光动力治疗老年性皮肤肿瘤应用及研究进展

皮肤肿瘤好发于老年人,其中较为常见的是非黑色素瘤皮肤癌(nonmelanoma skin cancer,NMSC)。光动力疗法近乎无创不损伤其他功能器官,对老年皮肤肿瘤具有安全、可重复、无耐药等优势。光动力疗法通过直接杀伤肿瘤及脉管系统、诱导抗瘤免疫等机制治疗皮肤肿瘤,临床上光动力治疗皮肤NMSC尤其是浅表性肿瘤疗效确切,亦可用于老年皮肤肿瘤预防、联合辅助治疗及姑息治疗。本文就光动力疗法治疗NMSC的现有研究成果进行综述。     

光动力治疗炎症性及感染性皮肤病的进展

光动力治疗在皮肤科领域应用广泛,如治疗鳞状细胞癌、基底细胞癌、Paget病、Bowen病、光线性角化病、痤疮、鲜红斑痣及尖锐湿疣等取得了满意疗效.目前关于光动力治疗适应证的研究已扩展到银屑病、口腔扁平苔藓及部分局部感染性皮肤病中,取得了一定的疗效,尤其是对面部扁平疣及皮肤利什曼病等几种炎症/感染性皮肤病,更显示出高效率、低复发及美容效果好等优点,值得进一步研究.     

ALA-PDT治疗皮肤肿瘤的长期疗效分析

目的了解5-氨基酮戊酸光动力疗法(ALA-PDT)治疗皮肤肿瘤的长期疗效。方法调查41名皮肤肿瘤患者,经光动力治疗或光动力联合激光、微波、手术、冷冻治疗后10年病情复发的情况。结果治愈率BCC为84.62%,Bowen病100%,乳房外Paget病50%,鲍温样丘疹病100%,日光性角化100%。鳞状细胞癌50%。3年后痊愈率,BCC为61.54%,Bowen病80%,鲍温样丘疹病85.71%,大部分日光性角化和鳞状细胞癌患者失访。已治愈的患者中,10年后只有1例BCC患者复发。结论 5-氨基酮戊酸光动力治疗皮肤肿瘤后如果3年不复发,其10年后也很少复发。     

干细胞在皮肤病中的应用

干细胞是存在于所有多细胞组织中,具有自我更新、增殖分化潜能的一种未分化细胞。干细胞的种类随研究的深入逐渐增多。干细胞治疗相关疾病的具体机制多数未明。目前在皮肤科领域,干细胞研究主要集中于皮肤损伤修复与组织工程学再生以及自身免疫相关性疾病、遗传性皮肤病、皮肤自然衰老与光老化、皮肤肿瘤等疾病治疗方面。干细胞应用的适应证随着研究的深入逐渐增加,特别在目前传统治疗方法棘手的自身免疫疾病、遗传性皮肤病、皮肤肿瘤等领域显示出优势。     

5-氨基酮戊酸光动力疗法治疗人乳头瘤病毒感染

光动力疗法(photodynamic therapy,PDT)是一种非侵入性靶向性治疗方法。用于治疗皮肤浅表肿瘤,如:日光性角化、基底细胞癌、鲍温病等。随着人们对ALA-PDT认识的深入,近年来该方法在皮肤科被用于治疗越来越多的非肿瘤性疾病,如:痤疮、光老化、银屑病、皮肤利什曼病、皮肤疣等。本文对ALA-PDT在治疗人乳头瘤病毒感染相关疾病中的应用进行了综述。     

紫外线皮肤光损伤及其防治的研究进展

皮肤直接受到日光紫外线照射，紫外线辐射后可诱发皮肤多种损伤，包括光老化、各种皮肤癌如基底细胞癌、鳞状细胞癌和恶性黑素瘤、光敏反应和光毒反应、光线性角化等各种与光有关的皮肤病。因此减缓和改善皮肤光损伤的研究是当今国际上最热点的领域之一。     

氨基酮戊酸光动力疗法临床应用专家共识

近年来氨基酮戊酸光动力治疗皮肤病在我国发展迅速。为规范、指导、推动氨基酮戊酸光动力治疗皮肤病,中华医学会皮肤性病学分会组织从事光动力治疗研究的相关专家集体讨论制定了本共识,供我国皮肤科医师以及其他相关学科医师在进行氨基酮戊酸光动力治疗实践时参考……     

