[Increased risk of developing a second primary cutaneous nevus-associated melanoma in patients previously diagnosed with the disease]

BACKGROUND

Patients diagnosed with primary cutaneous melanoma have a greater lifetime risk of developing further melanomas. Most of these melanomas appear to arise de novo, but a proportion of them develop in pre-existing melanocytic nevi.

OBJECTIVE

To determine risk factors associated with the development of a second cutaneous melanoma arising on a nevus in patients diagnosed with cutaneous melanoma.

PATIENTS AND METHODS

A series of 981 patients diagnosed with cutaneous melanoma was selected; 47 of them had been diagnosed with a second melanoma. These 47 patients were classified into 2 groups according to whether or not there was histological evidence that the melanoma was associated with a nevus.

RESULTS

Age at diagnosis less than 40 years, tumor location on the trunk, and superficial spreading subtype were independent risk factors for the appearance of a primary melanoma on a nevus. The only factor associated with the appearance of a second nevus-associated melanoma was that the first melanoma was also associated with a nevus (odds ratio, 9.51; 95% confidence interval 1.6-56.56; P=.042).

CONCLUSIONS

Nevus-associated melanomas develop mainly in young patients, on the trunk, and are of the superficial spreading subtype. A history of primary cutaneous melanoma arising on a nevus is associated with a 9-fold increase in the risk of developing a second nevus-associated melanoma. These findings highlight the need for careful follow-up of all melanocytic lesions in patients who have had a primary nevus-associated melanoma.

[Intralymphatic histiocytosis and cancer of the colon]

Intralymphatic histiocytosis is a condition with nonspecific clinical features but with characteristic histopathological and immunohistochemical findings. It presents as a poorly demarcated erythematous plaque or a lesion similar to livedo reticularis, usually located on the limbs. Histologically, dilated vessels containing mononuclear cells are observed in the reticular dermis. In the past, the majority of these cases were thought to be cases of reactive angioendotheliomatosis or intravascular lymphoma, but the development of more specific immunohistochemical markers showed that these were dilated lymph vessels containing histiocytes, and so were considered as a separate condition. We present the case of a man with a past history of left axillary lymphadenectomy for lymphatic tuberculosis, leukocytoclastic vasculitis, and cancer of the colon. The patient developed an erythematous plaque in the left pectoral region. Histology and immunohistochemical stains of the lesion revealed histiocytes within dilated lymph vessels in the reticular dermis, but no neoplastic cells. We present a new case of intralymphatic histiocytosis in a patient with autoimmune and neoplastic diseases.

[Problems in defining melanoma regression and prognostic implication]

Between 10 % and 35 % of all melanomas show histological regression. That is, there is an area within the melanoma where the tumor retreats or disappears to be progressively replaced by fibrosis with presence of melanophages and variable degrees of inflammation, and neovascularization. Such regression is generally considered an indicator of poor prognosis in melanoma, although a number of studies contradict this affirmation. In this review, we summarize the leading articles about the influence of regression on melanoma prognosis. The results of these studies are very inconsistent, and so the prognostic significance of regression is somewhat controversial. We believe that some of these differences can be explained by differing criteria for regression and so we propose clear histological criteria to define early and sustained regression.

[Clinical and epidemiologic profile of melanoma patients according to sun exposure of the tumor site]

INTRODUCTION

Melanomas arising in areas with comparable levels of sun exposure have been shown to have similar genetic profiles. The aim of this study was to characterize the clinical features of melanoma patients according to the pattern of sun exposure: chronic, intermittent, or none.

MATERIAL AND METHODS

From our melanoma database, we selected 789 consecutive patients with melanoma diagnosed in our center since January 2000. Epidemiologic data, phenotype, and personal and family history of cancer were retrieved. The observed frequency of each variable was compared.

RESULTS

Most melanoma patients presented tumors on areas exposed intermittently to sunlight. In addition, these patients presented higher numbers of common and atypical melanocytic nevi and the melanoma very frequently arose in a pre-existing nevus. The second largest group was formed by patients with tumors on areas chronically exposed to sun and that had all the clinical lesions (solar lentigines and actinic keratoses) and epidemiological characteristics typical of these areas. Finally, patients with melanomas on areas not exposed to sun were older, as occurred in the group with chronic exposure, and the diagnosis was made at more advanced stages of the disease.

