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Garbe C, Forsea AM, Amaral T, Arenberger P, Autier P, Berwick M, Boonen B, Bylaite M, Del Marmol V, Dreno B, Fargnoli MC, Geller AC, Green AC, Greinert R, Hauschild A, Harwood CA, Hoorens I, Kandolf L, Kaufmann R, Kelleners-Smeets N, Lallas A, Lebbé C, Leiter U, Lim HW, Longo C, Malvehy J, Moreno D, Pellacani G, Peris K, Robert C, Saiag P, Schadendorf D, Peter Soyer H, Stockfleth E, Stratigos A, Uhara H, Vieira R, Volkmer B, Weinstock MA, Whitaker D, Zalaudek I, Whiteman DC, Brochez L. Skin cancers are the most frequent cancers in fair-skinned populations, but we can prevent them. Eur J Cancer 2024; 204:114074. [PMID: 38691877 DOI: 10.1016/j.ejca.2024.114074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
Cancers of the skin are the most commonly occurring cancers in humans. In fair-skinned populations, up to 95% of keratinocyte skin cancers and 70-95% of cutaneous melanomas are caused by ultraviolet radiation and are thus theoretically preventable. Currently, however, there is no comprehensive global advice on practical steps to be taken to reduce the toll of skin cancer. To address this gap, an expert working group comprising clinicians and researchers from Africa, America, Asia, Australia, and Europe, together with learned societies (European Association of Dermato-Oncology, Euromelanoma, Euroskin, European Union of Medical Specialists, and the Melanoma World Society) reviewed the extant evidence and issued the following evidence-based recommendations for photoprotection as a strategy to prevent skin cancer. Fair skinned people, especially children, should minimise their exposure to ultraviolet radiation, and are advised to use protective measures when the UV index is forecast to reach 3 or higher. Protective measures include a combination of seeking shade, physical protection (e.g. clothing, hat, sunglasses), and applying broad-spectrum, SPF 30 + sunscreens to uncovered skin. Intentional exposure to solar ultraviolet radiation for the purpose of sunbathing and tanning is considered an unhealthy behaviour and should be avoided. Similarly, use of solaria and other artificial sources of ultraviolet radiation to encourage tanning should be strongly discouraged, through regulation if necessary. Primary prevention of skin cancer has a positive return on investment. We encourage policymakers to communicate these messages to the general public and promote their wider implementation.
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Affiliation(s)
- Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Ana-Maria Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | - Teresa Amaral
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Charles University Third Medical Faculty and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Philippe Autier
- International Prevention Research Institute (i-PRI), Dardilly, France
| | - Marianne Berwick
- University of New Mexico Comprehensive Cancer Centre, Albuquerque, USA
| | | | - Matilda Bylaite
- Faculty of Medicine, Centre of Dermatovenereology, Clinic of Infectious Diseases and Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dreno
- France Nantes University, Inserm 1302, INCIT, F-44000 Nantes, France
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alan C Geller
- Department of Social and Behavioural Sciences, Public Health Campus, Boston, MA, USA
| | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rüdiger Greinert
- Skin Cancer Centre, Laboratory for Molecular Cell Biology, Elbe Hospital Buxtehude, Buxtehude, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Catherine A Harwood
- Department of Dermatology, Barts Health NHS Trust and Centre for Cell Biology and Cutaneous Research Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Isabelle Hoorens
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Roland Kaufmann
- Department of Dermatology, Venerology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Dermatology, Maastricht UMC+ Comprehensive Cancer Centre, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- Université Paris Cite, AP-HP Dermato-oncology and CIC, Cancer institute APHP. Nord Paris Cité, France; INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Centre, Reggio Emilia, Italy
| | - Joseph Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - David Moreno
- Medical-&-Surgical Dermatology Service. Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Giovanni Pellacani
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Ketty Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Caroline Robert
- Department of Medical Oncology, Gustave Roussy and Paris Saclay University, Villejuif, France
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré hospital, APHP, & EA 4340 "Biomarkers in cancerology and haematooncology", UVSQ, Université Paris-Saclay, 92104 Boulogne-Billancourt, France
| | - Dirk Schadendorf
- Department of Dermatology & West German Cancer Centre, University Hospital Essen & German Cancer Consortium, Campus Essen & National Centre for tumour Diseases (NCT)-West, Campus Essen, Germany
| | - H Peter Soyer
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | | | - Alex Stratigos
- First Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Hisashi Uhara
- Department of Dermatology, Sapporo Medical University, Sapporo, Japan
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Beate Volkmer
- Skin Cancer Centre, Laboratory for Molecular Cell Biology, Elbe Hospital Buxtehude, Buxtehude, Germany
| | | | | | - Iris Zalaudek
- Department of Dermatology and Venereology of the Hospital Clinics Giuliano Isontino (ASUGI), Maggiore Hospital, Trieste, Italy
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Lieve Brochez
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
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Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, Berking C, Arenberger P, Bylaite-Bučinskiene M, Del Marmol V, Dirschka T, Dreno B, Forsea AM, Harwood CA, Hauschild A, Heerfordt IM, Kauffman R, Kelleners Smeeths N, Lallas A, Lebbe C, Leiter U, Longo C, Mijušković Ž, Pellacani G, Puig S, Saiag P, Šitum M, Stockfleth E, Salavastru C, Stratigos A, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes). J Eur Acad Dermatol Venereol 2024. [PMID: 38451047 DOI: 10.1111/jdv.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.
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Affiliation(s)
- Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endrocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - Matilda Bylaite-Bučinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany
- CentroDerm Clinic, Wuppertal, Germany
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Ida Marie Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Roland Kauffman
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners Smeeths
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP, Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Caterina Longo
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Željko Mijušković
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Susana Puig
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mirna Šitum
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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Goolamali SI, Shim TN, Purdie K, Mladkova N, Francis N, Harwood CA, Bunker CB. Is the presence of Merkel cell polyomavirus and human papillomavirus DNA in keratinocyte cancers and precancers associated with HIV status? A case-control study. Clin Exp Dermatol 2024; 49:263-266. [PMID: 37793080 DOI: 10.1093/ced/llad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
The epidemiology and potential pathogenic roles of human papillomavirus (HPV) and Merkel cell polyomavirus (MCV) in keratinocyte cancers (KCs) arising in people living with HIV (PLWH) compared with HIV-negative individuals are poorly understood. These issues were investigated by a case-control study in which the presence of MCV and HPV DNA was identified by polymerase chain reaction in microdissected formalin-fixed paraffin-embedded tissue from PLWH and HIV-negative individuals. The samples comprised 190 cutaneous and genital KCs/precancers (actinic keratoses, n = 43; cutaneous squamous cell carcinoma (cSCC) in situ, n = 24; basal cell carcinoma, n = 78; cSCC, n = 34; penile carcinoma in situ, n = 9; penile SCC, n = 2 from 104 individuals (PLWH, n = 51; HIV-negative, n = 53). Almost one-quarter of samples were positive for MCV: this was not significantly associated with either HIV status (P = 0.06) nor lesion type. Overall, 36% (16/44) of MCV-positive lesions were coinfected with HPV; this was also not associated with HIV status. These findings indicate that if these viruses do contribute to the pathogenesis of KCs, it is likely to be independent of HIV status.
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Affiliation(s)
- Sacha I Goolamali
- Dermatology Department, Chelsea and Westminster Hospital, London, UK
| | - Tang N Shim
- Dermatology Department, Chelsea and Westminster Hospital, London, UK
| | - Karin Purdie
- Blizard Institute, Queen Mary University of London, UK
| | | | | | | | - Christopher B Bunker
- Dermatology Department, Chelsea and Westminster Hospital, London, UK
- Dermatology Department, University College Hospital, London, UK
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de Jong E, Genders R, Harwood CA, Green AC, Plasmeijer EI, Proby C, Geissler E, Ferrándiz-Pulido C, Ducroux E, Euvrard S, Geusau A, Jahn-Bassler K, Borik-Heil L, Rácz E, Nägeli M, Hofbauer GFL, Piaserico S, Russo I, Mackintosh L, Borges-Costa J, Angeliki-Gkini M, Zavattaro E, Savoia P, Imko-Walszuk B, Dębska-Slizień A, Garmyn M, van Kelst S, Ricar J, Cetkovska P, Matin R, Güleç AT, Seçkin D, Anene CA, Oliveira WRP, Rademaker M, Goeman J, van Geloven N, Ruiz E, Murad F, Karn E, Schmults CD, Bouwes Bavinck JN. Cumulative incidence and risk factors for cutaneous squamous cell carcinoma metastases in organ transplant recipients: The Skin Care in Organ Transplant Patients in Europe-International Transplant Skin Cancer Collaborative metastases study, a prospective multicenter study. J Am Acad Dermatol 2024:S0190-9622(24)00157-9. [PMID: 38301923 DOI: 10.1016/j.jaad.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/23/2023] [Accepted: 01/07/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Solid organ transplant recipients (SOTRs) are believed to have an increased risk of metastatic cutaneous squamous cell carcinoma (cSCC), but reliable data are lacking regarding the precise incidence and associated risk factors. METHODS In a prospective cohort study, including 19 specialist dermatology outpatient clinics in 15 countries, patient and tumor characteristics were collected using standardized questionnaires when SOTRs presented with a new cSCC. After a minimum of 2 years of follow-up, relevant data for all SOTRs were collected. Cumulative incidence of metastases was calculated by the Aalen-Johansen estimator. Fine and Gray models were used to assess multiple risk factors for metastases. RESULTS Of 514 SOTRs who presented with 623 primary cSCCs, metastases developed in 37 with a 2-year patient-based cumulative incidence of 6.2%. Risk factors for metastases included location in the head and neck area, local recurrence, size > 2 cm, clinical ulceration, poor differentiation grade, perineural invasion, and deep invasion. A high-stage tumor that is also ulcerated showed the highest risk of metastasis, with a 2-year cumulative incidence of 46.2% (31.9%-68.4%). CONCLUSIONS SOTRs have a high risk of cSCC metastases and well-established clinical and histologic risk factors have been confirmed. High-stage, ulcerated cSCCs have the highest risk of metastasis.
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Affiliation(s)
- Estella de Jong
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - Roel Genders
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Elsemieke I Plasmeijer
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Department of Dermatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte Proby
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Edward Geissler
- Division of Experimental Surgery, Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Emilie Ducroux
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Sylvie Euvrard
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Karin Jahn-Bassler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Liliane Borik-Heil
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Emõke Rácz
- Department of Dermatology, University Medical Centre Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Mirjam Nägeli
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Günther F L Hofbauer
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Irene Russo
- Unit of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy; Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCSS, Padua, Italy
| | - Lorna Mackintosh
- Department of Dermatology, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - João Borges-Costa
- Department of Dermatology, Hospital de Santa Maria and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Maria Angeliki-Gkini
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Elisa Zavattaro
- Dermatology Unit, Departments of Translational Medicine and Health Science, University of Eastern Piedmont, Novara, Italy
| | - Paola Savoia
- Dermatology Unit, Departments of Translational Medicine and Health Science, University of Eastern Piedmont, Novara, Italy
| | - Beata Imko-Walszuk
- N Dermatology and STD Outpatient Clinic, Copernicus Medical Centre, Gdansk, Poland
| | - Alicja Dębska-Slizień
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marjan Garmyn
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie van Kelst
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Ricar
- Department of Dermatovenereology, Charles University Hospital, Pilsen, Czech Republic
| | - Petra Cetkovska
- Department of Dermatovenereology, Charles University Hospital, Pilsen, Czech Republic
| | - Rubeta Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ayşe Tülin Güleç
- Department of Dermatology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Deniz Seçkin
- Department of Dermatology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Chinedu Anthony Anene
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Centre for Cancer Biology and Therapy, School of Applied Sciences, London South Bank University, London, United Kingdom
| | | | - Marius Rademaker
- Department of Dermatology, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Jelle Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Emily Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily Karn
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Ramjee S, Mohamedthani H, Patel AU, Goiriz R, Harwood CA, Osborne RH, Cheng C, Hasan ZU. The Effect of Remote Digital Services on Health Care Inequalities Among People Under Long-Term Dermatology Follow-Up: Cross-Sectional Questionnaire Study. JMIR Dermatol 2023; 6:e48981. [PMID: 38064259 PMCID: PMC10746975 DOI: 10.2196/48981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Given the expansion of remote digital dermatology services from the National Health Service, particularly during the COVID-19 pandemic, there is a need for methods that identify patients at risk of digital exclusion to guide equitable representation in service co-design processes and tailor remote services to the needs of their patient population. OBJECTIVE This quality improvement project aims to inform the redesign of remote services to optimally support the ongoing needs of patients with chronic skin diseases, ensuring that the services are tailored to patients' digital health literacy requirements. METHODS We profiled the digital health literacy of 123 people with chronic skin conditions who require long-term surveillance in 2 specialist clinics (London, United Kingdom) using the Multidimensional Readiness and Enablement Index for Health Technology (READHY) questionnaire alongside the Optimizing Health Literacy and Access (Ophelia) process for hierarchical cluster analysis. RESULTS The cluster analysis of READHY dimensions in responding participants (n=116) revealed 7 groups with distinct digital and health literacy characteristics. High READHY scores in groups 1 (n=22, 19%) and 2 (n=20, 17.2%) represent those who are confident with managing their health and using technology, whereas the lower-scoring groups, 6 (n=4, 3.4%) and 7 (n=12, 10.3%), depended on traditional services. Groups 3 (n=27, 23.3%), 4 (n=23, 19.8%), and 5 (n=8, 6.9%) had varying digital skills, access, and engagement, highlighting a population that may benefit from a co-designed dermatology service. CONCLUSIONS By identifying patient groups with distinguishable patterns of digital access and health literacy, our method demonstrates that 63.8% (n=74) of people attending specialist clinics in our center require support in order to optimize remote follow-up or need an alternative approach. Future efforts should streamline the READHY question profile to improve its practicality and use focus groups to elicit strategies for engaging patients with digital services.
