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Seretis K, Boptsi E, Boptsi A. Extracellular Vesicles as Novel Diagnostic and Therapeutic Agents for Non-Melanoma Skin Cancer: A Systematic Review. Int J Mol Sci 2024; 25:2617. [PMID: 38473864 DOI: 10.3390/ijms25052617] [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: 01/02/2024] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Standard non-melanoma skin cancer (NMSC) treatment involves surgery, recently combined with chemotherapy or immunotherapy in cases of advanced tumors. EVs, including exosomes, are integral to carcinogenesis, and are found in NMSC releasing mediators impacting tumor progression. Nevertheless, the precise intercellular signaling role of NMSC-derived EVs remains unclear. This review aims to elucidate their potential role in NMSC diagnosis and treatment. This systematic review encompassed literature searches in electronic databases from inception to September 2023, based on certain inclusion and exclusion criteria, addressing NMSC-derived EVs, their molecular cargo, and their implications in the diagnosis, prognosis, and treatment of NMSC. Key components were identified. Extracellular vesicle (EV) proteins and RNA have emerged as diagnostic biomarkers in EV-based liquid biopsy. Circular RNA CYP24A1, known for its molecular stability, holds promise as a diagnostic biomarker. Long noncoding RNAs (lincRNA-PICSAR) and Desmoglein 2 (DSg2) are linked to drug resistance, serving as prognostic biomarkers. EV mediators are being actively investigated for their potential role as drug delivery agents. In conclusion, this systematic review showed that NMSC-derived EVs display promise as therapeutic targets and diagnostic biomarkers. Further research is imperative to fully comprehend EV mechanisms and explore their potential in cancer diagnosis and treatment.
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Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, Medical School, University of Ioannina, 45100 Ioannina, Greece
| | - Eleni Boptsi
- Department of Plastic Surgery, Medical School, University of Ioannina, 45100 Ioannina, Greece
| | - Anastasia Boptsi
- Department of Plastic Surgery, Medical School, University of Ioannina, 45100 Ioannina, Greece
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2
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Markopoulos G, Lampri E, Tragani I, Kourkoumelis N, Vartholomatos G, Seretis K. Intraoperative Flow Cytometry for the Rapid Diagnosis and Validation of Surgical Clearance of Non-Melanoma Skin Cancer: A Prospective Clinical Feasibility Study. Cancers (Basel) 2024; 16:682. [PMID: 38398076 PMCID: PMC10887295 DOI: 10.3390/cancers16040682] [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: 01/04/2024] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Non-melanoma skin cancer (NMSC) is the most prevalent cancer in humans, with a high global incidence. We present a prospective clinical feasibility study on the use of intraoperative flow cytometry (iFC) for the instant diagnosis of NMSC and its complete surgical clearance. Flow cytometry, a laser-based technique, quantifies cell features, which has applications in cancer research. This study aim is to explore the potential applicability of iFC in detecting and characterizing NMSC and its surgical margins. In total, 30 patients who underwent diagnosis for NMSC were recruited. The method demonstrated high sensitivity (95.2%) and specificity (87.1%), with an accuracy of 91.1%, as confirmed with a receiver operating characteristic curve analysis. The results also indicated that most tumors were diploid, with two cases being hypoploid. The average G0/G1 fractions for normal and tumor tissue samples were 96.03 ± 0.30% and 88.03 ± 1.29%, respectively, with the tumor index escalating from 3.89 ± 0.30% to 11.95 ± 1.29% in cancerous cells. These findings underscore iFC's capability for precise intraoperative NMSC characterization and margin evaluation, promising enhanced complete tumor excision rates. Given the technique's successful application in various other malignancies, its implementation in NMSC diagnosis and treatment holds significant promise and warrants further research in clinical trials.
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Affiliation(s)
- Georgios Markopoulos
- Haematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45110 Ioannina, Greece; (G.M.); (G.V.)
| | - Evangeli Lampri
- Department of Pathology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (E.L.); (I.T.)
| | - Ioulia Tragani
- Department of Pathology, Medical School, University of Ioannina, 45110 Ioannina, Greece; (E.L.); (I.T.)
| | - Nikolaos Kourkoumelis
- Department of Medical Physics, Medical School, University of Ioannina, 45110 Ioannina, Greece;
| | - Georgios Vartholomatos
- Haematology Laboratory-Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45110 Ioannina, Greece; (G.M.); (G.V.)
