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Ahmady S, Nelemans PJ, Kelleners-Smeets NWJ, Arits AHMM, de Rooij MJM, Kessels JPHM, Essers BAB, Mosterd K. Surgical excision versus topical 5% 5-fluorouracil and photodynamic therapy in treatment of Bowen's disease: A multicenter randomized controlled trial. J Am Acad Dermatol 2024; 90:58-65. [PMID: 37666424 DOI: 10.1016/j.jaad.2023.08.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Randomized controlled trials comparing the effectiveness of 5-fluorouracil cream, methylaminolevulinate photodynamic therapy (MAL-PDT) and surgical excision in patients with Bowen's disease are lacking. METHODS In this multicenter noninferiority trial, patients with a histologically proven Bowen's disease of 4-40 mm were randomly assigned to excision with 5 mm margin, 5% 5-fluorouracil cream twice daily for 4 weeks, or 2 sessions of MAL-PDT with 1 week interval. The primary outcome was the proportion of patients with sustained clearance at 12 months after treatment. A noninferiority margin of 22% was used. RESULTS Between May 2019 and January 2021, 250 patients were randomized. The proportion of patients with sustained clearance was 97.4% (75/77) after excision, 85.7% (66/77) after 5-fluorouracil, and 82.1% (64/78) after MAL-PDT. Absolute differences were -11.7% (95% CI -18.9 to -4.5; P = .0049) for 5-fluorouracil versus excision and -15.4% (95% CI -23.1 to -7.6; P = .00078) for MAL-PDT versus excision. Both noninvasive treatments significantly more often led to good or excellent cosmetic outcome. CONCLUSIONS Based on our predefined noninferiority margin of 22%, 5-fluorourcail is noninferior to excision and associated with better cosmetic outcome. For MAL-PDT noninferiority to excision cannot be concluded. Therefore, 5-fluorouracil should be preferred over excision and MAL-PDT in treatment of Bowen's disease.
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Affiliation(s)
- Shima Ahmady
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Aimee H M M Arits
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Dermatology, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Brigitte A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
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Yang P, He B, Zhong J, Zhao X, Bu Z. Assessment of therapeutic efficacy in seven cases of basal cell carcinoma in the ear and nose region treated with new surgical excision and immediate photodynamic therapy. Photodiagnosis Photodyn Ther 2023; 44:103904. [PMID: 37984528 DOI: 10.1016/j.pdpdt.2023.103904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most prevalent non-melanoma skin tumor. It commonly affects exposed areas. Currently, surgical resection is considered the primary approach for BCC treatment. However, BCC frequently affects exposed facial areas, leading to visible scars after surgery. PDT has garnered increasing recent attention, demonstrating superior efficacy and favorable cosmetic outcomes for superficial BCCs. However, it shows limited treatment effectiveness for deep-seated tumors. Most of the current literature focuses on the combination of surgery and postoperative PDT, while no studies have reported on the use of standard surgical excision with intraoperative margin pathological monitoring and immediate PDT. Therefore, we implemented a treatment protocol combining surgery and immediate PDT. Accordingly, this paper aimed to explore the effectiveness, cosmetic outcomes, and other relevant advantages of this therapeutic approach. METHODS We aimed to evaluate this approach in seven patients with BCC on the nose and ears. Standard surgical excision of skin lesions was performed, with intraoperative frozen section examination of the margins, followed by immediate postoperative PDT for the wounds, and continued periodic PDT during the second phase of wound healing. RESULTS All seven cases demonstrated significant improvement. The cosmetic rating was 100 % and no cases of recurrence existed among the seven patients. CONCLUSIONS This approach effectively minimized the surgical wound, improved tumor clearance, achieved precise therapeutic effects, and reduced the recurrence rate. Moreover, it produced favorable cosmetic outcomes.
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Affiliation(s)
- Ping Yang
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, China
| | - Beilei He
- The Fourth School of Medicine Affiliated to Zhejiang Chinese Medical University, China
| | - Jianbo Zhong
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, China
| | - Xingyun Zhao
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, China
| | - Zhangyu Bu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, China.
