Keratosis pilaris atrophicans faciei (KPAF) is a rare, hereditary, follicular disorder categorized in the atrophicans subtypes of keratosis pilaris (KP). Nowadays it can be treated with light and ...laser devices. Lasers with wavelengths <600 nm, especially pulsed dye laser (PDL), are effective for treatments of KPAF. Here, we present a case with KPAF treated with 585 nm diode laser, a kind of laser system functioning with differential wavelength modified optically pumped semiconductor (D-WMOPS) technology. Our case is the first patient reported to have been treated with this laser technology in the literature.
Ingenol mebutate (IngMeb) 0.015% or 0.05% is approved for actinic keratosis (AK) areas of 25 cm2 or less; some patients require treatment of larger fields.
To determine efficacy and safety of IngMeb ...0.027% in areas of AK of up to 250 cm2 during an 8-week initial assessment period and extended 12-month follow-up.
This phase 3, randomized, double-blind, vehicle-controlled trial (NCT02361216) enrolled adult patients with 5 to 20 AK lesions on the face/scalp (25-250 cm2) or chest (approximately 250 cm2). Patients received once-daily IngMeb or vehicle for 3 consecutive days on the full face, full balding scalp, or approximately 250 cm2 on the chest. The primary endpoint was complete AK clearance (AKCLEAR 100; week 8). Additional endpoints included partial AK clearance (AKCLEAR 75), recurrence, patient satisfaction, cosmetic outcome, and safety.
IngMeb was superior to vehicle for complete AK clearance (21.4% vs 3.4%, P < .001) and AK clearance of 75% or greater (59.4% vs 8.9%, P < .001) at week 8. Probability of sustained clearance during the 12-month follow-up was 22.9% for patients treated with IngMeb. Increased treatment satisfaction and cosmetic outcomes were observed with IngMeb versus vehicle. No unexpected safety signals were identified.
Localized skin responses hindered maintenance of double-blinding.
IngMeb 0.027% was superior to vehicle for treatment of AK areas of up to 250 cm2. The safety profile of IngMeb was as expected.
TRAF1 is a member of the TRAF protein family, which regulates the canonical and noncanonical NF-κB signaling cascades. Although aberrant TRAF1 expression in tumors has been reported, the role of ...TRAF1 remains elusive. Here, we report that TRAF1 is required for solar UV-induced skin carcinogenesis. Immunohistochemical analysis showed that TRAF1 expression is up-regulated in human actinic keratosis and squamous cell carcinoma. In vivo studies indicated that TRAF1 expression levels in mouse skin are induced by short-term solar UV irradiation, and a long-term skin carcinogenesis study showed that deletion of TRAF1 in mice results in a significant inhibition of skin tumor formation. Moreover, we show that TRAF1 is required for solar UV-induced extracellular signal-regulated kinase–5 (ERK5) phosphorylation and the expression of AP-1 family members (c-Fos/c-Jun). Mechanistic studies showed that TRAF1 expression enhances the ubiquitination of ERK5 on lysine 184, which is necessary for its kinase activity and AP-1 activation. Overall, our results suggest that TRAF1 mediates ERK5 activity by regulating the upstream effectors of ERK5 and also by modulating its ubiquitination status. Targeting TRAF1 function might lead to strategies for preventing and treating skin cancer.
Skin cancer is the most common cancer in the United States. Current estimates are that one in five Americans will develop skin cancer in their lifetime. A skin cancer diagnosis is challenging for ...dermatologists requiring a biopsy from the lesion and histopathological examinations. In this article, we used the HAM10000 dataset to develop a web application that classifies skin cancer lesions.
This article presents a methodological approach that utilizes dermoscopy images from the HAM10000 dataset, a collection of 10015 dermatoscopic images collected over 20 years from two different sites, to improve the diagnosis of pigmented skin lesions. The study design involves image pre-processing, which includes labelling, resizing, and data augmentation techniques to increase the instances of the dataset. Transfer learning, a machine learning technique, was used to create a model architecture that includes EfficientNET-B1, a variant of the baseline model EfficientNET-B0, with a global average pooling 2D layer and a softmax layer with 7 nodes added on top. The results of the study offer a promising method for dermatologists to improve their diagnosis of pigmented skin lesions.
