Treatment Of Skin Tumors Research Articles

Synthetic Peptide Drugs for Targeting Skin Cancer: Malignant Melanoma and Melanotic Lesions.

Peptides play decisive roles in the skin, ranging from host defense responses to various forms of neuroendocrine regulation of cell and organelle function. Synthetic peptides conjugated to radionuclides or photosensitizers may serve to identify and treat skin tumors and their metastatic forms in other organs of the body. In the introductory part of this review, the role and interplay of the different peptides in the skin are briefly summarized, including their potential application for the management of frequently occurring skin cancers. Special emphasis is given to different targeting options for the treatment of melanoma and melanotic lesions. Radionuclide Targeting: α-Melanocyte-stimulating hormone (α-MSH) is the most prominent peptide for targeting of melanoma tumors via the G protein-coupled melanocortin-1 receptor that is (over-)expressed by melanoma cells and melanocytes. More than 100 different linear and cyclic analogs of α-MSH containing chelators for 111In, 67/68Ga, 64Cu, 90Y, 212Pb, 99mTc, 188Re were synthesized and examined with experimental animals and in a few clinical studies. Linear Ac-Nle-Asp-His-D-Phe-Arg-Trp-Gly-Lys-NH2 (NAP-amide) and Re-cyclized Cys- Cys-Glu-His-D-Phe-Arg-Trp-Cys-Arg-Pro-Val-NH2 (Re[Arg11]CCMSH) containing different chelators at the N- or C-terminus served as lead compounds for peptide drugs with further optimized characteristics. Alternatively, melanoma may be targeted with radiopeptides that bind to melanin granules occurring extracellularly in these tumors. Photosensitizer targeting: A more recent approach is the application of photosensitizers attached to the MSH molecule for targeted photodynamic therapy using LED or coherent laser light that specifically activates the photosensitizer. Experimental studies have demonstrated the feasibility of this approach as a more gentle and convenient alternative compared to radionuclides.

Assessment of Thermal Damage During Skin Tumor Treatment Using Thermal Wave Model: A Realistic Approach

In this study, a three-layered skin tissue has been modeled to assess the heat transfer characteristics in laser skin tumor–tissue interaction. A finite-volume-based two-dimensional numerical bioheat transfer model has been put together to study the damage prediction of healthy tissues by considering both Fourier and non-Fourier laws. The combination of the bioheat transfer equation with Fourier law forms the parabolic equation (Pennes model) and with the non-Fourier equation forms the hyperbolic equation (thermal wave model). In this paper, the laser source is provided on the outer layer of the skin to dismantle the undesired tumor region exemplified as inhomogeneity (tumor) present in the intermediate layer. Heat input through the laser source is on until it reaches the tumor-killing criteria. The heat transport equation has been discretized by the finite volume method (FVM). The finite-volume-based numerical model is developed in such a way that the non-Fourier model predictions can be obtained through conventional Fourier-based solver. The central difference scheme is adopted for discretizing the spatial derivative terms. An implicit scheme is applied to treat the transient terms in the model. For few cases of the hyperbolic problems, certain limitation for a chosen implicit scheme has also been addressed in this paper. The results are validated with the existing literatures. The evaluated results are based on both the Fourier and the non-Fourier model, to investigate the temperature distribution and thermal damage by ensuring irreversible thermal damage in the whole tumor region placed in the dermis layer. Thermal damage of the healthy tissue is found to be more in the time scale of the thermal wave model.

