The purpose of this review is to compare the clinical effectiveness and cost-effectiveness of imiquimod (IMQ) to other treatment modalities for the treatment of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). This report is the first in the series of three reports on IMQ. The following two reports will be on actinic keratosis and genital warts.

Detailed mechanisms on the effect of oxidative stress (OS), an etiological factor involved in photocarcinogenesis, remain to be fully elucidated. We used immunohistochemical methods to study OS in the DNA, protein and lipids of patients with actinic keratosis (AK), Bowen's disease (BD) and squamous cell carcinoma (SCC). Between January 2009 and December 2014, we treated 230 patients; 79 had AK, 61 had (BD) and 90 had cutaneous SCC; 28 healthy subjects served as the normal controls. OS on DNA, protein and lipids was assessed by the expression of 8-hydroxydeoxyguanosine (8-OHdG), dityrosine (DT) and malondialdehyde (MDA), respectively. 8-OHdG was significantly overexpressed in AK and BD lesions compared with surrounding non-lesional tissue, SCC lesions and the healthy controls. DT was more highly expressed in AK, BD and SCC than in the controls. There was no significant difference among AK, BD and SCC. The expression of MDA was higher in AK, BD and SCC lesions than the controls; SCC showed the highest expression. Our observations suggest that DNA oxidation plays an important role in the early stage of carcinogenesis, that protein oxidation is involved in all stages of carcinogenesis and that lipid oxidation is strongly implicated in the late stages of carcinogenesis.

Actinic keratosis (AK) is considered as a superficial squamous cell carcinoma (SCC). A central role in the pathogenesis is played by chronic sun exposure. UVB causes direct damage to DNA, producing pyrimidine dimers, and suppressing the protective role of p53. The stepwise progression of AK, with an increased expression of anti-apoptotic Bcl-2, favors the progression to SCC. Moreover, the dermal response characterized by inflammation and mediated by prostaglandins is a critical component of tumorigenesis that promotes tumor growth, tissue invasion, angiogenesis and metastasis. Other risk factors are represented by age, gender, photo type and drugs. Areas Covered: In this review, the authors have documented the different therapies planned for AKs involved in the pathogenesis phases. It is also possible to propose to the patient a rotational approach to control the subclinical lesions present in the cancerization field. Therapy should be individualized, based on features of AK lesions, clinical evidence of severity cancerization field, patient's medical status and needs and previous AKs' treatment strategies. Expert Opinion: The usefulness of long-term treatment with piroxicam and sun filters or diclofenac targeting the inflammation phases of skin tumorigenesis favors AKs' healing and determine greater control of cancerization field. Nonsteroidal anti-inflammatory drugs can be safely used in patients who use photosensitizing drugs and, therefore, are more at risk of developing skin tumors. Instead, immunomodulatory therapies, which require shorter treatment, are characterized by more common local side effects. Patient education in dermatology results in improved adherence and outcomes.

The purpose of this review is to compare the clinical effectiveness and cost-effectiveness of imiquimod (IMQ) compared to other treatment modalities for the treatment of genital warts (GW). This report is the third in the series of three reports on IMQ. The previous two reports were on IMQ for the treatment of basal cell and squamous carcinoma, and actinic keratosis.

A 52-year-old white man with alcoholic cirrhosis presented to the Mohs surgery clinic with a 1-month history of tender "bumps" located diffusely on his scalp. Two biopsies performed at an outside institution were read as "basal cell carcinoma" and "actinic keratosis." The patient was scheduled for a large excision of the scalp for presumed multiple nodules of basal cell carcinoma and desired a second opinion from our Mohs surgery clinic.

Reflectance confocal microscopy has been used to monitor treatment efficacy in non-melanoma skin cancer, but few studies have compared different therapies using the same confocal criteria. We compare a single score designed in previous study to evaluate confocal, histological, and immunohistochemical results obtained before and after two treatments of actinic keratosis (AK) and in field cancerisation area. Thirty volunteer male patients, aged >50-year old, with at least three clinically visible AKs on the bald scalp, were included in this study: 15 patients were submitted to 3% diclofenac therapy and 15 to 5% fluorouracil therapy. Confocal imaging was performed on a 5 × 5 cm skin area. In five patients of each group we performed cutaneous biopsies. Scaling, upper nucleated cells, and inflammatory cells showed a higher percentage reduction in field cancerisation, especially in diclofenac treatment group, while in AK inflammatory cells showed a greater percentage reduction in 5-fluorouracil treatment group. Both therapies are efficacious, but their effectiveness is different on the single parameters of the confocal, histology, immunohistochemically.

A sign is a physical feature or microscopic change which can be observed when the patient or their tissue specimen is evaluated. An astute clinician or pathologist may be able to diagnose a patient's condition by recognizing this unique morphologic feature or pathological change. In dermatology, the flag sign-alternating transverse bands of the skin or its adnexal structures that are analogous to the alternating colors of the stripes of a flag-has been associated with distinctive disorders of the hair, skin, or nails. The hair flag sign is characterized by alternating horizontal bands of hypopigmentation of the hair (in children with kwashiorkor type of protein-calorie malnutrition) or hyperpigmentation of the hair (in a male child who has intravenously received several cycles of high-dose methotrexate). In skin, the flag sign can be observed microscopically in actinic keratosis, and demonstrates by alternating parakeratosis and orthokeratosis of the stratum corneum-corresponding to the type of hyperkeratosis occurring above the interadnexal epidermis or the ostea of the acrosyringia and acrotrichia. The nail flag sign-noted in some individuals who have diabetes mellitus, diverticulitis, leprosy, or vitiligo-presents with alternating white and pink-red horizontal bands beginning at the proximal nail fold and extending distally to the free edge of the nail plate. A man with chronic diverticulitis and the nail flag sign is reported; he also has a history of congenital leukonychia, actinic keratoses, basal cell carcinoma and psoriasis. In addition, the features of hair, skin, and nail flag signs are reviewed. The detection of the dermatology flag sign can prompt a pathologist to consider the diagnosis of actinic keratosis. Alternating horizontal bands of hair color can indicate protein-calorie malnutrition or an effect of chemotherapy in a child. Certain autoimmune, inflammatory, or infectious conditions in individuals present with white and pink-red horizontal bands on their nails.

Seborrhoeic keratosis and actinic keratosis are common skin lesions, and the latter is a precursor for skin malignancy. The treatment regime can be lesion-directed or field-directed. Current lesion-directed treatments include cryotherapy, shave excision, and laser ablation. Field-directed treatment typically encompasses multiple topical agents. This article presents the authors' experience of lesion- and field-directed erbium:YAG laser treatment of 547 patients (Fotona Dualis XS Laser). In this series of patients, those who had resurfacing as field therapy showed no recurrence during the 12-month review period. However, there were six cases of recurrence in the group who underwent lesion-directed treatment over the same period. Furthermore, the results illustrated that the incidence of recurrence of actinic keratosis with malignant transformation was around 2.5%. The production of p53-negative keratin sites after laser ablation acts as a protective environment in the prevention of cutaneous malignancies. Thus, laser ablation not only removes lesions and resurfaces, but also protects against skin cancer. Therefore, this treatment is very welcome, especially in light of the increasing incidence of skin cancers.