Nonmelanotic Skin Cancer Research Articles

S213: Non Melanotic Skin Cancer of the Head and Neck—A Practical Update

Nonmelanotic skin cancer of the head and neck has risen in incidence of the last 15 years. In some areas this has increased by more than 40%. It is therefore likely that more practitioners will be exposed to this in their office practice. The aims of this seminar are to improve recognition by discussing the salient features of conditions ranging from actinic keratosis and Bowen's disease through to squamous cell carcinoma. We will also discuss the high-risk sites and patterns that may warrant treatment of nodal tissue.

Reconstruction of anterior auricular conchal defect after malignancy excision: Revolving-door flap versus full-thickness skin graft

Skin tumours of the anterior auricular concha are not uncommon. Wider excision and immediate reconstruction are required to reduce the risks of recurrence of the disease, cartilage infection and external ear distortion. Many surgical methods have been described for reconstruction of conchal defects. Post-auricular island flaps, such as the revolving-door (RD) flap, and full-thickness skin grafts (FTSGs) are the most-performed procedures. Although the RD flap has been fully described, it is not widely accepted and many surgeons, in their daily practice, prefer to use FTSG. It is a common experience that FTSGs are more subjected to centripetal contraction, decreasing the structural firmness of the conchal cavity and affecting functional and aesthetic outcomes. Furthermore, FTSGs are more prone to delay in wound healing due to the difficult access to this region that hinders adequate tie-over dressings. Between March 2003 and January 2007, 40 patients affected by T1 and T2 non-melanotic skin cancer and T1 melanoma of the anterior conchal surface of the external ear were included in a prospective study and randomly assigned to the RD reconstructed group or to the FTSG reconstructed group to investigate, compare and define advantages and disadvantages of both the techniques. Visual Analogue Scale (VAS) was used to evaluate the overall outcome and the colour and texture match. No flap or skin graft total loss was observed. Six patients (30%) showed partial failure of FTSG. The RD group demonstrated excellent cosmetic outcome, ideal colour match, adequate structure of external ear, projection and shape. Wilcoxon matched-pairs rank-sum test demonstrated statistically significant higher scores for the RD group compared to the FTSG group (p<0.0001). The RD harvesting technique is easy and quicker than the FTSG technique. RD flap should be considered as the first choice for reconstruction of anterior auricular conchal defects following wider excision of skin tumours.

Extended orbital exenteration in the treatment of advanced periocular skin cancer with primary reconstruction with a galeacutaneous flap

Extended orbital exenteration includes the removal of orbital contents together with the surrounding orbital wall(s). Skin cancers (basal cell cancer and squamous cell skin cancer) arising in the periorbital region could present as invasive tumours infiltrating the orbit and orbital walls. We describe the treatment of advanced invasive skin cancers of the periorbital region by extended orbital exenteration. A retrospective consecutive series over a nine-year period, included 21 extended orbital exenterations treated in a tertiary referral centre. The margins of excision were clear in 18. Twenty postoperative defects were reconstructed using galea-skin flaps, and one defect was left to heal by secondary intention. Two patients died of their disease during the three-year follow up. The reconstruction with frontal or frontoparietal galea-skin flap is a suitable option. The technique is versatile and simple, and gives acceptable aesthetic results. The operating time is shorter than that required for microvascular reconstructions, and the complication rate is low. The secondary defect can be closed primarily or by skin grafting. Extended orbital exenteration offers the best chances of cure in the treatment of non-melanotic skin cancers that have infiltrated the orbit and orbital walls.

Sex-specific incidence and temporal trends in solid tumours in young people from Northern England, 1968-2005.

