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Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, Berking C, Arenberger P, Bylaite-Bučinskiene M, Del Marmol V, Dirschka T, Dreno B, Forsea AM, Harwood CA, Hauschild A, Heerfordt IM, Kauffman R, Kelleners Smeeths N, Lallas A, Lebbe C, Leiter U, Longo C, Mijušković Ž, Pellacani G, Puig S, Saiag P, Šitum M, Stockfleth E, Salavastru C, Stratigos A, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes). J Eur Acad Dermatol Venereol 2024. [PMID: 38451047 DOI: 10.1111/jdv.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.
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Affiliation(s)
- Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endrocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - Matilda Bylaite-Bučinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany
- CentroDerm Clinic, Wuppertal, Germany
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Ida Marie Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Roland Kauffman
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners Smeeths
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP, Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Caterina Longo
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Željko Mijušković
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Susana Puig
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mirna Šitum
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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Jacques C, Bacqueville D, Jamin EL, Maitre M, Delsol C, Simcic-Mori A, Bianchi P, Noustens A, Jouanin I, Debrauwer L, Bessou-Touya S, Stockfleth E, Duplan H. Multi-omics approach to understand the impact of sun exposure on an in vitro skin ecosystem and evaluate a new broad-spectrum sunscreen. Photochem Photobiol 2024; 100:477-490. [PMID: 37485720 DOI: 10.1111/php.13841] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/28/2023] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Abstract
A reconstructed human epidermal model (RHE) colonized with human microbiota and sebum was developed to reproduce the complexity of the skin ecosystem in vitro. The RHE model was exposed to simulated solar radiation (SSR) with or without SPF50+ sunscreen (with UVB, UVA, long-UVA, and visible light protection). Structural identification of discriminant metabolites was acquired by nuclear magnetic resonance and metabolomic fingerprints were identified using reverse phase-ultra high-performance liquid chromatography-high resolution mass spectrometry, followed by pathway enrichment analysis. Over 50 metabolites were significantly altered by SSR (p < 0.05, log2 values), showing high skin oxidative stress (glutathione and purine pathways, urea cycle) and altered skin microbiota (branched-chain amino acid cycle and tryptophan pathway). 16S and internal transcribed spacer rRNA sequencing showed the relative abundance of various bacteria and fungi altered by SSR. This study identified highly accurate metabolomic fingerprints and metagenomic modifications of sun-exposed skin to help elucidate the interactions between the skin and its microbiota. Application of SPF50+ sunscreen protected the skin ecosystem model from the deleterious effects of SSR and preserved the physiological interactions within the skin ecosystem. These innovative technologies could thus be used to evaluate the effectiveness of sunscreen.
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Affiliation(s)
- Carine Jacques
- Pierre Fabre Dermo-Cosmetics and Personal Care, Centre R&D Pierre Fabre, Toulouse, France
| | - Daniel Bacqueville
- Pierre Fabre Dermo-Cosmetics and Personal Care, Centre R&D Pierre Fabre, Toulouse, France
| | - Emilien L Jamin
- MetaboHUB-MetaToul, National Infrastructure of Metabolomics and Fluxomics, Toulouse, France
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Martine Maitre
- Pierre Fabre Dermo-Cosmetics and Personal Care, Centre R&D Pierre Fabre, Toulouse, France
| | | | - Aimée Simcic-Mori
- Pierre Fabre Dermo-Cosmetics and Personal Care, Centre R&D Pierre Fabre, Toulouse, France
| | - Pascale Bianchi
- Pierre Fabre Dermo-Cosmetics and Personal Care, Centre R&D Pierre Fabre, Toulouse, France
| | - Anais Noustens
- Pierre Fabre Dermo-Cosmetics and Personal Care, Centre R&D Pierre Fabre, Toulouse, France
| | - Isabelle Jouanin
- MetaboHUB-MetaToul, National Infrastructure of Metabolomics and Fluxomics, Toulouse, France
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Laurent Debrauwer
- MetaboHUB-MetaToul, National Infrastructure of Metabolomics and Fluxomics, Toulouse, France
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Sandrine Bessou-Touya
- Pierre Fabre Dermo-Cosmetics and Personal Care, Centre R&D Pierre Fabre, Toulouse, France
| | - Eggert Stockfleth
- Department of Dermatology, Venerology and Allergology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Hélène Duplan
- Pierre Fabre Dermo-Cosmetics and Personal Care, Centre R&D Pierre Fabre, Toulouse, France
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Abu Rached N, Ocker L, Stockfleth E, Bechara FG. Secukinumab is effective in a patient on haemodialysis for end-stage renal disease and severe hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024. [PMID: 38376098 DOI: 10.1111/jdv.19868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Nessr Abu Rached
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Lennart Ocker
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
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Abu Rached N, Gambichler T, Ocker L, Skrygan M, Seifert C, Scheel CH, Stockfleth E, Bechara FG. Haptoglobin is an independent marker for disease severity and risk for metabolic complications in hidradenitis suppurativa: A prospective study. J Eur Acad Dermatol Venereol 2024; 38:205-213. [PMID: 37669834 DOI: 10.1111/jdv.19495] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease that is highly correlated with obesity. Haptoglobin serum levels have recently been recognized as an important biomarker linking obesity with chronic inflammation. OBJECTIVE To compare haptoglobin with previously proposed serum biomarkers for the determination of disease severity in HS patients. For this purpose, disease severity of HS patients was determined by a panel of clinical scores as well as several risk factors, such as weight and smoking habits. METHODS A prospective, diagnostic accuracy study was performed at the International Centre for Hidradenitis suppurativa/Acne inversa Bochum (ICH). The study included a total of 263 patients, including 131 who had a confirmed diagnosis of HS in Hurley I (n = 16), II (n = 56) and III (n = 59) HS, and 132 healthy controls. The main outcome was to identify serological inflammatory markers for HS disease severity [severe (III) vs. moderate/mild (II/I)] as assessed by Hurley classification. RESULTS The serum levels of acute phase proteins haptoglobin and CRP, as well as the number of neutrophils in peripheral blood, number of monocytes, the systemic immune-inflammation index and the pan-immune-inflammatory value correlated with disease severity according to established clinical scores (mHSS, SAHS, Hurley, DLQI). HS patients had significantly higher haptologlobin levels compared to healthy controls. Logistic regression analysis revealed haptoglobin as the only independent marker predicting severe HS. CONCLUSION In this prospective study, we discovered that the serum levels of the acute phase protein haptoglobin levels serve as an independent marker of disease severity in HS. While this presents the first study in the context of HS. Thus, the present data not only yield a highly promising serum marker to be further validated.
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Affiliation(s)
- N Abu Rached
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology and Phlebology, Christian Hospital Unna, Unna, Germany
| | - L Ocker
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C Seifert
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C H Scheel
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
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Stockfleth E, Heppt MV, Bégeault N, Delarue A. Evaluating the Efficacy and Safety of 4% 5-Fluorouracil Cream in Patients with Actinic Keratosis: An Expert Opinion. Acta Derm Venereol 2023; 103:adv11954. [PMID: 37982726 PMCID: PMC10680462 DOI: 10.2340/actadv.v103.11954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/16/2023] [Indexed: 11/21/2023] Open
Abstract
Actinic keratosis is a lesion that develops in sun-exposed areas of the skin and is considered to be a precancerous condition or an early in situ squamous cell carcinoma. Treatment of actinic keratosis is important for reducing skin cancer risk, with treatment choice based on patient-, lesion- and treatment-related considerations. Of the topical treatments used for field-directed therapy, those containing 5-fluorouracil are among the most effective and widely prescribed. The most recently developed topical 5-fluorouracil preparation (Tolak®; Pierre Fabre, France) contains 4% 5-fluorouracil in an aqueous cream. This narrative review discusses data on 4% 5-fluorouracil cream to treat actinic keratosis, and provides the authors' expert opinion on issues associated with it use. The effect of the cream has been evaluated in phase 2 and 3 trials of adult patients with actinic keratosis on the face, ears or scalp. These trials included patients with severe baseline disease, defined by high lesion counts and large-size treatment fields, which possibly affected the proportion of patients who were able to achieve complete clearance. Other efficacy parameters (e.g. percentage change in lesion count, ≥ 75% clearance of lesions or clinically significant changes in validated severity scales) should also be assessed to fully evaluate 4% 5-fluorouracil treatment efficacy in these patients. Nevertheless, 4% 5-fluorouracil is associated with high efficacy, a low level of recurrence and a satisfactory safety profile.
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Affiliation(s)
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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Leiter U, Heppt MV, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3-Leitlinie "Aktinische Keratose und Plattenepithelkarzinom der Haut" - Update 2023, Teil 2: Epidemiologie und Ätiologie, Diagnostik, Therapie des invasiven Plattenepithelkarzinoms der Haut, Nachsorge und Prävention: S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention. J Dtsch Dermatol Ges 2023; 21:1422-1434. [PMID: 37946644 DOI: 10.1111/ddg.15256_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/18/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungAktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um einen evidenzbasierten Rahmen für die klinische Entscheidungsfindung zu schaffen, wurde die S3‐Leitlinie "Aktinische Keratose und kutanes Plattenepithelkarzinom" aktualisiert und um die Themen Plattenepithelkarzinom in situ (Morbus Bowen) und Cheilitis actinica, die Manifestation der AK am Lippenrot, erweitert. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, politische Entscheidungsträger und Versicherungsgesellschaften, die sich mit der Diagnose und Behandlung von Patienten mit nicht‐melanozytärem Hautkrebs befassen. Für Patienten und deren Angehörige existiert eine gesonderte Patientenleitlinie. In diesem Teil behandeln wir die Themen Epidemiologie und Ätiologie, Diagnostik, Therapie des invasiven Plattenepithelkarzinoms der Haut, Nachsorge und Prävention.
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Affiliation(s)
- Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Markus V Heppt
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Theresa Steeb
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Mareike Alter
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Teresa Amaral
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | - Jürgen C Becker
- Translationale Hautkrebsforschung (TSCR), DKTK Essen/Düsseldorf, Universitätsmedizin Essen
| | | | - Helmut Breuninger
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | | | - Moritz Felcht
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus Heidelberg GmbH, Heidelberg
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
| | | | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Axel Hauschild
- Hautklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Abteilung Dermatologie und Umweltmedizin, Universität Osnabrück, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Lukas Kofler
- Studienzentrum Operative Dermatologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen
| | - Oliver Koelbl
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg
| | - Albrecht Krause-Bergmann
- Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädie, Plastische-, Ästhetische- und Handchirurgie, Sektion für Plastische-, Ästhetische- und Handchirurgie, Gütersloh
| | | | - Steffen Krohn
- Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Carmen Loquai
- Klinikum Bremen-Ost, Klinik für Dermatologie, Dermatochirurgie, Dermatoonkologie und Allergologie, Hautkrebszentrum Bremen
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | - Peter Mohr
- Elbe Kliniken Stade Buxtehude, Klinikum Buxtehude
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg
| | - Christina Pfannenberg
- Klinik für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | - Carmen Salavastru
- Klinik für Kinderdermatologie, Onkologische Dermatologie - Forschungseinheit, Colentina Universitätsklinikum, Bucharest, "Carol Davila" Universitätsmedizin, Bukarest, Rumänien
| | - Lutz Schmitz
- CentroDerm Wuppertal, Heinz-Fangman-Straße 57, Wuppertal
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | | | | | - Susanne Voelter-Mahlknecht
- Institut für Arbeitsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Dirk Vordermark
- Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | | | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Medizincampus Süd, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische und Ästhetische Operationen, Klinikum Osnabrück
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Claus Garbe
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
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7
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Leiter U, Heppt MV, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, ElGammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention. J Dtsch Dermatol Ges 2023; 21:1422-1433. [PMID: 37840404 DOI: 10.1111/ddg.15256] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 03/11/2023] [Accepted: 08/18/2023] [Indexed: 10/17/2023]
Abstract
Actinic keratosis (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention.