PCTAIRE1/CDK16/PCTK1 is overexpressed in cutaneous squamous cell carcinoma and regulates p27 stability and cell cycle

BackgroundPCTAIRE1 (also known as cyclin-dependent kinase 16 (Cdk16) and PCTK1) is a Cdk family protein that has been implicated in spermatogenesis. We recently revealed the function of PCTAIRE1 in the tumorigenesis of malignancies, including breast and prostate cancers; however, the tumorigenic function of PCTAIRE1 in cutaneous squamous cell carcinoma (SCC) remains unclear. ObjectiveIn this study, we investigated the role of PCTAIRE1 in the tumorigenesis of cutaneous SCCs. Methods and resultsIn cutaneous/oral SCC A431, DJM-1, HSC-3 cells, PCTAIRE1 gene-knockdown was found to diminish cell proliferation as assessed by cell counting and clonogenic assays. FACS analyses of annexin V-PI staining and DNA content showed PCTAIRE1 knockdown to cause G2/M arrest followed by apoptosis. The depletion of PCTAIRE1 was found to lead to the accumulation of tumor suppressor p27 and down-regulation of c-Myc. In tumor xenografts of A431 cells, the conditional knockdown of PCTAIRE1 restores p27 protein expression and suppresses tumor growth. Clinically, in primary tumors from patients with SCC, PCTAIRE1 is more highly expressed in malignant lesions than in adjacent normal epidermis. Conversely, expression levels of p27 are significantly lower in SCC than in normal epidermis. ConclusionsOur findings reveal a crucial function for PCTAIRE1 in regulating p27, c-Myc levels and tumor growth in cutaneous SCC cells, suggesting that PCTAIRE1 could be a novel target for skin tumor treatment.

Indication guidelines for Mohs micrographic surgery in skin tumors.

Mohs micrographic surgery is a technique used to excise skin tumors based on comprehensive surgical mapping, in which the surgeon removes the tumor, followed by a complete histological evaluation of the tumor's margins. The correlation of the presence of a tumor in histological examinations and its precise location on the surgical map result in a complete removal of the tumor with maximum normal tissue preservation. The present article seeks to provide general practitioners and healthcare specialists with guidelines regarding recommendations for Mohs micrographic surgery to treat skin tumors, based on the most reliable evidence available in medical literature on the subject. This bibliographic review of scientific articles in this line of research was conducted based on data collected from MEDLINE/PubMed. The search strategy used in this study was based on structured questions in the Patient, Intervention, Control, and Outcome (PICO) format. MeSH terms were used as descriptors. The indications of this technique are related to recurrence, histology, size, definition of tumor margins, and location of tumors. These guidelines attempt to establish the indications of Mohs surgery for different types of skin tumors.

Photodynamic therapy for the treatment of 18 cases of skin tumors

Objective To evaluate the efficacy of photodynamic therapy in the treatment of skin tumors unsuitable for surgery. Methods Totally, 8 cases of actinic keratosis (AK) , 6 cases of squamous cell carcinoma (SCC) , 3 cases of Bowen's disease, and 1 case of basal cell carcinoma (BCC) were treated with aminolevulinic acid-based photodynamic therapy. Aminolevulinic acid 20% solution was prepared, and applied to skin lesions. After 4-6 hours, the lesions were irradiated with red light at an energy density of 80 to 100 J/cm2 for 20 minutes. Totally, 3 to 6 sessions of photodynamic therapy were given at a frequency of once a week. The therapeutic effect was evaluated at the end of the course of treatment. Results Eight patients with AK, 4 SCC and 3 Bowen's disease achieved complete remission, and another 2 patients with SCC and 1 BCC achieved partial remission. No recurrence was observed in any of the 18 patients at 1, 2, 3 and 6 months after the end of treatment. Conclusion Aminolevulinic acid-based photodynamic therapy is a kind of non-invasive approach to the treatment of skin tumors unsuitable for surgery with no risk of obvious scar formation. Key words: Skin neoplasms; Photochemotherapy; Treatment outcome; Aminolevulinic acid; Surgical procedures, elective

Electrochemotherapy -an effective method for the treatment of tumors with a combination of chemotherapeutic agent and electric field

