[Treatment of stage I malignant melanoma. Open questions and recommendations]. / Zur Therapie des malignen Melanoms im Stadium I. Offene Fragen und Empfehlungen.

The excision of malignant melanomas is accepted worldwide as a therapy of choice but there are controversies concerning resection margins, prophylactic lymph node dissection, isolated hyperthermic perfusion of extremities and adjuvant therapy in high-risk patients. The relevant literature is analyzed with regard to these aspects, and based on this analysis and our own experiences in more than 3,600 melanoma patients, recommendations for therapy of primary malignant melanomas and follow-up are given.

[Diagnosis and therapy of ulcus molle today. Case report and review of the literature]. / Diagnose und Therapie des Ulcus molle heute. Kasuistik und Literaturübersicht.

Chancroid, an ulcerous disease of the genitalia caused by Haemophilus ducreyi, occurs rarely but regularly in Germany. Exact diagnosis is based on the clinical features and a direct smear, and in particular on cultivation of the organism, showing its unique macromorphological characteristics. The sensitivity of cultivation has increased due to the development of selective media for primary isolation. Resistance problems during the last decade meant that a change to new therapeutic strategies was unavoidable. The work presented here includes a case report and a review of the recent literature, it illustrates modern methods of diagnosis and treatment of Haemophilus ducreyi infections 100 years after the first description of the organism.

Low- and high-risk malignant melanoma--III. Prognostic significance of the resection margin.

The influence of the resection margin on the prognosis of malignant melanoma was investigated in 577 cases (stage I), 285 with later recurrences and 292 disease-free for at least 5 yr. The resection margins varied considerably, with less than or equal to 10 mm in 172 cases and ca. 50 mm in 85 cases. Low- and high-risk melanomas (determined by means of tumor thickness and mitotic index) were found to be distributed evenly, with only minor variations for different resection margins. The occurrence of metastases was found to be independent of the resection margin, and several statistical methods were used (correlation coefficients, chi-square tests, discriminant analyses). This was also true when high-risk cases were analyzed separately. In contrast, for low-risk melanoma (68 cases), the six metastatic cases had a resection margin less than or equal to 20 mm (11.8% vs 0%, P = 0.3). Furthermore, local recurrences (40 in 482 cases) were seen more frequently in cases with a resection margin less than 30 mm (10.0 vs 2.9%, P = 0.02). However, local recurrences did not appear to be responsible for disseminated disease, as 82.1% were at high and 10.3% were at medium risk. The benefit of a 5-cm resection margin could not be substantiated in this study. A 3-cm resection margin may be necessary to lower the risk of local recurrences and a 2-cm margin appeared to be sufficient for low-risk melanoma.

[PUVA therapy in persistent light reaction]. / PUVA-Therapie bei persistierender Lichtreaktion.

The diagnostic procedure in two patients suffering from persistent light reaction is described. In addition a modification of standard 8-methoxypsoralen-UVA (PUVA) schedule is presented which is necessary because of the extreme sensitivity to UV electromagnetic wave lengths in this photodermatosis. Both patients were able, for the first time in 8 years, to resume normal outdoor activities.

[Growth of finger nails in psoriasis patients undergoing PUVA therapy]. / Fingernagelwachstum bei Psoriatikern unter PUVA-Therapie.

In 78 persons aged 13-78 years with and without psoriasis the daily growth rate of fingernails was measured on three nails each of the right and left hand. Untreated patients with psoriasis had an increased growth rate (112.7 +/- 25.5 micrometers) compared to control subjects (102.5 +/- 18.5 micrometers) without psoriasis (p less than or equal to 0.001). In patients with psoriatic nail involvement the growth rate was significantly increased (113.9 +/- 29.2 micrometers). Photochemotherapy (PUVA) slowed down the nail growth rate in patients without nail involvement (92.8 +/- 21.8 micrometers) vs. untreated psoriatics without nail involvement (p less than or equal to 0.05). In psoriatics with nail involvement, PUVA therapy had no measurable effect on the growth rate of fingernails.

Autoradiographic and planimetric analyses of the inflammatory infiltrate in psoriatic lesions under PUVA-therapy.

The effects of oral 8-methoxypsoralen-photochemotherapy (PUVA-therapy) on the inflammatory infiltrate in 14 psoriatic skin lesions and on normal skin of 7 controls were investigated by means of autoradiography and planimetry. Under PUVA-therapy, one finds a significant decrease in dermal cells per millimeter lesion in psoriasis. Percentage of 3H-TdR-labeled dermal cells in the lesions and total number of dermal cells in the control group do not change significantly. The relative decrease of dermal cells per millimeter lesion in psoriasis is far less significant than the reduction of 3H-TdR-labeled epidermal cells under PUVA-therapy.

[Photoaugmentation. a photobiological phenomenon (author's transl)]. / Photoaugmentation. Ein photobiologisches Phänomen.

The phenomenon of photoaugmentation was investigated in 37 male and female patients. UVA, UVB and UVC was applied with a high intensity grafting monochromator. Photoaugmentation could be induced following UVA plus UVB immediately or dissociated up to 3 h, but not after 24 h (15 J/cm2 lambda 351 less than or equal to 389 nm [UVA] + 13 mJ/cm2 lambda 290 less than or equal to 310 nm [UVB] = 1/2 MED). Simarily the reversed application of UVB plus UVA lead to photoaugmentation. With UVA plus UVC, photoaugmentation could not be elicited in every patient. Moreover, photoaugmentation was demonstrated in albino rabbits using a new light apparatus with a liquid filled light conducting core. Photoaugmentation seems to be an important biological phenomenon in association with sunburn, pigmentation, photoxicity, phototherapy, photochemotherapy, and UV-light induced cutaneous premalignanacies and malignancies.