Multiple primary melanomas.

BACKGROUND: Patients with clinically diagnosed dysplastic nevi or a family history of melanoma with or without histologically diagnosed dysplastic nevi seem to be at higher risk for the development of multiple melanomas. OBJECTIVE: Our purpose was to determine which factors increased the risk for the development of subsequent melanomas. METHODS: This was a retrospective study in 56 patients with 157 melanomas. RESULTS: Early age at onset (58.9%), clinically diagnosed dysplastic nevi (82.0%), a histologically diagnosed dysplastic nevus (64%), family history of clinically diagnosed dysplastic nevi (70.8%) or melanoma (64.7%) and a histologically diagnosed dysplastic nevus in combination with a family history of melanoma (48%) were found in a high percentage of patients. The mean age at diagnosis was 38.2 years. The mean interval between the first and second melanoma was 34.3 months. Of the second melanomas, 76.8% developed in a different anatomic region from the first melanomas. The mean tumor thickness (Breslow) decreased from 1.11 mm for the first melanomas to 0.90 mm for the second melanomas. CONCLUSION: The results suggest that genetic factors might be involved in a certain subset of patients in whom melanomas develop early and successively.

A new surgical complication related to corticosteroids in a patient with Henoch-Schönlein purpura.

In this case presentation of a 4-year-old boy with histopathologically proven Henoch-Schönlein purpura the authors report a surgical complication that occurred under corticosteroids; this had not been described previously. Relief of abdominal pain was dramatic and the hematemesis disappeared, but an entero-enteral fistula and abscess developed without any sign of peritonitis. Therefore, when corticosteroids are used for symptomatic relief, and intermittent bowel obstruction persists during their use, surgical complications should be suspected. In such cases, intermittent small bowel obstruction might be the only sign of a grave surgical complication.

The distribution of cellular adhesion molecules in pigmented skin lesions.

BACKGROUND: The process of multistep tumor development has been studied thoroughly in the development of malignant melanomas. The authors investigated the expression of cellular adhesion molecules in nevomelanocytic lesions to explore a postulated role of adhesion molecules in cell-cell and cell-matrix interactions during tumor development. METHODS: Sections of 20 nevocellular nevi, 35 dysplastic nevi, 6 melanomas in situ, and 20 malignant melanomas were investigated with respect to their expression of intercellular adhesion molecule-1 (ICAM-1), inducible cell adhesion molecule-110 (INCAM-110)/vascular cell adhesion molecule-1 (VCAM-1), E-selectin, lymphocyte function-associated antigen-1 (LFA-1), and the integrins for very late antigen-(VLA) alpha-(alpha) 2 and VLA-alpha 6; for these studies, monoclonal antibodies were used and indirect immunoperoxidase and immunofluorescence staining methods were performed. RESULTS: In the transformation from benign to malignant neoplasms, the expression of ICAM-1 was upregulated strongly. The expression of VLA-alpha 2 on tumor cells increased whereas that of VLA-alpha 6 decreased; these alterations corresponded to changes previously observed in their ligands within the extracellular matrix. These results were statistically significant. In addition, ICAM-1, INCAM-110/VCAM-1, and E-selectin were detected in activated endothelial cells, probably as a result of cytokine activation. The ligand for ICAM-1, LFA-1, was confined to mononuclear cells. CONCLUSIONS: The increase in ICAM-1 and VLA-alpha 2 expression and the decrease of VLA-alpha 6 expression may, in combination with specific matrix alterations, lead to a change in cell-cell and cell-matrix interaction, thereby contributing to the invasive property of melanocytic tumor cells. The neoexpression of INCAM-110/VCAM-1 and E-selectin in pigmented skin lesions may play a role in both infiltrative growth and the generation of a host reaction toward these tumors.

The extracellular matrix in pigmented skin lesions: an immunohistochemical study.

In recent years the interaction between tumour cells and the surrounding extracellular matrix in the process of tumour development, invasion and metastasis has been a focus of interest. We studied frozen sections of nine naevocellular naevi (junctional, compound and intradermal), 40 dysplastic naevi, six pagetoid in situ melanomas and 12 superficial spreading melanomas in order to determine the expression of: the basement membrane proteins collagen type IV and laminin, the interstitial collagen types I, III and VI, and fibronectin and tenascin. An indirect immunoperoxidase technique was used. In the various stages of melanocytic tumour progression we observed: 1 loss of type IV collagen and laminin within dermal melanocytic cell nests; 2 de novo expression of basement membrane type IV collagen and increased expression of the interstitial collagen types I, III and VI, as well as tenascin and fibronectin in the dermal stroma surrounding dysplastic naevus cells and melanoma cells; 3 presence of extracellular matrix components in close association with intra-epidermally located invading atypical melanocytes. These data demonstrate the complex alterations of the composition of the extracellular matrix from bland naevi through lesions with progressive atypia to invasive melanoma. The changes described result in a molecular environment which melanocytes with an altered adhesion molecule profile are able to invade.

Pneumatosis cystoides intestinalis in intestinal pseudoobstruction. Resolution after therapy with metronidazole.

A 66-year-old man with chronic idiopathic intestinal pseudoobstruction was admitted for pneumatosis cystoides intestinalis, complicated by pneumoperitoneum. The latter conditions resolved after treatment with metronidazole. There was no favorable effect of the prokinetic agents cisapride and erythromycin. To the authors' knowledge, this is the first reported case of successful treatment of pneumatosis cystoides intestinalis with metronidazole in primary chronic intestinal pseudoobstruction.