The role of radiotherapy in the management of cutaneous squamous cell carcinoma: a retrospective study on 92 cases.

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer in the world after basal cell carcinoma. Treatment of choice for cSCC is surgery, but radiotherapy (RT) is a valid alternative and has been recommended in selected cases. The aim was to evaluate the cure rate of RT for cSCC and to compare the results in the two settings of RT as exclusive or second line treatment. METHODS: The outcome of 92 cSCC treated with RT in the period from 2002 to 2019 in our department was retrospectively reviewed. RESULTS: In 56 cases RT was first-line treatment while in 36 it was administered as second-line treatment after incomplete excision or failure of previous treatments. The five-year cure-rate was 74% (71.34% in patients treated with primary RT and 77.37% in patients treated with RT as second-line treatment), while the ten-year cure-rate was 67% (57.07% and 77.37% respectively in patients treated with primary RT or with second line RT). Log rank test showed statistical significance between the cure-rate of the two groups with better therapeutic results after second-line RT (P<0.05). CONCLUSIONS: Our data confirm RT as an effective therapy for cSCC when surgery excision is contraindicated or in case of tumors localized in certain regions where the cosmetic-functional outcome is better than surgery. Better therapeutic results are achieved with second-line RT.

Hypofractionated radiotherapy for nonmelanoma skin cancer during the COVID-19 pandemic: experience in 31 cases.

As a result of the coronavirus disease 2019 (COVID-19) pandemic, radiation therapies have been modulated to reduce the risk of infection during outpatient activities and hypofractionated regimens or radiotherapy delay for nonmelanoma skin cancer (NMSC) were suggested. Hypofractionated radiotherapy not only may confer no disadvantage in regard to outcome when compared to a more protracted schedule but might also reduce the risk of infection. We report the experience of a dermatologic radiation therapy department concerning a group of patients with a diagnosis of NMSC selected for a radiation treatment plan aimed to minimize the number of their accesses to our department.

Radiation therapy of non-melanoma skin cancer of the pinna: an Italian 35-year experience.

BACKGROUND: Radiation therapy (RT) is a well-known alternative to surgery for the treatment of non-melanoma skin cancer (NMSC), especially in elderly people or in patients who cannot undergo or refuse surgical procedure. It has also a pivotal role in those areas, as pinna, where both function and cosmesis must be preserved. We report our experience in treating cutaneous carcinoma of the auricle with radiation therapy. METHODS: We conducted a retrospective monocentric study on 363 NMSC of the auricle treated by conventional energy radiation therapy as a primary treatment or with adjuvant and salvage purpose. Tumors involving the external canal of the ear or regional lymph node at diagnosis were excluded. RESULTS: A complete response has been obtained in 95.5% with a 2- and 5-year cure rate respectively of 84% and 76%. Fifty-two tumors developed a central or marginal relapse. Aesthetic result was good or acceptable in the majority of the cases. No cartilage necrosis has been registered. CONCLUSIONS: Our experience confirms safety and effectiveness of RT on selected auricle carcinoma, affording good cosmetic and functional results.

Ultraviolet A phototest positivity is associated with higher free erythrocyte protoporphyrin IX concentration and lower transferrin saturation values in erythropoietic protoporphyria.

BACKGROUND: Erythropoietic protoporphyria (EPP) is a rare disorder of heme biosynthesis hallmarked by early-onset photosensitivity and mainly due to defective ferrochelatase activity leading to increased erythrocyte protoporphyrin IX (PPIX) levels. Evidence regarding the relationship between erythrocyte PPIX concentration and photosensitivity is limited. METHODS: To investigate the relationship between free erythrocyte PPIX (FEP) concentration; routine laboratory tests, particularly iron metabolism biomarkers; and ultraviolet (UV) A/visible light phototesting findings, 20 genetically confirmed EPP and one XLPP treatment-naive patients were included in our study. They underwent UVA and visible light phototesting. On the same day, blood samples were collected for measurement of FEP, serum iron, transferrin, transferrin saturation, and ferritin, 25-hydroxyvitamin D, and liver enzyme levels. RESULTS: Median FEP concentration at the time of phototesting was 57.50 (IQR: 34.58-102.70) µg/g of Hb. UVA and visible light phototesting were positive in 9 (42.9%) and 8 (38.1%) patients, respectively. Median FEP concentration was significantly higher in UVA phototest-positive patients than in those negative (64.37 [IQR: 57.45-121.82] vs 45.35 [IQR: 24.53-74.61] µg/g of Hb, respectively; P = .04486). Similarly, UVA photosensitive individuals had significantly lower median serum iron levels (61.5 [IQR: 33.5-84] µg/dL vs 109 [IQR: 63.25-154] µg/dL, respectively; P = .01862) and transferrin saturation values (15.005 [IQR: 7.0775-18.41] % vs 29.645 [IQR: 17.8225-34.3575] %; P = .0109) than those negative. CONCLUSIONS: Our study demonstrates that UVA phototest positivity is associated with higher FEP concentration and lower transferrin saturation and serum iron concentration in EPP.

