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Background: Photodynamic therapy (PDT) of superficial basal cell carcinomas using endogenous protoporphyrin IX generated by topically applied 5-aminolevulinic acid (5-ALA) is an innovative and clinically encouraging approach., Objective: This paper reports on the first results of an ongoing clinical study on photodynamic therapy of 55 basal cell carcinomas in 19 patients., Methods: Because of the chemical instability of 5-ALA, a novel nanocolloid lotion was developed. This formulation was applied to the lesions under occlusive dressing 6 h before irradiation with visible light from an unfiltered halogen lamp. Light-induced fluorescence was used to ascertain the superficial extension of the tumors. The response to the therapy was assessed by visual inspection and in 13 patients also by biopsies., Results: After a single treatment, 47 (85%) basal cell carcinomas showed a complete response at a follow-up time of at least 6 months. For the remaining 8 (15%) lesions, a partial response was observed, indicated by a marked reduction of the tumor size. The treatment modality without local anesthetics was well tolerated by all patients, with only slight discomfort during light irradiation., Conclusion: Our results indicate that 5-ALA-PDT with our novel formulation, a nanocolloid lotion, is a highly effective and convenient therapy for the treatment of superficial basal cell carcinomas. Its use in the treatment of nodular tumors needs further investigations.

Background and Objective: Local PUVA (psoralen plus UVA light) is an effective outpatient treatment for patients with palmoplantar eczema or psoriasis. In this study, the efficacy, applicability and patient acceptance of two local forms of 8-methoxypsoralen (8-MOP) PUVA therapy were compared., Methods: The study design was a left-right comparison (n = 37): the left hand or foot was treated with (aqueous) 8-MOP bath PUVA whereas the right received (ethanolic) 8-MOP lotion PUVA. After 1 month, the more successful treatment was continued on both sides until lesions cleared., Results: Both therapies were effective and both useful for particular clinical applications: patients with erosive lesions and rhagades appreciated the gentleness of bath PUVA. Those with pustules or hyperkeratotic lesions appreciated the greater effectiveness of 8-MOP lotion PUVA. The total UVA dose and number of sessions to clearance were smaller with 8-MOP lotion. There was no difference in the length of the relapse-free period. Therapy nonresponders usually became apparent within the first 12 sessions., Conclusions: The difference between bath PUVA and lotion PUVA can be described as 'gentle' versus 'strong' therapy. The better therapy depends on clinical indication.

The present study firstly aimed at understanding the relationship between sun exposure, pigmentary traits and the history of sunburns. Secondly, the significance of UV-exposure for cutaneous melanoma and for melanocytic naevi was investigated. The case-controlled study comprised 513 patients with primary cutaneous melanoma and 498 controls matched by age and gender. Multivariate logistic regression analysis was used to study melanoma risk factors. The number of common melanocytic naevi was associated with age, gender, the history of sunburns and UV-exposure during holidays (odds-ratio = 1.9; 95% confidence interval = [1.1, 3.4]) for 3 weeks or more. The number of atypical melanocytic naevi was significantly related to age, gender, pigmentary traits, the history of sunburns and UV-exposure during holidays (odds-ratio = 3.5; 95% confidence interval = [1.4, 9.0]) for 2 months or more. The results of the present study showed that both the history of sunburn and intensive sun exposure during holidays were important for the development of melanocytic naevi and, therefore, indirectly for cutaneous melanoma. In addition, a particular type of pigmentation was found to be related to atypical melanocytic naevi.

