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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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Fernández-Galván A, Rodríguez-Jiménez P, González-Sixto B, Abalde-Pintos MT, Butrón-Bris B. Topical and Intralesional Immunotherapy for the Management of Basal Cell Carcinoma. Cancers (Basel) 2024; 16:2135. [PMID: 38893254 PMCID: PMC11172323 DOI: 10.3390/cancers16112135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Basal Cell Carcinoma (BCC) is the most common type of cancer among the white population. Individuals with fair skin have an average lifetime risk of around 30% for developing BCC, and there is a noticeable upward trend in its incidence rate. The principal treatment objectives for BCC involve achieving the total excision of the tumor while maximizing the preservation of function and cosmesis. Surgery is considered the treatment of choice for BCC for two main reasons: it allows for the highest cure rates and facilitates histological control of resection margins. However, in the subgroup of patients with low-risk recurrence or medical contraindications for surgery, new non-surgical treatment alternatives can provide an excellent oncological and cosmetic outcome. An evident and justified instance of these local therapies occurred during the COVID-19 pandemic, a period when surgical interventions carried out in hospital settings were not a viable option.
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Affiliation(s)
- Aurora Fernández-Galván
- Dermatology Department, Hospital Universitario La Princesa, Diego de León St. 62, 28006 Madrid, Spain; (A.F.-G.); (B.B.-B.)
| | - Pedro Rodríguez-Jiménez
- Dermatology Department, Hospital Universitario La Princesa, Diego de León St. 62, 28006 Madrid, Spain; (A.F.-G.); (B.B.-B.)
- Dermatology Department, Hospital Ruber Internacional, 28034 Madrid, Spain
| | - Beatriz González-Sixto
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain; (B.G.-S.); (M.T.A.-P.)
| | - María Teresa Abalde-Pintos
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain; (B.G.-S.); (M.T.A.-P.)
| | - Beatriz Butrón-Bris
- Dermatology Department, Hospital Universitario La Princesa, Diego de León St. 62, 28006 Madrid, Spain; (A.F.-G.); (B.B.-B.)
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Paul S, Knight A. The Importance of Basal Cell Carcinoma Risk Stratification and Potential Future Pathways. JMIR DERMATOLOGY 2023; 6:e50309. [PMID: 37902813 PMCID: PMC10644189 DOI: 10.2196/50309] [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: 06/26/2023] [Revised: 09/09/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common human cancer. Although there are surgical and topical treatments available, surgery remains the mainstay of treatment, leading to higher costs. What is needed is an accurate risk assessment of BCC so that treatments can be planned in a patient-centered manner. OBJECTIVE In this study, we will review the literature about guidelines for the management of BCC and analyze the potential indicators of high-risk BCC. Using this risk assessment approach, we will propose pathways that will be able to optimize treatments more efficiently. METHODS This paper presents a perspective from a skin cancer expert and clinic involved in the treatment of both simple and complex cases of BCC. It addresses the key challenges associated with accurate risk stratification prior to any treatment or procedure. Different immunohistochemical and angiogenic markers for high-risk BCC were reviewed in this study. RESULTS The expression of interleukin-6, vascular endothelial growth factor, and mast cells within BCC correlates with its aggressiveness. Other immunohistochemical markers, such as Cyclin D1 and Bcl-2, also play a significant role-Cyclin D1 is higher in the aggressive BCC, while Bcl-2 is lower in the aggressive BCC, compared to the nonaggressive variants. CONCLUSIONS Based on our research, we will conclude that using immunohistochemical and angiogenic markers for risk assessment and stratification of BCC can help optimize treatment, ensuring that surgical procedures are used only when necessary.
