher F Brewer
- Department of Plastic and Reconstructive Surgery, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Reema Chawla
- Department of Plastic and Reconstructive Surgery, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Animesh J K Patel
- Department of Plastic and Reconstructive Surgery, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
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18
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Ascierto PA, Schadendorf D. Update in the treatment of non-melanoma skin cancers: the use of PD-1 inhibitors in basal cell carcinoma and cutaneous squamous-cell carcinoma. J Immunother Cancer 2022; 10:jitc-2022-005082. [PMID: 36455990 PMCID: PMC9716987 DOI: 10.1136/jitc-2022-005082] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 12/05/2022] Open
Abstract
Non-melanoma skin cancer (NMSC) includes a wide range of cutaneous tumors, the most frequent of which are basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (CSCC). Although NMSC is usually cured by surgical resection, in rare cases it can progress to locally advanced and metastatic disease. Risk factors for advanced disease include comorbidities, neglect, and immunosuppression. Advanced NMSC may require systemic treatment if surgery and radiation are not feasible. Chemotherapy, epidermal growth factor receptor (EGFR) inhibitors in CSCC, and hedgehog inhibitors in BCC have been used but are generally of limited benefit, with responses often short-lived and toxicity issues. Given the high mutational burden of NMSC, the use of immunotherapy has been investigated and two anti-PD-1 antibodies, cemiplimab and pembrolizumab, are approved for the treatment of advanced CSCC not curable by surgery or radiation. Both have shown durable responses with good tolerability in patients in phase II trials and anti-PD-1 therapy is now the standard of care for locally advanced and metastatic CSCC. PD-1 blockade is also approved as second-line therapy in advanced BCC, with frequent and durable responses after failure on hedgehog inhibitor therapy. PD-1 checkpoint inhibition is being assessed for NMSC in combination with other modalities, including oncolytic viruses and EGFR inhibitors. Adjuvant and neoadjuvant use of cemiplimab and pembrolizumab is also being investigated with several ongoing trials. Further clinical trials of immunotherapy must be prioritized in NMSC for further improvement in outcomes.
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Affiliation(s)
- Paolo A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Innovative Therapy, National Cancer Institute IRCCS Pascale Foundation, Napoli, Italy
| | - Dirk Schadendorf
- Department for Dermatology, Venerology and Allergology, University Hospital Essen & German Cancer Consortium, Partner Site Essen, Essen, Germany
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19
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Kalil GH, Taylor CS, Jefferson GD. A case of head and neck cutaneous squamous cell carcinoma highlighting aggressive perineural features. Radiol Case Rep 2022; 17:4459-4461. [PMID: 36189160 PMCID: PMC9515433 DOI: 10.1016/j.radcr.2022.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 11/21/2022] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer in the United States following basal cell carcinoma. The majority are successfully cured by surgical excision or Mohs microsurgery. A subset of cSCCs are more aggressive and likely to recur locally, spread to regional lymph nodes or even distantly, and can even result in death. High-risk features of cSCC including perineural invasion of nerve >0.1 mm in diameter and invasion beyond the subcutaneous fat are not routinely reported by Mohs microsurgery. Facial cSCC commonly involves branches of the facial nerve (VII) or trigeminal nerve (V). Clinical symptoms associated with cranial nerve VII and V involvement include pain, paresthesia of the face and tongue, facial paralysis. Assessment of nerve involvement by magnetic resonance imaging (MRI) is the most optimal imaging modality. Here, we present a case where Mohs microsurgery was performed on a facial cSCC 1.5 years prior to the development of facial paresis. We aim to highlight the interesting perineural path resulting in facial paralysis and associated symptomatology, the importance of MRI, and to remind clinicians of important high-risk features of cSCC.
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Affiliation(s)
- Grant H. Kalil
- University of Mississippi School of Medicine, 2500 N State St, Jackson, MS 39216, USA
| | - Charlotte S. Taylor
- Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Gina D. Jefferson
- Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, 2500 N State St, 5 East, Jackson, MS 39216, USA
- Corresponding author.
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20
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Akaike T, Cahill K, Akaike G, Huynh ET, Hippe DS, Shinohara MM, Liao J, Apisarnthanarax S, Parvathaneni U, Hall E, Bhatia S, Cheng RK, Nghiem P, Tseng YD. Management and Prognosis of Cardiac Metastatic Merkel Cell Carcinoma: A Case-Control Study and Literature Review. Cancers (Basel) 2022; 14:cancers14235914. [PMID: 36497395 PMCID: PMC9741306 DOI: 10.3390/cancers14235914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Merkel cell carcinoma (MCC), an aggressive neuroendocrine skin cancer, has a high rate (20%) of distant metastasis. Within a prospective registry of 582 patients with metastatic MCC (mMCC) diagnosed between 2003-2021, we identified 9 (1.5%) patients who developed cardiac metastatic MCC (mMCC). We compared overall survival (OS) between patients with cardiac and non-cardiac metastases in a matched case-control study. Cardiac metastasis was a late event (median 925 days from initial MCC diagnosis). The right heart was predominantly involved (8 of 9; 89%). Among 7 patients treated with immunotherapy, 6 achieved a complete or partial response of the cardiac lesion. Among these 6 responders, 5 received concurrent cardiac radiotherapy (median 20 Gray) with immunotherapy; 4 of 5 did not have local disease progression or recurrence in the treated cardiac lesion. One-year OS was 44%, which was not significantly different from non-cardiac mMCC patients (45%, p = 0.96). Though it occurs relatively late in the disease course, cardiac mMCC responded to immunotherapy and/or radiotherapy and was not associated with worse prognosis compared to mMCC at other anatomic sites. These results are timely as cardiac mMCC may be increasingly encountered in the era of immunotherapy as patients with metastatic MCC live longer.
