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Skin Cancer

Determining Your Prognosis

Your prognosis is a prediction of the outcome of your disease. What is the risk of succumbing to the cancer or the risk of its coming back? These are the big questions on most people’s minds after receiving a diagnosis of throat cancer. Prognosis is based on many factors, and a survival rate is an estimate based on large populations of patients who have been given a similar stage of their skin cancer. There are many specific factors that are unique to each patient that may influence treatment success.

Estimated Disease-Specific Survival is the percentage of people with a specific cancer who are alive at a given time point, such as five years after diagnosis. It excludes people who may have died from a disease other than their cancer. It is probably the best estimate we have in these large national databases as to the prognosis of a particular type of cancer at each stage.

Prognosis for basal cell carcinoma of the skin

The factors associated with prognosis for basal cell carcinoma are discussed above, and they separate patients into low-risk and high-risk groups. In any case, the majority of BCCs are caught early, grow slowly and do not frequently invade deeply. Therefore, the cure rate is extremely high for most BCCs (up to 99 percent).10 Walling HW, Fosko SW, Geraminejad PA, Whitaker DC, Arpey CJ. Aggressive basal cell carcinoma: Presentation, pathogenesis, and management. Cancer and Metastasis Reviews. 2004;23(3-4):389-402. However, there are those rare basal cell carcinomas that are more aggressive and more likely to come back, invade deeply and spread to other parts of the body. You should speak to your doctor about your specific case if you have a more advanced basal cell carcinoma.

Prognosis of squamous cell carcinoma of the skin

The major prognostic factors associated with survival of SCC of the skin are accounted for in the staging system described above. Survival data that reflects your particular situation is difficult to come by in the U.S. because these cancers are not required to be reported to national databases, and advanced squamous cell carcinoma of the skin is quite rare. The majority of squamous cell carcinomas of the skin are caught early, in low stages, and are well treated with surgical removal. You should speak to your doctor about your specific case.

A large study from the Netherlands of almost 70,000 patients with invasive squamous cell carcinoma of the skin found that the five-year estimated disease-specific survival rate was 92 percent for men and 95 percent for women.11 Hollestein LM, de Vries E, Nijsten T. Trends of cutaneous squamous cell carcinoma in the Netherlands: Increased incidence rates, but stable relative survival and mortality 1989-2008. European Journal of Cancer. 2012;48(13):2046-2053. Almost all of these patients were in Stage I (more than 50,000 patients). Even though less than 1.5 percent of patients were diagnosed in Stage III or Stage IV in this study, some prognostic data was still analyzed. They found that women diagnosed with a Stage III or IV SCC had a significantly worse prognosis compared to males (estimated disease-specific survival of 46 percent versus 62 percent). Their analysis by stage group found the following11 Hollestein LM, de Vries E, Nijsten T. Trends of cutaneous squamous cell carcinoma in the Netherlands: Increased incidence rates, but stable relative survival and mortality 1989-2008. European Journal of Cancer. 2012;48(13):2046-2053.:

Stage of Squamous Cell Carcinoma of the Skin 5-Year Estimated Disease-Specific Survival for Men 5-Year Estimated Disease-Specific Survival for Women
Stage I 95% 98%
Stage II 76% 76%
Stage III / IV 62% 46%

*Stage III and IV were combined in the survival analysis because there were too few examples in these categories to analyze separately.

Also, when looking at the site of the squamous cell carcinoma, the estimated disease-specific survival of males with an SCC on the scalp or neck (89 percent) was lower than that of an SCC on the lip (95 percent) and ear (93 percent).11 Hollestein LM, de Vries E, Nijsten T. Trends of cutaneous squamous cell carcinoma in the Netherlands: Increased incidence rates, but stable relative survival and mortality 1989-2008. European Journal of Cancer. 2012;48(13):2046-2053.

