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1.
Lancet Gastroenterol Hepatol ; 6(4): 327-334, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33714370

RESUMO

Anal squamous cell carcinoma is the most common type of anal cancer and is largely associated with anal human papillomavirus infection. The incidence of anal squamous cell carcinoma is increasing, and although still uncommon in the general population, a high incidence has been noted in specific population groups (eg, patients with HIV, men who have sex with men [MSM], recipients of solid organ transplants, women with genital neoplasia, and patients with systemic lupus erythematosus or inflammatory bowel disease). The higher incidence among individuals who are HIV-positive makes anal squamous cell carcinoma one of the most common non-AIDS-defining cancers among HIV-positive individuals. Anal cancer screening in high-risk groups aims to detect high-grade squamous intraepithelial lesions, which are considered anal precancerous lesions, and for which identification can provide an opportunity for prevention. A blind anal cytology is normally the first screening method, and for patients with abnormal results, this approach can be followed by an examination of the anal canal and perianal area under magnification, along with staining-a technique known as high-resolution anoscopy. Digital anorectal examination can enable early anal cancer detection. Several societies are in favour of screening for HIV-positive MSM and recipients of transplants. There are no current recommendations for screening of anal precancerous lesions via endoscopy, but in high-risk groups, a careful observation of the squamocolumnar junction should be attempted. Several treatments can be used to treat high-grade squamous intraepithelial lesions, including argon plasma coagulation or radiofrequency ablation, which are largely limited by high recurrence rates. Gastroenterologists need to be aware of anal squamous cell carcinoma and anal precancerous lesions, given that patients at high risk are frequently encountered in the gastroenterology department. We summarise simple procedures that can help in early anal squamous cell carcinoma detection.


Assuntos
Neoplasias do Ânus/prevenção & controle , Carcinoma de Células Escamosas/prevenção & controle , Lesões Pré-Cancerosas/prevenção & controle , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Humanos , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/terapia , Proctoscopia , Melhoria de Qualidade
2.
Mol Carcinog ; 60(2): 138-150, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33378592

RESUMO

Prognosis for patients with recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC) remains poor. Development of more effective and less toxic targeted therapies is necessary for HNSCC patients. Checkpoint kinase 1 (CHK1) plays a vital role in cell cycle regulation and is a promising therapeutic target in HNSCC. Prexasertib, a CHK1 inhibitor, induces DNA damage and cell death, however, its effect on the tumor immune microenvironment (TIME) is largely unknown. Therefore, we evaluated a short-term and long-term effects of prexasertib in HNSCC and its TIME. Prexasertib caused increased DNA damage and cell death in vitro and significant tumor regression and improved survival in vivo. The gene expression and multiplex immunohistochemistry (mIHC) analyses of the in vivo tumors demonstrated increased expression of genes that are related to T-cell activation and increased immune cell trafficking, and decreased expression of genes that related to immunosuppression. However, increased expression of genes related to immunosuppression emerged over time suggesting evasion of immune surveillances. These findings in gene expression analyses were confirmed using mIHC which showed differential modulation of TIME in the tumor margins and as well as cores over time. These results suggest that evasion of immune surveillance, at least in part, may contribute to the acquired resistance to prexasertib in HNSCC.


Assuntos
Carcinoma de Células Escamosas/prevenção & controle , Quinase 1 do Ponto de Checagem/antagonistas & inibidores , Neoplasias de Cabeça e Pescoço/prevenção & controle , Pirazinas/farmacologia , Pirazóis/farmacologia , Microambiente Tumoral/efeitos dos fármacos , Ensaios Antitumorais Modelo de Xenoenxerto/métodos , Animais , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/metabolismo , Linhagem Celular Tumoral , Quinase 1 do Ponto de Checagem/genética , Quinase 1 do Ponto de Checagem/metabolismo , Dano ao DNA , Neoplasias de Cabeça e Pescoço/genética , Neoplasias de Cabeça e Pescoço/metabolismo , Humanos , Masculino , Camundongos Endogâmicos C57BL , Inibidores de Proteínas Quinases/farmacologia , Análise de Sobrevida , Carga Tumoral/efeitos dos fármacos , Carga Tumoral/genética , Microambiente Tumoral/genética , Microambiente Tumoral/imunologia
3.
BMC Med ; 18(1): 406, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33349257

