Palliative total skin electron beam therapy (TSEBT) for advanced cutaneous T-cell lymphoma

Our aim was to analyze the effectiveness of palliative total skin electron beam therapy (TSEBT) in the management of advanced cutaneous T-cell non-Hodgkin's lymphoma (CTCL). Eighteen patients (median age 59 years) with advanced and therapy-refractory CTCL in stages IIB-IV were treated with TSEBT for the first time. The most common histological subtype was Mycosis fungoides (72%). All patients suffered from lymphoma-associated symptoms. Median daily fractions of 1 Gy were administered up to a median total dose of 25 Gy. The median follow-up period was 11 months. Nine patients (50%) achieved a complete response and seven patients (39%) had a limited response. The actuarial one-year progression-free survival was 24%. Four patients (22%) had continuing remission over a median period of six months. Lymphoma associated symptoms were improved in 16 patients (89%). The median overall survival after receiving TSEBT was 12 months, resulting in an actuarial one-year overall survival of 48%. Treatment related acute effects (grade 1 or 2) were observed in all patients during radiation therapy. Transient grade 3 epitheliolyses developed in five patients (28%), late skin effects (grade 1 and 2) in 16 patients (89%), and hypohidrosis was seen in six patients (33%). We conclude that TSEBT is a very efficient and tolerable palliative treatment for patients with advanced CTCL.     

Cutaneous T-cell lymphoma treated with electron beam irradiation in Indian patients

BACKGROUND: Cutaneous T-cell lymphoma (CTCL) is a rare occurrence in India. Total skin electron irradiation (TSEI) is a well-accepted therapeutic modality for the treatment of CTCL throughout the world. The aim of this study was to retrospectively analyze the treatment outcome of TSEI in Indian patients with CTCL and to determine the different parameters affecting the disease-free survival in these patients. METHODS: Fourteen male patients between 27 and 82 years of age with CTCL (duration of disease, 4 months to 2 years) were treated with TSEI between 1985 and 1998. Seven patients had early stage disease, while the other seven had advanced disease. Two patients had lymph node involvement at the time of presentation. The TSEI was performed according to the Stanford technique delivering a total dose in the range 8-36 Gy. RESULTS: Of the 14 patients, 10 showed complete remission following TSEI. The total follow-up period was 4-110 months (median, 52 months). Five patients were disease free at the end of 5 years. Two patients died due to rapid progression of the disease, while the cutaneous lesions relapsed in three patients after 2-27 months and one patient developed visceral metastasis. CONCLUSIONS: TSEI was an effective therapeutic modality for the treatment of CTCL in this group of patients, both as a curative and palliative measure, although the long-term prognosis is poor.     

Total skin electron irradiation therapy in mycosis fungoides using high-dose rate mode: a preliminary experience

INTRODUCTION: Total skin electron irradiation (TSEI) therapy is the treatment of choice for mycosis fungoides. However, conventional TSEI therapy is time consuming as well as patient unfriendly. Therefore we used high-dose rate (HDR) mode TSEI in these patients. High-dose rate mode of TSEI is a technological innovation attached to a Linear Accelerator (Philips, SL-20, Netherlands), which can deliver an electron beam of 30 Gy/min at the iso-center. The iso-center faces the patient, 100 cm away from the target of the linear accelerator. The patient is treated at a distance of 10 feet from the iso-center of the linear accelerator. The dose delivered to the skin was 1.13 Gy/min, making the treatment execution much easier and patient compliance much better. METHODS: Seven male patients between 40 and 64 years in age having mycosis fungoides for 9-18 months were treated by TSEI using high-dose rate mode between 1998 and 2000. The TSEI was performed according to the Stanford technique, delivering a total dose of 36 Gy. Each patient received a dose of 1.2 Gy/field/day. There were six fields, i.e. anterior, posterior, left and right anterior obliques, and left and right posterior obliques in both the upper and lower parts of the body. The eyes and nails were shielded at each session of radiotherapy. The times taken at each session of the therapy and radiation-associated side-effects were determined in each patient. The patients were followed up to 26 months (median 9 months) to look for any relapse. RESULTS: Three patients had early stage disease (IB) whereas four patients had advanced disease (IIB). Six patients out of these had complete remission following TSEI while one patient died as a result of progression of the disease during treatment. The treatment time taken at each treatment session in each individual patient was approximately 15 min. Radiation-associated morbidity was seen in all patients. Cutaneous lesions relapsed in two patients after 4 and 10 months, respectively, while four patients were alive without the disease at the end of 2 years. CONCLUSIONS: Total skin electron irradiation using high-dose rate mode delivery of electrons is an easy, better, compliant and effective therapeutic modality for treatment of mycosis fungoides with an acceptable range of toxicities.     

