IgG4 subclass in malignant melanoma.

Three hundred and ninety-seven sera from 185 melanoma patients were studied. These sera were classified into three groups according to stage of disease. An alteration in the level of the IgG4 subclass was found. It was related to the dissemination of disease. The percentage of abnormalities (either increased or decreased levels of IgG4) was more frequent in patients with stage II and III diseases (55 and 53%, respectively) than in patients with stage I(19%). The higher frequencies of high titers of IgG4 were essentially detected in advanced disease. The biologic significance of the increase of IgG4 in melanoma remains obscure. The increase may be related to the development of facilitating antibodies of the IgG4 subclass.

Immunoelectron microscopy of type III collagen in normal and scleroderma skin.

Normal and scleroderma skin was studied by indirect immuno-electron microscopy with specific antibodies against Type III collagen. Fine collagen fibrils, 200-400 A in diameter were labeled with antitype III collagen antibodies. These antibodies attached to the collagen fibril forming rings with a 650 A periodicity. Fibrils with more than 600 A in diameter were only labeled with antitype I collagen antibodies. Type III collagen was found around small blood vessels, adipocytes and smooth muscle cells, thus, corresponding to the distribution of reticulin.

Preclinical and clinical evaluation of topical acid products for skin tumors.

Distinct differences between topical acid preparations can be detected by simple preclinical and clinical pharmacologic models designed to evaluate potential utility in the treatment of superficial skin tumors. The models distinguish a tissue-dissolving (ulcerating) effect from a tissue-fixation (mummifying) effect, as reflected by a distinct and lasting discoloration of hair in vitro or the skin surface in vivo. Double-blind clinical comparison of the response to different preparations of matched pairs of small superficial skin tumors in 33 subjects demonstrated for greater utility for nitric acid preparations of appropriate strength (6 to 7N), with added oxidizable organic acids, over the mineral acid alone. The nitrate reduction products generated in such preparations markedly speed up discoloration in the models and apparently contribute to the improved clinical utility of the topical treatment by enhancing the speed and intensity of tissue fixation, but not tissue erosion. The architecture of lesions eradicated by such mixtures is generally adequately preserved for histologic diagnosis of the extruded tissue.

Validity of the histopathological criteria used for diagnosing dysplastic naevi. An interobserver study by the pathology subgroup of the EORTC Malignant Melanoma Cooperative Group.

Ten (dermato)pathologists studied 50 cutaneous melanocytic lesions including common naevocellular naevi, dysplastic naevi (DN), melanomas in situ and invasive primary melanomas, with emphasis on the histological criteria of DN. Using a standardised form, 20 defined histopathological features were scored (semi)quantitatively. Concordance of diagnosis, efficacy and reproducibility of features were investigated. DN were distinguished well from the other entities (mean Po 0.87). Agreement on the degree of atypia of DN was low. The reproducibility of the scoring was best for the following features: irregular nests, lymphohistiocytic infiltrate, marked junctional proliferation and large nuclei. The overall values of these features to discriminate between DN and non-DN were better than for the other features studied. Using the presence of at least three of the four features as a condition for the diagnosis of DN, values for sensitivity, specificity and positive and negative predictive values were 0.86, 0.91, 0.96 and 0.73, respectively. On the basis of the results these features seem best suited as histological criteria for the diagnosis of DN.

Recreational exposure to sunlight and lack of information as risk factors for cutaneous malignant melanoma. Results of an European Organization for Research and Treatment of Cancer (EORTC) case-control study in Belgium, France and Germany. The EORTC Malignant Melanoma Cooperative Group.

