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Ultraviolet Radiation, Langerhans' Cells, and Skin Cancer: Conspiracy and Failure

Ultraviolet Radiation, Langerhans' Cells, and Skin Cancer: Conspiracy and Failure Abstract On the basis of clinical and epidemiologic evidence, there can be little doubt that UV radiation is the predominant causal factor in cutaneous carcinogenesis in humans.1,2 Equally, work with laboratory animals has clearly demonstrated that skin cancer is associated with a failure of the immune system to recognize tumor antigens and/or to destroy malignant cells.3 In this context, UV-induced skin cancers may be viewed as the end result of a confrontation in which cutaneous and systemic elements of the immune system begin as coconspirators for tumor destruction, and end in a failure of surveillance and defense. In this month's issue of the Archives, Alcalay et al4 present observations concerning aberrations in the appearance and distribution of Langerhans' cells (LCs) in the epidermal components of squamous cell carcinomas. Their findings suggest that epidermal LCs, which are considered the outermost sentinels of the immune system, play a relevant role References 1. Urbach F, Forbes PD. Photocarcinogenesis . In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, eds. Dermatology in General Medicine . New York, NY: McGraw-Hill International Book Co; 1987:1475-1480. 2. Harber LC, Bickers DR. Ultraviolet carcinogenesis . In: Photosensitivity Diseases . Philadelphia, Pa: WB Saunders Co; 1981:246-257. 3. Kripke ML. Immunobiology of photocarcinogenesis . In: Parrish JA, ed. The Effect of Ultraviolet Radiation on the Immune System . New Brunswick, NJ: Johnson & Johnson Products Inc; 1983:87-106. 4. Alcalay J, Goldberg LH, Wolf JE Jr, Kripke ML. Variations in the number and morphology of Langerhans cells in the epidermal component of squamous cell carcinomas . Arch Dermatol. 1989;125:917-920.Crossref 5. Unna PG. Die Histopathologie der Hautkrankheiten . Berlin, Germany: A Hirschwald; 1894. 6. Dulbreuilh W. Dermatoses par insolation: brulure ou radiodermatite chroniques . Gas Hop. 1920;78:1237-1243. 7. Findlay GM. Ultraviolet light and skin cancer . Lancet . 1928;2:1070-1073.Crossref 8. Blum HF. Carcinogenesis by Ultraviolet Light . Princeton, NJ: Princeton University Press; 1959. 9. Blum HF. Ultraviolet radiation and skin cancer: in mice and men . Photochem Photobiol. 1976;24:249-254.Crossref 10. Gordon D, Silverstone H. Worldwide epidemiology of premalignant and malignant cutaneous lesions . In: Andrade R, ed. Cancer of the Skin . Philadelphia, Pa: WB Saunders Co; 1976:405-436. 11. Doll R, Payne P, Waterhouse J. Cancer Incidence in Five Continents . New York, NY: Springer-Verlag NY Inc; 1970. 12. Urbach F. Genetic and environmental interactions in skin carcinogenesis . In: Environment and Cancer . Baltimore, Md: Williams & Wilkins; 1972. 13. Emmett EA. Ultraviolet radiation as a cause of skin tumors . CRC Crit Rev Toxicol. 1974;2:211-220.Crossref 14. Burnett FM. Immunological surveillance in neoplasia. Transplant Rev. 1971;7:3-25. 15. Penn I. The incidence of malignancies in transplant recipients . Transplant Proc. 1975;7:323-326. 16. Sontheimer RD, Bergstresser PR, Gailiunas P Jr, Helderman H, Gilliam JN. Perturbation of epidermal Langerhans cells in immunosuppressed human renal allograft recipients . Transplantation . 1984;37:168-174.Crossref 17. Fisher MS, Kripke ML. Systemic alteration induced in mice by ultraviolet radiation and its relationship to ultraviolet carcinogenesis . Proc Natl Acad Sci USA. 1977;74;1688-1692.Crossref 18. Daynes RA, Schmitt MK, Roberts LK, Spellman CW. Phenotypic and physical characteristics of the lymphoid cells involved in the immunity to syngeneic UV-induced tumors . J Immunol. 