Non-Melanoma Skin Cancer
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Basal Cell Carcinoma is the most common type of skin cancer, it occurs when basal cells (round cells found in the outer layer of skin) become cancerous. The second most common type of skin cancer is Squamous Cell Carcinoma, this is where squamous cells (the flat, scaly cells on the surface of the skin) become malignant . Cure rates are very high for both basal cell carcinoma and squamous cell carcinoma. In addition there are a number of other, less common cancers starting in the skin including Merkel cell tumours and cutaneous lymphomas and sarcomas (see the sections on sarcoma and lymphoma for more information about these).

Menu: Non-Melanoma Skin Cancer

Information for Patients and the Public
Information for Health Professionals / Researchers
Latest Research Publications
Basal Cell Carcinoma
Squamous Cell Carcinoma
Cutaneous T-cell Lymphoma
Dermatofibrosarcoma Protuberans
Merkel Cell Cancer
Prevention of Skin Cancer
Skin Cancer

Information Patients and the Public (12 links)


Information for Health Professionals / Researchers (9 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Belkin DA, Mitsui H, Wang CQ, et al.
CD200 upregulation in vascular endothelium surrounding cutaneous squamous cell carcinoma.
JAMA Dermatol. 2013; 149(2):178-86 [PubMed]
OBJECTIVE: To characterize the presence of CD200 and CD200 receptor (CD200R) in the human cutaneous squamous cell carcinoma (SCC) microenvironment and to define a possible role for the CD200 axis in immune evasion by SCC.
DESIGN: Gene expression in SCC vs normal skin was studied. Laser capture microdissection was used to determine differential expression of CD200 in normal skin vs actinic keratosis vs SCC in situ vs invasive SCC. Immunofluorescence microscopy was used to define expression of CD200R on macrophages, myeloid dendritic cells, natural killer cells, and T cells in SCC vs normal skin. The effects of SCC supernatant on induction of CD200 in human blood endothelial cells was also examined.
SETTING: Academic Medical Center with an established Section of Mohs and Dermatologic Surgery and an active Cutaneous Biology Research Program.
PARTICIPANTS: Surgical discard tissue from deidentified patients and samples of normal skin from healthy volunteers were used in this study.
MAIN OUTCOME MEASURES: Expression of CD200 on SCC-associated blood vessels; expression of CD200 receptor on SCC-associated macrophages and T cells; and induction of CD200 on endothelial cells by SCC supernatants.
RESULTS: CD200 gene and message were upregulated in SCC stroma. Immunostaining revealed a higher number of CD200(+) cells in SCC stroma than in normal dermis (180.8 cells/mm(2) vs 24.6 cells/mm(2)) (P<.01). CD200 was further identified mainly on blood vessel endothelium in SCC. Tumor supernatant was able to induce CD200 expression on human dermal blood endothelial cells in culture. CD200R was identified on macrophages and dendritic cells in SCC microenvironment.
CONCLUSIONS: CD200 expression on local blood vessels may promote tumor progression by suppressing CD200R myeloid cells during diapedesis. These data highlight a previously unrecognized mechanism of immune evasion by SCC and may provide guidance for the development of targeted therapy.


Griffin JR, Wriston CC, Peters MS, Lehman JS
Decreased expression of intercellular adhesion molecules in acantholytic squamous cell carcinoma compared with invasive well-differentiated squamous cell carcinoma of the skin.
Am J Clin Pathol. 2013; 139(4):442-7 [PubMed]
Intercellular adhesion proteins are poorly characterized in acantholytic squamous cell carcinoma (ASCC), a more aggressive tumor than nonacantholytic invasive well-differentiated squamous cell carcinoma (SCC) of the skin. In this study we compared expression of Dsg3, E-cadherin, and syndecan-1 in ASCC and SCC. Immunohistochemical detection of Dsg3, E-cadherin, and syndecan-1 in 22 ASCCs and 22 SCCs was graded on a semiquantitative scale for intensity of staining (SI) and degree of circumferential staining (CS) about the cell membrane. Results were assessed by means of conditional logistic regression and χ(2) analysis. Dsg3 and E-cadherin expression (SI, CS) was significantly decreased (P < .05) in ASCC compared with SCC, whereas staining for syndecan-1 was similar in the 2 tumor types. Differences in expression of adhesion markers between ASCC and SCC may contribute to the development of acantholysis in ASCC and its more aggressive biologic behavior.


