National Comprehensive Cancer Network

About NCCN

NCCN Flash Update: NCCN Guidelines® & NCCN Compendium® for Non-Melanoma Skin Cancers

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) Non-Melanoma Skin Cancers. These NCCN Guidelines® are currently available as Version 1.2018.

  • Basal Cell Skin Cancer
    • Adjuvant Treatment for high-risk localized disease (BCC-3)
      • For patients with positive margins after Mohs micrographic surgery or resection with complete circumferential margin assessment, the following statement was revised: “Multidisciplinary tumor board consultation (consider a hedgehog pathway inhibitor or clinical trial)”
      • For patients with positive margins treated with Mohs micrographic surgery or resection with complete margin assessment or RT, the following statement was revised: “If residual disease is present, and further surgery and RT are contraindicated, consider multidisciplinary tumor board consultation (consider a hedgehog pathway inhibitor or clinical trial)”
    • Principles of Treatment for Basal Cell Skin Cancer (BCC-B)
      • 6th bullet was amended: “Use of nicotinamide has been may be effective in reducing the development of basal cell skin cancers.”
    • Principles of Radiation Therapy page for Basal Cell Skin Cancer was extensively revised. (BCC-C)
  • Squamous Cell Skin Cancer
    • Local, Low-risk Squamous Cell Skin Cancer (SCC-2)
      • Primary Treatment
        • A statement was amended: "Standard excision If lesion can be excisedwith 4–6 mm clinical margins and postoperative margin assessmentand second intention healing, linear repair, or skin graft"
      • Adjuvant Treatment
        • Footnote "i" was amended: "Excision with complete circumferential peripheral and deep margin assessment (CCPDMA) with frozen orpermanent section analysis or intraoperative frozen section analysis isan alternative to Mohs micrographic surgery."
    • Local, High-Risk Squamous Cell Skin Cancer (SCC-3)
      • Primary Treatment
        • A statement was amended: "Standard excision with wider surgical margins and postoperative margin assessment and with linear or delayed repair are recommended when excising high-risk tumors with standard excision".
        • Footnote "k" was amended: "In certain high-risk lesions, consider sentinel lymph node mapping, although the benefit of and indication forthis technique has yet to be proven."
      • Adjuvant Treatment
        • For patients with positive margins after Mohs micrographic surgery or resection with complete circumferential margin assessment, the following statement was amended: "RT and/or multidisciplinary tumor board consultation to discuss chemoradiation or clinical trial".
        • For patients with negative margins after standard excision, the following statement was added: "If extensive perineural or large-nerve involvement, recommend adjuvant RT"
        • For patients with positive margins after standard excision, subsequently treated with Mohs micrographic surgery or resection with complete circumferential margin assessment or RT, the following statement was added: "If residual disease is present, and further surgery is contraindicated, consider multidisciplinary tumor board consultation and discuss chemoradiation or clinical trial"
    • Recurrence/Disease progression title was revised. (SCC-6)
      • Footnote "x" for "Multidisciplinary tumor board consultation" was amended: "Clinical trials (eg, immune checkpoint inhibitors) are recommended for metastatic cutaneous squamous cell carcinoma. If the patient is a solid organ transplant recipient receiving immunosuppressive therapy, consider dose reduction of the immunosuppressive agent(s) and/or minimizing the doses of calcineurin inhibitors and/or antimetabolites in favor of mTOR inhibitors where appropriate. Cisplatin, either as a single agent or combined with 5-FU, and EGFR inhibitors (eg, cetuximab) have each occasionally produced useful responses, but data supporting efficacy are limited. Consider palliative RT/surgery for symptomatic sites. SBRT may also be considered in select patients."
    • Principles of Treatment for Squamous Cell Skin Cancer (SCC-B)
      • 6th bullet added: “Use of nicotinamide may be effective in reducing the development of squamous cell skin cancers”.
    • Principles of Radiation Therapy for Squamous Cell Skin Cancer page was extensively revised. (SCC-C)
    • Identification and Management of High-Risk Patients (SCC-D)
      • Treatment of Precancers title was amended: “Treatment Of Precancers (Diffuse Actinic Keratoses, Field Cancerization)” (SCC-D [2 of 3])
        • 1st sub-bullet was amended: "Accepted treatment modalities include cryotherapy, topical 5-fluorouracil, topical imiquimod, topical ingenolmebutate, photodynamic therapy (eg, amino levulinic acid [ALA], porfimer sodium), and curettage and electrodesiccation (C&E)."
      • Prevention (SCC-D [3 of 3])
