Advertisement

Der Hautarzt

, Volume 67, Issue 11, pp 857–866 | Cite as

Kutanes Plattenepithelkarzinom

  • U. LeiterEmail author
  • R. Gutzmer
  • M. Alter
  • C. Ulrich
  • A. S. Lonsdorf
  • M. M. Sachse
  • U. Hillen
Leitthema

Zusammenfassung

Das Plattenepithelkarzinom (PEK) der Haut ist eine der häufigsten Krebsarten der kaukasischen Population und hat einen Anteil von 20 % aller malignen Hauttumoren. Die Diagnose basiert auf der klinischen Untersuchung. Eine Exzision und histologische Sicherung sind bei allen klinisch verdächtigen Läsionen erforderlich, um eine prognostische Einschätzung und korrekte Behandlung zu ermöglichen. Die Therapie der ersten Wahl ist die vollständige Exzision mit histologischer Schnittrandkontrolle. Eine Sentinellymphknotenbiopsie (SLNB) kann bei PEK >6 mm Tumordicke angewandt werden, derzeit liegt aber noch keine klare Evidenz bezüglich der prognostischen und therapeutischen Aussagekraft vor. Die Radiatio kann eine Alternative zur Chirurgie bei inoperablen PEKs darstellen oder adjuvant bei hohem Rezidivrisiko erwogen werden. Im fernmetastasierten Stadium können verschiedene Chemotherapeutika, EGFR („epidermal growth factor receptor“)-Inhibitoren oder Immun-Checkpoint-Blocker eingesetzt werden. Da die Evidenz hier jedoch gering ist, sollte eine medikamentöse Therapie vorzugsweise in klinischen Studien erfolgen. Die Nachsorge sollte risikoadaptiert stattfinden und schließt primär eine dermatologische Kontrolle – bei Hochrisikopatienten ergänzt um Ultraschalluntersuchungen – ein.

Schlüsselwörter

Therapie Management Plattenepithelkarzinom der Haut Exzision Histologie 

Cutaneous squamous cell carcinoma

Abstract

Squamous cell carcinoma (SCC) of the skin accounts for 20 % of non-melanoma skin cancer and is one of the most frequent types of cancer in Caucasian populations. Diagnosis is based on the clinical features and should be histopathologically confirmed to adequately address the prognosis and treatment. Complete surgical excision with histopathological control of excision margins is the gold standard in the treatment of primary SCC. Sentinel lymph node biopsies (SLNB) can be considered in SCC with a tumor thickness of >6 mm but there is currently no evidence concerning prognostic and therapeutic effects. Radiotherapy can be discussed as an alternative to surgery for inoperable tumors or as adjuvant therapy for a high risk of recurrence. In SCC with distant metastases various chemotherapeutic agents are used; however, there is no standard regimen. The epidermal growth factor receptor (EGFR) inhibitors and immune checkpoint blockers can be discussed as treatment options, preferentially in clinical trials. There is no standard follow-up schedule for patients with SCC. A risk-adapted follow-up is recommended based on the risk of metastatic spread or development of new lesions primarily by dermatological control and supplemented by ultrasound investigations in high risk patients.

Keywords

Treatment Management Skin neoplasms Excision Histology 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

