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Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, Berking C, Arenberger P, Bylaite-Bučinskiene M, Del Marmol V, Dirschka T, Dreno B, Forsea AM, Harwood CA, Hauschild A, Heerfordt IM, Kauffman R, Kelleners-Smeets N, Lallas A, Lebbe C, Leiter U, Longo C, Mijušković Ž, Pellacani G, Puig S, Saiag P, Šitum M, Stockfleth E, Salavastru C, Stratigos A, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes). J Eur Acad Dermatol Venereol 2024; 38:1024-1047. [PMID: 38451047 DOI: 10.1111/jdv.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.
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Affiliation(s)
- Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endrocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - Matilda Bylaite-Bučinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany
- CentroDerm Clinic, Wuppertal, Germany
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catherine 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, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Ida Marie Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Roland Kauffman
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP, Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Caterina Longo
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Željko Mijušković
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Susana Puig
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mirna Šitum
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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Li Pomi F, Peterle L, d'Aloja A, Di Tano A, Vaccaro M, Borgia F. Anti-aging Effects of Tirbanibulin 1% Ointment: A Real-Life Experience. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01178-0. [PMID: 38740726 DOI: 10.1007/s13555-024-01178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Tirbanibulin 1% ointment has been licensed to treat non-hyperkeratotic actinic keratosis (AKs) on the face and scalp in adults to ensure excellent patient tolerability due to the mild side effects and the brief application time compared to other topical therapies on the market. A growing body of evidence suggests that, beyond their primary function, the treatments for AKs and the cancerization field may inadvertently confer substantial cosmetic benefits to patients. METHODS We report a single-center retrospective case series of patients referred to the Dermatology Unit of the University Hospital of Messina, Italy, between February and December 2023 seeking treatment for AKs in the context of photodamaged areas in which the application of tirbanibulin 1% ointment induced, besides clearance of AKs, anti-aging effects on both skin texture and solar lentigos. RESULTS Seven patients affected by Olsen grade 1-2 AKs experienced a powerful rejuvenating effect in the treated areas, with a marked efficacy in skin lightening and clearance of solar lentigo. CONCLUSIONS Tirbanibulin 1% ointment seems able to improve skin aging as a desirable side effect at the site of application for AKs on chronic photodamaged skin. Such preliminary observation needs further confirmation in real-life studies on larger cohorts of patients, to explain the pathogenic mechanisms responsible for such aesthetically relevant results.
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Affiliation(s)
- Federica Li Pomi
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127, Palermo, Italy
| | - Lucia Peterle
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Andrea d'Aloja
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Antonio Di Tano
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy.
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Rudolph V, Leven AS, Eisenburger R, Schadendorf D, Wiegand S. Interdisciplinary management of skin cancer. Laryngorhinootologie 2024; 103:S100-S124. [PMID: 38697144 DOI: 10.1055/a-2171-4570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The interdisciplinary treatment of skin cancer in the head and neck area requires close collaboration between different specialist disciplines. The most common non-melanoma skin cancer tumor entities are cutaneous squamous cell carcinoma and basal cell carcinoma as well as their precursor lesions. One of the less common tumors is Merkel cell carcinoma, which also occurs primarily in light-exposed areas and, in contrast to squamous and basal cell carcinoma, is more likely to metastasize. Due to the low tendency of basal cell carcinoma as well as cutaneous squamous cell carcinoma to metastasize, a cure can often be achieved by surgery. If the tumor growth exceeds certain levels it may require collaboration between dermatology and otorhinolaryngology. The primary goal of this interdisciplinary collaboration is to achieve a functional, cosmetically and aesthetically acceptable result in addition to adequate tumor treatment. Depending on the stage of the tumor and the clinical course, a case may be discussed in an interdisciplinary tumor board in order to determine a personalised, appropriate and adequate treatment concept for each patient, including prevention, therapy and follow-up.
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Affiliation(s)
- Victoria Rudolph
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Anna-Sophia Leven
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Robin Eisenburger
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Thamm JR, Welzel J, Schuh S. Diagnosis and therapy of actinic keratosis. J Dtsch Dermatol Ges 2024; 22:675-690. [PMID: 38456369 DOI: 10.1111/ddg.15288] [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: 01/31/2023] [Accepted: 09/28/2023] [Indexed: 03/09/2024]
Abstract
Actinic keratosis (AK) is considered a chronic and recurring in situ skin neoplasia, with a possible transformation into invasive squamous cell carcinoma (SCC). Among others, predominant risk factors for development of AK are UV-light exposure and immunosuppression. Basal epidermal keratinocyte atypia (AK I) and proliferation (PRO score) seem to drive malignant transformation, rather than clinical appearance of AK (Olsen I-III). Due to the invasiveness of punch biopsy, those histological criteria are not regularly assessed. Non-invasive imaging techniques, such as optical coherence tomography (OCT), reflectance confocal microscopy (RCM) and line-field confocal OCT (LC-OCT) are helpful to distinguish complex cases of AK, Bowen's disease, and SCC. Moreover, LC-OCT can visualize the epidermis and the papillary dermis at cellular resolution, allowing real-time PRO score assessment. The decision-making for implementation of therapy is still based on clinical risk factors, ranging from lesion- to field-targeted and ablative to non-ablative regimens, but in approximately 85% of the cases a recurrence of AK can be observed after a 1-year follow-up. The possible beneficial use of imaging techniques for a non-invasive follow-up of AK to detect recurrence or invasive progression early on should be subject to critical evaluation in further studies.
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Affiliation(s)
- Janis Raphael Thamm
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Schuh
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
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5
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Thamm JR, Welzel J, Schuh S. Diagnose und Therapie aktinischer Keratosen. J Dtsch Dermatol Ges 2024; 22:675-691. [PMID: 38730534 DOI: 10.1111/ddg.15288_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/28/2023] [Indexed: 05/13/2024]
Abstract
Actinic keratosis (AK) is considered a chronic and recurring in situ skin neoplasia, with a possible transformation into invasive squamous cell carcinoma (SCC). Among others, predominant risk factors for development of AK are UV-light exposure and immunosuppression. Basal epidermal keratinocyte atypia (AK I) and proliferation (PRO Score) seem to drive malignant turnover, rather than clinical appearance of AK (Olsen I-III). Due to the invasiveness of punch biopsy, those histological criteria are not regularly assessed. Non-invasive imaging techniques, such as optical coherence tomography (OCT), reflectance confocal microscopy (RCM) and line-field confocal OCT (LC-OCT) are helpful to distinguish complex cases of AK, Bowen's disease and SCC. Moreover, LC-OCT can visualize the epidermis and the papillary dermis at cellular resolution, allowing real-time PRO Score assessment. The decision-making for implementation of therapy is still based on clinical risk factors, ranging from lesion- to field-targeted and ablative to non-ablative regimes, but in approximately 85% of the cases a recurrence of AK can be observed after a 1-year follow-up. The possible beneficial use of imaging techniques for a non-invasive follow-up of AK to detect recurrence or invasive progression early on should be subject to critical evaluation in further studies.
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Affiliation(s)
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg
| | - Sandra Schuh
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg
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Courtenay LA, Barbero-García I, Martínez-Lastras S, Del Pozo S, Corral de la Calle M, Garrido A, Guerrero-Sevilla D, Hernandez-Lopez D, González-Aguilera D. Near-infrared hyperspectral imaging and robust statistics for in vivo non-melanoma skin cancer and actinic keratosis characterisation. PLoS One 2024; 19:e0300400. [PMID: 38662718 PMCID: PMC11045066 DOI: 10.1371/journal.pone.0300400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/26/2024] [Indexed: 04/28/2024] Open
Abstract
One of the most common forms of cancer in fair skinned populations is Non-Melanoma Skin Cancer (NMSC), which primarily consists of Basal Cell Carcinoma (BCC), and cutaneous Squamous Cell Carcinoma (SCC). Detecting NMSC early can significantly improve treatment outcomes and reduce medical costs. Similarly, Actinic Keratosis (AK) is a common skin condition that, if left untreated, can develop into more serious conditions, such as SCC. Hyperspectral imagery is at the forefront of research to develop non-invasive techniques for the study and characterisation of skin lesions. This study aims to investigate the potential of near-infrared hyperspectral imagery in the study and identification of BCC, SCC and AK samples in comparison with healthy skin. Here we use a pushbroom hyperspectral camera with a spectral range of ≈ 900 to 1600 nm for the study of these lesions. For this purpose, an ad hoc platform was developed to facilitate image acquisition. This study employed robust statistical methods for the identification of an optimal spectral window where the different samples could be differentiated. To examine these datasets, we first tested for the homogeneity of sample distributions. Depending on these results, either traditional or robust descriptive metrics were used. This was then followed by tests concerning the homoscedasticity, and finally multivariate comparisons of sample variance. The analysis revealed that the spectral regions between 900.66-1085.38 nm, 1109.06-1208.53 nm, 1236.95-1322.21 nm, and 1383.79-1454.83 nm showed the highest differences in this regard, with <1% probability of these observations being a Type I statistical error. Our findings demonstrate that hyperspectral imagery in the near-infrared spectrum is a valuable tool for analyzing, diagnosing, and evaluating non-melanoma skin lesions, contributing significantly to skin cancer research.
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Affiliation(s)
- Lloyd A. Courtenay
- CNRS, PACEA UMR 5199, Université de Bordeaux, Bât B2, Pessac, 33600, France
| | - Inés Barbero-García
- Department of Cartographic and Land Engineering, Higher Polytechnic School of Ávila, Universidad de Salamanca, Ávila, Spain
| | - Saray Martínez-Lastras
- Department of Cartographic and Land Engineering, Higher Polytechnic School of Ávila, Universidad de Salamanca, Ávila, Spain
| | - Susana Del Pozo
- Department of Cartographic and Land Engineering, Higher Polytechnic School of Ávila, Universidad de Salamanca, Ávila, Spain
| | | | - Alonso Garrido
- Institute of Regional Development, University of Castilla la Mancha, Campus Universitario s/n, Albacete, Spain
| | - Diego Guerrero-Sevilla
- Institute of Regional Development, University of Castilla la Mancha, Campus Universitario s/n, Albacete, Spain
| | - David Hernandez-Lopez
- Institute of Regional Development, University of Castilla la Mancha, Campus Universitario s/n, Albacete, Spain
| | - Diego González-Aguilera
- Department of Cartographic and Land Engineering, Higher Polytechnic School of Ávila, Universidad de Salamanca, Ávila, Spain
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Wood BA, Harvey NT, Mesbah Ardakani N, Paton D. Bowen disease is not synonymous with intraepidermal squamous cell carcinoma. Pathology 2024; 56:322-324. [PMID: 38360444 DOI: 10.1016/j.pathol.2023.10.021] [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: 08/03/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 02/17/2024]
Abstract
The terms 'Bowen disease' and 'intraepidermal squamous cell carcinoma' are sometimes considered synonymous. In this paper we present historical, clinical, histological and molecular evidence that this is incorrect. The term Bowen disease should be reserved for a subset of intraepidermal squamous cell carcinoma with a distinctive and reproducible morphological pattern, described in detail by Bowen in 1912. One other common subset of intraepidermal squamous cell carcinoma represents progression of actinic keratosis. In some cases the separation of these two common patterns of intraepidermal squamous cell carcinoma can be challenging and there are patterns of intraepidermal squamous cell carcinoma which appear to represent other distinct pathways. However, there is emerging biological evidence to support this distinction and reason to suspect that the types of invasive squamous cell carcinoma which arise from these different pathways may show important clinical and biological differences, particularly in the era of targeted and immunomodulatory therapy for advanced disease.
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Affiliation(s)
- Benjamin A Wood
- Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia; Clinipath Pathology, Osborne Park, WA, Australia.
| | - Nathan T Harvey
- Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Nima Mesbah Ardakani
- Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - David Paton
- Clinipath Pathology, Osborne Park, WA, Australia
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Zha W, Huang J, Lyu T, Miao F, Wu M, Shen J, Zhu R, Wang H, Shi L. Full-face ALA-PDT for facial actinic keratosis: Two case reports. Photodiagnosis Photodyn Ther 2024; 45:103927. [PMID: 38097119 DOI: 10.1016/j.pdpdt.2023.103927] [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: 10/01/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Abstract
We reported two cases of full-face 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) for facial multiple actinic keratosis (AK). After the full-face ALA-PDT, we observed that the AK lesions on the faces of the patients were completely cleared and facial rejuvenation was achieved. In our follow-up, one patient was free of recurrence for over 13 months and the other one for over 28 months. The experience of these two cases may indicate that full-face ALA-PDT has an excellent therapeutic effect while potentially preventing the recurrence of AK.
