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Melanocyte grafting with epidermal cell suspensions

Introduction

Surgical treatment of vitiligo is a possibility for limited areas in patients with stable generalized vitiligo, especially when there is a complete loss of melanocytes within areas bearing a significant aesthetic damage. The best indication for melanocyte grafting is segmental vitiligo which is a stable localized form of the disease, with usually  a  complete loss of pigment. The potential for repigmentation is best appreciated under Wood’s light examination. This technique allows to evaluate the amount of melanocytes that are still present at the dermo-epidermal junction, and to make a judgement for medically assisted and/or spontaneous repigmentation.

Melanocyte grafting is a surgical technique which is not reimbursed by the French Healthcare insurance system on a routine  basis, but which is available at our referral centre for French national social security affiliates.

Indication

Segmental vitiligo with complete loss of melanocytes
Generalized vitiligo with marked aesthetic prejudice, stable for at least 6 to 12 months and previous failure of correctly conducted medical treatments (PUVA, UVB, Others)

Surgical techniques. Different techniques can be used for melanocyte grafting/ There is no comparative study allowing to make a comparison in terms of outcome.
In our department, we use a technique developed by Dr Gauthier which is described below :


  • Day 1:
    1st Step : A thin piece of normally pigmented skin from the donor site is harvested by shaving under local anesthesia (scalp or buttock) as shown in Figure 1. The wound is secondly covered with occlusive topical antibiotic bandage and adhesive tape. In the same time, blood is obtained from the patient to save serum (Figure 2).
    2nd Step : preparation of the recipient site : margins of treated area and injection areas are marked with a surgical micrographic pen. Then, freezing the skin with liquid nitrogen allows to create recipient blisters (Figure 3). 
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  • Day 2:
    1st Step: A mechanical dermo-epidermal separation and suspension is performed to obtain epidermal cells containing melanocytes . Syringes containing a mix of melanocytes and serum previously obtained are prepared (Figure 2).
    2nd Step:  the injection of the preparation within the blisters of the recipient site is performed (Figure 5) before the application of an occlusive topical antibiotic bandage and adhesive tape. 
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  • Commentaries.
    Results of a surgical graft will be evaluated between month 3 and 6 following treatment (Figures 6, 7 and 8). Additional treatment with natural or artificial UV exposure and/or topical tacrolimus may be associated. Additional grafts may be necessary to achieve a more homogeneous  repigmentation of the treated area.
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References

Gauthier Y, Surleve-Bazeille JE. Autologous grafting with noncultured melanocytes: a simplified method for treatment of depigmented lesions. J Am Acad Dermatol. 1992 Feb;26(2 Pt 1):191-4.


van Geel N, Ongenae K, De Mil M, Naeyaert JM. Modified technique of autologous noncultured epidermal cell transplantation for repigmenting vitiligo: a pilot study. Dermatol Surg. 2001 Oct;27(10):873-6.


Olsson MJ, Juhlin L. Long-term follow-up of leucoderma patients treated with transplants of autologous cultured melanocytes, ultrathin epidermal sheets and basal cell layer suspension. Br J Dermatol. 2002 Nov;147(5):893-904.


van Geel N, Ongenae K, Vander Haeghen Y, Vervaet C, Naeyaert JM. Subjective and objective evaluation of noncultured epidermal cellular grafting for repigmenting vitiligo. Dermatology. 2006;213(1):23-9.


Mulekar SV. Long-term follow-up study of segmental and focal vitiligo treated by autologous, noncultured melanocyte-keratinocyte cell transplantation. Arch Dermatol. 2004 Oct;140(10):1211-5.


Czajkowski R. Comparison of melanocytes transplantation methods for the treatment of vitiligo. Dermatol Surg. 2004 Nov;30(11):1400-5.

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