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  • Presentation

F049 Respect the Dormant Beast: Optimizing Your Management of High-Risk Cutaneous SCCs

Description

The discussion centers on the management and prevention of high-risk cutaneous squamous cell carcinomas (CSCCs). Dr. John Bisaria emphasizes the importance of understanding field cancerization, a phenomenon where skin cancer arises not just from isolated cells but across areas of skin, particularly in regions exposed to chronic UV radiation. A new assessment tool, the Fast Tool, is introduced as a means to identify patients at high risk for developing skin cancer, with Fast Stage 3 indicating a significantly elevated risk, making proactive management vital. Additionally, the use of the medication acetretin is highlighted for its effectiveness in preventing new skin cancers, proven through a patient case study demonstrating zero new tumors after treatment initiation. Furthermore, the session covers practical tips for photodynamic therapy (PDT), enhancing patient comfort and efficacy, such as the use of cold ultrasound gel during treatment and pre-treating with topical agents to improve treatment outcomes. The overall message stresses the need to be proactive in managing patients with high-risk skin conditions to prevent the development of invasive cancers.

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Conclusions

  • Field cancerization increases the risk of squamous cell carcinoma (SCC) due to multifocal clinical atypia in areas of chronic UV exposure.
  • The Field Cancerization and Activity Severity Tool (FAST) effectively predicts skin cancer risk, especially in patients with stage III FAST classifications.
  • FAST stage III patients have a significantly higher risk (80 times more) of developing SCC, emphasizing the need for aggressive monitoring and treatment.
  • Acitretin is effective in preventing new cases of squamous cell carcinoma, showing a 68% reduction in skin cancer incidence in treated patients.
  • Acitretin is recommended for patients with a history of five or more invasive SCCs over two to three years or significant field disease despite other treatments.
  • Photodynamic therapy (PDT) combined with pre-treatment using 5-Fluorouracil (5-FU) enhances treatment efficacy for actinic keratosis and SCC.
  • Cyclic PDT significantly reduces SCC lesion incidence in high-risk patients, with median counts decreasing significantly after treatment.
  • Cornejo, et al. JAAD CME Field Cancerization: Treatment. 2020; 83(3): 719-30.
  • *Bhullar S, Christensen SR. Effectiveness of acitretin for skin cancer prevention in immunosuppressed and immunocompetent patients. J Am Acad Dermatol. 2024; 90(4): 821-2.
  • Bouwes Bavinck JN, Tieben LM, Van Der Woude FJ, Tegzess AM, Hermans J, Ter Scheaget J, Vermeer BJ. Prevention of Skin Cancer and Reduction of Keratotic Skin Lesions During Acitretin Therapy in Renal Transplant Recipients: A Double-Blind, Placebo-Controlled Study.