Interdigital melanoma simultaneously affecting two neighboring interdigital spaces : First description in the medical literature.

BACKGROUND: Interdigital melanoma, as a subtype of acral lentiginous melanoma, is relatively uncommon in the Caucasian population. It frequently goes unrecognized for a prolonged period of time prior to diagnosis, due to its asymptomatic nature and variable clinical appearance. METHODS: We report the case of a 67-year-old Caucasian woman who presented with interdigital malignant melanoma affecting two neighboring interdigital spaces. It had evolved over a period of more than 15 years and had been initially misdiagnosed as tinea pedis due to the macerated appearance of the lesion and a positive mycologic examination. RESULTS: We highlight the striking involvement of two adjacent interdigital spaces and the neighboring area of the sole of the foot by the tumor. The melanoma was staged as IIIC, with pathologic grading T4bN2bM CONCLUSIONS: The involvement of two adjacent interdigital spaces is unusual and, to our knowledge, has not been previously highlighted in the medical literature. It may be explained, in part, by the longstanding nature of the lesion in our patient.

Disease and treatment outcome in chronic active hepatitis C with occult HBV infection.

BACKGROUND/AIMS: To evaluate the clinical course and effect of antiviral treatment in chronic active hepatitis C with coexisting occult hepatitis B infection. METHODOLOGY: Basic liver enzymes, histological activity of hepatitis (Ishak score), biochemical and virological response rate at the end of treatment and 6 months later of 30 patients (15 of them positive for hepatitis B core antibody in serum) with chronic active hepatitis C are compared. All patients were treated with Interferon alpha-2b 3ME three times weekly and oral Ribavirin 1000/1200 mg daily for six months. RESULTS: The pure hepatitis C group demonstrates markedly higher biochemical and histological (necroinflammatory) activity. After treatment the pure hepatitis C group shows normalization of serum ALT in 73% (vs. 66% in hepatitis B core antibody-positive patients); loss of detectable HCV-RNA in serum in 47% (vs. 35%) and sustained biochemical response 6 months later in 28% vs. 40% respectively. CONCLUSIONS: Patients with circulating hepatitis B core antibodies might develop some degree of immune tolerance against hepatitis C virus, with less advanced hepatolysis and necroinflammation even in the presence of HCV viremia and worse virological therapeutic response, associated with frequent sustained ALT normalization.