Maurice PD, Fenton T, Cross N, et al.
A dedicated dermatology clinic for renal transplant recipients: first 5 years of a New Zealand experience.
N Z Med J. 2013; 126(1369):27-33 [PubMed]
AIM: Cancer following organ transplantation is a growing public health concern. We describe the first 5 years' experience of a dedicated dermatology clinic for renal transplant recipients, the first of its type in New Zealand.
METHODS: Data from patients seen in the clinic were collected on a nephrology/dermatology database.
RESULTS: 86 of 99 transplant recipients had a baseline dermatology assessment. Seventy-one skin cancers (45 squamous, 25 basal cell carcinomas, 1 melanoma) were found in 17 patients. Eighteen of these were an incidental finding at the baseline post-transplant examination of 7 patients: they had not been noted either by the patient or by their nephrologist. A further 44 cancers were found in 13 patients at follow-up examinations in the dedicated clinic. Squamous and basal cell carcinomas received definitive treatment after 26 and 38 days (median) respectively. A brief analysis showed this to be a cost-effective way of diagnosing and treating skin cancer in this cohort of patients.
CONCLUSION: The clinic is enabling prompt diagnosis and cost-effective treatment of skin cancers developing in renal transplant recipients and is also identifying significant numbers of pre-existing skin cancers in these patients.


Olaofe OO, Omoniyi-Esan GO, Omonisi AE, Alakinyoola AL
Pseudoangiosarcomatous squamous cell carcinoma in an old surgical scar of an African woman.
Afr J Med Med Sci. 2012; 41(3):317-20 [PubMed]
BACKGROUND: Squamous cell carcinoma, a malignant proliferation of keratinocytes, can be found in many regions of the body covered by stratified squamous epithelium and in areas covered by other epithelia but which had undergone squamous metaplasia. Squamous cell carcinoma has many variants.
METHODOLOGY: We, retrospectively, reviewed the case file and histological features of a 75 year old trader with a rare variant of squamous cell carcinoma arising from an old surgical scar.
CASE REPORT: The 75-year-old African female trader presented to the hospital with three and a-half month history of a swelling in the anterior aspect of the left leg arising from an old surgical scar. Clinical examination showed an irregularly shaped ulcer measuring 14 x 16 cm with an everted edge and a hyperpigmented floor. Histologic sections of the specimen showed the infiltration of the papillary and reticular dermis of the skin by sheets of atypical spindle cells with areas of squamous differentiation. There was a contiguous area of capillary-like structures constituting about 30% of the sections examined. The neoplastic cells were positive for vimentin and cytokeratin but were negative for CD34. The diagnosis was pseudoangiosarcomatous squamous cell carcinoma.
CONCLUSION: This tumour can be found in Africans and in an old surgical scar. It can coexist with other variants of squamous cell carcinoma. There may be need in the future to add a new mixed variant to the current classification scheme.


Kent R, Glorioso S, Nordberg ML
A model for cutaneous squamous cell carcinoma in vemurafenib therapy.
J La State Med Soc. 2012 Nov-Dec; 164(6):311-3 [PubMed]
Vemurafenib is a chemotherapeutic BRAF inhibitor, or dabrafenib, that has been FDA-approved for treatment in metastatic melanoma positive for the V600E mutation. BRAF inhibitors, including vemurafenib, are linked to the development of cutaneous squamous cell carcinoma and keratoacanthoma. Furthermore, pathological analysis has shown these secondary tumors do not harbor the same mutations as the primary cancer, suggesting de novo pathogenesis. In accordance, patients require close dermatological follow-up due to the high prevalence rates of these tumors. This paper takes the form of an extensive case-and-review article exploring the development of these tumors and their management.


Kostović K, Pastar Z, Ceović R, et al.
Photodynamic therapy in dermatology: current treatments and implications.
Coll Antropol. 2012; 36(4):1477-81 [PubMed]
This article provides an update on photodynamic therapy by discussing each of the essential components in sequence: mechanisms of action, common photosensitizers, typical light sources, and indications. In dermatology, photodynamic therapy (PDT) is mainly used in the treatment of superficial skin cancers: actinic keratoses, Bowen's disease and superficial basal cell carcinomas. However the range of indications has been expanding continuously. PDT is also used for the treatment of other oncological indications and non-malignant conditions such as acne vulgaris and photoaged skin. The 5-aminolevulinic acid (ALA) or its methyl ester (MAL) is applied topically as photosensitizer before activation with visible light. The advantages of topical PDT are: ability to treat multiple lesions simultaneously, low invasiveness, good tolerance and excellent cosmetic results.


Husein-Elahmed H, Gutierrez-Salmeron MT, Naranjo-Sintes R, Aneiros-Cachaza J
Factors related to delay in the diagnosis of basal cell carcinoma.
J Cutan Med Surg. 2013 Jan-Feb; 17(1):27-32 [PubMed]
BACKGROUND: There is often a delay between the clinical emergence of a basal cell carcinoma (BCC) and the point in time at which the patient presents for definitive diagnosis and treatment. Previously published studies on delays regarding skin cancer have focused on melanoma rather than BCC. We conducted a study aimed at identifying factors associated with the detection of BCC and reasons for the delay in diagnosis.
METHOD: A monocentric study was performed. Patients with a primary BCC diagnosed in 2010 were included in the study. They were asked about factors concerning BCC awareness and detection, tumor characteristics, previous history of nonmelanoma cutaneous cancer, family history of nonmelanoma cutaneous cancer, and the presence of comorbidities. Data were analyzed using SPSS software.
RESULTS: The mean diagnostic delay for BCC in our hospital setting was estimated at 19.79 ± 14.71 months. Delayed diagnosis was significantly associated with patients over 65 years, those without a previous history of BCC, those without a family history of BCC, those with BCC located elsewhere than the head or neck, and those with lesions not associated with itching or bleeding.
CONCLUSION: This study revealed considerable delay in the diagnosis of BCC. The main reason for delay in the diagnosis seems to be the initial decision of the patient to seek medical advice. These data suggest a need for greater information for the general public on the symptoms and signs that should prompt suspicion of a BCC.


