Problematic End Points in a Keratinocyte Carcinoma Chemoprevention Trial —Reply

In Reply We appreciate the close scrutiny of our published work and the opportunity to elaborate on the end points we used for analysis of the trial data. The VAKCC Trial primary end point was the rate of occurrence of keratinocyte carcinoma (KC) over the course of the 4-year trial. In the process of creating and executing this trial, however, the study team explicitly discussed that there were other important outcomes. In particular, while we did not have evidence to guide our estimation of the timing and duration of the effect of our intervention, if any, on the occurrence of KC, basal cell carcinoma, or squamous cell carcinoma (SCC), we realized that a short-term effect on risk (eg, during the first year) could be of considerable clinical importance even if the effect did not persist for the entire duration of the trial. We further recognized that even if there was a substantial effect in the first year, it could be lost in the 4-year results unless specifically examined. Hence, when analysis plans were discussed prior to unblinding the data, it was explicitly stated by the study chair, and summarized in the form of email guidance to the study statistician, that outcomes at 1 year were important to calculate and report. With the focus on completing the report, we chose not to officially amend the statistical analysis plan. This was an administrative decision that did not prevent appropriate analysis and should not prevent appropriate scientific interpretation. The final an...
Source: JAMA Dermatology - Category: Dermatology Source Type: research

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In this study, a case of a 56-year-old woman with cutaneous metaplastic carcinoma in the neck is reported. It harbored basal cell carcinoma, squamous cell carcinoma, and sebaceous carcinoma, as well as osteosarcoma (with fibroblastic, osteoblastic, aneurysmal bone cyst-like, and chondroblastic patterns). To our knowledge, the literature does not mention sebaceous carcinoma in cutaneous metaplastic carcinoma. Epidemiology and intact mismatch repair proteins of this case support sporadic pathogenesis for this neoplasm. The patient has been followed up for 3 years after surgery with free margins, and no local recurrence or di...
Source: The American Journal of Dermatopathology - Category: Pathology Tags: Extraordinary Case Report Source Type: research
In conclusion, dermoscopy is valuable for the diagnosis of CNH as a first screening tool because of a consistent global dermoscopic configuration (daisy pattern), consisting of radially arranged white thick lines surroun ding a central rounded yellow/brown clod.
Source: Archives of Dermatological Research - Category: Dermatology Source Type: research
Conclusion: This study showed that it is possible to distinguish between the different nonmelanoma skin cancers by using OCT, but further prospective studies have to be conducted to validate the sensitivity and specificity of the criteria.Skin Pharmacol Physiol 2018;31:238 –245
Source: Skin Pharmacology and Physiology - Category: Dermatology Source Type: research
The anterior and posterior lamellae should be simultaneously reconstructed to repair the upper and lower eyelid's full thickness defects after resection of a malignant tumor. The author described a gingivoalveolar mucosal graft for posterior lamellar reconstruction of the lower eyelid. Between November 2014 and September 2017, 11 patients (6 women, 5 men; mean age 62.7 years) with 13 posterior lamellar defect of lower eyelid underwent reconstruction with gingivoalveolar mucosal graft. The defects ranged from 10 x 8 mm to 20 x 10 mm. For 11 lower eyelid defects, the anterior lamellar defect was previously recons...
Source: Journal of Craniofacial Surgery - Category: Surgery Tags: Clinical Studies Source Type: research
Abstract Cutaneous squamous cell carcinoma (cSCC) is an increasing public health problem. It is a primary malignant skin tumor with Malpighian differentiation and together with basal cell carcinoma is classified among nonmelanoma skin cancers (NMSCs). cSCC usually occurs on photoexposed areas, such as the head, the neck, and the extremities, and its incidence increases with age. Invasive forms of this skin tumor tend to be more aggressive showing a higher metastatic potential, usually regarding regional lymph nodes. Treatment options for invasive cSCCs include both surgical and nonsurgical options. The therapeutic...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
Conclusions: With appropriate patient selection and choosing as lowest dose per fraction as possible, HDR brachytherapy with customized surface molds yields good oncological and cosmetic results for the treatment of localized skin BCC and SCC. PMID: 29789760 [PubMed]
Source: Journal of Contemporary Brachytherapy - Category: Cancer & Oncology Tags: J Contemp Brachytherapy Source Type: research
Seminars in Plastic Surgery 2018; 32: 060-068 DOI: 10.1055/s-0038-1642057Mohs micrographic surgery (MMS) is a specialized technique for treating skin malignancies that offers the highest cure rate by allowing histological evaluation of the entire peripheral and deep margins. MMS also maximally preserves as much uninvolved, normal adjacent tissue as possible, allowing for the best cosmetic and functional outcomes. When used for appropriate indications, this technique is also more cost-effective than other treatment modalities. In this article, the authors will discuss the development of MMS, the steps involved in this proce...
Source: Seminars in Plastic Surgery - Category: Cosmetic Surgery Authors: Tags: Review Article Source Type: research
AbstractPurpose of ReviewThe aims of this report are to review literature supporting the use of Mohs micrographic surgery for treatment of non-melanoma skin cancer and to address indications and potential limitations of this form of therapy for non-melanoma skin cancer.Recent FindingsThe first randomized controlled trial comparing standard excision to Mohs micrographic surgery for treatment of facial basal cell carcinoma has recently been published, demonstrating a lower recurrence rate after Mohs surgery compared to standard excision after a 5-year and 10-year follow-up period, supporting its use in the treatment of high-...
Source: Current Otorhinolaryngology Reports - Category: ENT & OMF Source Type: research
AbstractPurpose of ReviewActinic keratosis (AK) is the most common sun-induced preneoplastic lesion, and together with photo-aging and skin cancer, it places a huge burden on healthcare systems. The clinical distinction between AK and incipient squamous cell carcinoma (SCC) can be difficult, and therefore, clinical diagnosis is not always reliable and certain. Skin biopsies are sometimes mandatory, and physicians must be aware of the importance of accurate diagnosis and management, as other malignant neoplasms (melanoma, basal cell carcinoma) cannot always be reliably distinguished from AK, especially when pigmented and in...
Source: Current Dermatology Reports - Category: Dermatology Source Type: research
We report the case of a 60-year-old man with an infrapalpebral pearly papule, measuring 0.6 cm in diameter. The lesion was excised with a clinical hypothesis of basal cell carcinoma or squamous cell carcinoma. Histopathological analysis revealed a malignant neoplasm with syncytial arrangement of cells with vesicular nuclei, associated with dense lymphocytic infiltrate. Immunohistochemistry revealed cytokeratin-positive cells (AE1/AE3) and p63 protein, indicating epithelial histogenesis and squamous differentiation. A negative Epstein-Barr virus test result was achieved by immunohistochemistry. Primary lymphoepithelioma-lik...
Source: Anais Brasileiros de Dermatologia - Category: Dermatology Source Type: research
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