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Sánchez V, Carpio E, Fardales VE, Martínez B, Arias AI, Brito E, Bermudez N, Rodríguez Y. Long-term follow-up of patients with high-risk facial basal cell carcinoma treated with interferon. An Bras Dermatol 2024; 99:391-397. [PMID: 38383261 DOI: 10.1016/j.abd.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Surgery is the treatment of choice for patients with basal cell carcinoma (BCC). When surgery is not a choice, only radiotherapy is recommended for patients with high-risk facial BCC. Interferon could be an acceptable therapeutic option for these patients. OBJECTIVE To evaluate the long-term clinical response to interferon therapy in patients with high-risk facial BCC. METHODS Patients with high-risk facial BCC were treated with perilesional injections of alpha-2b+ gamma interferons. Those with incomplete clinical response were reevaluated, their residual tumors excised, and declared cured. Patients treated with interferon and those treated with interferon plus surgery were followed for five years. Time to recurrence and the emergence of a new facial BCC were estimated by Kaplan-Meier survival analysis. Adverse events were documented. RESULTS This study included 195 participants; 143 (73.3%) showed a complete response (95% CI 67.2‒80.1). Patients developed recurrence after a mean of 55 months (95% CI 53.8‒57.4). The estimated rate of recurrence was 12.3% (95% CI 7.4‒17.1). Patients developed a new BCC after a mean of 52.7 months (95% CI 50.4‒54.9). The estimated rate for development of a new BCC was 20.0% (95% CI 14.4‒25.9). Fifteen (7.7%) patients abandoned the study during follow-up. Adverse events were frequent but moderate or mild; fever and local pain were the most frequent. STUDY LIMITATIONS Observational cohort design without a control group for comparison. CONCLUSIONS Perilesional injections of alpha-2b+ gamma interferons in patients with facial high-risk BCC offer a satisfactory cure rate after five years of follow-up with an acceptable safety profile.
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Affiliation(s)
- Vladimir Sánchez
- Dermatology Department. Polyclinic Juana Naranjo Leon, Sancti Spíritus, Cuba
| | - Emilio Carpio
- Department of Biomedical Sciences, Universidad de Ciencias Médicas, Sancti Spíritus, Cuba.
| | - Vicente Eloy Fardales
- Department of Biomedical Sciences, Universidad de Ciencias Médicas, Sancti Spíritus, Cuba
| | - Belkys Martínez
- Dermatology Department, Polyclinic Camilo Cienfuegos, Yaguajay, Sancti Spíritus, Cuba
| | - Ana Iris Arias
- Dermatology Department, Polyclinic Manuel de Jesús Lara Cantero, Trinidad, Sancti Spíritus, Cuba
| | - Elizabeth Brito
- Dermatology Department, Center Polyclinic Juana Naranjo Leon, Sancti Spíritus, Cuba
| | - Niurka Bermudez
- Dermatology Department, Polyclinic Antonio Ávila Valdivia, Jatibonico, Sancti Spíritus, Cuba
| | - Yoel Rodríguez
- Dermatology Department, Arcelio Suárez Bernal, Jatibonico, Sancti Spíritus, Cuba
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Maleki M, Layegh P, Kiafar B, Teimoorian M, Darchini-Maragheh E, Razmara M. Treatment of basal cell carcinoma with intralesional interferon alfa-2b: an open-label clinical trial. Expert Rev Anticancer Ther 2023; 23:753-760. [PMID: 37256542 DOI: 10.1080/14737140.2023.2219449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/03/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common cutaneous cancer. We report the efficacy and aesthetic outcome of intralesional IFN-α 2b injection for the treatment of BCC and compare with the surgical method. MATERIALS AND METHODS Intralesional IFN-α 2b was injected in 58 BCC lesions from 20 patients three times a week for three weeks. Control group was retrospectively selected among patients who underwent surgical method (standard surgical excision) for BCC including 58 lesions from 24 patients. All patients were followed up for one year in terms of recurrence and cosmetic outcome. RESULTS Two patients (four lesions) failed to complete the treatment period. After three weeks, 40 (68.96%) lesions were completely cured. Nine (15.51%) lesions achieved complete healing in less than 9 sessions. Five (8.62%) lesions were completely cured by an extra week of injection. In aggregate, complete healing was observed in 54 (93.10%) lesions. In the surgery group, complete lesion elimination was detected in 52 (89.65%) lesions (p = 0.40). After one year, cosmetic outcome was significantly more favorable in the study group compared to the surgery group (p = 0.003). Recurrence was not detected in any of the groups after one year follow-up. CONCLUSION Intralesional IFN-α 2b injection is an appropriate treatment choice for BCC. CLINICAL TRIAL REGISTRY We used Iranian registery of Clinical trials; The IRCT code is: 2017093017756N30.
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Affiliation(s)
- Masoud Maleki
- Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pouran Layegh
- Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Kiafar
- Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrdad Teimoorian
- Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahdi Razmara
- Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Healsmith MF, Berth-Jones J, Fletcher A, Graham-Brown RA. Treatment of Basal Cell Carcinoma with Intralesional Interferon Alpha-2b. J R Soc Med 2018; 84:524-6. [PMID: 1941852 PMCID: PMC1293410 DOI: 10.1177/014107689108400907] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a series of 11 basal cell carcinomas of various types treated with nine intra-lesional injections of 1.5 million units of interferon alpha-2b. The diagnosis was confirmed histologically in each case. After 3 months' follow-up six tumours had resolved both clinically and histologically. In three cases the tumour size was reduced. One tumour grew larger. Side effects were well tolerated except by one subject who was withdrawn. Those cases which responded have now been followed-up for between 12 and 26 months with no clinical or histological evidence of tumour recurrence. This is the longest period of follow-up so far reported for this novel treatment. The results are encouraging and, if maintained in future series, may indicate a useful role for interferon alpha in the management of this common cutaneous malignancy.
