Locally advanced non-melanomatous skin cancer: Contemporary radiotherapeutic management

McDowell, Lachlan; Yom, Sue S.

doi:10.1016/j.oraloncology.2019.104443

Cited by 9 publications

(7 citation statements)

References 89 publications

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“…There are no consensus guidelines for postoperative contouring of cutaneous SCCs for adjuvant radiotherapy, but prophylactic irradiation to the nodal basin should be considered when the risk of occult disease exceeds 15%. 23 Given the low risk of occult disease in the parotid gland (10%), a reduction in radiation to the parotid gland can be considered in very posterior lesions in the absence of any clinical or radiological suspicion, to help reduce the associated morbidity of irradiation to salivary glands, however this would require careful multi‐disciplinary discussion on a case‐by‐case basis. A reduction in dose to level 1 cervical nodal station may also be considered given the very low risk of nodal spread at 2.4%.…”

Section: Discussionmentioning

confidence: 99%

“…Ultimately the role of surgery is to adequately stage the nodal basin to determine the patients candidacy for adjuvant radiotherapy, and not to remove all microscopic disease. There are no consensus guidelines for postoperative contouring of cutaneous SCCs for adjuvant radiotherapy, but prophylactic irradiation to the nodal basin should be considered when the risk of occult disease exceeds 15% 23 . Given the low risk of occult disease in the parotid gland (10%), a reduction in radiation to the parotid gland can be considered in very posterior lesions in the absence of any clinical or radiological suspicion, to help reduce the associated morbidity of irradiation to salivary glands, however this would require careful multi‐disciplinary discussion on a case‐by‐case basis.…”

Section: Discussionmentioning

confidence: 99%

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Pattern of nodal metastasis of cutaneous squamous cell carcinoma involving the temporal bone

Hintze

O'Riordan

Jones

et al. 2022

Laryngoscope Investig Oto

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Objective: The objective of this study was to explore the pattern of lymph-node spread of SCCs involving the temporal bone. Methods:We retrospectively reviewed all cutaneous SCCs involving the temporal bone over a 20-year time-period. Forty-one patients were eligible.Results: Mean age was 72.8 years. The diagnosis was cutaneous SCC in all cases.All patients underwent a temporal bone resection, 70.7% had a neck-dissection and 78.0% a parotidectomy.Level 2 was the most common area of neck metastasis, and occurred in 12.2%. The parotid had disease in 34.1%. 51.2% of patients underwent free-flap reconstruction.Mean overall survival of the cohort was 4.2 years.Conclusions: Overall, the rate of cervical nodal metastasis was 22.0% and 13.5% in the occult setting. The parotid was involved in 34.1% and 10.0% in the occult setting.Results from the present study support consideration for performing a parotidectomy at the time of temporal bone resection, while a neck dissection can be performed for adequate staging of the nodal basin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pattern of nodal metastasis of cutaneous squamous cell carcinoma involving the temporal bone

Hintze

O'Riordan

Jones

et al. 2022

Laryngoscope Investig Oto

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“…Six cases (8.4%) required predominantly partial auriculectomy, and 3 (4.2%) required partial parotidectomy. Regarding low‐risk lesions, primary radiotherapy is indicated only in nonsurgical candidates or per patient preference, and adjuvant primary radiotherapy is recommended in the context of perineural invasion or perineural tumor spread, incomplete or close surgical margins, large tumors, locally advanced disease, lymph node involvement, or immunosuppression 26 …”

Section: Discussionmentioning

confidence: 99%

“…Regarding low-risk lesions, primary radiotherapy is indicated only in nonsurgical candidates or per patient preference, and adjuvant primary radiotherapy is recommended in the context of perineural invasion or perineural tumor spread, incomplete or close surgical margins, large tumors, locally advanced disease, lymph node involvement, or immunosuppression. 26 Various guidelines exist for the surgical management of BCC; however, the varied distribution of histologic subtypes led to alternative approaches based on individual patient factors. 27 Histologically, low-risk lesions present with nodular or superficial growth patterns, whereas high-risk lesions demonstrate aggressive growth patterns, including basosquamous, sclerosing, mixed infiltrative, or micronodular features in any portion of the tumor.…”