U. Leiter, R. Gutzmer, M. Alter, C. Ulrich, A.S. Lonsdorf, M.M. Sachse und U. Hillen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Alter M, Satzger I, Schrem H, Kaltenborn A, Kapp A, Gutzmer R (2014) Non-melanoma skin cancer is reduced after switch of immunosuppression to mTOR-inhibitors in organ transplant recipients. J Dtsch Dermatol Ges 12:480–488PubMedGoogle Scholar
  2. 2.
    Association of Population-based Cancer Registries in Germany (2011) Incidence and mortality of cancer in the German federal states. In: GEKID-Atlas. GEKID, SaarbückenGoogle Scholar
  3. 3.
    Berg D, Otley CC (2002) Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol 47:1–17 (quiz 18–20)CrossRefPubMedGoogle Scholar
  4. 4.
    Borradori L, Sutton B, Shayesteh P, Daniels GA (2016) Rescue therapy with anti-programmed cell death protein 1 inhibitors (PD-1) of advanced cutaneous squamous cell carcinoma and basosquamous carcinoma: preliminary experience in 5 cases. Br J Dermatol. doi: 10.1111/bjd.14642 Google Scholar
  5. 5.
    Brantsch KD, Meisner C, Schönfisch B, Trilling B, Wehner-Caroli J, Röcken M, Breuninger H (2008) Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol 9:713–720CrossRefPubMedGoogle Scholar
  6. 6.
    Brem R, Li F, Montaner B, Reelfs O, Karran P (2010) DNA breakage and cell cycle checkpoint abrogation induced by a therapeutic thiopurine and UVA radiation. Oncogene 29:3953–3963CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Breuninger H, Brantsch K, Eigentler T, Hafner HM (2012) Comparison and evaluation of the current staging of cutaneous carcinomas. J Dtsch Dermatol Ges 10:579–586PubMedGoogle Scholar
  8. 8.
    Breuninger H, Eigentler T, Bootz F, Hauschild A, Kortmann RD, Wolff K, Stockfleth E, Szeimies RM, Rompel R, Garbe C, Grabbe S (2013) Brief S2k guidelines – cutaneous squamous cell carcinoma. J Dtsch Dermatol Ges 11(Suppl 3):37–47CrossRefPubMedGoogle Scholar
  9. 9.
    Chang AL, Kim J, Luciano R, Sullivan-Chang L, Colevas AD (2016) A case report of unresectable cutaneous squamous cell carcinoma responsive to pembrolizumab, a programmed cell death protein 1 inhibitor. JAMA Dermatol 152:106–108CrossRefPubMedGoogle Scholar
  10. 10.
    Chen AC, Martin AJ, Choy B, Fernandez-Penas P, Dalziell RA, McKenzie CA, Scolyer RA, Dhillon HM, Vardy JL, Kricker A, St George G, Chinniah N, Halliday GM, Damian DL (2015) A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention. N Engl J Med 373:1618–1626CrossRefPubMedGoogle Scholar
  11. 11.
    Chren MM, Linos E, Torres JS, Stuart SE, Parvataneni R, Boscardin WJ (2013) Tumor recurrence 5 years after treatment of cutaneous basal cell carcinoma and squamous cell carcinoma. J Invest Dermatol 133:1188–1196CrossRefPubMedGoogle Scholar
  12. 12.
    DeTemple V, Satzger I, Walter A, Schaper K, Gutzmer R (2016) Effects of mTOR inhibitors on cytokine production and differentiation in keratinocytes. Exp Dermatol. doi: 10.1111/exd.13079 PubMedGoogle Scholar
  13. 13.
    El Ghissassi F, Baan R, Straif K, Grosse Y, Secretan B, Benbrahim-Tallaa L, Guha N, Freeman C, Galichet L, Cogliano V (2009) A review of human carcinogens – part D: radiation. Lancet Oncol 10(8):751–752. doi: 10.1016/s1470-2045(09)70213-x CrossRefPubMedGoogle Scholar
  14. 14.
    English DR, Armstrong BK, Kricker A, Winter MG, Heenan PJ, Randell PL (1998) Demographic characteristics, pigmentary and cutaneous risk factors for squamous cell carcinoma of the skin: a case-control study. Int J Cancer 76:628–634CrossRefPubMedGoogle Scholar
  15. 15.
    Euvrard S, Kanitakis J, Claudy A (2003) Skin cancers after organ transplantation. N Engl J Med 348:1681–1691CrossRefPubMedGoogle Scholar
  16. 16.
