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1.
J Am Acad Dermatol ; 86(5): 1010-1019, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34082036

RESUMO

BACKGROUND: Incorporating patient-related factors associated with treatment outcomes could improve personalized care in older patients with basal cell carcinoma (BCC). OBJECTIVE: To evaluate and identify predictors of treatment burden, treatment outcomes, and overall survival in patients aged ≥70 years, surgically treated for BCC in the head and neck area. METHODS: The data from the prospective, multicenter Basal Cell Carcinoma Treatment in Older Adults (BATOA) cohort study were extracted to evaluate the experienced treatment burden (visual analog scale, 0-10 cm; lower scores indicating higher treatment burden), treatment outcomes, and mortality. RESULTS: A total of 539 patients were included (median age, 78 years). The patients experienced a low overall treatment burden (median, 8.6) and good cosmetic results. The predictors of higher treatment burden were instrumental activities of daily living (iADL) dependency, female sex, complications, larger tumor diameter, and polypharmacy. Thirty-five patients (6.5%) died (none of the deaths were due to BCC) within the follow-up period; the predictors of mortality were increasing comorbidity index and iADL dependency. No difference in these outcomes was seen between Mohs micrographic surgery and conventional excision after correction for covariates. Age was not significantly associated with any outcome. LIMITATIONS: A selection bias may exist owing to the observational design. CONCLUSION: BCC management decisions based on chronological age alone should be avoided, whereas more attention is recommended for patient-related factors. Based on these data, early BCC intervention is beneficial for robust and fit patients or those experiencing symptoms.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Atividades Cotidianas , Idoso , Carcinoma Basocelular/patologia , Estudos de Coortes , Feminino , Humanos , Cirurgia de Mohs/métodos , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Neoplasias Cutâneas/patologia
2.
Exp Dermatol ; 30(5): 733-738, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33656186

RESUMO

BACKGROUND: Basal cell carcinoma (BCC) is the most common type of skin cancer with incidence rates rising each year. Mohs micrographic surgery (MMS) is most often chosen as treatment for BCC on the face for which each frozen section has to be histologically analysed to ensure complete tumor removal. This causes a heavy burden on health economics. OBJECTIVES: To develop and evaluate a deep learning model for the automated detection of BCC-negative slides and classification of BCC in histopathology slides of MMS based on whole-slide image (WSI). METHODS: Two deep learning models were developed on the basis of 171 digitized H&E frozen slides from 70 different patients. The first model had a U-Net architecture and was used for the segmentation of BCC. A subsequent convolutional neural network used the segmentation to classify the whole slide as BCC or BCC-negative. RESULTS: Quantitative evaluation over manually labelled ground truth data resulted in a Dice score of 0.66 for the segmentation of BCC and an area under the receiver operating characteristic curve (AUC) of 0.90 for the slide-level classification. CONCLUSIONS: This study demonstrates that through WSIs deep learning models may be a feasible option to improve the clinical workflow and reduce costs in histological analysis of BCC in MMS.


Assuntos
Carcinoma Basocelular/cirurgia , Aprendizado Profundo , Cirurgia de Mohs , Neoplasias Cutâneas/cirurgia , Carcinoma Basocelular/patologia , Humanos , Margens de Excisão , Invasividade Neoplásica , Neoplasias Cutâneas/patologia
3.
Acta Derm Venereol ; 96(3): 351-4, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26551377

RESUMO

Photodynamic therapy (PDT) with light emitting diode (LED) illumination is a frequently used treatment modality for actinic keratosis (AK) with excellent cosmetic outcome. A major disadvantage, however, is the high pain score. Pulsed dye laser (PDL) illumination has been suggested, but the long-term efficacy of this treatment is unknown. In this split-face study we prospectively treated 61 patients with AK, with both LED-PDT and PDL-PDT. The mean change in the number of lesions between the end of follow-up and start of therapy was -4.25 (95% confidence interval (95% CI) -5.07; -3.43) for LED-PDT and -3.88 (95% CI -4,76; -2.99) for PDL-PDT, with a non-significant difference (p = 0.258) of -0.46 (95% CI -1.28; 0.35). The percentage decrease from baseline in the total number of AK was 55.8% and 47.8%, respectively, at 12-month follow-up. Visual analogue scale pain score was lower after PDL (mean 2.64) compared with LED illumination (mean 6.47). These findings indicate that PDL-PDT is an effective alternative illumination source fo.


