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Knecht-Gurwin K, Stefaniak AA, Chlebicka I, Szepietowski JC. Basal Cell Carcinoma: Comprehensive Review with Emphasis on Scar Tissue Manifestation and Post-Vaccination Incidence. Biomedicines 2024; 12:1769. [PMID: 39200233 PMCID: PMC11351840 DOI: 10.3390/biomedicines12081769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/03/2024] [Accepted: 08/04/2024] [Indexed: 09/02/2024] Open
Abstract
Basal cell carcinoma (BCC) arising within scar tissue is a rare but clinically significant phenomenon. This comprehensive review aims to provide a succinct overview of the current state of knowledge regarding the etiological factors, pathogenesis, clinical presentation, and management of BCC. This study constitutes a literature review pertaining to BCC, with a particular emphasis on BCC developing within scar tissue. It also provides a clinical case presentation of a patient who had developed BCC in a BCG post-vaccination scar and a review of analogous findings available in the existing literature. Despite the fact that an array of mechanisms play a role in injury-related BCC growth, the main mechanism remains ambiguous and yet to be elucidated. The review also includes a detailed description of the various therapeutic options available for BCC, ranging from surgical interventions to novel pharmacological treatments. By examining these intersections, the review seeks to elucidate the potential mechanisms, identify risk factors, and suggest considerations for clinical practice. The findings underscore the importance of vigilant dermatological assessment in patients with scar tissue and those recently vaccinated, aiming to improve early detection and optimize management strategies for BCC.
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Affiliation(s)
| | | | | | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chałubińskiego 1, 50-368 Wrocław, Poland; (K.K.-G.); (A.A.S.); (I.C.)
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2
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Iska S, Sokol G, Sawani A, Patibandla P. Massive Presentation of a Neglected Basal Cell Ulcer on the Forehead and Outcome With Radiation Therapy: A Case Report and Literature Review. Cureus 2023; 15:e34383. [PMID: 36874684 PMCID: PMC9977204 DOI: 10.7759/cureus.34383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Basal cell carcinoma (BCC) of the scalp is the most common cancer of the skin and is locally invasive. The patched/hedgehog intracellular signaling pathway is responsible for regulating cell growth and tumor formation by inactivating mutation of protein patched homolog 1 (PTCH1) or activating mutation of Smoothened (SMOm). BCC can cause significant morbidity from local destruction if neglected. The risk of metastasis and death is 6.5% in tumors greater than or equal to 2 cm in size. The gold standard treatment is surgical excision. Radiation therapy is used to treat skin cancers as an adjuvant or in patients who are not candidates for surgical intervention or who refuse therapy. It works by using low-energy X-rays or electron beam radiation. They work on the superficial skin and do not affect the organs deeper. Here, we describe the case of a man who presented with an unwitnessed seizure and was found to have a large ulcer on his forehead, which was later diagnosed to be BCC of the scalp eroding the calvarium. The base of the ulcer was the patient's dura and brain. He was successfully treated with electron beam radiation therapy for six weeks with careful preservation of brain tissue. The patient's skin was re-epithelialized and the bone was recalcified. The ulcer on the forehead has completely regressed. This case report and literature review illustrates the evidence to propose the importance of radiation therapy and its potential to be the first-line treatment in BCC, especially in similar cases like ours. Multimodality treatment with a radiation oncologist, dermatologist, and medical oncologist can save patients from devastating outcomes.
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Affiliation(s)
- Sindu Iska
- Internal Medicine, Cleveland Clinic Florida, Weston, USA
| | - Gerald Sokol
- Radiation Oncology, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Ali Sawani
- Internal Medicine, Cleveland Veterans Affairs Medical Center, Cleveland, USA
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3
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Advances in Management and Therapeutics of Cutaneous Basal Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14153720. [PMID: 35954384 PMCID: PMC9367462 DOI: 10.3390/cancers14153720] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Basal cell carcinoma (BCC) is the most common malignancy in humans with a range of treatment options available. Tumor and patient characteristics aid in risk-stratification, which influences treatment considerations. Here, we review the advancements in surgical, topical, field, immunotherapeutic, molecular-targeted, and experimental treatment modalities that can be employed in the correct clinical setting for the treatment of BCC. Abstract Basal cell carcinoma (BCC), the most common cancer in humans, is a malignant neoplasm of cells derived from the basal layer of the epidermis. Tumor characteristics such as histologic subtype, primary versus recurrent tumor, anatomic location, size, and patient attributes determine the risk level and acceptable treatment options. Surgical options offer histologic confirmation of tumor clearance. Standard excision provides post-treatment histologic assessment, while Mohs micrographic surgery (MMS) provides complete margin assessment intraoperatively. Additional treatment options may be employed in the correct clinical context. Small and low-risk BCCs, broad field cancerization, locally-advanced disease, metastatic disease, cosmetic concerns, or morbidity with surgical approaches raise consideration of other treatment modalities. We review herein a range of treatment approaches and advances in treatments for BCC, including standard excision, MMS, electrodesiccation and curettage, ablative laser treatment, radiation therapy, targeted molecular therapies, topical therapies, field therapies, immunotherapy, and experimental therapies.
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4
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Hernandez LE, Mohsin N, Levin N, Dreyfuss I, Frech F, Nouri K. Basal Cell Carcinoma: an updated review of pathogenesis and treatment options. Dermatol Ther 2022; 35:e15501. [PMID: 35393669 DOI: 10.1111/dth.15501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
Basal cell carcinoma (BCC) remains the most common malignancy worldwide. BCC pathogenesis is a result of the interplay between one's environment, genetics, and phenotypic factors. BCC has a low mortality but given its increasing incidence and potential to cause local destruction thus resulting in significant morbidity, it is vital for dermatologists to remain up to date with recent updates in this malignancy's pathogenesis and treatment. This article provides a comprehensive review of the pathogenesis of BCC as well as the current treatments available and clinical trials underway. We also touch upon the updated National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology in respect to BCC's recommended treatment modalities.
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Affiliation(s)
- Loren E Hernandez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Noreen Mohsin
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicole Levin
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Isabella Dreyfuss
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, Florida, USA
| | - Fabio Frech
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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5
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Gupta N, Ruiz ES. Current Perspectives in the Treatment of Locally Advanced Basal Cell Carcinoma. Drug Des Devel Ther 2022; 16:183-190. [PMID: 35058688 PMCID: PMC8765439 DOI: 10.2147/dddt.s325852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/06/2022] [Indexed: 12/30/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common cancer in Caucasians, and its incidence continues to rise. Generally, BCCs have good outcomes when diagnosed and treated early. However, 1-10% of patients will develop advanced disease due to either delays in accessing treatment or aggressive tumors that may be refractory to treatment. Locally advanced basal cell carcinomas (laBCCs) are large, aggressive, or recurrent tumors that have the potential to invade surrounding tissues including bone, cartilage, nerve, and muscle. Treatment requires a multi-disciplinary approach where different modalities including surgery, radiation therapy, Hedgehog Pathway Inhibitors, and immunotherapy can be considered.
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Affiliation(s)
- Neha Gupta
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Jamaica Plain, MA, USA
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Jamaica Plain, MA, USA
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6
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Non-Surgical Treatments for Keratinocyte Carcinomas. Adv Ther 2021; 38:5635-5648. [PMID: 34652721 DOI: 10.1007/s12325-021-01916-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Skin cancer is the most common malignancy worldwide, comprising approximately 30% of all human tumors. In recent decades, the incidence of keratinocyte carcinomas, which include basal cell carcinoma and cutaneous squamous cell carcinoma, has been steadily increasing globally (Rogers et al. in JAMA Dermatol 151(10):1081-1086. https://doi.org/10.1001/jamadermatol.2015.1187 , 2015; Nehal and Bichakjian in N Engl J Med 379(4):363-374. https://doi.org/10.1056/nejmra1708701 , 2018). Most tumors are cured with surgical excision; however, some tumors are best treated with non-surgical approaches. Superficial tumors can often be cured with non-surgical methods whereas more advanced stage tumors may not be amenable to surgery. Additionally, surgical treatment may not be available for all populations depending on geographic location and accessibility to care. This article reviews commonly utilized nonsurgical options such as cryotherapy, photodynamic therapy, topical treatments, and radiation as well as systemic treatments including immunotherapies and chemotherapies.
