Dermatoscopy of Neoplastic Skin Lesions: Recent Advances, Updates, and Revisions

Non-melanoma skin cancer includes several types of cutaneous tumors, with basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) as the commonest. Among the available therapeutic options, surgical excision is the mainstay of treatment for both tumors. However, tumor features and patients' comorbidities may limit the use of these techniques, making the treatment challenging. As regards BCC, even if hedgehog inhibitors revolutionized the therapeutic scenario, there are still patients unresponsive or intolerant to these drugs. In this context, cemiplimab has been approved as second-line treatment. As regards SCC, cemiplimab was the first systemic therapy approved. The objective of this manuscript was to investigate the efficacy and safety of cemiplimab for the management of BCC and cSCC. Cemiplimab has a durable and significant effect for the management of BCC and CSCC, with a favorable safety profile. Different specialists including oncologists, radiologists, dermatologists, and surgeons are required to guarantee an integrated approach, leading to the best management of patients. Moreover, the collaboration among specialists will allow them to best manage the TEAEs, reducing the risk of treatment suspension or discontinuation. Certainly, ongoing studies and more and more emerging real-world evidence, will allow us to better characterize the role of cemiplimab for the management of advanced non-melanoma skin cancer.

Introduction: The baseline data of primary malignant cutaneous soft tissue tumors in this environment had been determined. It is important that as the years roll by, data collection and analyses are indispensable to determine the current trend of this tumor on one hand and compare it with the baseline data from previous studies on the other hand. The aim of this study is therefore to determine the frequency and the histopathological types of primary malignant cutaneous soft tissue tumors at the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. Methodology: This was a retrospective study of all primary malignant cutaneous soft tissue tumors that were histologically diagnosed from 1st of January 2004 to 31st of December 2013 in the Department of Morbid Anatomy, UBTH. Data were obtained from departmental archives. Data analysis was done using the SPSS statistical package version 16 (V.16.0). Results: A total of 187 malignant cutaneous tumors were diagnosed over the study period, and 87 (46.52%) of these cases were primary malignant cutaneous soft tissue tumors. Their mean age was in the fourth decade of life. Females were slightly more affected with a male:female ratio of 1:1.2. The histopathological types were angiosarcomas (2.3%), dermatofibrosarcoma protuberance (10.3%), and Kaposi's sarcoma (87.4%) in increasing order of frequency. Conclusion: The earlier determined reference point data of primary cutaneous soft tissue tumors in our environment were updated to include cutaneous angiosarcoma, thus bringing this rare tumor to the attention of both the pathologist and dermatologist. An increase in the frequency of dermatofibrosarcoma protuberance and Kaposi's sarcoma was also noted.

Management of Non-melanoma Skin Cancer

PurposeTo report our experience with the delivery of passively scattered proton therapy in the management of nonmelanoma skin cancers with clinical perineural invasion.Materials and MethodsWe reviewed the medical records of patients who received definitive or postoperative proton therapy for nonmelanoma skin cancer with clinical perineural invasion at our institution and updated patient follow-up when possible. All patients were treated with curative intent with or without the delivery of concurrent systemic therapy. We report disease control rates and the rates of late toxicity among this cohort.ResultsTwenty-six patients treated between 2008 and 2017 were included in the analysis. Following proton therapy, the 3-year overall, cause-specific, and disease-free survival rates were 59%, 73%, and 60%, respectively. The 3-year local control, local regional control, and distant metastasis-free survival rates were 80%, 65%, and 96%, respectively. On univariate analysis, surgical resection before radiation therapy significantly improved local regional control rates at 3 years (55% versus 86%; P = .04). Grade 3+ late toxicities occurred in 13 patients (50%) and the most common toxicities included grade 3+ keratitis of the ipsilateral eye, which occurred in 4 patients (15%) and grade 3+ brain necrosis in 4 patients (15%).ConclusionProton therapy is effective in the management of nonmelanoma skin cancer with clinical perineural invasion. Although disease control and complication rates compare favorably to those previously published for photon-based radiation therapy, the risk for late toxicity is significant and patients should be appropriately counseled.