RESUMO

BACKGROUND: Colposcopy diagnosis and directed biopsy are the key components in cervical cancer screening programs. However, their performance is limited by the requirement for experienced colposcopists. This study aimed to develop and validate a Colposcopic Artificial Intelligence Auxiliary Diagnostic System (CAIADS) for grading colposcopic impressions and guiding biopsies. METHODS: Anonymized digital records of 19,435 patients were obtained from six hospitals across China. These records included colposcopic images, clinical information, and pathological results (gold standard). The data were randomly assigned (7:1:2) to a training and a tuning set for developing CAIADS and to a validation set for evaluating performance. RESULTS: The agreement between CAIADS-graded colposcopic impressions and pathology findings was higher than that of colposcopies interpreted by colposcopists (82.2% versus 65.9%, kappa 0.750 versus 0.516, p < 0.001). For detecting pathological high-grade squamous intraepithelial lesion or worse (HSIL+), CAIADS showed higher sensitivity than the use of colposcopies interpreted by colposcopists at either biopsy threshold (low-grade or worse 90.5%, 95% CI 88.9-91.4% versus 83.5%, 81.5-85.3%; high-grade or worse 71.9%, 69.5-74.2% versus 60.4%, 57.9-62.9%; all p < 0.001), whereas the specificities were similar (low-grade or worse 51.8%, 49.8-53.8% versus 52.0%, 50.0-54.1%; high-grade or worse 93.9%, 92.9-94.9% versus 94.9%, 93.9-95.7%; all p > 0.05). The CAIADS also demonstrated a superior ability in predicting biopsy sites, with a median mean-intersection-over-union (mIoU) of 0.758. CONCLUSIONS: The CAIADS has potential in assisting beginners and for improving the diagnostic quality of colposcopy and biopsy in the detection of cervical precancer/cancer.


Assuntos
Inteligência Artificial , Carcinoma de Células Escamosas/diagnóstico , Colposcopia/métodos , Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Biópsia/métodos , Biópsia/estatística & dados numéricos , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , China/epidemiologia , Colposcopia/estatística & dados numéricos , Confiabilidade dos Dados , Testes Diagnósticos de Rotina/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Valor Preditivo dos Testes , Gravidez , Reprodutibilidade dos Testes , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem
4.
J Cosmet Sci ; 71(4): 191-198, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33022203

RESUMO

This review summarizes the evidence on the protection against skin cancer afforded by sunscreen. Solid evidence can come only from randomized controlled trials, despite a multitude of case-control and cohort studies that have addressed the issue, because observational evidence is intractably confounded since those at highest risk of skin cancer are naturally the highest users of sunscreen. Findings of the single human trial conducted in subtropical Australia during 1992-1996 with follow-up to 2014 showed that the application of a broad-spectrum, sun protection factor 16 sunscreen to exposed skin of the head and neck and upper limbs at least 3-4 days per week in adulthood can reduce the risk of developing cutaneous squamous cell carcinoma and melanoma but does not appear to reduce the risk of basal cell carcinoma (BCC) overall, although it may reduce the occurrence of multiple BCCs over time.


Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Melanoma , Neoplasias Cutâneas , Carcinoma Basocelular/tratamento farmacológico , Carcinoma Basocelular/prevenção & controle , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/prevenção & controle , Humanos , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/prevenção & controle , Protetores Solares
5.
Dermatol Online J ; 26(7)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32898403

RESUMO

Poorly controlled and long-standing hidradenitis suppurativa (HS) increases the risk of squamous cell carcinoma (SCC). We report a 54-year-old woman with an over 20-year history of HS, who had previously undergone wide perineal excision with secondary intention healing and presented with a painful verrucous vulvar plaque and proximal non-healing perineal wound. The patient had four perineal scouting biopsies performed and excisional biopsy with no evidence of high-grade dysplasia or carcinoma on histology. Chromogenic in situ hybridization was negative for HPV 16 and 18 mRNA; the patient's HIV and HSV PCR were also negative. Our patient was treated with interferon alfa-2b with notable clinical improvement. There is currently no standardized stepwise approach to monitoring verrucous lesions in HS patients with significant risk factors for SCC. Our report highlights a vigilant approach to monitoring. If scouting biopsies are negative, complete testing for high risk HPV strains (HPV 16 and 18) is warranted. If negative, we recommend follow up every 6 months with no further biopsies except if overt clinical changes are observed. We also recommend treatment of verrucous changes to decrease risk of possible malignant conversion. Interferon alfa-2b was effective in decreasing the verrucous lesion burden in our patient and may be considered.


