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Mattia A, Thompson A, Lee SK, Hong HG, Green WH, Cognetta AB. Superficial X-ray in the treatment of nonaggressive basal and squamous cell carcinoma in the elderly: A 22-year retrospective analysis. J Am Acad Dermatol 2024; 90:1052-1054. [PMID: 38224912 PMCID: PMC11015976 DOI: 10.1016/j.jaad.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/17/2024]
Affiliation(s)
| | - Anthony Thompson
- Florida State University College of Medicine, Tallahassee, Florida
| | - Sang Kyu Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland; Department of Statistics and Probability, Michigan State University, East Lansing, Michigan
| | - Hyokyoung G Hong
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Sarracco G, Rinaldi F, Cusano F. A case of grade 3 squamous cell carcinoma successfully treated with methotrexate. Dermatol Reports 2024; 16:9647. [PMID: 38623368 PMCID: PMC11017714 DOI: 10.4081/dr.2024.9647] [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: 12/16/2022] [Accepted: 01/10/2023] [Indexed: 04/17/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is a non-melanoma skin cancer whose lesions mostly arise on light-exposed sites. Patients with compromised immunity, Fitzpatrick I or II skin phototype, and previous burn scars or radiations are more at risk of developing it. The treatment of choice for cSCC is surgery; however nonsurgical options are generally reserved for patients who refuse a very invasive treatment or cannot tolerate a surgical procedure. We report a case of cSCC successfully treated with intralesional methotrexate.
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Kowalski S, Karska J, Tota M, Skinderowicz K, Kulbacka J, Drąg-Zalesińska M. Natural Compounds in Non-Melanoma Skin Cancer: Prevention and Treatment. Molecules 2024; 29:728. [PMID: 38338469 PMCID: PMC10856721 DOI: 10.3390/molecules29030728] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/27/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
The elevated occurrence of non-melanoma skin cancer (NMSC) and the adverse effects associated with available treatments adversely impact the quality of life in multiple dimensions. In connection with this, there is a necessity for alternative approaches characterized by increased tolerance and lower side effects. Natural compounds could be employed due to their safety profile and effectiveness for inflammatory and neoplastic skin diseases. These anti-cancer drugs are often derived from natural sources such as marine, zoonotic, and botanical origins. Natural compounds should exhibit anti-carcinogenic actions through various pathways, influencing apoptosis potentiation, cell proliferation inhibition, and metastasis suppression. This review provides an overview of natural compounds used in cancer chemotherapies, chemoprevention, and promotion of skin regeneration, including polyphenolic compounds, flavonoids, vitamins, alkaloids, terpenoids, isothiocyanates, cannabinoids, carotenoids, and ceramides.
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Affiliation(s)
- Szymon Kowalski
- Faculty of Medicine, Wroclaw Medical University, Pasteura 1, 50-367 Wroclaw, Poland; (S.K.); (M.T.); (K.S.)
| | - Julia Karska
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10, 50-367 Wroclaw, Poland;
| | - Maciej Tota
- Faculty of Medicine, Wroclaw Medical University, Pasteura 1, 50-367 Wroclaw, Poland; (S.K.); (M.T.); (K.S.)
| | - Katarzyna Skinderowicz
- Faculty of Medicine, Wroclaw Medical University, Pasteura 1, 50-367 Wroclaw, Poland; (S.K.); (M.T.); (K.S.)
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre for Innovative Medicine, Santariškių 5, 08410 Vilnius, Lithuania
| | - Małgorzata Drąg-Zalesińska
- Department of Human Morphology and Embryology, Division of Histology and Embryology, Faculty of Medicine, Wroclaw Medical University, T. Chalubińskiego 6a, 50-368 Wroclaw, Poland;
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Cassalia F, Danese A, Tudurachi I, Federico S, Zambello A, Guidotti A, Franceschin L, Bolzon A, Naldi L, Belloni Fortina A. PRAME Updated: Diagnostic, Prognostic, and Therapeutic Role in Skin Cancer. Int J Mol Sci 2024; 25:1582. [PMID: 38338862 PMCID: PMC10855739 DOI: 10.3390/ijms25031582] [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: 12/31/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Preferentially Expressed Antigen in Melanoma (PRAME), a member of the cancer/testis antigen family, is central to the field of skin cancer diagnostics and therapeutics. As a nuclear receptor and transcriptional regulator, PRAME plays a critical role in inhibiting retinoic acid signalling, which is essential for cell differentiation and proliferation. Its aberrant overexpression in various malignancies, particularly cutaneous melanoma, is associated with more aggressive tumour phenotypes, positioning PRAME as both a diagnostic and prognostic marker. In melanoma, PRAME is typically highly expressed, in contrast to its weak or absent expression in benign nevi, thereby improving the accuracy of differential diagnoses. The diagnostic value of PRAME extends to various lesions. It is significantly expressed in uveal melanoma, correlating to an increased risk of metastasis. In acral melanomas, especially those with histopathological ambiguity, PRAME helps to improve diagnostic accuracy. However, its expression in spitzoid and ungual melanocytic lesions is inconsistent and requires a comprehensive approach for an accurate assessment. In soft tissue sarcomas, PRAME may be particularly helpful in differentiating melanoma from clear cell sarcoma, an important distinction due to their similar histological appearance but different treatment approaches and prognosis, or in detecting dedifferentiated and undifferentiated melanomas. In non-melanoma skin cancers such as basal cell carcinoma, squamous cell carcinoma, and Merkel cell carcinoma, the variable expression of PRAME can lead to diagnostic complexity. Despite these challenges, the potential of PRAME as a therapeutic target in melanoma is significant. Emerging immunotherapies, including T-cell-based therapies and vaccines targeting PRAME, are being investigated to exploit its cancer-specific expression. Ongoing research into the molecular role and mechanism of action of PRAME in skin cancer continues to open new avenues in both diagnostics and therapeutics, with the potential to transform the management of melanoma and related skin cancers.
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Affiliation(s)
- Fortunato Cassalia
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (I.T.); (A.Z.); (A.G.); (L.F.); (A.B.); (A.B.F.)
| | - Andrea Danese
- Dermatology Unit, Department of Integrated Medical and General Activity, University of Verona, 37100 Verona, Italy;
| | - Ina Tudurachi
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (I.T.); (A.Z.); (A.G.); (L.F.); (A.B.); (A.B.F.)
| | - Serena Federico
- Dermatology Unit, University of Magna Graecia, 88100 Catanzaro, Italy;
| | - Anna Zambello
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (I.T.); (A.Z.); (A.G.); (L.F.); (A.B.); (A.B.F.)
| | - Alessia Guidotti
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (I.T.); (A.Z.); (A.G.); (L.F.); (A.B.); (A.B.F.)
| | - Ludovica Franceschin
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (I.T.); (A.Z.); (A.G.); (L.F.); (A.B.); (A.B.F.)
| | - Anna Bolzon
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (I.T.); (A.Z.); (A.G.); (L.F.); (A.B.); (A.B.F.)
| | - Luigi Naldi
- Department of Dermatology, Ospedale San Bortolo, 36100 Vicenza, Italy;
- Centro Studi Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED), 24121 Bergamo, Italy
| | - Anna Belloni Fortina
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy; (I.T.); (A.Z.); (A.G.); (L.F.); (A.B.); (A.B.F.)
- Pediatric Dermatology Department of Women’s and Child’s Health (SDB), University of Padua, 35121 Padua, Italy
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Donohue C, Salusti-Simpson M, Bombardier N, Weinberger CH. Basal cell carcinoma arising at the site of a previously irradiated infantile hemangioma. Pediatr Dermatol 2024; 41:145-147. [PMID: 37525410 DOI: 10.1111/pde.15403] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
We describe a case of a previously irradiated infantile hemangioma in a patient 1 year of age. At the age of 78, the patient presented with a pink, pearly plaque at the previously irradiated infantile hemangioma site and was found to have a nodular basal cell carcinoma. [Correction added on 30 August 2023, after first online publication: In the preceding sentence, patient age has been corrected in this version] This case highlights the rare, but long-term risks of radiation therapy for hemangiomas, but also presents an interesting historical vignette in dermatological treatments, with photographic documentation. It also represents the longest time interval between irradiation of an infantile hemangioma and the development of a basal cell skin cancer, 70 years in this case.
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Affiliation(s)
- Caroline Donohue
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - Nathan Bombardier
- Division of Dermatology, University of Vermont Medical Center, Burlington, Vermont, USA
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Eedara BB, Manivannan B, Alabsi W, Sun B, Curiel-Lewandrowski C, Zhang T, Bode AM, Mansour HM. Comprehensive Physicochemical Characterization, In Vitro Membrane Permeation, and In Vitro Human Skin Cell Culture of a Novel TOPK Inhibitor, HI-TOPK-032. Int J Mol Sci 2023; 24:15515. [PMID: 37958502 PMCID: PMC10650786 DOI: 10.3390/ijms242115515] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Nonmelanoma skin cancers (NMSC) are the most common skin cancers, and about 5.4 million people are diagnosed each year in the United States. A newly developed T-lymphokine-activated killer cell-originated protein kinase (TOPK) inhibitor, HI-TOPK-032, is effective in suppressing colon cancer cell growth, inducing the apoptosis of colon cancer cells and ultraviolet (UV) light-induced squamous cell carcinoma (SCC). This study aimed to investigate the physicochemical properties, permeation behavior, and cytotoxicity potential of HI-TOPK-032 prior to the development of a suitable topical formulation for targeted skin drug delivery. Techniques such as scanning electron microscopy (SEM), energy-dispersive X-ray (EDX) spectroscopy, differential scanning calorimetry (DSC), hot-stage microscopy (HSM), X-ray powder diffraction (XRPD), Karl Fisher (KF) coulometric titration, Raman spectrometry, confocal Raman microscopy (CRM), attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR), and Fourier transform infrared microscopy were used to characterize HI-TOPK-032. The dose effect of HI-TOPK-032 on in vitro cell viability was evaluated using a 2D cell culture of the human skin keratinocyte cell line (HaCaT) and primary normal human epidermal keratinocytes (NHEKs). Transepithelial electrical resistance (TEER) at the air-liquid interface as a function of dose and time was measured on the HaCAT human skin cell line. The membrane permeation behavior of HI-TOPK-032 was tested using the Strat-M® synthetic biomimetic membrane with an in vitro Franz cell diffusion system. The physicochemical evaluation results confirmed the amorphous nature of the drug and the homogeneity of the sample with all characteristic chemical peaks. The in vitro cell viability assay results confirmed 100% cell viability up to 10 µM of HI-TOPK-032. Further, a rapid, specific, precise, and validated reverse phase-high performance liquid chromatography (RP-HPLC) method for the quantitative estimation of HI-TOPK-032 was developed. This is the first systematic and comprehensive characterization of HI-TOPK-032 and a report of these findings.
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Affiliation(s)
- Basanth Babu Eedara
- Center for Translational Science, Florida International University, Port St. Lucie, FL 34987, USA; (B.B.E.); (B.M.)
| | - Bhagyashree Manivannan
- Center for Translational Science, Florida International University, Port St. Lucie, FL 34987, USA; (B.B.E.); (B.M.)
| | - Wafaa Alabsi
- Skaggs Pharmaceutical Sciences Center, College of Pharmacy, The University of Arizona, Tucson, AZ 85721, USA; (W.A.); (B.S.)