Assuntos
Ácido Aminolevulínico/análogos & derivados , Ceratose Actínica/terapia , Lasers de Corante , Terapia com Luz de Baixa Intensidade/instrumentação , Fotoquimioterapia/instrumentação , Fármacos Fotossensibilizantes/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/administração & dosagem , Ácido Aminolevulínico/efeitos adversos , Feminino , Humanos , Ceratose Actínica/diagnóstico , Lasers de Corante/efeitos adversos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Preferência do Paciente , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Estudos Prospectivos , Indução de Remissão , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
4.
Dermatology ; 230(2): 161-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25633994

RESUMO

BACKGROUND: The incidence and prevalence of skin cancer is rising. A detection model could support the (screening) process of diagnosing non-melanoma skin cancer. METHODS: A questionnaire was developed containing potential actinic keratosis (AK) and basal cell carcinoma (BCC) characteristics. Three nurses diagnosed 204 patients with a lesion suspicious of skin (pre)malignancy and filled in the questionnaire. Logistic regression analyses generated prediction models for AK and BCC. RESULTS: A prediction model containing nine characteristics correctly predicted the presence or absence of AK in 83.2% of the cases. BCC was predicted correctly in 91.4% of the cases by a model containing eight characteristics. The nurses correctly diagnosed AK in 88.3% and BCC in 90.9% of the cases. CONCLUSIONS: Detection or screening models for AK and BCC could be made with a limited number of variables. Nurses also diagnosed skin lesions correctly in a high percentage of cases. Further research is necessary to investigate the robustness of these findings, whether the percentage of correct diagnoses can be improved and how best to implement model-based prediction in the diagnostic process.


Assuntos
Carcinoma Basocelular/diagnóstico , Ceratose Actínica/diagnóstico , Modelos Teóricos , Padrões de Prática em Enfermagem , Neoplasias Cutâneas/diagnóstico , Idoso , Carcinoma Basocelular/patologia , Competência Clínica , Dermatologia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Clínicos Gerais , Humanos , Ceratose Actínica/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Neoplasias Cutâneas/patologia , Inquéritos e Questionários
5.
Lancet Oncol ; 14(7): 647-54, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23683751

RESUMO

BACKGROUND: Superficial basal-cell carcinoma is most commonly treated with topical non-surgical treatments, such as photodynamic therapy or topical creams. Photodynamic therapy is considered the preferable treatment, although this has not been previously tested in a randomised control trial. We assessed the effectiveness of photodynamic therapy compared with imiquimod or fluorouracil in patients with superficial basal-cell carcinoma. METHODS: In this single blind, non-inferiority, randomised controlled multicentre trial, we enrolled patients with a histologically proven superficial basal-cell carcinoma at seven hospitals in the Netherlands. Patients were randomly assigned to receive treatment with methylaminolevulinate photodynamic therapy (MAL-PDT; two sessions with an interval of 1 week), imiquimod cream (once daily, five times a week for 6 weeks), or fluorouracil cream (twice daily for 4 weeks). Follow-up was at 3 and 12 months post-treatment. Data were collected by one observer who was blinded to the assigned treatment. The primary outcome was the proportion of patients free of tumour at both 3 and 12 month follow up. A pre-specified non-inferiority margin of 10% was used and modified intention-to-treat analyses were done. This trial is registered as an International Standard Randomised controlled trial (ISRCTN 79701845). FINDINGS: 601 patients were randomised: 202 to receive MAL-PDT, 198 to receive imiquimod, and 201 to receive fluorouracil. A year after treatment, 52 of 196 patients treated with MAL-PDT, 31 of 189 treated with imiquimod, and 39 of 198 treated with fluorouracil had tumour residue or recurrence. The proportion of patients tumour-free at both 3 and 12 month follow-up was 72.8% (95% CI 66.8-79.4) for MAL-PDT, 83.4% (78.2-88.9) for imiquimod cream, and 80.1% (74.7-85.9) for fluorouracil cream. The difference between imiquimod and MAL-PDT was 10.6% (95% CI 1.5-19.5; p=0.021) and 7.3% (-1.9 to 16.5; p=0.120) between fluorouracil and MAL-PDT, and between fluorouracil and imiquimod was -3.3% (-11.6 to 5.0; p=0.435. For patients treated with MAL-PDT, moderate to severe pain and burning sensation were reported most often during the actual MAL-PDT session. For other local adverse reactions, local skin redness was most often reported as moderate or severe in all treatment groups. Patients treated with creams more often reported moderate to severe local swelling, erosion, crust formation, and itching of the skin than patients treated with MAL-PDT. In the MAL-PDT group no serious adverse events were reported. One patient treated with imiquimod and two patients treated with fluorouracil developed a local wound infection and needed additional treatment in the outpatient setting. INTERPRETATION: Topical fluorouracil was non-inferior and imiquimod was superior to MAL-PDT for treatment of superficial basal-cell carcinoma. On the basis of these findings, imiquimod can be considered the preferred treatment, but all aspects affecting treatment choice should be weighted to select the best treatment for patients. FUNDING: Grant of the Netherlands Organization for Scientific Research ZONMW (08-82310-98-08626).