Laser‐assisted depigmentation for resistant vitiligo: a retrospective case series with long‐term follow‐up

Background Blanching creams are used to depigment and to achieve uniform skin tone in widespread vitiligo. Length of the treatment and side‐effects strongly limit their use in common practice. Objectives To assess the long‐term efficacy and tolerance of Q‐Switched (QS) lasers for depigmenting the remaining unaffected skin in vitiligo. Methods Retrospective study of vitiligo patients treated with QS lasers in the Department of Dermatology of the University Hospital of Nice, France, from 2002 to 2011. Localizations and the percentage of body surface area of treated lesions, the total number of sessions and the possible relapses and side‐effects, were analysed. Global satisfaction of the patients was evaluated on a visual analogical scale. Results Sixteen areas of normally pigmented skin were treated in six patients. The median number of sessions to achieve a complete depigmentation was 2 (1–6). The mean duration of follow‐up was 36 months (19–120). One third of the patients had no relapse. A complete repigmentation was observed after 21 months in one patient; a 50% repigmentation was noted in one patient, 7 months after the end of the treatment. Two patients showed a minimal repigmentation (<25%), 18 months and 9 years after the first laser treatments. The repigmentations were effectively treated with a maintenance session. The mean total number of sessions performed during this period was 3 (1–20). Side‐effects were limited to transient purpura and crusts. The satisfaction of the patients was excellent (mean 9/10). Conclusions QS lasers appear as an efficient and safe modality for depigmenting normal skin in vitiligo.     

Powerful neodymium laser radiation for the treatment of facial carcinoma: 5 year follow-up data

A retrospective non-comparative follow-up study was performed to evaluate the curative efficacy of powerful neodymium laser radiation (λ = 1,060 nm) for the treatment of 2,837 patients with 3,001 histologically confirmed facial skin carcinoma lesions of stages T1-2N0M0: 2,743 primary basal cell carcinomas (BCC), 172 recurrent limited basal cell carcinomas (RLBCC), and 86 primary squamous cells carcinomas (SCC). All patients were followed-up from 5 to 11 years (mean: 8.2 years; median: 7.0 years) after treatment. The overall recurrence rate (RR) after treatment with laser radiation of facial carcinomas was 2.5% of all irradiated tumours (mean: 13.4 months; median: 11.0 months). Patients with BCC treated by radiation with the pulsed Neodymium (Nd) laser developed RR in 2.2% of cases and patients treated with the Nd:YAG laser had RR of 3.1%. Recurrences following treatment for RLBCC, and those of SCC, after irradiation with the Nd laser appeared in 4.1% and 4.6% of patients, respectively. Neodymium laser radiation is a safe and effective means of treating facial carcinomas of stages T1-2N0M0 with good cosmetic results.     

