Squamous cell carcinoma.

Nonmelanoma skin cancer is the most common cancer in the United States, with over 1.3 million cases expected to occur in the year 2001. Approximately 80 percent of nonmelanoma skin cancers are basal-cell carcinomas, and 20 percent are squamous-cell carcinomas.1 Squamous-cell carcinoma is the second most common cancer among whites.2 Unlike almost all basal-cell carcinomas, cutaneous squamous-cell carcinomas are associated with a substantial risk of metastasis. Incidence In 1994 in the United States, the lifetime risk of squamous-cell carcinoma was 9 to 14 percent among men and 4 to 9 percent among women.3 Although it is known that this neoplasm . . .

Cutaneous Squamous-Cell Carcinoma

Summary Background Cutaneous squamous-cell carcinomas (SCC) are among the most common cancers capable of metastasis. Current Tumour Node Metastasis (TNM) staging includes horizontal tumour size, involvement of extradermal structures, and degree of differentiation. The aim of this study was to prospectively analyse the key factors predicting metastasis and local recurrence in cutaneous SCC. Methods We assessed prospectively investigated potential risk factors for metastasis or local recurrence of SCC, previously suggested by retrospective studies and small case series, in 615 white patients. Between Jan 1, 1990, and Dec 31, 2001, all patients underwent surgery for cutaneous SCC with complete histological examination of the three-dimensional excision margins (3D-histology) in one centre. Univariate and multivariate analysis included tumour thickness, horizontal size, body site, histological differentiation, desmoplastic growth, history of multiple SCC, and immunosuppression. Primary endpoints were time to metastasis and time to local recurrence, defined as the time from date of diagnosis of the primary tumour to the date of diagnosis of metastasis or local recurrence, respectively. Findings 653 patients were enrolled in the study. 38 patients were lost to follow-up leaving 615 assessable patients (median age 73 years [range 27–98]). During a median follow-up period of 43 months (range 1–165), 26 (4%) of 615 patients developed metastases and 20 patients developed local recurrence (3%). Tumours 2·0 mm or less in thickness did not metastasise. Metastases occurred in 12 (4%) of 318 tumours between 2·1 mm and 6·0 mm in thickness, and in 14 (16%) of 90 tumours with a thickness greater than 6·0 mm. On multivariate analysis, key prognostic factors for metastasis were increased tumour thickness (hazard ratio 4·79 [95% CI 2·22–10·36]; p Interpretation Only SCC greater than 2·0 mm in thickness are associated with a significant risk of metastasis. Tumours greater than 6·0 mm are associated with a high risk of metastasis and local recurrence. Desmoplastic growth is an independent risk factor for local recurrence. Studies should assess the role of follow-up visits and sentinel-lymph-node biopsy in high-risk patients. Funding This study was supported by the German Research Foundation/Sonderforschungsbereich 685 and Deutsche Krebshilfe (MR), the intramural Angewandte Klinische Forschung fellowship (203-1-0) from the University Medical School, Eberhard Karls University Tuebingen (KDB), and the ‘Sudwestdeutsche Tumorzentrum'—Comprehensive Cancer Centre Tubingen (KDB, MR, HB).

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(08)70178-5.pdf

Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study.

https://www.thelancet.com/pdfs/journals/lancet/PIIS014067360961196X.pdf

Non-melanoma skin cancer

In the United States more than 100,000 people are living with solid organ transplants. The intense immunosuppressive regimens necessary for prolonged survival of allografts significantly increase the rates of both internal and cutaneous malignancies in recipients of solid organ transplants. Skin cancer is the most common cancer in patients after transplantation. Because of the early onset and high tumor burden in transplant recipients, dermatologists have significant challenges in managing the treatment of these patients. This article describes the epidemiology and clinical presentation of skin cancer during posttransplantation immunosuppression, discusses pathogenic cofactors, and reviews the optimal management for mild and severe skin cancer in transplant recipients.