Advances in the molecular definition of surface proteins (adhesion molecules) involved in tumor metastasis may help to explain the invasive behavior of malignant tumors, that is, the migration of tumor cells involving reversible adhesive contacts, their release in the circulation, and their extravasation into distant sites. Intercellular adhesion molecule-3 (ICAM-3), the third receptor for the lymphocyte function-associated antigen molecule-1 (LFA-1) was recently characterized. We investigated fresh frozen skin biopsies from 10 patients with mycosis fungoides, four with pleomorphic T-cell lymphoma, six with Sézary syndrome, 10 with primary cutaneous B-cell lymphoma, and 10 with eczematous lesions as controls. The biopsies were compared with lymph node biopsies of five patients with known cutaneous T-cell lymphoma (CTCL), 10 with primary nodal B-cell lymphoma, and 11 with lymph-node specimens showing dermatopathic lymphadenopathy as controls. The specimens were stained with ICAM-3 antibody (Bender Medical Science) using the alkaline phosphatase antialkaline phosphatase method. Using cytomorphologic criteria, neoplastic lymphocytes could be differentiated from smaller reactive cells. Staining intensities were classified semiquantitatively as follows: 4, strong expression in 75 to 100% of the tumor cells; 3, 50 to 75%; 2, 25 to 50%; 1, 5 to 25%; and 0 fewer than 5% of the tumor cells. The endothelial cells in skin biopsies of seven of 30 primary cutaneous lymphomas expressed ICAM-3. In contrast, no expression of ICAM-3 could be demonstrated on endothelial cells in lymph nodes infiltrated with tumor cells of CTCL. Finally, endothelial cells of lymph nodes infiltrated with primary nodal B-cell lymphomas showed expression of ICAM-3 in three of 10 patients. The endothelial cells in the 11 control patients presenting with both eczematous lesions and dermatopathic lymphadenopathy showed no staining for ICAM-3. Every patient who expressed ICAM-3 on endothelial cells showed systemic spread of this disease. The findings suggest that ICAM-3 expression may be induced on endothelial cells in late-stage cutaneous lymphomas, probably by a cytokine-mediated mechanism.

Background: Peripheral and tissue eosinophilia are associated with a group of idiopathic inflammatory syndromes. The idiopathic hypereosinophilic syndrome represents a spectrum of disorders characterized by prolonged eosinophilia of an undetectable cause and significant organ dysfunction. The pathogenic role of the eosinophil in these conditions is attested to by evidence of eosinophil activation and degranulation at sites of tissue injury. Recently, an overlapping range of idiopathic eosinophilic muscle disease with an overall good prognosis has been described., Results: We describe a patient with a syndrome of idiopathic myositis with eosinophilia and eosinophilic cellulitislike cutaneous manifestations. Histopathological studies of the skin and muscle revealed eosinophilic infiltration. Elevated serum levels of eosinophilic cationic protein and interleukin-5 paralleling disease activity were detected., Conclusions: This patient demonstrates clinical and laboratory features of eosinophilic myositis with eosinophilic cellulitislike skin lesions. The elevated serum levels of interleukin-5 and eosinophilic cationic protein may be responsible for the eosinophilia and tissue injury, respectively. With the advances in our understanding of cytokine-dependent regulatory mechanisms governing the eosinophil reaction, more targeted ways of manipulating eosinophilia as well as the entry and activation of eosinophils within specific tissues can be expected.

History and Clinical Findings: Two months after being diagnosed as having refractory anaemia with an excess of blasts in transformation (RAEB-T), a 62-year-old man presented in the emergency room with fever (40 degrees C) for two weeks and scattered deep-red macular indolent efflorescences over the chest, back, face and thighs. Other than splenomegaly there were no significant findings on physical examination., Investigations: Erythrocyte sedimentation rate was increased to 38 mm in the first hour. Haemoglobin concentration and platelet count were at the lower limits of normal, white cell count within the normal range. Differential count: 60 erythroblasts per 100 leukocytes and 33.5 blast cells. Two skin biopsies revealed massive oedema in the upper corium and focal erythrocyte extravasations. There were perivascular and perifollicular inflammatory infiltrates in the deeper layers and elastosis of the corium. There was no leukocytoclastic vasculitis. These findings established the diagnosis of Sweet syndrome and erythroleukaemia., Treatment and Course: The erythroleukaemia was treated symptomatically and the skin changes gradually receded under prednisone, 1 mg/kg, but new spots occurred when the prednisone dose was halved. Candida oesophagitis occurred as a complication of the erythroleukaemia. Chest radiogram showed diffuse infiltrates in both upper lobes of the lung. Despite intensive antimycotic and antibiotic treatment the patient died 10 days later from pulmonary aspergillosis., Conclusion: This case report describes the rare occurrence of Sweet syndrome during the transformation from a myelodysplastic Syndrome to erythroleukaemia.

