Vismodegib as Eye-Sparing Neoadjuvant Treatment for Locally Advanced Periocular Basal Cell Carcinoma.

Locally-advanced periocular basal cell carcinoma (BCC) pose many therapeutic challenges due to the need to preserve functionality and cosmesis of the orbit and periocular area. Surgical excision and subsequent orbital exenteration are two recognized modalities of treatment. Vismodegib is currently an FDA-approved monotherapy for locally-advanced and metastatic BCC. We present a case of the use of vismodegib as neoadjuvant therapy prior to surgical excision of a locally-advanced periocular recurrent BCC in a 75-year-old male. The patient’s tumor successfully responded to vismodegib allowing surgical excision with clear margins. The orbit was saved in a patient who otherwise would have required complete orbital exenteration. J Drugs Dermatol. 20(5):552-554. doi:10.36849/JDD.5661.

Comparison of Grenz ray and photodynamic therapy for field treatment of actinic keratoses on the forearm: A case series.

BACKGROUND: Actinic Keratosis is an intraepidermal neoplasm that represents the second most common reason for dermatologic visits in the United States. Sustained clearance with existing therapies is highly variable. OBJECTIVE: To assess the effects of combination and monotherapy with photodynamic therapy (PDT), grenz ray therapy, and PDT with microneedling (microchannel skin system) for actinic damage of the dorsal forearms and hands. METHODS: Full ethics approval was obtained through a Human Subjects Committee. Four patients with diffuse actinic field damage on their forearms and hands were recruited for the study. The dorsal forearm and hand from the elbow to the metacarpophalangeal joint were divided into four equal sections. Section 1 was treated with PDT. Section 2 was treated with grenz ray. Section 3 was treated with PDT plus microneedling. Section 4 was treated with grenz ray and PDT with microneedling. Lesion counts were recorded with transparent grids, photographed and evaluated by the same investigator at baseline, 1, 2, 3 and 6 months. RESULTS: At month 6 post treatment, lesion counts, as a per cent reduction from baseline, were 91.7% in section 1 (PDT); 97.3% in section 2 (grenz ray); 92.9% in section 3 (PDT + microneedle); and 93.9% in section 4 (grenz ray + PDT + microneedle). CONCLUSION: The greatest reduction occurred in the grenz ray monotherapy section and the second greatest reduction in the grenz ray, PDT, microneedling section. Further research on the efficacy of grenz ray therapy for field treatment of actinic keratosis of the forearms and hands is needed.

Case Report: Triple Combination Therapy for Recalcitrant Perineal Pyoderma Gangrenosum

Pyoderma gangrenosum (PG) is a destructive ulcerative process, which is usually idiopathic or associated with underlying systemic disease. Its pathogenesis remains unknown. A 30-year-old male with a history of Crohn's disease presented with an advanced perineal and inguinal ulcer consistent with pyoderma gangrenosum, which only partially responded to oral and intralesional corticosteroids and adalimumab 80mg biweekly. The patient was started on adjunct combination cyclosporine and thalidomide, which resulted in prompt relief and profound healing. Treatment of pyoderma gangrenosum is often challenging with no standardized treatment protocols. Combination therapy should be considered in patients with refractory disease, especially with failure of monotherapy. J Drugs Dermatol. 2019;18(3):307-310.

Ultrafast mid-infrared high harmonic and supercontinuum generation with n2 characterization in zinc selenide.

Polycrystalline ZnSe is an exciting source of broadband supercontinuum and high-harmonic generation via random quasi phase matching, exhibiting broad transparency in the mid-infrared (0.5-20 µm). In this work, the effects of wavelength, pulse power, intensity, propagation length, and crystallinity on supercontinuum and high harmonic generation are investigated experimentally using ultrafast mid-infrared pulses. Observed harmonic conversion efficiency scales linearly in propagation length, reaching as high as 36%. For the first time to our knowledge, n2 is measured for mid-infrared wavelengths in ZnSe: n2(λ=3.9 µm)=(1.2±0.3)×10-14 cm2/W. Measured n2 is applied to simulations modeling high-harmonic generation in polycrystalline ZnSe as an effective medium.

Recalcitrant Diffuse Cutaneous Sarcoidosis With Perianal Involvement Responding to Adalimumab.

Recalcitrant cutaneous sarcoidosis with perianal involvement is rare. To our knowledge we present the first documented case of cutaneous sarcoidosis with perianal involvement successfully treated with adalimumab.

J Drugs Dermatol. 2017;16(12):1305-1306.

Practice and Educational Gaps in Radiation Therapy in Dermatology.

Guidelines for appropriate use of superficial radiation therapy are based on decades of research; although no formal appropriate use criteria have been developed, they are warranted. Superficial radiation in the outpatient dermatologic setting is the least expensive form of radiation treatment. Although higher cure rates may be possible with Mohs surgery, this should never argue against dermatologists retaining and refining a modality, nor should we limit its use by our successors. Most important, our elderly and infirm patients should continue to benefit from superficial radiation therapy in outpatient dermatologic settings.

Palmoplantar keratoses and Bowen's disease in a Vietnam veteran: Could Agent Blue be implicated?

Agent Blue was an arsenical herbicide used extensively in the Vietnam War. Arsenic is one of the known causes of acquired palmoplantar keratoderma (PPK). The most common manifestation of arsenic exposure in susceptible individuals is bilateral palmoplantar hyperkeratosis. We report a 67-year-old man with no known prior exposure to arsenic in the USA or family history of PPK who developed multiple squamous cell carcinoma in situ (SCCIS) and palmoplantar hyperkeratotic lesions beginning 23 years after service in Vietnam. The SCCIS were located on the trunk and extremities in both sun-exposed and non-sun-exposed sites and his palmoplantar lesions were diagnosed concurrently with his SCCIS. He has continued to develop SCCIS since his first visit to our clinic 25 years ago.

A possible chemopreventive role for photodynamic therapy in Gorlin syndrome: a report of basal cell carcinoma reduction and review of literature.

Multiple basal cell carcinomas (BCC) are a significant cause of morbidity and disfigurement in patients with naevoid basal cell carcinoma syndrome (NBCCS). Chemopreventive strategies are needed to reduce the formation of new BCC in these patients. Appropriate evidence-based guidelines for photodynamic therapy chemoprevention in NBCCS do not exist. We herein report one patient treated with methyl aminolevulinate PDT with red light (630 nm) activation to continue sustained chemoprevention following other BCC chemopreventive modalities and a relevant literature review.

Urticaria after methyl aminolevulinate photodynamic therapy in a patient with nevoid basal cell carcinoma syndrome.

Methyl aminolevulinate photodynamic therapy (MAL-PDT) is utilized in several countries for the treatment of basal cell carcinoma, but allergic sensitization has been reported by the manufacturer. To the best of our knowledge, we report the first case of urticaria following MAL-PDT in a patient with nevoid basal cell carcinoma syndrome. Prophylactic use of antihistamines may allow continued use of MAL-PDT in this setting.