Non-melanoma skin cancer: United Kingdom National Multidisciplinary Guidelines

Journal of Laryngology and Otology - Tập 130 Số S2 - Trang S125-S132 - 2016
Carrie Newlands1, Roger Currie2, Aamir Memon3, S. Whitaker4, Tim Woolford5
1Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Guildford, UK
2Department of Oral and Maxillofacial Surgery, Ayrshire and Arran Health Board, UK
3Department of Dermatology, Southport and Ormskirk NHS Trust, Ormskirk, UK
4Department of Oncology, Royal Surrey County Hospital, Guildford, uk
5Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK

Tóm tắt

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides consensus recommendations on the management of cutaneous basal cell carcinoma and squamous cell carcinoma in the head and neck region on the basis of current evidence.Recommendations• Royal College of Pathologists minimum datasets for NMSC should be adhered to in order to improve patient care and help work-force planning in pathology departments. (G)• Tumour depth is of critical importance in identifying high-risk cutaneous squamous cell carcinoma (cSCC), and should be reported in all cases. (R)• Appropriate imaging to determine the extent of primary NMSC is indicated when peri-neural involvement or bony invasion is suspected. (R)• In the clinically N0 neck, radiological imaging is not beneficial, and a policy of watchful waiting and patient education can be adopted. (R)• Patients with high-risk NMSC should be treated by members of a skin cancer multidisciplinary team (MDT) in secondary care. (G)• Non-infiltrative basal cell carcinoma (BCC) <2 cm in size should be excised with a margin of 4–5 mm. Smaller margins (2–3 mm) may be taken in sites where reconstructive options are limited, when reconstruction should be delayed. (R)• Where there is a high risk of recurrence, delayed reconstruction or Mohs micrographic surgery should be used. (R)• Surgical excision of low-risk cSCC with a margin of 4 mm or greater is the treatment of choice. (R)• High-risk cSCC should be excised with a margin of 6 mm or greater. (R).• Mohs micrographic surgery has a role in some high-risk cSCC cases following MDT discussion. (R)• Delayed reconstruction should be used in high-risk cSCC. (G)• Intra-operative conventional frozen section in cSCC is not recommended. (G)• Radiotherapy (RT) is an effective therapy for primary BCC and cSCC. (R)• Re-excision should be carried out for incompletely excised high-risk BCC or where there is deep margin involvement. (R)• Incompletely excised high-risk cSCC should be re-excised. (R)• Further surgery should involve confirmed marginal clearance before reconstruction. (R)• P+ N0 disease: Resection should include involved parotid tissue, combined with levels I–III neck dissection, to include the external jugular node. (R)• P+ N+ disease: Resection should include level V if that level is clinically or radiologically involved. (R)• Adjuvant RT should include level V if not dissected. (R)• P0 N+ disease: Anterior neck disease should be managed with levels I–IV neck dissection to include the external jugular node. (R)• P0 N+ posterior echelon nodal disease (i.e. occipital or post-auricular) should undergo dissection of levels II–V, with sparing of level I. (R)• Consider treatment of the ipsilateral parotid if the primary site is the anterior scalp, temple or forehead. (R)• All patients should receive education in self-examination and skin cancer prevention measures. (G)• Patients who have had a single completely excised BCC or low-risk cSCC can be discharged after a single post-operative visit. (G)• Patients with an excised high-risk cSCC should be reviewed three to six monthly for two years, with further annual review depending upon clinical risk. (G)• Those with recurrent or multiple BCCs should be offered annual review. (G)

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Tài liệu tham khảo

10.1016/j.bjoms.2014.01.015

10.1002/lary.20608

10.1111/j.1365-2133.2008.08666.x

10.1097/01.MLG.0000158349.64337.ED

Slater, 2014, Dataset for the Histological Reporting of Primary Invasive Cutaneous Squamous Cell Carcinoma and Regional Lymph Nodes

10.1054/bjom.2000.0322

10.1002/hed.20417

2006, Improving Outcomes for People with Skin Tumours Including Melanoma

Edge, 2009, AJCC Cancer Staging Manual

10.1002/cncr.11798

10.1007/s13671-013-0041-2

2006, Improving Outcomes for People with Skin Tumours including Melanoma (update). The Management of Low-risk Basal Cell Carcinomas in the Community

10.1016/j.jcms.2009.07.007

10.1159/000312649

Bath-Hextall, 2007, Interventions for basal cell carcinoma of the skin, Cochrane Database Syst Rev, CD003412

2009, Management of the Patient with Primary Squamous Cell Carcinoma

2014, Management of Primary Cutaneous Squamous Cell Carcinoma

10.1001/jamadermatol.2013.2139

10.1200/JCO.2012.48.5326

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Thông tin xuất bản

Journal of Laryngology and Otology

Tập 130 Số S2

S125-S132

Thông tin tác giả