Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey.

BACKGROUND: Oral propranolol is widely prescribed as first-line treatment for infantile haemangiomas (IHs). Anecdotally, prescribing practice differs widely between centres. OBJECTIVES: The Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce was founded to establish patterns of use of propranolol in IHs. METHODS: Participating centres entered data on all of their patients who had completed treatment with oral propranolol for IHs, using an online data capture tool. RESULTS: The study cohort comprised 1097 children from 39 centres in eight European countries. 76·1% were female and 92·8% had a focal IH, with the remainder showing a segmental, multifocal or indeterminate pattern. The main indications for treatment were periocular location (29·3%), risk of cosmetic disfigurement (21·1%) and ulceration and bleeding (20·6%). In total 69·2% of patients were titrated up to a maintenance regimen, which consisted of 2 mg kg(-1) per day (85·8%) in the majority of cases. 91·4% of patients had an excellent or good response to treatment. Rebound growth occurred in 14·1% upon stopping, of whom 53·9% were restarted and treatment response was recaptured in 91·6% of cases. While there was no significant difference in the treatment response, comparing a daily maintenance dose of < 2 mg kg(-1) vs. 2 mg kg(-1) vs. > 2 mg kg(-1) , the risk of adverse events was significantly higher: odds ratio (OR) 1 vs. adjusted OR 0·70, 95% confidence interval (CI) 0·33-1·50, P = 0·36 vs. OR 2·38, 95% CI 1·04-5·46, P = 0·04, Ptrend < 0·001. CONCLUSIONS: The PITCH survey summarizes the use of oral propranolol across 39 European centres, in a variety of IH phases, and could be used to inform treatment guidelines and the design of an interventional study.

Current trends and controversies in cutaneous melanoma.

Cutaneous melanoma is an emerging and complex health problem. Management may require the expertise of multiple specialties. Although the outlook for advanced disease remains very poor, there are major advances in the understanding of melanoma. The heterogeneous nature of melanoma is more apparent and as such it is becoming evident that in the future we will probably utilise multiple approaches to treat disease and treatments may be tailored to individual needs. We can anticipate that as technology improves and information continues to accrue, our increased understanding of melanoma will lead to improved treatment of advanced disease.

Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy.

BACKGROUND: Narrow-band ultraviolet B (NB-UVB) phototherapy is a widely used treatment. Psoralen-UVA photochemotherapy (PUVA) increases skin cancer risk and some animal studies have raised the possibility of an increased risk with NB-UVB. The risk of skin cancer in humans following treatment with NB-UVB is unknown. OBJECTIVES: This current analysis forms part of an ongoing study ultimately aiming to define the long-term carcinogenic risk of NB-UVB treatment in humans. METHODS: Details of all patients receiving NB-UVB treatment until 31/12/2002 in Tayside, Scotland, were accessed from a treatment database and linked to the Scottish Cancer Registry. Indirect standardization was used to compare skin cancer incidence in the study population with age and sex matched cancer registry data for the Tayside population. We also assessed the effect of NB-UVB exposure treatment numbers on the risk of developing skin cancer. RESULTS: Of 4690 records reviewed, 4665 were suitable for analysis with 3886 records linked with the cancer registry and 3867 followed-up for at least 6 months before 31/12/02 (the date at which cancer registration was deemed to be complete). The median number of NB-UVB treatments was 29 with 352 patients receiving > or = 100 treatments. The study gave 24,753 person-years of follow up. First skin cancers recorded in study patients were 27 basal cell carcinomas (BCC), seven squamous cell carcinomas (SCC) and six melanomas. No association was found between NB-UVB exposure alone (without PUVA) and any skin cancer. For NB-UVB and PUVA treated patients there was an association with BCC, with 27 BCCs found compared with 14.1 expected in the matched population. CONCLUSION: We found no significant association between NB-UVB treatment and BCC, SCC or melanoma. There was a small increase in BCCs amongst those also treated with PUVA. These reassuring results do not demonstrate the early increase in skin cancers that was found associated with PUVA treatment. However, cautious interpretation is required as the cohort contained relatively few patients who had a high treatment number and because the slow evolution of skin cancers may result in a delayed incidence peak. Ongoing risk assessment is therefore essential.