Vulvar melanomas are seen in about 3% of all melanomas. The percentage reaches 10% of all malignant tumors of the vulva. The mean age of the patients is approximately 55 years. The first symptoms noticed by the patients are bleeding, pruritus, or a mass in the groin. Vulvar melanomas are mostly located at the labia minora. The differential diagnosis comprises different pigmented lesions, such as seborrheic keratosis, nevocellular nevus, lentigo, or hyperpigmentations of different origin. There is no typical histopathological pattern, but mostly melanomas of this site are of the mucosal-lentiginous type. As treatment modalities, most investigators propose a complete excision for melanomas thinner than 1 mm, and for thicker melanomas a wide excision. Recent investigations have shown that hemivulvectomies or vulvectomies do not show a better survival. The question of a prophylactic ipsilateral lymph node dissection is not answered yet. The survival rates depend on the tumor thickness and/or the infiltration level. The importance of an early diagnosis should be stressed in vulvar melanomas, especially through an accurate inspection of the vulva at the time of a genital examination. In addition, vulvar self examinations are an excellent possibility for early diagnosis. This allows a definite treatment and vulvar conservation.

Background: Verrucous carcinoma is a slowly growing, well-differentiated neoplasm with a predilection for the oral cavity., Objective: Data on the association of human papillomavirus (HPV) with oral verrucous carcinoma are very scarce. We searched for the presence of HPV in different stages of the tumour in a patient repeatedly treated by means of surgery, cryotherapy, radiotherapy and chemotherapy over a decade., Methods: HPV DNA was detected in archival tumour tissue by nested PCR. HPV types were identified based on restriction fragment analysis., Results: HPV type 11 was found in 1 early-stage and HPV 16 in 2 late-stage biopsy specimens of the tumour., Conclusion: Our findings provide further evidence for a role of HPV in oral verrucous carcinoma. The case history emphasizes the importance of a joint clinicopathological approach to this tumour.

Adhesion molecules are involved in leukocyte recruitment, lymphocyte recirculation, and in several aspects of tumour biology. Recent discoveries of surface proteins on tumour cells involved in tumour metastasis may explain the invasive behaviour, the migration involving reversible adhesive contacts, the release into the circulation and the extravasation of tumour cells. CD44 is a family of glycoproteins involved in cell-cell and cell-matrix interactions. The v6 (variant exon v6) form of CD44 confers a metastatic potential onto some carcinoma cells. In the present study, the expression of CD44v6 on skin biopsies of 10 inflammatory skin diseases, 30 cutaneous lymphomas (CL), 11 reactive lymph nodes, 10 primary nodal non-Hodgkin's lymphomas (NHL) and 5 secondary nodal NHL was investigated immunohistochemically. None of the 10 nodal NHL were CD44v6 positive for the neoplastic B- or T-cells, whereas 11/12 CL with systemic spread showed a distinct CD44v6 expression in the skin. CD44v6 was not expressed on the tumour cells of skin biopsies of patients without systemic spread (18 cases of CL). In conclusion, CD44v6 expression is connected to an aggressive behaviour of CL.

Minor nail trauma may cause bluish discoloration of the nail, while tangential skin trauma on the heel can result in a so-called black heel. To rule out melanoma in such clinical situations, a biopsy is needed to reveal homogeneous eosinophilic masses deposited under the nail plate or within it (transepidermal elimination). Most dermatopathologists attempt to demonstrate the presence of hemoglobin in these eosinophilic masses with Prussian blue stain, which typically remains negative. In our experience, these traumatically induced blood deposits are always situated in avascular spaces, devoid of degrading phagocytes. Consequently, a histochemical stain for these deposits should be directed specifically toward hemoglobin, not hemosiderin. In the dermatopathologic literature, the various techniques to detect hemoglobin deposits in tissue sections are not well-known. We would like to emphasize benzidine stain, a highly selective and efficient method to demonstrate the presence of hemoglobin deposits in histologic sections. To date, benzidine stain has not been utilized to characterize splinter hemorrhage (subungual hematoma). Of concern, the use of benzidine in histopathology laboratories is restricted because this agent is a known carcinogen, while the non-mutagenic derivative, 3,3',5,5'-tetramethylbenzidine, does not stain histologic sections. Patent blue V, a completely different and less specific agent, stains hemoglobin an intense blue-green.

