Actinic Keratosis

NEW YORK – For treating actinic keratoses appearing over large or disseminated surface areas, daylight is often a better strategy than artificial light is for activating photodynamic therapy (PDT), according to an update on strategies at the summer meeting of the American Academy of Dermatology.

The evidence that daylight is at least as effective as artificial light for grade 1 and 2 actinic keratoses has created a “really exciting new opportunity” for those with disseminated disease, according to Dr. Emily J. Fisher, director of Mohs surgery at Mercy Health Physicians, Cincinnati, Ohio. This approach is not only a more efficient way to treat large or multiple areas of skin, but it is better tolerated, further facilitating treatment of bigger surface areas.

Moreover, for physicians not currently equipped with blue or red artificial light, daylight activation “is a great way to incorporate PDT into your practice,” Dr. Fisher added. She suggested that PDT, which has been associated with clearance rates exceeding 70% with a single treatment in many studies, appears to be at least as effective as the topical treatments that are employed more often, such as 5-fluorouracil (5-FU) or imiquimod.

When comparing efficacy across studies, “PDT seems to have a higher response than [does] our topical treatments,” but Dr. Fisher cautioned that there are no high-quality, head-to-head comparisons, so there is no definitive evidence of the superiority of one over the other.

However, in patients with multiple actinic keratoses spread over a substantial area of the skin or who have lesions in more than one anatomical site, daylight PDT is a practical approach now widely used in Europe and several other parts of the world, according to Dr. Fisher. She reported that five randomized trials have demonstrated that daylight PDT is effective.

Most aspects of daylight PDT are the same as conventional PDT, according to Dr. Fisher. The skin is first prepared by removing scales and crusts to improve penetration of the photodynamic agent, whether aminolevulinate acid (ALA) or methyl aminolevulinate (MAL). Prior to light exposure, the occlusion time with the photodynamic agent is the same 3 hours. Also, light exposure in both cases should begin within 30 minutes, which may be a consideration for those depending on daylight.

“Patients really should not go indoors or into shade for more than 5 minutes at a time,” Dr. Fisher reported. The problem is that the activity of the intracellular photosensitizing chemicals can build up without light exposure, producing pain and reducing the tolerability of the treatment.

Consensus guidelines have been published for daylight PDT in Australia (J Eur Acad Dermatol Venereol. 2012 Jun;26[6]:673-9.). According to Dr. Fisher, the guidelines recommend a light intensity of greater than 130 W/m², which is a dose provided by sunlight within the continental United States but not at distant points from the equator, such as Alaska. The guidelines also specify that sun exposure take place with a minimum temperature of 10° C. Dr. Fisher said that activity is diminished at lower temperatures.

“After 2 hours of exposure, patients should wash off the ALA and avoid further exposure for about 48 hours,” said Dr. Fisher, who recommended chemical sunscreens on areas of the skin not being treated.

“I think that over the next few years, this is going to have a big place in patient treatment. It is more convenient and better tolerated,” Dr. Fisher reported. She said that several modifications with the potential to enhance efficacy, such as pretreatment with retinoids or employing 5-FU after PDT, are strategies that have shown promise in small studies and may prove to be helpful through expanded clinical investigation.

NEW YORK – For treating actinic keratoses appearing over large or disseminated surface areas, daylight is often a better strategy than artificial light is for activating photodynamic therapy (PDT), according to an update on strategies at the summer meeting of the American Academy of Dermatology.

The evidence that daylight is at least as effective as artificial light for grade 1 and 2 actinic keratoses has created a “really exciting new opportunity” for those with disseminated disease, according to Dr. Emily J. Fisher, director of Mohs surgery at Mercy Health Physicians, Cincinnati, Ohio. This approach is not only a more efficient way to treat large or multiple areas of skin, but it is better tolerated, further facilitating treatment of bigger surface areas.

Moreover, for physicians not currently equipped with blue or red artificial light, daylight activation “is a great way to incorporate PDT into your practice,” Dr. Fisher added. She suggested that PDT, which has been associated with clearance rates exceeding 70% with a single treatment in many studies, appears to be at least as effective as the topical treatments that are employed more often, such as 5-fluorouracil (5-FU) or imiquimod.

When comparing efficacy across studies, “PDT seems to have a higher response than [does] our topical treatments,” but Dr. Fisher cautioned that there are no high-quality, head-to-head comparisons, so there is no definitive evidence of the superiority of one over the other.

However, in patients with multiple actinic keratoses spread over a substantial area of the skin or who have lesions in more than one anatomical site, daylight PDT is a practical approach now widely used in Europe and several other parts of the world, according to Dr. Fisher. She reported that five randomized trials have demonstrated that daylight PDT is effective.

Most aspects of daylight PDT are the same as conventional PDT, according to Dr. Fisher. The skin is first prepared by removing scales and crusts to improve penetration of the photodynamic agent, whether aminolevulinate acid (ALA) or methyl aminolevulinate (MAL). Prior to light exposure, the occlusion time with the photodynamic agent is the same 3 hours. Also, light exposure in both cases should begin within 30 minutes, which may be a consideration for those depending on daylight.

“Patients really should not go indoors or into shade for more than 5 minutes at a time,” Dr. Fisher reported. The problem is that the activity of the intracellular photosensitizing chemicals can build up without light exposure, producing pain and reducing the tolerability of the treatment.

Consensus guidelines have been published for daylight PDT in Australia (J Eur Acad Dermatol Venereol. 2012 Jun;26[6]:673-9.). According to Dr. Fisher, the guidelines recommend a light intensity of greater than 130 W/m², which is a dose provided by sunlight within the continental United States but not at distant points from the equator, such as Alaska. The guidelines also specify that sun exposure take place with a minimum temperature of 10° C. Dr. Fisher said that activity is diminished at lower temperatures.

“After 2 hours of exposure, patients should wash off the ALA and avoid further exposure for about 48 hours,” said Dr. Fisher, who recommended chemical sunscreens on areas of the skin not being treated.

“I think that over the next few years, this is going to have a big place in patient treatment. It is more convenient and better tolerated,” Dr. Fisher reported. She said that several modifications with the potential to enhance efficacy, such as pretreatment with retinoids or employing 5-FU after PDT, are strategies that have shown promise in small studies and may prove to be helpful through expanded clinical investigation.

NEW YORK – For treating actinic keratoses appearing over large or disseminated surface areas, daylight is often a better strategy than artificial light is for activating photodynamic therapy (PDT), according to an update on strategies at the summer meeting of the American Academy of Dermatology.

The evidence that daylight is at least as effective as artificial light for grade 1 and 2 actinic keratoses has created a “really exciting new opportunity” for those with disseminated disease, according to Dr. Emily J. Fisher, director of Mohs surgery at Mercy Health Physicians, Cincinnati, Ohio. This approach is not only a more efficient way to treat large or multiple areas of skin, but it is better tolerated, further facilitating treatment of bigger surface areas.

Moreover, for physicians not currently equipped with blue or red artificial light, daylight activation “is a great way to incorporate PDT into your practice,” Dr. Fisher added. She suggested that PDT, which has been associated with clearance rates exceeding 70% with a single treatment in many studies, appears to be at least as effective as the topical treatments that are employed more often, such as 5-fluorouracil (5-FU) or imiquimod.

When comparing efficacy across studies, “PDT seems to have a higher response than [does] our topical treatments,” but Dr. Fisher cautioned that there are no high-quality, head-to-head comparisons, so there is no definitive evidence of the superiority of one over the other.

However, in patients with multiple actinic keratoses spread over a substantial area of the skin or who have lesions in more than one anatomical site, daylight PDT is a practical approach now widely used in Europe and several other parts of the world, according to Dr. Fisher. She reported that five randomized trials have demonstrated that daylight PDT is effective.

Most aspects of daylight PDT are the same as conventional PDT, according to Dr. Fisher. The skin is first prepared by removing scales and crusts to improve penetration of the photodynamic agent, whether aminolevulinate acid (ALA) or methyl aminolevulinate (MAL). Prior to light exposure, the occlusion time with the photodynamic agent is the same 3 hours. Also, light exposure in both cases should begin within 30 minutes, which may be a consideration for those depending on daylight.

“Patients really should not go indoors or into shade for more than 5 minutes at a time,” Dr. Fisher reported. The problem is that the activity of the intracellular photosensitizing chemicals can build up without light exposure, producing pain and reducing the tolerability of the treatment.

