Precancerous Skin Lesions Research Articles

A comprehensive analysis of coding and non-coding transcriptomic changes in cutaneous squamous cell carcinoma

Cutaneous Squamous Cell Carcinoma (cSCC) is the most common and fastest-increasing cancer with metastatic potential. Long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs) are novel regulators of gene expression. To identify mRNAs, lncRNAs and circRNAs, which can be involved in cSCC, RNA-seq was performed on nine cSCCs and seven healthy skin samples. Representative transcripts were validated by NanoString nCounter assays using an extended cohort, which also included samples from pre-cancerous skin lesions (actinic keratosis). 5,352 protein-coding genes, 908 lncRNAs and 55 circular RNAs were identified to be differentially expressed in cSCC. Targets of 519 transcription factors were enriched among differentially expressed genes, 105 of which displayed altered level in cSCCs, including fundamental regulators of skin development (MYC, RELA, ETS1, TP63). Pathways related to cell cycle, apoptosis, inflammation and epidermal differentiation were enriched. In addition to known oncogenic lncRNAs (PVT1, LUCAT1, CASC9), a set of skin-specific lncRNAs were were identified to be dysregulated. A global downregulation of circRNAs was observed in cSCC, and novel skin-enriched circRNAs, circ_IFFO2 and circ_POF1B, were identified and validated. In conclusion, a reference set of coding and non-coding transcripts were identified in cSCC, which may become potential therapeutic targets or biomarkers.

Chemical peeling for acne and melasma: current knowledge and innovations.

The skin is a dynamic organ that continuously eliminates an infinite number of keratinized cells through physiological mechanism. Chemical peeling is a widely used cosmetic procedure in medical practice. This technique consists of the application of one or more chemical ablative agents to the skin's surface in order to induce keratolysis or keratocoagulation. Exfoliation is followed by skin and epidermal regeneration from the adjacent epithelium and skin adnexa. Moreover, through an inflammatory reaction and the activation of the inflammation mediators, an increase in fibroblastic synthesis and in the production of new collagen and glycosaminoglycan fibers is induced. After the first treatment session, the appearance and the texture of the skin are significantly improved. Peeling agents may be divided into superficial (epidermis-papillary dermis), medium-depth (papillary to upper reticular dermis) and deep subtypes based on the depth of their penetration (mid-reticular dermis). Superficial peel is mainly used for dyschromia, acne, post-inflammatory hyperpigmentation, melasma and actinic keratosis. Medium depth peel mainly treats solar keratosis or lentigines, pigmentary disorders and superficial scars. Skin photo-ageing, deep scars or wrinkles and precancerous skin lesions require a deep chemical peeling. The aim of this article is to review recent advances in chemical peel of melasma and acne.

A precancerous skin lesion that is often misdiagnosed.

Disseminated superficial actinic porokeratosis (DSAP) is a precancerous skin condition often seen by dermatologists that is characterised bymultiple annular hyperkeratotic lesions on sun-exposed areas. In Australia, DSAP is not a rare condition, possibly owing to Australia's high levels of sun exposure, and patients with DSAP often initially present to general practitioners (GPs). Alack of awareness about DSAP may result in misdiagnosis and inappropriate management of the condition. The aim of this article is to provide an overview of DSAP relevant to GPs to better facilitate diagnosis, management and referral to a dermatologist. The underlying pathophysiological mechanism of DSAP is unknown. Although there is currently no effective standardised treatment, ongoing management is warranted, given the potential for malignant transformation. Suggested strategies include frequent full skin checks, patient education about sun protection and ablative treatment (such as cryotherapy) if indicated. Suspicious lesions require excision and histopathology.