Patients with anti-SSA(Ro)-positive Sjögren's syndrome (SS)/lupus erythematosus (LE) overlap are a immunogenetically, serologically and clinically homogeneous group; what they have in common is an increased frequency of the HLA-DR3 phenotype, demonstrating SSA(Ro) antibody activity and the typical annular, polycyclic, erythematous lesions of subacute cutaneous LE. The sicca symptoms of SS may develop long after the cutaneous lesions of LE have been present, or vice versa, as well as vasculitic, purpuric, and Sweet's syndrome-like lesions. The elderly, predominantly female patients are at enhanced risk for pulmonary and neurological disease, but glomerulonephritis occurs infrequently. We present an 81-year-old, SSA(Ro) antibody-positive and HLA-DR3-positive woman with SS/LE overlap syndrome, who had cutaneous LE for 30 years, developing sicca symptoms, vasculitic and Sweet's syndrome-like skin lesions only years after the LE symptoms. Although there is still some discussion as to whether phenotypical SS/LE overlap represents a distinct disease or is secondary SS in SLE or systemic SS with cutaneous involvement, the SS/LE overlap syndrome seems well enough delineated to be considered as a disease entity with separate implications for therapy and prognosis. Its position in the spectrum of anti-SSA(Ro) antibody- and HLA-DR3-positive diseases and its relationship to SS and to anti-SSA(Ro) antibody-positive LE are discussed.

Idiopathic middermal elastolysis (IMDE) is a rare disorder with two different clinical presentations: type I lesions, with tiny wrinkles along skin cleavage lines in large confluent areas, and type II lesions, with small perifollicular papular protrusions. The histopathological picture is characteristic. IMDE is mainly seen in healthy young or middle-aged women. We describe a 60-year-old male patient with this disorder. The special interest of this case report is that there was no photosensitivity and no exacerbation with PUV therapy. IMDE is probably a special sort of elastolytic disorder, for which immunologic mechanisms seem possible.

The pathogenesis of psoriasis is not fully understood, but two mechanisms seem important, i.e. epidermal proliferation and an inflammatory process. Among these, the cytokines production and the expression of adhesion molecules, are the most important. To make an exact diagnosis of psoriasis it is essential to have the case history and the clinical findings. In difficult cases it might be necessary to make a biopsy. If the patient has not been treated, the histopathology is very characteristic. There are two main possibilities for treatment: either local therapy or internal therapy. Local treatment usually starts with the treatment of keratotic plaques, mostly by baths (salt or sulphur), followed by ointments or oils containing salicylic acid 5% or 10%. After a couple of days a specific local treatment is started. In the clinic or in a day care center one might use the classical therapeutic modalities such as dyes (Castellani) or tar or dithranol preparations. The inconveniences of these modalities are that they either color the body or the textiles or that they smell. These preparations, especially in combination with UV light, are very effective and useful. On an outpatient basis corticosteroid preparations are mostly used, but in certain skin areas they might provoke skin atrophy. With the development of the vitamin-D derivative calcipotriol, further progress has been achieved. This preparation is not colored, does not smell and is not followed by atrophy. The efficacy of calcipotriol is similar to potent corticosteroids. Calcipotriol can very well be combined with UV therapy. UV therapy modalities consist in solar light therapy (sea shore or mountains), UVB phototherapy, SUP therapy, or PUVA therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