Assuntos
Hidradenite Supurativa/complicações , Interferon alfa-2/uso terapêutico , Verrugas/tratamento farmacológico , Biópsia , Carcinoma de Células Escamosas/prevenção & controle , Transformação Celular Neoplásica , Condiloma Acuminado/patologia , Diagnóstico Diferencial , Feminino , Hidradenite Supurativa/cirurgia , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Períneo/patologia , RNA Viral/análise , Falha de Tratamento , Vulva/patologia , Verrugas/etiologia , Cicatrização
6.
J Gastroenterol Hepatol ; 35(10): 1761-1768, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32367575

RESUMO

BACKGROUND AND AIM: This study aimed to evaluate effects of endoscopic screening method in different starting age groups and further confirm the optimum starting age for esophageal squamous cell cancer (ESCC) screening. METHODS: This study received institutional review board approval, and 6825 residents aged 40 to 69 years in high prevalence communities were assigned to the screening group or the control (non-screening) group from Hebei, China. Cumulative mortalities during the 14-year period, relative risk for participants who underwent screening, and numbers needed to invite for screening to save one life were compared between the screening group and the control group of different starting age groups at 14-year follow-up. RESULTS: The 14-year risks of ESCC mortality were one in 55, one in 17, and one in 9 for a person screened in the starting age group of 40, 50, and 60 years old. The cumulative mortalities of ESCC in screening groups were significantly lower than control groups in starting age groups of 40 years (1.42% vs 2.38%, P = 0.033) and 50 years (4.18% vs 7.13%, P = 0.005). Relative risks for participants who underwent screening were 0.60 and 0.59 for the starting age groups of 40 and 50 years. Numbers needed to invite for screening to save one life were 104 and 34 for participants in 40 years old group and 50 years old group, respectively. CONCLUSIONS: In conclusion, people in high prevalence area of ESCC should have endoscopy screening once at their 50 years. Forty years will be preferably defined as the starting age for screening in areas with sufficient health resources.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiologia , Detecção Precoce de Câncer/métodos , Endoscopia Gastrointestinal/métodos , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/epidemiologia , Programas de Rastreamento/métodos , Adulto , Fatores Etários , Idade de Início , Idoso , Carcinoma de Células Escamosas/prevenção & controle , China/epidemiologia , Estudos Transversais , Neoplasias Esofágicas/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Fatores de Tempo
7.
Rev Med Suisse ; 16(688): 646-650, 2020 Apr 01.
Artigo em Francês | MEDLINE | ID: mdl-32239839

RESUMO

Actinic keratoses are the most frequent precancerous lesions on Caucasian skin, often giving rise to squamous cell carcinomas. Appropriate prophylaxis, screening, and early intervention can substantially reduce the incidence of the latter. While isolated actinic keratoses can easily be treated by means of cryotherapy or curettage, multiple lesions often occurring on chronically sun-damaged skin demand more potent therapeutic strategies, such as topical cytostatic or immunomodulatory drugs, or photodynamic therapy. In this review, we give a practice-oriented overview on clinical manifestations, prevention, and treatment of actinic keratoses, and we emphasise the role of general practitioners in the management of this important pathology.


Assuntos
Ceratose Actínica/terapia , Carcinoma de Células Escamosas/prevenção & controle , Humanos , Fotoquimioterapia , Neoplasias Cutâneas/prevenção & controle
8.
Eur J Cancer ; 128: 60-82, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32113941

