Rintala Flap and Posterior Perichondrial Cutaneous Graft: A Combined Approach for Nasal Tip Reconstruction.

Nasal tip reconstruction requires a meticulous approach due to the complexity of the nasal anatomy and its aesthetic importance. Many procedures have been described to restore this aesthetic unit, including the paramedian forehead flap, which is one of the workhorse flaps. However, despite excellent final outcomes, this procedure may be refused by patients, due to its temporary conspicuous appearance possibly associated with serious psychological implications, and the need of multiple interventions. We aimed to present an approach combining the Rintala flap and the posterior perichondrial cutaneous graft as a valuable alternative to treat large nasal tip defects.

Survival outcomes and epidemiology of Merkel cell carcinoma of the lower limb and hip: A Surveillance, Epidemiology, and End Results analysis 2000-2018.

BACKGROUND: Merkel cell carcinoma of lower limb and hip skin is a rare skin tumor that has a high recurrence rate. OBJECTIVE: To assess epidemiology and survival outcomes of the lower limb and hip Merkel cell carcinoma, which are less addressed in the literature. METHODS: The Surveillance, Epidemiology, and End Results database was searched for all cases of skin Merkel cell carcinoma between 2000 and 2018. Demographic and clinicopathologic features were compared between lower limb and other skin localizations using the t test or χ2 test. The overall survival (OS) of lower limb Merkel cell carcinoma was calculated using the Kaplan-Meier method. Subgroups were compared using the log rank test. Multivariate cox regression was used to identify independent prognostic factors. RESULTS: In total, 976 patients were identified. The mean age was 72.7 years. The median OS was 68 months, better than that of other localizations. Older age, regional lymph node, and distant metastasis were associated with low OS. Surgery with >1-cm margins, when associated with radiotherapy, had the best OS. Age, tumor size, lymph node status, presence of metastasis, and treatment sequence were identified as independent prognostic factors. CONCLUSION: Lower limb and hip Merkel cell carcinomas have better OS than tumors in other skin localizations. In this dataset, the best OS was ensured using surgery with >1-cm margins and adjuvant radiotherapy.

Corrigendum: Epigenetics and Metabolism in Health and Disease.

[This corrects the article DOI: 10.3389/fgene.2018.00361.].

[A plethora of choices: treating actinic keratoses]. / Traitement des kératoses actiniques†: l'embarras du choix.

Actinic keratoses are the most frequent precancerous lesions on Caucasian skin, often giving rise to squamous cell carcinomas. Appropriate prophylaxis, screening, and early intervention can substantially reduce the incidence of the latter. While isolated actinic keratoses can easily be treated by means of cryotherapy or curettage, multiple lesions often occurring on chronically sun-damaged skin demand more potent therapeutic strategies, such as topical cytostatic or immunomodulatory drugs, or photodynamic therapy. In this review, we give a practice-oriented overview on clinical manifestations, prevention, and treatment of actinic keratoses, and we emphasise the role of general practitioners in the management of this important pathology.

Les kératoses actiniques sont les lésions précancéreuses les plus fréquentes du phénotype caucasien, présentant un risque de transformation en carcinomes épidermoïdes cutanés. L'incidence de ces derniers peut être réduite par la prophylaxie, le dépistage et la prise en charge dermatologique précoce. Alors que les kératoses actiniques isolées peuvent être facilement traitées par la cryothérapie ou le curettage, les lésions multiples, survenant souvent sur la peau chroniquement endommagée par le soleil, exigent des stratégies thérapeutiques plus puissantes, telles que des médicaments topiques cytostatiques ou immunomodulateurs, ou la thérapie photodynamique (PDT). Cet article donne un aperçu pratique des manifestations cliniques, de la prévention et du traitement des kératoses actiniques, et souligne le rôle des médecins généralistes dans la gestion de cette pathologie importante.

Epigenetics and Metabolism in Health and Disease.

