Iris Pigmented Lesions and Risk of Cutaneous Melanoma: Case-Control Study in Lithuania.

The global incidence of cutaneous melanoma (CM) is rising, necessitating early detection and identification of risk factors across different populations. A case-control study with 180 patients with primary diagnosed CM and 182 healthy controls was conducted. Participants underwent ophthalmic and skin examinations, where the identification and counting of common melanocytic nevi (CMN) and atypical melanocytic nevi (AMN) was performed. During ophthalmic examination, high-resolution slit lamp iris images were taken. Images were categorized according to iris periphery, collaret, and freckles. There was no difference in iris periphery and collaret color between groups. However, blue/grey iris periphery and blue collaret with or without freckles were the most common patterns. The presence of pigmented iris lesions and 2-5 mm and ≥5 mm in diameter CMNs was strongly associated with CM risk. The evidence from this study indicates that blue or grey periphery and blue collaret iris pattern with iris freckles are 2.74 times higher in the CM group than controls. Further research is needed to explore iris patterns' association with CM risk in diverse populations.

Activated and Naïve Allogenic Human Placental Mesenchymal Stromal Cells Exert an Immunomodulatory Effect on Hidradenitis Suppurativa Patient Peripheral Blood Mononuclear Cells.

This pilot study aimed to evaluate the immunomodulatory effect of placental mesenchymal stem/stromal cells (MSCs) on peripheral blood mononuclear cells (PBMCs) from patients with hidradenitis suppurativa (HS). Blood samples were collected from 3 healthy and 3 patients with HS. Isolated PBMCs were stained with carboxyfluorescein succinimidyl ester (CFSE) and stimulated with phorbol 12-myristate 13-acetate (PMA)/Ionomycin solution. The PBMCs of patients with HS were co-cultured with naïve MSCs (n-MSCs), activated with tumor necrosis factor (TNF)-α (10 ng/mL) and interferon (IFN)-γ (10 ng/mL) MSCs (a-MSCs), or adalimumab (30 µg/mL). The division index (proliferation inhibition) of PBMCs was analyzed by flow cytometry using the Proliferation Modeling tool after 5 days of coculture. The relative inflammatory gene expression dynamics and cytokine secretion were quantified in triplicate using real-time polymerase chain reaction (PCR) and Luminex assays. PBMCs from the HS control group showed statistically significant increases in interleukin (IL)-6 and IFN-γ cytokine concentrations and IL-17A gene expression when compared with healthy subjects. Statistically significant reduction of the division index was found in the a-MSCs group (P = 0.04). Also, the Luminex assay revealed significantly reduced proinflammatory cytokine concentrations of IL-9 (P = 0.022) and IL-17A (P = 0.022) in the a-MSCs group with the same trend of numerical lowering in n-MSCs group when compared to HS control. The results of real-time PCR revealed a numerical increase in the expression of the IL-1ß, IL-36α, and TNF-α genes in both the a-MSCs and n-MSCs groups compared with the HS control. In conclusion, our findings suggest that MSCs can effectively curb PBMCs proliferation and suppress the production of inflammatory cytokines. Moreover, the preactivation of MSCs with IFN-γ and TNF-α before use can enhance their therapeutic effectiveness. Nevertheless, a larger sample size is imperative to validate these results.

Accuracy of a Smartphone-Based Artificial Intelligence Application for Classification of Melanomas, Melanocytic Nevi, and Seborrheic Keratoses.

Current artificial intelligence algorithms can classify melanomas at a level equivalent to that of experienced dermatologists. The objective of this study was to assess the accuracy of a smartphone-based "You Only Look Once" neural network model for the classification of melanomas, melanocytic nevi, and seborrheic keratoses. The algorithm was trained using 59,090 dermatoscopic images. Testing was performed on histologically confirmed lesions: 32 melanomas, 35 melanocytic nevi, and 33 seborrheic keratoses. The results of the algorithm's decisions were compared with those of two skilled dermatologists and five beginners in dermatoscopy. The algorithm's sensitivity and specificity for melanomas were 0.88 (0.71-0.96) and 0.87 (0.76-0.94), respectively. The algorithm surpassed the beginner dermatologists, who achieved a sensitivity of 0.83 (0.77-0.87). For melanocytic nevi, the algorithm outclassed each group of dermatologists, attaining a sensitivity of 0.77 (0.60-0.90). The algorithm's sensitivity for seborrheic keratoses was 0.52 (0.34-0.69). The smartphone-based "You Only Look Once" neural network model achieved a high sensitivity and specificity in the classification of melanomas and melanocytic nevi with an accuracy similar to that of skilled dermatologists. However, a bigger dataset is required in order to increase the algorithm's sensitivity for seborrheic keratoses.

