Non-melanoma Skin Cancer: Essentials for Oncologists

Cover
Half Title
Title Page
Copyright Page
Table of Contents
Foreword
Preface
Contributors
Chapter 1 Biology of Skin Invasion and Skin Metastases
	1.1 Introduction
	1.2 Basal Cell Carcinoma
		1.2.1 Clinical Aspects
		1.2.2 Biological Aspects of Pathogenesis and Metastasizing Process
			1.2.2.1 Molecular Alterations
			1.2.2.2 Other Biological Alterations
	1.3 Cutaneous Squamous Cell Carcinoma
		1.3.1 Clinical Aspects
		1.3.2 Biological Aspects of Pathogenesis and Metastasizing Process
			1.3.2.1 Molecular Alterations
			1.3.2.2 Other Biological Alterations
	1.4 Merkel Cell Carcinoma
		1.4.1 Clinical Aspects
		1.4.2 Biological Aspects of Pathogenesis and Metastasizing Process
			1.4.2.1 Molecular Alterations
			1.4.2.2 Other Biological Alterations
	References
Chapter 2 Chemoprevention and Photoprotection in Non-Melanoma Skin Neoplasms
	2.1 Introduction
	2.2 Non-Melanoma Skin Cancers
		2.2.1 Squamous Cell Carcinoma
		2.2.2 Basal Cell Carcinoma
	2.3 Chemoprevention Agents
		2.3.1 Vitamin A and Retinoids
			2.3.1.1 Systemic Acitretin
			2.3.1.2 Systemic Isotretinoin (13-cis-retinoic acid)
			2.3.1.3 Topical Tretinoin
			2.3.1.4 Dietary Vitamin A
		2.3.2 Nicotinamide
		2.3.3 Capecitabine
		2.3.4 Arachidonic Acid Pathway Inhibition
		2.3.5 Topical and Field Therapies
			2.3.5.1 5-fluorouracil
			2.3.5.2 Imiquimod
			2.3.5.3 Photodynamic Therapy
			2.3.5.4 Sodium Diclofenac
		2.3.6 Other Agents
			2.3.6.1 Vitamin D
			2.3.6.2 Difluoromethylornithine (DFMO)
			2.3.6.3 Polyphenol Pathway
		2.3.7 Future Targets: Microbiome and Glucocorticoids
	2.4 Photoprotection: Sunscreens
		2.4.1 Sun Protection Factor
		2.4.2 UVA Protection Labeling
	2.5 Conclusions
	References
Chapter 3 Aetiology and Epidemiology of Non-Melanoma Skin Neoplasms
	3.1 Introduction
	3.2 Chapter Content
		3.2.1 Global Epidemiology of NMSC
		3.2.2 High Latitude and NMSC
		3.2.3 UV and NMSC
		3.2.4 Vitamin D3 and Skin Cancer Risk
		3.2.5 Skin Pigmentation and Risk of NMSC
		3.2.6 Identification of At-Risk Patients from Genetic and Clinical Risk Scores
		3.2.7 Immune Suppression and NMSC
		3.2.8 NMSC Survival
		3.2.9 Sequalae of NMSC
		3.2.10 Cutaneous T-Cell Lymphoma
		3.2.11 Merkel Cell Carcinoma
		3.2.12 Adnexal Tumours
		3.2.13 Kaposi’s Sarcoma
	3.3 Conclusions
	References
Chapter 4 Clinical Presentation of Non-Melanoma Skin Cancer and Selected Dermatological Manifestations
	4.1 Introduction
	4.2 Basal Cell Carcinoma
	4.3 Cutaneous Squamous Cell Carcinoma
	4.4 Merkel Cell Carcinoma
	4.5 Cutaneous Malignant Appendageal Tumours
	4.6 Soft Tissue Tumours
	4.7 Primary Cutaneous Lymphomas
	4.8 Skin and Subcutaneous Metastases from Skin Tumours and Internal Malignancies
	4.9 Cutaneous Carcinogenesis Related to Viral Infections
	4.10 Cutaneous Carcinogenesis Related to Dermatological Treatments