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Affiliation(s)
- M F Healsmith
- Department of Dermatology, Leicester Royal Infirmary
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Abstract
PURPOSE OF REVIEW The use of agents which exhibit the ability to potently activate the innate immune response has gained significant interest as therapeutics to treat cancer. We will review the history and the current applications of these agents to treat skin cancer and cutaneous T-cell lymphoma. RECENT FINDINGS Particular attention has been focused upon Toll-like receptor (TLR) agonists, including imidazoquinolines, which can trigger TLR 7 and TLR 8, and cytosine-phosphate-guanine (CpG) oligodeoxynucleotides, which activate TLR 9-expressing cells. Imiquimod, a TLR 7 agonist, has been found to be efficacious for basal cell and squamous cell cancers, as well as cutaneous T-cell lymphoma and lentigo maligna melanoma. CpGs have demonstrated efficacy for cutaneous T-cell lymphoma. Additional more potent compounds, including resiquimod, are presently in clinical trials for several types of skin cancers. SUMMARY TLR agonists that can activate the innate immune response have been used to treat a variety of skin cancers including basal cell cancer, squamous cell cancer, lentigo maligna melanoma and cutaneous T-cell lymphoma. Significant clinical efficacy has been observed for all of these conditions. It is anticipated that additional members of the TLR agonist family will be available in the clinic for the future treatment of skin cancers as well as other malignancies.
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Chitwood K, Etzkorn J, Cohen G. Topical and Intralesional Treatment of Nonmelanoma Skin Cancer: Efficacy and Cost Comparisons. Dermatol Surg 2013; 39:1306-16. [DOI: 10.1111/dsu.12300] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wettstein R, Erba P, Itin P, Schaefer D, Kalbermatten D. Treatment of basal cell carcinoma with surgical excision and perilesional interferon-α. J Plast Reconstr Aesthet Surg 2013; 66:912-6. [DOI: 10.1016/j.bjps.2013.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/02/2013] [Indexed: 12/15/2022]
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Abstract
BACKGROUND Immunotherapy for cutaneous malignancy involves manipulating the immune system to treat and prevent skin cancer. Although initial efforts were fraught with low success rates and technical challenges, more-recent endeavors have yielded response rates approaching 50% for treating metastatic melanoma. Many of these advances are a result of increasing knowledge of the immune system's intricacies and continued progress in laboratory techniques. OBJECTIVE To review our current understanding of the skin immune system and discuss how these factors contribute to the host response to malignancy and to report the current state of immunotherapeutic techniques. MATERIALS AND METHODS An extensive PubMed literature search was conducted in topics involving immunotherapy with specific relevance to cutaneous malignancy using the MeSH terms "immunotherapy" and "skin cancer." RESULTS Despite initially poor patient responses to these treatment modalities, recent gains in scientific knowledge and clinical intervention protocols have brought immunotherapy to the forefront of prospective skin cancer therapeutics, particularly for advanced melanoma. CONCLUSIONS Current treatment options for advanced cutaneous malignancies such as melanoma are low in efficacy. Immunotherapies have the potential to provide novel approaches to address this, particularly when used in combination. The authors have indicated no significant interest with commercial supporters.
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Affiliation(s)
- Sherrif F Ibrahim
- Division of Dermatologic Surgery, Department of Dermatology, University of Rochester Medical Center, Rochester, New York 14623, USA.
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Murchison AP, Walrath JD, Washington CV. Non-surgical treatments of primary, non-melanoma eyelid malignancies: a review. Clin Exp Ophthalmol 2011; 39:65-83; quiz 92-3. [PMID: 21040309 DOI: 10.1111/j.1442-9071.2010.02422.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The diagnosis and management of periocular cutaneous malignancies are essential components of an ophthalmologist's practice. Skin cancers comprise nearly one-third of newly diagnosed malignancies. Furthermore, the incidence of skin cancer appears to be increasing. Multiple treatment modalities exist for periocular cutaneous malignancy. Surgical extirpation, often with the combined expertise of a Mohs micrographic surgeon, is typically the first line therapy and is often curative in the periocular region, depending on a variety of factors, including tumour histology, specific location, depth of invasion and surgical technique. However, there are instances where a less invasive, non-surgical treatment option is warranted, including patients who are poor surgical risks or those with diffuse disease. The purpose of this article is to review the literature and describe the non-surgical treatment options, indications and efficacies for non-melanoma primary eyelid malignancies.
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Affiliation(s)
- Ann P Murchison
- Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Philadelphia, Pennsylvania 19107, USA.
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11
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Kirby JS, Miller CJ. Intralesional chemotherapy for nonmelanoma skin cancer: a practical review. J Am Acad Dermatol 2010; 63:689-702. [PMID: 20605654 DOI: 10.1016/j.jaad.2009.09.048] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 09/22/2009] [Accepted: 09/23/2009] [Indexed: 11/27/2022]
Abstract
Intralesional chemotherapy for nonmelanoma skin cancer has existed for more than 5 decades. However, it is used so infrequently that recent consensus guidelines for the treatment of basal cell and squamous cell carcinoma do not include intralesional chemotherapy. Barriers to the use of intralesional chemotherapy include the off-label use of these agents, absence of therapeutic guidelines, a relatively small number of patients treated, and a lack of large, well-designed trials with long-term follow-up. Surgical intervention remains the gold standard for the treatment of nonmelanoma skin cancer; however, intralesional chemotherapy remains an option for well-selected patients who cannot or will not undergo surgery. The objectives of this article are to determine response rates and suggest reasonable treatment guidelines for the treatment of squamous cell carcinoma, keratoacanthoma, and basal cell carcinoma with the most widely available intralesional agents (methotrexate, 5-fluorouracil, bleomycin, and interferon).
