ABSTRACT: The incidence of multiple basal cell carcinomas (BCCs) is not well documented.
To calculate the cumulative risks, rates and risk factors for the development of subsequent histologically confirmed BCCs.
For this cohort study the Dutch nationwide network and registry of histopathology and cytopathology (PALGA) was used. The first 2483 patients diagnosed with a first histologically confirmed BCC in the year 2004 were followed for 5years. Multifailure survival models were used to study whether gender or age affected the risk of developing subsequent tumours.
During our observational period, the 2483 patients developed a total of 3793 histologically confirmed BCCs. The 5-year cumulative risk of developing one or more subsequent BCCs was 29·2%. Incidence rates were 25,318 per 100,000person-years in the first 6months after first BCC diagnosis, decreasing to 6953 per 100,000person-years after 5years of follow-up. Males compared with females had a 30% [adjusted hazard ratio (HR) 1·30, 95% CI (confidence interval) 1·11-1·53] higher risk of developing multiple BCCs and those aged 65-79years had more than 80% (adjusted HR 1·81, 95% CI 1·37-2·41) higher risk of having subsequent tumours compared with patients younger than 50years.
The high incidence rate of subsequent BCCs among patients with a first BCC is highest in the first months after diagnosis of the first BCC but persists long term, indicating that patients with BCC should undergo full-body skin examinations at first presentation and subsequent follow-up visits. Special attention should be paid to males and persons of older age at index lesion.
British Journal of Dermatology 06/2011; 165(4):874-81. · 3.67 Impact Factor
ABSTRACT: To calculate the cumulative risks and incidence rates for the development of multiple (two or more) basal cell carcinomas (BCC).
A retrospective cohort study with data from PALGA, the nationwide network and registry of histopathology and cytopathology in the Netherlands.
Using pathology reports, the first 2483 patients diagnosed with a first histologically confirmed BCC in the year 2004 were retrospectively followed for 5 years. The Andersen-Gill survival analysis was used to study whether gender or age affected the risk of developing multiple BCCs.
In total, 2483 patients developed 3793 BCCs. The five-year cumulative risk of developing multiple BCCs was 29.2%. The incidence rate for the development of two or more BCCs was 25,318 per 100,000 person-years in the first half year after first BCC diagnosis, decreasing to 6953 per 100,000 person-years after 5 years of follow-up. Compared with women men had a 30% (adjusted HR 1.30; 95% CI 1.11-1.53) higher risk of developing multiple BCCs and those aged 65-79 years had an 80% (adjusted HR 1.81; 95% CI 1.37-2.41) higher risk of having two or more BCCs compared with patients younger than 50 years.
Almost one third of the patients with a BCC developed two or more BCCs, most frequently in the period shortly after the first BCC. At diagnosis of BCC a full body skin examination should be performed and repeated annually for at least three years.
Nederlands tijdschrift voor geneeskunde 01/2011; 155(47):A4110.
ABSTRACT: The aim of this review was to describe briefly the mechanism and history of photodynamic therapy (PDT). The achieved preclinical and clinical results in Rotterdam are discussed in the light of a search to optimize aminolevulinic acid-photodynamic therapy (ALA-PDT). As the incidence of skin cancer is rising, an optimized treatment in non-melanoma skin cancer is needed.
Giornale Italiano di Dermatologia e Venereologia 08/2009; 144(4):433-9.
ABSTRACT: Photodynamic therapy (PDT) is an accepted treatment for superficial basal cel carcinoma (sBCC) and Bowens disease. In Rotterdam, extensive preclinical research has lead to an optimized twofold illumination scheme for aminolevulinic acid-PDT (ALA-PDT).
To provide additional evidence of ALA-PDT for sBCC, Bowens disease (BD), nodular BCC (nBCC) and actinic keratosis (AK) using a 2-fold illumination scheme after a single application of ALA.
Five hundred fifty-two lesions (430 sBCC, 20 nBCC, 32 BD, 70 AK) were treated with ALA-PDT using a twofold illumination scheme. ALA was applied topically for 4 h. Lesions were treated with two light fractions of 20 and 80 J/cm(2) separated by a 2-h dark interval.
