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Abu Rached N, Gambichler T, Ocker L, Skrygan M, Seifert C, Scheel CH, Stockfleth E, Bechara FG. Haptoglobin is an independent marker for disease severity and risk for metabolic complications in hidradenitis suppurativa: A prospective study. J Eur Acad Dermatol Venereol 2024; 38:205-213. [PMID: 37669834 DOI: 10.1111/jdv.19495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease that is highly correlated with obesity. Haptoglobin serum levels have recently been recognized as an important biomarker linking obesity with chronic inflammation. OBJECTIVE To compare haptoglobin with previously proposed serum biomarkers for the determination of disease severity in HS patients. For this purpose, disease severity of HS patients was determined by a panel of clinical scores as well as several risk factors, such as weight and smoking habits. METHODS A prospective, diagnostic accuracy study was performed at the International Centre for Hidradenitis suppurativa/Acne inversa Bochum (ICH). The study included a total of 263 patients, including 131 who had a confirmed diagnosis of HS in Hurley I (n = 16), II (n = 56) and III (n = 59) HS, and 132 healthy controls. The main outcome was to identify serological inflammatory markers for HS disease severity [severe (III) vs. moderate/mild (II/I)] as assessed by Hurley classification. RESULTS The serum levels of acute phase proteins haptoglobin and CRP, as well as the number of neutrophils in peripheral blood, number of monocytes, the systemic immune-inflammation index and the pan-immune-inflammatory value correlated with disease severity according to established clinical scores (mHSS, SAHS, Hurley, DLQI). HS patients had significantly higher haptologlobin levels compared to healthy controls. Logistic regression analysis revealed haptoglobin as the only independent marker predicting severe HS. CONCLUSION In this prospective study, we discovered that the serum levels of the acute phase protein haptoglobin levels serve as an independent marker of disease severity in HS. While this presents the first study in the context of HS. Thus, the present data not only yield a highly promising serum marker to be further validated.
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Affiliation(s)
- N Abu Rached
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology and Phlebology, Christian Hospital Unna, Unna, Germany
| | - L Ocker
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C Seifert
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C H Scheel
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
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Gambichler T, Elfering J, Meyer T, Bruckmüller S, Stockfleth E, Skrygan M, Käfferlein HU, Brüning T, Lang K, Wagener D, Schröder S, Nick M, Susok L. Protein expression of prognostic genes in primary melanoma and benign nevi. J Cancer Res Clin Oncol 2022; 148:2673-2680. [PMID: 34757537 PMCID: PMC9470607 DOI: 10.1007/s00432-021-03779-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the protein expression characteristics of genes employed in a recently introduced prognostic gene expression assay for patients with cutaneous melanoma (CM). METHODS We studied 37 patients with CM and 10 with benign (melanocytic) nevi (BN). Immunohistochemistry of primary tumor tissue was performed for eight proteins: COL6A6, DCD, GBP4, KLHL41, KRT9, PIP, SCGB1D2, SCGB2A2. RESULTS The protein expression of most markers investigated was relatively low (e.g., DCD, KRT9, SCGB1D2) and predominantly cytoplasmatic in melanocytes and keratinocytes. COL6A6, GBP4, and KLHL41 expression was significantly enhanced in CM when compared to BN. DCD protein expression was significantly correlated with COL6A6, GBP4, and KLHL41. GBP4 was positively correlated with KLHL41 and inversely correlated with SCGB2B2. The latter was also inversely correlated with serum S100B levels at time of initial diagnosis. The presence of SCGB1D2 expression was significantly associated with ulceration of the primary tumor. KRT9 protein expression was significantly more likely found in acral lentiginous melanoma. The presence of DCD expression was less likely associated with superficial spreading melanoma subtype but significantly associated with non-progressive disease. The absence of SCGB2A2 expression was significantly more often observed in patients who did not progress to stage III or IV. CONCLUSIONS The expression levels observed were relatively low but differed in part with those found in BN. Even though we detected some significant correlations between the protein expression levels and clinical parameters (e.g., CM subtype, course of disease), there was no major concordance with the protective or risk-associated functions of the corresponding genes included in a recently introduced prognostic gene expression assay.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
| | - J Elfering
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - T Meyer
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - S Bruckmüller
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - H U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - K Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - D Wagener
- Pathology/Labor Lademannbogen MVZ GmbH, Hamburg, Germany
| | - S Schröder
- Pathology/Labor Lademannbogen MVZ GmbH, Hamburg, Germany
| | - M Nick
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
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Stockfleth E, Ortiz Brugués A. Foreword. J Eur Acad Dermatol Venereol 2022; 36 Suppl 6:3-4. [PMID: 35738807 DOI: 10.1111/jdv.18199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- E Stockfleth
- Department of Dermatology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - A Ortiz Brugués
- Laboratoires Dermatologiques Avène, Pierre Fabre Dermo-Cosmétique, Lavaur, France
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Stockfleth E, Revol O. Encouraging sun protection early in life: from a successful prevention programme in children to the identification of psychological barriers in adolescents. J Eur Acad Dermatol Venereol 2022; 36 Suppl 6:12-21. [PMID: 35738808 DOI: 10.1111/jdv.18194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
Children and adolescents have high rates of sunburn and high levels of ultraviolet radiation (UVR) exposure and are therefore at risk of developing skin cancer in later life. Minimizing UVR exposure in childhood and adolescence may be the most important component of skin cancer prevention efforts. Thus, age-adapted prevention campaigns, targeting children, adolescents and caregivers, are needed to change sun protection behaviour among individuals in these age groups. In the first part of this review, we describe the 'SunPass' programme, which was initiated in Germany in 2010 as the first nationwide educational intervention for sun safety designed to teach kindergarten children and their caregivers how to protect themselves from overexposure to the sun. Implemented in 55 kindergartens, this programme has been shown to be effective at improving sun protection behaviour (P < 0.001) and hat use (P = 0.029) among kindergarten children, as well as at improving shade practices and increasing demand for protective clothing (P < 0.001). Up to 40 000 children, 50 000 parents/grandparents and 2500 kindergarten caregivers took part in the SunPass programme in Germany from 2019 to June 2021. The programme has also been adapted and implemented in several other European countries and could be readily adapted for use elsewhere. In the second part of this review, we discuss the specific challenges faced by adolescents and consider how these issues may impact their sun protection behaviour. Adolescents have difficulties suppressing responses to reward-related cues and projecting themselves into the future. They also place a lot of importance on social acceptance and cosmetic appearance, and their higher risk of depression, addiction and impulsivity make them vulnerable to tanning addiction. These specificities need to be acknowledged by dermatologists, so they can adapt their therapeutic relationship and develop effective sun protection interventions for this generation.
