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Maytin EV, Kaw U, Ilyas M, Mack JA, Hu B. Blue light versus red light for photodynamic therapy of basal cell carcinoma in patients with Gorlin syndrome: A bilaterally controlled comparison study. Photodiagnosis Photodyn Ther 2018; 22:7-13. [PMID: 29471147 DOI: 10.1016/j.pdpdt.2018.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/12/2018] [Accepted: 02/14/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is a non-scarring alternative for treating basal cell carcinoma (BCC) in patients with Basal Cell Nevus Syndrome (BCNS), also known as Gorlin syndrome. In Europe, red light (635 nm) is the predominant source for PDT, whereas in the United States blue light (400 nm) is more widely available. The objective of this study was to conduct a head-to-head comparison of blue light and red light PDT in the same BCNS patients. METHODS In a pilot study of three patients with 141 BCC lesions, 5-aminolevulinate (20% solution) was applied to all tumors. After 4 h, half of the tumors were illuminated with blue light and the remainder with red light. To ensure safety while treating this many tumors simultaneously, light doses were escalated gradually. Six treatments were administered in three biweekly sessions over 4 months, with a final evaluation at 6 months. Tumor status was documented with high-resolution photographs. Persistent lesions were biopsied at 6 months. RESULTS Clearance rates after blue light (98%) were slightly better than after red light (93%), with blue light shown to be statistically non-inferior to red light. Eight suspicious lesions were biopsied, 5 after red light (5/5 were BCC) and 3 after blue light (1 was BCC). Blue light PDT was reportedly less painful. CONCLUSION Blue light and red light PDT appear to be equally safe and perhaps equally effective for treating BCC tumors in BCNS patients. Further studies to evaluate long-term clearance after blue light PDT are needed.
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Affiliation(s)
- Edward V Maytin
- Department of Dermatology, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH 44195, United States; Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States.
| | - Urvashi Kaw
- Department of Dermatology, Cleveland, OH 44195, United States
| | - Muneeb Ilyas
- Department of Dermatology, Cleveland, OH 44195, United States
| | - Judith A Mack
- Department of Dermatology, Cleveland, OH 44195, United States; Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH 44195, United States
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States
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Abstract
Background: Unilateral localized basal cell carcinomas are an uncommon finding that presents both a diagnostic and therapeutic challenge. Exclusion of unilateral nevoid basal cell carcinoma syndrome is indicated. There are few reports in the literature regarding this entity and even less regarding therapeutic strategies. Objective: We present a patient with unilateral localized basal cell carcinomas who was successfully treated with photodynamic therapy. Methods: Photodynamic therapy was started using Levulan® Kerastick® as previously described. The topical solution was applied to the patient's back and illuminated the following day via the BLU-U Blue Light Illuminator. Results: The patient tolerated the procedure well and without complications. The patient had an excellent therapeutic response with no clinically apparent basal cell carcinomas for 18 months. Conclusions: We report a patient with unilateral basal cell carcinomas successfully treated with photodynamic therapy. This uncommon entity represents a diagnostic challenge in its inherent absence of the classic clinical and radiographic findings of nevoid basal cell carcinoma syndrome. Like nevoid basal cell carcinoma syndrome, unilateral basal cell carcinomas poses a therapeutic challenge with the sheer number of cutaneous tumors. The use of photodynamic therapy carries a proven therapeutic efficacy, a low rate of adverse events and excellent cosmesis.
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Affiliation(s)
- Joshua E. Lane
- Section of Dermatology, Department of Medicine, The Medical College of Georgia, Augusta, GA, USA
- Joshua E. Lane, 308 Coliseum Drive, Suite 200, Macon, GA, 31217, USA
| | | | - Tanda N. Lane
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jack L. Lesher
- Section of Dermatology, Department of Medicine, The Medical College of Georgia, Augusta, GA, USA
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3
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Abstract
Gorlin-Goltz syndrome (GGS) is an infrequent multisystemic disease with an autosomal dominant trait, with complete penetrance and variable expressivity, though sporadic cases have been described. This article includes a case report and an extensive review of the GGS with regard to its history, incidence, etiology, features, investigations, diagnostic criteria, keratocystic odontogenic tumor and treatment modalities.
