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Abdul Gafoor SM, Robinson S, Diskantova S, Woodcock E, Yethenpa S, Holloran S, Nelson T. Patient-initiated follow-up for high-risk cutaneous squamous cell carcinoma: how we do it and 2 years of outcome data. Clin Exp Dermatol 2024; 49:1205-1212. [PMID: 38747386 DOI: 10.1093/ced/llae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND For patients with high-risk cutaneous squamous cell carcinomas (cSCCs), current guidance suggests we should offer post-treatment follow-up appointments at regular intervals for 24 months. Is this to improve prognosis, provide psychological support or find the next cancer? Recent data confirm that recurrence and metastasis are rarer events, and that perhaps these intense follow-up schedules do not really lead to improved health outcomes. OBJECTIVES To question whether current follow-up practices are truly needed by introducing an option of patient-initiated follow-up (PIFU). METHODS We enrolled 476 patients with cSCC (January 2020-January 2023) who fulfilled the definition of high-risk cSCC based on guidelines in use at the time. Of the total, 59 did not fulful the inclusion criteria and were excluded; 250 (52.5%) did not recontact us during the 2-year period, with no clinical record of complications or recurrences; and 167 (35.1%) utilized the PIFU pathway, of which 119 patients required only one face-to-face appointment. Seven patients (1.5%) developed metastatic disease, 11 (2.3%) developed recurrence and 68 (14.3%) developed cSCC at another site. All lesions were identified by the patient via PIFU. We saved 1250 follow-up appointments from those who did not contact us (n = 250), financially equating to £181 462.50. CONCLUSIONS Our data imply that PIFU can be considered safe alternative practice for patients with cSCC. Patients independently identified the need for review without scheduled follow-up, making these appointments available to other patient cohorts. Although follow-up appointments may provide mental health support, they can be inconvenient and not the ideal use of our healthcare resources. Our findings support a call for revision of existing skin cancer health policies to cope with and subsequently improve our practices for better patient care.
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Affiliation(s)
| | - Sophie Robinson
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Emma Woodcock
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Sonam Yethenpa
- Department of Dermatology, Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Sophie Holloran
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Toby Nelson
- Department of Dermatology, University Hospitals Plymouth NHS Trust, Plymouth, UK
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2
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Dettrick A, Foden N, Hogan D, Azer M, Blazak J, Atwell D, Buddle N, Min M, Livingston R, Banney L, Donkin R. The hidden Australian skin cancer epidemic, high-risk cutaneous squamous cell carcinoma: a narrative review. Pathology 2024; 56:619-632. [PMID: 38871593 DOI: 10.1016/j.pathol.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
Deaths from non-melanoma skin cancers (NMSCs) have almost doubled in Australia in recent years. Cutaneous squamous cell carcinoma (cSCC) constitutes approximately 20% of NMSCs, but is responsible for most of the deaths. Most skin cancers are easy to diagnose and treat and therefore cSCC are often trivialised; however, there is a high-risk subgroup of cSCC (HRcSCC) that is associated with a high risk of metastasis and death. The definition of early HRcSCC and our ability to identify them is evolving. Many significant prognostic factors have been identified, but a universally accepted prognostic index does not exist. Guidelines for workup, treatment, and follow-up leave many important decisions open to broad interpretation by the treating physician or multidisciplinary team. Some of the treatments used for metastatic cSCC are not supported by robust evidence and the prognosis of metastatic cSCC is guarded. In this review, we highlight the rapid rise in NMSC deaths and discuss some of the deficiencies in our knowledge of how to define, diagnose, stage, and manage HRcSCC.