光动力疗法治疗18例皮肤肿瘤

目的 观察光动力疗法在不宜行手术治疗的皮肤肿瘤中的疗效.方法 8例光线性角化病、6例鳞状细胞癌、3例Bowen病和1例基底细胞癌患者行氨基酮戊酸光动力治疗.氨基酮戊酸配成20％溶液涂于皮损,4～6h后行635 nm红光照射,能量密度为80～ 100 J/cm2,时间20 min,每周照射1次,共3 ～6次,疗程结束后观察疗效.结果 8例光线性角化病,4例鳞状细胞癌,3例Bowen病得到完全缓解,2例鳞状细胞癌,1例基底细胞癌得到部分缓解.18例患者在治疗结束后1、2、3、6个月随访时皮损均无复发.结论 氨基酮戊酸光动力疗法对于不宜行手术治疗的皮肤肿瘤是一种无创、无明显瘢痕形成的治疗方法.     

长链非编码RNA FEZF1-AS1靶向miR-4443促进非黑色素瘤皮肤癌转移

目的探索FEZF1-AS1在非黑色素瘤皮肤癌(Nonmelanoma skin carcinoma,NMSC)中与miR-4443的靶向调节关系。方法通过实时荧光定量聚合酶链反应(PCR)方法检测NMSC组织和癌旁正常组织的相对表达量;通过卡方检验分析FEZF1-AS1的表达量与临床特征之间的关系;通过MTT实验检测FEZF1-AS1异常表达对NMSC细胞增殖能力的影响;通过TRANSWELL实验检测FEZF1-AS1异常表达对NMSC细胞迁移和侵袭能力的影响;通过荧光素酶报告基因实验验证FEZF1-AS1与miR-4443之间的靶向调节关系。结果 FEZF1-AS1在NMSC组织中表达上调(P=0.046);且其高表达与性别(P=0.010)、肿瘤型别(P0.01)、疾病史(P=0.005)相关;FEZF1-AS1过表达能够促进NMSC细胞增殖(P0.01)、迁移(P0.01)和侵袭(P0.01);FEZF1-AS1与miR-4443存在靶向结合关系(P0.01)。结论 FEZF1-AS1靶向miR-4443促进NMSC细胞迁移、侵袭和增殖。     

光动力疗法治疗皮肤鳞状上皮细胞癌7例疗效观察

目的观察5-氨基酮戊酸光动力疗法(ALA-PDT)治疗皮肤鳞状细胞癌的临床疗效和复发率。方法对7例经组织病理学确诊的皮肤鳞状细胞癌进行(ALA-PDT治疗。结果经(3~6)次治疗后,7例患者溃疡面均被肉芽组织覆盖后愈合。随访6月后,均未发现原皮损处复发,2例患者治疗部位有轻度刺痛、瘙痒。结论对皮肤鳞状细胞癌尤其老年患者,ALA-PDT疗法损伤小、美容效果好。     

Realizing the cosmetic potential of topical photodynamic therapy

Several open studies report the efficacy of topical photodynamic therapy (PDT) for non-melanoma skin cancer (NMSC) and precursor lesions. PDT may also be effective in various inflammatory and infectious dermatoses. As a tissue sparing modality, PDT may be preferable for large and/or multiple lesions and those in sites where disfigurement or poor healing from conventional therapies is a particular risk. Limited comparison data confirms that topical PDT achieves superior cosmesis to conventional therapies in actinic keratoses, squamous cell carcinoma in-situ and basal cell carcinoma. This review assesses the current data and proposes potential future applications for topical PDT including the treatment of photo-damaged skin.     

Non-melanoma skin cancers: Photodynamic therapy,cryotherapy, 5-fluorouracil,imiquimod, diclofenac,or what? Facts and controversies

Surgical modalities–excision, Mohs micrographic surgery, and electrodesiccation with curettage–are the preferred treatments for nonmelanoma skin cancer (NMSC). When used within guidelines, they have cure rates greater than 90%. Despite this, many other treatments have been studied and utilized for NMSC. We present a comprehensive review of the literature on these topical treatments. Photodynamic therapy (PDT) is administered under numerous and significantly varied regimens, and there are a wide range of cure rates reported. Even with aggressive regimens, PDT is not as effective as surgery is, and it is not a first-line therapy for NMSC. The cryotherapy regimen aggressive enough to adequately treat NMSC carries adverse effects and cosmetic outcomes poor enough to negate its usefulness. Topical 5-fluorouracil and imiquimod are efficacious and safe for the treatment of superficial basal cell carcinoma (BCC) but not other BCC subtypes or squamous cell carcinoma. They are self-administered twice daily for several weeks; therefore, patient and tumor selection are vital to ensuring adherence. There are currently insufficient data to support the use of topical diclofenac and ingenol mebutate for NMSC.     

