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Eva Krishna Sutedja, Panji Respati Satjamanggala, Endang Sutedja, Kartika Ruchiatan Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Eva Krishna Sutedja, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62 8122014300, Email evakrishna@yahoo.comAbstract: Basal cell carcinoma (BCC) is a malignant tumor originating from epidermal cells. A case of BCC was reported in a 67-year-old female, with the initial complaint of skin-colored papules, which later turned into a nodule with erosion and crusts on the right shoulder. The diagnosis is established from findings consistent with nodular BCC on physical examination, and from dermoscopic appearance revealing ulceration, blue-gray ovoid nests, deeply pigmented border, and arborizing vessels. Histopathological examination showed tumor cells forming palisading structures with myxoid stroma, polymorphic, hyperchromatic and mitotic nuclei, as well as fibrocollagen connective tissue cells with lymphocyte infiltrates. Cryotherapy is a therapeutic option for BCC in old patients and has a cure rate of around 95%. Observation on the 25th day revealed clinical improvement with reduced nodular lesion size; thus, further cryotherapy was needed to enhance the therapeutic outcomes.Keywords: cryotherapy, histopathological examination, nodular basal cell carcinoma

[Display omitted] • Activity 1: Synthesis & characterisation of GNRs and hydrogel-forming materials. • Activity 2: Design, manufacture & characterisation of unloaded and GNRs-loaded HFLN. • Activity 3: In vitro/ex vivo investigation of GNRs-mediated PPTT using GNRs-loaded HFLN. Basal cell carcinoma (BCC) is the most common form of skin cancer and responsible for most of the cancer related morbidities and pose a significant public health concern worldwide. Surgery treatment modality is able to clear the BCC, yet it mostly leads to scar formation. Plasmonic photothermal therapy (PPTT) which involves using gold nanostructures and near-infrared (NIR) light to kill the BCC cells by local heating is associated with excellent tissue preservation and healing without scarring. Parenteral administration of such gold nanostructures suffers from off-target delivery and side effects. Delivering such phototherapeutics directly to the BCC proved to be an attractive alternative route of administration yet encountered with penetration limitations due to the stratum corneum (SC) fierce barrier. In the current study, we developed and optimised a novel NIR light-responsive hydrogel-forming long needle (HFLN) loaded with Gold nanorods (GNRs) as a potential plasmonic photothermal device for localised treatment of nodular BCC. The HFLN was prepared from Gantrez® S-97 and poly(ethylene glycol) (PEG) 200 Da and characterized in terms of swelling, insertion and mechanical properties. GNRs were synthesised and tunned using seed-mediated growth method. The integrated devices developed could revolutionise BCC treatment benefiting both patients and healthcare providers. [ABSTRACT FROM AUTHOR]

Background The role of dermoscopy in distinguishing the histopathological subtypes of basal cell carcinoma (BCC) is not fully elucidated. Aims To determine the accuracy of dermoscopy in diagnosing different BCC subtypes. Methods The dermoscopic features of 102 histopathologically verified BCCs were studied retrospectively. The tumours were classified as superficial (n=33,32.3%), nodular (n=46,45.1%) and aggressive (n=23,22.6%) BCCs by histopathology. Statistical analysis included Cohen's kappa test, proportion of correlation, measures of diagnostic accuracy, diagnostic odds ratio and the credibility ratio of positive (LR+) and negative (LR-) tests. Results The highest value in all performed tests was seen in superficial BCCs (kappa 0.85; proportion of correlation 93%; diagnostic accuracy 93.1%), good correlation was noted in nodular BCCs (kappa 0.62, proportion of correlation 80%; diagnostic accuracy 80.4%) but dermoscopic correlation with histopathology was low for aggressive BCCs (kappa 0.13; proportion of correlation 79%; diagnostic accuracy 78.4%). Short, fine telangiectasias (83.3%) showed the greatest importance for the diagnosis of superficial BCCs, blue-grey ovoid nests (61.8%) had the highest diagnostic accuracy in nodular BCCs, while arborising vessels (79.4%) was the most significant dermoscopic feature for the diagnosis of aggressive BCCs. Limitations This was a retrospective analysis and included only Caucasian patients from a single centre. Conclusion The highest agreement of dermoscopic features with the histologic type was found in superficial BCCs. We did not find any specific dermoscopic structure that could indicate a diagnosis of aggressive BCC. The presence of relevant dermoscopic features in the evaluated cases was determined by the depth of tumour invasion and not by its histology. [ABSTRACT FROM AUTHOR]

