Modified topical photodynamic therapy of superficial skin tumors, utilizing aminolevulinic acid, penetration enhancers, red light, and hyperthermia.

BACKGROUND: Photodynamic therapy (PDT) is a noninvasive selective therapy for a specific group of skin tumors. OBJECTIVE: In this study we used a modified topical medication in which ethyleneamine tetra acetic acid (EDTA) and dimethylsulphoxid (DMSO) were added to 5-aminolevulinic acid 20% (ALA) followed by exposure to a novel high output light source emitting red and infrared irradiation. METHODS: ALA 20%-EDTA 2%-DMSO 2% in a water in oil cream base was applied to the tumors. After 12 hours the tumor was exposed to red (585-720 nm; 150 mW/cm2) and near infrared irradiation (1.25-1.6 mm; 50 mW/cm2) for 10-15 minutes by the VersaLight incoherent filtered light source. RESULTS: Complete responses were achieved after one to three ALA-PDT treatments in 26/31 lesions of superficial or small nodular basal cell carcinoma (BCC) (84%), and in four of five in superficial squamous cell carcinoma (SCC) (80%). Complete clearance was achieved in one patient with Bowen's disease of the penis. CONCLUSIONS: Topical PDT utilizing ALA 20%-EDTA 2%-DMSO 2% as the photosensitizer and VersaLight as the light source is a noninvasive, nearly painless treatment with excellent therapeutic and cosmetic results. Our data show the efficiency of this therapy for patients with certain subtypes of BCC, SCC, and Bowen's disease.

[Topical photodynamic therapy in basal and squamous cell carcinoma and penile Bowen's disease with 20% aminolevulinic acid, and exposure to red light and infrared light].

Photodynamic therapy (PDT) is a noninvasive selective therapy for a specific group of skin tumors. 5-aminolevulinic acid 20% in a water-in-oil cream base was applied to the tumors as a photosensitizer and was followed after 12 hours by exposure to a high output light source emitting red (585-720 nm; 150 mW/cm2) and near infrared irradiation (1.25-1.6 mm; 50 mW/cm2) for 10-15 minutes (VersaLight, incoherent filtered light source). Complete responses were achieved after 1-3 treatments in 26/31 lesions of superficial or small nodular basal cell carcinoma (BCC) and 4/5 in superficial, squamous cell carcinoma (SCC) lesions. There was a patient with Bowen's disease of the penis. Follow-up was for 12-24 months. This noninvasive, nearly painless treatment gives excellent therapeutic and cosmetic results. Our data show its efficacy for certain subtypes of BCC, SCC and Bowen's disease. Further studies will determine the exact cure and recurrence rates with this modality and compare it to other modes of skin cancer therapy.

Mucinous syringometaplasia. An immunohistochemical and ultrastructural study of a case.

Mucinous syringometaplasia (MS) is an unusual skin lesion of unknown etiology, characterized histologically by epidermal invaginations lined by mucin-laden goblet-like cells and by nonkeratinized squamous cells. The present case study was performed to elucidate further the characteristics of this lesion using immunohistochemistry and electron microscopy. The mucin-laden cells in the MS lesion stained positively for carcinoembryonic antigen, epithelial membrane antigen, and low molecular weight keratins. The ultrastructural examination, which was performed on deparaffined sections, revealed two morphological variants of mucous granules. Electron-dense mucous granules predominated in the mucus-containing cells, which were situated among the keratinocytes adjacent to the epidermal invaginations, mostly in the lower parts of the epidermis. Larger, electron-lucent granules containing flocculent material were found more abundantly in the cells lining the epidermal invaginations. Also, some of the mucus-containing cells showed bundles of tonofilaments; structures that appeared to be isolated short, stubby microvilli; and attachments to adjacent mucus-containing cells and keratinocytes by desmosomes. The ultrastructural and immunohistochemical findings in our case suggest that the mucinous changes occurred as a metaplastic process in the resident epidermal cells and were accompanied by changes in cellular antigen expression resembling those of simple secretory epithelium.

