الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Epidermal tumors are those lesions arise from proliferation of epidermal keratinocytes that include a variety of common skin neoplasms such as seborrheic keratosis, actinic keratosis and BCC.
Treatment of skin tumors could be surgical or non-surgical. Physical destructive methods are good choice for SK treatment, while NMSCs are best treated with surgical excision. Meanwhile, AK treatment is challenging issue due to occurrence in multiple number that commonly affects elderly patients, besides frequent recurrences of lesion. Actinic keratosis treatment is either lesion directed for single and few lesions or field directed for multiple lesions. Multiple AKs are difficult to treat surgically due to risk of acquiring large eroded area, while lesion’s removal by full ablative laser is associated with risk of scaring and prolonged downtime especially in elderly cases who have decreased healing ability. Systemic treatment is also not suitable due to risk of side effects in such age groups. Topical therapy is preferred in field therapy as it has less side effects and more convenience than destructive methods. Combined topical and physical destructive methods gives better responses with sustained clearance of lesion.
Topical 5-Fluorouracil is well-established as effective agent in treatment of AK and sBCC. It acts as an anti-metabolic pyrimidine analogue that inhibits cell proliferation. In spite of its efficacy in AK treatment, 5FU has several drawbacks including frequent skin irritation and poor skin penetration mainly in thick and deep lesions that is due to its hydrophilic nature.
Fractional CO2 laser is a minimally invasive modality that works by forming channels of microthermal zones with intervening normal zones thus providing better safety and shorter recovery time compared to conventional CO2 laser resurfacing.
Fractional CO2 laser assisted drug delivery method helps 5FU skin permeation through microthermal zones enabling the drug to bypass lipid rich skin barrier thus improving effectiveness of drug.
The aim of study was to assess efficacy and safety of fractional CO2 laser assisted 5-FU 5% solution in treatment of superficial non-melanocytic epidermal tumors. Twenty two adult cases having a total of 121 lesions were included in the study. Cases were recruited from the Dermatology Outpatient Clinic of the Alexandria Main University Hospital and they had been diagnosed clinically, dermoscopically and histopathologically with non-melanocytic epidermal tumors.
Patients were divided into 2 groups; a group of benign tumors (group A) that consisted of 13 cases having 24 SK lesions and one case having a single BLK lesion, while the group of premalignant and malignant tumors (group B) consisted of 6 cases having 94 AK lesions and 2 cases having BCC.
Each patient received 3 sessions of fractional CO2 laser. Sessions were repeated every 4 weeks followed by application of 5%5FU solution under occlusion for 3 days. Three days after each session side effects were evaluated. Clinical and dermoscopic examinations were performed at the end of the third month to detect both clinical response and long term side effects, as well as at the end of the ninth month to detect recurrences.
Regarding clinical response to treatment per lesions number at the end of treatment, group A revealed partial response in 84% of lesions and complete response in 16% of lesions. group B revealed complete response in 74% of lesions and partial response in 26% of lesions. There was a statistically significant difference between both groups as regard clinical response at the end of treatment according to lesions’ number (p=<0.001). group B showed better responses to treatment than group A.
from 6 cases having AKs (n=94 lesions), 4 cases had multiple lesions (n=92 lesions), complete response was observed in 71 lesions (77.2%) and partial response was observed in 21 lesions (22.8%). Out of 6 cases who had AK, 2 cases each had single lesion (n=2 lesions), both of them showed partial response. Cases with multiple actinic keratosis lesions showed better results.
At the end of follow up, cases of both groups maintained the same clinical responses seen at the end of treatment.
Three sessions of AFXL CO2 assisted topical 5FU 5% solution were safe well tolerated modality. Side effects to treatment were minimal in both groups with no recorded erosions, scars or infections with only mild to moderate erythema, mild average pain score and no down time.
group A showed localized mild to moderate erythema in 92.2% of cases with a range of (0 to 2) and a mean of (1.26 ± 0.59) , while pain was recorded in 28.6% of cases ranging from 0 to 7 with a mean of (0.83 ± 1.93). Post treatment hyperpigmentation was observed in 21.4%, while hypopigmentation was observed in 7.1% of cases.
group B showed localized mild to moderate erythema in 87.5% of cases with a range of (0 to 2) and a mean of (1.13 ± 0.64) , while pain was recorded in 62.5% of cases ranging from 0 to 2.7 with a mean of (0.96 ± 1.13). Post treatment dyspigmentation was not observed in any of cases.
The treatment represents an effective and safe method in the treatment of superficial non-melanocytic epidermal tumors especially in cases with multiple AK.