The risk to develop melanoma from small or medium size congenital naevus remain controversial. The main goal of the present study was to determine the interest of three immunohistochemical markers (Ki67, HMB45 and p53) in predicting malignant transformation of these congenital naevi and to see if a specific immunohistochemical profile of such transformed naevi can be identified. The markers (Ki67, HMB45 and p53) have been used retrospectively on sections of small or medium size congenital naevi (group NC, n = 15), of melanoma developed on small or medium size congenital naevi (group MNC, n = 15) and of melanoma developed on acquired naevi (group MNA, n = 15). The labelled cells have been counted in different cutaneous layers: junction, superficial dermal layer and deep dermal layer. No reactivity was observed for the three markers in group NC. The percentage of labelled cells was significantly different for the three markers between the group NC and the groups MNC and MNA. There was no difference between the groups MNC and MNA. In the groups MNC and MNA, a gradient in the percentage of labelled cells was observed between superficial and deep layers. These three markers do not differentiate melanoma developed from congenital naevi of small or medium size and melanoma developed from acquired naevi. Moreover, the results suggest that these three markers are useless in predicting the risk of malignant transformation of small or medium size congenital naevi.

Journal of the European Academy of Dermatology and VenereologyVolume 22, Issue 4 p. 514-515 Is sentinel lymph node biopsy useful in regressive and/or ulcerated thin cutaneous melanomas? A Hutin, A Hutin Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Heenen, M Heenen Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorP Vereecken, P Vereecken Department of Dermatology, Erasme Hospital, Brussels, Belgium, CHU-Brugmann, Brussels, Belgium, and Bordet, Brussels, BelgiumSearch for more papers by this authorJ Van Geertruyden, J Van Geertruyden Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorO De Lathouwer, O De Lathouwer Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorE Steels, E Steels Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorL Gordower, L Gordower Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Trakatelli, M Trakatelli Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Laporte, M Laporte Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this author A Hutin, A Hutin Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Heenen, M Heenen Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorP Vereecken, P Vereecken Department of Dermatology, Erasme Hospital, Brussels, Belgium, CHU-Brugmann, Brussels, Belgium, and Bordet, Brussels, BelgiumSearch for more papers by this authorJ Van Geertruyden, J Van Geertruyden Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorO De Lathouwer, O De Lathouwer Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorE Steels, E Steels Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorL Gordower, L Gordower Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Trakatelli, M Trakatelli Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Laporte, M Laporte Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this author First published: 19 July 2007 https://doi.org/10.1111/j.1468-3083.2007.02376.xCitations: 2 *Corresponding author, tel. +32 (0)2 5554612; fax +32 (0)2 5554164; E-mail: [email protected] DOI: 10.1111/j.1468-3083.2007.02376.x Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Lens MB, Dawes M, Newton-Bishop JA, Goodacre T. Tumour thickness as a predictor of occult lymph node metastases in patients with stage I and II melanoma undergoing sentinel lymph node biopsy. Br J Surg 2002; 89: 1223–1227. 2 Kesmodel SB, Karakousis GC, Botbyl JD et al . Mitotic rate as a predictor of sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol 2005; 12: 449–458. 3 Nguyen CL, McClay F, Cole DJ et al . Melanoma thickness and histology predict sentinel lymph node status. Am J Surg 2001; 181: 8–11. 4 Guitart J, Lowe L, Piepkorn M et al . Histological characteristics of metastasizing thin melanomas. Arch Dermatol 2002; 138: 603–608. 5 Cook MG, Spatz A, Bröcker EB, Ruiter DJ. Identification of histological features associated with metastatic potential in thin (< 1.0 mm) cutaneous melanoma with metastases. A study on behalf of the EORTC Melanoma Group. J Pathol 2002; 197: 188–193. 6 Vereecken P, Laporte M, Petein M, Steels E, Heenen M. Evaluation of extensive initial staging procedure in intermediate/high risk melanoma patients. J Eur Acad Dermatol Venereol 2005; 19: 66–73. 7 King R, Googe PB, Mihm MC. Thin melanomas. Clin Lab Med 2000; 20: 713–729. 8 Ranieri JM, Wagner JD, Wenck S, Johnson CS, Coleman JJ 3rd. The prognostic importance of sentinel lymph node biopsy in thin melanoma. Ann Surg Oncol 2006; 13: 927–932. Citing Literature Volume22, Issue4April 2008Pages 514-515 ReferencesRelatedInformation

