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Riva HR, Malick H, Lauck KC, Singh V, Tolkachjov SN. Sex disparities in surgery for extramammary Paget disease: a SEER population-based study. Int J Dermatol 2024. [PMID: 38867439 DOI: 10.1111/ijd.17319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Hannah R Riva
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | | | - Kyle C Lauck
- Division of Dermatology, Baylor University Medical Center, Dallas, TX, USA
| | - Vishwajeet Singh
- Biostatistics and Epidemiology Consulting Lab, Office of Research, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Stanislav N Tolkachjov
- Texas A&M College of Medicine, Dallas, TX, USA
- Division of Dermatology, Baylor University Medical Center, Dallas, TX, USA
- Epiphany Dermatology, Dallas, TX, USA
- Department of Dermatology, University of Texas at Southwestern, Dallas, TX, USA
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2
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Mansilla-Polo M, Morgado-Carrasco D, Toll A. Review on the Role of Paraffin-embedded Margin-controlled Mohs Micrographic Surgery to Treat Skin Tumors. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:555-571. [PMID: 38395222 DOI: 10.1016/j.ad.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/29/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Paraffin-embedded margin-controlled Mohs micrographic surgery (PMMS) includes various procedures such as slow Mohs or deferred Mohs technique, the Muffin and Tübingen techniques, and staged margin excision, or the spaghetti technique. PMMS is a variation of conventional Mohs micrographic surgery (MMS) that allows histopathological examination with delayed margin control. PMMS requires minimum training and may be adopted by any hospital. The setback is that PMMS can require procedures across multiple days. PMMS lowers the rate of recurrence of basal cell carcinoma vs wide local excision in high-risk basal cell carcinoma, and improves the rates of recurrence and survival in lentigo maligna. PMMS can be very useful in high-risk squamous cell carcinoma treatment. Finally, it is a promising technique to treat infrequent skin neoplasms, such as dermatofibrosarcoma protuberans, or extramammary Paget's disease, among others. In this article, we present a literature narrative review on PMMS, describing techniques and indications, and highlighting long-term outcomes.
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Affiliation(s)
- M Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Health Research Institute (IIS) La Fe, Valencia, Spain
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Dermatology, Hospital de Figueres, Fundació Alt Empordà, Spain
| | - A Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
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3
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Mansilla-Polo M, Morgado-Carrasco D, Toll A. Review on the Role of Paraffin-embedded Margin-controlled Mohs Micrographic Surgery to Treat Skin Tumors. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T555-T571. [PMID: 38648936 DOI: 10.1016/j.ad.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/29/2023] [Accepted: 02/06/2024] [Indexed: 04/25/2024] Open
Abstract
Paraffin-embedded margin-controlled Mohs micrographic surgery (PMMS) includes various procedures such as slow Mohs or deferred Mohs technique, the Muffin and Tübingen techniques, and staged margin excision, or the spaghetti technique. PMMS is a variation of conventional Mohs micrographic surgery (MMS) that allows histopathological examination with delayed margin control. PMMS requires minimum training and may be adopted by any hospital. The setback is that PMMS can require procedures across multiple days. PMMS lowers the rate of recurrence of basal cell carcinoma vs wide local excision in high-risk basal cell carcinoma, and improves the rates of recurrence and survival in lentigo maligna. PMMS can be very useful in high-risk squamous cell carcinoma treatment. Finally, it is a promising technique to treat infrequent skin neoplasms, such as dermatofibrosarcoma protuberans, or extramammary Paget's disease, among others. In this article, we present a literature narrative review on PMMS, describing techniques and indications, and highlighting long-term outcomes.
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Affiliation(s)
- M Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, España; Health Research Institute (IIS) La Fe, Valencia, España
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Department of Dermatology, Hospital de Figueres, Fundació Alt Empordà, España
| | - A Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
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4
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Escolà H, Llombart B, Escolà-Rodríguez A, Barchino-Ortiz L, Marcoval J, Alcaraz I, Beà-Ardébol S, Toll A, Miñano-Medrano R, Rodríguez-Jiménez P, López-Nuñez M, Ferrándiz-Pulido C, Jaka A, Masferrer E, Aguayo-Ortiz RS, Yébenes M, Arandes-Marcocci J, Ruiz-Salas V, Turrión-Merino L, Just M, Sánchez-Schmidt J, Leal L, Mayo-Martínez F, Haya-Martínez L, Sandoval-Clavijo A, Dradi GG, Delgado Y, Verdaguer-Faja J, López-Castillo D, Pujol RM, Deza G. Therapeutic outcomes and survival analysis of Extramammary Paget's disease: A multicentre retrospective study of 249 patients. J Am Acad Dermatol 2024; 90:66-73. [PMID: 37704106 DOI: 10.1016/j.jaad.2023.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Evidence regarding long-term therapeutic outcomes and disease-specific survival (DSS) in Extramammary Paget's disease (EMPD) is limited. OBJECTIVES To assess the DSS and outcomes of surgical and nonsurgical therapeutic modalities in a large cohort of EMPD patients. METHODS Retrospective chart review of EMPD patients from 20 Spanish tertiary care hospitals. RESULTS Data on 249 patients with a median follow-up of 60 months were analyzed. The estimated 5-, 10-, and 15-year DSS was 95.9%, 92.9%, and 88.5%, respectively. A significantly lower DSS was observed in patients showing deep dermal invasion (≥1 mm) or metastatic disease (P < .05). A ≥50% reduction in EMPD lesion size was achieved in 100% and 75.3% of patients treated with surgery and topical therapies, respectively. Tumor-free resection margins were obtained in 42.4% of the patients after wide local excision (WLE). The 5-year recurrence-free survival after Mohs micrographic surgery (MMS), WLE with tumor-free margins, WLE with positive margins, radiotherapy, and topical treatments was 63.0%, 51.4%, 20.4%, 30.1%, and 20.8%, respectively. LIMITATIONS Retrospective design. CONCLUSIONS EMPD is usually a chronic condition with favorable prognosis. MMS represents the therapeutic alternative with the greatest efficacy for the disease. Recurrence rates in patients with positive margins after WLE are similar to the ones observed in patients treated with topical agents.