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Affiliation(s)
- Joslyn S Kirby
- Department of Dermatology, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA.
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12
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Shuttleworth D, Marks R. A comparison of the effects of intralesional interferon α-2b and topical 5% 5-fluorouracil cream in the treatment of solar keratoses and Bowen's disease. J DERMATOL TREAT 2009. [DOI: 10.3109/09546638909086695] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bottomley W, Keczkes K. Treatment of basal cell carcinomas with intralesional recombinant interferonα-2b. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639109089047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Turan A, Saricaoglu H, Baskan EB, Toker SC, Tunali S. Treatment of infiltrating basal cell carcinoma with the combination of intralesional IFNalpha-2b and topical imiquimod 5% cream. Int J Dermatol 2009; 48:214-5. [PMID: 19200213 DOI: 10.1111/j.1365-4632.2009.03576.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Caccialanza M, Piccinno R, Percivalle S, Rozza M. Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: our experience in 671 lesions. J Eur Acad Dermatol Venereol 2009; 23:1044-9. [PMID: 19368616 DOI: 10.1111/j.1468-3083.2009.03247.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The skin overlying the nose cartilage is a particularly frequent localization of skin carcinoma (about 25% of all carcinomas occurring on the head and neck). It is therefore of great practical interest to identify the best therapy, able to combine effectiveness with a good cosmetic and functional result. OBJECTIVE To verify both the therapeutic effectiveness of dermatologic radiotherapy and its 'toxicity' in the treatment of a large number of skin carcinomas overlying the cartilage of the nose. METHODS A retrospective study was done on 671 basal and squamous cell carcinomas treated by kilovoltage radiotherapy in the period 1972-2007. RESULTS The mean follow-up time was 38.016 months (range, 1-351 months). The 5-year cure rate was 88.09%. Cosmetic results were evaluated as 'good' or 'acceptable' in 96.84% of the treated lesions in complete remission. So far, no complication or sequelae to the radiologic treatment have been observed. CONCLUSION Dermatologic radiotherapy showed to be a safe, effective and non-invasive method, superior, on the basis of the literature data, to any other available therapeutic modality in the management of basal and squamous cell skin carcinomas localized over the nasal cartilages.
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Affiliation(s)
- M Caccialanza
- Photoradiotherapy Unit, Institute of Dermatological Sciences of University, Mangiagalli e Regina Elena, IRCCS, Milan, Italy.
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Meyer T, Stockfleth E. Clinical investigations of Toll-like receptor agonists. Expert Opin Investig Drugs 2008; 17:1051-65. [PMID: 18549341 DOI: 10.1517/13543784.17.7.1051] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Toll-like receptors (TLR) represent a family of surface molecules that function as primary sensors of the innate immune system to recognize microbial pathogens. Ligand binding to TLR results in activation of cellular signaling pathways that regulate expression of genes involved in inflammation and immunity. OBJECTIVE Use of synthetic TLR ligands (agonists) for treatment and prevention of infectious and neoplastic diseases. METHODS Review of literature about clinical investigations of agonists of TLR 4, 7, 8, and 9. RESULTS/CONCLUSIONS Imiquimod was the first TLR agonist approved for treatment of anogenital warts, actinic keratosis and superficial basal cell carcinoma in humans. Several other agonists of TLRs 4, 7, 8 and 9 were also shown to be effective for treatment of infections and cancers and, furthermore, were used as adjuvants for vaccination. Based on safety and efficacy of the TLR agonists used to date, applications are likely to increase in the future.
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Affiliation(s)
- Thomas Meyer
- University of Hamburg, University Hospital Hamburg-Eppendorf, Institute of Medical Microbiology, Virology and Hygiene, Martinistrasse 52, 20246 Hamburg, Germany.
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Huerva V, Mangues I. Surgery of basal cell carcinoma around the lacrimal canaliculus can be necessary after primary treatment with intralesional interferon alpha 2b. Indian J Ophthalmol 2007; 56:85-6. [PMID: 18158420 PMCID: PMC2636066 DOI: 10.4103/0301-4738.37590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Prstojevich SJ, Nierzwicki BL. Treatment options for premalignant and malignant cutaneous tumors. Oral Maxillofac Surg Clin North Am 2007; 17:147-60, v. [PMID: 18088774 DOI: 10.1016/j.coms.2005.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Whenever possible, surgical excision of skin cancers should be the gold standard of treatment. There are many considerations when choosing one treatment modality over another. These include the lesion's location, the surgeon's experience and comfort level, the patient's health status and their potential compliance, access to available technology, and economic considerations for the patient and the provider. Regardless of the type of therapy, all forms of treatment share the following goals: complete disease cure, preservation of normal tissue, preservation of function, and optimal cosmesis.
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Affiliation(s)
- Steven J Prstojevich
- Department of Oral and Maxillofacial Surgery, University of Missouri-Kansas City, Truman Medical Center, 2301 Holmes Street, Kansas City, MO 64108, USA.