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Affiliation(s)
- Maya Ramesh
- Department of Oral Pathology, Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamil Nadu, India
| | - Ramesh Krishnan
- Department of Pedodontics and Preventive Dentistry, Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamil Nadu, India
| | - Paul Chalakkal
- Department of Pedodontics and Preventive Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India
| | - George Paul
- Dental Polyclinic and Maxillofacial Centre, Salem, Tamil Nadu, India
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4
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Abstract
Gorlin-Goltz syndrome is a rare genetic condition showing a variable expressiveness. It is inherited in a dominant autosomal way. The strongest characteristic of the disease includes multiple basal cell carcinomas, jaw cysts, palmar and plantar pits, skeletal abnormalities and other developmental defects. Owing to the fact that the condition tends to be a multisystemic disorder, familiarity of various medical specialists with its manifestations may reduce the time necessary for providing a diagnosis. It will also enable them to apply adequate methods of treatment and secondary prevention. In this study, we present symptoms of the disease, its diagnostic methods and currently used treatments. We searched 2 scientific databases: Medline (EBSCO) and Science Direct, for the years 1996 to 2011. In our search of abstracts, key words included nevoid basal cell carcinoma syndrome and Gorlin-Goltz syndrome. We examined 287 studies from Medline and 80 from Science Direct, all published in English. Finally, we decided to use 60 papers, including clinical cases and literature reviews. Patients with Gorlin-Goltz syndrome need particular multidisciplinary medical care. Knowledge of multiple and difficult to diagnose symptoms of the syndrome among professionals of various medical specialties is crucial. The consequences of the disease pose a threat to the health and life of patients. Therefore, an early diagnosis creates an opportunity for effective prevention and treatment of the disorder. Prevention is better than cure.
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Affiliation(s)
- Małgorzata Kiwilsza
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Abstract
Basal cell carcinoma is the most common malignant neoplasm in humans and its incidence has increased over the last decades. Its high frequency significantly burdens the health system, making the disease a public health issue. Despite the low mortality rates and the rare occurrence of metastases, the tumor may be locally invasive and relapse after treatment, causing significant morbidity. Exposure to ultraviolet radiation is the main environmental risk factor associated with its cause. However, other elements of risk are described, such as light skin phototypes, advanced age, family history of skin carcinoma, light eyes and blond hair, freckles in childhood and immunosuppression. Behavioral aspects such as occupational sun exposure, rural labor and sunburns at a young age also play a role. Between 30% and 75% of the sporadic cases are associated with patched hedgehog gene mutation, but other genetic changes are also described. The tumor is commonly found in concomitance with skin lesions related to chronic sun exposure, such as actinic keratoses, solar lentigines and facial telangiectasia. The prevention of basal cell carcinoma is based on the knowledge of risk factors, early diagnosis and treatment, as well as on the adoption of specific measures, particularly in susceptible populations. The authors present a review of the epidemiology of basal cell carcinoma.
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Affiliation(s)
- Valquiria Pessoa Chinem
- Department of Dermatology and Radiotherapy, Faculty of Medicine of Botucatu, Sao Paulo State University (FMB-UNESP), Botucatu, SP, Brasil
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Tierney E, Petersen J, Hanke CW. Photodynamic diagnosis of tumor margins using methyl aminolevulinate before Mohs micrographic surgery. J Am Acad Dermatol 2011; 64:911-8. [DOI: 10.1016/j.jaad.2010.03.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 02/28/2010] [Accepted: 03/15/2010] [Indexed: 10/18/2022]
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7
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Baliga SD, Rao SS. Nevoid-basal cell carcinoma syndrome: a case report and overview on diagnosis and management. J Maxillofac Oral Surg 2010; 9:82-6. [PMID: 23139577 DOI: 10.1007/s12663-010-0024-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 12/18/2009] [Indexed: 10/19/2022] Open
Abstract
Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is a rare condition characterized by varied clinical manifestations like multiple Basal Cell Carcinomas (BCC), multiple Keratocystic Odontogenic Tumours (KCOT), palmar and/or plantar pits and ectopic calcification of the falx cerebri, which are considered as the major criteria for diagnosis. The occurrence of jaw manifestations makes it an important diagnostic problem for oral and maxillofacial surgeons and often clinicians encounter this aspect which finally leads to the diagnosis of this syndrome. This paper reports a case of NBCCS and provides an overview on the diagnosis and management of this enigmatic entity.
