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Rofail D, Ciesluk A, Lovell T, Marquis P, Fury MG, Chen CI. A Patient-Relevant Measurement Strategy to Assess Clinical Benefit of Novel Therapies for Non-metastatic Cutaneous Squamous Cell Carcinoma. Oncol Ther 2024:10.1007/s40487-024-00304-4. [PMID: 39354264 DOI: 10.1007/s40487-024-00304-4] [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: 05/11/2024] [Accepted: 08/20/2024] [Indexed: 10/03/2024] Open
Abstract
INTRODUCTION Although cutaneous squamous cell carcinoma (CSCC) is the second most common type of skin cancer, research describing the patient experience is limited. This study sought to create a conceptual model of non-metastatic disease, to assess patient-reported outcome (PRO) instruments commonly used in CSCC against this model, and to develop a patient-relevant measurement strategy for evaluating the benefit of new therapies. METHODS Researchers conducted a literature review, a review of patient blogs, and interviews with dermatologists to draft the conceptual model. A total of 22 patients with CSCC participated in 60-min phone interviews, which were subsequently transcribed, coded, and analyzed; the conceptual model was then updated. PRO instruments used in CSCC were assessed for content validity on the basis of this. RESULTS The CSCC patient experience includes physical symptoms, psychological impacts, and behavior changes. Existing PRO instruments were assessed against the conceptual model using targeted subdomains considered to be relevant for assessing clinical benefit. Four modules of the FACE-Q® Skin Cancer instrument, plus de novo items developed for concepts not assessed by the FACE-Q® [lesion symptoms, negative treatment effects (including symptomatic), and experience of care], provide the best coverage for the concepts of interest hypothesized to show the benefit of novel treatments. CONCLUSIONS This research provides a comprehensive understanding of the experience of patients with non-metastatic CSCC, and the effects of its treatment. It also identifies unmet needs in a subgroup of patients reporting negative treatment experiences. Further cognitive debriefing and psychometric analysis of de novo items are warranted for applications in clinical research.
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Affiliation(s)
- Diana Rofail
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA.
| | - Anna Ciesluk
- Modus Outcomes, A THREAD Company, Cambridge, MA, USA
| | - Teya Lovell
- Modus Outcomes, A THREAD Company, Cambridge, MA, USA
| | | | - Matthew G Fury
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
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2
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Abdul Gafoor SM, Robinson S, Diskantova S, Woodcock E, Yethenpa S, Holloran S, Nelson T. Patient-initiated follow-up for high-risk cutaneous squamous cell carcinoma: how we do it and 2 years of outcome data. Clin Exp Dermatol 2024; 49:1205-1212. [PMID: 38747386 DOI: 10.1093/ced/llae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND For patients with high-risk cutaneous squamous cell carcinomas (cSCCs), current guidance suggests we should offer post-treatment follow-up appointments at regular intervals for 24 months. Is this to improve prognosis, provide psychological support or find the next cancer? Recent data confirm that recurrence and metastasis are rarer events, and that perhaps these intense follow-up schedules do not really lead to improved health outcomes. OBJECTIVES To question whether current follow-up practices are truly needed by introducing an option of patient-initiated follow-up (PIFU). METHODS We enrolled 476 patients with cSCC (January 2020-January 2023) who fulfilled the definition of high-risk cSCC based on guidelines in use at the time. Of the total, 59 did not fulful the inclusion criteria and were excluded; 250 (52.5%) did not recontact us during the 2-year period, with no clinical record of complications or recurrences; and 167 (35.1%) utilized the PIFU pathway, of which 119 patients required only one face-to-face appointment. Seven patients (1.5%) developed metastatic disease, 11 (2.3%) developed recurrence and 68 (14.3%) developed cSCC at another site. All lesions were identified by the patient via PIFU. We saved 1250 follow-up appointments from those who did not contact us (n = 250), financially equating to £181 462.50. CONCLUSIONS Our data imply that PIFU can be considered safe alternative practice for patients with cSCC. Patients independently identified the need for review without scheduled follow-up, making these appointments available to other patient cohorts. Although follow-up appointments may provide mental health support, they can be inconvenient and not the ideal use of our healthcare resources. Our findings support a call for revision of existing skin cancer health policies to cope with and subsequently improve our practices for better patient care.
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Affiliation(s)
| | - Sophie Robinson
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Emma Woodcock
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Sonam Yethenpa
- Department of Dermatology, Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Sophie Holloran
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Toby Nelson
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Jain AS, Duncan NB, Potter HD, Burkat CN, Warner EJ. A rare case of acantholytic squamous cell carcinoma presenting on non-sun exposed palpebral conjunctiva. Am J Ophthalmol Case Rep 2024; 35:102089. [PMID: 38975032 PMCID: PMC11225004 DOI: 10.1016/j.ajoc.2024.102089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 05/19/2024] [Accepted: 06/01/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose This report describes the clinical and histological characteristics and management of a keratinized lesion of the palpebral conjunctiva in a 59-year-old male. The lesion was identified as a rare acantholytic variant of squamous cell carcinoma that atypically arose from a non-sun exposed region of palpebral conjunctiva. Management was complete excision via Mohs surgery. Observations A 59-year-old male presented with ocular irritation and chronic foreign body sensation in the right eye. Exam revealed a keratinized lesion in the right lower tarsal conjunctiva, and an initial shave biopsy was non-diagnostic. 12 months later, the patient presented with similar symptoms and a larger, more irregular lesion for which histopathology of a tarsal-involving excisional biopsy was consistent with acantholytic squamous cell carcinoma with involved margins. The patient subsequently underwent complete excision via Mohs surgery and a secondary reconstruction. Conclusions and importance Acantholytic variants of squamous cell carcinoma are rare and are described as arising from areas with routine sun exposure. This case reports such a lesion arising from non-sun exposed tarsal conjunctiva, as identified by histopathology of a full-thickness excisional biopsy. The lesion was successfully managed with complete excision via Mohs surgery and secondary reconstruction. Given that this histologic variant may be more aggressive and have higher rates of recurrence than other forms of squamous cell carcinoma, this case highlights the importance of complete excisional biopsy and accurate histopathology of concerning periocular lesions and offers a template for management of similar lesions. The unique presenting location should bring awareness to consideration of this type of malignancy developing on palpebral conjunctiva.
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Affiliation(s)
- Asha S. Jain
- The University of Wisconsin School of Medicine and Public Health, Madison, WI, 53705, USA
| | - Nicole B. Duncan
- The Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Heather D. Potter
- The Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Cat N. Burkat
- The Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Evan J. Warner
- The Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, 53705, USA
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Niinimäki P, Siuko M, Tynninen O, Kivelä TT, Uusitalo M. Cutaneous squamous cell carcinoma of the eyelid in northern latitudes, a 25-year experience in Finland. Acta Ophthalmol 2024; 102:535-543. [PMID: 38057922 DOI: 10.1111/aos.15819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To evaluate the incidence, clinical features, diagnostic challenges, management and prognosis of cutaneous squamous cell carcinoma of the eyelid (ecSCC) in southern Finland, northern Europe, latitude 62° N. METHODS Patients were identified from the Finnish Cancer Registry and the Helsinki University Hospital databases during a 25-year period (1998-2022). Age, sex, location, clinical and histopathological diagnosis, treatment and outcome were retrieved. RESULTS Cutaneous squamous cell carcinoma of the eyelid (ecSCC) was diagnosed in 58 patients. The mean age-standardized incidence was 1.03 per 100 000. Median age at the time of histopathological diagnosis was 79 (range 55-93) years; sex ratio was 0.52. Clinical diagnosis in the referral was ecSCC in only three patients. The most frequent misdiagnosis (38%) was basal cell carcinoma (BCC). One or more of the known risk factors (smoking, history of extensive sun exposure, systemic immunosuppression and previous in situ cSCC/cSCC) were documented in 71% of the patients. More than one third (38%) of the patients developed in situ SCC elsewhere on the skin; one third (31%) of the patients had invasive cSCC elsewhere. During the median follow-up time of 24 months, three patients experienced local recurrence, four patients developed metastatic disease (median 19 months) and two patients died of metastatic ecSCC. CONCLUSION The estimated incidence of ecSCC in Finland (predominantly white Caucasian) was higher than in a previous study from Europe. Clinical diagnosis of ecSCC is difficult and often misdiagnosed as BCC. Immunosuppression as a risk factor should noticed. Recurrences of ecSCC, which may be lethal, were infrequent.
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Affiliation(s)
- Paula Niinimäki
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika Siuko
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Olli Tynninen
- Department of Pathology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero T Kivelä
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marita Uusitalo
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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5
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Hamamin OS, Shareef FU, Ahmed HB, Kareem SI, Abdul Aziz JM. Cutaneous Squamous Cell Carcinoma on the Eyebrow of a Woman: A Rare Case Report. Cureus 2024; 16:e65447. [PMID: 39184757 PMCID: PMC11345041 DOI: 10.7759/cureus.65447] [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: 07/25/2024] [Indexed: 08/27/2024] Open
Abstract
The exact incidence of cutaneous squamous cell carcinoma (CSCC) or nonmelanoma skin cancer is unknown, and it is believed that the rate of occurrence is increasing with the growing elderly population and sun exposure, and it is more prevalent in males than in females. In this article, we describe the case of an 81-year-old woman who presented with a lesion on the right upper eyebrow. The patient had been consulting a dermatologist and undergoing treatment for three months. However, the lesion did not show any signs of improvement, and the dermatologist speculated that it might be a common wound that was healing slowly because of her diabetes. Imaging revealed an ulcerating skin lesion on the right upper eyebrow without connection to the deeper structures. Surgical intervention was chosen with the patient's consent. This rare case of CSCC on a woman's eyebrow showed that skin cancer can occur in unusual locations and in people without risk factors.
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Affiliation(s)
- Omed S Hamamin
- Dentistry, Komar University of Science and Technology, Sulaymaniyah, IRQ
| | - Farman U Shareef
- Medical Laboratory Science, Charmo University, Sulaymaniyah, IRQ
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, IRQ
| | | | - Sattar I Kareem
- Medical Laboratory Science, University of Human Development, Sulaymaniyah, IRQ
| | - Jeza M Abdul Aziz
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, IRQ
- Biomedical Sciences, Komar University of Science and Technology, Sulaymaniyah, IRQ
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Ezzibdeh R, Diop M, Divi V. Neoadjuvant Immunotherapy in Non-melanoma Skin Cancers of the Head and Neck. Curr Treat Options Oncol 2024; 25:885-896. [PMID: 38916713 DOI: 10.1007/s11864-024-01197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 06/26/2024]
Abstract
OPINION STATEMENT Neoadjuvant immunotherapy will change the standard of care for advanced resectable cutaneous squamous cell carcinoma (cSCC) and possibly other non-melanoma skin cancers. With pathological complete response rates around 50% for cSCC in early studies, neoadjuvant therapy allows patients the possibility of significant reduction in tumor size, de-escalation of adjuvant therapy, and improved long-term outcomes. Patients must be carefully selected to ensure that there is a margin of safety with respect to resectability, such that if a tumor progresses on neoadjuvant therapy, there remains a curative surgical option that is acceptable to the patient. The optimal treatment paradigm is an area of active research, with many researchers questioning whether adjuvant therapy, or even local therapy, is necessary in patients who seem to have a complete response. The ability to predict who will respond will become even more critical to answer, as a significant number of patients do not want to risk their disease progressing, especially in cosmetically sensitive areas of the head and neck. Recent studies in melanoma show promise for improved response rates using combination therapies, and these strategies may apply to cSCC as well. The use of LAG-3 inhibitors or mRNA vaccine technology may further improve the utility of neoadjuvant strategies.
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Affiliation(s)
- Rami Ezzibdeh
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Welch Road, Rm 170, Stanford, CA, 94305, USA
| | - Mohamed Diop
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Welch Road, Rm 170, Stanford, CA, 94305, USA
| | - Vasu Divi
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 900 Welch Road, Rm 170, Stanford, CA, 94305, USA.
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7
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Zürcher S, Martignoni Z, Hunger RE, Benzaquen M, Seyed Jafari SM. Mohs Micrographic Surgery for Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2024; 16:2394. [PMID: 39001454 PMCID: PMC11240455 DOI: 10.3390/cancers16132394] [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] [Received: 05/01/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND The first-line treatment of the localized form of cutaneous squamous cell carcinoma (cSCC) remains surgical excision. Either conventional excision (CE) with margins or Mohs micrographic surgery (MMS) may be preferred, depending on the risk factors of cSCC, the characteristics of the tumor, and the available technical facilities. METHODS This article presents a systematic review of the current literature spanning from 1974 to 2023, comparing outcomes of cSCC treated with MMS versus cSCC treated with conventional excision. RESULTS Out of the 6821 records identified through the database search, a total of 156 studies were screened, of which 10 were included in the review. The majority of the included studies showed that treatment of cSCC with MMS consistently exhibits a significantly lower risk of recurrence compared to treatment with CE. In addition, MMS is emerging as the preferred technique for the resection of cSCC located in aesthetically or functionally challenging anatomical areas. CONCLUSION The studies generally demonstrate that MMS is a safer and more effective treatment of cSCC than CE. Nevertheless, outcomes such as recurrence rates and cost-effectiveness should be assessed more precisely, in order to allow for a more tailored approach in determining the appropriate indication for the use of MMS.
