Laser Therapy for Vulvar Lichen Sclerosus, a Systematic Review.

Lichen sclerosus (LS) is a chronic inflammatory disease that mainly affects the anogenital area, with a higher incidence in post-menopausal women. In the long term, it can lead to loss of vulvar architecture or progress to squamous cell carcinoma. The evidence-based treatment involves high-potency topical corticosteroids in long regimens. However, second-line treatments are not well-established, including laser therapy. This current study aims to assess the level of evidence supporting this therapy. We conducted a search for primary-level studies published before April 2023 through MEDLINE/PubMed, Embase, Web of Science, Scopus, and CENTRAL, with no restrictions on the publication language or date. The methodological quality and risk of bias of the included studies were evaluated using the updated Cochrane Collaboration's tool for assessing risk of bias (RoB-2). Six studies (177 patients) met our eligibility criteria. Laser therapy was compared to topical corticosteroid treatment in five out of six studies. No significant histological differences were found, except for an increase in collagen production in the laser group. A greater reduction in itching, pain, and dyspareunia at 1 and 3 months of treatment in the laser group, as well as in the Skindex-29 at 6 months, was reported. Patient satisfaction was significantly higher among those who received laser therapy. Tolerability was excellent. No significant differences were observed in any of the previous aspects in the study compared to the placebo. In conclusion, there is not enough evidence to recommend laser therapy as a standalone treatment.

Retrospective Real-Life Data, Efficacy and Safety of Vismodegib Treatment in Patients with Advanced and Multiple Basal Cell Carcinoma: 3-Year Experience from a Spanish Center.

BACKGROUND: Basal cell carcinoma (BCC) is the most common type of skin cancer and can represent a therapeutic challenge in patients with locally advanced disease. Vismodegib is a hedgehog pathway inhibitor approved by the FDA for use in this type of tumor. We present a case series to describe our experience with the use of vismodegib. METHODS: A retrospective study that included patients treated with vismodegib at our dermatology unit was conducted. Monthly follow-up was performed, and we registered the clinical evolution and adverse reactions. RESULTS: A total of six patients with locally advanced BCCs were included (50% males and 50% females), with a mean age of 78.5 years old. The treatment was administered over a mean of 5 months. A complete response was observed in four cases and partial response in two cases. No recurrence was detected, with a median follow-up duration after discontinuation of 18 months. Most patients (83%) had at least one adverse event, and two needed dose adjustment temporarily or permanently to continue. The main adverse effect was muscle spasms (66.7%). The main limitation of our study was the small sample, which was not representative of the general population. CONCLUSIONS: Vismodegib is a safe and effective treatment for locally advanced BCC, and its role in unresectable BCC seems to be an important option in these challenging cases.

Laser Therapy for the Treatment of Actinic Cheilitis: A Systematic Review.

Actinic cheilitis (AC) is a chronic inflammation of the lip considered an oral, potentially malignant disorder associated with an increased risk of lip squamous cell carcinoma (SCC) development. Controversies surrounding current therapeutic modalities of AC are under debate, and the implications of laser treatment have not been specifically investigated through a systematic review design. The present study aims to evaluate the degree of evidence of laser for the treatment of AC in terms of efficacy and safety. We searched for primary-level studies published before January 2022 through MEDLINE/PubMed, Embase, Web of Science, Scopus and CENTRAL, with no limitation in publication language or date. We evaluated the methodological quality and risk of bias of the studies included using the updated Cochrane Collaboration's tool for assessing risk of bias (RoB-2). Twenty studies (512 patients) met our eligibility criteria. Laser therapy showed a complete clearance of AC in 92.5% patients, with a maximum recurrence rate of 21.43%, and a very low frequency of malignant transformation to SCC (detected in only 3/20 studies analyzed). In addition, cosmetic outcomes and patient satisfaction were described as excellent. In conclusion, our findings indicate that laser therapy is a high efficacy approach to AC.

Treatment of superficial basal cell carcinoma with 7.8% 5-aminolaevulinic acid nanoemulsion-based gel (BF-200 ALA) and photodynamic therapy: Results in clinical practice in a tertiary hospital.

Photodynamic therapy (PDT) is an effective treatment option for the treatment of superficial basal cell carcinoma (sBCC). Recent publications have demonstrated that PDT with 7.8% 5-aminolaevulinic acid nanoemulsion-based gel (BF-200 ALA-PDT) is an effective and safe alternative for the treatment of sBCC). To investigate the efficacy and safety of 7.8% 5-aminolaevulinic acid nanoemulsion-based gel (BF-200 ALA)-PDT for the treatment of sBCC. A non-controlled, open-label single centre study was conducted. Patients received one PDT cycle with two PDT sessions one-week apart. In case that clinical-dermoscopy evaluation of treatment outcome revealed remaining lesions, a second PDT cycle was performed. The clinical results at the dermoscopy and fluorescence diagnosis level were histologically confirmed in all patients. Treatment response was evaluated 3, 6, and 12 months after last PDT session. A total of 31 patients (12 men and 19 women), with a median age of 63.74 years were included in this study. 3-month after PDT-session, 23/31 patients were complete responders (74.19%) after two BF-200 ALA -PDT sessions. Esthetic outcome was considered good-to-excellent. 5 Aminolevulinic acid 7.8% nanoemulsion-based gel (BF-200 ALA) PDT is an effective therapy option for the treatment of sBCC. Complete clearance rates were higher in those patients who received only one PDT cycle. These results show a similar tendency as shown in other publications.