CONCLUSIONS

There are many patients who did not fit these patterns of melanoma development. Clinical and biological characterization is therefore necessary to determine alternative pathways of development in order to establish specific preventive measures.

[Proliferative cutaneous epithelioid angiomatous nodule]

The cutaneous epithelioid angiomatous nodule is an uncommon benign vascular proliferation that has only recently been described. Clinically, it usually presents as a solitary, fast-growing, small reddish papulous or nodular lesion on the trunk or limbs of adults. Histopathologic study reveals a proliferation of epithelioid cells and predominantly solid, well delimited, unilobular growth in the superficial dermis. Well defined vessels are often found permeating the lesion, which also shows a certain degree of inflammatory infiltration. The cells contain abundant pink cytoplasm, often with vacuoles, and vesicular nuclei with prominent nucleoli. The morphology of these cells is relatively uniform, without atypia or pleomorphism, although mitoses are not uncommon. We report 2 new cases of cutaneous epithelioid angiomatous nodules, the first in a 28-year-old pregnant woman and the second in a 27-year-old man. In both cases, the usual characteristics of this entity were present, but with the peculiarity of a high mitotic index. We discuss the differential diagnosis of cutaneous epithelioid angiomatous nodules with other vascular proliferations that exhibit epithelioid cytology.

"Self and parent-assessed skin cancer risk factors in school-age children"

OBJECTIVE

To evaluate sunburn, sun sensitivity factors and sun protection behavior in school-age children.

METHODS

2002 to 2004 survey of 2942 children in primary schools of Valencia, Spain, and their parents, using a self-administered questionnaire filled by the children with the help of their parents.

RESULTS

Having a fair skin (OR: 2.05; 95% CI: 1.38-3.04), light coloured eyes (OR: 1.38; 95% CI: 1.12-1.68), freckles (OR: 1.32; 95% CI:1.12-1.56), and older age (OR: 2.34; 95% CI:1.96-2.80) were associated with occurrence of sunburns. Hair color, gender, use of sunscreens, wearing T-shirts and sunglasses were not. Wearing hats (OR: 0.64; 95% CI: 0.54-0.75) was inversely associated. Parents were significantly more inclined to protect younger and fair-skinned children with sunscreen and T-shirts.

CONCLUSIONS

As expected, phenotype is related to sunburns and appears to influence parent's sun protection behaviours.

[Chemotherapy-induced acral erythema: a clinical and histopathologic study of 44 cases]

INTRODUCTION

Acral erythema, also known as palmoplantar erythrodysesthesia or hand-foot syndrome, is a relatively common cutaneous reaction caused by a variety of chemotherapeutic agents. It presents during cancer treatment as painful erythema and paresthesia affecting the palms and soles. It seems to be dose dependent and its appearance is determined by both the peak plasma concentration and the cumulative dose of the chemotherapeutic agent. The symptoms and histopathology findings are suggestive of direct cytotoxicity affecting the epidermis of the extremities caused by high concentrations of chemotherapeutic agents. The most commonly implicated agents are doxorubicin, 5-fluoracil and its derivatives, cytarabine, and docetaxel.

MATERIAL AND METHODS

We present the clinical and histologic characteristics of a series of patients diagnosed with chemotherapy-induced acral erythema. The study included all patients who developed acral erythema lesions following chemotherapy between January 2000 and December 2003.

RESULTS AND CONCLUSIONS

Out of 2186 patients who underwent chemotherapy, 44 cases of acral erythema were identified, representing an incidence of 2.01 % during the study period and 16.75 % of all cutaneous lesions attributed to chemotherapy. The most commonly implicated drug was 5-fluoracil administered by continuous infusion and the highest incidence was observed in patients treated with liposomal doxorubicin. Acral erythema was a dose-limiting toxic effect in 29.5 % of cases. The histologic findings varied according to the clinical severity of the lesions and included interface dermatitis with variable keratinocyte necrosis, dilation of the superficial vascular plexus, and limited inflammatory infiltrate. The most commonly used treatment was pyridoxine, along with topical treatments such as cold compresses, emollients, and topical corticosteroids.

[Protocol proposal for the histological report of the primary tumor in patients with cutaneous melanoma from the Task Force for Cutaneous Melanoma of the Valencian Community]

This text compiles a histological protocol proposal for cutaneous melanoma agreed by the Task Force for Cutaneous Melanoma of the Valencian Community. It brings together the protocol itself and, in addition, includes a description of each of the proposed variables that has shown to have a greater prognostic impact in previous works.

