Treatment Of Nonmelanoma Skin Cancer Research Articles

MSOR12 Presentation Time: 8:55 AM: Skin Brachytherapy, an Alternative Treatment for Non-Melanoma Skin Cancer: A Case Series from a Low Middle Income Country, Latin American Experience

MSOR12 Presentation Time: 8:55 AM: Skin Brachytherapy, an Alternative Treatment for Non-Melanoma Skin Cancer: A Case Series from a Low Middle Income Country, Latin American Experience

Surgical Margins of Nonmelanoma Skin Cancers in Mohs Surgery: Dermoscopy Versus Naked Eye.

Mohs micrographic surgery (MMS) offers high cure rates for nonmelanoma skin cancer (NMSC) but relies on precise margin assessment, traditionally initiated by the naked eye. Dermoscopy has emerged as a potential tool to improve margin delineation. To compare the efficacy of dermoscopic versus naked eye evaluation in marking initial MMS margins for NMSC. A multicenter, prospective study on patients with NMSC undergoing MMS was conducted. Patients were randomized into dermoscopy and naked eye groups. Statistical analysis was performed using statistical package for social sciences. A total of 127 patients were enrolled, with 63 in the naked eye group and 64 in the dermoscopy group. No significant differences in age, sex distribution, or histological subtype were found. The average number of MMS stages and accuracy of initial margins were comparable between groups. Despite its potential, the authors' study found no significant reduction in total MMS stages using dermoscopy. Novel imaging modalities or standardized dermoscopic criteria should be explored to enhance margin assessment accuracy and improve outcomes in NMSC treatment. Dermoscopic evaluation of presurgical margins does not effectively assess lateral/deep margins nor contribute to a reduction in total MMS stages. Improving the authors' understanding of presurgical margin assessment techniques can lead to better treatment outcomes for NMSC.

Chloro-aluminum phthalocyanine encapsulation into liquid crystalline nanodispersions enhance skin penetration and phototoxicity in skin cancer cells

Non-melanoma skin cancer is one of the most common tumors in the world. Photodynamic therapy (PDT) is currently a non-invasive therapeutic option for the treatment of skin cancer and actinic keratosis. Chloro-aluminum phthalocyanine (AlClPc) is a second-generation photosensitizer that has been studied for application in PDT. However, it has the disadvantage of self-aggregating in a biological environment, which impairs its therapeutic action, making it a candidate for nanocarrier delivery. Among the nanocarriers, liquid crystalline nanodispersions (LCN) are biocompatible and present unique organizational characteristics that make them suitable for skin delivery of drugs. Herein, a new LCN based on oleic acid (OA), Phosal 75SA® containing or not D-α-Tocopherol polyethylene glycol 1000 succinate (TPGS) was developed and characterized aiming its application for skin cancer. The selected LCN with AlClPc showed nanometric size (152.3 ± 1.93 nm), adequate PDI (0.231 ± 0.009) and encapsulation efficiency (70.26 ± 3.87 %) and stability for 30 days. Also, LCN were characterized by polarized light microscopy and small angle X-ray diffraction (SAXS) resulting in hexagonal liquid crystalline nanodispersions. In the in vitro skin penetration test, LCN-AlClPc showed better penetration into the deeper skin layers than the control. LCN-AlClPc showed greater phototoxicity in the A431 tumor cell line than the control in the same cell line and also greater phototoxicity in A431 when compared to L929 fibroblast cells. Thus, LCN developed could improve the phototoxicity and skin penetration in vitro and are potential drug delivery systems for the treatment of non-melanoma skin cancer.