	4.11 Genetic Conditions Predisposing to Skin Tumours and Contraindicating (Skin) Radiotherapy
	4.12 Conclusions
	References
Chapter 5 Dermatopathology of Keratinocyte Tumors
	5.1 Introduction
	5.2 Basal Cell Carcinoma (BCC)
		5.2.1 Histopathology
		5.2.2 Differential Diagnosis
		5.2.3 Molecular Pathology
	5.3 Carcinoma Precursors (Premalignant Keratosis)
		5.3.1 Actinic Keratosis
		5.3.2 Arsenical Keratosis
		5.3.3 PUVA Keratosis
	5.4 Cutaneous Squamous Cell Carcinoma (cSCC)
	5.5 cSCC in Situ (Bowen Disease)
		5.5.1 Histopathology
		5.5.2 Molecular Pathology
	5.6 Invasive cSCC
		5.6.1 Histopathology
		5.6.2 Differential Diagnosis
		5.6.3 Molecular Pathology
	5.7 Other Rare Skin Pathologies
	5.8 Conclusions
	Additional Reading
	References
Chapter 6 Dermatopathology of Merkel Cell Carcinoma, Cutaneous Lymphoma and Cutaneous Soft Tissue Sarcoma
	6.1 Introduction
	6.2 Merkel Cell Carcinoma
		6.2.1 Step 1: Confirming Neuroendocrine Differentiation and Excluding Other Tumour Types
		6.2.2 Step 2: Primary Cutaneous versus Metastatic Origin
		6.2.3 Step 3: Staging and Assessment of Prognostic Factors
		6.2.4 Merkel Cell Polyomavirus (MCPyV)
	6.3 Primary Cutaneous Lymphoma: An Overview
		6.3.1 Diagnostic Approach to Primary Cutaneous T Cell Lymphoma
		6.3.2 Mycosis Fungoides
		6.3.3 CD30 Lymphoproliferative Conditions
		6.3.4 Primary Cutaneous Anaplastic Large Cell Lymphoma (PCALCL)
		6.3.5 Lymphomatoid Papulosis (LyP)
		6.3.6 Examples of Other Subtypes of Cutaneous T Cell Lymphoma
		6.3.7 Diagnostic Approach to Primary Cutaneous B Cell Lymphoma
		6.3.8 Primary Cutaneous Marginal Zone Lymphoma (PCMZL)
		6.3.9 Primary Cutaneous Follicle Centre Cell Lymphoma (PCFCCL)
		6.3.10 Primary Cutaneous Diffuse Large B Cell Lymphoma, Leg Type (PCDLBCL-LT)
		6.3.11 Examples of Other Subtypes of Cutaneous B Cell Lymphoma
	6.4 Cutaneous Soft Tissue Sarcoma
		6.4.1 Basic Principles of Sarcoma Pathology
		6.4.2 Angiosarcoma
		6.4.3 Dermatofibrosarcoma Protuberans
		6.4.4 Pleomorphic Dermal Sarcoma
		6.4.5 Cutaneous Leiomyosarcoma (Atypical Smooth Muscle Tumour)
		6.4.6 Examples of Other Primary Cutaneous Sarcoma
	6.5 Conclusion
	Additional Reading
	References
Chapter 7 Imaging in Non-Melanoma Skin Neoplasms
	7.1 Introduction
	7.2 Chapter Content
		7.2.1 Dermoscopy
		7.2.2 Optical Coherence Tomography (OCT)
		7.2.3 Reflectance Confocal Microscopy (RCM)
		7.2.4 High Frequency Skin Ultrasound (HFUS) (20–100 MHz)
		7.2.5 Computed Tomography (CT)
		7.2.6 MRI
		7.2.7 PET-CT/Positron Emission Tomography Radiolabeled 18-Fluorodeoxyglucose (18-FDG)
	7.3 Image and Follow-Up
	7.4 Conclusions
	References
Chapter 8 Skin Biopsy for Non-Melanoma Skin Cancer
	8.1 Introduction
	8.2 Operating Facilities
		8.2.1 Operating Couch
		8.2.2 Lamp
		8.2.3 Emergency Equipment
		8.2.4 Haemostasis – Cautery and Diathermy
		8.2.5 Fume Extractors
	8.3 Procedure
