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Magalhães IA, Costa GAJ, Borges MMF, Carlos ACAM, Mesquita KC, Arruda LMAD, Cunha MDPSS, Sousa FB, Silva PGDB. Deficiency in infiltration of CD8/CD3 positive lymphocytes and macrophages plays a role in lip carcinogenesis: an immunohistochemical study. Braz J Otorhinolaryngol 2024; 90:101379. [PMID: 38219446 PMCID: PMC10826144 DOI: 10.1016/j.bjorl.2023.101379] [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: 08/21/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE To evaluate the immunoexpression profile for CD8, CD3, CD20 and CD68 in the process and carcinogenesis of Carcinoma of the vermilion lip. METHODS Average cell count with positive expression for CD3, CD8, CD20 and CD68. The CD8/CD3 ratio calculated in the region was based on the percentage of positive cells in a total of malignant cells. Kruska-Wallis/Dunn, Mann-Whitney and Spearman correlation tests (SPSS, p < 0.05) were used. RESULTS In the Aquitic Cheilitis samples, there was an increase in intraepithelial CD8+ and CD68+. In LSCCs, there was an increase in peritumoral and intratumoral CD3+, CD8+, CD20+ and CD68+ cells. In peritumoral LSCC, CD3+ and CD8+ showed a direct correlation (p = 0.004), and CD68+ and CD8+ (p = 0.017). In the intraepithelial region, CD8+ correlated with CD20+ (p = 0.014) and CD68+ (p = 0.013). In the CAs, CD3 (p < 0.001) and CD8 (p = 0.025) correlated intraepithelial and subepithelial. In LSCC CD3+ (p = 0.002), CD8+ (p = 0.001) and CD68+ (p = 0.030) had intra and peritumoral correlation. CONCLUSION CD68+ is the first interacting cell with the greatest capacity to migrate to the tumor and interact with CD3, CD8 and CD20. Apparently, CD20 affects perineural invasion. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
| | | | - Marcela Maria Fontes Borges
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Clínica Dentária, Divisão de Patologia Oral, Fortaleza, CE, Brazil
| | - Anna Clara Aragão Matos Carlos
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Clínica Dentária, Divisão de Patologia Oral, Fortaleza, CE, Brazil
| | | | | | | | - Fabrício Bitu Sousa
- Unichristus, Departamento de Odontologia, Fortaleza, CE, Brazil; Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Clínica Dentária, Divisão de Patologia Oral, Fortaleza, CE, Brazil
| | - Paulo Goberlânio de Barros Silva
- Unichristus, Departamento de Odontologia, Fortaleza, CE, Brazil; Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Clínica Dentária, Divisão de Patologia Oral, Fortaleza, CE, Brazil; Hospital Haroldo Juaçaba, Instituto Cearense do Câncer, Fortaleza, CE, Brazil.
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2
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Laser Therapy for the Treatment of Actinic Cheilitis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084593. [PMID: 35457467 PMCID: PMC9028420 DOI: 10.3390/ijerph19084593] [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: 02/28/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022]
Abstract
Actinic cheilitis (AC) is a chronic inflammation of the lip considered an oral, potentially malignant disorder associated with an increased risk of lip squamous cell carcinoma (SCC) development. Controversies surrounding current therapeutic modalities of AC are under debate, and the implications of laser treatment have not been specifically investigated through a systematic review design. The present study aims to evaluate the degree of evidence of laser for the treatment of AC in terms of efficacy and safety. We searched for primary-level studies published before January 2022 through MEDLINE/PubMed, Embase, Web of Science, Scopus and CENTRAL, with no limitation in publication language or date. We evaluated the methodological quality and risk of bias of the studies included using the updated Cochrane Collaboration's tool for assessing risk of bias (RoB-2). Twenty studies (512 patients) met our eligibility criteria. Laser therapy showed a complete clearance of AC in 92.5% patients, with a maximum recurrence rate of 21.43%, and a very low frequency of malignant transformation to SCC (detected in only 3/20 studies analyzed). In addition, cosmetic outcomes and patient satisfaction were described as excellent. In conclusion, our findings indicate that laser therapy is a high efficacy approach to AC.
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3
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Yang Y, Shen S, Wang P, Wang X. Efficacy of photodynamic therapy in actinic cheilitis: a systematic review. Photodiagnosis Photodyn Ther 2022; 38:102782. [PMID: 35218940 DOI: 10.1016/j.pdpdt.2022.102782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) has gradually developed into a promising modality for actinic cheilitis (AC), and many new PDT strategies are emerging. However, comprehensive reviews evaluating the efficacy of PDT strategies for AC are lacking. OBJECTIVE To systematically review the safety and efficacy of PDT strategies for AC. METHODS A systematic review was conducted using three databases to compare several types of PDT for AC in terms of clinical response (CR), histopathology response (HR), cosmetic result, and adverse events. RESULTS A total of 19 studies were included, and 292 subjects were finally enrolled. The complete CR rate of ALA-patch PDT, traditional photodynamic therapy (T-PDT), and daylight photodynamic therapy (DL-PDT) was 80.00% (24/30), 65.14% (114/179), and 76.74% (33/43), respectively. The rate of painless patients was 87.10% (27/31) in DL-PDT, whereas the rate was only 31.25% (15/48) in T-PDT. The rates of moderate and severe local phototoxicity were 47.78% (43/90) in T-PDT, 0.00% (0/23) in DL-PDT, and 21.05% (4/19) in ALA-patch PDT. CONCLUSION Published literature suggests that ALA-patch PDT seem to achieve high complete CR rate. Besides, DL-PDT might be a well-tolerated therapy compared with T-PDT and ALA-patch PDT. However, these assumptions are made based on very limited data. It is necessary to conduct a long-term larger sample randomized controlled trial to further evaluate the efficacy and adverse events of various PDT schemes for AC.
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Affiliation(s)
- Yuling Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai
| | - Shuzhan Shen
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai
| | - Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai.
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai.
