[Dermatofibrosarcoma Darier and Ferrand. Immunohistochemistry study of 38 cases. Research on a specific marker]. / Dermatofibrosarcome de Darier et Ferrand. Etude immunohistochimique de 38 cas. A la recherche d'un marqueur spécifique.

This is a retrospective pathological and immunohistochemical study of 38 cases of dermatofibrosarcoma protuberans. It is a rare dermal and subcutaneous spindle cell tumor which may be difficult to diagnose. We tested the value of the CD34 antibody and compared this series with 15 fibrous histiocytomas and II neurofibromas. Thirty-one dermatofibrosarcoma protuberans were positive for CD34 and 7 were negative. All the fibrous histiocytomas were negative. Nine neurofibromas were positive with variable expression of CD34 antigen. The CD34 antibody seems to be a sensitive marker to differentiate dermatofibrosarcoma protuberans from fibrous histiocytoma. It is specific for the dermatofibrosarcoma protuberans in the context of differential diagnosis between these two tumors. The role of immunohistochemical staining remains useful within the anatomoclinical context.

Rationale for automatic scanners in laser treatment of port wine stains.

Laser therapy of port wine stains (PWS) is well established. However, the application of lasers to PWS treatment over the last decade has resulted in the use of many laser systems. The goal of this study is to describe the different laser parameters, treatment techniques, and delivery systems. Two methods, coagulation and microvaporization, are used to destroy the abnormal blood vessels. The coagulation method results in excellent treatment, but it requires careful control of laser parameters during the treatment process. Scanning devices can be utilized for this purpose. The microvaporization method, obtained with a pulsed dye laser, is restricted to PWS composed of small vessels since it is difficult to obtain a pulse longer than 450 microseconds. In addition, numerous retreatments are needed with the pulsed dye method. The initial assessment of the patient should contribute to an improvement in the choice of laser parameters and the outcome of treatment.

Relation between skin surface temperature and minimal blanching during argon, Nd-YAG 532, and CW dye 585 laser therapy of port-wine stains.

Laser photocoagulation has proven to be valuable in the treatment of port-wine stains. In this application, the minimal blanching technique is used as an indicator of suitable dosage since it has been demonstrated that the immediate appearance a white mark is required to achieve permanent blanching a few months later. The objective of the investigations undertaken in this study was to correlate the temperature attained at the surface of port-wine stains with immediate blanching, upon irradiation with different laser fluences. A comparative study was performed using an argon laser (all lines), a 532 nm Nd:YAG and a 585 nm argon pumped dye laser. Surface temperature was studied using an infrared camera. Temperature was measured on 10 different port-wine stains using different fluences. Whitening threshold fluence was related to surface temperature. It appeared that whitening threshold fluence corresponded to a surface temperature of 53 degrees C (+/- 3 degrees C). The whitening threshold fluence was dependent on port-wine stains and wavelength. However, whitening threshold fluence remained lower for 532 nm and 585 nm and it correlated to the absorption curve of hemoglobin.

Comparative study of the "point-by-point technique" and the "scanning technique" for laser treatment of port-wine stain.

Photocoagulation using the argon laser has been proven to be an effective method for the treatment of port-wine stains (PWS). However, it is very difficult to reproduce the parameters of laser treatment. This leads to inaccurate energy dosages secondary to the difference in treatment patterns. The aim of this study was to compare the conventional point-by-point technique (PT) for PWS treatment against a new scanning technique (ST) using a device called "Hexascan" (PREIN & Partners, Ferney-Voltaire, France). A total of 249 patients (171 females and 78 males) using the argon laser have been studied in a retrospective study. Clinical results are presented. For each technique, blanching and hypertrophic scarring were examined. The results are classified into two groups: satisfactory and unsatisfactory. The clinical results show that the ST with the Hexascan is superior to the conventional PT. Scarring is drastically reduced because overdosage and overheating are avoided. Because of precisely controlled spot patterns, quality and homogeneity of blanching is improved. Treatment time can be reduced to 20% of that of the PT.

Robotized scanning laser handpiece for the treatment of port wine stains and other angiodysplasias.

Port wine stains are currently treated by the argon laser with the "point-by-point" technique, or the "painting technique." In both cases, the quality of the results depends greatly on the dermatologist's experience. Furthermore, the first technique is slow, and the second is painful and requires anesthesia. Therefore, we have decided to design a robotized system with the following specifications: easy, fast, non-painful treatment giving a homogeneous and reproducible blanching. The system is made of a handpiece with the scanning mechanism and a control box with the microprocessor. The system is independent of the laser (no electrical connection) and has its own power meter. The deposit of energy was optimized in function of heat diffusion in the skin. Over a 12-month period, 123 patients were treated with the robotized handpiece. The treatment modalities and the results conformed to the above-mentioned specifications. Hypertrophic scars were not reported. Therefore, we think that this system will be an interesting tool for the laser treatment of port wine stains and other cutaneous angiodysplasias.

Management of vulvar condylomata acuminata with argon laser.

One hundred and one female patients with vulvar condylomata acuminata were treated with the argon laser. Most were managed under regional or general anesthesia because of the large size and extent of the warts. Ten patients were lost to follow-up after the first session. Of 91 other patients, 78 (86%) were free of lesions on follow-up examinations after one or two treatments. The 13 other patients had recurrent lesions: seven patients underwent three laser sessions; four required four sessions, and 2 others required five and six sessions, respectively. These results were comparable with those achieved with the carbon dioxide laser.