- Department of Chemistry and Biochemistry, The University of Arizona, Tucson, AZ 85721, USA
| | - Bo Sun
- Skaggs Pharmaceutical Sciences Center, College of Pharmacy, The University of Arizona, Tucson, AZ 85721, USA; (W.A.); (B.S.)
| | - Clara Curiel-Lewandrowski
- Skin Cancer Institute, The University of Arizona Cancer Center, Tucson, AZ 85724, USA;
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ 85724, USA
- Department of Medicine, Division of Dermatology, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA
| | - Tianshun Zhang
- The Hormel Institute, University of Minnesota, Austin, MN 55912, USA; (T.Z.); (A.M.B.)
| | - Ann M. Bode
- The Hormel Institute, University of Minnesota, Austin, MN 55912, USA; (T.Z.); (A.M.B.)
| | - Heidi M. Mansour
- Center for Translational Science, Florida International University, Port St. Lucie, FL 34987, USA; (B.B.E.); (B.M.)
- Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
- Department of Cell Biology & Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
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7
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Tow R, Hanoun S, Andresen B, Shahid A, Wang J, Kelly KM, Meyskens FL, Huang Y. Recent Advances in Clinical Research for Skin Cancer Chemoprevention. Cancers (Basel) 2023; 15:3819. [PMID: 37568635 PMCID: PMC10417305 DOI: 10.3390/cancers15153819] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Neoplasm arising from the keratinocytes or melanocytes in the skin is the most prevalent type of cancer in the United States and worldwide. Since ultraviolet (UV) radiation may be a causing factor for several types of skin cancer, effective strategies to manage skin cancer include preventive measures such as minimizing exposure to UV and applying sunscreens. However, the effect of sunscreen in reducing skin cancer incidence remains uncertain. An alternative approach to prevent skin cancer is chemoprevention, which is defined as using either natural products or synthetic compounds to inhibit, delay, or reverse the development of cancer. Preclinical studies have demonstrated the effectiveness of multiple pharmacological agents and dietary supplements. However, whether preclinical findings can be translated into clinical application is unknown. This review evaluates the state of recent clinical trials investigating chemopreventive agents focusing on skin cancer to compare the target populations, interventions, endpoints, and outcomes of these trials. The ClinicalTrials and PubMed databases were searched for their available literature using the key words "skin cancer" and "chemoprevention". The objective of this review is to provide updated information on the effectiveness and side effects of promising chemopreventive agents in human subjects and to identify research gaps.
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Affiliation(s)
- Ruby Tow
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA; (R.T.); (S.H.); (B.A.); (A.S.); (J.W.)
| | - Samuel Hanoun
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA; (R.T.); (S.H.); (B.A.); (A.S.); (J.W.)
| | - Bradley Andresen
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA; (R.T.); (S.H.); (B.A.); (A.S.); (J.W.)
| | - Ayaz Shahid
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA; (R.T.); (S.H.); (B.A.); (A.S.); (J.W.)
| | - Jeffrey Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA; (R.T.); (S.H.); (B.A.); (A.S.); (J.W.)
| | - Kristen M. Kelly
- Department of Dermatology, University of California, Irvine, CA 92697, USA;
| | - Frank L. Meyskens
- Departments of Medicine and Biological Chemistry, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92868, USA;
| | - Ying Huang
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766, USA; (R.T.); (S.H.); (B.A.); (A.S.); (J.W.)
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Arcuri D, Ramchatesingh B, Lagacé F, Iannattone L, Netchiporouk E, Lefrançois P, Litvinov IV. Pharmacological Agents Used in the Prevention and Treatment of Actinic Keratosis: A Review. Int J Mol Sci 2023; 24:ijms24054989. [PMID: 36902419 PMCID: PMC10003023 DOI: 10.3390/ijms24054989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/31/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Actinic keratosis (AK) is among the most commonly diagnosed skin diseases with potentially life-threatening repercussions if left untreated. Usage of pharmacologic agents represents one of many therapeutic strategies that can be used to help manage these lesions. Ongoing research into these compounds continues to change our clinical understanding as to which agents most benefit particular patient populations. Indeed, factors such as past personal medical history, lesion location and tolerability of therapy only represent a few considerations that clinicians must account for when prescribing appropriate treatment. This review focuses on specific drugs used in either the prevention or treatment of AKs. Nicotinamide, acitretin and topical 5-fluorouracil (5-FU) continue to be used with fidelity in the chemoprevention of actinic keratosis, although some uncertainty persists in regard to which agents should be used in immunocompetent vs. immunodeficient/immunosuppressed patients. Topical 5-FU, including combination formulations with either calcipotriol or salicylic acid, as well as imiquimod, diclofenac and photodynamic light therapy are all accepted treatment strategies employed to target and eliminate AKs. Five percent of 5-FU is regarded as the most effective therapy in the condition, although the literature has conflictingly shown that lower concentrations of the drug might also be as effective. Topical diclofenac (3%) appears to be less efficacious than 5% 5-FU, 3.75-5% imiquimod and photodynamic light therapy despite its favorable side effect profile. Finally, traditional photodynamic light therapy, while painful, appears to be of higher efficacy in comparison to its more tolerable counterpart, daylight phototherapy.
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Affiliation(s)
- Domenico Arcuri
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | | | - François Lagacé
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | - Lisa Iannattone
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | | | | | - Ivan V. Litvinov
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
- Division of Dermatology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- Correspondence:
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Ansorge C, Miocic JM, Schauer F. Skin diseases in hospitalized geriatrics: a 9-year analysis from a University Dermatology Center in Germany. Arch Dermatol Res 2022; 314:427-437. [PMID: 34076756 PMCID: PMC9163006 DOI: 10.1007/s00403-021-02244-9] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/24/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
The demographic trend of an ageing society is mirrored in the rising number of hospitalized geriatric patients in Germany. However, there is still a wide gap of knowledge regarding the dermatological diseases, comorbidities and performed procedures within this growingly important group of patients. The study was conducted as a retrospective monocentric data analysis of all patients 65 years or older from the Department of Dermatology, Medical Center-University of Freiburg, Germany. In total, 10,009 individual hospitalisations were included from 2009 to 2017, and there was a notable increase of geriatric patients in the study period. This study illustrates the following: leading major diagnoses included malignant neoplasm of the head and neck, ulcerated and non-ulcerated inflammatory spectrum of chronic venous insufficiency, whereas angina pectoris, type 2 diabetes and cardiac diseases were noted most frequently as secondary diagnoses. Patients with venous diseases had considerably more often cardiopulmonary minor diagnoses, whereas endocrine diagnoses peaked in the cohort of patients with psoriasis and psychiatric and muscululoskeletal disorders in patients with bullous dieseases. Moh's surgery, dressings and multimodal dermatological treatments were the most often encoded procedures.
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Affiliation(s)
- Claudia Ansorge
- Department of Dermatology and Venereology, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstraße 7, 79104, Freiburg, Germany
| | - Johannes M Miocic
- Institute of Earth and Environmental Sciences, University of Freiburg, Freiburg, Germany
- Geo-Energy, Energy and Sustainability Research Institute Groningen, University of Groningen, Nijenborgh 6, 9747 AG, Groningen, The Netherlands
| | - Franziska Schauer
- Department of Dermatology and Venereology, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstraße 7, 79104, Freiburg, Germany.
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Ramelyte E, Restivo G, Mannino M, Levesque MP, Dummer R. Advances in the drug management of basal cell carcinoma. Expert Opin Pharmacother 2022; 23:573-582. [PMID: 35081851 DOI: 10.1080/14656566.2022.2032646] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common skin cancer in humans. Recently, BCCs were suggested to be classified into 'easy to treat' and 'difficult to treat,' and different therapeutic options are suggested for their management. AREAS COVERED In this review, the authors discuss treatment options that are approved, recommended for, or are still in development for treatment of BCC. The review covers approved local therapies, such as imiquimod and 5-fluorouracil, and systemic therapies, such as hedgehog inhibitors. New medical agents, investigated in clinical trials, are reviewed. These include: targeted therapies, such as GLI antagonists or anti-VEGFR agents, immunotherapies, such as checkpoint inhibitors, recombinant cytokines or silencing RNA, as well as intralesional virotherapies with modified adeno- or herpes viruses. EXPERT OPINION The progress made in recent years has improved the management of patients with advanced BCC; however, neither tumor targeting nor immune system engaging agents provide a cure. New treatment approaches directed not only to known targets but also the tumor microenvironment are in development and are anticipated to improve the management of difficult to treat BCC.
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Affiliation(s)
- Egle Ramelyte
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Gaetana Restivo
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Maria Mannino
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Mitchell P Levesque
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Tamas T, Baciut M, Nutu A, Bran S, Armencea G, Stoia S, Manea A, Crisan L, Opris H, Onisor F, Baciut G, Crisan B, Opris D, Bumbu B, Tamas A, Dinu C. Is miRNA Regulation the Key to Controlling Non-Melanoma Skin Cancer Evolution? Genes (Basel) 2021; 12:1929. [PMID: 34946878 DOI: 10.3390/genes12121929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
Non melanoma skin cancer (NMSC) is one of the most common types of skin cancer. It has a number of subtypes, which include basal cell carcinoma, cutaneous squamous cell carcinoma and Merkel cell carcinoma. MicroRNAs are short, non-coding RNA (ribonucleic acid) molecules, capable of regulating gene expression at a post transcriptional level. They play a pivotal role in a variety of physiologic cellular functions and pathologies, including malignant diseases. The development of miRNAs represents an important study field, which has been extensively exploited in melanoma for almost a decade with promising results, therefore we consider it a stepstone for further research projects also in non-melanoma skin cancers. The aim of our study was to explore the current literature in order to present the role of the different miRNAs in some of the most frequent types of NMSC pertaining to oncogenesis, evolution and therapy. The most relevant and accurate available data from the literature were evaluated. Our study concluded that there are almost 100 miRNAs which can be upregulated or downregulated and can play a role in oncogenesis. They can be easily identified in circulation, are stable and they can be important diagnosis/prognosis and therapy monitoring markers.
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Abstract
Purpose of Review The therapeutic landscape for non-melanoma skin cancer (NMSC) has recently expanded with the development of effective and targeted immunotherapy. Here, we provide an overview of the role of immunotherapy in the management of advanced cutaneous carcinomas. Recent Findings Several agents were recently U.S. Food and Drug Administration (FDA)-approved for the treatment of locally advanced and metastatic cutaneous squamous cell carcinoma, Merkel cell carcinoma, and basal cell carcinoma. However, recent approvals in tissue-agnostic indications may also benefit other NMSCs including cutaneous adnexal solid tumors with high tumor mutation burdens or microsatellite instability. Furthermore, while FDA-approved indications will likely continue to expand, continued studies are needed to support the role of immunotherapy in the neoadjuvant, adjuvant, and refractory settings. Summary Immunotherapy is emerging as the standard of care for several advanced NMSCs not amenable to surgery and radiation. Ongoing evaluation of the clinical trial landscape is needed to optimize enrollment and ensure continued innovation.