RATIONALE, DEVELOPMENT AND IMPLEMENTATION OF THE FUNCTIONAL-ORGANIZATIONAL MODEL FOR IMPROVEMENT OF SECONDARY PREVENTION OF ACTINIC KERATOSIS

It is known that effective prevention of skin cancer is to identify individuals with a high level of risk factors for skin cancer, timely diagnosis and active treatment of precancerous skin lesions. Among the diseases that pose an increased risk of squamous cell carcinoma are actinic keratosis. Thus, effective prevention of actinic keratosis is one of the crucial factors in justifying cost minimization and improving patients' quality of life.
 Aim – to substantiate the improvement of secondary prevention of actinic keratosis by developing a functional-organizational model based on a process approach.
 Material and methods.The methods of system and process approach, system and content analysis are applied in the research; medical-statistical, descriptive modeling. Statistical processing of material using EZR v. 1.35.
 Results. The proposed model envisages a number of structural elements and functions inherent in them, from the provision of health services at the level of a health care facility to communicative, informational-analytical, educational-methodological and scientific, resource and regulatory support at the territorial and national levels of government. The advantages of the proposed model include its justification based on the results of research, international developments, as well as current regulatory documents, medical standards. The implementation of the model will allow the healthcare provider to select and apply the necessary set of preventive measures in accordance with the medical-technological standards of medical care. The values ​​of the coefficients of variation for all the distinguished advantages of the model, which were evaluated during the examination, did not exceed 10.0%, which indicates a low degree of variability and unanimity of expert estimates.
 Conclusions. The proposed functional and organizational model for improving the secondary prevention of actinic keratosis is in line with the principles of comprehensiveness and continuity of medical care and provides patients with quality and affordable medical care while optimizing available resources.

Successful application of modified keystone flaps following skin tumor ablation.

Skin cancer and precancerous skin lesions cause significant soft-tissue defects following tumor ablation. Recently, keystone flaps have gained popularity due to their simplicity, versatility, and reliability.We evaluated the efficacy of modified keystone flaps for soft-tissue reconstruction following skin tumor ablation in 2 medical centers.We reviewed the medical records of patients who received modified keystone flaps following the removal of skin tumors from January 2017 to December 2017. The diagnosis, site, flap size, and complications were recorded.Forty-one modified keystone flaps were evaluated, and the wound dimensions ranged from 1 cm × 1 cm to 18 cm × 9.5 cm, with an average size of 9.8 cm × 6.4 cm. With our selection strategy, specific modified keystone flaps were designed for the soft-tissue defects. The flap dimensions ranged from 2.2 cm × 1 cm to 26 cm × 10 cm, with an average size of 14.3 cm × 7.5 cm. Two patients developed minor wound dehiscence (4.9%), and 1 patient developed partial flap loss (2.4%), but all of these patients healed after local wound care without the need for surgical intervention.Our selection strategy for modified keystone flaps is a feasible and reliable option for reconstruction following skin tumor excision.

Expression of Ki67 in Precancerous Squamous Cell Skin Lesion of Mice Induced by DMBA

Background: Squamous cell carcinoma (SCC) is an invasive skin cancer that is found in the human skin. SCC growth from the precancerous lesion is known as a wart or papilloma. Ki67 is a protein expressed by cells during proliferation. Cells with higher Ki67 expression showed abnormal regulation of apoptosis. 5-FU is an antimetabolite compound that works as a DNA/RNA pyrimidine antagonist molecule that can induce cell apoptosis. The main objective of this research is to evaluate the inhibition proliferation of precancerous squamous cell in skin lesion induced by DMBA/croton oil treated by using 5-FU cream topically compared to 5% imiquimod cream. Methods: This research assesses three different concentrations of 5-FU cream namely 1%, 2%, and 5% topically on 24 wild type mice divided into 6 groups of 4 each including positive control (with carcinogenesis but without treatment), negative control (without treatment ; normal), carcinogenesis with treatment 5-FU cream (1%, 2%, and 5%) or 5% imiquimod cream. The expression of Ki67 was analyzed using immunohistochemistry. Statistical analysis was performed by one-way ANOVA using SPSS version 23. Results: Based on this research, 5-FU cream treatment during 4 weeks (week 10-week 14) showed the decrease of cumulative number of papilloma (p<0.05) and immunohistochemistry analysis resulted in the lowest Ki67 expression in 5-FU 2% and 5% groups compared to 5% imiquimod cream (p<0.05). Conclusions: 5-FU cream treatment during 4 weeks showed a decrease of papilloma and Ki67 expression in 5-FU cream 2% and