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Affiliation(s)
- Ulrike Leiter
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Teresa Amaral
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), DKTK Essen/Düsseldorf, University Medicine Essen, Essen, Germany
| | | | - Helmut Breuninger
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Thomas Diepgen
- Institute of Clinical Social Medicine, University Heidelberg, Heidelberg, Germany
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Moritz Felcht
- Department of Dermatosurgery, St. Josefhospital Heidelberg GmbH, Heidelberg, Germany
- Department of Dermatology, Venereology und Allergy, University Medicine Mannheim, Mannheim, Germany
| | - Michael J Flaig
- Department of Dermatology and Allergy, University Hospital, LMU Munich, München, Germany
| | - Markus Follmann
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical School, Mainz, Germany
| | - Rüdiger Greinert
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Uwe Hillen
- Department of Dermatology & Venerology, Vivantes Hospital Neukölln, Berlin, Germany
| | | | - Swen Malte John
- Department of Dermatology and Environmental Medicine, University of Osnabrueck, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrück, Germany
| | - Lukas Kofler
- Study Center for Dermatosurgery, University Hospital Tuebingen, Eberhard-Karls-University, Tübingen, Germany
| | - Oliver Koelbl
- Clinic and Polyclinic for Radiooncology, University Medical Center Regensburg, Regensburg, Germany
| | - Albrecht Krause-Bergmann
- Clinic for Trauma-, Orthopedics-, and Plastic Surgery, Department for Plastic-, Aesthetic- and Handsurgery, Gütersloh, Germany
| | | | - Steffen Krohn
- German Social Accident Insurance (DGUV), Berlin, Germany
| | - Thomas Langer
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Carmen Loquai
- Department of Dermatology, Medical Center Bremen-Ost, Bremen, Germany
| | - Christoph R Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Peter Mohr
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - Monika Nothacker
- Association of the Scientific Medical Societies in Germany (AWMF), Institute for Medical Knowledge Management, c/o Philipps Universität Marburg, Marburg, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carmen Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, "Colentina" Clinical Hospital, Bucharest 020125, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Rumania
| | | | - Eggert Stockfleth
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Claas Ulrich
- Dermatologie am Regierungsviertel, Berlin, Germany
| | - Susanne Voelter-Mahlknecht
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department for Oral and Maxillofacial Surgery, Plastic and Aesthetic Operations, Osnabrück, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Claus Garbe
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
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8
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Heppt MV, Leiter U, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3-Leitlinie "Aktinische Keratose und Plattenepithelkarzinom der Haut" - Update 2023, Teil 1: Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung und Versorgungsstrukturen: S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma"- update 2023, part 1: treatment of actinic keratosis, actinic cheilitis, cutaneous squamous cell carcinoma in situ (Bowen's disease), occupational disease and structures of care. J Dtsch Dermatol Ges 2023; 21:1249-1262. [PMID: 37845050 DOI: 10.1111/ddg.15231_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 03/04/2023] [Accepted: 07/27/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungAktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um eine evidenzbasierte Grundlage für die klinische Entscheidungsfindung zu schaffen, wurde die S3‐Leitlinie „Aktinische Keratose und kutanes Plattenepithelkarzinom“ aktualisiert und um die Themen Plattenepithelkarzinom in situ (Morbus Bowen) und Cheilitis actinica, die Manifestation der AK am Lippenrot, erweitert. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, politische Entscheidungsträger und Versicherungsgesellschaften, die sich mit der Diagnose und Behandlung von Patienten mit nichtmelanozytärem Hautkrebs befassen. Für Patienten und deren Angehörige existiert eine gesonderte Patientenleitlinie. In diesem Teil behandeln wir die Themen Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung an AK und PEK sowie Versorgungsstrukturen.
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Affiliation(s)
- Markus V Heppt
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Theresa Steeb
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Mareike Alter
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Teresa Amaral
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | - Jürgen C Becker
- Translationale Hautkrebsforschung (TSCR), DKTK Essen/Düsseldorf, Universitätsmedizin Essen
| | | | - Helmut Breuninger
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | | | - Moritz Felcht
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus Heidelberg GmbH, Heidelberg
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
| | | | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Axel Hauschild
- Hautklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Abteilung Dermatologie und Umweltmedizin, Universität Osnabrück, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Lukas Kofler
- Studienzentrum Operative Dermatologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen
| | - Oliver Koelbl
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg
| | - Albrecht Krause-Bergmann
- Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädie, Plastische-, Ästhetische- und Handchirurgie, Sektion für Plastische-, Ästhetische- und Handchirurgie, Gütersloh
| | | | - Steffen Krohn
- Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Carmen Loquai
- Klinikum Bremen-Ost, Klinik für Dermatologie, Dermatochirurgie, Dermatoonkologie und Allergologie, Hautkrebszentrum Bremen
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | - Peter Mohr
- Elbe Kliniken Stade Buxtehude, Klinikum Buxtehude
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg
| | - Christina Pfannenberg
- Klinik für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | - Carmen Salavastru
- Klinik für Kinderdermatologie, Onkologische Dermatologie - Forschungseinheit, Colentina Universitätsklinikum, "Carol Davila" Universitätsmedizin, Bucharest, Bukarest, Rumänien
| | - Lutz Schmitz
- CentroDerm Wuppertal, Heinz-Fangman-Straße 57, Wuppertal
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | | | | | - Susanne Voelter-Mahlknecht
- Institut für Arbeitsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Dirk Vordermark
- Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | | | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Medizincampus Süd, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische und Ästhetische Operationen, Klinikum Osnabrück
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Claus Garbe
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
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9
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Heppt MV, Leiter U, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma"- update 2023, part 1: treatment of actinic keratosis, actinic cheilitis, cutaneous squamous cell carcinoma in situ (Bowen's disease), occupational disease and structures of care. J Dtsch Dermatol Ges 2023; 21:1249-1262. [PMID: 37845077 DOI: 10.1111/ddg.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 03/04/2023] [Accepted: 07/27/2023] [Indexed: 10/18/2023]
Abstract
SummaryActinic keratosis (AK) are common lesions in light‐skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence‐based framework for clinical decision making, the guideline “actinic keratosis and cutaneous squamous cell carcinoma” was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office‐based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to AK, actinic cheilitis, Bowen's disease, occupational disease and care structures.
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Affiliation(s)
- Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Ulrike Leiter
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Teresa Amaral
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), DKTK Essen/Düsseldorf, University Medicine Essen, Essen, Germany
| | | | - Helmut Breuninger
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Thomas Diepgen
- Institute of Clinical Social Medicine, University Heidelberg, Heidelberg, Germany
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Moritz Felcht
- Department of Dermatosurgery, St. Josefhospital Heidelberg GmbH, Heidelberg, Germany
- Department of Dermatology, Venereology und Allergy, University Medicine Mannheim, Mannheim, Germany
| | - Michael J Flaig
- Department of Dermatology and Allergy, University Hospital, LMU Munich, München, Germany
| | - Markus Follmann
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical School, Mainz, Germany
| | - Rüdiger Greinert
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Uwe Hillen
- Department of Dermatology & Venerology, Vivantes Hospital Neukölln, Berlin, Germany
| | | | - Swen Malte John
- Department of Dermatology and Environmental Medicine, University of Osnabrueck, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrück, Germany
| | - Lukas Kofler
- Study Center for Dermatosurgery, University Hospital Tuebingen, Eberhard-Karls-University, Tübingen, Germany
| | - Oliver Koelbl
- Clinic and Polyclinic for Radiooncology, University Medical Center Regensburg, Regensburg, Germany
| | - Albrecht Krause-Bergmann
- Clinic for Trauma-, Orthopedics-, and Plastic Surgery, Department for Plastic-, Aesthetic- and Handsurgery, Gütersloh, Germany
| | | | - Steffen Krohn
- German Social Accident Insurance (DGUV), Berlin, Germany
| | - Thomas Langer
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Carmen Loquai
- Department of Dermatology, Medical Center Bremen-Ost, Bremen, Germany
| | - Christoph R Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Peter Mohr
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - Monika Nothacker
- Association of the Scientific Medical Societies in Germany (AWMF), Institute for Medical Knowledge Management, c/o Philipps Universität Marburg, Marburg, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carmen Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, "Colentina" Clinical Hospital, Bucharest 020125, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Rumania
| | | | - Eggert Stockfleth
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Claas Ulrich
- Dermatologie am Regierungsviertel, Berlin, Germany
| | - Susanne Voelter-Mahlknecht
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department for Oral and Maxillofacial Surgery, Plastic and Aesthetic Operations, Osnabrück, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Claus Garbe
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
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Stockfleth E, Dréno B, Bacqueville D, Duplan H, Ortiz Brugués A. Foreword. J Eur Acad Dermatol Venereol 2023; 37 Suppl 6:3-5. [PMID: 37671997 DOI: 10.1111/jdv.19007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/23/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Eggert Stockfleth
- Department of Dermatology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Brigitte Dréno
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | | | - Hélène Duplan
- Laboratoire Pierre Fabre, Centre R&D, Toulouse, France
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11
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Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, Bataille V, Brochez L, Del Marmol V, Dummer R, Forsea AM, Gaudy-Marqueste C, Harwood CA, Hauschild A, Höller C, Kandolf L, Kellerners-Smeets NWJ, Lallas A, Leiter U, Malvehy J, Marinović B, Mijuskovic Z, Moreno-Ramirez D, Nagore E, Nathan P, Stratigos AJ, Stockfleth E, Tagliaferri L, Trakatelli M, Vieira R, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023. Eur J Cancer 2023; 192:113254. [PMID: 37604067 DOI: 10.1016/j.ejca.2023.113254] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.
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Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London SE1 7EH, UK
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Ana-Marie Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | | | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nicole W J Kellerners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands; Department of Dermatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, Croatia
| | - Zeljko Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - David Moreno-Ramirez
- Dermatology. Medicine School, University of Seville, University Hospital Virgen Macarena, Seville-Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Eggert Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
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Falkenberg C, Dirschka T, Gilbert G, Stockfleth E, Homey B, Schmitz L. Basal Proliferation and Acantholysis May Represent Histological High-Risk Factors for Progression into Invasive Squamous Cell Carcinoma: A Comparison Study in Solid Organ Transplant Recipients and Matched Immunocompetent Patients. Cancers (Basel) 2023; 15:cancers15061765. [PMID: 36980650 PMCID: PMC10046608 DOI: 10.3390/cancers15061765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Histological risk factors of AKs cannot be directly determined. Recent studies indicate that AKs restricted to the lower third of the epidermis (AK I), with marked basal proliferation (PRO III) and acantholysis, are associated with an increased risk of progression to invasive squamous cell carcinoma (iSCC). To confirm the aforementioned histological risk factors, this study compared AKs from solid organ transplant recipients (sOTRs), known to carry an up to 250-fold higher risk for progression into iSCC, to a matched immunocompetent control group (ICG). In total, 111 AKs from 43 sOTRs showed more AKs (n = 54, 48.7%) graded as AK I compared to 35 AKs (31.5%) in the ICG (p = 0.009). In line with these findings, 89 AKs (80.2%) from sOTRs showed pronounced basal proliferation (PRO III) compared to 37 AKs (33.3%) in the ICG (p < 0.0001). Acantholysis was more frequent in sOTRs than the ICG (59.5% vs. 32.4%, p < 0.0001) and more frequently associated with advanced basal proliferation (p < 0.0001). In conclusion, this study showed that acantholytic AKs graded as AK I and PRO III are predominantly found in a population at high risk of iSCC. Thus, AKs with marked basal proliferation and acantholysis should be assumed to be histological high-risk factors for the progression into iSCC.
