Treatment of inoperable painful recurrent basal cell carcinoma by a novel approach

CHAPTER 2 Diagnosis of basal cell carcinoma CHAPTER 2.1 Agreement between histological subtype on punch biopsy and surgical excision in primary basal cell carcinoma CHAPTER 2.2 Subtyping basal cell carcinoma by clinical diagnosis versus punch biopsy CHAPTER 3 Treatment of basal cell carcinoma CHAPTER 3.1 Overall treatment success after treatment of primary superficial basal cell carcinoma: a systematic review and meta-analysis of randomized and non-randomized trials. CHAPTER 3.2 Three year follow-up results of photodynamic therapy versus imiquimod versus fluorouracil for treatment of superficial basal cell carcinoma: a single blind, non-inferiority, randomized controlled trial. CHAPTER 3.3 Photodynamic therapy versus topical imiquimod for treatment of superficial basal cell carcinoma: a subgroup analysis within a non-inferiority randomized controlled trial CHAPTER 3.4 Tumor thickness and adnexal extension of superficial basal cell carcinoma as determinants of treatment failure for methylaminolevulinate photodynamic therapy, imiquimod and 5-fluorouracil CHAPTER 3.5 Fractionated 5-aminolaevulinic acid photodynamic therapy following partial debulking versus surgical excision in nodular basal cell carcinoma: a randomized controlled trial with at least five year follow-up CHAPTER 4 Discussion and valorization

Topical photodynamic therapy has been used for the treatment of superficial and nodular basal cell carcinomas, with varying cure rates. This study aims to evaluate the effectiveness of topical photodynamic therapy in the treatment of superficial and nodular basal cell carcinomas in Asian patients treated at the National Skin Centre, Singapore. A retrospective analysis of Asian patients with histologically confirmed basal cell carcinomas and treated with photodynamic therapy was performed. Eight Chinese patients, with an equal gender distribution and mean age of 83.4 years were included. Five of eight basal cell carcinomas were superficial while the remaining three were nodular. The basal cell carcinomas were located in the head and neck in seven patients. The overall clearance rate at 3 months was 87.5% while the clearance rate for superficial and nodular basal cell carcinomas was 100% and 66.6% respectively at 3 months. At 12 months, the overall clearance rate was 85. 7%. This is a retrospective analysis with small patient numbers. In this small series of eight Asian patients, topical photodynamic therapy has been shown to be effective and generally well-tolerated in the treatment of basal cell carcinomas, particularly of the superficial subtype. However, larger studies are needed to evaluate its overall efficacy in Asian patients.

The incidence of skin cancer and especially basal cell carcinoma (BCC) has increased in the last decade and is still increasing. Many treatment modalities can be used to treat BCC; surgical excision is the most frequently used. Mohs' micrographic surgery (MMS) is an advanced excision technique which is often used to treat BCC in the U.S.A. In Europe it is practised less frequently. The aim of this article was to evaluate the efficiency of MMS for the treatment of facial BCC. In a retrospective study recurrence rates after the treatment of facial BCC by MMS were estimated by reviewing the records of all patients with BCCs (620 patients with 720 BCCs) treated by MMS in our department from April 1992 until December 1999. The 5-year recurrence rates estimated from this study were 3.2% for primary BCC and 6.7% for recurrent BCC. Prognostic factors for recurrence are: an aggressive histopathological subtype, more than four Mohs' stages, a large defect size and a recurrent BCC. Based on the fact that MMS provides the lowest recurrence rates, it is the treatment of first choice for primary facial BCCs with an aggressive histopathological subtype and for recurrent BCCs in the face.

Response to: Comment on 'Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines'.

Cryotherapy is a commonly discussed method for treatment of basal cell carcinoma skin cancer. Some uncertainty remains about its efficacy relative to other modalities. To determine the efficacy and adverse events profile of cryotherapy for the treatment of basal cell carcinoma compared to other therapeutic options or non-intervention. We systematically searched PubMed, OVID, Cochrane Library, EMBASE, CINHAL, and CANCERLIT databases for the following terms: "cryotherapy", AND "basal cell carcinoma", OR "cryosurgery" OR "cryoablation" up to April 2018. Two independent reviewers screened the results and extracted the data. Study endpoints included basal cell carcinoma recurrence, cosmetic outcome, and healing time. Study quality was assessed using the Jadad scale. Six clinical studies met our inclusion criteria. The efficacy and safety of cryotherapy alone or with curettage in the treatment of primary superficial and nodular basal cell carcinoma was comparable to photodynamic therapy and surgery, respectively. Cryotherapy was inferior to radiation in terms of recurrence rate. Most patients had better cosmetic outcomes with photodynamic therapy and surgery compared to cryotherapy alone, and cryotherapy with curettage. Current available data suggests equivalent efficacy of cryotherapy alone compared to photodynamic therapy or surgery, but inferior to radiotherapy. More studies are necessary to draw definitive conclusions.

Although surgical therapy continues to be the gold standard for the treatment of basal cell carcinoma given high cure rates and the ability to histologically confirm tumor clearance, there are a number of nonsurgical treatment options that may be considered based on individual tumor characteristics, functional and cosmetic considerations, patient comorbidities and patient preference. Topical 5-fluorouracil 5% cream and imiquimod 5% cream have been US FDA-approved for the treatment of superficial basal cell carcinoma. Additionally, a number of new and emerging topical agents and techniques have been described for the treatment of basal cell carcinoma and will be reviewed herein.

