Liliane Marot

Availability of digital dermoscopy in daily practice dramatically reduces the number of excised melanocytic lesions: results from an observational study

Backgroundu2002 Digital dermoscopy has been shown to permit an earlier detection of melanoma. However, few studies have investigated its added value in reducing unnecessary excisions in everyday clinical practice.

Granulomes sarcoïdosiques après injections de toxine botulique A (Botox®) pour correction de rides

Background. The introduction of foreign material into the skin can lead to sarcoidal reactions. Such a reaction is reported, consecutive to injections of botulic toxin A (Botox((R))). Case report. A 57-year-old woman, noticed the occurrence of frontal and glabellar nodules, 3 weeks after the injection of botulic toxin A (Botox((R))), for the correction of wrinkles. Histopathological examination revealed a sarcoidal granuloma. Clinical and biological investigations were negative, ruling out the hypothesis of systemic sarcoidosis. The lesion could be reproduced experimentally by an intradermal injection of botulic toxin A on the volar aspect of the forearm. Corticosteroids per os associated with intralesional injections of triamcinolone acetonide were followed by a complete regression of the nodules. Discussion. The occurrence of sarcoidal granulomas at the sites of injection of botulic toxin A (Botox((R))) has not been reported - so far - in the literature. Systemic sarcoidosis has been ruled out. The sarcoical reaction has been reproduced experimentally by the intradermal injection of botulic toxin A, but not by saline. This leads to think that the sarcoical reaction was provoked by antigenic stimulation, comparable to the Kveim reaction, and did not correspond to scar sarcoidosis.

Selective use of sequential digital dermoscopy imaging allows a cost reduction in the melanoma detection process: a Belgian study of patients with a single or a small number of atypical nevi

Background Dermoscopy is a technique which improves melanoma detection. Optical dermoscopy uses a handheld optical device to observe the skin lesions without recording the images. Sequential digital dermoscopy imaging (SDDI) allows storage of the pictures and their comparison over time. Few studies have compared optical dermoscopy and SDDI from an economic perspective. Objective The present observational study focused on patients with one-to-three atypical melanocytic lesions, i.e. lesions considered as suspicious by optical dermoscopy. It aimed to calculate the “extra-costs” related to the process of melanoma detection. These extra-costs were defined as the costs of excision and pathology of benign lesions and/or the costs of follow-up by SDDI. The objective was to compare these extra-costs when using optical dermoscopy exclusively versus optical dermoscopy with selective use of SDDI. Methods In a first group of patients, dermatologists were adequately trained in optical dermoscopy but worked without access to SDDI. They excised all suspicious lesions to rule out melanoma. In a second group, the dermatologists were trained in optical and digital dermoscopy. They had the opportunity of choosing between immediate excision or follow-up by SDDI (with delayed excision if significant change was observed). The comparison of extra-costs in both groups was made possible by a decision tree model and by the division of the extra-costs by the number of melanomas diagnosed in each group. Belgian official tariffs and charges were used. Results The extra-costs in the first and in the second group were respectively €1,613 and €1,052 per melanoma excised. The difference was statistically significant. Conclusions Using the Belgian official tariffs and charges, we demonstrated that the selective use of SDDI for patients with one-to-three atypical melanocytic lesions resulted in a significant cost reduction.

Optimization of electron paramagnetic resonance imaging for visualization of human skin melanoma in various stages of invasion

Abstract:u2002 Malignant melanoma is a tumor characterized by the uncontrolled proliferation of melanocytes, mainly in skin, but also in eyes. Its incidence is rising each year. To improve the diagnosis and treatment of the tumor, it is essential to develop new effective methods to early detect and characterize melanoma. Previously, we demonstrated in a single‐shot study that it was possible to map free radicals of melanin pigments using an electron paramagnetic resonance (EPR)‐based method. Furthermore, we demonstrated that X‐Band (9u2003GHz) EPR spectrometry was an accurate tool to assess the growth stage of a pigmented tumor. The aim of the present study was to investigate the ability of EPR imaging to detect and localize melanin pigments inside melanin phantoms, B16 melanoma tumor models and resected human melanomas. We show that EPR can provide an accurate image of synthetic samples, both in terms of shape and size, with errors always lower than 10% compared to the real size. Regarding melanoma studies, the ability of EPR imaging to map accurately the melanoma was depending on the concentration of melanin in the sample, which is proportional to the growth stage of the tumor and the consequent signal‐to‐noise ratio (SNR) provided by the EPR signal intensity. This led us to define an operational concept, considering SNR and interferences with other EPR signals, to determine when EPR imaging was feasible.

