PDF herunterladen
Facial Plast Surg 2020; 36(02): 141-147
DOI: 10.1055/s-0040-1709132
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Emily S. Misch
1   Department of Otolaryngology—Head and Neck Surgery, University of Colorado, Aurora, Colorado
,
Adam M. Terella
1   Department of Otolaryngology—Head and Neck Surgery, University of Colorado, Aurora, Colorado
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
15. Mai 2020 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

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.

Keywords

nonmelanoma skin cancer - squamous cell carcinoma - basal cell carcinoma - high risk - reconstruction
 

  • References

  • 1 Guy Jr GP, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the U.S., 2002-2006 and 2007-2011. Am J Prev Med 2015; 48 (02) 183-187
    CrossrefPubMedSuche in Google Scholar
  • 2 Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the U.S. population, 2012. JAMA Dermatol 2015; 151 (10) 1081-1086
    CrossrefPubMedSuche in Google Scholar
  • 3 Amin MB, Edge S, Greene F. , et al, eds. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017
    Suche in Google Scholar
  • 4 Edge SB, Byrd DR, Compton CC. , et al, eds. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010
    Suche in Google Scholar
  • 5 Warner CL, Cockerell CJ. The new seventh edition American Joint Committee on Cancer staging of cutaneous non-melanoma skin cancer: a critical review. Am J Clin Dermatol 2011; 12 (03) 147-154
    CrossrefPubMedSuche in Google Scholar
  • 6 Canueto J, Burquillo J, Moyano-Bueno D. , et al. Comparing the eighth and the seventh editions of the American Joint Committee on Cancer staging system and the Brigham and Women's Hospital alternative staging system for the cutaneous squamous cell carcinoma: implications for clinical practice. J Am Acad Dermatol 2019; 80 (01) 106-113
    CrossrefPubMedSuche in Google Scholar
  • 7 Karia PS, Morgan FC, Califano JA, Schmults CD. Comparison of tumor classifications for cutaneous squamous cell carcinoma of the head and neck in the 7th vs 8th edition of the AJCC cancer staging manual. JAMA Dermatol 2018; 154 (02) 175-181
    CrossrefPubMedSuche in Google Scholar
  • 8 Jambusaria-Pahlajani A, Kanetsky PA, Karia PS. , et al. Evaluation of AJCC tumor staging for cutaneous squamous cell carcinoma and a proposed alternative tumor staging system. JAMA Dermatol 2013; 149 (04) 402-410
    CrossrefPubMedSuche in Google Scholar
  • 9 Roscher I, Falk RS, Vos L. , et al. Validating 4 staging systems for cutaneous squamous cell carcinoma using population-based data: a nested case-control study. JAMA Dermatol 2018; 154 (04) 428-434
    CrossrefPubMedSuche in Google Scholar
  • 10 Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P. ; Work Group; Invited Reviewers. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol 2018; 78 (03) 540-559
    CrossrefPubMedSuche in Google Scholar
  • 11 National Comprehensive Cancer Center. NCCN clinical practice guidelines in oncology; basal cell carcinoma (V1.2020). Available at: www.nccn.org . Accessed December 14, 2019
    PubMed
  • 12 Thompson AK, Kelley BF, Prokop LJ, Murad MH, Baum CL. Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis, and disease-specific death: a systematic review and meta-analysis. JAMA Dermatol 2016; 152 (04) 419-428
    CrossrefPubMedSuche in Google Scholar
  • 13 Ross AS, Schmults CD. Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature. Dermatol Surg 2006; 32 (11) 1309-1321
    PubMedSuche in Google Scholar
  • 14 Wermker K, Kluwig J, Schipmann S, Klein M, Schulze HJ, Hallermann C. Prediction score for lymph node metastasis from cutaneous squamous cell carcinoma of the external ear. Eur J Surg Oncol 2015; 41 (01) 128-135
    CrossrefPubMedSuche in Google Scholar
  • 15 Wang DM, Kraft S, Rohani P. , et al. Association of nodal metastasis and mortality with vermillion vs cutaneous lip location in cutaneous squamous cell carcinoma of the lip. JAMA Dermatol 2018; 154 (06) 701-707
    CrossrefPubMedSuche in Google Scholar
  • 16 Brantsch KD, Meisner C, Schönfisch B. , et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol 2008; 9 (08) 713-720
