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Díaz-Calvillo P, Muñoz-Barba D, Ureña-Paniego C, Maul LV, Cerminara S, Kostner L, Martínez López A, Arias-Santiago S. Effects of COVID-19 Pandemic on the Diagnosis of Melanoma and Keratinocyte Carcinomas: a Systematic Review and Meta-analysis. Acta Derm Venereol 2024; 104:adv19460. [PMID: 38483083 PMCID: PMC10953710 DOI: 10.2340/actadv.v104.19460] [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: 09/18/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
Since December 2019, the COVID-19 pandemic has profoundly affected healthcare. The real effects of the COVID-19 pandemic on skin cancer are still unclear, more than 3 years later. This study aims to summarise the pandemic's impact on skin cancer diagnosis and outcome. A systematic review and meta-analysis was conducted, selecting studies comparing skin cancer diagnosis and prognosis post-pandemic with pre-pandemic data. A total of 27 papers were reviewed including 102,263 melanomas and 271,483 keratinocyte carcinomas. During the initial pandemic months (January-July 2020), melanoma surgeries dropped by 29.7% and keratinocyte carcinomas surgeries by 50.8%. Early pandemic tumours exhibited greater thickness and stage. In a long-term period beyond the initial months, melanoma surgeries decreased by 9.3%, keratinocyte carcinomas by 16.6%. No significant differences were observed in the Breslow thickness of melanomas after the start of the pandemic (mean difference 0.06, 95% confidence interval -0.46, 0.58). Melanomas operated on post-pandemic onset had an increased risk of ulceration (odds ratio 1.35, 95% confidence interval 1.22-1.50). Keratinocyte carcinomas showed increased thickness and worsened stage post-pandemic. However, studies included were mostly retrospective and cross-sectional, reporting diverse data. This review indicates that the pandemic likely caused delays in skin cancer diagnosis and treatment, potentially impacting patient outcomes.
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Affiliation(s)
- Pablo Díaz-Calvillo
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Daniel Muñoz-Barba
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Clara Ureña-Paniego
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Sara Cerminara
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Lisa Kostner
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland.
| | - Antonio Martínez López
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Salvador Arias-Santiago
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Department of Dermatology, University of Granada, Granada, Spain
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Díaz-Calvillo P, Sánchez-Díaz M, Rodríguez-Pozo JÁ, Martínez-Ruiz V, Martínez-López A, Arias-Santiago S. Impact of COVID-19 Pandemic on Cutaneous Squamous Cell Carcinoma: A Single-Centre Study of Epidemiologic, Clinic and Histopathological Factors. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T224-T230. [PMID: 38185206 DOI: 10.1016/j.ad.2024.01.004] [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: 07/19/2023] [Accepted: 10/12/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic may have adversely affected the early diagnosis of skin cancer. OBJECTIVE To compare epidemiological, clinical and histopathological characteristics in patients undergoing cutaneous squamous cell carcinoma (SCC) surgery before and after the beginning of the pandemic. MATERIAL & METHODS We conducted a cross-sectional study including two case series: (1) patients operated on for SCC in the year after the first state of alarm in Spain (15 March 2020), and (2) patients with SCC operated on in the previous year. Epidemiological, clinical and histopathological variables, tumour stage and risk grade were collected. RESULTS 248 patients were included (127 undergoing surgery before the pandemic and 121 after the pandemic). After the beginning of the pandemic, the percentage of high-risk SCC significantly increased from 35.3% to 46.2% (p=0.011). However, no significant differences were found in thickness, perineural invasion or metastases. CONCLUSIONS Although there has not been a significant reduction in the number of SCC operated on after the pandemic, there has been a significant increase in high-risk SCC. All this could lead to an increase in skin cancer mortality in the future.
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Affiliation(s)
- P Díaz-Calvillo
- Servicio de Dermatología, Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - M Sánchez-Díaz
- Servicio de Dermatología, Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - J Á Rodríguez-Pozo
- Servicio de Dermatología, Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - V Martínez-Ruiz
- Instituto de Investigación Biosanitaria (IBS), Granada, Spain; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - A Martínez-López
- Servicio de Dermatología, Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria (IBS), Granada, Spain.
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria (IBS), Granada, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Granada, Granada, Spain
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3
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Díaz-Calvillo P, Sánchez-Díaz M, Rodríguez-Pozo JÁ, Martínez-Ruiz V, Martínez-López A, Arias-Santiago S. Impact of COVID-19 Pandemic on Cutaneous Squamous Cell Carcinoma: A Single-Centre Study of Epidemiologic, Clinic and Histopathological Factors. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:224-230. [PMID: 37858857 DOI: 10.1016/j.ad.2023.10.003] [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: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic may have adversely affected the early diagnosis of skin cancer. OBJECTIVE To compare epidemiological, clinical and histopathological characteristics in patients undergoing cutaneous squamous cell carcinoma (SCC) surgery before and after the beginning of the pandemic. MATERIAL & METHODS We conducted a cross-sectional study including two case series: (1) patients operated on for SCC in the year after the first state of alarm in Spain (15 March 2020), and (2) patients with SCC operated on in the previous year. Epidemiological, clinical and histopathological variables, tumour stage and risk grade were collected. RESULTS 248 patients were included (127 undergoing surgery before the pandemic and 121 after the pandemic). After the beginning of the pandemic, the percentage of high-risk SCC significantly increased from 35.3% to 46.2% (p=0.011). However, no significant differences were found in thickness, perineural invasion or metastases. CONCLUSIONS Although there has not been a significant reduction in the number of SCC operated on after the pandemic, there has been a significant increase in high-risk SCC. All this could lead to an increase in skin cancer mortality in the future.
