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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention-Update 2023. Eur J Cancer 2023; 193:113251. [PMID: 37717283 DOI: 10.1016/j.ejca.2023.113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. Overall, cSCC mostly has very good prognosis after treatment, with 5-year cure rates greater than 90%. Despite the overall favourable prognosis and the proportionally rare deaths, cSCC is associated with a high total number of deaths due to its high incidence. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV) and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update recommendations on cSCC, based on current literature and expert consensus. Part 1 of the guidelines addresses the updates on classification, epidemiology, diagnosis, risk stratification, staging and prevention in immunocompetent as well as immunosuppressed patients.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital Zurich, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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2
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Bryce-Alberti M, Gonzalez MR, Quevedo-Ramirez A, Pretell-Mazzini J. Squamous Cell Carcinoma Arising from Chronic Osteomyelitis in the Extremities: Treatment Approach and Oncological Outcomes-A Systematic Review of the Literature. J Skin Cancer 2022; 2022:2671420. [PMID: 36262471 PMCID: PMC9576437 DOI: 10.1155/2022/2671420] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/29/2022] [Indexed: 12/05/2022] Open
Abstract
Aims In chronic osteomyelitis-derived squamous cell carcinoma, what are the demographic and clinical variables, risk factors associated with worse outcomes, and results of treatment modalities used? Methods A systematic review was performed using PubMed and EMBASE. Articles were evaluated for inclusion and exclusion criteria, and for quality analysis. PRISMA guidelines were applied. Demographic and clinical data and therapeutic approaches were presented narratively and in descriptive statistics registered at PROSPERO. Results Most patients were male (40/49), trauma was the most common etiology (27/36), and about half of all SCC were in the tibia (25/48). Amputation was the main definitive treatment (42/47). Adjuvant treatments were not analyzed. Well-differentiated SCC accounted for 58.3% (21/36) of all tumors. Bone invasion was described in 82.8% (24/29); recurrence, in 7.7% (3/39); and metastasis, in 7.7% (3/39). Recurrence and metastasis occurred more frequently when bone invasion was present (p = 0.578 and p = 0.646, respectively). SCC with lymph node involvement showed a higher tendency to metastasize (p = 0.377). Compared with limb salvage, amputation was associated with a tendency for less recurrence (p = 0.312) and longer survival (p = 0.219). Conclusions COM-derived SCC mostly occurs after trauma and is usually located in the tibia. Bone invasion is common, and patients predominantly undergo amputation. This treatment is associated with a trend toward higher survival, compared to limb salvage.
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Affiliation(s)
| | - M. R. Gonzalez
- Facultad de Medicina Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Juan Pretell-Mazzini
- Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South FL. Plantation, FL, USA
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3
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Baba N, Kato H, Nakamura M, Matsushita S, Aoki M, Fujimoto N, Kato T, Iino S, Saito S, Yasuda M, Asai J, Ishikawa M, Yatsushiro H, Kawahara Y, Matsuya T, Araki R, Teramoto Y, Hasegawa M, Tokunaga T, Nakamura Y. Narrower clinical margin in high or very high-risk squamous cell carcinoma: a retrospective, multicenter study of 1,000 patients. J Dtsch Dermatol Ges 2022; 20:1088-1099. [PMID: 35927033 DOI: 10.1111/ddg.14810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES In cutaneous squamous cell carcinoma (cSCC), adherence to guideline-recommended fixed surgical margins is often difficult, and narrower margins are preferable. This study aimed to evaluate relapse and disease-specific death with narrower margins for high or very high-risk cSCC. PATIENTS/METHODS We retrospectively investigated high or very high-risk cSCC patients who underwent tumor excision. Patients were divided into guideline-recommended standard margin group (SMG) and narrower-margin group (NMG). Co-primary outcomes were local relapse, SCC relapse, and SCC death. Cumulative incidence function (CIF) was used to describe SCC death probability and competing risk mortality. Gray's test was used to compare differences in CIF between the groups. RESULTS In total, 1,000 patients with cSCC (high-risk, 570; very high-risk, 430) were included. In the high-risk cohort, there were no significant differences in incomplete excision rate (IER) between SMG and NMG (2.6 % vs. 3.0 %, P > 0.99). However, in the very high-risk cohort, IER in SMG was significantly lower than in NMG (8.9 % vs. 16.2 %, P = 0.03). No significant differences were observed between SMG and NMG for local relapse (high-risk, P = 0.56; very high-risk, P = 0.70), SCC relapse (high-risk, P = 0.30; very high-risk, P = 0.47), and SCC death (high-risk, P = 0.23; very high-risk, P = 0.83). CONCLUSIONS Surgical margin size has limited impact on margin control, relapse, and disease-specific death in high-risk cSCC.
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Affiliation(s)
- Natsuki Baba
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Dermatology, University of Fukui, Fukui, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shigeto Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Megumi Aoki
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Noriki Fujimoto
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Takeshi Kato
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Shiro Iino
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Shintaro Saito
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahito Yasuda
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Jun Asai
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masashi Ishikawa
- Department of Dermatology, Saitama Cancer Center, Saitama, Japan
| | | | - Yu Kawahara
- Department of Dermatology, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Taisuke Matsuya
- Department of Dermatology, Asahikawa Medical University, Hokkaido, Japan
| | - Ryuichiro Araki
- Community Health Science Center, Saitama Medical University, Saitama, Japan
| | - Yukiko Teramoto
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Minoru Hasegawa
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Takahiro Tokunaga
- Medical Research Support Center, University of Fukui Hospital, Fukui, Japan.,Research Promotion Office, Shinseikai Toyama Hospital, Toyama, Japan
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
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4
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Baba N, Kato H, Nakamura M, Matsushita S, Aoki M, Fujimoto N, Kato T, Iino S, Saito S, Yasuda M, Asai J, Ishikawa M, Yatsushiro H, Kawahara Y, Matsuya T, Araki R, Teramoto Y, Hasegawa M, Tokunaga T, Nakamura Y. Knapperer Resektionsrand bei Plattenepithelkarzinomen mit hohem oder sehr hohem Risiko: eine retrospektive multizentrische Studie mit 1000 Patienten. J Dtsch Dermatol Ges 2022; 20:1088-1100. [PMID: 35971579 DOI: 10.1111/ddg.14810_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
HINTERGRUND UND ZIELE Bei kutanen Plattenepithelkarzinomen (PEK) ist die Einhaltung der in Leitlinien empfohlenen festen Resektionsränder oft schwierig und knappere Ränder sind wünschenswert. Ziel dieser Studie war die Bewertung des Auftretens von Rezidiven und krankheitsspezifischen Todesfällen bei knapperen Resektionsrändern für PEK mit hohem oder sehr hohem Risiko. PATIENTEN/METHODEN PEK-Patienten mit hohem oder sehr hohem Risiko, bei denen eine Tumorexzision durchgeführt wurde, wurden retrospektiv untersucht. Die Patienten wurden in eine Gruppe mit Standardrand gemäß Leitlinienempfehlung (standard margin group, SMG) und eine Gruppe mit knapperen Rändern (narrower-margin group, NMG) eingeteilt. Gemeinsame primäre Endpunkte waren lokales Rezidiv, PEK-Rezidiv und PEK-bedingter Tod. Die Wahrscheinlichkeit eines PEK-bedingten Tods und konkurrierender Mortalitätsrisiken wurde mittels kumulativer Inzidenzfunktion (CIF) beschrieben. Unterschiede bei der CIF zwischen den Gruppen wurden mit dem Test nach Gray verglichen. ERGEBNISSE Insgesamt wurden 1.000 Patienten mit PEK (hohes Risiko, 570; sehr hohes Risiko, 430) eingeschlossen. In der Kohorte mit hohem Risiko gab es keine signifikanten Unterschiede bei der unvollständigen Exzisionsrate (IER) zwischen SMG und NMG (2,6 % vs. 3,0 %, P > 0,99). In der Kohorte mit sehr hohem Risiko war die IER in der SMG jedoch signifikant geringer als in der NMG (8.9 % vs. 16.2 %, P = 0,03). Keine signifikanten Unterschiede zwischen SMG und NMG wurden für Lokalrezidiv (hohes Risiko, P = 0.56; sehr hohes Risiko, P = 0,70), PEK-Rezidiv (hohes Risiko, P = 0,30; sehr hohes Risiko, P = 0,47) und PEK-bedingtem Tod (hohes Risiko, P = 0,23; sehr hohes Risiko, P = 0,83) beobachtet. SCHLUSSFOLGERUNGEN Die Größe des Resektionsrands hat einen begrenzten Einfluss auf Randkontrolle, Rezidive und krankheitsspezifischen Tod bei PEK mit hohem Risiko.