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Affiliation(s)
- E Stockfleth
- Klinik für Dermatologie und Ruhr-Universität Bochum, Gudrunstrasse 52, Bochum, Germany
| | - O Revol
- Child Development Unit, Hospices Civils de Lyon, Bron, France
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Gambichler T, Stockfleth E, Susok L. Aggressive cutaneous squamous cell carcinoma in a hydroxyurea- and ruxolitinib-pretreated patient with polycythaemia vera. J Eur Acad Dermatol Venereol 2021; 36 Suppl 1:63-65. [PMID: 34855240 DOI: 10.1111/jdv.17406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/02/2021] [Indexed: 12/26/2022]
Abstract
Hydroxyurea and ruxolitinib are frequently used to treat myeloproliferative disorders, including polycythaemia vera, and chronic treatment is associated with many cutaneous adverse effects such as the development of aggressive non-melanoma skin cancer (NMSC). We report an 85-year-old man with a history of hydroxyurea- and ruxolitinib-treated polycythaemia vera who was referred for the management of progressively growing tumours on his scalp. Histopathology of the largest scalp lesion revealed a partly desmoplastic cutaneous squamous carcinoma with perineural invasion. Initial imaging revealed metastatic disease in cervical lymph nodes, bones and lungs. The scalp lesions were successfully treated with bleomycin-based electrochemotherapy. Under initial systemic therapy using four cycles of cetuximab, metastatic disease progressed. Following the approval by the health insurance, compassionate use of pembrolizumab monotherapy was initiated. After three cycles of pembrolizumab, however, metastatic disease further progressed and the patient finally died from global respiratory insufficiency. The present case exemplifies the cutaneous adverse effects of long-term hydroxyurea and ruxolitinib therapy, frequently resulting in highly aggressive NMSCs that are usually not responsive to systemic treatments even such as immune checkpoint inhibitors.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
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Gambichler T, Hartenstein I, Dreißigacker M, Stockfleth E, Stücker M, Schaller J, Schulze HJ, Becker JC, Käfferlein HU, Brüning T, Lang K. Expression of Hedgehog signalling molecules in microcystic adnexal carcinoma. Clin Exp Dermatol 2021; 46:1052-1057. [PMID: 33714217 DOI: 10.1111/ced.14634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Microcystic adnexal carcinoma (MAC) is a rare skin neoplasm that has not been characterized on a molecular basis. AIM To assess expression profiles of Hedgehog (HH) signalling molecules in MAC and control tumours. METHODS Immunohistochemistry was performed for Sonic Hedgehog (SHH), Indian Hedgehog (IHH), Patched 1 (PTCH1) and Smoothened (SMO) on patient MAC tissue (n = 26) and control tumour tissue, including syringoma (SyG; n = 11), trichoepithelioma (TE; n = 11) and basal cell carcinoma (BCC; n = 12) tissues. RESULTS Patched 1 and SMO immunoreactivity was significantly higher in BCC than in SyG, TE or MAC (P < 0.001 and P < 0.03, respectively). The highest IHH expression was observed in BCC and TE compared with SyG and MAC (P < 0.04). Notably, the highest SHH protein expression was observed in SyG compared with MAC, TE and even BCC (P < 0.001). In patients with MAC, SMO immunoreactivity significantly (r = 0.51; P < 0.01) correlated with PTCH1 expression. Further correlation studies did not show significant associations between the HH expression markers assessed (P > 0.05). CONCLUSION Our results indicate that alterations of the HH signalling are unlikely to play a major role in the pathogenesis of MAC, which is in contrast to the morphologically similar BCC and TE. Our observation provides additional information to the limited molecular pathology knowledge on this rare tumour.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - I Hartenstein
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Dreißigacker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Stücker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J Schaller
- Dermatopathology Duisburg, Duisburg, Germany
| | - H-J Schulze
- Fachklinik Hornheide, Skin Cancer Center, Department of Dermatology and Dermato-Histo-Pathology, Münster, Germany
| | - J C Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany.,Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - H U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - K Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
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Susok L, Stücker M, Bechara FG, Stockfleth E, Gambichler T. Multivariate analysis of prognostic factors in patients with nodular melanoma. J Cancer Res Clin Oncol 2021; 147:2759-2764. [PMID: 33630139 PMCID: PMC8310843 DOI: 10.1007/s00432-021-03562-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Nodular melanoma (NM) is associated with worse disease outcome when compared to superficial spreading melanoma (SSM). We aimed to perform a single-center analysis of prognostic factors in patients with NM and compare the data with SSM patients. METHODS We studied 228 patients with NN and 396 patients with SSM. Patients with in situ melanomas or stage IV at diagnosis were not included in the study. Data were analyzed using the Mann-Whitney test, Chi-square test, Kaplan-Meier curves including the log-rank test, and logistic regression model. RESULTS When compared to patients with SSM, patients with NM had less likely lower Clark level, higher tumor thickness, less likely tumor regression, more often ulcerated tumors, and less likely a history of precursor lesions such as a nevus. Within a 5-year follow-up we observed significantly more disease relapses and deaths in NM patients than in SSM patients. On multivariate analysis, disease relapse in NM patients was independently predicted by tumor thickness and positive SLNB, whereas melanoma-specific death of NM patients was independently predicted by male sex and tumor thickness. Histologic regression also remained in the logistic regression model as a significant independent negative predictor of NM death. CONCLUSIONS We did not observe that NM subtype was per se a significant independent predictor for disease relapse or melanoma-specific death. Among the well-known prognostic factors such as tumor thickness and male sex, NM is also associated with other unfavorable factors such as absence of regression.
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Affiliation(s)
- L Susok
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M Stücker
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
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Gambichler T, Bünnemann H, Scheel CH, Bechara FG, Stücker M, Stockfleth E, Becker JC. Does very early timing of lymph node surgery after resection of the primary tumour improve the clinical outcome of patients with melanoma? Clin Exp Dermatol 2020; 45:1011-1018. [PMID: 32422686 DOI: 10.1111/ced.14291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with cutaneous melanoma (CM), the time span between resection of the primary tumour and sentinel lymph node biopsy (SLNB) as well as the subsequent interval between SLNB and complete lymph node dissection (CLND) varies greatly. AIM To determine whether very early timing of SLNB after resection of the primary tumour, or timing of CLND after SLNB affect the clinical outcome of patients with CM, compared with longer time intervals. METHODS We compared the time spans between complete resection of the primary tumour and SLNB, and the interval between SLNB and CLND in a cohort of 896 patients with melanoma who had undergone SLNB. An interval between primary resection and SLNB or between SLNB and CLND of up to 7 days was classified as very early (VE-SLNB and VE-CLND, respectively). This time span was compared with intervals of > 7 days. Univariate and multivariate statistics were performed. RESULTS VE-SLNB was significantly associated with the presence of micrometastases. However, this was probably due to tumour thickness being significantly higher in patients with VE-SLNB compared with patients with later SLNB. Importantly, VE-SLNB was not significantly associated with disease relapse and VE-CLND was not associated with melanoma-specific death. CONCLUSIONS VE-SLNB and VE-CLND neither improved nor worsened the clinical outcome of patients. Thus, timing of SLNB and CLND has no influence on the overall clinical outcome of patients with melanoma. Our findings support the rational planning of lymph node surgery after resection of the primary tumour and provide help for effective patient counselling.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - H Bünnemann
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - C H Scheel
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - F G Bechara
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - M Stücker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
| | - E Stockfleth
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
| | - J C Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
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Hessam S, Gambichler T, Skrygan M, Scholl L, Sand M, Meyer T, Stockfleth E, Bechara F. Increased expression profile of NCSTN, Notch and PI3K/AKT3 in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 35:203-210. [DOI: 10.1111/jdv.16962] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/14/2020] [Indexed: 12/27/2022]
Affiliation(s)
- S. Hessam
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
- Department of Dermatology and Phlebology Katharinen‐Hospital Unna Unna Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - M. Skrygan
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - L. Scholl
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - M. Sand
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
- Department of Plastic and Reconstructive Surgery St. Josef‐Hospital Essen‐Kupferdreh Germany
| | - T. Meyer
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - F.G. Bechara
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
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Gellrich FF, Hüning S, Beissert S, Eigentler T, Stockfleth E, Gutzmer R, Meier F. Medical treatment of advanced cutaneous squamous-cell carcinoma. J Eur Acad Dermatol Venereol 2020; 33 Suppl 8:38-43. [PMID: 31833610 DOI: 10.1111/jdv.16024] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/21/2019] [Indexed: 01/23/2023]
Abstract
Considering the rising incidence, cutaneous squamous-cell carcinoma (cSCC) has a high clinical relevance. In patients with localized cSCC, complete surgical resection is indicated. Radiotherapy should be performed in patients with non-resectable tumours or in patients who are not suitable for surgery. Systemic therapy is reserved for cSCC that are neither surgically nor radiotherapeutically curable due to their extensive local spread and/or local or distant metastasis. In the absence of prospective randomized phase 3 trials to evaluate and compare the efficacy and safety of chemotherapeutics, epidermal growth factor receptor (EGFR) inhibitors and anti-PD-1 antibodies, no final recommendation for systemic therapy can be given for patients with locally advanced or metastatic cSCC. Anti-PD-1 antibodies currently show promising results with response rates of up to 50% in both locally advanced and metastatic cSCC. Anti-PD-1 antibodies appear to achieve higher response rates compared with EGFR inhibitors, and the duration of response appears to be superior to both chemotherapy and EGFR inhibitors. Compared with chemotherapy, the side effect profile of anti-PD-1 antibodies appears to be favourable. Altogether, PD-1 inhibitors are expected to become the new standard of care for patients with locally advanced and metastatic cSCC. Currently, placebo-controlled clinical trials are investigating the adjuvant use of cemiplimab and pembrolizumab in patients undergoing resection and radiotherapy of high-risk cSCC. Patients not eligible for anti-PD-1 treatment, e.g. in organ transplant recipients, or in patients refractory to anti-PD-1 may be offered EGFR inhibitors and/or chemotherapies. Chemotherapies appear to be superior to EGFR inhibitors in terms of response rates, whereas EGFR inhibitors have a more favourable toxicity profile. EGFR inhibitors are therefore more suitable for multimorbid and/or frail elderly patients. By combining EGFR inhibitors with local therapy such as surgery or radiotherapy, response rates and duration of response may be improved.
