pep005 and Precancerous-Conditions

Actinic keratoses are premalignant skin lesions with the risk of converting into squamous cell carcinoma, and therefore they should be treated. Treatment modalities include cryotherapy, photodynamic therapy, carbon dioxide laser and also topical treatments such as imiquimode, ingenol mebutate, 5-fluorouracil and diclophenac. In the future, the treatment of actinic keratosis can be more often done in primary health care. The most favorable treatment modality depends on patient age, general health, and the thickness, size and localization of the lesion.

Topics: Administration, Topical; Aminoquinolines; Anti-Inflammatory Agents, Non-Steroidal; Antineoplastic Agents; Cryotherapy; Diclofenac; Diterpenes; Fluorouracil; Humans; Imiquimod; Keratosis, Actinic; Laser Therapy; Photochemotherapy; Precancerous Conditions; Primary Health Care

The cost of topical treatments for actinic keratosis (AK) has historically been evaluated in relation to the number of lesions requiring treatment or simply by the price of a single tube/sachet of the drug used.. To demonstrate a new method of costing topical treatments in AK, which takes into account the actual cancerization area treated.. In order to evaluate the actual cost of each treatment, the official approval status of the drug was used to estimate the amount of cream needed per one cm. Areas which could be treated with a single tube/sachet of Metvix. Changing treatment costing strategy in the management of multiple AKs towards costing per cancerization area instead of costing per lesion is a much more accurate representation of the 'real world cost' for AK.

Topics: Administration, Topical; Aminolevulinic Acid; Cohort Studies; Cost of Illness; Diclofenac; Diterpenes; Drug Administration Schedule; Female; Fluorouracil; Health Care Costs; Humans; Imiquimod; Italy; Keratosis, Actinic; Male; Photochemotherapy; Precancerous Conditions; Retrospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome

Actinic cheilitis (AC) can precede the development of squamous cell carcinoma of the lip, a location with high risk of invasiveness and metastasis. We communicate the good results that we obtained when treating seven patients suffering from AC with ingenol mebutate (IM) 0,015% concentration gel on three consecutive days. Three patients achieved complete clearance and four significant improvement. IM is a topical field treatment approved for actinic keratosis. To our knowledge, reported experience in the management of AC with IM is very limited. Local skin responses grade 3 were the main adverse event observed and they resolved in all patients without specific therapy within 1 to 2 weeks. IM is characterized by its rapid clinical effect, its favorable safety profile and its dosing period of only 3 days, shorter than with other field therapies. All these facts make it an attractive new therapy for AC, with need for further study.

Topics: Administration, Topical; Aged; Aged, 80 and over; Antineoplastic Agents; Cheilitis; Disease Management; Diterpenes; Drug Administration Schedule; Female; Gels; Humans; Lip Neoplasms; Male; Middle Aged; Precancerous Conditions; Treatment Outcome

We present the case of a healthy 76-year-old man with a whitish, hyperkeratotic lesion of the lower lip diagnosed as actinic cheilitis (AC) previously treated with classic red light photodynamic therapy 5 years ago. Initial treatment with 5% imiquimod cream - also with intensified application - failed. After 2 cycles thrice daily, consecutive applications of 150 μg/g ingenol mebutate gel at 3 weeks' interval, the lesions cleared completely. Surprisingly, no pustular or crusting reaction or other side effect occurred contrary to expectation. Remission was stable for 10 months, when recurrence occurred. Ingenol mebutate proved to be a feasible and safe treatment in this otherwise refractory case of AC.

Topics: Administration, Cutaneous; Aged; Antineoplastic Agents; Cheilitis; Chronic Disease; Diterpenes; Humans; Lip; Lip Neoplasms; Male; Neoplasm Recurrence, Local; Precancerous Conditions; Skin Neoplasms

Skin cancer is the most prevalent cancer worldwide and is primarily caused by chronic UV exposure. Here, we describe the topical field-directed treatment of SKH1/hr mice with UVB-damaged skin with ingenol mebutate, a new topical drug shown to be effective for the treatment of actinic keratosis (AK). Application of 0.05% ingenol mebutate gel to photo-damaged skin resulted in a ≈70% reduction in the number of skin lesions that subsequently emerged compared with placebo treatment. Ingenol mebutate treatment also reduced the number of mutant p53 keratinocyte patches by ≈70%. The treatment resulted in epidermal cell death, acute inflammation, recruitment of neutrophils, hemorrhage, and eschar formation, all of which resolved over several weeks. Ingenol mebutate field-directed treatment might thus find utility in the removal of subclinical precancerous cells from UV-damaged skin. Field-directed treatment may be particularly suitable for patients who have AKs surrounded by UV-damaged skin.

Topics: Animals; Antineoplastic Agents; Apoptosis; Carcinoma, Squamous Cell; Disease Models, Animal; Diterpenes; Dose-Response Relationship, Drug; Keratinocytes; Keratosis, Actinic; Male; Mice; Mice, Hairless; Mutation; Neoplasms, Radiation-Induced; Precancerous Conditions; Skin; Skin Neoplasms; Tumor Suppressor Protein p53; Ultraviolet Rays