Laser induced thermotherapy of multiple actinic keratosis

Abstract

Actinic keratosis (AK) is one of the most common precancerous diseases of the skin, which is characterized by local intraepidermal atypia of keratinocytes that occurs under the influence of ultraviolet radiation, clinically manifested by typical foci of hyperkeratosis in exposed areas of the skin. This is an urgent medical and social problem due to the potential tendency of atypical keratinocytes to malignant transformation, proliferation of keratinocytes and their spread beyond the epidermis with the development of tumor progression [1]. Recently, a number of authors have established important features of the course of this precancerous tumor. First of all, we are talking about an increased risk of malignant transformation of AK into squamous cell carcinoma in the presence of a history of visceral malignancy, as well as the same changes in the lesion and the adjacent clinically unaffected skin in the form of accumulation of genetic and epigenetic mutations that form "cancerization fields" [ 33,34], indicating the need to treat AK, especially multiple foci, using the ablastic rule with the capture of 1-1.5 cm of apparently healthy skin [35,36]. For the treatment of multiple AK foci in a patient with an aggravated oncological history, for the first time, we used, in an independent version, a modern method of treatment - laser-induced thermotherapy (LITT). LITT is a non-invasive, antitumor, immunomodulatory method based on the selective death of atypical keratinocytes in the epidermis by local tissue heating to a temperature of 42.5-44℃ (hyperthermia) caused by infrared laser radiation with a wavelength of 800-1300 nm. The presented case of AK in a patient with breast cancer in history was characterized by a combination of keratotic and erythematous forms of the tumor. At the same time, LITT with an extended exposure zone by 1 cm from the visible boundaries of the lesions was not only clinically effective in terms of immediate and long-term results, but also gave an excellent cosmetic result with a completely satisfactory tolerability of the treatment procedure.

Keywords

actinic keratosis / laserinduced thermotherapy / basal cell carcinoma / squamous cell carcinoma / field cancerization

References

[1] Marques E, Chen TM. Actinic keratosis. 2022 May 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.

[2] Marques E., Chen T.M. Actinic keratosis. 2022 May 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022.

[3] Khlebnikova AN, Selezneva EV. Actinic keratosis. Consilium medicum. Oncodermatology dermatology. 2010;(2):8–12. (In Russ).

[4] Хлебникова А.Н., Селезнева Е.В. Актинический кератоз // Сonsilium medicum. Онкодерматология, дерматология. 2010. № 2. С. 8–12.

[5] Yaldiz M. Prevalence of actinic keratosis in patients attending the dermatology outpatient clinic. Medicine (Baltimore). 2019;98(28):e16465. doi: 10.1097/MD.0000000000016465

[6] Yaldiz M. Prevalence of actinic keratosis in patients attending the dermatology outpatient clinic // Medicine (Baltimore). 2019. Vol. 98, N 28. Р. e16465. doi: 10.1097/MD.0000000000016465

[7] Chen GJ, Feldman SR, Williford PM, et al. Clinical diagnosis of actinic keratosis identifies an elderly population at high risk of developing skin cancer. Dermatol Surg. 2005;31(1):43–47. doi: 10.1097/00042728-200501000-00009

[8] Chen G.J., Feldman S.R., Williford P.M., et al. Clinical diagnosis of actinic keratosis identifies an elderly population at high risk of developing skin cancer // Dermatol Surg. 2005. Vol. 31, N 1. Р. 43–47. doi: 10.1097/00042728-200501000-00009

[9] Pandel R, Poljšak B, Godic A, Dahmane R. Skin photoaging and the role of antioxidants in its prevention. ISRN Dermatol. 2013;2013:930164. doi: 10.1155/2013/930164

[10] Pandel R., Poljšak B., Godic A., Dahmane R. Skin photoaging and the role of antioxidants in its prevention // ISRN Dermatol. 2013. Vol. 2013. Р. 930164. doi: 10.1155/2013/930164

[11] Figueras MT. From actinic keratosis to squamous cell carcinoma: pathophysiology revisited. J Eur Acad Dermatol Venereol. 2017;31(Suppl 2):5–7. doi: 10.1111/jdv.14151

[12] Figueras M.T. From actinic keratosis to squamous cell carcinoma: pathophysiology revisited // J Eur Acad Dermatol Venereol. 2017. Vol. 31, Suppl 2. Р. 5–7. doi: 10.1111/jdv.14151

