Is more dose and skin reaction required when treating early lentigo maligna definitively with radiotherapy? A case series

Fogarty, GB; Hong, Aayoung; Rocha, Lílian Kelly Faria Licarião; Vilain, RE; Ferguson, Peter M.; Guitera, Pascale

doi:10.15406/ijrrt.2020.07.00280

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…One hypothesis is that AIMP, being more similar to normal tissue than invasive disease, is more capable to repair radiation damage than invasive disease and may therefore require dose escalation until the development of grade 3 skin reaction. [10][11][12] This strategy is similar to managing the treatment with imiquimod until a specific inflammatory reaction is attained. Indeed, most of the cases treated with imiquimod at baseline had initial very low inflammation, and patients had to apply a dose escalation protocol to trigger the inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…Despite RT dose following guidelines for lentigo maligna, 10 they all recurred with MIS. One hypothesis is that AIMP, being more similar to normal tissue than invasive disease, is more capable to repair radiation damage than invasive disease and may therefore require dose escalation until the development of grade 3 skin reaction 10–12 . This strategy is similar to managing the treatment with imiquimod until a specific inflammatory reaction is attained.…”

Section: Discussionmentioning

confidence: 99%

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Confocal microscopy, dermoscopy, and histopathology features of atypical intraepidermal melanocytic proliferations associated with evolution to melanoma in situ

et al. 2021

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Background Atypical intraepidermal melanocytic proliferations (AIMP) is a descriptive term sometimes applied to biopsies that do not fulfill diagnostic criteria of melanoma. They are common on sun-damaged skin, but their definition and management are controversial.Objective To describe dermoscopic (DS), reflectance confocal microscopic (RCM) and histopathological features of AIMP and identify features associated with subsequent melanoma in situ (MIS). Methods A retrospective analysis of AIMP lesions correlated with patient outcome at two melanoma tertiary centers between 2005 and 2015. Results Thirty-four patients were included. Nine (26%) patients had MIS in subsequent biopsies. Predictors of later MIS were target-like pattern (OR:12.0 [CI: 1.23, 117.41]; P = 0.032) and high-density vascular network (OR:12 [CI: 1.23-117.41], P: 0.032) on DS, and presence of dendritic cells touching each other (OR:9.1 [CI: 1.54, 54.59], P = 0.014) on RCM. Clinical predictors of worse outcome included a previous history of MIS at the same site. Radiotherapy for AIMP had a high failure rate (all patients presented with recurrent disease, three as AIMP and two as MIS).Conclusions Considering that most cases in this series received non-surgical treatment at baseline, we recommend close monitoring for lesions with target-like pattern and density vascular network on DS and treatment for lesions with progression of atypia and/or with "confluent" dendritic cells on RCM. Although the number of patients in this series is very low, early surgery is recommended for MIS cases that recur as AIMP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Confocal microscopy, dermoscopy, and histopathology features of atypical intraepidermal melanocytic proliferations associated with evolution to melanoma in situ

et al. 2021

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“…14 As described elsewhere, it seems that melanoma in-situ disease still needs dose and is not as radiosensitive as in-situ disease of keratinocytic lineage. 26 Good palliation was achieved in the two cases palliatively treated.…”

Section: Analysis For the Whole Cohort With Keratinocytic Lineage Who...mentioning

confidence: 92%

“…As more scalps were part of the dose-finding cohort, a higher dose, even to 60 Gy as per in-situ disease in other tissues, was prescribed. 25,26 Recurrences occurred in 10 out of 27 (37%) legs. Only three legs with recurrences completed the prescribed RT (30%).…”

Section: Analysis For the Whole Cohort With Keratinocytic Lineage Who...mentioning

confidence: 99%

Field-based radiotherapy using volumetric modulated arc therapy (VMAT) for skin field cancerisation (SFC)–outcomes from 100 consecutive fields

