Clinical and histological evaluation of 1% nadifloxacin cream in the treatment of acne vulgaris in Korean patients

Objectives Nadifloxacin is a fluoroquinolone with broad‐spectrum antibacterial activity. Although it is used as an acne treatment in some European countries, it has not been used to treat Korean acne patients. We aimed to evaluate the clinical efficacy and safety of 1% nadifloxacin cream and the histological changes it incurs when used to treat mild to moderate facial acne in Korean patients. Methods An eight‐week, randomized, prospective, split‐face, double‐blind, vehicle‐controlled trial was performed. All participants were treated with 1% nadifloxacin cream on one‐half of the face and vehicle cream on the other, twice per day for eight weeks. Results At final visits, inflammatory acne lesions were reduced by 70% on nadifloxacin‐treated skin and increased by 13.5% on vehicle‐treated skin; non‐inflammatory acne lesions showed reductions of 48.1 and 10.1%, respectively. A significant difference was observed between the two treatments at four weeks. Histopathological examinations of the acne lesions showed decreased inflammation and interleukin‐8 expression but no change in transforming growth factor‐β expression in nadifloxacin‐treated skin compared with vehicle‐treated skin after eight weeks of treatment. Conclusions Nadifloxacin 1% cream is an effective, safe, and well‐tolerated topical treatment for Korean patients with mild to moderate acne vulgaris. Histopathological changes after nadifloxacin treatment were well correlated with clinical outcomes. Therefore, nadifloxacin can be used as an effective and safe treatment option in the management of mild to moderate acne in Asian subjects.     

A Case of Axillary Adenoid Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common skin cancer with a steadily increasing incidence. Ultraviolet radiation is considered the single most important risk factor for BCC, because the tumor occurs most frequently in sun-exposed areas of the body, with approximately four of five BCCs occurring on the face. BCC occurs infrequently in non-sun-exposed skin. The axilla is one of the most sun-protected areas of the body, and BCC arising at this site is very rare. We herein report a case of adenoid BCC which arose from the axilla in a 33-year-old woman.     

Treatment of acquired bilateral nevus of Ota‐like macules (Hori's nevus) using 1064‐nm Q‐switched Nd:YAG laser with low fluence

Background Acquired bilateral nevus of Ota‐like macules (ABNOM), or Hori's nevus, is a common dermal melanocytic hyperpigmentation in Asians. Aim To describe the effect of 1064‐nm Q‐switched Nd:YAG laser (QSNY) with low fluence in South Korean patients with ABNOM. Methods Fifteen South Korean patients (13 women and two men; mean age, 33.2 years; range, 26–52 years; Fitzpatrick skin type IV), clinically diagnosed with ABNOM, and treated using 1064‐nm QSNY with low fluence, were enrolled in this study. Patients were treated with 1064‐nm QSNY using a MedLite C6? (HoyaConBio Inc., Fremont, CA, USA) at 1–2‐week intervals. The laser settings were 2.2–2.6 J/cm² using a 6‐mm spot size, followed by 4–6 J/cm² using a 4‐mm spot size. Results The median number of QSNY treatment sessions was 11 (range, 10–15). Follow‐up results 2 months after the final treatment revealed that seven of the 15 patients (46.7%) demonstrated clinical improvement of 76–100%, and five (33.3%) of 51–75%. Three patients showed moderate clinical improvement between 26% and 50%. Post‐therapy dyschromia, including hypo‐ and hyperpigmentation, was not observed. Conclusion We suggest that QSNY with low fluence provides an easy‐to‐perform, low‐downtime, effective treatment algorithm in certain cases of ABNOM in Asian patients.     