    CrossrefPubMedSuche in Google Scholar
  • 17 Levine HL, Bailin PL. Basal cell carcinoma of the head and neck: identification of the high risk patient. Laryngoscope 1980; 90 (6 Pt 1): 955-961
    CrossrefPubMedSuche in Google Scholar
  • 18 Silverman MK, Kopf AW, Bart RS, Grin CM, Levenstein MS. Recurrence rates of treated basal cell carcinomas. Part 3: Surgical excision. J Dermatol Surg Oncol 1992; 18 (06) 471-476
    CrossrefPubMedSuche in Google Scholar
  • 19 Morgan FC, Ruiz ES, Karia PS, Besaw RJ, Neel VA, Schmults CD. Factors predictive of recurrence, metastasis, and death from primary basal cell carcinoma 2 cm or larger in diameter. J Am Acad Dermatol 2019 . doi:10.1016/j.jaad.2019.09.075 (e-pub ahead of print).
    PubMedSuche in Google Scholar
  • 20 Rowe DE, Carroll RJ, Day Jr CL. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol 1992; 26 (06) 976-990
    CrossrefPubMedSuche in Google Scholar
  • 21 Krediet JT, Beyer M, Lenz K. , et al. Sentinel lymph node biopsy and risk factors for predicting metastasis in cutaneous squamous cell carcinoma. Br J Dermatol 2015; 172 (04) 1029-1036
    CrossrefPubMedSuche in Google Scholar
  • 22 Bøgelund FS, Philipsen PA, Gniadecki R. Factors affecting the recurrence rate of basal cell carcinoma. Acta Derm Venereol 2007; 87 (04) 330-334
    CrossrefPubMedSuche in Google Scholar
  • 23 Mullen JT, Feng L, Xing Y. , et al. Invasive squamous cell carcinoma of the skin: defining a high-risk group. Ann Surg Oncol 2006; 13 (07) 902-909
    CrossrefPubMedSuche in Google Scholar
  • 24 Edwards MJ, Hirsch RM, Broadwater JR, Netscher DT, Ames FC. Squamous cell carcinoma arising in previously burned or irradiated skin. Arch Surg 1989; 124 (01) 115-117
    PubMedSuche in Google Scholar
  • 25 Collins L, Asfour L, Stephany M, Lear JT, Stasko T. Management of non-melanoma skin cancer in transplant recipients. Clin Oncol (R Coll Radiol) 2019; 31 (11) 779-788
    CrossrefPubMedSuche in Google Scholar
  • 26 Peleva E, Exton LS, Kelley K, Kleyn CE, Mason KJ, Smith CH. Risk of cancer in patients with psoriasis on biological therapies: a systematic review. Br J Dermatol 2018; 178 (01) 103-113
    CrossrefPubMedSuche in Google Scholar
  • 27 Gupta A, Veness M, De'Ambrosis B, Selva D, Huilgol SC. Management of squamous cell and basal cell carcinomas of the head and neck with perineural invasion. Australas J Dermatol 2016; 57 (01) 3-13
    PubMedSuche in Google Scholar
  • 28 Carter JB, Johnson MM, Chua TL, Karia PS, Schmults CD. Outcomes of primary cutaneous squamous cell carcinoma with perineural invasion: an 11-year cohort study. JAMA Dermatol 2013; 149 (01) 35-41
    CrossrefPubMedSuche in Google Scholar
  • 29 Ross AS, Whalen FM, Elenitsas R, Xu X, Troxel AB, Schmults CD. Diameter of involved nerves predicts outcomes in cutaneous squamous cell carcinoma with perineural invasion: an investigator-blinded retrospective cohort study. Dermatol Surg 2009; 35 (12) 1859-1866
    CrossrefPubMedSuche in Google Scholar
  • 30 Karia PS, Morgan FC, Ruiz ES, Schmults CD. Clinical and incidental perineural invasion of cutaneous squamous cell carcinoma: a systematic review and pooled analysis of outcomes data. JAMA Dermatol 2017; 153 (08) 781-788
    CrossrefPubMedSuche in Google Scholar
  • 31 Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R. Basal cell carcinoma treated with Mohs surgery in Australia III. Perineural invasion. J Am Acad Dermatol 2005; 53 (03) 458-463
    CrossrefPubMedSuche in Google Scholar
  • 32 Cho M, Lee J, James CL, Marshman G, Huilgol SC. Scalp basal cell carcinoma: review of 2,202 cases. Dermatol Surg 2016; 42 (07) 834-841
    CrossrefPubMedSuche in Google Scholar
  • 33 Cherpelis BS, Marcusen C, Lang PG. Prognostic factors for metastasis in squamous cell carcinoma of the skin. Dermatol Surg 2002; 28 (03) 268-273
    PubMedSuche in Google Scholar
  • 34 Martorell-Calatayud A, Sanmartín Jimenez O, Cruz Mojarrieta J, Guillén Barona C. Cutaneous squamous cell carcinoma: defining the high-risk variant. Actas Dermosifiliogr 2013; 104 (05) 367-379
    CrossrefPubMedSuche in Google Scholar