Consensus guidelines have been published for daylight PDT in Australia (J Eur Acad Dermatol Venereol. 2012 Jun;26[6]:673-9.). According to Dr. Fisher, the guidelines recommend a light intensity of greater than 130 W/m², which is a dose provided by sunlight within the continental United States but not at distant points from the equator, such as Alaska. The guidelines also specify that sun exposure take place with a minimum temperature of 10° C. Dr. Fisher said that activity is diminished at lower temperatures.

“After 2 hours of exposure, patients should wash off the ALA and avoid further exposure for about 48 hours,” said Dr. Fisher, who recommended chemical sunscreens on areas of the skin not being treated.

“I think that over the next few years, this is going to have a big place in patient treatment. It is more convenient and better tolerated,” Dr. Fisher reported. She said that several modifications with the potential to enhance efficacy, such as pretreatment with retinoids or employing 5-FU after PDT, are strategies that have shown promise in small studies and may prove to be helpful through expanded clinical investigation.

Cryosurgery followed by topical ingenol mebutate cleared extensive regions of actinic keratosis, which helped reveal residual squamous cell carcinomas, according to a report in the August issue of the Journal of Drugs in Dermatology.

The findings show that ingenol mebutate can clear multiple AKs and reduce the number of scarring biopsies required to identify SCCs, said Dr. Miriam S. Bettencourt, a dermatologist in group practice in Henderson, Nev. “In our dermatology clinic, many of the patients with a long history of AK who were treated with ingenol mebutate used sequentially after cryosurgery have achieved complete or partial clearance of AKs.”

Ingenol mebutate gel after cryosurgery cleared AKs more effectively than cryosurgery alone in a recent phase III trial (J Drugs Dermatol. 2014 Jun;13[6]741-7), Dr. Bettencourt noted. She described six men and one woman who each had at least 10 recurrent or hyperkeratotic AKs and previously had undergone cryosurgery. She treated all patients with cryosurgery, followed 2 weeks later by two or three once-daily applications of ingenol mebutate gel at strengths of 0.05% or 0.015%, respectively (J Drugs Dermatol. 2015 Aug;14[8];813-8). One course of ingenol mebutate gel cleared 50%-100% of AKs, Dr. Bettencourt said. She treated residual AKs with cryosurgery, and five patients also received at least one more course of ingenol mebutate to re-treat a partially cleared area or to treat a separate area. Shave biopsies of 10 residual suspicious lesions taken 3-8 months later all revealed invasive SCCs, which were treated with Mohs micrographic surgery (MMS). “These lesions may have been preexisting at the time of topical treatment but not readily recognized as suspicious in the heavily actinically damaged skin, in which suspected or small SCCs may be adjacent to or obscured by AKs,” she said. “Alternatively, these tumors may have been spontaneous new SCCs. In either case, we suggest that effective clearance of AKs from the palette of sun-damaged skin with ingenol mebutate permitted prompt recognition of these lesions as suspicious, and led to further diagnosis and treatment with MMS.”

All patients developed mild to moderate localized redness, flaking, and crusting starting on the second day of ingenol mebutate treatment and resolving within a week of finishing the course, Dr. Bettencourt said.

She reported that she had no relevant financial conflicts.

Cryosurgery followed by topical ingenol mebutate cleared extensive regions of actinic keratosis, which helped reveal residual squamous cell carcinomas, according to a report in the August issue of the Journal of Drugs in Dermatology.

The findings show that ingenol mebutate can clear multiple AKs and reduce the number of scarring biopsies required to identify SCCs, said Dr. Miriam S. Bettencourt, a dermatologist in group practice in Henderson, Nev. “In our dermatology clinic, many of the patients with a long history of AK who were treated with ingenol mebutate used sequentially after cryosurgery have achieved complete or partial clearance of AKs.”

Ingenol mebutate gel after cryosurgery cleared AKs more effectively than cryosurgery alone in a recent phase III trial (J Drugs Dermatol. 2014 Jun;13[6]741-7), Dr. Bettencourt noted. She described six men and one woman who each had at least 10 recurrent or hyperkeratotic AKs and previously had undergone cryosurgery. She treated all patients with cryosurgery, followed 2 weeks later by two or three once-daily applications of ingenol mebutate gel at strengths of 0.05% or 0.015%, respectively (J Drugs Dermatol. 2015 Aug;14[8];813-8). One course of ingenol mebutate gel cleared 50%-100% of AKs, Dr. Bettencourt said. She treated residual AKs with cryosurgery, and five patients also received at least one more course of ingenol mebutate to re-treat a partially cleared area or to treat a separate area. Shave biopsies of 10 residual suspicious lesions taken 3-8 months later all revealed invasive SCCs, which were treated with Mohs micrographic surgery (MMS). “These lesions may have been preexisting at the time of topical treatment but not readily recognized as suspicious in the heavily actinically damaged skin, in which suspected or small SCCs may be adjacent to or obscured by AKs,” she said. “Alternatively, these tumors may have been spontaneous new SCCs. In either case, we suggest that effective clearance of AKs from the palette of sun-damaged skin with ingenol mebutate permitted prompt recognition of these lesions as suspicious, and led to further diagnosis and treatment with MMS.”

All patients developed mild to moderate localized redness, flaking, and crusting starting on the second day of ingenol mebutate treatment and resolving within a week of finishing the course, Dr. Bettencourt said.

She reported that she had no relevant financial conflicts.

Cryosurgery followed by topical ingenol mebutate cleared extensive regions of actinic keratosis, which helped reveal residual squamous cell carcinomas, according to a report in the August issue of the Journal of Drugs in Dermatology.

The findings show that ingenol mebutate can clear multiple AKs and reduce the number of scarring biopsies required to identify SCCs, said Dr. Miriam S. Bettencourt, a dermatologist in group practice in Henderson, Nev. “In our dermatology clinic, many of the patients with a long history of AK who were treated with ingenol mebutate used sequentially after cryosurgery have achieved complete or partial clearance of AKs.”

Ingenol mebutate gel after cryosurgery cleared AKs more effectively than cryosurgery alone in a recent phase III trial (J Drugs Dermatol. 2014 Jun;13[6]741-7), Dr. Bettencourt noted. She described six men and one woman who each had at least 10 recurrent or hyperkeratotic AKs and previously had undergone cryosurgery. She treated all patients with cryosurgery, followed 2 weeks later by two or three once-daily applications of ingenol mebutate gel at strengths of 0.05% or 0.015%, respectively (J Drugs Dermatol. 2015 Aug;14[8];813-8). One course of ingenol mebutate gel cleared 50%-100% of AKs, Dr. Bettencourt said. She treated residual AKs with cryosurgery, and five patients also received at least one more course of ingenol mebutate to re-treat a partially cleared area or to treat a separate area. Shave biopsies of 10 residual suspicious lesions taken 3-8 months later all revealed invasive SCCs, which were treated with Mohs micrographic surgery (MMS). “These lesions may have been preexisting at the time of topical treatment but not readily recognized as suspicious in the heavily actinically damaged skin, in which suspected or small SCCs may be adjacent to or obscured by AKs,” she said. “Alternatively, these tumors may have been spontaneous new SCCs. In either case, we suggest that effective clearance of AKs from the palette of sun-damaged skin with ingenol mebutate permitted prompt recognition of these lesions as suspicious, and led to further diagnosis and treatment with MMS.”

All patients developed mild to moderate localized redness, flaking, and crusting starting on the second day of ingenol mebutate treatment and resolving within a week of finishing the course, Dr. Bettencourt said.

She reported that she had no relevant financial conflicts.

VANCOUVER – Field therapy for actinic keratoses using topical ingenol mebutate resulted in improved patient-reported outcomes in an observational study, Dr. Thomas L. Diepgen reported at the World Congress of Dermatology.

Topical ingenol mebutate won regulatory approval for the field treatment of actinic keratoses on the strength of four randomized, double-blind placebo-controlled clinical trials, but patients and their physicians need to know how the drug performs in clinical practice. The answer is, quite well, said Dr. Diepgen of the University of Heidelberg (Germany), who presented the results of the observational study emphasizing patient-reported outcomes in 826 patients whose actinic keratoses (AKs) were treated with ingenol mebutate (Picato) in 292 German dermatologists’ offices.

Bruce Jancin/Frontline Medical Media

Unlike in randomized clinical trials, where strict eligibility criteria often result in a skewed population of participants, this observational study provided a representative snapshot of German patients seeking AK therapy. Their mean age was 73 years, with a mean 6.2-year duration of AKs and a median baseline of 5 lesions. Eighty percent of patients had previously undergone other types of therapy for the AKs, and 34% of them had a history of nonmelanoma skin cancer.

