Cases Of Non-melanoma Skin Cancer Research Articles

PCN30 - Cost-Effectiveness of Surgical Excision Vs Mohs Micrographic Surgery for Non-Melanoma Skin Cancer

Non-melanoma skin cancer rates are increasing worldwide and annually 2-3 million cases of non-melanoma skin cancer are being reported. Mohs micrographic surgery and surgical excision are two treatment methods for this type of cancer. Regarding the fact that the results concerning the cost effectiveness of these methods are inconclusive.The current paper aims at determining and comparing the cost-effectiveness of surgical excision and Mohs micrographic surgery. Based on the results of this paper amore cost-effective method for treatment could be determined. The current study has a retrospective cohort design. A number of 630 patients suffering from non-melanoma skin cancer who at some point of time during the years 2007-10 referred to Al-Zahra or Seyyed Al-shohada hospitals in Isfahan were followed up for four years and then the incremental cost effectiveness ratio (ICER) of the two methods were calculated. The Average cost of the surgical excision and Mohs surgery methods in Iran was obtained as 185501670 ($618.7) and 12236890 ($408.1) Iranian Rials, respectively. Recurrence percentage was also reported as 7.9% and 8.7% for surgical excision and Mohs micrographic surgery, respectively. The incremental cost effectiveness ratio of surgical excision in comparison with Mohssurgery was calculated as 7891600 ($263.2) Iranian Rails per recurrence avoided. Since no significant difference was seen between the two methods and regarding the fact that Mohs surgery is less expensive than surgical excision, it seems like Mohs is more affordable, however further studies in different populations of the country are needed.

Risk of skin cancer in patients on chronic haemodialysis: a nationwide, population-based study in Taiwan.

Patients on chronic haemodialysis (HD) have a higher incidence of cancer. However, the risk of skin cancer in this population has rarely been investigated. To investigate the risk of nonmelanoma skin cancer (NMSC) and cutaneous melanoma in patients on chronic HD and to explore the associated risk factors. We performed retrospective cohort and nested case-control studies using records in the Taiwanese National Health Insurance Research Database between 1999 and 2013. The HD cohort included 79 668 incident patients on HD, for whom the standardized incidence ratios (SIRs) for incident NMSC and cutaneous melanoma were determined. In the nested case-control study, patients on HD with NMSC were matched to those without skin cancers. The impact of various factors on the development of NMSC was determined by conditional logistic regression analysis. Among the 79 668 patients on HD, 248 cases of NMSC and 22 cases of cutaneous melanoma occurred after a mean 4·95 years of follow-up. The SIRs for NMSC and cutaneous melanoma in patients on HD were 1·58 (95% confidence interval 1·39-1·79) and 1·44 (95% confidence interval 0·91-2·19), respectively. Of the patients on HD, a higher risk of NMSC was found in men (1·5-fold), South Taiwan residents (twofold) and patients with uraemic pruritus after long-term antihistamine treatment (1·53-fold). However, the incidence of NMSC was not increased in patients with uraemic pruritus receiving ultraviolet B phototherapy. Patients on chronic HD are at higher risk of NMSC. Uraemic pruritus further increases the risk of NMSC, which might be prevented by ultraviolet B phototherapy.

Trends in incidence and survival analysis in non-melanoma skin cancer from 1994 to 2012 in Girona, Spain: A population-based study

IntroductionWe present an epidemiological study focused on Non-melanoma skin cancers (NMSC), including squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Merkel cell carcinoma (MCC), dermatofibrosarcoma protuberans (DFS) and adnexal and skin appendages neoplasm (ASAN), a neoplasm understudied in cancer registries. Material and methodsWe analyze trends of incidence and survival of NMSC registered with the Cancer Registry of Girona, Spain. ResultsWe found 14389 cases of NMSC, accounting 3,474 SCC, 10729 BCC, 33 MCC, 61 DFSP and 71 ASAN. Incidence increased significantly in SCC and BCC with annual percentage of change of 1.6 and 1.5, respectively, but not in MCC, DFS or ASAN. Five-year relative survival for both sexes was 90.1% in SCC, 99.8% in BCC, 44.2% in MCC, 93.7% in DFS and 84% in ASAN. ConclusionsOur study confirms the increasing incidence and good survival of SCC and BCC and enhances knowledge on the epidemiology of the less incidental NMSC.

Coffee, tea and caffeine intake and the risk of non-melanoma skin cancer: a review of the literature and meta-analysis.

Laboratory studies suggested that caffeine and other nutrients contained in coffee and tea may protect against non-melanoma skin cancer (NMSC). However, epidemiological studies conducted so far have produced conflicting results. We performed a literature review and meta-analysis of observational studies published until February 2016 that investigated the association between coffee and tea intake and NMSC risk. We calculated summary relative risk (SRR) and corresponding 95% confidence intervals (95% CI) by using random effects with maximum likelihood estimation. Overall, 37,627 NMSC cases from 13 papers were available for analysis. Intake of caffeinated coffee was inversely associated with NMSC risk (SRR for those in the highest vs. lowest category of intake: 0.82, 95% CI 0.75-0.89, I 2=48%), as well as intake of caffeine (SRR 0.86, 95% CI 0.80-0.91, I 2=48%). In subgroup analysis, these associations were limited to the basal cell cancer (BCC) histotype. There was no association between intake of decaffeinated coffee (SRR 1.01, 95% CI 0.85-1.21, I 2=0) and tea (0.88, 95% CI 0.72-1.07, I 2=0%) and NMSC risk. There was no evidence of publication bias affecting the results. The available evidence was not sufficient to draw conclusions on the association between green tea intake and NMSC risk. Coffee intake appears to exert a moderate protective effect against BCC development, probably through the biological effect of caffeine. However, the observational nature of studies included, subject to bias and confounding, suggests taking with caution these results that should be verified in randomized clinical trials.

