Effectiveness and Safety of Topical Phototherapy in the Treatment of Dermatological Diseases

Phototherapy consists in the use of ultraviolet (UV) radiation from artificial sources for therapeutic purposes. Despite the introduction of new and powerful drugs (including biological and target therapies), phototherapy remains an established, lower cost, and effective option for the treatment of many common skin diseases

Cutaneous Metastases from Malignant Melanoma: Clinical Features and New Therapeutic Perspectives

In this chapter, cutaneous metastases from malignant melanoma will be analyzed from a clinical and a prognostic point of view. This non rare condition is often distressing for the patient, as cutaneous lesions increase progressively in number and size and are frequently worsened by ulceration, bleeding and pain. After a general introduction about the incidence of cutaneous involvement in melanoma natural history, clinical classification of skin metastases will be provided. Then, the impact of cutaneous localizations on prognosis will be evaluated. In the last paragraph, the different therapeutic options for the management of patients with loco-regional or diffused cutaneous metastases will be reviewe

Role of the Microbiota in Skin Neoplasms: New Therapeutic Horizons

The skin and the gut are regularly colonized by a variety of microorganisms capable of interacting with the immune system through their metabolites and influencing the balance between immune tolerance and inflammation. Alterations in the composition and diversity of the skin microbiota have been described in various cutaneous diseases, including skin cancer, and the actual function of the human microbiota in skin carcinogenesis, such as in progression and metastasis, is currently an active area of research. The role of Human Papilloma Virus (HPV) in the pathogenesis of squamous cell carcinoma is well consolidated, especially in chronically immunosuppressed patients. Furthermore, an imbalance between Staphylococcus spp., such as Staphylococcus epidermidis and aureus, has been found to be strongly related to the progression from actinic keratosis to squamous cell carcinoma and differently associated with various stages of the diseases in cutaneous T-cell lymphoma patients. Also, in melanoma patients, differences in microbiota have been related to dissimilar disease course and prognosis and may affect the effectiveness and tolerability of immune checkpoint inhibitors, which currently represent one of the best chances of a cure. From this point of view, acting on microbiota can be considered a possible therapeutic option for patients with advanced skin cancers, even if several issues are still open

Usefulness of photodynamic therapy as a possible therapeutic alternative in the treatment of basal cell carcinoma

Basal cell carcinoma (BCC) is the most common cancer in individuals with fair skin type (I–II) and steadily increasing in incidence (70% of skin malignancy). It is locally invasive but metastasis is usually very rare, with an estimated incidence of 0.0028%–0.55%. Conventional therapy is surgery, especially for the H region of the face and infiltrative lesions; in case of inoperable tumors, radiotherapy is a valid option. Recently, topical photodynamic therapy (PDT) has become an effective treatment in the management of superficial and small nodular BCC. PDT is a minimally invasive procedure that involves the administration of a photo-sensibilizing agent followed by irradiation at a pre-defined wavelength; this determines the creation of reactive oxygen species that specifically destroy target cells. The only major side effect is pain, reported by some patients during the irradiation. The high cure rate and excellent cosmetic outcome requires considering this possibility for the management of patients with both sporadic and hereditary BCC. In this article, an extensive review of the recent literature was made, in order to clarify the role of PDT as a possible alternative therapeutic option in the treatment of BCC

After Surgery: Follow-Up Guidelines of Melanoma Patients

There are several main reasons to begin a follow-up schedule after surgical treatment of the primary cutaneous lesion in patients affected by melanoma. The main goal is the early detection of disease recurrence, even if the impact of a prompt treatment on prognosis is still debated (Barth et al 1995, Atkins et al 2008, Garbe et al 2008). Several authors believe that early detection of asymptomatic metastases does not affect overall survival (Barth et al 1995, Atkins et al 2008). Others (Garbe et al 2008) showed a clear survival benefit for an early with respect to late metastases detection, with a 3-year survival rate of 76%, compared to the 38% of patients with late diagnosis. The early relapse recognition might lead to a more complete and less invasive surgical treatment, with potential benefits for the patient

Inflammatory Cutaneous Diseases in Renal Transplant Recipients.

Kidney transplant recipients frequently suffer from skin infections and malignancies, possibly due to the effects of long-term immunosuppressive therapy. While the relationships between immunosuppression and these pathological conditions have been widely investigated, little is known about the relative incidence and characteristics of inflammatory skin diseases in this type of patient. In this study, we analyze the incidence of a number of inflammatory cutaneous diseases in a cohort of patients who underwent kidney transplantation. Although our study shows a relatively low incidence of these pathologies in transplanted patients-in agreement with the general action of immunosuppressant therapies in reducing inflammation-we scored a different efficacy of the various immunosuppressive regimens on inflammatory and autoimmune skin diseases. This information can be key for designing immunosuppressive regimens and devising accurate follow-up protocols

An unusual cutaneous infection caused by Mycobacterium marinum

Introduction. Mycobacterium marinum is a non-tubercular mycobacterium residing in fresh or salt water (in tropical or temperate areas); it is a fish and human pathogen, and in immunocompromised patients can cause severe cutaneous and subcutaneous infections.Case presentation.A 46-year-old white man who underwent immunosuppressive therapy was admitted to our department in May 2016 for skin lesions previously diagnosed as 'unusual erysipelas'. We rejected the hypothesis of erysipelas, due to the clinical features, and our diagnostic hypotheses were oriented towards sporotrichosis, atypical mycobacteriosis, cutaneous tuberculosis and cutaneous sarcoidosis. Histological examination performed after a skin biopsy was compatible with a diagnosis of sporotrichosis. However, PCR performed on fresh tissue demonstrated the presence ofM. marinum.Conclusion.The case reported is interesting for the unusual clinical localization and modality of infection. The patient became infected by contact with contaminated remains or in the sea, in a geographical area not endemic forM.marinum. The previous state of immunosuppression favoured infection; however, the presence ofM. marinumin this area suggests a possible tropicalization of the water of the Mediterranean Sea. To our knowledge, this case is the only one reported in the literature with this modality of infection and in that geographical area