1979;122:2458-2464. 19. Toews GB, Bergstresser PR, Tigelaar RE, Streilein JW. Epidermal Langerhans cell density determines whether contact hypersensitivity or unresponsiveness follows skin painting with DNFB . J Immunol. 1980;124:445-453. 20. Elmets CA, Bergstresser PR, Tigelaar RE, Wood PJ, Streilein JW. Analysis of the mechanism of unresponsiveness produced by haptens painted on skin exposed to ultraviolet radiation . J Exp Med. 1983;158:781-794.Crossref 21. Jessup JM, Hanna N, Palaszynski E, Kripke ML. Mechanisms of depressed reactivity to dinitrochlorobenzene and ultraviolet-induced tumors during ultraviolet carcinogenesis in BALB/c mice . Cell Immunol. 1978;38:105-115.Crossref 22. Cruz PD Jr, Bergstresser PR. The low dose model of UVB-induced immunosuppression . Photodermatology. 1988;5:151-161. 23. Kripke ML, Morison WL. Modulation of immune function by UV radiation . J Invest Dermatol. 1985;85( (suppl) ):62s-66s.Crossref 24. Wolff K, Stingl G. The Langerhans cell . J Invest Dermatol. 1983;80( (suppl) ):17s-21s.Crossref 25. Aberer W, Schuler G, Stingl G, Honigsmann H, Wolff K. Ultraviolet light depletes surface markers of Langerhans cells . J Invest Dermatol. 1981;76:202-210.Crossref 26. Lynch DH, Gurish MF, Daynes RA. Relationship between epidermal Langerhans cell density ATPase activity and the induction of contact hypersensitivity . J Immunol. 1981;126:1892-1897. 27. Koulu L, Jansen CT, Vander M. Effect of UVA and UVB irradiation on human epidermal Langerhans cell membrane markers defined ATPase activity and monoclonal antibodies (OKT6 and anti-Ia) . Photodermatology . 1985;2:339-346. 28. Aberer W, Romani N, Elbe A, Stingl G. Effects of physiochemical agents on murine epidermal Langerhans cells and Thy-1+ dendritic epidermal cells . J Immunol. 1986;136:1210-1216. 29. Hanau D, Fabre M, Lepoittevin JP, Stampf JL, Grosshans E, Benezra C. ATPase and morphologic changes induced by UVB on Langerhans cells in guinea pigs . J Invest Dermatol. 1985;85:135-138.Crossref 30. Czernielewski J, Vaigot P, Asselineau D, Prunieras M. In vitro effect of UV radiation on immune function and membrane markers of human Langerhans cells . J Invest Dermatol. 1984;83:62-65.Crossref 31. Nordlund JJ, Ackles AE, Lerner AB. The effects of ultraviolet light and certain drugs on Ia-bearing Langerhans cells in murine epidermis . Cell Immunol. 1981;60:50-63.Crossref 32. Silberberg-Sinakin I, Thorbecke GJ. Contact hypersensitivity and Langerhans cells . J Invest Dermatol. 1980;75:61-67.Crossref 33. Ptak W, Rozycka D, Askenase PW, Gershon RK. Role of antigen presenting cells in the development and persistence of contact hypersensitivity . J Exp Med. 1980;151:362-375.Crossref 34. Streilein JW, Bergstresser PR. Haptens can serve as surrogate transplantation antigens in a manner that demonstrates H-2 restriction of graft rejection . J Exp Med. 1983;157:1354-1359.Crossref 35. Streilein JW, Lonsberry LW, Bergstresser PR. Depletion of epidermal Langerhans cells and Ia immunogenicity from tapestripped mouse skin . J Exp Med. 1982;155:863-871.Crossref 36. Streilein JW, Wood PJ, Lonsberry LW, Bergstresser PR. Induction of H-2 restricted contact hypersensitivity by haptenderivatized skin grafts: evidence that the immunologic signal includes H-2 determinants derived from skin . Transplantation. 1984;37:195-201.Crossref 37. Stingl G, Gazze-Stingl LA, Aberer W, Wolff K. Antigen presentation by murine epidermal Langerhans cells and its alteration by ultraviolet B light . J Immunol. 1981;127:1707-1713. 38. Sontheimer RD. The mixed epidermal cell-lymphocyte reaction, II: epidermal Langerhans cells are responsible for the enhanced allogeneic lymphocyte stimulating capacity of human epidermal cells . J Invest Dermatol. 