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Lee T, Oka T, Demehri S. High-Risk Non-Melanoma Skin Cancers: Biological and Therapeutic Advances. Hematol Oncol Clin North Am 2024; 38:1071-1085. [PMID: 38908957 DOI: 10.1016/j.hoc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
Nonmelanoma skin cancers (NMSCs) are the most common cancers, with high-risk NMSCs sharing features such as poor histologic differentiation, invasion into deeper layers, and anatomic location. NMSC includes basal cell carcinoma, cutaneous squamous cell carcinoma, and Merkel cell carcinoma. Herein, the authors describe advances in understanding the genetic mechanisms of malignant transformation and the composition of tumor microenvironment for these cancers. They summarize recent therapeutic advances, including targeted therapy and immunotherapy for NMSCs. Effective skin protection against ultraviolet radiation-induced carcinogenesis remains an urgent unmet need for NMSC prevention. The authors highlight immune-based interventions as novel strategies to address this need.
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Affiliation(s)
| | - Tomonori Oka
- Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Shadmehr Demehri
- Harvard Medical School, Boston, MA 02115, USA; Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, MA 02114, USA.
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Gellrich FF, Laske J, Steininger J, Eberl N, Meier F, Beissert S, Hobelsberger S. Ex Vivo Confocal Microscopy Speeds up Surgical Margin Control of Re-Excised Skin Tumors and Greatly Shortens In-Hospital Stay. Cancers (Basel) 2024; 16:3209. [PMID: 39335180 PMCID: PMC11429506 DOI: 10.3390/cancers16183209] [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: 08/29/2024] [Revised: 09/08/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES To ensure that non-melanoma skin cancer (NMSC) is completely removed in healthy tissue, micrographically controlled surgery (3D histology) is often performed, which can prolong the inpatient stay. This study examined ex vivo reflectance confocal microscopy (evRCM) for perioperative assessment of surgical margins, specifically in cases where re-excision was necessary due to incomplete removal of cutaneous tumor tissue. METHODS NMSC re-excisions were evaluated using evRCM by a cutaneous surgeon, with retrospective review by an independent pathologist when results differed from histology. RESULTS evRCM demonstrated high specificity (0.96; 95% CI, 0.90-0.99) but low sensitivity (0.20; 95% CI, 0.06-0.51). Unlike pathology, which discards outer surgical margins, evRCM examined the true surgical margins. Retrospective pathology analysis of the misdiagnosed cases confirmed that 25% (n = 2/8) were false negative and 75% (n = 6/8) were potentially false positive, resulting in a sensitivity of 0.2-0.8. Notably, evRCM led to a 113-day reduction in in-hospital stays, probably resulting in increased patient satisfaction and cost-effectiveness. CONCLUSIONS evRCM was valuable for speeding up the assessment of surgical margins in patients with re-excised NMSC. Proper tissue preparation and assessment require interdisciplinary collaboration between cutaneous surgeons, pathologists, and physician assistants, emphasizing the need for standardized operating procedures.
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Affiliation(s)
- Frank Friedrich Gellrich
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Jörg Laske
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Julian Steininger
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Nadia Eberl
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Friedegund Meier
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Sarah Hobelsberger
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
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Hammas K, Nardin C, Boyer S, Michel C, Aubin F, Woronoff AS. Incidence and trends of first basal cell carcinomas in France between 1980 and 2019: a regional population-based registry study. Br J Dermatol 2024; 191:519-528. [PMID: 38748494 DOI: 10.1093/bjd/ljae201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most frequent malignancy reported in populations with fair skin. In most countries, BCCs are only partially or not at all recorded, and incidence data are lacking. OBJECTIVES This study assessed the current incidence rates and trends in the only two French départements where BCCs have been recorded for several decades. METHODS This regional population-based study thus used data from two French cancer registries (Doubs and Haut-Rhin) where first-time BCC diagnoses were recorded. The European age-standardized incidence rates (EASR) were calculated per 100 000 person-years (PY). The trends and the annual percentages of change were assessed using joinpoint analysis. RESULTS In all, 48 989 patients were diagnosed with a first BCC in the study period. The median age at diagnosis was 69 years and the BCCs were mainly located on the head and neck (68.8%). In the Doubs area between 1980 and 2016, the EASR of BCC increased from 59.9 to 183.1 per 100 000 PY. The annual increase for men was 5.73% before 1999 and 1.49% thereafter, and among women 4.56% before 2001 and 1.31% thereafter. In the Haut-Rhin area, the EASR increased from 139.2 in 1991 to 182.8 per 100 000 PY in 2019. Among men, the EASR increased annually by 2.31% before 2000, and by 0.29% after 2000; among women, it increased by 0.95% over the entire period (1991-2019). In the most recent period and for these two départements, the age-specific incidence rates of BCC for men and women were close before the age of 60 years, except for the 40-49-year age group, where the rates were significantly higher among women. For patients aged 60 years and over, men had much higher rates of BCC. CONCLUSIONS BCC incidence has increased since 1980 and is still rising, particularly among men and the elderly. A slowing was observed from 2000, which could be explained by a shift in the management of BCCs and by the possible efficacy of prevention actions. This study provides insight into the BCC burden in France and highlights the need to maintain effective prevention strategies, as incidence is still increasing.
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Affiliation(s)
- Karima Hammas
- Registre des cancers du Haut-Rhin, Groupe hospitalier de la région de Mulhouse et Sud-Alsace (GHRMSA), F-68000 Mulhouse, France
| | - Charlée Nardin
- Université Franche Comté, EFS, Inserm UMR RIGHT, F-25000 Besançon, France
- Service de Dermatologie, Centre Hospitalier Universitaire, F-25000 Besançon, France
| | - Séverine Boyer
- Registre des cancers du Haut-Rhin, Groupe hospitalier de la région de Mulhouse et Sud-Alsace (GHRMSA), F-68000 Mulhouse, France
| | - Catherine Michel
- Service de Dermatologie, Groupe hospitalier de la région de Mulhouse et Sud-Alsace (GHRMSA), F-68000 Mulhouse, France
| | - François Aubin
- Université Franche Comté, EFS, Inserm UMR RIGHT, F-25000 Besançon, France
- Service de Dermatologie, Centre Hospitalier Universitaire, F-25000 Besançon, France
| | - Anne-Sophie Woronoff
- Université Franche Comté, EFS, Inserm UMR RIGHT, F-25000 Besançon, France
- Registre des tumeurs du Doubs, Centre Hospitalier Universitaire, F-25000 Besançon, France
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Alkassis S, Shatta M, Wong DJ. Therapeutic Advances in Advanced Basal Cell Carcinoma. Cancers (Basel) 2024; 16:3075. [PMID: 39272933 PMCID: PMC11394629 DOI: 10.3390/cancers16173075] [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: 07/19/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
Basal cell carcinoma (BCC) is the most common type of cancer with an estimated 3.6 million cases diagnosed annually in the US alone. While most cases are treatable with low recurrence rates, 1-10% progress to an advanced stage which can behave aggressively, leading to local destruction and posing substantial challenges in management. The pathogenesis often involves dysregulation of the patched/hedgehog protein family, a pivotal pathway targeted by recently approved therapies. Furthermore, the role of immunotherapy is evolving in this type of tumor as we learn more about tumor microenvironment dynamics. In recent years, there have been advancements in the therapeutic landscape of advanced BCC, offering patients new hope and options for managing this complex and potentially life-threatening condition. In this review, we aim to provide a comprehensive overview of this disease, including the risk factors, underlying pathogenesis, current treatment options of advanced disease, and the ongoing exploration and development of novel therapies.
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Affiliation(s)
- Samer Alkassis
- Division of Hematology/Oncology, Department of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Maya Shatta
- Covenant Health-Statcare Hospitalist Group, Knoxville, TN 37919, USA
| | - Deborah J Wong
- Division of Hematology/Oncology, Department of Medicine, University of California, Los Angeles, CA 90095, USA
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Catalano M, Nozzoli F, De Logu F, Nassini R, Roviello G. Management Approaches for High-Risk Cutaneous Squamous Cell Carcinoma with Perineural Invasion: An Updated Review. Curr Treat Options Oncol 2024; 25:1184-1192. [PMID: 39102167 PMCID: PMC11416415 DOI: 10.1007/s11864-024-01234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 08/06/2024]
Abstract
OPINION STATEMENT Cutaneous squamous cell carcinoma (cSCC) stands as the second most prevalent non-melanoma skin cancer worldwide, comprising approximately 20% of all cutaneous malignancies. Determining its precise incidence poses challenges; however, reports indicate a global increase in its prevalence. At the time of diagnosis, the majority of cSCCs are localized, resulting in favorable 5-year cure rates surpassing 90%. Nevertheless, a subset of patients (3-7%) encounters locally advanced or metastatic cSCC, leading to substantial morbidity and mortality. The risk of metastasis ranges from 0.1% to 9.9%, carrying an associated mortality risk of 2.8%. Factors influencing recurrence, metastasis, and disease-specific mortality underscore the significance of perineural invasion (PNI) as a key indicator. Patients with PNI may manifest clinical symptoms and/or radiologic signs of PNI, while the majority remain asymptomatic, and PNI is frequently identified upon histologic examination. Despite its lower frequency compared to other cancer types, PNI serves as a recognized adverse prognostic factor for cSCC. Surgery is the elective treatment for these patients, while the role of adjuvant radiotherapy (ART) is yet contentious and have not been conclusively assessed, particularly in clear surgical margin. Prospective comparative studies are required to comprehensively evaluate the benefit and the risks of ART for cSCC and PNI patients.
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Affiliation(s)
- Martina Catalano
- Section of Clinical Pharmacology & Oncology, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Filippo Nozzoli
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesco De Logu
- Section of Clinical Pharmacology & Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Romina Nassini
- Section of Clinical Pharmacology & Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giandomenico Roviello
- Section of Clinical Pharmacology & Oncology, Department of Health Sciences, University of Florence, Florence, Italy
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Quadri M, Palazzo E. The Role of the Neurotrophin Network in Skin Squamous Cell Cancer and the Novel Use of the Zebrafish System. JID INNOVATIONS 2024; 4:100295. [PMID: 39100386 PMCID: PMC11296245 DOI: 10.1016/j.xjidi.2024.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 08/06/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most prevalent form of skin cancer. An increasing number of cSCCs are associated with dysregulation of key molecules that control skin homeostasis. These observations have increased interest in the role of neurotrophins and their receptors in the pathogenesis of cSCC. They have been demonstrated to have a considerable impact on the aggressiveness potential of skin cancer by both in vitro and in vivo models. In this context, mouse models are classically used to dissect proliferation versus differentiation balance, but they have some limitations in terms of time, space, and costs. Recently, zebrafish models have been implemented as a new tool to obtain information regarding the invasive capacity and metastasis of neoplastic cells. By xenotransplantation technique, cSCC cells from a patient's biopsy or cell line can be successfully characterized, with or without the presence of genetic manipulation or treatments. In addition, the evaluation of the immune microenvironment contributes to potentially identifying connections and homologies with humans. In this review, we retrace the role of the neurotrophin network in healthy and pathological skin, particularly in cSCC. We review how zebrafish models can be important tools for studying cSCC development, growth, and potential treatments.