In the next 10 years, one billion people are estimated to suffer from disabling consequences of metabolic disorders, making them the number one noncommunicable disease on a global scale by 2030. Lots of risk factors such as dietary intake, lack of exercise and other life style behaviors are considered to play a role in the development of metabolic disorders. Despite the efforts that have been undertaken to unravel their potential causes, the underlying molecular mechanisms remain elusive. Evidence suggests that the pathogenesis involves changes on chromatin and chromatin-modifying enzymes, which can contribute to a persistent dysregulated metabolic phenotype. Indeed, a rising number of studies links epigenetic alterations with the diagnosis and prognosis of metabolic disorders. A prerequisite for exploiting these findings for pharmacological intervention is a detailed understanding of how differential epigenetic modifications control cell metabolism. In this mini review, we summarize the recent advances in uncovering the interplay between epigenetics and metabolic pathways on a cellular level and highlight potential new avenues for alternative treatment strategies.

Ingenol Mebutate for Recalcitrant Chronic Actinic Cheilitis.

We present the case of a healthy 76-year-old man with a whitish, hyperkeratotic lesion of the lower lip diagnosed as actinic cheilitis (AC) previously treated with classic red light photodynamic therapy 5 years ago. Initial treatment with 5% imiquimod cream - also with intensified application - failed. After 2 cycles thrice daily, consecutive applications of 150 µg/g ingenol mebutate gel at 3 weeks' interval, the lesions cleared completely. Surprisingly, no pustular or crusting reaction or other side effect occurred contrary to expectation. Remission was stable for 10 months, when recurrence occurred. Ingenol mebutate proved to be a feasible and safe treatment in this otherwise refractory case of AC.

[Chronic leg ulcers and Pseudomonas aeruginosa infection]. / Surinfection de plaie chronique par Pseudomonas aeruginosa.

Pseudomonas aeruginosa (PA) is a Gram-negative germ, responsible for severe infections. PA infected chronic wounds are a clinically highly relevant topic. PA has a natural resistance to many antibiotics, and there is no consensus on a first-line antibiotic to be used. In the context of chronic ulcers with an unfavorable evolution, we suggest intravenous antibiotic therapy, ideally on an in-patient basis. Given the sparse evidence from clinical trials, we heavily rely on clinical experience when it comes to managing chronic ulcers infected with PA.

Cutaneous leukocytoclastic vasculitis associated with letrozole.

Aromatase inhibitors are increasingly used in the treatment of early and metastatic breast cancer. They can produce various skin adverse effects but are only rarely associated with cutaneous vasculitis. We report the first case of cutaneous vasculitis clearly associated with the use of aromatase inhibitor letrozole.

[New therapeutic weapons in stage IV melanoma]. / Nouvelles armes thérapeutiques contre le mélanome de stade IV.

The treatment of stage IV melanoma has been revolutionized over the last years with the development of immunotherapies that, for the first time, have shown a significant benefit in overall survival, as well as with extremely effective targeted therapies, that also led to improved survival. These results are the fruits of an important translational research effort that allowed a rational approach with a very fast clinical development. The treatment of metastatic melanoma is, therefore, an illustration of the new paradigms of modern molecular research in oncology. In this review, we will present the various agents that have made the proof of their clinical benefit, as well as the scientific discoveries that allowed their development. Some of the remaining questions will be touched upon with the ongoing clinical trials. Inclusion of patients in these studies remains the top priority to improve on the clinical care.

Influence of nanoreactor environment and substrate location on the activity of horseradish peroxidase in olive oil based water-in-oil microemulsions.

Oxidative enzymatic reactions using horseradish peroxidase (HRP) were carried out in water-in-oil (w/o) microemulsions composed of olive oil/lecithin/1-propanol/water, a model biomimetic system. The substrates used (gallic acid, octyl gallate and 2,2'-azino-bis[3-ethylbenzo-thiazoline-6-sulfonic acid] (ABTS)) have different hydrophobicities and possible locations in the microemulsion system. HRP reactivity with reference to substrate hydrophobicity and structural characteristics of the microemulsions is discussed. The nature of the enzyme microenvironments was examined using dynamic light scattering (DLS), differential scanning calorimetry (DSC) and diffusion NMR (DOSY) methodologies while the location of various enzymatic substrates in the microemulsion phase was assessed by solubility measurements and by taking pressure-area isotherms of mixed monolayers of the substrates with dipalmitoyl-phosphatidylcholine (DPPC), which is a major constituent of lecithin. In contrast to the bulk aqueous phase, in the severely restricted environment of the polar domains of the microemulsion HRP reacted faster with octyl gallate, a substrate that is solubilized at the lipid interfaces. HRP was deactivated in the olive oil microemulsions within a few hours, a phenomenon that has also been observed in other microemulsion systems.