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Sol S, Boncimino F, Todorova K, Waszyn SE, Mandinova A. Therapeutic Approaches for Non-Melanoma Skin Cancer: Standard of Care and Emerging Modalities. Int J Mol Sci 2024; 25:7056. [PMID: 39000164 PMCID: PMC11241167 DOI: 10.3390/ijms25137056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Skin cancer encompasses a range of cutaneous malignancies, with non-melanoma skin cancers (NMSCs) being the most common neoplasm worldwide. Skin exposure is the leading risk factor for initiating NMSC. Ultraviolet (UV) light induces various genomic aberrations in both tumor-promoting and tumor-suppressing genes in epidermal cells. In conjunction with interactions with a changed stromal microenvironment and local immune suppression, these aberrations contribute to the occurrence and expansion of cancerous lesions. Surgical excision is still the most common treatment for these lesions; however, locally advanced or metastatic disease significantly increases the chances of morbidity or death. In recent years, numerous pharmacological targets were found through extensive research on the pathogenic mechanisms of NMSCs, leading to the development of novel treatments including Hedgehog pathway inhibitors for advanced and metastatic basal cell carcinoma (BCC) and PD-1/PD-L1 inhibitors for locally advanced cutaneous squamous cell carcinoma (cSCC) and Merkel cell carcinoma (MCC). Despite the efficacy of these new drugs, drug resistance and tolerability issues often arise with long-term treatment. Ongoing studies aim to identify alternative strategies with reduced adverse effects and increased tolerability. This review summarizes the current and emerging therapies used to treat NMSC.
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Affiliation(s)
- Stefano Sol
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Fabiana Boncimino
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Kristina Todorova
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | | | - Anna Mandinova
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
- Broad Institute of Harvard and MIT, 7 Cambridge Center, Cambridge, MA 02142, USA
- Harvard Stem Cell Institute, 7 Divinity Avenue, Cambridge, MA 02138, USA
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Haghsay Khashechi E, Afaghmehr A, Heydari N, Barfar A, Shokri J. Laser-mediated Solutions: Breaking Barriers in Transdermal Drug Delivery. AAPS PharmSciTech 2024; 25:142. [PMID: 38898170 DOI: 10.1208/s12249-024-02849-z] [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: 12/11/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Skin diseases pose challenges in treatment due to the skin's complex structure and protective functions. Topical drug delivery has emerged as a preferred method for treating these conditions, offering localized therapy with minimal systemic side effects. However, the skin's barrier properties frequently limit topical treatments' efficacy by preventing drug penetration into deeper skin layers. In recent years, laser-assisted drug delivery (LADD) has gained attention as a promising strategy to overcome these limitations. LADD involves using lasers to create microchannels in the skin, facilitating the deposition of drugs and enhancing their penetration into the target tissue. Several lasers, such as fractional CO2, have been tested to see how well they work at delivering drugs. Despite the promising outcomes demonstrated in preclinical and clinical studies, several challenges persist in implementing LADD, including limited penetration depth, potential tissue damage, and the cost of LADD systems. Furthermore, selecting appropriate laser parameters and drug formulations is crucial to ensuring optimal therapeutic outcomes. Nevertheless, LADD holds significant potential for improving treatment efficacy for various skin conditions, including skin cancers, scars, and dermatological disorders. Future research efforts should focus on optimizing LADD techniques, addressing safety concerns, and exploring novel drug formulations to maximize the therapeutic benefits of this innovative approach. With continued advancements in laser technology and pharmaceutical science, LADD has the potential to revolutionize the field of dermatology and enhance patient care.
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Affiliation(s)
| | | | - Niloofar Heydari
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ashkan Barfar
- Faculty of Pharmacy, Tabriz University of Medical Science, Tabriz, Iran
- Department of pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Shokri
- Department of pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
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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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4
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Koumprentziotis IA, Rompoti N, Liopyris K, Nicolaidou E, Stratigos A. Photodynamic Therapy for the Treatment of Basal Cell Carcinoma: A Comprehensive Review of Randomized Controlled Trials. Dermatol Pract Concept 2024; 14:dpc.1402a105. [PMID: 38810046 PMCID: PMC11136039 DOI: 10.5826/dpc.1402a105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common skin cancer worldwide and has been reported to have a rising incidence in the last years. Multiple therapeutic modalities are approved for the treatment of BCC, making it difficult for physicians to choose the most suitable option for every patient. Photodynamic therapy (PDT) using either 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) as photosensitizing agents is an established treatment option for low-risk BCC. OBJECTIVES This review aims to summarize the available evidence from randomized clinical trials (RCTs) that utilize either ALA or MAL PDT and compare it with other treatment modalities. The main outcomes related to the effectiveness, adverse events, cosmetic outcomes and pain sensation, along with data from long-term follow-ups will be presented and discussed. METHODS Thorough literature searches were conducted through the electronic databases ClinicalTrials. gov and Pubmed/MEDLINE from inception up to 28 March 2023. Only studies in English were included. All relevant data were extracted accordingly from the eligible studies. RESULTS Eight RCTs included superficial BCC (sBCC) alone, 7 included nodular BCC (nBCC), 2 included both sBCC and nBCC and 1 included BCC of unspecified subtype. Follow-up duration ranged from 3 months to 5 years. Both ALA-PDT and MAL-PDT demonstrated acceptable efficacy, adverse events, cosmetic outcomes and pain sensation while no major differences were observed between them. PDT was less effective than surgery but with better reported cosmetic outcomes. CONCLUSIONS PDT is a safe and efficacious treatment option for sBCC and to a lesser extent nBCC.
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Affiliation(s)
- Ioannis-Alexios Koumprentziotis
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Natalia Rompoti
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Liopyris
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Electra Nicolaidou
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Stratigos
- 1 Department of Dermatology and Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Boutin J, Genevois C, Couillaud F, Lamrissi-Garcia I, Guyonnet-Duperat V, Bibeyran A, Lalanne M, Amintas S, Moranvillier I, Richard E, Blouin JM, Dabernat S, Moreau-Gaudry F, Bedel A. CRISPR editing to mimic porphyria combined with light: A new preclinical approach for prostate cancer. MOLECULAR THERAPY. ONCOLOGY 2024; 32:200772. [PMID: 38596305 PMCID: PMC10899051 DOI: 10.1016/j.omton.2024.200772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 04/11/2024]
Abstract
Thanks to its very high genome-editing efficiency, CRISPR-Cas9 technology could be a promising anticancer weapon. Clinical trials using CRISPR-Cas9 nuclease to ex vivo edit and alter immune cells are ongoing. However, to date, this strategy still has not been applied in clinical practice to directly target cancer cells. Targeting a canonical metabolic pathway essential to good functioning of cells without potential escape would represent an attractive strategy. We propose to mimic a genetic metabolic disorder in cancer cells to weaken cancer cells, independent of their genomic abnormalities. Mutations affecting the heme biosynthesis pathway are responsible for porphyria, and most of them are characterized by an accumulation of toxic photoreactive porphyrins. This study aimed to mimic porphyria by using CRISPR-Cas9 to inactivate UROS, leading to porphyrin accumulation in a prostate cancer model. Prostate cancer is the leading cancer in men and has a high mortality rate despite therapeutic progress, with a primary tumor accessible to light. By combining light with gene therapy, we obtained high efficiency in vitro and in vivo, with considerable improvement in the survival of mice. Finally, we achieved the preclinical proof-of-principle of performing cancer CRISPR gene therapy.
