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Notes: Objective There is accumulating evidence that in spite of the large campaigns against excessive solar exposure undertaken by dermatologists worldwide, children and adolescents are still spending long periods in the sun, and do not follow the recommended sun protection guidelines.The purpose of the present study was to evaluate sun exposure in a group of young Israeli adults and to compare it to their knowledge and application of the various sun protection methods.Methods 202 Caucasian volunteers, (mean age 21.4 ± 2.6), filled out detailed questionnaires on their sun exposure and sun protection habits.Results More than 80% of our study participants are regularly sun exposed for longer than 2 h per day whereas sunscreens are utilized only by 64.9%. Sunscreen use was significantly more prevalent in females than males (81.3% vs. 46.5%). The majority of sunscreen users and nonusers believed that sunscreen could prevent skin cancer (94.3% and 82.0%, respectively) and that these compounds can slow skin aging (90.8% and 76.4% respectively). The understanding of the meaning of the “SPF” was significantly higher in the sunscreen users (85%) than in the nonusers (62.0%). The majority of sunscreen users utilized less than 150 ml of the compound per year which is probably an inadequate amount for a year for full body protection. The two most common reasons for not using sunscreens regularly, were that the application is time consuming, and that sunscreens prevent tanning.Conclusion Our data reveals a discrepancy between a considerably good understanding of the need for sun protection and the still deficient application of these measures especially in young adult males.

Notes: Photodynamic therapy (PDT) is based on the phototoxicity of photosensitizers, mostly porphyrins. Since systemic photodynamic therapy with δ-aminolevulinic acid (δ-ALA) causes prolonged whole-skin photosensitivity, topical photodynamic therapy was developed. We describe the histological findings and the results of immunohistochemical staining for bcl-2 protein in the basal cell carcinoma of a 71-year-old patient treated by photodynamic therapy with δ-ALA. After histological confirmation of the diagnosis, 20%δ-ALA in an aqueous cream base was applied to one lesion for 3 h. After 3 h the tumor was exposed to light emitted by a Kodak carousel light projector. Biopsies were taken before exposure and at days 3 and 21 after exposure. The specimens were stained with hematoxylin-eosin and with monoclonal antibody to bcl-2 protein. The intermediate histological response 3 days after exposure was characterized by “squamoid” transformation of the tumor cells along with signs of necrosis, loss of bcl-2 expression and an inflammatory cell reaction. Clinical and histological examinations 3 weeks after treatment showed no sign of residual tumor.

Notes: A 39-year-old man developed sore throat with swallowing difficullies in late September 1983. A suspicion of foreign body in the esophagus was ruled out by esophagosc opy. At that time, the patient was in good general health, with normal body temperature. The only pertinent physical finding was a wide erosion over the right side of the palate, fie was admitted 3 weeks later to the otorhinolaryngology department at Rambam Medical Center because of a sudden worsening of his oral complaints and rise in body temperature to 38C with general malaise. On examination, there were wide erosions on the palate; and on laryngoscopy, the epiglottis showed edema, redness, and fibrin deposits. Total peripheral blood count showed hemoglobin 16 mg/dL and leukocytes 10.500/mm3, with a differential count of 75% polymorpho-nuclears, 1% stabs, 11% lymphocytes, l% monocytes, 5% eosinophils, and 7% atypical cells. The results of the following routine blood examinations were normal: glucose, urea, electrolytes, calcium, phosphorus, alkaline phosphatase, creatinine, uric acid, albumin, globulin, and complement C3 and C4. Electrophoresisand immunoelectrophoresis of serum proteins and urinalysis results were within normal values. Antinuclear factor was negative. The diagnosis of acute epiglottitis was made, and the patient was treated by intravenous crystalline penicillin with only slight improvement. A week later, a blistering eruption appeared on the skin, and the patient was transferred to the dermatologic department for further investigation. On examination, the eruption consisted of flaccid vesicles, bullae, and erosions on the back, dorsa of hands, and inguinal folds; erosions of the oral mucosa were still present. Nikoisky sign was positive. A biopsy specimen from the skin showed a suprabasal blister, and the basal cells remain attached to the dermis, giving a “row of tombstones” appearance (Fig. 1). The diagnosisof pemphigus vulgaris was made, and the patient was put on an initial dose of daily 100 mg fluocortolone. After 2 weeks, the dosage was elevated to 150 mg per day, and 10 days later, improvement was achieved. The dosage of oral corticosteroids was cautiously tapered, and the patient was discharged at the end of November 1983.The patient was well until mid-March 1984, on a maintenance dose of 50 mg fluocortolone every 48 hours. New oral lesions appeared suddenly, had a spontaneous remission a few days later, and reappeared again a week later, and the patient was readmitted to the dermatologit department. The fluocortolone was increased to a daily dose of 50 mg. The patient's general condition was good, with moon face and erosions on the oral mutosa and epiglottis. The relevant laboratory test results were leukocytes 10500/mm3, with a differential count of 76% polymorphonuciears, 3% eosinophils, 17% lymphocytes, and 4% atypical cells. Cytologic smears Irom oral erosions revealed acantholytic and multinucieated cells, some with inclusion bodies, HSV type 1 was isolated from oral smears. Serum antihodies against HSV were detected by complement fixation tesl in a liter of 1:40. During this hospitalization, a loose vesicle also appeared on the abdomen, which on histologic: examination showed a suprahasal blister, few acantholytic cells, and multinucleated cells in the detached epidermis (Fig. 2). Direct immunofluores-cence studies showed a deposition of intercellular IgG. Circulating antiepithelial IgG antibodies were present in a titer of 1:40. Because of the herpetic infection and to enable discontinuation of corticosteroid treatment, gold therapy was started with a weekly dose of 50 mg aurothioglucose intra-muscularly. A slow improvement was observed in the oral and epiglottal lesions. In mid-June 1984, new vesicles appeared on the oral mucosa and HSV was again isolated; a spontaneous remission followed a week later. After a total dose of 500 mg of gold compound was reached, the dosage of corticosteroids was gradually discontinued.

