Management of Non-Melanoma Skin Cancer: Radiologists Challenging and Risk Assessment
Abstract
:1. Introduction
2. Diagnostic Imaging and Non-Melanoma Skin Cancer
Staging and Risk Stratification
3. Diagnostic Tools and Non-Melanoma: Staging and Surveillance
4. Follow-Up and Surveillance: Time
5. Treatment Assessment of NMSCs in Immunotherapy
6. Imaging of Immune—Related Adverse Events
7. Conclusions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AJCC | American Joint Committee on Cancers |
AK | actinic keratosis |
BCC | Basal cell carcinoma |
CPD | confirmed progression disease |
iCR | immune complete response |
CTCAE | Common Terminology Criteria for Adverse Events |
DP | disease progression |
HFUS | High-frequency US |
ICB | immune checkpoint blockades |
irAEs | immune-related adverse events |
ITM | in transit |
LN | lymph node |
MCC | Merkel cell carcinomas |
MSC | melanoma skin cancer |
NCCN | National Comprehensive Cancer Network |
NMSC | Non-melanoma skin cancer |
PR | progression rate |
RC | response criteria |
RECIST | Response Evaluation Criteria in Solid Tumours |
SCC | squamous cell cancers |
SD | stable disease |
SLNB | sentinel lymph node biopsy |
SNB | sentinel node biopsy |
SNL | sentinel lymph node |
SUV | standardized uptake value |
TNM | tumour-node-metastasis |
UEP | unequivocal progression |
UPD | unconfirmed progression disease |
References
- Sung, H.; Ferlay, J.; Siegel, R.L.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021, 71, 209–249. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Global Health Estimates: Leading Causes of Death. Available online: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death (accessed on 15 January 2023).
- Urban, K.; Mehrmal, S.; Uppal, P.; Giesey, R.L.; Delost, G.R. The global burden of skin cancer: A longitudinal analysis from the Global Burden of Disease Study, 1990–2017. JAAD Int. 2021, 2, 98–108. [Google Scholar] [CrossRef] [PubMed]
- Khazaei, Z.; Ghorat, F.; Jarrahi, A.; Adineh, H.; Sohrabivafa, M.; Goodarzi, E.J.W.C.R.J. Global incidence and mortality of skin cancer by histological subtype and its relationship with the human development index (HDI); an ecology study in 2018. World Cancer Res. J. 2019, 6, e13. [Google Scholar]
- Eide, M.J.; Krajenta, R.; Johnson, D.; Long, J.J.; Jacobsen, G.; Asgari, M.M.; Lim, H.W.; Johnson, C.C. Identification of Patients with Nonmelanoma Skin Cancer Using Health Maintenance Organization Claims Data. Am. J. Epidemiol. 2010, 171, 123–128. [Google Scholar] [CrossRef] [Green Version]
- Apalla, Z.; Lallas, A.; Sotiriou, E.; Lazaridou, E.; Ioannides, D. Tendencias epidemiológicas en cáncer de piel. Dermatol. Pract. Concept. 2017, 7, 1–6. [Google Scholar]
- Ciążyńska, M.; Kamińska-Winciorek, G.; Lange, D.; Lewandowski, B.; Reich, A.; Sławińska, M.; Pabianek, M.; Szczepaniak, K.; Hankiewicz, A.; Ułańska, M.; et al. The incidence and clinical analysis of non-melanoma skin cancer. Sci. Rep. 2021, 11, 4337. [Google Scholar] [CrossRef]
- Miligi, L. Ultraviolet Radiation Exposure: Some Observations and Considerations, Focusing on Some Italian Experiences, on Cancer Risk, and Primary Prevention. Environments 2020, 7, 10. [Google Scholar] [CrossRef] [Green Version]
