NCCN Announces Guideline Updates for Various Skin Cancers

Submitted by admin5 on Thu, 09/21/2017 - 17:28

The National Comprehensive Cancer Network (NCCN) released updated guidelines for the treatment of basal cell skin cancer, squamous cell skin cancer, and merkel cell carcinoma.

The new recommendations for basal cell skin cancer involve changes to primary and secondary treatments, as well as risk factors for recurrence. In the primary treatment of low-risk disease, standard excision is still recommended, but “if lesion can be excised” was removed for tumors with 4 mm clinical margins and “postoperative margin assessment” was added. Low-risk disease adjuvant treatment for positive margins after standard excision was also amended: complete “circumferential” margin assessment was added to Mohs micrographic surgery or resection.

High-risk disease may also be treated in the primary setting with Mohs micrographic surgery or resection with complete circumferential margin assessment. However, for patients with positive margins after either procedure, multidisciplinary tumor board consultation should no longer consider a hedgehog pathway inhibitor. The same recommendation is given for patients with residual disease and for whom further surgery or radiation therapy are contraindicated.

As for risk factors for recurrence, “metatypical” tumors were removed from high-risk, aggressive growth pattern factor.

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Recommendations for squamous cell skin cancer are similar to those for basal cell disease. In the primary treatment of low-risk disease, standard excision is still recommended, but “if lesion can be excised” was removed for tumors with 4-6 mm clinical margins and “postoperative margin assessment” was added. Low-risk disease adjuvant treatment for positive margins after standard excision was also amended: complete “circumferential” margin assessment was added to Mohs micrographic surgery or resection, just as in basal cell skin cancer.

In high-risk disease, the same recommendations are added as in basal cell disease.

The new recommendations for merkel cell carcinoma provide multiple updates for the use of whole body imaging. To identify and quantify regional and distant metastasis—as well as to evaluate the extent of lymph node or visceral organ involvement—whole body FDG PET/CT scans are now recommended. As for the Principles of Systemic Therapy section, nivolumab (category 2A) and avelumab (category 2A) were added as options for disseminated disease.—Zachary Bessette