Which Treatment Option for NMSC Confers the Best Cosmetic Results?
Brachytherapy (BT) and Mohs micrographic surgery (MMS) had better cosmetic results compared with conventional excision (CE) and external-beam radiation therapy (EBRT), according to the findings of a recent meta-analysis published in the journal Cancer. The treatment options had similar and low 1-year recurrence rates.
In the systematic review, the researchers identified 58 studies on PubMed published from 1985 to 2018 that included a total of 21,371 patients with stage T1 to T2N0 basal cell carcinomas and squamous cell carcinomas treated with one of four options: CE (n=24), MMS (n=13), EBRT (n=19), or BT (n=7). They assessed cosmesis, which was classified as either good, fair, or poor, and rate of 1-year recurrence as the primary and secondary outcomes, respectively.
The summary effect size for good cosmesis was 81% (95% CI, 70.6%-89.6%) for CE, 74.6% (95% CI, 63%-84.6%) for EBRT, and 97.6% (95% CI, 91.3%-100%) for BT, the researchers said. In the only study that reported cosmesis with MMS, they found good cosmesis was 96%. “BT had improved good cosmesis over EBRT and was similar to CE and MMS,” the researchers added. However, no significant differences were seen for fair or poor cosmesis.
In addition, the 1-year recurrence rates were low, with 0.8% (95% CI, 0.3%-1.6%) for CE, 0.2% (95% CI, 0%-0.6%) for MMS, 2% (95% CI, 1.3%-2.7%) for EBRT, and 0% (95% CI, 0%-0.5%) for BT.
“For T1-T2N0 skin cancers, BT and MMS have improved cosmesis over EBRT and CE,” the researchers concluded. “It is unclear whether this is because of treatment superiority or selection and reporting bias. Local control is similar among all modalities at 1 year.”
Reference
Lee CT, Lehrer EJ, Aphale A, Lango M, Galloway TJ, Zaorsky NG. Surgical excision, Mohs micrographic surgery, external-beam radiotherapy, or brachytherapy for indolent skin cancer: an international meta-analysis of 58 studies with 21,000 patients. Cancer. 2019;125(20):3582-3594. doi:10.1002/cncr.32371
Vaccine Provides Herd Immunity for Oral HPV Infections
The prevalence of vaccine-type oral human papillomavirus (HPV) infections declined by 37% from 2009 to 2016 among unvaccinated men, according to a recent study. The finding, published in JAMA, suggests the vaccine provides herd immunity against oral HPV infections.
Using data from the National Health and Nutrition Examination Survey from 2009 to 2016, the researchers sought to determine whether the vaccine provided herd immunity against oral HPV infections in unvaccinated men and women aged 18 to 59 years (n=13,676).
Vaccination rates for men and women increased from 0% to 5.8% and 7.3% to 15.1%, respectively, during the study period. The prevalence of vaccine-type oral HPV infections declined from 2.7% during 2009 to 2010 to 1.6% during 2015 to 2016 in unvaccinated men, and this decline was not heterogeneous by age, the researchers said. However, the prevalence of nonvaccine-type HPV infections did not change among men. Among women, the prevalence of vaccine-type and nonvaccine-type HPV infections did not change.
“Vaccine-type oral HPV prevalence declined by 37% between 2009 to 2010 and 2015 to 2016 in a sample of unvaccinated US men aged 18 to 59 years, suggesting herd protection against oral HPV infections,” the researchers said. “Herd protection likely arises from increased levels of female HPV vaccination in the US population.
“The lack of herd protection toward oral HPV infections in unvaccinated women could reflect low statistical power due to low prevalence in women,” they added.
Reference
Chaturvedi AK, Graubard BI, Broutian T, et al. Prevalence of oral HPV infection in unvaccinated men and women in the United States, 2009-2016. JAMA. 2019;322(10):977-979. doi:10.1001/jama.2019.10508
SPF 50 vs SPF 100: Which Offers Better Protection?
Sun protection factor (SPF) 100+ sunscreen appears to offer better protection against sunburn at the beach compared with SPF 50+ sunscreen, according to the findings of a recent study in the Journal of American Academy of Dermatology.
“Beach vacations are high-risk settings for overexposure to UV radiation,” the researchers said. They compared the efficacy of SPF 50+ with SFP 100+ sunscreens under actual beach use among 55 healthy participants. All participants applied sunscreen SPF 50+ to one side of their face and body and SPF 100+ sunscreen to the other half for up to 5 consecutive days. On the mornings after sunscreen exposure, participants underwent blinded clinical evaluation for erythema by a single grader and objective instrumental assessments, colorimetry, and diffuse reflectance spectroscopy.
The researchers found 31 (56%) participants had more sunburn on the SPF 50+ side compared with four (7%) on the SPF 100+ side after 5 days of sunscreen. “Overall, mean erythema intensity demonstrated statistically significantly less erythema on the SPF 100+ side compared to SPF 50+,” they said.
In addition, the first observed sunburn occurred on the SPF 50+ side after 1 day while the first sunburn on the SPF 100+ side occurred 3 days after sun exposure.
“SPF 100+ was significantly more effective in protecting against UV-induced erythema and sunburn than SPF 50+ in actual use within a beach vacation setting,” the researchers concluded.
However, their study was limited due to only including participants with skin phototype I who were recruited from a local beach area and only monitoring the initial application of sunscreen.
Reference
Kohli I, Nicholson CL, Williams JD, et al. Greater efficacy of SPF 100+ sunscreen compared to SPF 50+ in sunburn prevention during five consecutive days of sunlight exposure: a randomized, double-blind clinical trial [published online September 19, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.09.018
Therapeutic Drug Monitoring Effective for IL-12/23 Inhibitor
A recent study, published in JAMA Dermatology, found therapeutic drug monitoring of ustekinumab (Stelara) levels may be helpful for developing treatment strategies.
While dose adjustment informed by the measurement of circulating drug levels has been found to effectively optimize outcomes and reduce costs in various settings, there is limited evidence on this approach for ustekinumab, the researchers said.
They conducted a prospective observational study to evaluate the clinical utility of therapeutic drug monitoring among 491 patients with psoriasis enrolled in the Biomarkers of Systemic Treatment Outcomes in Psoriasis study within the British Association of Dermatologists Biologic and Immunomodulators Register from June 2009 to December 2017. A total of 853 samples were analyzed using an enzyme-linked immunosorbent assay to measure serum ustekinumab levels. In addition, the Psoriasis Area and Severity Index (PASI) was used to assess disease activity.
The researchers found only 17 patients (3.5%) had detectable antidrug antibodies. After adjusting for baseline PASI score, age, and ustekinumab dose, the researchers found early measured drug levels (1-12 weeks after initiating treatment) were associated with PASI 75 response within 6 months after treatment (odds ratio, 1.38; 95% CI, 1.11-1.71). However, this finding was not consistent for other PASI outcomes, the researchers said.
“This real-world study provides evidence that measurement of early serum ustekinumab levels could be useful to direct the treatment strategy for psoriasis,” the researchers concluded. “Adequate drug exposure early in the treatment cycle may be particularly important in determining clinical outcome.”
Reference
Tsakok T, Wilson N, Dand N, et al; BADBIR Study Group, PSORT Consortium. Association of serum ustekinumab levels with clinical response in psoriasis [published online September 18, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.1783