- Bais, A.F.; Lucas, R.M.; Bornman, J.F.; Williamson, C.E.; Sulzberger, B.; Austin, A.T.; Wilson, S.R.; Andrady, A.L.; Bernhard, G.; McKenzie, R.L.; et al. Environmental effects of ozone depletion, UV radiation and interactions with climate change: UNEP Environmental Effects Assessment Panel, update 2017. Photochem. Photobiol. Sci. 2018, 17, 127–179. [Google Scholar] [CrossRef]
- Griffin, L.L.; Ali, F.R.; Lear, J.T. Non-melanoma skin cancer. Clin. Med. 2016, 16, 62–65. [Google Scholar] [CrossRef]
- Xu, Y.G.; Aylward, J.L.; Swanson, A.M.; Spiegelman, V.S.; Vanness, E.R.; Teng, J.M.; Snow, S.N.; Wood, G.S. Nonmelanoma skin cancers: Basal cell and squamous cell carcinomas. In Abeloff’s Clinical Oncology; Elsevier: Amsterdam, The Netherlands, 2020; pp. 1052–1073. [Google Scholar]
- Warner, C.L.; Cockerell, C.J. The new seventh edition American joint committee on cancer staging of cutaneous non-melanoma skin cancer. Am. J. Clin. Dermatol. 2011, 12, 147–154. [Google Scholar] [CrossRef]
- Newlands, C.; Currie, R.; Memon, A.; Whitaker, S.; Woolford, T. Non-melanoma skin cancer: United Kingdom National Multidisciplinary Guidelines. J. Laryngol. Otol. 2016, 130, S125–S132. [Google Scholar] [CrossRef] [PubMed]
- Kučinskienė, V.; Samulėnienė, D.; Gineikienė, A.; Raišutis, R.; Kažys, R.; Valiukevičienė, S. Preoperative assessment of skin tumor thickness and structure using 14-MHz ultrasound. Medicina 2014, 50, 150–155. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Loescher, L.J.; Janda, M.; Soyer, H.P.; Shea, K.; Curiel-Lewandrowski, C. Advances in Skin Cancer Early Detection and Diagnosis. Semin. Oncol. Nurs. 2013, 29, 170–181. [Google Scholar] [CrossRef]
- Humphreys, T.R.; Shah, K.; Wysong, A.; Lexa, F.; MacFarlane, D. The role of imaging in the management of patients with nonmelanoma skin cancer: When is imaging necessary? J. Am. Acad. Dermatol. 2017, 76, 591–607. [Google Scholar] [CrossRef]
- Burton, K.A.; Ashack, K.A.; Khachemoune, A. Cutaneous Squamous Cell Carcinoma: A Review of High-Risk and Metastatic Disease. Am. J. Clin. Dermatol. 2016, 17, 491–508. [Google Scholar] [CrossRef]
- Ting, P.T.; Kasper, R.; Arlette, J.P. Metastatic basal cell carcinoma: Report of two cases and literature review. J. Cutan. Med. Surg. 2005, 9, 10–15. [Google Scholar] [CrossRef]
- Toll, A.; Margalef, P.; Masferrer, E.; Ferrándiz-Pulido, C.; Gimeno, J.; Pujol, R.M.; Bigas, A.; Espinosa, L. Active nuclear IKK correlates with metastatic risk in cutaneous squamous cell carcinoma. Arch. Dermatol. Res. 2015, 307, 721–729. [Google Scholar] [CrossRef]
- Heuke, S.; Vogler, N.; Meyer, T.; Akimov, D.; Kluschke, F.; Röwert-Huber, H.-J.; Lademann, J.; Dietzek, B.; Popp, J. Detection and Discrimination of Non-Melanoma Skin Cancer by Multimodal Imaging. Healthcare 2013, 1, 64–83. [Google Scholar] [CrossRef] [Green Version]
