Adherence to the National Comprehensive Cancer Network Criteria of Complete Circumferential Peripheral and Deep Margin Assessment in Treatment of High-Risk Basal and Squamous Cell Carcinoma

2020 ◽  
Vol 46 (12) ◽  
pp. 1473-1480 ◽  
Author(s):  
Melissa J. Danesh ◽  
Tyler D. Menge ◽  
Lydia Helliwell ◽  
Meera Mahalingam ◽  
Abigail Waldman
Keyword(s):  
Squamous Cell Carcinoma ◽  
High Risk ◽  
National Comprehensive Cancer Network ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Margin Assessment ◽  
Deep Margin ◽  
Cancer Network

Squamous Cell Carcinoma: Epidemiology, Risk Factors, and Treatment Options

2017 ◽  
Author(s):  
Jeffrey M Farma ◽  
Elena P Lamb
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Radiation Therapy ◽  
High Risk ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Treatment Options ◽  
Primary Treatment ◽  
Surgical Margins ◽  
Margin Assessment

Ultraviolent (UV) solar radiation is considered to be the dominant risk factor for development of squamous cell carcinoma (SCC). The development of SCC appears to be linked to the cumulative dose of UV radiation over time. Identifying patients with high-risk factors for developing SCC includes chronic immunosuppression, exposure to ionizing radiation, and certain genetic syndromes. Primary treatment goals of cutaneous SCC include cure of tumor with maximal preservation of function. Treatment options should be stratified for low- and high-risk SCC. Primary treatment options for low-risk SCC include (1) curettage and electrodesiccation, (2) excision with postoperative margin assessment (POMA) with 4 to 6 mm margins, and (3) radiation therapy (RT) for nonsurgical candidates. Options for high-risk SCC lesions include (1) Mohs surgery or resection with complete circumferential peripheral and deep margin assessment, (2) excision with POMA with wider surgical margins and primary or delayed repair, and (3) RT for nonsurgical candidates.     This review contains 4 figures, 5 tables, and 32 references. Key words: cutaneous squamous cell carcinoma, Mohs micrographic surgery, pathologic risk factors, radiation therapy, surgical margins 

Squamous Cell Carcinoma: Epidemiology, Risk Factors, and Treatment Options

2017 ◽  
Author(s):  
Jeffrey M Farma ◽  
Elena P Lamb
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Radiation Therapy ◽  
High Risk ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Treatment Options ◽  
Primary Treatment ◽  
Surgical Margins ◽  
Margin Assessment

Ultraviolent (UV) solar radiation is considered to be the dominant risk factor for development of squamous cell carcinoma (SCC). The development of SCC appears to be linked to the cumulative dose of UV radiation over time. Identifying patients with high-risk factors for developing SCC includes chronic immunosuppression, exposure to ionizing radiation, and certain genetic syndromes. Primary treatment goals of cutaneous SCC include cure of tumor with maximal preservation of function. Treatment options should be stratified for low- and high-risk SCC. Primary treatment options for low-risk SCC include (1) curettage and electrodesiccation, (2) excision with postoperative margin assessment (POMA) with 4 to 6 mm margins, and (3) radiation therapy (RT) for nonsurgical candidates. Options for high-risk SCC lesions include (1) Mohs surgery or resection with complete circumferential peripheral and deep margin assessment, (2) excision with POMA with wider surgical margins and primary or delayed repair, and (3) RT for nonsurgical candidates.     This review contains 4 figures, 5 tables, and 32 references. Key words: cutaneous squamous cell carcinoma, Mohs micrographic surgery, pathologic risk factors, radiation therapy, surgical margins 

Population-based analysis of National Comprehensive Cancer Network (NCCN) guideline adherence for patients with anal squamous cell carcinoma in California.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 1-1
Author(s):  
Priyanka Kumar ◽  
Michael Del Rosario ◽  
Jenny Chang ◽  
Argyrios Ziogas ◽  
Mehraneh D. Jafari ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
National Comprehensive Cancer Network ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Treatment Guidelines ◽  
Anal Squamous Cell Carcinoma ◽  
Cancer Network ◽  
To Receive ◽  
Disease Specific

