Stefano Simonetti

The single-photon emission computed tomography/computed tomography: a new procedure to perform the sentinel node biopsy in patients with head and neck melanoma.

The aim of this study was to define and validate a new technique to detect the sentinel node (SN) in patients treated for head and neck melanoma. In a small series of 23 head and neck melanoma patients, lymphatic mapping was followed by SN biopsy, using in 12 patients a new diagnostic imaging technique, single-photon emission computed tomography/computed tomography. The procedure is described and the major problems encountered are discussed. The preliminary data show that identification of SN using single-photon emission computed tomography/computed tomography never failed in 12 patients, and biopsies performed, compared with those in a standard group, took significantly less time (Mann–Whitney test P=0.006). In conclusion, the authors underline the possibility of a wide use for this technique.

Prognostic role of sentinel node biopsy in patients with thick melanoma: a meta-analysis.

Objectives  Sentinel lymph node (SLN) biopsy is a prognostic tool for patients with intermediate‐thickness melanomas. However, controversies exist regarding its role in patients with thick melanomas (tumour thickness greater than 4.0 mm). We performed a meta‐analysis to assess the prognostic role of SLN in thick melanoma in terms of disease‐free survival (DFS) and overall survival (OS).

Clinical improvement of psoriasis in an AIDS patient effectively treated with combination antiretroviral therapy.

Psoriasis has been classified as a T-cell-mediated inflammatory disease. The paradoxical exacerbation of psoriasis in AIDS has not been fully explained. We describe a case of a 45-y-old male with AIDS whose coincidental psoriasis resolved following antiretroviral therapy. Dramatic improvement was seen 4 weeks after combination antiretroviral therapy including enfuvirtide was started. In advanced HIV disease psoriasis could represent a clinical index of progression of HIV disease. Several pathogenetic factors involved in the clinical manifestations of psoriasis in the HIV-infected population are discussed.

Atrial Natriuretic Peptide and Guanylin-activated Guanylate Cyclase Isoforms in Human Sweat Glands

The ultracytochemical localization of membrane-bound guanylate cyclases A and C, stimulated by atrial natriuretic peptide and guanylin respectively, has been studied in human sweat glands. The results showed that the peptides stimulated guanylate cyclases A and C in both eccrine and apocrine glands. In the secretory cells, enzymatic activity was present on the plasma membranes and on intracellular membranes involved in the secretory mechanism. In eccrine glands, the cells of the excretory duct also presented enzymatic activity on the plasma membranes. In both glands, myoepithelial cells, surrounding the secretory cells, exhibited only guanylate cyclase A activity. These localizations of enzymatic activity suggest a role for both atrial natriuretic peptide and guanylin in regulating glandular secretion.

Malignant syphilis with ocular involvement in an HIV–infected patient

Malignant syphilis is now considered a rare disease, more commonly affecting individuals with poor health, malnutrition or HIV infection. We present a 34-year-old man with HIV infection who developed multiple atypical cutaneous ulcerations, leonine facies, a scleral nodule and keratitis with visual loss. The diagnosis of malignant syphilis was delayed due to the insidious presentation, but was confirmed via immunohistochemical (IHC) staining with anti-Treponema antibodies of a skin biopsy. Significant clinical improvement was observed following a 15-day course of penicillin and tigecycline therapy. In advanced HIV disease, cutaneous manifestations are often difficult to identify and present a challenge for the clinician. Clinical manifestations of secondary syphilis vary greatly, earning the epigram of ‘the great imitator’. It is important to recognize atypical presentations of syphilis, especially among HIV-infected individuals. Unlike historical cases of malignant syphilis, Treponema pallidum was found in the tissue section using IHC staining methods. We emphasize the importance of lues maligna in the differential diagnosis of HIV-infected patients with diffuse ulceronodular lesions as well as the usefulness of histological investigations and IHC studies.

Topical cidofovir for severe warts in a patient affected by AIDS and Hodgkin's lymphoma

We describe a 42-year-old man with AIDS and Hodgkins lymphoma whose severe and recalcitrant cutaneous warts resolved following treatment with local 1% cidofovir. Clinically significant improvements were observed in a two-week period of therapy. In advanced HIV disease complicated by additional haematological malignancy, cutaneous warts may be difficult to treat and present a challenge for the attending physicians. In similar clinical condition topical anti-human papillomavirus therapy may prove to be safe and curative.

Cutaneous Crohn's disease successfully treated with adalimumab.

regressive melanoma (case 8) of the series are shown and described in Fig. 2. A few previous studies suggested some criteria to differentiate regression in SK-SL and melanoma. In particular, a higher prevalence of coarse granules in the former and pepper-like granules in the latter, has been reported. 4–8 Other dermoscopic clues have emerged from our series, thus we propose the following panel of criteria to differentiate regression in these two entities (Table 1): in melanoma regression, melanophages are often seen as tiny pepper-like blue-grey granules, sometimes with a multifocal and irregular distribution or confluent in globular or thick linear structures, usually smaller and more blurred than the aggregates found in regressive SK-SL. Furthermore, white scar-like areas are frequently observed. Regression in SK-SL is usually characterized by coarser and sharper blue-grey granules with a greater tendency to aggregate in larger globular structures than in melanoma and white scarlike areas are usually absent. In conclusion, the differential diagnosis between regressive SK-SL and melanoma might be challenging when dealing with fully regressive lesions. Although some regression features seem to be quantitatively and qualitatively different, confocal microscopy or, even better, a biopsy remains mandatory in these doubtful cases. R. Pampena, S. Piana, E. Moscarella, C. Longo, A. Lallas, R. Alfano, G. Argenziano* Department of Medical and Surgical Sciences and Biotechnologies, Division of Dermatology ‘Daniele Innocenzi’, Sapienza University of Rome, Polo Pontino, Terracina, Italy, Pathology Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy, Dermatology and Skin Cancer Unit, 1st Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy, Department of Anesthesiology, Surgery and Emergency, Second University of Naples, Naples, Italy, Dermatology Unit, Second University of Naples, Naples, Italy *Correspondence: G. Argenziano. E-mail: g.argenziano@gmail.com

Gangrenous Chickenpox with Atypical Clinical and Histopathological Findings

Varicella (chickenpox) is a highly contagious disease caused by varicella zoster virus (VZV). The primary infection results in acute varicella with fever, malaise, and a widely disseminated vesicular and itching rash, frequently solving with scars. The rash begins on the face, scalp, and trunk and occurs in crops; typically, lesions are at different stages of evolution. The oral mucous membrane is frequently involved, with small painful ulcers [1]. Histopathology is characterized by intraepidermal blister, acantholysis or necrosis of the epithelium, and lymphoid infiltrates. Infected cells show characteristic viral cytopathic effects with ballooning degeneration, eosinophilic cytoplasmic inclusions, and glassy, eosinophilic, nuclear inclusions with marginated chromatin, often with multiple nuclei [2].

Human Papilloma Virus–Associated Lips Verrucous Carcinoma in HIV-Infected Male

Human papillomavirus (HPV) infection, widely known as the necessary cause of cervical cancer, has been established as a major etiologic factor for head and neck cancer (HNC). HIV-infected individuals are at higher risk of HPV-associated cancers than the general population. We describe a 45-year-old man with HIV and HPV coinfection, who presented progressively enlarging verrucous neoformations of the lips. The final diagnosis of verrucous carcinoma was delayed. Early detection of HPV lesions in oral mucosa and HPV screening activities could be important in improving the diagnostic sensitivity for the HIV-infected patients with oral cancer.