Skin Cancer Management: A Practical Approach

Description

Authorship by leading experts in the field One-of-a-kind chapters on radiologic imaging of head and neck skin cancer, management of skin cancer in skin of color, and intralesional and perilesional treatment of skin cancers Discussion of potential complications and their management Boxed insets that emphasize important clinical facts The incidence of skin cancer continues to rise, as do the challenges physicians face in treating the growing population of skin cancer patients. Skin Cancer Management: A Practical Approach, 2nd edition addresses the spectrum of skin cancers from the precancerous to the inoperable. In this revised and updated edition, a wide selection of medical treatments and surgical procedures are described in detail and supplemented with an abundance of full-color figures. Numerous case studies help to illustrate the various techniques. Foreword Preface Acknowledgments Contents Contributors Chapter 1: Biopsy Techniques and Interpretation Biopsy Technique Pre-op Site Preparation and Anesthesia Hemostasis Shave Biopsy Equipment Technique Complications Saucerization Equipment Technique Punch Biopsy Equipment Technique Biopsy Care Incisional Biopsy Equipment Technique Complications Wedge Biopsy Complications Excisional Biopsy Technique Complications Biopsy Log Interpretation of Results Tissue Orientation and Margin Evaluation Reporting of Surgical Margins Fundamental Slide Interpretation Low Power Develop a Method for Examining Skin Specimens Knowing the Clinician Too Small a Sample Too Aggressive a Sample Two-Step Management Too Little or Too Much Information Know Your Laboratory One Diagnosis Only Too Many Diagnoses Summary References Chapter 2: Topical Therapies for Nonmelanoma Skin Cancers Imiquimod Mechanism of Action Side Effect Profile 5-Fluorouracil Mechanism of Action Side Effect Profile Diclofenac Mechanism of Action Side Effect Profile Ingenol Mebutate Mechanism of Action Side Effect Profile Topical Therapy for Actinic Keratoses: The Authors’ Experience Monotherapy for Actinic Keratoses Imiquimod Versus 5-Fluorouracil for AKs Imiquimod and 5-FU Combination Therapy 5-FU and Calcipotriol Combination Therapy Combination Therapy with Cryotherapy Ingenol Mebutate Cost and Treatment Choice for Actinic Keratoses Experimental Topical Therapies Topical Therapy and Nonmelanoma Skin Cancer: The Authors’ Experience Basal Cell Cancer Monotherapy Imiquimod 5-Fluorouracil Ingenol Mebutate Diclofenac Squamous Cell Cancer Monotherapy Imiquimod 5-Fluorouracil Diclofenac Combination Topical Therapy Topical Therapy as a Surgical Adjunct to NMSC Preoperative Topical Therapy Intraoperative Topical Therapy Postoperative Topical Therapy Unusual Situations/Complications/Variations Problematic Areas Lips Eyelids Penis Basal Cell Nevus Syndrome Transplant Patients Delayed Mohs Micrographic Surgery The Skip Area Controversy Summary References Chapter 3: Chemical Peels for Precancerous Skin Lesions Classification Indications Contraindications Advantages Current Products Available Patient Selection Informed Consent Setup Patient Preparation Analgesia and Sedation Application Technique Post-procedure Complications Summary References Chapter 4: Photodynamic Therapy Photosensitizers and Light Sources Photodynamic Therapy for Actinic Keratoses Patient Selection, Education, and Consent Technique of Application for Actinic Keratoses Treatment Schedule for Actinic Keratoses Combination Therapies for Actinic Keratoses PDT as a Prevention Modality Photodynamic Therapy for Squamous Cell Carcinoma In Situ, Superficial Basal Cell Carcinoma, and Nodular Basal Cell Carcinoma Patient Selection, Education, and Consent Technique of Application for Superficial Non-Melanoma Skin Cancers Treatment Schedule for Superficial Non-Melanoma Skin Cancers Combination Therapies for Non-Melanoma Skin Cancers Extramammary Paget’s Disease Adverse Reactions and Pain Management Summary References Chapter 5: Intralesional and Perilesional Treatment of Skin Cancers Methotrexate Indications and Contraindications Pre-treatment Considerations Preparing MTX for Injection Description of Technique Post-injection Care Expected Course of Treatment and Follow-Up Illustrative Case 5.1 Illustrative Case 5.2 Illustrative Case 5.3 Illustrative Case 5.4 Interferon Indications and Contraindications Pre-treatment Considerations: Basal Cell Cancers Pre-treatment Considerations: Squamous Cell Cancers and Malignant Melanomas Obtaining Interferon α2b Description of Technique (BCC, SCC, MIS) Administering Interferon α2b Make Sure to Always Post-injection Care Expected Course of Treatment and Follow-Up (BCC, SCC, MIS) 5-Fluorouracil Keratoacanthomas Squamous Cell Carcinomas Basal Cell Carcinomas Indications Contraindications Pre-treatment Considerations Obtaining and Preparing