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Giovannacci I, Meleti M, Garbarino F, Cesinaro AM, Mataca E, Pedrazzi G, Reggiani C, Paganelli A, Truzzi A, Elia F, Giacomelli L, Magnoni C. Correlation between Autofluorescence Intensity and Histopathological Features in Non-Melanoma Skin Cancer: An Ex Vivo Study. Cancers (Basel) 2021; 13:cancers13163974. [PMID: 34439130 PMCID: PMC8393486 DOI: 10.3390/cancers13163974] [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: 06/30/2021] [Revised: 07/24/2021] [Accepted: 07/29/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Non-melanoma skin cancers (NMSC) are the most prevalent neoplasms worldwide, especially in the Caucasian population. Radical surgical excision is considered the therapeutic gold standard, while incomplete tumor removal is invariably associated with recurrence and the need for reintervention. Autofluorescence (AF) spectroscopy has recently been investigated for early diagnosis of NMSC and assessment of tumor margins. Understanding changes in AF intensity in association with peculiar histological features could improve the diagnostic accuracy of skin fluorescence spectroscopy. The main goal of our work was to investigate the correlation between the intensity of cutaneous AF and the histopathological features of NMSC. The intensity of fluorescence emission in tissues obtained from NMSC samples was approximately 4 times lower than that in healthy conditions. In fact, mean AF intensity for BCC group was 4.5 and 4.4 for SCCs, with further variability being recorded according to histopathologic subtypes. Histopathological features such as hyperkeratosis, neoangiogenesis, fibrosis and elastosis are statistically associated with a decrease in AF intensity. Our data suggest that such tissue alterations could be responsible for the difference in AF emission between neoplastic and healthy tissue. These results support the potential application of AF as a useful non-invasive diagnostic tool for NMSCs. Abstract Non-melanoma skin cancer (NMSC) is the most common malignant tumor affecting fair-skinned people. Increasing incidence rates of NMSC have been reported worldwide, which is an important challenge in terms of public health management. Surgical excision with pre-operatively identified margins is one of the most common and effective treatment strategies. Incomplete tumor removal is associated with a very high risk of recurrence and re-excision. Biological tissues can absorb and re-emit specific light wave-lengths, detectable through spectrophotometric devices. Such a phenomenon is known as autofluorescence (AF). AF spectroscopy has been widely explored for non-invasive, early detection of NMSC as well as for evaluation of surgical margins before excision. Fluorescence-aided diagnosis is based on differences in spectral characteristics between healthy and neoplastic skin. Understanding the biological basis of such differences and correlating AF intensity to histological features could improve the diagnostic accuracy of skin fluorescence spectroscopy. The primary objective of the present pre-clinical ex vivo study is to investigate the correlation between the intensity of cutaneous AF and the histopathological features of NMSC. Ninety-eight lesions suggestive for NMSCs were radically excised from 75 patients (46 M; 29 F; mean age: 79 years). After removal, 115 specific reference points on lesions (“cases”; 59 on BBC, 53 on SCC and 3 on other lesions) and on peri-lesional healthy skin (controls; 115 healthy skin) were identified and marked through suture stitches. Such reference points were irradiated at 400–430 nm wavelength, and resulting emission AF spectra were acquired through spectrophotometry. For each case, AFIR (autofluorescence intensity ratio) was measured as the ratio between the number of photons emitted at a wavelength ranging between 450 and 700 nm (peak: 500 nm) in the healthy skin and that was captured in the pathological tissue. At the histological level, hyperkeratosis, neoangiogenesis, cellular atypia, epithelial thickening, fibrosis and elastosis were quantified by light microscopy and were assessed through a previously validated grading system. Statistical correlation between histologic variables and AFIR was calculated through linear regression. Spectrometric evaluation was performed on 230 (115 cases + 115 controls) reference points. The mean AFIR for BCC group was 4.5, while the mean AFIR for SCC group was 4.4 and the fluorescence peaks at 500 nm were approximately 4 times lower (hypo-fluorescent) in BCCs and in SCCs than in healthy skin. Histological variables significantly associated with alteration of AFIR were fibrosis and elastosis (p < 0.05), neoangiogenesis, hyperkeratosis and epithelial thickening. Cellular atypia was not significantly associated with alteration of AFIR. The intensity of fluorescence emission in neoplastic tissues was approximately 4 times lower than that in healthy tissues. Histopathological features such as hyperkeratosis, neoangiogenesis, fibrosis and elastosis are statistically associated with the decrease in AFIR. We hypothesize that such tissue alterations are among the possible biophysical and biochemical bases of difference in emission AF between neoplastic and healthy tissue. The results of the present evaluation highlighted the possible usefulness of autofluorescence as diagnostic, non-invasive and real-time tool for NMSCs.
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Affiliation(s)
- Ilaria Giovannacci
- Department of Dermatology, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (I.G.); (F.G.); (C.R.); (A.P.)
| | - Marco Meleti
- Centro Universitario di Odontoiatria, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
| | - Federico Garbarino
- Department of Dermatology, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (I.G.); (F.G.); (C.R.); (A.P.)
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Anna Maria Cesinaro
- Department of Anatomic Pathology, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.M.C.); (E.M.)
| | - Ema Mataca
- Department of Anatomic Pathology, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.M.C.); (E.M.)
| | - Giuseppe Pedrazzi
- Department of Medicine and Surgery and Robust Statistics Academy, University of Parma, 43121 Parma, Italy;
| | - Camilla Reggiani
- Department of Dermatology, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (I.G.); (F.G.); (C.R.); (A.P.)
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Alessia Paganelli
- Department of Dermatology, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (I.G.); (F.G.); (C.R.); (A.P.)
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Arianna Truzzi
- School of Dentistry, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.T.); (F.E.)
| | - Federica Elia
- School of Dentistry, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.T.); (F.E.)
| | | | - Cristina Magnoni
- Department of Dermatology, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (I.G.); (F.G.); (C.R.); (A.P.)
- Correspondence: ; Tel.: +39-059-422-2464; Fax: +39-059-422-4271
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Abi Karam M, Kourie HR, Jalkh N, Mehawej C, Kesrouani C, Haddad FG, Feghaly I, Chouery E, Tomb R. Molecular profiling of basal cell carcinomas in young patients. BMC Med Genomics 2021; 14:187. [PMID: 34284772 PMCID: PMC8293576 DOI: 10.1186/s12920-021-01030-w] [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: 08/21/2020] [Accepted: 07/05/2021] [Indexed: 12/30/2022] Open
Abstract
Background Basal cell carcinoma (BCC) represents by far the most common non-melanoma skin cancer (NMSC) in the world with an increasing incidence of 3% to 10% per year, especially in patients under the age of 40. While variants in the sonic Hedgehog and cell cycle regulation pathways account for the majority of BCC cases in adults, the molecular etiology of BCC in young patients is unelucidated yet. This study aims to investigate the molecular profile of BCC in the young population. Methods 28 tumors belonging to 25 Lebanese patients under the age of 40, presenting different stages of BCC and diagnosed at Hôtel Dieu de France—Saint Joseph University Medical Center were included in this study. A selected panel of 150 genes involved in cancer was analyzed by Next Generation Sequencing (NGS) in the 28 included tumors. Results Genetic variants detected in more than 5% of the reads, with a sequencing depth ≥ 50x, were selected. Two hundred and two genetic variants in 48 different genes were detected, with an overall average sequencing depth of 1069x. Among the 28 studied tumors, 18 (64.3%) show variations in the PTCH1 gene, 6 (21.4%) in TP53 and 3 (10.7%) in SMO. Conclusions This is the first study reporting NGS-based analysis of BCC in a cohort of young patients. Our results highlight the involvement of the hedgehog and cell cycle regulation pathways in the genesis of BCC in the general population. The inclusion of a larger cohort of young patients is needed to confirm our findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-021-01030-w.
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Affiliation(s)
- Marc Abi Karam
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. .,Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Nadine Jalkh
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Cybel Mehawej
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Carole Kesrouani
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fady Gh Haddad
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Iman Feghaly
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Eliane Chouery
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Roland Tomb
- Dermatology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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15
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Affiliation(s)
- Ramon Staeger
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
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16
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Sierro TJ, Blumenthal LY, Hekmatjah J, Chat VS, Kassardjian AA, Read C, Armstrong AW. Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: A population-based study. J Am Acad Dermatol 2021; 86:373-378. [PMID: 34246700 DOI: 10.1016/j.jaad.2021.07.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND As the United States becomes more diverse, determining differences in health care utilization and costs in the management of skin cancers is fundamental to decision-making in health care resource allocation and improving care for underserved populations. OBJECTIVE To compare health care use and costs among non-Hispanic White, Hispanic White, and non-Hispanic Black patients with keratinocyte carcinoma. METHODS A nationwide cross-sectional study was performed using Medical Expenditure Panel Survey data from 1996 to 2015. RESULTS Among 54,503,447 patients with keratinocyte carcinoma (weighted) over a 20-year period, 53,134,351 (97%) were non-Hispanic White; 836,030 (1.5%) were Hispanic White; and 170,755 (0.3%) were non-Hispanic Black. Compared to non-Hispanic White patients, Hispanic White patients had significantly more ambulatory visits per person per year (5.4 vs 3.5, P = .003). Compared to non-Hispanic White patients, non-Hispanic Black patients had significantly more ambulatory visits (13.1 vs 3.5, P = .027) and emergency department visits (2.3 vs 1.1, P < .001), and incurred significantly higher ambulatory costs ($5089 vs $1131, P = .05), medication costs ($523 vs $221, P = .022), and total costs per person per year ($13,430 vs $1290, P = .032). LIMITATIONS Data for squamous cell carcinomas and basal cell carcinomas are combined. CONCLUSIONS Keratinocyte carcinoma was more costly to treat and required more health care resources in non-Hispanic Black and Hispanic White patients than in non-Hispanic White patients.
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Affiliation(s)
- Tiffany J Sierro
- University of Southern California Keck School of Medicine, Los Angeles, California
| | | | - Joshua Hekmatjah
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Vipawee S Chat
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Ari A Kassardjian
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Charlotte Read
- University of Southern California Keck School of Medicine, Los Angeles, California; Department of Medicine, Imperial College London, London, United Kingdom
| | - April W Armstrong
- University of Southern California Keck School of Medicine, Los Angeles, California.
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17
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Chouhan R, Patel R, Shakib K, Mitsimponas K. Surgical excision of non-melanoma skin cancer: no end in site? Br J Oral Maxillofac Surg 2021:S0266-4356(21)00209-6. [PMID: 34275678 DOI: 10.1016/j.bjoms.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/17/2021] [Indexed: 11/23/2022]
Abstract
Non-melanoma skin cancer (NMSC) is the most common type of cancer in the UK and Ireland, accounting for approximately 20% of all new malignancies recorded, with evidence of increasing incidence. Surgical excision is regarded as the gold standard treatment for such lesions; however, incomplete excision incurs both physical and financial strain on patients and the healthcare service. Our aim is to identify which anatomical regions of the head and neck pose greater risk of incomplete excision and raise awareness for future surgical practice. Manual data collection was carried out on all patients admitted to the OMFS department for surgical excision of NMSCs between January 2016 and December 2017. Information collected included clinical notes and MDT outcomes. NMSCs excised via Mohs surgery. All tumours incompletely excised and requiring further treatment were noted with particular emphasis on the site of the lesion within the head and neck region, and the location of the positive margin on the specimen itself. A total of 506 NMSCs were excised (307 BCC, 199 SCC). Of these, 7.8% (n=24) and 6.0% (n=12), respectively, required further treatment due to incomplete excision. The incompletely exised lesions were predominately located on the nose (13.3%), temple (15.0%), and ear (12.8%). Our results demonstrate that our department is successfully excising NMSCs with minimal cases requiring further management. This study has identified anatomical profiles posing a higher risk of incomplete removal. Alongside the conventionally challenging sites of the nose and ear, we have highlighted additional risk within the temporal region. We therefore propose that Mohs surgery or a two-stage procedure should be considered as management for the temple at future MDTs.
