A profile of invasive cutaneous malignant melanoma in Malta: 1993–2002

BACKGROUND: The incidence of malignant melanoma of the skin has risen in every part of the world where reliable cancer registration data are found. OBJECTIVE: Our study aims to describe the changing incidence of and survival from invasive cutaneous malignant melanoma in Malta, by analysing the data from the 211 cases that were registered at the Malta National Cancer Registry between 1993 and 2002. RESULTS: The age standardized incidence rates for invasive cutaneous malignant melanoma rose from 3.7 per 100,000 population per year for males and 5.1 for females in the first 5-year period, to 8.0 per 100,000 population per year for males and 5.9 for females in the second 5-year period. In both sexes, numbers of thin (< or = 1.0 mm) invasive melanomas increased significantly between 1993 and 2002; males also registered a significant increase in intermediate-thickness (1.01-4.0 mm) melanomas. The increase in numbers of thin and intermediate-thickness melanomas between the two 5-year periods was greatest in patients aged 60 years and over. The overall absolute 5-year survival rate for the first period was 74% and for the second period 92%. CONCLUSION: Numbers of reported cases of invasive cutaneous malignant melanoma in Malta have more than doubled during the 10-year study period. This is mostly due to a marked rise in the diagnosis of thin melanomas in both sexes, occurring mainly in patients aged 60 years and over. As thin melanomas are of low metastasizing potential, this has resulted in an increase in survival between the two 5-year study periods.     

Heterogeneity in the linear shiny white structures in melanomas seen with polarized light according to histopathological association: Cross-sectional observational study in 118 cutaneous melanomas

Polarized dermoscopy enables visualization of linear shiny white structures in melanomas, thought to be due to the existence of fibrosis in the dermis. Our objective was to establish the existence of two types of linear shiny white structures and assess their association with different histological structures. We performed a cross-sectional study including all non-acral, non-facial melanomas from our hospital with linear shiny white structures. The outcome variable was the type of linear shiny white structures: shiny white streaks and white strands. We evaluated their association with explanatory variables that may affect the reflectance of melanomas and Breslow index. We used χ² statistics and also calculated the sensitivity and specificity of each linear shiny white structure to predict those variables. We detected linear shiny white structures in 118 melanomas. Regarding shiny white streaks, we only found a statistically significant positive relationship with fibrosis in the papillary dermis. Regarding white strands, we found statistically significant and positive relationships with hyperkeratosis, Breslow index of 0.8 mm or more and acanthosis. Sensitivity and specificity study revealed that the presence of shiny white streaks was the most sensitive (81.7%) and specific (72.3%) for fibrosis in the papillary dermis, and presence of white strands was the most sensitive (91.1%) and specific (85.7%) for hyperkeratosis.     

特殊部位的原发性皮肤淀粉样变性3例

报告3例部位特殊的原发性皮肤淀粉样变性。3例患者皮损分别发生于外耳、乳房及额部,由小而密集的褐色斑疹或丘疹组成,或呈苔藓样改变,不伴或伴有瘙痒。皮损组织病理检查示:真皮乳头层淀粉样蛋白沉积,刚果红和结晶紫染色阳性。诊断:原发性皮肤淀粉样变性。     

Treatment of primary cutaneous follicular centre lymphoma with rituximab: a report of two cases

Rituximab (anti-CD20 chimeric monoclonal antibody) has been demonstrated to have significant activity in nodal B-cell lymphomas, with very few associated adverse effects. Although primary cutaneous B-cell lymphomas (PCBCL) also express the CD20 antigen, relatively few reports of rituximab use in PCBCL have been published to date. We present two cases of primary cutaneous follicular centre lymphoma treated with rituximab (375 mg/m(2)/week intravenously for 4 weeks). Both cases responded to rituximab, with one partial response and one complete response seen. No adverse effects were observed. To date, disease progression has occurred in one case during overall follow up at 6 and 17 months. The potential role of rituximab in the treatment of these lymphomas is discussed.     

Natural history of invasive cutaneous melanoma in Styria,Austria 2001–2003

Background: Rising melanoma incidences have created the need of assessment of epidemiological and clinical data. Patients and methods: We investigated the natural history of invasive cutaneous melanoma in Styria, a province of Austria, in the years 2001–2003. 1082 patients, 511 men and 571 women, mean age 58.2 ± 16.7 years, were collected. Besides basic melanoma data, special histologic features such as regression structures, ulceration, microsatellites and vascular invasion were investigated. Furthermore, lymph node pathology in case of sentinel node biopsy and/or lymph node dissection was recorded. Results: Mean annual incidence (crude rate) was 28.6 per 100,000 inhabitants, age standardized rate 24.5 per 100,000 (95 % CI 22.4–26.6). Cumulative risk (0– 74 years) was 1.92, lifetime risk 1 in 52. Superficial spreading melanoma was the most common type in both sexes, men on the trunk and women on the extremities. Only 11 % of all melanomas were in easily visible areas. Median tumor thickness was 0.75 mm, ranging between 0.2 and 50.0 mm. Sentinel node biopsy was performed in 158 melanomas (14.6 %),and was positive in 22 %.Primary therapeutic lymph node dissection was performed in 19 patients, showing metastases in 18 patients. Conclusions: The investigation revealed an unclear high melanoma incidence for invasive melanomas in our province, requiring further investigation.     

