Immune Response Modification: A New Paradigm for the Management of Actinic Keratoses and Nonmelanoma Skin Cancers

A supplement to Skin & Allergy News supported by a restricted educational grant from 3M Pharmaceuticals. This supplement was jointly sponsored by Excerpta Medica, Inc. and Skin & Allergy News.
Highlights of presentations developed from a roundtable discussion that took place in Miami, FL on December 12, 2003.

•Faculty
•Target Audience
•Educational Needs
•Learning Objectives
•CME Recognition

To view the supplement, click the image above. To take the CME test, download and print out the PDF file, and follow the test instructions on page 16.

Faculty

Introduction
Stuart J. Salasche, MD
Chair
Clinical Professor, Medicine
University of Arizona
Tucson
Consultant: 3M Pharmaceuticals

Mechanisms of Action of Field Therapies
Anthony A. Gaspari, MD
Professor of Dermatology
Department of Dermatology
University of Maryland School of Medicine
Baltimore
Consultant: 3M Pharmaceuticals

Exploring the Evidence for Immune Response Modification
in the Immunocompromised Patient Population
Prof Dr med Eggert Stockfleth
Head of Derm-Oncology Department
Clinic for Dermatology, Venereology and Allergy
University School of Medicine, Charité
Berlin, Germany
Consultant: 3M Pharmaceuticals

Efficacy of Field Therapy for Actinic Keratosis
Mark G. Lebwohl, MD
Professor and Chairman
Mt. Sinai School of Medicine
New York
Received funding for clinical trials and grants for speaking from 3M Pharmaceuticals.

Basal Cell Carcinoma and Invasive Squamous Cell Carcinoma: Evaluating the Options
Stephen P. Shumack, MD
Head, Department of Dermatology
St. George Hospital
Sydney, Australia
Received funding for clinical research from 3M and Bioglan Pharmaceuticals. He discusses the unlabeled use of the investigational product imiquimod for the treatment of basal cell carcinoma.

Judging Efficacy of Treatments for Actinic Keratosis
Joseph L. Jorizzo, MD
Professor and Former (Founding) Chair
Department of Dermatology
Wake Forest University Medical Center
Winston-Salem, NC
On the Speaker's Bureau at 3M and Dermik Laboratories, Inc. He discusses the unapproved use of combination therapy including fluorouracil cream 0.5%, and imiquimod.

Target Audience

This activity has been developed for dermatologists and other health care professionals who are involved in the treatment of patients with actinic keratoses (AKs) and nonmelanoma skin cancers—invasive squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs).

Educational Needs

The incidence of actinic keratosis (AK)—increasingly recognized as squamous cell carcinoma (SCC) in situ—as well as SCC and basal cell carcinoma continues to rise in the United States. This is largely the result of greater numbers of individuals living longer lives; most have a long history of cumulative skin damage from ultraviolet light.

For isolated, discrete lesions that occur on areas of the skin other than the head and neck (typically areas of cosmetic concern to patients and physicians alike), cryosurgery or other destructive modalities may be considered as effective, relatively low-cost options for eliminating lesions. However, destructive modalities are not preferred when a lesion is present on the head or neck (because of the risk for hypopigmentation and/or scarring) or when a patient has multiple lesions on any given area of the skin (both for cosmetic reasons and for patient comfort). Moreover, it is now known that the occurrence of one or more AKs in a given area is a likely indicator of cumulative sun damage in that region of the skin and that subclinical lesions are probably present. For these reasons, interest in so-called field therapy is increasing. Clinicians much remain up-to-date on the results of laboratory and clinical investigations regarding field treatments, including 5-fluorouracil, photodynamic therapy, diclofenac, and imiquimod.

Learning Objectives

By reading and studying this supplement, participants should be able to:

• Describe the concept of “field cancerization” and field therapy.

• List and describe the methods of field therapy for AKs and nonmelanoma skin cancers, including 5-fluorouracil, photodynamic therapy, diclofenac, and imiquimod.

• Discuss the results from well-controlled clinical trials concerning the efficacy, safety, and dosages of topical field therapies for AKs and nonmelanoma skin cancers.

• Explain the role of prophylactic therapy in managing patients with cumulative photodamage.

CME Recognition

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Excerpta Medica, Inc., and Skin & Allergy News.

Excerpta Medica designates this educational activity for a maximum of 1.5 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the educational activity.

The American Medical Association has determined that non-U.S. licensed physicians who participate in this activity are eligible for AMA/Physician's Recognition Award category 1 credit.

Term of approval: April 2004-March 2005.

Copyright © 2004 by International Medical News Group

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