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Mellerio JE, Robertson SJ, Bernardis C, Diem A, Fine JD, George R, Goldberg D, Halmos GB, Harries M, Jonkman MF, Lucky A, Martinez AE, Maubec E, Morris S, Murrell DF, Palisson F, Pillay EI, Robson A, Salas-Alanis JC, McGrath JA. Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa: best clinical practice guidelines. Br J Dermatol 2015; 174:56-67. [PMID: 26302137 DOI: 10.1111/bjd.14104] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/24/2022]
Abstract
This article summarizes recommendations reached following a systematic literature review and expert consensus on the diagnosis and management of cutaneous squamous cell carcinomas in people with epidermolysis bullosa. The guidelines are intended to help inform decision making by clinicians dealing with this complex complication of a devastating disease.
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Affiliation(s)
- J E Mellerio
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K.,Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - S J Robertson
- Department of Dermatology, The Royal Melbourne Hospital, The Royal Children's Hospital and Monash Medical Centre, Melbourne, Australia
| | - C Bernardis
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - A Diem
- Department of Dermatology, Paracelsus Medical University, Salzburg, Austria
| | - J D Fine
- Division of Dermatology, Vanderbilt University School of Medicine, Nashville, TN, U.S.A
| | - R George
- Department of Palliative Care, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - D Goldberg
- Division of Dermatology, University of Massachusetts, Worcester, MA, U.S.A
| | - G B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - M Harries
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - M F Jonkman
- Department of Dermatology, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Lucky
- Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, U.S.A
| | - A E Martinez
- Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - E Maubec
- Department of Dermatology, APHP, Avicenne Hospital, Bobigny, France
| | - S Morris
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - D F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales, Sydney, Australia
| | - F Palisson
- Facultad de Medicina, Clínica Alemana, Santiago, Chile
| | - E I Pillay
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - A Robson
- Department of Dermatopathology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - J C Salas-Alanis
- Basic Sciences Department, Universidad de Monterrey, Monterrey, Mexico
| | - J A McGrath
- St John's Institute of Dermatology, King's College London (Guy's Campus), London, U.K
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Fine JD, Mellerio JE. Extracutaneous manifestations and complications of inherited epidermolysis bullosa: part II. Other organs. J Am Acad Dermatol 2009; 61:387-402; quiz 403-4. [PMID: 19700011 DOI: 10.1016/j.jaad.2009.03.053] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 02/22/2009] [Accepted: 03/02/2009] [Indexed: 10/20/2022]
Abstract
It is well known, primarily via case reports and limited case series, that nonepithelial tissues may become injured in patients with epidermolysis bullosa. Only recently, however, have there been data generated from large, well characterized cohorts. Our objective is to provide dermatologists with a comprehensive review of each of these major extracutaneous complications, with a summary of the pertinent literature and evidence-based recommendations for surveillance, evaluation, and management. Some epidermolysis bullosa subtypes are at risk for severe injury of the bone marrow, musculoskeletal system, heart, kidney, and teeth, and for the development of squamous cell carcinoma, basal cell carcinoma, or malignant melanoma. If untreated, significant morbidity or mortality may result.
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Affiliation(s)
- Jo-David Fine
- The National Epidermolysis Bullosa Registry, and Department of Medicine (Dermatology), Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Fine JD, Johnson LB, Weiner M, Li KP, Suchindran C. Epidermolysis bullosa and the risk of life-threatening cancers: the National EB Registry experience, 1986-2006. J Am Acad Dermatol 2008; 60:203-11. [PMID: 19026465 DOI: 10.1016/j.jaad.2008.09.035] [Citation(s) in RCA: 263] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 06/13/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Case series have demonstrated that potentially lethal cutaneous squamous cell carcinomas arise in patients with recessive dystrophic epidermolysis bullosa (RDEB), although the magnitude of this risk is undefined. METHODS Systematic case finding and data collection were performed throughout the continental United States (1986-2002) by the National EB Registry on 3280 EB patients to determine cumulative and conditional risks for squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and malignant melanoma (MM) within each major EB subtype, as well as the cumulative risk of death from each tumor. Study design was cross-sectional, with a nested randomly sampled longitudinal subcohort (N = 450). RESULTS SCCs arose primarily in RDEB, especially the Hallopeau-Siemens subtype (RDEB-HS), first beginning in adolescence. Less frequently, SCCs occurred in junctional EB (JEB). Cumulative risks rose steeply in RDEB-HS, from 7.5% by age 20 to 67.8%, 80.2%, and 90.1% by ages 35, 45, and 55, respectively. In Herlitz JEB, the risk was 18.2% by age 25. SCC deaths occurred only in RDEB, with cumulative risks in RDEB-HS of 38.7%, 70.0%, and 78.7% by ages 35, 45, and 55, respectively. MM arose in RDEB-HS, with a cumulative risk of 2.5% by age 12. BCCs arose almost exclusively in the most severe EB simplex subtype (Dowling-Meara) (cumulative risk = 43.6% by age 55). LIMITATIONS Mutational analyses were performed on only a minority of enrollees in the National EB Registry, preventing evaluation of the possible influence of specific genotypes on the risk of developing or dying from cutaneous SCCs. CONCLUSIONS SCC is the most serious complication of EB within adults, especially those with RDEB-HS. By mid-adulthood, nearly all will have had at least one SCC, and nearly 80% will have died of metastatic SCC despite aggressive surgical resection. When compared with SCCs arising within the normal population, the remarkably high risk of occurrence of and then death from SCCs among RDEB patients suggests likely differences in pathogenesis. Additional studies of EB-derived tumors and SCC cell lines may not only provide new insights into the mechanisms of carcinogenesis but also means whereby these particular tumors may be prevented or more effectively treated.
