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Aoki KC, Glick BP, Bartos S. Complex Management of Basal Cell Carcinoma in a Frail Patient. Cureus 2024; 16:e53518. [PMID: 38440025 PMCID: PMC10911882 DOI: 10.7759/cureus.53518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Basal cell carcinoma (BCC) is one of the most common cancers diagnosed in older patients and has low mortality. Surgical versus medical management is considered in patients with multiple comorbidities and limited life expectancy (LLE), where the risk-to-benefit ratio must be carefully assessed. Watchful waiting (WW) is a viable option for some patients with severe LLE when follow-up care can be provided vigilantly and frequently. Special consideration should be given to morbidity factors such as tumor growth, bleeding, pain, and social withdrawal that negatively affect the quality of life. We present the case of a 75-year-old male with a past medical history of multiple system atrophy, who presented with a BCC on the ear and face. We discuss the management of this patient and factors that may have led to the inappropriate use of WW.
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Affiliation(s)
- Kawaiola Cael Aoki
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Brad P Glick
- Dermatology, Larkin Community Hospital Palm Springs Campus, Margate, USA
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2
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Lee J, Nguyen NT, Wright J, Yeung KKD, Sagar S, Kim DH, Ostapiak O, Doerwald-Munoz L, Whelan T. A phase 2 study of stereotactic body radiation therapy for squamous cell carcinoma of the head and neck (SHINE): a single arm clinical trial protocol. BMC Cancer 2023; 23:379. [PMID: 37098494 PMCID: PMC10131380 DOI: 10.1186/s12885-023-10807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/03/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Cancers of the head and neck region are often characterized by locally advanced, non-metastatic disease. Standard treatments for advanced cervico-facial cancers of the skin or primary head and neck squamous cell carcinoma (HNSCC) include combinations of surgery, radiation and chemotherapy, which are associated with high rates of acute toxicity and complications. Stereotactic body radiotherapy (SBRT) has been shown to be a promising modality of treatment for this patient population in retrospective studies; to our knowledge, there are no prospective clinical studies evaluating the safety and efficacy of SBRT in these patients. METHODS This phase 2, single institution, single arm study aims to evaluate response rates to SBRT in older age patients with locally advanced HNSCC for whom primary surgery is not recommended or performed. The intervention is SBRT 45 Gy in 5 fractions given every 3-4 days. Toxicity, quality of life and patient outcomes will be recorded regularly up to 24 months after completion of SBRT. DISCUSSION For this patient population, SBRT may offer a shorter and more effective treatment than the current standard of care palliative regimens. If the study demonstrates that SBRT is safe and effective, then this may lead to randomized studies comparing conventional radiotherapy to SBRT for selected head and neck cancer patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04435938 . Date registered: June 17, 2020.
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Affiliation(s)
- Justin Lee
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
- Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, ON, CA, L8V 5C2, Canada.
| | - Nhu Tram Nguyen
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, ON, CA, L8V 5C2, Canada
| | - James Wright
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, ON, CA, L8V 5C2, Canada
| | - Ka-Kit David Yeung
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, ON, CA, L8V 5C2, Canada
| | - Stephen Sagar
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, ON, CA, L8V 5C2, Canada
| | - Do-Hoon Kim
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, ON, CA, L8V 5C2, Canada
| | - Orest Ostapiak
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, ON, CA, L8V 5C2, Canada
| | - Lilian Doerwald-Munoz
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, ON, CA, L8V 5C2, Canada
| | - Timothy Whelan
- Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, ON, CA, L8V 5C2, Canada
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3
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Beatty P, Blasco MC, Doyle C, McFeely O, Murphy L, Andrawis M, Tobin AM. When overtreatment of cutaneous malignancy becomes an unacceptable burden for patients with limited life expectancy: a patient's perspective. Clin Exp Dermatol 2023; 48:410-411. [PMID: 36745577 DOI: 10.1093/ced/llac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 01/22/2023]
Abstract
Concern has been raised that there is a potential for over treatment of NMSCs among older patients, given the relative low risk of the tumour to their health and the high burden of treatment. This article explores one patient’s perspective of the treatment of multiple NMSCs.
