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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S27 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 the use of PDt for treatment of skin cancer, fnding encouraging results for some types of cancers (table 7). the role of PDt in the treatment of invasive scc is limited owing to potential metastases. Bowen's disease, an scc in situ, may be considered an early stage or intra-epidermal form of scc. transplant patients have an elevated risk for cutaneous epithelial neoplasms, including aK and Bowen's disease. a controlled trial (n=40) found that for transplant patients with skin cancer, PDt preceded by application of 20% ala was a safe and edective treatment with good cosmetic results. 150 ala- PDt may be particularly helpful when treating immunosuppressed patients with large regions of lesions. nevoid basal cell carcinoma syndrome (nBccs) is an autosomal dominant disorder that is associated with congenital abnormalities as well as increased risk of medulloblastoma and early development of Bcc. 151,152 in a single- center case series, three children with Bccs and basaloid follicular hematomas (BfHs) over 12 to 25 percent of their Bsas were treated with 20% ala over up to 22 percent of their Bsas for 24 hours with occlusion. 153 they were then treated with PDt in felds up to 7cm (dye laser) or 16mm (lamp) with as many as 36 felds treated in one session. after 4 to 7 sessions, the patients had 85- to 98-percent overall clearance and excellent cosmetic outcomes with no scarring. the patients tolerated the treatments well, morbidity was minimal, and they healed quickly. results were durable up to six years. 153 ala selectively accumulates in the tumor rather than in normal skin. 154 note that it may be necessary to use local anesthetic with ala-PDt. Bf-200 10% ala gel relies on a nanoemulsion (Bf-200) to enhance transport of ala through the stratum corneum down to the basal membrane, allowing the light source to achieve an even greater depth of penetration. the red light source recommended for PDt is the Bf-rhodoleD. in a study comparing Bf-200 10% ala nanoemulsion gel to 20% ala cream in 20 patients, Bf-200 ala was associated with more intense protoporphyin x (Ppix) guorescence under guorescence microscopy compared to 20% ala cream. 155 in a Phase 3 study from the european union, 156 PDt with methyl aminolevulinate (Mal) was compared to Bf-200 10% ala gel for the treatment of Bcc. a major statistical endpoint of this study was noninferiority of Bf- 200-ala versus Mal, which was met. complete clearance rates for patients (93.4% vs. 91% for Bf-200-ala and Mal, respectively) and complete clearance of all types of lesions (94.6% vs. 92.9% for Bf-200-ala and Mal, respectively) were similar. thicker and more nodular Bccs showed better response to Bf- 200-ala than Mal (figure 5). cosmetic outcomes were excellent for the Bf-200 ala patients. thus, it appears that Bf-200 ala is very edective in the treatment of non- aggressive Bccs, particularly lesions less than 1mm thick, and it is superior to Mal for the treatment of nodular Bccs, possibly because of its deeper skin penetration. topical imiquimod 5% cream. Multiple case reports support the use of imiquimod 5% cream for the treatment of scc in situ. in a case study of a kidney transplant patient with a history of metastatic prostate cancer, an invasive scc in situ was treated at the hairline with 5% imiquimod cream applied three times per week and left on overnight (8 hours). after three weeks, the tumor had regressed noticeably but central erythema was still evident. other than scaling, no adverse events occurred over the 12- week course. 157 topical 5% imiquimod cream was used to treat a large facial scc in situ (Bowen's disease) in a 75-year-old woman with a history of Bowen's disease. the cream was applied every other night over six weeks, resulting in total clearance at the end of the course and no recurrence observed in eight months. 158 combination therapy may be of value in particularly diecult cases, such as scc on fngers where surgical intervention may compromise function. four patients with scc in situ on a digit were frst treated with imiquimod cream as a monotherapy; all failed. two of those patients also underwent 5-fu cream treatment monotherapy and failed. 159 all four patients were then administered imiquimod and 5-fu combination therapy for eight weeks with good response and no recurrence at 12 to 23 months after treatment. in a retrospective analysis of histological biopsy specimens of superfcial Bcc, 127 cases were reviewed where the patient had been treated primarily with imiquimod fve times per week over a six-week course with a mean follow-up period of 34 months (range 3–91). 160 t AblE 7. summary of photodynamic therapy for skin cancer 143 CAnCEr COMPlEtE rEsPOnsE rECUrrEnCE rAtE PAtIEnt fOllOW UP Bcc (10 studies) 50–100% 0–44% 3–36 months s cc in situ (5 studies) 5 0– 100% 0 –52% 1 2–18 months s cc invasive (1 study) 8 % 9 2% 3 6 months Bcc: basal cell carcinoma; scc: squamous cell carcinoma

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