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18
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Falkenberg C, Schmitz L, Dicke K, Dervenis V, Szeimies RM, Dirschka T. Pretreatment with ablative fractional carbon dioxide laser improves treatment efficacy in a synergistic PDT protocol for actinic keratoses on the head. Photodiagnosis Photodyn Ther 2021; 34:102249. [PMID: 33711530 DOI: 10.1016/j.pdpdt.2021.102249] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A recently proposed synergistic photodynamic therapy protocol (s-PDT) combining advantages of both conventional- and daylight-PDT proved to be an effective and almost painless treatment for patients with actinic keratoses (AKs). This study investigated the safety and efficacy of an additional ablative fractional CO2-laser (AFXL) pretreatment. METHODS 28 patients with AKs on the head received s-PDT using 5-aminolevulinic acid. AFXL pretreatment was conducted using the following parameters: pulse energy 8 mJ, spot density 50 spots/cm2, power 30 W, beam size 4-18 mm. Outcome was assessed by AK area and severity index (AKASI) and lesion count (LC) before and 3 months after treatment. Safety was monitored by blood pressure and pulse measurements. Intensity of pain was determined by use of a visual analog scale (VAS). RESULTS Most patients (96.4 %) showed a significant AKASI reduction (P < 0.0001) 3 months after PDT (median AKASI 1.6 [0-2.4]) compared to baseline (5.3 [4-7.75]). Median reduction rate was 75.5 % (61.3 %-100 %). Eleven patients (39.3 %) achieved AKASI 100, three (10.7 %) AKASI 75 and ten (35.7 %) AKASI 50. Blood pressure and pulse did not change significantly throughout treatment. Median VAS for pain during irradiation was 0 (0-0), 0 (0-2) and 0 (0-2) at the beginning, in the meantime and at the end, respectively. Compared to data without AFXL pretreatment, this study showed significantly higher AKASI and LC reduction rates (75.5 % vs. 63.7 % [P = 0.023] and 91.3 % vs. 80.4 % [P = 0.043]). CONCLUSIONS S-PDT with AFXL pretreatment represents a safe and almost painless treatment for patients with AKs on the head and improves treatment efficacy.
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Affiliation(s)
- C Falkenberg
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany.
| | - L Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany; Institute of Dermatopathology, MVZ Corius DermPathBonn, Bonn, Germany
| | - K Dicke
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany
| | - V Dervenis
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany
| | - R M Szeimies
- Clinic for Dermatology and Allergology, Klinikum Vest, Recklinghausen, Germany
| | - T Dirschka
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany
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Besson C, Moore A, Wu W, Vajdic CM, de Sanjose S, Camp NJ, Smedby KE, Shanafelt TD, Morton LM, Brewer JD, Zablotska L, Engels EA, Cerhan JR, Slager SL, Han J, Berndt SI. Common genetic polymorphisms contribute to the association between chronic lymphocytic leukaemia and non-melanoma skin cancer. Int J Epidemiol 2021; 50:1325-1334. [PMID: 33748835 DOI: 10.1093/ije/dyab042] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Epidemiological studies have demonstrated a positive association between chronic lymphocytic leukaemia (CLL) and non-melanoma skin cancer (NMSC). We hypothesized that shared genetic risk factors between CLL and NMSC could contribute to the association observed between these diseases. METHODS We examined the association between (i) established NMSC susceptibility loci and CLL risk in a meta-analysis including 3100 CLL cases and 7667 controls and (ii) established CLL loci and NMSC risk in a study of 4242 basal cell carcinoma (BCC) cases, 825 squamous cell carcinoma (SCC) cases and 12802 controls. Polygenic risk scores (PRS) for CLL, BCC and SCC were constructed using established loci. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Higher CLL-PRS was associated with increased BCC risk (OR4th-quartile-vs-1st-quartile = 1.13, 95% CI: 1.02-1.24, Ptrend = 0.009), even after removing the shared 6p25.3 locus. No association was observed with BCC-PRS and CLL risk (Ptrend = 0.68). These findings support a contributory role for CLL in BCC risk, but not for BCC in CLL risk. Increased CLL risk was observed with higher SCC-PRS (OR4th-quartile-vs-1st-quartile = 1.22, 95% CI: 1.08-1.38, Ptrend = 1.36 × 10-5), which was driven by shared genetic susceptibility at the 6p25.3 locus. CONCLUSION These findings highlight the role of pleiotropy regarding the pathogenesis of CLL and NMSC and shows that a single pleiotropic locus, 6p25.3, drives the observed association between genetic susceptibility to SCC and increased CLL risk. The study also provides evidence that genetic susceptibility for CLL increases BCC risk.
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Affiliation(s)
- Caroline Besson
- Service d'hématologie et Oncologie, Centre Hospitalier de Versailles, Le Chesnay; Université Paris-Saclay, UVSQ, Inserm, Équipe "Exposome et Hérédité", CESP, 94805, Villejuif, France
| | - Amy Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Wenting Wu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, USA
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nicola J Camp
- Department of Internal Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Karin E Smedby
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Tait D Shanafelt
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Lydia Zablotska
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - James R Cerhan
- Service d'hématologie et Oncologie, Centre Hospitalier de Versailles, Le Chesnay; Université Paris-Saclay, UVSQ, Inserm, Équipe "Exposome et Hérédité", CESP, 94805, Villejuif, France
| | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jiali Han
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Ferini G, Molino L, Bottalico L, De Lucia P, Garofalo F. A small case series about safety and effectiveness of a hypofractionated electron beam radiotherapy schedule in five fractions for facial non melanoma skin cancer among frail and elderly patients. ACTA ACUST UNITED AC 2021; 26:66-72. [PMID: 33948304 DOI: 10.5603/rpor.a2021.0013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/10/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
Background The aim of the study was to evaluate local control and toxicities of strongly hypofractionated electron beam radiotherapy (RT) in elderly and fragile patients with facial nonmelanoma skin cancer (NMSC). Materials and methods We enrolled patients aged ≥ 65 years with facial NMSC, Karnofsky Performance Status (KPS) ≥ 40 and life expectancy ≥ 6 months, amenable neither to daily RT nor surgery. Radiotherapy consisted of 35 Gy, delivered with 6 MeV electron beam, in 5 fractions of 7 Gy/day twice a week (tw). Prescription isodoses were 100% for cT1-cT2 and 90% for cT3-cT4. Objective response was assessed clinically 4 and 8 weeks after the end of RT and then monitored every 6 months. Side effects were assessed according to the CTCAE scale. Results 12 patients of median age 89.5 years with a total of 23 NMSC cN0 achieved a median follow-up time of 6 months (range 1-10), with total treatment compliance. 10/12 patients had a 40 ≤ KPS < 70 and 2/12 a 70 ≤ KPS < 90. 5/12 patients had synchronous lesions. 22/23 lesions were classified as T1-T2 and had complete response (CR), 1/23 as T4 with partial response (PR). Within 4 weeks after the end of treatment, G1 toxicity was reported for 12/23 lesions, G2 for 8/23, G3 for 3/23, G4 for 0/23, all disappeared 8 weeks later, with or without topical therapy. After last follow-up (1 June 2020) 1/12 patients died with PR from senile marasmus, 11/12 are alive with CR and widely tolerated toxicities. Conclusions Extreme hypofractionation of radiotherapy dose for facial NMSC is effective, safe and suitable for elderly patients.
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Affiliation(s)
| | - Laura Molino
- Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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Alshammari ES, Aljagthmi AA, Stacy AJ, Bottomley M, Shamma HN, Kadakia MP, Long W. ERK3 is transcriptionally upregulated by ∆Np63α and mediates the role of ∆Np63α in suppressing cell migration in non-melanoma skin cancers. BMC Cancer 2021; 21:155. [PMID: 33579235 PMCID: PMC7881562 DOI: 10.1186/s12885-021-07866-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/04/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND p63, a member of the p53 gene family, is an important regulator for epithelial tissue growth and development. ∆Np63α is the main isoform of p63 and highly expressed in Non-melanoma skin cancer (NMSC). Extracellular signal-regulated kinase 3 (ERK3) is an atypical mitogen-activated protein kinase (MAPK) whose biochemical features and cellular regulation are distinct from those of conventional MAPKs such as ERK1/2. While ERK3 has been shown to be upregulated in lung cancers and head and neck cancers, in which it promotes cancer cell migration and invasion, little is known about the implication of ERK3 in NMSCs. METHODS Fluorescent immunohistochemistry was performed to evaluate the expression levels of ΔNp63α and ERK3 in normal and NMSC specimens. Dunnett's test was performed to compare mean fluorescence intensity (MFI, indicator of expression levels) of p63 or ERK3 between normal cutaneous samples and NMSC samples. A mixed effects (ANOVA) test was used to determine the correlation between ΔNp63α and ERK3 expression levels (MFI). The regulation of ERK3 by ΔNp63α was studied by qRT-PCR, Western blot and luciferase assay. The effect of ERK3 regulation by ΔNp63α on cell migration was measured by performing trans-well migration assay. RESULTS The expression level of ∆Np63α is upregulated in NMSCs compared to normal tissue. ERK3 level is significantly upregulated in AK and SCC in comparison to normal tissue and there is a strong positive correlation between ∆Np63α and ERK3 expression in normal skin and skin specimens of patients with AK, SCC or BCC. Further, we found that ∆Np63α positively regulates ERK3 transcript and protein levels in A431 and HaCaT skin cells, underlying the upregulation of ERK3 expression and its positive correlation with ∆Np63α in NMSCs. Moreover, similar to the effect of ∆Np63α depletion, silencing ERK3 greatly enhanced A431 cell migration. Restoration of ERK3 expression under the condition of silencing ∆Np63α counteracted the increase in cell migration induced by the depletion of ∆Np63α. Mechanistically, ERK3 inhibits the phosphorylation of Rac1 G-protein and the formation of filopodia of A431 skin SCC cells. CONCLUSIONS ERK3 is positively regulated by ∆Np63α and mediates the role of ∆Np63α in suppressing cell migration in NMSC.
