Pablo Lázaro

Clinical significance of CXCR3 and CXCR4 expression in primary melanoma.

Tumor cell migration involved in metastases is a tightly regulated, nonrandom process. Chemokines have been identified as critical molecules guiding cell migration. We performed a prospective study to analyze a possible association between the expression of chemokine receptors CXCR3 and CXCR4 by primary melanoma and clinical outcome. Forty primary melanomas were available for analysis; 57% of the tumors expressed CXCR3 and 35% expressed CXCR4 by melanoma cells. At initial diagnosis, 5 patients had subclinical lymph node involvement and after a median follow‐up time of 32 months, 2 additional patients developed regional lymph node metastases and 5 patients developed distant metastases. The expression of CXCR4, but not CXCR3, by melanoma cells in primary lesions was significantly associated with the presence of ulceration, increased tumor thickness, a greater risk of developing regional and distant metastases and a higher mortality rate. Our study underscores the value of CXCR4 expression as a useful marker for predicting outcome in patients with localized melanoma. In addition, our findings support that, among chemokine receptors, CXCR4 might be an appropriate therapeutic target for adjuvant therapy in patients at risk for metastatic disease.

Paediatric psoriasis--narrowband UVB treatment.

Narrowband UV‐B is a safe and efficacious option for the treatment of adult psoriasis. However, the use of this therapy has been limited in children due to its long‐term carcinogenic potential. It has proven to be an adequate alternative in patients whose condition is refractory to topical treatment.

Acrokeratosis paraneoplastica (Bazex syndrome)

Bazex syndrome is a paraneoplastic dermatosis characterized by acral psoriasiform lesions associated with an underlying neoplasm. We present the case of a 64‐year‐old patient that was diagnosed with squamous cell lung carcinoma after being evaluated for lesions compatible with paraneoplastic acrokeratosis. With a high frequency Bazex syndrome is the earliest marker of an underlying subclinical neoplasm. An early suspicion is of the outmost importance in order to perform a prompt diagnosis of an underlying malignancy. We propose a diagnostic algorithm upon suspicion of acrokeratosis paraneoplastica and review the pathogenesis of this entity.

Epidermolysis bullosa acquisita: diagnosis by fluorescence overlay antigen mapping and clinical response to high‐dose intravenous immunoglobulin

Epidermolysis bullosa acquisita (EBA) is a chronic, subepidermal blistering disease characterized by the presence of autoantibodies to type VII collagen, located below the lamina densa of the basement membrane zone (BMZ). There is a large clinical and histological overlap between EBA and other subepidermal autoimmune bullous diseases, therefore, complex immunological techniques are required to make an accurate diagnosis. Therapy of EBA is also a difficult issue. Most patients do not respond to several common immunosuppressive agents. We describe a patient who has shown a good response to high‐dose intravenous immunoglobulin therapy.

Cutaneous necrosis induced by acenocoumarol.

Cutaneous necrosis is an infrequent but well‐documented complication of oral anticoagulants. In the pathogenesis of cutaneous necrosis induced by oral anticoagulants recent hypotheses favour the combined role of local factors and a transient unbalance of coagulation mechanisms leading to an hypercoagulable state. There exists a genetic factor that determines a decreased level of two vitamin‐K dependent glycoproteins, namely protein C and protein S. We present the case of an obese woman that developed an extensive cutaneous necrosis while receiving acenocoumarol for a deep venous thrombosis. She had an heterozygous deficit for protein C. The histopathologic findings of vessel thrombi and red blood cell extravasation were consistent with the clinical picture. A biopsy specimen taken from an initial lesion disclosed images of leucocytoclastic vasculitis. We reviewed the literature focusing on the pathogenesis and the histopathology of the disease.

Centrifugal lipodystrophy mimicking 'lipodystrophia centrifugalis abdominalis infantilis' in a Caucasian adult.

Editor Lipodystrophia centrifugalis abdominalis infantilis (LCAI) is a very rare disorder that has been reported mainly in Asian children. 1 Lesions appear during early childhood, tend to spread centrifugally to adjacent areas over the course of several years and usually resolve spontaneously during adolescence. A 21-year-old Spanish man consulted us for an asymptomatic cutaneous lesion that had been present since early childhood. It was initially located at the middle-right side of his abdomen, near the periumbilical area, and over the past 2 years had spread centrifugally up and out towards his right flank. Physical examination revealed a large, slightly violaceous plaque with ill-defined borders over the right flank and with an extensive depressed surface in the periumbilical area (fig. 1). Two cutaneous biopsies were performed, one from the depressed area and one from the right flank. Histologically the main findings in both biopsies were a decrease in the number and size of adipocytes, without any significant findings in the epidermis or the dermis (fig. 2). These findings were consistent with localized lipoatrophy. Based on the clinical signs, histological findings and particular evolution, initially we classified this case as lipodystrophia centrifugalis abdominalis. When we later reviewed the literature, we found centrifugal lipodystrophy as a more suitable name for this entity. 2

Long‐term remission of stage IVa mycosis fungoides following treatment with I‐131 for concomitant thyroid carcinoma

Abstract Background Treatment in advanced stage mycosis fungoides is often palliative. New approaches, like radioimmunotherapy, are necessary. However, only partial responses or short-term remissions are obtained with all these methods. Case report: A 37-year-old female had a tumor stage mycosis fungoides and a thyroid carcinoma with lymph node involvement. Both tumors are now in complete remission 9 years after following a combined treatment with I-131 (total dose 250 mCi). Conclusion: Further studies are needed to assess the role of I-131 in the treatment of mycosis fungoides.