Hutin, A.; Heenen, M.; Vereecken, P.; Van Geertruyden, J.; De Lathouwer, O.; Steels, E.; Gordower, L.; Trakatelli, M.; Laporte, M. Author Information

Dendritic cell (DC) vaccines are used for the induction of anti-tumor T cell reaction in melanoma patients. DC are generated in vitro, pulsed with antigen and matured prior to injection. They are supposed to migrate to lymph nodes and to present the processed antigen to naive T cells allowing activation of tumor-specific lymphocytes. It has been suggested that intradermal injection allows a superior migration to the lymph node. Eight HLA-A2 positive patients with stage III or IV melanomas expressing NA 17 antigen were collected. They were included in a pilot trial of vaccination in which they received IL3/INFb DC presenting the NA17 A2 antigen. In each patient, a skin biopsy was performed at the injection site, 24 h after inoculation. The striking features of the biopsies were the presence of a perivascular CD3+/CD8+ T cell infiltrate with a slight population of CD4+ cells and the presence of a massive neutrophilic infiltrate associated with the injected DC still present, realizing a suppurative granuloma. The persistence of DC 24 h after the injection suggests that migration in the lymph node is not necessary for the induction of the immune response. The skin itself could be the location of a reaction starting with a massive recruitment of neutrophils.

Dermatology, and more specifically cutaneous oncology, has evolved from a descriptive science concept towards multifaceted medico-surgical medicine which is nowadays based not only on observation. In this view, the importance of prevention and early detection of skin cancers including cutaneous melanoma has been recognized and has created a new challenge. Thanks to this proactive approach, the improvement in the prognosis of newly diagnosed melanomas has been demonstrated, but many efforts have to be brought to reduce the incidence and the mortality of this potentially aggressive tumor.

INTRODUCTION:Early diagnosis and treatment of metastases have been shown to improve overall survival of melanoma patients. The purpose of this study was to evaluate the impact of extensive initial staging, including positron emission tomography (PET) scan on the management of melanoma patients. PATIENTS AND METHODS:Forty-three patients with intermediate/poor prognosis primary melanoma benefited from complementary excision and sentinel lymph node biopsy (SLB) after clinical and paraclinical staging (computed tomography, nuclear magnetic resonance and whole body fluorodeoxyglucose PET scan). RESULTS:No systemic metastases were demonstrated, while the SLB procedure emphasized the presence of regional lymph node metastases in 10 patients as suggested by the PET scan in four patients (sensitivity of the PET scan 40%). These 10 patients with early diagnosed lymph node involvement benefited from early surgery and were included in adjuvant treatment protocols. A secondary primary cancer was fortuitously diagnosed and treated early in two patients. CONCLUSIONS:The development of new adjuvant therapies and therapeutic procedures (specific and non-specific immunotherapy, gamma-knife radiosurgery, etc.) now raises the relevance of extensive staging in intermediate/poor prognosis melanoma patients. We confirm in our series that PET scan is not useful to detect micrometastasis and cannot replace SLB in initial regional staging. However, we show in our study that 12 of 43 patients were treated early or were included early in treatment protocols thanks to the extensive staging procedure. Nevertheless, it seems important to evaluate through larger prospective trials the real impact of these early diagnoses and new treatments on overall survival before defining new diagnostic and therapeutic guidelines.

2524 Background: Although some encouraging results were obtained with the standard dendritic cells (DC) generated with GM-CSF and interleukin (IL)-4, further improvements are clearly needed. DC generated with type-I interferon were found to have interestingly high expression of MHC and costimulatory molecules, of migration-enhancing CCR7 chemokine receptor, of Th-1 response-promoting IL-15 cytokine, and of IFN-α in response to poly I:C. They were shown to induce efficient T cell responses against tumor antigens in vitro. Herein, we investigated the ability of DC generated in interferon (IFN)-β and IL-3 (DC I3) and activated by poly I:C to migrate and to induce CD8+ T cell responses against the NA17-A2 tumor peptide in patients (pts) with stage III or IV melanoma. Methods: DC were generated from adherent PBMC by a 6-day culture with IL-3 and IFN-β followed by overnight maturation with poly I:C and loading with NA17.A2 peptide. 9 HLA-A2 pts with stage III or IV NA17+ melanoma received 3 DC I3 vaccines (weeks 0, 3, 6) (20x10E6 i.d./s.c. and 2.5x10E intranodal). Anti-NA17-A2 CD8+ T cell responses were measured using mixed lymphocyte-peptide culture under limiting dilution conditions followed by enumeration of cells stained with NA17-HLA-A2 tetramers. DC labeling with In-111 enables to study cell migration after injection. Results: We found that the DC I3 vaccine was well tolerated with only minor and transient flu-like symptoms and local inflammatory reaction at the site of injection. In 7 out of the 9 pts, isotopic imaging documented DC migration from the injection site to draining lymph nodes. Anti-NA17-A2 CD8+ T cell responses were found in 4 out of 7 pts: from <0.6 (min pre-vaccine) to 21 (max post-vaccine) specific T cells/10E6 CD8+ lymphocytes. Among 4 pts with no evidence of disease (NED), 3 remained free of disease at >9, >11 and >13 months, and among 5 pts with evaluable lesions, one had stable disease (SD) (>6mo). All of these patients with stable NED (but one pt) and SD were in the T cell responder group. Conclusions: DC generated in type-I IFN might represent an interesting alternative to DC generated in IL-4 and GM-CSF for the development of more efficient cellular vaccines against melanoma. No significant financial relationships to disclose.