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Affiliation(s)
- Tomoko Akaike
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Correspondence: ; Tel.: +1-206-221-4594
| | - Kelsey Cahill
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Gensuke Akaike
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
- TRA Medical Imaging, Tacoma, WA 98402, USA
| | - Emily T. Huynh
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Michi M. Shinohara
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jay Liao
- Department of Radiation Oncology, University of Washington, Seattle, WA 91895, USA
| | | | - Upendra Parvathaneni
- Department of Radiation Oncology, University of Washington, Seattle, WA 91895, USA
| | - Evan Hall
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Shailender Bhatia
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Richard K. Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, WA 98195, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Yolanda D. Tseng
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
- Department of Radiation Oncology, University of Washington, Seattle, WA 91895, USA
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21
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Bilski M, Cisek P, Baranowska I, Kordzińska-Cisek I, Komaniecka N, Hymos A, Grywalska E, Niedźwiedzka-Rystwej P. Brachytherapy in the Treatment of Non-Melanoma Skin Peri-Auricular Cancers-A Retrospective Analysis of a Single Institution Experience. Cancers (Basel) 2022; 14. [PMID: 36428708 DOI: 10.3390/cancers14225614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
Abstract
The location of skin neoplasms in the area of the ears qualifies patients to the so-called high-risk group. The location of neoplasms within the auricle and around the ear often causes many problems in surgical treatment. This is due to the presence of cartilage, the difficulty of performing procedures with obtaining a visually satisfactory cosmetic effect, especially in the presence of extensive lesions and can lead to positive surgical margins which leads to a high risk of recurrence. In such cases, the use of brachytherapy, both as an independent method and as a complementary method after surgery, may be an effective method of local control with an acceptable risk of radiation complications. However, there are no large retrospective studies on the use of brachytherapy in this anatomical region. The aim of the study was to analyse the effectiveness, toxicity profile, and cosmetic effect of two different brachytherapy techniques (contact and interstitial brachytherapy). Methods: This paper presents the results of a retrospective analysis of 33 patients treated with contact or interstitial high-dose-rate (HDR) brachytherapy for skin cancers of the outer ear, involving the auricle and the skin of the adjacent area. Brachytherapy was used both as a definitive treatment (15 patients—43%) and adjuvant treatment after surgery (18 patients—57%). The basic criterion for adjuvant treatment was a positive or narrow (<1 mm) resection margin. Fraction doses from 3 to 7 Gy per fraction were used at intervals from six hours (interstitial brachytherapy) to a maximum of seven days (contact brachytherapy). The treatment time ranged from 1 to 42 days, and the total dose range was 7 to 49 Gy. The follow-up was 29.75 months (range 2−64). Results: In the group of patients treated with adjuvant therapy, in the patients with post-radiation reaction, the mean time from surgery to the start of brachytherapy was 7.72 ± 3.05 weeks, the median was 8 (6−12) weeks, and in the group without post-radiation reaction, the mean time was 11.13 ± 4.41 weeks, the median time was 11 weeks (8−14). The risk of a post-radiation reaction increased significantly more often in patients with more advanced disease. In the case of contact brachytherapy, the post-radiation reaction occurred significantly more often (14/21 patients—43%) than in the case of interstitial brachytherapy (3/11 patients—9.4%). In patients with post-radiation reactions, a significantly larger volume of the skin receiving a dose of 200% was found, and the volume receiving a dose of 150% was close to statistical significance. The mean volume of the skin receiving a 200% dose in the group with post-radiation reactions was 28.05 ± 16.56 cm3, the median was 24.86 (0.5−52.3) cm3, and the mean volume in the group without post-radiation reaction was 17.98 ± 10.96 cm3, median 14.95 (3.9−44.96) cm3. The result was statistically significant (Z = 2.035, p = 0.041). Conclusion: Interstitial HDR (high-dose-rate) brachytherapy for non-melanoma skin cancers around the ear is highly effective, short, and has a relatively low burden on the patient. The toxicity of the treatment was low. In the case of contact brachytherapy, the toxicity profile is slightly higher but acceptable for patients. This method is preferred in patients in whom interstitial brachytherapy is impossible to perform due to anatomical and logistical reasons. The unquestionable advantage of contact brachytherapy is its ability to be performed on an outpatient basis without the need to stay in the hospital. No severe and late CTCAE ≥III and late RTOG ≥III toxicity was observed. In patients after surgery, in order to minimise the risk of radiation reaction, it is optimal to start treatment at least eight weeks after surgery. In the presence of extensive lesions, the use of interstitial brachytherapy seems to be more advantageous, especially when the expected volume of healthy skin in the dose range of 200% and 150% is above 15 cm3 and 50 cm3, respectively.
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22
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Oh Y, Zheng Z, Kim KY, Xu X, Pei M, Oh B, Kim SK, Chung KY, Roh MR. A nomogram combining clinical factors and biomarkers for predicting the recurrence of high-risk cutaneous squamous cell carcinoma. BMC Cancer 2022; 22:1126. [PMID: 36324094 PMCID: PMC9632077 DOI: 10.1186/s12885-022-10213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Although determining the recurrence of cutaneous squamous cell carcinoma (cSCC) is important, currently suggested systems and single biomarkers have limited power for predicting recurrence. Objective In this study, combinations of clinical factors and biomarkers were adapted into a nomogram to construct a powerful risk prediction model. Methods The study included 145 cSCC patients treated with Mohs micrographic surgery. Clinical factors were reviewed, and immunohistochemistry was performed using tumor tissue samples. A nomogram was constructed by combining meaningful clinical factors and protein markers. Results Among the various factors, four clinical factors (tumor size, organ transplantation history, poor differentiation, and invasion into subcutaneous fat) and two biomarkers (Axin2 and p53) were selected and combined into a nomogram. The concordance index (C-index) of the nomogram for predicting recurrence was 0.809, which was higher than that for the American Joint Committee on Cancer (AJCC) 7th, AJCC 8th, Brigham and Women’s Hospital, and Breuninger staging systems in the patient data set. Conclusion A nomogram model that included both clinical factors and biomarkers was much more powerful than previous systems for predicting cSCC recurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10213-2.
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Affiliation(s)
- Yeongjoo Oh
- Department of Dermatology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Zhenlong Zheng
- Department of Dermatology, Yanbian University Hospital, Yanji City, Jilin Provence, China.,Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ki-Yeol Kim
- Department of Dental Education, BK21 PLuS Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Xiangshu Xu
- Department of Dermatology, Yanbian University Hospital, Yanji City, Jilin Provence, China.,Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Meiling Pei
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byungho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kyem Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Yang Chung
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, 63 Gil 20 Eonju-Ro, Gangnam-Gu, Seoul, 06229, Korea.
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23
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Vonk J, de Wit JG, Voskuil FJ, Koldijk M, Rácz E, Hooghiemstra WT, Doff JJ, Diercks GF, van Dam GM, Witjes MJ, de Visscher SA. Fluorescence molecular imaging using cetuximab-800CW in cutaneous squamous cell carcinoma surgery: a proof-of-concept study. Br J Dermatol 2022; 187:810-812. [PMID: 35762264 PMCID: PMC9804538 DOI: 10.1111/bjd.21722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/20/2022] [Accepted: 06/26/2022] [Indexed: 01/05/2023]
Affiliation(s)
| | | | - Floris J. Voskuil
- Department of Oral & Maxillofacial Surgery,Department of Pathology & Medical Biology
| | | | | | | | | | | | - Gooitzen M. van Dam
- Department of Nuclear Medicine and Molecular ImagingUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands,AxelaRx/TRACER BVGroningenthe Netherlands
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24
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Khorasanchi A, Wu R, Kendra K, Verschraegen C. Recent Advances in Immunotherapy for Patients with Head and Neck Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:5325. [PMID: 36358744 PMCID: PMC9657466 DOI: 10.3390/cancers14215325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Cutaneous squamous cell cancer is a form of skin cancer, which is typically found in older fair-skinned individuals with frequent sun exposure. Most patients present with limited disease and can be treated with a combination of surgery and/or radiation with favorable outcomes. A small percentage of patients present with more aggressive, widespread disease. Immunotherapy has dramatically improved outcomes and has become the preferred treatment option for these patients. In this review article, the rationale for using immunotherapy in patients with squamous cell skin cancer is discussed. A summary of the new treatment options currently being explored is also provided. Abstract Cutaneous squamous cell carcinoma (CSCC) is the second most common non-melanoma skin cancer. A majority of patients present with localized disease, but some can present with locally advanced or metastatic disease. Most of these advanced cases occur in the anatomical head and neck region and are associated with more aggressive disease, necessitating prompt and effective treatment. Prior to the emergence of immunotherapy, systemic treatment options were limited to platinum-based chemotherapy and salvaged with targeted epidermal growth factor therapy. These therapies were associated with poor efficacy and increased toxicity in an often frail, older population. Immunotherapy has dramatically improved outcomes in this patient population due to its favorable side effect profile, durable treatment response, and improved overall outcomes. In this review, an overview of the recent advances of immunotherapy in the management of CSCC in the anatomical head and neck region is provided, with a focus on advanced presentations.