- Avallone, A.; Pecori, B.; Bianco, F.; Aloj, L.; Tatangelo, F.; Romano, C.; Granata, V.; Marone, P.; Leone, A.; Botti, G.J.O.; et al. Critical role of bevacizumab scheduling in combination with pre-surgical chemo-radiotherapy in MRI-defined high-risk locally advanced rectal cancer: Results of the Branch trial. Oncotarget 2015, 6, 30394–30407. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Danti, G.; Flammia, F.; Matteuzzi, B.; Cozzi, D.; Berti, V.; Grazzini, G.; Pradella, S.; Recchia, L.; Brunese, L.; Miele, V. Gastrointestinal neuroendocrine neoplasms (GI-NENs): Hot topics in morphological, functional, and prognostic imaging. Radiol. Med. 2021, 126, 1497–1507. [Google Scholar] [CrossRef] [PubMed]
- Hussein, M.A.M.; Cafarelli, F.P.; Paparella, M.T.; Rennie, W.J.; Guglielmi, G. Phosphaturic mesenchymal tumors: Radiological aspects and suggested imaging pathway. La Radiol. Medica 2021, 126, 1609–1618. [Google Scholar] [CrossRef] [PubMed]
- Cellini, F.; Di Franco, R.; Manfrida, S.; Borzillo, V.; Maranzano, E.; Pergolizzi, S.; Morganti, A.G.; Fusco, V.; Deodato, F.; Santarelli, M.; et al. Palliative radiotherapy indications during the COVID-19 pandemic and in future complex logistic settings: The NORMALITY model. Radiol. Med. 2021, 126, 1619–1656. [Google Scholar] [CrossRef] [PubMed]
- Granata, V.; Fusco, R.; Filice, S.; Catalano, O.; Piccirillo, M.; Palaia, R.; Izzo, F.; Petrillo, A. The current role and future prospectives of functional parameters by diffusion weighted imaging in the assessment of histologic grade of HCC. Infect. Agents Cancer 2018, 13, 23. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Petrillo, A.; Fusco, R.; Petrillo, M.; Granata, V.; Delrio, P.; Bianco, F.; Pecori, B.; Botti, G.; Tatangelo, F.; Caracò, C.J.O. Standardized index of shape (DCE-MRI) and standardized uptake value (PET/CT): Two quantitative approaches to discriminate chemo-radiotherapy locally advanced rectal cancer responders under a functional profile. Oncotarget 2017, 8, 8143. [Google Scholar] [CrossRef] [Green Version]
- Granata, V.; Fusco, R.; Avallone, A.; Filice, F.; Tatangelo, F.; Piccirillo, M.; Grassi, R.; Izzo, F.; Petrillo, A. Critical analysis of the major and ancillary imaging features of LI-RADS on 127 proven HCCs evaluated with functional and morphological MRI: Lights and shadows. Oncotarget 2017, 8, 51224–51237. [Google Scholar] [CrossRef] [Green Version]
- De Filippo, M.; Puglisi, S.; D’Amuri, F.; Gentili, F.; Paladini, I.; Carrafiello, G.; Maestroni, U.; Del Rio, P.; Ziglioli, F.; Pagnini, F. CT-guided percutaneous drainage of abdominopelvic collections: A pictorial essay. Radiol. Med. 2021, 126, 1561–1570. [Google Scholar] [CrossRef]
- Pampena, R.; Palmieri, T.; Kyrgidis, A.; Ramundo, D.; Iotti, C.; Lallas, A.; Moscarella, E.; Borsari, S.; Argenziano, G.; Longo, C. Orthovoltage radiotherapy for nonmelanoma skin cancer (NMSC): Comparison between 2 different schedules. J. Am. Acad. Dermatol. 2016, 74, 341–347. [Google Scholar] [CrossRef]
- Baheti, A.D.; Tirumani, S.H.; Giardino, A.; Rosenthal, M.H.; Tirumani, H.; Krajewski, K.; Ramaiya, N.H. Basal Cell Carcinoma: A Comprehensive Review for the Radiologist. Am. J. Roentgenol. 2015, 204, W132–W140. [Google Scholar] [CrossRef]
- Aubry, S.; Leclerc, O.; Tremblay, L.; Rizcallah, E.; Croteau, F.; Orfali, C.; Lepage, M. 7-Tesla MR imaging of non-melanoma skin cancer samples: Correlation with histopathology. Ski. Res. Technol. 2012, 18, 413–420. [Google Scholar] [CrossRef]