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Affiliation(s)
- Serena Ramjee
- Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
| | - Hanen Mohamedthani
- Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
| | - Aditya Umeshkumar Patel
- Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
| | - Rebeca Goiriz
- Dermatology Department, Barts Health NHS Trust, London, United Kingdom
| | - Catherine A Harwood
- Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom
- Dermatology Department, Barts Health NHS Trust, London, United Kingdom
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Zeeshaan-Ul Hasan
- Dermatology Department, Barts Health NHS Trust, London, United Kingdom
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6
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Wang J, Harwood CA, Bailey E, Bewicke-Copley F, Anene CA, Thomson J, Qamar MJ, Laban R, Nourse C, Schoenherr C, Treanor-Taylor M, Healy E, Lai C, Craig P, Moyes C, Rickaby W, Martin J, Proby C, Inman GJ, Leigh IM. Transcriptomic analysis of cutaneous squamous cell carcinoma reveals a multigene prognostic signature associated with metastasis. J Am Acad Dermatol 2023; 89:1159-1166. [PMID: 37586461 DOI: 10.1016/j.jaad.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Metastasis of cutaneous squamous cell carcinoma (cSCC) is uncommon. Current staging methods are reported to have sub-optimal performances in metastasis prediction. Accurate identification of patients with tumors at high risk of metastasis would have a significant impact on management. OBJECTIVE To develop a robust and validated gene expression profile signature for predicting primary cSCC metastatic risk using an unbiased whole transcriptome discovery-driven approach. METHODS Archival formalin-fixed paraffin-embedded primary cSCC with perilesional normal tissue from 237 immunocompetent patients (151 nonmetastasizing and 86 metastasizing) were collected retrospectively from four centers. TempO-seq was used to probe the whole transcriptome and machine learning algorithms were applied to derive predictive signatures, with a 3:1 split for training and testing datasets. RESULTS A 20-gene prognostic model was developed and validated, with an accuracy of 86.0%, sensitivity of 85.7%, specificity of 86.1%, and positive predictive value of 78.3% in the testing set, providing more stable, accurate prediction than pathological staging systems. A linear predictor was also developed, significantly correlating with metastatic risk. LIMITATIONS This was a retrospective 4-center study and larger prospective multicenter studies are now required. CONCLUSION The 20-gene signature prediction is accurate, with the potential to be incorporated into clinical workflows for cSCC.
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Affiliation(s)
- Jun Wang
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Catherine A Harwood
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Emma Bailey
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Chinedu Anthony Anene
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK; Centre for Biomedical Science Research, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - Jason Thomson
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Mah Jabeen Qamar
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Rhiannon Laban
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Craig Nourse
- Cancer Research UK Beatson Institute, Glasgow, Scotland, UK
| | | | - Mairi Treanor-Taylor
- Cancer Research UK Beatson Institute, Glasgow, Scotland, UK; School of Cancer Sciences, University of Glasgow, Scotland, UK
| | - Eugene Healy
- Dermatopharmacology, University of Southampton, Southampton General Hospital, Southampton, UK; Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chester Lai
- Dermatopharmacology, University of Southampton, Southampton General Hospital, Southampton, UK; Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Craig
- Cellular Pathology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - Colin Moyes
- Queen Elizabeth University Hospital, Glasgow, Scotland
| | | | - Joanne Martin
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Charlotte Proby
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland
| | - Gareth J Inman
- Cancer Research UK Beatson Institute, Glasgow, Scotland, UK; School of Cancer Sciences, University of Glasgow, Scotland, UK
| | - Irene M Leigh
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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7
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Cernova J, Junejo MH, Ligaj M, Hussain F, Harwood CA. Cutaneous Squamous Cell Cancer on the Waistline Associated with Saree-wearing: A Case Report and Literature Review. Acta Derm Venereol 2023; 103:adv11970. [PMID: 38014830 PMCID: PMC10695123 DOI: 10.2340/actadv.v103.11970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/03/2023] [Indexed: 11/29/2023] Open
Abstract
Abstract is missing Short communication
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Affiliation(s)
- Jeva Cernova
- Department of Dermatology, Royal London Hospital, London, UK.
| | | | - Marcin Ligaj
- Department of Histopathology, Barts Health NHS Trust, London, UK
| | - Fawad Hussain
- 3Department of Dermatology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
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8
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment-Update 2023. Eur J Cancer 2023; 193:113252. [PMID: 37708630 DOI: 10.1016/j.ejca.2023.113252] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/16/2023]
Abstract
In order to update recommendations on treatment, supportive care, education, and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV), and the European Organisation of Research and Treatment of Cancer (EORTC) was formed. Recommendations were based on an evidence-based literature review, guidelines, and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable), and distant metastatic cSCC. For common primary cSCC, the first-line treatment is surgical excision with postoperative margin assessment or micrographically controlled surgery. Achieving clear surgical margins is the most important treatment consideration for patients with cSCCs amenable to surgery. Regarding adjuvant radiotherapy for patients with high-risk localised cSCC with clear surgical margins, current evidence has not shown significant benefit for those with at least one high-risk factor. Radiotherapy should be considered as the primary treatment for non-surgical candidates/tumours. For cSCC with cytologically or histologically confirmed regional nodal metastasis, lymph node dissection is recommended. For patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiotherapy, anti-PD-1 agents are the first-line systemic treatment, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drugs Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC, include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiotherapy. Multidisciplinary board decisions are mandatory for all patients with advanced cSCC, considering the risks of toxicity, the age and frailty of patients, and co-morbidities, including immunosuppression. Patients should be engaged in informed, shared decision-making on management and be provided with the best supportive care to improve symptom management and quality of life. The frequency of follow-up visits and investigations for subsequent new cSCC depends on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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9
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention-Update 2023. Eur J Cancer 2023; 193:113251. [PMID: 37717283 DOI: 10.1016/j.ejca.2023.113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. Overall, cSCC mostly has very good prognosis after treatment, with 5-year cure rates greater than 90%. Despite the overall favourable prognosis and the proportionally rare deaths, cSCC is associated with a high total number of deaths due to its high incidence. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV) and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update recommendations on cSCC, based on current literature and expert consensus. Part 1 of the guidelines addresses the updates on classification, epidemiology, diagnosis, risk stratification, staging and prevention in immunocompetent as well as immunosuppressed patients.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital Zurich, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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10
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Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, Bataille V, Brochez L, Del Marmol V, Dummer R, Forsea AM, Gaudy-Marqueste C, Harwood CA, Hauschild A, Höller C, Kandolf L, Kellerners-Smeets NWJ, Lallas A, Leiter U, Malvehy J, Marinović B, Mijuskovic Z, Moreno-Ramirez D, Nagore E, Nathan P, Stratigos AJ, Stockfleth E, Tagliaferri L, Trakatelli M, Vieira R, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023. Eur J Cancer 2023; 192:113254. [PMID: 37604067 DOI: 10.1016/j.ejca.2023.113254] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.
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Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London SE1 7EH, UK
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Ana-Marie Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | | | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nicole W J Kellerners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands; Department of Dermatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, Croatia
| | - Zeljko Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - David Moreno-Ramirez
- Dermatology. Medicine School, University of Seville, University Hospital Virgen Macarena, Seville-Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Eggert Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
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11
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Bailey P, Ridgway RA, Cammareri P, Treanor-Taylor M, Bailey UM, Schoenherr C, Bone M, Schreyer D, Purdie K, Thomson J, Rickaby W, Jackstadt R, Campbell AD, Dimonitsas E, Stratigos AJ, Arron ST, Wang J, Blyth K, Proby CM, Harwood CA, Sansom OJ, Leigh IM, Inman GJ. Driver gene combinations dictate cutaneous squamous cell carcinoma disease continuum progression. Nat Commun 2023; 14:5211. [PMID: 37626054 PMCID: PMC10457401 DOI: 10.1038/s41467-023-40822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
The molecular basis of disease progression from UV-induced precancerous actinic keratosis (AK) to malignant invasive cutaneous squamous cell carcinoma (cSCC) and potentially lethal metastatic disease remains unclear. DNA sequencing studies have revealed a massive mutational burden but have yet to illuminate mechanisms of disease progression. Here we perform RNAseq transcriptomic profiling of 110 patient samples representing normal sun-exposed skin, AK, primary and metastatic cSCC and reveal a disease continuum from a differentiated to a progenitor-like state. This is accompanied by the orchestrated suppression of master regulators of epidermal differentiation, dynamic modulation of the epidermal differentiation complex, remodelling of the immune landscape and an increase in the preponderance of tumour specific keratinocytes. Comparative systems analysis of human cSCC coupled with the generation of genetically engineered murine models reveal that combinatorial sequential inactivation of the tumour suppressor genes Tgfbr2, Trp53, and Notch1 coupled with activation of Ras signalling progressively drives cSCC progression along a differentiated to progenitor axis. Taken together we provide a comprehensive map of the cSCC disease continuum and reveal potentially actionable events that promote and accompany disease progression.
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Affiliation(s)
- Peter Bailey
- School of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK.
- Department of Surgery, University of Heidelberg, Heidelberg, 69120, Germany.
- Section Surgical Research, University Clinic Heidelberg, Heidelberg, 69120, Germany.
| | | | - Patrizia Cammareri
- Cancer Research UK Beatson Institute, Glasgow, G61 1BD, UK
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XR, UK
| | - Mairi Treanor-Taylor
- Cancer Research UK Beatson Institute, Glasgow, G61 1BD, UK
- Edinburgh Medical School, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | | | | | - Max Bone
- School of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK
- Cancer Research UK Beatson Institute, Glasgow, G61 1BD, UK
| | - Daniel Schreyer
- School of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Karin Purdie
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, E1 1BB, UK
| | - Jason Thomson
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, E1 1BB, UK
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - William Rickaby
- St John's Institute of Dermatology, St Thomas's Hospital, London, SE1 7EP, UK
| | - Rene Jackstadt
- Cancer Research UK Beatson Institute, Glasgow, G61 1BD, UK
- German Cancer Research Centre (DKFZ), Heidelberg, 61920, Germany
| | | | - Emmanouil Dimonitsas
- 1st Department of Dermatology and Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, 16121, Greece
| | - Alexander J Stratigos
- 1st Department of Dermatology and Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, 16121, Greece
| | - Sarah T Arron
- Department of Dermatology, University of of California at San Francisco, San Francisco, CA, USA
| | - Jun Wang
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, E1 1BB, UK
| | - Karen Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK
- Cancer Research UK Beatson Institute, Glasgow, G61 1BD, UK
| | - Charlotte M Proby
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, DD1 4HN, UK
| | - Catherine A Harwood
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, E1 1BB, UK
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - Owen J Sansom
- School of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK
- Cancer Research UK Beatson Institute, Glasgow, G61 1BD, UK
| | - Irene M Leigh
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, E1 1BB, UK.
| | - Gareth J Inman
- School of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK.
- Cancer Research UK Beatson Institute, Glasgow, G61 1BD, UK.
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12
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L'Orphelin JM, Cassecuel J, Kandolf L, Harwood CA, Tookey P, Junejo MH, Hogan S, Lebbé C, Appalla Z, Kränke TM, Pellacani G, Cerasuolo D, Dujovic B, Del Marmol V, Forschner A, Garbe C, Bataille V, Ressler JM, Sollena P, Dompmartin A, Peris K, Dreno B. Cutaneous manifestations induced by check point inhibitors in 120 melanoma patients - The European MelSkinTox study. J Eur Acad Dermatol Venereol 2023. [PMID: 37042810 DOI: 10.1111/jdv.19112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/07/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Checkpoint inhibitors provide an effective approach for the melanoma treatment. They prolong lymphocyte effects, which explains the cytotoxicity underlying immune-related adverse events (IrAEs). Cutaneous IrAEs affect nearly 40% of PD-1i and 50% of CTLA4i treated patients. Severe cutaneous irAE do not often occur but could be life-threatening and may persist despite treatment discontinuation. METHODS We aim to investigate cutaneous IrAEs in a cohort of patients treated with ICI across Europe in an effort to characterize the reactions in a real-world, phase IV, post-marketing study using a follow-up questionnaire. Data since November 2016 until March 2021 were obtained from the Melskintox database, a European multicentric biobank dedicated to the follow-up of melanoma and cutaneous adverse events, supported by EADO. The dermatoses reported were pooled into 4 categories: inflammatory dermatosis, bullous diseases, drug-related eruptions and pigmentary diseases. RESULTS Inflammatory benign dermatoses (n=63) represented the most common group of reactions (52.5%), followed by drug-related eruptions (n=24, 20%), pigmentary diseases (n=23, 19.2%), and bullous diseases (n=10, 8.3%). Grade II (n=41, 34.2%) are represented by bullous pemphigoid, eczema, hypodermitis, lichenoid eruption, maculo-papular rash, pruritus, psoriasis-like rash, urticarial eruption and vitiligo. Grade III (n=18, 15.0%) are represented by bullous pemphigoid, lichenoid eruption, and rashes. Grade IV (n=2, 1.7%) is only represented by bullous disease. Most cutaneous IrAEs led to immunotherapy continuation (n=95, 88.0%). CR is associated with more severe the cutaneous irAEs. We report an average time-to-onset of 208 days and some late-onset events. CONCLUSION Our study has characterized the clinical spectrum of cutaneous irAEs, their timing and severity and their relationship with tumour response. Grade I-II cutaneous IrAE are easily managed allowing ongoing anti-cancer treatment. Severe late-onset cutaneous irAE are not uncommon. A dermatologic follow-up helps mitigate the risk of life-threatening adverse events. These findings highlight the importance of onco-dermatologic involvement in management of patients with melanoma receiving immunotherapy.