A multicenter study on extramammary Paget's disease in Korea

Background There has been little research on extramammary Paget’s disease (EMPD) conducted in Asia. Methods The aim of this multicenter study was to investigate the clinicopathological features, biological behavior, and treatment of EMPD in 194 Korean patients over a five‐year period. Results As expected, this disease exhibited a male dominance (3.9:1) pattern. To distinguish the true association of malignancy with EMPD from coincidental occurrence of malignancy, we modified Chanda’s guidelines. This analysis determined that there was an accompanying malignancy in 26 patients (14.4%), which included stomach (six cases), rectum (three cases), and colon (three cases) malignancies. With regard to treatment, 112 patients (58%) underwent conventional excisions, and 22 (11.4%) had Mohs surgery. Follow‐up data for periods of 3–180 months were available for 147 patients; these data indicated that 42 patients (28.6%) experienced local recurrences. Patients who underwent Mohs micrographic surgery experienced a lower rate of recurrence (12.5%) than patients who underwent conventional excision (33.3%). Conclusions In summary, this Korean population‐based study demonstrated that the clinical features of EMPD, such as gender predominance, are consistent with reports from other Asian population‐based studies. However, this study additionally demonstrated that the rate of association with malignancy in the Korean population (14.4%) was higher than that observed in other Asian studies.     

Topical methyl aminolaevulinate photodynamic therapy in patients with basal cell carcinoma prone to complications and poor cosmetic outcome with conventional treatment

Background Conventional treatment of basal cell carcinoma (BCC) causes morbidity and/or disfigurement in some patients because of the location (e.g. mid‐face) and size of the lesion. Objectives Following reports that such difficult‐to‐treat BCC lesions have been treated successfully with topical methyl aminolaevulinate (MAL) photodynamic therapy (PDT), a multicentre study was performed to determine the response of such BCC to MAL‐PDT. Methods An open, uncontrolled, prospective, multicentre study was conducted comprising patients with superficial and/or nodular BCC who were at risk of complications, poor cosmetic outcome, disfigurement and/or recurrence using conventional therapy. Patients were given one or two cycles within 3 months of topical MAL‐PDT, each consisting of two treatments 1 week apart. Tumour response was assessed clinically at 3 months after the last PDT, with histological confirmation of all lesions in clinical remission. The cosmetic outcome was rated. Patients with a BCC in remission will be followed up for 5 years for recurrence, of which the 24‐month follow‐up is reported here. Ninety‐four patients with 123 lesions were enrolled and treated with MAL‐PDT at nine European primary care and referral university hospitals. An independent blinded study review board (SRB) retrospectively excluded nine patients and a total of 15 lesions from the efficacy analysis, for not having a difficult‐to‐treat BCC according to the protocol. Results The lesion remission rate at 3 months was 92% (45 of 49) for superficial BCC, 87% (45 of 52) for nodular BCC, and 57% (four of seven) for mixed BCC, as assessed by clinical examination, and 85% (40 of 47), 75% (38 of 51), and 43% (three of seven), respectively, as assessed by histological examination and verified by the SRB. At 24 months after treatment, the overall lesion recurrence rate was 18% (12 of 66). The cosmetic outcome was graded as excellent or good by the investigators in 76% of the cases after 3 months follow‐up, rising to 85% at 12 months follow‐up, and 94% at 24 months follow‐up. Conclusions Topical MAL‐PDT is effective in treating BCC at risk of complications and poor cosmetic outcome using conventional therapy. MAL‐PDT preserves the skin and shows favourable cosmetic results.     

Axillary basal cell carcinoma: case report and literature review

Axillary basal cell carcinoma (BCC) has been rarely reported. The axilla is a site that is less likely to be monitored by the patient, thus there is a potential for delay in diagnosis and treatment. Surgical excision is the most widely used treatment method for its effectiveness, simplicity and histologic control. BCC is easily treated when it is detected early. There are 33 cases of axillary BCCs reported in the literature, and only one case has been reported in Asia. Herein we report on the second case of primary axillary BCC in an Asian female.     