[13] Fernández-Figueras MT, Carrato C, Sáenz X, et al. Actinic keratosis with atypical basal cells (AK I) is the most common lesion associated with invasive squamous cell carcinoma of the skin. J Eur Acad Dermatol Venereol. 2015;29(5):991–997. doi: 10.1111/jdv.12848

[14] Figueras M.T., Carrato C., Sáenz X., et al. Actinic keratosis with atypical basal cells (AK I) is the most common lesion associated with invasive squamous cell carcinoma of the skin // J Eur Acad Dermatol Venereol. 2015. Vol. 29, N 5. Р. 991–997. doi: 10.1111/jdv.12848

[15] Lee YB, Lee JH, Kim YH, et al. Positive association between actinic keratosis and internal malignancies: a nationwide population-based cohort study. Sci Rep. 2021;11(1):19769. doi: 10.1038/s41598-021-99225-9

[16] Lee Y.B., Lee J.H., Kim Y.H., et al. Positive association between actinic keratosis and internal malignancies: a nationwide population-based cohort study // Sci Rep. 2021. Vol. 11, N 1. Р. 19769. doi: 10.1038/s41598-021-99225-9

[17] Philipp-Dormston WG, Müller K, Novak B, et al. Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: Results from a large-scale observational study analysing effects of diagnoses and disease progression. J Eur Acad Dermatol Venereol. 2018;32(7):1138–1146. doi: 10.1111/jdv.1470

[18] Philipp-Dormston W.G., Müller K., Novak B., et al. Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: results from a large-scale observational study analysing effects of diagnoses and disease progression // J Eur Acad Dermatol Venereol. 2018. Vol. 32, N 7. Р. 1138–1146. doi: 10.1111/jdv.1470

[19] Green AC, McBride P. Squamous cell carcinoma of the skin (non-metastatic). BMJ Clin Evid. 2014;2014:1709.

[20] Green A.C., McBride P. Squamous cell carcinoma of the skin (non-metastatic) // BMJ Clin Evid. 2014. Vol. 2014. Р. 1709.

[21] Stockfleth E. The importance of treating the field in actinic keratosis. J Eur Acad Dermatol Venereol. 2017;31(Suppl 2):8–11. doi: 10.1111/jdv.14092. PMID: 28263021

[22] Stockfleth E. The importance of treating the field in actinic keratosis // J Eur Acad Dermatol Venereol. 2017. Vol. 31, Suppl 2. Р. 8–11. doi: 10.1111/jdv.14092

[23] Li X, Lovell JF, Yoon J, Chen X. Clinical development and potential of photothermal and photodynamic therapies for cancer. Nat Rev Clin Oncol. 2020;17(11):657–674. doi: 10.1038/s41571-020-0410-2

[24] Li X., Lovell J.F., Yoon J., Chen X. Clinical development and potential of photothermal and photodynamic therapies for cancer // Nat Rev Clin Oncol. 2020. Vol. 17, N 11. Р. 657–674. doi: 10.1038/s41571-020-0410-2

[25] Nelson C, Rigel D, Smith S, et al. Phase IV, open-label assessment of the treatment of actinic keratosis with 3% diclofenac sodium topical gel (Solaraze). J Drugs Dermatol. 2004;3(4):401–407.

[26] Nelson C., Rigel D., Smith S., et al. Phase IV, open-label assessment of the treatment of actinic keratosis with 3% diclofenac sodium topical gel (Solaraze) // J Drugs Dermatol. 2004. Vol. 3, N 4. Р. 401–407.