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Affiliation(s)
- Natsuki Baba
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Dermatology, University of Fukui, Fukui, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shigeto Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Megumi Aoki
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Noriki Fujimoto
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Takeshi Kato
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Shiro Iino
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Shintaro Saito
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahito Yasuda
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Jun Asai
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masashi Ishikawa
- Department of Dermatology, Saitama Cancer Center, Saitama, Japan
| | | | - Yu Kawahara
- Department of Dermatology, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Taisuke Matsuya
- Department of Dermatology, Asahikawa Medical University, Hokkaido, Japan
| | - Ryuichiro Araki
- Community Health Science Center, Saitama Medical University, Saitama, Japan
| | - Yukiko Teramoto
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Minoru Hasegawa
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Takahiro Tokunaga
- Medical Research Support Center, University of Fukui Hospital, Fukui, Japan.,Research Promotion Office, Shinseikai Toyama Hospital, Toyama, Japan
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
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5
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Costantino A, Canali L, Festa BM, Spriano G, Mercante G, De Virgilio A. Sentinel lymph node biopsy in high-risk cutaneous squamous cell carcinoma of the head and neck: Systematic review and meta-analysis. Head Neck 2022; 44:2288-2300. [PMID: 35713173 DOI: 10.1002/hed.27121] [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: 01/31/2022] [Revised: 04/11/2022] [Accepted: 06/01/2022] [Indexed: 11/07/2022] Open
Abstract
The aim of our study was to better define the role of sentinel lymph node biopsy (SLNB) in high-risk cutaneous squamous cell carcinoma of the head and neck (cSCCHN). A systematic review and meta-analysis was performed according to the PRISMA statement. Seven-hundred and five patients were included from 20 studies. The pooled SLN identification rate was 98.8% (95%CI: 97.0-99.8). The median number of SLN excised was 3.6 (n = 371, 95%CI: 2.0-4.4). The pooled SLNB positive rate and cumulative regional recurrence rate (RRR) in negative SLNB were 5.6% (95%CI: 2.6-9.6) and 2.9% (95%CI: 0.5-7.2), respectively. The high SLN identification rate demonstrates SLNB feasibility in cSCCHN. The low SLNB positive rate and the relatively high RRR raise some doubts concerning its clinical utility. Further studies are mandatory to define predictors of lymph node metastases able to better select patients that may benefit from a SLNB.
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Affiliation(s)
- Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Luca Canali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
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6
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Recent Advanced in the Treatment of Advanced SCC Tumors. Cancers (Basel) 2022; 14:cancers14030550. [PMID: 35158818 PMCID: PMC8833343 DOI: 10.3390/cancers14030550] [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: 12/02/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Squamous cell carcinoma (SCC) is the second most frequent form of skin cancer after basal cell carcinoma. While most SCC can be treated by surgery or radiotherapy, some progress into an advanced form and are no longer suitable for these treatments. Guidelines and staging systems have help to define these advanced SCC (aSCC), for which prognosis was very poor until recently. Platin-based chemotherapy was traditionally used, but few prospective trials and no treatment regimen was recommended. Furthermore, toxicity in elderly patients limited its use. The development of immunotherapy has improved the prognosis of these difficult-to-treat aSCC. In this review, we define high risk and aSCC and explored current treatment strategies for these tumors.
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7
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Kim Y, Lehrer EJ, Wirth PJ, Khesroh EA, Brewer JD, Billingsley EM, Zaorsky NG, Lam C. Adjuvant radiotherapy may not significantly change outcomes in high-risk cutaneous squamous cell carcinomas with clear surgical margins: A systematic review and meta-analysis. J Am Acad Dermatol 2021; 86:1246-1257. [PMID: 34890701 DOI: 10.1016/j.jaad.2021.11.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The role of adjuvant radiotherapy for high-risk cutaneous squamous cell carcinomas (cSCC) after surgery with negative margins is unclear. OBJECTIVE To conduct a systematic review and meta-analysis examining the risk of poor outcomes for those treated with surgery vs. surgery and adjuvant radiotherapy. METHODS A comprehensive search of articles was executed in PubMed, Embase, and Cochrane Database. Random-effected meta-analyses were conducted. RESULTS Thirty-three studies comprised of 3,867 high-risk cSCC were included. There were no statistically significant differences in poor outcomes between the surgery vs. surgery and adjuvant radiotherapy groups. Estimates for local recurrence were 15.2% (95% confidence interval [CI]: 6.3%-27%) vs. 8.8% (CI: 1.6%-20.9%), regional metastases were 11.5% (CI: 7.2%-16.7%) vs. 4.4% (CI: 0%-18%), distant metastases were 2.6% (CI: 0.6%-6%) vs. 1.7% (CI: 0.2%-4.5%) and disease-specific deaths were 8.2% (CI: 1.2%-20.6%) vs. 19.7% (CI: 3.8%-43.7%) for the surgery group vs. surgery and adjuvant radiotherapy group respectively. LIMITATIONS Retrospective nature of most studies with a lack of sufficient patient-specific data. CONCLUSIONS For patients with high risk cSCC treated with margin-negative resection, there were no differences in poor outcomes between the surgery vs. surgery and adjuvant radiotherapy groups. Randomized-controlled trials are necessary to define the benefit of adjuvant radiotherapy in this setting.
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Affiliation(s)
- Yesul Kim
- Department of Dermatology, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul J Wirth
- Department of Dermatology, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - Eiman A Khesroh
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve, Fairport Harbor, Ohio
| | - Charlene Lam
- Department of Dermatology, Penn State Health Hershey Medical Center, Hershey, Pennsylvania.
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8
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Wilkie MD, Lancaster J, Roland NJ, Jones TM. Elective management of regional nodal basins in cutaneous squamous cell carcinoma of the head and neck: Controversies and contemporary perspectives. Oral Oncol 2021; 120:105432. [PMID: 34218060 DOI: 10.1016/j.oraloncology.2021.105432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
Non-melanoma skin cancer (NMSC) is among the most common cancers worldwide, with an incidence that continues to rise. Although cutaneous squamous cell carcinoma (cSCC) constitutes only approximately 20% of such cases, it represents the most common cause of NMSC mortality, owing largely to the propensity for development of regional lymph node metastases (LNM), which, when present, carry a dismal prognosis. Whilst overall rates of LNM are low, there are a number of patient and tumour factors that likely confer considerably higher risks, which has led several investigators to propose more proactive elective management of regional nodal basins in selected high-risk cases. Current international guidelines, however, do not recommend any elective treatment or sampling of regional nodal basins in the absence of clinically apparent disease. The purpose of this review is to explore in detail the fundamental issues underlying this controversy, focusing specifically on cSCC of the head and neck (cSCCHN). In particular the rationale for more a proactive elective approach to regional nodal basins, including the evidence-base underlying identification of potentially high-risk factors for development of LNM is discussed, along with oncological outcomes for those patients that do go onto suffer LNM. We also provide contemporary perspectives and evidence for approaches to electively managing regional nodal basins, and offer insight into how these may develop both in the clinical and research arenas.
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Affiliation(s)
- Mark D Wilkie
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom.
| | - Jeffrey Lancaster
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom
| | - Nicholas J Roland
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom
| | - Terence M Jones
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom
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9
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Saito Y, Fujikawa H, Takatsuka S, Abe R, Takenouchi T. Risk factors for lymph node metastasis in cutaneous squamous cell carcinoma: a long-term retrospective study of Japanese patients. Int J Clin Oncol 2020; 26:606-612. [PMID: 33175299 DOI: 10.1007/s10147-020-01830-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (CSCC) is one of the most common skin cancers. Prognosis is favorable following surgical resection of early-stage disease, but the management of the metastatic disease is challenging. Several prognostic risk factors have been described in the American Joint Committee on Cancer/the Union for International Cancer Control (UICC) 8th edition staging and the Brigham and Women's Hospital T classification system. However, their clinical validity in Asian populations is unclear because of racial differences in the clinical characteristics of CSCC. This study aimed to identify factors that could predict lymph node metastasis in Asian patients. METHODS This retrospective single-center study evaluated 540 patients with primary CSCC between 1989 and 2013. Five factors were evaluated for their ability to predict lymph node metastasis: maximum tumor diameter, tumor thickness, depth of invasion, degree of differentiation, and infiltrative growth pattern (INF). RESULTS Tumor diameter > 2 cm (p < 0.0001), tumor thickness > 6 mm (p < 0.0001), invasion beyond the subcutaneous fat (p < 0.0001), poor differentiation (p = 0.042), and INFc infiltration (p < 0.0001) were associated with lymph node metastasis in the univariate analyses. In the multivariate analysis, lymph node metastasis was independently associated with tumor size > 2 cm [hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.4-6.2; p = 0.006], tumor thickness > 6.0 mm (HR 2.9, 95% CI 1.3-6.4; p = 0.007), and invasion beyond the subcutaneous fat (HR 2.3, 95% CI 1.0-5.1; p = 0.045). CONCLUSION Larger tumor diameter, greater tumor thickness, and deeper invasion included in the UICC T classification system are associated with increased risks of lymph node metastasis from CSCC in Japanese patients.