Pigmentation in basal cell carcinoma involves enhanced endothelin-1 expression

Basal cell carcinoma (BCC) is the most prevalent malignant skin tumor. In Asian patients, marked pigmentation in BCC lesions is often observed. Recently, endothelins (ETs) have been implicated to participate in the pigmentation process of BCC. Therefore, we set out to investigate the involvement of ET in the pigmentation process of BCC and the potential regulators in the pigmentation pathway. We explored the effects of an established BCC cell line on melanocytes. The growth factor profiles of BCC culture supernatant and effects of supernatant on melanocytes were documented. Potential regulators involved in the pigmentation pathway were also studied. The immunohistochemical staining of pigmented and non-pigmented BCC specimens was performed to confirm our in vitro findings. Our results showed that BCC supernatant contained significant amount of ET-1, basic fibroblast growth factor, and nerve growth factor. Furthermore, BCC supernatant stimulated melanin formation of cultured melanocytes. Addition of ET-receptor antagonist abrogated the melanogenic effect of BCC supernatant on melanocytes. Introduction of UVB irradiation decreased the ET-1 secretion by BCC cells. Immunohistochemical staining of the pigmented facial BCC specimens showed prominent expression of ET-1 on pigmented BCC, while the non-pigmented facial BCC specimens showed little ET-1 reactivity. Tumor necrosis factor-alpha (TNF-alpha) staining showed little expression on BCC specimens, regardless of pigmentation status. In summary, our results indicate that enhanced ET-1 expression in pigmented BCC plays an important role in the hyperpigmentation of this tumor. Moreover, this enhanced ET-1 cascade showed little correlation with UV irradiation and TNF-alpha expression in our study.     

Cumulative risks and rates of subsequent basal cell carcinomas in the Netherlands

Background The incidence of multiple basal cell carcinomas (BCCs) is not well documented. Objectives To calculate the cumulative risks, rates and risk factors for the development of subsequent histologically confirmed BCCs. Methods For this cohort study the Dutch nationwide network and registry of histopathology and cytopathology (PALGA) was used. The first 2483 patients diagnosed with a first histologically confirmed BCC in the year 2004 were followed for 5 years. Multifailure survival models were used to study whether gender or age affected the risk of developing subsequent tumours. Results During our observational period, the 2483 patients developed a total of 3793 histologically confirmed BCCs. The 5‐year cumulative risk of developing one or more subsequent BCCs was 29·2%. Incidence rates were 25 318 per 100 000 person‐years in the first 6 months after first BCC diagnosis, decreasing to 6953 per 100 000 person‐years after 5 years of follow‐up. Males compared with females had a 30% [adjusted hazard ratio (HR) 1·30, 95% CI (confidence interval) 1·11–1·53] higher risk of developing multiple BCCs and those aged 65–79 years had more than 80% (adjusted HR 1·81, 95% CI 1·37–2·41) higher risk of having subsequent tumours compared with patients younger than 50 years. Conclusions The high incidence rate of subsequent BCCs among patients with a first BCC is highest in the first months after diagnosis of the first BCC but persists long term, indicating that patients with BCC should undergo full‐body skin examinations at first presentation and subsequent follow‐up visits. Special attention should be paid to males and persons of older age at index lesion.     

Mohs' micrographic surgery for treatment of basal cell carcinoma of the face--results of a retrospective study and review of the literature

BACKGROUND: The incidence of skin cancer and especially basal cell carcinoma (BCC) has increased in the last decade and is still increasing. Many treatment modalities can be used to treat BCC; surgical excision is the most frequently used. Mohs' micrographic surgery (MMS) is an advanced excision technique which is often used to treat BCC in the U.S.A. In Europe it is practised less frequently. OBJECTIVE: The aim of this article was to evaluate the efficiency of MMS for the treatment of facial BCC. METHODS: In a retrospective study recurrence rates after the treatment of facial BCC by MMS were estimated by reviewing the records of all patients with BCCs (620 patients with 720 BCCs) treated by MMS in our department from April 1992 until December 1999. RESULTS: The 5-year recurrence rates estimated from this study were 3.2% for primary BCC and 6.7% for recurrent BCC. Prognostic factors for recurrence are: an aggressive histopathological subtype, more than four Mohs' stages, a large defect size and a recurrent BCC. CONCLUSION: Based on the fact that MMS provides the lowest recurrence rates, it is the treatment of first choice for primary facial BCCs with an aggressive histopathological subtype and for recurrent BCCs in the face.     