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Affiliation(s)
- Julian Boutin
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- CHU de Bordeaux, Biochemistry Laboratory, 33000 Bordeaux, France
| | - Coralie Genevois
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Vivoptic Platform INSERM US 005—CNRS UAR 3427-TBM-Core, Bordeaux University, 33000 Bordeaux, France
| | - Franck Couillaud
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Vivoptic Platform INSERM US 005—CNRS UAR 3427-TBM-Core, Bordeaux University, 33000 Bordeaux, France
| | - Isabelle Lamrissi-Garcia
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
| | - Veronique Guyonnet-Duperat
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Vect’UB, Vectorology Platform, INSERM US 005—CNRS UAR 3427-TBM-Core, Bordeaux University, 33000 Bordeaux, France
| | - Alice Bibeyran
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- Vect’UB, Vectorology Platform, INSERM US 005—CNRS UAR 3427-TBM-Core, Bordeaux University, 33000 Bordeaux, France
| | - Magalie Lalanne
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
| | - Samuel Amintas
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- CHU de Bordeaux, Tumor Biology and Tumor Bank Laboratory, 33000 Bordeaux, France
| | - Isabelle Moranvillier
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
| | - Emmanuel Richard
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- CHU de Bordeaux, Biochemistry Laboratory, 33000 Bordeaux, France
| | - Jean-Marc Blouin
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- CHU de Bordeaux, Biochemistry Laboratory, 33000 Bordeaux, France
| | - Sandrine Dabernat
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- CHU de Bordeaux, Biochemistry Laboratory, 33000 Bordeaux, France
| | - François Moreau-Gaudry
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- CHU de Bordeaux, Biochemistry Laboratory, 33000 Bordeaux, France
| | - Aurélie Bedel
- University of Bordeaux, INSERM, UMR 1312, Bordeaux Institute of Oncology, 146 Rue Léo Saignat, 33076 Bordeaux, France
- CHU de Bordeaux, Biochemistry Laboratory, 33000 Bordeaux, France
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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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Paul T, Palaniyandi K, Gnanasampanthapandian D. Therapeutic Approaches to Increase the Survival Rate of Cancer Patients in the Younger and Older Population. Curr Aging Sci 2024; 17:16-30. [PMID: 38062658 DOI: 10.2174/0118746098241507231127114248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/25/2023] [Accepted: 09/22/2023] [Indexed: 05/18/2024]
Abstract
Various developments have been observed in the treatment of cancer patients, such as higher survival rates and better treatment outcomes. However, expecting similar outcomes in older patients remains a challenge. The main reason for this conclusion is the exclusion of older people from clinical trials for cancer drugs, as well as other factors, such as comorbidity, side effects, age-related frailties and their willingness to undergo multiple treatments. However, the discovery of new techniques and drug combinations has led to a significant improvement in the survival of the elderly population after the onset of the disease. On the other hand, cancer treatments have not become more complex for the younger population when compared to the older population, as the younger population tends to respond well to treatment trials and their physiological conditions are stable in response to treatments. In summary, this review correlates recent cancer treatment strategies and the corresponding responses and survival outcomes of older and younger patients.
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Affiliation(s)
- Tharrun Paul
- Cancer Science Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, 603203, Chengalpattu, India
| | - Kanagaraj Palaniyandi
- Cancer Science Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, 603203, Chengalpattu, India
| | - Dhanavathy Gnanasampanthapandian
- Cancer Science Laboratory, Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, 603203, Chengalpattu, India
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8
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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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9
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Hasan N, Nadaf A, Imran M, Jiba U, Sheikh A, Almalki WH, Almujri SS, Mohammed YH, Kesharwani P, Ahmad FJ. Skin cancer: understanding the journey of transformation from conventional to advanced treatment approaches. Mol Cancer 2023; 22:168. [PMID: 37803407 PMCID: PMC10559482 DOI: 10.1186/s12943-023-01854-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/30/2023] [Indexed: 10/08/2023] Open
Abstract
Skin cancer is a global threat to the healthcare system and is estimated to incline tremendously in the next 20 years, if not diagnosed at an early stage. Even though it is curable at an early stage, novel drug identification, clinical success, and drug resistance is another major challenge. To bridge the gap and bring effective treatment, it is important to understand the etiology of skin carcinoma, the mechanism of cell proliferation, factors affecting cell growth, and the mechanism of drug resistance. The current article focusses on understanding the structural diversity of skin cancers, treatments available till date including phytocompounds, chemotherapy, radiotherapy, photothermal therapy, surgery, combination therapy, molecular targets associated with cancer growth and metastasis, and special emphasis on nanotechnology-based approaches for downregulating the deleterious disease. A detailed analysis with respect to types of nanoparticles and their scope in overcoming multidrug resistance as well as associated clinical trials has been discussed.
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Affiliation(s)
- Nazeer Hasan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Arif Nadaf
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Mohammad Imran
- Frazer Institute, Faculty of Medicine, University of Queensland, Brisbane, 4102, Australia
| | - Umme Jiba
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Afsana Sheikh
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Waleed H Almalki
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Umm Al-Qura University, 24381, Makkah, Saudi Arabia
| | - Salem Salman Almujri
- Department of Pharmacology, College of Pharmacy, King Khalid University, 61421, Asir-Abha, Saudi Arabia
| | | | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Kuthambakkam, India.
| | - Farhan Jalees Ahmad
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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10
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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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11
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Krieter M, Schultz E. [Current Management of Basal Cell Carcinoma]. Dtsch Med Wochenschr 2023; 148:1081-1087. [PMID: 37611571 DOI: 10.1055/a-1958-2603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
For the management of basal cell carcinoma, the primary performance of a risk stratification, which is decisive for the further diagnostic and therapeutic steps, is becoming increasingly important.Various non-invasive methods are available to confirm the clinical diagnosis. Histological confirmation of the diagnosis is recommended in unclear cases. In poorly displaced lesions, preoperative cross-sectional imaging of the tumor area should be performed to exclude osseous infiltration.The gold standard in treatment remains surgery, which should be performed by means of micrographically controlled surgery if possible. In addition, there are other therapeutic methods such as radiotherapy or a number of topical therapy options (photodynamic therapy, cryotherapy or application of 5-fluorouracil or imiquimod), which can be used in certain cases. Also for advanced or metastatic basal cell carcinoma, effective drugs are available in the form of the hedgehog inhibitors, for which there is now several years of application experience with regard to efficacy and handling of adverse events. With the PD-1 inhibitor cemiplimab, a further therapeutic option for non-operable or metastatic tumors has been available since June 2021.The most important preventive measure is consistent textile or chemical UV protection in already affected individuals. In addition, nicotinamide and celecoxib can be used orally for prevention. For follow-up, the current S2k guideline recommends regular self-monitoring and standardized medical check-ups.
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Affiliation(s)
- Manuel Krieter
- Universitätsklinik für Dermatologie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - Erwin Schultz
- Universitätsklinik für Dermatologie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
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12
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Tan IJ, Pathak GN, Silver FH. Topical Treatments for Basal Cell Carcinoma and Actinic Keratosis in the United States. Cancers (Basel) 2023; 15:3927. [PMID: 37568743 PMCID: PMC10416997 DOI: 10.3390/cancers15153927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Skin cancer is an overarching label used to classify a variety of cutaneous malignancies. Surgical excision procedures are the commonly used treatments for these lesions; however, the choice to perform operative intervention may be influenced by other factors. Established research and literature suggest that topical treatments limit the need for surgical intervention and its commonly associated adverse effects, including infection and scarring. In addition, the growing indications for the usage of topical therapies in BCC treatment, as well as their increased availability and therapeutic options, allow for their greater applicability in the dermatology clinic. Certain topical therapies have been highlighted in research, especially those targeting basal cell carcinoma (BCC) and actinic keratosis (AK). There is also a clear correlation between cost and treatment outcomes, considering BCC's ever-growing prevalence and the proportion of excised lesions being reported as malignant. This review will discuss BCC and AK lesion criteria that result in the most successful outcomes using topical treatments, then highlight the various topical treatment options, and finally address their clinical significance moving forward.
