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Quadri M, Palazzo E. The Role of the Neurotrophin Network in Skin Squamous Cell Cancer and the Novel Use of the Zebrafish System. JID INNOVATIONS 2024; 4:100295. [PMID: 39100386 PMCID: PMC11296245 DOI: 10.1016/j.xjidi.2024.100295] [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: 01/29/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 08/06/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most prevalent form of skin cancer. An increasing number of cSCCs are associated with dysregulation of key molecules that control skin homeostasis. These observations have increased interest in the role of neurotrophins and their receptors in the pathogenesis of cSCC. They have been demonstrated to have a considerable impact on the aggressiveness potential of skin cancer by both in vitro and in vivo models. In this context, mouse models are classically used to dissect proliferation versus differentiation balance, but they have some limitations in terms of time, space, and costs. Recently, zebrafish models have been implemented as a new tool to obtain information regarding the invasive capacity and metastasis of neoplastic cells. By xenotransplantation technique, cSCC cells from a patient's biopsy or cell line can be successfully characterized, with or without the presence of genetic manipulation or treatments. In addition, the evaluation of the immune microenvironment contributes to potentially identifying connections and homologies with humans. In this review, we retrace the role of the neurotrophin network in healthy and pathological skin, particularly in cSCC. We review how zebrafish models can be important tools for studying cSCC development, growth, and potential treatments.
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Affiliation(s)
- Marika Quadri
- DermoLAB, Department of Surgical, Medical, Dental and Morphological Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Palazzo
- DermoLAB, Department of Surgical, Medical, Dental and Morphological Science, University of Modena and Reggio Emilia, Modena, Italy
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2
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Catalano M, Nozzoli F, De Logu F, Nassini R, Roviello G. Management Approaches for High-Risk Cutaneous Squamous Cell Carcinoma with Perineural Invasion: An Updated Review. Curr Treat Options Oncol 2024:10.1007/s11864-024-01234-z. [PMID: 39102167 DOI: 10.1007/s11864-024-01234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 08/06/2024]
Abstract
OPINION STATEMENT Cutaneous squamous cell carcinoma (cSCC) stands as the second most prevalent non-melanoma skin cancer worldwide, comprising approximately 20% of all cutaneous malignancies. Determining its precise incidence poses challenges; however, reports indicate a global increase in its prevalence. At the time of diagnosis, the majority of cSCCs are localized, resulting in favorable 5-year cure rates surpassing 90%. Nevertheless, a subset of patients (3-7%) encounters locally advanced or metastatic cSCC, leading to substantial morbidity and mortality. The risk of metastasis ranges from 0.1% to 9.9%, carrying an associated mortality risk of 2.8%. Factors influencing recurrence, metastasis, and disease-specific mortality underscore the significance of perineural invasion (PNI) as a key indicator. Patients with PNI may manifest clinical symptoms and/or radiologic signs of PNI, while the majority remain asymptomatic, and PNI is frequently identified upon histologic examination. Despite its lower frequency compared to other cancer types, PNI serves as a recognized adverse prognostic factor for cSCC. Surgery is the elective treatment for these patients, while the role of adjuvant radiotherapy (ART) is yet contentious and have not been conclusively assessed, particularly in clear surgical margin. Prospective comparative studies are required to comprehensively evaluate the benefit and the risks of ART for cSCC and PNI patients.
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Affiliation(s)
- Martina Catalano
- Section of Clinical Pharmacology & Oncology, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Filippo Nozzoli
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesco De Logu
- Section of Clinical Pharmacology & Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Romina Nassini
- Section of Clinical Pharmacology & Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giandomenico Roviello
- Section of Clinical Pharmacology & Oncology, Department of Health Sciences, University of Florence, Florence, Italy
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3
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Pietkiewicz P, Stefaniak A, Giedziun P, Calik J, Lewandowicz M, Mazur E, Cantisani C, Navarrete-Dechent C, Akay BN, Szepietowski JC, Rosendahl C. "One blade, two cuts?" A multidisciplinary survey investigating practice variability of scalpel blade change for simultaneous excision of multiple skin lesions in the same patient. Int J Dermatol 2024. [PMID: 39095955 DOI: 10.1111/ijd.17416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Skin cancer incidence increases globally, requiring effective preventive measures and evidence-based treatment strategies. Current guidelines advocate for surgical excision as a first-line treatment for most early skin cancers. The study investigated practices regarding changing scalpel blades when excising multiple skin lesions in the same patient during the same visit (CSB) and explored how beliefs about iatrogenic seeding influence individual norms of practice. METHODS A multidisciplinary survey was conducted among 173 medical specialists involved in skin cancer care. Participants provided demographic information, years of experience, and practices regarding CSB in four clinical scenarios (first excised tumor: basal cell carcinoma, squamous cell carcinoma, melanoma suspect, and evident melanoma). Practice variations based on specialty, experience, and beliefs about seeding risk were statistically assessed. RESULTS Surgeons exhibited a significantly higher tendency to change blades compared to non-surgeons across all diagnoses. Iatrogenic seeding (56.52%) and clinical training (18.84%) were the main reasons provided for CSB. Beliefs about seeding risk did not differ significantly between specialties. CONCLUSIONS Although the practice of CSB lacks strong scientific rationale, the approach to this practice significantly varies among different medical specialties. Healthcare professionals should critically evaluate and standardize evidence-based practices to ensure optimal patient care and mitigate potential harm.
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Affiliation(s)
- Paweł Pietkiewicz
- Zwierzyniecka Medical Center, Poznań, Poland
- Polish Dermatoscopy Group, Poznań, Poland
| | - Aleksandra Stefaniak
- Polish Dermatoscopy Group, Poznań, Poland
- Department of Dermatology, Venereology and Allergology, Wroclaw, Poland
| | - Piotr Giedziun
- Polish Dermatoscopy Group, Poznań, Poland
- Faculty of Information and Communication Technology, Wrocław University of Science and Technology, Wrocław, Poland
| | - Jacek Calik
- Polish Dermatoscopy Group, Poznań, Poland
- Department of Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Michał Lewandowicz
- Polish Dermatoscopy Group, Poznań, Poland
- Department of Surgical Oncology, Breast Cancer Unit, Regional Oncology Center, Łódź, Poland
| | - Ewelina Mazur
- Polish Dermatoscopy Group, Poznań, Poland
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Carmen Cantisani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, "Sapienza Medical School" University of Rome, Rome, Italy
| | - Cristian Navarrete-Dechent
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bengü N Akay
- Faculty of Medicine, Department of Dermatology, Ankara University, Ankara, Turkey
| | | | - Cliff Rosendahl
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Tehran University of Medical Sciences, Tehran, Iran
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Dettrick A, Foden N, Hogan D, Azer M, Blazak J, Atwell D, Buddle N, Min M, Livingston R, Banney L, Donkin R. The hidden Australian skin cancer epidemic, high-risk cutaneous squamous cell carcinoma: a narrative review. Pathology 2024; 56:619-632. [PMID: 38871593 DOI: 10.1016/j.pathol.2024.05.002] [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: 10/22/2023] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
Deaths from non-melanoma skin cancers (NMSCs) have almost doubled in Australia in recent years. Cutaneous squamous cell carcinoma (cSCC) constitutes approximately 20% of NMSCs, but is responsible for most of the deaths. Most skin cancers are easy to diagnose and treat and therefore cSCC are often trivialised; however, there is a high-risk subgroup of cSCC (HRcSCC) that is associated with a high risk of metastasis and death. The definition of early HRcSCC and our ability to identify them is evolving. Many significant prognostic factors have been identified, but a universally accepted prognostic index does not exist. Guidelines for workup, treatment, and follow-up leave many important decisions open to broad interpretation by the treating physician or multidisciplinary team. Some of the treatments used for metastatic cSCC are not supported by robust evidence and the prognosis of metastatic cSCC is guarded. In this review, we highlight the rapid rise in NMSC deaths and discuss some of the deficiencies in our knowledge of how to define, diagnose, stage, and manage HRcSCC.
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Affiliation(s)
- Andrew Dettrick
- Anatomical Pathology, Pathology Queensland, Sunshine Coast, Qld, Australia; School of Health, University of the Sunshine Coast, Qld, Australia.
| | - Neil Foden
- Ear, Nose and Throat, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - David Hogan
- Ear, Nose and Throat, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Mary Azer
- Medical Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - John Blazak
- Radiology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Daisy Atwell
- Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Nicole Buddle
- Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Myo Min
- School of Health, University of the Sunshine Coast, Qld, Australia; Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Sunshine Coast, Qld, Australia
| | - Ryan Livingston
- Plastic Surgery, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Leith Banney
- Dermatology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Rebecca Donkin
- School of Health, University of the Sunshine Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Sunshine Coast, Qld, Australia
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Tejera-Vaquerizo A, Gómez-Tomás Á, Jaka A, Toll A, Del Río M, Ferrándiz-Pulido C, Fuente MJ, Carrasco C, Almazán-Fernández FM, Toledo-Pastrana T, Ferrer-Fuertes A, Ribero S, Avallone G, Cañueto J, Santos-Juanes J, Sanmartín O. Sentinel lymph node biopsy versus observation in high-risk cutaneous squamous cell carcinoma in immunosuppressed and immunocompetent patients: An inverse probability of treatment weighting study. J Eur Acad Dermatol Venereol 2024; 38:1588-1598. [PMID: 38738666 DOI: 10.1111/jdv.20051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/28/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND The survival benefit of sentinel lymph node biopsy (SLNB) in immunocompetent and immunosuppressed patients with high-risk cutaneous squamous cell carcinoma (cSCC) has not been established. OBJECTIVE To determine whether SLNB improves disease-specific survival (DSS) in high-risk cSCC. Secondary objectives were to analyse disease-free survival, nodal recurrence-free survival and overall survival (OS). METHODS Multicentre, retrospective, observational cohort study comparing survival outcomes in immunosuppressed and immunocompetent patients treated with SLNB or watchful waiting. Inverse probability of treatment weighting was used to adjust for possible confounding effects. RESULTS We studied 638 tumours in immunocompetent patients (SLNB n = 42, observation n = 596) and 173 tumours in immunosuppressed patients (SLNB n = 28, observation n = 145). Overall, SLNB was positive in 15.7% of tumours. SLNB was associated with a reduced risk of nodal recurrence (NR) (hazard ratio [HR], 0.05 [95% CI, 0.01-0.43]; p = 0.006), disease specific mortality (HR, 0.17 [95% CI, 0.04-0.72]; p = 0.016) and all-cause mortality (HR, 0.33 [95% CI, 0.15-0.71]; p = 0.004) only in immunocompetent patients. CONCLUSIONS SLNB was associated with improvements in NR, DSS and OS in immunocompetent but not in immunosuppressed patients with high-risk cSCC.
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Affiliation(s)
- Antonio Tejera-Vaquerizo
- Cutaneous Oncology Unit, Hospital San Juan de Dios, Córdoba, Spain
- Dermatology Department, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, Spain
| | - Álvaro Gómez-Tomás
- Dermatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ane Jaka
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Agustín Toll
- Dermatology Department, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - María Del Río
- Plastic Surgery Department, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Carla Ferrándiz-Pulido
- Dermatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María J Fuente
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Cristian Carrasco
- Plastic Surgery Department, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Tomás Toledo-Pastrana
- Dermatology Department, Hospital Quirón Salud Infanta Luisa, Hospital Quirón Salud Sagrado Corazón, Sevilla, Spain
| | | | - Simone Ribero
- Section of Dermatology, Medical Sciences Department, University of Turin, Turin, Italy
| | - Gianluca Avallone
- Section of Dermatology, Medical Sciences Department, University of Turin, Turin, Italy
| | - Javier Cañueto
- Dermatology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Jorge Santos-Juanes
- Dermatology Department, Central Universitary Hospital of Asturias and Instituto de Investigación Sanitaria of Principado de Asturias, IUOPA, Oviedo University, Oviedo, Spain
| | - Onofre Sanmartín
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
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6
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Marti-Marti I, Toll A. [Translated article] Cutaneous squamous cell carcinoma that are difficult-to-manage with conventional local treatments. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00582-9. [PMID: 38972578 DOI: 10.1016/j.ad.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/30/2023] [Accepted: 03/11/2024] [Indexed: 07/09/2024] Open
Affiliation(s)
- I Marti-Marti
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
| | - A Toll
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Szeimies RM, Ulrich C, Ferrándiz-Pulido C, Hofbauer GFL, Lear JT, Lebbé C, Piaserico S, Hædersdal M. The "Personalising Actinic Keratosis Treatment for Immunocompromised Patients" (IM-PAKT) Project: An Expert Panel Opinion. Dermatol Ther (Heidelb) 2024; 14:1739-1753. [PMID: 38902589 PMCID: PMC11264500 DOI: 10.1007/s13555-024-01215-y] [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: 03/18/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
Actinic keratosis (AK) is an intraepithelial condition characterized by the development of scaly, erythematous lesions after repeated exposure to ultraviolet radiation. Significant immunosuppression is a risk factor for the development of AK and subsequent lesion progression to squamous cell carcinoma. Immunocompromised patients (ICPs), particularly organ transplant recipients, often have more advanced or complex AK presentations and an increased risk of skin carcinomas versus non-ICPs with AK, making lesions more difficult to treat and resulting in worse treatment outcomes. The recent "Personalising Actinic Keratosis Treatment" (PAKT) consensus reported that delivering patient-centric care may play a role in supporting better clinical outcomes and patient satisfaction with treatments for chronic dermatologic conditions such as AK, which require repeated cycles of treatment. Additionally, currently published guidance and recommendations were considered by the PAKT panel to be overly broad for managing ICPs with their unique and complex needs. Therefore, the "Personalising Actinic Keratosis Treatment for Immunocompromised Patients" (IM-PAKT) panel was established to build upon general recommendations from the PAKT consensus. The panel identified current gaps in guidance for AK care in ICPs, offered practical care approaches based on typical ICP scenarios, and highlighted the need to adapt AK management to optimize care and improve treatment outcomes in ICPs. In particular, dermatologists should establish collaborative and transparent relationships with patients' multidisciplinary teams to enhance overall care for patients' comorbidities: given their increased risk of progression to malignancy, earlier assessments/interventions and frequent follow-ups are vital.The panel also developed a novel "triage" tool outlining effective treatment follow-up and disease surveillance plans tailored to patients' risk profiles, guided by current clinical presentation and relevant medical history. Additionally, we present the panel's expert opinion on three fictional ICP scenarios to explain their decision-making process for assessing and managing typical ICPs that they may encounter in clinical practice.