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Affiliation(s)
- Yuki Saito
- Department of Dermatology, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata, 951-8566, Japan. .,Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Hiroki Fujikawa
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sumiko Takatsuka
- Department of Dermatology, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata, 951-8566, Japan
| | - Riichiro Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata, 951-8566, Japan
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10
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Zeng S, Fu L, Zhou P, Ling H. Identifying risk factors for the prognosis of head and neck cutaneous squamous cell carcinoma: A systematic review and meta-analysis. PLoS One 2020; 15:e0239586. [PMID: 32991600 PMCID: PMC7523977 DOI: 10.1371/journal.pone.0239586] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/10/2020] [Indexed: 01/22/2023] Open
Abstract
In this study, we sought to identify the potential impacts of disease characteristics on the prognosis of cutaneous squamous cell carcinoma (cSCC). We searched the PubMed, EmBase, and Cochrane Library databases from their inception until February 2020 to identify studies that investigated the prognosis of cSCC. The pooled effect estimates were applied using odds ratios (OR) and 95% confidence intervals (CI) and were calculated using the random-effects model. Forty-three studies including a total of 21,530 patients and reporting 28,627 cases of cSCC were selected for the final meta-analysis. Poor differentiation (OR, 3.54; 95% CI, 2.30–5.46; P < 0.001), perineural invasion (OR, 3.27; 95% CI, 1.60–6.67; P = 0.001), Breslow greater than 2 mm (OR, 5.47; 95% CI, 2.63–11.37; P < 0.001), diameter greater than 20 mm (OR, 4.62; 95% CI, 2.95–7.23; P < 0.001), and location on temple (OR, 3.20; 95% CI, 1.12–9.15; P = 0.030) were associated with an increased risk of recurrence, whereas immunosuppression status and location on cheek, ear, or lip were not associated with the risk of recurrence. Poor differentiation (OR, 6.82; 95% CI, 4.66–9.99; P < 0.001); perineural invasion (OR, 7.15; 95% CI, 4.73–10.83; P < 0.001); Breslow greater than 2 mm (OR, 6.11; 95% CI, 4.05–9.21; P < 0.001); diameter greater than 20 mm (OR, 5.01; 95% CI, 2.56–9.80; P < 0.001); and location on ear (OR, 2.38; 95% CI, 1.39–4.09; P = 0.002), lip (OR, 2.15; 95% CI, 1.26–3.68; P = 0.005), and temple (OR, 2.77; 95% CI, 1.20–6.40; P = 0.017) were associated with an increased risk of metastasis, whereas immunosuppression status and location on cheek did not affect the risk of metastasis. Finally, poor differentiation (OR, 5.97; 95% CI, 1.82–19.62; P = 0.003), perineural invasion (OR, 6.64; 95% CI, 3.63–12.12; P < 0.001), and Breslow greater than 2 mm (OR, 3.42; 95% CI, 1.76–6.66; P < 0.001) were associated with an increased risk of disease-specific death, whereas diameter; immunosuppression status; and location on ear, lip, and temple did not affect the risk of disease-specific death. We found that differentiation, perineural invasion, depth, diameter, and location could affect the prognosis of cSCC. The potential role of other patient characteristics on the prognosis of cSCC should be identified in further large-scale prospective studies.
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Affiliation(s)
- Shihua Zeng
- Department of Dermatology, Chengdu Second People’s Hospital, Chengdu, China
- * E-mail:
| | - Lixin Fu
- Department of Dermatology, Chengdu Second People’s Hospital, Chengdu, China
| | - Peimei Zhou
- Department of Dermatology, Chengdu Second People’s Hospital, Chengdu, China
| | - Hua Ling
- Department of Anesthesiology, Chengdu Second People’s Hospital, Chengdu, China
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11
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Wu S, Slater NA, Sayed CJ, Googe PB. PD‐L1
and
LAG
‐3 expression in advanced cutaneous squamous cell carcinomas. J Cutan Pathol 2020; 47:882-887. [DOI: 10.1111/cup.13709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 03/03/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sam Wu
- Department of Dermatology University of North Carolina Chapel Hill North Carolina USA
| | - Nathaniel A. Slater
- Department of Dermatology University of North Carolina Chapel Hill North Carolina USA
| | - Christopher J. Sayed
- Department of Dermatology University of North Carolina Chapel Hill North Carolina USA
| | - Paul B. Googe
- Department of Dermatology University of North Carolina Chapel Hill North Carolina USA
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12
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Kofler L, Kofler K, Schulz C, Breuninger H, Häfner HM. Sentinel lymph node biopsy for high-thickness cutaneous squamous cell carcinoma. Arch Dermatol Res 2020; 313:119-126. [PMID: 32385689 PMCID: PMC7864829 DOI: 10.1007/s00403-020-02082-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 04/19/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Abstract
Squamous cell carcinomas are among the most common skin tumors and show a risk of metastasis depending on various factors such as tumor thickness, localization, histological subtype and immune status of the patient. Sentinel lymph node biopsy (SLNB) SLNB represents a possibility for assessing the locoregional lymph node status. In this study, the role of the SLNB in lymph node status and survival was analyzed. Retrospectively, 720 patients with high-risk squamous cell carcinoma (tumor thickness > 5 mm) were examined. 150 patients agreed to SLNB, 570 patients did not undergo histologic confirmation of lymph node status and were included directly in follow-up. In 101 patients, a sentinel lymph node was successfully marked and extirpated, followed by regular follow-up examinations.A total of 11.11% of the patients showed lymph node metastasis in the course of their treatment, with no difference in the proportion of patients in the SLNB group (11.9%) and the observation group (11.4%) (p = 0.873). The proportion of distant metastasis also did not differ between the groups (p = 0.898). In 3.96% of the patients in the SLNB group, a metastasis was found in the sentinel lymph node. Tumor-specific death was observed in 7.14% of the patients in the SLNB group and 4.74% in the observation group (p = 0.269). Although SLNB is a principally suitable method for determining lymph node status, the available data do not provide any benefit regarding further metastasis or tumor-specific survival.
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Affiliation(s)
- Lukas Kofler
- Department of Dermatology and Center for Dermatologic Surgery, Eberhard-Karls University of Tuebingen, Liebermeisterstraße 25, 72076, Tübingen, Germany
| | - Katrin Kofler
- Department of Dermatology and Center for Dermatologic Surgery, Eberhard-Karls University of Tuebingen, Liebermeisterstraße 25, 72076, Tübingen, Germany.
| | - Claudia Schulz
- Department of Dermatology and Center for Dermatologic Surgery, Eberhard-Karls University of Tuebingen, Liebermeisterstraße 25, 72076, Tübingen, Germany
| | - Helmut Breuninger
- Department of Dermatology and Center for Dermatologic Surgery, Eberhard-Karls University of Tuebingen, Liebermeisterstraße 25, 72076, Tübingen, Germany
| | - Hans-Martin Häfner
- Department of Dermatology and Center for Dermatologic Surgery, Eberhard-Karls University of Tuebingen, Liebermeisterstraße 25, 72076, Tübingen, Germany
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13
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Bernal Martínez Á, Fernández Letamendi N, Delgado Martínez J, Sampietro de Luis J, Gómez-Escolar Larrañaga L, Sanz Aranda E. Risk Factors and Mortality in Cutaneous Squamous Cell Carcinoma of the Head and Neck. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2018.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Cañueto J, Tejera-Vaquerizo A, Redondo P, Botella-Estrada R, Puig S, Sanmartin O. A review of terms used to define cutaneous squamous cell carcinoma with a poor prognosis. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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15
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Bernal Martínez ÁJ, Fernández Letamendi N, Delgado Martínez J, Sampietro de Luis JM, Gómez-Escolar Larrañaga L, Sanz Aranda E. Risk Factors and Mortality in Cutaneous Squamous Cell Carcinoma of the Head and Neck. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:325-328. [PMID: 32340691 DOI: 10.1016/j.ad.2018.09.025] [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: 04/03/2018] [Revised: 09/05/2018] [Accepted: 09/23/2018] [Indexed: 10/24/2022] Open
Abstract
The variant of cutaneous squamous cell carcinoma, known as high-risk cutaneous squamous cell carcinoma, has a higher incidence of metastasis. Certain characteristics define this high-risk tumor and are predictors of increased risk of metastasis, although the risk factors are not yet well established. This observational retrospective study of 392 cases of high-risk cutaneous squamous cell carcinoma of the head and neck explored the tumor risk factors for metastasis and the association between metastasis and death. The only factor with a significant positive association with mortality was tumor invasion of noncutaneous structures. A total of 6.6% of the tumors metastasized, and mortality was 30.8%. These findings are consistent with observations reported in the literature.
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Affiliation(s)
| | | | | | | | | | - Ester Sanz Aranda
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
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16
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A review of terms used to define cutaneous squamous cell carcinoma with a poor prognosis. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:281-290. [PMID: 32359704 DOI: 10.1016/j.ad.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/10/2019] [Accepted: 06/02/2019] [Indexed: 02/01/2023] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in humans and its incidence is both underestimated and on the rise. cSCC is referred to in the literature as high-risk cSCC, locally advanced cSCC, metastatic cSCC, advanced cSCC, and aggressive cSCC. These terms can give rise to confusion and are not always well defined. In this review, we aim to clarify the concepts underlying these terms with a view to standardizing the description of this tumor, something we believe is necessary in light of the new drugs that have been approved or are in development for cSCC.
