A Review of Immunocryosurgery and a Practical Guide to Its Applications

Immunocryosurgery is a minimally invasive combinational therapeutic procedure that has been designed, developed, and evaluated in the Dermatology Department of the University of Ioannina from 2004. In a fixed time protocol, this approach combines immune stimulatory therapy with imiquimod and cryosurgery, i.e., cryosurgery is applied during continuous imiquimod treatment. Laboratory findings in tissue and blood level credit the efficacy to the synergy of imiquimod and cryosurgery. The synergy has been established through clinical trials and the excellent feasibility and efficacy demonstrated in clinical practice. Immunocryosurgery has extensive proof of excellent efficacy, comparable to surgery, in the treatment of basal cell carcinoma. It has also been evaluated in cases of Bowen’s disease, keratoacanthoma, Merkel cell carcinoma, lentigo maligna, and cutaneous squamous cell carcinoma with or without the addition of adjuvants. The aims of this review are to detail the immunocryosurgery protocol with the addition of daily practice clinical tips, compile data on the mechanism of action of immunocryosurgery, and delineate indications and possible future applications. Most of the available data originate from the treatment of BCC, of all histological types and localizations, and the principles reported mainly reflect on evidence related to the treatment of this common skin cancer.

Laterality and site-specific distribution patterns of Lentigo Maligna and Lentigo Maligna Melanoma

Background: Melanoma has been described to have preferential left-sided laterality on the human body. The distribution and invasion patterns of lentigo maligna (LM) and lentigo maligna melanoma (LMM) have not been well described. Methods: This was a cross-sectional, retrospective study at a single, academic center. LM and LMM cases from 2008-2018 in the dermatopathology registry were analyzed. Results: A total of 392 cases were included (241 LM and 151 LMM). There was no laterality preference overall. The only exception were neoplasms located on the head/neck, which showed a left-sided laterality. LM and LMM had the highest incidence on the head/neck, followed by upper extremities, trunk, then lower extremities. Men had a higher incidence on the head/neck and trunk, while women had a higher incidence on the extremities. Interestingly, the upper extremities and the right side of the female body had a higher propensity for invasive lesions. Conclusion: While melanomas demonstrate preferential left-sided laterality, LM and LMM only share this pattern in respect to the head/neck region. Our results complement previous study findings which characterize LM and LMM as a head/neck and upper extremity pathology. Finally, our study suggests that certain body sites and laterality have an increased propensity for invasion.

795 Adequacy of Surgical Excision Margins in Lentigo Maligna: An Audit

Aim The optimal excision margin for Lentigo Maligna (LM) lesions has been a frequent topic of debate. An audit was carried out to compare the excision margins used for LM excisions with current NICE guidelines, and to assess the adequacy of these excision margins. Method A retrospective study was carried out to analyse all excisions of LM lesions in 2018. 33 patients were identified from the plastic surgery departmental database. Patient demographics, the site and distribution of LM lesions, and any history of previous skin cancer were analysed. Patient electronic records, operative notes, and histopathological reports were examined to determine the number of excisions done for each LM lesion along with the peripheral and deep surgical excision margins, and the histological clearance achieved. Complete histological clearance was determined by the Multidisciplinary team for each lesion. Results 60 cases were identified. 60% of cases were located on the head and neck. The average peripheral surgical excision margin at first excision was 2.3mm. 55% of patients had a 2nd excision. The average peripheral surgical excision margin at 2nd excision was 5.4mm. 70.6% of cases achieved complete histological clearance at 2nd excision. 72.7% of lesions excised at 2nd excision with a 5mm or less surgical excision margin achieved complete histological clearance. Conclusions Taking >5mm surgical excision margins did not increase the rate of complete histological clearance for Lentigo Maligna lesions.