Assessment of Treatment Approaches and Outcomes in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Insights From a Pan-European Multicenter Study.

IMPORTANCE: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe drug reactions associated with a high rate of mortality and morbidity. There is no consensus on the treatment strategy. OBJECTIVE: To explore treatment approaches across Europe and outcomes associated with the SJS/TEN disease course, as well as risk factors and culprit drugs. DESIGN, SETTING, AND PARTICIPANTS: A retrospective pan-European multicenter cohort study including 13 referral centers belonging to the ToxiTEN ERN-skin subgroup was conducted. A total of 212 adults with SJS/TEN were included between January 1, 2015, and December 31, 2019, and data were collected from a follow-up period of 6 weeks. MAIN OUTCOMES AND MEASURES: Risk factors for severe acute-phase complications (acute kidney failure, septicemia, and need for mechanical ventilation) and mortality 6 weeks following admission were evaluated using a multivariable-adjusted logistic regression model. One tool used in evaluation of severity was the Score of Toxic Epidermal Necrolysis (SCORTEN), which ranges from 0 to 7, with 7 the highest level of severity. RESULTS: Of 212 patients (134 of 211 [63.7%] women; mean [SD] age, 51.0 [19.3] years), the mean (SD) body surface area detachment was 27% (32.8%). In 176 (83.0%) patients, a culprit drug was identified. Antibiotics (21.2%), followed by anticonvulsants (18.9%), nonsteroidal anti-inflammatory drugs (11.8%), allopurinol (11.3%), and sulfonamides (10.4%), were the most common suspected agents. Treatment approaches ranged from best supportive care only (38.2%) to systemic glucocorticoids (35.4%), intravenous immunoglobulins (23.6%), cyclosporine (10.4%), and antitumor necrosis factor agents (3.3%). Most patients (63.7%) developed severe acute-phase complications. The 6-week mortality rate was 20.8%. Maximal body surface area detachment (≥30%) was found to be independently associated with severe acute-phase complications (fully adjusted odds ratio [OR], 2.49; 95% CI, 1.21-5.12; P = .01) and SCORTEN greater than or equal to 2 was significantly associated with mortality (fully adjusted OR, 10.30; 95% CI, 3.82-27.78; P < .001). Cyclosporine was associated with a higher frequency of greater than or equal to 20% increase in body surface area detachment in the acute phase (adjusted OR, 3.44; 95% CI, 1.12-10.52; P = .03) and an increased risk of infections (adjusted OR, 7.16; 95% CI, 1.52-33.74; P = .01). Systemic glucocorticoids and intravenous immunoglobulins were associated with a decreased risk of infections (adjusted OR, 0.40; 95% CI, 0.18-0.88; P = .02). No significant difference in 6-week mortality was found between treatment groups. CONCLUSIONS AND RELEVANCE: This cohort study noted differences in treatment strategies for SJS/TEN in Europe; the findings suggest the need for prospective therapeutic studies to be conducted and registries to be developed.

Formaldehyde 2% is not a useful means of detecting allergy to formaldehyde releasers- results of the ESSCA network, 2015-2018.

