1
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Tong JY, Huilgol SC, James C, Selva D. Recommendations for risk stratification of periocular squamous cell carcinoma. Surv Ophthalmol 2023; 68:964-976. [PMID: 37172747 DOI: 10.1016/j.survophthal.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Periocular squamous cell carcinoma is a common cutaneous malignancy with generally favorable outcomes; however, the periocular region is intrinsically a high-risk location, and there exist a subset of lesions with a propensity for poor outcomes. Orbital invasion, intracranial perineural spread, nodal and distant metastasis are feared complications. There are several staging systems for eyelid carcinoma and cutaneous squamous cell carcinoma, but the definition of high-risk lesions remains heterogeneous. It is unclear exactly which lesions can be safely deescalated, and which require nodal evaluation and adjuvant multimodal therapy. We seek to answer these questions by summarizing the literature on clinicopathologic variables, molecular markers, and gene profiling tests in periocular squamous cell carcinoma, with the extrapolation of data from the cutaneous squamous cell carcinoma literature. Standardized pathology reports with information on tumor dimensions, histological subtype and grade, perineural invasion, and lymphovascular invasion should become uniform. Integration with gene expression profiling assessments will individualize and improve the predictive accuracy of risk stratification tools to ultimately inform multidisciplinary decision-making.
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Affiliation(s)
- Jessica Y Tong
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Shyamala C Huilgol
- Adelaide Skin & Eye Centre, South Australia, Australia; Department of Dermatology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Craig James
- Clinpath Laboratories, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Adelaide Skin & Eye Centre, South Australia, Australia
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2
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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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3
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Fisher R, Ji-Xu A, Abbott R, Basu T, Brown A, Foley C, Glen C, Gupta G, Hasan Z, Ismail F, Khalid A, Khoo A, Koumaki D, Lally A, Lear JT, McGrath E, McKenna K, Milligan A, Mulholland O, Tasker F, Harwood CA, Proby CM, Matin RN. Clinicopathological characteristics of individuals with co-existing melanoma and chronic lymphocytic leukaemia: a multicentre cohort study. Clin Exp Dermatol 2022; 47:1976-1981. [PMID: 35801421 DOI: 10.1111/ced.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with a prior diagnosis of chronic lymphocytic leukaemia (CLL) have a higher risk of developing melanoma (MM) and exhibit poorer outcomes when compared to patients without CLL. However, there are limited data reporting the clinicopathological features of MM diagnosed in patients with CLL. OBJECTIVES To review clinicopathological characteristics of patients with co-existing diagnoses of MM and CLL. METHODS A retrospective review was undertaken for patients with co-existing diagnoses of MM and CLL between 2005-2015 in 11 centres in the UK and Ireland. RESULTS Overall, 46 cutaneous MM identified in 45 patients were included. In 28 (62.2%) patients, MM was diagnosed after an existing diagnosis of CLL. In this group, mean Breslow thickness was 2.7 mm (range = 0.2-25 mm). Ten (35.7%) tumors developed locoregional recurrence and 8 (28.6%) developed distant metastases. Melanoma-specific mortality was 5/28 (17.9%) and all-cause mortality was 13/28 (46.4%). In 17 patients, MM was diagnosed before CLL. In this group, mean BT was 2.9 mm (range = 0.4-14 mm), 5 (29.4%) developed locoregional recurrence and 3 (17.6%) distant metastases. Melanoma-specific mortality was 1/17 (5.8%) and all-cause mortality was 5/17 (29.4%) in this group. CONCLUSIONS To our knowledge, this is the first and largest cohort study to report clinicopathological data of co-existing melanoma and CLL in the UK and Ireland. Although the thickness of primary melanoma was not different before or after a CLL diagnosis, melanoma recurrence and melanoma-specific mortality appear to be more common in patients with a prior diagnosis of CLL.
