F. Pelletier

Dermatofibrosarcoma protuberans: a population-based cancer registry descriptive study of 66 consecutive cases diagnosed between 1982 and 2002

Background  Dermatofibrosarcoma protuberans (DFSP) is a rare malignant tumour of the skin, with an estimated incidence of 0.8 to five cases per 1 million people per year.

Efficacy of high doses of botulinum toxin A for treating provoked vestibulodynia

Summary Background  Provoked vestibulodynia is difficult to treat. The beneficial effects of botulinum toxin A are being considered because of the muscular anomalies observed in this pathology.

Circulating vascular endothelial growth factor in cutaneous malignant melanoma

Background  Angiogenesis has been reported as a parameter of potential prognostic value in solid tumours, as it may facilitate tumour growth and metastasis. One of the most important growth factors involved in angiogenesis is vascular endothelial growth factor (VEGF).

Increased Levels of Circulating Microparticles Are Associated with Increased Procoagulant Activity in Patients with Cutaneous Malignant Melanoma

Microparticles (MPs) are known to be increased in various malignancies and are involved in tumor invasion, angiogenesis, coagulation, and metastasis. We investigated the plasma levels of annexin-V MPs (AV(+)MPs), platelet-derived MPs (PMPs), and endothelial-derived MPs (EMPs) in patients with melanoma (n=129) and in healthy controls (n=49). A functional coagulation test STA Procoag-PPL measuring the clotting time was performed on samples containing MPs to evaluate their procoagulant potential. The plasma levels of PMPs, EMPs, and AV(+)MPs were significantly higher, and the clotting time-PPL was significantly lower in melanoma patients than in healthy controls. The plasma levels of PMPs, EMPs, and AV(+)MPs were higher in stage IV than in the other stages of melanoma, but with no significant difference. In addition, we observed an inverse correlation between PMPs, AV(+)MPs, and clotting times. Our data suggest that MPs are involved in the progression of melanoma and may be associated to melanoma-associated thrombogenesis.

Eczéma aigu d’un pied au diméthylfumarate

témoigne de l’importance de ce problème, dont les médias français se sont fait l’écho à la suite d’une communication du réseau de vigilance français Revidal à l’Académie européenne de dermatologie (Dr C. Lecoz — communication non publiée) [3]. Comme dans notre observation, les patch-tests réalisés avec les échantillons de tissu du fauteuil étaient positifs [3]. Quant au test au fumarate, l’intensité de la réaction rappelle la sévérité des réactions au dinitrochlorobenzène (DNCB), ce qui incite à ne tester ce produit qu’avec une extrême prudence, d’autant plus qu’il s’agit aussi d’un agent irritant. À cet égard, même s’il s’agit d’un composant du Fumaderm®, médicament oral utilisé depuis 1995 en Allemagne dans le traitement du psoriasis, sa commercialisation sous forme topique n’est pas envisageable [4]. L’observation présentée ici est singulière par le retard diagnostique lié à une présentation clinique trompeuse d’inflammation pigmentée d’exceptionnelle sévérité, sans altération épidermique. Au-delà de la possibilité d’une réaction initiale eczématiforme éteinte spontanément ou sous dermocorticoïdes, le tableau histologique d’infiltrat lymphoïde avec quelques nécroses kératinocytaires et corps de Civatte est à rapprocher des dermites de contact lichénoïdes décrites avec les graisses minérales, le trichloréthylène, le trioxyde d’antimoine ou les produits de développement de photographie [5], mais avec une inflexion vers un aspect scléro-inflammatoire qui mérite d’être signalée.

Primary cutaneous lymphomas: A population-based descriptive study of 71 consecutive cases diagnosed between 1980 and 2003

Although primary cutaneous lymphomas (PCL) are the second most common group of extra-nodal non-Hodgkin lymphomas, few epidemiological data are available in the literature, and most of them are provided by large databases from population-based cancer registries in the US or patients attending a single institution. We conducted this study to investigate the epidemiological and clinical features of PCL diagnosed in the département of Doubs from 1980 to 2003. Data were collected from the Doubs cancer registry from 1980 to 2003. Seventy-one patients with PCL were investigated. 82% were cutaneous T-cell lymphoma (CTCL) and 18% were cutaneous B-cell lymphoma (CBCL). Among CTCL, mycosis fungoides (MF) represented 58% and Sezary syndrome 10%. The standardised incidence rate of PCL was 0.42 for 100 000 person-years and significantly increased from 0.21 in 1980–1984 to 0.70 in 2000–2003 (p <0.05). The incidence rate of CTCL was 0.34 for 100 000 person-year and significantly increased from 0.2 to 0.57 (p <0.05). For MF and CBCL, the incidence rates were 0.20 and 0.08, respectively and did not vary significantly from 1980–1984 to 2000–2003. Five-year survival was 64.5% for PCL patients similar to MF patients. Our results provide updated data on the incidence of PCL in France.

