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• W2040909872 abstract "Hitashi Mizutani and colleagues (Aug 29, p 709)1Mizutani H Shirakata Y Adachi A Hashimoto K Shimuzu M Cultured epidermal-sheet graft for epidermodysplasia verruciformis.Lancet. 1998; 352: 709Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar report a new surgical treatment for cancer lesions in patients with epidermodysplasia verruciformis (EV) by means of cultured epidermal sheet grafts. Their argument for this approach is: the ability to exclude human papilloma virus (HPV) infection in cultured epidermal sheets; the possibility to store these cultures for a longer time; and the limited size of the donor site needed for the procedure (just 2 cm2Gruzzendorf-Conen EI Papillomaviruses pathogenic to human and their relationship to oncogenesis.Hautarzt. 1990; 41: 658-661PubMed Google Scholar in their case). This approach was inspired by the fear of the annual increase of malignant lesions and the diminished availability of donor sites from normal unaffected skin. Co-factors, such as ultraviolet radiation, radiographs, or chronic trauma are also needed in EV-HPV oncogenesis.2Gruzzendorf-Conen EI Papillomaviruses pathogenic to human and their relationship to oncogenesis.Hautarzt. 1990; 41: 658-661PubMed Google Scholar Since ultraviolet radiation through sun exposure is the most common co-factor, taking account of co-factors is relevant so as not to get the wrong impression that the entire skin is in danger of malignant transformation. Oncogenesis in patients with EV is a slow process which lasts for years or decades.3Majewski S Jablonska S Skin autografts in epidermodysplasia verruciformis: human papillomavirus-associated cutaneous changes need over 20 years for malignant conversion.Cancer Res. 1997; 57: 4214-4216PubMed Google Scholar To treat the lesions with virus-free keratinocyte cultures seems ideal only at the first view. The conventional treatment with split-thickness skin grafts shows that unaffected grafts after transplantation will soon become infected with HIV.3Majewski S Jablonska S Skin autografts in epidermodysplasia verruciformis: human papillomavirus-associated cutaneous changes need over 20 years for malignant conversion.Cancer Res. 1997; 57: 4214-4216PubMed Google Scholar Such infection is likely in cultured keratinocytes, but the development of a recurrent cancer lesion will need again a lengthy period of co-factor exposition. That explains Mizutani and colleagues' report of no relapses during the first 3 years of follow-up—it is a matter of time and not of virus-purified cultures. Since there are no reports of too little donor site to treat the EV-related cancer lesion, Mizutani and colleagues' fear of diminished skin available is irrelevant. From our experience of treating severe burn victims, we know that it is possible to replace even 50% of the skin surface without the need of skin cultures. We also know that most skin-graft donor sites re-epithelialise without the need for further treatment (unlike sheet grafting). In the time needed for culture, the donor sites will be healed already. The only advantage of cultured sheet grafts might be the banking of the cultured sheets. Unfortunately the researchers do not tell us how long such cultures can be stored. We always recommend the tried-and-true split-thickness skin graft, and find no indication for the high-tech weapon of keratinocyte cultures." @default.
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• W2040909872 date "1998-11-01" @default.
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• W2040909872 title "Cultured sheet grafts in epidermodysplasia verruciformis" @default.
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• W2040909872 doi "https://doi.org/10.1016/s0140-6736(05)61072-0" @default.
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