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Affiliation(s)
- F F Gellrich
- Dermatology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Dresden, Germany
| | - S Hüning
- Dermatology, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - S Beissert
- Dermatology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Dresden, Germany
| | - T Eigentler
- Dermatology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - E Stockfleth
- Dermatology and Allergology, University of Bochum, Bochum, Germany
| | - R Gutzmer
- Department of Dermatology and Allergy, Skin Cancer Center, Hannover Medical School, Hannover, Germany
| | - F Meier
- Dermatology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Dresden, Germany
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11
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Dejonckheere G, Suppa M, Del Marmol V, Meyer T, Stockfleth E. The actinic dysplasia syndrome - diagnostic approaches defining a new concept in field carcinogenesis with multiple cSCC. J Eur Acad Dermatol Venereol 2020; 33 Suppl 8:16-20. [PMID: 31833608 DOI: 10.1111/jdv.15949] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/23/2019] [Indexed: 12/19/2022]
Abstract
Usually, SCC lesions are surrounded by a number of clinically visible and non-visible (subclinical) areas of actinically damaged skin containing cells with dysplasia, and thus may be designated actinic dysplasia syndrome. The epithelial damage is caused mainly by UV radiation, inducing mutations in keratinocytes that may confer growth advantages resulting in preneoplastic fields. The development of visible dysplastic lesions (actinic keratosis - AK) and subsequent progression to invasive SCC requires further mutations in cancer-associated genes, like tumour suppressor genes and cell cycle regulators. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) represent a considerable advantage for the investigation of field cancerization. In addition, imaging allows the non-invasive monitoring of topical treatments for AKs. RCM provides in vivo horizontal skin sections with a high, 1-μm lateral resolution (similar to histopathology) but with a limited penetration (about 200 μm), which can hamper the visualization of important areas such as the dermal-epidermal junction. Conventional OCT has better penetration (1-2 mm) at the expense of a more limited resolution (much lower than histopathology). Line-field confocal OCT (LC-OCT) combines the high precision of RCM and the good penetration of OCT in a single device and therefore appears to be very useful in diagnosing/managing AKs.
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Affiliation(s)
- G Dejonckheere
- Department of Dermatology and Venerology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - M Suppa
- Department of Dermatology and Venerology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - V Del Marmol
- Department of Dermatology and Venerology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - T Meyer
- Department of Dermatology, Venerology and Allergology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Venerology and Allergology, St. Josef Hospital, Ruhr-University, Bochum, Germany
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12
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Gambichler T, Steuke AK, Schmitz L, Stockfleth E, Becker JC. Altered hydroxymethylation in cutaneous squamous cell carcinoma and keratoacanthoma. Br J Dermatol 2020; 183:955-957. [PMID: 32407588 DOI: 10.1111/bjd.19219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - A-K Steuke
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Schmitz
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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13
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Hessam S, Gambichler T, Höxtermann S, Skrygan M, Sand M, Garcovich S, Meyer T, Stockfleth E, Bechara F. Frequency of circulating subpopulations of T‐regulatory cells in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 34:834-838. [DOI: 10.1111/jdv.16071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022]
Affiliation(s)
- S. Hessam
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - S. Höxtermann
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - M. Skrygan
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - M. Sand
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
- Department of Plastic and Reconstructive Surgery St. Josef‐Hospital Essen‐Kupferdreh Germany
| | - S. Garcovich
- Institute of Dermatology F. Policlinico Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - T. Meyer
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - F.G. Bechara
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
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14
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Gambichler T, Ardabili S, Lang K, Dreißigacker M, Scheel C, Brand-Saberi B, Skrygan M, Stockfleth E, Käfferlein HU, Brüning T, Becker JC. Expression of Lefty predicts Merkel cell carcinoma-specific death. J Eur Acad Dermatol Venereol 2020; 34:2016-2020. [PMID: 32022949 DOI: 10.1111/jdv.16271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/27/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Lefty and Nodal are transforming growth factor β-related proteins, which, beside their role in determination of laterality during embryogenesis, have also been linked with cancer progression. OBJECTIVES Prompted by the observed significant left-sided laterality of Merkel cell carcinoma (MCC), we addressed whether Lefty and Nodal are expressed in MCC and correlated expression patterns with clinical parameters such as MCC laterality and patient outcome. METHODS Expression of Lefty and Nodal in primary MCC was assessed in 29 patients by immunohistochemistry. The histology (H-)score was calculated and correlated with clinical parameters. RESULTS The median (range) H-score of Lefty and Nodal was 17.6 (0-291) and 74.9 (0.7-272), respectively. There was a significant correlation between Lefty expression and Nodal expression (correlation coefficient of 0.60, P = 0.0006). There was no significant correlation between Lefty expression and Nodal expression with either tumour laterality, gender, age, Merkel cell polyomavirus status, disease stage, anatomical localization of primary tumours or disease relapse. On univariate analysis, low Lefty expression and Nodal expression were significantly associated with MCC-specific death (P = 0.010 and P = 0.019, respectively). On univariate analysis, low Lefty expression was the only significant independent predictor for MCC-specific death (P = 0.025) as indicated by an odds ratio of 14 (95% CI: 1.43-137.33). CONCLUSIONS Lefty and Nodal are frequently expressed in MCC, but not correlated with tumour laterality. Importantly, our data suggest that a low level of Lefty expression in primary MCC is a strong predictor of MCC-specific death.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - S Ardabili
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - K Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - M Dreißigacker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - C Scheel
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - B Brand-Saberi
- Department of Anatomy and Molecular Embryology, Medical Faculty, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - H U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - J C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Gambichler T, Susok L, Fels M, Schneider‐Gold C, Hof zum Berge F, Stockfleth E, Ayzenberg I. Autoimmune radiculoplexus neuropathy under adjuvant nivolumab treatment of a female patient with melanoma. Br J Dermatol 2020; 182:246-247. [DOI: 10.1111/bjd.18358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T. Gambichler
- Skin Cancer Center Ruhr‐University Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - L. Susok
- Skin Cancer Center Ruhr‐University Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - M. Fels
- Department of Neurology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - C. Schneider‐Gold
- Department of Neurology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - F. Hof zum Berge
- Department of Neurology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - E. Stockfleth
- Skin Cancer Center Ruhr‐University Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - I. Ayzenberg
- Department of Neurology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
- Department of Neurology Sechenov First Moscow State Medical University Moscow Russia
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16
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Gambichler T, Schröter U, Höxtermann S, Susok L, Stockfleth E, Becker JC. Decline of programmed death-1-positive circulating T regulatory cells predicts more favourable clinical outcome of patients with melanoma under immune checkpoint blockade. Br J Dermatol 2019; 182:1214-1220. [PMID: 31361026 DOI: 10.1111/bjd.18379] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of T regulatory lymphocytes (Tregs) and their immunosuppressive mechanisms in the context of programmed death (PD)-1 blockade is not completely understood. OBJECTIVES To assess the impact of PD-1-blocking antibody treatment on Treg subpopulations in the blood. METHODS We studied circulating Treg subpopulations in patients with melanoma under nivolumab or pembrolizumab treatment using flow cytometry and correlated these findings with clinical outcomes. RESULTS These analyses revealed that the frequency of CD4+ CD25++ CD127- PD-1+ lymphocytes (PD-1+ Tregs) significantly decreased after the first cycle of immunotherapy (23% vs. 8·6%, P = 0·043). Compared with patients who did not show a significant decline of PD-1+ Tregs after the first treatment, those who did had better clinical outcomes with respect to progression-free survival (PFS, P = 0·022) and melanoma-specific death (MSD, P = 0·0038). Multivariate analysis confirmed that a significant decline of PD-1+ Tregs in peripheral blood after the first treatment cycle is a significant predictor of more favourable PFS and MSD (P = 0·04 and 0·017, respectively). Interestingly, the occurrence of immune-related adverse events was also an independent predictor for decreased risk of MSD (P = 0·047; odds ratio 0·064, 95% confidence interval 0·0042-0·97). CONCLUSIONS We provide preliminary evidence that circulating PD-1+ Tregs rapidly decline after the initiation of treatment with PD-1-blocking antibodies, which is associated with reduced risk of melanoma progression and MSD. Patients showing no decrease of these PD-1+ Tregs in peripheral blood are characterized by an impaired response to immune checkpoint blockade and worse outcome. What's already known about this topic? Programmed death (PD)-1-blocking antibodies are highly effective in melanoma treatment. However, more than half of patients do not benefit from this therapy and to date it is difficult to predict which patients will respond to it. What does this study add? PD-1-blocking antibody therapy rapidly results in a decline of circulating PD-1+ T regulatory cells (Tregs). What is the translational message? Patients showing a decrease of PD-1+ Tregs appear to have better clinical outcome under PD-1 treatment.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - U Schröter
