Dermatoscopic vascular patterns in cutaneous Merkel cell carcinoma.

BACKGROUND: Merkel cell carcinoma (MCC) is one of the most aggressive primary cutaneous malignancies. The clinical diagnosis of MCC is often delayed. Although the rarity of this skin cancer partially explains the low clinical suspicion by physicians, the absence of characteristic clinical features contributes to the delay in diagnosis. Dermatoscopy has proven a useful diagnostic tool in other cutaneous malignancies; however, the dermatoscopic features of cutaneous MCC are unknown. OBJECTIVE: We performed dermatoscopy on 10 primary cutaneous MCC to describe the dermatoscopic features and correlate these findings with the histopathologic parameters. METHODS: Consecutive patients with cutaneous MCC were identified and their tumors were evaluated under dermatoscopy. An 8-point MCC histopathology profile was recorded for each primary tumor in an attempt to correlate individual parameters with dermatoscopic features. RESULTS: All 10 tumors showed an irregular vascular pattern under dermatoscopy and demonstrated milky-red areas/globules and numerous linear irregular vessels. No correlation was noted between dermatoscopic and histopathologic features. LIMITATIONS: The patients were from a single institution and tumors evaluated by a single dermatoscopic reviewer. Because of the rarity of this tumor, a small number of tumors were evaluated (10). CONCLUSION: MCC exhibits a variety of dermatoscopic vascular patterns, most commonly milky-red areas/globules, polymorphous vessels, and linear-irregular vessels. Although we found no specific dermatoscopic pattern for MCC in our series, the polymorphous vascular pattern was atypical and suggestive of a malignant process. Further studies should be done to investigate the potential correlation between dermatoscopic features and histopathologic parameters.

Familial basaloid follicular hamartoma: a report of one family.

Basaloid follicular hamartoma is a rare but benign adnexal neoplasm that can simulate basal cell carcinoma. Both sporadic and familial variants have been described. We illustrate a family cluster of this unusual entity which presented as milia-like or hyperpigmented papules. Criteria for distinction between the hamartoma and carcinoma are delineated, although evolution of basaloid follicular hamartoma into basal cell carcinoma may also be a possibility.

Biochemotherapy in patients with advanced vulvovaginal mucosal melanoma.

Patients with advanced vulvovaginal mucosal melanoma generally have a dismal prognosis, and no effective systemic therapy for the disease has been reported. The objective of this retrospective clinical study was to assess the clinical benefit of biochemotherapy in this patient population. We evaluated the medical records of all patients with advanced vulvovaginal mucosal melanoma treated with biochemotherapy at our institution. Our search yielded 11 patients with adequate documentation for study inclusion: eight patients had undergone treatment with cisplatin (CDDP), vinblastine (VB), dacarbazine (DTIC), interferon-alpha (IFN) and interleukin-2 (IL-2), one with CDDP, VB, DTIC and IFN, one with CDDP, temozolomide and IFN, and one with CDDP, VB, DTIC, tamoxifen, IFN and IL-2. All IL-2 treatments were administered intravenously. The median follow-up duration was 10 months (range, 2-44 months). Four patients (36%) showed partial responses, but none showed a complete response. Two patients did not return for follow-up evaluation after the completion of treatment. The median time to disease progression in all 11 patients was 3 months; however, the median time to disease progression in those with a partial response or stable disease was 6 months. One patient was alive at the last documented follow-up visit (51 months). The median overall survival duration from the start of biochemotherapy was 10 months. Biochemotherapy appears to have significant activity against advanced vulvovaginal melanoma, and should be considered as a systemic treatment option for advanced, metastatic, vulvovaginal melanoma.