Nonmelanoma Cutaneous Malignancies Research Articles

PD51-10 COMPETING MORTALITY IN BLADDER CANCER PATIENTS AFTER CYSTECTOMY: THE ROLE OF SECOND NON-UROTHELIAL CANCERS

You have accessJournal of UrologyBladder Cancer: Invasive III (PD51)1 Sep 2021PD51-10 COMPETING MORTALITY IN BLADDER CANCER PATIENTS AFTER CYSTECTOMY: THE ROLE OF SECOND NON-UROTHELIAL CANCERS Patrick Hensley, Zhigang Duan, Kelly Bree, Akshay Sood, Andrea Kokorovic, Hui Zhao, Charles Guo, Neema Navai, Colin Dinney, and Ashish Kamat Patrick HensleyPatrick Hensley More articles by this author , Zhigang DuanZhigang Duan More articles by this author , Kelly BreeKelly Bree More articles by this author , Akshay SoodAkshay Sood More articles by this author , Andrea KokorovicAndrea Kokorovic More articles by this author , Hui ZhaoHui Zhao More articles by this author , Charles GuoCharles Guo More articles by this author , Neema NavaiNeema Navai More articles by this author , Colin DinneyColin Dinney More articles by this author , and Ashish KamatAshish Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002078.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Muscle-invasive bladder cancer (MIBC) is associated with considerable disease- and treatment-related morbidity and mortality and is often diagnosed in heavily co-morbid patients. With improved surgical techniques and therapeutic options, survivorship in MIBC patients is of emerging relevance. We investigate the role of second non-urothelial cancer (SNUC) as a competing mortality risk factor in post-radical cystectomy (RC) patients. METHODS: An IRB-approved study of patients who underwent RC for cT2-3 MIBC from 2005-2018 was performed. The site and timing of biopsy-proven SNUC was recorded. Patients with less than 24-months of post-operative follow-up, those with non-melanoma cutaneous malignancies, and incidental prostate cancer were excluded. The cumulative incidence of SNUC and mortality were estimated with modified Kaplan-meier analysis. RESULTS: Median follow-up time for the 468 patients who underwent RC was 5.0 years (IQR 3.4-7.1 years). SNUC developed in 70 (15.0%) patients at a median 3.0 years (IQR 1.3-5.5 years) from RC with a cumulative incidence of SNUC at 3, 5 and 10 years after RC 7.2%, 11.4% and 23.5%, respectively. The most common sites for SNUC were lung (N=20, 4.3%) and hematologic malignancies (N=15, 3.2%). Bladder cancer surveillance imaging identified 70.0% of lung cancers and 62.5% of gastrointestinal cancers. Compared to lung cancers identified during symptomatic workup, those found on surveillance were more commonly stage 1 (78.6% vs. 16.7%, p=0.018) and non-lethal (64.3% vs. 16.6%, p=0.141). Bladder cancer mortality was surpassed by other-cause mortality as the leading cause of death 8 years after RC (Figure). The 15-year cumulative risk of mortality was: 21.0% for bladder cancer (95% CI 13.1%-30.1%), 10.5% for SNUC (95% CI 6.5%-15.7%), and 34.5% for other-cause (95% CI 21.6%-47.7%). CONCLUSIONS: SNUC developed in 15% of post-RC patients, with the majority identified on surveillance imaging. Other-cause mortality surpassed that of bladder cancer mortality in year 8 after RC. These data have clinical significance with regards to patient counseling, survivorship and oncologic surveillance in the highly co-morbid MIBC population. Source of Funding: Urology Care Foundation Research Scholars Award to PJH (IRG 85-001-25); Wayne B. Duddlesten Professorship and the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant to AMK © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e909-e909 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Hensley More articles by this author Zhigang Duan More articles by this author Kelly Bree More articles by this author Akshay Sood More articles by this author Andrea Kokorovic More articles by this author Hui Zhao More articles by this author Charles Guo More articles by this author Neema Navai More articles by this author Colin Dinney More articles by this author Ashish Kamat More articles by this author Expand All Advertisement Loading ...

A case of lip squamous cell carcinoma with a familial history of Xeroderma pigmentosum

Xeroderma pigmentosum is an orphan hereditary photosensitive human disorder that is recognized by the development of skin lesions in sun-exposed regions of the body due to severe photosensitivity. Patients with this condition have an abnormal DNA repair process due to a genetic mutation. Xeroderma pigmentosum is considered as a risk factor of cancer since the affected population may develop various cutaneous cancers including both melanoma and non-melanoma cutaneous malignancies even at a younger age than the general population. This risk concerns also asymptomatic heterozygote individuals. Here, we present a case of 46years old man with a familial history of Xeroderma pigmentosum who developed a microscopically confirmed squamous cell carcinoma of the lip.