The daily vitamin intake of the Swiss population seems to be good. In certain situations or population groups a vitamin or mineral salt deficiency is still possible. It seems more useful to show the different changes of the skin, mucous membranes, hair or nails in the various vitamin or mineral salt deficiencies than to enumerate the vitamins. In a first part, skin signs such as seborrhoic-dermatitis-like or acrodermatitis-enteropathica-like changes, perlèches, xeroderma, hyperpigmentation or less frequent skin changes e.g. edema, intertriginous or ichthyosiform lesions, are mentioned. The second portion then shows lesions of the mucous membranes which are seen in different vitamin or mineral salt deficiencies, e.g. glossitis, cheilitis, stomatitis, aphthous ulcers or gingivitis. In a third chapter the consequences on the hair as alopecias or hair shaft alterations are discussed. Finally, in the last section, the possible nail changes as dystrophies or discolorations are mentioned. A table with the functions and the daily recommended doses of the vitamins and some mineral salts is given.

Osteopoikilosis (Osteopathia condensans disseminata) is a rare and usually asymptomatic sclerosing bone dysplasia of unknown origin. Familial clustering suggests a dominant inheritance. The observation of a 47-year-old woman lead to differential diagnostic considerations in view of the literature on about 350 cases. For 2 years the patient has been complaining about pain and stiffness of both hands with swelling of the fingers. Additionally, she remarked about bilateral paresthesias corresponding to the sensory innervation of the median nerve. Clinical examination revealed a sensory carpal tunnel syndrome and mild synovitis of the proximal interphalangeal joints with skin induration and limited flexion of the fingers. In addition, some finger and toe nails showed pitting and most fingers had scar-like linear skin alterations. Radiologic findings showed symmetric, well-defined, homogeneous sclerosing areas in spongy bone. The combination of symmetrical sclerosing bone densities, hereditary character, and associated skin and joint manifestations suggests the existence of a general connective tissue disease.

Several case-control studies identified common and atypical melanocytic nevi as major risk indicators for the development of cutaneous melanoma. The present investigation was planned to detect factors associated with the prevalence of these melanoma risk markers. Whole-body examination findings and interview data of 513 melanoma patients and 498 age- and sex-matched control subjects were analyzed. Existence of more than 50 common melanocytic nevi and the presence of atypical melanocytic nevi were significantly related to age and gender, with significantly elevated relative risk for their prevalence before the age of 60 and in males. Additionally, sunburns before the age of 20 were significantly associated with both more than 50 common melanocytic nevi (relative risk = 1.7) and the presence of atypical melanocytic nevi (relative risk = 1.5). Actinic lentigines were found more frequently with increasing age, and the presence of actinic lentigines was significantly related to a tendency of freckling in adolescence (relative risk = 2.0) and to two or more sunburns after the age of 20 (relative risk = 1.6). In conclusion, sunburns before the age of 20 contribute to the development of multiple melanocytic nevi and atypical melanocytic nevi. In adulthood, this type of sun exposure is associated with the development of actinic lentigines. The relative risk of developing cutaneous melanoma increases in association with the development of these benign melanocytic lesions.

Different pigmentary characteristics as well as different parameters of sun exposure have previously been identified as risk factors for developing cutaneous melanoma. The aim of the present study was to identify significant risk factors, determine the related magnitude of their estimated relative risks, and define criteria for the detection of persons at risk. Five hundred thirteen melanoma patients and 498 controls matched for age and sex underwent a whole-body examination for the number and type of melanocytic lesions and were interviewed on ultraviolet exposure and other potential risk factors. The total number of common melanocytic nevi on all body sites represented the most important risk factor in multiple logistic regression analysis with a relative risk of 7.6 for subjects with more than 100 versus no more than 10 melanocytic nevi. Other significant independent risk factors were the number of atypical melanocytic nevi (relative risk, 6.1 for at least 5 melanocytic nevi versus none), the number of actinic lentigines (relative risk, 3.5 for many versus none), hair color, skin type, and reported melanocytic nevus growth. No single parameter of sun exposure was significantly related to melanoma risk in the multivariate analysis. Groups with an estimated relative risk between 1 and 121.0 were distinguished by considering common and atypical melanocytic nevi as well as actinic lentigines as the decisive criteria. In conclusion, even without any information on the case history, whole-body examination and diagnosis of pigmented lesions was found to be an effective strategy for identifying persons at risk of developing melanoma. Furthermore, clinical recognition of at least 5 atypical melanocytic nevi without histologic examination is a key for identifying subjects at high risk.