1985;85( (suppl) ):21s-26s.Crossref 39. Braathen LR, Thorsby E. Studies on human epidermal Langerhans cells, I: allo-activating and antigen-presenting capacity . Scand J Immunol. 1980;11:401-408.Crossref 40. Streilein JW, Bergstresser PR. Genetic basis of ultraviolet B effects on contact hypersensitivity . Immunogenetics . 1988;27:252-258.Crossref 41. Glass MJ, Bergstresser PR, Tigelaar RE, Streilein JW. In vivo low dose ultraviolet B (UVB) radiation universally induces contact hypersensitivity (CH) suppressor cells . J Invest Dermatol. 1984;82:397. 42. Rae V, Yoshikawa T, Streilein JW, Taylor JR. Unresponsiveness induced in man by DNCB painted on UVB-treated skin . Clin Res. In press. 43. Sauder DN, Tamaki K, Moshell AN, Fujiwara H, Katz SI. Introduction of tolerance to topically applied TNCB using TNP-conjugated ultraviolet light-irradiated epidermal cells . J Immunol. 1981;127:261-266. 44. Cruz PD Jr, Nixon-Fulton J, Tigelaar RE, Bergstresser PR. Disparate effects of in vitro low-dose UVB irradiation on intravenous immunization with purified epidermal cell subpopulations for the induction of contact hypersensitivity . J Invest Dermatol. 1989;92:160-165.Crossref 45. Sullivan S, Bergstresser PR, Tigelaar RE, Streilein JW. Induction and regulation of contact hypersensitivity by resident, bone marrow-derived, dendritic epidermal cells: Langerhans cells and Thy-1+ epidermal cells . J Immunol. 1986;137:2460-2467. 46. Granstein RD, Askari M, Whitaker D, Murphy GF. Epidermal cells in activation of suppressor lymphocytes: further characterization . J Immunol. 1987;138:4055-4062. 47. Baadsgaard O, Fox DA, Cooper KD. Human epidermal cells from ultraviolet light-exposed skin preferentially activate autoreactive CD4+2H4+ suppressor-inducer lymphocytes and CD8+ suppressor-inducer lymphocytes . J Immunol. 1988;140:1738-1744. 48. Jun BD, Roberts LK, Cho BH, Robertson B, Daynes RA. Parallel recovery of epidermal antigen-presenting cell activity and contact hypersensitivity responses in mice exposed to ultraviolet irradiation: the role of a prostaglandin-dependent mechanism . J Invest Dermatol. 1988;90:311-316.Crossref 49. Noonan FP, DeFabo EC, Morrison H. Cis-urocanic acid, a product formed by ultraviolet B irradiation of the skin, initiates an antigen presentation defect in splenic dendritic cells in vivo . J Invest Dermatol. 1988;90:92-99.Crossref 50. Robertson B, Gahring L, Newton R, Daynes R. In vivo administration of interleukin-1 to normal mice depresses their capacity to elicit contact hypersensitivity responses: prostaglandins are involved in this modification of immune function . J Invest Dermatol. 1987;88:380-387.Crossref 51. Schwarz T, Urbanski F, Kirnbauer R, Kock A, Gschnait F, Luger TA. Detection of a specific inhibitor of interleukin-1 in sera of UVB-treated mice . J Invest Dermatol. 1988;91:536-540.Crossref 52. Taieb A, Cooper KD, Nickoloff BJ, Marcelo CL. Langerhans cells can bind to keratinocytes and modulate their growth in vitro . J Invest Dermatol. 1988;90:611. 53. Pelamberger H, Gazze-Stingl LA, Pogantsch S, Steiner G, Wolff K, Stingl G. Generation of cytotoxic T lymphocytes against alloantigens and TNP-modified syngeneic cells by epidermal cells: requirement for Ia-bearing Langerhans cells . Immunobiology . 1982;163:122-123. 54. Polla L, Margolis R, Goulston C, Parrish JA, Granstein RD. Enhancement of the elicitation phase of the murine contact hypersensitivity response by prior exposure to local ultraviolet radiation . J Invest Dermatol. 1986;86:13-17.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Ultraviolet Radiation, Langerhans' Cells, and Skin Cancer: Conspiracy and Failure