The Successful Treatment of Multiple Cutaneous Malignancies with HPV Vaccination: Case Report

An elderly, immunocompetent patient presented multiple invasive squamous cell carcinomas of the keratoacanthoma subtype superimposed on a psoriatic plaque. After failing initial treatment with oral acitretin, alternative therapies were considered. Due to the patient’s advanced age, location of the tumors and extensive tumor burden, invasive therapy was deemed impractical. After careful consideration, the more novel approach of injecting the 9-valent HPV vaccine was performed. Ten months after the first dose, the patient’s skin displayed neither clinical or histologic evidence of any residual cancer. We believe that this is the second reported case of the 9-valent HPV vaccine successfully treating non-melanoma cutaneous malignancies.

Ocular Adnexal Reconstruction for Cutaneous Periocular Malignancies.

Although the majority of lesions present in the periocular region are benign, periocular cutaneous malignancies are certainly not uncommon and must be considered. The management of nonmelanoma cutaneous malignancies is predominately surgical with Mohs micrographic surgery or excision with frozen sections. The approach to reconstruction of the resulting defects depends on the defect location and size. When able, it is preferable to close lesions directly or with the recruitment of adjacent tissue in an effort to preserve the inherent anatomy. The eyelid's dynamic function is thus maintained, which is essential for optimal ocular surface protection. However, larger and more extensive defects will require complex reconstructions that are able to restore the necessary structural integrity to the eyelids. The authors review the various reconstruction approaches for defects of all sizes involving the periocular area including nonmarginal defects and defects of the lower and upper eyelids, as well as those of the medial canthal region.

Obtaining High Cure Rates for Challenging Facial Malignancies: A New Method for Producing Rapid, Accurate, High-Quality Frozen Sections

The authors developed a new system to provide rapid, accurate, full-face frozen sections. To evaluate the efficacy of the system when applied to the treatment of nonmelanoma cutaneous malignancies using Mohs micrographic surgery (MMS). Patients undergoing MMS procedures between 2003 and 2007 for nonmelanoma head and neck cutaneous malignancies were prospectively collected. Specimens were prepared either in a traditional cryostat-based manner or using the new system. A total of 196 patients with 234 head and neck nonmelanoma cutaneous malignancies were included. The majority of tumours were basal cell carcinomas (89.5%). Of these, 38% demonstrated aggressive histologies (sclerosing or micronodular), and 30% were recurrent. On average, two levels (range one to six) and four blocks (range two to 23) were required to obtain clear margins. The mean defect size was 3.68 cm(2) (range 0.13 cm(2) to 37.68 cm(2)). Over the five-year study period, there were two recurrences in 234 cases (less than 1%), which compares favourably with other MMS series. The new system was associated with a shorter operative time than traditional specimen preparation (102 min versus 131 min; P=0.004). The new and traditional specimen preparation groups were similar in terms of the number of previous recurrences (29% versus 30%; P=1.00), defect size (3.7 cm(2) versus 4.0 cm(2); P=0.81) and the number of levels required (1.9 versus 1.5; P=0.05). The new system enables fast, accurate, full-face frozen section specimens that are ideal for MMS. The speed of specimen preparation is demonstrated by faster operative times, and a low recurrence rate attests the accuracy and quality of the sections.

Isolated limb infusion with melphalan for the treatment of advanced nonmelanoma cutaneous malignancies

Isolated limb infusion with melphalan for the treatment of advanced nonmelanoma cutaneous malignancies

Elective Parotidectomy in the Management of Advanced Auricular Malignancies

The purpose of this study is to determine whether elective parotidectomy is necessary in patients with clinically and radiographically N0 parotid disease with isolated primary auricular nonmelanoma cutaneous malignancies. Auricular malignancies are typically managed by wedge resection or wide local excision. Although small lesions are easily managed by conservative excision, large bulky tumors, those with multifocal involvement, and recalcitrant lesions, often require more extensive resection including total auriculectomy, parotidectomy, and/or neck dissection. A 10-year retrospective case review from four tertiary university medical centers from 1992 to 2002. Information was retrospectively retrieved using a database of patients from the department of pathology. Seventy-one charts were reviewed. Patients with a clinical history of advanced nonmelanoma auricular carcinoma undergoing elective parotidectomy and/or neck dissection with clinically and radiographically N0 nodal disease were evaluated for the presence of occult parotid metastasis. All patients underwent parotidectomy in conjunction with a total auriculectomy for surgical extirpation of their primary auricular carcinoma. Parotid specimens were evaluated for histopathologic evidence of metastatic neoplastic disease. Pathological examination showed no histological evidence of occult parotid metastasis in all 19 patients who underwent elective parotidectomy in the presence of clinically and radiographically N0 nodal disease of the parotid or cervical regions. Parotidectomy may not be necessary in the surgical management of advanced auricularcarcinoma in the absence of clinically positive parotid disease or external auditory canal involvement.

