RESUMO
Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) is approved in Europe for the treatment of actinic keratosis and Bowen's disease, both intraepithelial forms of squamous cell carcinoma (SCC). A therapeutic effect of MAL-PDT has been recently suggested for superficial, microinvasive and well-differentiated cutaneous SCC. We describe the successful use of MAL-PDT in a recently observed patient with microinvasive SCC of the lower lip and review published data on the use of PDT with MAL or d-aminolevulinic acid (ALA) in cutaneous microinvasive SCC. A patient with a biopsy-proven recurrent microinvasive SCC of the lower lip was treated with 2 cycles of MAL-PDT. Complete clinical, dermoscopic and histopathological clearance was obtained after 2 cycles of MAL-PDT with an excellent cosmetic result and a sustained remission after 24-month follow-up. A review of the few studies reporting on the use of MAL-PDT or ALA-PDT for cutaneous microinvasive SCCs was carried out. MAL-PDT might represent a non-invasive treatment option for microinvasive SCC of the lower lip if patients are not eligible for surgery. Post-treatment histopathological confirmation and a long-term follow-up are strictly recommended.
Assuntos
Ácido Aminolevulínico/análogos & derivados , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias Labiais/tratamento farmacológico , Neoplasias Induzidas por Radiação/tratamento farmacológico , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Idoso , Ácido Aminolevulínico/uso terapêutico , Carcinoma de Células Escamosas/patologia , Queilite/tratamento farmacológico , Dermoscopia , Humanos , Neoplasias Labiais/patologia , Masculino , Invasividade Neoplásica , Neoplasias Induzidas por Radiação/patologia , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/patologia , Luz Solar/efeitos adversos , Resultado do TratamentoRESUMO
Cutaneous malignancies have been significantly associated with autoimmune connective tissue diseases (ACTDs). This review focuses on the current state of knowledge on skin cancer risk in the most prevalent ACTDs in dermatology including lupus erythematosus, scleroderma, dermatomyositis and Sjögren syndrome. Potential pathogenetic mechanisms for the association between ACTDs and malignancy involve disease-related impairment of immune system, sustained cutaneous inflammation, drug-associated immune suppression and increased susceptibility to acquired viral infections. An additional causal role might be played by environmental factors such as UV exposure and smoking. The occurrence of skin cancer can have a profound impact on the already compromised quality of life of ACTD patients. Therefore, effective screening and monitoring strategies are essential for ACTD patients as early detection and prompt therapeutic intervention can reduce morbidity and mortality in these patients.