Nonmelanoma Skin Cancer With Aggressive Subclinical Extension in Immunosuppressed Patients.

Immunosuppression (IS), such as in solid-organ transplant recipients (SOTRs) and patients with human immunodeficiency virus (HIV) or hematologic malignant neoplasms, increases the risk of developing nonmelanoma skin cancers (NMSCs). However, it is unknown whether IS patients are at increased risk of developing NMSCs with aggressive subclinical extensions (NMSC-ASE), which may extend aggressively far beyond conventional surgical margins. To study clinical characteristics of NMSC-ASE among immunocompetent (IC) and various subgroups of IS patients and to suggest a predictive model for NMSC-ASE lesions. A 6-year retrospective review of 2998 NMSC cases between February 26, 2007, and February 17, 2012, at the Dermatologic and Mohs Micrographic Surgery Unit of the University of California, San Diego, Medical Center. Nonmelanoma skin cancers that required at least 3 Mohs micrographic surgery stages with final surgical margins of at least 10 mm were defined as ASE lesions. All cases were categorized into 1 of 2 groups, IS or IC. Immunosuppressed cases were further subcategorized into 3 subgroups: SOTRs and patients with HIV or hematologic malignant neoplasm. The data were analyzed in December 2012. We evaluated the odds ratio of having NMSC-ASE lesions in IS patients (SOTRs, HIV, hematologic malignant neoplasm) compared with IC patients. Other clinical characteristics and preoperative risks were analyzed and compared. Of all 2998 cases, we identified 805 NMSC-ASE cases: 137 IS and 668 IC. Immunosuppressed patients had an odds ratio of 1.94 of having ASE lesions compared with IC patients (95% CI, 1.54-2.44; P < .001). Additionally, the SOTR subgroup was associated with a 2.74 odds of having NSMC-ASE compared with non-SOTRs (95% CI, 2.00-3.76; P < .001), and the presence of hematologic malignant neoplasm was associated with 1.74 times the odds compared with IC patients (95% CI, 1.04-2.90; P = .04). Multivariate analysis found older age (P < .001), lesion locations such as zone 1 (OR, 1.39 [95% CI, 1.04-1.85]; P = .02) or zone 2 (OR, 1.45 [95% CI, 1.08-1.94]; P = .01), and IS status (OR, 1.94 [95% CI, 1.54-2.44]; P < .001) to be significant predictors of ASE. The findings of this study suggest an increased risk for NMSC-ASE lesions in IS patients, especially in SOTRs and those with hematologic malignant neoplasm, but not patients with HIV. Statistically significant predictors of NMSC-ASE lesions such as age, location, and IS status can help physicians choose the most appropriate treatment modalities and optimize surgical planning.

Impact of residential UV exposure in childhood versus adulthood on skin cancer risk in Caucasian, postmenopausal women in the Women's Health Initiative.

Sun exposure is a major risk factor for skin cancer; however, the relative contribution of ultraviolet (UV) exposure during childhood versus adulthood on skin cancer risk remains unclear. Our goal was to determine the impact of residential UV, measured by AVerage daily total GLObal solar radiation (AVGLO), exposure during childhood (birth, 15years) versus adulthood (35, 50years, and present) on incident non-melanoma skin cancer (NMSC) and malignant melanoma (MM) in postmenopausal women. Women were followed with yearly surveys throughout the duration of their participation in the Women's Health Initiative Observational study, a multicenter study from 1993 to 2005. A total of 56,557 women had data on all observations and were included in the baseline characteristics. The main exposure, residential UV (as measured by AVGLO), was measured by geographic residence during childhood and adulthood. Outcome was risk of incident NMSC and MM. Over 11.9years (median follow-up), there were 9,195 (16.3%) cases of NMSC and 518 (0.92%) cases of MM. Compared with the reference group (women with low childhood and low adulthood UV), women with low childhood and high adulthood UV had a 21% increased risk of NMSC (odds ratio 1.21, 95% confidence interval 1.12, 1.31). Women with high childhood and high adulthood UV had a 19% increased risk of NMSC (odds ratio 1.19, 95% confidence interval 1.11, 1.27). Surprisingly, women with high childhood UV and low adulthood UV did not have a significant increase in NMSC risk compared with the reference group (odds ratio 1.08, 95% confidence interval 0.91, 1.28) in multivariable models. Residential UV exposure in childhood or adulthood was not associated with increased melanoma risk. This study reveals an increase in NMSC risk associated with adulthood residential UV exposure, with no effect for childhood UV exposure.

Correlation of Inflammation in Frozen Sections With Site of Nonmelanoma Skin Cancer.