Understanding the Importance of Daily Imaging in the Treatment of Non-Melanoma Skin Cancer with Image-Guided Superficial Radiation Therapy

Image-guided superficial radiation therapy (IGSRT) combines superficial radiation therapy (SRT) with full dermal visualization (FDV) via high-resolution dermal ultrasound (HRDUS) for the treatment of non-melanoma skin cancer (NMSC). The gold standard for IGSRT delivery includes a comprehensive cancer care model with support for dermatologists from a multidisciplinary team. When delivered in this model, IGSRT can achieve cure rates of 99% for treatment of NMSC. This paper focuses on the benefits of HRDUS used in conjunction with SRT for NMSC. Medical records from 7 dermatology clinics of 883 patients with 1507 cases of NMSC treated with IGSRT between 2017 and 2018 were retrospectively reviewed. In total, 92% of the NMSC lesions showed daily depth fluctuations, 60.32% of lesions did not require changes during therapy, and nearly 40% of lesions required at least one compensatory change during therapy. In total, 83% of NMSC lesions were labeled as high risk based on the 2024 NCCN guidelines. Increasing and decreasing tumor depth measurements during IGSRT inform dermatologists when adaptive changes in energy (kV), TDF, and dose will result in more efficacy and less toxicity, respectively.

Therapeutic targeting of siRNA/anti-cancer drug delivery system for non-melanoma skin cancer. Part I: Development and gene silencing of JAK1siRNA/5-FU loaded liposome nanocomplexes

Non-melanoma skin cancer (NMSC) is one of the most prevalent cancers, leading to significant mortality rates due to limited treatment options and a lack of effective therapeutics. Janus kinase (JAK1), a non-receptor tyrosine kinase family member, is involved in various cellular processes, including differentiation, cell proliferation and survival, playing a crucial role in cancer progression. This study aims to provide a more effective treatment for NMSC by concurrently silencing the JAK1 gene and administering 5-Fluorouracil (5-FU) using liposome nanocomplexes as delivery vehicles. Utilizing RNA interference (RNAi) technology, liposome nanocomplexes modified with polyethylene imine (PEI) were conjugated with siRNA molecule targeting JAK1 and loaded with 5-FU. The prepared formulations (NL-PEI) were characterized in terms of their physicochemical properties, morphology, encapsulation efficiency, in vitro drug release, and stability. Cell cytotoxicity, cell uptake and knockdown efficiency were evaluated in human-derived non-melanoma epidermoid carcinoma cells (A-431). High contrast transmission electron microscopy (CTEM) images and dynamic light scattering (DLS) measurements revealed that the nanocomplexes formed spherical morphology with uniform sizes ranging from 80-120 nm. The cationic NL-PEI nanocomplexes successfully internalized within the cytoplasm of A-431, delivering siRNA for specific sequence binding and JAK1 gene silencing. The encapsulation of 5-FU in the nanocomplexes was achieved at 0.2 drug/lipid ratio. Post-treatment with NL-PEI for 24, 48 and 72 h showed cell viability above 80 % at concentrations up to 8.5 × 101 µg/mL. Notably, 5-FU delivery via nanoliposome formulations significantly reduced cell viability at 5-FU concentration of 5 µM and above (p < 0.05) after 24 h of incubation. The NL-PEI nanocomplexes effectively silenced the JAK1 gene in vitro, reducing its expression by 50 %. Correspondingly, JAK1 protein level decreased after transfection with JAK1 siRNA-conjugated liposome nanocomplexes, leading to a 37 % reduction in pERK (phosphor extracellular signal-regulated kinase) protein expression. These findings suggest that the combined delivery of JAK1 siRNA and 5-FU via liposomal formulations offers a promising and novel treatment strategy for targeting genes and other identified targets in NMSC therapy.

Nanoemulsions in Skin Cancer Therapy: A Promising Frontier.

