Ausilia Maria Manganoni

Neutrophilic Eccrine Hidradenitis in a Healthy Woman

Dr. Ausilia M. Manganoni, Divisione Dermatologia, Spedali Civili, I-25125 Brescia (Italy) #3⁄8 • ‘% 2 days duration. The patient had received no drugs and was in good health. Physical examination revealed painful edematous red plaques on the plantar areas, suggesting chilblains. The skin lesions resolved without sequelae within 3 weeks. The histologic examination revealed a superficial and deep inflammatory infiltrate in the dermis predominantly composed of neutrophils. The heavy infiltrate surrounded the eccrine coil and the dermal eccrine ducts and occasionally reached the acrosyringium (fig. 1). Necrosis and vacuolar degeneration of eccrine coil cells were also noted (fig. 2). Focal abscesslike accumulations of neutrophils were found both in the superficial and the deep parts of the dermis. Vessels were occasionally surrounded by neutrophils, but endothelial neFig. 1. NEH: an infiltrate predominantly of neutrophils is seen around the eccrine coil, the dermal eccrine ducts and reaching the acrosyringium. Neutrophilic eccrine hidradenitis (NEH) has been described in patients receiving chemotherapy [1-4]. To the best of our knowledge, we report the second case of NEH in an otherwise healthy individual. A 23-year-old Hispanic waitress was hospitalized for evaluation of slight tender skin lesions on the plantar regions of both feet of

Dermoscopy of scalp tumours: a multi-centre study conducted by the international dermoscopy society

Background  Little is known about the dermoscopic features of scalp tumours.

Recurrent Melanocytic Nevi and Melanomas in Dermoscopy: Results of a Multicenter Study of the International Dermoscopy Society

IMPORTANCE Differentiating recurrent nevi from recurrent melanoma is challenging. OBJECTIVE To determine dermoscopic features to differentiate recurrent nevi from melanomas. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study of 15 pigmented lesion clinics from 12 countries; 98 recurrent nevi (61.3%) and 62 recurrent melanomas (38.8%) were collected from January to December 2011. MAIN OUTCOMES AND MEASURES Scoring the dermoscopic features, patterns, and colors in correlation with the histopathologic findings. RESULTS In univariate analysis, radial lines, symmetry, and centrifugal growth pattern were significantly more common dermoscopically in recurrent nevi; in contrast, circles, especially if on the head and neck area, eccentric hyperpigmentation at the periphery, a chaotic and noncontinuous growth pattern, and pigmentation beyond the scars edge were significantly more common in recurrent melanomas. Patients with recurrent melanomas were significantly older than patients with recurrent nevi (mean [SD] age, 63.1 [17.5] years vs 30.2 [12.4] years) (P<.001), and there was a significantly longer time interval between the first procedure and the second treatment (median time interval, 25 vs 8 months) (P<.001). In a multivariate analysis, pigmentation beyond the scars edge (P=.002), age (P<.001), and anatomic site (P=.002) were significantly and independently associated with the diagnosis of recurrent melanoma in dermoscopy. CONCLUSIONS AND RELEVANCE Dermoscopically, pigmentation beyond the scars edge is the strongest clue for melanoma. Dermoscopy is helpful in evaluating recurrent lesions, but final interpretation requires taking into account the patient age, anatomic site, time to recurrence, growth pattern, and, if available, the histopathologic findings of the first excision.

Dermoscopic, histological and immunohistochemical evaluation of cancerous features in acquired melanocytic nevi that have been repeatedly exposed to UVA or UVB

Abstract:  Previous studies have reported that repeated solar and artificial UVB (280–320 nm) and UVA (320–400 nm) exposures can modify acquired melanocytic nevi (AMN). We therefore investigated the clinical, dermoscopic, histological and immunohistochemical changes in AMN exposed to UVB and UVA radiation. Twenty healthy volunteers with at least three AMN on the trunk were enrolled in the present study and randomized into two groups to receive equally effective doses of narrow‐band (NB)‐UVB or UVA1. Three exposures per week were delivered for a total of 4 weeks. During exposures, one AMN was left unprotected, a second one was shielded with an opaque adhesive tape and the third nevus was covered with a commercial sunscreen. After the irradiation cycle, the AMN were surgically removed and underwent histological and immunohistochemical assessment of melanocyte/melanogenesis‐related proteins (MART‐1, tyrosinase, HMB‐45), cell cycle activation markers (Ki‐67, topoisomerase IIalpha, p53, Cdk2) and transcription factors (microphthalmia‐associated transcription factor, STAT3). Nevi that were exposed to NB‐UVB or UVA1 also showed statistically significant increase in size and changes in their dermoscopic features, including overall darkening, increased pigment network expression, formation of branched streaks, and increased number and size of brown globules and dots. AMN that had been covered with opaque tape or sunscreen did not show changes in size or dermoscopic features following UVA1 or NB‐UVB exposure. Histological and immunohistochemical analysis did not show any significant change in exposed AMN in comparison with AMN shielded with an opaque adhesive tape or covered with the sunscreen.

