Interventions for non-metastatic squamous cell carcinoma of the skin.
BACKGROUND
Squamous cell carcinoma (SCC) is the second most common skin cancer, and is becoming increasingly common around the world. Left untreated, it may spread to other parts of the body, and, although the risk is low, it may ultimately lead to death. Surgical excision is the first line of treatment for most skin SCCs, although other forms of treatment are also used depending upon the nature and site of the tumour and individual participant factors. A multi-professional approach is therefore required for the management of people with this condition.


OBJECTIVE
To assess the effects of treatments for primary non-metastatic squamous cell carcinoma of the skin.


METHODS
In February 2010 we searched for relevant trials in The Cochrane Skin Group Specialised Register, The Cochrane Library (Issue 1, 2010), MEDLINE, EMBASE, PsycINFO, AMED, LILACS, and the ongoing trials registries.


METHODS
We only included randomised controlled trials (RCTs) of interventions for primary SCC of the skin. Inclusion criteria were: adults with one or more histologically proven primary SCCs of the skin which had not metastasised. The primary outcome measures were time to recurrence one to five years after treatment, and quality of life. Secondary outcomes included early treatment failure within six months, number of adverse events by the end of treatment, aesthetic appearance as assessed by the participant and clinician, discomfort to the participant during and after treatment, and death.


METHODS
Two authors (LL, FB-H) independently carried out study selection and assessment of methodological quality and data extraction.


RESULTS
One trial involving 65 people was included. This compared the time to recurrence in participants with aggressive skin SCC who were randomised to receive either adjuvant 13-cis-retinoic acid and interferon alpha after surgery with or without radiation treatment, or no adjuvant therapy after their initial treatment. There was no significant difference in time to recurrence of tumour between the two groups (hazard ratio 1.08, 95% confidence intervals 0.43 to 2.72).Most studies identified from the searches were excluded as they were either uncontrolled case series, did not include participants with invasive primary SCC, or included only participants with recurrent or metastatic disease.


CONCLUSIONS
Little evidence from RCTs comparing the efficacy of different interventions for primary cutaneous SCCs exists. There is a clear need for well-designed randomised studies in order to improve the evidence base for the management of this condition.
Lansbury
Louise
L
Centre of Evidence Based Dermatology, The University of Nottingham, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR.
Leonardi-Bee
Jo
J
Perkins
William
W
Goodacre
Timothy
T
Tweed
John A
JA
Bath-Hextall
Fiona J
FJ
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D012878:Skin Neoplasms / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*
J Am Acad Dermatol. 1994 May;30(5 Pt 1):774-8
8176018
Dermatol Surg. 2002 Mar;28(3):268-73
11896781
N Engl J Med. 1979 Dec 27;301(26):1410-2
514321
J Am Acad Dermatol. 1992 Jun;26(6):976-90
1607418
Br J Dermatol. 2002 Nov;147(5):950-6
12410706
Br J Dermatol. 2000 Dec;143(6):1224-9
11122025
Med J Aust. 2006 Jan 2;184(1):6-10
16398622
Hautarzt. 1989 Dec;40(12):774-7
2695500
Arch Dermatol. 1995 Feb;131(2):164-9
7857112
J Otolaryngol. 2007 Jun;36(3):148-55
17711768
Br J Dermatol. 1986 Dec;115(6):649-55
3801305
Br Med J. 1976 Jan 24;1(6003):188-90
55288
J Clin Oncol. 2001 Jan 1;19(1):231-8
11134217
Public Health Rep (1896). 1961 Apr;76:345-8
13685076
J Eur Acad Dermatol Venereol. 2003 Nov;17 Suppl 3:1-498
14519105
J Clin Oncol. 1984 Jul;2(7):756-61
6376719
J Am Acad Dermatol. 1987 Aug;17(2 Pt 1):233-8
3624562
Transplantation. 2000 Nov 27;70(10):1479-84
11118094
J Am Acad Dermatol. 1989 Aug;21(2 Pt 1):241-8
2768574
J Am Acad Dermatol. 2006 Nov;55(5):741-60; quiz 761-4
17052479
BMJ. 1996 May 11;312(7040):1215-8
8634569
Am J Epidemiol. 1996 Dec 1;144(11):1034-40
8942434
J Invest Dermatol. 2003 Aug;121(2):252-8
12880415
J Invest Dermatol. 2005 Mar;124(3):505-13
15737190
Transplantation. 1996 Mar 15;61(5):715-21
8607173
Am J Clin Oncol. 1991 Apr;14(2):133-41
1903023
J Natl Cancer Inst. 2006 Mar 15;98(6):389-95
16537831
N Engl J Med. 2001 Mar 29;344(13):975-83
11274625
J Ir Med Assoc. 1969 Feb;62(380):41-6
4895865
Lancet. 1995 Aug 12;346(8972):403-6
7623570
J Clin Oncol. 2007 May 20;25(15):1974-8
17513803
JAMA. 1995 Feb 1;273(5):408-12
7823387
Cancer Epidemiol Biomarkers Prev. 2000 Mar;9(3):291-7
10750668
Wien Med Wochenschr. 1968 Jan 13;118(2):34-6
5667723
Cancer. 1976 Jul;38(1):8-12
59628
J Am Acad Dermatol. 1999 Feb;40(2 Pt 1):177-86
10025742
Int J Cancer. 1998 Nov 23;78(5):587-93
9808527
Cancer. 1983 Jun 15;51(12 Suppl):2448-52
6850522
Cochrane Database Syst Rev. 2007 Jan 24;(1):CD003412
17253489
Transplantation. 1990 Mar;49(3):506-9
2316011
Circulation. 1981 Oct;64(4):669-73
7023743
N Engl J Med. 1992 Dec 3;327(23):1649-62
1435901
Lancet. 1996 Mar 16;347(9003):735-8
8602006
Arch Pathol Lab Med. 2003 May;127(5):589-92
12708903
Br J Dermatol. 2002 Apr;146 Suppl 61:1-6
11966724
J Photochem Photobiol B. 2001 Oct;63(1-3):8-18
11684447
J Am Acad Dermatol. 1992 Mar;26(3 Pt 2):467-84
1564155
JAMA. 1989 Oct 20;262(15):2097-100
2795783
Arch Dermatol. 1993 Oct;129(10):1286-90
8215493
J Invest Dermatol. 2002 Jun;118(6):1038-43
12060400
J Biomed Sci. 2006 Sep;13(5):657-66
16807664
Arch Dermatol. 1986 Oct;122(10):1124-6
3767398
Br J Plast Surg. 1987 Nov;40(6):598-604
3690092
Br J Dermatol. 2006 Mar;154(3):498-504
16445782
Surgery. 1980 Feb;87(2):177-83
6986671
Cancer. 1995 Jan 15;75(2 Suppl):667-73
7804993
Arch Dermatol. 1961 Oct;84:623-9
14485715
Arch Dermatol. 2004 Jan;140(1):26-32
14732656
J Am Acad Dermatol. 1981 Nov;5(5):535-43
7298919
Stat Med. 1998 Dec 30;17(24):2815-34
9921604
Epidemiology. 2007 Nov;18(6):776-84
17917604
J Surg Oncol. 1976;8(1):35-42
55523
Dermatol Surg. 1996 Mar;22(3):217-26
8599733
Br J Dermatol. 2002 Jan;146(1):18-25
11841362
Cancer Lett. 1991 Sep;59(3):183-92
1913614
Curr Opin Infect Dis. 2002 Apr;15(2):101-14
11964909