Designing a Massive Open Online Course (MOOC) in face-to-face sessions. A blended design to teach practical histology.

Teaching histology, through virtual microscopy in educational strategies, undeniably moved towards the digitization and distancing of teaching. The setting up of the Massive Open Online Course (MOOC) entitled "Introduction to Histology: exploring the tissues of the human body" made it possible to exploit the potential to share digital resources with a wider audience while being integrated into the teaching on-campus students. This article described the pedagogical choices prevailing during the design of the MOOC and its combination with face-to-face sessions to achieve specific learning outcomes. The pedagogical alignment of learning outcomes described according to their cognitive levels, with online and face-to-face learning activities and evaluation methods has been demonstrated. The impact of such a blended design into an academic program has been ascertained using perception and performance data. Student satisfaction and engagement as well as motivational cues were identified. The level of performance was maintained in the educational strategy implemented and made it possible to achieve the objectives expected by the teachers. The benefits of integrating a MOOC with classroom-based teaching were highlighted, as well as barriers that could hinder the successful implementation.

[Melanoma : the patient's care pathway. From diagnosis to therapy]. / Le mélanome : le trajet de soins du patient. Le mélanome : le trajet de soins du patient Du diagnostic au traitement Du diagnostic au traitement.

The management of melanoma is a typical example of a pluridisciplinary approach, in order to provide the patient with a rapid and adequate treatment plan after the initial diagnosis. Both in the domains of dermatology, pathology and oncology, enormous progress has been made. Recent advances permit a rapid access to diagnostic techniques using teledermoscopy, an improved diagnostic accuracy using dermoscopy, pre-interventional high-frequency ultrasound and optical coherence tomography, a determination of risk factors using immunohistochemistry and genetic analyses on the pathology samples. Furthermore, the development of immunotherapies, in particular the anti-PD1 antibodies, and the directed therapies, therapies permitting an increased number of patients to experience an increased survival with an acceptable tolerance profile in the event of metastatic lesions. This article describes the patient's care pathway, from the initial diagnosis, staging, to an eventual treatment and follow-up.

Le traitement du mélanome est un exemple type de collaboration multidisciplinaire, afin de pouvoir garantir au patient une prise en charge rapide dès le moment de la détection de la lésion. Tant au niveau dermatologique, anatomopathologique et oncologique, d'énormes progrès ont eu lieu ces dernières années. Ils permettent un accès au diagnostic de plus en rapide par la télédermoscopie, une précision diagnostique accrue par la dermoscopie, l'ultrason à haute fréquence et la tomographie par cohérence optique, une détermination des facteurs de risque immunohistochimiques et génétiques sur les analyses anatomo-pathologiques ainsi que le recours à des immunothérapies, notamment les anti-PD1, et à des traitements ciblés. Ces nouveaux traitements permettent souvent une plus longue survie du patient, avec un profil de tolérance acceptable en cas de lésions métastatiques. Cet article reprend le trajet de soins du patient, du diagnostic initial et du staging au traitement éventuel avec son suivi.

[Locally advanced and metastatic cutaneous squamous cell carcinoma treated with cemiplimab]. / Carcinome spinocellulaire cutané localement avancé et métastatique traité par cémiplimab.

The treatment of locally advanced or metastatic cutaneous squamous cell carcinoma (cSCC) essentially relies on surgery and eventually radiotherapy of the treated site and afferent lymph nodes. Unfortunately, some cases are no candidates for surgery or radiotherapy and a systemic treatment may be indicated. Chemotherapies are only partially efficacious and associated with potential toxicities. A recent study evaluating the efficacy and tolerance of cemiplimab, a PD1 antagonist for locally advanced and metastatic cSCC demonstrated an objective response rate of 49 % and 47 % for locally advanced and metastatic cSCC, while maintaining a response of at least 6 months of 63 % and 60 %, respectively. We present a clinical case of a patient with a locally advanced cSCC of the forehead with bone resorption and cervical lymphadenopathies. After failure of multiple surgical interventions and radiotherapies, he responded partially to cemiplimab immunotherapy with a good safety profile.

Le traitement du carcinome spinocellulaire cutané (cSCC) localement avancé et/ou métastatique repose essentiellement sur la chirurgie et, éventuellement, sur une radiothérapie de la zone chirurgicale et de l'aire ganglionnaire afférente. Malheureusement, certains cas ne sont plus opérables ou accessibles à la radiothérapie et un traitement systémique est alors indiqué. Les chimiothérapies sont peu efficaces et potentiellement toxiques. Une étude récente évaluant l'efficacité et la tolérance du cémiplimab, un antagoniste PD1, dans les cSCC localement avancés et métastatiques, démontre une réponse objective confirmée de 49 % et de 47 %, respectivement, avec un maintien de la réponse d'au moins 6 mois de 63 % et de 60 %, respectivement. Nous présentons le cas d'un patient avec un cSCC localement avancé au niveau du front, avec effraction osseuse et adénopathies cervicales, ayant eu de multiples chirurgies et radiothérapies. Il a présenté une réponse partielle au cémiplimab avec un profil de tolérance satisfaisant.