This study addressed the impact of exposure to ultraviolet radiation on the risk of cutaneous malignant melanoma (CMM), as well as the behavioral components at stake in its occurrence. We performed a one-to-one unmatched case-control study among subjects aged 20 years or more with naturally non-pigmented skin in Germany, France and Belgium. Four-hundred and twenty consecutive patients with CMM diagnosed from 1 January 1991 on were derived from hospital registries; 447 controls were chosen randomly in the same municipality as cases. Subjects unaware of the dangers of exaggerated exposure to sunlight display an estimated CMM risk of 3.72% (95% confidence interval 2.63-5.26). The number of holiday weeks spent annually in sunny resorts and sunbathing during the hot hours of the day are strong risk factors in the three countries, but not the number of years spent outdoors, as farmers or building workers. Multiple logistic adjustments on the host characteristics increases the CMM risk associated with recreational exposure to sunlight, as well as the adjustment on the unawareness of the dangers of exaggerated exposure to sunlight. Recreational exposure to sunlight and sunburn early in life seem capable of fostering the proliferation of pigmented lesions of the skin. Our data support the hypothesis that most CMM develop from pigmented lesions of the skin containing initiated melanocytes, and that the cell proliferation due to brutal, intermittent exposures to solar radiation amplifies the likelihood of a melanocyte entering into a malignant process.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intraepidermal melanocytic proliferation. A practical guide to the classification of ambiguous melanotic skin lesions and of possible precursors of malignant melanomas]. / Les prolifeérations mélanocytaires intra-épidermiques. Guide pratique de classification des lésions mélaniques cutanées ambigués et de quelques précurseurs possibles des mélanomes malins.

A group of senior Pathologists engaged in review work on international randomized trials for the W.H.O and/or the E.O.R.T.C., propose a new simplified classification of melanocytic lesions with an intra-epidermal component, applicable in routine. This classification attempts to introduce standards to permit morphological identification of a large group of intra-epidermal melanocytic proliferations with three classes of atypia (slight, mild, severe) and group of malignant melanomas especially those without dermal invasion. The new definitions and objective criteria (at cytological and architectural level) of diagnosis are given with examples of equivalence between some established entities and this new universal terminology.

[Establishment of a 2-stage prognostic classification of primary malignant melanoma derived from a multidimensional analysis and from an agreement study]. / Etablissement d'une classification pronostique en 2 stades du mélanome malin primitif à partir d'une analyse multidimensionnelle et d'une étude de concordance.

Slides of 198 patients with primary malignant melanoma have been reevaluated independently by three pathologists; considered parameters were histologic type, Clark's level and tumor thickness. The agreement between pathologists is excellent, especially for histologic type and thickness. The use of the Cox's regression model, dealing with disease free interval as response criterion, shows that the main prognostic factor is tumor thickness, whatever the pathologist. A prognostic staging is thus proposed, based only on the tumor thickness, less than 2 mm, greater than 2 mm. The prognostic value of this staging is confirmed on a new sample of 145 patients. This classification is used as decision tool in a new randomized clinical trial.

[Histology and physiology of black skin]. / Histologie et physiologie de la peau noire.

The aim of this article is to review the experimental knowledge concerning black skin. We point out its histological and physiological features without discussing here the specific pathology of black patients. Under the microscope skin structure is roughly the same in all races, but morphological differences exist, particularly within the epidermis, with potential practical consequences. In comparison with white skin, the black skin stratum corneum is equal in thickness but more compact: about twenty cell layers are observed in blacks versus sixteen layers in whites. The lipid content of black epidermis is also somewhat higher, and this perhaps explains the greater cellular cohesion, hence the difficulty in stripping off the black horny layer. These findings could also explain a slightly inferior permeability of black skin to certain chemicals. The hair of blacks in naturally more brittle and more susceptible to breakage and spontaneous knotting than that of whites. The kinky or wooly form of black hair, the weak intercellular cohesion between cortical cells and the specific hair grooming practices among black people account for these effects. The higher electrical resistance of black skin suggests that the black epidermis would be less hydrated than white epidermis. Anatomically, the amount of sweat glands in black and white skins is identical and varies with climatic changes but not with racial factors. Likewise, sweating is thought to be similar in both races, taking into account the contradictory results from studies, but black subjects withstand humid heat better while whites cope better with dry heat.(ABSTRACT TRUNCATED AT 250 WORDS)

[Dermatologic risks of quartz-halogen lamps]. / Risques dermatologiques des sources quartz-halogène.