Merkel cell carcinoma arising in immunosuppressed patients treated with high-dose ultraviolet A1 (320–400 nm) phototherapy: a report of two cases

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumour of the skin. Though immunodeficiency is the most relevant risk factor, ultraviolet (UV) radiation is also involved, but as of yet we do not know the action spectrum, pattern or dose which would produce a dangerous exposure. A retrospective study of two immunosuppressed patients who developed MCC during, or soon after a treatment cycle with high dose UVA1 exposures was conducted, in order to understand wether repeated exposures to suberythemogenic UVA1 radiation may have a cancerogenic activity provoking MCC in immunosuppressed patients.

Nodal staging in localized melanoma. The experience of the Brescia Melanoma Unit

BACKGROUND AND OBJECTIVES We report our experience with patients affected by cutaneous melanoma undergoing sentinel node (SN) biopsy. METHODS From November 1997 to October 2000 we performed 128 selective lymphadenectomies (SN biopsy) on 127 patients with cutaneous melanoma with Breslow thickness>1 mm or regression or ulceration. Age, sex, tumour location ad histology were recorded. RESULTS Two hundred and thirty eight SNs were identified by lymphoscintigraphy in 167 lymphatic stations, 236 of them were identified intraoperatively using a gamma probe and patent blue V injection. Twenty-one patients had SNs with melanoma metastases (15.8%), 12 patients in the groin, eight patients in the axilla and one patient in the neck. After therapeutic lymphadenectomy eight more lymph nodes with metastases of melanoma were found in the specimens of three patients. After a follow-up ranging from 10 to 56 months the results are that 111 patients are free of disease. Ten patients died. Three patients have visceral metastases and are alive. One patient has developed two more melanomas. One patient was lost to follow-up. CONCLUSIONS Our data confirm the clinical reliability of the SN technique in melanoma; for optimisation of the therapeutic strategy, this technique might be considered the standard method of nodal staging in the evaluation of melanoma patients.

Specific skin infiltration as first sign of chronic myelomonocytic leukemia with an unusual phenotype

A patient who had a plaque on his forehead as the first sign of chronic myelomonocytic leukemia (CMML) is described. Histologic studies, which formerly led to the misdiagnosis of non-Hodgkins lymphoma, revealed CMML with an unusual phenotype. This represents a rare type of CMML for the following reasons: (1) specific cutaneous involvement is rarely the first sign of CMML; (2) the unique phenotype was detected by immunohistology on lesional skin, specifically, the leukemic infiltrate was CD4-positive and notably negative for CD15, the pan myeloid/monocytic marker.

Cutaneous epithelioid malignant schwannoma: review of the literature and case report

A case of malignant epithelioid schwannoma in the skin is reported. This was a rare variant of a malignant tumour that arose on the back of a 35-year-old male without neurofibromatosis. Clinically the nodule appeared to be a benign cyst but as it was painful it was decided to remove it. Ultrastructural and immunohistochemical features of the lesion were consistent with those of malignant epithelioid schwannoma so a radical excision was performed. Most ordinary malignant schwannoma are located in the deep soft tissue of the proximal portions of the upper and lower extremities and trunk; to the best of our knowledge only 26 cases of malignant epithelioid schwannoma in the skin and subcutis have been described in the literature. For the 14 male and 12 female patients reviewed, the median age was 43 years (range 19-84). Upper extremities were the most common sites (10 of 26). Seven patients developed local recurrences and four developed metastases: two to lung, one to lung and lymph node, and one to lung, liver and brain. All patients with local recurrence and all except one who developed metastases did not undergo wide local excision. We can conclude that malignant epithelioid schwannoma in the skin and subcutis is eminently curable if treated with wide local excision.

Repeated equally effective suberythemogenic exposures to ultraviolet (UV)A1 or narrowband UVB induce similar changes of the dermoscopic pattern of acquired melanocytic nevi that can be prevented by high-protection UVA-UVB sunscreens

BACKGROUND Sunlight modifies the size and the dermoscopic pattern of acquired melanocytic nevi (AMN). OBJECTIVE We investigated whether repeated exposures to equally effective suberythemogenic doses of ultraviolet (UV)A or UVB can induce changes in the dermoscopic features of AMN. METHODS Twenty volunteers received equally effective doses of narrowband UVB or UVA1. During exposures, an AMN was covered with an opaque tape, another was shielded with the sunscreen, and another was left unprotected. RESULTS Nevi exposed to either narrowband UVB and UVA1 showed statistically significant changes in their dermoscopic features: increased size, increase of pigment network, overall color darkening, formation of focal branched streaks, and increased number and size of brown dots and globules. LIMITATIONS The study is a clinical cohort study on a small number of selected patients. CONCLUSION AMN show similar changes in size and dermoscopic pattern after narrowband UVB and UVA1 exposures.

Report of 27 cases of naevus spilus in 2134 patients with melanoma: is naevus spilus a risk marker of cutaneous melanoma?

phase of the cell cycle. On the other hand, the calprotectin immunolabelling throughout the epidermis appeared strikingly motheaten indicating severe vacuolar alterations. As seen in other disorders, the Mac 387-positive keratinocytes were either metabolically altered or engaged in a regenerative phase. The combination of these features was interpreted as a sublethal sign. The dermal dendrocyte alterations were reminiscent of the methotrexate-induced changes. In some instances, CAR associated with anti-cancer treatment may be predictive for the drug efficacy. Such a feature has not been evaluated so far for pemetrexed.