Khan AA, Potter M, Cubitt JJ, et al.
Guidelines for the excision of cutaneous squamous cell cancers in the United Kingdom: the best cut is the deepest.
J Plast Reconstr Aesthet Surg. 2013; 66(4):467-71 [PubMed]
Surgical excision remains the gold standard for the management of cutaneous squamous cell cancers (SCC) and national guidelines for operative radial margins predict 95% oncological clearance with a margin of 4 mm for low-risk and 6 mm for high-risk tumours. We retrospectively analysed all cutaneous SCC excisions performed across 4 regional Plastic surgical units in England over a consecutive 24-month period and collected data on tumour characteristics, operative and histological margins and completeness of excision. We identified 633 eligible SCC excisions of which 265 (42%) were over 2 cm in diameter with 37 recurrent tumours (5.8%). The mean radial operative margin was 6.5 mm across all tumours and 8.4 mm for tumours greater than 2 cm. The mean histological tumour diameter was 21 mm. The overall incomplete excision rate was 7.6% (7.9% for tumours >2 cm). Ninety-four percent (45/48) of incomplete excisions involved the deep margin and only 3 out of 633 excisions (0.47%) were incomplete at a radial margin only. No differences were observed in tumour size or excision margin between incompletely and completely excised tumours. Incomplete excisions were most common on the ear, nose and cheek. In summary our analysis demonstrates that despite adherence to recommended surgical margins for cutaneous SCCs the incomplete excision rate remains higher than expected. We believe that this is because most incomplete excisions are incomplete at the deep margin and question the utility of performing increasingly wide excisions, and, the generalisability of the evidence upon which recommendations for radial margins are based.


Carter JB, Johnson MM, Chua TL, et al.
Outcomes of primary cutaneous squamous cell carcinoma with perineural invasion: an 11-year cohort study.
JAMA Dermatol. 2013; 149(1):35-41 [PubMed]
OBJECTIVE: To identify factors associated with poor outcomes in perineurally invasive squamous cell carcinoma.
DESIGN: Retrospective cohort study.
SETTING: Two academic hospitals in Boston, Massachusetts.
PATIENTS: Adults with perineural SCC diagnosed from 1998 to 2008.
MAIN OUTCOME MEASURES: Hazard ratios (HRs) for local recurrence, nodal metastasis, death from disease, and overall death, adjusted for known prognostic factors.
RESULTS: A total of 114 cases were included, all but 2 involving unnamed nerves. Only a single local recurrence occurred in cases with no risk factors other than nerve invasion. Tumors with large nerve (≥ 0.1 mm in caliber) invasion were significantly more likely to have other risk factors, including diameters of 2 cm or greater (P<.001), invasion beyond the subcutaneous fat (P<.003), multiple nerve involvement (P<.001), infiltrative growth (P=.01), or lymphovascular invasion (P=.01). On univariate analysis, large nerve invasion was associated with increased risk of nodal metastasis (HR, 5.6 [95% CI, 1.1-27.9]) and death from disease (HR, 4.5 [95% CI, 1.2-17.0]). On multivariate analysis, tumor diameter of 2 cm or greater predicted local recurrence (HR, 4.8 [95% CI, 1.8-12.7]), >1 risk factor predicted nodal metastasis (2 factors: HR, 4.1 [95% CI, 1.0-16.6]), lymphovascular invasion predicted death from disease (HR, 15.3 [95% CI, 3.7-62.8]), and overall death (HR, 1.1 [95% CI, 1.0-1.1]). Invasion beyond subcutaneous fat also predicted overall death (HR, 2.1 [95% CI, 1.0-4.3]).
CONCLUSIONS: Squamous cell carcinoma involving unnamed small nerves (<0.1 mm in caliber) may have a low risk of poor outcomes in the absence of other risk factors. Large-caliber nerve invasion is associated with an elevated risk of nodal metastasis and death, but this is due in part to multiple other risk factors associated with large-caliber nerve invasion. A larger study is needed to estimate the specific prognostic impact of nerve caliber.


