Consensus for Nonmelanoma Skin Cancer Treatment

Kauvar, Arielle N. B.; Cronin, Terrence A.; Roenigk, Randall K.; Hruza, George J.; Bennett, Richard G.

doi:10.1097/dss.0000000000000296

Cited by 141 publications

(72 citation statements)

References 126 publications

(154 reference statements)

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“…1–5 However, skin biopsy is an invasive procedure, takes days to process for pathology, and the limited sampling may lead to incomplete diagnostic assessment. Limited sampling during biopsy and pathology processing 6,7 fails to identify deeper and aggressive tumors in 1 of 6 cases, especially in mixed-histological subtypes 8,9 and in those superficial and nodular BCCs which have deeper components.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

et al. 2018

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IMPORTANCE The limited tissue sampling of a biopsy can lead to an incomplete assessment of basal cell carcinoma (BCC) subtypes and depth. Reflectance confocal microscopy (RCM) combined with optical coherence tomography (OCT) imaging may enable real-time, noninvasive, comprehensive three-dimensional sampling in vivo, which may improve the diagnostic accuracy and margin assessment of BCCs.OBJECTIVE To determine the accuracy of a combined RCM-OCT device for BCC detection and deep margin assessment. DESIGN, SETTING, AND PARTICIPANTSThis pilot study was carried out on 85 lesions from 55 patients referred for physician consultation or Mohs surgery at Memorial Sloan Kettering Skin Cancer Center in Hauppauge, New York. These patients were prospectively and consecutively enrolled in the study between January 1, 2017, and December 31, 2017. Patients underwent imaging, with the combined RCM-OCT probe, for previously biopsied, histopathologically confirmed BCCs and lesions clinically or dermoscopically suggestive of BCC. Only patients with available histopathologic examination after imaging were included. MAIN OUTCOMES AND MEASURESImprovements in sensitivity, specificity, and diagnostic accuracy for BCC using the combined RCM-OCT probe as well as the correlation between OCT-estimated depth and histopathologically measured depth were investigated. RESULTSIn total, 85 lesions from 55 patients (27 [49%] were female and 28 [51%] were male with a median [range] age of 59 [21-90] years) were imaged. Imaging was performed on 25 previously biopsied and histopathologically confirmed BCCs and 60 previously nonbiopsied but clinically or dermoscopically suspicious lesions. Normal skin and BCC features were correlated and validated with histopathologic examination. In previously biopsied lesions, residual tumors were detected in 12 of 25 (48%) lesions with 100% sensitivity (95% CI, 73.5%-100%) and 23.1% specificity (95% CI, 5.0%-53.8%) for combined RCM-OCT probe. In previously nonbiopsied and suspicious lesions, BCCs were diagnosed in 48 of 60 (80%) lesions with 100% sensitivity (95% CI, 92.6%-100%) and 75% specificity (95% CI, 42.8%-94.5%). Correlation was observed between depth estimated with OCT and depth measured with histopathologic examination: the coefficient of determination (R 2 ) was 0.75 (R = 0.86; P < .001) for all lesions, 0.73 (R = 0.85; P < .001) for lesions less than 500 μm deep, and 0.65 (R = 0.43; P < .001) for lesions greater than 500 μm deep. CONCLUSIONS AND RELEVANCECombined RCM-OCT imaging may be prospectively used to comprehensively diagnose lesions suggestive of BCC and triage for treatment. Further validation of this device must be performed on a larger cohort.

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Section: Introductionmentioning

confidence: 99%

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

et al. 2018

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“…Moreover, as observed in our cohort too, periocular tumors tend to develop in fair-skin patients over 60 years of age, who have a history of significant sun exposure [20, 22] – all factors which are known to be associated with the development of skin cancer at any site [23-25], hence concomitant skin cancer is not rare. Among the therapy options for periocular malignancies, such as surgery, RT, cryotherapy, topical immunomodulatory drugs and photodynamic therapy, Mohs’ micrographic surgery or intraoperative frozen section is the mainstay of treatment for invasive tumors [4-9, 21]. The 5-year recurrence of periocular skin tumors after Mohs’ micrographic surgery is reported to be 2.0% in BCC [21] and 3.6% in SCC [20].…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, in situ lesions, such as actinic keratosis (AK) and Bowen’s disease (BD), can affect the periocular skin [2, 3]. Although the majority of cutaneous neoplasms can be treated by excision [4-9], excessive surgical intervention in the periocular site may lead to anatomical dysfunction and poor aesthetic outcome [10-12]. Less invasive approaches, such as photodynamic therapy or cryotherapy, represent a treatment option for superficial cutaneous neoplasms [7-9].…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy in Periocular Cutaneous Malignancies: A Retrospective Study