Topical Sunscreen Application Preventing Skin Cancer: Systematic Review

Background: Avoiding extended exposure to direct sunlight and the topical application of sunscreen when exposed are the main techniques used to protect the skin form sunburn, photoaging, and skin cancer risk (melanoma and non-melanoma skin cancer). Preventive strategies could lead to a significant reduction of the excessive health system cost for the treatment of these conditions. Sunscreen employment and efficacy stay controversial despite decades of humane use with health benefits closely related. At the present, few studies still found a connection between the use of sunscreen and not significant long-term benefits from UV induced damages. Objectives: To assess the effects of sunscreens for preventing melanoma, non-melanoma skin cancer (basal or squamous carcinoma and melanoma) and precancerous skin lesions. Method: Published literature (1993–2017) was reviewed and eligible studies that reported the impact of sunscreen use in the prevention of melanoma, non-melanoma skin cancer, or precancerous skin lesion were selected. Result: Starting from 532 sources, a total of seven articles met the inclusion criteria and they have been subjected to a systematic review. All of the included studies suggest that sunscreen use is associated with a reduction in melanoma, squamous cell carcinoma, and precancerous skin lesions; however, the difficulties in evaluating the efficiency of sunscreen were pointed out. Conclusion: The review of the experimental evidence supports the topical application of sunscreen as an effective effort in preventing skin cancer and precancerous skin lesions.

A NATURAL PRODUCT DECURSIN ENHANCES THE RADIOSENSITIZATION OF IONIZING RADIATION AGAINST DMBA-INDUCED TUMOR

Objective: Radiation therapy has gained significant attention for the treatment and prevention of solid and malignant human tumors. However, after periodical exposures, radiation therapy losses its efficacy against cancer cells displaying radio-resistant phenotypes. Therefore, decursin might improve the efficiency of radiotherapy against a variety of human cancers.
 Methods: The chemopreventive efficacy of decursin was evaluated against B16F10 cancer cell lines and DMBA/croton oil-induced skin carcinogenesis in BALB/c mice. Decursin was administered intraperitoneal at the dose of 20 mg/kg/day for 8 weeks following exposure to 5 Gy of ionizing radiation (IR) after 1 month of DMBA application. Western blot was performed for underlying mechanism of radioresistance.
 Results: Decursin suppressed the proliferation and viability of melanoma cancer cell lines in a concentration- and time-dependent manner. The in vivo data collected from mice model revealed that decursin reduced the precancerous skin lesions and the incidence of tumor bearing in radiation-exposed mice. Decursin also enhanced the effect of IR by downregulation of Akt/NFκB pathway through activation of IκBα.
 Conclusion: Our results suggest that the activation of Akt/NFκB establishes a pro-survival response to radiation that may account for the development of radioresistance. Decursin blocks the abnormal expression of these proteins and potentiates the radiotherapeutic effect.

Topical Diclofenac Reprograms Metabolism and Immune Cell Infiltration in Actinic Keratosis.

Background: Melanoma and squamous cell carcinoma of the skin are characterized by an altered glucose metabolism, but little is known about metabolic changes in precancerous skin lesions such as actinic keratosis (AK). Here, we studied the central carbon metabolism and immune cell infiltrate of actinic keratosis lesions before, under, and 4 weeks after treatment with topical diclofenac (Solaraze®).Methods: This study was designed as a prospective, randomized, controlled, monocentric investigation (ClinicalTrials.gov Identifier: NCT01935531). Myeloid and T cell infiltration was analyzed in skin biopsies from 28 patients by immunohistochemistry. Furthermore, immune cell activation was determined via quantitative real-time PCR (IFN-γ, IL-10, CSF1, TGF-β, IL-6). Glucose, amino acid and Krebs' cycle metabolism was studied by mass spectrometry prior, during and after treatment with topical diclofenac. Biopsies from sun-exposed, untreated, healthy skin served as controls.Results: Increased lactate and decreased glucose levels suggested accelerated glycolysis in pre-treatment AK. Further, levels of Krebs' cycle intermediates other than citrate and amino acids were elevated. Analysis of the immune infiltrate revealed less epidermal CD1a+ cells but increased frequencies of dermal CD8+ T cells in AK. Treatment with diclofenac reduced lactate and amino acid levels in AK, especially in responding lesions, and induced an infiltration of dermal CD8+ T cells accompanied by high IFN-γ mRNA expression, suggesting improved T cell function.Discussion: Our study clearly demonstrated that not only cancers but also pre-malignant skin lesions, like AK, exhibit profound changes in metabolism, correlating with an altered immune infiltrate. Diclofenac normalizes metabolism, immune cell infiltration and function in AK lesions, suggesting a novel mechanism of action.

Incidence and Risk Factors of Keratinocyte Carcinoma After First Solid Organ Transplant in Ontario, Canada

Keratinocyte carcinoma (KC), also known as nonmelanoma skin cancer, is the most common malignancy after solid organ transplant. Epidemiologic data on posttransplant KC in North America are limited by a lack of KC capture in cancer and transplant registries. To estimate the incidence and identify risk factors for posttransplant KC. This population-based inception cohort study in Ontario, Canada, used linked administrative databases and a health insurance claims-based algorithm. Participants were adult recipients of a first kidney, liver, heart, or lung transplant from January 1, 1994, to December 31, 2012. The cohort (n = 10 198) was followed up to December 31, 2013. Data were analyzed from May 31, 2016, to April 21, 2017. Solid organ transplant with functioning graft. Age- and sex-adjusted standardized incidence ratio for KC in the transplant cohort was compared with that in the general population. Cumulative incidence of posttransplant KC was estimated using cumulative incidence functions, accounting for the competing risks of death or kidney graft loss. The association between KC and patient-, transplant-, and health services-related factors was evaluated with a multivariable cause-specific hazards model. A total of 10 198 transplant recipients were included in the study. The median (interquartile range [IQR]) age at transplant was 51 (41-59) years, with most recipients being male (6608 [64.8%]) and white (5964 [58.5%]). Posttransplant KC was diagnosed in 1690 patients (16.6%) after a median (IQR) of 3.96 (1.94-7.09) years, with an incidence rate of 2.63 per 100 patient-years (95% CI, 2.51-2.76). The rate of KC was significantly higher after transplant compared with the general population (standardized incidence ratio, 6.61; 95% CI, 6.31-6.93). The highest 10-year cumulative incidence was in the subsets of patients with a history of pretransplant skin cancer (66.5%), older than 50 years at transplant (27.5% for 51-65 years; 40.5% for >65 years), and of the white race (24.1%). The strongest independent risk factors for KC included older age at transplant (adjusted hazard ratio [aHR], 9.27; 95% CI, 7.08-12.14 for >65 years vs 18-35 years), white vs black race (aHR, 8.50; 95% CI, 4.03-17.91), pretransplant invasive skin cancer (aHR, 4.30; 95% CI, 3.72-4.98), and posttransplant precancerous skin lesions (aHR, 4.32; 95% CI, 3.77-4.95). The incidence of KC appeared to be substantially increased after transplant, particularly in patients who were older at transplant, were white, and had a history of cancerous or precancerous skin tumors; intensified skin cancer screening, education, and early use of chemopreventive interventions may be warranted for these high-risk patient subsets.

Photodynamic therapy: A hot topic in dermato-oncology.

