Shauna Higgins

SLNB in cutaneous SCC: A review of the current state of literature and the direction for the future

The concept of the sentinel lymph node biopsy (SLNB) has been universally accepted for melanoma, however, remains controversial for squamous cell carcinoma (SCC). We performed a quantitative review on 260 cases of SCC that had a SLNB. The positivity rate was found to be 14.6%. Literature was qualitatively reviewed to determine whether a positive SLNB has any bearing on prognosis in SCC cases, finding a significant relationship between poor prognosis and a positive SLN (P = 0.0082).

Skin Cancer Prevention Among Hispanics: a Review of the Literature

Purpose of ReviewWe review the existing scientific literature regarding skin cancer in Hispanics to aid in formulating a research agenda for prevention targeted to this at-risk population.Recent FindingsHispanics are a diverse population with a rising incidence of both melanoma and non-melanoma skin cancer. Compared with non-Hispanic whites, Hispanics have poorer disease outcomes and higher rates of acral lentiginous melanoma, an aggressive subtype. Hispanics practice suboptimal sun protection and skin surveillance behaviors and experience rates of sunburn comparable with non-Hispanic whites. Despite these risk behaviors, little skin cancer education and prevention has been targeted to this population.SummaryFurther research is warranted to understand the interplay of biological, psychosocial, cultural, and health care factors influencing skin cancer prevention behaviors and outcomes in Hispanics. We recommend future investigation into the histological, sociocultural, and health care differences and disparities among Hispanics and within subpopulations to develop tailored, culturally informed prevention strategies.

Triple Advancement Flap for the Lateral Upper Forehead and Temple

The forehead is a region of the face that can be challenging to reconstruct after Mohs surgery. There is a large range in shape and anatomic boundaries between patients. Distortion of these boundaries, particularly when reconstructing larger defects, can result in significant facial asymmetry. Considerations in reconstruction after forehead surgery include the location and defect size, the laxity of the patient’s tissue, the age of the patient, and the extent of rhytids and brow ptosis. The triple advancement flap, also known as the Mercedes flap, is a reconstructive technique used for small and large defects in the skin and subcutaneous tissue. It has been previously described for closing primary excisional defects on difficult-to-close anatomic locations such as the shoulder, temple, sternum, heel, malleolar region, and the scalp. First characterized by Tamir et al, it has been described as a combination of a purse-string suture, dogear repair, and multidirectional advancement flap for the closure of circular wounds. It is particularly useful in areas of bior trifurcation of contour and tension lines. Variations of the Mercedes flap have been described. We frequently use the Mercedes flaps for repair of circular or oval defects on the forehead, temple, and preauricular cheek areas. We have found it to be particularly useful for the lateral upper forehead and the temple next to the lateral canthus. Our technique is as follows. Following the clearance of tumor after Mohs, the reconstruction is planned and marked. All incision and closure lines are placed within, or parallel to, minimum skin tension lines. The lines of tension in the area are established in such a way that the 3 radiating arms of Surgical Letter 777952 CMSXXX10.1177/1203475418777952Journal of Cutaneous Medicine and SurgeryChow et al research-article2018

The relevance of a suppressor of fused (SUFU) mutation in the diagnosis and treatment of Gorlin syndrome

BCC: basal cell carcinoma GS: Gorlin syndrome Hh: Hedgehog pathway PTCH1: patched 1 SMO: smoothened SUFU: suppressor of fused INTRODUCTION Nevoid basal cell carcinoma syndrome, also known as Gorlin syndrome (GS), is an aberrant activation of the sonic hedgehog pathway (Hh). GS was first described in the literature in 1894 and the Hh pathway’s role in its development was discovered thereafter. The Hh pathway regulates cell growth and development of the integumentary, central nervous, and musculoskeletal systems, where its overactivation causes abnormalities. In GS, this manifests as, among other clinical sequela, numerous basal cell carcinomas (BCC) that vary in quantity from a few to several thousand. BCC as a symptom of GS occurs in 90% of white patients but only 40% of African-American patients because of increased epidermal melanin in the latter group and thus increased protection from ultraviolet light exposure. Onset of these BCCs can occur as young as 3 years; however, they typically begin to appear at approximately 25 years of age. The additional clinical sequelae of GS are included in the criteria for diagnosis, established in 1993 by Evans et al and revised in 1997 by Kimonis. These include keratocysts of the jaw, palmar, and plantar pitting; bilamellar falx cerebri calcification; and splayed, bifid, or fused ribs. In GS, the Hh pathway mutation is most often of the gene patched 1 (PTCH1), which encodes a transmembrane receptor found early in the pathway. In rare cases, a mutation in the suppressor of fused (SUFU ) gene, encoding a component downstream of PTCH1, can cause GS (Fig 1). It was not until 2009 that an SUFU mutation was implicated in GS with its relevance centered on a clinically distinct phenotype including a 33% risk of medulloblastoma

