Squamous cell carcinoma of the skin medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(36 intermediate revisions by 8 users not shown)
Line 1: Line 1:
__NOTOC__
{{Squamous cell carcinoma}}
{{Squamous cell carcinoma}}
{{CMG}}; '''Associate Editor(s)-in-Chief:''' [[User:Aditya Govindavarjhulla|Aditya Govindavarjhulla, M.B.B.S.]] [mailto:agovi@perfuse.org], [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:rgudetti@perfuse.org]
{{CMG}}; '''Associate Editor(s)-in-Chief:''' [[User:Aditya Govindavarjhulla|Aditya Govindavarjhulla, M.B.B.S.]] [mailto:agovi@wikidoc.org], [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:ravitheja.g@gmail.com]
== Overview ==
Medical therapy for squamous cell carcinoma includes [[chemotherapy]] with [[cisplatin]], topical [[fluorouracil]], [[capecitabine]], [[methotrexate]], [[cetuximab]], [[bleomycin]] and [[doxorubicin]]. Other treatment modalities include [[cryotherapy]], [[radiation therapy]] and [[photodynamic therapy]].


== Overview ==
*
Squamous cell carcinoma is a locally invasive tumor that can be treated successfully in up to 95% - 98% cases with a timely management. The available options for treatment are as follows
 
== Medical Therapy ==
Once the diagnosis of cutaneous squamous cell carcinoma (SCC) has been established by skin biopsy and histopathologic examination, the assessment of the risk of locoregional recurrence and regional or distant metastasis is the most important step to determine the treatment approach.
 
Characteristics that impact the risk for recurrence and metastasis include:<ref name="pmid27882625">{{cite journal| author=Skulsky SL, O'Sullivan B, McArdle O, Leader M, Roche M, Conlon PJ et al.| title=Review of high-risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology. | journal=Head Neck | year= 2017 | volume= 39 | issue= 3 | pages= 578-594 | pmid=27882625 | doi=10.1002/hed.24580 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27882625  }}</ref>
* Location of [[tumor]]
*[[Tumor]] depth ( > 2mm) and size
*[[Immunosuppression|Immunosuppressed]] patients
* Site of previous [[radiotherapy]]
*[[Chronic inflammation]]
* Rapidly growing [[tumor]]
*[[Neurological|Neurologic]] [[symptoms]]
* Poorly differentiated [[tumor]]
*[[Acanthocytes|Acantholytic]] (adenoid), adenosquamous, desmoplastic, or metaplastic (carcinosarcomatous) subtypes
*[[Lymph node]] involvement
 
According to the 2018 NCCN guidelines and in order to determine the approach to treatment, low risk and high risk cutaneous squamous cell carcinoma can be categorized as follows:<ref name="pmid27882625">{{cite journal| author=Skulsky SL, O'Sullivan B, McArdle O, Leader M, Roche M, Conlon PJ et al.| title=Review of high-risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology. | journal=Head Neck | year= 2017 | volume= 39 | issue= 3 | pages= 578-594 | pmid=27882625 | doi=10.1002/hed.24580 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27882625  }}</ref>
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Low risk of cutaneous SCC
! style="background:#4479BA; color: #FFFFFF;" align="center" + |High risk of cutaneous SCC
|-
| style="background:#DCDCDC;" align="center" + |Well-defined, primary lesions <20 mm located on trunk or extremities (excluding pretibia, hands, feet, nail units, and ankles)
| style="background:#F5F5F5;" align="center" + |Lesions ≥20 mm located on trunk or extremities (excluding pretibia, hands, feet, nail units, and ankles)
|-
| style="background:#DCDCDC;" align="center" + |Well-defined, primary lesions <10 mm located on cheeks, forehead, scalp, neck, and pretibia
| style="background:#F5F5F5;" align="center" + |Lesions ≥10 mm located on cheeks, forehead, scalp, neck, and pretibia
|-
| style="background:#DCDCDC;" align="center" + |Primary tumor
| style="background:#F5F5F5;" align="center" + |Lesions of any size located in the "mask area" (ie, central face, eyelids, eyebrows, periorbital, temple, nose, lips, chin, mandible, pre- and postauricular), genitalia, hands, and feet
|-
| style="background:#DCDCDC;" align="center" + |Histopathologically well or moderately differentiated tumor, <2 mm in thickness, without perineural, lymphatic, or vascular invasion
| style="background:#F5F5F5;" align="center" + |Histopathologically poorly differentiated tumor, ≥2 mm in thickness, with perineural, lymphatic, or vascular invasion
|}
 
