Non-melanoma Skin Cancer: Essentials for Oncologists

Cover
Half Title
Title Page
Copyright Page
Table of Contents
Foreword
Preface
Contributors
Chapter 1 Biology of Skin Invasion and Skin Metastases
1.1 Introduction
1.2 Basal Cell Carcinoma
1.2.1 Clinical Aspects
1.2.2 Biological Aspects of Pathogenesis and Metastasizing Process
1.2.2.1 Molecular Alterations
1.2.2.2 Other Biological Alterations
1.3 Cutaneous Squamous Cell Carcinoma
1.3.1 Clinical Aspects
1.3.2 Biological Aspects of Pathogenesis and Metastasizing Process
1.3.2.1 Molecular Alterations
1.3.2.2 Other Biological Alterations
1.4 Merkel Cell Carcinoma
1.4.1 Clinical Aspects
1.4.2 Biological Aspects of Pathogenesis and Metastasizing Process
1.4.2.1 Molecular Alterations
1.4.2.2 Other Biological Alterations
References
Chapter 2 Chemoprevention and Photoprotection in Non-Melanoma Skin Neoplasms
2.1 Introduction
2.2 Non-Melanoma Skin Cancers
2.2.1 Squamous Cell Carcinoma
2.2.2 Basal Cell Carcinoma
2.3 Chemoprevention Agents
2.3.1 Vitamin A and Retinoids
2.3.1.1 Systemic Acitretin
2.3.1.2 Systemic Isotretinoin (13-cis-retinoic acid)
2.3.1.3 Topical Tretinoin
2.3.1.4 Dietary Vitamin A
2.3.2 Nicotinamide
2.3.3 Capecitabine
2.3.4 Arachidonic Acid Pathway Inhibition
2.3.5 Topical and Field Therapies
2.3.5.1 5-fluorouracil
2.3.5.2 Imiquimod
2.3.5.3 Photodynamic Therapy
2.3.5.4 Sodium Diclofenac
2.3.6 Other Agents
2.3.6.1 Vitamin D
2.3.6.2 Difluoromethylornithine (DFMO)
2.3.6.3 Polyphenol Pathway
2.3.7 Future Targets: Microbiome and Glucocorticoids
2.4 Photoprotection: Sunscreens
2.4.1 Sun Protection Factor
2.4.2 UVA Protection Labeling
2.5 Conclusions
References
Chapter 3 Aetiology and Epidemiology of Non-Melanoma Skin Neoplasms
3.1 Introduction
3.2 Chapter Content
3.2.1 Global Epidemiology of NMSC
3.2.2 High Latitude and NMSC
3.2.3 UV and NMSC
3.2.4 Vitamin D3 and Skin Cancer Risk
3.2.5 Skin Pigmentation and Risk of NMSC
3.2.6 Identification of At-Risk Patients from Genetic and Clinical Risk Scores
3.2.7 Immune Suppression and NMSC
3.2.8 NMSC Survival
3.2.9 Sequalae of NMSC
3.2.10 Cutaneous T-Cell Lymphoma
3.2.11 Merkel Cell Carcinoma
3.2.12 Adnexal Tumours
3.2.13 Kaposi’s Sarcoma
3.3 Conclusions
References
Chapter 4 Clinical Presentation of Non-Melanoma Skin Cancer and Selected Dermatological Manifestations
4.1 Introduction
4.2 Basal Cell Carcinoma
4.3 Cutaneous Squamous Cell Carcinoma
4.4 Merkel Cell Carcinoma
4.5 Cutaneous Malignant Appendageal Tumours
4.6 Soft Tissue Tumours
4.7 Primary Cutaneous Lymphomas
4.8 Skin and Subcutaneous Metastases from Skin Tumours and Internal Malignancies
4.9 Cutaneous Carcinogenesis Related to Viral Infections
4.10 Cutaneous Carcinogenesis Related to Dermatological Treatments
4.11 Genetic Conditions Predisposing to Skin Tumours and Contraindicating (Skin) Radiotherapy
4.12 Conclusions
References
Chapter 5 Dermatopathology of Keratinocyte Tumors
5.1 Introduction
5.2 Basal Cell Carcinoma (BCC)
5.2.1 Histopathology
5.2.2 Differential Diagnosis
5.2.3 Molecular Pathology
5.3 Carcinoma Precursors (Premalignant Keratosis)
5.3.1 Actinic Keratosis
5.3.2 Arsenical Keratosis