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Affiliation(s)
- Rolf-Markus Szeimies
- Department of Dermatology & Allergology, Klinikum Vest GmbH Academic Teaching Hospital, Recklinghausen, Germany.
| | - Claas Ulrich
- GmbH & Department of Dermatology, Collegium Medicum, Charité Universitätsmedizin, Berlin, Germany
| | - Carla Ferrándiz-Pulido
- Department of Dermatology, University Hospital Vall d'Hebron, Barcelona, Spain
- Factultad de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Gunther F L Hofbauer
- Universität Zürich, Zurich, Switzerland
- Dermatologische Klinik, Universitätsspital Zürich, Zurich, Switzerland
| | - John Thomas Lear
- Department of Dermatology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Celeste Lebbé
- Dermato-Oncology and CIC AP-HP Hôpital Saint Louis, INSERM U976, Université Paris Cite, Paris, France
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Merete Hædersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Chen S, Chen H, Wang X, Zhang D, Zhang L, Cheng J, Zhang Q, Hua Z, Miao X, Shi J. Expression analysis and biological regulation of silencing regulatory protein 6 (SIRT6) in cutaneous squamous cell carcinoma. An Bras Dermatol 2024; 99:535-545. [PMID: 38548549 PMCID: PMC11220918 DOI: 10.1016/j.abd.2023.08.010] [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: 06/17/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (CSCC) is one of the most common types of skin cancer worldwide. Therefore, the identification of biomarkers associated with CSCC progression could aid in the early detection of high-risk squamous cell carcinoma and the development of novel therapeutic strategies. OBJECTIVE This study aimed to investigate the expression patterns of silent mating type Information Regulation 2 homolog 6 (SIRT6) in CSCC and its clinical significance. METHODS The protein expression level of SIRT6 in tissues was detected by immunohistochemistry, and the correlation between SIRT6 expression and clinicopathological parameters in CSCC patients was analyzed. The relative expression of SIRT6 in CSCC cell lineage and tissue specimens was determined by western blotting and PCR. The effect of SIRT6 silencing on cell proliferation was evaluated using cell counting kit 8. Wound healing, transwell method, and flow cytometry were used to investigate the migration, invasion, and cell cycle distribution/apoptosis of CSCC cells after SIRT6 silencing, respectively. Western blot was used to detect the expression of EMT (Epithelial-Mesenchymal Transition), cycle, apoptosis, and other related proteins. RESULTS The high expression of SIRT6 was correlated with the location of cancer tissue and Broder staging in CSCC patients. Knockdown of SIRT6 inhibited the proliferation, migration, invasion and EMT of CSCC cells, and promoted their apoptosis, with cells blocked in G1 phase. STUDY LIMITATIONS No animal experiments were conducted to further verify the results. CONCLUSION Decreased expression of SIRT6 can inhibit the occurrence and development of CSCC.
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Affiliation(s)
- Sai Chen
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, People's Republic of China
| | - Hongxia Chen
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, People's Republic of China
| | - Xu Wang
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, People's Republic of China
| | - Dongmei Zhang
- Jiangsu Provincial Medical Key Discipline (Laboratory) Cultivation Unit of Immunology, Nantong First People's Hospital, People's Republic of China; Medical Research Center, Affiliated Hospital 2 of Nantong University, People's Republic of China
| | - Li Zhang
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, People's Republic of China
| | - Jiawei Cheng
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, People's Republic of China
| | - Qi Zhang
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, People's Republic of China
| | - Zhixiang Hua
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, People's Republic of China
| | - Xu Miao
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, People's Republic of China
| | - Jian Shi
- Department of Dermatology, Affiliated Hospital 2 of Nantong University, People's Republic of China.
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Meng Y, Chen S, Li P, Wang C, Ni X. Tumor Cell Membrane-Encapsulated MLA Solid Lipid Nanoparticles for Targeted Diagnosis and Radiosensitization Therapy of Cutaneous Squamous Cell Carcinoma. Mol Pharm 2024; 21:3218-3232. [PMID: 38885477 DOI: 10.1021/acs.molpharmaceut.3c01247] [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: 06/20/2024]
Abstract
Squamous cell carcinoma (SCC) is a common nonmelanoma skin cancer. Radiotherapy plays an integral role in treating SCC due to its characteristics, such as diminished intercellular adhesion, heightened cell migration and invasion capabilities, and immune evasion. These problems lead to inaccurate tumor boundary positioning and radiotherapy tolerance in SCC treatment. Thus, accurate localization and enhanced radiotherapy sensitivity are imperative for effective SCC treatment. To address the existing limitations in SCC therapy, we developed monoglyceride solid lipid nanoparticles (MG SLNs) and enveloped them with the A431 cell membrane (A431 CM) to create A431@MG. The characterization results showed that A431@MG was spherical. Furthermore, A431@MG had specific targeting for A431 cells. In A431 tumor-bearing mice, A431@MG demonstrated prolonged accumulation within tumors, ensuring precise boundary localization of SCC. We further advanced the approach by preparing MG SLNs encapsulating 5-aminolevulinic acid methyl ester (MLA) and desferrioxamine (DFO) with an A431 CM coating to yield A431@MG-MLA/DFO. Several studies have revealed that DFO effectively reduced iron content, impeding protoporphyrin IX (PpIX) biotransformation and promoting PpIX accumulation. Simultaneously, MLA was metabolized into PpIX upon cellular entry. During radiotherapy, the heightened PpIX levels enhanced reactive oxygen species (ROS) generation, inducing DNA and mitochondrial damage and leading to cell apoptosis. In A431 tumor-bearing mice, the A431@MG-MLA/DFO group exhibited notable radiotherapy sensitization, displaying superior tumor growth inhibition. Combining A431@MG-MLA/DFO with radiotherapy significantly improved anticancer efficacy, highlighting its potential to serve as an integrated diagnostic and therapeutic strategy for SCC.
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Affiliation(s)
- Yanyan Meng
- School of Pharmacy, Changzhou University, Changzhou 213164, China
- Department of Radiotherapy Oncology, Changzhou No.2 People's Hospital, Nanjing Medical University, Changzhou 213003, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou 213003, China
- Changzhou Key Laboratory of Medical Physics, Changzhou 213003, China
| | - Shaoqing Chen
- Department of Radiotherapy Oncology, Changzhou No.2 People's Hospital, Nanjing Medical University, Changzhou 213003, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou 213003, China
- Changzhou Key Laboratory of Medical Physics, Changzhou 213003, China
| | - Pengyin Li
- School of Pharmacy, Changzhou University, Changzhou 213164, China
- Department of Radiotherapy Oncology, Changzhou No.2 People's Hospital, Nanjing Medical University, Changzhou 213003, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou 213003, China
- Changzhou Key Laboratory of Medical Physics, Changzhou 213003, China
| | - Cheli Wang
- School of Pharmacy, Changzhou University, Changzhou 213164, China
| | - Xinye Ni
- Department of Radiotherapy Oncology, Changzhou No.2 People's Hospital, Nanjing Medical University, Changzhou 213003, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou 213003, China
- Changzhou Key Laboratory of Medical Physics, Changzhou 213003, China
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10
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Attal ZG, Shalata W, Soklakova A, Tourkey L, Shalata S, Abu Saleh O, Abu Salamah F, Alatawneh I, Yakobson A. Advanced and Metastatic Non-Melanoma Skin Cancer: Epidemiology, Risk Factors, Clinical Features, and Treatment Options. Biomedicines 2024; 12:1448. [PMID: 39062023 PMCID: PMC11274597 DOI: 10.3390/biomedicines12071448] [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: 05/20/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Non-melanoma skin cancers (NMSC) form the majority of skin cancers, with basal cell carcinoma (BCC) being the most common and cutaneous squamous cell carcinoma (cSCC) being second. Prolonged ultraviolet (UV) exposure, aging, male gender, and immunosuppression represent most of the causes of this category of diseases. BCCs and cSCCs both include different types of skin cancers, such as nodular or morpheaform BCC or flat cSCC. Locally advanced and metastatic NMSCs cannot be treated surgically; thus, systemic therapy (TKI and Immunotherapy) is needed. Interestingly, NMSCs are frequently linked to abnormal Hedgehog (HH) signaling which most systemic immunotherapies for these cancers are based upon. Of note, the first line therapies of BCC, sonidegib and vismodegib, are HH inhibitors. Programmed death receptor 1 antibody (PD-1) inhibitors such as cemiplimab, pembrolizumab, and nivolumab have been approved for the treatment of cSCC. Thus, this paper reviews the epidemiology, risk factors, clinical features, and treatment options for both BCC and cSCC.
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Affiliation(s)
- Zoe Gabrielle Attal
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Walid Shalata
- The Legacy Heritage Center, Dr Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Arina Soklakova
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Lena Tourkey
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Sondos Shalata
- Nutrition Unit, Galilee Medical Center, Nahariya 22000, Israel
| | - Omar Abu Saleh
- Department of Dermatology and Venereology, The Emek Medical Centre, Afula 18341, Israel
| | - Fahed Abu Salamah
- Department of Dermatology, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel
| | - Ibrahim Alatawneh
- Department of Dermatology, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel
| | - Alexander Yakobson
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
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11
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Wang Z, Hu H, Ou Y, Wang C, Yue K, Lin K, Ou J, Zhang J. Computer-Aided Assessment of Repigmentation Rates in Vitiligo Patients: Implications for Treatment Efficacy - A Retrospective Study. J Invest Dermatol 2024:S0022-202X(24)01733-0. [PMID: 38909840 DOI: 10.1016/j.jid.2024.05.016] [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: 11/11/2023] [Revised: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 06/25/2024]
Abstract
Precise evaluation of repigmentation in vitiligo patients is crucial for monitoring treatment efficacy and enhancing patient satisfaction. This study aimed to develop a computer-aided system for assessing repigmentation rates in vitiligo patients, providing valuable insights for clinical practice. A retrospective study was conducted at the Dermatology Department of Shenzhen People's Hospital between June 2019 and November 2022. Pre- and post-treatment images of vitiligo lesions under Wood's lamp were collected, involving 833 participants stratified by sex, age, and pigmentation patterns. Our results demonstrated that the marginal pigmentation pattern exhibited a higher repigmentation rate of 72% compared with the central non-follicular pattern at 45%. Males had a slightly higher average repigmentation rate of 0.37 in comparison to females at 0.33. Among age groups, individuals aged 0-20 years showed the highest average repigmentation rate at 0.41, while the oldest age group (61-80 years) displayed the lowest rate at 0.25. Analysis of multiple visits identified the marginal pattern as the most prevalent (60%), with a mean repigmentation rate of 40%. This study introduced a computational system for evaluating vitiligo repigmentation rates, enhancing our comprehension of patient responses, and ultimately contributing to enhanced clinical care.
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Affiliation(s)
- Zheng Wang
- School of Computer Science, Hunan First Normal University, Changsha, China; Department of Dermatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China; Key Laboratory of Informalization Technology for Basic Education, Changsha, China
| | - Hui Hu
- School of Computer Science, Hunan First Normal University, Changsha, China; Key Laboratory of Informalization Technology for Basic Education, Changsha, China
| | - Yangyang Ou
- School of Computer Science, Hunan First Normal University, Changsha, China; Key Laboratory of Informalization Technology for Basic Education, Changsha, China
| | - Chong Wang
- Department of Dermatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China; Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, China
| | - Kejuan Yue
- School of Computer Science, Hunan First Normal University, Changsha, China; Key Laboratory of Informalization Technology for Basic Education, Changsha, China
| | - Kaibin Lin
- School of Computer Science, Hunan First Normal University, Changsha, China; Key Laboratory of Informalization Technology for Basic Education, Changsha, China
| | - Jiarui Ou
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, China; Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.
| | - Jianglin Zhang
- Department of Dermatology, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China; Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, China; Department of Geriatrics, Shenzhen People's Hospital, (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.
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12
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Nardone V, Napolitano S, Gagliardi F, Esposito A, Caraglia F, Briatico G, Scharf C, Ronchi A, D'Onofrio I, D'Ippolito E, Russo A, Belfiore MP, Franco R, Argenziano G, Ciardiello F, Reginelli A, Cappabianca S, Troiani T. Previous radiotherapy increases the efficacy of cemiplimab in the treatment of locally advanced and metastatic cutaneous squamous cell carcinoma: A retrospective analysis. J Am Acad Dermatol 2024:S0190-9622(24)00919-8. [PMID: 38885840 DOI: 10.1016/j.jaad.2024.06.023] [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: 03/24/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Cemiplimab, a programmed cell death-1 inhibitor approved in 2018 for patients with locally advanced or metastatic cutaneous squamous cell carcinoma (cSCC) who are ineligible for curative therapies, lacks clarity regarding the optimal patient selection despite its known efficacy. OBJECTIVE This retrospective study aims to assess the real-world treatment patterns and outcomes in patients with cSCC at our institution. METHODS A retrospective analysis of consecutively treated patients with cemiplimab for cSCC was conducted. Progression-free survival (PFS) and overall survival were evaluated alongside clinical-pathologic characteristics. RESULTS Forty-five patients were included, of which 73.3% were male with a median age of 77 years. After 18 months of median follow-up median PFS and overall survival were not reached with a mean of 21.3 months ± 2.2 months and 25.3 ± 2.1 months, respectively. Univariate and multivariate analyses revealed significant correlations only between PFS and previous radiotherapy (P values: .043 and .046, respectively). LIMITATIONS Limitations include its retrospective nature, the low number of patients analyzed, and the potential for inherent biases. CONCLUSIONS The study reveals a significant association between prior radiotherapy and improved PFS in cemiplimab-treated cSCC, suggesting the potential for combining radiotherapy with cemiplimab. Further exploration of this combined approach is warranted.