| | - Konstantinos Seretis
- Department of Plastic Surgery, Medical School, University of Ioannina, 45110 Ioannina, Greece
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3
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Verdaguer-Faja J, Toll A, Boada A, Guerra-Amor Á, Ferrándiz-Pulido C, Jaka A. Management of Cutaneous Squamous Cell Carcinoma of the Scalp: The Role of Imaging and Therapeutic Approaches. Cancers (Basel) 2024; 16:664. [PMID: 38339415 PMCID: PMC10854799 DOI: 10.3390/cancers16030664] [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: 12/27/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common subtype of skin cancer. The scalp is one of the most frequently affected locations and is associated with a higher rate of complications, compared to other locations. In addition, it has a characteristic thickness and anatomical structure that may influence both growth pattern and treatment of primary cSCC; while clinical peripheral margins may be easily achieved during the surgery, vertical excision of the tumor is limited by the skull. Despite having a unique anatomy, current guidelines do not contemplate specific recommendations for scalp cSCC, which leads to inconsistent decision-making in multidisciplinary committees when discussing tumors with high risk factors or with close margins. This article provides specific recommendations for the management of patients with scalp cSCC, based on current evidence, as well as those aspects in which evidence is lacking, pointing out possible future lines of research. Topics addressed include epidemiology, clinical presentation and diagnosis, imaging techniques, surgical and radiation treatments, systemic therapy for advanced cases, and follow-up. The primary focus of this review is on management of primary cSCC of the scalp with localized disease, although where relevant, some points about recurrent cSCCs or advanced disease cases are also discussed.
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Affiliation(s)
- Júlia Verdaguer-Faja
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Aram Boada
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Álvaro Guerra-Amor
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carla Ferrándiz-Pulido
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ane Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (J.V.-F.); (A.B.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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4
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Gaitanis G, Seretis K, Zampeta A, Spyridonos P, Bassukas ID. A single-centre retrospective comparison of immunocryosurgery with standard surgical excision for the treatment of non-superficial, head and neck basal cell carcinoma. J Eur Acad Dermatol Venereol 2024; 38:e134-e136. [PMID: 37641949 DOI: 10.1111/jdv.19479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Affiliation(s)
- G Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - K Seretis
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - A Zampeta
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - P Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - I D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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5
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Vardaki MZ, Pavlou E, Simantiris N, Lampri E, Seretis K, Kourkoumelis N. Towards non-invasive monitoring of non-melanoma skin cancer using spatially offset Raman spectroscopy. Analyst 2023; 148:4386-4395. [PMID: 37593769 DOI: 10.1039/d3an00684k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BCC (basal cell carcinoma) and SCC (squamous cell carcinoma) account for the vast majority of cases of non-melanoma skin cancer (NMSC). The gold standard for the diagnosis remains biopsy, which, however, is an invasive and time-consuming procedure. In this study, we employed spatially offset Raman spectroscopy (SORS), a non-invasive approach, allowing the assessment of deeper skin tissue levels and collection of Raman photons with a bias towards the different layers of epidermis, where the non-melanoma cancers are initially formed and expand. Ex vivo Raman measurements were acquired from 22 skin biopsies using conventional back-scattering and a defocused modality (with and without a spatial offset). The spectral data were assessed against corresponding histopathological data to determine potential prognostic factors for lesion detection. The results revealed a positive correlation of protein and lipid content with the SCC and BCC types, respectively. By further correlating with patient data, multiple factor analysis (MFA) demonstrated a strong clustering of variables based on sex and age in all modalities. Specifically for the defocused modality (zero and 2 mm offset), further clustering occurred based on pathology. This study demonstrates the utility of the SORS technology in NMSC diagnosis prior to histopathological examination on the same tissue.
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Affiliation(s)
- Martha Z Vardaki
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
- Institute of Chemical Biology, National Hellenic Research Foundation, 48 Vassileos Constantinou Avenue, Athens, 11635, Greece
| | - Eleftherios Pavlou
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | | | - Evangeli Lampri
- Department of Pathology, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Konstantinos Seretis
- Department of Plastic Surgery, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Nikolaos Kourkoumelis
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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6
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Spyridonos P, Gaitanis G, Likas A, Seretis K, Moschovos V, Feldmeyer L, Heidemeyer K, Zampeta A, Bassukas ID. Image Perceptual Similarity Metrics for the Assessment of Basal Cell Carcinoma. Cancers (Basel) 2023; 15:3539. [PMID: 37509205 PMCID: PMC10377636 DOI: 10.3390/cancers15143539] [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: 06/10/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Efficient management of basal cell carcinomas (BCC) requires reliable assessments of both tumors and post-treatment scars. We aimed to estimate image similarity metrics that account for BCC's perceptual color and texture deviation from perilesional skin. In total, 176 clinical photographs of BCC were assessed by six physicians using a visual deviation scale. Internal consistency and inter-rater agreement were estimated using Cronbach's α, weighted Gwet's AC2, and quadratic Cohen's kappa. The mean visual scores were used to validate a range of similarity metrics employing different color spaces, distances, and image embeddings from a pre-trained VGG16 neural network. The calculated similarities were transformed into discrete values using ordinal logistic regression models. The Bray-Curtis distance in the YIQ color model and rectified embeddings from the 'fc6' layer minimized the mean squared error and demonstrated strong performance in representing perceptual similarities. Box plot analysis and the Wilcoxon rank-sum test were used to visualize and compare the levels of agreement, conducted on a random validation round between the two groups: 'Human-System' and 'Human-Human.' The proposed metrics were comparable in terms of internal consistency and agreement with human raters. The findings suggest that the proposed metrics offer a robust and cost-effective approach to monitoring BCC treatment outcomes in clinical settings.
