Phacomatosis pigmentokeratotica: speckled-lentiginous nevus in association with nevus sebaceus

We report a case of a congenital nevus sebaceus with numerous brown macules and papules in the left auricular region. In the same lesion, pigmented basal cell carcinomas developed later in life. Additionally, on the left side of the neck, both shoulders and the left arm, features of nevus spilus with melanocytic and blue nevi were present. Such a combination of nevus sebaceus with melanocytic lesions may be explained by the concept of twin spotting and represent another case of phacomatosis pigmentokeratotica.

Detection of melanoma cells in the blood of melanoma patients by melanoma-inhibitory activity (MIA) reverse transcription-PCR

The detection of tumor-specific mRNA transcripts in the blood of patients by reverse transcription (RT)-PCR has been used as a very sensitive technique for determining systemically disseminated tumor cells. On the basis of previous expression studies, we aimed to trace melanoma cells in the blood of melanoma patients by RT-PCR of melanoma-inhibitory activity (MIA) mRNA. To detect sensitively MIA transcripts in total RNA isolated from peripheral blood mononuclear cells (PBMCs), we established a sensitive PCR-ELISA system. With this assay, we detected one melanoma cell in 2 ml of blood by a single round of 32 PCR cycles. A total of 295 PBMC samples isolated from 166 patients with melanocytic tumors were tested with the MIA RT-PCR-ELISA: (a) 58 patients (99 samples) with malignant melanomas in stage I; (b) 49 patients (65 samples) with malignant melanomas in stage II; and (c) 47 patients (116 samples) with metastasized melanomas (stages III and IV), with an additional 12 patients (15 samples) with benign melanocytic nevi. Forty-four (26.8%) of 164 samples isolated from patients with melanomas in stages I and II were positive for MIA mRNA; in stages III/IV, 33 (28.4%) of 116 samples of patients, irrespective of clinically evident disease, were positive. Eleven (84.6%) of 13 PBMC samples from patients with metastasized melanoma and clinically evident disease without treatment were MIA mRNA-positive in contrast to only 19 (25.7%) of 74 samples isolated from patients in stage IV with metastasis during chemotherapy. Furthermore, none of the 16 PBMC samples of patients in stage IV without clinically detectable metastases at that time point during chemotherapy was MIA mRNA-positive. Interestingly, of the 44 positive samples (26.8%) isolated from patients with melanomas in stages I and II, 20 were still positive when retested after complete excision of the tumor. Our results reveal that amplification of MIA mRNA from the PBMCs of patients with malignant melanomas by PCR-ELISA provides a useful means to detect tumor cells in the systemic blood circulation. A correlation between positive blood samples and tumor burden in stages III and IV was detected, and, in addition, a significant effect of chemotherapy with respect to the reduction of the number of systemically spread tumor cells was observed. However, MIA amplification seems to be of little value as a surrogate marker for clinical staging or the detection of metastatic disease.

Assessment of microsatellite instability and loss of heterozygosity in sporadic keratoacanthomas

Variations in the length of simple repetitive tandem repeats (microsatellite instability, MIN) between constitutive and tumour DNA, which is characteristic of tumours in patients affected with hereditary nonpolyposis colon cancer (HNPCC), have been found to be very important in the carcinogenesis of a variety of human neoplasms. Recently, MIN has been found in sebaceous and colorectal tumours as well as in keratoacanthomas of Muir-Torre syndrome. In order to elucidate the significance of both MIN and loss of heterozygosity (LOH) in the pathogenesis of sporadic keratoacanthomas, the presence of MIN and LOH at five loci [chromosome 5q21 (D5S346, APC), 9p21 (D9S171, p16), 10pter (D10S89, Mfd28), 11p (D11S904) and 17p12 (D17S520, p53)] was evaluated. MIN was found at only one locus (p53) in 1 of 12 keratoacanthomas and no evidence for the presence of LOH could be detected. Our results suggest that, in contrast to keratoacanthomas associated with Muir-Torre syndrome, neither MIN nor LOH appear to be significant in the induction of sporadic keratoacanthomas.

Naevi spili, Café-au-lait spots and melanocytic naevi aggregated alongside Blaschko's lines, with a review of segmental melanocytic lesions

This is the first case in the literature describing naevi spili, café-au-lait spots and melanocytic naevi aggregated along-side Blaschko's lines. The pattern of melanocytic lesions in our patient is different from the congenital pigmentary syndromes and the segmental distribution of melanocytic naevi, the quadrant distribution of dysplastic naevi or the partial unilateral lentiginosis which here are shortly reviewed. The distribution may be a result of a somatic mutation occurring at an early stage of embryogenesis when neural structures had already been formed.