Participants completed the Skindex-16 quality of life questionnaire at their baseline office visit, and again 8 weeks later. The Skindex-16 doesn’t ask disease-specific questions, but this 16-item questionnaire was employed in the earlier pivotal randomized trials (N. Engl. J. Med. 2012;366:1010-19), and investigators felt they should utilize the same instrument, said Dr. Diepgen.

Scores on the Skindex-16 improved significantly from a mean baseline of 24.3 out of a possible 96 points to 12.1 after 8 weeks.

Similarly, when patients were asked to rate their skin roughness, wrinkling, and/or blotchiness on a 0-3 scale, their mean scores fell from 1.46 at baseline to 0.69 at follow-up. Ninety-eight percent of patients reported no new skin anomalies such as hypopigmentation in the treatment area.

Session cochair Dr. Marc Bourcier of the University of Sherbrooke (Que.) observed that this study underscores that the timing of quality of life assessment makes an enormous difference. Had the assessment taken place at day 4, for example, when ingenol mebutate–induced skin irritation would have been prominent, the results would have been very different. Dr. Diepgen agreed, noting that he and his coinvestigators wanted to evaluate patients’ response to the long-lasting results of the treatment, rather than to the transient experience of the therapy.

The study was sponsored by Leo Pharma. Dr. Diepgen reported having received research grants and speakers fees, and/or serving on advisory boards for Leo and more than a dozen other pharmaceutical companies.

bjancin@frontlinemedcom

VANCOUVER – Field therapy for actinic keratoses using topical ingenol mebutate resulted in improved patient-reported outcomes in an observational study, Dr. Thomas L. Diepgen reported at the World Congress of Dermatology.

Topical ingenol mebutate won regulatory approval for the field treatment of actinic keratoses on the strength of four randomized, double-blind placebo-controlled clinical trials, but patients and their physicians need to know how the drug performs in clinical practice. The answer is, quite well, said Dr. Diepgen of the University of Heidelberg (Germany), who presented the results of the observational study emphasizing patient-reported outcomes in 826 patients whose actinic keratoses (AKs) were treated with ingenol mebutate (Picato) in 292 German dermatologists’ offices.

Bruce Jancin/Frontline Medical Media

Unlike in randomized clinical trials, where strict eligibility criteria often result in a skewed population of participants, this observational study provided a representative snapshot of German patients seeking AK therapy. Their mean age was 73 years, with a mean 6.2-year duration of AKs and a median baseline of 5 lesions. Eighty percent of patients had previously undergone other types of therapy for the AKs, and 34% of them had a history of nonmelanoma skin cancer.

Participants completed the Skindex-16 quality of life questionnaire at their baseline office visit, and again 8 weeks later. The Skindex-16 doesn’t ask disease-specific questions, but this 16-item questionnaire was employed in the earlier pivotal randomized trials (N. Engl. J. Med. 2012;366:1010-19), and investigators felt they should utilize the same instrument, said Dr. Diepgen.

Scores on the Skindex-16 improved significantly from a mean baseline of 24.3 out of a possible 96 points to 12.1 after 8 weeks.

Similarly, when patients were asked to rate their skin roughness, wrinkling, and/or blotchiness on a 0-3 scale, their mean scores fell from 1.46 at baseline to 0.69 at follow-up. Ninety-eight percent of patients reported no new skin anomalies such as hypopigmentation in the treatment area.

Session cochair Dr. Marc Bourcier of the University of Sherbrooke (Que.) observed that this study underscores that the timing of quality of life assessment makes an enormous difference. Had the assessment taken place at day 4, for example, when ingenol mebutate–induced skin irritation would have been prominent, the results would have been very different. Dr. Diepgen agreed, noting that he and his coinvestigators wanted to evaluate patients’ response to the long-lasting results of the treatment, rather than to the transient experience of the therapy.

The study was sponsored by Leo Pharma. Dr. Diepgen reported having received research grants and speakers fees, and/or serving on advisory boards for Leo and more than a dozen other pharmaceutical companies.

bjancin@frontlinemedcom

VANCOUVER – Field therapy for actinic keratoses using topical ingenol mebutate resulted in improved patient-reported outcomes in an observational study, Dr. Thomas L. Diepgen reported at the World Congress of Dermatology.

Topical ingenol mebutate won regulatory approval for the field treatment of actinic keratoses on the strength of four randomized, double-blind placebo-controlled clinical trials, but patients and their physicians need to know how the drug performs in clinical practice. The answer is, quite well, said Dr. Diepgen of the University of Heidelberg (Germany), who presented the results of the observational study emphasizing patient-reported outcomes in 826 patients whose actinic keratoses (AKs) were treated with ingenol mebutate (Picato) in 292 German dermatologists’ offices.

Bruce Jancin/Frontline Medical Media

Unlike in randomized clinical trials, where strict eligibility criteria often result in a skewed population of participants, this observational study provided a representative snapshot of German patients seeking AK therapy. Their mean age was 73 years, with a mean 6.2-year duration of AKs and a median baseline of 5 lesions. Eighty percent of patients had previously undergone other types of therapy for the AKs, and 34% of them had a history of nonmelanoma skin cancer.

Participants completed the Skindex-16 quality of life questionnaire at their baseline office visit, and again 8 weeks later. The Skindex-16 doesn’t ask disease-specific questions, but this 16-item questionnaire was employed in the earlier pivotal randomized trials (N. Engl. J. Med. 2012;366:1010-19), and investigators felt they should utilize the same instrument, said Dr. Diepgen.

Scores on the Skindex-16 improved significantly from a mean baseline of 24.3 out of a possible 96 points to 12.1 after 8 weeks.

Similarly, when patients were asked to rate their skin roughness, wrinkling, and/or blotchiness on a 0-3 scale, their mean scores fell from 1.46 at baseline to 0.69 at follow-up. Ninety-eight percent of patients reported no new skin anomalies such as hypopigmentation in the treatment area.

Session cochair Dr. Marc Bourcier of the University of Sherbrooke (Que.) observed that this study underscores that the timing of quality of life assessment makes an enormous difference. Had the assessment taken place at day 4, for example, when ingenol mebutate–induced skin irritation would have been prominent, the results would have been very different. Dr. Diepgen agreed, noting that he and his coinvestigators wanted to evaluate patients’ response to the long-lasting results of the treatment, rather than to the transient experience of the therapy.

The study was sponsored by Leo Pharma. Dr. Diepgen reported having received research grants and speakers fees, and/or serving on advisory boards for Leo and more than a dozen other pharmaceutical companies.

bjancin@frontlinemedcom

VANCOUVER – Indoor simulated daylight photodynamic therapy for actinic keratoses sidesteps the major shortcoming of natural daylight PDT by providing a standardized, dermatologist-controlled light dose that’s not dependent upon the vagaries of weather, season, or outdoor temperature, Dr. Uwe Reinhold reported at the World Congress of Dermatology.

Daylight PDT, in which the photosensitizing agent is activated by natural light, is an increasingly popular concept that originated in Scandinavia but is starting to catch on in the United States. Daylight PDT is less expensive and far less painful than traditional PDT, in which the photosensitizer is activated by a pulsed dye laser or an intense pulsed light device. But on a rainy day or a cold, short, winter day, it can be a problem getting sufficient daylight outdoors to reliably activate the PDT, noted Dr. Reinhold of the Dermatology Center Bonn (Germany) Friedensplatz.

© Dr-Strangelove/thinkstockphotos.com

Dr. Reinhold and his colleagues solved that problem by installing a special lamp system on the ceiling of a treatment room in the office. The system enables a dermatologist to simultaneously treat several patients, who receive their 2-hour light dose while seated comfortably in the treatment room reading a book or resting.

Dr. Reinhold presented a retrospective study of 32 patients who underwent simulated daylight PDT (SDL-PDT) in his office. At baseline, the patients had a mean of 5.3 AKs on the scalp and/or face. At follow-up 12 weeks after their second and final SDL-PDT session, they averaged 0.4 AKs. Ninety-three percent of all AKs were cleared, and three-quarters of the patients were completely AK-free.

Traditional PDT is so painful that compliance becomes an issue, Dr. Reinhold noted. In contrast, SDL-PDT, like daylight PDT, is almost pain free. Pain assessment on a 0-10 visual analog scale conducted during the first SDL-PDT session showed mean scores of 0.1, 0.3, and 0.6 at 30, 60, and 90 minutes after illumination began. None of the patients required an analgesic, according to the dermatologist.

