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Toulemonde E, Faiz S, Dubois R, Verhasselt-Crinquette M, Carpentier O, Abi Rached H, Mortier L. Photodynamic therapy for the treatment of primary cutaneous B-cell marginal zone lymphoma: A series of 4 patients. JAAD Case Rep 2023; 33:62-66. [PMID: 36860806 PMCID: PMC9969199 DOI: 10.1016/j.jdcr.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Elise Toulemonde
- Department of Dermatology, Claude Huriez Hospital, Lille University Hospital, Lille, France,Correspondence to: Elise Toulemonde, BA, 2 Ave Oscar Lambret, 59000, Lille, France.
| | - Sarah Faiz
- Department of Dermatology, Claude Huriez Hospital, Lille University Hospital, Lille, France,Department of Dermatology, Hospital of Douai, Douai, France
| | - Romain Dubois
- Department of Anatomopathology, Biology and Pathology Center Pierre-Marie Degand, CHU Lille, Lille, France
| | | | - Olivier Carpentier
- Department of Dermatology, Claude Huriez Hospital, Lille University Hospital, Lille, France,Department of Dermatology, Hospital of Roubaix, Roubaix, France
| | - Henry Abi Rached
- Department of Dermatology, Claude Huriez Hospital, Lille University Hospital, Lille, France
| | - Laurent Mortier
- Department of Dermatology, Claude Huriez Hospital, CARADERM and University of Lille, U1189 Inserm, Lille, France
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Farberg AS, Marson JW, Soleymani T. Advances in Photodynamic Therapy for the Treatment of Actinic Keratosis and Nonmelanoma Skin Cancer: A Narrative Review. Dermatol Ther (Heidelb) 2023; 13:689-716. [PMID: 36662422 PMCID: PMC9984667 DOI: 10.1007/s13555-023-00888-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023] Open
Abstract
Photodynamic therapy (PDT) with photosensitization using 5-aminolevulinic acid (ALA) [including a nanoemulsion (BF-200 ALA)] is approved in the USA for the treatment of actinic keratoses (AKs); another derivative, methyl aminolevulinate, is not approved in the USA but is used in Europe. For AK treatment, the photosensitizer may be applied to individual AK lesions or, depending on treatment regimen, to broader areas of sun-damaged skin to manage field cancerization, although not all products are approved for field treatment. ALA-PDT and photosensitizers have also been used off-label for the treatment of nonmelanoma skin cancers, primarily basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (cSCC). Advantages of PDT include potentially improved cosmesis and patient satisfaction; disadvantages include pain and duration of treatment. Alternative illumination approaches, including intense pulsed light as well as pulsed-dye lasers, have also been used successfully. Pretreating the affected tissue or warming during incubation can help to increase photosensitizer absorption and improve therapeutic efficacy. Combinations of multiple treatments are also under exploration. Reducing incubation time between photosensitizer application and illumination may significantly reduce pain scores without affecting treatment efficacy. Substituting daylight PDT for a conventional illumination source can also reduce pain without compromising efficacy. The objective of this narrative review is to describe current and ongoing research in the use of topical photosensitizers and modified light delivery regimens to achieve improved therapeutic outcomes with less toxicity in patients with AK, cSCC, BCC, and field cancerization.