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Affiliation(s)
- Andrew Dettrick
- Anatomical Pathology, Pathology Queensland, Sunshine Coast, Qld, Australia; School of Health, University of the Sunshine Coast, Qld, Australia.
| | - Neil Foden
- Ear, Nose and Throat, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - David Hogan
- Ear, Nose and Throat, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Mary Azer
- Medical Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - John Blazak
- Radiology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Daisy Atwell
- Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Nicole Buddle
- Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Myo Min
- School of Health, University of the Sunshine Coast, Qld, Australia; Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Sunshine Coast, Qld, Australia
| | - Ryan Livingston
- Plastic Surgery, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Leith Banney
- Dermatology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Rebecca Donkin
- School of Health, University of the Sunshine Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Sunshine Coast, Qld, Australia
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3
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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Pennachioli E, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2024; 9:103005. [PMID: 38688192 PMCID: PMC11067535 DOI: 10.1016/j.esmoop.2024.103005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Cutaneous squamous cell carcinoma (CSCC) accounts for ∼20%-25% of all skin tumors. Its precise incidence is often challenging to determine due to limited statistics and its incorporation with mucosal forms. While most cases have a favorable prognosis, challenges arise in patients presenting with locally advanced or metastatic forms, mainly appearing in immunocompromised patients, solid organ transplantation recipients, or those facing social difficulties. Traditionally, chemotherapy and targeted therapy were the mainstays for advanced cases, but recent approvals of immunotherapeutic agents like cemiplimab and pembrolizumab have revolutionized treatment options. These guidelines, developed by the Italian Association of Medical Oncologists (AIOM) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, aim to guide clinicians in diagnosing, treating, and monitoring patients with CSCC, covering key aspects from primitive tumors to advanced stages, selected by a panel of experts selected by AIOM and other national scientific societies. The incorporation of these guidelines into clinical practice is expected to enhance patient care and address the evolving landscape of CSCC management.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, IRCCS European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- IRCCS Humanitas Research Hospital, Milan
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- Surgical Pathology Department, IRCCS Galeazzi Sant'Ambrogio, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - E Pennachioli
- Division of Melanoma, Sarcomas and Rare Tumors, IRCCS European Institute of Oncology, Milan
| | - K Peris
- Dermatology, Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgery Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genova, Genoa, Italy.
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4
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Boutros A, Croce E, Tanda ET, Cecchi F, Arecco L, Genova C, Baldelli I, Lambertini M, Raposio E, Del Mastro L, Spagnolo F. Early discontinuation of cemiplimab in patients with advanced cutaneous squamous cell carcinoma. J Geriatr Oncol 2024; 15:101640. [PMID: 37798175 DOI: 10.1016/j.jgo.2023.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/29/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Andrea Boutros
- Skin Cancer Unit, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy.
| | - Elena Croce
- Skin Cancer Unit, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
| | - Enrica Teresa Tanda
- Skin Cancer Unit, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Cecchi
- Skin Cancer Unit, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Genova
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ilaria Baldelli
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genoa, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Edoardo Raposio
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genoa, Genova, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Spagnolo
- Skin Cancer Unit, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genoa, Genova, Italy
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Sinclair R, Wong XL, Shumack S, Baker C, MacMahon B. The role of micrometastasis in high-risk skin cancers. Australas J Dermatol 2024; 65:143-152. [PMID: 38156714 DOI: 10.1111/ajd.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/30/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
The propensity to metastasize is the most important prognostic indicator for solid cancers. New insights into the mechanisms of early carcinogenesis have revealed micrometastases are generated far earlier than previously thought. Evidence supports a synergistic relationship between vascular and lymphatic seeding which can occur before there is clinical evidence of a primary tumour. Early vascular seeding prepares distal sites for colonisation while regional lymphatics are co-opted to promote facilitative cancer cell mutations. In response, the host mounts a global inflammatory and immunomodulatory response towards these cells supporting the concept that cancer is a systemic disease. Cancer staging systems should be refined to better reflect cancer cell loads in various tissue compartments while clinical perspectives should be broadened to encompass this view when approaching high-risk cancers. Measured adjunctive therapies implemented earlier for low-volume, in-transit cancer offers the prospect of preventing advanced disease and the need for heroic therapeutic interventions. This review seeks to re-appraise how we view the metastatic process for solid cancers. It will explore in-transit metastasis in the context of high-risk skin cancer and how it dictates disease progression. It will also discuss how these implications will influence our current staging systems and its consequences on management.