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4
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Seoane J, Warnakulasuriya S, Bagán JV, Aguirre-Urizar JM, López-Jornet P, Hernández-Vallejo G, González-Moles MÁ, Pereiro-Ferreiros M, Seoane-Romero J, Varela-Centelles P. Assembling a consensus on actinic cheilitis: A Delphi study. J Oral Pathol Med 2021; 50:962-970. [PMID: 33998055 DOI: 10.1111/jop.13200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 01/18/2023]
Abstract
AIMS To discuss the terminology to define and classify actinic cheilitis (AC) and to build a consensus on the diagnostic and therapeutic approaches to AC. METHODS Two-round Delphi study using a questionnaire including 34 closed sentences (9 on terminology and taxonomy, 5 on potential for malignant transformation, 12 on diagnostic aspects, 8 on treatment) and 8 open questions. Experts' agreement was rated using a Likert scale (1-7). RESULTS A consensus was reached on 24 out 34 statements (73.5%) and on 5 out of 8 (62.5%) close-ended questions. The response rate was identical in both rounds (attrition of 0%). AC is the term with the highest agreement (median of 7 (strongly agree; IQR: 6-7)) and the lowest dispersion (VC = 21.33). 'Potentially malignant disorder' was the preferred classification group for AC (median of 7) and 85.6% of participants showing some level of agreement (CV < 50). Experts (66.75%) consider AC a clinical term (median: 7; IQR: 4-7) and believe definitive diagnosis can be made clinically (median: 6; IQR: 5-7), particularly by inspection and palpation (median: 5; IQR: 4-6). Histopathological confirmation is mandatory for the management of AC (median: 5; IQR: 2.5-7), even for homogeneous lesions (median: 5; IQR: 3.5-6). Consensus was reached on all treatment statements (VC < 50). CONCLUSIONS AC is a potentially malignant disorder with a significant lack of agreement on diagnostic criteria, procedures, biopsy indications and the importance of techniques to assist in biopsy. A consensus was reached on nomenclature and management of this disorder.
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Affiliation(s)
- Juan Seoane
- Department of Surgery and Medical-Surgical Specialities, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Pía López-Jornet
- Department of Oral Medicine, University of Murcia, Hospital Morales Meseguer, Murcia, Spain
| | | | | | | | - Javier Seoane-Romero
- USC International School of Doctorate, Ciudad Real University Hospital, Ciudad Real, Spain
| | - Pablo Varela-Centelles
- Department of Surgery and Medical-Surgical Specialities, University of Santiago de Compostela, Santiago de Compostela, Spain.,CS Praza do Ferrol. EOXI Lugo, Cervo e Monforte, Department of Surgery and Medical-Surgical Specialities, Galician Health Service, Univeristy of Santiago de Compostela, Lugo, Spain
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5
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Romano A, Di Stasio D, Gentile E, Petruzzi M, Serpico R, Lucchese A. The potential role of Photodynamic therapy in oral premalignant and malignant lesions: A systematic review. J Oral Pathol Med 2021; 50:333-344. [PMID: 33217059 DOI: 10.1111/jop.13139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is considered as a valid treatment option in various branches of dentistry. This systematic review aims to evaluate the usefulness of PDT for treatment of oral premalignant and malignant lesions. METHODS The MeSH terms "Photodynamic therapy" and "PDT," in combination with other terms, have been searched by three search engines (PubMed, ISI Web of Science, and the Cochrane Library), and a systematic review has been performed. The Population, Intervention, Comparison, Outcomes, and Study design (PICOS) has been applied as method to outline our study eligibility criteria. Risk of Bias in Non-randomized Studies of Intervention (ROBINS-I) has been performed too. RESULTS Initial results were 1513. Definitely, 27 studies met our selection criteria. CONCLUSIONS Topical PDT is an easy to perform technique, well-tolerated treatment and it appears to be an effective method with encouraging achievements in the treatment of premalignant and malignant lesions of the soft tissues of the oral cavity; nevertheless more studies are required to integrate the up-to-date experience of this application.
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Affiliation(s)
- Antonio Romano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dario Di Stasio
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrica Gentile
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "A. Moro", Bari, Italy
| | - Rosario Serpico
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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6
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Trager MH, Farmer K, Ulrich C, Basset-Seguin N, Herms F, Geskin LJ, Bouaziz JD, Lebbé C, de Masson A, Bagot M, Dobos G. Actinic cheilitis: a systematic review of treatment options. J Eur Acad Dermatol Venereol 2020; 35:815-823. [PMID: 33251620 DOI: 10.1111/jdv.16995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/02/2020] [Indexed: 12/20/2022]
Abstract
Actinic cheilitis is a premalignant condition that can progress to squamous cell carcinoma with a higher propensity for metastasis than cutaneous squamous cell carcinoma. Optimal treatment for actinic cheilitis has not been established, and evidence-based estimates of clinical cure in the dermatology literature are limited. Here, we review and synthesize outcome data published for patients with actinic cheilitis after treatment with various modalities. A systematic review was conducted in MEDLINE, Embase and the Cochrane library for English, French and German-language studies and references of included articles from inception to 20 January 2020. Studies were included if they reported on at least six patients with biopsy-proven actinic cheilitis. After quality appraisal, results of studies with the strongest methodology criteria were synthesized. 18 studies of 411 patients (published 1985 to 2016) were included. The majority of the studies were case series. Carbon dioxide laser ablation and vermilionectomy were associated with the most favourable outcomes with fewest recurrences. Chemical peel and photodynamic therapy were associated with higher recurrence. Adverse effects generally resolved in the weeks following treatment and cosmetic outcomes were favourable overall. In conclusion, there is a lack of high-quality comparative studies evaluating different treatment options for actinic cheilitis. The included publications used various outcome measures; however, the majority reported on the recently defined core outcome sets. These results suggest that both carbon dioxide laser ablation and vermilionectomy are effective treatments for actinic cheilitis. Prospective head-to-head studies are needed to compare these treatment modalities and to assess patient preferences.
