Development of a Core Outcome Set for Basal Cell Carcinoma (BCC), Including Low-Risk and Advanced Tumors
BACKGROUND:There is variation in the outcomes reported in clinical studies of basal cell carcinoma (BCC). This can prevent effective meta-analyses to answer important clinical questions. OBJECTIVE:To identify a recommended minimum set of core outcomes for BCC clinical trials. METHODS:Patient and professional Delphi process to cull a long-list, culminating in a consensus meeting. To be provisionally accepted, outcomes needed to be deemed 'important' (score: 7-9, of maximum of 9) by 70% of each stakeholder group. RESULTS:235 candidate outcomes identified via a systematic literature review and survey of key stakeholders were reduced to 74 that were rated by 100 health care professionals and patients in two Delphi rounds. 27 outcomes were provisionally accepted. The final core set of 5 agreed-upon outcomes after the consensus meeting was: complete response; persistent or serious adverse events; recurrence-free survival; quality of life; and patient satisfaction, including with cosmetic outcome. LIMITATIONS/CONCLUSIONS:English-speaking patients and professionals rated outcomes extracted from English-language studies. CONCLUSIONS:A core outcome set (COS) for basal cell carcinoma has been developed. Use of relevant measures may improve the utility of clinical research and the quality of therapeutic guidance available to clinicians.
Invasive and in situ squamous cell carcinoma of the skin: a nationwide study in Iceland
BACKGROUND:The worldwide incidence of cutaneous squamous cell carcinoma (cSCC) is increasing. OBJECTIVES/OBJECTIVE:To evaluate the tumour burden of in situ and invasive cSCC in Iceland, where the population is exposed to limited ultraviolet radiation. METHODS:This whole-population study used the Icelandic Cancer Registry, which contains records of all in situ and invasive cSCC cases from 1981 to 2017. Incidence of cSCC was evaluated according to age, anatomical location, residence and multiplicity, and trends were assessed using joinpoint analysis. Age-standardized rates (WSR) and age-specific incidence rates per 100Â 000 person-years were calculated, along with cumulative and lifetime risks. RESULTS:Between 1981 and 2017, in situ cSCC WSR increased from 1Â·2 to 19Â·1 for men and from 2Â·0 to 22Â·3 for women. Invasive cSCC WSR rose from 4Â·6 to 14 for men and from 0Â·3 to 13Â·2 for women. The average number of in situ cSCC lesions was 1Â·71 per woman and 1Â·39 per man. Women developed more in situ cSCCs than invasive cSCCs in almost all anatomical locations, whereas men developed more invasive cSCCs, mostly on the head and neck. The rates of in situ cSCC were higher in Reykjavik compared with rural areas. Furthermore, women more commonly developed multiple in situ lesions. For lip cSCCs, invasive lesions occurred more frequently than in situ lesions among both sexes. Joinpoint analysis showed that in situ cSCC in women exhibited the most rapid incidence increase. CONCLUSIONS:cSCC has become an increasingly significant public health problem in Iceland. Tanning bed use and travelling abroad may contribute to skin cancer development. Public health efforts are needed to stem the behaviours leading to this rapid rise in cSCC.
Fairness and transparency in medical journals [Editorial]
Bridging the Gap: Integrating Gene Expression Profiling into Clinical Practice
Topical Scar Treatment Products for Wounds: A Systematic Review
BACKGROUND:There is an increasing number of over-the-counter topical products that are said to prevent pathologic scar formation and improve scar cosmesis. However, robust clinical data are lacking to substantiate these claims and to guide selection of topical products. OBJECTIVE:To determine the effectiveness of topical scar management products, including silicone gel, Allium cepa onion extract, vitamin E, trolamine, and microporous tape. METHODS AND MATERIALS/METHODS:A PubMed search (2005-2019) was performed to identify studies of topical scar management products. Randomized controlled trials (RCTs), quasi-RCTs, meta-analyses, and controlled clinical trials were included for analysis. RESULTS:A total of 34 trials were included in this study. Of the 16 trials investigating silicone gel sheets, numerous high-quality RCTs found that silicone gel sheets and silicone gels significantly improved scar outcomes. Only a limited number of studies supported the effectiveness of onion extract, vitamin E, trolamine, and microporous tape products. CONCLUSION/CONCLUSIONS:Silicone gel products are an effective noninvasive treatment to prevent formation of pathologic scars and improve mature scars. Further high-quality studies are needed to elucidate the long-term effectiveness of these therapies.
Basal cell carcinoma: an emerging epidemic in women in Iceland
BACKGROUND:An epidemic of BCCs has led to a significant healthcare burden in Caucasian populations. OBJECTIVES/OBJECTIVE:To provide an update on incidence-rates and tumor-burden in an unselected, geographically isolated population that is exposed to a low level of UV radiation. METHODS:A whole population study using a cancer registry containing records of all BCC cases in 1981-2017. We assessed BCC incidence according to age, residence and multiplicity and assessed trends using joinpoint-analysis. Age-standardized and age-specific incidence rates were calculated along with cumulative and lifetime-risks. RESULTS:Throughout the study period, the age standardized incidence rates increased from 25.7 to 59.9 for men, and from 22.2 to 83.1 for women (per 100.000). Compared to the single tumor-burden, total tumor-burden in the population was 1.72 times higher when accounting for multiplicity. In the beginning of the study period, the world-standardized-rates in men and women were similar, but by the end of the study period the rates were 39% higher in women (83.1, 95% CI [77.9-88.3]) compared to men (59.9, 95% CI [55.6-64.2]). This increase was most prominent in women years on sites that are normally not exposed to UV radiation in Iceland, the trunk and legs. CONCLUSIONS:This is the only reported population in which the incidence of BCC is significantly higher in women than in men. The period of notable increase in BCC lesions correlates with the period of increase in tanning bed and travel popularity. The high multiplicity rates suggest that total tumor burden worldwide might be higher than previously thought.
Risk factors for recurrent and metastatic cutaneous squamous cell carcinoma in immunocompromised patients
Nanoparticles in Dermatologic Surgery
Nanotechnology is an emerging branch of science that involves the engineering of functional systems on the nanoscale (1-100 nm). Nanotechnology has been utilized in biomedical and therapeutic agents with the aim of providing novel treatment solutions where small molecule size may be beneficial for modulation of biologic function. Recent investigation in nanomedicine has become increasingly important to cutaneous pathophysiology, such as functional designs directed towards skin cancers and wound healing. This review outlines the application of nanoparticles relevant to dermatologic surgery.
Commentary on Analysis of Speaking Opportunities by Gender at National Dermatologic Surgery Conferences
Outcomes for Basal Cell Carcinoma Treated With Vismodegib Extended Alternate Day Dosing