Vincenzo Roberti

Erythema annulare centrifugum as the presenting sign of breast carcinoma.

© 2008 The Authors JEADV 2009, 23 , 317–368 Journal compilation

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.

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.

The “firework” pattern in dermoscopy

Trichofolliculoma was first described in 1944 as a benign tumor of hair follicles, which usually occurs in adults as a solitary nodule on the face; however, it sometimes develops on the scalp or neck. A 62-year-old man presented to the Department of Dermatology, University of Rome ‘‘Sapienza’’, with a four-month history of a rapidly increasing asymptomatic lesion in the preauricular region. The lesion appeared as a 0.8 cm skin-colored nodule, with thin brownish strips with irregular borders. It had not previously been treated. The patient underwent dermoscopy, which showed the presence of a central brown zone from which several radial dark brown projections started towards the periphery of the lesion, assuming a crown shape, in the absence of a pigment network; this peculiar aspect configures a new dermoscopy feature, the ‘‘firework’’ pattern (Fig. 1). Though, clinically, the lesion appeared as a nodule mimicking basal cell carcinoma, the dermoscopic examination was not consistent with it, because there were no specific dermoscopic structures such as linear and arborizing telangiectasia, structureless or leaf-like areas, large blue–gray ovoid nests or blotches, multiple blue–gray globules, spoke wheel areas, and focal ulceration. Excisional biopsy was performed. The sections were stained with hematoxylin and eosin for histopathological examination, which showed a large cystic space lined by squamous epithelium containing horny material. Radiating from these ‘‘primary’’ hair follicles, multiple, small, abnormal ‘‘secondary’’ hair follicles were present. The stroma was rich in fibroblasts and was oriented in parallel bundles of fibers encapsulating the epithelial proliferation (Fig. 2). The dark brown projections seen in dermoscopy histopathologically correspond to the nests of cells radiating from a follicular epithelium. To our knowledge, there are no previous descriptions of dermoscopic pattern of trichofolliculoma. Even if in most cases diagnosis is based only on the clinical aspect, dermoscopy examination is a useful diagnostic tool because of the striking relation between dermoscopical image and histopathological features.

Predictive factors for false negative sentinel lymph node in melanoma patients.

BACKGROUND Sentinel lymph node biopsy (SLNB) represents a useful tool for staging melanoma patients. However false‐negative SLNB are reported in the literature. OBJECTIVE The aim of our study is to identify predictive factors for false‐negative SLNB in melanoma patients. MATERIALS AND METHODS We conducted a retrospective analysis on 316 melanoma patients who underwent SLNB and were followed up at the Department of Dermatology and Plastic Surgery of University of Rome “Sapienza” from March 1994 to June 2008. RESULTS In our patients, SLNB was positive in 35 cases (11.07%) whereas it was negative in 281 cases (88.93%); 12/316 patients (3.8%) had positive SLNB and positive therapeutic lymph node dissection (TLND); 23/316 (7.28%) patients had positive SLNB and negative TLND; 266/316 (84.18%) patients had negative SLNB but without subsequent metastases in the SLN site; 15/316 (4.74%) patients had negative SLNB, but with subsequent metastases in the same SLN site (false‐negative patients). Among the different prognostic factors, only ulceration was the main predictive factor for false‐negative SLNB, according to statistical analysis (p=.0420). CONCLUSION Our data confirm that SLNB is a useful technique for staging melanoma patients. However, in patients with negative SLNB, a closer follow‐up is recommended when ulceration is present. The authors have indicated no significant interest with commercial supporters.

Bromhidrosis induced by Sphingomonas paucimobilis: A case report

Bromhidrosis is a clinical disorder characterized by excessive or abnormal foul axillary odour due to the interaction of apocrine glands with micro-organisms which causes a serious personal and social handicap for affected people. We present the case of a 50-year-old caucasian female with bromhidrosis. The patient referred that this symptom had begun two months previously. Her past treatments included antibacterial soap, topical antibacterial agents and perfumes, but none of these relieved the patient of the odour. A cultural examination of axillary smear was carried out and it revealed the presence of ciprofloxacin sensible Sphingomonas paucimobilis. Therefore the patient was treated with ciprofloxacin and after 1 week the infection resolved completely.

Molluscum contagiosum on a tattoo: usefulness of dermoscopy

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The fragile X mental retardation protein regulates tumor invasiveness-related pathways in melanoma cells

The fragile X mental retardation protein (FMRP) is lacking or mutated in patients with the fragile X syndrome (FXS), the most frequent form of inherited intellectual disability. FMRP affects metastasis formation in a mouse model for breast cancer. Here we show that FMRP is overexpressed in human melanoma with high Breslow thickness and high Clark level. Furthermore, meta-analysis of the TCGA melanoma data revealed that high levels of FMRP expression correlate significantly with metastatic tumor tissues, risk of relapsing and disease-free survival. Reduction of FMRP in metastatic melanoma cell lines impinges on cell migration, invasion and adhesion. Next-generation sequencing in human melanoma cells revealed that FMRP regulates a large number of mRNAs involved in relevant processes of melanoma progression. Our findings suggest an association between FMRP levels and the invasive phenotype in melanoma and might open new avenues towards the discovery of novel therapeutic targets.