201
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Approaches to Perineural, Lymphovascular, and Single-Cell Disease. Dermatol Surg 2019; 45 Suppl 2:S118-S128. [PMID: 31764297 DOI: 10.1097/dss.0000000000002259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mohs micrographic surgeons should be adept in identifying and managing perineural invasion (PNI), lymphovascular invasion (LVI), and single-cell spread (SCS), features denoting high-risk behavior of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and microcystic adnexal carcinoma (MAC). OBJECTIVE The purpose of this article is to review the literature and guidelines regarding the diagnosis of PNI, LVI, and SCS in BCC, cSCC, and MAC and examine the role of advanced diagnostic studies, adjuvant therapy, and reconstructive techniques of these high-risk tumors. MATERIALS AND METHODS We performed a literature search including the following terms: PNI, LVI, SCS, BCC, cSCC, keratinocyte carcinoma, MAC, sentinel lymph node biopsy, radiation, chemotherapy, and staging. Relevant studies, case reports, and review articles were included, as well as National Comprehensive Cancer Network guidelines. RESULTS Pancytokeratin immunohistochemistry may aid in the diagnosis of high-risk features of BCC and cSCC. Reconstruction of the Mohs defect should be carefully considered to allow for thorough inspection. Radiation therapy should be considered as an adjuvant treatment option for high-risk cSCC and BCC. Close surveillance for recurrence is warranted. CONCLUSION The Mohs surgeon should be competent in identification of high-risk tumors and to understand how best to manage, further treat, and follow these tumors.
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202
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Cañueto J, Jaka A, Corchete L, González‐Pérez A, García‐Castro R, Fuente M, Membrive I, March Á, Mañes A, Posada R, Pujol R, Román‐Curto C, Toll A. Postoperative radiotherapy provides better local control and long‐term outcome in selective cases of cutaneous squamous cell carcinoma with perineural invasion. J Eur Acad Dermatol Venereol 2019; 34:1080-1091. [DOI: 10.1111/jdv.16001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 08/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- J. Cañueto
- Departamento de Dermatología Hospital Universitario de Salamanca Salamanca Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL) Hospital Universitario de Salamanca Salamanca Spain
| | - A. Jaka
- Departamento of Dermatología Hospital Germans Trias i Pujol Badalona Spain
| | - L.A. Corchete
- Instituto de Investigación Biomédica de Salamanca (IBSAL) Hospital Universitario de Salamanca Salamanca Spain
| | - A.Mª. González‐Pérez
- Departamento de Dermatología Hospital Universitario de Salamanca Salamanca Spain
| | - R. García‐Castro
- Departamento de Dermatología Hospital Universitario de Salamanca Salamanca Spain
| | - Mª.J. Fuente
- Departamento of Dermatología Hospital Germans Trias i Pujol Badalona Spain
| | - I. Membrive
- Servicio de Radioterapia Hospital del Mar (Parc de Salut Mar) Barcelona Spain
| | - Á. March
- Departamento of Dermatología Hospital del Mar (Parc de Salut Mar) Barcelona Spain
| | - A. Mañes
- Departamento de Radioterapia Oncológica Instituto Catalán de Oncología Badalona Spain
| | - R. Posada
- Departmento de Anatomía Patológica Hospital Germans Trias i Pujol Badalona Spain
| | - R.M. Pujol
- Departamento of Dermatología Hospital del Mar (Parc de Salut Mar) Barcelona Spain
| | - C. Román‐Curto
- Departamento de Dermatología Hospital Universitario de Salamanca Salamanca Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL) Hospital Universitario de Salamanca Salamanca Spain
| | - A. Toll
- Departamento of Dermatología Hospital del Mar (Parc de Salut Mar) Barcelona Spain
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203
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Bailey A, Vasicek B, Tao J, Janeczek M, Mitri A, Tung R. Management of keratinocyte carcinoma - Special considerations in the elderly. Int J Womens Dermatol 2019; 5:235-245. [PMID: 31700979 PMCID: PMC6831749 DOI: 10.1016/j.ijwd.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/05/2019] [Accepted: 05/12/2019] [Indexed: 02/06/2023] Open
Abstract
Keratinocyte carcinomas (KCs) are now an epidemic in The United States of America, especially in elderly patients. KCs, including basal cell carcinoma and squamous cell carcinoma, can lead to disfigurement and occasionally death. However, the lower mortality rate associated with KC compared with melanoma allows for increased flexibility in the selection of treatment. Flexibility in treatment is particularly important in the elderly given that this patient population often has medical comorbidities that should be considered. These patients may have multiple KCs, higher risk tolerance to recurrence, and different concerns about cosmetic outcomes compared with their younger counterparts. We review treatment options for KCs and how the selection of each option may affect the elderly patient.
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Affiliation(s)
- Alison Bailey
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Brooke Vasicek
- Loyola University Chicago, Division of Dermatology, Chicago, Illinois
| | - Joy Tao
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Monica Janeczek
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Andia Mitri
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
| | - Rebecca Tung
- Loyola University Chicago, Stritch School of Medicine, Chicago, Illinois
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204
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Bachar G, Mizrachi A, Rabinovics N, Guttman D, Shpitzer T, Ad-El D, Hadar T. Prognostic Factors in Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/0145561316095010-1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck poses a significant therapeutic challengedue to its aggressive biologic behavior. We conducted a retrospective study of71 patients—58 men and 13 women, aged 28 to 88 years (mean: 71)—who had been treated atour university-affiliated tertiary care medical center for metastatic cutaneous SCCover a 15-year period. In addition to demographic data, we compiled and analyzed information on tumor characteristics, the site and extent of metastasis, treatment, follow-up, and outcome. Among the tumor factors, poorly differentiated carcinoma was an independent predictor of poorer disease-free survival, and olderage was found to be an independent predictor of poorer overall survival. We found no significant difference in disease-free or disease-specific survival among patients with parotid involvement, neck involvement, or both. In our series, the site of nodal involvement appeared to have no prognostic significance in patients with metastatic cutaneous SCC of the head and neck.
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Affiliation(s)
- Gideon Bachar
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Rabinovics
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Guttman
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Shpitzer
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dean Ad-El
- Department of Plastic and Reconstructive Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Hadar
- Department of Otorhinolaryngology–Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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205
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Stevenson ML, Carucci J, Colegio OR. Skin cancer in transplant recipients: Scientific retreat of the international immunosuppression and transplant skin cancer collaborative and skin care in organ transplant patients—Europe. Clin Transplant 2019; 33:e13736. [DOI: 10.1111/ctr.13736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Mary L. Stevenson
- The Ronald O. Perelman Department of Dermatology NYU Langone Health New York New York
| | - John Carucci
- The Ronald O. Perelman Department of Dermatology NYU Langone Health New York New York
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206
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Chua B, Jackson JE, Lin C, Veness MJ. Radiotherapy for early non-melanoma skin cancer. Oral Oncol 2019; 98:96-101. [DOI: 10.1016/j.oraloncology.2019.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/10/2019] [Accepted: 09/18/2019] [Indexed: 11/25/2022]
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207
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Chapalain M, Baroudjian B, Dupont A, Lhote R, Lambert J, Bagot M, Lebbe C, Basset-Seguin N. Stage IV cutaneous squamous cell carcinoma: treatment outcomes in a series of 42 patients. J Eur Acad Dermatol Venereol 2019; 34:1202-1209. [PMID: 31587382 DOI: 10.1111/jdv.16007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/28/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The prevalence and incidence of cutaneous squamous cell carcinoma (cSCC) are increasing due to the ageing of the population and sun exposure. Advanced cSCC forms (locally advanced and/or locoregional metastatic and/or distant metastatic) account for approximately 3% of cSCC and can result in death. OBJECTIVE Analysis of the clinical characteristics and treatment outcomes in stage IV cSCC with unresectable locoregional extension and/or the presence of metastases. METHODS A retrospective study was conducted at a single-centre university hospital for stage IV cSCC patients followed between 1 January 2008 and 31 December 2015. Descriptive analyses (demographic, anatomo-clinical characteristics, treatment sequences, response to treatment and survival analysis) were performed. RESULTS The study included 42 patients (median age = 75.5 years) with a diagnosis of stage IV cSCC who were treated with at least one line of chemotherapy and/or cetuximab. At the time of diagnosis, 85.7% of the patients had locoregional extension (19% of locally advanced and 67% of locoregional metastatic) and 14.3% had distant metastatic disease. Regarding treatment, 40% and 36% of patients received no more than 1 and 2 systemic treatment lines, respectively. The 4-year overall survival was 6%, and the median follow-up was 18.6 months. The objective response rate was 55% after the first line of treatment with a median progression-free survival (PFS) of 6.18 months and 12% after the second line with a median PFS of 6.51 months. Grade 3 and 4 adverse events were observed for 33% of patients. CONCLUSION Our study confirms a very poor prognosis of stage IV cSCC and a poor response to conventional therapies, indicating that the stage IV cSCC patient population remains with unmet medical needs.
