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Background Early detection of skin cancer is still a major challenge in dermatology practice today. While surveillance programs are offered to high-risk patients, systematic total-body examination (TBE) in the general population is not cost-effective. In the past, we demonstrated that a lesion-directed screening (LDS) in the general population delivered similar detection rates to TBE and was less time-consuming. Objectives To study whether a lesion-directed early-access consultation can optimize skin cancer detection in dermatology practice. Methods In this observational study, we offered an early-access consultation in patients contacting the dermatology department concerning 1 or 2 lesions of concern meeting predefined criteria. Results 342 persons were seen at the dermatology department after triage by phone. Skin cancer detection rate was 13.2% (4.1% for melanoma). If advised/referred by a doctor skin cancer detection rate was 23.6% (9% for melanoma). With a history of skin cancer, detection rate was 24.3% (4.3% for melanoma). In patients with no referral and a negative history of skin cancer, detection rate was 7.7% (1.7% for melanoma), which is at least triple the rates reported by population-based screening programs. In patients in whom the index lesion was benign, worry of having skin cancer had decreased significantly by the end of the consultation. Additional total-body examination in these patients had low additional detection rate (0.5%) and a high number of unnecessary excisions (number needed to excise 13). Conclusions An early-access dermatology consultation for LDS after triage by phone resulted in high overall skin cancer and melanoma detection rates. Our data indicate that performing TBE is especially useful if the index lesion is suspicious. In addition to surveillance programs in high-risk patients, LDS may be a way to optimize skin cancer detection in the general population and use available time more efficiently in daily dermatology practice.

Background Laser-assisted photodynamic therapy is being explored as a method to enhance efficacy of photodynamic therapy (PDT). Objective To compare a continuous (CL) and a fractional (FL) ablative CO2 laser-assisted methyl aminolevulinate (MAL) PDT in the management of superficial basal cell carcinoma (sBCC) and Bowen's disease (BD). Methods Thirty treatment areas in fifteen patients with inoperable, histologically verified sBCC or BD received CL or FL after intrapatient randomization. Laser treatment was followed by MAL application and illumination occurred 3 h later. This treatment was repeated after 2 weeks. An equivalence analysis was performed on the primary endpoint efficacy, while secondary endpoints pain, side-effects and aesthetics were evaluated using paired samples tests. Patients were also asked for their preferred treatment. Results An excellent efficacy of 92.9% (sBCC, 100%; BD, 80%) was found in both CL + PDT and FL + PDT after 12 months. Equivalence could not be established. Little pain was perceived in most patients during PDT illumination. PDT treatment in FL + PDT was less painful, significantly during the second treatment (P = 0.026). Side-effects were mild to moderate with erythema being the most frequent immediate side-effect, followed by oedema, crusting and burning sensation. Pigmentary changes occurred in 21% (CL + PDT) to 29% (FL + PDT), and aesthetics were good to excellent in all patients. CL + PDT and FL + PDT did not significantly differ in side-effects (P = 0.219-1.000) or aesthetics (P = 0.157-1.000). Conclusions Results in this pilot study support the promising role of laser-assisted PDT. Both treatment arms demonstrated the same efficacy as well as comparable side-effects and aesthetics. PDT illumination was significantly less painful in the FL + PDT group, suggesting a preference for FL + PDT. The authors recommend further investigation with a larger sample size, a subgroup analysis between sBCC and BD and comparison of different treatment protocols before one technique could be preferred to another.

Background Mohs micrographic surgery is a tissue sparing surgical technique for removal of skin cancer. To optimize the cosmetic result of scars and skin grafts after surgery non invasive procedures as non-ablative fractional laser (NAFL) resurfacing are attractive. Objective To evaluate efficacy and safety of 1540 nm NAFL in the treatment of scars and skin grafts after Mohs micrographic surgery. Methods An intra-individual randomized controlled trial (RCT) with split lesion design and single blinded outcome evaluations. Patients receive four treatments at monthly interval with NAFL [StarLux-300 with Lux 1540 nm fractional handpiece (Palomar technologies)]. Primary endpoint to evaluate efficacy is a blinded on site visual and palpable Physician Global Assessment (PhGA). Adverse event and pain registration are used to evaluate safety. Patient’s global assessment (PGA) and skin reflectance measurements are secondary endpoints. Results The PhGA score comparing the treated to the untreated control side of 24 patients is significant different 1 (P = 0.009) and 3 (P = 0.001) months after treatment (Wilcoxon signed rank test). Patients experienced mild to moderate pain. Four days after the treatments patients reported erythema (67%), oedema (31%), crusts (22%), burning sensation (14%), purpura (9%) and vesicles (4%). No long term adverse events are reported. PGA is significant different 1 (P