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BACKGROUND: Access to dermatologists is limited in parts of the US, making primary care clinicians (PCCs) integral for early detection of skin cancers. A handheld device using elastic scattering spectroscopy (ESS) was developed to aid PCCs in their clinical assessment of skin lesions. METHODS: In this prospective study, 3 PCCs evaluated skin lesions reported by patients as concerning and scanned each lesion with the handheld ESS device. The comparison was pathology results or a 3-dermatologist panel examining high resolution dermatoscopic and clinical images. PCCs reported their diagnosis, management decision, and confidence level for each lesion. Evaluation of results included sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and Area Under the Curve (AUC). RESULTS: A total of 155 patients and 178 lesions were included in the final analysis. The most commonly patient-reported concerning feature was "new or changing lesion" (91.6%). Device diagnostic sensitivity and specificity were 90.0% and 60.7%, respectively, based on biopsy result or dermatologist panel reference standard; comparatively, PCC sensitivity was 40.0% and 84.8% specificity without the use of the device. Device NPV was 98.9%, and device PPV was 13.6%. The device recommended patient referral to dermatology with 88.2% concordance with the dermatologist panel. AUC for the device and PCCs were 0.815 and 0.643, respectively. CONCLUSIONS: The use of the ESS device by PCCs can improve diagnostic and management sensitivity for select malignant skin lesions by correctly classifying most benign lesions of patient concern. This may increase skin cancer detection while improving access to specialist care.
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Sensibilidade e Especificidade , Neoplasias Cutâneas , Humanos , Estudos Prospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Análise Espectral/métodos , Adulto , Detecção Precoce de Câncer/métodos , Atenção Primária à Saúde , Idoso de 80 Anos ou mais , Dermoscopia/instrumentação , Valor Preditivo dos TestesRESUMO
Melanoma, accounting for a significant proportion of skin cancer-related deaths, has variable survival outcomes based on the stage at diagnosis and treatment efficacy. Traditional treatments, while effective, pose risks of scarring and systemic side effects. Laser therapy offers an emerging non-surgical alternative, with CO2 lasers particularly showing promise in palliative care.A comprehensive search was conducted using PubMed, focusing on laser therapy for melanoma treatment. The search included studies on both stand-alone and adjunct laser therapies, with inclusion criteria requiring peer-reviewed articles detailing treatment outcomes for primary, recurrent, or metastatic melanoma.The literature shows that laser therapy for melanoma falls into four major types when categorized by laser medium: solid-state, diode, pulse-dye, and gas (CO2). Data on solid-state lasers for melanoma are limited and their use remains controversial. However, one study with high-energy pulsed neodymium lasers reported a 5-year survival of 82.9% with minimal adverse effects for primary melanoma. CO2 laser therapy has been effective for palliative treatment, with one study showing 54.8% of patients with recurrent melanoma surviving 5.4 years post-ablation. For metastatic melanoma, numerous studies have shown that CO2 laser therapy can provide symptomatic relief and disease control. Combination therapies using lasers and immune-based therapies have demonstrated enhanced outcomes and immune activation, highlighting the potential of laser therapies in melanoma management.While traditional treatments remain the standard for primary melanoma, laser therapies, particularly CO2 laser ablation, show substantial promise in palliative care for metastatic melanoma. Careful patient selection and assessment are crucial for achieving positive outcomes.
