Update of cetuximab for non-melanoma skin cancer

Introduction: Non-melanoma skin cancer (NMSC) has become the most common malignancy in humans. Targeted therapies are recent developments for these tumors. Monoclonal antibody cetuximab has proven its efficacy and has improved tolerability compared to classical chemotherapy protocols, and this prompted us to analyze new data on the use of cetuximab in cutaneous NMSC.

Areas covered: The monoclonal antibody cetuximab against epidermal growth factor receptor (EGFR) has been investigated for its use in NMSC during the years between 2011 and 2013. A PUBMED research 2011 – 2013 has been conducted using the following terms: ‘Non-melanoma skin cancer AND cetuximab’, ‘cutaneous squamous cell carcinoma AND cetuximab’, and ‘basal cell carcinoma AND cetuximab’ and ‘cetuximab AND skin toxicity’. Available data were analyzed – irrespective of their level of evidence, that is, case reports and case series were included.

Expert opinion: Current evidence of cetuximab's efficacy in NMSC was mainly obtained in cutaneous squamous cell carcinoma (SCC) and to a lesser extent in basal cell carcinoma (BCC). Response rates vary for neoadjuvant, adjuvant, monotherapy and combined therapy with cetuximab. Limitations are the low number of patients treated (33 patients with SCC, 4 patients with BCC) and the low quality of studies reported. Management of cutaneous toxicities of EGFR inhibitors is necessary, and guidelines are available. Proactive therapy might also prevent skin toxicity of higher grades, with EGFR inhibitor cetuximab as an option for recurrent or advanced NMSC of the skin. It seems to be justified particularly in very high risk epithelial tumors. There is an urgent need for Phase III trials. In the future, combined drug therapy with other monoclonal antibodies and/or radiotherapy may further improve efficacy and response rates for NMSC.     

乳腺癌病人放射性皮肤损伤的护理现状

女性乳腺癌患病率一直居高不下,并且发病日趋年轻化。研究发现[1],对乳腺癌病人除应用手术治疗外再配以积极放疗,有利于病人的治疗和康复。放射治疗是通过放射线杀死残余癌细胞,防止向其他组织器官扩散,达到局部控制和根治的目的 [2]。     

Cetuximab in non-melanoma skin cancer

Human epidermal growth factor receptor 2 (HER2) was acknowledged as an important therapeutic target in breast cancer more than 25 years ago. Subsequently, significant basic science and translational discoveries have resulted in the approval of four HER2-targeted therapies over the past 15 years. This editorial discusses future challenges regarding selection and development of treatments for HER2-positive breast cancer, which can only be met by continuing to support research efforts into the basic mechanisms by which cancer cells escape targeted therapies. Identifying specific molecular mechanisms underlying the sensitivity or resistance to each HER2-targeted agent will ultimately allow individualized therapy for each patient.     

Precision laparoscopic sentinel node navigation surgery for femoral skin cancer

Navigation surgery using indocyanine green (ICG) fluorescence imaging has been used in thoracoabdominal surgery, and its usefulness has been reported in many cases. In this study, laparoscopic lateral lymph node dissection was performed using ICG fluorescence imaging in a patient with left femoral spinous cell carcinoma with inguinal and external iliac lymph node metastases. Spinous cell carcinoma is classified as a rare cancer in Japan, and there is a scarcity of evidence for pelvic lymph node dissection, as well as a lack of studies that mention the dissection area. We hypothesized that visualization of lymph nodes and lymph flow using intraoperative ICG fluorescence imaging would indicate the area of dissection and lead to more efficient dissection. In conclusion, intraoperative ICG fluorescence imaging may be useful in this area where there is limited evidence, although there are some limitations.     

Porocarcinoma of the left arm: A report of a rare skin cancer case and literature review

Porocarcinoma is a rare type of skin cancer that develops from the intraepidermal ductal part of eccrine sweat glands. It can arise de novo or from poroma ground with high potential for locoregional metastatic spread, morbidity, and mortality. It mostly occurs in elderly patients.     