	8.4 Lesion Identification and Marking
	8.5 Preoperative Assessment
	8.6 Consent
		8.6.1 Preoperative
		8.6.2 Post‐Operative
	8.7 Infection Control
	8.8 Local Anaesthetic
		8.8.1 Dose
	8.9 Punch Biopsy
	8.10 Shave Biopsy/Excision
	8.11 Curettage
	8.12 Incisional Biopsy
	8.13 Histological Sample
	8.14 Safety and Governance in Skin Surgery
	8.15 Avoiding Wrong‐Site Surgery
	Further Reading and Key Resources
	Useful Websites
	Useful Textbooks
Chapter 9 Staging Systems in Non-Melanoma Skin Neoplasms and Prognostication
	9.1 Introduction
	9.2 Cutaneous Squamous Cell Carcinoma
		9.2.1 Risk Factors for Poor Outcomes
		9.2.2 Staging Systems
			9.2.2.1 International Union Against Cancer
			9.2.2.2 The American Joint Committee on Cancer, Eighth Edition
			9.2.2.3 Brigham and Women’s Hospital Staging System
	9.3 Basal Cell Carcinoma
		9.3.1 Risk Factors for Poor Outcomes
		9.3.2 Staging Systems
			9.3.2.1 American Joint Committee on Cancer, Eighth Edition
			9.3.2.2 Brigham and Women’s Hospital Staging System
	9.4 Merkel Cell Carcinoma
	9.5 Cutaneous T Cell Lymphoma
	9.6 Cutaneous Soft Tissue Sarcoma
	9.7 Conclusion
	References
Chapter 10 Topical, Ablative and Light-Based Therapies for Non-Melanoma Skin Neoplasms
	10.1 Introduction
	10.2 Topical Therapies
		10.2.1 Imiquimod
		10.2.2 Fluorouracil (5-FU)
		10.2.3 Topical Corticosteroids
		10.2.4 Nitrogen Mustard
		10.2.5 Carmustine
		10.2.6 Topical Retinoids
	10.3 Curettage and Electrodesiccation (ED&C)
	10.4 Cryosurgery
	10.5 Photodynamic Therapy (PDT)
	10.6 Ultraviolet Phototherapy
	10.7 Laser
	10.8 Electrochemotherapy and Intralesional Agents
	References
Chapter 11 Primary Excision and Surgical Reconstruction in Non-Melanoma Skin Neoplasms
	11.1 Introduction
	11.2 Primary Excision
		11.2.1 Management of Non-Melanoma Skin Cancer
		11.2.2 Standard Surgical Excision
		11.2.3 Electrodessication and Curettage
	11.3 Surgical Reconstruction
		11.3.1 Principles of Plastic Surgery
	11.4 Basic Reconstruction Techniques
		11.4.1 Graft
			11.4.1.1 Skin Graft
			11.4.1.2 Cartilage Graft
			11.4.1.3 Bone Graft
		11.4.2 Flap
			11.4.2.1 Random Flap
			11.4.2.2 Axial Flap
			11.4.2.3 Perforator Flap
			11.4.2.4 Free Flap
		11.4.3 Other Reconstructive Techniques: Z-Plasty
	11.5 Pearls and Pitfalls in Facial Reconstruction
		11.5.1 Nose Reconstruction
		11.5.2 Eyelid Reconstruction
		11.5.3 Lip Reconstruction
		11.5.4 Cheek Reconstruction
	11.6 Conclusions
	References
Chapter 12 Mohs Surgery
	12.1 Introduction
	12.2 History
	12.3 Surgical Technique
		12.3.1 Surgical Excision
		12.3.2 Histopathological Examination
		12.3.3 Precise Mapping
		12.3.4 Wound Management/Reconstruction
	12.4 Slow-Mohs
	12.5 Indications
		12.5.1 General Indications
		12.5.2 Specific Indications
			12.5.2.1 Basal Cell Carcinoma (BCC)
			12.5.2.2 Squamous Cell Carcinoma (SCC)
		12.5.3 Rarer Tumours