Skin cancer in organ transplant recipients: Epidemiology, pathogenesis, and management.

We reviewed all studies since 1940 on the prognosis of squamous cell carcinoma (SCC) of the skin and lip. The following variables are correlated with local recurrence and metastatic rates: (1) treatment modality, (2) prior treatment, (3) location, (4) size, (5) depth, (6) histologic differentiation, (7) histologic evidence of perineural involvement, (8) precipitating factors other than ultraviolet light, and (9) host immunosuppression. Local recurrences occur less frequently when SCC is treated by Mohs micrographic surgery. This local recurrence rate differential in favor of Mohs micrographic surgery holds true for primary SCC of the skin and lip (3.1% vs 10.9%), for ear SCC (5.3% vs 18.7%), for locally recurrent (previously treated) SCC (10% vs 23.3%), for SCC with perineural involvement (0% Ys 47%), for SCC of size greater than 2 cm (25.2% vs 41.7%), and for SCC that is poorly differentiated (32.6% vs 53.6%).

Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip : implications for treatment modality selection

The striking impression obtained from reviewing the cancer literature is how difficult it is to analyze the data for answers to many important biologic, behavioral, prognostic, and therapeutic questions about squamous cell carcinoma of the skin. This article addresses current concepts, controversies, and management of cutaneous squamous cell carcinoma (excluding the lip and oral mucosa).

Squamous cell carcinoma of the skin (excluding lip and oral mucosa).

background. It was noted that females, particularly young females, outnumbered males with basal cell Carcinoma (BCC) of the upper lip among patients treated by Mohs micrographic surgery in Vancouver, British Columbia.

objective. To investigate female-to-male ratios for BCC of the upper lip at the Vancouver Mohs micrographic surgery Service, and to compare this with data from the provincial-wide registry as well as with worldwide data in the literature.

methods. The female-to-male ratios by age group were determined for 136 upper lip lesions treated at the Mohs Service from 1983 to 1992. Similar data were obtained from 731 perioral BCCs recorded at the provincial-wide registry from 1982 to 1989. The literature was reviewed for comparative data worldwide.

results. At the Mohs Service females outnumber males 3.5:1 for upper lip BCCs. Young females 30–39 years old outnumber males 16:1. Regional data from the British Columbia Cancer Registry confirm that females outnumber males 2:1 for the lip region (including upper lip, lower lip, nasolabial fold). This is significant when compared with all BCCs diagnosed in the prov-ince (ie, all sites), in which males outnumber females 1.3:1. Data from the literature worldwide confirm this relationship.

conclusion. BCC of the upper lip is a female-predominated disease. Young females are at a much higher risk for this disease than young males.

Females vastly outnumber males in basal cell carcinoma of the upper lip. A peculiar subset of high risk young females is described.

The practice of dermatology has always carried with it the risk of patient-acquired infection. This review covers health risks associated with the care of HIV-infected patients and patients who are chronic carriers of hepatitis B or C virus, protection options to reduce exposure, and protocols should exposure occur. Hepatitis B continues to be a major risk to health care workers, killing approximately 200 per year. In contrast, as of 1990, only 327 total health care personnel had acquired HIV, with no deaths reported. Data are lacking regarding hepatitis C, but it appears to be an increasing concern. Needlesticks are the most common form of occupational transmission, with an infectivity rate of 30% for hepatitis B, 3% for hepatitis C, and 0.3% for HIV. Universal precautions are the cornerstones of safety. Hepatitis B vaccination, zidovudine prophylaxis, and hepatitis C therapy are discussed as postexposure recommendations are reviewed.

Dan E. Rowe

Papers

Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip : implications for treatment modality selection

Squamous cell carcinoma of the skin (excluding lip and oral mucosa).

Females vastly outnumber males in basal cell carcinoma of the upper lip. A peculiar subset of high risk young females is described.

Hepatitis, HIV, and the dermatologist: A risk review