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Patel PV, Pixley JN, Dibble HS, Feldman SR. Recommendations for Cost-Conscious Treatment of Basal Cell Carcinoma. Dermatol Ther (Heidelb) 2023; 13:1959-1971. [PMID: 37531073 PMCID: PMC10442296 DOI: 10.1007/s13555-023-00989-x] [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: 04/20/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Basal cell carcinoma (BCC) affects 3.3 million Americans annually. Treatment modalities for BCC include many surgical and nonsurgical options. The cost of BCC treatment can pose a substantial burden to patients and the healthcare system. Cost can be an important consideration in BCC treatment planning. OBJECTIVE We present an approach to the management of BCC when cost reduction is a priority. METHODS A PubMed literature search identified studies on effectiveness of current BCC therapies. Treatment prices were obtained from the Medicare National Fee Schedule, GoodRx, and pharmaceutical companies. The American Academy of Dermatology's (AAD) guidelines for treating BCC were used to develop recommendations for cost-reductive treatment. RESULTS The cost of treating a primary superficial BCC < 0.5 cm arising on Area M (cheeks, forehead, scalp, neck, jawline, pretibial surface) was $143 with curettage and electrodesiccation (C&E), $143 with cryosurgery, $210 with standard excision and simple reconstruction (SE), $1221 with Mohs Micrographic Surgery (MMS) and simple reconstruction, $472 with imiquimod, $186 with 5-fluorouracil (5-FU), and $354-$371 for photodynamic therapy (PDT). The cost of treating a primary nodular BCC 1.1-2 cm arising on Area L (trunk and extremities, excluding pretibial surface, hands, feet, nail units and ankles) was $183 with C&E, $183 with cryosurgery, $251 with SE and simple reconstruction, $1163-1351 with MMS and simple reconstruction, $472 with imiquimod, $186 with 5-FU, and $354-$371 for photodynamic therapy (PDT). The cost of treating a giant BCC (BCC > 10 cm with aggressive behavior) was $465-3311 with radiation, $139,560 with vismodegib, $144,452 with sonidegib, ~ $44.5 with cisplatin (medication cost only), and at least $184,836 with cemiplimab-rwlc. CONCLUSIONS For a primary superficial BCC < 0.5 cm arising on Area M, the cost-conscious algorithm prioritizes C&E or cryosurgery. For a primary nodular BCC 1.1-2 cm arising on Area L, the cost-conscious algorithm prioritizes C&E, cryosurgery, or 5-FU. For a giant BCC, the cost-conscious algorithm identifies superficial radiation therapy as first line.
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Affiliation(s)
- Palak V Patel
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA.
| | - Jessica N Pixley
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
| | - Hannah S Dibble
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Same Day Biopsy and Treatment of Non-Melanoma Skin Cancer in Patients with Field Cancerization: A Retrospective Chart Study. J Skin Cancer 2023; 2023:9990046. [PMID: 36777100 PMCID: PMC9908359 DOI: 10.1155/2023/9990046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023] Open
Abstract
Background Patients with field cancerization will develop numerous superficial non-melanoma skin cancers (NMSCs). Treating patients with field cancerization can be challenging and burdensome due to the numerous non-melanoma skin cancers (NMSCs) they develop and the frequent dermatology visits required for biopsy and treatment. Objective The success rate of diagnosing and treating lesions suspicious for NMSCs on the same day is measured, immediately after biopsy. Methods We retrospectively reviewed records of patients with same day lesion diagnosis and curettage treatment to determine diagnostic accuracy, treatment failure, and number needed to treat to reduce a follow-up treatment. Results A total of 237 lesions underwent same day biopsy and treatment, of which the majority were NMSC (66%) or actinic keratosis (23%). Patients had at least 3 months and a median of 17 months follow-up. A total of 20 lesions either recurred or were deemed to require additional treatment. The number needed to treat (NNT) to prevent one follow-up treatment was 1.3. Limitations: sample size limited ability to determine risk factors for treatment failure. Conclusion Simultaneous diagnosis and treatment of superficial NMSCs is a successful way of improving efficiency and patient satisfaction.
