Relationship between tumor-associated immune infiltrate and p16 staining over clinicopathological features in acral lentiginous melanoma.

PURPOSE: This study aims to evaluate the association between composition of tumor-infiltrating lymphocytes (TIL) and expression of p16 in acral lentiginous melanoma (ALM), and their impact on prognosis. MATERIALS AND METHODS: A cohort of 148 surgical pathology specimens of ALM was studied. TIL were evaluated by immunohistochemical detection of CD3 and CD8, along with CD20, CD4, CD68, and CD163 in a subset of 43 cases. p16 protein expression was also investigated in all the cases. RESULTS: The median age was 66 years, median Breslow thickness was 6.0 mm, grade III TIL was found in 28.4% and lymph nodes were involved in 54.2%. Breslow thickness (p < 0.001), stage I-II (p < 0.001), negative lymph nodes (p < 0.001) and < 10% p16 (p = 0.01) were associated with longer survival. Grade III of TIL was associated with thinner Breslow thickness (p = 0.008) and lower mitosis (p = 0.047). A higher density of CD3 TIL was associated with male gender (p = 0.008), thinner Breslow thickness (p = 0.047), negative lymph node (p = 0.031), early stage (p = 0.046), and p16 nuclear expression of > 10% (p = 0.045). Higher CD8 TIL was associated with > p16 (p = 0.03). Survival analysis found that longer survival had a trend to be associated with high TIL (p = 0.090). Levels of CD3+ and CD8+ cells were correlated with those of CD4+, CD20+, CD68+ and CD163+ immune cells. CONCLUSIONS: Higher levels of TIL tend to be associated with better overall survival in ALM. Loss of expression of p16 is associated with lower levels of CD3+ and CD8+ TIL, indicating a probable relationship between p16 and TIL immune response in ALM .

Individuals exhibiting conspicuous nevi (lentigo simplex) are resistant to allergic rhinitis/conjunctivitis (pollinosis), but those who do not show increased susceptibility to pollinosis.

We investigated 115 individuals in Tokyo from two groups of persons with conspicuous nevi on the head, neck, and arms, etc. (nevus-positive group) and persons who do not exhibit such nevi (nevi-negative group) interviewing them to determine whether they suffered from allergic rhinitis/conjunctivitis (pollinosis) and examining them for the presence and extent of nevi. There was a distinct correlation: only 5 persons among 85 individuals of the nevus-positive group suffered from pollinosis, and all 30 people in the nevus-negative group had pollinosis. Thus, individuals exhibiting conspicuous nevi are resistant to pollinosis, but those who do not show increased susceptibility to pollinosis.

Regresión de un melanoma lentiginoso acralcon inmunoterapia usando un complejopolisacárido extraído de Mycobacteriumtuberculosis (Tubercin) / Regression of an acral lentiginous melanoma with an immunotherapy using a Mycobacterium tuberculosis-extracted polysaccharide complex (Tubercin)

Una mujer de 77 años se presentó en consulta con una lesión pigmentada no dolorosa que había padecido durante 10 años, aproximadamente, pero que había aumentado significativamente en tamaño durante los últimos 3 meses. Sus antecedentes no eran reseñables, pero había sido granjera durante más de 50 años y se exponía sistemáticamente a cantidades excesivas de luz solar. En la exploración se observó una lesión de 11 x 15 mm en la base del dedo pulgar de la mano izquierda. La lesión era de color negro, sobresalía ligeramente y tenía forma irregular, con un borde relativamente demarcado. En la exploración histológica de la muestra de la biopsia se encontró un melanoma lentiginoso acral (MLA) con un grosor de 4 mm. Mediante tomografía computarizada de todo el cuerpo y gammagrafía ósea se demostró que no había metástasis distales. La paciente rechazó no sólo el tratamiento quirúrgico, sino también el tratamiento de quimioterapia recomendado debido a su edad avanzada. Entonces fue enviada al Centro Colaborador de la OMS de Hepatitis Vírica de la Universidad Nacional de Kyungpook para considerar la inmunoterapia con Tubercin. La paciente aceptó realizar un ensayo farmacológico con Tubercin, que se inició el 24 de diciembre de 1999. Recibió tres inyecciones subcutáneas en la zona de la lesión de 0,3 ml de Tubercin e inyecciones intramusculares en los glúteos en días alternos. Después de diez meses de tratamiento, la lesión presentó un aspecto de mácula de color castaño suave y se observó casi una regresión completa. En la exploración histológica de control realizada después de un año no se encontraron pruebas de melanoma (Figura 1). El sistema de tratamiento se redujo a la administración cada dos semanas de dos inyecciones de 0,2 ml en la lesión y una inyección intramuscular de 2 ml. Después de otro año, el tratamiento será reducido a una inyección intramuscular de 1 ml cada dos semanas. La paciente ha permanecido sin metástasis y no ha presentado reacciones sistémicas ni locales (AU)

Topical chemotherapy of lentigo maligna with 5-fluorouracil.

Three patients with biopsy-proven lentigo maligna were treated with topical 5-fluorouracil. Treatment consisted of twice daily application of 5% 5-fluorouracil cream for 13, 6, and 9 weeks, respectively. Two patients demonstrated presence of invasive melanoma; in one the melanoma was evident before chemotherapy, and in the other the lesion became evident after chemotherapy. In both the lentigo was treated topically and the melanoma excised locally. Posttreatment followup times through April 1, 1974 have been 42, 24, and 22 months, respectively. There has been no evidence of metastases in any patient. Topical chemotherapy with 5-fluorouracil cream appears to offer an encouraging alternative method of therapy for lentigo maligna of the face.