Method of Assessing Skin Cancerization and KeratosesTM (MASCK™): development and photographic validation in multiple anatomical sites of a novel assessment tool intended for clinical evaluation of patients with extensive skin field cancerization

Baker, Christopher M.; James, Amelia C; Supranowicz, Madeleine; Spelman, Lynda; Shumack, Stephen; Cole, J.M.; Weightman, Warren; Sinclair, Robert J.; Foley, Peter

doi:10.1111/ced.15136

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…Increased disease severity, and by extension, treatment outcome, is difficult to assess for field cancerization. Although new grading scales are designed to capture severity in the context of new lesions, 4 more studies are required for widespread clinical utilization. Combining objective grading into treatment algorithms 5,30,31 will assist in establishing clearer metrics of treatment success in the future.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Genotypic changes manifest as a spectrum of severity, including actinic damage, actinic keratoses (AKs) of increasing number, thickness and distribution. 1,4,5 Extensive skin field cancerization (ESFC) is a new concept without a clear definition but refers to particularly broad, contiguous areas of disease involvement, generally ≥50 cm 2 , or an entire anatomic unit of skin. 6 Patients often have a history of multiple field therapies, high keratinocyte cancer (KC) burden [7][8][9][10][11] and poor quality of life (QoL).…”

Section: Introductionmentioning

confidence: 99%

“…Skin field cancerization is the clinical term used to describe damage resulting from chronic solar exposure and associated ultraviolet light (UVL)‐induced DNA mutations 1–3 . Genotypic changes manifest as a spectrum of severity, including actinic damage, actinic keratoses (AKs) of increasing number, thickness and distribution 1,4,5 . Extensive skin field cancerization (ESFC) is a new concept without a clear definition but refers to particularly broad, contiguous areas of disease involvement, generally ≥50 cm 2 , or an entire anatomic unit of skin 6 .…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety analysis: 24‐month outcomes from a prospective cohort of 106 fields treated with widefield radiation therapy for extensive skin field cancerization, with or without keratinocyte cancers

Spelman,

Potter,

Baker

et al. 2023

JEADV Clinical Practice

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BackgroundWidefield radiation therapy (RT) has emerged as a treatment option for extensive skin field cancerization (ESFC), with or without keratinocyte cancer (KC).ObjectivesTo assess the long‐term efficacy, safety, cosmesis and quality of life outcomes for patients with ESFC ± KC receiving widefield RT.MethodsNDROR (National Dermatology Radiation Oncology Registry) is an open‐label, prospective, nonrandomized, multicentre registry of patients receiving widefield RT at 11 Australian radiation oncology clinics from a single organization. Field/lesion clearance efficacy and cosmesis were assessed in a cohort of patients with at least 24 months follow‐up. Patient‐reported quality of life using EQ‐5D‐5L questionnaires was performed at each visit. Toxicity analysis was performed on data from patients who completed treatment and had at least 3 months follow‐up.ResultsCombined investigator‐assessed field treatment success and lesion clearance at 24 months were ≥96% and 93.5%, respectively. The incidence of new KC within the treated field was 10%. Common Terminology Criteria for Adverse Event grade 1–2 radiation‐induced skin toxicities were reported in >92% of fields at the end of treatment, with 5.8% of fields exhibiting grade 3 toxicities. Toxicity resolved rapidly at the cessation of treatment, with grade 1–2 alopecia and xerosis the most prevalent toxicities after 24 months (51.8% and 43.4%, respectively). Cosmesis in treated fields was assessed as excellent or good in 98% of fields at 24 months. Quality of life significantly improved compared to baseline (baseline: mean visual analogue scale (VAS) 80.65, n = 183) at 24 months follow‐up (mean VAS 84.32, N = 83; improvement of 3.67; p = 0.026).ConclusionsThis analysis indicates that widefield RT is an effective and generally well‐tolerated treatment for ESFC ± KC. Treatment has a favourable safety and cosmesis profile within the period of follow‐up and is associated with significant improvements in quality of life for patients. Widefield RT may be considered for certain patients with extensive disease who have exhausted or are unsuitable for other therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety analysis: 24‐month outcomes from a prospective cohort of 106 fields treated with widefield radiation therapy for extensive skin field cancerization, with or without keratinocyte cancers