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8
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Kirby JS, Miller CJ. Intralesional chemotherapy for nonmelanoma skin cancer: a practical review. J Am Acad Dermatol 2010; 63:689-702. [PMID: 20605654 DOI: 10.1016/j.jaad.2009.09.048] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 09/22/2009] [Accepted: 09/23/2009] [Indexed: 11/27/2022]
Abstract
Intralesional chemotherapy for nonmelanoma skin cancer has existed for more than 5 decades. However, it is used so infrequently that recent consensus guidelines for the treatment of basal cell and squamous cell carcinoma do not include intralesional chemotherapy. Barriers to the use of intralesional chemotherapy include the off-label use of these agents, absence of therapeutic guidelines, a relatively small number of patients treated, and a lack of large, well-designed trials with long-term follow-up. Surgical intervention remains the gold standard for the treatment of nonmelanoma skin cancer; however, intralesional chemotherapy remains an option for well-selected patients who cannot or will not undergo surgery. The objectives of this article are to determine response rates and suggest reasonable treatment guidelines for the treatment of squamous cell carcinoma, keratoacanthoma, and basal cell carcinoma with the most widely available intralesional agents (methotrexate, 5-fluorouracil, bleomycin, and interferon).
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Affiliation(s)
- Joslyn S Kirby
- Department of Dermatology, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA.
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9
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Zhang XB, Zhang SQ, Li CX, Huang ZM, Luo YW. Acitretin systemic and retinoic acid 0.1% cream supression of basal cell carcinoma. Dermatol Reports 2010; 2:e4. [PMID: 25386240 PMCID: PMC4211482 DOI: 10.4081/dr.2010.e4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 12/12/2009] [Accepted: 12/14/2009] [Indexed: 11/23/2022] Open
Abstract
Retinoids have been used for years as monotherapy and/or in combination for treatment and suppression of cutaneous malignancies in patients with basal cell nevus syndrome, xeroderma pigmentosum, or cutaneous T-cell lymphoma (CTCL) basal cell carcinoma (BCC). We report 4 cases with BCC confirmed by histopathology who were treated by short-term systemic acitretin combined with retinoic acid 0.1% cream. The 4 cases with BCC showed good response to the treatment without severe adverse effects during treatment and follow-up. The finding suggests that acitretin may be an appropriate treatment option for elderly patients who require less invasive treatment for BCC.
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Affiliation(s)
- Xi-Bao Zhang
- Guangzhou Institute of Dermatology, Guangzhou, China
| | | | | | | | - Yu-Wu Luo
- Guangzhou Institute of Dermatology, Guangzhou, China
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11
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Haylett AK, Ward TH, Moore JV. DNA Damage and Repair in Gorlin Syndrome and Normal Fibroblasts After Aminolevulinic Acid Photodynamic Therapy: A Comet Assay Study ¶. Photochem Photobiol 2007. [DOI: 10.1562/0031-8655(2003)0780337ddarig2.0.co2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Abstract
An association between systemic malignancy and cutaneous manifestations has long been recognized. The cutaneous features that can occur are numerous and heterogeneous, and many different etiologic mechanisms are represented - from direct tumor invasion of skin or distant metastases to a wide variety of inflammatory dermatoses that may occur as paraneoplastic phenomena. In addition, there are a number of inherited syndromes that carry an increased risk of cutaneous as well as internal malignancies. While some of these inherited syndromes and paraneoplastic phenomena are exceedingly rare, all clinicians will be aware of the common cutaneous manifestations of advanced malignant disease such as generalized xerosis and pruritus. This review classifies these wide-ranging cutaneous manifestations of internal malignancy into five basic groups and provides practical advice regarding diagnosis and screening of patients who initially present with a cutaneous complaint. Also included is up-to-date information on two rapidly expanding and exciting areas of research that are likely to have far-reaching clinical implications: (i) clarification of underlying humoral mechanisms, for example, in the malignant carcinoid syndrome; and (ii) identification of an increasing number of specific genetic defects that confer a susceptibility to malignancy.Increased clinician awareness regarding the associations between these lesions and internal malignancy or inherited syndromes will facilitate screening and early diagnosis.
