1
|
López Montalbán S, Alarcón Soldevilla F, Abenza Baeza S, Miranda Rollón MD, López Ávila Á, Yago Ugarte I. Intralesional methotrexate and new approaches for neoadjuvance treatment in squamous cell periocular carcinoma. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024:S2173-5794(24)00137-3. [PMID: 39038784 DOI: 10.1016/j.oftale.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/05/2024] [Indexed: 07/24/2024]
Abstract
This study arises from the need to understand the different therapies for cutaneous squamous cell carcinoma (SCC), especially in challenging clinical situations where conventional therapeutic options may not be optimal. The purpose of the study is to assess the efficacy and safety of intralesional methotrexate (MTX) as neoadjuvant therapy in the treatment of periocular SCC. The outcome of a patient after two separate intralesional MTX infiltrations 2 weeks apart is described. Therapeutic response was evaluated, achieving a significant reduction in tumor size and subsequently performing surgical excision of the residual lesion. The procedure was well tolerated, with no local or distant recurrences in the follow up. Intralesional MTX may be an effective and safe option in the neoadjuvant treatment of periocular SCC. Furthermore, we highlight the growing importance of immunotherapy in the approach to SCC and the need to familiarize specialists with these new treatments.
Collapse
Affiliation(s)
- S López Montalbán
- Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
| | | | - S Abenza Baeza
- Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - M D Miranda Rollón
- Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Á López Ávila
- Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - I Yago Ugarte
- Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| |
Collapse
|
2
|
Nofal A, Alakad R, Wahid R, Hoseiny HAM. Intralesional methotrexate versus 5-flurouracil in the treatment of keratoacanthoma. Arch Dermatol Res 2024; 316:400. [PMID: 38878177 PMCID: PMC11180009 DOI: 10.1007/s00403-024-03139-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Keratoacanthoma (KA) is a benign neoplasm that affects mainly photodamaged skin. It is locally destructive and may rarely spread. Surgery is not always suitable and usually disfiguring. Thus, non-operative modalities represent good alternatives. OBJECTIVE To assess and compare the efficacy of intralesional methotrexate (MTX) and 5-flurouracil (5-FU) in the treatment of KA. PATIENTS AND METHODS Randomized controlled trial included 20 patients with biopsy proven KA divided into 2 equal groups; group (A) received intralesional MTX, 25 mg/ml and group (B) received intralesional 5-FU, 50 mg/ml every 2 weeks till complete clearance or for a maximum 5 sessions. RESULTS In the MTX group, complete clearance was observed in 7 patients (70%) compared to 8 patients (80%) in the 5- FU group with no statistically significant difference. However, the median number of injections needed to achieve complete response in the MTX group was 3 sessions versus only 2 sessions in the 5-FU group. LIMITATIONS the small sample size due to the relatively low incidence of KAs in our population. CONCLUSION Intralesional therapy is a good alternative to surgery in selected cases of KA. Both drugs showed comparable efficacy, but 5-FU may give faster results, hence increasing patient satisfaction and compliance.
Collapse
Affiliation(s)
- Ahmad Nofal
- Dermatology, Venereology &Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Rania Alakad
- Dermatology, Venereology &Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Reham Wahid
- Physiology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Heba Allah Mohamed Hoseiny
- Dermatology, Venereology &Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt.
| |
Collapse
|
3
|
Silvestre Torner N, Gruber Velasco F, Romero Jiménez B, Vargas Laguna E. [Translated article] Intralesional Methotrexate for Keratoacanthomas: A Case Series. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T279-T281. [PMID: 36717071 DOI: 10.1016/j.ad.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- N Silvestre Torner
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
| | - F Gruber Velasco
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - B Romero Jiménez
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - E Vargas Laguna
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| |
Collapse
|
4
|
Silvestre Torner N, Gruber Velasco F, Romero Jiménez B, Vargas Laguna E. Intralesional Methotrexate for Keratoacanthomas: A Case Series. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:279-281. [PMID: 36273558 DOI: 10.1016/j.ad.2022.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- N Silvestre Torner
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
| | - F Gruber Velasco
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - B Romero Jiménez
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - E Vargas Laguna
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| |
Collapse
|
5
|
Mei D, Song L, Gao JQ, Wu J. Interventional treatment of keratoacanthoderma: a case report. J Int Med Res 2022; 50:3000605221143287. [PMID: 36565019 PMCID: PMC9793027 DOI: 10.1177/03000605221143287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This current case report describes a 56-year-old male patient with a skin mass on his lip that had been growing for 1 year. The pathological findings demonstrated that the epidermis was characterized by hyperkeratosis, hyperplasia and hypertrophy and was formed in the shape of a crater. The skin on both ends had developed into a ball-like growth that resembled a volcanic cone. There was invasive growth of heterotype squamous epithelium and a small number of inflammatory cells infiltrating the dermis. Immunohistochemistry demonstrated an increase in P16 (the focus, +) and the hot spot Ki-67 index. The diagnosis was of tumour-like hyperplasia, malignancy and moderate-to-severe dysplasia confirming that it was keratoacanthoma. The patient underwent surgical resection and was discharged from hospital, but the tumour returned. Paclitaxel and cisplatin were administered intraoperatively and bilateral lingual artery perfusion chemoembolization was undertaken six times. This procedure led to an excellent postoperative recovery and discharge from hospital. Tumour therapy was regarded as successful. The patient's medical history included acute lymphoblastic leukaemia L1 and long-term immunosuppressant use. After a 6-month period of follow-up, he died from systemic organ failure as a consequence of having too many ailments.
