1
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Hoashi T, Ishikawa M, Uehara J, Oashi K, Maeda S, Kato J, Saruta H, Shichinohe R, Ohashi R, Nakamura Y, Koga H, Sugaya M. Japanese Dermatological Association guidelines: Outlines of Japanese clinical guidelines for basal cell carcinoma 2021. J Dermatol 2024; 51:e90-e105. [PMID: 38264942 DOI: 10.1111/1346-8138.16944] [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: 06/09/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 01/25/2024]
Abstract
To summarize the current therapies for skin cancers, the Japanese Skin Cancer Society issued the first guidelines for skin cancers, including melanoma, squamous cell carcinoma, basal cell carcinoma (BCC), and extramammary Paget's disease, in 2007. These guidelines were revised in 2015. Herein, we present the English version of the 2021 edition of the Japanese clinical guidelines for BCC. In the latest edition, all procedures were performed according to the Grading of Recommendations, Assessment, Development and Evaluation systems. The clinical questions that could not be answered were selected for further analysis. A comprehensive literature search, systematic review, and recommendations for each clinical question were determined by a multidisciplinary expert panel comprising dermatologists, a plastic and reconstructive surgeon, and a pathologist. Surgical resection is the gold-standard therapy of BCC. Radiotherapy or topical treatments, other than surgical resection, have been used in some cases. Patients with unresectable or metastatic BCC require systemic therapy. Novel agents, such as immune response modifiers or hedgehog pathway inhibitors, are emerging worldwide for the treatment of BCC. Based on these viewpoints, four relevant clinical questions regarding, surgical resection, radiotherapy, topical treatment, and systemic therapy, were raised in this report that aims to help clinicians select suitable therapies for their patients.
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Affiliation(s)
| | - Masashi Ishikawa
- Department of Dermatology, Saitama Cancer Center, Saitama, Japan
| | - Jiro Uehara
- Department of Dermatologic Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kohei Oashi
- Department of Dermatology, Saitama Cancer Center, Saitama, Japan
| | - Shintaro Maeda
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Junji Kato
- Department of Dermatology, Sapporo Medical University, Sapporo, Japan
| | - Hiroshi Saruta
- Department of Dermatology, Kurume University School of Medicine, Fukuoka, Japan
| | - Ryuji Shichinohe
- Department of Plastic and Reconstructive Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Yoshio Nakamura
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Koga
- Department of Dermatology, Shinshu University, Matsumoto, Japan
| | - Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Narita, Japan
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2
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Schoelles KJ, Auw-Haedrich C. Updates on eyelid cancers. Asia Pac J Ophthalmol (Phila) 2024; 13:100057. [PMID: 38615904 DOI: 10.1016/j.apjo.2024.100057] [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: 02/03/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/16/2024] Open
Abstract
In this review, we aim to provide an overview of the five most common malignant eyelid tumors with current treatment recommendations based on international guidelines. Particular attention is paid to the clinicopathological correlation and the update with regard to adequate treatment. Newer systemic therapies enrich the existing treatment options, of which complete tumor excision remains the most important therapeutic measure.
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3
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Gaitanis G, Seretis K, Zampeta A, Spyridonos P, Bassukas ID. A single-centre retrospective comparison of immunocryosurgery with standard surgical excision for the treatment of non-superficial, head and neck basal cell carcinoma. J Eur Acad Dermatol Venereol 2024; 38:e134-e136. [PMID: 37641949 DOI: 10.1111/jdv.19479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Affiliation(s)
- G Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - K Seretis
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - A Zampeta
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - P Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - I D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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4
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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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5
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Queirolo P, Cinquini M, Argenziano G, Bassetto F, Bossi P, Boutros A, Clemente C, de Giorgi V, Del Vecchio M, Patuzzo R, Peris K, Quaglino P, Reali A, Zalaudek I, Spagnolo F. Guidelines for the diagnosis and treatment of basal cell carcinoma: a GRADE approach for evidence evaluation and recommendations by the Italian Association of Medical Oncology. ESMO Open 2023; 8:102037. [PMID: 37879235 PMCID: PMC10598491 DOI: 10.1016/j.esmoop.2023.102037] [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: 05/29/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common form of cancer, with a high impact on the public health burden and social costs. Despite the overall prognosis for patients with BCC being excellent, if lesions are allowed to progress, or in a small subset of cases harboring an intrinsically aggressive biological behavior, it can result in local spread and significant morbidity, and conventional treatments (surgery and radiotherapy) may be challenging. When a BCC is not amenable to either surgery or radiotherapy with a reasonable curative intent, or when metastatic spread occurs, systemic treatments with Hedgehog inhibitors are available. These guidelines were developed, applying the GRADE approach, on behalf of the Italian Association of Medical Oncologists (AIOM) to assist clinicians in treating patients with BCC. They contain recommendations with regard to the diagnosis, treatment and follow-up, from primitive tumors to those locally advanced or metastatic, addressing the aspects of BCC management considered as priorities by a panel of experts selected by AIOM and other national scientific societies. The use of these guidelines in everyday clinical practice should improve patient care.
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Affiliation(s)
- P Queirolo
- Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - G Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples
| | - F Bassetto
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua
| | - P Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia
| | - A Boutros
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa
| | - C Clemente
- UO SMEL-2, Surgical Pathology, Department of Pathology and Laboratory Medicine, IRCCS-Policlinico San Donato, Milan
| | - V de Giorgi
- Dermatology Unit, Azienda USL Toscana Centro, Florence; Section of Dermatology, Department of Health Sciences, University of Florence, Florence
| | - M Del Vecchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Patuzzo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Melanoma and Sarcoma Unit, Milan
| | - K Peris
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - P Quaglino
- Department of Medical Sciences, Clinic of Dermatology, University of Turin, Turin
| | - A Reali
- Radiation Oncology Department, Michele e Pietro Ferrero Hospital, Verduno
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste
| | - F Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.
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Martora F, Ascierto P, Palla M, Costa C, D'Andrea M, Di Trolio R, Scarpato L, Marasca C. Tirbanibulin: an alternative topical approach to manage superficial basal cell carcinoma. Comment on: 'Successful treatment of field cancerization on the dorsum of the hands with 1% tirbanibulin ointment'. Clin Exp Dermatol 2023; 48:1373-1374. [PMID: 37566741 DOI: 10.1093/ced/llad271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 08/13/2023]
Abstract
We read with great interest the article recently published by Abril-Pérez et al. in which they present a case of successful treatment of refractory actinic keratoses and field cancerization on the dorsum of the hands using 1% tirbanibulin ointment in a patient with sun-exposed and damaged skin. We think the case presented by the authors is very useful and we agree with many aspects of it and we wanted to report our own experience of using this drug for another dermatological cancer pathology, basal cell carcinoma.
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Affiliation(s)
- Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Paolo Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Marco Palla
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Claudia Costa
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Mirella D'Andrea
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Rossella Di Trolio
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Luigi Scarpato
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - Claudio Marasca
- Dermatology Unit, Medical Department, "Antonio Cardarelli" National Hospital of Naples, Italy
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Hackney J, Swerlick RA, Muir J. The limits of claims databases: A response to "A comparison of invasive squamous cell carcinoma greater than 1 year after treatment with 5-fluorouracil, imiquimod, or photodynamic therapy with aminolevulinic acid". J Am Acad Dermatol 2023; 89:e219-e220. [PMID: 36775103 DOI: 10.1016/j.jaad.2022.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 02/12/2023]
Affiliation(s)
- Joshua Hackney
- School of Medicine, Griffith University, Queensland, Australia.
| | - Robert A Swerlick
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - James Muir
- The University of Queensland, Brisbane, Queensland, Australia
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8
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Wolswijk T, Adan F, Nelemans PJ, Defauwes A, Mosterd K. Optical coherence tomography for diagnosing recurrent or residual basal cell carcinoma after topical treatment: A diagnostic cohort study. J Am Acad Dermatol 2023; 89:728-733. [PMID: 37391069 DOI: 10.1016/j.jaad.2023.06.033] [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: 02/13/2023] [Revised: 05/26/2023] [Accepted: 06/09/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Recurrent/residual basal cell carcinoma (BCC) after topical treatment may not be visible during clinical and dermatoscopic examination (CDE). Optical coherence tomography (OCT) may detect these subclinical recurrences or residues. OBJECTIVE To compare the diagnostic accuracy of CDE with that of CDE combined with OCT (CDE-OCT) for detecting recurrent/residual BCC after topical treatment of superficial BCC. METHODS In this diagnostic cohort study, the suspicion level for recurrence or residue was recorded on a 5-point confidence scale. All patients with high suspicion of recurrence or residue based on CDE and/or CDE-OCT were referred for punch biopsy. Patients with a low suspicion on CDE and CDE-OCT were asked to (voluntarily) undergo a control biopsy. Histopathologic results of the biopsy were used for verification of CDE and CDE-OCT diagnoses (gold standard). RESULTS This study included 100 patients. A histopathologic recurrent/residual BCC was found in 20 patients. For recurrence or residue detection, sensitivity was 100% (20 of 20) for CDE-OCT and 60% (12 of 20) for CDE (P = .005) and specificity was 95% for CDE-OCT and 96.3% for CDE (P = .317). The area under the curve for CDE-OCT (0.98) was significantly higher than that for CDE (0.77) (P = .001). LIMITATIONS Results are based on 2 OCT assessors. CONCLUSION Compared with CDE alone, CDE-OCT results in a significantly higher ability to detect recurrent/residual BCCs after topical treatment.
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Affiliation(s)
- Tom Wolswijk
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands; GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Fieke Adan
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands; GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | | | - Aniek Defauwes
- Maastricht University, Faculty of Health Medicine and Life Sciences, Maastricht, the Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands; GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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9
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Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, Bataille V, Brochez L, Del Marmol V, Dummer R, Forsea AM, Gaudy-Marqueste C, Harwood CA, Hauschild A, Höller C, Kandolf L, Kellerners-Smeets NWJ, Lallas A, Leiter U, Malvehy J, Marinović B, Mijuskovic Z, Moreno-Ramirez D, Nagore E, Nathan P, Stratigos AJ, Stockfleth E, Tagliaferri L, Trakatelli M, Vieira R, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023. Eur J Cancer 2023; 192:113254. [PMID: 37604067 DOI: 10.1016/j.ejca.2023.113254] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.