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Affiliation(s)
- Wenjing Zha
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, PR China
| | - Jianhua Huang
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, PR China
| | - Ting Lyu
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, PR China
| | - Fei Miao
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, PR China
| | - Minfeng Wu
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, PR China
| | - Jie Shen
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, PR China
| | - Rongyi Zhu
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, PR China
| | - Hongwei Wang
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, PR China
| | - Lei Shi
- Department of Dermatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, PR China.
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9
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Li Pomi F, Vaccaro M, Pallio G, Rottura M, Irrera N, Borgia F. Tirbanibulin 1% Ointment for Actinic Keratosis: Results from a Real-Life Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:225. [PMID: 38399512 PMCID: PMC10890708 DOI: 10.3390/medicina60020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Tirbanibulin 1% ointment is a novel synthetic anti-proliferative agent that inhibits tubulin polymerization. It is approved for treating actinic keratosis (AK) on the face and scalp in adults. It has demonstrated good efficacy, an adequate safety profile and excellent patient adherence in the phase 3 clinical trials, however data about its real-life efficacy and safety are lacking. Here we report the experience of the dermatology unit of the University Hospital of Messina. Materials and Methods: We performed a spontaneous open-label, prospective non-randomized study to assess the effectiveness and safety of tirbanibulin 1% ointment for the treatment of 228 AKs in 38 consecutive patients-28 males (73%) and 10 females (26%)-aged between 52 and 92 years (mean age: 72 ± 8.92 years). Results: Total clearance was recorded in 51% of lesions, while partial clearance was recorded in 73% of lesions. An excellent tolerability profile and high compliance rate were observed, with no treatment discontinuation due to the onset of adverse events. Conclusion: Our real-life experience confirms the effectiveness and safety of tirbanibulin ointment for the treatment of AKs.
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Affiliation(s)
- Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; (F.L.P.); (M.V.)
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; (F.L.P.); (M.V.)
| | - Giovanni Pallio
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy;
| | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Messina, 98125 Messina, Italy; (M.R.); (N.I.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Messina, 98125 Messina, Italy; (M.R.); (N.I.)
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; (F.L.P.); (M.V.)
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Soare C, Cozma EC, Celarel AM, Rosca AM, Lupu M, Voiculescu VM. Digitally Enhanced Methods for the Diagnosis and Monitoring of Treatment Responses in Actinic Keratoses: A New Avenue in Personalized Skin Care. Cancers (Basel) 2024; 16:484. [PMID: 38339236 PMCID: PMC10854727 DOI: 10.3390/cancers16030484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Non-melanocytic skin cancers represent an important public health problem due to the increasing incidence and the important local destructive potential. Thus, the early diagnosis and treatment of precancerous lesions (actinic keratoses) is a priority for the dermatologist. In recent years, non-invasive skin imaging methods have seen an important development, moving from simple observational methods used in clinical research, to true diagnostic and treatment methods that make the dermatologist's life easier. Given the frequency of these precancerous lesions, their location on photo-exposed areas, as well as the long treatment periods, with variable, imprecise end-points, the need to use non-invasive imaging devices is increasingly evident to complete the clinical observations in the diagnosis and treatment of these lesions, with the aim of increasing accuracy and decreasing the adverse effects due to long treatment duration. This is the first review that brings together all skin imaging methods (dermoscopy, reflectance confocal microscopy, ultrasonography, dermoscopy-guided high frequency ultrasonography, and optical coherence tomography) used in the evaluation of actinic keratoses and their response to different treatment regimens.
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Affiliation(s)
- Cristina Soare
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Elena Codruta Cozma
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Celarel
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Rosca
- Department of Dermatology, University Military Hospital “Dr. Carol Davila”, 010825 Bucharest, Romania;
| | - Mihai Lupu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Vlad Mihai Voiculescu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
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11
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Stockfleth E, Heppt MV, Bégeault N, Delarue A. Evaluating the Efficacy and Safety of 4% 5-Fluorouracil Cream in Patients with Actinic Keratosis: An Expert Opinion. Acta Derm Venereol 2023; 103:adv11954. [PMID: 37982726 PMCID: PMC10680462 DOI: 10.2340/actadv.v103.11954] [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: 05/03/2023] [Accepted: 08/16/2023] [Indexed: 11/21/2023] Open
Abstract
Actinic keratosis is a lesion that develops in sun-exposed areas of the skin and is considered to be a precancerous condition or an early in situ squamous cell carcinoma. Treatment of actinic keratosis is important for reducing skin cancer risk, with treatment choice based on patient-, lesion- and treatment-related considerations. Of the topical treatments used for field-directed therapy, those containing 5-fluorouracil are among the most effective and widely prescribed. The most recently developed topical 5-fluorouracil preparation (Tolak®; Pierre Fabre, France) contains 4% 5-fluorouracil in an aqueous cream. This narrative review discusses data on 4% 5-fluorouracil cream to treat actinic keratosis, and provides the authors' expert opinion on issues associated with it use. The effect of the cream has been evaluated in phase 2 and 3 trials of adult patients with actinic keratosis on the face, ears or scalp. These trials included patients with severe baseline disease, defined by high lesion counts and large-size treatment fields, which possibly affected the proportion of patients who were able to achieve complete clearance. Other efficacy parameters (e.g. percentage change in lesion count, ≥ 75% clearance of lesions or clinically significant changes in validated severity scales) should also be assessed to fully evaluate 4% 5-fluorouracil treatment efficacy in these patients. Nevertheless, 4% 5-fluorouracil is associated with high efficacy, a low level of recurrence and a satisfactory safety profile.
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Affiliation(s)
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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12
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Orte Cano C, Suppa M, del Marmol V. Where Artificial Intelligence Can Take Us in the Management and Understanding of Cancerization Fields. Cancers (Basel) 2023; 15:5264. [PMID: 37958437 PMCID: PMC10649750 DOI: 10.3390/cancers15215264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/15/2023] Open
Abstract
Squamous cell carcinoma and its precursor lesion actinic keratosis are often found together in areas of skin chronically exposed to sun, otherwise called cancerisation fields. The clinical assessment of cancerisation fields and the correct diagnosis of lesions within these fields is usually challenging for dermatologists. The recent adoption of skin cancer diagnostic imaging techniques, particularly LC-OCT, helps clinicians in guiding treatment decisions of cancerization fields in a non-invasive way. The combination of artificial intelligence and non-invasive skin imaging opens up many possibilities as AI can perform tasks impossible for humans in a reasonable amount of time. In this text we review past examples of the application of AI to dermatological images for actinic keratosis/squamous cell carcinoma diagnosis, and we discuss about the prospects of the application of AI for the characterization and management of cancerization fields.
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Affiliation(s)
- Carmen Orte Cano
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Groupe d’Imagerie Cutanée Non Invasive (GICNI), Société Française de Dermatologie (SFD), 75008 Paris, France
| | - Véronique del Marmol
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
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13
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Thamm JR, Daxenberger F, Viel T, Gust C, Eijkenboom Q, French LE, Welzel J, Sattler EC, Schuh S. KI-basierte Bestimmung des PRO-Scores in aktinischen Keratosen anhand von LC-OCT-Bilddatensätzen: Artificial intelligence-based PRO score assessment in actinic keratoses from LC-OCT imaging using Convolutional Neural Networks. J Dtsch Dermatol Ges 2023; 21:1359-1368. [PMID: 37946638 DOI: 10.1111/ddg.15194_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/22/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungHintergrundMit Hilfe des histologischen PRO‐Scores (I–III) kann das Risiko einer malignen Transformation aktinischer Keratosen (AK) abgeschätzt werden, indem er das Ausmaß der Undulation und basalen Proliferation der dermoepidermalen Junktionszone (DEJ) bewertet. Die konfokale Line‐Field optische Kohärenztomographie (LC‐OCT) ermöglicht eine nichtinvasive Bestimmung des PRO‐Scores in Echtzeit. Anhand von LC‐OCT‐Bilddatensätzen kann eine künstliche Intelligenz (KI) mit Hilfe von Convolutional Neural Networks (CNN) zur automatischen Quantifizierung des PRO‐Scores von AK in vivo trainiert werden.Patienten und MethodikConvolutional Neural Networks wurden trainiert, um LC‐OCT‐Bilder von gesunder Haut und von AK zu segmentieren. PRO‐Score‐Modelle wurden in Übereinstimmung mit dem histopathologischen Goldstandard entwickelt und an einer Teilmenge von 237 LC‐OCT‐AK‐Bildern trainiert und an 76 Bildern getestet, wobei der von der KI‐berechnete PRO‐Score mit dem visuellen Konsens der Bildgebungsexperten verglichen wurde.ErgebnisseEine signifikante Übereinstimmung wurde in 57/76 (75%) Fällen festgestellt. Die KI‐basierte Bewertung des PRO‐Scores korrelierte am besten mit dem visuellen Score für PRO II (84,8%) vs. PRO III (69,2%) vs. PRO I (66,6%). In 25% der Fälle kam es zu Fehlinterpretationen, die meist auf eine Verschattung der DEJ sowie störende Merkmale wie Haarfollikel zurückzuführen waren.SchlussfolgerungenDie Ergebnisse deuten darauf hin, dass CNN für die automatische Quantifizierung des PRO‐Scores in LC‐OCT‐Bilddatensätzen hilfreich sind. Dies könnte zur nichtinvasiven Bewertung des Proliferationsrisikos in der Diagnostik und Nachsorge von AK herangezogen werden.
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Affiliation(s)
- Janis R Thamm
- Abteilung für Dermatologie und Allergologie, Universitätsklinikum, Universität Augsburg, Augsburg, Deutschland
| | - Fabia Daxenberger
- Abteilung für Dermatologie und Allergologie, Universitätsklinikum, LMU München, München, Deutschland
| | - Théo Viel
- DAMAE Medical Paris, Paris, Frankreich
| | - Charlotte Gust
- Abteilung für Dermatologie und Allergologie, Universitätsklinikum, LMU München, München, Deutschland
| | - Quirine Eijkenboom
- Abteilung für Dermatologie und Allergologie, Universitätsklinikum, LMU München, München, Deutschland
| | - Lars E French
- Abteilung für Dermatologie und Allergologie, Universitätsklinikum, LMU München, München, Deutschland
| | - Julia Welzel
- Abteilung für Dermatologie und Allergologie, Universitätsklinikum, Universität Augsburg, Augsburg, Deutschland
| | - Elke C Sattler
- Abteilung für Dermatologie und Allergologie, Universitätsklinikum, LMU München, München, Deutschland
| | - Sandra Schuh
- Abteilung für Dermatologie und Allergologie, Universitätsklinikum, Universität Augsburg, Augsburg, Deutschland
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14
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention-Update 2023. Eur J Cancer 2023; 193:113251. [PMID: 37717283 DOI: 10.1016/j.ejca.2023.113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. Overall, cSCC mostly has very good prognosis after treatment, with 5-year cure rates greater than 90%. Despite the overall favourable prognosis and the proportionally rare deaths, cSCC is associated with a high total number of deaths due to its high incidence. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV) and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update recommendations on cSCC, based on current literature and expert consensus. Part 1 of the guidelines addresses the updates on classification, epidemiology, diagnosis, risk stratification, staging and prevention in immunocompetent as well as immunosuppressed patients.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital Zurich, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine 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, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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15
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Thamm JR, Daxenberger F, Viel T, Gust C, Eijkenboom Q, French LE, Welzel J, Sattler EC, Schuh S. Artificial intelligence-based PRO score assessment in actinic keratoses from LC-OCT imaging using Convolutional Neural Networks. J Dtsch Dermatol Ges 2023; 21:1359-1366. [PMID: 37707430 DOI: 10.1111/ddg.15194] [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: 12/18/2022] [Accepted: 06/22/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND AND OBJECTIVES The histological PRO score (I-III) helps to assess the malignant potential of actinic keratoses (AK) by grading the dermal-epidermal junction (DEJ) undulation. Line-field confocal optical coherence tomography (LC-OCT) provides non-invasive real-time PRO score quantification. From LC-OCT imaging data, training of an artificial intelligence (AI), using Convolutional Neural Networks (CNNs) for automated PRO score quantification of AK in vivo may be achieved. PATIENTS AND METHODS CNNs were trained to segment LC-OCT images of healthy skin and AK. PRO score models were developed in accordance with the histopathological gold standard and trained on a subset of 237 LC-OCT AK images and tested on 76 images, comparing AI-computed PRO score to the imaging experts' visual consensus. RESULTS Significant agreement was found in 57/76 (75%) cases. AI-automated grading correlated best with the visual score for PRO II (84.8%) vs. PRO III (69.2%) vs. PRO I (66.6%). Misinterpretation occurred in 25% of the cases mostly due to shadowing of the DEJ and disruptive features such as hair follicles. CONCLUSIONS The findings suggest that CNNs are helpful for automated PRO score quantification in LC-OCT images. This may provide the clinician with a feasible tool for PRO score assessment in the follow-up of AK.