Photodynamic therapy (PDT) is a modern, non-invasive therapeutic method used for the destruction of various cells and tissues. It requires the simultaneous presence of three components: a photosensitizer (PS), a light source and oxygen. Precancerous skin lesions are conditions associated with a high likelihood of malignant transformation to squamous cell carcinoma. Data available so far indicate that PDT is a promising treatment method which can be successfully employed in several medical fields including dermatology, urology, ophthalmology, pneumology, cardiology, dentistry and immunology. Numerous authors therefore have studied this technique in order to improve its efficacy. As a result, significant advancement has been achieved with regard to PSs and drug delivery systems. Substantial progress was also obtained with respect to PDT for the treatment of precancerous skin lesions, several authors focusing their efforts on the study of daylight-PDT and on identifying methods of decreasing technique-related pain. This review reports on the most recent findings in PDT, with emphasis on cutaneous precancerous lesions.

Immune consequences induced by photodynamic therapy in non-melanoma skin cancers: a review.

Photodynamic therapy (PDT) is widely used in dermatology to treat precancerous skin lesions and superficial non-melanoma skin cancers (NMSCs), including premalignant actinic keratosis, cutaneous squamous cell carcinoma in situ, and superficial basal cell carcinoma. The long-term cure rates of PDT range from 70 to 90% in NMSC patients, with excellent cosmetic results and good tolerance. However, the mechanism of action of PDT on tumors is complex. PDT not only kills tumor cells directly but also rapidly recruits immune cells to release inflammatory mediators to activate antitumor immunity. PDT-induced tumor death, also called immunogenic cell death, can trigger both innate and adaptive immune response, further enhancing the antitumor effect. For instance, inoculation of tumor cells killed via PDT to animals triggered a stronger antitumor immunity in vivo than tumor cell lysates produced by other treatments. More importantly, many immunotherapy regimens based on the immune effect of PDT have been developed and demonstrated to be a promising therapeutic method for cancer in pre-clinical trials. Therefore, increasing efforts have been undertaken to investigate the immune responses associated with PDT. In the present review, we first introduce the antitumor effect and the associated mechanisms of PDT in cancers. Then, we summarize studies on the immune responses induced by PDT in NMSCs. We also discuss the potential mechanisms underlying the process.

Astragalin Attenuates UVB Radiation-induced Actinic Keratosis Formation.

Background: Actinic Keratosis (AK), is the most common precancerous skin lesion induced by the excessive Ultra-violet B (UVB) and is a significant threat to the public health. UVB exposure causes oxidative DNA damage and is considered to be a significant contributor to AK and subsequent development of skin cancer. Besides, activation of p38 MAPK also plays a significant role in the development of AK.Objective: This study aimed at the development of a nature compound which can inhibit UVB-induced AK.Method: MTS Cell Proliferation Assay Kit was used to detect the toxicity of astragalin. HE-staining, Immunohistochemical, Western blot and Enzyme Linked Immunosorbent Assay were applied to examine the clinicopathologic feature of AK and the change of p38 MAPK signal pathway treated with astraglin under the condition of UVB in vitro and in vivo.Results: In our clinical findings revealed that p38 MAPK, phospho-MSK1, and γ-H2AX were significantly highly expressed in human AK tissue than the normal healthy skin tissue. Moreover, in vitro studies showed that UVB induced the phospho-MSK1 and γ-H2AX in a time- and dose-dependent manner in HaCaT cells. Further, in vitro kinase assay demonstrated that astragalin could directly bind to p38 MAPK and suppress p38 MAPK activity. Furthermore, astragalin exhibited no toxicity and suppressed the UVB-induced expression of phospho-MSK1 and γ-H2AX by suppressing p38 MAPK activity in a time-dependent and dose-dependent manner in HaCaT cells. The in vivo studies with animal UV model demonstrated that astragalin inhibited UVB-induced expression of phospho-MSK1 and γ-H2AX in Babl/c mice.Conclusion: These results suggested that p38 MAPK is a direct valid molecular target of astragalin for the attenuation of UVB-induced AK. Furthermore, astragalin could be a potential promising novel natural therapeutic agent for the prevention and management of UVB-induced AK with high target specificity and low toxicity.

