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Chauvel-Picard J, Tognetti L, Cinotti E, Habougit C, Suppa M, Lenoir C, Rubegni P, Del Marmol V, Berot V, Gleizal A, Vercherin P, Dejonckheere G, Raffaelli C, Cardot-Leccia N, Azulay N, Sudaka-Bahadoran A, Perrot JL, Bahadoran P. Role of ultra-high-frequency ultrasound in the diagnosis and management of basal cell carcinoma: pilot study based on 117 cases. Clin Exp Dermatol 2023; 48:468-475. [PMID: 36763772 DOI: 10.1093/ced/llad001] [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: 10/12/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Ultrasound imaging has recently benefited from the introduction of a new 70 MHz transducer able to provide high-resolution images, i.e. ultra-high-frequency ultrasound (UHFUS). AIM To study the morphological features of basal cell carcinomas (BCCs) and measure BCC thickness by means of UHFUS examination. METHODS In this retrospective multicentric study, 171 consecutive patients underwent UHFUS examination between November 2018 and May 2019 for suspected BCC. Diagnosis was confirmed by histopathology. A series of morphological parameters including echogenicity, structure, borders, shape composition (presence of intralesional structures) were investigated along with objective measurements such as thickness (maximum distance between the surface of the epidermis and the deepest part of the tumour) and width. RESULTS In total, 117 BCCs from 93 patients were examined, including superficial (n = 13; 11.1%), nodular (n = 64; 54.7%), infiltrative (n = 18; 15.4%), mixed subtypes (n = 20; 17.1%) and other subtypes (n = 2; 1.7%). The most frequently observed UHFUS parameters included: hypoechoic signal (n = 80; 68.4%, P < 0.001), homogeneous structure (n = 76, 65.0%, P = 0.01), well-defined borders (n = 77, 65.8%, P < 0.001) and elongated shape (n = 71, 60.7%, P < 0.001). An excellent correlation was found between the BCC thickness measured by UHFUS and the value estimated by histology (interclass correlation ≥ 0.80). CONCLUSION UHFUS is a new rapid and easy noninvasive skin imaging technique able to provide data on the dimensions and morphology of BCCs in real time and at the bedside. These characteristics mean UHFUS has a number of possible applications, ranging from presurgical mapping to the detection of disease recurrence and treatment monitoring.
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Affiliation(s)
| | - Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, Siena, Italy
| | - Cyril Habougit
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Mariano Suppa
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Clement Lenoir
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, Siena, Italy
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Berot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | - Paul Vercherin
- Department of Public Health, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Guillame Dejonckheere
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Nicholas Azulay
- Department of Dermatology, Centre Hospitalier Universitaire de Nice, INSERM 1065 C3M Team 1, Université Côte d'Azur, Nice, France
| | | | - Jean L Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Philippe Bahadoran
- Department of Dermatology, Centre Hospitalier Universitaire de Nice, INSERM 1065 C3M Team 1, Université Côte d'Azur, Nice, France
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2
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Gülseren D, Elçin G, Erkin G, Gököz Ö. The correlation between tumor thickness and aggressive histopathological pattern in Basal cell carcinoma. J Cosmet Dermatol 2022; 21:2577-2580. [DOI: 10.1111/jocd.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/23/2021] [Accepted: 09/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Duygu Gülseren
- Department of Dermatology School of Medicine Hacettepe University Ankara Turkey
| | - Gonca Elçin
- Department of Dermatology School of Medicine Hacettepe University Ankara Turkey
| | - Gül Erkin
- Department of Dermatology School of Medicine Hacettepe University Ankara Turkey
| | - Özay Gököz
- Department of Pathology School of Medicine Hacettepe University Ankara Turkey
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3
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Woźniak Z, Trzeciakowski W, Chlebicka I, Ziółkowski P. Photodynamic diagnosis and photodynamic therapy in basal cell carcinoma using a novel laser light source. Photodiagnosis Photodyn Ther 2020; 31:101883. [PMID: 32574799 DOI: 10.1016/j.pdpdt.2020.101883] [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: 04/22/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
The aim of the present study was evaluating the effects and safety of new laser light source in PDD and PDT of basal cell carcinoma, BCC. The patients presented challenging localizations of the tumor or tumor combined with Gorlin syndrome. The PDD and PDT was performed in 50 patients with 54 histologically confirmed BCCs. The photosensitizer precursor, 5-ALA in cream, was used and the tumors were then illuminated, for PDD at 405 nm, and for PDT at 638 nm by means of newly designed laser. The novel feature of the laser was the combination of violet and red light in a single fiber output which enabled us to perform PDD and PDT alternatingly. The patients received one or more PDT sessions and they were observed during the next 36 months. The complete responses (CR, remissions) of the lesions were considered as no visible tumor after that time period. CR were observed in 87 % of the lesions in the entire group of patients. The results of present study show that the new laser allowing for both PDD and PDT was effective in producing satisfactory responses in the treatment of basal cell carcinoma.