Background Definition of the colour of pigmented skin lesions (PSLs) with the naked eye remains subjective and may be influenced by lighting. This problem underlines the usefulness of instrumental assessments such as epiluminescence microscopy and colorimetric devices.Objective and methods We describe here a new method of colour analysis of PSLs with the Visi-Chroma (TM) VC-100 device, which illuminates the surface of the skin with white light-emitting diodes (LEDs) and analyses the reflected light by a red-green-blue (RGB) charge-coupled device (CCD) colour camera. Twenty-one PSLs to be excised for cosmetic or medical reasons were analysed by this device with clinicopathological correlation.Conclusions This method is feasible and might be useful to assess the colour of PSLs and allow comparisons for changes over time. Further studies are needed to determine the usefulness of this device in clinical practice.

INTRODUCTION:Epidermoid skin carcinoma is the second most frequent skin cancer. It is rarely considered as aggressive. Other than its extension through the blood of lymph circulation, perineural invasion is also a significant form of tumoral invasion. We report a case of recurrent epidermoid skin carcinoma beginning with a neurological symptomatology.OBSERVATION:A 77 year-old man with a history of right fronto-temporal epidermoid skin carcinoma turned up at our clinic with a ptosis of the right eyelid and hypoesthesia in the nerve VI area. He later developed pain in the arch of the eyebrow and diplopia. Five weeks later, two subcutaneous nodules appeared. Histology revealed a neuro-invasive epidermoid carcinoma explaining the clinical picture. Re-loading of the histological sections of the first injury confirmed the clearly differentiated invasive epidermoid carcinoma. However, renewed classified sections revealed neoplastic cells surrounding the nerve branches in the deep dermis.DISCUSSION:Other than the extension through the blood or lymph circulation, epidermoid cutaneous cancers exhibit varying invasion of the nerve structures. Neurotropism is an aggressiveness marker. Only the pathologico-anatomic investigation enables an early diagnosis. In the case of recurrence, neurological symptomatology can precede skin injuries and make diagnosis difficult. The follow-up of the carriers of this type of tumor must include a neurological examination.

Introduction. Epidermoid skin carcinoma is the second most frequent skin cancer. It is rarely considerated as aggressive. Other thant its extension through the blood of lymph circulation, perineural invasion is also a significant form of tumoral invasion. We report a case of recurrent epidermoid skin carcinoma beginning with a neurological symptomatology.Observation. A 77 year-old man with a history of right fronto-temporal epidermoid skin carcinoma turned up at our clinic with a ptosis of the right eyelid and hypoesthesia in the nerve VI area. He later developed pain in the arch of the eyebrow and diplopia. Five weeks later, two subcutaneous nodules appeared. Histology revealed a neuro-invasive epidermoid carcinoma explaining the clinical picture. Re-loading of the histological sections of the first injury confirmed the clearly differentiated invasive epidermoid carcinoma. However, renewed classified sections revealed neoplastic cells surrounding the nerv branches in the deep dermis.Discussion. Other than the extension through the blood or lymph circulation, epidermoid cutaneous cancers exhibit varying invasion of the nerve structures. Neurotropism is an aggressiveness marker. Only the pathologico-anatomic investigation enables an early diagnosis. In the case of recurrence, neurological symptomatology can precede skin injuries and make diagnosis difficult. The follow-up of the carriers of this type of tumor must include a neurological examination.

