RESUMO
BACKGROUND: Sentinel lymph node dissection (SLND) is considered a standard staging procedure providing important prognostic information on melanoma patients. It remains a matter of debate, whether SLND and hence, removal of potential lymph node micrometastasis will alter survival outcome. OBJECTIVE: The aim of this group-matched analysis was to compare survival data of a large cohort of melanoma patients who were treated by wide local excision only (WLE) and nodal observation (WLE group) to a group of patients treated with WLE plus SLND group to investigate the potential therapeutic benefit of SLND in the treatment of patients with melanoma. METHODS AND MATERIALS: A total of 596 consecutive patients who had undergone WLE plus SLND between 1996 and 2003 were assessed. As a historical control group 596 patients treated with WLE and nodal observation but without SLND between 1986 and 1995 were selected. The groups were matched according to sex, age, Breslow tumour thickness and localization of primary tumour. The adjuvant treatment and follow-up examinations were performed according to protocols of the German Dermatologic Cooperative Oncology Group (DeCOG) and applicable study protocols that our clinic participated in; and hence, subject to change over time. RESULTS: Kaplan-Meier testing revealed significant differences in survival in favour of the SLND group. Mean overall tumour-specific survival (OS) was 102.7 months in the SLND group vs. 97.0 months in the WLE group respectively (P-value: 0.024). Disease-free survival (log-rank test: 0.003) and time to lymph node progression (P-value: <0.01) also differed significantly between the two groups. CONCLUSION: SLND is not only an important diagnostic procedure, but might also be of therapeutic benefit in terms of disease-free and overall tumour-specific survival of melanoma patients.
Assuntos
Excisão de Linfonodo , Melanoma/cirurgia , Linfonodo Sentinela/cirurgia , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática , Masculino , Melanoma/tratamento farmacológico , Melanoma/secundário , Pessoa de Meia-Idade , Micrometástase de Neoplasia , Estudos Retrospectivos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Taxa de Sobrevida , Adulto JovemRESUMO
Metal implant sensitivity (intolerance) can cause pain, reduced mobility, loosening of the implant and skin rashes. Knowledge of differential diagnoses, histology and appropriate diagnostics are essential for proper diagnosis. To outline typical clinical signs and histology in metal-implant-associated skin lesions we present three exemplary patients from our implant allergy outpatient department and give an overview of the current literature regarding metal implant sensitivity. In patients with a negative patch test the lymphocyte transformation test may reveal metal sensitization. Even "pure" titanium alloys may contain traces of nickel. The histology of implant-associated skin reactions goes from teleangiectatic postimplantation erythema to eczema and vasculitis. Based on the synopsis of history, clinical picture, allergological testing and histology, metal implant sensitivity can be diagnosed more precisely.
Assuntos
Dermatite de Contato/etiologia , Dermatite de Contato/patologia , Distúrbios do Sono por Sonolência Excessiva/etiologia , Distúrbios do Sono por Sonolência Excessiva/patologia , Metais/efeitos adversos , Próteses e Implantes/efeitos adversos , Dermatite de Contato/imunologia , Diagnóstico Diferencial , Distúrbios do Sono por Sonolência Excessiva/imunologia , HumanosRESUMO
BACKGROUND: Since dermal fillers were introduced in 1981, millions of patients have undergone wrinkle treatment with dermal fillers. Except for autologous fat, all fillers can act as potential foreign bodies, which have the potential ability to induce an immune reaction. Persisting material may induce activation of the immune system and finally granuloma formation. Frequency, histology, and clinical presentation of such foreign body reactions may vary depending on the filler used. CASE REPORT: This case describes a patient who received innumerable filler injections over the last two decades presenting with massive facial granulomas.
