RESUMO
Pyogenic granuloma (PG) is a vascular endothelial growth factor (VEGF)-related neoangiogenic process. Minor trauma, chronic irritation, certain drugs and pregnancy may favor PG. Viral triggers have not been reported up to date. A 52-year-old woman with hairy-cell leukemia presented because of a 3-month history of a giant pseudotumoral lesion on her left cheek. All prior antibacterial, antifungal and anti-inflammatory treatments had failed. Histology revealed PG with sparse and isolated epithelial cell aggregates. Immunohistochemistry (IHC) identified herpes simplex virus type-I (HSV-I) antigens in the nuclei and cytoplasm of normal-appearing as well as cytopathic epithelial cells, suggesting a chronic, low-productive HSV infection. No HSV-I signal was evidenced in the endothelial cells of the PG. Furthermore, IHC revealed VEGF in the HSV-I infected epithelial cells as well as within the PG endothelial cells. These results incited oral treatment with valaciclovir, and the PG promptly resolved after 2 weeks. These findings suggest that a chronic HSV-I infection might play an indirect, partial role in neoangiogenesis, presumably via HSV-I infection-related stimulation of keratinocytic VEGF production.
RESUMO
BACKGROUND: More than 90% of vitamin D synthesis is dependent on UV exposure. Photosensitive disorders such as lupus erythematosus, protoporphyria and xeroderma require strict sun avoidance, and vitamin D deficiency has been demonstrated in these patients. Melanoma patients are also instructed to avoid sun exposure and may hence be expected to be vitamin D deficient. MATERIALS AND METHODS: Winter and summer vitamin D levels were compared in a group of melanoma patients (n =61) and age- and phototype-matched controls (n = 53) without photosensitive disorders. RESULTS: Oral supplementary vitamin D intake was reported in 32.7% of the melanoma patients and in 15.1% in the control group. Despite oral supplementation, only 25% of the melanoma patients and the controls presented with vitamin D levels of 30 ng/mL or higher. In non-supplemented subjects in the melanoma and control groups, respectively, mean winter vitamin D levels were below the recommended threshold at 12.6 ng/mL vs. 13.2 ng/mL, respectively, but not statistically different. These values increased significantly in both groups during the summer to 24.6 and 23.8 ng/mL respectively. CONCLUSION: Unexpected, significant increases in vitamin D levels were seen in melanoma patients during summer, suggesting non-adherence with photoprotective measures and reflecting a heliophilic behaviour. Vitamin D supplementation is recommended in melanoma patients during both winter and summer.
