Michael J Veness

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Verified

Michael verified their affiliation via an institutional email.

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• MBBS MMed MD (Sydney) MD (UNSW) FRANZCR
• Professor (Full) at Westmead Hospital

(1) Background: It is controversial if Merkel cell carcinomas (MCCs) spread to lymph nodes or distant metastases (LNM/DM) first. (2) Methods: A total of 303 patients from six institutions (March 1982–February 2015) were combined with individual patient data from a PubMed search, totaling 949 patients. The primary outcome was recurrence patterns. (3...

(1) Background: Knowledge regarding the optimal radiotherapy dose for Merkel-cell carcinoma (MCC) remains limited. (2) Methods: Following a PubMed search, equivalent doses in 2 Gy fractions (Gy2) were compared. (3) Results: Of the 949 patients, 939 were evaluable, with 728 (77.5%) cases localized to the primary site and 171 irradiated without chemo...

Total 949 patients identified with individual data At diagnosis: 730/949 (76.9%) stage I+II, 176/949 (18.5%) stage III, 22/949 (2.3%) stage IV, 21/949 (2.2%) unknown stage | | Yes | 215 developed nodal metastases within their lifetime: 130 were before diagnosis of distant metastases , 24 simultaneous, 6 after distant metastases 896 Brand new case t...

Background: Optimal radiotherapy doses for Merkel cell carcinoma are unknown. Methods: After a PubMed literature search, we analyzed data by Equivalent Dose in 2-Gy fractions (EQD2). Results: 939/949 data were evaluable: 728/939 (77.5%) presented with localized disease, of which 171 were irradiated alone, with a median primary EQD2 of 50 (14.0-72.0...

This describes a basic research method - how to deduce the pattern of spread of any cancer even in developing countries without expensive imaging. We cannot presume the epidemiology and natural history in developing countries are the same as rich developed countries.

Merkel cell carcinoma is a neuroendocrine tumor that behaves somewhat like small cell carcinoma and may be more aggressive than melanoma. The limb is easily checked by patients and may explain better outcome than the trunk.

This research on skin cancer shows how we can analyze the proper radiotherapy treatment volume. It can be used in a similar manner on other cancers.

Background: Optimal radiotherapy doses for Merkel cell carcinoma are unknown. Methods: After a PubMed literature search, we analyzed data by Equivalent Dose in 2-Gy fractions (EQD2). Results: 939/949 data were evaluable: 728/939 (77.5%) presented with localized disease, of which 171 were irradiated alone, with a median primary EQD2 of 50 (14.0-72.0...

Background: There is controversy if Merkel cell carcinomas (MCCs) spread to lymph nodes or distant metastases (DM) first. Methods: Data from six institutions (March 1982 to Feb 2015) formed an aggregated database of 303 patients. The primary outcome was recurrence patterns. Results: (a) More patients presented with lymph node metastases (LNM) than...

Importance The eighth edition tumor, node, metastasis (TNM) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) is a poor predictor of survival in patients with lymph node metastases, possibly due to the inclusion of extranodal extension (ENE). Objective To identify the key determinants of prognosis in patients with nodal metastat...

Merkel cell carcinoma is a rare cutaneous neuroendocrine tumor. It is radiosensitive so even 8 Gy/1 fraction can be successful in case reports. However to achieve long term cure, a median dose of 50 Gy/25f or equivalent is needed. Attempt to increase it to 60 Gy/30f perhaps may increase local control but does not reach statistically significance.

The optimal RT volumes for Merkel cell carcinoma are controversial, especially considering different scenarios of post radical lymph node dissection, sentinel lymph node biopsy/nodal excision/selective lymphadenectomy, or after PET scan staging. For small primary size, <= 1 cm, we wonder if the risk of nodal spread is low enough to forgo nodal elec...

Purpose: To find optimal RT volumes for MCC. Methods and Materials: We performed PubMed search, retrieved studies to analyze nodal recurrence and 5-year Kaplan-Meier cause-specific survival (5yKMCSS). Results: TABLE 1 shows patient characteristics. 84% (789/939) had initial nodal surgery: lymph node dissection (LND) 8.5% (80/939), excision 3.1% (29...

Background We aimed to identify predictors of distant metastatic recurrence (DMR) in patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases treated with curative intent. Methods Predictors of DMR were identified using Cox regression in a multicenter study of 1151 patients. Results The 5‐year risk of DMR was 9...