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25
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van Lee CB, Kouloubis N, Wakkee M, Kelleners-Smeets NWJ, Nellen RGL, van Rengen A, de Vijlder HC, Wijne LCC, Nijsten T, van den Bos RR. Rate and Characteristics of Incompletely Excised Cutaneous Squamous Cell Carcinoma: A Dermatological Daily Practice Multicenter Prospective Cohort Study. Dermatol Surg 2022. [PMID: 36194767 DOI: 10.1097/DSS.0000000000003606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Incomplete excision of squamous cell carcinoma (cSCC) is associated with an increased risk of recurrence, metastasis, and mortality. OBJECTIVE To determine the rate and characteristics of incompletely excised cSCC in a dermatological daily practice setting. METHODS Prospective study of all patients who gave informed consent, with a cSCC treated with standard excision (SE) at 1 of 6 Departments of Dermatology in the Netherlands between 2015 and 2017. Pathological reports were screened to detect all incompletely excised cSCCs. RESULTS A total of 592 patients with 679 cSCCs were included, whereby most cases were low risk cSCC (89%). The rate of incompletely excised cSCC was 4% (n = 26), and the majority were high-risk cSCCs of which 24 invaded the deep excision margin. CONCLUSION This prospective study showed that in a dermatological setting, the risk of an incompletely excised cSCC is low (4%) for a cohort that was dominated by low-risk cSCCs. Most incompletely excised cSCCs were of high risk, and incompleteness was almost always at the deep margins. These results suggest that for high-risk cSCC, one should pay attention especially to the deep margin when performing SE, and/or microscopic surgery should be considered.
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26
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Fraga SD, Besaw RJ, Murad F, Schmults CD, Waldman A. Complete Margin Assessment Versus Sectional Assessment in Surgically Excised High-Risk Keratinocyte Carcinomas: A Systematic Review and Meta-Analysis. Dermatol Surg 2022; 48:704-710. [PMID: 35778249 DOI: 10.1097/dss.0000000000003462] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Keratinocyte carcinomas (KCs) are the most diagnosed cancers worldwide and are commonly excised via complete margin assessment (CMA) or excision with sectional assessment (SA). National Comprehensive Cancer Network guidelines encourage CMA for KC with high-risk features. OBJECTIVE To systematically compare recurrence outcomes for CMA vs SA in high-risk KC based on National Comprehensive Cancer Network guidelines criteria. MATERIALS AND METHODS EMBASE and MEDLINE were searched for articles reporting recurrences of high-risk KC undergoing excision using CMA or SA. High-risk KCs were defined as recurrent, having perineural invasion (PNI), or basal cell carcinomas (BCC) with aggressive histology. Chi-squared tests and risk ratios evaluated differences between CMA and SA groups, and a random-effects meta-analysis was performed. RESULTS Twenty-eight studies met inclusion criteria. Pooled percentages of locoregional recurrences were significantly lower with CMA vs SA for all KCs (3.9% [95% CI: 2.9-4.9] vs 13.5% [7.7, 19.2, p = .001]), cutaneous squamous cell carcinoma with PNI (9.8% [5.4-14.1] vs 32.0% [25.0-39.0], p < .001), and recurrent BCC (4.4% [2.9-5.9] vs 11.9% [8.0-15.8], p < .001). CONCLUSION For high-risk KCs, recurrence risk was over 3-times greater with SA compared with CMA. Expanded access to CMA for high-risk KC is likely to reduce recurrence risk and improve clinical outcomes.
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Affiliation(s)
- Sophia D Fraga
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert J Besaw
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abigail Waldman
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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27
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Kim MJ, Lim H, Park DH. Current strategies for aesthetic soft tissue refinement in nasal reconstruction. Arch Craniofac Surg 2022; 23:95-102. [PMID: 35811340 PMCID: PMC9271655 DOI: 10.7181/acfs.2022.00689] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/18/2022] [Indexed: 11/25/2022] Open
Abstract
The challenges of successful nasal reconstruction, which are related to the anatomical complexity of the region, have been extensively studied. Revisional operations are often required to achieve proper nasal reconstruction, with results resembling the premorbid nasal status. This is necessary to ensure the quality of life of skin cancer patients. Fundamental nasal reconstruction requires both proper soft tissue coverage and proper function. However, earlier studies in the field primarily focused on the functional aspect of nose reconstruction, although the cosmetic aspect is also an important factor to consider. In response to this need, many recent studies on nose reconstruction have proposed various refinement strategies to improve aesthetic satisfaction. Most plastic surgeons accept the nasal aesthetic subunit principle as a standard for nasal reconstruction. This review outlines the commonly used surgical refinement options and management strategies for postoperative complications based on the subunit principle. In patients with nasal defects, a proper technical strategy might help minimize revision operations and optimize the long-term results.
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Affiliation(s)
- Min Ji Kim
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hyoseob Lim
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Dong Ha Park
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
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28
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Tang TY, Tang JY, Chu-Sung Hu S, Chiao-Li Ke K, Cheng ST. Electronic brachytherapy for non-melanoma skin cancer in Asians: Experience from a Taiwan medical center. J Formos Med Assoc 2022; 121:2317-2323. [DOI: 10.1016/j.jfma.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 10/31/2022] Open
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29
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Hunt WTN, Earp E, Brown AC, Veitch D, Wernham AGH. A review of Mohs Micrographic Surgery for skin cancer: Part 3 - Squamous Cell Carcinoma. Clin Exp Dermatol 2022; 47:1765-1773. [PMID: 35315541 DOI: 10.1111/ced.15187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
This review is part three of a series assessing the evidence for Mohs micrographic surgery (MMS) for treatment of cutaneous malignancies. The evidence for using MMS to treat cutaneous squamous cell carcinoma (cSCC) is presented and discussed. Medline, Embase and Cochrane databases were searched and 39 papers were identified. We included all clinical trials and observational studies including retrospective reports. We excluded editorials and systematic reviews or meta-analyses. We categorised the evidence under the following headings: tumour recurrence, specific site outcomes (ear, lip, scalp and periocular), cSCC with PNI, and cost effectiveness. Whilst there are many observational studies indicating the potential benefits of MMS in the management of certain cSCCs, no randomised controlled trials (RCT) were identified. This evidence suggests that MMS has a lower recurrence rate than other treatments for cSCC, including standard excision. Many studies were single-armed, having no comparator but do demonstrate a low to very low recurrence rate of cSCC following MMS. Further methodologically robust studies with comparator arms are needed, including RCT evidence, given the overall quality of included studies was low and highly heterogeneous.
