[MELALIB 15: A retrospective observational study of 383 cases of melanoma diagnosed by dermatologists in private practice]. / MELALIB15 : étude observationnelle rétrospective de 383 mélanomes dépistés par des dermatologues libéraux.

BACKGROUND: Early detection of melanoma constitutes a major challenge and is a common reason for dermatological consultations. There is no recent data on melanomas diagnosed in the private medical sector in France, nor on the circumstances of diagnosis. PATIENTS AND METHODS: This was a retrospective observational study on records collating data on all new consecutive cases of melanoma diagnosed between January 2015 and June 2018, in the private sector only, by volunteer dermatologists belonging to the association for continuing medical education, "Dermatologie Paris XV". A data collection sheet was prepared on which to record information about the dermatologist, the patient, the main complaint, the characteristics of the melanoma, and the initial treatment given, using the computerized list provided by our dermatopathology offices. RESULTS: The study involved 383 cases of melanoma, 37% in situ and 63% invasive, which consisted chiefly of superficial spreading melanoma. The median age of the cohort was 61 years and patients were predominantly female (58%). Follow-up of high-risk patients and complete routine examination (in those consulting for another reason) resulted in direct detection by a dermatologist of 202 of the 383 melanomas (52.7%); these melanomas had a lower median Breslow index than the rest of the cohort and were thin in the main. When patients consulted for a suspect lesion (139 cases), the lesion had been identified mostly by either the patient or by a relative (61% of cases). The decision to consult was made chiefly by the patients themselves, and the Breslow index was thicker. An initial consultation for nevus screening resulted in diagnosis of 42 melanomas, i.e. only 11% of the cohort. Dermoscopy was performed by 92% of the dermatologists participating in the study. Melanoma excision was performed in the office by the practitioner in 75% of cases, and management was validated at multidisciplinary meetings in 65% of cases. CONCLUSION: In terms of French primary care, dermatologists in private practice play a key role in ensuring early detection and initial management of melanoma.

[In-transit metastasis in melanoma: Efficacy of topical imiquimod combined with carbon dioxide laser or with electrocautery]. / Métastases en transit du mélanome : efficacité de l'imiquimod topique combiné au laser CO2 ou à l'électrocoagulation.

BACKGROUND: In-transit metastases in cutaneous melanoma are common and difficult to manage. Therapy is mainly palliative. Use of topical imiquimod has been assessed for surface metastases. PATIENTS AND METHODS: We report on four patients with cutaneous melanoma metastases treated with topical imiquimod associated with carbon dioxide laser in the first two patients and with electrocoagulation in the two others. For two patients, we noted complete regression of the lesions after 15 and 18 months. For the two others, treatment was stopped after 9 to 10 months because of progression of subcutaneous metastasis and distant metastasis. DISCUSSION: Topical imiquimod is an alternative treatment used in superficial in-transit metastasis of melanoma. Its use as a monotherapy is sometimes ineffective. We elected to use combined pre-treatment with carbon dioxide laser or electrocoagulation in order to potentiate the action of imiquimod. This simple and inexpensive therapeutic strategy constitutes a palliative treatment that can allow prolonged local control of cutaneous metastasis.

[Subacute cutaneous lupus gyratus repens]. / Lupus subaigu gyratus repens.

BACKGROUND: Erythema gyratum repens is a rare paraneoplastic eruption. To date, only sixty have appeared in the literature. We report a patient with clinical and histological cutaneous subacute lupus and typical erythema gyratum repens. CASE REPORT: A 86-year-old woman presented with a 2-month history erythematous patches, confined mainly to the trunk, arms, thighs and the face. Cutaneous biopsy was compatible with cutaneous subacute lupus. After 4 weeks of hydroxychloroquine treatment, physical examination revealed erythematous, concentric, serpiginous and scaly bands on the trunk. Erythematous patches persisted on the limbs and the face. Physical examination and investigations in search of an internal malignancy were negative. All cutaneous lesions resolved after three months of chloroquine and dapsone treatment. DISCUSSION: Fourteen cases of erythema gyratum repens have been reported unassociated with underlying malignancy. This eruption usually precedes the occurrence of the neoplasm. Erythema gyratum repens is a migrating gyrate erythema with a serpiginous, concentric appearance creating a wood-grain look in the skin, which is pathognomonic. Histological findings are not specific, showing light parakeratosis and perivascular lymphocytic infiltrate of superficial dermis. Five cases of cutaneous lupus associated with erythema gyratum repens eruption have been reported. Considering the negative check-up in search of internal malignancy on a follow-up period of 20 months, our case is a probably a particular form of subacute lupus.