Medical care of [[squamous cell carcinoma]] of the skin includes cryosurgery, electrosurgery, radiation therapy and topical treatment for cutaneous lesions, and chemotherapy for systemic disease.
* '''[[Chemotherapy]]'''
** Used for patients with locally advanced squamous cell carcinoma of the skin that cannot be adequately managed with surgical excision or radiation therapy or in patients with metastatic squamous cell carcinoma.
** Chemotherapeutic agents used:
***[[Cisplatin]]
***[[Topical]] [[fluorouracil]]
***[[Capecitabine]]
***[[Methotrexate]]
***[[Cetuximab]]
***[[Bleomycin]]
***[[Doxorubicin]]
**[[Cisplatin]] and [[carboplatin]] have been used as chemosensitizing agents in conjunction with [[radiation therapy]] for patients with squamous cell carcinoma of the skin arising in noncutaneous sites. However, an additional benefit with these agents has not been demonstrated in patients with high-risk cutaneous squamous cell carcinoma.


* [[Cryotherapy]]
* [[Cryotherapy|'''Cryotherapy''']]<ref name="pmid3166941">{{cite journal| author=Holt PJ| title=Cryotherapy for skin cancer: results over a 5-year period using liquid nitrogen spray cryosurgery. | journal=Br J Dermatol | year= 1988 | volume= 119 | issue= 2 | pages= 231-40 | pmid=3166941 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3166941  }}</ref>
* [[Electrosurgery]] ([[curettage]] and electrodessication)
** Destroys [[malignant]] cells by freezing them and then allowing them to thaw.
* Topical therapy  ([[5-Flourouracil]], photodynamic therapy, and [[Imiquimod]] for cutaneous lesions.  
** Useful for small, well-defined, low-risk invasive cutaneous squamous cell carcinoma, and for [[Bowen's disease]]
While systemic treatment includes
** Liquid nitrogen is applied to the tumor and a surrounding rim of normal-appearing skin (usually ≥3 mm).
* Radiation therapy
** Tumor cell death is due to the formation of [[intracellular]] and [[extracellular]] ice crystals, [[Hypertonic|hypertonicity]], disruption of the [[phospholipid membrane]], and [[vascular]] [[Stasis (medicine)|stasis]].
* Surgical excision
** Quick procedure and cost-effective
* [[Mohs Microsurgery]]
** Not indicated for large recurrent lesions, deeply invasive lesions, and other high risk cutaneous squamous cell carcinoma


== Medical Treatment ==
* '''Topical [[5-fluorouracil]] (5-FU)'''<ref name="pmid11369927">{{cite journal| author=Hamouda B, Jamila Z, Najet R, Slim T, Rafiaa N, Noureddine B et al.| title=Topical 5-fluorouracil to treat multiple or unresectable facial squamous cell carcinomas in xeroderma pigmentosum. | journal=J Am Acad Dermatol | year= 2001 | volume= 44 | issue= 6 | pages= 1054 | pmid=11369927 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11369927  }}</ref>
Medical care of [[Squamous cell carcinoma]] (SCC) includes cryosurgery, electrosurgery, Radiation therapy and topical treatment for cutaneous lesions and and Chemotherapy for systemic disease.
** Is approved by the Food and Drug Administration (FDA) for the treatment of [[actinic keratoses]].
** Although topical 5-FU is not approved for the treatment of cutaneous squamous cell carcinoma in situ, it is widely used for this indication when other treatment modalities are impractical and for patients who refuse surgical treatment.
** It is especially valuable for situations in which postoperative healing is compromised, such as in lesions that involve the lower extremity in elderly patients or those with venous stasis disease.
**[[Topical]] 5-FU is also useful to treat the widespread cutaneous squamous cell carcinoma in situ lesions that may occur in [[arsenical dermatitis]] or [[xeroderma pigmentosum]] (XP).<ref name="pmid11209116">{{cite journal| author=Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens ML| title=Imiquimod 5% cream in the treatment of Bowen's disease. | journal=J Am Acad Dermatol | year= 2001 | volume= 44 | issue= 3 | pages= 462-70 | pmid=11209116 | doi=10.1067/mjd.2001.111335 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11209116  }}</ref>
** Topical 5-FU is available in 0.5%, 1% and 5% concentrations.
*** 1% and 0.5% are used for actinic keratosis.
**** 5% cream is used twice daily for 4 - 8 weeks in the treatment of cutaneous squamous cell carcinoma in situ.
** Cure rates of up to 85% were achieved in one study with this type of treatment. For recurrent disease, courses are repeated.
**[[5-FU]] gives favorable cosmetic results, but is contraindicated in invasive lesions.