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Affiliation(s)
- P Díaz-Calvillo
- Dermatology Unit, Virgen de las Nieves University Hospital, Granada, Spain; TECe19-Investigational and Translational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - M Sánchez-Díaz
- Dermatology Unit, Virgen de las Nieves University Hospital, Granada, Spain; TECe19-Investigational and Translational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - J Á Rodríguez-Pozo
- Dermatology Unit, Virgen de las Nieves University Hospital, Granada, Spain; TECe19-Investigational and Translational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - V Martínez-Ruiz
- TECe19-Investigational and Translational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), Granada, Spain; Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
| | - A Martínez-López
- Dermatology Unit, Virgen de las Nieves University Hospital, Granada, Spain; TECe19-Investigational and Translational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), Granada, Spain.
| | - S Arias-Santiago
- Dermatology Unit, Virgen de las Nieves University Hospital, Granada, Spain; TECe19-Investigational and Translational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), Granada, Spain; Department of Dermatology, University of Granada, Granada, Spain
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Jović M, Marinković M, Suđecki B, Jurišić M, Bukumirić Z, Jovanović M, Stojičić M, Jeremić J. COVID-19 and Cutaneous Squamous Cell Carcinoma-Impact of the Pandemic on Unequal Access to Healthcare. Healthcare (Basel) 2023; 11:1994. [PMID: 37510435 PMCID: PMC10378852 DOI: 10.3390/healthcare11141994] [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: 05/29/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Most skin tumors are not fatal, but if not treated in a timely manner, they can lead to significant morbidity. Due to the COVID-19 pandemic and in order to create more capacities for the treatment of COVID-19-positive patients as well as to contain the spread of the virus, the healthcare system was reorganized worldwide, leading to decreased access to preventive screening programs. The aim of this study was to evaluate the impact of the pandemic on healthcare accessibility to cutaneous squamous cell carcinoma patients in Serbia. This retrospective study was conducted at the Clinic for Burns, Plastic, and Reconstructive Surgery, University Clinical Center of Serbia in Belgrade. Patient demographics and pathohistological findings of tumors of patients living in and outside the capital in the period before, during, and after the pandemic were compared. The two groups did not show any differences regarding the largest tumor diameter prior and during the pandemic; however, this difference became extremely noticeable after the pandemic (15 mm vs. 27 mm; p < 0.001). While cSCCs are commonly slow-growing tumors, the impact of the COVID-19 pandemic is not negligible. This study found a population at a significant risk of cSCC metastasis, with additional evidence likely to emerge in the upcoming years.
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Affiliation(s)
- Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Branko Suđecki
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Zoran Bukumirić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Leus AJG, Haisma MS, Terra JB, Diercks GFH, Van Kester MS, Halmos GB, Rácz E, Van Dijk BAC, Plaat BEC. Age-related Differences in Tumour Characteristics and Prognostic Factors for Disease Progression in Cutaneous Squamous Cell Carcinoma of the Head and Neck. Acta Derm Venereol 2022; 102:adv00652. [PMID: 34935990 PMCID: PMC9631266 DOI: 10.2340/actadv.v101.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Guidelines for cutaneous squamous cell carcinoma of the head and neck do not take the age of the patient into account, but instead assume equal tumour characteristics and prognostic factors for poor outcome in younger and elderly patients. The aim of this study was to compare tumour characteristics of younger (< 75 years) and elderly (≥ 75 years) patients and identify age-specific risk factors for progression of disease, comprising local recurrence, nodal metastasis and distant metastasis. Patient and tumour characteristics were compared using χ2 or Fisher's exact tests. Multivariable competing risk analyses were performed to compare risk factors for progression of disease, incorporating the risk of dying before developing progression of disease. A total of 672 patients with primary cutaneous squamous cell carcinoma of the head and neck were retrospectively included. Larger tumour diameter, worse differentiation grade and deeper invasion were observed in older patients. In elderly patients, but not in younger patients, tumour diameter ≥ 40 mm, moderate differentiation grade and an invasion depth ≥ 2 mm were independent risk factors for progression of disease.
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Affiliation(s)
- Alet J G Leus
- Department of Dermatology, University Medical Center Groningen, Hanzeplein 1, NL-9700 RB Groningen. The Netherlands.