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Affiliation(s)
- C Elise Kleyn
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
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13
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Madan V, Loncaster JA, Allan D, Lear JT, Sheridan L, Leach C, Allan E. Nodular basal cell carcinoma in Gorlin's syndrome treated with systemic photodynamic therapy and interstitial optical fiber diffuser laser. J Am Acad Dermatol 2006; 55:S86-9. [PMID: 17052541 DOI: 10.1016/j.jaad.2005.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 10/31/2005] [Accepted: 12/05/2005] [Indexed: 01/28/2023]
Abstract
Nodular basal cell carcinomas resistant to multiple forms of treatment in two patients with nevoid basal cell carcinoma syndrome (Gorlin's syndrome) were treated with systemic porfimer sodium-based photodynamic therapy. Interstitially placed optical diffuser fibers were used to deliver light. Good response to treatment was seen on clinical evaluation and on measurement by a 20-MHz high-resolution ultrasound.
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Affiliation(s)
- Vishal Madan
- Dermatology Centre, Hope Hospital, Salford, Manchester, M6 8HD, UK
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14
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Abstract
BACKGROUND Unilateral localized basal cell carcinomas are an uncommon finding that presents both a diagnostic and therapeutic challenge. Exclusion of unilateral nevoid basal cell carcinoma syndrome is indicated. There are few reports in the literature regarding this entity and even less regarding therapeutic strategies. OBJECTIVE We present a patient with unilateral localized basal cell carcinomas who was successfully treated with photodynamic therapy. METHODS Photodynamic therapy was started using Levulan) Kerastick) as previously described. The topical solution was applied to the patient's back and illuminated the following day via the BLU-U Blue Light Illuminator. RESULTS The patient tolerated the procedure well and without complications. The patient had an excellent therapeutic response with no clinically apparent basal cell carcinomas for 18 months. CONCLUSIONS We report a patient with unilateral basal cell carcinomas successfully treated with photodynamic therapy. This uncommon entity represents a diagnostic challenge in its inherent absence of the classic clinical and radiographic findings of nevoid basal cell carcinoma syndrome. Like nevoid basal cell carcinoma syndrome, unilateral basal cell carcinomas poses a therapeutic challenge with the sheer number of cutaneous tumors. The use of photodynamic therapy carries a proven therapeutic efficacy, a low rate of adverse events and excellent cosmesis.
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Affiliation(s)
- Joshua E Lane
- Section of Dermatology, Department of Medicine, The Medical College of Georgia, Augusta, GA, USA.
