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Dermatologic Surgery : Official... Sep 2011Despite numerous case reports, epidemiologic evidence regarding true rate of skin cancer in scars of any etiology is sparse. (Review)
Review
BACKGROUND
Despite numerous case reports, epidemiologic evidence regarding true rate of skin cancer in scars of any etiology is sparse.
METHODS
Systematic literature review of all published epidemiologic studies on skin cancer in scar tissue from surgery, ulcers, or burns using citation databases and manual review.
RESULTS
There were no epidemiologic data to quantify risk of skin cancer in surgical scars or chronic ulcers. Two eligible cohort studies were identified, from Denmark and Sweden, in which skin cancers in 16, 903 and 37,095 burn patients, respectively, were ascertained through cancer registry follow-up. Each reported standardized incidence ratios (SIRs) for skin cancer types on any site that were uniformly less than unity compared with the general population. Only the Danish cohort assessed skin cancers specifically on past burn injury sites and found a burn-site-specific SIR of 1.2 (95% confidence interval (CI)=0.4-2.7) for squamous cell carcinoma (SCC), 0.7 (95% CI=0.4-1.1) for basal cell carcinoma, and 0.3 (95% CI=0.0-1.2) for melanoma.
CONCLUSIONS
Available epidemiologic data suggest that burn patients are not at higher risk of skin cancers in general, although a modest excess of SCC in burn scars cannot be excluded, nor can excess risk with longer follow-up. Risk of skin cancer in scars other than burn scars has not been investigated epidemiologically.
Topics: Burns; Cicatrix; Denmark; Humans; Incidence; Risk; Skin Neoplasms; Sweden
PubMed: 21635634
DOI: 10.1111/j.1524-4725.2011.02060.x -
Postepy Dermatologii I Alergologii Jun 2023Basal cell carcinoma (BCC) is the most common skin cancer in humans, occurring in more than 50% of Caucasians during their lifetime, with a frequency rate that is... (Review)
Review
INTRODUCTION
Basal cell carcinoma (BCC) is the most common skin cancer in humans, occurring in more than 50% of Caucasians during their lifetime, with a frequency rate that is continually increasing.
MATERIAL AND METHODS
We present a systematic review summarizing the role of transforming growth factor β (TGF-β), cathelicidin, and human β-defensins (HBDs) in the pathogenesis of BCC. The major online databases including PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to extract studies regarding the levels of TGF-β, HBD, and cathelicidin in BCC.
RESULTS
A total of 14 studies met the inclusion criteria and were included in this systematic review. There were 6 studies that included initially established levels of TGF-β in BCCs. A total of 87 BCCs were analysed, and a common result was that the TGF-β levels increase in the BCCs compared to the control groups. Analogously, 2 studies contained numerical data on HBD levels but with a different in methodology. The level of cathelicidin was established in 108 BCCs and was significantly higher in the BCC group than in the control group.
CONCLUSIONS
The presented review shows evidence that proteins like TGF-β, HBD, and cathelicidin play a role in developing BCC. Protein levels or their expression are elevated in patients with BCC. Furthermore, a critical review of the literature was presented and discussed, highlighting its shortcomings.
PubMed: 37545828
DOI: 10.5114/ada.2023.124747 -
Cancers Nov 2021The aim of this study was to examine the association between indoor tanning use and the risk of overall and early-onset (age < 50) melanoma and non-melanoma skin cancer... (Review)
Review
The aim of this study was to examine the association between indoor tanning use and the risk of overall and early-onset (age < 50) melanoma and non-melanoma skin cancer (NMSC). To evaluate the association between indoor tanning and skin cancer, a systematic review of the literature published until July 2021 was performed using PubMed, EMBASE, and MEDLINE. Summary relative risk (RR) from 18 studies with 10,406 NMSC cases and 36 studies with 14,583 melanoma cases showed significant association between skin cancer and indoor tanning (melanoma, RR= 1.27, 95% CI 1.16-1.39; NMSC, RR = 1.40, 95% CI 1.18-1.65; squamous cell carcinoma (SCC), RR = 1.58, 95% CI 1.38-1.81; basal cell carcinoma (BCC), RR = 1.24, 95% CI 1.00-1.55). The risk was more pronounced in early-onset skin cancer (melanoma, RR = 1.75, 95% CI 1.14-2.69; NMSC, RR = 1.99, 95% CI 1.48-2.68; SCC, RR = 1.81, 95% CI 1.38-2.37; BCC, RR = 1.75, 95% CI 1.15-2.77). Moreover, first exposure at an early age (age ≤ 20 years) and higher exposure (annual frequency ≥ 10 times) to indoor tanning showed increasing risk for melanoma (RR = 1.47, 95% CI 1.16-1.85; RR = 1.52, 1.22-1.89) and NMSC (RR = 2.02, 95% CI 1.44-2.83; RR = 1.56, 95% CI 1.31-1.86). These findings provide evidence supporting primary prevention policies regulating modifiable behaviors to reduce the additional risk of skin cancer among younger adults.
