A retrospective study of changes in skin cancer characteristics over 11 years

Photoprotection in occupational dermatology

Skin cancer has become a substantial matter of public health and in the workplace, accounting for a significant share of all reported occupational diseases. The most important external factor in the development of skin cancer is exposure to solar ultraviolet radiation. Outdoor workers have already been identified as a high-risk category. The need for interventions to improve the sun protection behavior of outdoor workers has recently been understood. Outdoor workers' risk perceptions and attitudes toward sun protection methods are likely to influence practical sun protection behavior at work, and despite the fact that many workers have expressed interest in improving their sun protection behavior, outdoor workers' unique needs are still neglected. Occupational dermatology is predicted to become more concerned with photoprotection in the decades ahead. Preventive action against the rapidly increasing number skin cancer cases is in great demand around the globe. In terms of preventive measures, the full range of available options should be used as needed to address the current difficulties in a goal-oriented way. This will almost certainly only be achievable if preventative efforts on a collective and individual level are successfully paired with support from policymakers to inspire long-term change.

Sun protection and occupation: Current developments and perspectives for prevention of occupational skin cancer

A substantial proportion of all reported occupational illnesses are constituted by skin cancer, making this disease a serious public health issue. Solar ultra-violet radiation (UVR) exposure is the most significant external factor in the development of skin cancer, for which the broad occupational category of outdoor workers has already been identified as high-risk group. Sun protection by deploying adequate technical, organizational, and person-related measures has to be understood as a functional aspect of workplace safety. To prevent skin cancers brought on by-typically cumulative-solar UVR exposure, outdoor workers must considerably lower their occupationally acquired solar UVR doses. Estimating cumulative sun exposure in outdoor workers requires consideration of the level of solar UVR exposure, the tasks to be done in the sun, and the employees' solar UVR preventive measures. Recent studies have highlighted the necessity for measures to enhance outdoor workers' sun protection behavior. In the coming decades, occupational dermatology is expected to pay increasing attention to sun protection at work. Also, the field of dermato-oncology will likely be concerned with sky-rocketing incidences of occupational skin cancers. The complete range of available alternatives should be utilized in terms of preventive actions, which seems pivotal to handle the present and future challenges in a purposeful manner. This will almost definitely only be possible if politicians' support is effectively combined with communal and individual preventive actions in order to spur long-term transformation.

Hedgehog pathway inhibitor real-world treatment patterns in patients with basal cell carcinoma: a claims-based analysis

Aims: To examine real-world treatment patterns for Hedgehog pathway inhibitors (HHIs) for the treatment of advanced basal cell carcinoma. Patients & methods: HHI initiators between January 2013 and June 2019 were identified from IBM MarketScan^® claims data. Time to treatment discontinuation and reinitiation were estimated using Kaplan-Meier methods using a 60-day grace period. Results: Among 526 patients with basal cell carcinoma who initiated an HHI, median time to first discontinuation was 144 days, and risk of discontinuation by 12 months was 88.0%. Probability of reinitiation within 12 months was 19.7%, and median time to second discontinuation was 118 days. Conclusion: HHI discontinuation was common and reinitiation uncommon in clinical practice. Future research should evaluate persistence with recently approved therapies.

Dermatoscopically narrowed surgical margins for head and neck basal cell carcinoma: A retrospective case-control study

BACKGROUND

Basal cell carcinoma (BCC) can cause extensive tissue damage if untreated. Complete surgical excision is the treatment of choice, but especially in the head-and neck area, defining both radical and healthy skin sparing surgical margins is complex.

MATERIALS AND METHODS

Excised, small (≤ 1 cm), BCCs of the head and neck were retrospectively analyzed, comparing histological properness of surgical margins after clinical-dermatoscopical preoperative evaluation (cases), vs. clinical evaluation only (controls) and recurrences.