Description of Technique Note on Technique Post-injection Care Expected Course and Follow-Up Adverse Effects Bleomycin Squamous Cell Carcinoma/Keratoacanthoma Basal Cell Carcinoma Metastatic Cutaneous Malignant Melanoma Indications Contraindications Pre-treatment Considerations Obtaining and Preparing Description of Technique Post-Injection Care Expected Course and Follow-Up Adverse Effects References Chapter 6: Electrodesiccation and Curettage Indications Contraindications Preoperative Considerations Description of Technique Postoperative Care Use of Curettage Alone Complications Summary References Chapter 7: Cryosurgery Basic Cryobiology Indications Contraindications Preoperative Considerations Equipment Techniques Monitoring of Freeze Depth Basal Cell and Squamous Cell Carcinoma Cure Rates Illustrative Case 7.1 Illustrative Case 7.2 Illustrative Case 7.3 Illustrative Case 7.4 Leukoplakia and Actinic Cheilitis Keratoacanthoma Postoperative Care Long-Term Follow-Up Studies Immunocryosurgery Summary References Chapter 8: Optimizing Surgical Outcomes Preoperative Considerations Bleeding Tendency Wound Healing History of Hypertrophic Scar or Keloid Formation Prophylactic Antibiotics and Antiviral Medication Allergies Implantable Cardiac Devices Patient Expectations Intraoperative Considerations Operating Suite Surgical Site Preparation Skin Marking Choice of Antiseptic Solution Anesthesia Staff Preparation Hand Washing/Surgical Scrubbing Surgical Site Draping Intraoperative Monitoring Tissue Manipulation Hemostasis Designing the Closure Suturing the Wound Postoperative Considerations Pain Control Antibiotics Timing of Suture Removal Summary References Chapter 9: Anxiolysis, Anesthesia, and Analgesia Preoperative Considerations Local Anesthetic Agents Indications and Contraindications Topical Anesthesia Infiltrative Anesthesia Additives to Local Anesthetics Epinephrine Sodium Bicarbonate Field Blocks Regional Nerve Blocks Facial Nerve Blocks Digital Nerve Block Hand Nerve Blocks Foot Nerve Blocks Penile Nerve Block Tumescent Anesthesia Postoperative Analgesia Adverse Effects and Complications Summary References Chapter 10: Excision Techniques and Materials Patient Preparation Antibiotic Prophylaxis Site Preparation and Anesthesia Preoperative Antisepsis Anesthesia Excision Margins Specimen Handling Hemostasis Suture Materials Natural Versus Synthetic Absorbable Versus Nonabsorbable Monofilament Versus Multifilament Versus Barbed Size and Tensile Strength Needles Staples Skin Adhesive Skin Tape Closure Techniques Second Intention Layered Closures: Suture Techniques Deep Sutures Buried Vertical Mattress/Set-Back Suture Running Subcuticular Closure Purse-String Repair Epidermal Suture Techniques Description of Procedure Elliptical Excision Standing Cones (Dog Ears) Post-Procedure Care Complications Summary References Chapter 11: Mohs Surgery Indications for Mohs Surgery Cure Rates Following Mohs Surgery Basal Cell Carcinoma Squamous Cell Carcinoma Preoperative Considerations Guide to the Mohs Surgery Procedure Slide Preparation Variations on the Mohs Surgery Technique Complications and Follow-Up References Chapter 12: Principles of Cutaneous Flap Surgery Indications and Contraindications to Flap Closure Preoperative Considerations Flap Design Random Pattern Flaps Advancement Flaps The Island Pedicle Flap Rotation Flaps Transposition Flaps Axial Flaps Surgical Pearls for Cutaneous Flap Surgery Complications in Cutaneous Flap Reconstruction Acute Complications Management of the Ischemic Flap Delayed Complications Summary References Chapter 13: Techniques in Skin Grafting General Principles Full-Thickness Skin Grafts Technique Preoperative Planning Donor Site Considerations Procedure Immobilization Postoperative Care Special Situations Complications Split-Thickness Skin Grafts Equipment Technique Dressing Donor Site Care Postoperative Complications Vacuum-Assisted Closure (VAC) Free Cartilage Grafts Technique Dressing Complications Composite Grafts Technique Dressing Donor Sites Postoperative Care Complications Summary References Chapter 14: Nail Surgery and Malignant Tumors of the Nail Unit Anatomy Preoperative Considerations Instruments Tourniquet Radiographs Anesthesia Distal Wing Block Technique Distal Digital Block Technique Nail Avulsion Technique Punch Biopsy of the Nail Bed Technique Nail Matrix Biopsy Punch Biopsy of the Nail Matrix Technique Shave Biopsy of the Nail Matrix (Tangential Matrix Excision) Technique Lateral Longitudinal Excision Dressings Complications Malignant Tumors of the Nail Unit Verrucae Bowen’s Disease Treatment Squamous Cell Carcinoma Treatment Verrucous Carcinoma Treatment Basal Cell Carcinoma Treatment Metastatic Tumors Treatment Melanoma Treatment Summary References Chapter 15: Practical Management of Melanoma Clinical Presentation and Initial Assessment Medical History Physical Examination Biopsy Imaging and Laboratory Tests Radiologic Imaging Laboratory Investigations Staging of Melanoma Management of Melanoma In Situ (Stage 0) Biopsy and Diagnosis of Melanoma In Situ Excision of Melanoma In Situ Non-Surgical Treatment of Melanoma In Situ Challenges of Melanoma In Situ Management Management of Primary Melanoma (Stages I and II) Definitive Excision of Primary Melanoma Staging the Regional Lymph Node Basin Management of Melanoma with Regional Metastasis (Stage III) The Role of Completion Lymph Node Dissection Adjuvant Therapies for High-Risk Melanoma Regional Recurrences Management of Unresectable Stage III and Metastatic (Stage IV) Melanoma Evaluation of Patients with Suspected Metastatic Melanoma Systemic Therapy for Unresectable Stage III and Stage IV Melanoma Metastasectomy Radiation Therapy Intralesional Injection with T-VEC Regional Therapy Best Supportive Care Surveillance Conclusion References Chapter 16: Skin Cancer in Skin of Color Unique Features of Skin of Color Role of the Ozone Layer Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanoma Mycosis Fungoides Treatment Options and Operative Considerations Summary References Chapter 17: Management of Skin Cancers in Solid Organ Transplant Recipients Epidemiology Keratinocyte Carcinoma Following Organ Transplantation Melanoma Following Organ Transplantation Pathogenesis Immunosuppression and Skin Cancer Azathioprine Cyclosporine Sirolimus Voriconazole Presentation and Natural History Primary cSCC in Organ Transplant Patients Field Cancerization In-transit Metastasis Nodal Metastasis Distant Metastasis Basal Cell Carcinoma Melanoma Management of Cutaneous Squamous Cell Carcinoma Actinic Keratosis and Squamous Cell Carcinoma In Situ Management of Field Cancerization Topical 5-Fluorouracil (5-FU) Imiquimod Diclofenac Photodynamic Therapy (PDT) Oral Retinoids Capecitabine Nicotinamide Primary Invasive Cutaneous SCC Metastatic Cutaneous SCC Modification of Immunosuppression Cetuximab Immune Checkpoint Inhibitors Management of Basal Cell Cancer in Transplant Recipients Vismodegib Management of Melanoma in Transplant Recipients Dermatologic Screening, Prevention, and Follow-up in Transplant Recipients Summary References Chapter 18: Imaging of Head and Neck Skin Cancer Anatomic Planes Imaging Techniques Computerized Tomography Contraindications Strengths and Limitations Magnetic Resonance Imaging Contraindications Strengths and Limitations Ultrasound Strengths and Limitations Positron-Emission Tomography Lymphoscintigraphy Strengths and Limitations Imaging Pathology Basal Cell Carcinoma Illustrative Case 18.1 Cutaneous Squamous Cell Carcinoma Illustrative Case 18.2 Illustrative Case 18.3 Illustrative Case 18.4 Melanoma Illustrative Case 18.5 Dermatofibrosarcoma Protuberans Illustrative Case 18.6 Merkel Cell Carcinoma Illustrative Case 18.7 Sebaceous Carcinoma Angiosarcoma Illustrative Case 18.8 Summary References Chapter 19: Radiation Oncology in Skin Cancer Treatment Indications for Radiation Radiation Modalities Used to Treat Skin Tumors Radiation in the Treatment of Specific Skin Malignancies Basal and Squamous Cell Carcinomas Melanoma Merkel Cell Carcinoma Adnexal Carcinoma Mycosis Fungoides Radiation for Advanced Disease and for Palliation Complications from Radiation Summary References Chapter 20: When to Refer Out Reasons to Refer Out The Lesion The Patient Psychological Referrals The Doctor The Doctor’s Colleagues Specialists to Whom You May Need to Refer Medical Oncology Geneticists Surgical Oncology Radiation Oncology Prosthetics References Chapter 21: Chemoprevention of Keratinocyte Carcinomas Oral Retinoids Indications Contraindications Dosing Recommendations Adverse Effects Mucocutaneous Side Effects Laboratory Monitoring Pregnancy Testing Skeletal Toxicities Use in Organ Transplant Recipients Wound Healing Topical Retinoid Therapy Topical Tretinoin Adapalene Tazarotene Application of Topical Retinoids Nicotinamide Vismodegib Nonsteroidal Anti-inflammatory Drugs Topical Diclofenac Solid Organ Transplant Recipients Mammalian Target of Rapamycin Inhibitors (mTOR-I) Capecitabine Other Promising Agents DNA Repair Enzymes Conclusion References Chapter 22: Systemic Therapy for Locally Advanced and Metastatic Non-Melanoma Skin Cancer Hedgehog Pathway Inhibitor Vismodegib Sonidegib Laboratory Monitoring Management of Adverse Events Management of Muscle Spasm Management of Alopecia Management of Dysgeusia Pregnancy and Fertility Warnings and Precautions Treatment Resistance Potential Risk for Squamous Cell Carcinoma Development Immunotherapy Program Death-1 Inhibitor Pembrolizumab Nivolumab Cemiplimab Laboratory Monitoring and Special Considerations Cytotoxic T Lymphocyte-Associated Antigen 4 Inhibitor Future Directions Conclusion References Index