Involution of keloid implants in athymic mice treated with pirfenidone or with triamcinolone.

The experimental drug pirfenidone (PFD) has been evaluated as an inhibitor of keloid proliferation and compared with triamcinolone (TAC) injections by studying the involution of active human keloid implants in athymic nude mice (nu-nu). PFD was fed to mice with keloid implants at a level of 2.75 mg/g of feed. At this level PFD had no adverse effect on the body weights of the mice. Implant weights in both PFD-fed and control mice decreased with time. The weights of the implants from the PFD group were significantly lower than those of the control implants at 60 and 90 days after implantation. Consequently PFD may cause an increased degradation and absorption of keloid tissue. The implants from the PFD mice were not significantly different histologically from the implants of the mice with corresponding implants. The chondroitin-4-sulfate (C4S) levels of the implants from PFD-fed mice were not significantly different from those of the implants from control mice. Therefore the mechanism of action of PFD apparently is not mediated by an effect on C4S metabolism. In contrast, the injections of TAC at a level that caused temporary body weight loss in the mice resulted in significant decreases in both hyaluronic acid (HA) and C4S in the keloid implants. Histologically, fibroblasts disappeared from the implants treated with TAC by 20 days after injection. At 30 days after TAC injection, HA and C4S were not detected by electrophoresis in keloid implants; only dermatan sulfate appeared to be present.

Unilateral atrophoderma of Pasini and Pierini.

Atrophoderma of Pasini and Pierini usually appears as isolated, round to oval depressed areas of otherwise normal-appearing skin. The clinical appearance has been likened to "footprints in the snow" or depressions with "cliff drop" borders. The condition is of unknown cause and most commonly occurs on the back, but it is occasionally seen elsewhere on the body. A literature search revealed only one previous report of unilateral atrophoderma of Pasini and Pierini.

Nonrepair of exposed frontal bone after Mohs' surgery for extensive basal cell carcinoma.

When it is necessary to expose frontal bone with or without periosteum after Mohs' surgery for extensive carcinomas of the forehead, simple wound care will allow granulations to cover the bone and healing will be complete. In situations where it is not advisable to cover exposed frontal bone with or without periosteum, simple care of the defects should allow complete healing.

Chemosurgery for familial malignant melanomas.

Three patients with numerous melanomatous lesions of the B-K mole syndrome are reported who were the first to be treated chemosurgically. The fixed-tissue chemosurgical technique provided a microscopically controlled, safe, effective, and conservative means of removing the melanomas. Atypical moles suspected of malignant change were removed by biopsy-excision.

Tendency of fluorouracil to conceal deep foci of invasive basal cell carcinoma.

Topical fluorouracil treatment of invasive basal cell carcinomas (BCC) is not recommended because it often produces the appearance of control with superficial inhibition of the tumor as the deeper extensions continue to grow, which results in a needless delay in obtaining effective treatment. These conclusions are based on data obtained during the microscopically controlled excision of 103 invasive BCCs of the face that had recurred after topical fluorouracil treatment.