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Affiliation(s)
- M Chapalain
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - B Baroudjian
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - A Dupont
- Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,Department of Biostatistics, Hôpital Saint-Louis, AP-HP, Paris, France
| | - R Lhote
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - J Lambert
- Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,Department of Biostatistics, Hôpital Saint-Louis, AP-HP, Paris, France
| | - M Bagot
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - C Lebbe
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
| | - N Basset-Seguin
- Dermatology Department, Hôpital Saint-Louis, AP-HP, Paris, France.,Inserm Unité 976, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
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208
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Sepehripour S, Dawood O, Hatter S, Williams L, Zahd Z, Liebmann R, Dheansa B. An assessment of histological margins and recurrence of completely excised cutaneous SCC. J Plast Reconstr Aesthet Surg 2019; 73:899-903. [PMID: 32184053 DOI: 10.1016/j.bjps.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 08/26/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
There is a paucity of data relating to histological margins of cutaneous squamous cell carcinoma (cSCC) and local recurrence. Retrospective data were collected for 721 patients with cSCC treated at Queen Victoria Hospital, UK, and followed up for five years. The local recurrence rate was 6.1%, the mean time to recurrence was 12.61 months and 93% of recurrences occurred within two years. Sixty-six per cent of recurrences had a deep margin of 2.5 mm or less (p 0.041). The Pearson's correlation coefficient showed a strong correlation with tumour grade (r=0.82, p, 0.05), lymphovascular invasion (r=0.73. p<0.05), medium correlation with deep histological margin(r= -0.55, p<0.05), a weak correlation with male sex (r= 0.31, p<0.05) and the anatomical site of head and neck (r=0.31, p<0.05).The multiple regression analysis model using the 5 variables generated an r value of 0.71 and adjusted r square of 0.7. In conclusion, our findings are consistent with previously mentioned prognostic indicators and also demonstrate that deep histological margin is a significant predictor of local recurrence of cSCC. We recommend larger multi-institutional studies to confirm the above results to subsequently guide the specialist skin multidisciplinary teams' recommendations.
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Affiliation(s)
| | - O Dawood
- Queen Victoria Hospital, East Grinstead
| | - S Hatter
- Queen Victoria Hospital, East Grinstead
| | | | - Z Zahd
- Queen Victoria Hospital, East Grinstead
| | | | - B Dheansa
- Queen Victoria Hospital, East Grinstead
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209
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Mooney CP, Martin RCW, Dirven R, Ashford BG, Shannon K, Palme CE, Ngo Q, Wykes J, Davies S, Gao K, Ch’ng S, Low TH, Gupta R, Clark JR. Sentinel Node Biopsy in 105 High-Risk Cutaneous SCCs of the Head and Neck: Results of a Multicenter Prospective Study. Ann Surg Oncol 2019; 26:4481-4488. [DOI: 10.1245/s10434-019-07865-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 11/18/2022]
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210
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Breuninger H, Eigentler T, Häfner H, Leiter U. Lokale chirurgische Therapie des kutanen Plattenepithelkarzinoms: Defizite und Kontroversen in der Literatur. J Dtsch Dermatol Ges 2019; 17:999-1004. [DOI: 10.1111/ddg.13941_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/16/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Ulrike Leiter
- Universitäts‐HautklinikEberhard Karls Universität Tübingen
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211
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BODIPY-based asymmetric monosubstituted (turn-on) and symmetric disubstituted (ratiometric) fluorescent probes for selective detection of phosgene in solution and gas phase. Anal Chim Acta 2019; 1078:168-175. [DOI: 10.1016/j.aca.2019.06.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/01/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
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212
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Kofler L. [Classification of cutaneous squamous cell carcinoma : How do I recognise my high-risk patient?]. DER HAUTARZT 2019; 70:870-874. [PMID: 31560082 DOI: 10.1007/s00105-019-04484-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous squamous cell carcinomas are the second most common malignant tumours of the skin. In most cases, they are primarily treatable by surgery. Various risk factors for local recurrence as well as metastasis and tumor-specific death have been described. Various classification systems are available for risk stratification. Tumour thickness is the strongest risk factor for the development of local recurrences, but also for metastasis and tumour-specific death. In addition, the immune status of patients, location and histological factors such as growth patterns and differentiation play an important role in the assessment of the individual risk. According to these parameters, patients should be included in a risk-adapted follow-up regimen. The risk of local recurrence and metastasis is highest in the first few years after excision, which is why follow-up care should be more intensive during this time.
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Affiliation(s)
- Lukas Kofler
- Universitätshautklinik, Studienzentrum Operative Dermatologie, Eberhard-Karls Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
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213
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Breuninger H, Eigentler T, Häfner HM, Leiter U. Local surgical treatment of cutaneous squamous cell carcinoma: deficits and controversies in the literature. J Dtsch Dermatol Ges 2019; 17:999-1004. [PMID: 31545559 DOI: 10.1111/ddg.13941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/16/2019] [Indexed: 02/06/2023]
Abstract
The prognostic impact of primary excision in the treatment of cutaneous squamous cell carcinoma depends on certain tumor characteristics (risk factors), the surgical approach chosen and the subsequent histological examination. For the development of the AWMF (Association of Scientific Medical Societies in Germany) guidelines for squamous cell carcinoma, the most conclusive guidelines available were evaluated using the DELBI tool (German Instrument for the Methodological Appraisal of Guidelines). These were the Scottish and Canadian guidelines as well as the joint guidelines published by EDF, EADO and EORTC. The primary literature on the aforementioned topics that was used for these guidelines included 49 studies and 9 reviews. None of the studies had a prospective, randomized design; 19 studies contained prospective data; 30 studies provided retrospective data. Overall, the results were heterogeneous. Not only were there discrepancies in terms of the validity of the various risk factors for locoregional disease progression - such as dedifferentiation, desmoplasia and perineural invasion - but also with respect to tumor thickness and surgical consequences. Differences were also found regarding the histological processing method used. In general, there are two such methods: conventional histology (bread loaf technique) and complete histological assessment of excision margins. The latter was found to be associated both with low recurrence rates and low metastatic rates, possibly due to the fact that patients treated with the latter method had lower-risk tumors. Publications on bread loaf histology lacked precise information as to how the tissue was actually processed. Likewise, there was a lack of usable data in terms of the surgical margins used in the primary excision. Conclusion: The current literature is inconsistent and insufficient with regard to the various prognostic factors and the surgical approach to cutaneous squamous cell carcinoma.