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Affiliation(s)
- Robert Sinclair
- Queensland Institute of Dermatology, Brisbane, QLD, Australia
| | - Xin Lin Wong
- St George Dermatology and Skin Cancer Centre, New South Wales, Kogarah, Australia
| | - Stephen Shumack
- St George Dermatology and Skin Cancer Centre, New South Wales, Kogarah, Australia
- Department of Dermatology, Royal North Shore Hospital, New South Wales, Sydney, Australia
| | - Christopher Baker
- Department of Dermatology, St Vincents Hospital, Victoria, Melbourne, Australia
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6
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Frenkel CH, Iltis AS, Casingal V, Atlas J. Considering Innovative Clinical Care for Organ Transplant Patients With Advanced Cutaneous Head and Neck Malignancies. Otolaryngol Head Neck Surg 2024; 170:630-633. [PMID: 37702195 DOI: 10.1002/ohn.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Catherine H Frenkel
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Ana S Iltis
- Department of Philosophy, Center for Bioethics, Health & Society Wake Forest University, Winston-Salem, North Carolina, USA
| | - Vincent Casingal
- Department of Transplant Surgery, Atrium Health, Charlotte, North Carolina, USA
| | - Jennifer Atlas
- Department of Hematology and Medical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
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7
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Perry JR, Genenger B, Thind AS, Ashford B, Ranson M. PIK Your Poison: The Effects of Combining PI3K and CDK Inhibitors against Metastatic Cutaneous Squamous Cell Carcinoma In Vitro. Cancers (Basel) 2024; 16:370. [PMID: 38254859 PMCID: PMC10814950 DOI: 10.3390/cancers16020370] [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: 12/20/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is a very common skin malignancy with poor prognosis for patients with locally advanced or metastatic cSCC (mcSCC). PI3K/AKT/mTOR and cell cycle signalling pathways are often dysregulated in mcSCC. A combination drug approach has been theorised to overcome the underwhelming clinical performance of targeted inhibitors as single agents. This study investigates the potential of targeted inhibition of the p110α-subunit of PI3K with PIK-75 or BGT226 (P13Ki), and of CDK1/2/5/9 with dinaciclib (CDKi) as single agents and in combination. The patient-derived mcSCC cell lines, UW-CSCC1 and UW-CSCC2, were used to assess cell viability, migration, cell signalling, cell cycle distribution, and apoptosis. PIK-75, BGT226, and dinaciclib exhibited strong cytotoxic potency as single agents. Notably, the non-malignant HaCaT cell line was unaffected. In 2D cultures, PIK-75 synergistically enhanced the cytotoxic effects of dinaciclib in UW-CSCC2, but not UW-CSCC1. Interestingly, this pattern was reversed in 3D spheroid models. Despite the combination of PIK-75 and dinaciclib resulting in an increase in cell cycle arrest and apoptosis, and reduced cell motility, these differences were largely negligible compared to their single-agent counterpart. The differential responses between the cell lines correlated with driver gene mutation profiles. These findings suggest that personalised medicine approaches targeting PI3K and CDK pathways in combination may yield some benefit for mcSCC, and that more complex 3D models should be considered for drug responsiveness studies in this disease.
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Affiliation(s)
- Jay R. Perry
- School of Chemistry and Molecular Bioscience, Molecular Horizon, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; (B.G.); (A.S.T.)
| | - Benjamin Genenger
- School of Chemistry and Molecular Bioscience, Molecular Horizon, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; (B.G.); (A.S.T.)
| | - Amarinder Singh Thind
- School of Chemistry and Molecular Bioscience, Molecular Horizon, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; (B.G.); (A.S.T.)
- Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia;
| | - Bruce Ashford
- Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia;
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Marie Ranson
- School of Chemistry and Molecular Bioscience, Molecular Horizon, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia; (B.G.); (A.S.T.)
