Pityriasis lichenoides-like secondary syphilis and neurosyphilis in a HIV-infected patient.

Papulo- and vesiculo-necrotic lesions are rare manifestations of secondary syphilis. Until now it has been described only in HIV-infected patients with advanced stages of immunosuppression. This case report describes an unusual case of PLEVA-like syphilis in a 33-year-old man with newly diagnosed HIV infection. Despite that the CD4 cells level and viral load did not indicate the advance stage of immunosuppression, the unusual manifestation of syphilis and neurosyphilis occurred. The presented case indicates the need for HIV screening in every patient with syphilis especially when the clinical manifestation is unusual. Importance of syphilis testing in every case with atypical rashes should be also highlighted.

[Dermoscopic pattern analysis of acral melanocytic nevi]. / Analiza wzorców dermoskopowych zmian melanocytowych zlokalizowanych w okolicach akralnych.

BACKGROUND: Dermoscopy is a non-invasive diagnostic technique that allows visualization melanocytic lesions in even up to 100x magnification. Pattern, structure, distribution and density of melanin pigmentation allows to perform differential diagnosis between benign melanocytic nevi and malignant melanoma. Unique anatomical structure of acral volar skin determine the dermoscopic patterns of acral melanocytic lesions OBJECTIVE: The aim of the study was to analyse retrospectively dermoscopic patterns observed on the soles of the feet of the patients who were diagnosed at the Department of Dermatology Jagiellonian University, Krakow. MATERIALS AND METHODS: Using retrospective data 360 dermoscopic images of acral melanocytic lesions present on the soles of 257 Caucasian patients were analysed, 179 (69.6%) women and 78 (30.4%) men. The types of patterns, the frequency of their occurrence and distribution of patterns on the skin soles of the feet have been analysed. Statistical analysis was performed using IBM SPSS Statistics. RESULTS: The most common pattern was the lattice-like pattern, which was seen in 120 (33.3%) images of melanocytic nevi. The fibrillar pattern was detected in 109 (30%) images and the parallel furrow pattern was identified in 80 (22.2%) images. 131 (36.4%) melanocytic lesions were located in arch area of the soles, while 126 (35%) in areas directly pressed by body weight and 103 (28.6%) in other areas. The fibrillar pattern was mostly observed in melanocytic lesions located in areas directly pressed by body weight 94 (86.2%), while the lattice-like pattern in arch area 81 (67.5%) and the parallel furrow pattern in other areas of the soles of the feet 51 (63.7%). Two of the melanocytic lesions showed nonspecific pattern and one parallel ridge pattern. One acral malignant lesion localized in arch area of the sole was detected. CONCLUSION: Dermoscopic patterns seen in melanocytic nevi in European population are similar to those seen in Japanese population. In analysed population the most common patten was lattice like pattern, followed by fibrillar and parallel furrow pattern, which differs from results of other studies Analysis showed differences in distribution of melanocytic nevi between anatomical sites of the soles. The lattice-like pattern was mosly observed in arch area, the fibrillar pat tern in areas directly pressed by body weight, the parallel furrow pattern in other areas. Vast majority of dermoscopic images showed patterns describing benign melanocytic lesions. Three of 360 melanocytic lesions had dermoscopic signs of malignancy.

[The latest diagnostical methods and therapy in melanoma]. / Najnowsze metody diagnostyczne i leczenie w czerniaku.

Molecular biology, immunology, diagnostic and treatment of cutaneous melanoma have been analyzed on the basis of current literature due to the increasing frequency of this cancer. Due to the increasing frequency of melanoma it is crucial to detect early the malignant lesions on the basis of physical examination and noninvasive diagnostic methods (dermatoscopy, videodermatoscopy with total body photography). Histopathological examination is conclusive. In diagnostic imaging of early stage melanoma it is very important to evaluate the regional lymph node. In clinical practice, the cross-sectional imaging modalities including computed tomography (CT), ultrasound and magnetic resonance (MR) are widely used to assess lymph nodes. Sentinel lymph node (SLN) biopsy is currenly a valuable and reliable diagnostic procedure for precise staging of patients with clinically no cutaneous melanoma. The presence of SLN metastases is the most important negative factor for clinical outcome in melanoma patients. Introduction of RT-PCR allowed to detect individual cancer cells in tested sample of blood or tissue. Surgical treatment is an essential therapeutic modality in patients with melanoma. Treatment of a primary melanoma involves local excision of the tumour with a margin of skin and subcutaneous tissue. The role of systemic therapy is still a matter of clinical trials. Today's systemic therapy modalities include the use of biological agents (e.g. interferon alfa and interleukin 2) and cytotoxic agents. The efficacy of different types of melanoma vaccines (antigenic, cellular, DNA, GMTV) has been analyzed in numerous clinical trials. Results of these trials are still unsatisfactory. Dendritic cells in melanoma therapy will be very important in the future. Dendritic cells are the most efficient stimulators of T lymphocyte response among professional antygen presenting cells (APC) and the only APC capable to prime naive T lymphocytes with the antygen. A response to weakly immunogenic and tolerogenic tumor antigens can be achived with the use of DC as APC. This review represents an attempt to discuss current evidence on the place of adjuvant and palliative systemic therapy in melanoma.