Lepesant P., Crinquette M., Alkeraye S., Mirabel X., Dziwniel V., Cribier B., Mortier L.   Vismodegib induces significant clinical response in locally advanced trichoblastic carcinoma.  Br. J. Dermatol..  2015 ;173 :1059-1062

Patients with advanced basal cell carcinoma due to local extension or metastatic disease were previously at a therapeutic impasse. Targeted inhibition of the sonic hedgehog pathway by vismodegib represents a new therapeutic strategy. Adnexal carcinomas are rare malignant skin tumours derived from epithelial annexes. Conventional treatment of adnexal tumours is based on surgical excision. Although the radiosensitivity of adnexal carcinomas has not been established, radiotherapy could be offered alone or in combination in locally advanced or inoperable disease. Chemotherapy represents a therapeutic option in the treatment of metastatic adnexal tumours. Currently there is no effective treatment for these tumours when they become metastatic or unresectable, and treatment is palliative. Sunitinib represents a new therapeutic strategy, with efficiency described in the literature for a small number of patients. However, its efficacy is partial, and its tolerance is not always good. We report a patient with trichoblastic carcinoma, initially diagnosed as basal cell carcinoma, treated effectively with vismodegib. The remarkable response we have observed in this patient suggests an encouraging therapeutic role of vismodegib in trichoblastic carcinoma that should be evaluated in a carefully designed trial.

Leila M., Narducci F., Mariette C., Alain D., Vanseymortier M., Leblanc E., Paoletti X., Collinet P., Clisant S., Piessen G., Penel N.   Reporting adverse events (AEs) in cancer surgery randomized trial: A systemic analysis of published trials in oesogastric (OG) and gynecological (GY) cancer patients.  Eur. J. Cancer.  2015 ;51 :S140-S140
Leclere F. M., Vogt P. M., Moreno-Moraga J., Alcolea J. M., Casoli V., Mordon S. R., Trelles M. A.   Laser-assisted lipolysis for neck and submental remodeling in Rohrich type IV patients: Fact or fiction?.  J. Cosmet. Laser Ther..  2015 ;17 :31-36

BACKGROUND: Since the first studies by Apfelberg in 1994 and the mathematical model of Mordon introduced in 2004, laser-assisted lipolysis (LAL) has been on the rise. In a previous study, we presented our results in patients treated with LAL for Rohrich type I to III aging neck. The average cervicomental angle decreased from 152.6 +/- 5.9 to 123.6 +/- 8.8 degrees after LAL. This demonstrated a systematic decrease in fat thickness, and improved skin tightening. OBJECTIVE: This new protocol focuses solely on LAL in the Rohrich type IV aging neck. METHODS: Between June 2012 and February 2013, a prospective study was performed on 10 patients treated with LAL for Rohrich type IV aging neck. The laser used in this study was a 1470 nm diode laser (Alma Lasers, Caesarea, Israel). Laser energy was transmitted through a 600 mum optical fiber and delivered in a continuous mode, at 15 W power. Previous mathematical modeling suggested that 0.1 kJ was required in order to destroy 1 ml of fat. Patients were asked to fill out a satisfaction questionnaire. The cervicomental angle was measured 6 months postoperatively, and compared with the preoperative values. RESULTS: No seromas were observed, but prolonged edema was observed in two patients. Pain during anesthesia and discomfort after the procedure were minimal. The average cervicomental angle decreased from 191.5 +/- 5.7 to 164.9 +/- 14.2 degrees (p < 0.01). This demonstrated a systematic decrease in fat thickness and improved skin tightening. Even though the cervicomental angle was higher than 140 degrees in each case, the investigators, in agreement with the patients, decided to perform a complementary surgery with platysma muscle advancement and plication six months after LAL, in only two of the ten patients. This complementary surgery led to a mean cervicomental angle of 140.2 +/- 11.4, and fair satisfaction of both patients and investigators. CONCLUSION: LAL alone appears insufficient for complete remodeling in Rohrich type IV aging neck. While LAL alone is sufficient for Grade I to III, a complementary surgery must be added for Grade IV.

