Marieke H. Roozeboom

Overall treatment success after treatment of primary superficial basal cell carcinoma: a systematic review and meta-analysis of randomized and nonrandomized trials

Background  Several noninvasive treatment modalities are available for superficial basal cell carcinoma (sBCC).

Fractionated 5-aminolevulinic acid photodynamic therapy after partial debulking versus surgical excision for nodular basal cell carcinoma: A randomized controlled trial with at least 5-year follow-up

BACKGROUND Although effective in superficial basal cell carcinoma (BCC), the treatment effect of photodynamic therapy (PDT) in nodular BCC (nBCC) is still questionable. The relation between tumor thickness and PDT failure is unclear. OBJECTIVE We sought to compare long-term effectiveness of fractionated 20% 5-aminolevulinic acid (ALA)-PDT with prior partial debulking versus surgical excision in nBCC. The effect of tumor thickness on ALA-PDT failure was analyzed. METHODS 173 primary, histologically proven nBCCs in 151 patients were randomized to fractionated ALA-PDT (n = 85) or surgical excision (n = 88). Two PDT illuminations were performed with a 1-hour interval. Follow-up was at least 5 years posttreatment. Clinical recurrences were confirmed histologically. RESULTS A total of 171 nBCCs were treated and had a median follow-up of 67 months (range 0-106). At 60 months, 23 tumors had recurred in the ALA-PDT group and 2 tumors in the surgical excision group. Cumulative recurrence probabilities 5 years posttreatment were 30.7% (95% confidence interval [CI] 21.5%-42.6%) for ALA-PDT and 2.3% (95% CI 0.6%-8.8%) for surgical excision (P < .0001). Two tumors in the ALA-PDT group recurred at 72 and 91 months posttreatment. Cumulative probability of recurrence-free survival post-PDT was 65.0% (95% CI 51%-76%) for nBCC measuring greater than 0.7 mm in thickness and 94.4% (95% CI 67%-99%, P = .018) for tumors less than or equal to 0.7 mm. LIMITATIONS Tumor thickness on punch biopsy specimen might differ from the total lesion thickness. CONCLUSIONS In nBCC, 5-year cumulative probability of recurrence after surgical excision is lower than after fractionated ALA-PDT with prior debulking. Although surgical excision remains the gold standard of treatment, PDT might be an alternative for inoperable patients with thin (≤0.7 mm) nBCC.

Agreement between histological subtype on punch biopsy and surgical excision in primary basal cell carcinoma

Background  Diagnosis of clinically suspected basal cell carcinoma (BCC) by histological confirmation with punch biopsy has been recommended before treatment. Even shave biopsy has been proposed as useful to predict the correct subtype in primary BCC in 76–81%, whereas the agreement between histological BCC subtype on punch biopsy and subsequent excision specimens in recurrent BCC is 67.1%. However, no large studies on the agreement between histological BCC subtype seen on punch biopsy and the following surgical excision are performed in primary BCC.

Photodynamic therapy vs. topical imiquimod for treatment of superficial basal cell carcinoma: a subgroup analysis within a noninferiority randomized controlled trial

A recent noninferiority randomized controlled trial (RCT) indicated that imiquimod can be considered as superior to methylaminolevulinate photodynamic therapy (MAL‐PDT) in the treatment of superficial basal cell carcinoma (sBCC). Knowledge of treatment effectiveness in subgroups of patients is of great value in clinical practice to select the most effective treatment for an individual patient with sBCC.