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Advances in Management and Therapeutics of Cutaneous Basal Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14153720. [PMID: 35954384 PMCID: PMC9367462 DOI: 10.3390/cancers14153720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Basal cell carcinoma (BCC) is the most common malignancy in humans with a range of treatment options available. Tumor and patient characteristics aid in risk-stratification, which influences treatment considerations. Here, we review the advancements in surgical, topical, field, immunotherapeutic, molecular-targeted, and experimental treatment modalities that can be employed in the correct clinical setting for the treatment of BCC. Abstract Basal cell carcinoma (BCC), the most common cancer in humans, is a malignant neoplasm of cells derived from the basal layer of the epidermis. Tumor characteristics such as histologic subtype, primary versus recurrent tumor, anatomic location, size, and patient attributes determine the risk level and acceptable treatment options. Surgical options offer histologic confirmation of tumor clearance. Standard excision provides post-treatment histologic assessment, while Mohs micrographic surgery (MMS) provides complete margin assessment intraoperatively. Additional treatment options may be employed in the correct clinical context. Small and low-risk BCCs, broad field cancerization, locally-advanced disease, metastatic disease, cosmetic concerns, or morbidity with surgical approaches raise consideration of other treatment modalities. We review herein a range of treatment approaches and advances in treatments for BCC, including standard excision, MMS, electrodesiccation and curettage, ablative laser treatment, radiation therapy, targeted molecular therapies, topical therapies, field therapies, immunotherapy, and experimental therapies.
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Kubanov AA, Saytburkhanov RR, Plakhova XI, Kondrakhina IN. Non-surgical treatments for basal cell skin cancer. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Basal cell carcinoma is the most common nonmelanoma skin cancer. It originates from undifferentiated cells in the basal cell layer of the epidermis or from the outer root sheath of the hair follicle. The most important factor in development of basalioma is ultraviolet radiation. Surgery is considered the gold standard of treatment for basal cell cancer. However, nonsurgical options are available for individuals who are unsuitable for surgery. The purpose of this review is to summarize the efficacy and indications of alternative, nonsurgical treatments that can be used in the management of basal cell cancer
Effective nonsurgical treatments include destructive methods (eg, curettage and electrodessication, cryosurgery, laser), photodynamic therapy, topical medications, hedgehog pathway inhibitors. Nonsurgical therapeutic alternatives are safe and effective for the treatment of BCC. Factors such as tumor location, size, and histopathological subtype should be taken into consideration when selecting optimal treatment, cosmetic results and patient preference should be considered too.
To search for the necessary literature, the PubMed, MedLine, Web of Science and RSCI databases were used.
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Abstract
Basal cell carcinoma (BCC) is the most common malignancy and the incidence is rising. BCCs have low mortality but can cause significant morbidity primarily through local destruction. The pathogenesis is linked to the interplay between environmental and patient-derived characteristics. There are multiple therapeutic modalities, and appropriate selection requires knowledge of complications, cosmetic outcomes, and recurrence rates. This article reviews the epidemiology, staging, treatment, and prevention of BCC.
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Affiliation(s)
- Dennis P Kim
- Mohs Micrographic Surgery, Brigham and Women's Faulkner Hospital, 1153 Centre Street, Suite 4J, Jamaica Plain, MA 02130-3446, USA
| | - Kylee J B Kus
- Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309-4482, USA
| | - Emily Ruiz
- High-Risk Skin Cancer Clinic, Dana Farber/Brigham and Women's Cancer Center, Mohs and Dermatologic Surgery Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, 1153 Centre Street, Suite 4J, Jamaica Plain, MA 02130-3446, USA.