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17
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Leiter U, Heppt MV, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies R, Ulrich C, Welzel J, Wermker K, Garbe C, Berking C. S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma (cSCC) – short version, part 2: epidemiology, surgical and systemic treatment of cSCC, follow‐up, prevention and occupational disease. J Dtsch Dermatol Ges 2020; 18:400-413. [DOI: 10.1111/ddg.14072] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Ulrike Leiter
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Markus V. Heppt
- Department of Dermatology and AllergologyUniversity Medical Center LMU Munich Munich Germany
- Department of DermatologyFriedrich Alexander University of Erlangen‐Nuremberg Erlangen Germany
| | - Theresa Steeb
- Department of Dermatology and AllergologyUniversity Medical Center LMU Munich Munich Germany
- Department of DermatologyFriedrich Alexander University of Erlangen‐Nuremberg Erlangen Germany
| | - Teresa Amaral
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Andrea Bauer
- Department of DermatologyCarl Gustav Carus University Medical Center Dresden Germany
| | - Jürgen C. Becker
- Department of DermatologyEssen University Medical Center Essen Germany
| | | | - Helmut Breuninger
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Thomas Diepgen
- Institute for Clinical Social MedicineHeidelberg University Medical Center Heidelberg Germany
| | - Thomas Dirschka
- CentroDerm Clinic and Medical Faculty of Witten Herdecke University Wuppertal Germany
| | - Thomas Eigentler
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Michael Flaig
- Department of Dermatology and AllergologyUniversity Medical Center LMU Munich Munich Germany
| | | | | | | | - Ralf Gutzmer
- Department of Dermatology and AllergyHanover Medical School Hanover Germany
| | - Uwe Hillen
- Department of Dermatology and VenereologyVivantes Medical Center Berlin‐Neukölln Germany
| | | | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück Osnabrück Germany
| | - Oliver Kölbl
- Department of Radiation OncologyRegensburg University Medical Center Regensburg Germany
| | | | - Christoph Löser
- Department of DermatologyLudwigshafen Medical Center Ludwigshafen Germany
| | - Dorothee Nashan
- Department of DermatologyDortmund Medical Center Dortmund Germany
| | - Seema Noor
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Monika Nothacker
- Association of Scientific Medical Societies in Germany (AWMF) Berlin Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional RadiologyUniversity Medical Center Tübingen Germany
| | | | - Lutz Schmitz
- Department of DermatologyRuhr University of Bochum Bochum Germany
| | | | - Rolf‐Markus Szeimies
- Department of DermatologyKnappschaftskrankenhaus Recklinghausen Recklinghausen Germany
| | - Claas Ulrich
- Department of DermatologyCharité University Medical Center Berlin Germany
| | - Julia Welzel
- Department of Dermatology and AllergologyUniversity of Augsburg Augsburg Germany
| | - Kai Wermker
- Department of Oral and Maxillofacial SurgeryOsnabrück Medical Center Osnabrück Germany
| | - Claus Garbe
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Carola Berking
- Department of Dermatology and AllergologyUniversity Medical Center LMU Munich Munich Germany
- Department of DermatologyFriedrich Alexander University of Erlangen‐Nuremberg Erlangen Germany
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18
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Leiter U, Heppt MV, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Welzel J, Wermker K, Garbe C, Berking C. S3‐Leitlinie „Aktinische Keratose und Plattenepithelkarzinom der Haut“ – Kurzfassung, Teil 2: Epidemiologie, chirurgische und systemische Therapie des Plattenepithelkarzinoms, Nachsorge, Prävention und Berufskrankheit. J Dtsch Dermatol Ges 2020; 18:400-413. [PMID: 32291932 DOI: 10.1111/ddg.14072_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ulrike Leiter
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Markus V Heppt
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München.,Klinik für Dermatologie, Universitätsklinikum Erlangen
| | - Theresa Steeb
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München
| | - Teresa Amaral
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Andrea Bauer
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Helmut Breuninger
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Thomas Diepgen
- Institut für klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Michael Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München
| | | | | | | | - Ralf Gutzmer
- Klinik für Dermatologie, Medizinische Hochschule Hannover
| | - Uwe Hillen
- Klinik für Dermatologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück
| | - Oliver Kölbl
- Klinik für Strahlentherapie, Universitätsklinikum Regensburg
| | | | | | | | - Seema Noor
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin
| | - Christina Pfannenberg
- Klinik für Diagnostische unter Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | | | - Lutz Schmitz
- Klinik für Dermatologie, Ruhr-Universität Bochum
| | | | | | - Claas Ulrich
- Klinik für Dermatologie, Charité - Universitätsmedizin Berlin
| | | | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum Osnabrück
| | - Claus Garbe
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Carola Berking
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München.,Klinik für Dermatologie, Universitätsklinikum Erlangen
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19
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European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention. Eur J Cancer 2020; 128:60-82. [PMID: 32113941 DOI: 10.1016/j.ejca.2020.01.007] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in the white populations, accounting for 20% of all cutaneous malignancies. Factors implicated in cSCC etiopathogenesis include ultraviolet radiation exposure and chronic photoaging, age, male sex, immunosuppression, smoking and genetic factors. A collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organisation of Research and Treatment of Cancer (EORTC) was formed to update recommendations on cSCC classification, diagnosis, risk stratification, staging and prevention, based on current literature, staging systems and expert consensus. Common cSCCs are typically indolent tumors, and most have a good prognosis with 5-year cure rates of greater than 90%, and a low rate of metastases (<4%). Further risk stratification into low-risk or high-risk common primary cSCC is recommended based on proposed high-risk factors. Advanced cSCC is classified as locally advanced (lacSCC), and metastatic (mcSCC) including locoregional metastatic or distant metastatic cSCC. Current systems used for staging include the American Joint Committee on Cancer (AJCC) 8th edition, the Union for International Cancer Control (UICC) 8th edition, and Brigham and Women's Hospital (BWH) system. Physical examination for all cSCCs should include total body skin examination and clinical palpation of lymph nodes, especially of the draining basins. Radiologic imaging such as ultrasound of the regional lymph nodes, magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography-computed tomography (PET-CT) scans are recommended for staging of high-risk cSCC. Sentinel lymph node biopsy is currently not recommended. Nicotinamide, oral retinoids, and topical 5-FU have been used for the chemoprevention of subsequent cSCCs in high-risk patients but are not routinely recommended. Education about sun protection measures including reducing sun exposure, use of protective clothing, regular use of sunscreens and avoidance of artificial tanning, is recommended.
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20
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Abstract
Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in the United States. Outcomes are generally favorable, but a subset of cSCC is biologically distinct and requires a different approach because of its higher risk of local recurrence, metastasis, and death. This article focuses on the recent literature regarding identification of this high-risk subset, efforts to validate and improve the prognostic ability of staging systems, and updates in management.
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21
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Thiem DGE, Scharr K, Pabst AM, Saka B, Kämmerer PW. Facial cutaneous squamous cell carcinoma - microscopic safety margins and their impact on developing local recurrences. J Craniomaxillofac Surg 2019; 48:49-55. [PMID: 31810842 DOI: 10.1016/j.jcms.2019.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Surgical excision remains the treatment of choice for facial cutaneous squamous cell carcinoma (cSCC) despite there being no generally accepted diameter of clear margins. Therefore, the aim of this study was to evaluate the impact of microscopic clear margins diameter (mCMD) with respect to the development of local recurrences (LR). MATERIALS AND METHODS The medical records of 99 patients with a total of 142 cases of facial cSCC, who underwent surgical treatment between January 2010 and December 2015, were reviewed for demographic data and clinicopathological features. RESULTS 100 cases were diagnosed as primary cSCC and 42 cases as secondary cSCC. Of these, nine (6.3%) developed LR. Mean time to LR was 20 months, with the cheek as the predominant site 55.5% (n = 5). Wound closure was either primary (56%) or secondary (44%), depending on the site. Although no significant correlation between mCMD and LR was found (rPearson = 0.029; rPearson = 0.015), >4.1 mm was shown to be a negative cut-off-value (horizontally and vertically) without LR (100% vs 0%). CONCLUSIONS Based on these results, however descriptive they are, the authors consider histological confirmation of clear margins to be necessary for reducing the formation of LR. Thus, consistent testing and histopathological reporting, in a multicentered effort, are needed to further clarify the role of mCMD in the development of cSCC-LR.
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Affiliation(s)
- D G E Thiem
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany.
| | - K Scharr
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - A M Pabst
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072 Koblenz, Germany
| | - B Saka
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - P W Kämmerer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany
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Mooney CP, Martin RCW, Dirven R, Ashford BG, Shannon K, Palme CE, Ngo Q, Wykes J, Davies S, Gao K, Ch’ng S, Low TH, Gupta R, Clark JR. Sentinel Node Biopsy in 105 High-Risk Cutaneous SCCs of the Head and Neck: Results of a Multicenter Prospective Study. Ann Surg Oncol 2019; 26:4481-4488. [DOI: 10.1245/s10434-019-07865-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 11/18/2022]
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Kofler L. [Classification of cutaneous squamous cell carcinoma : How do I recognise my high-risk patient?]. DER HAUTARZT 2019; 70:870-874. [PMID: 31560082 DOI: 10.1007/s00105-019-04484-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous squamous cell carcinomas are the second most common malignant tumours of the skin. In most cases, they are primarily treatable by surgery. Various risk factors for local recurrence as well as metastasis and tumor-specific death have been described. Various classification systems are available for risk stratification. Tumour thickness is the strongest risk factor for the development of local recurrences, but also for metastasis and tumour-specific death. In addition, the immune status of patients, location and histological factors such as growth patterns and differentiation play an important role in the assessment of the individual risk. According to these parameters, patients should be included in a risk-adapted follow-up regimen. The risk of local recurrence and metastasis is highest in the first few years after excision, which is why follow-up care should be more intensive during this time.