[The psoriasis--metabolic syndrome comorbidity, a complex multigenic disease]. / La comorbidité psoriasis-syndrome métabolique, une maladie multigénique complexe.

Psoriasis is a common chronic inflammatory dermatitis mediated by cytokines released by dendritic plasmacytoid cells in combination with Th1- and Th17-cells. This complex and multifactorial condition is commonly associated with some comorbidities. The complexity of a coordinated management of such intricated pathologies is obvious. It calls for the so-called medicine "centered around the patient" which tops off the evidence-based medicine. Vitamin D by its immunomodulatory effect on T helper cells exerts a therapeutic benefit on psoriasis and some of its comorbidities including the metabolic syndrome. A vitamin D oral treatment was proposed in order to reduce the cardiovascular risk, and the ensuing morbidity and mortality.

[The thousand and one facets of skin stem cells. The future has found new roots]. / Les mille et un visages des cellules souches multipotentes de la peau. L'avenir a trouvé de nouvelles racines.

Multipotent stem cells of adult skin are found in distinct biological locations identified as niches. These stem cell populations are defined by specific molecular and functional attributes. The epidermal stem cells are found in the interfollicular areas and in the bulge and isthmus of the hair follicles. Dermal stem cells are harbored in the peripilar connective tissue sheaths and in the hair papilla. Some skin stem cells are found in extracutaneous sites. Other stem cells are involved in pathology, such as neoplastic stem cells identified in malignant melanomas.

[Physico-biological foundation of skin fluorescence--review]. / Fondements physico-biologiques de la fluorescence cutanée--Revue.

Fluorescence is a peculiar aspect of photoluminescence. Some intrinsic components of the skin are fluorophores. Other synthetic components are metabolized into fluorophores. These characteristics may be used for identifying some specific aspects of skin physiopathology. Recent technological evolution has provided new devices bringing sensitive and specific information from the skin. This review presents a synthesis of the progress made in the field of fluorescence and specular reflexion of incident UV light on the skin.

[Spectral analysis of the microvasculature of primary cutaneous melanoma]. / Introduction à l'analyse spectrale des réseaux microvasculaires du mélanome cutané primitif.

Cutaneous malignant melanoma represents one of the most dramatic skin cancers because its incidence is steadily growing in White populations. Of note, its metastatic risk and mortality dramatically increase when the primary neoplasm reaches about one millimeter thick. It is believed that angiogenesis and lymphangiogenesis associated with cutaneous melanoma potentially influence the neoplastic progression of the primary tumor and its metastases. In some instances, both the intratumoral and peritumoral microvasculature are correlated to booming of the tumoral growth fraction. In addition, the vascular network serves as a migration path for the intravascular and perivascular neoplastic spread. Hence, the quantification of the microvasculature might help establishing a prognostic factor of evolution. Among the available methods, spectral analysis of immunohistochemical sections highlighting vessels helps defining the microvasculature distribution. The benefit of using spectral analysis is discussed and the modalities of application of this analytical method are scrutinized.

[How I explore ... the diagnosis of syphilis]. / Comment j'explore ... l'hypothèse diagnostique d'une syphilis.

The versatility of the clinical presentations of syphilis is large. A laboratory diagnosis is required in any case where a clinical assumption is raised. Two main diagnostic methods are available according to the lesion aspects and the staging of the disease. They rely on the recognition of the spirochete or on the identification of the immune response using specific and non specific serology tests.

[Finding the drug in cutaneous drug eruptions]. / Imputabilité médicamenteuse dans les iatrogénies cutanées.

Drug eruptions are frequently encountered. Their putative diagnosis is based on a set of imputability arguments. The histopathological aspect is often evocative of the nature of the dermatosis. It varies according to the type of drug reaction. Some drug eruptions follow a benign course, but others are life-threatening.

[Behind the scenes of breast cancer]. / Les coulisses du cancer mammaire.

A 55 year-old women presented with lesions simulating cysts of the scalp. The dermatopathological examination revealed a metastasis of a breast adenocarcinoma. At the diagnosis disclosure, the patient recognized having concealed for 7 years a neoplastic wound replacing one of her breasts. About this case report, we report the astonishing clinical diversity of skin metastases of breast adenocarcinomas.

[Mammary Paget's disease]. / La maladie de Paget mammaire indicatrice d'un adénocarcinome sous-jacent.

Mammary Paget's disease is an intraepithelial carcinoma present on the nipple and its areola. The tumor typically develops in middle aged women. It is frequently associated or contiguous to an underlying galactophoric adenocarcinoma. The histopathologic and immunopathologic aspects are typical and linked to the presence of Paget's cells. Early diagnosis is required searching for a possible underlying carcinoma. The surgical treatment is directed by the characteristics of the deep mammary carcinoma.