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Affiliation(s)
- Janis R Thamm
- Department of Dermatology and Allergology, University Hospital, University of Augsburg, Augsburg, Germany
| | - Fabia Daxenberger
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | | | - Charlotte Gust
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - Quirine Eijkenboom
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital, University of Augsburg, Augsburg, Germany
| | - Elke C Sattler
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - Sandra Schuh
- Department of Dermatology and Allergology, University Hospital, University of Augsburg, Augsburg, Germany
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16
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Daxenberger F, Deußing M, Eijkenboom Q, Gust C, Thamm J, Hartmann D, French LE, Welzel J, Schuh S, Sattler EC. Innovation in Actinic Keratosis Assessment: Artificial Intelligence-Based Approach to LC-OCT PRO Score Evaluation. Cancers (Basel) 2023; 15:4457. [PMID: 37760425 PMCID: PMC10527366 DOI: 10.3390/cancers15184457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Actinic keratosis (AK) is a common skin cancer in situ that can progress to invasive SCC. Line-field confocal optical coherence tomography (LC-OCT) has emerged as a non-invasive imaging technique that can aid in diagnosis. Recently, machine-learning algorithms have been developed that can automatically assess the PRO score of AKs based on the dermo-epidermal junction's (DEJ's) protrusion on LC-OCT images. A dataset of 19.898 LC-OCT images from 80 histologically confirmed AK lesions was used to test the performance of a previous validated artificial intelligence (AI)-based LC-OCT assessment algorithm. AI-based PRO score assessment was compared to the imaging experts' visual score. Additionally, undulation of the DEJ, the number of protrusions detected within the image, and the maximum depth of the protrusions were computed. Our results show that AI-automated PRO grading is highly comparable to the visual score, with an agreement of 71.3% for the lesions evaluated. Furthermore, this AI-based assessment was significantly faster than the regular visual PRO score assessment. The results confirm our previous findings of the pilot study in a larger cohort that the AI-based grading of LC-OCT images is a reliable and fast tool to optimize the efficiency of visual PRO score grading. This technology has the potential to improve the accuracy and speed of AK diagnosis and may lead to better clinical outcomes for patients.
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Affiliation(s)
- Fabia Daxenberger
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Maximilian Deußing
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Quirine Eijkenboom
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Janis Thamm
- Department of Dermatology and Allergology, University Hospital, University of Augsburg, 86179 Augsburg, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Lars E. French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
- Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital, University of Augsburg, 86179 Augsburg, Germany
| | - Sandra Schuh
- Department of Dermatology and Allergology, University Hospital, University of Augsburg, 86179 Augsburg, Germany
| | - Elke C. Sattler
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
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17
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Toffoli L, Dianzani C, Bonin S, Guarneri C, Guarneri F, Giuffrida R, Zalaudek I, Conforti C. Actinic Keratoses: A Prospective Pilot Study on a Novel Formulation of 4% 5-Fluorouracil Cream and a Review of Other Current Topical Treatment Options. Cancers (Basel) 2023; 15:cancers15112956. [PMID: 37296918 DOI: 10.3390/cancers15112956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Actinic keratosis (AK) is one of the most common skin diseases, with a low risk of progression into invasive squamous cell carcinoma. We aim to assess efficacy and safety of a novel formulation of 5-Fluorouracil (5-FU) 4% with once daily application for the treatment of multiple AKs. METHODS A pilot study was performed on 30 patients with a clinical and dermoscopic diagnosis of multiple AKs, enrolled between September 2021 and May 2022 at the Dermatology Departments of two Italian hospitals. Patients were treated with 5-FU 4% cream once daily for 30 consecutive days. The Actinic Keratosis Area and Severity Index (AKASI) was calculated before starting therapy, and at each follow-up, to assess objective clinical response. RESULTS The cohort analyzed included 14 (47%) males and 16 (53%) females (mean age: 71 ± 12 years). A significant decrease in AKASI score at both 6 and 12 weeks (p < 0.0001) was observed. Only three patients (10%) discontinued therapy, and 13 patients (43%) did not report any adverse reactions; no unexpected adverse events were observed. CONCLUSIONS In the setting of topical chemotherapy and immunotherapy, the new formulation of 5-FU 4% proved to be a highly effective treatment for AKs and field cancerization.
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Affiliation(s)
- Ludovica Toffoli
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy
| | - Caterina Dianzani
- Department of Plastic Surgery Unit, Section of Dermatology, University Campus Biomedico of Rome, 00128 Rome, Italy
| | - Serena Bonin
- Department of Medical Science, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Fabrizio Guarneri
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, 98124 Messina, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, 98124 Messina, Italy
| | - Iris Zalaudek
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy
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18
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Baskaran D, Nagamani Y, Merugula S, Premnath SP. MSRFNet for skin lesion segmentation and deep learning with hybrid optimization for skin cancer detection. THE IMAGING SCIENCE JOURNAL 2023. [DOI: 10.1080/13682199.2023.2187518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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19
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Dubois-Pot-Schneider H, Khairallah G, Brzenczek C, Plénat F, Marchal F, Amouroux M. Transcriptomic Study on Human Skin Samples: Identification of Two Subclasses of Actinic Keratoses. Int J Mol Sci 2023; 24:ijms24065937. [PMID: 36983009 PMCID: PMC10058209 DOI: 10.3390/ijms24065937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Actinic keratoses (AKs) are sun-damaged skin areas that affect 20% of the European adult population and more than 50% of people aged 70 years and over. There are currently no clinical or histological features allowing us to identify to which clinical class (i.e., regression or progression) an AK belongs. A transcriptomic approach seems to be a robust tool for AK characterization, but there is a need for additional studies, including more patients and elucidating the molecular signature of an AK. In this context, the present study, including the largest number of patients to date, is the first aiming at identifying biological features to objectively distinguish different AK signatures. We highlight two distinct molecular profiles: AKs featuring a molecular profile similar to squamous cell carcinomas (SCCs), which are called "lesional AKs" (AK_Ls), and AKs featuring a molecular profile similar to normal skin tissue, which are called "non-lesional AKs" (AK_NLs). The molecular profiles of both AK subclasses were studied, and 316 differentially expressed genes (DEGs) were identified between the two classes. The 103 upregulated genes in AK_L were related to the inflammatory response. Interestingly, downregulated genes were associated with keratinization. Finally, based on a connectivity map approach, our data highlight that the VEGF pathway could be a promising therapeutic target for high-risk lesions.
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Affiliation(s)
| | - Grégoire Khairallah
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
- Department of Plastic, Aesthetic and Reconstructive Surgery, Metz-Thionville Regional Hospital, 57530 Ars-Laquenexy, France
| | | | | | - Frédéric Marchal
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
- Département de Chirurgie, Institut de Cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
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Falkenberg C, Dirschka T, Gilbert G, Stockfleth E, Homey B, Schmitz L. Basal Proliferation and Acantholysis May Represent Histological High-Risk Factors for Progression into Invasive Squamous Cell Carcinoma: A Comparison Study in Solid Organ Transplant Recipients and Matched Immunocompetent Patients. Cancers (Basel) 2023; 15:cancers15061765. [PMID: 36980650 PMCID: PMC10046608 DOI: 10.3390/cancers15061765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Histological risk factors of AKs cannot be directly determined. Recent studies indicate that AKs restricted to the lower third of the epidermis (AK I), with marked basal proliferation (PRO III) and acantholysis, are associated with an increased risk of progression to invasive squamous cell carcinoma (iSCC). To confirm the aforementioned histological risk factors, this study compared AKs from solid organ transplant recipients (sOTRs), known to carry an up to 250-fold higher risk for progression into iSCC, to a matched immunocompetent control group (ICG). In total, 111 AKs from 43 sOTRs showed more AKs (n = 54, 48.7%) graded as AK I compared to 35 AKs (31.5%) in the ICG (p = 0.009). In line with these findings, 89 AKs (80.2%) from sOTRs showed pronounced basal proliferation (PRO III) compared to 37 AKs (33.3%) in the ICG (p < 0.0001). Acantholysis was more frequent in sOTRs than the ICG (59.5% vs. 32.4%, p < 0.0001) and more frequently associated with advanced basal proliferation (p < 0.0001). In conclusion, this study showed that acantholytic AKs graded as AK I and PRO III are predominantly found in a population at high risk of iSCC. Thus, AKs with marked basal proliferation and acantholysis should be assumed to be histological high-risk factors for the progression into iSCC.
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Affiliation(s)
- Conrad Falkenberg
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- CentroDerm Clinic, Heinz-Fangman-Straße 57, 42287 Wuppertal, Germany
| | - Georgia Gilbert
- Edinburgh Medical School, The University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University, 44780 Bochum, Germany
| | - Bernhard Homey
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Lutz Schmitz
- CentroDerm Clinic, Heinz-Fangman-Straße 57, 42287 Wuppertal, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University, 44780 Bochum, Germany
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21
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Agarwala S, Mata DA, Safeer LZ, Hafeez F. Proliferative actinic keratoses are associated with adverse clinical outcomes relative to actinic keratoses without a proliferative growth pattern. Br J Dermatol 2023; 188:439-440. [PMID: 36637139 DOI: 10.1093/bjd/ljac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/12/2022] [Accepted: 11/26/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Saira Agarwala
- Department of Dermatology, St. Luke's University Health Network, Temple University School of Medicine, Bethlehem, PA, USA
| | | | - Laraib Z Safeer
- Department of Dermatology, St. Luke's University Health Network, Temple University School of Medicine, Bethlehem, PA, USA
| | - Farhaan Hafeez
- Department of Dermatology, St. Luke's University Health Network, Temple University School of Medicine, Bethlehem, PA, USA
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22
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McEwen MW, Tirado M, Lipman S, Patel T, Jones A. Organ transplant status, anatomic location, and age impact rates of adnexal involvement of actinic keratoses. J Cutan Pathol 2023; 50:62-65. [PMID: 36054580 DOI: 10.1111/cup.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/11/2022] [Accepted: 08/28/2022] [Indexed: 01/03/2023]
Abstract
Actinic keratoses (AKs) are pre-malignant skin lesions that can give rise to squamous cell carcinomas. Involvement of adnexal structures by AKs has been postulated to confer resistance to therapy and facilitate malignant progression. In our study, we identified several factors associated with increased risk of adnexal involvement of AKs. We found an increased risk of follicular involvement in AKs on the head and neck, a slightly increased risk of eccrine involvement with increasing age, and an increased risk of eccrine involvement in organ transplant patients. Additionally, our data showed a higher overall rate of follicular involvement of AKs than previously reported.
