[Reprint of: New guidelines for stage III melanoma (the French Cutaneous Oncology Group)]. / Republication de : Actualisation des données concernant le mélanome stade III : nouvelles recommandations du groupe français de cancérologie cutanée.

Improved knowledge of sentinel node procedures coupled with the results of adjuvant clinical trials in stage III melanoma have prompted the French Cutaneous Oncology Group to propose new guidelines for the management of stage III melanoma. These guidelines comply with the principles of the evidence-based medicine.

[New guidelines for stage III melanoma (the French Cutaneous Oncology Group)]. / Actualisation des données concernant le mélanome stade III : nouvelles recommandations du groupe français de cancérologie cutanée.

Improved knowledge of sentinel node procedures coupled with the results of adjuvant clinical trials in stage III melanoma have prompted the French Cutaneous Oncology Group to propose new guidelines for the management of stage III melanoma. These guidelines comply with the principles of the evidence-based medicine.

[Recurrent atypical mycobacterial infections in the adult: think of autoantibodies against interferon-gamma !]. / Infections récurrentes à mycobactéries atypiques chez l'adulte : attention aux autoanticorps anti-interféron-gamma!

INTRODUCTION: Disseminated non-tuberculosis mycobacterial infections are associated with a defect of the cellular immune response. They have been mainly reported in AIDS patients. Cases related to the presence of anti-interferon-γ autoantibodies are rare. CASE REPORT: We report a non HIV-infected 45-year-old Thai woman, with a past medical history of Graves' disease. She presented with recurrent disseminated and severe non-tuberculous mycobacterial infections that were related to the production of anti-interferon-γ autoantibody. The diagnosis was suspected in the presence of a negative interferon-γ release assay (IGRA) including with the positive control, and evidenced by the identification of specific antibodies. CONCLUSION: Anti-interferon-γ autoantibody production is a rare cause of non tuberculous mycobacterial infection. Such a mechanism should be suspected in non HIV-infected patients and especially in those having an Asiatic ethnicity or an associated immune disorder. A negative IGRA (including with the positive control) is a reliable diagnostic tool and should be completed with the identification of specific autoantibodies.

[Total skin electron beam therapy for early-stage mycosis fungoides: immediate results and long-term follow-up in 68 patients]. / Electronthérapie corporelle totale du mycosis fongoïde aux stades précoces: 68 cas.

BACKGROUND: Our aim was to evaluate the efficacy of total skin electron beam therapy (TSEB) in the management of early-stage mycosis fungoides in order to assess its position in relation to other skin-directed therapies. PATIENTS AND METHODS: A retrospective study of 68 patients (30 in stage T1 and 38 in stage T2). RESULTS: The median treatment duration was 6 weeks. Three months after the end of TSEB, a complete clinical response occurred in 66 patients (97%). The most marked effects of acute toxicity included localized ulcerations in 13 patients (13.2%) not requiring hospitalization. Mean follow-up was 6.5 years (1.6 to 28.7). The overall survival rates at 5 and 10 years were 86% and 71%, respectively. Thirty-nine patients (57.4%) experienced relapse with a mean disease-free interval of 1.8 years. The disease-free survival rates at 5 and 10 years were 41% and 31%, respectively. This rate was higher when TSEB was performed early (p=0.031). Twenty-one years after TSEB, only one case of cutaneous malignancy (basal cell carcinoma) was noted. DISCUSSION: Because of its high response rates and rapidity of action, TSEB should be considered as first-line therapy in the management of early-stage mycosis fungoides.

Polyethylenimine-mediated in vivo gene transfer of a transmembrane superantigen fusion construct inhibits B16 murine melanoma growth.

Immunotherapy has been proposed as a therapeutic strategy in advanced-stage melanomas in which other therapeutic options have little effect. The Staphylococcus enterotoxin A (SEA) has been used to stimulate an antitumoral immune response but its use is hampered by severe systemic side effects. Here, we show that SEA can be targeted to melanoma cells to limit these side effects. More specifically, we used a nonviral vector, the cationic polymer, polyethylenimine (PEI), to express a transmembrane SEA fusion construct (pSEA-TM) in B16F10-induced subcutaneous melanoma in mice. The efficacy of this in vivo transfection was enhanced by concomitant infusion of epinephrine to induce local vasoconstriction. In these conditions, repeated injections of pSEA-TM/PEI complexes elicited a significant response, as evidenced by tumor growth inhibition, without systemic adverse effects. T cell infiltration of the tumors, together with positive lymphocyte proliferation tests, suggested local and systemic immune responses. Altogether, PEI-mediated targeting of SEA to melanoma tumor cells in vivo efficiently stimulates the antitumor immune response without inducing the side effects observed with systemic administration of SEA.

[Immediate patent blue-induced hypersensitivity during sentinel node detection: The value of cutaneous tests]. / Hypersensibilité immédiate après injection de bleu patenté lors du repérage du ganglion sentinelle : intérêt des tests cutanés.

BACKGROUND: Patent blue is a blue dye commonly used for sentinel node detection in the management of melanoma and breast cancer. Immediate hypersensitivity reactions to patent blue such as blue urticaria, bronchospasm or anaphylactic shock are not rare, being seen in 0.8 to 2.8% of patent blue-treated patients. PATIENTS AND METHODS: We report three cases of anaphylactic shock and two cases of urticaria developed after injection of patent blue in the context of sentinel node detection in breast cancer patients. Immediately after surgery, two patients developed generalized urticaria followed by circulatory collapse requiring resuscitation. The third patient presented massive anaphylactic shock without cutaneous or respiratory signs. Blue urticaria without haemodynamic disturbance was seen in the latter two patients. Prick tests using patent blue were positive for the three patients with positive intradermal reactions (1/10,000 dilution) in all patients. DISCUSSION: These observations underline the severity of patent blue-induced shocks with delayed onset, since they are often observed at the end of surgery. While the mode of sensitization is poorly understood, food and textile dyes are thought to play a role. Skin prick tests provide a simple and reliable method of diagnosing these events. There is a real risk of late anaphylactic shock during sentinel node detection using patent blue and discussion is needed concerning alternative methods of sentinel node detection.

[Infliximab-induced skin reaction with visceral manifestations and high levels of anti-DNA antibodies]. / Toxidermie avec manifestations systémiques et sérologie lupique induites par l'infliximab.

BACKGROUND: Infliximab is a monoclonal anti-Tumor Necrosis Factor alpha-antibody (anti-TNFalpha) that has demonstrated its efficacy in the treatment of rheumatoid arthritis, Crohn's disease and psoriasis. CASE REPORT: We report the case of a 59 year-old woman with a 20-year history of rheumatoid arthritis consulting for an atypical erythematosus rash 18 months after her first infusion of infliximab. The rash was associated with inflammatory syndrome, incipient renal failure and high levels of antinuclear antibodies with the presence of anti-dsDNA antibodies. Lack of specificity in both skin manifestations and histology ruled out a diagnosis of drug-induced lupus. Discontinuation of treatment with infliximab resulted in improvement of all clinical signs together with a significant decrease of antinuclear antibody titers within six months. DISCUSSION: Induction of antinuclear antibodies and/or anti-dsDNA antibodies is often seen in patients treated with TNFalpha inhibitors. Cases of true systemic lupus erythematosus or anti-TNFalpha-related eruption in a context of autoimmunity, as seen in our patient, have been reported only rarely. All cases were reversible upon discontinuation of treatment.