			12.5.3.1 Dermatofibrosarcoma protuberans (DFSP)
	12.6 Preoperative Considerations
	12.7 Postoperative Evaluation and Considerations
		12.7.1 Healing by Secondary Intention
		12.7.2 Primary Closure
		12.7.3 Skin Grafting
		12.7.4 Local Flap Reconstruction
	12.8 Advantages of MMS
	12.9 Disadvantages of MMS
	12.10 Conclusions
	References
Chapter 13 Nodal Metastases in Head and Neck Skin Squamous Cell Carcinomas
	13.1 Introduction
	13.2 Patterns of Lymph Node Spread
	13.3 High-Risk Cancer
	13.4 Role of Imaging
	13.5 Management of Parotid Nodes
	13.6 Management of N
	13.7 Sentinel Lymph Node Biopsy
	13.8 Management of N+, Adjuvant and Salvage Strategies
	13.9 Conclusions
	References
Chapter 14 Radiobiology of the Skin and Non-Melanoma Skin Neoplasms
	14.1 Introduction
	14.2 Side Effects of Ionizing Radiation
	14.3 Pathophysiology and Mechanisms
		14.3.1 Radiation-Induced Cell Death
		14.3.2 Radiosensitivity of Stem Cells and Progenitors
		14.3.3 Inflammatory Response
		14.3.4 Radiation-Induced Fibrosis
		14.3.5 TGF-β and Principal Signaling in Radiation Fibrosis
		14.3.6 Damage to the Vasculature
		14.3.7 Wound Healing in Previously Irradiated Skin
		14.3.8 Skin Cancerogenesis
	14.4 Effect of Total Dose and Fractionation
	14.5 Reirradiation
	14.6 Brachytherapy
	14.7 FLASH Radiotherapy
	14.8 Conclusions
	References
Chapter 15 Medical Physics and Planning in Skin Radiotherapy and Brachytherapy
	15.1 Introduction
	15.2 Brachytherapy
		15.2.1 Surface Applicators in Brachytherapy
		15.2.2 HDR Surface Brachytherapy Using Flap, Mold, and Custom-Made Surface Applicators
			15.2.2.1 Pre-Treatment Preparation and Simulation
			15.2.2.2 Treatment Planning
			15.2.2.3 Treatment Delivery
		15.2.3 Interstitial Applicators
			15.2.3.1 Applicator Placement
			15.2.3.2 Simulation and Planning
			15.2.3.3 QA Considerations
		15.2.4 Alpha DaRT
	15.3 External Beam Radiotherapy
		15.3.1 Electrons
			15.3.1.1 Electron Percentage Depth Doses (PDDs)
			15.3.1.2 Changes with Beam Energy
			15.3.1.3 Field Size and Shaping
			15.3.1.4 Internal Shielding
			15.3.1.5 Clinical Plan Complexities
			15.3.1.6 Clinical Electron Beam Planning
		15.3.2 Megavoltage Treatment – High-Energy Photons
			15.3.2.1 Treatment Technique
		15.3.3 Kilovoltage Treatment – Low Energy Photons
			15.3.3.1 Treatment
	15.4 Conclusions
	References
Chapter 16 Radiotherapy to the Primary in Keratinocyte and Merkel Cell Cancers and to Skin Metastases
	16.1 Introduction
	16.2 History of Radiotherapy in Dermatology and Dermato-Oncology
	16.3 Modern Radiotherapy in NMSC
	16.4 Basal Cell Carcinoma
		16.4.1 Definitive RT
		16.4.2 Adjuvant RT
	16.5 Squamous Cell Carcinoma
		16.5.1 Definitive RT
		16.5.2 Adjuvant RT
	16.6 Perineural Invasion
	16.7 Contraindications
	16.8 Primary Merkel Cell Carcinoma and Postoperative Local RT
	16.9 Skin Appendageal (Adnexal) Tumours
