Vincenzo Panasiti

Comparison of diagnostic methods in the diagnosis of dermatomycoses and onychomycoses

Direct microscopic examination of potassium hydroxide (KOH)‐prepared specimens is the simplest, cheapest method used for the diagnosis of mycotic infections of the skin. However, KOH preparations have been reported to have 5–15% of false‐negative results, possibly because of the low visibility of scant, scattered fungal material of the nail scrapings and because the detection of fungal elements depends on the skill of the observer [Arch Dermatol133 (1997) 1317; Clin Microbiol Rev8 (1995) 240]. We compared two different KOH‐based staining methods in order to obtain reliable results in shorter time than expected for cultures. A total of 124 patients with suspect diagnosis of dermatomycosis or onychomycosis were enrolled. Two scrapings from the same lesion of each patient were stained with KOH‐Chlorazole and KOH‐Acridine Orange (AO), respectively; cultural examination of the same specimen was considered as diagnostic gold standard. The two methods showed neither significantly different sensitivity nor specificity; however, for onychomycoses, we observed a slightly higher sensitivity for KOH‐Chlorazole and a higher specificity for KOH‐AO. We suggest the use of both techniques in order to improve detection of fungal infection, especially for onychomycoses.

CD133 and ABCB5 as stem cell markers on sentinel lymph node from melanoma patients

In the last years the nature of initiating melanoma cells has been discussed and the melanoma stem cell theory has been proposed as and alternative and/or supplemental view of newborning melanoma cells. It has been described that melanoma cells derived from metastatic melanoma specimens as well as melanoma cell lines are able to grow in an embryonic stem cell-based media and these melanoma stem-like cells possess capacity of self-renewal and high tumorigenicity. In 2005 the first evidence of a stem-cell like population existence in human melanoma has been provided. CD133 or prominin-1 is one of most studied marker of staminality expressed by melanoma cells; specifically, the down regulation of CD133 leads to a reduced cell capacity to metastatize. Nevertheless, there is disagreement concerning the constant presence of CD133þ cells in primary and metastatic melanomas. ABCB5, the third member of the human P-gp family, is a rhodamine and doxorubicin efflux transporter, identified as a novel drug transporter involved in drugresistance in human malignant melanoma. ABCB5 was found to be specifically expressed on CD133þ tumor

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.

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.

Rhodotorula mucilaginosa skin infection in a patient treated with sorafenib.

J Med 2013; 368: 2530. 9 Maurer M, Altrichter S, Bieber T et al. Efficacy and safety of omalizumab in patients with chronic urticaria who exhibit IgE against thyroperoxidase. J. Allergy Clin Immunol. 2011; 128: 202–209. 10 Antonicelli L, Stagnozzi G, Giuliodoro S et al. The safety of omalizumab therapy in a patient with severe persistent allergic asthma and hepatitis C. Ann Allergy Asthma Immunol 2009; 103: 269–270.

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.

IGFBP-3 inhibits Wnt signaling in metastatic melanoma cells

In previous works, we have shown that insulin‐like growth factor‐binding protein‐3 (IGFBP‐3), a tissue and circulating protein able to bind to IGFs, decreases drastically in the blood serum of patients with diffuse metastatic melanoma. In agreement with the clinical data, recombinant IGFBP‐3 was found to inhibit the motility and invasiveness of cultured metastatic melanoma cells and to prevent growth of grafted melanomas in mice. The present work was aimed at identifying the signal transduction pathways underlying the anti‐tumoral effects of IGFBP‐3. We show that the anti‐tumoral effect of IGFBP‐3 is due to inhibition of the Wnt pathway and depends upon the presence of CD44, a receptor protein known to modulate Wnt signaling. Once it has entered the cell, IGFBP‐3 binds the Wnt signalosome interacting specifically with its component GSK‐3β. As a consequence, the β‐catenin destruction complex dissociates from the LRP6 Wnt receptor and GSK‐3β is activated through dephosphorylation, becoming free to target cytoplasmic β‐catenin which is degraded by the proteasomal pathway. Altogether, the results suggest that IGFBP‐3 is a novel and effective inhibitor of Wnt signaling. As IGFBP‐3 is a physiological protein which has no detectable toxic effects either on cultured cells or live mice, it might qualify as an interesting new therapeutic agent in melanoma, and potentially many other cancers with a hyperactive Wnt signaling.