Quantification of 5-FU in skin samples for the development of new delivery systems for topical cancer treatment.

5-Fluorouracil (5-FU) is used for the topical treatment of pre-cancerous skin lesions. However, previous reports focus on 5-FU quantification in plasma samples, failing to provide information about drug quantification in the skin. Therefore, the aim of this work was to develop a simple and reliable analytical method employing HPLC-UV for 5-FU quantification in skin samples. Chromatographic separation was obtained using the commonly available Lichrospher RP-C18 endcapped column. Porcine ear skin matrix-based analytical curves with thymine, as internal standard, were used. 5-FU was eluted at 5.2 min and thymine at 13.0 min. The method was selective, precise and accurate in the linear range from 0.3 to 6 μg/mL. The samples were stable after three cycles of freeze/thawing and extraction efficiency rates above 95% were obtained. In vitro skin penetration studies of an aqueous solution and a commercial cream of 5-FU were performed. The cream improved 5-FU retention into the skin and permeation through the skin compared to the solution. Therefore, the method developed herein can be applied to the study of formulations for topical delivery of 5-FU.

Nanosecond-Pulsed DBD Plasma For A Clinical Trial Of Actinic Keratosis

Actinic keratosis (AK) is a pre-cancerous skin lesion, the earliest clinical stage in a continuum of malignancy that may lead to squamous cell carcinoma (SCC), a skin cancer that accounts for significant morbidity (over 1 million cases in the US annually), and thousands of preventable deaths annually. This translates to a total direct cost for AK of about $1.2 billion and approximately 8.2 million office visits annually. Available treatments ablate lesions via cryotherapy, curettage or long-term application of chemotherapeutic or immune-modulator drugs. They are typically associated with pain, scarring and inflammation, undesirable side effects that reduce patient compliance. To address these, we studied the use of non-equilibrium, atmospheric pressure plasma (NEAPP) for the treatment of AK in a small clinical trial. [1] One month post NEAPP treatment, over 50% of the lesions achieved full clinical resolution or showed significant improvement. Abscopal effects were observed in some cases, possibly through immune stimulation. [2] Furthermore, no patient experienced adverse effects, immediate or delayed. One year follow-up showed no recurrence of any of the treated lesions. [unpublished data] 2-year follow-up results and further optimization of treatment under a new clinical trial will be presented. Our results demonstrate that NEAPP may serve as a potential, effective treatment for AKs. Download : Download high-res image (166KB) Download : Download full-size image Evaluation of nspDBD treatment of AK. 9 lesions fully resolved, 3 showed significant improvement

The Value of Digital Dermatoscopy in the Diagnosis and Treatment of Precancerous Skin Lesions

Abstract We propose that through the presented study, to strengthen the value of the pre-excision digital dermatoscopy by emphasizing its accuracy compared to the histopathological examination in the diagnosis and treatment of precancerous lesions of the skin for which the histopathological examination of certainty can only be performed after post-excision.

A Computational Investigation of the Uncatalysed and Water-Catalysed Acyl Rearrangements in Ingenol Esters

Ingenol esters have been identified as potent anticancer and HIV latency reversing agents. Ingenol-3-angelate was recently approved as a topical treatment for precancerous actinic keratosis skin lesions. It was found, however, that ingenol esters can undergo a series of acyl rearrangements, which may affect their biological potency and the shelf-life of drug formulations. We use double-hybrid density functional theory to explore the mechanisms for the uncatalysed and water-catalysed acyl migrations in a model ingenol ester. The uncatalysed reaction may proceed either via a concerted mechanism or via a stepwise mechanism that involves a chiral orthoester intermediate. We find that the stepwise pathway is kinetically preferred by a significant amount of ΔΔH‡298 = 44.5 kJ mol−1. The uncatalysed 3-O-acyl to 5-O-acyl and 5-O-acyl to 20-O-acyl stepwise rearrangements involve cyclisation and ring-opening steps, both concomitant with a proton transfer. We find that the ring-opening step is the rate-determining step for both rearrangements, with reaction barrier heights of ΔH‡298 = 251.6 and 177.1 kJ mol−1 respectively. The proton transfers in the cyclisation and ring-opening steps may be catalysed by a water molecule. The water catalyst reduces the reaction barrier heights of these steps by over 90 kJ mol−1.

