Primary cutaneous CD8+ and CD30+ T-cell lymphoproliferative disorders: case reports and clinical implications.

BACKGROUND: CD8+ CD30+ primary cutaneous T-cell lymphomas (PCTCL) are rare entities with overlapping pathological features and variable outcome. OBJECTIVES: We sought to highlight the importance of correlation between pathological findings and clinical presentation for correct classification of the disease. MATERIALS & METHODS: Two cases of CD8+ CD30+ PCTCL were investigated. The first patient presented with a multiple necro-erythematous lesion of the limb and the second with a papulo-necrotic lesion of the eyelid. RESULTS: Despite a different clinical presentation, pathological findings were similar in both cases. Clinico-pathological correlation led to a diagnosis of primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma in the first case and primary cutaneous anaplastic large-cell lymphoma in the second. The first patient died shortly after diagnosis and the second is alive without recurrence. CONCLUSIONS: Clinico-pathological correlation is essential for the correct identification of these rare diseases.

Melanoma diagnosis: predictive value of macroscopic changes observed by the patient.

About half of the melanomas are detected by patients but the mean thickness of such melanomas is higher than when diagnosed by physicians. Symptoms and signs described by patients are dynamic changes and pruritus, the appearance of a new lesion having been rarely investigated. These observations are documented for melanomas but not for benign naevi. To the best of our knowledge, this is the first study in which both melanomas and suspected excised naevi were included. The main objectives were to (a) analyse the value of the anamnestic predictors for melanoma versus non-melanoma and (b) calculate the influence of age on the most significant anamnestic predictors. In order to reach these objectives, we prospectively collected data on symptoms (pruritus, anxiety) and signs (de novo appearance, dynamic changes and bleeding) described by patients undergoing the excision of lesions clinically diagnosed as melanocytic and considered as suspicious by 46 Belgian dermatologists. Among 1865 lesions, dynamic changes and de novo appearance were significant predictors for melanoma versus non-melanoma diagnosis in all patients and patients older than 50, respectively. More precisely, dynamic changes and de novo appearance occurred to be strong predictors for melanoma diagnosis in patients greater than 41.5 and greater than 44.5 years, respectively. Pruritus was not significant for melanoma diagnosis. As a conclusion, when mid-age or older patients observe melanocytic lesions as recently changed or newly appeared, such lesions should be considered more carefully than when observed by young patients.

Successful Management of Acquired Hemophilia A Associated with Bullous Pemphigoid: A Case Report and Review of the Literature.

Background. Acquired hemophilia A (AHA) is a rare condition, due to the spontaneous formation of neutralizing antibodies against endogenous factor VIII. About half the cases are associated with pregnancy, postpartum, autoimmune diseases, malignancies, or adverse drug reactions. Symptoms include severe and unexpected bleeding that may prove life-threatening. Case Study. We report a case of AHA associated with bullous pemphigoid (BP), a chronic, autoimmune, subepidermal, blistering skin disease. To our knowledge, this is the 25th documented case of such an association. Following treatment for less than 3 months consisting of methylprednisolone at decreasing dose levels along with four courses of rituximab (monoclonal antibody directed against the CD20 protein), AHA was completely cured and BP well-controlled. Conclusions. This report illustrates a rare association of AHA and BP, supporting the possibility of eradicating the inhibitor with a well-conducted short-term treatment.

Cost-effectiveness analysis in melanoma detection: A transition model applied to dermoscopy.

AIM: The main aim of this study is to demonstrate how our melanoma disease model (MDM) can be used for cost-effectiveness analyses (CEAs) in the melanoma detection field. In particular, we used the data of two cohorts of Belgian melanoma patients to investigate the cost-effectiveness of dermoscopy. METHODS: A MDM, previously constructed to calculate the melanoma burden, was slightly modified to be suitable for CEAs. Two cohorts of patients entered into the model to calculate morbidity, mortality and costs. These cohorts were constituted by melanoma patients diagnosed by dermatologists adequately, or not adequately, trained in dermoscopy. Effectiveness and costs were calculated for each cohort and compared. Effectiveness was expressed in quality-adjusted life years (QALYs), a composite measure depending on melanoma-related morbidity and mortality. Costs included costs of treatment and follow-up as well as costs of detection in non-melanoma patients and costs of excision and pathology of benign lesions excised to rule out melanoma. RESULTS: The result of our analysis concluded that melanoma diagnosis by dermatologists adequately trained in dermoscopy resulted in both a gain of QALYs (less morbidity and/or mortality) and a reduction in costs. CONCLUSION: This study demonstrates how our MDM can be used in CEAs in the melanoma detection field. The model and the methodology suggested in this paper were applied to two cohorts of Belgian melanoma patients. Their analysis concluded that adequate dermoscopy training is cost-effective. The results should be confirmed by a large-scale randomised study.

Selective use of sequential digital dermoscopy imaging allows a cost reduction in the melanoma detection process: a belgian study of patients with a single or a small number of atypical nevi.

BACKGROUND: Dermoscopy is a technique which improves melanoma detection. Optical dermoscopy uses a handheld optical device to observe the skin lesions without recording the images. Sequential digital dermoscopy imaging (SDDI) allows storage of the pictures and their comparison over time. Few studies have compared optical dermoscopy and SDDI from an economic perspective. OBJECTIVE: The present observational study focused on patients with one-to-three atypical melanocytic lesions, i.e. lesions considered as suspicious by optical dermoscopy. It aimed to calculate the "extra-costs" related to the process of melanoma detection. These extra-costs were defined as the costs of excision and pathology of benign lesions and/or the costs of follow-up by SDDI. The objective was to compare these extra-costs when using optical dermoscopy exclusively versus optical dermoscopy with selective use of SDDI. METHODS: In a first group of patients, dermatologists were adequately trained in optical dermoscopy but worked without access to SDDI. They excised all suspicious lesions to rule out melanoma. In a second group, the dermatologists were trained in optical and digital dermoscopy. They had the opportunity of choosing between immediate excision or follow-up by SDDI (with delayed excision if significant change was observed). The comparison of extra-costs in both groups was made possible by a decision tree model and by the division of the extra-costs by the number of melanomas diagnosed in each group. Belgian official tariffs and charges were used. RESULTS: The extra-costs in the first and in the second group were respectively €1,613 and €1,052 per melanoma excised. The difference was statistically significant. CONCLUSIONS: Using the Belgian official tariffs and charges, we demonstrated that the selective use of SDDI for patients with one-to-three atypical melanocytic lesions resulted in a significant cost reduction.