Basal cell carcinoma in young adults: not more aggressive than in older patients.

BACKGROUND: An increased incidence of sporadic basal cell carcinoma (BCC) has been observed in young adults within the last years. It has been hypothesized that these BCC in younger subjects might be more aggressive compared to BCC in the elderly. OBJECTIVE: To compare BCC recurrence rates between young and older patients. METHODS: Retrospective study of patients under the age of 35 years (group 1) with previously untreated BCC and comparison with BCC in patients older than 35 years (group 2). Each patient in group 1 was matched with 2 patients in group 2. RESULTS: 70 patients in group 1 and 140 patients in group 2 were included. The median follow-up was 76 months. In group 1, 13% of the BCC were of the morphea-like type and 9% in group 2 (p = 0.30), respectively. The 5-year recurrence rate was 4.6% in group 1 and 9.8% in group 2. They did not significantly differ between the two groups (log rank test p = 0.48). CONCLUSION: BCC in young patients are not more aggressive than in older patients.

Differential expression of epithelial sodium channel subunit mRNAs in rat skin.

Three subunits (alpha, beta, gamma) of the amiloride-sensitive epithelial sodium channel have been recently characterized. The channel subunits have significant homologies with the Caenorhabditis elegans mec-4, mec-10 and deg-1 genes, which are involved in control of cell volume and mecanotransduction. These subunits are coexpressed at equivalent levels in the renal collecting duct and the distal colon epithelium which are high resistance sodium transporting epithelia. We have investigated whether these subunits were expressed, at the mRNA level, in transporting as well as non transporting epithelial cells of rat skin. In full-thickness abdominal skin only alpha and gamma subunit mRNAs were detected, while all three subunit mRNAs were present in sole skin, as demonstrated by RNase-protection assay. Furthermore, the level of expression of each subunit varied with the epithelial cell type as demonstrated by in situ hybridization: epidermal and follicular keratinocytes express mostly alpha and gamma subunits (while beta was low); a prevalence of beta and gamma was observed in sweat glands. Thus, it appeared that two out of the three subunit mRNAs predominated in each epithelial structure. In addition, mRNAs of the alpha, beta and gamma subunits of the amiloride-sensitive sodium channel were expressed at a higher level in large suprabasal epidermal keratinocytes (which undergo terminal differentiation) than in small proliferative basal keratinocytes.

[Multifocal epithelioid hemangioendothelioma with partial remission after interferon alfa-2a treatment]. / Hémangioendothéliome épithélioïde multifocal en rémission partielle sous traitement par interféron alpha 2a.

INTRODUCTION: Epithelioid hemangioendothelioma (EHE) is a rare vascular tumour of the soft tissue having an intermediate malignancy. Cutaneous presentations have exceptionally been reported. OBSERVATION: A young woman, initially affected by an EHE with cutaneous and bone involvement, then with pulmonary and hepatic localizations, was in partial remission after one year of treatment with alpha 2a interferon. DISCUSSION: In a critical review of the literature, we describe the main features of this tumour and the difficulties to classify this entity in the vascular tumors' spectrum. Histologically, epithelioid hemangioendothelioma has a very characteristic appearance and is clearly different from other vascular tumors as angiolymphoid hyperplasia with eosinophilia and Kimura's disease. The assumption of a multicentric or a metastatic origin when multiple tumor deposits are found, is still not elucidated. Different therapeutic approaches are proposed: surgery, interferon, interleukin-2, retinoids. Randomized studies would be necessary to confirm our results with alpha 2a interferon but are probably difficult to realize because of the lack of cases.