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Affiliation(s)
- Sven Zürcher
- Department of Dermatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
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8
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Diede C, Walker T, Carr DR, Shahwan KT. Grading differentiation in cutaneous squamous cell carcinoma: a review of the literature. Arch Dermatol Res 2024; 316:434. [PMID: 38935165 DOI: 10.1007/s00403-024-03184-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 05/23/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
Poor differentiation is strongly associated with poor outcomes in cutaneous squamous cell carcinoma (CSCC). In addition, the National Comprehensive Cancer Network (NCCN) guidelines designate poorly differentiated tumors as "very high risk". Despite its clear prognostic implications, there is no standardized grading system for CSCC differentiation in common use today. CSCC differentiation is graded inconsistently by both dermatopathologists and Mohs surgeons, and reliability studies have demonstrated suboptimal inter- and intra-rater reliability in both of these groups. The absence of a standardized and reliable grading system has impeded the use of differentiation in CSCC staging, despite its apparent correlation with disease outcomes. We performed a comprehensive review of the literature summarizing historical CSCC differentiation grading systems, as well as grading systems in non-cutaneous head and neck SCC as a point of reference. Relevant articles were identified by searching Embase and PubMed, as well as by reviewing reference lists for additional articles and histology textbook excerpts. CSCC grading systems that were identified and summarized include the historical Broders system, the World Health Organization system, the College of American Pathologists' system, and a system described by a 2023 Delphi consensus panel of dermatopathologists.
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Affiliation(s)
- Claire Diede
- University of North Dakota, School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Trent Walker
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - David R Carr
- Department of Dermatology, The Ohio State University Medical Center, 6700 University Blvd, Columbus, OH, 43016, USA
| | - Kathryn T Shahwan
- University of North Dakota, School of Medicine and Health Sciences, Grand Forks, ND, USA.
- Department of Dermatology, The Ohio State University Medical Center, 6700 University Blvd, Columbus, OH, 43016, USA.
- Department of Dermatology, Altru Health System, Grand Forks, Grand Forks, ND, USA.
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9
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Jiang R, Fritz M, Que SKT. Cutaneous Squamous Cell Carcinoma: An Updated Review. Cancers (Basel) 2024; 16:1800. [PMID: 38791879 PMCID: PMC11119634 DOI: 10.3390/cancers16101800] [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: 04/12/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Representing the second most common skin cancer, the incidence and disease burden of cutaneous squamous cell carcinoma (cSCC) continues to increase. Surgical excision of the primary site effectively cures the majority of cSCC cases. However, an aggressive subset of cSCC persists with clinicopathological features that are indicative of higher recurrence, metastasis, and mortality risks. Acceleration of these features is driven by a combination of genetic and environmental factors. The past several years have seen remarkable progress in shaping the treatment landscape for advanced cSCC. Risk stratification and clinical management is a top priority. This review provides an overview of the current perspectives on cSCC with a focus on staging, treatment, and maintenance strategies, along with future research directions.
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Affiliation(s)
- Rina Jiang
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Mike Fritz
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Syril Keena T. Que
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Pennachioli E, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2024; 9:103005. [PMID: 38688192 PMCID: PMC11067535 DOI: 10.1016/j.esmoop.2024.103005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Cutaneous squamous cell carcinoma (CSCC) accounts for ∼20%-25% of all skin tumors. Its precise incidence is often challenging to determine due to limited statistics and its incorporation with mucosal forms. While most cases have a favorable prognosis, challenges arise in patients presenting with locally advanced or metastatic forms, mainly appearing in immunocompromised patients, solid organ transplantation recipients, or those facing social difficulties. Traditionally, chemotherapy and targeted therapy were the mainstays for advanced cases, but recent approvals of immunotherapeutic agents like cemiplimab and pembrolizumab have revolutionized treatment options. These guidelines, developed by the Italian Association of Medical Oncologists (AIOM) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, aim to guide clinicians in diagnosing, treating, and monitoring patients with CSCC, covering key aspects from primitive tumors to advanced stages, selected by a panel of experts selected by AIOM and other national scientific societies. The incorporation of these guidelines into clinical practice is expected to enhance patient care and address the evolving landscape of CSCC management.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, IRCCS European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- IRCCS Humanitas Research Hospital, Milan
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- Surgical Pathology Department, IRCCS Galeazzi Sant'Ambrogio, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - E Pennachioli
- Division of Melanoma, Sarcomas and Rare Tumors, IRCCS European Institute of Oncology, Milan
| | - K Peris
- Dermatology, Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgery Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genova, Genoa, Italy.
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11
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Rudolph V, Leven AS, Eisenburger R, Schadendorf D, Wiegand S. Interdisciplinary management of skin cancer. Laryngorhinootologie 2024; 103:S100-S124. [PMID: 38697144 DOI: 10.1055/a-2171-4570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The interdisciplinary treatment of skin cancer in the head and neck area requires close collaboration between different specialist disciplines. The most common non-melanoma skin cancer tumor entities are cutaneous squamous cell carcinoma and basal cell carcinoma as well as their precursor lesions. One of the less common tumors is Merkel cell carcinoma, which also occurs primarily in light-exposed areas and, in contrast to squamous and basal cell carcinoma, is more likely to metastasize. Due to the low tendency of basal cell carcinoma as well as cutaneous squamous cell carcinoma to metastasize, a cure can often be achieved by surgery. If the tumor growth exceeds certain levels it may require collaboration between dermatology and otorhinolaryngology. The primary goal of this interdisciplinary collaboration is to achieve a functional, cosmetically and aesthetically acceptable result in addition to adequate tumor treatment. Depending on the stage of the tumor and the clinical course, a case may be discussed in an interdisciplinary tumor board in order to determine a personalised, appropriate and adequate treatment concept for each patient, including prevention, therapy and follow-up.
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Affiliation(s)
- Victoria Rudolph
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Anna-Sophia Leven
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Robin Eisenburger
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
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12
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Imran M, Islam Tiwana M, Mohsan MM, Alghamdi NS, Akram MU. Transformer-based framework for multi-class segmentation of skin cancer from histopathology images. Front Med (Lausanne) 2024; 11:1380405. [PMID: 38741771 PMCID: PMC11089103 DOI: 10.3389/fmed.2024.1380405] [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] [Received: 02/01/2024] [Accepted: 04/01/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Non-melanoma skin cancer comprising Basal cell carcinoma (BCC), Squamous cell carcinoma (SCC), and Intraepidermal carcinoma (IEC) has the highest incidence rate among skin cancers. Intelligent decision support systems may address the issue of the limited number of subject experts and help in mitigating the parity of health services between urban centers and remote areas. Method In this research, we propose a transformer-based model for the segmentation of histopathology images not only into inflammation and cancers such as BCC, SCC, and IEC but also to identify skin tissues and boundaries that are important in decision-making. Accurate segmentation of these tissue types will eventually lead to accurate detection and classification of non-melanoma skin cancer. The segmentation according to tissue types and their visual representation before classification enhances the trust of pathologists and doctors being relatable to how most pathologists approach this problem. The visualization of the confidence of the model in its prediction through uncertainty maps is also what distinguishes this study from most deep learning methods. Results The evaluation of proposed system is carried out using publicly available dataset. The application of our proposed segmentation system demonstrated good performance with an F1 score of 0.908, mean intersection over union (mIoU) of 0.653, and average accuracy of 83.1%, advocating that the system can be used as a decision support system successfully and has the potential of subsequently maturing into a fully automated system. Discussion This study is an attempt to automate the segmentation of the most occurring non-melanoma skin cancer using a transformer-based deep learning technique applied to histopathology skin images. Highly accurate segmentation and visual representation of histopathology images according to tissue types by the proposed system implies that the system can be used for skin-related routine pathology tasks including cancer and other anomaly detection, their classification, and measurement of surgical margins in the case of cancer cases.
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Affiliation(s)
- Muhammad Imran
- Department of Mechatronics Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Mohsin Islam Tiwana
- Department of Mechatronics Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Mashood Mohammad Mohsan
- Department of Computer and Software Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Norah Saleh Alghamdi
- Department of Computer Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Muhammad Usman Akram
- Department of Computer and Software Engineering, National University of Sciences and Technology, Islamabad, Pakistan
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Krönert MIC, Schwarzenböck SM, Kurth J, Heuschkel M, Krause BJ, Emmert S, Tietze JK. Patient-Orientated Evaluation of Treatment of Non-Melanoma Skin Cancer with Rhenium-188 Compared to Surgery. Healthcare (Basel) 2024; 12:921. [PMID: 38727478 PMCID: PMC11083370 DOI: 10.3390/healthcare12090921] [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] [Received: 03/06/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Non-melanoma skin cancers (NMSCs) are responsible for up to one-third of all human malignancies. Surgery is usually the treatment of choice, but patients often experience pain during the procedure. Topical rhenium-188 resin skin cancer treatment (RSCT) may be a valid therapeutic alternative. METHODS In this monocentric pilot study, 19 patients suffering from NMSC were treated with RSCT. Most of these patients had also experienced surgery, either because they developed a new NMSC in aftercare, or they had suffered previously from NMSC. Three RSCT-treated patients, who had no exposure to surgery so far, were paired with three matched patients, who had received surgery. We sought to evaluate and compare the patients' experience with both treatments. A questionnaire assessed patients' perceptions regarding side effects, aesthetic outcomes, wound care, fear of complications, and personal treatment preferences. Patients evaluated the different parameters of their either RSCT- or surgery-treated lesions on a scale from 0-10. RESULTS Patients were more afraid of complications before surgery than before RSCT (p = 0.04). Treatment with RSCT caused significantly less pain on treatment day (mean 0.56) than surgery (mean 2.32) (0 no pain, 10 maximum pain) (p = 0.02) and 14 days after the procedure (mean 0.89 versus mean 2.47) (p = 0.02). On day 14, RSCT-treated lesions were also significantly less itchy (mean 0.34) than after surgery (mean 1.50). Most patients were very satisfied with the aesthetic outcome after both RSCT (mean 8.42) and surgery (mean 8.31) (p = 0.89). In the case of a new NMSC, the majority of patients who experienced both treatments would rather be treated primarily with RSCT (44%) or would consider both options (31%); only 19% preferred surgery. CONCLUSION Patients evaluated RSCT as less painful than surgery. The aesthetic outcomes of both treatments were comparable. For pain-sensitive patients, RSCT might be a preferable treatment option.
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Affiliation(s)
- Maila I. C. Krönert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (M.I.C.K.); (S.E.)
| | - Sarah M. Schwarzenböck
- Department of Nuclear Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (S.M.S.); (J.K.); (M.H.); (B.J.K.)
| | - Jens Kurth
- Department of Nuclear Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (S.M.S.); (J.K.); (M.H.); (B.J.K.)
| | - Martin Heuschkel
- Department of Nuclear Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (S.M.S.); (J.K.); (M.H.); (B.J.K.)
| | - Bernd J. Krause
- Department of Nuclear Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (S.M.S.); (J.K.); (M.H.); (B.J.K.)
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (M.I.C.K.); (S.E.)
| | - Julia K. Tietze
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (M.I.C.K.); (S.E.)
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14
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Artosi F, Costanza G, Di Prete M, Garofalo V, Lozzi F, Dika E, Cosio T, Diluvio L, Shumak RG, Lambiase S, Di Raimondo C, Campa S, Piscitelli P, Miani A, Bianchi L, Campione E. Epidemiological and clinical analysis of exposure-related factors in non-melanoma skin cancer: A retrospective cohort study. ENVIRONMENTAL RESEARCH 2024; 247:118117. [PMID: 38218521 DOI: 10.1016/j.envres.2024.118117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The incidence of non-melanoma skin cancers (NMSCs) increased over last decades, probably due to environmental concerns or to the increase of frail patients with age related comorbidities. Currently, the relationship of increasing global skin cancer rates with increased ultraviolet radiations (UVRs) resulting from stratospheric ozone depletion, global warming, and air pollution from fossil-fuel combustion. AIMS We conducted a retrospective epidemiological study including 546 NMSC patients managed at the Dermatology Unit of the Tor Vergata Hospital to highlight different trends of sun exposure or different comorbidities. METHODS Descriptive and inferential statistical analyses were performed to evidence differences between continous variable and Spearman rank test for dicotomical variables. Charlson Comorbidity Index was calculated to obtain the 10-years survival rate in order to identify the mean comorbidity burden of our patients. RESULTS Considering patients with comorbidities (73.81%), actinic keratoses (AKs) was the most frequent lesion. In patients with a history of previous melanoma, basal cell carcinoma (BCC) was predominant (ANOVA test, p < 0.05) with a statistically significant correlation (rho = 0.453; p < 0.01). Squamous cell carcinoma (SCC) showed a higher rate in arterial hypertension patients, followed by the chronic heart failure and hematologic neoplasms (60%, 29.7% and 32.1%, respectively) groups. Men were more affected than women, representing 61.54% of patients. Chronic sun exposure is directly correlated with SCC rho = 0.561; p < 0.01), whereas BCC correlated with a history of sunburns (rho = 0.312; p < 0.05). CONCLUSIONS History of photo-exposition had an important role on NMSC development especially for work or recreational reasons. Sex, age, and presence of comorbidities influenced different NMSC types. BCC was more frequent in younger patients, associated with melanoma and sunburns. The presence of SCC is associated with older patients and the hypertension group. AKs were diagnosed predominantly in oldest men, with a chronic sun-exposure history, and hematologic neoplasms group.