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Melanoma , Cuidados Paliativos , Neoplasias Cutâneas , Humanos , Melanoma/terapia , Melanoma/mortalidade , Melanoma/cirurgia , Melanoma/radioterapia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Cuidados Paliativos/métodos , Resultado do Tratamento , Lasers de Gás/uso terapêutico , Lasers de Gás/efeitos adversos , Terapia a Laser/métodos , Terapia a Laser/efeitos adversos , Terapia Combinada , Lasers de Estado Sólido/uso terapêutico , Lasers de Estado Sólido/efeitos adversos , Recidiva Local de NeoplasiaRESUMO
BACKGROUND: Amid a movement toward value-based healthcare, increasing emphasis has been placed on outcomes and cost of medical services. To define and demonstrate the quality of services provided by Mohs surgeons, it is important to identify and understand the key aspects of Mohs micrographic surgery (MMS) that contribute to excellence in patient care. OBJECTIVE: The purpose of this study is to develop and identify a comprehensive list of metrics in an initial effort to define excellence in MMS. METHODS: Mohs surgeons participated in a modified Delphi process to reach a consensus on a list of metrics. Patients were administered surveys to gather patient perspectives. RESULTS: Twenty-four of the original 66 metrics met final inclusion criteria. Broad support for the initiative was obtained through physician feedback. LIMITATIONS: Limitations of this study include attrition bias across survey rounds and participation at the consensus meeting. Furthermore, the list of metrics is based on expert consensus instead of quality evidence-based outcomes. CONCLUSION: With the goal of identifying metrics that demonstrate excellence in performance of MMS, this initial effort has shown that Mohs surgeons and patients have unique perspectives and can be engaged in a data-driven approach to help define excellence in the field of MMS.
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Neoplasias Cutâneas , Cirurgiões , Humanos , Neoplasias Cutâneas/cirurgia , Cirurgia de Mohs , Consenso , BenchmarkingRESUMO
Oncolytic viral immunotherapies are agents which can directly kill tumor cells and activate an immune response. Oncolytic viruses (OVs) range from native/unmodified viruses to genetically modified, attenuated viruses with the capacity to preferentially replicate in and kill tumors, leaving normal tissue unharmed. Talimogene laherparepvec (T-VEC) is the only OV approved for patient use in the United States; however, during the last 20 years, there have been a substantial number of clinical trials using OV immunotherapies across a broad range of cancers. Like T-VEC, many OV immunotherapies in clinical development are based on the herpes simplex virus type 1 (HSV-1), with genetic modifications for tumor selectivity, safety, and immunogenicity. Despite these modifications, HSV-1 OV immunotherapies are often treated with the same biosafety guidelines as the wild-type virus, potentially leading to reduced patient access and logistical hurdles for treatment centers, including community treatment centers and small group or private practices, and healthcare workers. Despite the lack of real-world evidence documenting possible transmission to close contacts, and in the setting of shedding and biodistribution analyses for T-VEC demonstrating limited infectivity and low risk of spread to healthcare workers, barriers to treatment with OV immunotherapies remain. With comprehensive information and educational programs, our hope is that updated biosafety guidance on OV immunotherapies will reduce logistical hurdles to ensure that patients have access to these innovative and potentially life-saving medicines across treatment settings. This work reviews a comprehensive collection of data in conjunction with the opinions of the authors based on their clinical experience to provide the suggested framework and key considerations for implementing biosafety protocols for OV immunotherapies, namely T-VEC, the only approved agent to date.
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Photodynamic Therapy (PDT) with 10% aminolevulinic acid (ALA) gel and narrow-band red light has been previously shown to be safe and effective for the treatment of squamous cell carcinoma in situ (SCCis) on the trunk and extremities. However, there is a paucity of data in the literature evaluating long-term disease recurrence after PDT. Hence, we performed a follow-up study in which nine of the original twelve patients from our pilot study returned 29-40 months after their last PDT treatment. All patients were clinically clear of disease and only one of seven patients biopsied had residual disease, indicating a long-term clearance rate of 88%. Cosmetic outcomes and patient satisfaction were favorable. Our data supports that red-light PDT with 10% ALA gel can achieve long-term clinical and histopathologic disease clearance and is a viable alternative to surgery for select SCCis.
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Carcinoma de Células Escamosas , Fotoquimioterapia , Humanos , Ácido Aminolevulínico/uso terapêutico , Fármacos Fotossensibilizantes/uso terapêutico , Seguimentos , Fotoquimioterapia/métodos , Projetos Piloto , Recidiva Local de Neoplasia/tratamento farmacológico , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/patologiaRESUMO
IMPORTANCE: There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE: To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW: Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS: The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE: Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.
