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NCCN Flash Updates™: NCCN Guidelines® & NCCN Compendium® Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Basal Cell Skin Cancer, Dermatofibrosarcoma Protuberans, Merkel Cell Carcinoma, and Squamous Cell Skin Cancer. These NCCN Guidelines® are currently available as Version 1.2016. 

  • Merkel Cell Carcinoma
    • Primary and Adjuvant Treatment: Clinical N0 Disease (MCC-2)
      • For management of the draining nodal basin, footnote "g" was added: "In the head and neck region, risk of false-negative SLNBs is higher due to aberrant lymph node drainage and frequent presence of multiple SLN basins. If SLNB is not performed or is unsuccessful, consider irradiating nodal beds for subclinical disease (See MCC-B).”
    • Treatment of Clinical M1 Disease
      • Under “Follow-up”, footnote "p" was added: "As immunosuppressed patients are at high risk for recurrence, more frequent follow-up may be indicated. Immunosuppressive treatments should be minimized as clinically feasible." (MCC-5)
    • Principles of Radiation Therapy (MCC-B)
      • The MCC-B page was divided into two pages, "Primary Tumor Site" and "Draining Nodal Basin" and extensively revised.
    • Principles of Excision (MCC-C)
      • Under "Surgical Approaches", for the 2nd sub-bullet, "When tissue sparing is of critical importance" was removed and modified to: "Techniques for more exhaustive histologic margin assessment may be considered (Mohs technique, modified Mohs, CCPDMA), provided they do not interfere with SLNB when indicated."
      • Under "Reconstruction"
        • A bullet was removed: "Immediate reconstruction is recommended in most cases."
        • The following bullet was modified: "It is recommended that any reconstruction involving extensive undermining or tissue movement be delayed until negative histologic margins are verified and SLNB is performed if indicated."
  • Dermatofibrosarcoma Protuberans
    • Principles of Pathology  (DFSP-A)
      • Footnote "2", "FS-DPSF should be noted when present as it is associated with a poor prognosis,” was added to the bullet describing fibrosarcomatous transformation. (FS-DFSP)
    • Principles Of Excision (DFSP-B)
      • The following statement was added to the “Goal” section: “Specimens from debulking excisions should be examined to identify fibrosarcomatous transformation (FS-DFSP) if present.”
  • Basal Cell Skin Cancer
    • Primary Treatment (BCC-2)
      • Under “Curettage and electrodesiccation”, the 1st bullet statement, “In non-hair bearing areas,” was changed to: “Excluding terminal hair-bearing areas, such as scalp, pubic, axillary regions, and beard area in men.”
    • Adjuvant Treatment (BCC-3)
      • “Vismodegib” was replaced with “a hedgehog pathway inhibitor” and footnote “n”, “Current FDA approved hedgehog pathway inhibitors include vismodegib and sonidegib,” under “Adjuvant Treatment” in the “Standard excision” pathway, when margins are positive: “If residual disease is present, and further surgery and RT are contraindicated, consider multidisciplinary tumor board consultation (consider a hedgehog pathway inhibitor or clinical trials).”
      • Under “Adjuvant Treatment”, in the “Mohs or resection” pathway, when margins are positive, a treatment option was added: “RT and/or multidisciplinary tumor board consultation (consider a hedgehog pathway inhibitorn or clinical trial)
    • Recurrence (BCC-4)
      • Under “Follow-up”, footnote “o” was added: “If no further skin cancers are identified in the first 2 years, when less frequent follow-up may be appropriate.”
      • Under “Recurrence”, "Regional” and “Distant metastases” pathways were combined into a “Nodal or distant metastases” pathway.
      • “Vismodegib” was replaced with “a hedgehog pathway inhibitor” and footnote “n”, “Current FDA approved hedgehog pathway inhibitors include vismodegib and sonidegib”, in the “Nodal or distant metastases” pathway: “Multidisciplinary tumor board consultation (consider a hedgehog pathway inhibitor or clinical trials).”
    • Risk Factors for Recurrence (BCC-A)
      • Footnote “3”, describing “Aggressive growth pattern”, was revised: “Having morpheaform, basosquamous (metatypical), sclerosing, mixed infiltrative, or micronodular features is any portion of the tumor. In some cases basosquamous (metatypical) tumors may be prognostically similar to SCC. Clinicopathologic consultation is recommended.”
  • Squamous Cell Skin Cancer
    • Primary Treatment (SCC-2)
      • Under “Curettage and electrodesiccation”, the 1st bullet statement, “In non-hair bearing areas”, was changed to: “Excluding terminal hair-bearing areas, such as scalp, pubic, axillary regions, and beard area in men.” Risk Factors for Local Recurrence or Metastases (SCC-A)
      • Under "Pathology", the following risk factors were revised:
        • “Adenoid (acantholytic), adenosquamous (showing mucin production), or desmoplastic or basosquamous (metatypical) subtypes”
        • “Perineural, lymphatic, or vascular involvement”
    • Identification and Management of High-Risk Patients (SCC-D)
      • Under "Definition", the following statement was modified: “In these patients, urgent diagnosis and treatment of lesions are important, and nodal staging (radiologic or pathologic) may be considered in those with significant risk of nodal metastases.”
      • For treatment of satellite lesions and in-transit metastases, the recommendation to treat aggressively with “strong consideration of radiation therapy as primary therapy” was replaced with “multidisciplinary tumor board consultation.”

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit NCCN.org.

To access the NCCN Biomarkers Compendium®, please visit NCCN.org/biomarkers.

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

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

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