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Affiliation(s)
- Valerio Nardone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Stefania Napolitano
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Federico Gagliardi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alfonso Esposito
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesco Caraglia
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giulia Briatico
- Dermatology Unit, Mental and Physical Health and Preventive Medicine Department, University of Campania "L. Vanvitelli", Naples, Italy
| | - Camila Scharf
- Dermatology Unit, Mental and Physical Health and Preventive Medicine Department, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Mental and Physical Health and Preventive Medicine Department, University of Campania "L. Vanvitelli", Naples, Italy
| | - Ida D'Onofrio
- Radiotherapy Unit, Division Ospedale del Mare, Ospedale del Mare, ASL Napoli 1 Centro, Naples, Italy
| | - Emma D'Ippolito
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Anna Russo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Renato Franco
- Pathology Unit, Mental and Physical Health and Preventive Medicine Department, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Mental and Physical Health and Preventive Medicine Department, University of Campania "L. Vanvitelli", Naples, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Teresa Troiani
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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13
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Pezzulla D, Pastore F, Fionda B, Cellini F, Di Franco R, Ciabattoni A, Corazzi F, Cossa S, Dominici L, Draghini L, Gherardi F, Lillo S, Longo S, Mazzarotto R, Navarria F, Piccolo F, Stefanelli A, Vicenzi L, Zamagni A, Maranzano E, Tagliaferri L. Radiation Therapy in Non-Melanoma Skin Cancers: An Italian Survey on Behalf of the Italian Association of Radiotherapy and Clinical Oncology. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00219-X. [PMID: 38971685 DOI: 10.1016/j.clon.2024.06.006] [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: 01/09/2024] [Revised: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 07/08/2024]
Abstract
AIMS The National Palliative Care and Interventional Radiotherapy Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) carried out a survey whose aim was to obtain a "snapshot" of the real-world practice of nonmelanoma skin cancer (NMSC) treatments in Italy. MATERIALS AND METHODS The survey was conducted on SurveyMonkey's online interface and was sent via e-mail to our society Radiation Oncologists. RESULTS Fifty-eight Italian radiation oncologists (ROs), representing 54 centers, answered the survey. Thirteen percent of the ROs declared they treat fewer than 10 NMSC lesions annually, 36% treat between 11 and 20, and 51% treat more than 20 lesions annually. Interventional radiotherapy (IRT) was offered by 25% of the ROs, and every case was reportedly discussed by a multidisciplinary team (71%). Electrons (74%), volumetric modulated arc therapy (V-MAT) (57%), three-dimensional conformal radiotherapy (3D-CRT) (43%), and IRT (26%) were the main treatment options. With external beam radiotherapy (EBRT), 46 and 53 different RT schedules were treated for curative and palliative intent, respectively; whereas for IRT, there were 21 and 7 for curative and palliative intent, respectively. The most popular EBRT curative options were 50-70.95/22-35 fractions (fx) and 50-70 Gy/16-20fx and for EBRT palliative settings, 30Gy/10fx, and 20-35Gy/5fx. For IRT, the most popular curative options were 32-50Gy/8-10fx and 30-54Gy/3-5fx, whereas 30Gy/6fz was the palliative option. Less than 10 re-RT cases were reported in one year in 42.5%, 11-20 cases in 42.5%, and >20 cases annually in 15%. Electrons (61%), VMAT (49%), and BRT (25%) were the most widely used approaches: 20-40Gy in 10fx and 20-25Gy in 5fx were the recommended fractionations. CONCLUSION The survey shows a variegated reality. A national registry with more detailed data could help in undercover its causes.
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Affiliation(s)
- D Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Italy
| | - F Pastore
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Italy
| | - B Fionda
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Italy.
| | - F Cellini
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Italy
| | - R Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Italy
| | - A Ciabattoni
- UOC Radioterapia, Ospedale San Filippo Neri, ASL Roma 1, Italy
| | - F Corazzi
- S.C. Radioterapia aziendale USL Umbria1 Ospedale Città di Castello (PG), Italy
| | - S Cossa
- UOC Radioterapia, Fondazione "Casa Sollievo della Sofferenza," IRCCS, S. Giovanni Rotondo, Foggia, Italy
| | - L Dominici
- Department of Radiotherapy, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - L Draghini
- Radiation Oncology Centre, S Maria Hospital, Terni, Italy
| | - F Gherardi
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Italy
| | - S Lillo
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - S Longo
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Italy
| | - R Mazzarotto
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Integrata, 37124 Verona, Italy
| | - F Navarria
- Radiation Oncology Department, National Cancer Institute (CRO)- IRCCS, Aviano, Italy
| | - F Piccolo
- SC di Radioterapia Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - A Stefanelli
- Operational Unit of Oncological Radiotherapy, St Anna University Hospital of Ferrara, Italy
| | - L Vicenzi
- Radiation Oncology, Fondazione Policlinico Universitario Campus Biomedico, Italy
| | - A Zamagni
- Radiation Oncology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum-Bologna University, Italy
| | - E Maranzano
- Former Full Professor of Radiation Oncology, University of Perugia, Italy
| | - L Tagliaferri
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Italy
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14
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Lu H, Peng Z, Zheng Z, Li C, Wang Y, Liang L, Chen Y, Zeng K. Blocking the ATR-SerRS-VEGFA pathway targets angiogenesis for UV-induced cutaneous squamous cell carcinoma. Mol Carcinog 2024; 63:1160-1173. [PMID: 38695641 DOI: 10.1002/mc.23716] [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: 12/12/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 05/16/2024]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most prevalent form of skin cancer, with an escalating incidence rate and a notable potential (up to 5%) for metastasis. Ultraviolet radiation (UVA and UVB) exposure is the primary risk factor for cSCC carcinogenesis, with literature suggesting ultraviolet radiation (UVR) promotes vascular endothelial growth factor A (VEGFA) expression. This study aims to investigate UVR-induced upregulation of VEGFA and explore combination therapeutic strategies. The skin squamous cell carcinoma cell line A431 was exposed to specific durations of ultraviolet radiation. The effect of emodin on ATR/SerRS/VEGFA pathway was observed. The cell masses were also transplanted subcutaneously into mice (n = 8). ATR inhibitor combined with emodin was used to observe the growth and angiogenesis of the xenografts. The results showed that UV treatment significantly enhanced the phosphorylation of SerRS and the expression level of VEGFA in A431 cells (p < 0.05). Treatment with emodin significantly inhibited this expression (p < 0.05), and the combination of emodin and ATR inhibitor further enhanced the inhibitory effect (p < 0.05). This phenomenon was further confirmed in the xenograft model, which showed that the combination of ATR inhibitor and emodin significantly inhibited the expression of VEGFA to inhibit angiogenesis (p < 0.05), thus showing an inhibitory effect on cSCC. This study innovatively reveals the molecular mechanism of UV-induced angiogenesis in cSCC and confirms SerRS as a novel target to inhibit cSCC angiogenesis and progression in vitro and in vivo studies.
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Affiliation(s)
- Hongyan Lu
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhangsong Peng
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhaohui Zheng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Changxing Li
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Youyi Wang
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liuping Liang
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuxiang Chen
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kang Zeng
- Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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15
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Yan J, Wang B, Zhang G, Liao C, Zhao Z, Wang P, Wang X. Neoadjuvant Photodynamic Therapy: An Updated Therapeutic Approach for Non-Melanoma Skin Cancers. Curr Treat Options Oncol 2024; 25:813-826. [PMID: 38761266 DOI: 10.1007/s11864-024-01209-0] [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] [Accepted: 04/17/2024] [Indexed: 05/20/2024]
Abstract
OPINION STATEMENT Non-melanoma skin cancers (NMSCs) are the most common malignancy and surgical excision is considered treatment of choice for the majority of cases. However, surgery can be very extensive in cases of large, multiple, or cosmetic-sensitive tumors located on areas such as scalp and face or genital region, leading to significant functional and cosmetic deficit. Aminolaevulinic acid photodynamic therapy (ALA-PDT) has emerged as a widely used approach in a variety of skin diseases, demonstrating remarkable efficacy in treatment of actinic keratosis, Bowen disease and basal cell carcinoma. Besides, when employed as a preoperative intervention, ALA-PDT effectively reduces tumor size and minimizes subsequent local surgical morbidity. With its minimally invasive nature and proven effectiveness, ALA-PDT holds significant promise as a neoadjuvant treatment option for NMSCs. In cases where the tumor is large, invasive, multiple, or located in cosmetically and functionally sensitive areas, or when considering patient factors such as age, comorbidity, willingness to undergo surgery, and post-operative quality-of-life, surgical intervention or radiotherapy alone may be impracticable or unacceptable. In such scenarios, neoadjuvant ALA-PDT can offer remarkable outcomes. In order to further ensure the maximum benefit of patients from neoadjuvant PDT, collaboration with multidisciplinary teams and whole-process management may be in need.
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Affiliation(s)
- Jia Yan
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Bo Wang
- Avera Medical Group Aberdeen, South Dakota, Aberdeen, 57401, USA
- Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Caihe Liao
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Zijun Zhao
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China.
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China.
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16
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Wu Z, Tao C, Yang L, Yan Y, Pan L, Zhang L. Treatment benefit of electrochemotherapy for superficial squamous cell carcinoma: a systematic review and single-arm meta-analysis. Clin Transl Oncol 2024:10.1007/s12094-024-03522-4. [PMID: 38758386 DOI: 10.1007/s12094-024-03522-4] [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: 02/17/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Treating aggressive superficial squamous cell carcinoma (SCC) poses challenges due to invasiveness. Palliative care is recommended for inoperable cases with extensive tumors near vital organs, risking disfigurement or functional impairment. Electrochemotherapy (ECT) is an emerging cutaneous tumor treatment, but its efficacy against superficial SCC remains uncertain. This study conducts a systematic review and single-arm meta-analysis to evaluate ECT's effectiveness against superficial SCC and provide current evidence for clinical practice. METHODS Embase, PubMed and Cochrane Library were searched for studies up to May 2023. The random effects model analyzed complete response (CR) and partial response (PR), with subgroup assessment based on drug dosage, treatment response evaluation, tumor size, primary/recurrent status, and tumor location. RESULTS Ten studies involving 162 patients and 208 tumors were included. Pooled CR and PR rates for ECT-treated superficial SCC were 66.5% (95% CI 48.4%-82.5%; I2 = 84%) and 20.3% (95% CI 10.5%-32.3%; I2 = 70%), respectively. Subgroup analysis indicated ECT's superiority in treating primary tumors (PR: 70%, CR: 30%) and tumors ≤ 3 cm (PR: 81.3%, CR: 10.1%) compared to recurrent tumors (PR: 56.7%, CR: 36.5%) and tumors > 3 cm (PR: 45.2%, CR: 34.4%). CONCLUSION This single-arm meta-analysis confirms ECT's efficacy against superficial SCC, especially in primary tumors and those ≤ 3 cm in diameter. The study highlights the impact of tumor location and response evaluation on ECT's benefits, warranting further investigation through additional research.
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Affiliation(s)
- Zhuoxia Wu
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Chen Tao
- School of Mathematics and Statistics, Northeast Normal University, Changchun, 130024, Jilin, China.
| | - Liehao Yang
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Yan Yan
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Lingfeng Pan
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Lianbo Zhang
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
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17
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Faoro L, Salizzato V, Coppola M, Carpanese D, Fabozzi A, Tondulli L, Marconcini R, Spagnolo F, Del Bianco P, Chiarion-Sileni V, Piccin L. Real-world multicentre observational study of effectiveness and toxicity in patients with advanced cutaneous squamous cell carcinoma treated with cemiplimab. J Eur Acad Dermatol Venereol 2024. [PMID: 38712988 DOI: 10.1111/jdv.20066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Affiliation(s)
- L Faoro
- Specialization School in Hospital Pharmacy, University of Pisa, Pisa, Italy
- Pharmacy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - V Salizzato
- Melanoma Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - M Coppola
- Pharmacy, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - D Carpanese
- Immunology and Molecular Oncology Diagnostics, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - A Fabozzi
- Medical Oncology 3, Veneto Institute of Oncology IOV-IRCCS, Castelfranco Veneto, Italy
| | - L Tondulli
- Oncology Department, Integrated University Hospital of Verona, Verona, Italy
| | - R Marconcini
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - F Spagnolo
- Skin Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - P Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - V Chiarion-Sileni
- Melanoma Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - L Piccin
- Melanoma Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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18
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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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19
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Kim JY, Min S, Park JKH, Kim SW. Squamous Cell Carcinoma Arising From Epidermal Cyst: A Case Series of 9 Patients With a Literature Review. Ann Plast Surg 2024; 92:575-579. [PMID: 38669586 DOI: 10.1097/sap.0000000000003880] [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: 04/28/2024]
Abstract
ABSTRACT Epidermal cysts are among the most common benign subcutaneous tumors. However, malignant transformation of benign epidermal cysts into squamous carcinomas has been reported. Owing to its low incidence rate, the clinical and pathological features of this condition are not well understood. This study aimed to analyze the clinical and pathological characteristics of the malignant transformation of epidermal cysts, which could suggest an appropriate treatment strategy. We conducted a retrospective study of 9 patients diagnosed with squamous cell carcinoma arising from epidermal cysts. All patients underwent surgical excision, and clinical information regarding patient demographics, tumor characteristics, treatment, and outcomes was analyzed. The average age at diagnosis was 57.3 years, with an average latency period of 15.4 years. Five patients had undergone prior cyst excision or drainage, with an average of 2.3 episodes of recurrence. Surgical excision was the primary treatment in all cases, and 2 patients with margin involvement at the final pathology underwent re-excision with additional resection margins. No recurrence was observed during the follow-up period. Four patients had immune dysregulation due to an underlying chronic kidney disease or cancer. Our study emphasizes the need for increased awareness of squamous cell carcinoma arising from epidermal cysts in patients with a history of cyst existence or recurrence, especially those with immune deficiencies. We expect these findings to contribute to early suspicion of malignant transformation and guide adequate clinical decision-making.