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Affiliation(s)
- Conrad Falkenberg
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- CentroDerm Clinic, Heinz-Fangman-Straße 57, 42287 Wuppertal, Germany
| | - Georgia Gilbert
- Edinburgh Medical School, The University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University, 44780 Bochum, Germany
| | - Bernhard Homey
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Lutz Schmitz
- CentroDerm Clinic, Heinz-Fangman-Straße 57, 42287 Wuppertal, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University, 44780 Bochum, Germany
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13
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Stockfleth E, Jouary T, Farnetani F, Pascual AM, De Almeida Agudo C, Voisard JJ, Bégeault N, Delarue A. Severity of Local Skin Reactions with 4% 5-Fluorouracil Plus Emollient versus 4% 5-Fluorouracil Alone in Patients with Actinic Keratosis: A Single-Blind Randomised Trial. Dermatol Ther (Heidelb) 2023; 13:1013-1027. [PMID: 36856965 DOI: 10.1007/s13555-023-00902-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Topical 5-fluorouracil (5-FU)-containing treatments are effective for actinic keratosis (AK); however, they frequently lead to transient local skin reactions (LSRs), which often result in treatment non-adherence. METHODS The aim of this international, phase IV clinical trial was to investigate whether addition of an emollient to topical 4% 5-FU would reduce the frequency and severity of LSRs over 4 weeks of treatment (intervention group) compared with 4% 5-FU alone (control group) in patients with AK. The primary objective was to assess the severity of LSRs (i.e. erythema, flaking/scaling, crusting, swelling, vesiculation/pustulation and erosion/ulceration) at week 4 of treatment (or before, in case of a major local reaction). Key secondary objectives were LSR total scores at weeks 2 and 8, the scores of individual LSR items at each visit, and the proportions of patients with 100% and ≥ 75% AK lesion clearance at week 8. RESULTS In total, 141 patients were included in the efficacy analysis (71 in the intervention group and 70 in the control group). There were no statistically or clinically significant differences between the treatment groups in terms of LSR total score at week 4 (overall and by subgroups defined by the number of lesions and patient age at baseline), scores of individual LSR items at any time point, and AK lesion clearance rates at week 8. LSR scores with topical 4% 5-FU alone were lower than expected. Skin reactions were the most common treatment-emergent adverse events in both groups, leading to treatment discontinuation in nine patients (12.3%) in the intervention group and seven (9.9%) in the control group. No new safety signals were observed with the addition of an emollient to 4% 5-FU. CONCLUSIONS Daily emollient applications during the 4-week treatment course did not impact the safety and efficacy profile of 4% 5-FU.
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Affiliation(s)
- Eggert Stockfleth
- Kath. Klinikum Bochum St. Josef-Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Thomas Jouary
- CH Pau, Service de Dermatologie, 4 Bd Hauterive, 64000, Pau, France
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | | | | | | | | | - Alain Delarue
- Pierre Fabre SA, Les Cauquillous, 81500, Lavaur, France
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Abu Rached N, Gambichler T, Dietrich JW, Ocker L, Seifert C, Stockfleth E, Bechara FG. The Role of Hormones in Hidradenitis Suppurativa: A Systematic Review. Int J Mol Sci 2022; 23:ijms232315250. [PMID: 36499573 PMCID: PMC9736970 DOI: 10.3390/ijms232315250] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease manifesting in inverse body regions. In a systematic review, the role of hormones in HS will be presented to better understand the pathomechanisms of HS. The review is based on the PRISMA criteria. Systematic research was carried out using keywords. Subsequently, the data were analyzed based on the clinical response and other relevant information. The main focus of our systematic review was on HS manifestation, exacerbation, sex hormones, antiandrogen therapy, thyroid function, polycystic ovary syndrome, insulin resistance, and adipokines. In HS, there appears to be a dysregulated adipokine release that is shifted towards pro-inflammatory adipokines. Insulin resistance is significantly more common in HS than in healthy patients regardless of BMI, age, and gender. Insulin resistance in HS patients leads to further cardiovascular disease. The mechanism of insulin resistance and role of adipokines should be investigated in future studies to better provide the pathomechanisms of HS. The role of androgens seems to be important in a certain subgroup of female patients. Anti-androgenic therapy can be useful and helpful in some patients. However, further studies are needed to better understand the hormonal relationship in HS.
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Affiliation(s)
- Nessr Abu Rached
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
- Correspondence: (N.A.R.); (F.G.B.); Tel.: +49-234-509-3420 (N.A.R.)
| | - Thilo Gambichler
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany
- Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Caroline Seifert
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Eggert Stockfleth
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Falk G. Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
- Correspondence: (N.A.R.); (F.G.B.); Tel.: +49-234-509-3420 (N.A.R.)
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Schlesinger T, Stockfleth E, Grada A, Berman B. Tirbanibulin for Actinic Keratosis: Insights into the Mechanism of Action. Clin Cosmet Investig Dermatol 2022; 15:2495-2506. [PMID: 36415541 PMCID: PMC9675993 DOI: 10.2147/ccid.s374122] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/19/2022] [Indexed: 08/13/2023]
Abstract
Actinic keratosis (AK) is a common pre-neoplastic skin lesion constituted by uncontrolled proliferation of atypical keratinocytes that may evolve to squamous cell carcinoma. With global prevalence increasing, AK is expected to be the most common carcinoma of the skin. Tirbanibulin is a reversible tubulin polymerization inhibitor with potent anti-proliferative and anti-tumoral effects. In-vivo and in-vitro studies have shown that tirbanibulin significantly inhibits cell proliferation, tumor growth and downregulates Src signaling with no overt toxicity. Early phase and Phase III trials have shown high lesion clearance, compliance, and few side effects of once daily tirbanibulin treatment. This review discusses tirbanibulin anti-cancer activity, focusing on tubulin polymerization and Src signaling inhibitory effects, highlighting relevant literature and novel preclinical results from the ATNXUS-KX01-001 study. Furthermore, we address the relevant findings obtained in recent clinical trials to evaluate the safety, efficacy, pharmacokinetics, clearance efficacy, and side effects of the 1% tirbanibulin ointment applied once daily. In summary, we highlight preclinical and clinical evidence on the use of tirbanibulin as an effective and safe treatment option for AK.
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Affiliation(s)
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Ayman Grada
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian Berman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Gambichler T, Elfering J, Meyer T, Bruckmüller S, Stockfleth E, Skrygan M, Käfferlein HU, Brüning T, Lang K, Wagener D, Schröder S, Nick M, Susok L. Protein expression of prognostic genes in primary melanoma and benign nevi. J Cancer Res Clin Oncol 2022; 148:2673-2680. [PMID: 34757537 PMCID: PMC9470607 DOI: 10.1007/s00432-021-03779-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the protein expression characteristics of genes employed in a recently introduced prognostic gene expression assay for patients with cutaneous melanoma (CM). METHODS We studied 37 patients with CM and 10 with benign (melanocytic) nevi (BN). Immunohistochemistry of primary tumor tissue was performed for eight proteins: COL6A6, DCD, GBP4, KLHL41, KRT9, PIP, SCGB1D2, SCGB2A2. RESULTS The protein expression of most markers investigated was relatively low (e.g., DCD, KRT9, SCGB1D2) and predominantly cytoplasmatic in melanocytes and keratinocytes. COL6A6, GBP4, and KLHL41 expression was significantly enhanced in CM when compared to BN. DCD protein expression was significantly correlated with COL6A6, GBP4, and KLHL41. GBP4 was positively correlated with KLHL41 and inversely correlated with SCGB2B2. The latter was also inversely correlated with serum S100B levels at time of initial diagnosis. The presence of SCGB1D2 expression was significantly associated with ulceration of the primary tumor. KRT9 protein expression was significantly more likely found in acral lentiginous melanoma. The presence of DCD expression was less likely associated with superficial spreading melanoma subtype but significantly associated with non-progressive disease. The absence of SCGB2A2 expression was significantly more often observed in patients who did not progress to stage III or IV. CONCLUSIONS The expression levels observed were relatively low but differed in part with those found in BN. Even though we detected some significant correlations between the protein expression levels and clinical parameters (e.g., CM subtype, course of disease), there was no major concordance with the protective or risk-associated functions of the corresponding genes included in a recently introduced prognostic gene expression assay.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
| | - J Elfering
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - T Meyer
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - S Bruckmüller
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - H U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - K Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - D Wagener
- Pathology/Labor Lademannbogen MVZ GmbH, Hamburg, Germany
| | - S Schröder
- Pathology/Labor Lademannbogen MVZ GmbH, Hamburg, Germany
| | - M Nick
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
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Zhu J, Gillissen B, Dang Tran DL, May S, Ulrich C, Stockfleth E, Eberle J. Inhibition of Cell Proliferation and Cell Viability by Sinecatechins in Cutaneous SCC Cells Is Related to an Imbalance of ROS and Loss of Mitochondrial Membrane Potential. Antioxidants (Basel) 2022; 11:antiox11071416. [PMID: 35883905 PMCID: PMC9312260 DOI: 10.3390/antiox11071416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
The term sinecatechins designates an extract containing a high percentage of catechins obtained from green tea, which is commercially registered as Veregen or Polyphenon E (PE) and may be considered for treatment of cutaneous squamous cell carcinoma (cSCC) and actinic keratosis (AK). As shown here, treatment of four cSCC cell lines with 200 µg/mL of PE resulted in strong, dose-dependent decrease in cell proliferation (20–30%) as well as strongly decreased cell viability (4–21% of controls, 48 h). Effects correlated with loss of mitochondrial membrane potential, whereas early apoptosis was less pronounced. At the protein level, some activation of caspase-3 and enhanced expression of the CDK inhibitor p21 were found. Loss of MMP and induced cell death were, however, largely independent of caspases and of the proapoptotic Bcl-2 proteins Bax and Bak, suggesting that sinecatechins induce also non-apoptotic, alternative cell death pathways, in addition to apoptosis. Reactive oxygen species (ROS) were downregulated in response to PE at 4 h, followed by an increase at 24 h. The contributory role of initially reduced ROS was supported by the antioxidant N-acetyl cysteine, which in combination with PE further enhanced the negative effects on cell viability. Thus, sinecatechins inhibited cell proliferation and viability of cSCC cells, which could suggest the use of PE for AK treatment. The mechanisms appear as linked to an imbalance of ROS levels.
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Affiliation(s)
- Jiaqi Zhu
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (J.Z.); (D.L.D.T.); (S.M.); (C.U.)
- Department of Gynecology and Obstetrics, Jilin University, Changchun 130001, China
| | - Bernd Gillissen
- Department of Hematology, Oncology, and Tumor Immunology, Charité–Universitätsmedizin Berlin, 13125 Berlin, Germany;
| | - Dieu Linh Dang Tran
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (J.Z.); (D.L.D.T.); (S.M.); (C.U.)
- Beuth-Hochschule für Technik Berlin–University of Applied Sciences, Luxemburger Str. 10, 13353 Berlin, Germany
| | - Stefanie May
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (J.Z.); (D.L.D.T.); (S.M.); (C.U.)
| | - Claas Ulrich
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (J.Z.); (D.L.D.T.); (S.M.); (C.U.)
| | - Eggert Stockfleth
- Dermatologie, Venerologie und Allergologie, Klinikum Bochum, Ruhr-Universität Bochum, Gudrunstr. 56, 44791 Bochum, Germany;
| | - Jürgen Eberle
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (J.Z.); (D.L.D.T.); (S.M.); (C.U.)