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Nemer KM, Bauman TM, Laurin Council M, Hurst EA. Surveyed dermatologists are less likely to curette invasive squamous cell carcinoma in solid organ transplant recipients. Int J Womens Dermatol 2020; 6:99-101. [PMID: 32258341 PMCID: PMC7105649 DOI: 10.1016/j.ijwd.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 11/27/2022] Open
Abstract
Background The risk of squamous cell carcinoma (SCC) is increased in solid organ transplant recipients (OTRs), and preferential treatment modalities vary among clinicians. Objectives The purpose of this study was to survey dermatologists regarding practice patterns for electrodesiccation and curettage (EDC) of SCC in OTRs and nontransplant patients. Methods An 18-question survey was sent to dermatologist members of the International Transplant Skin Cancer Collaborative, Association of Professors of Dermatology, and American College of Mohs Surgery. Differences in EDC practice patterns for treatment of SCC in OTRs and nontransplant patients were evaluated. Results Dermatologists in this study (N = 227) were more likely to treat SCC with EDC in nontransplant patients (67.4%) than in OTRs (48.0%; P = .0003). Dermatologists who perform EDC in both groups (n = 108) were unlikely to use EDC on the H-zone of the face; they were more likely to EDC tumors on non-H-zone areas of the face and neck in nontransplant patients compared to OTRs (P = .0007). Dermatologists were more likely to use EDC over surgery in nontransplant patients compared to OTRs with the following demographics: dementia or psychiatric disease (P = .04), multiple medical comorbidities (P = .03), or anticoagulation medications (P = .02). Conclusions In OTRs with SCC, 48% of clinicians would consider EDC. The main factors that affect the decision to perform EDC include tumor location and patient comorbidities.
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Affiliation(s)
- Kathleen M Nemer
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tyler M Bauman
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
| | - M Laurin Council
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
| | - Eva A Hurst
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
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O'Donoghue N, Mowatt D, Sykes AJ. Electrochemotherapy and Ablative Therapies in Non-melanoma Skin Cancer. Clin Oncol (R Coll Radiol) 2019; 31:e1-e9. [PMID: 31543301 DOI: 10.1016/j.clon.2019.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/02/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
Although surgery and radiotherapy remain the most commonly used treatments for non-melanoma skin cancer, there are a variety of alternatives. Here we discuss the use of electrochemotherapy and ablative treatments and examine the evidence for their effectiveness against a number of non-melanoma skin cancers.
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Affiliation(s)
- N O'Donoghue
- Salford Royal NHS Foundation Trust Hospital, Salford, UK
| | - D Mowatt
- The Christie NHS Foundation Trust Hospital, Manchester, UK
| | - A J Sykes
- The Christie NHS Foundation Trust Hospital, Manchester, UK.
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Lin MJ, Dubin DP, Giordano CN, Khorasani H, Kriegel DA. Presurgical Curettage Improves Accuracy for Nonmelanoma Skin Cancer Excision. J Cutan Med Surg 2019; 23:617-623. [PMID: 31422679 DOI: 10.1177/1203475419871048] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Presurgical curettage before nonmelanoma skin cancer surgery may help delineate tumor subclinical extensions. OBJECTIVE To determine histologically whether presurgical curettage appropriately or inappropriately changes excision specimen size. MATERIALS AND METHODS One hundred fifty consecutive nonmelanoma skin cancers treated with Mohs micrographic surgery. The clinical margin (CM) was marked. Presurgical curettage was then performed and the resultant presurgical curettage margin (PCM) marked. Frozen section analysis of the CM and PCM revealed whether the curettage-induced margin change was appropriate or unnecessary. RESULTS Presurgical curettage appropriately increased the surgical margin in 9.3% of cases, reducing the number of Mohs stages from 2 to 1. It appropriately decreased the surgical margin in 17.3% thereby conserving normal skin. In 19.4% of cases the curettage increased the margin in situations where the CM had underestimated the size of the tumor; however, in these cases, the curettage did not increase the margin sufficiently to clear the tumor. In 44.0% of cases the PCM did not change the size of the stage I specimen compared to the CM and confirmed the CM. In 10.0% of cases, preoperative curettage reduced margin accuracy by removing healthy tissue (8.0%) or underestimating tumor (2.0%). These errors were associated with eyelid location, severe background photodamage, and morpheiform/infiltrating/sclerosing basal cell carcinomas. CONCLUSION Presurgical curettage can improve tumor excision accuracy and efficiency. Careful tumor selection is important to optimize curette utility.