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7
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Leow LJ, Teh N. Clinical clearance of complex basal cell carcinoma in patients receiving sonidegib: A case series. Dermatol Ther 2021; 35:e15217. [PMID: 34816547 PMCID: PMC9285371 DOI: 10.1111/dth.15217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 10/20/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
Basal cell carcinoma (BCC) is the most common cancer worldwide. While most BCC cases respond to surgical management, complex BCC often presents treatment challenges for patients unsuitable for, or refractory to, surgery and radiotherapy—limiting treatment options. Hedgehog pathway inhibitors (HHI) have emerged as an important treatment option for patients with complex BCC—providing a durable treatment modality and improved clinical outcomes. We present a case series of 10 patients with complex BCC treated with sonidegib, an oral HHI, at a dose of 200 mg once daily for a mean duration of 6 months and a mean follow‐up of 7 months. Of these patients, sonidegib monotherapy was curative in eight cases. Of the remaining two patients, treatment with sonidegib arrested tumor progression and decreased tumor size to a point where surgical removal was straightforward. The positive treatment response we observed supports use of sonidegib as an effective treatment option for patients with complex BCC.
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Affiliation(s)
- Liang Joo Leow
- Aesthetic Dermatology, Sydney and Griffith, New South Wales, Australia.,Department of Dermatology, St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Natalie Teh
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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8
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Differences in actin expression between primary and recurrent facial basal cell carcinomas as a prognostic factor of local recurrence. Postepy Dermatol Alergol 2021; 38:490-497. [PMID: 34377133 PMCID: PMC8330871 DOI: 10.5114/ada.2021.107935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Due to a relatively high recurrence rate of facial basal cell carcinoma (BCC), its morbidity is very significant. Aim To analyse the expression of α-SMA, E-cadherin, Ber-Ep4 and MOC-31 as predictors of local recurrence in a group of patients with primary and recurrent BCCs of the face in correlation with histological and clinical data. Material and methods The study cohort included 79 patients with facial BCC (52 with primary BCC and 27 with recurrent BCC) who were treated at the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University, Krakow in 1997-2009. Results Significant risk factors for local recurrence included: recurrent tumour (p = 0.001), multifocal BCC (p = 0.01), incomplete tumour excision (p = 0.02) and the aggressive infiltrating histologic subtype of BCC (p = 0.05). In the group of primary BCCs, positive expression of stromal α-SMA (p = 0.03) correlated with a statistically significant higher recurrence rate and so did positive expression of α-SMA in tumour cells of recurrent BCC (p = 0.002). In the group of primary aggressive BCC subtypes, reduced expression of MOC-31 was also associated with a higher rate of relapse (p = 0.02). Conclusions Our findings provide information about α-SMA and MOC-31 expression in primary and recurrent BCCs. These data may contribute to the formulation of a more targeted treatment plan and follow-up strategy for patients with facial basal cell carcinoma.
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9
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Wilmas KM, Garner WB, Ballo MT, McGovern SL, MacFarlane DF. The role of radiation therapy in the management of cutaneous malignancies. Part II: When is radiation therapy indicated? J Am Acad Dermatol 2021; 85:551-562. [PMID: 34116100 DOI: 10.1016/j.jaad.2021.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Radiation therapy may be performed for a variety of cutaneous malignancies, depending on patient health status, tumor clinical and histologic features, patient preference, and resource availability. Dermatologists should be able to recognize the clinical scenarios in which radiation therapy is appropriate, as this may reduce morbidity, decrease risk of disease recurrence, and improve quality of life. The second article in this 2-part continuing medical education series focuses on the most common indications for radiation therapy in the treatment of basal cell carcinoma, cutaneous squamous cell carcinoma, dermatofibrosarcoma protuberans, Merkel cell carcinoma, Kaposi sarcoma, angiosarcoma, cutaneous lymphoma, melanoma, undifferentiated pleomorphic sarcoma, and sebaceous carcinoma.
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Affiliation(s)
- Kelly M Wilmas
- Department of Dermatology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas.
| | - Wesley B Garner
- Department of Radiation Oncology, West Cancer Center, Germantown, Tennessee
| | - Matthew T Ballo
- Department of Radiation Oncology, West Cancer Center, Germantown, Tennessee
| | - Susan L McGovern
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Deborah F MacFarlane
- Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer, Houston, Texas
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10
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Nasr I, McGrath EJ, Harwood CA, Botting J, Buckley P, Budny PG, Fairbrother P, Fife K, Gupta G, Hashme M, Hoey S, Lear JT, Mallipeddi R, Mallon E, Motley RJ, Newlands C, Newman J, Pynn EV, Shroff N, Slater DN, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol 2021; 185:899-920. [PMID: 34050920 DOI: 10.1111/bjd.20524] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Affiliation(s)
- I Nasr
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - E J McGrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - C A Harwood
- Barts Health NHS Trust, London, E1 1BB, UK.,National Cancer Research Institute's Skin Cancer Clinical Studies Group and Non-Melanoma Skin Cancer Subgroup, London, UK
| | - J Botting
- Royal College of General Practitioners, London, UK
| | - P Buckley
- Independent Cancer Patients' Voice, London, UK
| | - P G Budny
- British Association of Plastic, Reconstructive & Aesthetic Surgeons, London, UK.,Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | | | - K Fife
- Royal College of Radiologists, London, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G Gupta
- NHS Lothian, Lauriston Building, Edinburgh, EH3 9EN, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - S Hoey
- Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - J T Lear
- British Society for Skin Care in Immunosuppressed Individuals, London, UK.,Salford Royal NHS Foundation Hospital, Salford, M6 8HD, UK.,Manchester Academic Health Science Centre, Manchester, M20 2LR, UK
| | - R Mallipeddi
- British Society for Dermatological Surgery, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - E Mallon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - R J Motley
- University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - C Newlands
- British Association of Oral and Maxillofacial Surgeons, London, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - J Newman
- British Dermatological Nursing Group, Belfast, Ireland.,King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - E V Pynn
- Nevill Hall Hospital, Abergavenny, NP7 7EG, UK
| | - N Shroff
- Primary Care Dermatology Society, Rickmansworth, UK
| | - D N Slater
- Royal College of Pathologists, London, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
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11
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Katipally R, Agrawal N, Juloori A. Radiation Therapy for Cutaneous Malignancies of the Head and Neck. Otolaryngol Clin North Am 2021; 54:307-327. [PMID: 33602518 DOI: 10.1016/j.otc.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Radiation therapy plays an integral role in the management of cutaneous malignancies of the head and neck. This article highlights the use of radiation therapy in the definitive and adjuvant setting for basal cell carcinoma, cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma. Themes that emerge include the overall efficacy of radiation therapy as a local therapy, the relevance of cosmesis, functional outcomes, late toxicities as secondary end points, and the multitude of treatment modalities that are used.
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Affiliation(s)
- Rohan Katipally
- Department of Radiation and Cellular Oncology, Duchossois Center for Advanced Medicine, University of Chicago Medicine, 5758 South Maryland Avenue, MC 9006, Chicago, IL 60637, USA.
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medicine, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Aditya Juloori
- Department of Radiation and Cellular Oncology, Duchossois Center for Advanced Medicine, University of Chicago Medicine, 5758 South Maryland Avenue, MC 9006, Chicago, IL 60637, USA
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12
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Yu L, Oh C, Shea CR. The Treatment of Non-Melanoma Skin Cancer with Image-Guided Superficial Radiation Therapy: An Analysis of 2917 Invasive and In Situ Keratinocytic Carcinoma Lesions. Oncol Ther 2021; 9:153-166. [PMID: 33547631 PMCID: PMC8140015 DOI: 10.1007/s40487-021-00138-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction An image-guided form of superficial ionizing radiation therapy (IGSRT) is becoming a commonly used alternative to surgery for non-melanoma skin cancer (NMSC). However, there is little literature evidence evaluating the efficacy and safety of this approach. This study evaluates the efficacy and safety of IGSRT in treating a large number of patients with NMSC. Methods The medical records of 1632 stage 0–II patients with 2917 invasive and in situ NMSC lesions treated from years 2017 to 2020 were reviewed. No patients had clinical evidence of regional lymph node or distant disease at presentation. Results Treatment, guided by pre-treatment ultrasound imaging to adjust radiation energy and dose, combined with a fractionation treatment schedule of 20 or more treatment fractions, was safe and well tolerated. Of 2917 NMSC lesions treated, local tumor control was achieved in 2897 lesions, representing a 99.3% rate of control. Conclusion IGSRT should be considered as a first-line option for treating NMSC tumors in suitable early stage patients. Cure rates observed in this initial period of follow-up are similar, and potentially superior with further follow-up, to traditional superficial radiation therapy (SRT) and surgical options. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-021-00138-4.