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Affiliation(s)
- Rachel Fisher
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antonio Ji-Xu
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - Rachel Abbott
- Department of Dermatology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Tanya Basu
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Alistair Brown
- Charles Centre Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Catherine Foley
- Department of Dermatology, St Vincent's University Hospital, Dublin, Republic of Ireland
| | - Catriona Glen
- Department of Dermatology, NHS Lanarkshire, Lanarkshire, UK
| | - Girish Gupta
- Department of Dermatology, NHS Lanarkshire, Lanarkshire, UK
| | - Zeeshaan Hasan
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - Ferina Ismail
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| | - Amina Khalid
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK
| | - Andre Khoo
- Department of Dermatology, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Dimtra Koumaki
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| | - Aoife Lally
- Department of Dermatology, St Vincent's University Hospital, Dublin, Republic of Ireland
| | - John T Lear
- Department of Dermatology, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Emily McGrath
- Charles Centre Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Kevin McKenna
- Department of Dermatology, Belfast Trust Hospitals, Belfast, UK
| | - Alan Milligan
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| | | | - Fiona Tasker
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Charlotte M Proby
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK
| | - Rubeta N Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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4
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Bhavsar‐Bhakta P, Hamza M, Mehravaran S, Krishnan B, He Q, Tyring S, Rady P, Rivero G, Cohen DN, Sosa IR. The contribution of human papilloma virus infection to cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia. EJHAEM 2021; 2:228-235. [PMID: 35845291 PMCID: PMC9176019 DOI: 10.1002/jha2.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/08/2022]
Abstract
Patients with chronic lymphocytic leukemia (CLL), a B‐cell malignancy characterized by impaired humoral and cellular immunity, are at increased risk of developing cutaneous squamous cell carcinoma (cSCC). Human papilloma virus (HPV) is the most common sexually transmitted infection worldwide and it has been associated with various malignancies, including cSCC. Impaired cell‐mediated immunity is considered a primary risk factor in HPV‐induced cSCC. We examined cSCC lesions from CLL patients with consensus review and HPV genetic analysis to further characterize the relationship between HPV and prevalence of cutaneous malignancy in this population. Eleven patients with CLL contributed 35 cSCCs. Treatment with chemotherapy shortened the latency time to first cSCC. HPV was detected in 54% of the lesions. Among the HPV‐positive cSCC lesions, 84% of the lesions contained alpha‐genus HPV, 42% contained beta‐genus HPV, and 26% of the lesions contained both genera. There was a significant association between HPV‐containing lesions and peritumoral lymphocytic inflammation, suggesting this as a future area for further characterization. The majority of the lesions, including those with alpha‐genus HPV, occurred in sun‐exposed areas, such as the scalp and face. These findings may lead to practice‐changing recommendations for skin cancer, including the use of vaccinations to reduce HPV‐associated skin cancer.
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Affiliation(s)
| | - Mugahed Hamza
- Department of Pathology & Immunology, Baylor College of Medicine Houston Texas USA
| | - Sepideh Mehravaran
- Department of Pathology & Immunology, Baylor College of Medicine Houston Texas USA
| | - Bhuvaneswari Krishnan
- The Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine Houston Texas USA
| | - Qin He
- Department of Dermatology McGovern Medical School Houston Texas USA
| | - Steven Tyring
- Department of Dermatology McGovern Medical School Houston Texas USA
| | - Peter Rady
- Department of Dermatology McGovern Medical School Houston Texas USA
| | - Gustavo Rivero
- Department of Medicine, Baylor College of Medicine Houston Texas USA
- The Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine Houston Texas USA
| | - Daniel N. Cohen
- Department of Pathology & Immunology, Baylor College of Medicine Houston Texas USA
- Bristol Myers Squibb Lawrenceville New Jersey USA
| | - Iberia Romina Sosa
- The Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine Houston Texas USA
- Department of Hematology and Oncology, Fox Chase Cancer Center Philadelphia Pennsylvania USA
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5
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Cutaneous Head and Neck Cancers in the High-Risk Immunosuppressed Population. Otolaryngol Clin North Am 2021; 54:397-413. [PMID: 33602516 DOI: 10.1016/j.otc.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The immunosuppressed (IS) population encompasses a diverse cohort of patients to include iatrogenically immunocompromised organ transplant recipients as well as patients with chronic lymphoid malignancies, human immunodeficiency virus/acquired immunodeficiency syndrome, and autoimmune disorders. Cutaneous cancers in this high-risk patient group are clinically distinct from the general immunocompetent population, showing aggressive behavior with associated poor outcomes. This article reviews the pathogenesis, epidemiology, incidence, prognosis, and special considerations required in managing cutaneous cancers in the IS patient population.