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Affiliation(s)
- Helena Escolà
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain; Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
| | - Beatriz Llombart
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Alba Escolà-Rodríguez
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Joaquim Marcoval
- Department of Dermatology, Hospital de Bellvitge, Barcelona, Spain
| | | | | | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ane Jaka
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, Spain
| | - Emili Masferrer
- Department of Dermatology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Rafael S Aguayo-Ortiz
- Department of Dermatology, Hospital Universitari Arnau de Vilanova - Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Mireia Yébenes
- Department of Dermatology, Hospital Parc Taulí, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Miquel Just
- Department of Dermatology, Hospital Joan XXIII, Tarragona, Spain
| | | | - Lorena Leal
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | | | | | | | - Yolanda Delgado
- Department of Dermatology, Hospital de la Princesa, Madrid, Spain
| | - Júlia Verdaguer-Faja
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, Spain
| | | | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain; Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Gustavo Deza
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain; Department of Medicine, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
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Luo OD, Bose R, Bawazir MA, Thuraisingam T, Ghazawi FM. A Review of the Dermatologic Clinical Applications of Topical Photodynamic Therapy. J Cutan Med Surg 2024; 28:NP1. [PMID: 38243786 DOI: 10.1177/12034754231216969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Topical photodynamic therapy is a widely approved therapy for actinic keratoses and low-risk nonmelanoma skin cancers with a rapidly growing range of emerging indications for other cutaneous diseases. This review summarizes the best-available evidence to provide a clinical update for dermatologists on the approved and emerging indications of photodynamic therapy. The body of evidence suggests that photodynamic therapy is superior or noninferior to other available treatment modalities for actinic keratoses, low-risk basal cell carcinomas, Bowen's disease, skin field cancerization, chemoprevention of keratinocyte carcinomas in organ transplant recipients, photoaging, acne vulgaris, and cutaneous infections including verrucae, onychomycosis, and cutaneous leishmaniasis. There is emerging evidence that photodynamic therapy plays a role in the management of actinic cheilitis, early-stage mycosis fungoides, extramammary Paget disease, lichen sclerosis, and folliculitis decalvans but there are no comparative studies with other active treatment modalities. Common barriers to topical photodynamic therapy include procedural pain, costs, and the time required for treatment delivery. There is significant heterogeneity in the photodynamic therapy protocols reported in the literature, including different photosensitizers, light sources, number of treatments, time between treatments, and use of procedural analgesia. Topical photodynamic therapy should be considered in the management of a spectrum of inflammatory, neoplastic, and infectious dermatoses. However, more comparative research is required to determine its role in the treatment algorithm for these dermatologic conditions and more methodological research is required to optimize photodynamic therapy protocols to improve the tolerability of the procedure for patients.
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Affiliation(s)
- Owen Dan Luo
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Reetesh Bose
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed A Bawazir
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Thusanth Thuraisingam
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Feras M Ghazawi
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
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Filonenko E, Kaprin A, Volchenko N, Grigorievykh N, Ivanova-Radkevich V. Photodynamic therapy in a patient with perianal extramammary Paget's disease. Photodiagnosis Photodyn Ther 2023; 42:103603. [PMID: 37169171 DOI: 10.1016/j.pdpdt.2023.103603] [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: 03/07/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
Extramammary Paget's disease is a rare neoplasm of apocrine gland-bearing areas of the skin. One of the most common localizations of such a tumor is the perianal area. Surgery is the most frequently reported therapy. However, it is invasive and complicated by a high recurrence rate. An alternative to surgical treatment may be non-invasive photodynamic therapy. We describe in this article the case of a 69-year-old patient with extramammary Paget's disease (a large tumor in the perianal area 22 × 18 cm) successfully treated with chlorin e6 photodynamic therapy.
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Affiliation(s)
- E Filonenko
- P.A. Hertsen Moscow Oncology Research Center - Branch of Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Moscow, Russia.
| | - A Kaprin
- P.A. Hertsen Moscow Oncology Research Center - Branch of Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Moscow, Russia; Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - N Volchenko
- P.A. Hertsen Moscow Oncology Research Center - Branch of Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - N Grigorievykh
- P.A. Hertsen Moscow Oncology Research Center - Branch of Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Moscow, Russia
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