Basal cell carcinoma in a series of renal transplant recipients: epidemiology and clinicopathologic features

Background Basal cell carcinoma (BCC) is the most common malignancy among Caucasians worldwide. The risk of BCC is 10–16 times higher among immunosuppressed transplant recipients compared with the general population. Objective To analyze the incidence, clinical presentation, histologic features, treatment and recurrence rate of BCC in a cohort of 69 renal transplant recipients (RTRs; 53 male). Methods Retrospective population‐based cohort study of immunosuppressed RTRs. Results Ten of 69 patients (14.5%, five male) developed a total of 17 BCCs, mostly on the head. Mean age at first diagnosis of BCC was 65.5 ± 8.5 years, and latency between kidney transplantation and diagnosis of the first BCC was 11.1 ± 6.3 years (mean ± SD). The risk of female RTRs to develop BCCs appeared to be three times higher than the risk of male RTRs, and female RTRs developed BCCs earlier after transplantation. Nodular BCC was the most common histologic subtype. Most BCCs in these RTRs were treated by complete surgical excision. Recurrence after surgical excision was observed in one of the 10 patients (10%). Conclusion Our results suggest female RTRs to be at higher risk to develop cutaneous BCCs than male RTRs. There are no differences in localization and clinicopathologic presentation of BCCs developing in RTRs compared with immunocompetent patients. Therefore, BCCs in RTRs do not require different treatment than in other patient groups. As patients tend to develop a second BCC, close follow‐up is mandatory.     

Clinical features of Korean patients with rhinophyma

Rhinophyma results from hyperplasia of the sebaceous glands and connective tissue. Clinical features in Asian rhinophyma patients are largely underreported. In this study, we aimed to evaluate the clinical features of rhinophyma in Korean patients. We reviewed clinical photos and medical records of 39 Korean patients diagnosed with rhinophyma and assessed the severity and clinical course by using the classical National Rosacea Society index. The male : female ratio was 6.8:1, and over 90% of the patients were older than 40 years. The mild‐grade rhinophyma was the most dominant (46.1%), followed by the moderate (41.0%) and severe (12.8%) grades. Disease progression to severe grade occurred over an average of 8.2 years. Furthermore, 70% of all cases revealed lesion distribution limited to the nose. As disease severity progressed to higher grades, the extent of nasal involvement increased (Pearson correlation coefficient, 0.685). Rhinophyma is a slowly progressing disease showing male predominance unrelated to specific trigger factors. In many cases, this disease often exclusively affects the nose in Asian patients.     

Do tutorials on application method enhance adapalene–benzoyl peroxide combination gel tolerability in the treatment of acne?

Fixed‐dose combination adapalene 0.1% and benzoyl peroxide 2.5% gel (A‐BPO) has rarely been studied for Asian acne patients, while they have complained of local irritations more often when applying individual components. In this study, we compared A‐BPO gel with benzoyl peroxide (BPO) in terms of efficacy and tolerability in Korean patients first, and assessed the clinical benefit of a dermatological tutorial on application technique in reducing irritations for A‐BPO. This study was conducted as a single‐blind controlled split‐face trial for a 12‐week period. Each half facial side of 85 patients was randomly assigned to either A‐BPO or BPO. Success rate, lesion counts and safety profiles were evaluated (analysis I). During initial assignment, all patients were further randomized to either dermatological tutorial (DT) or non‐tutorial (NT) subgroups depending on the presence of dermatologists' tutorials for application methods to their A‐BPO sides. Clinical data of the A‐BPO side was compared between two subgroups (analysis II). As a result, A‐BPO gel outperformed BPO, demonstrating better efficacy in success rates and lesion counts as early as 1 week. However, A‐BPO proved significantly less tolerable compared with both BPO and previous A‐BPO data from Caucasians. Bioengineering measurements further confirmed clinical data (analysis I). The DT subgroup achieved much better tolerability with comparable therapeutic efficacies compared with the NT subgroup (analysis II). In conclusion, A‐BPO demonstrated higher efficacies in acne compared with BPO in Korean patients, while skin irritation levels were notable concurrently. Dermatologists' education for application methods would significantly decrease these side‐effects, maintaining superior efficacy levels.     