	16.10 Palliative Radiotherapy for Skin Cancer and Skin Metastases
	16.11 Conclusions
	References
Chapter 17 Post-Operative Radiation Therapy for Keratinocyte Carcinoma and Merkel Cell Carcinoma
	17.1 Introduction
	17.2 Squamous Cell Carcinoma and Basal Cell Carcinoma
		17.2.1 Defining High Risk for SCC
		17.2.2 Simulation Technique (Porceddu et al. 2020)
		17.2.3 Radiation Volume Considerations (Likhacheva et al. 2020, Porceddu et al. 2018)
			17.2.3.1 Radiation Volume for the Primary Tumor Bed
			17.2.3.2 Radiation Volume for the Nodal Bed
		17.2.4 Radiation Techniques, Dose, and Fractionation Schemes for External Beam Radiation (Porceddu et al. 2020)
	17.3 Merkel Cell Carcinoma (MCC)
		17.3.1 Radiation Volume Considerations
			17.3.1.1 Radiation Volume for the Primary Tumor Bed (Poulsen et al. 2003)
			17.3.1.2 Radiation Volume for the Nodal Bed
		17.3.2 Radiation Technique, Dose, and Fractionation Schemes
	17.4 Radiation for Palliation of Skin Cancers
		17.4.1 SCC and BCC
		17.4.2 MCC
	17.5 Conclusions
	References
Chapter 18 Experiences when Irradiating Grafts and Flaps for Skin Cancer
	18.1 Introduction
	18.2 Assessing the Patient
		18.2.1 History
		18.2.2 Examination
		18.2.3 PORT after Simple Closure
	18.3 About Grafts and Flaps
		18.3.1 PORT after Grafts and Flaps
		18.3.2 Specific Radiation Prescription Considerations When Treating around Grafts and Flaps
		18.3.3 RT volume
		18.3.4 RT Modality
		18.3.5 RT Dose and Fractionation
		18.3.6 When Immediate PORT Is Not Given Due to Concerns of Graft or Flap Survival
	18.4 Experiences during RT Delivery
		18.4.1 Flaps May Not Exhibit Acute Effects
		18.4.2 Acute Skin Toxicity Can Move According to Gravity
			18.4.2.1 Transplanted skin may have different radiation sensitivity to that of its new environment
		18.4.3 Late Toxicity
	18.5 Conclusion
	Acknowledgments
	References
Chapter 19 Skin Brachytherapy (Contact and Interventional Radiotherapy)
	19.1 Introduction
	19.2 Brachytherapy (BT) in General Terms
	19.3 When to Choose Primary Skin BT Instead of Primary Surgery
	19.4 Advantages of BT over EBRT
	19.5 Indications for Skin BT
	19.6 Contraindications for Skin BT
	19.7 Modes of Treatment in Skin BT
	19.8 Techniques Used in Superficial BT
		19.8.1 Multicatheter Flaps
		19.8.2 Personalized Custom Moulds
		19.8.3 3-D Printed Moulds
		19.8.4 Surface Shielded Applicators
		19.8.5 Electronic BT Applicators
	19.9 Techniques Used in Interstitial BT
		19.9.1 Flexible Catheters
		19.9.2 Rigid Needles
		19.9.3 Less Frequently Used Techniques
	19.10 Radiation Doses and Schedules in Skin BT
	19.11 Side Effects of Skin BT
	19.12 Local Control and Cosmetic Outcomes in Skin BT
	19.13 Conclusions
	References
Chapter 20 Early and Late Toxicity in Skin Radiotherapy
	20.1 Introduction
	20.2 Acute and Late Effects of Superficial Radiotherapy for Skin Cancers
		20.2.1 Dermatitis