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15
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16
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Madan V, Loncaster J, Allan D, Lear J, Sheridan L, Leach C, Allan E. Systemic photodynamic therapy with Photofrin for naevoid basal cell carcinoma syndrome—A pilot study. Photodiagnosis Photodyn Ther 2005; 2:273-81. [DOI: 10.1016/s1572-1000(05)00101-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 09/30/2005] [Accepted: 10/03/2005] [Indexed: 11/17/2022]
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17
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Loncaster JA, Moore JV, Allan D, Allan E. An ultrasound analysis of the response of Gorlin syndrome-related and sporadic basal cell carcinomas to aminolaevulinic acid photodynamic therapy. Photodiagnosis Photodyn Ther 2005; 2:149-55. [DOI: 10.1016/s1572-1000(05)00064-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Revised: 06/16/2005] [Accepted: 06/20/2005] [Indexed: 10/25/2022]
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18
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Abstract
Several hereditary tumor syndromes are associated with characteristic skin lesions which may facilitate an early diagnosis. We summarize clinical features and recent progress in understanding the etiology and pathogenesis of two selected tumor syndromes, namely nevoid basal cell carcinoma syndrome (Gorlin syndrome) and Cowden syndrome. Both are autosomal dominantly inherited disorders. Nevoid basal cell carcinoma syndrome is characterized by the early onset of multiple basal cell carcinomas as as well as developmental defects and a predisposition for other benign and malignant tumors. The syndrome is caused by germline mutations in the PTCH tumor suppressor gene. Cowden syndrome is associated with pathognomonic mucocutaneous lesions, such as facial trichilemmomas, acral keratoses, and mucocutaneous papillomatosis. In addition, Cowden patients are predisposed to carcinomas of the thyroid, breast and endometrium. Cowden syndrome is caused by germline mutations in the PTEN tumor suppressor gene. Identification of the genes causing hereditary tumor syndromes as well as generation of genetically engineered mouse models have greatly advanced our understanding of the molecular pathogenesis of these diseases. Furthermore, novel pathogenesis-based pharmacological strategies are being developed that promise to improve prevention and therapy.
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Watts RJ, Paletz J. Gorlin's syndrome: An interesting case study and literature review. Can J Plast Surg 2004; 12:76-8. [PMID: 24115880 DOI: 10.1177/229255030401200203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gorlin's syndrome, or basal cell nevus syndrome, is a relatively rare disease. It consists of a classic pentad of features comprised of multiple basal cell carcinomas, jaw cysts, calcification of the falx cerebri, pitting of the palmar and plantar surfaces and rib anomalies. A review of the clinical features, differential diagnosis, clinical work-up and current treatment is presented.
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Affiliation(s)
- Robyn J Watts
- Division of Plastic Surgery, New Halifax Infirmary, Dalhousie University, Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia
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20
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Manfredi M, Vescovi P, Bonanini M, Porter S. Nevoid basal cell carcinoma syndrome: a review of the literature. Int J Oral Maxillofac Surg 2004; 33:117-24. [PMID: 15050066 DOI: 10.1054/ijom.2003.0435] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2003] [Indexed: 11/18/2022]
Abstract
The nevoid basal cell carcinoma syndrome (NBCCS) or Gorlin-Goltz Syndrome is an autosomal dominant disorder principally characterized by cutaneous basal cell carcinomas, multiple keratocysts, and skeletal anomalies. The present report reviews current knowledge of this disorder that has profound relevance to specialists in Oral and Maxillo-Facial Surgery, Oral Medicine and Radiology.
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Affiliation(s)
- M Manfredi
- Sezione di Odontostomatologia--Dipartimento Scienze Otorino-Odonto Oftalmologiche e Cervico-Facciali, Università degli Studi di Parma, Italy.
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Doctoroff A, Oberlender SA, Purcell SM. Full-face carbon dioxide laser resurfacing in the management of a patient with the nevoid basal cell carcinoma syndrome. Dermatol Surg 2004; 29:1236-40. [PMID: 14725671 DOI: 10.1111/j.1524-4725.2003.29395.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Multiple surgical procedures are often a source of discomfort, pain, and disfigurement for patients with the nevoid basal cell carcinoma syndrome (NBCCS). OBJECTIVE The patient with NBCCS had approximately 45 identifiable basal cell carcinomas on her face. Multiple Mohs surgeries were performed to remove the largest tumors. A tumor-free plane was not achieved in several lesions despite removal of multiple tissue layers. The treatment of the remaining tumors presented a significant challenge. METHODS Full-face CO2 laser resurfacing was performed after curettage and local laser ablation of all visible tumors. RESULTS The patient healed well postoperatively. She developed six basal cell carcinomas on her face during the 10-month follow-up period. These were easily treated with Mohs surgery and imiquimod cream. CONCLUSION CO2 laser resurfacing is a useful surgical modality for treatment of multiple facial basal cell carcinomas in the patients with NBCCS. It allows treatment of all the facial lesions in a single session and minimizes suffering resulting from repeated surgical procedures. Additionally, the layer of skin damaged by ultraviolet radiation is removed, allowing for easier management after resurfacing.