Finally, while the AJCC staging system is important to predict survival, it does not allow for any patient (clinical) factors to be accounted for in the staging. For example, there is good data to suggest that immunosuppressed patients (organ transplant recipients, HIV carriers, leukemia and lymphoma patients) have a slightly worse prognosis than those with an intact immune system.12 Lardar T, Shea SM, Sharfman W, Liegeois N, Sober AJ. Improvements in the Staging of Cutaneous Squamous-Cell Carcinoma in the 7th Edition of the AJCC Cancer Staging Manual. Annals of Surgical Oncology. 2010;17(8):1979-1980. Also, tumors on the ear and possibly lips have been linked with spread to other sites and a worse prognosis.11 Hollestein LM, de Vries E, Nijsten T. Trends of cutaneous squamous cell carcinoma in the Netherlands: Increased incidence rates, but stable relative survival and mortality 1989-2008. European Journal of Cancer. 2012;48(13):2046-2053.

Prognosis for Malignant Melanoma of the Skin

The following aspects of malignant melanoma of the skin may affect your prognosis. Again, this is a discussion you should have with your doctor because every cancer is a little different. In general:

Factors That Can Affect Your Chances of Cure
Stage The staging system is made to correlate with prognosis. Therefore, it is not a big surprise that stage of the cancer is related to the chances of survival. The lower the stage, the better the prognosis. This takes into account the size of the tumor and spread to other parts of the body, including lymph nodes, among a few other variables.
Thickness of the Tumor This is the most important factor in predicting survival for melanoma. If the tumor is thin (less than 0.75 mm), the prognosis is quite good. However, tumors thicker than 4 mm had an estimated disease-specific survival rate of just under 50 percent at 10 years.13 Cockburn M, Peng D, Key C. Chapter 12: Melanoma. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.
Anatomic Site There is a hypothesis that lesions on visible parts of the skin do better than those in hidden parts. This may simply be because lesions in visible parts are detected at an earlier stage.
Type of Melanoma Knowing the type of melanoma is important. For example, superficial spreading melanoma and Hutchinsons Melanotic Freckle have better prognosis than nodular or acral lentiginous melanoma.13 Cockburn M, Peng D, Key C. Chapter 12: Melanoma. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.
Ulceration of the Tumor Tumor ulceration is a diagnosis made under the microscope. It indicates that there is no completely intact epidermis above the primary melanoma. What we know is that for the same T-stage, a patient with an ulcerated melanoma does worse. Actually, their prognosis is pretty much the same as the next T-stage higher for a non-ulcerated melanoma.14 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Chapter 31: Melanoma of the Skin. P329.

It is very difficult to discuss prognosis without understanding all the details of your cancer, and this is a conversation you’re better off having in person with your doctor. In general, for patients with malignant melanoma, SEER data and AJCC show the following14, Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Chapter 31: Melanoma of the Skin. P329.15 Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD.:

5-year Estimated Disease-Specific Survival by Stage at Diagnosis for 2002-2008
Stage at Diagnosis 5-year  Estimated Disease-Specific Survival (%)
Overall 91%
Localized (confined to primary site) 98%
Regional (spread to lymph nodes) 62%
Distant (cancer has spread to another part of the body) 15%
Stage 5-Year Estimated Disease-Specific Survival 10-Year Estimated Disease-Specific Survival
IA 97% 95%
IB 92% 86%
IIA 81% 67%
IIB 70% 57%
IIC 53% 40%
IIIA 78% 68%
IIIB 59% 43%
IIIC 40% 24%
IV 15-20% 10-15%

Prognosis for Merkel Cell Carcinoma

The prognosis for Merkel cell carcinoma can depend on a few factors, the most important being the stage at diagnosis:

Factors That Can Affect Your Chances of Cure
Stage The staging system is made to correlate with prognosis. Therefore, it is not a big surprise that stage of the cancer is related to the chances of survival. The lower the stage, the better the prognosis. This takes into account the size of the tumor and spread to other parts of the body, including lymph nodes, among a few other variables.14, Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Chapter 31: Melanoma of the Skin. P329.16 Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003;49:832-41.
Immune Status A number of studies have shown that patients who have compromised immune systems (such as in HIV/AIDS, chronic leukemia and transplant patients) do a little worse than healthier people.17, Engels EA, Frisch M, Goedert JJ, Biggar RJ, Miller RW. Merkel cell carcinoma and HIV infection. The Lancet. 2002;359(9305):497-498.18, Buell JF, Trofe J, Hanaway MJ, et al. Immunosuppresion and Merkel cell cancer. Transplant Proc. 2002;34(5):1780-1.19 Penn I, First MR. Merkel cell carcinoma in organ recipients: report of 41 cases. Transplantation. 1999;68(11):1717-21.
Anatomic Site There is some controversy in the studies, but one analysis of SEER data found that MCC on the limbs had a better prognosis than MCC in the head and neck or trunk.16 Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003;49:832-41.