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Affiliation(s)
- Aaron S. Farberg
- grid.486749.00000 0004 4685 2620Section of Dermatology, Baylor Scott & White Health System, Dallas, TX USA ,Bare Dermatology, Dallas, TX USA
| | - Justin W. Marson
- grid.262863.b0000 0001 0693 2202SUNY Downstate Health Sciences University, Brooklyn, NY USA
| | - Teo Soleymani
- grid.19006.3e0000 0000 9632 6718Division of Dermatologic Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA USA
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Folic acid conjugated PAMAM-modified mesoporous silica-coated superparamagnetic iron oxide nanoparticles for potential cancer therapy. J Colloid Interface Sci 2022; 625:711-721. [PMID: 35772201 DOI: 10.1016/j.jcis.2022.06.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/06/2022] [Accepted: 06/17/2022] [Indexed: 01/10/2023]
Abstract
In this study, novel folate-receptor-targeted polyamidoamine (PAMAM) dendrimer functional mesoporous silica-coated magnetic nanoparticles were prepared for drug delivery agents for photodynamic therapy applications. The surface of the magnetic nanoparticles was coated with mesoporous silica (M-MSN). The M-MSN nanoparticles were functionalized with siloxane-cored PAMAM dendrons (generation 1 to 3). The surface of the M-MSN-PAMAM nanocarriers was targeted with folic acid. Indocyanine green (ICG) a near-infrared dye was loaded in the M-MSN-PAMAM nanocarriers and the photodynamic therapy efficiency of the drug-loaded nanocarriers was evaluated on MCF-7 cells. MCF-7 cells were subjected to tissue culture E-Plate that was used to generate dynamic real-time data by measuring electrical impedance across interdigitated microelectrodes on the bottom of the plate. Light source (LEDs) was designed as a system that fit 96 well-plate and cells were irradiated at 785 nm for 20 min. Also, these results were confirmed by WST-1 assay in dark and light conditions for MCF-7 cells. The results showed that in vitro application of ICG loaded M-MSN-PAMAM-FA causes apoptosis in the MCF-7 cell line.
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Ratkaj I, Mušković M, Malatesti N. Targeting Microenvironment of Melanoma and Head and Neck Cancers
in Photodynamic Therapy. Curr Med Chem 2022; 29:3261-3299. [DOI: 10.2174/0929867328666210709113032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
Background:
Photodynamic therapy (PDT), in comparison to other skin cancers,
is still far less effective for melanoma, due to the strong absorbance and the role of
melanin in cytoprotection. The tumour microenvironment (TME) has a significant role in
tumour progression, and the hypoxic TME is one of the main reasons for melanoma progression
to metastasis and its resistance to PDT. Hypoxia is also a feature of solid tumours
in the head and neck region that indicates negative prognosis.
Objective:
The aim of this study was to individuate and describe systematically the main
strategies in targeting the TME, especially hypoxia, in PDT against melanoma and head
and neck cancers (HNC), and assess the current success in their application.
Methods:
PubMed was used for searching, in MEDLINE and other databases, for the
most recent publications on PDT against melanoma and HNC in combination with the
TME targeting and hypoxia.
Results:
In PDT for melanoma and HNC, it is very important to control hypoxia levels,
and amongst the different approaches, oxygen self-supply systems are often applied. Vascular
targeting is promising, but to improve it, optimal drug-light interval, and formulation
to increase the accumulation of the photosensitiser in the tumour vasculature, have to
be established. On the other side, the use of angiogenesis inhibitors, such as those interfering
with VEGF signalling, is somewhat less successful than expected and needs to be
further investigated.
Conclusion:
The combination of PDT with immunotherapy by using multifunctional nanoparticles
continues to develop and seems to be the most promising for achieving a
complete and lasting antitumour effect.
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Affiliation(s)
- Ivana Ratkaj
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
| | - Martina Mušković
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
| | - Nela Malatesti
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
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The Immunogenetic Aspects of Photodynamic Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:433-448. [DOI: 10.1007/978-3-030-92616-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Azzopardi EA, Abdelrahman W, Azzopardi E, O’Leary B, Yarrow J, Miles N, Barbara C, Camilleri L, Clementoni MT, Murison M. Treatment of cutaneous basal cell carcinoma with combined laser extirpation and methyl aminolevulinic acid: five-year success rates. Ann R Coll Surg Engl 2021; 103:263-271. [PMID: 33557701 PMCID: PMC10752010 DOI: 10.1308/rcsann.2020.7020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Basal cell carcinoma is the most common cancer. Excisional surgery is associated with a high clearance rate, at the expense of significant functional and aesthetic morbidity, especially within the T-zone or for extensive lesions. We report five-year follow-up outcomes for carbon dioxide laser extirpation of cutaneous basal cell carcinoma, assisted by immediate methyl aminolevulinate photodynamic therapy and cost-benefit considerations. MATERIALS AND METHODS Retrospective cohort database analysis of adult patients with biopsy-proven primary cutaneous basal cell carcinoma, completing five years of follow-up. Direct per-lesion cost was compared with conventional wide local excision. Patients with morphoeic basal cell carcinoma were excluded. RESULTS Treated lesions were up to 1% total body surface area and up to 3.8mm (1.38 ± 0.695cm, mean ± standard deviation) in biopsy-proven depth. At the five-year follow-up mark, 93.6% of treated areas remained free of recurrence. Nodular basal cell carcinoma was the most common subtype (41.5%). A mean tumour depth greater than 2 ± 0.872mm was significantly associated with recurrence (Mann-Whitney, p = 0.0487). For a service delivered through the NHS at 2015 prices, we report a 43% saving, equating to a saving of £235 per basal cell carcinoma or a national annualised saving of £70 million by 2025 for the NHS. CONCLUSION Our results suggest that CO2-assisted photodynamic therapy is non-inferior to excision but may offer better functional and cosmetic preservation at a fraction of the direct like for like cost of operative surgery. Investigation of this method by randomised controlled methodology is warranted.
