P7962

P8703How to enhance the efficacy of topic photodynamic therapy for thetreatment of nodular facial BCC

Carmen Salavastru, MD, PhD, 2nd Department of Dermatology, ‘‘Colentina’’Clinical Hospital, Bucharest, Romania; Fabiola Copaci, MD, 2nd Department ofDermatology, ‘‘Colentina’’ Clinical Hospital, Bucharest, Romania; George SorinTiplica, MD, PhD, 2nd Department of Dermatology, ‘‘Colentina’’ ClinicalHospital, Bucharest, Romania; Laura Gheorghita, MD, 2nd Department ofDermatology, ‘‘Colentina’’ Clinical Hospital, Bucharest, Romania; LauraNedelcu, MD, 2nd Department of Dermatology, ‘‘Colentina’’ Clinical Hospital,Bucharest, Romania

Treatment of facial basal cell carcinoma (BCC) may be challenging in a number ofcases (comorbidities, extensive actinic damage of the skin, recurrence on apreviously excised lesion). In such cases, photodynamic therapy (PDT) with 5-amino-levulinic acid (5-ALA) might be a treatment option. Out of 29 patients, 14menand 15 women, with a total of 58 facial BCC (nodular histologic subtype, 9ulcerated) who were treated with 5-ALA PDT from January 2010 to May 2013, 9cases with a tumor height between 2 and 5 mm were treated as follows: for betterpenetration of the 5-ALA 20% cream, a CO2 ablative fractionated laser was used todrill through the lesion before application of the cream both before the first andsecond treatment session; the second exposure followed 30 days apart. A punchbiopsy (4-mm) from the lesionwas taken before treatment. 5-ALA creamwas appliedon the lesions and 3mm around the lesions in a continuous layer, 1 mm in thickness.After 4 hours of occlusion with 5-ALA cream, the lesions were exposed to 633 nmwavelength light, for a total dose of 126 J/cm2. The same dose was used for bothsessions. No recurrence was clinically observed at 9 months of follow-up. Thecosmetic result was appreciated as excellent by both the patients and the clinician.Side effects were noted: pain and stinging sensation that appeared during therapyand slight erythema was present for 3 to 7 days after the sessions. PDT seems to bean efficient treatment method for nodular basal cell carcinoma, especially whenused in combination with other procedures that are used to enhance the depth ofpenetration of the photosensitizer.

AB136

cial support: None identified.

Commer

J AM ACAD DERMATOL

P7675Infected giant dermatofibrosarcoma protuberans causing septic shock

Michelle Gatica-Torres, MD, Instituto Nacional de Ciencias M�edicas y Nutrici�onSalvador Zubir�an, Mexico City, Mexico; Alma Ileana Molina-Hern�andez, MD,Instituto Nacional de Ciencias M�edicas y Nutrici�on Salvador Zubir�an, MexicoCity, Mexico; Jos�e Manuel D�ıaz-Gonz�alez, MD, Instituto Nacional de CienciasM�edicas y Nutrici�on Salvador Zubir�an, Mexico City, Mexico; Juan M Ru�ız-Matta,MD, Instituto Nacional de Ciencias M�edicas y Nutrici�on Salvador Zubir�an, MexicoCity, Mexico; Judith Dom�ınguez-Cherit, MD, Instituto Nacional de CienciasM�edicas y Nutrici�on Salvador Zubir�an, Mexico City, Mexico

Dermatofibrosarcoma protuberans (DFSP) is an uncommon low-grade mesen-chymal neoplasia affecting dermis and subcutis with an increased local invasivecapacity. Tumor cells usually stain positive for CD34. A 52-year-old woman came tothe emergency department of our institution for the first time with a huge (253 233 13 cm) infected tumor on her posterior trunk, causing refractory septic shock.The clinical diagnosiswas DFSP. Emergency excision had to be performed in order toattain control of the septic focus. The mass had been present since 8 years before,but the patient had previously declined surgery. Histopathologic and immunohis-tochemical analysis revealed a CD34-negative DFSP. Pathologically negative marginswere achieved and as soon as the patient became hemodinamically stable a skin graftwas placed. Our case demonstrates an uncommon presentation of a giant and CD34-negative DFSP, causing a major complication. Initial surgical management should beachieved when diagnosed in order to avoid complications and more extensivesurgeries.

cial support: None identified.

Commer

P7934Ingenol mebutate gel topically applied under occlusion to superficialbasal cell carcinoma is efficacious compared with marginal effect inseborrheic keratosis

Michael Freeman, The Skin Centre, Benowa, Australia; John R. Zibert, LEOPharma A/S, Ballerup, Denmark; Kim Mark Knudsen, LEO Pharma A/S, Ballerup,Denmark; Lynda Spelman, Specialist Connect, Woolloongabba, Australia; RobertRosen, Southderm Proprietary Ltd, Kogarah, Australia

Ingenol mebutate 0.05% gel (IngMeb) has shown to be effective when appliedtopically and locally to squamous cell carcinoma in situ, whereas only marginaleffect is evident in seborrheic keratosis (SebK), indicating selectivity for malignantover benign cells. Occlusive dressings (ODr) may enhance penetration of topicallyapplied drugs; we therefore investigated, in 2 open-label, phase 2 trials, the safetyand efficacy of IngMeb under different ODrs in treating superficial basal cellcarcinoma (sBCC) or SebK on nonhead locations. Patients received IngMeb, appliedto either 1 histologically confirmed sBCC once daily on 3 consecutive days with: no-ODr (24 pts), semi-ODr (Opsite) (26 pts) or full-ODr (Finn chamber) (25 pts) (total75 pts); or SebK lesions (total 24 pts). Half of the patients’ lesions (40) wereoccluded with semi-ODr (Opsite) daily for all 3 consecutive dayswhile the other halfhad no-ODr (40). For both studies the safety, including composite local skin reaction(LSR) grading (max score of 24), and the efficacy including clinical clearance rate(CCR) was assessed, for sBCC on day 120, for SebK day 43. At end of the sBCC trialthe treatment area was excised and histologic clearance rate (HCR) was evaluated.For sBCC in the full-ODr group, 81.5% of patients tolerated only 1 treatment; in thesemi-ODr group and the no-ODr group, 79.2% and 95.8% of patients receivedtreatment on all 3 days, respectively. For SebK, all patients received studymedication on all 3 days on at least 1 lesion. The LSRs were 11.3 with full-ODr atday 3 in sBCC; semi-ODr 7.5 (sBCC) and 5.5 (SebK); and no-ODr 8.9 (sBCC) and 4.5(SebK) at day 4. In sBCC, full-ODr group 4 patients had scarring at baseline and ofthese, 3 had no scarring present at day 120. However, 1 patient was depigmented, 3patients had signs of hyperpigmentation and 4 reported scarring in the treatmentarea at day 120. In the other treatment groups (sBCC and SebK) there was no changein pigmentation or scarring. All adverse drug reactions were resolved at the end ofthe trial. For sBCC the HCR and CCR were, respectively: 70.4%, 74.1% in full-ODr,37.5%, 75.0% in semi-ODr and 54.2%, 75.0% in no-ODr. For SebK the CCRwas 20.0%and 15.0% for semi-ODr and no-ODr, respectively. The clinical effect in SebK wasmarginal, despite occlusion. However, the highest efficacy in terms of 70.4% HCRwas seen with treatment under full occlusion in sBCC. ClinicalTrials.gov numbers:NCT01325688 and NCT01214564.

d by LEO Pharma A/S.

Supporte

MAY 2014