Electrochemotherapy is a local treatment for skin tumors and also deep seated tumors and metastases. Electrochemotherapy is based on enhanced cytotoxic effectiveness of bleomycin or cisplatin by electroporation, which increases drug delivery into cells in tumors. Electrochemotherapy is an ablative technique of high effectiveness with over 80% objective responses of electrochemotherapy treated tumors. Its advantage is the simplicity of the procedure that can be utilized in treatment of different tumor histiotypes. Currently it is predominantly used in palliative intent when the other treatment options have been exhausted. For the translation of electrochemotherapy into the clinics also the technological development that is now focusing into the treatment of deep-seated tumors was important. In Slovenia we are at the forefront in the treatment of liver tumors and head and neck tumors, while the others are developing electrochemotherapy for treatment of bone and brain metastases as well as endoluminal tumors.

ELEKTROKEMOTERAPIJA – UČINKOVITA METODA ZDRAVLJENJA TUMORJEV S KOMBINACIJO KEMOTERAPEVTIKA IN ELEKTRIČNEGA POLJA

Electrochemotherapy is a local treatment for skin tumors and also deep seated tumors and metastases. Electrochemotherapy is based on enhanced cytotoxic effectiveness of bleomycin or cisplatin by electroporation, which increases drug delivery into cells in tumors. Electrochemotherapy is an ablative technique of high effectiveness with over 80% objective responses of electrochemotherapy treated tumors. Its advantage is the simplicity of the procedure that can be utilized in treatment of different tumor histiotypes. Currently it is predominantly used in palliative intent when the other treatment options have been exhausted. For the translation of electrochemotherapy into the clinics also the technological development that is now focusing into the treatment of deep-seated tumors was important. In Slovenia we are at the forefront in the treatment of liver tumors and head and neck tumors, while the others are developing electrochemotherapy for treatment of bone and brain metastases as well as endoluminal tumors.

Tumorogenesis and skin tumours in the elderly

More than 1.5 million people were diagnosed with skin cancer in 2012 in Germany-of which 318,000 were malignant melanoma. The number of malignant skin tumours has increased by 60% since 2005. Epithelial skin cancers are even more common. Since 2012, 1.3 million diagnoses have been documented. This incidence represents an increase of 79% within 7 years. The number of skin cancer patients treated in German hospitals has also increased. In 2014, 99,613 patients were treated as inpatients with the diagnosis of skin cancer; in 2000 there were 57,147 patients. This was the largest growth rate among all cancer treatments in hospitalised patients. The continuously changing age pyramid leads to an expected further growth of the incidence of skin tumours. In parallel the development of molecular knowledge in tumorigenesis is also rapid. A series of cell-specific mutations have been described in recent years for various skin tumours. Mutations are found mainly in genes engaging their translation products at key positions in regulatory cell metabolism or cell division. These include oncogenes, which have greatly increased activity due to targeted mutations or tumor suppressor genes and act under physiological conditions as negative regulators that are inactivated by mutations. These findings have led to the development of a series of new promising compounds for the treatment of skin tumours.

Novel simple templates for reproducible positioning of skin applicators in brachytherapy.

PurposeEsteya and Valencia surface applicators are designed to treat skin tumors using brachytherapy. In clinical practice, in order to avoid errors that may affect the treatment outcome, there are two issues that need to be carefully addressed. First, the selected applicator for the treatment should provide adequate margin for the target, and second, the applicator has to be precisely positioned before each treatment fraction. In this work, we describe the development and use of a new acrylic templates named Template La Fe-ITIC. They have been designed specifically to help the clinical user in the selection of the correct applicator, and to assist the medical staff in reproducing the positioning of the applicator. These templates are freely available upon request.Material and methodsTemplates that were developed by University and Polytechnic Hospital La Fe (La Fe) and Hospital Clínica Benidorm (ITIC) in cooperation with Elekta, consist of a thin sheet made of transparent acrylic. For each applicator, a crosshair and two different circles are drawn on these templates: the inner one corresponds to the useful beam, while the outer one represents the external perimeter of the applicator. The outer circle contains slits that facilitate to draw a circle on the skin of the patient for exact positioning of the applicator. In addition, there are two perpendicular rulers to define the adequate margin. For each applicator size, a specific template was developed.ResultsThe templates have been used successfully in our institutions for more than 50 patients’ brachytherapy treatments. They are currently being used for Esteya and Valencia applicators.ConclusionsThe template La Fe-ITIC is simple and practical. It improves both the set-up time and reproducibility. It helps to establish the adequate margins, an essential point in the clinical outcome.