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Affiliation(s)
- Lio Yu
- Radiation Oncology, Laserderm Dermatology, Smithtown, NY, USA. .,SkinCure Oncology, Burr Ridge, Illinois, USA.
| | - Chad Oh
- The Weinberg Group, Washington, D.C., USA
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Sequential Treatment of Superficial Basal Cell Carcinomas With Topical Methyl Aminolevulinate Photodynamic Therapy and Imiquimod 5% Cream: A Retrospective Study of Clinical and Cosmetic Outcomes. Dermatol Surg 2021; 46:1272-1278. [PMID: 32011386 DOI: 10.1097/dss.0000000000002306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) and imiquimod 5% (IMQ) cream are established treatments for superficial basal cell carcinoma (sBCC). Both have high initial response rates and recurrence rates of up to 37%. Recent studies demonstrate that PDT and imiquimod may act on sBCCs via synergistic immunomodulatory pathways. OBJECTIVE To describe the sequential use of MAL-PDT and imiquimod 5% cream in the treatment of sBCCs and report treatment tolerability, cosmetic outcomes, and efficacy. MATERIALS AND METHODS This is a retrospective case series of patients presenting over a 2-year period with primary sBCC who underwent 2 cycles of topical MAL-PDT, followed by 6 weeks of imiquimod 5% cream. Outcome measures were resolution of the index lesion at 3 months, side effects, cosmetic outcome, and long-term recurrence (LTR). RESULTS A total of 17 consecutive patients (n = 17) with a combined 21 sBCCs (n = 21) were included. The median length of follow-up was 72 months (range 24-95 months). Long-term recurrence occurred in 2/21 lesions (10%). CONCLUSION Sequential use of PDT and imiquimod was well tolerated with good cosmetic outcomes. The 10% LTR rate is at the lower end of the range reported for single modality treatment; however, larger samples are required to evaluate efficacy differences.
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14
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Recurrence of Basal Cell Carcinoma After Mohs Micrographic Surgery: A 4-Year Retrospective Analysis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.105799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Among non-melanoma skin cancers (NMSC), Basal cell carcinoma (BCC) is one of the most common. Objectives: We endeavored to assess the recurrence rate of BCC after surgery and compare tumors recurrence based on different aspects. Methods: This was a retrospective and observational study which was analyzed medical records of 154 patients who had Mohs micrographic surgery (MMS) from March 2013 to February 2017 in two clinical centers. For finding if the clinical characteristics of the patients have related to tumoral recurrence, we gathered them, including gender and age of the patient, tumor size, site, and its histological type plus the existence of ulcer in malignancy. Data were analyzed using SPSS 22 statistical software. Statistical difference between proportions was determined by χ2 analysis. Results: The majority of patients (74%) were female (57%) older than 60 years old. Most tumors, based on the histopathological diagnosis, were Infiltrating (43.5%) and nodular and infiltrating (40.3%), respectively. The mean tumor size was 1.81 cm and most of them (74%) were larger than 1 cm. The tumor site was mostly in the nasal (56.5%) followed by the cheek (11%). Most patients (96.8%) had one lesion. The recurrence rate was 1.9%. The mean interval between surgeries to recurrence was 13 months. There was no significant difference between recurrence rate and age, sex, tumor type in terms of clinical diagnosis, tumor location, tumor size, number of lesions, and type of tumor (P < 0.05). Conclusions: the rate of recurrence of BCC in patients treated with MMS is low (1.9%). We recommend the utilization of the MMS technique for the treatment of BCC.
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15
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Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics. Adv Anat Pathol 2020; 27:331-353. [PMID: 32618586 DOI: 10.1097/pap.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. In Europe, the incidence of BCC ranges from 44.6 to 128 cases per 100,000 inhabitants annually, whereas in the United States, the yearly incidence rate ranges between 500 and 1500. The global incidence has been calculated to be as high as 10 million cases of BCC per year. There are 2 main clinical patterns of BCC-the familial BCC in basal cell nevus syndrome and sporadic BCC. The etiology of cutaneous BCC is usually the result of the interaction between solar ultraviolet radiation and genetic factors. Somatic or germline mutations in the effector components of the hedgehog signaling pathway (ie, PTCH1, PTCH2, SMO or SUFU genes) are responsible for ∼90% of the cases of both sporadic and familial BCC, all causing a constitutive activation of the hedgehog pathway. Cutaneous BCC very rarely metastasizes, and diagnosis in metastatic sites can be very difficult. Metastatic BCC has weakly effective therapeutic options with a poor prognosis until few years ago. In 2012, small-molecule therapies, involving inactivation of the hedgehog signaling pathway, and capable of reducing tumor growth and progression have been introduced into clinical practice for advanced (locally advanced or metastatic) BCC. We performed a comprehensive literature review on metastatic BCC and found at least 915 cases reported to date. In addition, we extensively discussed the differential diagnosis of metastatic BCC, and outlined the advances in clinical therapeutics involving these small molecules.
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Abstract
Basal cell carcinoma (BCC) is the most common malignancy and the incidence is rising. BCCs have low mortality but can cause significant morbidity primarily through local destruction. The pathogenesis is linked to the interplay between environmental and patient-derived characteristics. There are multiple therapeutic modalities, and appropriate selection requires knowledge of complications, cosmetic outcomes, and recurrence rates. This article reviews the epidemiology, staging, treatment, and prevention of BCC.
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Affiliation(s)
- Dennis P Kim
- Mohs Micrographic Surgery, Brigham and Women's Faulkner Hospital, 1153 Centre Street, Suite 4J, Jamaica Plain, MA 02130-3446, USA
| | - Kylee J B Kus
- Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309-4482, USA
| | - Emily Ruiz
- High-Risk Skin Cancer Clinic, Dana Farber/Brigham and Women's Cancer Center, Mohs and Dermatologic Surgery Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, 1153 Centre Street, Suite 4J, Jamaica Plain, MA 02130-3446, USA.
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Lee CT, Lehrer EJ, Aphale A, Lango M, Galloway TJ, Zaorsky NG. Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients. Cancer 2019; 125:3582-3594. [DOI: 10.1002/cncr.32371] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/25/2019] [Accepted: 06/06/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Charles T. Lee
- Department of Radiation Oncology Fox Chase Cancer Center Philadelphia Pennsylvania
| | - Eric J. Lehrer
- Department of Radiation Oncology Icahn School of Medicine at Mount Sinai New York New York
| | - Abhishek Aphale
- Department of Dermatology Fox Chase Cancer Center Philadelphia Pennsylvania
| | - Miriam Lango
- Department of Surgery Fox Chase Cancer Center Philadelphia Pennsylvania
| | - Thomas J. Galloway
- Department of Radiation Oncology Fox Chase Cancer Center Philadelphia Pennsylvania
| | - Nicholas G. Zaorsky
- Department of Radiation Oncology Fox Chase Cancer Center Philadelphia Pennsylvania
- Department of Radiation Oncology Penn State Cancer Institute Hershey Pennsylvania
- Department of Public Health Sciences Penn State College of Medicine Hershey Pennsylvania
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18
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Lazarevic D, Ramelyte E, Dummer R, Imhof L. Radiotherapy in Periocular Cutaneous Malignancies: A Retrospective Study. Dermatology 2019; 235:234-239. [PMID: 30939473 DOI: 10.1159/000496539] [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: 08/13/2018] [Accepted: 12/27/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Due to the importance of function and cosmetics, periocular skin malignancies represent a therapeutic challenge. OBJECTIVE To evaluate the safety and efficacy of radiotherapy (RT) treating periocular skin tumors. METHODS Data of patients with periocular tumors treated with grenz or soft X-rays at the University Hospital Zurich, Switzerland, between 2009 and 2014 were reviewed. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with associated in situ lesions, cutaneous melanoma, lentigo maligna (LM), cutaneous lymphoma and Kaposi's sarcoma were included in the analysis. RESULTS We found 159 periocular lesions in 145 patients. Overall recurrence was highest for actinic keratosis and Bowen's disease (27%), melanoma (17%) and LM (15%), whereas SCC and BCC showed recurrence in 11 and 10%, respectively. 45% of all recurrences occurred within 12 months after treatment, with a median time to recurrence of 13 months (range 3-73). CONCLUSION RT, which provides a good therapeutic response with minimal adverse events, is a therapy option for periocular cutaneous malignancies.