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Affiliation(s)
- Matthew W McEwen
- Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mariantonieta Tirado
- Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sonja Lipman
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tejesh Patel
- Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Allison Jones
- Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Schlesinger T, Stockfleth E, Grada A, Berman B. Tirbanibulin for Actinic Keratosis: Insights into the Mechanism of Action. Clin Cosmet Investig Dermatol 2022; 15:2495-2506. [PMID: 36415541 PMCID: PMC9675993 DOI: 10.2147/ccid.s374122] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/19/2022] [Indexed: 08/13/2023]
Abstract
Actinic keratosis (AK) is a common pre-neoplastic skin lesion constituted by uncontrolled proliferation of atypical keratinocytes that may evolve to squamous cell carcinoma. With global prevalence increasing, AK is expected to be the most common carcinoma of the skin. Tirbanibulin is a reversible tubulin polymerization inhibitor with potent anti-proliferative and anti-tumoral effects. In-vivo and in-vitro studies have shown that tirbanibulin significantly inhibits cell proliferation, tumor growth and downregulates Src signaling with no overt toxicity. Early phase and Phase III trials have shown high lesion clearance, compliance, and few side effects of once daily tirbanibulin treatment. This review discusses tirbanibulin anti-cancer activity, focusing on tubulin polymerization and Src signaling inhibitory effects, highlighting relevant literature and novel preclinical results from the ATNXUS-KX01-001 study. Furthermore, we address the relevant findings obtained in recent clinical trials to evaluate the safety, efficacy, pharmacokinetics, clearance efficacy, and side effects of the 1% tirbanibulin ointment applied once daily. In summary, we highlight preclinical and clinical evidence on the use of tirbanibulin as an effective and safe treatment option for AK.
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Affiliation(s)
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Ayman Grada
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian Berman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Balcere A, Konrāde-Jilmaza L, Pauliņa LA, Čēma I, Krūmiņa A. Clinical Characteristics of Actinic Keratosis Associated with the Risk of Progression to Invasive Squamous Cell Carcinoma: A Systematic Review. J Clin Med 2022; 11:jcm11195899. [PMID: 36233766 PMCID: PMC9571814 DOI: 10.3390/jcm11195899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Actinic keratosis (AK) is one of the most common lesions on chronically sun-damaged skin that has the risk of progression to invasive squamous cell carcinoma (SCC). With the possibilities of using digital technologies for following-up skin lesions and their increased use in the past few decades, our objective was to update the review by Quaedvlieg et al., 2006, and to review prospective studies from 2005 onwards to identify the clinical characteristics of AK that later progressed to SCC. Methods: The PubMed, Scopus, and ScienceDirect databases were searched for relevant articles. The search had the following criteria: English language, human subjects and year from 2005 onwards. The study protocol was registered in the Prospero database with the record number CRD42020200429 and followed the PRISMA guidelines. The risk-of-bias assessment was performed using the QUIPS tool. Results: From the 5361 studies screened, 105 reports were evaluated for eligibility, and 2 articles with 621 patients were included. The main AK types associated with the development of SCC were found to be baseline AK, also known as a long-standing AK, and merging AK, also called an “AK patch”.
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Affiliation(s)
- Alise Balcere
- Department of Dermatology and Venereology, Riga Stradiņš University, LV-1010 Riga, Latvia
- Correspondence:
| | | | | | - Ingrīda Čēma
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Riga Stradiņš University, LV-1007 Riga, Latvia
| | - Angelika Krūmiņa
- Department of Infectiology, Riga Stradiņš University, LV-1006 Riga, Latvia
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25
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Veronese F, Seoni S, Tarantino V, Buttafava M, Airoldi C, Meiburger KM, Zavattaro E, Savoia P. AKASI and Near-Infrared Spectroscopy in the combined effectiveness evaluation of an actinic keratoses preventive product in immunocompetent and immunocompromised patients. Front Med (Lausanne) 2022; 9:987696. [PMID: 36160127 PMCID: PMC9489998 DOI: 10.3389/fmed.2022.987696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The high incidence of actinic keratoses among both the elderly population and immunocompromised subjects and the considerable risk of progression from in situ to invasive neoplasms makes it essential to identify new prevention, treatment, and monitoring strategies. Objective The aim of this study was to evaluate the efficacy on AKs of a topical product (®Rilastil AK Repair 100 +) containing high-protection sunscreens, a DNA Repair Complex with antioxidant and repairing action against UV-induced DNA damage, and nicotinamide, a water-soluble derivative of vitamin B3 that demonstrated several photoprotective effects both in vitro and in vivo. Methods The study enrolled 74 Caucasian patients, which included 42 immunocompetent and 32 immunosuppressed subjects. The efficacy of the treatment has been evaluated through the clinical index AKASI score and the non-invasive Near-Infrared Spectroscopy method. Results The AKASI score proved to be a valid tool to verify the efficacy of the product under study, highlighting an average percentage reduction at the end of treatment of 31.37% in immunocompetent patients and 22.76% in organ transplant recipients, in comparison to the initial values, with a statistically significant reduction also in the single time intervals (T0 vs. T1 and T1 vs. T2) in both groups. On the contrary, the Near-Infrared Spectroscopy (a non-invasive technique that evaluates hemoglobin relative concentration variations) did not find significant differences for O2Hb and HHb signals before and after the treatment, probably because the active ingredients of the product under study can repair the photo-induced cell damage, but do not significantly modify the vascularization of the treated areas. Conclusion The results deriving from this study demonstrate the efficacy of the product under study, confirming the usefulness of the AKASI score in monitoring treated patients. Near-Infrared Spectroscopy could represent an interesting strategy for AK patients monitoring, even if further large-scale studies will be needed.
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Affiliation(s)
| | - Silvia Seoni
- Biolab, PolitoBIOMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | | | - Matteo Buttafava
- School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Kristen M. Meiburger
- Biolab, PolitoBIOMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Elisa Zavattaro
- SCDU Dermatologia, AOU Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- *Correspondence: Elisa Zavattaro,
| | - Paola Savoia
- SCDU Dermatologia, AOU Maggiore della Carità, Novara, Italy
- School of Medicine, University of Eastern Piedmont, Novara, Italy
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
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26
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Genenger B, Perry JR, Ashford B, Ranson M. A tEMTing target? Clinical and experimental evidence for epithelial-mesenchymal transition in the progression of cutaneous squamous cell carcinoma (a scoping systematic review). Discov Oncol 2022; 13:42. [PMID: 35666359 PMCID: PMC9170863 DOI: 10.1007/s12672-022-00510-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 02/07/2023] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is a disease with globally rising incidence and poor prognosis for patients with advanced or metastatic disease. Epithelial-mesenchymal transition (EMT) is a driver of metastasis in many carcinomas, and cSCC is no exception. We aimed to provide a systematic overview of the clinical and experimental evidence for EMT in cSCC, with critical appraisal of type and quality of the methodology used. We then used this information as rationale for potential drug targets against advanced and metastatic cSCC. All primary literature encompassing clinical and cell-based or xenograft experimental studies reporting on the role of EMT markers or related signalling pathways in the progression of cSCC were considered. A screen of 3443 search results yielded 86 eligible studies comprising 44 experimental studies, 22 clinical studies, and 20 studies integrating both. From the clinical studies a timeline illustrating the alteration of EMT markers and related signalling was evident based on clinical progression of the disease. The experimental studies reveal connections of EMT with a multitude of factors such as genetic disorders, cancer-associated fibroblasts, and matrix remodelling via matrix metalloproteinases and urokinase plasminogen activator. Additionally, EMT was found to be closely tied to environmental factors as well as to stemness in cSCC via NFκB and β-catenin. We conclude that the canonical EGFR, canonical TGF-βR, PI3K/AKT and NFκB signalling are the four signalling pillars that induce EMT in cSCC and could be valuable therapeutic targets. Despite the complexity, EMT markers and pathways are desirable biomarkers and drug targets for the treatment of advanced or metastatic cSCC.
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Affiliation(s)
- Benjamin Genenger
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.
| | - Jay R Perry
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Bruce Ashford
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Marie Ranson
- School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.
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27
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Del Regno L, Catapano S, Di Stefani A, Cappilli S, Peris K. A Review of Existing Therapies for Actinic Keratosis: Current Status and Future Directions. Am J Clin Dermatol 2022; 23:339-352. [PMID: 35182332 PMCID: PMC9142445 DOI: 10.1007/s40257-022-00674-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 01/17/2023]
Abstract
Actinic keratosis (AK) is a chronic skin disease in which clinical and subclinical cutaneous lesions coexist on sun-exposed areas such as the head and neck region and the extremities. The high prevalence of AK means the disease burden is substantial, especially in middle-aged and elderly populations. Evidence indicates that AK may progress into invasive cutaneous squamous cell carcinoma, so the European guidelines recommend treatment of any AK regardless of clinical severity. Given the aging population and therefore the increasing incidence of AK and cutaneous field carcinogenesis, further updates on the long-term efficacy of current therapies and new investigational agents are critical to guide treatment choice. Patients often have difficulty adequately applying topical treatments and coping with adverse local skin reactions, leading to less than optimum treatment adherence. The development of associated local skin symptoms and cosmetic outcomes for the area of interest are also relevant to the choice of an appropriate therapeutic strategy. Treatment is always individually tailored according to the characteristics of both patients and lesions. This review focuses on the therapeutic approaches to AK and illustrates the currently available home-based and physician-managed treatments.
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Comparative Efficacy and Safety of Tirbanibulin for Actinic Keratosis of the Face and Scalp in Europe: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. J Clin Med 2022; 11:jcm11061654. [PMID: 35329979 PMCID: PMC8952421 DOI: 10.3390/jcm11061654] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 01/08/2023] Open
Abstract
Actinic keratosis (AK) is a chronic skin condition that may progress to cutaneous squamous cell carcinoma. We conducted a systematic review of efficacy and safety for key treatments for AK of the face and scalp, including the novel 5-day tirbanibulin 1% ointment. MEDLINE, PubMed, Embase, Cochrane Library, clinical trial registries and regulatory body websites were searched. The review included 46 studies, of which 35 studies included interventions commonly used in Europe and were sufficiently homogenous to inform a Bayesian network meta-analysis of complete clearance against topical placebo or vehicle. The network meta-analysis revealed the following odds ratios and 95% credible intervals: cryosurgery 13.4 (6.2–30.3); diclofenac 3% 2.9 (1.9–4.3); fluorouracil 0.5% + salicylic acid 7.6 (4.6–13.5); fluorouracil 4% 30.3 (9.1–144.7); fluorouracil 5% 35.0 (10.2–164.4); imiquimod 3.75% 8.5 (3.5–22.4); imiquimod 5% 17.9 (9.1–36.6); ingenol mebutate 0.015% 12.5 (8.1–19.9); photodynamic therapy with aminolevulinic acid 24.1 (10.9–52.8); photodynamic therapy with methyl aminolevulinate 11.7 (6.0–21.9); tirbanibulin 1% 11.1 (6.2–20.9). Four sensitivity analyses, from studies assessing efficacy after one treatment cycle only, for ≤25 cm2 treatment area, after 8 weeks post-treatment, and with single placebo/vehicle node confirmed the findings from the base case. Safety outcomes were assessed qualitatively. These results suggest that tirbanibulin 1% offers a novel treatment for AK, with a single short treatment period, favourable safety profile and efficacy, in line with existing topical treatments available in Europe.
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29
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Arisi M, Guasco Pisani E, Calzavara-Pinton P, Zane C. Cryotherapy for Actinic Keratosis: Basic Principles and Literature Review. Clin Cosmet Investig Dermatol 2022; 15:357-365. [PMID: 35283641 PMCID: PMC8906699 DOI: 10.2147/ccid.s267190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
Actinic keratoses (AKs) are pre-malignant epithelial lesions induced by chronic cumulative UV exposure. Several guidelines concerning AKs treatment have been published in the past years. Among destructive procedures, cryotherapy is today considered a standard first-line approach in case of single lesions. The aim of the present review article is to analyse the treatment technique, its efficacy and safety.
