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Dettrick A, Foden N, Hogan D, Azer M, Blazak J, Atwell D, Buddle N, Min M, Livingston R, Banney L, Donkin R. The hidden Australian skin cancer epidemic, high-risk cutaneous squamous cell carcinoma: a narrative review. Pathology 2024; 56:619-632. [PMID: 38871593 DOI: 10.1016/j.pathol.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
Deaths from non-melanoma skin cancers (NMSCs) have almost doubled in Australia in recent years. Cutaneous squamous cell carcinoma (cSCC) constitutes approximately 20% of NMSCs, but is responsible for most of the deaths. Most skin cancers are easy to diagnose and treat and therefore cSCC are often trivialised; however, there is a high-risk subgroup of cSCC (HRcSCC) that is associated with a high risk of metastasis and death. The definition of early HRcSCC and our ability to identify them is evolving. Many significant prognostic factors have been identified, but a universally accepted prognostic index does not exist. Guidelines for workup, treatment, and follow-up leave many important decisions open to broad interpretation by the treating physician or multidisciplinary team. Some of the treatments used for metastatic cSCC are not supported by robust evidence and the prognosis of metastatic cSCC is guarded. In this review, we highlight the rapid rise in NMSC deaths and discuss some of the deficiencies in our knowledge of how to define, diagnose, stage, and manage HRcSCC.
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Affiliation(s)
- Andrew Dettrick
- Anatomical Pathology, Pathology Queensland, Sunshine Coast, Qld, Australia; School of Health, University of the Sunshine Coast, Qld, Australia.
| | - Neil Foden
- Ear, Nose and Throat, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - David Hogan
- Ear, Nose and Throat, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Mary Azer
- Medical Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - John Blazak
- Radiology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Daisy Atwell
- Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Nicole Buddle
- Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Myo Min
- School of Health, University of the Sunshine Coast, Qld, Australia; Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Sunshine Coast, Qld, Australia
| | - Ryan Livingston
- Plastic Surgery, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Leith Banney
- Dermatology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Rebecca Donkin
- School of Health, University of the Sunshine Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Sunshine Coast, Qld, Australia
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Thakker S, Yousefzadeh N, Al‐Mondhiry J. Pseudoprogression of cutaneous squamous cell carcinoma invading the super vermillion border following programmed death-1 inhibitor monotherapy. SKIN HEALTH AND DISEASE 2024; 4:e400. [PMID: 39104642 PMCID: PMC11297434 DOI: 10.1002/ski2.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/04/2024] [Accepted: 05/18/2024] [Indexed: 08/07/2024]
Abstract
A 55-year-old woman with a moderately differentiated cutaneous squamous cell carcinoma (cSCC) of the upper lip experienced initial tumour growth and new lymphadenopathy after starting immunotherapy with Cemiplimab, but achieved complete remission with no adverse events after five infusions. This case underscores the potential of immunotherapy for cSCC in sensitive head and neck areas and illustrates the phenomenon of pseudoprogression, where apparent tumour growth can occur before clinical improvement.
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Affiliation(s)
- Sach Thakker
- Georgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
| | | | - Jafar Al‐Mondhiry
- Inova Schar Cancer InstituteFairfaxVirginiaUSA
- University of Virginia School of MedicineCharlottesvilleVirginiaUSA
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3
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Gilmore A, Castillo B, Golda N, Braudis K, Smith E. Postoperative permanent section evaluation of Mohs micrographic surgery debulk specimens does not result in upstaging of cutaneous squamous cell carcinoma compared to stage at the completion of surgery: A retrospective case series. JAAD Int 2024; 15:100-104. [PMID: 38500871 PMCID: PMC10945241 DOI: 10.1016/j.jdin.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 03/20/2024] Open
Abstract
Background Mohs micrographic surgery (MMS) is used for the treatment of high-risk cutaneous squamous cell carcinoma (cSCC). MMS examines the surgical margins in real time and does not commonly examine the central component of the tumor. Objective To determine if debulk specimens provide additional details relevant to tumor staging not gained from routine MMS. Methods A retrospective chart review of debulk specimens taken during MMS for cSCC was performed. Dermatopathology reports were analyzed and tumors were staged using Brigham and Women's Hospital and American Joint Committee on Cancer's 8th edition staging systems. Results Permanent section evaluation of debulk specimens did not result in clinically meaningful information for staging that could not be gained from MMS layers or initial biopsy analysis. Limitations A single institution, and a small sample size of 39 tumors. Conclusions Evaluation of debulk specimens during MMS may not always be an effective use of time or health care resources.
