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Yan F, Schmalbach CE. Updates in the Management of Advanced Nonmelanoma Skin Cancer. Surg Oncol Clin N Am 2024; 33:723-733. [PMID: 39244290 DOI: 10.1016/j.soc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
Basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and Merkel cell carcinoma (MCC) comprise the majority of nonmelanoma skin cancers. Advances have been made in treatment. Sentinel node biopsy should be considered for locally advanced, clinically node-negative cSCCs and MCCs. BCC patients failing traditional surgery and/or radiation are candidates for systemic hedgehog inhibitor therapy. Immune checkpoint inhibitor treatment is available for patients who failed traditional treatment with surgery and/or radiation or who are not candidates for these modalities. Specifically, cemiplimab is approved for advanced BCC; cemiplimab and pembrolizumab for advanced cSCC; and avelumab, pembrolizumab, and retifanlimab-dlwr for recurrent/metastatic MCC.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple Hospital, Philadelphia, PA, USA
| | - Cecelia E Schmalbach
- Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple Hospital, Philadelphia, PA, USA.
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2
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Gellrich FF, Laske J, Steininger J, Eberl N, Meier F, Beissert S, Hobelsberger S. Ex Vivo Confocal Microscopy Speeds up Surgical Margin Control of Re-Excised Skin Tumors and Greatly Shortens In-Hospital Stay. Cancers (Basel) 2024; 16:3209. [PMID: 39335180 PMCID: PMC11429506 DOI: 10.3390/cancers16183209] [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: 08/29/2024] [Revised: 09/08/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES To ensure that non-melanoma skin cancer (NMSC) is completely removed in healthy tissue, micrographically controlled surgery (3D histology) is often performed, which can prolong the inpatient stay. This study examined ex vivo reflectance confocal microscopy (evRCM) for perioperative assessment of surgical margins, specifically in cases where re-excision was necessary due to incomplete removal of cutaneous tumor tissue. METHODS NMSC re-excisions were evaluated using evRCM by a cutaneous surgeon, with retrospective review by an independent pathologist when results differed from histology. RESULTS evRCM demonstrated high specificity (0.96; 95% CI, 0.90-0.99) but low sensitivity (0.20; 95% CI, 0.06-0.51). Unlike pathology, which discards outer surgical margins, evRCM examined the true surgical margins. Retrospective pathology analysis of the misdiagnosed cases confirmed that 25% (n = 2/8) were false negative and 75% (n = 6/8) were potentially false positive, resulting in a sensitivity of 0.2-0.8. Notably, evRCM led to a 113-day reduction in in-hospital stays, probably resulting in increased patient satisfaction and cost-effectiveness. CONCLUSIONS evRCM was valuable for speeding up the assessment of surgical margins in patients with re-excised NMSC. Proper tissue preparation and assessment require interdisciplinary collaboration between cutaneous surgeons, pathologists, and physician assistants, emphasizing the need for standardized operating procedures.
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Affiliation(s)
- Frank Friedrich Gellrich
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Jörg Laske
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Julian Steininger
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Nadia Eberl
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Friedegund Meier
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Sarah Hobelsberger
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
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3
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Winter L, Ries J, Vogl C, Trumet L, Geppert CI, Lutz R, Kesting M, Weber M. Comparative Analysis of Inhibitory and Activating Immune Checkpoints PD-1, PD-L1, CD28, and CD86 in Non-Melanoma Skin Cancer. Cells 2024; 13:1569. [PMID: 39329753 PMCID: PMC11430031 DOI: 10.3390/cells13181569] [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: 06/05/2024] [Revised: 08/29/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024] Open
Abstract
The establishment of immunotherapy applying immune checkpoint inhibitors (ICI) has provided an important new option for the treatment of solid malignant diseases. However, different tumor entities show dramatically different responses to this therapy. BCC responds worse to anti-PD-1 ICIs as compared to cSCC. Differential immune checkpoint expression could explain this discrepancy and, therefore, the aim of this study was to analyze activating and inhibitory immune checkpoints in cSCC and BCC tissues. Tissue microarrays of the invasive front as well as the tumor core of BCC and cSCC samples were used to evaluate PD-1, PD-L1, CD28, and CD86 expression and their topographic distribution profiles by chromogenic immunohistochemistry. QuPath was used to determine the labeling index. The expression of PD-1, PD-L1, and CD28 was significantly higher in both the tumor core and the invasive front of cSCC samples as compared to BCC (p < 0.001). In addition, the ratios of PD-L1/CD86 (p < 0.001) and CD28/CD86 (p < 0.001) were significantly higher in cSCC. The invasive front of both tumor entities showed higher expression levels of all immune markers compared to the tumor core in both tumor entities. The significantly higher expression of PD-1, PD-L1, and CD28 in cSCC, along with the predominance of the inhibitory ligand PD-L1 as compared to the activating CD86 in cSCC, provide a potential explanation for the better objective response rates to anti-PD-1 immunotherapy as compared to BCC. Furthermore, the predominant site of interaction between the immune system and the tumor was within the invasive front in both tumor types.