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Medina-Lara A, Grigore B, Lewis R, Peters J, Price S, Landa P, Robinson S, Neal R, Hamilton W, Spencer AE. Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis. Health Technol Assess 2021; 24:1-332. [PMID: 33252328 DOI: 10.3310/hta24660] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tools based on diagnostic prediction models are available to help general practitioners diagnose cancer. It is unclear whether or not tools expedite diagnosis or affect patient quality of life and/or survival. OBJECTIVES The objectives were to evaluate the evidence on the validation, clinical effectiveness, cost-effectiveness, and availability and use of cancer diagnostic tools in primary care. METHODS Two systematic reviews were conducted to examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. Bibliographic searches were conducted on MEDLINE, MEDLINE In-Process, EMBASE, Cochrane Library and Web of Science) in May 2017, with updated searches conducted in November 2018. A decision-analytic model explored the tools' clinical effectiveness and cost-effectiveness in colorectal cancer. The model compared patient outcomes and costs between strategies that included the use of the tools and those that did not, using the NHS perspective. We surveyed 4600 general practitioners in randomly selected UK practices to determine the proportions of general practices and general practitioners with access to, and using, cancer decision support tools. Association between access to these tools and practice-level cancer diagnostic indicators was explored. RESULTS Systematic review 1 - five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 - 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools. DECISION MODEL In the absence of studies reporting their clinical outcomes, QCancer and risk assessment tools were evaluated against faecal immunochemical testing. A linked data approach was used, which translates diagnostic accuracy into time to diagnosis and treatment, and stage at diagnosis. Given the current lack of evidence, the model showed that the cost-effectiveness of diagnostic tools in colorectal cancer relies on demonstrating patient survival benefits. Sensitivity of faecal immunochemical testing and specificity of QCancer and risk assessment tools in a low-risk population were the key uncertain parameters. SURVEY Practitioner- and practice-level response rates were 10.3% (476/4600) and 23.3% (227/975), respectively. Cancer decision support tools were available in 83 out of 227 practices (36.6%, 95% confidence interval 30.3% to 43.1%), and were likely to be used in 38 out of 227 practices (16.7%, 95% confidence interval 12.1% to 22.2%). The mean 2-week-wait referral rate did not differ between practices that do and practices that do not have access to QCancer or risk assessment tools (mean difference of 1.8 referrals per 100,000 referrals, 95% confidence interval -6.7 to 10.3 referrals per 100,000 referrals). LIMITATIONS There is little good-quality evidence on the clinical effectiveness and cost-effectiveness of diagnostic tools. Many diagnostic prediction models are limited by a lack of external validation. There are limited data on current UK practice and clinical outcomes of diagnostic strategies, and there is no evidence on the quality-of-life outcomes of diagnostic results. The survey was limited by low response rates. CONCLUSION The evidence base on the tools is limited. Research on how general practitioners interact with the tools may help to identify barriers to implementation and uptake, and the potential for clinical effectiveness. FUTURE WORK Continued model validation is recommended, especially for risk assessment tools. Assessment of the tools' impact on time to diagnosis and treatment, stage at diagnosis, and health outcomes is also recommended, as is further work to understand how tools are used in general practitioner consultations. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068373 and CRD42017068375. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Bogdan Grigore
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Jaime Peters
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sarah Price
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Paolo Landa
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Richard Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Hamilton
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
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Lee J, Forrester VJ, Novicoff WM, Guffey DJ, Russell MA. Surgical delays of less than 1 year in Mohs surgery associated with tumor growth in moderately- and poorly-differentiated squamous cell carcinomas but not lower-grade squamous cell carcinomas or basal cell carcinomas: A retrospective analysis. J Am Acad Dermatol 2021; 86:131-139. [PMID: 34499990 DOI: 10.1016/j.jaad.2021.08.059] [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: 05/26/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Evidence is controversial and limited concerning whether surgical delays are associated with tumor growth for cutaneous squamous cell carcinomas (SCCs) and basal cell carcinomas. OBJECTIVE Identify tumor subpopulations that may demonstrate an association between tumor growth and surgical delay. METHODS We retrospectively analyzed 299 SCCs and 802 basal cell carcinomas treated with Mohs surgery at a single institution. Time interval from biopsy to surgery represented surgical delay. Change in major diameter (ΔMD) from size at biopsy to postoperative defect represented tumor growth. Independent predictors of ΔMD were identified by multivariate analysis. Linear regression was then utilized to assess for whether the ΔMD from these independent predictors trended with surgical delay. RESULTS Surgical delays ranged from 0 to 331 days. Among SCCs, histologic subtype and prior treatment were identified as independent predictors of ΔMD. Significant associations between ΔMD and surgical delay were found for poorly- and moderately-differentiated SCCs, demonstrating growth rates of 0.28 cm and 0.24 cm per month of delay, respectively. The ΔMD for SCCs with prior treatment and basal cell carcinoma subgroups did not vary with surgical delay. LIMITATIONS Retrospective design, single center. CONCLUSION Surgical delays of less than a year were associated with tumor growth for higher-grade SCCs, with effect sizes bearing potential for clinical significance.
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Affiliation(s)
- Jack Lee
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia.