Background: Multiple studies have reported on dermoscopic structures in basal cell carcinoma (BCC) and its subtypes, with varying results.Objective: To systematically review the prevalence of dermoscopic structures in BCC and its subtypes.Methods: Databases and reference lists were searched for relevant trials according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for the relative proportion of BCC dermoscopic features. Random-effects models were used to estimate summary effect sizes.Results: Included were 31 studies consisting of 5950 BCCs. The most common dermoscopic features seen in BCC were arborizing vessels (59%), shiny white structures (49%), and large blue-grey ovoid nests (34%). Arborizing vessels, ulceration, and blue-grey ovoid nests and globules were most common in nodular BCC; short-fine telangiectasia, multiple small erosions, and leaf-like, spoke wheel and concentric structures in superficial BCC; porcelain white areas and arborizing vessels in morpheaform BCC; and arborizing vessels and ulceration in infiltrative BCC.Limitations: Studies had significant heterogeneity. Studies reporting BCC histopathologic subtypes did not provide clinical data on pigmentation of lesions.Conclusion: In addition to arborizing vessels, shiny white structures are a common feature of BCC. A constellation of dermoscopic features may aid in differentiating between BCC histopathologic subtypes. [ABSTRACT FROM AUTHOR]

Background: Photodynamic therapy (PDT) with topical δ-Aminolevulinic acid (ALA) has efficacy in treating basal cell carcinoma (BCC) but is limited by incomplete penetration of ALA into the deeper dermis. This prospective open-label pilot trial investigated the safety and efficacy of photosensitizer jet injection for PDT (JI-PDT) for BCC treatment. It was performed with 15 patients (n = 15) with histologically confirmed, untreated, low-risk nodular BCCs at a single institution., Methods: For the intervention, JI-PDT patients (n = 11) received two sessions of jet-injected ALA with PDT separated by four to 6 weeks. To further understand treatment technique, another group of patients (n = 4) received jet-injected ALA followed by tumor excision and fluorescence microscopy (JI-E). Treatment tolerability was assessed by local skin responses (LSR) score at five distinct time intervals. Fluorescence microscopy assessed protoporphyrin IX penetration depth and biodistribution within the tumor. At the primary endpoint, tumor clearance was evaluated via visual inspection, dermoscopy and reflectance confocal microscopy. Postinjection and postillumination pain levels, and patient satisfaction, were scored on a 0-10 scale., Results: Fifteen participants with mean age of 58.3, who were 15/15 White, non-Hispanic enrolled. The median composite LSR score immediately after JI-PDT was 5 (interquartile range [IQR] = 3) which decreased to 0.5 (IQR = 1) at primary endpoint (p < 0.01). Immunofluorescence of excised BCC tumors with jet-injected ALA showed photosensitizer penetration into papillary and reticular dermis. Of the 13 JI-PDT tumors, 11 had tumor clearance confirmed, 1 recurred, and 1 was lost to follow-up. 1/11 patients experienced a serious adverse event of cellulitis. 70% of patients had local scarring at 3 months. Patients reported an average pain level of 5.6 (standard deviation [SD] = 2.3) during jet injection and 3.7 (SD = 1.8) during light illumination., Conclusions: Jet injection of ALA for PDT treatment of nodular low-risk BCC is tolerable and feasible and may represent a novel modality to improve PDT., (© 2024 Wiley Periodicals LLC.)

A 64 year-old Caucasian male patient with a long history of ultraviolet light exposure and multiple actinic keratoses presented with a large, erythematous, and scaly plaque on his forehead. Biopsies revealed superficial basal cell carcinoma (sBCC). Because the patient wanted the shortest possible topical regimen, his sBCC was treated with two overnight ingenol mebutate (IM) 0.05% gel applications. He tolerated the local skin reaction (LSR) well, and at approximately six weeks post-treatment, biopsies showed no evidence of sBCC. The patient was happy with the cosmetic outcome and has remained free of clinical recurrence for 18 months. Although IM gel is only FDA approved for the treatment of actinic keratosis, it has also been used off-label to treat other epithelial lesions, including basal cell carcinoma (BCC), anogenital warts, and Bowen's disease. One clinical trial, multiple case series and case reports, and now this report, have demonstrated IM's utility in treating BCC. IM treatment is therefore a promising alternative to surgery for select BCC, with major advantages, including a short treatment duration and generally favorable cosmetic outcome. [ABSTRACT FROM AUTHOR]

Surgical excision is the first-choice treatment for basal cell carcinoma (BCC). Other treatments with topical agents such as 5-fluoruracil or imiquimod have also been suggested for use in superficial BCC (sBCC). Ingenol mebutate (IM) is a novel agent employed in the treatment of superficial actinic keratoses. The drug has been also successfully used in the treatment of sBCC. A case of large nodular BCC (nBCC) of the face in a 100-year-old inoperable woman is described. IM 0.015% gel was applied once daily for three consecutive days. This dose regimen was repeated for seven rounds within 11 months, with complete cure of the tumor. Mild local skin reactions, which were tolerated well, were observed. Selected cases of nBCC could be treated with IM gel, but the optimal concentration of the drug and the standard dose regimen of treatment are yet to be determined.

