George T. Reizner

Eccrine porocarcinoma of the face

Eccrine porocarcinoma is a rare tumor of the skin. We report a case on the chin that was successfully treated with Mohs surgery. In our review of the worlds literature 105 cases were compiled. The tumor most often occurs in the elderly and affects men more frequently than women. It may develop from a preexisting benign poroma and may also appear as a verrucous or nodular, ulcerative growth. Approximately 50% of the tumors occur on the lower extremities; the leg is the most common site. Microscopically the tumor demonstrates both intraepidermal and dermal invasion and is capable of forming satellite lesions and in-transit metastases when lymphatic vessels are invaded. The local recurrence and regional metastatic rates are both approximately 20%. Distant metastasis occurs in 12% of cases. The mortality rate is more than 65% when regional nodes are involved.

PUVA and skin cancer: A historical cohort study on 492 patients

BACKGROUND The safety of psoralen plus ultraviolet A (PUVA) light therapy has been an issue of debate. A few multiple-center cooperative studies have reported an increase of basal cell and squamous cell carcinomas among PUVA-treated patients. In our institute, more than 1000 patients have been treated with PUVA since 1975. OBJECTIVE We investigated the incidence of skin cancer among patients who received high doses of PUVA to see whether such incidence increased. METHODS This is a historical cohort study of two comparison groups of patients. Subjects under study were 492 psoriasis patients who received PUVA treatments between 1975 and 1989. One group of 103 patients, defined as the high-dose group, received an accumulated PUVA dose of 1000 joules/cm2 or more; another group of 389 patients, as the low-dose group, received 200 joules/cm2 or less. The occurrence of skin cancer in the two comparison groups is analyzed. RESULTS In the high-dose group we observed an increased number of patients with squamous cell carcinoma, keratoacanthoma, and actinic keratosis. We did not see any patients with genital cancer, melanoma, or an increased number of patients with basal cell carcinoma. CONCLUSION The risk of squamous cell carcinoma developing in patients who received a high dose of PUVA is confirmed. We speculate a combination of factors, including PUVA, may contribute to this risk.

Basal cell carcinoma in Kauai, Hawaii: The highest documented incidence in the United States

BACKGROUND In Kauai, Hawaii, we observed an exceedingly high incidence of basal cell carcinoma in an earlier 1-year study. OBJECTIVE Our purpose was to report the incidence of basal cell carcinoma in a defined population in Hawaii. METHODS A prospective 5-year population-based incidence study was conducted on Kauai, Hawaii, between 1983 and 1987 to investigate the frequency of basal cell carcinomas in Caucasian residents. A total of 242 residents, 161 men and 81 women, were identified with an initial episode of basal cell carcinoma during the 5-year period. RESULTS The average annual incidence per 100,000 Kauai Caucasian residents standardized to the 1980 U.S. white population was 576 for men and 298 for women with a combined incidence of 422. The average patient age was 56.5 years, and men had a significantly higher incidence of cancer than women (p < 0.000001). The head and neck was the most common site. The trunk was the second most common site, representing one third of lesions. Subsequent new basal cell carcinomas occurred in 16.9% of patients. Only 3.3% of patients had recurrent carcinomas after treatment. CONCLUSION Kauais incidence rates of basal cell carcinoma are the highest yet documented in the United States. As an unexpected finding, a decreasing incidence trend was noted in the studys later years and may warrant further investigation. Finally, a significant number of basal cell carcinomas developed on the trunk, suggesting and reinforcing the expectation that sun exposure is not limited to the face and neck in this Hawaiian population.

Bowen's disease (squamous cell carcinoma in situ) in Kauai, Hawaii: A population-based incidence report

BACKGROUND The incidence of Bowens disease (squamous cell carcinoma in situ) is rarely investigated. OBJECTIVE Our purpose was to report the incidence of Bowens disease in a defined Caucasian population in Kauai, Hawaii. METHODS We conducted a prospective 5-year population study. RESULTS We found 71 Caucasian residents, 44 men and 27 women, who had an initial episode of Bowens disease during the 5-year period. The average annual incidence rate per 100,000 Caucasian residents of Kauai, standardized to the 1980 U.S. Caucasian population, was 174 for men and 115 for women, with a combined rate of 142. The incidence increased in older age groups. The mean age of the patients was 65.2 years. The most common anatomic site was the extremities. Subsequent Bowens disease occurred in eight patients (11.3%). Recurrence after treatment developed in only one patient (1.4%). Twenty-six patients (36.6%) had concurrent skin cancers, either basal cell carcinoma or squamous cell carcinoma, or both. There was no increased incidence of internal malignancy. CONCLUSION The incidence of Bowens disease is high in Caucasian residents of Kauai and is 10 times higher than that reported from a northern Midwestern community. Kauais intense ambient UV light and greater opportunity for year-round outdoor activities likely contributes to this higher rate.