Assuntos
Ácido Aminolevulínico/uso terapêutico , Aminoquinolinas/administração & dosagem , Carcinoma Basocelular/tratamento farmacológico , Fluoruracila/administração & dosagem , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Antimetabólitos Antineoplásicos/administração & dosagem , Antineoplásicos/administração & dosagem , Carcinoma Basocelular/patologia , Feminino , Seguimentos , Humanos , Imiquimode , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Método Simples-Cego , Neoplasias Cutâneas/patologia
6.
Lancet Oncol ; 9(12): 1149-56, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19010733

RESUMO

BACKGROUND: Basal-cell carcinoma (BCC) is the most common form of skin cancer and its incidence is still rising worldwide. Surgery is the most frequently used treatment for BCC, but large randomised controlled trials with 5-year follow-up to compare treatment modalities are rare. We did a prospective randomised controlled trial to compare the effectiveness of surgical excision with Mohs' micrographic surgery (MMS) for the treatment of primary and recurrent facial BCC. METHODS: Between Oct 5, 1999, and Feb 27, 2002, 408 primary BCCs (pBCCs) and 204 recurrent BCCs (rBCCs) in patients from seven hospitals in the Netherlands were randomly assigned to surgical excision or MMS. Randomisation and allocation was done separately for both groups by a computer-generated allocation scheme. Tumours had a follow-up of 5 years. Analyses were done on an intention-to-treat basis. The primary outcome was recurrence of carcinoma, diagnosed clinically by visual inspection with histological confirmation. Secondary outcomes were determinants of failure and cost-effectiveness. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN65009900. FINDINGS: Of the 397 pBCCs that were treated, 127 pBCCs in 113 patients were lost to follow-up. Of the 11 recurrences that occurred in patients with pBCC, seven (4.1%) occurred in patients treated with surgical excision and four (2.5%) occurred in patients treated with MMS (log-rank test chi(2) 0.718, p=0.397). Of the 202 rBCCs that were treated, 56 BCCs in 52 patients were lost to follow-up. Two BCCs (2.4%) in two patients treated with MMS recurred, versus ten BCCs (12.1%) in ten patients treated with surgical excision (log-rank test chi(2) 5.958, p=0.015). The difference in the number of recurrences between treatments was not significant for pBCC, but significantly favoured MMS in rBCC. In pBCC, Cox-regression analysis showed no significant effects from risk factors measured in the study. In rBCC, aggressive histological subtype was a significant risk factor for recurrence in the Cox-regression analysis. For pBCC, total treatment costs were euro1248 for MMS and euro990 for surgical excision, whereas for rBCC, treatment costs were euro1284 and euro1043, respectively. Dividing the difference in costs between MMS and surgical excision by their difference in effectiveness leads to an incremental cost-effectiveness ratio of euro23 454 for pBCC and euro3171 for rBCC. INTERPRETATION: MMS is preferred over surgical excision for the treatment of facial rBCC, on the basis of significantly fewer recurrences after MMS than after surgical excision. However, because there was no significant difference in recurrence of pBCC between treatment groups, treatment with surgical excision is probably sufficient in most cases of pBCC.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Faciais/cirurgia , Custos de Cuidados de Saúde , Cirurgia de Mohs/economia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/economia , Análise Custo-Benefício , Neoplasias Faciais/economia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/economia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Neoplasias Cutâneas/economia , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/métodos , Resultado do Tratamento
7.
Patient Educ Couns ; 60(2): 179-86, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16442459

