Evolution histologique des carcinomes basocellulaires récidivants

TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Intérêt de l'association streptomycine et rifampicine (schéma OMS) dans le traitement de l'infection à Mycobacterium ulcerans (ulcère de Buruli) (évaluation après un an chez 103 patients au Bénin)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Le « bon médecin » : enquête auprès des patients

Contexte : Le public utilise souvent le terme « bon médecin » pour désigner le professionnel de santé auquel il se réfère ou souhaite s’adresser. But : Analyser la notion de « bon médecin » comme besoin ressenti par une population. Méthodes : Nous avons préparé un court texte explicatif pour des personnes consultant en dermatologie, malades et accompagnants, indiquant qu’ils venaient dans un lieu de formation médicale. Dans chaque réponse ont été identifiés et colligés des mots clefs. Un essai de regroupement des mots clefs par item définissant un champ de compétence a été fait. Résultats : Nous avons interrogé 103 personnes (51 femmes, 51 hommes, 1 non précisé, âge 10-91 ans). Seules 4 personnes avaient la même définition pour le médecin et le bon médecin et 2 n’avaient pas défini le « bon médecin ». La majorité des patients font une grande différence entre le médecin et le bon médecin, portant sur des habiletés de communication et les qualités humaines et professionnelles. Discussion : Nos résultats rejoignent les réponses exposées récemment dans la littérature, majoritairement le fait de médecins. Malgré certaines limites, cette enquête apporte des éléments quantitatifs sur certains besoins ressentis et sur les dimensions de la compétence professionnelle, et qualitatifs sur le vocabulaire utilisé par les patients, ce qui permet d’influer sur les objectifs de formation. Ces données sont issus d’un vécu mais expriment bien des besoins ressentis, voire attendus par une population. Elles pourraient être exploitées comme information auprès d’étudiants pour les aider à préparer leur formation professionnelle

First case of “bubonulus” in L2 lymphogranuloma venerum

Since 2003, an ongoing lymphogranuloma venereum (LGV) proctitis outbreak has been reported in industrialised countries with a new variant designated L2b. Only men who have sex with men (MSM) are affected and most are HIV co‐infected; delayed or incorrect diagnoses are frequent. We report a rare clinical case of LGV primary stage called “bubonulus” with penile adenopathy and secondary local acute lymphoedema in an MSM seropositive man. This is the first case described of this clinical presentation with a L2b genovar strain, occurring immediately after use of a sex toy. It suggests that this presentation is favoured by host immunity and behavioural factors. These factors may also play a part in the new outbreak of LGV

Panniculitis Associated with MEK Inhibitor Therapy: An Uncommon Adverse Effect

The combination of MEK inhibitor (cobimetinib, trametinib) and BRAF inhibitor (vemurafenib, dabrafenib) is now the first-line treatment in patients with BRAF V600-mutated metastatic melanoma. This association reduces cutaneous adverse events induced by BRAF inhibitors alone, including photosensitivity, hand-foot syndrome, hyperkeratosis, alopecia, skin papillomas, keratoacanthomas, and squamous-cell carcinomas. While panniculitis has exceptionally been reported with BRAF inhibitors, this rare side effect has never been described with the use of MEK inhibitors. We present here the first observation of panniculitis strictly induced by MEK inhibitors. Indeed, 10 days after the initiation of combined treatment with cobimetinib and vemurafenib for metastatic melanoma, our patient developed panniculitis predominantly on the upper and lower extremities. These cutaneous nodules disappeared during cobimetinib intermissions and recurred while the molecule was resumed. Recurrence of cutaneous nodules was observed after initiation of trametinib combined with dabrafenib, and resolved once again with trametinib discontinuation. We believe that clinicians should be aware of this cutaneous adverse event in patients treated with combined therapy, which can lead to unfounded BRAF inhibitor treatment discontinuation and compromise the antitumor response. Our case suggests a class effect linked with the MEK inhibition pharmacodynamic activity. Finally, laboratory investigation and histopathological examination are mandatory to exclude other panniculitis etiologies and subcutaneous metastasis of melanoma

Predictive clinical features of eczema craquelé associated with internal malignancy.