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Affiliation(s)
| | - W Abdelrahman
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - E Azzopardi
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - B O’Leary
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - J Yarrow
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | - N Miles
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
| | | | | | | | - M Murison
- Morriston Hospital, Swansea Bay
University Health Board, Swansea,
UK
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Xing J, Gong Q, Akakuru OU, Liu C, Zou R, Wu A. Research advances in integrated theranostic probes for tumor fluorescence visualization and treatment. NANOSCALE 2020; 12:24311-24330. [PMID: 33300527 DOI: 10.1039/d0nr06867e] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
At present, cancer is obviously a major threat to human health worldwide. Accurate diagnosis and treatment are in great demand and have become an effective method to alleviate the development of cancer and improve the survival rate of patients. A large number of theranostic probes that combine diagnosis and treatment methods have been developed as promising tools for tumor precision medicine. Among them, fluorescent theranostic probes have developed rapidly in the frontier research field of precision medicine with their real time, low toxicity, and high-resolution merit. Therefore, this review focuses on recent advances in the development of fluorescent theranostic probes, as well as their applications for cancer diagnosis and treatment. Initially, small-molecule fluorescent theranostic probes mainly including tumor microenvironment-responsive fluorescent prodrugs and phototherapeutic probes were introduced. Subsequently, nanocomposite probes are expounded based on four types of nano-fluorescent particles combining different therapies (chemotherapy, photothermal therapy, photodynamic therapy, gene therapy, etc.). Then, the capsule-type "all in one" probes, which occupy an important position in theranostic probes, are summarized according to the surface carrier type. This review aims to present a comprehensive guide for researchers in the field of tumor-related theranostic probe design and development.
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Affiliation(s)
- Jie Xing
- Cixi Institute of Biomedical Engineering, CAS Key Laboratory of Magnetic Materials and Devices, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, PR China. and University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Qiuyu Gong
- Cixi Institute of Biomedical Engineering, CAS Key Laboratory of Magnetic Materials and Devices, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, PR China.
| | - Ozioma Udochukwu Akakuru
- Cixi Institute of Biomedical Engineering, CAS Key Laboratory of Magnetic Materials and Devices, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, PR China. and University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Chuang Liu
- Cixi Institute of Biomedical Engineering, CAS Key Laboratory of Magnetic Materials and Devices, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, PR China. and University of Chinese Academy of Sciences, Beijing, 100049, PR China
| | - Ruifen Zou
- Cixi Institute of Biomedical Engineering, CAS Key Laboratory of Magnetic Materials and Devices, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, PR China.
| | - Aiguo Wu
- Cixi Institute of Biomedical Engineering, CAS Key Laboratory of Magnetic Materials and Devices, Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, PR China.