RESUMO

OBJECTIVE: The main objective of the study was to assess which health beliefs predict and explain satisfaction with the facial health state of patients undergoing surgery for basal cell carcinoma. METHODS: Data were collected by administering a newly developed questionnaire pre-operatively and 6 months post-operatively (n = 222). RESULTS: Results show that satisfaction as measured by post-operative worrying, susceptibility and fear of developing a new BCC at other facial sites can be predicted by pre-operative health beliefs. In addition, some patients an increase in perceived susceptibility, fear of recurrence of BCC on the same site or fear of developing a new BCC at other facial sites. CONCLUSION: Our findings indicate that both pre- and post-operative perceptions predict and explain for a substantial part the extent to which patients are satisfied with their facial health state 6 months after surgery. PRACTICE IMPLICATIONS: Administering a short questionnaire at the start of the treatment period will give physicians a better understanding of how patients experience this skin disease. It will also help them to adjust information about BCC and its consequences to the needs of the patient.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Faciais/cirurgia , Satisfação do Paciente , Neoplasias Cutâneas/cirurgia , Idoso , Carcinoma Basocelular/psicologia , Neoplasias Faciais/psicologia , Análise Fatorial , Medo , Feminino , Seguimentos , Humanos , Funções Verossimilhança , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Países Baixos , Neoplasias Cutâneas/psicologia , Inquéritos e Questionários
8.
Lancet ; 364(9447): 1766-72, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15541449

RESUMO

BACKGROUND: Rates of recurrence of facial basal-cell carcinoma are consistently lower after Mohs' micrographic surgery (MMS) than after other treatments, such as surgical excision (SE). However, MMS is more time-consuming and therefore more expensive than SE. We investigated the types of facial basal-cell carcinomas in which MMS was more effective than SE. METHODS: 408 primary and 204 recurrent facial carcinomas (374 and 191 patients, respectively) were analysed separately in this prospective randomised study. Patients were assigned SE or MMS (each 204 primary, 102 recurrent), and received treatment at two hospitals in the Netherlands. The primary outcome was recurrence of carcinoma. Analysis was by intention to treat. FINDINGS: Of the basal-cell carcinomas included in the trial, 397 primary (198 MMS, 199 SE) and 201 recurrent (99, 102) tumours were actually treated. Of patients with primary carcinomas, 21 had both MMS and SE on different tumours. Nine with recurrent carcinomas had both treatments on different skin tumours. 66 primary and 13 recurrent carcinomas were lost to follow-up. Of the primary carcinomas, five (3%) recurred after SE compared with three (2%) after MMS during 30 months of follow-up. Of the recurrent carcinomas, three (3%) recurred after SE and none after MMS during 18 months of follow-up. Four recurrent carcinomas randomly assigned to the SE group were treated with MMS. Although both differences favoured MMS, they were not significant (primary, difference 1% [95% CI -2.5% to 3.7%], p=0.724; recurrent, 3.2% [-2.0% to 5.0%], p=0.119). Total operative costs of MMS were higher than those of SE (primary 405.79 Euros vs 216.86 Euros, recurrent 489.06 Euros vs 323.49 Euros; both p<0.001). INTERPRETATION: No definitive conclusion on recurrence rates of primary or recurrent basal-cell carcinomas is yet possible. Although recurrence rates were lower after MMS than after SE, the differences were not significant.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Faciais/cirurgia , Cirurgia de Mohs , Neoplasias Cutâneas/cirurgia , Idoso , Carcinoma Basocelular/patologia , Neoplasias Faciais/patologia , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Neoplasias Cutâneas/patologia
10.
Plast Reconstr Surg ; 113(3): 857-61, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15108876