After a minimum follow-up of 12 months, in average follow-up of 2 years, an overall complete response of 95% was seen for all lesions. For sBCC, the complete response at 2 years was 97% (for AK 98%, for BD 84% and for nBCC 80% after 2 years). A sub-analysis of the results of lesions larger than 2 cm showed CR at 2 years of 89% for all lesions (n = 57). Cosmetic outcome was good to excellent in 95% of the treated lesions.
ALA-PDT using a twofold illumination scheme of 20 plus 80 J/cm(2) separated by a 2-h dark interval leads to high complete response rates at 2 years and can be regarded as an evidence-based treatment modality for superficial growing non-melanoma skin cancer and the (pre)malignant AK. The Rotterdam fractionated approach should be included in future guidelines.
Journal of the European Academy of Dermatology and Venereology 05/2008; 22(4):426-30. · 2.98 Impact Factor
ABSTRACT: Photodynamic therapy of superficial basal cell carcinoma using topical 5-aminolevulinic acid and a light fluence of 75-100
J cm−2 yields unsatisfactory long term clinical response rates. In a range of pre-clinical models illumination with two light fractions
separated by 2 hours apart was considerably more effective than single illumination. Response is further enhanced if the fluence
of the first light fraction is reduced while the cumulative fluence is maintained. We have demonstrated that these encouraging
pre-clinical results are also evident for the clinical ALA-PDT of the treatment of superficial basal cell carcinoma. In a
large scale randomised study including 505 primary sBCC we have shown that therapy using two light fractions of 20 and 80
Jcm−2 performed 4 and 6 hours after the application of a single dose of 20% ALA results in a significant increase in complete response
(P ̃ 0.002, log-rank test). Twelve months after therapy, complete response rate following a two-fold illumination is 97% whereas
the complete response to a single illumination is 89%. Numerous studies are underway investigating the mechanism underlying
the increase in tissue response. Increased efficacy is not simply associated with an increasing PpIX content of the tissues
during the treatment scheme and there is no direct relationship between the total amount of PpIX utilised and efficacy. We
have shown that fractionated illumination does not enhance the efficacy of PDT using methyl-ester derivatives of ALA despite
almost identical PpIX fluorescence kinetics during therapy. Our most recent data suggest that the in-vivo distribution of
MAL and ALA and the exact site of PDT induced damage, is an important parameter in the mechanism underlying fractionated illumination
for ALA-PDT. There is significant potential for the future use of light fractionation in other organs.
Keywords:Photodynamic therapy–protoporphyrin IX–optimisation–skin.
12/2007: pages 89-98;
ABSTRACT: Clinical practice guidelines are increasingly used. To determine the quality of guidelines the Appraisal of Guidelines and Research and Evaluation (AGREE) instrument was developed and introduced in 2001. The AGREE instrument consists of 23 criteria, grouped in six domains.
Assessment of quality of evidence-based guidelines in dermatological oncological care according to the AGREE instrument.
We searched MEDLINE, PubMed, EMBASE and Cochrane literature and relevant websites of guidelines development programmes and the national dermatological society to identify evidence-based dermatological guidelines especially in the treatment of to basal cell carcinoma, squamous cell carcinoma and melanoma. Twenty guidelines, published between 1990 and 2005, were appraised according to the AGREE instrument by three authors. Standardized domain scores were calculated as advised by AGREE. We compared guidelines published before 2002 with those published later.
Domain scores in the domains Scope & Purpose and Clarity were scored best. Applicability and Editorial Independence were scored worst (see Table 1). In time a weak trend towards better guidelines was seen. This trend can be attributed to better scores in the domains Search Strategy and Level of Evidence which are closely related to evidence-based medicine. The increase in score is due to more explicitly mentioning the search strategy, possible conflict of interest and involvement of different specialties in development of the guideline. Using the Mann-Whitney test to compare guidelines published before the AGREE and afterwards only a statistically significant better score was found for the domain Clarity (P < 0.05; Table 2).
Guidelines in dermatological oncological care are of reasonable quality according to the AGREE instrument. The domains in the AGREE instrument concern especially the methods of development of guidelines. The score according to AGREE can be improved by explicitly mentioning the different items. As clinical guidelines are regarded to be an important instrument to improve quality of care, improvements are needed.
Journal of the European Academy of Dermatology and Venereology 10/2007; 21(9):1193-8. · 2.98 Impact Factor