Cutaneous lupus erythematosus-treatment with pulsed dye laser

Because of its vascular selectivity, the flashlamp-pumped pulsed dye laser (585 nm) is efficacious in the treatment of vascular lesions and is successfully used for the treatment of port-wine stains and haemangiomas in children. Based on the encouraging results with these cutaneous vascular disorders, the cutaneous lesions of patients with lupus erythematosus (LE) have now also been treated with the pulsed dye laser. Cutaneous lesions in lupus erythematosus are often difficult to treat with readily available local therapeutic methods. We report here on a group of 12 patients whose LE lesions were treated with the pulsed dye laser. In 10 patients, the LE was limited to the skin, while two patients had systemic LE (SLE). Even in the two patients with SLE, a significant improvement of skin lesions was achieved. After a mean number of 51 laser sessions, a median clearance rate of 70% was attained for nine patients. In one case, the laser treatment failed to clear the lesions. Two patients did not show any visible improvement of the lesions, but pain and itching were significantly reduced. There were few side-effects. No prolonged laser-induced scarring occurred and in only two patients was hyperpigmentation seen, which had resolved completely after 4 and 5 months, respectively. During a median follow-up of 7 months (range: 3-32 months), only one patient (after a complete clearance of the skin lesions) had a small relapse. In summary, the pulsed dye laser is an effective therapy for the treatment of superficial skin lesions in LE.     

Total cutaneous electron beam therapy of mycosis fungoides

Electron beam irradiation of the entire skin surface was used to treat 25 patients with mycosis fungoides from 1977 to January 1988. A plexiglas screen was used to reduce the energy of the 8 MeV beam of a Sagittaire linear accelerator to 4 MeV. A total dose of 30 Gy was delivered in 12 fractions over days. This series includes 17 men and 8 women with a mean age of 44 years (range 13-78 years) and a mean follow-up of 34 months (range 6-92 months). The following-up staging system was used: stage A: superficial lesions covering less than 50 p. 100 of the body surface; stage B: superficial lesions covering more than 50 p. 100 of the body surface; stage C: tumors of the skin, lymph nodes and/or visceral organs, Sezary's syndrome. All stage A patients achieved complete remission. One developed recurrent disease in a very limited area 17 months after radiation therapy. No stage A patient died of mycosis fungoides. 6/9 stage B patients achieved complete remission; 4 of these developed recurrent disease localized to the skin 6 to 13 months after electron therapy. These recurrences were controlled by topical nitrogen mustard, puva therapy or localized irradiation. 1 patient showed no response and died of cutaneous mycosis fungoides. 5/10 stage C patients obtained complete remission but all relapsed within a mean period of 7 months. 4/5 of the patients not responding to electron therapy died of their disease and one is alive 16 months after completion of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Does adjuvant alpha‐interferon improve outcome when combined with total skin irradiation for mycosis fungoides?

BACKGROUND: Patients with mycosis fungoides (MF) experience frequent disease recurrences following total skin electron irradiation (TSEI) and may benefit from adjuvant therapy. OBJECTIVES: To review the McGill experience with adjuvant alpha-interferon (IFN) in the treatment of MF. METHODS: From 1990 to 2000, 50 patients with MF were treated with TSEI: 31 with TSEI alone and 19 with TSEI + IFN. Median TSEI dose was 35 Gy. In the TSEI + IFN group, IFN was given subcutaneously at 3 x 10(6) units three times per week starting 2 weeks prior to start of TSEI, continued concurrently with the radiation and for an additional 12 months following TSEI. The TSEI alone group included 16 men and 15 women with a median age of 61 years (range 31-84). The TSEI + IFN group included 14 men and five women with a median age of 51 years (range 24-83). Clinical stage was IA, IB, IIA, IIB, III and IVA in 2, 9, 4, 8, 1 and 7 patients of the TSEI group and 0, 3, 3, 7, 4 and 2 patients of the TSEI + IFN group. RESULTS: Median follow up for living patients was 70 months. All patients responded to treatment. Complete response (CR) rate was 65% following TSEI and 58% following TSEI + IFN (P = 0.6). Median overall survival (OS) was 61 months following TSEI and 38 months following TSEI + IFN (P = 0.4). Acute grade II-III dermatitis was seen in all patients. Fever, chills or myalgia were seen in 32% of patients treated with TSEI + IFN. CONCLUSIONS: Concurrent IFN and TSEI is feasible, with acceptable toxicity. Even when controlling for disease stage, the addition of IFN did not appear to increase CR rate, disease-free survival or OS.     

