High-risk Non-melanoma Skin Cancer Research Articles

Personalized 125I Seed Interstitial Brachytherapy for Patients Aged 80 Years and Over with Early Primary High-risk Non-melanoma Skin Cancer.

The aim of this study is to explore the safety and efficacy of iodine-125 seeds interstitial brachytherapy (PISI-BT) for patients aged 80 and above with early primary high-risk non-melanoma skin cancer (NMSC). In this retrospective single-center study, we collected and analyzed data from patients ≥ 80 years of age with early primary high-risk NMSC treated with PISI-BT between December 2003 and May 2020. Survival status, efficacy, adverse effects (AEs), cosmetic outcomes, and treatment cost were analyzed (data cut-off: November 20th, 2021). Only 9 patients met the inclusion criteria (median age, 86 years (81-90)). Five patients had an Eastern Cooperative Oncology Group (ECOG) score of 1, and allthe patients had at least one comorbidity. Six patients showed complete responseand three showed partial response, while none had stable or progressive disease. No recurrences, disease persistence, or AEs were detected during the follow-up period. After a median follow-up of 29.3 months (3-99), only two patients were alive, but the cause of death in the remaining patients was not related to NMSC. The cosmetic outcomes were excellent and good in two and four patients, respectively, while could not be evaluated in three patients. The cost (which was within the scope of medical insurance reimbursement) was acceptable. PISI-BT could be an alternative treatment option in patients above 80 years old with early primary high-risk NMSC and comorbidities.

Mohs micrographic surgery in immunosuppressed vs immunocompetent patients: Results of a prospective nationwide cohort study (REGESMOHS, Spanish registry of Mohs surgery).

Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest. This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates. The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed. IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients. This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group.

PO111: Personalized 125i Seeds Interstitial Brachytherapy for Age 80 or Older Patients with Early Primary High-Risk Non-Melanoma Skin Cancer

PO111: Personalized 125i Seeds Interstitial Brachytherapy for Age 80 or Older Patients with Early Primary High-Risk Non-Melanoma Skin Cancer

Pacientes inmunosuprimidos con cáncer de piel no melanoma intervenidos con cirugía micrográfica de Mohs en Uruguay

IntroductionImmunosuppressed patients have a higher risk of developing skin cancer compared to the general population. In turn, these tumors are usually more aggressive, have a higher rate of recurrence and metastasis. Mohs micrographic surgery (MMS) is recommended as first-line treatment in this group of patients. ObjectivesThe aim of this study is to describe the epidemiological characteristics of immunosuppressed patients with non-melanoma skin cancer (NMSC) who required MMS at a single institution. MethodsObservational, cross-sectional, descriptive, single-center study that includes patients diagnosed with non-melanoma skin cancer and also immunosuppression who were treated with Mohs micrographic surgery in the Dermatology Service of the Hospital de Clinicas between November 2013 and November 2021. ResultsOf 437 Mohs micrographic surgeries performed over a period of 8 years, 30 were performed on 18 immunosuppressed patients. The most frequent cause of immunosuppression was solid organ transplantation, and among these, kidney transplantation prevailed. Squamous cell carcinoma was the most frequent tumor found, most were primary tumors, but 3 recurrences were observed. The most frequent location of the tumors was in the head. The most frequently used closure of the defect was simple closure. ConclusionMohs micrographic surgery is the gold standard for high-risk non-melanoma skin cancer such as those seen in immunosuppressed patients. Given the high recurrence rate observed in these patients, close follow-up is important to provide early diagnosis and appropriate treatment.

Cirugía micrográfica de Mohs en carcinomas cutáneos: primeros 250 casos en la Unidad de Cirugía Dermatológica

IntroductionMohs micrographic surgery (CMM) it’s a surgical technique for treatment of skin carcinomas, indicated in high-risk tumors. It allows control of 100% of the tumor margins, achieving the best healing rates and the biggest healthy tissue preservation compared with conventional techniques. ObjectivesLearn the epidemiologic characteristics of the first 250 patients treated with CMM at the clinical hospital “Dr. Manuel Quintela”. Patients and methodsA retrospective observational study was performed collecting epidemiological data and linked data of the first 250 patients treated with MMS at the Dermatology department between November 2013 and May 2018. Results58.4% of the patients were male, 41.6% were female. The average age was 68 years. We found equitative distribution between Montevideo (52.8%) and the rest of the country (47.2%). The basal cell carcinoma represented 67.2% of the treated carcinomas. The spinocellular carcinoma represented the 31.2%. The most frequent location was the head. Simple closure was the more common reconstruction method used. The vast majority of the cases corresponded to primary tumors (91.6%). DiscusionThe epidemiologic characteristics founded in our study our study were similar to those described in similar studies on other geographic areas. The CMM its the gold standard for the high-risk non-melanoma skin cancer treatment, allowing to control 100% of the surgical margins, achieving better oncologic, functional and esthetic results.