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Affiliation(s)
- M H Trager
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - K Farmer
- Skin Cancer Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - C Ulrich
- Skin Cancer Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - N Basset-Seguin
- Department of Dermatology, APHP, Saint-Louis Hospital, Paris, France.,U976, INSERM, Saint-Louis Hospital, Paris, France.,Université de Paris, Paris, France
| | - F Herms
- Department of Dermatology, APHP, Saint-Louis Hospital, Paris, France
| | - L J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - J-D Bouaziz
- Department of Dermatology, APHP, Saint-Louis Hospital, Paris, France.,U976, INSERM, Saint-Louis Hospital, Paris, France.,Université de Paris, Paris, France
| | - C Lebbé
- Department of Dermatology, APHP, Saint-Louis Hospital, Paris, France.,U976, INSERM, Saint-Louis Hospital, Paris, France.,Université de Paris, Paris, France
| | - A de Masson
- Department of Dermatology, APHP, Saint-Louis Hospital, Paris, France.,U976, INSERM, Saint-Louis Hospital, Paris, France.,Université de Paris, Paris, France
| | - M Bagot
- Department of Dermatology, APHP, Saint-Louis Hospital, Paris, France.,U976, INSERM, Saint-Louis Hospital, Paris, France.,Université de Paris, Paris, France
| | - G Dobos
- Department of Dermatology, APHP, Saint-Louis Hospital, Paris, France.,U976, INSERM, Saint-Louis Hospital, Paris, France.,Université de Paris, Paris, France
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7
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Treatments of actinic cheilitis: A systematic review of the literature. J Am Acad Dermatol 2020; 83:876-887. [DOI: 10.1016/j.jaad.2019.07.106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/16/2019] [Accepted: 07/30/2019] [Indexed: 01/27/2023]
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8
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Andreadis D, Pavlou AM, Vakirlis E, Anagnostou E, Vrani F, Poulopoulos A, Kolokotronis A, Ioannidis D, Sotiriou E. Daylight photodynamic therapy for the management of actinic cheilitis. Arch Dermatol Res 2020; 312:731-737. [PMID: 32266532 DOI: 10.1007/s00403-020-02069-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/30/2020] [Indexed: 12/20/2022]
Abstract
Early identification and adequate treatment of actinic cheilitis (AC), which affects the lower lip vermillion and is considered a precursor of squamous cell carcinoma, is mandatory. Photodynamic therapy (PDT) has been successfully used in AC. PDT with the use of daylight (DLPDT) is equally effective and more convenient than the conventional PDT. Data on short and long-term efficacy of DLPDT in AC are limited. Our primary purpose was to assess efficacy of DLPDT in AC as well as safety and tolerance. Twenty-two individuals with histologically confirmed AC received 2 MAL (5-aminolevulinic acid)-DLPDT sessions 1 week apart. Patients were evaluated clinically 3, 6, and 12 months after treatment. Non-complete responders were biopsied and excluded from the study if histological alterations were indicative of AC. Adverse events were recorded from baseline to the end of the 12-month follow-up period. Twenty patients completed the study. Overall, complete clinical response 12 months after treatment was 80% (16/20), while an association between treatment response and grade of dysplasia was observed (p = 0.016). With respect to response by grade, complete clinical response achieved in grade I AC was 100% (12/12) and 50% (4/8) in grade II AC. Main adverse events included mild erythema, oedema, and scaling, with no pain associated with DLPDT. According to our results, DLPDT seems to be of significant benefit for the treatment of grade I AC. Combination with the other treatment modalities could improve the efficacy in grade II AC. Further studies are needed for the assessment of late recurrences.
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Affiliation(s)
- Dimitrios Andreadis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Achilleia -Maria Pavlou
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstratios Vakirlis
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Anagnostou
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Vrani
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Poulopoulos
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Kolokotronis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ioannidis
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elena Sotiriou
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Varela-Centelles P, Seoane-Romero J, García-Pola MJ, Leira-Feijoo Y, Seoane-Romero JM. Therapeutic approaches for actinic cheilitis: therapeutic efficacy and malignant transformation after treatment. Int J Oral Maxillofac Surg 2020; 49:1343-1350. [PMID: 32171621 DOI: 10.1016/j.ijom.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/10/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
Actinic cheilitis (AC) is a sun-induced premalignant lesion. AC is a clinical term housing a wide pathological spectrum ranging from hyperkeratosis to invasive squamous cell carcinoma. The aim of this systematic review was to examine the therapeutic efficacy of different approaches in clinical, histological, and cosmetic terms, and the malignization rate after treatment. A systematic search was undertaken in October 2016 and updated in April 2019 at MEDLINE (from 1966), Embase (from 1980), and Proceedings Web of Science (Conference Proceedings Citation Index-Science (CPCI-S) from 1990) databases. The search strategy was (("actinic" or "solar") AND ("cheilitis")) using both medical subject headings (MeSH) and freetext. A total of 392 potentially eligible reports were identified. After the selection procedure, 20 articles were included. It was concluded that surgical treatment is the first line of treatment for AC and has proved useful for the clinical and pathological control of the disorder. However, there was no evidence of effective treatment in preventing malignant transformations. Non-surgical procedures showed less consistent results, although drug therapy may improve the results obtained by other therapeutic approaches.
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Affiliation(s)
- P Varela-Centelles
- CS Praza do Ferrol, EOXI Lugo, Cervo, e Monforte, Galician Health Service, Lugo, Spain.
| | - J Seoane-Romero
- School of Medicine & Dentistry, University "Santiago de Compostela", Coruña, Spain
| | - M J García-Pola
- Department of Surgery and Medical-Surgical Specialities, University of Oviedo, Oviedo, Spain
| | - Y Leira-Feijoo
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - J M Seoane-Romero
- Department of Surgery and Medical-Surgical Specialities, University of Oviedo, Oviedo, Spain
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10
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Radakovic S, Dangl M, Tanew A. 5-Aminolevulinic acid patch (Alacare) photodynamic therapy for actinic cheilitis: data from a prospective 12-month follow-up study on 21 patients. J Eur Acad Dermatol Venereol 2020; 34:2011-2015. [PMID: 31999856 PMCID: PMC7496675 DOI: 10.1111/jdv.16247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/08/2020] [Indexed: 11/29/2022]
Abstract
Background Actinic cheilitis (AC) is a variant of actinic keratosis (AK) affecting the lips and caused by chronic ultraviolet exposure. Objective Alacare is a self‐adhesive, skin‐coloured 5‐aminolaevulinic acid patch that has been developed for use in photodynamic therapy (PDT) of mild‐to‐moderate AK. Based on promising preliminary results in the treatment of AC with Alacare patch PDT, we decided to extend our previous investigation to gain more data on the efficacy, tolerability, safety and cosmetic outcome of Alacare patch PDT for AC. Methods Twenty‐one patients with a clinical diagnosis of mild‐to‐moderate AC were included in the study and subjected to one single session of PDT. After occlusion with the Alacare patch for 4 h, the AC lesions were illuminated for 10 min with red light at a dose of 37 J/cm2. All patients received local anaesthesia prior to illumination. Additionally, all lesions were cooled during PDT with a cold air blower. PDT‐induced pain and skin phototoxicity were monitored during and up to 7 days after PDT. Clinical assessment of efficacy, cosmetic outcome and global patient satisfaction was performed at 3, 6 and 12 months after treatment. Results Nineteen patients completed the study. Three months after PDT, 17 patients (89.5%) had achieved complete remission. Of these, one patient presented with recurrence of AC at the 6‐month follow‐up, whereas all other patients remained in remission until the end of the observation period. The complete clinical cure rate at 1 year after a single Alacare patch PDT thus was 84.2%. Pain during illumination and the phototoxic skin reaction were in general mild to moderate. The cosmetic outcome was excellent. Conclusion The present prospective study on Alacare patch PDT for AC confirms its high clinical efficacy, good tolerability and favourable cosmetic effects. Alacare patch PDT should be considered as a valid treatment option for patients with AC.