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Affiliation(s)
- Linus Winter
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.W.); (C.V.)
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), 91052 Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), 91052 Erlangen, Germany
| | - Jutta Ries
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.W.); (C.V.)
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), 91052 Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), 91052 Erlangen, Germany
| | - Christoph Vogl
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.W.); (C.V.)
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), 91052 Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), 91052 Erlangen, Germany
| | - Leah Trumet
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.W.); (C.V.)
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), 91052 Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), 91052 Erlangen, Germany
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Carol Immanuel Geppert
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), 91052 Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), 91052 Erlangen, Germany
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.W.); (C.V.)
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), 91052 Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), 91052 Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.W.); (C.V.)
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), 91052 Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), 91052 Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.W.); (C.V.)
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Comprehensive Cancer Center Alliance WERA (CCC WERA), 91052 Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), 91052 Erlangen, Germany
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4
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Loranger N, Karn E, Wang D, Schmults C, Ruiz E. Assessing outcomes of cutaneous squamous cell carcinoma with large-calibre nerve invasion as solitary high-risk factor: A single-institution cohort study. J Eur Acad Dermatol Venereol 2024. [PMID: 39254363 DOI: 10.1111/jdv.20325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/20/2024] [Indexed: 09/11/2024]
Affiliation(s)
- Nicole Loranger
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emily Karn
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David Wang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chrysalyne Schmults
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emily Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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5
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Comune R, Ruggiero A, Portarapillo A, Villani A, Megna M, Tamburrini S, Masala S, Sica G, Sandomenico F, Bortolotto C, Preda L, Scaglione M. Cutaneous Squamous Cell Carcinoma: From Diagnosis to Follow-Up. Cancers (Basel) 2024; 16:2960. [PMID: 39272818 PMCID: PMC11394133 DOI: 10.3390/cancers16172960] [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: 07/04/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/15/2024] Open
Abstract
Cutaneous squamous cell carcinoma (SCC) is the second most frequent skin cancer, accounting for approximately 20% of all cutaneous malignancies, and with an increasing incidence due to the progressive increment of the average age of life. The diagnosis is usually firstly suspected based on clinical manifestations; however, dermoscopic features may improve diagnostic sensitivity in cases of an uncertain diagnosis and may guide the biopsy, which should be performed to histopathologically prove the tumor. New diagnostic strategies may improve the sensitivity of the cutaneous SCC, such as reflectance confocal microscopy and line-field confocal optical coherence, for which increasing data have been recently published. Imaging has a central role in the staging of the diseases, while its exact role, as well as the choice of the best techniques, during the follow-up are not fully clarified. The aim of this literature review is to describe diagnostic clinical and instrumental tools of cutaneous SCC, with an insight into the role of imaging in the diagnosis and follow-up of cutaneous SCC.
