Current Cancer Therapy Reviews (v.12, #2)

Meet Our Editorial Board Member by Dennis K. Watson (77-77).

Merkel Cell Carcinoma - Current State and the Future by Patricia Tai, Khanh Vu, Vamsee Torri, Derek Suderman, Arbind Dubey (79-86).
Merkel cell carcinoma (MCC) is a rare type of skin cancer. It is the first human cancer known to be associated with a polyomavirus. The vast majority of publications are case reports. Our goal is to discuss practical suggestions for the treatment, based on our clinical experience and a review of the literature. Surgery is the initial treatment of choice. Radiotherapy is used as primary or adjuvant treatment. The chemotherapeutic approach follows that of neuroendocrine neoplasms, using cisplatin and etoposide. Researchers are looking into other active drugs which have been used for melanoma including temozolomide, and PD-1 inhibitors. Scientists are studying mutations in MCC to identify potential targets for more effective systemic treatments. We hope this review will be useful for clinicians to apply current principles and provide food for thought to improve treatment outcomes.

Recurrent Scalp Lesions from Glioblastoma: Case Report and Literature Review by Alisson R. Teles, Marcelo R. Roxo, Marcus V.M. Collares, Kelly R. Neves, Eduardo Cambruzzi, Marcelo P. Ferreira (87-93).
In spite of being the most common primary brain tumor in adults, extracranial metastases are rarely seen during the lifetime of patients with glioblastoma. Majority of metastases occur in chest, abdomen, bone, lymph nodes, and spinal cord. Scalp lesions from glioblastoma are extremely rare, with only few cases reported in the literature. Scalp glioblastomas have been reported to occur via direct extension of the intracranial tumor across the craniotomy defect or as a nodule along the surgical approach distinct from the recurrent intracranial tumor. In the latter presentation, the mechanisms involved are supposed to be direct tumor cell implantation during the primary surgery or hematogenous dissemination of tumor cells. We report a case of a 60-year-old man who presented recurrent scalp lesions from glioblastoma. This illustrative case highlights the importance of suspicious of disease spread in patients with glioblastoma who present with scalp lesions after surgery. Also, we review the literature concerning epidemiology, pathogenesis, treatment, and prognosis.

Pattern of Care for Skin Cancers - Canada and France by Khanh Vu, Patricia Tai, Avi Assouline, Claude Krzisch (94-98).
Canada and France do not have a lot of sunshine but skin cancer is still the most common tumor. The majority of the population is white. The pattern of care for skin cancers is similar to the delivery of care for other cancers. No extra resources are allocated to skin cancer. The general practitioners are the first care providers for skin cancers. Excision or biopsy of the skin lesion establishes the diagnosis. If residual disease is present, further treatments are provided by general practitioners, dermatologists, general or plastic surgeons and radiation oncologists. If adjuvant or definitive treatments are required, patients are referred to cancer services to consider radiotherapy, chemotherapy, targeted therapy or immunotherapy. Both Canada and France have waiting lists for referrals.

Treatment Decisions for Non-Melanoma Skin Cancer (NMSC) by Khanh Vu, Patricia Tai, Arbind Dubey, Rashmi Koul, Elizabeth A. Barnes (99-109).
Selection of treatment for non-melanoma skin cancer (NMSC) takes into account many factors, including different host, tumor and treatment factors. Examples of these factors are presented. Ultimately the treatment decision is affected by the availability of surgical, dermatological, radiotherapeutic expertise and supportive resources. Different treatment options are discussed in this review. After appropriate education and guidance, patients' wish should take the first priority. The treatment of skin cancer requires experience, and discussion in multidisciplinary team meetings is strongly encouraged.

Radiotherapy for Non-Melanoma Skin Cancer by Khanh Vu, Patricia Tai, Joseph S.K. Au (110-123).
This review summarizes techniques, indications and contraindications for radiotherapy for non-melanoma skin cancer. Different radiotherapy techniques including brachytherapy, electron treatments, photon treatments with electronic brachytherapy, linear accelerator, and orthovoltage machines are available. Radiation oncologists have to select the best technique for different sites and scenarios. Details of specific radiotherapeutic preparation and clinical care discussed in this review will be of great help to the reader at the point of care.

Photodynamic therapy has many treatment applications for malignant and premalignant lesions of the skin. The basic principle involves application of a photosensitizer followed by exposure of the target tissues to light. 5-aminolevulinic acid is a natural occurring compound in the heme biosynthesis pathway. Its metabolite protoporphyrin IX is a photosensitizer that has the ability to selectively damage premalignant, malignant, and certain abnormal tissues, rendering its wide application for use in actinic keratosis, Bowen's disease, and basal cell carcinoma. Adequate lesion preparation is critical for successful treatment. Ongoing research on the clinical use of photodynamic therapy, its potential impact in oncological patient management and on public health and cost is continuously evolving. The perfection of this light therapy on patient treatment awaits results of future clinical trials.