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Affiliation(s)
- S Radakovic
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - M Dangl
- Landesklinikum Gmünd, Gmünd, Austria
| | - A Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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11
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Treatment of actinic cheilitis: a systematic review. Clin Oral Investig 2019; 23:2041-2053. [DOI: 10.1007/s00784-019-02895-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/03/2019] [Indexed: 12/24/2022]
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12
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de Oliveira Bezerra HI, Gonzaga AKG, da Silveira ÉJD, de Oliveira PT, de Medeiros AMC. Fludroxycortide cream as an alternative therapy for actinic cheilitis. Clin Oral Investig 2019; 23:3925-3931. [PMID: 30673866 DOI: 10.1007/s00784-019-02823-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/16/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The objective of the study is to assess, by clinical follow-up, the efficacy of the dermatological cream Fludroxycortide 0.125 mg/g (Drenison®) in the treatment of actinic cheilitis (AC). MATERIAL AND METHODS Twenty-three patients diagnosed with AC participated in the study. Fifteen were submitted to corticotherapy with Fludroxycortide, applied three times a day for up to 6 weeks, associated with lip sunscreen (LS) before sun exposure. In the control group of eight patients, only the use of LS was established. At each weekly return, a photographic record was made of the lesion. After treatment, images were evaluated and scores were assigned to verify clinical evolution. Also, patients treated with Fludroxycortide responded to a questionnaire, to assess drug tolerability and treatment satisfaction. RESULTS In the group treated with Fludroxycortide (n = 15), five patients showed total improvement, seven presented partial improvement, and three showed no clinical change. Concerning the patients treated with LS (n = 8), one presented total remission of the clinical lesion characteristics, four exhibited partial improvement, and three exhibited no clinical lip alteration. No case presented symptom worsening. Of the 15 patients undergoing corticotherapy, 12 were satisfied and reported that the product was not irritating and contributed to lesion improvement. CONCLUSIONS Conventional treatment with LS was effective in the remission of some AC lesions, but treatment responses were improved when associated with Fludroxycortide, especially in the more severe cases. CLINICAL RELEVANCE As it is a non-invasive therapy leading, in most cases, to adequate clinical results, safety, and tolerability, Fludroxycortide can be considered an effective alternative treatment for AC.
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Affiliation(s)
- Hanna Isa de Oliveira Bezerra
- Department of Dentistry, Federal University of Rio Grande do Norte, Avenue Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, USA.
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13
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Farah CS, Pollaers K, Frydrych A. Management of Premalignant Disease of the Oral Mucosa. HEAD AND NECK CANCER CLINICS 2019. [DOI: 10.1007/978-981-13-2931-9_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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14
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Husein-ElAhmed H, Almazan-Fernandez FM, Husein-ElAhmed S. Ingenol mebutate versus imiquimod versus diclofenac for actinic cheilitis: a 6-month follow-up clinical study. Clin Exp Dermatol 2018; 44:231-234. [PMID: 30242791 DOI: 10.1111/ced.13763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- H Husein-ElAhmed
- Department of Dermatology, Hospital General de Baza, Avenida Murcia S/N, CP 18800, Granada, Spain
| | | | - S Husein-ElAhmed
- Department of Dermatology, Hospital General de Baza, Avenida Murcia S/N, CP 18800, Granada, Spain
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Levi A, Hodak E, Enk CD, Snast I, Slodownik D, Lapidoth M. Daylight photodynamic therapy for the treatment of actinic cheilitis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 35:11-16. [PMID: 30066408 DOI: 10.1111/phpp.12415] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/07/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Actinic cheilitis (AC) is a common, chronic premalignant condition resulting from protracted sun exposure affecting the vermilion border of the lower lip. Treatment of AC aims at terminating the progression to squamous cell carcinoma by obliterating the primary lesion, and includes ablative methods; nonablative modalities such as cryotherapy, electrodessication, chemical peeling, topical imiquimod and 5-fluorouracil; and photodynamic therapy (PDT). Daylight-activated PDT, in which natural daylight serves as the light source, showed promising results in the treatment of actinic keratoses with substantially less pain than conventional PDT. PURPOSE To determine the safety and efficacy of daylight PDT in a series of patients with AC. METHODS Eleven patients with AC were treated with daylight PDT. All patients underwent repeated treatment sessions until clinical and histological remission were achieved. RESULTS Cure rate was 91% (10 of 11 patients, three females/eight males; mean age 59.2 ± 14.4 years). Mean number of treatments to attain cure was 2.7. Patients experienced mild erythema and minimal to no pain during treatment. CONCLUSIONS Daylight PDT is a promising modality for the treatment of AC, with impressive cosmetic results and few side effects.
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Affiliation(s)
- Assi Levi
- Photodermatosis Clinic and Laser Unit, Department of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Photodermatosis Clinic and Laser Unit, Department of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Claes D Enk
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Igor Snast
- Photodermatosis Clinic and Laser Unit, Department of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Slodownik
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, School of Public Health, Department of Environmental and Occupational Health, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Lapidoth
- Photodermatosis Clinic and Laser Unit, Department of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lupu M, Caruntu A, Caruntu C, Boda D, Moraru L, Voiculescu V, Bastian A. Non-invasive imaging of actinic cheilitis and squamous cell carcinoma of the lip. Mol Clin Oncol 2018; 8:640-646. [PMID: 29725529 PMCID: PMC5920479 DOI: 10.3892/mco.2018.1599] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/22/2018] [Indexed: 01/20/2023] Open
Abstract
An early diagnosis is of overwhelming importance for the management and prognosis of mucocutaneous cancer. Actinic cheilitis (AC), defined by the clonal expansion of genomically unstable keratinocytes, is the most common potentially malignant lesion affecting the lips. Squamous cell carcinoma (SCC) is the most frequent oral malignancy, and there is strong evidence that the majority of the SCCs of the lip originate from AC. There is considerable difficulty in discerning between dysplasia and invasive carcinomas solely on a clinical basis. Although dermoscopy has become an essential tool for skin tumor evaluation, reflectance confocal microscopy (RCM) is a non-invasive imaging technology that has proved itself extremely useful in the diagnosis and monitoring of several skin diseases, including AC and SCC. The present study aimed to re-emphasize the usefulness of RCM in the early detection of malignant transformation, using AC and SCC of the lips as working examples. Due to the apparent innocuousness of AC for numerous patients, it is not possible to overstress the importance of a correct and early diagnosis, proper treatment and long-term patient follow-up as being essential for preventing the progression to lip SCC, or for its timely diagnosis.