* [[Cryotherapy]] destroys malignant cells by freezing and thawing. It is useful for small, well-defined, low-risk invasive SCCs and for [[Bowen's disease]]. In cryosurgery, liquid nitrogen is applied to the tumor and a surrounding rim of normal-appearing skin (usually ≥3 mm). The frozen area is then allowed to thaw unaided. In most cases, the tumor is refrozen to complete two freeze-thaw cycles; for Bowen's disease, a single freeze-thaw cycle may be sufficient.<ref>{{cite journal |author=Holt PJ |title=Cryotherapy for skin cancer: results over a 5-year period using liquid nitrogen spray cryosurgery |journal=Br. J. Dermatol. |volume=119 |issue=2 |pages=231–40 |year=1988 |month=August |pmid=3166941 |doi= |url=}}</ref>.Tumor cell death is due to the formation of intra and extracellular ice crystals, hypertonicity, disruption of the phospholipid membrane, and vascular stasis. Cryotherapy is a quick procedure and is cost-effective. This therapy is not indicated for large recurrent lesions,deeply invasive and other high risk SCC.
* [[Radiation therapy|'''Radiation therapy''']]  
* Electrosurgery is usually employed if the lesion is small, well defined and located in non-critical areas of the body. It is also cost-effective, gives favorable cosmetic results and has a low complication rate. The procedure is performed by alternatively curetting away tumor and then electrodessicating the ulcer base including a rim of normal surrounding skin. Cure rates of nearly 96% can be achieved with this treatment provide the lesion is small and well defined. This treatment should be avoided on the mid-face region. It is contraindicated in recurrent, large, poorly defined and other high risk SCCs.
** In high-risk cSCC, [[radiation therapy]] is not routinely utilized as monotherapy given the higher rate of local recurrence (15 to 20 percent or greater) compared with surgery with or without postoperative [[radiation therapy]].<ref name="pmid20870631">{{cite journal| author=Miller SJ, Alam M, Andersen J, Berg D, Bichakjian CK, Bowen G et al.| title=Basal cell and squamous cell skin cancers. | journal=J Natl Compr Canc Netw | year= 2010 | volume= 8 | issue= 8 | pages= 836-64 | pmid=20870631 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20870631  }}</ref>
* Topical [[5-fluorouracil]] (5-FU) is approved by the Food and Drug Administration (FDA) for the treatment of [[actinic keratoses]]. Although topical 5-FU is not approved for the treatment of SCC in situ, it is widely used for this indication when other treatment modalities are impractical and for patients who refuse surgical treatment.  It is especially valuable for situations in which postoperative healing is compromised, such as lesions that involve the lower extremity in elderly patients or those with venous stasis disease.  Topical 5-FU is also useful to treat the widespread SCC in situ lesions that may occur in [[arsenical dermatitis]] or [[xeroderma pigmentosum]] (XP).<ref>{{cite journal |author=Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens ML |title=Imiquimod 5% cream in the treatment of Bowen's disease |journal=J. Am. Acad. Dermatol. |volume=44 |issue=3 |pages=462–70 |year=2001 |month=March |pmid=11209116 |doi=10.1067/mjd.2001.111335 |url=}}</ref> Topical 5-FU is available in 5%, 1% and 0.5% concentrations. 1% and 0.5% are used for actinic keratosis. 5% cream is used twice daily for 4 - 8 weeks in the treatment of SCC in situ. Cure rates of up to 85% were achieved in one study with this type of treatment. For recurrent disease courses are repeated. It gives favorable cosmetic results. [[5-FU]] is contraindicated in invasive lesions.
