Immunohistochemical expression of vitamin D receptor in melanocytic naevi and cutaneous melanoma: a case-control study.

BACKGROUND: Vitamin D deficiency is associated with higher risk of cancer, possibly due to its antiproliferative, antiangiogenic, proapoptotic, cell-differentiating and anti-invasive effects. The anticarcinogenic role of vitamin D in melanoma is still a matter of debate. Loss of nuclear and cytoplasmic vitamin D receptor (VDR) expression in melanoma cells has been reported. OBJECTIVES: To analyse VDR immunohistochemical expression in benign dermal naevi (DN) and malignant melanoma (MM). METHODS: A case-control study evaluated nuclear and cytoplasmic VDR immunohistochemical staining in 54 DN and 55 MM tissue samples. RESULTS: There was significantly higher cytoplasmic VDR positivity in DN compared with MM (59% vs. 16%, P < 0·001). The mean VDR cytoplasmic expression was also higher in DN vs. MM (P < 0·001). No differences in nuclear VDR positivity were observed between groups, but mean nuclear VDR expression was significantly lower in DN vs. MM (P = 0·02). The loss of cytoplasmic VDR in MM was associated with Clark level, tumour staging and American Joint Committee on Cancer pTNM staging (P=0·004, 0·009 and 0·02, respectively). CONCLUSIONS: Alterations in VDR expression and localization are found in MM compared with DN. Loss of cytoplasmic VDR was associated with melanoma tumour size, suggesting that loss of cytoplasmic VDR may be a prognostic factor.

The use of a sunscreen containing DNA-photolyase in the treatment of patients with field cancerization and multiple actinic keratoses: a case-series.

Cutaneous field cancerization (CFC) is associated witha high-risk of developing cutaneous squamous cellcarcinoma (cSCC). It manifests as actinic keratoses(AK) as one of the few macroscopic alterations in CFCpatients. A prospective, single-arm, case-series wasperformed to evaluate the utility of a novel sunscreencontaining DNA-photolyase for treatment of CFCin nine subjects (mean age 70.6 years, male: femaleratio 5:4). The cream was applied topically twicedaily on CFC/AK areas and patients were followedup for three months, with no other treatments. Theprimary outcome was the overall response rate (ORR),categorized as complete response (CR, completeresolution of AKs), partial response (PR, reduction inthe number of AKs), and no-response (NR, similar/increase in number of AKs). A 100% PR was observed.All subjects displayed at minimum, a 50% reductionin their lesion number and most patients experiencedalmost CR. Evaluation of AK numbers revealed anabsolute count reduction of 76.6% in the number oflesions, with the mean number of lesions reducedfrom 13.4 to 3.1 (p < 0.0001). No adverse events werereported. Patients with CFC may benefit from noveltopical applications containing DNA-photolyase,at minimum, as complementary therapy for themanagement of CFC disease. We propose a newconcept called "active photoprotection" because of itsdual mechanism involving therapy and protection.

Vitamin D axis and its role in skin carcinogenesis: a comprehensive review

Vitamin D (VD) is a secosteroid hormone that is mainly synthesized in the skin upon exposure to UVB radiation. VD is widely known for its role in calcium metabolism; however, multiple endocrine, paracrine and autocrine functions of VD have been described, including a prominent role on carcinogenesis. In recent years, multiple associations between VD deficiency and different types of cancer have been described, supported by evidence of anti-proliferative, anti-angiogenic, pro-apoptotic, cell-differentiating and anti-invasive effects of this hormone. An immunomodulatory role of VD associated to cancer microenvironment has also been suggested. Regarding skin cancer, it has been shown that VD inhibits tumor development in basal cell carcinoma, squamous cell carcinoma, and melanoma in vitro. Some studies have suggested that lower VD levels may be a risk factor for skin cancer, while others have shown the opposite; there is also preliminary evidence on the role of VD supplementation for the prevention of melanoma in vivo. In this review, we explore the mechanisms of VD effects on carcinogenesis and the available scientific evidence of the interplay between VD and the genesis of both non-melanoma and melanoma skin cancer. (AU)

Cutaneous manifestations in renal transplant recipients of Santiago, Chile.

