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Facial Plastic Surgery Clinics of North... Aug 2017Skin is composed of the epidermis, dermis, and adnexal structures. The epidermis is composed of 4 layers-the stratums basale, spinosum, granulosum, and corneum. The... (Review)
Review
Skin is composed of the epidermis, dermis, and adnexal structures. The epidermis is composed of 4 layers-the stratums basale, spinosum, granulosum, and corneum. The dermis is divided into a superficial papillary dermis and deeper reticular dermis. Collagen and elastin within the reticular dermis are responsible for skin tensile strength and elasticity, respectively. The 2 most common kinds of nonmelanoma skin cancers are basal cell and squamous cell carcinoma. Both are caused by a host of environmental and genetic factors, although UV light exposure is the single greatest predisposing factor.
Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Dermis; Epidermal Cells; Epidermis; Gene-Environment Interaction; Humans; Skin; Skin Neoplasms
PubMed: 28676156
DOI: 10.1016/j.fsc.2017.03.001 -
The New England Journal of Medicine Jun 2023
Review
Topics: Humans; Carcinoma, Squamous Cell; Skin; Skin Neoplasms
PubMed: 37314707
DOI: 10.1056/NEJMra2206348 -
Archives of Pathology & Laboratory... Nov 2017- Basal cell carcinoma (BCC) is the most common human malignant neoplasm and is a frequently encountered diagnosis in dermatopathology. Although BCC may be locally... (Review)
Review
CONTEXT
- Basal cell carcinoma (BCC) is the most common human malignant neoplasm and is a frequently encountered diagnosis in dermatopathology. Although BCC may be locally destructive, it rarely metastasizes. Many diagnostic entities display morphologic and immunophenotypic overlap with BCC, including nonneoplastic processes, such as follicular induction over dermatofibroma; benign follicular tumors, such as trichoblastoma, trichoepithelioma, or basaloid follicular hamartoma; and malignant tumors, such as sebaceous carcinoma or Merkel cell carcinoma. Thus, misdiagnosis has significant potential to result in overtreatment or undertreatment.
OBJECTIVE
- To review key features distinguishing BCC from histologic mimics, including current evidence regarding immunohistochemical markers useful for that distinction.
DATA SOURCES
- Review of pertinent literature on BCC immunohistochemistry and differential diagnosis.
CONCLUSIONS
- In most cases, BCC can be reliably diagnosed by histopathologic features. Immunohistochemistry may provide useful ancillary data in certain cases. Awareness of potential mimics is critical to avoid misdiagnosis and resulting inappropriate management.
Topics: Adenocarcinoma, Sebaceous; Biomarkers, Tumor; Carcinoma, Basal Cell; Diagnosis, Differential; Hamartoma; Histiocytoma, Benign Fibrous; Humans; Immunohistochemistry; Immunophenotyping; Skin; Skin Neoplasms
PubMed: 29072946
DOI: 10.5858/arpa.2017-0222-RA -
Current Treatment Options in Oncology Sep 2018Dermatoscopy (dermoscopy) improves the diagnosis of benign and malignant cutaneous neoplasms in comparison with examination with the unaided eye and should be used... (Review)
Review
Dermatoscopy (dermoscopy) improves the diagnosis of benign and malignant cutaneous neoplasms in comparison with examination with the unaided eye and should be used routinely for all pigmented and non-pigmented cutaneous neoplasms. It is especially useful for the early stage of melanoma when melanoma-specific criteria are invisible to the unaided eye. Preselection by the unaided eye is therefore not recommended. The increased availability of polarized dermatoscopes, and the extended use of dermatoscopy in non-pigmented lesions led to the discovery of new criteria, and we recommend that lesions should be examined with polarized and non-polarized dermatoscopy. The "chaos and clues algorithm" is a good starting point for beginners because it is easy to use, accurate, and it works for all types of pigmented lesions not only for those melanocytic. Physicians, who use dermatoscopy routinely, should be aware of new clues for acral melanomas, nail matrix melanomas, melanoma in situ, and nodular melanoma. Dermatoscopy should also be used to distinguish between different subtypes of basal cell carcinoma and to discriminate highly from poorly differentiated squamous cell carcinomas to optimize therapy and management of non-melanoma skin cancer. One of the most exciting areas of research is the use of dermatoscopic images for machine learning and automated diagnosis. Convolutional neural networks trained with dermatoscopic images are able to diagnose pigmented lesions with the same accuracy as human experts. We humans should not be afraid of this new and exciting development because it will most likely lead to a peaceful and fruitful coexistence of human experts and decision support systems.
