Nonmelanoma skin cancer - from actinic keratosis to cutaneous squamous cell carcinoma.

Actinic keratoses (AKs) are defined as intraepithelial proliferation of atypical keratinocytes. Given their potential for progression to invasive squamous cell carcinoma, they may eventually evolve into a life-threatening disease. In recent decades, there has been a significant increase in the incidence of AKs, primarily due to changes in recreational activities and demographic trends in industrialized countries. As it is currently impossible to predict if and when a given AK might progress to invasive carcinoma, rigorous treatment of field cancerization is a key component in preventing potential progression. In addition to a broad armamentarium of procedures as well as pharmaceutical treatment options, primary prevention through diligent UV protection likewise plays a crucial role. New clinical, histomorphological, or molecular classifications are needed to be able to reliably stratify patients based on their individual risk. Especially in light of socio-economic aspects, such a step might prevent over- and undertreatment of an ever-growing patient population and help develop treatment concepts based on individual patient needs.

[Multifocal penile intraepithelial neoplasia--targeted treatment with imiquimod]. / Multifokale intraepitheliale Neoplasie--gezielte Therapie mit Imiquimod.

A 78-year-old male sought dermatologic consultation for multifocal persistent red lesions of the glans penis. Various topical treatments had proved unsuccessful. Histologic examination revealed penile intraepithelial neoplasia (PIN). Polymerase chain reaction (PCR) showed amplification of human papillomavirus type 16 (HPV-16) DNA. Urological consultants recommended amputation of the glans; the patient rejected this, as well as any other surgical procedure. Therefore, he was treated in our dermatologic practice with imiquimod 5 % cream administered daily over 12 weeks. After therapy was completed, no clinical or histologic evidence of residual tumor was found and HPV-16 DNA was no longer detectable. Local skin reactions such as erosions and edema of the glans accompanied by tingling and itching were well-tolerated by the patient. Imiquimod 5 % cream may represent an alternative local treatment option for multifocal PIN.

Therapy of cutaneous squamous cell carcinoma in two retirement home residents.

The incidence of cutaneous squamous cell carcinomas (SCC) has been increasing by about 5% per year of the past 40 years in a population which is growing continuously older and as such presents a growing therapeutic challenge. We report on two elderly female residents of a retirement home with histologically confirmed SCC on the back of the hand. In one case the tumor was completely excised and covered with a graft. In the second case the patient refused all surgical and radiotherapeutic procedures. We sought an adequate therapeutic alternative considering the extent and thickness of the tumor. Topical application of the immune response modifier imiquimod appeared to represent an alternative solution because of its unique antineoplastic mode of action, even though there was no published experience with this approach. She has remained tumor-free for four years, justifying our decision. In both cases, a comparable cosmetic result with full functional capacity of the hands was obtained. Imiquimod 5% cream was approved last year for the treatment of superficial basal cell carcinoma.

[Solar keratosis: from precancerous lesion to pre-invasive squamous cell carcinoma--therapeutic approach with a bioinductive method]. / Die solare Keratose: Von der Präkanzerose zum präinvasiven Plattenepithelkarzinom--Therapeutischer Ansatz nach dem Bioinduktionsverfahren.

BACKGROUND: Solar keratoses are precancerous lesions in chronically UV-damaged skin with histological features consistent with pre-invasive squamous cell carcinoma. They require therapeutic intervention in order to prevent progression towards invasive carcinoma. Treatment options include topical medications and destructive methods. We report on a new approach--topical bioinductive therapy with imiquimod 5% cream. PATIENTS AND METHODS: In a prospective case series, 7 patients with solar keratoses have been treated with topical imiquimod 5%. The cream was applied 5 days/week over 2 weeks. After end of treatment, the outcome was assessed at regular control visits and, in some cases, histologically confirmed. One patient was followed up as untreated control. RESULTS: In 6 of the 7 treated patients, the lesions cleared completely; one patient did not respond. The patients did not show new solar keratoses during a follow-up period of about 2 years. The untreated patient showed spontaneous clearance of his keratoses. Local skin reactions during treatment included erythema, oedema and erosions in varying degrees, all of which completely resolved. CONCLUSIONS: Bioinductive therapy with imiquimod 5% cream represents a promising therapeutic approach for cutaneous precancerous lesions such as solar keratoses.