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - S Höxtermann
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany
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17
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Gambichler T, Chatzipantazi M, Schröter U, Stockfleth E, Gedik C. Patients with melanoma of unknown primary show better outcome under immune checkpoint inhibitor therapy than patients with known primary: preliminary results. Oncoimmunology 2019; 8:e1677139. [PMID: 31741779 PMCID: PMC6844308 DOI: 10.1080/2162402x.2019.1677139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Melanoma of unknown primary (MUP) is an uncommon clinical subtype of melanoma of known primary (MKP). Objectives: We aimed to compare treatment outcomes of MUP and MKP patients who had undergone therapy with immune checkpoint inhibitors (ICPI). Methods: We studied 41 metastatic melanoma patients (32 with MKP and 9 with MUP) with an indication for ICPI. Results: Clinical characteristics such as age, gender, stage of disease, etc., did not significantly differ (P < .05) between MUP and MKP patients. 20/32 (62.5%) melanoma-specific deaths (MSD) were observed in the MKP group, whereas 2/9 (22.2%) were detected in the MUP group (P = .035). On logistic regression, the MUP status proved to be an independent predictor for a more favorable outcome under immunotherapy when compared to MKP (P = .030). Conclusion: Our preliminary results indicate that MUP patients show better clinical outcome under ICPI when compared to MKP.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Maria Chatzipantazi
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Ulrike Schröter
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Cansu Gedik
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
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18
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Gambichler T, Selke L, Rüddel I, Dreißigacker M, Stockfleth E, Schmitz L. Expression of indolamine-2,3-dioxygenase and cyclooxygenase-2 in different disease stages of cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2019; 33:e446-e447. [PMID: 31251418 DOI: 10.1111/jdv.15763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - L Selke
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - I Rüddel
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - M Dreißigacker
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - L Schmitz
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
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19
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Gambichler T, Salveridou K, Schmitz L, Käfferlein H, Brüning T, Stockfleth E, Sand M, Lang K. Low Drosha protein expression in cutaneous T‐cell lymphoma is associated with worse disease outcome. J Eur Acad Dermatol Venereol 2019; 33:1695-1699. [DOI: 10.1111/jdv.15652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022]
Affiliation(s)
- T. Gambichler
- Department of Dermatology Ruhr‐University Bochum Bochum Germany
| | - K. Salveridou
- Department of Dermatology Ruhr‐University Bochum Bochum Germany
| | - L. Schmitz
- Department of Dermatology Ruhr‐University Bochum Bochum Germany
| | - H.U. Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances Ruhr‐University Bochum (IPA) Bochum Germany
| | - T. Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances Ruhr‐University Bochum (IPA) Bochum Germany
| | - E. Stockfleth
- Department of Dermatology Ruhr‐University Bochum Bochum Germany
| | - M. Sand
- Department of Dermatology Ruhr‐University Bochum Bochum Germany
| | - K. Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances Ruhr‐University Bochum (IPA) Bochum Germany
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20
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Schmitz L, Grinblat B, Novak B, Hoeh AK, Händschke K, von Dobbeler C, Bierhoff E, Szeimies RM, Gambichler T, Torezan L, Festa-Neto C, Stockfleth E, Dirschka T. Somatic mutations in kinetochore gene KNSTRN are associated with basal proliferating actinic keratoses and cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2019; 33:1535-1540. [PMID: 30972880 DOI: 10.1111/jdv.15615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/01/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Mutations in kinetochore gene KNSTRN accelerate the development of cutaneous squamous cell carcinoma (SCC) and may correlate with different histological classifications of actinic keratosis (AKs). OBJECTIVE To determine KNSTRN gene mutation frequency in healthy skin (HS), actinically damaged skin (ADS), in AKs with different histomorphological gradings and invasive SCCs. METHODS All samples were histologically evaluated. AK lesions were additionally classified according to their upwards (AK I-III) and downwards (PRO I-III) directed growth pattern. Mutation analyses of all samples were performed using the Sanger method. RESULTS With one exception, all detected mutations in KNSTRN gene showed an alanine-to-glutamate substitution at codon 40 (p.Ala40Glu). p.Ala40Glu mutation was found in 6.9% (2/29) of HS, in 16.1% (5/31) of ADS, in 18.3% (20/109) of AKs and in 30.0% (9/30) of invasive SCCs. Further stratification of AKs using the common AK classification of Röwert-Huber revealed the p.Ala40Glu mutation in 14.7% (5/43), 13.3% (4/30) and 24.4% (11/45) (AK I, II and III). In contrast, the new PRO classification showed a distribution of 3.6% (1/28) in PRO I, 21.7% (13/60) in PRO II and 28.6% (6/21) in PRO III. Mutation frequency in HS showed significant differences compared to AKs classified as PRO III and invasive SCCs (P < 0.05). In contrast, there were no statistically significant differences between HS and AKs when classified according to Röwert-Huber. CONCLUSIONS Recurrent somatic mutation p.Ala40Glu in KNSTRN gene is associated with basal proliferating AKs in accordance with invasive SCCs. This supports the impact of basal proliferative pattern in terms of progression.
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Affiliation(s)
- L Schmitz
- Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - B Grinblat
- Department of Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - B Novak
- Department of Animal Physiology, Ruhr-University, Bochum, Germany
| | - A-K Hoeh
- CentroDerm GmbH, Wuppertal, Germany
| | | | | | - E Bierhoff
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - R-M Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany
| | - T Gambichler
- Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - L Torezan
- Department of Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - C Festa-Neto
- Department of Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - E Stockfleth
- Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - T Dirschka
- CentroDerm GmbH, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
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21
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Schmitz L, Gupta G, Stücker M, Doerler M, Gambichler T, Welzel J, Szeimies RM, Bierhoff E, Stockfleth E, Dirschka T. Evaluation of two histological classifications for actinic keratoses - PRO classification scored highest inter-rater reliability. J Eur Acad Dermatol Venereol 2019; 33:1092-1097. [PMID: 30887613 DOI: 10.1111/jdv.15580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Actinic keratoses (AKs) can histologically be classified by the extent of atypical keratinocytes throughout the epidermis or their pattern of basal proliferation. Currently, no data on the inter-rater reliability of both scores is available. OBJECTIVE To evaluate the inter-rater reliability of the two classification schemes; histological grade (AK I-III) and basal proliferation (PRO I-III). METHODS Histological images of 54 AKs were classified by 21 independent dermatopathologists with regard to basal proliferation (PRO I-III), histological grade (AK I-III) and assumed risk of progression into invasive carcinoma. RESULTS Overall, of the 54 AKs 16.7% (9/54) were classified as AK I, 66.7% (36/54) as AK II, and 16.7% (9/54) as AK III. With regards to basal growth pattern, 25.9% (14/54) were classified as PRO I, 42.6% (23/54) as PRO II, and 31.5% (17/54) as PRO III. We observed a highly significant inter-rater reliability for PRO-grading (P < 0.001) which was higher than for AK-grading (Kendall's W coefficient: AK = 0.488 vs. PRO = 0.793). We found substantial agreement for assumed progression risk for AKs with worsening basal proliferation (k = 0.759) compared to moderate agreement (k = 0.563) for different AK-gradings. CONCLUSIONS Histological classification of basal growth pattern (PRO) showed higher inter-rater reliability compared to the established classification of atypical keratinocytes throughout epidermal layers. Moreover, experienced dermatopathologists considered basal proliferation to be more important in terms of progression risk than upwards directed growth patterns. It should be considered to classify AKs according to their basal proliferation pattern (PRO I-III).
