Gisela Metzler

The incidence and mortality of cutaneous melanoma in Southern Germany: trends by anatomic site and pathologic characteristics, 1976 to 2003.

Cutaneous melanoma (CM) incidence and mortality have risen dramatically during the past 2 generations, particularly among Caucasian populations. Detailed, long‐term trends of CM in relation to clinical and pathologic characteristics in a Central European population have not been published to date.

Ultrastructural localization of HMB-45 binding sites

Three malignant melanomas, two melanoma metastases, two junctional dysplastic nevi, and normal skin were embedded in Lowicryl. Ultrathin sections were incubated with HMB‐45 and a gold‐labeled anti‐mouse antibody. Gold particles indicating the presence of HMB‐45 were found in melanosomes Stage 1 and 2 and in the non‐melanized portion of melanosomes Stage 3. Melanosomes Stage 4 and melanosome complexes in keratino‐cytes, as well as in melanophages, were consistently negative. No specific labelling with HMB‐45 was seen in eccrine glands of normal skin.

Bimodal immune activation in psoriasis.

Psoriasis is an immune‐regulated skin disease with various clinical subtypes and disease activities. The majority of patients present with predominantly stable plaques. At the onset of new lesions, plaque‐type psoriasis frequently demonstrates pin‐sized and highly inflammatory papules sometimes with an inflammatory border. The histopathology of initial psoriasis differs from stable plaque‐type psoriasis. Early lesions demonstrate innate immune cells with neutrophils, degranulating mast cells and macrophages. These are followed by interleukin (IL)‐1‐dependent T helper (Th)17 cells, finally resulting in the Th1‐dominated immunopathology of stable plaque‐type psoriasis, where mononuclear cells predominate with interspersed neutrophilic (Munro) microabscesses. These features suggest a bimodal immune pathway where alternate activation of either innate (autoinflammatory) or adaptive (autoimmune) immunity predominates. Neutrophilic infiltrations appear during early psoriasis with Munro abscesses. They are time limited and occur periodically, clinically best seen in linear nail pitting. These features strongly suggest a critical role for an IL‐1–Th17‐dominated autoinflammation in the initiation of psoriasis, followed by a Th1‐dominated late‐phase reaction. The concept of bimodal immune activation helps to explain results from therapeutic interventions that are variable and previously only partly understood.

The Dermatoscopic Pattern of Clear-Cell Acanthoma Resembles Psoriasis vulgaris

Background: Dermatoscopy (dermoscopy, epiluminescence microscopy) is used for the early detection of malignant tumors and avoidance of unnecessary excisions of benign skin tumors. Objective: Description of the dermatoscopic pattern of clear-cell acanthoma. Methods: Video dermatoscopy at 20-fold magnification of a clear-cell acanthoma and psoriasis vulgaris. Results: Homogeneous, symmetrically or bunch-like arranged, pinpoint-like capillaries were seen in the clear-cell acanthoma and in psoriasis vulgaris. Conclusion: The dermatoscopic psoriasis-like pattern of clear-cell acanthoma is a diagnostic clue which may help the clinician to identify this benign epidermal tumor and to differentiate it from other benign and malignant tumors of the skin.

Improvement of overall survival of patients with cutaneous melanoma in Germany, 1976-2001: which factors contributed?

A hypothesis generated a retrospective analysis of the improvement of survival over time in patients with cutaneous melanoma (CM) in order to identify factors contributing to this progress.

Malignant chondroid syringoma: immunohistopathology.

Malignant chondroid syringoma, also called malignant mixed tumor of the skin, is a rare variant of a malignant tumor derived from sweat gland cells. Histologically the tumor is composed of an epithelial and a mesenchymal component. The epithelial structures show glandular differentiation and carcinomatous features. They are embedded in a mucinous stroma with spindle mesenchymal cells and areas of chondroid differentiation. The epithelial cells express cytokeratins. The luminal epithelial cells show binding to the lectin Ulex europaeus; intraluminal cells are carcinoembryonic antigen positive. The stromal cells are cytokeratin negative and sporadically positive for vimentin. Chondroid areas are S-100 protein and vimentin positive. No labeling for actin is seen.

Clinical course and prognostic factors of Merkel cell carcinoma of the skin.

