Linked article: This article is commentary on by L. Fania et al., pp. e439–e440 in this issue. To view this article visit https://doi.org/10.1111/jdv.14965

No abstract

Keratinocyte skin carcinomas (squamous cell carcinoma, basal cell carcinoma [BCC], Bowen disease [BD]) inflict significant morbidity and constitute a treatment challenge in renal transplant recipients (RTR). Immunocryosurgery has shown efficacy >95% in the treatment of BCC and BD in immunocompetent patients. The present study evaluated the safety, feasibility and efficacy, of immunocryosurgery in the treatment of BCC and BD in a series of RTR. During a 3‐year period, biopsy‐confirmed cases of BCC and BD were treated with a standard immunocryosurgery cycle (5 weeks daily imiquimod and a session of cryosurgery at day 14). Safety was evaluated by comparing graft function markers between immunocryosurgery treated RTR patients and matched controls. Ten BCC (8 nodular, 1 basosquamous, 1 superficial; diameter 6–14 mm; mean 9.2 mm) and nine BD disease lesions in nine patients (7 men, 2 women; age range: 54–70 years, mean: 62.1 years) were treated with immunocryosurgery and followed‐up for two to 5 years. Five BCC were located on the “H area” of the face. No patient showed clinical or laboratory signs of transplant dysfunction during treatment or follow‐up. Seven out of 10 BCC lesions cleared completely after one 5‐week immunocryosurgery cycle, two cleared after repeat and intensified treatment cycles and one responded only partially (clearance rate: 90%). Seven out of nine BD lesions cleared after one 5‐week immunocryosurgery cycle and one lesion after two cycles (clearance rate: 88.9%). In conclusion, immunocryosurgery is a safe, feasible and effective minimally invasive treatment alternative to standard surgical modalities for BCC and BD in RTR.

Bowen's disease (BD) is a relatively rare in situ squamous cell carcinoma (SCC) with a limited potential of becoming invasive. Ingenol mebutate (IM) was relatively successful for the treatment of BD lesions in small case series. Optical coherence tomography (OCT) is a promising method for the diagnosis of cutaneous keratinocytic carcinomas, including BD. Herein we report the treatment of BD with the combination of cryosurgery and IM and the application of OCT imagining in treatment monitoring. Patients treated within a period of 12 months are retrospectively compiled. Treatment consisted of a mild cryosurgery session (liquid N2, open spray, and 2 freeze-thaw cycles of 15 sec each) of a field including the BD lesion and a 0.5cm rim and IM application for 4 consecutive days starting at the cryosurgery day. Four patients (3 females; average age: 76.5 years) with 4 lesions (20-70mm maximal diameter; average 36.2mm) were included. Healing was excellent and no relapse was observed at 12 months' follow-up. Baseline OCT revealed a disarranged, thickened epidermis, while a normally layered epidermis overlying a hyperreflective dermis was present after treatment. Conclusively, the combination of cryosurgery followed by IM is a feasible, effective treatment for BD that should be evaluated in further studies.