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Affiliation(s)
- Mariachiara Arisi
- Department of Dermatology, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Edoardo Guasco Pisani
- Department of Dermatology, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Cristina Zane
- Department of Dermatology, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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Topical Pharmacotherapy for Actinic Keratoses in Older Adults. Drugs Aging 2022; 39:143-152. [PMID: 35156172 PMCID: PMC8873057 DOI: 10.1007/s40266-022-00919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/21/2022]
Abstract
Actinic keratosis is caused by excessive lifetime sun exposure. It must be treated, regardless of thickness, because it is the biologic precursor of invasive squamous cell carcinoma, a potentially deadly malignancy. Physical ablative techniques such as cryotherapy, lasers, and curettage are the most used treatments for isolated lesions. Multiple lesions are treated with topical drugs, chemical peelings, and physical techniques. Drug preparations containing diclofenac plus hyaluronate, aminolevulinic acid, and methyl aminolevulinate and different concentrations of imiquimod and 5-fluorouracil are approved for this clinical indication. All treatments have a good profile of efficacy and tolerability although there are relevant differences in the clearance rate, tolerability, and type and frequency of adverse effects. In addition, they have very different mechanisms of action and treatment protocols. No differences in the efficacy and tolerability were found in older patients compared with younger patients, therefore no dose adjustments are needed. That said, older patients often need to be motivated to treat actinic keratoses and a careful attention to expectations, needs, and preferences should be used to obtain the maximal adherence and prevent treatment failure. This goal can be achieved with a careful evaluation not only of published efficacy, toxicity, and tolerability data but also of practical topics such as the frequency of daily applications, the overall duration of therapy, and the need for a caregiver. Finally, particular attention must be paid in the case of frail patients and immunosuppressed patients.
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31
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Bohne AS, Kähler KC. Update aktinische Keratosen – Neuigkeiten und Relevanz für den Alltag. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1487-3992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Ziel der Arbeit Die im März 2020 zuletzt überarbeitete Leitlinie „Aktinische Keratosen und Plattenepithelkarzinome der Haut“ hat aufgrund der Zunahme der klinischen Studien zum Thema aktinische Keratosen den höchsten Grad für Methodik (S3) erreicht, da diese nicht nur konsensbasiert sondern auch evidenzbasiert verfasst wurde. Diesen Entwicklungen gerecht zu werden und den klinisch relevanten Teil des aktuellen Stands des Wissens zu vermitteln, ist Ziel dieses Artikels.
Methodik Anhand der aktuellen epidemiologischen Lage wird der dramatisch wachsende Bedarf für das bessere Verständnis der Ätiologie aktinischer Keratosen deutlich. Ebenso gilt es, Patienten mit aktinischen Keratosen und therapiebedürftigen Ko-Morbiditäten vor einem therapiebedingten, erhöhten Risiko für die Entwicklung weiterer aktinischer Keratosen oder Plattenepithelkarzinomen zu bewahren. Die Möglichkeit der Spontanremission aktinischer Keratosen sollte ebenso wenig vernachlässigt werden wie eine mögliche Progredienz in ein Plattenepithelkarzinom. Die kontroverse Diskussion der fortwährend postulierten, sequenziellen Abfolge der histologischen Grade aktinischer Keratosen zum Plattenepithelkarzinom beinhaltet klinische und histologische Fallstricke. Diese sollten bei der Therapieentscheidung ebenso bedacht werden wie die Wünsche und Erwartungen der Patienten an ein Therapieregime. Eine bleibende Schwierigkeit ist die fehlende Standardisierung erhobener Daten zu den zahlreichen zur Verfügung stehenden Therapieoptionen. Das Potenzial dieses Forschungsgebietes für neue Therapiealternativen und präventive Maßnahmen lässt nach wie vor auf weitere, interessante Entwicklungen hoffen.
Ergebnisse Der gut etablierte kausale Zusammenhang zwischen kumulativer UV-Strahlung in der Entwicklung von Plattenepithelkarzinomen und aktinischer Keratosen hat zur Anerkennung berufsbedingter UV-Exposition als Berufserkrankung geführt, die auch die Anerkennung multipler aktinischer Keratosen als Berufserkrankung beinhaltet. Das therapeutische Handeln sollte durch die Gesamtanzahl der aktinischen Keratosen, das Ausmaß der betroffenen Fläche, die Dynamik des Krankheitsgeschehens und den Wunsch des Patienten bestimmt werden. Ein besonderes Augenmerk sollte auf den Patienten liegen, denen die Krankheitseinsicht fehlt oder die nur wenig motiviert zur Therapie sind. Es könnte der Schlüssel zur Verbesserung der Therapieadhärenz und Akzeptanz sein, diese Patienten zu erkennen und ihre Bedürfnisse in das Arzt-Patienten-Gespräch zu integrieren. Die Differenzierung zwischen lokalisierten aktinischen Keratosen und einer Feldkanzerisierung stellt ein wichtiges Entscheidungskriterium für die Wahl der empfohlenen Therapie dar. Die Rücknahme der Zulassung von Ingenolmebutat in der EU durch die EMA im Jahr 2020 hat das Spektrum der lokaltherapeutischen Optionen eingeschränkt. Der periinterventionelle Schmerz ist nach wie vor der limitierende Faktor für die konventionelle photodynamische Therapie, jedoch schreitet die Entwicklung für schmerzärmere Varianten weiter voran. Es ist zu erwarten, dass sich in den kommenden Jahren durch eine bessere Evidenzlage für weitere systemische oder lokaltherapeutische Optionen neue Behandlungsstrategien ergeben werden. Besonders im Fokus wird sicherlich nach wie vor die Präventionsforschung stehen, die v. a. den Erhalt einer erzielten Remission beinhaltet.
Schlussfolgerung Die aktuellen Forschungsergebnisse und -bestrebungen zur Thematik der aktinischen Keratosen sind aufgrund des zukünftig gesteigerten Bedarfes zum einen notwendig und zum anderen sehr ermutigend. Das Ende des therapeutischen Horizonts ist gegenwärtig noch nicht erreicht.
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Affiliation(s)
- Ann-Sophie Bohne
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Katharina C. Kähler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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The Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma: A Comprehensive Review and Clinical Recommendations by a Panel of Experts. Cancers (Basel) 2022; 14:cancers14020377. [PMID: 35053539 PMCID: PMC8773547 DOI: 10.3390/cancers14020377] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 12/19/2022] Open
Abstract
Cutaneous squamous cell carcinomas (CSCC) account for about 20% of all keratinocyte carcinomas, which are the most common form of cancer. Heterogeneity of treatments and low mortality are a challenge in obtaining accurate incidence data and consistent registration in cancer registries. Indeed, CSCC mostly presents as an indolent, low-risk lesion, with five-year cure rates greater than 90% after surgical excision, and only few tumors are associated with a high-risk of local or distant relapse; therefore, it is particularly relevant to identify high-risk lesions among all other low-risk CSCCs for the proper diagnostic and therapeutic management. Chemotherapy achieves mostly short-lived responses that do not lead to a curative effect and are associated with severe toxicities. Due to an etiopathogenesis largely relying on chronic UV radiation exposure, CSCC is among the tumors with the highest rate of somatic mutations, which are associated with increased response rates to immunotherapy. Thanks to such strong pre-clinical rationale, clinical trials led to the approval of anti-PD-1 cemiplimab by the FDA (Food and Drug Administration) and EMA (European Medicines Agency), and anti-PD-1 pembrolizumab by the FDA only. Here, we provide a literature review and clinical recommendations by a panel of experts regarding the diagnosis, treatment, and follow-up of CSCC.
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A Computer-Aided Diagnosis System Using Deep Learning for Multiclass Skin Lesion Classification. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2021; 2021:9619079. [PMID: 34912449 PMCID: PMC8668359 DOI: 10.1155/2021/9619079] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
In the USA, each year, almost 5.4 million people are diagnosed with skin cancer. Melanoma is one of the most dangerous types of skin cancer, and its survival rate is 5%. The development of skin cancer has risen over the last couple of years. Early identification of skin cancer can help reduce the human mortality rate. Dermoscopy is a technology used for the acquisition of skin images. However, the manual inspection process consumes more time and required much cost. The recent development in the area of deep learning showed significant performance for classification tasks. In this research work, a new automated framework is proposed for multiclass skin lesion classification. The proposed framework consists of a series of steps. In the first step, augmentation is performed. For the augmentation process, three operations are performed: rotate 90, right-left flip, and up and down flip. In the second step, deep models are fine-tuned. Two models are opted, such as ResNet-50 and ResNet-101, and updated their layers. In the third step, transfer learning is applied to train both fine-tuned deep models on augmented datasets. In the succeeding stage, features are extracted and performed fusion using a modified serial-based approach. Finally, the fused vector is further enhanced by selecting the best features using the skewness-controlled SVR approach. The final selected features are classified using several machine learning algorithms and selected based on the accuracy value. In the experimental process, the augmented HAM10000 dataset is used and achieved an accuracy of 91.7%. Moreover, the performance of the augmented dataset is better as compared to the original imbalanced dataset. In addition, the proposed method is compared with some recent studies and shows improved performance.
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Cinotti E, Tognetti L, Cartocci A, Lamberti A, Gherbassi S, Orte Cano C, Lenoir C, Dejonckheere G, Diet G, Fontaine M, Miyamoto M, Perez‐Anker J, Solmi V, Malvehy J, del Marmol V, Perrot JL, Rubegni P, Suppa M. Line-field confocal optical coherence tomography for actinic keratosis and squamous cell carcinoma: a descriptive study. Clin Exp Dermatol 2021; 46:1530-1541. [PMID: 34115900 PMCID: PMC9293459 DOI: 10.1111/ced.14801] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early and accurate diagnosis of cutaneous squamous cell carcinomas (SCCs) and actinic keratoses (AK) is fundamental to reduce their associated morbidity and to select the correct treatment. Line-field confocal optical coherence tomography (LC-OCT) is a new imaging device that can characterize healthy skin and basal cell carcinoma, but no large studies on keratinocyte cell tumours have yet been published. AIM To identify and describe LC-OCT criteria associated with SCC and AK, and to compare LC-OCT findings in these tumours. METHODS A retrospective observational multicentre study was conducted. Lesions were imaged with the LC-OCT device before surgery and examined histologically. LC-OCT criteria for AK/SCC were identified and their presence was evaluated in all study lesions. Univariate and multivariate analyses were performed to compare AK and SCCs, and to investigate differences between in situ and invasive tumours. RESULTS In total, 158 patients with 50 AK and 108 SCCs (62 in situ and 46 invasive) were included. Cytological and architectural alterations were found in most lesions, and differences were found between AK and SCCs. Although the visualization of the dermoepidermal junction (DEJ) was often hampered by hyperkeratosis and acanthosis, an outlined DEJ without broad strands was observed in almost all AK and almost all in situ SCCs, but in only three invasive SCCs (P < 0.001) when the DEJ was detectable. CONCLUSION Our results suggest that LC-OCT can help clinicians in the identification of AK and SCC and their differentiation, providing a real-time and noninvasive examination. Further studies are needed to confirm our data.
