Kerstin Karte

Treatment of relapsing or recalcitrant cutaneous T-cell lymphoma with pegylated liposomal doxorubicin☆☆☆★

BACKGROUND Pegylated liposomes are stable, long-circulating carriers useful for delivering doxorubicin to tumor sites with a lower toxicity than the free drug. Free doxorubicin is used in several treatment protocols for non-Hodgkins lymphoma. Although pegylated liposomal doxorubicin is currently used in the treatment of Kaposis sarcoma, no data are available for tumors, such as primary cutaneous T-cell lymphomas (CTCLs). OBJECTIVE Our purpose was to determine the efficacy and toxicity of pegylated liposomal doxorubicin in patients with relapsing or recalcitrant CTCL. The cumulative dose was limited to 320 mg. METHODS A prospective pilot study was performed. Six patients (1 woman and 5 men) aged 59 to 78 years with relapsing or recalcitrant CTCL of the mycosis fungoides type, stage (Ib/IIb), were treated with pegylated liposomal doxorubicin to induce a clinical response. The drug was administered at a dosage of 20 mg m(-2) once a month. Four patients received 8 doses, and 2 patients received 6 doses. RESULTS The best response was a complete response in 4 patients and a partial response in 2 patients. The final outcome was a complete response in 4, a partial response in 1, and progressive disease in 1 patient (overall response rate, 83%). The responders showed a decrease of lymphocytic infiltrates and activated T lymphocytes in skin biopsy specimens. Side effects were seen temporarily, ranging from grade 0 to grade 3. The most frequent side effects were mild anemia and lymphopenia. There was no need of additional therapy because of side effects. CONCLUSION These results indicate that patients with relapsing or recalcitrant CTCL can achieve a high response rate with pegylated liposomal doxorubicin and that a monthly dose is a well-tolerated regimen.

Biosurgery in wound healing – the renaissance of maggot therapy

Chronic wounds are a challenge for modern health care. A basic principle of treatment is the removal of sloughy, necrotic, devitalized tissue to prevent wound infection and delayed healing. Biosurgery (syn. maggot or larval therapy) is a promising adjunct to the whole spectrum of topical treatment methods, in particular for debridement. The term ‘biosurgery’ describes the use of living maggots on wounds to remove devitalized tissue, decrease the risk of infection and improve wound healing. The present paper gives a brief review of history, entomology, biochemistry and medical indications of biosurgery and the practical handling of maggots. We also provide some clinical data from the literature and our own experience in a wound care unit. Biosurgery is an effective and safe treatment option for debridement and disinfection.

Calculation of nail plate and nail matrix parameters by 20 MHz ultrasound in healthy volunteers and patients with skin disease

Background/aims: The objective, but noninvasive, assessment of the nail plate and nail matrix is of interest in dermatology, and cosmetics as well. These cutaneous structures were investigated with 20 MHz ultrasound. This study was performed to obtain data on normal nails in adults of different age groups, with a left–right comparison, and to investigate nail changes in selected dermatologic diseases.

Serum protein S100β in patients with malignant melanoma detected by an immunoluminometric assay

Abstract S100 protein is well established as a diagnostic tool in malignant melanoma immunohistology. In this study we measured S100β in serum with a recently developed luminometric immunoassay with a detection limit of 0.02 μg/l. By measuring S-100β in a group of apparently healthy individuals a mean value of 0.031 ± 0.026 μg/l was found. In the reference group, serum S100β was below 0.12 μg/l in all cases. To assess the sensitivity of the assay we investigated serum S-100β levels in 371 serum samples of 315 patients with histological proven malignant melanoma at different disease stages. Staging was performed according to the German Society of Dermatology classification. Significant differences were observed between the control group and stages IIb (P = 0.01) and IV (P = 0.001). In tumour-bearing patients of stages IIIb and IV, the difference was highly significant (P < 0.0001). S100β > 0.20 μg/l helps to distinguish between tumour-free and tumour-bearing patients with a specificity of 97.0% and a sensitivity of 64.6%. Our results demonstrate the serum S100β is of limited value as a melanoma marker. However, it has clinical significance for identifying tumour-positive patients in advanced malignant melanoma stages III and IV.

Remittance spectroscopy mapping of human skin in vivo

Remittance spectroscopy of human skin may be influenced by probe application pressure and body site.

Soluble ICAM-1 seems to be related to prognosis in malignant melanoma.

