P29TOPICAL 0.5% FLUOROURACIL TREATMENT FOLLOWING MOHS’ SURGERY FORSQUAMOUS CELL CARCINOMA FOR THE PREVENTION OF FUTURE SQUAMOUSCELL CARCINOMAPerry Robins, MD, NYU Medical Center, New York, NY, United States, Elizabeth Hale,MD, NYU Medical Center, New York, NY, United States

Squamous cell carcinoma (SCC) occurs most commonly in patients with extensive actinicdamage and often occurs in sun-exposed skin areas. This form of skin cancer typicallyfollows a spectrum of events beginning with the development of sun-damaged keratin-ocytes that have the potential to develop into actinic keratoses (AKs), which are com-monly referred to as precursor lesions to SCC. With continued sun damage and acquiredmutations, some of these actinic keratosis lesions may progress to SCC. Topical 0.5%fluorouracil is commonly used for the treatment of patients with actinic keratosis. It ishighly likely that actinic keratoses and sun-damaged keratinocytes are present in the skinsurrounding a SCC. Histological evidence of AKs and solar elastosis are often apparent atthe margins of frozen tissue sections obtained during Mohs’ surgery for SCC. Therefore,it is proposed that treatment with topical 0.5% fluorouracil following Mohs’ surgery maydiminish the future development of SCC in the same area by eradicating both clinical andsubclinical actinic keratosis lesions. The objective of this pilot study is to determine ifadministration of topical 0.5% fluorouracil cream following Mohs’ surgery for SCCdiminishes the occurrence of future SCC cases in the same area. A total of 5-10 patientsundergoing Moh’s surgery for SCC will be enrolled and treated. After complete excisionwith frozen microscopic control, patients will apply topical 0.5% fluorouracil once dailyfor 3 weeks. Clinical improvement of the surrounding skin will be evaluated followingtreatment. Adverse events will be followed continuously through self-reporting and activequestioning during all visits. Final data will be presented.

Disclosure not available at press time.

Medical writing supported by Dermik Laboratories.

P30SKIN CANCER RISK ASSESSMENTAnthony D Peterson, MD, Loyola University Chicago, Maywood, IL, United States, HeatherDownes, BS, Loyola University Chicago, Maywood, IL, United States, June Robinson, MD,Loyola University Chicago, Maywood, IL, United States

Background: Improving skin cancer risk perception may enhance primary and secondaryprevention of skin cancer.

Objective: To develop reliable measures, which are easy to use for both individuals whomay be at risk and health care workers, assessing skin cancer risk by evaluating the skintype, environmental exposure to ultraviolet radiation, and evidence of photodamage.

Methods: Fifty people with a history of skin cancer and their family members providedresponses to questions that assessed the Fitzpatrick skin type, and the total sun burdenscore. The total sun burden scoring system was developed in 1999 by Espana et al. toquantify the total sun burden of an individual. This score was based on a points systemsummed from four periods of an individual’s life (�20y, 20-40y, 41-60y, �60y). Test,re-test for reliability was repeated after a two week interval.

Two physicians independently evaluated photodamage on the forearm of subjects withno sun exposure during this time and repeated it in 6 weeks. Actinic keratoses, pigmen-tary change, wrinkles, atrophy, telangiectasia, and tenting were quantitatively gradedwith the first three as: (none � 0, mild � 1, moderate � 2, severe � 3), the last three as:(present � 1, absent � 0).

Results: The Fitzpatrick skin type assessment and Total Sun Burden Score were reliable.Photodamage features with interobserver reliability were actinic keratosis, telangiectasia,pigmentary change, and atrophy.

Conclusion: Many environmental risk assessments, which are self-reported from thepatient’s memory, are highly subjective. Our adaptation of the Sun Burden Score removesthe subjectivity from the person’s report of the amount of sun at their residence. Usingthe ultraviolet index, a numerical value was assigned to the location of residence toquantify an individual’s UV exposure. Also, the total sun burden score was adjusted tocompare occupational sun exposure to exposure associated with vacation for thoseresiding in North America. A weighting scale relates each photoaging criteria to the skincancer risk with actinic keratoses having the greatest weight.

The Fitzpatrick skin type and total sun burden scores may become self-administered tests.The photodamage assessment can be learned by non-dermatologists when the skillstraining is learned in a structured mentorship under standardized conditions. Future studywill determine if these tools enhance risk perception.