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Affiliation(s)
- J-M L'Orphelin
- Department of Dermatology, Caen-Normandie University Hospital, Caen, France
| | - J Cassecuel
- Nantes Université, Nantes - Angers INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, F-44000, Nantes, France
| | - L Kandolf
- Department of Dermatology, Medical Faculty Military Medical Academy, Crnotravska 17, 11000, Belgrade
| | - C A Harwood
- Department of Dermatology, Second Floor, South Tower, Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1 BB and Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, 4, Newark Street, E1 2AT, London
| | - P Tookey
- Department of Dermatology, Second Floor, South Tower, Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1 BB and Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, 4, Newark Street, E1 2AT, London
| | - M H Junejo
- Department of Dermatology, Second Floor, South Tower, Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1 BB and Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, 4, Newark Street, E1 2AT, London
| | - Sarah Hogan
- Department of Dermatology, Second Floor, South Tower, Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1 BB and Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, 4, Newark Street, E1 2AT, London
| | - C Lebbé
- Department of Dermatology, APHP Hôpital Saint Louis, 1 avenue Claude-Vellefaux, 75010, Paris
| | - Z Appalla
- Second Department of Dermatology, Aristotle University of Thessaloniki, Greece
| | - T-M Kränke
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A- 8036, Graz
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia via del Pozzo 71, 41124, Modena
| | - D Cerasuolo
- Biostatistics and Clinical Research Unit, Caen-Normandy University Hospital, Caen, France
| | - Branko Dujovic
- Department of Dermatology, Medical Faculty Military Medical Academy, Crnotravska 17, 11000, Belgrade
| | - V Del Marmol
- Department of Dermatology- Hôpital Erasme - Université Libre de Bruxelles - 808 route de Lennik - 1070, Bruxelles, Belgium
| | - A Forschner
- Department of Dermatology, Eberhard Karls University, Liebermeister Str. 25, 72076, Tuebingen, Germany
| | - C Garbe
- Department of Dermatology, Eberhard Karls University, Liebermeister Str. 25, 72076, Tuebingen, Germany
| | - V Bataille
- Department of Dermatology, Hemel Hempstead Hospital NHS, Hillfield Rd, HP2 4AD, London
| | - J M Ressler
- Department of Dermatology, Medical University of Vienna, Waehringerguertel 18-20, A-1090, Vienna
| | - P Sollena
- Department of Medical Science, Dermatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo a Gemelli 8, 00168, Rome, Italy
| | - A Dompmartin
- Department of Dermatology, Caen-Normandie University Hospital, Caen, France
| | - K Peris
- Department of Medical Science, Dermatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo a Gemelli 8, 00168, Rome, Italy
- Department of Dermatology, Catholic University of Rome, Largo F. Vito 1, 00168, Rome, Italy
| | - B Dreno
- Nantes Université, Nantes - Angers INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, F-44000, Nantes, France
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13
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van Bodegraven B, Vernon S, Eversfield C, Board R, Craig P, Gran S, Harwood CA, Keohane S, Levell NJ, Matin RN, Proby C, Rajan N, Rous B, Ascott A, Millington GWM, Venables ZC. "Get Data Out" Skin: national cancer registry incidence and survival rates for all registered skin tumour groups for 2013-2019 in England. Br J Dermatol 2023; 188:777-784. [PMID: 36814132 DOI: 10.1093/bjd/ljad033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Providing detailed skin cancer statistics, including incidence and survival, by tumour type and patient characteristics is important for up-to-date epidemiological information. OBJECTIVES To create a new clinically relevant consensus-based classification for registered skin tumours using tumour type and patient characteristics and to describe its application to all registered English tumours between 2013-19. METHOD Tumours with skin topographical codes (ICD-10) and morphology and behaviour (ICD-O3) were grouped together in an iterative process creating a hierarchical tree structure. The primary level grouping partitioned skin tumours into skin cancer, melanoma-in-situ, extramammary Paget disease and tumours of uncertain malignant potential. Second level groups split skin cancer into keratinocyte cancer (KC), melanoma and rare cancers. Third level split KC into basal cell carcinoma (BCC) and squamous cell carcinoma (cSCC). Further groups were split into genital or non-genital, first or subsequent, age, gender, stage, or NHS (National Health Service) region. Incidence counts, Kaplan-Meier and net-survival estimates and referral routes (two-week wait (TWW), general practitioner (GP), outpatient) categorisations were calculated for each grouping across all years. RESULTS 1,445,377 skin cancers and 49,123 precancerous lesions and undefined entities were registered in England between 2013-19. Skin tumours and skin cancer incidence rates are increasing for most tumour types. The most common type of skin cancer was BCC with an incidence rate of 282.36 per 100,000 person-years (PY) (95% confidence interval (CI): 280.98 - 283.76, n=158,934) in 2019, followed by cSCC with 85.24 per 100,000 PY (95% CI: 84.48 - 86.00, n=47,977) and melanoma with 27.24 (95% CI: 26.81 - 27.67, n= 15,332) per 100,000 PY. Each year approximately 1,800 rare skin cancers, 1,500 genital cSCC and 100 extramammary Paget disease are registered. Of 15,000 melanoma there are 120 cases of melanoma in under 25s yearly.1-year and 5-year overall net survival varies by tumour type. cSCC 5-year net survival (89.8% (95% CI: 88.8 - 90.9)) was comparable to the net survival of all melanoma's (89.6% (95% CI: 88.7 -90.6)). BCC had excellent survival (overall net survival >100%). Patients with late-stage melanoma, Merkel cell carcinoma and genital cSCC have a 5-year net survival below 60%. Older patients received fewer TWW referrals than their young counterparts with the same tumour type at the same location. Patients with acral lentiginous melanoma had fewer TWW referrals and more standard GP referrals than patients with common melanomas. CONCLUSION GDO (Get Data Out) skin provides detailed and up-to-date statistics on all registrable skin tumours in England, including for the first time pre-cancerous lesions and rare subtypes of common cancers. These data can be used by clinicians, researchers and commissioners to better understand skin cancer and improve resource allocation.
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Affiliation(s)
- Birgitta van Bodegraven
- British Association of Dermatologists, London, UK.,National Disease Registration Service, Data and Analytics, NHS England, UK
| | - Sally Vernon
- National Disease Registration Service, Data and Analytics, NHS England, UK
| | | | - Ruth Board
- Department of Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Paul Craig
- Department of Cellular Pathology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Sonia Gran
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen Keohane
- Department of Dermatology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Nick J Levell
- Norwich Medical School, University of East Anglia, Norwich, UK.,Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Rubeta N Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charlotte Proby
- Department of Dermatology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Neil Rajan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Brian Rous
- National Disease Registration Service, Data and Analytics, NHS England, UK
| | - Anna Ascott
- Department of Dermatology, University Hospitals Sussex, Worthing, UK
| | - George W M Millington
- Norwich Medical School, University of East Anglia, Norwich, UK.,Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Zoe C Venables
- National Disease Registration Service, Data and Analytics, NHS England, UK.,Norwich Medical School, University of East Anglia, Norwich, UK.,Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
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14
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Winn RT, Gazzani P, Venables ZC, Shah F, Gkini M, Jeetle S, Oliphant T, Wijesuriya N, Martin-Clavijo A, Husain A, Harwood CA, Rajan N. Variation in management of porocarcinoma: a 10-year retrospective review of 75 cases across three UK tertiary centres. Clin Exp Dermatol 2023; 48:121-124. [PMID: 36730509 DOI: 10.1093/ced/llac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- R T Winn
- Departments of Dermatology and Histopathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P Gazzani
- Departments of Pathology, University Hospitals Birmingham, UK.,Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Z C Venables
- Norwich Medical School, University of East Anglia, Norwich, UK.,National Disease Registration Service and NHS Digital, Leeds, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - F Shah
- Departments of Pathology, University Hospitals Birmingham, UK
| | - M Gkini
- Departments of Dermatology and Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Departments of Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Jeetle
- Departments of Histopathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - T Oliphant
- Departments of Dermatology and Histopathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - N Wijesuriya
- Departments of Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - A Husain
- Departments of Histopathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK.,Departments of Dermatology and Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - N Rajan
- Departments of Dermatology and Histopathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Departments of Dermatology and Pathology, University Hospitals Birmingham, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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15
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Junejo MH, Demirel S, Matin R, Proby C, Harwood CA. CorrespondenceShort shock or slow burn? Patient perspectives on treatment of actinic keratoses with 5-fluorouracil 5% cream monotherapy versus 5-fluorouracil plus calcipotriol combination therapy. Clin Exp Dermatol 2023; 48:31-32. [PMID: 36669179 DOI: 10.1093/ced/llac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/13/2022] [Indexed: 01/21/2023]
Affiliation(s)
| | - Sibel Demirel
- Department of Dermatology, Ninewells Hospital, Dundee, UK
| | - Rubeta Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, London, UK
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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16
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Kawsar A, Edwards C, Patel P, Heywood RM, Gupta A, Mann J, Harland C, Heelan K, Larkin J, Lorigan P, Harwood CA, Matin RN, Fearfield L. Checkpoint inhibitor-associated bullous cutaneous immune-related adverse events: a multicentre observational study. Br J Dermatol 2022; 187:981-987. [PMID: 35976170 DOI: 10.1111/bjd.21836] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Checkpoint inhibitor (CPI) therapy has significantly improved overall survival in several cancers including metastatic melanoma (MM) and in the adjuvant setting. Cutaneous immune-related adverse events (irAEs) secondary to CPIs are commonly observed; however, autoimmune blistering disorders such as bullous pemphigoid (BP) are rare. OBJECTIVES To review the prevalence, incidence risk, clinicopathological features and management of toxicity in bullous cutaneous irAEs associated with CPI therapy. METHODS A multicentre, retrospective, observational study of CPI-associated bullous irAEs in adults with all cancers across four UK specialist centres between 2006 and 2019. RESULTS In total, 7391 patients were identified. CPI-associated bullous irAEs including BP (n = 16) occurred in 0·3% (n = 22). The median age of onset was 76 years, and there was a male predominance. Most patients had cutaneous melanoma (73%, n = 16), of which 81% (13 of 16) were BRAF wildtype. Grade 1, 2, 3 and 4 skin toxicity occurred in 9%, 45%, 41% and 5%, respectively. The mucosae were involved in 27%, and 25% of confirmed cases of BP did not present with bullae. The median time to onset of bullous irAEs was 12 months, with a median total symptom duration of 6 months. Single PD-1/PD-L1 agents had a longer time to onset of symptoms than combination therapy (median 12 vs. 7 months, respectively). Overall, 91%, 64% and 9% of patients required one, two or three lines of treatment, respectively. Two cases occurred after completion of CPIs (1 and 3 months). Of the 20 cases that presented while on CPIs this was permanently discontinued in 55% (11 of 20) and temporarily held in 20% (four of 20). In the four held cases of CPI, bullous eruption reflared in 50%. CONCLUSIONS CPI-associated bullous skin toxicity is a rare cutaneous irAE occurring in approximately 0·3% of cases over 13 years of treated patients in this series. Not all cases are diagnostic of BP, but management remains the same. There is a prolonged latency of onset compared with other cutaneous irAEs, with a median time of 12 months, and they can occur after cessation of therapy. Discontinuation of CPIs may be required. Recognizing bullous irAEs promptly and referral to dermatology are essential to optimize management and improve patient outcomes and tumour responses. What is already known about this topic? Checkpoint inhibitor (CPI)-associated bullous pemphigoid is a rare dermatological immune-related adverse event (irAE) that has been reported in small case series and reports. What does this study add? This is the largest multicentre, observational study conducted in the UK over the longest period of 13 years, which demonstrates an overall incidence of bullous cutaneous irAEs secondary to CPIs of 0·3%. Clinical presentation is variable, with one-quarter of patients with bullous pemphigoid presenting without bullae, and mucosal involvement was noted in 27%. Prolonged pruritus is frequently a prodromal symptom. The median time to diagnosis is 12 months and irAEs rarely present after cessation of treatment. Time to onset of symptoms is longer with a single CPI, but with a shorter duration of symptoms compared with combination CPI therapy. Most patients had cutaneous melanoma, of which 81% were BRAF wildtype.
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Affiliation(s)
- Anusuya Kawsar
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Dermatology, The Royal Marsden Hospital NHS Foundation Trust, London, UK.,Department of Dermatology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Charlotte Edwards
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Dermatology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Pooja Patel
- Department of Dermatology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Richard M Heywood
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Aakriti Gupta
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jasmine Mann
- Department of Dermatology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Christopher Harland
- Department of Dermatology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Kara Heelan
- Department of Dermatology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - James Larkin
- Department of Dermatology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Paul Lorigan
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Catherine A Harwood
- Department of Dermatology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Rubeta N Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Louise Fearfield
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Dermatology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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17
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Bottomley MJ, Massey PR, Thuraisingham R, Doyle A, Rao S, Bibee KP, Bouwes Bavinck JN, Jambusaria-Pahlajani A, Harwood CA. Interventions After First Post-Transplant Cutaneous Squamous Cell Carcinoma: A Proposed Decision Framework. Transpl Int 2022; 35:10880. [PMID: 36484063 PMCID: PMC9722441 DOI: 10.3389/ti.2022.10880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
Cutaneous squamous cell carcinoma (CSCC) is a major cause of morbidity and mortality after organ transplant. Many patients subsequently develop multiple CSCC following a first CSCC, and the risk of metastasis and death is significantly increased compared to the general population. Post-transplant CSCC represents a disease at the interface of dermatology and transplant medicine. Both systemic chemoprevention and modulation of immunosuppression are frequently employed in patients with multiple CSCC, yet there is little consensus on their use after first CSCC to reduce risk of subsequent tumors. While relatively few controlled trials have been undertaken, extrapolation of observational data suggests the most effective interventions may be at the time of first CSCC. We review the need for intervention after a first post-transplant CSCC and evidence for use of various approaches as secondary prevention, before discussing barriers preventing engagement with this approach and finally highlight areas for future research. Close collaboration between specialties to ensure prompt deployment of these interventions after a first CSCC may improve patient outcomes.
