皮肤鳞状细胞癌:从病理生理学到新型治疗方法
Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches.
作者信息
Fania Luca, Didona Dario, Di Pietro Francesca Romana, Verkhovskaia Sofia, Morese Roberto, Paolino Giovanni, Donati Michele, Ricci Francesca, Coco Valeria, Ricci Francesco, Candi Eleonora, Abeni Damiano, Dellambra Elena
机构信息
IDI-IRCCS, Dermatological Research Hospital, via di Monti di Creta 104, 00167 Rome, Italy.
Department of Dermatology and Allergology, Philipps University, 35043 Marburg, Germany.
出版信息
Biomedicines. 2021 Feb 9;9(2):171. doi: 10.3390/biomedicines9020171.
Cutaneous squamous cell carcinoma (cSCC), a non-melanoma skin cancer, is a keratinocyte carcinoma representing one of the most common cancers with an increasing incidence. cSCC could be in situ (e.g., Bowen's disease) or an invasive form. A significant cSCC risk factor is advanced age, together with cumulative sun exposure, fair skin, prolonged immunosuppression, and previous skin cancer diagnoses. Although most cSCCs can be treated by surgery, a fraction of them recur and metastasize, leading to death. cSCC could arise de novo or be the result of a progression of the actinic keratosis, an in situ carcinoma. The multistage process of cSCC development and progression is characterized by mutations in the genes involved in epidermal homeostasis and by several alterations, such as epigenetic modifications, viral infections, or microenvironmental changes. Thus, cSCC development is a gradual process with several histological- and pathological-defined stages. Dermoscopy and reflectance confocal microscopy enhanced the diagnostic accuracy of cSCC. Surgical excision is the first-line treatment for invasive cSCC. Moreover, radiotherapy may be considered as a primary treatment in patients not candidates for surgery. Extensive studies of cSCC pathogenic mechanisms identified several pharmaceutical targets and allowed the development of new systemic therapies, including immunotherapy with immune checkpoint inhibitors, such as Cemiplimab, and epidermal growth factor receptor inhibitors for metastatic and locally advanced cSCC. Furthermore, the implementation of prevention measures has been useful in patient management.
皮肤鳞状细胞癌(cSCC)是一种非黑色素瘤皮肤癌,是一种角质形成细胞癌,是最常见的癌症之一,发病率呈上升趋势。cSCC可以是原位癌(如鲍温病)或浸润性癌。cSCC的一个重要危险因素是高龄,同时伴有累积的阳光照射、白皙皮肤、长期免疫抑制以及既往皮肤癌诊断史。尽管大多数cSCC可以通过手术治疗,但其中一部分会复发和转移,导致死亡。cSCC可以原发产生,也可以是光化性角化病(一种原位癌)进展的结果。cSCC发生和发展的多阶段过程的特征是参与表皮稳态的基因突变以及一些改变,如表观遗传修饰、病毒感染或微环境变化。因此,cSCC的发展是一个具有几个组织学和病理学定义阶段的渐进过程。皮肤镜检查和反射式共聚焦显微镜提高了cSCC的诊断准确性。手术切除是浸润性cSCC的一线治疗方法。此外,对于不适合手术的患者,放疗可被视为主要治疗方法。对cSCC致病机制的广泛研究确定了几个药物靶点,并促成了新的全身治疗方法的开发,包括使用免疫检查点抑制剂(如西米普利单抗)进行免疫治疗,以及用于转移性和局部晚期cSCC的表皮生长因子受体抑制剂。此外,预防措施的实施对患者管理很有帮助。