Inferior outcomes in immunosuppressed patients with high-risk cutaneous squamous cell carcinoma of the head and neck treated with surgery and radiation therapy

Manyam, Bindu V.; Gastman, Brian; Zhang, Alexandra Y.; Reddy, Chandana A.; Burkey, Brian B.; Scharpf, Joseph; Alam, Daniel S.; Fritz, Michael A.; Vidimos, Allison; Koyfman, Shlomo A.

doi:10.1016/j.jaad.2015.04.037

Cited by 64 publications

(36 citation statements)

References 34 publications

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“…Patients with an immune-compromised status inherently have a higher risk of developing cutaneous squamous cell carcinomas [20,21]. On top of the increased incidence, these tumors have a more insidious course of disease, justifying the need for fluorescence-guided resections [22]. Whether the same molecular targets could be used for this subset of CSCC patients was assessed by using the results of the candidates that proved usable by the TBSs, i.e., EGFR, αvβ6, and uPAR.…”

Section: Target Expression In Immune-compromised Patientsmentioning

confidence: 99%

EGFR and αvβ6 as Promising Targets for Molecular Imaging of Cutaneous and Mucosal Squamous Cell Carcinoma of the Head and Neck Region

Baart

Duijn

Egmond

et al. 2020

Cancers

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R0 resection is paramount in cutaneous squamous cell carcinoma (CSCC) and head and neck squamous cell carcinoma (HNSCC). However, in the setting of recurrence, immunocompromised patients, or non-keratinizing squamous cell carcinoma (SCC) with a spindle growth pattern, tumor borders are difficult, if not impossible, to determine. Fluorescence-guided surgery (FGS) aids in this differentiation. Potential targets for FGS of CSCC and HNSCC were evaluated. Most sections stained intensely for αvβ6 and epidermal growth factor receptor (EGFR) on tumor cells. Normal epithelium stained less for αvβ6 than for EGFR. In addition, soft tissue and stroma stained negative for both, allowing for clear discrimination of the soft tissue margin. Tumor cells weakly expressed urokinase plasminogen activator receptor (uPAR) while expression on stromal cells was moderate. Normal epithelium rarely expressed uPAR, resulting in clear discrimination of superficial margins. Tumors did not consistently express integrin β3, carcinoembryonic antigen, epithelial cell adhesion molecule, or vascular endothelial growth factor A. In conclusion, αvβ6 and EGFR allowed for precise discrimination of SSC at the surgically problematic soft tissue margins. Superficial margins are ideally distinguished with uPAR. In the future, FGS in the surgically challenging setting of cutaneous and mucosal SCC could benefit from a tailor-made approach, with EGFR and αvβ6 as targets.

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Section: Target Expression In Immune-compromised Patientsmentioning

confidence: 99%

EGFR and αvβ6 as Promising Targets for Molecular Imaging of Cutaneous and Mucosal Squamous Cell Carcinoma of the Head and Neck Region

Baart

Duijn

Egmond

et al. 2020

Cancers

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“… 8 , 9 We found a 2-year recurrence-free survival rate of 48% in the immunosuppressed population compared with 73% in the nonimmunosuppressed population for patients with locally advanced HNCSCC treated with resection and adjuvant radiotherapy. 10 As such, we often favor comprehensive treatment for these patients, including targeting nodal levels at risk and the course of the involved nerve, as we did in this patient.…”

Section: Discussionmentioning

confidence: 95%

Adjuvant radiotherapy in high-risk cutaneous squamous cell cancer of the head and neck in immunosuppressed patients

2015

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“…17,40 Immunosuppression is associated with higher rates of cSCC. 41,42 Solid organ transplant recipients, such as renal transplant patients, demonstrate a 100-fold increased risk for invasive cSCC compared with the general population. 41 Patients transplanted at an older age with a prior history of sun damage or with longer duration or greater intensity of immunosuppression may be at greater risk of developing cSCC.…”

Section: High-risk Pathological Featuresmentioning

confidence: 99%

“…43 Immunosuppression with azathioprine or calcineurin inhibitors is closely associated. 41,44 Unlike the NCCN guideline, the AJCC does not include immunosuppression as a high-risk feature of patients presenting with cSCC. 10,12 Incomplete excision of surgical margins is not currently recognized as a high-risk feature of cSCC.…”

Section: High-risk Pathological Featuresmentioning

confidence: 99%

High-risk Cutaneous Squamous Cell Carcinoma

Fitzgerald¹,

O’Neill²

2017

International Journal of Head and Neck Surgery

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Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer worldwide. Cutaneous squamous cell carcinoma can potentially be treated fully with minimal morbidity when detected early; however, certain subtypes of cSCC have been shown to confer a poorer prognosis for patients. In these high-risk tumors, increased incidence of recurrence, as well as metastasis to local lymph nodes and distant sites, is seen as a result of certain patient characteristics and pathological features. While guidelines regarding the management of high-risk cSCC have been produced, no clear consensus management or prognostic algorithms exist. In this review, we discuss current definitions of high-risk cSCC, recommendations regarding the management of cSCC, and current guidelines.

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Inferior outcomes in immunosuppressed patients with high-risk cutaneous squamous cell carcinoma of the head and neck treated with surgery and radiation therapy

Cited by 64 publications

References 34 publications

EGFR and αvβ6 as Promising Targets for Molecular Imaging of Cutaneous and Mucosal Squamous Cell Carcinoma of the Head and Neck Region

EGFR and αvβ6 as Promising Targets for Molecular Imaging of Cutaneous and Mucosal Squamous Cell Carcinoma of the Head and Neck Region

Adjuvant radiotherapy in high-risk cutaneous squamous cell cancer of the head and neck in immunosuppressed patients

High-risk Cutaneous Squamous Cell Carcinoma

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