Management of Incompletely Excised Skin Tumors: Our Experience

Robertson, Bernard F.; Wokes, James; Siddiqui, H.

doi:10.1097/dss.0000000000001323

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…A total of 106 832 BCC and 21 569 SCC excisions were included. These were excised from 53 796 patients across all studies (25 studies did not report the number of patients, instead reporting the number of lesions only) 16,17,34,49,59,60,62,68,69,71‐74,78,81,95,103,106,108,111,114,119,131,133,134 . The mean (± SD) age of patients undergoing BCC excision was 67·4 (± 14·9 years) and for SCC excision was 70·9 (± 14·1 years).…”

Section: Resultsmentioning

confidence: 99%

“…With SCC the margin used in different studies was infrequently reported in the larger studies. 17,42,59,78,106,114,124,128 When it was reported, several studies found no association between wider margins and reduced proportion of incomplete excision, 8,91 often as the deep margin was primarily affected. 91 This systematic review highlights that the current skin cancer pathways are effective, with dermatologists excising large numbers of low-risk lesions, while plastic, ophthalmological, and head and neck surgeons deal with more difficult lesions that may additionally require reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…These factors would be best explored using Bayesian techniques. With SCC the margin used in different studies was infrequently reported in the larger studies 17,42,59,78,106,114,124,128 . When it was reported, several studies found no association between wider margins and reduced proportion of incomplete excision, 8,91 often as the deep margin was primarily affected 91 …”

Section: Discussionmentioning

confidence: 99%

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Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*

et al. 2020

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Summary Background Keratinocyte or nonmelanoma skin cancer (NMSC) is the commonest malignancy worldwide. The usual treatment is surgical excision. Current guidelines underestimate incomplete excision rates. Objectives We aimed to determine the risk of incomplete excision of NMSCs through a systematic review and meta‐analysis of primary clinical studies. Methods A PRISMA‐compliant systematic review and meta‐analysis was performed using methodology proposed by Cochrane (PROSPERO CRD42019157936). A comprehensive search strategy was applied to MEDLINE, Embase, Scopus, CINAHL, EMCare, Cochrane Library and the grey literature (January 2000–27 November 2019). All studies were included except those on Mohs micrographic surgery, frozen section or biopsies. Abstract screening and data extraction were performed in duplicate. Risk of bias was assessed using a tool for prevalence/incidence studies. The primary outcome was the proportion of incomplete surgical excisions. A random‐effects model for pooling of binomial data was used. Differences between proportions were assessed by subgroup meta‐analysis and meta‐regression, which were presented as risk ratios (RRs). Results Searching identified 3477 records, with 110 studies included, comprising 53 796 patients with 106 832 basal cell carcinomas (BCCs) and 21 569 squamous cell carcinomas (SCCs). The proportion of incomplete excisions for BCC was 11·0% [95% confidence interval (CI) 9·7–12·4] and for SCC 9·4% (95% CI 7·6–11·4). Proportions of incomplete excisions by specialty were: dermatology, BCCs 6·2% and SCCs 4·7%; plastic surgery, BCCs 9·4% and SCCs 8·2%; general practitioners, BCCs 20·4% and SCCs 18·9%. The risk of incomplete excision for general practitioners was four times that of dermatologists for both BCCs (RR 3·9, 95% CI 2·0–7·3) and SCCs (RR 4·8, 95% CI 1·0–22·8). Studies were heterogeneous (I2 = 98%) and at high risk of bias. Conclusions The proportion of incomplete excisions is higher than previously reported. Excisions performed by specialists may lower the risk of incomplete excision.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*

et al. 2020

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“…In the other study, perineural invasion was not associated with incomplete excision ( 29 ). Re-excision was considered in 4 studies as a possible risk factor; only Tan et al ( 6 ) found a positive association with incomplete excision ( p < 0.001) ( 6 , 17 , 20 , 26 ).…”

Section: Resultsmentioning

confidence: 99%

Incomplete Excision of Cutaneous Squamous Cell Carcinoma; Systematic Review of the Literature