Large papillary thyroid cancer bed recurrence causing overlying skin ulceration and bleeding

Salvage surgery is an acceptable option for palliative treatment of thyroid bed recurrence in metastatic papillary thyroid carcinoma when other non‐invasive options fail to control local skin complications.     

167例低位直肠癌患者术前行综合治疗的肛周皮肤护理

目的探讨低位直肠癌患者术前行综合治疗各时段肛周皮肤急性损伤的防治及护理方法。方法对2004年1月-2008年12月167铡低位直肠癌患者行术前放化疗综合治疗的病例资料进行回顾性分析。对患者效纯疗麓强旺周皮肤反应予以按时段针对性护理。结果综合治疗过程中,167例患者肛周皮肤急性损伤均控制在Ⅰ-Ⅱ度（按CTC3．0标准）,无1例患者因皮损反应严重中断治疗。结论低位直肠癌患者术前行放化疗综合治疗,肛周皮肤护理是护理工作重点之一。分时段的皮肤护理可将患者肛周皮肤急性反应有效控制在Ⅱ度以下,在一定程度上提高了治疗的依从性．值得临床推广。     

Clinical fetal monitoring

Abstract

Ultraviolet (UV) radiation is a notorious environmental carcinogen. Acute and chronic UV radiation exposure increase the risk for skin cancer. Protecting oneself from both UVA and UVB radiation with broad-based sunscreen can prevent certain skin cancers, their precursors, and photoaging. Although sun protection factor only measures UVB protection, it is essential to consider protection from UVA radiation when deciding on a particular sunscreen product. Awareness of particular controversies associated with sunscreen, such as vitamin D deficiency and sunscreen toxicity, is necessary to adequately counsel patients with sunscreen concerns. Additionally, all physicians should be familiar with sunscreen composition, proper use, and benefits while encouraging patient compliance.     

Snake Eyes: Coral Snake Neurotoxicity Associated With Ocular Absorption of Venom and Successful Treatment With Exotic Antivenom

Background

Coral snake bites from Micrurus fulvius and Micrurus tener account for < 1% of all snake bites in North America. Coral snake envenomation may cause significant neurotoxicity, including respiratory insufficiency, and its onset may be delayed up to 13 h.

前臂游离皮瓣修复舌癌切除后缺损围术期护理

目的总结前臂游离皮瓣修复舌癌切除后缺损围术期的护理方法。方法对33例前臂游离皮瓣移植修复舌癌术后缺损的患者进行术前、术后的护理,尤其是严密观察皮瓣血运,及早发现血管危象。结果 33例患者皮瓣全部成活,其中有2例是在及时发现并尽早处理血管危象后成功。结论通过对前臂游离皮瓣修复舌癌术后缺损患者进行积极有效的围术期护理,极大提高了手术成功率和患者术后生活质量。     

非黑色素性皮肤癌病人生命质量测评研究

介绍了非黑色素性皮肤癌的特点、治疗方法以及生命质量测评工具及其应用,并提出非黑色素性皮肤癌病人生命质量测评的研究前景。     

改良术式预防乳腺癌术后皮瓣坏死的临床研究

目的 :探讨降低乳腺癌根治术后皮瓣坏死发生率的方法。方法 :实验组 12 0例患者采用改进的新方法(即电刀操作为主 ,双管双负压引流 ,无压力包扎 ) ,对照组 187例患者仍采用传统手术方法 (即普通手术刀操作为主 ,单管负压皮下引流 ,纱垫衬垫加压包扎 ) ,对 2组结果进行对比观察。结果 :实验组皮瓣坏死率为 5 .0 0 % ,对照组为 5 0 .80 % ,两者有极显著差异 (P<0 .0 1)。结论 :在进行乳腺癌根治术时采取以电刀操作为主、双管双负压引流、无压力包扎等改进措施 ,能明显减少乳腺癌术后皮瓣坏死发生率。     