RESULTS

Of 281 BCCs: 6 % (8/139) of cases and 8 % (12/142) of controls had unproper deep margins; 4 % (5/139) of cases, 20 % (29/142) of controls had unproper lateral margins (P < 0.001). Surgical 3 mm lateral margins were unproper in 0 % (15/66) of cases, 15 % (10/66) of controls (P > 0.005); surgical 1-2 mm lateral margins were unproper in 7 % (5/73) of cases, 25 % (19/76) of controls (P < 0.01). Of cases excised at 3 mm, 1-2 mm, and controls, 1.5 %, 0 %, and 7.7 % recurred, respectively.

CONCLUSIONS

BCC excision at 3 mm may be appropriate in the head and neck for small, dermatoscopically well-defined and non-aggressive BCCs, attaining surgical cure rates of 100 % and 1.5 % recurrences. Excision at 1-2 mm should be reserved only for BCCs in very difficult-to-treat areas, as the surgical cure rate was only 93 %.

Dermatoskopisch kontrollierte, schmalere Resektionsränder bei Basalzellkarzinomen an Kopf und Hals: Retrospektive Fallkontrollstudie

Hintergrund: Unbehandelt kann das Basalzellkarzinom (BCC) erhebliche Gewebezerstörungen verursachen. Die komplette chirurgische Exzision ist die Behandlung der Wahl. Allerdings stellt es besonders im Gesichts- und Halsbereich eine Herausforderung dar, den Tumor vollständig zu entfernen und möglichst viel gesundes Gewebe zu erhalten. Material und Methoden: Bereits exzidierte kleine BCC (≤ 1 cm) von Kopf oder Hals wurden retrospektiv analysiert. Verglichen wurde die histologisch kontrolliert angemessene Breite des Resektionsrandes nach präoperativer dermatoskopischer Untersuchung (Fälle) im Vergleich zur rein klinischen Untersuchung (Kontrollen), sowie die Rezidivrate. Ergebnisse: Bei 281 BCC: 6 % (8/139) der Fälle und 8 % (12/142) der Kontrollen zeigten inadäquate basale Resektionsränder; 4 % (5/139) der Fälle und 20 % (29/142) der Kontrollen zeigten inadäquate laterale Resektionsränder (P < 0.001). Laterale Resektionsränder von 3 mm waren in 0 % (15/66) der Fälle, jedoch in 15 % (10/66) der Kontrollen inadäquat (P >0.005); laterale Resektionsränder von 1-2 mm waren in 7 % (5/73) der Fälle und in 25 % (19/76) der Kontrollen inadäquat (P < 0.01). Rezidive traten in den Fällen mit 3 mm Resektionsrand in 1,5 % auf, in den Fällen mit 1-2 mm Resektionsrand bei 0 %, und bei den Kontrollen bei 7,7 %. Schlussfolgerung: Für BCC im Kopf- und Halsbereich erscheint ein Resektionsrand von 3 mm angemessen, sofern das BCC klein, dermatoskopisch gut definiert und wenig aggressiv ist. Hier zeigten sich operative Heilungsraten von 100 % mit 1,5 % Rezidiven. Resektionsränder von 1-2 mm sollten nur für BCC in sehr schwierig zu behandelnden Bereichen in Betracht gezogen werden, da die Heilungsrate hier nur bei 93 % lag.

Verrucous carcinoma arising from actinic keratosis: a case report

Verrucous carcinoma (VC) is a rare subtype of squamous cell carcinoma that commonly occurs in the oral cavity. However, VC of the facial skin is relatively rare. We report a case of a 91-year-old woman with VC of the facial skin in the left zygoma area. She was diagnosed with actinic keratosis (4 × 3 cm) of the same site approximately 12 years previously, but declined further treatment. The mass was excised with a minimum of 0.4 cm from gross margins with the result of free from tumor of all margins by frozen section, allowing for primary closure after skin undermining. Basal resection was performed in the preplatysmal plane. The diagnosis of VC was confirmed by histopathological examination. Postoperatively, the wound healed without incident and with no signs of facial nerve injury. To our knowledge, this is the first reported case of VC of facial skin arising from actinic keratosis.

