Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

https://www.unitypoint.org/desmoines/filesimages/Cancer%20Education/Oncology%20Nursing%20Conference/2015/2014%20NCCN%20Clin%20Pract%20Guidelines%20Male%20Sex%20Dysf.pdf

Clinical practice guidelines in oncology

Oxidative stress in skin plays a major role in the aging process. This is true for intrinsic aging and even more for extrinsic aging. Although the results are quite different in dermis and epidermis, extrinsic aging is driven to a large extent by oxidative stress caused by UV irradiation. In this review the overall effects of oxidative stress are discussed as well as the sources of ROS including the mitochondrial ETC, peroxisomal and ER localized proteins, the Fenton reaction, and such enzymes as cyclooxygenases, lipoxygenases, xanthine oxidases, and NADPH oxidases. Furthermore, the defense mechanisms against oxidative stress ranging from enzymes like superoxide dismutases, catalases, peroxiredoxins, and GSH peroxidases to organic compounds such as L-ascorbate, α-tocopherol, beta-carotene, uric acid, CoQ10, and glutathione are described in more detail. In addition the oxidative stress induced modifications caused to proteins, lipids and DNA are discussed. Finally age-related changes of the skin are also a topic of this review. They include a disruption of the epidermal calcium gradient in old skin with an accompanying change in the composition of the cornified envelope. This modified cornified envelope also leads to an altered anti-oxidative capacity and a reduced barrier function of the epidermis.

/pdf/oxidative-stress-in-aging-human-skin-3ohc7c9zri.pdf

Oxidative Stress in Aging Human Skin

N Engl J Med 2005;353:2262-9. Copyright © 2005 Massachusetts Medical Society. ccording to the american cancer society, skin cancer is the most common cancer, accounting for about half of all cancers in the United States. More than 1 million cases of skin cancer will be diagnosed in the United States this year. 1 Basal-cell carcinomas constitute approximately 80 percent of all nonmelanoma skin cancers. This article addresses cutaneous basal-cell carcinoma, which should be differentiated from the uncommon basal-cell carcinoma or basaloid carcinoma that arises in sites such as the prostate, pancreas, lung, cervix, salivary gland, thymus, and anal canal.

Current concepts : Basal-cell carcinoma

Basal cell carcinoma (BCC) is a malignant epithelial neoplasm of the skin preferentially affecting male caucasians and is rarely observed in patients with more intense skin pigmentation. A characteristic feature of BCCs are their extremely low risk to metastasize. Epidemiological data indicate that the overall incidence is increasing worldwide significantly by about 3-10% per annum.(1-3) Based on the increasing incidence of this usually not life-threatening tumour BCC appears to develop into a growing public health problem. This review elucidates the risk factors for the development and for the progression of BCC leading to an improved understanding of this tumour.

Epidemiology and aetiology of basal cell carcinoma.

https://www.jidonline.org/article/S0022-202X(15)36446-0/pdf

Non-melanoma skin cancer incidence and impact of skin cancer screening on incidence

Nonmelanoma skin cancer (NMSC) represents the most common form of cancer in Caucasians, with continuing increase in incidence worldwide. Basal cell carcinoma (BCC) accounts for 75% of cases of NMSC, and squamous cell carcinoma (SCC) accounts for the remaining majority of NMSC cases. Whilst metastasis from BCC is extremely rare, metastasis from high-risk SCC may be fatal. In this article, we review the aetiology, diagnosis and management of NMSC.

Nonmelanoma skin cancer

Background Patients with basal cell carcinoma (BCC) frequently develop further tumors during follow-up. Objective We sought to elucidate the relative effects of pattern of ultraviolet radiation exposure, and site and histologic type of the first tumor, on the rate of increase in BCC numbers. Methods We used negative binomial regression analysis to study the association of selected variables on the rate of increase in BCC numbers in 266 Caucasian patients who first presented with a tumor on the head/neck or trunk with nodular or superficial histology. Results Patients with an initial truncal BCC with superficial histology demonstrated significantly faster increases in BCC numbers than did patients with other site and histology combinations. Conclusions These data indicate that site and histology define subsets of patients with BCC.