Mohs micrographic surgery: the experience of the dermatology unit of the university of Milan confirms the superiority over traditional surgery in high-risk non-melanoma skin cancers.

The constant increase in the incidence of non-melanoma skin cancers (NMSC) makes their treatment a topic of paramount interest. Because most NMSC tend to develop in visible areas such as the headneck area, it is a priority to choose the less destructive therapy and more appropriate reconstructive technique. Mohs Micrographic Surgery (MMS) represents the treatment of choice for skin tumors in critical sites, recurrent tumors and tumors with aggressive histologic features. We collected patients affected by NMSC who underwent MMS at the Dermatology Unit of IRCCS Fondazione Ca' Granda, Milan, in the period March 2017-December 2021. One hundred and fifty-nine patients were enrolled in this retrospective observational study. The excision margins were chosen based on a dermoscopic evaluation. The main histological diagnoses were basal cell carcinoma (145, 91.2%) and squamous cell carcinoma (10, 6.3%), in areas with high functional or anatomical value. 121 out of 159 surgeries did not require further enlargement after the removal of the clinically and dermoscopically visible lesion, but in 38 cases (23.9% of cases) the pathologist required at least one subsequent enlargement, due to the persistence of neoplasm at the bottom or at the margins of the lesion. Only one recurrence has been reported so far. MMS is a pathology-controlled surgery with high intrinsic value because of the low risk of recurrences and should be routinely adopted for high-risk NMSC.

Mohs micrographic surgery in Singapore: A long-term follow-up review

Dear Editor, Mohs micrographic surgery (MMS) has become the treatment of choice for high-risk non-melanoma skin cancers (NMSC) worldwide.1 Unlike wide local excision, MMS enables precise microscopic removal of tumour foci while allowing maximal tissue preservation, thereby maintaining cosmesis and anatomical function.1 The MMS service in Singapore started in 2008, and we present our experience

The impact of treatment delay on skin cancer in COVID-19 era: a case-control study

BackgroundThe outbreak of COVID-19 pandemic led to a 2-month lockdown in Europe. Elective surgeries, including skin cancer excisions, were postponed. The purpose of this prospective case-control study was to assess the impact of the treatment delay on patients with non-melanoma skin cancer (NMSC) or melanoma operated in the first post-lockdown period.MethodsA comparative study of skin cancer operations performed in a 4-month period either in 2020 or in 2019 was conducted. All data were collected from a prospectively maintained clinic database and the pathological reports. Continuous variables were compared with t test or Mann-Whitney U test according to their distribution. Categorical variables were compared with Fisher exact test. Odds ratio (OR) with 95% confidence interval (95% CI) was used to assess the risk of excising high-risk NMSC in 2020 compared with 2019.ResultsSkin cancer excision was performed in 158 cases in 2020 compared to 125 cases in 2019 (26.4% increase). Significantly, more SCC were excised in 2020 (p = 0.024). No significant difference for several clinical parameters regarding BCC, SCC, and melanoma was identified. However, the reconstructive method applied, following NMSC excision, was significantly different, requiring frequently either skin grafting or a flap.ConclusionThese results indicate that skin cancer treatment delay, due to COVID-19 pandemic, is related to an increased incidence of SCC and more complicated methods of reconstruction. Considering the relapsing COVID-19 waves, significant skin cancer treatment delays should be avoided.Trial registrationThe study adhered to the STROBE statement for case-control studies.

Concordance between a Mohs surgeon and a dermatopathologist in evaluating Mohs cryosections.

Mohs micrographic surgery is the gold standard treatment for high-risk non-melanoma skin cancers. The success of Mohs relies on accurate histopathologic evaluation. Due to law restrictions in some European countries, Mohs surgeons are not permitted to report on histopathology; therefore, a pathologist evaluates the frozen sections. To retrospectively assess the concordance between the certified Mohs surgeon and the pathologist in evaluating the Mohs slides that were intraoperatively evaluated by the pathologist. Frozen section slides of a total of 237 Mohs cases between 2013 and 2020 were examined by the blinded Mohs surgeon, and the tumours were marked on copy maps. The copy maps and the original maps were compared, and the non-concordant cases were re-evaluated together by the Mohs surgeon and the dermatopathologist. The concordance rate was calculated, and the inter-rater agreement was statistically analysed using Cohen's Kappa coefficient. We report a high concordance rate (97.9%) and inter-rater agreement (0.96) between Mohs surgeon and dermatopathologist in evaluating Mohs slides. As a newly settled centre, our results are in alignment with experienced centres where the Mohs surgeon evaluates the slides herself and performs the surgery.