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Affiliation(s)
- Helmut Breuninger
- Department of Dermatology, Eberhard Karl University, Tübingen, Germany
| | - Thomas Eigentler
- Department of Dermatology, Eberhard Karl University, Tübingen, Germany
| | | | - Ulrike Leiter
- Department of Dermatology, Eberhard Karl University, Tübingen, Germany
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214
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Ahmed SR, Petersen E, Patel R, Migden MR. Cemiplimab-rwlc as first and only treatment for advanced cutaneous squamous cell carcinoma. Expert Rev Clin Pharmacol 2019; 12:947-951. [PMID: 31524530 DOI: 10.1080/17512433.2019.1665026] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: In September of 2018, the United States Federal Drug Administration (FDA) approved cemiplimab-rwlc (Libtayo) for advanced cutaneous squamous cell carcinoma (CSCC). Cemiplimab is an intravenous human monoclonal antibody directed against programmed cell death-1 receptor (PD-1). Cemiplimab blocks T-cell inactivation and enhances the immune system's anti-tumor response. Areas Covered: We review CSCC and the studies leading to cemiplimab's approval, including common side effects and safety issues experienced during the clinical trials. Expert Opinion: Immunotherapy, specifically checkpoint inhibitors, represents an increasingly utilized class of medications that is proving to be an effective treatment option for those with certain cancers. Over time, immunotherapy is likely to be the standard of care for immune-sensitive tumors. There are many challenges that the field faces, including the identification of reliable biomarkers to better predict response, decreasing toxicity, and the potential treatment of organ transplant patients.
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Affiliation(s)
- Saqib R Ahmed
- Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Erik Petersen
- Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Ravi Patel
- Department of Dermatology, The University of Texas McGovern Medical School at Houston , Houston , TX , USA
| | - Michael R Migden
- Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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215
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Rudhart SA, Schultz JD, Gehrt F, Pavel FL, Birk R, Hoch M, Stuck BA, Hoch S. CYFRA 21-1: a suitable tumor marker in patients with head and neck cutaneous squamous cell carcinoma? Eur Arch Otorhinolaryngol 2019; 276:3467-3475. [PMID: 31482332 DOI: 10.1007/s00405-019-05614-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/22/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE The clinical significance of cytokeratin fraction 21-1 (CYFRA 21-1) for patients with head and neck cutaneous squamous cell carcinoma (CSCC) is unknown. Thus, the aim of the study was to evaluate the clinical value of CYFRA 21-1 in the context of treatment and follow-up for these patients. METHODS The clinical, histological and laboratory data of a total of 55 patients with the first diagnosis of head and neck cutaneous squamous cell carcinoma (T1-T4, N0-N2b, M0-1) between 2003 and 2017 were retrospectively analyzed. In 25 cases, the primary tumor could be treated successfully without residual or recurrent disease in the further course. The average follow-up period was 2.3 years. In all patients, pretherapeutic determination of CYFRA 21-1 was performed using the ECLIA test kit. The cut-off value was set at 3.3 ng/ml. RESULTS In 18 patients (32.7%), regional recurrence was found in the course of treatment. Distant metastases could be observed in two patients (3.6%). In these cases, no significant increase of CYFRA 21-1 blood concentration was detected at the time of recurrence/metastasis. At the time of the first diagnosis, the mean value of CYFRA 21-1 blood concentration was 2.4 ng/ml; and in cases of regional recurrence or distant metastases, the initial mean CYFRA 21-1 concentration was 2.0 ng/ml. There was no statistically significant relationship between CYFRA 21-1 blood concentration and analyzed tumor characteristics. CONCLUSIONS According to current knowledge, the tumor marker CYFRA 21-1 is not clinically significant for treatment and follow-up of patients with head and neck CSCC.
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Affiliation(s)
- Stefan A Rudhart
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Johannes D Schultz
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Francesca Gehrt
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Friederike L Pavel
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Richard Birk
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Melika Hoch
- Department of Dermatology and Allergology, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Boris A Stuck
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
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216
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Stratification of Poor Outcomes for Cutaneous Squamous Cell Carcinoma in Immunosuppressed Patients Using the American Joint Committee on Cancer Eighth Edition and Brigham and Women's Hospital Staging Systems. Dermatol Surg 2019; 45:1117-1124. [DOI: 10.1097/dss.0000000000001774] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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217
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Mirbeik-Sabzevari A, Oppelaar E, Ashinoff R, Tavassolian N. High-Contrast, Low-Cost, 3-D Visualization of Skin Cancer Using Ultra-High-Resolution Millimeter-Wave Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:2188-2197. [PMID: 30843805 DOI: 10.1109/tmi.2019.2902600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The goal of this paper is to develop a new skin imaging modality which addresses the current clinical need for a non-invasive imaging tool that images the skin over its depth with high resolutions while offering large histopathological-like contrasts between malignant and normal tissues. We demonstrate that by taking advantage of the intrinsic millimeter-wave dielectric contrasts between normal and malignant skin tissues, ultra-high-resolution millimeter-wave imaging (MMWI) can achieve 3-D, high-contrast images of the skin. In this paper, an imaging system with a record-wide bandwidth of 98 GHz is developed using the synthetic ultra-wideband millimeter-wave imaging approach, a new ultra-high-resolution imaging technique recently developed by the authors. The 21 non-melanoma skin cancer (NMSC) specimens are imaged and compared with histopathology for evaluation. A programmable measurement platform is designed to automatically scan the tissues across a rectangular aperture plane. Furthermore, a novel frequency-domain imaging algorithm is developed to process the recorded signals and generate an image of the cancerous tissue. The high correlations achieved between MMWI images and histological images allow for rapid and accurate delineation of NMSC tissues. The millimeter-wave reflectivity values are also found to be statistically significant higher for cancerous areas with respect to normal areas. Since MMWI does not require tissue processing or staining, it can be performed promptly, enabling diagnosis of tumors at an early stage as well as simplify the tumor removal surgery to a single-layer excision procedure.
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Jubran J, Sengelmann RD. High-risk squamous cell carcinoma and its impact on a 62-year-old male surgeon. BMJ Case Rep 2019; 12:12/8/e229940. [PMID: 31471358 DOI: 10.1136/bcr-2019-229940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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Measurement of Tumor Thickness in Cutaneous Squamous Cell Carcinomas: Do the Different Methods Provide Better Prognostic Data? Am J Dermatopathol 2019; 42:337-342. [PMID: 31464719 DOI: 10.1097/dad.0000000000001511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common cause of nonmelanoma skin cancers. Although it has a relatively low mortality rate, it may be locally destructive and potentially metastasize. Tumor thickness of the primary lesion is one important parameter associated with biologic behavior. Such measurement is currently performed in different ways depending on the anatomic location and subspecialty (eg, skin vs. head and neck vs. gynecologic pathology). Furthermore, the new The American Joint Committee on Cancer eighth edition has changed the previously recommended method of measurement of cSCC of head and neck from a modified Breslow thickness to measuring from the granular layer of adjacent, normal-appearing skin to the deepest invasive tumor cell. This study evaluated the clinical significance on patient outcome by measuring tumor thickness using 4 common, currently available methods (measurement from: A. uninvolved dermoepidermal junction; B. top of granular cell layer of the epidermis overlying the tumor, that is, similar to Breslow thickness; C. dermoepidermal junction with in situ cSCC; D. top of granular layer of uninvolved skin) in 85 specimens from nongenital areas of 78 patients with cSCC. Thirty-five percent of them were from the head and neck area. Measurements were performed in millimeters using the digital ruler of image analysis software (Olympus cellSens Standard) on whole-slide scanned images. Associations between recurrence-free survival (RFS) and each method were assessed. When thickness was considered as a continuous measure, there was no statistically significant association between any of the 4 measurement techniques and RFS. When using the currently recommended 6.0-mm cutoff, methods B and C were significantly associated with RFS. Similarly, when optimal cutoff values were selected, all 4 methods were significantly associated with RFS in univariable analysis. However, in a multivariable model that included the techniques and location of lesion, only method B, using the optimal cutoff value of 8.7 mm, was independently associated with RFS. In summary, in our series of cSCC, measurement of thickness using a Breslow method (method B) was significantly associated with RFS using the optimal cutoff and the currently recommended 6.0 mm in univariable analyses and the optimal cutoff in a multivariable assessment. Therefore, our data indicate that measurement of tumor thickness in a manner similar to Breslow thickness may be used to help predict recurrence in patients with cSCC.