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Affiliation(s)
- Mihai Lupu
- Department of Dermatology, MEDAS Medical Center, Bucharest 030442, Romania
| | - Ana Caruntu
- ‘Carol Davila’ Central Military Emergency Hospital, Bucharest 010825, Romania
- ‘Titu Maiorescu’ University, Faculty of Medicine, Bucharest 031593, Romania
| | - Constantin Caruntu
- Department of Physiology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Dermatology, ‘Prof. N. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest 011233, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania
- Carol Medical Center, Bucharest 010626, Romania
| | - Liliana Moraru
- ‘Carol Davila’ Central Military Emergency Hospital, Bucharest 010825, Romania
| | - Vlad Voiculescu
- Department of Dermatology and Allergology, Elias Emergency University Hospital, Bucharest 011461, Romania
| | - Alexandra Bastian
- Department of Pathology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Pathology, ‘Colentina’ University Hospital, Bucharest 020125, Romania
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17
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Benati E, Pampena R, Bombonato C, Borsari S, Lombardi M, Longo C. Dermoscopy and reflectance confocal microscopy for monitoring the treatment of actinic cheilitis with ingenol mebutate gel: Report of three cases. Dermatol Ther 2018; 31:e12613. [PMID: 29687567 DOI: 10.1111/dth.12613] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/18/2018] [Indexed: 12/16/2022]
Abstract
Actinic cheilitis (AC) can precede the development of squamous cell carcinoma (SCC) of the lip, a location with higher risk of invasiveness and metastasis. Herein, we reported the use of ingenol mebutate (IngMeb) 0.015% gel on three consecutive days to treat three patients suffering from AC. All the three patients achieved complete clearance of AC with rapid clinical effect, favorable safety profile, good patient's compliance related to short time of applications, and few local skin reactions. So IngMeb is an attractive new therapy for AC. Moreover, the present case report adds further evidence to the usefulness of dermoscopy and Reflectance confocal microscopy (RCM) in the assessment and monitoring of treatment outcome.
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Affiliation(s)
- E Benati
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - R Pampena
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - C Bombonato
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - S Borsari
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - M Lombardi
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.,Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy
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18
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Abstract
Heath care providers should be comfortable with normal as well as pathologic findings in the lips, because the lips are highly visible and may display clinical manifestations of local, as well as systemic inflammatory, allergic, irritant, and neoplastic alterations. Fortunately, the lips are easily accessible. The evaluation should include a careful history and physical examination, including visual inspection, as well as palpation of the lips and an examination of associated cervical, submandibular, and submental nodes. Pathologic and microscopic studies, as well as a review of medications, allergies, and habits, may further highlight possible etiologies. Many lip conditions, including premalignant changes, are relatively easy to treat, when the abnormalities are detected early; however, advanced disease and malignancies are challenging for both the patient and clinician. Treatment should be focused on eliminating potential irritants or allergens and treatment of the primary dermatosis. In this paper we review physiologic variants as well as pathologic conditions of the lips.
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Gonzaga AKG, de Oliveira PT, da Silveira ÉJD, Queiroz LMG, de Medeiros AMC. Diclofenac sodium gel therapy as an alternative to actinic cheilitis. Clin Oral Investig 2017; 22:1319-1325. [PMID: 28986686 DOI: 10.1007/s00784-017-2237-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Actinic cheilitis (AC) is a potentially malignant lesion caused by prolonged exposure to ultraviolet light. The aim of this research was to analyze the efficacy of diclofenac sodium 3% gel in the treatment of this condition, through clinical follow-up. METHODS Thirty-one patients diagnosed with AC were instructed to perform a topical application of the gel three times a day for a period of 90 days. In each visit, a digital photography was obtained for verified progress and response to treatment. Two researchers evaluated all images after treatment was completed and assigned the following scores regarding clinical aspect of the lip: 1, complete improvement; 2, partial improvement; 3, no changes; 4, worsening of the clinical condition. In addition, the patients' tolerability to the drug and their satisfaction after treatment were evaluated. RESULTS Twelve cases abandoned the treatment for reasons unrelated to the study. Ten participants showed total remission of all clinical features of the lesion and three had partial improvement of the characteristics. One participant presented worsening of clinical condition, and in five cases, treatment was discontinued due to development of mild adverse effects at the site of gel application. Regarding satisfaction analyses and tolerability to the drug, from 14 patients who completed treatment without adverse effects or complications, most agreed fully that they were satisfied with the therapy (n = 11) and that the drug was not irritating to the mouth (n = 9). Patients are being monitored without clinical signs of recurrence and/or progression of the lesions. CONCLUSION Topical application of the drug has provided a convenient and well tolerated in most cases. CLINICAL RELEVANCE Diclofenac sodium gel (3%) may be a promising alternative for treatment of actinic cheilitis.
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Affiliation(s)
- Amanda Katarinny Goes Gonzaga
- Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, RN, Brazil. .,Department of Dentistry, Universidade Federal do Rio Grande do Norte, Av. Senador Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil.
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20
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Radakovic S, Tanew A. 5-aminolaevulinic acid patch-photodynamic therapy in the treatment of actinic cheilitis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 33:306-310. [PMID: 28703320 DOI: 10.1111/phpp.12332] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Actinic cheilitis (AC) is a common disease caused by chronic ultraviolet exposure. OBJECTIVE Alacare is a self-adhesive, skin coloured 5-aminolaevulinic acid (ALA) patch that has been developed for the treatment of mild to moderate actinic keratosis (AK). Considering the good results in the treatment of AK, the standardized delivery of ALA and the simple application Alacare patch- photodynamic therapy (PDT) appears as an interesting treatment option for AC. METHODS We retrospectively assessed the efficacy, tolerability and cosmetic outcome of Alacare patch-PDT in eleven patients with AC. After occlusion with the Alacare patches for 4 hours, the AC lesions were illuminated with narrowband red light and a dose of 37 J/cm2 . All patients were clinically assessed for efficacy, side effects and cosmetic outcome at 3, 6, 9 and 12 months after treatment. RESULTS Complete clinical response at the 3-month follow-up was achieved in eight of 11 patients (72,7%) and 12 of 15 AC lesions (80,0%), respectively. Up to the final 12-month follow-up, a recurrence was observed in two lesions. The complete clinical cure rate at 1 year after Alacare patch-PDT, thus, was 66,6% (10/15 lesions). The cosmetic outcome of the treatment was excellent in all cases. CONCLUSION Alacare patch-PDT was found to have substantial efficacy in the treatment of mild to moderate AC. Given its ease of use, absence of long-term side effects and the excellent cosmetic results Alacare patch-PDT might be considered as a promising new treatment option for the management of AC.
