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01-01-2015 | Non-melanoma skin cancer | Article

4. Non-melanoma Skin Cancer: Primary Non-surgical Therapies and Prevention Strategies

Authors: Malcolm A. Buchanan, BSc, MBChB, PhD, FRCS, Brett Levin, BMedSci, MBBS, MMedSci, FRACS, Michael Veness, MBBS, MMed, MD, MD, FRANZCR

Publisher: Springer India

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Abstract

Patients with non-melanoma skin cancer (NMSC) may be managed non-surgically on the basis of relevant tumour and patient factors. This chapter presents non-surgical treatment options for the two most common NMSCs—basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The management of Merkel cell carcinoma (often non-surgically) is discussed in Chap. 6. Excision, although considered the gold standard, is not always possible or considered the best option (Box 4.1). Numerous topical (e.g. 5-fluorouracil [5-FU], imiquimod) and intralesional (e.g. methotrexate, interferon) [1] options, as well as other modalities are widely available, often with ill-defined criteria for using them. Additionally, because the evidence to support these treatments is predominantly low-level with long-term follow-up (≤5 years) lacking, clinicians need to consider various issues before using any recommendation.
Literature
1.
Chitwood K, Etzkorn J, Cohen G. Topical and intralesional treatment of nonmelanoma skin cancer: efficacy and cost comparisons. Dermatol Surg. 2013;39:1306–16.CrossRefPubMed
2.
Veness MJ. The important role of radiotherapy in patients with non-melanoma skin cancer and other cutaneous entities. J Med Imaging Radiat Oncol. 2008;52:278–86.CrossRefPubMed
3.
National Comprehensive Cancer Network (NCCN). Practice guidelines in oncology: basal cell and squamous cell skin cancers. Version 2.2013. Accessed at www.​nccn.​org/​professionals/​physician_​gls/​PDF/​nmsc.​pdf on 24 Sept 2013.
4.
Najim M, Cross S, Gebski V, et al. Early-stage squamous cell carcinoma of the lip: the Australian experience and the benefits of radiotherapy in improving outcome in high-risk patients after resection. Head Neck. 2013;35:142630.
5.
Poulsen M, Burmeister B, Kennedy D. Preservation of form and function in the management of head and neck skin cancer. World J Surg. 2003;27:868–74.CrossRefPubMed
6.
Veness M, Richards S. Role of modern radiotherapy in treating skin cancer. Australas J Dermatol. 2003;44:159–66; quiz 167–8.CrossRefPubMed
7.
Dupree MT, Kiteley RA, Weismantle K, et al. Radiation therapy for Bowen’s disease: lessons for lesions of the lower extremity. J Am Acad Dermatol. 2001;45:401–4.CrossRefPubMed
8.
Beth-Hextall FJ, Perkins W, Bong J et al. Interventions for basal cell carcinoma of the skin. Cochrane Database Syst Rev. 2007;(1):CD003412.
9.
Petit JY, Avril MF, Margulis A, et al. Evaluation of cosmetic results of a randomized trial comparing surgery and radiotherapy in the treatment of basal cell carcinoma of the face. Plast Reconstr Surg. 2000;105:2544–51.CrossRefPubMed
10.
Smeets NWJ, Krekels GAM, Ostertag JU, et al. Surgical excision vs Mohs’ micrographic surgery for basal-cell carcinoma of the face: randomised controlled trial. Lancet. 2004;364:1766–72.CrossRefPubMed
11.
Wilson AW, Howsam G, Santhanam V, et al. Surgical management of incompletely excised basal cell carcinomas of the head and neck. Br J Oral Maxillofac Surg. 2004;42:311–4.CrossRefPubMed