Ross AD, Kumar P, Challacombe BJ, et al.
The addition of the surgical robot to skin cancer management.
Ann R Coll Surg Engl. 2013; 95(1):70-2 [PubMed]
We present the introduction of the surgical robot for pelvic lymphadenectomy for skin cancer through a cross-specialty collaboration. In this prospective series, we include the first report of cases undergoing robot-assisted pelvic lymph node dissection for Merkel cell carcinoma and melanoma in the recognised scientific literature.


Noss MR, Cha J
Erythematous penile lesion.
J Fam Pract. 2012; 61(12):753-5 [PubMed]
Previous efforts to diagnose the cause of this patient's rash had been unsuccessful. A biopsy confirmed our suspicions.


Colmont CS, Benketah A, Reed SH, et al.
CD200-expressing human basal cell carcinoma cells initiate tumor growth.
Proc Natl Acad Sci U S A. 2013; 110(4):1434-9 [PubMed] Free Access to Full Article
Smoothened antagonists directly target the genetic basis of human basal cell carcinoma (BCC), the most common of all cancers. These drugs inhibit BCC growth, but they are not curative. Although BCC cells are monomorphic, immunofluorescence microscopy reveals a complex hierarchical pattern of growth with inward differentiation along hair follicle lineages. Most BCC cells express the transcription factor KLF4 and are committed to terminal differentiation. A small CD200(+) CD45(-) BCC subpopulation that represents 1.63 ± 1.11% of all BCC cells resides in small clusters at the tumor periphery. By using reproducible in vivo xenograft growth assays, we determined that tumor initiating cell frequencies approximate one per 1.5 million unsorted BCC cells. The CD200(+) CD45(-) BCC subpopulation recreated BCC tumor growth in vivo with typical histological architecture and expression of sonic hedgehog-regulated genes. Reproducible in vivo BCC growth was achieved with as few as 10,000 CD200(+) CD45(-) cells, representing ~1,500-fold enrichment. CD200(-) CD45(-) BCC cells were unable to form tumors. These findings establish a platform to study the effects of Smoothened antagonists on BCC tumor initiating cell and also suggest that currently available anti-CD200 therapy be considered, either as monotherapy or an adjunct to Smoothened antagonists, in the treatment of inoperable BCC.


Silverberg MJ, Leyden W, Warton EM, et al.
HIV infection status, immunodeficiency, and the incidence of non-melanoma skin cancer.
J Natl Cancer Inst. 2013; 105(5):350-60 [PubMed] Article available free on PMC after 06/03/2014
Background The incidence of non-melanoma skin cancers (NMSCs), including basal cell (BCC) or squamous cell carcinoma (SCC), is not well documented among HIV-positive (HIV(+)) individuals. Methods We identified 6560 HIV(+) and 36 821 HIV-negative (HIV(-)) non-Hispanic white adults who were enrolled and followed up in Kaiser Permanente Northern California from 1996 to 2008. The first biopsy-proven NMSCs diagnosed during follow-up were identified from pathology records. Poisson models estimated rate ratios that compared HIV(+) (overall and stratified by recent CD4 T-cell counts and serum HIV RNA levels) with HIV(-) subjects and were adjusted for age, sex, smoking history, obesity diagnosis history, and census-based household income. Sensitivity analyses were adjusted for outpatient visits (ie, a proxy for screening). All statistical tests were two-sided. Results The NMSC incidence rate was 1426 and 766 per 100 000 person-years for HIV(+) and HIV(-) individuals, respectively, which corresponds with an adjusted rate ratio of 2.1 (95% confidence interval [CI] = 1.9 to 2.3). Similarly, the adjusted rate ratio for HIV(+) vs HIV(-) subjects was 2.6 (95% CI = 2.1 to 3.2) for SCCs, and it was 2.1 (95% CI = 1.8 to 2.3) for BCCs. There was a statistically significant trend of higher rate ratios with lower recent CD4 counts among HIV(+) subjects compared with HIV(-) subjects for SCCs (P trend < .001). Adjustment for number of outpatient visits did not affect the results. Conclusion HIV(+) subjects had a twofold higher incidence rate of NMSCs compared with HIV(-) subjects. SCCs but not BCCs were associated with immunodeficiency.


Grelck K, Sukal S, Rosen L, Suciu GP
Incidence of residual nonmelanoma skin cancer in excisions after shave biopsy.
Dermatol Surg. 2013; 39(3 Pt 1):374-80 [PubMed]
BACKGROUND: Nonmelanoma skin cancer is an increasingly common disease that is typically treated surgically. After histopathologic confirmation by biopsy, the carcinoma is typically removed by excision, but not all excisional specimens contain residual carcinoma.
OBJECTIVES: To define the rate of residual basal and squamous cell carcinomas within excisional specimens after shave biopsy in a general dermatology office.
METHODS: We retrospectively reviewed 439 consecutive cases sent to a single dermatopathology lab from a practitioner's general dermatology office who also performs Mohs micrographic surgery. One hundred cases had a histopathologically proven carcinoma on biopsy with subsequent excision. Histopathologic type, location, age, sex, and time from biopsy to excision were all analyzed for statistical association.
RESULTS: Of 57 cases of basal cell carcinoma, 34 (59.6%) had positive residuals. Of 43 cases of squamous cell carcinoma, 12 (27.9%) had positive residuals. Histologic type was significantly associated (p = .002) with residual carcinoma in excisional specimens, with basal cells 2.13 times as likely to have residual carcinoma present.
CONCLUSION: The rate of residual nonmelanoma carcinoma in excision specimens after shave biopsy was found to be different from previously reported in the literature. These data may have therapeutic ramifications if further substantiated.