Prevalence and prognostic value of cutaneous manifestations in patients with myelodysplastic syndrome

Background Skin manifestations associated with myelodysplastic syndrome (MDS) may reveal bone marrow transformation into acute myeloid leukaemia. Objective The objective of this study was to assess the prevalence of skin manifestations associated with MDS. In addition, we evaluated the risk of acute myeloid leukaemia transformation associated with skin manifestations. Methods We studied a cohort of 157 patients with primary MDS followed up prospectively for a median of 44 months. Skin lesions were prospectively assessed as part of medical examination every 6 months by a board certified dermatologist. Survival analyses were performed to assess the association between the presence of skin lesions and the risk of acute myeloid leukaemia. Results Fifteen patients (9.55%) experienced skin lesions previously reported as associated with MDS. These were neutrophilic dermatosis (7, 4.46%), specific lesions (5, 3.18%), cutaneous vasculitis (2, 1.27%) and Behçet disease (1, 0.63%). Survival analysis showed that the risk of transformation into acute myeloid leukaemia was slightly but not significantly increased in patients with skin lesions as compared with patients without skin lesions with a relative risk of 2.08 (95% CI 0.92–4.67). Conclusion The prevalence of skin lesions, mostly neutrophilic dermatosis and specific lesions, is relatively high in patients with MDS. There is a trend for a higher risk of transformation into acute myeloid leukaemia in patients with skin lesions.     

窄谱中波紫外线围白斑照射治疗难治性白癜风的临床疗效观察

【摘要】 目的 探讨窄谱中波紫外线围白斑照射治疗难治性白癜风的临床疗效。方法 回顾2019年6月至2020年11月南京医科大学第一附属医院皮肤科治疗的126例难治性白癜风,分别采用遮盖白斑、窄谱中波紫外线照射围白斑区域皮肤和常规照射白斑治疗,每周2次,持续3个月。治疗结束后评估2组的疗效。运用倾向性评分匹配分析,按1∶1匹配。采用单因素和多因素Logistic回归分析、分层分析围白斑照射法对于难治性白癜风的临床疗效。结果 采用围白斑照射组皮损420处,常规照射组257处,倾向性评分匹配后每组各190处,匹配前后,围白斑照射组有效率（71.9%、67.9%）均高于常规照射组（31.9%、30.0%,均P < 0.05）。倾向性评分匹配后单因素Logistic回归分析显示,围白斑照射与常规照射对疗效的影响差异有统计学意义（OR = 4.9,95% CI：3.2,7.6,P < 0.001）;多因素分析显示,围白斑照射与常规照射对疗效的影响差异亦有统计学意义（OR = 12.0,95% CI：6.5,22.3,P < 0.001）。对不同毛发类型与照射方法对白斑疗效的影响进行分层分析,匹配前,毛白白斑采用常规照射187处,围白斑照射246处,毛黑白斑采用常规照射70处,围白斑照射174处;匹配后,毛白白斑两照射组各140处,毛黑白斑各50处。对于毛白白斑,匹配前后围白斑照射组的有效率（77.6%、72.8%）均好于常规照射组（19.3%、20.7%,P < 0.01）。对于毛黑白斑,匹配后两组疗效差异无统计学意义（P = 0.908）。结论 围白斑窄谱中波紫外线对于治疗难治性白癜风尤其是白斑处毛发变白的皮损疗效优于一般照射方法。     