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Affiliation(s)
- Marika Quadri
- DermoLAB, Department of Surgical, Medical, Dental and Morphological Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Palazzo
- DermoLAB, Department of Surgical, Medical, Dental and Morphological Science, University of Modena and Reggio Emilia, Modena, Italy
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Thompson KG, Tripathi R, Jedrych J, Bibee KP, Scott JF, Ng E. Factors associated with residual tumor at time of Mohs micrographic surgery for basal cell and squamous cell carcinomas. J Am Acad Dermatol 2024:S0190-9622(24)02699-9. [PMID: 39168309 DOI: 10.1016/j.jaad.2024.08.018] [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: 04/23/2024] [Revised: 07/30/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Residual tumor is not always clinically apparent following biopsy of cutaneous carcinomas, which may prompt patients to question the need for definitive treatment. OBJECTIVE We investigated the percentage of cases in which residual tumor was histologically present at the time of Mohs micrographic surgery (MMS) for basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) and investigated factors associated with residual tumor. METHODS We examined 483 MMS cases performed for biopsy-proven BCC (n = 287) and SCC (n = 196) between October 2022 and April 2023. Single-stage MMS specimens were step-sectioned en face to exhaust the block. Univariate and multivariable logistic regression models were created. RESULTS Residual tumor was identified in 83.3% of BCC and 66.8% of SCC at the time of MMS (P = .01). In patients clinically appearing tumor-free following biopsy, residual histologic tumor was identified in 68.2% of BCC and 41.5% of SCC. Residual tumor was significantly more likely in men (P = .04), high-risk sites (P = .002), smaller biopsy sizes (P = .0003), and larger preoperative sizes (P < .0001). LIMITATIONS Single center, retrospective cohort. CONCLUSION The majority of patients with BCC and SCC have residual histologic tumor at the time of MMS, oftentimes even when tumor is not clinically apparent. Multiple factors impact the presence/absence of residual tumor.
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Affiliation(s)
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland
| | - Jaroslaw Jedrych
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland
| | - Kristin P Bibee
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland; Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Jeffrey F Scott
- Clinical Skin Center of Northern Virginia, Fairfax, Virginia
| | - Elise Ng
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland
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Dong Z, Chen Z, Tan Q. Body fat percentage vs body mass index in estimating basal cell carcinoma. Heliyon 2024; 10:e35297. [PMID: 39170446 PMCID: PMC11336599 DOI: 10.1016/j.heliyon.2024.e35297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/25/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024] Open
Abstract
Background The role of body mass index (BMI) in basal cell carcinoma (BCC) risk remains controversial, and limited information is available regarding the relationship between other physical measurements and BCC. Several recent studies have found a positive effect of adiposity on improved survival when obesity was determined solely by BMI (the "obesity paradox"). We hypothesize that body fat percentage (BFP) may serve as a more sensitive risk factor for BCC than BMI. Methods The study conducted a retrospective analysis of clinical data from two distinct centers in China. Individual patient-level data were obtained from medical record reviews spanning January 1, 2015, to December 31, 2022. Associations with outcomes were analyzed using univariate and stratified analyses and assessed using multiple logistic regression with adjustment for confounding factors. Additionally, we performed a meta-analysis to further test the observations in our study. Results A total of 337 patients, ranging in age from 50 to 91 years, with a mean age of 66.88 (standard deviation 10.16), were included. We observed no significant association between BMI and BCC after adjusting for confounders (OR: 0.71, 95 % CI: 0.36-1.40, P = 0.3186). There was also no convincing effect in a meta-analysis (n = 158,741) (OR: 0.99, 95 % CI: 0.93-1.06, P = 0.8). Furthermore, BFP was found to be associated with BCC (OR: 2.64, 95 % CI: 1.17-5.97, P = 0.0196), supported by strong clinical evidence. Conclusions Our study supports the hypothesis that BFP is superior to BMI in assessing BCC risk. Multiple logistic regression analyses, coupled with meta-analysis, provided robust evidence that BFP is a sensitive risk factor for BCC, while BMI appears unrelated to risk. According to these findings, routine healthcare practices could benefit from utilizing BFP measurements. The reduction of body fat percentage in low-fat diets may be beneficial for adjuvant treatment of BCC.
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Affiliation(s)
- Zheng Dong
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210008, China
- Department of Burn and Plastic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210008, China
| | - Zhenyu Chen
- Department of Plastic Surgery, Affiliated Hospital of Medical Collage Qingdao University, Qingdao, Shandong, 266000, China
| | - Qian Tan
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210008, China
- Department of Burn and Plastic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210008, China
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Knecht-Gurwin K, Stefaniak AA, Chlebicka I, Szepietowski JC. Basal Cell Carcinoma: Comprehensive Review with Emphasis on Scar Tissue Manifestation and Post-Vaccination Incidence. Biomedicines 2024; 12:1769. [PMID: 39200233 PMCID: PMC11351840 DOI: 10.3390/biomedicines12081769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/03/2024] [Accepted: 08/04/2024] [Indexed: 09/02/2024] Open
Abstract
Basal cell carcinoma (BCC) arising within scar tissue is a rare but clinically significant phenomenon. This comprehensive review aims to provide a succinct overview of the current state of knowledge regarding the etiological factors, pathogenesis, clinical presentation, and management of BCC. This study constitutes a literature review pertaining to BCC, with a particular emphasis on BCC developing within scar tissue. It also provides a clinical case presentation of a patient who had developed BCC in a BCG post-vaccination scar and a review of analogous findings available in the existing literature. Despite the fact that an array of mechanisms play a role in injury-related BCC growth, the main mechanism remains ambiguous and yet to be elucidated. The review also includes a detailed description of the various therapeutic options available for BCC, ranging from surgical interventions to novel pharmacological treatments. By examining these intersections, the review seeks to elucidate the potential mechanisms, identify risk factors, and suggest considerations for clinical practice. The findings underscore the importance of vigilant dermatological assessment in patients with scar tissue and those recently vaccinated, aiming to improve early detection and optimize management strategies for BCC.
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Affiliation(s)
| | | | | | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chałubińskiego 1, 50-368 Wrocław, Poland; (K.K.-G.); (A.A.S.); (I.C.)
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Stundys D, Kučinskaitė A, Gervickaitė S, Tarutytė G, Grigaitienė J, Tutkuviene J, Jančorienė L. Quality of Life in Patients Affected by Facial Basal Cell Carcinoma: Prospective Longitudinal Pilot Study and Validation of Skin Cancer Index in Lithuanian Language. Pragmat Obs Res 2024; 15:103-119. [PMID: 39130527 PMCID: PMC11314512 DOI: 10.2147/por.s471307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose Facial basal cell carcinoma (BCC) poses significant challenges due to its potential for local destruction and impact on quality of life (QoL). Continuous research is necessary to identify novel factors influencing the quality of life within this demographic across diverse cultural settings. The aims of this study were to translate, culturally adapt, and validate the Lithuanian version of Skin Cancer Index, subsequently utilizing this questionnaire in the pilot phase of the study to achieve the following: (1) identify the differences in short- and long-term QoL, (2) establish empirical correlations between SCI scores and aesthetic facial regions, evaluate the potential differences between age, gender, and tumor size groups. Patients and Methods A prospective longitudinal study was conducted with 100 consecutive patients. The SCI was translated into Lithuanian language, with a rigorous assessment of its psychometric properties to confirm validity. Alongside hypothesis testing, a detailed analysis of variables was conducted. Statistical techniques, including t-tests and ANOVA, were employed to compare scores across demographic and clinical groups, with effect size calculations for further interpretation. Results Our findings demonstrate that the Lithuanian SCI successfully fulfills the criteria established by the COSMIN checklist. Surgical treatment for facial BCC notably enhances QoL, particularly evident six months post-surgery. Analysis of SCI scores identified demographic and clinical factors associated with lower QoL, including female gender, treatment with skin plasty, and tumor sites in aesthetically sensitive areas like the cheek, nose, and eyelid. Conclusion The Lithuanian version of the SCI is a reliable and valid tool for assessing QoL in facial BCC patients. Our findings underscore the global relevance of understanding the multifactorial influences on QoL in BCC patients. Early diagnosis, less invasive treatment approaches, and tailored post-operative care are crucial in minimizing the psychological, social, and appearance-related burdens of facial BCC.
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Affiliation(s)
- Domantas Stundys
- Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Vilnius, 03101, Lithuania
| | | | - Simona Gervickaitė
- Vilnius University, Faculty of Medicine, Department of Anatomy, Histology and Anthropology, Vilnius, 03101, Lithuania
| | - Gabrielė Tarutytė
- Vilnius University, Faculty of Medicine, Department of Research and Innovation, Vilnius, 03101, Lithuania
- Vilnius University, Faculty of Mathematics and Informatics, Institute of Applied Mathematics, Vilnius, 03225, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, 08661, Lithuania
| | - Jūratė Grigaitienė
- Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Vilnius, 03101, Lithuania
| | - Janina Tutkuviene
- Vilnius University, Faculty of Medicine, Department of Anatomy, Histology and Anthropology, Vilnius, 03101, Lithuania
| | - Ligita Jančorienė
- Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Vilnius, 03101, Lithuania
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Carvalho VM, Nora GR, Collado FU, Xavier Júnior JCC. Rare Areolar Basal Cell Carcinoma Above Invasive Breast Carcinoma: Coincidence or Induction? Am J Dermatopathol 2024; 46:548-549. [PMID: 38842358 DOI: 10.1097/dad.0000000000002736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Vinícius Marinho Carvalho
- Pathology Department, Medical School, Salesian Catholic University Center Auxilium (Unisalesiano), Araçatuba, SP, Brazil
| | - Gustavo Resende Nora
- Dermatopathology Department. Araçatuba Pathology Institute, Araçatuba, SP, Brazil
- Santa Casa Hospital, Araçatuba, SP, Brazil
| | | | - José Cândido Caldeira Xavier Júnior
- Pathology Department, Medical School, Salesian Catholic University Center Auxilium (Unisalesiano), Araçatuba, SP, Brazil
- Dermatopathology Department. Araçatuba Pathology Institute, Araçatuba, SP, Brazil
- Santa Casa Hospital, Araçatuba, SP, Brazil
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12
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Bal Avci E, Koku Aksu AE, Ilhan Erdil D, Erdemir VA, Leblebici C. Clinical Characteristics of Local Recurrent Basal Cell Carcinoma After Surgical Excision: A Retrospective Study of the Patients From a Tertiary Clinical Center. Cureus 2024; 16:e66668. [PMID: 39262526 PMCID: PMC11389970 DOI: 10.7759/cureus.66668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most frequent form of skin cancer. The etiology of recurrent BCC is multifactorial, and the recurrence rate is variable. OBJECTIVE The aim of the study was to identify the risk factors of local recurrence after surgical excision in primary BCC. MATERIALS AND METHODS In our study, 934 patients histopathological diagnosed with BCCs between January 2017 and June 2022 were evaluated retrospectively. Among these, patients who were regularly followed up for at least three years were included in the study. Patients who underwent non-excision treatment were excluded. All the patients who had pathologically confirmed, surgically excised BCCs with safety margins and those with a clinicopathological diagnosis of recurrent BCCs. Demographic and clinical features of 78 patients with non-recurrent primary BCC and 55 patients with local recurrent BCC were compared. RESULTS The mean age was 69.7±11.7 years. The gender distribution was M/F:1.3. The time from diagnosis to total surgical excision was 2.3±1.4 months, and the time of recurrence was 27.5±23.3 months. The age of the patients, the time from diagnosis to total excision, the lesion size > 2 cm, and the presence of risk factors (such as radiotherapy, malignancy, and immunosuppression) were higher in the recurrent group than in the non-recurrent group (p < 0.05). Location (high/medium/low-risk area) and the presence of multiple lesions did not differ significantly between the recurrent and non-recurrent groups. CONCLUSION In patients with BCC, recurrence is often detected in the first three years after diagnosis. Our study determined age, lesion size, accompanying risk factors, and the length of time until total excision as risk factors for recurrence in BCC patients. The histological subtype and lesion localization did not differ between the group with and without recurrence.