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Affiliation(s)
- Matthew J. Bottomley
- Chinese Academy of Medical Sciences Oxford Institute (CAMS-COI), Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,Oxford Transplant Unit, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom,*Correspondence: Matthew J. Bottomley,
| | | | - Raj Thuraisingham
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, United Kingdom
| | - Alden Doyle
- Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Swati Rao
- Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Kristin P. Bibee
- Department of Dermatology, School of Medicine, John Hopkins University, Baltimore, MD, United States
| | | | - Anokhi Jambusaria-Pahlajani
- Division of Dermatology, Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Catherine A. Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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18
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Hasan Z, Ahmed I, Matin RN, Homer V, Lear JT, Ismail F, Whitmarsh T, Green AC, Thomson J, Milligan A, Hogan S, Van‐de‐Velde V, Mitchell‐Worsford L, Kentley J, Gaunt C, Jefferson‐Hulme Y, Bowden SJ, Gaunt P, Wheatley K, Proby CM, Harwood CA. Topical treatment of actinic keratoses in organ transplant recipients: a feasibility study for SPOT (Squamous cell carcinoma Prevention in Organ transplant recipients using Topical treatments). Br J Dermatol 2022; 187:324-337. [PMID: 34988975 PMCID: PMC9543168 DOI: 10.1111/bjd.20974] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/14/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk of cutaneous squamous cell carcinoma (cSCC) is significantly increased in organ transplant recipients (OTRs). Clearance of actinic keratoses (AKs) is generally regarded as a surrogate biomarker for cSCC prevention. OTR-cSCC chemoprevention with topical AK treatments has not been investigated in randomized controlled trials (RCTs), although there is evidence that 5% 5-fluorouracil (5-FU) may be chemoprotective in immunocompetent patients. OBJECTIVES To assess the feasibility, activity and evaluation outcomes relevant to the design of a future phase III RCT of topical cSCC chemoprevention in OTRs. METHODS OTRs with 10 or more AKs in predefined areas were randomized 1 : 1 : 1 to topical 5-FU, 5% imiquimod (IMIQ) or sunscreen (sun-protective factor 30+) in a phase II, open-label RCT over 15 months. Feasibility outcomes included proportions of eligible OTRs randomized, completing treatment and willing to be re-treated. AK activity [AK clearance, new AK development, patient-centred outcomes (toxicity, health-related quality of life, HRQoL)] and evaluation methodology (clinical vs. photographic) were assessed. RESULTS Forty OTRs with 903 AKs were randomized. All feasibility outcomes were met (56% of eligible OTRs were randomized; 89% completed treatment; 81% were willing to be re-treated). AK activity analyses found 5-FU and IMIQ were superior to sunscreen for AK clearance and prevention of new AKs. 5-FU was more effective than IMIQ in AK clearance and prevention in exploratory analyses. Although toxicity was greater with 5-FU, HRQoL outcomes were similar. CONCLUSIONS Trials of topical AK treatments in OTRs for cSCC chemoprevention are feasible and AK activity results support further investigation of 5-FU-based treatments in future phase III trials. What is already known about this topic? Cutaneous squamous cell carcinoma (cSCC) is significantly more common in immunocompromised individuals including organ transplant recipients (OTRs) compared with immunocompetent populations. cSCC chemoprevention activity of sunscreen and 5-fluorouracil-based (5-FU) actinic keratosis (AK) treatments has been demonstrated in randomized controlled trials (RCTs) in immunocompetent populations but not in OTRs. AKs are cSCC precursors and their clearance and prevention are generally regarded as surrogate endpoint biomarkers for potential cSCC chemoprevention activity. What does this study add? SPOT (SCC Prevention in OTRs using Topical treatments) has confirmed that RCTs of OTR-cSCC chemoprevention with topical AK treatments are feasible. It also suggests that topical 5-FU may be superior to 5% imiquimod and sunscreen in AK clearance and prevention. Together with recent evidence from several RCTs in the general population, these data provide a compelling rationale for further studies of intervention with 5-FU-based topical chemoprevention approaches in OTR-cSCC prevention.
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Affiliation(s)
| | - Ikhlaaq Ahmed
- Cancer Research UK Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | - Rubeta N. Matin
- Department of DermatologyChurchill Hospital, Oxford University Hospital NHS Foundation TrustOxfordUK
| | - Victoria Homer
- Cancer Research UK Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | - John T. Lear
- Department of DermatologySalford Royal NHS Foundation Trust, Salford, UK and Manchester Academic Science Centre, Manchester UniversityUK
| | | | - Tristan Whitmarsh
- Institute of AstronomyUniversity of CambridgeMadingley RoadCambridgeUK
| | | | - Jason Thomson
- Department of DermatologyBarts Health NHS TrustLondonUK
| | | | - Sarah Hogan
- Department of DermatologyBarts Health NHS TrustLondonUK
| | | | | | | | - Claire Gaunt
- Cancer Research UK Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | | | - Sarah J. Bowden
- Cancer Research UK Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | - Piers Gaunt
- Cancer Research UK Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials UnitUniversity of BirminghamBirminghamUK
| | | | - Catherine A. Harwood
- Department of DermatologyBarts Health NHS TrustLondonUK
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Queen Mary University of LondonUK
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Chikh A, Sanzà P, Raimondi C, Akinduro O, Warnes G, Chiorino G, Byrne C, Harwood CA, Bergamaschi D. Retraction: iASPP is a novel autophagy inhibitor in keratinocytes. J Cell Sci 2022; 135:276064. [PMID: 35876107 DOI: 10.1242/jcs.259757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Nwolise C, Rembielak A, Fitzpatrick R, Jenkinson C, Marsden J, Fairbrother P, Proby CM, Harwood CA, Matin RN. Adjuvant radiotherapy in patients with high-risk cutaneous Squamous Cell Carcinoma After surgery (SCC-AFTER): Patient and carer views regarding a proposed clinical trial. Clin Exp Dermatol 2022; 47:1875-1876. [PMID: 35722934 DOI: 10.1111/ced.15300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Chidiebere Nwolise
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Agata Rembielak
- Clinical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
| | | | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jerry Marsden
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Charlotte M Proby
- Division of Molecular and Clinical Medicine, Ninewells Hospital & Medical School, University of Dundee, UK
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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22
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Schlessinger DI, Reynolds KA, Dirr MA, Ibrahim SA, Yanes AF, Lazaroff JM, Godinez-Puig V, Chen BR, Kurta AO, Cotseones JK, Chiren SG, Furlan KC, Iyengar S, Behshad R, DeHoratius DM, Denes P, Drucker AM, Dzubow LM, Etzkorn JR, Harwood CA, Kim JYS, Lawrence N, Lee EH, Lissner GS, Marghoob AA, Matin RN, Mattox AR, Mittal BB, Thomas JR, Zhou XA, Zloty D, Schmitt J, Kirkham JJ, Armstrong AW, Basset-Seguin N, Billingsley EM, Bordeaux JS, Brewer J, Brown M, Brown M, Collins SAB, Fargnoli MC, De Azevedo SJ, Dummer R, Eggermont A, Goldman GD, Haedersdal M, Hale E, Hanlon A, Harms KL, Huang CC, Hurst EA, In GK, Kelleners-Smeets N, Kheterpal M, Leshin B, Mcdonald M, Miller SJ, Miller A, Mostow EN, Trakatelli M, Nehal KS, Ratner D, Rogers H, Sarin KY, Soon SL, Stasko T, Storrs PA, Tagliaferri L, Vidimos AT, Wong SL, Yu SS, Zalaudek I, Zeitouni NC, Zitelli JA, Poon E, Sobanko JF, Cartee TV, Maher IA, Alam M. Development of a Core Outcome Set for Basal Cell Carcinoma (BCC), Including Low-Risk and Advanced Tumors. J Am Acad Dermatol 2022; 87:573-581. [PMID: 35551965 DOI: 10.1016/j.jaad.2022.04.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/18/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is variation in the outcomes reported in clinical studies of basal cell carcinoma (BCC). This can prevent effective meta-analyses to answer important clinical questions. OBJECTIVE To identify a recommended minimum set of core outcomes for BCC clinical trials. METHODS Patient and professional Delphi process to cull a long-list, culminating in a consensus meeting. To be provisionally accepted, outcomes needed to be deemed 'important' (score: 7-9, of maximum of 9) by 70% of each stakeholder group. RESULTS 235 candidate outcomes identified via a systematic literature review and survey of key stakeholders were reduced to 74 that were rated by 100 health care professionals and patients in two Delphi rounds. 27 outcomes were provisionally accepted. The final core set of 5 agreed-upon outcomes after the consensus meeting was: complete response; persistent or serious adverse events; recurrence-free survival; quality of life; and patient satisfaction, including with cosmetic outcome. LIMITATIONS English-speaking patients and professionals rated outcomes extracted from English-language studies. CONCLUSIONS A core outcome set (COS) for basal cell carcinoma has been developed. Use of relevant measures may improve the utility of clinical research and the quality of therapeutic guidance available to clinicians.
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Affiliation(s)
- Daniel I Schlessinger
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kelly A Reynolds
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; University of Cincinnati College of Medicine, Cincinnati, OH
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Arianna F Yanes
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jake M Lazaroff
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Victoria Godinez-Puig
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brian R Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Jill K Cotseones
- Medical & Cosmetic Dermatology Service, Northwestern Medicine Regional Medical Group, Naperville, IL
| | - Sarah G Chiren
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karina C Furlan
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Sanjana Iyengar
- Department of Dermatology, West Virginia University, Morgantown, WV
| | - Ramona Behshad
- Department of Dermatology, Saint Louis University, St. Louis, MO
| | - Danielle M DeHoratius
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pablo Denes
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Dermatology, Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Jeremy R Etzkorn
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK; Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Naomi Lawrence
- Division of Dermatologic Surgery, Department of Dermatology, Cooper University Hospital, Camden, NJ
| | - Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gary S Lissner
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Ashfaq A Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Rubeta N Matin
- Department of Dermatology, Churchill Hospital, Oxford, UK
| | - Adam R Mattox
- Department of Dermatology, University of Minnesota, Minneapolis, MN
| | - Bharat B Mittal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - J Regan Thomas
- Department of Otolaryngology- Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Xiaolong Alan Zhou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David Zloty
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, Medical Faculty, Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jamie J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - April W Armstrong
- Keck School of Medicine, Department of Dermatology, University of Southern California Los Angeles
| | | | | | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, OH, USA
| | | | - Marc Brown
- Professor of Dermatology and Oncology; University of Rochester, MN, USA
| | - Mariah Brown
- Department of Dermatology, University of Colorado Hospital and School of Medicine
| | | | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Sergio Jobim De Azevedo
- Professor, Department of Medicine, Chief of Medical Oncology at Hospital de Clinicas de Porto Alegre, Brazil
| | - Reinhard Dummer
- University Hospital, Skin Cancer Center, Zurich, Switzerland
| | | | | | - Merete Haedersdal
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | | | | | - Kelly L Harms
- Department of Dermatology, the Comprehensive Cancer Center University of Michigan Medical School, Ann Arbor
| | - Conway C Huang
- Department of Dermatology, University of Alabama at Birmingham, AL, USA
| | - Eva A Hurst
- Distinctive Dermatology, Fairview Heights, IL, USA
| | - Gino K In
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | | | | | | | | | | | - Eliot N Mostow
- Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
| | - Myrto Trakatelli
- Associate Professor of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | - Kishwer S Nehal
- Attending Physician, Memorial Sloan Kettering Cancer Center; Director, Mohs and Dermatological Surgery; Professor of Dermatology, Weill Cornell Medical College, NY, USA
| | | | | | | | | | - Thomas Stasko
- Professor and Chair, The University of Oklahoma Department of Dermatology, OK, USA
| | - Paul A Storrs
- University of Illinois Chicago, Department of Dermatology, IL, USA
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Italy
| | | | | | - Siegrid S Yu
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Iris Zalaudek
- Department of Dermatology and Venereology, University of Trieste, Italy
| | | | - John A Zitelli
- Clinical Associate Professor of Dermatology, Otolaryngology, Plastic Surgery, University of Pittsburgh Medical Center, PA, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Joseph F Sobanko
- Department of Dermatology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; Division of Dermatologic Surgery, Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Todd V Cartee
- Department of Dermatology, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, MN
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Otolaryngology- Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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23
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Hudson RDA, Ameen M, George SMC, Harwood CA, Weller RB, Lear JT, Rout R, Surendranathan T, Petrovic M, Bewley AP. A Real-World Data Study on the Healthcare Resource Use for Uncontrolled Moderate-to-Severe Atopic Dermatitis in Secondary Care in the United Kingdom Prior to the Introduction of Biologic Treatment. CEOR 2022; 14:167-177. [PMID: 35399649 PMCID: PMC8992740 DOI: 10.2147/ceor.s333847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Whilst there is international evidence around the high healthcare resource utilization (HRU) associated with atopic dermatitis (AD), there is a lack of published data from the United Kingdom (UK). Methods A retrospective, descriptive, observational study was conducted to evaluate the burden of moderate-to-severe AD on the National Health Service (NHS) in an adult UK population treated with traditional standard of care prior to the introduction of biologics. Patients (n=59) were recruited from 6 UK NHS Hospital Trusts and observed over three years. Results 707 dermatology clinic visits were recorded over the observation period, amounting to 6.6 visits per patient-year, most commonly for routine check-ups most of which involved dermatology consultants (n=469, 66%). Physicians were the most consulted healthcare professional (n=652, 92%); emollients were the most common treatment (n=80 courses). 174 flares requiring additional medical advice were recorded in total (1.6 per patient-year). Discussion/Conclusions Complex treatment pathways for adult patients in the UK with moderate-to-severe AD incur considerable HRU, particularly for those patients non-responsive to systemic therapies with broad immunosuppressant action. Recent advances in biologics-based AD management could possibly have a significant positive impact on HRU through significant reduction in the number of NHS touch points identified in this study.
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Affiliation(s)
- Richard D A Hudson
- Sanofi, Berkshire, UK
- Correspondence: Richard DA Hudson, Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, RG6 1PT, UK, Email
| | | | | | | | - Richard B Weller
- NHS Lothian, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - John T Lear
- Salford Royal NHS Foundation Trust, Salford, UK
- Manchester Academic Health Science Centre, Manchester University, Manchester, UK
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Anene CA, Taggart E, Harwood CA, Pennington DJ, Wang J. Decosus: An R Framework for Universal Integration of Cell Proportion Estimation Methods. Front Genet 2022; 13:802838. [PMID: 35432466 PMCID: PMC9011041 DOI: 10.3389/fgene.2022.802838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/04/2022] [Indexed: 12/26/2022] Open
Abstract
The assessment of the cellular heterogeneity and abundance in bulk tissue samples is essential for characterising cellular and organismal states. Computational approaches to estimate cellular abundance from bulk RNA-Seq datasets have variable performances, often requiring benchmarking matrices to select the best performing methods for individual studies. However, such benchmarking investigations are difficult to perform and assess in typical applications because of the absence of gold standard/ground-truth cellular measurements. Here we describe Decosus, an R package that integrates seven methods and signatures for deconvoluting cell types from gene expression profiles (GEP). Benchmark analysis on a range of datasets with ground-truth measurements revealed that our integrated estimates consistently exhibited stable performances across datasets than individual methods and signatures. We further applied Decosus to characterise the immune compartment of skin samples in different settings, confirming the well-established Th1 and Th2 polarisation in psoriasis and atopic dermatitis, respectively. Secondly, we revealed immune system-related UV-induced changes in sun-exposed skin. Furthermore, a significant motivation in the design of Decosus is flexibility and the ability for the user to include new gene signatures, algorithms, and integration methods at run time.