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Affiliation(s)
- Diana Lazarevic
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland,
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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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20
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Vordermark D. Radiation Therapy in Basal Cell Carcinoma. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_14-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Abstract
Radiotherapy is an available but not well-known treatment for management of basal cell carcinoma. National organizations have established that standard therapy is complete surgical removal and radiation therapy is an option for inoperable tumors or those where the post-operative defect would be cosmetically disfiguring or functionally disabling. These therapeutic options, with histological sample, should be considered in the multidisciplinary management of patients with basal cell carcinoma. There are several types of radiotherapy: external radiation or interstitial brachytherapy, unfortunately, there is no consensus in the literature and the range of radiation regimens in common use is large. Very few randomized studies have been conducted to defi the optimum treatment in terms of recurrence rate, cosmetic outcome and side-eff In most of studies, the overall local control rate was between 80-100% and over 90% of patients reported good or excellent cosmetic outcome. Side-eff of radiotherapy most commonly reported are minor but in young patients one must be alert to the theoretical possibility of the induction of secondary malignancies. Cet article fait partie du numéro supplément Prise en charge des carcinomes basocellulaires difficiles à traiter réalisé avec le soutien institutionnel de Sun Pharma.
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Affiliation(s)
- C Velter
- Service de dermatologie, institut Gustave-Roussy, 94805 Villejuif, France.
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22
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Koelblinger P, Lang R. New developments in the treatment of basal cell carcinoma: update on current and emerging treatment options with a focus on vismodegib. Onco Targets Ther 2018; 11:8327-8340. [PMID: 30568456 PMCID: PMC6267762 DOI: 10.2147/ott.s135650] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common form of skin cancer worldwide. Although most BCCs can be treated by relatively simple surgical or nonsurgical methods, some patients with BCC may eventually develop advanced disease which can either be locally destructive or even include metastatic spread. The present review summarizes the current literature on the treatment of both early and advanced BCC with a focus on the hedgehog inhibitor vismodegib which has become an integral part of the management of patients with advanced BCC since its regulatory approval in 2012.
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Affiliation(s)
- Peter Koelblinger
- Department of Dermatology, Paracelsus Medical University, Salzburg, Austria,
| | - Roland Lang
- Department of Dermatology, Paracelsus Medical University, Salzburg, Austria,
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23
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Gunaratne DA, Veness MJ. Efficacy of hypofractionated radiotherapy in patients with non-melanoma skin cancer: Results of a systematic review. J Med Imaging Radiat Oncol 2018. [PMID: 29524319 DOI: 10.1111/1754-9485.12718] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radiation oncologists are increasingly tasked with the management of elderly patients with non-melanoma skin cancer, unsuitable for surgical intervention due to inoperable lesions and/or poor performance status. In this cohort, hypofractionated radiotherapy, delivered either daily, alternative daily or once weekly is highly effective. A systematic literature search was conducted of PUBMED, MEDLINE and EMBASE databases using the algorithm ('radiotherapy' OR 'radiation therapy' OR 'brachytherapy') AND ('hypofraction' OR 'hypofractionated' OR 'hypofractionation') AND ('skin neoplasms' OR 'carcinoma' OR 'malignancy') AND ('skin' OR 'epidermis' OR 'epidermal' OR 'cutaneous'). Forty relevant publications (1983-2017) encompassing 12,337 irradiated lesions were retrieved. Studies documented a mean age of 71.73 years and male predilection (54.5%). Both external beam radiotherapy and brachytherapy were utilized. Tumour subtype was squamous cell carcinoma (23.5%), basal cell carcinoma (75.2%) or others (1.3%). Irradiated lesions were primary (or denovo) (92.6%), located on the head and neck (95.7%) and received definitive therapy (96.5%). Analysis demonstrated a mean weighted total radiotherapy dose (38.15 Gy), dose per fraction (7.95 Gy) and treatments per week (2.98). Despite significant heterogeneity in the study population, the radiotherapy delivered and follow-up, local recurrence rate (crude or Kaplan-Meier analysis) did not exceed 7.9% in all but three of the 36 publications providing these data. Twenty-nine publications documented local control exceeding 90%. There is a body of evidence documenting the efficacy of hypofractionated radiotherapy as an option that confers no obvious disadvantage in local control when compared to traditional more protracted radiotherapy schedules.
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Affiliation(s)
- Dakshika A Gunaratne
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael J Veness
- Department of Radiation Oncology, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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24
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Migden MR, Chang ALS, Dirix L, Stratigos AJ, Lear JT. Emerging trends in the treatment of advanced basal cell carcinoma. Cancer Treat Rev 2018; 64:1-10. [DOI: 10.1016/j.ctrv.2017.12.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 12/16/2022]
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25
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Zaorsky NG, Lee CT, Zhang E, Galloway TJ. Skin CanceR Brachytherapy vs External beam radiation therapy (SCRiBE) meta-analysis. Radiother Oncol 2018; 126:386-393. [PMID: 29370985 PMCID: PMC7548033 DOI: 10.1016/j.radonc.2017.12.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE To compare cosmesis and local recurrence (LR) of definitive external beam radiation therapy (EBRT) vs brachytherapy (BT) for indolent basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin. MATERIALS AND METHODS Studies including patients with T1-2 N0 SCCs/BCCs treated with definitive EBRT/BT and ≥10 months follow-up were analyzed. The primary endpoint was post-treatment cosmesis, categorized as "good," "fair," or "poor." The secondary endpoint was LR. Mixed effects regression models were used to estimate weighted linear relationships between biologically equivalent doses with α/β = 3 (BED3) and cosmetic outcomes. RESULTS A total of 9965 patients received EBRT and 553 received BT across 24 studies. Mean age was 73 years, median follow-up was 36 months, and median dose was 45 Gy/10 fractions at 4.4 Gy/fraction. At BED3 of 100 Gy, "good" cosmesis was more frequently observed in patients receiving BT, 95% (95% CI: 88-100%) vs 79% (95% CI: 60-82%), p < 0.05. Similar results were found for "good" cosmesis at BED3 >100 Gy. No difference in "poor" cosmesis was noted at any BED3. LR was <7% for both at one year. CONCLUSION BT has favorable cosmesis over EBRT for skin SCCs/BCCs at common fractionation regimens. Prospective studies comparing EBRT vs BT are warranted.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA.
| | - Charles T Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Eddie Zhang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
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26
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The feasibility of using ultrasound during follow-up for superficial non-melanoma skin cancers after electronic brachytherapy. J Contemp Brachytherapy 2017; 9:535-539. [PMID: 29441097 PMCID: PMC5807995 DOI: 10.5114/jcb.2017.72358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/10/2017] [Indexed: 01/21/2023] Open
Abstract
Purpose Non-melanoma skin cancers (NMSCs) can be treated with a number of modalities including surgery, topical chemotherapy, or radiotherapy. Amongst the radiotherapeutic options, electronic brachytherapy (eBT) is an appealing treatment as it is usually given in a few fractions, it leads to good outcomes, and is increasingly being used. However, currently no follow-up imaging is routinely used or recommended to evaluate treatment response of NMSC. We aimed to use ultrasound (US) in follow-up after eBT for superficial NMSC to assess its feasibility in detecting possible tumor response. Material and methods Fourteen patients were treated between 2013-2015 for a NMSC using eBT. US guidance was used for treatment planning prior to eBT initiation. After completion of eBT, patients were seen in follow-up for both clinical exam and a repeat US at 1 month to evaluate if tumor response was detectable. Results Of the 14 patients, 6 were male and 8 were female. The mean age was 71 years. With a median follow-up of 20.5 months, all patients had a complete response based on physical exam. Eleven patients appeared to have a complete response based on US obtained > 1 month after completing eBT. To date, there have been no local recurrences or progression, and all patients are alive. Conclusions US is an objective imaging modality that may be able to assess NMSC response after eBT. Based on follow-up imaging, further treatment or observation may be recommended. Although this study is hypothesis generating, larger studies with pathologic confirmation of recurrences would be needed to validate US use for follow-up, avoiding possible painful and scarring biopsies in case of low suspicion of recurrence.