Fogarty¹,

Young²,

Lo³

et al. 2021

IJRRT

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Introduction: Skin field cancerisation (SFC) arises from prolonged sun exposure and increases with age, especially in fair skinned individuals. Multiple areas of the skin can be involved, resulting in poor quality of life and cosmesis. Invasive skin cancer can arise causing morbidity and even death. The long-term efficacy of traditional treatments is disappointing. Volumetric modulated arc therapy (VMAT) allows efficient definitive radiotherapy treatment of large convex skin fields. This retrospective, single-institution study presents a case series of 100 consecutive SFC fields in 74 patients. Methods: The first 100 fields treated with VMAT for SFC by the same clinician (GBF) were identified through departmental medical records. Patient, field, treatment, and outcome factors were collected for analysis. The date of the first consultation was collected to calculate the rate of referrals over time. Results: The first patient completed treatment in October 2013 and the last patient in May 2020. Seventy-four mostly male (84%) patients with a median age of 76 years were identified. At least 75% had previously undergone treatment for SFC and 11% were immunosuppressed. Twenty percent of patients had more than one field treated with VMAT. Ninety-three fields of keratinocytic lineage were found with most involving the legs (27), scalp (23) or nose (20). Average planning target volume (PTV) size was 175 (range 5 - 1282) cm3. Average prescribed dose was 50 (range 15 - 72) Gy, average delivered dose was 45 (range 4 - 72) Gy. Sixty-four (69%) of fields completed the prescribed course. There were 15 (16%) in-field recurrences. In-field control on an intention-to-treat basis was 89% at 12 months. For those who completed the prescribed treatment, in-field control at 12 months was 98% as compared with 71% for those who did not (p <.0001). PTV size did not impact treatment completion. In those who completed the prescribed treatment, recurrence was not associated with PTV size nor dose. The rate of referrals increased over time. Conclusion: VMAT for SFC is feasible and effective if the whole course is completed. These findings support our national protocol. More research is warranted to predict radiosensitivity so that treatment can be better tailored. Research to identify patients at risk of lower leg lymphoedema before they become symptomatic is also needed to ensure treatment completion thereby reducing the risk of recurrence.

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“…It could therefore be argued that at least the same dose is needed as for malignant disease. 33 More research is needed.…”

Section: Does the Problem Of Accelerated Repopulation Occur In Skinmentioning

confidence: 99%

A scientific approach to skin radiotherapy nursing Article 2 - The anatomy, physiology, pathology and radiobiology of skin and its diseases

Fogarty¹,

Mallon²,

Athar³

et al. 2022

IJRRT

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Nurses play an important role in the care of patients treated with radiotherapy (RT) for skin conditions such as skin cancers. A series of four articles will aim to supplement general oncology nurse training by providing a scientific basis to better understand the skin and its diseases, the use of RT in skin, and the management of necessary acute skin RT reactions to achieve best patient outcomes. The first article focused on the role of the nurse within the radiation oncology department and the initial patient assessment. This second article describes the anatomy, physiology, pathology and radiobiology of skin and its diseases. These concepts are fundamental to the understanding of how acute effects develop during treatment and how to best care for them. The transition time of normal keratinocytes in the epidermis from creation to demise (10-14 days) is discussed as essential to understanding the timing of acute RT effects. The effect of RT on DNA, and the different effects of RT on normal cells versus tumour cells, which underscore fractionation and normal tissue conservation, are also discussed. Finally, this article addresses the late effects of RT in normal skin, accelerated repopulation, types of skin cancers and their relative radiosensitivities, and the effects of RT on benign skin diseases. The third article will describe the skin RT prescription and plan, especially in relation to volume and dose; and the fourth will show how the nurse, by applying the knowledge from the previous articles, can predict, explain and care for the acute side effects that may arise during a course of skin radiotherapy.

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Is more dose and skin reaction required when treating early lentigo maligna definitively with radiotherapy? A case series

Cited by 5 publications

References 9 publications

Confocal microscopy, dermoscopy, and histopathology features of atypical intraepidermal melanocytic proliferations associated with evolution to melanoma in situ

Confocal microscopy, dermoscopy, and histopathology features of atypical intraepidermal melanocytic proliferations associated with evolution to melanoma in situ

Field-based radiotherapy using volumetric modulated arc therapy (VMAT) for skin field cancerisation (SFC)–outcomes from 100 consecutive fields

A scientific approach to skin radiotherapy nursing Article 2 - The anatomy, physiology, pathology and radiobiology of skin and its diseases

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