The impact of sentinel node dissection on disease-free and overall tumour-specific survival in melanoma patients: a single centre group-matched analysis of 1192 patients.

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.

[Metal implant sensitivity: clinical and histological presentation]. / Klinik und Histologie Metallimplantat-assoziierter Hauterscheinungen.

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.

[Massive granuloma formation after long-term use of dermal fillers]. / Ausgeprägte Granulombildung nach langjähriger dermaler Fillerinjektion.

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.

High-definition optical coherence tomography and reflectance confocal microscopy in the in vivo visualization of a reaction to permanent make-up.

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.

[Verrucous squamous cell carcinoma complicating hypertrophic lichen planus. Three case reports and review of the literature]. / Verruköses spinozelluläres Karzinom auf Lichen ruber hypertrophicus. Drei Fallberichte mit Literaturüberblick.

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.

Detection of Merkel cell polyomavirus DNA in atypical fibroxanthoma in correlation to clinical features.

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.

[Sjögren-associated MALT-type lymphoma of labial salivary glands: rare constellation with amyloidosis and IgM-paraproteinemia]. / Sjögren-assoziiertes MALT-Lymphom der Lippenspeicheldrüsen: Seltene Konstellation mit Amyloidbildung und IgM-Paraproteinämie.

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.

[Topical treatment of persistent cutaneous leishmaniasis with paromomycin]. / Topische Therapie einer persistierenden kutanen Leishmaniase mit Paromomycin.

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.

[Immunohistochemical and molecular-pathologic investigations in dermatohistology]. / Immunhistochemische und molekularpathologische Untersuchungen in der Dermatohistologie.

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.

Perniosis-like tinea corporis caused by Trichophyton verrucosum in cold-exposed individuals.

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.

Follicular mycosis fungoides. A histopathologic analysis of nine cases.

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.

Cutaneous manifestations of lymphoma: a clinical guide based on the WHO classification. World Health Organization.

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.