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      Non-metastatic Non-melanoma Skin Cancers: Our 3 Years of Clinical Experiences

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          Abstract

          BACKGROUND

          Nonmelanoma skin cancers (NMSC) constitute the largest group of skin cancers. In this study, NMSCs were analyzed retrospectively.

          METHODS

          Between June 2013 and March 2017, demographics and comorbidities of patients underwent reconstructive surgery for NMSC; their risk factors, types, diameters, differentiation, localizations, follow-up times, treatment methods and complications were compared and statistically analyzed.

          RESULTS

          Totally, 163 tumors [111 basal cell carcinoma and 52 cutaneous squamous cell carcinoma (cSCC)] were excized from 148 patients (63 females, 85 males). Mean age was 70.8 years. Fitzpatrick skin types were between 2-4 and 74 patients. Comorbidities were detected in 63 patients. Tumors were mostly localized in head and neck regions. Forty two lesions in cSCC group were good and 10 were medium differentiated. Defects were reconstructed with flaps in 108 patients. Others underwent primer suturation and grafting. Mean follow-up time was 16.2 months. There was not any complication except one graft failure. There were not significant statistical differences between two groups in terms of skin type, comorbidity, tumor size, fallow-up time and gender values. Conversely, differences of risk factor and age values between the groups were significant. There was a positive correlation between the tumor diameter and poor differentiation in cSCC group. Moreover, there was a negative correlation between tumor size and skin type values in groups.

          CONCLUSİON

          Our results are quite different from literature needing further multicentric studies on NMSC to clarify the difference.

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          Most cited references17

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          Epidemiology of cutaneous melanoma and non-melanoma skin cancer in Schleswig-Holstein, Germany: incidence, clinical subtypes, tumour stages and localization (epidemiology of skin cancer).

          U Kunze, A Katalinic, Simon Schäfer (2003)
          Population-based figures on skin cancer are essential for a realistic assessment of the personal disease burden, prevention modes and the need for caring. The Robert Koch Institute in Germany estimates the incidence of melanoma skin cancer as seven cases in 100 000 persons (age-standardized by the European standard rate). Population-based studies presumably show higher incidence rates of 10-16 cases in 100 000 persons. Few data exist for non-melanoma skin cancer (NMSC) as this is not systematically registered in Germany. To present the first population-based results from the Schleswig-Holstein (Germany) Cancer Registry on incidence, stage distribution, clinical types and localization of skin cancer and to compare the results with other studies. The Cancer Registry of the Bundesland Schleswig-Holstein with 3500 registering institutions, 100 of which are dermatological institutions, investigates all notifiable incident cancer cases according to international standards. From the recorded data all melanoma and NMSC cases were identified and evaluated. Between 1998 and 2001, 1784 malignant melanoma (MM) and 12 956 NMSC cases underwent diagnostic and analytical evaluation. For MM, age-standardized incidence rates were 12.3 and 14.8 in 100 000 men and women, respectively, and the mean age of men was greater than that of women (56.6 vs. 54.9 years, P < 0.05). Superficial spreading melanoma was the most frequent clinical type (39.1%). The tumours were predominantly located on the trunk in men (46.8%) in contrast to leg and hip in women (39.5%). For NMSC, the age-standardized incidence rates were 100.2 and 72.6 in 100 000 men and women, respectively. More than 80% of all tumours were basal cell carcinoma. The first population-based data from Schleswig-Holstein on the characteristics (age, sex, histological subtypes, localization and stage) of skin tumours agree well with the existing literature and may thus be regarded as representative. However, markedly higher incidences for MM and NMSC in the north of Germany compared with other parts of the country were observed. As the incidence rates from the north of Germany fit well into the European geographical pattern, we assume no regional increase. Therefore, the official German estimates on cutaneous tumours may largely depend on regional factors and may not be regarded as representative for all regions in Germany.
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            Non-melanoma skin cancer: United Kingdom National Multidisciplinary Guidelines