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Affiliation(s)
| | | | - Frederick H. Silver
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ 08854, USA
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13
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Melnikova N, Sheferov I, Panteleev D, Emasheva A, Druzhkova I, Ignatova N, Mishchenko T, Vedunova M. Design and Study of Nanoceria Modified by 5-Fluorouracil for Gel and Polymer Dermal Film Preparation. Pharmaceuticals (Basel) 2023; 16:1082. [PMID: 37630997 PMCID: PMC10458209 DOI: 10.3390/ph16081082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
In this work we studied nanoceria (CeO2NPs) and nanoceria modified by 5-fluorouracil (5FU) as potential APIs. Nanoceria were synthesized by precipitation in a matrix of hydroxyethyl cellulose or hydroxypropylmethyl cellulose, using cerium (III) nitrate and meglumine. Nanoceria properties were estimated by UV, FTIR and X-ray photoelectron spectra; scanning electron and atomic force microscopy; powder X-ray diffraction patterns and energy dispersive X-ray microanalysis. The cytotoxicity of nanoceria and polymer-protected nanoparticles was evaluated using the established cell line NCTC clone 929 (C3H/An mouse, subcutaneous connective tissue, clone of L. line). The morphology and metabolic activity of nanoparticles at 10 μg∙mL-1 of cells was not significant. In addition, the cytotoxic effects of nanoceria were assessed on two human colorectal cancer cell lines (HT29 and HCT116), murine melanoma B16 cells and normal human skin fibroblasts. An inhibitory effect was shown for HCT116 human colorectal cancer cells. The IC50 values for pure CeO2NPs and CeO2NPs-5FU were 219.0 ± 45.6 μg∙mL-1 and 89.2 ± 14.0 μg∙mL-1, respectively. On the other hand, the IC50 of 5FU in the combination of CeO2NPs-5FU was 2-fold higher than that of pure 5FU, amounting to 5.0 nmol∙mL-1. New compositions of nanoceria modified by 5-fluorouracil in a polymer matrix were designed as a dermal polymer film and gel. The permeability of the components was studied using a Franz cell.
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Affiliation(s)
- Nina Melnikova
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Ilya Sheferov
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Dmitry Panteleev
- Department of Pharmaceutical Chemistry, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia;
| | - Anastasia Emasheva
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Irina Druzhkova
- Research Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Nadezhda Ignatova
- Research Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Tatiana Mishchenko
- Institute of Biology and Biomedicine, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Maria Vedunova
- Institute of Biology and Biomedicine, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
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14
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Melnikova N, Sheferov I, Panteleev D, Emasheva A, Druzhkova I, Ignatova N, Mishchenko T, Vedunova M. Design and Study of Nanoceria Modified by 5-Fluorouracil for Gel and Polymer Dermal Film Preparation. Pharmaceuticals (Basel) 2023; 16:1082. [DOI: https:/doi.org/10.3390/ph16081082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2023] Open
Abstract
In this work we studied nanoceria (CeO2NPs) and nanoceria modified by 5-fluorouracil (5FU) as potential APIs. Nanoceria were synthesized by precipitation in a matrix of hydroxyethyl cellulose or hydroxypropylmethyl cellulose, using cerium (III) nitrate and meglumine. Nanoceria properties were estimated by UV, FTIR and X-ray photoelectron spectra; scanning electron and atomic force microscopy; powder X-ray diffraction patterns and energy dispersive X-ray microanalysis. The cytotoxicity of nanoceria and polymer-protected nanoparticles was evaluated using the established cell line NCTC clone 929 (C3H/An mouse, subcutaneous connective tissue, clone of L. line). The morphology and metabolic activity of nanoparticles at 10 μg∙mL−1 of cells was not significant. In addition, the cytotoxic effects of nanoceria were assessed on two human colorectal cancer cell lines (HT29 and HCT116), murine melanoma B16 cells and normal human skin fibroblasts. An inhibitory effect was shown for HCT116 human colorectal cancer cells. The IC50 values for pure CeO2NPs and CeO2NPs-5FU were 219.0 ± 45.6 μg∙mL−1 and 89.2 ± 14.0 μg∙mL−1, respectively. On the other hand, the IC50 of 5FU in the combination of CeO2NPs-5FU was 2-fold higher than that of pure 5FU, amounting to 5.0 nmol∙mL−1. New compositions of nanoceria modified by 5-fluorouracil in a polymer matrix were designed as a dermal polymer film and gel. The permeability of the components was studied using a Franz cell.
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Affiliation(s)
- Nina Melnikova
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Ilya Sheferov
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Dmitry Panteleev
- Department of Pharmaceutical Chemistry, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Anastasia Emasheva
- Faculty of Chemistry, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Irina Druzhkova
- Research Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Nadezhda Ignatova
- Research Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin Sq., 603950 Nizhny Novgorod, Russia
| | - Tatiana Mishchenko
- Institute of Biology and Biomedicine, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Maria Vedunova
- Institute of Biology and Biomedicine, Lobachevsky State University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
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15
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Mørk E, Mjønes P, Foss OA, Bachmann IM, Christensen E. Expression of β-Catenin, E-Cadherin, and α-Smooth Muscle Actin in Basal Cell Carcinoma Before Photodynamic Therapy in Non-recurrent and Recurrent Tumors: Exploring the Ability of Predicting Photodynamic Therapy Outcome. J Histochem Cytochem 2023; 71:111-120. [PMID: 36961748 PMCID: PMC10084567 DOI: 10.1369/00221554231161396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/10/2023] [Indexed: 03/25/2023] Open
Abstract
Photodynamic therapy (PDT) is an effective and cosmetically beneficial treatment of low-risk basal cell carcinomas (BCCs). To optimize PDT response, it is important to correctly select tumors. We sought to find markers that could identify such tumors beyond contributions from clinical and histological examination. Studies have shown that β-catenin, E-cadherin, and α-smooth muscle actin (SMA) expression can indicate BCC aggressiveness/BCC invasiveness. We wanted to use these markers in an explorative study to investigate whether they were differently expressed among non-recurring compared with recurring BCCs, to evaluate their ability of predicting PDT outcome. Fifty-two BCCs were stained with antibodies against β-catenin, E-cadherin, and α-SMA, and evaluated using immunoreactive score (IRS), subcellular localization, and stromal protein expression. Results showed that IRS of E-cadherin was significantly different among recurring compared with non-recurring BCCs and with area under a receiver operating characteristic curve of 0.71 (95% confidence interval: 0.56-0.86, p=0.025). Stromal β-catenin expression significantly increased among recurring BCCs. Some recurring BCCs had intense expression in the deep invading tumor edge. In conclusion, E-cadherin, and stromal and deep edge β-catenin expression were most prominent in BCCs that recurred post-PDT, suggesting they could potentially predict PDT outcome. Further studies are needed to investigate whether these results are of clinical value.
