• Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. Roujeau J-C*, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T, Auquier A, Bastuji-Garin S, Correia O, Locati F, Mockenhaupt M, Paoletti C, Shapiro S, Shear N, Schöpf E, Kaufman DW. N Engl J Med 1995;333:1600-7.

THE AUTHORS CONDUCTED A CASE-CONTROL STUDY

using data obtained through surveillance net­works in France, Germany, Italy, and Portugal to quantify the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis when using specific medi­cations. Among drugs that usually are used for short periods, the risks were increased for trimethoprim-sulfamethoxazole and other sulfonamide antibiotics, chlormezanone, aminopenicillins, quinolones, and cephalosporins. The multivariate relative risk for acetaminophen was 0.6 in France, but was 9.3 in the other countries. Among medications that typically are used for months or years, an increased risk, which was largely confined to the first two months of treatment, was determined for the following medica­tions: carbamazepine, phénobarbital, phenytoin, valproic acid, oxicam nonsteroidal antiinflammatory drugs, allopurinol, and corticosteroids. No significant increase in risk was found for thiazide diuretics or oral hypoglycémie agents. Although the use of a number of medications is associated with Stevens-Johnson syndrome or toxic epidermal necrolysis, for none of the drugs does the risk exceed five cases per million users per week.—George B. Bartley

*Service de Dermatologie, Hôpital H. Mondor, 94010 Créteil, France.

• Difïerentialdïagnose und Prognose bei 112 exzi-dierten epibulbären epithelialen Tumoren (Differ­ential diagnosis and prognosis of 112 excised epi-bulbar epithelial neoplasias). Seitz B*, Fischer M, Holbach LM, Naumann GOH. Klin Monatsbl Augenheilkd 1995;207:239-46.

THE AUTHORS REVIEWED THE CLINICAL FEATURES

and outcomes of 112 epithelial epibulbar tumors that were treated during the years 1980 to 1993. The

lesions included 50 papillomas, 49 cases of conjuncti-val or corneal intraepithelial neoplasia (CIN), 12 squamous cell carcinomas, and one mucoepidermoid carcinoma. The frequency with which various treat­ments were used was as follows: excisional biopsy (61%), additional lamellar keratectomy (14%), epi­thelial abrasion (10%), cautery (3%), cryotherapy (2%), excimer laser ablation (2%). The mucoepider­moid carcinoma required enucleation. Thirteen per cent of the papillomas recurred during an average follow-up interval of 6.3 years, whereas 30% of the cases of conjunctival or corneal intraepithelial neo­plasia or carcinoma recurred during a mean follow-up period of 4.8 years. Although the recurrence rate of CIN or carcinoma was 64% if the surgical margins of excision were involved with tumor, no patient whose surgical margins were clear developed a recurrent tumor. An extraocular malignancy was identified in 13% of the patients with CIN or carcinoma. —George B. Bartley

'Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany.

• Treatment of uveal melanoma metastatic to the liver. A review of the M.D. Anderson Cancer Center experience and prognostic factors. Bedikian AY*, Legha SS, Mavligit G, Carrasco CH, Khorana S, Plager C, Papadopoulos N, Benjamin RS. Cancer 1995;76:1665-70.

THE MEDIAN SURVIVAL OF PATIENTS WITH UVEAL

melanoma metastatic to the liver is approximately six months. Protocols designed for the treatment of cutaneous melanomas have had an "insignificant effect on overall survival." The authors reviewed the outcomes of 201 patients with liver métastases from uveal melanoma who were treated at one institution between 1968 and 1991. The percentage of patients who were alive 12, 24, and 36 months after diagnosis of metastatic disease was 23%, 5%, and 2%, respec­tively. Median survival was seven months (range, one month to 59 months). Systemic chemotherapy yield­ed a response rate of less than 1% and approximately 5% of patients had a partial response to hepatic

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