Background: The last melanoma staging system of the 2009 American Joint Committee on Cancer takes into account, for stage IV disease, the serum levels of lactate dehydrogenase (LDH) and the site of distant metastases. Objective: Our aim was to compare the significance of metastatic volume, as evaluated at the time of stage IV melanoma diagnosis, with other clinical predictors of prognosis. Methods: We conducted a retrospective multicentric study. To establish which variables were statistically correlated both with death and survival time, contingency tables were evaluated. The overall survival curves were compared using the Kaplan-Meier method. Results: Metastatic volume and number of affected organs were statistically related to death. In detail, patients with a metastatic volume >15 cm3 had a worse prognosis than those with a volume lower than this value (survival probability at 60 months: 6.8 vs. 40.9%, respectively). The Kaplan-Meier method confirmed that survival time was significantly related to the site(s) of metastases, to elevated LDH serum levels and to melanoma stage according to the latest system. Conclusion: Our results suggest that metastatic volume may be considered as a useful prognostic factor for survival among melanoma patients.

Background: Seborrheic keratosis (SK) is a frequent benign epithelial skin tumor. Generally its diagnosis is clinical, however SK can sometimes clinically simulate a melanocytic lesion; therefore we need dermoscopy to reach a correct diagnosis. Milia-like cysts and comedo-like openings are the common dermoscopic features of SK, but it is not a rare finding that SK can display one or more dermoscopic patterns suggestive of a melanocytic origin. Objectives: We describe a case series of SKs with a blue globular pattern simulating a melanocytic lesion. Methods: We retrospectively evaluated 224 SKs seen during 2011 at the Dermatoscopy Unit of the Department of Dermatology, University of Rome ‘Sapienza'. Results: Five SKs showed a blue globular pattern, without the SK main features generally seen in dermoscopy; globules were multiple, round or oval, well-demarcated, small and medium-sized, blue-colored and equally distributed within the lesion. Histopathologic examination was consistent with acanthotic SK. Conclusions: Identification of the blue globular pattern can be helpful for the dermoscopic diagnosis of SK, especially when its common dermoscopic features are absent.

We describe a 79-year-old female with a chronic venous ulceration infected by Staphylococcus aureus and Enterococcus faecalis and not responsive to conventional treatments. The patient was treated with Methyl-Aminolaevulinate Photodynamic Therapy (MAL-PDT). After four weeks the cutaneous swabs become negative and we observed a significant clinical improvement. Therefore we suppose that MALPDT could represent a valid therapeutic option in the treatment of infected chronic ulcers.

