[The Mosan Study Group of Pigmented Tumours facing toward the oligometastatic cutaneous melanoma]. / Le Groupe Mosan d'étude des Tumeurs Pigmentaires face au mélanome cutané oligométastatique.

The oligometastatic melanoma is a peculiar stage of cancer progression which is initially restricted to the initial body area. In most instances, only a small number of metastases are simultaneously present. The oligometastatic stage is synchronous when metastases are disclosed at the time of initial diagnosis of the primary cancer. Metastases are metachronous when they are detected after the initial treatment of the primary neoplasm. A variant of the disease is called the smouldering disease when cutaneous metastases grow or regress in unison. The smouldering disease is granted to a condition when some metastases keep grooving when other metastases regress.

Le mélanome oligométastatique est un mode particulier de progression cancéreuse qui se cantonne initialement au territoire de drainage lymphatique du site du cancer primitif. Dans la majorité des cas, un très petit nombre de métastases seraient présentes simultanément. Le stade oligométastatique est synchrone lorsque les métastases sont découvertes au moment du diagnostic initial du cancer primitif. Les métastases sont dites métachrones lorsqu'elles surviennent après traitement initial. Une variante de ce processus, décrite sous le nom de maladie couveuse ou «smouldering disease¼, concerne des lésions métastatiques cutanées qui grandissent et régressent de concert sur ce même territoire.

[Skin carcinogenesis in renal transplant recipients]. / La cancérogenèse dans la peau de patients transplantés rénaux.

Organ transplants are bound to the induction and upkeep of immunosuppression. The immunomodulatory regimen modalities have changed over time with an improvement of the overage graft survival. The effects are also present on the skin and its cancerogenesis which is particularly activated for the squamous cell carcinoma. A review of the recent medical literature reveals the importance of searching squamous cell carcinomas, actinic keratoses, seborrheic keratoses and keratocanthomas before and after organ transplants. The severity of the carcinomas is due to their multiplicity and to the progressive occurrence of more aggressive lesions. Prevention relies on a strict adherence to sun protection after transplantation and on refined immunosuppressive strategies.

Toute greffe d'organe s'accompagne de l'induction et de l'entretien d'un état d'immunosuppression. Les modalités des traitements immunosuppresseurs ont évolué au cours du temps avec une amélioration de la survie des greffons. Les effets se marquent aussi au niveau de la peau et de sa cancérogenèse qui est particulièrement active pour le carcinome spinocellulaire. Un survol de la littérature médicale récente semble indiquer l'importance de répertorier les carcinomes spinocellulaires, les kératoses actiniques, les kératoses séborrhéiques et les kératoacanthomes avant et dans le suivi d'une greffe. La gravité des carcinomes tient à leur multiplicité et à la survenue progressive de lésions biologiquement plus agressives. La prévention des lésions repose sur une protection solaire stricte dès la transplantation et sur l'adoption de stratégies immunosuppressives adaptées.

[New paradigms and metaphors in cutaneous melanoma treatment]. / Nouveaux paradigmes et métaphores du traitement du mélanome cutané.

In recent years, new drugs have been designed for treating advanced cutaneous malignant melanoma, in particular the metastases. They afford modest benefits despite the fact they are commonly heralded as breakthroughs in the lay press and by some medical opinion leaders. Unfortunately, the use of inflated descriptors of the drug efficacy leads to misunderstandings among the clinicians in charge of patients. Currently, vemurafenib, ipilimumab, pembrolizumab and nivolumab have demonstrated their relative activity in the control of advanced malignant melanoma. The results expected from surrogate markers of efficacy are magnified and idealized regarding the expectations from many patients. The recent therapeutic advance improves the median overall survival for a few months. Some combined treatments could possibly boost the current beneficial effects.

