Cutaneous melanoma in octogenarians: a single-institution review.

BACKGROUND: To identify the prognostic factors and assess the outcome of a group of octogenarian patients who were diagnosed with cutaneous melanoma (CM) in the Department of Dermatology of the "M. Bufalini" Hospital, Cesena, Italy from 1996 to 2013. METHODS: From the 1136 consecutive patients in our database, we selected 82 patients (7.2%) diagnosed with CM at age 80 or older. Their major clinical and histopathologic parameters were extracted and matched with those of the residual 1054 younger patients. RESULTS: Comparing our 82 patients with the group of 1054 patients with CM diagnosed in the same period, but at a younger age, we found that: 1) there was no significant difference regarding the patient's gender; 2) CM diagnosed in octogenarians was more frequently located on the head and neck (24.4% vs. 12.8%), and lower extremities (24.4% vs. 14.4%) (P=0.0001); 3) early diagnosis of CM (T1) was less frequent in octogenarians (31.7% vs. 62.6%), intermedium thickness CM (T2) was nearly the same in the 2 groups (15.8% vs. 16.5%), while diagnosis in category T3/T4 (42.6% vs. 21.0%) were significantly greater in octogenarians (P=0.0001); 4) ulceration was detected more frequently in octogenarians (18.3% vs. 10.7%) but the difference was not statistically significant. After a follow-up period of a median 58 months, 52 octogenarians (63.4%) were still alive and free from disease. Thirty of them (36.6%) had died, 14 (17.1%) of which because of melanoma. On the contrary, among the younger patients, 840 (81.6%) were alive, 132 (12.5%) died for melanoma and 75 (7.1%) for other causes. CONCLUSIONS: In our octogenarians, death for CM was not related to the old age but to the delayed diagnosis of cancer. Our results suggest that continuing educational programs for early diagnosis of CM should specifically include this segment of population.

Lichen planus induced by hepatitis B vaccination: a new case and review of the literature.

In May 1996, as part of his routine antihepatitis B (hepB) vaccination plan, a 28-year-old HbsAg-negative man, hospital worker, received his first dose (20 microg) of a recombinant vaccine (EngerixB-B, Smith Kline and Beecham, Belgium), administered via deltoid injection. The patient was otherwise healthy and taking no medication. Thirty days after the 2nd booster dose, several pruritic, polygonal, purple, papules appeared on the volar aspect of the patient's wrists. New lesions gradually spread to the arms and trunk (Fig. 1). The clinical diagnosis of lichen planus (LP) was confirmed by histology, which revealed hyperorthokeratosis, hypergranulosis, vacuolar degeneration of the basal layer cells and a dense, band-like lymphocytic infiltrate in the superficial dermis. The disease started to heal after treatment with topical clobetasol propionate 0.05% and sun exposure during the following summer. Five days after the 3rd booster dose, in November 1996, the dermatosis relapsed on the forearms, trunk, and legs. On that occasion, routine laboratory tests, including a complete blood count, blood chemistry and liver function tests, were within normal limits. Screening serologic tests for autoantibodies including antinuclear antibodies, antidouble-stranded DNA, anti-SS-A, anti-SS-B and anti-Sm were all negative. As a result of the inadequate levels of antihepatitis B antibodies, less than 10 IU/l in May 1998, in a high-risk patient who was frequently exposed to blood and its products, an additional booster dose was performed. Three days later a new recurrence of disseminated lichen planus occurred. The patient was successfully treated with prednisone 1 mg/kg/day for 2 weeks. There was no recurrence the following year.

Changing morbidity of cutaneous diseases in patients with HIV after the introduction of highly active antiretroviral therapy including a protease inhibitor.

BACKGROUND: Highly active antiretroviral therapy (HAART) is a combination of an HIV protease inhibitor (PI), one or two reverse transcriptase inhibitors (RTIs) and/or non-nuclease reverse transcriptase inhibitors (NNRTIs). This combination therapy is able to reduce peripheral HIV viral load, elevate CD4+ cell counts and improve the clinical outcome. AIM: To evaluate the impact of HAART therapy, including one PI, on the prevalence of skin diseases in patients with HIV/AIDS. PATIENTS AND METHODS: The study was performed by collecting data about HIV populations followed at the 'M. Bufalini' Infectious Diseases Unit and San Patrignano Medical Centre, Italy. The medical records regarding the dermatological diseases of such people were retrospectively examined in 12-month periods before (1996) and after (1999) the introduction of HAART. RESULTS: The two groups of patients were matched for age, gender and stage of HIV disease. During the first part of the study, 328 of the 456 patients (72%) sought medical advice 689 times for dermatoses. In the second period, 196 of the 502 patients (39%) made a total of 255 visits. There was a considerable decrease in the number of dermatological visits (-63%) and patients with dermatological problems (-40%). In the group that did not receive HAART, 66% of the patients had cutaneous infections, 25% had inflammatory cutaneous disorders, 8% adverse cutaneous drug reactions and 1% cutaneous neoplasms. In the group of patients treated with HAART, cutaneous infections were observed in 53% of patients, while 21% of patients had inflammatory dermatoses, 20% of patients showed adverse cutaneous drug reactions, and 1% had skin cancers. The remaining 5% asked to see a dermatologist for cosmetic reasons. CONCLUSIONS: The group of patients who received combination regimens including PIs had significantly lower cutaneous morbidity than those treated with nucleoside analogs alone. This tendency included both opportunistic infections and inflammatory cutaneous diseases. Adverse cutaneous drug reactions related to multidrug combination therapy were significantly higher in the group receiving HAART.