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Affiliation(s)
- Sharad Paul
- Auckland University of Technology, Auckland, New Zealand
- Skin Surgery Clinic, Auckland, New Zealand
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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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Niculet E, Bobeica C, Onisor C, Gurau G, Nechita A, Radaschin DS, Tutunaru D, Bujoreanu-Bezman L, Tatu AL. Basal Cell Carcinoma Perineural Invasion and Suggestive Signs of Perineural Invasion-Findings and Perspectives. Life (Basel) 2023; 13:1406. [PMID: 37374188 DOI: 10.3390/life13061406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Basal cell carcinoma (BCC) is a malignant tumor with a rising incidence and is the beneficiary of several innovative evaluation techniques. Histopathology remains the gold standard for assessment, having the possibility of addressing multiple high-risk factors such as perineural invasion (PNI). The current study included a number of 244 BCC patients and targeted the identification of positive PNI and its suggestive signs, and whether they correlated or not with other high-risk tumor signs. PNI was found in 20.1% of patients, with 30.7% of patients having perineural chronic inflammation (PCI), which is a suggestive sign of PNI. PNI was also found in larger tumors, with deeper Clark levels, in high-risk BCCs and high-grade tumors. PNI and PCI are both important for pathology reporting, aiding in treatment choice and further patient management, with possibly positive outcomes concerning morbidity and mortality.
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Affiliation(s)
- Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica-CIM-CID), "Dunărea de Jos" University, 800201 Galati, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Cristian Onisor
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Gabriela Gurau
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Aurel Nechita
- Department of Pediatrics, 'Sf. Ioan' Clinical Hospital for Children, 800487 Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Diana Sabina Radaschin
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica-CIM-CID), "Dunărea de Jos" University, 800201 Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
- Dermatology Department, "Sfanta Cuvioasa Parascheva" Hospital of Infectious Diseases, 800179 Galati, Romania
| | - Dana Tutunaru
- Department of Pharmaceutical Sciences, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Laura Bujoreanu-Bezman
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica-CIM-CID), "Dunărea de Jos" University, 800201 Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
- Dermatology Department, "Sfanta Cuvioasa Parascheva" Hospital of Infectious Diseases, 800179 Galati, Romania
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Ligeralde-Bascones KI, Gulmatico-Flores Z, Lim-Bueser HG, Espinoza-Thaebtharm A, Rescober-Valencia MC, Aguila KP, Anupol EBJ, Balete SL, Barcelona MV, Castro VCS, Fineza-Dela Cruz AMB, Lansangan PP, Manrique AMB, Olitoquit KD, Ortiz ACG, Palisoc ED, Santos DGV, See MRV, Sy AJF, Sy GC, Tana MG, Tayag JJS, Teo HMT. Diagnosis and management of basal cell carcinoma: interdisciplinary consensus statements of Jose R. Reyes Memorial Medical Center, a Department of Health Tertiary Hospital in Manila, Philippines. Int J Dermatol 2022; 62:812-821. [PMID: 36562635 DOI: 10.1111/ijd.16555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/19/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common cutaneous malignancy. Multiple risk factors are associated in the development of BCC, with ultraviolet light and genetics playing major roles. AIMS The departments of dermatology, medical oncology, ophthalmology, otorhinolaryngology, head and neck surgery, plastic surgery, and radiation oncology of the Jose R. Reyes Memorial Medical Center, Manila, Philippines, have convened and formulated consensus statements on the diagnosis and management of BCC patients seen in the institution. CONCLUSION The summary of the recommendations is: (1) Surgery is the treatment of choice for BCC. The range of margins (2-4 mm) depends on the type of BCC. (2) Mohs micrographic surgery (MMS) is indicated for high risk BCC. (3) Topical treatment with imiquimod or 5-flourouracil (5-FU) may be used for superficial BCC. (4) Destructive methods (cryotherapy, curettage and electrodessication, photodynamic therapy) may be used for low risk BCC. (5) Medical and/or radiation therapy is advised for cases where surgery is contraindicated or tumor is not amenable to surgery. Metastasis of this malignancy is rare. Follow-up, which may continue up until 2 years, is recommended for high risk BCC.