- Veness, M.J.; Oncology, R. Hypofractionated radiotherapy in patients with non-melanoma skin cancer in the post COVID-19 era: Time to reconsider its role for most patients. J. Med. Imaging Radiat. Oncol. 2020, 64, 591–594. [Google Scholar] [CrossRef]
- Silk, A.W.; Barker, C.A.; Bhatia, S.; Bollin, K.B.; Chandra, S.; Eroglu, Z.; Gastman, B.R.; Kendra, K.L.; Kluger, H.; Lipson, E.J.; et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of nonmelanoma skin cancer. J. Immunother. Cancer 2022, 10, e004434. [Google Scholar] [CrossRef]
- Marka, A.; Carter, J.B.; Toto, E.; Hassanpour, S. Automated detection of nonmelanoma skin cancer using digital images: A systematic review. BMC Med. Imaging 2019, 19, 21. [Google Scholar] [CrossRef]
- Malvehy, J.; Pellacani, G. Dermoscopy, Confocal Microscopy and other Non-invasive Tools for the Diagnosis of Non-Melanoma Skin Cancers and Other Skin Conditions. Acta Dermato-Venereol. 2017, 97, 22–30. [Google Scholar] [CrossRef] [Green Version]
- Fujimura, T.; Fujisawa, Y.; Otsuka, A.; Haass, N.K.J.F. Editorial: Recent Developments in Therapies and Diagnostic Tools for Melanoma and Non-melanoma Skin Cancer. Front. Med. 2020, 7, 613152. [Google Scholar] [CrossRef]
- Bezugly, A.; Rembielak, A. The use of high frequency skin ultrasound in non-melanoma skin cancer. J. Contemp. Brachyther. 2021, 13, 483–491. [Google Scholar] [CrossRef]
- Rohrbach, D.J.; Muffoletto, D.; Huihui, J.; Saager, R.; Keymel, K.; Paquette, A.; Morgan, J.; Zeitouni, N.; Sunar, U. Preoperative Map** of Nonmelanoma Skin Cancer Using Spatial Frequency Domain and Ultrasound Imaging. Acad. Radiol. 2014, 21, 263–270. [Google Scholar] [CrossRef] [Green Version]
- Pasquali, P.; Freites-Martinez, A.; Fortuño-Mar, A. Ex vivo high-frequency ultrasound: A novel proposal for management of surgical margins in patients with non-melanoma skin cancer. J. Am. Acad. Dermatol. 2016, 74, 1278–1280. [Google Scholar] [CrossRef] [Green Version]
- Piłat, P.; Borzęcki, A.; Jazienicki, M.; Gerkowicz, A.; Krasowska, D. High-frequency ultrasound in the diagnosis of selected non-melanoma skin nodular lesions. Adv. Dermatol. Allergol. 2019, 36, 572–580. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Alam, M.; Armstrong, A.; Baum, C.; Bordeaux, J.S.; Brown, M.; Busam, K.J.; Eisen, D.B.; Iyengar, V.; Lober, C.; Margolis, D.J. Guidelines of care for the management of cutaneous squamous cell carcinoma. J. Am. Acad. Dermatol. 2018, 78, 560–578. [Google Scholar] [CrossRef] [Green Version]
- Fahradyan, A.; Howell, A.; Wolfswinkel, E.; Tsuha, M.; Sheth, P.; Wong, A. Updates on the Management of Non-Melanoma Skin Cancer (NMSC). Healthcare 2017, 5, 82. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bichakjian, C.; Armstrong, A.; Baum, C.; Bordeaux, J.S.; Brown, M.; Busam, K.J.; Eisen, D.B.; Iyengar, V.; Lober, C.; Margolis, D.J.; et al. Guidelines of care for the management of basal cell carcinoma. J. Am. Acad. Dermatol. 2018, 78, 540–559. [Google Scholar] [CrossRef] [Green Version]
- Califano, J.; Lydiatt, W.; Nehal, K.S.; O’Sullivan, B.; Schmults, C.; Seethala, R.; Weber, R.; Shah, J. Cutaneous squamous cell carcinoma of the head and neck. In AJCC Cancer Staging Manual, 8th ed.; Springer: Berlin/Heidelberg, Germany, 2017. [Google Scholar]