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Affiliation(s)
- Eid S Alshammari
- Department of Biochemistry and Molecular Biology, Boonshoft School of Medicine, Wright State University, 112 Diggs Laboratory, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA.,Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakakah, 72388, Saudi Arabia
| | - Amjad A Aljagthmi
- Department of Biochemistry and Molecular Biology, Boonshoft School of Medicine, Wright State University, 112 Diggs Laboratory, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA
| | - Andrew J Stacy
- Department of Biochemistry and Molecular Biology, Boonshoft School of Medicine, Wright State University, 112 Diggs Laboratory, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA
| | - Mike Bottomley
- Department of Math and Microbiology, College of Science and Mathematics, Wright State University, Dayton, OH, 45435, USA
| | - H Nicholas Shamma
- Department of Dermatology, Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA
| | - Madhavi P Kadakia
- Department of Biochemistry and Molecular Biology, Boonshoft School of Medicine, Wright State University, 112 Diggs Laboratory, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA.
| | - Weiwen Long
- Department of Biochemistry and Molecular Biology, Boonshoft School of Medicine, Wright State University, 112 Diggs Laboratory, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA.
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Skroza N, Proietti I, Marchesiello A, Volpe S, Balduzzi V, Bernardini N, Maddalena P, Mambrin A, Michelini S, Tolino E, La Torre G, Potenza C. Do Diet and Lifestyles Play a Role in the Pathogenesis of NMSCs? Nutrients 2020; 12:E3459. [PMID: 33187245 DOI: 10.3390/nu12113459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: Literature highlights the role of risk factors like age, body mass index (BMI), tobacco smoking, alcohol intake and diet in the pathogenesis of several cancer types but little is known for non-melanoma skin cancers (NMSC). The aim of this epidemiological study was to evaluate the correlation between modifiable risk factors (BMI, metabolic panel, diet, lifestyle, medical history) and not modifiable risk factors (gender, age) and NMSC development. Methods: From February 2018 to September 2019, 162 patients affected by NMSC were compared to a group of 167 controls. A univariate and multivariate analysis was conducted to elaborate the data collected through face-to-face interviews. Results: While our evidence did not always reach statistical significance, NMSC study group patients exhibited high rates of analyzed risk factors (male gender aging over 55 years, high BMI, reduced physical activity) compared to the control group. Conclusions: Our study indicates that practicing more than 30 min of physical activity daily could be a protective factor against the NMSC onset. Other risk factors were not correlated with NMSC, but more evidence is needed to establish a possible link.
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Chu S, Mehrmal S, Uppal P, Giesey RL, Delost ME, Delost GR. Burden of skin disease and associated socioeconomic status in Europe: An ecologic study from the Global Burden of Disease Study 2017. JAAD Int 2020; 1:95-103. [PMID: 34409328 PMCID: PMC8361890 DOI: 10.1016/j.jdin.2020.07.001] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Dermatoses contribute to a large burden of global disease, but the relationship between socioeconomic status and the effect of dermatologic conditions in Europe is not well understood. Methods We selected Global Burden of Disease Study data sets to analyze disability-adjusted life-years (DALYs) and the annual rate of change of dermatoses between 1990 and 2017 in 43 European countries. The principal country-level economic factor used was gross domestic product per capita from the World Bank. Statistical analysis was performed with Spearman ρ correlation. Results Wealthier European countries had higher DALYs for melanoma, basal cell carcinoma, psoriasis, atopic dermatitis, acne, seborrheic dermatitis, alopecia, asthma, contact dermatitis, and viral skin disease. Poorer countries had higher DALYs of squamous cell carcinoma, urticaria, decubitus ulcers, pruritus, scabies, tuberculosis, and syphilis. Thirteen European countries were in the top 10th percentile globally for annual increase in skin and subcutaneous disease burden. Conclusion The majority of European countries have experienced an increase in skin and subcutaneous diseases in recent decades relative to the rest of the world, but the burden of individual dermatoses in Europe varies by country and socioeconomic status. DALYs can potentially serve as a purposeful measure for directing resources to improve the burden of skin disease in Europe.
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Affiliation(s)
- Sherman Chu
- College of Osteopathic Medicine of the Pacific Northwest, Western University of Health Sciences, Lebanon, Oregon
| | - Sino Mehrmal
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona
| | - Prabhdeep Uppal
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona
| | - Rachel L. Giesey
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Correspondence to: Rachel L. Giesey, DO, Department of Dermatology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Lakeside 3500, Cleveland, OH 44106.
| | - Maria E. Delost
- Department of Health Professions, Youngstown State University, Youngstown, Ohio
| | - Gregory R. Delost
- Apex Dermatology and Skin Surgery Center, Mayfield Heights, Ohio
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
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Abstract
Basal cell carcinoma (BCC) is the most common malignancy and the incidence is rising. BCCs have low mortality but can cause significant morbidity primarily through local destruction. The pathogenesis is linked to the interplay between environmental and patient-derived characteristics. There are multiple therapeutic modalities, and appropriate selection requires knowledge of complications, cosmetic outcomes, and recurrence rates. This article reviews the epidemiology, staging, treatment, and prevention of BCC.
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Affiliation(s)
- Dennis P Kim
- Mohs Micrographic Surgery, Brigham and Women's Faulkner Hospital, 1153 Centre Street, Suite 4J, Jamaica Plain, MA 02130-3446, USA
| | - Kylee J B Kus
- Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309-4482, USA
| | - Emily Ruiz
- High-Risk Skin Cancer Clinic, Dana Farber/Brigham and Women's Cancer Center, Mohs and Dermatologic Surgery Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, 1153 Centre Street, Suite 4J, Jamaica Plain, MA 02130-3446, USA.
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Olivera PA, Lasa JS, Bonovas S, Danese S, Peyrin-Biroulet L. Safety of Janus Kinase Inhibitors in Patients With Inflammatory Bowel Diseases or Other Immune-mediated Diseases: A Systematic Review and Meta-Analysis. Gastroenterology 2020; 158:1554-1573.e12. [PMID: 31926171 DOI: 10.1053/j.gastro.2020.01.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Inhibitors of Janus kinases (JAKs) are being developed for treatment of inflammatory bowel diseases and other immune-mediated diseases. Tofacitinib is effective in treatment of ulcerative colitis, but there are safety concerns. We performed a systematic review and meta-analysis to investigate the safety profile of tofacitinib, upadacitinib, filgotinib, and baricitinib in patients with rheumatoid arthritis, inflammatory bowel diseases, psoriasis, or ankylosing spondylitis. METHODS We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 1, 1990, through July 1, 2019. We performed a manual review of conference databases from 2012 through 2018. The primary outcome was incidence rates of adverse events (AEs) and serious AEs. We also estimated incidence rates of serious infections, herpes zoster infection, non-melanoma skin cancer, other malignancies, major cardiovascular events, venous thromboembolism, and mortality. We performed a meta-analysis, which included controlled studies, to assess the relative risk of these events. RESULTS We identified 973 studies; of these, 82 were included in the final analysis, comprising 66,159 patients with immune-mediated diseases who were exposed to a JAK inhibitor. Two-thirds of the included studies were randomized controlled trials. The incidence rate of AEs was 42.65 per 100 person-years and of serious AEs was 9.88 per 100 person-years. Incidence rates of serious infections, herpes zoster infection, malignancy, and major cardiovascular events were 2.81 per 100 person-years, 2.67 per 100 person-years, 0.89 per 100 person-years, and 0.48 per 100 person-years, respectively. Mortality was not increased in patients treated with JAK inhibitors compared with patients given placebo or active comparator (relative risk 0.72; 95% confidence interval 0.40-1.28). The meta-analysis showed a significant increase in risk of herpes zoster infection among patients who received JAK inhibitors (relative risk 1.57; 95% confidence interval 1.04-2.37). CONCLUSIONS In a systematic review and meta-analysis, we found an increased risk of herpes zoster infection among patients with immune-mediated diseases treated with JAK inhibitors. All other AEs were not increased among patients treated with JAK inhibitors.
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Affiliation(s)
- Pablo A Olivera
- Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Juan S Lasa
- Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina; Gastroenterology Department, Hospital Británico de Buenos Aires, Argentina
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Laurent Peyrin-Biroulet
- INSERM NGERE and Department of Hepatogastroenterology, Nancy University Hospital, Lorraine University, Vandoeuvre-lés-Nancy, France.
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Samaka RM, Basha MA, Mansour E. Does the Autophagy Related Gene 7 (ATG7) Have a Role in Non-Melanoma Skin Cancer? Clin Cosmet Investig Dermatol 2020; 13:49-58. [PMID: 32021368 PMCID: PMC6980838 DOI: 10.2147/ccid.s222051] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/29/2019] [Indexed: 12/14/2022]
Abstract
Purpose To evaluate the role of autophagy related gene 7 (ATG7) in non-melanoma skin cancer. Subjects and Methods This retrospective and prospective case-control study was performed on 104 patients with non-melanoma skin cancer (NMSC) in addition to 20 apparently healthy subjects matched for age and sex as a control group. Multiple skin biopsies were taken for immunohistochemical evaluation of ATG7 expression. Results Both epithelial and stromal ATG7 were expressed in all participants while all patients showed nucleocytoplasmic localization and controls showed both cytoplasmic and nucleocytoplasmic expression. In addition, significantly higher H-scores of ATG7 in both epithelium and stroma were detected in patients compared to controls (P<0.001). Conclusion ATG7 nucleocytoplasmic topographic localization might be involved in the pathogenesis of NMSC, which can open the gate for new target therapy for this skin cancer.
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Affiliation(s)
- Rehab M Samaka
- Pathology Department, Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - Mohammed A Basha
- Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - Eman Mansour
- Ministry of Health, El Menshawy General Hospital, Tanta, Egypt
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Basset Seguin N, Malvehy J, Nadal F, Creancier L, Rauly-Lestienne I, Beauchamp R, Hezareh M, Schmitt AM, Ulianov L. Risk behaviour and patient preferences for an improved non-melanoma skin cancer prevention modality for organ-transplanted patients: a European, multi-country, online patient community study. Eur J Dermatol 2019; 29:518-23. [PMID: 31647462 DOI: 10.1684/ejd.2019.3639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immunosuppressants used in organ transplant patients increase the risk of non-melanoma skin cancer. This study aimed to evaluate patient behaviours towards skin cancer prevention methods and to understand characteristics of a future prevention strategy based on patients' perspective. Carenity, a global online patient community, enabled the recruitment of 200 adult patients with solid organ transplants from four European countries: France, Italy, Spain and Germany. Most patients were well informed about the risk of skin cancer, but only 27% (53/200) monitored their skin. Most patients exposed themselves to intense sun exposure once a month or more. Nevertheless, more than half of patients were motivated to use additional prevention strategies and limit their sun exposure. The most appropriate prevention strategy was reported to be the use of a cosmetically attractive, water-resistant, paraben/fragrance-free cream. A one-size-fits-all approach is not an appropriate prevention strategy and an adapted approach based on patients' preferences may significantly contribute to better compliance and adherence.
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Conforti C, Corneli P, Harwood C, Zalaudek I. Evolving Role of Systemic Therapies in Non-melanoma Skin Cancer. Clin Oncol (R Coll Radiol) 2019; 31:759-68. [PMID: 31522944 DOI: 10.1016/j.clon.2019.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/16/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023]
Abstract
Keratinocyte cancers - basal and cutaneous squamous cell carcinoma (BCC, cSCC) - are the most common forms of non-melanoma skin cancer (NMSC) and there has been a significant increase in their incidence globally in recent decades. Although the majority of BCC and cSCC are cured with conventional surgery or radiotherapy, certain tumour or patient-determined factors may result in these modalities being inadequate or inappropriate, for example, locally advanced or metastatic disease, high tumour multiplicity, patient comorbidities and patient preferences. In these clinical circumstances, systemic treatment may be indicated, and over the past 10 years a number of new systemic agents have been approved. Nonetheless, effective systemic therapy for keratinocyte cancers remains an area of significant unmet clinical need. Improved understanding of the molecular and immune pathogenesis underlying tumour growth and development is critical for driving future advances and is a research priority. The aim of this review is to provide clinicians with an overview of systemic treatments for BCC and cSCC and will focus on current evidence for conventional chemotherapy, targeted therapies, immunotherapy, adjuvant and neoadjuvant therapy, chemoprevention and future prospects for novel systemic treatment approaches.