Section: Discussionmentioning

confidence: 99%

Treatment and Outcomes for Cutaneous Periauricular Basal Cell Carcinoma: A 16‐Year Institutional Experience

et al. 2020

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Objective To report a single institutional experience with the surgical management of cutaneous periauricular basal cell carcinoma. Study Design Retrospective chart review. Setting Tertiary academic center. Methods Retrospective chart review of 71 patients diagnosed with periauricular basal cell carcinoma managed surgically from 2000 to 2016. Data were analyzed with descriptive statistics. Results The median age at diagnosis was 73.0 years (interquartile range, 13.0). Of all lesions, 2.8% (n = 2) were preauricular, 80.3% (n = 57) auricular, and 16.9% (n=12) postauricular. Auricular subsites included conchal bowl (36.6%, n = 26), helix (21.1%, n = 15), antihelix (1.4%, n = 1), peritragus (5.6%, n = 4), triangular fossa (1.4%, n = 1), external auditory canal (2.8%, n = 2), and lobule skin (1.4%, n = 1). Surgical approach included wide local excision (80.3%, n = 57), partial auriculectomy (8.5%, n = 6), and total auriculectomy or other combinations of surgical methods (11.3%, n = 8). Due to aggressive pathology, 3 cases required concurrent parotidectomy, neck dissection, ear canal sleeve resection, or mastoidectomy. In sum, 52.1% (n = 37) of cases had clear margins on first pass in the operating room; 25.4% (n = 18) required further resection; and 12.7% (n = 9) demonstrated final positive/overturned margins read as negative from the frozen sections. Reconstruction included full-thickness (25.4%, n = 18) or superficial-thickness (29.6%, n = 21) skin grafts and local flap reconstruction (25.4%, n = 18), while 5.6% (n = 4) required combinations of free flap and/or other reconstruction techniques; 14.1% (n = 10) did not undergo formal reconstruction. Conclusion Periauricular basal cell carcinoma occurs in anatomically diverse locations in and around the ear, and multiple surgical methods are required for successful treatment.

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“…recurrence and metastasis [23][24][25][26]. Historically, post-operative radiation therapy (PORT) was used for management of perineural SCC [27]; however, the use of PORT with or without a PD-1 inhibitor is being evaluated in a clinical trial (NCT03969004-Study of Adjuvant Cemiplimab Versus Placebo After Surgery and Radiation Therapy in Patients With High Risk Cutaneous Squamous Cell Carcinoma). In contrast, some studies reported no significant changes in outcomes for patients with SCC and PNI.…”

Section: Plos Onementioning

confidence: 99%

MAGE-A3 is a prognostic biomarker for poor clinical outcome in cutaneous squamous cell carcinoma with perineural invasion via modulation of cell proliferation

et al. 2020

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Perineural invasion is a pathologic process of neoplastic dissemination along and invading into the nerves. Perineural invasion is associated with aggressive disease and a greater likelihood of poor outcomes. In this study, 3 of 9 patients with cutaneous squamous cell carcinoma and perineural invasion exhibited poor clinical outcomes. Tumors from these patients expressed high levels of MAGE-A3, a cancer testis antigen that may contribute to key processes of tumor development. In addition to perineural invasion, the tumors exhibited poor differentiation and deep invasion and were subsequently classified as Brigham and Women’s Hospital tumor stage 3. Cyclin E, A and B mRNA levels were increased in these tumors compared with normal skin tissues (102.93±15.03 vs. 27.15±4.59, 36.83±19.41 vs. 11.59±5.83, 343.77±86.49 vs. 95.65±29.25, respectively; p<0.05). A431 cutaneous squamous cell carcinoma cells pretreated with MAGE-A3 antibody exhibited a decreased percentage S-phase cells (14.13±2.8% vs. 33.97±1.1%; p<0.05) and reduced closure in scratch assays (43.88±5.49% vs. 61.17±3.97%; p = 0.0058). In a syngeneic animal model of squamous cell carcinoma, immunoblots revealed overexpression of MAGE-A3 and cyclin E, A, and B protein in tumors at 6 weeks. However, knockout of MAGE-A3 expression caused a reduction in tumor growth (mean tumor volume 155.3 mm3 vs. 3.2 mm3) compared with parental cells. These results suggest that MAGE-A3 is a key mediator in cancer progression. Moreover, elevated collagen XI and matrix metalloproteases 3, 10, 11, and 13 mRNA levels were observed in poorly differentiated cutaneous squamous cell carcinoma with perineural invasion compared with normal skin tissue (1132.56±882.7 vs. 107.62±183.62, 1118.15±1109.49 vs. 9.5±5, 2603.87±2385.26 vs. 5.29±3, 957.95±627.14 vs. 400.42±967.66, 1149.13±832.18 vs. 19.41±35.62, respectively; p<0.05). In summary, this study highlights the potential prognostic value of MAGE-A3 in clinical outcomes of cutaneous squamous cell carcinoma patients.

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Locally advanced non-melanomatous skin cancer: Contemporary radiotherapeutic management

Cited by 9 publications

References 89 publications

Pattern of nodal metastasis of cutaneous squamous cell carcinoma involving the temporal bone

Pattern of nodal metastasis of cutaneous squamous cell carcinoma involving the temporal bone

Treatment and Outcomes for Cutaneous Periauricular Basal Cell Carcinoma: A 16‐Year Institutional Experience

MAGE-A3 is a prognostic biomarker for poor clinical outcome in cutaneous squamous cell carcinoma with perineural invasion via modulation of cell proliferation

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