The procedure begins with curettage of hyperkeratotic lesions, followed by application of aminolevulinic acid (ALA) gel under occlusion for 30 minutes. Dr. Reinhold uses BF-200 (Ameluz), an ALA manufactured by Biofrontera, a German company, which is popular in Europe but not marketed in the United States. The gel contains 78 mg of ALA per gram. After the 30-minute incubation, the photosensitizer is removed and the special lights are switched on for 2 hours. Protective eye goggles aren’t needed. All patients receive a second treatment session 1 week later.

The lights Dr. Reinhold uses are Indoorlux, marketed by Swiss Red AG. One pair of lights is needed per patient. At a distance of 110-150 cm from the light source, the system produces 15,000-25,000 Lux. The lamps mimic the green and red components of daylight. The combined effective light dose at the wavelengths important in activating protoporphyrin IX so that it can destroy precancerous cells – green/yellow at 570-590 nm and orange/red at 620-640 nm – is 14.3-24.2 J/cm², depending upon the distance from the light source. That’s comfortably above the 9.4-10.8 J/cm² other investigators have determined is required for effective natural daylight PDT.

In the United States, however, as in Europe, SDL-PDT is currently an off-label therapy for AK treatment, he noted.

Dr. Reinhold reported serving as a consultant to Biofrontera and receiving speaking fees from the company.

bjancin@frontlinemedcom

VANCOUVER – Indoor simulated daylight photodynamic therapy for actinic keratoses sidesteps the major shortcoming of natural daylight PDT by providing a standardized, dermatologist-controlled light dose that’s not dependent upon the vagaries of weather, season, or outdoor temperature, Dr. Uwe Reinhold reported at the World Congress of Dermatology.

Daylight PDT, in which the photosensitizing agent is activated by natural light, is an increasingly popular concept that originated in Scandinavia but is starting to catch on in the United States. Daylight PDT is less expensive and far less painful than traditional PDT, in which the photosensitizer is activated by a pulsed dye laser or an intense pulsed light device. But on a rainy day or a cold, short, winter day, it can be a problem getting sufficient daylight outdoors to reliably activate the PDT, noted Dr. Reinhold of the Dermatology Center Bonn (Germany) Friedensplatz.

© Dr-Strangelove/thinkstockphotos.com

Dr. Reinhold and his colleagues solved that problem by installing a special lamp system on the ceiling of a treatment room in the office. The system enables a dermatologist to simultaneously treat several patients, who receive their 2-hour light dose while seated comfortably in the treatment room reading a book or resting.

Dr. Reinhold presented a retrospective study of 32 patients who underwent simulated daylight PDT (SDL-PDT) in his office. At baseline, the patients had a mean of 5.3 AKs on the scalp and/or face. At follow-up 12 weeks after their second and final SDL-PDT session, they averaged 0.4 AKs. Ninety-three percent of all AKs were cleared, and three-quarters of the patients were completely AK-free.

Traditional PDT is so painful that compliance becomes an issue, Dr. Reinhold noted. In contrast, SDL-PDT, like daylight PDT, is almost pain free. Pain assessment on a 0-10 visual analog scale conducted during the first SDL-PDT session showed mean scores of 0.1, 0.3, and 0.6 at 30, 60, and 90 minutes after illumination began. None of the patients required an analgesic, according to the dermatologist.

The procedure begins with curettage of hyperkeratotic lesions, followed by application of aminolevulinic acid (ALA) gel under occlusion for 30 minutes. Dr. Reinhold uses BF-200 (Ameluz), an ALA manufactured by Biofrontera, a German company, which is popular in Europe but not marketed in the United States. The gel contains 78 mg of ALA per gram. After the 30-minute incubation, the photosensitizer is removed and the special lights are switched on for 2 hours. Protective eye goggles aren’t needed. All patients receive a second treatment session 1 week later.

The lights Dr. Reinhold uses are Indoorlux, marketed by Swiss Red AG. One pair of lights is needed per patient. At a distance of 110-150 cm from the light source, the system produces 15,000-25,000 Lux. The lamps mimic the green and red components of daylight. The combined effective light dose at the wavelengths important in activating protoporphyrin IX so that it can destroy precancerous cells – green/yellow at 570-590 nm and orange/red at 620-640 nm – is 14.3-24.2 J/cm², depending upon the distance from the light source. That’s comfortably above the 9.4-10.8 J/cm² other investigators have determined is required for effective natural daylight PDT.

In the United States, however, as in Europe, SDL-PDT is currently an off-label therapy for AK treatment, he noted.

Dr. Reinhold reported serving as a consultant to Biofrontera and receiving speaking fees from the company.

bjancin@frontlinemedcom

VANCOUVER – Indoor simulated daylight photodynamic therapy for actinic keratoses sidesteps the major shortcoming of natural daylight PDT by providing a standardized, dermatologist-controlled light dose that’s not dependent upon the vagaries of weather, season, or outdoor temperature, Dr. Uwe Reinhold reported at the World Congress of Dermatology.

Daylight PDT, in which the photosensitizing agent is activated by natural light, is an increasingly popular concept that originated in Scandinavia but is starting to catch on in the United States. Daylight PDT is less expensive and far less painful than traditional PDT, in which the photosensitizer is activated by a pulsed dye laser or an intense pulsed light device. But on a rainy day or a cold, short, winter day, it can be a problem getting sufficient daylight outdoors to reliably activate the PDT, noted Dr. Reinhold of the Dermatology Center Bonn (Germany) Friedensplatz.

© Dr-Strangelove/thinkstockphotos.com

Dr. Reinhold and his colleagues solved that problem by installing a special lamp system on the ceiling of a treatment room in the office. The system enables a dermatologist to simultaneously treat several patients, who receive their 2-hour light dose while seated comfortably in the treatment room reading a book or resting.

Dr. Reinhold presented a retrospective study of 32 patients who underwent simulated daylight PDT (SDL-PDT) in his office. At baseline, the patients had a mean of 5.3 AKs on the scalp and/or face. At follow-up 12 weeks after their second and final SDL-PDT session, they averaged 0.4 AKs. Ninety-three percent of all AKs were cleared, and three-quarters of the patients were completely AK-free.

Traditional PDT is so painful that compliance becomes an issue, Dr. Reinhold noted. In contrast, SDL-PDT, like daylight PDT, is almost pain free. Pain assessment on a 0-10 visual analog scale conducted during the first SDL-PDT session showed mean scores of 0.1, 0.3, and 0.6 at 30, 60, and 90 minutes after illumination began. None of the patients required an analgesic, according to the dermatologist.

The procedure begins with curettage of hyperkeratotic lesions, followed by application of aminolevulinic acid (ALA) gel under occlusion for 30 minutes. Dr. Reinhold uses BF-200 (Ameluz), an ALA manufactured by Biofrontera, a German company, which is popular in Europe but not marketed in the United States. The gel contains 78 mg of ALA per gram. After the 30-minute incubation, the photosensitizer is removed and the special lights are switched on for 2 hours. Protective eye goggles aren’t needed. All patients receive a second treatment session 1 week later.

The lights Dr. Reinhold uses are Indoorlux, marketed by Swiss Red AG. One pair of lights is needed per patient. At a distance of 110-150 cm from the light source, the system produces 15,000-25,000 Lux. The lamps mimic the green and red components of daylight. The combined effective light dose at the wavelengths important in activating protoporphyrin IX so that it can destroy precancerous cells – green/yellow at 570-590 nm and orange/red at 620-640 nm – is 14.3-24.2 J/cm², depending upon the distance from the light source. That’s comfortably above the 9.4-10.8 J/cm² other investigators have determined is required for effective natural daylight PDT.

In the United States, however, as in Europe, SDL-PDT is currently an off-label therapy for AK treatment, he noted.

Dr. Reinhold reported serving as a consultant to Biofrontera and receiving speaking fees from the company.

bjancin@frontlinemedcom

Nicotinamide, an inexpensive, over-the-counter form of vitamin B₃, is safe and efficacious for the chemoprevention of nonmelanoma skin cancer in patients at high risk, according to data from the Australian Oral Nicotinamide to Reduce Actinic Cancer (ONTRAC) Study.

Results reported in a press briefing held before the annual meeting of the American Society of Clinical Oncology showed that patients taking nicotinamide were about one-fourth less likely than peers taking a placebo to develop new basal cell and squamous cell skin cancers. They also had a smaller reduction in new actinic keratoses.

