Field cancerization: Definition, epidemiology, risk factors, and outcomes - 19/08/20

Doi : 10.1016/j.jaad.2020.03.126

Tyler J. Willenbrink, MD ^a, Emily S. Ruiz, MD, MPH ^b, Christine M. Cornejo, MD ^b, Chrysalyne D. Schmults, MD, MSCE ^b, Sarah T. Arron, MD, PhD ^c, Anokhi Jambusaria-Pahlajani, MD, MSCE ^a,^⁎
^a Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas
^b Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
^c Department of Dermatology, University of California San Francisco, San Francisco, California

^∗Reprint requests: Anokhi Jambusaria-Pahlajani, MD, MSCE, Department of Dermatology, The University of Texas at Austin Dell Medical School, 1601 Trinity St, Ste 704B, Austin, TX 78701.Department of DermatologyThe University of Texas at Austin Dell Medical School1601 Trinity St, Ste 704BAustinTX78701

Abstract

Field cancerization was first described in 1953 when pathologic atypia was identified in clinically normal tissue surrounding oropharyngeal carcinomas. The discovery of mutated fields surrounding primary tumors raised the question of whether the development of subsequent tumors within the field represented recurrences or additional primary tumors. Since this initial study, field cancerization has been applied to numerous other epithelial tissues, including the skin. Cutaneous field cancerization occurs in areas exposed to chronic ultraviolet radiation, which leads to clonal proliferations of p53-mutated fields and is characterized by multifocal actinic keratoses, squamous cell carcinomas in situ, and cutaneous squamous cell carcinomas. In the first article in this continuing medical education series, we define field cancerization, review the available grading systems, and discuss the epidemiology, risk factors, and outcomes associated with this disease.

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Key words : actinic damage, actinic keratoses, cutaneous oncology, cutaneous squamous cell carcinoma, field cancerization, field change, field damage, field therapy, immunosuppression, keratinocyte carcinoma, actinic keratosis, NOTCH, NOTCH1, p53, p-53 clonal fields, squamous cell carcinoma, TP53

Abbreviations used : AK, AKASI, AK-FAS, BCC, CSCC, FC, KC, QoL, SOTR, UVR