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Affiliation(s)
- Paula Beatty
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - Marta Costa Blasco
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - Claire Doyle
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - Orla McFeely
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - Lisa Murphy
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - Madonna Andrawis
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - Anne-Marie Tobin
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
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4
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Lai M, Pampena R, Mirra M, Raucci M, Benati E, Borsari S, Lombardi M, Banzi M, Castagnetti F, Palmieri T, Piana S, Ramundo D, Pellacani G, Longo C. Characteristics and management of skin cancers in very elderly patients: A real-world challenge for clinicians. Exp Dermatol 2022; 31:1554-1562. [PMID: 35723894 DOI: 10.1111/exd.14627] [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: 04/03/2022] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
The increase life expectancy led to an expected increase in skin cancer incidence in older patients. Their treatment can require a complex decision-making process. Limited data are available on characteristics, management and outcome of skin tumours in nonagenarian and centenarian patients. The aim of our study was to describe epidemiology, clinical-pathological features and treatment strategies of skin cancers in a cohort of patients aged ≧95 years. A total of 116 patients ≧95 years of age presented for the evaluation of 225 skin lesions (mean of 1.94 lesions per patient). The mean age was 97.4 years, 57.8% were women. Most patients had an ECOG score of 3 (49.3%) or 4 (32%). Lesions were mainly located on the head and neck area (74.2%), upper (7.1%) and lower (6,2%) limbs. The majority of patients presented with non-melanoma skin cancers (183/225; 81.3%), 25/225 (11.1%) had actinic keratosis, 5 (2.2%) melanoma and 2 (0.9%) atypical fibroxanthoma. Forty-eight lesions (21.3%) were treated with surgery, 58 (25.8%) with radiotherapy. The management of 73 lesion (32.4%) was discussed at the multidisciplinary tumour board meeting. One patient died for the progression of a squamous cell carcinoma; 74 patients died for causes unrelated to skin tumours, 36 are still alive after a mean follow-up of 27.27 months. This cohort study confirms that age is not per se a contraindication for treatment of skin cancers in elderly patients. Our results support the importance of a patient-centred care approach that should take into consideration patient's preferences, comorbidities, compliance and possible adverse events.
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Affiliation(s)
- Michela Lai
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marica Mirra
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Margherita Raucci
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Benati
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Borsari
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mara Lombardi
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Banzi
- Medical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabio Castagnetti
- Breast Surgery Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Tamara Palmieri
- Radiotherapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Dafne Ramundo
- Radiotherapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, Rome, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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5
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van Winden MEC, Hetterschijt CRM, Bronkhorst EM, van de Kerkhof PCM, de Jong EMGJ, Lubeek SFK. Evaluation of Watchful Waiting and Tumor Behavior in Patients With Basal Cell Carcinoma: An Observational Cohort Study of 280 Basal Cell Carcinomas in 89 Patients. JAMA Dermatol 2021; 157:1174-1181. [PMID: 34495284 DOI: 10.1001/jamadermatol.2021.3020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Few studies have examined watchful waiting (WW) in patients with basal cell carcinoma (BCC), although this approach might be suitable in patients who might not live long enough to benefit from treatment. Objective To evaluate reasons for WW and to document the natural course of BCC in patients who chose WW and reasons to initiate later treatment. Design, Setting, and Participants An observational cohort study was performed at a single institution between January 2018 and November 2020 studying patients with 1 or more untreated BCC for 3 months or longer. Exposures Watchful waiting was chosen by patients and proxies regardless of this study. Main Outcome and Measures The reasons for WW and treatment were extracted from patient files and were categorized for analyses. Linear mixed models were used to estimate tumor growth and identify covariates associated with tumor growth. Results Watchful waiting was chosen for 280 BCCs in 89 patients (47 men [53%] and 42 women [47%]), with a median (interquartile range [IQR]) follow-up of 9 (4-15) months. The median (IQR) age of the included patients was 83 (73-88) years. Patient-related factors or preferences (ie, prioritizations of comorbidities, severe frailty, or limited life expectancy) were reasons to initiate WW in 74 (83%) patients, followed by tumor-related factors (n = 49; 55%). Treatment-related and circumstantial reasons were important for 35% and 46% of the patients, respectively. The minority of tumors increased in size (47%). Tumor growth was associated with BCC subtype (odds ratio, 3.35; 95% CI, 1.47-7.96; P = .005), but not with initial tumor size and location. The estimated tumor diameter increase was 4.46 mm (80% prediction interval, 1.42 to 7.46 mm) in 1 year for BCCs containing at least an infiltrative/micronodular component and 1.06 mm (80% prediction interval, -1.79 to 4.28 mm) for the remaining BCCs (only nodular/superficial component/clinical diagnosis). Most common reasons to initiate treatment were tumor burden or potential tumor burden, resolved reason(s) for WW, and reevaluation of patient-related factors. Conclusions and Relevance In this cohort study of patients with BCC, WW was an appropriate approach in several patients, especially those with asymptomatic nodular or superficial BCCs and a limited life expectancy. Patients should be followed up regularly to determine whether a WW approach is still suitable and whether patients still prefer WW and to reconsider consequences of treatment and refraining from treatment.
