National Comprehensive Cancer Network

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NCCN Guidelines and Compendium Updated

Flash Update Sent September 28, 2011

NCCN has published updates to the NCCN Guidelines and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Non-Melanoma Skin Cancers: Basal and Squamous Cell Skin Cancers; Dermatofibrosarcoma Protuberans; and Merkel Cell Carcinoma. These NCCN Guidelines are currently available as Version 1.2012.

Basal Cell and Squamous Cell Skin Cancers

  • Basal Cell Skin Cancer
    • A new footnote was added that states “Extensive disease includes deep structural involvement such as bone, or perineural disease.”
    • A new footnote was added describing low-risk histologic subtypes as including nodular, superficial and other non-aggressive growth patterns such as keratotic, infundibulocystic, and fibroepithelioma of Pinkus.
    • Methyl aminolevulinate (MAL) was added as an example of photodynamic therapy that can be used in patients with low-risk, superficial basal cell skin cancer, where surgery or radiation is contraindicated or impractical.
  • Squamous Cell Skin Cancer
    • A new footnote was added that states “Extensive disease includes deep structural involvement such as bone, perineural disease or lymphovascular invasion.”
    • For the treatment of patients with regional recurrence or distant metastases, footnote “r” regarding clinical trials changed to “Cisplatin, either as a single agent or combined with 5FU, and EGFR inhibitors (eg, cetuximab), have each occasionally produced useful responses, but data supporting efficacy are limited.”
    • In regards to risk factors for recurrence, for low-risk patients the depth of lesion thickness changed from “< 4 mm” to “< 2 mm.”· For high-risk patients, the depth of lesion thickness changed from “≥ 4 mm” to “≥ 2 mm.”
    • Methyl aminolevulinate (MAL) was added as an example of photodynamic therapy that can be used in patients with low-risk, squamous cell carcinoma in situ, where surgery or radiation is contraindicated or impractical.
    • For the management of high-risk patients with precancers, diclofenac (category 2B) was added as another therapeutic option to consider when treating actinic keratoses.

 

Merkel Cell Carcinoma

  • Follow-up visits for physical exam including complete skin and complete lymph node exam changed from “every 1-3 mo for year 1; every 3-6 mo for year 2; annually thereafter” to “every 3-6 mo for 2 years; then every 6-12 mo thereafter.”
  • For Principles of Radiation, the following statement was added, “Palliation:  A less protracted fractionation schedule may be used in the palliative setting, such as 30 Gy in 10 fractions.”
  • Principles of Excision
    • The bullets under “Reconstruction” were revised.
    • Footnote 3 regarding complete circumferential and peripheral deep-margin assessment (CCPDMA) that states, “Usually performed as a meticulous, comprehensive en face permanent section examination of all surgical margins,” is new to the algorithm.

Dermatofibrosarcoma Protuberans

  • Adjuvant Treatment: The option “Consider adjuvant RT” was removed for patients with negative surgical margins after excision.
  • Therapy for recurrence, the third recommendation changed to “Imatinib mesylate in cases where disease is unresectable or unacceptable functional or cosmetic outcomes will occur.”
  • Principles of Excision
    • Under Goal, the following statement was added, “Some form of complete histologic surgical margin examination is recommended, whenever possible.”
    • The bullets under “Reconstruction” were revised.
    • Footnote 2 regarding complete circumferential and peripheral deep-margin assessment (CCPDMA) that states, “Usually performed as a meticulous, comprehensive en face permanent section examination of all surgical margins,” is new to the algorithm.

 
NCCN has published updates to the following chapters of the NCCN Compendium® to reflect updates to Version 1.2012 of the corresponding NCCN Guidelines:

Pancreatic Adenocarcinoma


For the complete updated version of these and all NCCN Guidelines, visit NCCN.org.