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Affiliation(s)
- Ji-Young Kim
- From the Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul
| | - Sally Min
- From the Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul
| | - Joseph Kyu-Hyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang Wha Kim
- From the Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul
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20
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Potestio L, Scalvenzi M, Lallas A, Martora F, Guerriero L, Fornaro L, Marano L, Villani A. Efficacy and Safety of Cemiplimab for the Management of Non-Melanoma Skin Cancer: A Drug Safety Evaluation. Cancers (Basel) 2024; 16:1732. [PMID: 38730683 PMCID: PMC11083599 DOI: 10.3390/cancers16091732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Non-melanoma skin cancer includes several types of cutaneous tumors, with basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) as the commonest. Among the available therapeutic options, surgical excision is the mainstay of treatment for both tumors. However, tumor features and patients' comorbidities may limit the use of these techniques, making the treatment challenging. As regards BCC, even if hedgehog inhibitors revolutionized the therapeutic scenario, there are still patients unresponsive or intolerant to these drugs. In this context, cemiplimab has been approved as second-line treatment. As regards SCC, cemiplimab was the first systemic therapy approved. The objective of this manuscript was to investigate the efficacy and safety of cemiplimab for the management of BCC and cSCC. Cemiplimab has a durable and significant effect for the management of BCC and CSCC, with a favorable safety profile. Different specialists including oncologists, radiologists, dermatologists, and surgeons are required to guarantee an integrated approach, leading to the best management of patients. Moreover, the collaboration among specialists will allow them to best manage the TEAEs, reducing the risk of treatment suspension or discontinuation. Certainly, ongoing studies and more and more emerging real-world evidence, will allow us to better characterize the role of cemiplimab for the management of advanced non-melanoma skin cancer.
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Affiliation(s)
- Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, 541 24 Thessaloniki, Greece
| | - Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Luigi Guerriero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Luigi Fornaro
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Laura Marano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Alessia Villani
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
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21
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Marti-Marti I, Toll A. Cutaneous squamous cell carcinoma that are difficult-to-manage with conventional local treatments. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00337-5. [PMID: 38663726 DOI: 10.1016/j.ad.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/30/2023] [Accepted: 03/11/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- I Marti-Marti
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
| | - A Toll
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
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22
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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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23
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Crisan D, Tarnowietzki E, Bernhard L, Möller M, Scharffetter-Kochanek K, Crisan M, Schneider LA. Rationale for Using High-Frequency Ultrasound as a Routine Examination in Skin Cancer Surgery: A Practical Approach. J Clin Med 2024; 13:2152. [PMID: 38610917 PMCID: PMC11012407 DOI: 10.3390/jcm13072152] [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: 03/11/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Ultrasound and high-frequency ultrasound assessment of melanoma and non-melanoma skin cancer in the pre-therapeutical setting is becoming increasingly popular in the field of dermatosurgery and dermatooncology, as it can provide clinicians with relevant, "in vivo" parameters regarding tumor lateral and depth extension as well as potential locoregional spread, cancelling the need of more extensive imaging methods and avoiding a delay in diagnosis. Furthermore, preoperative sonography and color Doppler can aid in orienting the clinical diagnosis, being able in numerous situations to differentiate between benign and malignant lesions, which require a different therapeutic approach. This preoperative knowledge is of paramount importance for planning an individualized treatment regimen. Using sonography at the time of diagnosis, important surgical complications, such as neurovascular damage, can be avoided by performing a preoperative neurovascular mapping. Furthermore, sonography can help reduce the number of surgical steps by identifying the lesions' extent prior to surgery, but it can also spare unnecessary surgical interventions in cases of locally advanced lesions, which infiltrate the bone or already present with locoregional metastases, which usually require modern radiooncological therapies in accordance to European guidelines. With this review, we intend to summarize the current indications of sonography in the field of skin cancer surgery, which can help us improve the therapeutic attitude toward our patients and enhance patient counseling. In the era of modern systemic radiooncological therapies, sonography can help better select patients who qualify for surgical procedures or require systemic treatments due to tumoral extension.
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Affiliation(s)
- Diana Crisan
- Clinic of Dermatology and Allergology, University Clinic Ulm, 89081 Ulm, Germany
| | - Evelyne Tarnowietzki
- Clinic of Dermatology and Allergology, University Clinic Ulm, 89081 Ulm, Germany
| | - Lukas Bernhard
- Clinic of Dermatology and Allergology, University Clinic Ulm, 89081 Ulm, Germany
| | - Melina Möller
- Clinic of Dermatology and Allergology, University Clinic Ulm, 89081 Ulm, Germany
| | | | - Maria Crisan
- Department of Dermatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
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24
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Alberti A, Gurizzan C, Baggi A, Bossi P. Where do we stand with immunotherapy for nonmelanoma skin cancers in the curative setting? Curr Opin Otolaryngol Head Neck Surg 2024; 32:89-95. [PMID: 37997885 DOI: 10.1097/moo.0000000000000945] [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: 11/25/2023]
Abstract
PURPOSE OF REVIEW Nonmelanoma skin cancers (NMSC) represent a heterogeneous group of diseases that encompasses among the principal histologies basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and Merkel cell carcinoma (MCC). Given the fact that high tumor mutational burden due to ultraviolet mutagenesis represents a common hallmark of NMSCs, immunotherapy has proved to be a promising therapeutic approach in recent years. The aim of this review is to shed light on immunotherapy applications in NMSCs in the curative setting. RECENT FINDINGS Immune checkpoint inhibitors represent the first-line treatment of choice for advanced cSCC and MCC, while in second line for BCC. Given this success, more and more trials are evaluating the use of immune checkpoint blockade in neoadjuvant setting for NMSCs. Clinical trials are still ongoing, with the most mature data being found in cSCC. Also, translational studies have identified promising biomarkers of response. SUMMARY Locoregional treatments of NMSCs can have non negligible functional and cosmetic impacts on patients, affecting their quality of life. As immunogenic diseases, neoadjuvant immunotherapy represents a promising treatment that could change the therapeutic path of these patients. Upcoming results from clinical trials will address these crucial issues.
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Affiliation(s)
- Andrea Alberti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia
| | - Cristina Gurizzan
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia
| | - Alice Baggi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at the Azienda Socio Sanitaria Territoriale (ASST)-Spedali Civili, Brescia
| | - Paolo Bossi
- Department of Biomedical Sciences - Humanitas University, Medical Oncology and Hematology Unit
- Humanitas Cancer Center - IRCCS Humanitas Research Hospital, Rozzano MI, Italy
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25
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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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26
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Verkerk K, Geurts BS, Zeverijn LJ, van der Noort V, Verheul HM, Haanen JB, van der Veldt AA, Eskens FA, Aarts MJ, van Herpen CM, Jalving M, Gietema JA, Devriese LA, Labots M, Barjesteh van Waalwijk van Doorn-Khosrovani S, Smit EF, Bloemendal HJ. Cemiplimab in locally advanced or metastatic cutaneous squamous cell carcinoma: prospective real-world data from the DRUG Access Protocol. THE LANCET REGIONAL HEALTH. EUROPE 2024; 39:100875. [PMID: 38464480 PMCID: PMC10924203 DOI: 10.1016/j.lanepe.2024.100875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/12/2024]
Abstract
Background The DRUG Access Protocol provides patients with cancer access to registered anti-cancer drugs that are awaiting reimbursement in the Netherlands and simultaneously collects prospective real-world data (RWD). Here, we present RWD from PD-1 blocker cemiplimab in patients with locally advanced or metastatic cutaneous squamous cell carcinoma (laCSCC; mCSCC). Methods Patients with laCSCC or mCSCC received cemiplimab 350 mg fixed dose every three weeks. Primary endpoints were objective clinical benefit rate (CBR), defined as objective response (OR) or stable disease (SD) at 16 weeks, physician-assessed CBR, defined as clinician's documentation of improved disease or SD based on evaluation of all available clinical parameters at 16 weeks, objective response rate (ORR), and safety, defined as grade ≥ 3 treatment related adverse events (TRAEs) occurring up to 30 days after last drug administration. Secondary endpoints included duration of response (DoR), progression-free survival (PFS), and overall survival (OS). Findings Between February 2021 and December 2022, 151 patients started treatment. Objective and physician-assessed CBR were 54.3% (95% CI, 46.0-62.4) and 59.6% (95% CI, 51.3-67.5), respectively. ORR was 35.1% (95% CI, 27.5-43.3). After a median follow-up of 15.2 months, median DoR was not reached. Median PFS and OS were 12.2 (95% CI, 7.0-not reached) and 24.2 months (95% CI, 18.8-not reached), respectively. Sixty-eight TRAEs occurred in 29.8% of patients. Most commonly reported TRAE was a kidney transplant rejection (9.5%). Interpretation Cemiplimab proved highly effective and safe in this real-world cohort of patients with laCSCC or mCSCC, confirming its therapeutic value in the treatment of advanced CSCC in daily clinical practice. Funding The DRUG Access Protocol is supported by all participating pharmaceutical companies: Bayer, Janssen, Lilly, Merck, Novartis, Roche, and Sanofi.
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Affiliation(s)
- Karlijn Verkerk
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Birgit S. Geurts
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Laurien J. Zeverijn
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | | | - Henk M.W. Verheul
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - John B.A.G. Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Clinical Oncology, LUMC, Leiden, the Netherlands
- Head of Melanoma Clinic, CHUV, Lausanne, Switzerland
| | - Astrid A.M. van der Veldt
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ferry A.L.M. Eskens
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maureen J.B. Aarts
- Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carla M.L. van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University of Medical Center Groningen, Groningen, the Netherlands
| | - Jourik A. Gietema
- Department of Medical Oncology, University of Medical Center Groningen, Groningen, the Netherlands
| | - Lot A. Devriese
- Department of Medical Oncology, Division Beeld & Oncologie, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Mariette Labots
- Department of Medical Oncology, Amsterdam University Medical Center, Location VUMC, Cancer Center Amsterdam, the Netherlands
| | | | - Egbert F. Smit
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Haiko J. Bloemendal
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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27
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Pisano C, Leitenberger JJ, Pugliano-Mauro M, Carroll BT. Updates in Skin Cancer in Transplant Recipients and Immunosuppressed Patients: Review of the 2022-2023 Scientific Symposium of the International Immunosuppression and Transplant Skin Cancer Collaborative. Transpl Int 2024; 37:12387. [PMID: 38562207 PMCID: PMC10982388 DOI: 10.3389/ti.2024.12387] [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: 11/06/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
The International Immunosuppression and Transplant Skin Cancer Collaborative (ITSCC) and its European counterpart, Skin Care in Organ Transplant Patients-Europe (SCOPE) are comprised of physicians, surgeons, and scientist who perform integrative collaborative research focused on cutaneous malignancies that arise in solid organ transplant recipients (SOTR) and patients with other forms of long-term immunosuppression. In October 2022, ITSCC held its biennial 4-day scientific symposium in Essex, Massachusetts. This meeting was attended by members of both ITSCC and SCOPE and consisted of specialists including Mohs micrographic and dermatologic oncology surgeons, medical dermatologists, transplant dermatologists, transplant surgeons, and transplant physicians. During this symposium scientific workshop groups focusing on consensus standards for case reporting of retrospective series for invasive squamous cell carcinoma (SCC), defining immunosuppressed patient status for cohort reporting, development of multi-institutional registry for reporting rare tumors, and development of a KERACON clinical trial of interventions after a SOTRs' first cutaneous SCC were developed. The majority of the symposium focused on presentation of the most up to date research in cutaneous malignancy in SOTR and immunosuppressed patients with specific focus on chemoprevention, immunosuppression regimens, immunotherapy in SOTRs, spatial transcriptomics, and the development of cutaneous tumor registries. Here, we present a summary of the most impactful scientific updates presented at the 2022 ITSCC symposium.