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Affiliation(s)
- L Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - G Gupta
- Department of Dermatology, University Hospital Monklands, Lanarkshire, UK.,School of Medicine, University of Glasgow, Glasgow, UK
| | - M Stücker
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - M Doerler
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - J Welzel
- Department of Dermatology and Allergology, General Hospital Augsburg, Augsburg, Germany
| | - R M Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany
| | - E Bierhoff
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - T Dirschka
- CentroDerm Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
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22
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Gambichler T, Schmitt K, Rüddel I, Dreibigacker M, Stockfleth E, Becker JC. Decreased 5-hydroxymethylcytosine immunoreactivity in primary Merkel cell carcinoma is a strong predictor for disease-specific death. Br J Dermatol 2019; 181:389-390. [PMID: 30703276 DOI: 10.1111/bjd.17705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - K Schmitt
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - I Rüddel
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Dreibigacker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, German Cancer Consortium, Dermatology, University Duisburg-Essen, Essen, Germany
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Gambichler T, Stockfleth E, Susok L. Paraneoplastic hyperleucocytosis in a melanoma patient after initiation of ipilimumab and nivolumab combination therapy. J Immunother Cancer 2018; 6:113. [PMID: 30376886 PMCID: PMC6208032 DOI: 10.1186/s40425-018-0430-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Paraneoplastic hyperleucocytosis (PH) is sporadically seen in patients with advanced solid tumors. Case presentation We report a female patient with disseminated melanoma metastases. Two days after the first dosage of combined immunotherapy using the cytotoxic T lymphocyte antigen-4 (CTLA-4) blocker ipilimumab and the programmed death receptor-1 (PD-1) blocker nivolumab the patient developed asymptomatic hyperleucocytosis (over 120.000 leucocytes per μl) associated with elevated granulocyte colony-stimulating factor blood levels. Hematological and infectious disorders could be ruled out. Although paraneoplastic hyperleucocytosis spontaneously resolved she died from progressive disease about 60 days after start of treatment. Conclusions PH is extremely rare in malignant melanoma, however, most patients who developed this complication had preceding immunotherapies such as interleukin-2. The latter observation and the fact that our patient developed PH rapidly after initiation of ipilimumab and nivolumab immunotherapy indicate an immune-mediated mechanism which may trigger PH under unknown circumstances. The development of paraneoplastic hyperleucocytosis indicates a very poor prognosis.
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Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - L Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
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24
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Stockfleth E, Hofbauer G, Reinhold U, Popp G, Hengge U, Szeimies R, Brüning H, Anliker M, Hunger T, Dummer R, Ulrich C, Kenzelmann R, Surber C, French L. Topical resiquimod dosing regimens in patients with multiple actinic keratoses: a multicentre, partly placebo‐controlled, double‐blind clinical trial. Br J Dermatol 2018; 180:297-305. [DOI: 10.1111/bjd.17124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 12/13/2022]
Affiliation(s)
- E. Stockfleth
- Universitätshautklinik, St. Josef‐Hospital Gudrunstrasse 56 44791 Bochum Germany
| | - G.F.L. Hofbauer
- Dermatologische Klinik UniversitätsSpital Zürich Gloriastrasse 31 8091 Zürich Switzerland
| | - U. Reinhold
- Medizinisches Zentrum Bonn‐Friedensplatz Fachbereich Dermatologie Allergologie, Dermatologische Onkologie Friedensplatz 16 53111 Bonn Germany
| | - G. Popp
- Licca Clinical Research Institute Hofackerstrasse 19 86179 Augsburg Germany
| | - U.R. Hengge
- Hautzentrum Prof. Hengge Immermannstrasse 10 40210 Düsseldorf Germany
| | - R.M. Szeimies
- Klinikum Vest GmbH Knappschaftskrankenhaus, Abteilung Dermatologie Dorstener Strasse 151 45657 Recklinghausen Germany
| | - H. Brüning
- DERMAKIEL Allergie und Hautzentrum Schönberger Strasse 72–74 24148 Kiel Germany
| | - M. Anliker
- Dermatologie/Allergologie Kantonsspital St. Gallen Roschacher Strasse 95 9007 St. Gallen Switzerland
| | - T. Hunger
- Dermatologische Klinik Inselspital, Universitätsspital Bern Freiburgerstrasse 3 3010 Bern Switzerland
| | - R. Dummer
- Dermatologische Klinik UniversitätsSpital Zürich Gloriastrasse 31 8091 Zürich Switzerland
| | - C. Ulrich
- Hauttumorzentrum Charité (HTCC) Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin Charitéplatz 1 10117 Berlin Germany
| | - R. Kenzelmann
- Galderma Spirig Pharma AG Froschackerstrasse 6 4622 Egerkingen Switzerland
| | - C. Surber
- Dermatologische Klinik UniversitätsSpital Zürich Gloriastrasse 31 8091 Zürich Switzerland
- Dermatologische Klinik Universitätsspital Basel Petersgraben 4 4031 Basel Switzerland
| | - L.E. French
- Dermatologische Klinik UniversitätsSpital Zürich Gloriastrasse 31 8091 Zürich Switzerland
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25
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Schmitz L, Gambichler T, Kost C, Gupta G, Stücker M, Stockfleth E, Dirschka T. Cutaneous squamous cell carcinomas are associated with basal proliferating actinic keratoses. Br J Dermatol 2018. [DOI: 10.1111/bjd.16536] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- L. Schmitz
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - C. Kost
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - G. Gupta
- Department of Dermatology University Hospital Monklands Lanarkshire U.K
- School of Medicine University of Glasgow Glasgow U.K
| | - M. Stücker
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - T. Dirschka
- CentroDerm Clinic Heinz‐Fangman‐Straße 57 Wuppertal Germany
- Faculty of Health University Witten‐Herdecke Alfred‐Herrhausen‐Straße 50 Witten Germany
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26
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Gambichler T, Segert MH, Höxtermann S, Stockfleth E, Doerler M. Absence of immunoglobulin heavy chain rearrangement in primary Merkel cell carcinomas. Clin Exp Dermatol 2018; 43:947. [PMID: 29797735 DOI: 10.1111/ced.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 11/26/2022]
Affiliation(s)
- T Gambichler
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M H Segert
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - S Höxtermann
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M Doerler
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
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27
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Schmitz L, Stockfleth E. Actinic keratoses seldom occur alone. J Eur Acad Dermatol Venereol 2018; 32:513. [DOI: 10.1111/jdv.14908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- L. Schmitz
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
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28
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Gambichler T, Rüddel I, Hessam S, Bechara F, Stockfleth E, Schmitz L. Altered epigenetic pathways and cell cycle dysregulation in healthy appearing skin of patients with koebnerized squamous cell carcinomas following skin surgery. J Eur Acad Dermatol Venereol 2018; 32:1485-1491. [DOI: 10.1111/jdv.14887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/22/2018] [Indexed: 01/12/2023]
Affiliation(s)
- T. Gambichler
- Department of Dermatology; Skin Cancer Center; Ruhr-University Bochum; Bochum Germany
| | - I. Rüddel
- Department of Dermatology; Skin Cancer Center; Ruhr-University Bochum; Bochum Germany
| | - S. Hessam
- Department of Dermatology; Skin Cancer Center; Ruhr-University Bochum; Bochum Germany
| | - F.G. Bechara
- Department of Dermatology; Skin Cancer Center; Ruhr-University Bochum; Bochum Germany
| | - E. Stockfleth
- Department of Dermatology; Skin Cancer Center; Ruhr-University Bochum; Bochum Germany
| | - L. Schmitz
- Department of Dermatology; Skin Cancer Center; Ruhr-University Bochum; Bochum Germany
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29
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Stockfleth E, Harwood CA, Serra-Guillén C, Larsson T, Østerdal ML, Skov T. Response to 'Phase IV head-to-head randomized controlled trial comparing ingenol mebutate 0·015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp': reply from the authors. Br J Dermatol 2018; 178:813-814. [PMID: 29206275 DOI: 10.1111/bjd.16225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Bochum, Germany
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - C Serra-Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | - T Skov
- LEO Pharma A/S, Ballerup, Denmark
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30
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Stockfleth E, Harwood C, Serra-Guillén C, Larsson T, Østerdal M, Skov T. IV阶段一对一随机对照试验就治疗面部或头皮光化性角化病比较了巨大戟醇甲基丁烯酸酯0.015%凝胶与双氯芬酸钠3%凝胶. Br J Dermatol 2018. [DOI: 10.1111/bjd.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Stockfleth E, Harwood C, Serra-Guillén C, Larsson T, Østerdal M, Skov T. Phase IV head-to-head randomized controlled trial comparing ingenol mebutate 0·015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp. Br J Dermatol 2018. [DOI: 10.1111/bjd.16287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Schmitz L, Hessam S, Scholl L, Reitenbach S, Segert MH, Gambichler T, Stockfleth E, Bechara FG. Histological findings after argon plasma coagulation: an ex-vivo study revealing a possible role in superficial ablative treatment of the skin. Arch Dermatol Res 2018; 310:157-163. [PMID: 29350263 DOI: 10.1007/s00403-018-1810-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