BACKGROUND: Studies suggest that patch testing with formaldehyde releasers (FRs) gives significant additional information to formaldehyde 1% aq. and should be considered for addition to the European baseline series (EBS). It is not known if this is also true for formaldehyde 2% aq. OBJECTIVES: To determine the frequency of sensitization to formaldehyde 2% aq. and co-reactivity with FRs. To establish whether there is justification for including FRs in the EBS. MATERIALS AND METHODS: A 4-year, multi-center retrospective analysis of patients with positive patch test reactions to formaldehyde 2% aq. and five FRs. RESULTS: A maximum of 15 067 patients were tested to formaldehyde 2% aq. and at least one FR. The percentage of isolated reactions to FR, without co-reactivity to, formaldehyde 2% aq. for each FR were: 46.8% for quarternium-15 1% pet.; 67.4% imidazolidinyl urea 2% pet.; 64% diazolidinyl urea 2% pet.; 83.3% 1,3-dimethylol-5, 5-dimethyl hydantoin (DMDM) hydantoin 2% pet. and 96.3% 2-bromo-2-nitropropane-1,3-diol 0.5% pet. This demonstrates that co-reactivity varies between FRs and formaldehyde, from being virtually non-existent in 2-bromo-2-nitropropane-1,3-diol 0.5% pet. (Cohen's kappa: 0, 95% confidence interval [CI] -0.02 to 0.02)], to only weak concordance for quaternium-15 [Cohen's kappa: 0.22, 95%CI 0.16 to 0.28)], where Cohen's kappa value of 1 would indicate full concordance. CONCLUSIONS: Formaldehyde 2% aq. is an inadequate screen for contact allergy to the formaldehyde releasers, which should be considered for inclusion in any series dependant on the frequency of reactions to and relevance of each individual allergen.

Diagnostics of Melanocytic Skin Tumours by a Combination of Ultrasonic, Dermatoscopic and Spectrophotometric Image Parameters.

Dermatoscopy, high-frequency ultrasonography (HFUS) and spectrophotometry are promising quantitative imaging techniques for the investigation and diagnostics of cutaneous melanocytic tumors. In this paper, we propose the hybrid technique and automatic prognostic models by combining the quantitative image parameters of ultrasonic B-scan images, dermatoscopic and spectrophotometric images (melanin, blood and collagen) to increase accuracy in the diagnostics of cutaneous melanoma. The extracted sets of various quantitative parameters and features of dermatoscopic, ultrasonic and spectrometric images were used to develop the four different classification models: logistic regression (LR), linear discriminant analysis (LDA), support vector machine (SVM) and Naive Bayes. The results were compared to the combination of only two techniques out of three. The reliable differentiation between melanocytic naevus and melanoma were achieved by the proposed technique. The accuracy of more than 90% was estimated in the case of LR, LDA and SVM by the proposed method.

Clinical Characteristics of Hidradenitis Suppurativa Patients from a Reference Centre in Kaunas, Lithuania.

INTRODUCTION: Clinical data on hidradenitis suppurativa (HS) derived mainly from studies in Western Europe and the USA, raising the risk of potential selection bias. According to the official data, during 2006-2015 the incidence of HS in Lithuania was 23.5 cases per 100,000 population with a female-to-male ratio of 2:1. A more fine-grained data set would however be of great relevance to further understanding this disease. Collection of standardized data enables the comparison of populations of patients across samples. OBJECTIVES: To present a cohort of HS patients with uniformly collected data according to European Hidradenitis Suppurativa Foundation/European Reference Network-Skin recommendations. METHODS: The demographic and clinical data of a total of 37 HS patients, included over a 3-year period (from 2016 to January 2019) in a local database of the reference centre of Rare Skin Diseases in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos, were analysed. Non-parametric tests such as χ2 and Mann-Whitney were used for assessing interdependence between qualitative data. Logistic regression analysis was performed to find out the factors statistically related with significant diagnostic delay. RESULTS: The mean duration of diagnosis delay was 5.5 (±5.9) years in females and 6.6 (±8.2) years in males. A significant delay (>2 years) was reported in 29/37 (78.4%) cases and was not related with sex, age at HS diagnosis or disease severity. The groin area was more affected in females than in males. There was no statistically significant difference between sex and Hurley stage, HS Physician Global Assessment, International Hidradenitis Suppurativa Severity Score System, visual analogue scale and Dermatology Life Quality Index scores. Combined (medical and surgery) HS treatment was applied to 46.0% and monotherapy (medical or surgery) to 54.0% of patients. CONCLUSIONS: Standardized collection of epidemiological and clinical data is required to improve the quality of HS patient data and allow for international comparisons and pooling of data for research purposes.

Application of automatic statistical post-processing method for analysis of ultrasonic and digital dermatoscopy images.