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Affiliation(s)
- Matthew J Lin
- Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danielle P Dubin
- Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cerrene N Giordano
- Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hooman Khorasani
- Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David A Kriegel
- Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kim JY, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P, Bichakjian C, Armstrong A, Baum C, Bordeaux JS, Brown M, Busam KJ, Eisen DB, Iyengar V, Lober C, Margolis DJ, Messina J, Miller A, Miller S, Mostow E, Mowad C, Nehal K, Schmitt-Burr K, Sekulic A, Storrs P, Teng J, Yu S, Huang C, Boyer K, Begolka WS, Alam M. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol 2018; 78:540-559. [DOI: 10.1016/j.jaad.2017.10.006] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 01/05/2023]
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Čeović R, Petković M, Mokos ZB, Kostović K. Nonsurgical treatment of nonmelanoma skin cancer in the mature patient. Clin Dermatol 2018; 36:177-187. [DOI: 10.1016/j.clindermatol.2017.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kim JYS, Kozlow JH, Mittal B, Moyer J, Olenecki T, Rodgers P. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol 2018; 78:560-578. [PMID: 29331386 DOI: 10.1016/j.jaad.2017.10.007] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common form of human cancer and has an increasing annual incidence. Although most cSCC is cured with office-based therapy, advanced cSCC poses a significant risk for morbidity, impact on quality of life, and death. This document provides evidence-based recommendations for the management of patients with cSCC. Topics addressed include biopsy techniques and histopathologic assessment, tumor staging, surgical and nonsurgical management, follow-up and prevention of recurrence, and management of advanced disease. The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cSCC is noted, as is general information on the management of patients with metastatic disease.
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Affiliation(s)
| | | | - John Y S Kim
- Department of Plastic and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Jeffrey H Kozlow
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, Michigan
| | - Bharat Mittal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - Jeffrey Moyer
- Department of Otolaryngology, Plastic/Head/Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Thomas Olenecki
- Department of Internal Medicine, Ohio State University, Columbus, Ohio
| | - Phillip Rodgers
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
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Doğan F, Kemaloğlu CA. A very interesting traditional method in the treatment of skin lesions: aqua regia and related complications. SPRINGERPLUS 2016; 5:1585. [PMID: 27652158 PMCID: PMC5025418 DOI: 10.1186/s40064-016-3259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022]
Abstract
Background Aqua regia, a highly corrosive mixture of concentrated nitric acid and hydrochloric acid, is used to dissolve various metals such as gold and platinum that are not soluble in other types of acids. For the first time in the literature, we report the adverse effects that were observed following the utilization of this strong acid solution in the treatment of various skin lesions. Methods Between 2010 and 2013, 43 patients (55.8 % female) with a mean age of 40.2 years, were admitted to our hospital for scars, wounds or malign lesions related to the use of aqua regia on skin lesions. Sixteen patients reported to use aqua regia for treating wounds and 27 of them used it for their scars. Results Out of 43 patients, 9 patients developed necrosis, 12 had hypertrophic scars, 15 had scars and 7 had non-healing wounds resembling malignant lesions. The non-healing wounds were located in the facial region in five patients, in the cervical region in one and on the finger-tip in another. Histopathological examination of these non-healing wounds revealed basal and squamous cell carcinoma. The patients were admitted to the plastic surgery department approximately 6–24 months after aqua regia application with complaints of growing lesions. Secondary healing in the lesions with scar development in 55 % of the patients is an acceptable result. However, 27 % of the patients with hypertrophic scars and 16 % of the patients with malignant lesions required intervention. Conclusion This present study showed that non-medical alternative treatments have major risks. Aqua regia application might have resulted in the development or rapid progression of malignant tumours in seven patients. In the literature, it has been reported that a number of physical traumas may cause skin cancer. Based on this information, the possibility of such an effect of aqua regia cannot be excluded.
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Affiliation(s)
- Fatih Doğan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Adıyaman University, Altınşehir Mh. 3005 Sokak No:13, 02040 Adıyaman, Turkey
| | - Cemal Alper Kemaloğlu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Erciyes University, Kayseri, Turkey
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Lewin JM, Carucci JA. Advances in the management of basal cell carcinoma. F1000PRIME REPORTS 2015; 7:53. [PMID: 26097726 PMCID: PMC4447055 DOI: 10.12703/p7-53] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Basal cell carcinoma (BCC), a malignant neoplasm derived from non-keratinizing cells that originate in the basal layer of the epidermis, is the most common cancer in humans. Several factors such as anatomic location, histologic features, primary or recurrent tumors, and patient characteristics influence the choice of treatment modality for BCC. Mohs micrographic surgery (MMS) facilitates optimal margin control and conservation of normal tissue for the management of BCC; however, other treatment modalities may also be implemented in the correct clinical scenario. Other treatment modalities that will be reviewed include simple excision, electrodesiccation and curettage, cryotherapy, topical immunotherapy and chemotherapy, photodynamic therapy, and radiation therapy. In addition, targeted molecular therapeutic options for the treatment of advanced or metastatic BCC will be discussed in this informal review based on recent literature obtained by using PubMed with relevant search terms.