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Affiliation(s)
- Catherine Pisano
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Justin J. Leitenberger
- Department of Dermatology, Oregon Health & Science University, Portland, OR, United States
| | - Melissa Pugliano-Mauro
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Bryan T. Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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28
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Schneider S, Ferte T, Ducharme O, Dousset L, Prey S, Dutriaux C, Gerard E, Beylot-Barry M, Pham-Ledard A. Improved survival over time with immunotherapy in locally advanced and metastatic cutaneous squamous cell carcinomas. J Cancer Res Clin Oncol 2024; 150:133. [PMID: 38492114 PMCID: PMC10944410 DOI: 10.1007/s00432-023-05593-2] [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: 08/23/2023] [Accepted: 12/22/2023] [Indexed: 03/18/2024]
Abstract
PURPOSE Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in white-skinned populations. There is little information on the epidemiology of cSCC, and even less on advanced cases (acSCC). Therefore, we analyzed acSCC patients to describe their characteristics, management, and outcomes over time. METHODS A single-center retrospective study was conducted over a period of 5 years, including all patients who started systemic therapy for acSCC. The patient characteristics, cSCC management, response to therapy, and survival were recorded. Patients were stratified into equal chronological periods (periods 1 and 2). A subgroup analysis was performed to compare patients who received immunotherapy (group 1) with those who did not (group 2). RESULTS The study included 127 patients, and patient numbers increased by an average of 19.7% per year. Most patients were male (88/127), elderly (mean 81.6 years), with comorbidities, and 27.6% were immunocompromised. The median overall survival (OS) was higher in period 2 (20 months) than in period 1 (10 months) (hazard ratio [95% confidence interval] = 0.62 [0.39; 0.98], p = 0.04). The risk of progression increased with age and immunosuppression. Of the 64 patients who received second-line therapy, 38 had immunotherapy (group 1) and 26 received other therapies (group 2). Immunotherapy reduced mortality and progression by 71% (p = 0.004) and 67% (p = 0.002), respectively. CONCLUSIONS Patients with acSCC are usually very frail and elderly. OS increased over time, with a twofold improvement between periods 1 and 2, whereas progression-free survival (PFS) did not increase. Access to immunotherapy reduced mortality in a majority of patients in period 2. Immunosuppression and advanced age were associated with lower PFS.
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Affiliation(s)
- Sophie Schneider
- Dermatology Department, Hôpital Saint André, CHU Bordeaux, 1 Avenue Jean-Burguet, 33000, Bordeaux, France
| | - Thomas Ferte
- Public Health Centre, Methodological Support Unit for Clinical and Epidemiological Research, CHU Bordeaux, 33000, Bordeaux, France
| | - Océane Ducharme
- Dermatology Department, Hôpital Saint André, CHU Bordeaux, 1 Avenue Jean-Burguet, 33000, Bordeaux, France
| | - Léa Dousset
- Dermatology Department, Hôpital Saint André, CHU Bordeaux, 1 Avenue Jean-Burguet, 33000, Bordeaux, France
- Public Health Centre, Methodological Support Unit for Clinical and Epidemiological Research, CHU Bordeaux, 33000, Bordeaux, France
- INSERM U1312, BRIC, Team 5 Translational Research on Oncodermatology and Rare Skin Diseases, University Bordeaux, 33076, Bordeaux, France
| | - Sorilla Prey
- Dermatology Department, Hôpital Saint André, CHU Bordeaux, 1 Avenue Jean-Burguet, 33000, Bordeaux, France
- Public Health Centre, Methodological Support Unit for Clinical and Epidemiological Research, CHU Bordeaux, 33000, Bordeaux, France
- INSERM U1312, BRIC, Team 5 Translational Research on Oncodermatology and Rare Skin Diseases, University Bordeaux, 33076, Bordeaux, France
| | - Caroline Dutriaux
- Dermatology Department, Hôpital Saint André, CHU Bordeaux, 1 Avenue Jean-Burguet, 33000, Bordeaux, France
- Public Health Centre, Methodological Support Unit for Clinical and Epidemiological Research, CHU Bordeaux, 33000, Bordeaux, France
- INSERM U1312, BRIC, Team 5 Translational Research on Oncodermatology and Rare Skin Diseases, University Bordeaux, 33076, Bordeaux, France
| | - Emilie Gerard
- Dermatology Department, Hôpital Saint André, CHU Bordeaux, 1 Avenue Jean-Burguet, 33000, Bordeaux, France
| | - Marie Beylot-Barry
- Dermatology Department, Hôpital Saint André, CHU Bordeaux, 1 Avenue Jean-Burguet, 33000, Bordeaux, France
- Public Health Centre, Methodological Support Unit for Clinical and Epidemiological Research, CHU Bordeaux, 33000, Bordeaux, France
- INSERM U1312, BRIC, Team 5 Translational Research on Oncodermatology and Rare Skin Diseases, University Bordeaux, 33076, Bordeaux, France
| | - Anne Pham-Ledard
- Dermatology Department, Hôpital Saint André, CHU Bordeaux, 1 Avenue Jean-Burguet, 33000, Bordeaux, France.
- Public Health Centre, Methodological Support Unit for Clinical and Epidemiological Research, CHU Bordeaux, 33000, Bordeaux, France.
- INSERM U1312, BRIC, Team 5 Translational Research on Oncodermatology and Rare Skin Diseases, University Bordeaux, 33076, Bordeaux, France.
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Crisan D, Wortsman X, Catalano O, Badea R, Kastler S, Badea A, Manea A, Scharffetter-Kochanek K, Strilciuc S, Crisan M, Schneider LA. Präoperativer Hochfrequenzultraschall: Ein zuverlässiges Managementinstrument bei nichtmelanozytärem Hautkrebs der Ohrmuschel und der Nase: Pre-operative high-frequency ultrasound: A reliable management tool in auricular and nasal non-melanoma skin cancer. J Dtsch Dermatol Ges 2024; 22:357-366. [PMID: 38450937 DOI: 10.1111/ddg.15308_g] [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: 04/20/2023] [Accepted: 10/10/2023] [Indexed: 03/08/2024]
Abstract
ZusammenfassungHintergrund und ZielsetzungDas Wissen über die Tiefeninfiltration bei nichtmelanozytärem Hautkrebs (NMSC) mithilfe präoperativer Sonographie könnte den Ärzten ermöglichen, den am besten geeigneten therapeutischen Ansatz zu wählen, unnötige Operationen und teure bildgebende Verfahren zu vermeiden und die Diagnose und Behandlung nicht zu verzögern. In unserer retrospektiven, monozentrischen Studie haben wir die Nützlichkeit des Hochfrequenzultraschalls (HFUS) zur Beurteilung der Tiefeninfiltration bei aurikulären und nasalen NMSC‐Fällen untersucht und die darauffolgende Änderung des therapeutischen Ansatzes bewertet.Patienten und MethodikIn 60 NMSC‐Fällen haben wir die Genauigkeit des HFUS bei der Erkennung von Knorpel‐ und Knocheninfiltration sowie die Korrelation sonographischer und histologischer Parameter beurteilt.ErgebnisseIn 16,6% der Fälle wurde präoperativ eine tiefe Knorpel‐/Knochenbeteiligung oder eine lokoregionale Erkrankung identifiziert, was zu einer geänderten therapeutischen Strategie mit radioimmunologischer Behandlung anstelle von Operation führte. In zwei Fällen identifizierte der präoperative HFUS eine lokale Knorpelinfiltration, was die Anzahl der chirurgischen Eingriffe reduzierte. Bei den verbleibenden 48 Läsionen ohne Tiefeninfiltration wurde eine Korrelation von > 99% zwischen der histologischen und sonographischen Tumoreindringtiefe gefunden (p <0.001).SchlussfolgerungenPräoperativer HFUS beeinflusst das therapeutische Vorgehen bei NMSC, indem es eine subklinische Beteiligung tieferer Strukturen erkennt, umfangreichere diagnostische Maßnahmen vermeidet, Kosten reduziert und die Qualität der Gesundheitsversorgung verbessert. HFUS sollte in der Dermatochirurgie vor der Tumorentfernung zur optimierten Therapie und zur verbesserten Patientenberatung eingesetzt werden.
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Affiliation(s)
- Diana Crisan
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Ximena Wortsman
- Abteilung für Dermatologie, Medizinische Fakultät, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Abteilung für Dermatologie, Medizinische Fakultät, Universidad de Chile, Santiago, Chile
- Institut für Diagnostische Bildgebung und Forschung der Haut und Weichteile, Santiago, Chile
| | - Orlando Catalano
- Abteilung für Radiologie, Istituto Diagnostico Varelli, Neapel, Italien
| | - Radu Badea
- Abteilung für Medizinische Bildgebung, "Prof. Dr. Octavian Fodor" Regionales Institut für Gastroenterologie und Hepatologie, Cluj-Napoca, Rumänien
| | - Sabine Kastler
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Alexandru Badea
- Abteilung für Anatomie und Embryologie, "Iuliu Hatieganu" Universität für Medizin und Pharmazie, Cluj-Napoca, Rumänien
| | - Avram Manea
- Abteilung für Kiefer-, Gesichtschirurgie und Implantologie, "Iuliu Hatieganu" Universität für Medizin und Pharmazie, Cluj-Napoca, Rumänien
| | | | - Stefan Strilciuc
- Abteilung für Neurowissenschaften, Universität für Medizin und Pharmazie "Iuliu Hatieganu", Cluj-Napoca, Rumänien
| | - Maria Crisan
- Klinik für Dermatologie und Venerologie, Kreiskrankenhaus Cluj-Napoca, Cluj-Napoca, Rumänien
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Crisan D, Wortsman X, Catalano O, Badea R, Kastler S, Badea A, Manea A, Scharffetter-Kochanek K, Strilciuc S, Crisan M, Schneider LA. Pre-operative high-frequency ultrasound: a reliable management tool in auricular and nasal non-melanoma skin cancer. J Dtsch Dermatol Ges 2024; 22:357-365. [PMID: 38243870 DOI: 10.1111/ddg.15308] [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: 04/20/2023] [Accepted: 10/10/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND OBJECTIVES The knowledge of depth infiltration in non-melanoma skin cancer (NMSC) using pre-operative ultrasound could enable clinicians to choose the most adequate therapeutic approach, avoiding unnecessary surgeries and expensive imaging methods, delaying diagnosis and treatment. Our single-center retrospective study determined the usefulness of high-frequency ultrasound (HFUS) for depth infiltration assessment in auricular and nasal NMSC and assessed the subsequent change in therapeutic approach. PATIENTS AND METHODS In 60 NMSC cases, we assessed the accuracy of HFUS in cartilaginous/bone infiltration detection as well as the correlation of sonographic and histological parameters. RESULTS In 16.6% of cases, a deep cartilaginous/bone involvement or locoregional disease was identified pre-operatively, resulting in a changed therapeutical scheme of radio-immunological treatment rather than surgery. In two cases, pre-operative HFUS identified local cartilage infiltration, reducing the number of surgical procedures. Forty-eight remaining lesions with no depth infiltration were excised; a correlation of > 99% between the histologic and sonographic tumor depth (p<0.001) was found. CONCLUSIONS Pre-surgical HFUS influences the therapeutic management in NMSC by detecting subclinical involvement of deeper structures, avoiding more extensive diagnostics, reducing costs, and improving healthcare quality. High-frequency ultrasound should be implemented in dermatosurgery before tumor excision for optimized therapy and improved patient counseling.
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Affiliation(s)
- Diana Crisan
- Clinic of Dermatology and Allergology, University Clinic Ulm, Ulm, Germany
| | - Ximena Wortsman
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
| | - Orlando Catalano
- Department of Radiology, Istituto Diagnostico Varelli, Naples, Italy
| | - Radu Badea
- Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Sabine Kastler
- Clinic of Dermatology and Allergology, University Clinic Ulm, Ulm, Germany
| | - Alexandru Badea
- Department of Anatomy and Embriology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Avram Manea
- Department of Maxillofacial Surgery and Implantology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Stefan Strilciuc
- Department of Neuroscience, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Crisan
- Clinic of Dermatology and Venerology, Cluj-Napoca County Hospital, Cluj-Napoca, Romania
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Schoelles KJ, Auw-Haedrich C. Updates on eyelid cancers. Asia Pac J Ophthalmol (Phila) 2024; 13:100057. [PMID: 38615904 DOI: 10.1016/j.apjo.2024.100057] [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: 02/03/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/16/2024] Open
Abstract
In this review, we aim to provide an overview of the five most common malignant eyelid tumors with current treatment recommendations based on international guidelines. Particular attention is paid to the clinicopathological correlation and the update with regard to adequate treatment. Newer systemic therapies enrich the existing treatment options, of which complete tumor excision remains the most important therapeutic measure.
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Wong ZY, Wickham N, Bagirathan S, Leggate A, Smith SJ, Pollock J. Craniectomy with soft tissue reconstruction for locally advanced non-melanoma skin cancer of scalp with calvarial invasion: The Nottingham experience. J Plast Reconstr Aesthet Surg 2024; 90:175-182. [PMID: 38387413 DOI: 10.1016/j.bjps.2024.02.016] [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: 08/23/2023] [Revised: 11/09/2023] [Accepted: 02/01/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Locally advanced non-melanoma skin cancer (NMSC) involving the periosteum or calvarium poses a clinical challenge for patients who are unfit for immunotherapy due to medical comorbidities and/or frailty. This case series aims to investigate outcomes for patients undergoing craniectomy and soft tissue reconstruction. METHOD Patients who underwent craniectomy and soft tissue reconstruction for invasive NMSC with calvarium or periosteal invasion between 2016 and 2022 were included. Data, including demographics, operative details, and clinical outcomes, were gathered from Nottingham University Hospitals' digital health record and the histopathology electronic database. RESULT Eight patients (average age: 78.4 years, 3 females 5 males) with significant comorbidities and varying degrees of periosteal or bone invasion fulfilled the inclusion criteria. Diagnoses included four squamous cell carcinomas, two basal cell carcinomas, and two pleomorphic dermal sarcomas. Five patients had a history of prior incomplete deep margin excision. The median sizes for soft tissue defect, tumor and bone defect size were 51.83 cm2, 34.63 cm2 and 42.25 cm2, respectively. Intraoperative complications included one dural tear. Four patients underwent local flap reconstruction and with split-thickness skin grafting, four patients underwent free flap reconstruction. Adjuvant radiotherapy was administered to three patients. Complications comprised partial graft loss in two and complete graft loss in one. There was partial flap loss in one case. One patient required subsequent parotidectomy due to regional progression before achieving disease control. All patients achieved lasting locoregional disease control (average follow-up 29.7 months). CONCLUSION Craniectomy with soft tissue reconstruction proves to be a safe and effective treatment option in advanced NMSC of the scalp in patients unsuitable for immunotherapy due to frailty or medical co-morbidity.
