New Orleans — A presentation at the 63rd Annual Meeting of the American Academy of Dermatolgy examined the latest developments in the diagnosis and treatment of cutaneous oncology, surveying research done in the United States and in other countries as well.
Of the six topics presented by Clark C. Otley, M.D., associate professor of dermatology at the Mayo Clinic, several involved research developed by that institution recently.
"We have studied at the Mayo Clinic the phenomenon of skin cancer in patients with chronic lymphocytic leukemia (CCL), the most common low-grade leukemia," Dr. Otley says, reporting the results of a study recently concluded.
Merkel cell carcinoma Dr. Otley also reviewed studies of prognostic data for Merkel cell carcinoma.
"Another study which hasn't been published yet was done here and at Brown University which showed if you treat people with Merkel cell carcinoma with surgery, and add radiation, their chances of having a recurrence are lower," he says.
Lentigo maligna In other developments, two trials suggested efficacy of imiquimod (Aldara, 3M) for lentigo maligna. Of these two trials, one is from Oklahoma in 2003 and the other from England in 2004. The trials showed that imiquimod cream can successfully clear lentigo maligna. However, there was only a short follow-up on these patients and there have been cases in which people either did not respond or had a recurrence.
Transplant oncology Dr. Otley also discussed developments in transplant oncology.
"Skin cancer in solid organ transplant patients represents a substantial problem," he says.
"A study published in 2004 by Dr. Carucci showed that if you are a solid organ transplant patient with in transit metastatic squamous cell carcinoma, 33 percent of patients will die from that disease within two years," he explains. "Whereas if you don't have an organ transplant, none of the patients in the study have died. Treatment of in transit metastatic squamous cell carcinoma involves consideration of staging with sentinel lymph node biopsy, aggressive surgery, which may involve a wide margin after frozen section surgery, and then strongly considering radiation therapy."
Mohs vs. excision
Another recent trial Dr. Otley discussed involved Mohs surgery versus surgical excision for basal cell carcinoma of the face. Unfortunately, the results of the study, which was done in the Netherlands, were not definitive.
"The study was very difficult to carry out because the patients, the referring physicians and the surgeons refused to have people treated with surgical excision in some cases. This compromised the ability of the study to determine which was the better treatment," he says.
Disclosure: Dr. Otley is a consultant to Connetics Corp., which manufactures acitretin and some other topical medicines.