		20.2.2 Alopecia
		20.2.3 Ocular and Periocular Toxicity
		20.2.4 Nasal Mucositis and Epitaxis
		20.2.5 Necrosis
		20.2.6 Fatigue
	20.3 Scoring Normal Tissue Damage
		20.3.1 Scoring Systems Used
		20.3.2 Patient-Reported Outcome Measures and Quality of Life
	20.4 Management Strategies
		20.4.1 Topical Emollients and Hydration
		20.4.2 Topical Steroids
		20.4.3 Dressings
		20.4.4 Additional Interventions
			20.4.4.1 Topical Antimicrobials and Oral Antibiotics
			20.4.4.2 Analgesia
			20.4.4.3 Topical Eye Lubricants
		20.4.5 Additional Management Strategies for Late Effects
			20.4.5.1 Pentoxifylline
			20.4.5.2 Superoxide Dismutase
			20.4.5.3 Hyperbaric Oxygen Therapy
			20.4.5.4 Laser Therapy
		20.4.6 Patient Education
	20.5 Radiation Therapists’ Involvement
	20.6 Conclusion
	References
Chapter 21 Combined Radiotherapy and Systemic Treatment in Keratinocyte and Merkel Cell Carcinomas
	21.1 Introduction
	21.2 The Special Situation of the Skin Patient and Treatment Intent
	21.3 Principles of Combining Skin RT and Systemic Treatment for Skin Cancer
	21.4 New Non-Cytotoxic Systemic Therapies
	21.5 Scenario 1: When a Systemic Treatment Is Given Concurrently to Increase the Efficacy of the RT in Skin Cancer
		21.5.1 RT and Systemic Therapy with Cutaneous Squamous Cell Carcinoma (cSCC)
			21.5.1.1 Cytotoxic Chemotherapy (CCT)
			21.5.1.2 Non-Cytotoxic Systemic Therapies
	21.6 RT and Systemic Therapy with Basal Cell Carcinoma
	21.7 RT and Systemic Therapy with Merkel Cell Carcinoma
		21.7.1 Concurrent Systemic Treatment with RT in Merkel Cell Carcinoma
	21.8 Scenario 2: When a Patient Is receiving RT for Skin but Is Also Receiving Systemic Treatment for a Different Cancer
	21.9 Scenario 3: When a Patient Is Receiving RT for Skin and Is Also on Systemic Treatment for Non-Cancer Conditions
	21.10 Conclusion
	References
Chapter 22 Radiotherapy in Cutaneous Lymphomas and Cutaneous Sarcomas
	22.1 Cutaneous Lymphomas
	22.2 Primary Cutaneous T Cell Lymphomas
		22.2.1 Mycosis Fungoides
		22.2.2 Sézary Syndrome
		22.2.3 Primary Cutaneous CD30-Positive T Cell Lymphoproliferative Disorders
		22.2.4 Subcutaneous Panniculitis-Like T Cell Lymphomas (SPTCL)
		22.2.5 Primary Cutaneous Extranodal NK/T Cell Lymphoma, Nasal Type
		22.2.6 Primary Cutaneous Peripheral T Cell Lymphomas, Rare Subtypes
	22.3 Primary Cutaneous B Cell Lymphomas
		22.3.1 Primary Cutaneous Marginal Zone Lymphoma and Primary Cutaneous Follicle Centre Lymphoma
		22.3.2 Primary Cutaneous Diffuse Large B Cell Lymphoma, Leg Type
	22.4 Cutaneous Sarcomas
	22.5 Dermatofibrosarcoma Protruberans (DFSP)
	22.6 Dermal Sarcoma and Atypical Fibroxanthomas
	22.7 Cutaneous Leiomyosarcoma (LMS)
	22.8 Kaposi’s Sarcoma
		22.8.1 AIDS-Related Kaposi’s Sarcoma (Epidemic)
		22.8.2 Classical Kaposi’s Sarcoma
		22.8.3 Endemic Kaposi’s Sarcoma
		22.8.4 Iatrogenic Kaposi’s Sarcoma