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Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Aristidis Likas
- Department of Computer Science & Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece
| | - Konstantinos Seretis
- Department of Plastic Surgery and Burns, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Vasileios Moschovos
- Department of Plastic Surgery and Burns, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Athanasia Zampeta
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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7
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Bommakanti KK, Kosaraju N, Tam K, Chai-Ho W, St John M. Management of Cutaneous Head and Neck Squamous and Basal Cell Carcinomas for Immunocompromised Patients. Cancers (Basel) 2023; 15:3348. [PMID: 37444461 DOI: 10.3390/cancers15133348] [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: 05/09/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
The incidence of non-melanoma skin cancer (NMSC) continues to rise, and more than one million cases are diagnosed in the United States each year. The increase in prevalence has been attributed to increased lifespan and improvements in survival for conditions that increase the risk of these malignancies. Patients who are immunocompromised have a higher risk of developing NMSC compared to the general population. In immunosuppressed patients, a combination of prevention, frequent surveillance, and early intervention are necessary to reduce morbidity and mortality. In this review, we collate and summarize current knowledge regarding pathogenesis of head and neck cutaneous SCC and BCC within immunocompromised patients, examine the potential role of the immune response in disease progression, and detail the role of novel immunotherapies in this subset of patients.
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Affiliation(s)
- Krishna K Bommakanti
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
- UCLA Head and Neck Cancer Program (HNCP), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
| | - Nikitha Kosaraju
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
| | - Kenric Tam
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
- UCLA Head and Neck Cancer Program (HNCP), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
| | - Wanxing Chai-Ho
- UCLA Head and Neck Cancer Program (HNCP), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
- Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
| | - Maie St John
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
- UCLA Head and Neck Cancer Program (HNCP), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA
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8
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Seretis K, Bounas N, Lampri E, Lykoudis EG. Is adenoid basal cell carcinoma a low or high risk for recurrence histological subtype? A case-control study. Int J Dermatol 2023; 62:e239-e242. [PMID: 36691795 DOI: 10.1111/ijd.16592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/18/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023]
Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Nikolaos Bounas
- Department of Plastic Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Evangeli Lampri
- Pathology Department, Medical School, University of Ioannina, Ioannina, Greece
| | - Efstathios G Lykoudis
- Department of Plastic Surgery, Medical School, University of Ioannina, Ioannina, Greece
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9
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Tan B, Seth I, Fischer O, Hewitt L, Melville G, Bulloch G, Ashford B. Sex Disparity for Patients with Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Systematic Review. Cancers (Basel) 2022; 14:cancers14235830. [PMID: 36497312 PMCID: PMC9740937 DOI: 10.3390/cancers14235830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The incidence of head and neck cutaneous squamous cell carcinoma (HNcSCC) is unevenly distributed between men and women. At present, the mechanism behind this disparity remains elusive. This study conducted a systematic review and meta-analysis of proportions to investigate the disparity between sexes for patients with HNcSCC. PubMed, Scopus, EMBASE, MEDLINE, Emcare and CINAHL were searched in November 2021 and June 2022 (N > 50, English, human), and studies which examined the association between sex and HNcSCC were included. Analysis was conducted using RStudio with data and forest plots displaying males as a proportion of total patients with HNcSCC. Two independent researchers performed study selection, data extraction, data analysis and risk of bias. Eighty-two studies (1948 to 2018) comprising approximately 186,000 participants (67% male, 33% female) from 29 countries were included. Significantly more males had HNcSCC overall (71%; CI: 67−74). Males were also significantly more affected by cSCC of the ear (92%; CI: 89−94), lip (74%; CI: 66−81), and eyelid (56%; CI: 51−62). This study found HNcSCC disproportionately affected males overall and across all subtypes. Improving our understanding of sex-specific mechanisms in HNcSCC will better inform our preventive, therapeutic and prognostic practices.
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Affiliation(s)
- Brandon Tan
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Ishith Seth
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
| | - Olivia Fischer
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Lyndel Hewitt
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Correspondence: ; Tel.: +61-02-42534801
| | - Geoffrey Melville
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Gabriella Bulloch
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Bruce Ashford
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
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10
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Abstract
The reconstruction of facial defects focuses on the preservation of function without compromising facial symmetry and esthetics. The aim of the study is to describe and evaluate a revised 'facelift' flap technique to reconstruct large defects of the cheek, temple, frontotemporal area, and zygomatic arch. A prospective, observational study of facial defect reconstruction by means of a 'facelift' flap was conducted from January 2019 to January 2022. The revised 'facelift' flap technique, based on the defect location and characteristics, is described. The postoperative outcomes and patient satisfaction were evaluated. The flap was applied to 34 patients with defect diameters ranging from 3 cm to 9 cm. The mean operation time was 67±17 minutes and the mean hospital stay was 1 day. No major postoperative complications were encountered; reoperation was not needed. High patient satisfaction rates were reported (9.6±0.5). The revised facelift flap is a reliable and safe method for the reconstruction of large defects of the cheek, temple, frontotemporal area, and zygomatic arch, based on local tissue availability that ensures satisfactory esthetic outcomes with undetectable scars.