Alar anaesthesia: A kinder method

SUMMARY Local infiltration of anaesthetic in the ala of the nose is very uncomfortable for most patients. This is an area frequently operated on by dermatosurgeons under local anaesthesia as it is a common site for non-melanoma cutaneous malignancies. A simple method is described of providing more pleasant local anaesthesia for patients undergoing alar surgery by using nerve blocks prior to local infiltration.

Craniofacial Resection for Nonmelanoma Skin Cancer of the Head and Neck

We reviewed our experience with craniofacial resection for advanced, nonmelanoma skin cancer of the head and neck to determine prognostic factors, local control rate, disease free survival, morbidity, and mortality. Retrospective review of consecutive patients treated at a tertiary referral center from 1982 to 1993. Charts of patients having craniofacial resection for aggressive nonmelanoma cutaneous malignancies were reviewed and living patients followed for 10 additional years. Demographics, histology, previous interventions, treatment, surgical pathology, reconstructions, and complications were examined. The product-limit method was used to calculate survival functions, and the log-rank test was used to compare survival distributions. Thirty-five patients, mean age 66.7 years, received treatment at our facility. Follow-up ranged from 2 to 191 (mean 47.4) months. Histology included 20 squamous cell carcinomas (SCC) and 15 basal cell carcinomas (BCC). Sixty percent had craniofacial resection alone, and 28.6% also had postoperative radiotherapy. There were two perioperative deaths, and 37.1% suffered early and 14.3% late surgical complications. Two- and five- year survival was significantly better (P=.02) with BCC (92% and 76%) than with SCC (54% and 24%). Long-term disease-specific survival was 20%, and 11.4% of our subjects were living with disease. Intracranial extension (P=.02), perineural invasion (P=.049), and prior radiotherapy significantly decreased 5-year survival. Acceptable mortality and morbidity is possible using craniofacial resection to treat advanced nonmelanoma skin cancer. Although disease-specific survival remains poor, positive trends were noted in local control beginning at 2 years of follow-up. Because patients often have few remaining options for cure, craniofacial resection is justified when technically feasible.

Nonmelanoma cutaneous malignancy with regional metastasis

We performed a retrospective study of 28 patients to evaluate the management and outcome of regional metastasis from nonmelanoma cutaneous malignancies. There were 25 squamous cell, 1 basal cell, and 2 eccrine carcinomas. The most common primary locations were the temple, ear, and cheek. Median interval from primary resection to regional metastasis was 9 months, and such were commonly of the parotid, level IB, and level IIA nodes. Twenty-four patients underwent parotidectomy and/or neck dissection; 19 patients, postoperative radiation. Ten patients (36%) died from the disease, 2 patients (7%) have persisting disease, 5 (18%) have died from intercurrent disease, and 11 (39%) have no evidence of disease (minimum follow-up, 22 months; median, 34 months). Nonmelanoma cutaneous malignancies with regional metastasis have a poor prognosis despite aggressive therapy. When high-risk characteristics are detected, examination of the nearest "sentinel node," prophylactic lymphadenectomy, and/or regional irradiation might be justified; further study is warranted.

Nonmelanoma cutaneous malignancy with regional metastasis.

We performed a retrospective study of 28 patients to evaluate the management and outcome of regional metastasis from nonmelanoma cutaneous malignancies. There were 25 squamous cell, 1 basal cell, and 2 eccrine carcinomas. The most common primary locations were the temple, ear, and cheek. Median interval from primary resection to regional metastasis was 9 months, and such were commonly of the parotid, level IB, and level IIA nodes. Twenty-four patients underwent parotidectomy and/or neck dissection; 19 patients, postoperative radiation. Ten patients (36%) died from the disease, 2 patients (7%) have persisting disease, 5 (18%) have died from intercurrent disease, and 11 (39%) have no evidence of disease (minimum follow-up, 22 months; median, 34 months). Nonmelanoma cutaneous malignancies with regional metastasis have a poor prognosis despite aggressive therapy. When high-risk characteristics are detected, examination of the nearest "sentinel node," prophylactic lymphadenectomy, and/or regional irradiation might be justified; further study is warranted.