Argon plasma coagulation (APC) is an electrosurgical technique which can be used to ablate skin lesions with limited invasion depth into dermal tissue. Hence, APC might be well suited for the removal of epithelial tumours. However, there are no data on the effects of APC on human skin tissue. Thus, the aim of this study was to determine the extent of epidermal and dermal damage after APC of human skin. We performed APC ex-vivo on 91 freshly resected human skin samples, which were obtained after reconstructive surgical closures in actinically damaged areas. Tissue effects were evaluated histologically and compared across different power settings. Using 15, 30, and 45 W, median (interquartile range; IQR) coagulation depths were 110.0 µm (91.7-130.0), 113.3 µm (85.8-135.0), and 130.0 µm (100.0-153.3.0), respectively. Median (IQR) thickness of necrosis zone was 30.0 µm (23.3-40.0) at 15 W, 26.7 µm (20.0-41.6) at 30 W, and 43.3 µm (30.8-57.5) at 45 W. The Kruskal-Wallis test showed significant differences between 15 and 30 W versus 45 W for coagulation depth (P = 0.0414), necrosis zone (P = 0.0017), and necrosis according to overlaying epidermal thickness (P = 0.0467). In summary, APC is a simple and controllable electrosurgical technique to remove epidermal tissue with limited penetration to the dermis. Thus, APC is particularly suited for the ablation of epithelial skin lesions and, therefore, may serve as possible treatment approach for intraepithelial neoplasms such as actinic keratosis.
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Affiliation(s)
- L Schmitz
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - S Hessam
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - L Scholl
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - S Reitenbach
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - M H Segert
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Venereology and Allergology, Dermatologic Surgery Unit, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany.
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33
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Stockfleth E, Harwood CA, Serra-Guillén C, Larsson T, Østerdal ML, Skov T. Phase IV head-to-head randomized controlled trial comparing ingenol mebutate 0·015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp. Br J Dermatol 2018; 178:433-442. [PMID: 29030864 DOI: 10.1111/bjd.16048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ingenol mebutate (IngMeb) and diclofenac sodium (DS) are approved treatments for actinic keratosis (AK). OBJECTIVES To compare the efficacy and safety of IngMeb 0·015% gel with DS 3% gel (NCT02406014). METHODS Patients with 4-8 visible, discrete AK lesions on the face/scalp in a 25 cm2 contiguous area of skin were randomized 1:1 to IngMeb once-daily for three consecutive days or DS twice-daily for 90 days. Patients with AK lesions at Week 8 following IngMeb were offered a second IngMeb course. Primary end point was complete clearance of AK lesions (AKCLEAR 100) at end of first treatment course (Week 8, IngMeb; Week 17, DS). Secondary end points included AKCLEAR 100 at end of last treatment course and Week 17; adverse events (AEs) were assessed at these time points. Patients completed treatment satisfaction questionnaires for medication (TSQM; Week 17). RESULTS AKCLEAR 100 at end of first treatment course was higher with IngMeb (34%) vs. DS (23%; P = 0·006). AKCLEAR 100 at end of last IngMeb course (53%) and Week 17 (45%) was higher than DS (both P < 0·001). The most frequent AE was application-site erythema (IngMeb 19%; DS 12%). Treatment-related AE (TRAE) duration was shorter with IngMeb. TRAE withdrawals were lower for IngMeb (2%) vs. DS (6%). TSQM scores for global satisfaction (P < 0·001) and effectiveness (P = 0·002) were higher with IngMeb, as was dosing instruction adherence (≥ 90% vs. 70%). CONCLUSIONS AKCLEAR 100, patient treatment satisfaction and effectiveness were significantly higher with IngMeb compared with DS, demonstrating superiority of IngMeb for AK treatment on face/scalp.
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Affiliation(s)
- E Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Bochum, Germany
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - C Serra-Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | - T Skov
- LEO Pharma A/S, Ballerup, Denmark
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34
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Gambichler T, Brown V, Steuke AK, Schmitz L, Stockfleth E, Susok L. Baseline laboratory parameters predicting clinical outcome in melanoma patients treated with ipilimumab: a single-centre analysis. J Eur Acad Dermatol Venereol 2017; 32:972-977. [DOI: 10.1111/jdv.14629] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022]
Affiliation(s)
- T. Gambichler
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - V. Brown
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - A.-K. Steuke
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - L. Schmitz
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - E. Stockfleth
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - L. Susok
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
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35
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Ulrich M, Reinhold U, Falqués M, Rodriguez Azeredo R, Stockfleth E. Use of reflectance confocal microscopy to evaluate 5-fluorouracil 0.5%/salicylic acid 10% in the field-directed treatment of subclinical lesions of actinic keratosis: subanalysis of a Phase III, randomized, double-blind, vehicle-controlled trial. J Eur Acad Dermatol Venereol 2017; 32:390-396. [DOI: 10.1111/jdv.14611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 09/19/2017] [Indexed: 11/27/2022]
Affiliation(s)
- M. Ulrich
- CMB Collegium Medicum Berlin GmbH; Berlin Germany
| | - U. Reinhold
- Dermatological Center Bonn Friedensplatz; Bonn Germany
| | | | | | - E. Stockfleth
- Department of Dermatology; Ruhr-University; Bochum Germany
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36
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Schmitz L, Gambichler T, Gupta G, Stücker M, Stockfleth E, Szeimies R, Dirschka T. Actinic keratoses show variable histological basal growth patterns - a proposed classification adjustment. J Eur Acad Dermatol Venereol 2017; 32:745-751. [DOI: 10.1111/jdv.14512] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L. Schmitz
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - G. Gupta
- Department of Dermatology; Monklands Hospital; Lanarkshire UK
- University of Glasgow; Glasgow UK
| | - M. Stücker
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - R.M. Szeimies
- Department of Dermatology and Allergology; Vest Hospital; Academic Teaching Hospital University of Bochum; Recklinghausen Germany
| | - T. Dirschka
- CentroDerm Clinic; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
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Stockfleth E. 536 Sonidegib duration of response across 30 months: Results from the randomized phase 2 BOLT trial. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Bob A, Nielen F, Krediet J, Schmitter J, Freundt D, Terhorst D, Röwert-Huber J, Kanitakis J, Stockfleth E, Ulrich C, Weichenthal M, Egberts F, Lange-Asschenfeldt B. Tumor vascularization and clinicopathologic parameters as prognostic factors in merkel cell carcinoma. J Cancer Res Clin Oncol 2017. [PMID: 28639083 DOI: 10.1007/s00432-017-2455-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumor of the skin with an increasing incidence. The clinical course is variable and reliable prognostic factors are scarce. Tumor angiogenesis has been shown to have prognostic impact in different types of cancer. The aim of our study was to determine potential prognostic factors, including tumor vascularization, for clinical outcome of MCC. METHODS The medical records of 46 patients with MCC diagnosed between 1997 and 2010 were analyzed retrospectively. Tissue samples were immune-stained for the lymphatic endothelial vessel marker podoplanin/D2-40 and the panvascular marker CD31. These immunostained sections were analyzed using computer-assisted morphometric image analyses. Aside from the parameters of tumor vascularization, clinicopathologic features were investigated, and progression-free survival (PFS) and tumor-specific survival (TSS) were assessed. Univariate and multivariate analyses were performed to determine prognostic factors. RESULTS Male sex of the MCC patients and a high cross-sectional whole vessel area (WVA) in relation to the entire tumor area as determined on CD31-stained tumor sections were found to be negative prognostic factors for PFS in a univariate and multivariate regression analysis. Ulceration of the primary tumor was significantly associated with both impaired PFS and TSS. CONCLUSIONS Our results indicate a high prognostic impact of tumor vascularization on the clinical outcome of MCC patients. Male sex and ulceration of the primary MCC were identified as independent unfavorable prognostic markers for the clinical outcome. As an outlook, MCC patients with increased angiogenesis might be identified and subjected to a targeted anti-angiogenic treatment.