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11
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Rate and Characteristics of Incompletely Excised Cutaneous Squamous Cell Carcinoma: A Dermatological Daily Practice Multicenter Prospective Cohort Study. Dermatol Surg 2022; 48:1269-1273. [PMID: 36194767 DOI: 10.1097/dss.0000000000003606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Incomplete excision of squamous cell carcinoma (cSCC) is associated with an increased risk of recurrence, metastasis, and mortality. OBJECTIVE To determine the rate and characteristics of incompletely excised cSCC in a dermatological daily practice setting. METHODS Prospective study of all patients who gave informed consent, with a cSCC treated with standard excision (SE) at 1 of 6 Departments of Dermatology in the Netherlands between 2015 and 2017. Pathological reports were screened to detect all incompletely excised cSCCs. RESULTS A total of 592 patients with 679 cSCCs were included, whereby most cases were low risk cSCC (89%). The rate of incompletely excised cSCC was 4% (n = 26), and the majority were high-risk cSCCs of which 24 invaded the deep excision margin. CONCLUSION This prospective study showed that in a dermatological setting, the risk of an incompletely excised cSCC is low (4%) for a cohort that was dominated by low-risk cSCCs. Most incompletely excised cSCCs were of high risk, and incompleteness was almost always at the deep margins. These results suggest that for high-risk cSCC, one should pay attention especially to the deep margin when performing SE, and/or microscopic surgery should be considered.
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12
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An Algorithmic Approach for the Reconstruction of Extended Upper-Third Auricular Soft Tissue Defects. J Craniofac Surg 2022; 33:e452-e453. [DOI: 10.1097/scs.0000000000008298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022] Open
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13
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Marsidi N, Ottevanger R, Bouwes Bavinck JN, Krekel-Taminiau NMA, Goeman JJ, Genders RE. Risk factors for incomplete excision of cutaneous squamous cell carcinoma: a large cohort study. J Eur Acad Dermatol Venereol 2022; 36:1229-1234. [PMID: 35342992 PMCID: PMC9545629 DOI: 10.1111/jdv.18101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
Background The standard treatment for cutaneous squamous cell carcinoma (cSCC) is surgical excision. Failure to radically remove a cSCC is a risk for recurrence, progression and metastasis. Objectives This study investigates several risk factors for incomplete excision of cSCC. Methods All consecutive patients in a single institution treated with wide local excision for primary cSCC over a 10‐year period were included in this study. Risk factors such as: gender, age, immunosuppression, tumour size, location, differentiation grade, tumour depth, perineural and lymphovascular invasion (PNI and LVI) were extracted from the database. Univariable and (if applicable) multivariable logistic regression analysis were used to identify risk factors (P < 0.05). Generalized estimating equations (GEEs) were used for multiple tumours within the same patients. Results A total of 566 patients with 1159 cSCC were identified. Univariable and multivariable logistic regression analysis showed that depth beyond the dermis (OR: 5.7 95% CI: 3.1–10.5) was the only risk factor for incomplete excision of cSCC. Immunosuppression was only a risk factor in the deep plane (OR: 2.5, 95% CI: 1.3–4.6). Conclusion Tumour depth beyond the dermis is the most important risk factor for incomplete excision of cSCC. Immunosuppression is a risk factor in the deep plane but its relevance is uncertain. Immunosuppression is not consistently included in the current cSCC staging systems, but care should be taken when treating these patients.
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Affiliation(s)
- N Marsidi
- Department of dermatology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of dermatology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - R Ottevanger
- Department of dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J N Bouwes Bavinck
- Department of dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - N M A Krekel-Taminiau
- Department of plastic surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Department of plastic surgery, Alrijne hospital, Leiden, The Netherlands
| | - J J Goeman
- Department of biomedical data sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - R E Genders
- Department of dermatology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of dermatology, Roosevelt Clinic, Leiden, The Netherlands
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14
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Assessment of Skin Deep Layer Biochemical Profile Using Spatially Offset Raman Spectroscopy. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11209498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Skin cancer is currently the most common type of cancer with millions of cases diagnosed worldwide yearly. The current gold standard for clinical diagnosis of skin cancer is an invasive and relatively time-consuming procedure, consisting of visual examination followed by biopsy collection and histopathological analysis. Raman spectroscopy has been shown to efficiently aid the non-invasive diagnosis of skin cancer when probing the surface of the skin. In this study, we employ a recent development of Raman spectroscopy (Spatially Offset Raman Spectroscopy, SORS) which is able to look deeper in tissue and create a deep layer biochemical profile of the skin in areas where cancer lesions subtly evolve. After optimizing the measurement parameters on skin tissue phantoms, we then adopted SORS on human skin tissue from different anatomical areas to investigate the contribution of the different skin layers to the recorded Raman signal. Our results show that using a diffuse beam with zero offset to probe a sampling volume where the lesion is typically included (surface to epidermis-dermis junction), provides the optimum signal-to-noise ratio (SNR) and may be employed in future skin cancer screening applications.