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8
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Clingan P, Ladwa R, Brungs D, Harris DL, McGrath M, Arnold S, Coward J, Fourie S, Kurochkin A, Malan DR, Mant A, Sharma V, Shue H, Tazbirkova A, Berciano-Guerrero MA, Charoentum C, Dalle S, Dechaphunkul A, Dudnichenko O, Koralewski P, Lugowska I, Montaudié H, Muñoz-Couselo E, Sriuranpong V, Oliviero J, Desai J. Efficacy and safety of cosibelimab, an anti-PD-L1 antibody, in metastatic cutaneous squamous cell carcinoma. J Immunother Cancer 2023; 11:e007637. [PMID: 37848259 PMCID: PMC10582968 DOI: 10.1136/jitc-2023-007637] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Programmed cell death receptor-1 (PD-1)-blocking antibodies are approved to treat metastatic or locally advanced cutaneous squamous cell carcinoma (CSCC) cases ineligible for curative surgery or radiation. Notwithstanding, some patients experience inadequate responses or severe immune-related adverse events (AEs), indicating the need for improved therapies. Cosibelimab is a high-affinity programmed cell death-ligand 1 (PD-L1)-blocking antibody that activates innate and adaptive immunity by blocking PD-L1 interaction with PD-1 and B7-1 receptors. It is an unmodified immunoglobulin G1 subtype with a functional Fc domain capable of inducing antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity. Here, we present results of the pivotal study of patients with metastatic CSCC from an open-label, multicenter, multiregional, multicohort, phase 1 trial of cosibelimab. METHODS In this trial, participants with metastatic CSCC received cosibelimab 800 mg intravenously every 2 weeks. Primary endpoint was objective response rate (ORR) by independent central review using Response Evaluation Criteria in Solid Tumors, V.1.1. Secondary endpoints included duration of response (DOR) and safety. RESULTS Objective response was observed in 37 of 78 participants (47.4% (95% CI: 36.0% to 59.1%)), with median follow-up of 15.4 months (range: 0.4 to 40.5) as of data cut-off. Median DOR was not reached (range: 1.4+ to 34.1+ months), with response ongoing in 73.0% of participants. Common treatment-emergent AEs (≥15%) were fatigue (26.9%), rash (16.7%), and anemia (15.4%). Eighteen participants (23.1%) experienced immune-related AEs (grade 3: n=2 (2.6%); no grade 4/5). No treatment-related deaths were reported. CONCLUSIONS Cosibelimab demonstrated clinically meaningful ORR and DOR and was associated with a manageable safety profile. TRIAL REGISTRATION NUMBER NCT03212404.
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Affiliation(s)
- Philip Clingan
- Southern Medical Day Care Centre, Wollongong, New South Wales, Australia
| | - Rahul Ladwa
- Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Brungs
- Southern Medical Day Care Centre, Wollongong, New South Wales, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Margaret McGrath
- Medical Oncology, Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
| | - Susan Arnold
- Exellentis Clinical Trial Consultants, George, South Africa
| | | | | | - Andriy Kurochkin
- Municipal Nonprofit Enterprise of Sumy Regional Council Sumy Regional Clinical Oncology Dispensary, Sumy, Ukraine
| | | | - Andrew Mant
- Medical Oncology Unit, Eastern Health, Melbourne, Victoria, Australia
| | - Vinay Sharma
- Wits Clinical Research Chris Hani Baragwanath Clinical Trial Site, Johannesburg, South Africa
| | - Hong Shue
- Sunshine Coast Haematology and Oncology Clinic, Buderim, Queensland, Australia
| | - Andrea Tazbirkova
- Medical Oncology, Pindara Private Hospital, Gold Coast, Queensland, Australia
| | | | - Chaiyut Charoentum
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
| | - Stéphane Dalle
- Hospices Civils de Lyon - Hopital Lyon Sud, Pierre-Bénite, France
| | | | - Oleksandr Dudnichenko
- Kharkiv Medical Academy of Postgraduate Education, Chair of Oncology and Children's Oncology, Clinical base State institution "VT Zaycev Institute of General and Urgent Surgery of National Academy Medical Sciences of Ukraine", Kharkiv, Ukraine
| | - Piotr Koralewski
- Szpital Specjalistyczny im. Ludwika Rydygiera w Krakowie Sp. z o.o., Oddział Onkologii Klinicznej z Pododdziałem Dziennym, Kraków, Poland
| | - Iwona Lugowska
- Narodowy Instytut Onkologii im. Marii Skłodowskiej-Curie Państwowy Instytut Badawczy, Oddział Badań Wczesnych Faz, Warsaw, Poland
| | - Henri Montaudié
- Centre Hospitalier Universitaire de Nice - Hôpital l'Archet, Nice, France
| | - Eva Muñoz-Couselo
