M. Samimi

High-resolution cutaneous ultrasonography to differentiate lipoedema from lymphoedema.

Background  Lipoedema is an accumulation of fat abnormally distributed in the lower limbs, and lymphoedema is oedema caused by a deficiency of the lymphatic system. High‐resolution ultrasound operating at 20 MHz makes it possible to characterize dermal oedema.

Human Merkel cell polyomavirus: virological background and clinical implications

The Merkel cell polyomavirus (MCPyV), identified in humans in 2008, is associated with a relatively rare but aggressive neuroendocrine skin cancer, the Merkel cell carcinoma (MCC). MCC incidence is increasing due to the advancing age of the population, the increase in damaging sun exposure and in the number of immunocompromised individuals. MCPyV must be considered as the etiological agent of MCC and thus is the first example of a human oncogenic polyomavirus. MCPyV infection is common, and seroprevalence studies indicate that widespread exposure begins early in life. The majority of adults have anti‐MCPyV antibodies and there is a growing body of evidence that healthy human skin harbors resident or transient MCPyV suggesting that MCPyV infection persists throughout life. However, the mode of transmission, the host cells, and the latency characteristics of this virus remain to be elucidated. In addition, it is still not clear whether MCPyV is associated with diseases or lesions other than Merkel cell carcinoma. The etiologic role of MCPyV in MCC opens up opportunities to improve the understanding of this cancer and to potentially improve its treatment.

Efficacy of Infliximab for Hidradenitis Suppurativa: Assessment of Clinical and Biological Inflammatory Markers

Treatment of hidradenitis suppurativa (HS) is often unsatisfactory. The efficacy of infliximab for treatment of the disease has been suggested. The main objective of this study was to evaluate the efficacy and side-effects of infliximab in the treatment of moderate to severe HS, resistant to local and systemic treatments. The secondary objective was to determine whether inflammation blood test results were changed. A retrospective monocentric study of all the patients seen consecutively for HS and treated with infliximab was performed. A median of six intravenous infusions (range 3-19) were performed. The end-points were self-improvement of HS (globally and in terms of pain, seeping and quality of life). The condition of six of seven patients improved (by nearly 50%) and none was aggravated. Adverse effects occurred in two patients; eczematous eruption in one case and cervical abscess in another case. We found no significant changes in inflammatory blood marker values. In conclusion, infliximab therapy was shown to be efficient and well tolerated in six of seven patients with HS resistant to previous therapy in our series. This was in agreement with pre-existing literature showing that 52 of 60 patients (87%) were improved after infliximab therapy.

Prognostic value of antibodies to Merkel cell polyomavirus T antigens and VP1 protein in patients with Merkel cell carcinoma.

Merkel cell polyomavirus (MCPyV) is the main aetiological agent of Merkel cell carcinoma (MCC). Serum antibodies against the major MCPyV capsid protein (VP1) are detected in the general population, whereas antibodies against MCPyV oncoproteins (T antigens) have been reported specifically in patients with MCC.

Vitamin D deficiency is associated with greater tumor size and poorer outcome in Merkel cell carcinoma patients.

Merkel cell polyomavirus has been recognized to be associated with Merkel cell carcinoma (MCC), but the evolution of this cancer probably depends on various factors. Vitamin D deficiency, defined by serum 25‐hydroxyvitamin D levels <50 nmol/L, seems to influence cancer behavior and progression, but has never been assessed in MCC patients.

Syndrome de Klippel-Trenaunay

Klippel-Trenaunay syndrome (KTS) is a rare complex vascular congenital malformation. The characteristic triad is an association of a cutaneous capillary angioma of a limb, venous malformations, and hypertrophy of soft tissue and/or bone. Diagnosis is essentially clinical. Work-up of the lesion may involve noninvasive imaging: Doppler ultrasound, standard radiography, or magnetic resonance imaging (MRI). The presence of arteriovenous malformations is sought by clinical examination or ultrasound: they rule out a diagnosis of KTS. Management is multidisciplinary and involves especially venous control and orthopedic management of unequal limb lengths.

High-resolution ultrasonography assists the differential diagnosis of blue naevi and cutaneous metastases of melanoma

Background  Metastases of cutaneous melanoma may simulate benign blue naevi clinically.