Collapse
Affiliation(s)
| | - Lei Song
- Lei Song, Department of Interventional
Therapy, The Second Affiliated Hospital of Dalian Medical University, 467
Zhongshan Road, Shahekou District, Dalian, Liaoning Province, 116023, China.
| | | | | |
Collapse
|
6
|
Bosch-Amate X, Mancinelli C, Morgado-Carrasco D. [Translated article] RF - Nonsurgical Treatment of Keratoacanthomas. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
7
|
Bosch-Amate X, Mancinelli C, Morgado-Carrasco D. FR - Tratamiento no quirúrgico de los queratoacantomas. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:192-194. [DOI: 10.1016/j.ad.2020.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 10/20/2022] Open
|
8
|
Bosch-Amate X, Mancinelli C, Morgado-Carrasco D. RF - Nonsurgical Treatment of Keratoacanthomas. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
9
|
Tisack A, Fotouhi A, Fidai C, Friedman BJ, Ozog D, Veenstra J. A clinical and biological review of keratoacanthoma. Br J Dermatol 2021; 185:487-498. [PMID: 33864244 DOI: 10.1111/bjd.20389] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 01/08/2023]
Abstract
Keratoacanthoma (KA) is a common skin tumour that remains controversial regarding classification, epidemiology, diagnosis, prognosis and management. Classically, a KA manifests as a rapidly growing, well-differentiated, squamoid lesion with a predilection for sun-exposed sites in elderly people and a tendency to spontaneously regress. Historically, KAs have been considered a variant of cutaneous squamous cell carcinoma (cSCC) and are often reported as KA-type cSCC. However, the penchant for regression has led many to categorize KAs as biologically benign tumours with distinct pathophysiological mechanisms from malignant cSCC. The clinical and histopathological similarities between KA and cSCC, particularly the well-differentiated variant of cSCC, have made definitive differentiation difficult or impossible in many cases. The ambiguity between entities has led to the general recommendation for surgical excision of KAs to ensure a potentially malignant cSCC is not left untreated. This current standard creates unnecessary surgical morbidity and financial strain for patients, especially the at-risk elderly population. There have been no reports of death from a definitive KA to date, while cSCC has an approximate mortality rate of 1·5%. Reliably distinguishing cSCC from KA would shift management strategies for KAs towards less-invasive treatment modalities, prevent unnecessary surgical morbidity, and likely reduce associated healthcare costs. Herein, we review the pathophysiology and clinical characteristics of KA, and conclude on the balance of current evidence that KA is a benign lesion and distinct from cSCC.
Collapse
Affiliation(s)
- A Tisack
- Wayne State University School of Medicine, Detroit, MI, USA
| | - A Fotouhi
- Wayne State University School of Medicine, Detroit, MI, USA
| | - C Fidai
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - B J Friedman
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - D Ozog
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - J Veenstra
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
10
|
Mitri F, Hartschuh W, Toberer F. Multiple Keratoacanthomas after a Recent Tattoo: A Case Report. Case Rep Dermatol 2021; 13:23-27. [PMID: 33613230 PMCID: PMC7879243 DOI: 10.1159/000510707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022] Open
Abstract
We report on a 39-year-old man who presented with seven skin lesions on the right thigh 3 weeks after receiving a large tattoo which included red and black pigments. Initially, the lesions grew fast, later their growth stabilized. Histopathology showed well-circumscribed symmetric tumors with a central keratin-filled crater along with further trademarks of a keratoacanthoma. The patient had previously had multiple tattoos with no history of similar lesions. PCR analysis of one of the lesions revealed the presence of human papillomavirus 6. All lesions were excised with a safety margin. A 3-month follow-up revealed no further lesions.
Collapse
Affiliation(s)
- Fouad Mitri
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Hartschuh
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
11
|
Hoegler KM, Schleichert RA. Is the first-line treatment of keratoacanthomas surgical excision or injection of intralesional chemotherapy? J Am Acad Dermatol 2020; 83:1542-1543. [PMID: 32622139 DOI: 10.1016/j.jaad.2020.01.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Karl M Hoegler
- Department of Dermatology, University of Maryland Medical Center, Baltimore, Maryland.
| | - Rachel A Schleichert
- Department of Dermatology, University of Maryland Medical Center, Baltimore, Maryland
| |
Collapse
|