et al. 2019

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Background: Due to the importance of function and cosmetics, periocular skin malignancies represent a therapeutic challenge. Objective: To evaluate the safety and efficacy of radiotherapy (RT) treating periocular skin tumors. Methods: Data of patients with periocular tumors treated with grenz or soft X-rays at the University Hospital Zurich, Switzerland, between 2009 and 2014 were reviewed. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with associated in situ lesions, cutaneous melanoma, lentigo maligna (LM), cutaneous lymphoma and Kaposi’s sarcoma were included in the analysis. Results: We found 159 periocular lesions in 145 patients. Overall recurrence was highest for actinic keratosis and Bowen’s disease (27%), melanoma (17%) and LM (15%), whereas SCC and BCC showed recurrence in 11 and 10%, respectively. 45% of all recurrences occurred within 12 months after treatment, with a median time to recurrence of 13 months (range 3–73). Conclusion: RT, which provides a good therapeutic response with minimal adverse events, is a therapy option for periocular cutaneous malignancies.

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“…BCCs are commonly slow-growing tumors that rarely metastasize. Nonetheless, they can be locally invasive and result in considerable cosmetic, functional, and economic burdens 1,7…”

Section: Introductionmentioning

confidence: 99%

“…Surgical excision with predetermined margins is one of the most widely used and effective treatment strategies for well-defined BCCs; Mohs micrographic surgery is generally applied to higher-risk tumors and those in cosmetically sensitive areas 7,8. For superficial BCCs (sBCCs) of small size on the trunk or limbs, electrodessication and curettage (EDC) is an acceptable option of treatment 7–10…”

Section: Introductionmentioning

confidence: 99%

Treatment of superficial basal cell carcinoma with ingenol mebutate gel, 0.05%

Bettencourt

2016

CCID

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BackgroundBasal cell carcinoma (BCC) is the most common cancer in Caucasians. Surgical approaches are the most widely used and effective treatment strategies for well-defined BCC. However, for patients with low-risk, superficial BCCs (sBCCs), medical therapy may be a treatment option. In this small case series, we describe our experience in using topical treatment with ingenol mebutate gel, 0.05%, for patients who refused surgical treatment for sBCC.MethodsWe conducted a retrospective chart review of seven patients from our community dermatology practice for whom sBCC was treated with ingenol mebutate. The chart review extracted information on demography, dermatologic history, and prior treatment for actinic keratosis or skin cancer. Summary of the treatment outcome with ingenol mebutate included the size and location of the sBCCs, description of administration, local skin reactions, adverse events, and efficacy.ResultsHistopathologic analysis of a shave biopsy sample of suspicious lesions on the trunk confirmed nine sBCCs: a single sBCC in five patients and two well-separated lesions in each of the other two patients. Patients were treated at 10 to 14 days after shave biopsy; biopsy sites were not required to be fully healed. Lesions were either occluded using a standard adhesive bandage (n=6) or not occluded (n=3). All patients experienced local skin reactions that began on day 1 or 2 of treatment, peaked on days 2 to 7, and were largely resolved at 2 weeks. All sBCCs were clinically resolved on short-term follow-up at 2 to 4 weeks. Repeat biopsy of six lesion sites in four patients at 3 or 4 months confirmed histologic clearance. There were no clinically suspicious lesions in any patients at subsequent follow-up evaluations at 3-month intervals. The longest follow-up to date has been 14 months.ConclusionIngenol mebutate gel, 0.05%, was efficacious and well tolerated for the treatment of biopsy-confirmed sBCCs on the trunk in seven patients.

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Consensus for Nonmelanoma Skin Cancer Treatment

Cited by 141 publications

References 126 publications

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

Radiotherapy in Periocular Cutaneous Malignancies: A Retrospective Study

Treatment of superficial basal cell carcinoma with ingenol mebutate gel, 0.05%

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