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Zhong S, Zhang R, Mei X, Wang L. Efficacy of photodynamic therapy for the treatment of Bowen’s disease: An updated systematic review and meta-analysis of randomized controlled trials. Photodiagnosis Photodyn Ther 2020; 32:102037. [DOI: 10.1016/j.pdpdt.2020.102037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/14/2020] [Accepted: 09/25/2020] [Indexed: 12/01/2022]
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Intense pulsed light therapy with meibomian gland expression for dry eye disease. Can J Ophthalmol 2020; 55:189-198. [PMID: 31941589 DOI: 10.1016/j.jcjo.2019.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the effectiveness of intense pulsed light therapy (IPL) with meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD) and dry eye symptoms. DESIGN Systematic review followed by a meta-analysis. METHODS This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Literature sources included MEDLINE, Embase, Cochrane Library, and meeting abstracts from Canadian Ophthalmological Society, The Association for Research in Vision and Ophthalmology, The American Academy of Ophthalmology, and The European Society for Cataract and Refractive Surgeons. Articles underwent 3 stages of screening before data extraction and meta-analysis. RESULTS After the initial search, 502 studies were found. Six articles were included for meta-analysis, and data were extracted after 3 stages of screening. Meta-analysis indicated significant increase in tear break-up time (TBUT) post-treatment in the <1-month follow-up (standardized mean difference [SMD] = 1.29; confidence interval [CI]: 1.10-1.48), up-to-6-month follow-up (SMD = 1.71; CI: 1.46-1.96), and >6-month follow-up (SMD = 2.04; CI: 1.68-2.40) groups. Moreover, meta-analysis suggested a nonsignificant improvement in Standardized Patient Evaluation of Eye Dryness (SPEED) scores after IPL with MGX at the <1-month follow-up (SMD = -1.35; CI: -1.70 to -1.01), up-to-6-month follow-up (SMD = -1.68; CI: -1.93 to -1.43), and >6-month follow-up (SMD = -2.04; CI: -2.40 to -1.68) groups. Meta-analysis also indicated a nonsignificant improvement in Schirmer's test values at the up-to-2-month follow-up (SMD = -0.27; CI: -0.66 to 0.12), up-to-6-month follow-up (SMD = 0.04; CI: -0.25 to 0.33), and >6-month follow-up (SMD = -0.01; CI: -0.31 to 0.28) groups. CONCLUSIONS The results suggested a significant increase in TBUT and a nonsignificant increase in SPEED and Schirmer's test values at all follow-up periods post-treatment. Ultimately, IPL with MGX appears to be a promising therapy for MGD.
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Polymeric nanoparticles favor the in vitro dermal accumulation of Protoporphyrin IX (PpIX) with optimal biocompatibility and cellular recovery in culture of healthy dermal fibroblasts after Photodynamic Therapy. J Photochem Photobiol A Chem 2020. [DOI: 10.1016/j.jphotochem.2019.112109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Zhao S, Liu D, Shi W, Kang Y, Li Q, Liu Q, Chen M, Li F, Su J, Zhang Y, Wu L. Efficacy of a New Therapeutic Option for Vulvar Intraepithelial Neoplasia: Superficial Shaving Combined With Photodynamic Therapy. Lasers Surg Med 2019; 52:488-495. [DOI: 10.1002/lsm.23185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Shuang Zhao
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Hunan Key Laboratory of Skin Cancer and Psoriasis Changsha 410008 Hunan China
| | - Dihui Liu
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Wei Shi
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Yanan Kang
- Department of Obstetrics and Gynecology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Qingling Li
- Department of Pathology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Queping Liu
- Department of Pathology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Mingliang Chen
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
| | - Fangfang Li
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Hunan Key Laboratory of Skin Cancer and Psoriasis Changsha 410008 Hunan China
| | - Juan Su
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Hunan Key Laboratory of Skin Cancer and Psoriasis Changsha 410008 Hunan China
| | - Yu Zhang
