Management of high-risk squamous cell carcinoma of the skin
ABSTRACT Cutaneous squamous cell cancer (SCC) is the second most common skin cancer, accounting for one-fifth of all cutaneous malignancies. The majority arise on the head and neck skin, and cumulative UV exposure is thought to be the most likely etiological factor. The majority of deaths from SCC occur in a high-risk subgroup of patients. This high-risk subgroup of patients can be identified as those with tumors greater than 2 cm in diameter; tumor thickness over 4 mm; moderately/poorly differentiated or desmoplastic histological SCC subtype; ear, lip, hand, feet or genital tumor site; presence of perineural or lymphovascular invasion; nodal metastasis at presentation; recurrent SCC; SCC arising from scars or chronic skin disease, for example, chronic ulcers; and SCC arising in immunosuppressed patients. It is important to identify and aggressively treat these patients, as high-risk SCC are associated with a greater mortality and morbidity. This article reviews the diagnosis and management of such high-risk SCC.
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ABSTRACT: Explore the relationship between tumor location and prognosis among patients with Merkel cell carcinoma (MCC) of the head and neck. Retrospective analysis of large population database. Surveillance Epidemiology and End Results (SEER) database/multiple settings. Using the SEER database, the authors identified patients with MCC of the head and neck. They compared clinicopathologic characteristics and disease-specific survival (DSS) between patients with head and neck MCC at different anatomic subsites. DSS was estimated by the Kaplan-Meier method, and a multivariable regression model was constructed so that independent predictors of DSS could be determined. Of the 2104 patients identified, 61.0% were men. The mean age at diagnosis was 77.5 years. Tumors were most commonly located on the face (61.1%). Scalp tumors were significantly larger (10.4% >5 cm, P = .0001) and more likely to present with distant metastasis (8.7%, P = .07) than other head and neck tumors. Lip tumors had the highest rate of invasion into bone, cartilage, and muscle (13.7%, P = .012), and ear tumors had the highest rate of nodal metastasis (63.2%, P = .011). Patients with scalp/neck and lip primary sites had significantly worse survival on univariable analysis (P = .0054 and P = .0007, respectively); however, the lip was the only site associated with worse survival on multivariable analysis (hazard ratio = 1.8, P = .005). This study is the first to report lip location as an independent prognostic factor in head and neck MCC. More aggressive treatment of patients with MCC of the lip may be warranted to improve outcomes.Otolaryngology Head and Neck Surgery 12/2011; 146(3):403-8. DOI:10.1177/0194599811431789 · 1.72 Impact Factor
Article: Nonmelanoma Skin Cancer[Show abstract] [Hide abstract]
ABSTRACT: Nonmelanoma skin cancer (NMSC) represents the most common form of cancer in Caucasians, with continuing increase in incidence worldwide. Basal cell carcinoma (BCC) accounts for 75% of cases of NMSC, and squamous cell carcinoma (SCC) accounts for the remaining majority of NMSC cases. Whilst metastasis from BCC is extremely rare, metastasis from high-risk SCC may be fatal. In this article, we review the aetiology, diagnosis and management of NMSC.Journal of Cutaneous and Aesthetic Surgery 01/2012; 5(1):3-10. DOI:10.4103/0974-2077.94323
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ABSTRACT: Compare the dermatoscopy vascular features of well differentiated with non-well differentiated squamous cell carcinoma (SCC). A prospective study of 294 consecutive cases of histopathologically confirmed invasive SCC compared the dermatoscopic vascular features of well to combined moderate and poorly differentiated tumors. These features were recorded live directly from the patients and included: the percentage of pink in the tumor, the presence of branching, serpentine, dot, hairpin, glomerular and linear vessels, and the number of these vessel types present within each tumor. Vessel types were also reviewed by tumor depth in 1 mm increments. Two medical practices in Sydney, Australia. Eighty-six female and 208 male patients (29-95 years old). Dermatoscopic vascular feature variation between grades of tumor differentiation and tumor depth. Of 294 invasive SCCs, 255 (87%) were well differentiated, 32 (11%) were moderately differentiated and 7 (2%) were poorly differentiated. The percentage of pink areas within tumors varied between differentiation grades. The combined group of moderate and poorly differentiated tumors displayed more branching (28%, P<0.001) and serpentine (62%, P<0.005) blood vessels compared to well differentiated tumors (8% and 38%, respectively). Moderate and poorly differentiated tumors displayed larger numbers of vessel types (3.3) compared to well differentiated tumors (2.6, P < 0.01). Branching and serpentine vessels both increased in incidence with increasing tumor depth (p<0.05). Grades of tumor differentiation in SCC display varying dermatoscopic vascular features. The incidence of branching and serpentine vessels increases with increasing tumor depth and the shift towards poor differentiation.10/2012; 2(4):204a05. DOI:10.5826/dpc.0204a05