Vishal Madan

Non-melanoma skin cancer

The rising incidence and morbidity of non-melanoma skin cancers has generated great interest in unravelling of their pathogenesis and in the search for new non-invasive treatments. Whereas the role of cumulative sun exposure in pathogenesis of squamous-cell carcinoma seems clear, the relation between sun-exposure patterns and subtypes of basal-cell carcinoma remains undetermined. Several complex genotypic, phenotypic, and environmental factors contribute to pathogenesis of non-melanoma skin cancers. Unlike basal-cell carcinoma, squamous-cell carcinomas can arise from precursor lesions. Diagnosis of non-melanoma skin cancer is made clinically and confirmed by histological testing. Prognosis depends on lesion and host characteristics, which also dictate choice of treatment. Prevention strategies aim at reduction of sun exposure, but are of unproven benefit, especially for basal-cell carcinoma. Surgical excision with predetermined margins is the mainstay of treatment for squamous-cell carcinoma and for most basal-cell carcinomas. Of the new non-invasive treatments, only photodynamic therapy and topical imiquimod have become established treatments for specific subtypes of basal-cell carcinoma, and the search for more effective and tissue-salvaging therapies continues.

Nonmelanoma skin cancer

Nonmelanoma skin cancer (NMSC) represents the most common form of cancer in Caucasians, with continuing increase in incidence worldwide. Basal cell carcinoma (BCC) accounts for 75% of cases of NMSC, and squamous cell carcinoma (SCC) accounts for the remaining majority of NMSC cases. Whilst metastasis from BCC is extremely rare, metastasis from high-risk SCC may be fatal. In this article, we review the aetiology, diagnosis and management of NMSC.

Carbon dioxide laser treatment of rhinophyma: a review of 124 patients

Background  Rhinophyma is a progressive, localized or generalized nasal deformity resulting from hypertrophy of sebaceous and connective tissue. The CO2 laser has been used for treatment of rhinophyma, but the long‐term efficacy of the treatment is unknown.

Efficacy of topical tacrolimus 0.3% in clobetasol propionate 0.05% ointment in therapy-resistant cutaneous lupus erythematosus: a cohort study

Background.  Despite a range of available topical and systemic therapies, treatment of cutaneous lupus erythematosus (CLE) can be challenging.

Management of high-risk squamous cell carcinoma of the skin

Cutaneous squamous cell cancer (SCC) is the second most common skin cancer, accounting for one-fifth of all cutaneous malignancies. The majority arise on the head and neck skin, and cumulative UV exposure is thought to be the most likely etiological factor. The majority of deaths from SCC occur in a high-risk subgroup of patients. This high-risk subgroup of patients can be identified as those with tumors greater than 2 cm in diameter; tumor thickness over 4 mm; moderately/poorly differentiated or desmoplastic histological SCC subtype; ear, lip, hand, feet or genital tumor site; presence of perineural or lymphovascular invasion; nodal metastasis at presentation; recurrent SCC; SCC arising from scars or chronic skin disease, for example, chronic ulcers; and SCC arising in immunosuppressed patients. It is important to identify and aggressively treat these patients, as high-risk SCC are associated with a greater mortality and morbidity. This article reviews the diagnosis and management of such high-risk SCC.

A study of the efficacy of carbon dioxide and pigment-specific lasers in the treatment of medium-sized congenital melanocytic naevi

Background  Treatment of medium‐sized congenital melanocytic naevi (CMN) can be challenging.

Lentigo maligna--outcomes of treatment with Q-switched Nd:YAG and alexandrite lasers.

