Release: Embargoed until September 24, 2000Contact: Kenneth Satterfield202-371-4517 (9/23-27)703-519-1563[email protected]
AGGRESSIVE NON-MELANOMA SKIN CANCER REQUIRES DIVERSE TREATMENT STRATEGIES TO PRECLUDE RECURRENCE
Washington, DC -- Non-melanoma skin cancer (NMSC), which includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is the most common malignancy to affect humans. In the United States, incidence is at an epidemic level of approximately 900,000 to 1,200,000 new cases each year. Since the mid-1980s, incidence has been steadily rising due to uncertain causes. Eighty percent of these lesions occur in the cervicofacial region. For Caucasians, the life time risk for NMSC is seven to 11 percent for SCC and 28-33 percent for BCC. Although mortality from NMSC is relatively low (0.1-0.3 percent of incidence), the morbidity and treatment-related costs of this disease represent a significant burden to the health care system.
Of particular concern is a subset of this disease termed aggressive non-melanoma skin cancer (ANMSC). These lesions are identified by several features: rapid growth, diameter greater than 2cm, and recurrence. Additionally, poorly-differentiated SCC, spindle-cell type SCC, and morpheaform or basosquamous type BCC tend to exhibit more aggressive behavior. Management of ANMSC is further complicated by the potential sequelae of radical tumor resection. While the first priority of the surgeon should be definitive local control, possible functional and cosmetic results of surgical resection and underestimation of depth of invasion may lead to less aggressive excision of these tumors.
Because of the increasing incidence of ANMSC and the catastrophic effects of improper treatment of this disease, researchers reviewed the treatment of patients with ANMSC to evaluate the factors that predict tumor recurrence and affect patient survival. Their effort measured the effectiveness of current treatment protocols in an effort to modify future treatment strategies.
The authors of the study, "Management of Aggressive Non-melanoma Skin Cancer," are Stephen Lai, MD, PhD; Ara A Chalian, MD; Gregory S. Weinstein, MD; David I. Rosenthal, MD; Mitchell Machtay, MD and Randal S. Weber, MD, all from the University of Pennsylvania Medical Center, Philadelphia, PA. Their findings will be presented on September 27, 2000, at the Annual Meeting/Oto Expo of the American Academy of Otolaryngology -- Head and Neck Surgery Foundation, being held September 24-27, 2000, at the Washington, DC Convention Center.
Methodology: Fifty-four patients received treatment for ANMSC by the Department of Otorhinolaryngology -- Head and Neck Surgery at the University of Pennsylvania between 1996 and 1999. A retrospective review of patient treatment was undertaken. Patient demographics, primary lesion site, size, and facial pain/paralysis were noted. Additionally, history of prior disease, previous treatment, clinical evidence of regional metastasis, and predisposing factors (e.g., immunocompromised host) were obtained. Clinical work-up, including imaging studies or biopsy results, was collected. Surgical treatment and reconstruction strategies were noted. Pathologic data included lesion size, depth, histologic type, differentiation, surgical margin status, cervical node invasion, and evidence of perineural disease. Post-surgical follow-up and treatment with radiation therapy and chemotherapy were recorded. Outcome measures included site(s) of disease recurrence and survival.
Results: Patients presented with a median age of 69.5 years (range: 37-92 years) and 44 of the 54 patients were male. The majority of patients presented with primary lesions located in the periauricular (23/54), frontozygomatic (10/54), nasal (9/54), and neck (8/54) areas. Three patients had lip lesions and one patient had posterior skin disease. Eight patients presented with facial weakness or paralysis and 12 patients had clinical evidence of metastasis to the parotid gland and/or the neck. Thirty-two patients had primary lesions that were SCC and 22 were BCC. Twenty-five of the 54 patients presented with recurrent disease and all of these patients had Mohs' micrographic surgery as part of their prior treatment. Additionally, six patients had previously received radiation therapy.
Factors that were statistically significant in (p<0.05) determining tumor recurrence included: recurrence following previous treatment, status of surgical margins, tumor size, and depth of invasion. Despite post-operative radiation therapy administered to 26 patients, 13 patients sustained local-regional failures. Disease-free and overall survival were 65 percent and 82 percent, respectively, at 42 months. Tumor size and depth of invasion were related to disease-free and overall survival.
Conclusions: The authors conclude that:
(1) Tumor size and tumor depth are associated with disease recurrence and survival (disease-free and overall). Recurrent tumors are difficult to treat and are more likely to recur.
(2) Recurrence rates remain relatively high and mortality rates are much higher than for typical non-melanoma skin cancer.
(3) Continued research in this field is necessary to determine clinical and biological factors that predict aggressive tumor behavior.
(4) Patients may benefit from surgical treatment and radiation therapy as the initial treatment modalities.
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