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Spyridonos P, Gaitanis G, Likas A, Seretis K, Moschovos V, Feldmeyer L, Heidemeyer K, Zampeta A, Bassukas ID. Image Perceptual Similarity Metrics for the Assessment of Basal Cell Carcinoma. Cancers (Basel) 2023; 15:3539. [PMID: 37509205 PMCID: PMC10377636 DOI: 10.3390/cancers15143539] [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: 06/10/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Efficient management of basal cell carcinomas (BCC) requires reliable assessments of both tumors and post-treatment scars. We aimed to estimate image similarity metrics that account for BCC's perceptual color and texture deviation from perilesional skin. In total, 176 clinical photographs of BCC were assessed by six physicians using a visual deviation scale. Internal consistency and inter-rater agreement were estimated using Cronbach's α, weighted Gwet's AC2, and quadratic Cohen's kappa. The mean visual scores were used to validate a range of similarity metrics employing different color spaces, distances, and image embeddings from a pre-trained VGG16 neural network. The calculated similarities were transformed into discrete values using ordinal logistic regression models. The Bray-Curtis distance in the YIQ color model and rectified embeddings from the 'fc6' layer minimized the mean squared error and demonstrated strong performance in representing perceptual similarities. Box plot analysis and the Wilcoxon rank-sum test were used to visualize and compare the levels of agreement, conducted on a random validation round between the two groups: 'Human-System' and 'Human-Human.' The proposed metrics were comparable in terms of internal consistency and agreement with human raters. The findings suggest that the proposed metrics offer a robust and cost-effective approach to monitoring BCC treatment outcomes in clinical settings.
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Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Aristidis Likas
- Department of Computer Science & Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece
| | - Konstantinos Seretis
- Department of Plastic Surgery and Burns, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Vasileios Moschovos
- Department of Plastic Surgery and Burns, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Athanasia Zampeta
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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Willingness to Pay for Surgical Treatments for Basal Cell Carcinoma: A Population-Based Cross-Sectional Study. Dermatol Surg 2021; 47:467-472. [PMID: 33625136 DOI: 10.1097/dss.0000000000002874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Keratinocyte carcinoma (KC) treatment accounts for approximately $5 billion in spending per year, yet no studies have evaluated the US general public's willingness to pay (WTP) for these procedures. OBJECTIVE To determine the monetary value of surgical KC treatments, as perceived by society, as a measure of preference. PARTICIPANTS, METHODS AND MATERIALS We performed an internet-based age-, sex-, and race-stratified cross-sectional survey of 425 subjects representative of the US general population. Stated WTP and desirability of electrodesiccation and curettage (EDC), excision, and Mohs micrographic surgery (MMS) for facial and extrafacial basal cell carcinoma (BCC) were assessed. A discrete choice experiment was performed using maximum likelihood estimation, and a secondary analysis was performed to determine the influence of framing MMS as the best treatment option. RESULTS A total of 425 subjects finished their questionnaires, yielding a completion rate of 97%. Median (interquartile range) stated WTP for EDC, excision, and MMS were $1,000 (421-2,079), $1,503 (562-3,062), and $3,006 (1,250-5,084), respectively, when MMS was framed in a standard fashion. Stated WTP for MMS increased to $3,989 (2,015-5,801) when it was framed as the best option. For BCC on the back, WTP for MMS dropped by 12%. CONCLUSION There is markedly higher societal WTP for MMS on both the face and trunk, regardless of whether MMS is framed as the best option. Gold-standard bias may affect WTP and desirability in medical decision-making under uncertainty, inflating the WTP of options framed as the best while decreasing the desirability of alternatives.
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Abstract
BACKGROUND The increasing burden from basal cell carcinoma (BCC) has stimulated the development of alternative treatments for these tumors. OBJECTIVE This review focuses on upcoming laser treatments for BCC and highlights the limitations of these therapies. METHODS A PUBMED search was conducted for articles on laser therapy of BCC. Key studies involving lasers to treat BCC were reviewed. Novel approaches to BCC are also described. RESULTS Vascular-specific laser therapy has increasingly been studied as an addition in the therapeutic armamentarium of BCC. Although these studies demonstrate efficacy for nonaggressive BCC, optimization of this technique is ongoing to minimize scarring. A more targeted approach to the treatment of BCC, such as immunized photothermal therapy or laser-assisted chemotherapeutic delivery, may result in less scarring, while maintaining efficacy similar to that of lasers targeting tumor vasculature. CONCLUSION Vascular-specific laser therapies show promise in treating low-risk BCC; however, scarring is not an uncommon adverse event. Although only animal studies have been performed to date, laser-activated gold nanoparticle therapy and laser-assisted drug delivery of vismodegib are potential therapies that theoretically confer a more selective approach. Laser modalities demonstrate promise in the treatment of nonaggressive BCC, although long-term studies have yet to be published.
