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Li C, Wang P, Wang D, Shi L, Zhou Z, Zhang L, Zhang G, Chen C, Wang X. Fluorescence kinetics study of twice laser irradiation based HpD-PDT for nonmelanoma skin cancer. Lasers Surg Med 2022; 54:945-954. [PMID: 35391497 DOI: 10.1002/lsm.23538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/31/2021] [Accepted: 03/03/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hematoporphyrine injection (HpD)-based photodynamic therapy (HpD-PDT) has emerged as a promising cancer therapy. However, its tumor-targeting ability and metabolokinetics in nonmelanoma skin cancer (NMSC) have not been well explored. Importantly, photodynamic diagnosis is widely used for cancer lesion assessment and positioning to ensure effective therapy, while the photosensitizer metabolic kinetics study is utilized for biosafety assessment and light-protection instruction. These are particularly important for the optimization of therapeutic parameters. OBJECTIVES In the present study, NMSC patients were subjected to twice laser irradiation-based HpD-PDT strategy. Broadly, the study aimed to assess long-term variations in fluorescence (FL) intensity in vivo in NMSC patients after intravenous (i.v.) administration of HpD, and thus obtain information regarding metabolism, biosafety, and light-protection instruction for HpD during the therapy. METHODS In vitro experiments were used for the evaluation of absorption and fluorescent characterization of HpD in aqueous solution and cutaneous squamous cell carcinoma (SCC) cells. For in vivo assessment, 20 patients with NMSC, including SCC, basal cell carcinoma (BCC), Bowen disease (BD), extramammary Paget's disease (EMPD), and malignant proliferating tricholemmoma (APT), were recruited, and treated with HpD-PDT. To evaluate the selectivity and pharmacokinetics of HpD in vivo, relative changes in FL intensity for lesional, perilesional, and nonlesional skin of nonmelanoma skin cancer patients, before and after HpD injection, were semiquantitatively analyzed for 1 month, using the FL detection system and Wood's lamp. RESULTS The absorption and FL spectra were detected and semiquantitatively analyzed in HpD diluted solution and SCC cells after coincubation with HpD. After i.v. administration of HpD in EMPD patients, FL was detected in the skin lesions at 24 hours, and it was characterized by clear edges. Importantly, FL intensity in the skin lesions increased significantly at 48 and 72 hours postinjection, which was suitable for HpD-PDT. After 72 h, it decreased gradually and reached close to the baseline value at 4 weeks postinjection. No severe side effects were observed during HpD injection and the therapy. Urinary tract infection was recorded in one patient (with a previous history of recurrent urinary tract infections) after HpD-PDT, and the patient was cured afterward. Transient light was observed in two patients after HpD-PDT and they soon recovered after therapy. CONCLUSIONS The present study reported a significant increase in FL intensities at 48 and 72 hours after i.v. administration of HpD in patients with nonmelanoma skin cancers, which indicated accumulation of HpD at the cancer site. Importantly, HpD was found to be safe for NMSC patients. After therapy, FL intensities decreased, which indicated expending and metabolization of HpD. Thus, the results of the present study highlighted the suitability of a twice red-light laser irradiation strategy for the application of HpD-PDT in nonmelanoma skin cancer treatment.
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Affiliation(s)
- Chunxiao Li
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dixin Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhongxia Zhou
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chengqian Chen
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
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Maisel-Campbell A, Lin KA, Ibrahim SA, Kang BY, Anvery N, Dirr MA, Christensen RE, Aylward JL, Bari O, Bhatti H, Bolotin D, Cherpelis BS, Cohen JL, Condon S, Farhang S, Firoz B, Garrett AB, Geronemus RG, Golda NJ, Humphreys TR, Hurst EA, Jacobson OH, Jiang SB, Karia PS, Kimyai-Asadi A, Kouba DJ, Lahti JG, Council ML, Le M, MacFarlane DF, Maher IA, Miller SJ, Moioli EK, Morrow M, Neckman J, Pearson T, Peterson SR, Poblete-Lopez C, Prather CL, Ranario JS, Rubin AG, Schmults CD, Swanson AM, Urban C, Xu YG, Alam M, Yoo S, Poon E, Harikumar V, Weil A, Iyengar S, Schaeffer MR. Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study. JAMA Dermatol 2022; 158:770-778. [PMID: 35612849 DOI: 10.1001/jamadermatol.2022.1733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs. Objective To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals. Design, Setting, and Participants This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019. Exposures Mohs surgery for nonmelanoma skin cancer. Main Outcomes and Measures Reason for treatment selection. Results Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]). Conclusions and Relevance This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.