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Affiliation(s)
- Chinedu A. Anene
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- Centre for Cancer Biology and Therapy, School of Applied Science, London South Bank University, London, United Kingdom
- *Correspondence: Chinedu A. Anene,
| | - Emma Taggart
- Centre for Immunobiology, Barts and the London School of Medicine, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Catherine A. Harwood
- Centre for Cell Biology and Cutaneous Research, Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, United Kingdom
- Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Daniel J. Pennington
- Centre for Immunobiology, Barts and the London School of Medicine, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Jun Wang
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Massey PR, Schmults CD, Li SJ, Arron ST, Asgari MM, Bavinck JNB, Billingsley E, Blalock TW, Blasdale K, Carroll BT, Carucci JA, Chong AH, Christensen SR, Chung CL, DeSimone JA, Ducroux E, Escutia-Muñoz B, Ferrándiz-Pulido C, Fox MC, Genders RE, Geusau A, Gjersvik P, Hanlon AM, Harken EBO, Hofbauer GF, Hopkins RS, Leitenberger JJ, Loss MJ, Del Marmol V, Mascaró JM, Myers SA, Nguyen BT, Oliveira WRP, Otley CC, Proby CM, Rácz E, Ruiz-Salas V, Samie FH, Seçkin D, Shah SN, Shin TM, Shumack SP, Soon SL, Stasko T, Zavattaro E, Zeitouni NC, Zwald FO, Harwood CA, Jambusaria-Pahlajani A. Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement. JAMA Dermatol 2021; 157:1219-1226. [PMID: 34468690 PMCID: PMC9937447 DOI: 10.1001/jamadermatol.2021.3180] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.
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Affiliation(s)
- Paul R. Massey
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D. Schmults
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah T. Arron
- Sarah Arron MD, A Professional Corporation, San Mateo, California
| | - Maryam M. Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston,Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | | | | | - Travis W. Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Katie Blasdale
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Bryan T. Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - John A. Carucci
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Alvin H. Chong
- Skin Health Institute, Victoria, Australia,Department of Medicine (Dermatology), St Vincent’s Hospital Clinical School, The University of Melbourne, Victoria, Australia
| | - Sean R. Christensen
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Christina Lee Chung
- Montgomery Dermatology, King of Prussia, Pennsylvania,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | - Emilie Ducroux
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | | | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matthew C. Fox
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin
| | - Roel E. Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Petter Gjersvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Allison M. Hanlon
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee
| | | | | | - R. Samuel Hopkins
- Department of Dermatology, Oregon Health and Science University, Portland
| | | | - Manisha J. Loss
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Veronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - José M. Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sarah A. Myers
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Bichchau T. Nguyen
- Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts,Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Walmar R. P. Oliveira
- Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clark C. Otley
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Charlotte M. Proby
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Emőke Rácz
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Veronica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Faramarz H. Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Deniz Seçkin
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Syed N. Shah
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Thuzar M. Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | - Seaver L. Soon
- Scripps Green Hospital, Private Practice (The Skin Clinic MD), San Diego, California
| | - Thomas Stasko
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Elisa Zavattaro
- Dermatology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Nathalie C. Zeitouni
- Medical Dermatology Specialists, Phoenix, Arizona,Division of Dermatology, University of Arizona College of Medicine, Phoenix
| | - Fiona O’Reilly Zwald
- Piedmont Healthcare, Atlanta, Georgia,O’Reilly Comprehensive Dermatology Inc, Atlanta, Georgia,Mount Vernon Medical Center, Atlanta, Georgia
| | - Catherine A. Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, United Kingdom,The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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26
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Polubothu S, Zecchin D, Al-Olabi L, Lionarons DA, Harland M, Horswell S, Thomas AC, Hunt L, Wlodarchak N, Aguilera P, Brand S, Bryant D, Carrera C, Chen H, Elgar G, Harwood CA, Howell M, Larue L, Loughlin S, MacDonald J, Malvehy J, Barberan SM, da Silva VM, Molina M, Morrogh D, Moulding D, Nsengimana J, Pittman A, Puig-Butillé JA, Parmar K, Sebire NJ, Scherer S, Stadnik P, Stanier P, Tell G, Waelchli R, Zarrei M, Puig S, Bataille V, Xing Y, Healy E, Moore GE, Di WL, Newton-Bishop J, Downward J, Kinsler VA. Inherited duplications of PPP2R3B predispose to nevi and melanoma via a C21orf91-driven proliferative phenotype. Genet Med 2021; 23:1636-1647. [PMID: 34145395 PMCID: PMC8460442 DOI: 10.1038/s41436-021-01204-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Much of the heredity of melanoma remains unexplained. We sought predisposing germline copy-number variants using a rare disease approach. METHODS Whole-genome copy-number findings in patients with melanoma predisposition syndrome congenital melanocytic nevus were extrapolated to a sporadic melanoma cohort. Functional effects of duplications in PPP2R3B were investigated using immunohistochemistry, transcriptomics, and stable inducible cellular models, themselves characterized using RNAseq, quantitative real-time polymerase chain reaction (qRT-PCR), reverse phase protein arrays, immunoblotting, RNA interference, immunocytochemistry, proliferation, and migration assays. RESULTS We identify here a previously unreported genetic susceptibility to melanoma and melanocytic nevi, familial duplications of gene PPP2R3B. This encodes PR70, a regulatory unit of critical phosphatase PP2A. Duplications increase expression of PR70 in human nevus, and increased expression in melanoma tissue correlates with survival via a nonimmunological mechanism. PPP2R3B overexpression induces pigment cell switching toward proliferation and away from migration. Importantly, this is independent of the known microphthalmia-associated transcription factor (MITF)-controlled switch, instead driven by C21orf91. Finally, C21orf91 is demonstrated to be downstream of MITF as well as PR70. CONCLUSION This work confirms the power of a rare disease approach, identifying a previously unreported copy-number change predisposing to melanocytic neoplasia, and discovers C21orf91 as a potentially targetable hub in the control of phenotype switching.
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Affiliation(s)
- Satyamaanasa Polubothu
- Mosaicism and Precision Medicine Laboratory, Francis Crick Institute, London, UK
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - Davide Zecchin
- Mosaicism and Precision Medicine Laboratory, Francis Crick Institute, London, UK
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Lara Al-Olabi
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | | | - Mark Harland
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, Cancer Research UK Clinical Centre at Leeds, St James's University Hospital, Leeds, UK
| | - Stuart Horswell
- Bioinformatics and Biostatistics, Francis Crick Institute, London, UK
| | - Anna C Thomas
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Lilian Hunt
- Advanced Sequencing Facility, Francis Crick Institute, London, UK
| | - Nathan Wlodarchak
- McArdle Laboratory, Department of Oncology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Paula Aguilera
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Sarah Brand
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Dale Bryant
- Mosaicism and Precision Medicine Laboratory, Francis Crick Institute, London, UK
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Cristina Carrera
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Hui Chen
- McArdle Laboratory, Department of Oncology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Greg Elgar
- Advanced Sequencing Facility, Francis Crick Institute, London, UK
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizzard Institute, Barts, London, UK
| | - Michael Howell
- High Throughput Screening Facility, Francis Crick Institute, London, UK
| | - Lionel Larue
- Centre de Recherche, Developmental Genetics of Melanocytes, Institut Curie, Orsay, France
| | - Sam Loughlin
- North East Thames Regional Genetics Laboratory Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jeff MacDonald
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Sara Martin Barberan
- Mosaicism and Precision Medicine Laboratory, Francis Crick Institute, London, UK
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Vanessa Martins da Silva
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Miriam Molina
- Oncogene Biology Laboratory, Francis Crick Institute, London, UK
| | - Deborah Morrogh
- North East Thames Regional Genetics Laboratory Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dale Moulding
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Jérémie Nsengimana
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, Cancer Research UK Clinical Centre at Leeds, St James's University Hospital, Leeds, UK
| | - Alan Pittman
- Bioinformatics, St George's University of London, London, UK
| | - Joan-Anton Puig-Butillé
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Kiran Parmar
- Department of Twin Research and Genetic Epidemiology, King's College London, South Wing Block D, London, UK
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Stephen Scherer
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paulina Stadnik
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Philip Stanier
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Gemma Tell
- McArdle Laboratory, Department of Oncology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Regula Waelchli
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - Mehdi Zarrei
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Susana Puig
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | | | - Yongna Xing
- McArdle Laboratory, Department of Oncology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Eugene Healy
- Department of Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gudrun E Moore
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Wei-Li Di
- Infection, Immunity and Inflammation Programme, Immunobiology Section, UCL GOS Institute of Child Health, London, UK
| | - Julia Newton-Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, Cancer Research UK Clinical Centre at Leeds, St James's University Hospital, Leeds, UK
| | - Julian Downward
- Oncogene Biology Laboratory, Francis Crick Institute, London, UK
| | - Veronica A Kinsler
- Mosaicism and Precision Medicine Laboratory, Francis Crick Institute, London, UK.
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK.
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK.
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27
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Thomson J, Bewicke-Copley F, Anene CA, Gulati A, Nagano A, Purdie K, Inman GJ, Proby CM, Leigh IM, Harwood CA, Wang J. The Genomic Landscape of Actinic Keratosis. J Invest Dermatol 2021; 141:1664-1674.e7. [PMID: 33482222 PMCID: PMC8221374 DOI: 10.1016/j.jid.2020.12.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 01/12/2023]
Abstract
Actinic keratoses (AKs) are lesions of epidermal keratinocyte dysplasia and are precursors for invasive cutaneous squamous cell carcinoma (cSCC). Identifying the specific genomic alterations driving the progression from normal skin to skin with AK to skin with invasive cSCC is challenging because of the massive UVR-induced mutational burden characteristic at all stages of this progression. In this study, we report the largest AK whole-exome sequencing study to date and perform a mutational signature and candidate driver gene analysis on these lesions. We demonstrate in 37 AKs from both immunosuppressed and immunocompetent patients that there are significant similarities between AKs and cSCC in terms of mutational burden, copy number alterations, mutational signatures, and patterns of driver gene mutations. We identify 44 significantly mutated AK driver genes and confirm that these genes are similarly altered in cSCC. We identify azathioprine mutational signature in all AKs from patients exposed to the drug, providing further evidence for its role in keratinocyte carcinogenesis. cSCCs differ from AKs in having higher levels of intrasample heterogeneity. Alterations in signaling pathways also differ, with immune-related signaling and TGFβ signaling significantly more mutated in cSCC. Integrating our findings with independent gene expression datasets confirms that dysregulated TGFβ signaling may represent an important event in AK‒cSCC progression.
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Affiliation(s)
- Jason Thomson
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Findlay Bewicke-Copley
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Chinedu Anthony Anene
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Abha Gulati
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ai Nagano
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Karin Purdie
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Gareth J Inman
- Cancer Research UK Beatson Institute, Glasgow, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Charlotte M Proby
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Irene M Leigh
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Jun Wang
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.
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28
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Nasr I, McGrath EJ, Harwood CA, Botting J, Buckley P, Budny PG, Fairbrother P, Fife K, Gupta G, Hashme M, Hoey S, Lear JT, Mallipeddi R, Mallon E, Motley RJ, Newlands C, Newman J, Pynn EV, Shroff N, Slater DN, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol 2021; 185:899-920. [PMID: 34050920 DOI: 10.1111/bjd.20524] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Affiliation(s)
- I Nasr
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - E J McGrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - C A Harwood
- Barts Health NHS Trust, London, E1 1BB, UK.,National Cancer Research Institute's Skin Cancer Clinical Studies Group and Non-Melanoma Skin Cancer Subgroup, London, UK
| | - J Botting
- Royal College of General Practitioners, London, UK
| | - P Buckley
- Independent Cancer Patients' Voice, London, UK
| | - P G Budny
- British Association of Plastic, Reconstructive & Aesthetic Surgeons, London, UK.,Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | | | - K Fife
- Royal College of Radiologists, London, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G Gupta
- NHS Lothian, Lauriston Building, Edinburgh, EH3 9EN, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - S Hoey
- Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - J T Lear
- British Society for Skin Care in Immunosuppressed Individuals, London, UK.,Salford Royal NHS Foundation Hospital, Salford, M6 8HD, UK.,Manchester Academic Health Science Centre, Manchester, M20 2LR, UK
| | - R Mallipeddi
- British Society for Dermatological Surgery, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - E Mallon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - R J Motley
- University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - C Newlands
- British Association of Oral and Maxillofacial Surgeons, London, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - J Newman
- British Dermatological Nursing Group, Belfast, Ireland.,King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - E V Pynn
- Nevill Hall Hospital, Abergavenny, NP7 7EG, UK
| | - N Shroff
- Primary Care Dermatology Society, Rickmansworth, UK
| | - D N Slater
- Royal College of Pathologists, London, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
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29
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Kentley J, Allawh R, Rao S, Doyle A, Ahmad A, Nadhan K, Proby C, Harwood CA, Chung CL. The burden of cutaneous disease in solid organ transplant recipients of color. Am J Transplant 2021; 21:1215-1226. [PMID: 32659869 DOI: 10.1111/ajt.16210] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients (OTRs) are at increased risk of cutaneous malignancy. Skin disorders in OTRs of color (OTRoC) have rarely been systematically assessed. We aimed to ascertain the burden of skin disease encountered in OTRoC by prospectively collecting data from OTRs attending 2 posttransplant skin surveillance clinics: 1 in London, UK and 1 in Philadelphia, USA. Retrospective review of all dermatological diagnoses was performed. Data from 1766 OTRs were analyzed: 1024 (58%) white, 376 (21%) black, 261 (15%) Asian, 57 (3%) Middle Eastern/Mediterranean (ME/M), and 48 (2.7%) Hispanic; and 1128 (64%) male. Viral infections affected 45.1% of OTRs, and were more common in white and ME/M patients (P < .001). Fungal infections affected 28.1% and were more common in ME/M patients (P < .001). Inflammatory skin disease affected 24.5%, and was most common in black patients (P < .001). In addition, 26.4% of patients developed skin cancer. There was an increased risk of skin cancer in white vs nonwhite OTRs (HR 4.4, 95% CI 3.5-5.7, P < .001): keratinocyte cancers were more common in white OTRs (P < .001) and Kaposi sarcoma was more common in black OTRs (P < .001). These data support the need for programs that promote targeted dermatology surveillance for all OTRs, regardless of race/ethnicity or country of origin.