The model performs best in detecting melanocytic nevi lesions with an F1 score of 0.93. The F1 score for Actinic Keratosis, Basal Cell Carcinoma, Benign Keratosis, Dermatofibroma, Melanoma, and Vascular lesions was consecutively 0.63, 0.72, 0.70, 0.54, 0.58, and 0.80.
We classified seven distinct skin lesions in the HAM10000 dataset with an EfficientNet model reaching an accuracy of 84.3%, which provides a promising outlook for further development of more accurate models.
There is considerable variation in the literature regarding the dermatopathologic diagnostic features of and reporting guidelines for actinic keratosis (AK) and cutaneous squamous cell carcinoma ...(cSCC).
To develop consensus recommendations regarding diagnostic criteria, nomenclature, and reporting of AK and cSCC.
Literature review and cross-sectional multiround Delphi process including an international group of expert dermatopathologists followed by a consensus meeting.
Consensus was achieved regarding the key dermatopathologic features necessary for diagnosing cSCC, AK, and associated variants; grading of degree of cellular differentiation in cSCC; utility of immunohistochemistry for diagnosis of cSCC; and pathologic features that should be reported for cSCC and AK.
Consensus was not achieved on all questions considered.
Despite the lack of clarity in the literature, there is consensus among expert dermatopathologists regarding diagnostic criteria and appropriate reporting of AK and cSCC. Widespread implementation of these consensus recommendations may improve communication between dermatopathologists and clinicians, facilitating appropriate treatment of AK and cSCC.
Patients at risk of skin cancers can develop varying types of cutaneous malignancies. However, some subjects may develop only one type of lesion. In this cross-sectional study, the spectrum of ...premalignant (PM) and malignant skin lesions and their risk factors were studied. Therefore, 505 adult subjects (aged 21-79 years, 256 males and 249 females, 96 with immunosuppression) at risk of any type of skin cancer were examined for cutaneous malignancies, nevi, actinic keratoses, photodamage, and possible risk factors. First, 12 different groups were identified with a varying set of PM and/or malignant skin lesions. Next, 5 larger groups were formed from them: basal cell carcinoma (BCC) only, malignant melanoma (MM) only, squamous cell carcinoma (SCC) and/or PM, BCC + SCC and/or PM, and MM + keratinocyte carcinoma (KC) and/or PM. The groups with BCC or MM only were younger and showed less photodamage than the mixed groups, while SCC/PM showed similarity with them. In logistic regression analyses, the platelet-to-lymphocyte ratio was associated with an increased risk of concomitant KC (OR 1.028, p = 0.023) or SCC/PM (OR 1.009, p = 0.047) in subjects with MM or BCC, respectively. Actinic keratoses produced ORs 0.246-0.252 (p = 0.008-0.020) for BCC in subjects with SCC/PM. Interestingly, atypical mole syndrome decreased the risk of SCC/PM in subjects with BCC (OR 0.092, p = 0.001). Advanced age was a significant risk factor for an additional type of lesion in all 3 comparisons (ORs 1.088-1.388, p = 0.001). In conclusion, even though there are numerous patients with only one lesion type, advancing age may determine the final lesion multiplicity.
Background
Photodynamic therapy (PDT) is widely used as a treatment for actinic keratoses (AK), with new sunlight‐based regimens proposed as alternatives to lamp‐based treatments. Prescribing indoor ...daylight activation could help address the seasonal temperature, clinical supervision, and access variability associated with outdoor treatments.
Objective
To compare the AK lesion clearance efficacy of indoor daylight PDT treatment (30 min of 5‐aminolevulinic acid (ALA) pre‐incubation, followed by 2 h of indoor sunlight) versus a lamp‐based PDT treatment (30 min of ALA preincubation, followed by 10 min of red light).
Methods
A prospective clinical trial was conducted with 41 patients. Topical 10% ALA was applied to the entire treatment site (face, forehead, scalp). Patients were assigned to either the lamp‐based or indoor daylight treatment. Actinic keratosis lesion counts were determined by clinical examination and recorded for pre‐treatment, 1‐month, and 6‐month follow‐up visits.
