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Sentinel lymph node biopsy (SLNB) is a standard procedure for regional lymph node staging and still has the most important prognostic value for the outcome of patients with thin melanoma. In addition to ulceration, SLNB had to be considered even for a single mitotic figure in thin (2melanomas according to the AJCC7th staging system. SLNB was performed in 78 cases, of which nine (11.5%) showed SLN positivity. From them, interestingly, we found a relatively high positive sentinel rate (6/78–8%) in the case of thin primary melanomas ˂0.8 mm. Moreover, the presence of regression increased the probability of sentinel positivity by 5.796 fold. After reassessing pT stage based on the new AJCC8th, 37 pT1b cases were reordered into pT1a category. There was no significant relation between other characteristics examined (age, gender, Breslow, Clark level, and mitosis index) and sentinel node positivity. Based on our data, we suggest that mitotic rate alone is not a sufficiently powerful predictor of SLN status in thin melanomas. If strict histopathological definition criteria are applied, regression might be an additional adverse feature that aids in identifying T1 patients most likely to be SLN-positive. After reassessing of pT1b cases according to AJCC8thregression proved to be independent prognostic factor on sentinel lymph node positivity. Our results propose that sentinel lymph node biopsy might also be considered at patients with regressive thin (˂0.8 mm) melanomas.

Compression therapy plays a pivotal role in the treatment of venous leg ulcers and clinical observations include lymph stasis as contributing to the maintenance of chronic wounds. This finding raises the question whether further improvement in lymph circulation with manual lymph drainage (MLD) as a part of complex decongestive physiotherapy (CDP) can improve ulcer healing. We examined whether CDP improves healing of venous leg ulcers and compared the efficacy of CDP with that of multilayered compression with short-stretch bandages. Eight patients (mean age: 64.8 years, mean ulcer area: 23.07 cm2, duration of ulcers: 25.37 months) were treated with a 5-day-course of CDP and 9 patients (mean age: 70.77 years, mean ulcer area: 21.47 cm2, duration of ulcers: 15.8 months) were included in a 10-day-course of CDP. Control goup consisted of 9 patients (mean age: 56.33 years, mean ulcer area: 13.87 cm2, duration of ulcers: 6.11 months) receiving multilayered compression. Wound surface measurement was carried out on days 5 and 10 and ulcer area reduction rate was calculated as area (initial)-area (final)/time unit. There was no statistical difference between the 5-daycourse of CDP and compression of the same duration regarding ulcer healing (t=-1.62, df=15, p= 0.125). A 10-day-course of CDP significantly increased ulcer healing compared to compression of the same duration (t=-2.42, df=16, p= 0.039). Our preliminary results suggest that MLD as a part of CDP supports healing of venous leg ulcers.

Lipedema is a disproportional obesity featuring spontaneous or light pressure-induce pain and frequent hematoma formation due to even minor traumatic injuries. It is generally distinguished from general obesity primarily based on clinical hallmarks; however, this becomes difficult when appearing in a concomitant form (combination of obesity and lipedema). Our study group has recently demonstrated that lipedema-associated bruising is correlated with increased capillary fragility (CF) and also that CF could be significantly improved by complex decongestive physiotherapy (CDP). In this study, we measured CF in female subjects with lipedema (15) or non-complicated obesity (15) who were body mass index (BMI) and waist-to-hip ratio (WHR) matched. CF was evaluated with the vacuum suction method (VSM) using Parrot's angiosterrometer in both groups. Application of VSM resulted in a significantly higher number of petechiae in subjects with lipedema. Capillary fragility measurement appears to be a useful differential diagnostic tool between lipedema and obesity under these trial parameters.

Background. A number of well-known acquired and putative inherited etiological factors contribute to the development of venous leg ulcer (VLU). Aim. In this study we set out to perform a meta-analysis of putative genetic and acquired factors predisposing to VLU development. Methods. VLU patients (n=157) were divided into three subgroups in accordance with their acquired etiological factors. The frequencies of four genetic factors were determined: the R506Q (Leiden) mutation of the F5 gene, the G20210A mutation of the F2 (prothrombin) gene, the 2451 A/G SNP of the fibroblast growth factor receptor 2 (FGFR2) 3′ UTR, and the −308 G/A SNP of the tumor necrosis factor α (TNFA) promoter. Results. The −308 TNFA SNP exhibited a higher frequency among VLU patients without known acquired predisposing factor in their history, than among patients with thrombosis or soft tissue infection in their history (Fisher P=0.0173). Conclusions. This study has demonstrated that the group of VLU patients is heterogeneous in their genetic predisposing factors. Further large-scale studies are needed to delineate the associations among genetic and acquired etiological factors with regard to VLU development and to integrate the consequences of the already known genetic factors to the management of VLU.