RESUMO

Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in the white populations, accounting for 20% of all cutaneous malignancies. Factors implicated in cSCC etiopathogenesis include ultraviolet radiation exposure and chronic photoaging, age, male sex, immunosuppression, smoking and genetic factors. A collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organisation of Research and Treatment of Cancer (EORTC) was formed to update recommendations on cSCC classification, diagnosis, risk stratification, staging and prevention, based on current literature, staging systems and expert consensus. Common cSCCs are typically indolent tumors, and most have a good prognosis with 5-year cure rates of greater than 90%, and a low rate of metastases (<4%). Further risk stratification into low-risk or high-risk common primary cSCC is recommended based on proposed high-risk factors. Advanced cSCC is classified as locally advanced (lacSCC), and metastatic (mcSCC) including locoregional metastatic or distant metastatic cSCC. Current systems used for staging include the American Joint Committee on Cancer (AJCC) 8th edition, the Union for International Cancer Control (UICC) 8th edition, and Brigham and Women's Hospital (BWH) system. Physical examination for all cSCCs should include total body skin examination and clinical palpation of lymph nodes, especially of the draining basins. Radiologic imaging such as ultrasound of the regional lymph nodes, magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography-computed tomography (PET-CT) scans are recommended for staging of high-risk cSCC. Sentinel lymph node biopsy is currently not recommended. Nicotinamide, oral retinoids, and topical 5-FU have been used for the chemoprevention of subsequent cSCCs in high-risk patients but are not routinely recommended. Education about sun protection measures including reducing sun exposure, use of protective clothing, regular use of sunscreens and avoidance of artificial tanning, is recommended.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Consenso , Dermatologia/normas , Oncologia/normas , Neoplasias Cutâneas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Humanos , Linfonodos/diagnóstico por imagem , Imagem por Ressonância Magnética/normas , Estadiamento de Neoplasias/normas , Educação de Pacientes como Assunto/normas , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Roupa de Proteção/normas , Medição de Risco/normas , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/prevenção & controle , Sociedades Médicas/normas , Luz Solar/efeitos adversos , Protetores Solares/administração & dosagem , Ultrassonografia/normas
9.
Hautarzt ; 71(6): 455-462, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32206841

RESUMO

BACKGROUND: The disease burden of actinic keratoses and keratinocyte carcinoma can be reduced by primary and secondary prevention. However, these measures are often poorly received, especially among the high-risk group of outdoor workers. OBJECTIVES: The aim of this follow-up study was to investigate whether an improvement in sun protection and awareness of skin changes could be observed among the study population, especially outdoor workers, one year after a prevention campaign focusing on this topic. MATERIALS AND METHODS: In 2017, all participants who initially participated in a study at the Bavarian Central Agricultural Festival 2016 and agreed to participate in the follow-up study were contacted by mail and received the same questionnaire and evaluation questions regarding possible behavioral changes. RESULTS: A total of 400 people took part in the follow-up study (response rate 52.8%). Of the 240 outdoor workers, 45.0% said they were more conscious of protecting themselves from the sun and 68.8% said they were more aware of skin changes. About 85.0% of outdoor workers indicated that they would consult a dermatologist earlier and 65.8% desired further prevention campaigns regarding skin cancer and sun protection. CONCLUSION: Overall, the majority of participants reported that they had improved sun protection behavior and awareness of skin changes after the intervention. Based on the participants' self-disclosure, especially outdoor workers tended to use sun protection measure more frequently. These findings underline the importance of target group-oriented awareness and prevention campaigns to reduce the burden of skin cancer.


Assuntos
Carcinoma de Células Escamosas/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Queratinócitos , Ceratose Actínica/prevenção & controle , Roupa de Proteção , Neoplasias Cutâneas/prevenção & controle , Humanos , Inquéritos e Questionários
10.
J Intern Med ; 287(2): 134-152, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31733108

RESUMO

In 2007, human papillomavirus (HPV) type 16 was finally recognized as a risk factor, besides smoking and alcohol, for oropharyngeal squamous cell carcinoma (OPSCC), including tonsillar squamous cell carcinoma (TSCC), by the International Agency for Research against Cancer. Just before, in 2006, the Food and Drug Administration had approved Gardasil, the first vaccine against HPV16, 18, 6 and 11, for preventive vaccination women against cervical cancer. Concurrently, some Western countries, where smoking was decreasing, disclosed an epidemic increase in the incidence of OPSCC, especially of TSCC and base of tongue cancer (BOTSCC), together accounting for 80-90% of all OPSCCs, and mainly affecting men. The epidemic was later revealed to be due to a rise in HPV-positive cases, and scientists in the field suggested HPV vaccination also of boys. Globally, there are roughly 96 000 incident OPSCC cases/year of which 20-24% are caused by HPV, thereby accounting for around 22 000 OPSCC cases annually. Of these cases, 80-90% are due to HPV16 infection and would be prevented with the presently registered HPV vaccines. In Western countries, such as Sweden (with almost 400 TSCC and BOTSCC cases per year) and the United States, HPV prevalence in OPSCC is higher and around 70%. HPV vaccination of girls has been initiated in many countries, and the vaccines have been efficient and their side effects limited. HPV vaccination of boys has, however, been the exception, but should definitely not be delayed any further. It would benefit both girls and boys directly, and result in better and more robust herd immunity. Today, we have the possibility to eliminate several high-risk HPV types in the younger generations and avoid more than 600 000 cancer cases annually worldwide, and this possibility should be embraced by offering global pan-gender HPV vaccination.


