Based on the opinion that 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) may be disadvantageous to Oriental patients with dark skin, including Japanese, because the competing chromophore melanin inhibits the photochemical reaction, we assessed the therapeutic effects when Japanese AK were treated with ALA-PDT. Fifty-three lesions in ten patients were followed up for over one year. The cure rates of AK on the face including the neck and on extremities were 81.8% and 55.6%, respectively. The results were approximately the same cure rates as those reported for AK in Caucasian patients. However, a larger number of treatment sessions were required. In the red light range, incoherent light including 630 nm and 670 nm is superior to 630 nm laser light.
A 74-year-old woman with extensive inoperable vulval extramammary Paget's disease who had lymph node and pulmonary metastases, was treated with etoposide (VP16) 100 mg and 5000 cGy electron beam irradiation, which reduced the lesion by 60%. Following these interventions, the residual lesion was successfully treated with repeated photodynamic therapy using delta-aminolaevulinic acid, which achieved a nearly complete remission.
5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) in the standard manner is ineffective for pigmented basal cell carcinoma (pBCC), because melanin absorbs the photoactivating light interred for protoporphyrin IX. The objective of this study was to assess the therapeutic outcome of pBCCs with repeated ALA-PDT following removal of pigmentation with electro-curettage. After electro-curettage, 16 pBCCs were treated with a combination of topical application of 20% ALA in O/W emulsion and topical instillation of 10% ALA solution, followed by photoactivating light. ALA-PDT was performed more than three times. Fourteen of 16 pBCCs showed CR. Two pBCCs showing PR or NR were excised. Repeated ALA-PDT following electro-curettage was effective for pBCC.
We report a case of a 23-year-old woman with progressive hemifacial atrophy. She showed an atrophic change on the left side of her face for 8 years. A skin biopsy obtained from the lesion revealed the fibrotic changes in the deep dermis and adipose tissue with infiltrations of lymphocytes and plasma cells. She underwent the augmentation using a deepithelialized anteromedial thigh flap with endoscopic assistance. A specimen of the peripheral facial nerve taken from the region adjacent to the skin lesion during the operation showed atrophy of neurofibers with vacuole degeneration. On an electron microscopic examination, a high degree of degeneration of myelinated and unmyelinated axons was observed. These findings may provide direct evidence that atrophic changes of nerve fibers are closely related with the pathology of this disease.
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