isotretinoin and Basal-Cell-Nevus-Syndrome

The chemoprevention refers to the use of various types of chemical agents for preventing carcinogenic progression. Systemic retinoids are the most studied chemopreventive agents due to their capacity to regulate cell proliferation and their demonstrated efficacy in several clinical studies.. The aim of the authors was to give precise indications regarding the use of the systemic retinoid in the chemoprevention of non-melanoma skin cancer (NMSC).. The authors reviewed the literature found through a search to MEDLINE (from 2001 to December 2011).. Both acitretin and isotretinoin are effective for the prevention of NMSC. Isotretinoin is preferred in xeroderma pigmentosum and nevoid basal cell carcinoma syndrome, whereas acitretin is more used in transplant recipients, psoriasis and severe sun damage.. Despite numerous studies of the literature concerning retinoids in chemoprevention of NMSC, precise details of the type of retinoid to use, dosage and the duration of this preventive treatment and how to manage side effects in the case of long-lasting treatment are still not uniform and comparable. Moreover, neither guidelines nor approval by Food and Drug Administration exist to regulate the use of retinoids in chemoprevention.

Topics: Acitretin; Basal Cell Nevus Syndrome; Dermatologic Agents; Humans; Isotretinoin; Off-Label Use; Organ Transplantation; Psoriasis; Risk Factors; Skin Neoplasms; Sunlight; Xeroderma Pigmentosum

Topics: Administration, Oral; Basal Cell Nevus Syndrome; Female; Humans; Isotretinoin; Keratolytic Agents; Middle Aged; Organ Transplantation; Postoperative Complications; Practice Guidelines as Topic; Retinoids; Risk Factors; Skin Neoplasms; Xeroderma Pigmentosum

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Basal Cell Nevus Syndrome; Female; Humans; Interferon-alpha; Isotretinoin; Skin Neoplasms; Treatment Failure

Topics: Adult; Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Diseases in Twins; Humans; Isotretinoin; Male; Skin Neoplasms; Twins; Twins, Monozygotic

Two patients with multiple basal cell carcinomas, due either to the nevoid basal cell carcinoma syndrome (NBCCS) or arsenical insecticide exposure, were treated with oral isotretinoin for 7 or 8 years, respectively. Gradually decreasing dosage levels were employed. During the initial courses of therapy, high doses (2.0-3.0 mg/kg/day) were intended as chemotherapy. In these patients only 6 of 40 (15%) lesions underwent complete clinical regression. In subsequent courses aimed at chemoprevention, the dose was progressively reduced from 1.5 to 0.25 mg/kg/day. During therapy, no new lesions were observed in the patient with the arsenical exposure. The NBCCS patient developed 1 new lesion during therapy at 1.0 mg/kg/day, 1 new lesion at 0.5 mg/kg/day and 5 new lesions at 0.25 mg/kg/day. Treatment was discontinued and the patient with the arsenic exposure developed his first new tumor 17 months afterwards; in contrast, the NBCCS patient developed 29 tumors within 13 months. These findings suggest that long-term therapy with isotretinoin is needed for the continuation of the cancer chemopreventive effect. However, the need for continuous rather than intermittent maintenance therapy, and the determination of the optimal dose for this purpose may depend on the etiology of the multiple carcinomas and on the tolerability of the lowest effective dose by the individual patient. With these encouraging data, it now appears appropriate to expand this pilot study and perform larger trials to determine the usefulness of isotretinoin in the chemoprevention of basal cell carcinoma in patients with multiple tumors.

Topics: Basal Cell Nevus Syndrome; Carcinoma, Basal Cell; Humans; Isotretinoin; Male; Middle Aged; Neoplasms, Multiple Primary; Prognosis; Skin Neoplasms; Tretinoin