Nicola di Meo

Analysis of diagnostic criteria in adamantiades-behçet disease: a retrospective study.

Adamantiades-Behçets disease (ABD) is a chronic-relapsing, inflammatory and multi-systemic disease. Any organ or system may be involved: ABD presents a great variety of cutaneous and mucosal lesions, ocular manifestations, central and peripheral nervous system abnormalities, joint as well as gastrointestinal involvement. Since clear pathognomonic clinical features and laboratory tests are lacking, the diagnosis of ABD mainly relies on the characteristic clinical features. Several sets of diagnostic criteria have been used. The International Study Group for Behçet Disease (ISGBD) in 1990 formulated a set of criteria to warrant uniformity of both diagnosis and classification. Therefore, in 2006, a new set was proposed by the International Team for the Revision of the International Criteria for Behçets Disease (ITR-ICBD) not only to uniform the previous criteria but also to establish best accuracy, along with an optimum sensivity and specificity. The aims of this study are both to analyze the clinical features of ABD patients and to validate the ISGBD and ITR-ICDB criteria for the diagnosis of ABD in our cohort.

CASH algorithm versus 3‐point checklist and its modified version in evaluation of melanocytic pigmented skin lesions: The 4‐point checklist

Dermoscopy, in expert hands, increases accuracy, sensitivity and specificity in diagnosis of pigmented skin lesions of a single operator, compared with clinical examination. Simplified algorithmic methods have been developed to help less expert dermoscopists in diagnosis of melanocytic lesions. This study included 125 melanocytic skin lesions divided into melanocytic nevi, dysplastic nevi and thin melanomas (<1 mm). We compared the 3‐point checklist and CASH algorithm to analyze different pigmented skin lesions. Based on preliminary results, we proposed a new modified algorithm, called the 4‐point checklist, whose accuracy is similar to the CASH algorithm and whose simplicity is similar to the 3‐point checklist.

Primary nodular amyloidosis of the glans penis

D. TORL EY K . SHAMS J .R . INGRAM Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, West Yorkshire LS7 4SA, U.K. Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, U.K. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, U.K. Alan Lyell Centre for Dermatology, Southern General Hospital, Glasgow, U.K. Nottingham NHS Treatment Centre, Nottingham, U.K. Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, U.K. Department of Dermatology and Wound Healing, Institute of Infection and Immunity, Cardiff University, Cardiff, U.K. E-mail: k.warburton@doctors.org.uk

Electrochemotherapy as a novel treatment for primary cutaneous marginal zone B-cell lymphomas

In the present study, we describe the use of electrochemotherapy as alternative therapy for primary cutaneous marginal zone B‐cell lymphomas in patients unsuitable for surgery or radiotherapy. Our experience refers to three patients with primary cutaneous marginal zone B‐cell lymphomas related to Borrelia burgdorferi infection, treated with specific antimicrobial therapy and electrochemotherapy.

A unique pneumopathy in a patient with skin nodules and abscesses

A 34-year-old man was referred to the Department of Dermatology of our hospital because of a presumed diagnosis of perianal Crohn’s disease. Medical history was positive for severe acne, while there was no positive family history for either inflammatory bowel diseases or allergies. On physical examination, the patient was apyretic, with a blood pressure of 132/86 mmHg, heart rate of 76 beats/ min, 17 breaths/min, 97% oxygen saturation in room air. He reported a mild dyspnea occurred 1 month before, with Valleix points examination negative; however, auscultation revealed some crackles prevalently in the bases. Dermatological assessment showed multiple deep-seated inflamed nodules, fistulas and bridging scars on armpits and perianal area with scrotal involvement (Fig. 1). Laboratory investigations demonstrated an increased erythrocyte sedimentation rate (76 mm/h; range 20–50 mm/h); C-reactive protein was also elevated (18 mg/L; range 0.2–5 mg/L). Urine examination, procalcitonine and quantiferon-tests were negative. Therapy was initially azithromycin 500 mg daily for 3 consecutive days weekly for 6 weeks. At the same time, the dyspnea was also evaluated.

