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Background: The goal of chemoprevention is to reduce the risk of cancer development by reversing or blocking the tumorigenic process through the use of pharmacologic or natural agents. To determine the potential role of genetic alterations in assessing cancer risk and in evaluating the efficacy of chemopreventive agents, we studied 22 patients with advanced premalignant lesions of the head and neck who were part of a prospective cancer prevention trial that is investigating a regimen of 13-cis-retinoic acid, interferon alfa, and [Alpha]-tocopherol administered for 12 months or until disease progression. Methods: We used polymerase chain reaction analysis of microsatellite DNA sequences in cells from precancerous lesions to determine the frequencies of genetic alterations--namely, loss of heterozygosity (LOH) and microsatellite instability--at chromosomal loci that are commonly deleted in head and neck cancer. Results: Prior to treatment, 17 (81%) of 21, eight (44%) of 18, and eight (42%) of 19 patients who were informative (i.e., heterozygous) at chromosomes 9p21, 3p14, and 17p13, respectively, exhibited LOH in at least one of their lesion biopsy specimens. Among nine patients who exhibited LOH at chromosome 9p21 in pretreatment biopsy specimens and who had completed at least 5 months of therapy, the genetic loss persisted in eight--including three of the four patients who exhibited complete histologic responses (i.e., no evidence of dysplasia in their biopsy specimens). Implication: Our data suggest that clinical and histologic assessments of the response to chemopreventive agents may be insufficient to determine their efficacy and that critical genetic alterations could be used as independent biomarkers to augment the ability to evaluate the efficacy of such agents. [J Natl Cancer Inst 1998;90:1545-51]

Cutaneous granulomas are small red spots on the skin that can be swollen, inflamed, or infected. They can appear in association with a variety of different infectious diseases, and they can occur in people who have poor immune function due to immunodeficiency disorders or treatment with immunosuppressive drugs. (The immune system is the body's natural defense system for fighting infection. Patients who have undergone transplant surgery require treatment with drugs that suppress the immune system to prevent rejection of the donated tissue.) Cutaneous granulomas located on the arms, legs and face may be an early warning sign of immunodeficiency. This article describes the case reports of three children who developed cutaneous granulomas on their legs, arms and faces. All three children had severe lung and ear infections during early childhood. Not until after the cutaneous granulomas appeared was it determined that these children had some form of immunodeficiency. None of the children had AIDS or infection with HIV (the virus that causes AIDS). One child required a bone marrow transplant because of chronic anemia (abnormally low numbers of red blood cells). One year after the transplant the child developed cutaneous granulomas. Treatment with prednisone improved the skin lesions in this child. Prednisone improved the skin lesions in the other two children as well, but both of them died from severe immunodeficiency. It is concluded that children who develop cutaneous granulomas should be examined and tested for immunodeficiency. (Consumer Summary produced by Reliance Medical Information, Inc.)

Necrobiosis lipoidica (NL) is a skin condition that causes lesions, ulcers and atrophy. This disorder was first identified in 1929, and was reported to occur in patients with diabetes. However, it was soon discovered that NL can occur in people who do not have diabetes. In a recent study of 171 patients with NL, 65 percent of the patients had diabetes and many of the remaining patients had some form of glucose (sugar) intolerance. Although many patients with NL have diabetes, not all patients with diabetes have NL. It is estimated that 3 of every 1,000 diabetics will develop NL. The condition is three times more common in women than in men. The skin lesions start as small, firm, red-brown papules (raised bumps) that increase in size and become violet-brown with a yellow center. Half of the patients with NL have between four and eight skin lesions. The legs are the most common site to be affected, but the lesions can appear on the face, scalp, arms, hands, and fingers. The exact cause of NL is not known. Abnormalities in blood vessels, collagen (the major protein in connective tissue, cartilage and bone), sweat glands, nerves, the immune system, white blood cells, and blood lipids (fats) have been suggested as possible causes of NL. To date, there is no treatment that is 100 percent effective in treating NL. Several different types of medications, such as corticosteroids and aspirin, have been used with varying degrees of success. Ulceration occurs in about 35 percent of cases, but is rarely associated with infection, even in the diabetic population. In some cases, surgery may become necessary. In these cases, the skin lesion is removed and a skin graft is performed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological striae in adolescence may be mistaken for non-accidental injury. Early recognition that these lesions are not a manifestation of physical abuse will avoid embarrassment to and inconvenience for patients, […]