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Reply: Current Basal and Squamous Cell Skin Cancer Management. Plast Reconstr Surg 2019; 144:521e-522e. [PMID: 31461066 DOI: 10.1097/prs.0000000000005976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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221
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Pang G, Look Hong NJ, Paull G, Dobransky J, Kupper S, Hurton S, Kagedan DJ, Quan ML, Helyer L, Nessim C, Wright FC. Squamous Cell Carcinoma with Regional Metastasis to Axilla or Groin Lymph Nodes: a Multicenter Outcome Analysis. Ann Surg Oncol 2019; 26:4642-4650. [PMID: 31440926 DOI: 10.1245/s10434-019-07743-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) of the trunk/extremities with nodal metastasis represents a rare but significant clinical challenge. Treatment patterns and outcomes are poorly described. PATIENTS AND METHODS Patients with cSCC who developed axilla/groin lymph node metastasis and underwent curative-intent surgery between 2005 and 2015 were identified at four Canadian academic centers. Demographics, tumor characteristics, treatment patterns, recurrence rates, and mortality were described. Overall survival (OS) and disease-free survival (DFS) were calculated using Kaplan-Meier analysis. Predictors of survival and any recurrence were explored using Cox regression and logistic regression models, respectively. RESULTS Of 43 patients, 70% were male (median age 74 years). Median follow-up was 38 months. Median time to nodal metastasis was 11.3 months. Thirty-one and 12 patients had nodal metastasis to the axilla and groin, respectively. A total of 72% and 7% received adjuvant and neoadjuvant radiation, respectively, while 5% received adjuvant chemotherapy. Following surgery, 26% patients developed nodal and/or distant disease recurrence. Crude mortality rate was 39.5%. Mean OS was 5.3 years [95% confidence interval (CI) 3.9-6.8 years], and 5-year OS was 55.1%. Mean DFS was 4.8 years (95% CI 3.3-6.2 years), and five-year DFS was 49.3%. Any recurrence was the only independent predictor of death [p = 0.036, odds ratio (OR) = 29.5], and extracapsular extension (p = 0.028, OR = 189) and age (p = 0.017, OR = 0.823) were independent predictors of recurrence. CONCLUSIONS This represents the largest contemporary series to date of outcomes for patients with axilla/groin nodal metastases from cSCC. Despite aggressive treatment, outcomes remain modest, indicating the need for a continued multidisciplinary approach and integration of new systemic agents.
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Affiliation(s)
- George Pang
- Department of Surgery, Western University, London, ON, Canada.
| | | | - Gabrielle Paull
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Suzana Kupper
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Scott Hurton
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Daniel J Kagedan
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - May Lynn Quan
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lucy Helyer
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Carolyn Nessim
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Petersen ET, Ahmed SR, Chen L, Silapunt S, Migden MR. Review of systemic agents in the treatment of advanced cutaneous squamous cell carcinoma. Future Oncol 2019; 15:3171-3184. [PMID: 31382778 DOI: 10.2217/fon-2019-0158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Advanced cutaneous squamous cell carcinoma (cSCC) accounts for only 5% of all cases of cSCC but up to 60% of disease related deaths. Historically, this disease has lacked effective treatment options due to a combination of poor response rate, poor response durability and significant treatment-associated morbidity. Autumn of 2018 marked the first time ever that an agent received US FDA approval for advanced cSCC and the future is looking much brighter for this previously neglected patient population. The purpose of this article is to review the various systemic treatment options for advanced cSCC moving from the past to the present, highlighting their relative merits and shortcomings, and to briefly speculate on future developments in the field of advanced cSCC.
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Affiliation(s)
- Erik T Petersen
- University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA
| | - Saqib R Ahmed
- University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA
| | - Leon Chen
- University of Texas McGovern Medical School Department of Dermatology, Houston, TX 77030, USA
| | - Sirunya Silapunt
- University of Texas McGovern Medical School Department of Dermatology, Houston, TX 77030, USA
| | - Michael R Migden
- University of Texas MD Anderson Cancer Center, Department of Dermatology, Mohs and Dermasurgery Unit, Houston, TX 77030, USA.,University of Texas MD Anderson Cancer Center Department of Head & Neck Surgery, Houston, TX 77030, USA
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Wysong A, Higgins S, Blalock TW, Ricci D, Nichols R, Smith FL, Kossintseva I. Defining skin cancer local recurrence. J Am Acad Dermatol 2019; 81:581-599. [DOI: 10.1016/j.jaad.2019.03.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/23/2019] [Accepted: 03/29/2019] [Indexed: 12/22/2022]
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225
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Barazzetti DO, Barazzetti PHO, Cavalheiro BT, Ely JB, Nunes DH, Stamm AMNDF. Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel. An Bras Dermatol 2019; 94:304-312. [PMID: 31365659 PMCID: PMC6668942 DOI: 10.1590/abd1806-4841.20197842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/03/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazil, with squamous cell carcinoma (SCC) being one of its subtypes. It develops in photo-exposed areas, affecting social habits and causing negative influence on quality of life (QoL). OBJECTIVES To evaluate QoL in patients with primary cutaneous SCC. METHODS A cross-sectional study was performed in patients with clinical diagnosis of SCC, corroborated by dermoscopy and confirmed by histopathology; prior to resection of the tumor using the double-blade scalpel technique, a questionnaire on the Dermatology Life Quality Index (DLQI) was applied. RESULTS Among the 46 evaluated patients, mean age was 67.1 ± 16.0 years, with a predominance of males, low educational level and socioeconomic status, Fitzpatrick II phototype, history of outdoor work, and tumor location in exposed photo areas. Mean DLQI was 4.02 ± 0.63, and in the categorization, 11 (23.9%) had a moderate to severe negative effect on QoL. The skin tumor had a negative impact on daily activities (33% of cases), treatment effects (30%), and symptoms and feelings (29%). Study limitations: There is no gold standard instrument for assessing QoL in dermatological patients. CONCLUSION In the study sample, one-fourth of patients with SCC had a moderate to severe negative effect on quality of life.
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Affiliation(s)
| | | | | | - Jorge Bins Ely
- Department of Operating Technique and Experimental Surgery,
Universidade Federal de Santa Catarina (SC), Brazil
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226
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Badash I, Shauly O, Lui CG, Gould DJ, Patel KM. Nonmelanoma Facial Skin Cancer: A Review of Diagnostic Strategies, Surgical Treatment, and Reconstructive Techniques. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619865278. [PMID: 31384136 PMCID: PMC6657122 DOI: 10.1177/1179550619865278] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
Nonmelanoma skin cancer is the most common form of cancer in the United States, and the face is a common area for skin cancer development due to its frequent exposure to the sun. This article focuses on the surgical management of facial nonmelanoma skin cancers, including diagnostic considerations, biopsy techniques, and staging. In addition, we discuss surgical treatment options, including indications, techniques, outcomes, and facial reconstruction following tumor excision.
