Eszter Baltás

Electrochemotherapy of cutaneous metastases of melanoma - A case series study and systematic review of the evidence

OBJECTIVES Electrochemotherapy (ECT) is a novel therapeutic option for the treatment of cutaneous and subcutaneous metastases of malignant melanoma. During the treatment, electric pulses are applied to tumor nodules to deliver nonpermeant or poorly permeant chemotherapeutic agents into the cells, increasing local cytotoxicity of anticancer drugs. We compared the clinical effectiveness of ECT as an alternative palliative treatment option for unresectable metastatic lesions of malignant melanoma with a systematic review of reported outcomes. METHODS One hundred fifty-eight cutaneous and subcutaneous metastases of nine patients were treated with ECT. All treatments were performed under general anesthesia using intravenous bleomycin injection. Median follow-up was 195 days. RESULTS In our case series, complete response rate was 23%, and partial response rate was 39%. We observed no change in 30% and progressive disease in 8% of cases. CONCLUSIONS ECT is a simple and effective treatment of single or multiple cutaneous and subcutaneous metastases of melanoma with minimal side effects. Our results provide further data for the growing body of evidence in recently published studies that ECT used for palliation has clinical benefit. The authors have indicated no significant interest with commercial supporters.

Treatment of atopic dermatitis with the xenon chloride excimer laser

Background  Narrow‐band ultraviolet B phototherapy is an effictive and safe treatment for atopic dermatitis. We have previously found that the 308 nm xenon chloride excimer laser was more effective than the narrow‐band ultraviolet B light for the treatment of psoriasis, suggesting that ultraviolet B laser might offer advantages over narrow‐band ultraviolet B.

The Arg160Trp allele of melanocortin-1 receptor gene might protect against vitiligo.

Melanocortin‐1 receptor (MC1R) and agouti signaling protein (ASIP) play pivotal roles in the regulation of human pigmentation. We aimed to study whether single nucleotide polymorphisms (SNPs) of the MC1R and ASIP genes contribute to the pathogenesis of the polygenic pigment skin disorder, vitiligo. The PCR‐amplified, full‐length MC1R gene was studied with sequence analysis, and the 3′ untranslated region (3′ UTR) SNP of ASIP was detected using restriction fragment length polymorphism. The allele frequency of the ASIP SNP did not show any difference between the skin type, hair color and eye color‐matched 97 vitiligo patients and the 59 healthy control individuals. As one of the MC1R polymorphisms showed significantly higher incidence among fair‐skinned individuals (Fitzpatrick I + II, n = 140) than among dark‐skinned individuals (Fitzpatrick III + IV, n = 90), both vitiligo patients and controls were divided into two groups and the frequency of the MC1R alleles was studied separately in fair‐skinned and dark‐skinned subgroups of diseased and healthy groups. C478T, one of the MC1R SNPs studied in 108 fair‐skinned vitiligo patients and in 70 fair‐skinned healthy control individuals, showed a significant difference (P = 0.0262, odds ratio [95% confidence interval] = 3.6 [0.0046–0.1003]) in allele frequency between the two groups: the allele frequency was higher in the control group, suggesting protection against vitiligo. Computer prediction of antigenicity has revealed that the Arg160Trp amino acid change caused by this SNP results in a decrease in antigenicity of the affected peptide epitope.

Photodynamic Therapy of Non-melanoma Skin Cancer with Methyl Aminolaevulinate is Associated with Less Pain than with Aminolaevulinic Acid

© 2012 The Authors. doi: 10.2340/00015555-1223 Journal Compilation

BRAFV600E mutation in cutaneous lesions of patients with adult Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH) is characterized by the proliferation of pathologic Langerhans cells. The disease can develop in any age and can affect almost any organ. Cutaneous involvement is frequent in LCH. The recent demonstration of the activating, oncogenic BRAFV600E gene mutation in LCH samples strongly supports the neoplastic origin of the disease.

Successful treatment of multiple basaliomas with bleomycin-based electrochemotherapy: a case series of three patients with Gorlin-Goltz syndrome.

Gorlin-Goltz syndrome is a rare multisystemic disease, characterized by numerous basal cell carcinomas. The ideal approach for patients with the syndrome would be a treatment with a high cure rate, minimal scarring, short healing time and mild side-effects. Electrochemo-therapy is a novel therapeutic option that ablates tumours with electrical current and simultaneously administered anticancer drugs. Three patients with Gorlin-Goltz syndrome were treated with electrochemotherapy using intravenous bleomycin. Clinical response was obtained in 98 (99%) of the lesions, 86 (87%) of them showed complete response. In 2 tumours, regression was confirmed with histological examination. Long-term cosmetic results were excellent. We consider electrochemotherapy to be an additional tool in the therapeutic armamentarium for Gorlin-Goltz syndrome, and suggest using it as early as possible in selected patients to avoid disfiguring scarring.