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Affiliation(s)
- Jo-David Fine
- National Epidermolysis Bullosa Registry, Nashville, Tennessee, USA.
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Mallipeddi R, Keane FM, McGrath JA, Mayou BJ, Eady RAJ. Increased risk of squamous cell carcinoma in junctional epidermolysis bullosa. J Eur Acad Dermatol Venereol 2004; 18:521-6. [PMID: 15324385 DOI: 10.1111/j.1468-3083.2004.00968.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Non-Herlitz junctional epidermolysis bullosa (JEB) is an autosomal recessive genodermatosis characterized by skin fragility and blistering. It is usually caused by mutations in the genes encoding the basement membrane proteins laminin 5 or type XVII collagen. Clinically, impaired wound healing and chronic erosions cause major morbidity in affected patients. Previously it was thought that these individuals, unlike patients with dystrophic EB, did not have an increased risk of developing skin cancer. However, we describe three patients with non-Herlitz JEB (aged 42, 56 and 75 years) who developed cutaneous squamous cell carcinomas (SCCs). The tumours were well-differentiated in two cases, but one patient had multiple primary SCCs that were either well- or moderately differentiated. Most cases of SCC in non-Herlitz JEB described have occurred in those with laminin 5 defects and on the lower limbs. These clinicopathological observations have important implications for the management of patients with this mechanobullous disorder as well as providing further insight into the biology of skin cancer associated with chronic inflammation and scarring.
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Affiliation(s)
- R Mallipeddi
- Genetic skin disease group, Guy's, King's and St Thomas' School of Medicine, St John's Institute of Dermatology, St Thomas' Hospital, London SE1 7EH
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Abstract
Epidermolysis bullosa (EB) encompasses a group of inherited blistering skin disorders classified into three main subtypes of simplex, junctional and dystrophic. In recent years there have been substantial advances in our understanding of the molecular basis of these conditions and in the management of such patients. In spite of this progress, squamous cell carcinoma (SCC) is still a major cause of morbidity and mortality, particularly in Hallopeau--Siemens recessive dystrophic EB. The reason why dystrophic EB patients readily develop SCC with such a poor prognosis remains a mystery. This article reviews the epidemiology of cancer in inherited EB and also discusses the clinical features, histological assessment and treatment options of SCC in EB.
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Affiliation(s)
- R Mallipeddi
- Department of Cell and Molecular Pathology, The Guy's, King's College and St Thomas' Hospitals Medical School, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
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McGrath JA, Schofield OM, Mayou BJ, McKee PH, Eady RA. Epidermolysis bullosa complicated by squamous cell carcinoma: report of 10 cases. J Cutan Pathol 1992; 19:116-23. [PMID: 1597567 DOI: 10.1111/j.1600-0560.1992.tb01352.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Epidermolysis bullosa (EB) refers to a group of hereditary mechano-bullous conditions, many of which are associated with chronic scarring. Several forms of the disease have been reported in association with cutaneous malignancy. We present a series of 10 EB patients (eight generalised recessive dystrophic EB, one dominant dystrophic EB, one non-lethal junctional EB) aged 24-55 years with a total of 29 squamous cell carcinomas (SCC). Three patients died from metastatic disease associated with invasive, poorly differentiated SCC. Six cases had multiple primary SCC, including three patients with simultaneous multifocal disease. Twenty-eight of the 29 SCC arose on the limbs. Histology revealed that most of the SCC were well or moderately differentiated (22/29). Unusual histological findings included two verrucous SCC, as well as a spindle cell (angiosarcoma-like) SCC. Most of the SCC developed in areas of chronic non-healing ulceration (10/29) or longstanding hyperkeratotic crusting (14/29). The dermis around or beneath the carcinomas was densely scarred, more so than in non-malignant areas. In some cases it was difficult to distinguish the clinical appearances of certain areas of chronic ulceration, scarring, and crusting typical of dystrophic EB from many of the SCC. This study underlines the need for constant vigilance for the development of carcinomas in this group of patients, the occasional diagnostic difficulty, and the potential for metastasis.
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Affiliation(s)
- J A McGrath
- Institute of Dermatology, UMDS, London, England
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