The frequency of malignant melanoma is increasing worldwide and comprises in middle Europe about 10 per 100,000 inhabitants per year; it is fatal in each forth or fifth patient. Risk factors may be endogenous, like fair skin with high sensitivity for sun exposure and the presence of many, possibly atypical ('dysplastic') naevi, or exogenous, e.g. excessive exposure to ultraviolet light. The superficial spreading malignant melanoma is the most common form of clinical manifestation. Applying the A (asymmetry), B (border), C (color), D (diameter), E (elevation) rule is a reliable help for making the diagnosis of malignant melanoma. The differential diagnosis besides various naevi comprises a wide spectrum of pigmented new formations of the skin. Classification of malignant melanoma follows the TNM system; spread, tumor thickness and/or level of infiltration are appropriate parameters. The most important prognostic parameter is tumor thickness, which results in 10-year survival time of only 30% if it exceeds 3 mm. The therapy of malignant melanoma is performed by excision with margins between 1 and 3 cm, depending on tumor thickness. Frequency and type of investigations for follow-up controls depend on the risk for metastases, i.e. on tumor thickness. Best prevention is achieved by avoiding excessive exposure to ultraviolet light, especially during childhood, and by early diagnosis of thin melanoma.

In dermatologic oncology several good indications for radiotherapy are known. Precancerous lesions can be treated by grenz rays, as e.g. large senile (actinic) keratoses, lentigo maligna or large lesions of Bowen's disease or Queyrat's erythroplasia. Well-known indications are also mid-sized basal cell and squamous cell carcinomas, especially in the face of elderly patients. The lentigo-maligna melanoma should no longer be considered a radioresistant tumor, and it must be stressed that larger lesions can be successfully treated by radiotherapy. Dermato-radiotherapy shows also excellent palliative results, e.g. in cutaneous T-cell lymphomas such as mycosis fungoides, but also in Kaposi's sarcoma either of the classical type or AIDS-associated. In conclusion, radiotherapy is a good alternative treatment modality, especially in elderly patients, since it is painless and is possible on an outpatient basis with excellent functional results.

We present a clinically atypical case of discoid lupus erythematosus in the mother of a boy with chronic granulomatous disease. In this disorder, the phagocytes are unable to produce superoxide anion to degrade incorporated microorganisms. In addition to a discoid lupus erythematosus-like skin disease, recurrent stomatitis aphthosa, hidradenitis suppurativa and Raynaud phenomenon are markedly associated with heterozygote carriers of chronic granulomatous disease. Based on this conspicuous association, diverse models concerning the pathogenesis of lupus erythematosus are discussed.

A 51-year old patient with congenital basal cell naevus syndrome was treated with etretinate (50-100 mg/daily) over a period of 5 years (cumulative dose 110 g). Clinically he developed a stiff back with pronounced disability of both hips. Radiologically, axial involvement of the spine with severe diffuse idiopathic skeletal hyperostosis especially of the lumbar spine, and ossifications of both hips were documented. Rheumatological implications of long-term therapy with etretinate are discussed.

A 23-year-old woman presented with subcutaneous ossification, which together with short stature, stocky physique, round face and brachydactyly suggested Albright's hereditary osteodystrophy (AHO). Serum calcium and phosphorus levels were normal. AHO refers to the phenotype of the syndromes of pseudo-hypoparathyroidism (PHP) type Ia and pseudopseudohypoparathyroidism (PPHP), both considered genetically related variants with a defect of the alpha subunit of the stimulatory G protein of adenylate cyclase, necessary for the action of parathyroid and other hormones using cyclic AMP as an intracellular second messenger. PPHP differs from PHP in that it lacks parathyroid hormone resistance manifesting itself as hypocalcemia. Other endocrine end organ unresponsiveness, e.g. hypothyroidism and hypogonadism, may also be found with PHP. Both PHP and PPHP usually exhibit characteristic phenotypic abnormalities, of which subcutaneous ossification may be a presenting feature. The differential diagnosis of cutaneous calcification and ossification is outlined.

