Management of Skin Cancer in the High-Risk Patient

Abstract

Skin cancer is the most common of human cancers and outnumbers all other types of cancer combined in the USA by over threefold. The majority of non-melanoma skin cancers are easily treated with surgery or locally destructive techniques performed under local anesthesia in the cost-effective outpatient setting. However, there is a subset of "high-risk" cases that prove challenging in terms of morbidity, mortality, adjuvant treatment required, as well as overall cost to the health care system. In our opinion, the term "high risk" when applied to skin cancer can mean one of three things: a high-risk tumor with aggressive histologic and/or clinical features with an elevated risk for local recurrence or regional/distant metastasis, a high-risk patient with the ongoing development of multiple skin cancers, and a high-risk patient based on immunosuppression. We have recently proposed classifying NMSC as a chronic disease in a certain subset of patients. Although no consensus definition exists for a chronic disease in medicine, there are three components that are present in most definitions: duration of at least 1 year, need for ongoing medical care, and functional impairment and/or alteration of activities of daily living (ADLs) and quality of life (QOL). Immunosuppression can refer to exogenous (organ or stem cell transplant patients,) or endogenous (HIV, leukemia, lymphoma, genodermatoses with DNA mismatch repair problems or other immunosuppression) causes. These patients are at risk for high-risk tumors and/or the development of multiple tumors.

Survivin, a molecular target for therapeutic interventions in squamous cell carcinoma

“…Squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and melanoma are three major type of skin cancers. BCC and SCC are sometime called non-melanoma cancer [ 100 ]. Survivin is overexpressed in both melanoma and non-melanoma skin cancers [ 76 , 101 – 103 ].…”

Tratamento de múltiplos cbc’s recidivantes: Importância do rastreio precoce e na qualidade de vida do paciente

“…Paralelo a isso, há casos em que deve ser realizada a CMM em tumores primários, desde que estes obedeçam a características especiais: CBCs agressivos (exceto os ≤ 0,5 cm nas áreas de baixo risco); nodulares nas áreas de alto e intermediário risco e para os maiores que 2cm nas áreas de baixo risco; e, para todos os superficiais nas áreas de alto risco e para os maiores que 0,6 cm nas áreas de risco intermediários (Behan & Wysong 2016;Quazi et al, 2020).…”

Skin Oncoplasties: Is Z-Plasty A Technique of Choice In Situation of Limited Resources? Case of Burkina Faso.

“…The modalities of surgical treatment depend on the location, histological type, size of the lesion and the patient's condition [6,7]. In the West, the diagnosis of skin tumours is made at an early stage, with small lesions allowing resection and suturing in majority of cases [8][9][10]. The situation is quite different in developing countries, particularly in Burkina Faso [3,7].…”

“…The lesions are often large and brings the problem of skin coverage after their resections. Several reconstruction techniques allow skin coverage [10,11]. Skin grafts require a good basement and good hygiene conditions.…”