Halogene sources are used increasingly in general illumination. Their quartz envelop is technically necessary, but presents the disadvantage of to letting the emitted UVA, UVB and UVC go through. Originally used as in indirect lighting, they have been introduced as desk-top lamps, without filter. We have proceeded to the verification of their output with a spectrophotometer calibrated by actinometry and we have calculated their relative erythemal efficacy according to the Parrish's action spectrum for human erythema. We found that, at 10 cm from the human skin, the irradiance was able to induce a minimal erythema in about 10 minutes on clear back skin. At working distance (50 cm), a barely perceptible erythema could be observed on the back of the hands after 8 consecutive hours working. We also found that sunburn cells were present in the skin sensitized with a potent phototoxic agent (8-methoxypsoralen) applied 15 minutes before a 4-6 minutes irradiation with the halogen source (at 20 cm), thus, indicating a potential risk for local phototoxicity and photoallergy. The cumulative doses per year, for 4 hours exposure per day, five days a week, reaches 125 minimal erythemal doses, equivalent to the average yearly exposure of individuals for work and leisure. If one assumes that this regimen is maintained for 30 years, the risk for induction of skin cancers on the dorsal aspect of the hands and the forearms, may be increased by a 3.4 factor, according to the widely accepted previsional models.(ABSTRACT TRUNCATED AT 250 WORDS)

[Melanocytes in epiloia; ultrastructural aspects (about 7 cases) (author's transl)]. / les mélanocytes dans l'épiloïa; aspects ultrastructuraux (a propos de 7 cas).

Hypopigmented macules of epiloia have been studied by photonic and electron microscopy in 7 cases. The number of melanocytes was not decreased but these cells were hypotrophic and had a low tyrosinae activity. The melanosomes were smaller in size and their maturation rate was greatly reduced; many abnormal round and granular melanosomes, phaeomelanosome-like, were observed. In one case, such abnormal melanocytes were also occasionally found in normally pigmented control skin.

[Clinical and mycological study of 11 cases of genitopubic trichosporosis nodosa (white piedra)]. / Etude clinique et mycologique concernant 11 cas de trichosporie noueuse (piedra blanche) génito-pubienne.

Piedra (stone in Spanish) is the name given to a trichomycosis characterized by the formation of nodules resembling small stones. There are two varieties of the disease, depending on the colour of the nodules: white piedra and black piedra. Black piedra sharply differs from white piedra on three main scores: a) the causative agent is a black filamentous and sexed dematicious fungus, Piedraia hortai; b) the disease exclusively affects the scalp, and c) the geographical distribution of human black piedra is limited to tropical and subtropical areas (South America, South-East Asia). White piedra has a different aetiology, being caused by an asexual fungus, Trichosporon beigeli. The genus Trichosporon (Behrend, 1890) and the species T. beigeli (Vuillemin, 1902) were created from a case of piedra of the moustache. White piedra may involve hairy regions other than the scalp, such as the beard and moustache, less frequently the armpits, eyebrows, eyelashes and pubic hair. The disease has been observed in all continents, except Africa, and under all climates, although it is exceptionally found in cold areas (two indigenous cases in Finland). The observatio princeps of white piedra (on a false chignon) was published in 1865 by Beigel, in London. In France, only three cases, all concerning the moustache, were reported at the very beginning of this century No other case has been published in that country in the east 80 years. T. beigeli is a common saprophyte in nature. It has been found in soil, water, fruit, rotten vegetables, sawdust, as well as in man (skin, skin appendages, mucosae) and in animals (mammals, insects, mussels).(ABSTRACT TRUNCATED AT 250 WORDS)

[Haber's syndrome. First French family (2 cases)]. / Le syndrome de Haber. Première famille française (deux cas).