Background: Basal cell carcinoma of the skin (BCC, basalioma) is one of the most common malignant skin tumors. Dermoscopy is the most available today method of non-invasive diagnosis of skin tumors. Though, its usability is limited due to absence of prognostic dermoscopic criteria associated with different morphological variants of basalioma. Aim: To define dermoscopic features of different histological types of BCC. Materials and methods: 35 biopsy specimens from BCC lesions were evaluated. After clinical examination, superficial basalioma was diagnosed in 18 patients and nodular form in 17 patients. Results: Vascular structures were detected in 100% of cases. In patients with superficial multicentric type of basalioma, presence of all vascular types was a significant prognostic factor; predictive values of point- and spike-shaped vessels were 100 and 71.4%, respectively. Absence of point-shaped vessels and presence of other vascular types were associated with the prognosis of nodular basalioma. In patients with infiltrative type of basalioma, dendriform, tortuous and linear vessels in combination with short tiny teleangiectases and absence of spike-, comma-, point- or glome-like vessels had positive prognostic value. In patients with superficial multicentric and nodular types of basalioma, homogenous white and rose zones were most prevalent: in 53.8 and 57.1% of cases, respectively. In infiltrative type, this feature was typically absent (р

Nodular basal cell carcinoma is a deep skin lesion and one of the most common cancers. Conventional photodynamic therapy is limited to treatment of superficial skin lesions. The parenteral administration of near-IR preformed photosensitizers suffers from poor selectivity and may result in prolonged skin photosensitivity. Microneedles (MNs) can provide localized drug delivery to skin lesions. Intradermal delivery of the preformed near-IR photosensitizer; 5,10,15,20-tetrakis(2,6-difluoro-3- N -methylsulfamoylphenyl bacteriochlorin (Redaporfin™) using dissolving MN was successful in vitro and in vivo . MN demonstrated complete dissolution 30 min after skin application and showed sufficient mechanical strength to penetrate the skin to a depth of 450 μm. In vitro deposition studies illustrated that the drug was delivered and detected down to 5 mm in skin. In vivo biodistribution studies in athymic nude mice Crl:NU(NCr)- Foxn1 nu showed both fast initial release and localized drug delivery. The MN-treated mice showed a progressive decrease in the fluorescence intensity at the application site over the 7-day experiment period, with the highest and lowest fluorescence intensities measured being 9.2 × 10 10 ± 2.5 × 10 10 and 3.8 × 10 9 ± 1.6 × 10 9 p/s, respectively. By day 7, there was some migration of fluorescence away from the site of initial MN application. However, the majority of the body surfaces showed fluorescence levels that were comparable to those seen in the negative control group. This work suggests utility for polymeric MN arrays in minimally invasive intradermal delivery to enhance photodynamic therapy of deep skin lesions. [ABSTRACT FROM AUTHOR]

Background: Fast and simple microscopic evaluation of basal cell carcinoma (BCC) together with its subtype determination would accelerate diagnostic and therapeutic procedures in dermatology including Mohs surgery. Objectives: Assessing whether simplified 3‐criteria‐based ex vivo confocal microscopic (CM) examination can reliably predict BCC diagnosis and subtype. Analyzing interobserver agreement between expert and novice examiner. Methods: CM images of 235 skin samples from 150 patients were prospectively evaluated by 2 blinded examiners for the presence of 3 predefined BCC criteria namely presence of tumor mass, peripheral palisading and clefting. Results: Out of 235 skin samples 116 showed histological presence of BCC, confocally expert diagnosed a BCC in 110 and novice examiner in 107 samples. The overall sensitivity and specificity of detecting residual BCC was 96.6% and 98.7%, respectively. Confocally, examiners diagnosed correctly nodular BCC in 96.6%, respectively, 98.3%, superficial BCC in 96.8%, respectively, 93.5%, infiltrating BCC in 88.9%, respectively, 83.3% and other BCC subtype in 22.2%, respectively, 0% (expert and novice examiner, respectively). Conclusion: Ex vivo CM allowed intraoperative examination of BCC based on only 3‐criteria with high sensitivity and specificity, provided useful information on tumor subtype and showed that both experienced and non‐experienced examiners may use this diagnostic approach with excellent results. [ABSTRACT FROM AUTHOR]