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Affiliation(s)
- Marieke E C van Winden
- Radboud Institute for Health Sciences, Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Charlotte R M Hetterschijt
- Radboud Institute for Health Sciences, Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ewald M Bronkhorst
- Department of Biostatistics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter C M van de Kerkhof
- Radboud Institute for Health Sciences, Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Radboud Institute for Health Sciences, Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Satish F K Lubeek
- Radboud Institute for Health Sciences, Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
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6
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Gundogan B, Dowlut N, Rajmohan S, Borrelli MR, Millip M, Iosifidis C, Udeaja YZ, Mathew G, Fowler A, Agha R. Assessing the compliance of systematic review articles published in leading dermatology journals with the PRISMA statement guidelines: A systematic review. JAAD Int 2021; 1:157-174. [PMID: 34409336 PMCID: PMC8361930 DOI: 10.1016/j.jdin.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Reporting quality of systematic reviews and meta-analyses is of critical importance in dermatology because of their key role in informing health care decisions. Objective To assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Methods This review was carried out in accordance with PRISMA guidelines. Included studies were reviews published across 6 years in the top 4 highest-impact-factor dermatology journals of 2017. Records and full texts were screened independently. Data analysis was conducted with univariate multivariable linear regression. The primary outcome was to assess the compliance of systematic reviews and meta-analyses in leading dermatology journals with the PRISMA statement. Results A total of 166 studies were included and mean PRISMA compliance across all articles was 73%. Compliance significantly improved over time (β = .016; P = <.001). The worst reported checklist item was item 5 (reporting on protocol existence), with a compliance of 15% of articles. Conclusion PRISMA compliance within leading dermatology journals could be improved; however, it is steadily improving.
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Affiliation(s)
- Buket Gundogan
- University College London Hospital, London, United Kingdom
| | - Naeem Dowlut
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Mirabel Millip
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christos Iosifidis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yagazie Z Udeaja
- Luton and Dunstable University Hospital NHS Foundation Trust, Luton, United Kingdom
| | - Ginimol Mathew
- University College London Medical School, Gower Street, London, United Kingdom
| | | | - Riaz Agha
- Bart's Health NHS Foundation Trust, London, United Kingdom
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7
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[Surgical techniques in the treatment of basal cell carcinoma-a prospective investigation]. Hautarzt 2020; 71:960-968. [PMID: 32930855 PMCID: PMC7686215 DOI: 10.1007/s00105-020-04685-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hintergrund Basalzellkarzinome sind die häufigsten epithelialen Hauttumoren und eine häufige Indikation für dermatologische Eingriffe. Trotz der Etablierung medikamentöser Therapieoptionen stellt die Operation weiterhin die Therapie der Wahl dar. Hierbei stehen verschiedene Möglichkeiten zur Verfügung, die von der Kürettage bis hin zu komplexen dermatochirurgischen Eingriffen reichen. Neben dem Hauptaspekt der geringen lokalen Rezidivraten sind auch ästhetische Faktoren und die Anzahl der Eingriffe für die Wahl der Therapie wichtig. Methoden In dieser Studie wurden 347 Patienten mit 398 Basalzellkarzinomen (nodulärer Typ, Durchmesser bis 10 mm) prospektiv untersucht. Die Patienten wurden randomisiert in 2 Behandlungsarme eingeteilt: In einer Gruppe wurden die Tumoren kürettiert, in der anderen Gruppe exzidiert. Als Kontrolle dienten Patienten, die im gleichen Untersuchungszeitraum 3‑D-histologisch kontrolliert operiert wurden. Ergebnisse Die höchste lokale Rezidivrate wurde nach der Kürettage (14,0 %) beobachtet, während die Gruppe mit 3‑D-Histologie die niedrigste Rezidivrate (0,9 %; p < 0,001) aufwies. In der 3‑D-Gruppe waren mehr Re-Exzisionen erforderlich, um eine vollständige Entfernung des Tumors zu erreichen, als in der Gruppe mit histologischen Serienschnitten. Die Patienten bewerteten das ästhetische Ergebnis am besten nach der Kürettage. Die mittlere Nachbeobachtungszeit betrug 3,9 Jahre. Schlussfolgerung Die Wahl der chirurgischen Therapie bei kleinen nodulären Basalzellkarzinomen hängt von den individuellen Gegebenheiten ab. 3‑D-histologisch kontrollierte Exzisionen mit Wundverschluss nach vollständiger Tumorentfernung zeigten in unserer Studie die geringste Rezidivrate. Aber auch die Kürettage stellt eine mögliche chirurgische Therapieoption mit minimalem Aufwand und einer akzeptablen Rezidivrate dar, die zu guten ästhetischen Ergebnissen führen kann.