| | - Vernon J Forrester
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia
| | - Wendy M Novicoff
- Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Darren J Guffey
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia
| | - Mark A Russell
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia
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8
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Malignant Tumours Presenting as Chronic Leg or Foot Ulcers. J Clin Med 2021; 10:jcm10112251. [PMID: 34067425 PMCID: PMC8196993 DOI: 10.3390/jcm10112251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 01/18/2023] Open
Abstract
Our purpose was to collect data on the incidence of malignant skin tumours presenting as chronic leg or foot ulcers in a tertiary centre, and to analyse the frequency and type of initial clinical misdiagnoses in these cases. A retrospective chart review of cases with melanoma or other malignant neoplasms of the skin of the lower extremity treated in a tertiary centre during January 2010 until February 2020 was conducted to identify cases that presented as chronic ulcers. Out of 673 cases, 26 (3.9%) were identified with a total of 27 malignant tumours presenting as chronic ulcers of the lower leg or foot. Therefrom, seven were diagnosed as melanoma, eight as squamous cell carcinoma, and twelve as basal cell carcinoma. The mean interval until diagnosis for all tumour types was 44.4 months (median 24 months). A delay in correct treatment occurred in 12 out of 26 cases (46%) as a result of misdiagnosis with subsequent treatment as chronic leg or foot ulcers of a different etiology. Misdiagnoses were venous ulcer, traumatic wound, mixed arterial and venous ulcer, arterial ulcer, and ulcer of an unknown origin. Malignant ulcers presenting as chronic ulcers are rare, but often lead to misdiagnosis.
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Asai Y, Nguyen P, Hanna TP. Impact of the COVID-19 pandemic on skin cancer diagnosis: A population-based study. PLoS One 2021; 16:e0248492. [PMID: 33788858 PMCID: PMC8011724 DOI: 10.1371/journal.pone.0248492] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background The COVID-19 pandemic has been unprecedented and has led to drastic reductions in non-urgent medical visits. Deferral of these visits may have critical health impact, including delayed diagnosis for melanoma and other skin cancers. We examined the influence of the pandemic on skin biopsy rates in a large population-based cohort. Methods Using a universal health care claims dataset from Ontario, we examined skin biopsies from January 6, 2020 to September 27, 2020, and compared these to the same period for 2019. Those diagnosed with anogenital cancers, younger than 20 years, residing out-of-province and with lapses in coverage were excluded. The sensitivity and specificity of claims diagnoses compared to a validated algorithm to identify keratinocyte carcinoma (KC), or to the cancer registry for melanoma was evaluated. Factors associated with biopsy during the early pandemic were investigated with modified Poisson regression. Results A precipitous drop in total skin biopsies (15% of expected), biopsies for KC (18%) and melanoma (27%) was seen with the onset of COVID-19 cases (p<0.01). Claims diagnoses were of high specificity for KC (99%), and for melanoma (98%), though sensitivity was less (61%, 28% respectively). In adjusted analysis, the elderly (80+ years), females and residents of certain regions were less likely to be biopsied during the pandemic. Subsequently, there were substantial improvements in biopsy rates over 10 weeks. However, compared to 2019, a large backlog of expected cases still remained 28 weeks after lockdown (45,710 all biopsy, 9,104 KC, 595 melanoma). Interpretation A drastic reduction in skin biopsies is noted early in the COVID-19 pandemic; this disproportionately affected the elderly, females and certain geographic regions. Though biopsies subsequently increased, a large backlog of cases remained after almost half a year. This will have implications for downstream care of skin cancer. Efforts should be made to limit diagnostic delay.
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Affiliation(s)
- Yuka Asai
- Division of Dermatology, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Paul Nguyen
- ICES at Queen’s University, Kingston, ON, Canada
| | - Timothy P. Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston, ON, Canada
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
- * E-mail:
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Tejera-Vaquerizo A, Cañueto J, Toll A, Santos-Juanes J, Jaka A, Ferrandiz C, Sanmartín O, Ribero S, Moreno-Ramírez D, Almazán F, Fuente MJ, Podlipnik S, Nagore E. Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model. ACTAS DERMO-SIFILIOGRAFICAS 2020. [PMID: 34012154 PMCID: PMC7502279 DOI: 10.1016/j.adengl.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background and objectives Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma. Material and methods Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points. Results Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter > 4 cm or thickness > 6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (> 6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five- and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months. Conclusions In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect to see to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays.
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Affiliation(s)
- A Tejera-Vaquerizo
- Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río Córdoba, Spain
| | - J Cañueto
- Servicio de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - A Toll
- Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, Spain
| | - J Santos-Juanes
- Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - A Jaka
- Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, Spain
| | - C Ferrandiz
- Servicio de Dermatología, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
| | - S Ribero
- Departamento de Dermatología, Hospital Universitario de Turín, Turín, Italy
| | - D Moreno-Ramírez
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - F Almazán
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - M J Fuente
- Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, Spain
| | - S Podlipnik
- Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, Spain
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
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11
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Yahyaoui M, Abbassi N, Derfoufi A, Daoudi A, Agoumi O, Yacoubi H, Najib A, Serji B, Elharroudi T, Mouzouri N, Dikhaye S, Zizi N, Hadjkacem H. Giant squamous cell carcinomas of the shoulder. Pan Afr Med J 2020; 36:215. [PMID: 32963681 PMCID: PMC7490140 DOI: 10.11604/pamj.2020.36.215.11644] [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: 01/13/2017] [Accepted: 01/21/2017] [Indexed: 11/11/2022] Open
Abstract
Giant squamous cell carcinomas (SCC) larger than 5 cm in diameter are uncommon; there is no guideline on the size of an SCC that is considered giant. Treatment may be difficult with the need for large tissue resections and complex surgical reconstruction. We report a rare case of giant squamous cell carcinoma of the shoulder attached to deep anatomic planes. The entire mass was removed, resulting in a large defect that was repaired with myocutaneous flap rotation of the latissimus dorsi. Three courses of radiotherapy were performed after surgery. Fifteen months after the operation, the patient is well and working without any local recurrence and metastasis.