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20
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Smith DI, Swamy PM, Heffernan MP. Off-label uses of biologics in dermatology: Interferon and intravenous immunoglobulin (Part 1 of 2). J Am Acad Dermatol 2007; 56:e1-54. [PMID: 17190617 DOI: 10.1016/j.jaad.2006.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 05/04/2006] [Accepted: 06/19/2006] [Indexed: 11/29/2022]
Abstract
The introduction of a number of biologic therapies into the market has revolutionized the practice of dermatology. These therapies include interferons, intravenous immunoglobulin, infliximab, adalimumab, etanercept, efalizumab, alefacept, and rituximab. Most dermatologists are familiar with the Food and Drug Administration-approved indications of these medications. However, numerous off-label uses have evolved. As part 1 of a 2-part series, this article will review the literature regarding the off-label uses of the interferons and intravenous immunoglobulin in dermatology.
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Tucker SB, Polasek JW, Perri AJ, Goldsmith EA. Long-term follow-up of basal cell carcinomas treated with perilesional interferon alfa 2b as monotherapy. J Am Acad Dermatol 2006; 54:1033-8. [PMID: 16713458 DOI: 10.1016/j.jaad.2006.02.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 02/11/2006] [Accepted: 02/19/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Interferon alfa-2b (IFN) may be used to treat basal cell carcinoma (BCC) as an alternative to surgical or destructive methods. OBJECTIVE The purpose of this study is to determine the long-term effectiveness of IFN treatment for BCC. METHODS Fifty patients with 98 biopsy-proven primary superficial and nodular BCCs were treated perilesionally and intradermally with injections of IFN between 1985 and 1992. RESULTS Clinical cures were noted in 95 of 98 BCCs (51 nodular and 44 superficial), with a mean follow-up period of 10.5 years (9 months to 18.5 years). Of these, 35 of the 50 patients, which would include 68 of the 98 tumors, were followed up for a minimum of 10 years, with an average follow-up of 13.5 years. The 3 lesions requiring further treatment were nodular type BCC. One of these lesions showed no response to treatment, whereas the other two responded, then recurred at 4 and 154 months. Of the 68 tumors followed up for a minimum of 10 years, cure rates were 96%. Overall data analysis using Kaplan-Meier estimates showed 98% success rates at years 5 and 10, and a 96% success rate at year 15. LIMITATIONS Since 31% of patients could not be evaluated for more than 10-year follow-up, it is possible that the long-term cure rate is lower than that found in those available for evaluation. CONCLUSIONS Treatment of superficial and nodular BCCs with perilesional IFN is an acceptable treatment that may provide benefits over other treatment modalities depending on patients' individual needs. In addition, on the basis of this study, results of IFN treatment for BCC are comparable to most other methods of tumor destruction.
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Affiliation(s)
- Stephen B Tucker
- Department of Dermatology, The University of Texas Medical School at Houston, Texas, USA
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22
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Abstract
Further understanding of the pathogenesis of dermatologic conditions at a molecular level has led to targeted therapies. The topical immune response modifiers have contributed significantly to the treatment of cutaneous diseases. New topical remedies, particularly the Toll-like receptor agonists and calcineurin inhibitors, have added to the clinical armamentarium and have further advanced clinicians' ability to treat a wide variety of benign, premalignant, and malignant conditions. Furthermore, these agents have contributed to the understanding of the disease process. The next decade will witness even greater advances in targeted immunotherapies for dermatologic disease.
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Affiliation(s)
- Daniel N Sauder
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205-0900, USA.
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Oh CK, Son HS, Lee JB, Jang HS, Kwon KS. Intralesional interferon alfa-2b treatment of keratoacanthomas. J Am Acad Dermatol 2005; 51:S177-80. [PMID: 15577764 DOI: 10.1016/j.jaad.2004.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Complete excision is not always easy when a keratoacanthoma is large or located in certain anatomic areas. An effective nonsurgical treatment would be desirable in such cases. OBJECTIVE This was a pilot study of the effects of intralesional interferon alfa-2b in the treatment of rapidly growing keratoacanthomas. METHODS A total of 4 large, rapidly growing keratoacanthomas, which were located on the lower lip, neck, and cheeks of the 4 different patients, were treated with intralesional interferon alfa-2b injection weekly. Serial photographs were taken to observe the course of responses. RESULTS All lesions resolved completely in 5 to 7 weeks with acceptable cosmetic results. CONCLUSION Intralesional interferon alfa-2b can be a treatment modality of these difficult lesions.
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Affiliation(s)
- Chang-Keun Oh
- Department of Dermatology, Pusan National University College of Medicine, Busan, Korea.
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Pang KR, Wu JJ, Huang DB, Tyring SK, Baron S. Biological and clinical basis for molecular studies of interferons. METHODS IN MOLECULAR MEDICINE 2005; 116:1-23. [PMID: 16007741 PMCID: PMC7121562 DOI: 10.1385/1-59259-939-7:001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The cytokine family of interferons (IFNs) has multiple functions, including antiviral, anti-tumor, and immunomodulatory effects and regulation of cell differentiation. The multiple functions of the IFN system are thought to be an innate defense against microbes and foreign substances. The IFN system consists first of cells that produce IFNs in response to viral infection or other foreign stimuli and second of cells that establish the antiviral state in response to IFNs. This process of innate immunity involves multiple signaling mechanisms and activation of various host genes. Viruses have evolved to develop mechanisms that circumvent this system. IFNs have also been used clinically in the treatment of viral diseases. Improved treatments will be possible with better understanding of the IFN system and its interactions with viral factors. In addition, IFNs have direct and indirect effects on tumor cell proliferation, effector leukocytes and on apoptosis and have been used in the treatment of some cancers. Improved knowledge of how IFNs affect tumors and the mechanism that lead to a lack of response to IFNs would help the development of better IFN treatments for malignancies.