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Collier NJ, Rhodes LE. Photodynamic Therapy for Basal Cell Carcinoma: The Clinical Context for Future Research Priorities. Molecules 2020; 25:molecules25225398. [PMID: 33218174 PMCID: PMC7698957 DOI: 10.3390/molecules25225398] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/05/2020] [Accepted: 11/15/2020] [Indexed: 01/11/2023] Open
Abstract
Photodynamic therapy (PDT) is an established treatment option for low-risk basal cell carcinoma (BCC). BCC is the most common human cancer and also a convenient cancer in which to study PDT treatment. This review clarifies challenges to researchers evident from the clinical use of PDT in BCC treatment. It outlines the context of PDT and how PDT treatments for BCC have been developed hitherto. The sections examine the development of systemic and subsequently topical photosensitizers, light delivery regimens, and the use of PDT in different patient populations and subtypes of BCC. The outcomes of topical PDT are discussed in comparison with alternative treatments, and topical PDT applications in combination and adjuvant therapy are considered. The intention is to summarize the clinical relevance and expose areas of research need in the BCC context, ultimately to facilitate improvements in PDT treatment.
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Salmivuori M, Grönroos M, Tani T, Pölönen I, Räsänen J, Annala L, Snellman E, Neittaanmäki N. Hexyl aminolevulinate, 5-aminolevulinic acid nanoemulsion and methyl aminolevulinate in photodynamic therapy of non-aggressive basal cell carcinomas: A non-sponsored, randomized, prospective and double-blinded trial. J Eur Acad Dermatol Venereol 2020; 34:2781-2788. [PMID: 32196772 DOI: 10.1111/jdv.16357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the photodynamic therapy (PDT) of non-aggressive basal cell carcinomas (BCCs), 5-aminolevulinic acid nanoemulsion (BF-200ALA) has shown non-inferior efficacy when compared with methyl aminolevulinate (MAL), a widely used photosensitizer. Hexyl aminolevulinate (HAL) is an interesting alternative photosensitizer. To our knowledge, this is the first study using HAL-PDT in the treatment of BCCs. OBJECTIVES To compare the histological clearance, tolerability (pain and post-treatment reaction) and cosmetic outcome of MAL, BF-200 ALA and low-concentration HAL in the PDT of non-aggressive BCCs. METHODS Ninety-eight histologically verified non-aggressive BCCs met the inclusion criteria, and 54 patients with 95 lesions completed the study. The lesions were randomized to receive LED-PDT in two repeated treatments with MAL, BF-200 ALA or HAL. Efficacy was assessed both clinically and confirmed histologically at three months by blinded observers. Furthermore, cosmetic outcome, pain, post-treatment reactions fluorescence and photobleaching were evaluated. RESULTS According to intention-to-treat analyses, the histologically confirmed lesion clearance was 93.8% (95% confidence interval [CI] = 79.9-98.3) for MAL, 90.9% (95% CI = 76.4-96.9) for BF-200 ALA and 87.9% (95% CI = 72.7-95.2) for HAL, with no differences between the arms (P = 0.84). There were no differences between the arms as regards pain, post-treatment reactions or cosmetic outcome. CONCLUSIONS Photodynamic therapy with low-concentration HAL and BF-200 ALA has a similar efficacy, tolerability and cosmetic outcome compared to MAL. HAL is an interesting new option in dermatological PDT, since good efficacy is achieved with a low concentration.