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Abstract
Skin cancers are the most common neoplasms; frequently, they localize on the face. The aim of paper is to present the incidence of skin tumors in a single center from 2017 to 2019, describe trends in its frequency and find relations between neoplasms and sex, type of cancer, and its size. An analysis of histopathological files from the surgical department between 2017 and 2019 was calculated. These items were selected: sex, age, type of skin cancer, subtype of basal cell carcinoma (BCC), grading of squamous cell carcinoma (SCC), localization and dimensions of the tumor. The study sample consisted of 387 cases. BCC was the most common cancer and its nodular type was the most frequent. In older patients, the vertical dimension of excised carcinoma was significantly larger. Moreover, this connection was detected only in women compared to men. There were statistically significant differences between dimensions of the skin cancer and sex. In men group, skin cancers had statistically higher vertical dimensions and larger surface areas. On the face and head, BCC more often localizes in the nasal area, while SCC on the auricle. It has been demonstrated that the older the patient, the larger the vertical dimension of the tumor. As such, tumor size is larger in men than in women, as women usually see their physicians sooner than men: cosmetic concerns are more important to them.
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Evaluation of residual tumors and recurrence rates of malignant melanoma and non-melanoma skin cancer of head and neck region. MARMARA MEDICAL JOURNAL 2019. [DOI: 10.5472/marumj.637558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Mahadevan K, Sruthi S, Sridevi S, Vivek R. Fourth Dimension in Reconstruction of Defects Following Excision of Basal Cell Carcinoma of Head and Neck! J Cutan Aesthet Surg 2018; 11:110-119. [PMID: 30533984 PMCID: PMC6243820 DOI: 10.4103/jcas.jcas_100_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Basal cell carcinomas (BCCs) are the most common skin tumors of the face. Excision results in soft tissue defects that require reconstruction with the focus on form, function, and patient satisfaction. Aim: To analyze the reconstruction of BCC excision defects of the head and neck region using local flaps and skin grafts with respect to the four dimensions of oncological reconstruction: clearance, form, function, and patient satisfaction. Materials and Methods: This is a prospective study conducted on 88 patients who presented with BCC of the head and neck region and who were operated in our hospital from January 2015 to December 2016 with a minimum follow-up period of 6 months up to June 2017. All patients underwent wide local excision and reconstruction using appropriate local flaps or split-thickness skin graft (SSG). Patients were analyzed with respect to age, sex, site, size, reconstruction method, complications, and patient satisfaction using the customized Patient Satisfaction Questionnaire (PSQ), derived from PSQ III. Results: A total of 77.3% defects were immediately reconstructed using local flaps and 18.2% underwent SSG. All flaps and grafts survived well with a complication rate of 6.8%. Approximately 72.7% of patients had good satisfaction with the medical care and reconstruction. Conclusion: Post-excisional defects of BCC in the head and neck region have to be reconstructed with equal weightage to the four pillars of oncological reconstruction: clearance, form, function, and patient satisfaction. Flap reconstruction is ideal as it brings about reconstruction with patient satisfaction, which is indeed the fourth dimension in any reconstructive surgery.
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Affiliation(s)
- Kandasamy Mahadevan
- Department of Plastic Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
| | - Sridhar Sruthi
- Department of Plastic Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
| | - Shanmugam Sridevi
- Department of Plastic Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
| | - Rajamanoharan Vivek
- Department of Plastic Reconstructive and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
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Lobeck A, Weiss C, Orouji A, Koch PS, Heck M, Utikal J, Koenen W, Faulhaber J, Klemke CD, Felcht M. [Single center analysis of the dermatosurgical patient cohort of a tumor center in Germany]. Hautarzt 2018; 68:377-384. [PMID: 28361252 DOI: 10.1007/s00105-017-3951-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of skin cancer continues to increase. However, little is known about the dermatosurgical characteristics of the patients. PATIENTS AND METHODS In this single center, retrospective study, dermatosurgical reports of all patients treated because of basal cell carcinomas (BCC), squamous cell carcinomas (SCC), and malignant melanoma (MM) between 2004 and 2013 were analyzed. RESULTS During the observed period, the number of operated BCC rose by a factor of 1.86 and the number of MM by a factor of 2.3. In comparison to BCC/MM, there was a disproportionately high increase of SCC by a factor of 4.02. The average age was 71.5 ± 13.4 years (minimum: 14 years; maximum: 104 years), whereupon a significant increase of male age and a significant decrease of female age occurred. Almost 70% of all tumors were located in the head and neck area. The nose was most commonly treated. CONCLUSIONS During the last 10 years, the cohort of dermatosurgical patients changed in the tumor center. This should be verified in multicenter studies.