12.
Liu FF, Maki E, Warde P, et al. A management approach to incompletely excised basal cell carcinomas of the skin. Int J Radiat Oncol Biol Phys. 1991;20:423–8.CrossRefPubMed
13.
Kuflik G. Cryosurgery for skin cancer: 30-year experience and cure rates. Dermatol Surg. 2004;30:297–300.PubMed
14.
Thissen MR, Nieman FH, Ideler AH, et al. Cosmetic results of cryosurgery versus surgical excision for primary uncomplicated basal cell carcinoma of the head and neck. Dermatol Surg. 2000;26:759–64.CrossRefPubMed
15.
Rhodes LE, de Rie M, Enström Y, et al. Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma: results of a multicenter randomized prospective trial. Arch Dermatol. 2004;140:17–23.PubMed
16.
Braathen LR, Szeimies RM, Basset-Seguin N, et al. Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: an international consensus. J Am Acad Dermatol. 2007;56:125–43.CrossRefPubMed
17.
Cornell RC, Greenway HT, Tucker SB, et al. Intralesional interferon therapy for basal cell carcinoma. J Am Acad Dermatol. 1990;23:694–700.CrossRefPubMed
18.
Sterry W, European Dermatology Forum Guideline Committee. Guidelines: the management of basal cell carcinoma. Eur J Dermatol. 2006;16:467–75.PubMed
19.
Gross K, Kircik L, Kricorian G. 5% 5-fluorouacil cream for the treatment of small superficial basal cell carcinoma: efficacy, tolerability, cosmetic outcome and patient satisfaction. Dermatol Surg. 2007;33:433–9; discussion 440.PubMed
20.
Geisse JK, Rich P, Pandya A, et al. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: a double-blind, randomized, vehicle-controlled study. J Am Acad Dermatol. 2002;47:390–8.CrossRefPubMed
21.
Sekulic A, Migden MR, Oro AE, et al. Efficacy and safety of vismodegib in advanced basal-cell carcinoma. N Engl J Med. 2012;366:2171–9.CrossRefPubMed
22.
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;26:976–90.CrossRefPubMed
23.
Veness MJ. Defining patients with high-risk cutaneous squamous cell carcinoma. Australas J Dermatol. 2006;47:28–33.CrossRefPubMed
24.
Pugliano-Mauro M, Goldman G. Mohs surgery is effective for high-risk cutaneous squamous cell carcinoma. Dermatol Surg. 2010;36:1544–53.CrossRefPubMed
25.
Mendenhall WM, Amdur RJ, Hinerman RW, et al. Radiotherapy for cutaneous squamous and basal cell carcinomas of the head and neck. Laryngoscope. 2009;119:1994–9.CrossRefPubMed
26.
Veness MJ, Ong C, Cakir B, et al. Squamous cell carcinoma of the lip. Patterns of relapse and outcome: reporting the Westmead Hospital experience, 1980–1997. Australas Radiol. 2001;45:195–9.CrossRefPubMed
27.
Babington S, Veness MJ, Cakir B, et al. Squamous cell carcinoma of the lip: is there a role for adjuvant radiotherapy in improving local control following incomplete or inadequate excision? ANZ J Surg. 2003;73:621–5.CrossRefPubMed
28.
Lansbury L, Leonardi-Bee J, Perkins W et al. Interventions for non-metastatic squamous cell carcinoma of the skin. Cochrane Database Syst Rev. 2010;(4):CD007869.
29.
Nguyen TH, Ho DQ. Nonmelanoma skin cancer. Curr Treat Options Oncol. 2002;3:193–203.CrossRefPubMed
30.
Brewster AM, Lee JJ, Clayman GL, et al. Randomized trial of adjuvant 13-cis-retinoic acid and interferon alfa for patients with aggressive skin squamous cell carcinoma. J Clin Oncol. 2007;25:1974–8.CrossRefPubMed
31.
