The Use of Noninvasive Optical Coherence Tomography to Monitor the Treatment Progress of Vismodegib and Imiquimod 5% Cream in a Transplant Patient with Advanced Basal Cell Carcinoma of the Nose.
Immunosuppressed transplant recipients have increased risk for the development of basal cell carcinoma skin cancers. While oral vismodegib therapy has been successful in treating locally advanced basal cell tumors, few studies document its use and efficacy in organ transplant patients. In this immunocompromised population, topical imiquimod 5% cream has been shown to be an effective and well-tolerated option for superficial and nodular basal cell carcinomas. To the authors' knowledge, no data documents the use of optical coherence tomography, a noninvasive imaging technique, to monitor progress of such combined therapies on in vivo skin. The authors report the successful treatment of an extensive basal cell carcinoma on the nose of an immunosuppressed 54-year-old Caucasian man with a history of kidney and pancreas transplantations. By combining continuous noninvasive lesion monitoring with vismodegib 150mg/d therapy and adjuvant imiquimod 5% topical cream, the patient showed complete disease clearance on clinical, optical coherence tomography, and histological evaluation. This report supports the feasibility and efficacy of nonsurgical treatment of basal cell lesions in complicated transplant patients and the need for individualized treatment plans. A noninvasive follow-up tool, especially during nonsurgical therapy, is of critical value to ensure the best possible treatment outcome for the patient.
SUNY Downstate Medical Center, Brooklyn, New York;; New York Harbor Healthcare System, Brooklyn, New York;; Mount Sinai Medical Center, New York, New York.
Orit
O
Markowitz
SUNY Downstate Medical Center, Brooklyn, New York;; New York Harbor Healthcare System, Brooklyn, New York;; Mount Sinai Medical Center, New York, New York.
Michelle
M
Schwartz
Clin Exp Dermatol. 2004 May;29(3):237-9
15115500
Dermatol Surg. 2009 Jun;35(6):965-72
19397661
J Am Acad Dermatol. 2014 Aug;71(2):359-65
24725477
P T. 2012 Dec;37(12):670-82
23319845
J Clin Aesthet Dermatol. 2015 Oct;8(10):14-20
26557214
J Am Acad Dermatol. 2014 Mar;70(3):e65-6
24528922
J Eur Acad Dermatol Venereol. 2013 Jan;27(1):e97-104
22540280
JAMA Dermatol. 2015 Jan;151(1):70-2
25337679
J Am Acad Dermatol. 2014 Nov;71(5):904-911.e1
24929884
J Eur Acad Dermatol Venereol. 2015 Aug;29(8):1562-9
25640145
J Am Acad Dermatol. 1999 May;40(5 Pt 1):697-701
10321596
Br J Dermatol. 2012 Oct;167(4):856-64
22862425
N Engl J Med. 2012 Jun 7;366(23 ):2180-8
22670904
Transplantation. 1990 Mar;49(3):506-9
2316011
Skin Res Technol. 2014 May;20(2):170-6
24103017
Br J Dermatol. 2015 Aug;173(2):428-35
25904111
Cancer Metastasis Rev. 2004 Aug-Dec;23(3-4):389-402
15197337
J Clin Invest. 2012 Feb;122(2):455-63
22293184
J Am Acad Dermatol. 2015 Jul;73(1):99-105.e1
25913533