[Lasers in dermatology]. / Les lasers en dermatologie.

Lasers are mainly used in therapeutics for their thermic effects. In dermatology, the most appropriate is the argon laser and its only uncontroverted indication is part-wine stain. The blue-green radiations of the argon laser are selectively absorbed by the haemoglobin pigment, so that coagulation necrosis is maximum in the dysplastic vessels. Since the non-pigmented surrounding tissues and, more precisely, skin appendages are relatively respected, healing is rapid and of good quality. Following the often protracted treatment, a satisfactory downgrading of colour is obtained, without scar in 60-80% of cases. The best results are observed in dark portwine stains located on the face or trunk in adults. All other indications are open to discussion since the superiority of laser over other treatments remains to be demonstrated or confirmed. Interesting indications are spider angioma and telangiectasis of the face (argon laser), extensive ano-genital verrucosis (CO2 laser or argon laser), mucosal leukoplasia and some cases of Bowen's disease affecting the genitalia.

[Apropos of the Mali syndrome]. / A propos du syndrome de Mali.

The authors report two original cases of profuse pigmentation associated with proliferative lesions of the lower limbs, in patients with venous incompetence, suggestive if the syndrome described by Mali and al. in 1963. One case was in fact of Kaposi's disease associated with severe thrombocytopenia which was the cause of death, despite the use of Chloraminophene-Cortancyl. The other case was a woman with profuse pigmentation of the lower limbs associated with multiple disseminated lesions of allergic vasculitis, probably of drug origin. Suppression of the drug and rest led to a marked improvement in the lesions. Although very different from each other, both of these cases are suggestive of Mali's syndrome, but their treatment was totally opposite. The first case, a real vascular neoplasia, required the combination of antimitotic-steroid ; the second case, on the contrary, resolved with rest and a simple elastic bandage, like allcutaneous venous lesions, in particular Mali's syndrome.

Basal cell carcinoma overlying histiocytofibroma.

A case of basal cell epithelioma overlying a long-standing histiocytofibroma is presented. The association of these two tumors is a rare finding. The role of dermal factors in the pathogenesis of epidermal tumors is briefly discussed, just as the controversy about the reactive or neoplastic nature of the epidermal change.

[Bazin's hydroa vacciniforme : photobiological and metabolic study in 3 cases, and discussion on etiopathogenicity (author's transl)]. / L'hydroa vacciniforme de Bazin. A propose de trois observations originales. Etude photobiologique et métabolique. Discussion étiopathogénique.

The authors described three cases of Bazin's hydroa vacciniforme. Study of the history of the disease enables present nosological conceptions to be better understood. Diagnosis of hydroa vacciniforme is essentially clinical : appearance of the rash, periodicity and spontaneous improvement after puberty are characteristic. Hydroa vacciniforme has to be distinguished from porphyrias and polymorphous light sensitive eruptions. The etiology of this photodermatosis of child is unknown, but associated disturbances in tryptophan metabolism in some cases seem to be linked to a vitamin B6 deficiency.

[Laser in dermatology: biological effects; indications (author's transl)]. / Les lasers en dermatologie: effets biologiques - indications thérapeutiques.

The various laser-systems can be classified according to: 1) the wavelength or range of wavelengths of the beam and 2) the method of delivery of the laser output: continuous or pulsed. -- Principal continuous-wave lasers are: -- the argon-ion laser, which produces multiple transitions ranging from 448 to 544 nm, -- the neodymium yttrium aluminium garnet (Y. A. G.) operating in the near infrared at a wavelength of 1,060 nm, -- and the carbon-dioxide laser with its output occurring in the far infrared, at 10,600 nm. Continuous-wave lasers induce essentially thermal effects which are used to coagulate or volatilize various superficial skin lesions. But when high power density is required, the relative benefit of lasers as compared with other conventional thermal devices (such as high-frequency electrocoagulator) is not obvious. On the other hand, the argon laser is capable of selectivity damaging pigmented cutaneous lesions with satisfactory healing of the laser wound and sparing of the overlying skin. This selective absorption is useful in the treatment of some vascular lesions such as port-wine stain or melanotic lesions or tattoos, and gives a good results. The specific color absorption is not so pronounced with the Nd-YAG laser and is absent with the carbon dioxide laser, chiefly used as an "optical scalpel". Photochemical effects produced by other continuous-wave lasers such as U.V. lasers, seem to be of interest in photobiology research and in destruction of tumors after the addition of a colorant. -- Pulsed laser systems produce not only thermal but also "non-linear" reactions, which are not well-known. The classical ruby laser is still appropriate in the treatment of some skin lesions.

[Disseminated cutaneous osteomatosis in an infant (author's transl)]. / L'ostéomatose cutanée diffuse du nourrisson.

An infant with disseminated cutaneous osteomatosis as described by Worret and Burgdorf is described. The diagnosis was confirmed by histology which distinguished the bone formation from sub-cutaneous calcification. The prognosis of disseminated cutaneous osteomatosis is guarded because there may be extensive skin involvement and because of the absence of effective treatment.