Hypothyroidism Potentially Linked to Cutaneous Squamous Cell Carcinoma: Retrospective Study at a Single Tertiary Academic Medical Center

BACKGROUND There are multiple known risk factors for the development of cutaneous squamous cell carcinoma (SCC). OBJECTIVE To determine whether patients with cutaneous SCC have a higher prevalence of hypothyroidism than the general US population. MATERIALS AND METHODS A retrospective review was performed for patients seen at the University of Southern California with cutaneous SCC. Chart review was performed for the presence of hypothyroidism and thyroid replacement therapy before the diagnosis of SCC for each patient. Multiple prevalence studies were gathered from the literature for comparison, reporting the prevalence of overt and subclinical hypothyroidism in the general US population and/or elderly US population. RESULTS Of the 265 patients diagnosed with SCC of the skin, 61 (23%) of patients were found to have a preceding diagnosis of hypothyroidism. The prevalence of hypothyroidism among the population of SCC patients was significantly greater than the prevalence of hypothyroidism (overt and subclinical) in any general and/or elderly US population reported. CONCLUSION Patients with SCC of skin are more likely to have a history of hypothyroidism than the general population. The authors conclude that hypothyroidism may be linked to the development of cutaneous SCC.

Conflicts and Contradictions in Current Skin Cancer Screening Guidelines

Purpose of ReviewThe purpose of this paper is to review skin cancer screening guidelines from major public health/medical organizations.Recent FindingsNo consensus exists on whether or not screening to prevent skin cancer is warranted.SummaryThe best evidence of screening efficacy should come from population-based randomized trials, but is unlikely to exist due to feasibility constraints. Consequently, consensus should be built from observational/non-randomized designs, such as the SCREEN study in Germany. Current guidelines often focus on melanoma alone, while potential benefits of screening for non-melanoma skin cancers (NMSC) are largely overlooked. There may be less room for doubt regarding the value of screening, if both diseases were considered. Further, targeted approaches, i.e., screening only in high-risk populations, remain poorly defined and untested. Continuing to state that there is insufficient evidence to recommend screening leads to confusion about whether or not to screen and is unlikely to result in substantial changes to the morbidity of NMSC and significant mortality from melanoma.

Phytochemicals and Naturally Occurring Substances in the Chemoprevention of Skin Cancer

Purpose of ReviewNon-melanoma skin cancer outnumbers all other cancers combined by three to four-fold while melanoma is the fifth most common cancer overall, and the deadliest form of skin cancer. Despite treatment advancements in the past several decades, incidence continues to rise. Phytochemicals and other naturally occurring substances may provide sustainable chemopreventive solutions. The purpose of this study is to review the key findings from the literature and report on the level of evidence based on study design.Recent FindingsA comprehensive PubMed search was completed from 1984 to present using keywords “skin cancer chemoprevention” alone and with “phytochemicals,” “alternative,” “essential oils,” and “vitamins.” This search demonstrated that the literature strongly endorses the role of naturally occurring substances in the context of skin cancer chemoprevention, however the literature is predominantly comprised of data based on in vitro and animal based models.SummaryPrior to acceptance into mainstream practice, high quality prospective studies to evaluate the role of naturally occurring compounds in the context of skin cancer chemoprevention are indicated.