Beyond Nicotinamide Metabolism: Potential Role of Nicotinamide N-Methyltransferase as a Biomarker in Skin Cancers

Skin cancers (SC) collectively represent the most common type of malignancy in white populations. SC includes two main forms: malignant melanoma and non-melanoma skin cancer (NMSC). NMSC includes different subtypes, namely, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Merkel cell carcinoma (MCC), and keratoacanthoma (KA), together with the two pre-neoplastic conditions Bowen disease (BD) and actinic keratosis (AK). Both malignant melanoma and NMSC are showing an increasing incidence rate worldwide, thus representing an important challenge for health care systems, also because, with some exceptions, SC are generally characterized by an aggressive behavior and are often diagnosed late. Thus, identifying new biomarkers suitable for diagnosis, as well as for prognosis and targeted therapy is mandatory. Nicotinamide N-methyltransferase (NNMT) is an enzyme that is emerging as a crucial player in the progression of several malignancies, while its substrate, nicotinamide, is known to exert chemopreventive effects. Since there is increasing evidence regarding the involvement of this enzyme in the malignant behavior of SC, the current review aims to summarize the state of the art as concerns NNMT role in SC and to support future studies focused on exploring the diagnostic and prognostic potential of NNMT in skin malignancies and its suitability for targeted therapy.

Does reduction of the oncologic safety margin for facial basal cell carcinoma result in higher recurrence rates?

Background

Wide surgical excision is the gold standard for basal cell carcinoma (BCC) treatment. Typically, resection requires a safety margin ≥ 4 mm. We aimed to confirm BCC excisions’ cancer recurrence rate and safety on the facial region with new safety margins.

Methods

We included patients with primary BCC on the facial region who underwent wide excision with 2- or 3-mm safety margins at our institution between January 2010 and December 2018. Medical records were reviewed to confirm the epidemiology and surgical information. Recurrence was confirmed by physical examination through regular 6-month follow-up.

Results

We included 184 out of 233 patients in this study after applying the exclusion criteria. The mean age and follow-up period were 71.2±10.2 years and 29.3±13.5 months, respectively. The predominantly affected area was the nose (95 cases); a V-Y advancement flap was the most commonly used surgical method. There were two cases of recurrence in the 2 mm margin group and one recurrence in the group resected with 3 mm margins.

Conclusion

In this large cohort study, we found 2–3 mm excision margins can yield enough safety in facial BCCs. The recurrence rates were found to be comparable with those reported after wider margins.

Giant basal cell carcinoma of the left lateral neck

Basal cell carcinoma is a malignant epithelial neoplasm of the skin and the most common human skin cancer. It is generally associated with a good prognosis. In this case report, a giant basal cell carcinoma of the nodulo-ulcerative type showing wide ulceration with marginal multiple small nodules, is presented. It was trapezoidal in shape, having dimensions of 7 cm at the greatest basal width, 6 cm vertically with different anterior and posterior margin dimensions, and 5 cm horizontally at the top margin. After wide excision of the lesion including 5–10 mm safety margins, the wound was reconstructed with a local skin flap and split-thickness skin graft. The reconstructed wound healed well without recurrence for 1 year.

Oral nicotinamide: The role in skin cancer chemoprevention

The incidence of skin cancer has gradually increased in the last years and exposition to ultraviolet radiation remains the main risk factor. We performed a comprehensive review on the role of nicotinamide (NAM) in the chemoprevention of skin cancers. NAM, a water-soluble form of vitamin B3, interferes with skin carcinogenesis as it regulates immunosuppressor genes such as p53 and sirtuins and restores intracellular level of NAD+, a co-enzyme essential for energy production. Efficacy and safety of NAM was evaluated in a Phase III double-blinded control-placebo study (ONTRAC), thus demonstrating that the incidence of actinic keratoses and non-melanoma skin cancers was lower in the nicotinamide group than in placebo group. Further studies showed the efficacy of NAM also in transplanted patients and among inhabitants living in arsenic contamination areas. Despite the quick response to NAM supplementation, its intake need to be carried on chronically as the efficacy seems to vanish rapidly.