During Mohs micrographic surgery of nonmelanoma skin cancer (NMSC), inflammation in histologic frozen sections has been found to occasionally presage the detection of tumors in frozen sections of adjacent excision specimens. To quantify the correlation between the location of inflammation without visible tumor in histologic frozen sections and the location of subsequently detected NMSC. A retrospective cohort study of 3148 cases pertaining to frozen sections associated with the staged excision of NMSC was performed from September 8, 2008, to September 18, 2009, at an urban academic medical center, with the collected data analyzed on May 9, 2013. Consecutive cases of Mohs micrographic surgery performed at an academic medical center. For each wedge-shaped tissue segment corresponding with 1 hour of time on a clock face, the proportion of patients with inflammation at the source location of the segment who subsequently had a tumor at this same location; the proportion of patients who had neither inflammation nor subsequent tumor at the source location of the segment; the probability of subsequent tumor at this location given the prior finding of inflammation at the same location; and the probability that a location was without tumor in the absence of preexisting inflammation at that location. Of the medical records of 3148 cases of NMSC that were reviewed, 60 showed inflammation in histologic frozen sections from an excision specimen that was followed by tumor in the subsequent excision specimen. Of these 60, 39 (65%) were b asal cel carcinoma and 21 (35%) were squamous cell carcinomas; 53 (88%) were Mohs stage 1. In 7 of 12 segments, a significant positive correlation was found between the presence of inflammation and the presence of nearby tumor with correlation coefficients ranging from 0.196 to 0.384 (P < .05) . The probability that tumor was absent when inflammation was not seen at a particular location (ie, clock-face segment) in preceding sections from that location was 91%, with segment-specific probability values ranging from 82% to 96%. During Mohs micrographic surgery of NMSC with the examination of frozen sections, histologic inflammation is modestly predictive of adjacent tumor whereas lack of inflammation strongly predicts that no additional tumor will be found.

Using frozen section margin control technique to manage non-melanomatous skin lesions in high-risk sites

In the UK, non-melanoma skin cancers (NMSCs) that are incompletely excised, recurrent or in sites high risk for incomplete excision are often offered Mohs micrographic surgery (MMS). Variations in waiting times and geographical access to MMS affect patient preference for other treatments. Our unit offers excision of such lesions under complete margin frozen section histological examination. All NMSCs excised at our unit by complete margin frozen section histological analysis from 2010 to 2014 were retrospectively reviewed. The number of excisions required, complete excision rates and recurrences to date were analysed. Sixty-nine patients were treated using this technique with a total of 70 lesions excised. Approximately 71% of the excision margins were clear after primary excision, 27% at second excision and 1% at third excision. Patients had a mean follow-up of 12 months (range: 1-48) with no patients lost to follow-up and no recurrences reported to date. Ninety-eight percent of NMSC cases were completely excised and two cases were incompletely excised. We have found the rates of excision and recurrence of the high-risk NMSCs excised at our unit to be comparable to those reported with MMS. In addition, our data show that around 29% of patients would have had incomplete margins on primary resection, thus justifying the use of this technique in this group. We suggest that this technique is a safe and useful alternative to MMS in areas where waiting times or geographical patient preference may prohibit its use.

Relation of statin use with non-melanoma skin cancer: prospective results from the Women's Health Initiative.

Background:The relationship between statin use and non-melanoma skin cancer (NMSC) is unclear with conflicting findings in literature. Data from the Women's Health Initiative (WHI) Observational Study and WHI Clinical Trial were used to investigate the prospective relationship between statin use and NMSC in non-Hispanic white (NHW) postmenopausal women.Methods:The WHI study enrolled women aged 50–79 years at 40 US centres. Among 133 541 NHW participants, 118 357 with no cancer history at baseline and complete medication/covariate data comprised the analytic cohort. The association of statin use (baseline, overall as a time-varying variable, duration, type, potency, lipophilicity) and NMSC incidence was determined using random-effects logistic regression models.Results:Over a mean of 10.5 years of follow-up, we identified 11 555 NMSC cases. Compared with participants with no statin use, use of any statin at baseline was associated with significantly increased NMSC incidence (adjusted odds ratio (ORadj) 1.21; 95% confidence interval (CI): 1.07–1.35)). In particular, lovastatin (OR 1.52; 95% CI: 1.08–2.16), simvastatin (OR 1.38; 95% CI: 1.12–1.69), and lipophilic statins (OR 1.39; 95% CI: 1.18–1.64) were associated with higher NMSC risk. Low and high, but not medium, potency statins were associated with higher NMSC risk. No significant effect modification of the statin–NMSC relationship was found for age, BMI, smoking, solar irradiation, vitamin D use, and skin cancer history.Conclusions:Use of statins, particularly lipophilic statins, was associated with increased NMSC risk in postmenopausal white women in the WHI cohort. The lack of duration–effect relationship points to possible residual confounding. Additional prospective research should further investigate this relationship.

Expression Profile of Bcl-2 in Malignant Skin Tumors

Skin is the largest organ in the body and is most commonly affected by neoplasms. In the United States only, approximately 1.2 million cases of nonmelanoma skin cancer and 80,000 cases of melanoma are diagnosed annually. A large number of families of genes that regulate apoptosis have been identified in both normal and malignant cells. There is loss of bcl-2 protein expression with increasing tumor progression. The present study was undertaken to determine the presence and possible role of bcl-2 in primary cutaneous malignancies using immunohistochemical technique and was carried in the Department of Pathology, Government Medical College, Srinagar. Fifty surgical specimens were obtained from the surgical pathology files of Department of Pathology. Imnunohistochemical study was performed. Out of the fifty cases included in the present study, only twenty one cases (42.00%) were positive for bcl-2 oncoprotein while as twenty nine cases (58%)-exhibited negativity. Basal cell carcinomas constituted 38.10% of the total positive cases, followed by Malignant Melanoma (28.57%) where as Keratoacanthomas accounted for only 4.76% positive cases. Squamous cell carcinoma and Bowen's disease constituted 14.28% each to the positive cases.

