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Notes: Background In several studies an increased risk for development of breast cancer, malignant lymphoma and neoplasms of the kidney as second primary cancers in patients with cutaneous melanomas was discussed. Objectives To determine the risk for development of second primary neoplasms in patients with cutaneous melanomas. Methods A prospective study was performed between 1977 and 1992 to evaluate the occurrence of second primary malignancies in 4597 patients (2083 men, 2514 women) with invasive cutaneous melanomas, diagnosed and treated at the Department of Dermatology and Allergology, Ludwig-Maximilians-University, Munich, Germany. Results During a median follow-up of 7·2 years, 296 of 4597 patients (6·4%) developed one or more neoplasms at the time of or subsequent to the diagnosis of the first cutaneous melanoma. More than half of these patients developed one or more further melanomas (152, 3·3%). Cancers of the breast, prostate, colon, rectum and kidney occurred less frequently. Statistical calculations revealed a 33·8-fold increased risk for the development of a second melanoma in the entire group [relative risk 38·5 for men (95% CI, 30·4–48·1), 29·0 for women (95% CI, 22·0–37·5)]. Moreover, a significantly increased risk for the development of kidney carcinoma in men was found [relative risk 3·5 (95% CI, 1·4–7·2)]. Conclusions Thorough follow-up and skin examination in patients with cutaneous melanomas is recommended for early detection of other primary melanomas. Furthermore, ultrasound examinations routinely performed in melanoma patients for the detection of melanoma metastases may also be of value for early detection of kidney carcinomas in male patients.

Notes: Background  Although survival in patients with thin melanomas (tumour thickness ≤ 0·75 mm) is usually excellent, thin melanomas have the potential to metastasize.Objectives  To determine risk factors for the development of disease progression in patients with thin cutaneous melanomas.Methods  A retrospective study was performed between 1977 and 1998 to identify risk factors for the development of disease progression in 2302 patients with cutaneous melanoma with tumour thickness ≤ 0·75 mm, diagnosed and treated at the Department of Dermatology and Allergology, Ludwig-Maximilians University, Munich, Germany. The Kaplan–Meier method was used to estimate the influence of different clinical characteristics for the occurrence of first progression during 10 years of follow-up.Results  An analysis of the data from 6298 patients with cutaneous melanoma identified 2302 patients (37%) who presented with cutaneous melanoma with a tumour thickness ≤ 0·75 mm, without clinical signs of metastasis at initial diagnosis (clinical stage Ia). A small subgroup of our patients (77 of 2302) developed metastatic disease during the follow-up period. The estimated rate of occurrence of metastasis after 10 years of follow-up was 4·7%. The mean follow-up time was 62 months (median 46). Of these 77 patients, 16 experienced progression at the primary tumour site and 32 presented with regional lymph node metastases. Twenty-eight patients primarily developed systemic metastases (seven patients with and 20 without regional lymph node metastases, one patient with regional lymph node metastases and local recurrence). In one patient the primary site of metastatic disease was not reported. Clinical characteristics included age, sex of the patient and different subtypes of cutaneous melanoma: superficial spreading melanoma, nodular melanoma, acrolentiginous melanoma (ALM) and lentigo maligna melanoma (LMM). Male patients and patients with LMM or ALM were significantly over-represented (P = 0·02 and P = 0·002). In the group of 77 patients with thin melanomas (≤ 0·75 mm), local recurrence was over-represented as compared with those with melanomas 〉 0·75 mm. No difference in group was found for overall survival after the occurrence of lymph node metastasis as the first manifestation of disease progression.Conclusions  Thorough follow-up and skin examination is recommended for a subgroup of patients with thin tumours, which consists of male patients with LMM or ALM located in the head and neck region.

Notes: Summary Seborrhoea is one pathogenic factor for acne. Androgens induce sebum production, and excess androgen may provoke or aggravate acne. In women an androgen disorder is frequently suspected when acne is accompanied by hirsutism or menstrual irregularities. In men acne may be the only symptom of androgen excess. We report three male acne patients in whom hormonal screening revealed irregularities of androgen metabolism suggestive of late-onset congenital adrenal hyperplasia and who benefitted from low-dose glucocorticoids. Disorders of androgen metabolism may influence acne not only in women, but also in men, and these patients may benefit from low-dose glucocorticoid therapy.

Notes: Acne inversa is a recurrent, suppurative disease manifested by abscesses, fistulas, and scarring. Once considered to be a disease of the apocrine glands, it is actually a defect of follicular epithelium. Thus, the term hidradenitis suppurativa is a misnomer and should be abandoned. In cases of familial acne inversa, the pattern of transmission and number of affected individuals are consistent with autosomal dominant inheritance. Aetiological factors such as hyperandrogenism, obesity, smoking and chemical irritants are not consistently associated with the affection. Bacterial involvement is not a primary event in acne inversa, but is secondary to the disease process. Potential complications include dermal contraction, local or systemic infection due to the spread of microorganisms, systemic amyloidosis, arthropathy, and squamous cell carcinoma. As spontaneous resolution is rare and progressive disability is the rule, early definitive surgical intervention is advisable. The surgical procedure of choice in most cases is wide local excision and healing by secondary intention. Pharmacotherapeutic drugs, including synthetic retinoids and antiandrogens, do not prevent progression of the disease.