Non-melanoma skin cancer is the most frequently diagnosed malignancy worldwide and regularly presents in the head and neck region. As a result, dental professionals are in a key position to identify suspected cases and provide an onward referral. The specialist management of these patients requires a team approach. Although surgery is the mainstay of treatment, radiotherapy may be employed as a definitive or adjuvant treatment modality. This article provides an overview of the epidemiology, presentation and management of non-melanoma skin cancer as well as the interdisciplinary work between the restorative consultant and radiotherapy department to provide an innovative custom-made radiotherapy bolus. CPD/Clinical Relevance: To raise awareness of the presentation and management of non-melanoma skin cancer and the role of the restorative dentist within the multidisciplinary team.

Management of Non-melanoma Skin Cancer in Transplant Recipients

Introduction Teledermatology, which utilizes communication technologies to remotely assess skin lesions, has become a vital tool in healthcare. This study aimed to compare the diagnostic accuracy of teledermatology versus face-to-face examination and explore factors influencing accuracy, such as teledermatoscopy use, dermatoscopy type, and clinical experience. Methods Fifty-seven cutaneous tumors were evaluated using handheld or digital dermatoscopy in face-to-face examinations, and preliminary diagnoses were recorded. A definitive diagnosis was established through histopathological examination, which served as the reference standard. Macro and dermatoscopic images were then sent to six teledermatologists for remote diagnosis, and findings were analyzed statistically. Results The preliminary diagnosis matched the histopathological diagnosis in 84.2% of face-to-face cases. Teledermatologists achieved 63.7% accuracy with macro images alone, increasing to 70.8% with dermatoscopic images. Teledermatology showed lower accuracy than face-to-face examination, regardless of whether teledermatoscopy was used (p < 0.05), but accuracy significantly improved with dermatoscopic images (p = 0.004). The teledermatology’s accuracy for malignancy prediction was comparable to face-to-face examination (p > 0.05). Dermatoscopy type did not significantly impact accuracy (p > 0.05), while longer clinical experience correlated with higher accuracy (p < 0.05). Interrater reliability was poor for specific diagnoses but improved when categorizing lesions as malignant or benign (κ = 0.192, κ = 0.683). Conclusion Although teledermatology performed below face-to-face examination in terms of specific diagnoses, it remained effective in distinguishing between benign and malignant cutaneous tumors. The inclusion of teledermatoscopy and longer clinical experience enhanced diagnostic accuracy.

Non-melanoma skin cancer represents the most common form of cancer in humans. Cutaneous squamous cell carcinoma is second most common form behind basal cell carcinoma and is the most common type of cancer with significant metastatic potential. Immunosuppressed patients, including solid organ transplant recipients and those with human immunodeficiency virus infection, are at significantly elevated risk of cutaneous squamous cell carcinoma. This chapter discusses the incidence, presentation, diagnosis and management of non-melanoma skin cancer in patients with immunosuppression, with particular focus on the key areas of the management strategy that differ when compared to management of immunocompetent patients.

The current and future management of non-melanoma skin cancer (NMSC)—predominantly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)—represents a significant public health problem worldwide. Australia has one of the highest rates of skin cancer in the world, with data showing that NMSC is five times more common than all other cancers combined [1]. The sun-exposed head and neck (HN) is the most common location, with incidence rates continuing to rise 3–10 % per year. Although BCC is more common, the vast majority of NMSCs are localized and easily treated with simple excision. However, 5 % are considered high-risk (nearly always SCC) and metastasize to regional lymph nodes with the potential for distant spread [2].