Topical nitrogen mustard therapy in patients with Langerhans cell histiocytosis

Background Langerhans cell histiocytosis (LCH) is characterized by abnormal proliferation and infiltration of Langerhans cells in different organs. The skin is frequently involved either as unisystem or multisystem disease. Objectives To review the clinical response and side‐effects of nitrogen mustard therapy in LCH in children and adults with unisystem or multisystem disease. Patients and methods This retrospective study includes 10 children and four adults with LCH, treated with nitrogen mustard from 1975 to 2010. The median extent of skin involvement was 46% (range 5–100%). Results Overall, 13 patients had complete or partial response. Although eight patients achieved a complete response with a median time of 12·3 months (range 36 days to 1·9 years), six of these patients ultimately relapsed. One patient, who had unisystem disease limited to the skin, initially showed progression of her cutaneous lesions with nitrogen mustard treatment. Although subsequently the cutaneous lesions completely regressed, concomitant systemic involvement was noted. Four other patients similarly experienced improvement of their skin lesions with treatment, but also exhibited progression of the LCH systemically. The patients were treated with other therapies prior and adjunctive to nitrogen mustard. However, five patients had progression to other organs, despite regression of skin lesions, which supports that the treatment effect in the skin is related to topical nitrogen mustard. Six patients developed contact dermatitis to nitrogen mustard. Conclusions Topical nitrogen mustard can be an effective and safe therapy in both children and adults with cutaneous LCH, although relapses are common.     

DNA interstrand crosslinks visualized by electron microscopy in PUVA-treated psoriasis.

An electron microscopic method has been used to visualize crosslinks after total denaturation of DNA isolated from epidermis and dermis in patients with psoriasis treated with 8-methoxypsoralen (8-MOP) and irradiation with ultraviolet light at 360 nm (PUVA treatment). This technique enabled accurate measurement of the number and density of DNA interstrand crosslinks. 30 biopsies were studied and a total of 9503 DNA molecules were scored in the electron microscope. 6 patients were treated topically with 8-MOP and 10 were on systemic treatment and biopsies were obtained immediately after irradiation. 1% of the total DNA molecules examined contained 3 or more crosslinks. The overall frequency of crosslinks was almost identical in the epidermis (1.1%) and in the dermis (0.9%) and, furthermore, virtually the same in patients on topical and systemic PUVA treatment. The total number of crosslinks was of the same magnitude as those previously found by us in normal human skin. Thus, though the formation of interstrand DNA crosslinks can be considered as an indicator of damage of the genetic material, we were unable to demonstrate this as being a consequence of PUVA treatment using 8-MOP.     

Effect of heliotherapy on skin and joint symptoms in psoriasis: a 6-month follow-up study

The effect of heliotherapy on psoriasis skin lesions and arthritis was studied in a trial comprising 4 weeks of therapy in the Canary Islands and a 6-nionth follow-up period, A total of 373 patients participated in the heliotherapy and in patients completed the follow-up period. The severity of skin lesions was evaluated using a psoriasis severity index (PSI), and that of the arthropathy by using an arthritis index (AI).
During heliotherapy, the PSI decreased significantly from the initial median value of 4.5 to the final value of 0.2, A reduction in the PSI of at least 75% was achieved in 84% of the patients. Guttate psoriasis improved significantly better than plaque-type or erythrodermic psoriasis. There was no correlation between skin type and improvement. Initially, 129 patients had symptoms of arthritis. During heliotherapy, the AI decreased significantly from the initial median value of 6 to the final value of 2.
The median time until starting another treatment after heliotherapy was 80 days, and the PSI had returned to its original value in 49% of the patients in 6 months. In patients with joint symptoms the AI returned to the pretreatment level within 6 months.
A 4-week heliotherapy period effectively cleared psoriasis, alleviated joint symptoms, and reduced both morbidity and treatment requirement to a considerable extent in the ensuing 6-month period.     