- Hospital Universitario Vall d'Hebron, Passeig de la Vall d'Hebron, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - James Oliviero
- Checkpoint Therapeutics Inc, Waltham, Massachusetts, USA
| | - Jayesh Desai
- Department of Medical Oncology, Peter MacCallum Cancer Centre; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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9
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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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10
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Mazur E, Reich A. Photodynamic Therapy is an Effective Treatment of Facial Pigmented Actinic Keratosis. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00924-0. [PMID: 37162710 DOI: 10.1007/s13555-023-00924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Actinic keratosis (AK), or solar keratosis, is a precancerous condition of the skin, mainly caused by excessive and chronic exposure to ultraviolet radiation. Pigmented AK (pAK) is a rare variant of AK. Photodynamic therapy (PDT) is widely used to treat the classical variant of AK, but very limited data are available on the use of PDT in patients with pAK. The objective of this study was to assess the usefulness of PDT in the treatment of pAK. METHODS The study included 16 patients with 20 pAK lesions treated with PDT. All skin lesions were clinically and dermatoscopically assessed for typical features characteristic of pAK. Reflectance confocal microscopy (RCM) was also used to assess keratinocyte atypia, confirm pAK diagnosis, and rule out other disease entities. RESULTS After three PDT sessions, the complete resolution of all clinical features of pAK was observed in 80% of the studied lesions. Dermatoscopically, 65% of the lesions achieved 100% response and no cellular atypia was seen in the follow-up RCM images of 85% of lesions. CONCLUSIONS Photodynamic therapy is an effective treatment modality for pAK in fair-skinned individuals.
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Affiliation(s)
- Ewelina Mazur
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
- Doctoral School of the University of Rzeszow, University of Rzeszow, Rzeszow, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.
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González S, Gill M, Juarranz Á. Introduction to the Special Issue on "Keratinocyte Carcinomas: Biology and Evolving Non-Invasive Management Paradigms". Cancers (Basel) 2023; 15:cancers15082325. [PMID: 37190253 DOI: 10.3390/cancers15082325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/17/2023] Open
Abstract
Keratinocyte carcinomas (KCs) are the most prevalent form of cancer worldwide, and their incidence is rising dramatically, with an increasing trend in recent years [...].
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Affiliation(s)
- Salvador González
- Department of Medicine and Medical Specialties, Alcalá de Henares University, 28805 Madrid, Spain
| | - Melissa Gill
- Department of Medicine and Medical Specialties, Alcalá de Henares University, 28805 Madrid, Spain
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital Solna, 17176 Stockholm, Sweden
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Ángeles Juarranz
- Department of Biology, Faculty of Sciences, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Cozma EC, Banciu LM, Soare C, Cretoiu SM. Update on the Molecular Pathology of Cutaneous Squamous Cell Carcinoma. Int J Mol Sci 2023; 24:ijms24076646. [PMID: 37047618 PMCID: PMC10095059 DOI: 10.3390/ijms24076646] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, originating from keratinocytes of the spinous layer. Numerous risk factors have been discovered for the initiation and growth of this type of cancer, such as exposure to UV and ionizing radiation, chemical carcinogens, the presence of immunosuppression states, chronic inflammation, infections with high-risk viral strains, and, last but not least, the presence of diseases associated with genetic alterations. The important socio-economic impact, as well as the difficulty associated with therapy for advanced forms, has made the molecular mechanisms underlying this neoplasia more and more intensively studied, with the intention of achieving a better understanding and advancing the treatment of this pathology. This review aims to provide a brief foray into the molecular, genetic, and epigenetic aspects of this cancer, as well as the treatment methods, ranging from the first used to the latest targeted therapies.
