Joel L. Cohen MD, Mariah R. Brown MD
No abstract details for the moment.
Raminder Saluja MD, Jane Khoury MD, Susan P. Detwiler MD, Mitchel P. Goldman MD
Objective: An evaluation of the histological and clinical response to varying density settings (-10%, 0, and 10% overlap) with a frac-
tionally scanned CO2 laser.
Study design: Clinical and histological study evaluating abdominoplasty excised tissue for depth of penetration and width of tissue
ablated with varying density and energy settings utilizing a scanned microsecond pulsed CO2 laser. These parameters were corre-
lated clinically with patients treated with similar density settings.
Participants: Fifteen patients were enrolled with 5 patients in each group: group 1 (density 1 settings), group 2 (density 2 settings)
and group 3 (density 3 settings).
Main outcome: Histological differences of width and depth of tissue ablated with varying density settings and correlation with pho-
todamage improvement clinically.
Methods: Six samples of excised abdominoplasty tissue were treated with increased energy and density settings and were evalu-
ated histologically. Clinically, 15 patients with photodamage to the face were randomized to receive a fractional CO2 laser treatment
with density levels ranging from 1 to 3.
Results: Microarrays of tissue injury were visualized with multiple areas of superﬁ cial to full-thickness epidermal thermal damage.
As energy increased (90W to 100W), the width of basophilic coagulation of the subepidermal collagen increased. Increased density
paralleled increased depth of penetration of subepidermal coagulation. Patient assessment of discomfort, erythema, edema, and
satisfaction with the procedure was proportional to increasing densities.
Conclusion: A fractional CO2 laser produces photorejuvenation, erythema, edema and discomfort in proportion with the depth and
extent of epidermal and subepidermal thermal damage.
Adam J. Mamelak MD FRCPC, Steven Q. Wang MD, Leonard H. Goldberg MD FRCP
Background: Skin cancers on the nose are very common. Excision of these tumors results in surgical defects that can pose a chal-
lenge to repair.
Objective: To present the authors’ experience of using linear closures (LC) to repair surgical defects on the nose in patients who
underwent Mohs micrographic surgery (MMS).
Methods: A retrospective analysis was conducted of 4765 patients with skin malignancies on the nose that were treated with MMS
between July 1997 and January 2006. The following variables were examined: type of repair, age, and sex of the patients, postopera-
tive size of the defect, type of malignancy, location of the defect, and ﬁ nal length of the closure. Short-term and long-term complica-
tions were evaluated and discussed. In a second study arm, a limited prospective cosmetic outcome assessment of patients with
nasal defects repaired by LC compared to ﬂ aps and grafts was also conducted.
Results: There were 2053 patients (1020 men and 1033 women) who underwent LC of nasal defects after MMS. The average post-
operative defect size was 1.7 X 0.9 cm, with an average closure length of 2.7 cm (range: 0.6 cm to 8.5 cm). The 2 major malignancies
treated were basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) . Short-term complications were minimal. Nasal asym-
metry and/or raising of the nasal alae were occasionally seen, which improved over time. The cosmetic outcomes of the LC group
were rated higher than the ﬂ ap/graft group for lesions on the nose, although this was not statistically signiﬁ cant.
Conclusions: A vertical or slightly vertical linear closure for nasal defects after Mohs micrographic surgery is a robust and reliable
method to deliver excellent cosmetic and functional results. Linear closure should be considered for small and mid-sized cutaneous
nasal defects whenever possible.
Lionel Resnick MD, Harold Rabinovitz MD, David Binninger PhD, Maria Marchetti PhD, Herbert Weissbach PhD
Background: Actinic keratoses (AKs) are a precancerous condition of the skin that have the potential to become squamous cell
cancer (SCC). Sulindac is a Food and Drug Administration (FDA)-approved nonsteroidal anti-inﬂ ammatory drug (NSAID) that has been
shown to have clinically signiﬁ cant anticancer effects. Malignant cells may have a different response to oxidative stress than normal
Objective: To establish a role of increased reactive oxygen species (ROS) in the mechanism of cancer killing by sulindac in the
presence of an oxidizing agent. To assess the tolerability and efﬁ cacy of the combination of gels containing sulindac and hydrogen
peroxide in the treatment of patients with AKs.
Methods: Cell culture studies were performed using a skin SCC cell line and normal human epidermal keratinocytes. After treat-
ment with sulindac and an oxidizing agent, cell viability, and intracellular ROS levels were measured. An open-label clinical trial was
performed using sulindac and hydrogen peroxide gels daily for 3 weeks on AKs involving the upper extremities.