Introduction: Basal cell carcinoma (BCC) is the most commonly occurring cancer worldwide, and the overall incidence is still rising. Unfortunately, the cancer registry in Poland does not record BCC individually. Thus, the incidence of BCC in a defined population is unknown. Aim: Analysis of incidence rates of primary BCC in central Poland during 16 years considering sex, site distribution and age to determine trends. Material and methods: We retrospectively included all cases of BCC which were diagnosed and treated in the Department of Dermatology and Venereology, Medical University of Lodz, during the 16-year period from 1999 to 2015. Results: We recorded 945 BCCs occurring in 890 patients (504 females - 57%, 386 males - 43%). Patient's age was between 21 and 94. A distinct increase in BCC was observed after 1999, while after 2010 during the next 2-year period a slight decrease was noted. A statistically significant correlation was observed between histopathological types of BCC and the location of the lesions. The superficial type predominates on photoprotected areas, especially on the trunk, while the nodular type occurs mainly in facial areas. No statistically significant correlation was observed between histopathological types of BCC and sex. We found a significant increase in incidence for superficial BCC among middle-age patients, while the nodular type was observed more frequently among elderly subjects. Conclusions: Basal cell carcinoma is quite common in Poland and predominantly develops in the facial area. In middle-age patients the most common is superficial BCC, while in elderly people the nodular type is most common. Based on our results we assume that there is a strong need to educate general physicians to enable them to diagnose BCC in the early stages. [ABSTRACT FROM AUTHOR]

Background Basal cell carcinoma ( BCC) may present as superficial subtype alone ( sBCC) or superficial combined with other subtypes. The objective of this study was to compare sBCC without or with other BCC subtypes by age, sex and anatomic site. Methods We retrospectively collected superficial BCC with the above characteristics from an Australian center during 2009 to 2014. Results We recorded 1528 sBCC and 1622 superficial BCC combined with other BCC subtype cases. Males numbered 2007 and females 1140. On males, head sites (forehead, cheek, nose and ear combined) compared to limb plus trunk sites displayed a higher incidence of superficial BCC combined with either nodular and or aggressive BCC subtypes ( OR 13.15 CI 95% 8.9-19.5 P < .0001). On females a similar comparison also found a higher incidence of superficial BCC combined with solid subtype BCC on head sites compared to trunk and limb sites ( OR 9.66 CI 95% 5.8-16.1 P < .0001). Conclusion Superficial BCC alone is more likely on younger females on trunk and limb sites. Small partial biopsies reported as sBCC may miss other BCC subtypes present with higher risk on facial sites for males and females. Males had smaller proportions of superficial only subtype BCC on facial and ear sites compared to females. [ABSTRACT FROM AUTHOR]

Context: Histopathological evaluations can differentiate between clinically resembling trichoepithelioma (TE) and basal cell carcinoma (BCC) unless the biopsy specimens are small or superficial. Previous studies used immunohistochemical evaluation for Bcl-2 and cytokeratin 15 (CK15), in attempts to differentiate between these two entities, with heterogeneous findings. Aims: This study intended to compare the rate and patterns of Bcl-2 and CK15 expressions between specimens of TE and nodular BCC. Settings and Design: Case-series including formalin-fixed, paraffin-embedded cutaneous biopsies. Subjects and Methods: Twenty-two BCC and 12 TE specimens were stained for Bcl-2 and CK15 and examined microscopically. The rate and patterns of expressions were compared between the two groups. Statistical Analysis Used: Statistical analysis was performed using the statistical software (SPSS version 16.0; SPSS Inc., Chicago, IL, USA), Pearson Chi-square, or Fisher′s exact tests, wherever appropriate. Results: The two groups were comparable for the expression rate and patterns of Bcl-2 (86.4%: 5 central, 14 diffuse in BCC vs. 83.3%: 2 central, 8 diffuse in TE; P = 0.59 and 0.54 for rate and pattern, respectively). The rate of CK15 expression was significantly higher in TE specimens (66.7%: 4 central, 3 diffuse, 1 peripheral vs. 4.5%: 1 central; P < 0.001). The positive likelihood ratio in distinguishing the two neoplasms was 14.7 (95% confidence interval: 2.1-103.7). Conclusions: CK15 but not Bcl-2 staining may help in differentiating between BCC and TE even in BCCs with follicular differentiation.

