225treated by X-ray therapy, which is about the same proportion as at the start of my surgical odyssey 25 years ago.In a recent, otherwise excellent, review article entitled Skin Cancer: Recognition and treatment^ on page 56, under *treatment of non melanoma skin cancer', radiation therapy does not even rate a mention. This is totally inexplicable to me. I believe a more balanced view is provided by the quote from an article from TXicson, Arizona, presumably an area where basal cell carcinoma is also extremely prevalent;... cure rates achieved with radiation therapy alone are suqiassed only by the rales achieved wilh Mohs micrographic surgery. Radiation therapy produces hetter f\inctionat and cosmetic resuits than surgical excision for carcinomas t cm in size or larger, that involve the eyeiids, pinna of the ear. tip or other areas of the nose, or the skin of the upper lip.'The demise of X-ray therapy among dermatologists must have other reasons apart from results. Licensing problems, costs and pressures from radiotherapists may be why. Dermatologists must retain a multi-modalic approach if we are to continue to be perceived as the experts in treatment of skin cancer. A recent example that illustrates how we are losing ground in the status stakes is this remarkable criteria statement for the use of Interferon in the treatment of basal cell carcinomas produced by Pharmac, the pharmaceutical regulating body in New Zealand. 'Applications only from Radiation Oncologists, Plastic Surgeons and Dermatologists. Applications from Dermatologists will only be accepted with evidence from either a Plastic Surgeon or Oncologist that the patient was unsuitable for surgery'.* REFERENCES 1. Adams JD. TYansposition flap repair. Australas. J. DermatoL 1982; 23: 78-81. Dear Editor, Benign persistent papular acantholytic and dyskeratotic eruption with features of warty dyskeratoma * Different papular lesions are, to varying degrees, characterized by acantholysis and dyskeratosis,*"* These conditions may be solitary or multiple, cutaneous or mucosal. persistent or transient, familial or sporadic.We report a case of a 47-year-old white man with multiple acquired papulokeratotic lesions which appeared on his left chest and abdominal wall 6 months prior to consultation. He presented with the lesions during the winter months, and Figure 1 Papulokeratotic lesions on left cbest wall.Figure 2 Skin biopsy specimen showing a cup-shaped invagination of the acanthotic epidermis with a central parakeratotic core. At the basal layer, acantholysis and dyskeratosis can be seen (H&E).these did not worsen in the summertime. They were asymptomatic and, up to the time of writing this report, had persisted for 18 months. Physical examination disclosed several fleshcoloured to light brown, sometimes grouped, keratotic papules with crusted and umbilicated centres. They were 4-8 mm in size (Fig. 1). No other cutaneous or mucosal anomalies were present. His nails were also normal. There was no family history for disorders of keratinization. Dermal ridges wer...
been completely elucidated. Sjolin-Forsberg et al. suggest a local anti-inflammatory effect due to chloroquine's accumulation in the skin and the resultant decrease in cellular infiltrates after UVB exposure. 5 Recent results indicate that 3 months of chloroquine treatment significantly lower IL-6, IL-18 and TNF-α serum levels. 6 These data support the claim that anti-malarials have an anti-inflammatory effect, and this would help explain their photoprotective properties. Collectively, this evidence strongly supports the use of anti-malarials in LE patients, along with sunscreens and sun-protective clothes, especially during the spring and summer season.A Wozniacka,* † A Lesiak, † DP McCauliffe, ‡ A Sysa-Jedrzejowska † †Department
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