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Affiliation(s)
- Alexander Doctoroff
- Department of Dermatology, Philadelphia College of Osteopathic Medicine, 1259 South Cedar Crest Boulevard, Suite 100, Allentown, PA 18103-6206, USA
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Doctoroff A, Oberlender SA, Purcell SM. Full-Face Carbon Dioxide Laser Resurfacing in the Management of a Patient With the Nevoid Basal Cell Carcinoma Syndrome: . Dermatol Surg 2003; 29:1236-40. [DOI: 10.1097/00042728-200312000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder that causes defects in the DNA repair system. It is characterized by a marked sensitivity to sunlight, and sufferers develop serious sunburns with onset of poikilodermia in the light-exposed skin. Squamous cell carcinomas, basal cell carcinomas (BCCs) and malignant melanomas appear in childhood. Two sisters with XP presented with previously treated facial BCCs. They were treated with imiquimod 5% cream three times weekly, one for 6 weeks and the other for 10 weeks. Although both sisters temporarily discontinued treatment due to severe erythema and erosion, successful long-term clearance was observed with no recurrences in both cases.
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Affiliation(s)
- D Roseeuw
- Dermatology, Academic Hospital, Free University Brussels, Belgium
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24
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Giannotti B, Vanzi L, Difonzo EM, Pimpinelli N. The treatment of basal cell carcinomas in a patient with xeroderma pigmentosum with a combination of imiquimod 5% cream and oral acitretin. Clin Exp Dermatol 2003; 28 Suppl 1:33-5. [PMID: 14616811 DOI: 10.1046/j.1365-2230.28.s1.11.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Xeroderma pigmentosum (XP) is a rare autosomal recessive photosensitive disorder, which results in multiple face, neck and head basal cell carcinomas (BCCs), squamous cell carcinomas and melanomas. A 15-year-old boy with XP presented with multiple facial BCCs previously treated by surgical excision. Standard BCC treatments such as surgery are not ideal for patients with several facial BCCs because of the risk of scarring, and the patient refused further surgery. As an alternative, three times weekly application of imiquimod 5% cream in combination with oral acitretin (20 mg daily) was prescribed for 4-6 weeks. No adverse events were reported during treatment and all tumours had resolved at the 6-month follow up visit, highlighting the therapeutic potential of imiquimod 5% cream.
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Affiliation(s)
- B Giannotti
- Dipartimento Scienze Dermatologiche, Via degli Alfani, Firenze, Italy
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25
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Micali G, Lacarrubba F, Nasca MR, De Pasquale R. The use of imiquimod 5% cream for the treatment of basal cell carcinoma as observed in Gorlin's syndrome. Clin Exp Dermatol 2003; 28 Suppl 1:19-23. [PMID: 14616807 DOI: 10.1046/j.1365-2230.28.s1.7.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gorlin's syndrome (naevoid basal cell carcinoma) is an autosomal dominant tumour-predisposition syndrome. It typically consists of multiple basal cell carcinomas (BCCs) of the skin, odontogenic keratocysts of the jaw, various skeletal abnormalities and lamellar falx calcifications. Four patients with multiple facial and trunk BCCs (superficial and nodular) consistent with Gorlin's syndrome are reported. Imiquimod 5% cream was topically applied to the lesions 3-5 times a week for 8-14 weeks. Two of the patients suffered mild to severe erythema and developed superficial erosions but did not discontinue treatment. Imiquimod 5% cream successfully treated 13 out of 17 BCCs in these patients with Gorlin's syndrome, with no patient suffering a relapse at the follow-up visit.