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Bostanci S, Kocyigit P, Alp A, Erdem C, Gürgey E. Treatment of Basal Cell Carcinoma Located in the Head and Neck Region with Intralesional Interferon ??-2a. Clin Drug Investig 2005; 25:661-7. [PMID: 17532711 DOI: 10.2165/00044011-200525100-00005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Intralesional injections of interferon have been reported to provide successful results in the treatment of basal cell carcinoma. However, there are only a few reports describing the long-term efficacy of this therapy. The aim of our study was to evaluate the efficacy and long-term results of interferon alpha-2a (IFNalpha-2a) in the treatment of basal cell carcinoma. METHODS Twenty dermatopathologically proven basal cell carcinoma lesions were treated with intralesional IFNalpha-2a injections three times weekly for 3 weeks. The dose per injection was 1.5 x 10(6)IU if the lesion was <2cm in diameter and 3.0 x 10(6) IU if it was >/=2cm. Eight weeks after the last injection, the lesion sites were rebiopsied and all cases were reevaluated both clinically and dermatopathologically. Patients with complete cure were followed up for 7 years to determine the long-term results. RESULTS Eleven lesions (55%) showed complete clinical and dermatopathological remission, six lesions (30%) showed partial remission, and two lesions (10%) showed no response. One lesion (5%) increased in size during the treatment. No serious adverse effects were observed. During the follow-up period there was only one recurrence, at the fifth year. CONCLUSION Treatment with intralesional IFNalpha-2a was shown to be an effective therapeutic option for basal cell carcinoma, with low recurrence rates in long-term follow-up.
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Affiliation(s)
- Seher Bostanci
- School of Medicine, Department of Dermatology, Ankara University, Ankara, Turkey
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Abstract
The epidemic of nonmelanoma skin cancer (NMSC) continues, in part due to aging of the world's population, the frequency of early childhood sunburns, and episodic intense recreational sun exposure as opposed to sun exposure related to outdoor occupations. A nonsurgical approach to selected skin cancers could potentially decrease the expense and morbidity of surgical treatment for NMSC. The increase of comorbid medical conditions in the elderly makes alternatives to surgical management preferable under certain circumstances. This review will discuss medical alternatives ranging from biologic response modifiers to COX-2 inhibitors to lifestyle modifications, as well as their roles in the management of NMSC. This preliminary information will expand to include more therapeutic options for NMSC in the future. Further clinical trials are needed to better elucidate possible alternative treatment strategies for NMSC.
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Affiliation(s)
- Arun Chakrabarty
- Solano Clinical Research, Solano Dermatology Associates, Vallejo, California, USA
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Ammirati CT, Ioffreda MD, Hruza GJ. Malignant tumors of the keratinocytes and adnexae. Facial Plast Surg Clin North Am 2004; 11:141-63. [PMID: 15062270 DOI: 10.1016/s1064-7406(02)00042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Christie T Ammirati
- Department of Dermatology, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033, USA.
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Kim KH, Yavel RM, Gross VL, Brody N. Intralesional interferon alpha-2b in the treatment of basal cell carcinoma and squamous cell carcinoma: revisited. Dermatol Surg 2004; 30:116-20. [PMID: 14692941 DOI: 10.1111/j.1524-4725.2004.30020.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intralesional interferon (IFN) alpha-2b has been shown to be a safe and effective mode of treatment for basal cell carcinoma and squamous cell carcinoma. Multiple studies published in the 1980s through the early 1990s have demonstrated the efficacy of intralesional interferon in the treatment of these malignancies. Unfortunately, this modality appears to be underused. OBJECTIVE This article serves to remind dermatologists that in addition to cryotherapy, electrodesiccation, and surgical excision, intralesional IFN-alpha is an important part of the armamentarium in the treatment of nonmelanoma skin cancers. METHODS In addition to a review of the literature, we present eight cases in seven patients successfully treated with intralesional IFN for basal cell carcinoma and squamous cell carcinoma. CONCLUSIONS Its nonsurgical approach and excellent cosmetic results make IFNalpha-2b an attractive option for patients and an important alternative when other treatment modalities are impractical or contraindicated.
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Affiliation(s)
- Karen H Kim
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York, USA.
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Intralesional Interferon α-2b in the Treatment of Basal Cell Carcinoma and Squamous Cell Carcinoma. Dermatol Surg 2004. [DOI: 10.1097/00042728-200401000-00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Robinson JK, Hernandez C, Anderson ER, Nickoloff B. Topical and light-based treatments for basal cell carcinoma. ACTA ACUST UNITED AC 2003; 22:171-6. [PMID: 14649584 DOI: 10.1016/s1085-5629(03)00047-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Nonsurgical methods of treatment providing cure rates approaching those provided by surgery offer a significant advantage to patients with basal cell carcinoma (BCC) in certain anatomic locations. While intralesional interferon has been used to treat BCC with some success, the deliver method requires multiple visits to the doctor's office, which makes compliance a challenge for the patient. Initial success with light-based therapy of BCC over a decade ago has not evolved to the point where it is an effective, widely available treatment. The new class of immune response modifiers, represented by topical imiquimod cream, shows promise for providing topical treatment of early BCC. It is hoped that further developments of the class of drugs will produce an agent with fewer side effects and improved efficacy for nodular BCC.
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Affiliation(s)
- June K Robinson
- Department of Medicine, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA.