Desmoplastic melanoma may mimic a cutaneous peripheral nerve sheath tumor: Report of 3 challenging cases

Desmoplastic melanoma (DM) and cutaneous malignant peripheral nerve sheath tumors (MPNST) reveal histological and immunohistochemical similarities, including S100 positivity and negative staining for conventional melanocytic markers. We present 3 cases of cutaneous S100‐positive spindle cell tumors in elderly patients, in which first findings led to initial misdiagnoses as cutaneous MPNST and benign peripheral sheath nerve tumor (neurofibroma). The identification of adjacent atypical melanocytic hyperplasia in the overlying skin along with tumor cell proliferation, also in the superficial dermis, the neurotropic component and the absence of any relationship between the tumor and a major nerve, pre‐existing neural benign tumor or the existence of stigmata suggestive of neurofibromatosis raised consideration of a DM. Careful attention should be paid to the presence of a firm dermal nodule and atypical scar lesions especially in sun‐exposed areas (mainly head and neck region) in elderly patients associated with S100‐positive spindle cell proliferation, solar elastosis and adjacent atypical melanocytic proliferation. In such cases, the possibility of a DM should be excluded with caution, especially if the tumor reveals a paucicellular morphology resembling various non‐melanocytic neoplasms including malignant or benign peripheral sheath nerve tumors.     

Metastatic cutaneous plasmacytoma: a case report associated with IgA lambda multiple myeloma and a review of the literature of metastatic cutaneous plasmacytomas associated with multiple myeloma and primary cutaneous plasmacytomas.

We present the case of a 67-year-old Japanese woman with immunoglobulin A lambda (IgA lambda) multiple myeloma (MM). She had firm nodular cutaneous lesions on the trunk and scalp without adjacent bone involvement. The patient was diagnosed as having IgA lambda MM of stage IIIA with 52% plasmacytosis in the bone marrow six months before the appearance of the cutaneous lesions. The abnormal plasma cells showed moderate to marked dysplasia in both the bone marrow and skin lesions. The abnormal plasma cells in the bone marrow exhibited abnormal karyotypes: 41, XX, der (1) t (1p; 1q), -4, -10, -14, -16, -17, 17p+, that differed from the "unfavorable" karyotype reported previously. We reviewed the cases of metastatic cutaneous plasmacytoma in MM and cases of primary cutaneous plasmacytoma that have been reported in English or Japanese and identified the Ig class. Among the 83 cases of metastatic cutaneous plasmacytomas in MM, IgG, IgA, IgD, and Bence-Jones protein were found in 52%, 23%, 16%, and 6%, respectively. A disproportionately high frequency of IgD lambda MM was found to have spread to the skin, compared with the frequency of IgD MM itself, which was present in only around 2% of the MM cases. Among the 18 primary cutaneous plasmacytomas, IgG, IgA, and Bence-Jones protein were found in 56%, 11%, and 17%, respectively, but no IgD was found.     

Nodular melanomas: Analysis of the casistic and relationship with thick melanomas and diagnostic delay

The present study aimed to: (i) define thick melanomas related to nodular melanomas and other melanoma subgroups; and (ii) establish diagnostic delay in relation to the biological behavior of these melanomas and prevention programs. Cutaneous primary melanomas were studied. Nodular melanoma (NM), lentigo maligna melanoma (LMM) and superficial spreading melanoma (SSM) were selected. A further category named vertical growth melanoma (VGM) was also utilized. Analysis for sex, age, different values of thickness (1–2 mm, >2 mm; 1–3 mm, >3 mm; >4 mm), delay to diagnosis and patterns of detection were performed in all of the different subtypes. Eighty‐seven patients with melanomas more than 1 mm of Breslow's thickness out of 506 melanoma were collected. Twenty‐six were nodular cases, 39 SSM, five LMM and 17 VGM. Of those patients with NM, 42% had a thickness of more than 1–2 mm, 34% of 2–4 mm, 23% of more than 4 mm; and 54% with 1–3, 46% with more than 3 mm; and 58% with more than 2 mm. Even considering different values of thickness of more than 1 mm, a delay to diagnosis was significantly lower in NM (4.79 months) than in other subgroups. The value of more than 1 mm of Breslow's thickness may be sufficient to consider a melanoma to be thick. The lower diagnostic delay of NM suggests that they represent faster growing lesions probably with a different biological behavior than other melanoma subtypes. VGM should not be confused with NM, having a longer delay and different clinical features compared with the latter. They represent an area of diagnostic carelessness than potentially be improved.     