Analysis of Low Intensity Laser Therapy as adjuvant to Photodynamic Therapy in Nonmelanoma Skin Cancer.

The combination of Low Intensity Laser Therapy and Photodynamic Therapy constitutes a minimal invasive and highly selective alternative for the treatment of skin tumors. Photodynamic effectiveness, specially the absence of recurrence, highly depends on the type of tumor, as well as on several parameters such as those related with the optical source. Therefore it is important to have predictive tools to provide an appropriate treatment planning. This work proposes the use of a complex predictive model that includes a three-dimensional meshing of the considered tumor geometry and the optical propagation therein by a three-dimensional Monte Carlo method. The proposed tool is applied to three different types of skin tumors, squamous cell carcinoma, nodular and infiltrative basal cell carcinomas. The estimated volume of treatment, depending on the tumor type and source parameters, allows an appropriate treatment planning in order to avoid undesirable tumor recurrence.

Surgical Treatment of Skin Tumors

Surgical Treatment of Skin Tumors

Photodynamic therapy in combination with CO2 laser for the treatment of Bowen's disease.

Photodynamic therapy (PDT) involves the activation of a previously administered photosensitizing agent by visible light to induce tumor necrosis. Photosensitizers are topically applied in the treatment of skin tumors to avoid systemic side effects. In this study, we evaluated the feasibility and efficacy of aminolevulinic acid (ALA) as a photosensitizer (ALA-PDT) in combination with CO2 laser in the treatment of Bowen's disease (BD; intraepithelial squamous cell carcinoma). Twenty-two lesions from 18 patients were randomized into two groups: 11 lesions were treated with topical ALA-PDT (180J/cm(2) at 100mW/cm(2)) + CO2 laser for one to three sessions. The remaining 11 lesions were treated with CO2 laser alone, serving as control group. All patients were reviewed at ≤1-week intervals. Biopsies were taken from BD lesions prior to treatment. The initial evaluation was undertaken 1month after treatment, and biopsies were harvested for histological evaluation. Patients who did not respond to the three sessions of treatment were referred to surgical treatment. In the ALA-PDT + CO2 laser group, 72.73% (8/11) of BD lesions showed complete remission, with an overall clearance of 90.91%, and only one recurred (9%) during follow-up. Local side effects included mild erythema, edema, erosion, and burning and/or stinging sensation. No systemic side effects were observed. In the control group, 63.63% (7/11) of lesions had complete remission and the overall clearance was 54.55%. However, five lesions (45.45%) had recurrence. Local side effects included mild to moderate edema, erosion, ulceration, delayed healing, prolonged pain, and scarring. There existed a significant difference in recurrence rate between the two groups (P < 0.05). Moreover, after ALA-PDT plus CO2 laser treatment, complete necrosis was observed in responsive lesions, and 3months later, the atypical BD cells were replaced by normal keratinocytes. Topical ALA-PDT in combination with CO2 laser is safe, effective, and is associated with low recurrence and reduced side effects.