Comment on “Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines”

This study aims to optimize the treatment of basal cell carcinoma and basal cell nevus syndrome. Studies show that surgical excision is more effective than imiquimod 5% cream. Nevertheless, imiquimod 5% cream deserves a place in the treatment of nodular basal cell carcinoma. In addition, treatment of basal cell carcinomas with oral hedgehog signaling pathway inhibitors in patients with basal cell nevus syndrome is highly effective but is often associated with too many side effects to sustain long-term treatment. It is also important to obtain genetic confirmation of the diagnosis of basal cell nevus syndrome because the risk of jaw cysts and medulloblastoma differs for patients with a PTCH1 mutation compared with those with a SUFU mutation.

Mohs Micrographic Surgery for the Treatment of Basal Cell Carcinoma

The aim of this study was to evaluate the effect of photodynamic therapy with topical methylaminolevulinate for the treatment of basal cell carcinomas in a single dermatological department. Ninety patients (34.4% men and 65.6% women) with a total of 157 basal cell carcinomas (111 superficial, 40 nodular, 6 unknown) were treated. Primary endpoint was clinically observed recurrence verified by biopsy 3, 6 and 12 months after treatment, then once a year. Estimated patient recurrence rates were 7% at 3 months, 19% at 6 months, 27% at 12 months and 31% at 24 months. Patients aged over 60 years had significantly higher estimated recurrence rates compared with patients aged 60 years or under (at 12 months, 35% vs. 19%, p?=?0.01). Estimated recurrence rates for tumours was 4% at 3 months, 11% at 6 months, 16% at 12 months and 19% at 24 months. There were significantly higher estimated recurrence rates for nodular basal cell carcinomas compared with superficial basal cell carcinomas (at 12 months, 28% vs. 13%, p?=?0.008). In conclusion, photodynamic therapy is only appropriate for treatment of superficial basal cell carcinoma, and, age above 60 years and histology showing nodular basal cell carcinoma are independent risk factors for developing a recurrent basal cell carcinoma.

Efficacy and empirical analysis of electrodesiccation combined with photodynamic therapy in the treatment of high-risk basal cell carcinoma.

To evaluate retrospectively the long-term results of methyl aminolevulinate photodynamic therapy for the treatment of eyelid basal cell carcinoma. Sixteen consecutive patients with eyelid basal cell carcinoma were treated with methyl aminolevulinate photodynamic therapy between January 2002 and April 2003. Selection criteria were tumors located at least 3 mm from the tarsus, surgery not indicated because of poor general health, and recurrences with unclear location definition. Patients were treated with an 80-J cm light-emitting diode light source (632 nm) after topical application of methyl aminolevulinate cream and occlusion for 4 hours. Data were available for follow-up at day 1, week 1, month 1, and every 6 months for 5 years. The mean number of photodynamic therapy session per patient was 3.1 (range, 2-6) Complete clinical recovery was observed after the 5-year follow-up in 13 of 16 patients (82%). Two patients did not respond at all to treatment and 1 patient presented with recurrence after 3 years of tumor-free follow-up. Tolerance of treatment was good with few side effects. The absence of complications, good tolerance, and a notable success rate make this nonsurgical procedure promising for the treatment of basal cell carcinoma of the eyelid in selected patients.

In selected cases, conventional photodynamic therapy (C-PDT) is a valid alternative to surgery for the treatment of basal cell carcinoma (BCC). However, it is limited to superficial BCCs. Pretreatment of BCCs with ablative lasers may enhance its efficacy. We evaluated the C-PDT and CO2 laser combination therapy for the treatment of superficial and nodular BCCs. In this prospective, interventional, monocentric study, patients affected by BCC were treated with CO2 laser therapy, using a continuous superpulsed CO2 laser for nodular BCCs and a fractional CO2 laser for superficial BCCs. All patients were subsequently treated with photodynamic therapy using methyl aminolevulinate cream and an Aktilite CL128® (Galderma) lamp. 32 patients (20 males, 12 females) aged from 45 to 96 years (with a total of 181 BCCs) were treated using a CO2 laser combined with C-PDT. A 100% cure rate was achieved at three months, with no signs of relapse in 97.2% of the cases during the mean follow-up period (10.7 months, range 4 to 18 months). We observed mild adverse reactions and good aesthetic results. We recommend this combination therapy in selected cases, based on its high efficacy, good aesthetic results and few side effects.

Treatment of basal cell carcinoma (BCC) usually involves surgical interventions and laser ablation, but in locally advanced BCC, which arise either from earlier untreated lesions or from recurrence of aggressive BCC, surgery and radiotherapy are not helpful. Vismodegib, the first oral-targeted therapy for locally advanced and metastatic BCC, unsuitable for surgery or radiotherapy, was recently approved by US Food and Drug Administration (FDA). The drug was under the priority review program of FDA and was approved on the basis of promising results of phase II trial. Vismodegib acts by targeting the hedgehog pathway, which is activated abnormally in most BCCs. Approval of vismodegib is a big step ahead in the treatment of advanced BCC, where there was no other effective drug therapy till now.

Basal cell carcinoma (BCC) is the most common skin cancer. Recently, there has been renewed interest in various immunotherapies in the treatment of BCC. The current study is a randomized, open-label, placebo-controlled trial of intralesional Candida antigen in the treatment of nodular BCC. The objective of this study was to evaluate the safety and efficacy of intralesional Candida antigen in the treatment of BCC. In the control group, no patients had complete clearing of their tumor. In the Candida group, 10 of 17 (56%) patients had complete clearing of their tumor. The Fisher exact test was used to compare the two treatment groups. This showed the difference in clearance rates to be of borderline significance, with a p value of .105. Although immunotherapy with repeated injections of Candida antigen appears to be effective in clearing superficial and nodular BCCs, it is unlikely to alter our current treatment of BCC.