Guidelines

American Academy of Dermatology publishes guidelines for nonmelanoma skin cancers

Christopher K. Bichakjian

The American Academy of Dermatology published guidelines for the management of nonmelanoma skin cancer.

The document — released in January in Journal of the American Academy of Dermatology — contains information about early intervention, diagnosis, treatment, surgical and nonsurgical approaches, recommendations for metastatic disease, and follow-up care.

Christopher K. Bichakjian, MD, professor in the department of dermatology, chief of the division of cutaneous surgery and oncology, director of the multidisciplinary melanoma program, and director of the micrographic surgery and dermatologic oncology fellowship at University of Michigan, served as co-chair of the work group that developed the guidelines.

HemOnc Today spoke with Bichakjian about the need for the guidelines, what they recommend, and how dermatologists and oncologists can incorporate them into decision-making.

 

Question: Can you describe the need for these guidelines?

Answer: This document was spearheaded by American Academy of Dermatology. There was a need for guidelines specifically for dermatologists. National Comprehensive Cancer Network guidelines on nonmelanoma skin cancer include basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma and dermatofibrosarcoma protuberans. Although these are comprehensive guidelines, they are rarely consulted by dermatologists, so there was a need to create a document by dermatologists for dermatologists. Having said that, nonmelanoma skin cancer is not only treated by dermatologists, so we invited external reviewers. There are representatives from other specialties, including plastic surgery, radiation oncology, medical oncology, family practice and others who treat basal and squamous cell carcinomas on a regular basis. They were not primary authors of the manuscript, but we received excellent input from them.

 

Q: Who was involved in development of these guidelines?

A: All authors of the guidelines, with the exception of the external reviewers from other specialties, were American Academy of Dermatology members. The individual contributors were selected for their broad range in expertise, including epidemiology, dermatopathology, surgical and nonsurgical dermatology, those with expertise in topical therapies, laser therapies and radiation therapy. One of the work group members was a patient representative, who provided a critically important perspective when formulating recommendations for clinical management. As an example, this individual reminded the work group of the imprecise nature of the term “nonmelanoma skin cancer” when referring to basal and squamous cell carcinoma of the skin. Consistent with the current trend, the more recent term keratinocyte carcinoma is, therefore, used throughout the document when referring to these specific skin cancers originating from keratinocytes.

 

Q: Can you elaborate on the guideline development process and how long it took?

A: The workgroup first met in 2015 to decide on the scope and content of the intended guidelines. As an example, the decision was made not to include the management of actinic keratoses, premalignant lesions to squamous cell carcinoma, into the guidelines. It was felt that this topic was best addressed separately. The work group subsequently was divided into subgroups, each with their specific area of expertise. Once members of each subgroup had reviewed the available evidence and formulated their conclusions and recommendations, the data were brought back to the entire work group for consensus opinion.

 

Q: Can you provide an overview of the key elements of these guidelines?

A: The primary takeaway message is that surgery, whether excisional or destructive, remains the most effective way to treat the majority of basal and squamous cell carcinomas. Contrary to melanoma, there have been relatively few major changes in the management of basal cell carcinoma and cutaneous squamous cell carcinoma in recent years. Although this could be negatively interpreted, a more accurate and realistic interpretation is that the treatment of basal cell carcinoma and cutaneous squamous cell carcinoma typically is highly effective and curative. However, many treatment modalities exist with varying degrees of evidence to support their use. These American Academy of Dermatology guidelines of care seek to place currently available therapies in the appropriate context in an attempt to provide the dermatologist with evidence-based recommendations to optimally manage their patients with basal cell carcinoma and cutaneous squamous cell carcinoma. – by Rob Volansky

 

Reference:

Bichakjian CK, et al. J Am Acad Dermatol. 2018;doi:10.1016/j.jaad.2017.10.006.

 

For more information:

Christopher K. Bichakjian, MD, can be reached at 1500 E. Medical Center Drive #1, Ann Arbor, MI 48109; email: chriskb@med.umich.edu.

