Localized Non-melanoma Skin Cancer: Risk Factors of Post-surgical Relapse and Role of Postoperative Radiotherapy
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Skin Cancer (T Ito, Section Editor)
Localized Non-melanoma Skin Cancer: Risk Factors of Post-surgical Relapse and Role of Postoperative Radiotherapy Francesca Caparrotti, MD1 Idriss Troussier, MD1 Abdirahman Ali2 Thomas Zilli, MD1,2,* Address *,1 Department of Radiation Oncology, Geneva University Hospital, CH-1211, Geneva 14, Switzerland Email: [email protected] 2 Faculty of Medicine, Geneva University, Geneva, Switzerland
* The Author(s) 2020
Francesca Caparrotti and Idriss Troussier contributed equally as first authors This article is part of the Topical Collection on Skin Cancer Keywords Radiotherapy I Postoperative I Adjuvant I Non-melanoma skin cancer I Basal cell carcinoma I Squamous cell carcinoma
Opinion statement The mainstay treatment of localized non-melanoma skin cancer (NMSC) is surgical excision or Mohs surgery. However, approximately 5% of patients with NMSC harbor high-risk clinicopathologic features for loco-regional recurrence, and distant metastasis. Prognostic factors such as close or positive margins, tumor size ≥ 2 cm, poor tumor differentiation, perineural invasion, depth of invasion, and immunosuppression have all been associated with increased loco-regional recurrence and impaired survival rates. In these patients more aggressive treatments are needed and radiotherapy (RT) is often discussed as adjuvant therapy after surgical resection. Due to the retrospective setting and the heterogeneity of the available studies, indications for adjuvant RT in patients with localized resected NMSC harboring high-risk features remain debated. Studies highlighting the limitations of our current understanding of the independent prognosis of each risk factor are needed to better define the role of adjuvant RT on outcome of localized NMSC and standardize its indications in the clinical setting.
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Curr. Treat. Options in Oncol.
(2020) 21:97
Introduction Non-melanoma skin cancer (NMSC) is the most common type of neoplasia [1], with an incidence over 5 million cases annually in United States [2]. More than 95% of all NMSC are represented by basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). In contrast with melanoma which develops from melanocytes and represents a much more aggressive disease, NMSC develops from the keratinocytes of the skin and, in the majority of cases, has a better cure rate, mainly due to the fact that it remains limited to its primary site of disease. Most lesions (90%) appear in sun exposed regions, namely in the head and the neck, with only a minority (G 5%) that metastasizes to regional lymph nodes [3, 4], and are most commonly diagnosed in elderly people. However, in recent years, an increase in NMSC at younger ages has been described, due to prolonged unprotected sun exposure, the use of tanning beds, and an increase of immunosuppression [5]. The mainstay treatment of NMSC is surgical excision or Mohs surgery for the majority of patients especially those presenting a low-risk for relapse [6]. However, approximately 5% of patients with
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