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References (56)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1989.01670190109015
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Abstract

Abstract On the basis of clinical and epidemiologic evidence, there can be little doubt that UV radiation is the predominant causal factor in cutaneous carcinogenesis in humans.1,2 Equally, work with laboratory animals has clearly demonstrated that skin cancer is associated with a failure of the immune system to recognize tumor antigens and/or to destroy malignant cells.3 In this context, UV-induced skin cancers may be viewed as the end result of a confrontation in which cutaneous and systemic elements of the immune system begin as coconspirators for tumor destruction, and end in a failure of surveillance and defense. In this month's issue of the Archives, Alcalay et al4 present observations concerning aberrations in the appearance and distribution of Langerhans' cells (LCs) in the epidermal components of squamous cell carcinomas. Their findings suggest that epidermal LCs, which are considered the outermost sentinels of the immune system, play a relevant role References 1. Urbach F, Forbes PD. Photocarcinogenesis . In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF, eds. Dermatology in General Medicine . New York, NY: McGraw-Hill International Book Co; 1987:1475-1480. 2. Harber LC, Bickers DR. Ultraviolet carcinogenesis . In: Photosensitivity Diseases . Philadelphia, Pa: WB Saunders Co; 1981:246-257. 3. Kripke ML. Immunobiology of photocarcinogenesis . In: Parrish JA, ed. The Effect of Ultraviolet Radiation on the Immune System . New Brunswick, NJ: Johnson & Johnson Products Inc; 1983:87-106. 4. Alcalay J, Goldberg LH, Wolf JE Jr, Kripke ML. Variations in the number and morphology of Langerhans cells in the epidermal component of squamous cell carcinomas . Arch Dermatol. 1989;125:917-920.Crossref 5. Unna PG. Die Histopathologie der Hautkrankheiten . Berlin, Germany: A Hirschwald; 1894. 6. Dulbreuilh W. Dermatoses par insolation: brulure ou radiodermatite chroniques . Gas Hop. 1920;78:1237-1243. 7. Findlay GM. Ultraviolet light and skin cancer . Lancet . 1928;2:1070-1073.Crossref 8. Blum HF. Carcinogenesis by Ultraviolet Light . Princeton, NJ: Princeton University Press; 1959. 9. Blum HF. Ultraviolet radiation and skin cancer: in mice and men . Photochem Photobiol. 1976;24:249-254.Crossref 10. Gordon D, Silverstone H. Worldwide epidemiology of premalignant and malignant cutaneous lesions . In: Andrade R, ed. Cancer of the Skin . Philadelphia, Pa: WB Saunders Co; 1976:405-436. 11. Doll R, Payne P, Waterhouse J. Cancer Incidence in Five Continents . New York, NY: Springer-Verlag NY Inc; 1970. 12. Urbach F. Genetic and environmental interactions in skin carcinogenesis . In: Environment and Cancer . Baltimore, Md: Williams & Wilkins; 1972. 13. Emmett EA. Ultraviolet radiation as a cause of skin tumors . CRC Crit Rev Toxicol. 1974;2:211-220.Crossref 14. Burnett FM. Immunological surveillance in neoplasia. Transplant Rev. 1971;7:3-25. 15. Penn I. The incidence of malignancies in transplant recipients . Transplant Proc. 1975;7:323-326. 16. Sontheimer RD, Bergstresser PR, Gailiunas P Jr, Helderman H, Gilliam JN. Perturbation of epidermal Langerhans cells in immunosuppressed human renal allograft recipients . Transplantation . 1984;37:168-174.Crossref 17. Fisher MS, Kripke ML. Systemic alteration induced in mice by ultraviolet radiation and its relationship to ultraviolet carcinogenesis . Proc Natl Acad Sci USA. 1977;74;1688-1692.Crossref 18. Daynes RA, Schmitt MK, Roberts LK, Spellman CW. Phenotypic and physical characteristics of the lymphoid cells involved in the immunity to syngeneic UV-induced tumors . J Immunol. 