Three patients with atypical courses and manifestations of pityriasis lichenoides chronica (PLC) are presented. The first patient is a 21-year-old white woman who showed a good response of her PLC lesions as well as her reactive oligoarthritis to repeated PUVA treatments combined with oral prednisone during 1 year. The effect of the treatment then decreased. The patient developed a low-grade malignant lymphoma of the lung. When the lymphoma of the lung improved after chemotherapy, the PLC eruptions improved, too. The second patient is a 41-year-old man, whose Hodgkin's disease stage IVa was successfully treated by chemotherapy and radiotherapy in 1984. In 1987 he showed PLC lesions which responded well to PUVA therapy, later also in combination with etretinate. Until 1988 repeated skin biopsies revealed a non-specific eczematous pattern. In 1989 the recalcitrant PLC eruptions finally revealed a pleomorphic non-Hodgkin lymphoma of the skin with medium-sized cells. The third patient had a PLC for about 9 years when Hodgkin's disease stage Ia was diagnosed. At the beginning the skin biopsy showed an eczematous pattern, but 2 years later, in 1990, skin infiltrations of a large-cell, anaplastic non-Hodgkin lymphoma were seen. These cases show that PLC in rare cases may either represent a paraneoplastic skin disease or may itself develop into cutaneous lymphomas.

We describe 9 patients who presented Becker's nevus (BN) together with a malignant melanoma (MM). Eight patients were male. In 5 patients the MM was on the same body site as the BN. The melanoma was of the superficial-spreading type in 7 cases and in 1 patient was within the BN. Twice a dysplastic-nevus syndrome was diagnosed and in 2 patients a familial melanoma. To the best of our knowledge this is the first report of the co-occurrence of BN and MM.

We present an 84-year-old white male patient who, during a 2-year period, developed successively tumor infiltrations of an angiosarcoma in his face. The tumor started at the right lower eyelid, later appeared on the nose, the front, the cheeks and the earlobes. The first clinical impression was that of a rosacea. The tumors where successfully treated by soft X-rays, the total doses ranging from 4,800 to 5,600 cGy.

This report defines the influence of field soft X-ray irradiation on the integrity of epidermal Langerhans cells (LC) in the guinea pig and mouse systems. Male albino (Rockefeller strain) and piebald F 1 (2 X 13 strain) guinea pigs as well as C3H mice (H-2Kk) were exposed to one single shot of different dosages of soft X-rays [80, 1,200, 1,600, and 3,200 R; 30 kV, 0.5 mm aluminium filter, FSD (focus-skin distance) 12 cm]. 1 and 4 weeks after exposure, skin specimens were taken from the irradiated skin. The demonstration and evaluation of LC was performed basing on their expression of specific histochemical (ATPase) and functional immunologic markers (Ia antigens). Soft X-irradiation had pronounced effects on number and structure of ATPase- and Ia-antigen-positive cells. In the mouse system, 1 week after exposure to 800 and 1,200 R ATPase-positive cells and, in a more or less parellel manner, Ia-antigen-positive cells () were reduced to 74% (74%) and 70% (68%), respectively, and 4 weeks after exposure to 49% (47%) and 43% (40%), respectively. In the guinea pig system one single shot of 1,600 or 3,200 R produced, respectively, a 35% or a 38% reduction of ATPase-positive cells. Prolonged survival did not result in a further depletion of ATPase-positive cells.

A new subgroup of malignant melanoma, acral-lentiginous melanoma (ALM), is presented, which the authors have diagnosed in 8% of their melanoma patients. In a retrospective study the clinical and pathological findings in 44 patients with ALM are reviewed. A relationship was found between age, tumor diameter and thickness, pigmentation, ulceration, vasoinvasion and mitoses. The author's patients had a 5-year survival rate of 58%.

We treated 26 patients with condylomata acuminata with a 0.5% solution of podophyllotoxin (Condyline). Twelve of these patients were unsuccessfully pretreated with a common podophyllin 20% solution - some of them up to three months. In 22 patients (84.5%) we observed complete healing of lesions within 30 (6 bis 175) days with podophyllotoxin. Prompt response, minor side-effects, and the possibility for the patients to carry out the treatment themselves are the advantages of this podophyllotoxin preparation.