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Affiliation(s)
- E. Cinotti
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - L. Tognetti
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - A. Cartocci
- Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - A. Lamberti
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - S. Gherbassi
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - C. Orte Cano
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - C. Lenoir
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - G. Dejonckheere
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - G. Diet
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - M. Fontaine
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - M. Miyamoto
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - J. Perez‐Anker
- Melanoma UnitHospital Clinic BarcelonaUniversity of BarcelonaBarcelonaSpain
- CIBER de Enfermedades RarasInstituto de Salud Carlos IIIBarcelonaSpain
| | - V. Solmi
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - J. Malvehy
- Melanoma UnitHospital Clinic BarcelonaUniversity of BarcelonaBarcelonaSpain
- CIBER de Enfermedades RarasInstituto de Salud Carlos IIIBarcelonaSpain
| | - V. del Marmol
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - J. L. Perrot
- Department of DermatologyUniversity Hospital of Saint‐EtienneSaint‐EtienneFrance
| | - P. Rubegni
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - M. Suppa
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
- Department of DermatologyInstitut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
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Metabolomic Analysis of Actinic Keratosis and SCC Suggests a Grade-Independent Model of Squamous Cancerization. Cancers (Basel) 2021; 13:cancers13215560. [PMID: 34771721 PMCID: PMC8582912 DOI: 10.3390/cancers13215560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Actinic keratoses (AKs) are the most common sun-induced precancerous lesions that can progress to squamocellular carcinoma (SCC). AK I have been considered low-risk lesions, often evolving into AK II, the AK grade II and III have the potential to evolve to SCC. This research has assessed the metabolomic fingerprints of AK I, AK II, AK III and SCC by HR-MAS NMR spectroscopy, with the aim of evaluating the hypothesis of grade-association AK to SCC. The association between AKs and SCCs has also been evaluated by histopathology. Our findings support the notion that AK I are different from healthy skin and share different features with SCCs, indeed, they are metabolically active lesions with metabolic profiles similar to high-grade AKs and to SCC. The negative association of AKs with parakeratosis and the positive association with hypertrophy also suggested a similar behavior between AKs and SCCs. Therefore, all AKs should be treated independently from their clinical appearance or histological grade, since it is not possible to predict their potential evolution to SCC. Abstract Background—Actinic keratoses (AKs) are the most common sun-induced precancerous lesions that can progress to squamocellular carcinoma (SCC). Recently, the grade-independent association between AKs and SCC has been suggested; however, the molecular bases of this potential association have not been investigated. This study has assessed the metabolomic fingerprint of AK I, AK II, AK III and SCC using high resolution magic angle spinning (HR-MAS) nuclear magnetic resonance (NMR) spectroscopy in order to evaluate the hypothesis of grade-independent association between AK and SCC. Association between AKs and SCCs has also been evaluated by histopathology. Methods—Metabolomic data were obtained through HR-MAS NMR spectroscopy. The whole spectral profiles were analyzed through multivariate statistical analysis using MetaboAnalyst 5.0. Histologic examination was performed on sections stained with hematoxylin and eosin; statistical analysis was performed using STATA software version 14. Results—A group of 35 patients affected by AKs and/or SCCs and 10 healthy controls were enrolled for metabolomics analysis. Histopathological analysis was conducted on 170 specimens of SCCs and AKs (including the ones that underwent metabolomic analysis). SCCs and AK I were found to be significantly associated in terms of the content of some metabolites. Moreover, in the logistic regression model, the presence of parakeratosis in AKs appeared to be less frequently associated with SCCs, while AKs with hypertrophy had a two-fold higher risk of being associated with SCC. Conclusions—Our findings, derived from metabolomics and histopathological data, support the notion that AK I are different from healthy skin and share some different features with SCCs. This may further support the expanding notion that all AKs should be treated independently from their clinical appearance or histological grade because they may be associated with SCC.
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Xu D, Sun JF, Qi RQ, Zhang W, Dong LD, Liu TY, Zheng S, Niu RX, Zhang J, Cui TT, He L, Chen HD. A multicenter retrospective analysis of the clinical and pathological characteristics of 1188 cases of actinic keratosis in different ultraviolet radiation intensity areas of China. J Cosmet Dermatol 2021; 21:2879-2888. [PMID: 34719097 DOI: 10.1111/jocd.14479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Actinic keratosis (AK) is a precancerous disease, caused by ultraviolet radiation (UV). OBJECTIVE To analyze the clinical and pathological characteristics of AK in four areas with different ultraviolet radiation intensities. METHODS 1188 diagnosed AK patients, from January 2000 to July 2015, in dermatology department of four hospitals were collected. The UV intensity of hospital located cities from high to low is Kunming, Yinchuan, Shenyang and Nanjing. The information comes from medical records, and the pathological types and Keratinocyte Intraepithelial Neoplasia (KIN) grades were checked by two experienced pathologists. All information was conducted a retrospective multicenter research. RESULTS The patients were mainly middle-aged and elderly female, which was in direct contrast to the majority of men in European. The age of onset in Kunming group was lower than that in Yinchuan Group (p = 0.013) and Nanjing Group (p < 0.01). The course of disease in Kunming group was significantly shorter than that in Nanjing Group (p < 0.001). The lesions were almost located in the exposed area. The proportion of unexposed areas in Shenyang group was significantly higher than that in other groups (p < 0.001). There were statistical differences in pathological morphological classification among the four groups. These differences were not affected by age and gender. The number of KIN III grade patients in Shenyang group was significantly higher than that in other three groups (p < 0.05). CONCLUSION The Asian patients were mainly female. The clinical characteristics of AK are closely related to UV intensity, and environmental pollution, lifestyle, religious beliefs and other factors are also related.
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Affiliation(s)
- Dan Xu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian-Fang Sun
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Rui-Qun Qi
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
| | - Wei Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Ling-Di Dong
- Department of Dermatology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Tong-Yun Liu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Song Zheng
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
| | - Rui-Xian Niu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Juan Zhang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ting-Ting Cui
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hong-Duo Chen
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
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Curiel-Lewandrowski C, Myrdal CN, Saboda K, Hu C, Arzberger E, Pellacani G, Legat FJ, Ulrich M, Hochfellner P, Oliviero MC, Pasquali P, Gill M, Hofmann-Wellenhof R. In Vivo Reflectance Confocal Microscopy as a Response Monitoring Tool for Actinic Keratoses Undergoing Cryotherapy and Photodynamic Therapy. Cancers (Basel) 2021; 13:cancers13215488. [PMID: 34771651 PMCID: PMC8583298 DOI: 10.3390/cancers13215488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The assessment of actinic keratoses (AKs) in prevention and therapeutic trials, as well as clinical practice, could significantly benefit from the incorporation of non-invasive imaging technology. Such technology has the potential to enhance the objective evaluation of clinical and subclinical AKs with the added advantage of sequential monitoring. In vivo reflectance confocal microscopy (RCM) allows for the non-invasive imaging of AKs at a cellular level. We aimed to establish an in in vivo RCM protocol for AK response monitoring, ultimately leading to more reliable characterization of longitudinal responses and therapy optimization. Abstract Reflectance confocal microscopy (RCM) presents a non-invasive method to image actinic keratosis (AK) at a cellular level. However, RCM criteria for AK response monitoring vary across studies and a universal, standardized approach is lacking. We aimed to identify reliable AK response criteria and to compare the clinical and RCM evaluation of responses across AK severity grades. Twenty patients were included and randomized to receive either cryotherapy (n = 10) or PDT (n = 10). Clinical assessment and RCM evaluation of 12 criteria were performed in AK lesions and photodamaged skin at baseline, 3 and 6 months. We identified the RCM criteria that reliably characterize AK at baseline and display significant reduction following treatment. Those with the highest baseline odds ratio (OR), good interobserver agreement, and most significant change over time were atypical honeycomb pattern (OR: 12.7, CI: 5.7–28.1), hyperkeratosis (OR: 13.6, CI: 5.3–34.9), stratum corneum disruption (OR: 7.8, CI: 3.5–17.3), and disarranged epidermal pattern (OR: 6.5, CI: 2.9–14.8). Clinical evaluation demonstrated a significant treatment response without relapse. However, in grade 2 AK, 10/12 RCM parameters increased from 3 to 6 months, which suggested early subclinical recurrence detection by RCM. Incorporating standardized RCM protocols for the assessment of AK may enable a more meaningful comparison across clinical trials, while allowing for the early detection of relapses and evaluation of biological responses to therapy over time.
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Affiliation(s)
- Clara Curiel-Lewandrowski
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, AZ 85724, USA;
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA;
- Correspondence:
| | - Caitlyn N. Myrdal
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, AZ 85724, USA;
| | | | - Chengcheng Hu
- Department of Epidemiology and Biostatistics, Mel and Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85721, USA;
| | - Edith Arzberger
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria; (E.A.); (F.J.L.); (P.H.); (R.H.-W.)
| | - Giovanni Pellacani
- Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, 00185 Rome, Italy;
| | - Franz Josef Legat
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria; (E.A.); (F.J.L.); (P.H.); (R.H.-W.)
| | - Martina Ulrich
- CMB Collegium Medicum Berlin GmbH/Dermatology Office, 10117 Berlin, Germany;
| | - Petra Hochfellner
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria; (E.A.); (F.J.L.); (P.H.); (R.H.-W.)
| | | | - Paola Pasquali
- Pius Hospital of Valls, 43850 Tarragona, Spain;
- Faculty of Medicine and Health Sciences, University of Alcalá de Henares, 28801 Madrid, Spain;
| | - Melissa Gill
- Faculty of Medicine and Health Sciences, University of Alcalá de Henares, 28801 Madrid, Spain;
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Rainer Hofmann-Wellenhof
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria; (E.A.); (F.J.L.); (P.H.); (R.H.-W.)
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MicroRNA31 and MMP-1 contribute to the differentiated pathway of invasion -with enhanced epithelial-to-mesenchymal transition- in squamous cell carcinoma of the skin. Arch Dermatol Res 2021; 314:767-775. [PMID: 34647185 DOI: 10.1007/s00403-021-02288-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 12/11/2022]
Abstract
Epithelial to mesenchymal transition (EMT) is an important mechanism of invasion in cutaneous squamous cell carcinomas (cSCCs) and has been found to be enhanced in tumors originated from actinic keratosis with transformation limited to the basal epithelial layer -differentiated pathway-, compared to cases with invasion subsequent to complete epidermal transformation -classical pathway-. Several microRNAs and proteins can contribute to EMT modulation in cSCCs. MicroRNA21 and microRNA31 are involved in posttranscriptional regulation of protein expression and could play a relevant role in EMT and cSCC progression. Throughout the EMT process upregulation of matrix metalloproteinases (MMPs) enhances invasiveness and MMP-1 and MMP-3 contribute to local invasion, angiogenesis and metastasis in cSCCs. Additionally, cSCC development is associated with PTEN loss and NF-κB, NOTCH-1 and p63 activation. The aim of this work is to identify differences in the expression of those molecules between both pathways of cSCCs development. Eight tissue microarrays from 80 consecutive cSCCs were analyzed using LNA-based miRNA in situ hybridization for miRNA21 and miRNA31 evaluation, and immunohistochemistry for MMP-1, MMP-3, PTEN, NOTCH-1, NF-κB, p63 and CD31. Significantly higher expression of miRNA31 (p < 0.0001) and MMP-1 (p = 0.0072) and angiogenesis (p = 0.0199) were found in the differentiated pathway, whereas PTEN loss (p = 0.0430) was more marked in the classical pathway. No significant differences were found for the other markers. Our findings support a contribution of miRNA31 and MMP-1 in the differentiated pathway, associated to EMT and increased microvascularization. The greater PTEN loss in the classical pathway indicate that its relevance in cSCC is not EMT-related.