Notes: Impaired regulation of apoptosis is known to be associated with the development of various forms of cancer. Fas binding ro its ligand. Fas ligand (Fas-L), has been shown to trigger apoptosis in various cell types. Fas-L is expressed by melanoma cells and has been suggested to play a role in melanoma escape from immune surveillance. In the present study, we assessed apoptotic activity and examined Fas and Fas-L expression in malignant melanomas, Spitz nevi and ordinary melanocytic nevi. We evaluated apoptotic activity using terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling. Apoptotic activity was found to be minimal in melanomas and moderate in Spitz nevi. In contrast, common nevi demonstrated, significant levels of apoptosis in the deep parts of the tumor. Fas was found to be expressed by all Spitz nevi, most melanocytic nevi and approximately half of the malignant melanoma specimens. Fas expression was also significantly more pronounced in Spitz nevus cells as compared with, the two other tumors. The anti-Fas-L antibody was found to stain all three melanocytic tumors. Staining was shown to be stronger and more frequent in melanoma cells as compared to the nevus cells. Using the Spearman test, no significant correlation between Fas-L expression in melanoma cells and apoptosis in MM-infiltrating mononuclear cells was found, suggesting that Fas-L expression in melanoma cells may not be instrumental in their ability to escape immune mechanisms of defense. In contrast, increased levels of apoptosis in the deep parts of melanocytic nevi may reflect and possibly contribute to their benign nature.

Notes: This study was performed in an attempt to further elucidate the pathogenesis of delayed postburn blistering. Two cases were studied ultrastructurally and immunohistochemically, 1 with blisters on the recipient site of autologous split-thickness skin grafts and the other on the donor site. Ultrastructurally, the basement membrane was on the roof of the blisters in both cases, except for a single small blister in the first case where it was on the dermal floor. In the blister roofs, the basement membrane showed small or marked segments of discontinuity. In the adjacent non-blistered healed skin, the basement membrane was usually continuous, and anchoring fibrils were present. Immunoperoxidase staining on frozen sections, using antibodies to laminin, laminin 5, collagen IV, and collagen VII, showed a mostly continuous linear pattern in the adjacent non-blistered skin, which often became discontinuous near the blisters and markedly discontinuous in the blister roofs. In the blister floors, weakly stained linear or granular deposits of some of these components were sometimes also present. The results of this study support discontinuity of the basement membrane as the main anomaly in delayed postburn blistering. Disturbance in die reassembly or local breakdown of the basement membrane components might be the underlying defect.

Notes: The expression of c-myc protein was studied in formalin-fixed, paraffin-embedded sections of 16 compound Spitz nevi (SNs), 20 ordinary compound melanocytic nevi (MNs) and 30 malignant melanomas (MMs), using monoclonal antibody 9E10 and an immunoperoxidase technique. Nine (56%) SNs, 16 (80%) MNs and 23 (77%) MMs showed positive reactions in some of the tumor cells (P = non-significant). The staining reactions were mostly cytoplasmic, and moderate to strong in intensity. The frequencies of positively stained cells were higher in the MN and SN groups. Most of the lesions with a significant dermal component did not show stratification of staining with progressive descent into the dermis. Therefore, the mode of expression of c-myc in routinely processed specimens does not differentiate between SNs, MNs and MMs. One possible reason is that the increased expression of the c-myc protein is not sufficient alone to promote proliferation and malignant transformation in these types of tumors.