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31
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Stockfleth E, Trefzer U, Garcia-Bartels C, Wegner T, Schmook T, Sterry W. The use of Toll-like receptor-7 agonist in the treatment of basal cell carcinoma: an overview. Br J Dermatol 2003; 149 Suppl 66:53-6. [PMID: 14616352 DOI: 10.1046/j.0366-077x.2003.05626.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Basal cell carcinoma (BCC) is a subtype of nonmelanoma skin cancer (NMSC), with an increasing incidence worldwide. Currently, excision of the tumour with histological control is the standard therapy. However, high incidence rates have led to concern about the economic burden imposed by BCC management in many countries. Imiquimod is a member of a novel class of immune response modifiers (IRM), which works by using the toll-like receptor (TLR)-7. Although the exact mode of action is so far unknown, it is suggested to induce the expression of different cytokines like interleukin (IL)-1, IL-6, IL-12, interferon (IFN)-alpha and tumour necrosis factor (TNF)-alpha, which stimulate or enhance both the innate immune system and the cell-mediated immune response. Pre-clinical studies have indicated the potential of this TLR-7 agonist for the treatment of precancers and tumours in humans. A number of Phase II trials have demonstrated the efficacy of imiquimod for the treatment of BCC, although the most appropriate dosing regimen is being confirmed in Phase III studies. Imiquimod 5% cream for the treatment of mainly superficial BCC appears to be an effective and well-tolerated treatment option.
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Affiliation(s)
- E Stockfleth
- Department of Dermatology, University Hospital Charité, Schumannstrasse 20-21, D-10117 Berlin, Germany.
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Immunotherapy of Basal Cell Carcinoma. Dermatol Surg 2003. [DOI: 10.1097/00042728-200310000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Nonmelanoma skin cancer (NMSC) is one of the most common types of cancer in the world. There is strong evidence that ultraviolet (UV) light plays a central role in the molecular pathogenesis of NMSC development. UV light causes DNA damage and loss of activity of tumor suppressor genes and overexpression of oncogenes and other genes related to enhanced growth and survival as well as tissue invasion. Also, UV light impairs the cutaneous immune response, especially Langerhans cell antigen-presenting function, resulting in immune tolerance to developing tumor cells. Standard treatments for NMSC include surgical excision, curettage and electrodessication, and Moh's micrographic surgery. Immunotherapy of NMSC has been attempted in the form of dinitrobenzene sensitization followed by topical application on the tumor, intralesional interferon injections, or perilesional interleukin-2. These treatments, although showing promise, have not been developed because of lower efficacy compared with surgical approaches, morbidity associated with treatments, as well as the expense of using recombinant cytokine treatments. The topical immune response modifier imiquimod is being developed as a novel local treatment for selected NMSC. Studies of the mechanism of action of imiquimod in NMSC indicate the presence of activated, natural killer cells (innate immunity), T-lymphocytes (adaptive immunity), antigen-presenting cells, and cytokines consistent with a delayed-type hypersensitivity reaction (Th1-lymphocyte cytokine pattern). This agent has been associated with a high response rate for the treatment of superficial basal cell carcinoma, with clearance rates ranging from 70% to 90% in a number of clinical trials. This novel immunotherapy represents a new, nonsurgical treatment option in the care of patients with NMSC.
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Affiliation(s)
- Anthony A Gaspari
- Department of Dermatology, University of Maryland School of Medicine, Baltimore 21030, USA.
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Buechner S, Wernli M, Bachmann F, Harr T, Erb P. Intralesional interferon in basal cell carcinoma: how does it work? Recent Results Cancer Res 2002; 160:246-50. [PMID: 12079220 DOI: 10.1007/978-3-642-59410-6_29] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Basal cell carcinoma (BCC) is the most common skin cancer among Caucasians, and its incidence is increasing. Intralesional injection of interferon alpha (IFN alpha) has been shown to provide a safe and effective treatment for BCCs. The predominant mechanism for the effect of IFN alpha on BCC has been partially identified. We have shown that in untreated patients, BCC cells constitutively express CD95 ligand (CD95L), but not the receptor. BCC cells make use of the CD95 ligand to escape from a local immune response by averting the attack from activated CD95 receptor-positive CD4+ T cells. The CD95L of BCC cells is functional as CD95+ target cells incubated on BCC cryosections become apoptotic and are lysed. In IFN alpha-treated patients BCC cells express not only CD95L but also CD95 receptor, and regress by committing suicide or fratricide through apoptosis induction via CD95 receptor-CD95L interaction. Peritumoral infiltrating cells, predominantly CD4+ T cells, may support regression of BCC by the secretion of cytokines such as IFN gamma or interleukin-2 which may also be responsible for the up-regulation of CD95 on BCC cells.
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Affiliation(s)
- Stanislaw Buechner
- Department of Dermatology, University of Basel, Kantonsspital, Switzerland
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35
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Fenton S, Kennedy S, Moriarty P. The role of interferon alpha 2b as an adjunctive treatment in the management of aggressive basal cell carcinoma of the eyelids. ACTA OPHTHALMOLOGICA SCANDINAVICA 2002; 80:674-5. [PMID: 12485296 DOI: 10.1034/j.1600-0420.2002.800623_3.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
We studied the usefulness of imiquimod cream in the treatment of 3 patients with actinic keratoses. One patient was treated 3 times per week for 4 weeks and had a marked inflammatory response with nearly complete resolution of actinic keratoses. Two subsequent patients were treated in a bilateral paired comparison study. Both patients had similar numbers of actinic keratoses on symmetric areas and treated only one side with imiquimod cream 2 to 3 times per week with frequent rest periods to avoid inflammation. Both experienced marked reductions in actinic keratoses. After 8 weeks, both patients applied imiquimod cream twice per week for 9 months with continued reduction in actinic keratoses on both sides. Treatments were well tolerated. Imiquimod cream appears to be effective in the treatment of actinic keratoses. The main adverse effect is local inflammation, which can be avoided by reducing the frequency of application.