Abramson AK, Krasny MJ, Goldman GD
Tangential shave removal of basal cell carcinoma.
Dermatol Surg. 2013; 39(3 Pt 1):387-92 [PubMed]
OBJECTIVE: To determine the outcome of tangential shave removal (TS) of basal cell carcinoma (BCC) on the trunk and extremities.
DESIGN: Cohort study of patients with multiple truncal BCC treated using TS in an academic dermatologic surgery practice.
SETTING: Academic institution referral practice.
PATIENTS: Individuals with BCC referred to the dermatologic surgery unit for ongoing therapy of multiple lesions.
INTERVENTIONS: TS of amenable superficial and nodular BCCs with twice-annual follow-up. Lesions were removed using a scalpel as a uniform-depth mid-to-upper dermal shave and sent for routine pathology. Basic wound care was applied.
PRIMARY OUTCOME MEASURES: Apparent cure rate and outcome of scars.
RESULTS: One hundred eighty-two BCCs were treated in 19 individuals. Patients were followed for an average of 5.2 years. One lesion recurred. Three specimens had positive margins requiring further surgery. Scarring was acceptable and similar to what is observed with curettage and electrocoagulation.
CONCLUSIONS: TS is a reasonable treatment for primary superficial and nodular BCC on the trunk and extremities.


Moutran R, Maatouk I, Stephan F, Tomb R
Treatment of nodular basal cell carcinoma with cryotherapy and reduced protocol of imiquimod.
Cutis. 2012; 90(5):256-7 [PubMed]
Various treatment options are available for basal cell carcinoma (BCC). We report a case of a patient with a nodular BCC on the nose who was treated with combination therapy consisting of cryotherapy with liquid nitrogen followed by imiquimod cream 5% 5 times weekly for 6 weeks. Clearance of the lesion was histologically confirmed.


Iwasaki T, Kodama H, Matsushita M, et al.
Merkel cell polyomavirus infection in both components of a combined Merkel cell carcinoma and basal cell carcinoma with ductal differentiation; each component had a similar but different novel Merkel cell polyomavirus large T antigen truncating mutation.
Hum Pathol. 2013; 44(3):442-7 [PubMed]
Merkel cell polyomavirus infects up to 80% of patients with Merkel cell carcinoma. Combined Merkel cell carcinoma and cutaneous tumors occur occasionally. Previous reports have suggested that Merkel cell polyomavirus is absent from combined Merkel cell carcinoma and squamous cell carcinomas. This is the first report that Merkel cell polyomavirus infected in both lesions of a combined Merkel cell carcinoma and basal cell carcinoma. A 92-year-old Japanese man presented with a right thigh small subcutaneous mass. Histologic examination revealed a combined tumor with Merkel cell carcinoma and basal cell carcinoma with ductal differentiation. Both tumors and intermingled Merkel cells in basal cell carcinoma expressed Merkel cell polyomavirus large T antigen, and 17 and 240 copies of Merkel cell polyomavirus/cell were detected in the microdissected Merkel cell carcinoma and basal cell carcinoma specimens, respectively. Mutation analysis of Merkel cell polyomavirus large T antigen revealed a novel truncating mutation in Merkel cell carcinoma and a similar but different mutation in the basal cell carcinoma. These results suggest that each was infected by a different Merkel cell polyomavirus subclone derived from a single Merkel cell polyomavirus.


Terada T, Kamo M, Baba Y, Sugiura M
Microinvasive squamous cell carcinoma arising within seborrheic keratosis.
Cutis. 2012; 90(4):176-8 [PubMed]
Squamous cell carcinoma (SCC) arising within seborrheic keratosis (SK) is rare. We report an 84-year-old woman who presented with a rapidly growing black tumor on her left palpebral eyelid of several years' duration. Clinical examination revealed an elevated hemorrhagic black tumor that measured 0.9 x 0.9 x 0.6 cm. A clinical diagnosis of SK was made, but basal cell carcinoma could not be ruled out; therefore, excision with wide margins was performed. Histologically, the tumor was symmetrical and composed of benign basaloid cells with pseudohorn cysts in a reticulated pattern. The tumor showed heavy melanin deposition. The features were indicative of SK. An atypical cell cluster was seen in the central low area. These cells showed keratin pearls, individual keratinization, mitotic and apoptotic figures, nuclear atypia, and microinvasion, indicating microinvasive SCC. Immunohistochemistry revealed the microinvasive SCC area was true SCC. This case suggests that microinvasive SCC can arise within pigmented reticulated SK.