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Affiliation(s)
- Erik Mørk
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Patricia Mjønes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Olav A. Foss
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ingeborg M. Bachmann
- Institute of Medical Science, University of Bergen, Bergen, Norway
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - Eidi Christensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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16
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Nanofiber-based systems against skin cancers: Therapeutic and protective approaches. J Drug Deliv Sci Technol 2023. [DOI: 10.1016/j.jddst.2023.104367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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17
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Algarin YA, Jambusaria-Pahlajani A, Ruiz E, Patel VA. Advances in Topical Treatments of Cutaneous Malignancies. Am J Clin Dermatol 2023; 24:69-80. [PMID: 36169917 DOI: 10.1007/s40257-022-00731-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/26/2023]
Abstract
Surgical excision has been the preferred treatment for cutaneous malignancies, but can be affected by various considerations. Noninvasive, self-administered topical treatments represent an alternative option. The aim of this review was to evaluate and summarize evidence-based recommendations for topical treatments of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (CSCC), in situ melanoma (MIS), and extramammary Paget's disease (EMPD). Studies were reviewed on PubMed. Included studies were summarized, assessed for biases, and assigned a level of evidence to develop treatment recommendations. For the treatment of superficial BCC, complete clearance rates ranged from 90 to 93% for 5% 5-fluorouracil (5-FU) and 71 to 76% for imiquimod (IMQ). For the treatment of nodular BCC, clearance rates for photodynamic therapy (PDT) were 91% at 3 months, with a sustained lesion clearance response rate of 76% after 5 years of follow-up. Clearance rates were 53 to 76% with IMQ. For squamous cell carcinoma in situ, clearance rates ranged from 52 to 98% for PDT, 67 to 92% for 5-FU, and 75 to 93% for IMQ. For MIS, clearance rates ranged from 53 to 92% for IMQ. For EMPD, 54% of 110 patients in cohort studies and case series had a clinical complete response with IMQ. While surgical intervention remains the standard of care for skin cancer, non-invasive, self-administered topical treatments are highly desirable alternative options. Ultimately, the patient and provider should find a treatment modality that aligns with the patient's expectations and maintenance of quality of life.
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Affiliation(s)
| | | | - Emily Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vishal A Patel
- Department of Dermatology, The George Washington School of Medicine and Health Sciences, 2150 Pennsylvania Avenue 2B, NW, Washington, DC, 20037, USA.
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18
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Negussie AH, Mikhail AS, Owen JW, Hong N, Carlson CJ, Tang Y, Carrow KP, Mauda-Havakuk M, Lewis AL, Karanian JW, Pritchard WF, Wood BJ. In vitro characterization of immune modulating drug-eluting immunobeads towards transarterial embolization in cancer. Sci Rep 2022; 12:21886. [PMID: 36535979 PMCID: PMC9763333 DOI: 10.1038/s41598-022-26094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is an aggressive liver cancer with limited effective treatment options. In this study, we selected TLR agonists imiquimod (IMQ), gardiquimod (GARD), GS-9620 and DSR 6434, and a small molecule checkpoint inhibitor, BMS-202, for characterization of drug loading and release from radiopaque embolic beads (DC Bead LUMI) for potential use in image-guided transarterial embolization (TACE) of HCC. The maximum drug loading capacity and amount of drug released over time were determined by high performance liquid chromatography and compared with the commonly used anthracycline, doxorubicin hydrochloride (Dox). Maximum drug loading was 204.54 ± 3.87, 65.28 ± 3.09, 65.95 ± 6.96, 65.97 ± 1.54, and 148.05 ± 2.24 mg of drug per milliliter of DC Bead LUMI for Dox, GARD, DSR 6434, IMQ, and BMS-202, respectively. Fast loading and subsequent rapid release in saline were observed for IMQ, GARD, and DSR 6434. These drugs could also be partially removed from the beads by repeated washing with de-ionized water suggesting weak interaction with the beads. Aggregation of IMQ was observed in water and saline. GS-9620 partially decomposed in the solubilizing solution, so loading and release were not characterized. Compared to TLR agonists, slower loading and release were observed for Dox and BMS-202. Potential factors influencing drug loading into and release from DC Bead LUMI including steric hinderance, hydrophobicity, drug pKa, and the electrostatic nature of the beads are discussed. The maximum loading capacity of BMS-202 and Dox in DC Bead LUMI exceeded the maximum theoretical loading capacity of the beads expected from ionic interaction alone suggesting additional drug-bead or drug-drug interactions may play a role. Slightly more release was observed for BMS-202 at early time points followed by a slower release compared to Dox. Further study of these drug-bead combinations is warranted in search of new tools for locoregional delivery of immune-modulating agents for treatment of HCC via drug-eluting bead chemoembolization.
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Affiliation(s)
- Ayele H. Negussie
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Andrew S. Mikhail
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Joshua W. Owen
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Natalie Hong
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Camella J. Carlson
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Yiqing Tang
- grid.431821.dBiocompatibles UK Ltd (a BTG International Group Company), Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL Surrey UK
| | - Kendal Paige Carrow
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Michal Mauda-Havakuk
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Andrew L. Lewis
- grid.431821.dBiocompatibles UK Ltd (a BTG International Group Company), Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL Surrey UK
| | - John W. Karanian
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - William F. Pritchard
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA
| | - Bradford J. Wood
- grid.94365.3d0000 0001 2297 5165Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center, National Institutes of Health, Bethesda, MD USA ,grid.48336.3a0000 0004 1936 8075National Cancer Institute, National Institutes of Health, Bethesda, MD USA
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19
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Krieter M, Schultz E. [Current Management of Basal Cell Carcinoma]. Laryngorhinootologie 2022; 101:969-978. [PMID: 36513089 DOI: 10.1055/a-1861-7077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM OF STUDY We present the current standard in diagnosis and treatment of basal cell carcinoma. Useful procedures for clinical management should be derived from this. METHODS A systematic literature search was carried out in the PubMed online database. The collected information was analyzed and evaluated. An overall concept was created from the gained knowledge. RESULTS Basal cell carcinoma is the most common tumor in humans and its incidence is expected to increase in the future. When managing the disease, a one-dimensional orientation towards the clinical or histological subtype is not sufficient because of the heterogeneity of the tumor. The primary implementation of risk stratification, which is decisive for the further diagnostic and therapeutic steps, is becoming increasingly important. The gold standard in treatment continues to be the surgical procedure, which should be carried out using micrographically controlled surgery if possible. In addition, there are other therapeutic methods such as radiotherapy or a number of topical therapy options (photodynamic therapy, cryotherapy, application of 5-fluorouracil or imiquimod), which can be used in certain cases. Hedgehog inhibitors are also effective drugs for advanced or metastatic basal cell carcinoma. Practitioners have gained several years of experience with regard to effectiveness and handling of adverse events. With the PD-1 inhibitor cemiplimab, another therapeutic option for inoperable or metastatic tumors has been available since June 2021. CONCLUSION Basal cell carcinoma will continue to gain in relevance in daily dermatological practice in the coming years. A structured approach to the assessment of the existing risk category of the tumor and the subsequent determination of the optimal therapy regimen are of central importance. Advanced or metastatic tumors no longer represent a hopeless situation for the patient. With long-termhedgehog therapy, an adapted dosage scheme can avoid discontinuation of therapy due to side effects. The therapeutic potential of the PD-1 inhibitor cemiplimab can also be used with the side effect profile known from other types of skin cancer.