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6
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Soumerai JD, Tajmir SH, Hirsch MS, Massoth LR. Case 7-2019: A 73-Year-Old Woman with Swelling of the Right Groin and Fever. N Engl J Med 2019; 380:859-868. [PMID: 30811914 DOI: 10.1056/nejmcpc1816408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jacob D Soumerai
- From the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Shahein H Tajmir
- From the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Martin S Hirsch
- From the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
| | - Lucas R Massoth
- From the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Medicine (J.D.S., M.S.H.), Radiology (S.H.T.), and Pathology (L.R.M.), Harvard Medical School - both in Boston
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7
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Multicentric Mucinous Adenocarcinoma in the Periorbital Region. Ophthalmic Plast Reconstr Surg 2018; 34:e204-e206. [DOI: 10.1097/iop.0000000000001248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Xu MJ, Lazar AA, Garsa AA, Arron ST, Ryan WR, El-Sayed IH, George JR, Algazi AP, Heaton CM, Ha PK, Yom SS. Major prognostic factors for recurrence and survival independent of the American Joint Committee on Cancer eighth edition staging system in patients with cutaneous squamous cell carcinoma treated with multimodality therapy. Head Neck 2018. [DOI: 10.1002/hed.25114] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Melody J. Xu
- Department of Radiation Oncology; University of California San Francisco; San Francisco California
| | - Ann A. Lazar
- Department of Epidemiology and Biostatistics; University of California San Francisco; San Francisco California
| | - Adam A. Garsa
- Department of Radiation Oncology; University of California San Francisco; San Francisco California
| | - Sarah T. Arron
- Department of Dermatology; University of California San Francisco; San Francisco California
| | - William R. Ryan
- Department of Otolaryngology - Head and Neck Surgery; University of California San Francisco; San Francisco California
| | - Ivan H. El-Sayed
- Department of Otolaryngology - Head and Neck Surgery; University of California San Francisco; San Francisco California
| | - Jonathan R. George
- Department of Otolaryngology - Head and Neck Surgery; University of California San Francisco; San Francisco California
| | - Alain P. Algazi
- Department of Medicine; University of California San Francisco; San Francisco California
| | - Chase M. Heaton
- Department of Otolaryngology - Head and Neck Surgery; University of California San Francisco; San Francisco California
| | - Patrick K. Ha
- Department of Otolaryngology - Head and Neck Surgery; University of California San Francisco; San Francisco California
| | - Sue S. Yom
- Department of Radiation Oncology; University of California San Francisco; San Francisco California
- Department of Otolaryngology - Head and Neck Surgery; University of California San Francisco; San Francisco California
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9
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Manyam BV, Garsa AA, Chin RI, Reddy CA, Gastman B, Thorstad W, Yom SS, Nussenbaum B, Wang SJ, Vidimos AT, Koyfman SA. A multi-institutional comparison of outcomes of immunosuppressed and immunocompetent patients treated with surgery and radiation therapy for cutaneous squamous cell carcinoma of the head and neck. Cancer 2017; 123:2054-2060. [PMID: 28171708 DOI: 10.1002/cncr.30601] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/12/2016] [Accepted: 01/01/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients who are chronically immunosuppressed have higher rates of cutaneous squamous cell carcinoma of the head and neck (cSCC-HN). This is the largest multi-institutional study to date investigating the effect of immune status on disease outcomes in patients with cSCC-HN who underwent surgery and received postoperative radiation therapy (RT). METHODS Patients from 3 institutions who underwent surgery and also received postoperative RT for primary or recurrent, stage I through IV cSCC-HN between 1995 and 2015 were included in this institutional review board-approved study. Patients categorized as immunosuppressed had chronic hematologic malignancy, human immunodeficiency/acquired immunodeficiency syndrome, or had received immunosuppressive therapy for organ transplantation ≥6 months before diagnosis. Overall survival, locoregional recurrence-free survival, and progression-free survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using Cox proportional-hazards regression. RESULTS Of 205 patients, 138 (67.3%) were immunocompetent, and 67 (32.7%) were immunosuppressed. Locoregional recurrence-free survival (47.3% vs 86.1%; P < .0001) and progression-free survival (38.7% vs 71.6%; P = .002) were significantly lower in immunosuppressed patients at 2 years. The 2-year OS rate in immunosuppressed patients demonstrated a similar trend (60.9% vs 78.1%; P = .135) but did not meet significance. On multivariate analysis, immunosuppressed status (hazard ratio [HR], 3.79; P < .0001), recurrent disease (HR, 2.67; P = .001), poor differentiation (HR, 2.08; P = .006), and perineural invasion (HR, 2.05; P = .009) were significantly associated with locoregional recurrence. CONCLUSIONS Immunosuppressed patients with cSCC-HN had dramatically lower outcomes compared with immunocompetent patients, despite receiving bimodality therapy. Immune status is a strong prognostic factor that should be accounted for in prognostic systems, treatment algorithms, and clinical trial design. Cancer 2017;123:2054-2060. © 2017 American Cancer Society.
