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Cultured melanocyte suspensions
Cultured melanocyte suspensions
The CMS technique was first performed by Olsson and Juhlin in 1993 for the treatment of vitiligo.49 Similar to NCES, an ultra-thin skin graft is harvested and trypsinized; the suspension is then combined with culture medium, in addition to Dulbeccoโs Modified Eagle Medium (DMEM), followed by incubation at 37ยฐC for approximately 3 weeks. During this time, culture fluid is replaced daily. Part of the cultured cell suspension is then removed and stained with Trypan blue, which aids in determining viable melanocyte density, with a goal of 1,000 to 2,000 melanocytes/mm2 needed for successful transplantation. Once achieved, the cells are detached from plates and applied as a suspension to the prepared RS. The site is then covered with gauze presoaked in culture medium, followed by dressing placement. Bed rest is recommended for 1 to 10 hours, and dressing is typically removed after 7 to 10 days.50
Melanocyte expansion from a small DS using cell culturing makes CMS a useful method to treat large areas. One study showed no difference in repigmentation rate when a high (1:10โ1:160) versus a low ratio (โค1:10) was used for CMS.50 However, multiple sessions are required along with as a well-equipped laboratory with skilled technicians to isolate, culture, and cultivate melanocytes, making this a costly procedure.50
A review of the literature suggests that CMS and NCES produce similar results, and are both effective methods of inducing repigmentation. A distinct advantage of CMS is the ability to achieve a donor to recipient area ratio of up to 1:100 compared with 1:10 in NCES.51 However, the longer incubation and cell culture time, as well as the higher cost associated with a laboratory, makes CMS less desirable.51 There is also a theoretical risk of malignancy associated with the CMS technique, as one of the components of the culture medium, 12-tetradecanoylphorbol 13-acetate (TPA), is a tumor promoter. The advent of TPA-free solutions and mediums has made this less of a concern.52 A study involving 25 patients with stable local, segmental, mucosal, acrofacial, and vulgaris vitiligo types compared NCES and CMS and found that a
greater number of NCES-treated patches demonstrated greater than 70% repigmentation. However, there was no statistically significant difference in repigmentation between the two groups.51
Another study compared CMS plus PUVA, SBEG plus PUVA, cryotherapy plus PUVA, and PUVA alone in 20 patients with stable focal and generalized (acrofacial) vitiligo. There was no statistically significant difference between SBEG and CMS in terms of graft survival and time to repigmentation, but there was a complete lack of effectiveness observed in the groups treated with cryotherapy plus PUVA and PUVA alone.53 Another study involving 132 patients with stable piebaldism, halo nevi, and focal, segmental, and vulgaris vitiligo types compared CMS, ultra-thin STSG, and NCES treatment methods, and found that patients treated with STSG had better overall results.45