RESUMEN
Immunotherapies have revolutionized the management of advanced cutaneous malignancies. However, some patients fail to respond to these therapies, others are ineligible because of comorbidities, and a minority of patients experience treatment-limiting systemic immune-related adverse events. To address these issues and expand treatment options for patients with early-stage disease, a variety of immunotherapies are being developed for direct intratumoral administration. Agents including oncolytic viruses, monoclonal antibodies, cytokines, peptides, and pattern-recognition receptor agonists have been engineered to evoke a local immune response while minimizing systemic toxicity and have shown favorable results in preclinical and early clinical testing. This review covers the current landscape of intratumoral immunotherapies for the treatment of cutaneous melanoma, squamous cell carcinoma, and basal cell carcinoma, highlighting the diverse array of agents being explored and their potential benefits and challenges.
RESUMEN
Botulinum toxin type A (Botox) is thought to have antipruritic effects through inhibition of pruritic factors, including acetylcholine, substance P, and glutamate. The aim of this randomized, single-blind, placebo-controlled trial was to test the effect of botulinum toxin type A on cowhage, a non-histaminergic model for chronic itch. Botulinum toxin type A was injected into the arm of 35 healthy subjects, with a saline control injected into the contralateral arm. Thermal sensory parameters (warmth and heat thresholds and heat pain intensity) and itch intensity after cowhage application were examined on test areas. Botulinum toxin type A reduced itch intensity, overall perceived itch (area under the curve (AUC); percentage change from baseline), and peak itch intensity compared with the control at 1 week, 1 month, and 3 months. Botulinum toxin type A had no effect on thermal thresholds or heat pain intensity. In conclusion, botulinum toxin type A reduced cowhage itch for at least 3 months, which suggests that botulinum toxin type A is a potential long-lasting treatment for localized, non-histaminergic itch.
Asunto(s)
Toxinas Botulínicas Tipo A , Humanos , Toxinas Botulínicas Tipo A/efectos adversos , Antipruriginosos/efectos adversos , Método Simple Ciego , Prurito/tratamiento farmacológico , Prurito/inducido químicamente , Dimensión del Dolor , Método Doble CiegoAsunto(s)
Melanoma , Neoplasias Cutáneas , Humanos , Cirugía de Mohs , Márgenes de Escisión , Melanoma/cirugía , Neoplasias Cutáneas/cirugía , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/prevención & control , Recurrencia Local de Neoplasia/cirugía , Estudios RetrospectivosAsunto(s)
Linfangioma , Enfermedades Vasculares , Neoplasias de la Vulva , Femenino , Humanos , Polidocanol , Escleroterapia/efectos adversos , VulvaRESUMEN
Basal cell carcinoma (BCC) is one of the most common human cancers. Most cases of BCC are amenable to surgical and topical treatments with excellent prognosis if diagnosed timely and managed appropriately. However, in a small percentage of cases, it could be locally advanced BBC (laBCC) and not amenable to surgery or radiation, including recurrent, large tumors or tumors that invade deeper tissue. Hedgehog inhibitors (vismodegib and sonidegib) are approved as the first-line treatment of laBCC. PD-1 inhibitor immunotherapy (cemiplimab) is indicated for cases that progressed on or could not tolerate hedgehog inhibitors or when hedgehog inhibitors are contraindicated. Given the modest response and bothersome side effects of some of the agents above, there are reports of novel treatments, and clinical trials are currently evaluating multiple agents.
Asunto(s)
Antineoplásicos , Carcinoma Basocelular , Neoplasias Cutáneas , Humanos , Neoplasias Cutáneas/tratamiento farmacológico , Proteínas Hedgehog , Recurrencia Local de Neoplasia/tratamiento farmacológico , Carcinoma Basocelular/tratamiento farmacológico , Carcinoma Basocelular/inducido químicamente , Pronóstico , Antineoplásicos/efectos adversos , Anilidas/uso terapéutico , Anilidas/farmacologíaAsunto(s)
Amiloidosis Familiar/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Metotrexato/uso terapéutico , Enfermedades Cutáneas Genéticas/tratamiento farmacológico , Piel/efectos de los fármacos , Anciano , Amiloidosis Familiar/diagnóstico , Amiloidosis Familiar/inmunología , Sustitución de Medicamentos , Humanos , Masculino , Persona de Mediana Edad , Inducción de Remisión , Piel/inmunología , Piel/patología , Enfermedades Cutáneas Genéticas/diagnóstico , Enfermedades Cutáneas Genéticas/inmunología , Resultado del TratamientoAsunto(s)
Prurito/epidemiología , Esclerodermia Sistémica/epidemiología , Adulto , Anciano , Enfermedad Crónica , Costo de Enfermedad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Philadelphia/epidemiología , Prevalencia , Prurito/diagnóstico , Prurito/fisiopatología , Prurito/psicología , Calidad de Vida , Factores de Riesgo , Esclerodermia Sistémica/diagnóstico , Esclerodermia Sistémica/fisiopatología , Esclerodermia Sistémica/psicología , Estaciones del Año , Factores de TiempoRESUMEN
Patients with immunosuppressive conditions experience an increased frequency and severity of cutaneous malignancies. This article highlights management of keratinocyte carcinoma, melanoma, Merkel cell carcinoma, and Kaposi sarcoma in the setting of lymphoproliferative disorders, acquired immunodeficiencies, and organ transplantation. Advances in the safety of organ transplant recipient immunosuppression, early identification of risk factors, and new targeted therapies are improving skin cancer outcomes in immunocompromised populations.
Asunto(s)
Carcinoma de Células de Merkel , Neoplasias Cutáneas , Humanos , Huésped Inmunocomprometido , Piel/patología , Neoplasias Cutáneas/patología , Carcinoma de Células de Merkel/terapia , Terapia de Inmunosupresión/efectos adversosRESUMEN
Postoperative candida infection is a rarely reported complication in cutaneous surgery, although it may develop more often in particular clinical settings. We present a 59-year-old woman with a well-controlled human immunodeficiency virus infection. She developed a bright red eruption with satellite pustules 2 weeks after excision of recurrent lentigo maligna melanoma of the left lower eyelid and periocular region. Due to defect size and complexity of the reconstruction (glabellar transposition flap, Hughes flap, composite graft from upper contralateral eyelid, and full-thickness skin graft from ipsilateral retroauricular region), she was placed on prophylactic oral amoxicillin-clavulanic acid and topical bacitracin and polymyxin. Immediate postoperative course was unremarkable, and sutures were removed after 7 days. Three days later, she developed bright red erythema and pustules within the surgical site and complained of burning. Empirically she was switched to topical gentamicin and oral ciprofloxacin, and later to linezolid, due to inadequate response. Wound culture grew Candida albicans sensitive to fluconazole and voriconazole. After oral fluconazole and topical clotrimazole initiation, the patient rapidly improved. The graft remained viable and apart from small partial dehiscence on the cheek, the healing was unremarkable. Apart from the case presentation, we also discuss different factors associated with postoperative candida infection, including immunocompromised status, surgical procedure location, and postoperative antibiotic use. Early recognition and treatment of postoperative candida infections are crucial to prevent delayed healing and associated morbidity.