Background  Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin first described by Toker as ‘trabecular carcinoma of the skin’ in 1972. To date, the origin of the tumour cells still remains unclear.

Polymorphous vascular patterns in dermoscopy as a sign of malignant skin tumors. A case of an amelanotic melanoma and a porocarcinoma.

Background: Using dermoscopy (dermatoscopy, epiluminescence microscopy), malignant skin tumors can be detected earlier and unnecessary excisions of benign tumors can be avoided. Objective: Description of the dermoscopic vascular patterns of an amelanotic melanoma and a porocarcinoma. Methods: Dermoscopy of an amelanotic melanoma and a porocarcinoma at 10-fold magnification. Results: On dermoscopy polymorphous vascular patterns with pinpoint and hairpin-like vessels were seen. Conclusion: A reddish tumor without any pigmented network, globules or streaks but with polymorphous vascular patterns must be considered a malignant melanocytic or nonmelanocytic skin tumor.

Non-AIDS Associated Kaposi's Sarcoma: Clinical Features and Treatment Outcome

Background Kaposis sarcoma (KS) in HIV negative patients is rare and has to be distinguished from AIDS associated KS. Two groups are at risk to develop non-AIDS related KS: elderly men mainly of Mediterranean origin and persons with iatrogenic immunosuppression. Patients and Methods In order to define risk-groups and major clinical features we retrospectively evaluated clinical data of all patients with non-AIDS associated KS presenting to the Department of Dermatology, University Hospital Tuebingen between 1987 and 2009. Data were extracted from the tumor registry of the Comprehensive Cancer Center Tuebingen and from patient records. Results 20 patients with non-AIDS KS have been identified. The average age at KS onset was 66.6 years; the male-to-female-ratio was 3∶1. Most of the patients were immigrants from Mediterranean or Eastern European countries (60%). 15 cases of classic KS versus 5 cases of iatrogenic KS were observed. In 95% of the cases, KS was limited to the skin, without mucosal, lymph node or visceral manifestation. KS lesions were in all cases multiple and mostly bilateral, the most common localization was the skin of the lower extremities. Tumor control was achieved in nearly all cases by the use of local or systemic therapy. No patient died from KS. Conclusions Unlike KS in AIDS patients, non-AIDS associated KS is a rather localized process which rarely involves lymph nodes or organs. It is mostly seen in elderly males from Mediterranean or Eastern European countries and in most cases responsive on local or systemic therapeutic strategies.

Sex differences in survival of cutaneous melanoma are age dependent: an analysis of 7338 patients

This study identified sex differences in clinical presentation and survival for primary cutaneous melanoma without clinical evidence of metastasis at diagnosis from 1976 to 2008 in southern Germany. Melanoma-specific survival curves and estimated survival probabilities were generated using the Kaplan–Meier method. Multivariate survival analyses were carried out using the Cox modeling. Male patients had significantly thicker and more frequently ulcerated tumors and a lower 10-year disease-specific survival (DSS) and recurrence-free survival probability compared with females among patients of 43 years old or younger (DSS: 86.1 vs. 93.2%, P<0.001) and 44–60 years old (DSS: 83.5 vs. 90.1%, P<0.001). The survival advantage of female patients in terms of 10-year DSS and 10-year recurrence-free survival was not observed after an age of 60 years (P=0.21 and 0.51, respectively). Sex was of prognostic importance for DSS and survival after recurrence [hazards ratio (HR): 1.3; 95% confidence interval (CI): 1.1–1.6; P=0.002 and HR: 1.2; 95% CI: 1.0–1.5; P=0.018, respectively]. Stratified by age groups, sex remained of prognostic importance for DSS only in patients of 43 years or younger, and 44–60 years old (HR: 1.5; 95% CI: 1.0–2.1; P=0.03 and HR: 1.4; 95% CI: 1.1–2.0; P=0.02, respectively). Sex is an independent prognostic factor in surviving melanoma. The sex difference in survival with a better outcome for women is confined to melanoma patients of 60 years and younger. In addition, in younger age groups, male patients present with prognostically unfavorable features of primary melanoma. A female survival advantage is also known for other solid tumors such as colon and lung cancer; however, age dependency has not been studied.