	22.9 Angiosarcoma
	References
Chapter 23 Treatment of Locally Advanced and Metastatic Skin Carcinomas
	23.1 Introduction
	23.2 Basal Cell Carcinoma (BCC)
		23.2.1 Advanced BCC
		23.2.2 Treatment Options for Advanced BCC
			23.2.2.1 Hedgehog Inhibitors (HHI)
			23.2.2.2 Immunotherapy
			23.2.2.3 Chemotherapy
		23.2.3 Neoadjuvant Treatment
		23.2.4 Adjuvant Treatment
	23.3 Cutaneous Squamous Cell Carcinoma (cSCC)
		23.3.1 Advanced cSCC
		23.3.2 Treatment Options for Advanced cSCC
			23.3.2.1 Surgery and Radiotherapy
			23.3.2.2 Systemic Treatments for Advanced cSCC
	23.4 Future Strategies
	23.5 Conclusions
	References
Chapter 24 Systemic Treatment of Merkel Cell Carcinoma and Dermal Sarcomas
	24.1 Introduction
	24.2 Systemic Treatment of Merkel Cell Carcinoma
		24.2.1 Chemotherapy for Merkel Cell Carcinoma
			24.2.1.1 Background
			24.2.1.2 Chemotherapy Regimens
			24.2.1.3 Chemotherapy Outcomes
			24.2.1.4 Chemotherapy Toxicities
		24.2.2 Immunotherapy for Merkel Cell Carcinoma
			24.2.2.1 Background
			24.2.2.2 Mechanism of Action of Immune Checkpoint Inhibitors
			24.2.2.3 Anti PD-L1 Antibody – Avelumab
			24.2.2.4 Anti-PD1 Antibodies – Pembrolizumab and Other Anti-PD-1 Antibodies
			24.2.2.5 Immune-Related Adverse Events (irAEs)
		24.2.3 Future Systemic Treatments for Merkel Cell Carcinoma
	24.3 Systemic Treatment of Dermal Sarcomas
		24.3.1 Overview
		24.3.2 Principles of Chemotherapy for STS, Including Dermal Sarcomas
		24.3.3 Histology-Specific Treatments for Dermal Sarcomas
			24.3.3.1 Dermatofibrosarcoma Protuberans (DFSP)
			24.3.3.2 Cutaneous Leiomyosarcoma (cLMS)
			24.3.3.3 Cutaneous Angiosarcoma (cAS)
			24.3.3.4 Cutaneous Kaposi’s Sarcoma (cKS)
			24.3.3.5 Cutaneous Undifferentiated Pleomorphic Sarcoma (cUPS)
			24.3.3.6 Atypical Fibroxanthoma (AFX)
	24.4 Conclusion
	References
Chapter 25 Systemic Treatment of Cutaneous Lymphomas
	25.1 Cutaneous Lymphomas
	25.2 Diagnosis and Staging
	25.3 General Treatment Principles
	25.4 Systemic Treatments of Primary Cutaneous T-Cell Lymphoma
		25.4.1 Retinoids
		25.4.2 Interferons
		25.4.3 Extracorporeal Photopheresis
		25.4.4 Chemotherapy
			25.4.4.1 Methotrexate
			25.4.4.2 Gemcitabine
			25.4.4.3 Doxorubicin
			25.4.4.4 Other Agents
		25.4.5 Targeted Therapies
			25.4.5.1 Histone Deacetylase Inhibitors
			25.4.5.2 Brentuximab Vedotin
			25.4.5.3 Mogamulizumab
			25.4.5.4 Alemtuzumab
		25.4.6 Bone Marrow Transplant
	25.5 Systemic Treatment of Primary Cutaneous B-Cell Lymphoma
		25.5.1 Rituximab
	References
Chapter 26 Management of Skin Cancer in the Immunocompromised Patient
	26.1 Introduction
	26.2 Chapter Content
		26.2.1 Renal Transplantation-Induced Skin Cancer
		26.2.2 Pathogenesis of cSCC in Transplant Recipients
		26.2.3 Prevention of cSCC
		26.2.4 Diagnosis
		26.2.5 Management
		26.2.6 Follow-Up
		26.2.7 BCC in the Immunocompromised Patient