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Kiely J, Kostusiak M, Bloom O, Roshan A. Poorly differentiated cutaneous squamous cell carcinomas have high incomplete excision rates with UK minimum recommended pre-determined surgical margins. J Plast Reconstr Aesthet Surg 2020; 73:43-52. [PMID: 31473117 DOI: 10.1016/j.bjps.2019.06.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/07/2019] [Accepted: 06/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the UK, the British Association of Dermatology-British Association of Plastic, Reconstructive and Aesthetic Surgery (BAD-BAPRAS) guidelines recommend excision of high-risk cutaneous squamous cell carcinomas (cSCCs), including poorly differentiated cSCCs, with a minimum peripheral margin of 6 mm1. OBJECTIVES We assess whether the BAD-BAPRAS minimum margin achieves histological clearance in poorly differentiated cSCCs. PATIENTS AND METHODS Demographics, surgical notes and histological reports from all patients having a primary cSCC excised at the Plastic Surgery Department of Addenbrooke's Hospital, Cambridge, UK, between January 2017 and April 2018 were analysed. Ordinal regression was performed for excision margin status versus histological grade by using size and site as co-variates. RESULTS Of 296 cSCCs, 38(12.8%) were poorly differentiated. Patients with poorly differentiated cSCCs were older (81.1 years vs. 76.7 years, p = 0.038), had lesions on the face or scalp (89.2% vs. 52.1%, p = 0.0001), and had lymphovascular (10.5% vs. 0%, p = 0.001) or perineural invasion (15.8% vs. 2%, p = 0.002). Well-differentiated cSCCs were excised with an average peripheral margin of 4.72 mm (95% CI 4.25-5.18 mm), while poorly differentiated cSCCs were excised with a margin of 6.42 mm(95% CI 5.58-7.28 mm). Close or involved peripheral margins were seen in 3% of well-differentiated lesions but in 13.2% of poorly differentiated lesions (OR=45.02; p = 0.003). Deep margins were close in 13.1% (none involved) of well-differentiated lesions but close or involved in 50% of poorly differentiated lesions (OR=11.94; p = 0.001). CONCLUSIONS We demonstrate that poorly differentiated cSCCs are frequently incompletely excised in both peripheral and deep planes, despite adherence to guidelines. The UK BAD-BAPRAS guidelines should be urgently updated in line with international consensus.
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Sandborn WJ, Panés J, D'Haens GR, Sands BE, Su C, Moscariello M, Jones T, Pedersen R, Friedman GS, Lawendy N, Chan G. Safety of Tofacitinib for Treatment of Ulcerative Colitis, Based on 4.4 Years of Data From Global Clinical Trials. Clin Gastroenterol Hepatol 2019; 17:1541-1550. [PMID: 30476584 DOI: 10.1016/j.cgh.2018.11.035] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/26/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Tofacitinib is an oral, small-molecule inhibitor of JAK approved in several countries for the treatment of ulcerative colitis (UC). We report integrated safety analyses of tofacitinib-treated patients with moderate to severe UC. METHODS Patients receiving placebo or tofacitinib (5 or 10 mg) twice daily were analyzed as 3 cohorts: induction (phase 2 and 3 induction studies, n = 1220), maintenance (phase 3 maintenance study, n = 592), and overall (patients receiving tofacitinib 5 or 10 mg twice daily in phase 2, phase 3, or open-label, long-term extension studies, n = 1157; 1613 patient-years' exposure). Incidence rates (IRs; patients with events per 100 patient-years of exposure) were evaluated for select adverse events. RESULTS In the maintenance cohort, IRs for select adverse events were similar among treatment groups, except for a numerically higher IR of herpes zoster infection among patients who received tofacitinib 5 mg twice daily (2.1; 95% CI, 0.4-6.0) and statistically higher IR among patients who received tofacitinib 10 mg twice daily (IR, 6.6; 95% CI, 3.2-12.2) vs placebo (IR, 1.0, 95% CI, 0.0-5.4). For the overall cohort (84% received average dose of tofacitinib 10 mg twice daily), IRs were: death, 0.2 (95% CI, 0.1-0.6); serious infections, 2.0 (95% CI, 1.4-2.8); opportunistic infections, 1.3 (95% CI, 0.8-2.0); herpes zoster infection, 4.1 (95% CI, 3.1-5.2); malignancy (excluding non-melanoma skin cancer), 0.7 (95% CI, 0.3-1.2); non-melanoma skin cancer, 0.7 (95% CI, 0.3-1.2); major adverse cardiovascular events, 0.2 (95% CI, 0.1-0.6); and gastrointestinal perforations, 0.2 (95% CI, 0.0-0.5). CONCLUSIONS In safety analyses of patients with moderate to severe UC treated with tofacitinib, we observed a dose relationship with herpes zoster infection. Although follow-up time was relatively short, the safety profile of tofacitinib for patients with UC appeared similar to that reported for patients with rheumatoid arthritis and for patients with UC treated with biologic agents, except for the higher IR of herpes zoster infection. ClinicalTrials.gov, no: NCT00787202, NCT01465763, NCT01458951, NCT01458574, and NCT01470612.
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California, San Diego, La Jolla, California.
| | - Julián Panés
- Inflammatory Bowel Diseases Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Geert R D'Haens
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Bruce E Sands
- Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chinyu Su
- Pfizer Inc, Collegeville, Pennsylvania
| | | | | | | | | | | | - Gary Chan
- Pfizer Inc, Collegeville, Pennsylvania
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Abstract
Skin cancer can be classified as cutaneous malignant melanoma, basal cell carcinoma, and squamous cell carcinoma. Due to the high level of morbidity and mortality, skin cancer has become a global public health issue worldwide while the pathogenesis of skin cancer is still unclear. It is necessary to further identify the pathogenesis of skin cancer and find candidate targets to diagnose and treat skin cancer. A variety of factors are known to be associated with skin cancer including N-glycosylation, which partly explained the malignant behaviors of skin cancer. In this review, we retrieved databases such as PubMed and Web of Science to elucidate its relationship between glycosylation and skin cancer. We summarized some key glycosyltransferases and proteins during the process of N-glycosylation related to skin cancer, which was helpful to unmask the additional mechanism of skin cancer and find some novel targets of skin cancer.
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Affiliation(s)
- Ling Tang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, Hunan, China
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoping Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xu Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, Hunan, China
| | - Yeye Guo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, Hunan, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, Hunan, China
| | - Jianglin Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, Hunan, China
| | - Cong Peng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, China.
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, Hunan, China.
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, Hunan, China.
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, Hunan, China.
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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32
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Rogers EM, Connolly KL, Nehal KS, Dusza SW, Rossi AM, Lee E. Comorbidity scores associated with limited life expectancy in the very elderly with nonmelanoma skin cancer. J Am Acad Dermatol 2018; 78:1119-1124. [PMID: 29288096 PMCID: PMC5951753 DOI: 10.1016/j.jaad.2017.12.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/12/2017] [Accepted: 12/17/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is controversy regarding treatment of nonmelanoma skin cancer (NMSC) in very elderly individuals, with some suggesting that this population may not live long enough to benefit from invasive treatments. Tools to assess limited life expectancy (LLE) exist, but performance in the population of very elderly individuals with NMSC has not been well defined. OBJECTIVE Define comorbidity scores associated with LLE in very elderly individuals presenting for management of NMSC. METHODS A retrospective review of 488 patients age 85 or older presenting for NMSC management between July 1999 through December 2014 was performed. Comorbidities were scored by using the Adult Comorbidity Evaluation-27 (ACE-27) and age-adjusted Charlson comorbidity index (ACCI). Dates of death, follow-up, and overall survival were determined. RESULTS ACE-27 and ACCI scores were associated with overall survival; at scores of 3 and 7+, respectively, both were associated with less than 50% survival at 4 years. Patients who underwent Mohs micrographic surgery survived a median of 20 months longer than patients who did not. LIMITATIONS Retrospective study design and referral bias. CONCLUSIONS ACE-27 and ACCI scores predicted LLE. The cohort presenting for Mohs micrographic surgery had improved survival, despite similar intercohort comorbidity. This suggests that additional factors contributed to survival and that age and comorbidities alone are inadequate for making NMSC treatment decisions in very elderly individuals.
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Affiliation(s)
- Emma M Rogers
- Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | | | | | - Erica Lee
- Memorial Sloan Kettering Cancer Center, New York, New York.
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Schmitz L, Gupta G, Segert MH, Kost R, Sternberg J, Gambichler T, Stockfleth E, Dirschka T. Diclofenac Sodium 3% in Hyaluronic Acid 2.5% Gel Significantly Diminishes the Actinic Keratosis Area and Severity Index. Skin Pharmacol Physiol 2018; 31:206-211. [PMID: 29791916 DOI: 10.1159/000488248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/21/2017] [Accepted: 03/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Actinic keratosis area and severity index (AKASI) is a new assessment tool to quantify the severity of actinic damage on the head. Thus far, it has not been evaluated in monitoring the efficacy of field-directed topical treatments in actinic keratosis (AK) in routine clinical practice. Thus, the aim of this study was to determine treatment outcomes by using AKASI 3 months after the initiation of topical application of diclofenac sodium 3% in hyaluronic acid 2.5% gel (DFS) in patients with AKs on the head. METHODS We performed a retrospective analysis of patients with AKs who had AKASI scores prior to and after treatment with DFS. RESULTS Of the 24 patients included, 20 (83.3%) showed an improvement in AKASI, 2 (8.3%) a stable AKASI, and 2 (8.3%) a worsening of AKASI after a median (interquartile range) follow-up period of 91.5 days (89.8-104.3). The median AKASI reduction was 31.4% (16.7-59.1). The Wilcoxon test showed significant differences (p = 0.0008) between baseline and posttreatment AKASI values. CONCLUSIONS AKASI is an easy-to-use quantitative tool for assessing the treatment outcome of field-directed therapies. Field-directed therapies of AK should no longer be monitored by assessments based on lesion counts alone.