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Kapadia A, Hussain W. Optimizing curettage with a 'backhand'. J Eur Acad Dermatol Venereol 2012; 27:e139. [PMID: 22309100 DOI: 10.1111/j.1468-3083.2012.04459.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cutaneous squamous cell carcinoma of the head and neck. J Skin Cancer 2011; 2011:502723. [PMID: 21461387 PMCID: PMC3064996 DOI: 10.1155/2011/502723] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/15/2010] [Accepted: 12/15/2010] [Indexed: 12/13/2022] Open
Abstract
Cutaneous squamous cell carcinoma of the head and neck is an epidemic that reaches all parts of the world. Making the diagnosis relies on the acumen of the clinician and pathologist. Various pathologic subtypes exist and differ in histology and prognosis. High-risk tumors need aggressive treatment and vigilant surveillance to monitor for recurrence. Large tumors, deep tissue invasion, perineural involvement, recurrence, location in high-risk areas, and immunosuppression are implicated in worsening prognosis. Surgery is the mainstay of treatment with adjuvant radiation therapy as needed for aggressive tumors; however, other modalities are potentially useful for low-risk lesions. The use of Mohs surgery has become increasingly useful and has shown high success rates. Involvement of parotid and neck lymph nodes significantly affects outcomes and the physician should be comfortable with management of this complex disease. This paper examines the diagnosis, pathology, clinical course, and treatment options for cutaneous squamous cell carcinoma of the head and neck.
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Filho LLL, de Oliveira de Avelar Alchorne A, Pereira GC, Lopes LRS, de Carvalho TCB. Histological and immunohistochemical evaluation of basal cell carcinoma following curettage and electrodessication. Int J Dermatol 2008; 47:610-4. [PMID: 18477158 DOI: 10.1111/j.1365-4632.2008.03284.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most frequent non-melanoma skin cancer. Curettage and electrosurgery is probably the method most commonly used by dermatologists for the treatment of small and low risk BCCs. However, one is unable to determine the persistence of any residual tumor. This study was carried out in order to demonstrate the presence of such tumoral cells after curettage and electrofulguration. METHODS 20 primary BCC outpatients were studied at the Dermatology Service of Getúlio Vargas Hospital in the city of Teresina--State of Piauí--Brazil, with lesions of up to 1 cm in diameter on the face, and up to 1.5 cm elsewhere, and with no clinical signs of sclerosing and micronodular forms. Patients were anesthetized with 2% lidocaine with vasoconstrion and the lesions were curetted. Electrofulguration was conducted throughout the curetted area and 1 millimeter beyond. After two curettage and electrofulguration cycles, an incision around the resultant ulcer was made 2 mm beyond the visible bloody borders and in the base to the middle of subcutaneous fat. Two straight incisions were also carried out intersecting the lesion center, dividing it into quadrants. Each quadrant was incised and then fixed with 10% formalin. The quadrants and the fragments resulting from the curettage were in paraffin and histopathologically tested through hematoxylin/eosin stains and immunohistochemistry with Ber-EP4 marker. RESULTS There was evidence of persistent BCC in 5 of the 20 sites treated (25%): four (20%) in one quadrant and one (5%) in all four quadrants. 70-100% of tumor cells expressed Ber-EP4 in all 20 BCCs. CONCLUSIONS The persistence of tumoral residues after 2 curettage and electrofulguration cycles for basal cell carcinoma was found in 5 sites treated (25%). Despite the small cohort, such findings are very similar to those of other studies that applied curettage and electrocoagulation and indicated the probability of 25% of tumoral persistence.