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Affiliation(s)
| | - Witold Trzeciakowski
- Institute of High Pressure Physics of the Polish Academy of Sciences, Warsaw, Poland
| | - Iwona Chlebicka
- Department of Dermatology and Venerology, Wroclaw Medical University, Poland
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4
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León D, Buchegger K, Silva R, Riquelme I, Viscarra T, Mora-Lagos B, Zanella L, Schafer F, Kurachi C, Roa JC, Ili C, Brebi P. Epigallocatechin Gallate Enhances MAL-PDT Cytotoxic Effect on PDT-Resistant Skin Cancer Squamous Cells. Int J Mol Sci 2020; 21:ijms21093327. [PMID: 32397263 PMCID: PMC7247423 DOI: 10.3390/ijms21093327] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 02/06/2023] Open
Abstract
Photodynamic therapy (PDT) has been used to treat certain types of non-melanoma skin cancer with promising results. However, some skin lesions have not fully responded to this treatment, suggesting a potential PDT-resistant phenotype. Therefore, novel therapeutic alternatives must be identified that improve PDT in resistant skin cancer. In this study, we analyzed the cell viability, intracellular protoporphyrin IX (PpIX) content and subcellular localization, proliferation profile, cell death, reactive oxygen species (ROS) detection and relative gene expression in PDT-resistant HSC-1 cells. PDT-resistant HSC-1 cells show a low quantity of protoporphyrin IX and low levels of ROS, and thus a low rate of death cell. Furthermore, the resistant phenotype showed a downregulation of HSPB1, SLC15A2, FECH, SOD2 and an upregulation of HMBS and BIRC5 genes. On the other hand, epigallocatechin gallate catechin enhanced the MAL-PDT effect, increasing levels of protoporphyrin IX and ROS, and killing 100% of resistant cells. The resistant MAL-PDT model of skin cancer squamous cells (HSC-1) is a reliable and useful tool to understand PDT cytotoxicity and cellular response. These resistant cells were successfully sensitized with epigallocatechin gallate catechin. The in vitro epigallocatechin gallate catechin effect as an enhancer of MAL-PDT in resistant cells is promising in the treatment of difficult skin cancer lesions.
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Affiliation(s)
- Daniela León
- Laboratory of Integrative Biology, Centro de Excelencia en Medicina Traslacional—Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile; (D.L.); (K.B.); (T.V.); (B.M.-L.); (L.Z.)
| | - Kurt Buchegger
- Laboratory of Integrative Biology, Centro de Excelencia en Medicina Traslacional—Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile; (D.L.); (K.B.); (T.V.); (B.M.-L.); (L.Z.)
- Department of Basic Sciences, School of Medicine, Universidad de La Frontera, Temuco 4811230, Chile
| | - Ramón Silva
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud. Universidad Autónoma de Chile, Temuco 4810101, Chile; (R.S.); (I.R.)
| | - Ismael Riquelme
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud. Universidad Autónoma de Chile, Temuco 4810101, Chile; (R.S.); (I.R.)
| | - Tamara Viscarra
- Laboratory of Integrative Biology, Centro de Excelencia en Medicina Traslacional—Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile; (D.L.); (K.B.); (T.V.); (B.M.-L.); (L.Z.)