In Vivo Evidences of Nanosecond Pulsed Electric Fields for Melanoma Malignancy Treatment on Tumor-Bearing BALB/c Nude Mice

In order to get in vivo evidences of nanosecond pulsed electric fields (nsPEF) for skin tumor treatment, tumor models in 10 female BALB/c nude mice were established by inoculating them with human melanoma cells A375. These mice were randomly divided into treated group (exposed to nsPEF with intensity of 20 kV/cm and duration of 300 ns) and control group equally. Five days post-nsPEF treatment, tumor growth in the treated group was effectively inhibited (P < 0.01 compared with that in control group), typical apoptotic characteristics (DNA damage and fragmentation) were observed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), and significant increases in Bax and decreases in Bcl-2, micro-vessel density (MVD), vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) were observed by immunohistochemistry (P < 0.01). These experimental results indicate that in vivo tumor growth can be effectively inhibited by nsPEF, which activate two targets, apoptosis initiation and angiogenesis inhibition.

Electrochemotherapy: from the drawing board into medical practice

Electrochemotherapy is a local treatment of cancer employing electric pulses to improve transmembrane transfer of cytotoxic drugs. In this paper we discuss electrochemotherapy from the perspective of biomedical engineering and review the steps needed to move such a treatment from initial prototypes into clinical practice. In the paper also basic theory of electrochemotherapy and preclinical studies in vitro and in vivo are briefly reviewed. Following this we present a short review of recent clinical publications and discuss implementation of electrochemotherapy into standard of care for treatment of skin tumors, and use of electrochemotherapy for other targets such as head and neck cancer, deep-seated tumors in the liver and intestinal tract, and brain metastases. Electrodes used in these specific cases are presented with their typical voltage amplitudes used in electrochemotherapy. Finally, key points on what should be investigated in the future are presented and discussed.

English

Introduction Radiotherapy plays an important role in the treatment of skin tumours. For skin carcinomas, external irradiation (kilovoltage X-rays or electrons according to clinical characteristics) is more preferable than interstitial brachytherapy, which is recommended for tumours of the lip and nasal vestibule. Electrons are usually used for treating superficial lesions and skin cancers, as well as in the orthovoltage radiotherapy. In order to treat mycosis fungoides, total cutaneous electron beam radiation therapy is efficient for patients with limited superficial plaques. In the treatment of classical form of Kaposi’s sarcoma, radiotherapy can achieve local control, whereas it gives good palliative results in the epidemic form. New radiotherapy techniques, such as helical tomotherapy, showed increased advantages, including dose escalation to the target tumour volume and the best protection of adjacent organs at risk. The aim of this work is to accurately evaluate the efficiency and tolerance of old and new radiotherapy techniques in the treatment of different skin tumours and to review the already existing techniques. Conclusion With all these new treatment modalities, the modern radiotherapy technique becomes a highly adapted treatment for different tumour types, which is a part of the multidisciplinary management. Introduction Radiotherapy plays an important role in the treatment of skin tumours, such as those arising from non-melanoma skin cancer and primary cutaneous lymphoma. For non-melanoma skin cancers, including basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (CSC), Merkel cell carcinoma (MCC) and adnexal carcinoma (AC), complete surgical excision with a security margin is still the reference therapy. But, the choice of the treatment technique depends on various factors, such as the size of the tumour, the general condition of the patient, cosmetic considerations and recurrence. Radiotherapy is an effective option to control tumour growth and to improve quality of life of the patient. Histological confirmation is essential before radiotherapy initiation. For BCCs, radiotherapy is an alternative option if surgery is not preferred due to recurrence, incomplete excision, nodules of >2 cm in the head, or bone or cartilage involvement1. In such cases, 5–10-mm security margins are maintained depending on the tumour size, and superficial Xrays and electron beams are usually employed. A randomised controlled trial was conducted to compare radiotherapy with surgical excision of facial BCC of <4-cm diameter with 4-year failure rates of 7.5% and 0.7%, respectively (P = 0.003). Cosmetic outcomes significantly favoured surgical excision at 4 years in 87% of the surgery-treated patients, whereas 69% of the radiation-treated patients opined the cosmetic results to be satisfactory (P < 0.01). The study used different techniques of radiotherapy, including interstitial brachytherapy, contact therapy and conventional radiotherapy2. Despite these results, radiotherapy is still an option for BCCs that occur in areas where surgery would be technically difficult or would result in unacceptable tissue destruction, or for patients who would not be able to tolerate surgery3. In a study, the efficacy of electron beam radiotherapy for BCCs was evaluated; and 3-year local recurrence-free survival rates were found to be 97.6% for tumours treated with 54 Gy in 18 fractions and 96.9% with 44 Gy in 10 fractions4. Radiotherapy has also been compared with treatment with imiquimod 5% cream for nodular BCCs on the eyelid; in this study, remission rates were equivalent in both the groups, but tolerability was better in the radiotherapy group during the treatment5. For CSCs, radiotherapy is recommended when surgery is not possible, or it is used as an adjuvant in the treatment of high-risk tumours with 10–15-mm security margins6. The 3-year freedom from local recurrence was 97% with 54 Gy in 18 fractions, whereas it was 93.6% with 44 Gy in 10 fractions in a study about electron beam therapy4. Radiotherapy is particularly an option for CSCs overlying cartilage7, those with perineural invasion8,9, or with recurrence10. Adjuvant radiotherapy is also indicated of there is regional lymph node involvement11,12. For MCCs, radiotherapy is applied to the cavity of the excised primary or recurrent tumour13. Adjuvant regional radiotherapy on the tumour bed decreases regional recurrence, but * Corresponding author Email: youlia.kirova@curie.fr 1 Department of Radiation Oncology, Curie Institute, 26 Rue d’Ulm, 75005 Paris, France 2 Department of Dermatology, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France