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Affiliation(s)
- A Lobeck
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - C Weiss
- Medizinische Statistik, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
| | - A Orouji
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - P-S Koch
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - M Heck
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Dermatologische Praxis Dr. Heck und Kollegen, Griesheim, Deutschland
| | - J Utikal
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Klinische Kooperationseinheit Dermatoonkologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - W Koenen
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Dermatologie im Fronhof, Bad Dürkheim, Deutschland
| | - J Faulhaber
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Dermatologische Gemeinschaftspraxis: Dr. Weller, Prof. Dr. Faulhaber & Kollegen, Schwäbisch Gmünd, Deutschland
| | - C-D Klemke
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
- Hautklinik, Städtisches Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Karlsruhe, Deutschland
| | - M Felcht
- Dermatologie, Venerologie und Allergologie, Exzellenzzentrum Dermatologie des Landes Baden-Württemberg, Universitätsmedizin Mannheim (UMM) der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Aftenie C, Bordeianu I. Reconstruction methods of the middle facial region after skin tumor removal. ARS MEDICA TOMITANA 2017. [DOI: 10.1515/arsm-2016-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The purpose of this paper is highlighting the treatment used for patients with skin tumours in the middle third of the face. Fear of a malign skin disease have been rising public awareness of the danger of exposure to sunlight. The probability of developing a skin tumours increases with age. Non melanocytic skin cancers are currently the most common types of cancers in Caucasians; their incidence has steadily increased worldwide in recent decades in the context of actinic aggression and increased exposure to other carcinogens, with geographic variations depending on climate, sun exposure and skin phototype. Knowing the most common forms of benign and malignant skin tumours is crucial for a proper evaluation and therapeutic management. To restore the defects resulting from excision of different types of skin tumour, were used various surgical procedures. The choice of reconstruction method was done according to the need of each patient, considering the location, size and defect results as well as medical history and level of cooperation with each patient.
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Affiliation(s)
- C. Aftenie
- ENT& Oro-Maxillo-Facial Surgery Department, Constanta County Hospital
| | - I. Bordeianu
- Plastic Surgery Department, University “Ovidius” of Constanta
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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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Demirseren DD, Ceran C, Aksam B, Demirseren ME, Metin A. Basal cell carcinoma of the head and neck region: a retrospective analysis of completely excised 331 cases. J Skin Cancer 2014; 2014:858636. [PMID: 24864212 PMCID: PMC4016886 DOI: 10.1155/2014/858636] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/01/2014] [Accepted: 04/03/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of the study is to analyze all completely excised BCCs in the head and neck region with regard to age, sex, personal and familial history, skin type, tumor localization and size, histopathological subtype of tumor, reconstruction method, and recurrence rates. Incompletely excised BCCs were not included in this study since incomplete excision is the most important preventable risk factor for recurrence. In 320 patients, 331 lesions were retrospectively evaluated by dividing into the following 8 subunits: scalp, frontotemporal, orbital, nose, cheek, auricula, perioral, and chin-neck area. Most of the patients were in 60-70 age group (34.7%). The nose (32.3%) was the most common site of presentation. Clinically, all lesions and, histopathologically, most of the lesions (42.2%) presented were of the nodular type. All cases of recurrence after complete excision (n = 9, 2.7%) were located in the median parts of the head and neck region and were mainly diagnosed histopathologically as sclerotic and micronodular. Even though completely excised, head and neck region BCCs, especially which are more prone to recurrence due to anatomical and histopathological properties, should be more closely monitored in order to decrease morbidity and health care costs.
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Affiliation(s)
- Duriye Deniz Demirseren
- Department of Dermatology, Ataturk Training and Research Hospital, Bilkent Way, 06800 Ankara, Turkey
| | - Candemir Ceran
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk Training and Research Hospital, 06800 Ankara, Turkey
| | - Berrak Aksam
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk Training and Research Hospital, 06800 Ankara, Turkey
| | - Mustafa Erol Demirseren
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk Training and Research Hospital, 06800 Ankara, Turkey
| | - Ahmet Metin
- Department of Dermatology, Ataturk Training and Research Hospital, Bilkent Way, 06800 Ankara, Turkey
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Incomplete excision of non-melanoma skin cancer of the head and neck: can we predict failure? EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-013-0916-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stolle L, Kjerkegaard U. A single center retrospective study on 959 excisions of non-melanoma skin cancer in 2011. J Plast Reconstr Aesthet Surg 2013; 66:1630-2. [DOI: 10.1016/j.bjps.2013.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/30/2013] [Accepted: 05/05/2013] [Indexed: 11/16/2022]
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Khan AA, Potter M, Cubitt JJ, Khoda BJ, Smith J, Wright EH, Scerri G, Crick A, Cassell OC, Budny PG. Guidelines for the excision of cutaneous squamous cell cancers in the United Kingdom: the best cut is the deepest. J Plast Reconstr Aesthet Surg 2013; 66:467-71. [PMID: 23352886 DOI: 10.1016/j.bjps.2012.12.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
Surgical excision remains the gold standard for the management of cutaneous squamous cell cancers (SCC) and national guidelines for operative radial margins predict 95% oncological clearance with a margin of 4 mm for low-risk and 6 mm for high-risk tumours. We retrospectively analysed all cutaneous SCC excisions performed across 4 regional Plastic surgical units in England over a consecutive 24-month period and collected data on tumour characteristics, operative and histological margins and completeness of excision. We identified 633 eligible SCC excisions of which 265 (42%) were over 2 cm in diameter with 37 recurrent tumours (5.8%). The mean radial operative margin was 6.5 mm across all tumours and 8.4 mm for tumours greater than 2 cm. The mean histological tumour diameter was 21 mm. The overall incomplete excision rate was 7.6% (7.9% for tumours >2 cm). Ninety-four percent (45/48) of incomplete excisions involved the deep margin and only 3 out of 633 excisions (0.47%) were incomplete at a radial margin only. No differences were observed in tumour size or excision margin between incompletely and completely excised tumours. Incomplete excisions were most common on the ear, nose and cheek. In summary our analysis demonstrates that despite adherence to recommended surgical margins for cutaneous SCCs the incomplete excision rate remains higher than expected. We believe that this is because most incomplete excisions are incomplete at the deep margin and question the utility of performing increasingly wide excisions, and, the generalisability of the evidence upon which recommendations for radial margins are based.