Au cours des récentes années, de nouveaux médicaments ont été offerts pour le traitement du mélanome cutané avancé et, en particulier, de ses métastases. Ils apportent des bénéfices qualifiés de modestes par certains malgré leur présentation en tant qu'innovations par divers médias et par quelques médecins et biologistes élevés au rang de leaders d'opinion. Malheureusement, l'emploi de descripteurs inflationnistes de l'efficacité des médicaments entraîne certaines incompréhensions parmi les cliniciens en charge de ces patients. A ce jour, le vémurafénib, l'ipilimumab, le pembrolizumab et le nivolumab ont démontré leurs activités relatives dans le contrôle du mélanome avancé. Le bénéfice escompté par certains marqueurs de substitution de l'efficacité est magnifié et idéalisé par rapport aux attentes de beaucoup de patients. Les avancées thérapeutiques récentes procurent un accroissement de quelques mois à la survie médiane. Des traitements combinés pourraient améliorer le bénéfice dès à présent atteint.

[GAZING INTO A CRYSTAL BALL AND DETECTING SUBJECTS AT RISK FOR DEVELOPING CUTANEOUS MELANOMA]. / REGARDER DANS UNE BOULE DE CRISTAL ET DÉPISTER DES SUJETS À RISQUE POUR LE MÉLANOME CUTANÉ.

Cutaneous melanoma is the deadliest skin cancer showing an increasingly growing incidence in white populations of Europe and United States. Intensive research in recent years has begun to unlock its molecular pathogenesis. Screening the neoplasm at an early stage remains primordial. Hence, targeting populations at risk is likely efficient. In such an attempt, the regular clinical examination benefits from a series of non invasive procedures such as skin surface biopsies, in vivo confocal microscopy, dermoscopy and specular fluorescent light reflectance.

[SPORADIC SKIN MELANOMA BEYOND ITS NORMATIVE CLASSIFICATION. PLEA CONSIDERING ITS EVOLUTIVE CHARACTERISTICS]. / LE MÉLANOME CUTANÉ SPORADIQUE AU-DELÀ DE SA CLASSIFICATION NORMATIVE. Plaidoyer prenant en compte son particularisme évolutif.

For aeons, cutaneous sporadic melanoma, exhibiting either a slow or rapid growth rate, is identified using a set of well defined histopathological criteria. Such diagnostic step is greatly appreciated, and it brings a rough estimate of the probable evolution of the cancer. Some additional assessments try to improve the progressive prognosis of cutaneous melanoma. In this scope, fractals and spectral analyses expect to better perceive the individual progressive characteristics of each tumor. The extent in the tumoral germinative compartment and the peritumoral microvascular network are explored and should in a near future make clear the progressive potential of cutaneous melanoma. The posible tumoral regression and the immune reaction should be better perceived.

[EHLERS-DANLOS SYNDROME OF THE HYPERMOBILE TYPE: A MULTISYSTEMIC DISORDER. CONTRIBUTION OF SKIN ULTRASTRUCTURE TO INDIVIDUAL MANAGEMENT]. / SYNDROME D'EHLERS-DANLOS DE TYPE HYPERMOBILE : UNE ATTEINTE MULTI-SYSTÉMIQUE. Apport de l'ultrastructure cutanée pour une prise en charge personnalisée.

Ehlers-Danlos syndrome (EDS) represents a heterogeneous group of disorders of the connective tissue structure. Currently, several types are distinguished following a limited set of clinical signs and genetic mutations. However, there is a lack of specificity of most recognized genetic alterations with the current clinical typing. In addition, the criteria from dermatopathology, ultrastructure and biomechanics are not considered. In addition, the established EDS frontiers are hazardous because a series of anatomo-clinical signs are not considered in the classical EDS concept. The hypermobile type EDS represents an example of the diagnostic uncertainties. It results that guidelines based on evidence-based medicine cannot be established. Only an individual management can be offered to the concerned patients.

[Hair and their environment]. / Les cheveux et leur environnement.