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Affiliation(s)
- Jonathan Kentley
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Department of Dermatology, Chelsea and Westminster Hospital, London, UK
| | - Rina Allawh
- Montgomery Dermatology, Lankenau Institute for Medical Research, King of Prussia, Wynnewood, Pennsylvania, USA
| | - Swati Rao
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Alden Doyle
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Amar Ahmad
- Department of Cancer Intelligence, Cancer Research UK, London, UK
| | - Kumar Nadhan
- Department of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Charlotte Proby
- Jacqui Wood Cancer Centre, School of Medicine, University of Dundee, Dundee, UK
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Christina L Chung
- Montgomery Dermatology, Lankenau Institute for Medical Research, King of Prussia, Wynnewood, Pennsylvania, USA
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30
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Shim TN, Harwood CA, Marsh SG, Gotch FM, Quint W, de Koning MN, Francis N, Jameson C, Freeman A, Minhas S, Muneer A, Dinneen M, Bunker CB. The prevalence of human leucocyte antigen and human papillomavirus DNA in penile intraepithelial neoplasia in England 2011-2012. Int J STD AIDS 2021; 32:388-395. [PMID: 33576716 DOI: 10.1177/0956462420970727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The pathogenesis of penile intraepithelial neoplasia (PeIN) is unclear but human papillomavirus (HPV) infection and polymorphisms in human leucocyte antigen (HLA). OBJECTIVES To examine the prevalence of HPV DNA and HLA in PeIN. METHODS Adult Caucasian men with a clinical and histological diagnosis of PeIN, that is, Bowenoid papulosis (BP), Bowen's disease of penis (BDP) and erythroplasia of Queyrat (EQ) were selected and phenotyped from the clinical records. DNA was extracted from blood and paraffin-embedded sections for HLA and HPV typing, respectively. Human leucocyte antigen allele frequencies were compared with those derived from the UK-based Caucasian population. RESULTS Seventy-two cases of PeIN (20 BP, 34 BDP and 18 EQ) were studied. Human papillomavirus DNA was identified in 65/72 (90.2%) PeIN; Alphapapillomavirus types were detected in 62/72 (85%) followed by Betapapillomavirus types in 9/72 (12.5%) and cutaneous types in 7/72 (9.7%); HPV16 was the most prevalent genotype at 35/72 (48.6%) followed by HPV33 at 7/72 (9.7%); multiple infections were seen in 18/72 (25%) PeIN. HLA-C*15 (Bonferroni corrected p = 0.049) confers susceptibility to PeIN, whereas HLA-DQA1*01 (corrected p = 0.02) protects against PeIN. HPV16-associated PeIN cases showed no statistically significant association with HLA genotype after multiple corrections. CONCLUSION Human papillomavirus is involved in the pathogenesis of PeIN. Immunogenotype may play a role in the pathogenesis of PeIN.
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Affiliation(s)
- Tang Ngee Shim
- Dermatology Department, University College Hospital, Chelsea and Westminster Hospital, London, UK
| | - Catherine A Harwood
- Center for Cutaneous Research and Cell Biology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Steven Ge Marsh
- Anthony Nolan Research Institute and University College London Cancer Institute, London, UK
| | | | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, Netherlands
| | | | - Nick Francis
- Pathology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Charles Jameson
- Pathology Department, 4919University College London Hospital, London, UK
| | - Alex Freeman
- Pathology Department, 4919University College London Hospital, London, UK
| | - Suks Minhas
- Andrology Centre and the Institute of Urology, 4919University College London Hospital, London, UK
| | - Asif Muneer
- Andrology Centre and the Institute of Urology, 4919University College London Hospital, London, UK
| | - Michael Dinneen
- Urology Department, Chelsea and Westminster Hospital, London, UK
| | - Christopher B Bunker
- Dermatology Department, University College Hospital, Chelsea and Westminster Hospital, London, UK
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31
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Keohane SG, Botting J, Budny PG, Dolan OM, Fife K, Harwood CA, Mallipeddi R, Marsden JR, Motley RJ, Newlands C, Proby C, Rembielak A, Slater DN, Smithson JA, Buckley P, Fairbrother P, Hashme M, Mohd Mustapa MF, Exton LS. British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma 2020. Br J Dermatol 2021; 184:401-414. [PMID: 33150585 DOI: 10.1111/bjd.19621] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 12/18/2022]
Affiliation(s)
- S G Keohane
- British Society for Dermatological Surgery, London, UK.,Portsmouth Hospitals University NHS Trust, Portsmouth, PO3 6AD, UK
| | - J Botting
- Royal College of General Practitioners, London, UK.,Glebe Road Surgery, Barnes, SW13 0DR, UK
| | - P G Budny
- British Association of Plastic Reconstructive and Aesthetic Surgeons, London, UK.,Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - O M Dolan
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, BT12 6BA, UK
| | - K Fife
- Royal College of Radiologists, Holborn, London, WC2A 3JW, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - C A Harwood
- Barts Health NHS Trust, Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - R Mallipeddi
- British Society for Dermatological Surgery, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - J R Marsden
- Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK
| | - R J Motley
- University Hospital of Wales, Health Park, Cardiff, CF14 4XN, UK
| | - C Newlands
- British Association of Oral & Maxillofacial Surgeons, London, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - C Proby
- University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - A Rembielak
- Royal College of Radiologists, Holborn, London, WC2A 3JW, UK.,The Christie NHS Foundation Trust, Manchester, M20 4BX, UK.,The University of Manchester, Manchester, M13 9PL, UK
| | - D N Slater
- Royal College of Pathologists, London, E1 8BB, UK
| | - J A Smithson
- British Dermatological Nursing Group, Belfast, UK.,East Sussex Healthcare NHS Trust, Eastbourne, BN21 2UD, UK
| | | | | | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
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32
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Reynolds KA, Schlessinger DI, Yanes AF, Godinez-Puig V, Chen BR, Kurta AO, Cotseones JK, Chiren SG, Iyengar S, Ibrahim SA, Kang BY, Worley B, Behshad R, DeHoratius DM, Denes P, Drucker AM, Dzubow LM, Etzkorn JR, Harwood CA, Kim JYS, Lawrence N, Lee EH, Lissner GS, Marghoob AA, Guminiski A, Matin RN, Mattox AR, Mittal BB, Thomas JR, Zhou XA, Zloty D, Hughes BGM, Nottage MK, Green AC, Testori AAE, Argenziano G, Longo C, Zalaudek I, Lebbe C, Malvehy J, Saiag P, Cernea SS, Schmitt J, Kirkham JJ, Poon E, Sobanko JF, Cartee TV, Maher IA, Alam M. Development of a core outcome set for cutaneous squamous cell carcinoma trials: identification of core domains and outcomes. Br J Dermatol 2021; 184:1113-1122. [PMID: 33236347 DOI: 10.1111/bjd.19693] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The lack of uniformity in the outcomes reported in clinical studies of the treatment of cutaneous squamous cell carcinoma (cSCC) complicates efforts to compare treatment effectiveness across trials. OBJECTIVES To develop a core outcome set (COS), a minimum set of agreed-upon outcomes to be measured in all clinical trials of a given disease or outcome, for the treatment of cSCC. METHODS One hundred and nine outcomes were identified via a systematic literature review and interviews with 28 stakeholders. After consolidation of this long list, 55 candidate outcomes were rated by 19 physician and 10 patient stakeholders, in two rounds of Delphi exercises. Outcomes scored 'critically important' (score of 7, 8 or 9) by ≥ 70% of patients and ≥ 70% of physicians were provisionally included. At the consensus meeting, after discussion and voting of 44 international experts and patients, the provisional list was reduced to a final core set, for which consensus was achieved among all meeting participants. RESULTS A core set of seven outcomes was finalized at the consensus meeting: (i) serious or persistent adverse events, (ii) patient-reported quality of life, (iii) complete response, (iv) partial response, (v) recurrence-free survival, (vi) progression-free survival and (vii) disease-specific survival. CONCLUSIONS In order to increase the comparability of results across trials and to reduce selective reporting bias, cSCC researchers should consider reporting these core outcomes. Further work needs to be performed to identify the measures that should be reported for each of these outcomes.
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Affiliation(s)
- K A Reynolds
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - D I Schlessinger
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - A F Yanes
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - V Godinez-Puig
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - B R Chen
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - A O Kurta
- Department of Dermatology, Saint Louis University, St Louis, MO, USA
| | - J K Cotseones
- Medical & Cosmetic Dermatology Service, Northwestern Medicine Regional Medical Group, Naperville, IL, USA
| | - S G Chiren
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - S Iyengar
- Department of Dermatology, West Virginia University, Morgantown, WV, USA
| | - S A Ibrahim
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - B Y Kang
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - B Worley
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - R Behshad
- Department of Dermatology, Saint Louis University, St Louis, MO, USA
| | - D M DeHoratius
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - P Denes
- Division of Cardiology, Northwestern University, Chicago, IL, USA
| | - A M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - J R Etzkorn
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - J Y S Kim
- Division of Plastic and Reconstructive Surgery, Northwestern University, Chicago, IL, USA
| | - N Lawrence
- Division of Dermatologic Surgery, Cooper University Hospital, Camden, NJ, USA
| | - E H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - G S Lissner
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - A A Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - A Guminiski
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, Australia
| | - R N Matin
- Department of Dermatology, Churchill Hospital, Oxford, UK
| | - A R Mattox
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - B B Mittal
- Department of Radiation Oncology, Northwestern University, Chicago, IL, USA
| | - J R Thomas
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| | - X A Zhou
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - D Zloty
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - B G M Hughes
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Medical Oncology, The Prince Charles Hospital, Brisbane, QLD, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - M K Nottage
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - A C Green
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,CRUK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - A A E Testori
- Division of Dermatology, Fondazione IRCCS, Policlinico san Matteo, Pavia, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - I Zalaudek
- Department of Dermatology, Medical University of Trieste, Trieste, Italy
| | - C Lebbe
- APHP Department of Dermatology, Saint-Louis Hospital, INSERM U976, Université de Paris, Paris, France
| | - J Malvehy
- Department of Dermatology, Hospital Clinic of Barcelona, IDIBAPS and CIBER de Enfermedades Raras, Barcelona, Spain
| | - P Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - S S Cernea
- Dermatology Department of Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil
| | - J Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty, Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - J J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - E Poon
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - J F Sobanko
- Department of Dermatology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Division of Dermatologic Surgery, Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - T V Cartee
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA
| | - I A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - M Alam
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Caley MP, Martins VL, Moore K, Lashari M, Nissinen L, Kähäri VM, Alexander S, Jones E, Harwood CA, Jones J, Donaldson M, Marshall JF, O'Toole EA. Loss of the laminin subunit alpha-3 induces cell invasion and macrophage infiltration in cutaneous squamous cell carcinoma. Br J Dermatol 2020; 184:923-934. [PMID: 32767748 DOI: 10.1111/bjd.19471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is a common cancer that invades the dermis through the basement membrane. The role of the basement membrane in poorly differentiated cSCC is not well understood. OBJECTIVES To study the effect that loss of the laminin subunit alpha-3 (α3) chain from the tumour microenvironment has on tumour invasion and inflammatory cell recruitment. METHODS We examined the role of the basement membrane proteins laminin subunits α3, β3 and γ2 in SCC invasion and inflammatory cell recruitment using immunohistochemistry, short hairpin RNA knockdown, RNA-Seq, mouse xenograft models and patient tumour samples. RESULTS Analysis of SCC tumours and cell lines using antibodies specific to laminin chains α3, β3 and γ2 identified a link between poorly differentiated SCC and reduced expression of laminin α3 but not the other laminin subunits investigated. Knockdown of laminin α3 increased tumour invasion both in vitro and in vivo. Western blot and immunohistochemical staining identified increased phosphorylated myosin light chain with loss of laminin α3. Inhibition of ROCK (rho-associated protein kinase) but not Rac1 significantly reduced the invasive potential of laminin α3 knockdown cells. Knockdown of laminin subunits α3 and γ2 increased monocyte recruitment to the tumour microenvironment. However, only the loss of laminin α3 correlated with increased tumour-associated macrophages both in xenografted tumours and in patient tumour samples. CONCLUSIONS These data provide evidence that loss of the laminin α3 chain in cSCC has an effect on both the epithelial and immune components of cSCC, resulting in an aggressive tumour microenvironment.
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Affiliation(s)
- M P Caley
- Centre for Cell Biology and Cutaneous Research
| | - V L Martins
- Centre for Cell Biology and Cutaneous Research
| | - K Moore
- Barts Cancer Institute; Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Lashari
- Centre for Cell Biology and Cutaneous Research
| | - L Nissinen
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, and MediCity Research Laboratory, University of Turku, Turku, Finland
| | - V-M Kähäri
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, and MediCity Research Laboratory, University of Turku, Turku, Finland
| | - S Alexander
- Centre for Cell Biology and Cutaneous Research
| | - E Jones
- Centre for Cell Biology and Cutaneous Research
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research
| | - J Jones
- School of Molecular Biosciences, BLS 202F, Washington State University, Pullman, WA, USA
| | | | - J F Marshall
- Barts Cancer Institute; Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - E A O'Toole
- Centre for Cell Biology and Cutaneous Research
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34
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Shim TN, Harwood CA, Marsh SG, Gotch FM, Quint W, de Koning MN, Francis N, Jameson C, Freeman A, Minhas S, Dinneen M, Muneer A, Bunker CB. Immunogenetics and human papillomavirus (HPV) in male genital lichen sclerosus (MGLSc). Int J STD AIDS 2020; 31:1334-1339. [PMID: 33081649 DOI: 10.1177/0956462420949395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BackgroundThe pathogenesis of male genital lichen sclerosus (MGLSc) is controversial. Incriminated factors include infection with human papillomavirus (HPV) and autoimmunity (e.g. Human Leukocyte Antigen [HLA]). To address the roles of HLA and HPV in MGLSc we studied adult Caucasian males with a clinical and histological diagnosis of MGLSc. The men in the study attended two specialised Male Genital Dermatoses Clinics between July 2011 and September 2012 and were selected and phenotyped from the clinical records. DNA was extracted from blood and paraffin-embedded biopsy sections, for HLA and HPV typing, respectively. HLA allele frequencies were compared with those derived from the UK-based Caucasian population. Eighty-eight cases of MGLSc were identified. HPV DNA was detected in 33/88 (37.5%) cases of MGLSc. HPV16 was the most prevalent type found: 11/88 (12.5%) MGLSc. No statistically significant HLA associations were established but HLA-B*35, -B*51, -C*15, -DRB1*04, -DRB1*10 (predisposition) and -DQA1*01 (protection) were revealed as alleles of interest. HPV16-associated MGLSc cases showed no statistically significant association with HLA genotype. The relationship between HPV and MGLSc suggests a passenger effect rather than a pathogenic role. HLA is not associated with MGLSc nor co-existent HPV16.