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Affiliation(s)
- Zhen Y Wong
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, England, UK; Department of Neurosurgery, Queens Medical Centre, Nottingham, England, UK
| | - Neil Wickham
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, England, UK
| | - Shenbana Bagirathan
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, England, UK
| | - Alex Leggate
- Department of Neurosurgery, Queens Medical Centre, Nottingham, England, UK
| | - Stuart J Smith
- Department of Neurosurgery, Queens Medical Centre, Nottingham, England, UK
| | - Jonathan Pollock
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, England, UK.
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Tirado-Perez JP, Oakley A, Gansel R. Excision pathways for keratinocyte cancers diagnosed by teledermatology: a retrospective review. J Prim Health Care 2024; 16:90-95. [PMID: 38546776 DOI: 10.1071/hc23098] [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: 09/01/2023] [Accepted: 11/10/2023] [Indexed: 04/02/2024] Open
Abstract
Introduction The New Zealand population has one of the highest incidences of skin cancer in the world. Hospital waiting lists for surgical excision of keratinocytic skin cancers (basal cell carcinoma and squamous cell carcinoma) are lengthy, and increasingly, excisions are undertaken in primary care. Teledermatology, in response to general practitioners' electronic referrals (e-referrals), can improve clinical communication between general practitioners and dermatologists. Aim The aim of this study was to evaluate an excision pathway for keratinocytic cancers diagnosed by teledermatology. Methods A retrospective observational descriptive review of a 3-month cohort of primary care e-referrals was undertaken. Results Three hundred and fifty eight suspected keratinocytic cancers (KCs) were diagnosed by teledermatology; histology reports confirmed KC in 201 of 267 excisions (75%). The majority (77.2%) were excised by general practitioners an average of 25 days after the dermatologist's recommendation. The rest were excised by plastic surgeons in private (3.4%) or at a public hospital (19.5%) after an average of 40 or 134 days, respectively. Discussion E-referral pathways are now widely implemented. However, the ideal workflow for skin cancer management is unknown. We have demonstrated in New Zealand that surgery can be undertaken in primary care within a month of a teledermatology diagnosis and excision recommendation. Conclusion This study reports prompt excision of KCs by general practitioners after an e-referral and a teledermatology response.
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Affiliation(s)
- J P Tirado-Perez
- Dermatology Department, Virgen Macarena University Hospital, Sevilla, Spain
| | - A Oakley
- Department of Dermatology, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand; and Department of Medicine, The University of Auckland, Auckland
| | - R Gansel
- Department of Dermatology, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
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Lonsdorf AS, Edelmann D, Albrecht T, Brobeil A, Labrenz J, Johanning M, Schlenk RF, Goeppert B, Enk AH, Toberer F. Differential Immunoexpression of Inhibitory Immune Checkpoint Molecules and Clinicopathological Correlates in Keratoacanthoma, Primary Cutaneous Squamous Cell Carcinoma and Metastases. Acta Derm Venereol 2024; 104:adv13381. [PMID: 38323498 PMCID: PMC10863621 DOI: 10.2340/actadv.v104.13381] [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: 05/23/2023] [Accepted: 12/20/2023] [Indexed: 02/08/2024] Open
Abstract
Beyond established anti-programmed cell death protein 1/programmed cell death ligand 1 immunotherapy, T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif domain (TIGIT) and its ligand CD155 are promising novel inhibitory immune checkpoint targets in human malignancies. Yet, in cutaneous squamous cell carcinoma, evidence on the collective expression patterns of these inhibitory immune checkpoints is scarce. Complete tumour sections of 36 cutaneous squamous cell carcinoma, 5 cutaneous metastases and 9 keratoacanthomas, a highly-differentiated, squamoproliferative tumour, with disparately benign biologic behaviour, were evaluated by immunohistochemistry for expression of programmed cell death ligand 1 (Tumor Proportion Score, Immune Cell Score), TIGIT, CD155 and CD8+ immune infiltrates. Unlike keratoacanthomas, cutaneous squamous cell carcinoma displayed a strong positive correlation of programmed cell death ligand 1 Tumor Proportion Score and CD115 expression (p < 0.001) with significantly higher programmed cell death ligand 1 Tumor Proportion Score (p < 0.001) and CD155 expression (p < 0.01) in poorly differentiated G3-cutaneous squamous cell carcinoma compared with keratoacanthomas. TIGIT+ infiltrates were significantly increased in programmed cell death ligand 1 Immune Cell Score positive primary tumours (p = 0.05). Yet, a strong positive correlation of TIGIT expression with CD8+ infiltrates was only detected in cutaneous squamous cell carcinoma (p < 0.01), but not keratoacanthomas. Providing a comprehensive overview on the collective landscape of inhibitory immune checkpoint expression, this study reveals associations of novel inhibitory immune checkpoint with CD8+ immune infiltrates and tumour differentiation and highlights the TIGIT/CD155 axis as a potential new target for cutaneous squamous cell carcinoma immunotherapy.
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Affiliation(s)
- Anke S Lonsdorf
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Dominic Edelmann
- German Cancer Research Center, Heidelberg, Germany; NCT Trial Center, National Center for Tumor Diseases, German Cancer Research Center and Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Albrecht
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Brobeil
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Tissue Bank of the National Center for Tumor Diseases, Heidelberg, Germany
| | - Jannik Labrenz
- German Cancer Research Center, Heidelberg, Germany; NCT Trial Center, National Center for Tumor Diseases, German Cancer Research Center and Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz Johanning
- German Cancer Research Center, Heidelberg, Germany; NCT Trial Center, National Center for Tumor Diseases, German Cancer Research Center and Heidelberg University Hospital, Heidelberg, Germany
| | - Richard F Schlenk
- German Cancer Research Center, Heidelberg, Germany; NCT Trial Center, National Center for Tumor Diseases, German Cancer Research Center and Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Goeppert
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Institute of Pathology and Neuropathology, RKH Klinikum Ludwigsburg, Germany
| | - Alexander H Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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Markopoulos G, Lampri E, Tragani I, Kourkoumelis N, Vartholomatos G, Seretis K. Intraoperative Flow Cytometry for the Rapid Diagnosis and Validation of Surgical Clearance of Non-Melanoma Skin Cancer: A Prospective Clinical Feasibility Study. Cancers (Basel) 2024; 16:682. [PMID: 38398076 PMCID: PMC10887295 DOI: 10.3390/cancers16040682] [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: 01/04/2024] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Non-melanoma skin cancer (NMSC) is the most prevalent cancer in humans, with a high global incidence. We present a prospective clinical feasibility study on the use of intraoperative flow cytometry (iFC) for the instant diagnosis of NMSC and its complete surgical clearance. Flow cytometry, a laser-based technique, quantifies cell features, which has applications in cancer research. This study aim is to explore the potential applicability of iFC in detecting and characterizing NMSC and its surgical margins. In total, 30 patients who underwent diagnosis for NMSC were recruited. The method demonstrated high sensitivity (95.2%) and specificity (87.1%), with an accuracy of 91.1%, as confirmed with a receiver operating characteristic curve analysis. The results also indicated that most tumors were diploid, with two cases being hypoploid. The average G0/G1 fractions for normal and tumor tissue samples were 96.03 ± 0.30% and 88.03 ± 1.29%, respectively, with the tumor index escalating from 3.89 ± 0.30% to 11.95 ± 1.29% in cancerous cells. These findings underscore iFC's capability for precise intraoperative NMSC characterization and margin evaluation, promising enhanced complete tumor excision rates. Given the technique's successful application in various other malignancies, its implementation in NMSC diagnosis and treatment holds significant promise and warrants further research in clinical trials.
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Affiliation(s)
- Georgios Markopoulos
- Haematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45110 Ioannina, Greece; (G.M.); (G.V.)
| | - Evangeli Lampri
- Department of Pathology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (E.L.); (I.T.)
| | - Ioulia Tragani
- Department of Pathology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (E.L.); (I.T.)
| | - Nikolaos Kourkoumelis
- Department of Medical Physics, Medical School, University of Ioannina, 45110 Ioannina, Greece;
| | - Georgios Vartholomatos
- Haematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45110 Ioannina, Greece; (G.M.); (G.V.)
| | - Konstantinos Seretis
- Department of Plastic Surgery, Medical School, University of Ioannina, 45110 Ioannina, Greece
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Ye W, Ya‐xuan C, Shan‐shan T, Qiu L, Ting M, Shao‐jie C, Yu C. NR5A2 promotes malignancy progression and mediates the effect of cisplatin in cutaneous squamous cell carcinoma. Immun Inflamm Dis 2024; 12:e1172. [PMID: 38358044 PMCID: PMC10868143 DOI: 10.1002/iid3.1172] [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: 08/03/2023] [Revised: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Nuclear receptor subfamily five group A member two (NR5A2) plays a key role in the development of many tumor types, while it is uncertain in cutaneous squamous cell carcinoma (cSCC). The aim of this work was to determine the role of NR5A2 in cSCC proliferation, and to determine whether NR5A2 mediates the effect of cisplatin in cSCC. METHODS We performed a systematic study of existing data and conducted a preliminary bioinformatics analysis of NR5A2 expression in cSCC using bioinformatics databases. Immunohistochemical staining was performed on cSCC tissues of seven patients to study NR5A2 expression. NR5A2 expression was examined in human keratin-forming cells (HaCaT) and human cSCC cells (A431, Colo-16, SCL-1, SCL-2, and HSC-5). Stable A431 and SCL-2 cell lines consisting of sh-RNA-NR5A2 were constructed to detect changes in cell proliferation, cell cycle, apoptosis, and to determine the key proteins in the Wnt/β-catenin pathway. We also investigated changes in the effects of cisplatin on cSCC cells by CCK-8, clone formation assay, and Flow apoptosis assay after NR5A2 knockdown. RESULTS NR5A2 showed enhanced expression in cSCC tissues than in healthy tissues. Downregulation of NR5A2 in cSCC cells led to the formation of a less malignant phenotype. In contrast, the proliferative capacity of the cSCC cells was enhanced posttreatment with RJW100, an NR5A2 agonist. Additionally, NR5A2 knockdown led to a decrease in the expression level of the proteins in the Wnt/β-catenin pathway, and this inhibition was reversed by LiCl and recombinant antibody, Wnt3a. Moreover, NR5A2 knockdown resulted in diminished proliferative capacity and increased apoptotic cells after the addition of cisplatin. CONCLUSION NR5A2 plays a crucial role in the progression of cSCC, and the Wnt/β-catenin signaling pathway may be involved in the regulation of NR5A2-mediated cSCC. Knockdown of NR5A2 enhanced both the proliferation inhibiting and apoptosis promoting effects of cisplatin on cSCC.
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Affiliation(s)
- Wang Ye
- School of Clinical MedicineGuizhou Medical UniversityGuiyangChina
| | - Cao Ya‐xuan
- Department of DermatologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Tang Shan‐shan
- School of Clinical MedicineGuizhou Medical UniversityGuiyangChina
| | - Long Qiu
- School of Clinical MedicineGuizhou Medical UniversityGuiyangChina
| | - Ma Ting
- School of Clinical MedicineGuizhou Medical UniversityGuiyangChina
| | - Chen Shao‐jie
- School of Clinical MedicineGuizhou Medical UniversityGuiyangChina
- Department of Hepatobiliary SurgeryAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Cao Yu
- School of Clinical MedicineGuizhou Medical UniversityGuiyangChina
- Department of DermatologyAffiliated Hospital of Guizhou Medical UniversityGuiyangChina
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Rubino C, Trignano E, Bussu F, Serra PL, Rodio M, Tettamanzi M, Rampazzo S. Salvage Strategies for Local Recurrences of Squamous Cell Carcinoma of the Nasal Vestibule: A Single-Center Experience of 22 Years. J Clin Med 2024; 13:541. [PMID: 38256675 PMCID: PMC10816016 DOI: 10.3390/jcm13020541] [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: 12/14/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Squamous cell carcinomas of the nasal vestibule are an extremely rare neoplastic disease. Although brachytherapy is gaining popularity for primary treatment, surgery remains the best option in case of recurrences. The aim of this paper is to outline our treatment experience of local recurrence of SCCNVs over the past 22 years. We retrospectively reviewed the clinical data of the patients who underwent surgical treatment for local recurrence of SCCNV: data regarding age, sex, primary tumor treatment, recurrence location and time of appearance, surgical resection, type of reconstruction, postoperative complication, surgical revision, and re-recurrence rate were analyzed. Twenty patients were included in the study. The median period for recurrence appearance was 17 months, and the prevalent location of recurrence was the nasal alae. Prevalent reconstructive procedures were the nasolabial flap and paramedian forehead flap. No postoperative complications were observed, and one case of re-recurrence was detected at 12-months of follow-up. Based on our experience, salvage surgical procedures for SCCNV recurrences must be individualized and carefully planned, taking into account the peculiar pattern of tumor spread and the presence of scar and heavily radiotherapy damaged tissue from previous treatment; delayed reconstruction should be considered for all the cases with skeletal involvement.
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Affiliation(s)
- Corrado Rubino
- Plastic Surgery Unit, University Hospital Trust of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy; (C.R.); (E.T.); (M.R.); (M.T.)
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy;
| | - Emilio Trignano
- Plastic Surgery Unit, University Hospital Trust of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy; (C.R.); (E.T.); (M.R.); (M.T.)
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy;
| | - Francesco Bussu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy;
- Otolaryngology Division, University Hospital Trust of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy
| | - Pietro Luciano Serra
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy;
| | - Manuela Rodio
- Plastic Surgery Unit, University Hospital Trust of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy; (C.R.); (E.T.); (M.R.); (M.T.)
