Merkel cell polyomavirus strains in patients with merkel cell carcinoma.

We investigated whether Merkel cell carcinoma (MCC) patients in France carry Merkel cell polyomavirus (MCPyV) and then identified strain variations. All frozen MCC specimens and 45% of formalin-fixed and paraffin-embedded specimens, but none of the non-MCC neuroendocrine carcinomas specimens, had MCPyV. Strains from France and the United States were similar.

[Recognition and initial management of melanoma by general practitioners: A survey in a rural French area with low medical density]. / Reconnaissance et prise en charge initiale du mélanome par des médecins généralistes : enquête dans un département rural à très faible densité médicale.

INTRODUCTION: Cutaneous cancers are very common, easily visible on skin. The general practitioner (GP) is in the front line to manage the lesions. He has to recognize malignancy and refer most often to the specialist for excision, or consider that the lesion is benign and in ambiguous cases, offer clinical monitoring. The current low medical density in the Centre Val de Loire area makes access to general practitioners (GP) and dermatologists harder. The aim of this study was to evaluate GPs' everyday practice in cutaneous cancers screening in general, and particularly in melanoma screening, in a rural region of France. METHODS: We sent a questionnaire on November 24th 2015 to all GPs of the Cher department (204 questionnaires), to assess their knowledge and practice of melanoma. The questionnaire comprised 2 parts: the first part was composed of 23 items with a majority of questions focused on melanoma and the second part consisted of clinical cases including 5 benign cutaneous tumors, 4 melanomas and 1 pigmented basal cell carcinoma. GP's were asked to answer in each case: diagnosis, degree of certainty (from 0 to 10), practical attitude (excision, referral to dermatologist or surgeon or surveillance). Their answers were anonymous. The primary endpoint was whether medical decision regarding each case was appropriate, i.e. removal of malignant lesion or referral for removal, and reassurance or surveillance in benign lesions. RESULTS: The response rate was 35% (72 responses). Thirty-eight GPs (53%) had an appropriate management facing the 5 malignant lesions, 18 GP (25%) had an appropriate management in 4 out of 5 cases. The ABCDE rule was known by 58% of responders, the ugly duckling sign of 19%. GPs did not feel comfortable with melanoma: on a growing scale (from 0=not comfortable at all to 10=very comfortable) the average was 4.2 with a median at 5 (range 0-10). They expressed a strong need for training on this topic: on a scale increasing from 0 to 10, the average was 7.9 for a median to 8 (range 3-10). Knowledge about melanoma risk factors, and the level of ease dealing with screening of melanoma was not significantly associated with a better management. The main difficulties were lack of time and the increasing difficulty of access to dermatologist. Fast and easy access by teledermatology was solicited by 89% of GPs. CONCLUSION: GPs had often appropriate management of skin cancer. The major obstacles to skin's cancer screening were the lack of time and difficult access to dermatologists. The setting-up of an easier access with teledermatology was requested by 89% of responders, and should improve early detection of melanoma.

Locoregional multiple nodular panniculitis induced by Pseudomonas aeruginosa without septicemia: three cases and focus on predisposing factors.

IMPORTANCE: Pseudomonas aeruginosa-induced locoregional multiple nodular panniculitis without septicemia is an underreported condition, with only 3 cases reported to date. We report 3 new cases of P aeruginosa-induced multiple nodular panniculitis without septicemia and describe common features among all 6 cases, thus providing the first description, to our knowledge, of the natural history and potential predisposing factors for this entity. OBSERVATIONS: Median age of the 6 patients was 74 years (range, 54-84 years). Patients had inflammatory nodules on a lower limb (n = 6) that were unilateral (n = 6) and had no fever (n = 5). Blood cultures were negative (n = 5). Skin biopsy specimens revealed panniculitis (n = 5), with skin cultures positive for P aeruginosa (n = 6). Skin nodules resolved with systemic antibiotics (n = 5). The comorbidities recorded were type 1 or 2 diabetes mellitus (n = 5), overweight (n = 3), and combined locoregional anatomical changes in the lower limbs (n = 5). Local skin injury, which constituted the portal entry, was present in all cases, especially leg ulcers (n = 3). CONCLUSIONS AND RELEVANCE: We describe P aeruginosa-induced locoregional nodular panniculitis as a distinct entity. This should be investigated in elderly, diabetic, overweight patients with inflammatory nodules on a lower limb associated with locoregional anatomical changes and skin injury, with the optimal antibiotic regimen introduced as rapidly as possible.

[Diseases seen during a hospital consultation of nail diseases: prospective study]. / Motifs de consultation thématisée de maladie unguéale : étude prospective.