RESUMO

The common excision skin pattern is either a fusiform ellipse or another pattern with dissimilar length and width. The purpose of this study was to define the most advantageous skin pattern regarding skin waste, vertex angle, and scar length. Five skin excision patterns used traditionally for closure of round lesions were analyzed: fusiform ellipse, fusiform circle, rhomboid, mosque, and S-shaped. In the analysis, the pattern characteristics were formulated by geometric principles, from which the results were compared. The smallest skin waste was found in rhomboid and mosque patterns, whereas the largest skin waste was found in the fusiform circle and ellipse. The vertex angle was found to decrease monotonously with the excision length-to-width ratio for all patterns except the mosque shape, which is zero per definition. The paradigm stating that a vertex angle of 30 degrees or less is maintained for length-to-width ratios below 4 in the surgical ellipse was found incorrect. It holds only for rhomboid and S-shaped excisions. The scar length was found almost independent of the pattern, with a variance of 3 percent. The authors conclude that the most advantageous surgical skin patterns are the rhomboid and mosque excisions.


Assuntos
Biópsia/métodos , Cicatriz/patologia , Procedimentos Cirúrgicos Dermatológicos , Humanos , Matemática
11.
Eur J Cancer ; 50(17): 3011-20, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25262378

RESUMO

BACKGROUND: Basal cell carcinoma (BCC) is the most common form of cancer among Caucasians and its incidence continues to rise. Surgical excision (SE) is considered standard treatment, though randomised trials with long-term follow-up are rare. We now report the long-term results of a randomised trial comparing surgical excision with Mohs' micrographic surgery (MMS) for facial BCC. METHODS: 408 facial, high risk (diameter at least 1cm, H-zone location or aggressive histological subtype) primary BCCs (pBCCs) and 204 facial recurrent BCCs (rBCCs) were randomly allocated to treatment with either SE or MMS between 5th October 1999 and 27th February 2002. The primary outcome was recurrence of carcinoma. A modified intention to treat analysis was performed. FINDINGS: For primary BCC, the 10-year cumulative probabilities of recurrence were 4.4% after MMS and 12.2% after SE (Log-rank test χ(2) 2.704, p=0.100). For recurrent BCC, cumulative 10-year recurrence probabilities were 3.9% and 13.5% for MMS and SE, respectively (Log-rank χ(2) 5.166, p=0.023). A substantial proportion of recurrences occurred after more than 5years post-treatment: 56% for pBCC and 14% for rBCC. INTERPRETATION: Fewer recurrences occurred after treatment of high risk facial BCC with MMS compared to treatment with SE. The proportion of recurrences occurring more than 5years post-treatment was especially high for pBCC, stressing the need for long-term follow-up in patients with high risk facial pBCC.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Faciais/cirurgia , Cirurgia de Mohs/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/mortalidade , Neoplasias Faciais/mortalidade , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/mortalidade , Recidiva Local de Neoplasia/etiologia , Estudos Prospectivos , Resultado do Tratamento
12.
Arch Dermatol ; 146(3): 332-6, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20231509

RESUMO

The worldwide incidence of skin cancer (especially nonmelanoma skin cancer) has increased markedly during the last decades. Skin cancer should be considered a chronic disease. To manage the future costs and quality of care for patients with skin cancer, a revised health strategy is needed. These new strategies should be combined into a disease management system that organizes health care for one well-documented health care problem using a systematic approach. This article explores multiple opportunities for the development of a disease management system regarding skin cancer that will provide structured and multidisciplinary care.


Assuntos
Guias de Prática Clínica como Assunto , Prevenção Primária/normas , Encaminhamento e Consulta/normas , Neoplasias Cutâneas/prevenção & controle , Humanos , Relações Interprofissionais
13.
J Dermatolog Treat ; 20(5): 259-65, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19370466

