Line-Field Confocal Optical Coherence Tomography May Enhance Monitoring of Superficial Basal Cell Carcinoma Treated with Imiquimod 5% Cream: A Pilot Study

Line-field confocal optical coherence tomography (LC-OCT) is a novel, non-invasive technique for real-time skin imaging. Imiquimod (IQ) 5% cream is an immune response modifier currently approved for the treatment of small, superficial basal cell carcinoma (BCC). The aim of this study was to investigate if LC-OCT may be useful to enhance the treatment monitoring of BCC. Twenty superficial BCCs from 12 patients were treated with IQ 5% cream once daily, five days a week, for six weeks. Clinical and LC-OCT evaluations were performed at baseline and 4 weeks after the end of treatment. At the end of the study, 13 lesions showed a complete clinical and LC-OCT response, 4 lesions a partial clinical and LC-OCT response, and 3 lesions a complete clinical response but residual tumoral signs at LC-OCT. Our pilot study suggests that LC-OCT may represent a promising tool able to enhance the evaluation of the treatment response of BCCs to non-invasive treatments. In our case series, its use highlighted, through a detailed, fast, and complete examination of the treated area, three cases of residual BCC that otherwise would have gone undetected at clinical examination. Future studies on larger series of patients treated with different modalities and with a longer follow-up are advisable.

Surgeon Experience Level and Number of Mohs Stages: A Prospective Observational Study of In-training Surgeons

Background Comparisons of Mohs surgeons by experience level (early-, mid-, late-career) and their respective number of stages taken during Mohs have not detected any difference. However, data comparing the number of stages for attending Mohs surgeons to Mohs fellows is non-existent. Objective To prospectively observe and compare the mean number of Mohs stages taken for attending Mohs surgeons and fellows. Methods/Materials Procedural data from 2,140 Mohs cases over 24 months was collected and divided into an attending or fellow surgeon cohort. Results The attending cohort had a higher mean number of stages for all nonmelanoma skin cancer when compared to the fellow cohort (p=0.005). The attending cohort demonstrated a higher mean number of stages for non-aggressive, non-superficial basal cell carcinoma (p<0.001), but no difference was found for other cancer subtypes. No difference was detected when comparing the two cohorts’ performance at high, medium, and low risk surgical areas. Conclusion The attending cohort had a higher mean number of stages overall for combined types of skin cancer and for non-aggressive, non-superficial basal cell carcinoma specifically when stratified by diagnosis as compared to the fellow cohort. No difference existed in the mean number of stages between the cohorts based on surgical area.

Chemical injury induced by the use of topical imiquimod: case report

Chemical injury consists in damage caused by a substance when it comes into contact with living tissue. Certain drugs can cause this type of lesion in the oral mucosa. Imiquimod (INN) is an example. Erythema, edema, vesicles, erosions, ulcerations and inflammatory reactions are among the adverse effects associated with the use of INN. Nevertheless, since its effects disappear when terminating treatment, INN is still considered an essential drug in the treatment of condyloma acuminata, actinic cheilitis, superficial basal cell carcinoma and molluscum contagiosum. The objective of this work is to report a clinical case of a 34-year-old male patient presenting a symptomatic lesion on the lower and upper lip mucosa; while including a literature review on potential adverse effects when prescribing topical INN 5% for the oral mucosa.

A review of emerging and non-US FDA-approved topical agents for the treatment of basal cell carcinoma

Although surgical therapy continues to be the gold standard for the treatment of basal cell carcinoma given high cure rates and the ability to histologically confirm tumor clearance, there are a number of nonsurgical treatment options that may be considered based on individual tumor characteristics, functional and cosmetic considerations, patient comorbidities and patient preference. Topical 5-fluorouracil 5% cream and imiquimod 5% cream have been US FDA-approved for the treatment of superficial basal cell carcinoma. Additionally, a number of new and emerging topical agents and techniques have been described for the treatment of basal cell carcinoma and will be reviewed herein.

Nanocarriers for Photodynamic Therapy Intended to Cutaneous Tumors

Photodynamic Therapy (PDT) is a therapeutic modality used for several malignant and premalignant skin disor-ders, including Bowen's disease skin cancers and Superficial Basal Cell Carcinoma (BCC). Several photosensitizers (PSs) have been explored for tumor destruction of skin cancers, after their activation by a light source of appropriate wavelength. Topical release of PSs avoids prolonged photosensitization reactions associated with systemic administration; however, its clinical usefulness is influenced by its poor tissue penetration and the stability of the active agent. Nanotechnology-based drug delivery systems are promising tool to enhance the efficiency for PDT of cancer. This review focuses on PSs encap-sulated in nanocarriers explored for PDT of skin tumors.