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Affiliation(s)
- Lutz Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - Girish Gupta
- Department of Dermatology, Monklands Hospital, University of Glasgow, Airdrie, United Kingdom
| | - Marc Hanno Segert
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - Ricarda Kost
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - Julia Sternberg
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - Thilo Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - Thomas Dirschka
- CentroDerm Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
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Hasche D, Vinzón SE, Rösl F. Cutaneous Papillomaviruses and Non-melanoma Skin Cancer: Causal Agents or Innocent Bystanders? Front Microbiol 2018; 9:874. [PMID: 29770129 PMCID: PMC5942179 DOI: 10.3389/fmicb.2018.00874] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 01/22/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022] Open
Abstract
There is still controversy in the scientific field about whether certain types of cutaneous human papillomaviruses (HPVs) are causally involved in the development of non-melanoma skin cancer (NMSC). Deciphering the etiological role of cutaneous HPVs requires - besides tissue culture systems - appropriate preclinical models to match the obtained results with clinical data from affected patients. Clear scientific evidence about the etiology and underlying mechanisms involved in NMSC development is fundamental to provide reasonable arguments for public health institutions to classify at least certain cutaneous HPVs as group 1 carcinogens. This in turn would have implications on fundraising institutions and health care decision makers to force - similarly as for anogenital cancer - the implementation of a broad vaccination program against "high-risk" cutaneous HPVs to prevent NMSC as the most frequent cancer worldwide. Precise knowledge of the multi-step progression from normal cells to cancer is a prerequisite to understand the functional and clinical impact of cofactors that affect the individual outcome and the personalized treatment of a disease. This overview summarizes not only recent arguments that favor the acceptance of a viral etiology in NMSC development but also reflects aspects of causality in medicine, the use of empirically meaningful model systems and strategies for prevention.
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Affiliation(s)
- Daniel Hasche
- Division of Viral Transformation Mechanisms, Research Program "Infection, Inflammation and Cancer", German Cancer Research Center, Heidelberg, Germany
| | - Sabrina E Vinzón
- Laboratory of Molecular and Cellular Therapy, Fundación Instituto Leloir, IIBBA-CONICET, Buenos Aires, Argentina
| | - Frank Rösl
- Division of Viral Transformation Mechanisms, Research Program "Infection, Inflammation and Cancer", German Cancer Research Center, Heidelberg, Germany
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Patel R, Strimling R, Doggett S, Willoughby M, Miller K, Dardick L, Mafong E. Comparison of electronic brachytherapy and Mohs micrographic surgery for the treatment of early-stage non-melanoma skin cancer: a matched pair cohort study. J Contemp Brachytherapy 2017; 9:338-44. [PMID: 28951753 DOI: 10.5114/jcb.2017.68480] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/13/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose High-dose-rate electronic brachytherapy (EBT) provides a non-surgical treatment option for non-melanoma skin cancer (NMSC). This matched-pair cohort study compared the outcomes of treatment with EBT to those of Mohs micrographic surgery (MMS) in patients with NMSC. Material and methods At four treatment centers, patients treated with EBT were case matched to patients treated with MMS based on retrospectively-collected patient age, lesion size, location and type, and year of treatment. Follow-up data were prospectively collected and included local recurrence, toxicities, cosmesis, and patient-reported outcomes. Results The 369 patients (188 in the EBT treatment group and 181 in the MMS treatment group) had 416 lesions (208 in the EBT group and 208 in the MMS group), including 226 basal cell carcinomas (BCC) and 190 squamous cell carcinomas (SCC). Most patients were Caucasian (98.9% and 99.5%) and male (65.4% and 66.3%) of median age 80.7 (range: 61-98) (EBT) and 76.8 (range: 51-98) years (MMS). Most lesions were size > 1 cm and ≤ 2 cm, and located on the head. At mean 3.4 years post-treatment, 99.5% of EBT, and 100.0% of MMS-treated lesions were free of recurrence (p = ns). One recurrence was noted in the EBT group. Physicians rated cosmesis as “excellent” or “good” in 97.6% of EBT-treated lesions, and 95.7% of MMS-treated lesions. Conclusions This matched-pair cohort study supports the use of EBT as an effective non-surgical treatment option for NMSC with equivalent recurrence rates and cosmetic outcomes to MMS in appropriately-selected patients with early stage NMSC at extended follow-up.
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Abstract
INTRODUCTION This introductory skin cancer video module engages novice health care professionals to make histological-clinical correlations for the three most common skin cancers: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. The goal of this video module is to engage novice health care professionals (e.g., allied health, medical, nursing students) to go beyond the all-too-common phenomenon of memorizing gross and histological features of skin cancers without reference to the relationship between these features. METHODS By explicitly highlighting underlying histological-clinical correlations for BCC, SCC, and melanoma, this video module helps learners build a deeper and lasting knowledge of these common diseases. Materials in this module include a learner guide with instructions on how to complete the module; four chalk-talk videos that discuss classification of skin cancers, histological-clinical correlations for BCC, SCC, and melanoma, and how to distinguish among benign nevi, dysplastic nevi, and melanoma (total viewing time 54 minutes, 22 seconds); annotated slides used in the videos; and 10 multiple-choice self-assessment questions. RESULTS This module was successfully incorporated into the first-year flipped classroom curriculum for medical and dental students at Harvard Medical School. Written comments from students revealed that they enjoyed watching short concept videos to prepare for in-class, case-based discussions of BCC, SCC, and melanoma. DISCUSSION By illustrating histological-clinical correlations and reducing cognitive load of the material through use of cartoons and prototypical clinical images, this video module is an accessible initial resource for an emerging generation of millennial health care professionals to learn about common skin cancers.
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Affiliation(s)
| | - Arash Mostaghimi
- Assistant Professor of Dermatology and Internal Medicine, Harvard Medical School
- Director of Dermatology Inpatient Services and Co-Director of the Complex Medical Dermatology Fellowship Program, Brigham and Women's Hospital
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Donnenfeld M, Deschasaux M, Latino-Martel P, Diallo A, Galan P, Hercberg S, Ezzedine K, Touvier M. Prospective association between dietary folate intake and skin cancer risk: results from the Supplémentation en Vitamines et Minéraux Antioxydants cohort. Am J Clin Nutr 2015; 102:471-8. [PMID: 26156743 DOI: 10.3945/ajcn.115.109041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 02/10/2015] [Accepted: 05/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The role of folate in skin carcinogenesis is unclear, with experimental data suggesting potentially protective but also deleterious effects. OBJECTIVE Our main objective was to investigate the prospective association between dietary folate intake and risks of skin cancer (overall), nonmelanoma skin cancer (NMSC), and basal cell carcinoma (BCC). As an exploratory analysis, we also investigated the prospective association between erythrocyte folate concentration and skin cancer risk. DESIGN In this study, we included 5880 participants in the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) cohort (follow-up: 1994-2007) who completed at least six 24-h dietary records during the first 2 y of the study. Associations between sex-specific tertiles of dietary and erythrocyte folate and skin cancer risk were assessed by using multivariate Cox proportional hazards models. RESULTS After a median follow-up of 12.6 y, 144 incident skin cancers were diagnosed. Dietary folate intake was associated with increased risk of overall skin cancer [HR for tertile 3 compared with tertile 1 (HR(T3vs.T1)): 1.79; 95% CI: 1.07, 2.99; P-trend = 0.03], NMSC (HR(T3vs.T1): 1.85; 95% CI: 1.06, 3.23; P-trend = 0.03), and BCC (HR(T3vs.T1): 1.78; 0.98, 3.24; P-trend = 0.05). This association was observed in women (corresponding P-trend = 0.007, 0.009, and 0.009, respectively) but not in men (P-trend = 0.8, 0.8, and 0.9, respectively). P-interaction values between tertiles of dietary folate intake and sex were 0.04, 0.02, and 0.02 for overall skin cancer, NMSC, and BCC, respectively. Erythrocyte folate concentration was directly associated with increased risk of overall skin cancer (HR(T3vs.T1): 2.54; 95% CI: 0.95, 6.81; P-trend = 0.03), NMSC (HR(T3vs.T1): 3.49; 95% CI: 1.11, 11.0; P-trend = 0.01), and BCC (HR(T3vs.T1): 7.44; 95% CI: 1.57, 35.3; P-trend = 0.004) (men and women combined). CONCLUSIONS This prospective study suggests an association between dietary folate intake and erythrocyte folate concentration and increased risk of overall skin cancer, NMSC, and BCC. Although several mechanistic hypotheses and 2 previous large prospective studies on BCC are in line with these results, epidemiologic literature is limited, and future research is needed to better elucidate the potential role of folate in the cause of skin cancers.
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Affiliation(s)
- Mathilde Donnenfeld
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France
| | - Mélanie Deschasaux
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France
| | - Paule Latino-Martel
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France
| | - Abou Diallo
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France
| | - Serge Hercberg
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France; Public Health Department, Avicenne Hospital, Bobigny, France; and
| | - Khaled Ezzedine
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France; Dermatology Department, Saint André Hospital, Bordeaux, France
| | - Mathilde Touvier
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;
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Abstract
Glioma-associated oncogene homolog (GLI)1 is involved in controlling cell proliferation and angiogenesis. The aim of this work was to explore its possible role in non-melanoma skin cancer pathogenesis through its immunohistochemical (IHC) expression in skin biopsies of these diseases and correlating this expression with the clinico-pathological parameters of the studied cases. Seventy-six cutaneous specimens were studied; 30 cases with basal cell carcinoma (BCC), 30 cases with squamous cell carcinoma (SCC) and 16 normal skin samples, from age- and gender-matched subjects, as a control group. GLI1 was expressed in all BCC cases and in 60% of SCC cases. All SCC cases showed cytoplasmic, while 70% of BCC cases showed nucleocytoplasmic immunoreactivity. It was over expressed in BCC and SCC compared to normal skin (p = 0.01 and 0.0006, respectively). Higher Histo (H) score in BCC cases was significantly associated with female gender (p = 0.04), multiple lesions, desmoplastic stromal reaction and stromal angiogenesis (p < 0.001 for all). Higher H score in SCC cases was significantly associated with scalp location, nodular type, recurrent lesions, high tumor grade, lymphovascular invasion (p = 0.004 for all), inflammatory stromal reaction (p = 0.01), lymph node involvement and absence of calcification (p = 0.001 for both). In conclusion, GLI1 may play a role in BCC pathogenesis through its role in cell proliferation, migration, and angiogenesis. Its upregulation and cytoplasmic localization in SCC may suggest that its role in tumor pathogenesis is through mechanisms other than Hedgehog pathway activation. Further studies are needed to clarify the exact molecular basis of its oncogenic action.
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Affiliation(s)
- Ola Ahmed Bakry
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufiya University , Shibeen El Kom , Egypt and
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Chung CP, Rohan P, Krishnaswami S, McPheeters ML. A systematic review of validated methods for identifying patients with rheumatoid arthritis using administrative or claims data. Vaccine 2014; 31 Suppl 10:K41-61. [PMID: 24331074 DOI: 10.1016/j.vaccine.2013.03.075] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/15/2013] [Accepted: 03/26/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE To review the evidence supporting the validity of billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify patients with rheumatoid arthritis (RA) in administrative and claim databases. METHODS We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to RA and reference lists of included studies were searched. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria and extracted the data. Data collected included participant and algorithm characteristics. RESULTS Nine studies reported validation of computer algorithms based on International Classification of Diseases (ICD) codes with or without free-text, medication use, laboratory data and the need for a diagnosis by a rheumatologist. These studies yielded positive predictive values (PPV) ranging from 34 to 97% to identify patients with RA. Higher PPVs were obtained with the use of at least two ICD and/or procedure codes (ICD-9 code 714 and others), the requirement of a prescription of a medication used to treat RA, or requirement of participation of a rheumatologist in patient care. For example, the PPV increased from 66 to 97% when the use of disease-modifying antirheumatic drugs and the presence of a positive rheumatoid factor were required. CONCLUSIONS There have been substantial efforts to propose and validate algorithms to identify patients with RA in automated databases. Algorithms that include more than one code and incorporate medications or laboratory data and/or required a diagnosis by a rheumatologist may increase the PPV.