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Affiliation(s)
- Sonja Radakovic
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Adrian Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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21
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Chrun ES, Modolo F, Vieira D, Borges-Júnior Á, Castro RG, Daniel FI. Immunoexpression of HDAC1, HDAC2, and HAT1 in actinic cheilitis and lip squamous cell carcinoma. Oral Dis 2017; 23:505-510. [PMID: 28107582 DOI: 10.1111/odi.12641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acetylation and deacetylation are the most studied covalent histone modifications resulting in transcriptional regulation with histone deacetylases (HDAC) and histone acetyltransferases (HAT) as the main associated enzymes. These enzymes overexpression induces abnormal transcription of key genes that regulate important cellular functions, such as proliferation, cell cycle regulation, and apoptosis. Thus, the expression of different HATs and HDACs has been evaluated in various cancers. OBJECTIVE To investigate HDAC1, HDAC2 and HAT1 expression in lip squamous cell carcinoma (LSCC) and actinic cheilitis (AC) and to demonstrate their correlation with DNA metyltransferases (DNMTs). MATERIAL AND METHODS Thirty cases of lip squamous cell carcinoma (LSCC), thirty cases of actinic cheilitis (AC), and 28 cases of non-neoplastic epithelium as control were selected for immunohistochemical investigation. RESULTS Nuclear HDAC2 immunopositivity was significantly higher in AC (75.07% ± 29.70) when compared with LSCC (51.06% ± 39.02). HDAC1 and HAT1 nuclear immunostaining were higher in AC, with no statistical significance. When comparing data with our previous study, we found a positive correlation between HDAC1 X DNMT1/DNMT3b, HDAC2 X DNMT3b, and HAT1 X DNMT1/DNMT3b for certain studied groups. CONCLUSION This study showed higher levels of nuclear HDAC2 immunopositivity in AC, possibly indicating that this enzyme plays a key role in lip photocarcinogenesis early stages.
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Affiliation(s)
- E S Chrun
- Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - F Modolo
- Pathology Department and Dentistry Graduate Program, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Dsc Vieira
- Pathology Department, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Áls Borges-Júnior
- Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - R G Castro
- Dentistry Department, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - F I Daniel
- Pathology Department and Dentistry Graduate Program, Federal University of Santa Catarina, Florianopolis, SC, Brazil
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Andreadis D, Pavlou AM, Sotiriou E, Vrani F, Ioannides D, Kolokotronis A. Utility of photodynamic therapy for the management of oral potentially malignant disorders and oral cancer. TRANSLATIONAL RESEARCH IN ORAL ONCOLOGY 2016. [DOI: 10.1177/2057178x16669161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Photodynamic therapy (PDT), defined as “the light-induced inactivation of cells, microorganisms, or molecules,” combines the use of a photosensitive agent or photosensitizer (PS) activated by irradiation with a light source to produce reactive oxygen species and highly reactive singlet oxygen. PDT has been used for the treatment of different oral diseases with promising results. This review describes the basic principles of PDT, including the nature of PS and the light sources, and focuses on evaluating the efficacy of this method, according to the existing data, for the treatment of different oral diseases. PubMed was used as the source of the relevant literature, about the clinical application of PDT in actinic cheilitis (AC), leukoplakia, oral lichen planus, oral lichenoid lesions, and oral cancer. Complete response to PDT as high as 100% has been reported not only in cases of AC but also in dysplasias/carcinomas in situ, T1N0, and T2N0. According to the available data, PDT appears to be a safe, well-tolerated therapy with limited adverse effects and excellent cosmetic outcome. Although PDT is a very promising therapy, further research is needed in order to investigate the cases that fail to respond, to examine the long-term prognosis for cases of reported complete response and thus avoid the future recurrence of diseases.
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Affiliation(s)
- Dimitrios Andreadis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Achilleia-Maria Pavlou
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Sotiriou
- First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fani Vrani
- First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ioannides
- First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Kolokotronis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Poulin Y, Lynde CW, Barber K, Vender R, Claveau J, Bourcier M, Ashkenas J. Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses. J Cutan Med Surg 2016; 19:227-38. [DOI: 10.1177/1203475415583414] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Actinic keratosis (AK) and cheilitis (AC) are lesions that develop on photodamaged skin and may progress to form invasive squamous cell carcinomas (SCCs). Objective To provide guidance to Canadian health care practitioners regarding management of AKs and ACs. Methods Literature searches and development of graded recommendations were carried out as discussed in the accompanying introduction (chapter 1 of the NMSC guidelines). Results Treatment of AKs allows for secondary prevention of skin cancer in sun-damaged skin. Because it is impossible to predict whether a given AK will regress, persist, or progress, AKs should ideally be treated. This chapter discusses options for the management of AKs and ACs. Conclusions Treatment options include surgical removal, topical treatment, and photodynamic therapy. Combined modalities may be used in case of inadequate response. AKs are particularly common following the longterm immunosuppression in organ transplant patients, who should be monitored frequently to identify emerging lesions that require surgery.
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Affiliation(s)
- Yves Poulin
- Centre Dermatologique du Québec Métropolitain, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
| | - Charles W. Lynde
- Lynderm Research Inc, Markham, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Kirk Barber
- Kirk Barber Research, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada
| | - Ronald Vender
- Dermatrials Research, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Joël Claveau
- Clinique Dermatologique Joël Claveau, Québec, QC, Canada
| | - Marc Bourcier
- Durondel CP Inc, Moncton, NB, Canada
- Université de Sherbrooke, Sherbrooke, QC, Canada
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Abstract
This article increases awareness of the presentation, diagnosis and management of potentially malignant and malignant oral lesions and conditions and reviews the referral process.
