Skip to main content

Advertisement

SpringerLink
Log in

Interdisciplinary Surgical Management of Skin Cancer: the Saint Louis University Experience

  • Medical Surgery (M Alam, Section Editor)
  • Published:
Current Dermatology Reports Aims and scope Submit manuscript

Abstract

While the vast majority of skin cancers can be managed by a single practitioner in the outpatient setting, there is a subset of complex skin cancers that benefit from multidisciplinary care. At our institution, we have built strong collegial relationships with allied specialties such as surgical oncology, otolaryngology-head and neck surgery, plastic surgery, facial plastic surgery, and oculoplastic surgery. It is common for patients with high-risk or complex tumors to be seen pre-operatively by several allied specialties. This allows for care coordination and more seamless care in addition to fostering skin cancer expertise within our collaborators in allied specialties.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Donaldson MR, Coldiron BM. No end in sight: the skin cancer epidemic continues. Semin Cutan Med Surg. 2011;30(1):3–5.

    Article  CAS  PubMed  Google Scholar 

  2. Health USDo, Human S. Reports of the Surgeon General. The surgeon general’s call to action to prevent skin cancer. Washington DC: Office of the Surgeon General (US); 2014.

    Google Scholar 

  3. Alam M, Ibrahim O, Nodzenski M, et al. Adverse events associated with mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23 centers. JAMA Dermatol. 2013;149(12):1378–85.

    Article  PubMed  Google Scholar 

  4. Walling HW, Fosko SW, Geraminejad PA, Whitaker DC, Arpey CJ. Aggressive basal cell carcinoma: presentation, pathogenesis, and management. Cancer Metastasis Rev. 2004;23(3–4):389–402.

    Article  PubMed  Google Scholar 

  5. Culleton S, Breen D, Assaad D, et al. 5 years review of a unique multidisciplinary nonmelanoma skin cancer clinic. J Cutan Med Surg. 2011;15(4):220–6.

    Article  PubMed  Google Scholar 

  6. Rogers HW, Coldiron BM. Analysis of skin cancer treatment and costs in the United States Medicare population, 1996–2008. Dermatol Surg. 2013;39(1 Pt 1):35–42.

    Article  CAS  PubMed  Google Scholar 

  7. Cubitt JJ, Khan AA, Royston E, Rughani M, Middleton MR, Budny PG. Melanoma in Buckinghamshire: data from the inception of the skin cancer multidisciplinary team. J Skin Cancer. 2013;2013:843282.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Miranda S, Gbaguidi X, Carvalho P, Chassagne J. Merckel cell carcinoma: the impact of multidisciplinary management. J Nutr Health Aging. 2013;17(2):196–8.

    Article  CAS  PubMed  Google Scholar 

  9. Butler ST, Youker SR, Mandrell J, Flanagan KH, Fosko SW. The importance of reviewing pathology specimens before mohs surgery. Dermatol Surg. 2009;35(3):407–12.

    Article  CAS  PubMed  Google Scholar 

  10. Connolly SM, Baker DR, Coldiron BM, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for mohs micrographic surgery: a report of the American academy of dermatology, American college of mohs surgery, American society for dermatologic surgery association, and the American society for mohs surgery. J Am Acad Dermatol. 2012;67(4):531–50.

    Article  PubMed  Google Scholar 

  11. DiCaudo DJ, McCalmont TH, Wick MR. Selected diagnostic problems in neoplastic dermatopathology. Arch Pathol Lab Med. 2007;131(3):434–9.

    PubMed  Google Scholar 

  12. Kauvar AN, Cronin Jr T, Roenigk R, Hruza G, Bennett R. Consensus for nonmelanoma skin cancer treatment: basal cell carcinoma, including a cost analysis of treatment methods. Dermatol Surg. 2015;41(5):550–71.

    Article  CAS  PubMed  Google Scholar 

  13. Ferringer T. Immunohistochemistry in dermatopathology. Arch Pathol Lab Med. 2015;139(1):83–105.

    Article  PubMed  Google Scholar 

  14. Lee JJ, Murphy GF, Lian CG. Melanoma epigenetics: novel mechanisms, markers, and medicines. Lab Investig J Tech Methods Pathol. 2014;94(8):822–38.

    Article  CAS  Google Scholar 

  15. Newman J, Beal M, Schram SE, Lee PK. Mohs micrographic surgery for lentigo maligna and lentigo maligna melanoma using Mel-5 immunostaining: an update from the University of Minnesota. Dermatol Surg. 2013;39(12):1794–9.