Long-term outcome of a phase II study of weekly docetaxel with a short course of estramustine and enoxaparine in hormone-resistant prostate cancer patients

OBJECTIVE

The objective was to define the toxicity and activity of weekly docetaxel administered with a short course of estramustine and enoxaparine in patients with hormone-resistant prostate cancer (HRPC).

PATIENTS AND METHODS

Twenty-four patients were treated with the next regimen: weekly docetaxel 36 mg/m(2) iv for three consecutive weeks every 28 days, and estramustine 280 mg three times a day for three consecutive days beginning the day before docetaxel (days 1-3, 8-10 and 15-17). In order to prevent thromboembolic events, 40 mg of subcutaneous enoxaparine was administered daily sc on the same days as estramustine. Primary endpoints were: toxicity, especially the presence of thromboembolic events, PSA response rate and response in measurable disease. Secondary endpoints were: time to PSA progression and overall survival.

RESULTS

Nineteen of 24 patients (79.1%, 95% CI 71-87%) had a PSA response = or >50%. Four of the eleven patients with measurable disease had a partial response. The median time to PSA progression was 7 months (CI 95%: 6.5-9) and the median survival was 19 months (IC 95%: 11-24). Toxicity was manageable with no treatment- related mortality. Only two patients had grade 4 neutropenia. Two patients had thrombotic events, one deep venous thrombosis and one stroke. The main grade 3 non-haematologic toxicity was diarrhoea and asthenia, both in 25% of patients.

CONCLUSIONS

Weekly docetaxel with a short course of estramustine and enoxaparine is active and tolerable in HRPC patients. The observed incidence of thrombosis was lower than previously reported but the association of enoxaparine was not enough to completely prevent the thromboembolic events.

[Oral involvement in lymphomatoid papulosis]

Lymphomatoid papulosis is a cutaneous lymphoma with an indolent clinical behaviour characterized by chronic development of recurrent, self-limited lesions appearing as necrotic papules and with a pathology compatible with T cell lymphoma. Mucosal involvement by lymphomatoid papulosis is very rare but has been reported in the literature. It usually appears as ulcers in patients previously diagnosed of lymphomatoid papulosis. From a histological perspective it is characterized by an infiltrate of CD 30 positive atypical lymphocytes together with a mixed inflammatory infiltrate of eosinophils, neutrophils, histiocytes and plasma cells. We report the case of a man previously diagnosed of lymphomatoid papulosis that developed two ulcerated lesions in the tongue whose biopsy confirmed the diagnosis of oral involvement by lymphomatoid papulosis.

Dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DFSP) is a soft tissue neoplasm of intermediate malignancy that is initially localized to the skin from where it can invade deep structures (fat, fascia, muscle and bone). It is the most frequent fibrohistiocytic tumor, comprising approximately 1.8 % of all soft tissue sarcomas and 0.1 % of all cancers. It has an estimated incidence of 0.8-5 cases per one million persons per year. Treatment of localized disease consists in complete surgical excision of the lesion by conventional surgery with wide margins (>3 cm) or by micrographic Mohs surgery. Although the cases of metastatic DFSP do not reach 5 % of the total, almost all of them appear after previous local relapses. The prognosis for metastatic cases is very poor with a survival of less than 2 years following detection of metastatic disease. Patients with locally advanced DFSP are not candidates for an initial radical surgical therapy therefore neoadyuvant treatment is required prior to surgery in order to reduce tumor burden. In this regard, chemotherapy and radiotherapy have not been highly efficacious so it is necessary to consider new alternatives. The demonstration of the oncogenic power of the translocation COL1A1-PDGFB in DFSP has allowed the successful introduction of drug therapy with antagonists of the PDGFB receptor for metastatic or locally advanced cases.

[Giant dermatofibroma: case report and review of the literature]

Dermatofibroma is a very frequent lesion that usually appears as a slowly growing nodule in the dermis, and preferentially involves the lower extremities of women. Several clinical variants have been described. Giant dermatofibroma has been defined as a rare variant of dermatofibroma measuring more than 5 cm that presents typical histological features and a benign biological behavior. We report the case of a 52-year-old man that presented a giant dermatofibroma with a diameter of 6 cm in the right shoulder and we review the few cases of this variant that have been described in the literature.