		26.2.8 Melanoma in the Immunocompromised Patient
		26.2.9 HIV and Kaposi’s Sarcoma
	26.3 Conclusions
	References
Chapter 27 Dermatology and Oncology in Skin of Colour
	27.1 Introduction
	27.2 Epidemiology of Skin Neoplasms in Skin of Colour
		27.2.1 Black Skin
		27.2.2 Asian Skin
		27.2.3 White-Hispanic and Mixed-Race Skin
	27.3 Radiotherapy Skin Reactions in Skin of Colour
		27.3.1 Black Skin
		27.3.2 Asian Skin
		27.3.3 White-Hispanic and Mixed-Race Skin
	27.4 Conclusion
	Bibliography
Chapter 28 Skin Cancer Management in the Elderly and Frail
	28.1 Introduction
		28.1.1 Ageing Demographics
		28.1.2 Evidence Base for Older People with Cancer
		28.1.3 Under- versus Over-Treatment
	28.2 Physiology of Ageing
		28.2.1 What is Frailty?
		28.2.2 Why Is It Important in Skin Cancer?
	28.3 How Assessed?
		28.3.1 Screening (Screening Tools) and CGA (Different Domains)
		28.3.2 Treatment Options for Older Adults
		28.3.3 Specific Considerations for Older Patients Presenting for Treatment
		28.3.4 Radical Radiation Therapy
		28.3.5 Radical Brachytherapy and Skin Cancer: Advantages for Older/Frail Patients
		28.3.6 Palliative Treatments
	28.4 Conclusions
	References
Chapter 29 Quality of Life and Cosmetic Assessment in Skin Cancer Treatment
	29.1 Introduction
	29.2 Quality of Life
	29.3 Cosmetic Outcome
	29.4 Clinical Nurse Specialist (CNS) Perspective
	29.5 Conclusions
	References
Chapter 30 Emerging Trends and Future Directions in Skin Cancer Management
	30.1 Introduction
	30.2 Predicting the Scale of the Problem: The Importance and Challenges of NMSC Registration
	30.3 Non-Melanoma Skin Cancer Screening: Universal, Targeted or Not Justified?
	30.4 Artificial Intelligence in NMSC Management: From Diagnosis to Personalised Medicine
		30.4.1 Clinical Applications of AI in NMSC Management
		30.4.2 Barriers to Clinical Implementation of AI Applications
	30.5 Imaging and NMSC Management: Non-Invasive Technologies and Radiomics
		30.5.1 Non-Invasive Skin Imaging Technologies
		30.5.2 Medical Imaging and Radiomics
	30.6 Predicting NMSC Risk
		30.6.1 Patient Level Risk Stratification: Polygenic Risk Scores
		30.6.2 Tumour Level Risk Stratification
			30.6.2.1 Histological staging – Limitations and the Potential of Digital Pathology and AI
			30.6.2.2 Molecular Prognostic Tools
	30.7 Medical and Surgical Management of NMSC: Addressing Current Knowledge Gaps
		30.7.1 Surgical Modalities for Primary NMSC
		30.7.2 Adjuvant and Neoadjuvant Therapy for High-Risk NMSC
		30.7.3 Advanced and Metastatic Disease: Targeted and Immunotherapeutic Approaches
			30.7.3.1 Targeted Therapies
			30.7.3.2 Immunotherapy
		30.7.4 NMSC Prevention
	30.8 Radiotherapy: Contemporary and Potential Future Directions in NMSC Management
		30.8.1 Brachytherapy
		30.8.2 Cobra Project Brachytherapy Data Sharing
	30.9 Conclusions
	References
Index