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Background The incidence of actinic keratoses (AK) and non-melanoma skin cancer (NMSC) in organ transplant recipients (OTRs) is significantly higher than in immunocompetent patients. Rates of progression and recurrence following treatment are higher too, in part due to the effects of the immunosuppressant drugs. Conventional therapies for AK, using curettage, cryotherapy, surgical excision, topical therapies and photodynamic therapy (PDT), are often less effective, and may be inappropriate, for treating the greater numbers and extent of lesions in OTRs. Moreover, there are no specific protocols for treating this patient population that take into account the need for more frequent treatment and the increased pain associated with treating larger areas. Objectives Recently, a pan-European group of dermatologists with expertise in this area met to share current best practice in PDT for the treatment of AK in OTRs. Methods The group identified areas where PDT currently is not meeting the needs of these patients and discussed how these gaps might be addressed. Results/Conclusions This position article summarizes those discussions and makes recommendations concerning a standardized protocol for treating OTRs, for a large randomized controlled trial to provide robust data on safety, efficacy and optimal pain control, and to provide pharmaco-economics data that can be used to support extended reimbursement in this patient group. The authors also recommend a second clinical trial to further investigate induced immunosuppression with PDT in healthy volunteers. [ABSTRACT FROM AUTHOR]

The patched (PTCH) mutation rate in nevoid basal cell carcinoma syndrome (NBCCS) reported in various studies ranges from 40 to 80%. However, few studies have investigated the role of PTCH in clinical conditions suggesting an inherited predisposition to basal cell carcinoma (BCC), although it has been suggested that PTCH polymorphisms could predispose to multiple BCC (MBCC). In this study, we therefore performed an exhaustive analysis of PTCH (mutations detection and deletion analysis) in 17 patients with the full complement of criteria for NBCCS (14 sporadic and three familial cases), and in 48 patients suspected of having a genetic predisposition to BCC (MBCC and/or age at diagnosis < or =40 years and/or familial BCC). Eleven new germline alterations of the PTCH gene were characterised in 12 out of 17 patients harbouring the full complement of criteria for the syndrome (70%). These were frameshift mutations in five patients, nonsense mutations in five patients, a small inframe deletion in one patient, and a large germline deletion in another patient. Only one missense mutation (G774R) was found, and this was in a patient affected with MBCC, but without any other NBCCS criterion. We therefore suggest that patients harbouring the full complement of NBCCS criteria should as a priority be screened for PTCH mutations by sequencing, followed by a deletion analysis if no mutation is detected. In other clinical situations that suggest genetic predisposition to BCC, germline mutations of PTCH are not common. [ABSTRACT FROM AUTHOR]

Summary: An actinic keratosis (AK) is an area (lesion) of sun‐damaged skin, mainly found on sun‐exposed parts of the body, particularly the forearms, backs of the hands, face, ears, bald scalp and the lower legs. Left untreated, there is a small risk that an AK could progress into a form of skin cancer called squamous cell carcinoma. One way of treating AK is called photodynamic therapy (PDT). The usual, or conventional, protocol for using PDT to treat AK is called C‐PDT. It involves applying a light‐sensitising cream to the skin which is activated by a high‐intensity red light about 2.5 hours later. This causes intense inflammation in the skin which destroys abnormal, but not normal, skin tissue. The main drawback of C‐PDT is the pain experienced by patients during the treatment. Due to this pain, many patients cannot complete the treatment. The authors of this study, based in France and Germany, proposed a new protocol for PDT of AK, called P‐PDT. P‐PDT involves a revised red light activation: the light intensity has been considerably reduced and the activation begins only 30 minutes after the molecule (cream) application. This revision was expected to increase the patient's tolerance. The primary aim of the study was to assess whether P‐PDT is at least as effective as C‐PDT in destroying AK. One of the secondary aims was to compare pain levels between P‐PDT and C‐PDT. Forty‐six patients with AKs of the head were included. These patients were treated with P‐PDT on one side of the head and with C‐PDT on the other side. With 94.2% disappearance of AKs six months after the treatment, P‐PDT was found to be at least as effective as C‐PDT, which had a disappearance rate of 94.9%. Moreover, from the pain levels reported by the patients for each protocol, P‐PDT is much less painful, or even painless, compared to C‐PDT. This summary relates to the study: The conventional protocol vs. a protocol including illumination with a fabric‐based biophotonic device (the Phosistos protocol) in photodynamic therapy for actinic keratosis: a randomized, controlled, noninferiority clinical study Linked Article: Mordon et al. Br J Dermatol 2020; 182:76–84 [ABSTRACT FROM AUTHOR]

Summary: Actinic keratoses (AKs) are areas of sun‐damaged skin found mainly on sun‐exposed parts of the body, particularly the backs of the hands and forearms, the face and ears, and the scalp in balding men. They are usually harmless although they can be unsightly or inconvenient, and there is a very small risk of some actinic keratoses progressing to a form of skin cancer called squamous cell carcinoma. There are several possible treatments, including photodynamic therapy (PDT), in which a special light activates a cream called a photosensitiser, which has been applied to the affected area of skin. This treatment kills the abnormal cells in the skin. The photosensitisers approved in Europe for PDT of AKs require either activation by red light three hours after application of the photosensitiser (referred to as C‐PDT) or activation by daylight within 30 minutes following application of the photosensitiser (referred to as D‐PDT). The major drawback of C‐PDT is pain during treatment, whereas D‐PDT is nearly pain‐free due to the short time between photosensitiser application and daylight activation. Unfortunately, D‐PDT requires favourable weather conditions. The authors of this study, who belong to the ONCO‐THAI research unit based in France, therefore tested a way to activate the photosensitiser 30 minutes after application, by red light using a flexible, light‐emitting, fabric‐based device (hereinafter referred to as FLEXI‐PDT). This study aimed to assess whether FLEXI‐PDT is at least as effective as C‐PDT in destroying AK. The authors were also interested in whether pain scores differ between FLEXI‐PDT and C‐PDT. For these purposes, 35 patients with AKs on the scalp were treated with FLEXI‐PDT on one side of the scalp and with C‐PDT on the other side. Patients rated their pain during FLEXI‐PDT and during C‐PDT separately. The response of each AK (complete or incomplete disappearance) was assessed by a dermatologist at three months after treatment. From the analyses of the data collected, the authors showed that FLEXI‐PDT, which can be performed in all weather conditions, is at least as effective as and less painful than C‐PDT in destroying AK. Linked Article: Vicentini et al. Br J Dermatol 2019; 180:765–773 [ABSTRACT FROM AUTHOR]

The article presents a study on the condition of metastatic basal cell cercinoma (MBCC), referring to its rare condition, treatment, and the drugs possibly can be used. Study shows that the frequent overexpression of epidermal growth factor receptor in BCC prompted resulting to the use of antibody as palliative approach. It is noted that a chemotherapy is then interrupted due to a poor response following stabilization.