Use of DAPI cytofluorometric analysis of cellular DNA content to differentiate Spitz nevus from malignant melanoma.

Cellular DNA content was measured for the purpose of differentiating Spitz nevus from malignant melanoma using the cytofluorometric technique. DNA was stained by 4',6-diamidino-2-phenylindole, and measured by microfluorometer. Among 20 Spitz nevi examined, 18 of them showed a diploid DNA distribution histographic pattern similar to that of acquired pigmented nevi. The other two Spitz nevi had a few polyploid cells with the major population of cells containing diploid DNA content. In contrast, all malignant melanomas showed an aneuploid DNA distribution histographic pattern. The DNA index values of cells from Spitz nevi distributed in the similar range to that of acquired pigmented nevi and separated from those of malignant melanomas distributed in a much higher range. Our results suggest that cytofluorometric analysis of cellular DNA content reflects the biologic behavior more sensitively than do conventional clinical or histologic criteria, and that it serves as a useful aid for the differentiation of Spitz nevus from malignant melanoma.

Epithelioid cell melanomas have greater DNA ploidy abnormalities than spindle cell melanomas: cytological evidence for a higher malignant potential of the former.

The cellular DNA ploidy of 30 cases of malignant melanoma was measured by 4',6-diamidino-2-phenylindole-DNA (DAPI-DNA) microfluorometry. DNA histograms and DNA index values were compared among melanomas of different cell morphology. Epithelioid cell melanomas often showed greater DNA aneuploidy than spindle cell melanomas in terms of histographic pattern. DNA index values of the former (mean +/- standard error, 1.84 +/- 0.31) were significantly higher than those of the latter (1.55 +/- 0.24; P < 0.05). The DNA index values of mixed-type melanomas were intermediate. These results indicate that the epithelioid cell melanomas have greater DNA ploidy abnormalities which are usually correlated with a greater malignant potential in pigmentary neoplasms. Thus our results confirm clinical evidence that melanoma patients with the epithelioid type of cells have a poorer prognosis than those with the spindle type of cells.

A case of unusual syringoma: unilateral linear distribution and plaque formation.

We describe a 25-year-old woman with syringoma, clinically manifested by unilateral linear distribution and a plaque formation. Syringoma papules are located on the extensor aspect of the left upper arm, the left antecubital fossa, and the left side of the chest. The papules distributed in linear fashion on the left upper arm, and partially formed plaques on the left upper arm and the left antecubital fossa. Syringoma must be included in the differential diagnosis of unilateral linear papular or plaque skin lesions.

Linear IgA bullous dermatosis associated with ulcerative colitis.

A 41-year-old woman developed skin vesicles one week before examination. She had been suffering from ulcerative colitis since the age of 30. Histologic examination of a vesicle showed a subepidermal bulla accompanied by mononuclear leukocyte infiltration intermingled with eosinophils and neutrophils. Eosinophilia was also noted. Direct immunofluorescent test revealed linear deposits of IgA in the basement membrane zone.

Subungual pigmented nevus: evaluation of DNA ploidy in six cases.

The discrimination between subungual pigmented nevus and subungual melanoma in situ is still a clinical problem. We measured DNA ploidy in six cases of subungual melanotic lesions which exhibited the features of subungual pigmented nevus or lentigo simplex histologically. Five cases presented a diploid pattern with or without a slight increase of hyperdiploid cells. One case presented a polyploid pattern; it also exhibited histologically abnormal melanocytes with large nuclei and pigment-filled elongated dendrites. The DNA ploidy pattern and histologic features suggest that the lesion of this latter case contains abnormal melanocytes which probably have the potential to undergo a malignant transformation into a subungual melanoma. DNA ploidy analysis, therefore, is likely to provide information for evaluating the biologic behavior of subungual melanotic lesions.

Vogt-Koyanagi-Harada's syndrome associated with Hashimoto's thyroiditis.

Vogt-Koyanagi-Harada's syndrome has been known as an autoimmune disease which affects the melanocyte-containing tissues. We report a case of Vogt-Koyanagi-Harada's syndrome associated with Hashimoto's thyroiditis. IgM-class antibodies against nevus cells were detected in the patient's serum by indirect immunofluorescence test. These clinical and laboratory findings support the autoimmune theory of this rare syndrome.

[Preclinical and clinical studies on the efficacy of bifonazole in patients with tinea pedis at 10 years after approval. Part 1. Susceptibility to bifonazole of clinical isolates of dermatophytes].

An investigation was carried out to determine whether or not here had been any changes in the susceptibility of clinically isolated strains of Trichophyton metagrophytes and Trichophyton rubrum (both leading causes of tinea) to bifonazole, an imidazole derivative and antifungal for topical use. Susceptibility was measured in 107 strains of these fungi isolated from clinical samples during a study on the treatment of tinea pedis with Mycospor cream in 1995, 42 strains isolated and stored in 1990, and 39 strains isolated and stored prior to development of the drug. The results are as follows: (1) There was no distinct difference in the susceptibility to bifonazole of T. mentagrophytes strains isolated before 1986 and those isolated in 1990 or 1995. (2) T. rubrum strains isolated before 1986 were slightly more susceptible to bifonazole than those isolated in 1995, while the 1990 strains were slightly less susceptible than the 1995 strains, but the difference was not significant. (3) The highest MICs of bifonazole for all the T. mentagrophytes and T. rubrum strains isolated from before 1986 and those in 1995 were relatively low, being 2.5 micrograms/ml and 1.25 micrograms/ml, respectively. These results suggest that no resistance or reduced susceptibility to bifonazole has emerged among clinical isolates of dermatophytes since the development of the drug.

