Speed rate (SR) as a new dynamic index of melanoma behavior.

Melanomas are skin tumors that show a variety of biological behavior. Some develop very fast and some other grow extremely slow, with metastasis appearing, eventually, many years after the diagnosis. The number of mitoses in primary melanoma has been related to a more aggressive tumor and may have a potential as predictive factor for cutaneous melanoma survival. However, tumor mitotic rate is a static measure and in multivariate analysis on tumor survival, it has scored less than other tumor characteristics. We tried to evolve tumor mitotic rate from a static parameter to a time-dependent one. Similar to the already described growth rate (GR), we propose the speed rate (SR). SR is defined as the ratio of tumor mitotic rate to time to melanoma development. A prospective series of 345 patients with melanoma was investigated for the role of SR as predictive factor for sentinel lymph node (SLN) positivity and tumor progression. We calculated the best threshold for SR and GR to predict the risk of recurrence. Melanoma clinical and histological characteristics as well as GR were correlated in a multivariated analysis with SR. SR values >0.2 mitoses/month were associated with negative prognostic factors such as ulceration (82.8%), SLN positivity (80%), progression (82.8%), and death (85.7%). The association of GR > 0.3 mm/months and SR > 0.2 mitoses/month had a significant predictive value in terms of SLN positivity, progression, and recurrence-free survival. We propose SR as a new "dynamic" predictor of histological SLN positivity and melanoma recurrence risk. We think that he association with this new feature with GR may be helpful in improving the accuracy of predicted clinical outcome of patient especially with thin melanomas.

Photodynamic therapy plus topical retinoids in Darier's disease.

Darier's disease is a rare, genetically determined, chronic disorder of keratinization. Characterized clinically by a symmetrical eruption of hypercheratotic papules with predilection for the seborrhoeic areas of the body. Many treatments have been suggested: emollients, topical retinoids, dermoabrasion, topical steroids and intermittent courses of oral antibiotics. Systemic retinoids are usually the treatment of choice. We present a small case series of patients treated with PDT and topical retinoids with good results. This therapeutic modality could represent an alternative to systemic retinoid treatment.