[Management of non melanoma skin cancer by the general practitioner]. / Prise en charge des cancers cutanés non-mélanome par le médecin généraliste.

The incidence of skin cancer cases has increased significantly during the last decades. Non melanoma skin cancer (NMSC) is the most common cancer in Caucasian populations. This term refers to 2 major types of skin cancer : basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mortality from BCC and SCC is low but there may be substantial morbidity from disfigurement as these lesions tend to be located on the skin of the head and neck. Actinic keratosis is a premalignant condition that may evolve into SCC. Fortunately, skin cancer is amenable to early detection and potential cure. General practitioners may play a very important role in the timely diagnosis and management of these tumors. They are on the front line to detect NMSC : opportune examination coupled with good observation skills allow a high detection rate of suspicious lesions. It is essential to identify the high-risk patient as well as the clinical signs of suspicious lesions. This article outlines the clinical features of common NMSC and highlights which lesions should be best referred to a dermatologist.

L'incidence des cancers cutanés s'est considérablement accrue ces dernières décennies. Le terme de cancer cutané non-mélanome (CCNM) définit deux types principaux de cancers cutanés : le carcinome basocellulaire (CBC) et le carcinome spinocellulaire (CSC). Ce sont les néoplasies les plus fréquentes chez les sujets caucasiens. Leur mortalité est faible mais leur localisation préférentielle au visage et au cou est responsable d'une morbidité conséquente par séquelles cicatricielles, parfois lourdes. Les kératoses actiniques sont des lésions précancéreuses qui peuvent évoluer en CSC. La détection précoce des cancers cutanés permet d'obteni r un taux élevé de guérison. Les médecins généralistes jouent un rôle majeur dans le diagnostic et la prise en charge adéquate de ces tumeurs. Ils sont en première ligne pour détecter les CCNM : un examen clinique opportun associé à des compétences observationnelles assure un taux élevé de dépistage de lésions suspectes. Il est essentiel de reconnaître les patients à risque et d'identifier les lésions suspectes. Cet article reprend les présentations cliniques des principaux CCNM et souligne celles qui doivent être orientées vers le dermatologue.

[Sarcoidal granulomas following injections of botulic toxin A (Botox) for corrections of wrinkles]. / Granulomes sarcoïdosiques après injections de toxine botulique A (Botox) pour correction de rides.

BACKGROUND: The introduction of foreign material into the skin can lead to sarcoidal reactions. Such a reaction is reported, consecutive to injections of botulic toxin A (Botox). CASE REPORT: A 57-year-old woman, noticed the occurrence of frontal and glabellar nodules, 3 weeks after the injection of botulic toxin A (Botox), for the correction of wrinkles. Histopathological examination revealed a sarcoidal granuloma. Clinical and biological investigations were negative, ruling out the hypothesis of systemic sarcoidosis. The lesion could be reproduced experimentally by an intradermal injection of botulic toxin A on the volar aspect of the forearm. Corticosteroids per os associated with intralesional injections of triamcinolone acetonide were followed by a complete regression of the nodules. DISCUSSION: The occurrence of sarcoidal granulomas at the sites of injection of botulic toxin A (Botox(R)) has not been reported - so far - in the literature. Systemic sarcoidosis has been ruled out. The sarcoidal reaction has been reproduced experimentally by the intradermal injection of botulic toxin A, but not by saline. This leads to think that the sarcoidal reaction was provoked by antigenic stimulation, comparable to the Kveim reaction, and did not correspond to "scar sarcoidosis".