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Affiliation(s)
- M Salmivuori
- Department of Dermatology and Allergology, Päijät-Häme Social and Health Care Group, Lahti, Finland.,Department of Dermatology, Faculty of Medicine and Health Technology, Tampere University Hospital and Tampere University, Tampere, Finland.,Department of Dermatology and Allergology, Helsinki University Hospital, Helsinki, Finland
| | - M Grönroos
- Department of Dermatology and Allergology, Päijät-Häme Social and Health Care Group, Lahti, Finland.,Department of Dermatology, Faculty of Medicine and Health Technology, Tampere University Hospital and Tampere University, Tampere, Finland
| | - T Tani
- Department of Dermatology and Allergology, Päijät-Häme Social and Health Care Group, Lahti, Finland.,HUSLAB Laboratory Services, Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - I Pölönen
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - J Räsänen
- Department of Dermatology and Allergology, Päijät-Häme Social and Health Care Group, Lahti, Finland.,Department of Dermatology, Faculty of Medicine and Health Technology, Tampere University Hospital and Tampere University, Tampere, Finland
| | - L Annala
- Faculty of Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - E Snellman
- Department of Dermatology, Faculty of Medicine and Health Technology, Tampere University Hospital and Tampere University, Tampere, Finland.,Department of Dermatology, Satasairaala, Pori, Finland
| | - N Neittaanmäki
- Departments of Pathology and Dermatology, Institutes of Biomedicine and Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Huang CM, Kirchhof MG. Topical Imiquimod as a Treatment Option for Nodular Basal Cell Carcinoma: A Systematic Review. J Cutan Med Surg 2020; 24:495-503. [PMID: 32527151 DOI: 10.1177/1203475420931770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Surgical excision is considered standard treatment for nodular basal cell carcinoma (nBCC). However, patients who reject or are unsuited for surgery may benefit from imiquimod (IMQ) 5% cream as an alternative treatment. OBJECTIVES The objective of this study was to conduct a systematic review on the efficacy and safety of IMQ for the treatment of nBCC. MATERIALS AND METHODS The terms basal cell carcinoma AND imiquimod OR Aldara were searched on Ovid-MEDLINE, EMBASE, and Cochrane Library databases. Articles were included if they reported the efficacy or side effects of IMQ for nBCC. Primary outcomes included clearance (clinical and histological), recurrence rates, and adverse events. Number of lesions/subjects, treatment regimens, length of treatment, and time to recurrence were secondary outcomes. RESULTS Thirty-nine publications, totaling 738 lesions, revealed a 77.4% (335/433 lesions) clinical and 72.9% (390/535 lesions) histological clearance rate. Regimens ranged from once daily 2 days a week to twice daily 7 days a week. Average treatment duration was 8.81 (±3.49) weeks. There was a 1.80% recurrence rate after an average follow-up period of 13.03 (±15.09) months. Common adverse effects included erythema (77.2%), crusting (50.5%), pruritus (34.1%), tenderness/irritation (27.3%), ulceration (25.4%), burning (22.1%), and erosion (21.7%). Unforeseen side effects included conjunctivitis, keratitis, depigmentation, comedone formation, and ruptured epidermoid cysts. CONCLUSION Imiquimod showed clinical and histological clearance rates of over 70% for nBCC, with a recurrence rate of 1.80%. Although clearance rates are lower than surgery, IMQ can be considered as a treatment option for nBCC in those who decline or are unfit for surgical intervention.
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Affiliation(s)
- Christina M Huang
- 12365 Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, ON, Canada
| | - Mark G Kirchhof
- 12365 Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, ON, Canada
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Stundzaite-Barsauskiene G, Tutkuviene J, Barkus A, Jakimaviciene EM, Gibaviciene J, Jakutis N, Tutkus V, Venciute R, Dadoniene J. Facial perception, self-esteem and psychosocial well-being in patients after nasal surgery due to trauma, cancer and aesthetic needs (cluster analysis of multiple interrelations). Ann Hum Biol 2019; 46:537-552. [PMID: 31747819 DOI: 10.1080/03014460.2019.1690678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Facial anthropometric measurements in relation to self-esteem and self-perception have become a very popular topic, not only in anthropological and psychological research, but also in plastic reconstructive surgery.Aim: To compare the interrelations between facial perception, self-esteem and psychosocial well-being in patients after nasal surgery due to trauma, cancer and aesthetic needs.Subjects and methods: In total, ninety patients after nasal surgery (due to trauma, cancer and aesthetic reasons), and thirty control persons underwent facial anthropometry and answered questions related to facial perception (FP), self-esteem (SE) and psychosocial well-being (PW). Cluster analysis was performed.Results: Facial measurements were not related to the perception of the whole face in all investigated persons. The whole face and nasal perception were interrelated in the majority of male groups and in the control female group. SE in females from the control and cancer groups was not related to real facial parameters or FP, however, in females after aesthetic surgery it was related to nasal tip protrusion. SE in females after nasal surgery due to trauma was strongly related to FP. SE in almost all groups of males was related to real facial parameters, and in males after aesthetic surgery it was related to FP. PW was mostly linked to SE in males and females after aesthetic surgery, in other groups it was related to FP.Conclusions: FP was most frequently not related to real facial measurements; however, it was related to PW. Patients after aesthetic nasal surgery had specific relations between FP, SE and PW.
