Merkel Cell Polyomavirus Strains in Patients with Merkel Cell Carcinoma

We investigated whether Merkel cell carcinoma (MCC) patients in France carry Merkel cell polyomavirus (MCPyV) and then identified strain variations. All frozen MCC specimens and 45% of formalin-fixed and paraffin-embedded specimens, but none of the non-MCC neuroendocrine carcinomas specimens, had MCPyV. Strains from France and the United States were similar

Carcinome de Merkel et Polyomavirus de Merkel (séroprévalence du virus et détection virale par PCR, avec comparaison à un groupe témoin)

TOURS-BU Médecine (372612103) / SudocSudocFranceF

Locoregional Multiple Nodular Panniculitis Induced by Pseudomonas aeruginosa Without Septicemia Three Cases and Focus on Predisposing Factors

International audienceIMPORTANCE Pseudomonas aeruginosa-induced locoregional multiple nodular panniculitis without septicemia is an underreported condition, with only 3 cases reported to date. We report 3 new cases of P aeruginosa-induced multiple nodular panniculitis without septicemia and describe common features among all 6 cases, thus providing the first description, to our knowledge, of the natural history and potential predisposing factors for this entity. OBSERVATIONS Median age of the 6 patients was 74 years (range, 54-84 years). Patients had inflammatory nodules on a lower limb (n = 6) that were unilateral (n = 6) and had no fever (n = 5). Blood cultures were negative (n = 5). Skin biopsy specimens revealed panniculitis (n = 5), with skin cultures positive for P aeruginosa (n = 6). Skin nodules resolved with systemic antibiotics (n = 5). The comorbidities recorded were type 1 or 2 diabetes mellitus (n = 5), overweight (n = 3), and combined locoregional anatomical changes in the lower limbs (n = 5). Local skin injury, which constituted the portal entry, was present in all cases, especially leg ulcers (n = 3). CONCLUSIONS AND RELEVANCE We describe P aeruginosa-induced locoregional nodular panniculitis as a distinct entity. This should be investigated in elderly, diabetic, overweight patients with inflammatory nodules on a lower limb associated with locoregional anatomical changes and skin injury, with the optimal antibiotic regimen introduced as rapidly as possible

Reconnaissance et prise en charge initiale du mélanome par des médecins généralistes : enquête dans un département rural à très faible densité médicale

National audienceIntroduction : Cutaneous cancers are very common, easily visible on skin. The general practitioner (GP) is in the front line to manage the lesions. He has to recognize malignancy and refer most often to the specialist for excision, or consider that the lesion is benign and in ambiguous cases, offer clinical monitoring. The current low medical density in the Centre Val de Loire area makes access to general practitioners (GP) and dermatologists harder. The aim of this study was to evaluate GPs’ everyday practice in cutaneous cancers screening in general, and particularly in melanoma screening, in a rural region of France.Methods : We sent a questionnaire on November 24th 2015 to all GPs of the Cher department (204 questionnaires), to assess their knowledge and practice of melanoma. The questionnaire comprised 2 parts: the first part was composed of 23 items with a majority of questions focused on melanoma and the second part consisted of clinical cases including 5 benign cutaneous tumors, 4 melanomas and 1 pigmented basal cell carcinoma. GP's were asked to answer in each case: diagnosis, degree of certainty (from 0 to 10), practical attitude (excision, referral to dermatologist or surgeon or surveillance). Their answers were anonymous. The primary endpoint was whether medical decision regarding each case was appropriate, i.e. removal of malignant lesion or referral for removal, and reassurance or surveillance in benign lesions.Results : The response rate was 35% (72 responses). Thirty-eight GPs (53%) had an appropriate management facing the 5 malignant lesions, 18 GP (25%) had an appropriate management in 4 out of 5 cases. The ABCDE rule was known by 58% of responders, the ugly duckling sign of 19%. GPs did not feel comfortable with melanoma: on a growing scale (from 0 = not comfortable at all to 10 = very comfortable) the average was 4.2 with a median at 5 (range 0–10). They expressed a strong need for training on this topic: on a scale increasing from 0 to 10, the average was 7.9 for a median to 8 (range 3–10). Knowledge about melanoma risk factors, and the level of ease dealing with screening of melanoma was not significantly associated with a better management. The main difficulties were lack of time and the increasing difficulty of access to dermatologist. Fast and easy access by teledermatology was solicited by 89% of GPs.Conclusion : GPs had often appropriate management of skin cancer. The major obstacles to skin's cancer screening were the lack of time and difficult access to dermatologists. The setting-up of an easier access with teledermatology was requested by 89% of responders, and should improve early detection of melanoma.Introduction : Les cancers cutanés sont très fréquents, visibles sur peau, le médecin généraliste (MG) est en première ligne pour décider de la prise en charge : reconnaître la malignité et adresser le plus souvent au spécialiste pour l’exérèse, ou considérer que la lésion est bénigne et proposer une surveillance clinique. La faible densité médicale en région Centre Val de Loire rend l’accès au MG et au dermatologue difficile. Notre étude avait pour objectif d’évaluer la pratique des MG du Cher dans le dépistage des cancers cutanés de manière générale, et du mélanome en particulier.Méthodes : Nous avons adressé en novembre 2015 un questionnaire à tous les MG du département du Cher (soit 204 questionnaires) afin de connaître leur pratique du dépistage des cancers cutanés. Le questionnaire était divisé en deux parties : une première composée de 23 items avec une majorité de questions fermées sur le mélanome, une deuxième comportant une série de 10 cas cliniques (4 mélanomes, 1 basocellulaire tatoué, 4 nævus, 1 kératose séborrhéique). Les MG devaient répondre à 3 questions identiques pour chaque cas : diagnostic, degré de certitude (de 0 à 10), attitude pratique (exérèse, surveillance, recours au dermatologue ou au chirurgien). Leurs réponses étaient anonymes. Le critère de jugement principal était de savoir si les MG avaient une conduite adaptée devant une tumeur cutanée.Résultats : Nous avons reçu 72 réponses (taux de réponse de 35 %). Trente-huit médecins (53 %) avaient une attitude adaptée face aux 5 lésions malignes, et 18 médecins (25 %) une attitude adaptée dans 4 cas sur 5. La méthode ABCDE était connue de 58 % des répondeurs, le vilain petit canard de 19 %. Les MG ne se sentaient pas très à l’aise pour dépister un mélanome : sur une échelle croissante (de 0 = pas à l’aise du tout à 10 = très à l’aise) la moyenne était de 4,2 avec une médiane à 5 (valeurs extrêmes 0–10). Ils exprimaient un fort besoin de formation sur ce thème : sur une échelle croissante de 0 à 10, la moyenne était à 7,9 pour une médiane à 8 (extrêmes 3–10). L’âge, le mode d’exercice (seul ou en groupe), le nombre de consultations quotidiennes, le niveau de connaissance des facteurs de risque de développer un mélanome et le degré d’aisance ressentie pour le diagnostic du mélanome n’étaient pas associés significativement à une attitude plus ou moins adaptée. Les principales difficultés étaient le manque de temps et la difficulté croissante d’accès au dermatologue. La mise en place d’un accès facilité par télé-dermatologie était sollicitée par 89 % des répondeurs.Conclusion : Les MG ont une conduite pratique souvent adaptée dans la prise en charge initiale des tumeurs cutanées. Les principales difficultés identifiées étaient le manque de temps et la difficulté croissante d’accès au dermatologue. La mise en place d’un accès facilité par télé-dermatologie pourrait faciliter la prise en charge plus rapide du mélanome