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Affiliation(s)
- Amanda Maisel-Campbell
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois.,Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Katherine A Lin
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Noor Anvery
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | | | - Juliet L Aylward
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Omar Bari
- Mohs and Dermatologic Surgery Center, University of California, San Diego.,Division of Dermatology, University of California, Los Angeles
| | - Hamza Bhatti
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey.,The Skin Institute of South Florida, Coral Springs
| | - Diana Bolotin
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Basil S Cherpelis
- Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa
| | - Joel L Cohen
- AboutSkin Dermatology, Denver, Colorado.,Department of Dermatology, University of California Irvine
| | - Sean Condon
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,The Center For Dermatology Care, Thousand Oaks, California
| | - Sheila Farhang
- Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa.,Avant Dermatology and Aesthetics, Tucson, Arizona
| | - Bahar Firoz
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | | | - Roy G Geronemus
- Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York.,Laser and Skin Surgery Center of New York, New York, New York
| | - Nicholas J Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia
| | - Tatyana R Humphreys
- Main Line Center for Skin Surgery, Bala Cynwyd, Pennsylvania.,Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eva A Hurst
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.,Distinctive Dermatology, Fairview Heights, Illinois
| | - Oren H Jacobson
- Revere Health Central Utah Mohs, Provo.,St George's University School of Medicine, Grenada, West Indies
| | - S Brian Jiang
- Mohs and Dermatologic Surgery Center, University of California, San Diego
| | - Pritesh S Karia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - David J Kouba
- Wayne State University School of Medicine, Detroit, Michigan.,Toledo Clinic Facial Plastics and Dermatology, Toledo, Ohio
| | - James G Lahti
- Dermatology Partners of North Shore, Northbrook, Illinois
| | - Martha Laurin Council
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Marilyn Le
- Main Line Center for Skin Surgery, Bala Cynwyd, Pennsylvania
| | | | - Ian A Maher
- Department of Dermatology, St Louis University, St Louis, Missouri.,Department of Dermatology, University of Minnesota, Minneapolis
| | | | - Eduardo K Moioli
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Meghan Morrow
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Julia Neckman
- Laser and Skin Surgery Center of New York, New York, New York.,Metroderm, Atlanta, Georgia
| | - Timothy Pearson
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Anne Arundel Dermatology, Berlin, Maryland
| | - Samuel R Peterson
- Revere Health Central Utah Mohs, Provo.,ERderm, Newport Beach, California
| | | | | | - Jennifer S Ranario
- Department of Dermatology, MD Anderson Cancer Center, Houston, Texas.,US Dermatology Partners, Austin, Texas
| | - Ashley G Rubin
- Mohs and Dermatologic Surgery Center, University of California, San Diego.,Bernardo Dermatology Medical Group, Poway, California
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew M Swanson
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Christopher Urban
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.,Carolina Mountain Dermatology, Arden, North Carolina
| | - Y Gloria Xu
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | | | - Simon Yoo
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Alexandra Weil
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois
| | - Sanjana Iyengar
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois.,Department of Dermatology, West Virginia University, Morgantown
| | - Matthew R Schaeffer
- Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois.,Department of Surgery, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
