Reconstruction of retroauricolar surgical defect using the "jigsaw puzzle" advancement flap.

We present the case of a 55-year-old male patient who came to our attention because of a basal cell carcinoma of the right retroauricolar area, near the mastoid-auricle border. The tumor had a size of about 1.5 cm. Repairing retroauricolar surgical defects may be actually very challenging, firstly because an incorrect reconstruction may result in severe deformities which are extremely hard to conceal; so, we decided to employ the "jigsaw puzzle" advancement flap, a versatile flap, firstly successfully used in the reconstruction of a nasal ala defect.

Granuloma inframammary adultorum, a case report.

Granuloma inframammary adultorum represents a variant of erosive papulonodular dermatosis; we report a case of a patient with bilateral erosive plaques and nodules predominantly located under the breast.

Insulin-like-growth-factor-binding-protein-3 (IGFBP-3) contrasts melanoma progression in vitro and in vivo.

Insulin-like-factor-binding-protein 3 (IGFBP-3) is known to modulate the activity of insulin-like growth factors (IGFs) besides having a number of IGF-independent effects on cell growth and survival. IGFBP-3 has been reported to decrease significantly in the blood serum of patients affected by certain cancers. In the present work, we have evaluated the levels of IGFBP-3 in the blood serum and tissues of patients affected by cutaneous melanoma, showing that loss of IGFBP-3 from both is strongly correlated with disease progression and reduced survival. In vitro treatment with IGFBP-3 of human and murine metastatic melanoma cell lines specifically inhibited the cells' migratory and invasive behaviour, inducing up-regulation of melanocytic differentiation markers such as tyrosinase activity and melanin content. A molecular analysis of the cellular pathways transducing the effect of IGFBP-3 implicated the Akt-GSK3ß axis. Moreover, administration of IGFBP-3 in vivo to SCID mice inoculated with human metastatic melanoma cells strongly reduced or completely inhibited tumor growth. In summary, IGFBP-3 appears to exert a specific inhibitory effect on melanoma growth and dissemination, suggesting that it may qualify as a useful therapeutic agent in melanomas and perhaps other cancers, at the least as a valid adjuvant therapy during treatment with conventional anti-tumoral drugs.

Correlation between insulin-like growth factor binding protein-3 serum level and melanoma progression.

BACKGROUND: Insulin-like growth factor (IGF) binding protein (IGFBP)-3 is the main carrier of circulating IGFs and the main modulator of their activity. IGFBP-3 controls cellular availability of IGFs, which cannot exert their pro-proliferative activity while bound to IGFBP-3. Proteolysis of IGFBP-3 is one mechanism to control IGF release. A reduction of serum IGFBP-3 levels and the associated increased availability of IGFs may represent a strategy whereby melanoma increases its metastatic potential. OBJECTIVE: The aim of our study was to evaluate the correlation between the IGFBP-3 serum level and melanoma stage. METHODS: The study included 41 patients, 24 male and 17 female, with median age of 60 years (range 24-80), affected by cutaneous melanoma. Blood samples were taken from each patient and IGFBP-3 serum levels were measured using Western blot analysis with commercial antibodies. Values were normalized using commercial IGFBP-3. RESULTS: The statistical analysis showed that full-size, glycosylated IGFBP-3 concentrations were significantly lower in the sera of patients with stage IV melanoma. Low serum levels of IGFBP-3 correlated with both disease progression and presence of disease at the time of sample collection. In patients who underwent follow-up visits with further collections of blood samples, the concentrations of glycosylated IGFBP-3 decreased only in those who showed progression of disease. LIMITATIONS: Our study shows only preliminary results on a limited number of patients. CONCLUSION: We demonstrate that there is a significant inverse correlation between the serum concentration of full-size, glycosylated IGFBP-3 and disease progression in patients with melanoma.

Predictive factors for false negative sentinel lymph node in melanoma patients.