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Affiliation(s)
- Fabio Artosi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Gaetana Costanza
- Unit of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
| | - Monia Di Prete
- Dermatopathology Laboratory, Istituti Fisioterapici Ospitalieri, Istituto San Gallicano, via Fermo Ognibene 23, 00144, Rome, Italy.
| | - Virginia Garofalo
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy
| | - Flavia Lozzi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Emi Dika
- Dermatology, IRCCS Policlinico Sant'Orsola, via Massarenti 9, 40138, Bologna, Italy.
| | - Terenzio Cosio
- PhD Course Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
| | - Laura Diluvio
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Ruslana Gaeta Shumak
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Sara Lambiase
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Cosimo Di Raimondo
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Serena Campa
- Italian Society of Environmental Medicine, SIMA, Italy.
| | - Prisco Piscitelli
- Italian Society of Environmental Medicine, SIMA, Italy; University of Salento, Lecce, Italy.
| | - Alessandro Miani
- Italian Society of Environmental Medicine, SIMA, Italy; Department of Environmental Sciences and Policies, University of Milan, Milan, Italy.
| | - Luca Bianchi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Elena Campione
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
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Taccioli F, Blessent CGF, Paganelli A, Fagioli F, Chester JM, Kaleci S, Costantini M, Ferrari B, Fiorentini C, De Santis G, Magnoni C. Delay in Cutaneous Squamous Cell Carcinoma Diagnosis Due to Interrupted Services Is Associated with Worse Prognoses and Modified Surgical Approaches. Cancers (Basel) 2024; 16:1469. [PMID: 38672551 PMCID: PMC11048546 DOI: 10.3390/cancers16081469] [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: 03/01/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The delayed diagnosis of skin tumors is associated with a worsened prognosis. The impact of the interruption of clinical and surgical health services during the COVID-19 pandemic lockdowns has been documented among many pathologies. The impact of delayed diagnoses on patients with cutaneous squamous cell carcinomas (cSCCs) is poorly defined. OBJECTIVE To compare patient and lesion characteristics and the surgical management of excised cSCCs prior to the pandemic shutdown of services (2018-2019) with the phase following the pandemic's second wave (2021-2022). METHODS An observational, single-center, cross-sectional study of 416 surgically excised cSCCs over the course of two years was performed. Only patients with histologically confirmed cSCC were enrolled. Data collection included patient demographics and lesion characteristics, time to surgery, surgical approach, and histological data. RESULTS More cSCC lesions were excised prior to the interruption of services (n = 312 vs. n = 186). Lesions were significantly larger (1.7 ± 1.2 vs. 2.1 ± 1.5 cm; p = 0.006) and more invasive (52% vs. 89%; p < 0.001), in the period 2021-2022. Surgical reconstructive techniques were significantly different (p = 0.001). Metastatic involvement was confirmed in three subjects (one in 2018-2019 and two in 2021-2022). There were no significant differences in the time to surgery or patient characteristics. Multivariable regression analysis identified a 4.7-times higher risk of tumor invasion (OR 4.69, 95%CI 2.55-8.16, p < 0.001), a two-times higher chance of dermo-epidermal grafts (OR 2.06, 95%CI 1.09-3.88, p = 0.025), and a 3.2-times higher risk of positive surgical margins (OR 3.21, 95%CI 1.44-7.17, p = 0.004). CONCLUSIONS Diagnostic delays of cutaneous SCCs associated with reduced patient access to clinical and diagnostic services are associated with a 4.7-times increased risk of more severe invasion, a three-times increased risk of positive surgical margins, and a significant impact on surgical management, compared to the pre-pandemic period. Comparable patient cohort characteristics and time to surgery remained unchanged.
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Affiliation(s)
- Filippo Taccioli
- Department of Plastic Reconstructive and Aesthetic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Claudio Gio Francesco Blessent
- Department of Plastic Reconstructive and Aesthetic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Alessia Paganelli
- PhD Course in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Francesca Fagioli
- Health Directorate, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Johanna Mary Chester
- Surgical, Medical, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (J.M.C.); (S.K.)
| | - Shaniko Kaleci
- Surgical, Medical, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (J.M.C.); (S.K.)
| | - Matteo Costantini
- Institute of Pathology, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Barbara Ferrari
- Department of Dermatology, University of Modena and Reggio Emilia, 41125 Modena, Italy; (B.F.); (C.F.); (C.M.)
| | - Chiara Fiorentini
- Department of Dermatology, University of Modena and Reggio Emilia, 41125 Modena, Italy; (B.F.); (C.F.); (C.M.)
| | - Giorgio De Santis
- Department of Plastic Reconstructive and Aesthetic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Cristina Magnoni
- Department of Dermatology, University of Modena and Reggio Emilia, 41125 Modena, Italy; (B.F.); (C.F.); (C.M.)
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16
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Rampinelli V, Pinacoli A, Piazza C. Head and neck nonmelanoma skin cancers: surgical management and debated issues. Curr Opin Otolaryngol Head Neck Surg 2024; 32:62-70. [PMID: 38193646 PMCID: PMC10919275 DOI: 10.1097/moo.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW This review critically assesses the current literature and guidelines, aiming to clarify some of the most important factors that impact surgical strategies of head and neck nonmelanoma skin cancers (NMSCs), focusing on squamous, basal, and Merkel cell carcinomas. RECENT FINDINGS Recent developments underscore the complexity of treatment for NMSC, particularly in the head and neck region. There is a lack of high-level evidence for the management of these tumors, especially in advanced stages. The need to tailor the extent of surgical margins and parotid/neck management to different histotypes, considering the varying risk factors for recurrence, is beginning to emerge in the literature. Moreover, the role of immunotherapy and targeted therapies for locally advanced disease, alongside traditional treatment options, is progressively growing. SUMMARY NMSCs represent a heterogeneous group of malignancies with varying treatment complexities and prognoses. Management of NMSC is evolving towards an increasingly personalized strategy within a multidisciplinary therapeutic framework.
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Affiliation(s)
- Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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17
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Chen CI, Jalbert JJ, Wu N, Ruiz ES. Patterns of major cutaneous surgeries and reconstructions in patients with cutaneous squamous cell carcinoma in the USA. Future Oncol 2024; 20:691-701. [PMID: 37994593 DOI: 10.2217/fon-2023-0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Aim: Since use of major cutaneous surgeries/reconstructions among patients with cutaneous squamous cell carcinoma (CSCC) is not well described, we sought to quantify major cutaneous surgeries/reconstructions among patients with CSCC who were newly diagnosed and for those treated with systemic therapy, stratified by immune status. Methods: We used the Optum® Clinformatics® Data Mart database (2013-2020) and Kaplan-Meier estimators to assess risk of surgeries/reconstructions. Results: 450,803 patients were identified with an incident CSCC diagnosis, including 4111 patients with CSCC who initiated systemic therapy. The respective 7-year risks of major cutaneous surgeries/reconstructions were 10.9% (95% CI: 10.7-11.0) and 21.8% (95% CI: 17.6-25.8). Overall risk of major cutaneous surgeries/reconstructions was higher in patients who were immunocompromised than those who were immunocompetent. Conclusion: Approximately one in nine patients with CSCC will undergo ≥1 major cutaneous surgeries/reconstructions within 7 years of diagnosis; the risk increases in patients who initiate systemic therapy and among those who are immunocompromised.
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Affiliation(s)
- Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Ning Wu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Emily S Ruiz
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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18
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Horakova Z, Starek I, Zapletalova J, Salzman R. Tumour Recurrence, Depth of Invasion, and Temple Location as Independent Prognostic Parameters of Lymph Node Metastases of Head and Neck Cutaneous Squamous Cell Carcinomas. Int J Clin Pract 2024; 2024:9960948. [PMID: 38495750 PMCID: PMC10942823 DOI: 10.1155/2024/9960948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
The excellent survival rate of cutaneous squamous cell carcinoma (cSCC) exceeding 90% is reduced by the presence of nodal metastases by over 50%. We analysed various risk parameters of cSCC to predict the incidence of nodal metastases. A total of 118 patients with the head cSCC were included in a single-institution retrospective study covering the period from 2008 to 2020. Tumour recurrence, temple location, and tumour infiltration depth were found to be independent predictors of nodal metastases (increasing the probability of metastases by 8.0, 8.1, and 4.3 times, respectively). Furthermore, univariate analysis shows that the tumour size and T stage are significant factors increasing the risk of metastases. Several independent risk factors for the development of metastases in the head cSCC have been confirmed. These findings might help identify at-risk patients who require additional attention for adequate radical treatment and close follow-up. In contrast, elective treatment of lymph nodes is not recommended due to the low incidence of regional metastases.
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Affiliation(s)
- Zuzana Horakova
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic
| | - Ivo Starek
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic
| | - Jana Zapletalova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, Olomouc 775 15, Czech Republic
| | - Richard Salzman
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 185/6, Olomouc 779 00, Czech Republic
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19
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Theelen FFM, Veldhuizen IJ, Zhou C, Lee EH, van Hensbergen LJ, Broekhuysen CL, van der Hulst RRWJ, Hoogbergen MM. Patient Satisfaction Following Primary Closure or Second Intention Healing After Conventional Nasal Skin Cancer Excision: A Cross-sectional Cohort Study. Dermatol Surg 2024; 50:247-255. [PMID: 38048208 DOI: 10.1097/dss.0000000000004037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Nasal reconstruction after conventional surgical excision (CSE) of nonmelanoma skin cancer (NMSC) can be challenging. After excision and before the pathologic report, a simple reconstruction is favored. Yet, little is known about patient satisfaction after primary closure and second intention healing. OBJECTIVE Patient satisfaction after nasal defect reconstruction with primary closure or second intention healing, using the FACE-Q Skin Cancer. METHODS All patients who underwent CSE of nasal NMSC with immediate primary closure or second intention healing between March 2018 and March 2020 at Máxima Medisch Centrum Veldhoven were identified and asked to complete the FACE-Q Skin Cancer. RESULTS Of 183 patients, 140 patients completed the questionnaire. Fifty-five defects were closed by primary closure (38.5%) and 88 by second intention healing (61.5%). Thirty-one complications were reported (16.7%), of which 87.1% ( n = 27) after second intention healing ( p = .004). Both groups experienced high facial and scar satisfaction, low appearance-related distress, and no to minimal adverse effects. Second intention healing had 2.7 higher odds of achieving the maximum scar satisfaction score ( p = .02). CONCLUSION This study shows high satisfaction on facial and scar appraisal, low appearance-related distress, and no to minimal adverse effects for second intention healing and primary closure after CSE of nasal NMSC.
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Affiliation(s)
- Frederieke F M Theelen
- Department of Plastic and Reconstructive Surgery, Máxima Medisch Centrum, Veldhoven, the Netherlands
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Inge J Veldhuizen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Chao Zhou
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Erica H Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York
| | - Lusanne J van Hensbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Coralien L Broekhuysen
- Department of Plastic and Reconstructive Surgery, Máxima Medisch Centrum, Veldhoven, the Netherlands
| | - René R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
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20
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Yin X, Zhuang Y, Song H, Xu Y, Zhang F, Cui J, Zhao L, Yu Y, Zhang Q, Ye J, Chen Y, Han Y. Antibody-platinum (IV) prodrugs conjugates for targeted treatment of cutaneous squamous cell carcinoma. J Pharm Anal 2024; 14:389-400. [PMID: 38618248 PMCID: PMC11010626 DOI: 10.1016/j.jpha.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/07/2023] [Accepted: 11/01/2023] [Indexed: 04/16/2024] Open
Abstract
Antibody-drug conjugates (ADCs) are a new type of targeting antibodies that conjugate with highly toxic anticancer drugs via chemical linkers to exert high specificity and efficient killing of tumor cells, thereby attracting considerable attention in precise oncology therapy. Cetuximab (Cet) is a typical antibody that offers the benefits of good targeting and safety for individuals with advanced and inoperable cutaneous squamous cell carcinoma (cSCC); however, its anti-tumor activity is limited to a single use. Cisplatin (CisPt) shows good curative effects; however, its adverse effects and non-tumor-targeting ability are major drawbacks. In this study, we designed and developed a new ADC based on a new cytotoxic platinum (IV) prodrug (C8Pt(IV)) and Cet. The so-called antibody-platinum (IV) prodrugs conjugates, named Cet-C8Pt(IV), showed excellent tumor targeting in cSCC. Specifically, it accurately delivered C8Pt(IV) into tumor cells to exert the combined anti-tumor effect of Cet and CisPt. Herein, metabolomic analysis showed that Cet-C8Pt(IV) promoted cellular apoptosis and increased DNA damage in cSCC cells by affecting the vitamin B6 metabolic pathway in tumor cells, thereby further enhancing the tumor-killing ability and providing a new strategy for clinical cancer treatment using antibody-platinum (IV) prodrugs conjugates.