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Affiliation(s)
- Manuel Krieter
- Universitätsklinik für Dermatologie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - Erwin Schultz
- Universitätsklinik für Dermatologie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
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20
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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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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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22
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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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Scurtu LG, Petrica M, Grigore M, Avram A, Popescu I, Simionescu O. A Conservative Combined Laser Cryoimmunotherapy Treatment vs. Surgical Excision for Basal Cell Carcinoma. J Clin Med 2022; 11:jcm11123439. [PMID: 35743507 PMCID: PMC9224731 DOI: 10.3390/jcm11123439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023] Open
Abstract
Surgical excision is the standard treatment for basal cell carcinoma (BCC), but it can be challenging in elderly patients and patients with comorbidities. The non-surgical guidelines procedures are usually regarded as monotherapy options. This quasi-experimental, non-randomized, comparative effectiveness study aims to evaluate the efficacy of a combined, conservative, non-surgical BCC treatment, and compare it to standard surgical excision. Patients with primary, non-ulcerated, histopathologically confirmed BCCs were divided into a conservative treatment (129 patients) and a standard surgery subgroup (50 patients). The conservative treatment consisted of ablative CO2 laser, cryosurgery, topical occlusive 5-fluorouracil, and imiquimod. The follow-up examinations were performed 3 months after remission, then every 3 to 6 months, and were extended with telephone follow-ups. Cosmetic-self assessment was recorded during a telephone follow-up. Subjects from the conservative subgroup presented a clearance rate of 99.11%, and a recurrence rate of 0.98%. No recurrences were recorded in the surgical group, nor during the telephone follow-up. There were no differences regarding adverse events (p > 0.05). A superior self-assessment cosmetic outcome was obtained using the conservative method (p < 0.001). This conservative treatment is suitable for elders and patients with comorbidities, is not inferior to surgery in terms of clearance, relapses, or local adverse events, and displays superior cosmetic outcomes.
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Affiliation(s)
- Lucian G. Scurtu
- Department of Dermatology I, Colentina Hospital, “Carol Davila” University of Medicine and Pharmacy, 19-21 Stefan Cel Mare Road, 020125 Bucharest, Romania; (L.G.S.); (M.G.); (A.A.)
| | - Marian Petrica
- Faculty of Mathematics and Computer Science, University of Bucharest, 010014 Bucharest, Romania; (M.P.); (I.P.)
- Institute of Mathematical Statistics and Applied Mathematics of the Romanian Academy, 050711 Bucharest, Romania
| | - Mariana Grigore
- Department of Dermatology I, Colentina Hospital, “Carol Davila” University of Medicine and Pharmacy, 19-21 Stefan Cel Mare Road, 020125 Bucharest, Romania; (L.G.S.); (M.G.); (A.A.)
| | - Alina Avram
- Department of Dermatology I, Colentina Hospital, “Carol Davila” University of Medicine and Pharmacy, 19-21 Stefan Cel Mare Road, 020125 Bucharest, Romania; (L.G.S.); (M.G.); (A.A.)
| | - Ionel Popescu
- Faculty of Mathematics and Computer Science, University of Bucharest, 010014 Bucharest, Romania; (M.P.); (I.P.)
- Institute of Mathematics of the Romanian Academy, 010702 Bucharest, Romania
| | - Olga Simionescu
- Department of Dermatology I, Colentina Hospital, “Carol Davila” University of Medicine and Pharmacy, 19-21 Stefan Cel Mare Road, 020125 Bucharest, Romania; (L.G.S.); (M.G.); (A.A.)
- Correspondence: ; Tel.: +40-74-241-8662
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Turner LD, Zarkovic A, Lee Siew Hua J, Chan W, Ogra S, Brettell D, Ohana O, Gounder P, Hayes M, Madge S. Does the histopathological subtype of primary basal cell carcinoma predict the subtype of secondary tumours? What role do genetic mutations play? SKIN HEALTH AND DISEASE 2022; 3:e123. [PMID: 37013122 PMCID: PMC10066757 DOI: 10.1002/ski2.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/11/2022]
Abstract
Background Basal cell carcinoma (BCC) is one of the most common malignancies in the world. The frequency of histopathological subtypes and the distribution on the body of BCC has been well documented. Less has been written on the nature of secondary tumours. The genetics of BCC is starting to be understood, particularly with the advent of newer medical treatments (hedgehog inhibitors). Objectives To determine if primary basal cell carcinoma histopathological subtype predicts secondary tumour subtype, as well as their anatomical distribution. Methods A retrospective case series of patients over the age of 18 was performed from 2009 to 2014, with at least two separate diagnoses of BCC. Results In 394 identified patients, a total of 1355 BCCs arose in the cohort over the 6-year study period. The number of secondary BCCs per patient ranged from 2 to 19 tumours. Nodular BCC was the most likely to reoccur in secondary tumours (53.3%), followed by mixed subtypes (45.7%). Conclusions Within our study, we did find a predisposition for secondary BCCs to be of the same histopathological subtype as the primary, particularly with respect to nodular and mixed tumours. Furthermore, we found that secondary tumours were also more likely to occur on the same anatomical site as the primary tumour. We are only just beginning to under the genetic mutations involved in subtype formation.
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Affiliation(s)
- Liam D. Turner
- Department of Ophthalmology Hereford County Hospital Hereford UK
| | - Andrea Zarkovic
- Department of Ophthalmology Hereford County Hospital Hereford UK
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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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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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Condorelli AG, Motolese A, Borgia F, Bartolomeo LD, Bianchi L, Rossi PG, Ottone M, Guarneri F, Motolese A. Photodynamic therapy for superficial basal cell carcinomas: clinical features of partial responses and recurrences. Photodiagnosis Photodyn Ther 2022; 37:102727. [PMID: 35041983 DOI: 10.1016/j.pdpdt.2022.102727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is one of the most common skin cancers. Photodynamic therapy (PDT) is one of the first line therapy for superficial BCCs, providing good response and low side effects. The aim of current study is to evaluate the clinicopathological features associated with partial responses or recurrences of BCCs treated with one cycle-PDT (two sessions, one week apart). METHODS Superficial BCCs treated with PDT between 2016 and 2019 were analyzed. At the 6-month follow-up visit, BCCs were subdivided in "high clearance" or "partial response", based on clinical and/or dermoscopic examination. "High clearance" lesions underwent 24-month follow-up visit and were assigned to "sustained clearance" or "recurrence" groups. Information about age, sex, site, size of lesions, skin biopsy and multiple lesions were collected and the association with the outcomes were estimated with multivariable logistic models. RESULTS 234 superficial BCCs from 216 patients were analyzed. At the 6-month follow-up visit, 171 out of 234 BCCs (73%) presented a "high clearance", while 63 lesions (27%) showed a "partial response". 28 out of 171 high clearance BCCs (16%) presented a recurrence within 24 months. When "partial response" is compared with the "high clearance" or "sustained clearance" group, a significant difference in mean superficial size of lesions is detected, with higher values in "partial response". Head and neck BCCs have a double risk of recurrence within 24 months. CONCLUSIONS PDT is a good therapeutic option for superficial BCCs, even though BCCs of head and neck have a higher risk of recurrences and larger BCCs could need a supplementary treatment.
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Key Words
- BCC, basal cell carcinoma
- CI: confidence intervals
- IQR, interquartile range
- OR, odds ratio
- SD, standard deviation
- Superficial basal cell carcinomas, photodynamic therapy, non-ablative treatments, partial responses, recurrences, Abbreviations: PDT, photodynamic therapy
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Affiliation(s)
| | - Alfonso Motolese
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Borgia
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Di Bartolomeo
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lodovico Bianchi
- Department of Dermatology, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi di Varese, Varese, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Marta Ottone
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alberico Motolese
- S.C. Dermatologia, Azienda USL di Reggio Emilia - IRCCS, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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Kubanov AA, Saytburkhanov RR, Plakhova XI, Kondrakhina IN. Non-surgical treatments for basal cell skin cancer. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Basal cell carcinoma is the most common nonmelanoma skin cancer. It originates from undifferentiated cells in the basal cell layer of the epidermis or from the outer root sheath of the hair follicle. The most important factor in development of basalioma is ultraviolet radiation. Surgery is considered the gold standard of treatment for basal cell cancer. However, nonsurgical options are available for individuals who are unsuitable for surgery. The purpose of this review is to summarize the efficacy and indications of alternative, nonsurgical treatments that can be used in the management of basal cell cancer
Effective nonsurgical treatments include destructive methods (eg, curettage and electrodessication, cryosurgery, laser), photodynamic therapy, topical medications, hedgehog pathway inhibitors. Nonsurgical therapeutic alternatives are safe and effective for the treatment of BCC. Factors such as tumor location, size, and histopathological subtype should be taken into consideration when selecting optimal treatment, cosmetic results and patient preference should be considered too.
