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Few satisfactory treatment options are available for widespread areas affected by multiple actinic keratoses (AKs). Our primary objective was to assess the response rate to weekly 5-fluorouracil (5-FU) chemowraps on widespread AK lesions, and secondarily to assess tolerability, the percentage of patients with recurrence and time to recurrence, the response rate for patients with associated Bowen's disease (BD), and the percentage of squamous cell carcinomas (SCCs) identified after treatment. We conducted an open study which included all the patients who had been treated with weekly 5-FU chemowraps in our department over the course of five years for areas of widespread AKs. The response rate for AKs was 60%, with 20% complete responses among 25 patients after an average of 9.6 sessions (1 to 64). The treatment had to be discontinued because of toxicity in four patients; one case of contact dermatitis, one case of erosive pustular dermatosis, and two cases of Grade 2 irritations. Invasive SCCs were identified in five patients after treatment cessation. The median recurrence-free survival was five months. A 64% response rate was achieved for associated BD. The weekly application of 5-FU under occlusion seems to be an interesting, well-tolerated therapeutic option for the treatment of widespread AKs.

Primary cutaneous B-cell lymphomas are a rare entity. They are included in the distinct classification of primary cutaneous lymphomas, the WHO-EORTC. In order to be confirmed, the primary nature of a cutaneous lymphoma requires that negative results of a CT scan of the chest, abdomen and pelvis and of a bone marrow biopsy (BMB) be obtained. Nevertheless, there is a question as to whether BMB should be performed routinely in view of the good prognosis of certain cutaneous B-cell lymphomas and the invasive nature of the examination. To answer that question, we studied retrospectively 62 cases of cutaneous B-cell lymphomas in which a BMB was performed. In 4 cases, lymph nodes, and in one case pancytopenia were identified during the initial evaluation performed at the same time as BMB and thus these patients were excluded from the analysis. Among the 57 patients, the BMB was positive in only 3 patients (5.2%). Interestingly, the positivity of the biopsy did not significantly affect the way that the treatment was given. In conclusion, this study demonstrates that it is not indispensable to perform a routine BMB for a Primary cutaneous B-cell lymphoma with cutaneous lesions on examination and with negative CT Scan and blood laboratory evaluations.

Esthetic or functional repercussions in localized scleroderma may be considerable. Numerous treatments have been proposed with limited effectiveness. The purpose of this study was to evaluate the efficacy of high-dose zinc gluconate in the treatment of morphea. We are reporting a retrospective study of 17 patients with histologically confirmed localized scleroderma active for more than one year and whose treatment with a high potency dermocorticosteroid was a failure. The patients received 60 to 90 mg of zinc metal daily. The clinical evaluation was performed by the physician and the patient. An efficacy of 53% was obtained (5 partial remissions and 4 complete remissions) with a mean dose of 83.3 mg/day of zinc metal. Two patients (11.8%) had epigastralgia; no discontinuation of zinc gluconate for poor tolerability was noted.We conclude that high-dose zinc gluconate can therefore be a valuable alternative treatment for localized scleroderma, with good tolerability, although placebo-controlled studies are necessary to confirm our results.

Lapatinib is a dual tyrosine kinase inhibitor indicated in breast cancer [1] targeting the Human Epidermal Growth Factor Receptor-1 (HER1), also called EGFR and HER2. Lapatinib-induced skin toxicity is common, usually mild and is often similar to that reported with EGFR inhibitors (EGFRI). We report the first case of cutaneous vasculitis observed with lapatinib.A 57-year old patient was followed up for 2 years for a right breast adenocarcinoma with liver metastases at the initial diagnosis. She was [...]

ejd.2011.1527 Auteur(s) : Lucie Peuvrel, Gaelle Quereux, Anabelle Brocard, Jean Jacques Renaut, Brigitte Dreno brigitte.dreno@wanadoo.fr CHU de Nantes, Skin Cancer Unit, CIC biotherapie, INSERM 0305, 1 place Alexis Ricordeau, 44000 Nantes, France A 77-year-old man presented with micropapules of the scalp which appeared six months after the excision of a trichoblastic carcinoma of the left temple. His medical history included left facial neuralgia treated by radiotherapy 62 years earlier. Clinical examination [...]