Highlights •This ESMO Clinical Practice Guideline provides key recommendations for managing Merkel-cell carcinoma (MCC). •Recommendations are based on available scientific data and the multidisciplinary group of experts’ collective opinion. •The guideline covers clinical and pathological diagnosis, staging and risk assessment, treatment and follow-...

Merkel cell carcinoma is an aggressive but rare cutaneous neuroendocrine malignancy arising predominantly in older Caucasians. Lesions can arise anywhere on the body, and most (50–60%) patients present with a primary lesion with the incidence of subclinical nodal spread high (30–50%). There is an extensive body of evidence supporting the addition o...

Non-melanoma skin cancer of the sun-exposed scalp is typically a squamous cell carcinoma arising in older male patients after years of chronic sun exposure. Many patients have a long preceding history of treated actinic and superficially invasive lesions of the scalp, and the concept of skin field cancerisation may be relevant. Despite a large area...

Offers a comprehensive overview on the techniques used to treat skin cancer Discusses all aspects of skin cancer, including diagnosis and treatment Addresses the technical details of radiotherapy for skin cancers

Patients with cancer and diabetes face unique challenges. Limited data are available on diabetes management in patients undergoing concurrent chemoradiotherapy (CCRT), a curative intent anticancer therapy commonly associated with glucocorticoid administration, weight fluctuations and enteral feeds. This retrospective case–control study examined the...

Introduction: Early laryngeal carcinomas may be treated by transoral laser microsurgery (TLM) or external beam radiotherapy. We review our experience of surgical treatment of laryngeal pre-malignant and malignant lesions over the past 15 years in a high-volume head neck unit. Methods: A review of a prospective patient database of patients with l...

Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common malignancy in the Caucasian population. A minority of cases are inoperable at presentation, recur or develop metastatic disease with a historical 5-year overall survival of ~10%. Treatment options in this setting are generally palliative. Immunotherapy has emerged as a...

Cutaneous squamous cell carcinoma of the head and neck (HNcSCC) is one of the commonest malignancies. When patients present with regional metastatic disease, treatment escalation results in considerable morbidity and survival is markedly reduced. Owing to the high incidence, Australian institutions have been at the forefront of advocating for relia...

Background/Objectives: An involved or close resection margin in the setting of cutaneous SCC (cSCC) is associated with the risk of developing recurrence. The scalp poses unique anatomical challenges when obtaining adequate resection margins and further treatment may be required. We aimed to investigate the risk of recurrence in patients with scalp...

Purpose Sentinel lymph node biopsy (SLNB) is being increasingly used worldwide as a minimally invasive option to stage the clinically node negative neck (N0) in patients with early oral cavity squamous cell carcinomas (OCSCC). We performed this trial to assess the reliability and validity of the technique. Materials and Methods We did this prospec...

Background Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine tumour. While dermally invasive MCC is known to have a five-year survival of only 30-40%, the prognosis and management of MCC in situ (MCCis) is not widely reported. Objective We present a systematic review to elucidate the prognosis and management of MCCis. Methods...

Purpose Determine health professionals’ (HPs’) perceptions of oral mucositis (OM), including clinical presentation of chemotherapy (CT)-induced vs radiation therapy (RT)-induced OM, its assessment and management. Methods HPs involved in the care of head and neck cancer (HNC) patients receiving RT to the oral cavity/oropharynx and haematopoietic st...

Background In developing countries, oral squamous cell carcinoma (OSCC) is predominantly a cancer affecting older males who smoke tobacco. In countries with effective public health strategies, smoking rates are declining rapidly. It is not clear if patients who develop OSCC without these traditional risk factors represent a clinically distinct coho...

Introduction Merkel cell carcinoma (MCC) is a highly aggressive skin cancer with no survival benefit demonstrated using palliative cytotoxic chemotherapy in the setting of metastatic MCC. Recently, immune checkpoint inhibitors (anti-PD-L1/PD1) have been approved in this setting after durable clinical response was demonstrated in several clinical tr...

Background Over the last few decades evidence has accumulated for increasing incidence of oral cavity squamous cell carcinoma (OSCC) in a younger cohort. Prior studies examining the effect of age at diagnosis on prognosis have produced conflicting data. Methods A multi-institutional cohort study was performed across 6 different sites in Australia,...

