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Oncological aspects related to the non-surgical treatment of basal cell carcinoma – Response
Paulo Rodrigo Pacola
Department of Dermatology, Hospital Universitário Júlio Muller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
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Comments on: chemotherapeutical treatment of basal cell carcinoma with bleomycin via microinfusion of the drug into the skin (MMP®)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "324" "paginaFinal" => "325" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ivanka Miranda de Castro Martins, Ana Cláudia Cavalcante Espósito, Hélio Amante Miot" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Ivanka Miranda" "apellidos" => "de Castro Martins" ] 1 => array:2 [ "nombre" => "Ana Cláudia Cavalcante" "apellidos" => "Espósito" ] 2 => array:2 [ "nombre" => "Hélio Amante" "apellidos" => "Miot" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223003090" "doi" => "10.1016/j.abdp.2023.12.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223003090?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623002611?idApp=UINPBA00008Z" "url" => "/03650596/0000009900000002/v2_202407221312/S0365059623002611/v2_202407221312/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>" "titulo" => "Oncological aspects related to the non-surgical treatment of basal cell carcinoma – Response" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor,</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "325" "paginaFinal" => "326" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Paulo Rodrigo Pacola" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Paulo Rodrigo" "apellidos" => "Pacola" "email" => array:1 [ 0 => "paulopacola@bol.com.br" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Hospital Universitário Júlio Muller, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil" "identificador" => "aff0005" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The authors are grateful for the comments regarding the article: Chemotherapeutical treatment of basal cell carcinoma with bleomycin via microinfusion of the drug into the skin (MMP®)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and are aware of the main limitation of the study, which was the six-month follow-up. These controls were carried out after six months, through spindle biopsies and histopathology, which is the standard method for diagnosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is also known that only micrographic surgery using the Munich technique could assertively confirm the absence of disease throughout the scar, even five years after the treatment.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although the study ended in 2021, the patients continue to be monitored, so that after five years this cure rate can be updated and a new report can be published.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding safety margins, it is our knowledge that low-risk lesions require at least 4 mm and high-risk lesions require at least 6‒7 mm,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> and these guidelines were followed for the treated lesions.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding tumor thickness, as mentioned before, few lesions with tumor thickness >3 mm were included. In fact, only one of them showed recurrence within six months. In this case, this decision was made because it was located in a low-risk area and was elevated above skin level. This observation is necessary to recall that it was a criterion of the study to perform a shave biopsy in all lesions that were elevated above the normal skin surface (safety margin region) so that the penetrating needle reached the same depth both in the lesion and in the safety margin. And once the lesion is “leveled”, the tumor thickness decreases.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Considering the low risk of metastasis of basal cell carcinoma and the greater risk of local recurrence, it was decided to include such lesions, as well as lesions in high-risk areas so that there was a broader view of the therapeutic potential of the bleomycin technique in this study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The high rate (19%) of patients lost to follow-up was due to factors beyond the authors knowledge. And, in principle, not associated with any type of complication, so it cannot be stated or concluded that it had any relationship with the initial treatment and may be the result of sociocultural characteristics of the attended population. Therefore, these data were excluded from the analyses. It is important to emphasize that all patients were advised to return for follow-up. And, according to the commitment established through the FIC form, the post-surgical follow-up during five years was our responsibility, as well as offering other treatment options in case of recurrence.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We are thankful for the considerations, as they are always important and relevant for our improvement.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Paulo Rodrigo Pacola: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-09-28" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, Hospital Universitário Júlio Muller, Cuiabá, MT, Brazil.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapeutical treatment of basal cell carcinoma with bleomycin via microinfusion of the drug into the skin (MMP®)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.R. 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