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Affiliation(s)
- Xiangye Yin
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yingjie Zhuang
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Haiqin Song
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200023, China
| | - Yujian Xu
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Fan Zhang
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jianxin Cui
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lei Zhao
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yingjie Yu
- State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Qixu Zhang
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Jun Ye
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Youbai Chen
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yan Han
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
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21
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Zhang Y, Wang Y, Guo S, Cui H. METTL3-mediated HPV vaccine enhances the effect of anti PD-1 immunotherapy to alleviate the development of cutaneous squamous cell carcinoma. An Bras Dermatol 2024; 99:210-222. [PMID: 38030537 PMCID: PMC10943324 DOI: 10.1016/j.abd.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) develops from epithelial keratinocytes by dysregulation of self-renewal and differentiation. Recent studies have found that the size and number of cSCC tumors gradually decrease or even disappear after HPV vaccination. However, the role of the HPV vaccine in the cSCC mechanism is poorly understood. OBJECTIVE The aim of this study is to investigate the effect and mechanism of the HPV vaccine in cSCC. METHODS Immunofluorescence was used to study the immune infiltrating cells in the tumor tissues of patients with cSCC. The effects of the HPV vaccine on cSCC cells and tissues were studied by Cell Culture, Real-time PCR, Western Blot, Cytotoxicity Assay, Enzyme-linked Immunosorbent Assay, m6A Blotting, CCK-8 Assay, m6A Ribonucleic acid Methylation Quantification and tumor transplantation. RESULTS The HPV vaccine enhanced the toxic effect of CD8+T cells on cSCC cells and promoted the secretion of multiple cytokines by CD8+T cells. In addition, HPV vaccines can increase tumor sensitivity to anti-PD-1 therapy by downregulating METTL3 in tumor tissue, with the combination of HPV vaccine and PD-1 monoclonal antibodies producing enhanced immune cell infiltration compared to PD-1 blockade alone. STUDY LIMITATIONS It is important to note the limitations of this study, including the small sample size, the construction of the mouse model, and the choice of HPV vaccine and PD-1 monoclonal antibody, which may limit the generalization of our findings to a wider population. CONCLUSIONS It is hoped that this research will contribute to a deeper understanding of the role of the HPV vaccine in the treatment of cSCC. HPV vaccine is expected to become an important approach to alleviate the development of cSCC.
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Affiliation(s)
- Yingjie Zhang
- Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, China; The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Yiru Wang
- Department of Dermatology, Taiyuan Maternity and Child Health Care Hospital, Taiyuan, China
| | - Shuping Guo
- Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hongzhou Cui
- Department of Dermatology, First Hospital of Shanxi Medical University, Taiyuan, China; The First Clinical Medical College, Shanxi Medical University, Taiyuan, China.
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22
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Mittal A, Mittal BB. Comparative Analysis of US Guidelines for the Management of Cutaneous Squamous Cell and Basal Cell Carcinoma. J Skin Cancer 2024; 2024:3859066. [PMID: 38370137 PMCID: PMC10872771 DOI: 10.1155/2024/3859066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Background This study presents a comparative analysis of recently published guidelines to manage cutaneous squamous cell carcinoma (cSCC) and cutaneous basal cell carcinoma (cBCC) within the United States (US). Methods A PubMed database search was performed for the time period between June 1, 2016, and December 1, 2022. A comprehensive comparison was performed in the following clinical interest areas: staging and risk stratification, management of primary tumor and regional nodes with curative intent, and palliative treatment. Results Guidelines from 3 organizations were analyzed: the American Academy of Dermatology (AAD), the National Comprehensive Cancer Network (NCCN), and the American Society for Radiation Oncology (ASTRO). The guidelines used different methodologies to grade evidence, making comparison difficult. There was agreement that surgery is the preferred treatment for curative cBCC and cSCC. For patients ineligible for surgery, there was a consensus to recommend definitive radiation. AAD and NCCN recommended consideration of other topical modalities in selected low-risk cBCC. Postoperative radiation therapy (PORT) was uniformly recommended in patients with positive margins that could not be cleared with surgery and in patients with nerve invasion. The definition and extent of nerve invasion varied. All guidelines recommended surgery as the primary treatment in patients with lymph node metastases in a curative setting. The criteria used for PORT varied; NCCN and ASTRO used lymph node size, number of nodes, and extracapsular extension for recommending PORT. Both NCCN and ASTRO recommend consideration of systemic treatment along with PORT in patients with extracapsular extension. Conclusion: US guidelines provide contemporary and complementary information on the management of cBCC and cSCC. There are opportunities for research, particularly in the areas of staging, indications for adjuvant treatment in curative settings, extent of nerve invasion and prognosis, and the role of systemic treatments in curative and palliative settings.
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Affiliation(s)
- Amit Mittal
- Department of Dermatology, Mayo Clinic College of Medicine & Science, 200 First St SW, Rochester, MN 55905, USA
| | - Bharat B. Mittal
- Department of Radiation Oncology, Northwestern University, 251 E Huron LC-178, Chicago, IL 60611, USA
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23
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Inan Yuksel E, Cicek D, Demir B, Kocaman N, Calik I, Kuloglu T. Role of asprosin and meteorin-like peptide in progression of actinic keratosis to squamous cell carcinoma. Biotech Histochem 2024; 99:61-68. [PMID: 38192243 DOI: 10.1080/10520295.2024.2302016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Squamous cell carcinoma (SCC) often develops from an underlying premalignant lesion. Factors that affect the progression of actinic keratosis (AK) to invasive SCC are not fully known. Asprosin (ASP) and meteorin-like peptide (METRNL) are adipokines that are involved primarily in glucose metabolism. We investigated the expression of ASP and METRNL in AK and SCC to evaluate the role of these adipokines in the development of SCC. We used 15 SCC specimens, 12 AK specimens and 12 healthy control skin specimens. ASP and METRNL protein expression in tumor and surrounding tissue was evaluated using immunohistochemistry. ASP expression in tumor tissue was significantly greater in the SCC group than in the control and AK groups, but it did not differ significantly between the AK and control groups. A positive correlation was observed for both ASP and METRNL expressions between tumor tissue and adjacent epidermis, hair follicles, sebaceous gland, eccrine gland, inflammatory cells and vascular structures. ASP and METRNL may exert pro-tumor effects toward development of invasive SCC. The expression intensity of ASP and METRNL can be used as a biomarker of risk of progression to SCC.
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Affiliation(s)
- Esma Inan Yuksel
- Department of Dermatology, Biruni University Faculty of Medicine, Istanbul, Turkey
| | - Demet Cicek
- Department of Dermatology, Firat University School of Medicine, Elazig, Turkey
| | - Betul Demir
- Department of Dermatology, Firat University School of Medicine, Elazig, Turkey
| | - Nevin Kocaman
- Department of Histology and Embryology, Firat University School of Medicine, Elazig, Turkey
| | - Ilknur Calik
- Department of Pathology, Firat University School of Medicine, Elazig, Turkey
| | - Tuncay Kuloglu
- Department of Histology and Embryology, Firat University School of Medicine, Elazig, Turkey
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24
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Ong ZX, Kannan B, Phillips ARJ, Becker DL. Investigation of Staphylococcus aureus Biofilm-Associated Toxin as a Potential Squamous Cell Carcinoma Therapeutic. Microorganisms 2024; 12:293. [PMID: 38399697 PMCID: PMC10891956 DOI: 10.3390/microorganisms12020293] [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: 12/27/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 02/25/2024] Open
Abstract
Cancer therapies developed using bacteria and their components have been around since the 19th century. Compared to traditional cancer treatments, the use of bacteria-derived compounds as cancer therapeutics could offer a higher degree of specificity, with minimal off-target effects. Here, we explored the use of soluble bacteria-derived toxins as a potential squamous cell carcinoma (SCC) therapeutic. We optimized a protocol to generate Staphylococcus aureus biofilm-conditioned media (BCM), where soluble bacterial products enriched in the development of biofilms were isolated from a bacterial culture and applied to SCC cell lines. Bioactive components of S. aureus ATCC 29213 (SA29213) BCM display selective toxicity towards cancerous human skin SCC-12 at low doses, while non-cancerous human keratinocyte HaCaT and fibroblast BJ-5ta are minimally affected. SA29213 BCM treatment causes DNA damage to SCC-12 and initiates Caspase 3-dependent-regulated cell death. The use of the novel SA29213 bursa aurealis transposon mutant library led to the identification of S. aureus alpha hemolysin as the main bioactive compound responsible for the observed SCC-12-specific toxicity. The antibody neutralisation of Hla eradicates the cytotoxicity of SA29213 BCM towards SCC-12. Hla displays high SCC-12-specific toxicity, which is exerted primarily through Hla-ADAM10 interaction, Hla oligomerisation, and pore formation. The high target specificity and potential to cause cell death in a controlled manner highlight SA29213 Hla as a good candidate as an alternative SCC therapeutic.
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Affiliation(s)
- Zi Xin Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Skin Research Institute Singapore, Singapore 308232, Singapore
- Nanyang Institute of Technology in Health and Medicine, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore 639798, Singapore
| | - Bavani Kannan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | | | - David L. Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Skin Research Institute Singapore, Singapore 308232, Singapore
- National Skin Centre, Singapore 308205, Singapore
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25
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Feng J, Zhang W, Zeng W, Dong X, Wang Y, Gu Y, Lan Y, Yang W, Lu H. Expression Analysis of Retinal G Protein-coupled Receptor and its Correlation with Regulation of the Balance between Proliferation and Aberrant Differentiation in Cutaneous Squamous Cell Carcinoma. Acta Derm Venereol 2024; 104:adv13213. [PMID: 38299232 PMCID: PMC10831868 DOI: 10.2340/actadv.v104.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/03/2023] [Indexed: 02/02/2024] Open
Abstract
Retinal G protein-coupled receptor (RGR), a photosensitive protein, functions as a retinal photoisomerase under light conditions in humans. Cutaneous squamous cell carcinoma (cSCC) is linked to chronic ultraviolet exposure, which suggests that the photoreceptor RGR may be associated with tumorigenesis and progression of squamous cell carcinoma (SCC). However, the expression and function of RGR remain uncharacterized in SCC. This study analysed RGR expression in normal skin and in lesions of actinic keratosis, Bowen's disease and invasive SCC of the skin with respect to SCC initiation and development. A total of 237 samples (normal skin (n = 28), actinic keratosis (n = 42), Bowen's (n = 35) and invasive SCC (n = 132) lesions) were examined using immunohistochemistry. Invasive SCC samples had higher expression of RGR protein than the other samples. A high immunohistochemical score for RGR was associated with increased tumour size, tumour depth, Clark level, factor classification, and degree of differentiation and a more aggressive histological subtype. In addition, RGR expression was inversely correlated with involucrin expression and positively correlated with proliferating cell nuclear antigen (PCNA) and Ki67 expression. Furthermore, RGR regulates SCC cell differentiation through the PI3K-Akt signalling pathway, as determined using molecular biology approaches in vitro, suggesting that high expression of RGR is associated with aberrant proliferation and differentiation in SCC.
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Affiliation(s)
- Jianglong Feng
- 1. Department of Dermatology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China; 2. School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China ;3 .Department of Pathology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Wei Zhang
- Department of Dermatology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Wen Zeng
- Department of Dermatology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xian Dong
- Department of Dermatology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yu Wang
- Department of Dermatology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yangguang Gu
- Department of Dermatology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yinghua Lan
- Department of Dermatology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Wenxiu Yang
- Department of Pathology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Hongguang Lu
- Department of Dermatology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
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26
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Rafei-Shamsabadi D, Scholten L, Lu S, Castiglia D, Zambruno G, Volz A, Arnold A, Saleva M, Martin L, Technau-Hafsi K, Meiss F, von Bubnoff D, Has C. Epidermolysis-Bullosa-Associated Squamous Cell Carcinomas Support an Immunosuppressive Tumor Microenvironment: Prospects for Immunotherapy. Cancers (Basel) 2024; 16:471. [PMID: 38275911 PMCID: PMC10814073 DOI: 10.3390/cancers16020471] [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: 11/16/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024] Open
Abstract
Cutaneous squamous cell carcinomas (SCCs) are a major complication of some subtypes of epidermolysis bullosa (EB), with high morbidity and mortality rates and unmet therapeutic needs. The high rate of endogenous mutations and the fibrotic stroma are considered to contribute to the pathogenesis. Patients with dystrophic EB (DEB) and Kindler EB (KEB) have the highest propensity for developing SCCs. Another patient group that develops high-risk SCCs is immunosuppressed (IS) patients, especially after organ transplantation. Herein, we interrogate whether immune checkpoint proteins and immunosuppressive enzymes are dysregulated in EB-associated SCCs as an immune resistance mechanism and compare the expression patterns with those in SCCs from IS patients, who frequently develop high-risk tumors and sporadic SCCs, and immunocompetent (IC) individuals. The expression of indoleamine 2,3-dioxygenase (IDO), programmed cell death protein-1 (PD-1), programmed cell death ligand-1 (PD-L1), T cell immunoglobulin and mucin-domain-containing protein-3 (TIM-3), lymphocyte activation gene-3 (LAG-3), and inflammatory infiltrates (CD4, CD8, and CD68) was assessed via immunohistochemistry and semi-quantitative analysis in 30 DEB-SCCs, 22 KEB-SCCs, 106 IS-SCCs, and 100 sporadic IC-SCCs. DEB-SCCs expressed significantly higher levels of IDO and PD-L1 in tumor cells and PD-1 in the tumor microenvironment (TME) compared with SCCs from IC and IS individuals. The number of CD4-positive T cells per mm2 was significantly lower in DEB-SCCs compared with IC-SCCs. KEB-SCCs showed the lowest expression of the exhaustion markers TIM-3 and LAG-3 compared with all other groups. These findings identify IDO, PD-1, and PD-L1 to be increased in EB-SCCs and candidate targets for combinatory treatments, especially in DEB-SCCs.