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Affiliation(s)
- Lukas Kofler
- Universitätshautklinik, Studienzentrum Operative Dermatologie, Eberhard-Karls Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
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Pyne JH, Myint E, Clark SP, Clifopoulos C, Fishburn P, Gorji M, Hou R. Squamous cell carcinoma: pain as a clue to increased tumour diameter, increased invasion depth, the grade of differentiation, acantholysis and perineural invasion. Clin Exp Dermatol 2019; 45:180-186. [DOI: 10.1111/ced.14066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- J. H. Pyne
- Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - E. Myint
- Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - S. P. Clark
- Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - C. Clifopoulos
- School of Medicine University of Queensland Brisbane Australia
| | - P. Fishburn
- School of Medicine University of Queensland Brisbane Australia
| | - M. Gorji
- Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - R. Hou
- Prince of Wales Clinical School University of New South Wales Sydney Australia
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Gutzmer R, Wiegand S, Kölbl O, Wermker K, Heppt M, Berking C. Actinic Keratosis and Cutaneous Squamous Cell Carcinoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:616-626. [PMID: 32048593 PMCID: PMC6819699 DOI: 10.3238/arztebl.2019.0616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 03/29/2019] [Accepted: 07/04/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) and its precursors, actinic keratoses (AK), are common. Physicians of multiple specialties are confronted with their treatment. METHODS This review is based on publications retrieved by a selective search in PubMed, as well as on the German guidelines on AK and cSCC, skin cancer prevention, and surgery with histologic guidance. RESULTS Local treatments for AK include lesional cryotherapy, curettage, and laser ablation as well as field-directed treatments with topical agents, e.g., diclofenac plus hyaluronic acid, imiquimod, 5-fluorouracil, ingenol mebutate, and photodynamic therapy. These treatments can be administered in various sequences or combinations, depending on individual factors and the stage of the disease. The gold standard of treatment for cSCC is histologically confirmed complete resection; radiotherapy is an alternative. Locally uncontrollable or metastatic disease is treated with systemic drugs. The use of various chemotherapeutic agents, EGFR-directed therapies, and the PD-I inhibitor cemiplimab, either singly or in combination, has been described in uncontrolled trials and case series. Cemiplimab has a reported response rate of 47% and was recently approved for the treatment of advanced cSCC. CONCLUSION There are many options for the treatment of AK and cSCC that must be considered in the interdisciplinary care of these entities.
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Affiliation(s)
- Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology, Hannover Medical School
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig
| | - Oliver Kölbl
- Department of Radiotherapy, University Hospital Regensburg
| | - Kai Wermker
- Department of Oromaxillofacial, Plastic and Esthetic Surgery, Osnabrück Hospital GmbH, Osnabrück
| | - Markus Heppt
- Department of Dermatology and Allergology, University Hospital (LMU), Munich
| | - Carola Berking
- Department of Dermatology and Allergology, University Hospital (LMU), Munich
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Measurement of Tumor Thickness in Cutaneous Squamous Cell Carcinomas: Do the Different Methods Provide Better Prognostic Data? Am J Dermatopathol 2019; 42:337-342. [PMID: 31464719 DOI: 10.1097/dad.0000000000001511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common cause of nonmelanoma skin cancers. Although it has a relatively low mortality rate, it may be locally destructive and potentially metastasize. Tumor thickness of the primary lesion is one important parameter associated with biologic behavior. Such measurement is currently performed in different ways depending on the anatomic location and subspecialty (eg, skin vs. head and neck vs. gynecologic pathology). Furthermore, the new The American Joint Committee on Cancer eighth edition has changed the previously recommended method of measurement of cSCC of head and neck from a modified Breslow thickness to measuring from the granular layer of adjacent, normal-appearing skin to the deepest invasive tumor cell. This study evaluated the clinical significance on patient outcome by measuring tumor thickness using 4 common, currently available methods (measurement from: A. uninvolved dermoepidermal junction; B. top of granular cell layer of the epidermis overlying the tumor, that is, similar to Breslow thickness; C. dermoepidermal junction with in situ cSCC; D. top of granular layer of uninvolved skin) in 85 specimens from nongenital areas of 78 patients with cSCC. Thirty-five percent of them were from the head and neck area. Measurements were performed in millimeters using the digital ruler of image analysis software (Olympus cellSens Standard) on whole-slide scanned images. Associations between recurrence-free survival (RFS) and each method were assessed. When thickness was considered as a continuous measure, there was no statistically significant association between any of the 4 measurement techniques and RFS. When using the currently recommended 6.0-mm cutoff, methods B and C were significantly associated with RFS. Similarly, when optimal cutoff values were selected, all 4 methods were significantly associated with RFS in univariable analysis. However, in a multivariable model that included the techniques and location of lesion, only method B, using the optimal cutoff value of 8.7 mm, was independently associated with RFS. In summary, in our series of cSCC, measurement of thickness using a Breslow method (method B) was significantly associated with RFS using the optimal cutoff and the currently recommended 6.0 mm in univariable analyses and the optimal cutoff in a multivariable assessment. Therefore, our data indicate that measurement of tumor thickness in a manner similar to Breslow thickness may be used to help predict recurrence in patients with cSCC.
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Tumor Budding Is an Objective High-risk Factor Associated With Metastasis and Poor Clinical Prognosis in Cutaneous Squamous Cell Carcinoma Sized <4 cm. Am J Surg Pathol 2019; 43:975-983. [DOI: 10.1097/pas.0000000000001284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Jansen P, Petri M, Merz SF, Brinker TJ, Schadendorf D, Stang A, Stoffels I, Klode J. The prognostic value of sentinel lymph nodes on distant metastasis-free survival in patients with high-risk squamous cell carcinoma. Eur J Cancer 2019; 111:107-115. [PMID: 30849684 DOI: 10.1016/j.ejca.2019.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous cancer worldwide. Several tumour characteristics are considered to pose an elevated risk for systemic spread of carcinoma cells ('high-risk' features). Early detection of subclinical metastases could permit early treatment and improve overall survival. To detect occult metastases and evaluate risk of future distant metastases, diagnostic extirpation of the sentinel lymph node (SLNE) is routinely performed in cutaneous melanoma and can be offered in high-risk cutaneous squamous cell carcinoma (hrcSCC). However, the clinical utility of SLNE in patients with hrcSCC remains unknown. MATERIAL AND METHODS An ambidirectional cohort study with prospective patient recruitment was performed. Between July 2008 and April 2017, of 139 eligible patients, SLNE was performed in 114 cases (25 patients refused). Median follow-up was 23.7 months. RESULTS We analysed the characteristics of 114 patients with hrcSCC who underwent SLNE. Eighty-nine patients (78.1%) were men, and 25 patients (21.9%) were women (median age 72.2 years). In multivariable analyses, histopathological detection of ulceration (hazard ratio, HR 2.9 [95% confidence interval, CI 0.7-12.2]), perineural growth (HR 3.0 [95% CI 0.6-14.6]) and clinically occult SLN metastases (HR 10.7 [95% CI 1.9-60.6]) were strongly associated with future occurrence of distant metastases. A positive predictive value of 50% was noted for patients where SLN metastasis was detected to develop distant metastases. However, distant metastases also occurred in seven patients when histopathological SLN evaluation had shown no evidence of metastases. CONCLUSIONS Our data suggest SLNE is not a reliable diagnostic approach to evaluate the risk of future systemic carcinoma spread and development of distant metastases in patients with hrcSCC.
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Affiliation(s)
- Philipp Jansen
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; West German Cancer Center, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Maximilian Petri
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; West German Cancer Center, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Simon F Merz
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; West German Cancer Center, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany; Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Titus J Brinker
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; West German Cancer Center, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Andreas Stang
- Center of Clinical Epidemiology, c/o Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; West German Cancer Center, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; West German Cancer Center, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany.
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Abstract
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.
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Pyne JH, Myint E, Clark SP, Barr EM, Hou R. Early invasive squamous cell carcinoma recurrence rates: A study examining surgical margins, tumor surface diameter, invasion depth, and grade of differentiation in 1296 cases over 9 years. J Cutan Pathol 2018; 46:111-116. [PMID: 30421522 DOI: 10.1111/cup.13392] [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: 04/11/2018] [Revised: 10/14/2018] [Accepted: 11/08/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Invasive squamous cell carcinoma (SCC) is typically treated by surgical excision. METHODS Consecutive SCC excisions were reviewed prospectively in a single Australian center from 2009 to 2017. Cases were examined for recurrence by histopathologic margins, microscopic tumor surface diameter, invasion depth, grade of differentiation, and anatomic site. RESULTS Over 9 years, 1296 cases were collected. By grade of differentiation maximum average microscopic surface diameters ranged from 8.0 to 9.6 mm and maximum average depths from 1.3 to 2.5 mm. Minimum average histopathologic margins for well, moderate, and poorly differentiated SCC, respectively, were 1.4, 1.1, and 1.3 mm. Recurrence occurred in 1.7% of well (n = 18/1084), 1.8% moderate (n = 3/165) and 6.4% in poorly differentiated (n = 3/47) SCC. No recurrence occurred beyond a histopathologic margin of 3.5 mm for well and 2.5 mm for moderately differentiated SCC. Highest recurrence for well-differentiated SCC by anatomic site was the lip (7.0%) then ear (4.6%). CONCLUSION We found a recurrence rate of 1.0% for histopathologic margins of 1.5 mm with early well-differentiated SCC. The grade of differentiation and anatomic site had a larger influence on recurrence rates compared to the histopathologic margins. Poorly differentiated SCC and ear or lip sites require wider surgical margins.
