[Role of an anti-estrogen, tamoxifen, in the treatment of metastatic malignant melanoma]. / Place d'un anti-gestrogène, le tamoxifène, dans le traitement du mélanome malin métastasé.

The hormone-dependence of malignant melanoma is brought to mind by some epidemiological facts (rarely found in children, more frequently in females, higher frequency in case of prolonged use of oral contraceptives from an early age). On the other hand, estrogen receptors can be found in about 30 p. 100 of malignant melanomas. Starting from this hypothesis of a sub-population of hormone-dependent malignant melanomas, it seemed of interest to us to study the efficiency of an anti-estrogen, namely Tamoxifen (Nolvadex) in the management of metastatic malignant melanoma. It was used at a 40 mg daily dose-regimen on four patients (three post-menopausal females, one male) with multiple estrogen positive cutaneous metastases. In post-menopausal women, two cases of total regression were observed, associated with a distinct increase in progesterone receptors while under treatment and with a return to the initial stage when the treatment was stopped. This phenomenon can be explained by a double self-contradictory effect of the drug, already well known in other hormone-dependent cancers such as those of the breast or the endometrium, namely an anti-estrogen result on the tumoral growth and an estrogen result as attested by the synthesis of progesterone receptors. Certain malignant melanomas therefore behave as endocrine-dependent tumours and may so answer an anti-hormone treatment through a competitive fixation on estrogen-receptors. Our clinical results are in agreement with such a theory since Tamoxifen is at best effective on cutaneous metastases of post-menopausal women. The overall efficiency on all metastases is of the order of 10.6 p 100 (complete or partial regression).(ABSTRACT TRUNCATED AT 250 WORDS)

[Herpes gestationis. Apropos of 2 cases]. / L'herpès gestationis. A propos de deux cas.

Herpes gestationis is an autoimmune disorder specific of pregnancy. The authors report two cases of this condition with distinctive clinical and immunological features. Both the pathogenesis and the nosologic connections between Herpes gestationis and Bullous pemphigoid are reviewed and discussed.

[Incontinentia pigmenti. Apropos of a new case]. / Incontinentia pigmenti. A propos d'un nouveau cas.

This paper describes a new case of Incontinentia Pigmenti in a newborn. This genodermatosis develops mostly in females and three clinical stages are recognized. Other ectodermal abnormalities may be associated with a risk for the prognosis. The clinical, histological features and differential diagnosis are discussed.

Reaction to UV-induced erythema in young patients with basal cell carcinoma.

The effects of an irradiation 6 times the minimal erythemal dose of UVB were studied using a visual scale from 1 to 4+ in 12 patients aged under 45 years with a past medical history of basal cell carcinoma, and in 12 sex-, age- and skin-type-matched controls. Erythema was significantly more intense at days 15 (p less than 0.01) and 22 (p less than 0.001) in patients than in controls. Pigmentation was significantly weaker at day 22 than in controls (p less than 0.005).

Genital squamous cell carcinoma in men treated by photochemotherapy. A cancer registry-based study from 1978 to 1998.

BACKGROUND: One single report from the U.S. 16-centre-trial indicated that psoralen and ultraviolet A radiation (PUVA) therapy may induce an increased risk of genital tumours in men, and protection of the genital area is, therefore, recommended. OBJECTIVES: To evaluate the relevance of this risk in routine clinical practice. METHODS: Two groups of patients were included in a 1978-98 retrospective study. Case records of men with genital squamous cell carcinoma (SCC) identified from the Cancer Registry of the Doubs area of France were examined for a history of PUVA therapy, topical tar treatment, psoriasis, human papillomavirus infection or genital dermatitis. In addition, all the dermatologists of the Doubs area (in public and private practice) using PUVA therapy were asked to provide information on the number of patients having received PUVA therapy and whether the genital area was exposed during treatment. RESULTS: Between 1978 and 1998, among the 48 men who had developed a genital SCC in the Doubs area, only one had a history of intensive PUVA therapy. About 150,000 treatments with PUVA therapy had been performed by 15 dermatologists in the Doubs area for 5400 patients since 1978. No case of genital SCC had been reported, despite the fact that the genital area had not been protected during UVA exposure. CONCLUSIONS: Although retrospective, our study demonstrates that the occurrence of genital SCC in men treated with PUVA therapy is a very rare event in common dermatological practice.