According to SEER data, the 5-year estimated disease-specific survival rate for all stages is 63 percent, and the 10-year estimated disease-specific survival rate is 58 percent.20 Young JL, Ward, KC, Ries LAG. Chapter 30: Cancers of Rare Sites. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007. Further analysis of the SEER data found that, based on if the cancer has spread, the 10-year estimated disease-specific survival is as follows21 Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol. 2010:37:20.:

10-Year Estimated Disease-Specific Survival Rate
Localized to Skin Area 71%
Regional (Spread to Lymph nodes) 48%
Distant (spread to distant parts of the body) 20%

When looking stage by stage based on National Cancer Database (NCDB) statistics, we find the following14, Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Chapter 31: Melanoma of the Skin. P329.22 Wang TS, Byrne PJ, Jacobs LK, Taube JM. Merkel Cell Carcinoma: Update and Review. 2011 Seminars in Cutaneous Medicine and Surgery: 30(1):48-56.:

Stage at Diagnosis 5-Year Estimated Disease-Specific Survival
Stage IA 79%
Stage IB 60%
Stage IIA 58%
Stage IIB 49%
Stage IIC 47%
Stage IIIA 42%
Stage IIIB 26%
Stage IV 18%
References

1 Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United State: Incidence. J Am Academy of Dermatology. 1994;30:774.

2 American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society; 2012.

3 Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol. 2010:37:20-27.

4 LeBoit PE, Burg G, Weedon D, Sarasain A. (Eds.): World Health Organization. Classification of Tumours. Pathology and Genetics of Skin Tumours. IARC Press: Lyon 2006.

5 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Basal Cell and Squamous Cell Skin Cancers V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan. 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

6 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Melanoma V.3.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Feb 12, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

7 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Merkel Cell Carcinoma V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan. 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

8 Referenced with permission from the NCCN Guidelines for Patients®: Melanoma V.1.2013. © National Comprehensive Cancer Network, Inc 2013. All rights reserved. Accessed July 2, 2013. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

9 Rubin AI, Chen EH, Ratner D. Basal Cell Carcinoma. N Engl J Med. 2005;353:2262-2269.

10 Walling HW, Fosko SW, Geraminejad PA, Whitaker DC, Arpey CJ. Aggressive basal cell carcinoma: Presentation, pathogenesis, and management. Cancer and Metastasis Reviews. 2004;23(3-4):389-402.

11 Hollestein LM, de Vries E, Nijsten T. Trends of cutaneous squamous cell carcinoma in the Netherlands: Increased incidence rates, but stable relative survival and mortality 1989-2008. European Journal of Cancer. 2012;48(13):2046-2053.

12 Lardar T, Shea SM, Sharfman W, Liegeois N, Sober AJ. Improvements in the Staging of Cutaneous Squamous-Cell Carcinoma in the 7th Edition of the AJCC Cancer Staging Manual. Annals of Surgical Oncology. 2010;17(8):1979-1980.

13 Cockburn M, Peng D, Key C. Chapter 12: Melanoma. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

14 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Chapter 31: Melanoma of the Skin. P329.

15 Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD.

16 Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003;49:832-41.

17 Engels EA, Frisch M, Goedert JJ, Biggar RJ, Miller RW. Merkel cell carcinoma and HIV infection. The Lancet. 2002;359(9305):497-498.

18 Buell JF, Trofe J, Hanaway MJ, et al. Immunosuppresion and Merkel cell cancer. Transplant Proc. 2002;34(5):1780-1.

19 Penn I, First MR. Merkel cell carcinoma in organ recipients: report of 41 cases. Transplantation. 1999;68(11):1717-21.

20 Young JL, Ward, KC, Ries LAG. Chapter 30: Cancers of Rare Sites. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

21 Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol. 2010:37:20.

22 Wang TS, Byrne PJ, Jacobs LK, Taube JM. Merkel Cell Carcinoma: Update and Review. 2011 Seminars in Cutaneous Medicine and Surgery: 30(1):48-56.