Kroll2013

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Dear colleagues, i have a 65 yo lady diagnosed in May of this year with a large left palmar aspect, hand lesion. The latter was ulcerated and infiltrating, rendering the use of the hand obsolete. She Has no comorbidities whatsoever but a history of chronic palmoplantar psoriasis, which was treated intermittently by topical, and more recently some 2.5 years back developed a small centimetric lesion of the palmar aspect of the left MP joint of the thumb. This was resected twice in a private office and never with a pathological analysis until more recently when it grew substantially and required biopsy. Pathology reported a moderately differentiated SCC.
Her initial Staging had comprised a contrast enhanced CT Scan of the hand and a non enhanced CT of the chest, which ruled out parenchymal pulmonary metastases and axillary disease.

She underwent a rather complicated surgical excision although had negative margins, and went on to complete 5 cycles of Cisplatin based Cisplatin –5FU, Erbitux infusional combination chemotherapy and had staging FDG PET CT Scan revealing NED.
While there are no guidelines whatsoever in such case, and RT to the hand is mandatory one should extrapolate from data available for other diseases.
I need your opinion concerning the RT for the axilla or should i stick only to the TB?

Ty


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Mad Jack

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While I can in no way answer your question, I'm just curious- was she treated with radiation for her psoriasis back in the late 50s or 60s? Just curious if this was a case study in late pathogenic side effects of an obsolete treatment modality.
 

OTN

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She had adjuvant chemotherapy given for a margin-negative resection of a scca of the hand? What? That makes no sense to me.

She might not even need adjuvant RT to the tumor bed. Depends on pathologic features of rsxn: PNI, size of margins, grade, ease of re-resectability, etc.
 
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Palex80

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While I can in no way answer your question, I'm just curious- was she treated with radiation for her psoriasis back in the late 50s or 60s? Just curious if this was a case study in late pathogenic side effects of an obsolete treatment modality.
RT for psoriasis is not "obsolete".
It's not first line treatment.
We've performed it several times over the past years for therapy resistant cases with quite good results.
 
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medgator

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RT for psoriasis is not "obsolete".
It's not first line treatment.
We've performed it several times over the past years for therapy resistant cases with quite good results.
Prob not unreasonable considering the medical therapies are pretty immunosuppresive systemically and can pre-dispose to cancer/lymphoma. Psoriasis is a tough disease, different from say "acne" where RT really has no role being used IMO