BACKGROUND: Sentinel lymph node biopsy (SLNB) represents a useful tool for staging melanoma patients. However false-negative SLNB are reported in the literature. OBJECTIVE: The aim of our study is to identify predictive factors for false-negative SLNB in melanoma patients. MATERIALS AND METHODS: We conducted a retrospective analysis on 316 melanoma patients who underwent SLNB and were followed up at the Department of Dermatology and Plastic Surgery of University of Rome "Sapienza" from March 1994 to June 2008. RESULTS: In our patients, SLNB was positive in 35 cases (11.07%) whereas it was negative in 281 cases (88.93%); 12/316 patients (3.8%) had positive SLNB and positive therapeutic lymph node dissection (TLND); 23/316 (7.28%) patients had positive SLNB and negative TLND; 266/316 (84.18%) patients had negative SLNB but without subsequent metastases in the SLN site; 15/316 (4.74%) patients had negative SLNB, but with subsequent metastases in the same SLN site (false-negative patients). Among the different prognostic factors, only ulceration was the main predictive factor for false-negative SLNB, according to statistical analysis (p=.0420). CONCLUSION: Our data confirm that SLNB is a useful technique for staging melanoma patients. However, in patients with negative SLNB, a closer follow-up is recommended when ulceration is present. The authors have indicated no significant interest with commercial supporters.

The reticular point of view in dermatoscopy.

BACKGROUND: Different dermatoscopic algorithms have been developed to evaluate pigmented lesions of the skin, with pattern analysis being the most commonly used. We sought to develop and evaluate a diagnostic scoring system, the reticular point of view, to distinguish common melanocytic nevus from dysplastic nevus and from melanoma. METHODS: We analyzed 1543 pigmented lesions, most of which contained a pigment network, and assessed the presence of linear extensions, thickened or hyperpigmented lines, areas of abrupt cut off, and areas with large "holes." We then conducted statistical analyses on these parameters to verify which of these exerted the most influence on the dermatologist's decision to surgically excise the lesion and to verify which feature was most linked to histopathologic signs of dysplasia or malignancy. RESULTS: Among the lesions excised, histopathologic examination revealed 33 (10.28%) melanomas. Among these, 25 (75.75%) showed an asymmetric distribution of the pigment network, whereas 20 (60.6%) showed a linear extension of it. The analysis of our data showed that all the evaluated criteria were statistically significant and played an important role in the dermatologist's decision to perform surgical excision of the lesion. Regarding the diagnosis of melanoma, only the presence of large holes, areas of abrupt cut off, and linear extensions revealed statistical significance. LIMITATIONS: Reticular point of view may be useful only in lesions with a large pigment network. It is not applicable in nodular, thick, and amelanotic melanomas that are usually lacking in pigment network. CONCLUSION: Although pattern analysis represents the most effective analytical method in dermatoscopy, our scoring system may be useful to distinguish between benign lesions, which need only clinical follow-up, and malignant lesions, which need surgical excision.

Amoxicillin-clavulanic acid-induced linear immunoglobulin A bullous dermatosis: case report and review of the literature.

BACKGROUND: Linear immunoglobulin A bullous dermatosis (LABD) is an autoimmune subepidermal blistering disease, rarely induced by drugs. METHODS: We describe a case of a 47-year-old man who developed a severe blistering eruption after therapy with amoxicillin-clavulanic acid. RESULTS: Histopathologic examination and direct immunofluorescence were consistent with a diagnosis of LABD. Therapy with dapsone controlled the disease but, after sun exposure, there was a worsening of the illness. CONCLUSION: To our knowledge, this is the first case of amoxicillin-clavulanic acid-induced LABD in an adult.

Management of skin ulcers in a patient with mycosis fungoides.

We present a patient with a cutaneous T-cell lymphoma/mycosis fungoides (CTCL/MF) followed for more than 10 years. After several different aggressive treatments to control progression of CTCL/MF, the patient developed several ulcerated tumors on the abdomen and limbs. Specific systemic antibiotic therapy failed to treat skin infection. While treating the stage III CTCL with polychemotherapy, we used an active colloidal hydrogel topically to manage wound healing and to treat and prevent potential sources of sepsis. After 11 weeks of treatment we observed complete cicatrization of ulcerated tumors. We reported on this case to describe the importance of a correct management of skin ulcers in immunosuppressed patients in order to avoid possible systemic spread of infection which represents the major cause of death in these patients.