Summary
Background Actinic keratoses (AKs) arise after chronic sun exposure. Because long‐term ultraviolet (UV) damage may induce proliferation of atypical keratinocytes, treatment of AKs is ...recommended.
Objectives To compare 5‐fluorouracil 0·5%/salicylic acid 10·0% low‐dose 5‐FU/SA (Actikerall®) with diclofenac 3% in hyaluronic acid (diclofenac HA) and vehicle for the treatment of AKs.
Methods This was a randomized, placebo‐controlled, double‐blind, parallel‐group, multicentre trial. Patients received topical low‐dose 5‐FU/SA once daily, its vehicle or diclofenac HA twice daily for a maximum of 12 weeks. The final evaluation was at week 20. The primary objectives were to demonstrate the histological clearance rate of one predefined lesion. The secondary objectives were the improvement of treated lesions, tolerability and safety.
Results There were 470 patients with 4–10 AK lesions each (grade I or II) on the face/forehead or bald scalp included in the study. Low‐dose 5‐FU/SA was superior to diclofenac HA (P < 0·01) and vehicle (P < 0·0001) for histological clearance of one representative lesion 8 weeks post‐treatment. In 72·0%, 59·1% and 44·8% of patients in the low‐dose 5‐FU/SA, diclofenac HA and vehicle groups, respectively, the week‐20 biopsy revealed no AKs. Significantly more lesions were cleared with low‐dose 5‐FU/SA (74·5%) compared with diclofenac HA (54·6%; P < 0·001) or vehicle (35·5%; P < 0·001). Low‐dose 5‐FU/SA was superior in terms of complete clinical clearance: 55·4%, vs. diclofenac HA (32·0%, P < 0·001) and vehicle (15·1%P < 0·001). Application‐site disorders (mainly burning and inflammation) were more frequent with low‐dose 5‐FU/SA but mainly of mild to moderate intensity.
Conclusions Topical low‐dose 5‐FU/SA demonstrated higher histological and clinical clearance rates vs. diclofenac HA or vehicle. Low‐dose 5‐FU/SA is an effective lesion‐directed treatment for AKs.
Summary The term actinic keratosis (AK) describes a sun‐induced, clinical erythematous lesion covered with scale, but does not provide an understanding of the biology or histopathology of the lesion. ...Cousequeutly, several classification systems for AK have been suggested, but as yet no cousensus has been reached. These systems strive to correlate the pathological and clinical features to better provide physcians with the most accurate information to enable correct decisions to be made regarding treatments, Prognosis and metastatic potential. AK is a clinical description that has a histological diagnosis consistent with squamous cell carcinoma (SCC) in situ. We recommend an AK classification system that describes these lesions as squamous cell carcinomas (SCCs), using the terminology ‘early in situ SCC Type AK I’, ‘early in situ SCC type AK II’ and ‘in situ SCC Type AK III’, there by giving clinicians better guidance for diagnosis and specific treatment recommendations.
Background
Actinic keratosis (AK) is a frequent health condition attributable to chronic exposure to ultraviolet radiation. Several treatment options are available and evidence based guidelines are ...missing.
Objectives
The goal of these evidence‐ and consensus‐based guidelines was the development of treatment recommendations appropriate for different subgroups of patients presenting with AK. A secondary aim of these guidelines was the implementation of knowledge relating to the clinical background of AK, including consensus‐based recommendations for the histopathological definition, diagnosis and the assessment of patients.
Methods
The guidelines development followed a pre‐defined and structured process. For the underlying systematic literature review of interventions for AK, the methodology suggested by the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was adapted. All recommendations were consented during a consensus conference using a formal consensus methodology. Strength of recommendations was expressed based on the GRADE approach. If expert opinion without external evidence was incorporated into the reasoning for making a certain recommendation, the rationale was provided. The Guidelines underwent open public review and approval by the commissioning societies.
Results
Various interventions for the treatment of AK have been assessed for their efficacy. The consenting procedure led to a treatment algorithm as shown in the guidelines document. Based on expert consensus, the present guidelines present recommendations on the classification of patients, diagnosis and histopathological definition of AK. Details on the methods and results of the systematic literature review and guideline development process have been published separately.
Conclusions
International guidelines are intended to be adapted to national or regional circumstances (regulatory approval, availability and reimbursement of treatments).
Summary
Actinic keratosis is a UV light‐induced lesion and develops mostly in fair‐skinned patients being susceptible to solar damage. The term actinic keratosis (AK) describes clinically ill‐defined ...reddish to reddish‐brown scaly lesions on erythematous base in areas damaged severely by sunlight. The term does not imply anything about the biology or histopathology. Actinic keratoses (AKs) have been recognized as precursor of cancer or of precancerous lesions in the past but today they are considered as an early in situ squamous cell carcinoma 1,2 and are categorized in several classifications with subdivisions into three grades depending on the amount of atypical keratinocytes in the epidermis.3–6
The incidence of development of AK in caucasians increases with age, proximity to the equator and outdoor occupation. Australia has the highest skin cancer rate in the world. AKs are discovered in up to 40–50% of the Australian population older than 40 years.7 AKs are the most common malignant lesion of the skin.8–12
Background
Actinic keratosis (AK) is an early in situ epidermal cancer which can progress to invasive squamous cell carcinoma (SCC). Imiquimod 5% cream (IMIQ) and diclofenac 3% gel (DIC) are ...frequently used to treat AK; however, their long‐term effects following repeated treatment cycles have never been compared.