Community-Based Practice Variations in Topical Treatment of Actinic Keratoses

Actinic keratoses (AKs) are precancerous skin lesions afflicting nearly 58 million people in the United States per year and costing over a billion dollars annually to treat., Two of the most widely used topical field-based treatments for AKs are fluorouracil and imiquimod. Although variations exist in how these topical medications are prescribed in terms of frequency, duration, and strength for AK treatment, no studies have systematically examined how patient and health care provider factors impact prescribed regimens. Using data from a large community-based population, we examined how variations in fluorouracil and imiquimod prescription patterns for AKs treatment was influenced by patient age, sex, AK anatomic site, and prescriber type.

Effectiveness of photodynamic therapy in Bowen's disease: a retrospective observational study in 423 lesions.

Photodynamic therapy (PDT) is a well-known technique that is often used for treating superficial precancerous and cancerous skin lesions. However, only a handful of studies, with a relatively small number of treated lesions, have been carried out on the effectiveness of PDT for Bowen's disease (BD). This study aimed to assess the effectiveness and recurrence risk of PDT in the treatment of BD. The secondary objectives were to determine what factors affected the response rates and the cosmetic result of the treatment. In this retrospective observational study, the electronic patient charts at Sahlgrenska University Hospital (SUH) in Gothenburg, Sweden, were searched to find all patients diagnosed with BD who were treated with PDT between 1 January 2002 and 31 December 2014. Data were collected regarding clinical response at the first follow-up visit, recurrences during later follow-up visits and other relevant patient and tumour characteristics. In total, 423 BD lesions in 335 patients were included in the study. The mean FU duration was 11.2 months (range 0.2-151 months). The complete response rate at the first FU visit was 77.5% for all BD lesions. During later FU visits, another 60 recurrences were observed, which resulted in a recurrence rate of 18.3%. Thus, the overall clearance rate after FU was 63.4% for all BD lesions. Significant risk factors for unsuccessful treatment in this study were large lesion size (>2 cm) and a single PDT session. This study shows that PDT is a relatively effective treatment modality for BD.

The use of teledermoscopy in the accurate identification of cancerous skin lesions in the adult population: A systematic review

Background The use of teledermoscopy in the diagnostic management of pre-cancerous and cancerous skin lesions involves digital dermoscopic images transmitted over telecommunication networks via email or web applications. Teledermoscopy may improve the accuracy in clinical diagnoses of melanoma skin cancer if integrated into electronic medical records and made available to rural communities, potentially leading to decreased morbidity and mortality. Objective and method The purpose of this paper is to present a systematic review of evidence on the use of teledermoscopy to improve the accuracy of skin lesion identification in adult populations. The PRISMA method guided the development of this systematic review. A total of seven scholarly databases were searched for articles published between the years of 2000 and 2015. All studies were critically appraised using the Rosswurm and Larrabee critique worksheet, placed in a matrix for comparison evaluating internal and external validity and inspected for homogeneity of findings. Results Sixteen articles met inclusion criteria for this review. A majority of the studies were cross-sectional and non-experimental. Ten of the 16 focused on interobserver concordance and diagnostic agreement between teledermoscopy and another comparator. Instrumentation in conducting the studies showed inconsistency with reported results. Discussion Higher level evidence is needed to support clinical application of teledermoscopy for accuracy of diagnostic measurement in the treatment of pre-cancerous and cancerous skin lesions in adults. Future research is needed to develop a standardized, reliable and valid measurement tool for implementation in clinical practice.