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Affiliation(s)
- Mounir Yahyaoui
- Trauma-Orthopedics Service, University Hospital Mohammed VI, Oujda, Morocco
| | - Najib Abbassi
- Trauma-Orthopedics Service, University Hospital Mohammed VI, Oujda, Morocco
| | | | - Abdelkarim Daoudi
- Trauma-Orthopedics Service, University Hospital Mohammed VI, Oujda, Morocco
| | - Omar Agoumi
- Trauma-Orthopedics Service, University Hospital Mohammed VI, Oujda, Morocco
| | - Hicham Yacoubi
- Trauma-Orthopedics Service, University Hospital Mohammed VI, Oujda, Morocco
| | - Abdeljaouad Najib
- Trauma-Orthopedics Service, University Hospital Mohammed VI, Oujda, Morocco
| | - Badr Serji
- Oncology Surgery Service, University Hospital, Mohammed VI, Oujda, Morocco
| | - Tijjani Elharroudi
- Oncology Surgery Service, University Hospital, Mohammed VI, Oujda, Morocco
| | - Nabil Mouzouri
- Dermatology Service, University Hospital Mohammed VI, Oujda, Morocco
| | - Siham Dikhaye
- Dermatology Service, University Hospital Mohammed VI, Oujda, Morocco
| | - Nada Zizi
- Dermatology Service, University Hospital Mohammed VI, Oujda, Morocco
| | - Hanane Hadjkacem
- Radiology Service, University Hospital Mohammed VI, Oujda, Morocco
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12
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Baumann BC, MacArthur KM, Brewer JD, Mendenhall WM, Barker CA, Etzkorn JR, Jellinek NJ, Scott JF, Gay HA, Baumann JC, Manian FA, Devlin PM, Michalski JM, Lee NY, Thorstad WL, Wilson LD, Perez CA, Miller CJ. Management of primary skin cancer during a pandemic: Multidisciplinary recommendations. Cancer 2020; 126:3900-3906. [PMID: 32478867 PMCID: PMC7301000 DOI: 10.1002/cncr.32969] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Abstract
During the coronavirus disease 2019 (COVID‐19) pandemic, providers and patients must engage in shared decision making regarding the pros and cons of early versus delayed interventions for localized skin cancer. Patients at highest risk of COVID‐19 complications are older; are immunosuppressed; and have diabetes, cancer, or cardiopulmonary disease, with multiple comorbidities associated with worse outcomes. Physicians must weigh the patient's risk of COVID‐19 complications in the event of exposure against the risk of worse oncologic outcomes from delaying cancer therapy. Herein, the authors have summarized current data regarding the risk of COVID‐19 complications and mortality based on age and comorbidities and have reviewed the literature assessing how treatment delays affect oncologic outcomes. They also have provided multidisciplinary recommendations regarding the timing of local therapy for early‐stage skin cancers during this pandemic with input from experts at 11 different institutions. For patients with Merkel cell carcinoma, the authors recommend prioritizing treatment, but a short delay can be considered for patients with favorable T1 disease who are at higher risk of COVID‐19 complications. For patients with melanoma, the authors recommend delaying the treatment of patients with T0 to T1 disease for 3 months if there is no macroscopic residual disease at the time of biopsy. Treatment of tumors ≥T2 can be delayed for 3 months if the biopsy margins are negative. For patients with cutaneous squamous cell carcinoma, those with Brigham and Women's Hospital T1 to T2a disease can have their treatment delayed for 2 to 3 months unless there is rapid growth, symptomatic lesions, or the patient is immunocompromised. The treatment of tumors ≥T2b should be prioritized, but a 1‐month to 2‐month delay is unlikely to worsen disease‐specific mortality. For patients with squamous cell carcinoma in situ and basal cell carcinoma, treatment can be deferred for 3 months unless the individual is highly symptomatic. During the coronavirus disease 2019 (COVID‐19) pandemic, providers must help patients to make informed decisions regarding skin cancer management and assess the risk of potential COVID‐19–associated morbidity and/or mortality versus primary skin cancer morbidity and/or mortality. In this article, the authors summarize current data regarding the risk of COVID‐19 complications and mortality based on age and comorbidities, and review the literature assessing how treatment delays affect oncologic outcomes. They provide multidisciplinary recommendations regarding the timing of local therapy for patients with early‐stage skin cancers.