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Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London SE1 7EH, UK
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Ana-Marie Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | | | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nicole W J Kellerners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands; Department of Dermatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, Croatia
| | - Zeljko Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - David Moreno-Ramirez
- Dermatology. Medicine School, University of Seville, University Hospital Virgen Macarena, Seville-Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Eggert Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
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10
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Wu Y, Yang Z, Cheng K, Bi H, Chen J. Small molecule-based immunomodulators for cancer therapy. Acta Pharm Sin B 2022; 12:4287-4308. [PMID: 36562003 PMCID: PMC9764074 DOI: 10.1016/j.apsb.2022.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
Immunotherapy has led to a paradigm shift in the treatment of cancer. Current cancer immunotherapies are mostly antibody-based, thus possessing advantages in regard to pharmacodynamics (e.g., specificity and efficacy). However, they have limitations in terms of pharmacokinetics including long half-lives, poor tissue/tumor penetration, and little/no oral bioavailability. In addition, therapeutic antibodies are immunogenic, thus may cause unwanted adverse effects. Therefore, researchers have shifted their efforts towards the development of small molecule-based cancer immunotherapy, as small molecules may overcome the above disadvantages associated with antibodies. Further, small molecule-based immunomodulators and therapeutic antibodies are complementary modalities for cancer treatment, and may be combined to elicit synergistic effects. Recent years have witnessed the rapid development of small molecule-based cancer immunotherapy. In this review, we describe the current progress in small molecule-based immunomodulators (inhibitors/agonists/degraders) for cancer therapy, including those targeting PD-1/PD-L1, chemokine receptors, stimulator of interferon genes (STING), Toll-like receptor (TLR), etc. The tumorigenesis mechanism of various targets and their respective modulators that have entered clinical trials are also summarized.
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Affiliation(s)
| | | | - Kui Cheng
- Guangdong Provincial Key Laboratory of New Drug Screening, NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Huichang Bi
- Guangdong Provincial Key Laboratory of New Drug Screening, NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Jianjun Chen
- Guangdong Provincial Key Laboratory of New Drug Screening, NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
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11
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Lütgerath C, Weiß C, Böer‐Auer A. Klinisch‐pathologische Merkmale und histologische Tumorreste in Reexzisionspräparaten unvollständig resezierter Basalzellkarzinome. J Dtsch Dermatol Ges 2022; 20:1476-1484. [DOI: 10.1111/ddg.14884_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Christel Weiß
- Medizinische Statistik Biomathematik und Informationsverarbeitung Universitätsmedizin Mannheim
| | - Almut Böer‐Auer
- Dermatologikum Hamburg GmbH Hamburg
- Klinik für Hautkrankheiten Universitätsklinikum Münster
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12
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Lütgerath C, Weiß C, Böer‐Auer A. Clinicopathological features and histological tumor residues in re‐excision specimens of incompletely resected basal cell carcinomas. J Dtsch Dermatol Ges 2022; 20:1476-1483. [DOI: 10.1111/ddg.14884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/29/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics University Medical Centre Mannheim Germany
| | - Almut Böer‐Auer
- Dermatologikum Hamburg GmbH Hamburg Germany
- Department of Dermatology University Medical Centre Münster Germany
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13
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Zou Y, Zhu X, Xia R. Reflectance Confocal Microscopy Follow-up of Multifocal Superficial Basal Cell Carcinomas Treated With Imiquimod 5% Cream. Dermatol Pract Concept 2022; 12:e2022207. [PMID: 36534551 PMCID: PMC9681225 DOI: 10.5826/dpc.1204a207] [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: 03/28/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Patients with multifocal superficial basal cell carcinomas (sBCC) require a non-invasive treatment and follow-up with a non-invasive technique. Imiquimod 5% cream is a new non-invasive therapy for BCC. Reflectance confocal microscopy (RCM) is a non-invasive, real-time imaging technique. OBJECTIVES To evaluate and describe the feasibility and efficacy of imiquimod 5% cream for the treatment of multifocal sBCC using RCM. METHODS The efficacy of imiquimod 5% cream for the treatment of multifocal sBCC was evaluated, as well as the potential of RCM for assessing therapeutic effects. We reported four patients with 34 sBCC lesions were treated with imiquimod 5% cream. RCM was performed in the baseline and at 12 weeks, 24 weeks and 52 weeks after starting treatment. RESULTS Of 34 lesions treated with imiquimod 5%, 32 responded to the treatment and showed complete clinical clearing. Two subclinical BCC lesions were identified by RCM. The complete tumor clearance rate was 88.2%, and the efficiency rate was 97.1%. No lesion recurred at 24-month follow-up. RCM identified previously described confocal features of BCC and was more sensitive than clinical examination. Local skin reactions were relieved after expectant treatment. CONCLUSIONS Imiquimod 5% cream may be useful for the treatment of multifocal sBCC, and its side effects are easy to manage. RCM can be used for non-invasive monitoring of treatment response and improved the tumor clearance rate.
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Affiliation(s)
- Yunmin Zou
- Department of Dermatology, The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University Wuxi, Jiangsu Province, China
| | - Xiaohong Zhu
- Department of Dermatology, The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University Wuxi, Jiangsu Province, China
| | - Rushan Xia
- Department of Dermatology, The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University Wuxi, Jiangsu Province, China
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14
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Adan F, Nelemans PJ, Essers BAB, Brinkhuizen T, Dodemont SRP, Kessels JPHM, Quaedvlieg PJF, Dermont GJ, Winnepenninckx VJL, Abdul Hamid M, Kelleners-Smeets NWJ, Mosterd K. Optical coherence tomography versus punch biopsy for diagnosis of basal cell carcinoma: a multicentre, randomised, non-inferiority trial. Lancet Oncol 2022; 23:1087-1096. [DOI: 10.1016/s1470-2045(22)00347-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
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15
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Advances in Management and Therapeutics of Cutaneous Basal Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14153720. [PMID: 35954384 PMCID: PMC9367462 DOI: 10.3390/cancers14153720] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Basal cell carcinoma (BCC) is the most common malignancy in humans with a range of treatment options available. Tumor and patient characteristics aid in risk-stratification, which influences treatment considerations. Here, we review the advancements in surgical, topical, field, immunotherapeutic, molecular-targeted, and experimental treatment modalities that can be employed in the correct clinical setting for the treatment of BCC. Abstract Basal cell carcinoma (BCC), the most common cancer in humans, is a malignant neoplasm of cells derived from the basal layer of the epidermis. Tumor characteristics such as histologic subtype, primary versus recurrent tumor, anatomic location, size, and patient attributes determine the risk level and acceptable treatment options. Surgical options offer histologic confirmation of tumor clearance. Standard excision provides post-treatment histologic assessment, while Mohs micrographic surgery (MMS) provides complete margin assessment intraoperatively. Additional treatment options may be employed in the correct clinical context. Small and low-risk BCCs, broad field cancerization, locally-advanced disease, metastatic disease, cosmetic concerns, or morbidity with surgical approaches raise consideration of other treatment modalities. We review herein a range of treatment approaches and advances in treatments for BCC, including standard excision, MMS, electrodesiccation and curettage, ablative laser treatment, radiation therapy, targeted molecular therapies, topical therapies, field therapies, immunotherapy, and experimental therapies.
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16
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Tsironi T, Gaitanis G, Pappas C, Koutlas V, Dounousi E, Bassukas ID. Immunocryosurgery is a safe and feasible treatment for basal cell carcinoma and Bowen disease in renal transplant recipients. Dermatol Ther 2022; 35:e15405. [PMID: 35194902 DOI: 10.1111/dth.15405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Theodora Tsironi
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, Ioannina, Greece
| | - Charalambos Pappas
- Nephrology Department, University Hospital of Ioannina, Ioannina, Greece
| | - Vasileios Koutlas
- Nephrology Department, University Hospital of Ioannina, Ioannina, Greece
| | - Evangelia Dounousi
- Nephrology Department, University Hospital of Ioannina, Ioannina, Greece.,Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, Ioannina, Greece
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17
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Williams HC, McPhee M, Layfield C. Celebrating 20 years of the
UK
Dermatology Clinical Trials Network: Part 1 – developing and delivering high quality independent clinical trials. Clin Exp Dermatol 2022; 47:1048-1059. [PMID: 35199857 PMCID: PMC9322597 DOI: 10.1111/ced.15140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
The UK Dermatology Clinical Trials Network (UK DCTN) was formed in 2002 with the aim of developing and supporting high‐quality independent national clinical trials that address prioritized research questions for people with skin disease. Its philosophy is to democratize UK dermatological clinical research and to tackle important clinical questions that industry has no incentive to answer. The network also plays a key role in training and capacity development. Its membership of over 1000 individuals includes dermatology consultants, trainees, dermatology nurses, general practitioners, methodologists and patients. Its organizational structures are lean and include a co‐ordinating team based at the Centre of Evidence‐Based Dermatology in Nottingham, and an executive with independent members to ensure probity and business progression. A prioritization panel and steering group enable a pipeline of projects to be prioritized and refined for external funding from independent sources. The UK DCTN has supported and completed 12 national clinical trials, attracting investment of over £15 million into UK clinical dermatology research. Trials have covered a range of interventions from drugs such as doxycycline (BLISTER), silk clothing for eczema (CLOTHES) and surgical interventions for hidradenitis suppurativa (THESEUS). Trial results are published in prestigious journals and have global impact. Genuine partnership with patients and carers has been a strong feature of the network since its inception. The UK DCTN is proud of its first 20 years of collaborative work, and aims to remain at the forefront of independent dermatological health technology assessment, as well as expanding into areas including diagnostics, artificial intelligence, efficient studies and innovative designs.