- Department of Obstetrics and Gynecology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Gynecological Oncology Research and Engineering Center of Hunan ProvinceChangsha 410008 Hunan China
| | - Lisha Wu
- Department of Dermatology, Xiangya HospitalCentral South University 87 Xiangya Road Changsha 410008 Hunan China
- Hunan Key Laboratory of Skin Cancer and Psoriasis Changsha 410008 Hunan China
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South University Changsha 410008 Hunan China
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Rowan NJ. Pulsed light as an emerging technology to cause disruption for food and adjacent industries – Quo vadis? Trends Food Sci Technol 2019. [DOI: 10.1016/j.tifs.2019.03.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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A Retrospective Study of the Diagnostic Accuracy of In Vivo Reflectance Confocal Microscopy for Basal Cell Carcinoma Diagnosis and Subtyping. J Clin Med 2019; 8:jcm8040449. [PMID: 30987174 PMCID: PMC6518285 DOI: 10.3390/jcm8040449] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 12/15/2022] Open
Abstract
Current national and European guidelines recommend distinct management approaches for basal cell carcinoma (BCC) based on tumor location, size, and histopathological subtype. In vivo reflectance confocal microscopy (RCM) is a non-invasive skin imaging technique which may change the diagnostic pathway for BCC patients. This study aimed to determine the sensitivity and specificity of RCM for BCC diagnosis, assess the predictive values of several confocal criteria in correctly classifying BCC subtypes, and evaluate the intraobserver reliability of RCM diagnosis for BCC. We conducted a retrospective study in two tertiary care centers in Bucharest, Romania. We included adults with clinically and dermoscopic suspect BCCs who underwent RCM and histopathological examination of excision specimens. For RCM examinations, we used the VivaScope 1500 and histopathology of the surgical excision specimen was the reference standard. Of the 123 cases included in the analysis, BCC was confirmed in 104 and excluded in 19 cases. RCM showed both high sensitivity (97.1%, 95% CI (91.80, 99.40)) and specificity (78.95%, 95% CI (54.43, 93.95)) for detecting BCC. Several RCM criteria were highly predictive for BCC subtypes: cords connected to the epidermis for superficial BCC, big tumor islands, peritumoral collagen bundles and increased vascularization for nodular BCC, and hyporefractile silhouettes for aggressive BCC. Excellent intraobserver agreement (κ = 0.909, p < 0.001) was observed. This data suggests that RCM could be used for preoperative diagnosis and BCC subtype classification in patients with suspected BCCs seen in tertiary care centers.
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Requena MB, Vollet Filho JD, Barboza de Nardi A, Escobar A, da Rocha Adams R, Bagnato VS, de Menezes PFC. Topical and intradermal delivery of PpIX precursors for photodynamic therapy with intense pulsed light on porcine skin model. Lasers Med Sci 2019; 34:1781-1790. [PMID: 30903526 DOI: 10.1007/s10103-019-02771-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/06/2019] [Indexed: 11/26/2022]
Abstract
In order to purposely decrease the time of the photodynamic therapy (PDT) sessions, this study evaluated the effects of PDT using topical and intradermal delivery of two protoporphyrin (PpIX) precursors with intense pulsed light (IPL) as irradiation source. This study was performed on porcine skin model, using an IPL commercial device (Intense Pulse Light, HKS801). IPL effect on different administration methods of two PpIX precursors (ALA and MAL) was investigated: a topical cream application and an intradermal application using a needle-free, high-pressure injection system. Fluorescence investigation showed that PpIX distribution by needle-free injection was more homogeneous than that by cream, suggesting that a shorter drug-light interval in PDT protocols is possible. The damage induced by IPL-PDT assessed by histological analysis mostly shows modifications in collagens fibers and inflammation signals, both expected for PDT. This study suggested an alternative protocol for the PDT treatment, possibility half of the incubation time and with just 3 min of irradiation, making the IPL-PDT, even more, promising for the clinical treatment.