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Affiliation(s)
- Brian C Baumann
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly M MacArthur
- Division of Dermatologic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jerry D Brewer
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida at Gainesville, Gainesville, Florida, USA
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeremy R Etzkorn
- Division of Dermatologic Surgery, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nathaniel J Jellinek
- Dermatology Professionals Inc, East Greenwich, Rhode Island, USA.,Division of Dermatologic Surgery, Department of Dermatology, Brown University, Providence, Rhode Island, USA.,Division of Dermatologic Surgery, Department of Dermatology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Jeffrey F Scott
- Division of Dermatologic Surgery, Department of Dermatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - John C Baumann
- Princeton Radiation Oncology, Princeton, New Jersey, USA
| | - Farrin A Manian
- Department of Internal Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Phillip M Devlin
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut, USA
| | - Carlos A Perez
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christopher J Miller
- Division of Dermatologic Surgery, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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[Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model]. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:629-638. [PMID: 32513393 PMCID: PMC7211725 DOI: 10.1016/j.ad.2020.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 01/17/2023] Open
Abstract
Antecedentes y objetivos La pandemia del coronavirus SARS-CoV-2 ha provocado un confinamiento indefinido. Una posible consecuencia de esta situación es un retraso en los procedimientos asistenciales de las enfermedades oncológicas. El objetivo de este estudio es estimar el hipotético impacto en la supervivencia que tendría el aumento del tamaño tanto para los carcinomas de células escamosas (CCE) como de los melanomas. Material y método Estudio observacional retrospectivo de cohorte multicéntrico. Se desarrolló un modelo de crecimiento exponencial para cada tumor basado en el tiempo de evolución que refiere el paciente. Resultados Se incluyeron un total de 200 pacientes con CCE localizados en la cabeza y el cuello y 1.000 pacientes con melanoma cutáneo. Se calculó una curva de crecimiento exponencial para cada tumor y se estimó el tamaño del tumor tras 1, 2 y 3 meses tras el diagnóstico. En la muestra, los CCE mayores de 4 cm o > 6 mm de grosor (definidos como T3) pasaron de 83 (41,5%) en el grupo de estudio real a una estimación del 58,5, 70,5 y 72% tras 1, 2 y 3 meses de retraso quirúrgico estimado, respectivamente. Se estimó una disminución de la supervivencia específica de enfermedad (SEE) de un 6,2, 8,2 y 5,2% a los 2, 5 y 10 años, respectivamente, tras 3 meses de retraso. Para los melanomas ultragruesos (> 6 mm de Breslow) pasaron del 6,9% en el grupo de estudio al 21,9, 30,2 y 30,2% tras 1, 2 y 3 meses de demora. La SEE a los 5 y 10 años del grupo de estudio descendió un 14,4% en ambos tiempos. Conclusiones En ausencia de un adecuado diagnóstico y tratamiento de los pacientes con CCE y melanoma en la actual situación de confinamiento en España, podemos llegar a asistir a un considerable aumento de los casos de CCE y melanomas gruesos y de gran tamaño. Se deben fomentar los esfuerzos para promocionar la autoexploración y facilitar el acceso a los dermatólogos para no aumentar la demora de estos pacientes.
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14
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Giuffrida R, Conforti C, Schmid K, Deinlein T, Zalaudek I. Rate of growth-A novel surrogate marker for high-risk cutaneous squamous cell carcinoma? A case report and review of the literature. Dermatol Ther 2019; 33:e13156. [PMID: 31688974 DOI: 10.1111/dth.13156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is one of the most common nonmelanoma skin cancer worldwilde, with a more invasive growth pattern and higher potential to metastatize than basal cell carcinoma. Although several risk factors have been linked to a high metastatic potential of cSCC, no widely accepted classification system for this common subtype of cancer exists. Herein we report an emblematic case of rapidly growing and metastatic cSCC and discuss the rate of growth of the tumour (ROG) as novel prognostic high risk surrogate marker.
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Affiliation(s)
- Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Karin Schmid
- Institute of Physiology, Medical University of Graz, Austria
| | - Teresa Deinlein
- Department of Dermatology and Venereology, Medical University of Graz, Austria
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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15
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Cañueto J, Martín-Vallejo J, Cardeñoso-Álvarez E, Fernández-López E, Pérez-Losada J, Román-Curto C. Rapid growth rate is associated with poor prognosis in cutaneous squamous cell carcinoma. Clin Exp Dermatol 2018; 43:876-882. [PMID: 29756221 DOI: 10.1111/ced.13570] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) represents the most common form of skin cancer after basal cell carcinoma, and can be both locally invasive and metastatic to distant sites. Growth rate (GR) has been poorly evaluated in cSCC, despite clinical evidence suggesting that GR is an important risk factor in cSCC. AIM To analyse the influence of GR in cSCC prognosis. METHODS We retrospectively evaluated GR in a series of 90 cSCCs and tried to correlate GR with prognosis in cSCC. RESULTS We demonstrated that tumours with a GR of > 4 mm/month exhibit a higher risk of nodal progression and a shorter progression time to lymph node metastasis in cSCC than those with GR of < 4 mm/month. As expected, GR correlated with tumour proliferation, as determined by Ki-67 expression. CONCLUSIONS We consider a GR of 4 mm/month as the cutoff point that distinguishes between rapid- and slow-progressing tumours and, more importantly, to identify a subset of high-risk cSCCs.
