Management of malignant skin cancers

Malignant skin cancers are common and are increasing annually. They can be divided into two main groups, non-melanoma skin cancers (NMSC), which include basal cell carcinoma and squamous cell carcinoma, and malignant melanoma. This article reviews the various surgical and non-surgical treatment modalities available for the management of skin cancers.     

The management of malignant skin cancers

Malignant skin cancers are common and are ever increasing annually. They can be divided into two main groups, non-melanoma skin cancers (NMSC), which include basal cell carcinoma and squamous cell carcinoma, and malignant melanoma. This paper reviews the various surgical and non-surgical treatment modalities available for the management of skin cancers.     

The management of malignant skin cancers

Malignant skin cancers are common and are ever increasing annually. They can be divided into two main groups, non-melanoma skin cancers (NMSC), which include basal cell carcinoma and squamous cell carcinoma, and malignant melanoma. This article reviews the various surgical and non-surgical treatment modalities available for the management of skin cancers.     

Systemic strategies for chemoprevention of skin cancers in transplant recipients

BACKGROUND: Solid organ transplant recipients (OTRs) are a growing population at high risk for cutaneous neoplasms, resulting in significant post-transplant morbidity and mortality. Management of malignant and pre-malignant cutaneous lesions in transplant recipients is challenging, making prevention of such neoplasms paramount. The objectives of the present study are to review and analyze systemic strategies for chemoprevention of malignant and pre-malignant cutaneous neoplasms in OTRs. METHODS: MEDLINE and PubMed searches were performed to identify studies with original data quantifying the effects of systemic agents on the development of malignant cutaneous neoplasms in patients with solid organ transplants. RESULTS: We identified nine studies describing 111 transplant recipients that quantified the effects of oral retinoids on cutaneous neoplasms. A majority of the studies found a decrease in the number of malignant and pre-malignant cutaneous lesions in patients treated with systemic retinoids, with several studies noting increased benefit in those patients with multiple previous skin cancers. Multiple studies described a rebound effect, with increased numbers of neoplasms occurring following discontinuation of retinoids. Side effects often limited dosing, but required discontinuation of retinoids in a minority of patients. No studies were identified that adequately quantified the effects of other systemic agents on skin cancer incidence in this population. CONCLUSIONS: Although systemic retinoids are frequently used for chemoprevention of cutaneous malignancies in OTRs, the data supporting their use are composed largely of small uncontrolled case reports and case series. However, the available data suggest that retinoids have chemopreventative effects in this population. Although optimal dosing and indications for initiation of systemic retinoid therapy are not conclusive from the data, it suggests that retinoids are most effective in patients with multiple previous non-melanoma skin cancers. Side effects and beneficial effects were noted across a wide range of doses, suggesting that retinoids should be initiated at a low dose and increased as tolerated to a minimally effective dose. Further investigation through randomized controlled trials is needed to further clarify the tolerability and efficacy of multiple dosing regimens on the incidence of pre-malignant and malignant lesions in transplant recipients. The therapeutic role of other systemic agents in the transplant population has not been established.     

Autosomal dominant polycystic kidney disease: risk factor for nonmelanoma skin cancer following kidney transplantation

Nonmelanoma skin cancers (NMSC) are the most common malignant tumors following solid organ transplantation. Risk factors for NMSC mainly include immunosuppression, age, sun exposure and patient phototype. Recent findings have suggested that autosomal dominant polycystic kidney disease (ADPKD) may increase the risk of developing NMSC. We performed a monocenter retrospective study including all kidney recipients between 1985 and 2006 (n = 1019). We studied the incidence of NMSC, solid cancers and post‐transplantation lymphoproliferative disease (PTLD), and analyzed the following parameters: age, gender, phototype, time on dialysis, graft rank, immunosuppressive regimen, history of cancer and kidney disease (ADPKD versus others). Median follow‐up was 5.5 years (range: 0.02–20.6; 79 838 patient‐years). The cumulated incidence of NMSC 10 years after transplantation was 12.7% (9.3% for solid cancers and 3.5% for PTLD). Autosomal dominant polycystic kidney disease and age were risk factors for NMSC (HR 2.63; P < 0.0001 and HR 2.21; P < 0.001, respectively) using univariate analysis. The association between ADPKD and NMSC remained significant after adjustments for age, gender and phototype using multivariate analysis (HR 1.71; P = 0.0145) and for immunosuppressive regimens (P < 0.0001). Autosomal dominant polycystic kidney disease was not a risk factor for the occurrence of solid cancers after transplantation (HR 0.96; P = 0.89). Our findings suggest that ADPKD is an independent risk factor for developing NMSC after kidney transplantation.     