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P31IMPACT OF NEW IMMUNOSUPPRESSANTS ON THE DERMATOLOGICAL OUT-COME OF ORGAN TRANSPLANT PATIENTSClaas Ulrich, MD, Dept Dermatology, Charite, Berlin, 10117 Berlin, Germany, SylvieEuvrard, MD, Hospital Edouard Herriot, Lyon, France, Stuart Salasche, MD, University ofArizona Health Sciences Center, AZ, United States, Tobias Schmook, MD, Dept Derma-tology, Charite, Berlin, 10117 Berlin, Germany

Background: Skin infections and the increased risk for non-melanoma skin cancer (NMSC)represent a key problem in the long term maintenance of organ transplant patients. Theresponsibility of immunosuppressive treatments in the increased risk of skin cancer iswidely recognized and a decreased of tumors after reduction or cessation of treatmentshas been described. However especially in patients with already minimized immunosup-pressive levels a further lowering of the immunosuppression might induce graft rejection.Recent discussions therefore focus on combination or substitution of traditional drugswith new immunosuppressants related to a more specific immunosuppression. Never-theless only large networks could epidemiologically cover the amount of patients withdifferent immunosuppressive regimens required for a precise analysis of the actual impactof individual immunosuppressants.

Methods: In 2001 the European Skin Care in Organ Transplant Collaborative Networktogether with the US partner organization International Transplant-Skin Cancer Collabo-rative (ITSCC) established a computerized database to collect epidemiological informa-tion skin diseases and risk factors including immunosuppressive regimens. Meanwhile thecases of over 700 patients are documented and data analysis are constantly performed.

Results: Among patients on calcineurin inhibitors those treated with non TGF-betainducing potential benefited from a slightly lower skin cancer incidence. Combinationtherapies with mycophenolate mofetil (MMF) allows to lower the level of calcineurininhibitor dosages and in direct comparison with azathioprine MMF treated patientsshowed a significant lower skin cancer incidence. New immunosuppressive drugs likethe mTOR inhibitor rapamycin and everolimus showed a lower incidence of skin malig-nancy in all groups of patients treated with rapamycin related regimens.

Conclusions: Analysis of raised data on skin diseases and their relation to differentimmunosuppressive regiments may help transplant surgeons to improve the quality oflong term immunosuppressive therapies and might also have an impact on dermatologicaltherapies applied for chronic autoimmune disorders.

Disclosure not available at press time.

P32EFFICACY OF TOPICAL ANTIANGIOGENIC THERAPY FOR BASAL CELL AND SQUA-MOUS CELL CARCINOMA: A CASE SERIES OF 123 LESIONSSarvenaz Zand, Harvard Medical School, Cambridge, MA, United States, William W. Li,MD, Institute for Advanced Studies, The Angiogenesis Foundation, Cambridge, MA,United States, Vincent W. Li, MD, MBA, Institute for Advanced Studies, The AngiogenesisFoundation, Cambridge, MA, United States

Background: Approximately 1.3 million people in the U.S. are diagnosed annually withnonmelanoma skin cancer, including basal cell carcinoma (BCC) and squamous cellcarcinoma (SCC). In cases of extensive disease or severe comorbidities, conventionaltreatment modalities such as surgical excision, cryotherapy, or electrodessication andcurretage may be impractical, physically disfiguring, technically unfeasible, and mayimpair quality of life. Because angiogenesis is known to be a critical event in malignanttransformation in skin cancer, we sought to utilize a topical antiangiogenic approach intreating this patient population.

Methods: We devised a topical antiangiogenic regimen (OLCAT-005) for BCC, SCC in situ,and invasive SCC based on a multi-targeting combinatorial approach utilizing FDA-approved drugs. The regimen included imiquimod, tretinoin, calcipotriene, diclofenac,and hydrocortisone valerate in a 1:1:1:1:1 ratio. Each drug targets specific antiangiogenicmechanisms, including interferons, IL-12, RAR-alpha, endothelial apoptosis, COX-2 me-diated VEGF production, and basement membrane disruption. Patients who were unableto undergo or refused conventional treatment modalities were treated on an individualbasis using OLCAT-005. Frequency of administration was determined by an IndividualizedMaximally Tolerated Dose (IMTD) algorithm.

Results: A total of 123 lesions (30 SCC, 19 SCCIS, 74 BCC) on 19 patients were treatedfrom 1998-2003. Pathological confirmation of initial diagnosis and clinical response wasobtained in 18/19 and 15/19 patients, respectively. We found complete (100%) responsewith clinical and pathological clearance after 10-15 (mean � 12) weeks of treatment.Patient follow-up ranged from 1-42 months (mean � 23), during which no (0%) recur-rence was observed. Using the IMTD algorithm, OLCAT-005 was well-tolerated, witherythema as the most frequent reaction. Excellent cosmetic outcome was achievedwithout contour irregularity, atrophy, hypertrophic scar, or depigmentation.

Summary: We report the successful use of topical combination antiangiogenic therapy(OLCAT-005) for BCC, SCC in situ, and invasive SCC in patients unable to undergo orrefusing conventional treatment modalities. Complete responses were achieved with norecurrence. Further studies are ongoing.

Disclosure not available at press time.

P8 J AM ACAD DERMATOL MARCH 2004