Dermatologische Radiotherapie

Assessment of changes in lentigo maligna during radiotherapy by in-vivo reflectance confocal microscopy: a pilot study

BACKGROUND

Radiotherapy is an effective treatment for therapy of lentigo maligna (LM).

OBJECTIVES

To investigate the usefulness of in-vivo reflectance confocal microscopy (RCM) in radiotherapy of LM and document the changes within the lesions during treatment.

METHODS

A total of six lesions in six patients were investigated by RCM before, during and after radiotherapy. For diagnostic assessment three observers with experience in RCM diagnosis, blinded as to the stage of treatment, assessed the RCM images of each lesion and documented the findings by consensus.

RESULTS

Epidermal disarray worsened in three patients during radiotherapy and superficial necrosis was observed in four patients. Large pagetoid round/dendritic cells decreased or even vanished during or after radiotherapy. Dilated vessels and apoptotic cells were seen in all patients during radiotherapy as well as an increase of inflammatory cells in the epidermis and dermis in most of the patients. Dendritic cells with small dendrites were observed during radiotherapy in all patients with an increase in number in three patients. Melanophages appeared in five patients at least once during the examination period. All RCM images were assessed correctly by the three observers.

CONCLUSIONS

Reflectance confocal microscopy is a useful method to visualize changes during and after radiotherapy and might also be used for early detection of potential treatment failures. In addition, it might be helpful in planning radiotherapy.

[Skin tumours of the facial area]

Almost the complete spectrum of skin tumours can occur within the facial area, ranging from benign tumours of infancy to typical malignancies of old age. This spectrum is quiet heterogeneous and comprises every cell type within the skin as a possible origin for tumour growth. Among these are cells derived from the epidermis; adnexal structures; connective, fatty, and vascular tissue; muscle; nerves; melanocytes; and skin-infiltrating inflammatory cells. Due to this diversity, a correct assessment of the clinical findings compared with a histopathologic appraisal in cases of uncertainty is mandatory in order to recommend appropriate therapy. The present overview aims to summarise the basics of the most frequent and most important skin tumours occurring on the face.

Treatment of melanoma and nonmelanoma skin cancer

The incidence of skin cancer is increasing in Caucasian populations worldwide. Treatment approaches for Nonmelanoma skin cancer (NMSC) are predominantly curative and surgery can be regarded as standard of care. Nevertheless, novel and less invasive topical therapy modalities like photodynamic therapy or local immune modifiers are in progress. In contrast to NMSC, the mortality of melanoma has not changed considerably over the last years and decades. Melanoma survival mainly depends on primary tumor thickness underlining the importance of primary and secondary prevention by avoidance or early detection of the disease. The chance to cure melanoma patients is steadily decreasing with tumor stage. As the prognosis in distant metastatic disease is still poor, except for single situations therapy approaches are palliative and accompanied by an optimal supportive care of the patients concerned. Albeit removal of localized metastases is currently the most effective approach in metastatic melanoma, chemo- and chemoimmunotherapy has to be regarded as standard treatment in most of the cases. Novel and promising therapeutic options accrue from growing insights in tumor biology and immunology. Not only in melanoma, development and application of targeted therapies currently attract the most attention in the treatment of advanced tumors. First clinical experiences with those antiproliferative, antiangiogenic and proapoptotic agents reveal only moderate antitumoral activity in melanoma, so that future efforts aim at defining more effective combination strategies using chemo-, targeted and vaccination therapy approaches.