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Affiliation(s)
- A A Khan
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, United Kingdom.
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Palmer VM, Wilson PR. Incompletely excised basal cell carcinoma: residual tumor rates at Mohs re-excision. Dermatol Surg 2013; 39:706-18. [PMID: 23294110 DOI: 10.1111/dsu.12113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer, and incompletely excised BCC is a commonly encountered clinical scenario. OBJECTIVE To investigate the incidence of histologic and clinical evidence of residual BCC at Mohs micrographic surgery (MMS) for the treatment of incompletely excised BCC. METHODS AND MATERIALS One hundred incompletely excised BCCs, from our practice and referred to our practice by local family doctors, treated using MMS between 2005 and 2007 were studied. Patient data included sex, age, anatomic location of tumor, histologic subtype, margin involved, initial closure and closure after MMS, and Mohs stages required for histologic clearance. RESULTS Sixty-nine percent of incompletely excised BCCs had residual tumor at MMS re-excision, and 12% had clinically evident residual disease. CONCLUSION Immediate re-excision using MMS is recommended for treatment of incompletely excised BCC because the majority of cases have histologically detectable BCC. Watch and wait advice could lead to significant morbidity because recurrence may necessitate more extensive closures and costs. Long-term follow-up is recommended. It is important to conduct self-audits of incomplete excisions and follow up these patients.
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Affiliation(s)
- Vanessa M Palmer
- St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
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Andrade P, Brites MM, Vieira R, Mariano A, Reis JP, Tellechea O, Figueiredo A. Epidemiology of basal cell carcinomas and squamous cell carcinomas in a Department of Dermatology: a 5 year review. An Bras Dermatol 2012; 87:212-9. [PMID: 22570024 DOI: 10.1590/s0365-05962012000200004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 07/25/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Non-melanoma skin cancer, a common designation for both basal cell carcinomas and squamous cell carcinomas, is the most frequent malignant skin neoplasm. OBJECTIVE Epidemiologic characterization of the population with Non-melanoma skin cancer. METHODS Retrospective analysis of all patients diagnosed with Non-melanoma skin cancer based on histopathologic analysis of all incisional or excisional skin biopsies performed between 2004 and 2008 in a Department of Dermatology. RESULTS A total of 3075 Non-melanoma skin cancers were identified, representing 88% of all malignant skin neoplasms (n=3493) diagnosed in the same period. Of those, 68,3% were basal cell carcinomas. Most Non-melanoma skin cancer patients were female and over 60 years old. Of all Non-melanoma skin cancer, 81,7% (n=1443) were located in sun-exposed skin, and represented 95,1% of malignant skin neoplasms in sun-exposed skin. Non-melanoma skin cancer was the most frequent malignant skin neoplasm in most topographic locations, except for abdomen and pelvis - over 95% of all malignant skin neoplasms in the face, neck and scalp were Non-melanoma skin cancer. Basal cell carcinomas were clearly predominant in all locations, except in upper and lower limbs, lower lip and genitals, where squamous cell carcinomas represented respectively 77,7%, 77,4%, 94,7% and 95,3% of the Non-melanoma skin cancers. CONCLUSION Being the most common skin cancer, Non-melanoma skin cancer should be under constant surveillance, in order to monitor its epidemiologic dynamics, the efficiency of preventive measures and the adaptation of the healthcare resources.
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Affiliation(s)
- Pedro Andrade
- Serviço de Dermatologia e Venereologia, Hospitais da Universidade de Coimbra, EPE, Praceta Mota Pinto3000-075 Coimbra, Portugal.
