S1-Guidelines on UV phototherapy and photochemotherapy.

Known in part since antiquity, the salutary effects of sunlight again garnered increasing attention in the second half of the 19(th) century. The development of a device for ultraviolet irradiation of cutaneous tuberculosis by Finnsen at the onset of the twentieth century truly marked the beginning of modern phototherapy. In dermatology, treatment methods almost exclusively use wavelengths below the visible light range (ultraviolet light). Since the early 1970s, increasingly powerful artificial light sources have become available for UVB and UVA therapy as well as the combination of UVA and photosensitizers (photochemotherapy). High structural and procedural quality standards are an essential prerequisite for the implementation of effective as well as safe phototherapy. The following guidelines outline the current consensus of leading experts in the field of phototherapy with respect to indications, contraindications, and side effects of various treatment options available. Particular focus is also on adequate UV doses at the beginning and over the further course of treatment as well as on management of side effects.

S1-Leitlinie zur UV-Phototherapie und Photochemotherapie.

Die heilsame Wirkung des Sonnenlichts war teilweise schon im Altertum bekannt und fand in der zweiten Hälfte des 19. Jahrhunderts wieder zunehmend Beachtung. Den Beginn der modernen Phototherapien markiert die Entwicklung einer Apparatur zur ultravioletten Bestrahlung der Hauttuberkulose durch Finnsen zu Beginn des zwanzigsten Jahrhunderts. Zur Therapie von Hauterkrankungen finden beinahe ausschließlich die spektralen Bereiche unterhalb des sichtbaren Lichtes (ultraviolett) Anwendung. Seit den 1970er Jahren stehen zunehmend leistungsfähige künstliche Strahlenquellen bereit für die Therapie mit UVB, UVA und die Kombination von UVA mit Photosensibilisatoren (Photochemotherapie). Hohe strukturelle und prozedurale Qualitätsstandards sind unabdingbare Voraussetzung für die Durchführung einer gleichermaßen wirkungsvollen wie auch sicheren Phototherapie. Die Leitlinie formuliert den aktuellen Konsens führender Experten auf dem Gebiet der Phototherapie in Bezug auf die Indikationen für die jeweiligen Therapieverfahren, deren Gegenanzeigen und Nebenwirkungen und insbesondere für die Wahl der korrekten Dosis zu Beginn und im Verlauf einer Therapie sowie das Management von Nebenwirkungen.

Intermittent High-Dose Intravenous Interferon Alfa-2b for Adjuvant Treatment of Stage III Melanoma: Final Analysis of a Randomized Phase III Dermatologic Cooperative Oncology Group Trial.

PURPOSE: To evaluate the efficacy, safety, tolerability, and quality of life (QoL) in patients receiving intravenous, intermittent high-dose interferon alfa-2b (IFN-α-2b [iHDI]) compared with standard high-dose IFN-α-2b (HDI). PATIENT AND METHODS: Patients with stage III resected lymph node or in-transit metastasis from cutaneous malignant melanoma were randomly assigned to receive either a standard HDI regimen or three courses of IFN-α-2b 20 MIU/m(2) administered intravenously 5 days a week for 4 weeks then repeated every 4 months. Distant metastasis-free survival was the primary end point for efficacy analysis. In addition, relapse-free survival, overall survival, safety as determined by Common Terminology Criteria for Adverse Events criteria, and QoL were secondary end points. RESULTS: Of 649 patients enrolled, 22 patients were excluded from the intent-to-treat analysis. The remaining 627 patients were well balanced between the arms according to sex, age, and stage. After a median follow-up of 55 months, a multivariable Cox model revealed no significant differences for distant metastasis-free survival (hazard ratio [HR], 1.21; P = .12) or overall survival (HR, 1.01; P = .85). In contrast, the difference for relapse-free survival was significant (HR, 1.27; P = .03), favoring standard HDI. Early termination of treatment because of adverse events or QoL occurred significantly more often with HDI than with iHDI (26.0% v 14.8%; P < .001). CONCLUSION: Although the safety and QoL profiles for the intermittent regimen were favorable, no significant difference was observed for survival while the HR for relapse with iHDI was increased. Therefore, an iHDI regimen, as tested here, cannot be recommended as adjuvant treatment for high-risk melanoma.

Widespread cutaneous angiosarcoma of the scalp: diagnosis and soft tissue reconstruction with a combined double-muscle-free flap and split-thickness-skin graft.

BACKGROUND: Cutaneous angiosarcoma is a rare vascular tumor, which is usually located in the head and neck region. Because of the unspecific appearance, diagnoses are only secured after a histological examination of a tissue sample. CASE REPORT: After three punch biopsies, a 67-year-old patient, who had been healthy so far, was diagnosed with a cutaneous multilocated angiosarcoma of the scalp. Computed tomography of the head, neck, thorax, and abdomen was done for staging. It was without pathological findings. The tumor removal caused a scalp defect with a size of 30 x 30 cm. The cover of the defect was made by a combined microsurgical muscle flap with parts of the musculus latissimus dorsi and musculus serratus anterior. This flap was covered with split-thickness-skin in a second step. Eight weeks postoperative, the radiotherapy has started. CONCLUSION: This kind of treatment can be recommended because the early reconstruction allowed a soon adjuvant radiotherapy, and the patient regained a good quality of life due to the pleasant and aesthetically result.

[UV-radiation--sources, wavelength, environment]. / Ultraviolette Strahlung--Quellen, Spektren, Umwelteinflüsse.

The UV-radiation in our environment is part of the electromagnetic radiation, which emanates from the sun. It is designated as optical radiation and reaches from 290-4,000 nm on the earth's surface. According to international definitions UV irradiation is divided into short-wave UVC (200-280 nm), medium-wave UVB (280-320 nm), and long-wave UVA (320-400 nm). Solar radiation which reaches the surface of the globe at a defined geographical site and a defined time point is called global radiation. It is modified quantitatively and qualitatively while penetrating the atmosphere. Besides atmospheric conditions, like ozone layer and air pollution, geographic latitude, elevation, time of the season, time of the day, cloudiness and the influence of indirect radiation resulting from stray effects in the atmosphere and reflection from the underground play a role in modifying global radiation, which finally represents the biologically effective radiation. The radiation's distribution on the body surface varies according to sun angle and body posture. The cumulative UV exposure is mainly influenced by outdoor profession and recreational activities. The use of sun beds and phototherapeutic measures additionally may contribute to the cumulative UV dose.