1979;122:2458-2464. 19. Toews GB, Bergstresser PR, Tigelaar RE, Streilein JW. Epidermal Langerhans cell density determines whether contact hypersensitivity or unresponsiveness follows skin painting with DNFB . J Immunol. 1980;124:445-453. 20. Elmets CA, Bergstresser PR, Tigelaar RE, Wood PJ, Streilein JW. Analysis of the mechanism of unresponsiveness produced by haptens painted on skin exposed to ultraviolet radiation . J Exp Med. 1983;158:781-794.Crossref 21. Jessup JM, Hanna N, Palaszynski E, Kripke ML. Mechanisms of depressed reactivity to dinitrochlorobenzene and ultraviolet-induced tumors during ultraviolet carcinogenesis in BALB/c mice . Cell Immunol. 1978;38:105-115.Crossref 22. Cruz PD Jr, Bergstresser PR. The low dose model of UVB-induced immunosuppression . Photodermatology. 1988;5:151-161. 23. Kripke ML, Morison WL. Modulation of immune function by UV radiation . J Invest Dermatol. 1985;85( (suppl) ):62s-66s.Crossref 24. Wolff K, Stingl G. The Langerhans cell . J Invest Dermatol. 1983;80( (suppl) ):17s-21s.Crossref 25. Aberer W, Schuler G, Stingl G, Honigsmann H, Wolff K. Ultraviolet light depletes surface markers of Langerhans cells . J Invest Dermatol. 1981;76:202-210.Crossref 26. Lynch DH, Gurish MF, Daynes RA. Relationship between epidermal Langerhans cell density ATPase activity and the induction of contact hypersensitivity . J Immunol. 1981;126:1892-1897. 27. Koulu L, Jansen CT, Vander M. Effect of UVA and UVB irradiation on human epidermal Langerhans cell membrane markers defined ATPase activity and monoclonal antibodies (OKT6 and anti-Ia) . Photodermatology . 1985;2:339-346. 28. Aberer W, Romani N, Elbe A, Stingl G. Effects of physiochemical agents on murine epidermal Langerhans cells and Thy-1+ dendritic epidermal cells . J Immunol. 1986;136:1210-1216. 29. Hanau D, Fabre M, Lepoittevin JP, Stampf JL, Grosshans E, Benezra C. ATPase and morphologic changes induced by UVB on Langerhans cells in guinea pigs . J Invest Dermatol. 1985;85:135-138.Crossref 30. Czernielewski J, Vaigot P, Asselineau D, Prunieras M. In vitro effect of UV radiation on immune function and membrane markers of human Langerhans cells . J Invest Dermatol. 1984;83:62-65.Crossref 31. Nordlund JJ, Ackles AE, Lerner AB. The effects of ultraviolet light and certain drugs on Ia-bearing Langerhans cells in murine epidermis . Cell Immunol. 1981;60:50-63.Crossref 32. Silberberg-Sinakin I, Thorbecke GJ. Contact hypersensitivity and Langerhans cells . J Invest Dermatol. 1980;75:61-67.Crossref 33. Ptak W, Rozycka D, Askenase PW, Gershon RK. Role of antigen presenting cells in the development and persistence of contact hypersensitivity . J Exp Med. 1980;151:362-375.Crossref 34. Streilein JW, Bergstresser PR. Haptens can serve as surrogate transplantation antigens in a manner that demonstrates H-2 restriction of graft rejection . J Exp Med. 1983;157:1354-1359.Crossref 35. Streilein JW, Lonsberry LW, Bergstresser PR. Depletion of epidermal Langerhans cells and Ia immunogenicity from tapestripped mouse skin . J Exp Med. 1982;155:863-871.Crossref 36. Streilein JW, Wood PJ, Lonsberry LW, Bergstresser PR. Induction of H-2 restricted contact hypersensitivity by haptenderivatized skin grafts: evidence that the immunologic signal includes H-2 determinants derived from skin . Transplantation. 1984;37:195-201.Crossref 37. Stingl G, Gazze-Stingl LA, Aberer W, Wolff K. Antigen presentation by murine epidermal Langerhans cells and its alteration by ultraviolet B light . J Immunol. 1981;127:1707-1713. 38. Sontheimer RD. The mixed epidermal cell-lymphocyte reaction, II: epidermal Langerhans cells are responsible for the enhanced allogeneic lymphocyte stimulating capacity of human epidermal cells . J Invest Dermatol. 