RESUMO

BACKGROUND: Actinic keratoses (AK) are sun-induced epithelial skin lesions, which are at risk to progress to squamous cell carcinoma. One of the treatments of AK is photodynamic therapy (PDT), which often has to be repeated. Another treatment for these lesions is diclofenac 3% gel. Although both treatments have shown to be effective, they have never been studied together. OBJECTIVE: To investigate whether a pre-treatment of AK on the dorsum of the hands with diclofenac 3% gel improves the efficacy of PDT. METHODS: In this placebo-controlled, randomized, double-blind, pilot study with 10 patients, both hands were pre-treated--one with diclofenac gel and the other with placebo gel--and then the hands were treated with ALA-PDT. Total lesion number scores, total thickness scores and global improvement scores were used to assess efficacy. Pain scores were recorded during PDT. RESULTS: In both groups, the number of lesions significantly decreased. At 12 months' follow-up, significantly fewer AK were seen in the diclofenac group. Total lesion thickness scores decreased significantly in both groups. Pain during PDT was greater in the diclofenac group. CONCLUSIONS: Both treatments are effective in treating AK. A pre-treatment with diclofenac gel seems to result in fewer AK at 12 months' follow-up, compared to placebo. Side effects were worse when using the active drug.


Assuntos
Ácido Aminolevulínico/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/uso terapêutico , Ceratose Actínica/terapia , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Administração Cutânea , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Diclofenaco/administração & dosagem , Método Duplo-Cego , Feminino , Géis , Dermatoses da Mão/patologia , Dermatoses da Mão/terapia , Humanos , Ceratose Actínica/patologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento
14.
Lasers Surg Med ; 38(8): 731-9, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16912977

RESUMO

BACKGROUND AND OBJECTIVES: Many treatment modalities exist for actinic keratoses (AK). Topical 5-fluorouracil (5-FU) has been one of the standard treatments. Laser resurfacing is a more recent treatment option. In the literature prospective randomized studies comparing these treatments are lacking. STUDY DESIGN/PATIENTS AND METHODS: Prospective randomized study to compare topical 5-FU with Er:YAG laser resurfacing. Fifty-five patients with multiple AK on the scalp and or the face were included. Clinical and histopathological evaluation took place at 3, 6, and 12 months after treatment. RESULTS: At 3, 6, and 12 months after treatment, there were significantly less recurrences in the laser group compared to the group of patients treated with 5-FU. Side effects did occur more frequently in the laser group, especially erythema and hypopigmentation. CONCLUSIONS: Compared to treatment with topical 5-FU, Er:YAG laser resurfacing is more effective regarding recurrence rates. Although significantly more side effects occur, laser resurfacing is a useful therapeutic option especially in patients with widespread AK.


Assuntos
Fluoruracila/uso terapêutico , Ceratose/tratamento farmacológico , Ceratose/radioterapia , Terapia com Luz de Baixa Intensidade/métodos , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Face , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Couro Cabeludo , Resultado do Tratamento
15.
Dermatol Surg ; 29(4): 375-7, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12656816

RESUMO

BACKGROUND: Mohs micrographic surgery (MMS) is a technique that offers excellent cure rates in the treatment of basal cell carcinoma (BCC). One of the reasons for its success is the 100% visualization of the resection margins. Still, recurrences do occur in 2% to 5% of the treated BCCs. It has been suggested that BCC cells in frozen sections stained with hematoxylin and eosin (H&E) may be missed. OBJECTIVE: To determine whether an additional immunohistochemical staining with a cytokeratin marker (MNF 116) indicates BCC cells in sections in which the H&E-stained frozen sections were negative. METHODS: The Mohs procedure was performed under standard conditions in which H&E-stained slides were judged by the Mohs surgeon and the pathologist. After the H&E slides where judged negative, an extra slide was stained using immunohistochemistry and a monoclonal antibody against cytokeratin (MNF 116). RESULTS: A total of 143 complete slides were stained and judged by two Mohs surgeons and a pathologist. One of the 143 slides stained with MNF 116 showed positive staining where the H&E slides were negative, which is 0.7% of the slides. However, this single slide represents a failure of nearly 2% of the treated patients. CONCLUSION: Frozen sections stained with H&E in MMS offer enough security in detecting BCC cells during surgery; however, adjuvant cytokeratin staining can be useful in very selected cases of aggressive growing BCC.


Assuntos
Carcinoma Basocelular/cirurgia , Queratinas/análise , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais , Carcinoma Basocelular/patologia , Corantes , Amarelo de Eosina-(YS) , Secções Congeladas , Hematoxilina , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia
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