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Carcinoma de Células Escamosas , Ceratose Actínica , Transplante de Órgãos , Neoplasias Cutâneas , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Técnica Delphi , Humanos , Ceratose Actínica/etiologia , Ceratose Actínica/patologia , Ceratose Actínica/prevenção & controle , Transplante de Órgãos/efeitos adversos , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/prevenção & controle , TransplantadosRESUMO
BACKGROUND: Data evaluating the effectiveness of photodynamic therapy (PDT) with aminolevulinic acid (ALA) 10% nanoemulsion gel and red-light LED lamp for the treatment of squamous cell carcinoma in situ (SCCis) on the trunk and extremities is limited. Our study sought to investigate the safety and efficacy of utilizing ALA 10% gel with red-light lamp for the treatment of SCCis on the trunk and extremities. METHODS: A single center prospective study of 12 patients with biopsy proven SCCis underwent one or two cycles of red-light PDT with ALA 10 % gel and 3 hours incubation period. Each cycle consisted of two treatments approximately 10 days apart. All participants had a biopsy for histologic evaluation 4 weeks following the last treatment. RESULTS: All patients achieved clinical and histologic clearance following either one or two cycles at the 4-week post treatment follow up period. The majority of lesions were located on the extremities (n=10) with the remainder located on the trunk (n=2). The mean diameter of the lesions was 1.83 cm. Mild pain was noted in patients, with no interruption of treatment. CONCLUSIONS: Our study indicates that ALA 10% gel with a red-light lamp is a safe and effective treatment option for SCCis on the trunk and extremities.
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Carcinoma de Células Escamosas , Fotoquimioterapia , Ácido Aminolevulínico/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Extremidades , Humanos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Projetos Piloto , Estudos Prospectivos , Resultado do TratamentoAssuntos
Disparidades nos Níveis de Saúde , Hispânico ou Latino/estatística & dados numéricos , Melanoma/etnologia , Melanoma/secundário , Neoplasias Cutâneas/etnologia , Neoplasias Cutâneas/patologia , População Branca/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arizona/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Sistema de Registros , Neoplasias Cutâneas/diagnóstico , Adulto JovemAssuntos
Antineoplásicos Imunológicos/uso terapêutico , Produtos Biológicos/uso terapêutico , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Antineoplásicos Imunológicos/administração & dosagem , Produtos Biológicos/administração & dosagem , Herpesvirus Humano 1 , Humanos , Injeções Intralesionais , Metástase Linfática , Melanoma/patologia , Estadiamento de Neoplasias , Neoplasias Cutâneas/patologiaRESUMO
Photodynamic therapy (PDT) can be an effective treatment for actinic keratosis (AK) as well as selected non-melanoma skin cancers (NMSCs), such as Bowen's disease and superficial basal cell carcinoma. PDT has also demonstrated effectiveness in the management of acne vulgaris. Results from controlled clinical trials have shown the safety and efficacy of PDT for these conditions with the use of different photosensitizers and a wide range of light sources. PDT has been employed effectively as monotherapy and in combination with other topicals and alternate light or laser energy therapies. This article provides expert practical guidance for the use of the newest 5-aminolevulinic acid (ALA) product (ALA 10% gel) plus red light as monotherapy for AKs, NMSC, and acne. Here, information from clinical guidelines and a summary of supporting evidence is provided for each cutaneous condition. The authors also provide detailed guidance for employing ALA 10% gel, a photosensitizer precursor, for each of these applications.
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BACKGROUND: Talimogene laherparepvec (T-VEC) is the first oncolytic virus therapy approved by the United States Food and Drug Administration (in 2015) for the treatment of advanced-stage melanoma. Despite a paucity of Phase III trials for T-VEC as a therapy for non-melanoma cancers, successful off-label use of T-VEC for this purpose has been reported in the literature. OBJECTIVE: We sought to review the literature describing T-VEC as a treatment for non-melanoma cancer. METHODS: Systematic searches of the PubMed literature database and ClinicalTrials.gov website were performed in July 2020, focusing on T-VEC in combination with non-melanoma cancer, including squamous cell carcinoma, Merkel cell carcinoma, sarcoma, cutaneous B-cell lymphoma, and cutaneous T-cell lymphoma. Articles were screened based on their title and abstract. RESULTS: Nine articles with 87 patients were included. Relevant articles included case reports, case series, and Phase I and Phase II trials. The majority of patients in the studies had refractory cancers or had been heavily pretreated. Overall, T-VEC demonstrated efficacy for non-melanoma cancer, both independently and in combination with biologics. CONCLUSION: T-VEC has demonstrated efficacy for non-melanoma cancers. Phase III trials of T-VEC for this indication are warranted to expand its clinical utility.
