Subcutaneous sarcoidosis: a case series from a single center.

BACKGROUND: Sarcoidosis is a multisystemic granulomatous disease which not only affect the skin but can also involve the lymph nodes, eyes, and lungs. Subcutaneous sarcoidosis (SCS), is a rare form of sarcoidosis which is generally more prevalent in women in their 40s and 50s, characterized by subcutaneous, flesh-colored nodules, mostly localized on the limbs. A retrospective study to investigate clinical features and response to treatment in patients affected by SCS. METHODS: All patients with systemic and/or cutaneous sarcoidosis visited in our clinic hospital between 2012 and 2022. Out of this group, clinical features, and management of SCS patients were analyzed. RESULTS: Out of 102 patients with specific lesions of cutaneous sarcoidosis, with or without systemic involvement, 13 (13%) were diagnosed with SCS. CONCLUSIONS: Our study confirms that systemic involvement in SCS is the prevalent finding as expected. Moreover, SCS patients have a relatively good prognosis, and systemic treatment does not differ from first-line therapies for cutaneous sarcoidosis.

Cutaneous complications of immunosuppression in 812 transplant recipients: a 40-year single center experience.

BACKGROUND: As a consequence of the improvement in survival after solid organ transplantation, to visit transplant recipients with neoplastic and non-neoplastic skin disorders due to immunosuppressive treatment has become common for dermatologists. METHODS: Our endpoints were: 1) to investigate the most common skin diseases in a population of transplant recipients; 2) their associations with the type of immunosuppressant or transplant received; and 3) to compare our single center 40-year experience with the literature data. We retrospectively analyzed the clinical details of the adult patients transplanted in the years 1974-2014, visited for consultation at the Unit of Dermatology of our hospital. RESULTS: Pathologic conditions were observed in more than 3/4 of 812 adults during the follow-up (mean 12.1 years): nonmelanoma skin cancers or actinic keratoses were seen in 44.0% (N.=357) of patients, non-neoplastic events in 55.2% (N.=448). Heart transplant had the statistically significant highest rate of NMSC and AK (52.6%, P=0.0352). Patients receiving cyclosporine A developed at least one non-melanoma skin cancer or actinic keratosis in 57.7% of cases (P=0.0001), while tacrolimus showed a lower risk (33%, P=0.0001). CONCLUSIONS: As transplant recipients are susceptible to skin changes, especially after immunosuppressant treatments, a dermatological follow-up should be scheduled for each patient.

Sequential monitoring of pigmented lesions during dabrafenib treatment: a prospective study and a literature overview.

BACKGROUND: Targeted therapies in melanoma have shown clinical benefit in incrementing the overall survival of metastatic patients. However, cutaneous adverse events have been frequently associated with these drugs. METHODS: We report our experience in the management of patients treated with dabrafenib for metastatic melanoma, focusing on the monitoring of pigmented lesions. Dermatologic evaluation was performed during the first visit, at the start of each treatment and subsequently after every four weeks. Global nevi count, videodermoscopy of suspected lesions, and surgical excisions when necessary were performed at the beginning of the treatment and every fourth week. All other cutaneous adverse events (cAEs) were noted and documented. Eleven patients were included. RESULTS: The most important cAEs included palmo-plantar hyperkeratosis, diffuse xerosis and pigmented lesion changes. Regarding the latter, in 6 patients, especially in the first months of treatment, we observed hyperpigmentation and hyperkeratosis of the nevi, of the pigmented mucosae and, in one patient, hyperkeratotic changes on a cutaneous metastasis. Histopathology of the excised lesions showed one ex novo melanoma occurrence and benign changes to pre-existing nevi. CONCLUSIONS: The awareness of the importance of sequential monitoring of pigmented lesions, with particular attention to the lesions of new onset, is crucial for the best management of these complex patients.

Acral melanoma: correlating the clinical presentation to the mutational status.