            C Newlands, David R. Currie, A. Memon … (2016)
            This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides consensus recommendations on the management of cutaneous basal cell carcinoma and squamous cell carcinoma in the head and neck region on the basis of current evidence. Recommendations • Royal College of Pathologists minimum datasets for NMSC should be adhered to in order to improve patient care and help work-force planning in pathology departments. (G) • Tumour depth is of critical importance in identifying high-risk cutaneous squamous cell carcinoma (cSCC), and should be reported in all cases. (R) • Appropriate imaging to determine the extent of primary NMSC is indicated when peri-neural involvement or bony invasion is suspected. (R) • In the clinically N0 neck, radiological imaging is not beneficial, and a policy of watchful waiting and patient education can be adopted. (R) • Patients with high-risk NMSC should be treated by members of a skin cancer multidisciplinary team (MDT) in secondary care. (G) • Non-infiltrative basal cell carcinoma (BCC) <2 cm in size should be excised with a margin of 4–5 mm. Smaller margins (2–3 mm) may be taken in sites where reconstructive options are limited, when reconstruction should be delayed. (R) • Where there is a high risk of recurrence, delayed reconstruction or Mohs micrographic surgery should be used. (R) • Surgical excision of low-risk cSCC with a margin of 4 mm or greater is the treatment of choice. (R) • High-risk cSCC should be excised with a margin of 6 mm or greater. (R). • Mohs micrographic surgery has a role in some high-risk cSCC cases following MDT discussion. (R) • Delayed reconstruction should be used in high-risk cSCC. (G) • Intra-operative conventional frozen section in cSCC is not recommended. (G) • Radiotherapy (RT) is an effective therapy for primary BCC and cSCC. (R) • Re-excision should be carried out for incompletely excised high-risk BCC or where there is deep margin involvement. (R) • Incompletely excised high-risk cSCC should be re-excised. (R) • Further surgery should involve confirmed marginal clearance before reconstruction. (R) • P+ N0 disease: Resection should include involved parotid tissue, combined with levels I–III neck dissection, to include the external jugular node. (R) • P+ N+ disease: Resection should include level V if that level is clinically or radiologically involved. (R) • Adjuvant RT should include level V if not dissected. (R) • P0 N+ disease: Anterior neck disease should be managed with levels I–IV neck dissection to include the external jugular node. (R) • P0 N+ posterior echelon nodal disease (i.e. occipital or post-auricular) should undergo dissection of levels II–V, with sparing of level I. (R) • Consider treatment of the ipsilateral parotid if the primary site is the anterior scalp, temple or forehead. (R) • All patients should receive education in self-examination and skin cancer prevention measures. (G) • Patients who have had a single completely excised BCC or low-risk cSCC can be discharged after a single post-operative visit. (G) • Patients with an excised high-risk cSCC should be reviewed three to six monthly for two years, with further annual review depending upon clinical risk. (G) • Those with recurrent or multiple BCCs should be offered annual review. (G)
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              Cancer occurrence in Fars province, southern Iran

              D Mehrabani, SZ Tabei, ST Heydari … (2008)
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Plast Surg
                Journal ID (iso-abbrev): World J Plast Surg
                Journal ID (publisher-id): WJPS
                Title: World Journal of Plastic Surgery
                Publisher: Iranian Society for Plastic Surgeons (Tehran, Iran )
                ISSN (Print): 2228-7914
                ISSN (Electronic): 2252-0724
                Publication date (Print): September 2017
                Volume: 6
                Issue: 3
                Pages: 305-312
                Affiliations
                [1]Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Kirikkale University Kirkkale, Turkey
                Author notes
                [* ]Corresponding Author: Elif Sari, MD; Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Kirikkale University , Ankara, 71450 Kirikkale, Turkey. Tel: +90-506-3813703, Fax: +90-580-2252819, E-mail: drelifsanli@hotmail.com
                Article
                Publisher ID: wjps-6-305
                PMC ID: 5714975
                SO-VID: 2859955a-e7ff-4252-9807-4b4f9d5bfe5f
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 August 2016
                Date revision received : 12 May 2017
                Date accepted : 17 June 2017
                Categories
                Subject: Original Article

                Keywords: nonmelanoma skin cancer,basal cell carcinoma,squamous cell carcinoma,skin cancer
                Data availability:
                Keywords: nonmelanoma skin cancer, basal cell carcinoma, squamous cell carcinoma, skin cancer

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