SP-0092 This house believes that surgery should be considered for nose high risk non-melanoma skin cancer\\r

SP-0092 This house believes that surgery should be considered for nose high risk non-melanoma skin cancer\\r

SP-0090 This house believes that surgery should be considered for lip high risk non-melanoma skin cancer

SP-0090 This house believes that surgery should be considered for lip high risk non-melanoma skin cancer

SP-0091 This house believes that radiotherapy/brachytherapy should be considered for lip high risk non-melanoma skin cancer

SP-0091 This house believes that radiotherapy/brachytherapy should be considered for lip high risk non-melanoma skin cancer

Purse-string suture versus full-thickness skin graft: An efficacy and safety comparison study.

Purse-string suture (PSS) and full-thickness skin graft (FTSG) are two different approaches to the closure of circular skin defects. In this study, we compare the feasibility and the aesthetic outcome of these two techniques in high operatory risk non-melanoma skin cancer (NMSC) patients. We performed a retrospective study on 65 patients, treated with PSS or FTSG, and evaluated after a minimum follow-up of 6 months. The post-surgery assessment was based on the Vancouver scar scale (VSS) and differences in terms of defect areas, operative and healing times were performed both with parametric and nonparametric tests. Operative times in PSS were significantly lower than those needed for FTSG, without perioperative adverse events; PSS required a waiting time before removing the suture greater than FTSG. After surgery, PSS resulted in a median defect area reduction of 73%. No significant differences were found in the median value for VSS in the two groups. Based on our clinical experience, the PSS advantages in terms of feasibility, rapidity of execution, and mean defect area reduction were confirmed. So, this technique seems to be appropriate for fragile patients affected by NMSC, that cannot hold long surgical sessions.

Treatment of Non-melanoma Skin Cancers in the Absence of Mohs Micrographic Surgery.

Summary:Non-melanoma skin cancers are the most common malignancies globally. Although non-melanoma skin cancers exhibit low metastatic potential, they can be locally destructive, necessitating complex excisions and reconstructions. Mohs micrographic surgery is the gold-standard treatment for high-risk non-melanoma skin cancers in patients who are appropriate surgical candidates. Despite its efficacy, Mohs micrographic surgery is not readily available in most geographic regions, necessitating that plastic surgeons be well-versed in alternative treatment modalities for non-melanoma skin cancer. Herein, we will discuss the management of non-melanoma skin cancers in settings where Mohs micrographic surgery is not readily available.

Non-melanoma skin cancer in general practice: Radiotherapy is an effective treatment option.

Skin cancer is the most common malignancy that is managed in general practice, and non-melanoma skin cancer (NMSC) comprises the vast majority of presentations. Radiation therapy (RT) plays an important part in the management of NMSC and may be used as definitive treatment for low-risk cancers, as an adjuvant treatment for high-risk disease oralone for inoperable cases. The aims of this article are to discuss: 1)types of RT; 2) role of RT, including its advantages and disadvantages; 3) side effects (toxicity) of RT; 4) outcomes from RT; 5) low- versus high-risk NMSCs and6)some guidelines for general practitioners on when to refer patients forconsideration of RT. The primary goal of treatment for NMSC is to cure the patient, and a secondary goal is to provide the best cosmetic and functional result with the minimum impact on quality of life. In deciding what modality of treatment to use, clinicians will need to take into account the site of the tumour, clinical stage, histological subtype and any high-risk features, patient comorbidities as well as patient preferences. RT provides a safe and effective alternative to surgery in select cases and is particularly useful for the elderly or where surgery might have a negative impact on function or cosmesis.

High-Risk Nonmelanoma Skin Cancers: Identification, Management, and Reconstruction.

High-risk nonmelanoma skin cancers of the head and neck may be identified through a variety of tumor risk factors, including location on the lips or ears, size > 2 cm, recurrence, patient immunocompromised status, poor tumor differentiation, > 6 mm thickness, Clark level V depth of invasion, and presence of perineural spread. Surgical excision is the mainstay of treatment, with Mohs' micrographic surgery typically preferred to standard surgical excision. When reconstructing these defects, ensuring negative margins is of utmost importance and delaying reconstruction until confirmation of margins is recommended. Attention to the impact of immunosuppression and adjunct radiation therapy on wound healing is important for an optimal cosmetic outcome. As with all high-risk cancer patients, close follow-up and surveillance of these patients is imperative.