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Affiliation(s)
- J Cañueto
- Department of Dermatology, Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain.,Institute of Biomedical Medicine of Salamanca (IBSAL), Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain
| | - J Martín-Vallejo
- Department of Statistics, Facultad de Medicina, Universidad de Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - E Cardeñoso-Álvarez
- Department of Dermatology, Hospital Virgen de la Concha, Avenida de Requejo, Zamora, Spain
| | - E Fernández-López
- Department of Dermatology, Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain.,Institute of Biomedical Medicine of Salamanca (IBSAL), Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain
| | - J Pérez-Losada
- Institute of Biomedical Medicine of Salamanca (IBSAL), Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain.,Institute of Molecular and Cellular Cancer Biology (IBMCC), Centro de investigación del Cáncer (CIC), Instituto Mixto Universidad de Salamanca/CSIC, Campus Miguel de Unamuno, Salamanca, Spain
| | - C Román-Curto
- Department of Dermatology, Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain.,Institute of Biomedical Medicine of Salamanca (IBSAL), Hospital Universitario de Salamanca, Paseo de San Vicente, Salamanca, Spain
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16
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Mayo E, Sharma S, Horne J, Yuen H, Lee A, Gulati A. Squamous cell carcinoma of the pinna: which histological features could be used to predict prognosis? Br J Oral Maxillofac Surg 2017; 55:524-529. [DOI: 10.1016/j.bjoms.2017.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
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17
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Association Between Mohs Surgery Wait Times and Surgical Defect Size in Patients With Squamous Cell or Basal Cell Carcinoma of the Skin. Dermatol Surg 2015; 41:768-74. [DOI: 10.1097/dss.0000000000000378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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18
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Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, Macleod U, Mitchell ED, Pickett M, Rai T, Shaw K, Stuart N, Tørring ML, Wilkinson C, Williams B, Williams N, Emery J. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015; 112 Suppl 1:S92-107. [PMID: 25734382 PMCID: PMC4385982 DOI: 10.1038/bjc.2015.48] [Citation(s) in RCA: 630] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. METHODS Systematic review of the literature and narrative synthesis. RESULTS We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. CONCLUSIONS This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
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Affiliation(s)
- R D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - P Tharmanathan
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - B France
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - N U Din
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - S Cotton
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - J Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - W Hamilton
- University of Exeter Medical School, Exeter EX1 2LU, UK
| | - A Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - M Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - R Lewis
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - U Macleod
- Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - E D Mitchell
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - M Pickett
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - T Rai
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - K Shaw
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Stuart
- School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK
| | - M L Tørring
- Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark
| | - C Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - B Williams
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - J Emery
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia
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19
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Kricker A, Armstrong B, Hansen V, Watson A, Singh-Khaira G, Lecathelinais C, Goumas C, Girgis A. Basal cell carcinoma and squamous cell carcinoma growth rates and determinants of size in community patients. J Am Acad Dermatol 2013; 70:456-64. [PMID: 24373780 DOI: 10.1016/j.jaad.2013.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 11/05/2013] [Accepted: 11/07/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cutaneous basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) have poorer outcomes if treated when large. OBJECTIVE We sought to estimate the growth rate of BCCs and SCCs and examine the relationship of personal, pathway, and cancer factors with cancer size (diameter). METHODS We surveyed patients, pathology, and treatment for invasive BCCs and SCCs in 1 Australian region in 2000 through 2001. RESULTS BCC size increased with increasing time since first noticed. Relative to mean size at 0 to 2 months, the mean size ratio was 1.10 at 2 to 8 months and increased steadily to 1.81 at 5 to 10 years (P < .001). Few BCCs were untreated beyond 10 years. There was no consistent evidence that SCC size increased with increasing time. Larger BCCs were independently associated with older age, male sex, no skin checks by a physician, aggressive tumor type, ulceration and lesion-associated scar tissue, and larger SCCs with male sex, skin checks by a physician every 1 to 3 months, and location on limbs. LIMITATIONS Patient recall of dates and lack of thickness for SCCs are limitations. CONCLUSION Earlier diagnosis of BCCs, perhaps through skin checks by a physician, may reduce their size and improve outcome. SCC size did not evidently increase with time.
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Affiliation(s)
- Anne Kricker
- Sydney School of Public Health, University of Sydney, Sydney, Australia.
| | - Bruce Armstrong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Vibeke Hansen
- University Center for Rural Health, University of Sydney, Lismore, Australia
| | - Alan Watson
- Royal Newcastle Center, Newcastle, Australia
| | | | | | - Chris Goumas
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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20
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Grelck K, Sukal S, Rosen L, Suciu GP. Incidence of residual nonmelanoma skin cancer in excisions after shave biopsy. Dermatol Surg 2012; 39:374-80. [PMID: 23279620 DOI: 10.1111/dsu.12056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nonmelanoma skin cancer is an increasingly common disease that is typically treated surgically. After histopathologic confirmation by biopsy, the carcinoma is typically removed by excision, but not all excisional specimens contain residual carcinoma. OBJECTIVES To define the rate of residual basal and squamous cell carcinomas within excisional specimens after shave biopsy in a general dermatology office. METHODS We retrospectively reviewed 439 consecutive cases sent to a single dermatopathology lab from a practitioner's general dermatology office who also performs Mohs micrographic surgery. One hundred cases had a histopathologically proven carcinoma on biopsy with subsequent excision. Histopathologic type, location, age, sex, and time from biopsy to excision were all analyzed for statistical association. RESULTS Of 57 cases of basal cell carcinoma, 34 (59.6%) had positive residuals. Of 43 cases of squamous cell carcinoma, 12 (27.9%) had positive residuals. Histologic type was significantly associated (p = .002) with residual carcinoma in excisional specimens, with basal cells 2.13 times as likely to have residual carcinoma present. CONCLUSION The rate of residual nonmelanoma carcinoma in excision specimens after shave biopsy was found to be different from previously reported in the literature. These data may have therapeutic ramifications if further substantiated.