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Affiliation(s)
| | | | | | | | | | - Konrad P Aguila
- Department of Otorhinolaryngology, Head and Neck Surgery, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Elisa B J Anupol
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Solidad L Balete
- Department of Internal Medicine, Section of Medical Oncology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Marc V Barcelona
- Department of Radiation Oncology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Vhon C S Castro
- Department of Internal Medicine, Section of Medical Oncology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | | | - Patrick P Lansangan
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Aldric M B Manrique
- Department of Radiation Oncology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Katrina D Olitoquit
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Anthony C G Ortiz
- Department of Ophthalmology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Erwin D Palisoc
- Department of Ophthalmology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Danziel G V Santos
- Department of Ophthalmology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Melissa R V See
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Austin J F Sy
- Department of Otorhinolaryngology, Head and Neck Surgery, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Gerald C Sy
- Department of Surgery, Section of Plastic Surgery, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Mobbydick G Tana
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Joseph J S Tayag
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Honeylen M T Teo
- Department of Ophthalmology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
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Zhu T, Zhang W, Jiang P, Zhou S, Wang C, Qiu L, Shi H, Cui P, Wang J. Progress in Intradermal and Transdermal Gene Therapy with Microneedles. Pharm Res 2022; 39:2475-2486. [PMID: 36008737 DOI: 10.1007/s11095-022-03376-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/17/2022] [Indexed: 01/18/2023]
Abstract
Gene therapy is one of the most widely studied treatments and has the potential to treat a variety of intractable diseases. The skin's limited permeability, as the body's initial protective barrier, drastically inhibits the delivery effect of gene medicine. Given the potential adverse effects and physicochemical features of the medications, improving generic drug penetration into the skin barrier and achieving an effective level of target tissues remains a challenge. Microneedles have made tremendous improvements in aided gene transfer and medication delivery as a unique method. Microneedles offer the advantage of being minimally invasive and painless, as well as the ability to distribute gene medicines straight through the stratum corneum. Microneedles have been used to penetrate skin tissue with various nucleic acids and medicines in recent years, allowing for a wide range of applications in the treatment of skin ailments. This review focuses on skin-related disorders and immunity, and it primarily discusses the progress of microneedle transdermal gene therapy in recent years. It also complements the current major vectors and related microneedle gene therapy applications.
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Affiliation(s)
- Ting Zhu
- School of Pharmacy, Changzhou University, Changzhou, 213164, People's Republic of China
| | - Wenya Zhang
- School of Pharmacy, Changzhou University, Changzhou, 213164, People's Republic of China
| | - Pengju Jiang
- School of Pharmacy, Changzhou University, Changzhou, 213164, People's Republic of China
| | - Shuwen Zhou
- School of Pharmacy, Changzhou University, Changzhou, 213164, People's Republic of China
| | - Cheng Wang
- School of Pharmacy, Changzhou University, Changzhou, 213164, People's Republic of China
| | - Lin Qiu
- School of Pharmacy, Changzhou University, Changzhou, 213164, People's Republic of China
| | - Honglei Shi
- Wujin Hospital Affiliated With Jiangsu University, Changzhou, 213017, Jiangsu, People's Republic of China.
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213017, Jiangsu, People's Republic of China.
| | - Pengfei Cui
- School of Pharmacy, Changzhou University, Changzhou, 213164, People's Republic of China.
| | - Jianhao Wang
- School of Pharmacy, Changzhou University, Changzhou, 213164, People's Republic of China.
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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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Mustfa SA, Maurizi E, McGrath J, Chiappini C. Nanomedicine Approaches to Negotiate Local Biobarriers for Topical Drug Delivery. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202000160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Salman Ahmad Mustfa
- Centre for Craniofacial and Regenerative Biology King's College London London SE1 9RT UK
| | - Eleonora Maurizi
- Dipartimento di Medicina e Chirurgia Università di Parma Parma 43121 Italy
| | - John McGrath
- St John's Institute of Dermatology King's College London London SE1 9RT UK
| | - Ciro Chiappini
- Centre for Craniofacial and Regenerative Biology King's College London London SE1 9RT UK
- London Centre for Nanotechnology King's College London London WC2R 2LS UK
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Rouillé T, Aractingi S, Kadlub N, Fraitag S, How-Kit A, Daunay A, Hivelin M, Moguelet P, Picard A, Fontaine RH, Guégan S. Local Inhibition of MEK/Akt Prevents Cellular Growth in Human Congenital Melanocytic Nevi. J Invest Dermatol 2019; 139:2004-2015.e13. [PMID: 31059696 DOI: 10.1016/j.jid.2019.03.1156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 12/15/2022]
Abstract
The management of large congenital melanocytic nevi (lCMN) is based exclusively on iterative surgical procedures in the absence of validated medical therapy. The aim of our study was to develop an intra-lesional medical treatment for lCMN. Seventeen patients harboring NRAS-mutated lCMN were included. Nevocytes obtained from lCMN displayed an overactivation of mitogen-activated protein kinase and phosphoinositide 3-kinase (Akt) pathways. Mitogen-activated protein kinase/extracellular signal-regulated kinase (MEK) and Akt inhibitors reduced the nevosphere diameter in sphere-forming assays, as well as cell viability and proliferation in in vitro assays. Standardized lCMN explants were then cultured ex vivo with the same inhibitors, which induced a decrease in MelanA+ and Sox10+ cells in both epidermis and dermis. Finally, intradermal injections of these inhibitors were administered within standardized lCMN xenografts in Rag2-/- mice. They induced a dramatic decrease in nevocytes in treated xenografts, which persisted 30 days after the end of treatment. Using original nevus explant and xenograft preclinical models, we demonstrated that intradermal MEK/Akt inhibition might serve as neoadjuvant therapy for the treatment of NRAS-mutated congenital melanocytic nevi to avoid iterative surgeries.