Photosensitivity associated with antipsychotics, antidepressants and anxiolytics.

Photosensitivity reactions evoked by systemic agents are the result of the effects of the agent combined with subsequent exposure to light. Photosensitivity induced by exogenous parenteral agents accounts for an increasing portion of the total undesirable effects caused by environmental chemicals. The exponential increase in the number of new drugs introduced each year may be one of the factors explaining the increased number of reports describing photosensitivity induced by exogenous agents. There are many reports of photosensitivity caused by antipsychotic and antidepressant agents. Although the majority of the research was focused on the photosensitising potential of chlorpromazine, other antipsychotics and antidepressants have been shown to cause cutaneous photosensitivity. An extensive drug history must be taken whenever a patient presents with a reaction limited to, or accentuated in, light-exposed areas. It should be remembered that these reactions may present with a wide morphological spectrum ranging from sunburn-like responses to eczematous, lichenoid and even bullous lesions, resembling porphyria cutanea tarda. In order to properly diagnose photosensitivity to systemic drugs it is important to prove photosensitivity by phototesting and to rule out other causes of systemic photosensitivity such as systemic lupus erythematosus and porphyria cutanea tarda.

Histopathologic findings in the clinically uninvolved skin of patients with mycosis fungoides.

Several of the methods of treating plaque-stage mycosis fungoides (MF) advocate treatment of the whole skin, although relatively little information exists on the histologic appearance of clinically uninvolved MF skin. Our study was performed to elucidate the histologic appearance of the clinically uninvolved skin of plaque-stage MF patients. Biopsies were taken from the clinically uninvolved skin of 18 untreated patients with plaque-stage MF, 1 cm (near) and > or = 10 cm (far) from the MF plaques, and from 23 normal, healthy controls. Eight to 12 serial sections from each specimen were examined. The most common histologic finding, which was observed in six (33%) biopsies of near skin and four (22%) biopsies of far skin compared with only one (4%) biopsy of normal control (p = 0.02 and 0.1, respectively), consisted of mononuclear-cell infiltrate around a blood vessel in the papillary dermis, with extension of some of these cells into the overlying epidermis. More diffuse and epidermotropic mononuclear cell infiltrates were seen in an additional three (17%) biopsies of near skin, whereas mild nonepidermotropic superficial perivascular or perifollicular mononuclear cell infiltrates were observed in an additional four (17%) biopsies of the normal controls. In conclusion, the most common histologic finding in our study, which was observed predominantly in the MF group, might represent an earlier stage and clinically undetectable involvement of the normal-looking skin in MF patients.

Sun protection and sunscreen use after surgical treatment of basal cell carcinoma.

Sixty-three patients (mean age 54 +/- 9 years) who were treated for a basal cell carcinoma (BCC) and 54 control subjects (mean age 51 +/- 11 years) filled out detailed questionnaires on their sun exposure and sun protection habits. Patients were given the questionnaires at least 1 year after their skin tumors had been excised. Differences between patients and controls in mean age, gender, Fitzpatrick's skin type and eye and hair color were statistically nonsignificant. The level of education was high in both patients and controls (mean of 13.4 +/- 3.1 school years). Differences in education were statistically nonsignificant. We found that both patients and controls were knowledgeable about the role of sunscreens in preventing skin tumors (79% and 83% respectively) and in preventing sun-induced aging (90% and 85% respectively). Significantly more patients used sunscreens regularly (64%) compared with controls (36%). Nevertheless, our data show no statistically significant differences between the sun exposure habits of the patients previously treated for BCC and controls. Moreover, we found that, although 82% of the patients declared that they tried to avoid sun, only 49% regularly wore hats or shirts with long sleeves in the summer (19%). Sixty-two percent of the patients used two or fewer bottles of sunscreens per year, which is inadequate for effective year-round sun protection. In addition, we found that many patients, as well as the controls, applied sunscreens only once a day (57% and 46% respectively), did not reapply after swimming (58%, 74% respectively), and did not use sunscreens in the winter (49%, 61%). Our data show that, although patients after BCC removal have a significantly higher sunscreen use compared with controls, the amount and methods of application are less than adequate. Moreover, other simpler methods to prevent photodamage, such as simple sun avoidance or the use of protective clothing, are often neglected.

