CORRESPONDENCE
Konstantinos SERETIS1, Georgios GAITANIS2 and Ioannis D. BASSUKAS2*
1Department of Plastic and Reconstructive Surgery and 2Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, University of Ioannina, Greece. *E-mail: ibassuka@uoi.gr
Citation: Acta Derm Venereol 2024; 104: adv42287. DOI: https://doi.org/10.2340/actadv.v104.42287.
Copyright: © 2024 The Author(s). Published by MJS Publishing, on behalf of the Society for Publication of Acta Dermato-Venereologica. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/).
Published: Nov 20, 2024
We read with great interest the proposal of Philipp-Dormston et al. (1) to abandon the outdated, ill-defined umbrella designation “non-melanoma skin cancer” (NMSC) in favour of “keratinocyte cancer” (KC), a “more precise and reasonable terminology, valuing the relevance of keratinocyte-derived cancer”. Although we totally agree with the authors’ attempt to provide a reasonable revision in terminology of skin cancers, we are concerned that the omission of a reference to the involved organ (skin) from the needed specific terminology might entail the risk of ambiguity in the future. Therefore, the organ origin defining term “keratinocyte skin cancer” (KSC) serves to add precision over KC, for 2 main reasons. The keratinocyte is not an exclusively cutaneous cell type. Keratinocytes originating from the somatic ectoderm, exactly like those of the epidermis, build up the epithelial lining of a series of juxta-cutaneous mucous membranes (oral and nasal cavities, eye surfaces, external genitalia, distal anus) as well as the tissue framework of extra-cutaneous organs, such as the thymus. Moreover, cells with keratinocyte phenotype of mesodermal origin construct the epithelial lining of remote body cavities (pharynx, hypopharynx, tonsils, larynx, oesophagus, parts of the trachea, vagina, and cervix). From all the above extracutaneous sites cancers originate that share morphologic characteristics distinctive for their common cellular origin from keratinocytes, the squamous cell carcinomas (SCC). Because of the differing clinical aggressiveness of this neoplasm, depending on the anatomical location of its origin, we already apply the prefix “cutaneous” to denote SCC that develop from the epidermis and the skin adnexal structures (cSCC). For this reason, we believe that the umbrella term KC may introduce a significant conceptual discrepancy, because we will further need the organ designation to define exactly the SCC of cutaneous origin.
Overall, we would like to congratulate the authors for initiating a discussion in skin cancer terminology, in order to advance the understanding in patient and physician communication. Substituting in the outdated NMSC designation “NM” the letter “K”, leading to “KSC”, makes more sense than exchanging “NMS” for “K”. Maybe this further specification could have addressed the concerns of the 36% of dermatologists who doubted the convenience of the suggested KC terminology for physician–patient communication (1). In conclusion, within the clinical setting of dermato-oncology, “S” for skin remains an indispensable adjunct for the comprehensiveness of the corresponding designation.
Wolfgang G. PHILIPP-DORMSTON1,2, Lasse R. BRAATHEN3, Colin A. MORTON4, Merete HAEDERSDAL5, Yolanda GILABERTE6, Nicole BASSET-SEGUIN7,8, Elena SOTIRIOU9, Stine Regin WIEGELL10, Piergiacomo CALZAVARA-PINTON11,12, Thomas DIRSCHKA13, Hans Christian WULF10, Günther HOFBAUER14,15 and Rolf Markus SZEIMIES16
1Hautzentrum Köln (Cologne Dermatology), Köln, Germany, 2Faculty of Health, University Witten-Herdecke, Witten, Germany, 3Private Office, Bern, Switzerland, 4Stirling Community Hospital, Stirling, UK, 5Department of Dermatology, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark, 6Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain, 7Hôpital Saint-Louis, Paris, France, 8Université de Paris, Paris, France, 9First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece, 10Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark, 11Department of Dermatology, University of Brescia, Brescia, Italy, 12Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy, 13CentroDerm Wuppertal, Wuppertal, Germany, 14Medical Faculty, University of Zürich, Zürich, Switzerland, 15Dermatology Department, University Hospital of Zürich, Zürich, Switzerland, and 16Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Germany
We would like to thank Seretis et al. for their constructive commentary and greatly appreciate their acknowledgement of our publication to overcome the term “non-melanoma skin cancer” (NMSC) and their congratulations for “initiating a discussion in skin cancer terminology, in order to advance the understanding in patient and physician communication”.
In this context we are pleased to re-emphasize that our paper (1) talks about cancers of the skin and keratinocyte cancer (KC) is thus well defined. When used in real life, the location of the skin will also be given. Likewise, it should be defined in which other part of the body KC may be located, e.g., “oral KC”. The term KC is already well established in Anglo-American literature (2) and we appreciate that its use has now found its way into modern European dermatology.
We agree with the authors of the commentary in many respects and do not see any discrepancy between our points of views.