Non-Melanoma Skin Cancers Coverage from Every Angle
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AAD Guidelines for Non-Melanoma Skin Cancers

By: Joseph Fanelli
Posted: Tuesday, July 10, 2018

To assist in the management of primary cutaneous squamous cell and basal cell carcinomas, the American Academy of Dermatology (AAD) created evidence-based guidelines of care for patients with these non-melanoma skin cancers. The 2018 guidelines include recommendations for the prevention of recurrent non-melanoma skin cancers and strategies for treating metastatic squamous cell and basal cell cancers. The guidelines were published in the Journal of the American Academy of Dermatology by a committee co-chaired by Murad Alam, MD, of Northwestern University, and Christopher Bickakjian, MD, of the University of Michigan, Ann Arbor.

“Although many recommendations in these guidelines reaffirm common knowledge and current practice, other recommendations may remind clinicians of alternative therapeutic or preventive options when insufficient evidence is available to support new therapies or previously dogmatic practice patterns,” the authors commented.

The authors evaluated data from 188 studies published from 1960 to 2016 in developing the standards of care for the management of non-melanoma skin cancers. Among the recommendations was the use of punch, shave, and excisional biopsy techniques, as well as the use of radiation therapy for patients with low-risk cutaneous squamous cell carcinoma if surgery is not feasible or preferred. For low-risk cutaneous squamous cell cancers, the guidelines recommend standard excision with a 4-mm to 6-mm margin to a depth of the mid-subcutaneous adipose tissue with histologic margin assessment. A surgical excision with 4-mm clinical margins and histologic margin is recommended for basal cell cancers.

Topical therapies and photodynamic therapies are not recommended. The authors found insufficient evidence to make a recommendation on laser therapy or electronic surface brachiotherapy.

“Although many recommendations in these guidelines reaffirm common knowledge and current practice, other recommendations may remind clinicians of alternative therapeutic or preventive options when insufficient evidence is available to support new therapies or previously dogmatic practice patterns,” the authors commented.

The authors evaluated data from 188 studies published from 1960 to 2016 in developing the standards of care for the management of non-melanoma skin cancers. Among the recommendations was the use of punch, shave, and excisional biopsy techniques, as well as the use of radiation therapy for patients with low-risk cutaneous squamous cell carcinoma if surgery is not feasible or preferred. For low-risk cutaneous squamous cell cancers, the guidelines recommend standard excision with a 4 mm to 6 mm margin to a depth of the mid-subcutaneous adipose tissue with histologic margin assessment. A surgical excision with 4-mm clinical margins and histologic margin is recommended for basal cell cancers.



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