| | - Bárbara Mora-Lagos
- Laboratory of Integrative Biology, Centro de Excelencia en Medicina Traslacional—Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile; (D.L.); (K.B.); (T.V.); (B.M.-L.); (L.Z.)
| | - Louise Zanella
- Laboratory of Integrative Biology, Centro de Excelencia en Medicina Traslacional—Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile; (D.L.); (K.B.); (T.V.); (B.M.-L.); (L.Z.)
| | - Fabiola Schafer
- Department of Medical Specialties, School of Medicine, Universidad de La Frontera, Temuco 4811230, Chile;
| | - Cristina Kurachi
- São Carlos Institute of Physics, University of São Paulo (USP), P.O. Box 369, São Carlos 13560-970, São Paulo, Brazil;
| | - Juan Carlos Roa
- Department of Pathology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile;
| | - Carmen Ili
- Laboratory of Integrative Biology, Centro de Excelencia en Medicina Traslacional—Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile; (D.L.); (K.B.); (T.V.); (B.M.-L.); (L.Z.)
- Correspondence: (C.I.); (P.B.); Tel.: +56-45-2-596693 (C.I.); +56-45-2-596583 (P.B.)
| | - Priscilla Brebi
- Laboratory of Integrative Biology, Centro de Excelencia en Medicina Traslacional—Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile; (D.L.); (K.B.); (T.V.); (B.M.-L.); (L.Z.)
- Correspondence: (C.I.); (P.B.); Tel.: +56-45-2-596693 (C.I.); +56-45-2-596583 (P.B.)
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An JH, Shin JU, Kim HJ, Lee HJ, Yoon MS, Kim DH. Comparison of the Treatment Outcomes of Photodynamic Therapy and Ingenol Mebutate in Bowen's Disease: A Retrospective Observational Study. Ann Dermatol 2020; 32:47-52. [PMID: 33911708 PMCID: PMC7992644 DOI: 10.5021/ad.2020.32.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/05/2019] [Accepted: 11/09/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ji Hae An
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyun Jung Kim
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hee Jung Lee
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Moon Soo Yoon
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Dong Hyun Kim
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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6
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Aguilar-Bernier M, Rodríguez-Barón D, Rivas-Ruiz F, Segura-Palacios JM, de Troya Martín M. Long-term efficacy of photodynamic therapy with methyl aminolevulinate in treating Bowen's disease in clinical practice: A retrospective cohort study (2006-2017). PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:208-213. [DOI: 10.1111/phpp.12453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 12/15/2018] [Accepted: 01/18/2019] [Indexed: 12/20/2022]
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7
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Pyne JH, Myint E, Barr EM, Clark SP, Hou R. Basal cell carcinoma: variation in invasion depth by subtype, sex, and anatomic site in 4,565 cases. Dermatol Pract Concept 2018; 8:314-319. [PMID: 30479863 PMCID: PMC6246053 DOI: 10.5826/dpc.0804a13] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/26/2018] [Indexed: 11/01/2022] Open
Abstract
Background The depth of invasion by basal cell carcinoma (BCC) subtypes varies. Objective To investigate BCC invasion depth variation by subtype and anatomic site. Method A prospective consecutive case series of excised BCC from 2009 to 2014 in a single Australian clinic. Results Descending mean depths for a total of 4,565 BCC cases by subtype were as follows: nodulocystic, 1.9 mm (n = 84, 95% CI: 1.70-2.03, P = 0.66); nodular, 1.6 mm (n = 947, 95% CI: 1.53-1.63, P < 0.0001); aggressive, 1.5 mm (n = 925, 95% CI: 1.44-1.59, P < 0.0001); superficial combined with nodular, 0.9 mm (n = 1,081, 95% CI: 0.83-0.90, P < 0.0001); and superficial, 0.3 mm (n = 1,528, 95% CI: 0.32-0.36, P < 0.0001). Deeper invasion was associated with increased chronic sunlight exposed sites. The deepest aggressive BCCs occurred on the neck with a mean depth of 1.8 mm (n = 46, 95% CI: 1.47-2.21). Conclusion We found significant differences in the depth of invasion for BCCs by sex, subtype, and anatomic site. For BCC with characteristics matching this study, overall adequate microscopic excision depths are proposed: superficial, 1.0 mm; superficial combined with nodular, 2.0 mm; nodular, 3.0 mm; and aggressive, 3.0 mm.