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Pazdrowski J, Dańczak-Pazdrowska A, Golusiński P, Szybiak B, Silny W, Golusiński W. [The recurrence of facial basal cell carcinoma in patients treated at the Head and Neck Surgery Ward and Laryngological Oncology Clinic of the Greater Poland Cancer Centre in the years 2007-2010]. Otolaryngol Pol 2012; 66:185-90. [PMID: 22748679 DOI: 10.1016/s0030-6657(12)70767-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 02/01/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The incidence of basal-cell carcinomas (BCC) in Europe is estimated at 10 cases per 100,000 people and is continuously increasing. Recurrent cases of BCC tend to have a more aggressive progression. The treatment methods include: conventional surgery, Mohs surgery, laser therapy, cryosurgery, curettage and radiotherapy. The recurrence of basalcell carcinoma depends on the method of treatment and ranges between 4% and 18%. In the case of recurrent BCC the treatment method of choice is margin control surgery. AIM OF THE STUDY The purpose of this paper is to conduct a retrospective analysis of patients with facial BCC treated with classic surgery and laser therapy as well as to present a strategy for action in the case of recurrence. MATERIAL AND METHODS The retrospective analysis was conducted on patients with diagnosed facial BCC, treated at the Head and Neck Surgery Ward and Laryngological Oncology Clinic of the Greater Poland Cancer Centre in the years 2007-2010. The research included 58 patients aged 56-80; 34 women and 24 men. RESULTS Out of 58 patients 8 had recurrent BCC - 4 cases after laser therapy (Group A), and 4 cases after classic surgery (Group B). In 2 cases from Group A and all cases from Group B further treatment involved removal of the recurrent tumour by margin control surgery and skin flap plastic surgery. In 2 remaining cases from Group A further CO(2) laser therapy was performed under local anaesthesia and analgosedation. This type of treatment was chosen due to general medical and cardiological concerns which disqualified the use of general anaesthesia and conventional surgery. So far no further local recurrent cases of BCC have been diagnosed, and the follow-up periods range from 4 to 26 months. CONCLUSION Recurrent cases of BCC are 10% more frequent in patients treated with cryosurgery or laser therapy without margin control than in patients who had the tumour removed by margin control surgery. Margin control surgery remains the method of choice in cases involving large tumours, recurrence or spread by invasion.
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Affiliation(s)
- Jakub Pazdrowski
- Oddział Chirurgii Głowy i Szyi i Onkologii Laryngologicznej Wielkopolskiego Centrum Onkologii.
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Ferrandiz L, Ruiz-de-Casas A, Trakatelli M, de Vries E, Ulrich M, Aquilina S, Saksela O, Majewski S, Ranki A, Proby C, Magnoni C, Pitkänen S, Kalokasidis K, Siskou S, Hinrichs B, Altsitsiadis E, Stockfleth E, Moreno-Ramirez D. Assessing physicians’ preferences on skin cancer treatment in Europe. Br J Dermatol 2012; 167 Suppl 2:29-35. [DOI: 10.1111/j.1365-2133.2012.11084.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Osiecka B, Jurczyszyn K, Ziółkowski P. The application of Levulan-based photodynamic therapy with imiquimod in the treatment of recurrent basal cell carcinoma. Med Sci Monit 2012; 18:PI5-9. [PMID: 22293891 PMCID: PMC3560595 DOI: 10.12659/msm.882449] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Common skin tumors like basal- and squamous-cell carcinoma present a serious problem in modern medicine. Exposure to ultraviolet solar radiation is the main cause of these lesions. Since application of Aldara and PDT separately is well documented, we decided to use both methods together. The aim of our study was to evaluate the effectiveness of local photodynamic therapy supplemented with topical application of Aldara in basal-cell carcinoma. MATERIAL/METHODS Thirty-four patients ages 50 to 68 years were enrolled to the trial and underwent PDT treatment. Each case of BCC was histopathologically confirmed. Ten patients were subjected to local Levulan-PDT and placebo (Eucerin as vehicle cream), and 24 patients were subjected to Levulan-PDT and imiquimod. Photodynamic diagnosis (PDD) was used to detect and visualize suspicious foci (including cancer lesions). RESULTS In the group of patients who were treated using Levulan-PDT and placebo, 6 patients (60%) were totally cured and 4 lesions (40%) significantly decreased in size. In the group of patients treated with Levulan-PDT and imiquimod, 18 lesions totally disappeared (75%), 6 lesions significantly diminished, and in 1 patient small foci of previously excised BCC developed again in scar tissue 10 month after the first control examination. CONCLUSIONS Cure was achieved without any scarring and with very good cosmetic effects. Although this is the preliminary report, the presented modification of PDT seems to be reasonable and promising in treating basal-cell carcinoma.
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Affiliation(s)
- Beata Osiecka
- Photodynamic Therapy Laboratory, Department of Pathology, Wroclaw Medical University, Wroclaw, Poland.
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Basal cell carcinoma of the head and neck. J Skin Cancer 2010; 2011:496910. [PMID: 21209728 PMCID: PMC3010650 DOI: 10.1155/2011/496910] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/17/2010] [Accepted: 10/19/2010] [Indexed: 11/18/2022] Open
Abstract
Basal cell carcinoma (BCC) is a malignant neoplasm derived from nonkeratinizing cells that originate from the basal layer of the epidermis and is the most frequent type of skin cancer in humans, with cumulative exposure to ultraviolet radiation as an important risk factor. BCC occurs most frequently at sun-exposed sites, with the head and neck being common areas. Tumors can be classified as nodular, superficial, morpheaform, infiltrating, metatypic, and fibroepithelioma of Pinkus. Several treatment options such as surgical excision and nonsurgical procedures are available. The choice of treatment should be determined based on the histological subtype of a lesion, cost, its size and location, patient age, medical condition of the patient, treatment availability, and the patient's wishes. The aim of any therapy selected for BCC treatment involving the head and neck is to ensure complete removal, the preservation of function, and a good cosmetic outcome.
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