Skin cancer, a global burden for particularly white people, is classified as various histopathological types, including malignant melanoma, basal and squamous cell carcinoma, on the basis of affected different skin layers. Clinical adjuvant therapy (electro-chemotherapy, radio- and immuno therapy), surgical techniques (Cryosurgery, laser treatment, dermabrasion, Moh's micrographic surgery), photodynamic treatment and theranostic approaches are confined only for the treatment of serious health issues. Therefore, nanotechnology based approaches, especially nanoemulsion, a non-spontaneous, transparent or translucent, kinetically stable nanostructured (1-1000nm) colloidal dispersion (comprised of oil, water and surfactant/cosurfactant), are being popularised as a potential topical nanocarrier to deliver BCS class II and IV anti-neoplastic drugs attributing to its capacity for both active and passive tumor targeting in controlled or sustained manner and improving bioavailability via enhancing permeabilityretention effect with minimal adverse effects. Numerous research on nanoemulsion for the treatment of both melanoma and non-melanoma skin cancer is only limited to preclinical stages as several physiological variables reduce the effectiveness of nanoemulsion via restricting topical penetration.

Effectiveness and Patient Experiences of Rhenium Skin Cancer Therapy for Nonmelanoma Skin Cancer: Interim Results from the EPIC-Skin Study.

Nonmelanoma skin cancer and its treatment represent a significant global cancer burden for health care systems and patients. Rhenium skin cancer therapy (Rhenium SCT) is a novel noninvasive radionuclide nonmelanoma skin cancer treatment, which can be provided in a single outpatient session. The aim of this prospective, multicenter, single-arm, international, phase IV study (EPIC-Skin) is to assess clinic- and patient-reported outcomes of Rhenium SCT as a treatment for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods: Eligible patients had biopsy-proven stage I or stage II BCC or SCC lesions no more than 3 mm deep and no larger than 8 cm2 in area. Rhenium SCT resin was applied to an adhesive foil affixed to the target lesion in a single session. Interim efficacy and safety analysis were planned once 50% of target patients had recorded a 6-mo follow-up visit. Primary outcome is the proportion of lesions achieving complete response using modified RECIST. Secondary and other outcome measures include patient-reported quality of life (QoL), treatment comfort, and cosmesis. Results: A total of 182 patients was enrolled and administered Rhenium SCT (50 Gy dose to deepest point of target) to at least 1 BCC or SCC. Of 81 patients who reached the 6-mo posttreatment follow-up, it was found that 97.2% (103/106) of lesions showed complete responses and 2.8% (3/106) had partial responses. Improvements in QoL were also reported, whereas no patients reported any pain or discomfort during treatment. Adverse events were reported in 15.9% (29/182) of patients and were rated grade 1 (n = 19), grade 2 (n = 9), or grade 3 (n = 1). Conclusion: This preliminary analysis of the EPIC-Skin study indicates that Rhenium SCT is safe and effective for the treatment of BCC and SCC and is associated with significant QoL improvements. It will be particularly beneficial for lesions that are difficult to treat surgically because of size and location. It is also beneficial for patients with comorbidities or those unable to receive conventional fractionated radiotherapy.

Artificial Intelligence for Mohs and Dermatologic Surgery: A Systematic Review and Meta-Analysis.

Over the past decade, several studies have shown that potential of artificial intelligence (AI) in dermatology. However, there has yet to be a systematic review evaluating the usage of AI specifically within the field of Mohs micrographic surgery (MMS). In this review, we aimed to comprehensively evaluate the current state, efficacy, and future implications of AI when applied to MMS for the treatment of nonmelanoma skin cancers (NMSC). A systematic review and meta-analysis was conducted following PRISMA guidelines across several databases, including PubMed/MEDLINE, Embase, and Cochrane libraries. A predefined protocol was registered in PROSPERO, with literature search involving specific keywords related to AI and Mohs surgery for NMSC. From 23 studies evaluated, our results find that AI shows promise as a prediction tool for precisely identifying NMSC in tissue sections during MMS. Furthermore, high AUC and concordance values were also found across the various usages of AI in MMS, including margin control, surgical recommendations, similarity metrics, and in the prediction of stage and construction complexity. The findings of this review suggest promising potential for AI to enhance the accuracy and efficiency of Mohs surgery, particularly for NMSC.