In the last years the nature of initiating melanoma cells has been discussed and the melanoma stem cell theory has been proposed as and alternative and/or supplemental view of newborning melanoma cells. 1 Grichnik J.M. Melanoma, nevogenesis, and stem cell biology. J Invest Dermatol. 2008; 128: 2365-2380 Crossref PubMed Scopus (88) Google Scholar It has been described that melanoma cells derived from metastatic melanoma specimens as well as melanoma cell lines are able to grow in an embryonic stem cell-based media and these melanoma stem-like cells possess capacity of self-renewal and high tumorigenicity. In 2005 the first evidence of a stem-cell like population existence in human melanoma has been provided. 2 Fang D. Nguyen T.K. Leishear K. et al. A tumorigenic subpopulation with stem cell properties in melanomas. Cancer Res. 2005; 65: 9328-9337 Crossref PubMed Scopus (1107) Google Scholar CD133 or prominin-1 is one of most studied marker of staminality expressed by melanoma cells; specifically, the down regulation of CD133 leads to a reduced cell capacity to metastatize. 3 Rappa G. Fodstad O. Lorico A. The stem cell-associated antigen CD133 (Prominin-1) is a molecular therapeutic target for metastatic melanoma. Stem Cells. 2008; 26: 3008-3017 Crossref PubMed Scopus (194) Google Scholar Nevertheless, there is disagreement concerning the constant presence of CD133+ cells in primary and metastatic melanomas. ABCB5, the third member of the human P-gp family, is a rhodamine and doxorubicin efflux transporter, identified as a novel drug transporter involved in drug-resistance in human malignant melanoma. 4 Frank N.Y. Pendse S.S. Lapchak P.H. et al. Regulation of progenitor cell fusion by ABCB5 P-glycoprotein, a novel human ATP-binding cassette transporter. J Biol Chem. 2003; 278: 47156-47165 Crossref PubMed Scopus (196) Google Scholar , 5 Frank N.Y. Margaryan A. Huang Y. et al. ABCB5-mediated doxorubicin transport and chemoresistance in human malignant melanoma. Cancer Res. 2005; 65: 4320-4333 Crossref PubMed Scopus (465) Google Scholar ABCB5 was found to be specifically expressed on CD133+ tumor stem cell phenotype indicating that ABCB5+/CD133+ cells may represent the melanoma stem cells fraction. 6 Zabierowski S.E. Herlyn M. Melanoma stem cells: the dark seed of melanoma. J Clin Oncol. 2008; 26: 2890-2894 Crossref PubMed Scopus (117) Google Scholar , 7 Zabierowski S.E. Herlyn M. Learning the ABCs of melanoma-initiating cells. Cancer Cell. 2008; 13: 185-187 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar Due to the very small percentage of cancer stem cell among the total melanoma cell population a highly sensitive assay as the Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) is auspicable for the detection of tumor stem cell markers. Although the expression of CD133 and ABCB5 has been investigated in melanoma primary tumors and in melanoma cell lines, the involvement of these markers in sentinel lymph node (SLN) of melanoma patients has been poorly evaluated. From 2001, with the final version of staging melanoma, the status of SLN has been included as one of the most important prognostic factor. 8 Balch C.M. Buzaid A.C. Soong S.J. et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol. 2001; 19: 3635-3648 Crossref PubMed Scopus (2297) Google Scholar In this preliminary study we verified the expression of CD133 and ABCB5 by RT-PCR assay in 65 SLN of melanoma patients and correlated the results to the progression of disease. Forty-five melanoma patients at stage I, II and III of disease were enrolled and a total of 65 SLN were excised; informed consent was obtained from all patients. Tumor thickness, ulceration and level of invasion were documented as well as tumor type and stage of disease according to TNM classification of the American Joint Committee on Cancer Staging System for cutaneous melanoma. 9 Bach C.M. Gershenwald J.E. Soong S. et al. Final Version of 2009 AJCC Melanoma Staging and Classification. J Clin Oncol. 2009; 27: 6199-6206 Crossref PubMed Scopus (3727) Google Scholar Ten (10) normal lymph nodes (nLN), from patients with non-melanoma disease were used as negative controls. Lymphatic mapping and SLN biopsies were successfully performed as previously described in Ref. 10 Gradilone A. Gazzaniga P. Ribuffo D. et al. Survivin, bcl-2, bax, and bcl-X gene expression in sentinel lymph nodes from melanoma patients. J Clin Oncol. 2003; 21: 306-312 Crossref PubMed Scopus (96) Google Scholar After surgical excision, a part of each SLN and nLN was frozen in liquid nitrogen and stored at −80°C until use. Each lymph node was fixed in 5% formaldehyde and embedded in Paraplast. Sections were stained with Hematoxylin & Eosin (H&E), and Immunohistochemistry (IHC) was performed using antibodies against HMB-45 antigen and S-100 protein and detected with the avidin-biotin peroxidase technique. Negative controls were obtained if normal animal serum was used instead of specific primary antibodies. Only one sample was found positive for the IHC assay and a different one was found positive by H&E assay, (patients at stage IIIA and IIIB of disease, respectively). In all SLN and nLN we also assessed the expression of tyrosinase by a nested RT-PCR. Tyrosinase is expressed within both melanocytes and malignant melanoma cells and its detection by RT-PCR in other tissues could indicate the presence of metastatic disease. This marker was extensively used from the 1991 11 Smith B. Selby P. Southgate J. et al. Detection of melanoma cells in peripheral blood by means of reverse transcriptase and polymerase chain reaction. Lancet. 1991; 338: 1227-1229 Abstract PubMed Scopus (630) Google Scholar for the research of melanoma cells in blood and SLN, with different results; therefore its use is not yet validate in melanoma patients. 12 Gradilone A. Cigna E. Aglianò A.M. et al. Tyrosinase expression as a molecular marker for investigating the presence of circulating tumor cells in melanoma patients. Curr Cancer Drug Targets. 2010; 10: 529-538 Crossref PubMed Scopus (15) Google Scholar The SLNs were tested by histologic examination for the presence of nevus cell which could give a false positive results and they were found all negative.