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BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma that arises in areas rich in apocrine sweat glands. Photodynamic therapy (PDT) is a non-invasive technique demonstrating clinical efficacy in various case reports and case series for the treatment of EMPD. METHODS: A review of the current literature of patients with EMPD treated with PDT. RESULTS: 177 patients with 211 lesions were included in this review with an overall complete response rate of 59.7 %. Lesion size was correlated with the efficacy of 5-aminolevulinic acid (ALA) PDT. Topical methyl-ALA had lower complete response rates compared to ALA. Systemic PDT with intravenous sodium porfimer had high response rates but can be associated with more adverse reactions. The efficacy of PDT was enhanced with the combination of other treatments such as surgery, imiquimod, or laser ablation. PDT was also shown to be effective for previously treated lesions, recurrent lesions, and select invasive lesions. CONCLUSION: PDT can be a therapeutic option for EMPD patients. Given the lack of PDT guidelines, general recommendations for treatment are offered.
Assuntos
Doença de Paget Extramamária , Fotoquimioterapia , Ácido Aminolevulínico/uso terapêutico , Éter de Diematoporfirina/uso terapêutico , Humanos , Doença de Paget Extramamária/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêuticoAssuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Dermatologia/normas , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Neoplasias Cutâneas/terapia , Betacoronavirus/imunologia , COVID-19 , Quimioterapia Adjuvante/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Dermatologia/métodos , Humanos , Imunoterapia/efeitos adversos , Imunoterapia/normas , Controle de Infecções/normas , Infusões Intravenosas/normas , Oncologia/métodos , Cirurgia de Mohs/normas , Terapia Neoadjuvante/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco/normas , SARS-CoV-2 , Pele/patologia , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Telemedicina/normasRESUMO
Visual examination plays a central role in the diagnosis of skin diseases. Many dermatologists use magnification, or dermoscopy, to improve diagnostic certainty when assessing the skin under visible light. In addition to magnification, other technological advances have been made over the last century to improve our visual assessment of the skin. Examination of skin under ultraviolet (UV) radiation, with Wood's light, gained traction for its utility in assessing superficial cutaneous infections and pigmentary changes. During Wood's light examination, UV light is directed at the skin and fluorescence is detected by our eyes. The variable fluorescent characteristics of endogenous and exogenous cutaneous chromophores help us better diagnose skin disease. UV fluorescent photography is based on the same concept as the Wood's light, but also allows image analysis and documentation of the captured image. In addition to UV-induced fluorescence, the differential reflection and absorption of UV light captured in the UV spectral range can also provide a new contrast for diagnosing skin diseases during UV reflectance photography. This review discusses the most widely used UV imaging techniques and provides an overview of the role of UV imaging in dermatology.
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Dermatologia , Fotoquimioterapia , Dermatopatias , Humanos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes , Dermatopatias/diagnóstico por imagem , Raios UltravioletaAssuntos
Produtos Biológicos/administração & dosagem , Injeções Intralesionais/normas , Melanoma/terapia , Terapia Viral Oncolítica/métodos , Neoplasias Cutâneas/terapia , Produtos Biológicos/efeitos adversos , Relação Dose-Resposta a Droga , Esquema de Medicação , Herpesvirus Humano 1 , Humanos , Injeções Intralesionais/instrumentação , Melanoma/diagnóstico , Melanoma/patologia , Estadiamento de Neoplasias/métodos , Terapia Viral Oncolítica/efeitos adversos , Terapia Viral Oncolítica/instrumentação , Terapia Viral Oncolítica/normas , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Ultrassonografia de IntervençãoRESUMO
Myoepithelial carcinomas are rare tumors that make up 1 to 2 percent of all salivary gland neoplasms. We present a case of a 55-year-old man with myoepithelial carcinoma that developed into widespread cutaneous, lung, and brain metastases refractory to treatment, including newer immunotherapies. Newer strategies or treatments are needed for the future benefit of patients with advanced disease.