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Affiliation(s)
- Elif Bal Avci
- Department of Dermatology, Bayburt State Hospital, Bayburt, TUR
| | - Ayşe Esra Koku Aksu
- Department of Dermatology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, TUR
| | | | | | - Cem Leblebici
- Department of Pathology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, TUR
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Möbus L, Serra A, Fratello M, Pavel A, Federico A, Greco D. A Multi-Dimensional Approach to Map Disease Relationships Challenges Classical Disease Views. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2401754. [PMID: 38840452 PMCID: PMC11321629 DOI: 10.1002/advs.202401754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/05/2024] [Indexed: 06/07/2024]
Abstract
The categorization of human diseases is mainly based on the affected organ system and phenotypic characteristics. This is limiting the view to the pathological manifestations, while it neglects mechanistic relationships that are crucial to develop therapeutic strategies. This work aims to advance the understanding of diseases and their relatedness beyond traditional phenotypic views. Hence, the similarity among 502 diseases is mapped using six different data dimensions encompassing molecular, clinical, and pharmacological information retrieved from public sources. Multiple distance measures and multi-view clustering are used to assess the patterns of disease relatedness. The integration of all six dimensions into a consensus map of disease relationships reveals a divergent disease view from the International Classification of Diseases (ICD), emphasizing novel insights offered by a multi-view disease map. Disease features such as genes, pathways, and chemicals that are enriched in distinct disease groups are identified. Finally, an evaluation of the top similar diseases of three candidate diseases common in the Western population shows concordance with known epidemiological associations and reveals rare features shared between Type 2 diabetes (T2D) and Alzheimer's disease. A revision of disease relationships holds promise for facilitating the reconstruction of comorbidity patterns, repurposing drugs, and advancing drug discovery in the future.
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Affiliation(s)
- Lena Möbus
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE)Faculty of Medicine and Health TechnologyTampere UniversityTampere33520Finland
| | - Angela Serra
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE)Faculty of Medicine and Health TechnologyTampere UniversityTampere33520Finland
- Tampere Institute for Advanced StudyTampere UniversityTampere33520Finland
- Division of Pharmaceutical BiosciencesFaculty of PharmacyUniversity of HelsinkiHelsinki00790Finland
| | - Michele Fratello
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE)Faculty of Medicine and Health TechnologyTampere UniversityTampere33520Finland
| | - Alisa Pavel
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE)Faculty of Medicine and Health TechnologyTampere UniversityTampere33520Finland
- Applied Mathematics and Computer ScienceTechnical University of DenmarkKongens Lyngby2800Denmark
| | - Antonio Federico
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE)Faculty of Medicine and Health TechnologyTampere UniversityTampere33520Finland
- Tampere Institute for Advanced StudyTampere UniversityTampere33520Finland
- Division of Pharmaceutical BiosciencesFaculty of PharmacyUniversity of HelsinkiHelsinki00790Finland
| | - Dario Greco
- Finnish Hub for Development and Validation of Integrated Approaches (FHAIVE)Faculty of Medicine and Health TechnologyTampere UniversityTampere33520Finland
- Division of Pharmaceutical BiosciencesFaculty of PharmacyUniversity of HelsinkiHelsinki00790Finland
- Institute of BiotechnologyUniversity of HelsinkiHelsinki00790Finland
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14
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Williams K, Yaldo M, Olds H, Moossavi M. A large exophytic plaque on the shoulder of a skin of color patient. Int J Dermatol 2024; 63:1039-1040. [PMID: 38572509 DOI: 10.1111/ijd.17150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/05/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
A 75-year-old Black man presented for evaluation of a skin lesion on his right shoulder. The lesion had been present for 3 months and was bleeding. A physical exam demonstrated a 2.7 cm exophytic, crusted, blue-to-purple plaque. A shave biopsy was performed, and histopathological examination revealed anastomosing strands of basaloid cells in the dermis, leading to a diagnosis of fibroepithelioma of pinkus (FeP). FeP is a rare variant of basal cell carcinoma. It typically presents as a solitary, pink, pedunculated papule on the lower back, but the presentation can vary. This case contributes to the scarce literature on the occurrence of FeP in skin of color populations. Here, we raise the possibility that FeP may present differently in skin of color patients compared to white patients. Greater clinician awareness can foster improved identification, management, and understanding of FeP in diverse populations.
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Affiliation(s)
- Kirk Williams
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Marissa Yaldo
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Hailey Olds
- Department of Dermatology, Wayne State University, Detroit, Michigan, USA
| | - Meena Moossavi
- Department of Dermatology, Wayne State University, Detroit, Michigan, USA
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15
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Wang WE, Chen YT, Wang CH, Wang JH, Chang CH. Dermoscopic features of pigmented basal cell carcinoma according to size. Int J Dermatol 2024; 63:916-921. [PMID: 38288856 DOI: 10.1111/ijd.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Basal cell carcinoma (BCC), the most common skin cancer in humans, requires early detection. Dermoscopy enhances diagnostic accuracy through a noninvasive approach. Pigmented BCC (pBCC) is characterized by distinctive dermoscopic features, including the presence of pigmented globules or nests. While dermoscopic features of large pBCC (size >6 mm) have been extensively studied, limited data are available on small pBCC (size ≤6 mm) and its relationship with tumor progression. METHODS Dermoscopic images of histologically proven pBCCs were collected between 2014 and 2022 at Hualien Tzu Chi Hospital. Each image was analyzed for patterns of pigmentation, vasculature, and epidermal and dermal structures. Statistical analysis was performed to compare the differences according to the size and the trend during tumor progression. RESULTS In total, 135 pBCCs (48 small and 87 large) were included. Pigment structures were present in all cases. Short fine telangiectasia and small erosions constituted over 85% of the cases, showing no significant distinction between small and large pBCCs, nor any specific pattern correlating with tumor enlargement. The number of arborizing vessels, ulcerations, and shiny white structures showed an increasing trend associated with size progression. Arborizing vessels appeared when tumor size exceeded 6 mm. CONCLUSIONS This study provides a dynamic interpretation of the dermoscopic features of pBCC according to size enlargement. Short fine telangiectasia and small erosions are highly important features for the early diagnosis of small pBCCs. Arborizing vessels, ulceration, and shiny white structures are more frequent in large pBCCs, and they increase in association with tumor progression.
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Affiliation(s)
- Wei-En Wang
- Department of Dermatology, Skin Institute, Hualian Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yen-Ting Chen
- Department of Dermatology, Skin Institute, Hualian Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chien-Hsing Wang
- Division of Plastic Surgery, Department of Surgery and Trauma Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chung-Hsing Chang
- Department of Dermatology, Skin Institute, Hualian Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Doctoral Degree Program in Translational Medicine, Tzu Chi University and Academia Sinica, College of Medicine, Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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16
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Tomasini CF, Fiandrino G, Favale EM, Antoci F, Barruscotti S. Giant Morpheaform Basal Cell Carcinoma Mimicking Scarring Alopecia: Exception Prone to Neglect. Dermatopathology (Basel) 2024; 11:154-160. [PMID: 38921053 PMCID: PMC11202933 DOI: 10.3390/dermatopathology11020016] [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: 02/29/2024] [Revised: 05/21/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
A 74-year-old woman in good general health presented with a 5-year history of progressive hair loss over several years, interpreted as female androgenetic alopecia (AGA), and was treated with topical 5% Minoxidil without improvement. The patient's relevant medical history revealed infiltrating, triple-negative apocrine carcinoma of the right breast four years before, treated by quadrantectomy, radiation, lymphadenectomy and chemotherapy, with no recurrence at the last follow-up. On examination, there was an asymptomatic 15 × 15 cm firm and whitish area of scarring alopecia on the central scalp. Dermoscopy revealed multiple arborizing vessels and many telangiectasia. The clinical considerations included mainly cutaneous metastasis of breast carcinoma (alopecia neoplastica), pseudopelade of Broque and morpheaform basal cell carcinoma (BCC). A histopathologic examination revealed characteristic changes of morpheaform BCC with basaloid islands and cords of atypical basaloid cells diffusely infiltrating the dermis, embedded in a sclerotic and hypervascularized stroma. Secondary alopecia neoplastica due to morpheaform BCC on the scalp is an exceedingly rare entity, possessing subtle clinical features that may mimic both scarring and non-scarring alopecia. Delayed recognition may contribute to aggressive behavior and extensive local destruction. Treatment with hedgehog inhibitors in locally advanced BCC of the scalp, both in adjuvant and neoadjuvant modalities, is promising.
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Affiliation(s)
- Carlo Francesco Tomasini
- Dermatologic Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.M.F.); (S.B.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, Università degli Studi di Pavia, 27100 Pavia, Italy
| | - Giacomo Fiandrino
- Pathology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.F.); (F.A.)
| | - Emanuele Mario Favale
- Dermatologic Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.M.F.); (S.B.)
| | - Francesca Antoci
- Pathology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.F.); (F.A.)
| | - Stefania Barruscotti
- Dermatologic Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.M.F.); (S.B.)
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, Università degli Studi di Pavia, 27100 Pavia, Italy
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17
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Meinzenbach A, Kaatz M, Springer S, Zieger M. Representation of skin carcinomas in public awareness - Awareness worldwide and in Germany. J Dtsch Dermatol Ges 2024; 22:794-800. [PMID: 38643380 DOI: 10.1111/ddg.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/18/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND OBJECTIVES In recent years, there has been an increase in skin cancer. The aim of this study was therefore to investigate the representation of skin cancer in public awareness worldwide and in Germany, and to determine whether Skin Cancer Awareness Month is represented in the search interests of the Internet-using population in the same way as Breast Cancer Awareness Month worldwide. DATA AND METHODS In this study, Google Trends data were used to track levels of public awareness for different tumor entities and skin cancer types worldwide and for Germany. RESULTS The results of this analysis clearly showed a high level of relative public search interest in breast cancer worldwide in the awareness month of October. Worldwide and in Germany, there was a certain increase in search interest and a certain seasonal effect around the May awareness month for skin cancer. For example, the analysis showed a search interest in May and during the summer months in Germany. CONCLUSIONS It is likely that the population, for example in Germany, may benefit further from an even greater emphasis on the topic of skin cancer.
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Affiliation(s)
- Anne Meinzenbach
- Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- SRH Wald-Klinikum Gera GmbH, Gera, Germany
| | - Martin Kaatz
- SRH Wald-Klinikum Gera GmbH, Gera, Germany
- DRK Krankenhaus Chemnitz-Rabenstein, Chemnitz, Germany
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18
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Meinzenbach A, Kaatz M, Springer S, Zieger M. Repräsentation von Hautkarzinomen im öffentlichen Bewusstsein – Aufmerksamkeit weltweit und in Deutschland. J Dtsch Dermatol Ges 2024; 22:794-802. [PMID: 38857086 DOI: 10.1111/ddg.15406_g] [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: 05/04/2023] [Accepted: 02/18/2024] [Indexed: 06/11/2024]
Abstract
ZusammenfassungHintergrund und ZielsetzungIn den letzten Jahren ist eine Zunahme von Hauttumoren zu verzeichnen. Ziel dieser Studie war es daher, die Repräsentation von Hautkrebs im öffentlichen Bewusstsein weltweit und in Deutschland zu untersuchen und festzustellen, ob der Skin Cancer Awareness Month in den Suchinteressen der internetnutzenden Bevölkerung in gleicher Weise wie der Breast Cancer Awareness Month weltweit repräsentiert ist.Daten und MethodikIn dieser Studie wurden die Daten von Google Trends verwendet, um den Grad der öffentlichen Aufmerksamkeit für verschiedene Tumorentitäten und Hautkrebsarten weltweit und in Deutschland zu ermitteln.ErgebnisseDie Ergebnisse dieser Analyse zeigten deutlich ein hohes Niveau für das relative öffentliche Suchinteresse am Thema Brustkrebs weltweit im Sensibilisierungsmonat Oktober. Weltweit und in Deutschland war ein gewisser Anstieg des Suchinteresses beziehungsweise ein gewisser saisonaler Effekt um den Sensibilisierungsmonat Mai für Hautkrebs festzustellen. So zeigte die Analyse beispielsweise ein Suchinteresse im Mai und während der Sommermonate in Deutschland.SchlussfolgerungenEs ist wahrscheinlich, dass die Bevölkerung, zum Beispiel in Deutschland, weiterhin von einer noch stärkeren Betonung des Themas Hautkrebs profitieren könnte.