Several studies have proved the efficacy of photodynamic therapy (PDT) for low-risk basal cell carcinoma (BCC). The standard PDT treatment consists of two sessions performed with one-week interval 1. Although it is a well-tolerated treatment, the pain and the long stay at hospital area during PDT treatment must be improved. So, a new and portable PDT device was developed in order to offer part of PDT treatment at home. After a clinical and dermoscopic diagnosis, 8 nodular BCC were submitted to this pilot study. The lesions were debulked and the material taken to histological confirmation of BCC. Then, a 20% methyl aminolevunate cream was applied and the area was covered for 3 hours. The first illumination was performed at the hospital, using a commercial LED device system emitting at 630 nm. The lesion was illuminated for 20 minutes with 125 mW/cm2 totalizing 150J/cm2 of fluence. Immediately after the first illumination, a light layer cream was applied and the new portable irradiation device was fixed using a medical adhesive tape. The patient was sent home and advised to turn on the illumination after 1.5 hours, and turn it off after 2 hours (totalizing a 312J/cm2 of total fluence). Histological evaluation of the treated area was performed through a punch biopsy 30 days after treatment. The pain during PDT treatment was assessed every 3 minutes during the hospital session and self-reported every 20 minutes during home treatment on a numerical scale from 0 to 10. The median score values were compared between hospital and home treatments in 7 different moments using the T-Student test considering significant differences for a p-value <0,05. The patients were evaluated every 6 months through clinical and dermoscopy evaluation. The lesions comprised 8 nodular BCC (mean diameter of 8,38mm) distributed in 6 females and 9 males patients. The median age was 58 years old. Six BCC were located on trunk, and 2 were located on upper limbs. According to histological analysis, the clearance at 30 days after PDT was 86,67%. The pain score was significantly lower for the PDT treatment performed at home (Table 1). All the patients completed 1 year of follow up and showed no recurrence. Using a portable irradiation prototype delivering lower irradiance was possible to offer a less painful and more comfortable treatment. In this pilot study, our protocol presented promising results with 86.6% of clearance. A randomized clinical trial has been started (registration number: 32048720.8.0000.5434) to confirm these promising results and establishing this new protocol. [ABSTRACT FROM AUTHOR]

Background Surgical excision ( SE) is a first-line treatment for basal cell carcinoma ( BCC). Topical photodynamic therapy ( PDT) has also been used and has cosmetic advantages over surgery. The latest European guidelines for topical PDT recommended that it be used to treat nodular basal cell carcinoma ( nBCC) but a consensus has not been reached. Our study was to evaluate the efficacy of PDT versus SE for the treatment for nBCC by a meta-analysis. Materials and methods We searched PubMed, EMBASE, the Cochrane Library, CKNI, VIP, and relevant references up to October 2014 including randomized controlled trials ( RCTs) that compared PDT with SE for treatment of nBCC patients. A meta-analysis was conducted by using the Cochrane Collaboration's revman 5.0 software. Results We selected five studies that covered 596 of pathologically confirmed nBCC. We compared complete response rate ( RR) of PDT and SE at 3 months and 1, 2, 3, 4, and 5 years. We found that the RR was 0.95 (0.90, 1.00), 0.89 (0.80, 0.99), 0.83 (0.69, 1.00), 0.73 (0.63, 0.85), 0.84 (0.65, 1.08), and 0.79 (0.61, 1.03), respectively, for those time points, the cumulative probability of recurrence for the time points post-treatment, with an estimate at RR 5.28 (1.85, 15.12), 6.48 (2.46, 17.09), 9.67 (3.02, 30.99), 7.73 (2.81, 21.28), and 8.25 (3.01-22.62), respectively. Conclusion We observed no significant differences between PDT and SE for the complete RR, but there was an increased cumulative probability of recurrence. More large-scale RCTs are required to verify our findings. [ABSTRACT FROM AUTHOR]

Background: The management of basal cell carcinoma (BCC) depends, among other factors, on its histopathologic subtype. Although dermoscopic criteria of BCC have been investigated, the possible role of dermoscopy in predicting the tumor subtype remains unclear. Objectives: We sought to assess the diagnostic accuracy of dermoscopic criteria for differentiating superficial BCC (sBCC) from other BCC subtypes. Methods: Dermoscopic images of histopathologically confirmed BCCs were retrospectively evaluated for the presence of predefined criteria. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver operating characteristic curves. Results: In all, 77 sBCCs and 258 non-sBCCs were included. Maple leaf–like areas, short fine superficial telangiectasia, multiple small erosions, and shiny white-red structureless areas were potent predictors of sBCC, each making its diagnosis over 5-fold more likely. Conversely, the presence of arborizing vessels, blue-gray ovoid nests, and ulceration gave 11-fold, 15-fold, and 3-fold increased possibility for the diagnosis of non-sBCCs, respectively. Based on the results of the multivariate analysis, we propose a diagnostic algorithm that can predict the diagnosis of sBCC with a sensitivity of 81.9% and a specificity of 81.8%. Limitations: The retrospective design and the inclusion of only Caucasian patients are limitations. Conclusion: Dermoscopy is reliable in differentiating sBCC from other BCC subtypes. [Copyright &y& Elsevier]