Assuntos
Carcinoma de Células Escamosas/virologia , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus , Neoplasias da Língua/virologia , Neoplasias Tonsilares/virologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Prognóstico , Neoplasias da Língua/epidemiologia , Neoplasias da Língua/prevenção & controle , Neoplasias Tonsilares/epidemiologia , Neoplasias Tonsilares/prevenção & controle
12.
J Eur Acad Dermatol Venereol ; 34(2): 251-259, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31394005

RESUMO

Solid organ transplant recipients (sOTR) are at an increased risk of developing cutaneous cancers, especially squamous cell carcinoma (SCC). Photodynamic therapy (PDT) for the prevention and treatment of actinic keratosis (AK)/SCC in sOTR is increasingly prescribed given the increase in solid organ transplantations performed worldwide. PDT has added advantages of superior cosmetic outcomes and good safety profile compared to conventional surgical methods and other topical therapies. We aim to evaluate the role of PDT in the prevention and treatment of AK/SCC in sOTRs. The Cochrane Library, PubMed and EMBASE database were searched. Articles reporting PDT outcomes amongst sOTR with or without AK/SCC at baseline were selected. We classified the studies into two categories: (i) PDT as prevention measure and (ii) treatment of AK/SCC in sOTR. Primary outcome for the prevention category was 3-year incidence of AK/SCC and complete response (CR) of lesions after PDT exposure in the treatment category. Secondary outcomes were cosmesis and adverse reaction in both categories. Pooled results were expressed as risk difference (RD) with corresponding 95% confidence interval (95% CI). Twelve out of 641 articles met our eligibility criteria, out of which four RCTs reported the preventive effect of AK/SCC and another five RCTs reported the treatment effect of PDT in sOTR. One RCT did not report absolute number of lesions at baseline/end of study for results to be pooled in the quantitative analysis. The remaining three studies were cohort studies reporting treatment and preventive effect of PDT in sOTR. PDT group had a lower incidence as a preventive measure with pooled RD of 0.14 (95% CI 0.08-0.19). The CR in PDT was higher in the treatment group with a pooled RD of 0.77 (95% CI 0.6-0.94) and 0.50 (95% CI 0.22-0.79) in predivided lesional areas and number of lesions, respectively. In conclusion, PDT is efficacious for prevention and treatment of AK/SCC in sOTRs.


Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/prevenção & controle , Ceratose Actínica/tratamento farmacológico , Ceratose Actínica/prevenção & controle , Transplante de Órgãos , Fotoquimioterapia , Transplantados , Humanos , Resultado do Tratamento
13.
Rev. argent. coloproctología ; 30(4): 88-92, dic. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1096793

RESUMO

Introducción: Las lesiones escamosas intraepiteliales de alto grado anales (H-ASIL) son consideradas el precursor del carcinoma escamoso anal. Es por esto que distintas Sociedades recomiendan su pesquisa y tratamiento en poblaciones de alto riesgo. El objetivo del trabajo es describir las manifestaciones de H-ASIL en la anoscopía de alta resolución (AAR) en nuestros pacientes. Diseño: Retrospectivo, descriptivo. Pacientes y métodos: Revisión de historias clínicas e imágenes de AAR de pacientes con diagnóstico de H-ASIL entre enero de 2016 y julio de 2017. La evaluación anoscópica incluyó la unión escamocolumnar, el conducto anal distal y el área perianal. Frente al hallazgo de una lesión sospechosa de ASIL, se tomaron biopsias. Resultados: Entre enero de 2016 y julio de 2017 se realizaron 184 AAR. Se biopsiaron 143 lesiones sospechosas de ASIL. Veintiséis de ellas, presentes en 13 pacientes fueron H-ASIL. Once hombres (diez hombres que tienen sexo con hombre (HSH) con infección por VIH). Todas las lesiones eran subclínicas y se encontraron a nivel endoanal; eran en su totalidad acetoblancas. Se buscaron áreas con puntillado y/o mosaico sugestivas de ASIL. El uso de Lugol nos permitió aumentar el grado de sospecha y delimitar las lesiones. Se tomaron biopsias para anatomía patológica bajo visión directa. Conclusiones: Las H-ASIL son consideradas en la actualidad las precursoras del carcinoma escamoso anal; su detección y tratamiento prevendrían su desarrollo. En nuestra casuística, todos los pacientes se encontraban en al menos un grupo de riesgo. Las lesiones fueron subclínicas y requirieron de la anoscopía de alta resolución para su hallazgo, lo que permitió realizar un tratamiento dirigido. Es importante que los profesionales de la salud consideren la pesquisa de H-ASIL en población de riesgo. (AU)