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Affiliation(s)
- G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
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26
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Haylett AK, Ward TH, Moore JV. DNA Damage and Repair in Gorlin Syndrome and Normal Fibroblasts After Aminolevulinic Acid Photodynamic Therapy: A Comet Assay Study¶. Photochem Photobiol 2003; 78:337-41. [PMID: 14626660 DOI: 10.1562/0031-8655(2003)078<0337:ddarig>2.0.co;2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Using normal, untransformed, human fibroblasts, the effectiveness of aminolevulinic (ALA)-mediated photodynamic therapy (PDT) was investigated in terms of both clonogenic survival and DNA damage. The response of normal fibroblasts was then compared with Gorlin syndrome-derived fibroblasts (basal cell nevus syndrome [BCNS]). In terms of clonogenic survival, no significant differences were observed between the two groups of cells. Using the alkaline comet assay, initial DNA damage after PDT was measured. Some DNA damage was detected at higher doses, but this was fully repaired within 24 h of treatment. The BCNS-derived cells showed levels of initial damage that did not differ significantly from normal lines.
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Affiliation(s)
- A K Haylett
- Cancer Research-UK Laser Oncology Group, Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK.
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Affiliation(s)
- Alan T Lewis
- Department of Dermatology and Otorhinolaryngology-Head and Neck Surgery, Tulane University Health Science Center, New Orleans, Louisiana, USA
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Micali G, De Pasquale R, Caltabiano R, Impallomeni R, Lacarrubba F. Topical imiquimod treatment of superficial and nodular basal cell carcinomas in patients affected by basal cell nevus syndrome: a preliminary report. J DERMATOL TREAT 2002; 13:123-7. [PMID: 12227875 DOI: 10.1080/09546630260199488] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Imiquimod 5% cream has been shown to be effective in the treatment of superficial basal cell carcinomas (sBCCs). OBJECTIVE To evaluate the efficacy, safety and compliance of imiquimod 5% cream for the treatment of sBCCs and nodular BCCs (nBCCs) in patients affected by basal cell nevus syndrome. PATIENTS/METHODS Three patients (two male, one female) were enrolled in the study. Nine tumors (five sBCCs and four nBCCs), all ranging in size from 0.5 cm to 1 cm, were treated. Treatment consisted for sBCCs of three weekly applications and for nBCCs of five weekly applications for 8 weeks. Histological examination was performed at the beginning and at the end of the study. For small tumors, similar-appearing lesions were removed for baseline histological confirmation. Follow-up was performed at 1-week intervals in order to carefully detect any change. RESULTS Three sBCCs cleared clinically after 4 weeks of treatment and two nBCCs after 8 weeks. The remaining four lesions showed excellent clinical responses with evident (>50%) size reduction at 6 weeks, but no further improvement. Histological examination with multiple-step sections confirmed complete clearing for those lesions showing clinical resolution, except for one nBCC that showed scant tumor remnants. Local adverse effects (itching, erythema and bleeding) were mild and did not prompt discontinuation of treatment. No systemic side effects were noted. CONCLUSIONS Imiquimod 5% cream is an effective therapeutic option for both sBCC and nBCC in patients with basal cell nevus syndrome. The treatment was very well received by all patients engaged in the study, who stated their appreciation for a topical treatment rather than multiple surgical excisions. A higher number of applications and longer treatment periods are required for nBCCs.
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Affiliation(s)
- G Micali
- Dermatology Clinic, University of Catania, Italy.
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Nouri K, Chang A, Trent JT, Jiménez GP. Ultrapulse CO2 Used for the Successful Treatment of Basal Cell Carcinomas Found in Patients with Basal Cell Nevus Syndrome. Dermatol Surg 2002; 28:287-290. [DOI: 10.1097/00042728-200203000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nouri K, Chang A, Trent JT, Jiménez GP. Ultrapulse CO2 used for the successful treatment of basal cell carcinomas found in patients with basal cell nevus syndrome. Dermatol Surg 2002; 28:287-90. [PMID: 11896785 DOI: 10.1046/j.1524-4725.2002.01080.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Basal cell nevus syndrome (BCNS) is an inherited condition marked by multiple basal cell carcinomas (BCCs) associated with several other abnormalities. Various treatment modalities have been used to eradicate these tumors. However, recurrences and scarring limit their use. OBJECTIVE To evaluate the treatment of multiple BCCs associated with BCNS. METHODS We describe three cases of BCNS in which multiple BCCs were effectively treated with ultrapulse CO2 laser. Postoperative Mohs micrographic surgical sections (thin sections looking for residual tumor) verified complete histologic clearance of the tumors. RESULTS All three patients were effectively treated with ultrapulse CO2 laser. Minimal scarring was noted at follow-up. CONCLUSION Ultrapulse CO2 laser can be used to effectively treat small BCCs in low-risk areas associated with BCNS with minimal posttreatment scarring.