    Article  CAS  PubMed  Google Scholar 

  16. Rees JR, Zens MS, Celaya MO, Riddle BL, Karagas MR, Peacock JL. Survival after squamous cell and basal cell carcinoma of the skin: a retrospective cohort analysis. Int J Cancer J Int Cancer. 2015;137:878–84.

    Article  CAS  Google Scholar 

  17. Szewczyk M, Pazdrowski J, Golusinski P, Danczak-Pazdrowska A, Marszalek S, Golusinski W. Analysis of selected risk factors for nodal metastases in head and neck cutaneous squamous cell carcinoma. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2014.

  18. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9. Chicago, Ill. : 1960.

    Article  CAS  PubMed  Google Scholar 

  19. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609. This final report of the MSLT trial established that SLB has significant prognostic value. As would be expected, there was no difference in survival between SLB and control group.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Doepker MP, Zager JS. Sentinel lymph node mapping in melanoma in the twenty-first century. Surg Oncol Clin N Am. 2015;24(2):249–60.

    Article  PubMed  Google Scholar 

  21. Andtbacka RH, Gershenwald JE. Role of sentinel lymph node biopsy in patients with thin melanoma. J Natl Compr Cancer Netw: JNCCN. 2009;7(3):308–17.

    PubMed  Google Scholar 

  22. Han D, Zager JS, Shyr Y, et al. Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(35):4387–93.

    Article  Google Scholar 

  23. Dessureault S, Soong SJ, Ross MI, et al. Improved staging of node-negative patients with intermediate to thick melanomas (>1 mm) with the use of lymphatic mapping and sentinel lymph node biopsy. Ann Surg Oncol. 2001;8(10):766–70.

    Article  CAS  PubMed  Google Scholar 

  24. Mozzillo N, Pennacchioli E, Gandini S, et al. Sentinel node biopsy in thin and thick melanoma. Ann Surg Oncol. 2013;20(8):2780–6.

    Article  PubMed  Google Scholar 

  25. Tarantola TI, Vallow LA, Halyard MY, et al. Prognostic factors in Merkel cell carcinoma: analysis of 240 cases. J Am Acad Dermatol. 2013;68(3):425–32.

    Article  PubMed  Google Scholar 

  26. Schmults CD, Karia PS, Carter JB, Han J, Qureshi AA. Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10 years, single-institution cohort study. JAMA Dermatol. 2013;149(5):541–7. This study delineated risk factors for metastatic disease in cSCC, including perineural invasion, size > 2cm, and location on the temple or ear.

    Article  PubMed  Google Scholar 

  27. Carter JB, Johnson MM, Chua TL, Karia PS, Schmults CD. Outcomes of primary cutaneous squamous cell carcinoma with perineural invasion: an 11 years cohort study. JAMA Dermatol. 2013;149(1):35–41.

    Article  PubMed  Google Scholar 

  28. Krediet JT, Beyer M, Lenz K, et al. Sentinel lymph node biopsy and risk factors for predicting metastasis in cutaneous squamous cell carcinoma. Br J Dermatol. 2015;172(4):1029–36.

    Article  CAS  PubMed  Google Scholar 

  29. Gore SM, Shaw D, Martin RC, et al. Prospective study of sentinel node biopsy for high risk cutaneous squamous cell carcinoma of the head and neck. Head Neck. 2015. doi:10.1002/hed.24120. This is one of the first studies prospectively examining SLB for high risk cutaneous SCC. Their early data does seem to suggest a high false negative rate for SLB in cSCC (patients proceeding to regional recurrence after negative SLB), supporting the current standard of deferring SLB for cSCC outside of a study setting. Further study of this area is warranted.

    Google Scholar 

  30. Rowe DE, Carroll RJ, Day CL. Jr. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol. 1992;26(6):976–90.

    Article  CAS  PubMed  Google Scholar 

  31. Motley R, Kersey P, Lawrence C. Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma. Br J Dermatol. 2002;146(1):18–25.

    Article  CAS  PubMed  Google Scholar 

  32. Palme CE, O’Brien CJ, Veness MJ, McNeil EB, Bron LP, Morgan GJ. Extent of parotid disease influences outcome in patients with metastatic cutaneous squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 2003;129(7):750–3.

    Article  PubMed  Google Scholar 

  33. Kakizaki H, Malhotra R, Madge SN, Selva D. Lower eyelid anatomy: an update. Ann Plast Surg. 2009;63(3):344–51.

    Article  CAS  PubMed  Google Scholar 

  34. Alghoul M, Pacella SJ, McClellan WT, Codner MA. Eyelid reconstruction. Plast Reconstr Surg. 2013;132(2):288e–302e.

    Article  CAS  PubMed  Google Scholar 

  35. Mendenhall WM, Amdur RJ, Hinerman RW, et al. Skin cancer of the head and neck with perineural invasion. Am J Clin Oncol. 2007;30(1):93–6.