经直肠剪切波弹性成像对前列腺癌诊断价值的Meta分析

目的采用Meta分析评价经直肠剪切波弹性成像在前列腺癌诊断中的应用价值。方法检索2016年12月以前有关经直肠剪切波弹性成像诊断前列腺癌的中、英文文献,按照诊断性试验的纳入标准筛选文献,采用Meta-Disc 1.4及Stata 12.0软件对纳入的文献进行Meta分析。结果共纳入8篇文献,其中经直肠剪切波弹性成像诊断前列腺癌的研究有5篇,汇总分析后,其诊断前列腺癌的合并敏感度(SEN)为0.80[95%CI(0.75,0.84)],合并特异度(SPE)为0.75[95%CI(0.71,0.79)],阳性似然比(PLR)为3.60[95%CI(2.57,5.05)],阴性似然比(NLR)为0.17[95%CI(0.08,0.37)],SROC曲线下面积(AUC)为0.895。经直肠剪切波弹性成像辅助下穿刺诊断前列腺癌的研究亦是5篇,汇总分析后,其合并SEN为0.86[95%CI(0.83,0.88)],SPE为0.84[95%CI(0.82,0.85)],PLR为5.81[95%CI(3.07,10.99)],NLR为0.14[95%CI(0.04,0.49)],SROC曲线下面积(AUC)为0.924。结论经直肠剪切波弹性成像在前列腺癌诊断中有较好临床应用价值,且可作为经直肠超声引导下前列腺穿刺的辅助方法。     

Craniofacial surgery for nonmelanoma skin malignancy: report of an international collaborative study

BACKGROUND: This study examined the efficacy of craniofacial surgery (CFS) in treating locally advanced nonmelanoma skin cancer (NMSC). METHODS: One hundred twenty patients who underwent CFS for NMSC were identified from 17 participating institutions. Patient, tumor, and treatment information was analyzed for prognostic impact on survival. RESULTS: Surgical margins were negative in 74%, close in 3%, and involved in 23% of patients. Complications occurred in 35% of patients, half of which were local wound problems. Operative mortality was 4%. Median follow-up interval after CFS was 27 months. The 5-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates were 64%, 75%, and 60%, respectively. Squamous cell histology, brain invasion, and positive resection margins independently predicted worse OS, DSS, and RFS. CONCLUSION: CFS is an effective treatment for patients with NMSC invading the skull base. Histology, extent of disease, and resection margins are the most significant predictors of outcome.     

Using optical coherence tomography to evaluate skin sun damage and precancer

BACKGROUND AND OBJECTIVES: Optical coherence tomography (OCT) is a depth resolved imaging modality that may aid in identifying sun damaged skin and the precancerous condition actinic keratosis (AK). STUDY DESIGN/MATERIALS AND METHODS: OCT images were acquired of 112 patients at 2 sun protected and 2 sun exposed sites, with a subsequent biopsy. Each site received a dermatological evaluation, a histological diagnosis, and a solar elastosis (SE) score. OCT images were examined visually and statistically analyzed. RESULTS: Characteristic OCT image features were identified of sun protected, undiseased, sun damaged, and AK skin. A statistically significant difference (P<0.0001) between the average attenuation values of skin with minimal and severe solar elastosis was observed. Significant differences (P<0.0001) were also found between undiseased skin and AK using a gradient analysis. Using image features, AK could be distinguished from undiseased skin with 86% sensitivity and 83% specificity. CONCLUSION: OCT has the potential to guide biopsies and provide non-invasive measures of skin sun damage and disease state, possibly increasing efficiency of chemopreventive agent trials.     

