Erika Richtig

Age-related prevalence of dermoscopy patterns in acquired melanocytic naevi.

Background  Based on the dermoscopic classification of acquired melanocytic naevi, six different dermoscopic types can be distinguished by morphology (globular, globular‐reticular, globular‐homogeneous, reticular, reticular‐homogeneous, homogeneous) and by pigment distribution (uniform, central hyperpigmentation, central hypopigmentation, peripheral hyperpigmentation, peripheral hypopigmentation, multifocal hyper/hypopigmentation). It has been suggested that most individuals harbour one predominant dermoscopic type among their naevi.

Local recurrence in melanoma in situ: influence of sex, age, site of involvement and therapeutic modalities

Background Melanoma in situ (MIS) occurs on various body sites, in various age groups, and is managed by a variety of treatment modalities. Despite early treatment, recurrences may be encountered.

In vivo confocal laser scanning microscopy of melanocytic skin tumours: diagnostic applicability using unselected tumour images.

Background  In vivo confocal laser scanning microscopy (CLSM) represents a novel imaging tool that allows the noninvasive examination of skin cancer morphology in real time at a ‘quasi‐histopathological’ resolution viewing microanatomical structures and individual cells.

Reflectance confocal microscopy of facial lentigo maligna and lentigo maligna melanoma: a preliminary study.

Background  Facial lentigo maligna (LM) and lentigo maligna melanoma (LMM) may be difficult to diagnose clinically and dermoscopically. Reflectance confocal microscopy (RCM) enables the in vivo assessment of equivocal skin lesions at a cellular level.

In vivo confocal scanning laser microscopy of common naevi with globular, homogeneous and reticular pattern in dermoscopy

Background  A systematic examination and comparison of confocal scanning laser microscopy (CSLM) features of benign naevi showing different dermoscopic patterns has never been performed.

HGF-Promoted Motility in Primary Human Melanocytes Depends on CD44v6 Regulated via NF-kappa B, Egr-1, and C/EBP-beta

The regulation of CD44v6, a variant of the CD44 family of glycosylated adhesion molecules, through hepatocyte growth factor (HGF) has implications for motility in primary human melanocytes. We show that exposure of primary human melanocytes to HGF results in an increase of CD44v6 expression. Immunostaining of melanocytic lesions revealed low cytoplasmic positivity of CD44v6 in some nevi but high membranous expression in primary cutaneous melanomas, and cutaneous and lymph node metastases. HGF-dependent CD44v6 regulation in melanocytes is NF-kappaB dependent because BAY 11-7082, an inhibitor of NF-kappaB activation, but not interference with the mitogen-activated protein kinase or phosphatidylinositol 3-kinase cascade, antagonized HGF-induced CD44v6 expression. NF-kappaB-mediated transcriptional regulation of CD44v6 involves the transcription factors Egr-1 and CCAAT enhancer-binding protein-beta (C/EBP-beta). In gel shift assays, the initial binding of p100/p52 NF-kappaB, C/EBP-beta, and Egr-1 to the CD44 promoter experienced reshuffling toward increased affinity of C/EBP-beta after HGF stimulation. A blocking antibody to CD44v6 decreased HGF-induced c-Met phosphorylation as well as enhanced random- and site-directed migration. Our data show that HGF-induced motility in primary human melanocytes depends on c-Met-CD44v6 interaction, and that HGF-enhanced CD44v6 expression is required for motility and transcriptional upregulation of CD44v6, presumably mediated through a complex comprising NF-kappaB/C/EBP-beta and Egr-1.

Ocular melanoma: Epidemiology, clinical presentation and relationship with dysplastic nevi

Purpose: Ocular melanoma is a rare entity compared to cutaneous malignant melanoma. We examined the frequency of the tumor in a defined geographic region, its clinical presentation and its relationship with dysplastic nevi in 136 patients. Methods: 136 patients (64 men and 72 women; mean age 61.7 years, range 20–92 years) with ocular melanoma were treated at the University Hospital of Graz between June 1996 and December 2001. 129 had primary uveal melanoma in one eye (117 choroidal melanomas, 11 melanomas of the ciliary body and 1 of the iris), 2 patients had uveal melanoma in both eyes, 4 patients had conjunctival melanoma and 1 patient had a melanoma of the lacrimal sac. Epidemiology, history, potential risk factors, clinical presentation and relationship with dysplastic (= atypical) nevi were documented. Results: 48 patients (35.3%) showed more than five dysplastic nevi, compared to only 1.2% in the general population (χ2 test: p < 0.001). 5 (3.7%) had additional cutaneous melanoma and 7 (5.1%) had a family history of melanoma. The lifelong risk for the occurrence of an additional primary cutaneous melanoma was 2.9%, which is significantly higher than the usual estimate of 1% for the general population. Conclusions: Patients with primary ocular melanoma have an increased risk to develop cutaneous melanoma and should therefore be examined regularly by dermatologists.

Primary mucosal melanomas of the nasal cavity and paranasal sinuses

We present 14 patients with primary sinonasal melanomas (SM) identified from 1984–1997 in our archives (11/14 lateral nose, 1/14 nasal septum, 2/14 paranasal sinuses; 8M/6F, mean age 67.7 years, range 39–88 years). Survival was poor (median 9 months) with death related to extensive local disease and/or widespread hematogenous metastases. The following histological subtypes were identified in descending order: amelanotic small blue cell, pleomorphic, epithelioid, spindle cell and myxoid. High mitotic rate and vascular invasion, absence of tumor‐infiltrating lymphocytes and regression were features shared by all SM. Negative staining of B‐ and T‐cell markers, LCA, neuroendocrine markers such as NSE, chromogranin and synaptophysin, and CK‐negativity excluded olfactory neuroblastoma, small cell undifferentiated carcinoma, and lymphoma. S‐100 protein was expressed in all SM, but demonstrated variable staining intensity with areas of complete negativity. HMB45 was strongly and uniformly (>80%) expressed in all undifferentiated small blue cell SM. The pigmented SM were predominantly HMB45‐negative. The strong HMB45 staining in amelanotic small blue cell SM is explained by the reaction of HMB45 antibody with an oncofetal antigen found in immature melanosomes. In these poorly differentiated amelanotic malignant melanomas, antibody to HMB45 proved to be a superb diagnostic marker. We therefore strongly advocate the inclusion of HMB45 antibody in the panel of antibodies for initial work‐up of undifferentiated mucosal neoplasms, since a negative S‐100 stain in small biopsy material may result in incorrect classification of these neoplasms.

Temozolomide and interferon α2b in metastatic melanoma stage IV

Background  A multicentre, centrally randomized, open‐labelled study with temozolomide and interferon (IFN)‐α2b was carried out to study the therapeutic effect in patients with metastatic melanoma stage IV.

Erythema nodosum-like lesions during BRAF inhibitor therapy: Report on 16 new cases and review of the literature

BRAF inhibitors have been licensed for the therapy of BRAF‐mutated melanoma. Recently, inflammatory skin lesions clinically resembling erythema nodosum have been reported as therapy side‐effects that may lead to treatment discontinuation.