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27
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Zaorsky NG, Lee CT, Zhang E, Keith SW, Galloway TJ. Hypofractionated radiation therapy for basal and squamous cell skin cancer: A meta-analysis. Radiother Oncol 2017; 125:13-20. [PMID: 28843727 PMCID: PMC7534946 DOI: 10.1016/j.radonc.2017.08.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/21/2017] [Accepted: 08/07/2017] [Indexed: 02/09/2023]
Abstract
PURPOSE To characterize the cosmetic outcomes and local recurrence (LR) rates of various hypofractionated radiation therapy (RT) regimens for skin basal and squamous cell cancers (BCCs/SCCs). METHODS A PICOS/PRISMA/MOOSE selection protocol was performed to identify 344 articles published between 1985-2016 evaluating patients with T1-2 N0 SCCs/BCCs treated with definitive RT. Biologically equivalent doses with α/β=3 (BED3s) were calculated. The primary endpoint was post-treatment cosmesis. Mixed effects regression models were used to estimate weighted linear relationships between BED3 and cosmetic outcomes. RESULTS A total of 21 studies were identified detailing the treatment of 9729 skin BCC/SCC patients, across seven countries, with external beam RT (n=9255) or brachytherapy (n=474). Median follow-up was 36months (range: 12-77). Median dose was 45Gy/11 fractions (interquartile range: 37.5Gy/6-55Gy/18) at 4Gy/fraction (interquartile range: 2.5-6Gy); most hypofractionated 18.75Gy/1. There was a trend to decreased "good" cosmesis with higher total dose: -3.4% "good" cosmesis/10Gy BED3, p=0.01. Similarly, there was a trend to increased "fair" cosmesis with higher dose: +3.8% "fair" cosmesis/10Gy BED3,p=0.006. At a BED3 of 100Gy, the expected rate of "good" cosmesis is 79% (95% confidence interval: 70%, 88%). Hypofractionated schedules produced similar cosmesis to conventionally fractionated schedules, at the same BED3. Fewer than 8% of patients experienced "poor" cosmesis, independent of dose or fractionation regimen. CONCLUSION Hypofractionated RT has favorable cosmesis for patients with skin BCCs/SCCs. We recommend clinicians consider these commonly-used regimens, which all have BED3 of ∼100Gy: 50Gy/15 fractions, 36.75Gy/7 fractions, or 35Gy/5 fractions, as they result in "good" cosmesis in 80% of patients.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, USA.
| | - Charles T Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Eddie Zhang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - Scott W Keith
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA.
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28
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Gianfaldoni S, Gianfaldoni R, Wollina U, Lotti J, Tchernev G, Lotti T. An Overview on Radiotherapy: From Its History to Its Current Applications in Dermatology. Open Access Maced J Med Sci 2017; 5:521-525. [PMID: 28785349 PMCID: PMC5535674 DOI: 10.3889/oamjms.2017.122] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 11/05/2022] Open
Abstract
For more than a century, radiotherapy has been an effective treatment for oncologic patients. The Authors report a brief history of the radiation therapy and its actual indication for the treatments of cutaneous malignant diseases.
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Affiliation(s)
- Serena Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Roberto Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Uwe Wollina
- Krankenhaus Dresden-Friedrichstadt, Department of Dermatology and Venereology, Dresden, Sachsen, Germany
| | - Jacopo Lotti
- G. Marconi University, Department of Nuclear Physics, Subnuclear and Radiation, Rome, Italy
| | - Georgi Tchernev
- Medical Institute of the Ministry of Interior, Dermatology, Venereology and Dermatologic Surgery; Onkoderma, Private Clinic for Dermatologic Surgery, Dermatology and Surgery, Sofia 1407, Bulgaria
| | - Torello Lotti
- Universitario di Ruolo, Dipartimento di Scienze Dermatologiche, Università degli Studi di Firenze, Facoltà di Medicina e Chirurgia, Dermatology, Via Vittoria Colonna 11, Rome 00186, Italy
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29
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Campana LG, Marconato R, Valpione S, Galuppo S, Alaibac M, Rossi CR, Mocellin S. Basal cell carcinoma: 10-year experience with electrochemotherapy. J Transl Med 2017; 15:122. [PMID: 28569161 PMCID: PMC5452531 DOI: 10.1186/s12967-017-1225-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/27/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Electrochemotherapy (ECT), by combining manageable cytotoxic agents with short electric pulses, represents an effective palliative skin-directed therapy. The accumulated evidence indicates that ECT stands out as a safe and well-tolerated alternative treatment for patients with multiple or large basal cell carcinoma (BCC), who are not suitable for conventional treatments. However, long-term data and shared indications are lacking. METHODS In this observational study, we retrospectively analyzed 84 prospectively collected patients with multiple, recurrent or locally advanced BCC who were not candidate for standard therapies and received bleomycin-based ECT according to the European Standard Operative Procedures of ECT, from 2006 to 2016. RESULTS Disease extent was local, locally advanced and metastatic in 40 (48%), 41 (49%) and 3 (3%), respectively. Forty-four (52%) individuals had multiple BCCs. Grade 3 skin toxicity after ECT was observed in 6% of cases. Clearance rate was 50% (95% CI 39-61%). Primary presentation (p = 0.004), tumor size <3 cm (p < 0.001), well-defined borders (p = 0.021), absence of tumor ulceration (p = 0.001), non-aggressive BCC histology (p = 0.046) and age ≤69 years were associated with higher complete response rate. In patients with local BCC, the clearance rate was 72.5 and 85% after one or two ECT cycles, respectively. In the laBCC group, 32 patients (78%) achieved an objective response. Five-year recurrence rate for local and laBCC was 20 and 38%, respectively (p ≤ 0.001). CONCLUSIONS One or two ECT cycles with bleomycin may be a valuable palliative treatment in well-selected patients with multiple BCCs and favorable tumor features. Validation of predictive factors will be imperative to match patients with optimal ECT treatment modalities. Management of laBCC with ECT warrants further investigation. Trial registration ISRCTN14633165 Registered 24 March 2017 (retrospectively registered).
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Affiliation(s)
- Luca G Campana
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy. .,Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy.
| | | | - Sara Valpione
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy.,Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - Sara Galuppo
- Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mauro Alaibac
- Dermatology Unit, University of Padova, Padua, Italy
| | - Carlo R Rossi
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
| | - Simone Mocellin
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padua, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy
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30
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Non-melanoma skin cancer: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S125-S132. [PMID: 27841126 PMCID: PMC4873942 DOI: 10.1017/s0022215116000554] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides consensus recommendations on the management of cutaneous basal cell carcinoma and squamous cell carcinoma in the head and neck region on the basis of current evidence.