Platelet-activating factor antagonist WEB 2086 inhibits ultraviolet-B radiation-induced dermatitis in the human skin

It has been suggested that platelet-activating factor (PAF) plays a role in the pathomechanisms of various inflammatory diseases. In an experimental animal model we demonstrated earlier that a selective PAF receptor antagonist gel inhibits ultraviolet-B (UVB) light-induced edema in mouse ears. The goal of our present investigation was to determine whether locally applied WEB 2086, a selective PAF receptor antagonist, alters the dermatitis-causing effect of UVB light on human skin. We induced dermatitis in healthy volunteers by irradiating their skin with UVB light in increasing doses. The irradiated area was treated with WEB 2086 gel (3%) or with a placebo. Erythema was measured spectrophotometrically after 24 and 48 h. After both 24 and 48 h, the WEB 2086 gel significantly inhibited the UVB light-induced erythema at each radiation dose in comparison with the placebo. The PAF antagonist gel therefore proved to be effective against UVB-induced dermatitis. Our results may help to understand the relative importance of mediators in UVB-induced dermatitis and might perhaps pave the way to better therapeutic modalities in this condition.

Alzheimer's lymphocytes are resistant to ultraviolet B-induced apoptosis

In the present pilot investigation, the susceptibility of T-lymphocytes from Alzheimers disease (AD) subjects (n=22) and aged-matched, non-demented controls (CNT) (n=12) was examined with ultraviolet (UV) B light-induced apoptosis in vitro. The basal apoptotic ratios were similar in both groups. However, the AD lymphocytes displayed significantly (p<0.0001) lower apoptotic levels than those of the CNT lymphocytes at all of the applied UVB exposure doses (100, 200 and 300 mJ/cm(2)). These observations indicate that AD lymphocytes are more resistant than CNT lymphocytes to UVB irradiation.

Association of Skin Examination Behaviors and Thinner Nodular vs Superficial Spreading Melanoma at Diagnosis

Importance Early melanoma detection strategies include skin self-examination (SSE), physician skin examination (PSE), and promotion of patient knowledge about skin cancer. Objective To investigate the association of SSE, PSE, and patient attitudes with the detection of thinner superficial spreading melanoma (SSM) and nodular melanoma (NM), the latter of which tends to elude early detection. Design, Setting, and Participants This cross-sectional, questionnaire-based, multicenter study identified patients with newly diagnosed cutaneous melanoma at 4 referral hospital centers in the United States, Greece, and Hungary. Among 920 patients with a primary invasive melanoma, 685 patients with SSM or NM subtype were included. Interventions A standardized questionnaire was used to record sociodemographic information, SSE and PSE practices, and patient perceptions in the year prior to diagnosis. Main Outcomes and Measures Data were analyzed according to histologic thickness, with a 2-mm cutoff for thinner SSM and NM. Results Of 685 participants (mean [SD] age, 55.6 [15.1] years; 318 [46%] female), thinner melanoma was detected in 437 of 538 SSM (81%) and in 40 of 147 NM (27%). Patients who routinely performed SSE were more likely to be diagnosed with thinner SSM (odds ratio [OR], 2.61; 95% CI, 1.14-5.40) but not thinner NM (OR, 2.39; 95% CI, 0.84-6.80). Self-detected clinical warning signs (eg, elevation and onset of pain) were markers of thicker SSM and NM. Whole-body PSE was associated with a 2-fold increase in detection of thinner SSM (OR, 2.25; 95% CI, 1.16-4.35) and thinner NM (OR, 2.67; 95% CI, 1.05-6.82). Patient attitudes and perceptions focusing on increased interest in skin cancer were associated with the detection of thinner NM. Conclusions and Relevance Our findings underscore the importance of complementary practices by patients and physicians for the early detection of melanoma, including regular whole-body PSE, SSE, and increased patient awareness.

Clinical experiences with vemurafenib treatment of peripheral primitive neuroectodermal tumor in a patient suffering from malignant melanoma

A perifériás primitív neuroektodermális tumor (pPNET) kis kerek sejtekből álló, igen agresszív viselkedésű, ritka előfordulású neoplázia. Kezelésével kapcsolatosan kevés szakirodalmi adat áll rendelkezésre, melanóma malig nummal való együttes előfordulásáról közlemény nem található. 55 éves betegünknél a bal axillában növekvő konglomerátum kettős tumornak bizonyult, nyirokcsomó metasztázist adó melanóma és pPNET együttes előfordulását diagnosztizáltuk. Sebészi kezelést követően a pPNET rapidan jelentkező lokális recidíváját és pulmonális propagációját észleltük. Kemoradioterápiát, majd tekintettel a betegség progressziójára és a BRAF V600E mutációra, vemurafenib kezelést indítottunk. Két hét elteltével kifejezett gyulladással társuló gyors tumor regressziót észleltünk, azonban a kezelés ötödik, illetve hatodik hónapjában a bal axillában lokális recidíva és a pulmonális metasztázisok progressziója je lentkezett. Esetünket a ritka előfordulású pPNET BRAF-gátlóval történő első kezelési tapasztalata és melanómával való együttes előfordulása miatt tartjuk érdekesnek.