Molluscum contagiosum profus au cours d’une dermatite atopique traitée par tacrolimus : intérêt du cidofovir

Resume Introduction Le tacrolimus local est un immunosuppresseur non steroidien qui a montre son efficacite dans la dermatite atopique. On a parfois pu noter au cours du traitement la survenue d’infections cutanees, notamment virales. Observation Un homme de 35 ans etait traite pour une dermatite atopique severe depuis plusieurs mois par tacrolimus (Protopic ® ). Apres 5 mois de traitement, apparaissait une eruption diffuse de molluscum contagiosum, en particulier sur les zones corporelles ou l’application de tacrolimus avait ete importante. L’arret du tacrolimus et l’application d’une preparation a base de cidofovir a 3 p. 100 permettaient une guerison complete rapide en 8 jours, sans recidive avec plusieurs mois de recul. Discussion Les infections cutanees virales, en particulier a poxvirus, sont favorisees par les traitements immunosuppresseurs topiques, comme le tacrolimus, probablement avec un effet dose dependant. Paradoxalement, ils exercent un effet protecteur contre les infections bacteriennes, en restaurant l’integrite de la barriere cutanee. L’application de cidofovir a permis le traitement rapide d’une forme severe de molluscum contagiosum, sans effet indesirable notoire. Ceci corrobore plusieurs observations qui rapportent la meme efficacite et une bonne tolerance de cette molecule pour le traitement d’infections par des virus a ADN. Son utilisation offre ainsi des perspectives therapeutiques supplementaires pour les malades immunodeprimes qui ont souvent des formes extensives et difficiles a traiter d’infections habituellement banales.

Sentinel lymph node biopsy in melanoma: Our 8-year clinical experience in a single French institute (2002-2009)

BackgroundSince the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of SLNB for melanoma.MethodsA single center observational cohort of 203 melanoma patients with a primary cutaneous melanoma (tumour thickness > 1 mm) and without clinical evidence of metastasis was investigated from 2002 to 2009. Head and neck melanoma were excluded. SLN was identified following preoperative lymphoscintigraphy and intraoperative gamma probe interrogation.ResultsThe SLN identification rate was 97%. The SLN was tumor positive in 44 patients (22%). Positive SLN was significantly associated with primary tumor thickness and microscopic ulceration. The median follow-up was 39.5 (5–97) months. Disease progression was significantly more frequent in SLN positive patients (32% vs 13%, p = 0.002). Five-year DFS and OS of the entire cohort were 79.6% and 84.6%, respectively, with a statistical significant difference between SLN positive (58.7% and 69.7%) and SLN negative (85% and 90.3%) patients (p = 0.0006 and p = 0.0096 respectively). Postoperative complications after SLNB were observed in 12% of patients.ConclusionOur data confirm previous studies and support the clinical usefulness of SLNB as a reliable and accurate staging method in patients with cutaneous melanoma. However, the benefit of additional CLND in patients with positive SLN remains to be demonstrated.

Effects of anti‐TNF‐α agents on circulating endothelial‐derived and platelet‐derived microparticles in psoriasis

Psoriasis involves TNF‐α secretion leading to release of microparticles into the bloodstream. We investigated the effect of TNF blockers on microparticles levels before and after treatment in patients (twenty treated by anti‐TNF‐α agents and 6 by methotrexate) with severe psoriasis. Plasmatic microparticles were labelled using fluorescent monoclonal antibodies and were analysed using cytometry. Three months later, 70% of patients treated with anti‐TNF‐α agents achieved a reduction in PASI score of at least 75%. The clinical improvement in patients treated with anti‐TNF‐α agents was associated with a significant reduction of the mean number of platelet microparticles (2837/μl vs 1849/μl, P = 0.02) and of endothelial microparticles (64/μl vs 22/μl, P = 0.001). Microparticles are significantly decreased in psoriatic patients successfully treated by anti‐TNF‐α. Microparticles levels as circulating endothelial cells represent signs of endothelial dysfunction and are elevated in psoriasis. Then, TNF blockade may be effective to reduce cardiovascular risk through the reduction of circulating microparticles.

Rare skin cancer: a population-based cancer registry descriptive study of 151 consecutive cases diagnosed between 1980 and 2004.

Background. There are few epidemiological data available on rare skin cancer, including Merkel cell carcinoma, Pagets disease, adnexal carcinoma, and sarcoma. We conducted this study to investigate the epidemiological of rare skin cancer diagnosed in the département of Doubs from 1980 to 2004. Methods. Data were collected from a population-based cancer registry from 1980 to 2004. Diagnosis was based on the 3rd edition of the International Classification of Diseases for Oncology. The incidence rates were standardized on world population. Results. One hundred and fifty one patients were investigated (88 women and 63 men). Median age for the diagnosed disease was 63 years. The standardized incidence rate was 0.82/100 000 person-year (95% CI = 0.68–0.96) and increased from 0.25 in 1980–1984 to 1.50 in 2000–2004. Fifty nine cases (39%) were sarcomas, 35 (23%) adnexal carcinomas, 27 (18%) Merkel cell carcinoma and 27 (18%) Pagets disease. The standardized incidence rates were 0.37/100 000 (0.27–0.47) for sarcomas, 0.16 (0.10–0.22) for adnexal tumors, 0.13 (0.08–0.18) for Merkel cell carcinoma, and 0.15 (0.09–0.21) for Pagets disease. Conclusions. Our results based on a population-based cancer registry showed an increase of the standardized incidence rate for all types of rare skin tumors. These results may be useful when considering the growing interest in rare diseases in identifying risk factors and planning scientific research programmes.