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Steeb T, Wessely A, Petzold A, Brinker TJ, Schmitz L, Leiter U, Garbe C, Schöffski O, Berking C, Heppt MV. Evaluation of Long-term Clearance Rates of Interventions for Actinic Keratosis: A Systematic Review and Network Meta-analysis. JAMA Dermatol 2021; 157:1066-1077. [PMID: 34347015 DOI: 10.1001/jamadermatol.2021.2779] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Multiple interventions are available for the treatment of actinic keratosis (AK). However, most randomized clinical trials and meta-analyses focus on short-term efficacy outcomes. Objective To investigate and synthesize the long-term efficacy (≥12 months) of interventions for AK from parallel-arm randomized clinical trials. Data Sources Searches in MEDLINE, Embase, and Central were conducted from inception until April 6, 2020. The reference lists of the included studies and pertinent trial registers were hand searched. The study was completed February 27, 2021. Study Selection Two reviewers screened the titles and abstracts of 2741 records. Finally, 17 published reports (original studies and follow-up reports) referring to 15 independent randomized clinical trials with an overall sample size of 4252 patients were included. Data Extraction and Synthesis Two reviewers independently extracted data on study, patient, and intervention characteristics. Network meta-analysis (NMA) of each outcome was conducted with a frequentist approach. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidance for NMA was used to assess the certainty of evidence. The revised Cochrane risk-of-bias tool for randomized clinical trials was used to evaluate the methodologic quality. Main Outcomes and Measures Participant complete clearance, participant partial clearance, and lesion-specific clearance were the outcomes, with each assessed at least 12 months after the end of treatment. Results Data from 15 independent randomized clinical trials including 4252 patients were extracted and synthesized. Ten studies were included in an NMA for the outcome of participant complete clearance, with photodynamic therapy with aminolevulinate (ALA-PDT) showing the most favorable risk ratio (RR) compared with placebo (RR, 8.06; 95% CI, 2.07-31.37; GRADE, moderate), followed by imiquimod, 5% (RR, 5.98; 95% CI, 2.26-15.84; GRADE, very low), photodynamic therapy with methyl aminolevulinate (MAL-PDT) (RR, 5.95; 95% CI, 1.21-29.41; GRADE, low), and cryosurgery (RR, 4.67; 95% CI, 1.36-16.66; GRADE, very low). Similarly, ALA-PDT had the highest RR in the NMA for lesion-specific clearance (RR, 5.08; 95% CI, 2.49-10.33; GRADE, moderate). No NMA was possible for participant partial clearance owing to poor reporting of this outcome. Conclusions and Relevance This systematic review and network meta-analysis found that therapy including ALA-PDT, imiquimod, 5%, MAL-PDT, and cryosurgery was associated with significant long-term efficacy in the NMA. This study provides data for a possible use in an evidence-based framework for selecting interventions with sustained lesion clearance.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Anne Petzold
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lutz Schmitz
- Department of Dermatology, Ruhr-University, Bochum, Germany.,Institute of Dermatopathology, MVZ Corius DermPathBonn, Bonn, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Oliver Schöffski
- School of Business, Economics and Society, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Nürnberg, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
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Perino F, Fattori A, Piccerillo A, Bianchi L, Fargnoli MC, Frascione P, Pellacani G, Carbone A, Campione E, Esposito M, Rossi MT, Casari A, Calzavara-Pinton P, Peris K. Treatment adherence with diclofenac 3% gel among patients with multiple actinic keratoses: an integrated low-intensity intervention program versus standard-of-care. Ital J Dermatol Venerol 2021; 157:164-172. [PMID: 34282872 DOI: 10.23736/s2784-8671.21.07111-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diclofenac 3% gel is a widely used topical treatment with proven efficacy in reducing the burden of Actinic Keratosis (AK), however clinical benefit might not fully translate in clinical practice as non-adherence is substantial for prolonged treatment regimens. We evaluated the efficacy of an integrated low-intensity intervention program versus standard-of-care on treatment adherence among patients with multiple AK receiving diclofenac in hyaluronic acid gel 3%. METHODS We designed an open label, randomized, parallel group, interventional, multicenter, longitudinal cohort study including patients with multiple, grade I/II AKs. Visits were scheduled for end of treatment (T4), follow-up 1 (T5) and follow-up 2 (T6) at 90, 180 and 365 days from baseline, respectively. Patients in the intervention group received additional visits at 30 and 60 days from baseline, a brief health education intervention, an enhanced patient-physician communication, a weekly SMS reminder to medication prescriptions. RESULTS Patients were equally allocated between intervention (intervention group [IG], N=86) and control group (CG, N=86); at baseline, both groups had similar socio-demographic and clinical characteristics. Change scores from baseline showed a slight increment in quality of life related to AK in both groups (CG: ΔT4 - T1=-0.079; IG: ΔT4 - T1=-0.006; p=0.39) and in quality of physicianpatient interaction reported by IG (ΔT3 - T2=0.18; p<.0001). Adherence rate was not statistically different between IG and CG (28.4% vs 40.7%; p=0.11). Patients reported similar satisfaction for effectiveness, convenience and side effects of treatment. Clinical conditions improved over time and results did not differ between groups; complete clearance rate at 1 year was 18% and 29% for CG and IG, respectively. CONCLUSIONS Our findings showed no difference in adherence rate between the two groups, suggesting that enhanced follow-up interventions and health care education may not be sufficient drivers to promote adherence among this clinical population. Further studies are needed to explore barriers to adherence with treatments for AKs.
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Affiliation(s)
- Francesca Perino
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alice Fattori
- Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Piccerillo
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, Fondazione Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Maria C Fargnoli
- Dermatology, Department of Biotechnological and Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Pasquale Frascione
- UOSD Dermatologic Oncology IRCCS, San Gallicano Dermatological Institute Rome, Rome, Italy
| | - Giovanni Pellacani
- Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, Rome, Italy
| | - Anna Carbone
- UOSD Dermatologic Oncology IRCCS, San Gallicano Dermatological Institute Rome, Rome, Italy
| | - Elena Campione
- Dermatology Unit, Fondazione Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Maria Esposito
- Dermatology, Department of Biotechnological and Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria T Rossi
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - Alice Casari
- Dermatologia, AOU Policlinico Modena, Modena, Italy
| | | | - Ketty Peris
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy - .,Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Arisi M, Rossi MT, Spiazzi L, Guasco Pisani E, Venturuzzo A, Rovati C, Tomasi C, Venturini M, Calzavara-Pinton PG. A randomized split-face clinical trial of conventional vs indoor-daylight photodynamic therapy for the treatment of multiple actinic keratosis of the face and scalp and photoaging. J DERMATOL TREAT 2021; 33:2250-2256. [PMID: 34152936 DOI: 10.1080/09546634.2021.1944594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recently, indoor daylight photodynamic therapy (idl-PDT) has been developed; however, its efficacy and tolerability remain to be assessed. OBJECTIVE This is a not-inferiority study to compare treatment outcomes of cPDT with a red LED lamp and idlPDT with a polychromatic white LED lamp in adult patients affected by symmetrical AKs of face and/or scalp. METHODS In this comparative, intra-patient, split-face, randomized clinical trial forty-three adult patients were enrolled. Two contralateral and symmetrical target areas of the face and/or scalp harboring at least 5 AKs were selected and randomized 1:1 to treatment with cPDT and idlPDT. The AKs number and cumulative area were assessed at baseline (T0). Efficacy and cosmetic outcome were assessed 3 months after treatment (T1). RESULTS Total AKs number and area reduced significantly with both idlPDT (p < .0001) and cPDT (p < .0001) in comparison to baseline. cPDT was more painful (p < .0001) and induced a more severe inflammation (p < .0001). Twenty-nine patients (70.7%) gave their overall preference to idlPDT (p < .001). CONCLUSION idlPDT may represent an alternative treatment protocol to cPDT for in-office treatment of AKs patients with better tolerability and a not inferior efficacy.
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Affiliation(s)
- M Arisi
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - M T Rossi
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - L Spiazzi
- Medical Physics Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - E Guasco Pisani
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - A Venturuzzo
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - C Rovati
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - C Tomasi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - M Venturini
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - P G Calzavara-Pinton
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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Ruini C, Schuh S, Gust C, Hartmann D, French LE, Sattler EC, Welzel J. In-Vivo LC-OCT Evaluation of the Downward Proliferation Pattern of Keratinocytes in Actinic Keratosis in Comparison with Histology: First Impressions from a Pilot Study. Cancers (Basel) 2021; 13:2856. [PMID: 34201052 PMCID: PMC8228287 DOI: 10.3390/cancers13122856] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
It is known that actinic keratoses (AKs) can progress to invasive squamous cell carcinoma (SCC). The histological PRO grading of AKs is based on the growth pattern of basal keratinocytes and relates to their progression risk. AKs can be non-invasively characterized by line-field confocal optical coherence tomography (LC-OCT). The aim of the study was to define criteria for an LC-OCT grading of AKs based on the PRO classification and to correlate it with its histological counterpart. To evaluate the interobserver agreement for the LC-OCT PRO classification, fifty AKs were imaged by LC-OCT and biopsied for histopathology. PRO histological grading was assessed by an expert consensus, while two evaluator groups separately performed LC-OCT grading on vertical sections. The agreement between LC-OCT and histological PRO grading was 75% for all lesions (weighted kappa 0.66, 95% CI 0.48-0.83, p ≤ 0.001) and 85.4% when comparing the subgroups PRO I vs. PRO II/III (weighted kappa 0.64, 95% CI 0.40-0.88, p ≤ 0.001). The interobserver agreement for LC-OCT was 90% (Cohen's kappa 0.84, 95% CI 0.71-0.91, p ≤ 0.001). In this pilot study, we demonstrated that LC-OCT is potentially able to classify AKs based on the basal growth pattern of keratinocytes, in-vivo reproducing the PRO classification, with strong interobserver agreement and a good correlation with histopathology.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Sandra Schuh
- Department of Dermatology and Allergy, University Hospital, 86156 Augsburg, Germany;
| | - Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Lars Einar French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Elke Christina Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Julia Welzel
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
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Arisi M, Soglia S, Guasco Pisani E, Venturuzzo A, Gelmetti A, Tomasi C, Zane C, Rossi M, Lorenzi L, Calzavara-Pinton P. Cold Atmospheric Plasma (CAP) for the Treatment of Actinic Keratosis and Skin Field Cancerization: Clinical and High-Frequency Ultrasound Evaluation. Dermatol Ther (Heidelb) 2021; 11:855-866. [PMID: 33738749 PMCID: PMC8163902 DOI: 10.1007/s13555-021-00514-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/06/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Cold atmospheric plasma (CAP) has been clinically demonstrated to be an effective treatment for actinic keratosis (AK) in a number of case series. In this study, we evaluated the efficacy of CAP in the treatment of multiple AKs and assessed morphological changes induced on the skin field of cancerization both clinically and by high-frequency ultrasound (HFUS). METHODS Patients with multiple grade I-II AKs of the scalp and/or face who were resistant or intolerant to conventional field-directed treatments were enrolled. CAP treatments were performed using a microwave-driven argon plasma jet. At baseline and 3 months after the last CAP session, performance indexes were determined using three-dimensional digital pictures and HFUS investigations were performed on a representative Olsen grade II AK and a small spot of clinically unaffected skin within the test area. RESULTS Twelve patients were enrolled in the study. All clinical variables showed a statistically significant reduction after CAP. HFUS evaluation revealed that the total, epidermal and dermal thicknesses of the target AKs had not changed with treatment. CAP therapy significantly increased dermal density in both the target AK and the surrounding photodamaged skin and signficantly decreased the thickness of the subepidermal low-echogenic band in the perilesional skin, which is an ultrasound sign of photodamage. CONCLUSIONS Cold atmospheric plasma was found to be an effective treatment for patients with multiple AKs. CAP was not followed by skin atrophy. HFUS examiniation showed the CAP improved features of chronic photodamage of the dermis of the skin underlying and surrounding the AK spots.
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Affiliation(s)
- Mariachiara Arisi
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Simone Soglia
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Edoardo Guasco Pisani
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Anna Venturuzzo
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Alessandra Gelmetti
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Cesare Tomasi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cristina Zane
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Mariateresa Rossi
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Luisa Lorenzi
- Department of Pathology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Piergiacomo Calzavara-Pinton
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
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Piaserico S, Piccioni A, Gutiérrez Garcìa-Rodrigo C, Sacco G, Pellegrini C, Fargnoli MC. Sequential treatment with calcitriol and methyl aminolevulinate-daylight photodynamic therapy for patients with multiple actinic keratoses of the upper extremities. Photodiagnosis Photodyn Ther 2021; 34:102325. [PMID: 33965603 DOI: 10.1016/j.pdpdt.2021.102325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) is a widely used and effective treatment for actinic keratoses (AKs). However, cure rates are significantly reduced for AKs on acral sites. We compared the sequential regimen of topical calcitriol and methyl aminolevulinate (MAL) daylight-PDT (CAL-DL-PDT) versus placebo and MAL-DL-PDT (P-DL-PDT) on acral AKs in an intra-individual, randomized trial. METHODS Adult patients with multiple all grade AKs of the upper extremities were treated with daily topical calcitriol or placebo for 14 days followed by 2 sessions of DL-MAL-PDT. After 3 months, patients were evaluated for lesion response rate, both overall and by AK grade, and patient ≥ 75 % clearance rate. Safety assessments included pain VAS immediately after the first DL-PDT session, side effects after calcitriol pretreatment and 7 days after the first DL-PDT session. Cosmetic outcome by the physician and patient's preference were graded at the end of the study. RESULTS Forty-two patients were enrolled and 36/42 completed the study. After 3 months, the overall lesion response rate and patient ≥ 75 % clearance rate of CAL-DL-PDT were higher, albeit not significantly, than P-DL-PDT. According to grade, response rate of grouped AK II/III was significantly higher for CAL-DL-PDT than for P-DL-PDT while similar results were observed for grade I AKs. Mild erythema and itch were reported after calcitriol application. No significant difference was observed in pain intensity. Local skin reactions occurred more frequently on the CAL-DL-PDT-treated sides. Cosmetic outcome did not differ but overall subject's preference was slightly significantly in favor of P-DL-PDT. CONCLUSIONS CAL-DL-PDT is more effective than P-DL-PDT for thicker "difficult to treat" AKs on the upper extremities but is associated with increased local skin reactions.