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Actinic Keratosis: From the Skin to the Lip. J Oral Maxillofac Surg 2008; 66:1162-76. [DOI: 10.1016/j.joms.2008.01.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 01/07/2008] [Accepted: 01/09/2008] [Indexed: 11/24/2022]
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Rodriguez-Vigil T, Vázquez-López F, Perez-Oliva N. Recurrence rates of primary basal cell carcinoma in facial risk areas treated with curettage and electrodesiccation. J Am Acad Dermatol 2007; 56:91-5. [PMID: 17190625 DOI: 10.1016/j.jaad.2006.07.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Revised: 07/08/2006] [Accepted: 07/14/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND The incidence of basal cell carcinoma (BCC) is increasing. Curettage and electrodesiccation (CE) are not recommended for BCC treatment at medium- and high-risk facial sites. Surgical excision has been proposed as the treatment of choice. OBJECTIVE We sought to evaluate the cumulative recurrence rate (RR) of primary BCC in facial areas of medium and high risk after CE. METHODS This nonrandomized, clinical trial enrolled 257 patients with primary BCC located in medium- and high-risk facial areas, and treated with 4 or 5 cycles of CE by a single operator from a section specializing in BCC CE in a tertiary teaching hospital in Oviedo, Spain. Exclusion criteria for study entry included: recurrent BCC, fibrosing BCC, ill-defined BCC, and BCC larger than 10 mm in diameter (high-risk facial sites) or larger than 15 mm in diameter (medium-risk sites); BCC smaller than 4 mm; and nonbiopsy-proven BCC. BCCs included in the study were from the nose, and paranasal and nasal-labial fold (n = 105); eyelids and canthi (n = 48); perioral areas (n = 12); ears (n = 11); forehead and temples (n = 48); periauricular areas (n = 14); and malar areas and cheeks (n = 19). The primary outcome was recurrence of carcinoma, which was clinically evaluated by at least two observers in consensus. Data were analyzed using both a life table method and Kaplan-Meier analysis. The statistical analysis included best- and worst-case scenarios (which means that all cases lost to follow-up were considered as recurrences). RESULTS The 5-year cumulative non-RR in the best-case scenario was 98.80% (SE 0.70, 95% confidence interval 97.40%-100%); thus, a 5-year cumulative RR of 1.20% was found after CE in our medium- and high-risk BCCs of the face (best case). The 5-year cumulative non-RR in the worst-case scenario was 79.40% (95% confidence interval 78.90%-79.90%); thus, a 5-year cumulative RR of 20.60%. LIMITATIONS Retrospective design with a relatively small number of patients lost to follow-up is a study limitation. CONCLUSION High 5-year cure rates can be obtained after CE of primary, nonfibrosing BCCs of medium- and high-risk areas of the face performed in a specialized section.
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Affiliation(s)
- Tomas Rodriguez-Vigil
- Department of Dermatology, Asturias Central University Hospital, University of Oviedo, Spain
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21
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de Graaf YGL, Basdew VR, van Zwan-Kralt N, Willemze R, Bavinck JNB. The occurrence of residual or recurrent squamous cell carcinomas in organ transplant recipients after curettage and electrodesiccation. Br J Dermatol 2006; 154:493-7. [PMID: 16445781 DOI: 10.1111/j.1365-2133.2005.07069.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Organ transplant recipients frequently develop multiple squamous cell carcinomas (SCCs). Surgical excision and Mohs micrographic surgery are frequently used treatments for these carcinomas; however, curettage and electrodesiccation are a useful alternative in these patients. OBJECTIVES To evaluate the efficacy of curettage and electrodesiccation for the treatment of appropriately selected low-risk SCCs in organ transplant recipients at different sites. METHODS Between April 1989 and December 2004, 211 SCCs in 48 organ transplant recipients were treated by curettage and electrodesiccation. Only histologically confirmed SCCs were considered in this study. The charts of these patients were retrospectively reviewed and checked for the rate of residual or recurrent SCCs. The occurrence of residual or recurrent SCCs at different locations after treatment of SCCs with curettage and electrodesiccation was estimated with Kaplan-Meier survival analysis. RESULTS The mean follow-up time after curettage and electrodesiccation of the individual SCCs was 50 months (median 41; range 3-186). In total, 13 residual or recurrent SCCs were observed in 10 patients. The overall rate of residual or recurrent SCCs was 6%, with 7% for SCCs on the dorsum of the hands or fingers, 11% for SCCs on the head and neck, 0% for the forearms, and 5% for the remaining nonsun-exposed areas (shoulder, legs). No major clinical or cosmetic adverse events were registered after treatment. CONCLUSIONS In organ transplant recipients with many SCCs curettage and electrodesiccation can be a safe therapy for appropriately selected low-risk SCCs, with an acceptable cure rate.