- Correspondence: ; Tel.: +49-30-450-518-383
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Danneil O, Dörler M, Stockfleth E, Stücker M. Einflussfaktoren auf oberflächliche und tiefe Beinvenenthrombosen nach Schaumverödung von Krampfadern. J Dtsch Dermatol Ges 2022; 20:929-940. [PMID: 35881084 DOI: 10.1111/ddg.14748_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 01/21/2022] [Indexed: 12/21/2022]
Abstract
HINTERGRUND Bei einer Schaumsklerosierungstherapie von Varizen können als Nebenwirkungen sowohl tiefe (TVT) als auch oberflächliche Beinvenenthrombosen (OVT) auftreten. Noch weitgehend unklar sind die Risikofaktoren, welche die Entstehung einer OVT oder TVT nach Schaumsklerosierung begünstigen. Das Ziel dieser retrospektiven Analyse war, anhand eines größeren Kollektivs von Patienten mit thromboembolischen Komplikationen sowohl patienten- als auch eingriffsbezogene Risikofaktoren für thromboembolische Komplikationen durch eine Schaumsklerosierung herauszuarbeiten. PATIENTEN UND METHODIK Insgesamt wurden 170 Patienten untersucht, die eine Schaumsklerosierung erhielten. Vor dem Stichtag 17. März 2020 wurden die letzten 85 Patienten mit thromboembolischen Komplikationen als Studiengruppe A und die letzten 85 Patienten ohne thromboembolische Komplikationen als Kontrollgruppe B nach Sklerosierung mit aufgeschäumtem Sklerosierungsmittel erfasst und verglichen. ERGEBNISSE Patienten mit thromboembolischen Komplikationen hatten häufiger eine Thrombophilie (11/85 vs. 3/85). Die mittleren BMI-Werte waren in Gruppe A (25,9 ± 5,1) signifikant niedriger als in Gruppe B (28,0 ± 7,2) (P = 0,034). Thromboembolische Komplikationen zeigen sich nach Schaumsklerosierung eher am Unterschenkel (61/105) als am Oberschenkel (1/13) (P < 0,001) dabei häufiger nach dorsaler als nach ventraler Schaumsklerosierung (39 von 47 vs. 5 von 40, P < 0,001). Von den 39 thromboembolischen Komplikationen am dorsalen Unterschenkel waren 23 Muskelvenenthrombosen. SCHLUSSFOLGERUNG Das Risiko für Muskelvenenthrombosen nach Schaumsklerosierung ist vor allem bei schlanken Patienten, welche am dorsalen Unterschenkel sklerosiert werden, erhöht.
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Affiliation(s)
- Olivia Danneil
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Ruhr-Universität Bochum
| | - Martin Dörler
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Ruhr-Universität Bochum
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Ruhr-Universität Bochum
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Ruhr-Universität Bochum
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Danneil O, Dörler M, Stockfleth E, Stücker M. Factors influencing superficial and deep vein thrombosis after foam sclerotherapy in varicose veins. J Dtsch Dermatol Ges 2022; 20:929-938. [PMID: 35691945 DOI: 10.1111/ddg.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Side effects of foam sclerotherapy for varicose veins can include both deep (DVT) and superficial leg vein thrombosis (SVT). The risk factors that favor the development of SVT or DVT after foam sclerotherapy are still largely unclear. The aim of our retrospective analysis was to use a larger group of patients with thromboembolic complications to identify both patient-related and procedure-related risk factors for thromboembolic complications from foam sclerotherapy. PATIENTS AND METHODS A total of 170 patients who received foam sclerotherapy were examined. With reference to a cut-off date, March 17th, 2020, the 85 most recent patients with thromboembolic complications (study group A) were included and compared to the most recent 85 patients without thromboembolic complications (control group B), after sclerotherapy with foamed sclerosant. RESULTS Patients with a thromboembolic complication were more likely to have thrombophilia (11/85 vs. 3/85). The mean BMI values in group A (25.9 ± 5.1) were significantly lower than in group B (28.0 ± 7.2) (P = 0.034). Thromboembolic complications were more likely to appear after foam sclerotherapy on the lower leg (61/105) than on the thigh (1/13) (P < 0.001), particularly after dorsal than after ventral foam sclerotherapy (39 of 47 vs. 5 of 40, P < 0.001). Of the 39 thromboembolic complications on the dorsal lower leg, 23 were muscle vein thromboses. CONCLUSION The risk of muscle vein thrombosis after foam sclerotherapy is especially increased in slender patients with sclerosed, dorsal lower legs.
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Affiliation(s)
- Olivia Danneil
- Department of Dermatology, Venereology and Allergology, Center for Venous Diseases of the Departments of Dermatology and Surgery, Ruhr University of Bochum, Bochum, Germany
| | - Martin Dörler
- Department of Dermatology, Venereology and Allergology, Center for Venous Diseases of the Departments of Dermatology and Surgery, Ruhr University of Bochum, Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Center for Venous Diseases of the Departments of Dermatology and Surgery, Ruhr University of Bochum, Bochum, Germany
| | - Markus Stücker
- Department of Dermatology, Venereology and Allergology, Center for Venous Diseases of the Departments of Dermatology and Surgery, Ruhr University of Bochum, Bochum, Germany
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20
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Stockfleth E, Ortiz Brugués A. Foreword. J Eur Acad Dermatol Venereol 2022; 36 Suppl 6:3-4. [PMID: 35738807 DOI: 10.1111/jdv.18199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- E Stockfleth
- Department of Dermatology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - A Ortiz Brugués
- Laboratoires Dermatologiques Avène, Pierre Fabre Dermo-Cosmétique, Lavaur, France
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21
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Stockfleth E, Revol O. Encouraging sun protection early in life: from a successful prevention programme in children to the identification of psychological barriers in adolescents. J Eur Acad Dermatol Venereol 2022; 36 Suppl 6:12-21. [PMID: 35738808 DOI: 10.1111/jdv.18194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
Children and adolescents have high rates of sunburn and high levels of ultraviolet radiation (UVR) exposure and are therefore at risk of developing skin cancer in later life. Minimizing UVR exposure in childhood and adolescence may be the most important component of skin cancer prevention efforts. Thus, age-adapted prevention campaigns, targeting children, adolescents and caregivers, are needed to change sun protection behaviour among individuals in these age groups. In the first part of this review, we describe the 'SunPass' programme, which was initiated in Germany in 2010 as the first nationwide educational intervention for sun safety designed to teach kindergarten children and their caregivers how to protect themselves from overexposure to the sun. Implemented in 55 kindergartens, this programme has been shown to be effective at improving sun protection behaviour (P < 0.001) and hat use (P = 0.029) among kindergarten children, as well as at improving shade practices and increasing demand for protective clothing (P < 0.001). Up to 40 000 children, 50 000 parents/grandparents and 2500 kindergarten caregivers took part in the SunPass programme in Germany from 2019 to June 2021. The programme has also been adapted and implemented in several other European countries and could be readily adapted for use elsewhere. In the second part of this review, we discuss the specific challenges faced by adolescents and consider how these issues may impact their sun protection behaviour. Adolescents have difficulties suppressing responses to reward-related cues and projecting themselves into the future. They also place a lot of importance on social acceptance and cosmetic appearance, and their higher risk of depression, addiction and impulsivity make them vulnerable to tanning addiction. These specificities need to be acknowledged by dermatologists, so they can adapt their therapeutic relationship and develop effective sun protection interventions for this generation.
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Affiliation(s)
- E Stockfleth
- Klinik für Dermatologie und Ruhr-Universität Bochum, Gudrunstrasse 52, Bochum, Germany
| | - O Revol
- Child Development Unit, Hospices Civils de Lyon, Bron, France
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22
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Stockfleth E, Bégeault N, Delarue A. The Overall Number of Actinic Keratosis Lesions Is Not Predictable by the Number of Visible Lesions: Consequences for Field-Directed Therapies. Curr Ther Res Clin Exp 2022; 96:100661. [PMID: 35035632 PMCID: PMC8752874 DOI: 10.1016/j.curtheres.2021.100661] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Actinic keratoses are keratotic lesions occurring on skin areas extensively damaged by sunlight. Using data from a previously published Phase III randomized, controlled clinical trial in patients with at least 5 actinic keratoses, we explored the potential link between the number of visible actinic keratosis lesions before any treatment and the total number of lesions of the field cancerization as revealed by 5-fluorouracil cream. Our analysis suggests that the baseline number of visible actinic keratoses is a poor indicator of the real number of lesions in the field of cancerization, reinforcing the need to explain the field cancerization concept to patients. (Curr Ther Res Clin Exp. 2022; 82:XXX-XXX) © 2022 Elsevier HS Journals, Inc.
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Gambichler T, Stockfleth E, Susok L. Aggressive cutaneous squamous cell carcinoma in a hydroxyurea- and ruxolitinib-pretreated patient with polycythaemia vera. J Eur Acad Dermatol Venereol 2021; 36 Suppl 1:63-65. [PMID: 34855240 DOI: 10.1111/jdv.17406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/02/2021] [Indexed: 12/26/2022]
Abstract
Hydroxyurea and ruxolitinib are frequently used to treat myeloproliferative disorders, including polycythaemia vera, and chronic treatment is associated with many cutaneous adverse effects such as the development of aggressive non-melanoma skin cancer (NMSC). We report an 85-year-old man with a history of hydroxyurea- and ruxolitinib-treated polycythaemia vera who was referred for the management of progressively growing tumours on his scalp. Histopathology of the largest scalp lesion revealed a partly desmoplastic cutaneous squamous carcinoma with perineural invasion. Initial imaging revealed metastatic disease in cervical lymph nodes, bones and lungs. The scalp lesions were successfully treated with bleomycin-based electrochemotherapy. Under initial systemic therapy using four cycles of cetuximab, metastatic disease progressed. Following the approval by the health insurance, compassionate use of pembrolizumab monotherapy was initiated. After three cycles of pembrolizumab, however, metastatic disease further progressed and the patient finally died from global respiratory insufficiency. The present case exemplifies the cutaneous adverse effects of long-term hydroxyurea and ruxolitinib therapy, frequently resulting in highly aggressive NMSCs that are usually not responsive to systemic treatments even such as immune checkpoint inhibitors.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
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Abstract
Sunlight comprises radiation of different wavelengths, of which UVA and UVB are most important with respect to human skin diseases. Next to erythema, edema, and sunburns, UV radiation causes skin cancer. UV radiation of any wavelength is now considered as a class I carcinogen to humans. The mutagenic effects of UV radiation depend on DNA damage following direct absorption by nuclear DNA, resulting in cyclobutane pyrimidine dimers and pyrimidine (6-4) pyrimidone photoproducts that, if not repaired by nucleotide excision repair pathway, result in characteristic UV signature mutations (C→T or CC→TT transition). In addition, increased formation of reactive oxygen species by UV exposure may cause formation of 8-oxo-7,8-dihydro-2'-deoxyguanosine leading to T→G transversion. In addition, UV radiation has been shown to induce a number of immune modulations that largely result in local and potentially also in systemic immunosuppression, which may not only impair control of dysplastic and neoplastic skin lesions but also affect immuno-pathological and infectious skin diseases. Recent find-ings have shown that ambient doses of high-energy visible light, beyond the UV range, may also cause damage to human skin.