[27] Inoue T, Ishihara R. Photodynamic therapy for esophageal cancer. Clin Endosc. 2021;54(4):494–498. doi: 10.5946/ce.2020.073

[28] Inoue T., Ishihara R. Photodynamic therapy for esophageal cancer // Clin Endosc. 2021. Vol. 54, N 4. Р. 494–498. doi: 10.5946/ce.2020.073

[29] MoyMoy LS, Frost D, Moy S. Photodynamic therapy for photodamage, actinic keratosis, and acne in the cosmetic practice. Facial Plast Surg Clin North Am. 2020;28(1):135–148. doi: 10.1016/j.fsc.2019.09.012

[30] MoyMoy L.S., Frost D., Moy S. Photodynamic therapy for photodamage, actinic keratosis, and acne in the cosmetic practice // Facial Plast Surg Clin North Am. 2020. Vol. 28, N 1. Р. 135–148. doi: 10.1016/j.fsc.2019.09.012

[31] Li X, Lovell JF, Yoon J, Chen X. Clinical development and potential of photothermal and photodynamic therapies for cancer. Nat Rev Clin Oncol. 2020;17(11):657–674. doi: 10.1038/s41571-020-0410-2

[32] Li X., Lovell J.F., Yoon J., Chen X. Clinical development and potential of photothermal and photodynamic therapies for cancer // Nat Rev Clin Oncol. 2020. Vol. 17, N 11. Р. 657–674. doi: 10.1038/s41571-020-0410-2

[33] Chen C, Lee I, Tatsui C, et al. Laser interstitial thermotherapy (LITT) for the treatment of tumors of the brain and spine: a brief review. J Neurooncol. 2021;151(3):429–442. doi: 10.1007/s11060-020-03652-z

[34] Chen C., Lee I., Tatsui C., et al. Laser interstitial thermotherapy (LITT) for the treatment of tumors of the brain and spine: a brief review // J Neurooncol. 2021. Vol. 151, N 3. Р. 429–442. doi: 10.1007/s11060-020-03652-z

[35] Fargnoli MC, Peris K. Photodynamic therapy for basal cell carcinoma. Future Oncol. 2015;11(22):2991–2996. doi: 10.2217/fon.15.208

[36] Fargnoli M.C., Peris K. Photodynamic therapy for basal cell carcinoma // Future Oncol. 2015. Vol. 11, N 22. Р. 2991–2996. doi: 10.2217/fon.15.208

[37] Oseroff AR, Blumenson LR, Wilson BD, et al. A dose ranging study of photodynamic therapy with porfimer sodium (Photofrin) for treatment of basal cell carcinoma. Lasers Surg Med. 2006;38(5):417–426. doi: 10.1002/lsm.20363

[38] Oseroff A.R., Blumenson L.R., Wilson B.D., et al. A dose ranging study of photodynamic therapy with porfimer sodium (Photofrin) for treatment of basal cell carcinoma // Lasers Surg Med. 2006. Vol. 38, N 5. Р. 417–426. doi: 10.1002/lsm.20363

[39] Volgin VN, Stranadko EF, Sokolova TV, et al. Photodynamic therapy of basal cell skin cancer with a second-generation photosensitizer photoditazine. In: Abstracts of scientific papers of the X All-Russian Congress of Dermatovenerologists, October 7–10, 2008. Moscow; 2008. 84 p. (In Russ).

[40] Волгин В.Н., Странадко Е.Ф., Соколова Т.В., и др. Фотодинамическая терапия базальноклеточного рака кожи с фотосенсибилизатором второго поколения фотодитазином // Тезисы научных работ X Всероссийского съезда дерматовенерологов, 7–10 октября 2008 года. Москва, 2008. 84 с.

[41] Kaplan MA, Kapinus VN, Popuchiev VV, et al. Photodynamic therapy: results and prospects. Radiation Risk (Bulletin National Radiation Epidemiological Register). 2013;22(3):115–123. (In Russ).

[42] Каплан М.А., Капинус В.Н., Попучиев В.В., и др. Фотодинамическая терапия: результаты и перспективы // Радиация и риск (Бюллетень Национального радиационно-эпидемиологического регистра). 2013. Т. 22, № 3. C. 115–123.

[43] Fargnoli MC Peris K. Photodynamic therapy for basal cell carcinoma. Future Oncol. 2015;11(22):2991–2996. doi: 10.2217/fon.15.208

[44] Fargnoli M.C., Peris K. Photodynamic therapy for basal cell carcinoma // Future Oncol. 2015. Vol. 11, N 22. Р. 2991–2996. doi: 10.2217/fon.15.208

[45] Liu DH, Wu LS, Li JM, et al. Simple shaving combined with photodynamic therapy for refractory Bowen disease. Photodiagn Photodyn Ther. 2019;26:258–260. doi: 10.1016/j.pdpdt.2019.04.001