PDT Brazil - Photodynamic Therapy based M-ALA for non melanoma skin cancer: Ecuador experiences

s / Photodiagnosis and Photodynamic Therapy 12 (2015) 325–375 373 PDT Brazil Photodynamic Therapy based M-ALA for non melanoma skin cancer: Ecuador experiences Romero Paulina1,2, Cabrera Franklin1,2, Tello Sonia1,2, Kurachi Cristina1,2, Ramirez Patricia1,2, Guaman Leonel1,2, Avalos Eduardo1,2, Bagnato Vanderlei1,2 1 Escuela Politecnica Nacional, Departamento de Materiales, Electrica y Fisica Quito-Ecuador. Hospital Carlos Andrade Marin, Servicio de Dermatologia e Histopatologia. Quito – Ecuador 2 Sao Carlos Institute of Physics, University of Sao Paulo, Brazil In Ecuador the National Tumor Registry (RNT) show in 2002 the non-melanoma skin cancer was the second most common cancer in men and women, but in 2005 it takes the first place for women. Experience: 11 patients with surface CBC, 47 with nodular CBC, 2 with CBC recurrences (depht middle dermis), 2 with CBC recurrences (neural invasion) and 3 with surface CEC, were treated with Photodynamic therapy based inMetil -ALA 20% and the LINCE light source with 100 W/cm2, 635nm wavelength. During treatment was used the dermatoscopy to monitor lesions. The results were evaluated by histopathological studies where the initial depth of the lesions was evident. These assessments allowed to find the depth at which treatment is efficient. Patients were treated between 2012 2014 in the “Carlos Andrade Marin” Hospital and “Gonzalo Gonzalez” Dermatological Hospital in QuitoEcuador. Results: After 2 therapy sessions for suface CBC (depht middle dermis) 90% of the patients have a complete response, for nodular CBC after 4 sessions 86% of the patients have a complete response, for the CBC recurrences (neural invasion) don’t show an effective response, and for surface CEC after 6 sessions 100% of the patients have a complete response. http://dx.doi.org/10.1016/j.pdpdt.2015.07.186 PDT Brazil Therapy in Superficial Basal Cell Carcinoma: follow-up for 12 months L.I.S. Mota, M.F.M. Brito, J.S. Belo Universidade Federal de Pernambuco Brazil Therapy in Superficial Basal Cell Carcinoma: follow-up for 12 months. Fundamentals: Basal-cell cancer is the most prevalent non-melanoma skin cancer in Brazil andworldwide. Photodynamic therapy (PDT) is a noninvasive technique with excellent cosmetic outcome and curative results. Maintaining cure rates remains an object of study due to the recent introduction of this therapy in dermatology. Objective: Evaluate the clinical response of photodynamic therapy in superficial basal-cell carcinoma after 12 months of treatment in patients with initial complete response at the end of the third month after treatment. Methods: After curettage and application of methyl aminolevulinate, the lesion was occluded for 3 hours. Then it was discovered and submitted a 635nm LED (37 J/cm2), positioned eight centimeters from the patient, for eight minutes. Two sessions were realized with intervals of 14 days. Pictures were performed before treatment, at 3 and 12 months after treatment. Results: The analyses involved 35 patients, that were submitted a MAL-PDT and presented complete response in the evaluation of three months. These cancers were checked with 12 months. A maintenance of complete clinical response was observed in 85% (30/35). Conclusion: PDT-MAL is a safe and effective therapeutic approach in the treatment of superficial BCC, with maintenance http://dx.doi.org/10.1016/j.pdpdt.2015.07.187 PDT Brazil A New Approach for Basal Cell Carcinoma Treatment Kate C. Blanco, Natalia M. Inada, Ana Paula da Silva, Pedro Russignoli, Dora P. Ramirez, Hilde H. Buzza, Mirian D. Stringasci, Lilian T. Moriyama, Clovis Grecco, Cristina Kurachi, Vanderlei S. Bagnato Sao Carlos Institute of Physics, University of Sao Paulo, Brazil Non-melanomaskin cancer (NMSC) is themostprevalent cancer type in Brazil andworldwide. According to the National Institute of Cancer (INCA) at the last year, it was estimated 182,130 new cases of NMSC in Brazil. Photodynamic Therapy (PDT) has proven to be effective with an excellent cosmetic outcome and reliable treatment option. A Brazilian programwas established to determine the efficacy of topicalMAL-PDTusing a Brazilian device (LINCE,MMOptics, Brazil) and medication (methyl aminolevulinate, PDTPharma, Brazil). During four years with financial support by BNDES (Brazilian Development Bank), we are reporting the treatment of 994 basal cell carcinoma (BCC), around all country and Latin America. Through these data it was analyzed the efficiency of the treatment 30 days after the second PDT session. Were compared the gender, age, skin type, location and size of the lesions. The conclusion of this extensive and important project has shown the efficacy PDT with 81.7% of clearance of superficial BCC and 75.1% for nodular BCC, and a small relapse rate of 1.22%. http://dx.doi.org/10.1016/j.pdpdt.2015.07.188 Prospective, double-blind, randomized placebo-controlled trial of the efficacy of lidocaine and tetracaine cream 7%/7% for pain control during PDT Ana Gabriela Salvio1, Pedro E Russignoli 2, Natalia Mayumi Inada2, Elisangela Ramos de Oliveira1, Cristina Kurachi2, Vanderlei Salvador Bagnato2 1 Skin Deppartment of Amaral Carvalho Hospital, Brazil 2 Sao Carlos Institute of Physics, University of Sao

