Critical review of controversial issues in the management of advanced pediatric liver tumors.

Hepatocellular carcinoma (HCC) and hepatoblastoma (HB) are the most common primary tumors of liver in children. The management of patients with locally advanced, unresectable disease or those with extra-hepatic distant metastases provides substantial challenges to pediatric oncologists, hepatologists, and surgeons. Herein, we critically debate the two sides of three specific controversies: (1) the role of chemotherapy in the treatment of advanced pediatric HCC; (2) the indications for liver transplantation in children with HCC, specifically, the appropriateness of using adult Milan criteria; and (3) the role of liver trasplantation in children with unresectable HB that present with metastatic disease. Pediatr Blood Cancer 2011;56:1013-1018. © 2010 Wiley-Liss, Inc.

Comparison of self-reported lifetime sun exposure with two methods of cutaneous microtopography.

There is currently no "gold standard" for measuring lifetime sun exposure. Exploration of alternatives to self-reports is important for examining illnesses related to ultraviolet light exposure. Using skin replicas obtained from 184 controls in a breast cancer case-control study (Toronto, Ontario, Canada, 2004-2005), the authors compared self-reported indicators of lifetime sun exposure with two measures of cutaneous microtopography, the Beagley-Gibson system and skin line counts. With the Beagley-Gibson system, significantly increased odds ratios were found for age (odds ratio (OR) = 1.10, 95% confidence interval (CI): 1.05, 1.16), spending 7 days outside per week during the summer (OR = 3.33, 95% CI: 1.48, 7.50), and lifetime number of sunlamp sessions. Significantly decreased odds ratios were found for having darker skin, ever giving birth, and ever using sunlamps. With the skin line count approach, significant positive associations were found for age (OR = 2.31, 95% CI: 1.23, 4.35), age squared, duration of working in outdoor jobs (OR = 0.88, 95% CI: 0.79, 0.98), and average number of outdoor activities per week at ages 20-29 years (OR = 1.05, 95% CI: 1.00, 1.10). While the Beagley-Gibson method was associated with more variables than the skin line count method, both methods require further refinement before graded skin replicas can be recommended as a substitute for self-report measures.