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Affiliation(s)
- Hywel C. Williams
- Centre of Evidence Based Dermatology, Population and Lifespan Sciences, School of Medicine University of Nottingham Nottingham UK
| | - Margaret McPhee
- Centre of Evidence Based Dermatology, Population and Lifespan Sciences, School of Medicine University of Nottingham Nottingham UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, Population and Lifespan Sciences, School of Medicine University of Nottingham Nottingham UK
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18
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Ramelyte E, Restivo G, Mannino M, Levesque MP, Dummer R. Advances in the drug management of basal cell carcinoma. Expert Opin Pharmacother 2022; 23:573-582. [PMID: 35081851 DOI: 10.1080/14656566.2022.2032646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common skin cancer in humans. Recently, BCCs were suggested to be classified into 'easy to treat' and 'difficult to treat,' and different therapeutic options are suggested for their management. AREAS COVERED In this review, the authors discuss treatment options that are approved, recommended for, or are still in development for treatment of BCC. The review covers approved local therapies, such as imiquimod and 5-fluorouracil, and systemic therapies, such as hedgehog inhibitors. New medical agents, investigated in clinical trials, are reviewed. These include: targeted therapies, such as GLI antagonists or anti-VEGFR agents, immunotherapies, such as checkpoint inhibitors, recombinant cytokines or silencing RNA, as well as intralesional virotherapies with modified adeno- or herpes viruses. EXPERT OPINION The progress made in recent years has improved the management of patients with advanced BCC; however, neither tumor targeting nor immune system engaging agents provide a cure. New treatment approaches directed not only to known targets but also the tumor microenvironment are in development and are anticipated to improve the management of difficult to treat BCC.
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Affiliation(s)
- Egle Ramelyte
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Gaetana Restivo
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Maria Mannino
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Mitchell P Levesque
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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19
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Verkouteren BJ, Oostewechel LC, Nelemans PJ, Sinx KA, Arits AH, Vernemmen AI, Winnepenninckx VJ, Kelleners‐Smeets NW, Mosterd K. Prognostic factors for treatment failure of imiquimod treatment in basal cell carcinoma – an observational study. J Eur Acad Dermatol Venereol 2022; 36:e475-e477. [DOI: 10.1111/jdv.17962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/28/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Babette J.A. Verkouteren
- Department of Dermatology Maastricht University Medical Centre Maastricht the Netherlands
- GROW Research Institute for Oncology and Developmental Biology Maastricht University Maastricht the Netherlands
| | - Laura C.F. Oostewechel
- Department of Dermatology Maastricht University Medical Centre Maastricht the Netherlands
| | - Patty J. Nelemans
- Department of Epidemiology Maastricht University Medical Centre Maastricht the Netherlands
| | - Kelly A.E. Sinx
- Department of Dermatology Maastricht University Medical Centre Maastricht the Netherlands
- GROW Research Institute for Oncology and Developmental Biology Maastricht University Maastricht the Netherlands
| | - Aimée H.M.M. Arits
- Department of Dermatology Maastricht University Medical Centre Maastricht the Netherlands
- Department of Dermatology Catherina Hospital Eindhoven the Netherlands
| | | | | | - Nicole W.J. Kelleners‐Smeets
- Department of Dermatology Maastricht University Medical Centre Maastricht the Netherlands
- GROW Research Institute for Oncology and Developmental Biology Maastricht University Maastricht the Netherlands
| | - Klara Mosterd
- Department of Dermatology Maastricht University Medical Centre Maastricht the Netherlands
- GROW Research Institute for Oncology and Developmental Biology Maastricht University Maastricht the Netherlands
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20
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Niculet E, Craescu M, Rebegea L, Bobeica C, Nastase F, Lupasteanu G, Stan DJ, Chioncel V, Anghel L, Lungu M, Tatu AL. Basal cell carcinoma: Comprehensive clinical and histopathological aspects, novel imaging tools and therapeutic approaches (Review). Exp Ther Med 2021; 23:60. [PMID: 34917186 PMCID: PMC8630439 DOI: 10.3892/etm.2021.10982] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022] Open
Abstract
Basal cell carcinoma (BCC) is one of the most common malignant tumors worldwide, involving the skin. It is also part of keratinocyte carcinomas, alongside its squamous counterpart. It has low mortality and extremely low metastatic rates (although when present, it indicates a poor patient prognosis); it also has a high morbidity rate through local destruction and recurrence, particularly when perineural invasion is observed, clinically or histopathologically. BCC development is the result of environmental and patient factors, with genetics and ultraviolet radiation playing major roles. The clinical and histopathological aspects vary according to tumor subtype, being classified as high-risk tumors (nodular, superficial, pigmented and infundibulocystic BCC with adnexal differentiation) and fibroepithelial subtypes, or as high-risk tumors (micronodular, infiltrating, sclerosing/morphoeic and basosquamous subtype or the type with sarcomatoid differentiation). Dermoscopy is now complimented by novel in vivo diagnostic tools (optical coherence tomography, reflectance confocal microscopy, high-resolution ultrasonography, Raman spectroscopy or terahertz pulse imaging), improving the diagnostic accuracy and providing tumor depth and lateral margins without the use of invasive techniques. Novel treatment approaches for the treatment of BCC have recently been investigated with the use of hedgehog pathway inhibitors, such as Vismodegib. These approaches aim for complete resolution, minimal side-effects, high patient satisfaction with the optimal cosmetic results, particularly in key areas, such as the face. The present review article summarizes and discusses the comprehensive clinical and histopathological aspects of BCC, and presents novel imaging tools and therapeutic approaches that have been identified.
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Affiliation(s)
- Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania.,Department of Pathology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania.,Department of Clinical Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania
| | - Laura Rebegea
- Department of Clinical Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania.,Department of Neuropsychomotor Rehabilitation, 'Sf. Ioan' Clinical Hospital for Children, 800487 Galați, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania
| | - Florentina Nastase
- Department of Neuropsychomotor Rehabilitation, 'Sf. Ioan' Clinical Hospital for Children, 800487 Galați, Romania
| | - Gabriela Lupasteanu
- Department of Infectious Diseases, 'Sf. Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania.,Medical Doctoral School, 'Ovidius' University, 900573 Constanta, Romania
| | - Daniela Jicman Stan
- Department of Otorhinolaryngology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania.,Biomedical Doctoral School, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galați, 800010 Galați, Romania
| | - Valentin Chioncel
- Department of Cardio-Thoracic Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Clinical Cardiology, 'Bagdasar Arseni' Emergency Hospital, 041915 Bucharest, Romania
| | - Lucretia Anghel
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania
| | - Mihaela Lungu
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania
| | - Alin Laurentiu Tatu
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania.,Department of Dermatology, 'Sfanta Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania.,Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, 'Dunărea de Jos' University, 800010 Galați, Romania.,Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), 'Dunărea de Jos' University, 800010 Galați, Romania
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21
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Non-Surgical Treatments for Keratinocyte Carcinomas. Adv Ther 2021; 38:5635-5648. [PMID: 34652721 DOI: 10.1007/s12325-021-01916-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Skin cancer is the most common malignancy worldwide, comprising approximately 30% of all human tumors. In recent decades, the incidence of keratinocyte carcinomas, which include basal cell carcinoma and cutaneous squamous cell carcinoma, has been steadily increasing globally (Rogers et al. in JAMA Dermatol 151(10):1081-1086. https://doi.org/10.1001/jamadermatol.2015.1187 , 2015; Nehal and Bichakjian in N Engl J Med 379(4):363-374. https://doi.org/10.1056/nejmra1708701 , 2018). Most tumors are cured with surgical excision; however, some tumors are best treated with non-surgical approaches. Superficial tumors can often be cured with non-surgical methods whereas more advanced stage tumors may not be amenable to surgery. Additionally, surgical treatment may not be available for all populations depending on geographic location and accessibility to care. This article reviews commonly utilized nonsurgical options such as cryotherapy, photodynamic therapy, topical treatments, and radiation as well as systemic treatments including immunotherapies and chemotherapies.
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22
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Seidl-Philipp M, Frischhut N, Höllweger N, Schmuth M, Nguyen VA. Known and new facts on basal cell carcinoma. J Dtsch Dermatol Ges 2021; 19:1021-1041. [PMID: 34288482 PMCID: PMC8361778 DOI: 10.1111/ddg.14580] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/02/2021] [Indexed: 12/18/2022]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumor in light‐skinned people and amounts to about 75 % of all cases of skin cancer. Increasing incidence rates have been reported for decades all over the world. The main risk factors include UV radiation, male sex, light skin type, advanced age, long‐term immunosuppression, a positive individual or family history, and certain genodermatoses. BCC metastasizes only rarely, and its mortality is low, but it is associated with significant morbidity. Genetic mutations especially in the hedgehog pathway play an important role in BCC pathogenesis. Non‐invasive procedures such as optical coherence tomography or confocal laser scan microscopy are increasingly utilized for diagnostics in addition to visual inspection and dermatoscopy, but only in exceptional cases can histological confirmation of the diagnosis be dispensed with. Various clinical and histological subtypes have been defined. Differentiating between BCC with high and low risk of recurrence has a significant influence on the choice of treatment. Most BCC can be treated effectively and safely with standard surgery, or in selected cases with topical treatment. Locally advanced and metastasized BCC must be treated with radiation or systemic therapy. Radiation is also an option for older patients with contraindications for surgery. The hedgehog inhibitors vismodegib and sonidegib are currently approved for systemic therapy of BCC in Europe. Approval for the PD1 inhibitor cemiplimab as second‐line therapy is expected in the near future.
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Affiliation(s)
- Magdalena Seidl-Philipp
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
| | - Nina Frischhut
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
| | - Nicole Höllweger
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
| | - Matthias Schmuth
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
| | - Van Anh Nguyen
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
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23
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Singh M, Mehta Grewal A, Singh H, Sharma M, Kaur M, Gupta P, Zadeng Z. Long-term efficacy and safety of imiquimod 5% and fluorouracil 1% creams in medical monotherapy of complex eyelid basal cell carcinomas. Eur J Ophthalmol 2021; 32:2093-2100. [PMID: 34320864 DOI: 10.1177/11206721211035614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the long-term efficacy and safety of local application of imiquimod 5% and fluorouracil 1% creams in complex eyelid basal cell carcinomas (BCCs). METHODS A retrospective, non-comparative study in biopsy-proven, complex (involving canthi or >50% of eyelid length) eyelid BCC patients who were medically unfit for surgical procedures. All patients were medically treated with either of the creams using fixed-dose regimens for a minimum of 3 months. All received oral vitamin C 500 mg QID for 3 months as an adjunct for collagen healing. A minimum of "post-treatment" follow-up of 12 months was observed. RESULTS Of total 30 patients, imiquimod 5% and fluorouracil 1% were used in 16 and 14 patients, respectively. The mean age of our patients was 70.5 years. The co-morbidities included - severe coronary artery disease using blood-thinners (n = 19), poorly controlled diabetes (n = 12), poorly controlled hypertension (n = 6), on nebulization (n = 3), and tuberculosis with pulmonary fibrosis (n = 2). Complete clinical tumor resolution was noted in 10 and 8 patients over 12 and 16.5 weeks, respectively, in imiquimod and fluorouracil groups. Periocular skin erythema, chemical conjunctivitis, and skin depigmentation were seen in all the patients of imiquimod group. On the other hand, the local side-effect profile in fluorouracil patients was limited. CONCLUSION The medical treatment of complex eyelid BCC is a useful alternative to surgery in the elderly with significant co-morbidities. It provides a promising long-term relief with a tolerable side-effect profile. A prospective, randomized, double-blinded trial would provide stronger evidence for the efficacy of these drugs.