Nonmelanoma skin cancer after renal transplantation: a single-center experience in 1736 transplantations

Background Renal transplantation is associated with an increased incidence of nonmela‐noma skin cancer (NMSC) caused by immunosuppression. Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), the two major histological types of NMSC, exhibit more aggressive biological and clinical courses in renal transplant recipients (RTRs), with higher rates of recurrence and mortality than in the general population. Methods We retrospectively analyzed our experience of NMSC in 1736 renal transplantations performed over a 25‐year period. All cases of skin cancer after renal transplantation were included except those of skin cancer resulting from melanoma and mesenchymal skin tumors. Results In our series, the overall incidence of NMSC after transplantation was 2.2% (n = 39), and SCC represented the most frequent skin malignancy (64.1%), followed by BCC (17.9%), Bowen’s disease (10.2%), basosquamous carcinoma (5.1%), and a rare case of invasive sebaceous carcinoma (2.6%). A shift to newer immunosuppressive regimens after the initial diagnosis of NMSC had been implemented in eight cases (20.5%). The recurrence rate after initial treatment was 41% (n = 16), and distant metastatic disease was diagnosed in 15.4% (n = 6) of NMSC patients. The NMSC‐specific mortality rate was 25.6% (n = 10). Conclusions Nonmelanoma skin cancer remains a significant source of morbidity and mortality in RTRs, and post‐transplant surveillance should be increased.     

Photodynamic therapy using a novel photosensitizer,ATX-S10(Na): comparative effect with 5-aminolevulinic acid on squamous cell carcinoma cell line,SCC15, ultraviolet B-induced skin tumor,and phorbol ester-induced hyperproliferative skin

Photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA) is available for the treatment of actinic keratosis (AK). Recently, we developed a new PDT photosensitizer, ATX-S10(Na), and have shown that ATX-S10(Na) PDT is effective for the treatment of various human skin diseases, such as squamous cell carcinoma, Bowens disease, basal cell carcinoma, and psoriasis. In the present study, we compared the effects of ATX-S10(Na) PDT and ALA PDT on hyperproliferative skin induced by 12-O-tetradecanoylphorbol-13-acetate (TPA), on the squamous cell carcinoma cell line, SCC15, in vitro, and on UVB-induced skin tumors in vivo. TPA treatment induced epidermal acanthosis, which was more markedly suppressed by ATX-S10(Na) PDT than by ALA PDT. ATX-S10(Na) PDT more effectively eliminated UVB-induced AK and squamous cell carcinoma (SCC) than ALA PDT. Furthermore, both ATX-S10(Na) PDT and ALA PDT induced the death of SCC15 cells, and the effect of ATX-S10(Na) PDT was greater than that of ALA PDT. Our results indicate that ATX-S10(Na) PDT might be more effective than ALA PDT for the treatment of various skin diseases.     

Nonmelanoma skin cancer mortality (1988-2000): the Rhode Island follow-back study

OBJECTIVES: To estimate (1) the magnitude of and the components and factors associated with nonmelanoma skin cancer (NMSC) mortality and (2) the proportion of deaths misclassified as NMSC. DESIGN: Population-based follow-back study. SETTING AND PATIENTS: All Rhode Island residents whose deaths between 1988 and 2000 were attributed to NMSC. MAIN OUTCOME MEASURES: Distribution of diagnoses, verification of the causes of death, and characterization of associated factors. RESULTS: The proportion of misclassified deaths was significantly higher for nongenital NMSC (57%) than for genital NMSC (18%; P<.001). Most of the deaths misclassified as nongenital NMSC were caused by squamous cell carcinoma of mucosal surfaces. The age-adjusted NMSC mortality rate was 0.91 (per 100 000 persons per year), of which almost half (0.45) were due to genital carcinoma. Nonmelanoma skin cancer mortality increased sharply with age. The mortality rate from nongenital NMSC in men was more than twice that in women, but for genital NMSC this ratio was reversed. Skin cancers originating on the ear were responsible for more than a quarter of all deaths caused by nongenital NMSC. No cases of NMSC mortality occurred in organ transplant recipients. Many individuals had comorbid psychiatric conditions or evidence of unreasonable delay in seeking medical care for their lesions. CONCLUSIONS: Misclassifying the cause of death as nongenital NMSC accounts for a large source of error on death certificates in Rhode Island. Overall, nongenital squamous cell carcinoma and basal cell carcinoma death rates have declined, and mortality due to genital carcinoma was about half of total NMSC deaths. The dermatology community should emphasize prevention of mortality from genital skin cancer, while continuing to stress the importance of reducing excessive exposure to UV light and prompt treatment of NMSC.     