Leclère F. M., Vogt P. M., Casoli V., Vlachos S., Mordon S.   Laser-assisted cartilage reshaping for protruding ears: A review of the clinical applications.  Laryngoscope.  2015 ;125 :2067-2071

OBJECTIVES/HYPOTHESIS: In 2006, our institute reported the first clinical use of laser-assisted cartilage reshaping (LACR) for protruding ears. Since then, the technique has been developed and refined. This article reviews the literature on the clinical application of LACR. STUDY DESIGN: Literature review. METHODS: A MEDLINE literature search was performed on LACR combined with cross-referencing. The period of search was 1993 to 2014. Search terms used were: laser, cartilage reshaping, protruding ears, LACR. RESULTS: Only seven clinical studies using three different wavelengths were found in the literature: 1,064 nm (Nd:YAG), 10,600 nm (CO2), and 1540 nm (Er:Glass). Clinical outcomes, laser wavelength and parameters, and patient satisfaction are discussed in each case. CONCLUSIONS: The success rate for ear reshaping achieved with LACR appears promising. The use of this noninvasive technique will increase in the near future.

Leclere F. M., Schoofs M., Vogt P., Casoli V., Mordon S.   1950-nm diode laser-assisted microanastomoses (LAMA): an innovative surgical tool for hand surgery emergencies.  Lasers Med. Sci..  2015 ;30 :1269-1273

Based on previous observations, the 1950-nm diode laser seems to be an ideal wavelength for laser microvascular anastomoses. The data presented here, part of a larger ongoing study, assess its use in emergency hand surgery. Between 2011 and 2014, 11 patients were operated on for hand trauma with laser-assisted microanastomoses (LAMA) and prospectively analysed. LAMA was performed with a 1950-nm diode laser after placement of equidistant stitches. For vessel size <1.5 mm, the following laser parameters were used: spot size 400 mum, five spots for each wall, power 125 mW, and arterial/venous fluence 100/90 J/cm(2) (spot duration 1/0.9 s). Mean operating time for arterial and venous microanastomoses was 7.3 +/- 1.4 and 8.7 +/- 1.0 min, respectively. Three anastomoses required a secondary laser application. Arterial and venous patency rates were 100 % at the time of surgery. The success rate for the 11 procedures assessed clinically and with the Doppler was 100 %. The technique is compared to the current literature. The 1950-nm LAMA is a reliable tool with excellent results in emergency hand surgery. The system is very compact and transportable for utilization in the emergency operating room.

Leclere F. M., Moreno-Moraga J., Alcolea J. M., Vogt P. M., Royo J., Cornejo P., Casoli V., Mordon S., Trelles M. A.   Efficacy and Safety of Laser Therapy on Axillary Hyperhidrosis After One Year Follow-Up: A Randomized Blinded Controlled Trial.  Lasers Surg. Med..  2015 ;47 :173-179