“Nicotinamide, vitamin B₃, significantly reduced nonmelanoma skin cancers and keratoses in just 12 months in a group of pretty high-risk patients. It’s safe, it’s almost obscenely inexpensive, and it’s already widely commercially available, so this one’s ready to go straight into the clinic,” commented senior investigator Dr. Diona Damian, professor of dermatology at the University of Sydney.

She cautioned that the results apply only to the population studied: adults who had experienced two or more nonmelanoma skin cancers in the past 5 years.

“These are the people we’d be recommending it for – people who have already got a skin cancer track record. It’s not something that we’d recommend at this stage for the general population,” she said. Likewise, the findings do not speak to patients at the other end of the spectrum who are in treatment for advanced or metastatic skin cancer, as they also were excluded.

That said, the researchers are planning additional studies in other populations, such patients who are at high risk because they have immunosuppression, according to Dr. Damian.

“We still need the overall skin cancer prevention strategies of sun-safe behavior, sunscreen, and regular skin surveillance,” she stressed, “but we now have an additional exciting opportunity for affordable skin cancer chemoprevention which we can instantly translate into clinical practice.”

Dr. Peter Paul Yu, ASCO President and a medical oncologist and hematologist who is director of cancer research at the Palo Alto Medical Foundation, Sunnyvale, Calif., commented, “This is a very exciting prevention trial. We all know that we clamor for preventing rather than treating diseases, and this is a major advance for us.”

Exposure to ultraviolet light packs a one-two punch to the skin, both damaging cellular DNA and suppressing the skin’s immune response, according to Dr. Damian. The investigators opted to test nicotinamide as it counters both of these events.

The 386 patients in ONTRAC had heavily sun damaged skin, with a mean of 8 nonmelanoma skin cancers in the past 5 years and 50 keratoses at baseline. They were randomized evenly to receive nicotinamide (500 mg twice daily) or placebo for 12 months.

Results showed that the average number of new nonmelanoma skin cancers per patient during the treatment period was 1.77 in the nicotinamide group and 2.42 in the placebo group. The difference translated to a 23% lower rate of new cancers with the vitamin.

“There were comparable reductions seen for both basal and squamous cell carcinomas,” Dr. Damian noted. “Interestingly, this reduction in skin cancers seemed to start as early as the first 3-month visit. And then when people stopped taking their tablets after 12 months, the benefit was no longer seen. In other words, you need to continue taking the tablets in order for them to be effective.”

The nicotinamide group also had a roughly 15% lower rate of new actinic keratoses, compared with the placebo group.

“Nicotinamide was very well tolerated. There was no difference in adverse events, blood parameters, or blood pressure in the two arms” of the study, reported Dr. Damian. She stressed that it is critically important to distinguish nicotinamide from niacin (nicotinic acid), another form of vitamin B₃ that has a host of side effects such as headache and flushing.

“One of the great things about [nicotinamide] is that it really has hardly any drug interactions, which means that elderly patients who may be taking a whole cocktail of medications for their heart disease and their hypertension, and whatever else, the nicotinamide won’t interact with those,” she added.

Some evidence also has shown nonsteroidal anti-inflammatory drugs to reduce the risk of skin cancer. “The advantage of nicotinamide is that it doesn’t have the potential gastrointestinal bleeding or renal side effects of nonsteroidals, so it may be suitable for a group of people who aren’t suitable for taking nonsteroidals,” she said. “In our ONTRAC study, we didn’t find synergy or additional benefit in people who were coincidentally taking nonsteroidals for other indications.”

The trial’s results should be generalizable to similar high-risk patients in less sunny parts of the world, Dr. Damian said. “If their skin has shown that degree of damage to get skin cancer, then we suspect nicotinamide would offer benefits to them as well.”

Dr. Damian disclosed no relevant conflicts of interest. The study was funded by the National Health & Medical Research Council.

Nicotinamide, an inexpensive, over-the-counter form of vitamin B₃, is safe and efficacious for the chemoprevention of nonmelanoma skin cancer in patients at high risk, according to data from the Australian Oral Nicotinamide to Reduce Actinic Cancer (ONTRAC) Study.

Results reported in a press briefing held before the annual meeting of the American Society of Clinical Oncology showed that patients taking nicotinamide were about one-fourth less likely than peers taking a placebo to develop new basal cell and squamous cell skin cancers. They also had a smaller reduction in new actinic keratoses.

“Nicotinamide, vitamin B₃, significantly reduced nonmelanoma skin cancers and keratoses in just 12 months in a group of pretty high-risk patients. It’s safe, it’s almost obscenely inexpensive, and it’s already widely commercially available, so this one’s ready to go straight into the clinic,” commented senior investigator Dr. Diona Damian, professor of dermatology at the University of Sydney.

She cautioned that the results apply only to the population studied: adults who had experienced two or more nonmelanoma skin cancers in the past 5 years.

“These are the people we’d be recommending it for – people who have already got a skin cancer track record. It’s not something that we’d recommend at this stage for the general population,” she said. Likewise, the findings do not speak to patients at the other end of the spectrum who are in treatment for advanced or metastatic skin cancer, as they also were excluded.

That said, the researchers are planning additional studies in other populations, such patients who are at high risk because they have immunosuppression, according to Dr. Damian.

“We still need the overall skin cancer prevention strategies of sun-safe behavior, sunscreen, and regular skin surveillance,” she stressed, “but we now have an additional exciting opportunity for affordable skin cancer chemoprevention which we can instantly translate into clinical practice.”

Dr. Peter Paul Yu, ASCO President and a medical oncologist and hematologist who is director of cancer research at the Palo Alto Medical Foundation, Sunnyvale, Calif., commented, “This is a very exciting prevention trial. We all know that we clamor for preventing rather than treating diseases, and this is a major advance for us.”

Exposure to ultraviolet light packs a one-two punch to the skin, both damaging cellular DNA and suppressing the skin’s immune response, according to Dr. Damian. The investigators opted to test nicotinamide as it counters both of these events.

The 386 patients in ONTRAC had heavily sun damaged skin, with a mean of 8 nonmelanoma skin cancers in the past 5 years and 50 keratoses at baseline. They were randomized evenly to receive nicotinamide (500 mg twice daily) or placebo for 12 months.

Results showed that the average number of new nonmelanoma skin cancers per patient during the treatment period was 1.77 in the nicotinamide group and 2.42 in the placebo group. The difference translated to a 23% lower rate of new cancers with the vitamin.

“There were comparable reductions seen for both basal and squamous cell carcinomas,” Dr. Damian noted. “Interestingly, this reduction in skin cancers seemed to start as early as the first 3-month visit. And then when people stopped taking their tablets after 12 months, the benefit was no longer seen. In other words, you need to continue taking the tablets in order for them to be effective.”

The nicotinamide group also had a roughly 15% lower rate of new actinic keratoses, compared with the placebo group.

“Nicotinamide was very well tolerated. There was no difference in adverse events, blood parameters, or blood pressure in the two arms” of the study, reported Dr. Damian. She stressed that it is critically important to distinguish nicotinamide from niacin (nicotinic acid), another form of vitamin B₃ that has a host of side effects such as headache and flushing.

“One of the great things about [nicotinamide] is that it really has hardly any drug interactions, which means that elderly patients who may be taking a whole cocktail of medications for their heart disease and their hypertension, and whatever else, the nicotinamide won’t interact with those,” she added.

Some evidence also has shown nonsteroidal anti-inflammatory drugs to reduce the risk of skin cancer. “The advantage of nicotinamide is that it doesn’t have the potential gastrointestinal bleeding or renal side effects of nonsteroidals, so it may be suitable for a group of people who aren’t suitable for taking nonsteroidals,” she said. “In our ONTRAC study, we didn’t find synergy or additional benefit in people who were coincidentally taking nonsteroidals for other indications.”

The trial’s results should be generalizable to similar high-risk patients in less sunny parts of the world, Dr. Damian said. “If their skin has shown that degree of damage to get skin cancer, then we suspect nicotinamide would offer benefits to them as well.”

Dr. Damian disclosed no relevant conflicts of interest. The study was funded by the National Health & Medical Research Council.

Nicotinamide, an inexpensive, over-the-counter form of vitamin B₃, is safe and efficacious for the chemoprevention of nonmelanoma skin cancer in patients at high risk, according to data from the Australian Oral Nicotinamide to Reduce Actinic Cancer (ONTRAC) Study.