Ultrasonic and digital dermatoscopy diagnostic methods are used in order to estimate the changes of structure, as well as to non-invasively measure the changes of parameters of lesions of human tissue. These days, it is very actual to perform the quantitative analysis of medical data, which allows to achieve the reliable early-stage diagnosis of lesions and help to save more lives. The proposed automatic statistical post-processing method based on integration of ultrasonic and digital dermatoscopy measurements is intended to estimate the parameters of malignant tumours, measure spatial dimensions (e.g. thickness) and shape, and perform faster diagnostics by increasing the accuracy of tumours differentiation. It leads to optimization of time-consuming analysis procedures of medical images and could be used as a reliable decision support tool in the field of dermatology.

Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: Analysis of recurrence-free survival.

BACKGROUND AND AIM: Cutaneous squamous cell carcinoma (CSCC) is a malignant epithelial cell tumor. CSCC has a tendency to spread via lymphogenic pathway. Metastases are found in 2%-6% of cases. Prognosis of patients with CSCC is directly related to the morphology and localization of primary tumor. The aim of this study was to evaluate the recurrence-free survival of patients with CSCC after tumor excision and SLNB as well as to analyze morphologic CSCC features related to patient recurrence-free survival. MATERIALS AND MATERIALS: A retrospective analysis of 51 patients with CSCC, who underwent surgical treatment between January 1, 2012, and December 31, 2014, in the Clinic of Plastic and Reconstructive Surgery, Hospital of the Lithuanian University of Health Sciences, was done. The diagnosis of CSCC was verified on a histological examination, and all patients had no clinical evidence of nodal or distant metastases on a physical examination or imaging studies. Sentinel lymph node biopsy (SLNB) was performed for low- and high-risk CSCC patients. RESULTS: A total of 51 patients were enrolled into the study (34 women and 17 men). Total of 68 lymph nodes were removed during sentinel lymph node biopsy. No micrometastases were identified. Until April 1, 2015, no relapse event was documented. The mean time after operation was 27.5 months. During the follow-up period, no distant metastases were identified. CONCLUSIONS: No patient who had no micrometastases in sentinel lymph nodes developed local and distant CSCC metastases during the follow-up period. Our report supports the concept that SLNB can be applied for CSCC. It is obvious that larger prospective studies with longer follow-up period are needed to establish the efficacy of SLNB and define the optimal treatment of occult nodal metastasis for CSCC.

Automatic Differential Diagnosis of Melanocytic Skin Tumors Using Ultrasound Data.

We describe a novel automatic diagnostic system based on quantitative analysis of ultrasound data for differential diagnosis of melanocytic skin tumors. The proposed method has been tested on 160 ultrasound data sets (80 of malignant melanoma and 80 of benign melanocytic nevi). Acoustical, textural and shape features have been evaluated for each segmented lesion. Using parameters selected according to Mahalanobis distance and linear support vector machine classifier, we are able to differentiate malignant melanoma from benign melanocytic skin tumors with 82.4% accuracy (sensitivity = 85.8%, specificity = 79.6%). The results indicate that high-frequency ultrasound has the potential to be used for differential diagnosis of melanocytic skin tumors and to provide supplementary information on lesion penetration depth. The proposed system can be used as an additional tool for clinical decision support to improve the early-stage detection of malignant melanoma.

Automated Estimation of Melanocytic Skin Tumor Thickness by Ultrasonic Radiofrequency Data.

OBJECTIVES: High-frequency (>20-MHz) ultrasound (US) is a noninvasive preoperative tool for assessment of melanocytic skin tumor thickness. Ultrasonic melanocytic skin tumor thickness estimation is not always easy and is related to the experience of the clinician. In this article, we present an automated thickness measurement method based on time-frequency analysis of US radiofrequency signals. METHODS: The study was performed on 52 thin (≤1-mm) melanocytic skin tumors (46 melanocytic nevi and 6 melanomas). Radiofrequency signals were obtained with a single-element focused transducer (fundamental frequency, 22 MHz; bandwidth, 12-28 MHz). The radiofrequency data were analyzed in the time-frequency domain to make the tumor boundaries more noticeable. The thicknesses of the tumors were evaluated by 3 different metrics: histologically measured Breslow thickness, manually measured US thickness, and automatically measured US thickness. RESULTS: The results showed a higher correlation coefficient between the automatically measured US thickness and Breslow thickness (r= 0.83; P< .0001) than the manually measured US thickness (r = 0.68; P < .0001). The sensitivity of the automated tumor thickness measurement algorithm was 96.55%, and the specificity was 78.26% compared with histologic measurement. The sensitivity of the manually measured US thickness was 75.86%, and the specificity was 73.91%. CONCLUSIONS: The efficient automated tumor thickness measurement method developed could be used as a tool for preoperative assessment of melanocytic skin tumor thickness.

