Cutaneous field cancerization: clinical,histopathological and therapeutic aspects

The concept of "field cancerization" was first introduced by Slaughter in 1953 whenstudying the presence of histologically abnormal tissue surrounding oral squamouscell carcinoma. It was proposed to explain the development of multiple primary tumorsand locally recurrent cancer. Organ systems in which field cancerization has beendescribed since then are: head and neck (oral cavity, oropharynx, and larynx), lung,vulva, esophagus, cervix, breast, skin, colon, and bladder. Recent molecular studiessupport the carcinogenesis model in which the development of a field with geneticallyaltered cells plays a central role. An important clinical implication is that fieldsoften remain after the surgery for the primary tumor and may lead to new cancers,designated presently as "a second primary tumor" or "local recurrence," depending onthe exact site and time interval. In conclusion, the development of an expandingpre-neoplastic field appears to be a critical step in epithelial carcinogenesis withimportant clinical consequences. Diagnosis and treatment of epithelial cancers shouldnot only be focused on the tumor but also on the field from which it developed. Themost important etiopathogenetic, clinical, histopathological and therapeutic aspectsof field cancerization are reviewed in this article.