Journal of the European Academy of Dermatology and VenereologyVolume 23, Issue 3 p. 318-320 Erythema annulare centrifugum as the presenting sign of breast carcinoma V Panasiti, Corresponding Author V Panasiti Department of Dermatology University of Rome 'La Sapienza', Correspondence: V Panasiti. E-mail: [email protected]Search for more papers by this authorV Devirgiliis, V Devirgiliis Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this authorM Curzio, M Curzio Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this authorM Rossi, M Rossi Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this authorV Roberti, V Roberti Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this authorU Bottoni, U Bottoni Department of Dermatology and Oncology University of Catanzaro 'Magna Graecia', Viale del Policlinico, 155, 00161 Rome, ItalySearch for more papers by this authorS Calvieri, S Calvieri Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this author V Panasiti, Corresponding Author V Panasiti Department of Dermatology University of Rome 'La Sapienza', Correspondence: V Panasiti. E-mail: [email protected]Search for more papers by this authorV Devirgiliis, V Devirgiliis Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this authorM Curzio, M Curzio Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this authorM Rossi, M Rossi Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this authorV Roberti, V Roberti Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this authorU Bottoni, U Bottoni Department of Dermatology and Oncology University of Catanzaro 'Magna Graecia', Viale del Policlinico, 155, 00161 Rome, ItalySearch for more papers by this authorS Calvieri, S Calvieri Department of Dermatology University of Rome 'La Sapienza',Search for more papers by this author First published: 09 February 2009 https://doi.org/10.1111/j.1468-3083.2008.02848.xCitations: 10 DOI: 10.1111/j.1468-3083.2008.02848.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 References 1 Burgdorf WHC, Goltz RW. Figurate erythema. In TB Fitzpatrick, ed. Dermatology in General Medicine, Vol. 2, 3rd edn. Mc-Graw Hill, New York, 1987: 1010. Google Scholar 2 Darier J. De l'érythème annulaire centrifuge. Ann Dermatol Syphiligr 1916; 6: 57. Google Scholar 3 Ackerman AB. Histologic Diagnosis of Inflammatory Skin Disease. Lea & Febiger, Philadelphia, 1978: 231. Google Scholar 4 Toussaint S, Kamino H. Non infectious erythematous, papular, and squamous diseases of the skin. In D Elder, ed. Lever's Histopathology of the Skin, 8th edn. Lippincott-Raven, Philadelphia, 1997: 153. Google Scholar 5 Lazar P. Cancer, erythema annulare centrifugum, autoimmunity. Arch Dermatol 1963; 87: 246–251. 10.1001/archderm.1963.01590140108017 Web of Science®Google Scholar 6 Tsuji T, Kadoya A. Erythema annulare centrifugum associated with liver disease. Arch Dermatol 1986; 122: 1239–1240. 10.1001/archderm.1986.01660230029003 CASPubMedWeb of Science®Google Scholar 7 Mahood JM. Erythema annulare centrifugum: a review of 24 cases with special reference to its association with underlying disease. Clin Exp Dermatol 1985; 8: 383–387. 10.1111/j.1365-2230.1983.tb01797.x Web of Science®Google Scholar 8 Stokkermans-Dubois J, Beylot-Barry M, Vergier B, Bouabdallah K, Doutre MS. Erythema annulare centrifugum revealing chronic lymphocytic leukaemia. Br J Dermatol 2007; 157: 1045–1047. 10.1111/j.1365-2133.2007.08132.x CASPubMedWeb of Science®Google Scholar 9 Rosina P, D'Onghia FS, Barba A. Erythema annulare centrifugum and pregnancy. Int J Dermatol 2002; 41: 516–517. 10.1046/j.1365-4362.2002.01552_5.x CASPubMedWeb of Science®Google Scholar 10 Bottoni U, Innocenzi D, Bonaccorsi P et al . Erythema annulare centrifugum: report of a case with neonatal onset. J Eur Acad Dermatol Venereol 2002; 16: 500–503. 10.1046/j.1468-3083.2002.00546.x CASPubMedWeb of Science®Google Scholar Citing Literature Volume23, Issue3March 2009Pages 318-320 ReferencesRelatedInformation

Bromhidrosis is a clinical disorder characterized by excessive or abnormal foul axillary odour due to the interaction of apocrine glands with micro-organisms which causes a serious personal and social handicap for affected people. We present the case of a 50-year-old caucasian female with bromhidrosis. The patient referred that this symptom had begun two months previously. Her past treatments included antibacterial soap, topical antibacterial agents and perfumes, but none of these relieved the patient of the odour. A cultural examination of axillary smear was carried out and it revealed the presence of ciprofloxacin sensible Sphingomonas paucimobilis. Therefore the patient was treated with ciprofloxacin and after 1 week the infection resolved completely.