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Affiliation(s)
- Ido Badash
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Orr Shauly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher G Lui
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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227
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Riihilä P, Nissinen L, Knuutila J, Rahmati Nezhad P, Viiklepp K, Kähäri VM. Complement System in Cutaneous Squamous Cell Carcinoma. Int J Mol Sci 2019; 20:ijms20143550. [PMID: 31331124 PMCID: PMC6678994 DOI: 10.3390/ijms20143550] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/16/2022] Open
Abstract
Epidermal keratinocyte-derived cutaneous squamous cell carcinoma (cSCC) is the most common metastatic skin cancer with high mortality rates in the advanced stage. Chronic inflammation is a recognized risk factor for cSCC progression and the complement system, as a part of innate immunity, belongs to the microenvironment of tumors. The complement system is a double-edged sword in cancer, since complement activation is involved in anti-tumor cytotoxicity and immune responses, but it also promotes cancer progression directly and indirectly. Recently, the role of several complement components and inhibitors in the regulation of progression of cSCC has been shown. In this review, we will discuss the role of complement system components and inhibitors as biomarkers and potential new targets for therapeutic intervention in cSCC.
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Affiliation(s)
- Pilvi Riihilä
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, FI-20520 Turku, Finland
- The Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Kiinamyllynkatu 10, FI-20520 Turku, Finland
| | - Liisa Nissinen
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, FI-20520 Turku, Finland
- The Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Kiinamyllynkatu 10, FI-20520 Turku, Finland
| | - Jaakko Knuutila
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, FI-20520 Turku, Finland
- The Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Kiinamyllynkatu 10, FI-20520 Turku, Finland
| | - Pegah Rahmati Nezhad
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, FI-20520 Turku, Finland
- The Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Kiinamyllynkatu 10, FI-20520 Turku, Finland
| | - Kristina Viiklepp
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, FI-20520 Turku, Finland
- The Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Kiinamyllynkatu 10, FI-20520 Turku, Finland
| | - Veli-Matti Kähäri
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, FI-20520 Turku, Finland.
- The Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Kiinamyllynkatu 10, FI-20520 Turku, Finland.
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Abstract
Although surgical intervention remains the standard of care for nonmelanoma skin cancer, other treatment modalities have been studied and used. Nonsurgical treatment methods include cryotherapy, topical medications, photodynamic therapy, radiation therapy, Hedgehog pathway inhibitors, programmed cell death protein 1 inhibitors, and active nonintervention. Despite the favorable efficacy of surgical treatment methods, many factors, including but not limited to patient age, preference, and severity of disease, must be taken into consideration when choosing the most appropriate, patient-centered treatment approach.
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229
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Shelton ME, Adamson AS. Review and Update on Evidence-Based Surgical Treatment Recommendations for Nonmelanoma Skin Cancer. Dermatol Clin 2019; 37:425-433. [PMID: 31466583 DOI: 10.1016/j.det.2019.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nonmelanoma skin cancer (NMSC) is the most commonly diagnosed malignancy in the United States. Surgery is considered the gold standard treatment. Techniques include curettage and electrodesiccation, surgical excision, and Mohs micrographic surgery. While each is effective, there are relative advantages and disadvantages with respect to cost, time, quality of life, and role in patients with limited life expectancy. Preventing local tumor recurrence is the primary objective; however, recurrence rates are based on retrospective data, and high-quality comparator studies assessing effectiveness are scarce. Prospective and randomized controlled trials are imperative to create comprehensive, evidence-based recommendations for the surgical management of NMSC.
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Affiliation(s)
- Megan E Shelton
- Division of Dermatology, Department of Internal Medicine, University of Texas at Austin, Dell Medical School, 1601 Trinity Street, Building B, Stop Z0900, Austin, TX 78712, USA
| | - Adewole S Adamson
- Division of Dermatology, Department of Internal Medicine, University of Texas at Austin, Dell Medical School, 1601 Trinity Street, Building B, Stop Z0900, Austin, TX 78712, USA.
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Invasión perineural en el carcinoma epidermoide cutáneo. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:426-433. [DOI: 10.1016/j.ad.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/29/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023] Open
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231
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Pérez García M, Mateu Puchades A, Sanmartín Jiménez O. Perineural Invasion in Cutaneous Squamous Cell Carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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232
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Güney İB, Küçüker KA. Cilt kanserlerinde lenfosintigrafi ve cerrahi gama prob ile sentinel lenf nodu biyopsisinin minimal invaziv cerrahi yaklaşımındaki rolü. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.411652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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233
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Memar OM, Caughlin B. Nasal Reconstruction of Post-Mohs Defects >1.5 cm in a Single Cosmetic Subunit Under Local Anesthesia by a Combination of Plastic Surgeon and Mohs Surgeon Team: A Cross-sectional Study and Review of Algorithmic Nasal Defect Closures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2277. [PMID: 31624682 PMCID: PMC6635188 DOI: 10.1097/gox.0000000000002277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We present an algorithmic approach to the reconstruction of larger post-Mohs defects treated in a practice with both a plastic surgeon and Mohs surgeon. The aim of the study is to present post-Mohs reconstructive choices made by our team compared with closures done by solo dermatologists. METHODS A cross-sectional study was designed. Participants were 66 consecutive cases of nasal Mohs repairs performed under local anesthesia. For each Mohs case, data were collected on the age of the patient, smoking status, tumor type, tumor location, tumor diameter, the number of Mohs stages needed to clear the surgical margins of any remaining cancer, final defect diameter, reconstructive methods used, and postoperative complications. RESULTS Basal cell carcinoma was the most common tumor treated on the nose, and post-Mohs basal cell carcinoma defects were closed predominantly with full-thickness skin grafts (FTSGs), rotation flap (RF), or a combination of both. The sidewall was the cosmetic unit most affected by skin cancer, and defects were commonly closed by FTSG and RF. Fifty percent of the sidewall defects required more than 1 closure method, compared with 24% of the nasal tip defects. FTSG combination closure was performed on 20 cases, usually with an advancement flap. CONCLUSIONS The addition of a plastic surgeon shifted the nasal reconstructive techniques when compared with dermatologists alone. Post-Mohs defect >1.5 cm in a single cosmetic subunit was reconstructed under local anesthesia with either RF or a combination of FTSG and an advancement flap, whereas dermatologists most commonly chose a primary closure.
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Affiliation(s)
- Omeed M. Memar
- From the Academic Dermatology & Skin Cancer Institute, Chicago, Ill
| | - Benjamin Caughlin
- Department of Surgery, Division of Otolaryngology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Ill
- Division of Facial Plastic and Reconstructive Surgery, Jesse Brown VAMC, Chicago, Ill
- Division of Facial Plastic and Reconstructive Surgery, University of Illinois Health Hospital System, Chicago, Ill
- Kovak Cosmetic Center, Oakbrook Terrace, Ill
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Sayed L, Deodhar AK, Agarwal R. A single centre experience of squamous cell carcinoma of the upper limb requiring digital or hand amputation and review of literature. JPRAS Open 2019; 20:43-58. [PMID: 32158871 PMCID: PMC7061685 DOI: 10.1016/j.jpra.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022] Open
Abstract
Squamous cell carcinoma (SCC) is one of the most common primary malignancies affecting the upper limb. A range of treatment options exist for its management; amputation being indicated under certain instances. This is the first comprehensive case series and review of the literature reporting outcomes following amputation of the affected region for treatment of upper extremity SCC. We present a series of six patients with squamous cell carcinoma of the upper limb that required amputation alongside that of data from literature review. Patient demographics, risk factors, tumour characteristics and rates of recurrence, metastasis and mortality were recorded. A total of 45 patients with 49 histologically confirmed squamous cell carcinomas were identified from case series and literature review. Patients presenting with upper limb SCC were predominantly male and in their sixth decade of life. Mean follow up time was 30.5 months and the overall recurrence and metastatic rates were 8.2% and 14.3%, respectively. Mortality was 14.3% however only 6.1% was related to SCC metastasis. Rates of recurrence and metastasis are higher for SCCs affecting the hand as compared to other body sites. Furthermore, different regions of the hand appear to behave differently. SCC affecting the nail unit has a high recurrence and a low metastatic rate, whereas, SCC involving the palm and webspaces are aggressive and this is true despite amputation of the affected site.
