[Clinical-therapeutic evaluation of a new dermatologic preparation for topical use with a base of alcyonide and neomycin].
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Biomedical subjects
Publications and source records attributed to M Cristofolini.
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The diagnosis and removal of precursor and early lesions is the only method to improve the prognosis and survival rate in malignant melanomas of the skin since the aetiology of the disease is unknown and treatment ineffective when the neoplasm is diagnosed at an advanced stage. A campaign for the prevention and early diagnosis of melanoma is based on the health education of the entire population with the distribution of illustrative material that by teaching people to examine their skin will show up suspicious pigmentary lesions that can be examined and removed by the dermatologist. Thin melanoma is always curable when removed and constitutes the basic tumour to be described to the public as it is easily identified and has constant, typical features. Among the precursors the most interesting lesions is the sporadic or familial dysplastic nevus despite the controversy over its pathogenic significance and morphological aspect. The other pigmentary neoplasias (congenital and acquired nevus) only must to be removed when they present changes resembling thin melanoma.
The authors report the results obtained treating 39 subjects affected from psoriasis with hydropinic therapy and thermal balneo-therapy, using the thermal water of Comano. At the end of the treatment the results were rather bad with an inclusive reduction of 8.5% of the lesions as regards the initial data, but after 3-6 months an average per cent reduction of the lesions about 50% and in some cases quite a total regression of the psoriasis has been noted. No kind of collateral effects has been noted.
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A case of angiosarcoma involving primarily the gingiva in an 86-year-old woman is reported. The neoplasm was strongly positive for factor VIII-related antigen, negative for cytokeratins, and positive for vimentin, confirming the vascular nature of the tumor. The patient died from heart failure 1 month after surgical excision of the lesion without clinical evidence of metastasis.
Aspiration biopsy cytology is an accurate, safe, innocuous alternative to excisional biopsy in diagnosing the nature of concomitant superficial nodules or lymphadenopathy in patients with known cutaneous malignancy. In patients with penile cancer, aspiration biopsy cytology may avoid the morbidity (30-50%) and mortality (3%) of groin dissection staging. A positive aspirate is conclusive of Stage III tumor and, in patients with occult nodal metastases, may lead to early curative lymphadenectomy. In the present study of 28 patients with known cutaneous malignant melanoma, the aspiration biopsy cytology of 31 superficial nodules resulted in a cytologic diagnosis of metastasis in 29 nodules from 26 patients. In the management of patients with known melanoma, the positive cytology of superficial nodules is conclusive of metastatic disease and requires an accurate radiologic study to establish or exclude disseminated disease. Surgical removal of a metastatic superficial nodule is indicated when the lesion is considered localized disease and the patient, having been accurately examined, is determined to be apparently free of disease in other sites and organs. When systemic diffuse melanoma is found, the excision of metastatic superficial nodules is unnecessary. Positive aspiration cytology may avoid risk from ill-judged surgical procedures and indicate appropriate palliative treatment of the disease.
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Four patients with keratoacanthomas 2 to 3 cm in size were treated with etretinate. All the patients demonstrated early response and complete regression of the lesions. Follow-up (of 24 months in one case) did not reveal any recurrence.
Twelve cases of malignant spindle-cell and sarcomatoid tumours of the skin of debatable nature were studied by immunocytochemical methods, using four antisera which might help contribute to resolution of the problems. The initial diagnosis made on structural grounds was confirmed by immunocytochemistry in six of eight cases in which a specific diagnosis had been made (one melanoma, three squamous carcinomas and two atypical fibroxanthomas). One case, initially regarded as AFX was reclassified as a squamous carcinoma, while a further case of possible AFX could not be confirmed by immunocytochemical study. Of the four cases in which structural examination was inconclusive, two were identified as squamous carcinomas and one as a melanoma by virtue of tumour markers. The fourth case was an intriguing actin-rich tumour of uncertain nature. Immunocytochemistry, despite certain limitations, has a valuable role to play in the analysis of the problematic spindle-cell malignant and pseudomalignant tumours of the skin.
The management of nevoid basal-cell carcinomas in this syndrome is sometimes very difficult, because of the high number of tumors and of their particular localizations. The authors reviewed the literature and here report their experience in the treatment of nevoid basal-cell carcinoma syndrome with aromatic retinoid etretinate (RO 10-9359; Tigason).
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A case of a gigantic metastasizing keratoacanthoma in a woman who had impaired cellular immunity and autoimmune hemolytic anemia is described. The case suggests that disorders of humoral and cellular immunity may be responsible for development of recurrent and metastasizing keratoacanthomas.
Three derivatives of angelicin (1) [4'-methyl-, 4,4'-dimethyl-, and 4',5-dimethylangelicin (2a-c)] have been prepared with the aim of obtaining new agents for the photochemotherapy of psoriasis. These compounds form a complex in the dark with DNA that shows an affinity for the macromolecule higher than that of the parent angelicin (1). A correlation between their octanol/water partition coefficients and the association constants of the complexes has been observed. Compounds 2a-c photobind to DNA to a much higher extent than 1 and also more effectively than 8-methoxypsoralen (8-MOP), taken as reference compound. When activated with UV-A, the three compounds strongly inactivate T2 phage and inhibit epidermal DNA synthesis in mice. Moreover, they show a mutagenic activity markedly lower than that of 8-methoxypsoralen on Escherichia coli wild-type strain. Due to its lack of skin phototoxicity, its low mutagenic activity, and its antiproliferative activity, 2c was chosen for clinical evaluation. It proved to be effective in clearing psoriasis in two patients.
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