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Affiliation(s)
- John H Pyne
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Esther Myint
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Elizabeth M Barr
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Simon P Clark
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ruihang Hou
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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8
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Fadel M, Samy N, Nasr M, Alyoussef AA. Topical colloidal indocyanine green-mediated photodynamic therapy for treatment of basal cell carcinoma. Pharm Dev Technol 2016; 22:545-550. [DOI: 10.3109/10837450.2016.1146294] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Maha Fadel
- Pharmaceutical Technology Unit, Department of Medical Applications of Lasers, National Institute of Laser Enhanced Sciences, Cairo University, Cairo, Egypt,
| | - Nevien Samy
- Photobiology and Photosensitization Lab, Cairo University, Cairo, Egypt,
| | - Maha Nasr
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt, and
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Tumor thickness and adnexal extension of superficial basal cell carcinoma (sBCC) as determinants of treatment failure for methylaminolevulinate (MAL)-photodynamic therapy (PDT), imiquimod, and 5-fluorouracil (FU). J Am Acad Dermatol 2015; 73:93-8. [DOI: 10.1016/j.jaad.2015.03.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/13/2015] [Accepted: 03/26/2015] [Indexed: 11/17/2022]
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10
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Roozeboom M, Nelemans P, Mosterd K, Steijlen P, Arits A, Kelleners-Smeets N. Photodynamic therapy vs. topical imiquimod for treatment of superficial basal cell carcinoma: a subgroup analysis within a noninferiority randomized controlled trial. Br J Dermatol 2014; 172:739-45. [DOI: 10.1111/bjd.13299] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M.H. Roozeboom
- Department of Dermatology; Maastricht University Medical Centre; P. Debyelaan 25 P.O. Box 5800 6202 AZ Maastricht The Netherlands
- GROW Research Institute for Oncology and Developmental Biology; Maastricht University; Maastricht The Netherlands
| | - P.J. Nelemans
- Department of Epidemiology; Maastricht University; Maastricht The Netherlands
| | - K. Mosterd
- Department of Dermatology; Maastricht University Medical Centre; P. Debyelaan 25 P.O. Box 5800 6202 AZ Maastricht The Netherlands
- GROW Research Institute for Oncology and Developmental Biology; Maastricht University; Maastricht The Netherlands
| | - P.M. Steijlen
- Department of Dermatology; Maastricht University Medical Centre; P. Debyelaan 25 P.O. Box 5800 6202 AZ Maastricht The Netherlands
- GROW Research Institute for Oncology and Developmental Biology; Maastricht University; Maastricht The Netherlands
| | - A.H.M.M. Arits
- Department of Dermatology; Maastricht University Medical Centre; P. Debyelaan 25 P.O. Box 5800 6202 AZ Maastricht The Netherlands
- GROW Research Institute for Oncology and Developmental Biology; Maastricht University; Maastricht The Netherlands
| | - N.W.J. Kelleners-Smeets
- Department of Dermatology; Maastricht University Medical Centre; P. Debyelaan 25 P.O. Box 5800 6202 AZ Maastricht The Netherlands
- GROW Research Institute for Oncology and Developmental Biology; Maastricht University; Maastricht The Netherlands
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Haak C, Togsverd-Bo K, Thaysen-Petersen D, Wulf H, Paasch U, Anderson R, Haedersdal M. Fractional laser-mediated photodynamic therapy of high-risk basal cell carcinomas - a randomized clinical trial. Br J Dermatol 2014; 172:215-22. [DOI: 10.1111/bjd.13166] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 12/20/2022]
Affiliation(s)
- C.S. Haak