International audienceOBJECTIVE: To describe a series of hospitalized patients with eczema craquelé (EC) and the possible correlations between clinical features of EC and cancer in an open prospective observational study. PATIENTS AND INTERVENTIONS: The study population comprised 68 consecutive patients included between January 1, 1999 and December 31, 2000 who were followed up through December 2004. All patients who had localized or generalized EC were included. Patients underwent complete clinical examinations, routine laboratory tests, chest x-rays, abdominal ultrasound, and cutaneous biopsies performed on EC. MAIN OUTCOME MEASURES AND RESULTS: Rates of EC associated with cancer, clinical features of eczema, rate of recalcitrant eczema, relationship to other clinical prognostic factors, and paraneoplastic evolution were evaluated. Cancer was diagnosed in 32 patients (47%). We observed a significant difference in the presenting clinical signs of EC between patients with malignant tumors and patients without cancer. In patients with malignancies, EC was widespread on the trunk and we noted deep red and inflammatory fissures. In all cases, EC led to the discovery of malignancy or recurrence of cancer. CONCLUSION: Widespread EC, topical corticosteroid resistance, and deep red and inflammatory fissures were significantly correlated with neoplasia

Blue light is phototoxic for B16F10 murine melanoma and bovine endothelial cell lines by direct cytocidal effect.

ERMAInternational audienceUNLABELLED: The large number of studies devoted to the effect of ultraviolet light on biological systems, contrasts with the lack of experimental data concerning the direct effects of visible light. It has been shown that blue light inhibited the growth of B16F10 melanoma cell lines and reduced the percentage of S phase cells. Yet these effects are poorly understood. MATERIALS AND METHODS: Two cell lines and irradiation with blue light were used. Cell mortality and a possible mechanism of action were investigated. RESULTS: Exposure of B16F10 melanoma and bovine endothelial cells to blue light (wavelength 450 nm, 10 J/cm(2) from a Waldman lamp) induced a rapid and large reduction in viability followed by the death of virtually all the irradiated cells within 24 h. These results led us to expose a patient with haemorrhagic cutaneous melanoma metastasis to blue light. Irradiation led to an immediate arrest of haemorrhage, an inhibition of tumour growth and extensive tumour necrosis 24h after irradiation. CONCLUSION: Exposure to blue light may offer new approaches to the treatment of superficial skin carcinomas in humans

Imatinib mesylate as a preoperative therapy in dermatofibrosarcoma: results of a multicenter phase II study on 25 patients.

International audienceAIMS: The treatment of dermatofibrosarcoma protuberans (DFSP) involves wide local excision with frequent need for reconstructive surgery. A t(17;22) translocation resulting in COL1A1-PDGFB fusion is present in >95% of cases. Certain patient observations and a report on nine patients suggest that imatinib mesylate, targeting platelet-derived growth factor receptor beta, has clinical potential in DFSP. The primary aim of this phase II multicenter study was to define the percentage of clinical responders (Response Evaluation Criteria in Solid Tumors) to a 2-month preoperative daily administration of 600 mg of imatinib mesylate before wide local excision. The secondary aims were to determine tolerance, objective response from imaging results (ultrasound and magnetic resonance imaging), and pathologic responses observed in sequential tissue specimens. PATIENTS AND METHODS: A two-stage flexible design was used with interim analysis after the recruitment of six patients. Twenty-five adults suffering from primary or recurrent DFSP were included from July 2004 to May 2006. RESULTS: The COL1A1-PDGFB fusion gene was detected in 21 out of 25 patients following fluorescence in situ hybridization analysis (two cases were noninformative). A clinical response was achieved in nine (36%) patients (95% confidence interval, 18.9-57.5). The median relative tumoral decrease was 20.0% (range, -12.5 to 100). Apart from expected grade 1 or 2 side effects, we observed one grade 3 neutropenia, one grade 3 maculopapular rash, and one grade 4 transient transaminitis. CONCLUSION: Our results support the use of imatinib in a neoadjuvant setting in nonresectable DFSP, or when surgery is difficult or mutilating. These results will be useful for setting hypotheses in the evaluation of new drugs to treat primary or secondary resistance to imatinib