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Affiliation(s)
- Leela Sayed
- Department of Plastic Surgery, University Hospitals of Leicester, Infirmary Square, Leicester LE1 5WW, United Kingdom
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Cheng JY, Li FY, Ko CJ, Colegio OR. Cutaneous Squamous Cell Carcinomas in Solid Organ Transplant Recipients Compared With Immunocompetent Patients. JAMA Dermatol 2019; 154:60-66. [PMID: 29167858 DOI: 10.1001/jamadermatol.2017.4506] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Solid organ transplant recipients (SOTRs) have a 100-fold increased risk of squamous cell carcinoma (SCC), and they may develop more aggressive SCCs compared with immunocompetent individuals. Objective To compare outcomes associated with aggressive behavior of SCC in SOTRs and high-risk immunocompetent patients. Design, Setting, and Participants A retrospective cohort study of 58 SOTRs and 40 immunocompetent patients evaluated at the Yale Transplant Dermatology Clinic in New Haven, Connecticut, who had at least 1 SCC confirmed histopathologically between January 1, 2008, and December 31, 2015. Cumulative follow-up time for this study was 369 patient-years. Exposure Immunosuppressive medication regimen for SOTRs. Main Outcomes and Measures The primary outcome measure was tumor depth of SCC. Secondary outcome measures that reflected tumor aggressiveness included perineural invasion, regional metastases, nodal metastases, disease-specific death, and overall death. Results Of the 58 SOTR study participants, 14 were women and 44 were men; the mean (SD) age was 61.3 (8.4) years. Of the 40 immunocompetent study participants, 16 were women and 24 were men; the mean (SD) age was 69.8 (10.9) years, resulting in a statistically significant difference from the SOTR group. The mean (SD) number of years that SOTRs were immunosuppressed was 14.6 (9.2) years (range, 2-37 years). The SOTR and immunocompetent groups were statistically comparable regarding race and sex, patient care, follow-up time, numbers of skin lesions, and field cancerization and chemopreventive therapies. The SOTR group had a significantly higher annual frequency of visits (mean [SD], 4 [2] vs 3 [2] office visits per patient per year, P = .02) and annual biopsy rates (mean [SD], 6 [4] vs 5 [3] biopsies per patient per year, P = .04). The SOTRs developed SCCs that did not appear to be significantly more aggressive than those found in the immunocompetent control group. These SOTRs also did not develop significantly thicker tumors than the immunocompetent control group (median [IQR] tumor depth, 1.30 [0.90-1.60] mm in 35 SOTRs vs 1.22 [1.10-1.60] mm in 20 immunocompetent patients). Conclusions and Relevance The increased risk and the potential for aggressive behavior of SCCs in SOTRs may be successfully managed at a level comparable to that in high-risk immunocompetent individuals through close adherence to current dermatologic surveillance recommendations and a marginally lower threshold for biopsy of suspicious lesions for SOTRs.
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Affiliation(s)
- Joyce Y Cheng
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Fang-Yong Li
- Yale Center for Analytical Sciences, New Haven, Connecticut
| | - Christine J Ko
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Oscar R Colegio
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.,Yale Cancer Center, Yale-New Haven Hospital, New Haven, Connecticut.,Yale Transplant Dermatology Clinic, Yale-New Haven Transplantation Center, New Haven, Connecticut
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236
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Roscher I, Falk RS, Vos L, Clausen OPF, Helsing P, Gjersvik P, Robsahm TE. Validating 4 Staging Systems for Cutaneous Squamous Cell Carcinoma Using Population-Based Data: A Nested Case-Control Study. JAMA Dermatol 2019. [PMID: 29516080 DOI: 10.1001/jamadermatol.2017.6428] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Cutaneous squamous cell carcinoma (cSCC) has metastatic potential, but the prognostic value of current staging systems in nonselected patients is uncertain. Objective To assess the effect of risk factors for metastasis and to evaluate validity and usefulness of 4 staging systems for cSCC using population-based data. Design, Setting, and Participants This was a nationwide, population-based, nested case-control study. The Cancer Registry of Norway, which receives compulsory data on all cancers in the Norwegian population of approximately 5.2 million inhabitants. All patients diagnosed as having a primary invasive cSCC in the period 2000 to 2004 (n = 6721) were identified. Of these, 112 patients were diagnosed with metastasis within 5 years. As control patients, 112 patients with cSCC without metastases, matched for sex and age at diagnosis, were identified by random. Clinical data and biopsy specimens of primary cSCC were collected for all 224 patients. The biopsies were reexamined histologically by an experienced pathologist using well-established criteria for cSCC, yielding 103 patients with metastasis (cases) and 81 cSCC without metastasis (controls). Main Outcomes and Measures The ability of 4 cSCC staging systems (ie, the American Joint Committee on Cancer, 7th edition [AJCC 7] staging system, the staging system used by Breuninger et al, the Brigham and Women's Hospital [BWH] staging system, and the AJCC, 8th edition [AJCC 8] staging systems) to identify patients who developed metastasis with 5 years of follow-up. External validation was performed by logistic regression, discrimination (sensitivity, specificity, proportion correctly classified, concordance index), and calibration (R2, Hosmer-Lemeshow test, plots) statistics. Results Of 6721 patients; 3674 (54.7%) were men and 3047 (45.3%) were women, with a mean age at diagnosis of 78 years. Of the 103 patients with cSCC diagnosed with metastasis within 5 years, 60 [58.3%] were men, and mean [SD] age 72.7 [13.5] years. Of the 81 patients with cSCC without metastasis, 51 [63.0%] were men, and mean [SD] age 74.6 [11.7] 15 years. The staging systems distinguished poorly to moderately between patients who developed metastasis and those who did not. The ability to cluster patients with similar outcomes within the same staging category was low, particularly when using the AJCC 7 system. Using the AJCC 7 system, the risk of metastasis for T2 patients was 3-fold, compared with T1 patients (OR, 2.96; 95% CI, 1.43-6.15). In the system used by Breuninger et al, high-risk categories for diameter and tumor thickness and the BWH system's T2b category collected relatively homogeneous groups. In the systems used by Breuninger et al and Brigham-Women's Hospital, risk of metastasis was significantly elevated with increasing stage or risk category. Using the system by Breuninger et al, the risk of metastasis was less than 3-fold for tumors in the high-risk category of the combined variable (OR, 2.72; 95% CI, 1.29-5.74). The BWH system gave ORs for metastasis at 4.6 (95% CI, 2.23-9.49) and 21.31 (95% CI, 6.07-74.88) for the T2a and T2b categories, respectively. Conclusions and Relevance Using population-based data, 4 current staging systems for cSCC were unsatisfactory in identifying nonselected cSCC patients at high risk for metastasis. The system used by Breuninger gave the best results.