BackgroundThis study examined sex-specific patterns and temporal trends in the incidence of solid tumours in the Northern Region of England from 1968 to 2005. This updates earlier analyses from the region where sex was not considered in depth. Sex-specific analyses were carried out to determine whether sex differences might provide clues to aetiology.MethodsDetails of 3576 cases, aged 0–24 years, were obtained from a specialist population-based cancer registry. There were 1843 males (886 aged 0–14 years and 957 aged 15–24 years) and 1733 females (791 aged 0–14 years and 942 aged 15–24 years). Age-standardized incidence rates (per million population) were calculated. Linear regression was used to analyze temporal trends in incidence and annual percentage changes were estimated. Analyses were stratified by sex and by age-group.ResultsThere were marked differences in incidence patterns and trends between males and females and also between age-groups. For males central nervous system (CNS) tumours formed the largest proportion of under-15 cases and germ cell tumours was the largest group in the 15–24's, whilst for females CNS tumours dominated in the under-15's and carcinomas in the older group. For 0–14 year olds there were male-specific increases in the incidence of rhabdomyosarcoma (2.4% per annum; 95% CI: 0.2%–4.5%) and non-melanotic skin cancer (9.6%; 95% CI: 0.0%–19.2%) and female-specific increases for sympathetic nervous system tumours (2.2%; 95% CI: 0.4%–3.9%), gonadal germ cell tumours (8.6%; 95% CI: 4.3%–12.9%) and non-gonadal germ cell tumours (5.4%; 95% CI: 2.8%–7.9%). For 15–24 year olds, there were male-specific increases in gonadal germ cell tumours (1.9%; 95% CI: 0.3%–3.4%), non-gonadal germ cell tumours (4.4%; 95% CI: 1.1%–7.7%) and non-melanotic skin cancer (4.7%; 95% CI: 0.5%–8.9%) and female-specific increases for osteosarcoma (3.5%; 95% CI: 0.5%–6.5%), thyroid cancer (2.8%; 95% CI: 0.1%–5.6%) and melanoma (4.6%; 95% CI: 2.2%–7.1%).ConclusionThis study has highlighted notable differences between the sexes in incidence patterns and trends for solid tumours. Some of these sex-specific differences could have been obscured if males and females had been analysed together. Furthermore, they suggest aetiological differences or differential susceptibility to environmental factors between males and females.

Photodynamic Therapy in Dermatology: An Update on Applications and Outcomes

Photodynamic therapy is a relatively new and rapidly evolving therapeutic option in dermatology. Initially used for the treatment of actinic damage and nonmelanotic skin cancer, more recent work indicates efficacy in the treatment of a wide range of conditions, such as acne, infectious processes, cutaneous T-cell lymphoma, and photorejuvenation, among others. This article provides a comprehensive review of applications and outcomes that use topical photodynamic therapy in the treatment of dermatologic disease.

Latest news and product developments

Latest news and product developments

Biologic treatment of rheumatoid arthritis and the risk of malignancy: Analyses from a large US observational study

Induction of malignancy is a major concern when rheumatoid arthritis (RA) is treated with biologic therapy. A meta-analysis of RA biologic clinical trials found a general increased risk of malignancy, but this risk was not found in a large observational study. We undertook this study to assess the risk of malignancy among biologic-treated patients in a large US observational database. We studied incident cases of cancer among 13,001 patients during approximately 49,000 patient-years of observation in the years 1998-2005. Cancer rates were compared with population rates using the US National Cancer Institute SEER (Surveillance, Epidemiology, and End-Results) database. Assessment of the risk of biologic therapy utilized conditional logistic regression to calculate odds ratios (ORs) as estimates of the relative risk, further adjusted for 6 confounders: age, sex, education level, smoking history, RA severity, and prednisone use. Biologic exposure was 49%. There were 623 incident cases of nonmelanotic skin cancer and 537 other cancers. The standardized incidence ratios and 95% confidence intervals (95% CIs) compared with SEER data were as follows: all cancers 1.0 (1.0-1.1), breast 0.8 (0.6-0.9), colon 0.5 (0.4-0.6), lung 1.2 (1.0-1.4), lymphoma 1.7 (1.3-2.2). Biologics were associated with an increased risk of nonmelanotic skin cancer (OR 1.5, 95% CI 1.2-1.8) and melanoma (OR 2.3, 95% CI 0.9-5.4). No other malignancy was associated with biologic use; the OR (overall risk) of any cancer was 1.0 (95% CI 0.8-1.2). Biologic therapy is associated with increased risk for skin cancers, but not for solid tumors or lymphoproliferative malignancies. These associations were consistent across different biologic therapies.