Objective
To compare IMIQ and DIC in the treatment of AK with respect to the risk of change to grade III AK or invasive SCC, after 3 years.
Methods
Data were pooled from two randomized, active‐controlled, open‐label, multicentre, multinational, phase IV studies (Clinicaltrials.gov NCT00777127/NCT01453179), with two parallel groups. Studies were conducted between 2008 and 2015 and were almost identical in design. Patients eligible for inclusion were immunocompetent adults with 5–10 visible AK lesions on the face/scalp and grade I/II AK. The primary endpoint was inhibition of histological change to grade III AK or invasive SCC in the study treatment area, observed until month 36. Patients applied either IMIQ or DIC for a maximum of six treatment cycles.
Results
In total, 479 patients (IMIQ 242; DIC 237) were included in the full analysis set. Histological change to grade III AK or invasive SCC was observed until month 36 in 13 (5.4%) patients treated with IMIQ, compared with 26 (11.0%) patients treated with DIC (absolute risk difference –5.6% 95% confidence interval –10.7%, –0.7%). Time to histological change was greater in the IMIQ group than the DIC group (P = 0.0266). Frequency of progression to invasive SCC was lower with IMIQ than with DIC at all time points. Initial clearance rate was higher in the IMIQ group compared with the DIC group, while recurrence rate was lower. Both treatments were well tolerated.
Conclusions
Over 3 years, IMIQ was superior to DIC in clearing AK lesions and preventing histological change to grade III AK or invasive SCC and recurrence.
Epidemiology and aetiology of basal cell carcinoma Roewert-Huber, J.; Lange-Asschenfeldt, B.; Stockfleth, E. ...
British journal of dermatology (1951),
12/2007, Letnik:
157, Številka:
s2
Journal Article
Recenzirano
Summary
Basal cell carcinoma (BCC) is a malignant epithelial neoplasm of the skin preferentially affecting male caucasians and is rarely observed in patients with more intense skin pigmentation. A ...characteristic feature of BCCs are their extremely low risk to metastasize. Epidemiological data indicate that the overall incidence is increasing worldwide significantly by about 3–10% per annum.1–3 Based on the increasing incidence of this usually not life‐threatening tumour BCC appears to develop into a growing public health problem. This review elucidates the risk factors for the development and for the progression of BCC leading to an improved understanding of this tumour.
Summary
Background The influence of phenotype and detection of clonality on prognosis in early mycosis fungoides has never been addressed in large studies.
Objectives To correlate immunophenotype ...and detection of clonality with clinical outcome.
Methods We analysed 73 biopsy specimens from 68 patients with early mycosis fungoides (stage Ia or Ib) and at least 10 years of follow up (or dead of disease).
Results Four phenotypic groups could be identified: group A (α/β+ CD4+ CD8− TIA1−), 51 patients; median survival time 160 months; group B (α/β+ CD4− CD8+ TIA1+), 10 patients; median survival time 195 months; group C (α/β− CD4− CD8+/− TIA1+), five patients; median survival time 165 months; and group D (α/β+ CD4− CD8− TIA1−), two patients; median survival time 130 months. Survival curves did not show statistical differences among the groups. Monoclonality was detected in 36 of 67 tested biopsies (54%), and statistical analyses did not show prognostic differences between the clonal and nonclonal cases.
Conclusions We conclude that cytotoxic phenotype and detection of monoclonal T‐cell receptor‐γ gene rearrangement in early lesions of mycosis fungoides do not have any prognostic significance.
AK progressing to NMSC: at what stage? Kopera, D.; Goswami, N.; Kerl, H.
Journal of the European Academy of Dermatology and Venereology,
11/2016, Letnik:
30, Številka:
11
Journal Article
Introduction
Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are rare neurological disorders characterized by demyelination in and/or outside the pons. Whether ...diffusion-weighted imaging (DWI) might facilitate an earlier diagnosis has not yet been studied systematically.
Methods
We describe demographics, clinical presentation, and early magnetic resonance imaging (MRI) findings with special emphasis on the relevance for diagnosis of CPM and/or EPM in eight patients.
Results
Of the analysed eight patients (aged 37–70 years; two men, six women), CPM was diagnosed in three, EPM in one, and a combination of CPM and EPM in four patients. Aetiology was rapid correction of sodium in two patients; a combination of hyponatremia, alcoholism and alcohol withdrawal in five patients and unclear in one patient. Seven patients suffered from chronic alcoholism and four from malnutrition. Demyelinating lesions were found in the pons, thalamus, caudate nucleus, putamen and midbrain. While the lesions could be clearly delineated on T2- and T1-weighted images, DWI demonstrated a strong signal in only six patients. Furthermore, DWI demonstrated lesions only to some extent in two patients and was completely negative in two patients on initial MRI. In none of the patients did the demonstration of hyperintense lesions on DWI precede detection on conventional MRI sequences. Apparent diffusion coefficient (ADC) values were heterogenous with a decrease in two cases and an increase in the remainder.
Conclusions
We conclude that early DWI changes are a common finding in CPM/EPM but do not regularly precede tissue changes detectable on conventional MRI sequences. Heterogenous ADC values possibly represent different stages of disease.
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