Nonmelanoma skin cancer in Japanese ethnic Hawaiians in Kauai, Hawaii: An incidence report

BACKGROUND Incidence reports of nonmelanoma skin cancer (NMSC) in Japanese persons are limited. Most studies have relied primarily on hospital records or voluntary reporting systems. OBJECTIVE Our purpose was to determine the incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and Bowens disease (BD) in a defined Japanese population. METHODS A prospective 5-year population-based incidence study was conducted on the island of Kauai, Hawaii from 1983 through 1987. RESULTS Thirty Japanese Kauai residents, 12 men and 18 women, developed BCC during the 5-year study period. At the same time, 24 Japanese, 6 men and 18 women, were identified with SCC, and 11 had BD, three men and eight women. When standardized to the Japanese population in Japan, the annual BCC incidence rate was 30 per 100,000 Japanese Kauai residents with an average patient age of 75 years. More than 80% of these BCCs were localized to the head and neck. New BCCs developed in four patients with BCC, but none was a recurrence of a previously treated lesion. Five patients with BCC had SCC or BD concurrently or at other times. The SCC incidence was 23 per 100,000 Japanese Kauai residents with an average patient age of 80 years. The head and neck were again the most common anatomic sites. New SCCs subsequently occurred in two patients, in one of whom a localized recurrence also developed. Five patients with SCC had BCC simultaneously or at other times. The incidence of BD was 13 per 100,000 Japanese Kauai residents with an average patient age of 74 years. The extremities were the most common anatomic sites. One patient later had a new BD lesion and a recurrent BD lesion. Two patients had BCC or SCC at other times. CONCLUSION We report incidence rates of BCC, SCC, and BD at least 45 times higher in the Japanese population in Kauai, Hawaii than rates for the Japanese population in Japan. Kauais intense UV radiation and emphasis on outdoor activities may contribute. More Japanese women had NMSC than men, a sex difference not observed in Japan.

Comparative efficacy of oral erythromycin versus oral tetracycline in the treatment of acne vulgaris. A double-blind study.

The efficacy of erythromycin base (E-Mycin tablets, 333 mg) and the efficacy of tetracycline hydrochloride (Panmycin tablets) were compared in this double-blind, randomized study. Two hundred patients with moderate to moderately severe acne vulgaris were randomly assigned to the study. One hundred patients received 1 gm of erythromycin base by mouth per day for 4 weeks, followed by 333 mg/day for 8 weeks, plus placebo for tetracycline. The second group of patients received 1 gm of tetracycline by mouth per day for 4 weeks, followed by 500 mg/day for 8 weeks, plus placebo for erythromycin. Both drugs reduced acne severity to the same extent. Pustules, papules, and open comedo counts decreased significantly over the 12-week period. Seventy-seven percent of the erythromycin-treated patients and 89% of the tetracycline-treated patients stated that their acne was markedly improved or improved by week 12. Most of the side effects in patients treated with erythromycin were gastrointestinal symptoms. Among the side effects in patients treated with tetracycline were Candida vaginitis in one patient and pseudotumor cerebri in one patient.

Hyperpigmentation, neutrophilic alveolitis, and erythema nodosum resulting from minocycline

Hyperpigmentation, pulmonary infiltration, and erythema nodosum occurred in a patient receiving long-term minocycline therapy. Bronchoalveolar lavage revealed both a neutrophilic and an eosinophilic alveolitis. The pulmonary and systemic symptoms promptly resolved after discontinuation of minocycline.

Bowen's disease and internal malignancy: A matched case-control study†

Bowens disease has been reported as a skin marker for internal malignancy. We conducted a matched case-control study to evaluate the significance of this link. Fifty white men with Bowens disease diagnosed between 1977 and 1986 at a Veterans Administration Hospital were selected for study. These patients were matched by age, sex, race, and date of skin biopsy to 50 patients with basal cell carcinoma (control group 1) and another 50 patients with other dermatoses (control group 2). The original 50 patients with Bowens disease include 12 (24%) with various internal malignancies. In comparison, nine patients (18%) in control group 1 and seven patients (14%) in control group 2 had internal malignancies. These numbers do not substantiate a statistically significant increase in the frequency of internal malignancies in Bowens disease. We therefore conclude that Bowens disease is not a skin marker for internal malignancy in elderly white men.

Nonmelanoma skin cancer in Japanese residents of Kauai, Hawaii

A prospective 3-year survey of nonmelanoma skin cancer in Japanese-American residents of the Hawaiian island of Kauai was conducted beginning in January 1983. The crude rate for basal cell and squamous cell carcinoma was 123/100,000, 88 times higher than the corresponding figure from Japan. This discrepancy may be attributed to an increase in ultraviolet exposure due to lifestyle and latitude, but arsenic exposure may also have played a role. Nonmelanoma skin cancer in Japanese in Hawaii appears to be a significant problem that has not been appreciated because these malignancies are not reportable to tumor registries.

Non-melanoma skin cancer and keratoacanthoma in Filipinos : an incidence report from Kauai, Hawaii

Background. Non‐melanoma skin cancer is the most common malignancy in the white population of the United States with an estimated 700,000 new cases each year. Regrettably, data on minority racial groups are either scarce or lacking entirely.