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Affiliation(s)
- Y G L de Graaf
- Department of Dermatology, Leiden University Medical Centre, the Netherlands.
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Chung VQ, Bernardo L, Jiang SB. Presurgical Curettage Appropriately Reduces the Number of Mohs Stages by Better Delineating the Subclinical Extensions of Tumor Margins. Dermatol Surg 2006. [DOI: 10.1111/j.1524-4725.2005.31902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wu JK, Oh C, Strutton G, Siller G. An open-label, pilot study examining the efficacy of curettage followed by imiquimod 5% cream for the treatment of primary nodular basal cell carcinoma. Australas J Dermatol 2006; 47:46-8. [PMID: 16405483 DOI: 10.1111/j.1440-0960.2006.00222.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
SUMMARY The short-term efficacy of imiquimod 5% cream for the treatment of primary superficial basal cell carcinoma has been established. This study investigated its efficacy following curettage (without electrodesiccation) for the treatment of primary nodular basal cell carcinoma on the trunk and limbs. Seventeen patients with a total of 34 lesions were enrolled. Curettage was used to de-bulk the lesion and confirm suitable histology. Lesions displaying more aggressive subtypes (such as micronodular or morpheoic components) were excluded. Lesions were treated daily for 6 to 10 weeks with imiquimod 5% cream. Three months post treatment all lesions were excised, and 32 of 34 treated lesions (94%) were histologically clear of basal cell carcinoma. Fourteen of 17 patients rated the cosmetic outcome of treatment as excellent or good. Curettage followed by imiquimod 5% cream is effective for the treatment of primary nodular basal cell carcinoma on the trunk and limbs, and most patients are pleased with the cosmetic outcome.
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Affiliation(s)
- Jason K Wu
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
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Stasko T, Brown MD, Carucci JA, Euvrard S, Johnson TM, Sengelmann RD, Stockfleth E, Tope WD. Guidelines for the management of squamous cell carcinoma in organ transplant recipients. Dermatol Surg 2004; 30:642-50. [PMID: 15061849 DOI: 10.1111/j.1524-4725.2004.30150.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Solid-organ transplant recipients have a high incidence of cutaneous squamous cell carcinoma (SCC) and often develop multiple and aggressive tumors. There are few published studies or reviews, which provide guidance to the clinician in the treatment of these patients. OBJECTIVE The objective was to develop useful clinical guidelines for the treatment of skin cancer in organ transplant recipients (OTRs). METHODS The members of the Guidelines Committee of the International Transplant-Skin Cancer Collaborative (ITSCC) carried out a computerized search utilizing the databases of the National Library of Medicine for reports in the literature on SCC in OTRs. These reports were collectively examined by the group and combined with experiences from the members' clinical practices in the development of the guidelines. RESULTS More than 300 articles relating to SCC in OTRs were reviewed. In general, reports concerning the prevention and treatment of SCC in OTRs are of individual cases or small case series. They are retrospective in nature, statistically nonrigorous, and lack the complete epidemiologic data necessary to derive definitive conclusions. Combining these studies and collective clinical experience, however, is at present the best available method for devising guidelines for the treatment of SCC in OTRs. CONCLUSION Guidelines developed for the treatment of skin cancer in OTRs, supported by the best available data and collective clinical experience, may assist in the management of OTRs with SCC. The development of clinical pathways and complete documentation with rigorous prospective study is necessary to improve and refine future guideline development.
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Affiliation(s)
- Thomas Stasko
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Abstract
The number of skin cancers continues to rise with well over one million cases of skin cancer expected in the United States this year. Optimal management depends on early detection and treatment. The consequences of skin cancer may be particularly devastating in organ transplant recipients. In this article, management of squamous cell carcinoma in the organ transplant recipient is discussed.
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Affiliation(s)
- John A Carucci
- Department of Dermatology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10021, USA
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