Rosen T, Lebwohl MG
Prevalence and awareness of actinic keratosis: barriers and opportunities.
J Am Acad Dermatol. 2013; 68(1 Suppl 1):S2-9 [PubMed]
Actinic keratoses (AKs) are common skin lesions that appear after long-term exposure to ultraviolet radiation. The presence of AKs is associated with an increased risk for development of nonmelanoma skin cancer. AKs vary widely in clinical and histologic presentation, which contributes to inadequate identification and presents challenges for consensus classification. Clinically adequate reduction in AK prevalence requires a multifaceted approach. There is a reasonable need to increase awareness and knowledge about AK, including symptoms, prevention, and associated risk of nonmelanoma skin cancer, especially among the public at large. Safe and effective treatment strategies are needed to optimize clearance of AKs, ideally to prevent progression to invasive cutaneous neoplasia.


Cigna E, Tarallo M, Sorvillo V, et al.
Metatypical carcinoma of the head: a review of 312 cases.
Eur Rev Med Pharmacol Sci. 2012; 16(14):1915-8 [PubMed]
BACKGROUND: Metatypical cell carcinoma (MTC) is a quite rare malignancy accounting for 5% of all non melanoma skin cancers, with features of basal cell carcinoma and squamous cell carcinoma. It can be described as coexistence of basal cell carcinoma and squamous cell carcinoma with no transition zone between them.
AIM: Our review identified a correlation between gender and MTC affected region.
MATERIALS AND METHODS: We performed a retrospective study of 312 consecutive patients, diagnosed for MTC localized on face and scalp. Statistical analysis was made to determinate most affected areas, gender prevalence, average age, presence of ulceration and infiltration and peripheral clearance rate.
RESULTS: A relevant difference came out between two genders. χ2 test emphasized a relation between males and the presence of carcinoma on the scalp. In addition a strong correlation between mixed subtype and ulceration was evident. A strong relation between intermediate subtype and positive surgical margin was found; this data could identify a more aggressive behavior of intermediate type.
CONCLUSIONS: In our findings an important correlation between sun exposition and this tumor was found. Moreover, due to the difficulties that can occur in preserving the aesthetic subunits in the surgical treatment of these regions, the prevention of this pathology has an important role.


Harms PW, Patel RM, Verhaegen ME, et al.
Distinct gene expression profiles of viral- and nonviral-associated merkel cell carcinoma revealed by transcriptome analysis.
J Invest Dermatol. 2013; 133(4):936-45 [PubMed] Article available free on PMC after 01/10/2013
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine tumor with high mortality rates. Merkel cell polyomavirus (MCPyV), identified in the majority of MCCs, may drive tumorigenesis via viral T antigens. However, the mechanisms underlying pathogenesis in MCPyV-negative MCCs remain poorly understood. To nominate genes contributing to the pathogenesis of MCPyV-negative MCCs, we performed DNA microarray analysis on 30 MCCs. The MCPyV status of MCCs was determined by PCR for viral DNA and RNA. A total of 1,593 probe sets were differentially expressed between MCPyV-negative and MCPyV-positive MCCs, with significant differential expression defined as at least a 2-fold change in either direction and a P-value 0.05. MCPyV-negative tumors showed decreased RB1 expression, whereas MCPyV-positive tumors were enriched for immune response genes. Validation studies included immunohistochemistry demonstration of decreased RB protein expression in MCPyV-negative tumors and increased peritumoral CD8+ T lymphocytes surrounding MCPyV-positive tumors. In conclusion, our data suggest that loss of RB1 expression may have an important role in the tumorigenesis of MCPyV-negative MCCs. Functional and clinical validation studies are needed to determine whether this tumor-suppressor pathway represents an avenue for targeted therapy.


Kannan RY, Mathur BS
Perforator flaps of the facial artery angiosome.
J Plast Reconstr Aesthet Surg. 2013; 66(4):483-8 [PubMed]
For small to moderate-sized defects in the head and neck region, local flaps have been the mainstay of reconstruction for years. However, in certain instances, additional flap translation is required be it advancement, transposition or rotation. In such cases, the local flap concept is combined with perforator flap know-how, allowing larger loco-regional flaps to be raised to reconstruct relatively larger defects, even in cosmetically-expensive areas. In our cohort of fifteen patients', we have utilised detailed microanatomy of the facial artery perforators to reconstruct such defects with good results.