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Affiliation(s)
- David Rafei-Shamsabadi
- Department of Dermatology, Medical Center—University of Freiburg, Faculty of Medicine, 79104 Freiburg, Germany; (L.S.); (S.L.); (K.T.-H.); (F.M.); (C.H.)
| | - Lena Scholten
- Department of Dermatology, Medical Center—University of Freiburg, Faculty of Medicine, 79104 Freiburg, Germany; (L.S.); (S.L.); (K.T.-H.); (F.M.); (C.H.)
| | - Sisi Lu
- Department of Dermatology, Medical Center—University of Freiburg, Faculty of Medicine, 79104 Freiburg, Germany; (L.S.); (S.L.); (K.T.-H.); (F.M.); (C.H.)
- Department of Obstetrics and Gynaecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Daniele Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Via Monti di Creta 104, 00167 Rome, Italy;
| | - Giovanna Zambruno
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy;
| | - Andreas Volz
- Dermatologie am Rhein, 4051 Basel, Switzerland (A.A.)
| | | | - Mina Saleva
- Department of Dermatology and Venereology, University Hospital “Alexandrovska”, Faculty of Medicine, Sofia University of Medicine, 1431 Sofia, Bulgaria;
| | - Ludovic Martin
- MAGEC Nord Reference Center for Rare Skin Diseases, Department of Dermatology, Angers University Hospital, 49933 Angers, France;
| | - Kristin Technau-Hafsi
- Department of Dermatology, Medical Center—University of Freiburg, Faculty of Medicine, 79104 Freiburg, Germany; (L.S.); (S.L.); (K.T.-H.); (F.M.); (C.H.)
| | - Frank Meiss
- Department of Dermatology, Medical Center—University of Freiburg, Faculty of Medicine, 79104 Freiburg, Germany; (L.S.); (S.L.); (K.T.-H.); (F.M.); (C.H.)
| | - Dagmar von Bubnoff
- Department of Dermatology, Allergology and Venerology, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany;
| | - Cristina Has
- Department of Dermatology, Medical Center—University of Freiburg, Faculty of Medicine, 79104 Freiburg, Germany; (L.S.); (S.L.); (K.T.-H.); (F.M.); (C.H.)
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27
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Zheng S, Xie S, Yu H, Duan X, He Y, Ho C, Wan Y, Hang T, Chen W, Lyu J, Deng L. Competing-risks analysis for evaluating the prognosis of patients with microinvasive cutaneous squamous cell carcinoma based on the SEER database. BMC Med Res Methodol 2023; 23:286. [PMID: 38062392 PMCID: PMC10701925 DOI: 10.1186/s12874-023-02109-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Utilizing the traditional Cox regression model to identify the factors affecting the risk of mortality due to microinvasive cutaneous squamous cell carcinoma (micSCC) may produce skewed results. Since cause-specific mortality can guide clinical decision-making, this study employed the Fine-Gray model based on the Surveillance, Epidemiology, and End Results (SEER) database to identify significant predictive variables for the risk of micSCC-related mortality. METHODS This study used the information of patients with micSCC who were listed in the SEER database during 2000-2015. Cox regression and Fine-Gray models were utilized for the multivariable analysis, and Gray's test and the cumulative incidence function were used for the univariable analyses. RESULTS There were 100 patients who died from other reasons and 38 who died from micSCC among the 1259 qualified patients with micSCC. Most were female, white, married, had localized metastasis, etc. According to the univariable Gray's test (P < 0.05), the cumulative incidence rate for events of interest was strongly associated with age, sex, marital status, American Joint Committee on Cancer staging, radiation status, summary stage, chemotherapy status, surgery status, and tumor size. Multivariable Cox regression analysis and multivariable competing-risks analysis indicated that age, tumor size, and income were independent risk variables for the prognosis of patients with micSCC. In both age and tumor size variables, the competing-risks model showed a slight decrease in the hazard ratio and a slight narrowing of the 95% confidence interval compared with the Cox regression model. However, this pattern is not evident in the income variable. CONCLUSIONS This study established a Fine-Gray model for identifying the independent risk factors that influence the risk of mortality among patients with micSCC. This study uncovers that, in the context of competing risks, age, tumor size, and income serve as independent risk factors influencing the risk of mortality due to micSCC among patients. Our findings have the potential to provide more accurate risk assessments for patient outcomes and contribute to the development of individualized treatment plans.
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Affiliation(s)
- Suzheng Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
| | - Shuping Xie
- School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Hai Yu
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
| | - Xi Duan
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yong He
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
| | - Chichien Ho
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
| | - Yang Wan
- Guangzhou Jnumeso Bio-Technology Co., Ltd, Guangzhou, China
| | - Tie Hang
- Chinese Academy of Inspection and Quarantine Greater Bay Area, Zhongshan, China
| | - Wenhui Chen
- Shanghai Aige Medical Beauty Clinic Co., Ltd. (Agge), Shanghai, China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China.
| | - Liehua Deng
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China.
- Department of Dermatology, The Fifth Affiliated Hospital of Jinan University, Heyuan, China.
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28
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment-Update 2023. Eur J Cancer 2023; 193:113252. [PMID: 37708630 DOI: 10.1016/j.ejca.2023.113252] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/16/2023]
Abstract
In order to update recommendations on treatment, supportive care, education, and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV), and the European Organisation of Research and Treatment of Cancer (EORTC) was formed. Recommendations were based on an evidence-based literature review, guidelines, and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable), and distant metastatic cSCC. For common primary cSCC, the first-line treatment is surgical excision with postoperative margin assessment or micrographically controlled surgery. Achieving clear surgical margins is the most important treatment consideration for patients with cSCCs amenable to surgery. Regarding adjuvant radiotherapy for patients with high-risk localised cSCC with clear surgical margins, current evidence has not shown significant benefit for those with at least one high-risk factor. Radiotherapy should be considered as the primary treatment for non-surgical candidates/tumours. For cSCC with cytologically or histologically confirmed regional nodal metastasis, lymph node dissection is recommended. For patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiotherapy, anti-PD-1 agents are the first-line systemic treatment, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drugs Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC, include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiotherapy. Multidisciplinary board decisions are mandatory for all patients with advanced cSCC, considering the risks of toxicity, the age and frailty of patients, and co-morbidities, including immunosuppression. Patients should be engaged in informed, shared decision-making on management and be provided with the best supportive care to improve symptom management and quality of life. The frequency of follow-up visits and investigations for subsequent new cSCC depends on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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Huang SS, Toon CW, Harish V. The prognostic significance of lymphovascular invasion in cutaneous squamous cell carcinoma. ANZ J Surg 2023; 93:2727-2735. [PMID: 37727039 DOI: 10.1111/ans.18694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/12/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The majority of cutaneous squamous cell carcinomas (cSCC) have a favourable prognosis. However, a subset of cases follow an aggressive disease course with progression to metastasis and death. Several histopathological parameters are associated with poor outcomes, but lymphovascular invasion (LVI) has not been well studied. OBJECTIVE To assess the prognostic significance of LVI in cSCC and determine associations between LVI and cSCC. METHODS A retrospective review of 486 consecutive cases of cSCC over a 5-year period from a single centre was stratified by the presence or absence of LVI. Logistic regression and multivariate survival analysis were used to determine associations of LVI and prognostic significance of LVI, respectively. FINDINGS LVI was present in 41 cases (9.2%). LVI was significantly associated with increasing depth of invasion, microanatomical tumour location (subcutis vs. dermis), and tumour dimensions (P < 0.05). Univariate survival analysis revealed significantly lower 2-year overall survival rates for patients with LVI (37.1%) compared with those without (66.6%) (95% CI = 60.6-73.3, P < 0.001). LVI was also found to be an independent marker of poor disease-specific survival (HR = 0.232 (95% CI = 0.090-0.600), P = 0.003), poor overall survival (HR 0.338 (95% CI = 0.184-0.623), P < 0.001) and poor disease-free survival (HR 0.461 (95% CI = 0.230-0.923), P = 0.029) through multivariate analysis. CONCLUSIONS This study confirms that LVI is an independent poor prognosticator in cSCC, with significantly worse survival indices at 2 years. Future systems of risk stratification for cSCC should incorporate LVI.
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Affiliation(s)
- Sarah Suruo Huang
- Department of Burns, Plastic & Maxillofacial Surgery, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Christopher W Toon
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia
- St Vincent's Clinical School, University of NSW, Sydney, Australia
| | - Varun Harish
- Department of Burns, Plastic & Maxillofacial Surgery, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
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Catalano O, Crisan D, Díaz CPG, Cavallieri F, Varelli C, Wortsman X. Ultrasound Assessment of Skin Tumors Local Recurrence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2439-2446. [PMID: 37195073 DOI: 10.1002/jum.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/18/2023]
Abstract
Skin cancer may recur at or around the surgical site despite wide excisions. Prompt clinical and sonographic detection of local recurrence is important since subjects with relapsing melanomas or nonmelanoma malignancies can be managed efficaciously, with a relevant impact on morbidity and survival. Ultrasound is being employed with increasing frequency in the assessment of skin tumors, but most of the published articles relate to initial pretherapeutic diagnosis and staging. This review aims to offer an illustrated guide to the sonographic evaluation of locally recurring skin cancer. We introduce the topic, then we provide some sonographic tips for patient follow-up, then we describe the ultrasound findings in case of local recurrence, illustrating the main mimickers, and finally, we mention the role of ultrasound in guiding diagnostic and therapeutic percutaneous procedures.
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Affiliation(s)
| | - Diana Crisan
- Clinic of Dermatology and Allergology, University Clinic, Ulm, Germany
| | | | | | - Carlo Varelli
- Radiology Unit, Istituto Diagnostico Varelli, Naples, Italy
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues Clinic, University of Chile and Pontifical Catholic University of Chile, Santiago, Chile
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Abstract
BACKGROUND The cutaneous squamous cell carcinoma (CSCC) is the second most common nonmelanoma skin cancer with an increasing incidence rate. Patients presenting with high-risk lesions associated with locally advanced or metastatic CSCC face high rates of recurrence and mortality. METHODS Selective literature review based on PubMed and consideration of current guidelines "Aktinische Keratosen und Plattenepithelkarzinom der Haut" and "Prävention von Hautkrebs". FINDINGS Complete surgical excision with histopathological control of excision margins is the gold standard in the treatment of primary CSCC. Radiotherapy can be used as an alternative treatment of inoperable CSCCs. In 2019, the PD1-antibody cemiplimab, has been approved for the treatment of locally advanced and metastatic CSCC by the European Medicines Agency. After 3 years of follow up, Cemiplimab shows overall response rates of 46 %, the median overall survival and median response rate had not been reached yet. Additional immunotherapeutics, combinations with other agents and oncolytic viruses are all potentially worth study to try, so clinical trial data will be forthcoming over the next few years to guide optimal use of these agents. CONCLUSION Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Further development of existing therapeutic concepts, identification of new combination therapies and the development of new immunotherapeutics will be the key challenge over the next few years.
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Affiliation(s)
- Birgit Burda
- Klinik für Dermatologie, Klinikum Nürnberg Nord, Nürnberg, Deutschland
| | - Erwin S Schultz
- Klinik für Dermatologie, Klinikum Nürnberg Nord, Nürnberg, Deutschland
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Gupta R, Selinger CI, Ashford B, Chua MST, Clark JR, Damian DL, Jackett LA, James C, Johnson S, Ladwa R, Lambie D, McKenzie C, Tan ST, Scolyer RA. Implementing structured pathology reporting protocol for non-melanocytic skin cancers: practical considerations. Pathology 2023; 55:743-759. [PMID: 37573165 DOI: 10.1016/j.pathol.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
Non-melanocytic skin cancers (NMSCs) account for five times the incidence of all other cancers combined and cost US $6 billion annually. These are the most frequent specimens encountered in community pathology practice in many Western countries. Lack of standardised structured pathology reporting protocols (SPRPs) can result in omission of critical information or miscommunication leading to suboptimal patient management. The lack of standardised data has significant downstream public health implications, including insufficient data for reliable development of prognostic tools and health-economy planning. The Royal College of Pathologists of Australasia has developed an NMSC SPRP. A multidisciplinary expert committee including pathologists, surgeons, dermatologists, and radiation and medical oncologists from high volume cancer centres was convened. A systematic literature review was performed to identify evidence for including elements as mandatory standards or best practice guidelines. The SPRP and accompanying commentary of evidence, definitions and criteria was peer reviewed by external stakeholders. Finally, the protocol was revised following feedback and trialled in multiple centres prior to implementation. Some parameters utilised clinically for determining management and prognosis including tumour depth, lymphovascular invasion or distance to the margins lack high level evidence in NMSC. Dermatologists, surgeons, and radiation oncologists welcomed the SPRP. Pathologists indicated that the variety of NMSC specimens ranging from curettes to radical resections as well as significant differences in the biological behaviour of different tumours covered by the NMSC umbrella made use of a single protocol difficult. The feedback included that using a SPRP for low risk NMSC was neither clinically justified nor compensated adequately by the Australian Medicare Reimbursement Schedule. Following stakeholder feedback, the SPRP implementation was restricted to excision specimens of head and neck NMSC; and low-risk NMSC, such as superficial basal cell carcinoma, were excluded. Implementing NMSC SPRP fulfils an unmet clinical need. Unlike other cancers, NMSCs generate a range of specimen types and are reported in a wide range of pathology practices. Limiting use of SPRP to NMSC at higher risk of progression and providing formatted templates for easy incorporation into laboratory information systems were essential to successful deployment. In the future, further consideration should be given to implementing the SPRP to include all relevant specimens, including non-head and neck and low-risk NMSC specimens.