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Affiliation(s)
- Giedre Stundzaite-Barsauskiene
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Janina Tutkuviene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arunas Barkus
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Egle Marija Jakimaviciene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Nerijus Jakutis
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vytautas Tutkus
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ruta Venciute
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Dadoniene
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Electrochemotherapy in the treatment of locally advanced or recurrent eyelid-periocular basal cell carcinomas. Sci Rep 2019; 9:4285. [PMID: 30862897 PMCID: PMC6414678 DOI: 10.1038/s41598-019-41026-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/25/2019] [Indexed: 12/21/2022] Open
Abstract
There is increasing evidence about the effectiveness of electrochemotherapy (ECT) in the treatment of basal cell carcinomas in the head and neck region, although its role in the management of eyelid-periocular skin tumors has to be clarified. The aim of the present study is to evaluate the results of ECT in the treatment of locally advanced primary and recurrent eyelid-periocular skin basal cell carcinomas. Twelve patients with basal cell carcinoma involving the eyelid-periocular skin region were treated with ECT. Three patients had locally advanced primary tumors, while 9 patients had recurrent tumors. All treatments were performed according to the ESOPE guidelines, using Cliniporator TM device. All patients received bleomycin based ECT. The route of administration was intratumoral in 3 patients and intravenous in 9 patients. Tumor response was evaluated using the RECIST 1.1. criteria. ECT resulted in complete response of the periocular skin tumors in all patients. Lower eyelid ectropion was developed in 3 patients which had to be corrected surgically. ECT can be used effectively in the treatment of locally advanced or recurrent basal cell carcinomas in the eyelid-periocular skin region. Excellent tumor control can be achieved with good functional and cosmetic results without systemic adverse events with short interval follow-up.
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11
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Collier NJ, Haylett AK, Wong TH, Morton CA, Ibbotson SH, McKenna KE, Mallipeddi R, Moseley H, Seukeran D, Ward KA, Mohd Mustapa MF, Exton LS, Green AC, Rhodes LE. Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis. Br J Dermatol 2018; 179:1277-1296. [PMID: 29889302 DOI: 10.1111/bjd.16838] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) is an established treatment option for low-risk basal cell carcinoma (BCC). OBJECTIVES To compare efficacy, cosmesis and tolerability of PDT for BCC with alternative treatments. METHODS MEDLINE, PubMed, Embase and CENTRAL databases were searched from inception until 1 September 2017. Included studies were randomized controlled trials (RCTs) of PDT for nodular (n) and superficial (s) BCC reporting at least one of the following outcomes: clearance at 3 months and sustained at 1 or 5 years; recurrence at ≥ 1 year; cosmesis; adverse events; tolerability. RESULTS From 2331 search results, 15 RCTs (2327 patients; 3509 BCCs) were included. PDT efficacy (5-year sustained clearance) was high but inferior to excisional surgery [nBCC pooled risk ratio (RR) 0·76; 95% confidence interval (CI) 0·63-0·91], and without re-treatment of partially responding lesions, was modestly inferior to imiquimod (sBCC: RR 0·81; 95% CI 0·70-0·95) and similar to fluorouracil (sBCC: RR 0·88; 95% CI 0·75-1·04). Five-year sustained clearance was inferior with conventional vs. fractionated PDT (sBCC: RR 0·76; 95% CI 0·68-0·84). PDT cosmesis was superior to surgery (sBCC: RR 1·68, 95% CI 1·32-2·14; nBCC: RR 1·82, 95% CI 1·19-2·80) and cryosurgery (BCC: RR 3·73, 95% CI 1·96-7·07), and without re-treatment of partially responding lesions was similar to imiquimod (sBCC: RR 1·01, 95% CI 0·85-1·19) and fluorouracil (sBCC: RR 1·04, 95% CI 0·88-1·24). Peak pain was higher but of shorter duration with PDT than topical treatments. Serious adverse reactions were rarer with PDT than imiquimod (sBCC: RR 0·05, 95% CI 0·00-0·84) and fluorouracil (sBCC: RR 0·11, 95% CI 0·01-2·04). Combination PDT regimens demonstrated reduced recurrence and improved cosmesis; however, results from these small studies were often nonsignificant. CONCLUSIONS PDT is an effective treatment for low-risk BCC, with excellent cosmesis and safety. Imiquimod has higher efficacy than single-cycle PDT but more adverse effects. Highest efficacy is with excisional surgery. Fractionated and combination PDT options warrant further study.