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Affiliation(s)
- William T N Hunt
- Department of Dermatology, University Hospitals Plymouth NHS Trust, UK
| | - Eleanor Earp
- Department of Dermatology, Lauriston Building, Lauriston Place, Edinburgh, UK
| | | | - David Veitch
- Department of Dermatology, Leicester University Hospitals NHS Trust, Leicester, UK
| | - Aaron G H Wernham
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK.,Department of Dermatology, Leicester University Hospitals NHS Trust, Leicester, UK
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30
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Kofler K, Breuninger H, Eigentler T, Kofler L, Schaefer V, Blumenstock G, Häfner HM, Schnabl SM. Local Tumor Infiltration and Locoregional Recurrence in Desmoplastic Cutaneous Squamous Cell Carcinoma. Dermatol Surg 2022; 48:283-289. [PMID: 34966121 DOI: 10.1097/dss.0000000000003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Perusal of the literature of cutaneous squamous cell carcinoma (SCC) reveals that the role of the desmoplastic subtype is indistinct. Data on local infiltration and recurrence are inconsistent dependent on surgical technique, histological method, and investigated collective. OBJECTIVE The aim of the study was to analyze local infiltration and locoregional recurrence of the desmoplastic subtype under a uniform procedure. METHODS AND MATERIALS Between 2005 and 2015, 320 SCCs were analyzed and histological sections of all tumors were examined. Data collection included locoregional recurrence, metastasis rate, and tumor-specific death. The median follow-up was 36.5 months. RESULTS The desmoplastic subtype required significant more re-excisions (70.0% vs 23.9%, p < .001), more interventions until tumor-free margins were achieved (maximal 6 vs 2; p < .001), showed more widespread tumor infiltration with larger excisional margins (median 9 mm, 2-51 mm vs median 4 mm, 1-10 mm; p < .001), and a 5-fold higher local recurrence rate (26.7% vs 5.0%, p < .001). The metastasis rate (16.6% vs 2.3%, p < .001) was increased. CONCLUSION The desmoplastic subtype is characterized by a widespread local infiltration associated with perineural infiltration. It seems to be a marker for decreased histological detectability with a high rate of locoregional recurrence and metastasis.
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Affiliation(s)
| | | | | | | | | | - Gunnar Blumenstock
- Clinical Epidemiology and Applied Biometry, University of Tuebingen, Tuebingen, Germany
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31
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Stanganelli I, Spagnolo F, Argenziano G, Ascierto PA, Bassetto F, Bossi P, Donato V, Massi D, Massone C, Patuzzo R, Pellacani G, Quaglino P, Queirolo P, Zalaudek I, Palmieri G; on behalf of Italian Melanoma Intergroup (IMI). The Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma: A Comprehensive Review and Clinical Recommendations by a Panel of Experts. Cancers (Basel) 2022; 14:377. [PMID: 35053539 PMCID: PMC8773547 DOI: 10.3390/cancers14020377] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 12/19/2022] Open
Abstract
Cutaneous squamous cell carcinomas (CSCC) account for about 20% of all keratinocyte carcinomas, which are the most common form of cancer. Heterogeneity of treatments and low mortality are a challenge in obtaining accurate incidence data and consistent registration in cancer registries. Indeed, CSCC mostly presents as an indolent, low-risk lesion, with five-year cure rates greater than 90% after surgical excision, and only few tumors are associated with a high-risk of local or distant relapse; therefore, it is particularly relevant to identify high-risk lesions among all other low-risk CSCCs for the proper diagnostic and therapeutic management. Chemotherapy achieves mostly short-lived responses that do not lead to a curative effect and are associated with severe toxicities. Due to an etiopathogenesis largely relying on chronic UV radiation exposure, CSCC is among the tumors with the highest rate of somatic mutations, which are associated with increased response rates to immunotherapy. Thanks to such strong pre-clinical rationale, clinical trials led to the approval of anti-PD-1 cemiplimab by the FDA (Food and Drug Administration) and EMA (European Medicines Agency), and anti-PD-1 pembrolizumab by the FDA only. Here, we provide a literature review and clinical recommendations by a panel of experts regarding the diagnosis, treatment, and follow-up of CSCC.
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32
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Brambullo T, Azzena GP, Toninello P, Masciopinto G, De Lazzari A, Biffoli B, Vindigni V, Bassetto F. Current Surgical Therapy of Locally Advanced cSCC: From Patient Selection to Microsurgical Tissue Transplant. Review. Front Oncol 2021; 11:783257. [PMID: 34950589 PMCID: PMC8690035 DOI: 10.3389/fonc.2021.783257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Among the non-melanoma skin cancers (NMSC) the squamous cell carcinoma (SCC) is one of the most challenging for the surgeon. Local aggressiveness and a tendency to metastasize to regional lymph nodes characterize the biologic behavior. The variants locally advanced and metastatic require wide excision and node dissection. Such procedures can be extremely detrimental for patients. The limit of the surgery can be safely pushed forward with a multidisciplinary approach. The concept of skin oncoplastic surgery, the ablative procedures and the reconstructive options (skin graft, pedicled flap, microsurgical free flap) are discussed together with a literature review.
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Affiliation(s)
- Tito Brambullo
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Gian Paolo Azzena
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Paolo Toninello
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Giuseppe Masciopinto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Alberto De Lazzari
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Bernardo Biffoli
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Franco Bassetto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
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33
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Moreno-Ramírez D, Silva-Clavería F, Fernández-Orland A, Eiris N, Ruiz de Casas A, Férrandiz L. Surgery for Cutaneous Squamous Cell Carcinoma and its Limits in Advanced Disease. Dermatol Pract Concept 2021; 11:e2021167S. [PMID: 34877075 DOI: 10.5826/dpc.11s2a167s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 10/31/2022] Open
Abstract
Surgery remains the first-line therapeutic option for most patients with cutaneous squamous cell carcinoma (cSCC). However, in the current therapeutic landscape, surgery must attempt to the complete tumor resection (R0 resection) with the lowest risk of surgical complications. This double aim is usually accomplished through standard excision with clinical margins in patients with low-risk tumors or by some of the micrographically controlled surgery procedures for patients with tumors at high-risk of local recurrence and metastasis. Surgery is also a first-line treatment for nodal metastases of cSCC as well as an option to consider in patients who develop recurrences while receiving immunotherapy, or as a palliation procedure in patients with advanced tumors. Neoadjuvant immunotherapy, that is the use of a medical treatment before surgery, is under investigation in patients with cSCC. The decision-making process and guidelines recommendations regarding cSCC surgery are reviewed in this manuscript.
