Immunohistochemical expression of vitamin D receptor in melanocytic naevi and cutaneous melanoma: a case-control study

BACKGROUND

Vitamin D deficiency is associated with higher risk of cancer, possibly due to its antiproliferative, antiangiogenic, proapoptotic, cell-differentiating and anti-invasive effects. The anticarcinogenic role of vitamin D in melanoma is still a matter of debate. Loss of nuclear and cytoplasmic vitamin D receptor (VDR) expression in melanoma cells has been reported.

OBJECTIVES

To analyse VDR immunohistochemical expression in benign dermal naevi (DN) and malignant melanoma (MM).

METHODS

A case-control study evaluated nuclear and cytoplasmic VDR immunohistochemical staining in 54 DN and 55 MM tissue samples.

RESULTS

There was significantly higher cytoplasmic VDR positivity in DN compared with MM (59% vs. 16%, P < 0·001). The mean VDR cytoplasmic expression was also higher in DN vs. MM (P < 0·001). No differences in nuclear VDR positivity were observed between groups, but mean nuclear VDR expression was significantly lower in DN vs. MM (P = 0·02). The loss of cytoplasmic VDR in MM was associated with Clark level, tumour staging and American Joint Committee on Cancer pTNM staging (P=0·004, 0·009 and 0·02, respectively).

CONCLUSIONS

Alterations in VDR expression and localization are found in MM compared with DN. Loss of cytoplasmic VDR was associated with melanoma tumour size, suggesting that loss of cytoplasmic VDR may be a prognostic factor.

The use of a sunscreen containing DNA-photolyase in the treatment of patients with field cancerization and multiple actinic keratoses: a case-series

Cutaneous field cancerization (CFC) is associated witha high-risk of developing cutaneous squamous cellcarcinoma (cSCC). It manifests as actinic keratoses(AK) as one of the few macroscopic alterations in CFCpatients. A prospective, single-arm, case-series wasperformed to evaluate the utility of a novel sunscreencontaining DNA-photolyase for treatment of CFCin nine subjects (mean age 70.6 years, male: femaleratio 5:4). The cream was applied topically twicedaily on CFC/AK areas and patients were followedup for three months, with no other treatments. Theprimary outcome was the overall response rate (ORR),categorized as complete response (CR, completeresolution of AKs), partial response (PR, reduction inthe number of AKs), and no-response (NR, similar/increase in number of AKs). A 100% PR was observed.All subjects displayed at minimum, a 50% reductionin their lesion number and most patients experiencedalmost CR. Evaluation of AK numbers revealed anabsolute count reduction of 76.6% in the number oflesions, with the mean number of lesions reducedfrom 13.4 to 3.1 (p &lt; 0.0001). No adverse events werereported. Patients with CFC may benefit from noveltopical applications containing DNA-photolyase,at minimum, as complementary therapy for themanagement of CFC disease. We propose a newconcept called "active photoprotection" because of itsdual mechanism involving therapy and protection.

Cutaneous manifestations in renal transplant recipients of Santiago, Chile

INTRODUCTION

Renal transplant recipients have a heightened risk of developing various cutaneous manifestations, such as skin infections, skin cancer, and secondary effects of immunosuppressive drugs. These manifestations differ depending on the evaluated population. The objective of this study was to describe the prevalence of cutaneous manifestations among renal transplant recipients in Chile between 1979 and 2008.

METHODS

Patients were recruited and then evaluated using a standardized questionnaire. Dermatologic physical examination was performed in every patient describing skin lesions, immunosuppressive drug effects, and malignant diseases. All suspicious lesions were biopsied for analysis. Every patient was queried for the development of skin cancer after his or her transplantation.

RESULTS

A total of 91 patients were enrolled; ages 10-67 years. Sixty percent of the patients presented with an infection at the initial evaluation. The most common infection was onychomycosis (58%) and verruca vulgaris (25%). In this study 58% of patients developed cutaneous side effects of immunosuppressive drugs. Among the evaluated patients, 16% showed premalignant or malignant manifestations on physical examination. The most frequent manifestations were actinic keratosis (17%), basal cell carcinoma (1%), and squamous cell carcinoma (1%). On a retrospective analysis, 12% of patients developed skin cancer after transplantation, 66% squamous cell carcinoma and 34% basal cell carcinoma, with a ratio of 1.9 to 1.

DISCUSSION

Cutaneous manifestations in renal transplant recipients are generally secondary to immunosuppression. These patients show a greater risk of having human papilloma virus (HPV) infections and nonmelanoma skin cancer. Periodic dermatologic evaluation of these patients should be performed to detect early lesions and modify risk factors.

[Toxic epidermal necrolysis. Therapy in ICU with intravenous immunoglobulins in a case]

We report a 27 years old homosexual male with AIDS that was admitted to the ICU dehydrated, with fever and severe malaise. He had irregular bullae, an extensive purpuric exanthema and a zone of epidermic detachment in the right arm. A toxic epidermal necrolysis was diagnosed and therapy with i.v. immunoglobulins was started. After four days of treatment, bullous lesions disappeared and the extension of exanthema decreased. Toxic epidermal necrolysis is a potentially fatal disease and the use of intravenous immunoglobulins for this condition has been reported as successful.

Primary cutaneous angioplasmocellular hyperplasia

Two cases of solitary nodules on the skin of the trunk of young adults showing a peculiar pattern of proliferation of blood vessels and a mixed inflammatory infiltrate with predominance of polyclonal plasma cell infiltration are presented. Follow-up of these patients after complete surgical excision revealed no recurrence. We interpreted the lesions within the morphologic spectrum of plasma cell infiltrates of the skin to be reactive and/or hyperplastic, which we term primary cutaneous angioplasmocellular hyperplasia.

Free laminar thin band graft--a surgical therapeutic variant in the treatment of leg ulcers

For the past 2 years, we have been using a surgical technique for the treatment of leg ulcers caused by chronic venous insufficiency. This consists of a type of graft biologically and technically intermediate between Reverdin and Thiersh's types. We have named it the "free laminar thin band graft." In contrast to the Thiersh graft, this simple surgical technique requires little equipment, and it can be done quickly and easily as an office procedure, with little risk to the patient. In addition, it is a low cost procedure. In our experience with this technique, healing time is shorter and lesions recur later than with the Reverdin graft. The authors describe the surgical method and report a clinical case.