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Affiliation(s)
- Anne M Hegarty
- Consultant and Honorary Clinical Lecturer in the Department of Oral Medicine, Charles Clifford Dental Hospital, Sheffield S10 2SZ
| | - Keith D Hunter
- Reader and Honorary Consultant in the Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, Sheffield, South Yorkshire
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25
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Flórez Á, Batalla A, de la Torre C. Management of actinic cheilitis using ingenol mebutate gel: A report of seven cases. J DERMATOL TREAT 2016; 28:149-151. [PMID: 27241280 DOI: 10.1080/09546634.2016.1188196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Actinic cheilitis (AC) can precede the development of squamous cell carcinoma of the lip, a location with high risk of invasiveness and metastasis. We communicate the good results that we obtained when treating seven patients suffering from AC with ingenol mebutate (IM) 0,015% concentration gel on three consecutive days. Three patients achieved complete clearance and four significant improvement. IM is a topical field treatment approved for actinic keratosis. To our knowledge, reported experience in the management of AC with IM is very limited. Local skin responses grade 3 were the main adverse event observed and they resolved in all patients without specific therapy within 1 to 2 weeks. IM is characterized by its rapid clinical effect, its favorable safety profile and its dosing period of only 3 days, shorter than with other field therapies. All these facts make it an attractive new therapy for AC, with need for further study.
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Affiliation(s)
- Ángeles Flórez
- a Department of Dermatology , Pontevedra Hospital , Pontevedra , Spain
| | - Ana Batalla
- a Department of Dermatology , Pontevedra Hospital , Pontevedra , Spain
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26
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Rabinovich IM, Rabinovich OF, Abramova ES, Denisova MA. [Clinical and pathogenetic aspects of various forms of cheilitis]. STOMATOLOGII︠A︡ 2016; 95:67-72. [PMID: 27182564 DOI: 10.17116/stomat201695167-72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- I M Rabinovich
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - O F Rabinovich
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - E S Abramova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - M A Denisova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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27
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Lopes MLDDS, Silva Júnior FLD, Lima KC, Oliveira PTD, Silveira ÉJDD. Clinicopathological profile and management of 161 cases of actinic cheilitis. An Bras Dermatol 2016; 90:505-12. [PMID: 26375219 PMCID: PMC4560539 DOI: 10.1590/abd1806-4841.20153848] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun. OBJECTIVES To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading. METHODS Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system. RESULTS There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803). CONCLUSION This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies.
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28
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Abstract
The whole examination of oral cavity, other mucosae and skin is required when managing a cheilitis. Irritants (climatic, mechanical, caustic agents...) constitute the main aetiological factors of cheilitis. Allergic contact cheilitis should be investigated with a detailed anamnesis in order to search any causative agent in contact with the oral mucosae. Patch testing is required to confirm the diagnosis of delayed hypersensivity. Chronic actinic cheilitis occurs mostly in middle-aged, fair-skinned men. It is a potentially malignant condition that requires biopsies to exclude severe dysplasia or carcinoma. Angular cheilitis can occur spontaneously but is frequently related with several precipitating factors, such as systemic immune suppression, local irritation and moisture, fungal and/or bacterial infection. Cheilitis can also be seen in various systemic conditions such as lichen planus, lupus, atopic dermatitis and nutritional deficiencies. Erosive and crusty cheilitis and bullous erosive stomatitis are the main oral features of erythema multiforme and Stevens-Johnson syndrome. Granulomatous macrocheilitis (cheilitis granulomatosa) presents with intermittent or permanent lip swelling. It should be confirmed by a biopsy. It can be either isolated (Miescher macrocheilitis) or associated with various systemic conditions.
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Affiliation(s)
- Mahtab Samimi
- CHU de Tours, université François-Rabelais, service de dermatologie, 37044 Tours, France; ISP 1282, Inra, université de Tours, 37200 Tours, France.
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30
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Evaluation of vermillion border descriptors and relevance vector machines discrimination model for making probabilistic predictions of solar cheilosis on digital lip photographs. Comput Biol Med 2015; 63:11-8. [DOI: 10.1016/j.compbiomed.2015.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/07/2015] [Accepted: 04/15/2015] [Indexed: 11/22/2022]
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Fai D, Romanello E, Brumana MB, Fai C, Vena GA, Cassano N, Piaserico S. Daylight photodynamic therapy with methyl-aminolevulinate for the treatment of actinic cheilitis. Dermatol Ther 2015; 28:355-68. [DOI: 10.1111/dth.12258] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Dario Fai
- Phototherapy Unit-Dermatology Service, AUSL LECCE; Salento Italy
| | | | | | - Carlotta Fai
- Phototherapy Unit-Dermatology Service, AUSL LECCE; Salento Italy
| | - Gino Antonio Vena
- Dermatology and Venereology Private Practice, Bari and Barletta; Italy
| | - Nicoletta Cassano
- Dermatology and Venereology Private Practice, Bari and Barletta; Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Dermatology; University of Padua; Padua Italy
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Yardimci G, Kutlubay Z, Engin B, Tuzun Y. Precancerous lesions of oral mucosa. World J Clin Cases 2014; 2:866-872. [PMID: 25516862 PMCID: PMC4266835 DOI: 10.12998/wjcc.v2.i12.866] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/28/2014] [Accepted: 09/24/2014] [Indexed: 02/05/2023] Open
Abstract
Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. Oral lichen planus is one of the potentially malignant disorders that may be seen in six different subtypes including papular, reticular, plaque-like, atrophic, erosive, and bullous type, clinically. Atrophic and erosive subtypes have the greater increased malignant transformation risk compared to another subtypes. Although there are various etiological studies, the etiology of almost all these diseases is not fully understood. Geographically, etiologic factors may vary. The most frequently reported possible factors are tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. Early diagnosis is very important and can be lifesaving, because in late stages, they may be progressed to severe dysplasia and even carcinoma in situ and/or squamous cell carcinoma. For most diseases, treatment results are not satisfactory in spite of miscellaneous therapies. While at the forefront of surgical intervention, topical and systemic treatment alternatives such as corticosteroids, calcineurin inhibitors, and retinoids are widely used.