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Affiliation(s)
- Ingrid Roscher
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Ragnhild S Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Linda Vos
- The Cancer Registry of Norway, University of Oslo, Oslo, Norway
| | - Ole P F Clausen
- Department of Pathology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Per Helsing
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Petter Gjersvik
- Department of Dermatology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trude E Robsahm
- The Cancer Registry of Norway, University of Oslo, Oslo, Norway
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237
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Integrating the Management of Nodal Metastasis Into the Treatment of Nonmelanoma Skin Cancer. Semin Radiat Oncol 2019; 29:171-179. [DOI: 10.1016/j.semradonc.2018.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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238
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Shimizu A, Kuriyama Y, Hasegawa M, Tamura A, Ishikawa O. Nail squamous cell carcinoma: A hidden high-risk human papillomavirus reservoir for sexually transmitted infections. J Am Acad Dermatol 2019; 81:1358-1370. [PMID: 30930083 DOI: 10.1016/j.jaad.2019.03.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
Human papillomavirus (HPV) causes cervical cancer, anal cancer, vulvar cancer, vaginal cancer, penile cancer, and oropharyngeal cancer. Squamous cell carcinoma (SCC) in the genital region in particular is recognized to be caused by HPV infection, and intraepithelial lesions of the penis and vulva are termed penile intraepithelial neoplasia and vulvar intraepithelial neoplasia, respectively. Although SCC of the nail apparatus is recognized as being associated with high-risk HPVs, it is not well-known in general medicine, and its analysis has been insufficient. In this article, we reviewed 136 cases of HPV-associated nail SCC and SCC in situ and delineated their clinical characteristics. We found that half of the cases were high-risk HPV-associated. Almost all of the types were high-risk α-HPVs. This disease had a male dominance and left hand digit 3 and right hand digits 1-3 were typically affected. In this review, 24% of the cases of nail SCC had a history of other HPV-associated diseases, suggesting the possibility of genitodigital transmission. We propose that nail SCC is a hidden high-risk HPV-associated reservoir and should be recognized as a sexually transmitted infection.
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Affiliation(s)
- Akira Shimizu
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Yuko Kuriyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | | | | | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
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239
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Liu Y, Walker E, Iyer SR, Biro M, Kim I, Zhou B, Straight B, Bogyo M, Basilion JP, Popkin DL, Wilson DL. Molecular imaging and validation of margins in surgically excised nonmelanoma skin cancer specimens. J Med Imaging (Bellingham) 2019; 6:016001. [PMID: 30915384 DOI: 10.1117/1.jmi.6.1.016001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/01/2019] [Indexed: 02/05/2023] Open
Abstract
In an effort to increase the efficiency and cure rate of nonmelanoma skin cancer (NMSC) excisions, we have developed a point-of-care method of imaging and evaluation of skin cancer margins. We evaluate the skin surgical specimens using a smart, near-infrared probe (6qcNIR) that fluoresces in the presence of cathepsin proteases overexpressed in NMSC. Imaging is done with an inverted, flying-spot fluorescence scanner that reduces scatter, giving a 70% improved step response as compared to a conventional imaging system. We develop a scheme for careful comparison of fluorescent signals to histological annotation, which involves image segmentation, fiducial-based registration, and nonrigid free-form deformation on fluorescence images, corresponding color images, "bread-loafed" tissue images, hematoxylin and eosin (H&E)-stained slides, and pathological annotations. From epidermal landmarks, spatial accuracy in the bulk of the sample is ∼ 500 μ m , which when extrapolated with a linear stretch model, suggests an error at the margin of ∼ 100 μ m , within clinical reporting standards. Cancer annotations on H&E slides are transformed and superimposed on the fluorescence images to generate the final results. Using this methodology, fluorescence cancer signals are generally found to correspond spatially with histological annotations. This method will allow us to accurately analyze molecular probes for imaging skin cancer margins.
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Affiliation(s)
- Yiqiao Liu
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Ethan Walker
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Sukanya Raj Iyer
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Mark Biro
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States
| | - InYoung Kim
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States
| | - Bo Zhou
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Brian Straight
- Akrotome Imaging Inc., BioEnterprise, Cleveland, Ohio, United States
| | - Matthew Bogyo
- Stanford University, Department of Pathology, Stanford, California, United States.,Stanford University, Department of Microbiology and Immunology, Stanford, California, United States
| | - James P Basilion
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States.,Case Western Reserve University, Department of Radiology, Cleveland, Ohio, United States.,Case Western Reserve University, Fellow, National Foundation for Cancer Research, Cleveland, Ohio, United States
| | - Daniel L Popkin
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States.,Case Western Reserve University, Department of Dermatology, Cleveland, Ohio, United States
| | - David L Wilson
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States.,Case Western Reserve University, Department of Radiology, Cleveland, Ohio, United States
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240
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Willcox JL, Marks SL, Ueda Y, Skorupski KA. Clinical features and outcome of dermal squamous cell carcinoma in 193 dogs (1987-2017). Vet Comp Oncol 2019; 17:130-138. [PMID: 30684311 DOI: 10.1111/vco.12461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022]
Abstract
Squamous cell carcinoma (SCC) is a frequently recognized dermal tumour in dogs and has been described as a common pathology induced by solar ultraviolet radiation exposure. Little has been published about this neoplasm with regard to clinical features and outcome in dogs. This retrospective study included 193 dogs from a single institution histopathologically diagnosed with SCC of the dermis. Thirty-eight percent of all dogs had documented histopathologic actinic change. The overall median survival time was 1004 days, with the population demonstrating actinic change associated with a significantly longer survival time (median 1359 days, range 16-3530 days) compared to dogs without actinic change (median 680 days, range 16-3066 days) and this achieved significance on multivariate analysis (hazard ratio 0.42, 95% confidence interval 0.193-0.930, P = 0.032). These data demonstrate increased survival of dogs with SCC demonstrating actinic change over those with non-actinic SCCs, and purports long-term survival for these animals. Dogs received a variety of treatment approaches as a retrospective study, and future prospective studies will be necessary to investigate whether adjunct therapies such as radiation or chemotherapy offer improvement in survival for dermal SCC in the dog.
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Affiliation(s)
- Jennifer L Willcox
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Yu Ueda
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Katherine A Skorupski
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California
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241
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Kalin JH, Eroglu A, Liu H, Holtzclaw WD, Leigh I, Proby CM, Fahey JW, Cole PA, Dinkova-Kostova AT. Investigation into the use of histone deacetylase inhibitor MS-275 as a topical agent for the prevention and treatment of cutaneous squamous cell carcinoma in an SKH-1 hairless mouse model. PLoS One 2019; 14:e0213095. [PMID: 30865688 PMCID: PMC6415858 DOI: 10.1371/journal.pone.0213095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 02/14/2019] [Indexed: 02/02/2023] Open
Abstract
Cutaneous squamous cell carcinomas are a common form of highly mutated keratinocyte skin cancers that are of particular concern in immunocompromised patients. Here we report on the efficacy of topically applied MS-275, a clinically used histone deacetylase inhibitor, for the treatment and management of this disease. At 2 mg/kg, MS-275 significantly decreased tumor burden in an SKH-1 hairless mouse model of UVB radiation-induced skin carcinogenesis. MS-275 was cell permeable as a topical formulation and induced histone acetylation changes in mouse tumor tissue. MS-275 was also effective at inhibiting the proliferation of patient derived cutaneous squamous cell carcinoma lines and was particularly potent toward cells isolated from a regional metastasis on an immunocompromised individual. Our findings support the use of alternative routes of administration for histone deacetylase inhibitors in the treatment of high-risk squamous cell carcinoma which may ultimately lead to more precise delivery and reduced systemic toxicity.