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Affiliation(s)
- John H Pyne
- The Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Esther Myint
- The Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon P Clark
- The Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth M Barr
- The Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Ruihang Hou
- The Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Nodal staging of high-risk cutaneous squamous cell carcinoma. J Am Acad Dermatol 2018; 81:548-557. [PMID: 30227190 DOI: 10.1016/j.jaad.2018.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/03/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND While progress has been made in defining the clinical and histopathologic features of high-risk cutaneous squamous cell carcinoma (HRcSCC), optimal staging guidelines remain elusive. OBJECTIVE We seek to guide clinical practice regarding nodal staging options for patients with HRcSCC via review of evolving definitions of HRcSCC, nodal staging options, and how nodal staging may impact treatment and affect outcomes. METHODS This was a retrospective review of the published peer-reviewed literature regarding risk stratification, nodal staging, and treatment and outcomes for patients with HRcSCC via PubMed. RESULTS For patients without clinical lymphadenopathy, based on literature from head and neck SCC, preoperative nodal staging with ultrasonography may be more useful than computed tomography or magnetic resonance imaging. Early nodal disease is usually curable, and therefore obtaining a sentinel lymph node biopsy specimen may be considered in those with negative imaging while we await studies of nodal staging outcomes. LIMITATIONS More data are needed to validate the relationships between primary tumor stage and sentinel lymph node biopsy status and to determine if early detection of nodal disease impacts survival for patients with HRcSCC. CONCLUSION It is reasonable to consider nodal staging for patients with HRcSCC (Brigham and Women's Hospital stage T2b and T3) in the absence of clinically palpable lymphadenopathy via radiographic imaging and, if negative, sentinel lymph node biopsy.
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Cañueto J, Burguillo J, Moyano-Bueno D, Viñolas-Cuadros A, Conde-Ferreirós A, Corchete-Sánchez LA, Pérez-Losada J, Román-Curto C. Comparing the eighth and the seventh editions of the American Joint Committee on Cancer staging system and the Brigham and Women's Hospital alternative staging system for cutaneous squamous cell carcinoma: Implications for clinical practice. J Am Acad Dermatol 2018; 80:106-113.e2. [PMID: 30003984 DOI: 10.1016/j.jaad.2018.06.060] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 06/08/2018] [Accepted: 06/28/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The new eighth edition of the American Joint Committee on Cancer staging system (AJCC-8) incorporates changes regarding cutaneous squamous cell carcinoma (CSCC). OBJECTIVES We aimed to compare the AJCC-8 staging system with the previous seventh edition of the AJCC staging system (AJCC-7) and the Brigham and Women's Hospital (BWH) alternative staging system to identify their usefulness and the utility of their risk factors in defining prognostic groups in CSCC. METHODS A series of 186 CSCCs of the head and neck were retrospectively collected. All 3 staging systems were compared from the standpoint of their ability to predict poor prognosis. Binary logistic regression models were built to determine which risk factors were most relevant. RESULTS Poor prognosis was mainly associated with stage T2 of the AJCC-7, with stages T2b/T3 of the BWH system, and with stage T3 of the AJCC-8. The AJCC-8 and the BWH staging systems displayed overlap with each another in predicting poor prognosis, and both were superior to the AJCC-7. The new risk factors incorporated into the AJCC-8 and the poor degree of differentiation were independently associated with poor outcome. LIMITATIONS Retrospective study and few cases with bone invasion. CONCLUSIONS The AJCC-8 is more distinctive, monotonous, and homogeneous than the AJCC-7 and shows some overlap with the BWH system in stratification of tumors.
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Affiliation(s)
- Javier Cañueto
- Departamento de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca, Hospital Universitario de Salamanca, Salamanca, Spain.
| | - Javier Burguillo
- Departamento de Química-Física, Facultad de Farmacia, Campus Miguel de Unamuno, Salamanca, Spain
| | - David Moyano-Bueno
- Departamento de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Alex Viñolas-Cuadros
- Departamento de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Jesús Pérez-Losada
- Instituto de Investigación Biomédica de Salamanca, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Biología Molecular y Celular del Cáncer, Universidad de Salamanca/CSIC, Campus Miguel de Unamuno, Salamanca, Spain
| | - Concepción Román-Curto
- Departamento de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca, Hospital Universitario de Salamanca, Salamanca, Spain
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Wach MM, van Beek E, Ayabe R, Ruff S, Brown Z, Goldman DA, Zambirinis CP, Gholami S, Pulitzer M, Hernandez J, Coit D. Metastatic squamous cell carcinoma of known and unknown primary origin treated with axillary or inguinal lymphadenectomy. Am J Surg 2018; 216:963-968. [PMID: 30143231 DOI: 10.1016/j.amjsurg.2018.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/29/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Metastatic squamous cell carcinoma (SCC) to the axillary or inguinal lymph nodes from an unknown primary source is rarely encountered. We sought to evaluate a cohort of patients with metastatic SCC managed by lymphadenectomy to determine their survival and to determine which clinicopathologic factors were associated with outcome. METHODS All patients undergoing axillary or inguinal lymphadenectomy for SCC at our institution were identified retrospectively. Patients were stratified by unknown primary (UP) vs known skin primary (KP) tumors. Pertinent data on patient, tumor, and treatment variables was collected. RESULTS We identified 51 patients who met inclusion criteria. Of those, 20 patients (39%) had UP metastatic SCC and 31 patients (61%) had KP. The 5-year overall survival for UP was 65%, as compared to 49% for KP (p = 0.16). Cumulative incidence of recurrence was 46%. Cox regression failed to demonstrate a significant association between KP vs UP, HPV status, chemotherapy, or radiation with survival. CONCLUSIONS Nearly two-thirds of patients undergoing axillary or inguinal lymphadenectomy for metastatic SCC of unknown primary were alive five years following the procedure.
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Affiliation(s)
- Michael M Wach
- National Cancer Institute, National Institutes of Health, USA
| | | | - Reed Ayabe
- National Cancer Institute, National Institutes of Health, USA
| | - Samantha Ruff
- National Cancer Institute, National Institutes of Health, USA
| | - Zachary Brown
- National Cancer Institute, National Institutes of Health, USA
| | | | | | | | | | - Jonathan Hernandez
- National Cancer Institute, National Institutes of Health, USA; Memorial Sloan Kettering Cancer Center, USA
| | - Daniel Coit
- Memorial Sloan Kettering Cancer Center, USA.
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Tejera-Vaquerizo A, García-Doval I, Llombart B, Cañueto J, Martorell-Calatayud A, Descalzo-Gallego MA, Sanmartín O. Systematic review of the prevalence of nodal metastases and the prognostic utility of sentinel lymph node biopsy in cutaneous squamous cell carcinoma. J Dermatol 2018; 45:781-790. [DOI: 10.1111/1346-8138.14342] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/28/2018] [Indexed: 12/29/2022]
Affiliation(s)
| | - Ignacio García-Doval
- Investigation Unit; Fundación Piel Sana; Spanish Academy of Dermatology and Venereology; Madrid Spain
| | - Beatriz Llombart
- Dermatology Department; Instituto Valenciano de Oncología; Valencia Spain
| | - Javier Cañueto
- Dermatology Department; Hospital Clínico de Salamanca; Salamanca Spain
| | | | | | - Onofre Sanmartín
- Dermatology Department; Instituto Valenciano de Oncología; Valencia Spain
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35
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A Review of Cutaneous Squamous Cell Carcinoma Epidemiology, Diagnosis, and Management. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.60846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Park K. Recent advances of basal cell carcinoma, squamous cell carcinoma, and carcinoma in situ. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.11.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kun Park
- Department of Dermatology, Wonkwang University School of Medicine, Iksan, Korea
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Abstract
Cutaneous squamous cell carcinoma (cSCC) is a malignant neoplasm of the skin characterized by an aberrant proliferation of keratinocytes. Cutaneous SCC is the second most common malignancy globally, and usually arises in the chronically sun-damaged skin of elderly white individuals. From a pathologist's perspective, it is important to differentiate cSCC from the benign and reactive squamoproliferative lesions and identify the high-risk features associated with aggressive tumor behavior. In this article, we provide an up-to-date overview of cSCC along with its precursor lesions and important histologic variants, with a particular emphasis on the histopathologic features and molecular pathogenesis.
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Pyne JH, Barr E, Myint E, Clark SP, David M, Na R. Invasive squamous cell carcinoma: comparison of differentiation grade and tumour depth by anatomical site in 1666 tumours. Clin Exp Dermatol 2017; 43:3-10. [PMID: 29064114 DOI: 10.1111/ced.13222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Invasive squamous cell carcinomas (SCCs) presents with different grades of differentiation and depths of invasion. AIM To compare the grade of differentiation, tumour diameter and tumour depth by anatomical site in invasive SCC. METHODS Retrospective clinical and histopathological data on consecutive cases of SCC came from a clinic in Sydney, Australia were assessed. A multinomial logistic regression model was applied to compare grades of differentiation by age, sex, anatomical sites, and histological tumour maximum diameter and depth. RESULTS In total, 1666 SCCs were identified, including 82.1% (n = 1367) well-differentiated, 13.3% (n = 222), moderately differentiated and 4.6% (n = 77) poorly differentiated SCCs. Patients with poorly differentiated tumours were more likely to be older and male (both P < 0.001). The most common site for poor differentiation was the scalp in men (n = 12; 15.6%) and the cheek or chin in women (n = 7; 9.1%). In the multivariate model, compared with well-differentiated SCC, older age was significantly associated with poorly and moderately differentiated SCC (P < 0.01 and P = 0.02, respectively). Larger tumour diameters were related to poor differentiation (P = 0.03). Ear, forehead and chest sites had increased tumour depth and poor differentiation. CONCLUSIONS This study found increased rates of poorly differentiated SCC on the forehead and cheek for both sexes, while men displayed increased rates of poorly differentiated SCC on the bald scalp and the ears. Tumour diameter and depth increased as tumours varied from well-differentiated to moderately differentiated and from moderately differentiated to poorly differentiated. An increase in depth and increased prevalence of poorly differentiated tumours were found on the ears for men and on various facial sites for both sexes.
