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Biomedical subjects

A H Gladstein

Publications and source records attributed to A H Gladstein.

13 recordsLinked to original sources
PubMed1992

Recurrence rates of treated basal cell carcinomas. Part 4: X-ray therapy.

This is the fourth report in a series that reviews the experience in the Skin and Cancer Unit, from 1955 through 1982, with the treatment of basal cell carcinomas (BCCs). It concerns 862 primary (previously untreated) BCCs irradiated by a "standardized" x-ray therapy schedule. The overall 5-year recurrence rate for these lesions, as determined by the modified life-table method, was 7.4%. This rate was not significantly different from that experienced with 211 recurrent (previously treated) BCCs with a re-recurrence rate of 9.5% (P = .552). For the primary BCCs, multivariate analysis showed that increasing BCC diameter was the only independent risk factor for high recurrence rates (P = .003). The patient's age or sex, the duration of the BCC, the anatomic site of the BCC, or time-span treated (1955-1963, 1964-1972, 1973-1982) did not significantly affect the recurrence rate. Additional analysis showed that BCCs on the head less than 10 mm in diameter had a 5-year recurrence rate of 4.4% whereas those 10 mm or greater in diameter had a rate of 9.5%. Lastly, the proportion of recurrence-free treatment sites with a good or excellent long-term cosmetic outcome after x-ray therapy (63%) was lower than previous reports in this series with curettage-electrodesiccation (91%) and surgical excision (84%). Thus, if the long-term cosmetic outcome after treatment is not an overriding concern to the patient, x-ray therapy is an effective modality for many primary and recurrent BCCs.

Age Factors↗
PubMed1983

Malignant melanoma in situ in two patients treated with psoralens and ultraviolet A.

Two patients are reported who were treated with 8-methoxypsoralen and ultraviolet A (PUVA) for psoriasis and developed cutaneous lesions of malignant melanoma in situ (atypical melanocytic hyperplasia). One patient received 324.5 joules/cm2 of UVA. Seven months after discontinuing therapy, he developed a superficial spreading melanoma in situ in association with an intradermal nevus on the left posterior thoracic area. The second patient received 2,802 joules/cm of UVA. While on PUVA therapy she developed an in situ lentigo melanoma on her lower lip. To our knowledge only one other psoriatic patient and one patient with vitiligo have developed malignant melanomas after PUVA therapy, so that an increased incidence of malignant melanomas after PUVA therapy, so that an increased incidence of malignant melanoma following PUVA is not documented.

Adult↗
PubMed1983

Quinidine photosensitivity.

Two patients with quinidine photosensitivity had an eczematous dermatitis in a photosensitivity distribution on the face, neck, hands, and forearms. Histologically, both patients showed a bandlike dermal lymphohistiocytic infiltrate with overlying vacuolar changes and necrosis in keratinocytes at the dermoepidermal junction. On phototesting, both patients showed marked sensitivity to UV-A radiation. Sensitivity to UV-B was difficult to assess.

Administration, Oral↗
PubMed1982

Determination of half-dose depth in skin for soft x-rays.

Unlike superficial x-rays, the soft x-rays normally used in dermatologic practice spare unaffected underlying organs during treatment of cutaneous malignancies. However, since the dose with depth from soft x-rays varies markedly, it is important to know this relationship for optimal therapeutic results. The peak kilovoltage, and thus the energy of the beam, is generally selected so that the dose to the base of the lesion is one-half the surface dose. An absorbed dose of 3,400 rads to the surface and a dose of about one-half this amount to the base of most malignant lesions is one standard protocol for optimal therapeutic results. An accurate value of half-depth dose in skin is therefore necessary and is readily obtained from ordinary half-value layer measurements using the technic described.

Aluminum↗
PubMed1982

Actinic reticuloid.

A 58-year-old man has his condition diagnosed as actinic reticuloid on the basis of clinical and histologic findings and phototesting data. He had clinical features resembling mycosis fungoides in light-exposed areas. Histologic findings disclosed a bandlike infiltrate with atypical mononuclear cells in the dermis and scattered atypical cells in the epidermis. Electron microscopy disclosed mononuclear cells with bizarre, convoluted nuclei, resembling cerebriform cells of Lutzner. Phototesting disclosed a diminished minimal erythemal threshold to UV-B and UV-A. Microscopic changes resembling actinic reticuloid were reproduced in this patient 24 and 72 hours after exposure to 15 minimal erythemal doses of UV-B.

Humans↗
PubMed1977

Treatment of morphea-type basal cell carcinomas with radiation therapy.

Eight patients received superficial x-ray therapy for morphea-type basal cell carcinomas. Seven lesions did not recur. One recurrence adjacent to an irradiated field was observed; it was considered to be a geographic miss and has led us to include a wider field (10 mm) of normal-appearing skin beyond the clinical perimeter of the tumor when the lesion is ill-defined. The cosmetic results after treatment were poorer than anticipated for this schedule of radiation therapy, based on our extensive experience with other types of basal cell carcinomas. To obtain the best long-term results we believe that, where technically feasible Mohs surgery and conventional surgical excision with histologic verification of free margins are the treatments of choice for morphea-type basal cell carcinomas. However, our experience indicates that morphea-type basal-cell carcinomas can be cured with radiation therapy; therefore, x-rays have a place in the armamentarium of therapeutic modalities for this tumor if surgery is not feasible or if it is refused by the patient.

Aged↗
PubMed1976

Treatment of melanotic freckle with x-rays.

Sixteen patients were treated for melanotic freckle of Hutchinson (lentigo maligna) with the Miescher technique of x-ray therapy. Eleven patients had no local cutaneous recurrences of persistence following x-ray therapy. Five patients had local recurrence or persistence of their lesions. Three patients developed metastatic malignant melanoma. The first of these three patients had lentigo maligna melanoma, and the second patient had a melanotic freckle with atypical cells extending down the adnexae, including the sweat apparatus to the level of the coiled portion of one sweat gland. The third patient was considered to be in a precancerous phase at the time of irradiation. Nevertheless, metastases occurred. European colleagues indicate that they have not experienced such problems in using the Miescher technique. The procedure has been abandoned in our department, pending further clarification of the discrepancy between our results and those reported by our European colleagues.

Aged↗