Granulocyte-macrophage colony-stimulating factor alone or with dacarbazine in metastatic melanoma: a randomized phase II trial.

The potential antitumoral effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) led us to evaluate GM-CSF alone or with dacarbazine (DTIC) in metastatic melanoma in first line randomized phase II. Treatment was arm A: GM-CSF: 5 microg kg(-1), bid, 14 consecutive days every 21 days and arm B: GM-CSF: 5 microg kg(-1), bid, day 2 to day 19 every 21 days and DTIC: 800 mg m(-2), day 1 of each cycle. 32 patients (pts) were included, 15 pts in arm A and 17 in arm B. All pts had visceral metastatic sites. 9 had only one metastatic site. The median number of cycles given was 2 in arm A and 3 in arm B. 100% and 89.4% of the planned dose of GM-CSF was given in arm A and arm B respectively. No objective response was obtained. 19 pts experienced at least WHO grade 3 toxicity. All pts had fever, 29 had a decrease in performance status and 23 had pain. Grade 3 toxicity were fever (38.7%), decrease in performance status (32.3%), pain (19.4%) and dyspnoea (12.5%). In this study, GM-CSF alone or in association with DTIC did not induce any antitumoral activity with subsequent toxicity.

[Melanoma-associated retinopathy. Apropos of a case and review of the literature]. / Rétinopathie associée au mélanome cutané. A propos d'un cas et revue de la littérature.

We describe here a case of melanoma-associated retinopathy. In 1993, a 60 year-old man had a cutaneous malignant melanoma surgically removed from the third right toe (thickness 3.15 mm; level IV). One year later he complained suddenly of photopsias, shimmering lights and night blindness of the left eye. Visual acuity and fundus examination were normal. The left visual field showed a tubular aspect. The photopic electroretinogram (ERG) was negative, and the scotopic one was flat. Six weeks later the same symptoms occurred in the right eye. One month later, inguinal lymph nodes were invaded with cancer cells. The association of metastatic melanoma, ocular functional signs and ERG's abnormalities suggested the diagnosis of melanoma-associated retinopathy. This paraneoplastic syndrome is very rare: only seven cases have been described. Antibodies against retinal bipolar cells have shown up in three cases. Treatment is yet to be discovered.

[Atrophic collodion-like skin in long-term treatments with hydroxyurea]. / Atrophie cutanée collodionnée au cours de traitements prolongés par hydroxyurée.

INTRODUCTION: Despite good general and hematological tolerance, hydroxyurea frequently causes polymorphous skin lesions when given as long-term therapy. Distal skin atrophy, pseudodermatomyositis, pseudolichen and ulcerations have been observed. CASE REPORT: We report three cases of diffuse atrophic collodion skin in patients given long-term hydroxyurea. Histology findings demonstrated atrophy and the same signs located at the dermo-epidermal junction as seen in acute toxidermia due to hydroxyurea. Examination of the ultrastructure showed abnormalities in the proliferative epidermal layer which was disrupted by edema and a multiple, irregular basal membrane. DISCUSSION: The chronology of the lesions and partial resolution after treatment withdrawal together with clinical and histological signs demonstrating hydroxyurea impregnation would implicate hydroxyurea as the cause of this case of diffuse atrophic collodion skin. Cells in the epidermal layer of the skin, the most external layer in the organism, have a high turnover rate and would be more vulnerable to the cytostatic action of hydroxyurea than other tissues. The effect of hydroxyurea on keratinocytes implicated in the production and maintenance of the basal membrane would be one of the causes.

[Paraneoplastic retinopathy associated with cutaneous melanoma. An update apropos of a case]. / Rétinopathie paranéoplasique associée au mélanome cutané. Mise au point à propos d'un cas.

BACKGROUND: Ocular paraneoplastic syndromes are rare, and consist of optic neuropathy or retinopathy. Classically, these syndromes are related to carcinoma. Melanoma-associated retinopathy is extremely rare, and unrecognized. METHODS: A patient with metastatic cutaneous melanoma discovered and operated 18 months before. Visual complains consisted of xanthopsia and shimmering light vision, then hemeralopia, which dramatically worsened. Classical clinical examination, visual field and electroretinogram were performed. RESULTS: Visual acuity was 20/25, and fundus examination was normal. The visual field showed a tubular aspect, with V4 isopter remained, like an advanced retinitis pigmentosa. The photopic electroretinogram was negative, and the scotopic one was flat. CONCLUSION: This recent hemeralopia with normal fundus and "negative" electroretinogram, ruled out congenital stationary night blindness diagnosis, and suggested the diagnosis of melanoma-associated retinopathy. This is a rare paraneoplastic syndrome since to date only 7 cases have been reported. Immunochemistry studies, that show antibodies directed against bipolar cells, are consistent with selective reduction of the electroretinogram b wave.