Stabilization of cationic liposomes using hyaluronic acid-modified gold nanoparticles by post-microfluidics conjugation approach for drug delivery applications

lipid-based nanoparticles (LNPs), particularly liposomes, have gained prominence throughout the pharmaceutical sector as a hopeful means for transporting a range of therapeutic agents. Improving LNPs stability is crucial in pharmaceuticals, and drug delivery systems to ensure their effectiveness and reliability. The current research was undertaken to design a pH-responsive hyaluronic acid-modified gold nanoparticle-stabilized cationic liposome (SPC/DOPE/DOTAP) system (HA-SH/AuNPs@liposomes) to improve the stability of liposomes. This was achieved through a post-microfluidics conjugation technique to encapsulate the 5-fluorouracil (5-FU) anticancer drug, usually employed in nonmelanoma skin cancer (NMSC) treatment. Microfluidics is an emerging technology that can be employed as a powerful tool for designing nanoscale liposomes with highly uniform size distributions and acceptable colloidal stability. Utilizing a microfluidics toroidal mixer, affixed HA-SH/AuNPs (size: 12.56 ± 1.65 nm) to positively charged liposomes (size: 75 ± 0.68 nm and PDI: 0.032 ± 0.0021). These liposomes exhibited strong stability, limited fusion propensity, and minimal cargo release at neutral pH. The gold stabilizers detached in an acidic environment, releasing encapsulated therapeutic agents. The dynamic light scattering (DLS) analysis results indicate that HA-SH/AuNPs@Liposomes (size: 102.2 ± 1.3 nm and PDI: 0.11 ± 0.01) exhibit greater stability than bare liposomes over 4 weeks at 4 °C. This enhanced stability can be attributed to the presence of HA-SH/AuNPs in the liposomal structure. This research outlines a systematic method to optimize the size rapidly and PDI of liposomes by employing the Design of Experiments (DoE). The results highlighted that utilizing both the microfluidic technique and gold nanoparticle-stabilized liposomes offers benefits for creating controlled drug release formulations. This approach leads to enhanced biopharmaceutical characteristics and improved scalability of liposomal formulations.

Access to systemic treatment of non-melanoma skin cancer in Spain: a survey analysis.

Novel and highly effective drugs for non-melanoma skin cancer (NMSC) improve patient outcomes, but their high cost strains healthcare systems. Spain's decentralized public health system, managed by 17 autonomous communities (AaCc), raises concerns about equitable access. A cross-sectional survey (July-September 2023) was sent to Spanish Multidisciplinary Melanoma Group (GEM Group) members to assess access to new drugs. Fifty physicians from 15 Spanish AaCc responded to the survey. Access for drug with approved public reimbursement, Hedgehog inhibitors in basal-cell carcinoma and anti PD-L1 antibody in Merkel carcinoma, was observed in 84% and 86% of centers, respectively. For other EMA-approved treatments, but without reimbursement in Spain access decreased to 78% of centers. Heterogeneity in access was mainly observed intra regions. Unequal financial support for drugs for NMSC with creates a patchwork of access across Spanish hospitals, with variations even within the same AaCc.