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Affiliation(s)
| | - José Dirceu Vollet Filho
- São Carlos Institute of Physics, University of São Paulo (USP), São Carlos, São Paulo, Brazil
- Institute of Geosciences and Exact Sciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil
| | - Andrigo Barboza de Nardi
- College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, São Paulo, Brazil
| | - Andre Escobar
- College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, São Paulo, Brazil
| | - Rozana da Rocha Adams
- College of Agricultural and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, São Paulo, Brazil
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Nestor MS, Berman B, Goldberg D, Cognetta AB, Gold M, Roth W, Cockerell CJ, Glick B. Consensus Guidelines on the Use of Superficial Radiation Therapy for Treating Nonmelanoma Skin Cancers and Keloids. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2019; 12:12-18. [PMID: 30881578 PMCID: PMC6415702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: The use of superficial radiation therapy (SRT) has experienced a renaissance for treating nonmelanoma skin cancers (NMSCs) and recurrent keloids; however, published treatment guidelines are lacking. Objective: The objective of this work was to provide consensus guidelines on the use of SRT for treating NMSC and recurrent keloids based on a review of the literature and expert opinion. Methods and Materials: A search of the medical literature was performed to obtain published information on the use of SRT for review. A group of qualified dermatologists convened to discuss their views on the use of SRT for the treatment of NMSCs and recurrent keloids. The various guidelines were considered to have consensus based on a supermajority two-thirds vote. The final consensus guidelines are thus based on the medical literature, when available, and expert opinions. Results: Agreement on consensus guidelines was reached for numerous aspects of SRT use, including appropriate tumor types for SRT; anatomical areas suitable for SRT; energy, fractions, and scheduling recommendations for SRT; use of SRT in the presence of comorbidities; safety factors; and treatment recommendations for recurrent keloids, based the literature and on both the opinions of the expert group and a survey of experienced users. Conclusion: Consensus was reached that SRT is a safe and effective treatment for basal cell and squamous cell carcinomas and should be considered as the first-line form of radiation treatment. Postsurgical treatment of keloid excision suture lines with SRT significantly reduces keloid recurrence rates.
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Affiliation(s)
- Mark S Nestor
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Brian Berman
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - David Goldberg
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Armand B Cognetta
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Michael Gold
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - William Roth
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Clay J Cockerell
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
| | - Brad Glick
- Drs. Nestor and Berman are with the Center for Clinical and Cosmetic Research in A ventura, Florida and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine in Miami, Florida
- Dr. Goldberg is with Skin Laser & Surgery Specialists of NY/NJ, Icahn School of Medicine at Mount Sinai, and Fordham Law School in New York, New York
- Dr. Cognetta is with Dermatology Associates of Tallahassee in Tallahassee, Florida
- Dr. Gold is with Gold Skin Care Center, the Tennessee Clinical Research Center, Vanderbilt University School of Nursing, and Meharry Medical College School of Medicine in Nashville, Tennessee
- Dr. Roth is with Dermatology and Dermatological Surgery in Boynton Beach, Florida
- Dr. Cockerell is with Cockerell Dermatopathology in Dallas, Texas
- Dr. Glick is with the Glick Skin Institute in Margate, Florida
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Akbarzadeh F, Khoshgard K, Hosseinzadeh L, Arkan E, Rezazadeh D. Investigating the Cytotoxicity of Folate-Conjugated Bismuth Oxide Nanoparticles on KB and A549 Cell Lines. Adv Pharm Bull 2019; 8:627-635. [PMID: 30607335 PMCID: PMC6311633 DOI: 10.15171/apb.2018.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/27/2018] [Accepted: 08/15/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose: Lately, bismuth-based nanomaterials have been widely utilized in medical researches such as imaging, drug delivery and radio-sensitization. Despite their advantages, bismuth-based compounds have shown toxic effects in humans. There are few studies on cytotoxicity effects of bismuth oxide (Bi2O3) nanoparticles (NPs) in-vitro. In this study, we aimed to investigate cytotoxicity of bare and also folate and 5-aminolevulinic acid (5-ALA)-conjugated Bi2O3 NPs on nasopharyngeal carcinoma (KB) and lung cancer (A549) cell lines. Methods: Bi2O3 NPs were synthesized and conjugated with folate and 5-ALA. KB and A549 cells were cultured and incubated with 10, 20, 50 and 100 μg/ml concentrations of bare and folate-5-ALA-conjugated NPs. The survival rates were obtained after 2 and 24 hours incubation of the cells with NPs using MTT assay. Also, apoptosis and ROS generation induced by the NPs in the treated cells were obtained using Caspases-3 activity assay and flow cytometry analysis, respectively. Results: Bi2O3 NPs were successfully synthesized with average size of 19.2 ± 6.5 nm, then conjugated with 5-ALA and folate. Either naked or folate-conjugated NPs were easily taken up by the cells in a concentration-dependent manner and showed cytotoxic effects. The significant cell death was noted at the concentrations more than 50 μg/ml for both compounds. Conclusion: Results indicated low cytotoxicity of the prepared NPs at lower incubation periods, which is very important for their further applications. However, 24 hours incubation of the cells with both forms of NPs caused more cell killing and the cytotoxicity increased with increasing concentrations of the NPs.
