Federica Scarfì

Estrogens, estrogen receptors and melanoma

The skin is the largest nonreproductive target tissue on which estrogen plays many beneficial and protective roles. Although neither exogenous hormones nor pregnancy represent significant risk factors for melanoma, epidemiological data suggest a higher survival rate in women with metastatic disease versus men and in premenopausal versus postmenopausal patients. Despite the fact that hyperestrogenic signaling has long been implicated in the initiation and progression of several tumors, the role of estrogens in malignant melanoma is still unclear. The cellular effects of estrogens are mediated by two subtypes of estrogen receptors (ERs). Estrogen receptor β (ERβ), the predominant ER in the skin, antagonizes the proliferative action mediated by estrogen receptor α. According to recent immunohistochemical studies, ERβ protein expression decreases progressively with increased Breslow thickness and results in more invasive melanomas; thus, ERβ immunophenotype may distinguish melanomas linked to poor prognosis from those with a favorable course and lead to melanoma unresponsiveness to both estrogen and anti-estrogen treatment. Therefore, if future large-scale immunohistochemical and molecular studies point towards ERβ as an important factor in malignant melanoma progression, they will open up novel and targeted prognostic and therapeutic perspectives.

Is skin self-examination for cutaneous melanoma detection still adequate? A retrospective study.

Objective: The aim of this retrospective study was to analyze the relationship between detection pattern, tumor thickness, patient demographics, and personal and family history of melanoma in the era of noninvasive diagnosis. Methods: All patients with primary cutaneous melanoma who presented to the Department of Dermatology at the University of Florence between January 2000 and November 2010 were interviewed at the time of their final histopathological diagnoses of melanoma as part of their clinical record. The treating physician specifically questioned all patients about who had first detected or suspected the lesion that resulted in the histological diagnosis of melanoma. Results: A total of 802 melanoma patients were analyzed. The spouse found approximately 16% of the melanomas, and a similar percentage was discovered by the general practitioner. The largest group of melanomas (36%) was discovered during regular annual skin examinations by dermatologists, while another large group (33%) were discovered by the patients themselves. The data that emerged from our study is that self-detection was associated with a greater probability of having a thick melanoma and, therefore, a poor prognosis (odds ratio 1.56). Conclusions: Because the current mortality of melanoma is still stable, we are convinced that a new message should be introduced to encourage high-risk patients to have an annual skin examination as a rule.

Intralymphatic histiocytosis: cutaneous nodules and metal implants

To the Editor, We report the case of a 71-year-old man with a 5-year history of deep vein thrombosis in the left leg whose status after the placement of metal implants in both knees during the previous year. The patient presented with two asymptomatic, smooth, erythematous nodules on the left leg, below the knee, that had appeared 4 months previously (Fig. 1A). One papule bled after minor trauma. There was purple, livedo-like discoloration around the nodules. The patient did not have a history of any autoimmune

Specific challenges in the management of subungual melanoma

Subungual melanoma (SUM) is infrequent in the general population, accounting for 0.7–3.5% of all cutaneous melanomas. SUM absolute incidence is similar among different racial groups; however, the relative proportion among overall cutaneous melanoma cases within each population varies in relation to the frequency of sun-induced melanoma. Subungual melanoma most commonly presents as a discoloration of the nail, followed by a recalcitrant wound, a tumor, nail splitting and nail bed bleeding. In most cases, the clinical presentation will already exhibit features typical of late-stage lesions because many patients wait for several months or even years before consulting a physician for evaluation of nail changes. Misdiagnosis of SUM as subungual hematoma, chronic trauma or onychomycosis is still a frequent occurrence, significantly reducing the chances for early treatment. An appropriate diagnostic approach is crucial to allow early-stage diagnosis. The correct management of SUM hinges on early diagnosis and selection of the most appropriate surgical technique. Curative treatment of SUM currently entails surgical excision when the extent of invasion is limited.

Clinical presentation and management practice of systemic mastocytosis. A survey on 460 Italian patients

Systemic mastocytosis is a rare heterogeneous myeloproliferative neoplasm characterized by abnormal proliferation and activation of mast cells. We describe a large multicentre series of 460 adult patients with systemic mastocytosis, with a diagnosis based on WHO 2008 criteria, in a “real‐life” setting of ten Italian centers with dedicated multidisciplinary programs. We included indolent forms with (n = 255) and without (n = 165) skin lesions, smouldering (n = 20), aggressive (n = 28), associated with other hematological diseases mastocytosis (n = 21) and mast cell leukemia (n = 1). This series was uniquely characterized by a substantial proportion of patients with low burden of neoplastic mast cells; notably, 38% of cases were diagnosed using only minor diagnostic criteria according to WHO 2008 classification, underlying the feasibility of early diagnosis where all diagnostic approaches are made available. This has particular clinical relevance for prevention of anaphylaxis manifestations, that were typically associated with indolent forms. In multivariate analysis, the most important features associated with shortened overall survival were disease subtype and age at diagnosis >60 years. Disease progression was correlated with mastocytosis subtype and thrombocytopenia. As many as 32% of patients with aggressive mastocytosis suffered from early evolution into acute leukemia. Overall, this study provides novel information about diagnostic approaches and current presentation of patients with SM and underlines the importance of networks and specialized centers to facilitate early diagnosis and prevent disease‐associated manifestations. Am. J. Hematol. 91:692–699, 2016.