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Affiliation(s)
- J H Pyne
- School of Medicine, University of Queensland, Brisbane, Australia
| | - E Barr
- School of Medicine, University of Queensland, Brisbane, Australia
| | - E Myint
- School of Medicine, University of Queensland, Brisbane, Australia
| | - S P Clark
- School of Medicine, University of Queensland, Brisbane, Australia
| | - M David
- School of Medicine, University of Queensland, Brisbane, Australia
| | - R Na
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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Saenz-Sardà X, Carrato C, Pérez-Roca L, Puig L, Ferrándiz C, Ariza A, Fernández-Figueras MT. Epithelial-to-mesenchymal transition contributes to invasion in squamous cell carcinomas originated from actinic keratosis through the differentiated pathway, whereas proliferation plays a more significant role in the classical pathway. J Eur Acad Dermatol Venereol 2017; 32:581-586. [DOI: 10.1111/jdv.14514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/25/2017] [Indexed: 12/14/2022]
Affiliation(s)
- X. Saenz-Sardà
- Division of Oncology and Pathology; Department of Clinical Sciences Lund; Lund University; Lund Sweden
- Universitat Autònoma de Barcelona; Barcelona Spain
| | - C. Carrato
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Pathology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - L. Pérez-Roca
- Department of Pathology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - L. Puig
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Dermatology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - C. Ferrándiz
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Dermatology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - A. Ariza
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Pathology; Hospital Universitari Germans Trias i Pujol; Universitat Autònoma de Barcelona; Barcelona Spain
| | - M.-T. Fernández-Figueras
- Universitat Autònoma de Barcelona; Barcelona Spain
- Department of Pathology; Hospital Universitari General de Catalunya-QuironSalud; Universitat Autònoma de Barcelona; Barcelona Spain
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Mittal A, Colegio OR. Skin Cancers in Organ Transplant Recipients. Am J Transplant 2017; 17:2509-2530. [PMID: 28556451 DOI: 10.1111/ajt.14382] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/05/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023]
Abstract
Long-term utilization of immunosuppression in organ transplant recipients (OTRs) leads to decreased immune-mediated tumor surveillance and development of malignant tumors. A delicate balance needs to be maintained in the intensity of immunosuppression to keep the risk of malignancy low without jeopardizing life-saving graft function. OTRs are prone to developing skin cancers that exhibit unique epidemiologic, pathophysiologic, and prognostic characteristics. In this review, we discuss the most commonly reported skin cancers in OTRs: squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Kaposi sarcoma, Merkel cell carcinoma, and malignant melanoma (MM). Tumors in this high-risk population are aggressive and may respond poorly to standard therapies; however, new targeted therapies are promising. Checkpoint inhibitor antibodies have been used for treatment of cutaneous SCC, Merkel cell carcinoma, and MM; epidermal growth factor receptor inhibitors have been used for cutaneous SCC; hedgehog pathway inhibitors have been used for BCC; and BRAF and MEK inhibitors are being used increasingly in the management of MM. Guidelines for dermatologic screening are variable and primarily based on expert opinion. Prospective evidence-based trials by multidisciplinary groups are needed to better define surveillance schedules for pre- and posttransplant cutaneous malignancies.
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Affiliation(s)
- A Mittal
- Departments of Dermatology, Yale University School of Medicine, New Haven, CT
| | - O R Colegio
- Departments of Dermatology, Yale University School of Medicine, New Haven, CT.,Departments of Pathology, Yale University School of Medicine, New Haven, CT.,Departments of Surgery, Yale University School of Medicine, New Haven, CT.,Yale Cancer Center, Yale University School of Medicine, New Haven, CT.,Yale-New Haven Transplantation Center, Yale University School of Medicine, New Haven, CT
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Cutaneous Squamous Cell Carcinoma: Review of the Eighth Edition of the American Joint Committee on Cancer Staging Guidelines, Prognostic Factors, and Histopathologic Variants. Adv Anat Pathol 2017; 24:171-194. [PMID: 28590951 DOI: 10.1097/pap.0000000000000157] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cutaneous squamous cell carcinoma is the second most common form of nonmelanoma skin cancer after basal cell carcinoma and accounts for the majority of nonmelanoma skin cancer-related deaths. In 2017, the American Joint Committee on Cancer revised the staging guidelines of cutaneous squamous cell carcinoma to reflect recent evidence concerning high-risk clinicopathologic features. This update reviews the literature on prognostic features and staging, including the eighth edition of the American Joint Committee on Cancer Staging Manual. A wide range of histopathologic variants of cutaneous squamous cell carcinoma exists, several of which are associated with aggressive behavior. A review of cutaneous squamous cell carcinoma variants, emphasizing diagnostic pitfalls, immuhistochemical findings and prognostic significance, is included. Of note, the eighth edition of the American Joint Committee on Cancer Staging Manual refers to squamous cell carcinoma of the head and neck only.
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McLaughlin EJ, Miller L, Shin TM, Sobanko JF, Cannady SB, Miller CJ, Newman JG. Rate of regional nodal metastases of cutaneous squamous cell carcinoma in the immunosuppressed patient. Am J Otolaryngol 2017; 38:325-328. [PMID: 28202188 DOI: 10.1016/j.amjoto.2017.01.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/31/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Immunosuppressed solid organ transplant recipients (SOTRs) have an increased risk of developing cutaneous squamous cell carcinomas (cSCCs) with metastatic potential. This study sought to determine the rate of regional lymph node involvement in a large cohort of solid organ transplant patients with cutaneous head and neck squamous cell carcinoma. MATERIALS AND METHODS A retrospective chart review was performed on solid organ transplant patients with head and neck cutaneous squamous cell carcinoma treated at a tertiary academic medical center from 2005 to 2015. RESULTS 130 solid organ transplant patients underwent resection of 383 head and neck cutaneous squamous cell carcinomas. The average age of the patient was 63. Seven patients (5%) developed regional lymph node metastases (3 parotid, 4 cervical lymph nodes). The mean time from primary tumor resection to diagnosis of regional lymphatic disease was 6.7months. Six of these patients underwent definitive surgical resection followed by adjuvant radiation; one patient underwent definitive chemoradiation. 6 of the 7 patients died of disease progression with a mean survival of 15months. The average follow up time was 3years (minimum 6months). CONCLUSIONS Solid organ transplant recipients with cutaneous squamous cell carcinoma of the head and neck develop regional lymph node metastasis at a rate of 5%. Regional lymph node metastasis in this population has a poor prognosis and requires aggressive management and surveillance.
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Trodello C, Pepper JP, Wong M, Wysong A. Cisplatin and Cetuximab Treatment for Metastatic Cutaneous Squamous Cell Carcinoma: A Systematic Review. Dermatol Surg 2017; 43:40-49. [PMID: 27618393 DOI: 10.1097/dss.0000000000000799] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer and metastasizes in 2% to 5% of cases. OBJECTIVE Systematic evaluation of published cases of metastatic cSCC (mSCC) treated with cisplatin or cetuximab from 1989 to 2014. MATERIALS AND METHODS A literature search was performed to identify cases of mSCC treated with cisplatin or cetuximab. Patient demographics, tumor characteristics, response rates, and disease-free survivals were extracted. RESULTS A total of 60 cases of mSCC treated with cisplatin and 9 cases treated with cetuximab reported in the literature from 1989 to 2014 were included in the analysis. Patients treated with cetuximab obtained a complete response of 67%, an overall response of 78%, and a median disease-free survival of 25 (range 3-48) months. Patients treated with cisplatin obtained a complete response of 22%, an overall response of 45%, and a median disease-free survival of 14.6 (range 3-112) months. CONCLUSION Head-to-head prospective clinical studies between cetuximab and cisplatin are needed to determine which is more efficacious. In addition, prospective tumor registries and randomized controlled trials should be developed in order to establish the ideal systemic regimen in cSCC.
