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Background A recent noninferiority randomized controlled trial ( RCT) indicated that imiquimod can be considered as superior to methylaminolevulinate photodynamic therapy ( MAL- PDT) in the treatment of superficial basal cell carcinoma (s BCC). Knowledge of treatment effectiveness in subgroups of patients is of great value in clinical practice to select the most effective treatment for an individual patient with s BCC. Objectives To explore whether the relative treatment effect of MAL- PDT and imiquimod is consistent across subgroups defined by patient and tumour characteristics. Methods Data were derived from a single-blinded, noninferiority, multicentre RCT comparing MAL- PDT, topical imiquimod and fluorouracil ( ISRCTN79701845). Treatment success was defined as free of tumour recurrence at 12-month follow-up. Subgroup analyses were performed for subgroups defined by sex, age, tumour location and tumour size. Results Two hundred and two patients received MAL- PDT and 198 received imiquimod. The superiority of imiquimod vs. MAL- PDT was observed in subgroups of females, s BCC on the trunk and large tumours with risk differences in favour of imiquimod of 18·4% [95% confidence interval ( CI) 7·8-29·0%], 21·0% (95% CI 10·9-31·1%) and 18·9% (95% CI 7·1-30·7%), respectively. Higher probability of treatment success for imiquimod vs. MAL- PDT was consistently found in all other subgroups with the exception of s BCC localized on the lower extremities in older patients. In the latter subgroup, the risk difference at the expense of imiquimod was −57·3% (95% CI −81·7% to −32·9%). Conclusions Imiquimod remains the first-choice treatment for s BCC in terms of effectiveness. In older patients with s BCC on the lower extremities MAL- PDT might be preferred. Results should be interpreted carefully as subgroup analyses were exploratory and not driven by prior hypotheses. [ABSTRACT FROM AUTHOR]

Background Cosmetic results following non-invasive treatments are difficult to compare. Although qualified objective scar assessment scales are available, they are not used in dermatological studies. Usually a 4-point scale is used in dermatological scars. The reproducibility of this method has never been evaluated. Moreover, significant specific scar characteristics are lacking. The patient and observer scar assessment scale (POSAS) is a scale qualified for the assessments of surgical scars. It has proven to be as reliable as the widely used Vancouver Scar Scale, but has the advantage that it includes the patient's opinion and specifies different scar characteristics. Objective Both methods were used to evaluate cosmetic results following non-invasive treatments of superficial basal cell carcinoma (BCC). Methods A total of 54 lesions following non-invasive treatment for BCC in 54 patients were evaluated with the traditional 4-point scale and the POSAS. Results The 4-point scale showed the best reproducibility and had an intra-class correlation coefficient (ICC) of 0.66 (95% CI: 0.52-0.77) for a single observer and 0.85 (95% CI: 0.77-0.91) for multiple observers. The ICC of the POSAS was 0.41 (95% CI: 0.21-0.58) for a single observer and 0.67 (95% CI: 0.45-0.81) for three observers. The scar characteristics, vascularity and pigmentation were most decisive for the overall opinion. Conclusion The use of the 4-point scale is a valid method to compare scars of non-invasive dermatological treatments. Supplementary registering vascularity and pigmentation can be useful in future studies. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 25-year-old Sinhalese female patient who developed a diffuse palmoplantar keratoderma during childhood and suffered from Darier disease (DD). Topics include occurrence of small papules on her trunk during puberty, examination showing a diffuse palmoplantar keratoderma, with palmar pits, V-shaped notches, and longitudinal white bands in two finger nails, and the dffinding that DD in dark skin was often underdiagnosed.