Polypoid and fungating form of elephantiasic pretibial myxedema with involvement of the hands

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Cutaneous melanoma frequencies and seasonal trend in 20 years of observation of a population characterised by excessive sun exposure

Abstract Background. Cutaneous melanoma is an aggressive form of skin cancer. It has become an increasingly common neoplasm in the most developed countries, especially among individuals of European origin. Patients and methods. Anonymous data of patients with cutaneous melanoma were collected from the diagnostic database of the University Hospital of Trieste from 1 January 1990 to 10 December 2013. Our study is based on a population which was constant over the period of observation; it was also well-defined and characterised by unrestrained sun exposure. Results. The number of cutaneous melanomas increased during the period of observation with a seasonality trend and gender related differences both for anatomical sites distribution and stage of the disease. Moreover, 6% of our cohort developed multiple melanomas. Conclusions. In a well-defined population devoted to excessive sun exposure the frequencies of skin melanomas roughly doubled from 1990 to 2013 following a seasonal trend. In that population, prevention efforts according to gender specific risk behaviour, as well as follow-up programmes both for evaluation of metastatic spreading and for early diagnosis of additional skin melanomas, are crucial due to gender specific differences and to the occurrence of multiple melanomas.

The Influence of the Coexpression of CD4 and CD8 in Cutaneous Lesions on Prognosis of Mycosis Fungoides: A Preliminary Study

Background. Although techniques of immunophenotyping have been successful in characterizing the cells in the cutaneous infiltrates of mycosis fungoides little evidence suggests that variations in the phenotypic characterization correlate with prognosis. Objectives. In a preliminary prospective, single-centre, study we correlated the T-cell phenotype in cutaneous biopsies with the progression of the disease to determine whether the coexpression of CD4 and CD8 has an impact on prognosis. Methods. Skin biopsy specimens from 30 newly diagnosed patients were stained with immunoperoxidase techniques to determine their phenotypic characteristics. After a median followup of 42 months patients were divided into two groups with stable and progressive disease. Results. Eighteen patients had the conventional CD4+CD8− T-cell phenotype. Ten patients showed the coexpression of CD4 and CD8 and had a slightly lower rate of progressive disease. Conclusions. The coexpression of CD4 and CD8 in cutaneous lesions is not rare and is associated with a slightly lower rate of progressive disease. Since double positive CD4/CD8 phenotype is rarely reported in mycosis fungoides the presence on conventional immunophenotyping of both CD may be due to a “mixture” of neoplastic cells and inflammatory CD8+ tumor infiltrating lymphocytes. Immunohistochemical study combined with confocal microscopy could clarify this issue.

The role of O6-methylguanine-DNA methyltransferase in a long-surviving metastatic melanoma.

Background: Brain metastases commonly occur in patients with metastatic melanoma and are associated with a poor prognosis. Only a few chemotherapeutic agents have been shown to be potentially active. Resistance to chemotherapy is one of the main limitations to treatment. A key mechanism of resistance is O6-methylguanine-DNA methyltransferase (MGMT). The methylation of its promotor could inhibit the activity of this enzyme; consequently, it is very important to evaluate the methylation status of all available specimens. Case Report: We report the case of a long-surviving patient in whom combination treatment with an alkylating agent inhibiting MGMT, such as temozolomide, was useful in clinical control of the disease.

Improving the early diagnosis of early nodular melanoma: can we do better?

ABSTRACT Introduction: Cutaneous melanoma is the sixth most common malignant cancer in the USA. Among different subtypes of melanoma, nodular melanoma (NM) accounts about 14% of all cases but is responsible for more than 40% of melanoma deaths. Early diagnosis is the best method to improve melanoma prognosis. Unfortunately, early diagnosis of NM is particularly challenging given that patients often lack identifiable risk factors such as many moles or freckles. Moreover, early NM may mimic a range of benign skin lesions that are not routinely excised or biopsied in every day practice. For this reason, specific clinical and skin imaging clues have been proposed to improve early detection of NM. Areas covered: The review discusses about the noninvasive tools to diagnose thin melanoma, particularly NM. Expert commentary: Currently, dermatologists present a wide opportunity of diagnostic tools. Current data suggest that the early diagnosis of NM is a major challenge as the majority of early NM are symmetric, roundish, and lack specific pattern. Another promising strategy is based on recent data suggesting that artificial intelligence based on deep convolutional neural networking is able to outperform average dermatologist. Further research is necessary to validate the performance of this method in the real world and in the clinical setting.