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Affiliation(s)
- Bindu V Manyam
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Adam A Garsa
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Re-I Chin
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Chandana A Reddy
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Brian Gastman
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Wade Thorstad
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Brian Nussenbaum
- Department of Otolaryngology, Washington University, St. Louis, Missouri
| | - Steven J Wang
- Department of Otolaryngology, University of California San Francisco, San Francisco, California
| | | | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
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10
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Consensus for Nonmelanoma Skin Cancer Treatment, Part II: Squamous Cell Carcinoma, Including a Cost Analysis of Treatment Methods. Dermatol Surg 2016; 41:1214-40. [PMID: 26445288 DOI: 10.1097/dss.0000000000000478] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in the United States. Cutaneous squamous cell carcinoma has an estimated incidence of more than 700,000 new cases per year and a 5% risk of metastasis. OBJECTIVE To provide clinicians with guidelines for the management of cSCC based on evidence from a comprehensive literature review and consensus among the authors. MATERIALS AND METHODS The authors conducted an extensive review of the medical literature on treatment methods for cSCC, taking into consideration cure rates, recurrence and metastatic rates, aesthetic and functional outcomes, and cost effectiveness of the procedures. RESULTS Surgical treatments provide the best outcomes for cSCC. Mohs micrographic surgery is a cost-effective procedure that affords the highest cure rate, maximal tissue preservation, and superior cosmetic outcomes. Nonsurgical methods may be used as a primary treatment for low-risk squamous cell carcinomas, but the cure rates are lower. CONCLUSION The cure rate remains the most important consideration in choosing the treatment method, but additional factors, such as the patient's general medical condition, psychosocial circumstances, the location of the tumor and cost effectiveness of the therapy should be considered. Mohs micrographic surgery remains the preferred treatment for high-risk tumors and tumors located in cosmetically sensitive areas.
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11
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Manyam BV, Gastman B, Zhang AY, Reddy CA, Burkey BB, Scharpf J, Alam DS, Fritz MA, Vidimos AT, Koyfman SA. Inferior outcomes in immunosuppressed patients with high-risk cutaneous squamous cell carcinoma of the head and neck treated with surgery and radiation therapy. J Am Acad Dermatol 2015; 73:221-7. [DOI: 10.1016/j.jaad.2015.04.037] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/15/2015] [Accepted: 04/20/2015] [Indexed: 11/29/2022]
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12
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Consensus for nonmelanoma skin cancer treatment: basal cell carcinoma, including a cost analysis of treatment methods. Dermatol Surg 2015; 41:550-71. [PMID: 25868035 DOI: 10.1097/dss.0000000000000296] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common cancer in the US population affecting approximately 2.8 million people per year. Basal cell carcinomas are usually slow-growing and rarely metastasize, but they do cause localized tissue destruction, compromised function, and cosmetic disfigurement. OBJECTIVE To provide clinicians with guidelines for the management of BCC based on evidence from a comprehensive literature review, and consensus among the authors. MATERIALS AND METHODS An extensive review of the medical literature was conducted to evaluate the optimal treatment methods for cutaneous BCC, taking into consideration cure rates, recurrence rates, aesthetic and functional outcomes, and cost-effectiveness of the procedures. RESULTS Surgical approaches provide the best outcomes for BCCs. Mohs micrographic surgery provides the highest cure rates while maximizing tissue preservation, maintenance of function, and cosmesis. CONCLUSION Mohs micrographic surgery is an efficient and cost-effective procedure and remains the treatment of choice for high-risk BCCs and for those in cosmetically sensitive locations. Nonsurgical modalities may be used for low-risk BCCs when surgery is contraindicated or impractical, but the cure rates are lower.
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14
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Wong J, Breen D, Balogh J, Czarnota GJ, Kamra J, Barnes EA. Treating recurrent cases of squamous cell carcinoma with radiotherapy. ACTA ACUST UNITED AC 2010; 15:229-33. [PMID: 19008997 PMCID: PMC2582513 DOI: 10.3747/co.v15i5.196] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with chronic lymphocytic leukemia (cll) are at a significantly increased risk of developing cutaneous squamous cell carcinoma (scc), in part because of their impaired immunosurveillance. Here, we report the cases of 4 patients with cll who had locally aggressive cutaneous scc managed with radiotherapy for local recurrence following surgical excision. All tumours were located in the head-and-neck region. All patients initially achieved complete regression of disease; however, 2 had local recurrence a mean of 8 months after treatment completion. One patient died from progressive scc. Our findings agree with the high rates reported in literature of multiple tumours, local recurrence, metastases, and mortality from scc in patients with cll. Radiotherapy plays an important role in patient management, and it is the recommended treatment modality when complete surgical excision of disease would result in anatomic and functional defects. Radiotherapy is often used in the case of local recurrence after one or more attempts at surgical excision. Dose escalation through intensity-modulated radiotherapy, hyperfractionation, or novel treatment techniques such as high-intensity focused ultrasound may be explored to improve local control of scc lesions. To optimize patient outcomes, cutaneous scc arising in patients with a history of cll should be managed and followed in a multidisciplinary clinic, with regular skin surveillance and prompt treatment.