PubMed: 34885049
DOI: 10.3390/cancers13235940 -
Advances in Therapy Jan 2017The Hepatic CHEMOSAT Delivery System is an innovative medical device for the treatment of patients with unresectable primary liver tumors or unresectable hepatic... (Review)
Review
UNLABELLED
The Hepatic CHEMOSAT Delivery System is an innovative medical device for the treatment of patients with unresectable primary liver tumors or unresectable hepatic metastases from solid organ malignancies. This system is used to perform chemosaturation percutaneous hepatic perfusion (CS-PHP), a procedure in which a high dose of the chemotherapeutic agent melphalan is delivered directly to the liver while limiting systemic exposure. In a clinical trial program, CS-PHP with melphalan significantly improved hepatic progression-free survival in patients with unresectable hepatic metastases from ocular or cutaneous melanoma. Clinically meaningful hepatic responses were also observed in patients with hepatocellular carcinoma or neuroendocrine tumors. Furthermore, the results of published studies and case reports demonstrated that CS-PHP with melphalan resulted in favorable tumor response rates in a range of tumor histologies (ocular or cutaneous melanoma, colorectal cancer, and hepatobiliary tumors). Analyses of the safety profile of CS-PHP revealed that the most common adverse effects were hematologic events (thrombocytopenia, anemia, and neutropenia), which were clinically manageable. Taken together, these findings indicate that CS-PHP is a promising locoregional therapy for patients with primary and secondary liver tumors and has a acceptable safety profile.
FUNDING
Delcath Systems Inc., New York, NY, USA.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Carcinoma, Hepatocellular; Chemotherapy, Cancer, Regional Perfusion; Colorectal Neoplasms; Female; Humans; Liver Neoplasms; Male; Melanoma; Melphalan; Middle Aged; Skin Neoplasms; Melanoma, Cutaneous Malignant
PubMed: 27798773
DOI: 10.1007/s12325-016-0424-4 -
Health Technology Assessment... Jan 2010To assess the clinical effectiveness and cost-effectiveness of bevacizumab, combined with interferon (IFN), sorafenib tosylate, sunitinib and temsirolimus in the... (Review)
Review
OBJECTIVES
To assess the clinical effectiveness and cost-effectiveness of bevacizumab, combined with interferon (IFN), sorafenib tosylate, sunitinib and temsirolimus in the treatment of people with advanced and/or metastatic renal cell carcinoma (RCC).
DATA SOURCES
Electronic databases, including MEDLINE, EMBASE and the Cochrane Library, were searched up to September/October 2007 (and again in February 2008).
REVIEW METHODS
Systematic reviews and randomised clinical trials comparing any of the interventions with any of the comparators in participants with advanced and/or metastatic RCC were included, also phase II studies and conference abstracts if there was sufficient detail to adequately assess quality. Results were synthesised narratively and a decision-analytic Markov-type model was developed to simulate disease progression and estimate the cost-effectiveness of the interventions under consideration.