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Affiliation(s)
- Tang Ngee Shim
- Dermatology Department, University College Hospital, Chelsea and Westminster Hospital, London, UK
| | - Catherine A Harwood
- Center for Cutaneous Research and Cell Biology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Steven Ge Marsh
- Anthony Nolan Research Institute, University College London Cancer Institute, London, UK
| | | | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | | | - Nick Francis
- Pathology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Charles Jameson
- Pathology Department, University College London Hospital, London, UK
| | - Alex Freeman
- Pathology Department, University College London Hospital, London, UK
| | - Suks Minhas
- Andrology Centre and the Institute of Urology, University College London Hospital, London, UK
| | - Michael Dinneen
- Urology Department, Chelsea and Westminster Hospital, London, UK
| | - Asif Muneer
- Andrology Centre and the Institute of Urology, University College London Hospital, London, UK
| | - Christopher B Bunker
- Dermatology Department, University College Hospital, Chelsea and Westminster Hospital, London, UK
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35
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Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, Bataille V, Del Marmol V, Dummer R, Harwood CA, Hauschild A, Höller C, Haedersdal M, Malvehy J, Middleton MR, Morton CA, Nagore E, Stratigos AJ, Szeimies RM, Tagliaferri L, Trakatelli M, Zalaudek I, Eggermont A, Grob JJ. Response to: Comment on 'Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines'. Eur J Cancer 2020; 140:154-157. [PMID: 32978037 DOI: 10.1016/j.ejca.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Merete Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Old Road Campus, Oxford, OX3 9DU, UK
| | | | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Alexander J Stratigos
- 1(st)Department of Dermatology- Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Rolf-Markus Szeimies
- Clinic for Dermatology and Allergology, Klinikum Vest GmbH Teaching Hospital, Recklinghausen, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche Ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | | | - Jean J Grob
- University Department of Dermatology, Marseille, France
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36
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Durack A, Gran S, Gardiner MD, Jain A, Craythorne E, Proby CM, Marsden J, Harwood CA, Matin RN. A 10-year review of surgical management of dermatofibrosarcoma protuberans. Br J Dermatol 2020; 184:731-739. [PMID: 32599647 DOI: 10.1111/bjd.19346] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer. Standard treatment in the UK is either wide local excision (WLE) or Mohs micrographic surgery (MMS). It is unclear which approach has the lower recurrence rate. OBJECTIVES We undertook a retrospective comparative review of surgical management of DFSP in the UK National Health Service in order to define (i) current surgical practice for primary and recurrent DFSP, (ii) local recurrence rates for primary DFSP and (iii) survival outcomes for DFSP. METHODS A retrospective clinical case-note review of patients with histologically confirmed DFSP (January 2004 to December 2013) who have undergone surgical treatment. RESULTS The surgical management of 483 primary and 64 recurrent DFSP in 11 plastic surgery and 15 dermatology departments was analysed. Almost 75% of primary DFSP (n = 362) were treated with WLE and 20% (n = 97) with MMS. For recurrent DFSP, 69% (n = 44) and 23% (n = 15) of patients underwent WLE and MMS, respectively. Recurrent primary DFSP occurred in six patients after WLE and none after MMS. The median follow-up time was 25·5 months (interquartile range 6·8-45·1) for new and 19·8 (IQR 4·5-44·5) for recurrent DFSP [Correction added on 1 Feb 2021, after first online publication: 4.8 years (interquartile range 3.5-5.8) was incorrect], with eight reported deaths during the follow-up analysis period (one confirmed to be DFSP related). CONCLUSIONS WLE was the most common surgical modality used to treat DFSP across the UK. The local recurrence rate was very low, occurring only after WLE. Although a prospective randomized controlled trial may provide more definitive outcomes, in the absence of a clearly superior surgical modality, treatment decisions should be based on patient preference, clinical expertise and cost.
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Affiliation(s)
- A Durack
- Department of Dermatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Gran
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - M D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of Plastic and Reconstructive Surgery, Frimley Health Foundation NHS Trust, Frimley, UK
| | - A Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of Plastic and Reconstructive Surgery, Imperial College NHS Trust, London, UK
| | - E Craythorne
- Department of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C M Proby
- Department of Dermatology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - J Marsden
- Department of Dermatology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Barts Health NHS Trust, Queen Mary University of London, London, UK
| | - R N Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Steele L, Hong A, Balogh P, O'Toole EA, Harwood CA, Maruthappu T. Disseminated tinea incognita in a patient with ichthyosis vulgaris and eczema. Clin Exp Dermatol 2020; 46:210-212. [PMID: 32845026 DOI: 10.1111/ced.14406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 01/28/2023]
Affiliation(s)
- L Steele
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Hong
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - P Balogh
- Department of, Histopathology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - E A O'Toole
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - C A Harwood
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T Maruthappu
- Departments of, Department of, Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
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Willenbrink TJ, Jambusaria-Pahlajani A, Arron S, Seckin D, Harwood CA, Proby CM. Treatment approaches in immunosuppressed patients with advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2020; 33 Suppl 8:57-60. [PMID: 31833603 DOI: 10.1111/jdv.15843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/29/2019] [Indexed: 12/17/2022]
Abstract
Immunosuppression, both iatrogenic and disease-related, is associated with a greatly increased incidence of cutaneous SCC (cSCC) and with aggressive cSCC and worse disease outcomes. Consequently, rapid access to skin cancer services and prudent surgical choices, such as circumferential margin assessment, is essential when treating advanced cSCC in an immunosuppressed patient. For high-risk cancers and control of cSCC multiplicity, additional strategies should be actively considered within the multidisciplinary clinical care team. These include minimization or revision of immunosuppressive medications, systemic chemoprevention (including retinoids, nicotinamide, capecitabine) and adjuvant therapies such as radiotherapy. Unfortunately, there is a relative paucity of good evidence for many of these treatments in the immunosuppressed. Systemic treatments for metastatic cSCC are often contraindicated in organ transplant recipients, notably checkpoint inhibitor immunotherapy. There are also toxicity concerns with some conventional chemotherapies and EGFR inhibitors. Until recently, clinical trials have largely excluded immunosuppressed individuals. Development of more effective treatment for advanced cSCC in this high-risk group and prospective clinical trials are now research priorities.
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Affiliation(s)
- T J Willenbrink
- Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin-Dell Medical School, Austin, TX, USA
| | - A Jambusaria-Pahlajani
- Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin-Dell Medical School, Austin, TX, USA
| | - S Arron
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - D Seckin
- Department of Dermatology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - C M Proby
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
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Lara R, Adinolfi E, Harwood CA, Philpott M, Barden JA, Di Virgilio F, McNulty S. P2X7 in Cancer: From Molecular Mechanisms to Therapeutics. Front Pharmacol 2020; 11:793. [PMID: 32581786 PMCID: PMC7287489 DOI: 10.3389/fphar.2020.00793] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/13/2020] [Indexed: 12/18/2022] Open
Abstract
P2X7 is a transmembrane receptor expressed in multiple cell types including neurons, dendritic cells, macrophages, monocytes, B and T cells where it can drive a wide range of physiological responses from pain transduction to immune response. Upon activation by its main ligand, extracellular ATP, P2X7 can form a nonselective channel for cations to enter the cell. Prolonged activation of P2X7, via high levels of extracellular ATP over an extended time period can lead to the formation of a macropore, leading to depolarization of the plasma membrane and ultimately to cell death. Thus, dependent on its activation state, P2X7 can either drive cell survival and proliferation, or induce cell death. In cancer, P2X7 has been shown to have a broad range of functions, including playing key roles in the development and spread of tumor cells. It is therefore unsurprising that P2X7 has been reported to be upregulated in several malignancies. Critically, ATP is present at high extracellular concentrations in the tumor microenvironment (TME) compared to levels observed in normal tissues. These high levels of ATP should present a survival challenge for cancer cells, potentially leading to constitutive receptor activation, prolonged macropore formation and ultimately to cell death. Therefore, to deliver the proven advantages for P2X7 in driving tumor survival and metastatic potential, the P2X7 macropore must be tightly controlled while retaining other functions. Studies have shown that commonly expressed P2X7 splice variants, distinct SNPs and post-translational receptor modifications can impair the capacity of P2X7 to open the macropore. These receptor modifications and potentially others may ultimately protect cancer cells from the negative consequences associated with constitutive activation of P2X7. Significantly, the effects of both P2X7 agonists and antagonists in preclinical tumor models of cancer demonstrate the potential for agents modifying P2X7 function, to provide innovative cancer therapies. This review summarizes recent advances in understanding of the structure and functions of P2X7 and how these impact P2X7 roles in cancer progression. We also review potential therapeutic approaches directed against P2X7.
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Affiliation(s)
- Romain Lara
- Biosceptre (UK) Limited, Cambridge, United Kingdom
| | - Elena Adinolfi
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mike Philpott
- Centre for Cutaneous Research, Blizard Institute, Bart's & The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Francesco Di Virgilio
- Department of Morphology, Surgery and Experimental Medicine, Section of Pathology, Oncology and Experimental Biology, University of Ferrara, Ferrara, Italy
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40
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Patel A, Garcia LF, Mannella V, Gammon L, Borg TM, Maffucci T, Scatolini M, Chiorino G, Vergani E, Rodolfo M, Maurichi A, Posch C, Matin RN, Harwood CA, Bergamaschi D. Targeting p63 Upregulation Abrogates Resistance to MAPK Inhibitors in Melanoma. Cancer Res 2020; 80:2676-2688. [PMID: 32291316 DOI: 10.1158/0008-5472.can-19-3230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/04/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022]
Abstract
Targeting the MAPK pathway by combined inhibition of BRAF and MEK has increased overall survival in advanced BRAF-mutant melanoma in both therapeutic and adjuvant clinical settings. However, a significant proportion of tumors develop acquired resistance, leading to treatment failure. We have previously shown p63 to be an important inhibitor of p53-induced apoptosis in melanoma following genotoxic drug exposure. Here, we investigated the role of p63 in acquired resistance to MAPK inhibition and show that p63 isoforms are upregulated in melanoma cell lines chronically exposed to BRAF and MEK inhibition, with consequent increased resistance to apoptosis. This p63 upregulation was the result of its reduced degradation by the E3 ubiquitin ligase FBXW7. FBXW7 was itself regulated by MDM2, and in therapy-resistant melanoma cell lines, nuclear accumulation of MDM2 caused downregulation of FBXW7 and consequent upregulation of p63. Consistent with this, both FBXW7-inactivating mutations and MDM2 upregulation were found in melanoma clinical samples. Treatment of MAPK inhibitor-resistant melanoma cells with MDM2 inhibitor Nutlin-3A restored FBXW7 expression and p63 degradation in a dose-dependent manner and sensitized these cells to apoptosis. Collectively, these data provide a compelling rationale for future investigation of Nutlin-3A as an approach to abrogate acquired resistance of melanoma to MAPK inhibitor targeted therapy. SIGNIFICANCE: Upregulation of p63, an unreported mechanism of MAPK inhibitor resistance in melanoma, can be abrogated by treatment with the MDM2 inhibitor Nutlin-3A, which may serve as a strategy to overcome resistance.
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Affiliation(s)
- Ankit Patel
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Lucia Fraile Garcia
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Viviana Mannella
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Luke Gammon
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Tiffanie-Marie Borg
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Tania Maffucci
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Maria Scatolini
- Molecular Oncology Lab, Fondazione Edo ed Elvo Tempia, Biella, Italy
| | | | - Elisabetta Vergani
- Department of Experimental Oncology and Molecular Medicine, Immunotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Rodolfo
- Department of Experimental Oncology and Molecular Medicine, Immunotherapy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Maurichi
- Department of Surgery, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Christian Posch
- Department of Dermatology, The Rudolfstiftung Hospital, Vienna, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria.,Department of Dermatology, Technical University of Munich, Munich, Germany
| | - Rubeta N Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, United Kingdom
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Daniele Bergamaschi
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
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Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, Bataille V, Del Marmol V, Dummer R, Harwood CA, Hauschild A, Höller C, Haedersdal M, Malvehy J, Middleton MR, Morton CA, Nagore E, Stratigos AJ, Szeimies RM, Tagliaferri L, Trakatelli M, Zalaudek I, Eggermont A, Grob JJ. Comment on 'Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines'. Eur J Cancer 2020; 131:100-103. [PMID: 32241671 DOI: 10.1016/j.ejca.2020.02.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, IRCCS, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE17EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Merete Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, CIBERER, Barcelona, Spain
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Old Road Campus, Oxford, OX39DU, UK
| | | | - Eduardo Nagore
- Department of Dermatology, InstitutoValenciano de Oncologia, Valencia, Spain
| | - Alexander J Stratigos
- 1stDepartment of Dermatology- Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Rolf-Markus Szeimies
- Clinic for Dermatology and Allergology, Klinikum Vest GmbH Teaching Hospital, Recklinghausen, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - Alexander Eggermont
- Cancer Institute, GustaveRoussy Cancer Campus, Grand Paris, 94805, Villejuif, France
| | - Jean J Grob
- University Department of Dermatology, Marseille, France
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42
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Junejo MH, Kentley J, Rajpopat M, Tan XL, Mohd Mustapa MF, Harwood CA. Therapeutic options for erosive pustular dermatosis of the scalp: a systematic review. Br J Dermatol 2020; 184:25-33. [PMID: 32163590 DOI: 10.1111/bjd.19026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Erosive pustular dermatosis of the scalp (EPDS) is a chronic condition characterized by erosive plaques and subsequent scarring alopecia as a result of local trauma or inflammation. A number of therapeutic approaches have been described in the literature but there is no consensus of opinion on optimal treatment of the disease. OBJECTIVES To provide evidence-based recommendations for topical and systemic treatment of adult patients with EPDS by performing a systematic review. METHODS The MEDLINE, MEDLINE In-Process, Embase and Cochrane databases were searched from inception to 26 June 2019 in accordance with the PRISMA guidelines for studies involving adult patients treated for EPDS with at least one reported response to treatment. The study was registered on PROSPERO. Texts were reviewed independently by two authors. The risk of bias and quality of the studies were assessed using the Quality Appraisal Checklist for Case Series Studies. RESULTS In total 75 studies were included, involving 168 patients. Many treatments have been reported in the literature, with varying degrees of therapeutic success. The results were highly heterogeneous and methodological quality was very low. We were unable to perform a meta-analysis on the data. CONCLUSIONS The limited available evidence supports use of topical corticosteroids, with or without oral zinc, followed by maintenance therapy with topical calcineurin inhibitors as being effective in managing this condition. Topical photodynamic therapy is also potentially beneficial in the management of EPDS. Prospective, comparative, randomized controlled trials are required in order to provide further evidence to guide treatment.