PDT Brazil - A New Approach for Basal Cell Carcinoma Treatment

s / Photodiagnosis and Photodynamic Therapy 12 (2015) 325–375 373 PDT Brazil Photodynamic Therapy based M-ALA for non melanoma skin cancer: Ecuador experiences Romero Paulina1,2, Cabrera Franklin1,2, Tello Sonia1,2, Kurachi Cristina1,2, Ramirez Patricia1,2, Guaman Leonel1,2, Avalos Eduardo1,2, Bagnato Vanderlei1,2 1 Escuela Politecnica Nacional, Departamento de Materiales, Electrica y Fisica Quito-Ecuador. Hospital Carlos Andrade Marin, Servicio de Dermatologia e Histopatologia. Quito – Ecuador 2 Sao Carlos Institute of Physics, University of Sao Paulo, Brazil In Ecuador the National Tumor Registry (RNT) show in 2002 the non-melanoma skin cancer was the second most common cancer in men and women, but in 2005 it takes the first place for women. Experience: 11 patients with surface CBC, 47 with nodular CBC, 2 with CBC recurrences (depht middle dermis), 2 with CBC recurrences (neural invasion) and 3 with surface CEC, were treated with Photodynamic therapy based inMetil -ALA 20% and the LINCE light source with 100 W/cm2, 635nm wavelength. During treatment was used the dermatoscopy to monitor lesions. The results were evaluated by histopathological studies where the initial depth of the lesions was evident. These assessments allowed to find the depth at which treatment is efficient. Patients were treated between 2012 2014 in the “Carlos Andrade Marin” Hospital and “Gonzalo Gonzalez” Dermatological Hospital in QuitoEcuador. Results: After 2 therapy sessions for suface CBC (depht middle dermis) 90% of the patients have a complete response, for nodular CBC after 4 sessions 86% of the patients have a complete response, for the CBC recurrences (neural invasion) don’t show an effective response, and for surface CEC after 6 sessions 100% of the patients have a complete response. http://dx.doi.org/10.1016/j.pdpdt.2015.07.186 PDT Brazil Therapy in Superficial Basal Cell Carcinoma: follow-up for 12 months L.I.S. Mota, M.F.M. Brito, J.S. Belo Universidade Federal de Pernambuco Brazil Therapy in Superficial Basal Cell Carcinoma: follow-up for 12 months. Fundamentals: Basal-cell cancer is the most prevalent non-melanoma skin cancer in Brazil andworldwide. Photodynamic therapy (PDT) is a noninvasive technique with excellent cosmetic outcome and curative results. Maintaining cure rates remains an object of study due to the recent introduction of this therapy in dermatology. Objective: Evaluate the clinical response of photodynamic therapy in superficial basal-cell carcinoma after 12 months of treatment in patients with initial complete response at the end of the third month after treatment. Methods: After curettage and application of methyl aminolevulinate, the lesion was occluded for 3 hours. Then it was discovered and submitted a 635nm LED (37 J/cm2), positioned eight centimeters from the patient, for eight minutes. Two sessions were realized with intervals of 14 days. Pictures were performed before treatment, at 3 and 12 months after treatment. Results: The analyses involved 35 patients, that were submitted a MAL-PDT and presented complete response in the evaluation of three months. These cancers were checked with 12 months. A maintenance of complete clinical response was observed in 85% (30/35). Conclusion: PDT-MAL is a safe and effective therapeutic approach in the treatment of superficial BCC, with maintenance http://dx.doi.org/10.1016/j.pdpdt.2015.07.187 PDT Brazil A New Approach for Basal Cell Carcinoma Treatment Kate C. Blanco, Natalia M. Inada, Ana Paula da Silva, Pedro Russignoli, Dora P. Ramirez, Hilde H. Buzza, Mirian D. Stringasci, Lilian T. Moriyama, Clovis Grecco, Cristina Kurachi, Vanderlei S. Bagnato Sao Carlos Institute of Physics, University of Sao Paulo, Brazil Non-melanomaskin cancer (NMSC) is themostprevalent cancer type in Brazil andworldwide. According to the National Institute of Cancer (INCA) at the last year, it was estimated 182,130 new cases of NMSC in Brazil. Photodynamic Therapy (PDT) has proven to be effective with an excellent cosmetic outcome and reliable treatment option. A Brazilian programwas established to determine the efficacy of topicalMAL-PDTusing a Brazilian device (LINCE,MMOptics, Brazil) and medication (methyl aminolevulinate, PDTPharma, Brazil). During four years with financial support by BNDES (Brazilian Development Bank), we are reporting the treatment of 994 basal cell carcinoma (BCC), around all country and Latin America. Through these data it was analyzed the efficiency of the treatment 30 days after the second PDT session. Were compared the gender, age, skin type, location and size of the lesions. The conclusion of this extensive and important project has shown the efficacy PDT with 81.7% of clearance of superficial BCC and 75.1% for nodular BCC, and a small relapse rate of 1.22%. http://dx.doi.org/10.1016/j.pdpdt.2015.07.188 Prospective, double-blind, randomized placebo-controlled trial of the efficacy of lidocaine and tetracaine cream 7%/7% for pain control during PDT Ana Gabriela Salvio1, Pedro E Russignoli 2, Natalia Mayumi Inada2, Elisangela Ramos de Oliveira1, Cristina Kurachi2, Vanderlei Salvador Bagnato2 1 Skin Deppartment of Amaral Carvalho Hospital, Brazil 2 Sao Carlos Institute of Physics, University of Sao