RESULTS
A total of 888 titles and abstracts were retrieved in the clinical effectiveness review, including reports of eight clinical trials. Treatment with bevacizumab plus IFN or sunitinib had clinically relevant and statistically significant advantages over treatment with IFN alone, in terms of progression-free survival and tumour response, doubling median progression-free survival from approximately 5 months to 10 months. Temsirolimus had similar advantages over treatment with IFN in terms of progression-free and overall survival, increasing median overall survival from 7.3 to 10.9 months [hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.58 to 0.92)], as did sorafenib in comparison with best supportive care in terms of overall survival, progression-free survival and tumour response, with a doubling of progression-free survival (HR 0.51; 95% CI 0.43 to 0.60). However, the last was associated with an increased frequency of hypertension and hand-foot skin reaction compared with placebo. No fully published economic evaluations of any of the interventions could be located. However, estimates from the PenTAG model suggested that none of the interventions would be considered cost-effective at a willingness-to-pay threshold of 30,000 pounds per quality-adjusted life-year (QALY). Estimates of cost per QALY ranged from 71,462 pounds for sunitinib to 171,301 pounds for bevacizumab plus IFN. Although there are many similarities in the methodology and structural assumptions employed by PenTAG and the manufacturers of the interventions, in all cases the cost-effectiveness estimates from the PenTAG model were higher than those presented in the manufacturers' submissions. Cost-effectiveness estimates were particularly sensitive to variations in the estimates of treatment effectiveness, drug pricing (including dose intensity data), and health-state utility input parameters.
CONCLUSIONS
Treatment with bevacizumab plus IFN and sunitinib has clinically relevant and statistically significant advantages over treatment with IFN alone in patients with metastatic RCC. In people with three of six risk factors for poor prognosis, temsirolimus had clinically relevant advantages over treatment with IFN, and sorafenib tosylate was superior to best supportive care as second-line therapy. The frequency of adverse events associated with bevacizumab plus IFN, sunitinib and temsirolimus was comparable with that seen with IFN, although the adverse event profile is different. Treatment with sorafenib was associated with a significantly increased frequency of hypertension and hand-foot syndrome. Estimates from the PenTAG model suggested that none of the interventions would be considered cost-effective at a willingness-to-pay threshold of 30,000 pounds per QALY.
Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Benzenesulfonates; Bevacizumab; Carcinoma, Renal Cell; Cost-Benefit Analysis; Humans; Indoles; Kidney Neoplasms; Niacinamide; Phenylurea Compounds; Pyridines; Pyrroles; Sirolimus; Sorafenib; Sunitinib
PubMed: 20028613
DOI: 10.3310/hta14020 -
Gastroenterology Research and Practice 2017The most common pattern of esophageal cancer metastases (ECM) is to the lymph nodes, lung, liver, bones, adrenal glands, and brain. On the other hand, unexpected... (Review)
Review
The most common pattern of esophageal cancer metastases (ECM) is to the lymph nodes, lung, liver, bones, adrenal glands, and brain. On the other hand, unexpected metastasis (UM) spread to uncommon sites has increasingly reported and consequently affected the pathway of diagnosis, staging, and management. Using the PubMed database, a systematic search of the following headings "Esophageal" and "Metastasis" or "Metastases" was performed, 10049 articles were identified, and the articles were included if they demonstrated unexpected ECM. 84% of cases were men with an average age of 60.7 years. EC was located in the lower third in 65%. Two-thirds of the UM originated from the lower esophagus, and the two major histological types were adenocarcinoma 40% and squamous cell carcinoma 60%. Metastases were disseminated toward five main anatomical sites: the head and neck (42%), thoracic (17%), abdomen and pelvis (25%), extremities (9%), and multiple skin and muscle metastases (7%). The EC metastases were found to be synchronous 42% and metachronous 58%, isolated in 53.5% and multiple in 46.5%. The overall survival rate was 10.2 months. Since distant metastases are responsible for most EC-related deaths, understanding of ECM dissemination patterns needs more extensive studies. These critical data are the cornerstone of optimal cancer approach and treatment.
PubMed: 28659974
DOI: 10.1155/2017/1657310 -
World Journal of Surgical Oncology Mar 2023Transarterial chemoembolization (TACE) with tyrosine kinase inhibitors (TKIs) has been increasingly used to treat unresectable hepatocellular carcinoma (uHCC). However,... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Transarterial chemoembolization (TACE) with tyrosine kinase inhibitors (TKIs) has been increasingly used to treat unresectable hepatocellular carcinoma (uHCC). However, the superiority of combination therapy to TACE monotherapy remains controversial. Therefore, here we performed a meta-analysis to evaluate the efficacy and safety of TACE plus TKIs in patients with uHCC.
