Michela Curzio

Erythema annulare centrifugum as the presenting sign of breast carcinoma.

© 2008 The Authors JEADV 2009, 23 , 317–368 Journal compilation

Disseminated superficial actinic porokeratosis diagnosed by dermoscopy

upper or lower dermis. ADM occurs rarely outside Japan and very few cases have been described in non-Asian race people. The ADM in Europeans is a rare manifestation, and only the extrafacial type has been reported in this group of population. The pathogenesis of ADM is currently unknown. Hori et al. speculated that the pathogenesis of ADM may be attributed to the reactivation of pre-existing dermal melanocytes. Dormant dermal melanocytes may be present in the dermis from birth and that their melanin-synthesizing pathway may be activated by locally produced factors like inflammation, local trauma, or sun exposure. Mizushima et al. proposed that there are no triggers but that the melaninsynthesizing ability of the dermal melanocytes may increase more slowly than that of common naevus. Moreover, it is possible that dermal melanocytes may migrate from the basal layer of the epidermis or from hair bulbs. This case represents an unusual acquired pigmentary disorder that appears to be the result of dermal melanocytosis. To our knowledge, the bilateral and symmetrical upper back distribution, with extension to the breast is the first one in the broad spectrum of ADM.

Correlation between insulin-like growth factor binding protein-3 serum level and melanoma progression

BACKGROUND Insulin-like growth factor (IGF) binding protein (IGFBP)-3 is the main carrier of circulating IGFs and the main modulator of their activity. IGFBP-3 controls cellular availability of IGFs, which cannot exert their pro-proliferative activity while bound to IGFBP-3. Proteolysis of IGFBP-3 is one mechanism to control IGF release. A reduction of serum IGFBP-3 levels and the associated increased availability of IGFs may represent a strategy whereby melanoma increases its metastatic potential. OBJECTIVE The aim of our study was to evaluate the correlation between the IGFBP-3 serum level and melanoma stage. METHODS The study included 41 patients, 24 male and 17 female, with median age of 60 years (range 24-80), affected by cutaneous melanoma. Blood samples were taken from each patient and IGFBP-3 serum levels were measured using Western blot analysis with commercial antibodies. Values were normalized using commercial IGFBP-3. RESULTS The statistical analysis showed that full-size, glycosylated IGFBP-3 concentrations were significantly lower in the sera of patients with stage IV melanoma. Low serum levels of IGFBP-3 correlated with both disease progression and presence of disease at the time of sample collection. In patients who underwent follow-up visits with further collections of blood samples, the concentrations of glycosylated IGFBP-3 decreased only in those who showed progression of disease. LIMITATIONS Our study shows only preliminary results on a limited number of patients. CONCLUSION We demonstrate that there is a significant inverse correlation between the serum concentration of full-size, glycosylated IGFBP-3 and disease progression in patients with melanoma.

Intralesional interferon alfa-2b as neoadjuvant treatment for perianal extramammary Paget's disease.

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A cutaneous infection caused by Brevundimonas vesicularis: A case report

Brevundimonas vesicularis is a non-fermenting gram-negative bacillus, aerobic and motile. This microrganism is ubiquitous in the environment and has rarely been implicated in human infections. We present the second case of cutaneous infection caused by B. vesicularis in an immunocompetent patient.

Metastatic Volume: An Old Oncologic Concept and a New Prognostic Factor for Stage IV Melanoma Patients

Background: The last melanoma staging system of the 2009 American Joint Committee on Cancer takes into account, for stage IV disease, the serum levels of lactate dehydrogenase (LDH) and the site of distant metastases. Objective: Our aim was to compare the significance of metastatic volume, as evaluated at the time of stage IV melanoma diagnosis, with other clinical predictors of prognosis. Methods: We conducted a retrospective multicentric study. To establish which variables were statistically correlated both with death and survival time, contingency tables were evaluated. The overall survival curves were compared using the Kaplan-Meier method. Results: Metastatic volume and number of affected organs were statistically related to death. In detail, patients with a metastatic volume >15 cm3 had a worse prognosis than those with a volume lower than this value (survival probability at 60 months: 6.8 vs. 40.9%, respectively). The Kaplan-Meier method confirmed that survival time was significantly related to the site(s) of metastases, to elevated LDH serum levels and to melanoma stage according to the latest system. Conclusion: Our results suggest that metastatic volume may be considered as a useful prognostic factor for survival among melanoma patients.

Antibacterial activity of methyl aminolevulinate photodynamic therapy in the treatment of a cutaneous ulcer

We describe a 79-year-old female with a chronic venous ulceration infected by Staphylococcus aureus and Enterococcus faecalis and not responsive to conventional treatments. The patient was treated with Methyl-Aminolaevulinate Photodynamic Therapy (MAL-PDT). After four weeks the cutaneous swabs become negative and we observed a significant clinical improvement. Therefore we suppose that MAL-PDT could represent a valid therapeutic option in the treatment of infected chronic ulcers.

Predictive factors for false negative sentinel lymph node in melanoma patients.

BACKGROUND Sentinel lymph node biopsy (SLNB) represents a useful tool for staging melanoma patients. However false‐negative SLNB are reported in the literature. OBJECTIVE The aim of our study is to identify predictive factors for false‐negative SLNB in melanoma patients. MATERIALS AND METHODS We conducted a retrospective analysis on 316 melanoma patients who underwent SLNB and were followed up at the Department of Dermatology and Plastic Surgery of University of Rome “Sapienza” from March 1994 to June 2008. RESULTS In our patients, SLNB was positive in 35 cases (11.07%) whereas it was negative in 281 cases (88.93%); 12/316 patients (3.8%) had positive SLNB and positive therapeutic lymph node dissection (TLND); 23/316 (7.28%) patients had positive SLNB and negative TLND; 266/316 (84.18%) patients had negative SLNB but without subsequent metastases in the SLN site; 15/316 (4.74%) patients had negative SLNB, but with subsequent metastases in the same SLN site (false‐negative patients). Among the different prognostic factors, only ulceration was the main predictive factor for false‐negative SLNB, according to statistical analysis (p=.0420). CONCLUSION Our data confirm that SLNB is a useful technique for staging melanoma patients. However, in patients with negative SLNB, a closer follow‐up is recommended when ulceration is present. The authors have indicated no significant interest with commercial supporters.

Bromhidrosis induced by Sphingomonas paucimobilis: A case report

Bromhidrosis is a clinical disorder characterized by excessive or abnormal foul axillary odour due to the interaction of apocrine glands with micro-organisms which causes a serious personal and social handicap for affected people. We present the case of a 50-year-old caucasian female with bromhidrosis. The patient referred that this symptom had begun two months previously. Her past treatments included antibacterial soap, topical antibacterial agents and perfumes, but none of these relieved the patient of the odour. A cultural examination of axillary smear was carried out and it revealed the presence of ciprofloxacin sensible Sphingomonas paucimobilis. Therefore the patient was treated with ciprofloxacin and after 1 week the infection resolved completely.

Molluscum contagiosum on a tattoo: usefulness of dermoscopy

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