Maria Cristina Messina

Treatment of Cutaneous Tumors with Topical 5% Imiquimod Cream

INTRODUCTION There are various approaches to the treatment of cutaneous tumors; one of them is treatment with imiquimod, a synthetic toll-like receptor agonist with a low molecular weight that offers a topical, noninvasive, and non-surgical therapeutic option. The main objective of our study was to provide data on 89 patients who used a 5% imiquimod cream for the treatment of cutaneous tumors at the Cutaneous Oncology Group of the Dermatology Department of Hospital das Clinicas from 2003 to 2008. MATERIALS AND METHODS Here, we present our experience in the treatment of 123 cutaneous tumors of various types, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Bowen’s disease, erythroplasia of Queyrat, Paget’s disease, and trichoepithelioma, with 5% imiquimod cream from 2003 to 2008 in the Cutaneous Oncology Group of the Dermatology Department of Hospital das Clinicas. Patients were divided into two separate groups according to their diagnosis and comorbidities; these comorbidities included epidermodysplasia verruciformis, xeroderma pigmentosum, albinism, basal cell nevus syndrome, Brooke-Spiegler syndrome, HIV, chronic lymphocytic leukemia, B-cell lymphoma, and kidney transplantation. Treatment duration, response to imiquimod, follow-up, recurrence, and local and systemic reactions associated with use of the drug were analyzed. Epidemiological data were obtained and cure rates were calculated. RESULTS The ratio of women to men was 1.28:1, and the mean age was 63.1 years. Tumors were located mainly on the face, back, trunk, and legs. For patients with comorbidities, the overall cure rate was 38%. These specific patients demonstrated cure rates of 83.5% for superficial BCC and 50% for Bowen’s disease. Aggressive BCC and superficial and nodular BCC did not present a good response to treatment. Trichoepitheliomas and nodular BCC showed a partial response, and erythroplasia of Queyrat showed a complete response. For patients without comorbidities, the overall cure rate was 73%. For these patients, the cure rates were 85.7% for superficial and nodular BCC, 88% for superficial BCC, 57% for Bowen’s disease, 50% for nodular BCC, and 50% for aggressive BCC. One SCC lesion demonstrated a complete response, and tumors caused by Paget’s disease and erythroplasia of Queyrat presented a partial response. None of the tumors considered as clinically cured recurred. Thirty-seven lesions demonstrated no response to imiquimod. Having a cutaneous comorbidity, high-risk tumors such as mixed aggressive BCC (sclerodermiform or micronodular), nodular BCC, or Bowen’s disease, and presenting no local reaction to imiquimod were considered as risk factors for a worse prognosis. We demonstrate that patients with no response to imiquimod, even when they demonstrated no local reaction, can undergo another cycle of six weeks of imiquimod treatment and show a complete response. The healing pattern led to good cosmetic outcomes, and the side effects were tolerable. CONCLUSIONS Our experience confirms imiquimod as an effective treatment option for several types of cutaneous tumors, especially in patients without the cutaneous comorbidities cited above and with low-risk tumors. Imiquimod has a relatively low cost compared to other therapeutic options and can be delivered via ambulatory care to patients with surgery contraindications, and its side effects are tolerable.

Combined Treatment of Earlobe Keloids with Shaving, Cryosurgery, and Intralesional Steroid Injection: A 1‐Year Follow‐Up

Background Earlobe keloids are benign, fibrous proliferations that occur in predisposed persons at sites of cutaneous injury. No single best therapeutic modality is indicated. Objective To describe a 1‐year follow‐up of 12 patients with earlobe keloids treated by shaving followed by cryosurgery and intralesional injection of triamcinolone. Materials and Methods Twelve patients were treated with combined surgery and cryosurgery. Results After 1 year, major response was observed in nine cases (75%) and moderate response in two cases (16%); one case had a relapse 5 months after the surgery. Conclusion These results are highly encouraging because all patients showed improvement. Shaving associated with cryosurgery seems to be a useful treatment for large keloids scars.