    Euvrard S, Kanitakis J, Decullier E, Butnaru AC, Lefrancois N, Boissonnat P, Sebbag L, Garnier JL, Pouteil-Noble C, Cahen R, Morelon E, Touraine JL, Claudy A, Chapuis F (2006) Subsequent skin cancers in kidney and heart transplant recipients after the first squamous cell carcinoma. Transplantation 81:1093–1100CrossRefPubMedGoogle Scholar
  17. 17.
    Euvrard S, Morelon E, Rostaing L, Goffin E, Brocard A, Tromme I, Broeders N, del Marmol V, Chatelet V, Dompmartin A, Kessler M, Serra AL, Hofbauer GF, Pouteil-Noble C, Campistol JM, Kanitakis J, Roux AS, Decullier E, Dantal J (2012) Sirolimus and secondary skin-cancer prevention in kidney transplantation. N Engl J Med 367:329–339CrossRefPubMedGoogle Scholar
  18. 18.
    Geissler EK, Schlitt HJ, Thomas G (2008) mTOR, cancer and transplantation. Am J Transplant 8:2212–2218CrossRefPubMedGoogle Scholar
  19. 19.
    Glover MT, Deeks JJ, Raftery MJ, Cunningham J, Leigh IM (1997) Immunosuppression and risk of non-melanoma skin cancer in renal transplant recipients. Lancet 349:398CrossRefPubMedGoogle Scholar
  20. 20.
    Han W, Ming M, He TC, He YY (2010) Immunosuppressive cyclosporin A activates AKT in keratinocytes through PTEN suppression: implications in skin carcinogenesis. J Biol Chem 285:11369–11377CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Harwood CA, Mesher D, McGregor JM, Mitchell L, Leedham-Green M, Raftery M, Cerio R, Leigh IM, Sasieni P, Proby CM (2013) A surveillance model for skin cancer in organ transplant recipients: a 22-year prospective study in an ethnically diverse population. Am J Transplant 13:119–129CrossRefPubMedGoogle Scholar
  22. 22.
    Hillen U, Ulrich M, Alter M, Becker JC, Gutzmer R, Leiter U, Lonsdorf A, Messerschmidt A, Ulrich C (2014) Cutaneous squamous cell carcinoma: a review with consideration of special patient groups. Hautarzt 65:590–599CrossRefPubMedGoogle Scholar
  23. 23.
    Hollestein LM, de Vries E, Nijsten T (2012) Trends of cutaneous squamous cell carcinoma in the netherlands: increased incidence rates, but stable relative survival and mortality 1989–2008. Eur J Cancer 48:2046–2053CrossRefPubMedGoogle Scholar
  24. 24.
    Karia PS, Han J, Schmults CD (2013) Cutaneous squamous cell carcinoma: estimated incidence of disease, nodal metastasis, and deaths from disease in the United States, 2012. J Am Acad Dermatol 68:957–966CrossRefPubMedGoogle Scholar
  25. 25.
    Katalinic A, Kunze U, Schafer T (2003) Epidemiology of cutaneous melanoma and non-melanoma skin cancer in Schleswig-Holstein, Germany: incidence, clinical subtypes, tumour stages and localization (epidemiology of skin cancer). Br J Dermatol 149:1200–1206CrossRefPubMedGoogle Scholar
  26. 26.
    Koehl GE, Andrassy J, Guba M, Richter S, Kroemer A, Scherer MN, Steinbauer M, Graeb C, Schlitt HJ, Jauch KW, Geissler EK (2004) Rapamycin protects allografts from rejection while simultaneously attacking tumors in immunosuppressed mice. Transplantation 77:1319–1326CrossRefPubMedGoogle Scholar
  27. 27.
    Leiter U, Eigentler T, Garbe C (2014) Epidemiology of skin cancer. Adv Exp Med Biol 810:120–140PubMedGoogle Scholar
  28. 28.
    Levine DE, Karia PS, Schmults CD (2015) Outcomes of patients with multiple cutaneous squamous cell carcinomas: a 10-year single-institution cohort study. JAMA Dermatol 151:1220–1225CrossRefPubMedGoogle Scholar
  29. 29.
    Lewis CM, Glisson BS, Feng L, Wan F, Tang X, Wistuba II, El-Naggar AK, Rosenthal DI, Chambers MS, Lustig RA, Weber RS (2012) A phase II study of gefitinib for aggressive cutaneous squamous cell carcinoma of the head and neck. Clin Cancer Res 18:1435–1446CrossRefPubMedGoogle Scholar
  30. 30.