Haber's syndrome is a genodermatosis first described by Sanderson and Wilson (17) in 1965. Pursuing Dr. Haber's work, these authors reported three cases from one single family presenting with the dermatosis. A second family was reported by Seiji and Otaki (17) in 1971; Izaka described two cases (pedigree unknown, 13) and two more by Kikuchi (10, 13) in 1981 and 1983. We report here two new cases (brother and sister) discovered in 1984 (7) and representing the first French family. The dermatosis is characterized by clinical, genetic and histological criteria. It is transmitted as an autosomal dominant trait (fig. 1 and 2). Clinically, the face is affected by a rosacea-like dermatitis beginning in childhood and proceeding with pustular flare-ups. The facial lesions are frequently aggravated by exposure to the sun. The patients have pigmented keratotic lesions of the trunk resembling seborrhoeic warts. These lesions are very numerous and begin, on average, during the second decade of life. Some patients present with lesions that are diagnosed as Bowen's disease at histological examination (7, 17). Xerosis cutis is also present. Microscopically, the facial lesions consist of a necklace of basaloid cells around the hair and sebaceous follicles. The keratotic lesions have been reported as either intra-epidermal epitheliomas (17), or seborrheic warts without signs of malignancy (7, 10, 13), or equivalents of the facial lesions (19).

[Urinary evaluation of 5-S-cysteinyldopa and seric evaluation of IgG4 subclass during follow-up of 27 primitive malignant melanomas (author's transl)]. / Dosage urinaire de la 5-S-cystéinyldopa et dosage sérique de la sous-classe IgG4 au cours de la surveillance de 27 cas de mélanomes malins primitifs.

27 patients with SSM or NM level IV and V have been submitted to a monthly evaluation of their level of 5-S-cysteinyldopa in the urine and IgG4 subclass in their sera. For 5 patients who entered the stage II of their disease during the follow-up, 3 had elevation of the 5S and 5 had large variations of IgG4. On 21 patients in clinical remission, 10 had conjunctly an increase of 5S and variations of IgG4. The predictional value of these tests is discussed.

[IgG levels in the sera of melanoma patients (author's transl)]. / Etude des IgG dans les sérums des sujets porteurs de mélanomes.

397 sera from 185 melanoma patients have been tested. We classified our subjects into three groups, according to the stage of disease. An alteration of the level of IgG 4 sub-class was found and related to the extension of the disease. The percentage of abnormalities was more frequent in stage II and III (55 p. 100 and 53 p. 100) than in stage I (19 p. 100). High titers of IgG 4 subclass were essentially detected in advanced disease. The biological significance is discussed.

[IgG levels in the sera of melanoma patients (author's transl)]. / Etude des IgG dans les sérums de sujets porteurs de mélanomes.

397 sera from 185 melanoma patients have been tested. We classified our subjects into three groups, according to the stage of disease. An alteration of the level of IgG4 subclass was found and related to the extension of the disease. The percentage of abnormalities was more frequent in stage II and III (55 p. 100 and 53 p. 100) than in stage I (19 p. 100). High titers of IgG 4 subclass were essentially detected in advanced disease. The biological significance is discussed.

[Biological effects of solar radiations]. / Les effets biologiques des radiations solaires.

Main biological effects of ultra-violet radiations are discussed. At a dermatological point of view, most of these effects are harmful: actinic erythema, cutaneous cancerogenesis (basal and spinous cell carcinomas, malignant cutaneous melanomas). Photo-immunosuppression and photoaging of the skin are discussed. Two benefic actions of sunlight are reviewed: synthesis of vitamin D3 and positive action of visible radiations on human psychism.

Light-emitting diodes (LED) for domestic lighting: any risks for the eye?

Light-emitting diodes (LEDs) are taking an increasing place in the market of domestic lighting because they produce light with low energy consumption. In the EU, by 2016, no traditional incandescent light sources will be available and LEDs may become the major domestic light sources. Due to specific spectral and energetic characteristics of white LEDs as compared to other domestic light sources, some concerns have been raised regarding their safety for human health and particularly potential harmful risks for the eye. To conduct a health risk assessment on systems using LEDs, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), a public body reporting to the French Ministers for ecology, for health and for employment, has organized a task group. This group consisted physicists, lighting and metrology specialists, retinal biologist and ophthalmologist who have worked together for a year. Part of this work has comprised the evaluation of group risks of different white LEDs commercialized on the French market, according to the standards and found that some of these lights belonged to the group risk 1 or 2. This paper gives a comprehensive analysis of the potential risks of white LEDs, taking into account pre-clinical knowledge as well as epidemiologic studies and reports the French Agency's recommendations to avoid potential retinal hazards.