Analysis of the surgical management of skin cancer in the nonagenarian population: Twenty-five year data analysis from a single centre.

BACKGROUND: There were 142,101 new cases of non-melanomatous skin cancers reported by the UK National Cancer Statistics in 2015. The UK statistics published that the incidence is highest in the 90+ population and that this represented an overall 61% increase in skin cancer incidence in the UK in the last decade. This article aims to first provide an understanding of the change in service requirement over the last 25 years for skin cancer management in nonagenarians, and second, understand the subtypes of skin cancer and possible differences in the management for this cohort. METHODS: All skin cancer biopsies received by a UK university teaching hospital dermato-histopathology department were analysed over a five-year period spanning 2013-2017. This was compared with snap shot data at five-year intervals dating back to 1993. The patient demographics including age, sex and anatomical region were seen along with the types of skin cancers and histological subtypes. RESULTS: A total of 1050 skin cancers were managed with surgical input between January 2013 and December 2017 in 733 patients. The number of biopsies/year has increased 7-fold from 1993 (33) to 2017 (231). The annual cost of the surgical element to this service has dramatically increased, and in 2017, it was £220k compared to £33k in 1993. CONCLUSION: Partly because of the ageing UK population, there has been a dramatic increase in the demand on the surgical service regarding managing skin cancers in those over the age of 90. There is a higher rate of incomplete excision in this population than that reported in the national British Association of Dermatologists (BAD) guidelines. Despite higher incomplete excision rates, there is a low re-operation rate in this population probably due to patient comorbidities affecting reconstructive options, patient preference and clinical decisions on surgical morbidity versus benefit.

Association of mutations in FLNA with craniosynostosis.

Mutations of FLNA, an X-linked gene that encodes the cytoskeletal protein filamin A, cause diverse and distinct phenotypes including periventricular nodular heterotopia and otopalatodigital spectrum disorders (OPDS). Craniofacial abnormalities associated with OPDS include supraorbital hyperostosis, down-slanting palpebral fissures and micrognathia; craniosynostosis was previously described in association with FLNA mutations in two individual case reports. Here we present four further OPDS subjects who have pathological FLNA variants and craniosynostosis, supporting a causal link. Together with the previously reported patients, frontometaphyseal dysplasia was the most common clinical diagnosis (four of six cases overall); five patients had multiple suture synostosis with the sagittal suture being the most frequently involved (also five patients). No genotype-phenotype correlation was evident in the distribution of FLNA mutations. This report highlights the need to consider a filaminopathy in the differential diagnosis of craniosynostosis, especially in the presence of atypical cranial or skeletal features.

An appraisal of oral cancer and pre-cancer screening programmes in Europe: a systematic review.

BACKGROUND: Close to 50% of oral cancer (OC) patients still present in advanced stages of disease. Screening, in medicine and dentistry, is a strategy to identify an unrecognised disorder in individuals without signs and symptoms. There are several cancers that fit valid criteria for screening, but whether or not to screen a population for OC remains a dilemma. However, many screening programmes for OC and detection of potentially malignant disorders are described. Many of these have been conducted in Europe, but the feasibility of screening for OC has not been systematically addressed. METHODS: A systematic review was conducted using the key words of interest. Based on our inclusion criteria, 16 European studies spanning three decades were selected from the published English literature. These studies were systematically analysed. The results were discussed with an expert EU consortium built with the task to promote the early detection of OC. RESULTS: There were no consistent results or conclusions across the studies reviewed, largely as a result of there being a wide variety in the screening models and methods of data analysis adopted by each group. In nine of the studies reviewed, whilst descriptive findings from screening were presented, the authors had not attempted to analyse the outcomes. Additionally, only one study reported follow-up data of the screened population. CONCLUSIONS: In order to uphold the benefits of screening, it is necessary to demonstrate an improvement in survival rates following early detection. No such randomised control trials (RCT) on OC have been undertaken in Europe. Undertaking such a RCT may be difficult in the European setting. However, the feasibility of screening for OPMDs by conventional oral examination has been demonstrated, supporting a strategy to adopt appropriate screening models, and further action from the European countries should be to demonstrate methods of halting their progression by tested interventions. We provide a brief guideline for future screening studies.