Philipp Jansen1, Maximilian Petri1, Simon F Merz2, Titus J Brinker3, Dirk Schadendorf1, Andreas Stang4, Ingo Stoffels1, Joachim Klode5. 1. Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; West German Cancer Center, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany. 2. Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; West German Cancer Center, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany; Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany. 3. Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany. 4. Center of Clinical Epidemiology, c/o Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Germany. 5. Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; West German Cancer Center, University Duisburg-Essen, 45122 Essen, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany. Electronic address: joachim.klode@uk-essen.de.
Abstract
BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous cancer worldwide. Several tumour characteristics are considered to pose an elevated risk for systemic spread of carcinoma cells ('high-risk' features). Early detection of subclinical metastases could permit early treatment and improve overall survival. To detect occult metastases and evaluate risk of future distant metastases, diagnostic extirpation of the sentinel lymph node (SLNE) is routinely performed in cutaneous melanoma and can be offered in high-risk cutaneous squamous cell carcinoma (hrcSCC). However, the clinical utility of SLNE in patients with hrcSCC remains unknown. MATERIAL AND METHODS: An ambidirectional cohort study with prospective patient recruitment was performed. Between July 2008 and April 2017, of 139 eligible patients, SLNE was performed in 114 cases (25 patients refused). Median follow-up was 23.7 months. RESULTS: We analysed the characteristics of 114 patients with hrcSCC who underwent SLNE. Eighty-nine patients (78.1%) were men, and 25 patients (21.9%) were women (median age 72.2 years). In multivariable analyses, histopathological detection of ulceration (hazard ratio, HR 2.9 [95% confidence interval, CI 0.7-12.2]), perineural growth (HR 3.0 [95% CI 0.6-14.6]) and clinically occult SLN metastases (HR 10.7 [95% CI 1.9-60.6]) were strongly associated with future occurrence of distant metastases. A positive predictive value of 50% was noted for patients where SLN metastasis was detected to develop distant metastases. However, distant metastases also occurred in seven patients when histopathological SLN evaluation had shown no evidence of metastases. CONCLUSIONS: Our data suggest SLNE is not a reliable diagnostic approach to evaluate the risk of future systemic carcinoma spread and development of distant metastases in patients with hrcSCC.
BACKGROUND:Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous cancer worldwide. Several tumour characteristics are considered to pose an elevated risk for systemic spread of carcinoma cells ('high-risk' features). Early detection of subclinical metastases could permit early treatment and improve overall survival. To detect occult metastases and evaluate risk of future distant metastases, diagnostic extirpation of the sentinel lymph node (SLNE) is routinely performed in cutaneous melanoma and can be offered in high-risk cutaneous squamous cell carcinoma (hrcSCC). However, the clinical utility of SLNE in patients with hrcSCC remains unknown. MATERIAL AND METHODS: An ambidirectional cohort study with prospective patient recruitment was performed. Between July 2008 and April 2017, of 139 eligible patients, SLNE was performed in 114 cases (25 patients refused). Median follow-up was 23.7 months. RESULTS: We analysed the characteristics of 114 patients with hrcSCC who underwent SLNE. Eighty-nine patients (78.1%) were men, and 25 patients (21.9%) were women (median age 72.2 years). In multivariable analyses, histopathological detection of ulceration (hazard ratio, HR 2.9 [95% confidence interval, CI 0.7-12.2]), perineural growth (HR 3.0 [95% CI 0.6-14.6]) and clinically occult SLN metastases (HR 10.7 [95% CI 1.9-60.6]) were strongly associated with future occurrence of distant metastases. A positive predictive value of 50% was noted for patients where SLN metastasis was detected to develop distant metastases. However, distant metastases also occurred in seven patients when histopathological SLN evaluation had shown no evidence of metastases. CONCLUSIONS: Our data suggest SLNE is not a reliable diagnostic approach to evaluate the risk of future systemic carcinoma spread and development of distant metastases in patients with hrcSCC.
Authors: Patrick L Quinn; Jin K Kim; Vishnu Prasath; Neal Panse; Thomas J Knackstedt; Ravi J Chokshi Journal: Arch Dermatol Res Date: 2022-03-18 Impact factor: 3.017
Authors: Ahmed K Mousa; Anwar A Elshenawy; Salah M Maklad; Shaimaa M M Bebars; Hisham A Burezq; Sherif E Sayed Journal: Int Wound J Date: 2021-09-18 Impact factor: 3.099