METHODS
We searched four databases for eligible studies. The primary outcome was time to progression (TTP), while the secondary outcomes were overall survival (OS), tumor response rates, and adverse events (AEs). Pooled hazard ratios (HRs) with 95% confidence intervals (95% CIs) were collected for TTP and OS, and the data were analyzed using random-effects meta-analysis models in STATA software. OR and 95% CIs were used to estimate dichotomous variables (complete remission[CR], partial remission[PR], stable disease[SD], progressive disease[PD], objective response rate[ORR], disease control rate[DCR], and AEs) using RStudio's random-effects model. Quality assessments were performed using the Newcastle-Ottawa scale (NOS) for observational studies and the Cochrane risk of bias tool for randomized controlled trials (RCTs).
RESULTS
The meta-analysis included 30 studies (9 RCTs, 21 observational studies) with 8246 patients. We judged the risk of bias as low in 44.4% (4/9) of the RCTs and high in 55.6% (5/9) of the RCTs. All observational studies were considered of high quality, with a NOS score of at least 6. Compared with TACE alone or TACE plus placebo, TACE combined with TKIs was superior in prolonging TTP (combined HR 0.72, 95% CI 0.65-0.80), OS (combined HR 0.57, 95% CI 0.49-0.67), and objective response rate (OR 2.13, 95% CI 1.23-3.67) in patients with uHCC. However, TACE plus TKIs caused a higher incidence of AEs, especially hand-foot skin reactions (OR 87.17%, 95%CI 42.88-177.23), diarrhea (OR 18.13%, 95%CI 9.32-35.27), and hypertension (OR 12.24%, 95%CI 5.89-25.42).
CONCLUSIONS
Our meta-analysis found that TACE plus TKIs may be beneficial for patients with uHCC in terms of TTP, OS, and tumor response rates. However, combination therapy is also associated with a significantly increased risk of adverse reactions. Therefore, we must evaluate the clinical benefits and risks of combination therapy. Further well-designed RCTs are needed to confirm our findings.
TRIAL REGISTRATION
PROSPERO registration number: CRD42022298003.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Tyrosine Kinase Inhibitors; Chemoembolization, Therapeutic; Combined Modality Therapy; Treatment Outcome
PubMed: 37004052
DOI: 10.1186/s12957-023-02961-7 -
JAMA Dermatology Aug 2017Perineural invasion (PNI) in cutaneous squamous cell carcinoma (CSCC) has been associated with an increased risk of poor outcomes. Patients with PNI may present with... (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Perineural invasion (PNI) in cutaneous squamous cell carcinoma (CSCC) has been associated with an increased risk of poor outcomes. Patients with PNI may present with clinical symptoms and/or radiologic evidence of PNI (clinical PNI [CPNI]), yet most patients are asymptomatic and PNI is often found on histologic examination (incidental PNI [IPNI]). Evidence-based estimates of the risks of disease-related outcomes comparing IPNI and CPNI are limited in the dermatology literature.
OBJECTIVES
To review and synthesize outcomes data for patients with CSCC and CPNI or IPNI.
DATA SOURCES
A systematic review was conducted in MEDLINE and EMBASE for English-language articles published since inception to November 11, 2016.
STUDY SELECTION
All studies that reported a disease-related outcome (local recurrence, nodal metastasis, distant metastasis, or disease-specific death) of CSCCs with CPNI and IPNI were included.
DATA EXTRACTION AND SYNTHESIS
Articles were screened for eligibility, and any possible discrepancies in this screening were resolved. Data extracted included study characteristics, tumor characteristics, treatments performed, and disease-related outcomes. Overall risks of disease-related outcomes were generated by pooling patients from eligible studies. χ2 Statistics and Fisher exact tests were used to evaluate differences in disease-related outcomes.
MAIN OUTCOMES AND MEASURES
Risks of disease-related outcomes and 5-year recurrence-free, disease-specific, and overall survival.
RESULTS
A total of 12 studies containing 241 patients with CPNI and 381 patients with IPNI were included in the systematic review and analysis. The overall risks of local recurrence and disease-specific death were significantly higher in patients with CSCC and CPNI compared with those with CSCC and IPNI (local recurrence, 37% vs 17%; P < .001; disease-specific death, 27% vs 6%; P < .001). The risks of nodal metastasis and distant metastasis did not differ significantly by PNI classification. Patients with CSCC and CPNI had poorer mean 5-year recurrence-free survival and disease-specific survival compared with patients with IPNI (recurrence-free survival, 61% vs 76%; P = .009; disease-specific survival, 70% vs 88%; P = .002).