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Affiliation(s)
- Ruta Gupta
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia.
| | | | - Bruce Ashford
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Margaret S T Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Vic, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Diona L Damian
- Discipline of Dermatology, Bosch Institute, University of Sydney, and Royal Prince Alfred Hospital Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Louise A Jackett
- Department of Pathology, Austin Health, Melbourne, Vic, Australia
| | | | | | - Rahul Ladwa
- Department of Cancer Care Services, Princess Alexandra Hospital, Woolloongabba, Qld, Australia; Faculty of Medicine, University of Queensland, Herston, Qld, Australia
| | - Duncan Lambie
- Princess Alexandra Hospital, Pathology Queensland, Brisbane, Qld, Australia; Frazer Institute, University of Queensland, Brisbane, Qld, Australia
| | - Catriona McKenzie
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand; Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
| | - Richard A Scolyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Petitjean C, Bénateau H, Veyssière A, Morello R, Dompmartin A, Garmi R. Interest of frozen section procedure in skin tumors other than melanoma. J Plast Reconstr Aesthet Surg 2023; 84:377-384. [PMID: 37393761 DOI: 10.1016/j.bjps.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Skin tumors are common. Recommended treatment in most cases is surgery, with margins adapted. Except in the case of simple resection and suture, it is necessary to know the status of the margins before reconstructing the defect. A one-stage technique is possible with frozen section analysis, which gives the surgeon an intraoperative assessment of resection quality. The aim of our work is to study the reliability of the frozen section procedure. METHOD A retrospective study included 689 patients who underwent surgery for skin tumor (excluding melanoma) between January 2011 and December 2019 at the University Hospital of Caen, France. RESULTS In 639 patients (92.75%), the frozen section analysis found healthy margins. There were 21 cases of discrepancy between the frozen section analysis and final histology. Infiltrating and scleroderma-like basal cell carcinomas showed a significantly higher frequency of affected margins on frozen section analysis (p < 0.001). The tumor size and location played a significant role in the margin status. CONCLUSION In our department, the frozen section procedure is the reference examination indicating immediate flap reconstruction. The present study demonstrated its interest and overall reliability. However, it is to be used according to histologic type, size, and location.
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Affiliation(s)
- Clément Petitjean
- University Hospital Centre Caen, Department of Maxillofacial and Plastic Surgery, Caen, Basse-Normandie, France.
| | - Hervé Bénateau
- University Hospital Centre Caen, Department of Maxillofacial and Plastic Surgery, Caen, Basse-Normandie, France
| | - Alexis Veyssière
- University Hospital Centre Caen, Department of Maxillofacial and Plastic Surgery, Caen, Basse-Normandie, France
| | - Remi Morello
- University Hospital Centre Caen, Biostatistics and Clinical Research Department, Caen, Basse-Normandie, France
| | - Anne Dompmartin
- University Hospital Centre Caen, Department of Dermatology, Caen, Basse-Normandie, France
| | - Rachid Garmi
- University Hospital Centre Caen, Department of Maxillofacial and Plastic Surgery, Caen, Basse-Normandie, France
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Mager L, Gardeen S, Carr DR, Shahwan KT. Cemiplimab for the Treatment of Advanced Cutaneous Squamous Cell Carcinoma: Appropriate Patient Selection and Perspectives. Clin Cosmet Investig Dermatol 2023; 16:2135-2142. [PMID: 37581012 PMCID: PMC10423569 DOI: 10.2147/ccid.s381471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/25/2023] [Indexed: 08/16/2023]
Abstract
Five percent of patients with cutaneous squamous cell carcinoma develop locally advanced or metastatic disease that is not amenable to definitive surgical or radiation therapy. Cemiplimab, an antibody against programmed death receptor-1, was approved in the United States for the treatment of locally advanced and metastatic cutaneous squamous cell carcinoma in 2018. We performed a literature review on the use of cemiplimab in cutaneous squamous cell carcinoma, with an emphasis on efficacy, safety and tolerability, patient selection, and future directions. Embase and PubMed were searched for relevant terms, and 23 peer-reviewed journal articles presenting primary data on cemiplimab treatment in 5 or more subjects with cutaneous squamous cell carcinoma were included and summarized. Objective response rates in locally advanced and metastatic disease ranged from 42.9% to 50.8% in Phase I/II clinical trials and 32-77% (median 58%) in post-approval observational studies. Phase II trials looking at neoadjuvant use also had favorable response rates. Real-world studies demonstrated cemiplimab efficacy in periorbital tumors, tumors with large caliber perineural invasion, and tumors in solid organ transplant recipients. Cemiplimab was safe and well-tolerated in most patients. While side effects such as fatigue, diarrhea, pruritus, and rash were fairly common, only 9.8% of adverse events required cessation of therapy in phase II trials. Severe adverse events were primarily immune-mediated, including pneumonitis, myocarditis, myositis, and autoimmune hepatitis; the risk of treatment-related death was 3% in clinical trials. Further research on cemiplimab therapy in cutaneous squamous cell carcinoma is needed, and trials are now underway to obtain Phase IV long-term real-world data, further data on adjuvant and neoadjuvant use, and additional data in special populations such as stem cell and solid organ transplant recipients.
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Affiliation(s)
- Layna Mager
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - David R Carr
- Department of Dermatology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Kathryn T Shahwan
- Department of Dermatology, The Ohio State University Medical Center, Columbus, OH, USA
- Department of Dermatology, Altru Health System, Grand Forks, ND, USA
- Department of Internal Medicine, University of North Dakota, Grand Forks, ND, USA
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Ma J, Huang L, Gao YB, Li MX, Chen LL, Yang L. Circ_TNFRSF21 promotes cSCC metastasis and M2 macrophage polarization via miR-214-3p/CHI3L1. J Dermatol Sci 2023; 111:32-42. [PMID: 37442735 DOI: 10.1016/j.jdermsci.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is a highly invasive disease with the potential to metastasize and cause fatality. Therefore, it is crucial to understand the mechanism behind cSCC in order to devise effective strategies to combat this disease. OBJECTIVE We investigated the function of circ_TNFRSF21/miR-214-3p/CHI3L1 axis in cSCC. METHODS The features of circ_TNFRSF21 was characterized using Sanger sequencing, and RNase R/actinomycin D treatment. Genes and M1/M2 markers levels were assessed by qRT-PCR and IHC. The proliferation, migration, and invasion of cells were evaluated by CCK-8, colony formation, EdU incorporation, and transwell assays. Tumor growth and metastasis in vivo were evaluated by nude mouse xenograft model. Interactions of circ_TNFRSF21/miR-214-3p and miR-214-3p/CHI3L1 were validated by RNA immunoprecipitation and dual luciferase assay. RESULTS Circ_TNFRSF21 and CHI3L1 expression were elevated in both human cSCC tissues and cells, whereas miR-214-3p was reduced. Circ_TNFRSF21 silencing or miR-214-3p overexpression suppressed cSCC cell proliferation, migration, invasion, and M2 macrophage polarization. Circ_TNFRSF21 functioned as a sponge for miR-214-3p while miR-214-3p directly targeted CHI3L1. Knockdown of miR-214-3p reversed the effects of circ_TNFRSF21 knockdown on cSCC development, while CHI3L1 upregulation reversed the effects of miR-214-3p overexpression. Furthermore, knockdown of circ_TNFRSF21 inhibited cSCC tumor growth and metastasis in vivo. CONCLUSION Circ_TNFRSF21 plays a significant role in cSCC progression by enhancing cell proliferation, migration, invasion, and M2 macrophage polarization through inhibiting miR-214-3p and subsequent disinhibition of CHI3L1. These findings deepen our understanding of the molecular mechanism of cSCC and propose the circ_TNFRSF21/miR-214-3p/CHI3L1 axis as promising diagnosis markers or therapeutic targets for cSCC.
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Affiliation(s)
- Jun Ma
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangdong Province, PR China
| | - Lei Huang
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangdong Province, PR China
| | - Yan-Bin Gao
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangdong Province, PR China
| | - Min-Xiong Li
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangdong Province, PR China
| | - Liang-Long Chen
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangdong Province, PR China
| | - Lei Yang
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangdong Province, PR China.
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Agrez M, Rybchyn MS, De Silva WGM, Mason RS, Chandler C, Piva TJ, Thurecht K, Fletcher N, Liu F, Subramaniam G, Howard CB, Blyth B, Parker S, Turner D, Rzepecka J, Knox G, Nika A, Hall A, Gooding H, Gallagher L. An immunomodulating peptide to counteract solar radiation-induced immunosuppression and DNA damage. Sci Rep 2023; 13:11702. [PMID: 37474630 PMCID: PMC10359417 DOI: 10.1038/s41598-023-38890-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/17/2023] [Indexed: 07/22/2023] Open
Abstract
Ultraviolet radiation (UVR) induces immunosuppression and DNA damage, both of which contribute to the rising global incidence of skin cancer including melanoma. Nucleotide excision repair, which is activated upon UVR-induced DNA damage, is linked to expression of interleukin-12 (IL-12) which serves to limit immunosuppression and augment the DNA repair process. Herein, we report an immunomodulating peptide, designated IK14800, that not only elicits secretion of IL-12, interleukin-2 (IL-2) and interferon-gamma (IFN-γ) but also reduces DNA damage in the skin following exposure to UVR. Combined with re-invigoration of exhausted CD4+ T cells, inhibition of UVR-induced MMP-1 release and suppression of B16F10 melanoma metastases, IK14800 offers an opportunity to gain further insight into mechanisms underlying the development and progression of skin cancers.
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Affiliation(s)
- Michael Agrez
- InterK Peptide Therapeutics Limited, Sydney, NSW, Australia.
- Australian Institute for Bioengineering and Nanotechnology and the ARC Training Centre for Innovation in Biomedical Imaging Technologies, University of Queensland, Brisbane, Australia.
| | - Mark Stephen Rybchyn
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, Australia
| | | | - Rebecca Sara Mason
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, Australia
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
| | | | - Terrence J Piva
- Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Kristofer Thurecht
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
- Australian Institute for Bioengineering and Nanotechnology and the ARC Training Centre for Innovation in Biomedical Imaging Technologies, University of Queensland, Brisbane, Australia
| | - Nicholas Fletcher
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
- Australian Institute for Bioengineering and Nanotechnology and the ARC Training Centre for Innovation in Biomedical Imaging Technologies, University of Queensland, Brisbane, Australia
| | - Feifei Liu
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
- Australian Institute for Bioengineering and Nanotechnology and the ARC Training Centre for Innovation in Biomedical Imaging Technologies, University of Queensland, Brisbane, Australia
| | - Gayathri Subramaniam
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
- Australian Institute for Bioengineering and Nanotechnology and the ARC Training Centre for Innovation in Biomedical Imaging Technologies, University of Queensland, Brisbane, Australia
| | - Christopher B Howard
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
- Australian Institute for Bioengineering and Nanotechnology and the ARC Training Centre for Innovation in Biomedical Imaging Technologies, University of Queensland, Brisbane, Australia
| | - Benjamin Blyth
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology at the University of Melbourne, Melbourne, Australia
| | - Stephen Parker
- InterK Peptide Therapeutics Limited, Sydney, NSW, Australia
| | | | | | - Gavin Knox
- Concept Life Sciences Limited, Edinburgh, Scotland
| | | | - Andrew Hall
- Concept Life Sciences Limited, Edinburgh, Scotland
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Banini M, Salvestrini V, Vultaggio A, Perlato M, Mecheri V, Cerbai C, Scotti V, Matucci A, Mangoni M, Livi L, Bonomo P. Desensitization Protocol for Cemiplimab-Related Infusion Reaction in Cutaneous Squamous Cell Carcinoma: A Case Report and Literature Review. Curr Oncol 2023; 30:6699-6707. [PMID: 37504351 PMCID: PMC10378378 DOI: 10.3390/curroncol30070491] [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: 05/26/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The landscape of systemic therapies for advanced non-melanoma skin cancers has been revolutionized by the advent of immunotherapy. Cemiplimab is the only immune checkpoint inhibitor (ICI) approved by the European Medicine Agency for recurrent/metastatic cutaneous squamous cell carcinoma (cSCC). Its excellent efficacy outcomes are achieved due to its good tolerability profile. The drug-related hypersensitivity reaction (HSR) is a well-known issue in oncology, but it is rarely reported in respect to immune checkpoint inhibitors. Cemiplimab is among the agents with the best infusion tolerability profiles. Clinical practice guidelines in this field are lacking. RESULTS We report on the successful management of a severe infusion reaction induced by Cemiplimab in a patient with cSCC based on a desensitization protocol, which led to adequate treatment delivery and prolonged clinical benefit. A review of the available literature on HSR rates and its management with ICIs, and on drug desensitization (DD) protocols and their efficacy, was conducted to highlight the limited knowledge on this topic and its importance. CONCLUSION Our experience highlights the need for a DD protocol in order to improve the treatment of HSRs, particularly when elicited by an immunotherapy agent, preventing treatment discontinuation and preserving its efficacy.