Hoguet A, Warrow D, Milite J, et al.
Mucin-producing sweat gland carcinoma of the eyelid: diagnostic and prognostic considerations.
Am J Ophthalmol. 2013; 155(3):585-592.e2 [PubMed]
PURPOSE: To describe the clinical and pathologic characteristics of mucin-producing sweat gland carcinoma of the eyelid and to determine whether neuroendocrine differentiation is of prognostic significance.
DESIGN: Retrospective interventional case series.
METHODS: Search of the New York Eye and Ear Infirmary pathology database between 1990 and 2011 identified 16 patients with mucin-producing sweat gland carcinoma. Clinical, histopathologic, and immunohistochemical analyses were performed on all identified cases.
RESULTS: The patients presented with vascularized, focally cystic, nonulcerated eyelid margin lesions. Histopathologic evaluation showed that 4 lesions (25%) had a cystic, papillary, and solid growth pattern with an in situ component, 7 (44%) were pure invasive mucinous carcinomas, and 5 (31%) demonstrated both growth patterns. Immunohistochemical analysis of 15 tumors showed that pure cystic/papillary lesions had a significantly greater percentage of synaptophysin-immunoreactive cells (P = .036). There was no significant difference in the number of neuroendocrine markers expressed or in the intensity of immunostaining among the 3 different growth patterns. Re-excision for margin clearance was performed in 8 of 13 cases (61.5%). Two of 13 lesions recurred (15%); 1 of these was an in situ tumor with cystic morphology and neuroendocrine differentiation and the other was pure invasive mucinous carcinoma. None of the lesions metastasized.
CONCLUSIONS: Mucin-producing sweat gland carcinoma pathologically represents a continuum, from an in situ lesion to a classic, invasive mucinous carcinoma. Immunohistochemical evidence of neuroendocrine differentiation can be observed in all lesions and does not appear to have a prognostic significance, arguing against the utility of immunohistochemical subtyping of mucinous sweat gland carcinomas.


Qiang L, Wu C, Ming M, et al.
Autophagy controls p38 activation to promote cell survival under genotoxic stress.
J Biol Chem. 2013; 288(3):1603-11 [PubMed] Article available free on PMC after 18/01/2014
Deregulated cell survival under carcinogen-induced genotoxic stress is vital for cancer development. One of the cellular processes critical for cell survival under metabolic stress and energy starvation is autophagy, a catabolic process involved in capture and delivery of cytoplasmic components to lysosomes for degradation. However, the role of autophagy following carcinogen-induced genotoxic stress remains unclear. Here we show that UVB radiation, a known human skin carcinogen that operates by causing DNA damage, induced autophagy and autophagic flux through AMP kinase activation. Autophagy deficiency sensitizes cells to UVB-induced apoptosis through increasing p62-dependent activation of the stress-activated protein kinase p38. Compared with normal human skin, autophagy was activated in human squamous cell carcinomas, in association with decreased phosphorylation of p38, and increased phosphorylation of ATR and formation of γ-H2AX, two markers of DNA damage response. Our results demonstrate that autophagy promotes cell survival through suppressing p62-mediated p38 activation and thus may facilitate tumor development under genotoxic stress. These findings suggest that autophagy plays an oncogenic role in epithelial carcinogenesis by promoting cell survival.


Delaney A, Shimizu I, Goldberg LH, MacFarlane DF
Life expectancy after Mohs micrographic surgery in patients aged 90 years and older.
J Am Acad Dermatol. 2013; 68(2):296-300 [PubMed]
BACKGROUND: The population of people aged 90 years and older is expected to more than triple by 2050. The incidence of skin cancers is increasing.
OBJECTIVE: We sought to determine whether treatment of patients aged 90 years and older with skin cancer by Mohs micrographic surgery (MMS) changed their survival.
METHODS: A group of 214 patients aged 90 years and older who underwent MMS from July 1997 to May 2006 was identified. Patient gender, age, tumor type, size, site, defect size, number of MMS stages, and surgical repair were recorded. Comorbid medical conditions were assessed using the Charlson index. Actual survival was compared with expected length of survival using life tables. Data were analyzed by the Kaplan-Meier method with log rank significance tests.
RESULTS: Average patient age was 92.3 years. All patients tolerated the procedures well with no deaths within 1 month after surgery. Median survival after surgery was 36.9 months. Tumor characteristics, defect size, number of surgical stages, and closure type did not affect survival. There was no significant difference in survival based on comorbidities according to Charlson scores. Instantaneous mortality hazard was highest 2 to 3 years after surgery.
LIMITATIONS: Specific causes of death were not accessible.
CONCLUSION: This growing section of the population may safely undergo MMS.


