Squamous Cell Carcinoma of the Eyelid Treated with Photodynamic Therapy

The use of photodynamic therapy in medical practice

Cancer therapy, especially for tumors near sensitive areas, demands precise treatment. This review explores photodynamic therapy (PDT), a method leveraging photosensitizers (PS), specific wavelength light, and oxygen to target cancer effectively. Recent advancements affirm PDT's efficacy, utilizing ROS generation to induce cancer cell death. With a history spanning over decades, PDT's dynamic evolution has expanded its application across dermatology, oncology, and dentistry. This review aims to dissect PDT's principles, from its inception to contemporary medical applications, highlighting its role in modern cancer treatment strategies.

Topical and Intralesional Immunotherapy for the Management of Skin Cancer in Special Locations: Lips and Eyelids

The use of topical and intralesional immunotherapy in the treatment of cutaneous malignant neoplasia in sensitive areas such as the lips and eyelids is discussed. Surgery may not be feasible or may result in deformities in these areas, making alternative treatment options necessary. A narrative literature review was conducted using MEDLINE (PubMed) as the main literature database, collecting available evidence of experiences with various topical and intralesional therapies in the aforementioned anatomical locations, ranging from case reports to clinical trials. The clearance rates and potential adverse reactions of therapeutic options such as imiquimod 5%, 5-fluorouracil (5-FU), photodynamic therapy (PDT), ingenol mebutate (IM), diclofenac, intralesional methotrexate, and interferon are reviewed. Although limited by their heterogeneity and the scarcity of clinical trials, these studies point towards promising response rates and minimal adverse effects, making these treatments viable options in selected cases.

Efficacy and safety of 5-aminolevulinic acid photodynamic therapy for the treatment of ulcerative squamous cell carcinoma

BACKGROUND

Photodynamic therapy is a nonsurgical alternative to conventional tumor excision for squamous cell carcinoma. In addition, photodynamic therapy has many advantages in improving wound healing, especially for diabetic foot lesions and infected ulcers. However, the effect of photodynamic therapy on ulcerative squamous cell carcinoma is not yet clear. In this study, we aimed to evaluate the effectiveness of photodynamic therapy in treating squamous cell carcinoma.

METHODS

A total of six cases of ulcerative squamous cell carcinoma were included in our study. Each ulcer region was irradiated with 120 J/cm² using a 635-nm red light-emitting diode after application of 5-aminolevulinic acid solution at 1-week intervals. The number of treatment sessions depended on the healing of the lesions.

RESULTS

The ulcerative lesions showed complete clinical remission with an average 3.7 photodynamic therapy sessions. There was no recurrence during a follow-up of 8.5 months (range, 3 months to 1 year). The patients were able to complete the treatment protocol with good cosmetic results and no significant complications. In addition, most patients reported significant improvement in their quality of life.

CONCLUSIONS

Photodynamic therapy is a promising method for treating ulcerative squamous cell carcinoma. However, its effects need to be validated in larger patient samples in clinical trials.

Present and future perspectives of photodynamic therapy for cutaneous squamous cell carcinoma

Cutaneous squamous cell carcinoma (SCC) is the second most common skin cancer. Surgery remains the main stay of treatment, but some patients are not eligible for surgery and, more importantly, lesions at critical sites need nonsurgical approaches for tissue preservation. In this context, photodynamic therapy (PDT) has been extensively studied as noninvasive or minimally invasive treatment, and studies have shown promising results in terms of safety, efficacy, and cosmetic outcome. Also, studies have proposed different mechanism for its efficacy. However, human studies demonstrating its efficacy are limited in terms of sample size and tumor depth of invasion. Good results are mainly seen in case reports of microinvasive SCC, which is defined as SCC limited to papillary dermis. This inadequacy is due to inadequate penetration of topically applied photosensitizers through keratinized tumor surfaces. To overcome these hurdles, pretreatment with lasers or microneedles and encapsulation of photosensitizers into nanoparticles have been tried. Hence, the present article will discuss studies that have demonstrated the efficacy and safety of PDT for cutaneous SCC, studies that have postulated the mechanism of action of PDT, agents that have been used as PDT enhancers, and finally, the recent use of adjuvant therapy in combination with PDT.

Photodynamic therapy with topical photosensitizers in mucosal and semimucosal areas: Review from a dermatologic perspective

Photodynamic Therapy is a procedure based on the interaction between a Photosensitizer, a light source with a specific wavelength and oxygen. The aim of this review is to provide a brief and updated analysis of scientific reports on the use of PDT with topical PS in the management of oncological, infectious, and inflammatory disorders involving mucosal and semimucosal areas, with a specific focus on diseases of dermatologic interest.