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Affiliation(s)
- Andrea Persaud
- Department of Dermatology, The Mount Sinai School of Medicine of New York University, New York, NY 1029, USA
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37
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Affiliation(s)
- Edith Orion
- Dermatology Unit, Kaplan Medical Center, Rehovot, Israel
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38
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Affiliation(s)
- Stuart Salasche
- Department of Medicine, Section of Dermatology, University of Arizona Health Sciences Center, Arizona, USA
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39
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Satomi H, Wang B, Fujisawa H, Otsuka F. Interferon-beta from melanoma cells suppresses the proliferations of melanoma cells in an autocrine manner. Cytokine 2002; 18:108-15. [PMID: 12096926 DOI: 10.1006/cyto.2002.1028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Interferon (IFN)-alpha and IFN-beta have been utilized in the treatment of melanoma as a form of cytokine therapy. While previous studies have demonstrated that melanocytes and melanoma cells produce a number of cytokines, it remains unclear whether or not melanocytes and melanoma cells per se produce IFN-alpha or IFN-beta. In the present study, we investigated the expression of IFN-alpha or IFN-beta in human melanocytes and five melanoma cell lines: G-361, C32TG, MMAc, MEWO and VMRC-MELG at both mRNA and protein levels. Both IFN-alpha and IFN-beta mRNA were detected in normal human melanocytes. Likewise, IFN-alpha mRNA was detected in all five melanoma cell lines. However, IFN-beta mRNA was only detected in one melanoma cell line, VMRC-MELG. When melanocytes and melanoma cells were treated with a potent IFN inducer, polyinosinic:polycytidylic acid (poly I:C), the mRNA expression of both IFN-alpha and IFN-beta was significantly upregulated. Poly I:C was not able to induce melanocytes or melanoma cells to produce detectable amounts of IFN-alpha protein, but able to induce a significant amount of IFN-beta in melanocytes and two of the melanoma cell lines: MMAc and VMRC-MELG. Moreover, similar to exogenous IFN-alpha and IFN-beta, poly I:C significantly inhibited the proliferation of all five melanoma cell lines. This suppressive effect was partially blocked by anti-IFN-beta antibody treatment in the IFN-beta-producing melanoma cell lines: MMAc and VMRC-MELG, but not in the non-IFN-beta-producing cell lines: G-361, C32TG and MEWO. Collectively, these studies have demonstrated for the first time that human melanocytes and melanoma cells produce IFN-beta. Furthermore, melanoma cells are capable of suppressing their own proliferation via secretion of endogenous IFN-beta. This finding may have important implications for melanoma therapy.
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Affiliation(s)
- Hisae Satomi
- Department of Dermatology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
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40
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Ultrapulse CO2 Used for the Successful Treatment of Basal Cell Carcinomas Found in Patients with Basal Cell Nevus Syndrome. Dermatol Surg 2002. [DOI: 10.1097/00042728-200203000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Nouri K, Chang A, Trent JT, Jiménez GP. Ultrapulse CO2 used for the successful treatment of basal cell carcinomas found in patients with basal cell nevus syndrome. Dermatol Surg 2002; 28:287-90. [PMID: 11896785 DOI: 10.1046/j.1524-4725.2002.01080.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Basal cell nevus syndrome (BCNS) is an inherited condition marked by multiple basal cell carcinomas (BCCs) associated with several other abnormalities. Various treatment modalities have been used to eradicate these tumors. However, recurrences and scarring limit their use. OBJECTIVE To evaluate the treatment of multiple BCCs associated with BCNS. METHODS We describe three cases of BCNS in which multiple BCCs were effectively treated with ultrapulse CO2 laser. Postoperative Mohs micrographic surgical sections (thin sections looking for residual tumor) verified complete histologic clearance of the tumors. RESULTS All three patients were effectively treated with ultrapulse CO2 laser. Minimal scarring was noted at follow-up. CONCLUSION Ultrapulse CO2 laser can be used to effectively treat small BCCs in low-risk areas associated with BCNS with minimal posttreatment scarring.
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Affiliation(s)
- Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA.
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42
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Berg D, Asgari M. Evidence-based medicine for dermatologic surgeons: concepts in critical appraisal of information. Dermatol Surg 2001; 27:511-4. [PMID: 11442584 DOI: 10.1046/j.1524-4725.2001.01022.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The term evidence-based medicine (EBM) is increasingly being used. Physicians, journal editors, insurance companies, and patients are applying its tenets to clinical decision making. Although there are concerns about the overly zealous application of EBM to clinical situations, many of the basic concepts are important in improving decision making. OBJECTIVE To define evidence-based medicine and to review potential problems in basing decision making entirely on less-than-ideal evidence. METHODS We reviewed the EBM literature and looked for examples in dermatology of pitfalls in decision making based on poor evidence. RESULTS Following a definition of EBM, we review problems inherent in anecdotes and uncontrolled trials, including the placebo effect. Examples of medical practice that have been altered by doing more rigorous studies are provided. CONCLUSIONS Concepts of EBM as currently defined should be considered by dermatologic surgeons in assessing the available information for clinical decision making.
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Affiliation(s)
- D Berg
- Division of Dermatology, University of Washington Medical Center, Seattle, WA 98195, USA.
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43
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Evidence-Based Medicine for Dermatologic Surgeons. Dermatol Surg 2001. [DOI: 10.1097/00042728-200106000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Chemotherapy has been used to treat a multitude of eye cancers. We attempted to review the role of chemotherapy in the treatment of ocular, adnexal, and orbital malignancies by conducting an extensive search of the medical literature. Unfortunately, the published reports typically contain few patients with limited follow-up, precluding definitive recommendations. For most eye cancers, multicenter trials will offer the potential to gather the numbers of patients required to determine the clinical utility of chemotherapy.