Reliability of solar keratosis clinical diagnosis: A prospective study.

Usually solar keratoses (SK) are diagnosed clinically. However other diseases may clinically present as erythematous macules, papules or patches on sun-exposed areas; therefore the histopathology remains the gold standard diagnostic tool. Our study, which assessed the efficacy of photodynamic therapy (PDT), showed that one in 20 clinically diagnosed SK lesions grade I-II identified by board-certified dermatologists were rosacea and only one in 40 were malignant lesions. These findings should be considered by clinicians who treat clinically diagnosed grade I-II SK without response to treatment or diagnose the recurrence of SK after PDT.

Preoperative assessment of skin tumor thickness and structure using 14-MHz ultrasound.

OBJECTIVE: The aim of this study was to compare the relationship between skin tumor thickness and homogeneity and to evaluate the accuracy of 14-MHz ultrasound while measuring the thickness of different skin tumors. MATERIAL AND METHODS: The ultrasonographic and histological analysis of 72 skin tumors was performed. Preoperative vertical tumor thickness (T) and structure of 12 melanomas, 34 melanocytic nevi and 26 basal cell carcinomas was assessed by 14-MHz ultrasonography. After the tumors were excised the vertical thickness measurement (Breslow index, pT) was performed by pathologist. According to the histological thickness all skin tumors were divided to thin (≤1mm) and thick (>1mm). The accuracy of the 14-MHz ultrasound measurements and correlation between the ultrasonographic and histological tumor thickness were estimated. RESULTS: Homogeneous structure was assessed for all thin (≤1mm) and the majority (81.3%) of thick (>1mm) melanocytic skin tumors. Nonhomogeneous structure was estimated in thin and thick basal cell carcinomas, accordingly 42.9% and 31.9%. Measurements of T and pT correlated moderately in thick (>1mm) tumors (r=0.694), while in thin (≤1mm) tumors correlation was low (r=0.336). Moderate correlation between ultrasonographic and histological thickness was computed for melanocytic skin tumors as well as for basal cell carcinomas (r=0.564 and r=0.690). CONCLUSIONS: Medium frequency ultrasound is not a reliable tool for the precise measurement of thin (≤1mm) skin tumors. Ultrasonography using a 14-MHz frequency transducer enables more precisely to measure the thickness of basal cell carcinoma than melanocytic skin tumors. The 14-MHz ultrasound is support tool to suggest the morphologic type of skin tumor.

Pain during topical photodynamic therapy of actinic keratoses with 5-aminolevulinic acid and red light source: randomized controlled trial.

BACKGROUND: Pain is the major drawback of photodynamic therapy (PDT), an otherwise effective treatment for actinic keratoses (AKs). OBJECTIVE: To determine pain intensity and its dependence upon various factors during PDT with 5-aminolevulinic acid for face/scalp AKs. METHODS: A prospective, randomized, within-patient comparison study was performed. Thirty-eight patients with at least two clearly definable, mild or moderate AKs were randomized to receive either a red light dose of 70 or 100 J/cm(2) as a first or second split face/scalp treatment. They were blinded to the light dose administered. Pain during treatment was assessed using a visual analog scale (VAS). RESULTS: The mean intensity of pain during the first treatment session was 5.00 (± 1.78), while during the follow-up VAS score was 4.50 (± 1.51). Bigger AKs (> 130 mm(2) ) were more painful than the smaller ones (P = 0.003) and AKs on the face were twice more painful than the ones on the scalp (P = 0.002). Gender and patient age were poor pain predictors. Pain was independent of the patient's Fitzpatrick skin type, AK clinical grade, pretreatment fluorescence intensity, and the light dose during PDT. CONCLUSION: Pain during PDT is associated with AK location and size. Treatment of bigger lesions (> 130 mm(2) ) results in more pain than smaller ones and treatment of the face is more painful than the scalp area.

Measurement of melanoma thickness--comparison of two methods: ultrasound versus morphology.