Prospective, double-blind, randomized placebo-controlled trial of the efficacy of lidocaine and tetracaine cream 7%/7% for pain control during PDT

s / Photodiagnosis and Photodynamic Therapy 12 (2015) 325–375 373 PDT Brazil Photodynamic Therapy based M-ALA for non melanoma skin cancer: Ecuador experiences Romero Paulina1,2, Cabrera Franklin1,2, Tello Sonia1,2, Kurachi Cristina1,2, Ramirez Patricia1,2, Guaman Leonel1,2, Avalos Eduardo1,2, Bagnato Vanderlei1,2 1 Escuela Politecnica Nacional, Departamento de Materiales, Electrica y Fisica Quito-Ecuador. Hospital Carlos Andrade Marin, Servicio de Dermatologia e Histopatologia. Quito – Ecuador 2 Sao Carlos Institute of Physics, University of Sao Paulo, Brazil In Ecuador the National Tumor Registry (RNT) show in 2002 the non-melanoma skin cancer was the second most common cancer in men and women, but in 2005 it takes the first place for women. Experience: 11 patients with surface CBC, 47 with nodular CBC, 2 with CBC recurrences (depht middle dermis), 2 with CBC recurrences (neural invasion) and 3 with surface CEC, were treated with Photodynamic therapy based inMetil -ALA 20% and the LINCE light source with 100 W/cm2, 635nm wavelength. During treatment was used the dermatoscopy to monitor lesions. The results were evaluated by histopathological studies where the initial depth of the lesions was evident. These assessments allowed to find the depth at which treatment is efficient. Patients were treated between 2012 2014 in the “Carlos Andrade Marin” Hospital and “Gonzalo Gonzalez” Dermatological Hospital in QuitoEcuador. Results: After 2 therapy sessions for suface CBC (depht middle dermis) 90% of the patients have a complete response, for nodular CBC after 4 sessions 86% of the patients have a complete response, for the CBC recurrences (neural invasion) don’t show an effective response, and for surface CEC after 6 sessions 100% of the patients have a complete response. http://dx.doi.org/10.1016/j.pdpdt.2015.07.186 PDT Brazil Therapy in Superficial Basal Cell Carcinoma: follow-up for 12 months L.I.S. Mota, M.F.M. Brito, J.S. Belo Universidade Federal de Pernambuco Brazil Therapy in Superficial Basal Cell Carcinoma: follow-up for 12 months. Fundamentals: Basal-cell cancer is the most prevalent non-melanoma skin cancer in Brazil andworldwide. Photodynamic therapy (PDT) is a noninvasive technique with excellent cosmetic outcome and curative results. Maintaining cure rates remains an object of study due to the recent introduction of this therapy in dermatology. Objective: Evaluate the clinical response of photodynamic therapy in superficial basal-cell carcinoma after 12 months of treatment in patients with initial complete response at the end of the third month after treatment. Methods: After curettage and application of methyl aminolevulinate, the lesion was occluded for 3 hours. Then it was discovered and submitted a 635nm LED (37 J/cm2), positioned eight centimeters from the patient, for eight minutes. Two sessions were realized with intervals of 14 days. Pictures were performed before treatment, at 3 and 12 months after treatment. Results: The analyses involved 35 patients, that were submitted a MAL-PDT and presented complete response in the evaluation of three months. These cancers were checked with 12 months. A maintenance of complete clinical response was observed in 85% (30/35). Conclusion: PDT-MAL is a safe and effective therapeutic approach in the treatment of superficial BCC, with maintenance http://dx.doi.org/10.1016/j.pdpdt.2015.07.187 PDT Brazil A New Approach for Basal Cell Carcinoma Treatment Kate C. Blanco, Natalia M. Inada, Ana Paula da Silva, Pedro Russignoli, Dora P. Ramirez, Hilde H. Buzza, Mirian D. Stringasci, Lilian T. Moriyama, Clovis Grecco, Cristina Kurachi, Vanderlei S. Bagnato Sao Carlos Institute of Physics, University of Sao Paulo, Brazil Non-melanomaskin cancer (NMSC) is themostprevalent cancer type in Brazil andworldwide. According to the National Institute of Cancer (INCA) at the last year, it was estimated 182,130 new cases of NMSC in Brazil. Photodynamic Therapy (PDT) has proven to be effective with an excellent cosmetic outcome and reliable treatment option. A Brazilian programwas established to determine the efficacy of topicalMAL-PDTusing a Brazilian device (LINCE,MMOptics, Brazil) and medication (methyl aminolevulinate, PDTPharma, Brazil). During four years with financial support by BNDES (Brazilian Development Bank), we are reporting the treatment of 994 basal cell carcinoma (BCC), around all country and Latin America. Through these data it was analyzed the efficiency of the treatment 30 days after the second PDT session. Were compared the gender, age, skin type, location and size of the lesions. The conclusion of this extensive and important project has shown the efficacy PDT with 81.7% of clearance of superficial BCC and 75.1% for nodular BCC, and a small relapse rate of 1.22%. http://dx.doi.org/10.1016/j.pdpdt.2015.07.188 Prospective, double-blind, randomized placebo-controlled trial of the efficacy of lidocaine and tetracaine cream 7%/7% for pain control during PDT Ana Gabriela Salvio1, Pedro E Russignoli 2, Natalia Mayumi Inada2, Elisangela Ramos de Oliveira1, Cristina Kurachi2, Vanderlei Salvador Bagnato2 1 Skin Deppartment of Amaral Carvalho Hospital, Brazil 2 Sao Carlos Institute of Physics, University of Sao

Mohs appropriate use criteria: retrospectively applied to nonmelanoma skin cancers at a single academic center.