Alam M, Helenowksi IB, Cohen JL, et al.
Association between type of reconstruction after Mohs micrographic surgery and surgeon-, patient-, and tumor-specific features: a cross-sectional study.
Dermatol Surg. 2013; 39(1 Pt 1):51-5 [PubMed]
BACKGROUND: There are few data to indicate whether the type of final wound defect is associated with the type of post-Mohs repair.
OBJECTIVE: To determine the methods of reconstruction that Mohs surgeons typically select and, secondarily, to assess the association between the method and the number of stages, tumor type, anatomic location, and patient and surgeon characteristics.
METHODS: Statistical analysis of procedure logs of 20 representative young to mid-career Mohs surgeons.
RESULTS: The number of stages associated with various repairs were different (analysis of variance, p < .001.). Linear repairs, associated with the fewest stages (1.5), were used most commonly (43-55% of defects). Primary repairs were used for 20.2% to 35.3% of defects of the nose, eyelids, ears, and lips. Local flaps were performed typically after two stages of Mohs surgery (range 1.98-2.06). Referral for repair and skin grafts were associated with cases with more stages (2.16 and 2.17 stages, respectively). Experienced surgeons were nominally more likely perform flaps than grafts. Regression analyses did not indicate any association between patient sex and closure type (p = .99) or practice location and closure type (p = .99).
CONCLUSIONS: Most post-Mohs closures are linear repairs, with more bilayered linear repairs more likely at certain anatomic sites and after a larger number of stages.


Flohil SC, Seubring I, van Rossum MM, et al.
Trends in Basal cell carcinoma incidence rates: a 37-year Dutch observational study.
J Invest Dermatol. 2013; 133(4):913-8 [PubMed]
Basal cell carcinoma (BCC) incidence rates are increasing. From 1973 to 2009, data on all first histologically confirmed BCCs were gained from the Eindhoven Cancer Registry to estimate trends in patient-based BCC incidence rates by sex, age group, and site in the southeast Netherlands. Trends in European age-standardized rates and age- and site-specific incidence rates were assessed by calculating the estimated annual percentage change (EAPC). Between 1973 and 2009, the European standardized rate quadrupled from 40 to 165 per 100,000 person-years for men and from 34 to 157 for women, significantly increasing since 1973 in both sexes, but accelerating from 2002 until 2009 with an EAPC of 6.8% (95% confidence interval (CI), 5.3-8.3) for men and 7.9% (95% CI, 6.2-9.7) for women. Women below the age of 40 years exhibited a constant linear increase of 6.3% since 1973. The head and neck region was most often affected in both sexes, but the steepest increase was seen for the trunk (EAPC men 13%, women 15%). In the absence of reliable tumor-based rates, these alarming patient-based rates are probably an interesting indicator for the impact of more intensive UV exposure in a prosperous European population.


Wagner JA
Cancer after heart transplant: implications for practice.
Prog Transplant. 2012; 22(4):374-8 [PubMed]
Cancer after heart transplant is recognized as a leading cause of morbidity and mortality. A man's clinical course after receiving a heart transplant is described, with emphasis on important clinical considerations in the care of heart transplant recipients.


Heath CH, Deep NL, Nabell L, et al.
Phase 1 study of erlotinib plus radiation therapy in patients with advanced cutaneous squamous cell carcinoma.
Int J Radiat Oncol Biol Phys. 2013; 85(5):1275-81 [PubMed] Article available free on PMC after 18/01/2014
PURPOSE: To assess the toxicity profile of erlotinib therapy combined with postoperative adjuvant radiation therapy in patients with advanced cutaneous squamous cell carcinoma.
METHODS AND MATERIALS: This was a single-arm, prospective, phase 1 open-label study of erlotinib with radiation therapy to treat 15 patients with advanced cutaneous head-and-neck squamous cell carcinoma. Toxicity data were summarized, and survival was analyzed with the Kaplan-Meier method.
RESULTS: The majority of patients were male (87%) and presented with T4 disease (93%). The most common toxicity attributed to erlotinib was a grade 2-3 dermatologic reaction occurring in 100% of the patients, followed by mucositis (87%). Diarrhea occurred in 20% of the patients. The 2-year recurrence rate was 26.7%, and mean time to cancer recurrence was 10.5 months. Two-year overall survival was 65%, and disease-free survival was 60%.
CONCLUSIONS: Erlotinib and radiation therapy had an acceptable toxicity profile in patients with advanced cutaneous squamous cell carcinoma. The disease-free survival in this cohort was comparable to that in historical controls.


Pulitzer M
Molecular diagnosis of infection-related cancers in dermatopathology.
Semin Cutan Med Surg. 2012; 31(4):247-57 [PubMed]
The association between viruses and skin cancer is increasingly recognized in a number of neoplasms, that is, cutaneous squamous cell carcinoma, Kaposi sarcoma, nasopharyngeal carcinoma, and Merkel cell carcinoma, as well as hematolymphoid malignancies such as adult T-cell leukemia/lymphoma and NK/T-cell lymphoma (nasal type) and post-transplant lymphoproliferative disorders. Molecular assays are increasingly used to diagnose and manage these diseases. In this review, molecular features of tumor viruses and related host responses are explored. The tests used to identify such features are summarized. Evaluation of the utility of these assays for diagnosis and/or management of specific tumor types is presented.


This page last updated: 22nd May 2013
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