[46] Liu D.H., Wu L.S., Li J.M., et al. Simple shaving combined with photodynamic therapy for refractory Bowen disease // Photodiagn Photodyn Ther. 2019. Vol. 26. Р. 258–260. doi: 10.1016/j.pdpdt.2019.04.001

[47] Piaserico S, Fortina AB, Rigotti P, et al. Topical photodynamic therapy of actinic keratosis in renal transplant recipients. Transpl Proc. 2007;39(6):1847–1850. doi: 10.1016/j.transproceed.2007.05.040

[48] Piaserico S., Fortina A.B., Rigotti P., et al. Topical photodynamic therapy of actinic keratosis in renal transplant recipients // Transpl Proc. 2007. Vol. 39, N 6. Р. 1847–1850. doi: 10.1016/j.transproceed.2007.05.040

[49] Kohl E, Torezan LA, Landthaler M et al. Aesthetic effects of topical photodynamic therapy. J Eur Acad Dermatol Venereol. 2010;24:1261–1269. doi: 10.1111/j.1468-3083.2010.03625.x

[50] Kohl E., Torezan L.A., Landthaler M., et al. Aesthetic effects of topical photodynamic therapy // J Eur Acad Dermatol Venereol. 2010. Vol. 24, N 11. Р. 1261–1269. doi: 10.1111/j.1468-3083.2010.03625.x

[51] Philipp-Dormston WG. Photodynamic therapy for aesthetic-cosmetic indications. G Ital Dermatol Venereol. 2018;153(6):817–826. doi: 10.23736/S0392-0488.18.05982-5

[52] Philipp-Dormston W.G. Photodynamic therapy for aesthetic-cosmetic indications // G Ital Dermatol Venereol. 2018. Vol. 153, N 6. Р. 817–826. doi: 10.23736/S0392-0488.18.05982-5

[53] Matveeva OV, Sukhova TE. Results of photodynamic therapy of basal cell skin cancer with intraocular use of a photosensitizer. Radiation Risk (Bulletin National Radiation Epidemiological Register). 2014;23(2):37–44. (In Russ).

[54] Матвеева О.В., Сухова Т.Е. Результаты фотодинамической терапии базальноклеточного рака кожи с внутриочаговым применением фотосенсибилизатора // Радиация и риск (Бюллетень Национального радиационно-эпидемиологического регистра). 2014. Т. 23, № 2. С. 37–44.

[55] Tretyakov EI. Experience in the treatment of multiple basal cell carcinoma in Gorlin–Goltz syndrome. Almanac of Clinical Medicine. 2016;44(1):88–95. (In Russ).

[56] Третьякова Е.И. Опыт лечения множественной базалиомы при синдроме Горлина–Гольтца // Альманах клинической медицины. 2016. Т. 44, № 1. С. 88–95.

[57] Prokofiev AA, Molochkov VA, Molochkov AV, et al. Photodynamic therapy of Kaposi’s sarcoma. Russ J Skin Venereal Diseases. 2011;(4):4–6. (In Russ).

[58] Прокофьев А.А., Молочков В.А., Молочков А.В., и др. Фотодинамическая терапия саркомы Капоши // Российский журнал кожных и венерических болезней. 2011. № 4. С. 4–6.

[59] Sukhova TE, Molochkov VA, Romanko YS, et al. Photodynamic therapy of actinic keratosis with the application of “Photoditazine”. Russ J Skin Venereal Diseases. 2010;(5):4–8. (In Russ).

[60] Сухова Т.Е., Молочков В.А., Романко Ю.С., и др. Фотодинамическая терапия актинического кератоза с аппликационным применением Фотодитазина // Российский журнал кожных и венерических болезней. 2010. № 5. С. 4–8.

[61] Molochkov VA, Romanko YS, Bely YA, et al. Laser-induced thermotherapy in the treatment of basal cell carcinoma. Clin Dermatology Venereology. 2012;10(4):43–47. (In Russ).

[62] Молочков В.А., Романко Ю.С., Белый Ю.А., и др. Лазериндуцированная термотерапия при лечении базалиомы // Клиническая дерматология и венерология. 2012. Т. 10, № 4. С. 43–47.