OBJECTIVE: The aim of our study was to investigate the association between non-invasive ultrasound examination and morphologic test results in the measurement of cutaneous melanoma thickness influencing surgical treatment strategy. METHODS: Our prospective clinical study has been conducted in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital (KUMH) since January 2004 until October 2008. A total of 100 patients with a clear clinical diagnosis of stage I-II cutaneous melanoma were enrolled in this study. Melanoma depth was measured using a linear 14-MHz frequency ultrasound sensor (Toshiba Xario XG). Surgically removed fragments of skin-subcutaneous tissue were fixated using 10% formalin solution in the operating theatre, and sent to KUMH Clinic of Pathological Anatomy. The most informative sections were analysed for tumour thickness, according to Breslow, as well as tumour type, vascular and lymphatic invasion and dissemination. A comparative data analysis of melanoma thickness measured by ultrasound (T) preoperatively and histologically estimated cutaneous melanoma (CM) thickness according to Breslow (pT) using the Bland-Altman method was performed. RESULTS: Higher mean difference of melanoma thickness (60 µm) between T and pT measurements was found when tumour thickness matched pT1 and pT2 categories. In cases of CM depth exceeding 2mm, mean difference of measurements between CM thickness determined by ultrasound and histological examination was lower (30 µm). Data regression analysis showed that correlation between T and pT measurements was lower when CM was thinner (1-2 mm) (Pearson's correlation coefficient, r: 0.283). In cases of thicker melanoma (>2 mm), strong and statistically significant (p<0.0001) correlation (r: 0.869) was observed. CONCLUSIONS: Correlation between melanoma thickness measured using a linear 14-MHz frequency ultrasound sensor and histologically estimated melanoma thickness according to Breslow was lower if melanoma was thinner (1-2 mm). However, in cases of thicker melanoma (>2 mm), very strong correlation between measurements was observed.

Lichen sclerosus et atrophicus in pediatric and adult male patients with congenital and acquired phimosis.

Lichen sclerosus et atrophicus is a chronic inflammatory sclerotic and atrophic disease of unknown cause that predominantly affects male and female genital skin. This study was designed to evaluate histological characteristics of congenital and acquired phimoses among pediatric (n=60) and adult (n=60) male patients who were admitted for circumcision to the Clinics of Urology and Pediatric Surgery of Kaunas University of Medicine Hospital between 2000 and 2003 and to determine the rate of lichen sclerosus et atrophicus and other histological diagnoses among them. This study demonstrates that 45.1% of congenital and 62.3% of acquired phimoses show histological signs of lichen sclerosus et atrophicus. The rate of lichen sclerosus et atrophicus was statistically significantly higher among patients with acquired than congenital phimosis. Boys with acquired narrowing of prepuce were statistically significantly 3.9 times more likely to develop lichen sclerosus et atrophicus than those with congenital phimosis. There were no statistically significant differences between rates of lichen sclerosus et atrophicus and other dermatological diagnoses among pediatric and adult male patients if the type of phimosis (acquired or congenital) was considered. Histological features of lichen sclerosus et atrophicus and other histological diagnoses in boys and men with phimosis were detected with equal frequency irrespective the age of the subjects. The rate of lichen sclerosus et atrophicus was similar among all boys (56.7%) and men (53.3%) treated for phimosis. Only the type of phimosis had a statistically significant influence on the rate of lichen sclerosus et atrophicus and other histological diagnoses.

Metastatic amelanotic nodular melanoma during pregnancy.

This case report presents a very aggressive course of amelanotic nodular melanoma during pregnancy resulting in death five months after delivery. A 34 year-old Caucasian woman at 19th week of the second pregnancy was diagnosed having amelanotic nodular melanoma (tumor thickness - 2.5 mm) with metastases to the regional right inguinal lymph node. Amelanotic nodular melanoma represents malignant melanocytic tumor of the skin, which clinically mimics a variety of benign and malignant skin conditions and therefore commonly leads to delayed diagnosis. Though primary tumor was excised immediately, other treatment procedures as radical lymphadenectomy and chemotherapy were delayed, and immunotherapy was not given totally. At the 29th week of pregnancy, the woman via naturalem delivered a healthy female child, and the chemotherapy was started. Since pregnancy limits the prescription of immunotherapy and chemotherapy, the prognosis for melanoma during pregnancy detected later than in the second stage is poor and can be illustrated by our reported case. Such patients seems to be at higher risk to develop metastasis of melanoma in the internal organs and occasionally even in the fetus; therefore, they should be timely informed about that.