High levels of antibodies against merkel cell polyomavirus identify a subset of patients with merkel cell carcinoma with better clinical outcome.

International audiencePURPOSE: A new human polyomavirus, Merkel cell polyomavirus (MCV), was identified in 2008 in tumor tissue of patients with Merkel cell carcinoma (MCC), a relatively rare human skin cancer. In this study, we investigated patients with MCC and controls for the presence of antibodies against MCV and their association with clinical characteristics. PATIENTS AND METHODS: Antibodies against MCV were investigated by enzyme-linked immunosorbent assay in 68 patients with MCC and 82 controls using VP1 virus-like particles produced in insect cells. RESULTS: Antibodies against MCV were detected in all patients with MCC and in 85% of controls. However, high antibody titers (> 10,000) were rarely observed in controls (7.3%) and they were detected in 64.7% of patients with MCC (P < .001) in contrast to the absence of VP1 expression in tumor samples. In addition, the geometric mean titer of anti-MCV in patients with MCC was around 14 times higher than that observed in MCV-positive controls (P < .001) and was not correlated with tumor viral load. High antibody titers were not found to be associated with any subject or tumor characteristics, but better progression-free survival was observed in patients with high antibody titers (hazard ratio, 4.6; 95% CI, 1.7 to 12.2; P = .002). CONCLUSION: High titers of MCV antibodies in a much higher proportion of patients with MCC than in controls confirmed the association between MCV infection and MCC. The findings also indicated that a better progression-free survival occurred in patients with high MCV antibody titers and suggested that there are at least two distinct etiologic causes of MCC

Vitamin D deficiency is associated with greater tumor size and poorer outcome in Merkel cell carcinoma patients

International audienceBackgroundMerkel cell polyomavirus has been recognized to be associated with Merkel cell carcinoma (MCC), but the evolution of this cancer probably depends on various factors. Vitamin D deficiency, defined by serum 25-hydroxyvitamin D levels <50nmol/L, seems to influence cancer behavior and progression, but has never been assessed in MCC patients. ObjectivesFirst, to evaluate whether vitamin D deficiency was associated with tumor characteristics and prognosis in a cohort of MCC patients. Second, to assess expression of the vitamin D receptor (VDR) in MCC tumors. MethodsClinical findings, Merkel cell polyomavirus markers and vitamin D status were assessed in a cohort of French MCC patients. The study was limited to the 89 patients for whom the serum sample had been collected within 3years after the diagnosis of MCC. Correlation between vitamin D deficiency and MCC characteristics and outcome were determined in regression analyses. VDR expression in MCC tumours was assessed by immunohistochemistry. ResultsVitamin D deficiency was noted in 65.1% of the patients and was independently associated with greater tumor size at diagnosis (P=0.006) and with metastasis recurrence (HR, 2.89; 95% CI, 1.03 to 8.13; P=0.043), but not with death from MCC, although there was a trend (HR, 5.28; 95% CI, 0.75 to 36.96; P=0.093). VDR was found to be strongly expressed in all 28 MCC tumor specimens investigated. ConclusionThe association between vitamin D deficiency and MCC characteristics and outcome, together with detection of the VDR in MCC cells, suggest that vitamin D could influence the biology of MCC

Marqueurs tumoraux et sériques dans les carcinomes à cellule de Merkel

National audienc