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Affiliation(s)
- N J Collier
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - A K Haylett
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - T H Wong
- Stirling Community Hospital, Stirling, U.K
| | - C A Morton
- Stirling Community Hospital, Stirling, U.K
| | - S H Ibbotson
- The Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital & Medical School, Dundee, U.K
| | - K E McKenna
- Department of Dermatology, Belfast City Hospital, Belfast, U.K
| | - R Mallipeddi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - H Moseley
- The Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital & Medical School, Dundee, U.K
| | - D Seukeran
- The James Cook University Hospital, Middlesborough, U.K
| | - K A Ward
- Cannock Chase Hospital, Cannock, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, U.K
| | - A C Green
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K.,CR-UK Manchester Institute, The University of Manchester, Manchester, U.K.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - L E Rhodes
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
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Etzkorn JR, Tuttle SD, Lim I, Feit EM, Sobanko JF, Shin TM, Neal DE, Miller CJ. Patients prioritize local recurrence risk over other attributes for surgical treatment of facial melanomas-Results of a stated preference survey and choice-based conjoint analysis. J Am Acad Dermatol 2018; 79:210-219.e3. [PMID: 29505861 DOI: 10.1016/j.jaad.2018.02.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/21/2017] [Accepted: 02/23/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Surgical treatment options for facial melanomas include conventional excision with postoperative margin assessment, Mohs micrographic surgery (MMS) with immunostains (MMS-I), and slow MMS. Patient preferences for these surgical options have not been studied. OBJECTIVES To evaluate patient preferences for surgical treatment of facial melanoma and to determine how patients value the relative importance of different surgical attributes. METHODS Participants completed a 2-part study consisting of a stated preference survey and a choice-based conjoint analysis experiment. RESULTS Patients overwhelmingly (94.3%) rated local recurrence risk as very important and ranked it as the most important attribute of surgical treatment for facial melanoma. Via choice-based conjoint analysis, patients ranked the following surgical attributes from highest to lowest in importance: local recurrence rate, out-of-pocket cost, chance of second surgical visit, timing of reconstruction, travel time, and time in office for the procedure. Consistent with their prioritization of low local recurrence rates, more than 73% of respondents selected MMS-I or slow MMS as their preferred treatment option for a facial melanoma. LIMITATIONS Data were obtained from a single health system. CONCLUSION Patients prefer surgical treatment options that minimize risk for local recurrence. Logistics for travel and treatment have less influence on patient preferences. Most survey participants chose MMS-I to maximize local cure and convenience of care.