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31
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Piccinno R, Benardon S, Gaiani FM, Rozza M, Caccialanza M. Dermatologic radiotherapy in the treatment of extensive basal cell carcinomas: a retrospective study. J DERMATOL TREAT 2017; 28:426-430. [PMID: 28132575 DOI: 10.1080/09546634.2016.1274365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The increase of the number of new cases for year of basal cell carcinoma (BCC) has brought also an increase of BCC difficult to treat (extensive, locally advanced and high risk forms). OBJECTIVE To evaluate retrospectively the results obtained with dermatologic radiotherapy (RT) for better defining the indications respect to new emerging treatments. METHODS A series of extensive 115 BCC treated with RT from 1977 to 2014 were selected for the study, since endowed with histological diagnosis on the amount of 181 extensive BCC. RT was performed with conventional energies (50-160 kV) administering a total dose ranging from 47 to 85 Gy (median 55 Gy). The mean follow up was 40.66 months (median 21 months). A statistical evaluation was performed with chi-square test to analyse the possible correlations among therapeutic and cosmetic results and size, localisation and clinical type of the lesions. RESULTS A complete remission (CR) was obtained in 70.43%, a partial remission (PR) in 20% of the lesions treated, while in 9.56% a no response (NR) or not evaluable response (NER) was registered. In 19% of the lesions a relapse was observed, with a five-year cure-rate of 55.13%. Cosmetic results were good in 28%, acceptable in 50% and not acceptable in 22% of the lesions in CR. In six lesions, localised at the trunk region, a chronic radiodermatitis developed. A statistically significative correlation was observed between therapeutic results and size, between cosmetic results and size and between therapeutic results and clinical type of BCC. CONCLUSION The treatment of extensive BCC is still a challenge and radiotherapy is one of the possible choices, preferred in the elderly, in relapsing cases, after incomplete excision, and in difficult localisations of the face. Radiotherapy might be included in sequential schedules of treatment to improve final results.
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Affiliation(s)
- R Piccinno
- a UO Dermatologia, Servizio di Fotoradioterapia.,b Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico , Milano , Italy
| | - S Benardon
- a UO Dermatologia, Servizio di Fotoradioterapia.,b Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico , Milano , Italy.,c Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti , Università degli Studi di Milano , Milano , Italy
| | - F M Gaiani
- a UO Dermatologia, Servizio di Fotoradioterapia.,b Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico , Milano , Italy
| | - M Rozza
- b Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico , Milano , Italy.,d UOSD Fisica Medica , Ospedale
| | - M Caccialanza
- a UO Dermatologia, Servizio di Fotoradioterapia.,b Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico , Milano , Italy
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32
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Alter M, Hillen U, Leiter U, Sachse M, Gutzmer R. Current diagnosis and treatment of basal cell carcinoma. J Dtsch Dermatol Ges 2016; 13:863-74; quiz 875. [PMID: 26882375 DOI: 10.1111/ddg.12798] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Basal cell carcinoma represents is most common tumor in fair-skinned individuals. In Germany, age-standardized incidence rates are 63 (women) and 80 (men) per 100,000 population per year. Early lesions may be difficult to diagnose merely on clinical grounds. Here, noninvasive diagnostic tools such as optical coherence tomography and confocal laser scanning microscopy may be helpful. The clinical diagnosis is usually confirmed by histology. Standard therapy consists of complete excision with thorough histological examination, either by means of micrographic surgery or, depending on tumor size and location as well as infiltration, using surgical margins of 3-5 mm or more. In particular, multiple basal cell carcinomas (such as in Gorlin-Goltz syndrome) and locally advanced as well as rarely also metastatic basal cell carcinoma may pose a therapeutic challenge. In superficial basal cell carcinoma, nonsurgical therapies such as photodynamic therapy or topical agents may be considered. In case of locally advanced or metastatic basal cell carcinoma, an interdisciplinary tumor board should issue therapeutic recommendations. These include radiation therapy as well as systemic therapy with a hedgehog inhibitor.
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Affiliation(s)
- Mareike Alter
- Department of Dermatology and Venereology, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Uwe Hillen
- Department of Dermatology, University Medical Center Essen, Essen, Germany
| | - Ulrike Leiter
- Center for Dermatooncology, Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Michael Sachse
- Department of Dermatology, Allergology, and Phlebology, Medical Center Bremerhaven, Bremerhaven, Germany
| | - Ralf Gutzmer
- Skin Tumor Center Hanover, Department of Dermatology, Allergology, and Venereology, Medical University Hanover, Hanover, Germany
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Ramelyte E, Amann VC, Dummer R. Sonidegib for the treatment of advanced basal cell carcinoma. Expert Opin Pharmacother 2016; 17:1963-8. [DOI: 10.1080/14656566.2016.1225725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Gene Expression and Proteome Analysis as Sources of Biomarkers in Basal Cell Carcinoma. DISEASE MARKERS 2016; 2016:9831237. [PMID: 27578920 PMCID: PMC4992754 DOI: 10.1155/2016/9831237] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/10/2016] [Indexed: 12/13/2022]
Abstract
Basal cell carcinoma (BCC) is the world's leading skin cancer in terms of frequency at the moment and its incidence continues to rise each year, leading to profound negative psychosocial and economic consequences. UV exposure is the most important environmental factor in the development of BCC in genetically predisposed individuals, this being reflected by the anatomical distribution of lesions mainly on sun-exposed skin areas. Early diagnosis and prompt management are of crucial importance in order to prevent local tissue destruction and subsequent disfigurement. Although various noninvasive or minimal invasive techniques have demonstrated their utility in increasing diagnostic accuracy of BCC and progress has been made in its treatment options, recurrent, aggressive, and metastatic variants of BCC still pose significant challenge for the healthcare system. Analysis of gene expression and proteomic profiling of tumor cells and of tumoral microenvironment in various tissues strongly suggests that certain molecules involved in skin cancer pathogenic pathways might represent novel predictive and prognostic biomarkers in BCC.
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Strom TJ, Caudell JJ, Harrison LB. Management of BCC and SCC of the Head and Neck. Cancer Control 2016; 23:220-7. [DOI: 10.1177/107327481602300305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background For decades radiotherapy (RT) has been shown to treat skin cancers; however, the indications, delivery methods, and techniques for RT continue to evolve. Methods Relevant prospective and retrospective reports were reviewed that addressed outcomes with, indications for, and delivery techniques used with RT for the management of cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the head and neck. Results Rates of local control higher than 90% are typically achievable for early-stage BCC and SCC of the head and neck. RT is often recommended for tumors located in cosmetically or functionally sensitive areas of the face, for patients who cannot tolerate anesthesia, for those taking anticoagulants, or for patients who prefer RT to other treatment options. A wide range of radiation doses, daily fractionation schedules, and radiation techniques have been shown to be effective for management. In general, postoperative local radiation is recommended following excision for patients with high-risk factors, including those whose tumors have close or positive margins, perineural invasion, invasion of the bone or nerves, or those with recurrent disease. Conclusions RT plays an integral role in the treatment of primary and postoperative cutaneous BCC and SCC of the head and neck. Prospective trials are in progress to address the roles of concurrent systemic therapy and RT for both cutaneous BCC and SCC.
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Affiliation(s)
- Tobin J. Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jimmy J. Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Louis B. Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Grossi Marconi D, da Costa Resende B, Rauber E, de Cassia Soares P, Fernandes JM, Mehta N, Lopes Carvalho A, Kupelian PA, Chen A. Head and Neck Non-Melanoma Skin Cancer Treated By Superficial X-Ray Therapy: An Analysis of 1021 Cases. PLoS One 2016; 11:e0156544. [PMID: 27367229 PMCID: PMC4930196 DOI: 10.1371/journal.pone.0156544] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 04/25/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION To report a single-institutional experience with the use of Superficial X-Ray Therapy (SXRT) for head and neck non-melanoma skin cancer (N-MSC) and to compare outcomes by prescribed fractionation schedules. MATERIALS AND METHODS The medical records of 597 patients with 1021 lesions (720 BCC, 242 SCC, 59 SCC in situ) treated with kilovoltage radiation from 1979-2013 were retrospectively reviewed. The majority of patients were treated according to 1 of 3 institutional protocols based on the discretion of the radiation oncologist: 1) 22 x 2.5 Gy; 2) 20 x 2.5 Gy; 3) 30 x 2.0 Gy. "T" stage at first presentation was as follows: Tis (59); T1 (765); T2 (175); T3 (6), T4 (9); Tx, (7). All patients were clinical N0 and M0 at presentation. Chi-square test was used to evaluate any potential association between variables. The Kaplan-Meier method was used to analyze survival with the Log Rank test used for comparison. A Cox Regression analysis was performed for multivariate analysis. RESULTS The median follow up was 44 months. No significant difference was observed among the 3 prescribed fractionation schemes (p = 0.78) in terms of RTOG toxicity. There were no failures among SCC in situ, 37 local failures (23 BCC, 14 SCC), 5 regional failures (all SCC) and 2 distant failures (both SCC). For BCC, the 5-year LC was 96% and the 10-year LC was 94%. For SCC the corresponding rates of local control were 92% and 87%, respectively (p = 0.03). The use of >2.0 Gy daily was significantly associated with improved LC on multivariate analysis (HR: 0.17; CI 95%: 0.05-0.59). CONCLUSION SXRT for N-MSC of the head and neck is well tolerated, achieves excellent local control, and should continue to be recommended in the management of this disease. Fractionation schedules using >2.0 Gy daily appear to be associated with improved LC.
