From the Guidelines
Epidermoid carcinoma, also known as squamous cell carcinoma, requires early detection and treatment to ensure excellent prognosis, with five-year cure rates exceeding 90% for most cases, and thus, regular skin checks should be performed in all at-risk patient groups, especially those with epidermolysis bullosa (EB) who have a high risk of developing SCC. The management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa involves clinical evaluation, surgical treatment, and radiotherapy.
Clinical Evaluation
Indicators of SCC in patients with EB include a nonhealing wound, a rapidly growing wound, a deep ulcer, an area of hyperkeratosis, and a wound with altered sensation 1. Regular skin checks should be performed in all at-risk EB patient groups, with a high index of suspicion for atypical wounds. Patients with RDEB-SG have a very high risk of developing SCC and should have a full skin examination every 3–6 months from age 10 years, while other groups should commence screening from age 20 years and take place every 6–12 months 1.
Treatment Options
Surgical excision is the standard treatment for EB SCCs, although the techniques used may vary depending on the site and size of the primary tumor, and surgical excision should be the primary approach for treating epidermoid carcinoma, with options including wide local excision, Mohs micrographic surgery, and amputation 1. Radiotherapy has been used widely in the treatment of EB SCCs, as either a definitive or palliative treatment of a primary tumor, and may be used for patients who cannot undergo surgery 1. Some key points to consider when treating epidermoid carcinoma include:
- Early detection and treatment are crucial for excellent prognosis
- Surgical excision is the primary approach
- Radiotherapy may be used for patients who cannot undergo surgery
- Regular skin checks should be performed in all at-risk patient groups
- Patients with RDEB-SG have a very high risk of developing SCC and should have frequent skin examinations.
From the Research
Epidermoid Carcinoma Overview
- Epidermoid carcinoma, also known as squamous cell carcinoma, is a type of cancer that can occur in various parts of the body, including the skin, anal canal, and mucous membranes 2.
- The prognosis for epidermoid carcinoma is generally good when treated early with surgical excision and a sufficient margin of healthy tissue 2.
Treatment Options
- Preoperative chemotherapy and radiation therapy have been shown to be effective in the management of anal epidermoid carcinoma, with a significant downstaging of the disease 3.
- Radiation therapy, with or without surgery, is a common treatment approach for epidermoid carcinoma of the anal margin, with a crude five-year survival rate of 59.2% and a cancer-specific five-year survival rate of 79.7% 4.
- Combined chemotherapy and radiation therapy is the standard of care for epidermoid carcinoma of the anus, with an overall survival rate of 74% at last follow-up 5.
Clinical and Treatment Factors Associated with Outcome
- The extent of disease is a significant clinical correlate with ultimate freedom from disease, with T1/T2N0 lesions having a better prognosis than T3N0 or T4N0/N+ lesions 5.
- The volume of irradiated small bowel should be minimized in patients with a history of major pelvic surgery or those who may need salvage surgery in the future 5.
- Additional malignancies are common in patients with anal cancer, with gynecologic, head and neck, and lung cancer being the most common types 5.
Malignant Transformation
- Epidermoid tumors can undergo malignant transformation, which carries a poor prognosis, with an average survival of 11.8 months regardless of therapy 6.
- Treatment strategies for malignant epidermoid tumors include palliative management, stereotactic radiosurgery, chemotherapy, and surgery plus multiple adjuvant therapies, with the latter showing the best survival outcomes 6.