Hair is influenced by the effects of the daily environment. Some toxic xenobiotics slow down or block the cell renewal of the hair matrix, thus inhibiting hair growth. The ultraviolet light obviously influences the physical structure and physiology of the hair follicle. Tobacco is similarly responsible for negative influences on the evolution of various alopecias. Several cosmetic procedures for maintaining and making hair more attractive are not always harmless, and they occasionally represent a possible origin for alopecia.

[CUTANEOUS INFECTIONS ASSOCIATED WITH HEMATOLOGICAL MALIGNANCIES]. / INFECTIONS CUTANÉES AU COURS DES HÉMOPATHIES MALIGNES.

Patients suffering from a malignant hemopathy represent a population at high risk for cutaneous infections that are potentially severe. Viral, bacterial and mycotic infections of the skin are not rare. Their semiology possibly appears falsely reassuring. Some skin lesions are primary events. Other lesions are secondary following contiguous extension of another deeper location, or represent a sign of septicemia. Taking care of the patient must be precocious and rigorous.

[Dermocosmetology as a support for targeted oncologic treatment]. / La dermocosmétique en appui de traitements oncologiques ciblés.

Some recently introduced targeted treatments in cancerology are responsible for adverse effects on the skin. These events alter the patient well-being. Adequate dermocosmetic management allows to curb the unwanted skin conditions without interfering with the targeted therapeutic effects. However, evidence-based support for using dermocosmetic products as adjunctive cancer treatment remains scarce. It remains nonetheless that the clinical perception is unanimously favourable for such procedure.

[Psoriasis syndrome with its comorbidities]. / Le syndrome psoriasis avec ses comorbidities.

The recognition of a complex disorder associating skin psoriasis and its comorbidities has considerably progressed over recent years. Beyond the skin lesions, psoriatic arthritis, the metabolic syndrome, type II diabetes, cardiovascular disease, inflammatory bowel diseases, and some cancers represent a group of chronic systemic disorders. The process is initiated and sustained by an immunological pathway involving Th1, Th17 and Th22 lymphocytes. The recognition of this complex disorder indicates that the clinical impact of psoriasis is not exclusively limited to the skin only.

[Your patient complains about hair loss. Contribution of a skin biopsy in noncicatricial alopecias]. / Votre patient se plaint d'une perte de cheveux Contribution de la biopsie cutanée dans le diagnostic des alopécies non cicatricielles.

The diagnosis of most alopecia problems is based on the clinical history and a well conducted clinical examination. The additional contributions of dermoscopy, trichoscopy and trichogram are helpful. However, a scalp biopsy is occasionally necessary to establish the correct diagnosis. The main noncicatricial alopecias are represented by androgenetic alopecia, alopecia areata, trichotillomania, traction and pressure alopecia, temporal triangular alopecia, ageing alopecia, loose anagen syndrome, telogen effluvium and anagen effluvium.

[Risking the skin for some joints]. / Risquer sa peau pour quelques ((joints)).

Marijuana, cannabis, hemp designate some plants and their extracts enriched in cannabinoids including change 9-tetrahydrocannabinol (THC). This soft drug exerts psychoactive effects and is responsible for adverse events appearing on the skin, mucosae and eyes. Contact allergic urticaria possibly occurs as well as Raynaud's phenomenon and arteritis resembling Buerger's disease. Glossitis and atrophic stomatitis may be associated with paronditis and uvular angioedema.

[Fibromyalgia: an unrecognized Ehlers-Danlos syndrome hypermobile type?]. / Fibromyalgie: un syndrome d'Ehlers-Danlos de type hypermobile qui s'ignore?

Some patients suffering from fibromyalgia present with clinical signs and alterations in the histopathology, immunohistochemistry and ultrastructure of the dermis similar to the Ehlers-Danlos syndrome, hypermobile type (EDSH). Some types of fibromyalgia possibly represent an undiagnosed EDSH.

[The MAP kianase cascade. A key target for treatments in skin cancerology]. / La cascade des MAP kinases: traitements ciblés en cancérologie cutanée.

