Camillo Farisoglio

Borrelia burgdorferi-Associated Primary Cutaneous Marginal-Zone B-Cell Lymphoma: A Case Report

An association between Borrelia burgdorferi with primary cutaneous B-cell lymphoma (PCBCL) has long been suspected but just recently, thanks to a polymerase chain reaction technique, it had been possible to demonstrate B. burgdorferi-specific DNA in skin lesions of patients with different PCBCL subtypes. Locating cases of PCBCL that are related to B. burgdorferi infection could be really important for therapeutic implications; in fact, there are several reports of PCBCL responding to antibiotic therapy against B. burgdorferi. We report a case of B. burgdorferi-associated primary cutaneous marginal-zone B-cell lymphoma that, after specific antimicrobial therapy, did not show any clinical regression. We can conclude that additional studies are necessary in order to establish the use of antimicrobial therapy in B. burgdorferi-associated PCBCL.

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.

Pigmentation of axillary sentinel nodes from extensive skin tattoo mimics metastatic melanoma: case report

The relationship between the occurrence of skin diseases and skin tattoos remains unclear. Dermatologic disorders have been reported to occur in about 2% of cases. In addition, tattoo pigment can migrate to the regional lymph nodes through the lymphatic vessels and subsequently mimic metastatic disease from melanoma.

Dermatofibrosarcoma protuberans in an adolescent: a case report and review of the literature.

Classically, dermatofibrosarcoma protuberans (DFSP) is a disease of adults. The world literature revision shows that several pediatric cases have been reported so far; this might suggest that the number of infants with the condition might be larger than that estimated previously. Here, we report the 183rd case of histologically confirmed DFSP in young age. A 14-year-old white male patient came under our care for a slowly growing, pale brownish lesion on the neck skin. A biopsy specimen showed a DFSP. Subsequently, a wide surgery excision with 3 cm of resection margins including the underlying fascia was performed. To date, the patient has been in follow-up for 6 years without evidence of recurrent disease. The clinical features and treatment of DFSP diagnosed in childhood and adolescence reported in the published literature are reviewed to provide new insights about this rare entity. The aim is to emphasize the importance of biopsy for histologic evaluation in the cases that show a persistent or a large cutaneous plaque or nodule without pathognomonic clinical features that permit a clinical diagnosis. An accurate knowledge of the disease is the prerequisite for a wider recognition and appropriate treatment.

Multidisciplinary team-working indicators of good practice in the clinical management of EGFR-inhibitor dermatologic toxicities.

Use of biologic agents targeting epidermal growth factor receptor (EGFR) continues to increase in the treatment of various malignancies. A significant limiting issue in the use of these agents is dermatological toxicity, mainly the papulopustular eruption in the seborrhoeic areas of the skin, reported in 60–80% of the patients. This dermatological toxicity often causes important physical discomfort and distress in patients interrupting the therapy. Many studies have shown significant correlation between the severity of skin toxicity and tumor response, so it is important for oncology practitioners to control the signs and symptoms of skin toxicity in order to prevent therapy interruption in these patients. The possible mechanism of EGFR inhibitor-related cutaneous toxicity is the inhibition of EGFR in the skin itself. EGFR plays a specific role in skin biophysiology and it is present mainly in keratinocytes, follicular epithelium, sebaceous sweat glands, and endothelium present in the dermis capillaries. At this time there is no consensus on management of EGFR inhibitorassociated rash, and a variety of treatment options have been used, such as steroids, antibiotics, and retinoic acid. We report the experience of the Dermato-Oncologic Unit of Brescia, Italy. Ten patients with severe follicular rash induced by cetuximab were evaluated for papular dermatitis that appeared on the face after 3 weeks of treatment with cetuximab. Dermatitis was diffuse. It was characterized by gradual appearance of erythematous, pruritic papules, and pustules on the trunk. Moist or weeping cutaneous lesions in the groin were common. Patients usually had itching and less often pain at the involved site. Often, as more lesions developed, various topical products composed of antibiotics, steroids, cosmetics, and antipruritic agents were applied to patients. It is possible that greasy and occlusive products might increase inflammation and itchy sensation. In order to protect against this natural tendency, physicians should provide more information to the patient on the currently available products, and cosmetics should be avoided. We treated these extensive cases with the administration of oral limecycline 300 mg/day. Locally, maintenance of cleanliness with sodium chloride (NaCl) solutions followed by local treatment with salicylic cream (salicylic acid 2% and sulfur colloid 2%) gradually improved dermatitis. Topical or oral steroid was not used because folliculitis may follow their application. It was recommended to all patients to avoid any traumatisms of papulopustular lesions and sun exposure. In these patients, treatment of pruritus with sedative antihistamine, such as hydroxyzine, seems reasonable. In all patients, skin reaction was well controlled and dose reduction or interruption of EGFR-target agent was not necessary. We think that a multidisciplinary program and collaboration between oncologist and dermatologist is very important for management of skin reactions, especially in cases of new therapeutic approach.

Association between multiple cutaneous melanoma and other primary neoplasms

Background.  The risk of a subsequent cancer is an important issue for patients with melanoma. The development of a second primary cancer in patients with a solitary melanoma has been discussed in several studies. However, to our knowledge, the incidence of second primary cancer (SPC) in patients with multiple primary melanoma (MPM) has not been thoroughly investigated.

Interval Sentinel Lymph Nodes: An Unusual Localization in Patients with Cutaneous Melanoma

Background. Recent studies have demonstrated that there exists a great variation in the lymphatic drainage in patients with malignant melanoma. Some patients have drainage to lymph nodes outside of conventional nodal basins. The lymph nodes that exist between a primary melanoma and its regional nodal basin are defined “interval nodes”. Interval node occurs in a small minority of patients with forearm melanoma. We report our experience of the Melanoma Unit of University Hospital Spedali Civili Brescia, Italy. Methods. Lymphatic mapping using cutaneous lymphoscintigraphy (LS) has become a standard preoperative diagnostic procedure to locate the sentinel lymph nodes (SLNs) in cutaneous melanoma. We used LS to identify sentinel lymph nodes biopsy (SLNB) in 480 patients. Results. From over 2100 patients affected by cutaneous melanoma, we identified 2 interval nodes in 480 patients with SLNB . The melanomas were both located in the left forearm. The interval nodes were also both located in the left arm. Conclusion. The combination of preoperative LS and intraoperative hand-held gamma detecting probe plays a remarkable role in identifying these uncommon lymph node locations. Knowledge of the unusual drainage patterns will help to ensure the accuracy and the completeness of sentinel nodes identification.

Multiple eruptive clear cell acanthoma.

BACKGROUND Clear cell acanthoma is a rare solitary benign epidermal tumor of unknown etiology. The disease arises in the middle-age, with no sex predominance. It appears as a single reddish papule or papule-nodule and a peripheral scaling collarette is characteristic. Although solitary lesions are the rule, less than 30 cases of multiple Clear cell acanthoma have been described in the literature to date. MAIN OBSERVATIONS We report an unusual case of a healthy 74-year-old male with multiple clear cell acanthoma on the lower extremities treated successfully with cryotherapy. CONCLUSIONS Despite significant progress in treatment of clear cell acanthoma, cryotherapy, based on liquid nitrogen, remains an important alternative in treating multiple clear cell acanthomas.