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Affiliation(s)
- Daniel Grossi Marconi
- Barretos Cancer Hospital, Department of Radiation Oncology, Barretos, Brazil
- * E-mail:
| | | | - Erick Rauber
- Barretos Cancer Hospital, Department of Radiation Oncology, Barretos, Brazil
| | | | | | - Niraj Mehta
- South Florida Radiation Oncology, Miami, Florida, United States of America
| | | | - Patrick A Kupelian
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Allen Chen
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States of America
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Clinical comparison of brachytherapy versus hypofractionated external beam radiation versus standard fractionation external beam radiation for non-melanomatous skin cancers. J Contemp Brachytherapy 2016; 8:191-6. [PMID: 27504127 PMCID: PMC4965500 DOI: 10.5114/jcb.2016.60598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 05/31/2016] [Indexed: 12/22/2022] Open
Abstract
Purpose Non-melanomatous skin cancer (NMSC) is the single most common cancer in the US. Radiation therapy is an excellent treatment alternative to surgery. High-dose-rate (HDR) brachytherapy and external beam radiotherapy (EBRT) are commonly used radiation treatment modalities but little data is published comparing these modalities. We present our institution's experience and outcomes with these therapeutic options. Material and methods From June 2005 to March 2013, 61 patients were treated with HDR brachytherapy (n = 9), hypofractionated EBRT (n = 30), or standard fractionation EBRT (n = 22) for NMSC. The primary outcome measure was local control at most remote follow-up and secondary outcome measures were overall survival, cosmetic outcome, and toxicity. Univariate analysis was performed to compare outcomes between treatment modalities. Kaplan-Meier analysis and log-rank test were used to compare overall survival. Results Median follow-up was 30 months. The most common histologies were BCC (47%) and SCC (44%); mean patient age was 83.3 years. Local control was 81% and 2-year actuarial overall survival was 89%. There was no statistical difference in local control or overall survival between treatment modalities. There was no statistical difference in cosmetic outcome or toxicity between treatment modalities, although five of six “poor” cosmetic outcomes and the only grade 3 toxic events were found in the standard fractionation EBRT group. Conclusions All modalities investigated represent effective treatments for NMSC and have good cosmetic outcomes and acceptable toxicity profiles. The finding of higher grade toxicity and a greater portion of patients experiencing toxicity among standard fractionation therapy is counter to expectations. There was no statistical significance to the finding and it is not likely to be meaningful.
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Clinicopathological analysis of recurrent basal cell carcinoma of the eyelid. Postepy Dermatol Alergol 2016; 33:42-6. [PMID: 26985178 PMCID: PMC4793053 DOI: 10.5114/pdia.2015.48039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 07/17/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Basal cell carcinoma (BCC) is the most common malignant neoplasm of the eyelids and surrounding structures, usually developing in the area of the lower lid and medial canthus. Invasive forms of BCC are connected with a high risk of recurrence, often due to incomplete excision of these lesions. Aim Clinical and pathological analysis of recurrent BCCs of the eyelids and surrounding structures. Material and methods We present clinical and pathological analysis including immunohistochemical reaction to Ki-67 antigen of 19 patients (11 women, 8 men) operated for recurrent BCCs of the eyelids in 2000–2012. Results In most cases, recurrences were present on the lower lid and in the medial canthus. In 15 patients the histopathological type did not change and in 4 cases it transformed into more invasive forms. The values of Ki-67 index for primary BCCs ranged between 1% and 20%, and for relapsing lesions between 11% and 48%. Conclusions Proper clinical and pathological evaluation to determine the risk of relapse in BCCs of the eyelids and surrounding structures should include the analysis of prognostic factors, in particular location and size, histopathological type and radicalness of surgical treatment of primary BCCs. Clinical and pathological analysis of patients with recurrent BCC of the eyelids and surrounding structures should be combined with the evaluation of proliferation index Ki-67, which is essential for prognosis and choice of the appropriate therapeutic method.
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Lackner B, Kazerounian S, Dunavölgyi R, Kuchar A. BCC Update – Diagnostik und Therapie. SPEKTRUM DER AUGENHEILKUNDE 2015. [DOI: 10.1007/s00717-015-0282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pampena R, Palmieri T, Kyrgidis A, Ramundo D, Iotti C, Lallas A, Moscarella E, Borsari S, Argenziano G, Longo C. Orthovoltage radiotherapy for nonmelanoma skin cancer (NMSC): Comparison between 2 different schedules. J Am Acad Dermatol 2015; 74:341-7. [PMID: 26589877 DOI: 10.1016/j.jaad.2015.09.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/30/2015] [Accepted: 09/12/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Radiotherapy is an established treatment for some types of patients with nonmelanoma skin cancer. A hypofractionated schedule has been proposed as a valuable option for elderly disabled patients to minimize the number of hospital visits. OBJECTIVE We sought to compare a weekly hypofractionated orthovoltage radiotherapy regimen with a standard daily one for the treatment of nonmelanoma skin cancer. METHODS A retrospective cohort study was performed on 436 tumors. Overall survival, disease-free survival, and cosmetic outcome were measured. Life-table analysis, Kaplan-Meier survival analysis, and multivariate Cox regression model were performed. RESULTS The hypofractionated regimen was not associated with increased recurrence rates and mortality, or with a poorer cosmetic outcome, when compared with the daily schedule. LIMITATIONS Absence of complete information about acute treatment toxicity and a shorter follow-up time for patients receiving the weekly schedule are limitations of this study. CONCLUSIONS A weekly hypofractionated regimen of orthovoltage radiotherapy seems to be the most appropriate approach in elderly disabled patients with nonmelanoma skin cancers.
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Affiliation(s)
- Riccardo Pampena
- Dermatology Unit "Daniele Innocenzi" Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Terracina, Italy
| | - Tamara Palmieri
- Radiotherapy Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Dafne Ramundo
- Radiotherapy Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiotherapy Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Aimilios Lallas
- Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Elvira Moscarella
- Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Stefania Borsari
- Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Caterina Longo
- Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
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Correia de Sá TR, Silva R, Lopes JM. Basal cell carcinoma of the skin (part 2): diagnosis, prognosis and management. Future Oncol 2015; 11:3023-38. [PMID: 26449265 DOI: 10.2217/fon.15.245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Basal cell carcinoma (BCC) is a heterogeneous malignant neoplasm with different biological and clinical behaviors, often slow growing and rarely metastatic and conveying an excellent prognosis. However, BCC is the most frequent skin cancer worldwide and can cause great morbidity, as most occur in high visible areas of the body, often relapse and may invade and destroy local tissues. This review aims to present a concise and updated overview of BCC histopathology and clinical presentation and progression. We also present a summary of currently available treatment options and some of the new promising agents.