Background and Objectives We performed a critical analysis of the 8th edition American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) with nodal metastases and compared the performance to the N1S3 and ITEM systems. Methods Multicenter study of 990 patients with metastatic HNcSCC treated with c...

Objectives The AJCC 8th edition (AJCC 8) has introduced depth of invasion (DOI) and extranodal extension (ENE) into staging for oral squamous cell carcinoma (OSCC). Although validations have been performed on institutional datasets have shown a good performance, particularly in early OSCC, there have been no studies on diverse patient populations t...

Background Metastatic cutaneous squamous cell carcinoma to the axilla is uncommon, with limited data to guide management. We sought to assess the outcomes of patients with this condition after surgery and radiotherapy. Methods A retrospective cohort study of patients treated at two Australian hospitals from 1994 through 2016 was performed. Result...

Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine malignancy. It is a rare tumor, but its incidence is increasing. MCC occurs most frequently in elderly Caucasian males on sun-exposed areas of the skin, and immunosuppression is a risk factor. There are two etiologically diverse subtypes of MCC: one due to clonal integration of t...

Objectives We aimed to determine if the number of nodal metastases is an independent predictor of survival in HNcSCC, whether it provides additional prognostic information to the AJCC N and TNM stage and identify optimal cut-points for risk stratification. Materials and methods Retrospective multi-institutional cohort study of patients with paroti...

http://cosa-2020.p.asnevents.com.au/days/2020-11-11/abstract/70858

Purpose Increasing evidence is accumulating for an alarming rising incidence of oral tongue SCC in a younger cohort, particularly in developed countries. The aim of this study is to analyse the change in incidence of OSCC in patients under the age of 45 in developed nations in the Asia-Pacific region. Patients and methods Population data was extra...

Background The 8th edition American Joint Committee on Cancer staging manual (AJCC8) introduced a separate staging system for head and neck cutaneous squamous cell carcinoma (HNcSCC) which parallels mucosal SCC and incorporates extranodal extension (ENE). This study aims to evaluate its prognostic utility. Methods Univariate analysis of 1146 patie...

Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine tumor of the skin with an estimated disease‐associated mortality of 15–33%. Australia has a higher incidence of MCC compared to the rest of the world, thought to be due to a higher ultraviolet index. The Australian MCC population is distinct from the MCC population of the Northern he...

Background The American Joint Committee on Cancer (AJCC) staging for head and neck cutaneous squamous cell carcinoma (HNcSCC) stratifies risk poorly. We hypothesized that this results from prognostic heterogeneity within N and TNM groups. Methods Retrospective analysis of disease‐specific survival (DSS) in a multicenter study of 1146 patients with...

Treatment personalisation remains an unmet need in oropharynx cancer (OPC). We aimed to determine whether gene expression signatures improved upon clinico-pathological predictors of outcome in OPC. The clinico-pathological predictors, AJCC version 7 (AJCC 7), AJCC 8, and a clinical algorithm, were assessed in 4 public series of OPC (n = 235). Liter...

The most frequent cancer worldwide is skin cancer, occurring at epidemic rates in countries exposed to high levels of chronic ultraviolet radiation such as Australia and New Zealand (ANZ). Australia has the highest incidence of non‐melanoma skin cancer (NMSC) in the world. NMSC is predominantly a cancer of the middle aged or elderly and accounts fo...

Radiation Therapy (RT) consensus contouring guidelines in the post-operative setting for complex cutaneous squamous cell carcinoma of the head and neck (cSCCHN) have been developed by expert clinicians in the field of head and neck and dermato-oncology and members of the Head and Neck Cancer International Group (HNCIG) to assist radiation oncologis...

Background: Elderly patients with mucosal squamous cell carcinomas of the head and neck (mHNSCC) represent a challenging clinical dilemma. Methods: A retrospective review was performed of patients ≥75 years, treated with curative-intent radiotherapy for mHNSCC in two quaternary Sydney hospitals between 2007 and 2017. Results: Ninety-five patie...

This article reviews the important role of radiotherapy in the management of early non-melanoma skin cancer, in the definitive and adjuvant settings. Therapeutic considerations and appropriate patient selection will be discussed, as well as evidence for efficacy and potential side-effects. Additionally, we present some recent advances which may imp...

Background: This study assessed changes over time of survival of head and neck cutaneous squamous cell carcinoma (HNcSCC) with lymph node metastases. Methods: A multicenter analysis of 1301 patients with metastatic HNcSCC treated between 1980 and 2017. Differences in disease-specific survival (DSS) and overall survival (OS) by decade were assess...