To search for the necessary literature, the PubMed, MedLine, Web of Science and RSCI databases were used.
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Krieter M, Schultz E. Aktuelles Management des Basalzellkarzinoms. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1487-3853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Ziel der Studie Der aktuelle Standard von Diagnostik und Therapie des Basalzellkarzinoms soll dargestellt werden. Hieraus sollen sinnvolle Vorgehensweisen für das klinische Management abgeleitet werden.
Methodik Es erfolgte eine systematische Literaturrecherche in der Online-Datenbank PubMed. Die gesammelten Informationen wurden analysiert und bewertet. Aus den gewonnenen Erkenntnissen wurde ein Gesamtkonzept erstellt.
Ergebnisse Das Basalzellkarzinom ist der häufigste Tumor des Menschen und die Inzidenz wird voraussichtlich künftig weiter zunehmen. Beim Management der Erkrankung wird eine eindimensionale Orientierung am klinischen bzw. histologischen Basalzellkarzinom-Subtyp der Heterogenität des Tumors nicht gerecht. Zunehmende Bedeutung gewinnt die primäre Durchführung einer Risikostratifizierung, die für die weiteren diagnostischen und therapeutischen Schritte maßgeblich ist. Goldstandard in der Behandlung bleibt weiterhin das operative Vorgehen, welches möglichst mittels mikrografisch kontrollierter Chirurgie erfolgen sollte. Daneben existieren weitere Therapieverfahren wie die Radiotherapie oder eine Reihe an topischen Therapieoptionen (photodynamische Therapie, Kryotherapie oder Applikation von 5-Fluoruracil bzw. Imiquimod), die in bestimmten Fällen zur Anwendung kommen können. Auch für fortgeschrittene oder metastasierte Basalzellkarzinome stehen mit den Hedgehog-Inhibitoren wirksame Medikamente zur Verfügung, für die inzwischen eine mehrjährige Anwendungserfahrung hinsichtlich Wirksamkeit und Umgang mit unerwünschten Ereignissen vorliegt. Mit den PD-1-Inhibitoren steht eine weitere systemische Therapieoption in Aussicht, deren Nutzen aktuell noch in klinischen Studien überprüft wird.
Schlussfolgerung Das Basalzellkarzinom wird in den kommenden Jahren weiter an Relevanz in der täglichen dermatologischen Praxis gewinnen. Eine strukturierte Herangehensweise zur Einschätzung der vorliegenden Risikokategorie des Tumors und die anschließende Festlegung des optimalen Therapieregimes sind von zentraler Bedeutung. Fortgeschrittene oder metastasierte Tumoren stellen keine aussichtslose Situation für den Patienten mehr dar. Durch adaptierte Dosierschemata kann ein nebenwirkungsbedingter Therapieabbruch unter langfristiger Hedgehog-Therapie vermieden werden. Das therapeutische Potenzial von PD-1-Inhibitoren könnte bald auch beim Basalzellkarzinom genutzt werden.
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Affiliation(s)
- Manuel Krieter
- Universitätsklinik für Dermatologie, Paracelsus Medizinische Privatuniversität Nürnberg, Deutschland
| | - Erwin Schultz
- Universitätsklinik für Dermatologie, Paracelsus Medizinische Privatuniversität Nürnberg, Deutschland
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Fredman G, Wenande E, Hendel K, Togsverd-Bo K, Haedersdal M. Efficacy and safety of laser-assisted combination chemotherapy: A follow-up study of treatment with 5-fluorouracil and cisplatin for basal cell carcinoma. Lasers Surg Med 2021; 54:113-120. [PMID: 34865224 DOI: 10.1002/lsm.23497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES There is a growing need for effective topical treatments for basal cell carcinoma (BCC). By altering the skin barrier, ablative fractional lasers (AFLs) enhance cutaneous uptake of the synergistic chemotherapeutic agents, cisplatin, and 5-fluorouracil (5-FU). In our recently reported clinical trial, AFL-assisted delivery of cisplatin and 5-FU showed favorable short-term clearance rates of 95% with good cosmetic results at 3 months. This follow-up study assessed sustained tumor clearance, safety, and cosmesis in the same patient cohort, observed 6- and 12-months posttreatment. MATERIALS AND METHODS This follow-up study assessed AFL-assisted cisplatin and 5-FU in low-risk BCC. Among the 18/19 patients who achieved clinical tumor clearance in our 3-months primary trial, all were included for a 6-months follow-up. At 12 months, 17/19 were included due to one 6-month residual. During follow-up visits, treated areas were evaluated for signs of recurrent tumour by clinical inspection and optical coherence tomography (OCT). Residual tumors were confirmed histologically. Cosmetic outcome was evaluated at both follow-up visits by patients and physicians. RESULTS Overall, complete tumor clearance was 89% (17/19) and 79% (15/19) at 6 and 12 months, respectively. Clearance rate for superficial BCCs (sBCCs) 1 year after treatment was 100% (6/6) and lower for nodular BCC (nBCC) at 69% (9/13). Among recurrent tumors, 67% (2/3) had received only a single treatment and all were of the nodular subtype, situated in the head and neck area. All histologically confirmed BCC recurrences were identified by OCT. Cosmetic outcomes were similarly rated "good" or "excellent" by patients and evaluators (p = 0.289 and p = 0.250). Treatment-related local skin reactions were mild and tolerable, consisting of persisting erythema in two patients at the end of the study. Dyspigmentation was commonly observed at both follow-up visits, while the appearance of scarring resolved in the majority of patients between 6 months (56%; 10/18) and 12 months (76%; 13/17). CONCLUSION AFL-assisted cisplatin + 5-FU in double sessions represents an acceptable and safe treatment strategy for low-risk sBCC, while clearance rates following single treatment or for nBCC seem inferior. This intensified topical strategy may be best suited to cases of multiple lesions or in instances where surgical excision or extended courses of at-home therapy is challenging.
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Affiliation(s)
- Gabriella Fredman
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Hendel
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Togsverd-Bo
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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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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Sobhani N, Samadani AA. Implications of photodynamic cancer therapy: an overview of PDT mechanisms basically and practically. J Egypt Natl Canc Inst 2021; 33:34. [PMID: 34778919 DOI: 10.1186/s43046-021-00093-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Tumor eradication is one of the most important challengeable categories in oncological studies. In this account, besides the molecular genetics methods including cell therapy, gene therapy, immunotherapy, and general cancer therapy procedures like surgery, radiotherapy, and chemotherapy, photodynamic adjuvant therapy is of great importance. Photodynamic therapy (PDT) as a relatively noninvasive therapeutic method utilizes the irradiation of an appropriate wavelength which is absorbed by a photosensitizing agent in the presence of oxygen. In this procedure, a series of events lead to the direct death of malignant cells such as damage to the microvasculature and also the induction of a local inflammatory function. PDT has participated with other treatment modalities especially in the early stage of malignant tumors and has resulted in decreasing morbidity besides improving survival rate and quality of life. High spatial resolution of PDT has attracted considerable attention in the field of image-guided photodynamic therapy combined with chemotherapy of multidrug resistance cancers. Although PDT outcomes vary across the different tumor types, minimal natural tissue toxicity, minor systemic effects, significant reduction in long-term disease, lack of innate or acquired resistance mechanisms, and excellent cosmetic effects, as well as limb function, make it a valuable treatment option for combination therapies. SHORT CONCLUSION In this review article, we tried to discuss the potential of PDT in the treatment of some dermatologic and solid tumors, particularly all its important mechanisms.
