Facial Nonmelanoma Skin Research Articles

Acute and subacute radiation toxicities of high-dose-rate brachytherapy in patients with nonmelanoma facial skin cancers

Acute and subacute radiation toxicities of high-dose-rate brachytherapy in patients with nonmelanoma facial skin cancers

Nonmelanoma Facial Skin Cancer: A Review of Diagnostic Strategies, Surgical Treatment, and Reconstructive Techniques

Nonmelanoma skin cancer is the most common form of cancer in the United States, and the face is a common area for skin cancer development due to its frequent exposure to the sun. This article focuses on the surgical management of facial nonmelanoma skin cancers, including diagnostic considerations, biopsy techniques, and staging. In addition, we discuss surgical treatment options, including indications, techniques, outcomes, and facial reconstruction following tumor excision.

Patient-Reported Outcomes and Factors Associated With Patient Satisfaction After Surgical Treatment of Facial Nonmelanoma Skin Cancer

This study measures patient-reported outcomes and identifies factors associated with patient satisfaction after excision of facial nonmelanoma skin cancer in the veteran population.

OA132] An investigation of possible radiophysical causes of recurrence for non-melanoma facial skin cancer treated with superficial X-rays

Purpose A 2010 cohort of 177 patients with 195 non-melanoma facial skin cancer received superficial kV X-rays radiotherapy (RT) with 14 cases (7.2%) of recurrence. The cases were analyzed with respect to tumor location on the head and within the radiation field. In this study, we investigate whether the recurrences could potentially be caused by underdosage of irregular surface areas within a treatment field. Methods The pathology of the tumors was mostly (77%) basal cell carcinoma (BCC) and the remaining squamous cell carcinoma (SCC). The recurrence rate was 10 and 4 cases for BCC and PCC, respectively. The recurrences were located on the nose (5), scalp (3), cheek, forehead and ear (2 each). Within the radiation field, 42% of recurrences were located on flat surfaces receiving the prescribed dose (i.e. radioresistant) and the remaining on curved surfaces or at the edge. To estimate the dose coverage of the latter, we used the EGSnrc RZ (cylindrical symmetrical) Monte Carlo software. A nose geometry was approximated by stacked water cylinders with dimensions (radius × depth in cm): 1 × 1+1.5 × 1 + 2 × 1 + 3 × 2 and compared with a standard full scatter geometry of 3 × 5. The dose was calculated for a 4 cm circular treatment field (1 cm margin) with a mono-energetic 40 keV point source which is the approximate effective energy of 80 kVp source (used clinically) as simulated by SpekCalc. The percentage depth dose (PDD) curve along the central axis and dose profile at the surface and therapeutic depth (85% dose level about 5 mm) for the two geometries were collected and compared. Results There was no difference in PDD for the nose and standard geometry. The radial nose dose profiles, however, showed a large underdosage of 50% (surface) to 30% (therapeutic) over the 3 most lateral mm as compared to the standard geometry. Conclusions The study showed that a large portion of the recurrences were placed on curved parts or edge of the radiation fields. Monte Carlo simulations suggest that such recurrences could potentially be caused by lateral underdosage. This could partly be corrected for by adding compensating scattering material around the treatment field.

Low-cost optical scanner and 3-dimensional printing technology to create lead shielding for radiation therapy of facial skin cancer: First clinical case series

PurposeThree-dimensional printing has been implemented at our institution to create customized treatment accessories, including lead shields used during radiation therapy for facial skin cancer. To effectively use 3-dimensional printing, the topography of the patient must first be acquired. We evaluated a low-cost, structured-light, 3-dimensional, optical scanner to assess the clinical viability of this technology. Methods and materialsFor ease of use, the scanner was mounted to a simple gantry that guided its motion and maintained an optimum distance between the scanner and the object. To characterize the spatial accuracy of the scanner, we used a geometric phantom and an anthropomorphic head phantom. The geometric phantom was machined from plastic and included hemispherical and tetrahedral protrusions that were roughly the dimensions of an average forehead and nose, respectively. Polygon meshes acquired by the optical scanner were compared with meshes generated from high-resolution computed tomography images. Most optical scans contained minor artifacts. Using an algorithm that calculated the distances between the 2 meshes, we found that most of the optical scanner measurements agreed with those from the computed tomography scanner within approximately 1 mm for the geometric phantom and approximately 2 mm for the head phantom. We used this optical scanner along with 3-dimensional printer technology to create custom lead shields for 10 patients receiving orthovoltage treatments of nonmelanoma skin cancers of the face. Patient, tumor, and treatment data were documented. ResultsLead shields created using this approach were accurate, fitting the contours of each patient's face. This process added to patient convenience and addressed potential claustrophobia and medical inability to lie supine. ConclusionsThe scanner was found to be clinically acceptable, and we suggest that the use of an optical scanner and 3-dimensional printer technology become the new standard of care to generate lead shielding for orthovoltage radiation therapy of nonmelanoma facial skin cancer.

Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer

Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer

Surgical treatment and reconstruction of nonmelanoma facial skin cancers.

After reading this article, the participant should be able to: (1) Identify the appropriate resection margins for common types of nonmelanoma skin cancer. (2) Discuss indications for secondary intention healing, skin grafting, and local flaps for reconstruction of facial skin cancer defects. (3) Describe at least one local flap for reconstruction of scalp, forehead, temple/cheek, periocular, nose, and lips. Current evidence for diagnosis and surgical treatment of nonmelanoma facial skin cancers is reviewed. In addition, reconstructive options for facial defects are discussed by anatomic location.

High-Dose-Rate (HDR) Brachytherapy for Facial Nonmelanoma Skin Cancer (NMSC) Using Custom-Made Molds and a Shortened Fractionation Schedule

Kinetic and semiquantitative parameters Median preradiation parameters Median postradiation parameters Median change in parameters K 0.025 0.020 0.028 Kep 0.192 0.159 0.065 ve 0.339 0.424 0.061 vp 0.001 0.002 0.001 Peak height 3.999 1.731 0.766 Time to peak 163.003 227.894 58.703 iAUC60 133.176 21.166 60.224 Uptake rate 0.062 0.015 0.049 Washout rate 0.178 0.168 0.003 International Journal of Radiation Oncology Biology Physics S616

Cost Effectiveness of Mohs Micrographic Surgery

Chren's study provides further evidence that for primary facial nonmelanoma skin cancers (NMSCs), recurrence rates with Mohs micrographic surgery (MMS) are modestly better than those for excision surgery. In 20 years, use of MMS has grown ∼10-fold and its cost now exceeds two billion dollars annually. Clinical experience and available data suggest that the skill of the treating physician is at least as important a determinant of outcome as the choice of MMS or excision. As patients and referring physicians increasingly share in the cost of more expensive procedures, evidence-based guidelines that establish the clinical circumstances in which the additional benefits of MMS outweigh its higher cost are needed, still lacking, and unlikely to become available.

An Evidence-Based Approach to the Treatment of Nonmelanoma Facial Skin Malignancies

The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.

MOC-PSSM CME Article: Nonmelanoma Facial Skin Malignancy

After studying this article, the participant should be able to: 1. Identify the environmental and genetic risk factors in developing nonmelanoma facial skin malignancy. 2. Understand the proper evaluation of a patient presenting with nonmelanoma facial skin malignancy. 3. Outline the various treatment options available for patients with nonmelanoma facial skin malignancy and understand the specific technique of Mohs' micrographic surgery versus surgical excision with frozen section control. 4. Describe the various options for reconstruction and the associated anesthetic requirements. The incidence of nonmelanoma facial skin malignancy is rising dramatically. Physicians should be well versed on the appropriate methodology required to both evaluate and treat these patients. A literature review was performed regarding the evaluation and various management options for patients with nonmelanoma facial skin malignancy. Specific attention was paid to the Mohs' technique versus surgical excision with frozen section control for treatment of these patients. An algorithm is presented regarding the appropriate assessment and treatment of patients with nonmelanoma facial skin malignancy. Comparison of the Mohs' technique with frozen section control showed potentially similar disease-free outcomes. However, the lack of adequate scientific studies for surgical excision with frozen section control was identified. Various treatment algorithms exist for nonmelanoma facial skin malignancy. Consideration must be given by the physician to patient comorbidities, anesthesia requirements, appropriate monitoring, and cost of excision.

Full face laser resurfacing: therapy and prophylaxis for actinic keratoses and non-melanoma skin cancer.

Although there are many effective treatment modalities for individual actinic keratoses (AKs), widespread lesions on the photoaged face pose a challenge due to inefficient and ineffective therapy resulting in high rates of recurrence after local destruction. Full face laser resurfacing offers an effective and efficient treatment option that successfully reduces the number of AK's on diffusely damaged skin and may show a prophylactic benefit for preventing non-melanoma skin cancers. To assess the efficacy of full face laser resurfacing in reducing the number of facial AK's by comparing preoperative and postoperative numbers of lesions present and to observe the incidence of non-melanoma skin cancer after full face laser resurfacing. A retrospective chart review of 24 patients with widespread facial AK's (greater than 30) treated with full face UPCO(2) and/or Er:Yag laser resurfacing was performed. All patients were a minimum of 1 year post-operative following facial laser resurfacing. The recurrence of AK's and the occurrence of facial non-melanoma skin cancers in these patients was assessed through chart analysis. Widespread AK's were effectively eliminated in all patients. Twenty-one patients (87%) remained lesion free for at least 1 year. Fourteen of the 24 patients (58.3%) showed no new lesions during a 2-year follow-up. There was an overall 94% reduction in total number of AK's. Adverse effects included transient perioral scarring in one patient, S. aureus infection in two patients, and dyschromia in two patients. Full face laser resurfacing provides long-term effective prophylaxis against AKs and may reduce the incidence of AK related squamous cell carcinoma.