The management of solitary trichoepithelioma versus basal cell carcinoma

Currently, all lesions diagnosed clinically as basal cell carcinoma (BCC) are treated by the excision of the lesion with 3–4 mm margins followed by histopathological examination to assess clearance and confirm the diagnosis. We present the findings of surgical incisional and excisional biopsy of three young patients diagnosed on clinical examination as having BCC, who were found on histological examination to have trichoepithelioma. Whilst it may be possible to distinguish the features of trichoepithelioma in incisional biopsy specimens on morphological grounds alone it is often difficult, and immunohistochemical staining, to delineate the features of the basement membrane, provides useful additional information in the histological diagnosis. As trichoepithelioma is more common in the young it should be considered in the differential diagnosis in young patients presenting with BCC-like lesions of the periocular tissues. This subgroup of patients should have incisional biopsy carried out, and if the diagnosis of trichoepithelioma is confirmed the lesion may be excised with a small margin of healthy tissue, thereby facilitating surgical repair

A phase I vaccination study with tyrosinase in patients with stage II melanoma using recombinant modified vaccinia virus Ankara (MVA-hTyr)

A significant percentage of patients with stage II melanomas suffer a relapse after surgery and therefore need the development of adjuvant therapies. In the study reported here, safety and immunological response were analyzed after vaccination in an adjuvant setting with recombinant modified vaccinia virus Ankara carrying the cDNA for human tyrosinase (MVA-hTyr). A total of 20 patients were included and vaccinated three times at 4-week intervals with 5x10(8) IU of MVA-hTyr each time. The responses to the viral vector, to known HLA class I-restricted tyrosinase peptides, and to dendritic cells transfected with tyrosinase mRNA, were investigated by ELISpot assay on both ex vivo T cells and on T cells stimulated in vitro prior to testing. The delivery of MVA-hTyr was safe and did not cause any side effects above grade 2. A strong response to the viral vector was achieved, indicated by an increase in the frequency of MVA-specific CD4+ and CD8+ T cells and an increase in virus-specific antibody titers. However, no tyrosinase-specific T-cell or antibody response was observed with MVA-hTyr in any of the vaccinated patients. Although MVA-hTyr provides a safe and effective antigen-delivery system, it does not elicit a measurable immune response to its transgene product in patients with stage II melanoma after repeated combined intradermal and subcutaneous vaccination. We presume that modification of the antigen and/or prime-boost vaccination applying different approaches to antigen delivery may be required to induce an effective tyrosinase-specific immune respons