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Affiliation(s)
- Manpreet Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Mehta Grewal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Himanshi Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjula Sharma
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Zoramthara Zadeng
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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24
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Seidl-Philipp M, Frischhut N, Höllweger N, Schmuth M, Nguyen VA. Bekanntes und Neues zum Basalzellkarzinom. J Dtsch Dermatol Ges 2021; 19:1021-1043. [PMID: 34288462 DOI: 10.1111/ddg.14580_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Magdalena Seidl-Philipp
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
| | - Nina Frischhut
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
| | - Nicole Höllweger
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
| | - Matthias Schmuth
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
| | - Van Anh Nguyen
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
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25
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Kash N, Silapunt S. A review of emerging and non-US FDA-approved topical agents for the treatment of basal cell carcinoma. Future Oncol 2021; 17:3111-3132. [PMID: 34156307 DOI: 10.2217/fon-2020-1147] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although surgical therapy continues to be the gold standard for the treatment of basal cell carcinoma given high cure rates and the ability to histologically confirm tumor clearance, there are a number of nonsurgical treatment options that may be considered based on individual tumor characteristics, functional and cosmetic considerations, patient comorbidities and patient preference. Topical 5-fluorouracil 5% cream and imiquimod 5% cream have been US FDA-approved for the treatment of superficial basal cell carcinoma. Additionally, a number of new and emerging topical agents and techniques have been described for the treatment of basal cell carcinoma and will be reviewed herein.
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Affiliation(s)
- Natalie Kash
- Department of Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology & Cosmetic Surgery Orlando Program, Maitland, FL 32751, USA
| | - Sirunya Silapunt
- Department of Dermatology, University of Texas McGovern Medical School at Houston, Houston, TX 77030, USA
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26
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Nasr I, McGrath EJ, Harwood CA, Botting J, Buckley P, Budny PG, Fairbrother P, Fife K, Gupta G, Hashme M, Hoey S, Lear JT, Mallipeddi R, Mallon E, Motley RJ, Newlands C, Newman J, Pynn EV, Shroff N, Slater DN, Exton LS, Mohd Mustapa MF, Ezejimofor MC. British Association of Dermatologists guidelines for the management of adults with basal cell carcinoma 2021. Br J Dermatol 2021; 185:899-920. [PMID: 34050920 DOI: 10.1111/bjd.20524] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Affiliation(s)
- I Nasr
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - E J McGrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - C A Harwood
- Barts Health NHS Trust, London, E1 1BB, UK.,National Cancer Research Institute's Skin Cancer Clinical Studies Group and Non-Melanoma Skin Cancer Subgroup, London, UK
| | - J Botting
- Royal College of General Practitioners, London, UK
| | - P Buckley
- Independent Cancer Patients' Voice, London, UK
| | - P G Budny
- British Association of Plastic, Reconstructive & Aesthetic Surgeons, London, UK.,Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | | | - K Fife
- Royal College of Radiologists, London, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G Gupta
- NHS Lothian, Lauriston Building, Edinburgh, EH3 9EN, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - S Hoey
- Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - J T Lear
- British Society for Skin Care in Immunosuppressed Individuals, London, UK.,Salford Royal NHS Foundation Hospital, Salford, M6 8HD, UK.,Manchester Academic Health Science Centre, Manchester, M20 2LR, UK
| | - R Mallipeddi
- British Society for Dermatological Surgery, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - E Mallon
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - R J Motley
- University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - C Newlands
- British Association of Oral and Maxillofacial Surgeons, London, UK.,Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - J Newman
- British Dermatological Nursing Group, Belfast, Ireland.,King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - E V Pynn
- Nevill Hall Hospital, Abergavenny, NP7 7EG, UK
| | - N Shroff
- Primary Care Dermatology Society, Rickmansworth, UK
| | - D N Slater
- Royal College of Pathologists, London, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
| | - M C Ezejimofor
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, UK
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Thomson J, Hogan S, Leonardi-Bee J, Williams HC, Bath-Hextall FJ. Interventions for basal cell carcinoma: abridged Cochrane systematic review and GRADE assessments. Br J Dermatol 2021; 185:499-511. [PMID: 33448328 DOI: 10.1111/bjd.19809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common cancer affecting white-skinned individuals, and the worldwide incidence is increasing. Although rarely fatal, BCC is associated with significant morbidity and costs. OBJECTIVES To assess the effects of interventions for primary BCC in immunocompetent adults. METHODS We updated our searches of the following databases to November 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and LILACS. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. We used standard methodological procedures expected by Cochrane. RESULTS We included 52 randomized controlled trials with 6990 participants (median age 65 years; range 20-95). Mean study duration was 13 months (range 6 weeks-10 years). Ninety-two per cent (n = 48/52) of studies exclusively included histologically low-risk BCC (nodular and superficial subtypes). The certainty of evidence was predominantly low or moderate for the outcomes of interest. Overall, surgical interventions have the lowest recurrence rates, and there may be slightly fewer recurrences with Mohs micrographic surgery over surgical excision for primary, facial BCC (high-risk histological subtype or located in the 'H-zone' or both) (low-certainty evidence). Nonsurgical treatments, when used for low-risk BCC, are less effective than surgical treatments, but recurrence rates are acceptable and cosmetic outcomes are probably superior. CONCLUSIONS Surgical interventions have lower recurrence rates and remain the gold standard for high-risk BCC. Of the nonsurgical treatments, topical imiquimod has the best evidence to support its efficacy for low-risk BCC. Priorities for future research include agreement on core outcome measures and studies with longer follow-up.
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Affiliation(s)
- J Thomson
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - S Hogan
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2, University of Nottingham, Nottingham, UK
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - F J Bath-Hextall
- Emeritus Professor, Evidence Based Health Care, University of Nottingham, Nottingham, UK
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28
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van Delft LCJ, Kelleners-Smeets NWJ. Interventions for basal cell carcinoma: from evidence to personalized treatment. Br J Dermatol 2021; 185:475. [PMID: 33822380 PMCID: PMC8453796 DOI: 10.1111/bjd.20059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
Linked Article:Thomson et al. Br J Dermatol 2021; 185:499–511.
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Affiliation(s)
- L C J van Delft
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, the Netherlands
| | - N W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, the Netherlands
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29
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Azzopardi EA, Abdelrahman W, Azzopardi E, O’Leary B, Yarrow J, Miles N, Barbara C, Camilleri L, Clementoni MT, Murison M. Treatment of cutaneous basal cell carcinoma with combined laser extirpation and methyl aminolevulinic acid: five-year success rates. Ann R Coll Surg Engl 2021; 103:263-271. [PMID: 33557701 PMCID: PMC10752010 DOI: 10.1308/rcsann.2020.7020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Basal cell carcinoma is the most common cancer. Excisional surgery is associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. We report five-year follow-up outcomes for carbon dioxide laser extirpation of cutaneous basal cell carcinoma, assisted by immediate methyl aminolevulinate photodynamic therapy and cost-benefit considerations. MATERIALS AND METHODS Retrospective cohort database analysis of adult patients with biopsy-proven primary cutaneous basal cell carcinoma, completing five years of follow-up. Direct per-lesion cost was compared with conventional wide local excision. Patients with morphoeic basal cell carcinoma were excluded. RESULTS Treated lesions were up to 1% total body surface area and up to 3.8mm (1.38 ± 0.695cm, mean ± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2 ± 0.872mm was significantly associated with recurrence (Mann-Whitney, p = 0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS. CONCLUSION Our results suggest that CO2-assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Investigation of this method by randomised controlled methodology is warranted.
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Affiliation(s)
| | - W Abdelrahman
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - E Azzopardi
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - B O’Leary
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - J Yarrow
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - N Miles
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | | | | | | | - M Murison
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
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30
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Mahajan S, Kalaivani M, Sethuraman G, Khaitan BK, Verma KK, Gupta S. A retrospective comparative study of outcome with surgical excision and repair versus nonsurgical and ablative treatments for basal cell carcinoma. Indian J Dermatol Venereol Leprol 2021; 87:348-356. [PMID: 33666033 DOI: 10.25259/ijdvl_170_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 01/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND There are few studies on basal cell carcinoma (BCC) from India. Long-term follow-up is available in only one study and the aesthetic outcome of treatment has not been evaluated in Indian patients. AIMS In this retrospective study on BCC, we compared treatment failure, recurrence rates and aesthetic outcomes on long-term follow-up between surgical excision and repair, and nonsurgical and ablative treatments. METHODS Records of patients with BCC treated in the dermatologic surgery clinic over the past 10 years were analyzed. Patients with histopathologically confirmed BCC who could be contacted were evaluated for recurrence, treatment failure, overall satisfaction and aesthetic outcomes by global aesthetic improvement scale. RESULTS Out of 98 patients, 72 were contactable. Four patients received both nonsurgical and ablative treatments and surgical excision and repair sequentially and were excluded. The mean age of patients was 57.9 ± 15.8 years (24-90 years) and the male: female ratio was 1.6:1. The most common site involved was the face (72.1%) followed by trunk and scalp, and the most common type of BCC was the pigmented superficial type (33.8%), followed by the pigmented noduloulcerative type (16.2%). There was no significant difference between the groups in the number of high-risk cases. The mean follow-up period was 37.1 ± 31.4 (range, 4-120) months. Fifty one patients were treated with surgical excision and repair, and 17 with nonsurgical and ablative treatments (9-imiquimod, 5-cryotherapy, 4-radiotherapy). Treatment failure was seen in 5 (7.4%) patients, all in the nonsurgical and ablative treatments group (P = 0.0006). Recurrence was seen in 2 (2.9%) patients, both in the surgical excision and repair group (P > 0.05). Mean patient satisfaction was significantly higher with surgical excision and repair, though there was no significant difference in the Global Aesthetic Improvement Scale between the groups. LIMITATIONS The sample size was low. Only telephonic and pictorial assessments were done where the patient could not come for follow-up. CONCLUSIONS Surgical excision and repair was associated with better outcomes than nonsurgical and ablative treatments. Treatment failures and adverse events were high with nonsurgical and ablative treatments. The recurrence rate was low.
