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National Comprehensive Cancer Network

About NCCN

NCCN Flash Updates: NCCN Templates® for Myeloproliferative Neoplasms, NCCN Radiation Therapy Compendium, and NCCN Guidelines® and NCCN Compendium® for Basal Cell Skin Cancers

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Myeloproliferative Neoplasms to reflect the currently published NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Myeloproliferative Neoplasms v3.2019.

  • The following NEW NCCN Template has been published:
    • MPN11: Fedratinib

NCCN has updated the NCCN Radiation Therapy Compendium to reflect recommendations within the following NCCN Guidelines®:

  • Multiple Myeloma Version 1.2020
  • Basal Cell Skin Cancer Version 1.2020
  • Dermatofibrosarcoma Protuberans Version 1.2020
  • Merkel Cell Carcinoma Version 1.2020
  • Squamous Cell Skin Cancer Version 1.2020
  • Acute Myeloid Leukemia Version 1.2020

NCCN has published updates to the NCCN Guidelines and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Basal Cell Skin Cancers. These NCCN Guidelines are currently available as Version 1.2020.

  • Clinical Presentation, Workup and Risk Status (BCC-1)
    • The first statement was modified: “Suspicious lesion Lesion suspicious for skin cancer
      • A pathway was added under Risk Status: “Initial presentation of advanced disease” that directs the reader to “See Treatment for Recurrence or Advanced Disease (BCC-4)”
    • A footnote was added: “For more information, see American Academy of Dermatology Association: https://www.aad.org/public/diseases/skin-cancer/basal-cell-carcinoma.”
    • A footnote was added: “For rare cases that present with regional or distant metastatic disease at diagnosis, treat as nodal or distant metastases pathway on BCC-4. Imaging modality and targeted area should be at the discretion of the treating team based on the suspected extent of disease (ie, local, regional, metastatic).”
  • Treatment for Local, Low-risk Basal Cell Skin Cancer (BCC-2)
    • Under Adjuvant Treatment, the phrase “complete circumferential margin assessment” was replaced with “CCPDMA” (as defined in footnote i). This abbreviation is also used on subsequent pages.
  • Treatment for Local, High-risk Basal Cell Skin Cancer (BCC-3)
    • Primary Treatment options were revised:
      • RT For non-surgical candidates:
        • RT
        • Systemic therapy if curative RT not feasible
    • Adjuvant Additional Treatment options were revised:
      • Positive margins following “Mohs micrographic surgery or resection with complete circumferential margin assessment CCPDMA”:
        • RT and/or Multidisciplinary tumor board consultation (consider a clinical trial) to discuss options:
        • Re-resect, if feasible
        • RT
        • Systemic therapy if curative RT and/or curative surgery not feasible
      • Positive margins following “Standard excision with wider surgical margins and postoperative margin assessment and with linear or delayed repair”:
        • Mohs micrographic surgery or resection with complete circumferential margin assessment CCPDMA, if feasible or Standard re-excision, if clinically feasible if CCPDMA not feasible or RT
        • If residual disease is present, and further surgery and RT are contraindicated is not feasible, consider multidisciplinary tumor board consultation (consider a clinical trial) to discuss options:
          • RT
          • Systemic therapy if curative RT not feasible
    • A footnote was revised: “For complicated cases, consider multidisciplinary tumor board consultation.”
    • A footnote was revised: “If surgery and RT are contraindicated For complicated cases, consider multidisciplinary tumor board consultation and therapy. For locally advanced disease in which curative RT and curative surgery are not feasible, consider treatment with hedgehog pathway inhibitors (vismodegib and sonidegib).
    • A footnote was revised: “Current FDA-approved hedgehog pathway inhibitors include vismodegib and sonidegib. Vismodegib is FDA approved for the treatment of adults with metastatic BCC, or with locally advanced BCC that has recurred following surgery or who are not candidates for surgery and who are not candidates for RT. Sonidegib is FDA approved for the treatment of adult patients with locally advanced BCC that has recurred following surgery or RT, or those who are not candidates for surgery or RT. Sonidegib is not FDA approved for metastatic BCC.
  • Follow-up and Recurrence or Advanced Disease (BCC-4)
    • Under Follow-up, a bullet was added: “Consider imaging if clinical exam insufficient for following disease”
    • Options for Recurrence or Advanced Disease were revised:
      • Bottom pathway (for patients with nodal or distant metastases): “Multidisciplinary tumor board consultation (consider a hedgehog pathway inhibitor or clinical trials) to consider one or more of the following options”:
        • Hedgehog pathway inhibitor
          • Vismodegib
          • Sonidegib (category 2B)
        • Surgery
        • RT
        • Clinical trial
    • A footnote was removed: “If surgery and RT are contraindicated, consider multidisciplinary tumor board consultation and therapy.”
    • A footnote was modified: “Current FDA-approved hedgehog pathway inhibitors include vismodegib and sonidegib. Vismodegib is FDA approved for the treatment of adults with metastatic BCC, or with locally advanced BCC that has recurred following surgery or who are not candidates for surgery and who are not candidates for RT. Sonidegib is FDA approved for the treatment of adult patients with locally advanced BCC that has recurred following surgery or RT, or those who are not candidates for surgery or RT. Sonidegib is not FDA approved for metastatic BCC, which is the reason for the category 2B designation.
    • A footnote was added: “Imaging modality and targeted area should be at the discretion of the treating team based on the suspected extent of disease (ie, local, regional, metastatic).”
  • Principles of Pathology (BCC-A)
    • Under Principles of Biopsy Reporting, the first bullet was modified: “Pathologic evaluation of skin biopsies is ideally performed by a dermatologist, or pathologist, or dermatopathologist who is experienced in interpreting cutaneous neoplasms.”
  • Principles of Treatment for Basal Cell Skin Cancer (BCC-C)
    • Bullet 4 was modified: “In patients with low-risk, superficial basal cell skin cancer, where surgery and RT are contraindicated or impractical not feasible, therapies such as topical imiquimod, topical 5-fluorouracil, topical imiquimod, photodynamic therapy...”
    • Bullet 7 was added: “Systemic therapy may be considered for complicated cases of locally advanced disease if curative surgery and curative RT are not feasible. Systemic therapy may be considered for cases of nodal or distant metastatic disease, especially if surgery and RT are not feasible.”
    • A footnote was modified: “Current FDA-approved hedgehog pathway inhibitors include vismodegib and sonidegib. Vismodegib is FDA approved for the treatment of adults with metastatic BCC, or with locally advanced BCC that has recurred following surgery or who are not candidates for surgery and who are not candidates for RT. Sonidegib is FDA approved for the treatment of adult patients with locally advanced BCC that has recurred following surgery or RT, or those who are not candidates for surgery or RT. Sonidegib is not FDA approved for metastatic BCC, and is recommended as a category 2B option in this setting.

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (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/patientguidelines.

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

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