Successful long-term management of a patient with late-stage metastatic colorectal cancer treated with panitumumab

INTRODUCTIONnRecent approval and introduction into clinical practice of epidermal growth factor receptor inhibitors such as the chimeric monoclonal antibody cetuximab and the fully human monoclonal antibody panitumumab have provided new treatment options for chemotherapy-refractory patients. Here, we report a case of a 47-year-old man with metastatic, chemotherapy-refractory colorectal cancer who achieved long-term partial remission during panitumumab therapy.nnnCASE PRESENTATIONnA 41-year-old male patient presented with a 24-hour history of abdominal pain and fever. A computed tomography (CT) scan revealed a voluminous and perforated abscess with a suspected tumour lesion in the sigmoid colon. The patient underwent sigmoidectomy and was diagnosed with a poorly differentiated necrotic carcinoma of the sigmoid colon with invasion in 13 of 19 tested lymph nodes. A colonoscopy revealed multiple tubular adenomas and a positron emission tomography CT scan showed multiple and bilateral hyperfixating lumbar-aortic lymph nodes leading to a final tumour classification of T4N2M1. Carcinoembryonic antigen (CEA) was elevated. The patient achieved a partial response following six cycles of FOLFIRI (irinotecan, 5-fluorouracil, leucovorin), then progressed and was enrolled in a trial where he received treatment with FOLFOX4 (oxaliplatin, leucovorin and 5-fluorouracil) with or without a vascular endothelial growth factor inhibitor (PTK787/ZK 222584 [valatinib]). Eight months later he progressed again and was included in a panitumumab (6mg/kg every 2 weeks) monotherapy trial. A partial response was noted after 8 weeks of therapy along with a rapid CEA reduction and decrease in lymph node size. The patient is continuing panitumumab treatment and is still in partial remission after 65 months treatment. He has non-mutated KRAS and no human-anti-human antibodies have been detected. During treatment the patient has on occasion experienced grade 1-2 diarrhoea as well as folliculitis and acne-like rash up to grade 3 in severity. Cutaneous toxicity was managed with a combination dose interruption/reduction and the use of topical agents. No eye or nail toxicities occurred.nnnCONCLUSIONnThis case shows that long-term responses are possible during panitumumab therapy and that this agent may be an effective long-term treatment option for selected patients with metastatic colorectal cancer. The associated skin toxicities can be successfully managed.

Characterization of the T cell response in allergic contact dermatitis caused by corticosteroids.

Background Delayed allergic hypersensitivity reactions have classically been described as type IV reactions, which are caused by T cells; however, the respective roles of CD4+ and CD8+ cells are yet to be defined. A central role for CD8+ cytotoxic T cells as effector cells has been suggested.

Cutis verticis gyrata du vertex, dans sa forme primaire essentielle et d’installation brutale

Le cutis verticis gyrata (CVG) est une maladie rare et lentement evolutive du cuir chevelu, qui se caracterise par la presence sur le scalp de cretes et de sillons mimant l’aspect des gyri du cortex cerebral. Differentes formes sont decrites, primaire (essentielle et non essentielle) et secondaire. Les formes paraneoplasiques sont exceptionnelles. La forme primaire essentielle est tres rarexa0et celle-ci est souvent rapportee chez des jeunes aux alentours de la puberte. Nous rapportons le cas d’un cutis verticis gyrata primaire essentiel, apparu chez un homme de 45xa0ans, sans antecedents familiaux connus. Le patient observe initialement un nodule localise sur le scalp, etiquete d’abces du cuir chevelu et mis sous antibiotherapie par le medecin traitant, sans amelioration clinique apparente. Tres vite, de multiples lesions cutanees similaires apparaissent, distribuees sur l’ensemble du vertex. Celles-ci s’accompagnent de douleurs locales a la palpation, de cephalees de tension, de pics hypertensifs et de sudations nocturnes. Une mise au point diagnostique, comprenant des imageries medicales (echographie des tissus mous et IRM cerebrale) et des prelevements cutanes, est realisee et revele la presence d’un epaississement dermohypodermique du cuir chevelu predominant au vertex avec de multiples replis cutanes. Le diagnostic de cutis verticis gyrata du vertex est retenu. Un bilan complementaire large est realise afin d’exclure une forme secondaire de CVG et se revele rassurant puisque aucune pathologie chronique ou neoplasie sous-jacente n’est retrouvee. Notre patient presente une forme rare de CVG, dite primitive essentielle. Un suivi clinique a ete preconise, la chirurgie etant difficilement envisageable, vu l’atteinte diffuse du cuir chevelu. Le suivi a 7xa0mois a montre une stabilisation des lesions et parallelement une disparition complete des symptomes associes. Cette affection implique des repercussions sociales et esthetiques importantes, et parfois fonctionnelles puisque des cas d’infections cutanees locales ont ete rapportes. Ce cas de CVG du vertex est atypique de par l’apparition aigue des lesions, l’extension rapide de celles-ci, les symptomes initiaux associes et l’âge inhabituel d’apparition de la pathologie.