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Affiliation(s)
- Soniya Mahajan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Gomathy Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Binod Kumar Khaitan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Kaushal Kumar Verma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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31
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Kofler L, Breuninger H, Schreiber RH, Eichner M, Häfner HM, Schnabl SM. Three-dimensional histology vs. serial section histology in the treatment of primary basal cell carcinoma: a randomized, prospective, blinded study of 569 tumours. J Eur Acad Dermatol Venereol 2021; 35:1323-1330. [PMID: 33539573 DOI: 10.1111/jdv.17155] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND For basal cell carcinoma (BCC), only few controlled data have been published so far, which directly compare micrographically controlled surgery with conventional serial section histology. In addition to Mohs surgery, which uses cryostat sections, also three-dimensional histology (3D-histology), based on paraffin sections, is available to ensure complete control of the margins and basic sections. OBJECTIVES To investigate the rate of local recurrence (LR) as well as the number of required re-excisions for basal cell carcinomas with serial section histology vs. 3D-histology. METHODS We compared serial sections histology with 3D-histology in a prospective, randomized, controlled blinded trial and analysed 569 BCC of all subtypes up to 30 mm diameter, 287 BCC in the 3D group and 282 BCC in the serial section group. Excisions were performed with adapted primary resection margin according to location and size of the tumour. Surgeons were blinded at the time of surgery as they did not know which histological method will be used. Both methods used paraffin sections. RESULTS Both groups did not differ regarding patients age, tumour location, tumour diameter, tumour subtypes or primary resection margins. In the serial section group, re-excisions were required in 21%; 24 tumours (8.4%) recurred after a median of 2.2 years. In the 3D-histology group, re-excisions were required in 39%; 10 tumours recurred (3.5%) after a median of 2.8 years. The recurrence rates differed significantly between both groups. Mean follow-up was 4.5 years. CONCLUSIONS 3D-histology is a useful technique to detect tumour outgrowths at the excision margins, but required a high rate of re-excisions. 3D-histology was associated with a significantly lower LR rate than serial section histology.
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Affiliation(s)
- L Kofler
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - H Breuninger
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - R H Schreiber
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - M Eichner
- Institute of Clinical Epidemiology and Applied Biometry, Eberhard-Karls University, Tübingen, Germany
| | - H-M Häfner
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - S M Schnabl
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
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32
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Islam MA, Rice J, Reesor E, Zope H, Tao W, Lim M, Ding J, Chen Y, Aduluso D, Zetter BR, Farokhzad OC, Shi J. Adjuvant-pulsed mRNA vaccine nanoparticle for immunoprophylactic and therapeutic tumor suppression in mice. Biomaterials 2021; 266:120431. [PMID: 33099060 PMCID: PMC7528902 DOI: 10.1016/j.biomaterials.2020.120431] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/15/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022]
Abstract
Synthetic mRNA represents an exciting cancer vaccine technology for the implementation of effective cancer immunotherapy. However, inefficient in vivo mRNA delivery along with a requirement for immune co-stimulation present major hurdles to achieving anti-tumor therapeutic efficacy. Here, we demonstrate a proof-of-concept adjuvant-pulsed mRNA vaccine nanoparticle (NP) that is composed of an ovalbumin-coded mRNA and a palmitic acid-modified TLR7/8 agonist R848 (C16-R848), coated with a lipid-polyethylene glycol (lipid-PEG) shell. This mRNA vaccine NP formulation retained the adjuvant activity of encapsulated C16-R848 and markedly improved the transfection efficacy of the mRNA (>95%) and subsequent MHC class I presentation of OVA mRNA derived antigen in antigen-presenting cells. The C16-R848 adjuvant-pulsed mRNA vaccine NP approach induced an effective adaptive immune response by significantly improving the expansion of OVA-specific CD8+ T cells and infiltration of these cells into the tumor bed in vivo, relative to the mRNA vaccine NP without adjuvant. The approach led to an effective anti-tumor immunity against OVA expressing syngeneic allograft mouse models of lymphoma and prostate cancer, resulting in a significant prevention of tumor growth when the vaccine was given before tumor engraftment (84% reduction vs. control) and suppression of tumor growth when given post engraftment (60% reduction vs. control). Our findings indicate that C16-R848 adjuvant pulsation to mRNA vaccine NP is a rational design strategy to increase the effectiveness of synthetic mRNA vaccines for cancer immunotherapy.
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Affiliation(s)
- Mohammad Ariful Islam
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jamie Rice
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emma Reesor
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Harshal Zope
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei Tao
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Lim
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jianxun Ding
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yunhan Chen
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dike Aduluso
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce R Zetter
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Omid C Farokhzad
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jinjun Shi
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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33
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Greig A, Aloni K, Orchard G, Shams M, Craythorne E, Fassihi H. Treatment of multiple facial basal cell carcinomas in a child with xeroderma pigmentosum complementation group C with Mohs micrographic surgery. Br J Dermatol 2020; 184:e4. [PMID: 33325539 DOI: 10.1111/bjd.19323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Greig
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - K Aloni
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - G Orchard
- Viapath, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - M Shams
- Viapath, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - E Craythorne
- National Xeroderma Pigmentosum Service, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - H Fassihi
- National Xeroderma Pigmentosum Service, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
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34
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Williams HC, Rogers NK, Chalmers JR, Thomas KS. Scoping the international impact from four independent national dermatology trials. Clin Exp Dermatol 2020; 46:657-662. [PMID: 33179251 DOI: 10.1111/ced.14506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research impact describes whether and how research results in wider benefits to society beyond academic publication. Little is known about translation of clinical trial research into dermatological practice. AIM We scoped international impact from four independently funded clinical trials published by our group over the past 10 years. METHODS This was a scoping survey of 35 international colleagues from 22 countries followed by a narrative summary of emergent themes. RESULTS All recipients kindly responded to the survey. At least 20 emergent themes were identified, which broadly included: (i) interest and enthusiasm in the concept of trying to document clinical trial impact; (ii) direct impacts such as adoption of the drug as tested and recommended from the trial results, including more confidence using the drug in slightly different ways for the same condition; (iii) the finding that trial impact was dependent on factors such as drug availability and country-specific disease patterns; and (iv) the educational value of good trial design for journal club discussions and improving future clinical trial designs in dermatology. Our survey suggests that uptake into clinical practice was surprisingly rapid and widespread. CONCLUSION Clinical trial research is of little use unless findings are translated into clinical practice for patient benefit. Our international scoping survey suggests that independent clinical trials that address important questions identified by the dermatology community have substantial, diverse and far-reaching impacts on dermatological practice.
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Affiliation(s)
- H C Williams
- Centre of Evidence Based Dermatology, School of Medicine, King's Meadow Campus, The University of Nottingham, Nottingham, UK
| | - N K Rogers
- Centre of Evidence Based Dermatology, School of Medicine, King's Meadow Campus, The University of Nottingham, Nottingham, UK
| | - J R Chalmers
- Centre of Evidence Based Dermatology, School of Medicine, King's Meadow Campus, The University of Nottingham, Nottingham, UK
| | - K S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, King's Meadow Campus, The University of Nottingham, Nottingham, UK
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35
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Collier NJ, Rhodes LE. Photodynamic Therapy for Basal Cell Carcinoma: The Clinical Context for Future Research Priorities. Molecules 2020; 25:molecules25225398. [PMID: 33218174 PMCID: PMC7698957 DOI: 10.3390/molecules25225398] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/05/2020] [Accepted: 11/15/2020] [Indexed: 01/11/2023] Open
Abstract
Photodynamic therapy (PDT) is an established treatment option for low-risk basal cell carcinoma (BCC). BCC is the most common human cancer and also a convenient cancer in which to study PDT treatment. This review clarifies challenges to researchers evident from the clinical use of PDT in BCC treatment. It outlines the context of PDT and how PDT treatments for BCC have been developed hitherto. The sections examine the development of systemic and subsequently topical photosensitizers, light delivery regimens, and the use of PDT in different patient populations and subtypes of BCC. The outcomes of topical PDT are discussed in comparison with alternative treatments, and topical PDT applications in combination and adjuvant therapy are considered. The intention is to summarize the clinical relevance and expose areas of research need in the BCC context, ultimately to facilitate improvements in PDT treatment.