Socioeconomic and Ethnic Disparities in Periocular Cutaneous Malignancies

Cutaneous malignancies make up the majority of periocular tumors diagnosed and treated by ophthalmologists. In this review, we examine literature regarding ethnic and socioeconomic disparities in incidence and clinical outcomes of the three most common cutaneous periocular tumors: basal cell carcinoma, squamous cell carcinoma, and melanoma. In all three tumor types, the literature shows an increased incidence among two groups: those with lightly pigmented skin and those of higher socioeconomic status. While incidence is high in these groups, clinical outcomes for these patients tend to be good. Those with lower socioeconomic status and ethnic minorities, on the other hand, have a low incidence but are more likely to have poor clinical outcomes. These disparities are likely the result of both biologic and behavioral differences between patients and could provide opportunities for intervention to change risk perception and improve outcomes.

Therapeutic and immune effects of 5-aminolevulinic acid photodynamic therapy on UVB-induced squamous cell carcinomas in hairless mice

The therapeutic effects of 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) on cutaneous squamous cell carcinoma (SCC) are not fully understood, and the usefulness of topical PDT in the treatment of SCC is still debatable. The most interesting aspect in SCC PDT is perhaps its potential in inducing antitumor immune responses. In this study, cutaneous SCCs were established by UVB irradiation of hairless mice and treated with multiple ALA PDT. Immunohistochemistry assays showed that ALA PDT could induce quick apoptosis, overexpression of TNFα and marked increases in DCs, CD4(+) and CD8(+) cells in tumor interstitium and subcutaneous connective tissues. However, a complete response was only achieved for small SCCs. The clinical value of ALA PDT-induced specific antitumor immune responses in long-term control of SCCs deserves further study.

Periocular cutaneous malignancies: a review of the literature

BACKGROUND

The periocular skin is susceptible to numerous benign and malignant neoplasms. Periocular malignancies may present differently, behave more aggressively, and pose greater challenges for treatment and repair than malignancies at other cutaneous sites. Between 5% and 10% of cutaneous malignancies occur periorbitally, with basal cell carcinoma reported as the most common malignant periocular tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma, cutaneous melanoma, Merkel cell carcinoma, and other rare tumors.

OBJECTIVE

To review the current literature on cutaneous malignancies of the periocular region pertaining to etiology, incidence, clinical presentation, differential diagnosis, complications, and treatment options.

MATERIALS AND METHODS

An extensive literature review was conducted using PubMed, searching for articles on periocular and periorbital cutaneous malignancies.

CONCLUSIONS

Timely diagnosis and management of periocular malignancies is essential because of their proximity to and potential to invade vital structures such as the orbit, sinuses, and brain. Surgical excision remains the standard of care for the majority of periorbital malignancies, but given the sensitive anatomic location, tissue-sparing techniques with margin control such as Mohs micrographic surgery are the preferred method for most nonmelanoma skin cancers. Depending on tumor type, other treatment modalities may include radiation, chemotherapy, cryosurgery, topical medications, and photodynamic therapy.

Photodynamic therapy for choroidal metastasis in 8 cases

PURPOSE

To determine the efficacy of photodynamic therapy (PDT) in the treatment of choroidal metastasis.

DESIGN

Retrospective, interventional case series.

PARTICIPANTS

Nine tumors in 8 eyes of 8 patients.

INTERVENTION

Photodynamic therapy using verteporfin at a dose of 6 mg/m(2) body surface area and 689 nm diode laser at an intensity of 600 mW/cm(2) for 83 seconds (50 J/cm(2)).

MAIN OUTCOME MEASURES

Tumor control and best-corrected visual acuity.

RESULTS

Nine choroidal metastases in 8 eyes were treated with 1 (8 tumors) or 2 (1 tumor) sessions of PDT. The mean tumor basal diameter was 7 mm (median, 7 mm [range, 2-13 mm]), and mean tumor thickness was 2.9 mm (median, 2.9 mm [range, 1.6-4 mm]). All 9 tumors were associated with shallow subretinal fluid. After PDT, complete control with resolution of subretinal fluid was achieved in 7 tumors (78%), with mean tumor thickness reduction of 39% (median, 43% [range, 6%-61%]). Two tumors failed to respond to PDT, both requiring plaque radiotherapy. Improvement or stabilization of vision was achieved in 7 eyes. Photodynamic therapy-related complications included intraretinal hemorrhage in 1 eye.