Background Malignant melanoma is an increasing public health problem worldwide; accordingly, identification of the constitutional and environmental factors which contribute to the development of the disease, and hence identification of the individuals at high risk of melanoma, is an indispensable step in all primary prevention efforts. Objectives This paper aims to assess the prevalence of different pigmented lesions among schoolchildren and to investigate their relationship with phenotypic pigmentary characteristics, sun exposure and other factors. Patients/methods A cross-sectional study was performed in two secondary schools in Szeged, Hungary. A total of 1320 schoolchildren, aged 14 to 18 years, underwent a whole-body skin examination. A standardized questionnaire was used to collect data on phenotypic, sun exposure and other variables. Results One to 10 common melanocytic naevi were found in 27% of the participants, and the naevus numbers were in the range of 10–100 in 67%; 5.4% of them had more than 100 common melanocytic naevi. The prevalence of clinically atypical naevi was 24.3%. Statistically significant associations were found between the number of pigmented lesions and gender, hair colour, eye colour, skin phototype, a history of severe painful sunburns and a family history of a large number of melanocytic naevi. Conclusion Our study population displayed a markedly high prevalence of clinically atypical melanocytic naevi. Moreover, a considerable proportion of the investigated individuals had multiple common melanocytic naevi. Since the presence of a large number of melanocytic naevi is a strong predictor for future melanoma development, health educational programmes on melanoma prevention should be aimed at young age groups.

A melanoma malignumban szenvedő betegek száma évről évre emelkedik a világ számos országában, köztük hazánkban is. A betegség kialakulásában szerepet játszó konstitucionális és környezeti tényezők felismerése, ezáltal a fokozott rizikónak kitett személyek azonosítása a primer prevenció elengedhetetlen eszközei. Célkitűzés: Jelen vizsgálatunkban felmértük a különböző festéksejtes bőrelváltozások előfordulásának gyakoriságát serdülő és fiatal felnőtt korosztály körében. Módszerek: Felmérésünkben 1320, 14 és 18 év közötti középiskolai tanuló vett részt. A bőrgyógyászati szűrővizsgálat során a közönséges festéksejtes anyajegy, az atípusos anyajegy, a veleszületett anyajegy, a lentigo és a szeplő prevalenciáját határoztuk meg. A diákok körében szétosztott kérdőív segítségével arra kerestük a választ, hogy a pigmentált bőrelváltozások, illetve az egyes fenotípusos jellegek, napozási szokások, valamint a rosszindulatú festéksejtes daganatok, a nagyszámú anyajegy családban történő esetleges előfordulása között milyen összefüggés áll fenn. Eredmények: A diákok túlnyomó többsége rendelkezett közönséges festéksejtes anyajeggyel: 1–10 számú anyajegy 27%-nál, 10–100 számú anyajegy 67%-nál, míg nagyszámú, 100 feletti anyajegy 5,4%-nál fordult elő. A vizsgálatban részt vett egyének 24,3%-ánál fordult elő klinikailag atípusos anyajegy, a veleszületett anyajegyek gyakorisága 6,2% volt. A vizsgált faktorok közül a nem, a hajszín, a szemszín, a bőrtípus, a gyermekkori hólyagos napégés előfordulása, valamint a családban előforduló nagyszámú festéksejtes anyajegy statisztikailag szignifikáns kapcsolatot mutatott az egyes pigmentált bőrelváltozások előfordulásának gyakoriságával. Következtetések: A világirodalmi adatokhoz képest igen magas volt az atípusos anyajeggyel, illetve a nagyszámú közönséges anyajeggyel rendelkező fiatalok száma, ami már önmagában is egyértelműen jelzi a bőr rosszindulatú festéksejtes daganatának kialakulására való fokozott hajlamot az adott populáción belül. Eredményeink igazolják, hogy a melanoma megelőzését szolgáló felvilágosító programokkal már a fiatal korosztályokat érdemes megcélozni. Rendszeres egészségnevelő tevékenységgel és megfelelő szűrővizsgálatokkal, a magas kockázatú személyek kiemelésén és gondozásán keresztül a melanoma mortalitási arányának jelentős csökkenését érhetjük el.

To the Editor .— The number of individuals with large numbers of common and atypical melanocytic nevi has been continuously increasing in several white populations. Subjects with dysplastic nevi are at a substantially increased risk for the development of both uveal and cutaneous malignant melanoma.1,2 Numerous epidemiologic data have demonstrated that sunlight exposure is the major environmental factor involved in the development of melanoma, and it also exerts a considerable influence on the nevus count of an individual.3 Blue-light phototherapy …