[63] Molochkov VA, Sukhova TE, Kazantseva KV, et al. Physical methods of therapy in the complex treatment of Kaposi’s sarcoma. Radiation Risk (Bulletin National Radiation Epidemiological Register). 2014;23(2):59–71. (In Russ).

[64] Молочков В.А., Сухова Т.Е., Казанцева К.В., и др. Физические методы терапии в комплексном лечении саркомы Капоши // Радиация и риск (Бюллетень Национального радиационно-эпидемиологического регистра). 2014. Т. 23, № 2. С. 59–71.

[65] Sukhova TE, Fedoseeva MI. Treatment of actinic keratosis at the present stage. Pharmateca. 2018;(S4):79–83. (In Russ). doi: 10.18565/pharmateca.2018.s5.79-83

[66] Сухова Т.Е., Федосеева М.И. Лечение актинического кератоза на современном этапе // Фарматека. 2018. № S4. С. 79–83. doi: 10.18565/pharmateca.2018.s5.79-83

[67] Cramer P, Stockfleth E. Actinic keratosis: where do we stand and where is the future going to take us? Expert Opin Emerg Drugs. 2020;25(1):49–58. doi: 10.1080/14728214.2020.1730810

[68] Cramer P., Stockfleth E. Actinic keratosis: where do we stand and where is the future going to take us? // Expert Opin Emerg Drugs. 2020. Vol. 25, N 1. Р. 49–58. doi: 10.1080/14728214.2020.1730810

[69] Stockfleth E. The importance of treating the field in actinic keratosis. J Eur Acad Dermatol Venereol. 2017;31(Suppl 2):8–11. doi: 10.1111/jdv.14092

[70] Stockfleth E. The importance of treating the field in actinic keratosis // J Eur Acad Dermatol Venereol. 2017. Vol. 31, Suppl 2. Р. 8–11. doi: 10.1111/jdv.14092

[71] Fernández JP, Méndez-Sánchez SC, Gonzalez-Correa CA, Miranda DA. Could field cancerization be interpreted as a biochemical anomaly amplification due to transformed cells? Med Hypotheses. 2016;97:107–111. doi: 10.1016/j.mehy.2016.10.026

[72] Fernández J.P., Méndez-Sánchez S.C., Gonzalez-Correa C.A., Miranda D.A. Could field cancerization be interpreted as a biochemical anomaly amplification due to transformed cells? // Med Hypotheses. 2016. N 97. Р. 107–111. doi: 10.1016/j.mehy.2016.10.026

[73] Takeshima H, Ushijima T. Accumulation of genetic and epigenetic alterations in normal cells and cancer risk. NPJ Precision Oncology. 2019;3:7. doi: 10.1038/s41698-019-0079-0

[74] Takeshima H., Ushijima T. Accumulation of genetic and epigenetic alterations in normal cells and cancer risk // NPJ Precision Oncology. 2019. N 3. Р. 7. doi: 10.1038/s41698-019-0079-0

[75] Naumova LA. A modern view on the concept of field carcinization. Bulletin of Surgut State University. Medicine. 2021;(2):61–70. (In Russ).

[76] Наумова Л.А. Современный взгляд на концепцию полевой канцеризации // Вестник СурГУ. Медицина. 2021. № 2. С. 61–70.

[77] Christensen SR. Recent advances in field cancerization and management of multiple cutaneous squamous cell carcinomas. F1000Research. 2018;7:F1000 Faculty Rev-690. doi: 10.12688/f1000research.12837.1

[78] Christensen S.R. Recent advances in field cancerization and management of multiple cutaneous squamous cell carcinomas // F1000Research. 2018. N 7. Р. F1000 Faculty Rev-690. doi: 10.12688/f1000research.12837.1

[79] Szeimies RM, Karrer S, Radakovic-Fijan S, et al. Photodynamic therapy using topical methyl 5-aminоlevulinate compared with cryotherapy for actinic keratosis: a prospective, randomized study. J Am Acad Dermatol. 2002;47(2):258–262.

[80] Szeimies R.M., Karrer S., Radakovic-Fijan S., et al. Photodynamic therapy using topical methyl 5-aminоlevulinate compared with cryotherapy for actinic keratosis: a prospective, randomized study // J Am Acad Dermatol. 2002. Vol. 47, N 2. P. 258–262.

RIGHTS & PERMISSIONS

Eco-Vector