Assuntos
Preenchedores Dérmicos/efeitos adversos , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/etiologia , Granuloma de Corpo Estranho/diagnóstico , Granuloma de Corpo Estranho/etiologia , Ácido Hialurônico/efeitos adversos , Idoso , Preenchedores Dérmicos/administração & dosagem , Diagnóstico Diferencial , Esquema de Medicação , Dermatoses Faciais/prevenção & controle , Feminino , Granuloma de Corpo Estranho/prevenção & controle , Humanos , Ácido Hialurônico/administração & dosagem , Estudos LongitudinaisRESUMO
BACKGROUND AND OBJECTIVES: After permanent make-up treatments, eczematous and granulomatous reactions may occur which need anti-inflammatory treatment. For the definite diagnosis oftentimes biopsies are recommended. In vivo imaging such as reflectance confocal microscopy (RCM) and high-definition optical coherence tomography (HD-OCT) has been successfully used in the non-invasive diagnosis of various dermatoses before. METHODS: Here, we report on non-invasive imaging of a reaction towards permanent make-up in a 40-year-old woman by using HD-OCT and RCM. RESULTS: Both in HD-OCT and in RCM subepidermal pigment and granulomatous changes could be visualized and correlated with the histopathological findings. Regression of the lesions in response to topical steroids and intralesional injections of steroids and 5-fluorouracil is reported and treatment options are discussed. CONCLUSION: Non-invasive imaging techniques such as HD-OCT and RCM allow the visualization and localization of exogenous pigment and help in the evaluation of adverse reactions due to permanent make-up tattooing.
Assuntos
Cosméticos , Microscopia Confocal , Tomografia de Coerência Óptica , Adulto , Feminino , HumanosAssuntos
Doenças Linfáticas/microbiologia , Infecções por Rickettsia/diagnóstico , Rickettsia rickettsii/isolamento & purificação , Mordeduras e Picadas/microbiologia , Doxiciclina/uso terapêutico , Eritema/tratamento farmacológico , Eritema/microbiologia , Febre/microbiologia , Humanos , Doenças Linfáticas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Infecções por Rickettsia/tratamento farmacológico , África do Sul , ViagemRESUMO
Lichen planus is a chronic mucocutaneous T-cell-mediated disease, whose cause is still unknown. The first case of lichen planus that transformed into squamous cell carcinoma was reported in 1903. We present three patients in whom squamous cell carcinomas were identified in chronic lichen planus. The world literature includes at least 91 cases, including our three cases. In an epidemiological study, no significant risk of transformation of cutaneous lichen planus into squamous cell carcinomas was found. In contrast, there is a significantly higher risk of malignant transformation in mucosal lichen planus, so that the WHO had graded mucosal lichen planus as a premalignant condition.
Assuntos
Carcinoma Verrucoso/complicações , Carcinoma Verrucoso/diagnóstico , Transformação Celular Neoplásica/patologia , Líquen Plano/complicações , Líquen Plano/diagnóstico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Carcinoma Verrucoso/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Líquen Plano/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/cirurgia , Resultado do TratamentoRESUMO
A clear etiopathogenetic concept for atypical fibroxanthoma (AFX) is not established yet. Nevertheless, AFX is known as a pleomorphic but indolent tumor primarily of the elderly and/or immunosuppressed patient occurring in severely sun- or radiation-damaged skin. These risk factors are almost identical to those of Merkel cell carcinoma (MCC), a highly malignant skin tumor being thought to be pathogenetically associated with the recently discovered Merkel cell polyomavirus (MCPyV). Because AFX and MCC share risk factors, the aim of this study was to evaluate presence of MCPyV DNA in 23 cases of AFX by PCR and direct DNA sequencing. Subsequently, we correlated clinical features with MCPyV DNA status in AFX. We detected MCPyV DNA in 4 of 23 AFX. All patients with MCPyV DNA-positive tumors were men. The mean age of patients with MCPyV DNA-positive AFX was 84.8 ± 8.7 years (vs. 75.2 ± 7.8 years of MCPyV DNA-negative AFX), the mean duration of tumor growth was 4.5 ± 2.3 months (vs. 5.1 ± 2.8 months) and the mean tumor diameter was 1.2 ± 0.3 cm (vs. 1.3 ± 0.7 cm). Ulceration was present in 75% of MCPyV DNA-positive tumors (vs. 65.2%). In conclusion, MCPyV DNA is present in 17% of AFX, in this cohort affecting predominantly male patients with higher age (>80 years). Clinical features seem to be independent of MCPyV DNA status. Although the role of MCPyV is unclear in this setting, it may act as a cofactor in the tumorigenesis of AFX in a subset of cases.