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Affiliation(s)
- Cecilia P Chung
- Division of Rheumatology, Vanderbilt University School of Medicine, 1161 21st Avenue South, D-3100, Medical Center North, Nashville, TN 37232-2358, USA.
| | - Patricia Rohan
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, WOC1 Building, Room 454S, 1401 Rockville Pike, Rockville, MD 20852-1428, USA
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-based Practice Center, Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue, Nashville, TN 37203-1738, USA.
| | - Melissa L McPheeters
- Vanderbilt Evidence-based Practice Center and Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue, Nashville, TN 37203-1738, USA.
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Jawed SI, Myskowski PL, Horwitz S, Moskowitz A, Querfeld C. Primary cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome): part II. Prognosis, management, and future directions. J Am Acad Dermatol 2014; 70:223.e1-17; quiz 240-2. [PMID: 24438970 DOI: 10.1016/j.jaad.2013.08.033] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [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: 07/26/2013] [Revised: 08/13/2013] [Accepted: 08/16/2013] [Indexed: 12/20/2022]
Abstract
Both mycosis fungoides (MF) and Sézary syndrome (SS) have a chronic, relapsing course, with patients frequently undergoing multiple, consecutive therapies. Treatment is aimed at the clearance of skin disease, the minimization of recurrence, the prevention of disease progression, and the preservation of quality of life. Other important considerations are symptom severity, including pruritus and patient age/comorbidities. In general, for limited patch and plaque disease, patients have excellent prognosis on ≥1 topical formulations, including topical corticosteroids and nitrogen mustard, with widespread patch/plaque disease often requiring phototherapy. In refractory early stage MF, transformed MF, and folliculotropic MF, a combination of skin-directed therapy plus low-dose immunomodulators (eg, interferon or bexarotene) may be effective. Patients with advanced and erythrodermic MF/SS can have profound immunosuppression, with treatments targeting tumor cells aimed for immune reconstitution. Biologic agents or targeted therapies either alone or in combination--including immunomodulators and histone-deacetylase inhibitors--are tried first, with more immunosuppressive therapies, such as alemtuzumab or chemotherapy, being generally reserved for refractory or rapidly progressive disease or extensive lymph node and metastatic involvement. Recently, an increased understanding of the pathogenesis of MF and SS with identification of important molecular markers has led to the development of new targeted therapies that are currently being explored in clinical trials in advanced MF and SS.
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Affiliation(s)
- Sarah I Jawed
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Steven Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Alison Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Christiane Querfeld
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York.
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Balagula Y, Kang S, Patel MJ. Synergism between mTOR pathway and ultraviolet radiation in the pathogenesis of squamous cell carcinoma and its implication for solid-organ transplant recipients. Photodermatol Photoimmunol Photomed 2014; 31:15-25. [PMID: 24517835 DOI: 10.1111/phpp.12115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 12/22/2022]
Abstract
Nonmelanoma skin cancers (NMSCs) are the most common malignancies in the United States in immunocompetent patients. Among the solid-organ transplant recipients, NMSCs represent a significant disease burden, and they tend to be multiple and more aggressive. While the precise mechanisms responsible for the higher risk of developing cutaneous squamous cell carcinomas (SCCs) have not been completely elucidated, ultraviolet (UV) light has been established to be critical in initiation and promotion of tumor development. More recently, significant emphasis has been placed on the role of the mammalian target of rapamycin (mTOR) pathway in SCC pathogenesis. Furthermore, some studies have demonstrated the ability of mTOR inhibitors to decrease the incidence of new SCCs in the immunosuppressed transplanted patient population. In this review, we will highlight and examine the most recent available data on the role of UV radiation and its interaction with mTOR pathway signaling in SCC pathogenesis.
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Affiliation(s)
- Yevgeniy Balagula
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA
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Kappelman MD, Farkas DK, Long MD, Erichsen R, Sandler RS, Sørensen HT, Baron JA. Risk of cancer in patients with inflammatory bowel diseases: a nationwide population-based cohort study with 30 years of follow-up evaluation. Clin Gastroenterol Hepatol 2014; 12:265-73.e1. [PMID: 23602821 PMCID: PMC4361949 DOI: 10.1016/j.cgh.2013.03.034] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/12/2013] [Accepted: 03/15/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND & AIMS Data regarding the risk of gastrointestinal and extraintestinal cancers in Crohn's disease (CD) and ulcerative colitis (UC) are needed to understand the clinical course of inflammatory bowel diseases (IBDs) and their treatments. METHODS We performed a nationwide historical cohort study using Danish health care databases. We identified patients with a diagnosis of CD or UC, recorded from 1978 through 2010, and followed them up until the first occurrence of cancer, death, or emigration. We used standardized incidence ratios (SIRs) to compare cancer incidence in CD and UC patients with that expected in the general population. RESULTS Excluding cancers diagnosed within 1 year of IBD diagnosis, 772 cases of invasive cancer occurred among 13,756 patients with CD (SIR, 1.3; 95% confidence interval [CI], 1.2-1.4) and 2331 occurred among 35,152 patients with UC (SIR, 1.1; 95% CI, 1.0-1.1). CD was associated weakly with gastrointestinal cancers (SIR, 1.2; 95% CI, 1.0-1.4) and extraintestinal cancers (SIR, 1.3; 95% CI, 1.2-1.4), with the strongest associations for hematologic malignancies (SIR, 1.9; 95% CI, 1.5-2.3), smoking-related cancers (SIR, 1.5; 95% CI, 1.3-1.8), and melanoma (SIR, 1.4; 95% CI, 1.0-1.9). Associations between UC and gastrointestinal and extraintestinal cancers were weaker (SIR, 1.1; 95% CI, 1.0-1.2; and SIR, 1.1; 95% CI, 1.0-1.1, respectively). The relative risk of extraintestinal cancers among patients with IBD was relatively stable over time, although the risk of gastrointestinal cancers decreased. CONCLUSIONS Patients with IBD, particularly CD, are at increased risk for gastrointestinal and extraintestinal malignancies. The relative risk of gastrointestinal malignancy has decreased since 1978, without a concomitant increase in the risk of nongastrointestinal malignancy.
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Affiliation(s)
| | | | - Millie D. Long
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Robert S. Sandler
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - John A. Baron
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Fietz D, Sivyer G, O'Brien D, Rosendahl C. The halo split skin graft in the management of non-melanoma skin cancer of the leg: a retrospective study. Dermatol Pract Concept 2013; 3:43-9. [PMID: 24282665 PMCID: PMC3839833 DOI: 10.5826/dpc.0304a11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/24/2013] [Accepted: 09/01/2013] [Indexed: 11/24/2022] Open
Abstract
Background: The purpose of this study was to compare the results of the halo split skin graft (HSSG) by two primary care skin cancer practitioners at one clinic at the Gold Coast, Queensland, Australia, to the results of the only previous study while adding to the body of evidence regarding use of the HSSG following excision of non-melanoma skin cancer on the leg. Method: A retrospective review of the notes (Jan 2010–Aug 2012) was performed of all cases of nonmelanoma skin cancer (NMSC) excisions in which split skin graft (SSG) closure with the HSSG was utilized on the leg. Results: There were a total of 68 HSSGs included over the 31 months of the study. Average lesion size was 19.4 mm (range 9–75 mm) and the average age of patients was 78 years (range 49–95 years) with 49% of patients being male. The average healing time was 4 weeks with 35/68 (51%) healing within 14 to 21 days. The overall infection rate was 8/68 (11.8%), which decreased to 4/53 (7.5%) when the ankle grafts were excluded. The graft failure rate was 7/68 (10%) with 3/68 (4.4%) having both infection and graft failure. Limitations: This was a retrospective study. Conclusion: The HSSG confines the surgical wounds to a single site, does not require specialized equipment and it is an economical and effective option for managing NMSC on the leg in situations where skin graft is indicated.
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Affiliation(s)
- Danika Fietz
- Mermaid Beach Medical Centre, Mermaid Beach, Gold Coast, Australia
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Nemazannikova N, Antonas K, Dass CR. Vitamin D: metabolism, molecular mechanisms, and mutations to malignancies. Mol Carcinog 2013; 53:421-31. [PMID: 23359295 DOI: 10.1002/mc.21999] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/16/2012] [Accepted: 12/12/2012] [Indexed: 01/30/2023]
Abstract
The potential protective effects of vitamin D against cutaneous carcinogenesis are still poorly understood. The inhibition, by vitamin D, of various cancers in in vitro and in vivo models has triggered detailed investigation of vitamin D effects on neoplastic behavior. Recent studies highlight that such neoplastic features as the tumor microenvironment, angiogenesis, DNA mutagenesis, and apoptosis are all connected to vitamin D metabolic pathways. This review discusses these connections. Vitamin D modulation of the cell cycle, DNA repair and apoptosis via its receptors (VDRs) may have a suppressive effect on skin cancer as some studies suggest. The regulation of multiple tumor signaling pathways by vitamin D may have an implication in cutaneous carcinogenesis and tumor progression to malignancy.
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Lee EH, Klassen AF, Nehal KS, Cano SJ, Waters J, Pusic AL. A systematic review of patient-reported outcome instruments of nonmelanoma skin cancer in the dermatologic population. J Am Acad Dermatol 2012; 69:e59-67. [PMID: 23102770 DOI: 10.1016/j.jaad.2012.09.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [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: 01/09/2012] [Revised: 08/22/2012] [Accepted: 09/04/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) has traditionally focused on minimizing recurrence and complication rates. However, the assessment of patient satisfaction and quality of life (QOL) is also important. These outcomes are best assessed by patient-reported outcome (PRO) instruments. OBJECTIVES We sought to conduct a systematic review of published PRO instruments purporting to measure aspects associated with QOL and/or patient satisfaction in the dermatologic BCC/SCC population and evaluate their development, content, and psychometric properties. METHODS PubMed, Embase, Cochrane via Wiley, PsycINFO, CINAHL, and HaPI from inception to April 2011 were searched. Articles that discussed the instrument development and validation process were included. RESULTS A total of 2212 articles were identified. Twenty met our inclusion criteria resulting in 6 PRO instruments: 3 general dermatology (Skindex, Dermatology Life Quality Index, dermatology quality of life scales), 1 general plastic surgery (Patient Outcomes of Surgery-Head/Neck), and 2 skin cancer-specific (Skin Cancer Index, disease-specific questionnaire). The 6 instruments all underwent some degree of formal development and validation, however, only the Skin Cancer Index was developed and validated in the BCC/SCC population. LIMITATIONS The review may not have included all relevant PRO instruments. CONCLUSIONS The Skin Cancer Index demonstrates the most evidence of its usefulness in patients with BCC/SCC. The Skindex-16, Dermatology QOL Scales, and Dermatology Life Quality Index target different aspects of QOL and should be used depending on the specific question being investigated. The Patient Outcomes of Surgery-Head/Neck may be beneficial to assess perceptions in appearance before and after surgical intervention.
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Affiliation(s)
- Erica H Lee
- Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
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