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Affiliation(s)
- Marco Banini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, L.go Brambilla 3, 50134 Florence, Italy
| | - Viola Salvestrini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, L.go Brambilla 3, 50134 Florence, Italy
| | | | - Margherita Perlato
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Valentina Mecheri
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Cecilia Cerbai
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, L.go Brambilla 3, 50134 Florence, Italy
| | - Vieri Scotti
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Monica Mangoni
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, L.go Brambilla 3, 50134 Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, L.go Brambilla 3, 50134 Florence, Italy
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
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Hyeraci M, Papanikolau ES, Grimaldi M, Ricci F, Pallotta S, Monetta R, Minafò YA, Di Lella G, Galdo G, Abeni D, Fania L, Dellambra E. Systemic Photoprotection in Melanoma and Non-Melanoma Skin Cancer. Biomolecules 2023; 13:1067. [PMID: 37509103 PMCID: PMC10377635 DOI: 10.3390/biom13071067] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Non-melanoma skin cancers (NMSCs), which include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and actinic keratosis (AK), are the most common cancer diseases in the Caucasian race. If diagnosed late and improperly treated, BCC and SCC can become locally advanced and metastasize. Malignant melanoma (MM) is less frequent but more lethal than NMSC. Given the individual and social burdens of skin cancers, performing an adequate prevention is needed. Ultraviolet (UV) ray exposure is one of the main risk factors for skin cancer. Thus, the first-choice prevention strategy is represented by photoprotection that can be both topical and systemic. The latter consists of the oral administration of molecules which protect human skin against the damaging effects of UV rays, acting through antioxidant, anti-inflammatory, or immunomodulator mechanisms. Although several compounds are commonly used for photoprotection, only a few molecules have demonstrated their effectiveness in clinical trials and have been included in international guidelines for NMSC prevention (i.e., nicotinamide and retinoids). Moreover, none of them have been demonstrated as able to prevent MM. Clinical and preclinical data regarding the most common compounds used for systemic photoprotection are reported in this review, with a focus on the main mechanisms involved in their photoprotective properties.
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Affiliation(s)
- Mariafrancesca Hyeraci
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167 Rome, Italy
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131Padua, Italy
| | | | - Marta Grimaldi
- Department of Medical and Surgical Sciences, Division of Dermatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Ricci
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167 Rome, Italy
| | - Sabatino Pallotta
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167 Rome, Italy
| | - Rosanna Monetta
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167 Rome, Italy
| | - Ylenia Aura Minafò
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167 Rome, Italy
| | - Giovanni Di Lella
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167 Rome, Italy
| | - Giovanna Galdo
- Dermatology Unit, AORN San Giuseppe Moscati, 83100 Avellino, Italy
| | - Damiano Abeni
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167 Rome, Italy
| | - Luca Fania
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167 Rome, Italy
| | - Elena Dellambra
- IDI-IRCCS, Dermatological Research Hospital, Via dei Monti di Creta 104, 00167 Rome, Italy
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Bommakanti KK, Kosaraju N, Tam K, Chai-Ho W, St John M. Management of Cutaneous Head and Neck Squamous and Basal Cell Carcinomas for Immunocompromised Patients. Cancers (Basel) 2023; 15:3348. [PMID: 37444461 DOI: 10.3390/cancers15133348] [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: 05/09/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
The incidence of non-melanoma skin cancer (NMSC) continues to rise, and more than one million cases are diagnosed in the United States each year. The increase in prevalence has been attributed to increased lifespan and improvements in survival for conditions that increase the risk of these malignancies. Patients who are immunocompromised have a higher risk of developing NMSC compared to the general population. In immunosuppressed patients, a combination of prevention, frequent surveillance, and early intervention are necessary to reduce morbidity and mortality. In this review, we collate and summarize current knowledge regarding pathogenesis of head and neck cutaneous SCC and BCC within immunocompromised patients, examine the potential role of the immune response in disease progression, and detail the role of novel immunotherapies in this subset of patients.
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Affiliation(s)
- Krishna K Bommakanti
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
- UCLA Head and Neck Cancer Program (HNCP), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
| | - Nikitha Kosaraju
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
| | - Kenric Tam
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
- UCLA Head and Neck Cancer Program (HNCP), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
| | - Wanxing Chai-Ho
- UCLA Head and Neck Cancer Program (HNCP), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
- Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
| | - Maie St John
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
- UCLA Head and Neck Cancer Program (HNCP), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
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40
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Bang S, Son H, Cha H, Song K, Park H, Kim H, Ko JY, Myung J, Paik S. Immunohistochemical Analysis of Single-Stranded DNA Binding Protein 2 in Non-Melanoma Skin Cancers. Biomedicines 2023; 11:1818. [PMID: 37509458 PMCID: PMC10376428 DOI: 10.3390/biomedicines11071818] [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: 05/16/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Single-stranded DNA binding protein 2 (SSBP2) is a tumor suppressor candidate. In this study, the expression level and clinicopathological significance of SSBP2 in squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) were evaluated. We also identified biological pathways associated with a set of genes potentially related to SSBP2. Immunohistochemistry (IHC) was performed on 70 SCC and 146 BCC cases to assess SSBP2 expression semi-quantitatively. In addition, the associations between SSBP2 expression and clinicopathological characteristics were analyzed. Gene ontology (GO) enrichment analysis was performed using publicly available data and web-based bioinformatics tools. Compared with BCC, SCC had a significantly low SSBP2 expression (p < 0.001). In total, 12 (17.1%) of the 70 SCC cases and 30 (20.5%) of the 146 BCC cases showed low SSBP2 expression. Among SCC cases, ulceration (p = 0.005) and a deep level of invasion (p = 0.012) showed an association with low SSBP2 expression. Local recurrence was slightly more common in the SCC subgroup with low SSBP2 expression, although the difference was not significant (p = 0.058). Using GO enrichment analysis, we identified several biological functions performed by a set of 36 genes in SCC. SSBP2 evaluation using IHC can be helpful in the differential diagnosis of SCC and BCC. SSBP2 expression was associated with tumor invasiveness in SCC.
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Affiliation(s)
- Seongsik Bang
- Department of Pathology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Hwangkyu Son
- Department of Pathology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Hyebin Cha
- Department of Pathology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Kihyuk Song
- Department of Pathology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Hosub Park
- Department of Pathology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Hyunsung Kim
- Department of Pathology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Joo Yeon Ko
- Department of Dermatology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Jaekyung Myung
- Department of Pathology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Seungsam Paik
- Department of Pathology, Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
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Ishizuki S, Nakamura Y. Role of Sentinel Lymph Node Biopsy for Skin Cancer Based on Clinical Studies. Cancers (Basel) 2023; 15:3291. [PMID: 37444401 DOI: 10.3390/cancers15133291] [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: 05/06/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The sentinel lymph node is the first lymph node from the primary tumor. Sentinel lymph node biopsy (SLNB) is a surgical procedure that can detect occult nodal metastasis with relatively low morbidity. It may also have a therapeutic effect via regional disease control. The Multicenter Selective Lymphadenectomy-I (MSLT-I) trial revealed a prognostic benefit from SLNB in melanoma patients. However, it remains unclear whether there is a prognostic benefit from SLNB in patients with nonmelanoma skin cancer owing to a lack of randomized prospective studies. Nevertheless, SLNB provides important information about nodal status, which is one of the strongest factors to predict prognosis and may guide additional nodal treatment. Currently, SLNB is widely used in the management of not only patients with melanoma but also those with nonmelanoma skin cancer. However, the utilization and outcomes of SLNB differ among skin cancers. In addition, SLNB is not recommended for routine use in all patients with skin cancer. In this review, we provide a summary of the role of SLNB and of the indications for SLNB in each skin cancer based on previously published articles.
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Affiliation(s)
- Shoichiro Ishizuki
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
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Elaldi R, Chamorey E, Schiappa R, Sudaka A, Anjuère F, Villarmé A, Culié D, Bozec A, Montaudié H, Poissonnet G. Comparative Performance of Four Staging Classifications to Select «High-Risk» Head and Neck Cutaneous Squamous Cell Carcinomas. J Clin Med 2023; 12:3929. [PMID: 37373623 DOI: 10.3390/jcm12123929] [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: 05/01/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Many classifications exist to select patients with "high-risk" head and neck cutaneous squamous cell carcinoma (HNCSCC). OBJECTIVE To compare the performance of the Brigham and Women's Hospital (BWH) classification with the performance of the American Joint Committee on Cancer 8th Edition (AJCC8), the Union for International Cancer Control 8th Edition (UICC8), and the National Comprehensive Cancer Network (NCCN) classifications. METHODS In this single-center retrospective study, HNCSCC resected in a tertiary care center were classified as "low-risk" or "high-risk" tumors according to the four classifications. Rates of local recurrence (LR), lymph node recurrence (NR), and disease-specific death (DSD) were collected. The performance of each classification was then calculated in terms of homogeneity, monotonicity, and discrimination and compared. RESULTS Two hundred and seventeen HNCSCC from 160 patients, with a mean age of 80 years, were included. For predicting the risk of any poor outcome and risk of NR, the BWH classification had the best specificity and positive predictive value. However, its concordance index was not significantly higher than that of the AJCC8 and UICC8 classifications. The NCCN classification was the least discriminant. CONCLUSIONS AND RELEVANCE This study suggests that the BWH classification is the most appropriate for predicting the risk of poor outcomes in patients with HNCSCC when compared with the NCCN, UICC8, and AJCC8 classifications.
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Affiliation(s)
- Roxane Elaldi
- Face and Neck Surgery Department, Antoine Lacassagne Center, 06100 Nice, France
- CNRS UMR7275, Institut de Pharmacologie Moléculaire et Cellulaire, Université Côte d'Azur, 06560 Valbonne, France
| | - Emmanuel Chamorey
- Statistics Department, Antoine Lacassagne Center, 06100 Nice, France
| | - Renaud Schiappa
- Statistics Department, Antoine Lacassagne Center, 06100 Nice, France
| | - Anne Sudaka
- Anatomopathology Department, Antoine Lacassagne Center, 06100 Nice, France
| | - Fabienne Anjuère
- CNRS UMR7275, Institut de Pharmacologie Moléculaire et Cellulaire, Université Côte d'Azur, 06560 Valbonne, France
| | - Agathe Villarmé
- Face and Neck Surgery Department, Antoine Lacassagne Center, 06100 Nice, France
| | - Dorian Culié
- Face and Neck Surgery Department, Antoine Lacassagne Center, 06100 Nice, France
| | - Alexandre Bozec
- Face and Neck Surgery Department, Antoine Lacassagne Center, 06100 Nice, France
| | - Henri Montaudié
- Dermatology Department, University Hospital of Nice, 06200 Nice, France
- INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, 06200 Nice, France
| | - Gilles Poissonnet
- Face and Neck Surgery Department, Antoine Lacassagne Center, 06100 Nice, France
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Dietz MD, Zelmanski MH, Choueiri MA. Radical Resection of Locally Advanced Chest Wall cSCC With Muscle Flap Reconstruction. Am Surg 2023:31348231175107. [PMID: 37139866 DOI: 10.1177/00031348231175107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Outcomes in those with advanced cutaneous squamous cell carcinoma (cSCC) are poor. Upon incidence of metastasis, the mortality rate has been shown to be >70% with median overall survival (OS) of less than 2 years. While there is no standardized combination and multimodal therapy recommendation for advanced cases, there is a significant necessity to include surgical intervention for improved locoregional control of disease and improved OS. Currently, Cisplatin as monotherapy or combination with Fluorouracil (5-FU), and radiotherapy followed by surgical intervention are the most likely regimens used in the treatment of advanced cSCC. Secondary chemotherapy options include carboplatin and paclitaxel. Here, we report the effectiveness of neoadjuvant chemoradiotherapy (CRT) using carboplatin and paclitaxel agents with intensity modulated radiation therapy (IMRT) followed by radical surgical resection, and later, muscle flap reconstruction with split-thickness skin grafting to treat a very high-risk Stage IV cSCC of the left chest wall.
