No abstract

No abstract

well as salt water soaks considerably decreases the minimal erythema dose. 9,10 So, if enhanced UV gain is the mode of action in BPT, one may question whether broadband UVB following bathing might yield a better synergistic effect than NB-UVB.To date, the BPT studies conducted by Dawe et al. 1 and Léauté-Labrèze et al. 2 have been the most useful clinical approaches in order to estimate whether there is any additional effect of salt water soaks prior to phototherapy. The results obtained from these observations will put the data of numerous previous retrospective and prospective uncontrolled investigations into perspective and may 'downregulate' the enthusiasm of many BPT followers, particularly in Germany. Nevertheless, the conclusion of the previously published controlled trials on BPT suggest a small beneficial effect of using salt water soaks prior to phototherapy. 1,2,5-7 Beyond pure efficacy rates, we have also to take into account the high acceptance of BPT by patients with psoriasis, possibly indicating a holistic approach including time for relaxation and psychological effects that may contribute significantly to the clearance of psoriasis. 1 Disregarding the slight therapeutic benefit from bathing prior to phototherapy, we have to consider the economical and practical drawbacks of BPT. 3,4 Conclusively, in special medical settings (e.g. rehabilitation clinics), particularly where natural resources (e.g. spas) can be used, it is certainly justified to employ BPT for routine use. However, there is no good reason to recommend the general replacement of phototherapy with BPT.

We report an 84-year-old Japanese woman who presented with a pedunculated malignant melanoma of the vaginal mucosa. Mucosal melanoma is believed to be more common in Japan than other countries, but such tumors of the vulvovaginal region are quite unusual. In our patient, three tumors were connected by a narrow pedicle. Three black tumors measuring 5-10 mm in diameter with a common pedicle were seen on the vaginal mucosa at five o'clock from the cervix. The tumors were hanging from the narrow pedicle. On histologic examination, they were diagnosed as malignant melanoma. Resection was done with a distal margin of 3 cm from the tumors and a margin of 1 cm from the cervix. The patient has had no evidence of local recurrence or distant metastasis. In our patient, the three main tumors had a common pedicle, which seems to be a unique finding. Since pedunculated malignant melanomas are rare, making a clinical diagnosis is difficult. Although pedunculated melanomas are recognized as having a high malignant potential because these lesions are generally thick, a relatively good outcome is sometimes reported. In our patient, there was no tumor infiltration into the dermis of the pedicle, and this may be one reason for the good outcome at present. There has been no previous report of a mucosal melanoma consisting of three tumors like those in the present patient.

No abstract