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Affiliation(s)
- Kurt Grelck
- Dermatology Associates of Wisconsin, Stevens Point, WI 54482, USA.
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21
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A metastasizing squamous cell carcinoma arising in a solitary epidermal nevus. Case Rep Dermatol Med 2012; 2012:109632. [PMID: 23259077 PMCID: PMC3504205 DOI: 10.1155/2012/109632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 05/29/2012] [Indexed: 11/18/2022] Open
Abstract
Aim. Secondary tumor rarely develops from epidermal nevus. We present a case of a metastasizing squamous cell carcinoma that developed in a solitary epidermal nevus. Case Report. An 82-years old Japanese female was presented with a red tumor on the left axilla. She reported that the tumor developed in a congenital epidermal nevus. A biopsy of the tumor showed that a well-differentiated squamous cell carcinoma (SCC) arose from the epidermal nevus. As a lymph node metastasis was found by sentinel lymph node biopsy, the patient received surgical excision of the lesion, axillary lymph node dissection, and postoperative radiation. Discussion. Secondary tumors developing in epidermal nevus are rare. To the best of our knowledge, only in two cases including the present case, SCC developed in a solitary epidermal nevus. There is no established clinical guideline for prophylactic removal of epidermal nevus. However, a biopsy should be done if a secondary malignancy is suspected in an epidermal nevus.
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22
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Endo Y, Tanioka M, Miyachi Y. Prognostic factors in cutaneous squamous cell carcinoma: is patient delay in hospital visit a predictor of survival? ISRN DERMATOLOGY 2011; 2011:285289. [PMID: 22363846 PMCID: PMC3262535 DOI: 10.5402/2011/285289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 09/22/2011] [Indexed: 11/23/2022]
Abstract
The patient's delay in the visit to a hospital seems to play an important role in prognosis in invasive cutaneous squamous cell carcinoma (SCC). This report explored prognostic factors of cutaneous SCC focusing on patient delay in hospital visit. Data of 117 Japanese patients who were treated for invasive cutaneous SCC in our facility between 2000 and 2010 were used for analysis. A multivariate Cox proportional-hazard modelling revealed that a pair of TNM stage (hazard ratio, 5.0; 95% CI, 1.8 to 13.9) and poorer histological differentiation (hazard ratio, 3.2; 95% CI, 0.93 to 10.3), and a pair of tumour size (hazard ratio, 1.02; 95% CI, 1.004 to 1.04) and rapid growth (hazard ratio, 8.25; 95% CI, 1.29 to 52.7) were a prognostic factor whereas patient delay in hospital visit was not. However, patient delay in hospital visit was correlated with larger tumour size.
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Affiliation(s)
- Y Endo
- Department of Dermatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Renzi C, Mastroeni S, Mannooranparampil TJ, Passarelli F, Pasquini P. Timely diagnosis of cutaneous squamous cell carcinoma: the GP's role. Fam Pract 2011; 28:277-9. [PMID: 21127020 DOI: 10.1093/fampra/cmq103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (SCC) is the second most frequent skin cancer among Caucasians. Advanced cases determine significant tissue destruction and they can metastasize. OBJECTIVES To evaluate the role of GPs in timely diagnosis of SCC, examining the probability of delay before the diagnosis and treatment of SCC among patients having first seen a GP compared to patients having accessed directly a dermatologist. METHODS We included a stratified sample of 308 SCC patients treated at a referral center in Italy. Medical records were reviewed and combined with patient interviews. RESULTS Multivariable analysis has shown that patients who have first seen a GP have a significantly lower likelihood of long patient delay [odds ratio (OR) = 0.45; 95% confidence interval (95% CI) 0.21-0.94; P = 0.04) compared to patients having accessed directly a dermatologist. Treatment delay was not associated with the specialization of the first doctor seen for the lesion (OR = 0.52; 95% CI 0.15-1.84; P = 0.31). CONCLUSION Our findings highlight the potential role of the GP in facilitating rapid access to appropriate health care.
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Affiliation(s)
- Cristina Renzi
- Clinical Epidemiology Unit, Istituto Dermopatico dell’Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy.
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Renzi C, Mastroeni S, Mannooranparampil TJ, Passarelli F, Potenza C, Pasquini P. Reliability of self-reported information on skin cancer among elderly patients with squamous cell carcinoma. Ann Epidemiol 2011; 21:551-4. [PMID: 21524593 DOI: 10.1016/j.annepidem.2011.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 02/02/2011] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to evaluate reliability of self-reported information on skin cancer among individuals aged > 65 years with cutaneous squamous cell carcinoma (SCC). METHODS A test-retest was performed with patients completing two questionnaires one month apart. RESULTS Among 102 recruited patients the response rate was 97.1% (mean age 80.9 years, 74.8% men). The majority of items showed substantial agreement: history of skin cancer screening (k = 0.88), past skin cancer in general (k = 0.92), basal cell carcinoma (k = 0.75), patient delay (k = 0.64) and total delay (k = 0.86). Agreement was high also for ages > 80 years. Recall of past SCCs (k = 0.48) and sunscreen use (k = 0.38) was less accurate. CONCLUSIONS Our study provided evidence on the reliability of patient reported skin cancer information among elderly individuals, who represent the majority of affected cases.
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Affiliation(s)
- Cristina Renzi
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy
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