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Affiliation(s)
- Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Antonella Piccioni
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Giorgia Sacco
- Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Cristina Pellegrini
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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Luger T, Dirschka T, Eyerich K, Gollnick H, Gupta G, Lambert J, Micali G, Ochsendorf F, Ständer S, Traidl-Hoffmann C. Developments and challenges in dermatology: an update from the Interactive Derma Academy (IDeA) 2019. J Eur Acad Dermatol Venereol 2021; 34 Suppl 7:3-18. [PMID: 33315305 DOI: 10.1111/jdv.17009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 01/09/2023]
Abstract
The 2019 Interactive Derma Academy (IDeA) meeting was held in Lisbon, Portugal, 10-12 May, bringing together leading dermatology experts from across Europe, the Middle East and Asia. Over three days, the latest developments and challenges in relation to the pathophysiology, diagnosis, evaluation and management of dermatological conditions were presented, with a particular focus on acne, atopic dermatitis (AD) and actinic keratosis (AK). Interesting clinical case studies relating to these key topics were discussed with attendees to establish current evidence-based best practices. Presentations reviewed current treatments, potential therapeutic approaches and key considerations in the management of acne, AK and AD, and discussed the importance of the microbiome in these conditions, as well as the provision of patient education/support. It was highlighted that active treatment is not always required for AK, depending on patient preferences and clinical circumstances. In addition to presentations, two interactive workshops on the diagnosis and treatment of sexually transmitted infections/diseases (STIs/STDs) presenting to the dermatology clinic, and current and future dermocosmetics were conducted. The potential for misdiagnosis of STIs/STDs was discussed, with dermoscopy and/or reflectance confocal microscopy suggested as useful diagnostic techniques. In addition, botulinum toxin was introduced as a potential dermocosmetic, and the possibility of microbiome alteration in the treatment of dermatological conditions emphasized. Furthermore, several challenges in dermatology, including the use of lasers, the complexity of atopic dermatitis, wound care, use of biosimilars and application of non-invasive techniques in skin cancer diagnosis were reviewed. In this supplement, we provide an overview of the presentations and discussions from the fourth successful IDeA meeting, summarizing the key insights shared by dermatologists from across the globe.
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Affiliation(s)
- T Luger
- Department of Dermatology, University of Münster, Münster, Germany
| | - T Dirschka
- Centroderm Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - K Eyerich
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Unit of Dermatology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - H Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke University, Magdeburg, Germany
| | - G Gupta
- University Department of Dermatology, Edinburgh, UK
| | - J Lambert
- Department of Dermatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Ochsendorf
- Department of Dermatology, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - S Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - C Traidl-Hoffmann
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Augsburg, Germany
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46
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Heerfordt IM, Poulsen T, Wulf HC. Actinic keratoses contiguous with squamous cell carcinomas are mostly non-hyperkeratotic and with severe dysplasia. J Clin Pathol 2021; 75:560-563. [PMID: 33863749 DOI: 10.1136/jclinpath-2021-207497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/03/2022]
Abstract
AIMS Actinic keratosis (AK) is a precursor of cutaneous squamous cell carcinoma (SCC). No validated parameters can predict which AKs will progress into SCCs, but especially thick AKs are under suspicion. The clinical and histopathological thickness of AKs is strongly correlated. This study aimed to investigate the thicknesses and degree of dysplasia of AKs contiguous with SCCs assuming these AKs represent the AKs that have undergone malignant transformation. METHODS Files of the Pathology Department, Hospital of Southern Jutland, Denmark, were reviewed. 111 cases met the inclusion criteria: a skin biopsy containing an invasive SCC. All SCCs merged with an AK at the edge. Degree of dysplasia, epidermal thickness and stratum corneum thicknesses of AKs were measured. RESULTS All AKs showed severe dysplasia. Most AKs had a stratum corneum thickness under 0.1 mm and an epidermal thickness under 0.5 mm, corresponding to clinically thin and non-hyperkeratotic AKs. CONCLUSIONS Our result suggests malignant progression potential of AKs regardless of thickness.
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Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Thomas Poulsen
- Department of Pathology, Hospital of Southern Jutland, Soenderborg, Denmark
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Zhu AQ, Wang LF, Li XL, Wang Q, Li MX, Ma YY, Xiang LH, Guo LH, Xu HX. High-frequency ultrasound in the diagnosis of the spectrum of cutaneous squamous cell carcinoma: Noninvasively distinguishing actinic keratosis, Bowen's Disease, and invasive squamous cell carcinoma. Skin Res Technol 2021; 27:831-840. [PMID: 33751714 DOI: 10.1111/srt.13028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/13/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate high-frequency ultrasound (HFUS) features for diagnosing cutaneous squamous cell carcinoma (cSCC) as a spectrum of progressively advanced malignancies, including precursor actinic keratosis (AK), Bowen's disease (BD), and invasive squamous cell carcinoma (iSCC). METHOD In this retrospective study, 160 skin lesions diagnosed histopathologically (54 AK, 54 BD, and 52 iSCC) in 160 patients were included. The HFUS features of AK, BD, and iSCC were analyzed. The obtained data were evaluated using univariate and forward multivariate logistic regression analyses. RESULTS The most significant HFUS features in AK were regular surface (odds ratio [OR], 8.42) and irregular basal border (OR, 6.36). The most significant HFUS features in BD were crumpled surface (OR, 19.62) and layer involvement confined to the epidermis (OR, 3.96). The most significant HFUS features in iSCC were concave surface (OR, 27.06), stratum corneum (SC) detachment (OR, 14.41), irregular basal border (OR, 4.01), and convex surface (OR, 3.73). The characteristics of surface features, basal border, and layer involvement could be valuable HFUS clues in the discrimination of AK, BD, and iSCC. CONCLUSION High-frequency ultrasound is valuable for the differentiation of AK, BD, and iSCC, which may allow dynamic and noninvasive monitoring in the spectrum of cSCC.
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Affiliation(s)
- An-Qi Zhu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Li-Fan Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Ming-Xu Li
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Yuan-Yuan Ma
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Tumor Minimally Invasive Treatment Center, Tongji University Cancer Center, Shanghai, China
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48
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Conforti C, Giuffrida R, Dianzani C, Guarneri F, Marangi GF, Neagu N, Persichetti P, Zalaudek I, di Meo N. Effectiveness and tolerability of treatment for isolated actinic keratoses: A retrospective comparison between cryotherapy, CO 2 laser and 5-fluorouracil 0.5%/salicylic acid 10. Dermatol Ther 2021; 34:e14846. [PMID: 33528869 DOI: 10.1111/dth.14846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
Actinic keratoses (AK) have been described as either intraepithelial keratinocytic dysplasia that can evolve into invasive squamous cell carcinoma (SCC) or as in situ SCC that can progress into an invasive form. A retrospective study was conducted to compare outcomes of three different topical therapies for patients with single AK (<4): cryotherapy, CO2 laser and 5-fluorouracil 0.5%/salicylic acid 10%. We included 72 patients who presented at the Dermatology Clinic of Maggiore Hospital of Trieste between 1 November 2019 and 31 January 2020 for the treatment of AKs. All treatments led to a significant reduction in the average diameter of AK. Pain felt by patients was significantly lower after 5-FU 0.5%/SA 10%. Side effects appeared similarly distributed among the three groups, with erythema and crusts being the most frequent. Aesthetic outcomes were highest in the 5-FU 5%/SA 10% group, as evaluated by both the patient and the operator. Cryotherapy, CO2 laser and 5-FU 5%/SA 10% were all effective, with no significant efficacy differences among them. Additionally, 5-FU 5%/SA 10% was proved to have the best aesthetic result and to cause the least pain, while necessitating long-term administration. This should be taken into account for patients with low pain tolerance and low treatment adherence. Cryotherapy and CO2 laser have the advantage of requiring a single session, which might be more suitable for uncooperative patients.
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Caterina Dianzani
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Guarneri
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | | | - Nicoleta Neagu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
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49
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Heppt MV, Leiter U, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Welzel J, Wermker K, Berking C, Garbe C. S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma - short version, part 1: diagnosis, interventions for actinic keratoses, care structures and quality-of-care indicators. J Dtsch Dermatol Ges 2020; 18:275-294. [PMID: 32130773 DOI: 10.1111/ddg.14048] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Actinic keratoses (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guideline is aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AK and cSCC. The guideline is also aimed at affected patients, their relatives, policy makers and insurance funds. In the first part, we will address aspects relating to diagnosis, interventions for AK, care structures and quality-of-care indicators.
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Affiliation(s)
- Markus V Heppt
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany.,Department of Dermatology, Universitätsklinikum Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Theresa Steeb
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany
| | - Teresa Amaral
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, Carl Gustav Carus University Medical Center, Dresden, Germany
| | - Jürgen C Becker
- Department of Dermatology, German Cancer Consortium (DKTK), Essen University Medical Center, Essen, and German Cancer Research Center, Heidelberg, Germany
| | | | - Helmut Breuninger
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Thomas Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital, Germany
| | - Thomas Dirschka
- CentroDerm Clinic and Medical Faculty of Witten Herdecke University, Wuppertal, Germany
| | - Thomas Eigentler
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Michael Flaig
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany
| | | | - Klaus Fritz
- Dermatology and Laser Center, Landau, Germany
| | | | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hanover Medical School, Hanover, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Medical Center, Berlin-Neukölln, Germany
| | | | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Oliver Kölbl
- Department of Radiation Oncology, Regensburg University Medical Center, Regensburg, Germany
| | | | - Christoph Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Seema Noor
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Monika Nothacker
- Association of Scientific Medical Societies in Germany (AWMF), Berlin, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, University Medical Center, Tübingen, Germany
| | | | - Lutz Schmitz
- Department of Dermatology, Ruhr University of Bochum, Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Ruhr University of Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Claas Ulrich
- Department of Dermatology, Charité University Medical Center, Berlin, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University of Augsburg, Augsburg, Germany
| | - Kai Wermker
- Department of Oral and Maxillofacial Surgery, Klinikum Osnabrück, Osnabrück, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany.,Department of Dermatology, Universitätsklinikum Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
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50
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Different Immunohistochemical Localization of Fatty Acid Binding Protein 5 in Actinic Keratosis Compared with That in Bowen's Disease: A Retrospective Study. Am J Dermatopathol 2020; 43:356-361. [PMID: 33055535 DOI: 10.1097/dad.0000000000001823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Actinic keratosis (AK) and Bowen's disease (BD) are common premalignant lesions of invasive squamous cell carcinoma that have different pathogenesis and clinical significance. Fatty acid-binding protein 5 (FABP5) is responsible for keratinocyte homeostasis and differentiation; however, no study has revealed its expression in AK and BD. Our study aimed to investigate the differential expression and significance of FABP5 in these lesions. Patients with pathologically confirmed cases of AK (n = 37) and BD (n = 12) were included in this study. FABP5 immunostaining pattern was assessed in the normal skin, AK and BD lesions, with a focus on the staining patterns of basal cells, atypical keratinocytes, and uninvolved epidermal keratinocytes. All patients with AK showed negative FABP5 expression in the atypical cells in the basal layer, whereas the uninvolved upper layers showed diffuse, strong FABP5 expression, regardless of the grade of AK. All patients with BD showed heterogeneous and diffuse FABP5 expression in atypical cells of all layers of the epidermis. This study is the first to investigate the role of FABP5 in premalignant skin lesions. The unique immunohistochemical localization of the FABP5 can be a helpful diagnostic marker, and altered fatty acid metabolism may be the key in understanding the different pathophysiology of AK and BD.
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