  • 35 National Comprehensive Cancer Center. NCCN clinical practice guidelines in oncology; squamous cell carcinoma (V1.2020). Available at: www.nccn.org . Accessed December 10, 2019
    PubMed
  • 36 Randle HW. Basal cell carcinoma. Identification and treatment of the high-risk patient. Dermatol Surg 1996; 22 (03) 255-261
    PubMedSuche in Google Scholar
  • 37 Haisma MS, Plaat BEC, Bijl HP. , et al. Multivariate analysis of potential risk factors for lymph node metastasis in patients with cutaneous squamous cell carcinoma of the head and neck. J Am Acad Dermatol 2016; 75 (04) 722-730
    CrossrefPubMedSuche in Google Scholar
  • 38 Roozeboom MH, Lohman BG, Westers-Attema A. , et al. Clinical and histological prognostic factors for local recurrence and metastasis of cutaneous squamous cell carcinoma: analysis of a defined population. Acta Derm Venereol 2013; 93 (04) 417-421
    CrossrefPubMedSuche in Google Scholar
  • 39 Ruiz ES, Karia PS, Morgan FC, Schmults CD. The positive impact of radiologic imaging on high-stage cutaneous squamous cell carcinoma management. J Am Acad Dermatol 2017; 76 (02) 217-225
    CrossrefPubMedSuche in Google Scholar
  • 40 Baum CL, Wright AC, Martinez JC. , et al. A new evidence-based risk stratification system for cutaneous squamous cell carcinoma into low, intermediate, and high risk groups with implications for management. J Am Acad Dermatol 2018; 78 (01) 141-147
    CrossrefPubMedSuche in Google Scholar
  • 41 Schmults CD, Karia PS, Carter JB, Han J, Qureshi AA. Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study. JAMA Dermatol 2013; 149 (05) 541-547
    CrossrefPubMedSuche in Google Scholar
  • 42 Kraus DH, Carew JF, Harrison LB. Regional lymph node metastasis from cutaneous squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 1998; 124 (05) 582-587
    CrossrefPubMedSuche in Google Scholar
  • 43 Kwon S, Dong ZM, Wu PC. Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: clinical experience and review of literature. World J Surg Oncol 2011; 9: 80
    CrossrefPubMedSuche in Google Scholar
  • 44 Ahmad FI, Su SY, Gross ND. The role of sentinel lymph node biopsy in the management of cutaneous malignancies. Facial Plast Surg Clin North Am 2019; 27 (01) 119-129
    CrossrefPubMedSuche in Google Scholar
  • 45 Ahadiat O, Higgins S, Kwon S, Wysong A. Underuse of the sentinel lymph node biopsy for high-risk squamous cell carcinoma of the skin. JAMA Dermatol 2018; 154 (01) 101
    PubMedSuche in Google Scholar
  • 46 Turner RJ, Leonard N, Malcolm AJ, Lawrence CM, Dahl MG. A retrospective study of outcome of Mohs' micrographic surgery for cutaneous squamous cell carcinoma using formalin fixed sections. Br J Dermatol 2000; 142 (04) 752-757
    CrossrefPubMedSuche in Google Scholar
  • 47 van Lee CB, Roorda BM, Wakkee M. , et al. Recurrence rates of cutaneous squamous cell carcinoma of the head and neck after Mohs micrographic surgery vs. standard excision: a retrospective cohort study. Br J Dermatol 2019; 181 (02) 338-343
    CrossrefPubMedSuche in Google Scholar
  • 48 Rowe DE, Carroll RJ, Day Jr CL. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol 1989; 15 (03) 315-328
    CrossrefPubMedSuche in Google Scholar
  • 49 Brodland DG, Zitelli JA. Surgical margins for excision of primary cutaneous squamous cell carcinoma. J Am Acad Dermatol 1992; 27 (2 Pt 1): 241-248
    CrossrefPubMedSuche in Google Scholar
  • 50 Kwan W, Wilson D, Moravan V. Radiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin. Int J Radiat Oncol Biol Phys 2004; 60 (02) 406-411
    CrossrefPubMedSuche in Google Scholar
  • 51 Palmer JD, Schneider CJ, Hockstein N. , et al. Combination of post-operative radiotherapy and cetuximab for high-risk cutaneous squamous cell cancer of the head and neck: a propensity score analysis. Oral Oncol 2018; 78: 102-107
    CrossrefPubMedSuche in Google Scholar
  • 52 Sullivan SR, Scott JR, Cole JK. , et al. Head and neck malignant melanoma: margin status and immediate reconstruction. Ann Plast Surg 2009; 62 (02) 144-148
    CrossrefPubMedSuche in Google Scholar
  • 53 Bootun R. Effects of immunosuppressive therapy on wound healing. Int Wound J 2013; 10 (01) 98-104
    CrossrefPubMedSuche in Google Scholar