Skin cancer

This chapter focuses on the management of skin cancer, exploring both malignant melanoma and non-melanoma skin cancer. The epidemiology of melanoma is covered, and risk factors are described. Management looks at both early-stage and widespread disease, including surgery, adjuvant drug therapy, and radiotherapy. There is further emphasis on recent developments in biological and immunotherapy treatments such as ipilimumab and nivolumab. Non-melanoma skin cancer is discussed, covering risk factors and presentation of these diseases and a summary of their management.

ROLE OF ADJUVANT DRUG THERAPY IN COMBINED TREATMENT FOR CHOLANGIOCELLULAR CARCINOMA

Cholangiocarcinoma (CC) is the second most common malignant disease of the liver. In recent decades various methods of treatment have been introduced. Nevertheless the number of treatment options for СС is still limited. Gemcitabine and cisplatin are the standard treatment for patients with inoperable CC. The second line of chemotherapy has not yet been standardized and depends on the interaction with first-line therapy. In addition many bile cancer studies to date cannot evaluate the differential activity of therapy of different anatomical localizations along the bile tract. There is no reliable evidence of the effectiveness of adjuvant therapy. The correlation of survival increase in patients with worse prognosis when using adjuvant therapy after surgical intervention seems to be reliable. The study of the molecular profile led to a more complex understanding of the genetic changes leading to clinically expressed malignant neoplasms and the possible future differentiation by anatomical or molecular structure would be optimal for the selection of chemotherapy.

Segmental Erythema Multiforme-Like Drug Eruption by Aromatase Inhibitor Anastrozole – First Case Report and another Example of an Immunocompromised District

Anastrozole is a non-selective aromatase inhibitor for adjuvant breast cancer therapy in postmenopausal women. Cutaneous adverse events have been reported. We observed a 64-year-old female patient with a medical history of locally advanced breast cancer of her right breast that was treated with radiotherapy and adjuvant drug therapy with anastrozole. She developed a segmental bullous eruption limited to the cancer-affected breast. Cessation of the aromatase inhibitor and systemic therapy with prednisolone cleared the lesions completely. This is the first report of a segmental erythema multiforme like drug eruption by anastrozole and another example of the concept of the immunocompromised district of skin.

Recurrent Respiratory Papillomatosis Causing Chronic Stridor and Delayed Speech in an 18-Month-Old Boy

Recurrent respiratory papillomatosis is a relatively uncommon disease that presents clinically with symptoms ranging from hoarseness to severe dyspnea. Human papilloma virus types 6 and 11 are important in the etiology of papillomas and are most probably transmitted from mother to child during birth. Although spontaneous remission is frequent, pulmonary spread and/or malignant transformation resulting in death has been reported. CO2laser evaporation of papillomas and adjuvant drug therapy using lymphoblastoid interferon-alpha are the most common treatments. However, several other treatments have been tried, with varying success. In the present report, a case of laryngeal papillomatosis presenting with chronic stridor and delayed speech is described.

Carbamazepine for acute psychosis with eeg abnormalities

Aim. To investigate the efficacy of carbamazepine as adjuvant drug therapy in acute paranoid psychosis with associated EEG abnormalities, compared to sole antipsychotic treatment. Methods. Eleven medication-naive patients diagnosed with acute paranoid psychosis with associated EEG abnormalities were divided into two treatment groups: sole fluphenazine group, with flexible dosing of 5-10 mg/day (n=6), and carbamazepine group (n=5) with the addition of carbamazepine (600 mg/day) to fluphenazine treatment. Clinical Global Impression (CGI), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), and EEG were assessed on the baseline and after 6 weeks of treatment. Paired and two-tailed t-tests were used for statistical significance. Results. All the patients showed significant improvement of mental state after 6 weeks of treatment with no significant differences in CGI, BPRS, and total SANS scores in relation to the therapy with carbamazepine. Nevertheless, after 6 weeks of the treatment, EEG findings were significantly better in carbamazepine group, in relation to the findings from the onset of the treatment, as well as in comparison to sole fluphenazine group. Conclusion. Although carbamazepine stabilized abnormal brain electrical activities it seemed that the associated EEG abnormalities were not significant for acute psychosis observed. These preliminary results suggested that there was no convincing evidence that carbamazepine was efficient as the augmentation of antipsychotic treatment for patients with both acute paranoid psychosis and EEG abnormalities.