Objectives: Tumor thickness (TT) and tumor depth of invasion (DOI) correlate with the risk of regional lymph node metastases in early oral tongue squamous cell carcinoma (OTSCC). We aimed to determine optimal cutoff points to guide elective nodal treatment in early OTSCC. Study design: This retrospective study included 145 patients treated betwe...

Background Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy with a propensity to metastasize to regional lymph nodes. Sentinel lymph node biopsy (SLNB) in patients with clinically node‐negative MCC has been utilized to identify patients with subclinical nodal metastases. This study aims to review the accuracy of SLNB in MCC an...

The global incidence of non‐melanoma skin cancer continues to increase as the global population ages with the highest incidence in the world occurring in Australian and New Zealand patients. There are numerous treatment options available for non‐melanoma skin cancer patients of which radiotherapy is an efficacious and versatile tissue preserving no...

Background Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine tumor arising on the head and neck in 40%‐50% of patients. Between 20% and 40% will harbor subclinical nodal metastasis. Methods Using search terms ‘Merkel AND sentinel’, MEDLINE, PUMED, and EMBASE databases were systematically reviewed for publications regard...

Purpose of Review The aim of this report is to review the literature on patients diagnosed with a “high-risk” cutaneous squamous cell carcinoma (cSCC), defined as the subset (5–10%) of cSCC patients at increased risk of developing predominantly local and/or regional recurrence and, to a lesser extent, distant metastasis. Recent Findings There are...

Merkel cell carcinoma (MCC) is an aggressive but rare cutaneous neuroendocrine malignancy arising predominantly in older Caucasians. Many (30–40%) will die from MCC despite treatment, usually from distant metastases. The incidence is increasing and lesions can arise anywhere on the body and are not just confined to the sun-exposed head and neck or...

Radiation oncologists are increasingly tasked with the management of elderly patients with non-melanoma skin cancer, unsuitable for surgical intervention due to inoperable lesions and/or poor performance status. In this cohort, hypofractionated radiotherapy, delivered either daily, alternative daily or once weekly is highly effective. A systematic...

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer and is usually associated with a favorable prognosis in most patients. However, a small minority of patients will be diagnosed with a high-risk cSCC (HRcSCC) and a proportion will have a poor outcome, in some cases causing death. HRcSCC is characterized by an increase in...

Introduction: TROG 09.03 prospectively studied the utility of Fluorine-18 Fluorodeoxyglucose (18-FDG) PET in the management of Merkel cell carcinoma of skin. Methods: Following consent and registration, a pre-treatment FDG-PET/CT was performed. Sites of avid disease were confirmed by cytology where practicable. Following surgery, patients with A...

Background: Immunocompromised patients with metastatic cutaneous nodal head and neck squamous cell carcinoma (HNSCC) have worse outcomes compared to the immunocompetent. The purpose of this study was to investigate the characteristics of the primary cutaneous squamous cell carcinoma (SCC), nodal pathology, and outcome between these 2 groups. Meth...

Metastases to the parotid gland are the commonest cause of parotid malignancies in many regions of the world including Australia. The most common etiology of these metastases is head and neck cutaneous squamous cell carcinoma (HNcSCC) followed by melanoma of the head and neck. This article focuses on the management of the aforementioned pathologies...

Merkel cell carcinoma (MCC) is a rare but highly aggressive skin cancer with neuroendocrine features. MCC pathogenesis is associated with either the presence of Merkel cell polyomavirus or chronic exposure to ultraviolet light (UV), which can cause a characteristic pattern of multiple DNA mutations. Notably, in the Northern hemisphere, the majority...

6008 Background: We report on the first multi-centre randomized phase III trial of post-operative radiotherapy (PORT) vs post-operative chemo-RT (CRT) in high-risk cutaneous squamous cell carcinoma of the head and neck (cSCCHN) (NCT00193895). Methods: The primary objective was to determine whether there was a freedom from loco-regional relapse (FLR...

Background: Merkel cell carcinoma (MCC) is an uncommon radiosensitive, neuroendocrine malignancy. Treatment often involves surgery; however, older, sicker patients may not be candidates for an operation. Institutions have published data favoring the role of definitive radiotherapy for macroscopic locoregional disease. Objective: Our objective wa...