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Affiliation(s)
- Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Scott D Tuttle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ilya Lim
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Elea M Feit
- Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Donald E Neal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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Patient Preferences for the Treatment of Basal Cell Carcinoma: A Mapping Review of Discrete Choice Experiments. Dermatol Surg 2018; 44:1041-1049. [DOI: 10.1097/dss.0000000000001564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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14
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Kessels J, Kreukels H, Nelemans P, Roozeboom M, van Pelt H, Mosterd K, de Haas E, Kelleners-Smeets N. Treatment of superficial basal cell carcinoma by topical photodynamic therapy with fractionated 5-aminolaevulinic acid 20% vs. two-stage topical methyl aminolaevulinate: results of a randomized controlled trial. Br J Dermatol 2018; 178:1056-1063. [DOI: 10.1111/bjd.15967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J.P.H.M. Kessels
- Department of Dermatology; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Dermatology; Zuyderland Medical Centre; Heerlen the Netherlands
- GROW School for Developmental Biology and Oncology
| | - H. Kreukels
- Department of Epidemiology; Maastricht University; Maastricht the Netherlands
| | - P.J. Nelemans
- Department of Dermatology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - M.H. Roozeboom
- Department of Dermatology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - H. van Pelt
- Department of Dermatology; VieCuri Medical Centre; Venlo/Venray the Netherlands
| | - K. Mosterd
- Department of Dermatology; Maastricht University Medical Centre; Maastricht the Netherlands
- GROW School for Developmental Biology and Oncology
| | - E.R.M. de Haas
- Department of Epidemiology; Maastricht University; Maastricht the Netherlands
| | - N.W.J. Kelleners-Smeets
- Department of Dermatology; Maastricht University Medical Centre; Maastricht the Netherlands
- GROW School for Developmental Biology and Oncology
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Combination vismodegib and photodynamic therapy for multiple basal cell carcinomas. Photodiagnosis Photodyn Ther 2018; 21:58-62. [DOI: 10.1016/j.pdpdt.2017.10.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/16/2017] [Accepted: 10/31/2017] [Indexed: 01/19/2023]
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16
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Shaw FM, Weinstock MA. Comparing Topical Treatments for Basal Cell Carcinoma. J Invest Dermatol 2018; 138:484-486. [DOI: 10.1016/j.jid.2017.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/15/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
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Abstract
With a clear increase in the incidence and a continuously earlier onset, the main risk factors for the development of basal cell carcinoma are still exposure to sunlight, fair skin, immunosuppression, carcinogens such as arsenic, chronic irritations and certain genodermatoses. Treatment options for localized resectionable basal cell carcinoma include micrographically controlled surgery, simple excision, curettage, laser ablation, cryosurgery, imiquimod, 5‑fluorouracil, photodynamic treatment and radiotherapy. Non-surgical treatment options are more suited for cases in which surgical procedures lead to disfigurement or functional impairments or for patients with a high surgical risk. Laser treatment, ablative and non-ablative as monotherapy or in combination can represent a meaningful treatment option in selected cases. In recent years there has been an increase in knowledge about the indications and effects of laser treatment of basal cell carcinoma; nevertheless, further studies with a high level of evidence are necessary.
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Affiliation(s)
- C Salavastru
- Abteilung für paediatrische Dermatologie, Colentina Clinical Hospital, 19-21 Stefan cel Mare Av., Bukarest, Rumänien. .,"Carol Davila" Universität für Medizin und Pharmazie, Bukarest, Rumänien.
| | - G S Tiplica
- "Carol Davila" Universität für Medizin und Pharmazie, Bukarest, Rumänien.,2. Dermatologische Klinik, Colentina Clinical Hospital, Bukarest, Rumänien
| | - K Fritz
- "Carol Davila" Universität für Medizin und Pharmazie, Bukarest, Rumänien.,Hautärzte und Laserzentrum, Landau (Pfalz), Deutschland
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Five-Year Results of a Randomized Controlled Trial Comparing Effectiveness of Photodynamic Therapy, Topical Imiquimod, and Topical 5-Fluorouracil in Patients with Superficial Basal Cell Carcinoma. J Invest Dermatol 2017; 138:527-533. [PMID: 29045820 DOI: 10.1016/j.jid.2017.09.033] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022]
Abstract
For the treatment of superficial basal cell carcinoma, a prospective, noninferiority, randomized controlled multicenter trial with 601 patients showed that 5% imiquimod cream was superior and 5-fluorouracil cream not inferior to methyl aminolevulinate photodynamic therapy (MAL-PDT) at 1 and 3 years after treatment. No definite conclusion could be drawn regarding the superiority of imiquimod over 5-fluorouracil. We now present the 5-year follow-up results according to the intention-to-treat analysis. Five years after treatment, the probability of tumor-free survival was 62.7% for methyl aminolevulinate photodynamic therapy (95% confidence interval [CI] = 55.3-69.2), 80.5% for imiquimod (95% CI = 74.0-85.6), and 70.0% for 5-fluorouracil (95% CI = 62.9-76.0). The hazard ratio for treatment failure of imiquimod and 5-fluorouracil were 0.48 (95% CI = 0.32-0.71, P < 0.001) and 0.74 (95% CI = 0.53-1.05, P = 0.09), respectively, when compared with methyl aminolevulinate photodynamic therapy. Compared with 5-fluorouracil, imiquimod showed a hazard ratio of 0.65 (95% CI 0.43-0.98, P = 0.04). In conclusion, 5 years after treatment, the results of this trial show that 5% imiquimod cream is superior to both methyl aminolevulinate photodynamic therapy and 5-fluorouracil cream in terms of efficacy for superficial basal cell carcinoma. We therefore consider 5% imiquimod cream as the first choice for noninvasive treatment in most primary superficial basal cell carcinomas.