        • 1st bullet was amended: “Use of nicotinamide or oral retinoids (acitretin, isotretinoin) has been effective in reducing the development of actinic keratoses and squamous cell carcinoma in some high-risk patients. Side effects of oral retinoids may be significant. Therapeutic effects disappear shortly after cessation of the drug. Oral retinoids are teratogenic and must be used with extreme caution in women of child-bearing potential. Topical retinoids have been shown not to reduce development of actinic keratosis or SCC."
        • 2nd bullet was added: "Use of nicotinamide may be effective in reducing the development of squamous cell skin cancers."
    • The AJCC TNM Staging System for Squamous Cell Carcinoma was updated to the 8th edition. (ST-1) (ST-2)
  • Dermatofibrosarcoma Protuberans
    • Adjuvant Treatment (DFSP-2)
      • For positive surgical margins pathway statement was amended: “RT (preferred) or Consider imatinib mesylate and Multidisciplinary consultation
    • Therapy For Recurrence/Metastasis (DFSP-2)
      • For the recurrence pathway a statement was amended: “Re-resection if feasible (preferred) and consider adjuvant RT...”
      • Footnote “h” was added: “For negative margins, RT is not recommended. RT can be considered for treatment of positive margins if not given previously and further resection is not feasible.”
      • For the metastasis pathway a statement was removed: “Consider clinical trial, imatinib mesylate, chemotherapy, RT, or resection as feasible, given the specific clinical circumstances”
      • Footnote “j” was added to “Multidisciplinary Consultation”: “See NCCN Guidelines for STAGE IV Soft Tissue Sarcoma (EXTSARC-5)”
      • Footnote was removed: “AIM (doxorubicin/ifosfamide/mesna) regimen or single-agent therapy with doxorubicin, ifosfamide, epirubicin, gemcitabine, dacarbazine, liposomal doxorubicin, temozolomide, vinorelbine, or pazopanib may be considered.”
      • Footnote “f” for RT was amended: “50–60 Gy for close-to-positiveindeterminate or positive margins, and up to 66 Gy for gross tumor (2 Gy fractions per day). Fields to extend widely beyond surgical margin (eg, 3–5 cm) when clinically feasible.”
    • Principles of Excision (DFSP-B)
      • Under Varied Approaches, footnote “1” for Mohs micrographic surgery was amended: “Mohs micrographic surgery is used primarily in DFSP to ensure complete removal and clear margins, and secondarily for its tissue-sparing capabilities. When Mohs micrographic surgery with margin assessment is being performed and the preoperative biopsy is considered insufficient for providing all the staging information required to properly treat the tumor, consider submission of the central specimen for permanent vertical sections.”
      • Under Varied Approaches, footnote “2” for CCPDMA was amended: “UsuallyShould be performed as a meticulous, comprehensive en face permanent section examination of all surgical margins."
  • Merkel Cell Carcinoma
    • Preliminary Workup (MCC-1)
      • Footnote "a" was amended: "The value of baseline MCPyV (Merkel cell polyomavirus) serology for prognostic significance and to track disease recurrence is being evaluated. Quantitation of MCPyV oncoprotein antibodies may be considered as part of initial workup; sero-negativepatients may have a higher risk of recurrence; in sero-positive patients, a rising titer may be an early indicator of recurrence." (Also for MCC-5)
    • Principles of Systemic Therapy (MCC-D)
      • Under Disseminated Disease
        • Pembrolizumab was moved from under "as clinical judgment dictates."
        • Nivolumab (category 2A) and avelumab (category 2A) were added as systemic therapy options.
        • 4th bullet was amended: "As clinicaljudgement indicates for patients with contraindications to checkpoint immunotherapy"
      • Footnote "2" was amended: "Preliminary data from non-randomized trials in patients with MCC demonstrate that response rates for pembrolizumab are similar to those previously reported for chemotherapy rates of durable response are improved with PD-1/PD-L1 blockade compared with cytotoxic therapy. The safety profiles for checkpoint immunotherapies are significantly different from cytotoxic therapies. Consult prescribing information for recommendations on detection and management of immune-related adverse events associated with checkpoint immunotherapies. Clinician and patient education is critical for safe administration of checkpoint immunotherapies."
    • The AJCC TNM Staging System for Merkel Cell Carcinoma was updated to the 8th edition. (ST-1) (ST-2)

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patients.

Free NCCN Guidelines apps for iPhone, iPad, and Android smartphones & tablets are now available! Visit NCCN.org/apps

About NCCN Flash Updates™ 
NCCN Flash Updates™ is a subscription service from NCCN that provides timely notification of updated and new information appearing in the NCCN Guidelines, the NCCN Compendium, and other NCCN Content. 

Subscribe to NCCN Flash Updates™ 

National Comprehensive Cancer Network® (NCCN®)
275 Commerce Drive, Suite 300
Fort Washington, PA 19034
Telephone: +1 215.690.0300 Fax: +1 215.690.0280 

Access information on permissions and licensing of NCCN Content  

© 2017 National Comprehensive Cancer Network. All Rights Reserved.