[Fundamental and clinical studies on the efficacy of bifonazole in patients with tinea pedis at 10 years after approval. Part 2. Clinical evaluation].

The usefulness of bifonazole (Mycospor), a topical imidazole antifungal agent approved 10 years ago, was evaluated for the treatment of tinea pedis. Mycospor cream was applied by 141 patients with tinea pedis once daily for 4 233ks, and the clinical efficacy and adverse reactions (as well as any correlations with susceptibility of isolates and the mycological activity of the agent against these isolates) were studied. The results were then compared to those of a previous study. The following results were obtained. 1. Mycological activity Mycological examination results became negative in 63.2% (36/57) of the patients with plantar tinea pedis, in 94.1% (32/34) of those with interdigital tinea pedis, and in 74.7% (68/91) of all tinea pedis patients. 2. Mycological activity and MIC No correlation was found between the MICs of bifonazole against the pathogenic fungi and the rate of eradication on mycological examination. 3. Improvement of symptoms The improvement rates for local symptoms were 82.5% for plantar tinea pedis, 85.7% for interdigital tinea pedis, and 83.7% for all tinea pedis. 4. Clinical efficacy Good clinical efficacies were found in 61.4% of the patients with plantar tinea pedis, in 88.6% of those with interdigital tinea pedis, and in 71.7% of all patients. 5. Safety Regarding adverse reactions, what seemed to be contact dermatitis was reported in 5 out of 127 cases (3.9%). The reaction decreased or disappeared in all cases. 6. Usefulness Mycospor was found to be useful in 64.9% of patients with plantar tinea pedis, in 88.6% of those with interdigital tinea pedis, and in 73.9% of all tinea pedis patients. 7. Comparison with former results The results obtained in the present clinical study were comparable to those obtained in patients with tinea pedis treated in a double-blind comparative study conducted during the development of as a new topical antifungal agent. From the above results, Mycospor cream was confirmed to be still useful, although it has been used widely for the topical treatment of cutaneous mycoses in the past 10 years since its approval.

Difference in clinical features and HLA antigens between familial and non-familial vitiligo of non-segmental type.

Of 131 patients with non-segmental vitiligo studied, 29 (22%) had a family history of this disorder. The clinical features and HLA antigens were assessed, and a comparison made between patients with familial and those with non-familial, non-segmental vitiligo. Familial patients developed skin lesions significantly earlier than non-familial patients. There was a significant association between HLA-B46 and familial non-segmental vitiligo, whereas HLA-A31 and CW4 were found in non-familial patients. The differences in clinical features and HLA phenotypes suggest heterogeneity in the pathogenic process between familial and non-familial vitiligo patients.

Successful differentiation of Spitz naevus from malignant melanoma by microfluorometric analysis of cellular DNA content.

Two cases of presumed Spitz naevus, whose diagnosis on clinical and histological grounds was uncertain, were examined for cellular DNA content using the technique of DAPI-DNA microfluorometry. They were compared with 20 cases, respectively, of clinically and histologically confirmed, Spitz naevus, malignant melanoma and acquired pigmented naevus. The two Spitz naevi showed a diploid pattern in a distribution histogram of cellular DNA content. The pattern was similar to that of confirmed Spitz naevi and of acquired pigmented naevi but different from the aneuploid pattern of malignant melanomas. DNA index values of the two cases were within the range of confirmed Spitz naevi and different from those of malignant melanomas. The DAPI-DNA microfluorometric method thus provided confirmatory evidence for the diagnosis of Spitz naevus. The method appears to reflect sensitively the biological behaviour of tumour cells, and is a useful aid to the diagnosis of uncertain Spitz naevi.

[Topographical differences in cellular DNA content between the radial growth phase and the vertical growth phase of superficial spreading melanoma].

The nuclear DNA content of tumor cells was measured during the radial growth (RGP) and vertical growth (VGP) phases of three cases of superficial spreading melanoma. To compare these two phases, the DNA distribution histogram was analyzed and the DNA index was calculated. A aneuploid population appeared histographically in all specimens of VGP; however, no such abnormal population could be detected in RGP. VGP cells contained greater numbers of polyploid cells and had a higher DNA index value than RGP cells in all cases. These findings support Clark's postulation that the appearance of a new clonal cell population contributes to the development of VGP from RGP in malignant melanoma.

Eruptive vellus hair cysts with sebaceous glands.

A patient is described who had eruptive vellus hair cysts with and without sebaceous glands in the cyst walls. An association is suggested between eruptive vellus hair cysts and the condition of steatocystoma multiplex.