Italian expert-based recommendations on the use of photo(chemo)therapy in the management of mycosis fungoides: Results of an e-Delphi consensus.

BACKGROUND: Phototherapy is a mainstay for the treatment of MF. However, there is scarce evidence for its use, mostly due to the lack of a unified schedule. AIMS: The primary aim of this study was to establish the first structured, expert-based consensus regarding the indications and technical schedules of NB-UVB and PUVA for MF. The secondary aim was to determine the consensus level for each specific item. MATERIALS & METHODS: E-delphi study. Item-specific expert consensus was defined as the number of "Totally Agree" results to ≥80% of the panelists. Cronbach alpha index ≥0.7 was used as a measure of homogeneity in the responses among questions related to the same topic. RESULTS: Overall, there was a high homogeneity among responders (0.78). On specific topics, the highest grade was observed for technical items (0.8) followed by indications for early (0.73) and advanced stages (0.7). CONCLUSIONS: Items related to the most canonical indications of phototherapy and to treatment schedules showed the highest agreements rates. There is consensus about the use of standardized treatment schedules for the induction and consolidation phases for NB-UVB and PUVA in MF.

Radiotherapy of primary cutaneous anaplastic large cell lymphoma: our experience in 30 cases.

BACKGROUND: Since the observation of new cases of primary cutaneous anaplastic large cell lymphoma (PCALCL) with a seemingly aggressive clinical presentation and a favorable response to radiation therapy (RT), a review of our series has been performed to evaluate the results of RT. MATERIALS AND METHODS: The study is a retrospective analysis of 30 patients with PCALCL treated with conventional energy RT. RESULTS: About 55 fields of irradiation were performed. Complete clinical response (CCR) was obtained in 29 cases and a partial clinical response (PCR) in one. Two lesions had a marginal relapse at 7 and 37 months, respectively. In eight cases, new lesions appeared in the same body district and in six cases, in body sites at distance from the field of treatment. Total radiation dose ranged from 15 to 35 Gy (median 25 Gy). Follow-up range was 2-218 months (median 38.5 months) with a local control rate of 85% and a relapse-free rate of 49% at 5 years from RT. Three cases developed a nodal involvement. CONCLUSIONS: PCALCL belongs to the group of primary cutaneous CD30+ lymphoproliferative disorders, accounting for 25-30% of cutaneous T-cell lymphomas. RT is considered of choice as alternative to surgical excision of solitary lesions. Recent studies have focused on ideal dose to obtain local control indicating 30 Gy as adequate, but others have hypothesized that lower doses may suffice. Our study confirms the excellent role of RT in the local control of the disease with total doses ≤25 Gy.

Results of radiotherapy in minimal stage mycosis fungoides: a reappraisal after ten years.

BACKGROUND: Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma, accounting for 54-72% of cases. When it presents as solitary or oligolesional picture, radiotherapy is considered potentially curative. To verify this, we have decided to evaluate the outcome in 15 patients studied in the period 1990-2007 after ten years. METHODS: The files of the patients were revised and they were recalled for a control. Two new cases were added. On the whole 17 patients were studied. All patients underwent histopathological ascertainment and staging investigations. All lesions were treated with conventional radiation therapy with a median dose of 25 Gy. RESULTS: After 1 month from the end of radiotherapy, complete remission (CR) occurred in 22 treatment fields (95.6%) and partial remission (PR) in one (4.4%). Radiotherapy was always well tolerated. At the last recorded visit (median follow up 130 months) 15 patients were alive without disease, and two had localized evidence of MF lesions, with a total 5-year cure-rate of 63.24% and of 66.71% if referred to the original updated series. None of the patients showed progression of the disease. CONCLUSIONS: Our results confirm that radiation therapy in the treatment of minimal stage MF contributes to afford good and durable results with negligible side effects and maintenance of good quality of life over the time.

Superficial radiotherapy for non-melanoma skin cancer of the lip: a 44-year Italian experience.