Results: In SCC cells, a combination of sulindac and an oxidizing agent lead to 400 to 500% increases in intracellular ROS, which
resulted in signiﬁ cant cell death. In sharp contrast, normal keratinocytes did not show increases in ROS levels and were not killed. A
clinical trial using the combination of sulindac and hydrogen peroxide therapy in 5 patients with AKs revealed that 60% of the treated
AKs responded and 50% showed no residual AK on histopathology specimens after skin biopsy.
Limitations: The small number of patients and the lack of a placebo group.
Conclusion: Increased levels of ROS appear to be important in the selective killing of cancer cells in the presence of sulindac and
oxidizing agents. Further studies are necessary to deﬁ ne the role of the combination of sulindac and oxidizing agent therapy in pa-
tients with AKs and skin cancer.
Manal Salah MD, Nevien Sami PhD, Maha Fadel PhD
Topical treatment of resistant psoriatic plaque stage lesions may be difﬁ cult and the systemic therapies seem inappropriate. There-
fore, a topical 0.1% methylene blue (MB) hydrogel was prepared and evaluated for percent drug content, drug uniformity, pH, rheo-
logical and organoleptic characters such as feel tackiness, grittiness sensation, and transparency in addition to release kinetics study
in vitro. The efﬁ ciency of the photodynamic therapy (PDT) of MB photo-activated using 565 mW Light emitting diode (LED) 670 nm
was evaluated in patients with resistant plaque psoriasis. The gel was evaluated in single blinded study. The patients were subjected
to repeated sessions of irradiation, skin biopsies from each patient in the beginning and at the end of the sessions were taken for
histopathological studies. Results showed the hydrogel was transparent nongritty and the drug uniformly dispersed with pH=7.2 and
viscosity value= 25.04 Pa. The drug content was found to be 99.4 ± 0.15 %. Drug release was following zero order kinetics with rate
constant K= 0.348 ± 0.01 and T
1\2 = 0.95±0.5 hours. Sixteen patients experienced complete clearance of their treated lesions. Skin
appeared normal in color, texture, and pliability with no complications indicating the lack of skin sensitivity. Histopathological examina-
tions showed nearly normal epidermis at the end of all sessions. The authors concluded that the prepared hydrogel was safe, stable,
and very effective. The results are encouraging to accept MB as a photosensitizer for PDT and as a safe and effective method for
treatment of selected cases of resistant localized psoriasis.
Michael Shaffelburg MD FRCPC
Background: Field-directed therapies for actinic keratosis include photodynamic therapy and imiquimod.
Objectives: The author designed a randomized, vehicle-controlled, split-face study to explore the safety and efﬁ cacy of photody-
namic therapy followed by imiquimod.
Methods: The entire face of adults with ≥10 facial actinic keratoses were treated with photodynamic therapy with aminolevulinic acid
20% at baseline and at month 1. At month 2, imiquimod 5% cream was applied to one-half of the face and vehicle to the other half,
2-times-per-week for 16 weeks. Lesion counts were performed at baseline and months 1, 2, 3, 4, 6, and 12; and local skin reactions
assessments at months 2, 3, 4, and 6.
Results: Of 25 participants enrolled, 24 completed the study. Baseline median lesions were 23.5 and 21.5 for the imiquimod- and
vehicle-treated sides, respectively. At month 12, median lesion reductions was 89.9% versus 74.5% (P=.0023), respectively. No
subject discontinued for an adverse event. Severe local skin reactions occurring in the most participants were erythema (17%) and
ﬂ aking/scaling/dryness (13%).
Conclusions: Photodynamic therapy followed by imiquimod was well tolerated and improved reduction of actinic keratoses.
Alan Menter MD, William Abramovits MD, Luz E. Colón MS, Lori A. Johnson PhD, Ronald W. Gottschalk MD
Topical corticosteroids are widely used in the treatment of psoriasis. This study was conducted to compare the efﬁ cacy and safety of
clobetasol propionate (CP) 0.005% spray to calcipotriene 0.005%-betamethasome diproprionate 0.064% (C-BD) ointment in patients
with moderate to severe plaque psoriasis. Assessments were made at baseline, week 2, week 4 (end of treatment) and week 8 (4
weeks posttreatment). An assessment for Overall Disease Severity (ODS) found that 75% of CP spray-treated patients achieved a
rating of clear or almost clear after 4 weeks of treatment compared to 45% of C-BD ointment-treated patients (P=.003). Adverse
events were reported by less than one-third of patients from each treatment group (31% for CP spray and 33% for C-BD ointment).