Identification of the Neutralizing Epitopes of Merkel Cell Polyomavirus Major Capsid Protein within the BC and EF Surface Loops

Merkel cell polyomavirus (MCPyV) is the first polyomavirus clearly associated with a human cancer, i.e. the Merkel cell carcinoma (MCC). Polyomaviruses are small naked DNA viruses that induce a robust polyclonal antibody response against the major capsid protein (VP1). However, the polyomavirus VP1 capsid protein epitopes have not been identified to date. The aim of this study was to identify the neutralizing epitopes of the MCPyV capsid. For this goal, four VP1 mutants were generated by insertional mutagenesis in the BC, DE, EF and HI loops between amino acids 88-89, 150-151, 189-190, and 296-297, respectively. The reactivity of these mutants and wild-type VLPs was then investigated with anti-VP1 monoclonal antibodies and anti-MCPyV positive human sera. The findings together suggest that immunodominant conformational neutralizing epitopes are present at the surface of the MCPyV VLPs and are clustered within BC and EF loops.

Merkel Cell Polyomavirus in Merkel Cell Carcinoma: Clinical and Therapeutic Perspectives

Merkel cell carcinoma (MCC) is a rare and often aggressive cutaneous cancer with a poor prognosis. The incidence of this cancer increases with age, immunodeficiency and sun exposure. Merkel cell polyomavirus (MCPyV), a new human polyomavirus identified in 2008, is detected in the majority of the MCCs and there is a growing body of evidence that healthy human skin harbors resident or transient MCPyV. A causal link between MCPyV and MCC has been evidenced and this is the first polyomavirus to be clearly implicated as a causal agent underlying a human cancer, and MCPyV was recently classified as a 2A carcinogen. MCC is thus a rare tumor caused by a very common viral skin infection. The aim of this review is to provide a basic overview of the epidemiological, clinical, and pathological characteristics of MCC, to present the current knowledge on MCPyV polyomavirus and its causal association with MCC development, and to describe the therapeutic implications of this causal link.

Arterial blood flow in limbs with port-wine stains can predict length discrepancy

SIR, Port-wine stains (PWS) on a limb can be part of Klippel– Trenaunay syndrome (KTS). This vascular disorder consists of PWS, venous abnormalities and limb hypertrophy. Limb hypertrophy has been reported in about 60% of patients with KTS. The length discrepancy may result in disfigurement, gait disturbance, pelvic tilting, scoliosis or back pain. One single study was conducted to determine risk factors for limb length discrepancy (LLD) in congenital vascular malformations. The extent of the malformation was the single independent risk factor for LLD. In healthy adults, arterial blood flow (ABF) is not significantly different between left and right proximal leg arteries. Mean difference is estimated to be almost 10%. Two previous studies have suggested that, in patients with KTS, ABF is greater in the limb with PWS. The purpose of this work was to determine whether the ultrasonographic measurement of ABF in limbs can predict LLD in children with congenital PWS on a limb. This retrospective study included children (age £ 16 years) followed up in the Hospital Centre of Tours (France) between 1992 and 2006 who had PWS on a limb. Excluded were patients with arteriovenous malformations or patients who had already had surgical treatment on limbs. The limbs were measured by tape measure. We considered as clinically relevant an LLD ‡ 10 mm. Duplex ultrasonography was performed to establish ABF at the proximal part of the limb. Results were expressed as mL min. For each child, ABF was determined at the same time in both the affected limb and the normal limb. Unaffected limbs were thus used as the control. The difference in ABF between the affected and normal limbs was expressed as a percentage. We considered as relevant a difference in ABF of ‡ 50% between the two limbs. Children who had been followed up for at least 1 year were reviewed, to determine whether they had developed an LLD or, if they already had one, if it had increased. We considered as clinically significant an LLD of ‡ 10 mm. Thirty children with 31 PWS on a limb were included. One child had PWS on both an upper and the homolateral lower limb. There was a clinically measurable LLD in 10 cases and no significant discrepancy in 21 cases (Table 1). Mean ABF in limbs with PWS was significantly greater than in normal limbs (P = 0Æ006). Mean ± SD difference in ABF between the limbs with PWS and the normal limbs was 45 ± 85% (Table 1). Twenty-three children with 24 PWS had been followed up (Table 1). Children who either developed an LLD ‡ 10 mm or showed an increase of ‡ 10 mm in a previous LLD had shown a significantly greater difference in ABF between the two limbs at first examination (P = 0Æ002). There was a relation between an ABF difference of ‡ 50% between affected and contralateral limbs at first examination