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Affiliation(s)
- Rosita Comune
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Antonio Portarapillo
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Alessia Villani
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, 80147 Naples, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, 21, 07100 Sassari, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy
| | - Fabio Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy
| | - Chandra Bortolotto
- Diagnostic Imaging and Radiotherapy Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Lorenzo Preda
- Diagnostic Imaging and Radiotherapy Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, 21, 07100 Sassari, Italy
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
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Cañueto J, Muñoz-Couselo E, Cardona-Machado C, Becerril-Andrés S, Martín-Vallejo J, Serra-Guillén C, Soria A, Serrano-Domingo JJ, Ortiz-Velez C, Lostes J, García-Castaño A, Puig S, Fernández de Misa R, Medina J, Aguado C, Ayala de Miguel P, Navarro-Navarro I, Masferrer E, Delgado M, Bellido-Hernández L, Sanmartin O. Efficacy and safety of cemiplimab in the treatment of advanced cutaneous squamous cell carcinoma: A multicentre real-world retrospective study from Spain and systematic review of the published data. J Eur Acad Dermatol Venereol 2024; 38:e666-e670. [PMID: 38308557 DOI: 10.1111/jdv.19821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Affiliation(s)
- J Cañueto
- Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - E Muñoz-Couselo
- Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - C Cardona-Machado
- Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - S Becerril-Andrés
- Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - J Martín-Vallejo
- Departamento de Estadística, Universidad de Salamanca y Unidad de Bioestadistica del IBSAL, Salamanca, Spain
| | - C Serra-Guillén
- Dermatology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - A Soria
- Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - C Ortiz-Velez
- Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Lostes
- Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - A García-Castaño
- Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - S Puig
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, IDIBAPS, CIBERER, Barcelona, Spain
| | - R Fernández de Misa
- Dermatology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - J Medina
- Medical Oncology, Hospital Virgen de la Salud, Toledo, Spain
| | - C Aguado
- Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - E Masferrer
- Dermatology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - M Delgado
- Medical Oncology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - L Bellido-Hernández
- Medical Oncology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - O Sanmartin
- Dermatology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain
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Verdaguer-Faja J, Guerra-Amor Á, Ferrándiz-Pulido C, Abril-Pérez C, Botella Estrada R, Masferrer E, Lopez-Castillo D, Deza G, Leal L, Marti-Marti I, Ruiz-Salas V, Yébenes M, Marqués Martin L, Baliu C, Castany A, Boada A, Toll A, Jaka A. Histological deep margins in cutaneous squamous cell carcinoma of the scalp and risk of recurrence. J Eur Acad Dermatol Venereol 2024. [PMID: 39036869 DOI: 10.1111/jdv.20250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Consensus is lacking on adequate deep histological margins in cutaneous squamous cell carcinoma (cSCC). Deep clearance for tumours located on the scalp is limited by anatomic constraints. OBJECTIVE To determine whether clear but close deep histological margins (<1 mm) confer a higher risk of recurrence in cSCCs of the scalp treated by wide local excision, compared to deep histological margins ≥1 mm. METHODS Multicentre retrospective observational cohort study and multivariate competing risk analysis to evaluate risk factors for recurrence. RESULTS In total, 295 patients with 338 cSCCs were included. Close deep histological margins were not associated with an increased cumulative incidence of recurrence (subhazard ratio [SHR] 1.96 [95% CI 0.87-4.41]). However, an increased risk of recurrence was observed for those tumours that presented concurrent invasion of the galea aponeurotica and close deep margins, as opposed to patients without these factors (SHR 3.52 [1.24-10.01]). Tumours with clear but close peripheral margins (<1 mm) also had higher risk of recurrence (SHR 5.01 [1.68-14.97]). LIMITATIONS Retrospective observational study based on pathology reports. CONCLUSION Deep histological margins <1 mm do not confer a greater risk of recurrence as long as the tumour is completely excised and the galea aponeurotica is not involved. Surgical excision of cSCC on the scalp should include the galea to ensure proper assessment of deep margins.