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Affiliation(s)
- Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA.
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Affiliation(s)
- N C Zeitouni
- Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Abstract
BACKGROUND Many patients suffer from multiple nonmelanoma skin cancers. We recently encountered two such patients who requested some form of prophylaxis against future skin cancers. OBJECTIVE To highlight the potential utility of laser resurfacing as a skin cancer prophylaxis. METHODS Two patients with histories of multiple facial skin cancers were treated with CO2 laser resurfacing for the purpose of skin cancer prophylaxis. RESULTS During a follow-up period of 33 and 52 months, both patients have remained free of skin cancers in the main treatment field while developing new tumors outside of this area. CONCLUSION Laser resurfacing should be considered as a potential method of achieving skin cancer prophylaxis in selected patients.
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Affiliation(s)
- R A Massey
- Department of Dermatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA
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Reutter JC, Stone MS. Answers to Self-Assessment examination of the American Academy of Dermatology Identification No. 899-205. J Am Acad Dermatol 1999; 40:794-796. [DOI: 10.1016/s0190-9622(99)70174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- J T Lear
- Department of Dermatology, Bristol Royal Infirmary, UK
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Krunic AL, Viehman GE, Madani S, Clark RE. Microscopically controlled surgical excision combined with ultrapulse CO2 vaporization in the management of a patient with the nevoid basal cell carcinoma syndrome. J Dermatol 1998; 25:10-2. [PMID: 9519602 DOI: 10.1111/j.1346-8138.1998.tb02337.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nevoid basal cell carcinoma syndrome is an autosomal dominant condition characterized by multiple basal cell carcinomas, skeletal abnormalities and sometimes mental retardation. The large number of tumors, which are often disfiguring, presents extreme difficulties in the treatment of these patients. Microscopically controlled excision, compared to other modalities (radiation therapy, photodynamic therapy, intralesional interferon alpha-2b) offers the highest cure rate. However, because of the large size and involvement of wide areas of the skin, this approach is sometimes impractical. The ultrapulse CO2 laser with high energy and short pulses achieves char-free ablation of the tumors, bloodless surgical field, minimal nonspecific thermal damage, rapid healing and diminished postoperative pain. Also, a number of lesions can be removed in a single session. We present a 48-year-old man with a 6.5 x 4.5 cm large basal cell carcinoma involving the anterior abdomen and navel area. The central thick portion of the tumor was resected by microscopically controlled excision with 3 stages, and wide thinner peripheral crescentic plaque vaporized with ultrapulse CO2 laser. The laser settings were 300 mJ energy/pulse and 100 W average power, which corresponds to the fluence of 7.5 J/cm2. Computerized pattern generator (ultrascan handpiece) was adjusted to patterns of 3 (circle) and 1 (square) with sizes varying from 5 to 7, and density of 9 (60% overlapping). The tumor was vaporized with 6 passes, all the way to deep reticular dermis. A fifteen month-follow up disclosed no recurrent disease. Subsequent biopsies revealed only a scar with postinflammatory hyperpigmentation. Our experience indicates that combined treatment with microscopically controlled excision and ultrapulse CO2 laser ablation is a suitable modality for the large tumor plaques involving concave and convex areas of the skin respectively. Microscopically controlled excision of thicker, concave portions of basal cell carcinoma plaques, where CO2 laser surgery is less feasible, presents an effective addition that renders this combined modality a successful method for the treatment of nevoid basal cell carcinoma syndrome.
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Affiliation(s)
- A L Krunic
- Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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