OBJECTIVE: Purpose of our study was to specify type of diseases seen during a hospital consultation of nails diseases. In our knowledge, no study on the subject was until published. METHODS: Study was realized in a forward-looking way during a period of 1 year between 13/09/2007 and 18/09/2008. It was realized in dermatology department at Orleans, during the consultation specialized in nail pathology (weekly vacation). RESULTS: One hundred and thirty-six patients were included in the study: 60.3% (82) was women. Average age was 47.9 years (extremes: 8-92 years). In all, 24.3% (33) of patients were sent by dermatologist, 8.1% (11) by hospital doctor, 2.1% (3) by pedicurist. Nail diseases observed were: ingrowing toenails: 36.8% (50 patients), onychomycoses: 31.6% (43 patients), traumatic or frictional nail lesions: 11.7% (16 patients), longitudinal mélanonychies: 8.1% (11), benign tumors: 5.1% (7 patients), nail psoriasis: 5.1% (7 patients), lichen: 1.5% (2 patients). DISCUSSION: Patients seen during this consultation were of all age, with a clear feminine ascendancy (probably connected to aesthetic embarrassment). A significant number of patients were sent by dermatologist (24.3%) or hospital doctor (8.2%): it is a consultation of expertise. Ingrowing toenails and onychomycoses were the most frequent motives for consultation, these correspond to nail pathologies the most frequent in general population.

[Interest of emergency dermatological consultation in a regional hospital]. / Intérêt d'une consultation dermatologique d'urgence dans un centre hospitalier régional.

INTRODUCTION: Dermatologists, both as hospital and as resident practitioners, are often requested to see emergencies of their discipline, although appointment planning are already fully booked months in advance. Orleans Regional Hospital (ORH) has opened a department of dermatological emergency consultation to try to help with this issue. A prospective, descriptive and consecutive study on patient characteristics was conducted during its first year operating. METHOD: In September 2011, we opened a department of dermatological emergency consultation. Reception is skin disorders evaluated by physicians or nurses as "emergencies", according to predefined criteria. Follow-up visits are performed in the afternoon. RESULTS: Within one year, 2209 medical visits were conducted, with an average of 8,7 emergency visits per day. The maximum numbers of patients treated by our dermatological emergency unit in one single morning was 19. Mondays were the busiest day of the week. The average age of a patient attending the department was 33 years, with 29% of pediatric patients (under 15 years old). The majority of patients presented spontaneously (43%), or were referred by general practitioners (25%). Adult and pediatric emergency departments sent 8% of patients. The two main reasons for consultation were rash (48%) and pruritus (16%). Diagnoses observed were mainly infections (24%) and eczema (14%). Scabies accounted for 9% of all diagnoses. In the aftermath of an emergency dermatological consultation, 84 patients were hospitalized, including 74 in the dermatology department of Orleans hospital totalling 505 days of hospitalization. CONCLUSION: The value of a dermatological emergency consultation is well demonstrated in areas where more medical services are available (such as cities with University hospitals available). It is even more justified in areas with a deficit of healthcare service availability such as Central France.

High levels of antibodies against merkel cell polyomavirus identify a subset of patients with merkel cell carcinoma with better clinical outcome.

PURPOSE: A new human polyomavirus, Merkel cell polyomavirus (MCV), was identified in 2008 in tumor tissue of patients with Merkel cell carcinoma (MCC), a relatively rare human skin cancer. In this study, we investigated patients with MCC and controls for the presence of antibodies against MCV and their association with clinical characteristics. PATIENTS AND METHODS: Antibodies against MCV were investigated by enzyme-linked immunosorbent assay in 68 patients with MCC and 82 controls using VP1 virus-like particles produced in insect cells. RESULTS: Antibodies against MCV were detected in all patients with MCC and in 85% of controls. However, high antibody titers (> 10,000) were rarely observed in controls (7.3%) and they were detected in 64.7% of patients with MCC (P < .001) in contrast to the absence of VP1 expression in tumor samples. In addition, the geometric mean titer of anti-MCV in patients with MCC was around 14 times higher than that observed in MCV-positive controls (P < .001) and was not correlated with tumor viral load. High antibody titers were not found to be associated with any subject or tumor characteristics, but better progression-free survival was observed in patients with high antibody titers (hazard ratio, 4.6; 95% CI, 1.7 to 12.2; P = .002). CONCLUSION: High titers of MCV antibodies in a much higher proportion of patients with MCC than in controls confirmed the association between MCV infection and MCC. The findings also indicated that a better progression-free survival occurred in patients with high MCV antibody titers and suggested that there are at least two distinct etiologic causes of MCC.