Specular light reflectance of flakes in seborrhoeic dermatitis of the scalp: a pilot study.

Seborrhoeic dermatitis and dandruff are common scalp conditions. In this study, we set out to explore a new method for rating both the severity of the scalp condition and the efficacy of scalp-care compounds. Scalp flakiness was sampled for 40 volunteers using adhesive-coated clear discs, with image analysis used to quantify the specular light reflectance (SLR) of the flakes Two ultraviolet (UV)-emitting charge-coupled device cameras (Visioscan VC98 and Visiopor PP34) were used. SLR clearly highlighted the flakiness with high contrast against a black background, and the recorded appearance could be conveniently submitted to the image-analysis system for quantification. In conclusion, SLR under UV illumination highlights scalp flakiness, allowing objective measurements.

[Unraveling the ichthyosis types]. / Comment j'explore...le méli-mélo des ichtyoses.

Ichthyoses are hereditary and sometimes acquired diseases of keratinisation. They are heterogeneous according to their clinical and histopathological presentations, as well as to the nature of their molecular and genetic alterations. We present the most frequent types of hereditary ichthyoses.

[Fungi, pets and their owners]. / Les champignons des villes et des champs, les animaux de compagnie et leurs propriétaires.

Some parasitic or pathogen fungi for pet skin are possibly transmitted to humans in whom they are responsible for superficial mycozoonoses. Cats, dogs and some small rodents are commonly involved. The lesions correspond to glabrous skin dermatophytoses and to microsporic tinea of the scalp. These disorders represent the vast majority of the prevalent mycozoonoses in Wallonia. Microsporum canis and Trichophyton mentagrophytes are the two fungi that are commonly involved.

[Actinic keratosis in tune with field photocarcinogenesis. A revisited concept]. / La kératose actinique au diapason de la photocarcinogenèse en champs. Un concept revisité.

Actinic keratosis should no more be considered as a single neoplasm calling for an individual treatment. The concept of actinic photocarcinogenesis presently turns upside down the perception of skin cancers induced by nonionizing electromagnetic radiations. Currently, the clinician should cope with the whole skin area that has been damaged by chronic exposures to the visible and the invisible spectrum of the light. The therapeutic archetypes are 5-fluorouracile 5% and imiquimod 5% carefully applied to the skin area.

[Hurting the "black, yellow, red" dogma of leg ulcers]. / Les ulcères de jambe. Le dogme "noir, jaune, rouge" mis à mal.

The medical history of a leg ulcer is spangled with episodes contributing to its chronicity before leading to possible healing. The complexity of the involved biological factors is undisputable. In order to simplify the management of these lesions, some doctors and nurses summarize the evolution of a leg ulcer in 3 phases according to the colour of the wound bed: black, yellow and red. The latter stage is commonly considered as a favourable condition for skin healing. We criticize such a concept by showing the anatomo-functional heterogeneity of the red wound bed.

[How I explore...skin by photodiagnosis using skin fluorescence and its functional imaging]. / Comment j'explore...la peau par le photodiagnostic utilisant la fluorescence cutanée et son imagerie fonctionnelle.

Under specific light illumination, skin produces peculiar fluorescent aspects. Such property can be used to provide diagnostic arguments or to disclose some peculiar functions of the skin. Some superficial infections (erythrasma, tinea versicolor, dermatophytic tinea,..) reveal fluorescence that may be intense. The pilosebaceous follicles enriched in Propionibacterium spp show fluorescence. Such property is lost during some anti-acne treatments. A quenching effect is observed after application of sunscreens. The (pre)neoplastic areas prepared for dynamic phototherapy become fluorescent. Pyranine labeling of the stratum corneum exhibits fluorescence allowing the assessment of the renewal activity of the epidermis.

[Diagnostic defects and therapeutic set-backs in hair disorders]. / Echec a l'echec diagnostique et thérapeutique dans les pertes de cheveux.

Hair loss, also called hair effluvium is often considered as an ancillary complaint. However, this situation is quite common in both genders. It is part of numerous clinical presentations in internal medicine and dermatology. Obviously, any correlation between a biologic abnormality and hair loss does not prove a relationship of causality. In absence of pathogenic diagnosis and causality criteria, chances are low to control adequately hair effluvium by a treatment given by the whims of fate. In addition, the risk and frequency of therapeutic inertia are increased. When the hair loss is not controlled and/or compensated by growth of new hairs, several types of alopecia inexorably develop.

[Making strides facing "second flowering" syphilis papules]. / Faire un faux pas face a des syphilides "de deuxième floraison".

In a recent past, the incidence of syphilis has increased in various geographical regions, particularly in urban areas. In addition, the disease is particularly associated with HIV infection. In secondary syphilis, the diagnosis may prove to be particularly difficult to reach because the clinico-pathological resemblance with other skin disorders is commonly high. The risk of diagnostic roaming is associated with therapeutic inertia which is highly prejudiciable to the patient.