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Affiliation(s)
- Cameron Trodello
- *School of Medicine, Keck School of Medicine of USC, Los Angeles, California; †Caruso Department of Otolaryngology, Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, California; ‡Medical Oncology, Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, California; §USC Department of Dermatology, Keck School of Medicine of USC, Los Angeles, California
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Pyne JH, Myint E, Barr EM, Clark SP, David M, Na R. Acantholytic invasive squamous cell carcinoma: tumor diameter, invasion depth, grade of differentiation, surgical margins, perineural invasion, recurrence and death rate. J Cutan Pathol 2017; 44:320-327. [DOI: 10.1111/cup.12869] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/20/2016] [Accepted: 12/13/2016] [Indexed: 02/04/2023]
Affiliation(s)
- J. H. Pyne
- School of MedicineUniversity of Queensland Brisbane Australia
| | - E. Myint
- School of MedicineUniversity of Queensland Brisbane Australia
| | - E. M. Barr
- School of MedicineUniversity of Queensland Brisbane Australia
| | - S. P. Clark
- School of MedicineUniversity of Queensland Brisbane Australia
| | - M. David
- School of MedicineUniversity of Queensland Brisbane Australia
| | - R. Na
- Prince of Wales Clinical SchoolUniversity of New South Wales Sydney Australia
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Skulsky SL, O'Sullivan B, McArdle O, Leader M, Roche M, Conlon PJ, O'Neill JP. Review of high‐risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology. Head Neck 2016; 39:578-594. [DOI: 10.1002/hed.24580] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/13/2016] [Accepted: 08/02/2016] [Indexed: 01/23/2023] Open
Affiliation(s)
| | - Barry O'Sullivan
- Department of Plastic and Reconstructive SurgeryBeaumont HospitalDublin Ireland
| | - Orla McArdle
- St. Luke's Radiation Oncology Network, Beaumont HospitalDublin Ireland
| | - Mary Leader
- Department of PathologyRoyal College of Surgeons in IrelandDublin Ireland
| | - Muireann Roche
- Department of DermatologyBeaumont Hospital and Royal College of Surgeons in IrelandDublin Ireland
| | - Peter J. Conlon
- Department of Nephrology and Renal TransplantationBeaumont Hospital and Royal College of Surgeons in IrelandDublin Ireland
| | - James Paul O'Neill
- Department of Neurosciences, Otolaryngology and Cochlear ImplantRoyal College of Surgeons in Ireland, Beaumont HospitalDublin Ireland
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Cytokeratin AE1/AE3 immunostaining and 3D-histology: improvement of diagnosis in desmoplastic squamous cell carcinoma of the skin. Arch Dermatol Res 2016; 309:43-46. [DOI: 10.1007/s00403-016-1700-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 11/08/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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Haisma MS, Plaat BE, Bijl HP, Roodenburg JL, Diercks GF, Romeijn TR, Terra JB. Multivariate analysis of potential risk factors for lymph node metastasis in patients with cutaneous squamous cell carcinoma of the head and neck. J Am Acad Dermatol 2016; 75:722-730. [DOI: 10.1016/j.jaad.2016.06.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 01/01/2023]
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Abstract
Non-melanoma skin cancer represents one-third of all malignancies and its incidence is expected to rise until the year 2040. Cutaneous squamous cell carcinoma (cSCC) represents 20 % of all non-melanoma skin cancer and is a deadly threat owing to its ability to metastasize to any organ in the body. Therefore, a better understanding of cSCC is essential to strengthen preventative measures and curable treatment options. Currently, research demonstrates that cSCC is diagnosed at a rate of 15-35 per 100,000 people and is expected to increase 2-4 % per year. With respect to metastatic cSCC, this disease is more common in men; people over the age of 75 years; and inhabitants of the south and mid-west USA. In 2010, the American Joint Committee on Cancer updated the Cancer Staging Manual's primary tumor designation to now include high-risk factors; however, factors such as immunosuppression and tumor recurrence were not included. Other staging systems such as Brigham and Women's Hospital have allowed for increased stratification of cSCC. High-risk cSCC is defined as a cSCC that is staged as N0, extends beyond basement membrane, and has high-risk features associated with sub-clinical metastasis. High-risk features are depth of invasion (>2 mm), poor histological differentiation, high-risk anatomic location (face, ear, pre/post auricular, genitalia, hands, and feet), perineural involvement, recurrence, multiple cSCC tumors, and immunosuppression. Epidermal growth factor receptor and nuclear active IκB kinase (IKK) expression are also predictive of metastatic capabilities. Clinically, the initial lesions of a cSCC tumor can present as a painless plaque-like or verrucous tumor that can ultimately progress to being large, necrotic, and infected. Tumors can also present with paresthesias or lymphadenopathy depending on the location involved. With respect to prognosis, metastatic cSCC is lethal, with several large studies demonstrating a mortality rate of >70 %. Therefore, treatment of metastatic cSCC is difficult and depends on the location involved and extent of metastasis. Treatment options include surgery, radiation therapy, chemotherapy, and any combination of the above. Surgery alone can be used for metastatic cSCC treatment, but is not as effective as surgery in conjunction with radiation therapy. Radiation therapy has some success as a monotherapy in low-risk or cosmetically sensitive areas such as the external ear, eyelid or nose. According to the 2013 National Comprehensive Cancer Network Guidelines, cisplatin as a single agent or combined with 5-fluorouracil hold the strongest support for the treatment of metastatic cSCC; however, the supporting evidence is inconsistent and a curative chemotherapeutic approach is still lacking. Epidermal growth factor receptor inhibitors are a newer class of agents being used in metastatic cSCC and hold some promise as a therapy for this disease. Other areas of interest in finding curative treatments for metastatic cSCC include p53, hypermethylation of specific genes, chromatin remodeling genes, and the RAS/RTK/PI3K pathway. This review addresses the epidemiology, staging, risk factors, clinical presentation, management, and new trends in the treatment of high-risk and metastatic cSCC.
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Maruyama H, Tanaka R, Fujisawa Y, Nakamura Y, Ito S, Fujimoto M. Availability of sentinel lymph node biopsy for cutaneous squamous cell carcinoma. J Dermatol 2016; 44:431-437. [DOI: 10.1111/1346-8138.13577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/02/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Hiroshi Maruyama
- Division of Clinical Medicine; Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Ryota Tanaka
- Division of Clinical Medicine; Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yasuhiro Fujisawa
- Division of Clinical Medicine; Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology; Saitama Medical University International Medical Center; Saitama Japan
| | - Shusaku Ito
- Department of Dermatology; Hitachi General Hospital; Hitachi Japan
| | - Manabu Fujimoto
- Division of Clinical Medicine; Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
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Thompson AK, Kelley BF, Prokop LJ, Murad MH, Baum CL. Risk Factors for Cutaneous Squamous Cell Carcinoma Recurrence, Metastasis, and Disease-Specific Death: A Systematic Review and Meta-analysis. JAMA Dermatol 2016; 152:419-28. [PMID: 26762219 DOI: 10.1001/jamadermatol.2015.4994] [Citation(s) in RCA: 334] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE To date, the magnitude of association and the quality of evidence for cutaneous squamous cell carcinoma (cSCC) and risk factors for outcomes have not been reviewed and analyzed systematically. OBJECTIVE To systematically analyze all published data on risk factors for recurrence, metastasis, and disease-specific death (DSD) of cSCC. DATA SOURCES Comprehensive search of Ovid MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, from each database's inception to May 14, 2015. STUDY SELECTION Inclusion criteria were studies of at least 10 patients, comparative data for at least 1 cSCC risk factor, and an outcome of interest. Exclusion criteria were noncutaneous squamous cell carcinoma (SCC), anogenital SCC, inability to extract cSCC data from other malignancy data, SCC in situ, Marjolin ulcer, and genetic disorders predisposing to cSCC. DATA EXTRACTION AND SYNTHESIS Two reviewers independently abstracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale. MAIN OUTCOMES AND MEASURES A priori outcomes were recurrence, metastasis, and DSD. RESULTS Thirty-six studies (17 248 patients with 23 421 cSCCs) were included. Significant risk factors for recurrence were the following: Breslow thickness exceeding 2 mm (risk ratio [RR], 9.64; 95% CI, 1.30-71.52), invasion beyond subcutaneous fat (RR, 7.61; 95% CI, 4.17-13.88), Breslow thickness exceeding 6 mm (RR, 7.13; 95% CI, 3.04-16.72), perineural invasion (RR, 4.30; 95% CI, 2.80-6.60), diameter exceeding 20 mm (RR, 3.22; 95% CI, 1.91-5.45), location on the temple (RR, 3.20; 95% CI, 1.12-9.15), and poor differentiation (RR, 2.66; 95% CI, 1.72-4.14). Significant risk factors for metastasis were: invasion beyond subcutaneous fat (RR, 11.21; 95% CI, 3.59-34.97), Breslow thickness exceeding 2 mm (RR, 10.76; 95% CI, 2.55-45.31), Breslow thickness exceeding 6 mm (RR, 6.93; 95% CI, 4.02-11.94), diameter exceeding 20 mm (RR, 6.15; 95% CI, 3.56-10.65), poor differentiation (RR, 4.98; 95% CI, 3.30-7.49), perineural invasion (RR, 2.95; 95% CI, 2.31-3.75), immunosuppression (RR, 1.59; 95% CI, 1.07-2.37), and location on the temple (RR, 2.82; 95% CI, 1.72-4.63), ear (RR, 2.33; 95% CI, 1.67-3.23), or lip (RR, 2.28; 95% CI, 1.54-3.37). Significant risk factors for DSD were: diameter exceeding 20 mm (RR, 19.10; 95% CI, 5.80-62.95), poor differentiation (RR, 5.65; 95% CI, 1.76-18.20), location on the ear (RR, 4.67; 95% CI, 1.28-17.12) or lip (RR, 4.55; 95% CI, 1.41-14.69), invasion beyond subcutaneous fat (RR, 4.49; 95% CI, 2.05-9.82), and perineural invasion (RR, 4.06; 95% CI, 3.10-5.32). Evidence quality was considered low to moderate. CONCLUSIONS AND RELEVANCE Tumor depth is associated with the highest RR of local recurrence and metastasis of cSCC, and tumor diameter exceeding 20 mm is associated with the highest RR of DSD. Unified, consistent collection and reporting of risk factors in a prospective, multicentered effort are needed to further understand the increasing incidence of cSCC.
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Affiliation(s)
| | | | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota4Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
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