Results reported in a press briefing held before the annual meeting of the American Society of Clinical Oncology showed that patients taking nicotinamide were about one-fourth less likely than peers taking a placebo to develop new basal cell and squamous cell skin cancers. They also had a smaller reduction in new actinic keratoses.

“Nicotinamide, vitamin B₃, significantly reduced nonmelanoma skin cancers and keratoses in just 12 months in a group of pretty high-risk patients. It’s safe, it’s almost obscenely inexpensive, and it’s already widely commercially available, so this one’s ready to go straight into the clinic,” commented senior investigator Dr. Diona Damian, professor of dermatology at the University of Sydney.

She cautioned that the results apply only to the population studied: adults who had experienced two or more nonmelanoma skin cancers in the past 5 years.

“These are the people we’d be recommending it for – people who have already got a skin cancer track record. It’s not something that we’d recommend at this stage for the general population,” she said. Likewise, the findings do not speak to patients at the other end of the spectrum who are in treatment for advanced or metastatic skin cancer, as they also were excluded.

That said, the researchers are planning additional studies in other populations, such patients who are at high risk because they have immunosuppression, according to Dr. Damian.

“We still need the overall skin cancer prevention strategies of sun-safe behavior, sunscreen, and regular skin surveillance,” she stressed, “but we now have an additional exciting opportunity for affordable skin cancer chemoprevention which we can instantly translate into clinical practice.”

Dr. Peter Paul Yu, ASCO President and a medical oncologist and hematologist who is director of cancer research at the Palo Alto Medical Foundation, Sunnyvale, Calif., commented, “This is a very exciting prevention trial. We all know that we clamor for preventing rather than treating diseases, and this is a major advance for us.”

Exposure to ultraviolet light packs a one-two punch to the skin, both damaging cellular DNA and suppressing the skin’s immune response, according to Dr. Damian. The investigators opted to test nicotinamide as it counters both of these events.

The 386 patients in ONTRAC had heavily sun damaged skin, with a mean of 8 nonmelanoma skin cancers in the past 5 years and 50 keratoses at baseline. They were randomized evenly to receive nicotinamide (500 mg twice daily) or placebo for 12 months.

Results showed that the average number of new nonmelanoma skin cancers per patient during the treatment period was 1.77 in the nicotinamide group and 2.42 in the placebo group. The difference translated to a 23% lower rate of new cancers with the vitamin.

“There were comparable reductions seen for both basal and squamous cell carcinomas,” Dr. Damian noted. “Interestingly, this reduction in skin cancers seemed to start as early as the first 3-month visit. And then when people stopped taking their tablets after 12 months, the benefit was no longer seen. In other words, you need to continue taking the tablets in order for them to be effective.”

The nicotinamide group also had a roughly 15% lower rate of new actinic keratoses, compared with the placebo group.

“Nicotinamide was very well tolerated. There was no difference in adverse events, blood parameters, or blood pressure in the two arms” of the study, reported Dr. Damian. She stressed that it is critically important to distinguish nicotinamide from niacin (nicotinic acid), another form of vitamin B₃ that has a host of side effects such as headache and flushing.

“One of the great things about [nicotinamide] is that it really has hardly any drug interactions, which means that elderly patients who may be taking a whole cocktail of medications for their heart disease and their hypertension, and whatever else, the nicotinamide won’t interact with those,” she added.

Some evidence also has shown nonsteroidal anti-inflammatory drugs to reduce the risk of skin cancer. “The advantage of nicotinamide is that it doesn’t have the potential gastrointestinal bleeding or renal side effects of nonsteroidals, so it may be suitable for a group of people who aren’t suitable for taking nonsteroidals,” she said. “In our ONTRAC study, we didn’t find synergy or additional benefit in people who were coincidentally taking nonsteroidals for other indications.”

The trial’s results should be generalizable to similar high-risk patients in less sunny parts of the world, Dr. Damian said. “If their skin has shown that degree of damage to get skin cancer, then we suspect nicotinamide would offer benefits to them as well.”

Dr. Damian disclosed no relevant conflicts of interest. The study was funded by the National Health & Medical Research Council.

ASHEVILLE, N.C. – Recent advances in basic science have shown how the local immune environment in tissue surrounding nonmelanoma skin cancer compares to adjacent normal tissue.

New Mexico Health Sciences Center’s Dr. Andrew Ondo reviewed the latest research in an interview at the annual meeting of the Noah Worcester Dermatological Society. “Each step along the way is a possible target for the treatment of squamous cell carcinoma,” said Dr. Ondo, who indicated that he had no financial conflicts to disclose.

[email protected]

ASHEVILLE, N.C. – Recent advances in basic science have shown how the local immune environment in tissue surrounding nonmelanoma skin cancer compares to adjacent normal tissue.

New Mexico Health Sciences Center’s Dr. Andrew Ondo reviewed the latest research in an interview at the annual meeting of the Noah Worcester Dermatological Society. “Each step along the way is a possible target for the treatment of squamous cell carcinoma,” said Dr. Ondo, who indicated that he had no financial conflicts to disclose.

[email protected]

ASHEVILLE, N.C. – Recent advances in basic science have shown how the local immune environment in tissue surrounding nonmelanoma skin cancer compares to adjacent normal tissue.

New Mexico Health Sciences Center’s Dr. Andrew Ondo reviewed the latest research in an interview at the annual meeting of the Noah Worcester Dermatological Society. “Each step along the way is a possible target for the treatment of squamous cell carcinoma,” said Dr. Ondo, who indicated that he had no financial conflicts to disclose.

[email protected]

ASHEVILLE, N.C. – What are the risk factors for invasive melanoma in patients with lentigo maligna? Size, for one thing, according to Dr. Suzanne M. Olbricht.

In an interview at the annual meeting of the Noah Worcester Dermatological Society, Dr. Olbricht of the Lahey Hospital and Medical Center in Burlington, Mass., reviewed evidence suggesting that the recurrence rate is highest for large lesions. “This is important information that helps us think about the treatments we can use,” she said.

Dr. Olbricht had no financial conflicts to disclose.

[email protected]

ASHEVILLE, N.C. – What are the risk factors for invasive melanoma in patients with lentigo maligna? Size, for one thing, according to Dr. Suzanne M. Olbricht.

In an interview at the annual meeting of the Noah Worcester Dermatological Society, Dr. Olbricht of the Lahey Hospital and Medical Center in Burlington, Mass., reviewed evidence suggesting that the recurrence rate is highest for large lesions. “This is important information that helps us think about the treatments we can use,” she said.

Dr. Olbricht had no financial conflicts to disclose.

[email protected]

ASHEVILLE, N.C. – What are the risk factors for invasive melanoma in patients with lentigo maligna? Size, for one thing, according to Dr. Suzanne M. Olbricht.

In an interview at the annual meeting of the Noah Worcester Dermatological Society, Dr. Olbricht of the Lahey Hospital and Medical Center in Burlington, Mass., reviewed evidence suggesting that the recurrence rate is highest for large lesions. “This is important information that helps us think about the treatments we can use,” she said.

Dr. Olbricht had no financial conflicts to disclose.

[email protected]

KISSIMMEE, FLA. – Reflective confocal microscopic imaging successfully guided carbon dioxide laser ablation of basal cell carcinomas, and imaging results fully matched those from Mohs histology, a small study found.

“Our results suggest that reflective confocal microscopy can accurately guide carbon dioxide laser ablation of superficial and early nodular basal cell carcinomas,” said Dr. Brian Hibler of Memorial Sloan Kettering Cancer Center in New York. The technique provides a real-time, noninvasive way to delineate the tumor area before ablation and to check for residual tumor between passes with the laser, he said at the annual meeting of the American Society for Laser Medicine and surgery.

While conventional and Mohs microscopic surgeries remain the gold standard for removing basal carcinomas (BCC), surgery is not an option for some patients because of tumor location, comorbidities, or personal preferences, Dr. Hibler noted. Past studies have reported good clinical and cosmetic outcomes with laser ablation of BCCs, but use of the modality has been limited because there was no way to assess response without excision or biopsies. Reflective confocal microscopy (RCM) uses a low-powered laser system that provides cellular-level imaging and can distinguish BCCs, he said.

Dr. Hibler and his colleagues performed baseline RCM of eight BCCs (three on the trunk, three on the extremities, and two on the head and neck) from seven patients aged 29-83 years. Two patients were men and five were women. The patients then underwent carbon dioxide laser ablation with a wavelength of 10,600 nm, pulse duration of 750 microseconds, and fluence of 7.5 J/cm², using a square pattern and density of 30%. If RCM revealed residual BCC, the researchers repeated the process up to two more times, for a maximum of three passes. They then removed the entire lesion using Mohs micrographic surgery, performing vertical histologic sectioning of the tissue.

