Mittal Amit, Mittal Bharat B
Department of Dermatology, Mayo Clinic College of Medicine & Science, 200 First St SW, Rochester, MN 55905, USA.
Department of Radiation Oncology, Northwestern University, 251 E Huron LC-178, Chicago, IL 60611, USA.
J Skin Cancer. 2024 Feb 9;2024:3859066. doi: 10.1155/2024/3859066. eCollection 2024.
This study presents a comparative analysis of recently published guidelines to manage cutaneous squamous cell carcinoma (cSCC) and cutaneous basal cell carcinoma (cBCC) within the United States (US).
A PubMed database search was performed for the time period between June 1, 2016, and December 1, 2022. A comprehensive comparison was performed in the following clinical interest areas: staging and risk stratification, management of primary tumor and regional nodes with curative intent, and palliative treatment.
Guidelines from 3 organizations were analyzed: the American Academy of Dermatology (AAD), the National Comprehensive Cancer Network (NCCN), and the American Society for Radiation Oncology (ASTRO). The guidelines used different methodologies to grade evidence, making comparison difficult. There was agreement that surgery is the preferred treatment for curative cBCC and cSCC. For patients ineligible for surgery, there was a consensus to recommend definitive radiation. AAD and NCCN recommended consideration of other topical modalities in selected low-risk cBCC. Postoperative radiation therapy (PORT) was uniformly recommended in patients with positive margins that could not be cleared with surgery and in patients with nerve invasion. The definition and extent of nerve invasion varied. All guidelines recommended surgery as the primary treatment in patients with lymph node metastases in a curative setting. The criteria used for PORT varied; NCCN and ASTRO used lymph node size, number of nodes, and extracapsular extension for recommending PORT. Both NCCN and ASTRO recommend consideration of systemic treatment along with PORT in patients with extracapsular extension. Conclusion: US guidelines provide contemporary and complementary information on the management of cBCC and cSCC. There are opportunities for research, particularly in the areas of staging, indications for adjuvant treatment in curative settings, extent of nerve invasion and prognosis, and the role of systemic treatments in curative and palliative settings.
本研究对美国近期发布的关于皮肤鳞状细胞癌（cSCC）和皮肤基底细胞癌（cBCC）管理的指南进行了比较分析。
在2016年6月1日至2022年12月1日期间对PubMed数据库进行检索。在以下临床关注领域进行了全面比较：分期和风险分层、以治愈为目的的原发性肿瘤和区域淋巴结管理以及姑息治疗。
分析了3个组织的指南：美国皮肤病学会（AAD）、美国国立综合癌症网络（NCCN）和美国放射肿瘤学会（ASTRO）。这些指南使用不同的方法对证据进行分级，难以进行比较。一致认为手术是治愈性cBCC和cSCC的首选治疗方法。对于不适合手术的患者，一致建议采用确定性放疗。AAD和NCCN建议在选定的低风险cBCC中考虑其他局部治疗方式。对于切缘阳性且无法通过手术清除的患者以及有神经侵犯的患者，均一致推荐术后放疗（PORT）。神经侵犯的定义和范围各不相同。所有指南均推荐手术作为治愈性情况下有淋巴结转移患者的主要治疗方法。PORT使用的标准各不相同；NCCN和ASTRO使用淋巴结大小、淋巴结数量和包膜外扩展情况来推荐PORT。NCCN和ASTRO均建议对于有包膜外扩展的患者在PORT的同时考虑全身治疗。结论：美国指南提供了关于cBCC和cSCC管理的当代补充信息。存在研究机会，特别是在分期、治愈性情况下辅助治疗的指征、神经侵犯的范围和预后以及全身治疗在治愈性和姑息性情况下的作用等领域。