Results
There was no statistical difference in the efficacy of AK lesion clearance between the red‐lamp (1‐month clearance = 57 ± 17%, 6‐month clearance = 57 ± 20%) and indoor daylight treatment (1‐month clearance = 61 ± 19%, 6‐month clearance = 67 ± 20%). A 95% confidence interval of the difference of the means was measured between −4.4% and 13.4% for 1‐month, and −2.2% and +23.6% for 6‐month timepoints when comparing the indoor daylight to the red‐lamp treatment, with a priori interval of equivalence of ±20%.
Limitations
Ensuring an equivalent dose between the indoor and lamp treatment cohorts limited randomisation since it required performing indoor daylight treatments only during sunny days.
Conclusion
Indoor‐daylight PDT provided equivalent AK treatment efficacy to a lamp‐based regimen while overcoming temperature limitations and UV‐block sunscreen issues associated with outdoor sunlight treatments in the winter.
Clinical trial registration
Clinicaltrials.gov listing: NCT03805737.
Indoor daylight photodynamic therapy (PDT) for actinic keratoses (AKs) could overcome the treatment limitations associated with lamp‐based PDT and outdoor daylight treatments. This study shows AK clearance equivalency between indoor daylight and red‐lamp PDT treatments, such that its adoption could enable accessible, well‐tolerated, treatments throughout all seasons.
Summary
Background
Actinic keratosis (AK) is a common sun‐related skin condition, which can progress to squamous cell carcinoma and occur in cancerized fields.
Objectives
To investigate in a phase ...I/II trial the safety and efficacy of ingenol disoxate as topical field therapy for patients with AK on the balding scalp.
Methods
Part 1 was a phase I, open‐label, dose‐escalation trial investigating up to six doses of ingenol disoxate to determine the maximum tolerated dose (MTD). Part 2 was a phase II, randomized, double‐blind, parallel group, vehicle‐controlled trial. Patients were randomized 2 : 2 : 1 to receive ingenol disoxate 0·037%, 0·05% or vehicle gel once daily for two consecutive days. Percentage reduction in AK count from baseline, complete clearance (AKCLEAR 100) and partial clearance (≥ 75% AK count reduction; AKCLEAR 75) were assessed at week 8.
Results
The MTD in part 1 was 0·075% based on a dose‐dependent increase in the number and severity of adverse events. Two lower doses of ingenol disoxate gel (0·037%, 0·05%) were assessed in part 2, which showed a reduction in AK count from baseline to week 8 (0·037%, 72·7%; 0·05%, 78·5% vs. vehicle 12·6; P < 0·001), and rates of AKCLEAR 100 and AKCLEAR 75 were significantly higher in active treatment groups compared with vehicle (P ≤ 0·007). Local skin responses peaked at day 3 and declined rapidly. Adverse events were generally mild to moderate in intensity, and were most commonly application site pain/pruritus.
Conclusions
Ingenol disoxate 0·037% and 0·05% gel was effective and superior to vehicle, and well tolerated as field therapy for AK on the balding scalp.
What's already known about this topic?
Actinic keratosis (AK) occurs in areas of sun‐exposed skin and can progress to squamous cell carcinoma if left untreated.
The presence of subclinical invisible and clinically visible lesions in fields of cancerization warrants prompt treatment with effective field therapies.
Ingenol mebutate is an effective and well‐tolerated field therapy indicated for the treatment of AK in areas of skin up to 25 cm2; however, patients may require treatment for larger areas.
What does this study add?
This trial assessed ingenol disoxate gel, an ingenol derivative optimized for treatment of AK on areas between 25 cm2 and 250 cm2 on the balding scalp.
Ingenol disoxate 0·037% and 0·05% gel was effective as field treatment of AK on the balding scalp (25 cm2–250 cm2) and well tolerated based on the adverse event and local skin response profile.
Respond to this article
Linked Comment: Bower. Br J Dermatol 2017; 176:1425–1426
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