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Affiliation(s)
| | - Roberto Silva
- Faculty of Medicine, Porto University, Praça de Gomes Teixeira, 4099-002 Porto, Portugal
| | - José Manuel Lopes
- Faculty of Medicine, Porto University, Praça de Gomes Teixeira, 4099-002 Porto, Portugal
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Gaballah MA, Ahmed RA. Diagnostic value of CD10 and Bcl2 expression in distinguishing cutaneous basal cell carcinoma from squamous cell carcinoma and seborrheic keratosis. Pathol Res Pract 2015; 211:931-8. [PMID: 26573127 DOI: 10.1016/j.prp.2015.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 06/29/2015] [Accepted: 09/08/2015] [Indexed: 12/01/2022]
Abstract
The distinction between cutaneous basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and seborrheic keratosis (SK), which are common entities in clinical practice, can be difficult clinically and histologically. CD10 and Bcl2 antigens are important factors in tumor growth, survival and spread. The aim of the present study is to define the frequency of CD10 and Bcl2 expression in such cutaneous tumors and its relation to the clinicopathological characteristics as well as their possible diagnostic utility. CD10 and Bcl2 immunohistochemistry was performed on 30 BCC, 20 SCC and 15 SK. 93.3% of SK cases and 53.3% of BCC cases showed significant expression of CD10 in tumor cells when compared either with each other or with SCC cases (100% negative). Stromal CD10 expression was positive in 50% of BCC cases and 75% of SCC cases. Stromal CD10 expression was significantly higher in high risk BCC and BCC with infiltrating deep margins; furthermore, it showed a significant positive correlation with grade of SCC. A significant inverse correlation between CD10 expression in stromal and tumor cells of BCC was present. Bcl2 was significantly expressed in 93.3% of SK cases and 80% of BCC cases when compared with SCC cases (100% negative). It was found that for distinguishing BCC from SK, only CD10 expression in tumor cells provided a high diagnostic value with positive likelihood ratio (PLR) was 7.00. In addition, CD10 and Bcl2 expression in tumor cells could give convincing diagnostic value to distinguish SCC from SK (PLR=15.00 for each marker). Moreover, for differentiating BCC from SCC, only Bcl2 in the tumor cells could provide a high diagnostic value (PLR=5.5). In conclusion, CD10 and Bcl2 can help in differentiating cutaneous BCC from SK and SCC. The overexpression of CD10 in the stromal cells of SCC and some variants of BCC suggests the invasive properties of such tumors.
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Alter M, Hillen U, Leiter U, Sachse M, Gutzmer R. Aktuelle Diagnostik und Behandlung des Basalzellkarzinoms. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.10_12798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mareike Alter
- Universitätsklinik für Dermatologie und Venerologie, Otto-von-Guericke- Universität Magdeburg
| | - Uwe Hillen
- Klinik für Dermatologie, Universitätsklinikum Essen
| | - Ulrike Leiter
- Zentrum für Dermato-Onkologie, Universitäts-Hautklinik Tübingen
| | - Michael Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven
| | - Ralf Gutzmer
- Hauttumorzentrum Hannover, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
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Haseltine JM, Wernicke AG, Formenti SC, Parashar B. Treatment of Non-Melanomatous Skin Cancer with Radiotherapy. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0117-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Caccialanza M, Piccinno R, Cuka E, Alberti Violetti S, Rozza M. Radiotherapy of morphea-type basal cell carcinoma: results in 127 cases. J Eur Acad Dermatol Venereol 2015; 28:1751-5. [PMID: 25564683 DOI: 10.1111/jdv.12404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The morphea-type basal cell carcinoma (MBCC) is a rare form of basal cell carcinoma (BCC) with lower response to treatments than other types of BCC.Objective To evaluate the role of radiotherapy (RT) in the therapeutic strategy of MBCC. METHODS A retrospective study was performed on 127 patients affected with MBCC, who underwent RT in the period 1982-2013. RT was delivered with conventional energies ranging from 50 to 120 kV and the administration of a total dose ranging from 40 to 70 Gy (mean 56.17 Gy). The irradiated fields included a margin of 1.5 cm around the lesion. RESULTS The median follow-up time was 29 months (range 1-324 months). Complete remission was observed in 122 patients (96.06%), partial remission in one (0.78%). Three cases were non-responsive (2.36%). In one case (0.78%), the lesion failed to heal after RT, since the onset of radiodermatitis histologically ascertained. The cure rate was 81.08% after 5 years and 78.02% after 10 years from the end of RT. Twelve cases relapsed (10.2%). CONCLUSION Because of the frequent diagnostic delay and its ill-defined margins, MBCC is difficult to cure. Our results after 5 years from RT (cure rate 81.08%) are more satisfactory respect to the others reported in the literature (69% and 72.3%), but less good than those obtained in other forms of primary malignant neoplasms of the skin (92.43%). Nevertheless,we consider that RT plays an important role in the therapeutic strategy of MBCCs. In fact, it can be applied easily in elderly patients, and in peculiar localization of the disease (eyelid, nose and ear), without being invasive.
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Cho M, Gordon L, Rembielak A, Woo T. Utility of radiotherapy for treatment of basal cell carcinoma: a review. Br J Dermatol 2014; 171:968-73. [DOI: 10.1111/bjd.13253] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. Cho
- Royal Adelaide Hospital Adelaide SA 5000 Australia
| | - L. Gordon
- Department of Dermatology Flinders Medical Centre Bedford Park SA 5047 Australia
| | | | - T.C.S. Woo
- Department of Radiation Oncology Riverina Cancer Care Centre Wagga Wagga NSW 2650 Australia
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Dreier J, Cheng P, Bogdan Alleman I, Gugger A, Hafner J, Tschopp A, Goldinger S, Levesque M, Dummer R. Basal cell carcinomas in a tertiary referral centre: a systematic analysis. Br J Dermatol 2014; 171:1066-72. [DOI: 10.1111/bjd.13217] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 01/21/2023]
Affiliation(s)
- J. Dreier
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - P.F. Cheng
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - I. Bogdan Alleman
- Department of Plastic, Reconstructive and Aesthetic Surgery University Hospital Zurich Zurich Switzerland
| | - A. Gugger
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - J. Hafner
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - A. Tschopp
- Division of Biostatistics Institute of Social and Preventive Medicine University of Zurich Zurich Switzerland
| | - S.M. Goldinger
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - M.P. Levesque
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - R. Dummer
- Department of Dermatology University Hospital Zurich Zurich Switzerland
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Lear JT, Corner C, Dziewulski P, Fife K, Ross GL, Varma S, Harwood CA. Challenges and new horizons in the management of advanced basal cell carcinoma: a UK perspective. Br J Cancer 2014; 111:1476-81. [PMID: 25211660 PMCID: PMC4200081 DOI: 10.1038/bjc.2014.270] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 02/24/2014] [Accepted: 04/02/2014] [Indexed: 02/06/2023] Open
Abstract
Basal cell carcinoma (BCC) is a common malignancy with a good prognosis in the majority of cases. However, some BCC patients develop a more advanced disease that poses significant management challenges. Such cases include locally advanced, recurrent or metastatic BCC, or tumours that occur in anatomical sites where surgical treatment would result in significant deformity. Until recently, treatment options for these patients have been limited, but increased understanding of the molecular basis of BCC has enabled potential therapies, such as hedgehog signalling pathway inhibitors, to be developed. A clear definition of advanced BCC as a distinct disease entity and formal management guidelines have not previously been published, presumably because of the rarity, heterogeneity and lack of treatment options available for the disease. Here we provide a UK perspective from a multidisciplinary group of experts involved in the treatment of complex cases of BCC, addressing the key challenges associated with the perceived definition and management of the disease. With new treatments on the horizon, we further propose a definition for advanced BCC that may be used as a guide for healthcare professionals involved in disease diagnosis and management.
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Affiliation(s)
- J T Lear
- MAHSC, Manchester Royal Infirmary, The University of Manchester, 46 Grafton Street, Oxford Road, Manchester M13 9NT, UK
| | - C Corner
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - P Dziewulski
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Broomfield, Chelmsford, Essex CM1 7ET, UK
| | - K Fife
- Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - G L Ross
- Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK
| | - S Varma
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK
| | - C A Harwood
- Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK
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Knani L, Romdhane O, Ben Rayana N, Mahjoub H, Ben Hadj Hamida F. Étude clinique et facteurs de risque de récidive des carcinomes basocellulaires des paupières : résultats d’une série tunisienne et revue de la littérature. J Fr Ophtalmol 2014; 37:107-14. [DOI: 10.1016/j.jfo.2013.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 05/27/2013] [Indexed: 10/25/2022]
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