E. Bernia’s research while affiliated with Instituto Valenciano de Oncologia and other places

Resumen El manejo del carcinoma de células escamosas cutáneo (cSCC) avanzado es complicado, siendo modesta la eficacia de muchos de los fármacos sistémicos disponibles. Cemiplimab ha demostrado su eficacia en el tratamiento del cSCC avanzado en ensayos clínicos, pero los datos del mundo real siguen siendo limitados. Con el objetivo de evaluar la eficacia de cemiplimab en un entorno clínico del mundo real, realizamos un estudio observacional prospectivo de 13 pacientes con cSCC avanzado. Seis pacientes (46%) tenían enfermedad localmente avanzada, mientras que 7 (54%) tenían enfermedad metastásica. Un total de 8 pacientes (62%) respondieron a cemiplimab, 5 (38%) mostraron una respuesta parcial y 3 (23%) mostraron una respuesta completa. Cuatro pacientes con respuesta parcial inicial presentaron una progresión de la enfermedad subsiguiente durante el seguimiento. Seis pacientes (46%) desarrollaron efectos secundarios, siendo leves la mayoría de los mismos (G1). La supervivencia libre de progresión fue de 5,9 meses, con un seguimiento medio de 9 meses. En conclusión, cemiplimab demostró su utilidad en el tratamiento del cSCC avanzado, con unas tasas de respuesta aceptables, un número destacable de respuestas completas y un perfil de seguridad muy bueno.

Management of advanced cSCC is challenging, and many available systemic medications have modest efficacy. Cemiplimab has demonstrated efficacy in the treatment of advanced cSCC in clinical trials, but real-world data are still limited. With the objective of evaluating the efficacy of cemiplimab in a real-world clinical setting, we conducted a prospective observational study of 13 patients with advanced cSCC. Six patients (46%) had locally advanced disease, while 7 (54%) had metastatic disease. A total of 8 patients (62%) responded to cemiplimab. Five (38%) showed a partial response, while 3 (23%) showed a complete response. Four patients with an initial partial response presented subsequent disease progression during follow-up. Six patients (46%) developed AEs, most of which were mild (G1). PFS was 5,9 months, with a median follow-up was 9 months. In conclusion, cemiplimab demonstrated its utility in the treatment of advanced cSCC, with acceptable response rates, a remarkable number of complete responses, and a very good safety profile.

A man in his late 70s with stage IV adenocarcinoma of the lung presented with acute onset of redness, pain, and swelling of both lower limbs. The patient had received 4 cycles of chemotherapy with carboplatin, pemetrexed, and pembrolizumab for progressive disease and was currently in maintenance with pemetrexed-pembrolizumab. The edema appeared 5 days after the patient’s 8th cycle of chemotherapy and evolved into sclerotic plaques. Physical examination revealed ill-defined, erythematoedematous plaques symmetrically distributed along the shins, with areas of induration (Figure, A). The patient remained afebrile and systemically well. Results of laboratory tests showed no elevation of inflammatory markers (normal white blood cell count and C-reactive protein level), with kidney, liver, and heart functions within the normal ranges. Results of venous Doppler ultrasonography imaging of the patient’s legs did not show evidence of deep vein thrombosis. A biopsy specimen was obtained for histopathologic analysis (Figure, B and C).

A woman in her 70s was referred to the dermatology department for evaluation of chronic lymphedema of the right arm that had become painful over the preceding 2 weeks. The patient had a history of invasive ductal carcinoma that was treated 18 years earlier with mastectomy and regional lymphadenectomy, followed by adjuvant chemotherapy and radiotherapy. No disease recurrence had been identified on annual clinical and radiologic examinations. Physical examination revealed signs of chronic lymphedema as well as diffuse yellow pigmentation and scattered ecchymotic lesions that affected the entire right upper extremity (Figure). Histological examination revealed diffuse dermal invasion by atypical sinusoidal vessels that dissected the collagen bundles. The neoplastic cells were pleomorphic, showing abundant mitotic figures, and had positive stain results for CD31, D2-40, ERG, and C-MYC. These findings were consistent with the diagnosis of Stewart-Treves syndrome.

Background Small series of ultrasound findings in dermatofibrosarcoma protuberans (DFSP) have been published, but the usefulness of this technique as a preoperative planning tool for tumor resection has not been studied. Materials and Methods We retrospectively reviewed patients with DFSP at our hospital that underwent ultrasound examination. Depth of invasion was evaluated by ultrasound and histopathology. Accuracy of ultrasound for assessing depth of tumor invasion was estimated. Results Thirty histopathologically confirmed DFSPs were studied. Classic finger‐like projections were observed in 73.3% of cases. A posterior hyperechoic area extending deep into the subcutaneous tissue correlated with the honeycomb DFSP pattern and was observed in 53.3% of patients. Concordance between ultrasound and histopathologic depth measurements was excellent. Lateral tumor extension and Doppler activity were not evaluated in our series. Conclusion Ultrasound showed excellent prediction of depth of invasion. Further studies are required to define the usefulness of ultrasound for determining lateral tumor extension.

Necrobiosis lipoidica is a rare chronic granulomatous disease. Multiple treatment approaches are available, but results are generally minimal and inconsistent. Some publications report variable results with photodynamic therapy (PDT) as a second line of treatment for refractory cases. We report 4 cases of necrobiosis lipoidica treated satisfactorily with conventional PDT using methyl aminolevulinate or 5-aminolevulinic acid BF-200 as the photosensitizing agent. All 4 patients were women with diabetes mellitus who had undergone treatment at least twice in the past, with little improvement. The lesions resolved completely with PDT, leaving only residual atrophy after a mean of 3.2 sessions per lesion.