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MESH Headings
- Administration, Topical
- Animals
- Benzamides/administration & dosage
- Benzamides/pharmacology
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/prevention & control
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cyclin-Dependent Kinase Inhibitor p21/metabolism
- Gene Expression Regulation, Neoplastic/drug effects
- Histone Deacetylase Inhibitors/administration & dosage
- Histone Deacetylase Inhibitors/pharmacology
- Humans
- Mice
- Mice, Hairless
- Neoplasms, Radiation-Induced/drug therapy
- Neoplasms, Radiation-Induced/metabolism
- Neoplasms, Radiation-Induced/prevention & control
- Pyridines/administration & dosage
- Pyridines/pharmacology
- Skin Neoplasms/drug therapy
- Skin Neoplasms/etiology
- Skin Neoplasms/metabolism
- Skin Neoplasms/prevention & control
- Tumor Burden/drug effects
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Jay H. Kalin
- Department of Medicine, Division of Genetics, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, United States of America
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Abdulkerim Eroglu
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD, United States of America
| | - Hua Liu
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD, United States of America
| | - W. David Holtzclaw
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD, United States of America
| | - Irene Leigh
- Division of Cancer Research, Jacqui Wood Cancer Centre, University of Dundee, Dundee, United Kingdom
| | - Charlotte M. Proby
- Division of Cancer Research, Jacqui Wood Cancer Centre, University of Dundee, Dundee, United Kingdom
| | - Jed W. Fahey
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Philip A. Cole
- Department of Medicine, Division of Genetics, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, United States of America
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Albena T. Dinkova-Kostova
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Cullman Chemoprotection Center, Johns Hopkins University, Baltimore, MD, United States of America
- Division of Cancer Research, Jacqui Wood Cancer Centre, University of Dundee, Dundee, United Kingdom
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242
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Wu MP, Sethi RKV, Emerick KS. Sentinel lymph node biopsy for high‐risk cutaneous squamous cell carcinoma of the head and neck. Laryngoscope 2019; 130:108-114. [DOI: 10.1002/lary.27881] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Michael P. Wu
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
| | - Rosh K. V. Sethi
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts U.S.A
| | - Kevin S. Emerick
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts U.S.A
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243
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Genders RE, Weijns ME, Dekkers OM, Plasmeijer EI. Metastasis of cutaneous squamous cell carcinoma in organ transplant recipients and the immunocompetent population: is there a difference? a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2019; 33:828-841. [PMID: 30793804 DOI: 10.1111/jdv.15396] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/14/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Organ transplant recipients (OTR) have a higher risk of developing cutaneous squamous cell carcinoma (cSCC) compared to the immunocompetent population. Immunosuppression is often stated as a risk factor for metastasis. However, evidence for this is scarce. OBJECTIVES To investigate the cSCC metastasis risk in OTR and the immunocompetent population by systematically reviewing the literature. METHODS A systematic review of the literature was performed up to January 2018 using: Medline; Embase; Web of Science and ISI Science Citation Index. Studies assessing cSCC metastasis risk in ORT or immunocompetent cohorts were considered. A pooled risk estimate for metastasis was calculated for the immunocompetent population and OTR separately. RESULTS The pooled metastasis risk estimate for OTR was, respectively, 7.3% (95% CI 6.2-8.4) for cSCC on total body, and 11.0% (95% CI 7.7-14.8) for cSCC of the head neck area. For the immunocompetent population reported risk estimate analysis showed a pooled metastatic risk of 3.1% (95% CI 2.8-3.4) in total body cSCC and of 8.5% (95% CI 7.3-9.8) in cSCC of the head and neck area. Pooled risk estimate per single cSCC in OTR was 1.3% (95% CI 1.0-1.7) in total body cSCC and 4.0% (95% CI 2.7-5.5) in cSCC of the head and neck area. In the immunocompetent population, these pooled risk estimates were, respectively, 2.4% (95% CI 2.1-2.6) and 6.7% (95% CI 5.7-7.8). CONCLUSIONS Organ transplant recipients show a higher overall risk of cSCC metastasis compared to the immunocompetent population. Metastasis risks per single cSCC were substantially lower in both groups. However, due to heterogeneity and differences between studies, comparisons are difficult. Comprehensive follow-up studies with defined cohorts are necessary to adequately asses the risk for cSCC metastasis.
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Affiliation(s)
- R E Genders
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - M E Weijns
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - O M Dekkers
- Department of clinical epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - E I Plasmeijer
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands
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245
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The Role of Sentinel Lymph Node Biopsy in the Management of Cutaneous Malignancies. Facial Plast Surg Clin North Am 2019; 27:119-129. [DOI: 10.1016/j.fsc.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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246
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247
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Kristiansson S, Reizenstein J, von Beckerath M, Landström F. Long-term follow-up in patients treated with electrochemotherapy for non-melanoma skin cancer in the head and neck area. Acta Otolaryngol 2019; 139:195-200. [PMID: 30734631 DOI: 10.1080/00016489.2018.1543950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Electrochemotherapy (ECT) is a cancer treatment modality where the intracellular accumulation of chemotherapeutic agents is enhanced by an applied electrical field. AIMS/OBJECTIVES To evaluate the long-term efficacy, safety and functional outcome after ECT treatment in high-risk non-melanoma skin cancer (NMSC) with curative intent. MATERIALS AND METHODS Seven patients with SCC or BCC in the head and neck area were treated with ECT with intratumoral bleomycin administration. RESULTS Five patients were cured by ECT as a mono-modality treatment after a median 10-year follow-up period. Two patients had recurrences and/or persisting tumors after treatment that required salvage surgery and radiotherapy. In two patients, the eye was spared with no visual impairment. In another patient, full facial nerve function was spared. CONCLUSIONS ECT can be a curative as well as an organ and function-sparing mono modality treatment in high-risk NMSC. SIGNIFICANCE Today ECT is mostly used as a palliative treatment. Its curative potential should be further investigated. Randomized studies comparing ECT with standard treatment is needed. Hopefully, this small study can encourage such studies.
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Affiliation(s)
- Stefan Kristiansson
- Department of Otolaryngology, Orebro Universitet Institutionen for Medicinska Vetenskaper, Örebro University Hospital, Örebro, Sweden
| | - Johan Reizenstein
- Department of Otolaryngology, Orebro Universitet Institutionen for Medicinska Vetenskaper, Örebro University Hospital, Örebro, Sweden
| | - Mathias von Beckerath
- Department of Otolaryngology, Orebro Universitet Institutionen for Medicinska Vetenskaper, Örebro University Hospital, Örebro, Sweden
| | - Fredrik Landström
- Department of Otolaryngology, Orebro Universitet Institutionen for Medicinska Vetenskaper, Örebro University Hospital, Örebro, Sweden
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248
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Characterize basal and squamous cell carcinomas as low or high risk based on size, location, histology, and clinical features. 2. Understand appropriate surgical margins in low- and high-risk lesions, and other management options, including Mohs micrographic surgery, electrodissection and curettage, topical agents, cryotherapy, photodynamic therapy, and radiation therapy. 3. Discuss adjuvant therapies for locally advanced and metastatic disease, including radiation therapy, chemotherapy, and targeted therapies such as hedgehog pathway inhibitors. 4. Educate patients on preventive measures such as skin examinations, sun protection, oral retinoids, and oral nicotinamide (vitamin B3). 5. Devise a reconstructive plan once clear oncologic margins are obtained. SUMMARY With the growing incidence of basal and squamous cell carcinoma, there is an increasing demand for appropriate oncologic management and aesthetic reconstruction. The goal of this CME article is to provide a foundation of knowledge to accurately diagnose, stage, and treat nonmelanoma skin cancers. In addition, it provides the practicing plastic surgeon alternate tools for managing these skin lesions, including topical agents, destructive therapies, and radiation therapy. Lastly, reconstructive plans for selected soft-tissue defects are discussed.
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249
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Does Recurrent Cutaneous Squamous Cell Carcinoma of the Head and Neck Warrant Adjuvant Treatment After Surgical Resection? DIFFICULT DECISIONS IN SURGERY: AN EVIDENCE-BASED APPROACH 2019. [DOI: 10.1007/978-3-030-15123-2_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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250
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Emerging Nonsurgical Therapies for Locally Advanced and Metastatic Nonmelanoma Skin Cancer. Dermatol Surg 2019; 45:1-16. [DOI: 10.1097/dss.0000000000001601] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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