A.M. Cesinaro

TTF-1, Cytokeratin 7, 34βE12, and CD56/NCAM Immunostaining in the Subclassification of Large Cell Carcinomas of the Lung

We selected a 4-stain immunopanel including thyroid transcription factor (7ITF)-], cytokeratin (CK)7, 34betaE12, and CD56/neural cell adhesion molecule(NCAM) to subclassify a series of 45 pulmonary large cell carcinomas (LCCs) on bronchial biopsy. All cases consisted of a large tumor cell proliferation with abundant cytoplasm, vesicular nuclei, and prominent nucleoli. Immunohistochemically, 27 tumors (60%)were subclassified as adenocarcinoma (7TF-1 +/CK7+,24; CK7+ only, 3), 10 (22%) as squamous cell carcinoma (34betaE12+ only), and 4 (9%) as LCC with neuroendocrine differentiation (CD56+, variably stained with TTF-I and CK7, 34betaE12-). In 4 cases, the tumors coexpressed CK7 and 34betaE12 (3 cases) or were completely unstained (I case). Surgically resected tumors matched exactly with the corresponding original biopsy specimens in 21 of 23 cases; consistent CD56 expression was a reliable marker in confirming a diagnosis of large cell neuroendocrine carcinoma even on biopsy. Our results suggest that the proposed 4-stainset of commercially available markers might help subclassify LCC even in small biopsy material, validating expression-profiling studies aimed at lung cancer classification and permitting more consistent patient enrollment for trials with targeted treatments.

Photodynamic therapy for basal cell carcinoma: clinical and pathological determinants of response

Background  Photodynamic therapy (PDT) is increasingly used in the treatment of basal cell carcinoma (BCC). However, scant information is available about the impact of both patient‐ and lesion‐related characteristics on the effectiveness of therapy. Therefore, on the basis of the current data, it is difficult to draw clear‐cut indications to use PDT for treatment of BCC in clinical practice.

In vivo confocal reflectance microscopy for the characterization of melanocytic nests and correlation with dermoscopy and histology

Transcription of early T-cell activation genes for interleukin (IL)-2, IL-3, IL-4, IL-5, granulocyte-macrophage colonystimulating factor and tumour necrosis factor-a is then inhibited. In addition to atopic dermatitis, calcineurin inhibitors have been reported to give successful treatment of several inflammatory and autoimmune skin diseases including contact dermatitis, psoriasis vulgaris, alopecia areata and chronic discoid lupus erythematosus. LIS is regarded by some as a nonscarring form of discoid lupus erythematosus. It therefore appears reasonable to infer that topical calcineurin inhibitors may be useful in treating LIS. The course of LIS is unpredictable. Most patients experience a waxing and waning course marked by intermittent improvement and subsequent exacerbation, which makes the evaluation of therapeutic effectiveness difficult. The rapid clinical response of our patient was more likely to be due to the effect of topical calcineurin inhibitors rather than to a natural course. In addition, the absence of recurrence of the skin eruptions during treatment also supported the effectiveness of topical calcineurin inhibitors in LIS. The most frequent adverse events associated with topical tacrolimus are a burning sensation, pruritus and erythema at the site of application. All these events are generally mild in nature and transient. Interestingly, the adverse event our patient experienced occurred after tacrolimus had been used for 2 weeks. Such a late-onset phenomenon has not been mentioned in the literature. Because of the uncertain risks of topical calcineurin inhibitors on photocarcinogenesis in humans, caution should be exercised in treating patients with LIS in sun-exposed areas. In addition, coexistent herpes simplex infection on the face is not uncommon. Topical calcineurin inhibitors should be avoided during active infection. Our results suggest that topical calcineurin inhibitors offer an effective treatment for LIS.

Hyporeflective pagetoid cells: a new clue for amelanotic melanoma diagnosis by reflectance confocal microscopy

Amelanotic melanoma represents a diagnostic challenge both clinically and dermoscopically. Few studies based on case series have explored the possibility of using reflectance confocal microscopy (RCM) to diagnose amelanotic melanoma.

In vivo micro-angiography by means of speckle-variance optical coherence tomography (SV-OCT) is able to detect microscopic vascular changes in naevus to melanoma transition

ohm M. An a-MSH hormone analog in erythropoietic protoporphyria. J Invest Dermatol 2015; 135: 929–931. 3 Hadley ME, Dorr RT. Melanocortin peptide therapeutics: historical milestones, clinical studies and commercialization. Peptides 2006; 27: 921–930. 4 Langan EA, Nie Z, Rhodes LE. Melanotropic peptides: more than just ‘Barbie drugs’ and ‘sun-tan jabs’? Br J Dermatol 2010; 163: 451–455. 5 del Marmol V, Luger T, Neumann NJ et al. Public health issues arising from sale of illegal and potentially unsafe ‘tanning chemicals’. Pigment Cell Melanoma Res 2009; 22: 648. 6 Evans-Brown M, Dawson RT, Chandler M, McVeigh J. Use of melanotan I and II in the general population. BMJ 2009; 338: b566. 7 Hussussian CJ, Struewing JP, Goldstein AM et al. Germline p16 mutations in familial melanoma. Nat Genet 1994; 8: 15–21. 8 Newton Bishop JA, Bishop DT. The genetics of susceptibility to cutaneous melanoma. Drugs Today 2005; 41: 193–203. 9 Paurobally D, Jason F, Dezfoulian B et al.Melanotan-associated melanoma. Br J Dermatol 2011; 164: 1403–1405. 10 Ong S, Bowling J. Melanotan-associated melanoma in situ. Australas J Dermatol 2012; 53: 301–302.

Small‐diameter melanocytic lesions: morphological analysis by means of in vivo confocal microscopy

Background  Small‐diameter melanocytic lesions represent a diagnostic challenge for clinicians, as they do not follow the ABCD rule for diagnosis and do not always display reliable histopathological criteria.

Towards an in vivo morphologic classification of melanocytic nevi

Nevi are common benign neoplasms and the main diagnostic entity in the differential diagnosis of melanoma. Reflectance confocal microscopy (RCM), a novel technique for skin imaging at cellular‐level magnification, has been shown to be useful for differentiating nevi from melanoma. However, systematic studies of the specific RCM features of nevi are still lacking.

Malignant melanoma in patients with hereditary nonpolyposis colorectal cancer

Background  Malignant melanoma (MM) is the most aggressive skin cancer. Most MMs are sporadic, and in this setting an association with mismatch repair (MMR) gene mutations, typical of hereditary nonpolyposis colorectal cancer (HNPCC) tumours, has been proposed.

Grading keratinocyte atypia in actinic keratosis: A correlation of reflectance confocal microscopy and histopathology

Actinic Keratosis (AK) is the clinical manifestation of cutaneous dysplasia of epidermal keratinocytes, with progressive trend towards squamous cell carcinoma.

Cost–benefit of reflectance confocal microscopy in the diagnostic performance of melanoma

The sub‐optimal diagnostic accuracy for melanoma leads to excise a high number of benign lesions, with consequent costs. Reflectance confocal microscopy (RCM) improves diagnostic specificity, thus possibly inducing a reduction in unnecessary excisions and related costs.