D. De Berker

A clinical study comparing methyl aminolevulinate photodynamic therapy and surgery in small superficial basal cell carcinoma (8-20 mm), with a 12-month follow-up.

Objective  To compare the efficacy and cosmetic outcome (CO) of photodynamic therapy with topical methyl aminolevulinate (MAL‐PDT) with simple excision surgery for superficial basal cell carcinoma (sBCC) over a 1‐year period.

Nail biology and nail science.

The nail plate is the permanent product of the nail matrix. Its normal appearance and growth depend on the integrity of several components: the surrounding tissues or perionychium and the bony phalanx that are contributing to the nail apparatus or nail unit.

Keratin expression in the normal nail unit: markers of regional differentiation

Differentiation within the nail unit was examined using a range of antikeratin monoclonal antibodies including the recently described antibody LHTric‐1, specific to the acidic hair‐type keratin Ha1. Keratinocytes of the nail matrix, nail bed and the digit pulp were characterized by different patterns of keratin expression. Nail matrix was the sole site of expression of Ha1, which colocalized in suprabasal matrix epidermis with epidermal keratins K1 and K10. Small amounts of K17 were found at the apex of the matrix in some cases. K6 and K16 were found where the epidermal surface folds forwards to become the ventral aspect of the proximal nail fold. The nail bed was distinguished by the absence of hair‐type keratin Ha1 and the absence of markers of cornified epidermis and mucosal differentiation K1/K10 and K4/K13, respectively, while K6, K16 and K17 were detected. The basal keratin conformation marker, LH6, was expressed suprabasally throughout the nail bed. This complement of keratins exists in the nail bed in the absence of notable proliferative activity, and suggests a state of minimally developed differentiation which may be afforded by the physical or biological properties of the overlying nail. Keratins, K6, K16 and K17 were all found in the digit pulp in limited amounts, possibly in association with the epidermal component of the eccrine duct. The simple epithelial keratins, K7, K8 and K18, were found in small amounts in the specimens from younger individuals, mainly in epibasal cells of the apex of the matrix and in putative Merkel cells.

Management of nail psoriasis

Nail psoriasis is often difficult to cure, but may respond to a range of different approaches used alone or together. As with treatment of psoriasis affecting skin, relapse is common and therapies may need to be maintained or repeated. The exact benefits of many of these treatments are not well documented in the literature. Basic nail care is important and topical therapies represent the main modality of treatment for the majority of cases. In severe nail disease, where there is a hypertrophic element, injection therapy with triamcinolone may be helpful. PUVA and other forms of radiation may be of benefit, but as with systemic therapy, they are usually useful in the context of treatment of psoriasis elsewhere on the body.

A multicentre, randomized, controlled study of the efficacy, safety and cost-effectiveness of a combination therapy with amorolfine nail lacquer and oral terbinafine compared with oral terbinafine alone for the treatment of onychomycosis with matrix involvement

Background  Onychomycosis is common, accounting for up to 50% of all nail disorders. Toenail onychomycosis can cause nail deformity, embarrassment, pain and walking difficulties. Some populations, such as individuals with diabetes, are at higher risk for developing secondary complications such as infections. Treatment takes many months and therapeutic choices can increase clinical effectiveness, lower toxicity and minimize healthcare costs.

Hair diagnoses and signs: the use of dermatoscopy.

Background.  Hair‐shaft examination is diagnostically useful in a range of adult and paediatric conditions.

Immunohistochemical staining for the differentiation of subungual keratoacanthoma from subungual squamous cell carcinoma.

Background.  Subungual keratotic tumours are rare. The clinical and histological distinctions between subungual keratoacanthomas (SUKAs) and subungual squamous cell carcinomas (SCCs) are important, but often difficult. Adequate methods of differentiation between the two are required, both for the purpose of management and for assessment of prognosis.

Clinical measurement of dimensions of basal cell carcinoma: effect of waiting for elective surgery

Fifty well‐defined basal cell carcinomas (BCCs) on the face, outside the central T, were studied to establish change in size between initial assessment and surgery. The major and minor diameters were measured at presentation and when the patients attended for elective excision 21–155 days later (mean 70). The median change in major diameter was an increase of 0·5 mm (range − 3 to + 4, P < 0·05). The median change in area was 4·71 mm2 (range − 54 to + 64, P < 0·05). Although there is a statistically significant increase in major diameter and area, it was small in clinical terms. The major axis increased by > 1 mm in 8% of cases. In no case was treatment or completeness of excision compromised by waiting. A mean delay of 10 weeks between review and surgery does not appear to compromise the outcome of treatment of BCC in patients with well‐defined BCCs of the face outside the central T.

The scleroatrophic syndrome of Huriez

We have examined 14 of 28 members of a four‐generation family. 10 of whom demonstrated the clinical features of the scleroatrophic syndrome of Huriez, a cancer‐prone dermatosis. Several members of this family demonstrated additional features, previously unrecorded in this syndrome, including poikiloderma‐like changes on the nose, flexion contractures of the little finger, a distinctive little finger nodule, and telangiectasia on the lips. Genetic linkage was excluded to distal chromosome 4q (LOD score ‐ 4.399 at θ= 0.001). This concurs with the recent reappraisal study of one of the two original families described by Huriez, in which no evidence of linkage between this syndrome and the MNSs erythrocytic system (mapped to 4q28‐q31) was found. This is the first report of a family from the U.K. with this syndrome.

Basal cell carcinoma follow-up practices by dermatologists: a national survey.

Background After treatment of a basal cell carcinoma (BCC) patients are at risk of recurrence of that BCC; also, patients who have had a primary BCC are those who have an increased risk of developing a subsequent primary BCC. However, long‐term hospital‐based follow‐up of all patients would put large strains on the U.K. health service.