A follow-up study of mortality among the arseniasis patients exposed to indoor combustion of high arsenic coal in Southwest Guizhou Autonomous Prefecture, China

This study was directed to ascertain the mortality of a group of arseniasis patients in an endemic rural township in Southwest China, where the residents were exposed for decades to indoor combustion of high arsenic coal. All the diagnosed arseniasis cases registered in 1991 were defined as the target population, which were assigned to three symptom subgroups by the severity of dermal lesions. The death cases were surveyed and checked. The follow-up period was 12.5 years. The standardized mortality ratio (SMR) of all death causes combined, all cancers combined, and the cancers at every site were analyzed. The age standardized mortality rates (ASMRs) were calculated in three subgroups using the procedure of standardization. One hundred and six death cases were recorded. Liver cirrhosis, non-melanotic skin cancer, lung and liver cancer were the four most prevalent death causes and referred to 70.8% (75/106) of the total death cases. The mortality of all death causes combined was not higher than that of the whole of China in 2001 (SMR = 0.76, 95% CI 0.63-0.93). The crude mortality rate of non-melanotic skin cancer in males reached up to 128.66/10(5). SMRs of lung cancer and larynx cancer in males (SMRs 2.84 and 27.27, 95% CIs 1.51-4.86 and 5.61-79.62, respectively) significantly exceeded the levels for all male Chinese. ASMRs of all death causes combined, all cancers combined and non-melanotic skin cancer in males of the severe dermal symptoms subgroup were significantly higher than those in medium and/or mild dermal symptom subgroups. A significantly increased mortality due to lung cancer and non-melanotic skin cancer was confirmed, alike the situation in other arseniasis endemic areas in the world. No significant elevation of mortality due to liver cancer and bladder cancer was observed. Male arseniasis patients diagnosed with severe skin lesions face higher risks of malignancies and of non-melanotic skin cancer in particular in the following years.

PET Scanning in Breast Cancer: A Clinician’s Perspective

Breast cancer is the most common cancer among women excluding nonmelanotic skin cancers, and is the second leading cause of cancer deaths in women. In 2005, it is estimated there will be over 200,000 women diagnosed with breast cancer and approximately 40,000 deaths from the disease. Although the incidence of breast cancer remains high, the rate of death from breast cancer has recently been estimated to have diminished by 25% to 38% through the contribution of screening mammography and adjuvant therapy. Despite these advances, breast cancer continues to remain a major personal and public health issue. Oncologists are continually seeking tools to aid the treatment decisions for patients with breast cancer. At every stage of a patient’s disease, accurate information is required to assess the extent of disease, the pattern of spread, and the response to therapy. The purpose of this paper is to review the existing data regarding the potential role of fluorodeoxyglucose positron emission topography (FDG-PET) scanning in the mangement of breast cancer patients from a clinician’s viewpoint.

Reconstruction of the Anterior and Lateral Cranial Base after Combined Transfacial and Subcranial Approach for Recurrent Nonmelanotic Skin Cancer

Introduction: Nonmelanotic skin cancer (basal cell and squamous cell carcinoma) is a highly curable disease while still in the early stage if treated according to basic oncological principles. If recurrent disease in some high-risk areas (such as the paranasal area and the pinna) is not radically treated it can spread and involve the skull base causing large defects in bone and soft tissue.

Prävention des Prostatakarzinoms

Prostate cancer has become the most frequently diagnosed male cancer next to non-melanotic skin cancer in the Western world. Preventive measures would therefore have important potential effects on the incidence and prevalence of this disease. A potential for effective prevention of prostate cancer is currently seen in dietary changes and perhaps in dietary supplementation with vitamins D and E or selenium. Pharmacological prevention seems a possibility with drugs acting on intraprostatic testosterone metabolism. Several large randomised trials are ongoing to clarify the potential for successful prostate cancer prevention.

Nonmelanotic Head and Neck Skin Cancer: A Practical Update

Nonmelanotic skin cancer of the head and neck has risen in incidence over the last 15 years. In some areas this has increased by more that 40%. It is therefore likely that more practitioners will be exposed to this in their office practice.