Spelman,

Potter,

Baker

et al. 2023

JEADV Clinical Practice

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“…Although the Olsen classification failed to reliably correlate with the histological severity of the lesions, it has been shown to be strongly correlated with the risk of cSCC development in a recent study 48 . Other clinical severity indexes have been proposed considering the entire area affected by AKs 49‐51 . Additionally, a recent practice related approach classified AK based on the overall burden of disease into the following categories 52 : (1) single AK (less than 5 AKs in a defined field), (2) multiple AKs (6+ lesions in a defined field), (3) field cancerization (6+ lesions associated with sun‐damaged skin and hyperkeratosis) and (4) AKs associated with immunosuppression.…”

Section: Clinical and Non‐invasive Diagnosis Of Aksmentioning

confidence: 99%

European consensus‐based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV‐induced dysplasia and field cancerization on behalf of European Association of Dermato‐Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes)

Kandolf,

Peris,

Malvehy

et al. 2024

Acad Dermatol Venereol

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A collaboration of multidisciplinary experts from the European Association of Dermato‐Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line‐field confocal‐OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment‐refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non‐hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self‐examination and repeated field cancerization treatments of previously affected skin areas in high‐risk patients are advised.

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“…Recently, the Method of Assessing Skin Cancerization and Keratoses (MASCK) was also developed [21]. It was created to provide a comprehensive score that objectively assesses the severity of extensive skin field cancerization area on any anatomical site or zone pre or post-treatment.…”

Section: Classification and Grading Of Akmentioning

confidence: 99%

An Update on Non-Invasive Skin Imaging Techniques in Actinic Keratosis—A Narrative Review

Korecka,

Kwiatkowska,

Mazur

et al. 2024

Medicina

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Nonmelanocytic skin cancers (NMSCs) are currently the most common group of human cancers and include all tumors that are not melanomas. Increased exposure to sunlight over the past few years, the lack of regular and proper use of sunscreen, the aging of the population, and better screening techniques are the reasons for the escalation in their diagnosis. Squamous cell carcinoma (SCC) comprises nearly 37% of the tumors in this group and can originate from actinic keratosis (AK), which usually presents as pink, often scaly plaques, usually located on the face or scalp. Advances in dermatoscopy, as well as the development of other non-invasive skin imaging modalities such as high-frequency ultrasound (HFUS), reflectance confocal microscopy (RCM), and optical coherence tomography (OCT), have allowed for greatly increased sensitivity in diagnosing these lesions and monitoring their treatment. Since AK therapy is usually local, and SCCs must be removed surgically, non-invasive imaging methods enable to correctly qualify difficult lesions. This is especially important given that they are very often located on the face, and achieving an appropriate cosmetic result after treatments in this area is very important for the patients. In this review, the authors describe the use of non-invasive skin imaging methods in the diagnosis of actinic keratosis.

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Method of Assessing Skin Cancerization and KeratosesTM (MASCK™): development and photographic validation in multiple anatomical sites of a novel assessment tool intended for clinical evaluation of patients with extensive skin field cancerization

Cited by 7 publications

References 29 publications

Efficacy and safety analysis: 24‐month outcomes from a prospective cohort of 106 fields treated with widefield radiation therapy for extensive skin field cancerization, with or without keratinocyte cancers

Efficacy and safety analysis: 24‐month outcomes from a prospective cohort of 106 fields treated with widefield radiation therapy for extensive skin field cancerization, with or without keratinocyte cancers

An Update on Non-Invasive Skin Imaging Techniques in Actinic Keratosis—A Narrative Review

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