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Affiliation(s)
- Nafiseh Sobhani
- Department of Basic Medical Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ali Akbar Samadani
- Healthy Ageing Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran. .,Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.
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Hellen R, Dhonncha EN, Havelin A, Kavanagh A, Moriarty B, Collins P. An open-label prospective study to assess short incubation time white LED light photodynamic therapy in the treatment of superficial basal cell carcinoma. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 38:322-327. [PMID: 34731500 DOI: 10.1111/phpp.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
Artificial white LED light photodynamic therapy (awl-PDT) is an effective, pain-free treatment for actinic keratosis. The efficacy of awl-PDT in the treatment of superficial basal cell carcinoma (sBCC) has not been assessed. Patients with histologically confirmed sBCC underwent two treatments of awl-PDT 1 week apart. Lesions were incubated with methyl 5-aminolaevulinic acid for 30 min and then illuminated using the Maquet Power LED 500 theatre light (405-800nm, 140 000 lux) to deliver an equivalent red light dose of 75 J/cm2 at a rate of 55 mW/cm2 . Pain was measured using a visual analogue scale during treatment. Clinical response was assessed at day 28. Follow-up continued 3 months for 1 year. Cosmetic outcome was assessed at 3 months and 1 year. Twenty-eight patients with 36 lesions and a mean age of 63.64 (SD 2.62) were recruited. The median lesion size was 15 mm (IQR 8.75). The response rate at day 28 was 100%. Recurrence rates were 3/36 (8.3%) at 3 months, 6/36 (16.7%) at 6 months, 10/36 (27.8%) at 9 months and 11/36 (30.6%) at 1 year. Median pain scores were 0/100 (IQR 0) and 0/100 (IQR 5) during treatments one and two, respectively. Cosmetic outcome was excellent or good in the majority of cases. Although initially effective for sBCC at 28 days, 30.6% of lesions recurred 1 year after awl-PDT. Pain scores were negligible, and the cosmetic outcome was favourable. Further head-to-head studies with optimised protocols are required to determine if awl-PDT has a role in the treatment of sBCC.
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Affiliation(s)
- Rebecca Hellen
- Department of Dermatology, The Charles Centre, St. Vincent's University Hospital, Dublin, Ireland
| | - Eilis Nic Dhonncha
- Department of Dermatology, The Charles Centre, St. Vincent's University Hospital, Dublin, Ireland
| | - Alison Havelin
- Department of Dermatology, The Charles Centre, St. Vincent's University Hospital, Dublin, Ireland
| | - Ann Kavanagh
- Department of Dermatology, The Charles Centre, St. Vincent's University Hospital, Dublin, Ireland
| | - Blaithin Moriarty
- Department of Dermatology, The Charles Centre, St. Vincent's University Hospital, Dublin, Ireland
| | - Paul Collins
- Department of Dermatology, The Charles Centre, St. Vincent's University Hospital, Dublin, Ireland
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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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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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36
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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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In vitro study on immune response modifiers as novel medical treatment options for cholesteatoma. Int J Pediatr Otorhinolaryngol 2021; 145:110743. [PMID: 33933986 DOI: 10.1016/j.ijporl.2021.110743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/24/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate cytokine profile of cholesteatoma and to collect information about important intercellular signaling pathways by establishing two different cell culture models, to block important intercellular signaling pathways in cholesteatoma by applying immune system modifier drugs to develop alternative medical therapy options for cholesteatoma. METHODS To observe the pathogenesis of cholesteatoma and to apply the immunomodulatory drugs, cholesteatoma tissue culture models were constituted with HEKa cells and cholesteatoma keratinocytes, which were obtained from 3 patients who underwent operations for cholesteatoma. Medicines including 5-fluorourasil, imiquimod, cyclosporine, and tacrolimus were applied on both cholesteatoma keratinocytes and HEKa cells. After 48 h of incubation, IL-1, IL-6, IL-8, IL-10, TNF-α, and Ki67 levels were measured to determine cell viability rates. RESULTS In the cholesteatoma control group, IL-6 and TNF-α levels were found higher than in the HEKa control group. All repurposed drugs in the study demonstrated anti-inflammatory, anti-proliferative, and cytotoxic effects on cholesteatoma. Imiquimod and tacrolimus in particular are potential treatment prospects for cholesteatoma due to their strong anti-inflammatory and cytotoxic effects. CONCLUSION Medical therapy options for cholesteatoma are still missing and surgery is not the ultimate solution. We have focused on intercellular inflammatory processes, which play significant roles in the pathogenesis of cholesteatoma in our paper. Inflammation and proliferation of cholesteatoma decreased after all repurposed drug applications in our study. Anti-inflammatory and anti-proliferative effects of tacrolimus and imiquimod was more significant than other drugs in the study. For this reason, tacrolimus and imiquimod should be examined in depth with in vivo studies in terms of efficacy and safety for medical treatment of cholesteatoma.
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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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40
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An injectable hydrogel co-loading with cyanobacteria and upconversion nanoparticles for enhanced photodynamic tumor therapy. Colloids Surf B Biointerfaces 2021; 201:111640. [DOI: 10.1016/j.colsurfb.2021.111640] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/27/2020] [Accepted: 02/15/2021] [Indexed: 01/10/2023]
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41
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Pathogenesis of Keratinocyte Carcinomas and the Therapeutic Potential of Medicinal Plants and Phytochemicals. Molecules 2021; 26:molecules26071979. [PMID: 33915735 PMCID: PMC8037492 DOI: 10.3390/molecules26071979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 12/24/2022] Open
Abstract
Keratinocyte carcinoma (KC) is a form of skin cancer that develops in keratinocytes, which are the predominant cells present in the epidermis layer of the skin. Keratinocyte carcinoma comprises two sub-types, namely basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). This review provides a holistic literature assessment of the origin, diagnosis methods, contributing factors, and current topical treatments of KC. Additionally, it explores the increase in KC cases that occurred globally over the past ten years. One of the principal concepts highlighted in this article is the adverse effects linked to conventional treatment methods of KC and how novel treatment strategies that combine phytochemistry and transdermal drug delivery systems offer an alternative approach for treatment. However, more in vitro and in vivo studies are required to fully assess the efficacy, mechanism of action, and safety profile of these phytochemical based transdermal chemotherapeutics.
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42
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Ewert de Oliveira B, Junqueira Amorim OH, Lima LL, Rezende RA, Mestnik NC, Bagatin E, Leonardi GR. 5-Fluorouracil, innovative drug delivery systems to enhance bioavailability for topical use. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2020.102155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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43
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Abstract
Introduction: Basal cell carcinoma (BCC) is the most frequent skin malignancy, with incidence increasing worldwide. Most BCC can be cured with local treatments (surgery or topical therapies), but advanced or recurrent forms require specific therapies. Significant developments targeting the sonic hedgehog signalization pathway have been made in the past years, paving the way for new therapies.Areas covered: This review details emerging drugs for BCC treatment, focusing on topical, intra-tumoral, and systemic therapies, such as new targeted therapies and immune checkpoint inhibitors. A literature search was conducted to identify ongoing studies using PudMed database and clinicaltrials.gov website.Expert opinion: Although surgery is and will probably remain the gold-standard therapy for BCC, treatment of recurrent, advanced, and metastatic tumors is evolving. Emergence of tumors resistant to targeted therapies lead the way to new approaches. Topical and intra-tumoral treatments represent alternatives to surgical morbidity, and many studies are ongoing. The first results of immune checkpoint inhibitors are encouraging in advanced and metastatic forms of the disease. New targeted therapies are needed to overcome or prevent the resistance to standard hedgehog pathway inhibitors.
