Field cancerization: Definition, epidemiology, risk factors, and outcomes

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.

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