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Toman J, Michael GM, Wisco OJ, Adams JR, Hubbs BS. Mohs Defect Repair with Dehydrated Human Amnion/Chorion Membrane. Facial Plast Surg Aesthet Med 2021; 24:48-53. [PMID: 34714143 PMCID: PMC8783622 DOI: 10.1089/fpsam.2021.0167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Importance: Reconstructing cosmetically sensitive defects in an aging population undergoing multiple Mohs micrographic surgeries (MMS) may be addressed with alternatives to surgery. Objective: Patients undergoing MMS with defect reconstruction in visually prominent areas receiving placental allograft were compared with traditional autologous tissue-based procedures—flaps and full-thickness skin grafts (FTSG). Design, Setting, and Participants: This retrospective case–control study evaluated patients who underwent MMS for removal of a basal or squamous cell carcinoma with same-day repair. Main Outcomes and Measures: The primary endpoint was the incidence and comparison of postoperative morbidity. Risk for developing medical or cosmetic sequelae was determined through multivariate logistic regression. Results: The study population consisted of 143 propensity score-matched pairs (n = 286) with moderate- to high-risk defects on the face, head, and neck. Compared with autologous tissue, placental allograft cases were associated with significantly lower risk for infection (p = 0.004), poor scar cosmesis (p < 0.0001), scar revision (p < 0.0001), or reoperation (p = 0.0007). Conclusions and Relevance: Postoperative complication rates for placental reconstructions did not exceed those demonstrated by autologous tissue counterparts, indicating this is a safe alternative to flap and FTSG in cosmetically sensitive repairs.
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Affiliation(s)
- Julia Toman
- Division of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Georgina M Michael
- Department of Clinical Research, MiMedx Group, Inc., Marietta, Georgia, USA
| | - Oliver J Wisco
- Dermatology Health Specialists, Bend, Oregon, USA.,Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John R Adams
- Advanced Dermatology and Skin Cancer Center, Manhattan, Kansas, USA.,Division of Dermatology, Department of Internal Medicine, University of Kansas School of Medicine, Wichita, Kansas, USA
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Pretzlaff K, West L, Nemeh MN, Srivastava D, Nijhawan RI. Wound care quality of life in aging patients undergoing electrodessication and curettage on the back. Arch Dermatol Res 2021; 314:477-480. [PMID: 34089376 DOI: 10.1007/s00403-021-02248-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
Patient satisfaction is an important consideration when determining the optimal treatment for non-melanoma skin cancer (NMSC). One critical aspect of patient satisfaction is post-procedural wound care quality of life (QOL), especially as the elderly population grows. This study aimed to evaluate post-procedural wound care QOL in elderly patients undergoing electrodessication and curettage (ED&C) for NMSC in difficult-to-reach areas, namely the posterior shoulder and back. To do so, patient demographics, functionality, co-morbidities, and post-procedural wound care QOL were assessed in twenty elderly patients (age > 65) who underwent ED&C for NMSC at a single academic dermatologic surgery clinic. Independent t-tests were used to evaluate how QOL related to patient age, gender, living situation, relationship status, co-morbidities, and functionality. Patients who lived alone had better-wound care QOL compared to patients who did not live alone (p = 0.04). Patients reported concerns about knocking the wound and did not feel they could care for the wound independently. Patients who were married, female, or had a lower comorbidity score reported poorer QOL, although this finding was not statistically significant. This study indicates that patients' QOL can be negatively affected by post-procedural wounds located in difficult-to-reach areas. As dermatologists strive to improve patient satisfaction, wound care quality of life should be considered when choosing treatment for NMSC.
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Affiliation(s)
- Kara Pretzlaff
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor, Suite 100, Dallas, 75390-9191, USA
| | - Lindsey West
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor, Suite 100, Dallas, 75390-9191, USA
| | - Michael N Nemeh
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor, Suite 100, Dallas, 75390-9191, USA
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor, Suite 100, Dallas, 75390-9191, USA
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor, Suite 100, Dallas, 75390-9191, USA.
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