5.3.3 PUVA Keratosis
5.4 Cutaneous Squamous Cell Carcinoma (cSCC)
5.5 cSCC in Situ (Bowen Disease)
5.5.1 Histopathology
5.5.2 Molecular Pathology
5.6 Invasive cSCC
5.6.1 Histopathology
5.6.2 Differential Diagnosis
5.6.3 Molecular Pathology
5.7 Other Rare Skin Pathologies
5.8 Conclusions
Additional Reading
References
Chapter 6 Dermatopathology of Merkel Cell Carcinoma, Cutaneous Lymphoma and Cutaneous Soft Tissue Sarcoma
6.1 Introduction
6.2 Merkel Cell Carcinoma
6.2.1 Step 1: Confirming Neuroendocrine Differentiation and Excluding Other Tumour Types
6.2.2 Step 2: Primary Cutaneous versus Metastatic Origin
6.2.3 Step 3: Staging and Assessment of Prognostic Factors
6.2.4 Merkel Cell Polyomavirus (MCPyV)
6.3 Primary Cutaneous Lymphoma: An Overview
6.3.1 Diagnostic Approach to Primary Cutaneous T Cell Lymphoma
6.3.2 Mycosis Fungoides
6.3.3 CD30 Lymphoproliferative Conditions
6.3.4 Primary Cutaneous Anaplastic Large Cell Lymphoma (PCALCL)
6.3.5 Lymphomatoid Papulosis (LyP)
6.3.6 Examples of Other Subtypes of Cutaneous T Cell Lymphoma
6.3.7 Diagnostic Approach to Primary Cutaneous B Cell Lymphoma
6.3.8 Primary Cutaneous Marginal Zone Lymphoma (PCMZL)
6.3.9 Primary Cutaneous Follicle Centre Cell Lymphoma (PCFCCL)
6.3.10 Primary Cutaneous Diffuse Large B Cell Lymphoma, Leg Type (PCDLBCL-LT)
6.3.11 Examples of Other Subtypes of Cutaneous B Cell Lymphoma
6.4 Cutaneous Soft Tissue Sarcoma
6.4.1 Basic Principles of Sarcoma Pathology
6.4.2 Angiosarcoma
6.4.3 Dermatofibrosarcoma Protuberans
6.4.4 Pleomorphic Dermal Sarcoma
6.4.5 Cutaneous Leiomyosarcoma (Atypical Smooth Muscle Tumour)
6.4.6 Examples of Other Primary Cutaneous Sarcoma
6.5 Conclusion
Additional Reading
References
Chapter 7 Imaging in Non-Melanoma Skin Neoplasms
7.1 Introduction
7.2 Chapter Content
7.2.1 Dermoscopy
7.2.2 Optical Coherence Tomography (OCT)
7.2.3 Reflectance Confocal Microscopy (RCM)
7.2.4 High Frequency Skin Ultrasound (HFUS) (20–100 MHz)
7.2.5 Computed Tomography (CT)
7.2.6 MRI
7.2.7 PET-CT/Positron Emission Tomography Radiolabeled 18-Fluorodeoxyglucose (18-FDG)
7.3 Image and Follow-Up
7.4 Conclusions
References
Chapter 8 Skin Biopsy for Non-Melanoma Skin Cancer
8.1 Introduction
8.2 Operating Facilities
8.2.1 Operating Couch
8.2.2 Lamp
8.2.3 Emergency Equipment
8.2.4 Haemostasis – Cautery and Diathermy
8.2.5 Fume Extractors
8.3 Procedure
8.4 Lesion Identification and Marking
8.5 Preoperative Assessment
8.6 Consent
8.6.1 Preoperative
8.6.2 Post‐Operative
8.7 Infection Control
8.8 Local Anaesthetic
8.8.1 Dose
8.9 Punch Biopsy
8.10 Shave Biopsy/Excision
8.11 Curettage
8.12 Incisional Biopsy
8.13 Histological Sample
8.14 Safety and Governance in Skin Surgery
8.15 Avoiding Wrong‐Site Surgery
Further Reading and Key Resources
Useful Websites
Useful Textbooks
Chapter 9 Staging Systems in Non-Melanoma Skin Neoplasms and Prognostication
9.1 Introduction
9.2 Cutaneous Squamous Cell Carcinoma
9.2.1 Risk Factors for Poor Outcomes
9.2.2 Staging Systems
9.2.2.1 International Union Against Cancer
9.2.2.2 The American Joint Committee on Cancer, Eighth Edition
9.2.2.3 Brigham and Women’s Hospital Staging System