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Spyridonos P, Gaitanis G, Tzaphlidou M, Bassukas ID. Spatial fuzzy c-means algorithm with adaptive fuzzy exponent selection for robust vermilion border detection in healthy and diseased lower lips. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 114:291-301. [PMID: 24661607 DOI: 10.1016/j.cmpb.2014.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/17/2014] [Accepted: 02/26/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Accurate lip contour identification is demanding since variations in color, form and surface texture, even in normal lips, introduce artifacts in non-adapted segmentation algorithms. Herein, a method for vermilion border detection and quantification in healthy and diseased lower lips is presented. AIM To quantify the morphological irregularities of lower lip border, to validate its discriminative power in solar cheilosis diagnosis and to provide supportive tools toward, cost effective, non invasive, disease monitoring. MATERIALS Segmentation algorithm for lower lip border was based on spatial fuzzy c-means clustering algorithm with adaptive selection of fuzzy exponent m. Lip features measuring morphological lip border deviations were estimated. The method of lip border extraction and quantitative description was evaluated in a gold standard set of 25 young volunteers without onset of lip diseases. Quantitative descriptors were evaluated in terms of correct classification rates in differentiating 30 healthy control cases from 41 patients with solar cheilosis and were further applied to quantify the therapeutic outcome after immunocryosurgery in eight patients with solar cheilosis. RESULTS Adaptive estimation of fuzzy exponent m substantially boosted the segmentation quality in gold standard cases yielding quite smooth lip contours and uniformly low values of lip irregularity features. Discriminant analysis highlighted the distance between the extracted and modeled vermilion border as a feature with excellent diagnostic accuracy (sensitivity and specificity 98% and 93% respectively). Results on patients with solar cheilosis followed up after treatment with immunocryosurgery showed that proposed quantitative lip marker was able to trace the improvement of disease after treatment. CONCLUSION Correct lip border recognition is the prerequisite for extracting essential morphological descriptors from lips with epithelial diseases like solar cheilosis. In this paper we presented an efficient method for the automatic identification and quantitative description of lower lip vermilion border morphology in health and disease using digital photography and image analysis techniques.
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Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, University of Ioannina, School of Health Sciences, University Campus, 45110 Ioannina, Greece.
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, University of Ioannina, School of Health Sciences, University Campus, 45110 Ioannina, Greece
| | - Margaret Tzaphlidou
- Department of Medical Physics, University of Ioannina, School of Health Sciences, University Campus, 45110 Ioannina, Greece.
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, University of Ioannina, School of Health Sciences, University Campus, 45110 Ioannina, Greece
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de Santana Sarmento DJ, da Costa Miguel MC, Queiroz LMG, Godoy GP, da Silveira EJD. Actinic cheilitis: clinicopathologic profile and association with degree of dysplasia. Int J Dermatol 2013; 53:466-72. [PMID: 24320079 DOI: 10.1111/ijd.12332] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by exposure to solar radiation. OBJECTIVES This study was conducted to evaluate the clinicopathologic profile of cases of AC and to verify associations with the degree of dysplasia. METHODS This retrospective study analyzed data for 40 patients with AC. Demographic, clinical, and histopathologic data were evaluated. Sections measuring 5 μm in thickness were cut, deparaffinized, and stained with hematoxylin and eosin for histologic examination. The degree of epithelial dysplasia was graded using the criteria defined by the World Health Organization. Two calibrated oral pathologists analyzed the slides. RESULTS Analysis of the AC patients sampled showed that 75.0% were male (P=0.002), 80.0% were aged≥40 years (P<0.001), 74.3% were Caucasian (P=0.004), and 68.6% had occupational exposure to sunlight (P=0.028). The most common clinical manifestation was white lesions (55.0%), and 40.0% of patients had no dysplasia. No significant associations emerged between the histologic grading of AC and gender (P=1.000), age (P=1.000), ethnicity (P=0.416), occupational exposure to sunlight (P=1.000), and clinical presentation (P=0.467). CONCLUSIONS The degree of dysplasia in AC was not statistically associated with gender, age, ethnicity, occupational exposure to sunlight, or clinical appearance. This study provides some support for the hypothesis that clinicopathologic features are not related to the degree of dysplasia in AC.
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Levi A, Wulf HC, Enk CD. Two cases of actinic cheilitis responsive to daylight-activated photodynamic therapy (DA-PDT). PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:268-71. [DOI: 10.1111/phpp.12057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Assi Levi
- Department of Dermatology; Hadassah-Hebrew University Medical School; Jerusalem; Israel
| | - Hans C. Wulf
- Department of Dermatology; Bispebjerg Hospital; Copenhagen; Denmark
| | - Claes D. Enk
- Department of Dermatology; Hadassah-Hebrew University Medical School; Jerusalem; Israel
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Manousaridis I, Leverkus M. Malignant epithelial tumors: Part II. Therapy and prevention. J Dtsch Dermatol Ges 2013; 11:9-25; quiz 26-7. [PMID: 23286911 DOI: 10.1111/ddg.12001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A multitude of surgical and non-surgical therapies are available to treat malignant epithelial tumors of the skin. The article summarizes the current treatment options for basal cell carcinoma, squamous cell carcinoma and keratoacanthoma. Moreover, the possibilities of primary and secondary prevention for high-risk patients are reviewed. The decision about the best therapeutic option depends on location, age, and general health of the patient as well as the risk of tumor recurrence.
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Affiliation(s)
- Ioannis Manousaridis
- Department of Dermatology, Venereology and Allergology of the Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Terapia fotodinámica versus imiquimod. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:488-501. [DOI: 10.1016/j.ad.2011.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/27/2011] [Accepted: 10/02/2011] [Indexed: 11/22/2022] Open
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Serra-Guillén C, Nagore E, Guillén C. Photodynamic Therapy vs Imiquimod. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jadotte YT, Schwartz RA. Solar cheilosis: An ominous precursor. J Am Acad Dermatol 2012; 66:187-98; quiz 199-200. [DOI: 10.1016/j.jaad.2011.09.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 08/31/2011] [Accepted: 09/04/2011] [Indexed: 11/15/2022]
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Sotiriou E, Lallas A, Goussi C, Apalla Z, Trigoni A, Chovarda E, Ioannides D. Sequential use of photodynamic therapy and imiquimod 5% cream for the treatment of actinic cheilitis: a 12‐month follow‐up study. Br J Dermatol 2011; 165:888-92. [DOI: 10.1111/j.1365-2133.2011.10478.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Sotiriou
- First Dermatology Department, Medical School, Aristotle University Thessaloniki, 54645 Thessaloniki, Greece
| | - A. Lallas
- First Dermatology Department, Medical School, Aristotle University Thessaloniki, 54645 Thessaloniki, Greece
| | - C. Goussi
- First Dermatology Department, Medical School, Aristotle University Thessaloniki, 54645 Thessaloniki, Greece
| | - Z. Apalla
- First Dermatology Department, Medical School, Aristotle University Thessaloniki, 54645 Thessaloniki, Greece
| | - A. Trigoni
- First Dermatology Department, Medical School, Aristotle University Thessaloniki, 54645 Thessaloniki, Greece
| | - E. Chovarda
- First Dermatology Department, Medical School, Aristotle University Thessaloniki, 54645 Thessaloniki, Greece
| | - D. Ioannides
- First Dermatology Department, Medical School, Aristotle University Thessaloniki, 54645 Thessaloniki, Greece
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