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy;
| | - Matilde Tettamanzi
- Plastic Surgery Unit, University Hospital Trust of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy; (C.R.); (E.T.); (M.R.); (M.T.)
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy;
| | - Silvia Rampazzo
- Plastic Surgery Unit, University Hospital Trust of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy; (C.R.); (E.T.); (M.R.); (M.T.)
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, Viale S. Pietro 43, 07100 Sassari, Italy;
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Pham JP, Rodrigues A, Goldinger SM, Sim HW, Liu J. Epidermal growth factor receptor inhibitors in advanced cutaneous squamous cell carcinoma: A systematic review and meta-analysis. Exp Dermatol 2024; 33:e14978. [PMID: 37971204 DOI: 10.1111/exd.14978] [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: 06/13/2023] [Revised: 10/01/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Patients with advanced cutaneous squamous cell carcinoma (cSCC) who are not eligible for or who fail to respond to anti-PD1 immunotherapy have few treatment options. Epidermal growth factor receptor (EGFR) inhibitors have been investigated as a therapeutic option for advanced cSCC; however, data are limited to small single-arm trials or retrospective studies. A systematic review and meta-analysis was conducted to PRISMA guidelines (CRD42023394300). Studies reporting on outcomes of EGFR inhibition in advanced cSCC were identified. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and adverse event (AE) rate were pooled using a random effects model and the inverse variance method. Twelve studies (six prospective, six retrospective) were identified, representing 324 patients. Pooled ORR was 26% (95% confidence interval [CI] 18-36), median PFS was 4.8 months (95% CI 3.9-6.6) and median OS was 11.7 months (95% CI 9.2-14.1). Any grade AEs occurred in 93% of patients (95% CI 85-97) while grade 3 and higher AEs occurred in 30% (95% CI 14-54). These results were similar between anti-EGFR monoclonal antibodies (MAbs) and tyrosine kinase inhibitors (TKIs). EGFR inhibitors can be considered in patients with advanced cSCC who are contraindicated for or progress on first-line anti-PD1 immunotherapy. Future studies should evaluate their activity and safety following anti-PD1, identify predictive biomarkers for their efficacy and explore combination approaches.
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Affiliation(s)
- James P Pham
- Department of Medical Oncology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Darlinghurst, New South Wales, Australia
| | - Anthony Rodrigues
- Department of Medical Oncology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Darlinghurst, New South Wales, Australia
| | - Simone M Goldinger
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Hao-Wen Sim
- Department of Medical Oncology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Darlinghurst, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Jia Liu
- Department of Medical Oncology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Clinical Campus, Darlinghurst, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Granger EE, Kim EY, Karn EE, Groover MK, Silk AW, Margalit DN, Tishler RB, Schoenfeld JD, Ruiz ES. Definitive radiation therapy for inoperable stage III/IV cutaneous squamous cell carcinoma: A single-institution retrospective cohort study. J Am Acad Dermatol 2024; 90:187-189. [PMID: 37734666 DOI: 10.1016/j.jaad.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Emily E Granger
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Y Kim
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily E Karn
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Morgan K Groover
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ann W Silk
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Danielle N Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Roy B Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Welponer T, Weber DD, Trattner L, Tockner B, Aminzadeh-Gohari S, Leb-Reichl V, Kaufmann A, Zauner R, Wimmer M, Wally V, Felder TK, Strunk D, Koller U, Bauer JW, Kofler B, Guttmann-Gruber C, Piñon Hofbauer J. Metformin shows anti-neoplastic properties by inhibition of oxidative phosphorylation and glycolysis in epidermolysis bullosa-associated aggressive cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2024; 38:112-123. [PMID: 37669776 DOI: 10.1111/jdv.19488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/18/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND While most cutaneous squamous cell carcinomas (cSCCs) are treatable, certain high-risk cSCCs, such as those in recessive dystrophic epidermolysis bullosa (RDEB) patients, are particularly aggressive. Owing to repeated wounding, inflammation and unproductive healing, RDEB patients have a 68% cumulative risk of developing life-threatening cSCCs by the age of 35, and a 70% risk of death by the age of 45. Despite aggressive treatment, cSCC represents the leading cause of premature mortality in these patients, highlighting an unmet clinical need. Increasing evidence points to a role of altered metabolism in the initiation and maintenance of cSCC, making metabolism a potential therapeutic target. OBJECTIVES We sought to determine the feasibility of targeting tumour cell energetics as a strategy to selectively hinder the growth advantage of aggressive cSCC. METHODS We evaluated the cell energetics profiles of RDEB-SCC cells by analysing available gene expression data against multiple gene signatures and single-gene targets linked to metabolic reprogramming. Additionally, we employed real-time metabolic profiling to measure glycolysis and respiration in these cells. Furthermore, we investigated the anti-neoplastic properties of the metformin against human and murine high-risk cSCCs in vitro and in vivo. RESULTS Gene expression analyses highlighted a divergence in cell energetics profiles between RDEB-SCC and non-malignant RDEB keratinocytes, with tumour cells demonstrating enhanced respiration and glycolysis scores. Real-time metabolic profiling supported these data and additionally highlighted a metabolic plasticity of RDEB-SCC cells. Against this background, metformin exerted an anti-neoplastic potential by hampering both respiration and glycolysis, and by inhibiting proliferation in vitro. Metformin treatment in an analogous model of fast-growing murine cSCC resulted in delayed tumour onset and slower tumour growth, translating to a 29% increase in median overall survival. CONCLUSIONS Our data indicate that metformin exerts anti-neoplastic properties in aggressive cSCCs that exhibit high-risk features by interfering with respiration and glycolytic processes.
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Affiliation(s)
- T Welponer
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - D D Weber
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - L Trattner
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - B Tockner
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - S Aminzadeh-Gohari
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - V Leb-Reichl
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - A Kaufmann
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - R Zauner
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - M Wimmer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - V Wally
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - T K Felder
- Department of Laboratory Medicine, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - D Strunk
- Cell Therapy Institute, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - U Koller
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - J W Bauer
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - B Kofler
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - C Guttmann-Gruber
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - J Piñon Hofbauer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
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Salido-Vallejo R, Escribano-Castillo L, Antoñanzas J, Roldán-Córdoba C, Velez A, Aguado-Gil L. Prognostic Outcomes of Cutaneous Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Retrospective Comparative Cohort Study. J Clin Med 2023; 12:7619. [PMID: 38137687 PMCID: PMC10744076 DOI: 10.3390/jcm12247619] [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: 11/01/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous neoplasm, and its incidence is on the rise. While most cSCCs have an excellent prognosis, certain risk factors, especially immunosuppression, have been associated with higher rates of local recurrence (LR), metastasis, and poor prognosis. This study aims to assess the risk factors for LR and metastasis development in cSCC among solid organ transplant recipients (SOTRs) and compare these rates with those in immunocompetent patients. MATERIALS AND METHODS A retrospective observational study included cSCC cases from the University Hospital Reina Sofía in Córdoba, Spain, between 2002 and 2019. Demographic, clinical, and histopathological data were collected. Local recurrence and metastasis rates were analyzed, along with progression-free survival. Univariate analyses were performed to identify prognostic factors in SOTRs. RESULTS Among 849 cSCC cases, we found higher rates of local recurrence and metastasis in tumors developed by SOTRs compared to those in immunocompetent individuals. However, no significant differences in local recurrence, metastasis, or progression-free survival were observed between the two groups. Risk factors for adverse outcomes in SOTRs included tumor size > 2 cm, depth > 4 mm, and a higher Clark level. A total of 34.4% of SOTRs developed a second primary cSCC during the follow-up. CONCLUSIONS In our study, cSCCs in SOTRs did not exhibit statistically significant differences in the rates of adverse outcomes compared to immunocompetent patients. The prognosis of cSCCs in SOTRs may be more related to other tumor-dependent risk factors than to the immunosuppression status itself. Future studies are needed to refine risk stratification and follow-up protocols to ensure the optimal management of high-risk cSCC cases, particularly among immunosuppressed patients.
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Affiliation(s)
- Rafael Salido-Vallejo
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain; (J.A.); (L.A.-G.)
- Department of Dermatology, Reina Sofía University Hospital, 14004 Córdoba, Spain;
| | | | - Javier Antoñanzas
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain; (J.A.); (L.A.-G.)
| | | | - Antonio Velez
- Department of Dermatology, Reina Sofía University Hospital, 14004 Córdoba, Spain;
| | - Leyre Aguado-Gil
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain; (J.A.); (L.A.-G.)
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Fietz S, Fröhlich A, Mauch C, de Vos-Hillebrand L, Fetter T, Landsberg J, Hoffmann F, Sirokay J. Manifestation of subacute cutaneous lupus erythematosus during treatment with anti-PD-1 antibody cemiplimab - a case report. Front Immunol 2023; 14:1324231. [PMID: 38143738 PMCID: PMC10748382 DOI: 10.3389/fimmu.2023.1324231] [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: 10/19/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The anti-programmed cell death protein 1 (PD-1) antibody cemiplimab has shown promising results in the treatment of unresectable or metastatic squamous cell carcinoma, however, frequently leads to immune-related adverse events limiting therapy efficacy. Although cutaneous side effects are common, only very few cases of cutaneous lupus erythematosus have been reported under anti-PD-1 immunotherapy. So far, no case of cutaneous lupus has been described under treatment with cemiplimab. Case report For the first time, we report the case of a patient with advanced squamous cell carcinoma, who developed clinical and histological findings in sun-exposed skin that were consistent with anti-SS-A/Ro antibody-positive subacute cutaneous lupus erythematosus (SCLE) under treatment with cemiplimab. Additionally, laboratory chemical analyses revealed a severe immune-related hepatitis without clinical symptoms. Both, the SCLE and the hepatitis, resolved after the administration of topical and systemic steroids and the discontinuation of anti-PD-1 therapy. Conclusion Treatment with cemiplimab can be associated with the appearance of cutaneous lupus erythematosus in sun-exposed areas. Application of topical and systemic glucocorticoids can lead to a rapid resolution of the skin eruptions. Moreover, our case illustrates the possibility of simultaneously occurring severe immune-related adverse events. This highlights the importance of additional diagnostics to avoid overlooking additional immune-related adverse events.
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Affiliation(s)
- Simon Fietz
- Center for Skin Diseases Bonn, University Hospital Bonn, Bonn, Germany
| | - Anne Fröhlich
- Center for Skin Diseases Bonn, University Hospital Bonn, Bonn, Germany
| | - Cornelia Mauch
- Center for Integrated Oncology, Cologne, Germany
- Center for Integrated Oncology, Bonn, Germany
| | | | - Tanja Fetter
- Center for Skin Diseases Bonn, University Hospital Bonn, Bonn, Germany
| | | | | | - Judith Sirokay
- Center for Skin Diseases Bonn, University Hospital Bonn, Bonn, Germany
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Alkhatib B, Waler A, Welch M, McCarthy J, Nam A, Friedman HI. Clinical Observation or Further Excision: A Retrospective Review of Margin-positive Squamous and Basal Cell Carcinomas. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5473. [PMID: 38111724 PMCID: PMC10727568 DOI: 10.1097/gox.0000000000005473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 12/20/2023]
Abstract
Background Patients determined to have margin-positive nonmelanoma skin cancer (NMSC) after initial shave or punch biopsy performed by a primary care physician or dermatologist are commonly referred to extirpative surgeons for definitive removal. Not infrequently, the residual tumor is not appreciable, and the exact location of the lesion is indiscernible. The consulting surgeon must decide to excise the presumed lesion or clinically monitor for recurrence. Methods This single-center, retrospective review examined patients with squamous and basal cell carcinomas referred over a 5-year period to two senior authors. Results In total, 233 patients had a total of 312 lesions excised. Thirty-nine (12.5%) of these lesions (in 33 patients) demonstrated no residual tumor on pathologic examination. Twelve patients were managed nonoperatively (5.15%) and observed to have had no tumor recurrence with a mean observation period of 14.66 months (range 1-54 months). Thus, approximately 19.3% of all patients referred had no residual tumor. Conclusion Based on our observations and low proclivity for metastases, nonoperative monitoring of NMSC may be a reasonable option for certain lesions less than 1 cm that are undiscernible at the time of referral.
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Affiliation(s)
- Bailey Alkhatib
- From the University of South Carolina School of Medicine Columbia, Columbia, S.C
| | - Alexandria Waler
- Division of Plastic Surgery Prisma Health/University of South Carolina School of Medicine
| | - Madelyn Welch
- From the University of South Carolina School of Medicine Columbia, Columbia, S.C
| | - Jack McCarthy
- Division of Plastic Surgery Prisma Health/University of South Carolina School of Medicine
| | - Arthur Nam
- Division of Plastic Surgery Prisma Health/University of South Carolina School of Medicine
| | - Harold I Friedman
- From the University of South Carolina School of Medicine Columbia, Columbia, S.C
- Division of Plastic Surgery Prisma Health/University of South Carolina School of Medicine
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Bratland Å, Munoz-Couselo E, Mortier L, Roshdy O, González R, Schachter J, Arance AM, Grange F, Meyer N, Joshi AJ, Billan S, Hughes BGM, Grob JJ, Ramakrishnan K, Ge J, Gumuscu B, Swaby RF, Gutzmer R. Health-Related Quality of Life with Pembrolizumab in Patients with Locally Advanced or Recurrent or Metastatic Cutaneous Squamous Cell Carcinoma: KEYNOTE-629. Dermatol Ther (Heidelb) 2023; 13:3165-3180. [PMID: 37943491 PMCID: PMC10689716 DOI: 10.1007/s13555-023-01059-y] [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: 08/09/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION At first interim analysis of KEYNOTE-629, health-related quality of life (HRQoL) with pembrolizumab was stable or improved over 48 weeks in recurrent or metastatic (R/M) cutaneous squamous cell carcinoma (cSCC). HRQoL results from the second interim analysis in R/M or locally advanced (LA) cSCC are presented. METHODS Patients received pembrolizumab 200 mg every 3 weeks for ≤ 2 years. Change in EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EQ-5D-5L scores were exploratory end points. Primary analysis was performed at week 12 to ensure adequate completion/compliance. Descriptive analyses were also conducted through weeks 48 and 75 for the LA and R/M cohorts, respectively. RESULTS At data cutoff (29 July 2020), mean scores in the LA cohort (n = 47) were stable from baseline to week 12 for EORTC QLQ-C30 global health status (GHS)/quality of life (QoL) (-0.27 points [95% confidence interval (CI) -10.93 to 10.39]), physical functioning (-1.29 points [95% CI -8.77 to 6.19]), and EQ-5D-5L visual analog scale (2.06 [95% CI -7.70 to 11.82]). HRQoL remained stable through week 48 in the LA cohort; 76.6% and 74.5% of patients had improved or stable GHS/QoL and physical functioning scores, respectively. HRQoL continued to show stability or improvement through week 75 in the R/M cohort (n = 99); 71.7% and 64.6% of patients had improved or stable GHS/QoL and physical functioning scores, respectively. CONCLUSIONS Pembrolizumab has demonstrated antitumor activity and manageable safety. The current analysis shows pembrolizumab treatment preserved HRQoL. Collectively, these results support pembrolizumab as standard of care for LA or R/M cSCC. TRIAL REGISTRATION ClinicalTrials.gov, NCT03284424-September 15, 2017.