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Affiliation(s)
- J Wong
- Department of Radiation Oncology, University of Toronto, Faculty of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
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15
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Trisomy 12 in a case of multiple cutaneous squamous cell carcinoma in association with chronic lymphocytic leukemia. Chin J Cancer Res 2007. [DOI: 10.1007/s11670-007-0150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Avitia S, Hamilton JS, Osborne RF. Invasive Metastatic Skin Cancer in the Background of Chronic Lymphocytic Leukemia. EAR, NOSE & THROAT JOURNAL 2007. [DOI: 10.1177/014556130708600207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sofia Avitia
- From the Department of Otolaryngology–Head and Neck Surgery, Charles R. Drew University of Medicine and Science
| | | | - Ryan F. Osborne
- Osborne Head and Neck Institute, Los Angeles
- Head and Neck Cancer Center, Cedars-Sinai Medical Center, Los Angeles
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17
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Abstract
There is a significant association between non-Hodgkin lymphoma, including chronic lymphocytic leukaemia, and both melanoma and non-melanoma skin cancer. This review highlights the existing data on the phenomenon of accelerated skin cancer in patients with non-Hodgkin lymphoma and specifically chronic lymphocytic leukaemia. The outcomes of patients with non-Hodgkin lymphoma (including chronic lymphocytic leukaemia) and non-melanoma skin cancer are worse than in patients without concomitant lymphoreticular malignancy, as shown by increased rates of local recurrence, regional metastasis and death. Pathogenic factors may be common between non-Hodgkin lymphoma and chronic lymphocytic leukaemia and skin cancer. The treatment of skin cancer in patients with non-Hodgkin lymphoma must factor in the worse prognosis and adapt standard therapeutic approaches to minimize the risk of metastasis and death. Preventive strategies and early detection are paramount in this high-risk population.
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MESH Headings
- Carcinoma, Basal Cell/complications
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/physiopathology
- Carcinoma, Basal Cell/therapy
- Carcinoma, Merkel Cell/complications
- Carcinoma, Merkel Cell/diagnosis
- Carcinoma, Merkel Cell/physiopathology
- Carcinoma, Merkel Cell/therapy
- Carcinoma, Squamous Cell/complications
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/physiopathology
- Carcinoma, Squamous Cell/therapy
- Combined Modality Therapy
- Humans
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/physiopathology
- Lymphoma, Non-Hodgkin/therapy
- Melanoma/complications
- Melanoma/diagnosis
- Melanoma/physiopathology
- Melanoma/therapy
- Prognosis
- Sarcoma, Kaposi/complications
- Sarcoma, Kaposi/diagnosis
- Sarcoma, Kaposi/physiopathology
- Sarcoma, Kaposi/therapy
- Skin Neoplasms/complications
- Skin Neoplasms/diagnosis
- Skin Neoplasms/physiopathology
- Skin Neoplasms/therapy
- Xanthomatosis/complications
- Xanthomatosis/diagnosis
- Xanthomatosis/physiopathology
- Xanthomatosis/therapy
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Affiliation(s)
- Clark C Otley
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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18
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Campbell RM, DiGiovanna JJ. Skin cancer chemoprevention with systemic retinoids: an adjunct in the management of selected high-risk patients. Dermatol Ther 2006; 19:306-14. [PMID: 17014486 DOI: 10.1111/j.1529-8019.2006.00088.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Systemic retinoids (isotretinoin, etretinate, and acitretin) have been shown to be effective chemotherapeutic agents in studies of patients with xeroderma pigmentosum, the nevoid basal cell carcinoma syndrome, and recipients of organ or bone marrow transplantation. In addition, patients who do not have these disorders but who are actively developing large numbers of new skin cancers may also benefit from this approach. All patients developing large numbers of skin cancers need rigorous UV protection and frequent dermatologic examinations. Although isotretinoin and acitretin share overlapping toxicities, there are differences that may affect drug choice. Because low doses may be effective, there are advantages to beginning treatment at a low dose, and subsequently, increasing dose if necessary, based on patient response. Laboratory monitoring including pregnancy testing should be performed before and during treatment. Long-term toxicity, primarily involving the skeletal system, can be monitored with imaging studies.
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Affiliation(s)
- Ross M Campbell
- Division of Dermatopharmacology, Department of Dermatology, Brown Medical School and Rhode Island Hospital, Providence, Rhode Island 02903, USA
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