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Affiliation(s)
- Júlia Verdaguer-Faja
- Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Álvaro Guerra-Amor
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos Abril-Pérez
- Department of Dermatology, Hospital Universitario La Fe, Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Rafael Botella Estrada
- Department of Dermatology, Hospital Universitario La Fe, Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
- Universidad de Valencia, Valencia, Spain
| | - Emili Masferrer
- Department of Dermatology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | | | - Gustavo Deza
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Lorena Leal
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ignasi Marti-Marti
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Verónica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mireia Yébenes
- Department of Dermatology, Hospital Parc Taulí, Sabadell, Spain
| | | | - Carola Baliu
- Department of Dermatology, Hospital Universitari d'Igualada, Igualada, Spain
| | - Anna Castany
- Department of Dermatology, Hospital Universitari d'Igualada, Igualada, Spain
| | - Aram Boada
- Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Ane Jaka
- Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Gaudy-Marqueste C, Grob JJ, Garbe C, Ascierto PA, Arron S, Basset-Seguin N, Bohne AS, Lenoir C, Dummer R, Fargnoli MC, Guminski A, Hauschild A, Kaufmann R, Lallas A, Del Marmol V, Migden M, Penicaud M, Rembielak A, Stratigos A, Tagliaferri L, Zalaudek I, Arance A, Badinand D, Bossi P, Challapalli A, Clementi M, Di Stefani A, Ferrándiz-Pulido C, Giuffrida R, Gravina GL, Ha P, Heinzerling L, Mallet S, Paradisi A, Mohr P, Piccerillo A, Rutkowski D, Saiag P, Sollena P, Trakatelli M, Wojcieszek P, Yom SS, Zelin E, Peris K, Malvehy J. Operational classification of cutaneous squamous cell carcinomas based on unsupervised clustering of real cases by experts. J Eur Acad Dermatol Venereol 2024. [PMID: 38961704 DOI: 10.1111/jdv.20209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND There is currently no staging system for cutaneous squamous cell carcinoma (cSCC) that is adapted to decision-making and universally used. Experts have unconscious ability to simplify the heterogeneity of clinical situations into a few relevant groups to drive their therapeutic decisions. Therefore, we have used unsupervised clustering of real cases by experts to generate an operational classification of cSCCs, an approach that was successful for basal cell carcinomas. OBJECTIVE To generate a consensual and operational classification of cSCCs. METHOD Unsupervised independent clustering of 248 cases of cSCCs considered difficult-to-treat. Eighteen international experts from different specialties classified these cases into what they considered homogeneous clusters useful for management, each with freedom regarding clustering criteria. Convergences and divergences between clustering were analysed using a similarity matrix, the K-mean approach and the average silhouette method. Mathematical modelling was used to look for the best consensual clustering. The operability of the derived classification was validated on 23 new practitioners. RESULTS Despite the high heterogeneity of the clinical cases, a mathematical consensus was observed. It was best represented by a partition into five clusters, which appeared a posteriori to describe different clinical scenarios. Applicability of this classification was shown by a good concordance (94%) in the allocation of cases between the new practitioners and the 18 experts. An additional group of easy-to-treat cSCC was included, resulting in a six-group final classification: easy-to-treat/complex to treat due to tumour and/or patient characteristics/multiple/locally advanced/regional disease/visceral metastases. CONCLUSION Given the methodology based on the convergence of unguided intuitive clustering of cases by experts, this new classification is relevant for clinical practice. It does not compete with staging systems, but they may complement each other, whether the objective is to select the best therapeutic approach in tumour boards or to design homogeneous groups for trials.
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Affiliation(s)
- C Gaudy-Marqueste
- Dermatology and Skin Cancer Department, Aix-Marseille University, APHM, Marseille, France
| | - J J Grob
- Dermatology and Skin Cancer Department, Aix-Marseille University, APHM, Marseille, France
| | - C Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - P A Ascierto
- Department of Skin Cancer, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - S Arron
- Peninsula Dermatology, Burlingame, California, USA
| | | | - A S Bohne
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - C Lenoir
- Department of Dermatology, Hôpitaux Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - R Dummer
- Skin Cancer Centre at University Hospital Zurich, Zurich, Switzerland
| | - M C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Guminski
- Department of Medical Oncology, Royan North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - R Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - A Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - V Del Marmol
- Department of Dermatology, University Hospital Erasme, Universite'Libre de Bruxelles, Brussels, Belgium
| | - M Migden
- Departments of Dermatology and Head and Neck Surgery, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - M Penicaud
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, Marseille, France
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - A Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - L Tagliaferri
- Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - A Arance
- Department of Medical Oncology and IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - D Badinand
- Department of Radiotherapy Oncology, Hospital La Timone, Marseille, France
| | - P Bossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - A Challapalli
- Department of Oncology, Bristol Haematology and Oncology Centre, UHBW, Bristol, UK
| | - M Clementi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Di Stefani
- UOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Ferrándiz-Pulido
- Department of Dermatology, University Hospital Vall d'Hebron, Barcelona, Spain
- Facultad de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - R Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology - University of Messina, Messina, Italy
| | - G L Gravina