New Molecular and Cellular Targets for Chemoprevention and Treatment of Skin Tumors by Plant Polyphenols: A Critical Review

New Molecular and Cellular Targets for Chemoprevention and Treatment of Skin Tumors by Plant Polyphenols: A Critical Review

New Molecular and Cellular Targets for Chemoprevention and Treatment of Skin Tumors by Plant Polyphenols: A Critical Review

As the incidence of skin tumors has been steadily growing, there is an urgent need for the preventive measures as well as the improved therapeutic approaches. In the last two decades, natural plant derived polyphenols (PPs, resveratrol, silibinin, green tea polyphenols, flavonoids, anthocyanins, etc.) have been drawing particular interest as emerging active substances in dermatological/cosmeceutical compositions for the prevention, slowing, or reversion of skin tumorigenesis (chemoprevention). When chronically applied to the skin, they supposedly would not damage normal skin cells or negatively affect their functions while they would suppress tumorigenic cell transformation, inhibit tumor cell proliferation, and activate tumor cell apoptosis. PPs are also reported to synergize with conventional anti-cancer therapies. The major aim of this critical review is to provide recent updates on the molecular and cellular targets for the prevention and therapy of skin tumors with a special focus on the crossroad between inflammation and carcinogenesis as the most promising approach to chemoprevention. Novel therapeutic targets as different as epidermal stem cells, cellular senescence, epigenetic enzymes involved in carcinogenesis, epidermal growth factor and aryl hydrocarbon receptors, and metabolic CYP1 subfamily enzymes are highlighted. The mechanisms of PPs interaction with these molecular and cellular targets are reviewed. The feasibility of PPs to prevent/ cure specific cutaneous toxicity connected to anti-EGFR therapy and to reduce multidrug resistance of skin tumors is also discussed.