Context: Histopathological evaluations can differentiate between clinically resembling trichoepithelioma (TE) and basal cell carcinoma (BCC) unless the biopsy specimens are small or superficial. Previous studies used immunohistochemical evaluation for Bcl-2 and cytokeratin 15 (CK15), in attempts to differentiate between these two entities, with heterogeneous findings. Aims: This study intended to compare the rate and patterns of Bcl-2 and CK15 expressions between specimens of TE and nodular BCC. Settings and Design: Case-series including formalin-fixed, paraffin-embedded cutaneous biopsies. Subjects and Methods: Twenty-two BCC and 12 TE specimens were stained for Bcl-2 and CK15 and examined microscopically. The rate and patterns of expressions were compared between the two groups. Statistical Analysis Used: Statistical analysis was performed using the statistical software (SPSS version 16.0; SPSS Inc., Chicago, IL, USA), Pearson Chi-square, or Fisher's exact tests, wherever appropriate. Results: The two groups were comparable for the expression rate and patterns of Bcl-2 (86.4%: 5 central, 14 diffuse in BCC vs. 83.3%: 2 central, 8 diffuse in TE; P = 0.59 and 0.54 for rate and pattern,respectively). The rate of CK15 expression was significantly higher in TE specimens (66.7%: 4 central, 3 diffuse, 1 peripheral vs. 4.5%: 1 central; P < 0.001). The positive likelihood ratio in distinguishing the two neoplasms was 14.7 (95% confidence interval: 2.1-103.7). Conclusions: CK15 but not Bcl-2 staining may help in differentiating between BCC and TE even in BCCs with follicular differentiation. [ABSTRACT FROM AUTHOR]

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. [Copyright &y& Elsevier]

Basal cell carcinoma (BCC) is the most common eyelid neoplasm comprising of about 90% of malignant tumors of eyelids. It is a slowly growing tumor and does not metastasize but can invade orbital and nearby intracranial structures. Histological subtypes of periocular BCC are nodular, infiltrative, sclerosing, micronodular, keratotic, basosquamous and superficial. We present a case of periocular BCC in an 83-year-old female which involved both upper and lower lids and medial canthus and had caused ulceration and ectropion of the lower lid with persistent watery eye. Histopathological examination of the lesion was consistent with nodular BCC. The patient was advised surgical excision of the tumor but the patient refused and was lost to follow-up. [ABSTRACT FROM AUTHOR]

• Photodynamic therapy with red light and metilaminolevulinic acid is commonly performed in two sessions one week apart. • There are limited long-term data about efficacy for small nodular basal cell carcinoma. • This long-term study improved the photodynamic therapy protocol without compromising its effectiveness; providing an effective and more comfortable treatment. Photodynamic therapy (PDT) has been reported as an excellent option for the treatment of small nodular basal cell carcinomas (nBCC). The standard protocol consists of two sessions, one week apart. Sometimes, returning to the hospital after one week can be impractical for elderly patients, due to comorbidities and mobility issues. Therefore, a new technique performed in one day could be superior for those patients. Evaluate the effectiveness of a PDT Single-visit protocol comparing to the standard protocol, as well as pain and long-term recurrence-free follow-up for nBCC. A total of 120 nBCC were treated through a Standard PDT protocol(two sessions, one week apart), and 120 nBCC were treated through a Single-visit PDT(two sessions in one day). A 30-day-after biopsy was performed in order to evaluate the results after the treatment. The lesions that had successful treatment were clinically and dermoscopically evaluated every 6 months up to 60 months. The pain score was compared between the groups(assessed every 3 min during PDT). A complete response at 30-days-after PDT biopsy was observed in 85% of Standard PDT and in 93.3% of Single-visit PDT. Regarding the pain during the illumination, less pain was observed during the second session of the Single-visit PDT. The recurrence-free follow up showed, after 60 months, an 69.0% cumulative probability of recurrence-free for Standard PDT and 80.6% for Single-visit PDT. The suggested Single-visit PDT protocol resulted in better outcomes at 30-day-after PDT biopsy and in lower recurrence rates than the Standard PDT protocol. A more comfortable and more efficient treatment was offered for the patients, with lower pain. [ABSTRACT FROM AUTHOR]

Background Skin cancer incidence rates have been increasing for decades and this increase is expected to continue. Surgical excision (SE) is the treatment of first choice for nodular basal cell carcinoma (nBCC). Photodynamic therapy (PDT) has proven to be an effective treatment for superficial basal cell carcinoma. Its long-term efficacy in nBCC has not yet been established. Objectives Prospectively compare the efficacy of 5-aminolaevulinic acid (ALA)–PDT and SE in terms of failure rates with long-term follow-up. Determinants of failure in the study population, such as the effect of tumour depth, were analysed retrospectively. Methods A randomized controlled trial in 173 primary nBCCs in 149 patients. Primary nBCCs were randomly assigned either to PDT ( n = 85) or to SE ( n = 88). Tumours treated with PDT were illuminated twice on the same day, 4 h after application of ALA cream, 3 weeks after debulking. SE was performed under local anaesthesia with a 3-mm margin, followed by histological examination. An intention-to-treat analysis was performed. Results In total, 171 primary nBCCs in 149 patients were treated. A 3-year interim analysis revealed that the cumulative incidence of failure was 2·3% for SE and 30·3% for PDT ( P < 0·001). Tumour depth and other analysed determinants of failure were not significantly related to treatment failure. Conclusions SE proved to be significantly more effective than treatment with fractionated illumination ALA–PDT. Therefore, in the treatment of primary nBCC, SE is preferred over PDT following this treatment regimen. [ABSTRACT FROM AUTHOR]

