[Facial skin cancers: Comparison of opinions in French multidisciplinary team meetings]. / Cancers cutanés de la face : avis comparés de réunions de concertation pluridisciplinaire françaises.

BACKGROUND: The aim of our study was to evaluate the diversity, or homogeneity, of recommendations made in multidisciplinary team meetings (MTM) concerning the management of facial skin cancers in France, and to analyze the determinants thereof. PATIENTS AND METHODS: We contacted a panel of dermatology and ENT multidisciplinary teams (MDT) and collected their recommendations made at meetings regarding 3 clinical cases: squamous cell carcinoma in a renal transplant patient with an incomplete excision margin (case 1), locally advanced basal cell carcinoma (case 2), and lentigo maligna (case 3). The responses were analyzed globally and then based on 2 subgroups defined by the presence or absence of a dermatologist in the MTM. The effect of the makeup of the MTM (based on the presence of a dermatologist, a plastic surgeon, an oncologist and an ENT specialist) was evaluated for the main therapeutic proposals. RESULTS: The opinions of the 45 MDMs that responded to the survey were mixed for the three cases as regards important elements such as the indication of surgical revision for case 1, the proposal of an alternative treatment to surgery for case 2, and monitoring arrangements for case 3. Certain proposals were associated with the presence of a dermatologist in the MTM, such as discussion of adaptation of immunosuppressive treatment and details of the surgical margins to be applied for case 1, as well as simple monitoring and details of monitoring arrangements in case 3. CONCLUSION: It is important to maintain dermatologists in MTMs on account of their expertise in all therapeutic areas concerning skin cancers.

[Wells syndrome mimicking facial cellulitis: Three cases]. / Syndrome de Wells mimant une cellulite infectieuse de la face : trois observations.

BACKGROUND: Wells syndrome, or eosinophilic cellulitis, is an uncommon inflammatory dermatosis of unknown etiology that is characterized by clinical features of pruritic cellulitis-like plaques on the extremities and a histological picture of eosinophilic infiltrate of the dermis with "flame figures". PATIENTS AND METHODS: Herein, we report three cases of idiopathic Wells syndrome masquerading as bacterial facial cellulitis. Under treatment with oral prednisone and/or combined therapy with levocetirizine and hydroxyzine, all patients showed a dramatic improvement of their skin lesions. DISCUSSION: These cases highlight the need to consider Wells syndrome in the differential diagnosis when evaluating a patient with facial cellulitis that does not respond to an initial antimicrobial regimen. In addition, our cases suggest that combined therapy with levocetirizine and hydroxyzine may be successfully used as first-line therapy or to prevent relapse after discontinuation of corticosteroid treatment.

Female genital mutilation in France.

PIP: The French Family Planning Association first protested to the World Health Organization in 1977 about its continuing silence about the genital mutilation of girls in Africa and the Far East. Though initially based more upon feminist concern for women's rights than upon the association's experience with female genital mutilation, the results of the practice became increasingly real and apparent in mother and child protection centers and family planning clinics as the wives and families of African immigrants arrived in France over the next few years. An estimated 100,000 immigrants live in the Paris region. The first reaction to the increasingly prevalent evidence of prior female genital mutilation was to not intervene in the practices of other cultures. It was only after a long period of raising awareness among health personnel, magistrates, institutes, and the general public that the problem began to be seen as something which needed to be addressed in France. It eventually took the death of two girls in 1982 to bring the issue into the open and force the authorities to take a stand against the practice in France. Health professionals and women attending family planning clinics are taught about female genital mutilation in an effort to prevent its continued practice. Information is also given to immigration candidates through French consulates about general family legislation in France and the prohibition of and punishment for female genital mutilation. Punishment can be from three months upwards in prison with fines. Several cases have come to court since 1982 and sentences have been passed against both fathers and mothers. Prevention kits of posters and leaflets have recently been published and distributed in the Paris area, but they will soon be available throughout France. Moreover, medical and social teams can and do report children at risk or who have suffered female genital mutilation through the normal channels for cases of child abuse.^ieng

Sex education in France.

PIP: The French Family Planning Movement (MFPF) has actively been involved in sex education within schools. In 1989, more than 1500 presentations were made to 23,000 pupils. Another activity is monitoring the application of statutes and regulations, for abortion, contraception, and sex education, and fighting to save and advance the rights of sexuality experts. Because of MFPF prominence in serious risks such as AIDs, sexual abuse, and rape, credibility has been enhanced. MFPF serves as a vehicle to change attitudes on male/female relationships. The government has permitted involvement in the preparation of a teaching program dealing with sexual abuse. The dominant influence of the Catholic Church on education has been evident since 1807. Up to WWI, religious morality was dominant. With Freud's contributions to the importance of sexuality in individual life, there were questions raised and a call for change in values and customs. In 1967, the statute was passed which authorized contraception, and sex education became an important issue. In 1973, Fontanet as Minister of Education outlined the recommendation for sex information and education in schools, including reproduction. Further official supportive recommendations were not made until 1985 when life education was entered into the primary syllabus. There was no provision even for teacher training; hence a wide variability in skills, commitment, and attitudes prevailed. MFPF reflects a position on tolerance in listening to others, expression and analysis of differences and critical thinking, identifying difficulties in talking about sex with respect to cultural and religious diversity, and help for the young in learning about their bodies, expressing feelings, and taking charge of emotions.^ieng