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Affiliation(s)
- Thomas Meyer
- Department of Dermatology, Venerology and Allergology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Venerology and Allergology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
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Meyer T, Sand M, Schmitz L, Stockfleth E. The Role of Circular RNAs in Keratinocyte Carcinomas. Cancers (Basel) 2021; 13:cancers13164240. [PMID: 34439394 PMCID: PMC8392367 DOI: 10.3390/cancers13164240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/29/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 12/19/2022] Open
Abstract
Keratinocyte carcinomas (KC) include basal cell carcinomas (BCC) and cutaneous squamous cell carcinomas (cSCC) and represents the most common cancer in Europe and North America. Both entities are characterized by a very high mutational burden, mainly UV signature mutations. Predominately mutated genes in BCC belong to the sonic hedgehog pathway, whereas, in cSCC, TP53, CDKN2A, NOTCH1/2 and others are most frequently mutated. In addition, the dysregulation of factors associated with epithelial to mesenchymal transition (EMT) was shown in invasive cSCC. The expression of factors associated with tumorigenesis can be controlled in several ways and include non-coding RNA molecules, such as micro RNAs (miRNA) long noncoding RNAs (lncRNA) and circular RNAs (circRNA). To update findings on circRNA in KC, we reviewed 13 papers published since 2016, identified in a PubMed search. In both BCC and cSCC, numerous circRNAs were identified that were differently expressed compared to healthy skin. Some of them were shown to target miRNAs that are also dysregulated in KC. Moreover, some studies confirmed the biological functions of individual circRNAs involved in cancer development. Thus, circRNAs may be used as biomarkers of disease and disease progression and represent potential targets of new therapeutic approaches for KC.
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Affiliation(s)
- Thomas Meyer
- Department of Dermatology St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany;
- Correspondence: ; Tel.: +49-234-5096014
| | - Michael Sand
- Department of Plastic and Reconstructive Surgery, St. Josef-Hospital, Heidbergweg 22–24, 45257 Essen, Germany;
| | - Lutz Schmitz
- Institute of Dermatopathology, MVZ Corius DermPath Bonn, GmbH, Trierer Strasse 70–72, 53115 Bonn, Germany;
| | - Eggert Stockfleth
- Department of Dermatology St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany;
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Abstract
Aim: To find out whether treatment with immune checkpoint inhibitors (ICIs) results in volume increase of the spleen. Patient & methods: We studied 49 stage III and IV melanoma patients with an indication for ICIs. Computer tomographic-assisted volumetry of spleens was performed. Results: After 3 months, median spleen volume was significantly increased when compared with the baseline volume. At 3 months, the increase of spleen volume was significantly associated with the use of ipilimumab and ipilimumab plus nivolumab. There was no significant association between spleen volume increase and clinical parameters. Conclusion: The median spleen volume of patients with cutaneous melanoma increases during the first months of ICI treatment, which was particularly attributable to the use of anti-CTLA-4 and anti-CTLA-4/anti-PD-1 regimens.
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Affiliation(s)
- Laura Susok
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Dominik Reinert
- Department of Radiology, Ruhr-University Bochum, Bochum, Germany
| | - Carsten Lukas
- Department of Radiology, Ruhr-University Bochum, Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Thilo Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
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Gambichler T, Abu Rached N, Tannapfel A, Becker JC, Vogt M, Skrygan M, Wieland U, Silling S, Susok L, Stücker M, Meyer T, Stockfleth E, Junker K, Käfferlein HU, Brüning T, Lang K. Expression of Mismatch Repair Proteins in Merkel Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13112524. [PMID: 34063983 PMCID: PMC8196722 DOI: 10.3390/cancers13112524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/10/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Merkel cell carcinoma (MCC) is a rare and highly malignant skin cancer with neuroendocrine differentiation. About 80% are Merkel cell polyomavirus (MCPyV) positive. The aim of this work was to immunohistochemically investigate the expression of mismatch repair proteins (MSH2, MSH6, MLH1, and PMS2) in MCC (n = 56). In a second step, tumors with a low expression were tested for microsatellite instability. Microsatellite instability in MCC could have an impact on immune checkpoint inhibitor therapy (ICI) outcome. This study showed a significant association between low expression of mismatch repair proteins and a negative MCPyV status. Microsatellite instability was detected in only one case. Future studies will establish whether this subset of MCC patients respond better to ICI. Abstract We aimed to assess for the first time the mismatch repair (MMR) protein expression in Merkel cell carcinoma (MCC). Immunohistochemistry was performed for MLH1, MSH2, MSH6, and PMS2 on patients’ tumor tissue (n = 56), including neighbored healthy control tissue. In cases with low-level MMR expression (<10th percentile), we performed multiplex PCR in combination with high-resolution capillary electrophoresis in order to confirm microsatellite instability (MSI). Microscopic evaluation revealed a high median expression for all MMR proteins studied (91.6–96.3%). However, six patients (56/10.7%) had low-level MLH1 expression, six (55/10.9%) had low-level MSH2 expression, five (56/8.9%) had low-level MSH6 expression, and six (54/11.1%) had low-level PMS2 expression. Together, we observed nine (56/16.1%) patients who had low-level MMR expression of at least one protein. Of the patients with low-level MMR expression, MSI evaluation was possible in five cases, revealing one case with high-level MSI. In all MMR proteins assessed, low-level expression was significantly (p = 0.0004 to p < 0.0001) associated with a negative Merkel cell polyomavirus (MCPyV) status. However, the expression profiles of the MMR proteins did not correlate with clinical outcome measures such as disease relapse or death (p > 0.05). MCC appears to be a malignancy characterized by low-level MMR rather than completely deficient MMR in a subset of cases, predominantly affecting MCPyV-negative tumors. Future studies will establish whether this subset of MCC patients respond better to immune checkpoint inhibitor therapy.
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Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
- Correspondence: (T.G.); (N.A.R.); Tel.: +49-234-509-6073 (N.A.R.)
| | - Nessr Abu Rached
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
- Correspondence: (T.G.); (N.A.R.); Tel.: +49-234-509-6073 (N.A.R.)
| | - Andrea Tannapfel
- Institute of Pathology, Ruhr-University Bochum, 44789 Bochum, Germany; (A.T.); (M.V.)
| | - Jürgen C. Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, 45147 Essen, Germany;
- Deutsches Krebsforschungszentrum (DKFZ), 69120 Heidelberg, Germany
| | - Markus Vogt
- Institute of Pathology, Ruhr-University Bochum, 44789 Bochum, Germany; (A.T.); (M.V.)
| | - Marina Skrygan
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Ulrike Wieland
- National Reference Center for Papilloma- and Polyomaviruses, Institute of Virology, University of Cologne, 50935 Cologne, Germany; (U.W.); (S.S.)
| | - Steffi Silling
- National Reference Center for Papilloma- and Polyomaviruses, Institute of Virology, University of Cologne, 50935 Cologne, Germany; (U.W.); (S.S.)
| | - Laura Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Markus Stücker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Thomas Meyer
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany; (M.S.); (L.S.); (M.S.); (T.M.); (E.S.)
| | - Klaus Junker
- Department of Pathology, Klinikum Bremen-Mitte, 28205 Bremen, Germany;
| | - Heiko U. Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances (IPA), Ruhr-University Bochum, 44789 Bochum, Germany; (H.U.K.); (T.B.); (K.L.)
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances (IPA), Ruhr-University Bochum, 44789 Bochum, Germany; (H.U.K.); (T.B.); (K.L.)
| | - Kerstin Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances (IPA), Ruhr-University Bochum, 44789 Bochum, Germany; (H.U.K.); (T.B.); (K.L.)
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Gambichler T, Hartenstein I, Dreißigacker M, Stockfleth E, Stücker M, Schaller J, Schulze HJ, Becker JC, Käfferlein HU, Brüning T, Lang K. Expression of Hedgehog signalling molecules in microcystic adnexal carcinoma. Clin Exp Dermatol 2021; 46:1052-1057. [PMID: 33714217 DOI: 10.1111/ced.14634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Microcystic adnexal carcinoma (MAC) is a rare skin neoplasm that has not been characterized on a molecular basis. AIM To assess expression profiles of Hedgehog (HH) signalling molecules in MAC and control tumours. METHODS Immunohistochemistry was performed for Sonic Hedgehog (SHH), Indian Hedgehog (IHH), Patched 1 (PTCH1) and Smoothened (SMO) on patient MAC tissue (n = 26) and control tumour tissue, including syringoma (SyG; n = 11), trichoepithelioma (TE; n = 11) and basal cell carcinoma (BCC; n = 12) tissues. RESULTS Patched 1 and SMO immunoreactivity was significantly higher in BCC than in SyG, TE or MAC (P < 0.001 and P < 0.03, respectively). The highest IHH expression was observed in BCC and TE compared with SyG and MAC (P < 0.04). Notably, the highest SHH protein expression was observed in SyG compared with MAC, TE and even BCC (P < 0.001). In patients with MAC, SMO immunoreactivity significantly (r = 0.51; P < 0.01) correlated with PTCH1 expression. Further correlation studies did not show significant associations between the HH expression markers assessed (P > 0.05). CONCLUSION Our results indicate that alterations of the HH signalling are unlikely to play a major role in the pathogenesis of MAC, which is in contrast to the morphologically similar BCC and TE. Our observation provides additional information to the limited molecular pathology knowledge on this rare tumour.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - I Hartenstein
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Dreißigacker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Stücker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J Schaller
- Dermatopathology Duisburg, Duisburg, Germany
| | - H-J Schulze
- Fachklinik Hornheide, Skin Cancer Center, Department of Dermatology and Dermato-Histo-Pathology, Münster, Germany
| | - J C Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany.,Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - H U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - K Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
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Susok L, Stücker M, Bechara FG, Stockfleth E, Gambichler T. Multivariate analysis of prognostic factors in patients with nodular melanoma. J Cancer Res Clin Oncol 2021; 147:2759-2764. [PMID: 33630139 PMCID: PMC8310843 DOI: 10.1007/s00432-021-03562-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Nodular melanoma (NM) is associated with worse disease outcome when compared to superficial spreading melanoma (SSM). We aimed to perform a single-center analysis of prognostic factors in patients with NM and compare the data with SSM patients. METHODS We studied 228 patients with NN and 396 patients with SSM. Patients with in situ melanomas or stage IV at diagnosis were not included in the study. Data were analyzed using the Mann-Whitney test, Chi-square test, Kaplan-Meier curves including the log-rank test, and logistic regression model. RESULTS When compared to patients with SSM, patients with NM had less likely lower Clark level, higher tumor thickness, less likely tumor regression, more often ulcerated tumors, and less likely a history of precursor lesions such as a nevus. Within a 5-year follow-up we observed significantly more disease relapses and deaths in NM patients than in SSM patients. On multivariate analysis, disease relapse in NM patients was independently predicted by tumor thickness and positive SLNB, whereas melanoma-specific death of NM patients was independently predicted by male sex and tumor thickness. Histologic regression also remained in the logistic regression model as a significant independent negative predictor of NM death. CONCLUSIONS We did not observe that NM subtype was per se a significant independent predictor for disease relapse or melanoma-specific death. Among the well-known prognostic factors such as tumor thickness and male sex, NM is also associated with other unfavorable factors such as absence of regression.