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Affiliation(s)
- Elena-Codruta Cozma
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
- Pathophysiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Laura Madalina Banciu
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Cristina Soare
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
- Surgery Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Sanda-Maria Cretoiu
- Department of Cell and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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13
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Girardi FM, Wagner VP, Martins MD, Abentroth AL, Hauth LA. Impact of AJCC 8 pT staging in cutaneous head and neck squamous cell carcinoma in a nonselected real-world patient sample. Head Neck 2023; 45:337-346. [PMID: 36345615 DOI: 10.1002/hed.27233] [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: 06/21/2022] [Revised: 10/08/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Our aim was to evaluate characteristics associated with worse survival and the effectiveness of AJCC 8 in a real-world cohort of HNCSCC from South Brazil. METHODS A 10-year retrospective cohort study (2011-2020) at a tertiary care center comprising 647 HNCSCC excised from 435 patients. RESULTS At multivariable analysis, ear/nose/zygomatic or periorbital site, compromised or exiguous margins, and advanced pT stage were independent factors associated to DFS, while age, pN, and loco-regional recurrence were independent factors associated to DSS. Cox-regression multivariable models showed that the pT stage was statistically significant for the DFS, but not DSS. A significant distinction was only observed between T1 and T2. CONCLUSION It was only in the lower categories of AJCC 8 (T1 and T2) that we were able to demonstrate the ability to stratify tumors with a significant risk of poor disease-related outcomes.
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Affiliation(s)
| | - Vivian P Wagner
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS, Brazil
| | | | - Luiz Alberto Hauth
- Integrated Oncology Center of Ana Nery Hospital, Santa Cruz do Sul, RS, Brazil
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Mirali S, Tang E, Drucker AM, Turchin I, Gooderham M, Levell N, Beecker J, Bissonnette R, Catherall H, Lapointe McKenzie JA, Hawkins N, Hong CH, Kalia S, Papp K, Chan AW. Follow-up of Patients With Keratinocyte Carcinoma: A Systematic Review of Clinical Practice Guidelines. JAMA Dermatol 2023; 159:87-94. [PMID: 36322063 DOI: 10.1001/jamadermatol.2022.4590] [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: 11/06/2022]
Abstract
Importance Patients treated for cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), collectively called keratinocyte carcinoma (KC), are at risk for recurrence, metastasis, and additional primary cutaneous malignant neoplasms. It is unclear how often patients should be seen for follow-up skin examination after initial treatment of KC. Objective To summarize the recommendations and evaluate the methodological quality of clinical practice guidelines for dermatologic follow-up of patients with BCC and invasive SCC. Evidence Review PubMed, MEDLINE, and Embase were searched for relevant articles published from January 2010 to March 2022. Search terms included guideline, squamous cell carcinoma, and basal cell carcinoma. National or international guidelines containing recommendations for follow-up frequency after a diagnosis of localized cutaneous KC were included. Quality was assessed using the 6 domains of the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool: (1) scope and purpose; (2) stakeholder development; (3) rigor of development; (4) clarity of presentation; (5) applicability; and (6) editorial independence. The Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) was used to guide study reporting. Findings Among the 14 guidelines meeting eligibility criteria, there was little consensus on the appropriate follow-up frequency after initial KC treatment. Overall duration of follow-up ranged from a single posttreatment visit to lifelong surveillance. Most guidelines stratified their recommendations by recurrence risk. For low-risk BCC and guidelines that did not stratify by risk, follow-up recommendations ranged from every 6 to 12 months. For high-risk BCC, 1 guideline suggested follow-up every 3 months, while 4 recommended every 6 months. For low-risk SCC, 5 guidelines recommended annual follow-up; 3 guidelines, every 6 months; and 1 guideline, every 3 months. For high-risk SCC, recommendations included a range of follow-up frequencies, spanning every 3 months (n = 5 guidelines), 4 months (n = 1), 6 months (n = 6), or annually (n = 4). One guideline did not use risk stratification and recommended annual screening. The highest scoring AGREE II domain was "scope and purpose," which assessed the guideline's overall objectives, and the lowest scoring was "applicability," which assessed barriers and facilitators to implementation. Conclusions and Relevance The findings of this systemic review highlight variations in follow-up recommendations for patients after initial treatment for KC. Randomized clinical trials are needed to define an optimal follow-up regimen.
