Archives of dermatology最新文献

Objective: To identify clinical and sociodemographic factors associated with very thick melanoma (VTM) (Breslow thickness, 3 mm) in France.

Design: Retrospective, population-based, case-case study using a survey of cancer registries and questionnaires to practitioners.

Setting: Five regions covering 19.2% of the French territory and 8.2 million inhabitants.

Cases: Cases included all incident melanomas with a Breslow thickness of 3 mm or greater (ie, VTM), diagnosed between January 1 and December 31, 2008, in residents of the study area (Alsace, Bourgogne, Champagne-Ardenne, Franche-Comte', and Lorraine, France), and a randomly selected sample of melanomas thinner than 3 mm.

Main outcome measures: Circumstances of diagnosis,clinical and pathological characteristics of melanomas,and sociodemographic characteristics of patients(age, sex, residence, home and family life conditions, educational level, and smoking habits).

Results: Among 898 melanomas, 149 (16.6%) were VTMs. Very thick melanomas were more often diagnosed in a general-practice setting than thinner melanomas.The rate of immediate clinical recognition by dermatologists was lower for VTMs than for thinner melanomas. In a multivariate logistic regression analysis,factors associated with VTM were the nodular and acrolentiginous types; the head and neck and lower limb locations; older age; male sex; and being single, separated,divorced, or widowed. When only factors related to patients were taken into account, older age, male sex,and living alone were independent risk factors for VTM.The most significant risk was observed for patients living alone.

Conclusions: Intrinsic factors related to the tumor and socio demographic characteristics of patients contribute to the occurrence of VTM. These factors should be better targeted in future secondary prevention programs.

Background: Paronychia has been reported in as many as 10% of patients treated with gefitinib. Although conservative management and treatment with topical or systemic antibiotics are beneficial, no effective method exists for intractable cases. Platelet-rich plasma (PRP)consists of a high concentration of platelets that promote wound healing through chemotaxis, cell proliferation,angiogenesis, and tissue remodeling.

Observations: We herein report a refractory case of gefitinib-induced paronychia successfully treated with autologous PRP. A 68-year-old woman who had been diagnosed as having lung adenocarcinoma with multiple bone and brain metastases initiated gefitinib therapy at an oral dose of 250 mg/d. After 1 month, multiple paronychia with periungual granulation appeared on the nailfold of the first, second, and third toenails of both feet.Because the paronychia recurred repeatedly despite use of a topical antibiotic, topical corticosteroid, and short term systemic antibiotic, she started PRP treatment. After 3 months, the lesion showed marked improvement with minimal pain or discharge.

Conclusion: This case highlights the therapeutic challenges of using PRP to promote tissue repair in intractable gefitinib-induced paronychia and merits further investigation.

OBJECTIVE To analyze variables affecting the treatment course and prognosis of Q-switched laser tattoo removal. DESIGN Observational prospective cohort study. SETTING The study was carried out in a referral center for surgery and laser surgery in Milan. PARTICIPANTS Of 397 consecutive patients initially enrolled from January 1, 1995, to December 31, 2010, 352 patients (201 men and 151 women; median age, 30 years) were included in the analysis. INTERVENTION All patients were treated by the same investigator with Q-switched 1064/532-nm Nd:YAG laser and Q-switched 755-nm alexandrite laser according to tattoo colors. Laser sessions were scheduled at 6-week or longer intervals. MAIN OUTCOME MEASURES Successful therapy was defined as removal of the tattoo, with no adverse effects other than transient hypochromia or darkening. RESULTS The cumulative rates of patients with successful tattoo removal were 47.2% (95% CI, 41.8%-52.5%) after 10 sessions and 74.8% (95% CI, 68.9%-80.7%) after 15 sessions. Smoking, the presence of colors other than black and red, a tattoo larger than 30 cm2, a tattoo located on the feet or legs or older than 36 months, high color density, treatment intervals of 8 weeks or less, and development of a darkening phenomenon were associated with a reduced clinical response to treatment. CONCLUSIONS To our knowledge, this study is the first to formally assess prognostic factors for effective tattoo removal by Q-switched laser. Several variables influence response rates and should be considered when planning tattoo removal treatments.