 

Disclosure: Bichakjian reports no relevant financial disclosures.

Christopher K. Bichakjian

The American Academy of Dermatology published guidelines for the management of nonmelanoma skin cancer.

The document — released in January in Journal of the American Academy of Dermatology — contains information about early intervention, diagnosis, treatment, surgical and nonsurgical approaches, recommendations for metastatic disease, and follow-up care.

Christopher K. Bichakjian, MD, professor in the department of dermatology, chief of the division of cutaneous surgery and oncology, director of the multidisciplinary melanoma program, and director of the micrographic surgery and dermatologic oncology fellowship at University of Michigan, served as co-chair of the work group that developed the guidelines.

HemOnc Today spoke with Bichakjian about the need for the guidelines, what they recommend, and how dermatologists and oncologists can incorporate them into decision-making.

 

Question: Can you describe the need for these guidelines?

Answer: This document was spearheaded by American Academy of Dermatology. There was a need for guidelines specifically for dermatologists. National Comprehensive Cancer Network guidelines on nonmelanoma skin cancer include basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma and dermatofibrosarcoma protuberans. Although these are comprehensive guidelines, they are rarely consulted by dermatologists, so there was a need to create a document by dermatologists for dermatologists. Having said that, nonmelanoma skin cancer is not only treated by dermatologists, so we invited external reviewers. There are representatives from other specialties, including plastic surgery, radiation oncology, medical oncology, family practice and others who treat basal and squamous cell carcinomas on a regular basis. They were not primary authors of the manuscript, but we received excellent input from them.

 

Q: Who was involved in development of these guidelines?

A: All authors of the guidelines, with the exception of the external reviewers from other specialties, were American Academy of Dermatology members. The individual contributors were selected for their broad range in expertise, including epidemiology, dermatopathology, surgical and nonsurgical dermatology, those with expertise in topical therapies, laser therapies and radiation therapy. One of the work group members was a patient representative, who provided a critically important perspective when formulating recommendations for clinical management. As an example, this individual reminded the work group of the imprecise nature of the term “nonmelanoma skin cancer” when referring to basal and squamous cell carcinoma of the skin. Consistent with the current trend, the more recent term keratinocyte carcinoma is, therefore, used throughout the document when referring to these specific skin cancers originating from keratinocytes.

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Q: Can you elaborate on the guideline development process and how long it took?

A: The workgroup first met in 2015 to decide on the scope and content of the intended guidelines. As an example, the decision was made not to include the management of actinic keratoses, premalignant lesions to squamous cell carcinoma, into the guidelines. It was felt that this topic was best addressed separately. The work group subsequently was divided into subgroups, each with their specific area of expertise. Once members of each subgroup had reviewed the available evidence and formulated their conclusions and recommendations, the data were brought back to the entire work group for consensus opinion.

 

Q: Can you provide an overview of the key elements of these guidelines?

A: The primary takeaway message is that surgery, whether excisional or destructive, remains the most effective way to treat the majority of basal and squamous cell carcinomas. Contrary to melanoma, there have been relatively few major changes in the management of basal cell carcinoma and cutaneous squamous cell carcinoma in recent years. Although this could be negatively interpreted, a more accurate and realistic interpretation is that the treatment of basal cell carcinoma and cutaneous squamous cell carcinoma typically is highly effective and curative. However, many treatment modalities exist with varying degrees of evidence to support their use. These American Academy of Dermatology guidelines of care seek to place currently available therapies in the appropriate context in an attempt to provide the dermatologist with evidence-based recommendations to optimally manage their patients with basal cell carcinoma and cutaneous squamous cell carcinoma. – by Rob Volansky

 

Reference:

Bichakjian CK, et al. J Am Acad Dermatol. 2018;doi:10.1016/j.jaad.2017.10.006.

 

For more information:

Christopher K. Bichakjian, MD, can be reached at 1500 E. Medical Center Drive #1, Ann Arbor, MI 48109; email: chriskb@med.umich.edu.

 

Disclosure: Bichakjian reports no relevant financial disclosures.