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Affiliation(s)
- Fatemeh Akbarzadeh
- Students Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Karim Khoshgard
- Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Hosseinzadeh
- Pharmaceutical Sciences Research Center, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Elham Arkan
- Nano Drug Delivery Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Davood Rezazadeh
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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17
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O’Connell KA, Okhovat JP, Zeitouni NC. Photodynamic therapy for Bowen’s Disease (squamous cell carcinoma in situ) current review and update. Photodiagnosis Photodyn Ther 2018; 24:109-114. [DOI: 10.1016/j.pdpdt.2018.09.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023]
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18
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Michelini M. Photodynamic therapy activated by intense pulsed light in the treatment of actinic keratosis. GIORN ITAL DERMAT V 2018; 155:470-476. [PMID: 30428649 DOI: 10.23736/s0392-0488.18.05894-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Actinic keratosis (AK), a hyperkeratotic lesion induced by solar exposure, is the precancerous lesion that most frequently develops into squamous cell carcinoma. Cryotherapy, topical fluorouracil 5, topical diclofenac 3% gel and, more recently, ingenol mebutate are used in addition to surgery. However, these treatments have varying degrees of effectiveness and are not always tolerated due to side effects. In recent years, photodynamic therapy (PDT), has asserted itself as a new effective and safe method for the treatment of actinic keratoses with almost no side effects. The aim of this study is to verify whether a third treatment may now be added to the "Conventional -PDT" and "Daylight-PDT": PhotoDynamic Therapy activated by Intense Pulsed Light (IPL-PDT). METHODS Thirty-one patients, 24 males and 7 females, in most cases elderly, were included in the trial. As in the previous methods, also in IPL-PDT, 5-methylaminolevulinic acid (MAL) was applied topically for a period of 3 hours. Thereafter, the occlusive dressing and the topical cream, were removed and the neoformation was irradiated with IPL, with a 640 nm filter with variable power. Irradiation was performed in single or multiple sessions, depending on the type of keratosis, to completely cover the lesion and the apparently healthy surrounding areas, i.e. the cancerization field. RESULTS Results were evaluated 3, 6 and 9 months after treatment. Treatment achieved a 95% complete clearance rate, with a 5% partial relapse, 9 months after the last treatment. CONCLUSIONS The above method is a valid alternative to methods already in use. The results obtained demonstrate the efficacy and tolerability of the treatment described which, due to its versatility and speed of use, is preferable to the methods used so far.
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Affiliation(s)
- Marco Michelini
- Department of Dermatology and Venereology, General Hospital, Alessandria, Italy -
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19
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Seah GL, Yu JH, Yang MY, Kim WJ, Kim JH, Park K, Cho JW, Kim JS, Nam YS. Low-power and low-drug-dose photodynamic chemotherapy via the breakdown of tumor-targeted micelles by reactive oxygen species. J Control Release 2018; 286:240-253. [PMID: 30071252 DOI: 10.1016/j.jconrel.2018.07.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 12/31/2022]
Abstract
Tumor-targeted delivery of anticancer agents using nanocarriers has been explored to increase the therapeutic index of cancer chemotherapy. However, only a few nanocarriers are clinically available because the physiological complexity often compromises their ability to target, penetrate, and control the release of drugs. Here, we report a method which dramatically increases in vivo therapeutic drug efficacy levels through the photodynamic degradation of tumor-targeted nanocarriers. Folate-decorated poly(ethylene glycol)-polythioketal micelles are prepared to encapsulate paclitaxel and porphyrins. Photo-excitation generates reactive oxygen species within the micelles to cleave the polythioketal backbone efficiently and facilitate drug release only at the illuminated tumor site. Intravenous injection of a murine xenograft model with a low dose of paclitaxel within the micelles, one-milligram drug per kg (mouse), corresponding to an amount less than that of Taxol by one order of magnitude, induces dramatic tumor regression without any acute systemic inflammation responses or organ toxicity under low-power irradiation (55 mW cm-2) at 650 nm.
