Low-dose systemic retinoids in preventing subsequent non-melanoma skin cancers (NMSC) in patients with history of NMSC: A systematic review

BACKGROUND: Non-melanoma skin cancers (NMSC) consists of  basal-cell carcinomas (BCC) and squamous-cell carcinomas (SCC).Certain populations are predisposed to develop  NMSC,  including  patients  with  previous  history  of  NMSC.Systemic  retinoids  have  shown  promising  results  in chemoprevention of recurrence of NMSC in other high-risk populations (xeroderma pigmentosum and renal-transplant patients).We  assessed  the  efficacy  and  safety  of  low-dose  systemic  retinoids  compared  with  placebo,  as  a  chemopreventive agent for NMSC in patients with previous NMSC.METHODOLOGY: Electronic  databases  were  systematically searched for this study. Participants in the studies selected must have had a biopsy-proven NMSC, over 18 years of age, with  no  exclusion  of  other  demographic  characteristics. All  types  of  systemic  retinoids  were  included  with  no restriction on dosage. Two authors independently performed standardized  eligibility  assessment  and  data-extraction.Differences in opinion were resolved by consensus with the third author. Statistical analysis was done using the Review Manager 5 software.RESULTS: Eleven full-text studies were assessed for eligibility out of 178 studies found. Five studies were excluded because of the different population, while the two articles used topical retinoids. Four articles were included. The interventions were 10.0 mg isotretinoin, 25,000IU retinol and 25.0 mg acitretin,compared with placebo. Meta-analysis produced RR of 0.94 (95% CI, 0.89-1.00), with moderate heterogeneity (34%) due to the difference in interventions used. There are significantly more  adverse  events  in  the  retinoids  group,  especially  in the  incidence  of  mucocutaneous  adverse  events,  and deranged lipid profile and liver enzymes.CONCLUSION: There is insufficient evidence to support the use of low-dose systemic retinoids as chemoprevention for patients with previous NMSC. Furthermore, adverse events may limit their use. Topical preparations with less side-effects may be investigated.

Clinicohistopathologic profile of patients who underwent Mohs micrographic surgery at the Dermatology Center of St. Luke's Medical Center from 2003-2008

BACKGROUND: Mohs Micrographic Surgery (MMS) is the microscopically-controlled excision of skin cancer. Although there have been several international studies on MMS for nonmelanoma skin cancer (NMSC) including 1 from Korea, there have been no reports yet on MMS in the Philippines. This is the first study on MMS for NMSC in the Philippines.OBJECTIVE: To describe the clinical and histopathologic profile of all patients who underwent MMS at the Dermatology Center, St. Luke's Medical Center, from March 2003- March 2008.METHODS: A retrospective study was conducted on all MMS cases done at the Mohs Surgery Unit of the Dermatology Center in St. Luke's Medical Center from March 2003- March 2008. Demographic and clinicohistologic profile of all cases were reviewed. Three to five-year recurrence rate was reported.RESULTS: A total of 75 cases were reviewed and included in the study. The mean age of the study population was 61.29 years old and 90 percent belong to the >40 age group. The male:female ratio was 3:1. There were almost equal number of Filipino and Caucasian patients. Most patients permanently reside in the Philippines, with a small percentage coming from nearby countries like Guam. One-fifth of the study population were retired military men. The most common tumor was basal cell carcinoma (BCC), primary cases outnumbering recurrent ones. The nose was the most common area affected with BCC, while the cheek was the most common site of squamous cell carcinoma (SCC). Majority of tumors done were d" 2 cm. The most common post-operative defect size incurred was also d" 2 cm. The most common primary indication for doing MMS was the location of the tumor. Most NMSCs were cleared after 2-3 stages. Local flaps were the most commonly used type of repair, followed by primary closure. Based on 3- to 5-year surveillance of cases done from 2003-2005, there has been no recurrence yet as of March 2008.CONCLUSION: The clinicohistopathologic profile of patients who underwent MMS in the Dermatology Center of St. Luke's Medical Center has similarities and differences with existing local and international literature. MMS, as offered by the first Mohs Surgery Unit in the country, caters mostly to the older age group with a predominance of the male population. The number of Filipino and Caucasian patients who underwent the procedure was almost equal. BCC is still the most common tumor treated in the Center with the face as the most common location. Most tumors were immediately cleared after few MMS stages. Success rate of the procedure in the Unit is very high, based on 3 to 5- year surveillance for recurrence.

Clinicohistopathologic profile of patients who underwent Mohs micrographic surgery at the Dermatology Center of St. Luke's Medical Center from 2003-2008

BACKGROUND: Mohs Micrographic Surgery (MMS) is the microscopically-controlled excision of skin cancer. Although there have been several international studies on MMS for nonmelanoma skin cancer (NMSC) including 1 from Korea, there have been no reports yet on MMS in the Philippines. This is the first study on MMS for NMSC in the Philippines.OBJECTIVE: To describe the clinical and histopathologic profile of all patients who underwent MMS at the Dermatology Center, St. Luke's Medical Center, from March 2003- March 2008.METHODS: A retrospective study was conducted on all MMS cases done at the Mohs Surgery Unit of the Dermatology Center in St. Luke's Medical Center from March 2003- March 2008. Demographic and clinicohistologic profile of all cases were reviewed. Three to five-year recurrence rate was reported.RESULTS: A total of 75 cases were reviewed and included in the study. The mean age of the study population was 61.29 years old and 90 percent belong to the >40 age group. The male:female ratio was 3:1. There were almost equal number of Filipino and Caucasian patients. Most patients permanently reside in the Philippines, with a small percentage coming from nearby countries like Guam. One-fifth of the study population were retired military men. The most common tumor was basal cell carcinoma (BCC), primary cases outnumbering recurrent ones. The nose was the most common area affected with BCC, while the cheek was the most common site of squamous cell carcinoma (SCC). Majority of tumors done were d" 2 cm. The most common post-operative defect size incurred was also d" 2 cm. The most common primary indication for doing MMS was the location of the tumor. Most NMSCs were cleared after 2-3 stages. Local flaps were the most commonly used type of repair, followed by primary closure. Based on 3- to 5-year surveillance of cases done from 2003-2005, there has been no recurrence yet as of March 2008.CONCLUSION: The clinicohistopathologic profile of patients who underwent MMS in the Dermatology Center of St. Luke's Medical Center has similarities and differences with existing local and international literature. MMS, as offered by the first Mohs Surgery Unit in the country, caters mostly to the older age group with a predominance of the male population. The number of Filipino and Caucasian patients who underwent the procedure was almost equal. BCC is still the most common tumor treated in the Center with the face as the most common location. Most tumors were immediately cleared after few MMS stages. Success rate of the procedure in the Unit is very high, based on 3 to 5- year surveillance for recurrence.