Assuntos
Carcinoma de Célula de Merkel/virologia , DNA Viral/isolamento & purificação , Células de Merkel/virologia , Infecções por Polyomavirus/virologia , Polyomavirus/isolamento & purificação , Dermatopatias/virologia , Neoplasias Cutâneas/virologia , Infecções Tumorais por Vírus/virologia , Xantomatose/virologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/patologia , Feminino , Alemanha , Humanos , Masculino , Células de Merkel/patologia , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polyomavirus/genética , Infecções por Polyomavirus/patologia , Análise de Sequência de DNA , Dermatopatias/patologia , Neoplasias Cutâneas/patologia , Infecções Tumorais por Vírus/patologia , Xantomatose/patologiaRESUMO
We report a complex and rare combination of clinical and histological findings in a 59-year-old female patient: severe sicca-syndrome due to M. Sjögren, marginal zone B-cell lymphoma (MALT-type) in labial salivary glands with localized amyloid deposition, IgM-paraproteinemia, and Bence-Jones proteinuria. The causal association of these findings could only be elucidated by intense interdisciplinary correlation of all findings.
Assuntos
Amiloidose/diagnóstico , Amiloidose/patologia , Imunoglobulina M/análise , Doenças Labiais/diagnóstico , Doenças Labiais/patologia , Neoplasias Labiais/diagnóstico , Neoplasias Labiais/patologia , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Linfoma de Zona Marginal Tipo Células B/patologia , Paraproteinemias/diagnóstico , Paraproteinemias/patologia , Neoplasias das Glândulas Salivares/diagnóstico , Neoplasias das Glândulas Salivares/patologia , Glândulas Salivares Menores/patologia , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/patologia , Proteína de Bence Jones/análise , Biópsia , Comportamento Cooperativo , Feminino , Humanos , Comunicação Interdisciplinar , Neoplasias Labiais/cirurgia , Imageamento por Ressonância Magnética , Melanoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/cirurgia , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologiaAssuntos
Carcinoma de Célula de Merkel/virologia , Neoplasias Pulmonares/virologia , Polyomavirus/isolamento & purificação , Neoplasias Cutâneas/virologia , Carcinoma de Pequenas Células do Pulmão/virologia , Infecções Tumorais por Vírus/virologia , Idoso , Carcinoma de Célula de Merkel/patologia , DNA Viral/análise , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Polyomavirus/genética , Análise de Sequência de DNA , Neoplasias Cutâneas/patologia , Carcinoma de Pequenas Células do Pulmão/patologia , Infecções Tumorais por Vírus/patologiaRESUMO
Cutaneous leishmaniasis is an infectious disease with increasing prevalence in Germany. Diagnosis and therapy may be difficult due to the variability of the clinical and histomorphological picture and resistance to therapy. In this case study we report on a female patient with a persistent cutaneous leishmaniasis successfully treated with topical administration of paromomycin.
Assuntos
Amebicidas/administração & dosagem , Dermatoses Faciais/tratamento farmacológico , Leishmaniose Cutânea/tratamento farmacológico , Paromomicina/administração & dosagem , Administração Tópica , Afeganistão , Animais , Biópsia , Mordeduras e Picadas/complicações , Criança , Doença Crônica , Culicidae , Diagnóstico Diferencial , Dermatoses Faciais/patologia , Feminino , Alemanha , Humanos , Leishmaniose Cutânea/patologia , Curativos Oclusivos , Vaselina/administração & dosagem , Pele/patologia , ViagemRESUMO
Despite sophisticated diagnostic algorithms, pure morphologic diagnosis has reached its limits in many areas of general and dermatologic pathology, especially in the wake of advances in basic sciences. Modern microscopic diagnosis, especially when evaluating lymphocytic and mesenchymal tumors, depends greatly on identifying the expression of surface markers (for example CD3 as T-cell surface receptor), signal proteins (cyclin D in cell cycle control) or structural proteins in tumor cells (actin in myogenous cells). Molecular biological methods include those techniques which make it possible to identify cellular and extracellular macro-molecules such as proteins and nucleic acids. At the protein level, the selective identification of proteins on sections via immunohistochemical methods is a widely used and essential component of modern pathologic-anatomic diagnosis.