The use of dermatoscopy in diagnosis and therapy of nonmelanocytic skin cancer.

Today, dermatoscopy is an integral part of every clinical skin examination, as it markedly enhances the early detection of melanocytic and nonmelanocytic skin cancer (NMSC) compared to naked‐eye inspection. Besides its diagnostic use, this noninvasive method is increasingly important in the selection of as well as the response assessment to various therapies used for NMSC, including basal cell carcinoma, actinic keratoses, squamous cell carcinoma, and also rare tumors such as Merkel cell carcinoma, angiosarcoma, or dermatofibrosarcoma protuberans. Thus, dermatoscopy is a valid tool for the preoperative assessment of tumor margins in basal cell carcinoma, but also for follow‐up of actinic keratoses after topical treatment. The present article presents an overview on the use of dermatoscopy in the diagnosis and therapy of various types of NMSC.

Skin self‐examination and the ABCDE rule in the early diagnosis of melanoma: is the game over?

1 de Paiva A, Meunier FA, Molgó J et al. Functional repair of motor endplates after botulinum neurotoxin type A poisoning: biphasic switch of synaptic activity between nerve sprouts and their parent terminals. Proc Natl Acad Sci USA 1999; 96:3200–5. 2 Nakamizo S, Egawa G, Miyachi Y, Kabashima K. Cholinergic urticaria: pathogenesis-based categorization and its treatment options. J Eur Acad Dermatol Venereol 2012; 26:114–16. 3 Duke WW. Urticaria caused specifically by the action of physical agents. JAMA 1924; 83:3–9. 4 Shelley WB, Shelley ED, Ho AK. Cholinergic urticaria: acetylcholine-receptor-dependent immediate-type hypersensitivity reaction to copper. Lancet 1983; 1:843–6. 5 Adachi J, Aoki T, Yamatodani A. Demonstration of sweat allergy in cholinergic urticaria. J Dermatol Sci 1994; 7:142–9. 6 Itakura E, Urabe K, Yasumoto S et al. Cholinergic urticaria associated with acquired generalized hypohidrosis: report of a case and review of the literature. Br J Dermatol 2000; 143:1064–6. 7 Sawada Y, Nakamura M, Bito T et al. Cholinergic urticaria: studies on the muscarinic cholinergic receptor M3 in anhidrotic and hypohidrotic skin. J Invest Dermatol 2010; 130:2683–6. 8 Bito T, Sawada Y, Tokura Y. Pathogenesis of cholinergic urticaria in relation to sweating. Allergol Int 2012; 61:539–44.

Erythema elevatum diutinum

A 58-year-old man was referred to our clinic with an 8-month history of red-brown nodules on the dorsal surface of his left hand. He reported that he collected fish in his home aquarium as a hobby. On this basis, a prior diagnosis of nontuberculous mycobacterial infection was made, but systemic clarithromycin was ineffective. The patient also reported a constant painful sensation, which worsened in the evening and after exposure to low temperatures. Dermatologic examination of the left hand revealed two large, tender, red-brown skin nodules on the extensor surfaces of the second and third metacarpophalangeal joint, one of which was partially covered by a hematic crust …

Seborrheic keratosis of the vulva clinically mimicking a genital wart: a case study.

1 Basavaraj KH, Ashok NM, Rashmi R, et al. The role of drugs in the induction and/or exarcebation of psoriasis. Int J Dermatol 2010; 49: 1351–1361. 2 Gupta AK, Sauder DN, Shear NH. Anti-fungal agents an overview. Part II. J Am Acad Dermatol 1994; 30: 911–933. 3 Byung-Soo K, Ho-Sun J, Seung-Wook J, et al. Generalized pustular psoriasis and hepatic dysfunction associated with oral terbinafine therapy. J Korean Med Sci 2007; 22: 167–169. 4 Gupta AK, Sibbald RG, Knowles SR, et al. Terbinafine therapy may be associated with the development of psoriasis de novo or its exacerbation: four case reports and a review of drug-induced psoriasis. J Am Acad Dermatol 1997; 36: 858–862. 5 Tsankov N, Angelova I, Kazandjieva J. Drug-induced psoriasis. Recognition and management. Am J Clin Dermatol 2000; 1: 159–165. 6 Ibrahimi OA, Gunawardane N, Sepehr A, Reynolds RV. Terbinafine-induced acute generalized exanthematous pustulosis (AGEP) responsive to high dose intravenous corticosteroid. Dermatol Online J 2009; 15: 8.

Generalized Granuloma Annulare and Non-Hodgkin's Lymphoma

© 2013 The Authors. doi: 10.2340/00015555-1510 Journal Compilation