继发性皮肤浆细胞瘤

报告1例继发于多发性骨髓瘤（multiple myelonm,MM)的皮肤桨细胞瘤，患者女，44岁，皮损为多发性，来源于MM直接蔓延和血行转移，组织病理检查示瘤细胞呈结节状浸润，免疫组化染色结果示IgG阳性表达，患者于皮损出现后78d死亡。     

无痛性多发性皮肤平滑肌瘤一例

患者,女,19岁。右上肢多发结节半年,左上肢多发结节1个月。皮肤组织病理示真皮可见束状及团块状平滑肌束。免疫组化证实过度增生的纤维为平滑肌。根据临床表现及组织病理结果,诊断为无痛性多发性皮肤平滑肌瘤。     

Multiple cutaneous immunocytoma with secondary anetoderma: a report of two cases

We describe two men with multiple erythematous dermal nodules which were clinically and histologically consistent with a diagnosis of primary cutaneous immunocytoma. Both patients exhibited the very unusual feature of secondary anetoderma occurring in spontaneously resolving lesions. There is one previous report of anetoderma in association with a plasmacytoma. The pathogenesis remains unknown but release of cytokines such as interleukin-6 may be implicated.     

原发皮肤恶性黑色素瘤细胞分子遗传学研究进展

本文综述了原发皮肤恶性黑色素细胞分子遗传学改变，染色体上的非随机改变主要发生在1、6、9、7及10号染色体上。     

Rituximab in cutaneous B-cell lymphoma: a report of two cases

We report two patients with primary cutaneous B-cell lymphoma who were treated with rituximab, a new anti-CD20 monoclonal antibody. The first patient, who had a diffuse large B-cell lymphoma of the lower leg, achieved an 85% improvement. The second patient, who had a primary cutaneous B-cell lymphoma, which had undergone high-grade transformation and systemic spread, achieved a minor response of approximately 30%. Both patients subsequently relapsed. The first patient achieved complete clearance with a second course of rituximab given with systemic chemotherapy, but again relapsed. Treatment with rituximab has been reported to produce response rates of 48% in relapsed systemic low-grade or follicular lymphoma, but there are no previous reports of the use of rituximab in primary cutaneous B-cell lymphoma.     

A series of melanomas smaller than 4 mm and implications for the ABCDE rule

BACKGROUND: Although multiple studies have reported that a significant number of melanomas have diameters of less than or equal to 6 mm at the time of diagnosis, there has been only one series evaluating the proportion of melanomas less than 4 mm in diameter. OBJECTIVE: The objective of this study was to determine the proportion of melanomas, in a single-practitioner, general dermatology practice, with clinical diameters less than 4 mm. METHODS: Information regarding each new diagnosis of melanoma had been recorded during the study period of 2000-2004. Patient records and pathology reports were examined from these patients. RESULTS: Thirteen (13.7%) of the 95 melanomas had diameters less than 4 mm at the time of presentation, including five invasive and eight in situ melanomas. The defining clinical characteristic of these lesions was intensity of pigment. Three of these 13 melanomas, including one invasive and two in situ lesions, showed features of regression. CONCLUSIONS: The findings of this study support those authors who have suggested elimination of the 6-mm diameter criterion in the ABCDE rule. In addition, this study provides further evidence that dark colour as a diagnostic criterion for melanoma should be given more emphasis. The substitution of 'D' to represent dark instead of diameter is worthy of consideration to enhance the value of the ABCDE mnemonic.     

Risk factors in a cohort of patients with multiple primary melanoma

Background: There are various known familial and environmental risk factors that influence the risk for melanoma. This study sought to define the risk factors for multiple primary melanoma. Methods: A telephone survey of patients with multiple primary melanomas was conducted from a private practice in south‐east Queensland, in order to examine various risk factors in this cohort. Results: Our findings of high rates of family history of melanoma (37%), and of dysplastic naevi (42%) support the influence of genotype in this high‐risk group. A family history of multiple primary melanomas, seen in 17% of our patients, is a risk factor not previously reported in similar cohort studies. Sixty‐eight per cent of patients had an equal or lesser degree of invasive malignancy in subsequent melanomas. Most multiple primary melanoma patients in this group (86.6%) were conducting self skin examination at least once per month. With regards to sun‐protective behaviour, 85% reported regular sunscreen use and 92% reported regular use of sun‐protective clothing; however, fewer had done this in childhood. Conclusions: Enhanced knowledge of the genetic and environmental risk factors for multiple primary melanomas can assist clinicians in assessing risk and planning surveillance of patients.     

巨大寻常疣并发皮角

目的:探讨巨大寻常疣并发多发巨大皮角的治疗及其与人乳头瘤病毒(HPV)亚型的相关性.方法:对3例手足巨大寻常疣并发对称性巨大皮角的患者采用抗病毒、手术、免疫、放疗和中药等综合治疗,同时应用免疫组化和PCR等方法研究其中2例患者皮损与HPV感染亚型的相关性.结果:3例患者的皮损全部治愈,随访至今无复发;其中2例患者的皮损均为HPV-2a感染,并发现编码E1和E7的基因存在突变.结论:巨大寻常疣并发皮角宜采用综合治疗.