The present study investigates the impact of the COVID-19 pandemic on the management of Non-Melanoma Skin Cancer (NMSC) in the head and neck region. Conducted at the University Hospital "Le Scotte" in Siena, Italy, the research includes 111 patients treated from 2018 to 2021. The study aims to understand how pandemic-related healthcare changes affected NMSC treatment, focusing on differences in diagnosis and management before and during the pandemic. Methods involved retrospective analysis of patient demographics, clinical characteristics, lesion details, and treatment modalities, using Jamovi software (version 1.6) for statistical analysis. Results revealed the scalp as the most common NMSC site, with Squamous Cell Carcinoma (SCC) being the predominant histotype. A significant rise in Basal Cell Carcinoma (BCC) cases and a reduction in surgery duration were noted during the pandemic. The shift to local anesthesia was more pronounced, reflecting the necessity to adapt to healthcare limitations. Despite the disruptions caused by the pandemic, there was no significant drop in NMSC cases, which is attributed to the noticeable nature of head and neck lesions. In conclusion, this study highlights that the COVID-19 pandemic significantly influenced surgical practices in NMSC management, emphasizing the need for effective healthcare strategies that balance quality patient care with public health safety measures.

Current Concepts in the Surgical Management of Non-melanoma Skin Cancers

A comprehensive guide to the surgical management of nonmelanoma skin cancer

Cutaneous malignant neoplasms are the most common subsequent neoplasm after blood or marrow transplant (BMT), but a full assessment among survivors is lacking. To identify risk factors for subsequent cutaneous malignant neoplasms using the BMT Survivor Study (BMTSS). This retrospective cohort study included patients who underwent transplant from 1974 to 2014 at City of Hope, University of Minnesota, or University of Alabama at Birmingham and survived 2 years or longer, as well as a comparison cohort of siblings. Both groups completed the BMTSS survey. Data analysis took place from October 2022 to October 2024. Demographics, pre-BMT and BMT-related therapeutic exposures, chronic graft-vs-host disease (cGVHD), and posttransplant immunosuppression. Incident cutaneous malignant neoplasms (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], and melanoma) after BMT. Exposures were evaluated for association with subsequent neoplasms using proportional subdistribution hazards models (reported as subdistribution hazard ratio [SHR] and 95% CI). Among the 3880 BMT survivors (median [range] age at BMT, 44.0 [0-78.0] years; 2165 [55.8%] male; 190 [4.9%] Black, 468 [12.1%] Hispanic, 2897 [74.7%] non-Hispanic White, and 325 [8.4%] of other race [including Asian and Pacific Islander] and multiracial) who were followed up for a median (range) of 9.5 (2.0-46.0) years, 605 developed 778 distinct cutaneous neoplasms (BCC, 321; SCC, 231; melanoma, 78; and unknown type, 148). The 30-year cumulative incidence of any cutaneous malignant neoplasm was 27.4% (BCC, 18.0%; SCC, 9.8%; and melanoma, 3.7%). Seventy-year cumulative probabilities of BCC, SCC, and melanoma were considerably higher in BMT survivors than siblings (18.1% vs 8.2%, 14.7% vs 4.2%, and 4.2% vs 2.4%, respectively). Among BMT survivors, risk factors for subsequent cutaneous malignant neoplasms included age of 50 years and older at BMT (BCC: SHR, 1.76; 95% CI, 1.36-2.29; SCC: SHR, 3.37; 95% CI, 2.41-4.72), male sex (BCC: SHR, 1.39; 95% CI, 1.10-1.75; SCC: SHR, 1.85; 95% CI, 1.39-2.45), pre-BMT monoclonal antibody exposure (BCC: SHR, 1.71; 95% CI, 1.27-2.31), allogeneic BMT with cGVHD (BCC: SHR, 1.48; 95% CI, 1.06-2.08; SCC: SHR, 2.61; 95% CI, 1.68-4.04 [reference: autologous BMT]), post-BMT immunosuppression (BCC: SHR, 1.63; 95% CI, 1.24-2.14; SCC: SHR, 1.48; 95% CI, 1.09-2.02; melanoma: SHR, 1.90; 95% CI, 1.16-3.12), and transplant at City of Hope (BCC: SHR, 3.55; 95% CI, 2.58-4.89; SCC: SHR, 3.57; 95% CI, 2.34-5.47 [reference: University of Minnesota]) or University of Alabama at Birmingham (BCC: SHR, 2.35; 95% CI, 1.35-4.23; SCC: SHR, 2.63; 95% CI, 1.36-5.08 [reference: University of Minnesota]). Race and ethnicity other than non-Hispanic White were protective for BCC (Black: no cases; Hispanic: SHR, 0.27; 95% CI, 0.16-0.44; other race and multiracial: SHR, 0.26; 95% CI, 0.14-0.50 [reference: non-Hispanic White]) and SCC (Black: SHR, 0.17; 95% CI, 0.04-0.67; Hispanic: SHR, 0.28; 95% CI, 0.16-0.50; other race and multiracial: SHR, 0.13; 95% CI, 0.05-0.37 [reference: non-Hispanic White]). Total body irradiation was associated with BCC risk among those younger than 50 years at BMT (SHR, 1.92; 95% CI, 1.27-2.92). In this cohort study, the high risk of cutaneous malignant neoplasms and malignant-specific risk factors suggest a need for personalized patient counseling and posttransplant dermatologic surveillance.