To the Editor: Risk calculation in melanoma patients is based principally on clinical, histological and radio-/sonographic examinations. It would be extremely helpful if prognosis and response to therapy could be monitored by laboratory investigation of blood or serum samples. The intracellular adhesion molecule1 (ICAM1 ), an immunoglobulin-like molecule, is involved in cell-cell adhesion. This molecule is essential for certain immunologic functions including non-MHC-restricted cytotoxicity. Expression of ICAM1 has been associated with aggressive tumor growth and reduced host antitumor response. Shedding of ICAM-1 from melanoma cells may impair immune recognition and lead to tumor spreading [ 1-31. A positive con-elation of immunostaining for ICAM-1 and tumor thickness has been observed in surgically removed primary melanoma. These investigators also reported, that sICAM1 was significantly higher in patients with stage IV disease than in those with stages 1-111 [4]. Another report showed increased soluble (s)ICAM-1 levels in all subgroups of melanoma patients ( n = 34) vs. controls (n = 11) [ 5 ] . These findings disagree with those of a study by Kageshita et al. [6] on 75 patients with melanoma and 43 controls in there was no significant difference between the two groups. One problem with these studies is the limited number of patients involved. The debate continues whether or not SICAM-1 can contribute to disease monitoring and prognostic evaluation. In a large series in our Oncology Outpatient Depart; ment we investigated whether or not SICAM-1 was correlated to disease stage and prognosis in 930 serum samples of a series of 270 melanoma patients (sex ratio 116 femaled99 males; age range 22-84 years; mean age 56 years) in different clinical stages and 78 samples from 78 controls. All patients were staged by in-depth clinical examination, sonography, computer tomography, scintigraphy and diagnostic surgery were performed. All patients underwent the staging procedure as recommended by the German Society for Dermatology (DDG) [7]. SICAM-1 was measured by a sensitive enzyme-linked immunosorbent assay (R&D Germany, Wiesbaden). We calculated the normal range (mean t SD) for SICAM-1 (71.3-257.3 ng/ml; mean 163.3 ng/ml). Melanoma patients in general had a higher mean value of SICAM-1 than controls ( P < 0.00005). We calculated significant differences between SICAM1 levels in stages Ia vs. IIa ( P < 0.005), IIb (P < O.OOl), IIIb and IV ( P < 0.00005). There were significant differences in SICAM1 between stages Ib and IIa ( P < 0.002), IIb (P < 0.0005), IIIb and IV (P < 0.00005). Significant differences were also found between stages IIa and IV ( P < 0.00005) or IIb and stage IV (P < 0.002); Table 1 [8].

Serologische Tumormarker beim malignen Melanom

Both the epidemiological situation and the stage-dependent prognosis contribute to the importance of malignant melanoma for dermato-Oncology. The present review contributes to serological tumor marker analysis and the practical input in diagnostics and follow-up. The paper discusses superoxide dismutases (SOD), intercellular adhesion molecule-1 (ICAM-1), and S-100β, Among the SODs MnSOD and CuZnSOD are of interest, but data are available only for CuZnSOD in the human system. The enzyme does not show any correlation to either tumor stage or prognosis. ICAM-1 is detectable in all tumor stages with a relationship to prognosis. A major disadvantage of ICAM-1 is its non-specificity for melanoma. S-100β does not correspond to lower tumor stages, but the level markedly increases in stages III and IV (DDG), when a tumorload is evident. It shows a high specificity for tumor presence in advanced melanoma. Its diagnostic efficacy, however, is low compared to imaging techniques such as positron emission tomography (PET).

Biochirurgie in der Behandlung chronischer Wunden

Biosurgery for the Treatment of Chronic Lesions Chronic wounds are a challenge of modern health care. A basic principle of treatment is the debridement to remove devitalized tissue to prevent wound infection and support healing. Biosurgery (syn. maggot or larval therapy) is a promising adjunct to the whole spectrum of surgical and topical treatment methods. The present paper gives a brief review on history, entomology, biochemistry and medical indications of biosurgery and the practical handling of maggots.

POSTVACCINATION INFLAMMATORY PAPULES OF THE SKIN—THINK OF BACILLE CALMETTE-GUÉRIN (BCG)

Hickman PR, McBurney EI, Fitzgerald RL. CTCL in patients under 20 years of age: a series of five cases. Pediatr Dermatol 1997; 14:93-97. Price NM, Hoppe RT, Deneau DG. Ointment-based mechlorethamine treatment for mycosis fungoides. Cancer 1983;52:2214-2219. Mechlorethamine hydrochloride. In: McEvoy GK, ed. American hospital formulary service, drug information. Bethesda: American Society of Hospital Pharmacists,