Surface dose reduction from bone interface in kilovoltage X‐ray radiation therapy: a Monte Carlo study of photon spectra

This study evaluated the dosimetric impact of surface dose reduction due to the loss of backscatter from the bone interface in kilovoltage (kV) X‐ray radiation therapy. Monte Carlo simulation was carried out using the EGSnrc code. An inhomogeneous phantom containing a thin water layer (0.5–5 mm) on top of a bone (thickness=1 cm) was irradiated by a clinical 105 kVp photon beam produced by a Gulmay D3225 X‐ray machine. Field sizes of 2, 5, and 10 cm diameter and source‐to‐surface distance of 20 cm were used. Surface doses for different phantom configurations were calculated using the DOSXYZnrc code. Photon energy spectra at the phantom surface and bone were determined according to the phase‐space files at the particle scoring planes which included the multiple crossers. For comparison, all Monte Carlo simulations were repeated in a phantom with the bone replaced by water. Surface dose reduction was found when a bone was underneath the water layer. When the water thickness was equal to 1 mm for the circular field of 5 cm diameter, a surface dose reduction of 6.3% was found. The dose reduction decreased to 4.7% and 3.4% when the water thickness increased to 3 and 5 mm, respectively. This shows that the impact of the surface dose uncertainty decreased while the water thickness over the bone increased. This result was supported by the decrease in relative intensity of the lower energy photons in the energy spectrum when the water layer was with and over the bone, compared to without the bone. We concluded that surface dose reduction of 7.8%–1.1% was found when the water thickness increased from 0.5–5 mm for circular fields with diameters ranging from 2–10 cm. This decrease of surface dose results in an overestimation of prescribed dose at the patient's surface, and might be a concern when using kV photon beam to treat skin tumors in sites such as forehead, chest wall, and kneecap.PACS number: 87.55.K‐; 87.55.ne; 87.57.uq

HDR-plesiotherapy for the treatment of anogenital extramammary Paget's disease

BackgroundExtramammary Paget disease (EMPD) is a rare condition that most commonly affects the anogenital region in the elderly. It may be associated with an underlying invasive carcinoma. Surgical excision is nowadays considered a standard treatment for extramammary Paget's disease, although this approach might not be suitable for all patients. Good rates of local control and cosmetic outcome have been achieved by using high-dose-rate (HDR) plesiotherapy in the treatment of skin tumors arising in different locations. Material and methodsWe present the results observed in a patient with EMPD treated by HDR plesiotherapy with a custom-made mold up to a final dose of 54Gy in 12 fractions of 450 cGy over 4 weeks. ResultsAfter a follow-up of 18 months, the patient is alive and without evidence of local or distant relapse. Acute toxicity was acceptable and cosmetic result was considered as excellent. ConclusionThis technique represents an attractive alternative for those patients who are not candidates for surgical procedures because of unacceptable risk of disfigurements or functional impairment, medical contraindications or patient preference.

Étude de la rétraction cutanée appliquée à la prise en charge des tumeurs cutanées. Cartographie du corps humain

Skin, the main organ of the human body, is equipped with own biomechanical characteristics, highly variable depending on intra-individual factors (location, weight status, dermatological diseases…) and interindividual (age, sex…). Despite some recent cutometric studies, our review of the literature shows that there is no currently reliable analytical model representing the biomechanical behavior of the skin. Yet, this is a central issue in dermatology surgery, especially in the treatment of skin tumors, for the proper observance of surgical margins.We studied prospectively on 75 resection specimens (about 71 patient(s)), for the treatment of skin lesions tumor suspicious or known malignant or benign. Room dimensions were measured before and 5 minutes after excision, leading us to calculate a ratio of retraction of the skin surface. This retraction was correlated with age, gender, tumor type, and anatomic location of the site of excision.The power of retraction of the skin varies significantly by region of the body. It is maximum in the upper limb (hand excluded) and in the cervical region. At the cephalic region, skin of the ear and periorbital skin have capacities of important early retraction. Unlike the lower limb (foot excluded), the back skin of the nose and face appear to be a minimum of shrinkage. Age also seems to change on that capacity shrinkage, sex would have no influence.Our study confirms the variations in the ability of skin retraction based on a number of factors. In dermato-oncology, that power retraction could cause significant differences between clinical surgical margins and final pathologist margins. We believe it must be taken into account by the couple surgeon-pathologist, especially in the context of invasive and/or recurrent tumors.