** Is an excellent choice for the management of initial small well defined lesions, especially primary SCCs in older individuals and those who are not candidates for surgical procedures. This form of treatment is administered in a fractionated form requiring nearly 30 treatments.<ref name="pmid2394605">{{cite journal| author=Lovett RD, Perez CA, Shapiro SJ, Garcia DM| title=External irradiation of epithelial skin cancer. | journal=Int J Radiat Oncol Biol Phys | year= 1990 | volume= 19 | issue= 2 | pages= 235-42 | pmid=2394605 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2394605  }}</ref>
* [[Radiation therapy]] is an excellent choice for the management of initial small well defined lesions, primary SCCs especially for older individuals and those who are not candidates for a surgical procedure. This form of treatment is administered in a fractionated form requiring nearly 30 treatments.<ref>{{cite journal |author=Lovett RD, Perez CA, Shapiro SJ, Garcia DM |title=External irradiation of epithelial skin cancer |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=19 |issue=2 |pages=235–42 |year=1990 |month=August |pmid=2394605 |doi= |url=}}</ref> For low risk lesions the cure rate approaches nearly 90%. The main advantage of this kind of treatment is sparing of the surrounding normal healthy skin and thus providing superior cosmetic benefits.
** For low risk lesions the cure rate approaches nearly 90%. The main advantage of this kind of treatment is sparing of the surrounding normal healthy skin, thus providing superior cosmetic benefits. [[Radiotherapy]] is contraindicated in:<ref name="pmid15380573">{{cite journal| author=Kwan W, Wilson D, Moravan V| title=Radiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin. | journal=Int J Radiat Oncol Biol Phys | year= 2004 | volume= 60 | issue= 2 | pages= 406-11 | pmid=15380573 | doi=10.1016/j.ijrobp.2004.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15380573  }}</ref>
[[Radiotherapy]] is contraindicated in
*** Tumors located on the trunk, extremities, ear and nose.
** Tumors located on the trunk, extremities, ear and nose.
*** Patients younger than 40-50 years.
** Patients younger than 40 and 50 years.
*** Recurrent SCCs that have previously been irradiated.
** Recurrent SCCs that are previously irradiated.
*** Cancers with large and poorly defined lesions, and other high risk SCCs.
** In cancers with large and poorly defined lesions and other high risk SCCs.
* '''Photodynamic therapy'''
In [[Nasopharyngeal]] squamous cell carcinoma [[Radiotherapy]] is the main stay of treatment along with [[Chemotherapy]] in advanced lesions. Here radiotherapy is administered to the tumor volume and also the adjoining lymph nodes. A multiinstitutional study showed that a dose of at least 66 Gy to the gross disease are needed for optimal control of the lesion.
** Based upon the ability of porphyrins to produce [[cytotoxicity]] in the presence of [[oxygen]] after stimulation by light of an appropriate wavelength
* Systemic [[Chemotherapy]] is used in advanced metastatic lesions that cannot be treated with Radiotherapy and surgery. [[Cisplatin]] combination regimens are particularly effective in the treatment of SCC of skin and lip. Combination of [[Cisplatin]] and [[Bleomycin]] seems to be very effective.
** Not recommended for the treatment of invasive [[cutaneous]] squamous cell carcinoma, due to high recurrence rates associated with [[photodynamic therapy]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Oncology]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
[[Category:Mature chapter]]
[[Category:Disease]]
[[Category:Grammar]]
 