É a biópsia incisional útil na classificação dos carcinomas basocelulares

BACKGROUND: Basal cell carcinoma is a tumor with many histologic types, each one with different aggressiveness potential. The known correlation between histologic types found in preoperative biopsy samples and excisional specimens is not absolute. Correspondence rates vary from 42.7 to 80.0% in medical literature. OBJECTIVE: To evaluate the correlation between histologic types of basal cell carcinoma in preoperative biopsies and their respective excised surgical specimens. METHODS: A retrospective analysis of 70 primary basal cell carcinoma cases submitted to preoperative biopsies and excisional surgery. The histologic evaluation was performed according to standard practice determining both the predominant and secondary histologic types found in preoperative biopsy materials and surgically excised specimens. RESULTS: There was a 78.3% correlation rate between the predominant histologic type of the biopsy and the surgical specimen, and an 87% correspondence between the predominant histologic type and/or secondary histologic type of the biopsy and/or predominant histologic type of the surgical specimen. CONCLUSION: The preoperative biopsy is useful for predicting the predominant basal cell carcinoma histologic type of the surgical excisional specimen in most cases. Nevertheless, when only the predominant histologic type found in biopsy is described, there is a 21.7% failure rate in diagnosis. When both predominant histologic types and secondary histologic types found in the biopsy are described, diagnostic failure drops to 13%.

Leg ulcers associated with factor V Leiden and prothrombin G20210A and methyltetrahydrofolate reductase mutations: successful treatment with warfarin.

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Guidelines of the Brazilian Dermatology Society for diagnosis, treatment and follow up of primary cutaneous melanoma - Part I

The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In the first part, the following clinical questions were answered: 1) The use of dermoscopy for diagnosis of primary cutaneous melanoma brings benefits for patients when compared with clinical examination? 2) Does dermoscopy favor diagnosis of nail apparatus melanoma? 3) Is there a prognostic difference when incisional or excisional biopsies are used? 4) Does revision by a pathologist trained in melanoma contribute to diagnosis and treatment of primary cutaneous melanoma? What margins should be used to treat lentigo maligna melanoma and melanoma in situ?

Correlação clínica e ultra-sonográfica na esclerodermia localizada cutânea

OBJETIVO: Apresentar os aspectos ultra-sonograficos da esclerodermia localizada e relaciona-los com os aspectos clinicos. MATERIAIS E METODOS: Foram analisadas 23 lesoes de esclerodermia localizada em 21 pacientes. Foi utilizado equipamento Logiq 700 com transdutor linear de 6-14 MHz. Foram avaliados, pelo dermatologista, o estagio da doenca (inflamatorio ou atrofico), e pelo radiologista, a espessura e a ecogenicidade da derme nas regioes afetadas e sas adjacentes. Foi feito acompanhamento de sete casos apos tratamento. RESULTADOS: Todas as lesoes apresentaram perda do padrao ultra-sonografico normal da derme. Os casos de lesao clinicamente atrofica (52,2%; 12/23) corresponderam a reducao da espessura e aumento da ecogenicidade da derme e os casos de lesao clinicamente inflamatoria (47,8%; 11/23) corresponderam a aumento da espessura e reducao da ecogenicidade da derme. Controles pos-tratamento mostraram alteracoes na espessura da derme. CONCLUSAO: Os achados ultra-sonograficos nos permitem associar o aumento da espessura e a reducao da ecogenicidade da derme com a fase inflamatoria da doenca, e a reducao da espessura e o aumento da ecogenicidade da derme com a fase atrofica da doenca. Notamos tambem que e possivel quantificar a espessura da derme e usar essa informacao no controle pos-tratamento associada a avaliacao clinica.

Brazilian guidelines for diagnosis, treatment and follow-up of primary cutaneous melanoma - Part II

The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed?