Šio tyrimo tikslas buvo įvertinti aktininės keratozės klinikinius ypatumus ir fotodinaminio gydymo skirtingomis raudonosios šviesos dozėmis veiks-mingumą. Aktininė keratozė – tai ikinavikinė odos liga, pasireiškianti ilgalaikio saulės poveikio srityse, o jos diagnozė nustatoma remiantis klinikiniu vaizdu. Histologinis tyrimas atliekamas tik neaiškiais atvejais. Vis tik pasitaiko diagnozavimo klaidų ir nesuta¬pimo atvejų tarp tyrėjų dermatologų bei dermatopatologų. Šiame darbe įvertinome ir nustatėme AK klinikinės raiškos ypatumus bei jų sąsajas su histologiniais požymiais, o taip pat AK klinikinio tyrimo jautrumą ir specifiškumą, remiantis histologinio tyrimo duomenimis. Nuo 0,025 iki 20 proc. atvejų AK transfor¬muojasi į plokščiųjų ląstelių karcinomą. Aktininę keratozę rekomenduojama gydyti, nes prognozuoti, kuri AK plis iš epidermio į gilesnius odos sluoksnius ir taps plokščiųjų ląstelių karcinoma, neįmanoma. Veiksmingas bei saugus būdas gydyti AK yra vietinio poveikio foto¬dinaminis gydymas, tačiau jo trūkumas – skausmas procedūros metu. Atlikę perspektyvųjį tyrimą, įvertinome aktininės keratozės klinikinės raiškos ypatumus po fotodinaminio gydymo su 5-aminolevulino rūgštimi. Nustatėme skausmą procedūros metu įtakojančius veiksnius. Nustatėme šio gydymo dviejomis raudonosios šviesos dozėmis veiksmingumą po dvejų metų stebėjimo bei AK atkrytį prognozuojančius veiksnius. Pateikėme praktines šio AK gydymo rekomendacijas. / The aim of this study was to evaluate clinical characteristics of actinic keratosis and the efficacy of photodynamic treatment with different red light doses. The diagnosis of AK is based upon its typical clinical aspects. However, there are data stating that diagnosing single AKs clinically is not precise and that there are even interobserver disagreements between dermatologists and dermatopathologists. In this study we assessed the clinical peculiarities of AK and its correlation with histological characteristics. We assessed the sensitivity and specificity of AK clinical diagnosis based on histopathological analysis. In 0.025% to 20% cases AK transforms into squamous cell carcinoma. It is impossible to predict which AK will spread from the epithelium into the deeper layers of the skin. Therefore, treatment of actinic keratosis is recommended in all cases. Topical photodynamic treatment is safe and effective therapy for AK but pain is the limitation of the procedure. We performed a prospective within-patient study and evaluated the clinical pecularities of actinic keratosis after photodynamic treatment. We assessed the factors that influence pain during the treatment. We assessed the efficacy of photodynamic treatment with different red light doses for actinic keratosis after two-years follow-up. Factors that influence the recurrence of AK were evaluated. Follow-up data for two years was used to formulate the practical recommendations of the study.

Made available in DSpace on 2014-06-11T19:23:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-18Bitstream added on 2014-06-13T20:30:45Z : No. of bitstreams: 1 costa_ss_me_jabo.pdf: 431915 bytes, checksum: 2bb4d7b793f721ee888c11f23b760d49 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Este estudo apresenta uma análise comparativa da taxa de proliferação celular e da expressão da enzima cicloxigenase-2 na pele de cães saudáveis e acometidos por ceratose actínica e carcinoma de células escamosas cutâneo (CCE). O objetivo foi avaliar o prognóstico destes cães utilizando-se a imunorreatividade a COX-2 e o índice de proliferação celular. Foram analisados 20 amostras de pele de cães, sendo 10 casos de ceratose actínica (G1) e 10 de CCE cutâneo (G2). Os dados epidemiológicos e as características clínicas e histopatológicas foram estudados. A taxa de proliferação celular foi avaliada por meio de índice mitótico (IM) e imunomarcação para MIB-1. A expressão da enzima cicloxigenase foi pesquisada por exame imunoistoquímico. Os cães da raça Pit Bull foram os mais acometidos em G1 e G2 e a média de idade foi 4,3 (±0,8) anos e 5,6 (±1,7) anos, respectivamente. Os valores médios do índice mitótico foram 0,4; 4,6 (±3,6) e 4,9 (±2,6) em G0, G1 e G2, respectivamente. Não houve diferença estatística entre G1 e G2, mas sim em relação ao G0. Houve imunomarcação para COX-2 em G1 e G2, a média dos escores foi 8,16 (±3,51) e 8,56 (±1,03), respectivamente. Não houve imunomarcação nas amostras de G0 e não houve diferença estatística entre G1 e G2, mas sim em relação ao G0 (p>0,05). A média da porcentagem de células imunomarcadas para Ki-67 em G0, G1 e G2 foi 0,4; 15,77 (± 8,81) e 17,71 (± 12,21), respectivamente. Não houve diferença entre G1 e G2, mas sim destes em relação ao G0 (p>0,05). A ceratose actínica se comportou como o CCE cutâneo, revelando não ser uma lesão pré-neoplásica, mas sim o estágio inicial da neoplasia propriamente dita. / This research presents a comparative analysis of cell proliferation index and cyclooxigenase-2 expression in skin of healthy and with actinic keratosis and cutaneous squamous cell carcinoma (SCC) dogs. The goal was to evaluate the prognosis of these dogs by COX-2 immunorreactivity and cell proliferation index. Skin sections from 20 dogs were evaluated, which 10 were actinic keratosis (G1) and 10 cutaneous SCC (G2). Epidemiological information, clinical and histopathological aspects were evaluated. Cell proliferation index hás been stimated by mitotic index (MI) and MIB-1 staining. Cyclooxigenase-2 expression has been analyzed by immunohistochemistry study. Pit Bull dogs were the main affected in G1 and G2 and the mean age was 4,3 (±0,8) years old and 5,6 (±1,7) years old, relatively. MI mean values were 0,4; 4,6 (±3,6) and 4,9 (±2,6) in G0, G1 and G2, relatively. There was no statistical difference between G1 and G2, but it did with G0. There was positive staining for COX-2 in G1 and G2, the score mean value was 8,16 (±3,51) and 8,56 (±1,03), relatively. There was no positive staining in G0 samples and neither statistical difference between G1 and G2, but it did with G0 (p>0,05). The positive cells for Ki-67 mean percentage in G0, G1 and G2 was 0,4; 15,77 (± 8,81) and 17,71 (± 12,21), relatively. There was no difference between G1 and G2, but it did with G0 (p>0,05). Actinic keratosis behavior was similar to cutaneous SSC, demonstrating that it is not a pre-neoplastic disease, but, in fact, the initial of neoplasm.

Orientador: Mário Roberto Hatayde / Banca: Mirela Tinucci Costa / Banca: Andrigo Barboza De Nardi / Resumo: Este estudo apresenta uma análise comparativa da taxa de proliferação celular e da expressão da enzima cicloxigenase-2 na pele de cães saudáveis e acometidos por ceratose actínica e carcinoma de células escamosas cutâneo (CCE). O objetivo foi avaliar o prognóstico destes cães utilizando-se a imunorreatividade a COX-2 e o índice de proliferação celular. Foram analisados 20 amostras de pele de cães, sendo 10 casos de ceratose actínica (G1) e 10 de CCE cutâneo (G2). Os dados epidemiológicos e as características clínicas e histopatológicas foram estudados. A taxa de proliferação celular foi avaliada por meio de índice mitótico (IM) e imunomarcação para MIB-1. A expressão da enzima cicloxigenase foi pesquisada por exame imunoistoquímico. Os cães da raça Pit Bull foram os mais acometidos em G1 e G2 e a média de idade foi 4,3 (±0,8) anos e 5,6 (±1,7) anos, respectivamente. Os valores médios do índice mitótico foram 0,4; 4,6 (±3,6) e 4,9 (±2,6) em G0, G1 e G2, respectivamente. Não houve diferença estatística entre G1 e G2, mas sim em relação ao G0. Houve imunomarcação para COX-2 em G1 e G2, a média dos escores foi 8,16 (±3,51) e 8,56 (±1,03), respectivamente. Não houve imunomarcação nas amostras de G0 e não houve diferença estatística entre G1 e G2, mas sim em relação ao G0 (p>0,05). A média da porcentagem de células imunomarcadas para Ki-67 em G0, G1 e G2 foi 0,4; 15,77 (± 8,81) e 17,71 (± 12,21), respectivamente. Não houve diferença entre G1 e G2, mas sim destes em relação ao G0 (p>0,05). A ceratose actínica se comportou como o CCE cutâneo, revelando não ser uma lesão pré-neoplásica, mas sim o estágio inicial da neoplasia propriamente dita. / Abstract: This research presents a comparative analysis of cell proliferation index and cyclooxigenase-2 expression in skin of healthy and with actinic keratosis and cutaneous squamous cell carcinoma (SCC) dogs. The goal was to evaluate the prognosis of these dogs by COX-2 immunorreactivity and cell proliferation index. Skin sections from 20 dogs were evaluated, which 10 were actinic keratosis (G1) and 10 cutaneous SCC (G2). Epidemiological information, clinical and histopathological aspects were evaluated. Cell proliferation index hás been stimated by mitotic index (MI) and MIB-1 staining. Cyclooxigenase-2 expression has been analyzed by immunohistochemistry study. Pit Bull dogs were the main affected in G1 and G2 and the mean age was 4,3 (±0,8) years old and 5,6 (±1,7) years old, relatively. MI mean values were 0,4; 4,6 (±3,6) and 4,9 (±2,6) in G0, G1 and G2, relatively. There was no statistical difference between G1 and G2, but it did with G0. There was positive staining for COX-2 in G1 and G2, the score mean value was 8,16 (±3,51) and 8,56 (±1,03), relatively. There was no positive staining in G0 samples and neither statistical difference between G1 and G2, but it did with G0 (p>0,05). The positive cells for Ki-67 mean percentage in G0, G1 and G2 was 0,4; 15,77 (± 8,81) and 17,71 (± 12,21), relatively. There was no difference between G1 and G2, but it did with G0 (p>0,05). Actinic keratosis behavior was similar to cutaneous SSC, demonstrating that it is not a pre-neoplastic disease, but, in fact, the initial of neoplasm. / Mestre

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-05-18T13:38:03Z No. of bitstreams: 1 soniamariacruzbastos.pdf: 1103097 bytes, checksum: cd7a339f9e0634c2bfe4c60f01ce3a45 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-05-18T14:07:57Z (GMT) No. of bitstreams: 1 soniamariacruzbastos.pdf: 1103097 bytes, checksum: cd7a339f9e0634c2bfe4c60f01ce3a45 (MD5) / Made available in DSpace on 2017-05-18T14:07:57Z (GMT). No. of bitstreams: 1 soniamariacruzbastos.pdf: 1103097 bytes, checksum: cd7a339f9e0634c2bfe4c60f01ce3a45 (MD5) Previous issue date: 2012-12-11 / Ceratoses Actínicas (CA) são lesões de pele frequentes, induzidas primariamente pela luz ultravioleta e que surgem preferencialmente na superfície da pele foto exposta. Representam a manifestação inicial da proliferação de ceratinócitos atípicos intra-epiteliais com um potencial de 0,25% e 20% ao ano de evoluir para o carcinoma espinocelular (CEC) que é metastatizante. São diagnosticadas clinicamente e tratadas ambulatorialmente. Prevalência mundial, com maior distribuição em indivíduos de pele clara fototipo I e II de Fitzpatrick. Existem vários tratamentos (tópicos, cirúrgicos e sistêmicos), sendo a prevenção a modalidade mais importante. O ácido glicólico, primeiro de uma série de alfa hidroxiácidos, quando aplicado topicamente, em baixas concentrações (2% a 12%) nos veículos, cremes, géis ou loções não iônicas, age como epidermolítico e ceratolítico. Isto o torna um excelente ativo no tratamento que propomos. Nosso objetivo foi pesquisar a efetividade ou não de uma nova conduta terapêutica para CA. Avaliar a adesão do paciente ao tratamento. Observar a apresentação de efeitos adversos indesejáveis. O Estudo foi Clínico, Prospectivo, Transversal em pacientes atendidos no Ambulatório de Dermatologia Geriátrica do HU/CAS da UFJF, total de 50 indivíduos. Todos portadores de ceratoses actínicas na face. O resultado mostra que a resolução total das CA não foi observada em todos os pacientes, mas houve adesão completa ao medicamento, não sendo observados efeitos adversos na população em estudo. Concluímos que mesmo não sendo completamente eficaz para o desaparecimento das lesões levou a uma diminuição acentuada do número de lesões e do índice de gravidade das mesmas. / Actinic keratoses (AK) are common skin lesions, primarily induced by ultraviolet light, occurring mainly on the photoexposed skin surface. They represent the initial manifestation of proliferation of atypical intraepithelial keratinocytes with a potential of 0.25% - 20% per year progress to squamous cell carcinoma (SCC), which is metastasizing. They are clinically diagnosed and treated on an outpatient basis. They are prevalent worldwide, with higher distribution in light-skinned individuals of Fitzpatrick phototype I and II. There are several treatments (topical, surgical and systemic), prevention being the most important modality. Glycolic acid, the first of a series of alpha hydroxyacids, when applied topically in low concentrations (2% to 12%) in cream, gels or nonionic lotions, acts as an epidermolytic and keratolytic. This makes it an excellent asset in the treatment that we propose. Our objective was to investigate the effectiveness or otherwise of a new therapeutic approach to AK, assess patient adherence to treatment and observe the appearance of adverse reactions. The study was clinical, prospective, transversal in patients seen at the Geriatric Dermatology Clinic of HU / CAS UFJF, 50 individuals altogether. All patients had actinic keratoses on their face. The result show that total resolution of AK was not observed in all patients, but there was complete adherence to medication, adverse effects not being observed in the study population. We conclude that, although not completely effective for the disappearance of the lesions, it led to a marked decrease in the number of lesions and the severity index of these.

A biomarker of skin cancer would be beneficial in evaluating the efficacy of potential cancer chemoprevention agents. To this end, we investigated the tumor suppresser gene p53 in precancerous actinic keratosis lesions (AK) and malignant squamous cell carcinomas (SCCs) using polymerase chain reaction and single-strand conformation polymorphism analysis (PCR-SSCP) techniques. In addition, p53 protein expression was evaluated using immunohistochemistical analysis with the PAB 1801 monoclonal antibody. Nine out of 13 (69%) SCCs and 8 of 15 (53%) AKs were positive for p53 mutations. In contrast, normal skin samples were negative for p53 mutations. Sequence analysis of AKs and SCCs showed primarily C to T transition mutations. Nuclear immunochemical staining for p53 was observed in 12 15 (80%) AK and 12 13 (92%) SSCs. These results suggest that p53 mutations may be involved in the malignant conversion of AKs to SCCs and that p53 may be useful as a biomarker to study the potential modulatory effects of cancer chemopreventive agents against skin cancer.

Made available in DSpace on 2015-07-22T20:50:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-04-28 / INTRODUÇÃO: Rejuvenescimento fotodinâmico refere-se ao tratamento do fotoenvelhecimento e das queratoses actínicas. OBJETIVO: Avaliar a eficácia da terapia fotodinâmica com ácido aminolevulínico a 20% (ALA) ¾ tópico e luz intensa pulsada no tratamento das queratoses actínicas e do fotoenvelhecimento facial. MÉTODOS: Quarenta e três pacientes com idade média 71,3 anos, fototipos de pele I e IV divididos em: Controle (aplicação LIP/18J); Tratamento-I (ALA incubado por duas horas; ativado por duas passagens de LIP/16J); Tratamento-II (ALA; duas passagens de LIP/18J), foram avaliados por dois observadores, clínica e fotograficamente, no Pré, 48 horas, 8 e 12 semanas após, pela escala de Griffiths. Cinco queratoses actínicas foram marcadas como alvo para contagem no Pós- Tratamento, sendo uma submetida à biopsia antes e depois do tratamento, para avaliação anatomopatológica de atipias e perda de polaridade. RESULTADOS: Testes não-paramétricos mostraram melhora significativa (rugas finas, alterações texturais, pigmentação irregular) nos Grupos-Tratamento-I/II. No Grupo Controle, significância apenas para alterações pigmentares. Queratoses actínicas tiveram redução maior nos Grupos II (68, 4%) e I (51,2%) em relação ao Controle (5%). Houve redução significativa da gravidade das atipias e perda de polaridade nos Grupos-TratamentoI/II em relação ao controle. CONCLUSÃO: A terapia fotodinâmica, com ácido 5aminolevulínico e luz intensa pulsada, mostrou-se efetiva no tratamento do fotoenvelhecimento e das queratoses actínicas faciais. O tratamento das queratoses actínicas foi mais efetivo com uso de maior energia. / BACKGROUND: Photodynamic rejuvenation is the term used to the treatment of actinic keratosis and photodamage with photodynamic therapy. OBJECTIVE: Evaluate the efficacy of photodynamic therapy with aminolevulinic acid and intense pulsed light in the treatment of actinic keratosis and photodamage. METHODS: Fourty three patients mean age 71,3 years, were randomized in three groups: Control (IPL 18J); Treatment I (ALA+ IPL 16J); and Treatment II ( ALA+ IPL 18J) and evaluated clinically an photographically by two observers in Pre, 48hs, 8 weeks and 12 weeks Post-Treatment using Griffth’s Photonumeric Scale. Five actinic keratosis were marked as target in Pre-Treatment and biopsies Pre and Post-Treatment were done in one lesion to evaluate atypias and loss of cellular polarity. RESULTS: Non parametric tests showed marked improvement in mottled pigmentation, texture fine wrinkles in Groups Treatment I and II. In Control Group improvement only in mottled pigmentation. Actinic Keratosis clearance in Groups Treatment I and II were 51,2% and 68,4% respectively, whereas in Group Control it was 5%. In relation to Control Group, Groups Treatment I and II showed significant reduction of atypias and improvement in loss of cellular polarity. CONCLUSIONS: Photodynamic therapy with aminolevulinic acid and intense pulsed light is effective in the treatment of photodamage and actinic keratosis. The resolution of actinic keratosis was better with higher levels of energy. / TEDE / BV UNIFESP: Teses e dissertações

Genetic changes are hallmarks of cancer development involving the activation and/or inactivation of oncogenes and tumour suppressor genes, respectively. In non-melanoma skin cancer (NMSC) development, the initiation of genetic mutations results from exposure to solar ultraviolet radiation. Non-melanoma skin cancers are comprised of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Several related cutaneous lesions also exist, of which solar keratoses (SK) are widely accepted as a precursor dysplasia to SCC development. The study of recurrent genetic changes present within NMSC and SK should help reveal causative mutations in skin cancer development. Such analysis could also elucidate links in the genetic similarity of these dysplasia. The rapid screening of numerical changes in DNA sequence copy number throughout the entire genome has been made possible by the advent of comparative genomic hybridisation (CGH). This technique enables the identification of net gains and loss of genetic material within a tumour DNA sample. Chromosomal regions of recurrent gain or loss identify loci containing putative oncogenes and tumour suppressor genes, respectively with potential roles in NMSC tumourigenesis. Used in conjunction with tissue microdissection and universal degenerate PCR techniques this can enable the elucidation of aberrations in small histologically distinct regions of tumour. Such a technique can utilize archival material such as paraffin embedded tissue, which is the major source of neoplastic material available for cancer research. This study used the CGH technique to investigate aberrations in BCC, SCC and SK samples. The screening of copy number abnormalities (CNAs) in BCC revealed that although these tumours were close to diploid and generally genetically stable, they did contain several recurrent aberrations. The loss of genetic material at 9q was identified in a third of BCC tumours studied. This is characteristic of inactivation of the PTCH tumour suppressor gene, a known attribute in some sporadic BCC development. Validation of this loss was performed via loss of heterozygosity, demonstrating good concordance with the CGH data. In addition the over-representation of the 6p chromosome arm was revealed in 47% of biopsies. This novel CNA is also commonly observed in other cutaneous neoplasias, including Merkel cell carcinoma and malignant melanoma. This suggests a possible common mechanism in development and or promotion in these cutaneous dysplasias, the mechanisms of which have yet to be clearly defined. In contrast to BCC, numerical genetic aberrations in SCC and SK were much more frequent. Several regions of recurrent gain were commonly shared between both dysplasias including gain of 3q, 4p, 5p, 8q, 9q, 14q, 17p, 17q and 20q. Common chromosomal regions of loss included 3p, 8p, 9p, 11p, 13q and 17p. In addition loss of chromosome 18 was significantly observed in SCC in comparison to SK, a possible defining event in SK progression to SCC. The identification of shared genetic aberrations suggests a clonal and genetic relationship between the two lesions. This information further supports the notion for re-classification of SK to an SCC in situ or superficial SCC. Finally, the CNAs detected have been similarly observed in other squamous cell-derived tumours, for example cervical and head and neck SCC. This provides further evidence to common mechanisms involved in the initiation, development and progression of SCC neoplasia. This study has identified a number of recurrent chromosomal regions, some of which are novel in NMSC development. The further delineation of these loci should provide additional evidence of their significance and degree of involvement in NMSC tumourigenesis. The identification of the cancer-causing genes mapped to these loci will further demarcate the genetic mechanisms of BCC and SCC progression. An understanding of the events involved in skin cancer formation and progression should shed additional light on molecular targets for diagnostics, management and therapeutic treatment.

Orientador: Hélio Amante Miot / Resumo: Fundamentos: Campo de cancerização cutâneo representa uma área com alterações genômicas induzidas pela radiação ultravioleta, cujo sinal de atividade são as queratoses actínicas (QA). Tratamentos que visem sua estabilização podem reduzir a incidência de QA e de tumores cutâneos não melanoma. Estudos em terapia fotodinâmica com metil aminolevulinato (TFD-MAL) no tratamento do campo de cancerização cutâneo mostram redução de até 89% na contagem de QA, já com colchicina tópica, há redução de até 78%. Até o momento, não há estudos comparando colchicina com TFD-MAL. Esse trabalho objetiva avaliar eficácia e segurança de colchicina 0,5% creme versus TFD-MAL no tratamento do campo de cancerização dos antebraços.Casuística e métodos: Ensaio clínico aberto, controlado, randomizado, envolvendo 36 pacientes do ambulatório de Dermatologia da UNESP-Botucatu, com 3-10 QAs em cada antebraço, tratados (cada antebraço) com creme de colchicina 0,5% (2x/dia por 10 dias) ou uma sessão de TFD-MAL; reavaliados após 60 dias. A avaliação clínica foi realizada pela contagem de QAs, seus subtipos clínicos, sua escala de gravidade e escala de fotoenvelhecimento dos antebraços. Avaliação histopatológica foi realizada pelo escore KIN (Keratinocyte Intraepithelial Neoplasia), atrofia epitelial e imunohistoquímica de p53 e Ki67. Todos os pacientes incluídos no estudo e randomizados fizeram parte da população ITT (intention to treat). Os dados do único dropout foram imputados como LOCF (last observed car... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Orientador: Hélio Amante Miot / Resumo: O tratamento do campo de cancerização tem o intuito de evitar a progressão das lesões pré-malignas ou desenvolvimento de lesões subclínicas, como forma de prevenção da carcinogênese. Existem diversas propostas de tratamento, porém, há poucos estudos com nicotinamida oral, nenhum comparando a eficácia entre 5-fluorouracil (5FU) tópico com fotoproteção, ou na sua associação com a nicotinamida oral. Objetivos: Avaliação da eficácia da nicotinamida oral, versus 5FU tópico intermitente, e fotoproteção, no tratamento do campo de cancerização cutâneo e queratoses actínicas (QA). Casuística e métodos: Desenho: ensaio clínico randomizado (em blocos), controlado (intrasujeito), duplo cego, fatorial. Participantes: pacientes imunocompetentes, que continham entre três e dez QA cada antebraço, selecionados durante os atendimentos do ambulatório oncológico do serviço de dermatologia da Faculdade de Medicina de Botucatu – UNESP no período de março a setembro de 2016. Houve randomização em blocos e alocação em grupos dos pacientes e antebraços. Intervenção: um grupo recebeu nicotinamida 500mg, via oral, cada 12h, e o outro, placebo. Um dos antebraços recebeu 5FU 5% creme, noturno, 3x por semana, e ambos, filtro solar (FPS 30) diurno. A duração dos tratamentos foi de 120 dias. Os pacientes foram avaliados nos momentos: T0 e T120 para avaliação clínica (contagem de QA, escore de gravidade de QA e escore de fotoenvelhecimento) e biópsia de pele para avaliação do grau de neoplasia intraepitelial... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: The treatment of the skin field cancerization is aimed at preventing the progression of premalignant lesions or the development of subclinical lesions as a way of preventing carcinogenesis. There are several treatment proposals, however, there are few studies with oral nicotinamide, none comparing the efficacy of topical 5-fluorouracil (5FU) with photoprotection, or its association with oral nicotinamide. Objectives: To evaluate the efficacy of oral nicotinamide versus intermittent topical 5FU and photoprotection in the treatment of cutaneous cancer and actinic keratoses (AK). Casuistry and methods: Design: randomized (blocks), controlled (intrasubject), double blind, factorial clinical trial. Participants: immunocompetent patients, who had between 3 and 10 AK each forearm, selected during the visits of the oncology outpatient clinic of the dermatology department of Botucatu Medical School - UNESP from March to September, 2016. There was randomization in blocks and allocation in Groups of patients and forearms. Intervention: one group received nicotinamide 500mg, orally every 12h, and the other, placebo. One of the forearms received 5FU 5% cream, overnight, 3x per week, and both, daytime (SPF 30) sunscreen. The duration of the treatments was 120 days. The patients were evaluated at the moments: T0 and T120 for clinical evaluation (AK score, AK severity score and photoaging score) and skin biopsy for evaluation of the levels of keratinocyte intraepithelial neoplasi... (Complete abstract click electronic access below) / Mestre

Submitted by Eliane Roio Ferreira null (eliane_roio@yahoo.com.br) on 2018-07-22T17:04:37Z No. of bitstreams: 1 Dissertacao Eliane 31-07-2017 (Salvo Automaticamente) repositorio.pdf: 1376384 bytes, checksum: fe63f38c9413fbb73b267ecfae5dfb34 (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-07-23T13:30:44Z (GMT) No. of bitstreams: 1 ferreira_er_me_bot.pdf: 1376384 bytes, checksum: fe63f38c9413fbb73b267ecfae5dfb34 (MD5) / Made available in DSpace on 2018-07-23T13:30:45Z (GMT). No. of bitstreams: 1 ferreira_er_me_bot.pdf: 1376384 bytes, checksum: fe63f38c9413fbb73b267ecfae5dfb34 (MD5) Previous issue date: 2017-08-24 / O tratamento do campo de cancerização tem o intuito de evitar a progressão das lesões pré-malignas ou desenvolvimento de lesões subclínicas, como forma de prevenção da carcinogênese. Existem diversas propostas de tratamento, porém, há poucos estudos com nicotinamida oral, nenhum comparando a eficácia entre 5-fluorouracil (5FU) tópico com fotoproteção, ou na sua associação com a nicotinamida oral. Objetivos: Avaliação da eficácia da nicotinamida oral, versus 5FU tópico intermitente, e fotoproteção, no tratamento do campo de cancerização cutâneo e queratoses actínicas (QA). Casuística e métodos: Desenho: ensaio clínico randomizado (em blocos), controlado (intrasujeito), duplo cego, fatorial. Participantes: pacientes imunocompetentes, que continham entre três e dez QA cada antebraço, selecionados durante os atendimentos do ambulatório oncológico do serviço de dermatologia da Faculdade de Medicina de Botucatu – UNESP no período de março a setembro de 2016. Houve randomização em blocos e alocação em grupos dos pacientes e antebraços. Intervenção: um grupo recebeu nicotinamida 500mg, via oral, cada 12h, e o outro, placebo. Um dos antebraços recebeu 5FU 5% creme, noturno, 3x por semana, e ambos, filtro solar (FPS 30) diurno. A duração dos tratamentos foi de 120 dias. Os pacientes foram avaliados nos momentos: T0 e T120 para avaliação clínica (contagem de QA, escore de gravidade de QA e escore de fotoenvelhecimento) e biópsia de pele para avaliação do grau de neoplasia intraepitelial dos queratinótitos (KIN), p53 e ki67. Foram avaliados ainda os efeitos adversos no T14. Desfechos: foram analisados por intenção de tratamento (ITT), e os dropouts imputados com os valores da última avaliação disponíveis (LOCF). Os grupos foram comparados por modelo linear generalizado de efeitos mistos. Resultados: Foram incluídos 36 participantes (72 antebraços). A média de idade foi 71,6 (8,6) anos, fototipos I e II prevaleceram (94%) e 61% eram do sexo feminino. Houve redução na contagem de QA para nicotinamida com 5FU (-71%) e com filtro solar (-50%), assim como para placebo e 5FU (-62%) e filtro solar (-60%), 5FU apresentou superioridade ao FPS (p<0,05). O clearance parcial de QA (>50%), apresentou redução para todos os subgrupos (-83%; -50%; -72%; -61%), com superioridade para 5FU (p<0,05). O clearance total de QA não apresentou diferença entre os tratamentos (p=0,72,). Houve redução do escore de gravidade de QA (-74%; -62%; -81%; -64%) e de fotoenvelhecimento (-10%; -6%; -22%; -8%), sem diferença entre os grupos (p>0,2). Os principais efeitos adversos observados foram eritema (50%) e dor local (5%) com uso de 5-FU, epigastralgia e náusea com nicotinamida (5%). Houve redução no escore KIN em todos os grupos (p<0,05), sem diferença entre os subgrupos. Houve redução da atrofia epitelial em todos os tratamentos (p<0,05), com superioridade para 5FU (p<0,05). Houve redução do escore Ki67 em ambos os tratamentos (p<0,05), com maior redução no grupo que recebeu nicotinamida (p<0,05). Para p53 não houve diferença entre os tratamentos (p=0,81). Ocorreram 3 dropouts. Conclusão: 5-FU tópico reduz a atividade do campo de cancerização de forma mais eficaz que o filtro solar quanto à contagem e ao clearance de QA. Nicotinamida oral não promoveu melhora clínica, mas histológica (Ki67), adicional à fotoproteção ou ao uso de 5FU. / Background: The treatment of the skin field cancerization is aimed at preventing the progression of premalignant lesions or the development of subclinical lesions as a way of preventing carcinogenesis. There are several treatment proposals, however, there are few studies with oral nicotinamide, none comparing the efficacy of topical 5-fluorouracil (5FU) with photoprotection, or its association with oral nicotinamide. Objectives: To evaluate the efficacy of oral nicotinamide versus intermittent topical 5FU and photoprotection in the treatment of cutaneous cancer and actinic keratoses (AK). Casuistry and methods: Design: randomized (blocks), controlled (intrasubject), double blind, factorial clinical trial. Participants: immunocompetent patients, who had between 3 and 10 AK each forearm, selected during the visits of the oncology outpatient clinic of the dermatology department of Botucatu Medical School - UNESP from March to September, 2016. There was randomization in blocks and allocation in Groups of patients and forearms. Intervention: one group received nicotinamide 500mg, orally every 12h, and the other, placebo. One of the forearms received 5FU 5% cream, overnight, 3x per week, and both, daytime (SPF 30) sunscreen. The duration of the treatments was 120 days. The patients were evaluated at the moments: T0 and T120 for clinical evaluation (AK score, AK severity score and photoaging score) and skin biopsy for evaluation of the levels of keratinocyte intraepithelial neoplasia (KIN), p53 and ki67. Adverse effects were also evaluated in the T14. Outcomes: were analyzed by intention to treat (ITT), and the imputed dropouts with the values of the last observation carried forward (LOCF). The groups were compared by generalized linear model of mixed effects. Results: 36 participants (72 forearms) were included. The mean age was 71.6 (8.6) years, phototypes I and II prevailed (94%) and 61% were female. There was a reduction in the counts of AK for nicotinamide with 5FU (-71%) and with sunscreen (-50%), as well as for placebo and 5FU (-62%) and sunscreen (-60%), 5FU presented SPF superiority (P <0.05). The partial clearance of AK (> 50%) presented a reduction for all subgroups (-83%, -50%, -72%, -61%), with a superiority of 5FU (p <0.05). Total clearance of AK did not show any difference between the treatments (p = 0.72,). There was a reduction in the severity score of AK (-74%, -62%, -81%, -64%) and of photoaging (-10%, -6%, -22%, -8%), with no difference between Groups (p> 0.2). The main adverse effects observed were erythema (50%) and local pain (5%) with use of 5-FU, epigastralgia and nausea with nicotinamide (5%). There was a reduction in the KIN score in all groups (p <0.05), with no difference between the subgroups. There was reduction of epithelial atrophy in all treatments (p <0.05), with superiority to 5FU (p <0.05). There was a reduction in the Ki67 score in both treatments (p <0.05), with a larger reduction in the nicotinamide group (p <0.05). For p53 there was no difference between treatments (p = 0.81). There were 3 dropouts: one per death, one refusal because the lesions improved, and one drop due to adverse local effects. Conclusion: Topical 5-FU reduces the activity of the cancerization field more effectively than the sunscreen in the counting and clearance of AK. Oral nicotinamide did not promote clinical improvement, but histological improvement (Ki67), additional to photoprotection or the use of 5FU.