Introduction: The high-grade anal intraepithelial lesions (H-ASIL) are considered the precursor of the anal squamous cell carcinoma. This is why different societies recommend the screening and treatment in high-risk populations. The objective of this paper is to describe H-ASIL manifestations in the high resolution anoscopy (HRA) in our patients. Design: Retrospective, Descriptive Patients and Methods: Review of clinical histories and pictures of HRA of patients with H-ASIL diagnosis between January 2016 and July 2017. The anoscopic evaluation included the squamocolumnar junction, the distal anal duct and the perianal area. In case of the finding of a suspicious lesion of ASIL, biopsies were taken. Results: Between January 2016 and July 2017 184 HRA were performed. 143 ASIL suspicious lesion were biopsied. Twentysix of them, in 13 patients, were H-ASIL. Eleven were men (10 men who have sex with men with HIV infection). All lesions were subclinical and found at endoanal level. The totality of them were acetowhite. Areas with coarse punctation and a mosaic pattern were suggestive of ASIL. The use of lugol´s iodine allows us to increase the grade of suspect and delimit the lesions. Biopsies were taken for pathology under direct vision. Conclusion: The H-ASIL are considered at the present the precursors of the anal squamous carcinoma. Its development could be prevented with de proper detection and treatment of the H-ASIL. In our casuistic, all patients are in at least one risk group. The lesions were subclinical and required of the high resolution anoscopy for their finding, which allows to perform a directed treatment. It is important that health professionals consider the H-ASIL screening in risk population. (AU)


Assuntos
Humanos , Masculino , Feminino , Neoplasias do Ânus/prevenção & controle , Lesões Pré-Cancerosas/diagnóstico , Carcinoma de Células Escamosas/prevenção & controle , Proctoscopia/métodos , Teste de Papanicolaou/métodos , Lesões Intraepiteliais Escamosas/diagnóstico , Canal Anal/patologia , Lesões Pré-Cancerosas/terapia , Infecções por HIV , Programas de Rastreamento , Estudos Retrospectivos , Fatores de Risco , Homossexualidade Masculina , Infecções por Papillomavirus , Diagnóstico Precoce , Lesões Intraepiteliais Escamosas/terapia
14.
Nature ; 575(7783): 519-522, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31666702

RESUMO

Immunosuppression increases the risk of cancers that are associated with viral infection1. In particular, the risk of squamous cell carcinoma of the skin-which has been associated with beta human papillomavirus (ß-HPV) infection-is increased by more than 100-fold in immunosuppressed patients2-4. Previous studies have not established a causative role for HPVs in driving the development of skin cancer. Here we show that T cell immunity against commensal papillomaviruses suppresses skin cancer in immunocompetent hosts, and the loss of this immunity-rather than the oncogenic effect of HPVs-causes the markedly increased risk of skin cancer in immunosuppressed patients. To investigate the effects of papillomavirus on carcinogen-driven skin cancer, we colonized several strains of immunocompetent mice with mouse papillomavirus type 1 (MmuPV1)5. Mice with natural immunity against MmuPV1 after colonization and acquired immunity through the transfer of T cells from immune mice or by MmuPV1 vaccination were protected against skin carcinogenesis induced by chemicals or by ultraviolet radiation in a manner dependent on CD8+ T cells. RNA and DNA in situ hybridization probes for 25 commensal ß-HPVs revealed a significant reduction in viral activity and load in human skin cancer compared with the adjacent healthy skin, suggesting a strong immune selection against virus-positive malignant cells. Consistently, E7 peptides from ß-HPVs activated CD8+ T cells from unaffected human skin. Our findings reveal a beneficial role for commensal viruses and establish a foundation for immune-based approaches that could block the development of skin cancer by boosting immunity against the commensal HPVs present in all of our skin.