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Affiliation(s)
- Florian Herms
- Department of Dermatology, Université De Paris, Hôpital Saint-Louis, Paris, France
| | - Nicole Basset-Seguin
- Department of Dermatology, Université De Paris, Hôpital Saint-Louis, Paris, France
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Strickler AG, Shah P, Bajaj S, Mizuguchi R, Nijhawan RI, Odueyungbo M, Rossi A, Ratner D. Preventing complications in dermatologic surgery: Presurgical concerns. J Am Acad Dermatol 2021; 84:883-892. [PMID: 33497750 DOI: 10.1016/j.jaad.2020.10.099] [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: 06/23/2019] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 01/19/2023]
Abstract
Cutaneous surgery has become critical to comprehensive dermatologic care, and dermatologists must therefore be equipped to manage the risks associated with surgical procedures. Complications may occur at any point along the continuum of care, and therefore assessing, managing, and preventing risk from beginning to end becomes essential. This review focuses on preventing surgical complications pre- and postoperatively as well as during the surgical procedure.
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Affiliation(s)
- Allen G Strickler
- Department of Dermatology, Geisinger Medical Center of Geisinger Commonwealth School of Medicine, Danville, Pennsylvania; Department of Laboratory Medicine, Geisinger Medical Center of Geisinger Commonwealth School of Medicine, Danville, Pennsylvania.
| | - Payal Shah
- School of Medicine, New York University Langone Health, New York, New York
| | - Shirin Bajaj
- Department of Dermatology, New York University Langone Health, New York, New York
| | - Richard Mizuguchi
- Department of Dermatology, Mount Sinai Medical School, New York, New York
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Anthony Rossi
- Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Désirée Ratner
- Department of Dermatology, New York University Langone Health, New York, New York
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45
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Sequential Treatment of Superficial Basal Cell Carcinomas With Topical Methyl Aminolevulinate Photodynamic Therapy and Imiquimod 5% Cream: A Retrospective Study of Clinical and Cosmetic Outcomes. Dermatol Surg 2021; 46:1272-1278. [PMID: 32011386 DOI: 10.1097/dss.0000000000002306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) and imiquimod 5% (IMQ) cream are established treatments for superficial basal cell carcinoma (sBCC). Both have high initial response rates and recurrence rates of up to 37%. Recent studies demonstrate that PDT and imiquimod may act on sBCCs via synergistic immunomodulatory pathways. OBJECTIVE To describe the sequential use of MAL-PDT and imiquimod 5% cream in the treatment of sBCCs and report treatment tolerability, cosmetic outcomes, and efficacy. MATERIALS AND METHODS This is a retrospective case series of patients presenting over a 2-year period with primary sBCC who underwent 2 cycles of topical MAL-PDT, followed by 6 weeks of imiquimod 5% cream. Outcome measures were resolution of the index lesion at 3 months, side effects, cosmetic outcome, and long-term recurrence (LTR). RESULTS A total of 17 consecutive patients (n = 17) with a combined 21 sBCCs (n = 21) were included. The median length of follow-up was 72 months (range 24-95 months). Long-term recurrence occurred in 2/21 lesions (10%). CONCLUSION Sequential use of PDT and imiquimod was well tolerated with good cosmetic outcomes. The 10% LTR rate is at the lower end of the range reported for single modality treatment; however, larger samples are required to evaluate efficacy differences.
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46
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Yan Y, Zeng S, Gong Z, Xu Z. Clinical implication of cellular vaccine in glioma: current advances and future prospects. J Exp Clin Cancer Res 2020; 39:257. [PMID: 33228738 PMCID: PMC7685666 DOI: 10.1186/s13046-020-01778-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023] Open
Abstract
Gliomas, especially glioblastomas, represent one of the most aggressive and difficult-to-treat human brain tumors. In the last few decades, clinical immunotherapy has been developed and has provided exceptional achievements in checkpoint inhibitors and vaccines for cancer treatment. Immunization with cellular vaccines has the advantage of containing specific antigens and acceptable safety to potentially improve cancer therapy. Based on T cells, dendritic cells (DC), tumor cells and natural killer cells, the safety and feasibility of cellular vaccines have been validated in clinical trials for glioma treatment. For TAA engineered T cells, therapy mainly uses chimeric antigen receptors (IL13Rα2, EGFRvIII and HER2) and DNA methylation-induced technology (CT antigen) to activate the immune response. Autologous dendritic cells/tumor antigen vaccine (ADCTA) pulsed with tumor lysate and peptides elicit antigen-specific and cytotoxic T cell responses in patients with malignant gliomas, while its pro-survival effect is biased. Vaccinations using autologous tumor cells modified with TAAs or fusion with fibroblast cells are characterized by both effective humoral and cell-mediated immunity. Even though few therapeutic effects have been observed, most of this therapy showed safety and feasibility, asking for larger cohort studies and better guidelines to optimize cellular vaccine efficiency in anti-glioma therapy.
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Affiliation(s)
- Yuanliang Yan
- Department of Pharmacy, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Shuangshuang Zeng
- Department of Pharmacy, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Zhijie Xu
- Department of Pathology, Xiangya Hospital, Central South University, 87 Xiangya Road, Hunan, 410008, Changsha, China.
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47
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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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48
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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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Altun E, Schwartzman G, Cartron AM, Khachemoune A. Beyond Mohs surgery and excisions: A focused review of treatment options for subtypes of basal cell carcinoma. Dermatol Ther 2020; 34:e14476. [PMID: 33125804 DOI: 10.1111/dth.14476] [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: 09/15/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. It originates from undifferentiated cells in the basal cell layer of the epidermis or from the outer root sheath of the hair follicle. The most important factor in development of BCC is ultraviolet radiation. Surgery is considered the gold standard of treatment for BCC. However, nonsurgical options are available for individuals who are unsuitable for surgery. The purpose of this review is to summarize the efficacy and indications of alternative, nonsurgical treatments that can be used in the management of BCC. An extensive literature review was performed for the nonsurgical options for the treatment of BCC. Resources searched included PubMed and Google Scholars, limited to the years 1995 to 2020. Key words searched included BCC, destructive methods, photodynamic therapy (PDT), radiotherapy, topical medication, laser, hedgehog pathway inhibitors (HPIs). The most relevant results such as systematic reviews, randomized controlled trials, or comparative studies were selected to provide a summary for the most common nonsurgical methods used for treating BCC. Effective nonsurgical treatments for BCC include destructive methods (eg, curettage alone, cryosurgery, or electrodessication), PDT, topical medications, radiotherapy, laser, and HPIs. Nonsurgical therapeutic alternatives are safe and effective for the treatment of BCC. Factors such as tumor location, size, and histopathological subtype should be taken into consideration when selecting optimal treatment. In addition to clinical factors, cosmetic results and patient preference should be considered.
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Affiliation(s)
- Ece Altun
- Department of Dermatology, Medipol Mega University Hospital, İstanbul, Turkey
| | - Gabrielle Schwartzman
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | | | - Amor Khachemoune
- Department of Dermatology, State University of New York Downstate, Brooklyn, New York, USA.,Department of Dermatology, Veterans Health Administration, Brooklyn, New York, USA
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50
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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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