Squamous cell carcinoma of the skin. Will heightened awareness of risk factors slow its increase?

The use of preauricular skin flaps in the treatment of ear malignancy in elderly patients

BACKGROUND

The ear is one of the face areas most affected by skin cancers, and the surgical reconstruction is often challenging because of tumor- and patient-related factors. Reconstructive options are essentially skin flaps and grafts or their combinations. The use of preauricular translocation (PAT) flap for auricular reconstructions is constantly increasing.

AIM AND METHODS

This retrospective study reports the comparison between the PAT flap and the full-thickness skin grafts (FTSGs) for surgical auricular defect reconstruction in elderly population (≥65 years) that typically shows poor compliance in the postoperative wound care management.

RESULTS

A total of 52 FTSGs (Group A) and 39 PAT (Group B) were performed between April 2007 and July 2020. The aim was to investigate, compare, and define advantages and disadvantages of both techniques. Visual Analogue Scale (VAS) was used to evaluate the overall patients' satisfaction. The mean surgical and healing times were longer in Group A (p < 0.05). No complications occurred in the PAT group, and all the flaps survived. In the FTSG group, the overall complication rate was 17.3% (four partial and three total graft failure, and two graft infections). T test was used to compare the VAS scores: Patients with PAT flap were more satisfied than those with FTSG (p < 0.05).

CONCLUSIONS

Preauricular translocation flap is a reproducible, safe, and quick option for auricular defects reconstruction in the ≥65 years population, associated with an easier patient management, high patient satisfaction, and excellent aesthetic result.

Treatment of advanced cutaneous squamous cell carcinoma: a Mohs surgery and dermatologic oncology perspective

Locally advanced or metastatic cutaneous squamous cell carcinoma no longer amenable to surgical resection or primary radiation therapy requires an alternative approach to treatment. Until 2018, management consisted of limited systemic chemotherapies, which carried marginal clinical benefit. The introduction of immunotherapy with anti-PD-1 antibodies resulted in alternative treatment options for advanced cutaneous squamous cell carcinoma with substantial antitumor activity, durable response and acceptable safety profile. The field of immunotherapeutics continues to expand with adjuvant, neoadjuvant and intralesional studies currently in progress. Herein, the authors discuss their approach for the treatment of advanced cutaneous squamous cell carcinoma from the perspective of a Mohs surgeon and a dermatologic oncologist.

Current Basal and Squamous Cell Skin Cancer Management

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Characterize basal and squamous cell carcinomas as low or high risk based on size, location, histology, and clinical features. 2. Understand appropriate surgical margins in low- and high-risk lesions, and other management options, including Mohs micrographic surgery, electrodissection and curettage, topical agents, cryotherapy, photodynamic therapy, and radiation therapy. 3. Discuss adjuvant therapies for locally advanced and metastatic disease, including radiation therapy, chemotherapy, and targeted therapies such as hedgehog pathway inhibitors. 4. Educate patients on preventive measures such as skin examinations, sun protection, oral retinoids, and oral nicotinamide (vitamin B3). 5. Devise a reconstructive plan once clear oncologic margins are obtained.

SUMMARY

With the growing incidence of basal and squamous cell carcinoma, there is an increasing demand for appropriate oncologic management and aesthetic reconstruction. The goal of this CME article is to provide a foundation of knowledge to accurately diagnose, stage, and treat nonmelanoma skin cancers. In addition, it provides the practicing plastic surgeon alternate tools for managing these skin lesions, including topical agents, destructive therapies, and radiation therapy. Lastly, reconstructive plans for selected soft-tissue defects are discussed.

FOXE1 is a target for aberrant methylation in cutaneous squamous cell carcinoma

BACKGROUND

Several cancer-related genes are silenced by promoter hypermethylation in skin cancers. However, to date the somatic epigenetic events that occur in cutaneous squamous cell carcinoma (SCC) tumorigenesis have not been well defined.

OBJECTIVES

To examine epigenetic abnormalities of FOXE1, a gene located on chromosome 9q22, a region frequently lost in SCC.

METHODS

We investigated the methylation status of FOXE1 in 60 cases of cutaneous SCC by methylation-specific polymerase chain reaction, and comparatively examined mRNA and protein expression by real-time polymerase chain reaction and Western blot, respectively.

RESULTS

We found a higher frequency of FOXE1 promoter hypermethylation in SCCs (55%), as compared with the adjacent uninvolved skin (12%) and blood control samples (9.5%). FOXE1 methylation was frequently seen in association with a complete absence of or downregulated gene expression. Treatment with the demethylating agent 5-Aza-2'-deoxycytidine resulted in profound reactivation of FOXE1 expression.

CONCLUSIONS

These results indicate that FOXE1 is a crucial player in development of cutaneous SCC.

Treatment of facial superficial basal cell carcinomas with imiquimod 5% cream

Basal cell carcinoma (BCC) is the most common form of skin cancer and occurs predominantly as two forms, nodular or superficial. We report cases of two females who presented with facial BCCs, one with a 2-month history of superficial BCC with a dual growth pattern (superficial BCC overlying a deep micronodular pattern BCC), and the other with a 4-year history of superficial BCC. Both patients had undergone previous unsuccessful treatments. Differing responses of facial superficial BCCs were observed following daily treatment with imiquimod 5% cream over 6 weeks. This included a treatment failure in the BCC with a dual growth pattern and complete clearance of the other superficial BCC.

Surgical treatment of nonmelanoma skin cancer

Nonmelanoma skin cancer is the most common human malignancy. An estimated 2.75 million patients worldwide are diagnosed with skin cancer each year, with more than one million in the United States alone. Treatment for skin cancer includes methods such as cryosurgery, curettage and electrodessication, local excision, and Mohs micrographic surgery. Regardless of the method used, the goal is to provide the patient with the safest, most cost-effective and curative treatment.

Frequency of pre-existing actinic keratosis in cutaneous squamous cell carcinoma

BACKGROUND

Controversy over the rate of malignant transformation of actinic keratosis (AK) into cutaneous squamous cell carcinoma (SCC) has generated considerable debate regarding the importance of treating all such precancers to preclude their transofrmation. Current changes in US healthcare policy will deny many individuals access to certain simple and effective treatment modalities for precancerous lesions.

OBJECTIVE

Our purpose was to determine whether there is a significant association between the presence of cutaneous SCC and pre-existing AK.

METHODS

One hundred and sixty five consecutive cases of cutaneous SCC, retrieved from the files of a university-affiliated dermatopathology laboratory serving north-central Florida, were selected for review by a single dermatopathologist (D.M.). Hematoxylin and eosin stained skin tissue slides were examined under light microscopy for the presence of AK in close proximity to, or giving rise to, cutaneous SCC.

RESULTS

Of the 165 cutaneous SCC cases reviewed, 82.4% (136 out of 165) were found to have concomitant AK giving rise to and/or in close proximity to SCC. Of the 136 AK-positive SCC cases, 26.7% (44) were identified as superficial SCC arising within an AK (AKSSCC) and 55.7% (92) had AK in close proximity to SCC (AK + SCC). Close proximity is defined to include AK changes located directly adjacent to (on the shoulder of) SCC, to a maximum distance of 8 mm away.

CONCLUSIONS

The 82.4% prevalence of concomitant AK and cutaneous SCC in our biopsy population suggests a strong correlation between these two lesions. The fact that 26.7% of these lesions had SCC arising from AK highlights the importance of early recognition and effective treatment for AK.