CONCLUSIONS AND RELEVANCE
Patients with CSCC and CPNI are at an increased risk of local recurrence and disease-specific death compared with patients with CSCC and IPNI and have a 30% risk of death. Patients with PNI may benefit from increased long-term surveillance. Further studies are needed to establish standardized guidelines on follow-up and dermatologic surveillance in this high-risk patient population.
Topics: Carcinoma, Squamous Cell; Disease-Free Survival; Humans; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Skin Neoplasms; Survival Rate
PubMed: 28678985
DOI: 10.1001/jamadermatol.2017.1680 -
PloS One 2014A large number of studies have tried to combine sorafenib with TACE for patients with unresectable hepatocellular carcinoma (HCC) and the results were controversial. We... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIM
A large number of studies have tried to combine sorafenib with TACE for patients with unresectable hepatocellular carcinoma (HCC) and the results were controversial. We conducted this systematic review and meta-analysis to evaluate the safety and efficacy of combination therapy of sorafenib and TACE in the management of unresectable HCC.
METHODS
MEDLINE, PsycINFO, Scopus, EMBASE, and the Cochrane Library were searched from January 1990 to October 2013 and these databases were searched for appropriate studies combining TACE and sorafenib in treatment of HCC. Two authors independently reviewed the databases and extracted the data and disagreements were resolved by discussion. Effective value and safety were analyzed. Effective value included disease control rate (DCR), time to progression (TTP) and overall survival (OS).
RESULTS
17 studies were included in the study. In the 10 noncomparative studies, DCR ranged from 18.4 to 91.2%. Median TTP ranged from 7.1 to 9.0 months, and median OS ranged from 12 to 27 months. In the 7 comparative studies, the hazard ratio (HR) for TTP was found to be 0.76 (95% CI 0.66-0.89; P<0.001) with low heterogeneity among studies (P = 0.243; I(2) = 25.5%). However, the HR for OS was found to be 0.81 (95% CI 0.65-1.01; P = 0.061) with low heterogeneity among studies (P = 0.259; I(2) = 25.4%). The common toxicities included fatigue, diarrhea, nausea, hand foot skin reaction (HFSR), hematological events, hepatotoxicity, alopecia, hepatotoxicity, hypertension and rash/desquamation. AEs are generally manageable with dose reductions.
CONCLUSIONS
Combination therapy may bring benefits for unresectable HCC patients in terms of TTP but not OS. Further well-designed randomized controlled studies are needed to confirm the efficacy of combination therapy.
Topics: Antineoplastic Agents; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Combined Modality Therapy; Disease Progression; Humans; Liver Neoplasms; Niacinamide; Phenylurea Compounds; Sorafenib; Survival Analysis; Time Factors
PubMed: 24651044
DOI: 10.1371/journal.pone.0091124 -
Indian Journal of Otolaryngology and... Oct 2022Orbital Exenteration is a major surgical procedure that consists of the removal of the orbital bone, orbital fat, eyeball, and its contents including extraocular...
Orbital Exenteration is a major surgical procedure that consists of the removal of the orbital bone, orbital fat, eyeball, and its contents including extraocular muscles. It is an extensive and morbid surgical procedure. Our aim is to systematically review the indications, complications and reconstruction methods utilised for orbital exenteration. An objective electronic database search was conducted in PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED published in 20 years period from 1999 till 2019. A total of 29 articles were shortlisted for the present review. Most of the studies have eyelid and canthus as most common primary site of malignancy leading to orbital exenteration. Basal cell carcinoma and squamous cell carcinoma being most common pathology. Other intraocular pathology was Retinoblastoma and melanoma. There were various reconstruction methods used by different authors and Sino-orbital fistula was most commonly occurring in majority of studies. Inspite of being a morbid surgery, Orbital Exenteration had acceptable survival and good quality of life. The aggressive pathology that requires orbital exenteration worldwide is mostly periorbital skin, sinus, and intraocular malignancies. The morbidity of the procedure is high with many surgical complications. However, in properly selected patients it can give better outcomes and survival.
PubMed: 36452694
DOI: 10.1007/s12070-020-02270-5