Assuntos
Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/prevenção & controle , Papillomaviridae/imunologia , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/virologia , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/virologia , Simbiose , Idoso , Idoso de 80 Anos ou mais , Animais , Linfócitos T CD8-Positivos/imunologia , Carcinogênese/efeitos da radiação , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Feminino , Humanos , Hospedeiro Imunocomprometido/imunologia , Masculino , Camundongos , Pessoa de Meia-Idade , Oncogenes , Papillomaviridae/genética , Papillomaviridae/patogenicidade , RNA Viral/análise , RNA Viral/genética , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Raios Ultravioleta
15.
PLoS One ; 14(10): e0224183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31648254

RESUMO

BACKGROUND: Anal squamous cell carcinoma (ASCC) is one of the most frequent non-AIDS-defining neoplasias in HIV patients, mainly in MSM, and it has been associated with chronic infection with high-risk human papilloma virus (HR-HPV). Our main objective was to determine HR-HPV clearance and acquisition rates and related factors and their relationship with the incidence of HSILs and ASCC in anal mucosa of HIV+ MSM. PATIENTS AND METHODS: The study included consecutive HIV-infected MSM between May 2010 and December 2018. Data were gathered at baseline and annually on their sexual behavior, CD4 and CD8 levels, plasma HIV viral load, and results of anal cytology, HPV PCR, and high-resolution anoscopy. RESULTS: Out of the 405 patients studied, 34.9% of patients cleared oncogenic genotypes (IQR: 37-69) within 49 months, and 42.9% acquired new genotypes within 36 months (IQR:12-60). In multivariate analysis, clearance was only significantly influenced by the duration of antiretroviral therapy (ART) (OR: 1.016, 95% CI 1.003-1.030). The incidence of HSILs was 30.86/1,000 patient-years and that of ASCC was 81.22/100,000 patient-years; these incidences were not influenced by the acquisition (acquired: 14.9% vs. non-acquired: 10.4%; p = 0.238) or clearance (cleared 11.4% vs. non-cleared: 13.2%; p = 0.662) rates of these viruses. CONCLUSIONS: The duration of ART appears to positively affect oncogenic genotype clearance in the anal mucosa of HIV+ MSM, although this clearance does not affect the incidence of HSILs or ASCC. The reduction in HSIL+ rate observed in our patients may be attributable to the bundle of measures adopted at our center.


Assuntos
Canal Anal/efeitos dos fármacos , Antirretrovirais/uso terapêutico , Neoplasias do Ânus/prevenção & controle , Carcinoma de Células Escamosas/prevenção & controle , Infecções por HIV/tratamento farmacológico , Papillomaviridae/genética , Infecções por Papillomavirus/prevenção & controle , Adulto , Canal Anal/virologia , Neoplasias do Ânus/etiologia , Carcinoma de Células Escamosas/etiologia , HIV/efeitos dos fármacos , Infecções por HIV/complicações , Infecções por HIV/virologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Papillomaviridae/classificação , Papillomaviridae/efeitos dos fármacos , Infecções por Papillomavirus/etiologia , Estudos Prospectivos
17.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 45(7): 497-503, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-189283

RESUMO

El cáncer orofaríngeo ocupa la sexta posición de incidencia mundial (después de los cánceres colorrectal, de mama, próstata, vejiga y útero); más del 90% son carcinomas de células escamosas. Puede originarse en el labio, en la cavidad oral, en la faringe y en la laringe. Son bien conocidos factores de riesgo como el tabaco, el alcohol y la mala higiene bucal; sin embargo, parecen ganar protagonismo las infecciones por virus del papiloma humano (VPH) y la disbiosis oral. Las lesiones cancerizables obedecen a gran variedad de factores, cuyo control entra en el ámbito de actuación del profesional. Aparte de controlar los factores locales, la posición del profesional de la salud es idónea para aconsejar al paciente respecto a hábitos saludables de vida que contribuyan a prevenir o tratar síndromes metabólico-endocrinos, por otra parte favorecedores de patología precancerosa y cancerosa en diversas ubicaciones orgánicas


Oropharyngeal cancer is in the sixth position of cancer incidence in the world (after colorectal, breast, prostate, bladder, and cervix uteri cancer). More than 90% of them are squamous cell carcinoma. This type of cancer can originate on the lip, oral cavity, pharynx, and larynx. The risk factors associated with oropharyngeal cancer are tobacco, alcohol, and poor oral hygiene. However, other conditions, such as infection with human papilloma virus (HPV) and oral dysbiosis, are gaining prominence. Pre-malignant and malignant lesions are related to diverse factors that can be monitored by the health professional. These professionals are also in an ideal position to influence and advise patients on healthy life habits that contribute to prevent or treat metabolic-endocrine syndromes associated with the development of pre-cancerous disease and cancer located in different organs