- Department of Biotechnological and Applied Clinical Sciences, Radiotherapy and Radiobiology Unit, University of L'Aquila, L'Aquila, Italy
| | - P Ha
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - L Heinzerling
- Department of Dermatology and Allergy, Ludwig-Maximilian University Hospital, LMU, Munich, Germany
| | - S Mallet
- Dermatology and Skin Cancer Department, Aix-Marseille University, APHM, Marseille, France
| | - A Paradisi
- UOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Mohr
- Department of Dermatology, Elbe-Kliniken Buxtehude, Buxtehude, Germany
| | - A Piccerillo
- UOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Rutkowski
- Department of Dermatology, Manchester Foundation Trust, Manchester, UK
| | - P Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - P Sollena
- UOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - P Wojcieszek
- Brachytherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland
| | - S S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - E Zelin
- Institute of Dermatology, Santa Maria Della Misericordia University Hospital, Udine, Italy
| | - K Peris
- UOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - J Malvehy
- Dermatology Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona and CIBER de enfermedades Raras, ICIII, Barcelona, Spain
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9
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Paganelli A, Zaffonato M, Donati B, Torricelli F, Manicardi V, Lai M, Spadafora M, Piana S, Ciarrocchi A, Longo C. Molecular and Histopathological Characterization of Metastatic Cutaneous Squamous Cell Carcinomas: A Case-Control Study. Cancers (Basel) 2024; 16:2233. [PMID: 38927938 PMCID: PMC11202054 DOI: 10.3390/cancers16122233] [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: 04/23/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND A subset of patients affected by cutaneous squamous cell carcinoma (cSCC) can exhibit locally invasive or metastatic tumors. Different staging classification systems are currently in use for cSCC. However, precise patient risk stratification has yet to be reached in clinical practice. The study aims to identify specific histological and molecular parameters characterizing metastatic cSCC. METHODS Patients affected by metastatic and non-metastatic cSCC (controls) were included in the present study and matched for clinical and histological characteristics. Skin samples from primary tumors were revised for several histological parameters and also underwent gene expression profiling with a commercially available panel testing 770 different genes. RESULTS In total, 48 subjects were enrolled in the study (24 cases, 24 controls); 67 genes were found to be differentially expressed between metastatic and non-metastatic cSCC. Most such genes were involved in immune regulation, skin integrity, angiogenesis, cell migration and proliferation. CONCLUSION The combination of histological and molecular profiles of cSCCs allows the identification of features specific to metastatic cSCC, with potential implications for more precise patient risk stratification.
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Affiliation(s)
- Alessia Paganelli
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda Unità Sanitaria Locale IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Marco Zaffonato
- Department of Dermatology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Benedetta Donati
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (B.D.); (F.T.); (V.M.); (A.C.)
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (B.D.); (F.T.); (V.M.); (A.C.)
| | - Veronica Manicardi
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (B.D.); (F.T.); (V.M.); (A.C.)
| | - Michela Lai
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (M.L.); (M.S.)
| | - Marco Spadafora
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (M.L.); (M.S.)
- Skin Cancer Center, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 40123 Reggio Emilia, Italy;
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (B.D.); (F.T.); (V.M.); (A.C.)
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
- Skin Cancer Center, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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10
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Lacerda PN, Lange EP, Luna NM, Miot HA, Abbade LPF. Efficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024; 38:1058-1069. [PMID: 38116955 DOI: 10.1111/jdv.19743] [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: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
The standard of care for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) involves excision by conventional surgery (CS) with a predefined safety margin of resection or micrographic surgery (MS) with microscopic margin control. Previous studies have reported the superiority of MS in reducing recurrences for high-risk BCC and SCC. This systematic review aimed to assess MS and CS recurrence rates by including randomized clinical trials (RCTs) and cohort studies. A systematic review and meta-analysis were conducted for related studies in PubMed, LILACS, Embase, Scopus, Web of Science, CINHAL and Cochrane until May 2023. RCTs and cohorts involving patients with BCC or SCC submitted to MS and CS were included. Risk of bias assessment followed Cochrane-recommended tools for RCTs and cohorts, and certainty of evidence followed the GRADE approach. Pooled estimates were used to determine the relative risk (RR) and absolute risk difference (RD) using a random-effects model. Seventeen studies were included, two RCTs and fifteen cohorts. There were 82 recurrences in 3050 tumours submitted to MS, with an overall recurrence rate of 3.1% (95% CI 2.0%-4.7%). For CS, there were 209 recurrences in 3453 tumours, with a recurrence rate of 5.3% (95% CI 2.9%-9.3%). The combined estimate of RR was 0.48 (95% CI 0.36-0.63), without heterogeneity nor evidence of publication bias (p > 0.3). The RD resulted in 2.9% (95% CI 1.0%-4.9%; NNT = 35). Regarding subgroup analysis, the RR for BBC was 0.37 (95% CI 0.25-0.54), and RD was 3.7% (95% CI 0.8%-6.5%; NNT = 28). For SCC, RR was 0.57 (95% CI 0.29-1.13), and RD was 1.9% (95% CI 0.8%-4.7%; NNT = 53). Among primary tumours, RR was 0.39 (95% CI 0.28-0.54), and for recurrent tumours was 0.67 (95% CI 0.30-1.50). There is moderate evidence based on two RCTs, and low evidence based on 15 cohort studies that MS is superior to CS in reducing recurrences of BCCs and primary tumours. The development of protocols that maximize the cost-effectiveness of each method in different clinical scenarios is paramount.
