Journal of Clinical and Aesthetic Dermatology

Updates on Psoriasis & Cutaneou Oncology

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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S28 P r o c e e D i n G s JCAD jOUrnAl Of ClInICAl And AEsthEtIC dErMAtOlOgy september 2017 • volume 10 • number 9 • supplement recurrence was clinically ascertained with histological confirmation. among the nonrecurrent cases, median tumor thickness was 0.26mm (range 0.09–0.61), but recurrent cases had a significantly greater median tumor thickness of 0.57mm (range 0.41–1.41, p<0.0001). lesions greater than 40mm had a recurrence rate of 58 percent, but there were no cases of recurrence for lesions 0.40mm or less. thus, topical imiquimod may be an edective treatment option for superfcial Bcc. a systematic review reported clearance rates for topical imiquimod 5% cream to be 43 to 100 percent for superfcial Bcc, 42 to 100 percent for nodular Bcc, 56 to 63 percent for infltrative Bcc, 73 to 88 percent for scc in situ, and 71 percent for invasive scc. 161 it was noted that the more intense ingammatory reactions to treatment could be associated with higher rates of tumor clearance. the relative advantages and disadvantages of topical imiquimod 5% cream are briegy summarized in table 8. Ingenol mebutate gel. a retrospective chart review (n=7) of patients with superfcial Bcc treated with ingenol mebutate over 10 to 14 days following a shave biopsy was conducted. 162 Patients were treated for four weeks. all lesions were resolved by the end of treatment, and six lesion sites in four patients at 3 or 4 months post treatment were biopsied to confrm histological clearance. all patients experienced localized adverse events that began on the frst day or two of treatment, peaked at two weeks, and then largely resolved at two weeks. Intralesional chemotherapy. intralesional chemotherapy can be used to treat Bcc and scc, but this approach is not mentioned in most guidelines, is not frequently employed, and has not been widely studied particularly with respect to long-term results. 163 a number of intralesional chemotherapeutic agents may be used, but there is little evidence in the literature to recommend one particular course over another (agent, dosing, frequency, and appropriate lab monitoring). ifn, 5-fu, and ifna are among the chemotherapeutic agents appropriate for intralesional therapy. in addition, methotrexate is gaining recognition for its intralesional or perilesional use in treating solitary keratoacanthoma (Ka). 164 for smaller Ka (<1 cm), a single injection from a peripheral site with the needle tip at the deeper central portion figure 5. lesion clearance by thickness and nodularity; lcc: lesion complete clearance; Mal: methyl aminolevulinate; Bf-200: nanoemulsion; ala: 5-aminolevulinic acid; nBcc: patients with basal cell carcinoma

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