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8
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van Winden MEC, Garcovich S, Peris K, Colloca G, de Jong EMGJ, Hamaker ME, van de Kerkhof PCM, Lubeek SFK. Frailty screening in dermato-oncology practice: a modified Delphi study and a systematic review of the literature. J Eur Acad Dermatol Venereol 2020; 35:95-104. [PMID: 32403174 PMCID: PMC7818261 DOI: 10.1111/jdv.16607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Abstract
Background Appropriate management and prevention of both under‐ and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato‐oncology care, since frailty is associated with adverse health outcomes. Objectives This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato‐oncology practice and to select the best existing FST(s) for this purpose. Methods A modified two‐round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5‐point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure. Results Consensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and cognition (4.1 ± 0.8). The FST should have appropriate measurement properties (4.0 ± 1.0), be quickly executed (4.2 ± 0.7), clinically relevant (4.3 ± 0.7), and both easily understandable (4.1 ± 1.2) and interpretable (4.3 ± 0.7). Of the 26 identified FSTs, four evaluated the content‐related domains: the Geriatric‐8 (G8), the modified Geriatric‐8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min. Conclusions The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato‐oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.
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Affiliation(s)
- M E C van Winden
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Garcovich
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - K Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Colloca
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis, Zeist, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S F K Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Lang BM, Balermpas P, Bauer A, Blum A, Brölsch GF, Dirschka T, Follmann M, Frank J, Frerich B, Fritz K, Hauschild A, Heindl LM, Howaldt HP, Ihrler S, Kakkassery V, Klumpp B, Krause-Bergmann A, Löser C, Meissner M, Sachse MM, Schlaak M, Schön MP, Tischendorf L, Tronnier M, Vordermark D, Welzel J, Weichenthal M, Wiegand S, Kaufmann R, Grabbe S. S2k Guidelines for Cutaneous Basal Cell Carcinoma - Part 2: Treatment, Prevention and Follow-up. J Dtsch Dermatol Ges 2020; 17:214-230. [PMID: 30762963 DOI: 10.1111/ddg.13755] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumor among fair-skinned individuals, and its incidence had been steadily rising in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 2 addresses issues such as proper risk stratification, the various therapeutic approaches, and prevention as well as follow-up of patients with basal cell carcinoma.
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Affiliation(s)
- Berenice M Lang
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Andrea Bauer
- Department of Dermatology, Carl Gustav Carus University Medical Center, Dresden, Germany
| | - Andreas Blum
- Dermatology and Teaching Practice, Konstanz, Germany
| | - G Felix Brölsch
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hanover Medical School, Hanover, Germany
| | - Thomas Dirschka
- CentroDerm Clinic, Wuppertal, Germany.,Faculty of Health, Witten-Herdecke University, Witten, Germany
| | | | - Jorge Frank
- Department of Dermatology, Venereology and Allergology, Göttingen University Medical Center, Göttingen, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Plastic Surgery, Rostock University Medical Center, Rostock, Germany
| | - Klaus Fritz
- Dermatology and Laser Center, Landau, Germany
| | - Axel Hauschild
- Department of Dermatology, Venereology and Allergology, Schleswig-Holstein University Medical Center, Kiel, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Cologne University Medical Center, Cologne, Germany
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Gießen University Medical Center, Gießen, Germany
| | - Stephan Ihrler
- Laboratory for Dermatohistology and Oral Pathology, Munich, Germany
| | - Vinodh Kakkassery
- Department of Ophthalmology, Schleswig-Holstein University Medical Center, Lübeck, Germany.,Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Bernhard Klumpp
- Department of Diagnostic and Interventional Radiology, Tübingen University Medical Center, Tübingen, Germany.,Department of Radiology, Rems-Murr Medical Center, Winnenden, Germany
| | | | - Christoph Löser
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Michael M Sachse
- Department of Dermatology, Allergology and Phlebology, Bremerhaven Medical Center, Bremerhaven, Germany
| | - Max Schlaak
