Efficacy and tolerability of 5-aminolevulinic acid 0.5% liposomal spray and intense pulsed light in wrinkle reduction of photodamaged skin

Photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) is effective for the treatment of photoaging

Prognostic Factors Influencing Tumor Response, Locoregional Control and Survival, in Melanoma Patients with Multiple Limb In-transit Metastases Treated with TNF alpha-based Isolated Limb Perfusion

Background: In isolated limb perfusion (ILP) with tumor necrosis factor-alpha (TNF alpha) and interferon (IFN)-gamma, pioneered by Lienard and Lejenne in 1988, TNF alpha was empirically employed at a dosage (3-4 mg) ten times higher than the systemic maximum tolerable close (MTD). We previously conducted a phase I/II study in 20 patients with in-transit melanoma metastases, using a combination of melphalan and TNF alpha at dosages ranging from 0.5 to 3.3 mg. The dose of 1 mg of TNFa was identified as optimal in terms of both efficacy and toxicity. The aim of the present study was to describe our experience with 113 stage IIIA/IIIAB melanoma patients treated with a TNF alpha-based ILP and identify prognostic factors for response, locoregional control and survival. Patients and Methods: Patients at stage IIIA-IIIAB (presence of in-transit metastases and/or regional node involvement) were considered eligible. The disease was bulky (>= 10 nodules :53 cm or fewer nodules with a diameter > 3 cm) in 42.5% of the patients and unresectable in 33%. Forty patients were treated with a TNFa dosage of > 1 mg and 73 with 1 mg. Patients with tumors in the tipper and lower limbs were submitted to ILP via axillary and iliac vessels, respectively. TNF alpha was injected in the arterial line of an extracorporeal circuit at the pre-established close, followed by melphalan (13 and 10 mg/l of limb volume for the upper and lower limbs, respectively) 30 minutes later. Results: Complete responses (CR) and partial responses (PR) were 63% and 24.5%, respectively, with an objective response (OR) of 87.5%. No change (NC) was observed in only 12.5% of the patients. Upon multivariate analysis, only bulky disease maintained its independent value for tumor response with an odds ratio of 4.07 and a p-value of 0.02. The 5-year locoregional disease-free survival was 42.7%. Upon multivariate analysis, the only prognostic factors were stage, age and bulky disease. The 5-year overall survival was 49%. Multivariate analysis showed that only, sex, stage and CR maintained their independent values. Conclusion: TNF alpha-based ILP was proven to be an effective treatment for melanoma patients with in-transit metastases. The TNF alpha dosage of 1 mg was as effective as 3-4 mg, with lower toxicity and cost. We propose that TNF alpha and melphalan-based ILP should be employed for bulky tumors or after failure of melphalan-based ILP

Diagnosis of pigmented skin lesions by dermoscopy: web-based training improves diagnostic performance of non-experts

Summary Background Dermoscopy has been shown to enhance the diagnosis of melanoma. However, use of dermoscopy requires training and expertise to be effective. Objectives To determine whether an Internet-based course is a suitable tool in teaching dermoscopy, and to evaluate the diagnostic value of pattern analysis and diagnostic algorithms in colleagues not yet familiar with this technique. Methods Sixteen colleagues who were not experts in dermoscopy were asked to evaluate the dermoscopic images of 20 pigmented skin lesions using different diagnostic methods (i.e. pattern analysis, ABCD rule, seven-point checklist and Menzies' method), before and after an Internet-based training course on dermoscopy. Mean ± SEM sensitivity, specificity and diagnostic accuracy, and kappa (κ) intraobserver agreement were evaluated for each diagnostic method before and after training for the 16 participants. Differences between mean values were assessed by means of two-tailed Wilcoxon rank-sum tests. Results There was a considerable improvement in the dermoscopic melanoma diagnosis after the Web-based training vs. before. Improvements in sensitivity and diagnostic accuracy were significant for the ABCD rule and Menzies' method. Improvements in sensitivity were also significant for pattern analysis, whereas the sensitivity values were high for the seven-point checklist in evaluations both before and after training. No significant difference was found for specificity before and after training for any method. There was a significant improvement in the κ intraobserver agreement after training for pattern analysis and the ABCD rule. For the seven-point checklist and Menzies' method there was already good agreement before training, with no significant improvement after training. Conclusions We demonstrated that Web-based training is an effective tool for teaching dermoscopy