Topical photodynamic therapy for prevention of new skin lesions in renal transplant recipients

Preclinical data suggest that topical methyl aminolevulinate photodynamic therapy may have potential in preventing new skin lesions in transplant recipients. An open intra-patient randomized study investigated the prevention potential of this treatment in 27 renal transplant patients with actinic keratoses and other skin lesions in two circular contralateral areas (5 cm diameter). The treatment area surface was debrided and methyl aminolevulinate cream (160 mg/g) was applied for 3 h prior to illumination by non-coherent red light (570-670 nm, light dose 75 J/cm2). The control area was not treated. The mean time to occurrence of the first new lesion was significantly longer in treated than control areas (9.6 vs 6.8 months, treatment difference 2.9 [95% confidence interval 0.2 to 5.5] months, p = 0.034). Over 12 months, 62% (16/26) of treated areas were free from new lesions compared with 35% (9/26) in control areas. These findings indicate that topical methyl aminolevulinate photodynamic therapy is a promising preventive treatment against new skin lesions in immunosuppressed patients.     

Three-year retrospective review of superficial radiotherapy for skin conditions in a Perth radiotherapy unit

Western Australia has only two superficial radiotherapy units, one of which is located at Fremantle Hospital, and run by the radiation oncologists of Perth Radiation Oncology Centre. A 3-year retrospective review was undertaken of all patients who underwent treatment at this unit from 1999 to 2001. Patients were identified from the unit's log book, and data was collected from their files. For malignant skin conditions, 369 lesions were treated in 259 patients over the study period. The patients' median age was 76 years. A wide variety of conditions were treated, but the most common diagnoses were basal cell carcinoma (237 lesions) and squamous cell carcinoma (92 lesions), most commonly located in the head region. The most frequently used treatment schedule was 36 Gy in six fractions over a 3-week period. Where radiotherapy was administered as primary treatment, the diagnoses had been biopsy-proven in only 53% of cases. Fifty-four patients underwent treatment of benign skin disease over the study period; most commonly keloid scars (41 patients) followed by warts (six patients). We conclude that superficial radiotherapy has a distinct role in dermatology, particularly for skin carcinomas around the nose and eyes, which cannot presently be superseded by electron beam therapy.     

Narrowband UVB and psoralen-UVA in the treatment of early-stage mycosis fungoides: a retrospective study

BACKGROUND: Treatment of early-stage mycosis fungoides (MF) consists of topical steroids, phototherapy (UVB), photochemotherapy (psoralen plus UVA [PUVA]), topical nitrogen mustard, or total skin electron-beam irradiation. It has been reported that the same effective UVB dose is safer than PUVA regarding carcinogenicity and produces fewer side effects. Narrowband UVB (311 nm) results in less irritation and erythema and is more effective compared with broadband UVB. OBJECTIVE: Our purpose in this retrospective study was to analyze the response to treatment, relapse-free interval, and irradiation dose in 56 patients with early-stage MF (stage Ia and Ib). A total of 21 patients were treated with narrowband UVB (311 nm); 35 patients were treated with PUVA. RESULTS: Narrowband UVB treatment led to complete remission in 17 of 21 patients (81%), partial remission in 4 of 21 (19%), and none showed progressive disease. PUVA treatment led to complete remission in 25 of 35 patients (71%), partial remission in 10 of 35 (29%), and none showed progressive disease. The mean relapse-free interval for patients treated with UVB was 24.5 months (range, 2-66 months) and for patients treated with PUVA, 22.8 months (range, 1-43 months). CONCLUSION: Narrowband UVB therapy for patients with early-stage MF is an effective treatment modality. It has several advantages over treatment with broadband UVB and PUVA. When treating patients with early-stage MF it may be beneficial to start with narrowband UVB therapy and, if there is progression or no response, switch to PUVA therapy.     

The patient with polymorphous light dermatosis. Skin type, hardening and other light-associated markers

From 1985 to 1989 we interviewed 312 patients suffering from polymorphous light eruption (PLE). The interviews were based on a questionnaire dealing with the various light-dependent factors that exacerbate the disease. Of 90 patients who were tested with artificial UV-A and UV-B irradiation sources, 60 reacted with typical PLE lesions: (a) 27 patients to UV-A alone, (b) 12 to UV-B alone, and (c) 21 to both UV-A and UV-B. Using UV-A provocation tests we were able to determine the anamnestic criteria indicating a possible UV-A induction of PLE, e.g. occurrence in the shade, no protection from window glass, no benefit from conventional sunscreens, and occurrence in solaria. The period from experimental irradiation to induction of skin lesions was shorter in skin types I and II than in skin type III and IV. Hardening phenomenon was reported by 37% of our patients. Of the UV-A-positive patients, 38% showed the first presentation of PLE lesions at the height of summer, as against 64% of the total number of patients questioned. Additional lesions at non-irradiated skin sites occurred in 25% of our patients, the frequency rising with increasing duration of the tendency to PLE.     