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Affiliation(s)
- Geok Leng Seah
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Jeong Heon Yu
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Moon Young Yang
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Woo Jin Kim
- Pathology Research Center, Department of Jeonbuk Inhalation Research, Korea Institute of Toxicology, 30 Baekhak-1-gil, Jeongup, Jeonbuk 56212, Republic of Korea
| | - Jin-Ho Kim
- Samsung Medical Center, Samsung Biomedical Research Institute, Irwon-dong, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Keunchil Park
- Samsung Medical Center, Samsung Biomedical Research Institute, Irwon-dong, Gangnam-gu, Seoul 06351, Republic of Korea; Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jae-Woo Cho
- Pathology Research Center, Department of Jeonbuk Inhalation Research, Korea Institute of Toxicology, 30 Baekhak-1-gil, Jeongup, Jeonbuk 56212, Republic of Korea
| | - Jee Seon Kim
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea.
| | - Yoon Sung Nam
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea; KAIST Institute for the NanoCentury, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea.
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20
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Latteri S, Catania VE, Malaguarnera G, Peri A, Bertino G, Frazzetto G, Borzì AM, Biondi A, Perrotta RE, Malaguarnera M. Carcinoembryonic Antigen Serum Levels in Nonmelanoma Skin Cancer. Biomedicines 2018; 6:biomedicines6010024. [PMID: 29473860 PMCID: PMC5874681 DOI: 10.3390/biomedicines6010024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 02/08/2023] Open
Abstract
Background: Carcinoembryonic antigen (CEA) is a glycoprotein, which is present in the foetal colon, some benign conditions and different malignancies, particularly in colon adenocarcinoma. We focused this study on non-melanoma skin cancer (NMSC). NMSC is a common malignancy and it is an important source of morbidity and death in the world. In this study we evaluated whether CEA level increases in NMSC. Patients and Methods: A total of 566 patients with non-melanoma skin cancer (NMSC) were enrolled; 286 patients with NMSC showed CEA levels above normal values, and 280 showed CEA levels below normal values. Patients with high levels of CEA underwent abdominal ultrasound, gastro endoscopy, colonoscopy, and abdominal CT scans. Results: We studied 566 patients, 286 were positive to CEA and 280 were negative. Of the 286 patients positive to CEA, 132 had basal cell carcinoma (64 patients had an associated cancer) and 154 had squamous cell carcinoma (75 patients were affected by cancer). Of the 280 patients negative to CEA, 130 had basal cell carcinoma (12 were associated with cancer), and 150 had squamous cell carcinoma (18 were associated with cancer). The mean age of the 566 case control subjects were 65–81 years. Of the 10 subjects that were the positive control for CEA, two had cancer. Of the 556 subjects that were the negative control for CEA, three had cancer. Conclusions: In patients that present high serum levels of CEA, we give attention to adenocarcinoma tumour first. The pattern of association may be attributable to bias because the group with NMSC were frequently evaluated than those with no history of NMSC. Our results showed that out of 286 patients that were CEA-positive, 139 had cancer, and of the 280 that were CEA-negative, 30 had cancer. Therefore, 20% of patients do not follow the trend. Other markers should be investigated.
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Affiliation(s)
- Saverio Latteri
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy.
| | - Vito Emanuele Catania
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy.
| | - Giulia Malaguarnera
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy.
- Research Centre "The Great Senescence", University of Catania, 95120 Catania, Italy.
| | - Andrea Peri
- Department of General Surgery, Policlinico "San Matteo", University of Pavia, 27100 Pavia, Italy.
| | - Gaetano Bertino
- Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
| | - Giuseppe Frazzetto
- Research Centre "The Great Senescence", University of Catania, 95120 Catania, Italy.
| | - Antonio Maria Borzì
- Research Centre "The Great Senescence", University of Catania, 95120 Catania, Italy.
| | - Antonio Biondi
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, 95100 Catania, Italy.
| | - Rosario Emanuele Perrotta
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, 95100 Catania, Italy.
| | - Michele Malaguarnera
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy.
- Research Centre "The Great Senescence", University of Catania, 95120 Catania, Italy.
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