Topical 5-aminolaevulinic acid photodynamic therapy for the treatment of skin conditions other than non-melanoma skin cancer

Topical 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) is used increasingly for superficial non-melanoma skin cancer (NMSC) and dysplasia. However, the relative accumulation of the photosensitizer protoporphyrin IX (PpIX) in diseased tissue is not specific for neoplastic disease, and has been shown after the application of ALA to benign proliferative skin conditions such as viral warts and psoriasis. This review appraises the quality of evidence available for the use of topical ALA-PDT in the treatment of skin conditions other than NMSC. The diseases that have been studied in most detail are recalcitrant viral warts, acne, psoriasis and cutaneous T-cell lymphoma. Publications relating to the treatment of other diseases by topical PDT are restricted to small case series or case reports. The relevant literature will be discussed and the potential for topical PDT in the treatment of several skin diseases is highlighted, although more detailed studies are required to clarify the role of PDT beyond the treatment of NMSC.     

Clinical efficacy of methyl aminolevulinate (Metvix) photodynamic therapy

Several studies have reported the efficacy of photodynamic therapy (PDT) in the treatment of non-melanoma skin cancer (NMSC) and pre-cursor lesions, such as actinic keratosis (AK). Recent studies investigating the use of methyl aminolevulinate (MAL, Metvix PDT have made comparisons to existing standard treatments for basal cell carcinoma (BCC) and AK in terms of efficacy, adverse events and cosmetic outcome. This review considers these studies as a body of evidence that supports the use of MAL PDT over traditional therapies in these conditions. The data thus far show PDT to be superior to cryotherapy, 5-fluorouracil (5FU) and excisional surgery in terms of cosmetic outcome, and equivalent in efficacy to other treatment modalities in managing AK and BCC. The studies also show an advantage in the treatment of extensive lesions.     

Recurrence rates associated with incompletely excised low-risk nonmelanoma skin cancer

Background: Reported recurrence rates for transected nonmelanoma skin cancer (NMSC) vary widely, and few studies have addressed recurrence of tumors followed clinically or treated with nonsurgical modalities.
Methods: Retrospective review of dermatopathology records from January 1999 to January 2005 was conducted to identify biopsies or excision specimens with histologically transected basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) which were not subsequently excised. Patient and tumor characteristics associated with recurrence were analyzed in a subgroup of patients with predominantly 'low-risk' and/or minimally transected NMSCs. Prospective follow up was performed through March 31, 2008. Data was analyzed with Chi-square and Fishers exact tests and multivariate logistic regression.
Results: Of 376 transected NMSCs, 27 (7.2%) recurred, including 20 (9%) of 223 BCCs and 7 (4.6%) SCCs in situ of 153 SCCs. The overall recurrence rate of the 124 minimally transected NMSCs was even lower (5.6%). Multivariate logistic regression identified three significant predictors of recurrence: tumor location on the head and neck (p = 0.041), tumor size (p = 0.00741) and superficial subtype of BCC (p = .035).
Conclusions: Although surgical excision of NMSC remains the standard of care, observation or nonsurgical treatment may be acceptable in many cases of incompletely excised low-risk or minimally transected NMSCs.     

Efficacy of topical photodynamic therapy for keratoacanthomas: a case-series of four patients

Topical photodynamic therapy (PDT) is an excellent treatment option for various non-melanoma skin cancers and precancerous lesions, including actinic keratosis, Bowen's disease, and basal cell carcinoma. The clinical use of PDT includes a broad range of neoplastic, inflammatory, and infectious skin diseases. There is also anecdotal evidence suggesting the efficacy of PDT for the treatment of keratoacanthomas (KA). We report a case-series of four patients with solitary KA confirmed by histology, treated with topical PDT with methylaminolevulinic acid (MAL) cream. After three sessions of PDT, the lesions completely disappeared. There was no evidence of recurrence and excellent cosmetic outcome was achieved after three years of follow-up. Topical photodynamic therapy with MAL can be a therapeutic alternative for KA with good clinical and cosmetic outcomes.