Choroidal nevus is one of the most common benign melanocytic tumor. The prevalence rate of choroidal nevi is 0.15% - 10.00%, which is high among whites and low among colored people, and is obvious higher in male than that in female. Secondary changes in the surrounding retina of the benign tumor, such as subretinal fluid and choroidal neovascularization, may result in vision loss. This benign tumor carries risks for transformation into malignant melanoma. The factors predictive of transformation into melanoma included greater thickness, subretinal fluid, visual symptoms, orange lipofuscin pigment, tumor location (tumor margin near optic disc), ultrasonography hollowness and absence of halo. Early identification of the related features which impair visual acuity is important for early treatment and better prognosis, and it is especially important to monitor the tendency of malignant transformation. Optical coherence tomography (OCT) could provide detailed information which aid in diagnosing, differentiating and monitoring of choroidal nevi. OCT and optical coherence tomography angiography are emerging as excellent techniques to investigate choroidal melanocytic lesions. The treatment modalities, such as laser photocoagulation, photodynamic therapy and intravitreal anti-vascular endothelium growth factor, have been proved to be effective for choroidal nevi with secondary changes. In the future, the relevant researches should be imposed to provide more detailed information in order to explore the nature and characteristics of this disease.
Objective To investigate the feasibility of human amniotic membrane-living skin equivalent (AM-LSE) in repairing the skin defect. Methods A 5-year-old boy with giant nevus at neck, shoulder, and back was admitted in July 2016. Normal skin tissue of the patient was harvested and keratinocytes and dermal fibroblasts were separated and expanded in vitro. Human AM was donated from a normal delivery and de-epithelialized for constructing an LSE as a matrix. Keratinocytes were seeded on the epithelial side of the AM which was previously seeded with fibroblasts on the stromal side and then the complex was lifted for air-liquid surface cultivation for 10 days and observed under naked eyes and sampled for histological study. The nevus was excised to deep fascia and the skin defect in size of 20 cm×15 cm was covered with artificial skin of collagen sponge for 2 weeks to enhance granulation tissue formation, and then the AM-LSE grafts of stamp size were grafted on. The dressing was changed until the wound healed. Results After 10 days of air-liquid surface cultivation, the AM-LSE developed a multilayered and differentiated epidermis with the fibroblasts-populated amnion as the dermal matrix. The LSE stamps survived and expanded to cover the whole wound. The grafted area showed normal skin color and soft contexture at 6 months after operation, and histological study showed well developed epidermis with compactly aligned basal cells, stratified and well differentiated squamous, granular layers and stratum corneum and well vascularized dermal compartment without inflammatory cells infiltration. Conclusion The cultivated AM-LSE with autologous cells can repair skin defect and survive for a long term without rejection.
ObjectiveTo evaluate the efficacy and safety of photodynamic treatment for port wine stains compared with gold standard pulsed dye laser.MethodsA literature search was performed in PubMed, CENTRAL, Embase, Web of Science, China National Knowledge Infrastructure, CQVIP, and Wanfang to identify the clinical randomized controlled studies on photodynamic therapy, pulsed dye laser, and port wine stains, which were published from the establishment of the databases to April 3rd, 2021, and the outcome measurements included effective rate and incidence of adverse reactions. Data were extracted and meta-analysis was performed with RevMan5.3 software, and the quality of evidence was evaluated according to GRADE standards.ResultsThree randomized controlled studies were included, with a total of 268 cases of port wine stains. Meta-analysis results showed that there was no statistically significant difference in the efficacy [relative risk (RR) =1.08, 95% confidence interval (CI) (0.89, 1.32), P=0.42] or the incidence of pigmentation [RR=1.03, 95%CI (0.65, 1.65), P=0.89] between photodynamic therapy and pulsed dye laser in the treatment of port wine stains.ConclusionsThe effectiveness and the occurrence of pigmentation of photodynamic therapy on port wine stains are not significantly different from those of pulsed dye laser. Photodynamic therapy is an effective and safe method for the treatment of port wine stains. Due to the limited literature included, large-scale prospective clinical trials are still needed to verify the conclusion.