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Affiliation(s)
- Sara Mirali
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
| | - Evan Tang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
| | - Aaron M Drucker
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Irina Turchin
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Brunswick Dermatology Center, Fredericton, New Brunswick, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
| | - Melinda Gooderham
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
- SKiN Centre for Dermatology, Peterborough, Ontario, Canada
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Nick Levell
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Jennifer Beecker
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Division of Dermatology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Robert Bissonnette
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Innovaderm Research, Montreal, Quebec, Canada
| | - Helen Catherall
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
| | - Jo-Ann Lapointe McKenzie
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Save Your Skin Foundation, Penticton, British Columbia, Canada
| | - Nicole Hawkins
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Peak Medical Specialty Clinic, Okotoks, Alberta, Canada
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Chih-Ho Hong
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Surrey, British Columbia, Canada
| | - Sunil Kalia
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kim Papp
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
- K Papp Clinical Research, Waterloo, Ontario, Canada
| | - An-Wen Chan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Skin Investigation Network of Canada (SkIN Canada), Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ascierto PA, Schadendorf D. Update in the treatment of non-melanoma skin cancers: the use of PD-1 inhibitors in basal cell carcinoma and cutaneous squamous-cell carcinoma. J Immunother Cancer 2022; 10:e005082. [PMID: 36455990 PMCID: PMC9716987 DOI: 10.1136/jitc-2022-005082] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 12/05/2022] Open
Abstract
Non-melanoma skin cancer (NMSC) includes a wide range of cutaneous tumors, the most frequent of which are basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (CSCC). Although NMSC is usually cured by surgical resection, in rare cases it can progress to locally advanced and metastatic disease. Risk factors for advanced disease include comorbidities, neglect, and immunosuppression. Advanced NMSC may require systemic treatment if surgery and radiation are not feasible. Chemotherapy, epidermal growth factor receptor (EGFR) inhibitors in CSCC, and hedgehog inhibitors in BCC have been used but are generally of limited benefit, with responses often short-lived and toxicity issues. Given the high mutational burden of NMSC, the use of immunotherapy has been investigated and two anti-PD-1 antibodies, cemiplimab and pembrolizumab, are approved for the treatment of advanced CSCC not curable by surgery or radiation. Both have shown durable responses with good tolerability in patients in phase II trials and anti-PD-1 therapy is now the standard of care for locally advanced and metastatic CSCC. PD-1 blockade is also approved as second-line therapy in advanced BCC, with frequent and durable responses after failure on hedgehog inhibitor therapy. PD-1 checkpoint inhibition is being assessed for NMSC in combination with other modalities, including oncolytic viruses and EGFR inhibitors. Adjuvant and neoadjuvant use of cemiplimab and pembrolizumab is also being investigated with several ongoing trials. Further clinical trials of immunotherapy must be prioritized in NMSC for further improvement in outcomes.
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Affiliation(s)
- Paolo A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Innovative Therapy, National Cancer Institute IRCCS Pascale Foundation, Napoli, Italy
| | - Dirk Schadendorf
- Department for Dermatology, Venerology and Allergology, University Hospital Essen & German Cancer Consortium, Partner Site Essen, Essen, Germany
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Recent Advances in Immunotherapy for Patients with Head and Neck Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14215325. [PMID: 36358744 PMCID: PMC9657466 DOI: 10.3390/cancers14215325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Cutaneous squamous cell cancer is a form of skin cancer, which is typically found in older fair-skinned individuals with frequent sun exposure. Most patients present with limited disease and can be treated with a combination of surgery and/or radiation with favorable outcomes. A small percentage of patients present with more aggressive, widespread disease. Immunotherapy has dramatically improved outcomes and has become the preferred treatment option for these patients. In this review article, the rationale for using immunotherapy in patients with squamous cell skin cancer is discussed. A summary of the new treatment options currently being explored is also provided. Abstract Cutaneous squamous cell carcinoma (CSCC) is the second most common non-melanoma skin cancer. A majority of patients present with localized disease, but some can present with locally advanced or metastatic disease. Most of these advanced cases occur in the anatomical head and neck region and are associated with more aggressive disease, necessitating prompt and effective treatment. Prior to the emergence of immunotherapy, systemic treatment options were limited to platinum-based chemotherapy and salvaged with targeted epidermal growth factor therapy. These therapies were associated with poor efficacy and increased toxicity in an often frail, older population. Immunotherapy has dramatically improved outcomes in this patient population due to its favorable side effect profile, durable treatment response, and improved overall outcomes. In this review, an overview of the recent advances of immunotherapy in the management of CSCC in the anatomical head and neck region is provided, with a focus on advanced presentations.