9.3 Basal Cell Carcinoma
9.3.1 Risk Factors for Poor Outcomes
9.3.2 Staging Systems
9.3.2.1 American Joint Committee on Cancer, Eighth Edition
9.3.2.2 Brigham and Women’s Hospital Staging System
9.4 Merkel Cell Carcinoma
9.5 Cutaneous T Cell Lymphoma
9.6 Cutaneous Soft Tissue Sarcoma
9.7 Conclusion
References
Chapter 10 Topical, Ablative and Light-Based Therapies for Non-Melanoma Skin Neoplasms
10.1 Introduction
10.2 Topical Therapies
10.2.1 Imiquimod
10.2.2 Fluorouracil (5-FU)
10.2.3 Topical Corticosteroids
10.2.4 Nitrogen Mustard
10.2.5 Carmustine
10.2.6 Topical Retinoids
10.3 Curettage and Electrodesiccation (ED&C)
10.4 Cryosurgery
10.5 Photodynamic Therapy (PDT)
10.6 Ultraviolet Phototherapy
10.7 Laser
10.8 Electrochemotherapy and Intralesional Agents
References
Chapter 11 Primary Excision and Surgical Reconstruction in Non-Melanoma Skin Neoplasms
11.1 Introduction
11.2 Primary Excision
11.2.1 Management of Non-Melanoma Skin Cancer
11.2.2 Standard Surgical Excision
11.2.3 Electrodessication and Curettage
11.3 Surgical Reconstruction
11.3.1 Principles of Plastic Surgery
11.4 Basic Reconstruction Techniques
11.4.1 Graft
11.4.1.1 Skin Graft
11.4.1.2 Cartilage Graft
11.4.1.3 Bone Graft
11.4.2 Flap
11.4.2.1 Random Flap
11.4.2.2 Axial Flap
11.4.2.3 Perforator Flap
11.4.2.4 Free Flap
11.4.3 Other Reconstructive Techniques: Z-Plasty
11.5 Pearls and Pitfalls in Facial Reconstruction
11.5.1 Nose Reconstruction
11.5.2 Eyelid Reconstruction
11.5.3 Lip Reconstruction
11.5.4 Cheek Reconstruction
11.6 Conclusions
References
Chapter 12 Mohs Surgery
12.1 Introduction
12.2 History
12.3 Surgical Technique
12.3.1 Surgical Excision
12.3.2 Histopathological Examination
12.3.3 Precise Mapping
12.3.4 Wound Management/Reconstruction
12.4 Slow-Mohs
12.5 Indications
12.5.1 General Indications
12.5.2 Specific Indications
12.5.2.1 Basal Cell Carcinoma (BCC)
12.5.2.2 Squamous Cell Carcinoma (SCC)
12.5.3 Rarer Tumours
12.5.3.1 Dermatofibrosarcoma protuberans (DFSP)
12.6 Preoperative Considerations
12.7 Postoperative Evaluation and Considerations
12.7.1 Healing by Secondary Intention
12.7.2 Primary Closure
12.7.3 Skin Grafting
12.7.4 Local Flap Reconstruction
12.8 Advantages of MMS
12.9 Disadvantages of MMS
12.10 Conclusions
References
Chapter 13 Nodal Metastases in Head and Neck Skin Squamous Cell Carcinomas
13.1 Introduction
13.2 Patterns of Lymph Node Spread
13.3 High-Risk Cancer
13.4 Role of Imaging
13.5 Management of Parotid Nodes
13.6 Management of N
13.7 Sentinel Lymph Node Biopsy
13.8 Management of N+, Adjuvant and Salvage Strategies
13.9 Conclusions
References
Chapter 14 Radiobiology of the Skin and Non-Melanoma Skin Neoplasms
14.1 Introduction
14.2 Side Effects of Ionizing Radiation
14.3 Pathophysiology and Mechanisms
14.3.1 Radiation-Induced Cell Death
14.3.2 Radiosensitivity of Stem Cells and Progenitors
14.3.3 Inflammatory Response
14.3.4 Radiation-Induced Fibrosis
14.3.5 TGF-β and Principal Signaling in Radiation Fibrosis
14.3.6 Damage to the Vasculature
14.3.7 Wound Healing in Previously Irradiated Skin
14.3.8 Skin Cancerogenesis
14.4 Effect of Total Dose and Fractionation
14.5 Reirradiation