522 © 2007 The Authors JEADV 2008, 22, 499–527 Journal compilation © 2007 European Academy of Dermatology and Venereology at the advancing edge of the tumour, and this progresses to fibrosis. New collagen fibres are formed from below and then at increasingly higher levels. The tumour shrinks as the inflammation and fibrosis move to higher levels. The final appearance is a scar. Batinac et al. described the histology of the ‘regression type’ of KA. Exoendophytic squamous proliferation is seen with a central, keratin-filled crater. The overlying epidermis extends around the crater, forming ‘lips’. With progressive regression of a KA, the keratin-filled crater becomes diminished, and the proliferating epithelium tended to flatten out, leaving a somewhat papillomatous base with underlying less intense chronic inflammation and fibrosis. When there is a history strongly suggestive of a KA, the presence of the moon crater sign gives greater confidence in making the diagnosis of a KA that has healed.

Brevundimonas vesicularis is a non-fermenting gram-negative bacillus, aerobic and motile. This microrganism is ubiquitous in the environment and has rarely been implicated in human infections. We present the second case of cutaneous infection caused by B. vesicularis in an immunocompetent patient.

Cryptococcosis is an opportunistic infection, the incidence of which is increased in the immunocompromised patients. Cryptococcus neoformans is an encapsulated fungus that mainly infects the lungs and the central nervous system, possibly involving different organs. Cutaneous cryptococcosis is classified into localized infection, usually occurring after traumatic inoculation (primary cutaneous cryptococcosis) and cutaneous manifestation due to hematogenous dissemination (secondary cutaneous cryptococcosis), mostly in patients with underlying immunosuppression. We report a case of cutaneous cryptococcosis in a patient affected by chronic lymphocytic leukaemia.

Dermoscopy allows early detection of melanoma also on acral volar skin. The majority of melanocytic nevi on palms and soles may show three major dermoscopic patterns: the parallel-furrow pattern, the lattice-like pattern, and the fibrillar pattern. Melanomas at these sites are characterized by the parallel ridge pattern. We present the case of a 59-year-old woman who had an oval papule of bluish color, measuring 0.6 × 0.9 cm, localized on her left sole, that had been present, unchanged, for more than 10 years. Dermoscopy showed a parallel ridge pattern. The histopathological examination revealed a combined blue nevus. We present this case to underline that on acral volar skin also intradermal nevi, such as combined blue nevi, may dermoscopically exhibit a parallel ridge pattern, simulating melanoma.

In the present study, we determined the incidence of dermatophyte species causing superficial mycoses among outpatients referred to the Department of Dermatology of the "La Sapienza" University of Rome between 2002 and 2004. Of the 3160 subjects studied, 1275 (40.3%) were positive for fungal infection, but only 252 (19.7%) of these had infections caused by dermatophytes. The dermatophyte most frequently isolated was Microsporum canis. Our epidemiological data were compared with those obtained previously by other authors in the same geographic area. For the first time we described an inversion of the T. rubrum/T. mentagrophytes ratio, the latter being more frequently encountered. We also observed the emergence of M. audouinii.

BACKGROUND:Trichorhinophalangeal syndrome (TRPS) is a rare autosomal dominant disorder, three types of which have been described in the literature. All of them are characterized by alopecia, facial dysmorphism and bone deformities. Deletions and nonsense mutations of the TRPS1 gene are responsible for most of the TRPS I and III cases with no clear genotype-phenotype correlation. The majority of missense mutations have been described at TRPS1 exon 6, encoding a presumptive GATA DNA-binding domain, and are known to be associated with the most severe forms of the phenotypic spectrum of TRPS. Mutation mapping at exon 7 described to date includes nonsense mutations and a familial case with an insertion mutation.OBJECTIVES:To determine a possible correlation between a mutation at exon 7 and mild TRPS phenotype.METHODS:We describe three members of an Italian family with TRPS I. All three showed clinical features typical of TRPS I such as temporal alopecia and facial abnormalities, but no mental retardation.RESULTS:Mutation analysis showed a missense mutation (R952C) in exon 7 of the TRPS1 gene.CONCLUSIONS:R952C is the first missense mutation described outside the GATA zinc-finger domain of TRPS1. In contrast with missense mutations occurring within this region, this mutation prevents the transport of the TRPS1 protein into the nucleus, therefore determining TRPS I by haploinsufficiency. We hypothesize that a TRPS exon 7 mutation could result in a mild phenotype.