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Affiliation(s)
- Priscila Neri Lacerda
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Eloana Pasqualin Lange
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Natália Miranda Luna
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Hélio Amante Miot
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Luciana Patrícia Fernandes Abbade
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
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11
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Lounas M, Ylitalo L, Salmi T, Jernman J, Palve J, Luukkaala T, Korhonen N. Recent Changes in the Incidence and Characteristics of Cutaneous Squamous Cell Carcinomas in Finland from 2006 to 2020: A Retrospective Cohort Study. Acta Derm Venereol 2024; 104:adv39891. [PMID: 38813742 PMCID: PMC11161811 DOI: 10.2340/actadv.v104.39891] [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: 03/03/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
Registers recording only 1 tumour per patient do not enable assessment of the real burden of cutaneous squamous cell carcinoma. To investigate recent changes in the incidence and characteristics of tumours, a retrospective 15-year patient cohort study was performed in Finland. Histopathological diagnoses of cutaneous squamous cell carcinomas diagnosed between 2016 and 2020 were obtained from the pathology database and clinical data from patient medical records and combined with previously collected data for the years 2006-2015. Altogether 1,472 patients with 2,056 tumours were identified. The crude incidence increased from 19/100,000 persons in 2006 to 42 in 2020 (p < 0.001), increasing most in people aged over 80 years. The percentage of tumours located on the trunk increased from 5.3% during the first 5-year period, 2006-2010, to 9.0% in 2016-2020. Also, the location of tumours was significantly different between men and women, as men had more tumours on the scalp and ears, and women on the lower limbs. A slight change in the tumours from poorly to well differentiated and a decrease in the invasion depth were noted between 2006 and 2020. As the burden of tumours continues to increase, more attention should be paid to their prevention.
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Affiliation(s)
- Marika Lounas
- Department of Dermatology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Leea Ylitalo
- Department of Dermatology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teea Salmi
- Department of Dermatology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Jernman
- Department of Pathology, Tampere University and Fimlab Laboratories, Tampere, Finland
| | - Johanna Palve
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - Tiina Luukkaala
- Research, Development and Innovation Centre, Tampere University Hospital and Health Sciences, Faculty of Social Sciences, Tampere University, Finland
| | - Niina Korhonen
- Department of Dermatology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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12
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Bailly-Caillé B, Levard R, Kottler D, Dompmartin A, L'Orphelin JM. Long-term survival after anti-PD-1 discontinuation in advanced cutaneous squamous cell carcinoma (cSCC): a proof of concept of benefit of concomitant cemiplimab and radiotherapy. Cancer Immunol Immunother 2024; 73:118. [PMID: 38713217 PMCID: PMC11076421 DOI: 10.1007/s00262-024-03700-x] [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: 02/28/2024] [Accepted: 04/05/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND In a princeps study we conducted in patients with advanced cutaneous squamous cell carcinoma treated with concomitant anti-Programmed cell death protein 1 (PD-1) and radiotherapy, we demonstrated a clinico radiological response to cemiplimab that appeared to persist over time, 1 year after treatment discontinuation. METHOD We conducted a single-center descriptive study at Caen Hospital from September 1, 2021 to September 2023, in 14 patients with advanced carcinoma treated with cemiplimab until September 1, 2021. The aim of this update is to examine clinical and radiological follow-up 2 years after discontinuation of cemiplimab. RESULTS Of the 12 patients with a partial or complete response, we report 8 (66.7%) persistent responses 2 years after stopping cemiplimab, with only 2 patients progressing to distant disease, one lost to follow-up, and one death a priori unrelated to the disease. CONCLUSION Our study confirms a long-term and persistent effect despite discontinuation of cemiplimab at least up to 2 years later.