Cryosurgery for Skin Cancer: 30-Year Experience and Cure Rates

Cryosurgery is capable of destroying nonmelanotic skin cancers, and numerous reports from around the world attest to its efficacy. However, there are few long-term data of large series of patients that were treated in this manner. To report and evaluate the author's experience of using deep cryosurgery in the management of basal and squamous cell carcinomas on all areas of the body over a 30-year period. Records of cryosurgical treatment in 4406 new and recurrent basal and squamous cell carcinomas in 2932 patients were reviewed. All cases were treated by the same physician. Liquid nitrogen was the cryogen. The open spray technique was mostly employed, and a double freeze-thaw cycle was carried out. Treatment was monitored clinically as well as by measurement of the tissue temperature in some cases;-50 degrees to-60 degrees C was reached in the tissue during the past 2 decades. The overall 30-year cure rate was 98.6% and was remarkably similar in all locations. A recent 5-year cure rate of 522 cases was 99.0%. There were five recurrences. Cryosurgery is a safe and effective treatment for selected nonmelanotic skin cancers and yields a high cure rate.

Second malignancies and Richter's syndrome in patients with chronic lymphocytic leukaemia treated with cladribine

The increased frequency of second malignancies in chronic lymphocytic leukaemia (CLL) is well known. Moreover, antineoplastic therapy additionally increases the risk of secondary cancers. In this study, we analysed whether treatment with cladribine (2-chlorodeoxyadenosine, 2-CdA) during the course of CLL had an impact on the subsequent occurrence of either secondary solid tumours or Richter's syndrome. There were 1487 eligible patients, 251 treated with 2-CdA alone, 913 treated with alkylating agents (AA)-based regimens alone and 323 treated with both 2-CdA and AA. Median time from the start of CLL treatment to the diagnosis of secondary malignancy was 1.9 years (0.5–5.1 years) for the 2-CdA group, 1.8 years (0.3–7.9 years) for the AA group and 3.9 years (0.3–8.4 years) for the 2CdA+AA group. A total of 68 malignancies were reported in 65 patients. Ten events were non-melanotic skin cancers and were excluded from the analysis, leaving 58 events in 58 patients. In the group of patients treated with 2-CdA alone, there were 15 (6.0%) cases, in the group of patients treated with AA alone there were 26 (2.8%) cases, and in the group treated with 2CdA+AA there were 17 (5.3%) cases of secondary malignancies. The differences between the frequency of secondary malignancies in the 2-CdA and 2-CdA+AA versus AA alone groups were not significant (P=0.05 and P=0.06, respectively). Only lung cancers occurred significantly more frequently in the 2-CdA (2.8%) and 2-CdA+AA (2.2%) treated groups compared with the AA patients (0.3%) (P<0.001 and P<0.01, respectively). In conclusion, 2-CdA in CLL patients does not seem to increase the risk of secondary malignancies except for lung cancers. However, further studies are necessary to establish the real risk of lung cancer in CLL patients treated with 2-CdA.

Low-dose acitretin appears to prevent the development of new non-melanotic skin cancers

Low-dose acitretin appears to prevent the development of new non-melanotic skin cancers

Genomic and phenomic correlations in the respiration of basal cell carcinomas.

Early last century Warburg1 described differences in metabolism between normal and cancer cells, however subsequent research did not bear out what he considered to be the “primary cause of cancer,” i.e., the replacement of respiration by fermentation 2. Since then attention continues to periodically focus on analysis of the enzymology &/or energetics of oxygen metabolism in cancer cells. Despite such studies, there is still debate as to whether cancers shift towards aerobic metabolism or transform toward a more anaerobic metabolism3. While many theories were advanced to explain those findings, no consistent pattern emerged to correlate the changes observed across all cancers studied. Among many such studies was an investigation we carried out into the enzymology and isoenzymology of human non-melanotic skin cancers (NMSCs). In that research, the levels of three enzymes involved in glucose metabolism, namely lactate dehydrogenase (LDH), aldolase and glucose-6-phospshate dehydrogenase (G-6-PDH), were shown to be depressed in basal cell carcinoma tissue (BCC) compared to normal skin. By contrast, the level of another enzyme, NADP+-dependent isocitrate dehydrogenase was elevated. Those results confirmed the fmdings of Halprin’s group4. In further studies of the same material, the isoenzyme patterns of two of those enzymes were altered in BCC relative to normal skin. The changes seen in the LDH isoenzyme patterns, i.e. increases in the anionic species, were consistent with a shift to a more anaerobic metabolism as were the changes observed in aldolase. To further characterize the oxygen metabolism of BCC, the respiration of small volumes of tissue were directly measured using oxygen electrodes.

