Excision of skin lesions. / Eksisjon av hudlesjoner.

Excision of skin lesions takes place regularly in general practice. The procedure is simple, but correct execution depends on a knowledge of skin anatomy and basic surgical principles. This article presents indications for excision of skin lesions and a recommended method based on clinical experience and relevant literature. The method can be used on both pigmented and non-pigmented lesions. Seborrheic keratoses are not discussed (1). The contents of the article apply to the primary health service.

[Mohs surgery in basal cell carcinoma on the face]. / Mohs' kirurgi ved basalcellekarsinom i ansiktet.

BACKGROUND: Basal cell carcinoma may have a locally aggressive growth pattern. This type of cancer is often located on the face and is difficult to limit clinically. Normal excision and tumour destructive treatment often lead to recurrence of the tumour. Mohs surgery is a radical technique for removing this type of lesion. MATERIAL AND METHOD: This review article is based on articles identified by searching in PubMed with the search words "Mohs surgery" and "basal cell carcinoma", as well as personal experience. RESULTS: 10-15 % of all basal cell carcinomas have an aggressive growth pattern with sub clinical ramifications. Mohs surgery involves use of peroperative histological assessment of horizontal frozen sections, meaning that 100 % of the resection surface can be assessed. The objective is to reduce the risk of recurrence. Since the method saves tissue, simpler reconstruction can often be chosen. Mohs surgery is resource-demanding, but with the lower risk of recurrence, the method can be cost-effective when used for the correct indications. INTERPRETATION: Mohs surgery should be considered in basal cell carcinoma with an aggressive growth pattern on the face.

Treatment with a barrier-strengthening moisturizer prevents relapse of hand-eczema. An open, randomized, prospective, parallel group study.

Hand eczema influences the quality of life. Management strategies include the use of moisturizers. In the present study the time to relapse of eczema during treatment with a barrier-strengthening moisturizer (5% urea) was compared with no treatment (no medical or non-medicated preparations) in 53 randomized patients with successfully treated hand eczema. The median time to relapse was 20 days in the moisturizer group compared with 2 days in the no treatment group (p = 0.04). Eczema relapsed in 90% of the patients within 26 weeks. No difference in severity was noted between the groups at relapse. Dermatology Life Quality Index (DLQI) increased significantly in both groups; from 4.7 to 7.1 in the moisturizer group and from 4.1 to 7.8 in the no treatment group (p < 0.01) at the time of relapse. Hence, the application of moisturizers seems to prolong the disease-free interval in patients with controlled hand eczema. Whether the data is applic-able to moisturizers without barrier-strengthening properties remains to be elucidated.

The combination of etanercept and methotrexate increases the effectiveness of treatment in active psoriasis despite inadequate effect of methotrexate therapy.

Many patients with moderate-to-severe plaque psoriasis do not respond adequately to methotrexate monotherapy. This pilot study, with a small patient population, was performed to evaluate the effectiveness and safety of etanercept and methotrexate combination in patients with plaque psoriasis and inadequate response to methotrexate. Outpatients with plaque psoriasis (Psoriasis Area and Severity Index > or = 8 and/or body surface area > 10%), despite methotrexate treatment (> or = 3 months; > or = 7.5 mg/week) were randomized to either etanercept with metho nottrexate tapered and discontinued (n = 28) or etanercept with continuous methotrexate (n = 31). Significantly more patients had a Physicians' Global Assessment of "clear"/"almost clear" in the combination group compared with etanercept/methotrexate taper (66.7 vs. 37.0%, respectively; p = 0.025). Adverse events were similar for both groups, with no cases of tuberculosis, malignancies or opportunistic infections reported. Addition of etanercept to methotrexate achieved significant improvement in psoriasis after 24 weeks.

Ruby laser treatment of congenital melanocytic naevi--a pessimistic view.

Congenital melanocytic naevi may be disfiguring and potentially malignant. Treatment with lasers is a relatively new option, and promising results have been published. Most studies include few patients, and describe the effect of different lasers and different techniques. The aim of this report is to evaluate the results of ruby laser treatment on facial congenital naevi in children. Fourteen children (age range 2-16 years) with medium-sized congenital naevi were included. All naevi had a facial distribution, and were considered unsuitable for surgical excision. Ten children (age range 2-5 years) were treated under general anaesthesia and 4 under local anaesthesia. Q-switched and normal mode ruby lasers were used in 12 children and normal mode only in 2. Treatments were performed at intervals of 2-20 months (median 3 months), and the number of treatments varied between 2 and 8 (median 3). The results were monitored by clinical photographs. None of the patients showed a satisfactory result. Based on these results, laser treatment with ruby laser in children with congenital naevi is not recommended outside of clinical studies. Laser treatment may have a malignant potential that in our opinion is not balanced by good clinical results.

Keratoacanthomas frequently show chromosomal aberrations as assessed by comparative genomic hybridization.

Keratoacanthomas are commonly occurring benign skin lesions localized to sun-exposed areas. They typically develop rapidly and may show cellular atypia and infiltration like cutaneous squamous cell carcinomas, but they finally regress spontaneously. This benign lesion shows a high degree of genetic instability as assessed by comparative genomic hybridization, with 35.7% (25 of 70) of the analyzed lesions harboring chromosomal aberrations. The same frequency of genetic imbalance was found in lesions from immunosuppressed organ transplant recipients (36.4%, 20 of 55) and in patients with keratoacanthomas without immunosuppression (33.3%, five of 15), indicating a common pathway in both situations. Recurrent aberrations, given as a fraction of lesions with aberrations, were gains on 8q (20.0%), 1p and 9q (each 16.0%), and deletions on 3p (20.0%), 9p (20.0%), 19p (20.0%), and 19q (16.0%). Many of the most frequently appearing aberrations in keratoacanthomas were not detected in any of the 10 squamous cell carcinomas analyzed, whereas some aberrations were shared by both types of lesions. Aberrations were found in early and late stages of keratoacanthoma development, indicating a role for genetic instability in the progression as well as involution of keratoacanthomas. There were no significant correlations between cytologic atypia and genetic imbalance, or between degree of infiltration and genetic aberrations, although there was a trend for keratoacanthomas with severe atypia to have aberrations. Thus malignant phenotypic development does not appear to be driven by the detected genetic aberrations. More detailed studies of chromosomal areas with recurrent aberrations are needed for the localization of putative genes that determine the biologic behavior of keratoacanthomas, and that may distinguish them from squamous cell carcinomas.