Ex vivo high‐definition optical coherence tomography of basal cell carcinoma compared to frozen‐section histology in micrographic surgery: a pilot study

Background Micrographic surgery is an established, but time‐consuming operating procedure for facial basal cell carcinoma (BCC). A new high‐definition (HD) optical coherence tomography (OCT) with high lateral and axial resolution in a horizontal (en‐face) and vertical (slice) imaging mode allows a fast and non‐invasive in vivo examination of BCC. Objectives To compare the diagnosis of BCC in excised tissue ex vivo by high‐definition optical coherence tomography (HD‐OCT) with the findings of frozen‐section histology in micrographic surgery. Methods Twenty freshly excised BCC were examined by HD‐OCT in the en‐face and slice imaging mode divided into four sections each in concordance with the four excision margins of histography, and subsequently processed for conventional micrographic evaluation. Results A total of 80 HD‐OCT images of 20 BCCs were evaluated and in 45% (9/20) HD‐OCT correlated perfectly with the histography results. The sensitivity and specificity for the 80 evaluated HD‐OCT images were 74% and 64% respectively. Conclusions High‐definition optical coherence tomography allows the postoperative identification of BCC in excised tissue ex vivo, but has still limitations in the recognition of tumour margins in comparison with the micrographic evaluation of frozen sections.     

Clinical Features of Cutaneous Premalignant Lesions in Busan City and the Eastern Gyeongnam Province,Korea: A Retrospective Review of 1,292 Cases over 19 Years (1995~2013)

BackgroundThe global prevalence of premalignant lesions has been continuously increasing in recent years, but there has been little research regarding the distribution and incidence of cutaneous premalignant lesions in Korean populations.ObjectiveWe conducted this retrospective study to analyze recent trends in the incidence and clinical patterns of cutaneous premalignant lesions in the Korean population.MethodsWe reviewed 1,292 cases (3,651 lesions) of patients with cutaneous premalignant lesions, including actinic keratosis (AK) and Bowen''s disease (BD), from the Department of Dermatology at Dong-A University Hospital (January 1995 to December 2013).ResultsThe average cutaneous premalignant lesion annual incidence was 1.82%, and the incidence continuously increased from 0.70% to 4.25% over the study period. The most common cutaneous premalignant lesion was AK (75.85%), followed by BD (24.15%). The mean age of onset was 68.76 years (men, 70.89 years; women, 65.56 years), and the male:female ratio of patients was 1:1.52. Major skin cancers, including squamous cell carcinoma (SCC, 8.90%), basal cell carcinoma (BCC, 6.42%), and malignant melanoma (MM, 0.70%), were detected in 15.79% of patients with cutaneous premalignant lesions. Three patients (0.23%) were previously diagnosed with both SCC and BCC. In addition, 59.13% of patients had a single lesion, while 40.87% had multiple lesions. Patient age, history of previous skin cancers, and occupation-related exposure to ultraviolet radiation were more common in patients with multiple lesions.ConclusionCutaneous premalignant lesion incidence has gradually increased in the Korean population.     