Home sampling and pooling of vaginal samples are effective tools for genetic screening of Chlamydia trachomatis among high school female students in Lithuania.

The aims were 1) to estimate the prevalence of C. trachomatis infection among sexually active female students in Kaunas, Lithuania; 2) to investigate the usefulness of personal invitation, self-sampling, and pooling of samples for screening; and 3) to evaluate the costs of the approaches used. A cross-sectional study inviting 795 female students (18-31 y of age) from 7 high schools and 1 college in Kaunas was performed. The response rate was 67% (533/795). Self-obtained vaginal samples were analysed, individually and pooled (n = 3), using Digene Hybrid Capture II CT/NG Test. The overall prevalence of C. trachomatis infection was 5.6%. Among the sexually active female students 20-24 y of age (n = 424), the prevalence was 7.1%; however, the prevalence varied from 0% to 14.2% at the different schools. For estimation of the population prevalence based solely on identification of C. trachomatis positive pools, the pooling strategy reduced the costs by 85%. For estimation of population prevalence and for diagnosis of each individual sample, pooling reduced the costs by 70%. Targeted screening, using pooling to reduce the expenses, mainly of 3rd and 4th y Lithuanian female students could be recommended. By extended personal contact and internet-based communication, increased participation rates may be attained.

Body-site distribution of common acquired melanocytic nevi associated with severe sunburns among children in Lithuania.

BACKGROUND: The aim of this cross-sectional study is to provide information on subsite-specific densities of melanocytic nevi by age, sex, and in relation to the history of severe sunburns. MATERIALS AND METHODS: This study was conducted in Kaunas, Lithuania, on a sample of 484 children aged 1-2 years, 4-5 years, 9-10 years, and 14-15 years. The questionnaire provided information about the history of severe sunburns since birth. Site-specific numbers and densities of melanocytic nevi of all sizes and nevi 2 mm or greater were studied. We used log-linear and Poisson regression models to estimate the effects of age, sex, and severe sunburns on the nevus density. RESULTS: The predicted total body density of nevi shows a considerable increase up to the age of roughly 10 years. Thereafter, the density increase tapered off. Median densities of nevi were highest on the face. The median density of nevi on the upper arms is higher than on the forearms. Similarly, the median density of nevi on the thighs is higher than on the lower legs. Estimates of the relative nevus densities related to the history of severe sunburns tend to be small with the exception of the legs for nevi 2 mm or greater (relative nevus density = 2.09, 95% CI 1.49-2.93). CONCLUSION: Nevus densities are highest on maximally or intermittently sun-exposed skin areas. With the exception of the legs among women, the subsite-specific ranking of nevus densities among adolescents follows a similar ranking as the skin melanoma incidence in Lithuania.

Neurosyphilis manifesting as spinal transverse myelitis.

Spinal myelitis caused by neurosyphilis is an extremely rare disease, and there are only few visual examples of magnetic resonance imaging scans. We present a clinical case of neurosyphilis, which is of great importance concerning diagnostic, differential diagnosis, and tactics of management. A patient complaining of progressive legs weakness, numbness, and shooting-like pain in the legs as well as pelvic dysfunction was admitted to the hospital. Neurological examination revealed spinal cord lesion symptoms: legs weakness, impairment of superficial and deep sensation together with pathological symptoms in the legs. Hernia of intervertebral disc or tumor was suspected, and myelography with computed tomography of the spine was performed. No pathological findings were observed. More precise examination of the patient (a small scar in the genitals and condylomata lata in anal region were noticed) pointed to possible syphilis-induced spinal cord lesion. Serologic syphilis diagnostic tests (Treponema pallidum hemagglutination assay, reagin plasma response, serum enzyme-linked immunosorbent assay) and cerebrospinal fluid tests (general cerebrospinal fluid test and Venereal Disease Research Laboratory test) confirmed the diagnosis of neurosyphilis. Spinal cord lesion determined by magnetic resonance imaging was evaluated as spinal syphilis or syphilis-induced myelitis. Conventional treatment showed a partial effect.