14.6 Brachytherapy
14.7 FLASH Radiotherapy
14.8 Conclusions
References
Chapter 15 Medical Physics and Planning in Skin Radiotherapy and Brachytherapy
15.1 Introduction
15.2 Brachytherapy
15.2.1 Surface Applicators in Brachytherapy
15.2.2 HDR Surface Brachytherapy Using Flap, Mold, and Custom-Made Surface Applicators
15.2.2.1 Pre-Treatment Preparation and Simulation
15.2.2.2 Treatment Planning
15.2.2.3 Treatment Delivery
15.2.3 Interstitial Applicators
15.2.3.1 Applicator Placement
15.2.3.2 Simulation and Planning
15.2.3.3 QA Considerations
15.2.4 Alpha DaRT
15.3 External Beam Radiotherapy
15.3.1 Electrons
15.3.1.1 Electron Percentage Depth Doses (PDDs)
15.3.1.2 Changes with Beam Energy
15.3.1.3 Field Size and Shaping
15.3.1.4 Internal Shielding
15.3.1.5 Clinical Plan Complexities
15.3.1.6 Clinical Electron Beam Planning
15.3.2 Megavoltage Treatment – High-Energy Photons
15.3.2.1 Treatment Technique
15.3.3 Kilovoltage Treatment – Low Energy Photons
15.3.3.1 Treatment
15.4 Conclusions
References
Chapter 16 Radiotherapy to the Primary in Keratinocyte and Merkel Cell Cancers and to Skin Metastases
16.1 Introduction
16.2 History of Radiotherapy in Dermatology and Dermato-Oncology
16.3 Modern Radiotherapy in NMSC
16.4 Basal Cell Carcinoma
16.4.1 Definitive RT
16.4.2 Adjuvant RT
16.5 Squamous Cell Carcinoma
16.5.1 Definitive RT
16.5.2 Adjuvant RT
16.6 Perineural Invasion
16.7 Contraindications
16.8 Primary Merkel Cell Carcinoma and Postoperative Local RT
16.9 Skin Appendageal (Adnexal) Tumours
16.10 Palliative Radiotherapy for Skin Cancer and Skin Metastases
16.11 Conclusions
References
Chapter 17 Post-Operative Radiation Therapy for Keratinocyte Carcinoma and Merkel Cell Carcinoma
17.1 Introduction
17.2 Squamous Cell Carcinoma and Basal Cell Carcinoma
17.2.1 Defining High Risk for SCC
17.2.2 Simulation Technique (Porceddu et al. 2020)
17.2.3 Radiation Volume Considerations (Likhacheva et al. 2020, Porceddu et al. 2018)
17.2.3.1 Radiation Volume for the Primary Tumor Bed
17.2.3.2 Radiation Volume for the Nodal Bed
17.2.4 Radiation Techniques, Dose, and Fractionation Schemes for External Beam Radiation (Porceddu et al. 2020)
17.3 Merkel Cell Carcinoma (MCC)
17.3.1 Radiation Volume Considerations
17.3.1.1 Radiation Volume for the Primary Tumor Bed (Poulsen et al. 2003)
17.3.1.2 Radiation Volume for the Nodal Bed
17.3.2 Radiation Technique, Dose, and Fractionation Schemes
17.4 Radiation for Palliation of Skin Cancers
17.4.1 SCC and BCC
17.4.2 MCC
17.5 Conclusions
References
Chapter 18 Experiences when Irradiating Grafts and Flaps for Skin Cancer
18.1 Introduction
18.2 Assessing the Patient
18.2.1 History
18.2.2 Examination
18.2.3 PORT after Simple Closure
18.3 About Grafts and Flaps
18.3.1 PORT after Grafts and Flaps
18.3.2 Specific Radiation Prescription Considerations When Treating around Grafts and Flaps
18.3.3 RT volume
18.3.4 RT Modality
18.3.5 RT Dose and Fractionation
18.3.6 When Immediate PORT Is Not Given Due to Concerns of Graft or Flap Survival
18.4 Experiences during RT Delivery
18.4.1 Flaps May Not Exhibit Acute Effects
18.4.2 Acute Skin Toxicity Can Move According to Gravity