Acral lentiginous melanoma (ALM) is the most common type of malignant melanoma (MM) in Asians, Afro-Americans and Middle-Easterners. It represents 1.5-10% of all MM cases, being the most common histological type of MM arising on palms, soles and nail apparatus, which is more generically defined as acral MM. To date no risk factors have been officially established, however a history of trauma may be involved in the pathogenesis of acral MM. This shows heterogeneous clinical features and frequently presents with advanced stage and aggressive behavior, often as a result of misdiagnosis or delayed identification. Dermoscopy is helpful for an early diagnosis of ALM: the most characteristic dermoscopic patterns are the parallel ridge and the irregular diffuse pigmentation. On histopathology ALM displays a lentiginous growth pattern, with melanocytes arranged as solitary units along the basilar epidermis, without notable pagetoid growth in the early stage. Not all acral MMs present a lentiginous pattern: superficial spreading melanoma and nodular melanoma patterns are also possible. Novel studies investigating the biologic characteristics of acral MM reported variable results: the overall mutational rates ranged respectively between 8.5% and 23% for KIT, between 3.6% and 33.3% for BRAF and between 3% and 47% for NRAS in ALMs. Increasing attention has been recently given to other genes, such as telomerase reverse transcriptase, platelet-derived growth factor receptor alfa and cyclin D1. Larger molecular investigations urge to describe the molecular profile of acral MM, to allow the development of specific targeted therapies.

A single institute's experience on melanoma prognosis: a long-term follow-up.

BACKGROUND: The prognosis of cutaneous melanoma is correlated to histopathologic parameters such as Breslow thickness, the presence of mitosis, ulceration and lymphatic involvement at the moment of the diagnosis. On the other hand, the prognostic value of parameters such as age, sex, and tumor localization are still a matter of debate. We evaluated herein the prognostic factors in melanoma patients during a long-term follow-up (60 months). METHODS: Melanoma patients presenting stage IB-III at diagnosis were included. Breslow thickness, ulceration, lymphatic involvement, patients' age, sex and tumor localization were correlated to patients' prognosis. Univariate Cox regressions and multivariate Cox proportional-hazards regression were performed. Successively, Kaplan-Meier was used for variables significantly associated with overall melanoma survival. RESULTS: A total of 115 melanoma patients were included in this study. During follow-up 82 (72.17%) patients survived and 33 (28.7%) died. In our dataset, Breslow thickness >2 mm (P=0.0007), patients age >50 years (P=0.005) and positive sentinel lymph node (P=0.0003) seem to be the most important variables correlated with the presence of metastases at 5 years follow-up. However distant metastases were also observed during follow-up in 14/26 patients presenting negative sentinel lymph node at diagnosis. CONCLUSIONS: Given the vital importance of target drugs and the newly introduced immunotherapies in cutaneous melanoma management, we would suggest that mutational analyses should also be extended to the subgroup of patients presenting microstaging parameters related to a poor prognosis in a long-term follow-up of 60 months.

Oral pigmentation in physiologic conditions, post-inflammatory affections and systemic diseases.

Melanocytes are found throughout the oral mucosa but usually go unnoticed because of their relatively low level of pigment production. When focally or generally active in pigment production or proliferation they may be responsible for several affections in the oral mucosae ranging from physiologic pigmentation, systemic diseases to malignant neoplasms. The diagnosis of oral pigmentations (OP) is usually challenging for the physician, but a careful examination of the oral cavity may reveal the first manifestation of underlying systemic diseases. Therefore, a full medical history (including drug assumption and smoking) together with a general dermatological examination are mandatory and represent the first approach to OPs. When the diagnosis cannot be reached clinically with enough certainty, a biopsy for histological examination is needed, also in order to exclude possible life threatening conditions such as melanoma. Dermoscopy is another reliable diagnostic tool to make a differential diagnosis between melanocytic lesions and other conditions and then to manage the follow-up of patients. Few papers on the subject have been published in the dermatological literature and the oral cavity is often poorly investigated during routine dermatological examinations. We therefore decided to perform a review of benign OPs, classifying them into diffuse (physiological/racial pigmentations, smoker's melanosis, drug-induced hyperpigmentation, post-inflammatory hyperpigmentation, black hairy tongue, OPs associated to systemic diseases) and localized (amalgam tattoo, melanocytic nevi, melanoacanthoma, melanosis) lesions.