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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S26 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 vehicle patients (99.1% vs. 83.6%). the study results of both groups remained similar and trended in the same manner during the 12 weeks of treatment but diverged markedly in the eight weeks after treatment stopped (figure 4). cryotherapy is appropriate for single, well- defned, hyperkeratonic aK lesions. field treatment represents a paradigm shift but treats aK as carcinoma in situ and recognizes that there are subclinical lesions in the feld that require treatment as well. topical agents are particularly appropriate for feld therapy in that they can treat broader areas and address the subclinical lesions as well. increasingly, these two therapies are combined for optimal patient management. rUMInAtIOns On thE WAr On CAnCEr the language physicians use to talk about cancer has always been the language of war: patients fought battles, researchers and their sponsors declared war, targets were identifed, tumors invaded, the latest drugs and treatments were put into our clinical armamentarium, and everyone wanted to fnd that elusive "silver bullet." a more realistic assessment today is that we understand more about cancer's pathogenesis and the genetic underpinnings of the disease than ever, but we remain unable to consistently cure many types of cancer. targeted therapies in which so much promise resided are not always edective and results are often not robust. cancer is adaptive and elusive, and it may be time to drop the war-time metaphors. 142 for example, rather than talking about cutaneous malignancies as cancer or precancer, perhaps it is better to talk about "indolent lesions of epithelial origin" and to recognize that this disease is a continuum of events that can be treated at any number of points. the new epidemic of bCC. recent studies from around the world are calling the observed increase in Bcc an epidemic. 143,144 in northern california, the rate of Bcc increased about 13 percent from 1998 to 2012. the exact incidence of Bcc is diecult to assess, because Bccs are not reportable cancers and do not have unique icD- 9 identifers. the rate of Bcc in the united states is estimated to be two million. 1 45 in the clinic, Bcc risk stratifcation can be based on two broad categories: clinical factors and histology. clinical features include the tumor's size and location, the depth of invasion, and whether the tumor had recurred, gone through-and-through, or had previously undergone radiation therapy (table 6). sCC. scc occurs less frequently than Bcc but it is likewise increasing, possibly due to better detection edorts, more exposure to sunlight, and increased longevity. about 2,000 americans die each year from some form of skin cancer. 146 an elevated risk exists in patients with scc with tumor diameter more than 2cm, Breslow depth more than 2mm, ulceration, a site of the scc on the ear or non-hairy lip, poor diderentiation (grade 3+), and perineural invasion. scc may be treated with oral capecitabine, a prodrug that converts in the body to 5-fu. 147 capecitabine is edective in treating forms of colorectal cancer, breast cancer, and gastric cancer, but it may be edective in treating scc as well. 148 the role of Pdt in cutaneous oncology. the role of PDt in treating skin cancers, such as superfcial Bcc, nodular Bcc, and scc, is a subject of growing importance. early studies found PDt could achieve good clearance results for many forms of cancer, perhaps on par with radiation, but recurrence rates were higher than with surgical excision or Mohs micrographic surgery (MMs). the use of multiple PDt sessions and the pretreatment with penetration enhancers, such as 5-aminolevulinic acid (ala), are providing promising new data. certainly, PDt has been and remains an important treatment option for those patients with Bcc and scc for whom surgery must be precluded. Marmur et al 149 conducted a literature review of tAblE 6. risk stratifcation for basal cell carcinoma patients ClInICAl fEAtUrE hIgh rIsK COMMEnts s ize of tumor >1cm on face; >2cm other regions n one Depth of invasion to the fascia; Muscle involvement; Perichondrium; Periosteum none location H-zone on face (i.e., nasolabial fold, nasal alar, orbital area and auricular area); any area of very limited tissue depth (eyelids, nose, ears) none recurrence recurrent tumor (including multiple recurrences) suspect involvement of entire scar Histology Perineural invasion; vascular invasion; lymph node invasion none

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