Herpes simplex virus type 2 (HSV-2) infection was one of the first opportunistic infections identified among patients with AIDS. In the literature there are many data suggesting that the natural history of HSV-2 infection is altered in HIV-HSV-2 co-infected patients. Furthermore, a relationship between HIV seropositivity and HBV infection because of their analogous way of transmission is also described. We report the case of a 37-year-old patient who suffered from multiple painful ulcerative lesions of the perianal region. Laboratory examination showed positivity for HIV and HBV infections. In HIV-positive patients perianal HSV-2 can have atypical manifestations, especially if co-infection by Candida albicans occurs.

Direct microscopic examination of potassium hydroxide (KOH)-prepared specimens is the simplest, cheapest method used for the diagnosis of mycotic infections of the skin. However, KOH preparations have been reported to have 5-15% of false-negative results, possibly because of the low visibility of scant, scattered fungal material of the nail scrapings and because the detection of fungal elements depends on the skill of the observer [Arch Dermatol133 (1997) 1317; Clin Microbiol Rev8 (1995) 240]. We compared two different KOH-based staining methods in order to obtain reliable results in shorter time than expected for cultures. A total of 124 patients with suspect diagnosis of dermatomycosis or onychomycosis were enrolled. Two scrapings from the same lesion of each patient were stained with KOH-Chlorazole and KOH-Acridine Orange (AO), respectively; cultural examination of the same specimen was considered as diagnostic gold standard. The two methods showed neither significantly different sensitivity nor specificity; however, for onychomycoses, we observed a slightly higher sensitivity for KOH-Chlorazole and a higher specificity for KOH-AO. We suggest the use of both techniques in order to improve detection of fungal infection, especially for onychomycoses.

Among patients with cutaneous T-cell lymphoma (CTCL), sepsis and pulmonary infections are the first cause of death. We report on a patient with CTCL who, after more than 10 years of aggressive antineoplastic treatments, showed extensive pulmonary infiltrations on staging CT scan. Repeated CT scans were inconclusive for an infectious process, and the patient was still asymptomatic. The diagnosis of mycobacteriosis was made on the microbiologic exam of bronchoalveolar lavage. Specific treatment was started with contemporary dosage reduction of chemotherapy. After six months of antibiotic treatment the pulmonary lesions improved, whereas CTCL progressed. Therefore, a new antineoplastic regimen was started obtaining control of CTCL, without aggravation of the pulmonary lesions. We highlight the diagnostic and therapeutic pitfalls encountered when pulmonary mycobacteriosis complicates the course and treatment of CTCL.

BACKGROUND Brain metastases are the most life-threatening among the secondary localizations of melanoma for their unresponsiveness to the surgical, radiotherapeutic and/or chemotherapeutic treatments. METHODS Accidentally, we observed a complete response (CR) in a patient undergoing chemotherapy with bleomycin, vincristine or Oncovin, CCNU or lomustine, dacarbazine (BOLD) regimen for metastatic melanoma including brain metastases, who was also treated with G-CSF to manage a concomitant leukopenia. After this observation, seven more patients with stage IV melanoma with brain metastases were treated with BOLD regimen repeated every 6 weeks with administration of G-CSF in the intervals. RESULTS Three patients presented CR (37.5%). Two patients stopped the treatment after two courses for evident progressive disease (25%). The other three patients showed stable disease (SD: 37.5%). Median duration of SD was 24 weeks. Among the eight patients, six (75%) achieved clinical benefit. Median time to progression was 8.5 months (range 0-74+ months). Median survival was 12.5 months (range 4-74+ months). Two patients are still alive and disease-free after 74 and 57 months, respectively. CONCLUSION We believe that the brilliant CR, the long duration of the disease-free intervals and the long survival in at least three of eight patients should encourage further research on BOLD with G-CSF for the treatment of advanced melanoma.

Department of Cutaneous-Venereal Diseases and Plastic and Reconstructive Surgery, University of Rome ‘La Sapienza’, Viale del Policlinico, 155, 00161 Rome, Italy. Tel: +39 06 4474 0757; Fax: +39 06 4462 104; e-mail: ugobottoni@uniroma1.it (U. Bottoni, A. Richetta, T.J. Mannooranparampil, V. Devirgiliis, M. Del Giudice, S. Calvieri). University of Rome ‘Tor Vergata’, Viale Oxford 81, 00100 Rome, Italy (P. Izzo). Department of Experimental Medicine and Pathology, University of Rome ‘La Sapienza’, Via Regina Elena, 324, 00161 Rome, Italy (M. Reale, L. Frati).