利用体外碎石机低能量冲击波促进皮瓣成活的初步研究

目的:探讨利用体外碎石机低能量冲击波促进皮瓣成活的可行性及探索理想的实验条件。方法:应用X线定位系统的KDE-2001A型体外冲击波碎石机以0.18mJ/mm2能量冲击波治疗对20只大鼠背部皮瓣模型分为单纯皮瓣组和冲击波治疗组,进行同体成活率对比观察结果:冲击波治疗组坏死面积明显小于单纯皮瓣对照组;冲击波治疗组毛细血管分布明显密集于单纯皮瓣组。结论:0.18mJ/mm2能量冲击波亦可提高皮瓣成活率,以X线C型臂为定位系统的国内碎石机可满足实验要求。     

Platysma skin flap: Laryngeal repair material to produce phonatory flap vibrational wave

The platysma skin flap was used for laryngeal reconstruction after vertical partial laryngectomy to improve the postoperative voice quality of patients with T2 and T3 glottic laryngeal carcinoma. Sixty‐nine patients with unilateral T2 and T3 glottic laryngeal carcinoma were included. Forty‐six patients received vertical partial laryngectomy, and a platysma skin flap was used for laryngeal reconstruction. The other 23 patients underwent transoral laser microsurgery. Subjective and objective examinations were performed to evaluate laryngeal morphology after the surgery. Acceptable voice quality was achieved for 46 patients who underwent vertical partial laryngectomy. Flap vibrational waves occurred in 19 cases (41.3%). The platysma skin flap is an ideal tissue for the reconstruction of articulation structure in open surgery of T2 and T3 unilateral glottic laryngeal carcinoma.     

太赫兹波对MG-63荷瘤小鼠快速活体成像的实验研究

摘要 [目的]实验研究太赫兹波对人成骨肉瘤细胞株MG-63荷瘤小鼠活体体内恶性肿瘤组织能否显像及其特异性,并探讨太赫兹波技术在骨肉瘤肿瘤组织切除术中的指导作用。[方法]利用华中科技大学光电国家重点实验室连续太赫兹成像系统,进行人成骨肉瘤细胞株MG-63荷瘤小鼠活体的THz波显像,并在活体成像指导下进行瘤体切除术（实验组）与肉眼下行瘤体切除术（对照组）再次检测进行对比,术中取出组织送病理切片;将术后人成骨肉瘤MG-63荷瘤小鼠继续饲养一周后再次行THz波显像。[结果]活体人成骨肉瘤MG-63荷瘤小鼠体内瘤体组织处出现强烈吸收信号,与周围组织差异明显;术后THz波显像及病理切片均显示太赫兹波指导下行瘤体切除术比肉眼下行瘤体切除术更为彻底;继续饲养一周后对照组荷瘤小鼠原位再次复发。[结论]太赫兹波技术能对人成骨肉瘤细胞株MG-63荷瘤小鼠中肿瘤组织特异性显像,且能良好指导手术切除恶性肿瘤组织,有望在临床中应用。     

Magnetic resonance imaging findings of chronic plantar fasciitis before and after extracorporeal shock wave therapy

