Patrick Antony Oberholzer

Prognostic markers in lentigo maligna patients treated with imiquimod cream: A long-term follow-up study

BACKGROUNDnMore data are needed to define factors that predict long-term success after imiquimod therapy for lentigo maligna (LM).nnnOBJECTIVEnWe sought to determine the demographic, clinical, and histologic prognostic markers of relapse-free survival in patients with LM who were treated with imiquimod.nnnMETHODSnThis was a single-arm, open-label, nonrandomized, prospective study.nnnRESULTSnEighty-nine patients with histologically confirmed LM and a median follow-up time of 4.8xa0years after imiquimod treatment were included in our study. Sixteen patients (18%) relapsed. Statistically significant indicators of an increased risk of local recurrence included: the total number of melanocytes, the number of basal and suprabasal melanocytes and the number of pagetoid spreading melanocytes.nnnLIMITATIONSnOur study was a single-center, nonrandomized study.nnnCONCLUSIONnAn assessment of different melanocyte fractions in the diagnostic baseline biopsy specimen may help to predict the response of LM to imiquimod therapy.

Localized Epidermal Cysts as a Radiation Recall Phenomenon in a Melanoma Patient Treated with Radiotherapy and the BRAF Inhibitor Vemurafenib

BRAF inhibitors are broadly used for metastatic melanoma with BRAF mutations. Their use results in various cutaneous side effects, such as the development of keratoacanthomas and squamous cell carcinomas. We report a patient with metastatic melanoma treated with vemurafenib who developed dozens of histologically confirmed epidermal cysts within 2 months after initiation of vemurafenib administration. The cystic lesions were observed only in the localized area where a large exophytic melanoma tumor mass had been previously irradiated. Localized epidermal cysts may constitute an unusual radiation recall reaction in patients treated with BRAF inhibitors.

Ultraviolet radiation protection and skin cancer awareness in recreational athletes: a survey among participants in a running event.

PRINCIPLEnUltraviolet radiation (UVR) protection and skin cancer awareness are essential in the avoidance of cutaneous malignancies. Skin cancer prevention programmes involve public educational campaigns, for example, for outdoor workers or school children. Since nonprofessional sun exposure (e.g. during outdoor sport) is increasing with todays lifestyle, we assessed UVR protection and skin cancer awareness among recreational athletes. This survey-based, paper/pencil study was designed to assess UVR protection and skin cancer awareness among recreational athletes attending the largest running event in Switzerland.nnnMETHODSnAll adults (age 18 and older) attending this run were invited to complete our survey at our study booth. Our form consisted of questions about participants personal characteristics such as age, gender, educational attainment, skin type, history of sunburns, and personal/family history of skin cancer, as well as participants subjective attitudes and behaviours relating to UVR protection and skin cancer avoidance. We calculated separate scores for individual UVR protection and skin cancer awareness. We tested these two scores in relation to educational level as a primary endpoint. In addition, the impacts of further distinct characteristics were assessed in multivariable analysis.nnnRESULTSnA total of 970 runners (457 males, 513 females, mean age 41.0 years) completed our survey. Our results indicate that UVR protection is dependent on age, gender, skin type and personal history of skin cancer. Educational attainment (at univariate level), age, gender and skin type (in multivariable analysis) significantly affected the skin cancer awareness score.nnnCONCLUSIONnOur findings suggest that protection measures among recreational sportsmen can be improved. Achievements are notable in older, fair skinned, female runners. Our findings indicate that further work is needed in the education of the general public, and athletes in particular.

Cetuximab-associated folliculitis predominantly affecting the lower limbs

A 61-year-old man presented with adenocarcinoma of the distal descending colon and extensive lymphatic metastasis. Following an initial left hemicolectomy and para-aortic lymphadenectomy, he received chemotherapy with FOLFOX/bevacizumab. FOLFOX is a triple combination therapy consisting of FOLinic a

Extra-nodal non-Hodgkin-lymphoma with an acneiform eruption: folliculotropic mycosis fungoides

A 59-yr-old Caucasian woman presented with a 9-month history of progressive, pruritic, acneiform lesions. The latter first developed on the back and slowly spread to the trunk, proximal extremities, neck, and face. The patient, a long-time smoker, had a history of hypertension, hypertriglyceridemia, and diabetes mellitus. On examination the patient had multiple white to yellow, comedo-like lesions, and papules on the neck and face (Fig. 1A) as well as some erythematous to brownish, slightly infiltrated plaques composed of keratotic, follicular-bound, and peak-coned papules on the back and proximal limbs (Fig. 1B). Histological examination of skin biopsy specimens obtained from the eyebrow, neck, and trunk revealed cystic dilatation of the follicular infundibulum with a keratotic plug, a folliculotropic lymphocytic infiltration with focal lining-up, exocytosis of T-lymphocytes, and Pautrier’s microabscess formation within the follicular epidermis (i.e., folliculotropism; Fig. 1C). Immunohistochemical studies demonstrated a lymphocytic cell infiltrate, mainly composed of CD3 positive T-lymphocytes (Fig. 1C). T-cell receptor gamma monoclonality within the skin was detectable. Hematologic laboratory parameters were unremarkable. The thoraco-abdominal CT scan did not show any hepatosplenomegaly or lymph node enlargement. Finally, the bone marrow was unaffected. The patient was diagnosed with a folliculotropic mycosis fungoides (FMF), T2N0M0B0, clinical stage IB. Folliculotropic mycosis fungoides, also termed pilotropic mycosis fungoides, is a distinct entity within the spectrum of primary cutaneous T-cell lymphoma (CTCL), which itself belongs to the group of extra-nodal non-Hodgkin-lymphoma. Folliculotropic mycosis fungoides is characterized by infiltration of the hair follicle epithelium by lymphoid neoplastic cells with or without mucin deposition. Clinically, FMF usually develops in elderly patients and predominates in men. In women, FMF occurs significantly later when compared with men, an observation implying the role of gender-specific hormones. Five to 10% of the patients suffer from a second neoplasia, which often is another non-MF hematologic malignant neoplasm. Pruritus is a common clinical feature. Unlike classical MF, the head and neck areas are frequently involved in FMF. Clinical features are polymorphous: acneiform lesions, comedones, cysts, pustules, keratosis pilaris-like lesions, follicular mucinosis-like plaques, and alopecia have all been described. The misleading clinical picture of this striking form of CTCL closely mimics a number of skin diseases, including acne, drugtriggered acneiform eruptions, Favre-Racouchot disease, dioxin-associated hamartomas, follicular eczema, primary lymphoma with secondary folliculotropic involvement of the skin. In summary, the diagnosis of FMF is challenging, thereby leading to a mean diagnostical delay of 5 yr. Histopathological studies are hence critical and essential. There is no standard treatment for FMF.