Basal cell carcinoma in Turkey

Basal cell carcinoma (BCC) is the most common form of cancer in Caucasians. This study was undertaken to define clinical features of BCC treated by surgical excision in Turkish patients. One-hundred and ninety-eight patients with 216 BCC, all treated by surgical excision, were studied prospectively. Age and sex distribution, personal and family history, skin type, site and size of the lesions, clinical type of the lesions, status of surgical margins and incidence of recurrence were analyzed. The male to female ratio was 9:10, and the average age of the patients was 64.5 years. Of the tumors, 91.5% occurred on the head and neck. There was also personal and/or family history of cancer in 24.8% of our cases. Of all BCC treated, 83.8% had a noduloulcerative clinical appearance. The vast majority of our patients were Fitzpatrick type 3 (53.0%) and type 2 (41.5%). There were seven recurrences after follow-up periods varying between 3 months and 2 years. In conclusion, clinical characteristics of BCC in Turkish patients have both similarities and differences compared with other countries.     

Topical niacin cream‐assisted 595‐nm pulsed‐dye laser treatment for facial flushing: retrospective analysis of 25 Korean patients

Background Flushing is defined clinically as a transient reddening of the face and other areas. Due to the transient nature of flushing, a patient may not show signs of flushing during laser treatment. Objective The aim of this study was to evaluate the efficacy and safety of 595‐nm pulsed‐dye laser treatment of flushing or erythema after provocation of flushing by topical niacin cream. Methods We retrospectively reviewed a total of 25 Korean patients with facial flushing who were treated with three sessions of 595‐nm pulsed‐dye laser after the application of topical niacin cream. Results Follow‐up results revealed that 12 of the 25 patients demonstrated marked (51–75%) clinical improvement of baseline facial erythema. Eight patients had moderate (26–50%) improvement and three demonstrated near total (≥75%) improvement. Two patients showed minimal to no (0–25%) improvement. We observed that the reactivity to topical niacin cream was markedly reduced in 64% of our patients after 595‐nm pulsed‐dye laser treatments. Minimal post‐therapy facial oedema was noted in most of the patients, which usually resolved spontaneously within 2 days. Pronounced facial swelling was observed in four patients. Conclusion We suggest that 595‐nm pulsed‐dye laser treatment after provocation of flushing by topical niacin cream may provide a new treatment algorithm for facial flushing in Asians.     

Basal cell carcinoma of the vulva: treatment with Mohs micrographic surgery

Vulval basal cell carcinomas (BCCs) are rare, representing < 5% of vulval malignancies and 1% of all BCCs. They often present with nonspecific symptoms and features that lead to large, poorly circumscribed and late‐presenting lesions. Current and conventional treatments used to treat vulval BCC include cryotherapy, imiquimod and excision. However, recurrence rates as high as 20% have been reported with these treatments. Furthermore, there are no current clinical guidelines for their management. We present the first reported series of patients with vulval BCC treated with Mohs micrographic surgery (MMS). We report seven cases of vulval BCC treated with MMS at a tertiary referral centre over 3 years. Follow‐up was performed at 3 months and up to 3 years. Our series demonstrates that there were no postoperative complications, functional sequelae or recurrences up to the 3‐year follow‐up. We therefore recommend that MMS should be considered in the management of vulval BCCs.     

Unique features of PTCH1 mutation spectrum in Chinese sporadic basal cell carcinoma