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Affiliation(s)
- A Bob
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - F Nielen
- Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - J Krediet
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - J Schmitter
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany.,Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - D Freundt
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - D Terhorst
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - J Röwert-Huber
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - J Kanitakis
- Department of Dermatology and Pathology, Edouard Herriot Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - E Stockfleth
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - Ch Ulrich
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany
| | - M Weichenthal
- Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - F Egberts
- Department of Dermatology, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany.
| | - B Lange-Asschenfeldt
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Berlin, Germany. .,Department of Dermatology, State Hospital Klagenfurt, Klagenfurt Am Wörthersee, Austria.
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Stockfleth E. The importance of treating the field in actinic keratosis. J Eur Acad Dermatol Venereol 2017; 31 Suppl 2:8-11. [DOI: 10.1111/jdv.14092] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- E. Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie; St. Josef-Hospital; Ruhr-Universität Bochum; Bochum Germany
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Gambichler T, Rooms I, Scholl L, Stockfleth E, Stücker M, Sand M. BH3-only protein Bim predicts advanced stage of cutaneous melanoma. J Eur Acad Dermatol Venereol 2016; 30:1926-1929. [PMID: 27356803 DOI: 10.1111/jdv.13791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/06/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bim having strong pro-apoptotic effects belongs to the BH3-only proteins of the Bcl-2 protein family and contributes to survival pathways in cancer cells. OBJECTIVES We aimed to investigate Bim protein expression in cutaneous melanoma (CM). METHODS Bim protein expression was assessed by immunohistochemistry in primary and metastatic melanomas and correlated with clinical and histopathological features. RESULTS The Bim immunoreactivity score of the primary melanomas investigated (4.6 ± 1.5) was significantly (P < 0.0001) higher than that observed in metastases (2.8 ± 1.1). Low Bim expression was significantly associated with primary nodular melanoma type (P = 0.005). Moreover, Bim expression was significantly inversely correlated with tumour thickness (r = -0.36; P = 0.0035), advanced stage of disease (stage III and IV; r = -0.60; P < 0.0001), disease relapse (r = -0.18; P = 0.034) and disease-related death (r = -0.19; P = 0.026). Advanced stage of disease was independently predicted by low Bim expression (P = 0.0010, odds ratio: 0.22, 95% CI: 0.10-0.56) on multivariate analysis; however, Bim was not shown to be an independent predictor for disease relapse (P = 0.40) and disease-related death (P = 0.77). CONCLUSIONS Our data demonstrate that Bim protein expression is significantly inversely correlated with melanoma features that are associated with worse prognosis. We have shown that Bim protein expression in CM is an independent predictor for advanced disease confirming that this pro-apoptotic BH3-only protein might be a potent biomarker and promising therapeutic target.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center of the Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
| | - I Rooms
- Skin Cancer Center of the Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Scholl
- Skin Cancer Center of the Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center of the Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Stücker
- Skin Cancer Center of the Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Sand
- Skin Cancer Center of the Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
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Sand M, Hessam S, Sand D, Bechara FG, Vorstius C, Bromba M, Stockfleth E, Shiue I. Stress-coping styles of 459 emergency care physicians in Germany. Anaesthesist 2016; 65:841-846. [DOI: 10.1007/s00101-016-0228-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/26/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022]
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Gambichler T, Petig AL, Stockfleth E, Stücker M. Expression of SOX10, ABCB5 and CD271 in melanocytic lesions and correlation with survival data of patients with melanoma. Clin Exp Dermatol 2016; 41:709-16. [DOI: 10.1111/ced.12928] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 11/26/2022]
Affiliation(s)
- T. Gambichler
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - A.-L. Petig
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - E. Stockfleth
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - M. Stücker
- Skin Cancer Center of the Department of Dermatology; Ruhr-University Bochum; Bochum Germany
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43
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Gambichler T, Scholl L, Bechara F, Stockfleth E, Stücker M. Worse outcome for patients with recurrent melanoma after negative sentinel lymph biopsy as compared to sentinel-positive patients. Eur J Surg Oncol 2016; 42:1420-6. [DOI: 10.1016/j.ejso.2016.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/09/2016] [Accepted: 03/31/2016] [Indexed: 11/30/2022] Open
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Schmitz L, Kahl P, Majores M, Bierhoff E, Stockfleth E, Dirschka T. Actinic keratosis: correlation between clinical and histological classification systems. J Eur Acad Dermatol Venereol 2016; 30:1303-7. [PMID: 26955898 DOI: 10.1111/jdv.13626] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/18/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are several clinical and histological classification systems for grading actinic keratosis (AK) lesions. The Olsen clinical classification scheme grades AK lesions according to their thickness and degree of hyperkeratosis (grades 1-3). The Roewert-Huber histological classification system grades AK lesions based on the extent of epidermal atypical keratinocytes (AK I-III). OBJECTIVE The aim of this study was to determine whether there is a correlation between these clinical and histological AK classification schemes. METHODS One AK lesion from patients in three pivotal clinical studies and routine practice was assessed clinically and histologically. A match in grading was defined as Olsen grade 1 being classified histologically as AK I, Olsen grade 2 as AK II and Olsen grade 3 as AK III. RESULTS Of the 892 lesions included, 29.0% were classified as Olsen grade 1, 59.6% as Olsen grade 2 and 11.3% as Olsen grade 3; 19.2% were histologically classified as AK I, 69.6% as AK II and 11.2% as AK III. Only 480 lesions (53.8%) had a matching clinical and histological classification. Of these matches, most were 'Olsen grade 2 = AK II' (83.1%). The Spearman's rank correlation coefficient for clinical and histological classification was r = 0.0499 (P = 0.137). CONCLUSIONS Clinical classification of AK lesions using the system of Olsen does not accurately match histological classification of the same lesions using the system of Roewert-Huber. Consequently, it is not possible to draw conclusions about the histology of AK lesions from their clinical appearance. This finding reinforces the need to treat all AK lesions as well as field cancerization.