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Affiliation(s)
- Anne Meinzenbach
- Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena
- SRH Wald-Klinikum Gera GmbH, Gera
| | - Martin Kaatz
- SRH Wald-Klinikum Gera GmbH, Gera
- DRK Krankenhaus Chemnitz-Rabenstein, Chemnitz
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Lacerda PN, Lange EP, Luna NM, Miot HA, Abbade LPF. Efficacy of micrographic surgery versus conventional excision in reducing recurrence for basal cell carcinoma and squamous cell carcinoma: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024; 38:1058-1069. [PMID: 38116955 DOI: 10.1111/jdv.19743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
The standard of care for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) involves excision by conventional surgery (CS) with a predefined safety margin of resection or micrographic surgery (MS) with microscopic margin control. Previous studies have reported the superiority of MS in reducing recurrences for high-risk BCC and SCC. This systematic review aimed to assess MS and CS recurrence rates by including randomized clinical trials (RCTs) and cohort studies. A systematic review and meta-analysis were conducted for related studies in PubMed, LILACS, Embase, Scopus, Web of Science, CINHAL and Cochrane until May 2023. RCTs and cohorts involving patients with BCC or SCC submitted to MS and CS were included. Risk of bias assessment followed Cochrane-recommended tools for RCTs and cohorts, and certainty of evidence followed the GRADE approach. Pooled estimates were used to determine the relative risk (RR) and absolute risk difference (RD) using a random-effects model. Seventeen studies were included, two RCTs and fifteen cohorts. There were 82 recurrences in 3050 tumours submitted to MS, with an overall recurrence rate of 3.1% (95% CI 2.0%-4.7%). For CS, there were 209 recurrences in 3453 tumours, with a recurrence rate of 5.3% (95% CI 2.9%-9.3%). The combined estimate of RR was 0.48 (95% CI 0.36-0.63), without heterogeneity nor evidence of publication bias (p > 0.3). The RD resulted in 2.9% (95% CI 1.0%-4.9%; NNT = 35). Regarding subgroup analysis, the RR for BBC was 0.37 (95% CI 0.25-0.54), and RD was 3.7% (95% CI 0.8%-6.5%; NNT = 28). For SCC, RR was 0.57 (95% CI 0.29-1.13), and RD was 1.9% (95% CI 0.8%-4.7%; NNT = 53). Among primary tumours, RR was 0.39 (95% CI 0.28-0.54), and for recurrent tumours was 0.67 (95% CI 0.30-1.50). There is moderate evidence based on two RCTs, and low evidence based on 15 cohort studies that MS is superior to CS in reducing recurrences of BCCs and primary tumours. The development of protocols that maximize the cost-effectiveness of each method in different clinical scenarios is paramount.
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Affiliation(s)
- Priscila Neri Lacerda
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Eloana Pasqualin Lange
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Natália Miranda Luna
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Hélio Amante Miot
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
| | - Luciana Patrícia Fernandes Abbade
- Department of Dermatology, Infectology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Universidade Estadual Paulista), Botucatu, Brazil
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Sciegienka S, Slijepcevic A, Lipsey K, Spataro E, Chen C. Time to Mohs Reconstruction: A Systematic Review Comparing Complication Rates between Immediate and Delayed Repair. Facial Plast Surg 2024; 40:370-377. [PMID: 37336502 DOI: 10.1055/a-2112-7073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Several known factors affect outcomes of Mohs facial defect reconstruction; however, the effect of repair timing on outcomes is ill-defined. The aim of this study was to determine postoperative complication rates between immediate and delayed repair of Mohs facial defects. Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines were used. Articles were selected using PICO format-population: Mohs facial defect patients, intervention: defect repair, comparator: immediate (<24 hours), or delayed (>24 hours) repair, outcome: complication rate. PubMed/Medline (1946-2020), EMBASE (1947-2020), Scopus (1823-2020), Web of Science (1900-2020), Cochrane Library, and Clinicaltrials.gov were searched. Two independent reviewers screened abstracts; those in English with human subjects reporting repair timing and complication rates were included. Search criteria yielded 6,649 abstracts; 233 qualified for review. Data were gathered from six studies; they alone contained comparative data meeting inclusion criteria. While many well-written studies were encountered, reported results varied widely. A statistically sound meta-analysis could not be completed due to large heterogeneity between studies, biasing the analysis towards the largest weighted study. Clinically important differences may exist between immediate and delayed Mohs reconstruction, but small study numbers, large heterogeneity, and lack of standardized outcome measures limit definitive conclusions. More studies are needed to perform appropriate meta-analyses, including studies using standardized methods of reporting Mohs outcome data.
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Affiliation(s)
- Sebastian Sciegienka
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri
| | - Allison Slijepcevic
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kim Lipsey
- Bernard Becker Medical Library, Washington University in St. Louis, St Louis, Missouri
| | - Emily Spataro
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - Collin Chen
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St Louis, Missouri
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21
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Khan R, Ahmed A, Khachemoune A. Ultrasound features of high-risk basal cell carcinoma: a systematic review. Arch Dermatol Res 2024; 316:210. [PMID: 38787399 DOI: 10.1007/s00403-024-02949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024]
Abstract
Basal Cell Carcinoma (BCC) is the most prevalent skin cancer and continues to witness a surge in incidence rates. The categorization of BCC subtypes into low or high risk, guided by recurrence and invasiveness metrics, underscores the need for precise differentiation. While the punch biopsy remains the gold standard for diagnosis, its invasiveness prompts a need for non-invasive alternatives. Ultrasound (US) has emerged as a noteworthy candidate, gaining momentum in its potential to offer a less intrusive diagnostic approach. We conducted a systematic review regarding features of the high-risk subtypes of BCC on US. A thorough literature search of PubMed Medline, Embase, and CINAHL databases was conducted according to PRISMA guidelines and a total of nine studies meeting our inclusion criteria were included in this review. Evidence is still nascent but US features such as lesional shape, depth, hyperechoic spots, and color doppler may be helpful in differentiating high-risk BCC subtypes. However, further prospective studies with standardized interventions and outcome measures are required.
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Affiliation(s)
- Raza Khan
- HCA Medical City Plano Graduate Medical Education, Plano, Texas, USA
| | - Amna Ahmed
- Dow University of Health Sciences Karachi, Sindh, Pakistan
| | - Amor Khachemoune
- Department of Dermatology, SUNY Downstate, Brooklyn, USA.
- Department of Dermatology, Veterans Affairs New York Harbor Healthcare System, 800 Poly Place, Sindh, New york, 11209, Pakistan.
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Barbarossa L, D’Onghia M, Cartocci A, Suppa M, Tognetti L, Cappilli S, Peris K, Perez-Anker J, Malvehy J, Baldino G, Militello C, Perrot JL, Rubegni P, Cinotti E. Understanding the Dermoscopic Patterns of Basal Cell Carcinoma Using Line-Field Confocal Tomography. Tomography 2024; 10:826-838. [PMID: 38921940 PMCID: PMC11209319 DOI: 10.3390/tomography10060063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Basal cell carcinoma (BCC) is the most frequent malignancy in the general population. To date, dermoscopy is considered a key tool for the diagnosis of BCC; nevertheless, line-field confocal optical coherence tomography (LC-OCT), a new non-invasive optical technique, has become increasingly important in clinical practice, allowing for in vivo imaging at cellular resolution. The present study aimed to investigate the possible correlation between the dermoscopic features of BCC and their LC-OCT counterparts. In total, 100 histopathologically confirmed BCC cases were collected at the Dermatologic Clinic of the University of Siena, Italy. Predefined dermoscopic and LC-OCT criteria were retrospectively evaluated, and their frequencies were calculated. The mean (SD) age of our cohort was 65.46 (13.36) years. Overall, BCC lesions were mainly located on the head (49%), and they were predominantly dermoscopically pigmented (59%). Interestingly, all dermoscopic features considered had a statistically significant agreement with the LC-OCT criteria (all p < 0.05). In conclusion, our results showed that dermoscopic patterns may be associated with LC-OCT findings, potentially increasing accuracy in BCC diagnosis. However, further studies are needed in this field.
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Affiliation(s)
- Lorenzo Barbarossa
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy (L.T.); (P.R.); (E.C.)
| | - Martina D’Onghia
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy (L.T.); (P.R.); (E.C.)
| | - Alessandra Cartocci
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy (L.T.); (P.R.); (E.C.)
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy (L.T.); (P.R.); (E.C.)
| | - Simone Cappilli
- Department of Dermatology, Sacred Heart Catholic University, 00168 Rome, Italy; (S.C.)
| | - Ketty Peris
- Department of Dermatology, Sacred Heart Catholic University, 00168 Rome, Italy; (S.C.)
| | - Javiera Perez-Anker
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, 28029 Barcelona, Spain
| | - Josep Malvehy
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, 28029 Barcelona, Spain
| | - Gennaro Baldino
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
| | - Caterina Militello
- Department of Pathological Anatomy, University of Siena, 53100 Siena, Italy
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy (L.T.); (P.R.); (E.C.)
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy (L.T.); (P.R.); (E.C.)
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Mørk E, Mjønes P, Foss OA, Mørk C, Bachmann IM, Kroon S, Dotterud LK, Helsing P, Vatne Ø, Christensen E. Clinical versus Histological Assessment of Basal Cell Carcinoma Subtype and Thickness of Tumours Selected for Photodynamic Therapy. Acta Derm Venereol 2024; 104:adv18308. [PMID: 38751175 PMCID: PMC11110808 DOI: 10.2340/actadv.v104.18308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/11/2024] [Indexed: 05/24/2024] Open
Abstract
Photodynamic therapy is an approved treatment for primary, superficial, and small nodular basal cell carcinomas with a thickness of < 2 mm located on low-risk sites. Histologically verified basal cell carcinomas clinically assessed as suited for photodynamic therapy were included. The study aimed to investigate the agreement between clinical and histological assessments of basal cell carcinoma subtypes and thickness of tumours selected for photodynamic therapy with histopathological evaluation as a reference. A total of 343 tumours were included. The agreement between clinical and histological diagnosis of basal cell carcinoma subtype was 72% (p < 0.001). Clinical assessment of subtype had a sensitivity of 93% and specificity of 55% for superficial tumours and a sensitivity of 55% and specificity of 85% for nodular tumours. The mean ± SD thickness values by clinical and histological assessments were 0.95 ± 0.53 and 0.86 ± 0.75. The difference of 0.09 mm was statistically significant (p = 0.017), but not considered to be clinically relevant, although the differences between specific subgroups could be relevant. Among basal cell carcinomas clinically diagnosed as superficial, 91% were histologically consistent with the current photodynamic therapy criteria. The main results suggest that histopathological evaluation should precede photodynamic therapy to ensure selection of suitable basal cell carcinomas. In selected cases, the clinical diagnosis alone may be adequate before proceeding with photodynamic therapy.