Assuntos
Biópsia/métodos , Dermatologia/métodos , Dermoscopia/métodos , Imuno-Histoquímica/tendências , Dermatopatias/patologia , Pele/patologia , Alemanha , Histologia , HumanosRESUMO
Trichophyton verrucosum is a zoophilic infectious agent causing 98% of the dermatophytic infections of cattle. Transmission to humans has, until recently, been rare. One reason for an increase of infection in humans and animals seems to be the decrease in immunisation of cattle. We report on three cases of pertinent human infections with disseminated, sharply defined, bluish red, partly oedematous nodules and plaques in particular not only on the thighs, but also on the trunk and arms. Two of our patients work with farm animals. The third one works as an assistant in a butcher shop, but lives on a cow farm. All three patients are often exposed to the cold. In all three cases T. verrucosum was detected by culture. Tinea corporis was histologically confirmed in two patients. Based on the microbiological results, we began a combined systemic and local antimycotic therapy with fluconazole 50 mg day(-1) in two patients, itraconazole 100 mg day(-1) in one patient p.o. combined with topical ciclopiroxolamine. All patients were cured. Dermatophytosis caused by T. verrucosum can, under certain circumstances, such as frequent exposure to cold or a long-term corticosteroid therapy, mimic the characteristic clinical picture of perniosis, as we demonstrate here.
Assuntos
Temperatura Baixa/efeitos adversos , Tinha/microbiologia , Trichophyton/isolamento & purificação , Adolescente , Adulto , Doenças dos Trabalhadores Agrícolas/microbiologia , Feminino , Humanos , MasculinoAssuntos
Borrelia burgdorferi , Eritema Migrans Crônico/diagnóstico , Administração Oral , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Western Blotting , Borrelia burgdorferi/isolamento & purificação , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Eritema Migrans Crônico/tratamento farmacológico , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Pele/microbiologia , Tetraciclinas , Fatores de Tempo , ViagemRESUMO
BACKGROUND: The spectrum of mycosis fungoides is exceedingly broad. Many different variants have been described, based on both clinical appearance and histological pattern. A rare form which shows preferential infiltration of hair follicles by malignant lymphocytes is follicular mycosis fungoides. METHODS: We reviewed our experience with nine cases of follicular mycosis fungoides. RESULTS: The unifying feature was infiltration of the hair follicle epithelium by atypical lymphocytes causing varying degrees of damage to the hair follicles. In some specimens the lymphocytes displayed only minor atypia leading to a misinterpretation as pseudolymphoma. Gene rearrangement studies were particularly helpful for establishing a diagnosis of malignant lymphoma. Additionally, epidermotropism of lymphocytes, eosinophils and mucin deposition were present to varying degrees. Mucin makes the distinction from mycosis fungoides-associated follicular mucinosis difficult. We found both dermal mucin and a follicular mucinosis pattern present at different stages of disease in the same patient. CONCLUSIONS: We suggest the term mycosis fungoides-associated follicular mucinosis should be replaced by follicular mycosis fungoides in future lymphoma classification schemes.
Assuntos
Folículo Piloso/patologia , Micose Fungoide/patologia , Neoplasias Cutâneas/patologia , Idoso , Biópsia , Complexo CD3/análise , Antígenos CD4/análise , Feminino , Genes Codificadores da Cadeia gama de Receptores de Linfócitos T/genética , Genótipo , Humanos , Imunofenotipagem , Antígenos Comuns de Leucócito/análise , Linfócitos/química , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Micose Fungoide/classificação , Neoplasias Cutâneas/classificaçãoRESUMO
Cutaneous lymphomas are a heterogeneous group of lymphomas that show variations in histology, immunophenotype, and prognosis. At the time of presentation, cutaneous lymphomas may be primary or may involve the skin as a secondary site of involvement. Primary cutaneous lymphomas, in many instances, are distinct from morphologically similar lymphomas arising in lymph nodes. Their natural history is often more indolent than nodal lymphomas, and for that reason, they often require different therapeutic approaches. A classification scheme should recognize those lymphomas that are unique to the skin, as well as those arising in other sites. The mode of presentation of a lymphoma is often an indication of underlying biological distinctions. However, organ-specific classification systems undermine communication among medical specialists. The World Health Organization classification of hematopoietic and lymphoid malignancies offers a comprehensive approach and proposes that lymphomas should be viewed as a list of individual diseases and that each disease can be defined by a constellation of morphological, biological, and clinical features. The current review will focus on the spectrum of primary and secondary cutaneous lymphomas, emphasizing those features of importance to the clinical oncologist.