[[de:Plattenepithelkarzinom]]
[[he:קרצינומת תאי קשקש]]
[[nl:Plaveiselcelcarcinoom]]
[[pl:Rak kolczystokomórkowy skóry]]
[[tr:Skuamöz hücreli karsinoma]]


{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}

Latest revision as of 04:02, 14 October 2019

Squamous cell carcinoma of the skin Microchapters

Home

Patient Info

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Squamous cell carcinoma of the skin from other Diseases

Epidemiology & Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT Scan

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Squamous cell carcinoma of the skin medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Squamous cell carcinoma of the skin medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Squamous cell carcinoma of the skin medical therapy

CDC on Squamous cell carcinoma of the skin medical therapy

Squamous cell carcinoma of the skin medical therapy in the news

Blogs on Squamous cell carcinoma of the skin medical therapy

Directions to Hospitals Treating Squamous cell carcinoma of the skin

Risk calculators and risk factors for Squamous cell carcinoma of the skin medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Raviteja Guddeti, M.B.B.S. [3]

Overview

Medical therapy for squamous cell carcinoma includes chemotherapy with cisplatin, topical fluorouracil, capecitabine, methotrexate, cetuximab, bleomycin and doxorubicin. Other treatment modalities include cryotherapy, radiation therapy and photodynamic therapy.

Medical Therapy

Once the diagnosis of cutaneous squamous cell carcinoma (SCC) has been established by skin biopsy and histopathologic examination, the assessment of the risk of locoregional recurrence and regional or distant metastasis is the most important step to determine the treatment approach.

Characteristics that impact the risk for recurrence and metastasis include:[1]

According to the 2018 NCCN guidelines and in order to determine the approach to treatment, low risk and high risk cutaneous squamous cell carcinoma can be categorized as follows:[1]

Low risk of cutaneous SCC High risk of cutaneous SCC
Well-defined, primary lesions <20 mm located on trunk or extremities (excluding pretibia, hands, feet, nail units, and ankles) Lesions ≥20 mm located on trunk or extremities (excluding pretibia, hands, feet, nail units, and ankles)
Well-defined, primary lesions <10 mm located on cheeks, forehead, scalp, neck, and pretibia Lesions ≥10 mm located on cheeks, forehead, scalp, neck, and pretibia
Primary tumor Lesions of any size located in the "mask area" (ie, central face, eyelids, eyebrows, periorbital, temple, nose, lips, chin, mandible, pre- and postauricular), genitalia, hands, and feet
Histopathologically well or moderately differentiated tumor, <2 mm in thickness, without perineural, lymphatic, or vascular invasion Histopathologically poorly differentiated tumor, ≥2 mm in thickness, with perineural, lymphatic, or vascular invasion

Medical care of squamous cell carcinoma of the skin includes cryosurgery, electrosurgery, radiation therapy and topical treatment for cutaneous lesions, and chemotherapy for systemic disease.