In September 2012, appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) were released by a collaboration of dermatology organizations including the American College of Mohs Surgery. The group sought to determine adherence to the Mohs AUC at the academic institution. The authors performed a retrospective chart review of all nonmelanoma skin cancers (NMSCs) treated within the University of Utah, Department of Dermatology, from January through March of 2012. They applied the Mohs AUC to analyze these cases. In total, the authors identified 724 patients and 1,026 cases of NMSCs, including 557 (54.3%) basal cell carcinomas and 469 (45.7%) squamous cell carcinomas. Of the 1,026 NMSCs, 350 (34.1%) were treated with MMS. Of these cases treated with MMS, there were 339 cases (96.9%) deemed appropriate, 4 (1.1%) uncertain, and 7 (2.0%) inappropriate per AUC. Also examined were 611 cases treated with modalities other than MMS, of which 60.7% would have met AUC for MMS. In a 3-month review of all NMSC cases at the academic center, there is a low percentage of cases performed that are inappropriate for MMS by AUC. At the institution, there is a large percentage of NMSC that meet AUC but are treated by other modalities. The use is highly appropriate for MMS, and these data suggest possible underutilization of MMS for certain NMSCs. Further studies are required to determine the effectiveness of other treatment modalities for NMSC that meet Mohs AUC.

Abstract 4570: Genetic deletion of TNFα in mice inhibits UVR-induced development of cutaneous squamous cell carcinomas via suppression of its own receptors and associated signals to epidermal cell survival

Abstract Skin cancer is the second most common malignancy encountered in the U.S. with an expected diagnosis of 1.3 million new cases of non-melanoma skin cancer each year. Cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most common non-melanoma forms of human skin cancer. BCC is rarely life threatening because it is slow growing and is mostly localized. SCC, unlike BCC, invades the nearby tissue. Chronic exposure to ultraviolet radiation (UVR) is the most common etiologic factor linked to the development of cutaneous SCC. PKCϵ transgenic mice provide a unique model to investigate the molecular basis of the development of SCC. PKC is a major intracellular receptor for the mouse skin tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA). PKCϵ is among six isoforms (α, δ, ϵ, η, μ, ζ) expressed in the mouse skin. To determine the in vivo functional specificity of PKCϵ in mouse skin carcinogenesis, we generated FVB/N PKCϵ transgenic mouse lines 224 and 215 that overexpress approximately 8- and 18-fold respectively PKCϵ protein over endogenous levels in basal epidermal cells. We observed that epidermal PKCϵ level dictates the susceptibility of transgenic mice to the development of SCC elicited by either the repeated exposure to UVR or using the DMBA-TPA tumor promotion protocol. Our earlier studies to elucidate mechanisms of PKCϵ-mediated development of SCC indicated an elevated release of cytokine TNFα. To conclusively determine whether TNFα is essential for the development of SCC in PKCϵ transgenic mice, we generated TNFα-knockout//PKCϵ transgenic mice by crossbreeding TNFα knockout mice with PKCϵ transgenic mice. We now present that deletion of both TNFα alleles in PKCϵ transgenic mice significantly (p = 0.0023) inhibited the development of cutaneous SCC by repeated UVR exposures. PKCϵ overexpressing mice deficient in TNFα elicited both increase in SCC latency (21 weeks) and decrease in SCC incidence (55%). Inhibition of SCC development in TNFα-knockout//PKCϵ transgenic mice accompanied by: 1) suppression of the expression levels of TNFα receptors TNFRI and TNFRII, 2) inhibition of the activation of transcription factors Stat3 and NF-κB, and 3) decreased expression levels of cell proliferation marker ornithine decarboxylase and metastatic markers MMP9 and MMP7. In summary, our results indicate that deletion of TNFα in mice inhibits UVR-induced development of cutaneous SCC probably via suppression of its own receptors and associated signals to epidermal cell survival pathways. (Support: NIH Grant CA102431) Citation Format: Ashok Singh, Anupama Singh, Samuel J. Bauer, Ajit K. Verma. Genetic deletion of TNFα in mice inhibits UVR-induced development of cutaneous squamous cell carcinomas via suppression of its own receptors and associated signals to epidermal cell survival. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4570. doi:10.1158/1538-7445.AM2015-4570

Skin cancer concerns particular to women.

BackgroundSkin cancer has reached epidemic proportions, with more new cases diagnosed annually than the combined incidence of cancers of the breast, prostate, lung, and colon. Estimates show 2 to 3 million new cases of non-melanoma skin cancer (NMSC) every year, and, among women, it is the young (younger than 45 years) who are disproportionately affected.ObjectiveThis article aims to address questions and concerns pertinent to skin cancer in a woman-centric way. An updated landscape of causative factors, the latest detection/treatment methods, and ultimately the preventative measures available to them are described.MethodsA broad literature search was conducted using the PubMed database with search terms focusing on female gender. Additional articles were identified from cited references.ConclusionsThe published findings on causation of melanoma skin cancer and non-melanoma skin cancer in females are outlined, as well as current detection methods and treatment options. Furthermore, a variety of preventative measures specific to women that can reduce the chance of being diagnosed with skin cancer are discussed.

