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Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008
Five-Year Follow-up of a Randomized, Prospective Trial of Topical Methyl Aminolevulinate Photodynamic Therapy vs Surgery for Nodular Basal Cell Carcinoma
Objective: To compare 5-year lesion recurrence rates in primary nodular basal cell carcinoma treated with topical methyl aminolevulinate photodynamic therapy (PDT) or simple excision surgery.
Design: Prospective, randomized, multicenter study.
Setting: University hospital dermatology departments.
Patients: A total of 97 patients, 50 with 53 lesions treated with methyl aminolevulinate PDT and 47 with 52 lesions treated by excision surgery, were included in the per protocol analysis. Of the lesions treated with methyl aminolevulinate PDT and surgery, 49 and 52, respectively, showed complete clinical response at 3 months after treatment and were observed for long-term outcome evaluation.
Interventions: Topical methyl aminolevulinate cream, 160 mg/g, applied for 3 hours before illumination (75 J/cm2 of red light at 570 to 670 nm) on 2 or 4 occasions (12 [23%] of 53 lesions); or excision surgery.
Main Outcome Measures: Histologically confirmed lesion recurrence, sustained lesion complete response rate (time-to-event analysis), and investigator assessment of cosmetic outcome, 5 years after the last treatment.
Results: At 5 years, recurrence was documented in 7 (14%) of 49 lesions (95% confidence interval [CI], 6%-27%) treated with methyl aminolevulinate PDT vs 2 (4%) of 52 lesions (95% CI, 1%-13%) treated with excision surgery (P = .09). Estimated sustained lesion complete response rates were 76% (95% CI, 59%-87%) and 96% (95% CI, 84%-99%), respectively (P = .01). More patients treated with methyl aminolevulinate PDT than surgery had an excellent or good cosmetic outcome: 27 (87%) of 31 patients (95% CI, 70%-96%) vs 19 (54%) of 35 patients (95% CI, 37%-71%) (P = .007).
Conclusions: Long-term follow-up indicates superior efficacy of surgery to methyl aminolevulinate PDT in nodular basal cell carcinoma. However, methyl aminolevulinate PDT is also an effective treatment for this indication and exhibits a more favorable cosmetic outcome.
Rhodes LE, de Rie MA, Leifsdottir R, et al
Effect of Cold Air Cooling on the Incidence of Postinflammatory Hyperpigmentation After Q-Switched Nd:YAG Laser Treatment of Acquired Bilateral Nevus of Ota–like Macules
Objective: To investigate the effect of cold air cooling on the incidence of postinflammatory hyperpigmentation (PIH) after laser treatment in Asian patients.
Design: Randomized, controlled, split-face study.
Setting: Skin laser center of a university hospital.
Patients: Twenty-three Thai women with acquired bilateral nevus of Ota–like macules.
Interventions: Patients were treated using a 1064-nm Q-switched Nd:YAG laser at an average fluence of 7.0 J/cm2 using a 3-mm spot size. The same laser fluence was used on both sides of the face in individual patients. One randomly selected face side of each patient was cooled using a cold air cooling device during and 30 seconds before and after laser irradiation, and the other side was irradiated without cooling.
Main Outcome Measures: Occurrence of PIH was objectively evaluated by measuring the melanin index using a spectrometer, and it was subjectively assessed by 2 nontreating physicians before treatment and once weekly for 4 weeks.
Results: Of the 21 patients who completed the study, 13 (62%) and 5 (24%) developed PIH on the cooled and uncooled sides, respectively. One patient (5%) had PIH on both the cooled and uncooled sides, and 2 (10%) did not experience PIH. The cooled sides were significantly more likely to become hyperpigmented after laser irradiation than the uncooled sides (relative risk, 2.6; 95% confidence interval, 1.13-6.00; P = .03). The clinical evaluation corresponded to the spectrometer reading.
Conclusion: Epidermal cooling with cold air is associated with an increased risk of PIH after Q-switched Nd:YAG laser treatment.
Trial Registration: clinicaltrials.gov Identifier: NCT00287001
Manuskiatti W, Eimpunth S, Wanitphakdeedecha R
Consensus Panel Recommendations for Chronic and Acute Wound Dressings
Objective: To seek a consensus on recommendations that would help health professionals choose appropriate wound dressings in daily practice, since a systematic review found only limited evidence to support reported indications for modern wound dressings.
Participants: A steering committee selected a panel of 27 experts with no declared conflicts of interest from lists of nursing staff and physicians (specialists or general practitioners) with long-standing experience of wound care. The lists were put forward by 15 French learned societies.
Evidence: The panelists received a recent systematic review of the literature, a classification of indications established by a working group, and definitions for the dressings.
Consensus Process: The steering committee designed questionnaires on chronic wounds and on acute wounds including burns for each of the 2 panels. The consensus method was derived from the nominal group technique adapted by RAND/UCLA. Panelists rated the relevance of each possible dressing-indication combination on the basis of the published evidence and their own experience. After the first round of rating, they met to discuss results and propose recommendations before taking part in a second round of rating. The working group peer reviewed the final recommendations.
Conclusions: A strong consensus was reached for use of the following combinations: for chronic wounds, (1) debridement stage, hydrogels; (2) granulation stage, foam and low-adherence dressings; and (3) epithelialization stage, hydrocolloid and low-adherence dressings; and for the epithelialization stage of acute wounds, low-adherence dressings. For specific situations, the following dressings were favored: for fragile skin, low-adherence dressings; for hemorrhagic wounds, alginates; and for malodorous wounds, activated charcoal.
Vaneau M, Chaby G, Guillot B
Topical Oxygen Emulsion: A Novel Wound Therapy
Objective: To investigate the use of a topical oxygen emulsion (TOE), consisting of a supersaturated oxygen suspension using perfluorocarbon components, on second-degree burns and partial-thickness wounds.
Design: Oxygen is a required substance for various aspects of wound repair, and increased oxygen tension in a wound has been shown to stimulate phagocytosis and to reduce the incidence of wound infection. Second-degree burns and partial-thickness wounds were created on the backs of specific pathogen-free pigs. Wounds were then randomly assigned to 1 of the following treatment groups: TOE, TOE vehicle, or air-exposed control.
Main Outcome Measure: Wounds were assessed for complete epithelialization using a salt-split technique.
Results: The TOE was able to significantly (P = .001) enhance the rate of epithelialization compared with both vehicle and untreated control. These data suggest that topical oxygen may be beneficial for acute and burn wounds.
Conclusions: The results obtained from this double-blind, control, in vivo study demonstrate that TOE can significantly enhance the rate of epithelialization of partial-thickness excisional wounds and second-degree burns. These findings could have considerable clinical implications for patients with surgical and burn wounds by providing functional skin at an earlier date to act as a barrier against environmental factors, such as bacteria invasion. Other types of wounds may also benefit from this therapy (eg, chronic wounds and surgical incisions). Additional studies, including clinical studies, are warranted.
Davis SC, Cazzaniga AL, Ricotti C, et al
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2008;10(1):68–69. doi:
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