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MESH Headings
- Humans
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Skin Neoplasms/drug therapy
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Skin Neoplasms/radiotherapy
- Male
- Female
- Aged
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- Middle Aged
- Aged, 80 and over
- Immune Checkpoint Inhibitors/therapeutic use
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Follow-Up Studies
- Chemoradiotherapy/methods
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Affiliation(s)
| | - Romain Levard
- Department of Dermatology, Caen-Normandie University Hospital, 14000, Caen, France.
| | - Diane Kottler
- Department of Dermatology, Caen-Normandie University Hospital, 14000, Caen, France
| | - Anne Dompmartin
- Department of Dermatology, Caen-Normandie University Hospital, 14000, Caen, France
| | - Jean-Matthieu L'Orphelin
- Department of Dermatology, Caen-Normandie University Hospital, 14000, Caen, France.
- INSERM ANTICIPE UMR1086, Interdisciplinary Research Unit for Cancer Prevention and Treatment, Normandie University, Research Building F-14000 François 3 Avenue Général Harris, BP 45026, 14076, Caen Cedex, France.
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13
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Cariti F, Caivano F, de Robertis V, Dadduzio S, Guarino P, Barbara F, Pontillo V, Russo C, Plantone F, Barbara M. Electrochemotherapy as palliative care in patients with local or metastatic recurrence of head and neck cancer: review of state of the art. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S37-S41. [PMID: 38745515 PMCID: PMC11098543 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/28/2024] [Indexed: 05/16/2024]
Abstract
Head and neck cancers are mostly represented by squamous cell carcinoma. Despite effective treatment of primary tumours, local recurrences and metastases are frequent, with up to a 60% risk of local and 30% of distant failure. Moreover, second primary tumours sometimes occur in these patients (2-3% per year). Treatment of recurrences, metastases, and second primary tumours can be extremely challenging for Otorhinolaryngologists, especially in patients who have already been treated with radiotherapy, previous surgery, or both. Electrochemotherapy represents an effective and valid option in these cases.
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Affiliation(s)
- Francesco Cariti
- Otolaryngology and Head and Neck Unit, Ospedale “Mons. Dimiccoli”, Barletta, Italy
| | - Francesca Caivano
- Otolaryngology and Head and Neck Unit, Policlinico di Bari, Bari, Italy
| | | | - Salvatore Dadduzio
- Otolaryngology and Head and Neck Unit, Ospedale “Mons. Dimiccoli”, Barletta, Italy
| | - Pierre Guarino
- Otolaryngology and Head and Neck Unit, Ospedale Civile Santo Spirito, Pescara, Italy
| | - Francesco Barbara
- Otolaryngology and Head and Neck Unit, Policlinico di Bari, Bari, Italy
| | - Vito Pontillo
- Otolaryngology and Head and Neck Unit, Policlinico di Bari, Bari, Italy
| | - Cosimo Russo
- Otolaryngology and Head and Neck Unit, Ospedale Di Venere, Bari, Italy
| | | | - Michele Barbara
- Otolaryngology and Head and Neck Unit, Ospedale Di Venere, Bari, Italy
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14
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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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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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Verdaguer-Faja J, Toll A, Boada A, Guerra-Amor Á, Ferrándiz-Pulido C, Jaka A. Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches. Cancers (Basel) 2024; 16:664. [PMID: 38339415 PMCID: PMC10854799 DOI: 10.3390/cancers16030664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common subtype of skin cancer. The scalp is one of the most frequently affected locations and is associated with a higher rate of complications, compared to other locations. In addition, it has a characteristic thickness and anatomical structure that may influence both growth pattern and treatment of primary cSCC; while clinical peripheral margins may be easily achieved during the surgery, vertical excision of the tumor is limited by the skull. Despite having a unique anatomy, current guidelines do not contemplate specific recommendations for scalp cSCC, which leads to inconsistent decision-making in multidisciplinary committees when discussing tumors with high risk factors or with close margins. This article provides specific recommendations for the management of patients with scalp cSCC, based on current evidence, as well as those aspects in which evidence is lacking, pointing out possible future lines of research. Topics addressed include epidemiology, clinical presentation and diagnosis, imaging techniques, surgical and radiation treatments, systemic therapy for advanced cases, and follow-up. The primary focus of this review is on management of primary cSCC of the scalp with localized disease, although where relevant, some points about recurrent cSCCs or advanced disease cases are also discussed.
