Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy.
Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy.
Medicina (Kaunas). 2023 Dec 24;60(1):30. doi: 10.3390/medicina60010030.
: Basal cell carcinoma (BCC) represents around 80% of all malignant skin cancers worldwide, constituting a substantial burden on healthcare systems. Due to excellent clearance rates (around 95%), surgery is the current gold-standard treatment. However, surgery is not always possible or preferred by patients. Numerous non-surgical therapies, sometimes combined, have been associated with promising tumor free survival rates (80-90%) in non-melanoma skin cancers (NMSCs). Most research has enrolled superficial basal cell carcinomas (sBCCs), with limited recent studies also involving low-risk nodular BCCs (nBCCs). Given lower efficacy rates compared to surgery, close monitoring during the follow-up period is essential for patients treated with non-surgical therapies. Monitoring with dermoscopy is constrained by low sensitivity rates. Reflectance confocal microscopy (RCM) is more sensitive in monitoring non-surgically treated NMSCs. : A 41-year-old woman with a single nBCC relapse following photodynamic therapy (PDT) located on the dorsum of the nose presented to our center. Given the aesthetically sensitive location of the lesion and the patient's preference for a non-surgical approach, a combined treatment of CO laser and PDT was prescribed. A superpulsed CO laser (power: 0.5-3 W, frequency: 10 Hz, spot size 2 mm) with two PDT sessions (2 weeks apart) were conducted. At 6 weeks follow-up, monitoring performed with RCM revealed a reduction but not eradication of basaloid tumor islands. Another 2 sessions of PDT were recommended. At 3, 12 and 30 months of follow-up, the nasal dorsum area of the previous nBBC lesion was noted to be slightly hypopigmented (observed clinically), with a mild erythematous background (observed by dermoscopy). RCM evaluation confirmed the absence of RCM BCC criteria. The cosmetic outcome was very much improved. : Combined CO laser and PDT for the treatment of a localized nBCC on the dorsum of the nose of a 41-year-old proved to offer tumor free survival at 30-month follow-up, as monitored with RCM. RCM is useful for the evaluation of non-surgical therapies as it has comparably higher sensitivity than dermoscopy and is especially useful in cases of suspected late recurrence. Further studies are needed to validate ongoing tumor free survival following this combined nonsurgical approach in the treatment of nBCC.
基底细胞癌（BCC）约占全球所有恶性皮肤癌的 80%，给医疗系统带来了巨大负担。由于清除率极高（约 95%），手术是目前的金标准治疗方法。然而，手术并非总是对患者可行或首选。许多非手术治疗方法，有时联合使用，与非黑色素瘤皮肤癌（NMSC）的无肿瘤生存率（80-90%）相关，已有令人鼓舞的结果。大多数研究纳入了浅表基底细胞癌（sBCC），最近的一些研究也涉及低风险结节性基底细胞癌（nBCC）。与手术相比，非手术治疗的疗效较低，因此接受非手术治疗的患者在随访期间需要密切监测。由于皮肤镜检查的敏感性较低，因此在监测非手术治疗的 NMSC 方面受到限制。反射共聚焦显微镜（RCM）在监测非手术治疗的 NMSC 方面更敏感。
一名 41 岁女性，因鼻部背侧单个 nBCC 光动力疗法（PDT）后复发，到我中心就诊。鉴于病变的美学敏感位置和患者对非手术方法的偏好，给予 CO 激光和 PDT 联合治疗。进行了两次 PDT 治疗（间隔 2 周）和一次超脉冲 CO 激光（功率：0.5-3 W，频率：10 Hz，光斑 2mm）。在 6 周随访时，RCM 监测显示基底样肿瘤岛有所减少但未完全消除。建议再进行两次 PDT 治疗。在 3、12 和 30 个月的随访中，观察到先前 nBBC 病变的鼻背区域略微色素减退（临床观察），伴有轻度红斑背景（皮肤镜观察）。RCM 评估证实无 RCM BCC 标准。美容效果显著改善。
在 41 岁患者的鼻部背侧采用 CO 激光和 PDT 联合治疗局限性 nBCC，RCM 监测 30 个月无肿瘤生存。与皮肤镜相比，RCM 具有更高的敏感性，对可疑晚期复发的情况尤其有用，是评估非手术治疗的有用工具。需要进一步研究来验证这种联合非手术方法治疗 nBCC 的持续无肿瘤生存率。