Evaluation of Aquaporin-3 Role in Nonmelanoma Skin Cancer: An Immunohistochemical Study

Aquaporin-3 (AQP3), is an aquaglyceroporin, that plays a role in cell proliferation, tumorigenesis, and cell migration. This study aimed at evaluating the possible role of AQP3 in nonmelanoma skin cancer (NMSC) pathogenesis through its immunohistochemical expression in skin biopsies of these diseases. One-hundred and thirty cutaneous specimens were studied. These included 60 cases of NMSC and 40 normal skin and 30 psoriasis samples, from age- and gender-matched subjects, as a control group. AQP3 was expressed in 66.7% of basal cell carcinoma (BCC) cases and in 93.3% of squamous cell carcinoma (SCC) cases. Higher AQP3 expression (p = .01), expression percentage (p = .01), and H score (p = .04) were significantly associated with SCC compared to BCC. Normal skin and psoriasis showed significantly higher AQP3 expression (p = .001, p < .001, respectively), expression percentage (p < .001 for both), and H score values (p < .001, p = .001, respectively) compared to NMSC. Higher H score values in BCC were significantly associated with female gender (p = .02) and with nodular lesions (p > .001). Higher H score values in SCC were significantly associated with grade III tumors (p = .04) and AQP3 percentage of expression was significantly correlated with grade III tumors (r = .48, p = .009). In conclusion, AQP3 may play a role in NMSC pathogenesis. This probably occurs through aquaporin-mediated glycerol transport and ATP generation. Its downregulation, observed in the current work, is mostly a result of excessive proliferation. Further studies are needed to investigate the therapeutic effect of its inhibition in NMSC treatment.

MC1R gene variants and non-melanoma skin cancer: a pooled-analysis from the M-SKIP project.

Background:The melanocortin-1-receptor (MC1R) gene regulates human pigmentation and is highly polymorphic in populations of European origins. The aims of this study were to evaluate the association between MC1R variants and the risk of non-melanoma skin cancer (NMSC), and to investigate whether risk estimates differed by phenotypic characteristics.Methods:Data on 3527 NMSC cases and 9391 controls were gathered through the M-SKIP Project, an international pooled-analysis on MC1R, skin cancer and phenotypic characteristics. We calculated summary odds ratios (SOR) with random-effect models, and performed stratified analyses.Results:Subjects carrying at least one MC1R variant had an increased risk of NMSC overall, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC): SOR (95%CI) were 1.48 (1.24–1.76), 1.39 (1.15–1.69) and 1.61 (1.35–1.91), respectively. All of the investigated variants showed positive associations with NMSC, with consistent significant results obtained for V60L, D84E, V92M, R151C, R160W, R163Q and D294H: SOR (95%CI) ranged from 1.42 (1.19–1.70) for V60L to 2.66 (1.06–6.65) for D84E variant. In stratified analysis, there was no consistent pattern of association between MC1R and NMSC by skin type, but we consistently observed higher SORs for subjects without red hair.Conclusions:Our pooled-analysis highlighted a role of MC1R variants in NMSC development and suggested an effect modification by red hair colour phenotype.

Solar ultraviolet radiation: properties, characteristics and amounts observed in Brazil and South America.

The beneficial and harmful effects of human exposure to solar ultraviolet radiation (UV-R) are topics that arouse great interest not only among physicians and scientists, but also the general public and the media. Currently, discussions on vitamin D synthesis (beneficial effect) are confronted with the high and growing number of new cases of non-melanoma skin cancer and other diseases of the skin and eyes (harmful effect) diagnosed each year in Brazil. However, the lack of scientific knowledge on the UV-R in Brazil and South America leads to adoption of protective measures based on studies conducted in Europe and USA, where the amounts of UV-R available at surface and the sun-exposure habits and characteristics of the population are significantly different from those observed in Brazil. In order to circumvent this problem, the Brazilian Society of Dermatology recently published the Brazilian Consensus of Photoprotection based on recent studies performed locally. The main goal of this article is to provide detailed educational information on the main properties and characteristics of UV-R and UV index in a simple language. It also provides: a) a summary of UV-R measurements recently performed in Brazil; b) a comparison with those performed in Europe; and, c) an evaluation to further clarify the assessment of potential harm and health effects owing to chronic exposures.

Surgical Management of Melanoma and Other Skin Cancers

The prevalence of malignant skin cancers has increased significantly over the past several years. Approximately 1.2 million cases of non-melanoma skin cancer are diagnosed per year. More alarming, up to 80,000 cases of melanoma are diagnosed per year, an incidence that has been steadily increasing, with a lifetime risk of 1 in 50 for the development of melanoma. The disturbing increase in the incidence of both non-melanoma skin cancer and melanoma can largely be attributed to the social attitude toward sun exposure. The clinical assessment and management of skin lesions can be challenging. This review describes the assessment process, including thorough history and examination; the need for possible biopsy; and excision criteria. Specific types of skin cancer are distinguished and include basal cell carcinoma; squamous cell carcinoma; and melanoma; and for each type the incidence; epidemiology; histologic subtypes; diagnosis; and both surgical and non-surgical treatments are provided. Stages I-IV of melanoma are detailed, with prognostic factors described. Surgical treatment for stages I and II include description of the margins of excision and sentinel lymph node biopsy. The surgical treatment of Stage III melanoma further includes therapeutic lymph node dissection and isolated limb perfusion. Adjuvant therapies are also presented and include radiotherapy and chemotherapy. The additional treatment of metastasectomy for Stage IV melanoma is described. For both Stage III and IV melanoma, the study of vaccines to host immune cells is reported. For Stage IV melanoma, the text also describes immunotherapy treatment. Operative procedures specific to superficial and deep groin dissections are outlined. This review contains 9 figures, 3 tables, and 96 references.