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Affiliation(s)
- L Susok
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M Stücker
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
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30
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Gambichler T, Tsagoudis K, Kiecker F, Reinhold U, Stockfleth E, Hamscho R, Egberts F, Hauschild A, Amaral T, Garbe C. Prognostic significance of an 11-gene RNA assay in archival tissue of cutaneous melanoma stage I-III patients. Eur J Cancer 2021; 143:11-18. [PMID: 33278769 DOI: 10.1016/j.ejca.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to validate the results of an 11-gene expression profiling (GEP) assay which aims to improve the precision of individual prognosis beyond conventional American Joint Committee on Cancer staging for patients with cutaneous melanoma. METHODS The reverse transcriptase polymerase chain reaction test of 11 prospectively selected genes was performed on 291 formalin-fixed, paraffin-embedded primary tumours of patients with stage I-III cutaneous melanoma. The expression levels of eight prognostic and three reference genes were used in a predefined algorithm to calculate a numerical score (-0.84 to 3.53) and then assign each patient to a preselected risk group (low versus high score) for melanoma-specific survival (MSS). RESULTS One hundred twenty-seven patients were allocated to the low-score group, with a corresponding five-year disease-free survival (DFS) and MSS of 95% and 99%, respectively. 164 patients were allocated to the high-score group, with a corresponding five-year DFS and MSS of 78% and 88%. Continuous regression analysis demonstrated decreasing MSS probabilities with increasing scores. In a multivariate cox regression, only the 11-GEP, tumour thickness and age were statistically associated with MSS (p = 0.0068, 0.002 and 0.0159). CONCLUSIONS The 11-GEP has been validated as an independent predictor of outcome for melanoma patients. More specifically, using an 11-GEP score cut-off of ≤0, the assay can identify patient cohorts with 10-year survival probabilities well above 90%. This information may be used in the decision-making for a potential adjuvant therapy.
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Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | | | - Felix Kiecker
- Skin Cancer Center, Department of Dermatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Reinhold
- Dermatological Centre Bonn Friedensplatz, Bonn, Germany
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Rami Hamscho
- Department of Dermatology and Allergology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Friederike Egberts
- Department of Dermatology and Venerology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Axel Hauschild
- Department of Dermatology and Venerology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.
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31
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Heppt MV, Leiter U, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Welzel J, Wermker K, Berking C, Garbe C. S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma - short version, part 1: diagnosis, interventions for actinic keratoses, care structures and quality-of-care indicators. J Dtsch Dermatol Ges 2020; 18:275-294. [PMID: 32130773 DOI: 10.1111/ddg.14048] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Actinic keratoses (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guideline is aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AK and cSCC. The guideline is also aimed at affected patients, their relatives, policy makers and insurance funds. In the first part, we will address aspects relating to diagnosis, interventions for AK, care structures and quality-of-care indicators.
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Affiliation(s)
- Markus V Heppt
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany.,Department of Dermatology, Universitätsklinikum Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Theresa Steeb
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany
| | - Teresa Amaral
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, Carl Gustav Carus University Medical Center, Dresden, Germany
| | - Jürgen C Becker
- Department of Dermatology, German Cancer Consortium (DKTK), Essen University Medical Center, Essen, and German Cancer Research Center, Heidelberg, Germany
| | | | - Helmut Breuninger
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Thomas Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital, Germany
| | - Thomas Dirschka
- CentroDerm Clinic and Medical Faculty of Witten Herdecke University, Wuppertal, Germany
| | - Thomas Eigentler
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Michael Flaig
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany
| | | | - Klaus Fritz
- Dermatology and Laser Center, Landau, Germany
| | | | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hanover Medical School, Hanover, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Medical Center, Berlin-Neukölln, Germany
| | | | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Oliver Kölbl
- Department of Radiation Oncology, Regensburg University Medical Center, Regensburg, Germany
| | | | - Christoph Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Seema Noor
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Monika Nothacker
- Association of Scientific Medical Societies in Germany (AWMF), Berlin, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, University Medical Center, Tübingen, Germany
| | | | - Lutz Schmitz
- Department of Dermatology, Ruhr University of Bochum, Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Ruhr University of Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Claas Ulrich
- Department of Dermatology, Charité University Medical Center, Berlin, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University of Augsburg, Augsburg, Germany
| | - Kai Wermker
- Department of Oral and Maxillofacial Surgery, Klinikum Osnabrück, Osnabrück, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany.,Department of Dermatology, Universitätsklinikum Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
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32
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Gambichler T, Bünnemann H, Scheel CH, Bechara FG, Stücker M, Stockfleth E, Becker JC. Does very early timing of lymph node surgery after resection of the primary tumour improve the clinical outcome of patients with melanoma? Clin Exp Dermatol 2020; 45:1011-1018. [PMID: 32422686 DOI: 10.1111/ced.14291] [Citation(s) in RCA: 3] [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] [Received: 02/03/2020] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with cutaneous melanoma (CM), the time span between resection of the primary tumour and sentinel lymph node biopsy (SLNB) as well as the subsequent interval between SLNB and complete lymph node dissection (CLND) varies greatly. AIM To determine whether very early timing of SLNB after resection of the primary tumour, or timing of CLND after SLNB affect the clinical outcome of patients with CM, compared with longer time intervals. METHODS We compared the time spans between complete resection of the primary tumour and SLNB, and the interval between SLNB and CLND in a cohort of 896 patients with melanoma who had undergone SLNB. An interval between primary resection and SLNB or between SLNB and CLND of up to 7 days was classified as very early (VE-SLNB and VE-CLND, respectively). This time span was compared with intervals of > 7 days. Univariate and multivariate statistics were performed. RESULTS VE-SLNB was significantly associated with the presence of micrometastases. However, this was probably due to tumour thickness being significantly higher in patients with VE-SLNB compared with patients with later SLNB. Importantly, VE-SLNB was not significantly associated with disease relapse and VE-CLND was not associated with melanoma-specific death. CONCLUSIONS VE-SLNB and VE-CLND neither improved nor worsened the clinical outcome of patients. Thus, timing of SLNB and CLND has no influence on the overall clinical outcome of patients with melanoma. Our findings support the rational planning of lymph node surgery after resection of the primary tumour and provide help for effective patient counselling.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - H Bünnemann
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - C H Scheel
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - F G Bechara
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - M Stücker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
| | - E Stockfleth
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
| | - J C Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
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33
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Gambichler T, Dreißigacker M, Kasakovski D, Skrygan M, Wieland U, Silling S, Gravemeyer J, Melior A, Cherouny A, Stücker M, Stockfleth E, Sand M, Becker JC. Patched 1 expression in Merkel cell carcinoma. J Dermatol 2020; 48:64-74. [PMID: 33180347 DOI: 10.1111/1346-8138.15611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022]
Abstract
The relevance of Hedgehog signaling in Merkel cell carcinoma has only been addressed by a few studies with conflicting results. Thus, we aimed to establish the expression of Hedgehog signaling molecules in Merkel cell carcinoma to characterize causes of aberrant expression and to correlate these findings with the clinical course of the patients. Immunohistochemistry was performed for Sonic, Indian, Patched 1 (PTCH1) and Smoothened on patients' tumor tissue. Respective mRNA expression was analyzed in 10 Merkel cell carcinoma cell lines using quantitative real-time polymerase chain reaction. PTCH1 sequencing and DNA methylation microarray analyses were carried out on tumor tissues as well as cell lines. PTCH1 immunoreactivity in Merkel cell carcinoma was similar to that of basal cell carcinomas, which both significantly differed from PTCH1 immunoreactivity in healthy skin. Most PTCH1 mutations found were synonymous or without known functional impact. However, on average, the promoter regions of both PTCH1 were hypomethylated independently from PTCH1 gene expression or Merkel cell polyomavirus status. PTCH1 and GLI1/2/3 genes were differently expressed in different cell lines; notably, there was a significant correlation between GLI2 and PTCH1 mRNA expression. Similar to PTCH1 protein expression in patient tissues, PTCH1 gene expression in Merkel cell carcinoma cell lines is highly variable, but due to the similar methylation pattern across Merkel cell carcinoma cell lines, effects other than methylation seem to be the reason for the differential expression and PTCH1 appears to be upregulated by GLI as a classical Hedgehog target gene.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Max Dreißigacker
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Dimitri Kasakovski
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Marina Skrygan
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Ulrike Wieland
- National Reference Center for Papilloma- and Polyomaviruses, Institute of Virology, University of Cologne, Cologne, Germany
| | - Steffi Silling
- National Reference Center for Papilloma- and Polyomaviruses, Institute of Virology, University of Cologne, Cologne, Germany
| | - Jan Gravemeyer
- Department of Dermatology, Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, University Duisburg-Essen, Essen, Germany
| | - Anita Melior
- Department of Dermatology, Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, University Duisburg-Essen, Essen, Germany
| | - Angela Cherouny
- Department of Dermatology, Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, University Duisburg-Essen, Essen, Germany
| | - Markus Stücker
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Michael Sand
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Department of Dermatology, Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, University Duisburg-Essen, Essen, Germany.,Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
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34
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Hessam S, Gambichler T, Skrygan M, Scholl L, Sand M, Meyer T, Stockfleth E, Bechara F. Increased expression profile of NCSTN, Notch and PI3K/AKT3 in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 35:203-210. [DOI: 10.1111/jdv.16962] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/14/2020] [Indexed: 12/27/2022]
Affiliation(s)
- S. Hessam
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
- Department of Dermatology and Phlebology Katharinen‐Hospital Unna Unna Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - M. Skrygan
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - L. Scholl
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - M. Sand
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
- Department of Plastic and Reconstructive Surgery St. Josef‐Hospital Essen‐Kupferdreh Germany
| | - T. Meyer
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - F.G. Bechara
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
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35
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Keeping S, Xu Y, Chen CI, Cope S, Mojebi A, Kuznik A, Konidaris G, Ayers D, Sasane M, Allen R, Huynh TMT, Popoff E, Freeman M, Andria ML, Fury MG, Singh K, Stockfleth E, Challapalli A, Schmults CD. Comparative efficacy of cemiplimab versus other systemic treatments for advanced cutaneous squamous cell carcinoma. Future Oncol 2020; 17:611-627. [PMID: 33052055 DOI: 10.2217/fon-2020-0823] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: To estimate the comparative efficacy of cemiplimab, a programmed cell death protein 1 inhibitor, versus EGFR inhibitors, pembrolizumab and platinum-based chemotherapy in terms of overall survival (OS) and progression-free survival. Patients & methods: We performed an indirect treatment comparison of cemiplimab and other available systemic therapies for patients with advanced cutaneous squamous cell carcinoma. Results: Cemiplimab was associated with benefits in OS (hazard ratios range: 0.07-0.52) and progression-free survival (hazard ratios range: 0.30-0.67) versus EGFR inhibitors and pembrolizumab (data from KEYNOTE-629). Cemiplimab was more efficacious versus platinum-based chemotherapy in terms of OS. Conclusion: Cemiplimab may offer improvements in survival for advanced cutaneous squamous cell carcinoma patients compared with existing systemic therapies.