BACKGROUND Surgical excision is considered the criterion standard treatment for lentigo maligna (LM) but may sometimes be unsuitable for elderly people or in the treatment of large lesions. OBJECTIVE To evaluate the role of Q‐switched neodymium‐doped yttrium aluminium garnet (QS:Nd:YAG) and alexandrite lasers in the treatment of LM. METHODS QS:NdYAG and alexandrite lasers were used to treat histologically proven LM in 22 patients who were considered unsuitable for wide surgical excision or declined it. Patients were assessed at 6‐month intervals for a maximum period of 5 years. RESULTS Complete clinical response was achieved in 12 patients after one to four treatments and a follow‐up of 2 to 5 years after last treatment. Excellent cosmesis was achieved in all patients. LM melanoma developed in two lesions, which were subsequently excised. Recurrence occurred in four patients. CONCLUSION Although QS:Nd:YAG and alexandrite laser treatment of LM produced long‐term clearance in 12 of the 22 patients, the ease and speed of this treatment and excellent cosmetic outcome achieved make this a suitable alternative to surgical excision, especially in elderly people, in treatment of large lesions, or in patients who refuse surgical treatment. The authors have indicated no significant interest with commercial supporters.

Focus on Basal Cell Carcinoma

Nonmelanoma skin cancers (NMSCs), which include basal and squamous cell cancers are the most common human cancers. BCCs have a relatively low metastatic rate and slow growth and are frequently underreported. Whilst there is a definite role of sunexposure in the pathogenesis of BCC, several additional complex genotypic, phenotypic and environmental factors are contributory. The high prevalence and the frequent occurrence of multiple primary BCC in affected individuals make them an important public health problem. This has led to a substantial increase in search for newer noninvasive treatments for BCC. Surgical excision with predetermined margins remains the mainstay treatment for most BCC. Of the newer non-invasive treatments only photodynamic therapy and topical imiquimod have become established in the treatment of certain BCC subtypes, while the search for other more effective and tissue salvaging therapies continues. This paper focuses on the pathogenesis and management of BCC.

Pulsed-dye laser treatment of angioma serpiginosum

Angioma serpiginosum (AS) is a rare, benign, vascular disorder comprising nonblanchable punctate red to purple lesions in a gyrate or serpiginous configuration. Tunable pulsed‐dye laser (PDL) therapy has been successfully used in the treatment of AS. We report our results of treatment of 12 AS sites in eight patients who were treated with PDL. After an average of 3.75 treatments, complete resolution of AS was seen in five lesions, an excellent response in four and a good response in three. Self‐limiting hyperpigmentation at the test sites was noted in two patients. This study provides further evidence of the efficacy of PDL for treatment of AS.

Systemic photodynamic therapy with Photofrin for naevoid basal cell carcinoma syndrome—A pilot study

BACKGROUND Treatment of basal cell carcinomas in naevoid basal cell carcinoma syndrome (NBCCS) poses several challenges. The sheer numbers of such lesions in these patients makes traditional therapeutic modalities like surgery, impractical. Topical photodynamic therapy (PDT) with δ-5-amino levulinic acid has increasingly been recognised as and safe and effective choice in the treatment of BCC. The probability of local control of BCC treated by PDT depends strongly on lesion thickness, thick nodular lesions being less responsive. Response to treatment is monitored by the reduction in the lesional size, but histopathological confirmation of regression is often required. METHOD We used systemic photodynamic therapy with Porfimer Sodium (Photofrin(®), Axcan Pharma Inc., Quebec, Canada), a systemic photosensitizer for treating multiple BCC in seven patients with NBCCS. Treatment response was monitored using a high resolution 20MHz ultrasound. RESULTS There was a substantial reduction in the number of superficial basal cell carcinomas with complete US regression after one treatment. A 74.2% reduction was seen in the size of thick lesions treated with external light. Thick nodular lesions in two patients treated with interstitial optical diffuser fibres in addition to external light showed 87.6% reduction in size as measured by high resolution ultrasound. CONCLUSIONS Our preliminary results indicate that systemic photodynamic therapy using Photofrin and external light either alone or with interstitial optical diffuser fibres; may be effective in treatment of multiple, thick and nodular BCC lesions in Naevoid basal cell carcinoma syndrome. Further studies are needed to confirm our observations. We found high resolution ultrasound an effective alternative to histopathological analysis in monitoring the response to treatment.