Topics: Adult; Aged; Algorithms; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Dermoscopy; Female; Humans; Keratosis, Actinic; Male; Melanoma; Sensitivity and Specificity; Skin; Skin Neoplasms; Melanoma, Cutaneous Malignant
PubMed: 30238167
DOI: 10.1007/s11864-018-0573-6 -
Current Treatment Options in Oncology Feb 2019Basal cell carcinomas (BCCs) are common skin cancers that tend to appear on sun-exposed skin. Pathobiologically, activation of the Hedgehog signaling pathway... (Review)
Review
Basal cell carcinomas (BCCs) are common skin cancers that tend to appear on sun-exposed skin. Pathobiologically, activation of the Hedgehog signaling pathway characterizes the majority of cases. In general, BCCs are slow-growing and rarely metastasize. Nevertheless, they are locally invasive and can be destructive. While typical cases are diagnosed based on clinical findings, the clinicopathological manifestations are varied. Consequently, skin biopsy is essential to confirm the diagnosis and evaluate the risk of recurrence. In the treatment of primary lesions, the initial goal is to complete tumor removal, whether by conventional surgical excision, Mohs micrographic surgery, cryosurgery, electrodesiccation and curettage, topical application of imiquimod or fluorouracil, photodynamic therapy, or radiation therapy. Of these treatments, surgical excision and Mohs surgery are the most commonly used because of their association with a low recurrence rate and the ability to confirm residual tumor pathologically. However, other treatment options may be preferred according to patient condition, tumor location, and risk of recurrence. In the treatment of metastatic or locally advanced lesions, smoothened inhibitors, which inhibit Hedgehog signaling pathway activation, were recently approved and impressive tumor shrinkage effects have been described. Although the exact prognosis of metastatic BCC has not been analyzed, it is probably poor due to the rarity of such condition. However, emerging molecular targeting agents hold therapeutic promise.
Topics: Antineoplastic Agents; Biopsy; Carcinoma, Basal Cell; Humans; Photochemotherapy; Prognosis; Skin; Skin Neoplasms; Surgical Procedures, Operative
PubMed: 30741348
DOI: 10.1007/s11864-019-0610-0 -
JCI Insight Mar 2019Topical calcipotriol plus 5-fluorouracil (5-FU) combination is an effective immunotherapy against actinic keratosis (AK), which is a precursor to squamous cell carcinoma... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Topical calcipotriol plus 5-fluorouracil (5-FU) combination is an effective immunotherapy against actinic keratosis (AK), which is a precursor to squamous cell carcinoma (SCC). However, the long-term effectiveness of calcipotriol plus 5-FU treatment for SCC prevention is unknown.
METHODS
We performed a blinded prospective cohort study on participants of a randomized double-blind clinical trial in which a 4-day course of topical calcipotriol plus 5-FU combination was compared to Vaseline plus 5-FU (control) for AK treatment. SCC and basal cell carcinoma (BCC) incidences were assessed at 1, 2, and 3 years after trial. Tissues were analyzed for calcipotriol plus 5-FU-induced T cell immunity in the skin.
RESULTS
Calcipotriol plus 5-FU-induced tissue-resident memory T (Trm) cell formation in face and scalp skin associated with significantly higher erythema scores compared with control (P < 0.01). Importantly, more participants in the test cohort remained SCC-free over the more than 1,500-day follow-up period (P = 0.0765), and significantly fewer developed SCC on the treated face and scalp within 3 years (2 of 30 [7%] versus 11 of 40 [28%] in control group, hazard ratio 0.215 [95% CI: 0.048-0.972], P = 0.032). Accordingly, significantly more epidermal Trm cells persisted in the calcipotriol plus 5-FU-treated face and scalp skin compared with control (P = 0.0028). There was no significant difference in BCC incidence between the treatment groups.
CONCLUSION
A short course of calcipotriol plus 5-FU treatment on the face and scalp is associated with induction of robust T cell immunity and Trm formation against AKs and significantly lowers the risk of SCC development within 3 years of treatment.
FUNDING
This research was supported by internal academic funds and by grants from the Burroughs Wellcome Fund, Sidney Kimmel Foundation, Cancer Research Institute, and NIH.
