Specificity of tyrosinase and HMB45 PCR in the detection of melanoma metastases in sentinel lymph node biopsies.

AIMS: Sentinel lymph node biopsy is an increasingly established procedure in the primary staging of high-risk melanoma patients. However, the laboratory evaluation of sentinel lymph node biopsies is a matter of controversy. The aim of this study was to determine the specificity of polymerase chain reaction (PCR) techniques for the evaluation of lymph nodes with regard to melanoma metastases in comparison with histology and immunohistology. METHODS AND RESULTS: Sentinel lymph nodes (n = 41) from 29 melanoma patients and 29 lymph nodes from 27 patients without melanoma were analysed by histology (H&E) and immunohistology (Melan A, HMB45). cDNA of these lymph nodes was subjected to LightCycler PCR amplification using primers specific for tyrosinase and HMB45. Two melanoma sentinel lymph nodes contained naevus cells by histology and immunohistology and were therefore excluded from further evaluation. Eight (20.5%) of the remaining 39 melanoma sentinel lymph nodes were positive by histology and immunohistology and tyrosinase PCR, 15.4% (6/39) were positive only by tyrosinase PCR, 2.6% (1/39) were positive only by histology and immunohistology. HMB45 PCR revealed positive results in 7.7% (3/39) sentinel lymph nodes, which were also positive by tyrosinase PCR and histology and immunohistology. Of non-melanoma lymph nodes 13.8% (4/29) and 14.8% (4/27) of non-melanoma patients were positive by tyrosinase PCR but negative by histology and immunohistology and HMB45 PCR. Thus, tyrosinase PCR had a specificity of only 85.2%. CONCLUSIONS: The specificity of tyrosinase PCR and the sensitivity of HMB45 PCR are too low to recommend these PCR examinations for the guidance of therapy, in particular complete regional lymph node dissection.

Application of imiquimod by suppositories (anal tampons) efficiently prevents recurrences after ablation of anal canal condyloma.

BACKGROUND: After surgical removal, anal canal condyloma (ACC) has a higher risk of recurrence compared with extragenital warts. OBJECTIVES: To reduce local recurrences of ACC using follow-up treatment with imiquimod-containing suppositories (anal tampons). METHODS: After ablation of ACC, 10 male patients received treatment with imiquimod suppositories three times weekly for 3-4 months. RESULTS: Treatment with imiquimod anal tampons was well tolerated. Early initial recurrences in some patients cleared after treatment with the imiquimod suppositories. Within a mean follow-up of 9 months no patient demonstrated recurrence of ACC. CONCLUSIONS: These data suggest that imiquimod anal tampons may represent a new therapeutic option to prevent recurrences of ACC following ablative surgery.

Successful treatment of anogenital Bowen's disease with the immunomodulator imiquimod, and monitoring of therapy by DNA image cytometry.

Imiquimod (Aldara, 3M) is an immune response modifier used for the treatment of anogenital warts. We report a 55-year-old non-immunocompromised woman with extensive, human papillomavirus (HPV) 16-positive anogenital Bowen's disease. After 5 months of local treatment with imiquimod, the lesions completely regressed clinically and histologically, and HPV 16 DNA was no longer detectable. Moreover, DNA image cytometry revealed DNA aneuploidy (an indicator of prospective malignancy) in pretreatment samples but not in post-treatment samples. Therefore, imiquimod might be a treatment option for Bowen's disease, particularly in patients where other treatment modalities such as surgery are contraindicated.

[Trigeminotrophic ulceration of the ala nasi in Wallenberg syndrome]. / Trigeminotrophe Ulzeration des Nasenflügels bei Wallenberg-Syndrom.

A patient developed a trophic ulceration of the nose after an acute bulbar ischemia with infarction of the right trigeminal nuclei. Neurologic examination showed symptoms of a Wallenberg syndrome including ipsilateral hyp- and paresthesia of the second trigeminal branch and disturbed sensibility and temperature sense on the contralateral half of the body. The right ala nasi showed the characteristic sickle-shaped defect (ulcération en arc). The differential diagnosis and therapeutic approaches are discussed.

Retiform hemangioendothelioma: another tumor associated with human herpesvirus type 8?

Retiform hemangioendothelioma is a rare low-grade angiosarcoma of the skin. It shares some clinical characteristics with Kaposi's sarcoma, a tumor with known human herpesvirus 8 (HHV-8) association. We report a case of retiform hemangioendothelioma in which we detected HHV-8 DNA sequences.

[Dermatitis papulosa juvenilis]. / Dermatitis papulosa juvenilis.

Juvenile papular dermatosis is characterized by hypopigmented lichenoid flat papules with predilection for the dorsa of the hands, the elbows and the knees. The disease affects children in the summer months. Changes observed in biopsy specimens show hyperkeratosis, a moderate degree of acanthosis and a lymphocytic perivascular infiltrate in the upper dermis. The pathogenetic influence of such rough materials as sand and wool and of photosensitivity in atopic patients is suggested. We report on a 9-year-old boy who developed lesions of juvenile papular dermatitis (especially severe on the face and the back of the knee) and extreme pruritus for the first time in summer 1994.

["Blue" variant of naevus spilus]. / "Blaue" Variante eines Naevus spilus.

We report on a 29-year-old female patient with an unusual pigmented lesion of the face. Clinically the lesion looked like a pigment patch of the naevus spilus type, while histological examination revealed the presence of dermal melanocytosis and multiple common blue naevi with a discrete lentiginous component in addition. The melanocytic nature of the infiltrate was ascertained by immunohistochemistry analysis using S 100 protein and HMB 45 antibodies. We interpret this lesion as agminated blue naevi in association with lentigo simplex, an unusual variant of speckled lentiginous naevus.