Reflective confocal microscopy generated reliable cellular-level images in real time on the tumor surface and up to 150 mcm deep, Dr. Hibler reported. Tissue from BCCs appears as dense nodular areas with adjacent spaces and red blood cell trafficking, he noted. Microscopy results were consistent with Mohs histology findings in all eight cases, including six in which the tumor was completely removed and two with residual tumor. One of these two cases was the only infiltrative BCC in the series, while the other might have been tissue artifact, Dr. Hibler said.

Patients experienced no adverse effects from the interventions, Dr. Hibler reported. “Future studies are planned are planned without Mohs, so we can use reflective confocal microscopy to longitudinally monitor for recurrence,” he added.

The study won an award at the meeting.

Dr. Hibler reported no funding sources and made no disclosures.

KISSIMMEE, FLA. – Reflective confocal microscopic imaging successfully guided carbon dioxide laser ablation of basal cell carcinomas, and imaging results fully matched those from Mohs histology, a small study found.

“Our results suggest that reflective confocal microscopy can accurately guide carbon dioxide laser ablation of superficial and early nodular basal cell carcinomas,” said Dr. Brian Hibler of Memorial Sloan Kettering Cancer Center in New York. The technique provides a real-time, noninvasive way to delineate the tumor area before ablation and to check for residual tumor between passes with the laser, he said at the annual meeting of the American Society for Laser Medicine and surgery.

While conventional and Mohs microscopic surgeries remain the gold standard for removing basal carcinomas (BCC), surgery is not an option for some patients because of tumor location, comorbidities, or personal preferences, Dr. Hibler noted. Past studies have reported good clinical and cosmetic outcomes with laser ablation of BCCs, but use of the modality has been limited because there was no way to assess response without excision or biopsies. Reflective confocal microscopy (RCM) uses a low-powered laser system that provides cellular-level imaging and can distinguish BCCs, he said.

Dr. Hibler and his colleagues performed baseline RCM of eight BCCs (three on the trunk, three on the extremities, and two on the head and neck) from seven patients aged 29-83 years. Two patients were men and five were women. The patients then underwent carbon dioxide laser ablation with a wavelength of 10,600 nm, pulse duration of 750 microseconds, and fluence of 7.5 J/cm², using a square pattern and density of 30%. If RCM revealed residual BCC, the researchers repeated the process up to two more times, for a maximum of three passes. They then removed the entire lesion using Mohs micrographic surgery, performing vertical histologic sectioning of the tissue.

Reflective confocal microscopy generated reliable cellular-level images in real time on the tumor surface and up to 150 mcm deep, Dr. Hibler reported. Tissue from BCCs appears as dense nodular areas with adjacent spaces and red blood cell trafficking, he noted. Microscopy results were consistent with Mohs histology findings in all eight cases, including six in which the tumor was completely removed and two with residual tumor. One of these two cases was the only infiltrative BCC in the series, while the other might have been tissue artifact, Dr. Hibler said.

Patients experienced no adverse effects from the interventions, Dr. Hibler reported. “Future studies are planned are planned without Mohs, so we can use reflective confocal microscopy to longitudinally monitor for recurrence,” he added.

The study won an award at the meeting.

Dr. Hibler reported no funding sources and made no disclosures.

KISSIMMEE, FLA. – Reflective confocal microscopic imaging successfully guided carbon dioxide laser ablation of basal cell carcinomas, and imaging results fully matched those from Mohs histology, a small study found.

“Our results suggest that reflective confocal microscopy can accurately guide carbon dioxide laser ablation of superficial and early nodular basal cell carcinomas,” said Dr. Brian Hibler of Memorial Sloan Kettering Cancer Center in New York. The technique provides a real-time, noninvasive way to delineate the tumor area before ablation and to check for residual tumor between passes with the laser, he said at the annual meeting of the American Society for Laser Medicine and surgery.

While conventional and Mohs microscopic surgeries remain the gold standard for removing basal carcinomas (BCC), surgery is not an option for some patients because of tumor location, comorbidities, or personal preferences, Dr. Hibler noted. Past studies have reported good clinical and cosmetic outcomes with laser ablation of BCCs, but use of the modality has been limited because there was no way to assess response without excision or biopsies. Reflective confocal microscopy (RCM) uses a low-powered laser system that provides cellular-level imaging and can distinguish BCCs, he said.

Dr. Hibler and his colleagues performed baseline RCM of eight BCCs (three on the trunk, three on the extremities, and two on the head and neck) from seven patients aged 29-83 years. Two patients were men and five were women. The patients then underwent carbon dioxide laser ablation with a wavelength of 10,600 nm, pulse duration of 750 microseconds, and fluence of 7.5 J/cm², using a square pattern and density of 30%. If RCM revealed residual BCC, the researchers repeated the process up to two more times, for a maximum of three passes. They then removed the entire lesion using Mohs micrographic surgery, performing vertical histologic sectioning of the tissue.

Reflective confocal microscopy generated reliable cellular-level images in real time on the tumor surface and up to 150 mcm deep, Dr. Hibler reported. Tissue from BCCs appears as dense nodular areas with adjacent spaces and red blood cell trafficking, he noted. Microscopy results were consistent with Mohs histology findings in all eight cases, including six in which the tumor was completely removed and two with residual tumor. One of these two cases was the only infiltrative BCC in the series, while the other might have been tissue artifact, Dr. Hibler said.

Patients experienced no adverse effects from the interventions, Dr. Hibler reported. “Future studies are planned are planned without Mohs, so we can use reflective confocal microscopy to longitudinally monitor for recurrence,” he added.

The study won an award at the meeting.

Dr. Hibler reported no funding sources and made no disclosures.

KISSIMMEE, FLA. – Fractional carbon dioxide laser resurfacing followed by 30 minutes of aminolevulinic acid plus blue light photodynamic therapy cleared 94% of actinic keratoses, significantly more than ALA-PDT alone, according to the findings of a randomized, single-blinded, split-face study of 20 patients.

Laser resurfacing was associated with worse short-term erythema, but erythema resolved in about 7 days and was not associated with other adverse events, Dr. Macrene Alexiades-Armenakas said at the annual meeting of the American Society for Laser Medicine and Surgery.

Historically, two sessions of 20% topical ALA and blue light PDT have yielded actinic keratosis cure rates of 78% to 89%, but only with ALA incubation times of 14-18 hours, said Dr. Alexiades-Armenakas, associate clinical professor at Yale University, New Haven, Conn.

©Dr-Strangelove/ThinkStockPhotos.com

“Increasing drug penetration may serve to enhance PDT efficacy and shorten incubation time,” she said.

To test that hypothesis, she compared the safety and efficacy of 15- and 30-minute incubations of ALA and blue light PDT, with or without CO₂ laser resurfacing. After cleaning patients’ faces with acetone wipes and applying a topical anesthetic for 1 hour, she randomly selected one half of each patient’s face for pretreatment with fractional CO₂ laser, using settings of 15-28 W, 500 mcm dot spacing, and 600-800 microsecond dwell time.

Next, she applied 5-ALA to the entire face, then performed blue light illumination for 1,000 seconds. Half of the 20 patients were randomly assigned ALA incubation times of 15 minutes, while the other half underwent 30-minute incubations. She rechecked patients at 1 week, 4 weeks, and 8 weeks, and took digital photographs at baseline and at each recheck using identical lighting conditions. A blinded evaluator scored each side of each face, defining clearance as complete regression of actinic keratosis.

At 8 weeks, the rate of complete clearance for the 10 patients who underwent 15-minute ALA incubations was 88% for laser resurfacing followed by ALA-PDT, compared with 74% for ALA-PDT alone (P < .05), Dr. Alexiades-Armenakas reported. Clearance rates for the 30-minute incubation group were 94% for laser followed by ALA-PDT and 82% for ALA-PDT alone (P < .05).

Skin treated only with ALA-PDT developed minimal to moderate erythema that resolved within 5-7 days for all patients, but the laser-resurfaced skin developed “moderate to significant” erythema that resolved within 5-7 days with home care, she said.

Taken together, the results indicate that fractional CO₂ laser treatment yields safe and effective clearance of actinic keratoses with “ultra-short” incubation times, Dr. Alexiades-Armenakas said.