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Thind AS, Ashford B, Strbenac D, Mitchell J, Lee J, Mueller SA, Minaei E, Perry JR, Ch’ng S, Iyer NG, Clark JR, Gupta R, Ranson M. Whole genome analysis reveals the genomic complexity in metastatic cutaneous squamous cell carcinoma. Front Oncol 2022; 12:919118. [PMID: 35982973 PMCID: PMC9379253 DOI: 10.3389/fonc.2022.919118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/27/2022] [Indexed: 12/13/2022] Open
Abstract
Metastatic cutaneous squamous cell carcinoma (CSCC) is a highly morbid disease requiring radical surgery and adjuvant therapy, which is associated with a poor prognosis. Yet, compared to other advanced malignancies, relatively little is known of the genomic landscape of metastatic CSCC. We have previously reported the mutational signatures and mutational patterns of CCCTC-binding factor (CTCF) regions in metastatic CSCC. However, many other genomic components (indel signatures, non-coding drivers, and structural variants) of metastatic CSCC have not been reported. To this end, we performed whole genome sequencing on lymph node metastases and blood DNA from 25 CSCC patients with regional metastases of the head and neck. We designed a multifaceted computational analysis at the whole genome level to provide a more comprehensive perspective of the genomic landscape of metastatic CSCC. In the non-coding genome, 3′ untranslated region (3′UTR) regions of EVC (48% of specimens), PPP1R1A (48% of specimens), and ABCA4 (20% of specimens) along with the tumor-suppressing long non-coding RNA (lncRNA) LINC01003 (64% of specimens) were significantly functionally altered (Q-value < 0.05) and represent potential non-coding biomarkers of CSCC. Recurrent copy number loss in the tumor suppressor gene PTPRD was observed. Gene amplification was much less frequent, and few genes were recurrently amplified. Single nucleotide variants driver analyses from three tools confirmed TP53 and CDKN2A as recurrently mutated genes but also identified C9 as a potential novel driver in this disease. Furthermore, indel signature analysis highlighted the dominance of ID signature 13 (ID13) followed by ID8 and ID9. ID9 has previously been shown to have no association with skin melanoma, unlike ID13 and ID8, suggesting a novel pattern of indel variation in metastatic CSCC. The enrichment analysis of various genetically altered candidates shows enrichment of “TGF-beta regulation of extracellular matrix” and “cell cycle G1 to S check points.” These enriched terms are associated with genetic instability, cell proliferation, and migration as mechanisms of genomic drivers of metastatic CSCC.
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Affiliation(s)
- Amarinder Singh Thind
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Bruce Ashford
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- *Correspondence: Bruce Ashford,
| | - Dario Strbenac
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Jenny Mitchell
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Jenny Lee
- Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW, Australia
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | - Simon A. Mueller
- Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW, Australia
- Department of Otorhinolaryngology, Head and Neck Surgery, Zurich University Hospital and University of Zurich, Zurich, Switzerland
| | - Elahe Minaei
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia
| | - Jay R. Perry
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia
| | - Sydney Ch’ng
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - N. Gopalakrishna Iyer
- Department of Head and Neck Surgery, National Cancer Center, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jonathan R. Clark
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia
| | - Ruta Gupta
- Anatomical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Marie Ranson
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia
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