Background Alterations of the PTCH1 gene have been found to contribute to both familial and sporadic basal cell carcinoma (BCC), especially in Caucasian patients. Furthermore, the majority of PTCH1 gene mutations in sporadic BCCs in Caucasian patients carry ultraviolet (UV) signatures, suggesting the key role of UV light in BCC development. However, sporadic BCC in non‐Caucasian population has a lower incidence, and the pathogenesis remains largely unknown. To date, there has been no mutation analysis on PTCH1 gene in Chinese patients with sporadic BCCs. Objective To investigate genetic alterations of the PTCH1 gene in Chinese sporadic BCCs. Methods Direct sequencing was used to screen for mutations in PTCH1 in 31 microdissected samples in Chinese sporadic BCCs. In addition, single nucleotide polymorphisms (SNPs) were studied for loss of heterozygosity (LOH). Results Nineteen PTCH1 mutations in 17 of the 31 BCCs (54.8%) were identified. SNP analysis revealed LOH of PTCH1 in 10 of 23 BCCs (43.5%). Interestingly, the majority of mutations identified (63.2%) were insertion/deletion, which was different from the results in Caucasian cases whose mutations are predominantly point mutations. Only two (10.5%) of the remaining seven mutations were UV‐specific C → T transition or tandem CC → TT transitions. All mutations occurred evenly throughout the entire PTCH1 protein domain without a hot‐spot detected. Conclusion Mutations and LOH in PTCH1 were also highly prevalent in Chinese sporadic BCCs. However, UV light plays a less role in causing these mutations, suggesting other potential mechanisms in the development of sporadic BCC in Chinese patients.     

Non‐invasive management of non‐melanoma skin cancer in patients with cancer predisposition genodermatosis: a role for confocal microscopy and photodynamic therapy

Background Patients with genodermatosis such as Gorlin syndrome (GS) and Xeroderma pigmentosum (XP) require a close follow‐up for early diagnosis and treatment of skin cancer. We aimed to evaluate the efficacy of methyl‐aminolevulinate (MAL) photodynamic therapy (PDT) in basal cell carcinomas (BCCs) from patients with GS and XP, and to determine the utility of reflectance confocal microscopy (RCM) in the diagnosis and the evaluation of therapeutic response. Patients and methods We included four patients with GS and two siblings with XP. Single or multiple lesions in localized areas were treated with 1–3 cycles of MAL PDT. RCM was performed before and 3 months after the treatment in target lesions in all the patients. Patients were followed up for 3 years. Results In XP patients, we treated 13 pigmented BCCs on the face. All the lesions responded to the treatment and six lesions showed a complete clinical clearing. In GS patients, facial or trunk areas with multiple BCCs were treated (up to 200). Complete clinical remission was obtained in 25–67% of the lesions. Some nodular and pigmented lesions failed to achieve a complete remission. RCM could identify already described confocal features for BCC. Tumour remissions could be assessed by this technique. Conclusions Methyl‐aminolevulinate PDT may be useful for the treatment of superficial BCC in GS and XP. In some nodular lesions, PDT may complement surgery reducing tumour size. RCM may be regarded in the future as a complementary technique in BCC for the diagnosis and post‐treatment assessment to non‐invasive therapeutic modalities.     

Clonal heterogeneity in curetted human epidermal cancers and precancers analysed by flow cytometry and compared with histology

DNA frequency distributions analysed by single nuclei flow cytometry were studied in sixty-five curetted human epidermal tumours, i.e. five actinic keratoses (AK), seven Bowen's diseases (BO), nine squamous cell carcinomas (SCC), forty-three basal cell carcinomas (BCC) and one baso-squamous carcinoma (BSC). Seventy-five per cent (16/21) of the samples with squamous cell differentiation (AK, BO and SCC) showed features suggestive of more than one stem cell population, against 24% of the pure BCC samples (11/43). The DNA indices for the tumours, i.e. the ratio between the DNA content of the tumour stem cell line G1 cells and normal epidermis G1 cells were calculated. For BCC and SCC a preponderance was found for near-diploid and near-tetraploid cell clones. The precancerous lesions contained clones with more broadly scattered DNA indices. The fractions of cells in S and G2M and S + G2M phases were calculated for the samples with only one detectable stem cell population. For the squamous cell tumours and the nodular (but not the superficial) BCC, these fractions were significantly different from the unaffected skin of patients with multiple epidermal cancers. The usefulness of cell cycle fraction determinations for curetted tumours is discussed.