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Bien DR, Danner M, Vennedey V, Civello D, Evers SM, Hiligsmann M. Patients' Preferences for Outcome, Process and Cost Attributes in Cancer Treatment: A Systematic Review of Discrete Choice Experiments. THE PATIENT 2017; 10:553-565. [PMID: 28364387 PMCID: PMC5605613 DOI: 10.1007/s40271-017-0235-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION As several studies have been conducted to elicit patients' preferences for cancer treatment, it is important to provide an overview and synthesis of these studies. This study aimed to systematically review discrete choice experiments (DCEs) about patients' preferences for cancer treatment and assessed the relative importance of outcome, process and cost attributes. METHODS A systematic literature review was conducted using PubMed and EMBASE to identify all DCEs investigating patients' preferences for cancer treatment between January 2010 and April 2016. Data were extracted using a predefined extraction sheet, and a reporting quality assessment was applied to all studies. Attributes were classified into outcome, process and cost attributes, and their relative importance was assessed. RESULTS A total of 28 DCEs were identified. More than half of the studies (56%) received an aggregate score lower than 4 on the PREFS (Purpose, Respondents, Explanation, Findings, Significance) 5-point scale. Most attributes were related to outcome (70%), followed by process (25%) and cost (5%). Outcome attributes were most often significant (81%), followed by process (73%) and cost (67%). The relative importance of outcome attributes was ranked highest in 82% of the cases where it was included, followed by cost (43%) and process (12%). CONCLUSION This systematic review suggests that attributes related to cancer treatment outcomes are the most important for patients. Process and cost attributes were less often included in studies but were still (but less) important to patients in most studies. Clinicians and decision makers should be aware that attribute importance might be influenced by level selection for that attribute.
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Affiliation(s)
- Daniela R Bien
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marion Danner
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Daniele Civello
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Silvia M Evers
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 6161, 6200 MD, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 6161, 6200 MD, Maastricht, The Netherlands.
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Niculescu L, Bierhoff E, Hartmann D, Ruzicka T, Berking C, Braunmühl TV. Optical coherence tomography imaging of basal cell carcinoma undergoing photodynamic therapy: A pilot study. Photodiagnosis Photodyn Ther 2017; 18:133-137. [PMID: 28179181 DOI: 10.1016/j.pdpdt.2017.01.185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/08/2017] [Accepted: 01/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Luana Niculescu
- Department of Dermatology and Allergology, Ludwig Maximilian University, Frauenlobstr. 9-11, 80337 Munich, Germany.
| | - Erhard Bierhoff
- Heinz-Werner-Seifert-Institute of Dermatopathology, Trierer Straße 70-72, 53115 Bonn, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergology, Ludwig Maximilian University, Frauenlobstr. 9-11, 80337 Munich, Germany; Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337 Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergology, Ludwig Maximilian University, Frauenlobstr. 9-11, 80337 Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergology, Ludwig Maximilian University, Frauenlobstr. 9-11, 80337 Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergology, Ludwig Maximilian University, Frauenlobstr. 9-11, 80337 Munich, Germany; Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337 Munich, Germany
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