Intracellular mitogen-activated protein kinases (MAPK) form a signalling cascade of proteins involved in cell proliferation, differentiation, migration and apoptosis. They are particularly activated by some cytokines, hormones, environmental stress and in skin cancers as well. A series of pharmacological compounds targeting the MAPK cascade dramatically changes skin cancerology, at least during a transient phase of the metastatic process. Some combined treatments possibly increase the median overall survival.

[Cutaneous malignant melanoma: one single disease ?]. / Le mélanome cutané: une seule maladie?

For the media and the public at large, malignant melanoma is the most dreadful cancer of the skin. This statement is obvious. However, some nuances merit to be considered. The clinical presentations, histopathology and molecular genetics point to the fact that malignant melanoma is not a single monolithic pathological condition. Different types of melanomas are distinguished based on distinct origins and contrasted prognoses. The management and information for the patient should be handled individually.

[Virus-induced cancers: interplay between genetics and environment]. / Les cancers viro-induits: interrelations génétique-environnement.

Among cancers diagnosed worldwide on a yearly basis, 20% are thought to be associated with a viral infection. The viruses involved are, by order of decreasing incidence, the hepatitis viruses, the papillomaviruses and the Epstein-Barr virus. These virus-induced cancers generate a high level of interest not only for the study of mechanisms involved in the neoplastic transformation, but also for the set-up of specific immunotherapies including prophylactic and therapeutic antitumor vaccination.

[The thousand and one facets of skin stem cells. The future has found new roots]. / Les mille et un visages des cellules souches multipotentes de la peau. L'avenir a trouvé de nouvelles racines.

Multipotent stem cells of adult skin are found in distinct biological locations identified as niches. These stem cell populations are defined by specific molecular and functional attributes. The epidermal stem cells are found in the interfollicular areas and in the bulge and isthmus of the hair follicles. Dermal stem cells are harbored in the peripilar connective tissue sheaths and in the hair papilla. Some skin stem cells are found in extracutaneous sites. Other stem cells are involved in pathology, such as neoplastic stem cells identified in malignant melanomas.

[Metastatic melanoma: some hope from ipilimumab and vemurafenib]. / Le mélanome métastatique: un vent d'espoir porté par l'ipilimumab et le vémurafénib.

Treating a patient with cutaneous malignant melanoma relies on the recognition of a clever stratification of the distinct stages of the disease. The histoprognostic criteria were recently revisited. In addition, translational research fueled the development of new treatments with at last increased efficacy in the metastatic stage. Such therapeutic advance improves the median overall survival for a few months. Some combined treatments could possibly boost the beneficial effects.

[A pin-point pattern of rapid occurrence on the skin of adolescents]. / Un semis ponctué d'apparition rapide sur la peau d'un adolescent.

In some instances, a dermatosis exhibits a rapid and focal surge of seemingly similar tiny lesions. We report a few typical exemples occurring in adolescents.

Cell proliferation in cutaneous malignant melanoma: relationship with neoplastic progression.

The establishment of the diagnosis of cutaneous malignant melanoma (CMM) always calls for histopathological confirmation. Further to the recognition of the CMM aspects, immunohistochemistry is helpful, in particular, in determining the size of the replicative compartment and the activity in each of the cell cycle phases (G(1), S, G(2), M). The involvement of cancer stem cells and transient amplifier cells in CMM genesis is beyond doubt. The proliferation activity is indicative of the neoplastic progression and is often related to the clinical growth rate of the neoplasm. It allows to distinguish high-risk CMM commonly showing a high growth rate, from those CMMs of lower malignancy associated with a more limited growth rate. The recruitment and progression of CMM cells in the cell cycle of proliferation depend on mitogen-activated protein kinase (MAPK) pathway and result from a loss of control normally involving a series of key regulatory cyclins. In addition, the apoptotic pathways potentially counteracting any excess in proliferative activity are out of the dependency of specific regulatory molecular mechanisms. Key molecular components involved in the deregulation of the growth fraction, the cell cycle phases of proliferation, and apoptosis are presently described in CMM.