    Article  PubMed  Google Scholar 

  36. Clayman GL, Lee JJ, Holsinger FC, et al. Mortality risk from squamous cell skin cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(4):759–65.

    Article  Google Scholar 

  37. Borah GL, Rankin MK. Appearance is a function of the face. Plast Reconstr Surg. 2010;125(3):873–8.

    Article  CAS  PubMed  Google Scholar 

  38. Rankin M, Borah GL. Perceived functional impact of abnormal facial appearance. Plast Reconstr Surg. 2003;111(7):2140–6. discussion 2147–2148.

    Article  PubMed  Google Scholar 

  39. Pope AW, Ward J. Factors associated with peer social competence in preadolescents with craniofacial anomalies. J Pediatr Psychol. 1997;22(4):455–69.

    Article  CAS  PubMed  Google Scholar 

  40. Alam M, Helenowksi IB, Cohen JL, et al. Association between type of reconstruction after mohs micrographic surgery and surgeon-, patient-, and tumor-specific features: a cross-sectional study. Dermatol Surg. 2013;39(1 Pt 1):51–5.

    Article  CAS  PubMed  Google Scholar 

  41. Morris DS, Elzaridi E, Clarke L, Dickinson AJ, Lawrence CM. Periocular basal cell carcinoma: 5 years outcome following slow mohs surgery with formalin-fixed paraffin-embedded sections and delayed closure. Br J Ophthalmol. 2009;93(4):474–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Ian A. Maher declares that he has no conflict of interest.

M. Yadira Hurley has received compensation from Actelion Pharmaceuticals US, Inc. for service as a speaker/presenter.

Michael Bernstein declares that he has no conflict of interest.

Eddie Hsueh declares that he has no conflict of interest.

Ronald Walker declares that he has no conflict of interest.

Scott Walen declares that he has no conflict of interest.

Gabriella Espinoza declares that she has no conflict of interest.

Scott W. Fosko has received compensation from Genentech for service as a consultant, speaker, and investigator.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Dermatology, Mohs Surgery and Cutaneous Oncology, Saint Louis University, 1755 S. Grand Blvd, St. Louis, MO, 63104, USA

    Ian A. Maher

  2. Department of Dermatology, Dermatology and Dermatopathology, Saint Louis University, 1755 S. Grand Blvd, St. Louis, MO, 63104, USA

    M. Yadira Hurley

  3. Department of Surgery, Division of Plastic and Reconstructive Surgery, Saint Louis University, 3635 Vista Avenue 3rd Floor N., Desloge Towers, St. Louis, MO, 63110, USA

    Michael Bernstein

  4. Department of Surgery, Division of General and Oncologic Surgery, Saint Louis University, 3635 Vista Avenue @ Grand Blvd. 3rd Floor N. Desloge Towers, St. Louis, MO, 63110, USA

    Eddie Hsueh

  5. Department of Otolaryngology, Head and Neck Surgery, Head and Neck Oncology; Microvascular Reconstruction, Saint Louis University, 3660 Vista, Suite 312, St. Louis, MO, 63110, USA

    Ronald Walker

  6. Department of Otolaryngology, Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, Saint Louis University, 3660 Vista Avenue, Suite 312, St. Louis, MO, 63110, USA

    Scott Walen

  7. Department of Ophthalmology, Saint Louis University, 1755 South Grand Boulevard, St. Louis, MO, 63104, USA

    Gabriella Espinoza

  8. Department of Dermatology, Department of Otolaryngology, Head and Neck Surgery, Department of Ophthalmology, Department of Internal Medicine, Saint Louis University, Saint Louis University School of Medicine, Saint Louis University Cancer Center, 1755 South Grand Blvd, St. Louis, MO, 63104, USA

    Scott W. Fosko

Authors
  1. Ian A. Maher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Yadira Hurley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Bernstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eddie Hsueh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ronald Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Scott Walen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gabriella Espinoza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Scott W. Fosko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ian A. Maher.

Additional information

This article is part of the Topical Collection on Medical Surgery

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maher, I.A., Hurley, M.Y., Bernstein, M. et al. Interdisciplinary Surgical Management of Skin Cancer: the Saint Louis University Experience. Curr Derm Rep 4, 147–154 (2015). https://doi.org/10.1007/s13671-015-0113-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13671-015-0113-6

Keywords

Search

Navigation