Dermoscopic signs as predictors of non-response to imiquimod treatment in superficial basal cell carcinoma

Aguilar, J. Aróstegui; Garcés, M. Hervella; Bayona, Juan Ignacio Yanguas; Rodríguez, M. Azcona; Ezquerro, Iñigo Martínez de Espronceda; Aldecoa-Otalora, J Sarriugarte

doi:10.23938/assn.0722

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Apalla et al [ 22 ] also described the persistence of ovoid globular structures as markers of BCC early relapse. Aguilar and colleagues [ 23 ] indicated dermoscopic failure patterns among patients treated with imiquimod as another example of non-invasive treatment. The presence of arborizing telangiectasia, blue-gray ovoid nests, ulceration, perpendicular white lines (chrysalis) and white-red structureless areas correlated with poor response of the treated tumor.…”

Section: Discussionmentioning

confidence: 99%

Basal Cell Carcinoma After High Dose Rate Brachytherapy: Medium-term Dermoscopic Evaluation of Cancer’s Response

Krzysztofiak,

Suchorzepka,

Tukiendorf

et al. 2023

Dermatol Ther (Heidelb)

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Introduction Basal cell carcinoma of the facial region remains a challenge for contemporary oncology due to the presence of aesthetic regions and critical organs. Surgery is not always the optimal solution, and high dose rate (HDR) brachytherapy has emerged as an organ-sparing treatment method whose effectiveness has been proven by a growing number of publications. Dermoscopy is a diagnostic tool that bridges clinical and pathological examination of skin lesions. It is routinely used for diagnosis, monitoring of treatment, and post-treatment evaluation; however, the literature lacks data concerning changes in dermoscopic patterns of skin cancers during and after irradiation. Methods Our team conducted a prospective non-randomized trial of 39 patients with high-risk basal cell carcinomas (BCCs), mostly localized within the high-risk zone (H-zone) of the facial region, and who qualified for HDR brachytherapy. HDR contact brachytherapy with custom-made surface molds was introduced, delivering a dose of 45 Gy in 9 fractions prescribed to the tumor. Every patient was observed clinically and dermoscopically at three observational points: before treatment, at the end of treatment (3rd week), and 24 weeks after the end of therapy. The evolution of clinical and dermoscopic patterns was observed by two independent dermoscopists using current diagnostic criteria. A database of 12,088 photographic observations was evaluated. Results Univariate logistic regression proved that brachytherapy decreases the number of clinical and dermoscopic patterns typical for basal cell carcinoma, as well as dermoscopic features not related to BCC, presumably due to the formation of scar tissue. In addition, univariate logistic regression with random effects proved a positive correlation between tumor size and presence of various dermoscopic patterns typical for BCC. Conclusion Dermoscopy is proven to be easy to perform and an adequate monitoring tool for patients with BCCs undergoing HDR brachytherapy.

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Section: Discussionmentioning

confidence: 99%

Basal Cell Carcinoma After High Dose Rate Brachytherapy: Medium-term Dermoscopic Evaluation of Cancer’s Response

Krzysztofiak,

Suchorzepka,

Tukiendorf

et al. 2023

Dermatol Ther (Heidelb)

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“…Besides J. A.Aguilar et al determined dermatoscopic patterns of the basal cell carcinoma which are predictors of clinical response for the therapy with imiquimod. Available focally located gray spots and multiple erosions up to 2 mm are the most typical BCC signs which have a good reaction on the local treatment [11].…”