Radiotherapy is a non-surgical option for patients with non-melanoma skin cancer. Lesions in middle-aged to older patients with good performance status are typically prescribed 4–5 weeks of outpatient weekday treatment. Daily radiotherapy fraction sizes of 2–3 Gy are recommended to decrease the late cutaneous consequences such as in-field hypopigme...

Skin cancer is the most common cancer observed worldwide. This chapter focuses on non‐melanoma skin cancer (NMSC), specifically basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and Merkel cell carcinoma (MCC). BCC is more common than SCC, while MCC is rare. NMSC commonly occurs on sun‐exposed areas, such as the head and neck region, with s...

Background: Head and neck cancer (HNC) encompasses a diverse group of tumors, and thus providing appropriate and tailored information to patients before, during, and after treatment is a challenge. The objective of the current study was to characterize the experience and unmet needs of patients with HNC with regard to information and support provi...

Background: Sentinel lymph node biopsy (SLNB) has become an alternative option to elective neck dissection (END) for early oral cavity squamous cell carcinoma (OCSCC) outside of Australia. We sought to assess the technical feasibility of SLNB and validate its accuracy against that of END in an Australian setting. Methods: We performed a prospect...

Background: In-transit metastasis from cutaneous squamous cell carcinoma (SCC) is an uncommon form of metastasis through lymphatics and occurs more commonly in immunosuppressed patients. Objective: To identify cases of in-transit SCC and determine patient characteristics, tumor features, management, and prognosis. Methods and materials: A mult...

Background: Lymph node density (LND) has been described as a prognostic factor for survival in patients with head and neck squamous cell carcinoma, particularly of the oral cavity. The aim of this study was to determine the prognostic significance of LND in patients with node positive oral tongue squamous cell carcinoma (OTSCC). Methods: Patient...

In most patients with a cutaneous squamous cell carcinoma (cSCC) local treatment is curative. However, a subset of patients will develop nodal metastases to draining regional lymph nodes. Most cSCC arise on the sun-exposed head and neck (HN) and subsequently the parotid and cervical nodes are the most frequent sites for the development of nodal met...

Radiotherapy has an important role in the management of patients with cutaneous malignancy. Non-melanoma skin cancer (NMSC) is the most frequent malignancy worldwide, and as such the absolute number of patients receiving radiotherapy each year is high. An often and well-documented scenario is the development of a second NMSC, if not within a previo...

Background: The prognostic variables in patients with metastatic cutaneous nodal squamous cell carcinoma (SCC) are well documented; however, the relationship between lymph node ratio (LNR) and outcome is not well researched. LNR represents the ratio of positive lymph nodes to total excised lymph nodes. We analyzed the correlation between LNR and o...

Patients with non-melanoma skin cancer (NMSC) may be managed non-surgically on the basis of relevant tumour and patient factors. This chapter presents non- surgical treatment options for the two most common NMSCs—basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The management of Merkel cell carcinoma (often non-surgically) is discussed...

Merkel cell carcinoma (MCC) is a rare aggressive cutaneous neuroendocrine malignancy which frequently metastasises to the regional lymphatic basin. Pathological assessment of regional lymph nodes with sentinel lymph node biopsy (SLNB) in patients without clinical involvement has permitted more accurate staging and more appropriate management. Nonet...

Background/objective: (18) F-fluorodeoxyglucose (FDG) positron emission tomography with simultaneous computed tomography (PET-CT) FDG PET-CT plays an important clinical role in the staging and management of Merkel cell carcinoma (MCC) although its role in stage I and II disease relative to a sentinel lymph node biopsy (SLNB) is undefined. This stu...

Skin cancer is the most common cancer observed worldwide. This chapter focuses on non-melanoma skin cancer (NMSC), specifically basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and Merkel cell carcinoma (MCC). BCC is more common than SCC, while MCC is rare. NMSC commonly occurs on sun-exposed areas, such as the head and neck region, with s...

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer in the world. A minority of patients will be given a diagnosis of a high-risk cSCC (HRcSCC) and a proportion of these will have a poor outcome. HRcSCC is characterized by an increase in aggressiveness manifested as locoregional recurrence, and occasionally death. The uti...

Perineural invasion (PNI) occurring in non-melanoma skin cancers (NMSC) is associated with an increased risk of locoregional recurrence and reduced disease-free survival. This necessitates early and accurate diagnosis, appropriate risk-stratification and a clear management strategy. The diagnosis of PNI is based on careful clinical assessment, imag...