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Affiliation(s)
- Sam Keeping
- Precision HEOR, Vancouver, BC V6H 3Y4, Canada
| | - Yingxin Xu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | - Ali Mojebi
- Precision HEOR, Vancouver, BC V6H 3Y4, Canada
| | - Andreas Kuznik
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | | | | | | | | | - Evan Popoff
- Precision HEOR, Vancouver, BC V6H 3Y4, Canada
| | | | | | - Matthew G Fury
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | - Eggert Stockfleth
- Department of Dermatology, University of Bochum, 44801 Bochum, Germany
| | - Amarnath Challapalli
- Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8ED, UK
| | - Chrysalyne D Schmults
- Brigham & Women's/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
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36
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Gellrich FF, Hüning S, Beissert S, Eigentler T, Stockfleth E, Gutzmer R, Meier F. Medical treatment of advanced cutaneous squamous-cell carcinoma. J Eur Acad Dermatol Venereol 2020; 33 Suppl 8:38-43. [PMID: 31833610 DOI: 10.1111/jdv.16024] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/21/2019] [Indexed: 01/23/2023]
Abstract
Considering the rising incidence, cutaneous squamous-cell carcinoma (cSCC) has a high clinical relevance. In patients with localized cSCC, complete surgical resection is indicated. Radiotherapy should be performed in patients with non-resectable tumours or in patients who are not suitable for surgery. Systemic therapy is reserved for cSCC that are neither surgically nor radiotherapeutically curable due to their extensive local spread and/or local or distant metastasis. In the absence of prospective randomized phase 3 trials to evaluate and compare the efficacy and safety of chemotherapeutics, epidermal growth factor receptor (EGFR) inhibitors and anti-PD-1 antibodies, no final recommendation for systemic therapy can be given for patients with locally advanced or metastatic cSCC. Anti-PD-1 antibodies currently show promising results with response rates of up to 50% in both locally advanced and metastatic cSCC. Anti-PD-1 antibodies appear to achieve higher response rates compared with EGFR inhibitors, and the duration of response appears to be superior to both chemotherapy and EGFR inhibitors. Compared with chemotherapy, the side effect profile of anti-PD-1 antibodies appears to be favourable. Altogether, PD-1 inhibitors are expected to become the new standard of care for patients with locally advanced and metastatic cSCC. Currently, placebo-controlled clinical trials are investigating the adjuvant use of cemiplimab and pembrolizumab in patients undergoing resection and radiotherapy of high-risk cSCC. Patients not eligible for anti-PD-1 treatment, e.g. in organ transplant recipients, or in patients refractory to anti-PD-1 may be offered EGFR inhibitors and/or chemotherapies. Chemotherapies appear to be superior to EGFR inhibitors in terms of response rates, whereas EGFR inhibitors have a more favourable toxicity profile. EGFR inhibitors are therefore more suitable for multimorbid and/or frail elderly patients. By combining EGFR inhibitors with local therapy such as surgery or radiotherapy, response rates and duration of response may be improved.
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Affiliation(s)
- F F Gellrich
- Dermatology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Dresden, Germany
| | - S Hüning
- Dermatology, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - S Beissert
- Dermatology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Dresden, Germany
| | - T Eigentler
- Dermatology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - E Stockfleth
- Dermatology and Allergology, University of Bochum, Bochum, Germany
| | - R Gutzmer
- Department of Dermatology and Allergy, Skin Cancer Center, Hannover Medical School, Hannover, Germany
| | - F Meier
- Dermatology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Dresden, Germany
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Dejonckheere G, Suppa M, Del Marmol V, Meyer T, Stockfleth E. The actinic dysplasia syndrome - diagnostic approaches defining a new concept in field carcinogenesis with multiple cSCC. J Eur Acad Dermatol Venereol 2020; 33 Suppl 8:16-20. [PMID: 31833608 DOI: 10.1111/jdv.15949] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/23/2019] [Indexed: 12/19/2022]
Abstract
Usually, SCC lesions are surrounded by a number of clinically visible and non-visible (subclinical) areas of actinically damaged skin containing cells with dysplasia, and thus may be designated actinic dysplasia syndrome. The epithelial damage is caused mainly by UV radiation, inducing mutations in keratinocytes that may confer growth advantages resulting in preneoplastic fields. The development of visible dysplastic lesions (actinic keratosis - AK) and subsequent progression to invasive SCC requires further mutations in cancer-associated genes, like tumour suppressor genes and cell cycle regulators. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) represent a considerable advantage for the investigation of field cancerization. In addition, imaging allows the non-invasive monitoring of topical treatments for AKs. RCM provides in vivo horizontal skin sections with a high, 1-μm lateral resolution (similar to histopathology) but with a limited penetration (about 200 μm), which can hamper the visualization of important areas such as the dermal-epidermal junction. Conventional OCT has better penetration (1-2 mm) at the expense of a more limited resolution (much lower than histopathology). Line-field confocal OCT (LC-OCT) combines the high precision of RCM and the good penetration of OCT in a single device and therefore appears to be very useful in diagnosing/managing AKs.
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Affiliation(s)
- G Dejonckheere
- Department of Dermatology and Venerology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - M Suppa
- Department of Dermatology and Venerology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - V Del Marmol
- Department of Dermatology and Venerology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - T Meyer
- Department of Dermatology, Venerology and Allergology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Venerology and Allergology, St. Josef Hospital, Ruhr-University, Bochum, Germany
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Gambichler T, Steuke AK, Schmitz L, Stockfleth E, Becker JC. Altered hydroxymethylation in cutaneous squamous cell carcinoma and keratoacanthoma. Br J Dermatol 2020; 183:955-957. [PMID: 32407588 DOI: 10.1111/bjd.19219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - A-K Steuke
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Schmitz
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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39
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Hessam S, Gambichler T, Höxtermann S, Skrygan M, Sand M, Garcovich S, Meyer T, Stockfleth E, Bechara F. Frequency of circulating subpopulations of T‐regulatory cells in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 34:834-838. [DOI: 10.1111/jdv.16071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022]
Affiliation(s)
- S. Hessam
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - S. Höxtermann
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - M. Skrygan
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - M. Sand
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
- Department of Plastic and Reconstructive Surgery St. Josef‐Hospital Essen‐Kupferdreh Germany
| | - S. Garcovich
- Institute of Dermatology F. Policlinico Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - T. Meyer
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
| | - F.G. Bechara
- Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum Bochum Germany
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Leiter U, Heppt MV, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies R, Ulrich C, Welzel J, Wermker K, Garbe C, Berking C. S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma (cSCC) – short version, part 2: epidemiology, surgical and systemic treatment of cSCC, follow‐up, prevention and occupational disease. J Dtsch Dermatol Ges 2020; 18:400-413. [DOI: 10.1111/ddg.14072] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Ulrike Leiter
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Markus V. Heppt
- Department of Dermatology and AllergologyUniversity Medical Center LMU Munich Munich Germany
- Department of DermatologyFriedrich Alexander University of Erlangen‐Nuremberg Erlangen Germany
| | - Theresa Steeb
- Department of Dermatology and AllergologyUniversity Medical Center LMU Munich Munich Germany
- Department of DermatologyFriedrich Alexander University of Erlangen‐Nuremberg Erlangen Germany
| | - Teresa Amaral
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Andrea Bauer
- Department of DermatologyCarl Gustav Carus University Medical Center Dresden Germany
| | - Jürgen C. Becker
- Department of DermatologyEssen University Medical Center Essen Germany
| | | | - Helmut Breuninger
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Thomas Diepgen
- Institute for Clinical Social MedicineHeidelberg University Medical Center Heidelberg Germany
| | - Thomas Dirschka
- CentroDerm Clinic and Medical Faculty of Witten Herdecke University Wuppertal Germany
| | - Thomas Eigentler
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Michael Flaig
- Department of Dermatology and AllergologyUniversity Medical Center LMU Munich Munich Germany
| | | | | | | | - Ralf Gutzmer
- Department of Dermatology and AllergyHanover Medical School Hanover Germany
| | - Uwe Hillen
- Department of Dermatology and VenereologyVivantes Medical Center Berlin‐Neukölln Germany
| | | | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück Osnabrück Germany
| | - Oliver Kölbl
- Department of Radiation OncologyRegensburg University Medical Center Regensburg Germany
| | | | - Christoph Löser
- Department of DermatologyLudwigshafen Medical Center Ludwigshafen Germany
| | - Dorothee Nashan
- Department of DermatologyDortmund Medical Center Dortmund Germany
| | - Seema Noor
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Monika Nothacker
- Association of Scientific Medical Societies in Germany (AWMF) Berlin Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional RadiologyUniversity Medical Center Tübingen Germany
| | | | - Lutz Schmitz
- Department of DermatologyRuhr University of Bochum Bochum Germany
| | | | - Rolf‐Markus Szeimies
- Department of DermatologyKnappschaftskrankenhaus Recklinghausen Recklinghausen Germany
| | - Claas Ulrich
- Department of DermatologyCharité University Medical Center Berlin Germany
| | - Julia Welzel
- Department of Dermatology and AllergologyUniversity of Augsburg Augsburg Germany
| | - Kai Wermker
- Department of Oral and Maxillofacial SurgeryOsnabrück Medical Center Osnabrück Germany
| | - Claus Garbe
- Department of DermatologyEberhard Karls University of Tübingen Tübingen Germany
| | - Carola Berking
- Department of Dermatology and AllergologyUniversity Medical Center LMU Munich Munich Germany
- Department of DermatologyFriedrich Alexander University of Erlangen‐Nuremberg Erlangen Germany
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Leiter U, Heppt MV, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Welzel J, Wermker K, Garbe C, Berking C. S3‐Leitlinie „Aktinische Keratose und Plattenepithelkarzinom der Haut“ – Kurzfassung, Teil 2: Epidemiologie, chirurgische und systemische Therapie des Plattenepithelkarzinoms, Nachsorge, Prävention und Berufskrankheit. J Dtsch Dermatol Ges 2020; 18:400-413. [PMID: 32291932 DOI: 10.1111/ddg.14072_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ulrike Leiter
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Markus V Heppt
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München.,Klinik für Dermatologie, Universitätsklinikum Erlangen
| | - Theresa Steeb
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München
| | - Teresa Amaral
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Andrea Bauer
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Helmut Breuninger
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Thomas Diepgen
- Institut für klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Michael Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München
| | | | | | | | - Ralf Gutzmer
- Klinik für Dermatologie, Medizinische Hochschule Hannover
| | - Uwe Hillen
- Klinik für Dermatologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück
| | - Oliver Kölbl
- Klinik für Strahlentherapie, Universitätsklinikum Regensburg
| | | | | | | | - Seema Noor
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin
| | - Christina Pfannenberg
- Klinik für Diagnostische unter Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | | | - Lutz Schmitz
- Klinik für Dermatologie, Ruhr-Universität Bochum
| | | | | | - Claas Ulrich
- Klinik für Dermatologie, Charité - Universitätsmedizin Berlin
| | | | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum Osnabrück
| | - Claus Garbe
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Carola Berking
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München.,Klinik für Dermatologie, Universitätsklinikum Erlangen
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42
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Heppt MV, Leiter U, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Welzel J, Wermker K, Berking C, Garbe C. S3‐Leitlinie „Aktinische Keratose und Plattenepithelkarzinom der Haut“ – Kurzfassung, Teil 1: Diagnostik, Interventionen bei aktinischen Keratosen, Versorgungsstrukturen und Qualitätsindikatoren. J Dtsch Dermatol Ges 2020; 18:275-294. [PMID: 32130769 DOI: 10.1111/ddg.14048_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Markus V Heppt
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München.,Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
| | - Ulrike Leiter
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Theresa Steeb
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Teresa Amaral
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - Jürgen C Becker
- Klinik für Dermatologie, Deutsches Konsortium für translationale Krebsforschung (DKTK), Universitätsklinikum Essen und Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - Eckhard Breitbart
- Arbeitsgemeinschaft Dermatologische Prävention (ADP), e.V., Buxtehude
| | - Helmut Breuninger
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg, Heidelberg
| | | | - Thomas Eigentler
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Michael Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | | | | | - Rüdiger Greinert
- Arbeitsgemeinschaft Dermatologische Prävention (ADP), e.V., Buxtehude
| | - Ralf Gutzmer
- Hauttumorzentrum Hannover, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover
| | - Uwe Hillen
- Klinik für Dermatologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Osnabrück
| | - Oliver Kölbl
- Klinik für Strahlentherapie, Universitätsklinikum Regensburg, Regensburg
| | | | - Christoph Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen, Ludwigshafen
| | | | - Seema Noor
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin
| | - Christina Pfannenberg
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen
| | | | - Lutz Schmitz
- Klinik für Dermatologie, Ruhr-Universität Bochum, Bochum
| | | | | | - Claas Ulrich
- Klinik für Dermatologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universität sklinikum Augsburg, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum Osnabrück, Osnabrück
| | - Carola Berking
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München.,Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
| | - Claus Garbe
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
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Abstract
Introduction: Actinic keratosis (AK) is a chronic disease which is mainly located across areas of sun-exposed skin. Clinical and subclinical lesions coexist across a large area resulting in a field cancerization. As these lesions have the potential to transform into invasive squamous cell carcinoma (iSCC), treatment is crucial. With global prevalence increasing, AK is expected to be the most common in situ carcinoma of the skin.Areas covered: In this article, we cover the established algorithm of treating AK and give an insight into the drugs under development. There are six compounds under development covering different treatment angles, from Sinecatechin a Polyphenon E which targets the link between HPV infection and development of AK, over Tirbanibulin which targets the SRC proto-oncogene and fast proliferating cells, to Tuvatexib a small-molecule dual VDAC/HK2 modulator that has shown that it can compete with the established therapies.Expert opinion: These new treatment options are moving us further toward a more individually tailored treatment for each patient considering his abilities, the size and location of his lesions but also the genetic bases as well as individual risk of transforming into a iSCC and possibly other factors contributing to each patients individual AK lesions.
