Clinical and experimental dermatology
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Clin. Exp. Dermatol. · Sep 2004
Clinical TrialOpen study of the efficacy and mechanism of action of topical imiquimod in basal cell carcinoma.
Imiquimod is an immune-response modifier that has been shown to be effective in the treatment of superficial and nodular basal cell carcinoma (BCC). The objective of this open-label study was to investigate the effectiveness of imiquimod 5% cream in superficial, nodular, and infiltrative BCC. Fifty-five Caucasian patients with primary BCC measuring 8 mm or more in diameter with a superficial, nodular, or infiltrative histological pattern were included in the study. ⋯ Multi-variate analysis demonstrated that baseline tumour size was the most powerful independent prognostic variable (P < 0.05). Treatment with imiquimod increased the apoptotic index (P < 0.05), reduced Bcl-2 expression (P < 0.05), and increased the number of CD3+, CD8+, CD20+, CD68+, granzyme B+, and S-100+ cells in the inflammatory infiltrate of the BCC (P < 0.05). In conclusion, imiquimod induced an antitumour immune response mediated by lymphocytes and macrophages, reduced Bcl-2 expression and increased the apoptotic index of BCC, and was clinically effective in 74% of BCCs after a 2-year follow-up period.
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Postgraduate higher specialist training of dermatology in the UK has become more structured over the past 8 years. Increased awareness of the need to police our profession has impelled the introduction of objective competency based assessment. Competency assessment will take three forms: mini clinical evaluation exercise, directly observed procedural skills and 360-degree assessment. These components of assessment will direct much needed rigour into the training system and may be the first step on the road to a formal exit examination in dermatology.