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Affiliation(s)
- Erik Mørk
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Patricia Mjønes
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Pathology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Olav A Foss
- Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cato Mørk
- Akershus Dermatology Centre, Lørenskog, Norway
| | - Ingeborg M Bachmann
- Institute of Medical Science, University of Bergen, Bergen, Norway; Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - Susanne Kroon
- Department of Dermatology and Venerology, Stavanger University Hospital, Stavanger, Norway
| | | | - Per Helsing
- Department of Dermatology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Øystein Vatne
- Department of Dermatology, Førde Central Hospital, Førde, Norway
| | - Eidi Christensen
- Department of Clinical and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Dermatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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24
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Chambers DB, Ghosh S, Taher MS, Salopek TG. Incidence of Nonmelanoma Skin Cancers in Alberta, Canada, From 2007 to 2018. J Cutan Med Surg 2024; 28:238-247. [PMID: 38374688 DOI: 10.1177/12034754241232677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Nonmelanoma skin cancer (NMSC) is the most common malignancy affecting Caucasian populations and has been seeing steady increases in incidence globally for decades. Our previous study (from Alberta, Canada) had shown a plateau in the incidence rates for NMSC. This contrasts with data from other regions within Canada and throughout the world that indicated a continued increase in incidence rates of NMSCs. OBJECTIVES The objective of this study was to provide an update on the trends in incidence of NMSC in Alberta, Canada, from 2007 to 2018. METHODS A retrospective analysis of patients from Alberta diagnosed with NMSC from 2007 to 2018 inclusive was conducted with data retrieved from Alberta Cancer Registry. Sex-, age-, anatomical location-, NMSC subtype-, stage-specific incidence rates and trends were examined. RESULTS From 2007 to 2018, overall incidence rates of NMSC increased by 36%. Invasive squamous cell carcinoma (SCC) and in situ SCC demonstrated the most significant increase, invasive SCC [annual percentage change (APC) 3.48, P = .014] and in situ SCC (APC 5.61, P = .0001). In addition, we were able to determine that females had the most significant increases in NMSC incidence rates from 2007 to 2018 particularly invasive SCC (APC 3.03, P = <.0001) and in situ SCC (APC 5.08, P = <.0001). CONCLUSIONS After initial levelling of NMSC incidence in Alberta in the early part of 21st century, the incidence of NMSC continues to increase over the past decade. The reasons for this change are not clear and likely multifactorial.
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Affiliation(s)
- Daniel B Chambers
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sunita Ghosh
- Department of Medical Oncology, University of Alberta, Edmonton, AB, Canada
| | - Muba S Taher
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Thomas G Salopek
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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25
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Kaur H, de Mesy Bentley KL, Rahman SM, Cohen PR, Smoller BR. Cutaneous Superficial Basal Cell Carcinoma is a Basal Cell Carcinoma In Situ: Electron Microscopy of a Case Series of Basal Cell Carcinomas. Dermatol Ther (Heidelb) 2024; 14:1359-1366. [PMID: 38722558 PMCID: PMC11116291 DOI: 10.1007/s13555-024-01151-x] [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: 02/20/2024] [Accepted: 03/26/2024] [Indexed: 05/24/2024] Open
Abstract
Basal cell carcinoma (BCC) is the most common skin cancer. Skin cancers may present either as a non-invasive tumor or an invasive malignancy. The terminology of carcinoma in situ is used when the tumor is either just limited to epidermis or not present as single cells or nests in the dermis. However, currently the terminology superficial BCC is inappropriately used instead of BCC in situ when the skin cancer is limited to epidermis. In this study we compare the pathologic changes of superficial, nodular, and infiltrative BCCs using electron microscopy to identify the ultrastructural characteristics and validate the previously proposed terminology. Three cases of BCC (superficial BCC, nodular BCC, and infiltrative BCC) diagnosed by dermatopathologists at our institute were selected for review. Paraffin block tissues from these cases were sent for electron microscopy studies which demonstrated disruption of basal lamina in both nodular and infiltrative type of BCC, while it remains intact in BCC superficial type after extensive examination. Therefore, similar to other in situ skin cancers, there is no invasion of the neoplasm in superficial BCC into the dermis. Hence, the older term superficial BCC should be appropriately replaced with the newer terminology BCC in situ.
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Affiliation(s)
- Harsimran Kaur
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, USA.
| | - Karen L de Mesy Bentley
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, USA
| | - Syed Minhaj Rahman
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Philip R Cohen
- Department of Dermatology, Davis Medical Center, University of California, Sacramento, CA, USA
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Bruce R Smoller
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, USA.
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA.
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26
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Idriss MH, Stull CM, Migden MR. Treatments on the horizon for locally advanced basal cell carcinoma. Cancer Lett 2024; 589:216821. [PMID: 38521198 DOI: 10.1016/j.canlet.2024.216821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/16/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Basal cell carcinoma (BCC) is one of the most common human cancers. Most cases of BCC are amenable to surgical and topical treatments with excellent prognosis if diagnosed timely and managed appropriately. However, in a small percentage of cases, it could be locally advanced BBC (laBCC) and not amenable to surgery or radiation, including recurrent, large tumors or tumors that invade deeper tissue. Hedgehog inhibitors (vismodegib and sonidegib) are approved as the first-line treatment of laBCC. PD-1 inhibitor immunotherapy (cemiplimab) is indicated for cases that progressed on or could not tolerate hedgehog inhibitors or when hedgehog inhibitors are contraindicated. Given the modest response and bothersome side effects of some of the agents above, there are reports of novel treatments, and clinical trials are currently evaluating multiple agents.
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Affiliation(s)
- Munir H Idriss
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Carolyn M Stull
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael R Migden
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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27
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Zhang Y, Lu Q. Immune cells in skin inflammation, wound healing, and skin cancer. J Leukoc Biol 2024; 115:852-865. [PMID: 37718697 DOI: 10.1093/jleuko/qiad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
Given the self-evident importance of cutaneous immunity in the maintenance of body-surface homeostasis, disturbance of the steady-state skin is inextricably intertwined with dysfunction in cutaneous immunity. It is often overlooked by people that skin, well-known as a solid physical barrier, is also a strong immunological barrier, considering the abundant presence of immune cells including lymphocytes, granulocytes, dendritic cells, and macrophages. What's more, humoral immune components including cytokines, immunoglobulins, and antimicrobial peptides are also rich in the skin. This review centers on skin inflammation (acute and chronic, infection and aseptic inflammation), wound healing, and skin cancer to elucidate the elaborate network of immune cells in skin diseases.
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Affiliation(s)
- Yuhan Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Jiangwangmiao Street No. 12, Xuanwu, Nanjing 210042, China
- Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Jiangwangmiao Street No. 12, Xuanwu, Nanjing 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China
| | - Qianjin Lu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Jiangwangmiao Street No. 12, Xuanwu, Nanjing 210042, China
- Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Jiangwangmiao Street No. 12, Xuanwu, Nanjing 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China
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28
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Krönert MIC, Schwarzenböck SM, Kurth J, Heuschkel M, Krause BJ, Emmert S, Tietze JK. Patient-Orientated Evaluation of Treatment of Non-Melanoma Skin Cancer with Rhenium-188 Compared to Surgery. Healthcare (Basel) 2024; 12:921. [PMID: 38727478 PMCID: PMC11083370 DOI: 10.3390/healthcare12090921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Non-melanoma skin cancers (NMSCs) are responsible for up to one-third of all human malignancies. Surgery is usually the treatment of choice, but patients often experience pain during the procedure. Topical rhenium-188 resin skin cancer treatment (RSCT) may be a valid therapeutic alternative. METHODS In this monocentric pilot study, 19 patients suffering from NMSC were treated with RSCT. Most of these patients had also experienced surgery, either because they developed a new NMSC in aftercare, or they had suffered previously from NMSC. Three RSCT-treated patients, who had no exposure to surgery so far, were paired with three matched patients, who had received surgery. We sought to evaluate and compare the patients' experience with both treatments. A questionnaire assessed patients' perceptions regarding side effects, aesthetic outcomes, wound care, fear of complications, and personal treatment preferences. Patients evaluated the different parameters of their either RSCT- or surgery-treated lesions on a scale from 0-10. RESULTS Patients were more afraid of complications before surgery than before RSCT (p = 0.04). Treatment with RSCT caused significantly less pain on treatment day (mean 0.56) than surgery (mean 2.32) (0 no pain, 10 maximum pain) (p = 0.02) and 14 days after the procedure (mean 0.89 versus mean 2.47) (p = 0.02). On day 14, RSCT-treated lesions were also significantly less itchy (mean 0.34) than after surgery (mean 1.50). Most patients were very satisfied with the aesthetic outcome after both RSCT (mean 8.42) and surgery (mean 8.31) (p = 0.89). In the case of a new NMSC, the majority of patients who experienced both treatments would rather be treated primarily with RSCT (44%) or would consider both options (31%); only 19% preferred surgery. CONCLUSION Patients evaluated RSCT as less painful than surgery. The aesthetic outcomes of both treatments were comparable. For pain-sensitive patients, RSCT might be a preferable treatment option.
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Affiliation(s)
- Maila I. C. Krönert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (M.I.C.K.); (S.E.)
| | - Sarah M. Schwarzenböck
- Department of Nuclear Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (S.M.S.); (J.K.); (M.H.); (B.J.K.)
| | - Jens Kurth
- Department of Nuclear Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (S.M.S.); (J.K.); (M.H.); (B.J.K.)
| | - Martin Heuschkel
- Department of Nuclear Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (S.M.S.); (J.K.); (M.H.); (B.J.K.)
| | - Bernd J. Krause
- Department of Nuclear Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (S.M.S.); (J.K.); (M.H.); (B.J.K.)
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (M.I.C.K.); (S.E.)
| | - Julia K. Tietze
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (M.I.C.K.); (S.E.)
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29
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Marsidi N, Ottevanger R, Demir YE, van Beugen S, Goeman JJ, Genders RE. Patient-reported outcome measurements in facial skin surgery and a comparison between Mohs micrographic surgery and conventional excisions. J Eur Acad Dermatol Venereol 2024. [PMID: 38644735 DOI: 10.1111/jdv.20025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/28/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Knowledge of the psychosocial impact of facial skin surgery on patients can help improve counselling strategies. OBJECTIVES The objective was to measure the psychological impact of facial skin cancer surgery on patients over a 1-year period. Secondary objective was to measure the difference between Mohs micrographic surgery (MMS) and conventional excision (CE) on these parameters. METHODS This observational survey study was conducted between March 2019 and July 2020. Patients who had facial skin surgery using MMS or CE were selected. Five surveys were conducted on four timepoints (preoperative, 1 week, 3 months and 1 year post-operative) measuring the quality of life, perceived stigmatization, body image, satisfaction with facial appearance and psychosocial distress. RESULTS A total of 228 patients (MMS 154 patients, CE 74 patients) were included for the analysis. Scores for quality of life did not significantly change, in the year after surgery (PCS-12 mean 50.5, SD 9.3 and MCS-12 50.6, SD 9.4); however, stigmatization (F (3, 235,39) 7,26, p < 0.01, d = -0.07), body image concerns (F (3, 198,28) = 3.75, p < 0.01, d = -0.14), satisfaction with facial appearance (F (3, 205,18) = 10.74, p < 0.01, d = 0.43) and psychosocial distress (F (3, 208,69) = 9.26, p < 0.01, d = -0.15) did change over time. The use of MMS or CE did not significantly affect outcome scores after 1 year. CONCLUSION Patients receiving facial skin cancer surgery exhibited low scores for perceived stigmatization and body image concerns. Their quality of life was not statistically influenced by facial surgery, and their satisfaction with their facial appearance and psychosocial distress even improved after 1 year. The results suggest that the surgical treatment type (MMS or CE) does not influence the outcome. The overall results can help in counselling strategies to improve expectations for patients receiving facial surgery.