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36
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Thomson J, Hogan S, Leonardi-Bee J, Williams HC, Bath-Hextall FJ. Interventions for basal cell carcinoma of the skin. Cochrane Database Syst Rev 2020; 11:CD003412. [PMID: 33202063 PMCID: PMC8164471 DOI: 10.1002/14651858.cd003412.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the commonest cancer affecting white-skinned individuals, and worldwide incidence is increasing. Although rarely fatal, BCC is associated with significant morbidity and costs. First-line treatment is usually surgical excision, but alternatives are available. New published studies and the development of non-surgical treatments meant an update of our Cochrane Review (first published in 2003, and previously updated in 2007) was timely. OBJECTIVES To assess the effects of interventions for BCC in immunocompetent adults. SEARCH METHODS We updated our searches of the following databases to November 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and LILACS. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions for BCC in immunocompetent adults with histologically-proven, primary BCC. Eligible comparators were placebo, active treatment, other treatments, or no treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Primary outcome measures were recurrence at three years and five years (measured clinically) (we included recurrence data outside of these time points if there was no measurement at three or five years) and participant- and observer-rated good/excellent cosmetic outcome. Secondary outcomes included pain during and after treatment, early treatment failure within six months, and adverse effects (AEs). We used GRADE to assess evidence certainty for each outcome. MAIN RESULTS We included 52 RCTs (26 new) involving 6690 participants (median 89) in this update. All studies recruited from secondary care outpatient clinics. More males than females were included. Study duration ranged from six weeks to 10 years (average 13 months). Most studies (48/52) included only low-risk BCC (superficial (sBCC) and nodular (nBCC) histological subtypes). The majority of studies were at low or unclear risk of bias for most domains. Twenty-two studies were industry-funded: commercial sponsors conducted most of the studies assessing imiquimod, and just under half of the photodynamic therapy (PDT) studies. Overall, surgical interventions have the lowest recurrence rates. For high-risk facial BCC (high-risk histological subtype or located in the facial 'H-zone' or both), there may be slightly fewer recurrences with Mohs micrographic surgery (MMS) compared to surgical excision (SE) at three years (1.9% versus 2.9%, respectively) (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.16 to 2.64; 1 study, 331 participants; low-certainty evidence) and at five years (3.2% versus 5.2%, respectively) (RR 0.61, 95% CI 0.18 to 2.04; 1 study, 259 participants; low-certainty evidence). However, the 95% CI also includes the possibility of increased risk of recurrence and no difference between treatments. There may be little to no difference regarding improvement of cosmetic outcomes between MMS and SE, judged by participants and observers 18 months post-operatively (one study; low-certainty evidence); however, no raw data were available for this outcome. When comparing imiquimod and SE for nBCC or sBCC at low-risk sites, imiquimod probably results in more recurrences than SE at three years (16.4% versus 1.6%, respectively) (RR 10.30, 95% CI 3.22 to 32.94; 1 study, 401 participants; moderate-certainty evidence) and five years (17.5% versus 2.3%, respectively) (RR 7.73, 95% CI 2.81 to 21.3; 1 study, 383 participants; moderate-certainty evidence). There may be little to no difference in the number of participant-rated good/excellent cosmetic outcomes (RR 1.00, 95% CI 0.94 to 1.06; 1 study, 326 participants; low-certainty evidence). However, imiquimod may result in greater numbers of good/excellent cosmetic outcomes compared to SE when observer-rated (60.6% versus 35.6%, respectively) (RR 1.70, 95% CI 1.35 to 2.15; 1 study, 344 participants; low-certainty evidence). Both cosmetic outcomes were measured at three years. Based on one study of 347 participants with high- and low-risk primary BCC of the face, radiotherapy may result in more recurrences compared to SE under frozen section margin control at three years (5.2% versus 0%, respectively) (RR 19.11, 95% CI 1.12 to 325.78; low-certainty evidence) and at four years (6.4% versus 0.6%, respectively) (RR 11.06, 95% CI 1.44 to 84.77; low-certainty evidence). Radiotherapy probably results in a smaller number of good participant- (RR 0.76, 95% CI 0.63 to 0.91; 50.3% versus 66.1%, respectively) or observer-rated (RR 0.48, 95% CI 0.37 to 0.62; 28.9% versus 60.3%, respectively) good/excellent cosmetic outcomes compared to SE, when measured at four years, where dyspigmentation and telangiectasia can occur (both moderate-certainty evidence). Methyl-aminolevulinate (MAL)-PDT may result in more recurrences compared to SE at three years (36.4% versus 0%, respectively) (RR 26.47, 95% CI 1.63 to 429.92; 1 study; 68 participants with low-risk nBCC in the head and neck area; low-certainty evidence). There were no useable data for measurement at five years. MAL-PDT probably results in greater numbers of participant- (RR 1.18, 95% CI 1.09 to 1.27; 97.3% versus 82.5%) or observer-rated (RR 1.87, 95% CI 1.54 to 2.26; 87.1% versus 46.6%) good/excellent cosmetic outcomes at one year compared to SE (2 studies, 309 participants with low-risk nBCC and sBCC; moderate-certainty evidence). Based on moderate-certainty evidence (single low-risk sBCC), imiquimod probably results in fewer recurrences at three years compared to MAL-PDT (22.8% versus 51.6%, respectively) (RR 0.44, 95% CI 0.32 to 0.62; 277 participants) and five years (28.6% versus 68.6%, respectively) (RR 0.42, 95% CI 0.31 to 0.57; 228 participants). There is probably little to no difference in numbers of observer-rated good/excellent cosmetic outcomes at one year (RR 0.98, 95% CI 0.84 to 1.16; 370 participants). Participant-rated cosmetic outcomes were not measured for this comparison. AEs with surgical interventions include wound infections, graft necrosis and post-operative bleeding. Local AEs such as itching, weeping, pain and redness occur frequently with non-surgical interventions. Treatment-related AEs resulting in study modification or withdrawal occurred with imiquimod and MAL-PDT. AUTHORS' CONCLUSIONS Surgical interventions have the lowest recurrence rates, and there may be slightly fewer recurrences with MMS over SE for high-risk facial primary BCC (low-certainty evidence). Non-surgical treatments, when used for low-risk BCC, are less effective than surgical treatments, but recurrence rates are acceptable and cosmetic outcomes are probably superior. Of the non-surgical treatments, imiquimod has the best evidence to support its efficacy. Overall, evidence certainty was low to moderate. Priorities for future research include core outcome measures and studies with longer-term follow-up.
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Affiliation(s)
- Jason Thomson
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Sarah Hogan
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, Clinical Sciences Building Phase 2, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Fiona J Bath-Hextall
- Emeritus Professor, Evidence Based Health Care, University of Nottingham, Nottingham, UK
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Vijay V, Alam MS, Subramanian N, Krishnakumar S, Biswas J, Mukherjee B. Periocular Basal Cell Carcinoma: 20-Years Experience at a Tertiary Eye Care Center of South India. Oman J Ophthalmol 2020; 13:129-135. [PMID: 33542600 PMCID: PMC7852420 DOI: 10.4103/ojo.ojo_130_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 04/19/2020] [Accepted: 08/16/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To study the clinical profile and management outcomes of periocular basal cell carcinoma (BCC). MATERIALS AND METHODS A retrospective analysis of all histopathologically proven cases of BCC between 1995 and 2015 was done. The demographic data, clinical presentation, histopathological subtype, and management outcomes were analyzed. RESULTS We had a total of 185 malignant eyelid tumors during the study period, out of which 37 (20%) were BCC. Thirty-two (86.5%) out of 37 cases were primary BCC. The mean age was 63.3 years. Pigmented ulcerative lesion (14, 38%), lower eyelid (19, 51%), and nodular BCC (15, 40%) were the most common presentation, periocular site, and histological subtype, respectively. 28 patients underwent excision under frozen section with an average tumor-free margin of 3.5 mm. Mean follow-up period was 18.78 months. Recurrence rate of 0% and 3.1% was noted in primary and recurrent BCC, respectively. CONCLUSION Periocular BCC commonly presents as pigmented ulcerative lesion in the lower lid. Excision biopsy under frozen section with an average tumor-free margin of 3.5 mm offers cure in most cases.
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Affiliation(s)
- Vathsalya Vijay
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Md Shahid Alam
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Nirmala Subramanian
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Subramanian Krishnakumar
- Larsen and Tubro Department of Ocular Pathology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Uveitis and Ocular Pathology, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Sabri AH, Cater Z, Gurnani P, Ogilvie J, Segal J, Scurr DJ, Marlow M. Intradermal delivery of imiquimod using polymeric microneedles for basal cell carcinoma. Int J Pharm 2020; 589:119808. [DOI: 10.1016/j.ijpharm.2020.119808] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/07/2020] [Accepted: 08/20/2020] [Indexed: 01/06/2023]
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Manoli SM, Moutsoudis A, Papageorgiou C, Lallas K, Rigas HM, Kyrmanidou E, Papadimitriou I, Paschou E, Spyridis I, Gkentsidi T, Sotiriou E, Vakirlis E, Ioannidis D, Apalla Z, Lallas A. Real-life data on basal cell carcinoma treatment: Insights on clinicians' therapeutic choices from an institutional hospital registry. Dermatol Ther 2020; 33:e14414. [PMID: 33064345 DOI: 10.1111/dth.14414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022]
Abstract
Basal cell carcinoma (BCC) is the most common skin cancer in white skin individuals. The treatment of choice is surgical excision, but several other therapeutic choices are available and might also be efficient and cost-effective in selected cases of low-risk BCC or when surgery is complicate or contraindicated. The aim of the current study was to analyze the applied treatments for BCC in the real-life practice of a tertiary hospital, and investigate factors associated to the tumor and the patients that might influence the treatment selection of clinicians. Data on all BCCs treated from 1st January 2018 to 31st December 2019 were extracted. A total of 751 BCCs from 585 patients were included. The baseline characteristics of patients and tumors, the type of applied treatment and the histopathologic report when available were analyzed. Most tumors were located on the head/neck (64.2%). The most frequently applied treatment was surgical excision (580/751, 77.2%). In 22.8% of tumors a nonsurgical treatment was selected. The most frequently selected alternative treatments were, imiquimod, cryosurgery, their combination (immunocryosurgery), and vismodegib. A pretreatment diagnosis of superficial BCC was associated with a 12-fold increased probability of selecting a nonsurgical treatment except of vismodegib. Every added year of age increased the probability of selecting a nonsurgical treatment by 3-fold. Every added mm of diameter increased the possibility of vismodegib use by 4%. Surgery is the most frequently applied BCC treatment, but nonsurgical modalities do also have an essential role in real settings.
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Affiliation(s)
| | - Andreas Moutsoudis
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | | | | | - Eirini Kyrmanidou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | - Eleni Paschou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ioannis Spyridis
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | - Elena Sotiriou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | | | - Zoe Apalla
- Second Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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Padya BS, Pandey A, Pisay M, Koteshwara KB, Chandrashekhar Hariharapura R, Bhat KU, Biswas S, Mutalik S. Stimuli-responsive and cellular targeted nanoplatforms for multimodal therapy of skin cancer. Eur J Pharmacol 2020; 890:173633. [PMID: 33049302 DOI: 10.1016/j.ejphar.2020.173633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
Interdisciplinary applications of nanopharmaceutical sciences have tremendous potential for enhancing pharmacokinetics, efficacy and safety of cancer therapy. The limitations of conventional therapeutic platforms used for skin cancer therapy have been largely overcome by the use of nanoplatforms. This review discusses various nanotechnological approaches experimented for the treatment of skin cancer. The review describes various polymeric, lipidic and inorganic nanoplatforms for efficient therapy of skin cancer. The stimuli-responsive nanoplatforms such as pH-responsive as well as temperature-responsive platforms have also been reviewed. Different strategies for potentiating the nanoparticles application for cancer therapy such as surface engineering, conjugation with drugs, stimulus-responsive and multimodal effect have also been discussed and compared with the available conventional treatments. Although, nanopharmaceuticals face challenges such as toxicity, cost and scale-up, efforts put-in to improve these drawbacks with continuous research would deliver exciting and promising results in coming days.