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Affiliation(s)
- M W Wilson
- The Department of Ophthalmology, University of Tennessee, Memphis, TN, USA
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45
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Epidemiología e inmunopatogenia del cáncer cutáneo no melanoma. El papel iniciador y promotor del VPH. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0213-9251(01)72496-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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46
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Monga SP, Wadleigh R, Sharma A, Adib H, Strader D, Singh G, Harmon JW, Berlin M, Monga DK, Mishra L. Intratumoral therapy of cisplatin/epinephrine injectable gel for palliation in patients with obstructive esophageal cancer. Am J Clin Oncol 2000; 23:386-92. [PMID: 10955870 DOI: 10.1097/00000421-200008000-00016] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obstructing esophageal cancer produces severe dysphagia with ensuing death within 90 days. Palliation is possible with modalities like stent placement, laser, and photodynamic therapy. However, these treatments have a high rate of complications, and the overall mortality is not altered. A new alternative treatment evaluated in this study is endoscopic intratumoral injection with cisplatin/epinephrine (CDDP/epi) gel. CDDP/epi gel injections were administered weekly for 3 to 8 weeks in nine patients, median age, 72 years; mean tumor volume (+/-SEM), 41.44 (+/-22.4) cm3. Eight patients had stage IV, and one had stage III esophageal carcinoma. The mean dysphagia score (+/-SEM) was 3.5 (+/-0.17). All patients were followed up until death. Dysphagia resolved in eight patients with reduction in mean dysphagia score (+/-SEM) from 3.5 (+/-0.17) to 0.75 (+/-0.28; p = 0.005). Tumor volume was reduced by 75% in one patient and by 50% in two patients. The median survival was 4 months. The longest follow-up has been 15 months (458 days). In this pilot study, intratumoral injection of CDDP/epi gel restored swallowing in eight of nine patients and was an effective and safe outpatient treatment in patients with obstructive esophageal cancer.
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Affiliation(s)
- S P Monga
- Department of Gastroenterology/Development and Molecular Biology, Department of Veterans Affairs Medical Center, Washington, DC 20422, USA
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47
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Abel EA. Skin neoplasias including cutaneous lymphoma, melanoma, and others: unapproved treatments or indications. Clin Dermatol 2000; 18:201-10. [PMID: 10742630 DOI: 10.1016/s0738-081x(99)00112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- E A Abel
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
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48
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Hottiger MO, Dam TN, Nickoloff BJ, Johnson TM, Nabel GJ. Liposome-mediated gene transfer into human basal cell carcinoma. Gene Ther 1999; 6:1929-35. [PMID: 10637444 DOI: 10.1038/sj.gt.3301036] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Direct intralesional injection of DNA encoding interferon-alpha2 (IFN-alpha2) was used in an effort to sustain local protein delivery for the treatment of human basal cell carcinoma (BCC). A novel model to study this malignancy was established by transplantation of human BCC tissue on to immunodeficient mice with a relatively high rate of engraftment and stable phenotype for superficial BCC (20 of 25; 80%). Gene transfer was significantly increased by using DNA liposome complexes (lipoplexes). Recombinant gene expression was detected predominantly in the epidermis and, to a lesser extent, in the dermis. Gene transfer of IFN-alpha2 using this method resulted in sustained production of IFN-alpha2 protein and increased expression of a known IFN-inducible gene, the class II major histocompatibility (MHC) antigen, and induced BCC regression, presumably through a non-immune mechanism. Intralesional injection of DNA lipoplexes encoding IFN-alpha protein may therefore be applicable to the treatment of cutaneous BCC.
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Affiliation(s)
- M O Hottiger
- Howard Hughes Medical Institute, University of Michigan Medical Center, Departments of Internal Medicine and Biological Chemistry, Ann Arbor, MI, USA
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49
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Affiliation(s)
- M Kashani-Sabet
- Cutaneous Oncology Division, Department of Dermatology, University of California at San Francisco, 94115, USA
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50
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Beutner KR, Geisse JK, Helman D, Fox TL, Ginkel A, Owens ML. Therapeutic response of basal cell carcinoma to the immune response modifier imiquimod 5% cream. J Am Acad Dermatol 1999; 41:1002-7. [PMID: 10570388 DOI: 10.1016/s0190-9622(99)70261-6] [Citation(s) in RCA: 286] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) responds to interferon therapy. Imiquimod is a cytokine and interferon inducer. OBJECTIVE This randomized, double-blind pilot trial evaluated the safety and efficacy of imiquimod 5% cream versus vehicle in the treatment of BCC. METHODS In this population of 35 patients with BCC, 24 received imiquimod 5% cream and 11 received vehicle cream in 1 of 5 dosing regimens for up to 16 weeks. Six weeks after treatment, an excisional biopsy of the target site was performed. RESULTS BCC cleared (on the basis of histologic examination) in all 15 patients (100%) dosed twice daily, once daily, and 3 times weekly; in 3 of 5 (60%) patients dosed twice weekly; 2 of 4 (50%) dosed once weekly; and in 1 of 11 (9%) treated with vehicle. Adverse events were predominantly local reactions at the target tumor site, with the incidence and severity of local skin reactions declining in groups dosed less frequently. CONCLUSION Imiquimod 5% cream shows clinical efficacy in the treatment of BCC.
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Affiliation(s)
- K R Beutner
- Department of Dermatology, University of California, San Francisco, the Department of Medicine, Sutter Solano Medical Center, Vallejo, Solano Dermatology Associates, Vallejo, CA, USA
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