P6617Photodynamic therapy in the treatment of extensive Bowen disease

Jorge Alonso Su�arez-P�erez, MD, Hospital Cl�ınico Virgen de la Victoria, M�alaga,Spain; Enrique Herrera, MD, Hospital Cl�ınico Virgen de la Victoria, M�alaga, Spain;Enrique Herrera-Acosta, MD, Hospital Cl�ınico Virgen de la Victoria, M�alaga,Spain; Norberto L�opez-Navarro, MD, Hospital Cl�ınico Virgen de la Victoria,M�alaga, Spain; Paula Mart�ın-Cuevas, MD, Hospital Cl�ınico Virgen de la Victoria,M�alaga, Spain; Ricardo Bosch, Hospital Cl�ınico Virgen de la Victoria, M�alaga,Spain

Background: Nonmelanoma skin cancer (NMSC), including BD, is themost commoncancer in white persons, particularly in Europe, the United States, and Australia, andthe incidence continues to rise. Surgical excision is the standard treatment for BD,but some patients may be unsuitable candidates for surgery because of their poorgeneral health status. Photodynamic therapy (PDT) is a simple, repeatable, out-patient procedure which is associated with minimal skin scaring and good cosmeticoutcomes in the treatment of NMSC. The efficacy of PDT in BD is supported bysubstantial research and clinical data.

Methods: Twenty-nine patients with 37 biopsy-proven BD lesions were treated withPDT. We defined extensive in those lesions[3 cm. Methyl aminolevulinate creamwas applied for 3 hours before illumination with an light emitting diode (LED) lightsource at a wavelength of 630 nm (energy density of 37 J/cm2). Treatment wasrepeated 1 week later.

Results: After 12 weeks of treatment, 33 of 37 Bowen disease lesions (90%) showedcomplete clinical response. Only 4 lesions recurred after a follow-up period of 12months. Cosmetic outcome at 12 months was good or excellent in 87% of patients.

Discussion: Bowen disease is a form of intraepithelial squamous cell carcinoma thatmainly affect older patients. Surgical excision is the preferred method of eradicatingBD and the modality with the lowest failure rate. Five-year response rates haveshown a recurrence rate of 19% after conventional surgery and 6.3% after Mohsmicrographic surgery. However, noninvasive procedures, such as PDT, are increas-ingly used by dermatologists, because of their generally favorable efficacy andadverse effects profile. The proven advantages of PDT include the simultaneoustreatment of multiple tumors and incipient lesions, relatively short healing times,good patient tolerance, and an excellent cosmetic outcome.

AB164

cial support: None identified.

Commer

P6109Plantar basal cell carcinoma: Case report

Teresa Pinto-Almeida, MD, Dermatology Department, Centro Hospitalar do Porto- Hospital de Santo Ant�onio, Porto, Portugal; Manuela Selores, MD, DermatologyDepartment, Centro Hospitalar do Porto - Hospital de Santo Ant�onio, Porto,Portugal; M�onica Caetano, MD, Dermatology Department, Centro Hospitalar doPorto - Hospital de Santo Ant�onio, Porto, Portugal; Ros�ario Alves, MD,Dermatology Department, Centro Hospitalar do Porto - Hospital de SantoAnt�onio, Porto, Portugal

Case report: A 69-year-old man presented with a plantar ulcerated lesion that slowlyenlarged over the previous year. He had dyslipidemia for which he was onatorvastatin and no other relevant past medical history. He had been a tradesmanfor all his life. He was a phototype III of Fitzpatrick. Physical examination revealed awell-defined exulceration with an erythematous base and hyperkeratotic borders,with 15 mm in diameter, localized in the plantar aspect of the distal 4th metatarsaland extending to the proximal 4th toe. Dermatoscopy was unspecific, with sparsetelangiectasia and no other evident structures. Wood’s lamp examination showed nofluorescence. Histopathologic examination revealed features compatible with abasal cell carcinoma. PAS staining was negative.

