Marshall A. Guill

Isotretinoin-basal cell carcinoma prevention trial: Design, recruitment results, and baseline characteristics of the trial participants

The Isotretinoin-Basal Cell Carcinoma Prevention Trial (ISO-BCC Study) is a double-masked, randomized, placebo controlled, multicenter clinical trial. It is the first intramural cancer chemoprevention trial sponsored by the Division of Cancer Prevention and Control of the National Cancer Institute. This trial was designed to evaluate the effectiveness of chronic administration of low dosage levels (10 mg) of a synthetic retinoid, isotretinoin, in reducing the incidence of basal cell carcinoma in a high-risk population and to determine the incidence and severity of side effects associated with this long-term treatment. Between 1984 and 1987, eight clinical centers enrolled 981 participants between the ages of 40 and 75, who had two or more biopsy proven basal cell carcinomas in the 5 years before trial entry. This article describes the trial design, recruitment results, and baseline characteristics of the participant population in the ISO-BCC Study.

Erythematous Plaques on the Eyelids

REPORT OF A CASEnA 21-year-old black man presented to the dermatology clinic with a complaint of redness and swelling of the lateral aspect of his right lower eyelid that progressed to the left lower eyelid. These symptoms were exacerbated by exposure to sunlight. Physical examination revealed erythematous plaques with areas of hair loss and scarring of the lower eyelids (Figs 1 and 2). Results of initial laboratory examinations were significant for the following: antinuclear antibody titer, 1:80 (in a speckled pattern), and a normal angiotensin-converting enzyme concentration. The chest roentgenogram was normal. A biopsy specimen of the right lower eyelid was obtained for routine histologic studies (Figs 3 and 4) and direct immunofluorescence (Fig 5). What is your diagnosis?nnnDIAGNOSISnDiscoid lupus erythematosus (DLE).nnnHISTOPATHOLOGIC FINDINGSnThe biopsy specimen of the right lower eyelid initially revealed mild-to-moderate chronic inflammatory changes with a patchy lymphohistiocytic infiltrate in a perivascular.

Brunsting-Perry pemphigoid simulating basal cell carcinoma†

The cases of three patients whose initial clinical presentations suggested superficial multicentric basal cell carcinoma are reported. Although routine histologic examinations were nonspecific, direct immunofluorescence studies showed immunoglobin and/or complement deposition patterns diagnostic of Brunsting-Perry variant pemphigoid. There is a wide spectrum of clinical presentation of Brunsting-Perry pemphigoid. In cases in which there is a minimum of blistering activity, the use of direct immunofluorescence is invaluable for definitive diagnosis.