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Affiliation(s)
- Thomas Rouillé
- Saint-Antoine Research Center, INSERM UMRS_938, Paris, France; Sorbonne Université, Paris, France
| | - Selim Aractingi
- Saint-Antoine Research Center, INSERM UMRS_938, Paris, France; Université Paris-Descartes, Paris, France; AP-HP, Hôpital Cochin, Department of Dermatology, Paris, France
| | - Natacha Kadlub
- Université Paris-Descartes, Paris, France; AP-HP, Hôpital Necker-Enfants-Malades, Department of Maxillofacial and Plastic Surgery, Paris, France
| | - Sylvie Fraitag
- AP-HP, Hôpital Necker-Enfants-Malades, Department of Pathology, Paris, France
| | - Alexandre How-Kit
- Laboratory for Functional Genomics, Fondation Jean Dausset-CEPH, Paris, France
| | - Antoine Daunay
- Laboratory for Functional Genomics, Fondation Jean Dausset-CEPH, Paris, France
| | - Mikael Hivelin
- Université Paris-Descartes, Paris, France; AP-HP, Hôpital Européen Georges-Pompidou, Department of Plastic Surgery, Paris, France
| | | | - Arnaud Picard
- Université Paris-Descartes, Paris, France; AP-HP, Hôpital Necker-Enfants-Malades, Department of Maxillofacial and Plastic Surgery, Paris, France
| | - Romain H Fontaine
- Saint-Antoine Research Center, INSERM UMRS_938, Paris, France; Sorbonne Université, Paris, France
| | - Sarah Guégan
- Saint-Antoine Research Center, INSERM UMRS_938, Paris, France; Université Paris-Descartes, Paris, France; AP-HP, Hôpital Cochin, Department of Dermatology, Paris, France.
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11
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Abstract
The incidence of basal cell carcinoma (BCC) is increasing as the population is aging and doubles every ten years. Surgery is the first-line treatment of BCC. Dermatological surgery is an oncological skin surgery whose first objective is to obtain a complete resection of the tumor. Its aim is also to reconstruct the defect using the optimal repair technique for the best cosmetic and scarring outcome and without functional impairment. The dermatological approach with the "oncological reading" of cutaneous tumors constitutes the essential preliminary time to the diagnosis of BCC and the identification of its limits. The perfect knowledge of the security margins in accordance with the guidelines allows a complete excision and a reconstruction in one stage under local anesthesia in the majority of cases. The surgical treatment must use 3D histology techniques or micrographic surgery to manage difficult cases of aggressive BCC in high risk zone or recurrence. Management of very aggressive BCC or locally advanced BCC is discussed in a multidisciplinary consultation by assessing the benefit/risk ratio of the surgical treatment and by identifying the appropriate surgeon after documenting the tumor, its operability and patient's adherence to the surgical treatment. © 2018. Published by Elsevier Masson SAS. All rights reserved. Cet article fait partie du numéro supplément Prise en charge des carcinomes basocellulaires difficiles à traiter réalisé avec le soutien institutionnel de Sun Pharma.
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Affiliation(s)
- J-M Amici
- Service de dermatologie, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France.
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