  • Chemotherapy
    • Used for patients with locally advanced squamous cell carcinoma of the skin that cannot be adequately managed with surgical excision or radiation therapy or in patients with metastatic squamous cell carcinoma.
    • Chemotherapeutic agents used:
    • Cisplatin and carboplatin have been used as chemosensitizing agents in conjunction with radiation therapy for patients with squamous cell carcinoma of the skin arising in noncutaneous sites. However, an additional benefit with these agents has not been demonstrated in patients with high-risk cutaneous squamous cell carcinoma.
  • Cryotherapy[2]
    • Destroys malignant cells by freezing them and then allowing them to thaw.
    • Useful for small, well-defined, low-risk invasive cutaneous squamous cell carcinoma, and for Bowen's disease
    • Liquid nitrogen is applied to the tumor and a surrounding rim of normal-appearing skin (usually ≥3 mm).
    • Tumor cell death is due to the formation of intracellular and extracellular ice crystals, hypertonicity, disruption of the phospholipid membrane, and vascular stasis.
    • Quick procedure and cost-effective
    • Not indicated for large recurrent lesions, deeply invasive lesions, and other high risk cutaneous squamous cell carcinoma
  • Topical 5-fluorouracil (5-FU)[3]
    • Is approved by the Food and Drug Administration (FDA) for the treatment of actinic keratoses.
    • Although topical 5-FU is not approved for the treatment of cutaneous squamous cell carcinoma in situ, it is widely used for this indication when other treatment modalities are impractical and for patients who refuse surgical treatment.
    • It is especially valuable for situations in which postoperative healing is compromised, such as in lesions that involve the lower extremity in elderly patients or those with venous stasis disease.
    • Topical 5-FU is also useful to treat the widespread cutaneous squamous cell carcinoma in situ lesions that may occur in arsenical dermatitis or xeroderma pigmentosum (XP).[4]
    • Topical 5-FU is available in 0.5%, 1% and 5% concentrations.
      • 1% and 0.5% are used for actinic keratosis.
        • 5% cream is used twice daily for 4 - 8 weeks in the treatment of cutaneous squamous cell carcinoma in situ.
    • Cure rates of up to 85% were achieved in one study with this type of treatment. For recurrent disease, courses are repeated.
    • 5-FU gives favorable cosmetic results, but is contraindicated in invasive lesions.
  • Radiation therapy
    • In high-risk cSCC, radiation therapy is not routinely utilized as monotherapy given the higher rate of local recurrence (15 to 20 percent or greater) compared with surgery with or without postoperative radiation therapy.[5]
    • Is an excellent choice for the management of initial small well defined lesions, especially primary SCCs in older individuals and those who are not candidates for surgical procedures. This form of treatment is administered in a fractionated form requiring nearly 30 treatments.[6]
    • For low risk lesions the cure rate approaches nearly 90%. The main advantage of this kind of treatment is sparing of the surrounding normal healthy skin, thus providing superior cosmetic benefits. Radiotherapy is contraindicated in:[7]
      • Tumors located on the trunk, extremities, ear and nose.
      • Patients younger than 40-50 years.
      • Recurrent SCCs that have previously been irradiated.
      • Cancers with large and poorly defined lesions, and other high risk SCCs.
  • Photodynamic therapy
    • Based upon the ability of porphyrins to produce cytotoxicity in the presence of oxygen after stimulation by light of an appropriate wavelength
    • Not recommended for the treatment of invasive cutaneous squamous cell carcinoma, due to high recurrence rates associated with photodynamic therapy

References

  1. ↑ 1.0 1.1 Skulsky SL, O'Sullivan B, McArdle O, Leader M, Roche M, Conlon PJ; et al. (2017). "Review of high-risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology". Head Neck. 39 (3): 578–594. doi:10.1002/hed.24580. PMID 27882625.
  2. ↑ Holt PJ (1988). "Cryotherapy for skin cancer: results over a 5-year period using liquid nitrogen spray cryosurgery". Br J Dermatol. 119 (2): 231–40. PMID 3166941.
  3. ↑ Hamouda B, Jamila Z, Najet R, Slim T, Rafiaa N, Noureddine B; et al. (2001). "Topical 5-fluorouracil to treat multiple or unresectable facial squamous cell carcinomas in xeroderma pigmentosum". J Am Acad Dermatol. 44 (6): 1054. PMID 11369927.
  4. ↑ Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens ML (2001). "Imiquimod 5% cream in the treatment of Bowen's disease". J Am Acad Dermatol. 44 (3): 462–70. doi:10.1067/mjd.2001.111335. PMID 11209116.
  5. ↑ Miller SJ, Alam M, Andersen J, Berg D, Bichakjian CK, Bowen G; et al. (2010). "Basal cell and squamous cell skin cancers". J Natl Compr Canc Netw. 8 (8): 836–64. PMID 20870631.
  6. ↑ Lovett RD, Perez CA, Shapiro SJ, Garcia DM (1990). "External irradiation of epithelial skin cancer". Int J Radiat Oncol Biol Phys. 19 (2): 235–42. PMID 2394605.
  7. ↑ Kwan W, Wilson D, Moravan V (2004). "Radiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin". Int J Radiat Oncol Biol Phys. 60 (2): 406–11. doi:10.1016/j.ijrobp.2004.03.006. PMID 15380573.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Squamous_cell_carcinoma_of_the_skin_medical_therapy&oldid=1584256"