Desire thinking as a mediator of the relationship between novelty seeking and craving.

Background: The construct of craving has been shown to play a crucial role in the development and maintenance of addictive behaviors. Both novelty seeking and desire thinking have been identified, respectively, as important temperamental and cognitive predictors of craving. Aims: In the present study we aimed to explore the relative contribution of novelty seeking and desire thinking towards craving, hypothesizing a sequence of multiple mediating relationships starting from novelty seeking and moving onto imaginal prefiguration, verbal perseveration and craving in serial fashion. Method: A convenience sample of 270 individuals completed measures assessing novelty seeking, desire thinking, and craving relating to a chosen activity. Results: Findings showed that, controlling for age and gender, desire thinking components predicted craving over and above novelty seeking. The indirect effect from novelty seeking to craving, via desire thinking components, was significant thus supporting a multiple-mediational sequence. Finally, the relationship between imaginal prefiguration and craving was found to be partially mediated by verbal perseveration. Conclusions: The findings provide support for the conceptualization of desire thinking as an independent construct in predicting craving over and above novelty seeking

Photodynamic therapy with topical methyl aminolaevulinate for 'difficult-to-treat' basal cell carcinoma

Background: Basal cell carcinoma (BCC) may be difficult to treat by conventional means, particularly if the lesions are large or located in the mid-face (H-zone). Photodynamic therapy (PDT) using topical methyl aminolaevulinate (MAL) may be a good noninvasive option for these patients. Objectives: To investigate the efficacy and safety of PDT using MAL for BCCs defined as ‘difficult to treat’, i.e. large lesions, in the H-zone, or in patients at high risk of surgical complications. Methods: This was a prospective, multicentre, noncomparative study. Patients were assessed 3, 12 and 24 months after the last PDT treatment. One hundred and two patients with ‘difficult-to-treat’ BCC were treated with MAL PDT, using 160 mg g−1 cream and 75 J cm−2 red light (570–670 nm), after lesion preparation and 3 h of cream exposure. Results: Ninety-five patients with 148 lesions were included in the per protocol analysis. The histologically confirmed lesion complete response rate at 3 months was 89% (131 of 148). At 12 months, 10 lesions had reappeared, and therefore the cumulative treatment failure rate was 18% (27 of 148). At 24 months, an additional nine lesions had reappeared, resulting in a cumulative treatment failure rate of 24% (36 of 148). The estimated sustained lesion complete response rate (assessed using a time-to-event approach) was 90% at 3 months, 84% at 12 months and 78% at 24 months. Overall cosmetic outcome was judged as excellent or good in 79% and 84% of the patients at 12 and 24 months, respectively. Follow-up is continuing for up to 5 years. Conclusions: MAL PDT is an attractive option for ‘difficult-to-treat’ BCC. Because of the excellent cosmetic results, the treatment is particularly well suited for lesions that would otherwise require extensive surgical procedures.C. Vinciullo, T. Elliott, D. Francis, K. Gebauer, L. Spelman, R. Nguyen, W. Weightman, A. Sheridan, C. Reid, D. Czarnecki, D. Murrel

A prospective study of the use of cryosurgery for the treatment of actinic keratoses

Background: Actinic keratoses are the most common actinic lesions on Caucasian skin. Cryosurgery with liquid nitrogen is commonly used to treat actinic keratoses, but there have been few studies examining the true rate of cure in everyday dermatologic practice. Aim: To determine prospectively the true efficacy of cryosurgery as a treatment for actinic keratoses in everyday dermatologic practice. Methods  A prospective, multicentered study (a subsidiary study of a photodynamic therapy trial) was performed. Patients with untreated actinic keratoses greater than 5 mm in diameter on the face and scalp were recruited. Eligible lesions received a single freeze–thaw cycle with liquid nitrogen given via a spray device and were reviewed 3 months thereafter. Each center used their preferred freeze time. The only treatment criterion was complete freezing of actinic keratoses and a 1-mm rim of normal skin. Treated lesions were assessed as complete response or noncomplete response. The influence of the duration of freeze, cosmetic outcomes, and adverse events were examined. Results: Ninety adult patients from the community with 421 eligible actinic keratoses were recruited. The overall individual complete response rate was 67.2%[SEM = ±3.5%; 95% confidence interval (CI) = 60.4–74.1%]. Complete response was 39% for freeze times of less than 5 s, 69% for freeze times greater than 5 s, and 83% for freeze times greater than 20 s. Cosmetic outcomes were good to excellent in 94% of complete response lesions. The main adverse events were pain, stinging, and burning during treatment, and hypopigmentation after healing. Conclusions: Cryosurgery is an effective treatment for actinic keratoses. The true complete response rate is significantly lower than that previously reported. The freeze duration influences successful treatment. Adverse events are mild and well tolerated.Keng-Ee Thai, Peter Fergin, Michael Freeman, Carl Vinciullo, David Francis, Lynda Spelman, Dedee Murrell, Chris Anderson, Warren Weightman, Catherine Reid, Alan Watson, Peter Fole