Long-Term Efficacy and Safety of Superficial Radiation Therapy in Subjects With Nonmelanoma Skin Cancer: A Retrospective Registry Study

Background: Low-dose superficial radiation therapy (SRT) effectively treats nonmelanoma skin cancer (NMSC) without requiring invasive excision. SRT is especially safe and effective among the elderly who comprise most patients with basal cell and squamous cell carcinomas (BCCs and SCCs). Objective: To demonstrate the long-term safety and efficacy of SRT for treating NMSC with a new generation device. Methods: A retrospective chart review was performed at four clinical study sites. The study population included male and female patients (N=516) treated with SRT for NMSC (N=776) including BCCs (n=448) and SCCs (n=328) prior to January 2015 with long-term follow-up records. Results: The overall mean (SD) total treatment dosage was 4652.33 (366.34) cGy (range, 3636.6 to 5455 cGy) administered over a mean of 12.3 (1.85) sessions. The overall Kaplan-Meier survival probability estimate (95% CI) was 0.989 (0.980, 0.998) at 24 months, 0.989 (0.969, 1.000) at 60 months, and 0.989 (0.942, 1.000) at 85 months. There were six recurrences of BCCs (n=4) and SCCs (n=2). The most common adverse event was hypopigmentation. Limitations: Retrospective study design and some incomplete data. Conclusion: It is estimated that 98.9% of nonmelanoma skin cancers will not recur after 85 months following superficial radiation therapy. J Drugs Dermatol. 2020;19(2)163-168. doi:10.36849/JDD.2020.4647

Borderline sebaceous neoplasm in a renal transplant patient without Muir-Torre syndrome.

Borderline sebaceous neoplasms are rare tumors that can be challenging to diagnose because of their admixture of histopathologic features. Most such tumors have been described in patients with Muir-Torre syndrome (MTS). We report the case of an immunosuppressed, 82-year-old African-American woman without MTS who developed a rapidly growing lesion on the left cheek. Histopathology revealed a borderline sebaceous neoplasm with predominant features of sebaceous adenoma and with focal features raising concern for the possibility of an evolving, well-differentiated, low-grade sebaceous carcinoma with a high mitotic index. In the setting of immunosuppression, borderline sebaceous neoplasms may occur outside of MTS; careful evaluation and conservative treatment are recommended in managing such tumors.

Does pulse stacking improve the results of treatment with variable-pulse pulsed-dye lasers?

BACKGROUND: It has been suggested that multiple stacked pulses of lower fluence may have a similar effect on targets as a single pulse of higher fluence. When treating vascular lesions, increasing the fluence beyond a certain point will increase the risk of purpura given a constant pulse duration. Stacking pulses of lower fluence may have the advantage of heating vessels to a critical temperature without creating purpura. OBJECTIVE: To determine whether stacking low-fluence pulses of a variable-pulse pulsed-dye laser would improve clinical results without significantly increasing side and adverse effects. METHODS: Twenty-five patients between the ages of 18 and 65 years with facial telangiectasia and skin types I-IV were enrolled in the study. For each subject, the cheek or nasal ala areas on either side of the facial midline with similar telangiectasia density ratings were randomized to single pulse and multiple stacked pulse groups. One side of the cheek or nasal ala was treated with single nonoverlapping pulses with the Candela Vbeam 595-nm pulsed-dye laser. The opposite side of the cheek or nose was treated with the same parameters but with three or four pulses stacked on top of each other at a 1.5-Hz repetition rate. Patients were asked to rate the pain of the procedure on each side on a 0 to 3 scale. Investigators rated the erythema and edema after the procedure as well as vessel clearing and overall telangiectasia density scale at 1 and 6 weeks after the procedure. RESULTS: Twenty-three patients completed the study. The mean pain rating was 1.58 for the pulse stacked side and 1.38 for the single-pass side. The mean erythema score after the procedure was 1.17 for the pulsed stacked side and 1.09 for the single pulsed side. The mean vessel clearing 1 week after the treatment was 74.3% for the pulse stacked side and 58.5% for the single pulsed side. The mean vessel clearing 6 weeks after the treatment was 87.6% for the pulse stacked side and 67.4% for the single pulsed side. The mean telangiectasia density scale score before treatment was 2.67 for the pulse stacked side and 2.59 for the single pulsed side. At 1 week after treatment, the mean telangiectasia density scale score was 1.06 for the pulsed stacked side and 1.5 for the single pulsed side. At 6 weeks after treatment, the mean telangiectasia density scale score was 0.72 for the pulsed stacked side and 1.30 for the single pulsed side. No patients experienced purpura in either group, and there were no cases of hyperpigmentation, hypopigmentation, or scar formation. One patient experienced significant edema on the side of the cheeks treated with pulse stacking. CONCLUSIONS: Treating superficial facial telangiectasia with a pulse stacking technique may improve clinical results without significantly increasing adverse effects.

Infantile myofibromatosis: support for autosomal dominant inheritance.

We describe a family in whom infantile myofibromatosis affected 3 generations. The disease expression in this family suggests an autosomal dominant inheritance pattern with variable penetrance.

Liquid injectable silicone: history, mechanism of action, indications, technique, and complications.

Medical grade liquid injectable silicone can be used for soft tissue augmentation to correct and replace lost volumes of the subcutaneous tissue. It is potentially a permanent tissue augmentation agent and is the most effective filler for certain indications. This article presents the history, mechanism of action, indications and contraindications, technique, and the possible complications of silicone and their treatment.