1 Background: Oncology-specific evidence-based treatment guidelines aim to improve cancer care. Our study analyzed adherence to the National Comprehensive Cancer Network (NCCN) treatment guidelines for anal squamous cell carcinoma in California and the associated impacts on survival. Methods: Patients aged 18 to 79 years diagnosed with anal squamous cell carcinoma (SCC) between January 1, 2004 and December 31, 2017 with follow-up through November 30, 2018 were identified in the California Cancer Registry. Patient demographics, socioeconomic status (SES) and tumor stage were identified. We determined whether patients received NCCN guideline-adherent care (AdC) by pre-defined criteria. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression for receiving AdC. Overall survival (OS) and disease specific-survival (DSS) were calculated using Cox regression models. Results: Of 4,740 patients with a diagnosis of anal SCC in California, 926 (19.5%) did not receive AdC (non-AdC). Non-AdC had worse DSS (HR 1.96, 95% CI = 1.56, 2.46, p < 0.0001) and worse OS (HR 1.87, 95% CI = 1.66, 2.12, p < 0.0001). Females were more likely to receive AdC (OR 1.38, 95% CI = 1.18, 1.62, p < 0.0001). Medicaid patients were less likely to receive AdC (OR 0.75, 95% CI = 0.57, 1.00, p = 0.0476). Patients with the lowest SES were less likely to receive AdC (OR 0.65, 95% CI = 0.50, 0.83, p = 0.0007). Characteristics associated with DSS and OS included female gender, black race, Medicare/Medicaid, and SES (particularly, lower-middle SES). Conclusions: NCCN guideline-adherent care was associated with improved disease-specific and overall survival in anal SCC patients in California.

Surgical Continuity of Care: A Multidisciplinary Approach to Managing the Mohs Micrographic Surgery Positive Deep Margin at the Parotid in Cutaneous Squamous Cell Carcinoma

2019 ◽  
Vol 3 (4) ◽  
pp. 258-265
Author(s):  
Brandon T Beal ◽  
Vamsi Varra ◽  
Melinda B Chu ◽  
Eric S Armbrecht ◽  
Ronald J Walker ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
High Risk ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Surgical Margins ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Deep Margin

Background: While high-risk characteristics for cutaneous squamous cell carcinoma (cSCC) and the management of metastatic cSCC have received considerable attention in the literature, standard of care management for the positive MMS margin at the parotid fascia in cSCC has yet to be clarified. The aim of this study is to better define optimal management approaches for the positive deep Mohs Micrographic Surgery (MMS) margin at the parotid fascia. Methods: Inclusion criteria for this retrospective case series were patients presenting to the Saint Louis University with biopsy proven cSCC with a positive deep MMS margin at the parotid fascia who were referred to HNS and treated with curative intent. The following data were recorded: age; gender; NCCN high-risk factors; adjuvant surgical, medical, radiation (RT), or chemoradiation (CRT) therapies; outcomes; and follow-up data. Results: Eight patients undergoing MMS had a positive deep margin at the parotid fascia. HNS performed 7 parotidectomies and 1 wide local excision (WLE), obtaining negative margins in 75.0% (6/8) of patients (5/7 parotidectomies and 1/1 WLE). Obtaining negative surgical margins (6/8 patients) resulted in a disease free survival (DFS) and overall survival (OS) of 27.8 and 43.6 months, respectively; compared to a DFS of 20.6 months and OS of 39.1 months for positive margins (2/8 patients). Conclusion: This study demonstrates that resection with negative surgical margins results in excellent long-term local and regional disease control, and overall survival for cSCC patients with positive deep MMS margin at the parotid fascia.

scholarly journals Outcomes of Post-Operative Treatment with Concurrent Chemoradiotherapy (CRT) in High-Risk Resected Oral Cavity Squamous Cell Carcinoma (OCSCC): A Multi-Institutional Collaboration

2021 ◽  
Vol 28 (4) ◽  
pp. 2409-2419
Author(s):  
Arslan Babar ◽  
Neil M. Woody ◽  
Ahmed I. Ghanem ◽  
Jillian Tsai ◽  
Neal E. Dunlap ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
High Risk ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Demographic Data ◽  
Disease Free Survival ◽  
Total Sample ◽  
High Dose ◽  
Pathologic Features

Adjuvant chemoradiation (CRT), with high-dose cisplatin remains standard treatment for oral cavity squamous cell carcinoma (OCSCC) with high-risk pathologic features. We evaluated outcomes associated with different cisplatin dosing and schedules, concurrent with radiation (RT), and the effect of cumulative dosing of cisplatin. An IRB-approved collaborative database of patients (pts) with primary OCSCC (Stage I–IVB AJCC 7th edition) treated with primary surgical resection between January 2005 and January 2015, with or without adjuvant therapy, was established from six academic institutions. Patients were categorized by cisplatin dose and schedule, and resultant groups compared for demographic data, pathologic features, and outcomes by statistical analysis to determine disease free survival (DFS) and freedom from metastatic disease (DM). From a total sample size of 1282 pts, 196 pts were identified with high-risk features who were treated with adjuvant CRT. Administration schedule of cisplatin was not significantly associated with DFS. On multivariate (MVA), DFS was significantly better in patients without perineural invasion (PNI) and in those receiving ≥200 mg/m2 cisplatin dose (p < 0.001 and 0.007). Median DFS, by cisplatin dose, was 10.5 (<200 mg/m2) vs. 20.8 months (≥200 mg/m2). Our analysis demonstrated cumulative cisplatin dose ≥200 mg/m2 was associated with improved DFS in high-risk resected OCSCC pts.

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