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

The surgical management of non-melanoma skin cancers has seen some significant changes over the past 20 years, as a result of developments in three equally important and overlapping specialties that deal with this specific pathology: plastic and reconstructive surgery, surgical oncology and dermatological surgery. Better understanding of vascular and particularly microvascular anatomy, coupled with technological advances in operating microscopes, microsurgical instrumentation and preoperative planning via advanced imaging, allows functional and aesthetic restoration of any radical oncological skin and soft-tissue surgery defect from head to toe. As reconstruction has practically lost its technical boundaries, resectional surgery can be executed without compromising on surgical margins, thus reducing rates of local recurrences and metastatic spread. The increasing use of Mohs surgery and its several advantages for difficult high-risk non-melanoma skin cancer in facial sites especially, offers optimal cure rates while reducing functional impairment and optimising cosmetic outcomes. Advances in preoperative planning utilising computed tomography and magnetic resonance imaging scans can help to predict the degree of resectability and tailor further treatments, including radiotherapy, accordingly. From the reconstructive point of view, these techniques provide a roadmap to select the best blood supply for the transplanted flap, thereby reducing complications and increasing success rates. The focus of skin cancer surgery has therefore shifted from pure cancer clearance and flap survival, to a high degree of functional and aesthetic reconstruction.

Effect of Postoperative Telephone Calls on Patient Satisfaction and Scar Satisfaction After Mohs Micrographic Surgery.

Mohs micrographic surgery is considered the gold standard for high-risk nonmelanoma skin cancer. Postoperative telephone follow-up (TFU) is linked to higher patient satisfaction; however, there are no randomized, blinded studies examining whether TFU after Mohs surgery improves patient satisfaction. To perform a randomized single-blinded prospective survey study examining whether patient satisfaction or scar satisfaction varied between Mohs patients who received a postoperative call and patients who did not. Patients were enrolled into "post-op call" or "no post-op call" groups. Both arms completed surveys at suture removal and 3-month follow-up visits. One hundred four subjects were enrolled, and demographics, the number of Mohs stages, and type of repair were controlled. At suture removal, both arms reported similar overall high satisfaction on the 5-point Likert scale (4.90 "call arm" vs 4.88 "no-call arm", p = .80). Patient and Observer Scar Assessment Scale (POSAS) scores were 3.37 in the "call arm" versus 3.81 in the "no-call arm", p = .31. At 3-month follow-up, results were similar. High overall satisfaction was reported in both arms. The TFU group reported higher overall satisfaction, but this difference was not significant. Scar satisfaction did not vary statistically between the arms, but POSAS scores in the call arm trended favorably.

Mohs Micrographic Surgery: Past, Present, and Future

Mohs micrographic surgery (MMS) is a frequently used technique that provides total margin visualization for treatment of skin neoplasms. To provide a comprehensive review of MMS literature, focusing on its origins, evidence behind present-day uses of MMS, and future directions. A literature search was conducted using PubMed to identify articles pertaining to MMS. The fresh frozen technique led to widespread use of MMS in the 1970s. One randomized controlled trial and several large prospective studies have demonstrated low recurrence rates for treatment of nonmelanoma skin cancer (NMSC). MMS, when compared with surgical excision, also achieved a statistically significant higher cure rate for treatment of recurrent NMSC. Studies have demonstrated low recurrence for the treatment of melanoma and melanoma in situ with MMS. MMS has also been shown to effectively treat several rare cutaneous neoplasms. The future of MMS is likely to include the adoption of noninvasive imaging, immunostaining, and digital technology. Mohs micrographic surgery is an effective treatment modality for numerous cutaneous neoplasms. It has achieved statistically significant superiority to surgical excision for the treatment of recurrent and high-risk NMSC. The future is likely to see increased use of noninvasive imaging, immunostaining, and digital technology.

Long-term follow-up in patients treated with electrochemotherapy for non-melanoma skin cancer in the head and neck area

Background: Electrochemotherapy (ECT) is a cancer treatment modality where the intracellular accumulation of chemotherapeutic agents is enhanced by an applied electrical field.Aims/Objectives: To evaluate the long-term efficacy, safety and functional outcome after ECT treatment in high-risk non-melanoma skin cancer (NMSC) with curative intent.Materials and methods: Seven patients with SCC or BCC in the head and neck area were treated with ECT with intratumoral bleomycin administration.Results: Five patients were cured by ECT as a mono-modality treatment after a median 10-year follow-up period. Two patients had recurrences and/or persisting tumors after treatment that required salvage surgery and radiotherapy. In two patients, the eye was spared with no visual impairment. In another patient, full facial nerve function was spared.Conclusions: ECT can be a curative as well as an organ and function-sparing mono modality treatment in high-risk NMSC.Significance: Today ECT is mostly used as a palliative treatment. Its curative potential should be further investigated. Randomized studies comparing ECT with standard treatment is needed. Hopefully, this small study can encourage such studies.