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Affiliation(s)
- M H Junejo
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - J Kentley
- Department of Dermatology, Chelsea and Westminster Hospital, London, UK
| | - M Rajpopat
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - X L Tan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - C A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
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Gollins CE, Shah A, Sinha K, Khan S, Paul N, Meeajun B, Abbott RA, Blasdale C, Cooper H, Harwood CA, Ismail F, Lear JT, Mackintosh L, McCormack S, Perrett CM, Proby CM, Durack A, Patalay R, Matin RN. Feasibility of a trial to evaluate nicotinamide for chemoprevention of skin cancers in organ transplant recipients in the UK. Br J Dermatol 2020; 183:394-396. [PMID: 32119116 DOI: 10.1111/bjd.18982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C E Gollins
- UK Departments of Dermatology:, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London
| | - A Shah
- Basildon University Hospital, Basildon and Thurrock Hospitals NHS Foundation Trust
| | - K Sinha
- Basildon University Hospital, Basildon and Thurrock Hospitals NHS Foundation Trust
| | - S Khan
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - N Paul
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - B Meeajun
- Dermatology, Whittington Hospital, Whittington Health NHS Trust, London
| | - R A Abbott
- University Hospital of Wales, Cardiff and Vale University Health Board
| | - C Blasdale
- Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust
| | - H Cooper
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - F Ismail
- Royal Free London NHS Foundation Trust
| | - J T Lear
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust
| | | | | | - C M Perrett
- University College Hospital, University College London Hospitals NHS Foundation Trust
| | - C M Proby
- Ninewells Hospital and Medical School, University of Dundee
| | - A Durack
- Cambridge University Hospitals NHS Foundation Trust
| | - R Patalay
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R N Matin
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
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44
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Proby CM, Harwood CA. Skin cancer burden in lung transplant recipients: we need to do better! Br J Dermatol 2020; 183:416-417. [PMID: 32100285 DOI: 10.1111/bjd.18903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C M Proby
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
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45
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, Dreno B, Concetta Fargnoli M, Forsea AM, Frenard C, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NWJ, Malvehy J, Del Marmol V, Middleton MR, Moreno-Ramirez D, Pellecani G, Peris K, Saiag P, van den Beuken-van Everdingen MHJ, Vieira R, Zalaudek I, Eggermont AMM, Grob JJ. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer 2020; 128:83-102. [PMID: 32113942 DOI: 10.1016/j.ejca.2020.01.008] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 01/11/2023]
Abstract
In order to update recommendations on treatment, supportive care, education and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer was formed. Recommendations were based on evidence-based literature review, guidelines and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable) and distant metastatic cSCC. For common primary cSCC (the most frequent cSCC type), first-line treatment is surgical excision with postoperative margin assessment or microscopically controlled sugery. Safety margins containing clinical normal-appearing tissue around the tumour during surgical excision and negative margins as reported in the pathology report are necessary to minimise the risk of local recurrence and metastasis. In case of positive margins, a re-excision shall be done, for operable cases. Lymph node dissection is recommended for cSCC with cytologically or histologically confirmed regional nodal involvement. Radiotherapy should be considered as curative treatment for inoperable cSCC, or for non-surgical candidates. Anti-PD-1 antibodies are the first-line systemic treatment for patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiation, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drug Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiation therapy. Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Patients should be engaged with informed decisions on management and be provided with best supportive care to optimise symptom management and improve quality of life. Frequency of follow-up visits and investigations for subsequent new cSCC depend on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université de Paris, INSERM U976, AP-HP, Dermatology Department, Saint Louis Hospital, Paris, France
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Dermatology Department, CHU Nantes, Université Nantes, CIC 1413, CRCINA Inserm U1232, Nantes, France
| | - Maria Concetta Fargnoli
- Dermatology - Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana M Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Romania
| | - Cecille Frenard
- Dermatology Department, CHU Nantes, Université Nantes, CIC 1413, CRCINA Inserm U1232, Nantes, France
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | | | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+, GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Belgium
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - David Moreno-Ramirez
- Department of Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré Hospital, APHP, EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Marieke H J van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Italy
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Lanz J, Bouwes Bavinck JN, Westhuis M, Quint KD, Harwood CA, Nasir S, Van-de-Velde V, Proby CM, Ferrándiz C, Genders RE, Del Marmol V, Forchetti G, Hafner J, Vital DG, Hofbauer GFL. Aggressive Squamous Cell Carcinoma in Organ Transplant Recipients. JAMA Dermatol 2019; 155:66-71. [PMID: 30516812 DOI: 10.1001/jamadermatol.2018.4406] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Squamous cell carcinoma (SCC) is the most frequent malignant neoplasm found in solid organ transplant recipients and is associated with a more aggressive disease course and higher risk of metastasis and death than in the general population. Objectives To report the clinicopathologic features of and identify factors associated with aggressive SCC in solid organ transplant recipients. Methods This retrospective multicentric case series included 51 patients who underwent solid organ transplantation and were found to have aggressive SCC, defined by nodal or distant metastasis or death by local progression of primary SCC. Standard questionnaires were completed by the researchers between July 18, 2005, and January 1, 2015. Data were analyzed between February 22, 2016, and July 12, 2016. Results Of the 51 participants, 43 were men and 8 were women, with a median age of 51 years (range, 19-71 years) at time of transplantation and 62 years (range, 36-77 years) at time of diagnosis of aggressive SCC. The distribution of aggressive SCC was preferentially on the face (34 [67%]) and scalp (6 [12%]), followed by the upper extremities (6 [12%]). A total of 21 tumors (41%) were poorly differentiated, with a median tumor diameter of 18.0 mm (range, 4.0-64.0 mm) and median tumor depth of 6.2 mm (range, 1.0-20.0 mm). Perineural invasion was present in 20 patients (39%), while 23 (45%) showed a local recurrence. The 5-year overall survival rate was 23%, while 5-year disease-specific survival was 30.5%. Conclusions and Relevance Results of this case series suggest that anatomical site, differentiation, tumor diameter, tumor depth, and perineural invasion are important risk factors in aggressive SCC in solid organ transplant recipients.
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Affiliation(s)
- Joana Lanz
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Marlies Westhuis
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen D Quint
- Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Shaaira Nasir
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Vanessa Van-de-Velde
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charlotte M Proby
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Carlos Ferrándiz
- Department of Dermatology, Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roel E Genders
- Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - Véronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Forchetti
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jürg Hafner
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Domenic G Vital
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
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47
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Venables ZC, Nijsten T, Wong KF, Autier P, Broggio J, Deas A, Harwood CA, Hollestein LM, Langan SM, Morgan E, Proby CM, Rashbass J, Leigh IM. Epidemiology of basal and cutaneous squamous cell carcinoma in the U.K. 2013-15: a cohort study. Br J Dermatol 2019; 181:474-482. [PMID: 30864158 PMCID: PMC7379277 DOI: 10.1111/bjd.17873] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), together known as keratinocyte cancers (KCs), are the commonest cancer in white ethnic populations. Recent improvements to registry data collection in England has allowed more accurate analysis of the epidemiology of BCC and cSCC and for the first time we are able to provide an accurate (representative) tumour burden for KC in the U.K. OBJECTIVES To estimate the incidence of BCC and cSCC in the U.K. METHODS A cohort of patients with KCs between 2013 and 2015 were identified using linkage to diagnostic codes derived from pathology reports collected into the national cancer registry. Data from England's cancer registry were combined with data from Scotland, Northern Ireland and Wales. European age-standardized incidence rates (EASRs) of the first BCC and cSCC per patient per annum (PPPA) were calculated. RESULTS In the U.K, the EASR of the first BCC and cSCC PPPA in 2013-15 were 285 and 77 per 100 000 person years, respectively (211 120 KCs total in 2015). The mean annual percentage increase was 5% between 2013 and 2015 for both BCC and cSCC. By counting the first KC PPPA, we include an additional 51% KCs compared with the previous reporting technique which counts only the first BCC and cSCC in a patient's lifetime, yet it represents a probable underestimation of 5-11% of the true tumour count. CONCLUSIONS Based on an improved methodology, a more representative incidence of KC is presented, which is essential to healthcare planning and will lead to improved understanding of the epidemiology of KC. What's already known about this topic? Keratinocyte cancers (KCs) are the most common cancers affecting white ethnic populations. The incidence of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) is increasing worldwide including the U.K., most commonly in elderly male Caucasian patients. These cancers are traditionally substantially underreported and frequently excluded from national cancer statistics. What does this study add? Using improved data collection methods in England and validated tumour-reporting techniques, we report the most accurate BCC and cSCC incidence data for the U.K. ever published. Identifying the first BCC and cSCC per patient per annum, the incidence of BCC and cSCC in the U.K. (excluding Wales) was 285 and 77 per 100 000 person years, respectively, between 2013 and 2015, with more than 210 000 KCs in the U.K. in 2015.
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Affiliation(s)
- Z C Venables
- Department of Dermatology, Leicester Royal Infirmary, Leicester, U.K.,Public Health England London Region, London, U.K.,Barts and The London School of Medicine and Dentistry, London, U.K
| | - T Nijsten
- Department of Dermatology, Erasmus Medical Center, Burg Jacobsplein 51, Rotterdam, 3015CA, the Netherlands
| | - K F Wong
- Public Health England London Region, London, U.K
| | - P Autier
- International Prevention Research Institute, Lyon, France
| | - J Broggio
- Public Health England London Region, London, U.K
| | - A Deas
- Information Services Division, NHS National Services Scotland, Glasgow, U.K
| | - C A Harwood
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, U.K
| | - L M Hollestein
- Department of Dermatology, Erasmus Medical Center, Burg Jacobsplein 51, Rotterdam, 3015CA, the Netherlands
| | - S M Langan
- St John's Institute of Dermatology, Department of Dermatology, London, U.K
| | - E Morgan
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, U.K
| | - C M Proby
- School of Medicine, University of Dundee, Dundee, Scotland, U.K
| | - J Rashbass
- Public Health England London Region, London, U.K
| | - I M Leigh
- Barts and The London School of Medicine and Dentistry, London, U.K
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48
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Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, Bataille V, Marmol VD, Dummer R, Harwood CA, Hauschild A, Höller C, Haedersdal M, Malvehy J, Middleton MR, Morton CA, Nagore E, Stratigos AJ, Szeimies RM, Tagliaferri L, Trakatelli M, Zalaudek I, Eggermont A, Grob JJ. Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines. Eur J Cancer 2019; 118:10-34. [DOI: 10.1016/j.ejca.2019.06.003] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
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49
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Hassan S, Purdie KJ, Wang J, Harwood CA, Proby CM, Pourreyron C, Mladkova N, Nagano A, Dhayade S, Athineos D, Caley M, Mannella V, Blyth K, Inman GJ, Leigh IM. A Unique Panel of Patient-Derived Cutaneous Squamous Cell Carcinoma Cell Lines Provides a Preclinical Pathway for Therapeutic Testing. Int J Mol Sci 2019; 20:E3428. [PMID: 31336867 PMCID: PMC6678499 DOI: 10.3390/ijms20143428] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) incidence continues to rise with increasing morbidity and mortality, with limited treatment options for advanced disease. Future improvements in targeted therapy will rely on advances in genomic/transcriptomic understanding and the use of model systems for basic research. We describe here the panel of 16 primary and metastatic cSCC cell lines developed and characterised over the past three decades in our laboratory in order to provide such a resource for future preclinical research and drug screening. METHODS Primary keratinocytes were isolated from cSCC tumours and metastases, and cell lines were established. These were characterised using short tandem repeat (STR) profiling and genotyped by whole exome sequencing. Multiple in vitro assays were performed to document their morphology, growth characteristics, migration and invasion characteristics, and in vivo xenograft growth. RESULTS STR profiles of the cSCC lines allow the confirmation of their unique identity. Phylogenetic trees derived from exome sequence analysis of the matched primary and metastatic lines provide insight into the genetic basis of disease progression. The results of in vivo and in vitro analyses allow researchers to select suitable cell lines for specific experimentation. CONCLUSIONS There are few well-characterised cSCC lines available for widespread preclinical experimentation and drug screening. The described cSCC cell line panel provides a critical tool for in vitro and in vivo experimentation.
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Affiliation(s)
- Sakinah Hassan
- Blizard Institute, Barts and the London School of Medicine and Dentistry, QMUL, London E1 2AT, UK
| | - Karin J Purdie
- Blizard Institute, Barts and the London School of Medicine and Dentistry, QMUL, London E1 2AT, UK
| | - Jun Wang
- Barts Cancer Institute, QMUL, London EC1M 6BQ, UK
| | - Catherine A Harwood
- Blizard Institute, Barts and the London School of Medicine and Dentistry, QMUL, London E1 2AT, UK
| | - Charlotte M Proby
- Division of Cancer, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Celine Pourreyron
- Division of Cancer, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Nikol Mladkova
- Blizard Institute, Barts and the London School of Medicine and Dentistry, QMUL, London E1 2AT, UK
| | - Ai Nagano
- Barts Cancer Institute, QMUL, London EC1M 6BQ, UK
| | - Sandeep Dhayade
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - Dimitris Athineos
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - Matthew Caley
- Blizard Institute, Barts and the London School of Medicine and Dentistry, QMUL, London E1 2AT, UK
| | - Viviana Mannella
- Blizard Institute, Barts and the London School of Medicine and Dentistry, QMUL, London E1 2AT, UK
| | - Karen Blyth
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - Gareth J Inman
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow G61 1GH, UK
| | - Irene M Leigh
- Blizard Institute, Barts and the London School of Medicine and Dentistry, QMUL, London E1 2AT, UK.
- Division of Cancer, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
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50
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Affiliation(s)
- I M Leigh
- Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 8AT, U.K
- Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, U.K
| | - C M Proby
- Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, U.K
| | - G J Inman
- Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, U.K
| | - C A Harwood
- Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 8AT, U.K
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