Section: Discussionmentioning

confidence: 99%

Clinical case of basal cell carcinoma therapy using 5 % imiquimod cream

et al. 2020

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A-research concept and design; B-collection and/or assembly of data; C-data analysis and interpretation; D-writing the article; E-critical revision of the article; F-final approval of the article Aim. To describe clinical case of the basal cell carcinoma treatment, determine personalized diagnostic algorithm of the patient management with further selection of the therapy method regarding visual, dermatoscopic and pathomorphological picture of disease. Materials and methods. The own observation of clinical case of local treatment of the patient with basal cell carcinoma by means of 5 % imiquimod cream was described. Results. Based on comprehensive examination of the patient with determination of features of visual, dermatoscopic and pathohistological picture the diagnosis "Basal cell carcinoma, nodular variant" was determined. Taking into account considerable traumatization and possibility of functional motor impairment after surgery it was determined to replace the treatment approach with the local use of 5 % imiquimod cream according to the standardized scheme. Step-by-step application of topical agent on the upper part of BCC affected area had also influence on the non-treated zone which began to regress by itself starting from the 9 th week. Spontaneous regress of BCC stipulates rare and unusual course of disease. Control clinical and pathomorphological examination did not reveal any neoplastic processes in skin after 12 weeks course of treatment with 5 % imiquimod cream and within 1 year of further observation. In case of BCC the possibility of using topical agents increases therapeutic potential and compliance between doctor and patient. Conclusions. Annual increase of quantity of new cases of non-melanoma skin tumours and variability of clinical implications enable the rise of oncological suspicion level among practicing physicians. Creation of personalized algorithm of diagnostics ensures making the diagnosis timely and selection of differential treatment approach. Neglecting the neoplasm with significant affected area size the topical use of 5 % imiquimod is the effective alternative to invasive intervention for treatment of patients with the basal cell carcinoma.

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Basal Cell Carcinoma Treated with High Dose Rate (HDR) Brachytherapy—Early Evaluation of Clinical and Dermoscopic Patterns during Irradiation

Krzysztofiak

Kamińska‐Winciorek

Tukiendorf

et al. 2021

Cancers

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Basal cell carcinoma (BCC) is the most frequent malignancy of the Caucasian population. Dermoscopy is an established diagnostic method providing the bridge between clinical and pathological examination. Surface skin high dose rate (HDR) brachytherapy is an organ sparing treatment method used for non-surgical candidates. This prospective study aimed to observe clinical and dermoscopic features and their evolution in 23 patients with pathologically confirmed BCC that have been treated with HDR brachytherapy. In all cases, custom-made surface moulds were used. HDR brachytherapy was performed with 192Ir, dose 45Gy was delivered to the tumour in nine fractions of 5Gy, three times a week. The evolution of clinical and dermoscopic features was followed up at the beginning of treatment, and on the day of every fraction (t1–t9). Dermoscopic evaluation of neoplastic and non-neoplastic structures was based on current diagnostic criteria according to current literature. Univariate logistic regression showed a decreasing number of clinical and pathological features of basal cell carcinoma with every treatment fraction. The effect was more strongly pronounced for cancer-related dermoscopic structures compared with non-neoplastic features. We used multivariate ordinal logistic regression with random effects to prove that the patients’ age corresponds with the tumour’s response to radiation—which may implicate a better response to treatment among older patients. High dose rate brachytherapy decreases the number of clinical and dermoscopic features typical for basal cell carcinoma. The effect is more pronounced among older patients.

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Dermoscopic signs as predictors of non-response to imiquimod treatment in superficial basal cell carcinoma

Abstract: ARTÍCULOS ORIGINALES bREvES0 Criterios dermatoscópicos como predictores de ausencia de respuesta a tratamiento con imiquimod en carcinomas basocelulares superficiales Dermoscopic signs as predictors of non-response to imiquimod treatment in superficial basal cell carcinoma

Cited by 3 publications

References 9 publications

Basal Cell Carcinoma After High Dose Rate Brachytherapy: Medium-term Dermoscopic Evaluation of Cancer’s Response

Basal Cell Carcinoma After High Dose Rate Brachytherapy: Medium-term Dermoscopic Evaluation of Cancer’s Response

Clinical case of basal cell carcinoma therapy using 5 % imiquimod cream

Basal Cell Carcinoma Treated with High Dose Rate (HDR) Brachytherapy—Early Evaluation of Clinical and Dermoscopic Patterns during Irradiation

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