INTRODUCTION: Hyperhidrosis is a debilitating problem that is not only uncomfortable and inconvenient, but also embarrassing in work and social situations. In spite of the availability of several options for the treatment of axillary hyperhidrosis, recently, there has been an increasing interest in the use of laser therapy. This study aims to evaluate the efficacy of a laser diode device emitting at wavelengths of 924 and 975 nm and classical curettage either alone, simultaneously or in combination. MATERIAL AND METHODS: A randomized prospective controlled trial was carried out on 100 patients divided into four groups, each with a different protocol: Laser alone at 975 nm (group 1), laser alone at 924/975 nm simultaneously (group 2), curettage alone (group 3), and finally laser at 924/975 nm followed by curettage (group 4). HDSS, starch test and GAIS were used to assess treatment efficacy. The follow-up extended to one year. Statistical analysis (SPSS) was used to determine the accuracy of the results. RESULT: Two patients of group 1 experienced burns during treatment, which took over a month to heal. This group of patients achieved the worst results: The starch test scale results after treatment were 2.48 +/- 0.51 and 2.76 +/- 0.44 (at 1 and 12 months). The GAIS results were 1.04 +/- 0.35 and 0.92 +/- 0.28 (1 and 12 months). In group 2 the starch test scale results after treatment were 1.36 +/- 0.49 and 1.48 +/- 0.51 (at 1 and 12 months). The GAIS results were 2.36 +/- 0.49 and 2.72 +/- 0.46 (at 1 and 12 months). In group 3, the starch test scale results after treatment were 1.56 +/- 0.51 and 1.76 +/- 0.60 (at 1 and 12 months), which corresponds to small to substantially smaller dark areas. The GAIS results were 2.28 +/- 0.46 and 2.64 +/- 0.49 (at 1 and 12 months). The best results were obtained in group 4: HDSS scores were reduced from 3.88 +/- 0.33 before treatment to 1.24 +/- 0.44 and 0.48 +/- 0.51 at the 1 and 12 months controls. The starch test scale results after treatment were 0.40 +/- 0.50 and 0.44 +/- 0.51 (at 1 and 12 months). The GAIS results were 3.72 +/- 0.54 and 3.76 +/- 0.44 (at 1 and 12 months). CONCLUSION: In this study, the laser at 924/975 nm combined with curettage was determined to be the optimal treatment option of those tested for axillary hyperhidrosis. This treatment was safe, with few side effects and improvement that persisted to one year follow-up.

Leclère F. M., Mordon S., Alcolea J., Martinez-Carpio P., Vélez M., Trelles M.   1064-nm Nd: YAG laser-assisted cartilage reshaping for treating ear protrusions.  Laryngoscope.  2015 ;125 :2461-2467

BACKGROUND: Correction of prominent ears is a common plastic surgical procedure. The laser-assisted cartilage reshaping (LACR) technique for protruding ears was developed at the French National Institute of Health and Medical Research in Lille, France, using both the 1064- and 1540-nm wavelengths, with a view to simplifying the surgical procedure. Herein we report our results with the 1064-nm wavelength. METHODS: Between 2008 and 2010, twenty-six 1064-nm LACR procedures in 14 patients were performed. Twelve patients received treatment to both ears, and 2 patients received treatment to one ear. Each procedure consisted of a single treatment session. The treatment consisted of laser irradiation of both sides of the helix with single pulses of 70 J/cm2. The beam diameter was 6 mm. Early and late complications were defined and reviewed for all patients. Satisfaction was assessed by patients using a visual analogue scale from 0 (unsatisfied) to 20 (highly satisfied). The superior and middle cephaloauricular distances were prospectively evaluated at 6 months after treatment. RESULTS: Complications included eight cases of localized skin burns and one case of dermatitis. The mean right/left superior and middle cephaloauricular distances were 10.5+/-1.5 mm/10.7+/-1.0 mm and 16.3+/-2.2 mm/16.3+/-2.8 mm, respectively, as compared to 17.5+/-2.9 mm/18.6+/-2.5 mm (P<0.01) and 24.5+/-2.6 mm/24.7+/-1.7 mm (P<0.01) before the operation. Mean patient satisfaction was 16.8/20+/-3.3. CONCLUSION: Despite promising results for cartilage reshaping, the 1064-nm LACR procedure often leads to skin burns and inflammatory tissue reaction after treatment. Moreover, LACR with the 1064-nm wavelength is painful and necessitates local anaesthesia. LEVEL OF EVIDENCE: 4.