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Affiliation(s)
- Andrea Gilmore
- Department of Dermatology, University of Missouri Columbia, Columbia, Missouri
| | - Brianna Castillo
- Department of Dermatology, University of Arizona, Tuscon, Arizona
| | | | - Kara Braudis
- Department of Dermatology, University of Missouri Columbia, Columbia, Missouri
| | - Emily Smith
- Department of Dermatology, Saint Louis University, St. Louis, Missouri
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Alexander MH, Cousins WJ, Ewen T, South AP, Lovat P, Stefanos N. The combined immunohistochemical expression of AMBRA1 and SQSTM1 identifies patients with poorly differentiated cutaneous squamous cell carcinoma at risk of metastasis: A proof of concept study. J Cutan Pathol 2024; 51:450-458. [PMID: 38421158 DOI: 10.1111/cup.14590] [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: 07/12/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) incidence continues to increase globally with, as of yet, an unmet need for reliable prognostic biomarkers to identify patients at increased risk of metastasis. The aim of the present study was to test the prognostic potential of the combined immunohistochemical expression of the autophagy regulatory biomarkers, AMBRA1 and SQSTM1, to identify high-risk patient subsets. METHODS A retrospective cohort of 68 formalin-fixed paraffin-embedded primary cSCCs with known 5-year metastatic outcomes were subjected to automated immunohistochemical staining for AMBRA1 and SQSTM1. Digital images of stained slides were annotated to define four regions of interest: the normal and peritumoral epidermis, the tumor mass, and the tumor growth front. H-score analysis was used to semi-quantify AMBRA1 or SQSTM1 expression in each region of interest using Aperio ImageScope software, with receiver operator characteristics and Kaplan-Meier analysis used to assess prognostic potential. RESULTS The combined loss of expression of AMBRA1 in the tumor growth front and SQSTM1 in the peritumoral epidermis identified patients with poorly differentiated cSCCs at risk of metastasis (*p < 0.05). CONCLUSIONS Collectively, these proof of concept data suggest loss of the combined expression of AMBRA1 in the cSCC growth front and SQSTM1 in the peritumoral epidermis as a putative prognostic biomarker for poorly differentiated cSCC.
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Affiliation(s)
- Michael H Alexander
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle Helix, Newcastle upon Tyne, Newcastle upon Tyne, UK
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William J Cousins
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle Helix, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Tom Ewen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle Helix, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Andrew P South
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Penny Lovat
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle Helix, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Niki Stefanos
- Cellular Pathology, Addenbrookes Hospital, Cambridge, UK
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Li Y, Tai Z, Ma J, Miao F, Xin R, Shen C, Shen M, Zhu Q, Chen Z. Lycorine transfersomes modified with cell-penetrating peptides for topical treatment of cutaneous squamous cell carcinoma. J Nanobiotechnology 2023; 21:139. [PMID: 37118807 PMCID: PMC10148442 DOI: 10.1186/s12951-023-01877-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/30/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Topical anticancer drugs offer a potential therapeutic modality with high compliance for treating cutaneous squamous cell carcinoma (cSCC). However, the existing topical treatments for cSCC are associated with limited penetrating ability to achieve the desired outcome. Therefore, there remains an urgent requirement to develop drugs with efficient anticancer activity suitable for treating cSCC and to overcome the skin physiological barrier to improve the efficiency of drug delivery to the tumor. RESULTS We introduced lycorine (LR) into the topical treatment for cSCC and developed a cell-penetrating peptide (CPP)-modified cationic transfersome gel loaded with lycorine-oleic acid ionic complex (LR-OA) (LR@DTFs-CPP Gel) and investigated its topical therapeutic effects on cSCC. The anti-cSCC effects of LR and skin penetration of LR-OA transfersomes were confirmed. Simultaneously, cationic lipids and modification of R5H3 peptide of the transfersomes further enhanced the permeability of the skin and tumor as well as the effective delivery of LR to tumor cells. CONCLUSIONS Topical treatment of cSCC-xenografted nude mice with LR@DTFs-CPP Gel showed effective anticancer properties with high safety. This novel formulation provides novel insights into the treatment and pathogenesis of cSCC.
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Affiliation(s)
- Ying Li
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai, 200443, China
- Shanghai Engineering Research Center for Topical Chinese Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai, 200443, China
- Shanghai Engineering Research Center for Topical Chinese Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Jinyuan Ma
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai, 200443, China
- Shanghai Engineering Research Center for Topical Chinese Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Fengze Miao
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai, 200443, China
- Shanghai Engineering Research Center for Topical Chinese Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai, 200443, China
- Shanghai Engineering Research Center for Topical Chinese Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Cuie Shen
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai, 200443, China
- Shanghai Engineering Research Center for Topical Chinese Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Min Shen
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai, 200443, China
- Shanghai Engineering Research Center for Topical Chinese Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Quangang Zhu
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai, 200443, China.
- Shanghai Engineering Research Center for Topical Chinese Medicine, 1278 Baode Road, Shanghai, 200443, China.
| | - Zhongjian Chen
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 1278 Baode Road, Shanghai, 200443, China.
- Shanghai Engineering Research Center for Topical Chinese Medicine, 1278 Baode Road, Shanghai, 200443, China.
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Giri A, Bauman JR. Pembrolizumab as monotherapy in locally advanced cutaneous squamous cell carcinoma. Expert Rev Anticancer Ther 2022; 22:1029-1038. [DOI: 10.1080/14737140.2022.2125382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Anshu Giri
- Department of Hematology and Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Jessica R. Bauman
- Department of Hematology and Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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