Acitretin for prophylaxis of cutaneous malignancies after cardiac transplantation

Background Heart transplant recipients have an increased risk of developing actinic keratoses and non-melanotic skin cancers when compared with the general population. Systemic retinoids have been shown to be beneficial in the treatment of such lesions in recipients of other organs, but as of yet the heart transplant model has rarely been studied. In this investigation we describe our experience with the use of acitretin in a group of heart transplant patients. Methods Five heart transplant recipients with multiple new skin cancer presentations were treated with acitretin at doses of either 10 or 25 mg/day. Inclusion criteria were based on progressive actinic keratoses, recurrent skin malignancies or continuous lesions despite treatment with appropriate topical therapies. Patients were excluded if they were women of child-bearing age, had severe hepatic or renal impairment or were taking contraindicated medications. Results Over the treatment period all patients showed a reduction in the number of new non-melanotic skin cancers excised and histologically confirmed. Three patients had a very large reduction and 2 patients had a more moderate reduction in the number of new presentations. All patients had an objective decrease in the number of actinic keratoses. All patients tolerated the drug well with only 1 patient transiently discontinuing the Acitretin due to side effects. No significant alterations in the biochemical tests or serum lipids were reported. Conclusions Over the treatment period, low-dose acitretin proved a valuable addition in the long-term strategy of reduction and treatment of non-melanotic skin cancers in heart transplant recipients with multiple skin cancers and actinic keratoses.

Cancer Incidence and Mortality in Northeastern Ontario, 1991–1998

This descriptive epidemiology study reports the cancer incidence and mortality experience of Northeastern Ontario residents during the 8-year period from 1991-1998. Standardized Incidence Ratios (SIRs), Standardized Mortality Ratios (SMRs) and 95% confidence intervals (CI) were calculated for a number of cancer sites (n = 25 for males, n = 26 for females), using rates determined from the Ontario population as the referent population. During the period 1991-1998, 24,019 cases of primary incident cancers (excluding non-melanotic skin cancer) and 11,677 deaths attributed to cancer occurred in Northeastern Ontario residents. Several cancer sites were significantly elevated in Northeastern Ontario residents. For example, trachea-bronchus-lung cancer incidence and mortality rates were significantly elevated. Rates were over 20% higher than those for the province of Ontario, for both males and females (SIR = 122, 95% CI = 118-127; SIR = 123, 95% CI = 117-129 for males and females, respectively; SMR = 125, 95% CI = 120-130; SMR = 125, 95% CI = 118-132 for males and females, respectively). For both males and females, the cancer incidence and mortality experience of residents of Northeastern Ontario were significantly higher than would be expected based on Ontario cancer rates, overall, and for a number of individual sites. While this study does not identify causal associations between risk factors and disease, these data should aid in cancer control planning, and generating hypotheses for further study.

Human papillomavirus and skin cancer.

Human papillomavirus (HPV) appears to be the most ubiquitous of the human viruses. Over 100 HPV types have been identified. A minority of HPV cause cutaneous warts and mucosal condylomata. The HPV that cause mucosal condylomata put the patient at various degrees of risk for developing cancers, particularly cervical cancer. The majority of HPV infect the skin of normal and immunocompromised individuals. In normal people, most of these HPV appear to establish a latent infection of the skin, most likely as normal flora residing in hair follicles; however, in patients with various systemic and localized depressions of cell-mediated immunity, some HPV infections appear to be involved in the development of nonmelanotic skin cancer and its precursor lesions in skin, usually in sunlight-exposed areas. Circumstantial evidence suggests that these HPV may have a role in promoting proliferative lesions of the skin, although their sites of active infection and mode of transmission to susceptible individuals remain unknown.

BASAL AND SQUAMOUS CELL CARCINOMA

Nonmelanotic skin cancer, primarily basal and squamous cell carcinoma, represents a major health concern in both the United States and the world. Primary care physicians must be able to recognize these cancers and perform the appropriate diagnostic tests to confirm their clinical suspicion. Several biopsy techniques are available for the physician to use in their office, and once diagnosis is confirmed, a variety of treatment modalities exist that provide excellent cure rates. Nevertheless, primary prevention with the use of sunscreen, protective clothing, and wide-brimmed hats is necessary to reduce the incidence of this costly disease.