Background:The non-surgical management of non-melanoma skin cancers is an area requiring clinical investigation. Radiotherapy has a role in treatment for a defined subset of patients.Aims:The application of radiotherapy is subject to availability of proper equipment, non-availability of which precludes appropriate radiotherapy in most centers in third world countries.Materials and Methods:The introduction of innovations is needed to circumvent this. Plesiotherapy is such a mode of therapy for non-melanoma skin cancer.Methods:The introduction of innovations is needed to circumvent this. Plesiotherapy is such a mode of therapy for non-melanoma skin cancer.Results:In this paper we present successful management of a cohort of non-melanoma skin cancer patients with plesiotherapy using stepping source192 Ir HDR source.Conclusions:Plesiothrapy is an effective mode of therapy for non-melanoma skin cancer.

Squamous cell carcinoma (SCC) is the most common skin cancer diagnosed in solid organ transplant recipients (OTRs) and confers significant mortality. The development of SCC in the genital region is elevated in nonwhite OTRs. Viral induction, specifically human papillomavirus (HPV), is hypothesized to play a role in the pathophysiology of these lesions. To assess the prevalence and types of genital lesions observed in OTRs. This retrospective review included 496 OTRs who underwent full skin examination from November 1, 2011, to April 28, 2017, at an academic referral center. The review was divided into 2 distinct periods before a change in clinical management that took effect on February 1, 2016 (era 1) and after that change (era 2). Patient awareness of genital lesions was assessed. All lesions clinically suggestive of malignant tumors were biopsied and underwent HPV polymerase chain reaction typing. Number and types of genital lesions, proportion of malignant tumors positive for HPV, and patients cognizant of genital lesions. Of the total 496 OTRs, 376 OTRs were evaluated during era 1 (mean [SD] age, 60 years; age range, 32-94 years; 45 [65.2%] male; 164 [43.6%] white) and 120 OTRs were evaluated during era 2 of the study (mean age, 56 years; age range, 22-79 years; 76 [63.3%] male; 30 [25.0%] white). Overall, 111 of the 120 OTRs (92.5%) denied the presence of genital lesions during the history-taking portion of the medical examination. Genital lesions were found in 53 OTRs (44.2%), cutaneous malignant tumors (basal cell carcinoma and SCC in situ) in 6 (5.0%), genital SCC in situ in 3 (4.2%), and condyloma in 29 (24.2%). Eight of the 12 SCC in situ lesions (66.7%) were positive for high-risk HPV. Seven tested positive for HPV-16 and HPV-18, and 1 tested positive for high-risk HPV DNA but could not be further specified. Genital lesions in OTRs are common, but awareness is low. All OTRs should undergo thorough inspection of genital skin as a part of routine posttransplant skin examinations. Patients with darker skin types are disproportionately affected by cutaneous genital malignant tumors and should undergo a targeted program of early detection, prevention, and awareness focused on the risk of genital skin cancer after transplant. High-risk HPV subtypes are associated with genital SCC in OTRs. Additional studies are warranted to identify significant risk factors for HPV infection and to assess the utility of pretransplant HPV vaccination in the prevention of cutaneous genital malignant tumors.