Summary: Background: Pain is a major side effect of topical photodynamic therapy (PDT), a relatively new and non-invasive treatment for particular types of basal cell carcinoma (BCC). In this study, we sought to characterise in more detail the quality and intensity of pain associated with PDT. Furthermore, we studied if gender, tumour size and localization as well as different light sources with comparable wavelengths had an influence on the pain. Methods: A total of 64 nodular BCCs in 55 patients, of which 48 BCCs underwent preceding debulking, were treated with 5-aminolevulinic acid (ALA-PDT). Two metal halogen light sources were randomly used. Pain assessment was performed using a visual analogue scale (VAS). Results: All patients experienced pain during illumination and 41.8% after illumination. The mean pain intensity was 3.88 with most patients experiencing burning (82.5%) or stinging (36.8%) sensations. Illumination with the Medeikonos® light source was experienced less painful than the Waldmann® lamp (4.64 versus 3.40; p =0.027). Gender as well as tumour localization and size did not alter the pain scores. Likewise, no differences were observed between patients who underwent debulking and those who did not. Conclusions: Treatment of single BCCs with ALA-PDT rarely results in unbearable pain. However, the degree of pain can vary depending on the light source used. Further studies are needed to unravel the pathomechanisms underlying the development of pain in PDT in order to develop adequate solutions for this undesirable side effect. [Copyright &y& Elsevier]

Surgical treatment of basal cell carcinomas using postoperative histological assessment is routinely practised in Australia. The efficacy of the procedure depends on key decisions made by the surgeon. The first is case selection that requires an understanding of the limitations of the procedure. The tumour border is then identified and a margin added. The margin selected should achieve the desired balance between incomplete excision rate and mean tissue sacrifice. There is an inverse relationship between these parameters; achieving a 5% incomplete excision rate requires a mean tissue sacrifice of over 4 mm. Factors affecting margin selection are discussed, unfortunately none allows a dramatic reduction in mean tissue sacrifice. The final decision involves interpreting and acting on the histological examination of the excised specimen. Tumour recurrence is rare (less than 2% at 5 years) if the tumour is clear of the surgical margin. The visualized histological margin required to ensure complete excision varies with histological technique and tumour properties. Routine reporting of histological margin in millimetres or horizontal sectioning is recommended. Tumour recurrence averages 38% when the histological margin is involved. The merits of careful clinical follow up of incompletely excised tumours or immediate re-excision are discussed. [ABSTRACT FROM AUTHOR]

• Partial debulking before MAL/PDT was tested for superficial and nodular BCC. • The high fluence applied (90 J/cm2) was effective and safe for all BCC treated. • Excellent or good cosmesis was observed over 3 years. The increase in the number of basal cell carcinoma (BCC) lesions has prompted use of minimally invasive therapies, including Photodynamic therapy (PDT).. The objective of the present work was to analyze the efficacy of methyl aminolevulinate-mediated photodynamic therapy (MAL-PDT) in patients suffering from superficial or nodular BCCs. A total of 220 BCC lesions (76 superficial and 144 nodular), clinically diagnosed and confirmed by histopathology analysis, were treated in 174 patients (mean age 72.5). Debulking using curettage was performed before two or three MAL-PDT sessions (λ = 630 nm; 90 J/cm2; 23 min) at 4-week intervals. Analyses of clinical clearance and cosmetic outcome were carried out by direct examination, dermoscopy, photographs, as well as by fluorescence diagnosis using a Wood's lamp. Evaluations were carried out at the different PDT sessions and follow-ups over a 3-year period. MAL-PDT was safe and highly tolerated. After an average of 2.6 MAL-PDT sessions, the overall clearance rate at 3-year follow-up was 96.1 % (95 % confidence interval [CI] 100 %–92 %) for superficial BCCs and 95.2 % (95 % [CI] 99 %-92 %) for nodular BCCs after an average of 2.7 sessions. Minimal side effects such as crushing, erythema and edema were reported. All BCC lesions showed excellent or good cosmetic results. The protocol followed in the present study has shown that MAL-PDT is a safe and effective treatment for superficial and nodular types of BCC. [ABSTRACT FROM AUTHOR]

Surgical excision is the first-choice treatment for basal cell carcinoma (BCC). Other treatments with topical agents such as 5-fluorouracil or imiquimod have also been suggested for use in superficial BCC (sBCC). Ingenol mebutate (IM) is a novel agent employed in the treatment of superficial actinic keratoses. The drug has been also successfully used in the treatment of sBCC. A case of large nodular BCC (nBCC) of the face in a 100-year-old inoperable woman is described. IM 0.015% gel was applied once daily for three consecutive days. This dose regimen was repeated for seven rounds within 11 months, with complete cure of the tumor. Mild local skin reactions, which were tolerated well, were observed. Selected cases of nBCC could be treated with IM gel, but the optimal concentration of the drug and the standard dose regimen of treatment are yet to be determined., Competing Interests: Competing interests: The authors have no conflicts of interest to disclose.