- Department of Dermatology and Allergology, Munich University Medical Center, Munich, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, Göttingen University Medical Center, Göttingen, Germany
| | | | - Michael Tronnier
- Department of Dermatology, Venereology and Allergology, Helios Medical Center, Hildesheim, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Halle University Medical Center, Martin Luther University, Halle, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, Augsburg Medical Center, Augsburg, Germany
| | - Michael Weichenthal
- Department of Dermatology, Venereology and Allergology, Schleswig-Holstein University Medical Center, Kiel, Germany
| | - Susanne Wiegand
- Department of Otolaryngology, Leipzig University Medical Center, Leipzig, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
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10
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11
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Sreekantaswamy S, Endo J, Chen A, Butler D, Morrison L, Linos E. Aging and the treatment of basal cell carcinoma. Clin Dermatol 2019; 37:373-378. [PMID: 31345326 DOI: 10.1016/j.clindermatol.2019.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Basal cell carcinoma (BCC) is the most commonly diagnosed type of skin cancer. BCCs are especially prevalent in the elderly population, given their association with cumulative sun exposure and other risk factors. In this contribution, we outline geriatric concepts related to the care of older adults with BCCs. We describe how a patient's life expectancy can be estimated and combined with tumor characteristics to determine lag time to benefit, a concept to better understand whether patients will experience the efficacy of a treatment within their life span. We also review the possibility of current BCC overdiagnosis and summarize the effectiveness, benefits, and risks of common treatments for BCCs, noting that all treatment modalities have special considerations when administered to older adults. In particular, nonsurgical treatments might be preferable for older adults with a limited life expectancy. Ultimately, we argue that the decision of whether and how to treat a BCC should be the result of shared decision-making between the provider and the patient and take into account not only tumor characteristics, but also patient values and preferences.
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Affiliation(s)
| | - Justin Endo
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy Chen
- University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Daniel Butler
- University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Lily Morrison
- Stanford University School of Medicine, Stanford, California, USA
| | - Eleni Linos
- Stanford University School of Medicine, Stanford, California, USA.
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12
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Dessinioti C, Plaka M, Soura E, Mortaki D, Papaxoinis G, Gogas H, Stratigos AJ. A Practical Guide for the Follow-Up of Patients with Advanced Basal Cell Carcinoma During Treatment with Hedgehog Pathway Inhibitors. Oncologist 2019; 24:e755-e764. [PMID: 31073024 DOI: 10.1634/theoncologist.2018-0924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 12/23/2022] Open
Abstract
The Hedgehog pathway inhibitors (HPIs), vismodegib and sonidegib, are increasingly employed in the treatment of patients with advanced basal cell carcinoma (BCC). The aim of this review is to create a synthesis of available information in the literature regarding the follow-up of patients with advanced BCC treated with HPIs and to provide the treating physician with a structured practical guide to standardize clinical practice. Several challenges during treatment are addressed: to optimally evaluate tumor responses, to differentiate between resistance (HPI rechallenge not possible) and recurrence (HPI rechallenge may be possible) in case of BCC regrowth, to readily assess for toxicity and tolerability issues, to provide patients with practical ways and behaviors to effectively cope with adverse events, and to improve patient adherence and quality of life. IMPLICATIONS FOR PRACTICE: This is a practical guide for clinical practice regarding the monitoring and follow-up of patients with advanced basal cell carcinoma (BCC) during treatment with the Hedgehog pathway inhibitors (HPIs) vismodegib and sonidegib. This review aims to bridge the gap in knowledge of assessing tumor response for BCC with both an externally visible component and an infiltrating component measurable with imaging. Furthermore, it addresses the follow-up for adverse events as a challenging multistep process involving practices aiming to readily assess new-onset symptoms of HPI toxicity, perform total-body skin examination, and improve patient adherence and quality of life.