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Affiliation(s)
- Bharath Singh Padya
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Abhijeet Pandey
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Muralidhar Pisay
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - K B Koteshwara
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Raghu Chandrashekhar Hariharapura
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kuruveri Udaya Bhat
- Department of Metallurgical and Materials Engineering, National Institute of Technology, Mangalore, Karnataka, 575025, India
| | - Swati Biswas
- Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Hyderabad, Telangana, 500078, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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[Surgical techniques in the treatment of basal cell carcinoma-a prospective investigation]. Hautarzt 2020; 71:960-968. [PMID: 32930855 PMCID: PMC7686215 DOI: 10.1007/s00105-020-04685-1] [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] [Indexed: 12/03/2022]
Abstract
Hintergrund Basalzellkarzinome sind die häufigsten epithelialen Hauttumoren und eine häufige Indikation für dermatologische Eingriffe. Trotz der Etablierung medikamentöser Therapieoptionen stellt die Operation weiterhin die Therapie der Wahl dar. Hierbei stehen verschiedene Möglichkeiten zur Verfügung, die von der Kürettage bis hin zu komplexen dermatochirurgischen Eingriffen reichen. Neben dem Hauptaspekt der geringen lokalen Rezidivraten sind auch ästhetische Faktoren und die Anzahl der Eingriffe für die Wahl der Therapie wichtig. Methoden In dieser Studie wurden 347 Patienten mit 398 Basalzellkarzinomen (nodulärer Typ, Durchmesser bis 10 mm) prospektiv untersucht. Die Patienten wurden randomisiert in 2 Behandlungsarme eingeteilt: In einer Gruppe wurden die Tumoren kürettiert, in der anderen Gruppe exzidiert. Als Kontrolle dienten Patienten, die im gleichen Untersuchungszeitraum 3‑D-histologisch kontrolliert operiert wurden. Ergebnisse Die höchste lokale Rezidivrate wurde nach der Kürettage (14,0 %) beobachtet, während die Gruppe mit 3‑D-Histologie die niedrigste Rezidivrate (0,9 %; p < 0,001) aufwies. In der 3‑D-Gruppe waren mehr Re-Exzisionen erforderlich, um eine vollständige Entfernung des Tumors zu erreichen, als in der Gruppe mit histologischen Serienschnitten. Die Patienten bewerteten das ästhetische Ergebnis am besten nach der Kürettage. Die mittlere Nachbeobachtungszeit betrug 3,9 Jahre. Schlussfolgerung Die Wahl der chirurgischen Therapie bei kleinen nodulären Basalzellkarzinomen hängt von den individuellen Gegebenheiten ab. 3‑D-histologisch kontrollierte Exzisionen mit Wundverschluss nach vollständiger Tumorentfernung zeigten in unserer Studie die geringste Rezidivrate. Aber auch die Kürettage stellt eine mögliche chirurgische Therapieoption mit minimalem Aufwand und einer akzeptablen Rezidivrate dar, die zu guten ästhetischen Ergebnissen führen kann.
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Pitney T, Muir J. Comment on "Surgery versus combined treatment with curettage and imiquimod for nodular basal cell carcinoma: One-year results of a noninferiority, randomized, controlled trial". J Am Acad Dermatol 2020; 84:e55. [PMID: 32860912 DOI: 10.1016/j.jaad.2020.08.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
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Iftimia N, Sahu A, Cordova M, Maguluri G, Gill M, Alessi-Fox C, Gonzalez S, Navarrete-Dechent C, Marghoob A, Chen CSJ, Rajadhyaksha M. The potential utility of integrated reflectance confocal microscopy-optical coherence tomography for guiding triage and therapy of basal cell carcinomas. J Cancer 2020; 11:6019-6024. [PMID: 32922542 PMCID: PMC7477415 DOI: 10.7150/jca.47026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/02/2020] [Indexed: 12/15/2022] Open
Abstract
The increasing rate of incidence and prevalence of basal cell carcinomas (BCCs) worldwide, combined with the morbidity associated with conventional surgical treatment has led to the development and use of alternative minimally invasive non-surgical treatments. Biopsy and pathology are used to guide BCC diagnosis and assess margins and subtypes, which then guide the decision and choice of surgical or non-surgical treatment. However, alternatively, a noninvasive optical approach based on combined reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) imaging may be used. Optical imaging may be used to guide diagnosis and margin assessment at the bedside, and potentially facilitate non-surgical management, along with long-term monitoring of treatment response. Noninvasive imaging may also complement minimally invasive treatments and help further reduce morbidity. In this paper, we highlight the current state of an integrated RCM/OCT imaging approach for diagnosis and triage of BCCs, as well as for assessing margins, which therefore may be ultimately used for guiding therapy.
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Affiliation(s)
- Nicusor Iftimia
- Physical Sciences, Inc., 20 New England Business Ctr. Drive, Andover, MA, USA
| | - Aditi Sahu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gopi Maguluri
- Physical Sciences, Inc., 20 New England Business Ctr. Drive, Andover, MA, USA
| | - Melissa Gill
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | | | | | - Ashfaq Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chih-Shan J Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Milind Rajadhyaksha
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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44
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Sabri A, Ogilvie J, McKenna J, Segal J, Scurr D, Marlow M. Intradermal Delivery of an Immunomodulator for Basal Cell Carcinoma; Expanding the Mechanistic Insight into Solid Microneedle-Enhanced Delivery of Hydrophobic Molecules. Mol Pharm 2020; 17:2925-2937. [PMID: 32510228 DOI: 10.1021/acs.molpharmaceut.0c00347] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Basal cell carcinoma (BCC) is the most common cutaneous malignancy in humans. One of the most efficacious drugs used in the management of BCC is the immunomodulator, imiquimod. However, imiquimod has physiochemical properties that limit its permeation to reach deeper, nodular tumor lesions. The use of microneedles may overcome such limitations and promote intradermal drug delivery. The current work evaluates the effectiveness of using an oscillating microneedle device Dermapen either as a pre- or post-treatment with 5% w/w imiquimod cream application to deliver the drug into the dermis. The effectiveness of microneedles to enhance the permeation of imiquimod was evaluated ex vivo using a Franz cell setup. After a 24-h permeation experiment, sequential tape strips and vertical cross-sections of the porcine skin were collected and analyzed using time-of-flight secondary ion mass spectrometry (ToF-SIMS). In addition, respective Franz cell components were analyzed using high-performance liquid chromatography (HPLC). Analysis of porcine skin cross-sections demonstrated limited dermal permeation of 5% w/w imiquimod cream. Similarly, limited dermal permeation was also seen when 5% w/w imiquimod cream was applied to the skin that was pretreated with the Dermapen, this is known as poke-and-patch. In contrast, when the formulation was applied first to the skin prior to Dermapen application, this is known as patch-and-poke, we observed a significant increase in intradermal permeation of imiquimod. Such enhancement occurs immediately upon microneedle application, generating an intradermal depot that persists for up to 24 h. Intradermal colocalization of isostearic acid, an excipient in the cream, with imiquimod within microneedle channels was also demonstrated. However, such enhancement in intradermal delivery of imiquimod was not observed when the patch-and-poke strategy was used with a non-oscillating microneedle applicator, the Dermastamp. The current work highlights that using the patch-and-poke approach with an oscillating microneedle pen may be a viable approach to improve the current treatment in BCC patients who would prefer a less invasive intervention relative to surgery.
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Affiliation(s)
- Akmal Sabri
- School of Pharmacy, University of Nottingham, Nottingham NG72RD, United Kingdom
| | - Jane Ogilvie
- Walgreens Boots Alliance, Thane Road, Nottingham NG90 1BS, United Kingdom
| | - John McKenna
- Leicester Royal Infirmary University Hospitals Leicester Dermatology Department, Infirmary Square, Leicester LE1 5WW, United Kingdom
| | - Joel Segal
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Engineering, University of Nottingham, Nottingham NG8 1BB, United Kingdom
| | - David Scurr
- School of Pharmacy, University of Nottingham, Nottingham NG72RD, United Kingdom
| | - Maria Marlow
- School of Pharmacy, University of Nottingham, Nottingham NG72RD, United Kingdom
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Sinx KAE, Nelemans PJ, Kelleners-Smeets NWJ, Winnepenninckx VJL, Arits AHMM, Mosterd K. Surgery versus combined treatment with curettage and imiquimod for nodular basal cell carcinoma: One-year results of a noninferiority, randomized, controlled trial. J Am Acad Dermatol 2020; 83:469-476. [PMID: 32320773 DOI: 10.1016/j.jaad.2020.04.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Nodular basal cell carcinoma (nBCC) is mostly treated with surgical excision. Interest in minimally invasive treatment of these low-risk tumors is increasing. We assessed the effectiveness of nBCC treatment with curettage and imiquimod cream compared with surgical excision. METHODS Patients with nBCC included in this randomized, controlled noninferiority trial were randomly assigned to either a curettage and imiquimod cream group or a surgical excision group. The primary endpoint was the proportion of patients free from treatment failure 1 year after the end of treatment. A prespecified noninferiority margin of 8% was used. A modified intention-to-treat and a per-protocol analysis was performed (ClinicalTrials.gov identifier NCT02242929). RESULTS One hundred forty-five patients were randomized: 73 to the curettage and imiquimod cream group and 72 to the surgical excision group. The proportion of patients free of recurrence after 12 months was 86.3% (63/73) for the curettage and imiquimod group and 100% (72/72) for the surgical excision group. The difference in efficacy was -13.7% (95% confidence interval -21.6% to -5.8%; 1-sided P = .0004) favoring surgical excision. CONCLUSION Noninferiority of curettage and imiquimod cream cannot be concluded. Given the still high efficacy of curettage and imiquimod cream and the indolent growth pattern of nBCC, curettage and imiquimod could still be a valuable treatment option with the possibility to prevent overuse of excisions. However, it cannot replace surgical excision.