Topics: Adaptive Immunity; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Calcitriol; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Double-Blind Method; Female; Fluorouracil; Humans; Immunotherapy; Male; Middle Aged; Prospective Studies; Skin; Skin Neoplasms
PubMed: 30895944
DOI: 10.1172/jci.insight.125476 -
Dermatologic Clinics Jul 2023Skin cancer is often associated with greater morbidity and mortality in skin of color patients because most medical literature and research on skin cancer to date has... (Review)
Review
Skin cancer is often associated with greater morbidity and mortality in skin of color patients because most medical literature and research on skin cancer to date has been predominantly focused on lighter skin types. It is crucial that dermatologic providers be able to recognize different presentations of skin cancer in skin of color patients to optimize the early detection of these tumors and ensure equitable outcomes. This article details the epidemiology, risk factors, clinical features, and disparities in the treatment of melanoma, squamous cell carcinoma, basal cell carcinoma, and mycosis fungoides subtype of cutaneous T-cell lymphoma in skin of color patients.
Topics: Humans; Carcinoma, Basal Cell; Mycosis Fungoides; Skin; Skin Neoplasms; Racial Groups
PubMed: 37236716
DOI: 10.1016/j.det.2023.02.013 -
Journal of Cutaneous Medicine and... 2023Verrucous carcinoma (VC) is a relatively rare locally aggressive, slow-growing, well-differentiated squamous cell carcinoma with minimal metastatic potential and is most... (Review)
Review
Verrucous carcinoma (VC) is a relatively rare locally aggressive, slow-growing, well-differentiated squamous cell carcinoma with minimal metastatic potential and is most frequent in the mucosa. Although rarely reported on the skin, cutaneous verrucous carcinomas (CVC) can appear anywhere, most commonly on the feet. However, clinical and pathologic diagnosis of CVC has been confusing and challenging. It can easily be mistaken for benign or more malignant conditions such as giant condyloma acuminata, keratoacanthoma, and pseudoepithelioma-like hyperplasia or squamous cell carcinoma, resulting in inappropriate management. In this review, we describe the different aspects associated with CVC, including its pathogenesis and clinicopathologic features. The available evidence for the differential diagnosis and treatment of CVC is discussed, and specific management recommendations are made. After the treatment, careful follow-up examinations of the excised area should be performed at regular intervals.
Topics: Humans; Carcinoma, Verrucous; Carcinoma, Squamous Cell; Buschke-Lowenstein Tumor; Skin Neoplasms; Skin
PubMed: 36789508
DOI: 10.1177/12034754231155895 -
Dermatologic Clinics Jan 2023Patients with immunosuppressive conditions experience an increased frequency and severity of cutaneous malignancies. This article highlights management of keratinocyte... (Review)
Review
Patients with immunosuppressive conditions experience an increased frequency and severity of cutaneous malignancies. This article highlights management of keratinocyte carcinoma, melanoma, Merkel cell carcinoma, and Kaposi sarcoma in the setting of lymphoproliferative disorders, acquired immunodeficiencies, and organ transplantation. Advances in the safety of organ transplant recipient immunosuppression, early identification of risk factors, and new targeted therapies are improving skin cancer outcomes in immunocompromised populations.
Topics: Humans; Immunocompromised Host; Skin; Skin Neoplasms; Carcinoma, Merkel Cell; Immunosuppression Therapy
PubMed: 36410975
DOI: 10.1016/j.det.2022.07.012 -
Cancer Radiotherapie : Journal de La... Jun 2023Skin adnexal carcinomas are rare skin cancer, developing from pilosebaceous, eccrine and apocrine unit. Treatment of localised tumours usually includes surgery and... (Review)
Review
Skin adnexal carcinomas are rare skin cancer, developing from pilosebaceous, eccrine and apocrine unit. Treatment of localised tumours usually includes surgery and radiotherapy. Indications and modalities of radiotherapy depend on the pathological subtype with a lack of consensus for some histologies. This review summarises the place of radiotherapy in terms of indication, dose and fractionation, volumes to irradiate and discuss ongoing studies.
Topics: Humans; Skin; Skin Neoplasms; Neoplasms, Adnexal and Skin Appendage; Carcinoma
PubMed: 37080860
DOI: 10.1016/j.canrad.2022.12.003