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Affiliation(s)
- N Marsidi
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Dermatology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - R Ottevanger
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y E Demir
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - S van Beugen
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - J J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Dermatology, Roosevelt Kliniek, Leiden, The Netherlands
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30
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Akella SS, Lee J, May JR, Puyana C, Kravets S, Dimitropolous V, Tsoukas M, Manwar R, Avanaki K. Using optical coherence tomography to optimize Mohs micrographic surgery. Sci Rep 2024; 14:8900. [PMID: 38632358 PMCID: PMC11024158 DOI: 10.1038/s41598-024-53457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/31/2024] [Indexed: 04/19/2024] Open
Abstract
Mohs micrographic surgery (MMS) is considered the gold standard for treating high-risk cutaneous basal cell carcinoma (BCC), but is expensive, time-consuming, and can be unpredictable as to how many stages will be required or how large the final lesion and corresponding surgical defect will be. This study is meant to investigate whether optical coherence tomography (OCT), a highly researched modality in dermatology, can be used preoperatively to map out the borders of BCC, resulting in fewer stages of MMS or a smaller final defect. In this prospective study, 22 patients with BCC undergoing surgical excision were enrolled at a single institution. All patients had previously received a diagnostic biopsy providing confirmation of BCC and had been referred to our center for excision with MMS. Immediately prior to performing MMS, OCT was used to map the borders of the lesion. MMS then proceeded according to standard protocol. OCT images were compared to histopathology for agreement. Histopathologic analysis of 7 of 22 MMS specimens (32%) revealed a total absence of BCC, indicating resolution of BCC after previous diagnostic biopsy. This outcome was correctly predicted by OCT imaging in 6 of 7 cases (86%). Nine tumors (9/22, 41%) had true BCC and required a single MMS stage, which was successfully predicted by pre-operative OCT analysis in 7 of 9 cases (78%). The final six tumors (27%) had true BCC and required two MMS stages for complete excision; preoperative OCT successfully predicted the need for a second stage in five cases (5/6, 83.3%). Overall, OCT diagnosed BCC with 95.5% accuracy (Cohen's kappa, κ = 0.89 (p-value = < 0.01) in the center of the lesion. Following a diagnostic biopsy, OCT can be used to verify the existence or absence of residual basal cell carcinoma. When residual tumor is present that requires excision with MMS, OCT can be used to predict tumor borders, optimize surgery and minimize the need for additional surgical stages.
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Affiliation(s)
- Sruti S Akella
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jenna Lee
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Julia Roma May
- School of Medicine, University of Illinois-Chicago, Chicago, IL, USA
| | - Carolina Puyana
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Sasha Kravets
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA
| | | | - Maria Tsoukas
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Rayyan Manwar
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA
| | - Kamran Avanaki
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA.
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA.
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31
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Gómez-Tomás Á, Falguera-Mayoral M, García-Patos V, Bassas-Freixas P, Palao-Doménech R, Ferrer-Fábrega B, Bodet D. Vitiligo-like basal cell carcinoma: An emerging entity in young women. Indian J Dermatol Venereol Leprol 2024; 0:1-3. [PMID: 38841972 DOI: 10.25259/ijdvl_672_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/13/2023] [Indexed: 06/07/2024]
Affiliation(s)
- Álvaro Gómez-Tomás
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Vicente García-Patos
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ricard Palao-Doménech
- Department of Plastic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Domingo Bodet
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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32
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Garmpis N, Dimitroulis D, Garmpi A, Tasioula PI, Damaskos C. Giant Basal Cell Carcinoma in a Renal Transplant Recipient: A Case Report. Cureus 2024; 16:e58956. [PMID: 38800195 PMCID: PMC11126782 DOI: 10.7759/cureus.58956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Basal cell carcinoma is a skin cancer with a more benign clinical course, compared to other skin cancers. However, when left neglected, it can cause serious morbidity and mortality. A basal cell carcinoma larger than 5 cm is defined as giant. Common causes of these carcinomas are negligence, immunosuppression, low socioeconomic status, physical or mental dysfunction, light exposure, exposure to radiation, existence of a previous lesion, recurrence after treatment, and aggressive histologic pattern. In some cases, giant basal cell carcinoma has been described to infiltrate multiple intracranial structures and to be associated with distant metastasis. Herein, we present a case of a giant basal cell carcinoma on the temporary scalp of a renal transplant recipient with depression.
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Affiliation(s)
- Nikolaos Garmpis
- NS Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, GRC
- Department of Surgery, Sotiria General Hospital, Athens, GRC
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Christos Damaskos
- NS Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, GRC
- Renal Transplantation Unit, Laiko General Hospital, Athens, GRC
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33
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McCrary MR, Foulis P, Gibbs J. Frequency and features of malignant tumors clinically mimicking cutaneous cysts: A retrospective chart review. J Cutan Pathol 2024; 51:311-316. [PMID: 38131170 DOI: 10.1111/cup.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Many cutaneous lesions are clinically suspected as "cyst"; however, following histopathological examination, are found to be more significant lesions. Here, we examine the frequency and features of malignancies with cutaneous cysts in the clinical differential. METHODS A retrospective study of surgical pathology specimens at the James A. Haley Veterans' Hospital from January 2018 to December 2022 was conducted. Cutaneous specimens containing the clinical diagnosis of "cyst" were included. The clinicopathological features were summarized. RESULTS Premalignant or malignant neoplasms accounted for 4.5% of all specimens submitted with cysts in the clinical differential. Most cyst-mimicking cancers were basal cell carcinoma (BCC) or squamous cell carcinoma (SCC); however, cancers with poorer prognoses, such as Merkel cell carcinoma and melanoma, also clinically masqueraded as cysts. The BCCs were predominately nodular, and the SCCs were largely well-differentiated and invasive. Many exhibited clinical signs and symptoms compatible with benign cysts, such as central punctum, pain, and rapid growth. Identified risk factors included history of prior non-melanoma skin cancer diagnosis, previous excision, and immunosuppression. CONCLUSIONS Many lesions clinically concerning cutaneous cysts were found to be malignancies following histopathological review. Accordingly, following biopsy all cyst-like lesions should be examined microscopically, especially in certain clinical contexts in which the incidence of skin cancer is increased.
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Affiliation(s)
- Myles R McCrary
- Anatomic and Clinical Pathology, University of South Florida, Tampa, Florida, USA
| | - Philip Foulis
- Anatomic and Clinical Pathology, University of South Florida, Tampa, Florida, USA
- Anatomic and Clinical Pathology, James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Julie Gibbs
- Anatomic and Clinical Pathology, University of South Florida, Tampa, Florida, USA
- Anatomic and Clinical Pathology, James A. Haley Veterans' Hospital, Tampa, Florida, USA
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da Silva Gomes B, Cláudia Paiva-Santos A, Veiga F, Mascarenhas-Melo F. Beyond the adverse effects of the systemic route: Exploiting nanocarriers for the topical treatment of skin cancers. Adv Drug Deliv Rev 2024; 207:115197. [PMID: 38342240 DOI: 10.1016/j.addr.2024.115197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/21/2023] [Accepted: 02/02/2024] [Indexed: 02/13/2024]
Abstract
Skin cancer is a heterogeneous disease that can be divided into two main groups, melanoma and nonmelanoma skin cancers. Conventional therapies for skin cancer have numerous systemic side effects and a high recurrence rate. Topical treatment is an alternative approach, but drug permeability remains a challenge. Therefore, nanocarriers appear as important nanotechnology tools that reduces both the side effects and improves clinical outcomes. This is why they are attracting growing interest. In this review, scientific articles on the use of nanocarriers for the topical treatment of skin cancer were collected. Despite the promising results of the presented nanocarriers and considering that some of them are already on the market, there is an urgent need for investment in the development of manufacturing methods, as well as of suitable toxicological and regulatory evaluations, since the conventional methods currently used to develop these nanocarriers-based products are more time-consuming and expensive than conventional products.
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Affiliation(s)
- Beatriz da Silva Gomes
- Laboratory of Development and Drug Technologies, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal.
| | - Ana Cláudia Paiva-Santos
- Laboratory of Development and Drug Technologies, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal; University of Coimbra, LAQV-REQUIMTE, Department of Pharmaceutical Technology, Faculty of Pharmacy, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal.
| | - Francisco Veiga
- Laboratory of Development and Drug Technologies, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal; University of Coimbra, LAQV-REQUIMTE, Department of Pharmaceutical Technology, Faculty of Pharmacy, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal.
| | - Filipa Mascarenhas-Melo
- University of Coimbra, LAQV-REQUIMTE, Department of Pharmaceutical Technology, Faculty of Pharmacy, Azinhaga Sta. Comba, 3000-548 Coimbra, Portugal; Higher School of Health, Polytechnic Institute of Guarda, Rua da Cadeia, 6300 - 307 Guarda, Portugal.
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Koumprentziotis IA, Rompoti N, Liopyris K, Nicolaidou E, Stratigos A. Photodynamic Therapy for the Treatment of Basal Cell Carcinoma: A Comprehensive Review of Randomized Controlled Trials. Dermatol Pract Concept 2024; 14:dpc.1402a105. [PMID: 38810046 PMCID: PMC11136039 DOI: 10.5826/dpc.1402a105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common skin cancer worldwide and has been reported to have a rising incidence in the last years. Multiple therapeutic modalities are approved for the treatment of BCC, making it difficult for physicians to choose the most suitable option for every patient. Photodynamic therapy (PDT) using either 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) as photosensitizing agents is an established treatment option for low-risk BCC. OBJECTIVES This review aims to summarize the available evidence from randomized clinical trials (RCTs) that utilize either ALA or MAL PDT and compare it with other treatment modalities. The main outcomes related to the effectiveness, adverse events, cosmetic outcomes and pain sensation, along with data from long-term follow-ups will be presented and discussed. METHODS Thorough literature searches were conducted through the electronic databases ClinicalTrials. gov and Pubmed/MEDLINE from inception up to 28 March 2023. Only studies in English were included. All relevant data were extracted accordingly from the eligible studies. RESULTS Eight RCTs included superficial BCC (sBCC) alone, 7 included nodular BCC (nBCC), 2 included both sBCC and nBCC and 1 included BCC of unspecified subtype. Follow-up duration ranged from 3 months to 5 years. Both ALA-PDT and MAL-PDT demonstrated acceptable efficacy, adverse events, cosmetic outcomes and pain sensation while no major differences were observed between them. PDT was less effective than surgery but with better reported cosmetic outcomes. CONCLUSIONS PDT is a safe and efficacious treatment option for sBCC and to a lesser extent nBCC.