CONCLUSIONS

Photodynamic therapy can be an effective alternative for the treatment of choroidal metastasis.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Ocular Photodynamic Therapy – Standard Applications and New Indications (Part 2)

Photodynamic therapy (PDT) has become a well-established treatment for vascular forms of age-related macular degeneration (AMD). The implementation of evidence-based medicine principles into the treatment regimen of AMD seems to be immensly important, since AMD continues to be the most frequent cause of blindness among patients older than 65 years in industrialized countries. Numerous randomized prospective studies demonstrated high levels of evidence for the efficacy of various treatment approaches such as laser photocoagulation, PDT, subretinal surgery or novel anti-angiogenic drugs [Arch Ophthalmol 2006;124:597-599]. The high evidence shown by these studies supported the rationale to use PDT also in additional, less frequent, vasoproliferative diseases. Although these 'case series' and 'individual case control studies' have a low level of evidence, they give us important information for treatment decisions in these rare conditions. The goal of this survey is to review the current literature regarding PDT in vasoproliferative and exudative ocular diseases outside AMD. Many studies modified the treatment parameters of PDT to address the specific pathology of the underlying disease. Table 1 summarizes the diseases and treatment parameters that are described in this part 2, the entire table of this review is included in part 1 (www.karger.com/doi/10.1159/ 000101922).

Management of malignant and benign eyelid lesions

PURPOSE OF REVIEW

The management of benign and malignant eyelid neoplasms has been extensively examined. This paper offers an overview of the most common eyelid lesions and their management based on a review of the relevant bibliography.

RECENT FINDINGS

Recent studies have focused on the results of nonsurgical approaches for benign and premalignant lesions that are routinely surgically excised. In the malignant group, a consensus has been reached over the preferred method of tumor excision for basal cell carcinoma: Mohs surgery or complete surgical excision with frozen-section control of the margins offers the lowest tumor-recurrence rate. Important acquisitions have been made on squamous cells for which sentinel node biopsy may reveal early metastatic cancer. Intraepithelial tumor growth is a peculiar feature of sebaceous gland carcinoma that seems to indicate an increased risk for orbital invasion. Recent reports regarding the rare tumor, Merkel cell carcinoma, recommend a wide surgical excision with 5 mm margins; this may reduce the incidence of lymph-node metastasis, haematogenous spread and local recurrences.

SUMMARY

Although treatment of the most common benign and malignant tumours affecting the eyelids has not radically changed over the years, recent reports have significantly improved the standard of care for affected patients.

Aggravation of Eyelid and Conjunctival Malignancies Following Photodynamic Therapy in DeSanctis-Cacchione Syndrome

A 5-year-old girl with DeSanctis-Cacchione syndrome (a severe variant of xeroderma pigmentosum) was referred for evaluation of multiple eyelid and bulbar conjunctival squamous cell carcinomas. Examination evidenced multiple vegetating lesions on the eyelid, bulbar conjunctiva, and cornea of both eyes. As the lesions were considered not to be manageable by surgical excision and would have required exenteration, photodynamic therapy was performed on the patient's left eye. Three months after photodynamic therapy, the patient presented with a dramatic increase in the extension of the tumors. Since xeroderma pigmentosum is a DNA repair disorder, the radiation involved in photodynamic therapy probably played an iatrogenic role in the evolution of the case. We believe that photodynamic therapy may be harmful to patients with DNA repair disorders.

[Tumors of the eyelids in the elderly]

The clinical aspect of tumors of the eyelids is polymorphous; however, the most frequent are benign tumors such as papillomas, basal cell carcinoma, squamous cell carcinoma, meibomian gland carcinoma, and melanomas. An important step in the management of the malignant types is to try to establish clear margins through histopathologic techniques: the Mohs technique, the rapid fixation technique, and the frozen section method are the most frequent technical tools used today. For the most malignant tumors such as malignant melanoma and Merkel cell tumor, lymph sentinel biopsy is a recent, valuable tool, but its benefit needs to be confirmed in large series.

[Pathology of the eyelid in elderly patients]

OBJECTIVE

Didactic review of the various features of eyelid pathology in elderly patients.

METHODS

Illustrated review centered on diagnosis of the usual aspects and pitfalls of eyelid pathology divided into semiological chapters (tumors, blisters, erythema, etc.).

RESULTS

Pathology of the eyelids in elderly patients is extremely polymorphic. It is mainly centered on skin cancers (basal cell carcinoma, squamous cell carcinoma, adnexal carcinomas, and melanoma). Most severe aspects of the inflammatory diseases of the eyelid are bullous diseases (cicatricial pemphigoid, pemphigus, Stevens-Johnson syndrome, etc.). A number of rare diseases deserve mention since their presence could lead to the diagnosis of internal or systemic diseases (dermatomyositis, necrobiotic xanthogranuloma, Erdheim-Chester, etc.). In such conditions, early diagnosis is often based on the observation of isolated periocular symptoms.

CONCLUSIONS

Even though topographic dermatology is a somewhat reductive vision of skin diseases, pathology of the eyelids deserves special mention because of its polymorphism as well as its diagnostic and/or therapeutic significance.