High Patient Satisfaction with Daylight-Activated Methyl Aminolevulinate Cream in the Treatment of Multiple Actinic Keratoses: Results of an Observational Study in Australia.

INTRODUCTION: Actinic keratoses (AK) are treated to reduce the risk of progression to squamous cell carcinoma and for symptomatic and cosmetic benefits. The objective of this observational study was to generate real-life data on the use of daylight photodynamic therapy with methyl aminolevulinate cream (MAL DL-PDT) in treating mild to moderate facial/scalp AK. METHODS: A multicenter, prospective, observational study was conducted in Australia in patients receiving a single treatment of MAL DL-PDT for mild to moderate AK. Efficacy was assessed 3 months after treatment by investigator-assessed improvement and patient- and physician-completed satisfaction questionnaires. Adverse events were recorded throughout the study. RESULTS: Overall, 81 patients were enrolled of mean age 62.7 years, mostly men (76.5%) with skin phototype I (64.2%) or II (35.8%) and a long history of AK (mean duration 16.8 years). Most had multiple lesions (82.7% had >10 lesions) of predominantly grade I (75.3%). At 3 months after treatment, almost half the patients (46.8%) required no further treatment. The proportions of patients and physicians satisfied to very satisfied with the MAL DL-PDT treatment were 79.7% and 83.3%, respectively. After receiving the treatment, 74.1% of patients indicated via the questionnaire that they were not bothered at all by the pain. Related AEs were reported in 48.1% of patients, mainly mild erythema (44.4%). CONCLUSIONS: In clinical practice in Australia, the use of MAL DL-PDT in treating multiple mild to moderate non-hyperkeratotic AK of the face and/or scalp results in high levels of patient and physician satisfaction reflecting the good efficacy and tolerability of this almost painless, convenient procedure. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT02674048. FUNDING: Galderma R&D.

An open-label, pilot study examining the efficacy of curettage followed by imiquimod 5% cream for the treatment of primary nodular basal cell carcinoma.

SUMMARY The short-term efficacy of imiquimod 5% cream for the treatment of primary superficial basal cell carcinoma has been established. This study investigated its efficacy following curettage (without electrodesiccation) for the treatment of primary nodular basal cell carcinoma on the trunk and limbs. Seventeen patients with a total of 34 lesions were enrolled. Curettage was used to de-bulk the lesion and confirm suitable histology. Lesions displaying more aggressive subtypes (such as micronodular or morpheoic components) were excluded. Lesions were treated daily for 6 to 10 weeks with imiquimod 5% cream. Three months post treatment all lesions were excised, and 32 of 34 treated lesions (94%) were histologically clear of basal cell carcinoma. Fourteen of 17 patients rated the cosmetic outcome of treatment as excellent or good. Curettage followed by imiquimod 5% cream is effective for the treatment of primary nodular basal cell carcinoma on the trunk and limbs, and most patients are pleased with the cosmetic outcome.

Atrophic dermatofibrosarcoma protuberans: an uncommon and misleading variant.

A 23-year-old man presented with an atrophic lesion on his left anterior shoulder that had been present for at least 10 years. A previous biopsy had suggested a fibrohistiocytic origin; however, clinically it resembled morphoea or atrophoderma, and the lesion was observed. Fifteen months later, the lesion was noted to have grown slightly. A repeat biopsy showed dermatofibrosarcoma protuberans, with a storiform spindle cell proliferation with positive CD34 staining. The lesion was excised with a 3-cm margin. Awareness of this rare presentation may assist in earlier diagnosis.

Psoriasis induced by topical imiquimod.

We report the provocation of localized psoriasis at the sites of application of topical imiquimod, possibly evolving into a generalized flare. A patient with pre-existing psoriasis that had been stable for 14 years was treated with imiquimod 5% cream daily for 6 weeks to three superficial basal cell carcinomas. During treatment one of the lesions developed severe local skin reactions necessitating rest periods, and received only 18 applications in 6 weeks. The other two lesions were treated for all 42 days. Psoriasiform changes developed at all three application sites. Nine-and-a-half weeks after completing treatment the patient developed disseminated small psoriatic lesions. Other recognized triggers of psoriasis were not identified. The psoriasis resolved slowly with conventional treatment.

Treatment of Bowen's disease and basal cell carcinoma of the nose with imiquimod 5% cream.

We report the successful use of topical imiquimod 5% cream for extensive multifocal, recurrent (post cryotherapy), biopsy-proven Bowen's disease of the nose. Treatment was applied on a once-a-day regimen, and a total of 32 applications over 9 weeks were used. A florid local skin reaction occurred early in the treatment, necessitating a rest period and decreasing the frequency of application. The Bowen's disease was coexistent with a multifocal superficial basal cell carcinoma (BCC) that had a partial response. Persistent BCC at 4 weeks post treatment was surgically excised. This tumour showed an unusual histological picture, with normal epidermis overlying residual BCC in the papillary dermis. The Bowen's disease remains clinically clear at 12-months follow up.