Correlation Between Histological Findings on Punch Biopsy Specimens and Subsequent Excision Specimens in Cutaneous Squamous Cell Carcinoma

Diagnosis and subsequent treatment of cutaneous squamous cell carcinoma are frequently based on punch biopsies. Regarding the current TNM classification and stage grouping for cutaneous squamous cell carcinoma, it is important to identify the high-risk features (infiltration depth > 4 mm, perineural and/or lymphovascular invasion and poor differentiation). This study investigates the agreement of histological high-risk features and TNM grouping stage on 3 mm punch biopsies and subsequent surgical excision in 105 patients diagnosed with cutaneous squamous cell carcinoma. On punch biopsy, infiltration depth > 4 mm is not identified in 83.3% (30/36), perineural invasion in 90.9% (10/11) and poor differentiation in 85.7% (6/7) of cases. The TNM stage was underestimated on punch biopsy in 15.4% (16/104). This study shows that on a 3 mm punch biopsy, high-risk features in cSCC can remain undetected and that the actual TNM stage is not identified in 1 out of 6 tumours.

Subtyping Basal Cell Carcinoma by Clinical Diagnosis Versus Punch Biopsy

International guidelines on the diagnosis and treatment of basal cell carcinoma (BCC) recommend a punch biopsy in the majority of clinically suspected BCC prior to treat ment. This is to confirm diagnosis and to identify the histological subtype (superficial, nodular, aggressive), which is necessary to know for optimal treatment selection (1, 2). A punch biopsy can detect the most aggressive subtype in 84–92% of cases, but has the disadvantages of discomfort for the patient and costs for the health care system (3–5). In contrast, clinical diagnosis is a painless, and possibly money-saving procedure (6). However, the difference in diagnostic accuracy of BCC subtyping between punch biopsy and clinical diagnosis has never been evaluated. This study compares the diagnostic accuracy of clinical assessment and histological diagnosis by punch biopsy for subtyping of BCC. Furthermore, we evaluated the impact of omitting the punch biopsy on treatment recommendations.

Comparison of long term cosmetic outcomes for different treatments of superficial basal cell carcinoma

more dermatologic care, SAF teledermatology can increase access to improved dermatologic care overall. The findings of our pilot study indicate that implementation of a teledermatology platform enhances referring provider knowledge and empowers them to provide dermatologic care for their patients. Limitations to this study’s validity include small sample size and the fact that the survey knowledge questions were identical before and after the intervention. Further studies with larger cohorts will be needed to capture the benefit of adding access to other educational modalities, such as VisualDx, to the use of teledermatology.

使用分级5-氨基酮戊酸20%和二级局部氨基乙酰丙酸甲酯通过局部光动力疗法来治疗表浅性基底细胞癌:随机对照试验结果

光动力疗法(PDT)常用于治疗表浅性基底细胞癌(sBCC)。它通过将卟啉前体膏涂抹于所影响的皮肤部位,并盖上敷料来治疗。几小时后揭开闭合的敷料,使用高强度的可见光照射皮肤部位,使癌细胞死亡。荷兰有两种卟啉前体,分别为5‐氨基酮戊酸20% (ALA)和氨基乙酰丙酸甲酯(MAL)。在传统MAL PDT中,皮肤每隔一周照射一次(光治疗)。对于ALA,皮肤每隔两小时接受两次不同的照射。这被称为分级ALA‐PDT。在这项来自荷兰的研究中,我们调查了这种分级ALA‐PDT是否优于传统MAL‐PDT。162名患者被随机分成两组。82名患者使用分级ALA‐PDT治疗,80名患者使用传统MAL‐PDT。12个月后,ALA‐PDT组有6起治疗失败(sBCC复发),MAL‐PDT组有13起治疗失败。尽管MAL‐PDT组的治疗失败数量高出一倍,但这一差异不具有统计显著性。其次,我们调查了两个治疗组的疼痛分数,因为PDT据悉会引起严重的灼烧感。我们发现与MAL‐PDT相比,ALA‐PDT会导致更剧烈的疼痛和更多副作用,例如红斑(红疹,如晒斑)、伤口/糜烂和囊泡(小水泡)。因此,对于治疗sBCC,相比MAL‐PDT,ALA‐PDT趋向于有更好的疗效,尽管差异并不显著。