18.4.2.1 Transplanted skin may have different radiation sensitivity to that of its new environment
18.4.3 Late Toxicity
18.5 Conclusion
Acknowledgments
References
Chapter 19 Skin Brachytherapy (Contact and Interventional Radiotherapy)
19.1 Introduction
19.2 Brachytherapy (BT) in General Terms
19.3 When to Choose Primary Skin BT Instead of Primary Surgery
19.4 Advantages of BT over EBRT
19.5 Indications for Skin BT
19.6 Contraindications for Skin BT
19.7 Modes of Treatment in Skin BT
19.8 Techniques Used in Superficial BT
19.8.1 Multicatheter Flaps
19.8.2 Personalized Custom Moulds
19.8.3 3-D Printed Moulds
19.8.4 Surface Shielded Applicators
19.8.5 Electronic BT Applicators
19.9 Techniques Used in Interstitial BT
19.9.1 Flexible Catheters
19.9.2 Rigid Needles
19.9.3 Less Frequently Used Techniques
19.10 Radiation Doses and Schedules in Skin BT
19.11 Side Effects of Skin BT
19.12 Local Control and Cosmetic Outcomes in Skin BT
19.13 Conclusions
References
Chapter 20 Early and Late Toxicity in Skin Radiotherapy
20.1 Introduction
20.2 Acute and Late Effects of Superficial Radiotherapy for Skin Cancers
20.2.1 Dermatitis
20.2.2 Alopecia
20.2.3 Ocular and Periocular Toxicity
20.2.4 Nasal Mucositis and Epitaxis
20.2.5 Necrosis
20.2.6 Fatigue
20.3 Scoring Normal Tissue Damage
20.3.1 Scoring Systems Used
20.3.2 Patient-Reported Outcome Measures and Quality of Life
20.4 Management Strategies
20.4.1 Topical Emollients and Hydration
20.4.2 Topical Steroids
20.4.3 Dressings
20.4.4 Additional Interventions
20.4.4.1 Topical Antimicrobials and Oral Antibiotics
20.4.4.2 Analgesia
20.4.4.3 Topical Eye Lubricants
20.4.5 Additional Management Strategies for Late Effects
20.4.5.1 Pentoxifylline
20.4.5.2 Superoxide Dismutase
20.4.5.3 Hyperbaric Oxygen Therapy
20.4.5.4 Laser Therapy
20.4.6 Patient Education
20.5 Radiation Therapists’ Involvement
20.6 Conclusion
References
Chapter 21 Combined Radiotherapy and Systemic Treatment in Keratinocyte and Merkel Cell Carcinomas
21.1 Introduction
21.2 The Special Situation of the Skin Patient and Treatment Intent
21.3 Principles of Combining Skin RT and Systemic Treatment for Skin Cancer
21.4 New Non-Cytotoxic Systemic Therapies
21.5 Scenario 1: When a Systemic Treatment Is Given Concurrently to Increase the Efficacy of the RT in Skin Cancer
21.5.1 RT and Systemic Therapy with Cutaneous Squamous Cell Carcinoma (cSCC)
21.5.1.1 Cytotoxic Chemotherapy (CCT)
21.5.1.2 Non-Cytotoxic Systemic Therapies
21.6 RT and Systemic Therapy with Basal Cell Carcinoma
21.7 RT and Systemic Therapy with Merkel Cell Carcinoma
21.7.1 Concurrent Systemic Treatment with RT in Merkel Cell Carcinoma
21.8 Scenario 2: When a Patient Is receiving RT for Skin but Is Also Receiving Systemic Treatment for a Different Cancer
21.9 Scenario 3: When a Patient Is Receiving RT for Skin and Is Also on Systemic Treatment for Non-Cancer Conditions
21.10 Conclusion
References
Chapter 22 Radiotherapy in Cutaneous Lymphomas and Cutaneous Sarcomas
22.1 Cutaneous Lymphomas
22.2 Primary Cutaneous T Cell Lymphomas
22.2.1 Mycosis Fungoides
22.2.2 Sézary Syndrome
22.2.3 Primary Cutaneous CD30-Positive T Cell Lymphoproliferative Disorders
22.2.4 Subcutaneous Panniculitis-Like T Cell Lymphomas (SPTCL)
22.2.5 Primary Cutaneous Extranodal NK/T Cell Lymphoma, Nasal Type
22.2.6 Primary Cutaneous Peripheral T Cell Lymphomas, Rare Subtypes
22.3 Primary Cutaneous B Cell Lymphomas
22.3.1 Primary Cutaneous Marginal Zone Lymphoma and Primary Cutaneous Follicle Centre Lymphoma
22.3.2 Primary Cutaneous Diffuse Large B Cell Lymphoma, Leg Type
22.4 Cutaneous Sarcomas
22.5 Dermatofibrosarcoma Protruberans (DFSP)
22.6 Dermal Sarcoma and Atypical Fibroxanthomas
22.7 Cutaneous Leiomyosarcoma (LMS)
22.8 Kaposi’s Sarcoma
22.8.1 AIDS-Related Kaposi’s Sarcoma (Epidemic)
22.8.2 Classical Kaposi’s Sarcoma
22.8.3 Endemic Kaposi’s Sarcoma
22.8.4 Iatrogenic Kaposi’s Sarcoma
22.9 Angiosarcoma
References
Chapter 23 Treatment of Locally Advanced and Metastatic Skin Carcinomas
23.1 Introduction
23.2 Basal Cell Carcinoma (BCC)
23.2.1 Advanced BCC
23.2.2 Treatment Options for Advanced BCC
23.2.2.1 Hedgehog Inhibitors (HHI)
23.2.2.2 Immunotherapy
23.2.2.3 Chemotherapy
23.2.3 Neoadjuvant Treatment
23.2.4 Adjuvant Treatment
23.3 Cutaneous Squamous Cell Carcinoma (cSCC)
23.3.1 Advanced cSCC
23.3.2 Treatment Options for Advanced cSCC
23.3.2.1 Surgery and Radiotherapy
23.3.2.2 Systemic Treatments for Advanced cSCC
23.4 Future Strategies
23.5 Conclusions
References
Chapter 24 Systemic Treatment of Merkel Cell Carcinoma and Dermal Sarcomas
24.1 Introduction
24.2 Systemic Treatment of Merkel Cell Carcinoma
24.2.1 Chemotherapy for Merkel Cell Carcinoma
24.2.1.1 Background
24.2.1.2 Chemotherapy Regimens
24.2.1.3 Chemotherapy Outcomes
24.2.1.4 Chemotherapy Toxicities
24.2.2 Immunotherapy for Merkel Cell Carcinoma
24.2.2.1 Background
24.2.2.2 Mechanism of Action of Immune Checkpoint Inhibitors
24.2.2.3 Anti PD-L1 Antibody – Avelumab
24.2.2.4 Anti-PD1 Antibodies – Pembrolizumab and Other Anti-PD-1 Antibodies
24.2.2.5 Immune-Related Adverse Events (irAEs)
24.2.3 Future Systemic Treatments for Merkel Cell Carcinoma
24.3 Systemic Treatment of Dermal Sarcomas
24.3.1 Overview
24.3.2 Principles of Chemotherapy for STS, Including Dermal Sarcomas
24.3.3 Histology-Specific Treatments for Dermal Sarcomas
24.3.3.1 Dermatofibrosarcoma Protuberans (DFSP)
24.3.3.2 Cutaneous Leiomyosarcoma (cLMS)
24.3.3.3 Cutaneous Angiosarcoma (cAS)
24.3.3.4 Cutaneous Kaposi’s Sarcoma (cKS)
24.3.3.5 Cutaneous Undifferentiated Pleomorphic Sarcoma (cUPS)
24.3.3.6 Atypical Fibroxanthoma (AFX)
24.4 Conclusion
References
Chapter 25 Systemic Treatment of Cutaneous Lymphomas
25.1 Cutaneous Lymphomas
25.2 Diagnosis and Staging
25.3 General Treatment Principles
25.4 Systemic Treatments of Primary Cutaneous T-Cell Lymphoma
25.4.1 Retinoids
25.4.2 Interferons
25.4.3 Extracorporeal Photopheresis
25.4.4 Chemotherapy
25.4.4.1 Methotrexate
25.4.4.2 Gemcitabine
25.4.4.3 Doxorubicin
25.4.4.4 Other Agents
25.4.5 Targeted Therapies
25.4.5.1 Histone Deacetylase Inhibitors
25.4.5.2 Brentuximab Vedotin
25.4.5.3 Mogamulizumab
25.4.5.4 Alemtuzumab
25.4.6 Bone Marrow Transplant
25.5 Systemic Treatment of Primary Cutaneous B-Cell Lymphoma
25.5.1 Rituximab
References
Chapter 26 Management of Skin Cancer in the Immunocompromised Patient
26.1 Introduction
26.2 Chapter Content
26.2.1 Renal Transplantation-Induced Skin Cancer
26.2.2 Pathogenesis of cSCC in Transplant Recipients
26.2.3 Prevention of cSCC
26.2.4 Diagnosis
26.2.5 Management
26.2.6 Follow-Up
26.2.7 BCC in the Immunocompromised Patient
26.2.8 Melanoma in the Immunocompromised Patient
26.2.9 HIV and Kaposi’s Sarcoma
26.3 Conclusions
References
Chapter 27 Dermatology and Oncology in Skin of Colour
27.1 Introduction
27.2 Epidemiology of Skin Neoplasms in Skin of Colour
27.2.1 Black Skin
27.2.2 Asian Skin
27.2.3 White-Hispanic and Mixed-Race Skin
27.3 Radiotherapy Skin Reactions in Skin of Colour
27.3.1 Black Skin
27.3.2 Asian Skin
27.3.3 White-Hispanic and Mixed-Race Skin
27.4 Conclusion
Bibliography
Chapter 28 Skin Cancer Management in the Elderly and Frail
28.1 Introduction
28.1.1 Ageing Demographics
28.1.2 Evidence Base for Older People with Cancer
28.1.3 Under- versus Over-Treatment
28.2 Physiology of Ageing
28.2.1 What is Frailty?
28.2.2 Why Is It Important in Skin Cancer?
28.3 How Assessed?
28.3.1 Screening (Screening Tools) and CGA (Different Domains)
28.3.2 Treatment Options for Older Adults
28.3.3 Specific Considerations for Older Patients Presenting for Treatment
28.3.4 Radical Radiation Therapy
28.3.5 Radical Brachytherapy and Skin Cancer: Advantages for Older/Frail Patients
28.3.6 Palliative Treatments
28.4 Conclusions
References
Chapter 29 Quality of Life and Cosmetic Assessment in Skin Cancer Treatment
29.1 Introduction
29.2 Quality of Life
29.3 Cosmetic Outcome
29.4 Clinical Nurse Specialist (CNS) Perspective
29.5 Conclusions
References
Chapter 30 Emerging Trends and Future Directions in Skin Cancer Management
30.1 Introduction
30.2 Predicting the Scale of the Problem: The Importance and Challenges of NMSC Registration
30.3 Non-Melanoma Skin Cancer Screening: Universal, Targeted or Not Justified?
30.4 Artificial Intelligence in NMSC Management: From Diagnosis to Personalised Medicine
30.4.1 Clinical Applications of AI in NMSC Management
30.4.2 Barriers to Clinical Implementation of AI Applications
30.5 Imaging and NMSC Management: Non-Invasive Technologies and Radiomics
30.5.1 Non-Invasive Skin Imaging Technologies
30.5.2 Medical Imaging and Radiomics
30.6 Predicting NMSC Risk
30.6.1 Patient Level Risk Stratification: Polygenic Risk Scores
30.6.2 Tumour Level Risk Stratification
30.6.2.1 Histological staging – Limitations and the Potential of Digital Pathology and AI
30.6.2.2 Molecular Prognostic Tools
30.7 Medical and Surgical Management of NMSC: Addressing Current Knowledge Gaps
30.7.1 Surgical Modalities for Primary NMSC
30.7.2 Adjuvant and Neoadjuvant Therapy for High-Risk NMSC
30.7.3 Advanced and Metastatic Disease: Targeted and Immunotherapeutic Approaches
30.7.3.1 Targeted Therapies
30.7.3.2 Immunotherapy
30.7.4 NMSC Prevention
30.8 Radiotherapy: Contemporary and Potential Future Directions in NMSC Management
30.8.1 Brachytherapy
30.8.2 Cobra Project Brachytherapy Data Sharing
30.9 Conclusions
References
Index