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Affiliation(s)
- Kelly A E Sinx
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | | | - Aimee H M M Arits
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands; Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Dermatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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Sinx KAE, van Loo E, Tonk EHJ, Kelleners-Smeets NWJ, Winnepenninckx VJL, Nelemans PJ, Mosterd K. Optical Coherence Tomography for Noninvasive Diagnosis and Subtyping of Basal Cell Carcinoma: A Prospective Cohort Study. J Invest Dermatol 2020; 140:1962-1967. [PMID: 32147505 DOI: 10.1016/j.jid.2020.01.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023]
Abstract
Noninvasive diagnostic strategies such as optical coherence tomography (OCT) enable detailed examination of skin tissue architecture and have potential for identification and subtyping of basal cell carcinoma (BCC). To evaluate the additional diagnostic value of OCT, a prospective cohort study was performed in 182 patients with 250 lesions suspected for non-melanoma skin premalignancies requiring a biopsy. Accuracy of BCC diagnosis and subtype on the basis of clinical examination (CE) of patients was compared with that on the basis of OCT scans in conjunction with clinical images of lesions (cOCT). Confidence levels were recorded on a 5-point scale, where score 0 indicated absence of BCC and scores 1-4 indicated increasing suspicion of BCC. Diagnostic performance parameters were compared using histopathologic diagnosis as gold standard. The patient-based area under the receiver operating characteristic curve (AUC) increased from 85.6% for CE to 91.2% for cOCT (P = 0.061) and the lesion-based AUC from 82.7% to 91.3% (P < 0.001). When confidence scores 1-4 were defined as positive, patient-based specificity increased from 47.5% (CE alone) to 76.8% (cOCT) at similar sensitivity (97.6% and 95.2%, respectively). cOCT slightly improved the ability to discriminate between superficial and nonsuperficial BCC subtypes and seemed to be a valuable addition to CE alone in the diagnosis and subtyping of BCC.
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Affiliation(s)
- Kelly A E Sinx
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Eva van Loo
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Erwin H J Tonk
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | | | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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Lang BM, Balermpas P, Bauer A, Blum A, Brölsch GF, Dirschka T, Follmann M, Frank J, Frerich B, Fritz K, Hauschild A, Heindl LM, Howaldt HP, Ihrler S, Kakkassery V, Klumpp B, Krause-Bergmann A, Löser C, Meissner M, Sachse MM, Schlaak M, Schön MP, Tischendorf L, Tronnier M, Vordermark D, Welzel J, Weichenthal M, Wiegand S, Kaufmann R, Grabbe S. S2k Guidelines for Cutaneous Basal Cell Carcinoma - Part 2: Treatment, Prevention and Follow-up. J Dtsch Dermatol Ges 2020; 17:214-230. [PMID: 30762963 DOI: 10.1111/ddg.13755] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumor among fair-skinned individuals, and its incidence had been steadily rising in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 2 addresses issues such as proper risk stratification, the various therapeutic approaches, and prevention as well as follow-up of patients with basal cell carcinoma.
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Affiliation(s)
- Berenice M Lang
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Andrea Bauer
- Department of Dermatology, Carl Gustav Carus University Medical Center, Dresden, Germany
| | - Andreas Blum
- Dermatology and Teaching Practice, Konstanz, Germany
| | - G Felix Brölsch
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hanover Medical School, Hanover, Germany
| | - Thomas Dirschka
- CentroDerm Clinic, Wuppertal, Germany.,Faculty of Health, Witten-Herdecke University, Witten, Germany
| | | | - Jorge Frank
- Department of Dermatology, Venereology and Allergology, Göttingen University Medical Center, Göttingen, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Plastic Surgery, Rostock University Medical Center, Rostock, Germany
| | - Klaus Fritz
- Dermatology and Laser Center, Landau, Germany
| | - Axel Hauschild
- Department of Dermatology, Venereology and Allergology, Schleswig-Holstein University Medical Center, Kiel, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Cologne University Medical Center, Cologne, Germany
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Gießen University Medical Center, Gießen, Germany
| | - Stephan Ihrler
- Laboratory for Dermatohistology and Oral Pathology, Munich, Germany
| | - Vinodh Kakkassery
- Department of Ophthalmology, Schleswig-Holstein University Medical Center, Lübeck, Germany.,Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Bernhard Klumpp
- Department of Diagnostic and Interventional Radiology, Tübingen University Medical Center, Tübingen, Germany.,Department of Radiology, Rems-Murr Medical Center, Winnenden, Germany
| | | | - Christoph Löser
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Michael M Sachse
- Department of Dermatology, Allergology and Phlebology, Bremerhaven Medical Center, Bremerhaven, Germany
| | - Max Schlaak
- Department of Dermatology and Allergology, Munich University Medical Center, Munich, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, Göttingen University Medical Center, Göttingen, Germany
| | | | - Michael Tronnier
- Department of Dermatology, Venereology and Allergology, Helios Medical Center, Hildesheim, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Halle University Medical Center, Martin Luther University, Halle, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, Augsburg Medical Center, Augsburg, Germany
| | - Michael Weichenthal
- Department of Dermatology, Venereology and Allergology, Schleswig-Holstein University Medical Center, Kiel, Germany
| | - Susanne Wiegand
- Department of Otolaryngology, Leipzig University Medical Center, Leipzig, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
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48
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Olabi B, Tasker F, Williams HC. 'Efficacy and safety of imiquimod 5% cream for basal cell carcinoma: a meta-analysis of randomized controlled trial': a critical appraisal. Br J Dermatol 2020; 183:650-654. [PMID: 31977075 DOI: 10.1111/bjd.18891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 12/11/2022]
Abstract
AIM Jia and He aimed 'to compare the efficacy and safety of imiquimod with other treatments in patients with basal cell carcinoma' (BCC). DESIGN AND INCLUSION CRITERIA Meta-analysis of studies that included patients with histologically confirmed BCC treated with imiquimod 5% cream compared with all other treatments, including vehicle, excisional surgery, cryosurgery, fluorouracil and methyl aminolaevulinate photodynamic therapy. OUTCOMES The main outcome measures included histological and composite clearance rates, success rates, complete response rates, tumour-free survival and adverse events. RESULTS Thirteen studies with a total of 4265 patients were included in the review. Pooled analyses comparing imiquimod with all or any of the listed comparators, including vehicle, demonstrated higher histological clearance rates [risk ratio (RR) 9·28, 95% confidence interval (CI) 5·56-15·5; P < 0·001], higher composite clearance rates (RR 34·2, 95% CI 21·3, 55·1; P = 0·001), no significant difference in success rates (RR 0·98, 95% CI 0·89-1·08; P = 0·73), higher complete response rates (RR 3·15, 95% CI 1·55-6·38; P = 0·001), no significant difference in tumour-free survival (RR 1·15, 95% CI 0·98-1·35; P = 0·088) and increased incidence of adverse events (RR 2·00, 95% CI 1·39-2·88; P < 0·001). CONCLUSIONS The authors state that 'imiquimod significantly exhibited benefit effect in improving the histological/composite clearance rates' compared with other treatments, and they suggest it could be used as the first-choice treatment for patients with BCC. COMMENT The main concerns related to the article by Jia and He are that the research question is replicative, it makes little sense to combine all BCC types in a meta-analysis, and it also makes no sense to combine an active treatment against a combination of vehicle and other active treatments. There are also concerns about bias related to the use of the same study data more than once in a meta-analysis. Furthermore, we have identified an example of covert duplicate publication, which further compounds the profusion of misleading systematic reviews.
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Affiliation(s)
- B Olabi
- UK Dermatology Clinical Trials Network, University of Nottingham, Kings Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, UK
| | - F Tasker
- UK Dermatology Clinical Trials Network, University of Nottingham, Kings Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, UK
| | - H C Williams
- UK Dermatology Clinical Trials Network, University of Nottingham, Kings Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, UK
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49
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Kakkassery V, Emmert S, Adamietz IA, Kovács G, Jünemann AM, Otte C, Zimbelmann M, Brosig A, Grisanti S, Heindl LM. [Alternative treatment options for periorbital basal cell carcinoma]. Ophthalmologe 2020; 117:113-123. [PMID: 31811367 DOI: 10.1007/s00347-019-01021-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Latest developments as well as established procedures offer alternative treatment approaches to basal cell carcinoma (BCC) when micrographically controlled surgical removal is not a valid option. OBJECTIVE Alternative treatment options for periorbital BCC are presented. METHODS A literature search was carried out and a structured display and analysis of the results are given. RESULTS Micrographically controlled surgical removal represents the gold standard in treatment of BCC. When for various reasons surgical removal is not a valid option, other procedures are required. The alternative treatment options can be divided into three main groups: treatment options for locally advanced or metastasized BCC, topical approaches for small and superficial BCC and prophylactic measures. While radiotherapy and systemic therapy are suitable for locally advanced BCC and are discussed in a tumor board, small and superficial BCC can be treated by topical medication. In cases of a previous BCC history, a prophylactic treatment can be considered. Combinations of systemic treatment and also neoadjuvant or adjuvant approaches before and after surgery are promising options for a successful outcome, which can further improve the standard treatment for locally advanced BCC. CONCLUSION Alternative treatment options for periocular BCC are available; however, the use is only indicated when microscopically controlled excision with subsequent oculoplastic reconstruction is not possible. According to the national guidelines a prior presentation to a suitable tumor board is practically compulsory.
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Affiliation(s)
- Vinodh Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Steffen Emmert
- Klinik und Poliklinik für Dermatologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | | | - György Kovács
- Gemelli INTERACTS - Università Cattolica del Sacro Cuore, Rom, Italien.,Bereich Interdisziplinäre Brachytherapie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Anselm M Jünemann
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Caroline Otte
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Michael Zimbelmann
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Anton Brosig
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Salvatore Grisanti
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
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50
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van Delft LCJ, van Loo E, Mosterd K, Kelleners-Smeets NWJ. Comment on "Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines". Eur J Cancer 2020; 131:98-99. [PMID: 31932177 DOI: 10.1016/j.ejca.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Lieke C J van Delft
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology Maastricht University Medical Centre+.
| | - Eva van Loo
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology Maastricht University Medical Centre
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology Maastricht University Medical Centre
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology Maastricht University Medical Centre
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