- Motaparthi, K.; Kapil, J.P.; Velazquez, E.F. Cutaneous Squamous Cell Carcinoma: Review of the Eighth Edition of the American Joint Committee on Cancer Staging Guidelines, Prognostic Factors, and Histopathologic Variants. Adv. Anat. Pathol. 2017, 24, 171–194. [Google Scholar] [CrossRef] [PubMed]
- Compton, C.C.; Byrd, D.R.; Garcia-Aguilar, J.; Kurtzman, S.H.; Olawaiye, A.; Washington, M.K. Cutaneous squamous cell carcinoma and other cutaneous carcinomas. In AJCC Cancer Staging Atlas; Springer: New York, NY, USA, 2012; pp. 357–370. [Google Scholar]
- Barile, A. Some thoughts and greetings from the new Editor-in-Chief. Radiol. Med. 2021, 126, 3–4. [Google Scholar] [CrossRef] [PubMed]
- Laverde-Saad, A.; Simard, A.; Nassim, D.; Jfri, A.; Alajmi, A.; O’Brien, E.; Wortsman, X.J.D. Performance of Ultrasound for Identifying Morphological Characteristics and Thickness of Cutaneous Basal Cell Carcinoma: A Systematic Review. Dermatology 2022, 238, 692–710. [Google Scholar] [CrossRef]
- Ossola, C.; Curti, M.; Calvi, M.; Tack, S.; Mazzoni, S.; Genesio, L.; Venturini, M.; Genovese, E.A. Role of ultrasound and magnetic resonance imaging in the prognosis and classification of muscle injuries in professional football players: Correlation between imaging and return to sport time. Radiol. Med. 2021, 126, 1460–1467. [Google Scholar] [CrossRef]
- Soyer Güldoğan, E.; Ergun, O.; Taşkın Türkmenoğlu, T.; Yılmaz, K.B.; Akdağ, T.; Özbal Güneş, S.; Durmaz, H.A.; Hekimoğlu, B.J.L.r.m. The impact of TI-RADS in detecting thyroid malignancies: A prospective study. Radiol. Med. 2021, 126, 1335–1344. [Google Scholar] [CrossRef]
- Keohane, S.G.; Proby, C.M.; Newlands, C.; Motley, R.J.; Nasr, I.; Mustapa, M.F.M.; Slater, D.N.; the British Association of Dermatologists (Squamous and Basal Cell Carcinoma Guideline Development Groups); the Royal College of Pathologists (Skin Cancer Lead). The new 8th edition of TNM staging and its implications for skin cancer: A review by the British Association of Dermatologists and the Royal College of Pathologists, U.K. Br. J. Dermatol. 2018, 179, 824–828. [Google Scholar] [CrossRef] [Green Version]
- MacFarlane, D.; Shah, K.; Wysong, A.; Wortsman, X.; Humphreys, T.R. The role of imaging in the management of patients with nonmelanoma skin cancer: Diagnostic modalities and applications. J. Am. Acad. Dermatol. 2017, 76, 579–588. [Google Scholar] [CrossRef]
- Mlosek, R.K.; Migda, B.; Migda, M. High-frequency ultrasound in the 21st century. J. Ultrason. 2020, 20, 233–241. [Google Scholar] [CrossRef]
- Kleinerman, R.; Marmur, E.; Whang, T.B.; Bard, R.L. Ultrasound in dermatology: Principles and applications. J. Am. Acad. Dermatol. 2012, 67, 478–487. [Google Scholar] [CrossRef]
- Roldán, F.A. Ultrasound Skin Imaging. Actas Dermo-Sifiliográficas 2014, 105, 891–899. [Google Scholar] [CrossRef]