Background: Radiotherapy is a valuable therapeutic option for the treatment of non-melanoma skin cancer (NMSC) in the ageing population, in non-surgical candidates, or when the tumor is extensive or localized in a cosmetically sensitive area such as the lips.Objective: We report our 44-year experience in treating basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the vermilion lip using superficial radiotherapy.Methods: Forty-seven patients with biopsy-proven BCC or SCC of the lip were retrospectively reviewed. All patients had been treated with superficial radiotherapy in our unit, as a primary treatment or with adjuvant and salvage purposes. Lymph-node involvement at presentation was negative in all patients.Results: Local disease control was achieved in 91% of cases. Cure rates of 85% were obtained at 5 and 10 years. Four patients presented local tumor recurrence and only one patient developed lymphatic involvement. Cosmetic outcome was good in the majority of cases, and all patients, except for one, fully preserved the vermilion lip functionality.Conclusions: Our findings confirm that superficial radiotherapy is an effective treatment for early BCC or SCC of the vermilion lip, especially in the ageing population, in high-risk tumors, and even if poor cosmetic outcome is expected from surgical excision.

Narrowband ultraviolet B phototherapy in childhood vitiligo: evaluation of results in 28 patients.

Phototherapy using narrowband ultraviolet B (UVB) is considered among the treatments of choice in vitiligo, even in childhood. The objective of the current study was to evaluate the profile of safety and effectiveness of such therapy in a group of children. An open, uncontrolled study was performed on 28 children with vitiligo who were receiving narrow band UVB phototherapy. The children were classified according to vitiligo type and phototype. Family history and presence of thyroid disease were investigated. Eighteen patients had received other treatments that was stopped 3 months before starting phototherapy. Phototherapy was administered twice a week. The mean duration of therapy was 10 ± 3.4 months. The mean total dose administered was 156.12 ± 79.4 J/cm(2). Photographs of lesions were taken before and at the end of treatment. The response to phototherapy was expressed as percentage of repigmentation. The data were statistically analyzed using SPSS (SPSS Inc., Chicago, IL). Fourteen percent of patients showed excellent response, 28.6% good response, 25% moderate response, and 28.6% mild response; the remaining 3.5% were not responsive. No side effects were observed except mild erythema requiring a decrease in dosage in a few patients. The results of the present study confirm those of other authors, with better results than adults probably related to good adherence of patients and their families. Nevertheless, high cumulative doses are not necessarily related to a good response. Therefore, we suggest stopping treatment after 6 months in nonresponding cases.

Psychological factors involved in prurigo nodularis: A pilot study.

Emotional stresses and psychological disorders seem to be concurrent factors in some cases of prurigo nodularis (PN), a chronic skin condition with a difficult therapeutic approach. In order to improve the therapeutic strategies, we performed a psychometric study on 20 patients affected by generalized and histological proven PN. Specific questionnaires were employed to examine the hypotheses (General Health Questionnaire, State Trait Anxiety Inventory - form Y, Beck Depression Inventory-II, and Eysenck Personality Questionnaire). The results show that symptoms of anxiety and depression associated with PN are more severe than in the control group and that some specific traits of personality are more frequently represented in such subjects. The results of our study represent a first attempt to analyze the psychological problems and the personality dimensions which seem to characterize PN patients. Such evidence supports the importance of a psychological approach in the clinical management of PN, which should always include psychological assessment and treatment together with the other therapeutic options.

Postoperative radiotherapy of auricular keloids: a 26-year experience.

BACKGROUND: Auricular keloids are very frequent and often have a peculiar response to therapy. Despite a variety of treatment options, recurrence is the norm. An integrated surgical-radiotherapy approach is suggested to have the most significant effect on recurrence rate, varying from 3.5% to 27%. The aim of this study was to assess, through a retrospective review of our cases, the effectiveness and safety of postoperative radiotherapy performed over 26 years and to observe whether all localizations of auricular keloids behave in the same way. METHODS: Sixty patients affected by 76 auricular keloids were included in this study. The median time interval between the surgery and the beginning of radiotherapy was 3 days. The total dose administered ranged from 10 Gy to 45 Gy, by means of weekly fractions of 5 Gy each. RESULTS: The mean follow-up was 47.85 months. In 10 cases (13.2%) a recurrence occurred. The 5-year relapse-free rate from the end of the combined treatment was 79.84%. The cosmetic result was judged as good in all cases. No late stochastic or non-stochastic damages were observed. CONCLUSION: Our data significantly support the dermatologic postoperative radiotherapy role in the treatment approach of all auricular keloids.

Minimal stage IA mycosis fungoides. Results of radiotherapy in 15 patients.