A letter to the editor is presented in response to the article, published by S. M. Campbell and colleagues, about the role of iron-chelating agent CP94 with 5-aminolaevulinic acid (ALA) cream for the enhancement of photodynamic therapy of nodular basal cell carcinoma.

Background The current guidelines for the management of basal cell carcinoma (BCC) suggest a different therapeutic approach according to histopathologic subtype. Although dermatoscopic and confocal criteria of BCC have been investigated, no specific studies were performed to evaluate the distinct reflectance confocal microscopy (RCM) aspects of BCC subtypes. Objectives To define the specific dermatoscopic and confocal criteria for delineating different BCC subtypes. Methods Dermatoscopic and confocal images of histopathologically confirmed BCCs were retrospectively evaluated for the presence of predefined criteria. Frequencies of dermatoscopic and confocal parameters are provided. Univariate and adjusted odds ratios were calculated. Discriminant analyses were performed to define the independent confocal criteria for distinct BCC subtypes. Results Eighty-eight BCCs were included. Dermatoscopically, superficial BCCs (n = 44) were primarily typified by the presence of fine telangiectasia, multiple erosions, leaf-like structures, and revealed cords connected to the epidermis and epidermal streaming upon RCM. Nodular BCCs (n = 22) featured the classic dermatoscopic features and well outlined large basaloid islands upon RCM. Infiltrative BCCs (n = 22) featured structureless, shiny red areas, fine telangiectasia, and arborizing vessels on dermatoscopy and dark silhouettes upon RCM. Limitations The retrospective design. Conclusion Dermatoscopy and confocal microscopy can reliably classify different BCC subtypes. [ABSTRACT FROM AUTHOR]

Background: Clinical differential diagnosis between incipient nodular basal carcinoma (NBC) and sebaceous hyperplasia (SH) of the face is difficult in some cases. A comparative histological analysis of these two entities led us to the hypothesis that 20MHz high-resolution ultrasonography (HRUS) may enable differentiation between NBC and SH., Patients and Methods: Seventy-seven facial tumours requiring histological confirmation to distinguish between NBC and SH were scanned using HRUS before excision. No other imaging technique was used. The ultrasound scans were submitted to two blinded reviewers who were asked to classify the ultrasound pictures of the tumours as either hypoechoic or isoechoic/hyperechoic. Hypoechogenicity was defined as a diagnostic criterion for NBC., Results: Reviewer response reproducibility for 2 images of the same tumour was 90%. Both reviewers agreed regarding the echogenicity classification of an image in 87.4% of cases. The sensitivity of the procedure was 90.9% for detection of NBC and 89.4% for detection of malignant lesions. Specificity was 69.6% for detection of basal cell carcinomas and 78.8% for detection of malignant lesions., Discussion: HRUS is a non-invasive examination technique with excellent sensitivity for the detection of NBC in differential diagnosis with SH. Hypoechogenicity is not specific to NBC. The sensitivity of HRUS in our study suffered as a result of ultrasonography difficulties regarding unexpected differential diagnoses of NBC as well as tumour localisation in seborrhoeic areas., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: In the last decades the number of skin carcinomas has dramatically increased, which is mainly connected with changes in lifestyle, especially with common use of artificial light sources such as sunbeds. Basal cell carcinoma (BCC) is the most common form of skin cancer in white populations. Basal cell carcinomas are divided into subtypes, depending on their clinical picture and histology. The main groups are nodular (nBCC) and superficial (sBCC) ones. The major recognized risk factors for basal cell carcinoma (BCC) are exposure to chronic and intermittent burning doses of sunlight. Other risk factors leading to the development of the nBCC and sBCC subtypes of BCC are not well established., Material and Methods: An analysis of 123 patients with either nBCC or sBCC, living in Lodz, Poland, regarding various intrinsic and environmental parameters was undertaken following the histological diagnosis of BCC., Results: No statistical differences were observed between the BCC subtype and sex, age, hair colour, eye colour, smoking, family history of skin cancer, occupation, or past episodes of sunburn. While sBCCs tended to occur on unexposed body sites in phototype I/II subjects who mainly avoided direct sunlight, nBCCs tended to occur on sun-exposed body sites in phototype III subjects who were frequently in direct sunlight., Conclusions: Thus the development of particular BCC subtypes is partially dependent on phototype and personal sun behaviour.