Discussion: Basal cell carcinoma (BCC) is the most common skin cancer. It usuallyaffects the sun exposed areas, mainly in the head and neck. Many risk factors for thedevelopment of this malignancy have been described, namely exposure to UVradiation, ionization radiation, chemical exposures (pesticides, asphalt, tar, polycy-clic aromatic hydrocarbons and arsenic), immunosuppression and genetic syn-dromes associated with increased nonmelanoma skin cancer. The development of aBCC in the plantar region is exceedingly uncommon and has rarely been reported.Our patient had no risk factors that could explain the development of a BCC in suchan atypical localization; he had no history of prolonged sun exposure, no occupa-tional predisposition, and no comorbidities. Differential diagnosis comprises mainlyinfections, including bacterial (Corynebacterium), fungal, or viral (HPV).Histopathology was crucial for the correct diagnosis, given the unspecific clinicaland dermatoscopic features, allowing the appropriate treatment of this malignancythat otherwise would have been overlooked. Treatment of plantar tumors can bechallenging. For our patient, either surgical excision (with a skin graft) orradiotherapy seemed to be appropriate options. Radiotherapy was performed andthe patient remains free of lesions after 1 year of follow-up.

cial support: None identified.

Commer

J AM ACAD DERMATOL

P6270Postradiation sarcoma: Report of a case

Ignacio Valenzuela Salas, Division of Dermatology, Hospital Universitario Virgende las Nieves, Granada, Spain; Aurelio Mart�ın Castro, Division of Pathology,Hospital Universitario Virgen de las Nieves, Granada, Spain; Cristina GarridoColmenero, Division of Dermatology, Hospital Universitario Virgen de las Nieves,Granada, Spain; Eliseo Mart�ınez Garc�ıa, Division of Dermatology, HospitalUniversitario Virgen de las Nieves, Granada, Spain; Jes�us Tercedor S�anchez,Division of Dermatology, Hospital Universitario Virgen de las Nieves, Granada,Spain; Valent�ın Garc�ıa Mellado, Division of Dermatology, Hospital UniversitarioVirgen de las Nieves, Granada, Spain

Background: Postradiation sarcomas are rare and highly malignant tumorswhich may appear as a consequence of radiotherapy. They may originate onbone or soft tissues. We report the case of a patient who developed a malignantfibrous histiocytoma 35 years after radiotherapy for a melanoma on her rightleg.

Case report: A 62-year-old woman with a history of superficial spreadingmelanoma Clark level IV in her right leg 35 years ago who underwent surgicalexcision, lymph node dissection and local radiation, achieving healing. Sheconsulted for an ulcer in the same limb, about 4 months of evolution that thepatient related to physical trauma. Physical examination revealed an ill-definedulcerated tumor of 6 cm in diameter on the lateral aspect of right leg. Weperformed a skin biopsy of the lesion that showed a malignant mesenchymalproliferation of spindle and poligonal cells with hyaline stroma, remarkablenuclear atypia, numerous mitoses and areas of necrosis. Immunohistochemicalstudy showed positivity for vimentin, CD68 and smooth muscle actin andnegativity against cytokeratins AE1 and AE3, S-100 protein, desmin, and EMA.On radiography, osteolytic and osteoblastic images were seen on tibia andfibula, as well as pathologic fracture at the distal fibula, coinciding with thelocation of the skin lesion. The CT and MRI showed destruction of thediaphysis of the fibula and infiltration of the muscle compartments. The patientwas referred to traumatology where she underwent transtibial amputation,confirming the histologic diagnosis of malignant fibrous histiocytoma in grade 3of the FFCC.

Discussion: Postradiation sarcomas account for 0.5% to 5.5% of sarcomas, occurringin patients who underwent radiotherapy for various benign and malignant diseases,after some years of latency. The most common are osteosarcomas, fibrosarcomas,and malignant fibrous histiocytomas. These tumors tend to be poorly differentiated,with high rates of local recurrence and metastasis and poor survival. In conclusion,sarcomas, in addition to radiodermatitis and basal and squamous cell carcinomas,should be considered in the differential diagnosis of skin lesions that appear onpreviously irradiated areas.

cial support: None identified.

Commer

APRIL 2013