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Affiliation(s)
- Ioannis-Alexios Koumprentziotis
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Natalia Rompoti
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Liopyris
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Electra Nicolaidou
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Stratigos
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Klein CM, Sivesind TE, Dellavalle RP. From the Cochrane Library: Visual Inspection and Dermoscopy, Alone or in Combination, for Diagnosing Keratinocyte Skin Cancers in Adults. JMIR DERMATOLOGY 2024; 7:e41657. [PMID: 38451581 PMCID: PMC10958336 DOI: 10.2196/41657] [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: 08/03/2022] [Revised: 07/18/2023] [Accepted: 02/03/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Pimentel B, Palmeiro A, Miroux-Catarino A. Basal Cell Carcinoma on an Atypical Location. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00183-2. [PMID: 38452891 DOI: 10.1016/j.ad.2023.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 03/09/2024] Open
Affiliation(s)
- B Pimentel
- Serviço de Dermatologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - A Palmeiro
- Serviço de Dermatologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - A Miroux-Catarino
- Serviço de Dermatologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Ondo AL, Kerner JD, Ondo IP, Kerner JV, Mousavi H, Trainor P, Shanler SD. Superficial basal cell carcinoma treated with curettage followed by topical imiquimod cream: A retrospective study. JAAD Int 2024; 14:99-101. [PMID: 38348135 PMCID: PMC10859270 DOI: 10.1016/j.jdin.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
- Andrew L. Ondo
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | | | | | - Jacob V. Kerner
- Department of Molecular, Cellular and Developmental Biology, University of California Santa Barbara, Santa Barbara, California
| | - Hossein Mousavi
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico
| | - Patrick Trainor
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico
| | - Stuart D. Shanler
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico
- Epiphany Dermatology, Las Cruces, New Mexico
- University of Rochester, Rochester, New York
- Department of Molecular, Cellular and Developmental Biology, University of California Santa Barbara, Santa Barbara, California
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico
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Adamus-Grabicka AA, Hikisz P, Sikora J. Nanotechnology as a Promising Method in the Treatment of Skin Cancer. Int J Mol Sci 2024; 25:2165. [PMID: 38396841 PMCID: PMC10889690 DOI: 10.3390/ijms25042165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The incidence of skin cancer continues to grow. There are an estimated 1.5 million new cases each year, of which nearly 350,000 are melanoma, which is often fatal. Treatment is challenging and often ineffective, with conventional chemotherapy playing a limited role in this context. These disadvantages can be overcome by the use of nanoparticles and may allow for the early detection and monitoring of neoplastic changes and determining the effectiveness of treatment. This article briefly reviews the present understanding of the characteristics of skin cancers, their epidemiology, and risk factors. It also outlines the possibilities of using nanotechnology, especially nanoparticles, for the transport of medicinal substances. Research over the previous decade on carriers of active substances indicates that drugs can be delivered more accurately to the tumor site, resulting in higher therapeutic efficacy. The article describes the application of liposomes, carbon nanotubes, metal nanoparticles, and polymer nanoparticles in existing therapies. It discusses the challenges encountered in nanoparticle therapy and the possibilities of improving their performance. Undoubtedly, the use of nanoparticles is a promising method that can help in the fight against skin cancer.
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Affiliation(s)
- Angelika A. Adamus-Grabicka
- Department of Bioinorganic Chemistry, Faculty of Pharmacy, Medical University of Lodz, Muszynskiego 1, 90-151 Lodz, Poland;
| | - Pawel Hikisz
- Department of Oncobiology and Epigenetics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland;
| | - Joanna Sikora
- Department of Bioinorganic Chemistry, Faculty of Pharmacy, Medical University of Lodz, Muszynskiego 1, 90-151 Lodz, Poland;
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Fang L, Simman R, Workman L, Ayoub S, Bratton C. Malignant wound aetiology, diagnosis and management: a case series and literature review. J Wound Care 2024; 33:102-117. [PMID: 38329829 DOI: 10.12968/jowc.2024.33.2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Malignant wounds develop when neoplastic cells invade the skin either locally or by lymphatic and haematogenous spread. They can present as hard-to-heal wounds and underlying causes include: primary skin cancer; metastasis of extracutaneous primary malignancy; malignant transformation of a hard-to-heal wound; iatrogenic injury; and cutaneous forms of cancers of non-skin origin. High clinical suspicion for a malignant wound should be confirmed with skin biopsy. The aim of this case series is to highlight a combination of both clinically clear cutaneous malignancies and not-so-obvious wounds caused by malignancy. METHOD This case series examines patients with malignant wounds of varying aetiology and appearance. For each case, we explain the pathophysiology, atypical features, diagnostic approach and treatment. We also discuss types of wound biopsy and general wound management principles. RESULTS Among the 11 cases analysed using descriptive statistics, median wound duration before presentation at our clinic was one year, while median age at presentation was 65 years. Our case series included the following diagnoses: cutaneous metastasis of invasive ductal carcinoma of the breast (n=2); cutaneous metastasis of colorectal adenocarcinoma (n=1); Marjolin's ulcer (n=1), basal cell carcinoma (BCC) (n=2), primary cutaneous squamous cell carcinoma (SCC) (n=1), metastatic malignant melanoma (n=1), cutaneous T-cell lymphoma (n=1), cutaneous angiosarcoma (n=1), Kaposi sarcoma (n=1) and recurrent tonsillar SCC with osteoradionecrosis (n=1); one case had both BCC and SCC. CONCLUSION Punch and excisional biopsies were the most frequently used diagnostic techniques. Local wound therapy addressed bleeding, malodour, exudate, pain and infection. However, wound healing is usually achieved once the underlying malignancy is treated. In advanced or metastatic disease, palliative wound care aims to prevent exacerbation of existing wounds and focuses on patient comfort.
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Affiliation(s)
- Lauren Fang
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
| | - Richard Simman
- University of Toledo, College of Medicine and Life Science, Department of Surgery, Toledo, Ohio, US
- Jobst Vascular Institute, ProMedica Health Network, Wound Care Program, Toledo, Ohio, US
| | - Lauren Workman
- Jobst Vascular Institute, ProMedica Health Network, Wound Care Program, Toledo, Ohio, US
| | - Samar Ayoub
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
| | - Camille Bratton
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
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Salvio AG, Requena MB, Stringasci MD, Fregolenti BA, Medero MMC, Silva RGS, Bagnato VS. Photodynamic therapy for nodular basal cell carcinoma up to 5mm located on high-risk area: Effectiveness and long-term follow-up results. Photodiagnosis Photodyn Ther 2024; 45:103919. [PMID: 38081567 DOI: 10.1016/j.pdpdt.2023.103919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023]
Abstract
SIGNIFICANCE Response rates evaluation of photodynamic therapy (PDT) for nodular basal cell carcinoma (BCC) treatment located on high-risk and low-risk areas of the face. APPROACH Two groups of nodular BCC were selected, debulked, and received 20% methyl aminolevulinate (MAL) hydrochloride cream. After 3 h, the first irradiation was performed (20 min, 150 J/cm2). Then, the cream was re-applied, and a second irradiation was performed after 1.5 h (20 min, 150 J/cm2). Clearance at 30 days and recurrence-free survival rate were evaluated. RESULTS The clearance at 30 days after PDT was 89% for the low-risk area group and 87% for the high-risk group. The recurrence-free survival at 60 months was 82% and 85% for the high-risk and low-risk groups, respectively. CONCLUSIONS No significant differences were observed between groups nor for clearance at 30 days, nor recurrence-free follow-up. These results make PDT possible option for nodular BCC less than 5 mm located in high-risk areas.
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Affiliation(s)
- Ana Gabriela Salvio
- Skin Department of Amaral Carvalho Hospital, Jaú, SP, Brazil; Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil.
| | | | | | | | | | | | - Vanderlei Salvador Bagnato
- Sao Carlos Institute of Physics, University of Sao Paulo, Sao Carlos, SP, Brazil; Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
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42
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Torun MT, Yılmaz GT. Can the Safe Surgical Margin Be Narrowed in Early-Stage Facial Basal Cell Carcinoma? Adv Skin Wound Care 2024; 37:1-7. [PMID: 38241456 DOI: 10.1097/asw.0000000000000093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To examine factors that affect the positive surgical margins of facial basal cell carcinoma (BCC) and investigate whether the surgical margin value can be narrowed in early-stage facial BCCs. METHODS Ninety-five patients were divided into the three groups based on prognosis: good (n = 48), mixed (n = 32), and poor (n = 15). The good prognosis group (group 1) included nodular and superficial subtypes; the mixed prognosis group (group 2) included nodular-infiltrative, nodular-micronodular, and nodular-sclerosing subtypes; and the poor prognosis group (group 3) included infiltrative and micronodular subtypes. RESULTS Groups 1 and 2 differed from each other significantly in terms of positive surgical margin (P = .002) and tumor thickness (P = .008), but group 3 did not (P = .851 and P = .804, respectively). With regard to surgical method (primary vs local flap repair), only tumor localization varied significantly (P < .001). CONCLUSIONS Groups differed significantly in terms of surgical margin positivity, the distance of the tumor to the surgical margin, and the tumor thickness. The intact surgical margin was 2 mm on average in this study, and the authors suggest that it may be possible to revise the surgical margin values recommended in the literature.
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Affiliation(s)
- Mümtaz Taner Torun
- In the Faculty of Medicine, Bandırma Onyedi Eylül University, Balıkesir, Bandırma, Turkey, Mümtaz Taner Torun, MD, is Associate Professor, Department of Ear Nose and Throat Diseases; and Gülden Taşova Yılmaz, MD, is Assistant Professor, Department of Pathology
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43
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Kassotis AS, Grimes J, Samie FH, Lewin JM, Levenson JA, Glass LRD. Risk factors for developing depressive symptoms in the immediate postoperative period after Mohs micrographic surgery. Orbit 2024; 43:22-27. [PMID: 36847522 DOI: 10.1080/01676830.2023.2179639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Mohs micrographic surgery (MMS) is a highly efficacious, tissue sparing method of skin cancer removal. Nevertheless, in the months to years after MMS, psychosocial distress has been described. The present study addressed the immediate period after MMS and assessed the frequency and risk factors for development of depressive symptoms. METHODS Subjects undergoing MMS at two physician practices (JL, FS) were included in this prospective cohort study. Preoperatively, a standardized depression screening, the Patient Health Questionnaire-8 (PHQ-8), was administered. After MMS, the PHQ-8 was readministered at weeks 1, 2, 4, 6, and 12. Average PHQ-8 score by week and change from baseline PHQ-8 score were the primary outcomes. RESULTS Sixty-three subjects were included of which 49 (78%) had a facial site. Twenty-two subjects (35%) had some increase in score during the 12-week follow-up period, of which 18 had a facial site. The oldest subjects (83-99 years, n = 14) had significantly higher PHQ-8 scores at week 4 (p < 0.01) and week 6 (p = 0.02) than all other age groups. There were no differences in scores between location groups. CONCLUSIONS One-third of subjects had some increase in score during the follow-up period. Those in the oldest age cohort were at highest risk of increased score. In contrast to prior literature, those with facial sites were not at higher risk. This difference may be explained by increased masking during the ongoing COVID-19 pandemic. Ultimately, consideration of patients' psychologic status in the immediate postoperative period after MMS, particularly in the elderly population, may enhance perceived patient outcomes.
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Affiliation(s)
- Alexis S Kassotis
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph Grimes
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesse M Lewin
- The Kimberly and Eric J. Waldman Department of Dermatology, Ichan School of Medicine at Mt. Sinai, New York, NY, USA
| | - Jon A Levenson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lora R Dagi Glass
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
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Chaudhry S, Lee K. Diagnosing and Managing Venous Stasis Disease and Leg Ulcers. Clin Geriatr Med 2024; 40:75-90. [PMID: 38000863 DOI: 10.1016/j.cger.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Venous insufficiency is a common medical condition that affects many individuals, especially those with advanced age. Chronic venous insufficiency can lead to secondary cutaneous changes that most commonly present as stasis dermatitis but can progress to more serious venous ulcers. Although venous ulcers are the most common cause of lower extremity ulcers, the differential diagnosis of leg ulcers is broad. This article will discuss clinical clues to help guide patient workup and will review basic clinical evaluation and management of common leg ulcers.
