Monitoring the Effectiveness of Noninvasive or Minimally Invasive Therapies for Nonmelanocytic Lesions Using
J M Villa-Gonzalez1, M R Gonzalez-Hermosa1, M Ardigò2
1Department of Dermatology, Cruces University Hospital, Spain; University of the Basque Country, Spain.
Abstract:
In vivo reflectance confocal microscopy (RCM) enables monitoring of non-melanocytic skin cancers (NMSC) treated with non-invasive or minimally invasive therapies. This systematic review analyzed studies on NMSC treated with these therapies and monitored by RCM. A total of 56 articles were included, with 40 focusing on squamous conditions, such as actinic keratosis and squamous cell carcinoma, 15 on basal cell carcinoma (BCC), and 1 on extramammary Paget's disease. Evaluated therapies included ablative laser, cryosurgery, photodynamic therapy, 5-fluorouracil, imiquimod, and tirbanibulin, among others. RCM demonstrated complete response in squamous conditions with normalization of the honeycomb pattern and reduction of scaling and parakeratosis, frequently allowing for detection of subclinical malignancy. In BCC, RCM showed complete response as disappearance of tumor islands. RCM allows treatment optimization and early monitoring, even when inflammation hinders clinical assessment. It is recommended that RCM evaluations be performed starting at least 1 month after treatment for squamous conditions and 3 months for BCC.
Insights
Reflectance confocal microscopy (RCM) effectively monitors non-melanocytic skin cancers (NMSC) after non-invasive treatments. RCM aids in assessing treatment response and optimizing patient care for various skin conditions.
Area of Science:
- Dermatology
- Oncology
- Medical Imaging
Background:
- Non-melanocytic skin cancers (NMSC) require effective monitoring after treatment.
- Non-invasive and minimally invasive therapies are increasingly used for NMSC.
- In vivo reflectance confocal microscopy (RCM) offers high-resolution imaging of skin structures.
Purpose of the Study:
- To systematically review the utility of RCM in monitoring NMSC treated with non-invasive or minimally invasive therapies.
- To analyze RCM findings for different types of NMSC and various treatment modalities.
- To establish optimal timing for RCM follow-up assessments.
Main Methods:
- Systematic review of 56 articles on NMSC treated with therapies like laser, cryosurgery, PDT, and topical agents.
- Analysis of studies utilizing RCM for monitoring treatment response in squamous conditions and basal cell carcinoma (BCC).
- Evaluation of RCM criteria for complete response, including normalization of skin patterns and tumor island disappearance.
Main Results:
- RCM showed complete response in squamous conditions via normalized honeycomb patterns and reduced scaling.
- RCM detected subclinical malignancy in squamous conditions.
- In BCC, RCM indicated complete response through the disappearance of tumor islands.
- RCM facilitated treatment optimization and early monitoring, even with inflammation.
Conclusions:
- RCM is a valuable tool for monitoring NMSC treatment response, offering objective assessment.
- Recommended RCM follow-up is 1 month post-treatment for squamous conditions and 3 months for BCC.
- RCM aids in treatment optimization and early detection of residual or recurrent disease.
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