INTRODUCTION: Renal transplant recipients have a heightened risk of developing various cutaneous manifestations, such as skin infections, skin cancer, and secondary effects of immunosuppressive drugs. These manifestations differ depending on the evaluated population. The objective of this study was to describe the prevalence of cutaneous manifestations among renal transplant recipients in Chile between 1979 and 2008. METHODS: Patients were recruited and then evaluated using a standardized questionnaire. Dermatologic physical examination was performed in every patient describing skin lesions, immunosuppressive drug effects, and malignant diseases. All suspicious lesions were biopsied for analysis. Every patient was queried for the development of skin cancer after his or her transplantation. RESULTS: A total of 91 patients were enrolled; ages 10-67 years. Sixty percent of the patients presented with an infection at the initial evaluation. The most common infection was onychomycosis (58%) and verruca vulgaris (25%). In this study 58% of patients developed cutaneous side effects of immunosuppressive drugs. Among the evaluated patients, 16% showed premalignant or malignant manifestations on physical examination. The most frequent manifestations were actinic keratosis (17%), basal cell carcinoma (1%), and squamous cell carcinoma (1%). On a retrospective analysis, 12% of patients developed skin cancer after transplantation, 66% squamous cell carcinoma and 34% basal cell carcinoma, with a ratio of 1.9 to 1. DISCUSSION: Cutaneous manifestations in renal transplant recipients are generally secondary to immunosuppression. These patients show a greater risk of having human papilloma virus (HPV) infections and nonmelanoma skin cancer. Periodic dermatologic evaluation of these patients should be performed to detect early lesions and modify risk factors.

Tipos histológicos y variables pronósticas en 569 casos de melanoma maligno de la piel, entre 1976 y 2001 / Histological types in 569 cases of malignant melanoma of the skin, between 1976 and 2001

El melanoma maligno (MM) primario de la piel ha incrementado su incidencia en todos los países del mundo, afectando a personas de todas las edades y de ambos sexos. Para conocer la frecuencia de tipos histológicos y de las variables pronósticas del melanoma maligno primario de la piel en nuestro hospital, se revisaron las biopsias del Departamento de Anatomía Patológica entre enero de 1976 y diciembre de 2001. Se revisaron 238.547 biopsias entre 1976 y 2001, encontrándose 569 casos de MM, 305 mujeres y 255 hombres; en 9 casos no se consignó el sexo. El promedio de edad de los casos fue de 51,8 años, sin diferencias entre hombres y mujeres. Del total de casos, 429 eran MM invasor (75,4 por ciento) y 140 MM in situ (24,6 por ciento). El tipo histológico del MM invasor más frecuentemente encontrado fue melanoma de tipo extensión superficial (27,4 por ciento), seguido por melanoma tipo nodular (17 por ciento). El promedio de espesor según Breslow para MM invasor fue de 1,2 mm. El MM de la piel es una neoplasia cada vez más frecuente en nuestro medio. En nuestra casuística tiende a predominar en mujeres y afecta a adultos en la edad media de la vida. Un porcentaje significativo de lesiones (24,6 por ciento) se detecta en una fase in situ, lo que es comparable al de estudios poblacionales norteamericanos.

Porocarcinoma ecrino asociado a poroma ecrino, leucemia linfática crónica y tumor de colisión metacrónico / Eccrine porocarcinoma in association with eccrine poroma, chronic lymphocytic leukemia and cutaneous collision tumor

Se presenta el caso de un paciente de sexo masculino de 78 años, con porocarcinoma ecrino del brazo, de 18 meses de evolución, asociado a un poroma ecrino en la piel del abdomen. Se realiza tratamiento quirúrgico de ambas lesiones. El estudio complementario demuestra una leucemia linfática crónica. Además, presentó en la evolución un tumor de colisión carcinoma basocelular-queratosis seborreica. Se revisan las características clínicas e histopatológicas del porocarcinoma ecrino y se discute esta rara asociación con el poroma ecrino y la leucemia linfática crónica (AU)

[Toxic epidermal necrolysis. Therapy in ICU with intravenous immunoglobulins in a case]. / Necrolisis epidérmica tóxica. Terapia en UCI con inmunoglobulinas intravenosas en un caso.

We report a 27 years old homosexual male with AIDS that was admitted to the ICU dehydrated, with fever and severe malaise. He had irregular bullae, an extensive purpuric exanthema and a zone of epidermic detachment in the right arm. A toxic epidermal necrolysis was diagnosed and therapy with i.v. immunoglobulins was started. After four days of treatment, bullous lesions disappeared and the extension of exanthema decreased. Toxic epidermal necrolysis is a potentially fatal disease and the use of intravenous immunoglobulins for this condition has been reported as successful.

Primary cutaneous angioplasmocellular hyperplasia.

Two cases of solitary nodules on the skin of the trunk of young adults showing a peculiar pattern of proliferation of blood vessels and a mixed inflammatory infiltrate with predominance of polyclonal plasma cell infiltration are presented. Follow-up of these patients after complete surgical excision revealed no recurrence. We interpreted the lesions within the morphologic spectrum of plasma cell infiltrates of the skin to be reactive and/or hyperplastic, which we term primary cutaneous angioplasmocellular hyperplasia.