Deka manufactures the fractional CO₂ laser tested in the study, and DUSA Pharmaceuticals manufactures the blue light PDT device and the ALA product. Dr. Alexiades-Armenakas reported receiving clinical research grants from Deka, DUSA Pharmaceuticals, Alma, and Syneron.

KISSIMMEE, FLA. – Fractional carbon dioxide laser resurfacing followed by 30 minutes of aminolevulinic acid plus blue light photodynamic therapy cleared 94% of actinic keratoses, significantly more than ALA-PDT alone, according to the findings of a randomized, single-blinded, split-face study of 20 patients.

Laser resurfacing was associated with worse short-term erythema, but erythema resolved in about 7 days and was not associated with other adverse events, Dr. Macrene Alexiades-Armenakas said at the annual meeting of the American Society for Laser Medicine and Surgery.

Historically, two sessions of 20% topical ALA and blue light PDT have yielded actinic keratosis cure rates of 78% to 89%, but only with ALA incubation times of 14-18 hours, said Dr. Alexiades-Armenakas, associate clinical professor at Yale University, New Haven, Conn.

©Dr-Strangelove/ThinkStockPhotos.com

“Increasing drug penetration may serve to enhance PDT efficacy and shorten incubation time,” she said.

To test that hypothesis, she compared the safety and efficacy of 15- and 30-minute incubations of ALA and blue light PDT, with or without CO₂ laser resurfacing. After cleaning patients’ faces with acetone wipes and applying a topical anesthetic for 1 hour, she randomly selected one half of each patient’s face for pretreatment with fractional CO₂ laser, using settings of 15-28 W, 500 mcm dot spacing, and 600-800 microsecond dwell time.

Next, she applied 5-ALA to the entire face, then performed blue light illumination for 1,000 seconds. Half of the 20 patients were randomly assigned ALA incubation times of 15 minutes, while the other half underwent 30-minute incubations. She rechecked patients at 1 week, 4 weeks, and 8 weeks, and took digital photographs at baseline and at each recheck using identical lighting conditions. A blinded evaluator scored each side of each face, defining clearance as complete regression of actinic keratosis.

At 8 weeks, the rate of complete clearance for the 10 patients who underwent 15-minute ALA incubations was 88% for laser resurfacing followed by ALA-PDT, compared with 74% for ALA-PDT alone (P < .05), Dr. Alexiades-Armenakas reported. Clearance rates for the 30-minute incubation group were 94% for laser followed by ALA-PDT and 82% for ALA-PDT alone (P < .05).

Skin treated only with ALA-PDT developed minimal to moderate erythema that resolved within 5-7 days for all patients, but the laser-resurfaced skin developed “moderate to significant” erythema that resolved within 5-7 days with home care, she said.

Taken together, the results indicate that fractional CO₂ laser treatment yields safe and effective clearance of actinic keratoses with “ultra-short” incubation times, Dr. Alexiades-Armenakas said.

Deka manufactures the fractional CO₂ laser tested in the study, and DUSA Pharmaceuticals manufactures the blue light PDT device and the ALA product. Dr. Alexiades-Armenakas reported receiving clinical research grants from Deka, DUSA Pharmaceuticals, Alma, and Syneron.

KISSIMMEE, FLA. – Fractional carbon dioxide laser resurfacing followed by 30 minutes of aminolevulinic acid plus blue light photodynamic therapy cleared 94% of actinic keratoses, significantly more than ALA-PDT alone, according to the findings of a randomized, single-blinded, split-face study of 20 patients.

Laser resurfacing was associated with worse short-term erythema, but erythema resolved in about 7 days and was not associated with other adverse events, Dr. Macrene Alexiades-Armenakas said at the annual meeting of the American Society for Laser Medicine and Surgery.

Historically, two sessions of 20% topical ALA and blue light PDT have yielded actinic keratosis cure rates of 78% to 89%, but only with ALA incubation times of 14-18 hours, said Dr. Alexiades-Armenakas, associate clinical professor at Yale University, New Haven, Conn.

©Dr-Strangelove/ThinkStockPhotos.com

“Increasing drug penetration may serve to enhance PDT efficacy and shorten incubation time,” she said.

To test that hypothesis, she compared the safety and efficacy of 15- and 30-minute incubations of ALA and blue light PDT, with or without CO₂ laser resurfacing. After cleaning patients’ faces with acetone wipes and applying a topical anesthetic for 1 hour, she randomly selected one half of each patient’s face for pretreatment with fractional CO₂ laser, using settings of 15-28 W, 500 mcm dot spacing, and 600-800 microsecond dwell time.

Next, she applied 5-ALA to the entire face, then performed blue light illumination for 1,000 seconds. Half of the 20 patients were randomly assigned ALA incubation times of 15 minutes, while the other half underwent 30-minute incubations. She rechecked patients at 1 week, 4 weeks, and 8 weeks, and took digital photographs at baseline and at each recheck using identical lighting conditions. A blinded evaluator scored each side of each face, defining clearance as complete regression of actinic keratosis.

At 8 weeks, the rate of complete clearance for the 10 patients who underwent 15-minute ALA incubations was 88% for laser resurfacing followed by ALA-PDT, compared with 74% for ALA-PDT alone (P < .05), Dr. Alexiades-Armenakas reported. Clearance rates for the 30-minute incubation group were 94% for laser followed by ALA-PDT and 82% for ALA-PDT alone (P < .05).

Skin treated only with ALA-PDT developed minimal to moderate erythema that resolved within 5-7 days for all patients, but the laser-resurfaced skin developed “moderate to significant” erythema that resolved within 5-7 days with home care, she said.

Taken together, the results indicate that fractional CO₂ laser treatment yields safe and effective clearance of actinic keratoses with “ultra-short” incubation times, Dr. Alexiades-Armenakas said.

Deka manufactures the fractional CO₂ laser tested in the study, and DUSA Pharmaceuticals manufactures the blue light PDT device and the ALA product. Dr. Alexiades-Armenakas reported receiving clinical research grants from Deka, DUSA Pharmaceuticals, Alma, and Syneron.

More than one-third of teens who undergo indoor tanning do so frequently, according to data from a survey of 1,850 public high school students from 27 schools in New Jersey.


The data were part of the 2012 New Jersey Youth Tobacco Survey, taken before New Jersey banned indoor tanning for individuals younger than 17 years of age in 2013. A total of 146 respondents reported indoor tanning within the past year, and approximately 38% reported 10 or more tanning sessions, wrote Elliot J. Coups, Ph.D., of Rutgers Cancer Institute of New Jersey, New Brunswick, and colleagues.

Overall, “frequent indoor tanning was significantly more common among indoor tanners who were current smokers, tanned to improve their mood, had used social media related to tanning salons, or indicated it would be very hard to stop indoor tanning,” the researchers noted, adding that social media might be an opportunity for interventions to reduce indoor tanning in this population.

Find the study in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2015.01.035).

More than one-third of teens who undergo indoor tanning do so frequently, according to data from a survey of 1,850 public high school students from 27 schools in New Jersey.


The data were part of the 2012 New Jersey Youth Tobacco Survey, taken before New Jersey banned indoor tanning for individuals younger than 17 years of age in 2013. A total of 146 respondents reported indoor tanning within the past year, and approximately 38% reported 10 or more tanning sessions, wrote Elliot J. Coups, Ph.D., of Rutgers Cancer Institute of New Jersey, New Brunswick, and colleagues.

Overall, “frequent indoor tanning was significantly more common among indoor tanners who were current smokers, tanned to improve their mood, had used social media related to tanning salons, or indicated it would be very hard to stop indoor tanning,” the researchers noted, adding that social media might be an opportunity for interventions to reduce indoor tanning in this population.

Find the study in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2015.01.035).

More than one-third of teens who undergo indoor tanning do so frequently, according to data from a survey of 1,850 public high school students from 27 schools in New Jersey.


The data were part of the 2012 New Jersey Youth Tobacco Survey, taken before New Jersey banned indoor tanning for individuals younger than 17 years of age in 2013. A total of 146 respondents reported indoor tanning within the past year, and approximately 38% reported 10 or more tanning sessions, wrote Elliot J. Coups, Ph.D., of Rutgers Cancer Institute of New Jersey, New Brunswick, and colleagues.

Overall, “frequent indoor tanning was significantly more common among indoor tanners who were current smokers, tanned to improve their mood, had used social media related to tanning salons, or indicated it would be very hard to stop indoor tanning,” the researchers noted, adding that social media might be an opportunity for interventions to reduce indoor tanning in this population.

Find the study in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2015.01.035).