Artificial intelligence for nonmelanoma skin cancer

Nonmelanoma skin cancers (NMSCs) are among the top five most common cancers globally. NMSC is an area with great potential for novel application of diagnostic tools including artificial intelligence (AI). In this scoping review, we aimed to describe the applications of AI in the diagnosis and treatment of NMSC. Twenty-nine publications described AI applications to dermatopathology including lesion classification and margin assessment. Twenty-five publications discussed AI use in clinical image analysis, showing that algorithms are not superior to dermatologists and may rely on unbalanced, nonrepresentative, and nontransparent training data sets. Sixteen publications described the use of AI in cutaneous surgery for NMSC including use in margin assessment during excisions and Mohs surgery, as well as predicting procedural complexity. Eleven publications discussed spectroscopy, confocal microscopy, thermography, and the AI algorithms that analyze and interpret their data. Ten publications pertained to AI applications for the discovery and use of NMSC biomarkers. Eight publications discussed the use of smartphones and AI, specifically how they enable clinicians and patients to have increased access to instant dermatologic assessments but with varying accuracies. Five publications discussed large language models and NMSC, including how they may facilitate or hinder patient education and medical decision-making. Three publications pertaining to the skin of color and AI for NMSC discussed concerns regarding limited diverse data sets for the training of convolutional neural networks. AI demonstrates tremendous potential to improve diagnosis, patient and clinician education, and management of NMSC. Despite excitement regarding AI, data sets are often not transparently reported, may include low-quality images, and may not include diverse skin types, limiting generalizability. AI may serve as a tool to increase access to dermatology services for patients in rural areas and save health care dollars. These benefits can only be achieved, however, with consideration of potential ethical costs.

Radiation Therapy in Non-Melanoma Skin Cancers: An Italian Survey on Behalf of the Italian Association of Radiotherapy and Clinical Oncology

AimsThe National Palliative Care and Interventional Radiotherapy Study Groups of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) carried out a survey whose aim was to obtain a "snapshot" of the real-world practice of nonmelanoma skin cancer (NMSC) treatments in Italy. Materials and methodsThe survey was conducted on SurveyMonkey's online interface and was sent via e-mail to our society Radiation Oncologists. ResultsFifty-eight Italian radiation oncologists (ROs), representing 54 centers, answered the survey. Thirteen percent of the ROs declared they treat fewer than 10 NMSC lesions annually, 36% treat between 11 and 20, and 51% treat more than 20 lesions annually. Interventional radiotherapy (IRT) was offered by 25% of the ROs, and every case was reportedly discussed by a multidisciplinary team (71%). Electrons (74%), volumetric modulated arc therapy (V-MAT) (57%), three-dimensional conformal radiotherapy (3D-CRT) (43%), and IRT (26%) were the main treatment options. With external beam radiotherapy (EBRT), 46 and 53 different RT schedules were treated for curative and palliative intent, respectively; whereas for IRT, there were 21 and 7 for curative and palliative intent, respectively. The most popular EBRT curative options were 50–70.95/22–35 fractions (fx) and 50–70 Gy/16-20fx and for EBRT palliative settings, 30Gy/10fx, and 20–35Gy/5fx. For IRT, the most popular curative options were 32–50Gy/8-10fx and 30–54Gy/3-5fx, whereas 30Gy/6fz was the palliative option. Less than 10 re-RT cases were reported in one year in 42.5%, 11–20 cases in 42.5%, and >20 cases annually in 15%. Electrons (61%), VMAT (49%), and BRT (25%) were the most widely used approaches: 20–40Gy in 10fx and 20–25Gy in 5fx were the recommended fractionations. ConclusionThe survey shows a variegated reality. A national registry with more detailed data could help in undercover its causes.

The effect of an online micro CE/CME on the multidisciplinary care of patients with nonmelanoma skin cancer.