- Department of Dermatology; D-92; Bispebjerg Hospital; University of Copenhagen; Bispebjerg Bakke 23 DK-2400 Copenhagen NV Denmark
- Wellman Center for Photomedicine; Massachusetts General Hospital; Harvard Medical School; Boston MA U.S.A
| | - K. Togsverd-Bo
- Department of Dermatology; D-92; Bispebjerg Hospital; University of Copenhagen; Bispebjerg Bakke 23 DK-2400 Copenhagen NV Denmark
| | - D. Thaysen-Petersen
- Department of Dermatology; D-92; Bispebjerg Hospital; University of Copenhagen; Bispebjerg Bakke 23 DK-2400 Copenhagen NV Denmark
| | - H.C. Wulf
- Department of Dermatology; D-92; Bispebjerg Hospital; University of Copenhagen; Bispebjerg Bakke 23 DK-2400 Copenhagen NV Denmark
| | - U. Paasch
- Departments of Dermatology, Venereology and Allergology; University of Leipzig; Leipzig Germany
| | - R.R. Anderson
- Wellman Center for Photomedicine; Massachusetts General Hospital; Harvard Medical School; Boston MA U.S.A
| | - M. Haedersdal
- Department of Dermatology; D-92; Bispebjerg Hospital; University of Copenhagen; Bispebjerg Bakke 23 DK-2400 Copenhagen NV Denmark
- Wellman Center for Photomedicine; Massachusetts General Hospital; Harvard Medical School; Boston MA U.S.A
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12
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Westers-Attema A, Lohman BG, van den Heijkant F, Nelemans PJ, Winnepenninckx VJ, Kelleners-Smeets NW, Mosterd K. Photodynamic Therapy in Bowen's Disease: Influence of Histological Features and Clinical Characteristics on Its Success. Dermatology 2014; 230:55-61. [DOI: 10.1159/000366500] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022] Open
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13
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Haedersdal M, Sakamoto FH, Farinelli WA, Doukas AG, Tam J, Anderson RR. Pretreatment with ablative fractional laser changes kinetics and biodistribution of topical 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL). Lasers Surg Med 2014; 46:462-9. [PMID: 24842112 DOI: 10.1002/lsm.22259] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES 5-Aminolevulinic acid (ALA) and methyl aminolevulinate (MAL) are porphyrin precursors used topically for photodynamic therapy (PDT). Previous studies have established that ablative fractional laser (AFXL) increases topical drug uptake. We evaluated kinetics and biodistribution of ALA- and MAL-induced porphyrins on intact and disrupted skin due to AFXL. MATERIALS AND METHODS Two Yorkshire swine were exposed to CO2 AFXL (10.6 µm, 1,850 µm ablation depth) and subsequent topical application of ALA and MAL cream formulations (20%, weight/weight). Porphyrin fluorescence was quantified by digital fluorescence photography (30, 90, and 180 minutes) and fluorescence microscopy at specific skin depths (180 minutes). RESULTS Porphyrins gradually formed over time, differently on intact and AFXL-disrupted skin. On intact skin (no AFXL), fluorescence photography showed that MAL initially induced higher fluorescence than ALA (t = 30 minutes MAL 21.1 vs. ALA 7.7 au, t = 90 minutes MAL 39.0 vs. ALA 26.6 (P < 0.009)) but reached similar intensities for long-term applications (t = 180 minutes MAL 56.6 vs. ALA 52 au, P = ns). AFXL considerably enhanced porphyrin fluorescence from both photosensitizers (P < 0.05). On AFXL-exposed skin, MAL expressed higher fluorescence than ALA for short-term application (t = 30 minutes, AFXL-MAL 26.4 vs. AFXL-ALA 14.1 au, P < 0.001), whereas ALA over time overcame MAL and induced the highest fluorescence intensities obtained (t = 180 minutes, AFXL-MAL 98.6 vs. AFXL-ALA 112.0 au, P < 0.001). In deep skin layers, fluorescence microscopy showed higher fluorescence in hair follicle epithelium for ALA than MAL (t = 180 minutes, 1.8 mm, AFXL-MAL 35.3 vs. AFXL-ALA 46.7 au, P < 0.05). CONCLUSIONS AFXL changes kinetics and biodistribution of ALA and MAL. It appears that AFXL-ALA favors targeting deep structures.