Surgery is without question the treatment of choice for the malignant melanoma (MM) of the skin. Radiotherapy, on the other hand, has been more and more neglected, especially because of the opinion that melanomas are "radioresistant". Because there is an increasing interest in the radiotherapy of MM in the recent years, and reviewing the experimental and clinical findings in the literature the following points are made: MM is not a "radioresistant" tumour and therefore the expression reduced radiosensitivity should be used instead; radiotherapy with beams of low linear energy transfer (LET) is also possible if the techniques involve the use of high dose per fraction or multiple fractions per day; different types of MM of the skin show a variable radiosensitivity in vitro and in vivo; and indications still exist for the radiotherapy of MM. All possibilities for the use of radiotherapy alone in MM have not yet been exhausted.

Groups of 10 CF1 female mice, irradiated to the thorax with a dual-head 137Cs gamma-RAY source, received single doses of 0, 5, 10, 15, or 25 Gy. One to forty-eight weeks later collagen synthesis was measured in minced skin specimens incubated in medium containing [3H]proline and then assayed for radioactive hydroxyproline. A progressive, generally dose-dependent increase in collagen biosynthesis, up to 50% above control sites, was found 1, 4, and 12 weeks after radiation exposure. These changes showed further small fluctuations at 12-36 weeks, increasing again at the 48-week interval. At the same times throughout the study fibroblasts were cultured from skin explants. Following the second subculture, these cells were also incubated in medium containing [3H]proline, and collagen synthesis was again determined by [3H]hydroxyproline assay. At all radiation dose levels studied, collagen production increased threefold by 12 weeks postradiation and remained elevated for the 48-week duration of the study. In vitro radiation dose response differences were not observed.

Clinical findings in Peutz-Jeghers-Syndrome in a 14-year-old female patient are presented. In addition differential diagnosis and therapeutic possibilities are discussed. Furthermore, the authors assume that ultrastructural characteristics of this pigment disorder are described for the first time.

A case of Morbus Kaposi in a 75-year-old patient is presented.

The authors describe 4 patients with Becker's nevus (BN) in two families. Another 4 patients of the german literature are also presented. Together with the first two published cases of BN, familial BN is now known in 10 patients. All three clinical types of BN could be noticed.

Keratosis lichenoides chronica may be seen clinically and histologically as a variant of lichen planus. One in three patients have nail involvement with changes that may superficially resemble psoriasis, but pitting and pustulosis do not occur. Hyperkeratotic hypertrophy of the periungual tissues is a distinctive feature. Psoralens and UV-A therapy as well as etretinate have improved some cases.

A clinico-pathologic study on 12 patients with subungual malignant melanoma (SUM) is presented and cases from the literature are reviewed. The difficult diagnosis of SUM as well as the differential diagnosis is discussed. The SUM sometimes called "melanotic whitlow", is often misdiagnosed and therefore may worsen the prognosis. Every persistent nail disorder which does not respond to treatment should rise suspicion of SUM, especially if not pigmented.

The study presented here is based on the clinicopathological and electron microscopical analysis of 39 patients with Becker's nevus (BN). The clinical picture is variable and we therefore suggest the following three types be distinguished: (1) the melanotic type, (2) the hypertrichotic type, and (3) the mixed type. In BN the sensitivity reaction was often diminished. Among the skin eruptions other than BN, we would like to stress that 12% of our patients showed a malignant melanoma. Histopathology concerns both epidermal and dermal structures. The electron microscopic findings corresponded well with those by light microscopy. As far as we know, the changes in collagen fibrils are demonstrated for the first time in this study.

In a 31-year-old patient with a basal cell nevus syndrome two basal cell epitheliomas occurred through exogenous factors. The tumors appeared within 18 years after BCG vaccination and 3 years after an intravenous drip respectively. In basal cell nevus syndrome this course of development of basal cell carcinomas is seldom described.