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Affiliation(s)
- Matthew D Dietz
- Department of General Surgery, West Virginia University School of Medicine- Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Mark H Zelmanski
- Department of General Surgery, West Virginia University School of Medicine- Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Mark A Choueiri
- Department of General Surgery, West Virginia University School of Medicine- Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
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Deniz Y, Işıktaş Acar E, Çetin Genç Ç. Effects of direct therapeutic radiation on pulpal surface of root dentin: an in vitro study. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2023; 62:261-268. [PMID: 36933029 DOI: 10.1007/s00411-023-01020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/27/2023] [Indexed: 05/18/2023]
Abstract
The aims of the study were to analyze the effects of therapeutic radiation on human root dentin samples from the aspect of possible alterations in crystallinity, micro-morphology, and composition. Fifty-six root dentin specimens were divided into seven groups (0, 10, 20, 30, 40, 50, and 60 Gy). Scanning electron microscope (SEM), energy-dispersive X-ray spectroscopy (EDX) and X-ray diffraction (XRD) analyses were performed on pulpal surfaces of root dentin after being irradiated by 6MV photon energy. Mineral compositions, Ca/P, P/N, Ca/N ratios, and hydroxyapatite pikes were calculated. Some deuteriations on the dentin surface were observed in SEM images after 30 Gy and subsequent doses. One-way ANOVA revealed that there was no significant alteration in weight percentages of C, O, Mg, Ca, P, and N between groups. Radiation did not influence stoichiometric Ca/P, Ca/N, and P/N molar ratios. XRD analysis did not show a remarkable decline in hydroxyapatite pikes by the increasing doses. Radiotherapy changes the micromorphology of circumpulpal dentin but does not affect elemental composition and crystallinity.
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Affiliation(s)
- Yeşim Deniz
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Çanakkale Onsekiz Mart University, Sahil Yolu Street, No: 5, Çanakkale, 17100, Turkey.
| | - Ezgi Işıktaş Acar
- Department of Medical Physics, Trakya University, Edirne, 22030, Turkey
| | - Çiğdem Çetin Genç
- Department of Dentomaxillofacial Surgery, Faculty of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, 17100, Turkey
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Solanes Vilanova F, Hellebuyck T, Chiers K. Histological Variants of Squamous and Basal Cell Carcinoma in Squamates and Chelonians: A Comprehensive Classification. Animals (Basel) 2023; 13:ani13081327. [PMID: 37106890 PMCID: PMC10135371 DOI: 10.3390/ani13081327] [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: 03/21/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
In the present study, the histological characteristics of squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs) obtained from 22 squamate and 13 chelonian species were retrospectively evaluated. While the examined tissues were originally diagnosed as 28 SCCs and 7 BCCs based on histological evaluation by a specialty diagnostic service, eight SCCs could be re-classified as BCCs and three SCCs proved to be non-neoplastic lesions. In addition, all SCCs and BCCs were classified into distinct histological variants. The SCCs could be categorized as one SCC in situ, three moderately differentiated SCCs, seven well-differentiated SCCs, and six keratoacanthomas. BCCs were classified as five solid BCCs, four infiltrating BCCs, five keratotic BCCs, and one basosquamous cell carcinoma. In addition, the present study reports the occurrence of BCCs in seven reptile species for the first time. In contrast to what has been documented in humans, IHC staining with the commercially available epithelial membrane antigen and epithelial antigen clone Ber-EP4 does not allow differentiation of SCCs from BCCs in reptiles, while cyclooxygenase-2 and E-cadherin staining seem to have discriminating potential. Although the gross pathological features of the examined SCCs and BCCs were highly similar, each tumor could be unequivocally assigned to a distinct histological variant according to the observed histological characteristics. Based on the results of this study, a histopathological classification for SCCs and BCCs is proposed, allowing accurate identification and differentiation of SCCs and BCCs and their histological variants in the examined reptile species. Presumably, BCCs are severely underdiagnosed in squamates and chelonians.
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Affiliation(s)
- Ferran Solanes Vilanova
- Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium
| | - Tom Hellebuyck
- Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium
| | - Koen Chiers
- Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium
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Yumeen S, Kahn BJ, Leonard A, Shah A, Qureshi AA, Saliba E. When Surgery Won't Cut It: Successful Management of Eruptive Squamous Atypia With Combination Medical Therapy. Cureus 2023; 15:e37694. [PMID: 37206513 PMCID: PMC10191199 DOI: 10.7759/cureus.37694] [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: 04/15/2023] [Indexed: 05/21/2023] Open
Abstract
The termeruptive squamous atypia(ESA) is used to describe squamous proliferations that do not present with high-grade histologic features and for which surgical management may exacerbate the condition. Non-surgical management of ESA with radiation, local or systemic chemotherapy, retinoids, or immunotherapy have been reported with variable success. In contrast, combination treatment with retinoids, immunomodulatory or chemotherapeutic agents may result in a more durable response. We report a case of recalcitrant ESA of the lower extremities where complete clinical remission was induced with triple combination medical management with intralesional 5-fluorouracil, field treatment with topical 5-fluorouracil and imiquimod, and oral acitretin. Our case adds to the literature supporting combination medical therapy for challenging cases of ESA.
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Affiliation(s)
- Sara Yumeen
- Dermatology, Warren Alpert Medical School of Brown University, Providence, USA
| | - Benjamin J Kahn
- Dermatology, Warren Alpert Medical School of Brown University, Providence, USA
| | - Alexandra Leonard
- Dermatology, Warren Alpert Medical School of Brown University, Providence, USA
| | - Asghar Shah
- Medicine, Brown University, Rhode Island, USA
| | - Abrar A Qureshi
- Dermatology/Epidemiology, Warren Alpert Medical School of Brown University, Providence, USA
| | - Elie Saliba
- Dermatology, Warren Alpert Medical School of Brown University, Providence, USA
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Prados-Carmona A, Llamas-Molina JM, Velasco-Amador P, Ruiz-Villaverde R, Ruiz-Carrascosa JC. High-risk Squamous Cell Carcinoma, a surgical challenge: the other face of the SARS-CoV-2 pandemic. J DERMATOL TREAT 2023; 34:2192841. [PMID: 36927214 DOI: 10.1080/09546634.2023.2192841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Lhuillier M, Brière M, Artifoni M, Chapal M, Peuvrel L, Saint-Jean M. Cemiplimab-induced cytokine-release syndrome: second case reported and review of the literature. Immunotherapy 2023; 15:229-234. [PMID: 36789558 DOI: 10.2217/imt-2021-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Cemiplimab, a human monoclonal antibody directed against PD-1, has provided more options in the treatment of locally advanced or metastatic cutaneous squamous-cell carcinoma at an unresectable state. Immune checkpoint inhibitors can induce several unfavorable reactions generally referred to as immune-related adverse effects. Cytokine-release syndrome is an immune-related adverse event that is infrequent and not well known. Diagnosis is difficult because of the unspecific symptoms (e.g., fever, hypotension) but it can also be life threatening. The authors report the case of a 62-year-old treated by cemiplimab for a cutaneous squamous-cell carcinoma of the diaper fold with iliac and inguinal lymph node extension. He presented with severe cytokine-release syndrome, concluding with the discontinuation of cemiplimab.
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Affiliation(s)
- Marine Lhuillier
- Department of Medical Oncology, ICO Cancer Center, Saint-Herblain, 44800, France
| | - Magali Brière
- Department of Infectious Disease, ICO Cancer Center, Saint-Herblain, 44800, France
| | - Mathieu Artifoni
- Department of Internal Medicine, University Hospital of Nantes, 44000, France
| | - Marion Chapal
- Departement of Nephrology, Hospital of Vendée, La Roche-Sur-Yon, 85000, France
| | - Lucie Peuvrel
- Department of Medical Oncology, ICO Cancer Center, Saint-Herblain, 44800, France
| | - Mélanie Saint-Jean
- Department of Medical Oncology, ICO Cancer Center, Saint-Herblain, 44800, France
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Averbuch I, Salman S, Shtamper N, Doweck I, Popovtzer A, Markel G, Hendler D, Finkel I, Moore A, Fenig E, Taha T, Mhameed K, Kurman N, Billan S. First-line programmed death-1 inhibitor treatment for locoregionally advanced or metastatic cutaneous squamous cell carcinoma - A real-world experience from Israel. Front Oncol 2023; 13:1117804. [PMID: 36793605 PMCID: PMC9924127 DOI: 10.3389/fonc.2023.1117804] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023] Open
Abstract
Objective Cutaneous squamous cell carcinoma (cSCC) is the second most common non-melanoma skin cancer worldwide. It is usually treated surgically, with very high cure rates. However, in 3%-7% of cases, cSCC metastasizes to lymph nodes or distant organs. Many of the affected patients are elderly with comorbidities who are not candidates for standard-of-care curative-intent treatment with surgery and/or radio-/chemotherapy. Immune checkpoint inhibitors, which target programmed cell death protein 1 (PD-1) pathways, have recently emerged as a potent therapeutic option. The present report presents the Israeli experience with PD-1 inhibitors for the treatment of loco-regionally advanced or metastatic cSCC in a diverse and elderly population, with or without the addition of radiotherapy. Material and methods The databases of two university medical centers were retrospectively searched for patients with cSCC treated with the PD-1 inhibitors cemiplimab or pembrolizumab between January 2019 and May 2022. Data on baseline, disease-related, treatment-related, and outcome parameters were collected and analyzed. Results The cohort included 102 patients of a median age 78.5 years. Evaluable response data were available for 93. The overall response rate was 80.6%: complete response in 42 patients (45.2%) and partial response in 33 (35.5%). Stable disease was recorded in 7 (7.5%) and progressive disease in 11 (11.8%). Median progression-free survival was 29.5 months. Radiotherapy was administered to the target lesion during PD-1 treatment in 22.5% of patients. mPFS was not significantly different in patients who treated with RT than patients how did not (NR vs 18.4 months, HR=0.93, 95%CI: 0.39 - 2.17, p<0.859). Any-grade toxicity was recorded in 57 patients (55%), including grade ‗3 in 25, of whom 5 (5% of cohort) died. Compared to toxicity-free patients, patients with drug toxicity had better progression-free survival (18.4 months vs not reached, HR=0.33, 95% CI: 0.13-0.82, p=0.012) and higher overall response rate (87% vs 71.8%, p=0.06). Conclusion This retrospective real-world study showed that PD-1 inhibitors were effective in the treatment of locally advanced or metastatic cSCC and appeared to be amenable for use in elderly or fragile patients with comorbidities. However, the high toxicity warrants consideration against other modalities. Induction or consolidation radiotherapy may improve the results. These findings need to be corroborated in a prospective trial.
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Affiliation(s)
- Itamar Averbuch
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saeed Salman
- The Joseph Fishman Oncology Center, Rambam Health Care Campus, Haifa, Affiliated to the Rappaport Faculty of Medicine, Israel Institute of Technology-Technion, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Noa Shtamper
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Doweck
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Department of Otolaryngology-Head and Neck Surgery, Carmel Medical Center, Haifa, Affiliated to the Rappaport Faculty of Medicine, Israel Institute of Technology-Technion, Haifa, Israel
| | - Aron Popovtzer
- Sharett Institute of Oncology, Hadassah Medical Center, Jerusalem, Affiliated with the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gal Markel
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Hendler
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Finkel
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Moore
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Fenig
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tarek Taha
- Oncology Institute, Baruch Padeh Medical Center, Poriya, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Poriya, Israel
| | - Kamel Mhameed
- The Joseph Fishman Oncology Center, Rambam Health Care Campus, Haifa, Affiliated to the Rappaport Faculty of Medicine, Israel Institute of Technology-Technion, Haifa, Israel
| | - Noga Kurman
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salem Billan
- The Joseph Fishman Oncology Center, Rambam Health Care Campus, Haifa, Affiliated to the Rappaport Faculty of Medicine, Israel Institute of Technology-Technion, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Brewer CF, Chawla R, Patel AJK. Galea vs periosteum: impact of excision depth on outcomes for cutaneous squamous cell carcinoma of the scalp. J Plast Surg Hand Surg 2023; 57:253-256. [PMID: 35412400 DOI: 10.1080/2000656x.2022.2060993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cutaneous squamous-cell carcinoma (cSCC) is the second most common skin cancer, with local recurrence rates of up to 10% in the scalp. To date there have been no direct comparisons of recurrence rates or deep margin involvement for surgical excision to different anatomical layers of the scalp. A multi-centre retrospective study of all cSCC excised from the scalp from 2015 to 2020 was conducted. Two hundred and seventy nine patients (17-female, 262-male) met the inclusion criteria (median age 82.2 years), incorporating a total of 302 cSCC's. Primary excision depth was galea in 80 cases and periosteum in 222 (26.5% and 73.5% respectively). A significantly greater proportion of lesions excised to galea had involved or close (<1mm) deep margins (n = 27, 33.8% galea vs n = 50, 22.5% periosteum, OR 2.74 [95% CI 1.38-5.45], p = .004). Local recurrence rates were also significantly higher for lesions excised to galea vs periosteum (n = 13, 16.3% vs n = 18, 8.1% respectively, p = .039), although this trend was lost after adjusting for deep margin status. To our knowledge, this study is the first to compare local recurrence rates and margin involvement for cSCC of the scalp excised to different depths. Our findings demonstrate a higher incidence of involved/close deep margins for lesions excised to galea, imposing a higher treatment burden and risk of recurrence for these patients. We therefore advocate including galea in surgical excision.
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Affiliation(s)
- Christopher F Brewer
- Department of Plastic and Reconstructive Surgery, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Reema Chawla
- Department of Plastic and Reconstructive Surgery, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Animesh J K Patel
- Department of Plastic and Reconstructive Surgery, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
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