Risk factors for unfavorable outcomes after endoscopic removal of submucosal invasive colorectal tumors.

BACKGROUND & AIMS: Oncologic surgery is recommended after endoscopic resection of submucosal invasive T1 colorectal carcinomas if patients are considered to be at high risk for tumor recurrence or metastasis. However, there are sparse data on the outcome of high-risk patients treated only by endoscopy. METHODS: Data were collected from 474 patients who underwent endoscopic resection for T1 colorectal cancers from 1974-2002 at Neuperlach Hospital in Munich, Germany. Patient files were reviewed, and patients or referring physicians were contacted to assess outcomes during a follow-up period of at least 24 months (n = 390). Histopathology and endoscopy factors associated with an unfavorable outcome (local recurrence of tumors, metastasis, or death from colorectal cancer) were assessed. RESULTS: Of the 390 patients followed, 141 received oncologic surgery, and 249 did not; overall, 10% had an unfavorable outcome (39/390). Multivariate regression analysis revealed that lymphatic vessel infiltration, poor grading of tumor stage, and incomplete endoscopic resection were risk factors for unfavorable outcomes (odds ratios, 7.8, 3.4, and 2.6, respectively). If these risk factors were applied to patients who did not receive oncologic surgery, negative predictive values for an unfavorable outcome were 94.6% for lymphatic vessel infiltration, 94.2% for poor grading of tumor stage, and 96.5% for incomplete endoscopic resection; positive predictive values were 44.4%, 42.9%, and 19.6%, respectively. CONCLUSIONS: Tumor infiltration of lymphatic vessels is the greatest risk factor for an unfavorable outcome after endoscopic resection for colorectal carcinoma. However, its positive predictive value is low. The decision to perform surgery after endoscopic resection of T1 colorectal cancers should be made on the basis of specific features of each patient.

Experience with non-ablative fractional photothermolysis with a dual-mode laser device (1,440/1,320 nm): no considerable clinical effect on hypertrophic/acne scars and facial wrinkles.

In the literature, non-ablative fractionated photothermolysis (nFP) is accredited with improvement of wrinkles and scars combined with a reduced downtime. The purpose of this work was to evaluate the impact of a combination laser (1,320/1,440 nm) for nFP on hypertrophic scars, acne scars, and facial wrinkles. Thirty-six patients suffering from hypertrophic scars (n = 7), acne scars (n = 9), and wrinkles (n = 20) were treated using a combination Nd:YAG laser [λ(em) = 1,320 and 1,440 nm, pulse duration: 3-ms single pulse, fluence: 8.0-9.0 J/cm(2) (1,320 nm); 2.0-2.5 J/cm(2) (1,440 nm)]. The appearance of the treated condition was evaluated in a retrospective study by two blinded investigators based on follow-up photographs and by patient self-assessment. The frequency of side-effects was also assessed. Both patients and blinded observers rated the treatment results for hypertrophic scars and acne scars as slight improvement, and for wrinkles as equal as compared to baseline. No serious side-effects were reported. The light device used did not lead to a considerable clinical improvement of hypertrophic scars, acne scars, or wrinkles in this study.

Split-face comparison of intense pulsed light with short- and long-pulsed dye lasers for the treatment of port-wine stains.

BACKGROUND: So far, pulsed dye lasers have been regarded as the gold standard in the treatment of port-wine stains (PWS). Recently, intense pulsed light (IPL) has been reported to achieve more pronounced fading in some patients. OBJECTIVES: To evaluate the efficacy and the side effects of IPL treatment of PWS in a direct comparison to the short-pulsed dye laser (SPDL) and the long-pulsed dye laser (LPDL). METHODS: Test spots (n = 158) were applied with IPL (λ(em) = 555-950 nm, pulse duration: 8-14 milliseconds (single pulse), fluence: 11-17.3 J/cm(2)), the SPDL (λ(em) = 585 nm, pulse duration: 0.45 milliseconds, fluence: 6 J/cm(2)), and the LPDL (λ(em) = 585/590/595/600 nm, pulse duration: 1.5 milliseconds, fluence: 12/14/16/18 J/cm(2)) in a side-by-side modus in untreated (n = 11) and previously treated (n = 14) patients with PWS. Lesion clearance was evaluated by three blinded investigators based on follow-up photographs 6 weeks after treatment. Incidence of side effects was assessed. RESULTS: In previously untreated PWS as well as in pretreated PWS, IPL treatments were rated significantly (P<0.05) better than treatments with the SPDL. In both groups, IPL and LPDL treatments did not differ significantly. Side effects were few in all settings. CONCLUSIONS: In PWS resistant to dye laser therapy, IPL showed additional lesion clearance. The use of IPL increases the therapeutic possibilities in PWS.

Management of EGFR-inhibitor associated rash: a retrospective study in 49 patients.

BACKGROUND: In recent years inhibitors directed against the epidermal growth factor receptor (EGFR) have evolved as effective targeting cancer drugs. Characteristic papulopustular exanthemas, often described as acneiform rashes, are the most frequent adverse effect associated with this class of novel cancer drugs and develop in > 90% of patients. Notably, the rash may significantly compromise the patients' quality of life, thereby potentially leading to incompliance as well as dose reduction or even termination of the anti-EGFR therapy. Yet, an effective dermatologic management of cutaneous adverse effects can be achieved. Whereas various case reports, case series or expert opinions on the management of EGFR-inhibitor (EGFRI) induced rashes have been published, data on systematic management studies are sparse. METHODS: Here, we present a retrospective, uncontrolled, comparative study in 49 patients on three established regimens for the management of EGFRI-associated rashes. RESULTS: Strikingly, patients' rash severity improved significantly over three weeks of treatment with topical mometason furoate cream, topical prednicarbate cream plus nadifloxacin cream, as well as topical prednicarbate cream plus nadifloxacin cream plus systemic isotretinoin. CONCLUSIONS: In summary our results demonstrate that EGFRI-associated rashes can be effectively managed by specific dermatologic interventions. Whereas mild to moderate rashes should be treated with basic measures in combination with topical glucocorticosteroids or combined regiments using glucocorticosteroids and antiseptics/antibiotics, more severe or therapy-resistant rashes are likely to respond with the addition of systemic retinoids.

Skin diseases following a Christmas tree pattern.

Pattern analysis of skin lesions is an art and a key competence of every dermatologist. Three major line patterns cover the human body-the dermatomes or Head zones, the nevoid lines of Blaschko, and the relaxed skin tension lines, or Langer lines. Head zones represent skin areas innervated from the same sensory neuronal segment or spinal nerve zone. Blaschko lines are borderlines of epidermal aberration caused by genetic mosaicism occurring in the early stages of embryogenesis. Langer lines show the direction of the lowest naturally occurring skin tension, and its thoracodorsal manifestation is the Christmas tree pattern. Here we review clinical aspects of pityriasis rosea, mycosis fungoides, stage 2 syphilis, exanthematic Kaposi sarcoma, exanthematic psoriasis, Leser-Trelat syndrome, and other primary skin diseases with a Christmas tree pattern. Secondary skin diseases, such as herpes zoster or indeterminate cell histiocytosis, may follow this pattern if they are linked to a primary skin disease by the Wolf isotopic response.