Assuntos
Humanos , Carcinoma de Células Escamosas/prevenção & controle , Neoplasias Orofaríngeas/prevenção & controle , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/etiologia , Neoplasias Orofaríngeas/epidemiologia , Neoplasias Orofaríngeas/etiologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Lesões Pré-Cancerosas/prevenção & controle , Fatores de Risco
18.
Dermatol Surg ; 45(12): 1442-1449, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31403546

RESUMO

BACKGROUND: Solid organ transplant recipients (SOTRs) are at an increased risk of epithelial malignancies, mainly squamous cell carcinoma, and its precursor lesions such as actinic keratoses, warts, and porokeratosis, which may respond to retinoid therapy. OBJECTIVE: To review the published evidence on the efficacy and safety of topical and systemic retinoids for the treatment and prophylaxis of malignant and premalignant conditions that mostly afflict SOTRs. MATERIALS AND METHODS: Systematic review of the literature to summarize the level of evidence and grade of recommendation for retinoid therapy with emphasis in the SOTR population. RESULTS: Acitretin has the highest strength of recommendation (Grade A) for prophylaxis of nonmelanoma skin cancer (NMSC) and treatment and prophylaxis of actinic keratoses in SOTR. In nonimmunosuppressed patients, acitretin and isotretinoin have a Grade B recommendation for treatment of recalcitrant warts. Topical retinoids have not shown efficacy in preventing NMSC in immunocompetent patients. CONCLUSION: Retinoids constitute a highly efficacious alternative for the management of the most common conditions that affect SOTRs. Acitretin has the most robust evidence for chemoprophylaxis in SOTRs. Knowledge about the specific indications and expected side effects of topical and systemic retinoids may help optimize their therapeutic potential.


Assuntos
Carcinoma de Células Escamosas/prevenção & controle , Fármacos Dermatológicos/administração & dosagem , Imunossupressores/efeitos adversos , Ceratose Actínica/prevenção & controle , Transplante de Órgãos/efeitos adversos , Neoplasias Cutâneas/prevenção & controle , Verrugas/prevenção & controle , Acitretina/administração & dosagem , Administração Cutânea , Administração Oral , Carcinoma de Células Escamosas/imunologia , Dermatologia/métodos , Medicina Baseada em Evidências/métodos , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Isotretinoína/administração & dosagem , Ceratose Actínica/imunologia , Neoplasias Cutâneas/imunologia , Transplantados , Resultado do Tratamento , Verrugas/imunologia
19.
J Photochem Photobiol B ; 198: 111565, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31374350

RESUMO

The incidence of skin cancers has increased worldwide, requiring more prevention of this type of cancer. The use of sunscreen and the control of the time of exposure to sunlight are the recognized forms of prevention. However, new substances have been researched in order to develop formulations with more efficient protective activity. Citral is a natural compound with lemon scent that is used in food and cosmetic industries. The present work evaluated the chemoprotective effect of citral during UVB-induced skin carcinogenesis. Male hairless mice HRS/J, 8-12 weeks old, were exposed to UVB irradiation for 24 weeks, with a cumulative radiation dose of 13.875 J/cm2. Citral (0.1, 0.5 and 1%) was applied to the skin at a dosage of 0.1 g/animal, 5 min after UVB exposure. At the end of the experiment, the number of lesion/animal, and size of lesions were measured. The histological sections of the skin were evaluated for the presence and intensity of actinic keratosis and squamous cell carcinoma. TUNEL assay was performed for apoptosis evaluation. Skin samples were used for the measurement of oxidative stress parameters (total radical-trapping antioxidant parameter of skin, glutathione, catalase activity and malondialdehyde), and cytokines levels (IL-1ß, IL-4, IL-10, IL-23, TNF-α, and IFNγ). Citral 1% completely inhibited UVB-induced skin carcinogenesis by reducing levels of oxidative stress and pro-inflammatory cytokines, increasing apoptotic rate in the skin.


Assuntos
Carcinoma de Células Escamosas/patologia , Monoterpenos/farmacologia , Neoplasias Cutâneas/patologia , Pele/efeitos dos fármacos , Raios Ultravioleta , Monoterpenos Acíclicos , Animais , Antioxidantes/metabolismo , Carcinoma de Células Escamosas/prevenção & controle , Catalase/metabolismo , Citocinas/metabolismo , Glutationa/metabolismo , Ceratose/patologia , Masculino , Malondialdeído/metabolismo , Camundongos , Camundongos Pelados , Monoterpenos/uso terapêutico , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/efeitos da radiação , Pele/metabolismo , Pele/efeitos da radiação , Neoplasias Cutâneas/prevenção & controle
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