- Zhu, A.Q.; Wang, L.F.; Li, X.L.; Wang, Q.; Li, M.X.; Ma, Y.Y.; ** a Common Language for Tumor Response to Immunotherapy: Immune-Related Response Criteria Using Unidimensional MeasurementsUnidimensional irRC as a Common Language for Immunotherapy. Clin. Cancer Res. 2013, 19, 3936–3943. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sheikhbahaei, S.; Marcus, C.V.; Sadaghiani, M.S.; Rowe, S.P.; Pomper, M.G.; Solnes, L.B. Imaging of Cancer Immunotherapy: Response Assessment Methods, Atypical Response Patterns, and Immune-Related Adverse Events, From the AJR Special Series on Imaging of Inflammation. Am. J. Roentgenol. 2022, 218, 940–952. [Google Scholar] [CrossRef] [PubMed]
- Cousin, S.; Italiano, A.J.C.C.R. Molecular Pathways: Immune Checkpoint Antibodies and their ToxicitiesSafety Profile of Immune Checkpoint Antibodies. Clin. Cancer Res. 2016, 22, 4550–4555. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kroschinsky, F.; on behalf of the Intensive Care in Hematological and Oncological Patients (iCHOP) Collaborative Group; Stölzel, F.; von Bonin, S.; Beutel, G.; Kochanek, M.; Kiehl, M.; Schellongowski, P. New drugs, new toxicities: Severe side effects of modern targeted and immunotherapy of cancer and their management. Crit. Care 2017, 21, 1–11. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Common Terminology Criteria for Adverse Events (CTCAE) V5; US Department of Health and Human Services: Washington, DC, USA, 2017.
- Arnaud-Coffin, P.; Maillet, D.; Gan, H.K.; Stelmes, J.-J.; You, B.; Dalle, S.; Péron, J. A systematic review of adverse events in randomized trials assessing immune checkpoint inhibitors. Int. J. Cancer 2019, 145, 639–648. [Google Scholar] [CrossRef]
- Barroso-Sousa, R.; Barry, W.T.; Garrido-Castro, A.C.; Hodi, F.S.; Min, L.; Krop, I.E.; Tolaney, S.M. Incidence of endocrine dysfunction following the use of different immune checkpoint inhibitor regimens: A systematic review and meta-analysis. JAMA Oncol. 2018, 4, 173–182. [Google Scholar] [CrossRef]
- Tang, S.-Q.; Tang, L.-L.; Mao, Y.-P.; Li, W.-F.; Chen, L.; Zhang, Y.; Guo, Y.; Liu, Q.; Sun, Y.; Xu, C.; et al. The Pattern of Time to Onset and Resolution of Immune-Related Adverse Events Caused by Immune Checkpoint Inhibitors in Cancer: A Pooled Analysis of 23 Clinical Trials and 8,436 Patients. Cancer Res. Treat. 2021, 53, 339–354. [Google Scholar] [CrossRef]
- Delaunay, M.; Cadranel, J.; Lusque, A.; Meyer, N.; Gounaut, V.; Moro-Sibilot, D.; Michot, J.-M.; Raimbourg, J.; Girard, N.; Guisier, F.; et al. Immune-checkpoint inhibitors associated with interstitial lung disease in cancer patients. Eur. Respir. J. 2017, 50, 1700050. [Google Scholar] [CrossRef]
- Nishino, M.; Hatabu, H.; Hodi, F.S. Imaging of Cancer Immunotherapy: Current Approaches and Future Directions. Radiology 2019, 290, 9–22. [Google Scholar] [CrossRef]
- Brahmer, J.R.; Abu-Sbeih, H.; Ascierto, P.A.; Brufsky, J.; Cappelli, L.C.; Cortazar, F.B.; Gerber, D.E.; Hamad, L.; Hansen, E.; Johnson, D.B.; et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J. Immunother. Cancer 2021, 9, e002435. [Google Scholar] [CrossRef] [PubMed]
Characteristics of Pseudo Progression and Hyper Progression | |
---|---|
Pseudo progression | Hyper-progression |
Pseudo progression is an initial progression in which the tumor burden or the number of tumor lesions increase initially and then decreases over time. | Hyperprogression is a tumor response in which the existing underlying tumor grows rapidly after initiating treatment with an immune checkpoint inhibitor. |
