J. Richard Taylor

Nonsurgical treatment of basal cell carcinomas with intralesional 5-fluorouracil/epinephrine injectable gel

BACKGROUND To develop a nonsurgical treatment alternative for basal cell carcinomas (BCCs), we evaluated intralesional sustained-release chemotherapy with 5-fluorouracil/epinephrine injectable gel (5-FU/epi gel). OBJECTIVE To optimize the dose and treatment schedule, we compared the safety, tolerance, and efficacy of six treatment regimens of 5-FU/epi gel in patients with BCCs. METHODS Two doses and four treatment schedules of 5-FU/epi gel were compared in an open-label, randomized study of 122 patients with biopsy-proven BCCs. One BCC per patient was treated for up to 4 to 6 weeks, then observed for 3 months at which time the tumor site was completely excised for histologic examination. RESULTS Overall, 91% of evaluable treated tumors (106 of 116) in all regimens had histologically confirmed complete tumor resolution. No clinically significant treatment-related systemic adverse events occurred. The best response rate, tolerance, and patient compliance with assigned dose were in patients receiving 0.5 ml of 5-FU/epi gel three times a week for 2 weeks. The complete response rate based on histologic assessment in this group was 100%. CONCLUSION Results demonstrate that treatment of BCC with 5-FU/epi gel is both safe and effective, may result in histologically confirmed complete response rates comparable to surgery, and provides a nonsurgical treatment alternative in selected patients.

Clinical diagnostic accuracy of basal cell carcinoma

The clinical diagnostic accuracy and index of suspicion of basal cell carcinoma were calculated. The data were compiled from dermatology residents, full-time dermatology university faculty, and dermatologists in private practice.

Epidermal ‘turnover time’—a new examination

A new model for assaying epidermal cell turnover times is presented. It is based on desquamation rates of the stratum corneum and the consequent obligatory turnover time of the keratinocyte layer. A total epidermal turnover time of 45 days is derived from the model for the human volar forearms.

Interrelationship between ultraviolet light and recurrent herpes simplex infections in man

In humans, epicutaneous application of a universally sensitizing dose (2000 micrograms) of dinitrochlorobenzene (DNCB) to skin exposed to 4 consecutive daily doses (144 mJ/cm2) of ultraviolet-B radiation (UVB) induces contact hypersensitivity (CH) in approximately 56% of normal, adult individuals (UVB-resistant--UVB-R), but not in the remaining 44% (UVB-susceptible--UVB-S). In patients with biopsy proven basal/squamous cell cancer, the frequency of the UVB-S trait exceeds 90%, indicating that this phenotype may be a risk factor for sunlight-induced skin cancer. Since many patients with recurrent herpes labialis complain that lip lesions are precipitated by acute sun exposure, we wondered whether the UVB-S trait might be associated with this recurrent disease. A group of 31 volunteers was selected, each with a history of numerous episodes of labialis secondary to reactivated herpes simplex virus-1 infection. Subjects were questioned carefully concerning factors, including sun exposure, thought to be important in precipitating lip lesions. Each individual was then subjected to the UVB plus DNCB protocol. When forearm skin of these individuals was assayed for CH after 30 days, 20 (65%) proved to be UVB-S (approximately 1.5 times the expected frequency), while the remainder displayed vigorous DNCB-specific CH. A strong history of sun-induced recurrent herpes simplex labialis did not predict the UVB phenotype. A subset of these subjects was exposed to 2 MEDs of UVB to their faces. None of the UVB-R subjects developed recurrent herpes labialis while 6 of 8 UVB-S subjects developed recurrent lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of methotrexate in vitro on epidermal cell proliferation

Epidermal cell migratory activity and epidermal cell proliferation are clearly dissociable in explant culture. Epidermal cell migration requires a non‐dialysable, 65,000 mol.wt factor which is destroyed at 100 C but is stable at 80 C for at least 30 min. In the presence of dialysed serum or heated serum (80° C for 30 min) or DNA synthesis inhibitors (methotrexate or hydroxyurea), cells will migrate from the explant but will not proliferate. At least two factors are required for normal proliferation under these restricted conditions—an adequate supply of DNA precursers, i.e. nucleosides, and a heat labile (80° C) non‐dialysable serum component.

Ultraviolet light treatment delays contact sensitization to nitrogen mustard

Contact sensitivity to nitrogen mustard was delayed after first treating patients with u.v. light. While the number of patients becoming sensitive to nitrogen mustard after ultraviolet light exposure was not significantly different from the control, the number of patients who became sensitive in the first 30 days was significantly less than the control group. It is postulated that this delay in sensitization is due to an alteration of the patients’ epidermal Langerhans cells, produced by the u.v. light exposure.

Squamous cell carcinoma in blacks with discoid lupus erythematosus

A case of squamous cell carcinoma (SCC) occurring in a black man with discoid lupus erythematosus (DLE) is described. From the literature, discoid lupus erythematosus seems to predispose blacks to squamous cell carcinoma of the skin which can metastasize. Exposure of unpigmented skin to the sun and other factors may be important.

Ciclopirox gel in the treatment of patients with interdigital tinea pedis

Background  Tinea pedis (athlete’s foot) is the most common fungal infection in the general population. Ciclopirox, a broad‐spectrum hydroxypyridone antifungal, has proven efficacy against the organisms commonly implicated in tinea pedis: Trichophyton rubrum, T. mentagrophytes and Epidermophyton floccosum.

Topical nitrogen mustard therapy in multicentric reticulohistiocytosis

The skin lesions of multicentric reticulohistiocytosis resolved with the daily application of 10 mg nitrogen mustard dissolved in 50 ml water.

A high SPF sunscreen's effects on UVB-induced immunosuppression of DNCB contact hypersensitivity

Several studies in mice of the protection afforded by sunscreens from UVB-induced suppression of contact hypersensitivity have yielded conflicting reports ranging from complete protection to no protection. Firstly, we sought to determine the effects of sunscreen and UVB on Langerhans cells; secondly we sought to determine whether the effect of preapplication of sunscreen with a sun protection factor of 30 could prevent local UVB-induced suppression of contact hypersensitivity to dinitrochlorobenzene in humans. In the first part of the study we compared a control group with a sunscreen plus UVB group and enumerated the number of Langerhans cells in each group. In the second part of the study we had four groups: a control group, a UVB group, a sunscreen group, and a sunscreen plus UVB group. Our results show that application of a sunscreen prior to UVB can prevent the decrease in number of Langerhans cells in an irradiated site. In the second part of the study, our results indicate that sunscreen, in itself, does not interfere with contact hypersensitivity, and that a high SPF sunscreen applied prior to UVB irradiation partially prevents suppression of contact hypersensitivity.