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Affiliation(s)
- Júlia Verdaguer-Faja
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Aram Boada
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Álvaro Guerra-Amor
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carla Ferrándiz-Pulido
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ane Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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Hamdan D, Gardair C, Pamoukdjian F, Peraldi Gardin MN, Nakouri I, Leboeuf C, Janin A, Lebbé C, Battistella M, Bousquet G. A Sub-Group of Kidney-Transplant Recipients with Highly Aggressive Squamous Cell Carcinoma Expressing Phosphorylated Serine392p53. Int J Mol Sci 2024; 25:1147. [PMID: 38256221 PMCID: PMC10816400 DOI: 10.3390/ijms25021147] [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: 11/28/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Cutaneous squamous cell carcinomas in kidney-transplant recipients are frequent, with an increasing incidence linked to long immunosuppression durations and exposure to ultraviolet radiation. p53 is at the cornerstone of ultraviolet-induced DNA damage, but the role of p53 post-translational modifications in this context is not yet deciphered. Here, we investigated the phosphorylation status of p53 at Serine 392 in 25 cutaneous squamous cell carcinomas in kidney-transplant recipients, compared with 22 non-transplanted patients. Cutaneous squamous cell carcinomas in transplanted patients occurred after a median period of 19 years of immunosuppression, with a median number of 15 cutaneous squamous cell carcinomas and more aggressive histological and clinical characteristics. There was no significant difference between Ki67, p53, and pSer392p53 expression in the two groups. Using principal component analysis, we identified a cluster of exclusively transplanted patients with a median of 23 years of immunosuppression duration, significantly more aggressive biological characteristics, and higher pSer392p53 expression. pSer392p53 was expressed in the whole tumor, suggesting an early carcinogenic event in the course of prolonged immunosuppression. This high, diffuse pSer392p53 expression, corresponding to a high level of DNA damage, might be useful to identify aggressive cutaneous squamous cell carcinomas in kidney-transplant recipients to treat them more aggressively.
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Affiliation(s)
- Diaddin Hamdan
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
- Medical Oncology Department, Hôpital La Porte Verte, F-78000 Versailles, France
| | - Charlotte Gardair
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
| | - Frédéric Pamoukdjian
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
- UFR Santé Médecine et Biologie Humaine, Campus Bobigny, Université Sorbonne Paris Nord, F-93439 Villetaneuse, France
- Geriatric Medicine Department, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, F-93000 Bobigny, France
| | - Marie-Noëlle Peraldi Gardin
- Nephrology-Renal Transplantation Department, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, F-75015 Paris, France
| | - Inès Nakouri
- Faculté de Santé, Assistance Publique-Hôpitaux de Paris Dermato-Oncology, Cancer Institute APHP. Nord Paris Cité, Institut National de la Santé et de la Recherche Médicale INSERM Unité U976, Saint Louis Hospital, Université Paris-Cite, F-75010 Paris, France
| | - Christophe Leboeuf
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
| | - Anne Janin
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
| | - Céleste Lebbé
- Faculté de Santé, Assistance Publique-Hôpitaux de Paris Dermato-Oncology, Cancer Institute APHP. Nord Paris Cité, Institut National de la Santé et de la Recherche Médicale INSERM Unité U976, Saint Louis Hospital, Université Paris-Cite, F-75010 Paris, France
| | - Maxime Battistella
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Faculté de Santé, Cancer Institute APHP. Nord Paris Cité, Institut National de la Santé et de la Recherche Médicale INSERM Unité U976, Université Paris-Cite, F-75010 Paris, France
| | - Guilhem Bousquet
- Faculté de Santé, Site Lariboisière, Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche UMR_S942 MASCOT, Université Paris-Cité, F-75006 Paris, France
- UFR Santé Médecine et Biologie Humaine, Campus Bobigny, Université Sorbonne Paris Nord, F-93439 Villetaneuse, France
- Medical Oncology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, F-93000 Bobigny, France
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