Associations between ultraviolet radiation, basal cell carcinoma site and histology, host characteristics, and rate of development of further tumors.

Cutaneous squamous cell cancer (SCC) is the second most common skin cancer, accounting for one-fifth of all cutaneous malignancies. The majority arise on the head and neck skin, and cumulative UV exposure is thought to be the most likely etiological factor. The majority of deaths from SCC occur in a high-risk subgroup of patients. This high-risk subgroup of patients can be identified as those with tumors greater than 2 cm in diameter; tumor thickness over 4 mm; moderately/poorly differentiated or desmoplastic histological SCC subtype; ear, lip, hand, feet or genital tumor site; presence of perineural or lymphovascular invasion; nodal metastasis at presentation; recurrent SCC; SCC arising from scars or chronic skin disease, for example, chronic ulcers; and SCC arising in immunosuppressed patients. It is important to identify and aggressively treat these patients, as high-risk SCC are associated with a greater mortality and morbidity. This article reviews the diagnosis and management of such high-risk SCC.

Management of high-risk squamous cell carcinoma of the skin.

and remained negative 12 weeks after completing all therapy (SVR 12). Daclatasvir, an NS5A inhibitor, is pan-genotypic and when combined with other DAAs has demonstrated very high SVR rates in difficult-to-treat patients infected with genotype 1b who are previous null responders to PEG-IFN and ribavirin (4). In addition, daclatasvir in combination with sofosbuvir, an NS5B inhibitor, has shown very promising results in treatment-naive genotype 1a, 1b, 2, and 3 infected patients as well as in genotype 1 patients who have failed therapy with boceprevir or telaprevir (5). Although the patient had a robust response to triple therapy, he continued to be HCV RNA detectable and thus was deemed a failure to boceprevir-based therapy and, in addition, he had several adverse events. Furthermore, because of drug-drug interactions caused by boceprevir, dose adjustments were required for the calcineurin inhibitor, tacrolimus. Daclatasvir in combination with PEG-IFN and ribavirin has already been successfully used in a liver transplant recipient who had not been exposed to a protease inhibitor (6). Daclatasvir has also been used in combination with sofosbuvir in a single case of cholestatic hepatitis C post-LT (7). However, this is the first case of successful treatment of hepatitis C with daclatasvir, PEG-IFN, and ribavirin after failure with a PI in an LT recipient. It is likely that the initial boceprevir-based therapy failed as a result of the patient being intolerant of the regimen. Largely, daclatasvir was effective because the patient demonstrated interferon responsiveness while on boceprevir. Although there were challenges of adverse events with interferonbased therapy, we opted not to treat the patient with only DAAs because of the high rate of viral resistance to these drugs without the backbone of pegylated interferon and ribavirin (8Y10). In this case, daclatasvir allowed PEGIFN and ribavirin to be administered at appropriate (although reduced) doses and without drug-drug interactions. While all-oral therapy with DAAs is desirable in these patients, it may not be pragmatic for reasons of cost and global availability. Therefore, daclatasvir may present an opportunity to treat the chalenging population of LT recipients, along with PEG-IFN and ribavirin, particularly in those who may have failed PI-based therapy. K. Rajender Reddy, MD Amina Wirjosemito, MPH Tanya M. Pavri, BA Lorie Sinese, PA-C 1 Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA

Increasing capacity for skin surveillance in a transplant review clinic.

Non-melanoma skin cancers, which include basal and squamous cell cancers, are the most common human cancers. Because of their relatively low metastatic rate and relatively slow growth these are frequently underreported. The high prevalence and the frequent occurrence of multiple primary tumours in affected individuals make non-melanoma skin cancers an important but underestimated public health problem.

/pdf/genomics-of-basal-and-squamous-cell-carcinomas-1j7q1nf580.pdf

Venura Samarasinghe

Papers

Nonmelanoma skin cancer

Associations between ultraviolet radiation, basal cell carcinoma site and histology, host characteristics, and rate of development of further tumors.

Management of high-risk squamous cell carcinoma of the skin.

Increasing capacity for skin surveillance in a transplant review clinic.

Genomics of Basal and Squamous Cell Carcinomas