IntroductionThe objective of this study is to examine the relationships between treatment outcome and changes in magnetic resonance (MR) imaging findings after extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis.MethodsThe subjects were 23 feet of 23 patients of refractory plantar fasciitis. The mean age was 53.7 years. The thickness of the plantar fascia (PF) and findings of a high-signal intensity area (HSIA) inside the PF, edema around the PF, and bone marrow edema (BME) of the calcaneus were investigated on MR images. The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and a visual analogue scale (VAS) were used. Correlations between an improvement in symptoms and one in the MRI findings were analyzed.ResultsThe mean thickness of the PF was 4.4 ± 1.6 mm before ESWT and 4.6 ± 1.8 mm six months after ESWT. After ESWT, there was a decrease in the numbers of feet showing HSIA inside the PF from 15 to 6, in edema around the PF from 16 to 2, and in BME of the calcaneus from 11 to 4. Clinical outcomes improved with ESWT from 70.3 ± 5.5 to 88.6 ± 9.1 points (JSSF), 74.1 ± 25.3 to 28.5 ± 24.4 points (VAS), respectively. Improvements in symptoms according to the JSSF and VAS scores and improvement in edema around the PF on MR images showed a significant correlation.ConclusionsEdema around the PF improved significantly in association with an improvement in symptoms after ESWT.     

In vivo photoacoustic molecular imaging of the distribution of serum albumin in rat burned skin

Information on the state of edema is important for treating severe burn injuries, but a method for noninvasive real-time quantitative diagnosis of edema is not available. Thus, in vivo spatiotemporal characteristics of serum albumin, which would behave differently from water in burned tissue, are not fully understood. In this study, we used a photoacoustic (PA) imaging method to visualize depth distribution of albumin in a rat deep burn model, for which Evans blue was used as a nontoxic molecular probe. Water content in the tissue and urine volume were also measured for reference. We performed PA imaging of albumin in three regions in the rats, burn and nonburn regions and their boundary, and the imaging showed that albumin started to leak out of the vessels in the boundary and diffused within the burned tissue. Diffusion of albumin into the nonburn region, where water content was increased, was limited. In the burn and boundary regions, albumin-originating PA signal increased in two phases: immediately after making burns and from 24 to 72 h after burn. The second increase is attributable to the selective return of water to the vessels, resulting in increased concentration of albumin in extravascular tissue.     

Skin cancer in transplant recipients: Scientific retreat of the international immunosuppression and transplant skin cancer collaborative and skin care in organ transplant patients—Europe

The International Immunosuppression and Transplant Skin Cancer Collaborative (ITSCC) is an organization of more than 500 physicians and scientists focused on the treatment of cutaneous malignancies following solid organ transplantation and in other forms of immunosuppression. It is well known that solid organ transplant recipients (SOTRs) have an approximate 100‐fold increase in the risk of developing skin cancer with consensus guidelines recommending these patients be managed as high risk for local recurrence and metastasis associated with poor outcomes. In September 2018, ITSCC and its European counterpart, the Skin Care in Organ Transplant Patients—Europe (SCOPE), held their biennial scientific retreat in Essex, MA to discuss novel findings in the pathogenesis of cutaneous malignancy including new treatment and prevention strategies in this at‐risk population for significant morbidity and mortality from their cutaneous disease. This meeting report is a summary of the novel findings discussed.     

Prospects in radionuclide imaging of prostate cancer

Prostate cancer is the most common malignancy in men in the Western world and represents a major health problem with substantial morbidity and mortality. Sensitivity and specificity of digital rectal examination (DRE) and evaluation of prostate specific antigen (PSA) are excellent methods for diagnosis of prostate cancer, but have limited value for staging. Imaging of prostate cancer has become increasingly important to improve staging and management of prostate cancer patients. Conventional imaging modalities, such as transrectal ultrasound and computed tomography, show limited accuracy for a reliable assessment of prostate cancer. Diagnostic value of magnetic resonance imaging has improved by dynamic contrast enhancement (DCI-MRI) and diffusion-weighted magnetic resonance imaging (DWI). Recently, substantial progress has been made in the development of functional and molecular imaging modalities, such as positron emission tomography using radiolabeled metabolic tracers, receptor-binding ligands, amino acids, peptides, or antibodies. Here, we review the value of these novel radionuclide imaging techniques in the assessment of prostate cancer.