窄谱紫外线照射联合地奈德乳膏治疗龟头白癜风患者有效性和安全性研究

目的:研究窄谱紫外线照射联合地奈德乳膏外用治疗龟头白癜风的有效性和安全性。方法:选取2014年1月至2016年1月在我院就诊治疗的龟头白癜风患者150例,随机均分为三组:治疗1组:患者50例,仅用地奈德乳膏外用治疗;治疗2组:患者50例,仅采用紫外线照射治疗;联合治疗组:患者50例,将紫外线照射与地奈德乳膏外用联合应用治疗患者。三组均治疗1个疗程(3个月/疗程),治疗后,比较三组患者治疗前后的疗效及安全性。结果:联合组患者的皮损总有效率(84%)均明显高于其他两治疗组(68%、64%),差异具有统计学意义(P0.05);联合组色素积分均较其他两治疗组增高,差异明显(P0.05);三组于治疗后不良反应发生率之间无显著性差异(P0.05)。结论:窄谱紫外线照射联合地奈德乳膏外用治疗龟头白癜风具有良好的临床疗效,且不良反应少,可广泛应用在临床中。     

5-Aminolevulinic acid-based photodynamic therapy for the treatment of two patients with extramammary Paget's disease

Photodynamic therapy (PDT), which employs a combination of a tumor-localizing photosensitizer and visible light, has been used in the treatment of extramammary Paget's disease (EMPD). Two patients with EMPD were treated with PDT using 5-aminolevulinic acid (ALA). Histologically, in both cases, Paget's cells were present within the epidermis. Case 1 was a 92-year-old male who underwent total extirpation for treatment of EMPD. Two topical ALA-PDT treatments were applied to parts of the lesions at a total dose of 200J/cm2. Case 2 was a 73-year-old female, whose lesions in the right labia majora were treated with 3 topical ALA-PDT sessions at a total dose of 300 J/cm2. Clinical findings after the irradiation showed improvement in both patients, and elimination of tumor cells in the epidermis was confirmed histologically. Case 1 had no recurrence in the irradiation field at three months after PDT. Case 2 had a recurrence only in the periphery parts of the lesions at two months after PDT, but the periphery lesions remitted with two more PDT treatments. Topical ALA-PDT is an effective treatment for EMPD with tumor cells within the epidermis. It is noninvasive and achieves a cosmetically excellent outcome, especially in elderly patients and those in poor general condition.     

Monochromatic excimer light (308 nm) in patch-stage IA mycosis fungoides

Recently, numerous studies have been reported concerning the treatment of early-stage mycosis fungoides (MF) with narrowband (311-nm) UVB, claiming a beneficial response. We have used for the first time a 308-nm monochromatic excimer light, a new kind of xenon-chloride lamp, in the treatment of patch stage IA MF. We treated 7 patch lesions in 4 patients with unequivocal clinicopathologic diagnosis of MF. All lesions achieved clinical and histologic complete remission. The number of weekly sessions varied from 4 to 11 (mean 6.5; median 5.5). The total UVB 308-nm irradiation dose ranged from 5 to 9.3 J/cm(2) (mean 7.1 J/cm(2); median 7 J/cm(2)). All lesions remained in stable complete remission after a follow-up of 3 to 28 months. No remarkable side effects were reported. Our preliminary results suggest that monochromatic excimer light phototherapy is a possibly very useful treatment modality in patch stage IA MF.