    Long MD, Martin CF, Pipkin CA, Herfarth HH, Sandler RS, Kappelman MD (2012) Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease. Gastroenterology 143:390–399.e1CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Lott DG, Manz R, Koch C, Lorenz RR (2010) Aggressive behavior of nonmelanotic skin cancers in solid organ transplant recipients. Transplantation 90:683–687CrossRefPubMedGoogle Scholar
  32. 32.
    Marcil I, Stern RS (2000) Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer: a critical review of the literature and meta-analysis. Arch Dermatol 136:1524–1530CrossRefPubMedGoogle Scholar
  33. 33.
    Martincorena I, Roshan A, Gerstung M, Ellis P, Van Loo P, McLaren S, Wedge DC, Fullam A, Alexandrov LB, Tubio JM, Stebbings L, Menzies A, Widaa S, Stratton MR, Jones PH, Campbell PJ (2015) Tumor evolution. High burden and pervasive positive selection of somatic mutations in normal human skin. Science 348(6237):880–886. doi: 10.1126/science.aaa6806 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Maubec E, Petrow P, Scheer-Senyarich I, Duvillard P, Lacroix L, Gelly J, Certain A, Duval X, Crickx B, Buffard V, Basset-Seguin N, Saez P, Duval-Modeste AB, Adamski H, Mansard S, Grange F, Dompmartin A, Faivre S, Mentre F, Avril MF (2011) Phase II study of cetuximab as first-line single-drug therapy in patients with unresectable squamous cell carcinoma of the skin. J Clin Oncol 29:3419–3426CrossRefPubMedGoogle Scholar
  35. 35.
    Mecca C, Ponzetti A, Caliendo V, Ciuffreda L, Lista P (2012) Complete response of metastatic cutaneous squamous cell carcinoma to cetuximab plus paclitaxel. Eur J Dermatol 22:758–761PubMedGoogle Scholar
  36. 36.
    Mehrany K, Weenig RH, Lee KK, Pittelkow MR, Otley CC (2005) Increased metastasis and mortality from cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia. J Am Acad Dermatol 53:1067–1071CrossRefPubMedGoogle Scholar
  37. 37.
    Mehrany K, Weenig RH, Pittelkow MR, Roenigk RK, Otley CC (2005) High recurrence rates of squamous cell carcinoma after Mohs’surgery in patients with chronic lymphocytic leukemia. Dermatol Surg 31:38–42 (discussion 42)CrossRefPubMedGoogle Scholar
  38. 38.
    Nappi O, Wick MR, Pettinato G, Ghiselli RW, Swanson PE (1992) Pseudovascular adenoid squamous cell carcinoma of the skin. A neoplasm that may be mistaken for angiosarcoma. Am J Surg Pathol 16:429–438CrossRefPubMedGoogle Scholar
  39. 39.
    O’Donovan P, Perrett CM, Zhang X, Montaner B, Xu YZ, Harwood CA, McGregor JM, Walker SL, Hanaoka F, Karran P (2005) Azathioprine and UVA light generate mutagenic oxidative DNA damage. Science 309:1871–1874CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Pedersen N, Duricova D, Elkjaer M, Gamborg M, Munkholm P, Jess T (2010) Risk of extra-intestinal cancer in inflammatory bowel disease: meta-analysis of population-based cohort studies. Am J Gastroenterol 105:1480–1487CrossRefPubMedGoogle Scholar
  41. 41.
    Renzi C, Caggiati A, Mannooranparampil TJ, Passarelli F, Tartaglione G, Pennasilico GM, Cecconi S, Potenza C, Pasquini P (2007) Sentinel lymph node biopsy for high risk cutaneous squamous cell carcinoma: case series and review of the literature. Eur J Surg Oncol 33:364–369CrossRefPubMedGoogle Scholar
  42. 42.
    Rettberg P, Horneck G (1999) Intrinsic and extrinsic biomarkers for the assessment of risks from environmental UV radiation. J Epidemiol 9(6 Suppl):78–83CrossRefGoogle Scholar
  43. 43.
    Ross AS, Schmults CD (2006) Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature. Dermatol Surg 32:1309–1321PubMedGoogle Scholar
  44. 44.