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Affiliation(s)
- Sofia Chaudhry
- Department of Dermatology, Saint Louis University School of Medicine, 1225 South Grand Boulevard, 3rd Floor, Saint Louis, MO 63104, USA.
| | - Kathryn Lee
- Saint Louis University School of Medicine, 1402 South Grand Boulevard, Saint Louis, MO 63104, USA
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45
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Council ML, Sheinbein DM. Common Skin Cancers in Older Adults Approach to Diagnosis and Management. Clin Geriatr Med 2024; 40:25-36. [PMID: 38000861 DOI: 10.1016/j.cger.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Skin cancers are the most common malignancies to affect older adults. The most common skin cancers, basal and squamous cell carcinoma, can usually be cured with surgery. Although less common, melanoma can be deadly when not caught in its earliest stages.
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Affiliation(s)
- Martha Laurin Council
- Department of Medicine (Dermatology), Washington University School of Medicine in St. Louis, 969 North Mason Road, Suite 200, St Louis, MO 63141, USA.
| | - David M Sheinbein
- Department of Medicine (Dermatology), Washington University School of Medicine in St. Louis, 969 North Mason Road, Suite 200, St Louis, MO 63141, USA
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Martora F, Ascierto PA, Scalvenzi M, Palla M, Costa C, D'Andrea M, Di Trolio R, Scarpato L, Marasca C. Tirbanibulin ointment to manage recurrence of superficial basal cell carcinoma of the face: case report. Clin Exp Dermatol 2024; 49:183-185. [PMID: 37758501 DOI: 10.1093/ced/llad334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
We present the case of a 64-year-old woman who presented to our clinic with a recurrence of superficial basal cell carcinoma to the left subocular region: the patient had been treated surgically about 4 months previously. Dermoscopy examination showed focal ulceration, linear and arborizing (branch-like) telangiectasia. The patient refused another surgical or topical treatment, such as imiquimod, or photodynamic therapy, for fear of related side effects. After discussing with the patient, we decided to start treatment with tirbanibulin ointment according to the schedule for actinic keratosis, once daily for 5 days.
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Affiliation(s)
- Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale
| | - Massimiliano Scalvenzi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Marco Palla
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale
| | - Claudia Costa
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Mirella D'Andrea
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale
| | - Rossella Di Trolio
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale
| | - Luigi Scarpato
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale
| | - Claudio Marasca
- Dermatology Unit, Medical Department, 'Antonio Cardarelli' National Hospital, Naples, Italy
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Khalil AA, Enezei HH, Aldelaimi TN, Mohammed KA. Advances in Diagnosis and Treatment of Basal Cell Carcinoma. J Craniofac Surg 2024:00001665-990000000-01294. [PMID: 38252534 DOI: 10.1097/scs.0000000000009959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024] Open
Abstract
Basal cell carcinoma (BCC) is one among the most prevalent malignant neoplasms that has exhibited a notable surge in global incidence over recent decades. This slow-growing malignancy is typified by its localized invasiveness while demonstrating an exceedingly rare metastatic proclivity. It predominantly afflicts the sun-exposed skin of aging individuals, with a heightened predilection for the maxillofacial region. Scraping cytology offers numerous benefits, including the potential for an earlier diagnosis and the absence of scarring, as opposed to a biopsy. The cytodiagnosis of BCC proves to be straightforward with various techniques, making it highly advantageous in an outpatient environment as a swift diagnostic method when planning a surgical excision. Our study sought to scrutinize the clinicopathological facets of BCC within the maxillofacial region. We compared advanced cytological techniques for diagnosis, including scraping, scratching, and imprinting using Papanicolau and Diff-Quick stains. In addition, we evaluated the therapeutic effectiveness of diode lasers operating at wavelengths of 940nm and 980n. A retrospective analysis was undertaken, encompassing facial BCC lesions smaller than 2.5 cm in diameter that underwent treatment through diode laser ablation between September 2021 and August 2023 at Ramadi Teaching Hospital and a private clinic in Ramadi City, Iraq. Among the cohort of 48 patients with BCC, a majority (58%) were 50 years of age or older, with a predominance of males (62%). The mean duration of lesion existence exceeded 4 months. The anatomical region most commonly involved was the middle 1/3 of the face, accounting for 34% of cases. Intriguingly, the therapeutic approach of diode laser ablation yielded exceptional esthetic and functional outcomes, which were consistently observed throughout the follow-up period post-healing. The occurrence of complications following diode laser ablation was relatively infrequent. This investigation revealed that cytological examination is easily conducted, eliminating the need for local anesthesia, saving time, being more cost-effective than a conventional biopsy, and delivering swift diagnoses. The process of smear-taking for cytology is well-tolerated, inflicting minimal trauma or discomfort on the patient. BCC predominantly afflicts elderly males and most frequently affects the middle third of the face. Notably, nodular BCC emerged as the prevailing histological subtype. The use of diode laser ablation exhibited a commendable track record, producing exemplary functional and esthetic outcomes over a 6-month follow-up period.
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Affiliation(s)
- Afrah A Khalil
- Department of Oral Diagnosis, Oral and Maxillofacial Pathologist, College of Dentistry, University of Anbar
| | - Hamid H Enezei
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Anbar Province, Iraq
| | - Tahrir N Aldelaimi
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Anbar Province, Iraq
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Dizon MP, Linos E, Swetter SM. Estimating remaining life expectancy in veterans with basal cell carcinoma using an automated electronic health record scoring system: A retrospective cohort study. J Am Acad Dermatol 2024; 90:98-105. [PMID: 37742837 DOI: 10.1016/j.jaad.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/26/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Active surveillance may be considered for low-risk basal cell carcinomas (BCCs) in patients with limited life expectancy; however, estimates of life expectancy are not readily available. Veterans Health Administration's Care Assessment Need (CAN) score may address this problem. OBJECTIVE We examined the CAN score's performance in predicting 1-, 3-, and 5-year mortality in US veterans with BCC. METHODS This retrospective cohort study used national Veterans Health Administration's electronic medical record data. The CAN score's performance in the prediction of mortality in veterans with BCC was evaluated based on tests of goodness-of-fit, discrimination, and calibration. RESULTS For 54,744 veterans with BCC treatment encounters between 2013 and 2018, the CAN score performed well in the prediction of mortality based on multiple tests. A threshold CAN score of 90 had a positive predictive value of 55% for 3-year mortality, clinically useful in identifying patients with intermediate-term survival. LIMITATIONS The study relied upon the combination of diagnosis codes and procedure codes to identify BCC cases. CONCLUSION The CAN score has the potential to improve the quality of cancer care for veterans by providing clinicians with an estimate of life expectancy and facilitating conversations in cases where active surveillance can be considered.
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Affiliation(s)
- Matthew P Dizon
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Health Policy, Stanford University School of Medicine, Palo Alto, California.
| | - Eleni Linos
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California
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Sharp K, Olafsdottir EJ, Sahni DR, Madsen S, Grant-Kels JM, Kristjansson A, Hoyt DW, Ungar JP, Frigerio A, Jonasson JG, Adalsteinsson JA. Survival of patients with basal cell carcinoma, squamous cell carcinoma, and squamous cell carcinoma in situ: A whole population study. J Am Acad Dermatol 2024; 90:91-97. [PMID: 37758026 DOI: 10.1016/j.jaad.2023.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/25/2023] [Accepted: 09/10/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Keratinocyte carcinoma (KC) is the commonest type of malignancy in humans; however, the impact of KC on survival is poorly understood. OBJECTIVES This study characterizes the impact of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and squamous cell carcinoma in situ (SCCis) on the survival of Icelanders. METHODS This whole population study evaluated relative survival of KC in Iceland by using a cancer registry containing records of all BCC, SCCis, and SCC cases recorded in Iceland between 1981 and 2015. RESULTS Between 1981 and 2015, 8767 Icelanders were diagnosed with their first localized KC. A total of 6473 individuals with BCC, 1194 with SCCis, and 1100 with invasive SCC, respectively. BCC was not associated with decreased survival except for men diagnosed with BCC between 1981 and 1995 for whom decreased 10-year relative survival was observed (85.3, 95% CI [77.9-92.7]). SCC and SCCis were both associated with a decrease in relative survival for certain population subgroups such as individuals <50 years of age at time of diagnosis. CONCLUSION Our whole population cohort survival study examining the Icelandic Cancer Registry supports prior studies demonstrating that BCC is not associated with a reduction in relative survival and that SCC and SCCis are associated with comparatively poor relative survival in certain population subgroups.
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Affiliation(s)
- Kelley Sharp
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut.
| | | | - Dev R Sahni
- Department of Dermatology, University of Utah Health, Salt Lake City, Utah
| | - Steve Madsen
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Arni Kristjansson
- Faculty of Medicine, Department of Pathology, University of Iceland, Reykjavik, Iceland
| | - David W Hoyt
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jonathan P Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Alice Frigerio
- Department of Dermatology, University of Utah Health, Salt Lake City, Utah
| | - Jon Gunnlaugur Jonasson
- Faculty of Medicine, Department of Pathology, University of Iceland, Reykjavik, Iceland; Department of Pathology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Jonas A Adalsteinsson
- Department of Dermatology, University of Utah Health, Salt Lake City, Utah; Faculty of Medicine, Department of Pathology, University of Iceland, Reykjavik, Iceland
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Luo OD, Bose R, Bawazir MA, Thuraisingam T, Ghazawi FM. A Review of the Dermatologic Clinical Applications of Topical Photodynamic Therapy. J Cutan Med Surg 2024; 28:NP1. [PMID: 38243786 DOI: 10.1177/12034754231216969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Topical photodynamic therapy is a widely approved therapy for actinic keratoses and low-risk nonmelanoma skin cancers with a rapidly growing range of emerging indications for other cutaneous diseases. This review summarizes the best-available evidence to provide a clinical update for dermatologists on the approved and emerging indications of photodynamic therapy. The body of evidence suggests that photodynamic therapy is superior or noninferior to other available treatment modalities for actinic keratoses, low-risk basal cell carcinomas, Bowen's disease, skin field cancerization, chemoprevention of keratinocyte carcinomas in organ transplant recipients, photoaging, acne vulgaris, and cutaneous infections including verrucae, onychomycosis, and cutaneous leishmaniasis. There is emerging evidence that photodynamic therapy plays a role in the management of actinic cheilitis, early-stage mycosis fungoides, extramammary Paget disease, lichen sclerosis, and folliculitis decalvans but there are no comparative studies with other active treatment modalities. Common barriers to topical photodynamic therapy include procedural pain, costs, and the time required for treatment delivery. There is significant heterogeneity in the photodynamic therapy protocols reported in the literature, including different photosensitizers, light sources, number of treatments, time between treatments, and use of procedural analgesia. Topical photodynamic therapy should be considered in the management of a spectrum of inflammatory, neoplastic, and infectious dermatoses. However, more comparative research is required to determine its role in the treatment algorithm for these dermatologic conditions and more methodological research is required to optimize photodynamic therapy protocols to improve the tolerability of the procedure for patients.
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Affiliation(s)
- Owen Dan Luo
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Reetesh Bose
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed A Bawazir
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Thusanth Thuraisingam
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Feras M Ghazawi
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
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