Pseudo progression is not true tumour progression, which has been proven by histopathological biopsies that found infiltration and recruitment of various immune cells, such as T or B lymphocytes, in the tumor. | Tumor samples of people who experienced hyperprogression were found to have a greater number of tumor-associated macrophages (macrophages are cells that are part of the immune system that are present in the area surrounding tumors or “tumor microenvironment”). |
The occurrence of pseudoprogression has led to the development of immune-related response-evaluation criteria. In this phenomenon, patients treated with immunotherapy experience an initial increase in tumor burden through enlargement of target lesions and/or development of new lesions, followed by a subsequent decrease in the tumor burden qualifying as a partial or complete response. | Hyper progression involves not only the more rapid growth of a tumor but a lower survival rate. In patients develo** hyperprogression, immunotherapy treatment should be stopped and the patient should be managed appropriately. |
Table of Definitions | |
---|---|
iCR | Immune control response is the disappearance of all lesions, measured or unmeasured, and no new lesions. |
iSD | Immune stable disease is referred as cancer that is neither decreasing nor increasing in extent or severity. |
iPr | unconfirmed progression disease |
iUPD | increase of non-target lesions or appearance of new lesion called iUPD |
iCPD | Development of another new lesion, increased size of the target or non-target lesions, and/or unequivocal progression of existing non-target lesions. |
irAEs | ||
---|---|---|
Favourable | Neutral | Unfavourable |
Develo** an irAE | Pruritus | High grade irAEs |
Certain irAEs: skin(vitiligo), endocrine, hepatic, gut hypophysitis, and colitis | Taking short term steroids for irAEs | Pre-existing autoimmune disease, i.e., earlier and high prevalence of irAEs |
Pre-existing psoriasis | Radiotherapy after treatment | Steroid use for cancer related symptoms |
Steroid-sparing therapy | Mucosal melanoma | |
Combined with radiotherapy | Low PD L1 expression |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Russo, G.M.; Russo, A.; Urraro, F.; Cioce, F.; Gallo, L.; Belfiore, M.P.; Sangiovanni, A.; Napolitano, S.; Troiani, T.; Verolino, P.; et al. Management of Non-Melanoma Skin Cancer: Radiologists Challenging and Risk Assessment. Diagnostics 2023, 13, 793. https://doi.org/10.3390/diagnostics13040793
Russo GM, Russo A, Urraro F, Cioce F, Gallo L, Belfiore MP, Sangiovanni A, Napolitano S, Troiani T, Verolino P, et al. Management of Non-Melanoma Skin Cancer: Radiologists Challenging and Risk Assessment. Diagnostics. 2023; 13(4):793. https://doi.org/10.3390/diagnostics13040793
Chicago/Turabian StyleRusso, Gaetano Maria, Anna Russo, Fabrizio Urraro, Fabrizio Cioce, Luigi Gallo, Maria Paola Belfiore, Angelo Sangiovanni, Stefania Napolitano, Teresa Troiani, Pasquale Verolino, and et al. 2023. "Management of Non-Melanoma Skin Cancer: Radiologists Challenging and Risk Assessment" Diagnostics 13, no. 4: 793. https://doi.org/10.3390/diagnostics13040793