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The clinical responses for these relatively unfavourable lesions (43% had failed previous treatments, 35% were situated in the head and neck region and 30% were > 2 cm in diameter), are comparable with existing nonsurgical treatments. An active ingredient of E. peplus sap has been identified as ingenol mebutate (PEP005). This clinical study affirms community experience with E. peplus sap, and supports further clinical development of PEP005 for the treatment of BCC, SCC and IEC.

The occurrence of the epidermal growth factor homologue, transforming growth factor alpha (TGF alpha), in embryonic and neoplastic tissues suggests that it may be an oncofetal version of epidermal growth factor. A strong case is developing for TGF alpha to have an autocrine mode of action in sustaining the autonomous growth of several types of tumour. We propose that TGF alpha normally has an autocrine role not only in stimulating the growth of some fetal tissues but also with postnatal epidermal cells in response to local stimuli--in particular ultraviolet radiation (UVR). As a first step to test this hypothesis we have checked whether UVR will induce the production of TGF alpha, measured by radioimmunoassay, using a highly specific monoclonal antibody which recognizes native, biologically active human TGF alpha. We found that cultures of normal foreskin melanocytes do not produce detectable amounts of TGF alpha when grown under routine conditions, but, within 12 h of exposure to low doses of short-wavelength UVR, significant quantities of TGF alpha are produced. The UVR-induced TGF alpha is both cell associated and released into the medium of these cultures. Also, UVR has a promoting action on epidermal cells which have been initiated by carcinogenic activity. A significant part of the promoting activity may be due to autocrine stimulation of multiplication of partially transformed epidermal cells. In this regard we found that UVR induced TGF alpha in HeLa cells and all human melanoma lines so far tested. Induction was complete within 24 h of a single exposure. Dose-response curves of TGF alpha induction in a malignant melanoma cell line showed a distinctive peak of factor induced by low (2 J/m2) doses of UVR. Higher doses which inhibit [3H]thymidine incorporation resulted in lower levels of induced TGF alpha. These findings are consistent with the participation of TGF alpha as an autocrine mediator of UVR-induced tumour promotion, as well as cell multiplication, in sun-exposed skin.

Introduction: Cancer care workers experience high levels of occupational stress that can have adverse mental and physical health consequences. Educating health professionals about self-care practices throughout their careers can potentially build resilience. Our study aimed to evaluate the effects of an educational intervention to improve recovery from job stress, increase satisfaction with current self-care practices and improve sleep quality. Methods: An equivalent, randomised comparison, pretest-post-test intervention design was used to investigate the effects of a 1-day workshop (plus educational material) compared with written educational material alone, on measures of recovery experiences (i.e. psychological detachment from work, relaxation, mastery experiences and control over leisure), satisfaction with recovery-related self-care practices and perceived sleep quality of 70 cancer care workers. Results: Workshop participants reported greater mean changes 6 weeks postworkshop for total recovery experiences (F(1,69) = 8.145, P = .008), selfcare satisfaction (F(1,69) = 8.277, P = .005) and perceived sleep quality (F(1,69) = 9.611, P = .003). There was a decline in the scores of the control group over the 6-week period for all measures. Workshop participants not only avoided this decline, but demonstrated increased mean scores, with a significant main effect 6 weeks post-workshop, compared with the control group (F(3,63) = 4.262, P = .008). Conclusions: A 1-day intervention workshop improved recovery skills, satisfaction with self-care practices and perceived sleep quality of oncology nurses and radiation therapists. Outcomes were enhanced when participants actively participated in experiential group-based learning compared with receiving written material alone. This intervention has the potential to enhance resilience and prevent burnout at different points in a cancer worker's career.

The regimen of radiation therapy used could form the basis for the treatment arm of a randomized trial.