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Affiliation(s)
- David Moreno-Ramírez
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Francisca Silva-Clavería
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Almudena Fernández-Orland
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Noemí Eiris
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Andrés Ruiz de Casas
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Lara Férrandiz
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
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de Jong E, Lammerts MUPA, Genders RE, Bouwes Bavinck JN. Update of advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2021; 36 Suppl 1:6-10. [PMID: 34855246 PMCID: PMC9299882 DOI: 10.1111/jdv.17728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022]
Abstract
The incidence of cutaneous squamous cell carcinoma (cSCC) is rapidly increasing. A growing part of this patient group is formed by immunocompromised patients, for example organ-transplant recipients (OTR). Although over 90% of the cSCC show a relatively harmless clinical behaviour, there is also a chance of developing advanced cSCC and metastases. Locally advanced cSCC are defined as cSCC that have locally advanced progression and are no longer amenable to surgery or radiation therapy. Better understanding of the clinical behaviour of cSCC is essential to discriminate between low- and high-risk cSCC. Staging systems are important and have recently been improved. Genetic characterisation of SCC will likely become an important tool to help distinguish low and high-risk cSCC with an increased potential to metastasise in the near future. Available treatments for high-risk and advanced cSCC include surgery, radiotherapy, chemotherapy and targeted therapy with epidermal growth factor receptors inhibitors. Anti-PD-1 antibodies show promising results with response rates of up to 50% in both locally advanced and metastatic cSCC but, in its present form, is not suitable for OTR.
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Affiliation(s)
- E de Jong
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M U P A Lammerts
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
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Abstract
Nearly two million cases of cutaneous squamous cell carcinoma (cSCC) are diagnosed every year in the United States alone. cSCC is notable for both its prevalence and its propensity for invasion and metastasis. For many patients, surgery is curative. However, patients experiencing immunosuppression or recurrent, advanced, and metastatic disease still face limited therapeutic options and significant mortality. cSCC forms after decades of sun exposure and possesses the highest known mutation rate of all cancers. This mutational burden complicates efforts to identify the primary factors driving cSCC initiation and progression, which in turn hinders the development of targeted therapeutics. In this review, we summarize the mutations and alterations that have been observed in patients’ cSCC tumors, affecting signaling pathways, transcriptional regulators, and the microenvironment. We also highlight novel therapeutic opportunities in development and clinical trials.
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Affiliation(s)
- Stephenie Droll
- Department of Molecular Biosciences, Northwestern University, Evanston, IL, USA
| | - Xiaomin Bao
- Department of Molecular Biosciences, Northwestern University, Evanston, IL, USA, .,Department of Dermatology, Northwestern University, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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36
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Fania L, Massone C, Cusano F, Fantini F, Dellambra E, Samela T, Passarelli F, Morese R, Tartaglione T, Maggiore M, Gentile P, Falchetto Osti M, Sampogna F, Pallotta S, Abeni D, Marchetti P, Naldi L. Integrated care pathways and the hub-and-spoke model for the management of non-melanoma skin cancer: A proposal of the Italian Association of Hospital Dermatologists (ADOI). Dermatol Reports 2021; 13:9278. [PMID: 34497705 PMCID: PMC8404423 DOI: 10.4081/dr.2021.9278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
The term non-melanoma skin cancer (NMSC) refers to skin cancer different from melanoma, and it is usually restricted to basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and their pre-cancerous lesions, e.g., actinic keratosis. These conditions represent the most frequent tumors in Caucasians and are characterized by an increasing incidence worldwide and a high socio-economic impact. The term Integrated Care Pathway (ICP) refers to "a complex intervention for the mutual decision making and organization of care processes for a well-defined group of patients during a well-defined period". The purpose of this paper is to present a proposal from the Italian Association of Hospital Dermatologists (ADOI) for an ICP organization of care of NMSC, considering the hub-and-spoke model in the different geographical areas. This proposal is based on the most recent literature and on documents from the Italian Association of Medical Oncology (AIOM), the European consensus-based interdisciplinary guidelines from the European Association of Dermato- Oncology (EADO), and the National Comprehensive Cancer Network (NCCN). We initially discuss the NMSC outpatient clinic, the role of the multidisciplinary working groups, and the hub-and-spoke model regarding this topic. Then, we define the ICP processes specific for BCC and SCC. The ICP for NMSC is an innovative strategy to guarantee the highest possible quality of health care while the hub-andspoke model is crucial for the organization of different health care structures. Considering the importance on this topic, it is essential to create a valid ICP together with an efficient organization within the different geographical areas.
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Affiliation(s)
- Luca Fania
- IDI-IRCCS, Dermatological Research Hospital, Rome
| | | | | | | | | | - Tonia Samela
- IDI-IRCCS, Dermatological Research Hospital, Rome
| | | | | | | | | | - Piercarlo Gentile
- University of Pittsburgh Medical Center, San Pietro Fatebenefratelli, Rome
| | | | | | | | | | | | - Luigi Naldi
- Centro Studi GISED, Bergamo and San Bortolo Hospital, Vicenza, Italy
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Ansai SI, Umebayashi Y, Katsumata N, Kato H, Kadono T, Takai T, Namiki T, Nakagawa M, Soejima T, Koga H, Sugaya M. Japanese Dermatological Association Guidelines: Outlines of Guidelines for Cutaneous Squamous Cell Carcinoma 2020. J Dermatol 2021; 48:e288-e311. [PMID: 33963604 DOI: 10.1111/1346-8138.15889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 01/04/2023]
Abstract
In consideration of the development of treatment options for squamous cell carcinoma (SCC), the Japanese Skin Cancer Society issued the first guidelines of SCC in 2007 and revised them in 2015. Here, we report the English version of the 2020 edition of the Japanese SCC guidelines. The first half of this article is an overview of SCC including actinic keratosis and Bowen's disease, and the second half discusses three clinical questions: (i) treatment of actinic keratosis; (ii) determination of the resection margin of the primary lesion; and (iii) treatment of radically incurable cases, as contemporary problems encountered in treating SCC. In these evaluations, all processes were implemented according to the Grading of Recommendations, Assessment, Development, Evaluation system. Also, items of recommendation concerning each clinical question were determined by a multidisciplinary expert panel consisting of dermatologists, plastic/reconstructive surgeons, radiologists, and oncologists through a comprehensive literature search and systematic reviews.
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Affiliation(s)
- Shin-Ichi Ansai
- Division of Dermatology and Dermatopathology, Nippon Medical School Musashi Kosugi-Hospital, Kawasaki, Japan
| | - Yoshihiro Umebayashi
- Department of Dermatology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Noriyuki Katsumata
- Department of Medical Oncology, Nippon Medical School Musashi Kosugi-Hospital, Kawasaki, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takafumi Kadono
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshihiro Takai
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Takeshi Namiki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Nakagawa
- Department of Plastic and Reconstructive Surgery, Shizuoka Prefectural Cancer Center, Nagaizumi, Japan
| | | | - Hiroshi Koga
- Department of Dermatology, Shinshu University, Matsumoto, Japan
| | - Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Narita, Japan
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González A, Etchichury D, Rivero JM, Adamo L. Squamous cell carcinoma of the external ear: 170 cases treated with Mohs surgery. J Plast Reconstr Aesthet Surg 2021; 74:2999-3007. [PMID: 33967017 DOI: 10.1016/j.bjps.2021.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/11/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Squamous cell carcinoma of the ear (SCC-E) shows high rates of local recurrence (LR) and lymph node metastases (NM). SCC-E is the leading cause of death from nonmelanoma skin cancer. OBJECTIVE To determine the LR and NM rates and survival after Mohs micrographic surgery (MMS). PATIENTS AND METHODS We treated 170 invasive SCC-E with MMS with a mean follow up of 48 months. Mean age was 76 years, 93.2% were male patients, mean size: 1.5 cm, and 61.8% of the tumours were well differentiated. RESULTS We observed 5 LRs, 2 locoregional recurrences, and 16 NMs in 23 patients. LR and NM rates were 4.1% and 10.6%, respectively. Only 3/25 recurrences occurred after 2 years of follow up. We observed 1(0.6%) distant metastasis (DM) in a patient who also presented LR + NM. Six out of seven cases with LR and 8/18 with NM died of disease, regardless of aggressive surgical rescue with or without adjuvant radiotherapy. Five-year overall survival, disease-free survival, and disease-specific survival were 81%, 82.6%, and 89.7%, respectively. CONCLUSIONS Undeniably, the outcome in SCC-E is determined by locoregional control. DM are sporadic and rarely the cause of death. Systematic reviews and retrospective studies show a solid trend in favor of MMS vs surgical excision. The LR rate of this series (4.1%) is one of the lowest published to date with regard to SCC-E, and confirms this assertion. We observed 10.6% NMs according to other series that treated the whole spectrum of SCC-E. Almost 2/3 of patients with NMs die after therapeutic rescue. We believe that it is essential to identify prognostic factors to select patients for one of the following: close surveillance (ultrasonography) during the first 2 years after surgery, sentinel node biopsy, or elective treatment of the nodes (surgery or radiotherapy).