不同方法对喉癌气管套管患者放疗皮肤损伤保护的临床研究

目的保护喉癌气管套管患者放射野皮肤,降低放疗皮肤损伤发生率,提高患者舒适度。方法选取156例喉癌术后气管套管放疗患者,分为敷料组52例,皮肤保护膜组46例,对照组44例。对照组采用基础护理方法,敷料组在基础护理后应用水胶体敷料保护放射野皮肤;皮肤保护膜组采用金因肽皮肤保护膜喷剂保护放射野皮肤。结果皮肤保护膜组患者皮肤损伤发生率、每日换药次数、换药时间均低于敷料组和对照组(P0.01);患者舒适度优于敷料组和对照组(P0.01)。结论皮肤保护膜可有效减少喉癌气管套管患者放疗皮肤损伤发生率,缩短换药时间,提高患者舒适度,提高护理质量和效率。     

肿瘤病人PICC置入部位医用粘胶剂相关性皮肤损伤的多因素分析

目的:调查肿瘤病人经外周静脉置入中心静脉导管(PICC)置入部位医用粘胶剂相关性皮肤损伤(MARSI)发生情况,分析相关影响因素。方法:回顾性收集2020年9月1日—2020年11月1日某院静脉导管中心382例PICC置管肿瘤病人的住院病历临床资料,根据MARSI发生情况分为未发生MARSI组和发生MARSI组,采用单因素和多因素Logistic回归分析肿瘤病人PICC置入部位发生MARSI的危险因素。结果:发生MARSI 60例,发生率为15.71%(60/382);MARSI类型主要以接触性皮炎[61.67%(37/60)]及机械性损伤[28.33%(17/60)]为主。单因素分析显示,穿刺部位、敷料种类、更换频次及是否使用紫杉醇是肿瘤病人PICC置入部位发生MARSI的相关因素(P<0.05)。Logistic多因素回归分析显示,穿刺部位[OR=4.042,95%CI(1.914,8.539),P<0.05]、是否使用紫杉醇[OR=27.915,95%CI(12.852,60.634),P<0.05]以及更换频次[OR=2.896,95%CI(1.334,6.284),P<0.05]是肿瘤病人PICC置入部位发生MARSI的独立影响因素。结论:肿瘤病人PICC置入部位MARSI发生率高,发生类型以接触性皮炎及机械性损伤为主,透明敷料更换频率过高、肱二头肌内侧穿刺、使用紫杉醇是MARSI发生的危险因素。在PICC维护过程中应关注MARSI的危险因素及高危人群。     

厄洛替尼治疗晚期非小细胞肺癌并发皮肤不良反应的护理对策

目的：针对厄洛替尼小分子靶向药引起的皮肤不良反应,研究控制及护理对策。方法：按照国际统一分级标准,观察皮疹特点并评估,采用全身用药与局部用药相结合,中西医治疗相结合,多种护理方法并用等措施预防和控制皮肤损害。结果：多数病人的皮肤不良反应得以减轻或治愈,能较好的控制皮疹的周期性发作。结论：系统皮肤护理和适当的药物治疗有助于改善小分子靶向药引起的皮肤不良反应,配合完成抗肿瘤治疗。     

Voriconazole-associated phototoxic dermatoses and skin cancer

Voriconazole’s antifungal spectrum, oral bioavailability, and proven efficacy in treatment of invasive mycoses have led to its widespread off-label use for antifungal prophylaxis. There is an increasing recognition that long-term voriconazole use is associated with accelerated sun-induced skin changes that include acute phototoxicity reactions, photoaging, actinic keratosis and esp. among immunocompromised patients, skin cancers. The mechanisms underlying these dermatologic adverse events are not clearly understood. Population-risks of long-term voriconazole use need to be prospectively investigated. This review aims to provide an in-depth assessment of published literature and highlight salient findings from retrospective studies and case series. A broad practical guideline for assessment and management of these patients is provided.