Topical 5% Imiquimod in the Treatment of Lentigo Maligna

2012 ◽  
Vol 16 (4) ◽  
pp. 245-249 ◽  
Author(s):  
Jessica G. Wong ◽  
Jack W.P. Toole ◽  
Alain A. Demers ◽  
Grace Musto ◽  
Marni C. Wiseman
Keyword(s):  
Effective Treatment ◽  
Tumor Size ◽  
Treatment Duration ◽  
Standard Treatment ◽  
Surgical Excision ◽  
Off Label Use ◽  
Lentigo Maligna ◽  
Imiquimod Cream ◽  
Off Label ◽  
The Mean

Background: Standard treatment for lentigo maligna (LM) is surgical excision with 5 to 10 mm margins. This can be cosmetically disfiguring. Imiquimod locally induces Toll-like receptors to release cytokines that destroy neoplastic melanocytes. Objective: The off-label use of topical 5% imiquimod cream may provide an alternative to surgery. This study reviews the use of imiquimod to treat LM. Methods: A 5-year retrospective and prospective chart analysis was conducted. Pretreatment biopsies confirmed the diagnosis. Treatment was individualized for each patient. Posttreatment biopsies and dermoscopy determined clearance of LM. Results: Twenty-seven patients were reviewed. There were 20 responders (74.1%) and 7 failures. The mean tumor size (area of an ellipse) was 6.69 cm2, and the mean treatment duration was 17.68 weeks. Neither the size of the tumor ( p = .86) nor treatment duration ( p = .18) was related to resolution of the lesion. Conclusion: Imiquimod is an effective treatment for LM that provides patients with a cosmetically favorable outcome when standard surgery is not an option.

scholarly journals Long-Term Outcomes of Radiofrequency Ablation for Treatment of Cystic Warthin Tumors versus Solid Warthin Tumors

2021 ◽  
Vol 18 (12) ◽  
pp. 6640
Author(s):  
Chih-Hung Cha ◽  
Sheng-Dean Luo ◽  
Pi-Ling Chiang ◽  
Wei-Chih Chen ◽  
Yu-Cheng Tung ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Effective Treatment ◽  
Tumor Size ◽  
Residual Tumor ◽  
Volume Reduction ◽  
Long Term Outcomes ◽  
Cystic Tumors ◽  
The Mean

Background: To describe the long-term outcomes of radiofrequency ablation (RFA) of parotid Warthin tumors that have different consistencies and locations. Methods: We reviewed ten patients with Warthin tumors undergoing RFA treatment from 2016 to 2019. The mean follow-up was 24.3 ± 13.1 months (range 7–42 months). Results: RFA was performed on 11 tumors in ten patients. Cystic tumors (n = 4) had better volume reduction ratios (VRR) than solid tumors (n = 7) at month one and month six, following RFA (77.9% vs. 47.3%, 95.1% vs. 80.6%, respectively, p = 0.003). Tumors in both superficial lobes and deep lobes (n = 7) were larger than tumors in superficial lobes alone (n = 4), though there was no difference in VRR after treatment. All residual tumors were found in superficial lobes. There was no increase in residual tumor size. Every patient showed marked cosmetic improvements, with visible tumors becoming non-palpable masses. Conclusions: RFA is a safe and effective treatment for Warthin tumors, with better volume reduction in cystic tumors. Results remained satisfying over the long-term for all residual tumors found in superficial lobes, making it easier for re-intervention if necessary.

scholarly journals Off-Label Use in Rare Diseases: Myasthenia Gravis, Lambert-Eaton Myasthenic Syndrome and Congenital Myasthenic Syndromes

2018 ◽  
Vol 2 (02) ◽  
pp. E118-E123
Author(s):  
Rudolf Janzen
Keyword(s):  
Myasthenia Gravis ◽  
Rare Diseases ◽  
Standard Treatment ◽  
Scientific Evidence ◽  
Off Label Use ◽  
Off Label ◽  
European Regulations ◽  
Myasthenic Syndrome ◽  
Regulatory Decisions ◽  
Label Use

AbstractThe off-label use of licensed drugs is widespread, and the risk of adverse events is elevated, especially if the scientific evidence is low. The treatment of rare diseases (<5/10,000) therefore may increase the risk of off-label use. The optimized standard treatment is primarily based on the regulatory decisions of the German Federal Joint Committee. The valid guidelines and the regulations of the German health system are discussed in this article. The criteria for indication and monitoring of off-label use are shown, especially focused on the problem of refractory myasthenia gravis. Escalation of treatment results regularly in off-label use. The arguments within the applicable guidelines should be followed. Some new aspects of the European regulations are likewise discussed.

scholarly journals Low Dose Gamma-knife Radiosurgery for Diffuse Brainstem Gliomas

2018 ◽  
Vol 25 (3) ◽  
pp. 217-225
Author(s):  
Julio C. Antico ◽  
Daniel Benzecry Almeida
Keyword(s):  
Effective Treatment ◽  
Gamma Knife ◽  
Tumor Size ◽  
Radiation Effects ◽  
Gamma Knife Radiosurgery ◽  
Prescription Dose ◽  
Brainstem Tumors ◽  
The Mean ◽  
Early Late

Introduction: Diffuse brainstem glial tumors remain a challenge. Despite many advances in neurosurgical techniques, no effective treatment is currently available. Recently, some authors showed beneficial results with gamma-knife radiosurgery (GK) for focal brainstem tumors. Objective: to analyze safety and effectiveness of GK in patients with diffuse brainstem gliomas. Methods: Eleven patients with diffuse brainstem gliomas treated with Gamma-knife from November 2001 to June 2009 were included. Complete data such as age, gender, symptoms, tumor size, prescription dose, adverse radiation effects and an early late follow-up were analyzed. Results: The mean age was 28.7 years (ranging from 1y 7m to 62y). Six patients were female and 5 were male. The gamma-knife prescription dose ranged from 6 to 7 Gy. All patients had clinical and imaging improvement at an early follow-up, although in 6, there was a late increase in tumor size and death. The others remained clinically stable or better. Larger tumors had a direct relationship with a poorer prognosis. No patient developed complications related to the radiosurgical treatment. Conclusion: Gamma-Knife is a safe and effective treatment for selected patients with diffuse brainstem tumors. The authors propose lower doses. Further studies are mandatory in order to analyze which patients could benefit from this treatment.

Indikationsfremde Anwendung von Medikamenten und Medizinprodukten in der Notfallmedizin

2019 ◽  
Vol 14 (04) ◽  
pp. 361-371
Author(s):  
Karl Peter Ittner ◽  
Joachim Koppenberg ◽  
Ute Walter
Keyword(s):  
Off Label Use ◽  
Off Label ◽  
Label Use

ZusammenfassungWenn zugelassene Arzneimittel außerhalb der in der entsprechenden Fachinformation dargelegten Beschreibungen angewendet werden, dann spricht man von einer nicht zulassungskonformen Anwendung oder von einem Off-Label-Use. Wie in fast allen medizinischen Fachgebieten gibt es auch im Rettungsdienst sogenannte Off-Label-Use-Pharmakotherapien. Sofern evidenzbasierte Informationen zu einer nicht zulassungskonformen Anwendung vorliegen, und insbesondere im konkreten Notfall keine zulassungskonforme Möglichkeit besteht, dann ist diese gerechtfertigt. Verwendet ein Notarzt aber ein Medizinprodukt außerhalb der Zulassung, dann stellt er ein neues Produkt her und haftet persönlich bei einem Patientenschaden.

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