    Royle JA, Baade PD, Joske D, Girschik J, Fritschi L (2011) Second cancer incidence and cancer mortality among chronic lymphocytic leukaemia patients: a population-based study. Br J Cancer 105:1076–1081CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Schmitt AR, Brewer JD, Bordeaux JS, Baum CL (2014) Staging for cutaneous squamous cell carcinoma as a predictor of sentinel lymph node biopsy results: meta-analysis of American Joint Committee on Cancer criteria and a proposed alternative system. JAMA Dermatol 150:19–24CrossRefPubMedGoogle Scholar
  46. 46.
    Schmults CD, Karia PS, Carter JB, Han J, Qureshi AA (2013) Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study. JAMA Dermatol 149:541–547CrossRefPubMedGoogle Scholar
  47. 47.
    Setshedi M, Epstein D, Winter TA, Myer L, Watermeyer G, Hift R (2012) Use of thiopurines in the treatment of inflammatory bowel disease is associated with an increased risk of non-melanoma skin cancer in an at-risk population: a cohort study. J Gastroenterol Hepatol 27:385–389CrossRefPubMedGoogle Scholar
  48. 48.
    Stratigos A, Garbe C, Lebbe C, Malvehy J, del Marmol V, Pehamberger H, Peris K, Becker JC, Zalaudek I, Saiag P, Middleton MR, Bastholt L, Testori A, Grob JJ, on behalf of the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), the European Organization for Research and Treatment of Cancer (EORTC) (2015) Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline. Eur J Cancer 51:1989–2007CrossRefPubMedGoogle Scholar
  49. 49.
    Surjana D, Halliday GM, Martin AJ, Moloney FJ, Damian DL (2012) Oral nicotinamide reduces actinic keratoses in phase II double-blinded randomized controlled trials. J Invest Dermatol 132:1497–1500CrossRefPubMedGoogle Scholar
  50. 50.
    Thompson AK, Kelley BF, Prokop LJ, Murad MH, Baum CL (2016) Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis, and disease-specific death: a systematic review and meta-analysis. JAMA Dermatol 152:419–428CrossRefPubMedGoogle Scholar
  51. 51.
    Weedon DMR, Kao GF, Harwood CA (2006) Keratinocytic tumors. IARC Press, LyonGoogle Scholar
  52. 52.
    Winkler JK, Schneiderbauer R, Bender C, Sedlaczek O, Frohling S, Penzel R, Enk A, Hassel JC (2016) Anti-PD-1 therapy in nonmelanoma skin cancer. Br J Dermatol. doi: 10.1111/bjd.14664 Google Scholar
  53. 53.
    Xiang F, Lucas R, Hales S, Neale R (2014) Incidence of nonmelanoma skin cancer in relation to ambient UV radiation in white populations, 1978–2012: empirical relationships. JAMA Dermatol 150:1063–1071CrossRefPubMedGoogle Scholar
  54. 54.
    Zwald FO, Brown M (2011) Skin cancer in solid organ transplant recipients: advances in therapy and management: part I. Epidemiology of skin cancer in solid organ transplant recipients. J Am Acad Dermatol 65:253–261 (quiz 262)CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • U. Leiter
    • 1
    Email author
  • R. Gutzmer
    • 2
  • M. Alter
    • 3
  • C. Ulrich
    • 4
  • A. S. Lonsdorf
    • 5
  • M. M. Sachse
    • 6
  • U. Hillen
    • 7
  1. 1.Zentrum für Dermato-Onkologie, Universitäts-HautklinikEberhard-Karls-Universität TübingenTübingenDeutschland
  2. 2.Hauttumorzentrum Hannover, Klinik für Dermatologie, Allergologie und VenerologieMedizinische Hochschule HannoverHannoverDeutschland
  3. 3.UniversitätshautklinikOtto von Guericke Universität MagdeburgMagdeburgDeutschland
  4. 4.Klinik für Dermatologie, Venerologie und AllergologieCharité – Universitätsmedizin BerlinBerlinDeutschland
  5. 5.Universitäts-HautklinikRuprecht-Karls-Universität HeidelbergHeidelbergDeutschland
  6. 6.Klinik für Dermatologie, Allergologie und PhlebologieKlinikum BremerhavenBremerhavenDeutschland
  7. 7.Klinik für DermatologieUniversitätsklinikum EssenEssenDeutschland

Personalised recommendations