Photodynamic therapy (PDT) or photodynamic chemotherapy is a new therapeutic two-step procedure consisting of an administration of a photosensitizer followed by light irradiation. PDT has been used for the treatment of cutaneous malignancies and offers the advantage over surgery of being a selective and non-invasive approach. The authors present a review of Medline-indexed experiences and trials of topical PDT in cutaneous oncology, and, by the way, remind anatomoclinical features of non-melanoma skin cancers. Complete response rates and cosmetic outcome after topical PDT with 5-aminolevulinic acid are encouraging and enable from now to consider this promising procedure as a new effective approach to manage skin cancers, particularily superficial and extensive lesions including actinic keratoses, superficial basocellular carcinomas and Bowen's disease.

Secondary lymphoedema of the leg can result in disruption of lymphatic vessels following lymph node surgery Evidence supports the use of complex decongestive physiotherapy (CDP) in such cases, despite the possibility of tumour recurrence due to this therapy in cancer patients. We present the case of a 52-year-old woman who developed in-transit metastases and systemic evaluable disease one month after starting CDP for secondary lymphoedema of the leg.

Assessment of T-cell activation is pivotal for evaluation of cancer immunotherapy. We initiated a clinical trial in patients with MAGE-A1 and/or -A3 tumors using autologous DC pulsed with MAGE peptides aimed at analyzing T-cell-derived, IFN-gamma secretion by cytokine flow cytometry and ELISPOT. We also tested whether further KLH addition could influence this response favorably. Monocyte-derived DC were generated from leukapheresis products. They were pulsed with the relevant MAGE peptide(s) alone in group A (n=10 pts) and additionally with KLH in group B (n=16 pts). A specific but transient increase in the number of peripheral blood T lymphocytes secreting IFN-gamma in response to the vaccine peptide(s) was observed in 6/8 patients of group A and in 6/16 patients of group B. We conclude that anti-tumor vaccination using DC pulsed with MAGE peptides induces a potent but transient anti-MAGE, IFN-gamma secretion that is not influenced by the additional delivery of a nonspecific, T-cell help.

PURPOSE:The authors report the complementary roles of lymphoscintigraphy in sentinel node mapping and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in a massively invaded sentinel node.MATERIALS AND METHODS:A 49-year-old woman was referred to the authors' institution after the resection of a malignant melanoma (Clark IV, Breslow 5.25) of the right buttock. No evidence of regional or distant organ metastases was observed on bone scintigraphy or thoracoabdominal or cerebral computed tomographs. Preoperative lymphoscintigraphy showed drainage around a circular structure, without any node detected. F-18 FDG PET imaging detected an area of focal, markedly hypermetabolic activity at the same location.RESULTS:The focal, markedly hypermetabolic activity detected by F-18 FDG PET corresponded to a massively invaded sentinel node not shown by lymphoscintigraphy but found and removed at the time of surgery. Radical regional lymphadenectomy showed only one small additional lymph node micrometastasis detected after immunohistochemical staining for S-100 protein and HMB45 antigen.CONCLUSIONS:This case emphasizes the complementary roles of lymphoscintigraphy sentinel node mapping and F-18 FDG PET. Indeed, a massively invaded sentinel node may be detected by PET but missed by lymphoscintigraphy.

Purpose: The authors report the complementary roles of lymphoscintigraphy in sentinel node mapping and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in a massively invaded sentinel node.Materials and Methods: A 49-year-old woman was referred to the authors' institution after the resection of a malignant melanoma (Clark IV, Breslow 5.25) of the right buttock. No evidence of regional or distant organ metastases was observed on bone scintigraphy or thoracoabdominal or cerebral computed tomographs. Preoperative lymphoscintigraphy showed drainage around a circular structure, without any node detected. F-18 FDG PET imaging detected an area of focal, markedly hypermetabolic activity at the same location.Results: The focal, markedly hypermetabolic activity detected by F-18 FDG PET corresponded to a massively invaded sentinel node not shown by lymphoscintigraphy but found and removed at the time of surgery. Radical regional lymphadenectomy showed only one small additional lymph node micrometastasis detected after immunohistochemical staining for S-100 protein and HMB45 antigen.Conclusions: This case emphasizes the complementary roles of lymphoscintigraphy sentinel node mapping and F-18 FDG PET. Indeed, a massively invaded sentinel node may be detected by PET but missed by lymphoscintigraphy.