[Laser therapy of dermatologic diseases].
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Biomedical subjects
Publications and source records attributed to M Landthaler.
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Approximately 5% of all malignant melanomas originate from primarily non-cutaneous sites. They are preferentially distributed along the choroid, the meninges, the subserous space of the oesophagus and the intestinal tract, at transitional areas of mucous membranes, and along organ capsules, the periadventitial tissues of major blood vessels, and, occasionally, muscle fasciae. Little is known about their biological behaviour; the prognosis, however, generally has to be considered less favourable than that of primary cutaneous malignant melanomas, probably at least in part because they are often not discovered until they are in advanced stages. There are no specific clinical signs suggestive for non-cutaneous malignant melanomas; symptoms vary with the site of manifestation of the tumours. Interpretation of these clinical data based on results from comparative anatomical studies leads to the conclusion that extracutaneous malignant melanomas in humans are residuals of phylogenetically old, extensive and well-developed non-cutaneous pigment cell patterns demonstrable in a variety of lower vertebrates, which result from interactions between organogenesis and pigment cell development during ontogeny. This demonstrates that consideration of fundamental principles of developmental biology can give diagnostic clues to the localizations at which primary non-cutaneous malignant melanomas may be suspected and can thus facilitate decisions about what diagnostic procedures are necessary.
There is a conflicting evidence regarding the value of a regional lymph node dissection in early clinical stages of head and neck Melanomas. The AA. reviewed the clinical histories of 500 patients presenting a malignant melanoma localized in the head and neck region and treated in their Hospital between 1967 and 1987. Results showed that the prophylactic neck dissection is necessary for lesions between 0.75 and 1.5 mm in thickness, whereas in tumours with a depth of invasion greater than 1.5 mm the outcome of the disease is not improved by the prophylactic neck dissection.
Unusual courses of infections with borrelia burgdorferi can make diagnosis problematic, but early and adequate therapy is mandatory to avoid further complications. In this paper a patient is presented who developed urticarial erythemas and hyperpigmentation with slack skin atrophy. Positive serological findings and the regression of the skin eruptions under antibiotic therapy confirmed the diagnosis of an unusual manifestation of Lyme borreliosis.
The incidence of further malignant tumors was analyzed by means of a retrospective study in 2335 melanoma patients. During the follow up 85 patients (3.64%) developed a second malignant tumor: 29 patients multiple primary malignant melanomas (mm), 49 a mm and a further nonmelanocytic malignant tumor, and 7 multiple primary mm and an additional non-melanocytic malignant tumor. Statistical calculations revealed that female melanoma patients have a 20 fold, and male melanoma patients a 30 fold increased risk to develop further malignant melanomas. In contrast, there was no increased incidence of non-melanocytic malignant tumors, breast carcinoma included. A total skin examination has therefore to be performed during follow up investigations of melanoma patients for early detection of further malignant melanomas.
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Prompted by the well-known difficulties of reliable and objective histologic differentiation between initial malignant melanoma (MM) and benign nevocytic nevi (NN), ultrastructural high-resolution image and multivariate analyses were evaluated for their diagnostic efficiency. Thirty-seven different features describing morphometry (area, circumference, and shape factor), amount of heterochromatin and euchromatin, chromatin homogeneity, and presence of smaller dark chromatin aggregations were determined by a MICROVAX 3500 computer in each of 1840 intraepidermal melanocytic nuclei of 17 MM and 20 NN. A strategy for the classification of cases based on the identification of markedly atypical melanocytic cells (MACS) was developed. MACS, selected in multivariate analysis with a linear combination of the eight most important features for cell classification, were found in 39.4% of the melanoma cells, but only in 0.3% of nevocytic nevus cells. The presence of MACS allowed a clear differentiation between MM and NN. All cases of MM had more than four MACS, whereas 17 cases of nevocytic nevi were MACS negative, and in each of the remaining three cases only one MAC was present. The percentage of MACS detected within intraepidermal parts of MM by using computerized high-resolution image analysis was found to be a highly efficient diagnostic marker. The new classification strategy has the potential of saving considerable time in subsequent studies, because preselected sampling and the calculation of only a few criteria have proven sufficient for correct classification of malignant melanomas.
We report on a 66-year-old male patient suffering from several squamous cell carcinomas and a myxoid atypical fibroxanthoma of the skin. The tumours developed in burn scars that the patient had had for more than 50 years and that had in part undergone actinic elastosis. The role of burn scars in the development of different skin tumours is pointed out. In addition, we discuss the differential diagnosis of the rare myxoid variant of atypical fibroxanthoma.
A 25-year-old male patient presenting with Prader-Labhart-Willi syndrome is reported. He had sought medical help because of lichenoid skin eruptions on his lower legs. Histologically the lesions turned out to be pseudo-Kaposi's sarcoma. The possible aetiopathologic relationship between the two primarily unassociated conditions is discussed.
In this review, the epidemiology and prognosis of malignant melanoma in childhood and adolescence (CMM) are discussed with reference to 627 patients reported in the literature. CMM accounts for only 1-2% of all melanomas, but there is the same increasing incidence as in adult melanoma. A distinction is made between congenital CMM (n = 27), CMM on giant congenital pigmented naevi (n = 69) and CMM in small pigmented lesions or de novo. The latter are identical in biological behaviour to melanomas in adults, while the CMM on giant naevi nearly always have an unfavourable outcome. Chemotherapy seems to be more effective in CMM than in adult melanomas, but prophylaxis is also the best therapy in children: early removal of congenital giant pigmented naevi and frequent monitoring, if not excision, of all congenital melanocytic lesions must be considered.
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A case of so-called blue rubber bleb naevus syndrome in a 17-year-old girl is presented. Apart from multiple haemangiomas of the skin, further lesions were present in the small and large intestine, which were demonstrated by endoscopy. The features characterizing the syndrome as a separate entity within the group of angiomatous diseases are discussed.
Prompted by the development of the lightweight, inexpensive and simple to use dermatoscopy, skin surface microscopy can now be applied in daily practice. The case reports presented here document the diagnostic improvement achieved with dermatoscopy in pigment skin lesions of children.
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A 16-year-old boy presenting with multiple slightly painful, bluish red papules and plaques on the left thorax is reported. The skin lesions were arranged in a linear and arched pattern following the lines of Blaschko. Clinical examination led to the suspicion of multiple leiomyomas, syringomas or glomus tumours. Histological examination revealed that the lesions were typical benign eccrine spiradenomas.
This article reports the aggravation of preexisting acne vulgaris in a 21-year-old male patient due to the abuse of anabolic drugs during body-building training. After cessation of anabolic drugs the acne healed, leaving hypertrophic scars. This case report shows that the acute aggravation of an acne vulgaris should cast suspicion on the use of hormone preparations.
Diseases of the skin and visible mucous membranes are important signs of HIV infection. Dermatitis and eczema present mostly as seborrheic dermatitis. Thirty-one % of asymptomatic patients in seropositive latency period and up to 83% of AIDS patients present with this common symptom of HIV infection. Up to now there is no clear answer about the importance of atopic manifestations in AIDS. In children with pediatric AIDS, atopic eczema has been described in up to 50% of cases. In adult patients however there are contradictory results about the frequency of atopic diseases.