Leclere F. M., Alcolea J. M., Vogt P., Moreno-Moraga J., Mordon S., Casoli V., Trelles M. A.   Laser-assisted lipolysis for arm contouring in Teimourian grades I and II: a prospective study of 45 patients.  Lasers Med. Sci..  2015 ;30 :1053-1059

Upper arm deformities secondary to weight loss or senile elastosis have led to an increased demand for aesthetic contouring procedures. We conducted this study to objectively assess if, in Teimourian low-grade upper arm remodelling, one session of laser-assisted lypolisis (LAL) could result in full patient satisfaction. Between 2011 and 2013, 45 patients were treated for unsightly fat arm Teimourian grade I (15 patients), grade IIa (15 patients) and grade IIb (15 patients) with one session of LAL. The laser used in this study was a 1470-nm diode laser (Alma Lasers, Cesarea, Israel) with the following parameters: continuous mode, 15 W power and transmission through a 600-mum optical fibre. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat. Treatment parameters and adverse effects were recorded.The arm circumference and skin pinch measurements were assessed pre and postoperatively. Patients were asked to file a satisfaction questionnaire. Pain during the anaesthesia and discomfort after the procedure were minimal. Complications included prolonged oedema in 11 patients. The average arm circumference decreased by 4.9 +/- 0.4 cm in the right arm (p < 0.01) and 4.7 +/- 0.5 cm in the left arm (p < 0.01) in grade I patients, 5.5 +/- 0.6 cm in the right arm (p < 0.01) and 5.2 +/- 0.5 cm in the left arm (p < 0.01) in grade IIa patients and 5.4 +/- 0.5 cm in the right arm (p < 0.01) and 5.3 +/- 0.5 cm in the left arm (p < 0.01) in grade IIB patients. The skin tightening effect was confirmed by the reduction of the skin calliper measurements in all three groups. Overall mean opinion of treatment was high for both patients and investigators. Of the 45 patients, all but one would recommend this treatment. A single session of LAL in upper arm remodelling for Teimourian grades I to IIb is a safe and reproducible technique. The procedure allows reduction in the amount of adipose deposits while providing full skin tightening.

Lebbe C., Robert C., Ricard S., Sassolas B., Grange F., Saiag P., Lhomel C., Mortier L.   Evolution of sun-protection measures for children.  J. Eur. Acad. Dermatol. Venereol..  2015 ;29 :20-22

BACKGROUND: The prevention of melanoma can be significantly improved by targeting information directly towards the subpopulation of children and, as a means to achieve it, towards young parents. OBJECTIVES: The objective of this analysis was to determine the evolution over time of the sun-protection measures adopted by parents for their young children. METHODS: The Edifice Melanoma survey was based on telephone interviews of a representative sample of 1502 subjects aged >/=18 years. This particular analysis focuses on 864 adults whose children are exposed to the sun for more than 10 days a year. We compared the characteristics and attitudes of two sub-groups of parents with regard to sun protection of young children: current-day behaviour of parents with children <15 years and behaviour in the past of parents whose children are now >/=15 years. RESULTS: Present-day parents are more likely than those of previous generations to systematically or often use hats (96% vs. 90%, P < 0.01), protective clothes (92% vs. 84%, P < 0.01), sunscreen (89% vs. 80%, P < 0.01) and sunglasses (63% vs. 44%, P < 0.01) for their children. Systematic application of sunscreen is also more frequent today than several years ago as reported by 81% of present-day parents vs. 74% of those in the past (P < 0.05). Cream is reapplied every 2 h by 41% of present-day parents, compared to 33%, in the past (P < 0.05). CONCLUSIONS: The attitude of parents towards sun protection for their children has improved over the past decade.

Lear J., Fife K., Dreno B., Kunstfeld R., Grob J. J., Mortier L., Ascierto P. A., Licitra L., Dutriaux C., Jouary T., Meyer N., Guillot B., Dummer R., Ernst D. S., Jones S., Basset-Seguin N., Hansson J., Hauschild A.   UK patient cases from the global single-arm, open-label, multicentre STEVIE study of the hedgehog pathway inhibitor vismodegib in patients with advanced basal cell carcinoma.  Br. J. Dermatol..  2015 ;173 :3-3