1985;85( (suppl) ):21s-26s.Crossref 39. Braathen LR, Thorsby E. Studies on human epidermal Langerhans cells, I: allo-activating and antigen-presenting capacity . Scand J Immunol. 1980;11:401-408.Crossref 40. Streilein JW, Bergstresser PR. Genetic basis of ultraviolet B effects on contact hypersensitivity . Immunogenetics . 1988;27:252-258.Crossref 41. Glass MJ, Bergstresser PR, Tigelaar RE, Streilein JW. In vivo low dose ultraviolet B (UVB) radiation universally induces contact hypersensitivity (CH) suppressor cells . J Invest Dermatol. 1984;82:397. 42. Rae V, Yoshikawa T, Streilein JW, Taylor JR. Unresponsiveness induced in man by DNCB painted on UVB-treated skin . Clin Res. In press. 43. Sauder DN, Tamaki K, Moshell AN, Fujiwara H, Katz SI. Introduction of tolerance to topically applied TNCB using TNP-conjugated ultraviolet light-irradiated epidermal cells . J Immunol. 1981;127:261-266. 44. Cruz PD Jr, Nixon-Fulton J, Tigelaar RE, Bergstresser PR. Disparate effects of in vitro low-dose UVB irradiation on intravenous immunization with purified epidermal cell subpopulations for the induction of contact hypersensitivity . J Invest Dermatol. 1989;92:160-165.Crossref 45. Sullivan S, Bergstresser PR, Tigelaar RE, Streilein JW. Induction and regulation of contact hypersensitivity by resident, bone marrow-derived, dendritic epidermal cells: Langerhans cells and Thy-1+ epidermal cells . J Immunol. 1986;137:2460-2467. 46. Granstein RD, Askari M, Whitaker D, Murphy GF. Epidermal cells in activation of suppressor lymphocytes: further characterization . J Immunol. 1987;138:4055-4062. 47. Baadsgaard O, Fox DA, Cooper KD. Human epidermal cells from ultraviolet light-exposed skin preferentially activate autoreactive CD4+2H4+ suppressor-inducer lymphocytes and CD8+ suppressor-inducer lymphocytes . J Immunol. 1988;140:1738-1744. 48. Jun BD, Roberts LK, Cho BH, Robertson B, Daynes RA. Parallel recovery of epidermal antigen-presenting cell activity and contact hypersensitivity responses in mice exposed to ultraviolet irradiation: the role of a prostaglandin-dependent mechanism . J Invest Dermatol. 1988;90:311-316.Crossref 49. Noonan FP, DeFabo EC, Morrison H. Cis-urocanic acid, a product formed by ultraviolet B irradiation of the skin, initiates an antigen presentation defect in splenic dendritic cells in vivo . J Invest Dermatol. 1988;90:92-99.Crossref 50. Robertson B, Gahring L, Newton R, Daynes R. In vivo administration of interleukin-1 to normal mice depresses their capacity to elicit contact hypersensitivity responses: prostaglandins are involved in this modification of immune function . J Invest Dermatol. 1987;88:380-387.Crossref 51. Schwarz T, Urbanski F, Kirnbauer R, Kock A, Gschnait F, Luger TA. Detection of a specific inhibitor of interleukin-1 in sera of UVB-treated mice . J Invest Dermatol. 1988;91:536-540.Crossref 52. Taieb A, Cooper KD, Nickoloff BJ, Marcelo CL. Langerhans cells can bind to keratinocytes and modulate their growth in vitro . J Invest Dermatol. 1988;90:611. 53. Pelamberger H, Gazze-Stingl LA, Pogantsch S, Steiner G, Wolff K, Stingl G. Generation of cytotoxic T lymphocytes against alloantigens and TNP-modified syngeneic cells by epidermal cells: requirement for Ia-bearing Langerhans cells . Immunobiology . 1982;163:122-123. 54. Polla L, Margolis R, Goulston C, Parrish JA, Granstein RD. Enhancement of the elicitation phase of the murine contact hypersensitivity response by prior exposure to local ultraviolet radiation . J Invest Dermatol. 1986;86:13-17.Crossref

Journal

Archives of Dermatology – American Medical Association

Published: Jul 1, 1989

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