e21006 Background: Nonmelanoma skin cancers (NMSCs), including basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (CSCC), are the most common malignancies diagnosed in the US and worldwide. While most are successfully cured with local therapies or surgery alone, immunotherapy agents have been added to the arsenal for advanced tumors that are unresectable or unlikely to be cured with surgery alone. Thus, the multidisciplinary care model in this clinical setting has numerous advantages; however, many healthcare professionals (HCPs) may not fully recognize the role of their colleagues and their value in caring for affected patients. The objective of this study was to assess the educational impact of an online micro continuing [medical] education (CE/CME) activity on the knowledge and competence of HCPs’ with respect to the role and value of the multidisciplinary team in the optimal care of patients receiving immunotherapy for NMSC. Methods: The educational activity consisted of a collection of six online video-based micro-CE/CME-certified chapters, presented by six respected NMSC experts, allowing learners to choose their chapters for participation. Educational impact was assessed with repeated paired pre-/post-assessment study design, where individual participants served as their own control. A McNemar’s test assessed significant levels of changes reported with P values &lt;.05 considered statistically significant. The activity launched September 2023; data were collected until January 2024. Results: The educational activity resulted in overall statistically significant improvements in HCPs’ knowledge and competence after education by chapter and by HCP audience type ( P &lt; .01), including oncologists, dermatologists, surgeons, nurses, and pharmacists. Results presented below highlight the improvements in HCPs’ knowledge and competence by chapter. Conclusions: This analysis demonstrates the success of an online CE/CME activity with micro video chapters on improving HCPs’ knowledge and competence related to the value of the multidisciplinary team members in the comprehensive care of patients receiving immunotherapy for the treatment of NMSCs. Despite these significant improvements, additional educational activities are needed to address residual gaps and further increase HCPs’ ability and comfort in providing care in this clinical setting. [Table: see text]

Revolutionizing non-melanoma skin cancer treatment: Receptor tyrosine kinase inhibitors take the stage.

Innovative treatments for non-melanoma skin cancers (NMSCs) are required to enhance patient outcomes. This review examines the effectiveness and safety of receptor tyrosine kinase inhibitors (RTKIs). A comprehensive review was conducted on the treatment potential of several RTKIs, namely cetuximab, erlotinib, gefitinib, panitumumab, and lapatinib. The findings indicate that these targeted therapies hold great promise for the treatment of NMSCs. However, it is crucial to consider relapse rates and possible adverse effects. Further research is needed to improve treatment strategies, identify patient groups that would benefit the most, and assess the long-term efficacy and safety, despite the favorable results reported in previous studies. Furthermore, it is crucial to investigate the potential benefits of integrating RTKIs with immunotherapy and other treatment modalities to enhance the overall efficacy of therapy for individuals with NMSC. Targeted therapies for NMSCs may be possible with the use of RTKIs. The majority of studies focused on utilizing epidermal growth factor receptor inhibitors as the primary class of RTKIs for the treatment of NMSC. Other RTKIs were only employed in experimental investigations. Research indicates that RTKIs could potentially serve as a suitable alternative for elderly patients who are unable to undergo chemotherapy and radiotherapy.

Non-Melanoma Skin Cancer Treatment Updates in the Elderly

Non-Melanoma Skin Cancer Treatment Updates in the Elderly

Photodynamic therapy in the treatment of non-melanoma skin cancer: A literature review

Objective: The following study aims to analyze the mechanism of action, efficacy, safety and recent trends in the use of photodynamic therapy (PDT) as a therapeutic approach in the treatment of non-melanoma skin cancer. In addition, it seeks to provide a comprehensive overview of the current state of knowledge on the subject, highlighting its use and availability in the Brazilian scenario. Methods: The research was carried out using a literature review based on data published in Periódicos CAPES, Biblioteca Virtual de Saúde (BVS) and UpToDate. Results: PDT is a technique that has already been consolidated globally and has several advantages in the treatment of non-melanoma skin cancer, as well as actinic keratoses, even in comprehensive cases. PDT is considered a non-invasive, fast, safe method, with few side effects, providing rapid recovery and being well tolerated by patients. It has a significant cure rate and excellent aesthetic results, differing from other treatments often cited for their disadvantages, such as undesirable scars. Conclusion: It is crucial to further explore the benefits of PDT, considering its application in different subtypes of non-melanoma skin cancer and optimizing protocols to expand its clinical application. As a promising innovation, the technology has the prospect of contributing to improving the quality of life of patients affected by this specific type of skin cancer.

Mohs micrographic surgery in immunosuppressed vs immunocompetent patients: Results of a prospective nationwide cohort study (REGESMOHS, Spanish registry of Mohs surgery).

Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest. This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates. The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed. IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients. This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group.

