RESUMO
Collision tumors consisting of melanoma and squamous cell carcinoma are very rare. We present the case of a deceptive hyperkeratotic nodule on the forearm of a 72-year-old woman, which clinically appeared to be a squamous cell carcinoma, keratoacanthoma type. Histological examination surprisingly revealed a coexisting epithelioid melanoma. Thus, this case report shows the importance of an early histopathological and immunohistochemical workup to prevent unnecessary diagnostic and therapeutic delay with negative effects on prognosis.
RESUMO
BACKGROUND: Fumaric acid esters (FAEs) are used for systemic therapy of moderate to severe psoriasis. Until recently, only a mixture of dimethyl fumarate (DMF) and three salts of ethyl hydrogen fumarate was available. However, a drug containing DMF as the sole ingredient was registered for the same indication in 2017. This prospective study aimed to investigate the switch from the currently used FAE mixture to DMF alone. PATIENTS AND METHODS: Forty patients were consecutively recruited, for whom the FAE mixture was switched to DMF alone on the basis of the last DMF-equivalent dose without interrupting treatment. At the first check-up after switching, the efficacy and tolerability of the DMF drug was compared with that of the previous treatment. RESULTS: The data show that the efficacy remained unchanged in the majority of patients. Tolerability (e.g. gastrointestinal complaints and flushing) of the DMF drug was rated equal or better in most patients than with the previous treatment. CONCLUSIONS: The results show that it is possible to switch psoriasis patients under stable therapy with the FAE mixture to the DMF drug directly and without interruption.