Wang JT, Palme CE, Morgan GJ, et al. Predictors of outcome in patients with metastatic cutaneous head and neck cutaneous squamous cell carcinoma involving cervical lymph nodes: improved survival with the addition of adjuvant radiotherapy. Head Neck. 2012;34:1524–8.CrossRefPubMed
32.
Ebrahimi A, Clark JR, Lorincz BB, et al. Metastatic head and neck cutaneous squamous cell carcinoma: defining a low risk patient. Head Neck. 2012;34:365–70.CrossRefPubMed
33.
Marcil I, Stern RS. Risk of developing a subsequent non-melanoma skin cancer in patients with a history of non-melanoma skin cancer: a critical review of the literature and meta-analysis. Arch Dermatol. 2000;136:1524–30.CrossRefPubMed
34.
Karagas MR, Nelson HH, Sehr P, et al. Human papillomavirus infection and incidence of squamous cell and basal cell carcinomas of the skin. J Natl Cancer Inst. 2006;98:389–95.CrossRefPubMed
35.
Bath-Hextall FJ, Leonardi-Bee J, Somchand N et al. Interventions for preventing non-melanoma skin cancers in high-risk groups. Cochrane Database Syst Rev. 2007;(4):CD005414.
36.
Cox NH, Eedy DJ, Morton CA, Therapy Guidelines and Audit Subcommittee, British Association of Dermatologists. Guidelines for management of Bowen’s disease: 2006 update. Br J Dermatol. 2006;156:11–21.CrossRef
37.
Gupta AK, Paquet M, Villanueva E, Brintnell W. Interventions for actinic keratosis. Cochrane Database Syst Rev. 2012;12:CD004415.
38.
Lebwohl M, Swanson N, Anderson LL, et al. Ingenol mebutate gel for actinic keratosis. N Engl J Med. 2012;366:1010–9.CrossRefPubMed
39.
Zwald FO, Brown M. Skin cancer in solid organ transplant recipients: advances in therapy and management: part I. Epidemiology of skin cancer in solid organ transplant recipients. J Am Acad Dermatol. 2011;65:253–61; quiz 262.CrossRefPubMed
40.
Kraemer KH, Lee MM, Andrews AD, et al. The role of sunlight and DNA repair in melanoma and nonmelanoma skin cancer. The xeroderma pigmentosum paradigm. Arch Dermatol. 1994;130:1018–21.CrossRefPubMed
41.
Lookingbill DP, Lookingbill GL, Leppard B. Actinic damage and skin cancer in albinos in northern Tanzania: findings in 164 patients enrolled in an outreach skin care program. J Am Acad Dermatol. 1995;32:653–8.CrossRefPubMed
42.
Goldberg LH, Firoz BF, Weiss GJ, et al. Basal cell nevus syndrome. Arch Dermatol. 2010;146:17–9.CrossRefPubMed
43.
Stern RS, Liebman EJ, Väkevä L. Oral psoralen and ultraviolet-A Light (PUVA) treatment of psoriasis and persistent risk of nonmelanoma skin cancer. J Natl Cancer Inst. 1998;90:1278–84.CrossRefPubMed
44.
Naldi L, Buzzetti R, Cecchi C et al. Educational programmes for the skin cancer prevention (protocol for a cochrane review). Cochrane Database Syst Rev. 2004;(2).
45.
Hill L, Ferrini RL. Skin cancer prevention and screening: summary of the American College of Preventive Medicine’s practice policy statements. CA Cancer J Clin. 1998;48:232–5.CrossRefPubMed
46.
Bavnick JN, Tieben LM, Van der Woude FJ, et al. Prevention of skin cancer and reduction of keratotic skin lesions during acitretin therapy in renal transplant recipients: a double-blind, placebo-controlled study. J Clin Oncol. 1995;13:1933–8.
47.
Clark LC, Combs Jr GF, Turnbull BW, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA. 1996;276:1957–63.CrossRefPubMed
48.
Dennert G, Zwahlen M, Brinkman M et al. Selenium for preventing cancer. Cochrane Database Syst Rev. 2011;(5):CD005195.