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Affiliation(s)
- Clio Dessinioti
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mikaella Plaka
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Soura
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Mortaki
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papaxoinis
- 1st Department of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Gogas
- 1st Department of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander J Stratigos
- Skin Cancer Unit, Department of Dermatology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
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13
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Lang BM, Balermpas P, Bauer A, Blum A, Brölsch GF, Dirschka T, Follmann M, Frank J, Frerich B, Fritz K, Hauschild A, Heindl LM, Howaldt HP, Ihrler S, Kakkassery V, Klumpp B, Krause-Bergmann A, Löser C, Meissner M, Sachse MM, Schlaak M, Schön MP, Tischendorf L, Tronnier M, Vordermark D, Welzel J, Weichenthal M, Wiegand S, Kaufmann R, Grabbe S. S2k-Leitlinie Basalzellkarzinom der Haut - Teil 2: Therapie, Prävention und Nachsorge. J Dtsch Dermatol Ges 2019; 17:214-231. [PMID: 30762951 DOI: 10.1111/ddg.13755_g] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus Dresden
| | | | - G Felix Brölsch
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover
| | - Thomas Dirschka
- CentroDerm, Wuppertal.,Fakultät für Gesundheit, Universität Witten-Herdecke
| | | | - Jorge Frank
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Bernhard Frerich
- Klinik und Poliklinik für Mund-, Kiefer- und plastische Gesichtschirurgie, Universitätsmedizin Rostock
| | | | - Axel Hauschild
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | - Hans-Peter Howaldt
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Gießen
| | | | - Vinodh Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck.,Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock
| | - Bernhard Klumpp
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen.,Radiologie, Rems-Murr-Klinikum Winnenden
| | | | | | - Markus Meissner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt
| | - Michael M Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven
| | - Max Schlaak
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München
| | - Michael P Schön
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | | | - Michael Tronnier
- Klinik für Dermatologie, Venerologie und Allergologie, Helios Klinikum Hildesheim
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Klinikum Augsburg
| | - Michael Weichenthal
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Roland Kaufmann
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt
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14
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Garcovich S, Colloca G, Sollena P, Andrea B, Balducci L, Cho WC, Bernabei R, Peris K. Skin Cancer Epidemics in the Elderly as An Emerging Issue in Geriatric Oncology. Aging Dis 2017; 8:643-661. [PMID: 28966807 PMCID: PMC5614327 DOI: 10.14336/ad.2017.0503] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/03/2017] [Indexed: 12/16/2022] Open
Abstract
Skin cancer is a worldwide, emerging clinical need in the elderly white population, with a steady increase in incidence rates, morbidity and related medical costs. Skin cancer is a heterogeneous group of cancers comprising cutaneous melanoma and non-melanoma skin cancers (NMSC), which predominantly affect elderly patients, aged older than 65 years. Melanoma has distinct clinical presentations in the elderly patient and represents a challenging question in terms of clinical management. NMSC includes the basal cell carcinoma and cutaneous squamous cell carcinoma and presents a wide disease spectrum in the elderly population, ranging from low-risk to high-risk tumours, advanced and inoperable disease. Treatment decisions for NMSC are preferentially based on tumour characteristics, patient’s chronological age and physician’s preferences and operational settings. Several treatment options are available for NMSC, from surgery to non-invasive/medical therapies, but patient-based factors, such as geriatric comorbidities and patient’s life expectancy, do not frequently modulate treatment goals. In melanoma, age-related variations in clinical management are significant and may frequently lead to under-treatment, limiting access to advanced surgical and medical treatments. Clinical decision-making in the care of elderly skin cancer patient should ideally implement a geriatric assessment, prioritizing patient-based factors and efficiently differentiating fit from frail cancer patients. Current clinical practice guidelines for NMSC and melanoma only partially address geriatric aspects of cancer care, such as frailty, limited life-expectancy, geriatric comorbidities and treatment compliance. We review the recent evidence on the scope and problem of skin cancer in the elderly population as well as age-related variations in its clinical management, highlighting the potential role of a geriatric approach in optimizing dermato-oncological care.
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Affiliation(s)
- Simone Garcovich
- 1Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Colloca
- 2Department of Geriatrics, Policlinico A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Sollena
- 1Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Bellieni Andrea
- 2Department of Geriatrics, Policlinico A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Lodovico Balducci
- 3Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL, USA
| | - William C Cho
- 4Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Roberto Bernabei
- 2Department of Geriatrics, Policlinico A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Ketty Peris
- 1Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
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15
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Ilic S, LeJeune J, Lewis Ivey ML, Miller S. Delphi expert elicitation to prioritize food safety management practices in greenhouse production of tomatoes in the United States. Food Control 2017. [DOI: 10.1016/j.foodcont.2017.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Schofield J, Linos E, Callander J. Management of skin cancer in the frail elderly: time for a rethink? Br J Dermatol 2016; 175:855-856. [DOI: 10.1111/bjd.15057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - E. Linos
- Department of Dermatology; University of California; San Francisco CA U.S.A
| | - J. Callander
- Betsi Cadwaladr University Health Board; Bangor Gwynedd U.K
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