BACKGROUND: Mycosis fungoides (MF) minimal disease stage IA, characterized by one or few close lesions (up to four), has been considered a distinct entity with a favourable prognosis, where local treatment such as radiotherapy could afford long-lasting remissions. OBJECTIVE: To review our experience in radiologic treatment of this subset of the disease and compare our results with those reported in the literature. METHODS: Fifteen patients presenting with MF minimal disease were treated with localized superficial X-ray therapy, with a total median dose of 22 Gy. RESULTS: At 1 month from the end of radiotherapy, complete remission was observed in 95.45% of irradiation fields and partial remission in 4.54%. The 5-year local progression-free rate was 93.75%, while the overall relapse-free rate at 5 and 10 years was 51%. CONCLUSIONS: After an excellent response to radiotherapy, MF minimal disease may experience local or distant failures, even after years. The identification of an optimal dose of radiation and the collection of more cases would be useful in giving new guidelines in the treatment of this subset of the disease.

Possibility of treating basal cell carcinomas of nevoid basal cell carcinoma syndrome with superficial x-ray therapy.

BACKGROUND: The nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin-Goltz syndrome, is a rare dermatological disease inherited according to an autosomal dominant pattern. From the dermatological point of view, the most evident characteristic of the syndrome is the early onset of multiple basal cell carcinomas (BCCs). An ideal treatment of BCCs of the NBCCS does not exist. OBJECTIVE: To evaluate if in particular cases (e.g. poor general health conditions, previous multiple surgical excisions) radiotherapy may be useful, under the condition that it does not promote the onset of new BCCs and that the healing of irradiated lesions is normal. METHODS: A study on 3 patients with 17 BCCs treated with superficial radiotherapy is here reported. RESULTS: Complete remission without carcinogenic effects was reached in all treated lesions, with a mean follow-up of 30.35 months. CONCLUSION: In our opinion, such results suggest the possibility of a cautious application of superficial radiotherapy in selected cases of NBCCS.

Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: results in 405 lesions.

The skin overlying the nose cartilage is a particularly frequent localization of skin carcinomas, for which it is of great practical interest to identify the best therapy, able to combine effectiveness with a good cosmetic and functional result. To this aim a retrospective study was performed regarding 405 basal and squamous cell carcinomas treated by kilovoltage radiotherapy in the period 1972-2002. The total dose of ionizing radiation administered ranged from 40 to 85 Gy, with different dose fractionations, according to the technique employed. The five-year cure-rate was 88.6%. Cosmetic results were evaluated as "good" or "acceptable" in 96.13% of the treated lesions in complete remission. So far, no complications nor sequelae to the radiological treatment have been observed. Our results show that superficial radiotherapy is able to provide high rates of remission in the treatment of nose basal and squamous cell carcinomas, without damaging the underlying cartilaginous tissues.

Dermatologic radiotherapy of primary cutaneous follicle center cell lymphoma.

A retrospective study was performed to evaluate the results of dermatologic radiotherapy in a large series of patients affected by primary cutaneous B-cell lymphomas. The study included 104 patients with cutaneous follicle center cell lymphoma treated with orthovoltage radiotherapy from 1973 to 2000. The total doses ranged from 14 to 35 Gy (mean 23.55 Gy). Results regarded 102 patients (mean follow-up 65.08 months). Complete remission was observed in all cases; 76 patients experienced a relapse after a mean interval of 22.03 months following radiotherapy, with a relapse-free rate of 22.82 % after 5 years. Extracutaneous progression was observed in 9 cases (8.82 %). An overall actuarial survival rate of 97.36 % was observed after 5 years. A salvage treatment of relapses brought 44 cases to remission. Although we have observed a relapse-free rate lower than that reported by others, dermatologic radiotherapy was "curative" in 25.49 % of cases. Such treatment appears particularly useful in the cases with few lesions and in the management of new cutaneous localizations of follicular center cell lymphoma.

Postoperative radiotherapy of keloids: a twenty-year experience.

In spite of several treatment modalities available, there is no method able to guarantee absolute success in the therapeutic approach to keloids. To evaluate the effectiveness and safety of postoperative radiotherapy we performed a retrospective study on 156 keloids, histologically ascertained, treated by means of orthovoltage radiotherapy in the last twenty years. The total doses administered ranged from 15 to 40 Gy. The radiotherapy started within 7 days from surgery in 127 lesions (81.4%), and within 3 weeks in the remaining 29 (18.6%). Surgical methods to minimize tension at wound sites were adopted. The follow-up ranged from 6 to 216 months. After irradiation a complete remission was obtained in 141 lesions (90.4%) and a partial response in 15 lesions (9.6%). The five-year relapse-free rate was 86.68%. Cosmetic results were evaluated as good or acceptable in 82.73% of the lesions. Afterwards, 17 lesions (10.89%) have relapsed. No stochastic or non stochastic effects have been observed.