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Affiliation(s)
- Merete Haedersdal
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114; Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, 2400, Denmark
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McKay KM, Sambrano BL, Fox PS, Bassett RL, Chon S, Prieto VG. Thickness of superficial basal cell carcinoma (sBCC) predicts imiquimod efficacy: a proposal for a thickness-based definition of sBCC. Br J Dermatol 2013; 169:549-54. [PMID: 23627639 DOI: 10.1111/bjd.12402] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common malignancy in the white population. It is an important driver of healthcare costs and causes significant morbidity. Topical imiquimod is a good noninvasive treatment alternative for surgical excision in superficial BCC (sBCC). However, there are currently no uniform histological definitions of sBCC. A definition based on tumour thickness might be a good alternative. OBJECTIVES To determine whether tumour thickness in sBCC is a predictor of treatment failure. METHODS We retrospectively examined 127 histological biopsy specimens of sBCC treated primarily with imiquimod five times a week for 6 weeks. Mean follow-up was 34 months (range 3-91). Recurrence was evaluated clinically with histological verification. RESULTS Among nonrecurrent cases the median tumour thickness was 0·26 mm (range 0·09-0·61), while for recurrent cases the median tumour thickness was 0·57 mm (range 0·41-1·41, P < 0·0001). Among lesions ≤ 0·40 mm in thickness, none recurred, whereas for lesions > 0·40 mm the recurrence rate was 58% (P < 0·0001). CONCLUSIONS We recommend the use of tumour thickness to define the superficial pattern in pathology reports for BCC as this can help to determine treatment response of sBCC to imiquimod.
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Affiliation(s)
- K M McKay
- Departments of Dermatology and Pathology, The University of Alabama at Birmingham, Birmingham, AL, U.S.A
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Betz CS, Rauschning W, Stranadko EP, Riabov MV, Volgin VN, Albrecht V, Nifantiev NE, Hopper C. Long-term outcomes following foscan®-PDT of basal cell carcinomas. Lasers Surg Med 2012; 44:533-40. [DOI: 10.1002/lsm.22056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2012] [Indexed: 01/25/2023]
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Smucler R, Kriz M, Lippert J, Vlk M. Ultrasound guided ablative-laser assisted photodynamic therapy of basal cell carcinoma (US-aL-PDT). Photomed Laser Surg 2012; 30:200-5. [PMID: 22316283 DOI: 10.1089/pho.2011.3107] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE With proper noninvasive ultrasound measurement of tumor depth, case selection for laser pre-ablation followed by PDT is possible. This combination of methods provides a less invasive approach to the treatment of BCC. BACKGROUND DATA Basal cell carcinoma (BCC) primarily affects the face, and, therefore, radical excision is problematic because of the possibility of poor aesthetic outcomes. Photodynamic therapy (PDT) offers an advantage in aesthetic outcomes, but topical PDT is only effective for tumors with a depth up to 2 mm. MATERIALS AND METHODS Seventy-five histologically verified BCCs from 67 patients were selected and divided into three therapeutic groups based on the tumor depth, which was determined by 20 MHz skin ultrasound. The three groups were: A/<2 mm (PDT), B/ 2-3 mm (Er:YAG laser ablation+PDT), and C/>3 mm (diode laser ablation+PDT). The treatment consisted of laser ablation (or no ablation) followed by the application of methyl-aminolevulinate (MAL) and a 3-h treatment period using an occlusive bandage. Subsequently, illumination with 630 nm (MAL-PDT) was performed. MAL-PDT was repeated 1-3 weeks after the first treatment. A clinical evaluation was performed after 6 months. RESULTS A 100% clearance rate (CR) in the group with the deepest tumors was observed. In addition, a 94.7% CR occurred in the group with tumors 2-3 mm in depth, and an 81.2% CR was observed in the group with superficial tumors. CONCLUSIONS With proper ultrasound case selection and laser ablation before MAL-PDT, the depth of a BCC lesion is not a limiting factor for PDT, and aesthetic outcomes are very good. Therefore, ultrasound-guided ablative laser-assisted PDT of BCC can be the method of choice, particularly in aesthetically challenging cases.
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Affiliation(s)
- Roman Smucler
- Centre of Photonic Medicine, Charles University, Prague, Czech Republic.
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