Patient-Orientated Evaluation of Treatment of Non-Melanoma Skin Cancer with Rhenium-188 Compared to Surgery.

Non-melanoma skin cancers (NMSCs) are responsible for up to one-third of all human malignancies. Surgery is usually the treatment of choice, but patients often experience pain during the procedure. Topical rhenium-188 resin skin cancer treatment (RSCT) may be a valid therapeutic alternative. In this monocentric pilot study, 19 patients suffering from NMSC were treated with RSCT. Most of these patients had also experienced surgery, either because they developed a new NMSC in aftercare, or they had suffered previously from NMSC. Three RSCT-treated patients, who had no exposure to surgery so far, were paired with three matched patients, who had received surgery. We sought to evaluate and compare the patients' experience with both treatments. A questionnaire assessed patients' perceptions regarding side effects, aesthetic outcomes, wound care, fear of complications, and personal treatment preferences. Patients evaluated the different parameters of their either RSCT- or surgery-treated lesions on a scale from 0-10. Patients were more afraid of complications before surgery than before RSCT (p = 0.04). Treatment with RSCT caused significantly less pain on treatment day (mean 0.56) than surgery (mean 2.32) (0 no pain, 10 maximum pain) (p = 0.02) and 14 days after the procedure (mean 0.89 versus mean 2.47) (p = 0.02). On day 14, RSCT-treated lesions were also significantly less itchy (mean 0.34) than after surgery (mean 1.50). Most patients were very satisfied with the aesthetic outcome after both RSCT (mean 8.42) and surgery (mean 8.31) (p = 0.89). In the case of a new NMSC, the majority of patients who experienced both treatments would rather be treated primarily with RSCT (44%) or would consider both options (31%); only 19% preferred surgery. Patients evaluated RSCT as less painful than surgery. The aesthetic outcomes of both treatments were comparable. For pain-sensitive patients, RSCT might be a preferable treatment option.

Fragile hands: targeting nonmelanoma skin cancer on older hands using 595nm pulsed dye laser.

The mainstay of treatment for nonmelanoma skin cancer (NMSC) on thin skin remains surgical, but procedures on older hands may be complicated by skin fragility and dermal atrophy. Used without cooling, 595nm (nm) pulsed dye laser (PDL) has the capability of destroying NMSC through nonspecific thermal necrosis. The purpose of this study was to understand recurrence of NMSC on dorsal hands of older patients after one or two treatments using 595nm PDL. A retrospective chart review identified 147 cases of NMSC located on the dorsal hands treated with 595nm PDL. Cases of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) were included. All patients received one to two treatments with PDL. The primary outcome was the recurrence of carcinoma. Among NMSC cases treated with PDL, recurrence occurred in 12 patients (8.2%). No cases of BCC recurred during the study period. Recurrence of SCC was 4.7% for SCC in situ and 10.4% recurrence for invasive SCC (p = 0.34). Among 71 patients treated once, recurrence occurred in 10 patients (14.1%), and among 76 cases treated twice, recurrence occurred in 2 patients (2.6%, p = 0.01). Two treatments of PDL for NMSC on the dorsal hands of older patients was well tolerated, had low recurrence, and seemed more effective than one treatment.

Photodynamic application in diagnostic procedures and treatment of non-melanoma skin cancers.

Skin tumors commonly seen in dermatology are involved in all layers of the skin and appendages. While biopsy of affected skin remains an essential method to confirm diagnosis and to predicate tumor prognosis, it has its limitations. Recently, photodynamic diagnosis (PDD) has demonstrated high sensitivity in detecting affected skin and mucosal tissues, providing valuable guidance for precision surgery to resect skin and mucosal tumors. In this review, we summarized the literatures concerning the applications of PDD in diagnostic process and treatment of skin and mucosal conditions such as actinic keratoses (AK), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Bowen's disease (BD) and extramammary Paget's disease (EMPD). The findings suggest that PDD holds substantial promise for expanding clinical applications and deserves further research exploration.