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Affiliation(s)
- Abel González
- Angel H. Roffo Oncology Institute, Mohs Surgery Unit, Head and Neck Department, Alexander Fleming Institute, Skin Cancer Oncology, 1180 Cramer St., CABA (ZIP 1426), Buenos Aires, Argentina.
| | - Dardo Etchichury
- Angel H. Roffo Oncology Institute, Mohs Surgery Unit, Head and Neck Department, Alexander Fleming Institute, Skin Cancer Oncology, 1180 Cramer St., CABA (ZIP 1426), Buenos Aires, Argentina
| | - Juan Mario Rivero
- Angel H. Roffo Oncology Institute, Mohs Surgery Unit, Head and Neck Department, Alexander Fleming Institute, Skin Cancer Oncology, 1180 Cramer St., CABA (ZIP 1426), Buenos Aires, Argentina
| | - Lucia Adamo
- Angel H. Roffo Oncology Institute, Mohs Surgery Unit, Head and Neck Department, Alexander Fleming Institute, Skin Cancer Oncology, 1180 Cramer St., CABA (ZIP 1426), Buenos Aires, Argentina
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Massey PR, Gupta S, Rothstein BE, Konnikov N, Mahalingam M, Ruiz ES, Schmults CD, Waldman A. Total Margin-Controlled Excision is Superior to Standard Excision for Keratinocyte Carcinoma on the Nose: A Veterans Affairs Nested Cohort Study. Ann Surg Oncol 2021; 28:3656-3663. [PMID: 33742233 DOI: 10.1245/s10434-021-09604-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Keratinocyte carcinoma (KC), including basal and squamous cell carcinoma, is the most common human malignancy. Limited real-world data have compared surgical outcome or cost between total margin-controlled excision (TMCE) and standard excision (SE), the two most common treatments for invasive KC. We compared reconstruction, margin status, and cost between TMCE and SE for KC on the nose at a Veterans Affairs (VA) healthcare system. METHODS Randomly selected primary KCs on the nose ≤3 cm that were confined to soft tissue, without nerve or lymphovascular invasion, and treated with SE or TMCE between 2000 and 2010, were assessed. Utilization of flap or graft reconstruction and margin status following all surgical attempts were recorded. Costs were based on Current Procedural Terminology codes standardized to 2019 Medicare payments. RESULTS Overall, 148 cases were included in each treatment group. Baseline characteristics were similar between groups, although SE tumor median diameter was 1 mm larger. SE was associated with increased utilization of flap or graft reconstruction (odds ratio 2.05, 95% confidence interval 1.16-3.59, p = 0.01). Positive margins were present in 24% of SEs initially and remained positive after the final recorded excision in 9% of cases. No positive final margins were noted in TMCE cases. SE cost per tumor was significantly higher than TMCE ($429.03 ± 143.55; p = 0.003). CONCLUSIONS Surgical management of KC with SE is associated with increased reconstruction complexity, a significant risk of positive margins, and higher cost compared with TMCE. The 23% risk of positive margins supports National Comprehensive Cancer Network guidelines for the treatment of high-risk KC with TMCE, unless delayed reconstruction is employed.
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Affiliation(s)
- Paul R Massey
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sameer Gupta
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Nellie Konnikov
- Department of Dermatology, Veterans Affairs, Boston Healthcare System, Boston, MA, USA
| | - Meera Mahalingam
- Dermatopathology Section, Department of Pathology and Laboratory Medicine, Veterans Affairs, Boston Healthcare System, Boston, MA, USA
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Veterans Affairs, Boston Healthcare System, Boston, MA, USA
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abigail Waldman
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Dermatology, Veterans Affairs, Boston Healthcare System, Boston, MA, USA.
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Fania L, Didona D, Di Pietro FR, Verkhovskaia S, Morese R, Paolino G, Donati M, Ricci F, Coco V, Ricci F, Candi E, Abeni D, Dellambra E. Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines 2021; 9:171. [PMID: 33572373 DOI: 10.3390/biomedicines9020171] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC), a non-melanoma skin cancer, is a keratinocyte carcinoma representing one of the most common cancers with an increasing incidence. cSCC could be in situ (e.g., Bowen’s disease) or an invasive form. A significant cSCC risk factor is advanced age, together with cumulative sun exposure, fair skin, prolonged immunosuppression, and previous skin cancer diagnoses. Although most cSCCs can be treated by surgery, a fraction of them recur and metastasize, leading to death. cSCC could arise de novo or be the result of a progression of the actinic keratosis, an in situ carcinoma. The multistage process of cSCC development and progression is characterized by mutations in the genes involved in epidermal homeostasis and by several alterations, such as epigenetic modifications, viral infections, or microenvironmental changes. Thus, cSCC development is a gradual process with several histological- and pathological-defined stages. Dermoscopy and reflectance confocal microscopy enhanced the diagnostic accuracy of cSCC. Surgical excision is the first-line treatment for invasive cSCC. Moreover, radiotherapy may be considered as a primary treatment in patients not candidates for surgery. Extensive studies of cSCC pathogenic mechanisms identified several pharmaceutical targets and allowed the development of new systemic therapies, including immunotherapy with immune checkpoint inhibitors, such as Cemiplimab, and epidermal growth factor receptor inhibitors for metastatic and locally advanced cSCC. Furthermore, the implementation of prevention measures has been useful in patient management.