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Affiliation(s)
- L Schmitz
- Department of Dermatology, Ruhr-University, Bochum, Germany.,CentroDerm GmbH, Wuppertal, Germany
| | - P Kahl
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - M Majores
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - E Bierhoff
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - E Stockfleth
- Department of Dermatology, Ruhr-University, Bochum, Germany
| | - T Dirschka
- CentroDerm GmbH, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
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45
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Gambichler T, Mamali K, Patsinakidis N, Moritz R, Mucke M, Skrygan M, Stockfleth E, Stücker M. Decreased expression of ten-eleven translocation 2 protein is associated with progressive disease and death in patients with mycosis fungoides. Br J Dermatol 2015; 174:652-3. [PMID: 26384468 DOI: 10.1111/bjd.14174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
| | - K Mamali
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - N Patsinakidis
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - R Moritz
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - M Mucke
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M Skrygan
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M Stücker
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
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Affiliation(s)
- D. Reinau
- Basel Pharmacoepidemiology Unit; Division of Clinical Pharmacy and Epidemiology; Department of Pharmaceutical Sciences; University of Basel; Basel Switzerland
| | | | - E. Stockfleth
- Department of Dermatology; Klinikum für Dermatologie; Venerologie und Allergologie; St. Josef-Hospital; Ruhr-Universität Bochum; Bochum Germany
| | - C. Surber
- Department of Dermatology; University Hospital; Basel Switzerland
- Department of Dermatology; University Hospital; Zürich Switzerland
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Werner R, Stockfleth E, Connolly S, Correia O, Erdmann R, Foley P, Gupta A, Jacobs A, Kerl H, Lim H, Martin G, Paquet M, Pariser D, Rosumeck S, Röwert-Huber HJ, Sahota A, Sangueza O, Shumack S, Sporbeck B, Swanson N, Torezan L, Nast A. Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version. J Eur Acad Dermatol Venereol 2015; 29:2069-79. [DOI: 10.1111/jdv.13180] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/02/2015] [Indexed: 12/22/2022]
Affiliation(s)
- R.N. Werner
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. Stockfleth
- Department of Dermatology, Venerology and Allergology; Skin Cancer Center (HTCC); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S.M. Connolly
- Department of Dermatology; Mayo Clinic; Scottsdale Arizona USA
| | - O. Correia
- Centro Dermatologia Epidermis; Instituto CUF and Faculty of Medicine of University of Porto; Porto Portugal
| | - R. Erdmann
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - P. Foley
- Skin and Cancer Foundation Victoria; Carlton Victoria Australia
- St. Vincent's Hospital Melbourne; Fitzroy Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
| | - A.K. Gupta
- Division of Dermatology; Department of Medicine; University of Toronto; Toronto Ontario Canada
- Mediprobe Research Inc.; London Ontario Canada
| | - A. Jacobs
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H. Kerl
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - H.W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit Michigan USA
| | - G. Martin
- Dermatology Laser Center of Maui; Kihei Hawaii USA
| | - M. Paquet
- Mediprobe Research Inc.; London Ontario Canada
| | - D.M. Pariser
- Division of Dermatology and Virginia Clinical Research Inc; Eastern Virginia Medical School; Norfolk Virginia USA
| | - S. Rosumeck
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H.-J. Röwert-Huber
- Division of Dermatopathology; Department of Dermatology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Sahota
- Department of Dermatology; Whipps Cross University Hospital; London UK
| | - O.P. Sangueza
- Department of Pathology; Wake Forest Baptist Medical Center; Winston-Salem North Carolina USA
- Department of Dermatology; Wake Forest Baptist Medical Center; Winston-Salem North Carolina USA
| | - S. Shumack
- Department of Dermatology; Northern Medical School; University of Sydney; Sydney New South Wales Australia
| | - B. Sporbeck
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - N.A. Swanson
- Dermatology, Surgery, and Otolaryngology; Oregon Health and Science University; Portland Oregon USA
- Surgical and Cosmetic Dermatology and Clinical Operations; Oregon Health and Science University Knight Cancer Institute; Portland Oregon USA
| | - L. Torezan
- Faculty of Medicine; Hospital das Clínicas; Universidade de São Paulo; São Paulo Brazil
| | - A. Nast
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
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Dirschka T, Peris K, Gupta G, Alomar A, Aractingi S, Dakovic R, Stockfleth E. Imiquimod 3.75% in actinic keratosis: efficacy in patients with and without rest periods during treatment. J Eur Acad Dermatol Venereol 2015; 30:1416-7. [DOI: 10.1111/jdv.13260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T. Dirschka
- Dermatological Practice Centre; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
| | - K. Peris
- Department of Dermatology; Catholic University of Rome; Largo A. Gemelli 8 00168 Rome Italy
| | - G. Gupta
- Department of Dermatology; Monklands Hospital; Airdrie Lanarkshire ML6 0JS UK
| | - A. Alomar
- Department of Dermatology; Institut Universitari Quiron Dexeus; Av. Carles III 71-75 8028 Barcelona Spain
| | - S. Aractingi
- Service de Dermatologie Allergologie; Hôpital Cochin; 89 rue d'Assas 75006 Paris France
- Université Paris 5 Descartes; Paris France
| | - R. Dakovic
- Meda Pharma GmbH & Co. KG; Benzstrasse 1 61353 Bad Homburg Germany
| | - E. Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie; St. Josef-Hospital; Ruhr-Universität Bochum; Bochum Germany
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Krediet J, Beyer M, Lenz K, Ulrich C, Lange-Asschenfeldt B, Stockfleth E, Terhorst D. Sentinel lymph node biopsy and risk factors for predicting metastasis in cutaneous squamous cell carcinoma. Br J Dermatol 2015; 172:1029-36. [DOI: 10.1111/bjd.13508] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 01/28/2023]
Affiliation(s)
- J.T. Krediet
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - M. Beyer
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - K. Lenz
- Institute of Biometry and Epidemiology; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - C. Ulrich
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - B. Lange-Asschenfeldt
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
| | - E. Stockfleth
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
- Clinic for Dermatology; Venerology and Allergology; St. Josef-Hospital Bochum - University Hospital of the Ruhr-Universität Bochum; 44791 Bochum Germany
| | - D. Terhorst
- Skin Cancer Center Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; 10117 Berlin Germany
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50
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Pflugfelder A, Andonov E, Weide B, Dirschka T, Schempp C, Stockfleth E, Stratigos A, Krüger-Krasagakis S, Bauer J, Garbe C, Eigentler TK. Lack of activity of betulin-based Oleogel-S10 in the treatment of actinic keratoses: a randomized, multicentre, placebo-controlled double-blind phase II trial. Br J Dermatol 2015; 172:926-32. [PMID: 25124939 DOI: 10.1111/bjd.13342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Betulinic acid and other triterpenes have shown strong antitumour activity in vitro and in vivo. A triterpene extract of birch bark formed the base of Oleogel-S10 and allowed topical application. Two previous trials have shown efficacy and tolerability in the treatment of actinic keratoses (AKs) with betulin-based Oleogel-S10. OBJECTIVES To confirm the efficacy and tolerability/safety of Oleogel-S10 in the treatment of AKs in a multicentre placebo-controlled study. METHODS Patients (n = 165) were treated topically for 3 months in a four-arm parallel study design, randomly allocated to A (n = 53) Oleogel-S10 once daily, B (n = 51) Oleogel-S10 twice daily, or C (n = 25) or D (n = 28) placebo (petroleum jelly) once or twice daily, respectively. Clinical efficacy in this double-blind study was assessed by the investigators. Final and baseline biopsies were evaluated by central histopathology. RESULTS Complete clearance of the target lesions was seen in 4% of patients in group A and 7% in group B, but not in the placebo groups. A clearance rate of > 75% was seen for 15% and 18% of patients in groups A and B, respectively, and for 13% in the placebo groups. These differences were not statistically significant. Histopathologically, 43·9% of patients showed a downgrading or clearance of the marker AK with no significant differences between the groups. Treatment with Oleogel-S10 was well tolerated. The tolerability as assessed by the investigator was mostly 'very good' (78·8%), followed by 'good' (18·2%) and only 1·2% assessed it as 'intolerable'. Patient-assessed tolerability was graded mostly 'very good' (56·4%) or 'good' (34·5%). CONCLUSIONS Treatment with Oleogel-S10 was well tolerated during a treatment period of 3 months, yet was no better than placebo in terms of efficacy in the treatment of AKs.
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Affiliation(s)
- A Pflugfelder
- Center for Dermatooncology, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
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