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Affiliation(s)
- Philipp Cramer
- St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Eggert Stockfleth
- St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Bochum, Germany
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Gambichler T, Ardabili S, Lang K, Dreißigacker M, Scheel C, Brand-Saberi B, Skrygan M, Stockfleth E, Käfferlein HU, Brüning T, Becker JC. Expression of Lefty predicts Merkel cell carcinoma-specific death. J Eur Acad Dermatol Venereol 2020; 34:2016-2020. [PMID: 32022949 DOI: 10.1111/jdv.16271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/27/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Lefty and Nodal are transforming growth factor β-related proteins, which, beside their role in determination of laterality during embryogenesis, have also been linked with cancer progression. OBJECTIVES Prompted by the observed significant left-sided laterality of Merkel cell carcinoma (MCC), we addressed whether Lefty and Nodal are expressed in MCC and correlated expression patterns with clinical parameters such as MCC laterality and patient outcome. METHODS Expression of Lefty and Nodal in primary MCC was assessed in 29 patients by immunohistochemistry. The histology (H-)score was calculated and correlated with clinical parameters. RESULTS The median (range) H-score of Lefty and Nodal was 17.6 (0-291) and 74.9 (0.7-272), respectively. There was a significant correlation between Lefty expression and Nodal expression (correlation coefficient of 0.60, P = 0.0006). There was no significant correlation between Lefty expression and Nodal expression with either tumour laterality, gender, age, Merkel cell polyomavirus status, disease stage, anatomical localization of primary tumours or disease relapse. On univariate analysis, low Lefty expression and Nodal expression were significantly associated with MCC-specific death (P = 0.010 and P = 0.019, respectively). On univariate analysis, low Lefty expression was the only significant independent predictor for MCC-specific death (P = 0.025) as indicated by an odds ratio of 14 (95% CI: 1.43-137.33). CONCLUSIONS Lefty and Nodal are frequently expressed in MCC, but not correlated with tumour laterality. Importantly, our data suggest that a low level of Lefty expression in primary MCC is a strong predictor of MCC-specific death.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - S Ardabili
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - K Lang
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - M Dreißigacker
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - C Scheel
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - B Brand-Saberi
- Department of Anatomy and Molecular Embryology, Medical Faculty, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - H U Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurances, Ruhr-University Bochum (IPA), Bochum, Germany
| | - J C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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45
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Lear JT, Hauschild A, Stockfleth E, Squittieri N, Basset-Seguin N, Dummer R. Efficacy and Safety of Sonidegib in Adult Patients with Nevoid Basal Cell Carcinoma Syndrome (Gorlin Syndrome): Results from a Phase 2, Double-Blind, Randomized Trial. Clin Cosmet Investig Dermatol 2020; 13:117-121. [PMID: 32104037 PMCID: PMC7008063 DOI: 10.2147/ccid.s233097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022]
Affiliation(s)
| | - Axel Hauschild
- Klinik Für Dermatologie, Venerologie Und Allergologie Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Gambichler T, Susok L, Fels M, Schneider‐Gold C, Hof zum Berge F, Stockfleth E, Ayzenberg I. Autoimmune radiculoplexus neuropathy under adjuvant nivolumab treatment of a female patient with melanoma. Br J Dermatol 2020; 182:246-247. [DOI: 10.1111/bjd.18358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T. Gambichler
- Skin Cancer Center Ruhr‐University Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - L. Susok
- Skin Cancer Center Ruhr‐University Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - M. Fels
- Department of Neurology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - C. Schneider‐Gold
- Department of Neurology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - F. Hof zum Berge
- Department of Neurology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - E. Stockfleth
- Skin Cancer Center Ruhr‐University Department of Dermatology, Venereology and Allergology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
| | - I. Ayzenberg
- Department of Neurology Ruhr‐University Bochum St Josef Hospital Gudrunstraße 56 44791 Bochum Germany
- Department of Neurology Sechenov First Moscow State Medical University Moscow Russia
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Stockfleth E. Hautkrebs, eine Volkskrankheit. J Dtsch Dermatol Ges 2019; 17:1221-1222. [PMID: 31885169 DOI: 10.1111/ddg.13993_g] [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: 11/30/2022]
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Gambichler T, Schröter U, Höxtermann S, Susok L, Stockfleth E, Becker JC. Decline of programmed death-1-positive circulating T regulatory cells predicts more favourable clinical outcome of patients with melanoma under immune checkpoint blockade. Br J Dermatol 2019; 182:1214-1220. [PMID: 31361026 DOI: 10.1111/bjd.18379] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of T regulatory lymphocytes (Tregs) and their immunosuppressive mechanisms in the context of programmed death (PD)-1 blockade is not completely understood. OBJECTIVES To assess the impact of PD-1-blocking antibody treatment on Treg subpopulations in the blood. METHODS We studied circulating Treg subpopulations in patients with melanoma under nivolumab or pembrolizumab treatment using flow cytometry and correlated these findings with clinical outcomes. RESULTS These analyses revealed that the frequency of CD4+ CD25++ CD127- PD-1+ lymphocytes (PD-1+ Tregs) significantly decreased after the first cycle of immunotherapy (23% vs. 8·6%, P = 0·043). Compared with patients who did not show a significant decline of PD-1+ Tregs after the first treatment, those who did had better clinical outcomes with respect to progression-free survival (PFS, P = 0·022) and melanoma-specific death (MSD, P = 0·0038). Multivariate analysis confirmed that a significant decline of PD-1+ Tregs in peripheral blood after the first treatment cycle is a significant predictor of more favourable PFS and MSD (P = 0·04 and 0·017, respectively). Interestingly, the occurrence of immune-related adverse events was also an independent predictor for decreased risk of MSD (P = 0·047; odds ratio 0·064, 95% confidence interval 0·0042-0·97). CONCLUSIONS We provide preliminary evidence that circulating PD-1+ Tregs rapidly decline after the initiation of treatment with PD-1-blocking antibodies, which is associated with reduced risk of melanoma progression and MSD. Patients showing no decrease of these PD-1+ Tregs in peripheral blood are characterized by an impaired response to immune checkpoint blockade and worse outcome. What's already known about this topic? Programmed death (PD)-1-blocking antibodies are highly effective in melanoma treatment. However, more than half of patients do not benefit from this therapy and to date it is difficult to predict which patients will respond to it. What does this study add? PD-1-blocking antibody therapy rapidly results in a decline of circulating PD-1+ T regulatory cells (Tregs). What is the translational message? Patients showing a decrease of PD-1+ Tregs appear to have better clinical outcome under PD-1 treatment.
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Affiliation(s)
- T Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - U Schröter
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - S Höxtermann
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Susok
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J C Becker
- Translational Skin Cancer Research, DKTK Partner Site Essen/Düsseldorf, West German Cancer Center, Dermatology, University Duisburg-Essen, Essen, Germany
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Sand M, Bromba A, Sand D, Gambichler T, Hessam S, Becker JC, Stockfleth E, Meyer T, Bechara FG. Dicer Sequencing, Whole Genome Methylation Profiling, mRNA and smallRNA Sequencing Analysis in Basal Cell Carcinoma. Cell Physiol Biochem 2019; 53:760-773. [PMID: 31647206 DOI: 10.33594/000000171] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND/AIMS Perturbations in the expression of microRNAs (miRNAs) and their maturing machinery components such as Dicer have been previously described for basal cell carcinoma (BCC). However, the mutational status of Dicer in BCC is unclear. Further, the sclerodermiform subtype of BCC (sBCC) has not been previously investigated regarding its methylation profile or its smallRNA expression profile via RNA sequencing. We conducted this study to investigate the mutational status of Dicer in BCC. METHODS Dicer sequencing was performed on the Illumina MiSeq System in a total of 16 BCC samples (8 nodular BCCs, 8 sBCCs) and mapped against the human reference genome (i.e., hg19). Dicer sequencing was performed in all 16 BCC samples. We performed whole genome methylation profiling with Infinium MethylationEPIC BeadChips as well as mRNA and smallRNA sequencing in 5 sBCCs with the Illumina NextSeq500 next-generation sequencing system. RESULTS Compared to the wildtype Dicer sequence, we found 5 to 7 variants per sBCC sample including insertion, deletion, and multiple nucleotide variants. Global methylation profiles were highly similar between groups. mRNA sequencing revealed S100A9, KRT14, KRT10, S100A8, S100A7, COX1, KRT1, COX3, and smallRNA sequencing analysis miR-21, miR-99a, miR26-a-2, let-7f, let-7g, let-7i, miR-100, and miR-205 were the most strongly expressed in sBCCs. CONCLUSION We identified a variety of Dicer mutations that could play a role in aberrant miRNA expression in BCC. The noted RNA sequences should be further evaluated in functional studies to explore their potential pathogenetic role in sBCC.
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Affiliation(s)
- Michael Sand
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany.,Department of Plastic Surgery, St. Josef Hospital, Catholic Clinics of the Ruhr Peninsula, Essen, Germany,
| | - Annabelle Bromba
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Daniel Sand
- Department of Physiological Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Thilo Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Schapoor Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Department of Translational Skin Cancer Research, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Meyer
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
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Gambichler T, Chatzipantazi M, Schröter U, Stockfleth E, Gedik C. Patients with melanoma of unknown primary show better outcome under immune checkpoint inhibitor therapy than patients with known primary: preliminary results. Oncoimmunology 2019; 8:e1677139. [PMID: 31741779 PMCID: PMC6844308 DOI: 10.1080/2162402x.2019.1677139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/13/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Melanoma of unknown primary (MUP) is an uncommon clinical subtype of melanoma of known primary (MKP). Objectives: We aimed to compare treatment outcomes of MUP and MKP patients who had undergone therapy with immune checkpoint inhibitors (ICPI). Methods: We studied 41 metastatic melanoma patients (32 with MKP and 9 with MUP) with an indication for ICPI. Results: Clinical characteristics such as age, gender, stage of disease, etc., did not significantly differ (P < .05) between MUP and MKP patients. 20/32 (62.5%) melanoma-specific deaths (MSD) were observed in the MKP group, whereas 2/9 (22.2%) were detected in the MUP group (P = .035). On logistic regression, the MUP status proved to be an independent predictor for a more favorable outcome under immunotherapy when compared to MKP (P = .030). Conclusion: Our preliminary results indicate that MUP patients show better clinical outcome under ICPI when compared to MKP.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Maria Chatzipantazi
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Ulrike Schröter
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Cansu Gedik
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
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