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41
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Dunne JA, Nayar R, Defty C, Tehrani H, Morton J. Cutaneous squamous cell carcinoma-mms or MMS? J Plast Reconstr Aesthet Surg 2020; 74:1355-1401. [PMID: 33414091 DOI: 10.1016/j.bjps.2020.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- J A Dunne
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, W6 8RF London, United Kingdom.
| | - R Nayar
- St Helen's Hospital, St Helen's and Knowsley Teaching Hospitals NHS Trust, Marshalls Cross Rd, WA9 3DA Saint Helens, United Kingdom
| | - C Defty
- St Helen's Hospital, St Helen's and Knowsley Teaching Hospitals NHS Trust, Marshalls Cross Rd, WA9 3DA Saint Helens, United Kingdom
| | - H Tehrani
- St Helen's Hospital, St Helen's and Knowsley Teaching Hospitals NHS Trust, Marshalls Cross Rd, WA9 3DA Saint Helens, United Kingdom
| | - J Morton
- St Helen's Hospital, St Helen's and Knowsley Teaching Hospitals NHS Trust, Marshalls Cross Rd, WA9 3DA Saint Helens, United Kingdom
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42
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Cogrel O. Quoi de neuf en dermatologie instrumentale en 2020 ? Ann Dermatol Venereol 2020; 147:12S9-12S14. [PMID: 33267944 DOI: 10.1016/s0151-9638(20)31102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- O Cogrel
- Praticien hospitalier, Responsable de l'unité de dermatologie instrumentale, Service de Dermatologie, Hôpital Saint-André, CHU de Bordeaux.
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43
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Kravvas G, Ge L, Ng J, Shim TN, Doiron PR, Watchorn R, Kentley J, Panou E, Dinneen M, Freeman A, Jameson C, Haider A, Francis N, Minhas S, Alnajjar H, Muneer A, Bunker CB. The management of penile intraepithelial neoplasia (PeIN): clinical and histological features and treatment of 345 patients and a review of the literature. J DERMATOL TREAT 2020; 33:1047-1062. [DOI: 10.1080/09546634.2020.1800574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G. Kravvas
- Department of Dermatology, University College London Hospitals, London, UK
| | - L. Ge
- Department of Dermatology, University College London Hospitals, London, UK
| | - J. Ng
- Department of Dermatology, Chelsea & Westminster Hospital, London, UK
| | - T. N. Shim
- Department of Dermatology, University College London Hospitals, London, UK
| | - P. R. Doiron
- Department of Dermatology, University College London Hospitals, London, UK
| | - R. Watchorn
- Department of Dermatology, University College London Hospitals, London, UK
| | - J. Kentley
- Department of Dermatology, Chelsea & Westminster Hospital, London, UK
| | - E. Panou
- Department of Dermatology, University College London Hospitals, London, UK
| | - M. Dinneen
- Department of Urology, Chelsea & Westminster Hospital, London, UK
| | - A. Freeman
- Department of Histopathology, University College London Hospitals, London, UK
| | - C. Jameson
- Department of Histopathology, University College London Hospitals, London, UK
| | - A. Haider
- Department of Histopathology, University College London Hospitals, London, UK
| | - N. Francis
- Department of Histopathology, Imperial College Hospitals, London, UK
| | - S. Minhas
- Department of Urology, Imperial College Hospitals, London, UK
| | - H. Alnajjar
- Department of Urology, University College London Hospitals, London, UK
| | - A. Muneer
- Department of Urology, University College London Hospitals, London, UK
| | - C. B. Bunker
- Department of Dermatology, University College London Hospitals, London, UK
- Department of Dermatology, Chelsea & Westminster Hospital, London, UK
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44
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Claveau J, Archambault J, Ernst DS, Giacomantonio C, Limacher JJ, Murray C, Parent F, Zloty D. Multidisciplinary management of locally advanced and metastatic cutaneous squamous cell carcinoma. Curr Oncol 2020; 27:e399-e407. [PMID: 32905333 PMCID: PMC7467796 DOI: 10.3747/co.27.6015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Non-melanoma skin cancers are the most prevalent form of cancer, with cutaneous squamous cell carcinoma (cscc) being the 2nd most common type. Patients presenting with high-risk lesions associated with locally advanced or metastatic cscc face high rates of recurrence and mortality. Accurate staging and risk stratification for patients can be challenging because no system is universally accepted, and no Canadian guidelines currently exist. Patients with advanced cscc are often deemed ineligible for either or both of curative surgery and radiation therapy (rt) and, until recently, were limited to off-label systemic cisplatin-fluorouracil or cetuximab therapy, which offers modest clinical benefits and potentially severe toxicity. A new systemic therapy, cemiplimab, has been approved for the treatment of locally advanced and metastatic cscc. In the present review, we provide recommendations for patient classification and staging based on current guidelines, direction for determining patient eligibility for surgery and rt, and an overview of the available systemic treatment options for advanced cscc and of the benefits of a multidisciplinary approach to patient management.
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Affiliation(s)
- J Claveau
- Centre hospitalier universitaire de Québec-Université Laval, Quebec City, QC
| | - J Archambault
- Centre hospitalier universitaire de Québec-Université Laval, Quebec City, QC
| | | | - C Giacomantonio
- Departments of Surgery and of Pathology, Dalhousie University, Halifax, NS
| | - J J Limacher
- University of Toronto, Toronto, ON
- Women's College Hospital, Toronto, ON
| | - C Murray
- University of Toronto, Toronto, ON
- Women's College Hospital, Toronto, ON
| | - F Parent
- Centre hospitalier universitaire de Québec-Université Laval, Quebec City, QC
| | - D Zloty
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC
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45
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Leus AJG, Frie M, Haisma MS, Terra JB, Plaat BEC, Steenbakkers RJHM, Halmos GB, Rácz E. Treatment of keratinocyte carcinoma in elderly patients - a review of the current literature. J Eur Acad Dermatol Venereol 2020; 34:1932-1943. [PMID: 32030838 PMCID: PMC7496368 DOI: 10.1111/jdv.16268] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022]
Abstract
A large percentage of the patients with keratinocyte carcinoma (KC, formerly known as non‐melanoma skin cancer) is of advanced age and often too frail for standard therapies. However, no specific treatment recommendations are given for this population. This review aimed to give an overview of the current literature on the best practice for the treatment of elderly patients with KC. A literature search was performed in MEDLINE, using ‘keratinocyte carcinoma’, ‘elderly’, ‘treatment’ and various synonyms. Case reports, reviews, comments, non‐English literature and studies with a sample size <15 were excluded. After selection, a total of 47 studies were reviewed. Two types of studies were identified, focusing on (I) the effect of age on treatment outcomes and (II) alternative treatment schedules for elderly patients. Studies on surgery, the gold standard, describe larger lesions and defect size in the elderly population. Recurrence rate, complication rate and disease‐specific survival were not affected by age. Depending on the expected morbidity of a suggested (re‐)excision and patient preferences, a conservative watchful waiting policy can be agreed upon as a shared decision. Other common treatment modalities, such as adjuvant radiotherapy, photodynamic therapy and systemic therapy for basal cell carcinoma (BCC), show comparable results in the elderly and younger population. Alternative treatment schedules for elderly patients include primary hypofractionated radiotherapy, which seems effective and well‐tolerated, although research is limited to case series. Additionally, localized and topical treatments seem safe and effective especially for low‐risk tumours. Data are lacking on the efficacy of systemic therapies of metastatic KC in elderly patients. Efficacy of most treatments (with the exception of photodynamic therapy) is not dependent on age. There is need for more research on the efficacy of adjusted treatment modalities, such as hypofractionated radiotherapy and palliative or curative systemic treatment.