Genders

Marsidi²,

Michi³

et al. 2020

Acta Derm Venereol

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Treatment of choice for cutaneous squamous cell carcinoma is complete surgical excision. Incomplete excision of cutaneous squamous cell carcinoma has an increased risk of local recurrence, deep subclinical progression and increased risk of metastasis. In this systematic review, incomplete excision rates for cutaneous squamous cell carcinoma ranged from 0.4% to 35.7%. An overall incomplete excision rate of 13% was calculated. Risk factors include location in the head & neck area, tumor depth and size, invasive growth, type of operator and re-excision. These factors should be taken into account in the management of cutaneous squamous cell carcinoma surgical treatment. The treatment of choice for cutaneous squamous cell carcinoma is complete surgical excision. Incomplete excision of cutaneous squamous cell carcinoma has an increased risk of local recurrence, deep subclinical progression, and metastasis. This study aimed to investigate the proportion and risk factors of incomplete excised cutaneous squamous cell carcinoma. A systematic review of the literature was performed. Incomplete excision rates for cutaneous squamous cell carcinoma ranged from 0.4% to 35.7%. The pooled incomplete excision risk estimate was 13% (95% confidence interval 9-17%). Risk factors noted in more than one study for incomplete excision included tumor depth and size, type of operator, head and neck localization, and former incomplete excision. We found an overall incomplete excision rate of 13% for cutaneous squamous cell carcinoma. Risk factors should be taken into account in the management of cutaneous squamous cell carcinoma surgical treatment.

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“…4–, 6 One of the most effective therapeutic approaches at the early stages for skin cancers include misplaced surgical tumor excision 1, 2 ; however, surgery can result in disfigurement, requiring skin grafts for covering the defects, and such surgeries can be quite costly-prohibitively so for some patients. 7–9 Arresting proliferation or inducing programmed cell death in proliferating cancer cells is another effective cancer therapy option. 10–13 Significant advances have been made toward a better understanding of mechanisms through which melanoma and non-melanoma skin cancers are triggered and sustained.…”

Section: Introductionmentioning

confidence: 99%

Identification of potential inhibitors of cutaneous Melanoma and Non-Melanoma skin cancer cells through in-vitro and in-silico screening of a small library of Phenolic compounds

Boateng

Roy

Agbo

et al. 2022

Preprint

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Melanoma and nonmelanoma skin cancer are the most lethal and commonest forms of skin cancers affecting one fifth of the US population. With the aim of identifying new lead compounds as starting point for attaining cost effective therapies, a small library of about 90 molecules was screened in vitro against A375, SKMEL28, A431, SCC12 skin cancer cell lines. About 35 of them, mainly dihydroquinolines, CC and CN linked biphenyls, and substituted methyl gallate or aniline derivatives, displayed low micromolar range activities, primarily against the A431 and SCC12 squamous carcinoma cell lines, with only a handful of these compounds displaying any activity against the A375 and SKMEL28 melanoma cell lines. Compounds 11 (A431: IC50 = 5.0 lower case Greek muM, SCC12: IC50 = 2.9 lower case Greek muM, SKMEL-28: IC50 = 4.9 lower case Greek muM, A375: IC50 = 6.7 lower case Greek muM) and 13 (A431: IC50 = 5.0 lower case Greek muM, SCC-12: IC50 = 3.3 lower case Greek muM, SKMEL-28: IC50 = 13.8 lower case Greek muM, A375: IC50 = 17.1 lower case Greek muM) were the most active across all these cell lines. Furthermore, many of the hit compounds showed little to no activity against mammalian nontumorigenic immortalized HaCaT cells, with a far better selectivity index than cisplatin (a well-known anticancer agent used as a positive control). Compounds 11 and 13 significantly and dose dependently induced apoptosis of SCC12 and SKMEL28 cells as evidenced by the downregulation of Bcl2 and upregulation of Bax protein expression levels, and by cleaved caspase 3, caspase 9 and PARP levels. Both agents also significantly reduced scratch wound healing, colony formation, and activated expression levels of major cancer molecular targets such as RSK/AKT/ERK1/2 and S6K1. To provide a better attribute profile for each of the hit molecules, in silico target(s) prediction, pharmacokinetic and ADMET studies are also reported, together with some preliminary structure activity relationship outlines. The SwissTargetPrediction web-based tool identified CDK8, CLK4, nuclear receptor ROR, tyrosine protein-kinase Fyn/LCK, ROCK1/2, and PARP, all of which are dysregulated in skin cancers, as likely targets for these hit compounds. Furthermore, the SwissADME web_tool predicted these compounds to exhibit high GI tract absorption, good skin permeation, and a viable biodegradability profile. To summarize, these data highlight the promising anticancer potential of these small molecules leads, warranting further investigation and/or optimization towards obtaining clinical candidates for combatting both melanoma and nonmelanoma skin cancers.

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Management of Incompletely Excised Skin Tumors: Our Experience

Abstract: In the authors' region, local surgical management of incompletely excised skin tumors has yielded results comparable to Mohs surgery. Mohs surgery remains a viable option in specific cases.

Cited by 9 publications

References 11 publications

Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*

Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*

Incomplete Excision of Cutaneous Squamous Cell Carcinoma; Systematic Review of the Literature

Identification of potential inhibitors of cutaneous Melanoma and Non-Melanoma skin cancer cells through in-vitro and in-silico screening of a small library of Phenolic compounds

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