Amiodarona y efectos secundarios cutáneos / Amiodarone and secondary cutaneous effects

El clorhidrato de amiodarona es un agente antiarrítmico con efectos secundarios cutáneos conocidos. Un grupo multidisciplinario de especialistas estudió durante 2 años a 148 pacientes en tratamiento crónico con amiodarona, con el propósito de evaluar los efectos secundarios del fármaco. Todos los pacientes fueron examinados por el mismo dermatólogo, buscando la presencia de alteraciones cutáneas y su correlación con la dosis y duración del tratamiento; 79 eran mujeres, con un promedio de edad de 65 años. Las dosis de amiodarona comprendían un rango de 100 a 400 mg/día. Los pacientes fueron controlados durante 2 años, pero el período de terapia con amiodarona fue de 1 a 9 años. Se encontró fotosensibilidad en 39,3 por ciento de los pacientes, hiperpigmentación azul-grisácea en 10 por ciento , ambos sin relación con la dosis. La presencia de eritema facial se constató en el 24 por ciento de los casos y se estableció que existía relación con la dosis. Un paciente debió suspender la terapia debido a una erupción pruriginosa de placas infiltrativas, las que regresaron completamente al suspender fármacos. 76 por ciento de los pacientes presentaban uno o más trastornos cutáneos diferentes de los relacionados con la miodarona. Estos incluyen micosis de pies y uñas, queratosis actínicas y seborreicas, xerosis y distrofias ungueales. Los efectos secundarios cutáneos son muy comunes y bien tolerados en los pacientes en terapia con amiodarona. La suspensión del tratamiento debido a los efectos secundarios cutáneos fue poco frecuente

[Efficacy and secondary effects of chronic treatment with amiodarone]. / Eficacia y efectos secundarios del tratamiento crónico con amiodarona.

Long-term therapy with amiodarone has been associated with a high incidence of adverse side effects, that precludes its indication for common cardiac arrhythmias. We have prospectively studied 218 patients (pts), aged 32-87 years, under chronic amiodarone therapy that were followed for 2 years and evaluated for efficacy and adverse side effects. Previous amiodarone treatment ranged from 1 to 135 months. Cardiac arrhythmias were paroxysmal AF (PAF) in 120 pts, sustained VT (SVT) in 36 pts, paroxysmal supraventricular tachycardia (PSVT) in 21 pts, unsustained VT (UVT) in 18 pts and miscellaneous in 23 pts. Amiodarone doses ranged from 500 to 4200 mg per week. Amiodarone was effective in 65% of all patients. No difference was observed between efficacy and type of arrhythmia. Dermatologic toxicity was found in 36%, neurologic toxicity in 23%, thyroid toxicity in 13.4% and pulmonary fibrosis en 2.5% of pts. Amiodarone was discontinued routinely when pulmonary toxicity was present. We conclude that amiodarone therapy is effective in a wide spectrum of arrhythmias. Although drug therapy was associated with a high incidence of adverse side effects, these did not preclude continuation of treatment.

Plasma cells within the infiltrate of primary cutaneous malignant melanoma of the skin. A confirmation of its histoprognostic value.

Plasma cells within the infiltrate of primary cutaneous malignant melanoma have been reported as a valuable criterion for the prediction of lymph node metastases. In order to evaluate plasma cells, their prognostic significance and their relationship with other clinical and histological parameters, 132 cases of malignant melanoma (29 plasma cell positive and 103 plasma cell negative) were studied. The Breslow thickness, location, and ulceration were the variables related to the presence of plasma cells. The most important variables in predicting survival were lymph node involvement, clinico-pathological type, age, plasma cells, and lymphatic emboli. The most important variables for disease-free interval were lymph node involvement, plasma cells, and age.

Free laminar thin band graft--a surgical therapeutic variant in the treatment of leg ulcers.

For the past 2 years, we have been using a surgical technique for the treatment of leg ulcers caused by chronic venous insufficiency. This consists of a type of graft biologically and technically intermediate between Reverdin and Thiersh's types. We have named it the "free laminar thin band graft." In contrast to the Thiersh graft, this simple surgical technique requires little equipment, and it can be done quickly and easily as an office procedure, with little risk to the patient. In addition, it is a low cost procedure. In our experience with this technique, healing time is shorter and lesions recur later than with the Reverdin graft. The authors describe the surgical method and report a clinical case.