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Affiliation(s)
- A J G Leus
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - M Frie
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - M S Haisma
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - J B Terra
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - B E C Plaat
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - R J H M Steenbakkers
- Department of Radiotherapy, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - G B Halmos
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - E Rácz
- Department of Dermatology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
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Walker E, Liu Y, Kim I, Biro M, Iyer SR, Ezaldein H, Scott J, Merati M, Mistur R, Zhou B, Straight B, Yim JJ, Bogyo M, Mann M, Wilson DL, Basilion JP, Popkin DL. A Protease-Activated Fluorescent Probe Allows Rapid Visualization of Keratinocyte Carcinoma during Excision. Cancer Res 2020; 80:2045-2055. [PMID: 32132111 DOI: 10.1158/0008-5472.can-19-3067] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/10/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022]
Abstract
Keratinocyte carcinomas, including basal and squamous cell carcinomas, are the most common human cancers worldwide. While 75% of all keratinocyte carcinoma (4 million annual cases in the United States) are treated with conventional excision, this surgical modality has much lower cure rates than Mohs micrographic surgery, likely due to the bread-loaf histopathologic assessment that visualizes <1% of the tissue margins. A quenched protease-activated fluorescent probe 6qcNIR, which produces a signal only in the protease-rich tumor microenvironment, was topically applied to 90 specimens ex vivo immediately following excision. "Puzzle-fit" analysis was used to correlate the fluorescent images with histology. Probe-dependent fluorescent images correlated with cancer determined by conventional histology. Point-of-care fluorescent detection of skin cancer had a clinically relevant sensitivity of 0.73 and corresponding specificity of 0.88. Importantly, clinicians were effectively trained to read fluorescent images within 15 minutes with reliability and confidence, resulting in sensitivities of 62%-78% and specificities of 92%-97%. Fluorescent imaging using 6qcNIR allows 100% tumor margin assessment by generating en face images that correlate with histology and may be used to overcome the limitations of conventional bread-loaf histology. The utility of 6qcNIR was validated in a busy real-world clinical setting, and clinicians were trained to effectively read fluorescent margins with a short guided instruction, highlighting clinical adaptability. When used in conventional excision, this approach may result in higher cure rates at a lower cost by allowing same-day reexcision when needed, reducing patient anxiety and improving compliance by expediting postsurgical specimen assessment. SIGNIFICANCE: A fluorescent-probe-tumor-visualization platform was developed and validated in human keratinocyte carcinoma excision specimens that may provide simple, rapid, and global assessment of margins during skin cancer excision, allowing same-day reexcision when needed.
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Affiliation(s)
- Ethan Walker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Yiqiao Liu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - InYoung Kim
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Mark Biro
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sukanya Raj Iyer
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Harib Ezaldein
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey Scott
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Miesha Merati
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Rachel Mistur
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Bo Zhou
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | | | - Joshua J Yim
- Chemical and Systems Biology, Stanford University, Palo Alto, California
| | - Matthew Bogyo
- Chemical and Systems Biology, Stanford University, Palo Alto, California.,Department of Pathology, Stanford University, Palo Alto, California.,Department of Microbiology and Immunology, Stanford University, Palo Alto, California
| | - Margaret Mann
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - David L Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.,Department of Radiology, Case Western Reserve University, Cleveland, Ohio
| | - James P Basilion
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio. .,Department of Radiology, Case Western Reserve University, Cleveland, Ohio.,Fellow, National Foundation for Cancer Research, Case Western Reserve University, Cleveland, Ohio
| | - Daniel L Popkin
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio. .,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
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47
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, Dreno B, Concetta Fargnoli M, Forsea AM, Frenard C, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NWJ, Malvehy J, Del Marmol V, Middleton MR, Moreno-Ramirez D, Pellecani G, Peris K, Saiag P, van den Beuken-van Everdingen MHJ, Vieira R, Zalaudek I, Eggermont AMM, Grob JJ. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer 2020; 128:83-102. [PMID: 32113942 DOI: 10.1016/j.ejca.2020.01.008] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 01/11/2023]
Abstract
In order to update recommendations on treatment, supportive care, education and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer was formed. Recommendations were based on evidence-based literature review, guidelines and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable) and distant metastatic cSCC. For common primary cSCC (the most frequent cSCC type), first-line treatment is surgical excision with postoperative margin assessment or microscopically controlled sugery. Safety margins containing clinical normal-appearing tissue around the tumour during surgical excision and negative margins as reported in the pathology report are necessary to minimise the risk of local recurrence and metastasis. In case of positive margins, a re-excision shall be done, for operable cases. Lymph node dissection is recommended for cSCC with cytologically or histologically confirmed regional nodal involvement. Radiotherapy should be considered as curative treatment for inoperable cSCC, or for non-surgical candidates. Anti-PD-1 antibodies are the first-line systemic treatment for patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiation, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drug Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiation therapy. Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Patients should be engaged with informed decisions on management and be provided with best supportive care to optimise symptom management and improve quality of life. Frequency of follow-up visits and investigations for subsequent new cSCC depend on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université de Paris, INSERM U976, AP-HP, Dermatology Department, Saint Louis Hospital, Paris, France
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Dermatology Department, CHU Nantes, Université Nantes, CIC 1413, CRCINA Inserm U1232, Nantes, France
| | - Maria Concetta Fargnoli
- Dermatology - Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana M Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Romania
| | - Cecille Frenard
- Dermatology Department, CHU Nantes, Université Nantes, CIC 1413, CRCINA Inserm U1232, Nantes, France
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | | | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+, GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Belgium
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - David Moreno-Ramirez
- Department of Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, APHP, EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Marieke H J van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Italy
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48
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van Lee CB, Mooyaart AL, van den Bos RR. Mohs micrographic surgery vs. standard surgical excision?: reply from authors. Br J Dermatol 2019; 182:517-518. [PMID: 31529460 DOI: 10.1111/bjd.18538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C B van Lee
- Department of Dermatology, Erasmus Medical Centre Cancer Institute, Rotterdam, the Netherlands
| | - A L Mooyaart
- Department of Pathology, Erasmus Medical Centre Cancer Institute, Rotterdam, the Netherlands
| | - R R van den Bos
- Department of Dermatology, Erasmus Medical Centre Cancer Institute, Rotterdam, the Netherlands
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49
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Affiliation(s)
- D N Slater
- Histopathology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 4LA,, U.K
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50
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Abstract
Cutaneous squamous cell carcinoma (cSCC) is a form of non-melanoma skin cancer responsible for more deaths in the USA than all other skin cancers combined. Some features, including anatomic site, are considered high risk in nature and pose a challenge for complete tumour removal. We present a case of a 62-year-old male surgeon with a multiply recurrent cSCC of the right conchal bowl. The tumour described herein was doubly recurrent to excision with a standard margin and could ultimately not be cleared with Mohs micrographic surgery. Ultimately, it necessitated auriculectomy and parotidectomy. This case exemplifies the pitfalls of traditional wide local excision with standard pathologic processing for high-risk cSCC.
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Affiliation(s)
- Jubran Jubran
- Santa Barbara Skin Institute, Santa Barbara, California, USA
| | - Roberta D Sengelmann
- Santa Barbara Skin Institute, Santa Barbara, California, USA.,Dermatology, Irvine School of Medicine, University of California, Irvine, California, USA
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