Ultraviolet radiation induces phosphorylation of the epidermal growth factor receptor.

Ultraviolet light in solar radiation is responsible for more than 600,000 malignancies each year in the United States alone, making it the most efficient environmental carcinogen known. Ultraviolet radiation-induced direct DNA damage is thought to be responsible for its initiating properties, while the promotional aspects of such radiation are poorly defined and only recently gaining attention. We show here for the first time that physiologically relevant doses of ultraviolet radiation induce phosphorylation of the epidermal growth factor receptor in A431 keratinocytes at tyrosine sites within 30 min. Such alteration of this major signal transduction system is probably an important step in the ultraviolet radiation-induced, epidermal cell-signalling cascade.

Influence of cumulative sun exposure on the prevalence of common acquired nevi.

BACKGROUND: Conflicting evidence exists on the relation between sun exposure and the number of common acquired nevi. The increase in the number of common acquired nevi until early adulthood and their greater concentration on sun-exposed areas suggested that the growth of common acquired nevi is promoted by UV radiation. Nevertheless, it was noticed that although solar exposure accumulates with age, the number of common acquired nevi decreases after the third decade. OBJECTIVE: Our purpose was to examine the relation between the prevalence of common acquired nevi and accumulative sun exposure. METHODS: The number of common acquired nevi on 128 patients with multiple solar keratoses (SK) was compared with their number on 82 control subjects. The existence of SK served as a biologic marker for long-term solar effects. RESULTS: On patients with SK we counted 1285 nevi (mean 10.0 nevi per person) and on control subjects, 1521 nevi (mean 18.5 nevi) (p = 0.0046; Kruskal-Wallis test). The finding that persons exhibiting signs of accumulating sun effects have fewer nevi was maintained irrespective to differences of gender, occupation, and complexion. CONCLUSION: Our data suggest that accumulating solar effects may contribute to the natural maturation and elimination of common acquired nevi in late adulthood.

Seborrheic skin and acne vulgaris as protective factors against the development of basal cell epithelioma.

This study was conducted in order to evaluate a possible protective role of seborrheic complexion and a history of acne on the development of basal cell epithelioma (BCE). For this purpose, 77 patients with this tumor were examined and asked to fill out a questionnaire. The questionnaire included demographic data and questions about skin type, eye and hair colors, sun exposure habits and a past history of acne. The nature, number and location of tumors, the texture of skin and acne scars were noted by a physician. A group of 93 age-, sex- and skin-color-matched patients served as controls. The results show a clear relationship between seborrheic features and a lower risk of developing BCE, after controlling for solar exposure using the Mantel-Haenszel summary measure. The same trend was found in patients with a history of acne. Whether ultraviolet light absorption by sebum, an anticancer activity of Propionibacterium acnes or other factors play a protective role against the development of BCE is as yet unclear.

[Erythema ab igne].

Erythema ab igne (EAI) has not been common since coal stoves have no longer been in general use for heating. Nevertheless, each winter several patients with macular-reticular skin lesions considered to be EAI are seen in our clinic. Correct diagnosis depends on awareness of the condition. 3 women, aged 17, 34 and 50, respectively, in whom EAI was induced by prolonged sitting close to an electrical heating device are presented. When this was discontinued the skin lesions disappeared. In the majority of reported cases of EAI the course was benign, similar to that in our patients in whom there were no additional related lesions. However, isolated cases of squamous cell carcinoma developing in patients with EAI have been described. In other cases the local heating which caused the EAI was applied for relief of pain and the appearance of EAI was the first clue to an underlying internal disease.