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Affiliation(s)
- Åse Bratland
- Head and Neck Oncology, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
| | - Eva Munoz-Couselo
- Department of Medical Oncology, Melanoma and Other Skin Tumors Unit, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - Laurent Mortier
- Department of Dermatology, INSERM U 1189, Université Lille, Centre Hospitalier Regional Universitaire de Lille, 2, Avenue Oscar Lambret, 59037, Lille, France
| | - Osama Roshdy
- Division of Dermatology, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
| | - Rene González
- Surgical Oncology, Centro Estatal de Cancerologiade Chihuahua, C. Ejercito Mexicano 3700, 31000, Chihuahua, Mexico
| | - Jacob Schachter
- Division of Oncology, Level 2, Cancer Center (Oncology Institute), Sheba Medical Center-Tel Hashomer, Emek HaEla Street 1, 52621, Ramat Gan, Israel
| | - Ana M Arance
- Medical Oncology, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Florent Grange
- Dermatology/Oncology, CHU Reims-Hôpital Robert Debre, Avenue du General Koenig Service de Dermatologie, 51100, Reims, France
- Dermatology Department, Valence Hospital, 179 Bd Maréchal Juin, 26000, Valence, France
| | - Nicolas Meyer
- Onco-Dermatology, Institut Claudius Regaud, Institut Universitaire du Cancer and CHU, 1 Avenue Irene Joliot Curie, 31059, Toulouse, France
| | - Abhishek Jagdish Joshi
- Department of Medical Oncology, Townsville University Hospital, 55 Keane Street, Douglas, QLD, 4814, Australia
| | - Salem Billan
- Head and Neck Malignancies Unit, Rambam Health Care Campus, Technion-Israel Institute of Technology, HaAliya HaShniya St 8, 52621, Haifa, Israel
| | - Brett G M Hughes
- Oncology, Clinical Research Unit, Medical Oncology, Royal Brisbane and Women's Hospital, Butterfield Street, Ground Floor, Building 34, Herston, QLD, 4029, Australia
- Department of Oncology, University of Queensland, 308 Queen St, Brisbane, QLD, 4000, Australia
| | - Jean-Jacques Grob
- Dermatology, AIX-Marseille University and APHM Hospital Marseille, 264 Rue Saint Pierre, 13385, Marseille, France
| | | | - Joy Ge
- Medical Oncology, Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, 07065, USA
| | - Burak Gumuscu
- Medical Oncology, Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, 07065, USA
| | - Ramona F Swaby
- Medical Oncology, Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, 07065, USA
| | - Ralf Gutzmer
- Department of Dermatology, Skin Cancer Center Hannover, Hannover Medical School, Carl-Neuberg-Str. 1, 60325, Hannover, Germany
- Department of Dermatology, Johannes Wesling Medical Center Hans-Nolte-Straße 1, 32429, Minden, Germany
- Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
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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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47
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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 1: Diagnostics and prevention-Update 2023. Eur J Cancer 2023; 193:113251. [PMID: 37717283 DOI: 10.1016/j.ejca.2023.113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. Overall, cSCC mostly has very good prognosis after treatment, with 5-year cure rates greater than 90%. Despite the overall favourable prognosis and the proportionally rare deaths, cSCC is associated with a high total number of deaths due to its high incidence. A collaboration of multidisciplinary 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 Organization of Research and Treatment of Cancer (EORTC), was formed to update recommendations on cSCC, based on current literature and expert consensus. Part 1 of the guidelines addresses the updates on classification, epidemiology, diagnosis, risk stratification, staging and prevention in immunocompetent as well as immunosuppressed patients.
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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, 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, 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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48
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Morelló-Vicente A, Espejo-Marín M, Oteiza-Rius I, Antoñanzas J, Vélez A, Salido-Vallejo R. Increased Risk of Local Recurrence in Cutaneous Squamous Cell Carcinoma Arising in Sun-Exposed Skin: A Retrospective Cohort Study. Cancers (Basel) 2023; 15:5037. [PMID: 37894404 PMCID: PMC10605016 DOI: 10.3390/cancers15205037] [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: 09/18/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing over the years. Risk factors for local recurrence and metastasis have been widely studied in highly sun-exposed areas of the body but less data exist about less sun-exposed ones. The main objective of this study is to compare the risk of local recurrence and metastases in patients with cSCC in highly sun-exposed areas compared to cSCC in less sun-exposed areas. MATERIAL AND METHODS A retrospective observational study was carried out, including 558 patients with histopathologically confirmed cSCC at the Reina Sofía University Hospital (HURS), Córdoba, during the period from 1 January 2017 to 31 December 2020. Demographic, clinical and anatomopathological data were collected. RESULTS Local recurrence occurs more often in highly sun-exposed areas (15.8%) compared to less sun-exposed ones (7.4%) (p < 0.05). However, no differences in the rate of metastases in both groups were found. The presence of affected surgical margins and tumor thickness were identified as independent risk factors for cSCC in low sun-exposure areas. CONCLUSIONS cSCC located in anatomical areas of high sun exposure presented a greater risk of developing local recurrence in our population, which could suggest that these tumors have worse prognosis than those that lie in areas that do not receive chronic sun exposure.
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Affiliation(s)
- Ana Morelló-Vicente
- Dermatology Department, University Clinic of Navarra, 31008 Pamplona, Spain; (A.M.-V.); (I.O.-R.); (J.A.)
| | | | - Inés Oteiza-Rius
- Dermatology Department, University Clinic of Navarra, 31008 Pamplona, Spain; (A.M.-V.); (I.O.-R.); (J.A.)
| | - Javier Antoñanzas
- Dermatology Department, University Clinic of Navarra, 31008 Pamplona, Spain; (A.M.-V.); (I.O.-R.); (J.A.)
| | - Antonio Vélez
- Dermatology Department, Reina Sofía University Hospital, 14004 Córdoba, Spain;
| | - Rafael Salido-Vallejo
- Dermatology Department, University Clinic of Navarra, 31008 Pamplona, Spain; (A.M.-V.); (I.O.-R.); (J.A.)
- Dermatology Department, Reina Sofía University Hospital, 14004 Córdoba, Spain;
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49
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Abbotto E, Miro C, Piacente F, Salis A, Murolo M, Nappi A, Millo E, Russo E, Cichero E, Sturla L, Del Rio A, De Flora A, Nencioni A, Dentice M, Bruzzone S. SIRT6 pharmacological inhibition delays skin cancer progression in the squamous cell carcinoma. Biomed Pharmacother 2023; 166:115326. [PMID: 37611438 DOI: 10.1016/j.biopha.2023.115326] [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: 06/27/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023] Open
Abstract
Sirtuin 6 (SIRT6) has a critical role in cutaneous Squamous Cell Carcinoma (cSCC): SIRT6 silencing in skin SCC cells has pro-differentiating effects and SIRT6 deletion abrogated DMBA-TPA-induced skin tumorigenesis in mice. On the other hand, SIRT6 acts as tumor suppressor in SCC by enhancing glycolysis in tumor propagating cells. Herein, pharmacological modulation of SIRT6 deacetylase activity was investigated in cSCC, with S6 (inhibitor) or MDL-800 (activator). In cSCC cells, S6 recreated the pro-differentiating effects of SIRT6 silencing, as the levels of Keratin 1, Keratin 10 and Loricrin were upregulated compared to controls. Next, the effects of SIRT6 pharmacological modulation were evaluated in a DMBA-TPA-induced skin cancer mouse model. Mice treated with the inhibitor S6 in a preventive approach, i.e. at the beginning of the promotion stage, presented reduced number and size of papillomas, compared to the controls. The epidermal hyperproliferation marker Keratin 6 and the cSCC marker Keratin 8 were less abundant when SIRT6 was inhibited. In S6-treated lesions, the Epithelial-Mesenchymal Transition (EMT) markers Zeb1 and Vimentin were less expressed compared to untreated lesions. In a therapeutic approach, i.e. treatment starting after papilloma appearance, the S6 group presented reduced papillomas (number and size), whereas MDL-800-treated mice displayed an opposite trend. In S6-treated lesions, Keratin 6 and Keratin 8 were less expressed, EMT was less advanced, with a higher E-cadherin/Vimentin ratio, indicating a delayed carcinogenesis when SIRT6 was inhibited. Our results confirm that SIRT6 plays a role in skin carcinogenesis and suggest SIRT6 pharmacological inhibition as a promising strategy in cSCC.
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Affiliation(s)
- Elena Abbotto
- DIMES, Section of Biochemistry, University of Genova, Viale Benedetto XV, 1, 16132 Genova, Italy
| | - Caterina Miro
- Department of Clinical Medicine and Surgery, University of Napoli Federico II, Via Pansini, 5, 80131 Napoli, Italy
| | - Francesco Piacente
- DIMES, Section of Biochemistry, University of Genova, Viale Benedetto XV, 1, 16132 Genova, Italy
| | - Annalisa Salis
- DIMES, Section of Biochemistry, University of Genova, Viale Benedetto XV, 1, 16132 Genova, Italy
| | - Melania Murolo
- Department of Clinical Medicine and Surgery, University of Napoli Federico II, Via Pansini, 5, 80131 Napoli, Italy
| | - Annarita Nappi
- Department of Clinical Medicine and Surgery, University of Napoli Federico II, Via Pansini, 5, 80131 Napoli, Italy
| | - Enrico Millo
- DIMES, Section of Biochemistry, University of Genova, Viale Benedetto XV, 1, 16132 Genova, Italy
| | - Eleonora Russo
- Department of Pharmacy, University of Genova, Viale Benedetto XV, 3, 16132 Genova, Italy
| | - Elena Cichero
- Department of Pharmacy, University of Genova, Viale Benedetto XV, 3, 16132 Genova, Italy
| | - Laura Sturla
- DIMES, Section of Biochemistry, University of Genova, Viale Benedetto XV, 1, 16132 Genova, Italy
| | - Alberto Del Rio
- Innovamol Consulting Srl, Strada San Faustino 167, 41126 Modena, Italy; Institute of Organic Synthesis and Photoreactivity (ISOF), National Research Council of Italy (CNR), Via P. Gobetti 101, I-40129 Bologna, Italy
| | - Antonio De Flora
- DIMES, Section of Biochemistry, University of Genova, Viale Benedetto XV, 1, 16132 Genova, Italy
| | - Alessio Nencioni
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy.
| | - Monica Dentice
- Department of Clinical Medicine and Surgery, University of Napoli Federico II, Via Pansini, 5, 80131 Napoli, Italy
| | - Santina Bruzzone
- DIMES, Section of Biochemistry, University of Genova, Viale Benedetto XV, 1, 16132 Genova, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy.
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50
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Dessinioti C, Stratigos AJ. Immunotherapy and Its Timing in Advanced Basal Cell Carcinoma Treatment. Dermatol Pract Concept 2023; 13:dpc.1304a252. [PMID: 37992360 PMCID: PMC10656142 DOI: 10.5826/dpc.1304a252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 11/24/2023] Open
Abstract
For patients with advanced basal cell carcinoma (BCC), including locally advanced or metastatic BCC not amenable to curative surgery or radiotherapy, hedgehog pathway inhibitors (HHI) vismodegib and sonidegib are approved as first-line systemic treatment. Results from clinical trials highlight that the overall discontinuation rate of HHI treatment varies from 88% to 92% with vismodegib and is approximately 92% with sonidegib, and half of patients will discontinue HHI after approximately 8 to 12 months. The main factors weighing in on the decision to discontinue HHI include efficacy (tumor response), adverse events and patient decision. In clinical practice, some of the patients that stop HHI may be re-evaluated if the tumor becomes amenable to surgery, or restart HHI at a later time, while others will need to switch to immunotherapy, depending on the reasons for HHI discontinuation. In this review, we revisit the therapeutic decisions considering a switch from HHI to immunotherapy with anti-PD-1 agent cemiplimab and we highlight the place of cemiplimab in the therapeutic ladder for patients with advanced BCC. We discuss the evidence on the efficacy and safety of anti-PD-1 agents as second-line systemic monotherapy, or in combination with other treatments, and the emergence of checkpoint immunotherapy as a neoadjuvant treatment.
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Affiliation(s)
- Clio Dessinioti
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Alexander J Stratigos
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
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