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Organ transplants are bound to the induction and upkeep of immunosuppression. The immunomodulatory regimen modalities have changed over time with an improvement of the overage graft survival. The effects are also present on the skin and its cancerogenesis which is particularly activated for the squamous cell carcinoma. A review of the recent medical literature reveals the importance of searching squamous cell carcinomas, actinic keratoses, seborrheic keratoses and keratocanthomas before and after organ transplants. The severity of the carcinomas is due to their multiplicity and to the progressive occurrence of more aggressive lesions. Prevention relies on a strict adherence to sun protection after transplantation and on refined immunosuppressive strategies.

In recent years, new drugs have been designed for treating advanced cutaneous malignant melanoma, in particular the metastases. They afford modest benefits despite the fact they are commonly heralded as breakthroughs in the lay press and by some medical opinion leaders. Unfortunately, the use of inflated descriptors of the drug efficacy leads to misunderstandings among the clinicians in charge of patients. Currently, vemurafenib, ipilimumab, pembrolizumab and nivolumab have demonstrated their relative activity in the control of advanced malignant melanoma. The results expected from surrogate markers of efficacy are magnified and idealized regarding the expectations from many patients. The recent therapeutic advance improves the median overall survival for a few months. Some combined treatments could possibly boost the current beneficial effects.

Basal cell carcinomas (BCCs) are the most frequent human cancer. Over 90% of all BCCs have a mutation in PTCH1 or smoothened, two conducting proteins of the Hedgehog pathway. They rarely progress deeply and metastasize; however, if they do, these advanced basal cell carcinoma become amenable to treatment by inhibiting the Hedgehog and the P13K-mTOR pathways. Such innovative drugs include vismodegib, cyclopamine, itraconazole, everolimus and a few other agents that are in early clinical development.

Cutaneous melanoma is the deadliest skin cancer showing an increasingly growing incidence in white populations of Europe and United States. Intensive research in recent years has begun to unlock its molecular pathogenesis. Screening the neoplasm at an early stage remains primordial. Hence, targeting populations at risk is likely efficient. In such an attempt, the regular clinical examination benefits from a series of non invasive procedures such as skin surface biopsies, in vivo confocal microscopy, dermoscopy and specular fluorescent light reflectance.

For aeons, cutaneous sporadic melanoma, exhibiting either a slow or rapid growth rate, is identified using a set of well defined histopathological criteria. Such diagnostic step is greatly appreciated, and it brings a rough estimate of the probable evolution of the cancer. Some additional assessments try to improve the progressive prognosis of cutaneous melanoma. In this scope, fractals and spectral analyses expect to better perceive the individual progressive characteristics of each tumor. The extent in the tumoral germinative compartment and the peritumoral microvascular network are explored and should in a near future make clear the progressive potential of cutaneous melanoma. The posible tumoral regression and the immune reaction should be better perceived.

Intracellular mitogen-activated protein kinases (MAPK) form a signalling cascade of proteins involved in cell proliferation, differentiation, migration and apoptosis. They are particularly activated by some cytokines, hormones, environmental stress and in skin cancers as well. A series of pharmacological compounds targeting the MAPK cascade dramatically changes skin cancerology, at least during a transient phase of the metastatic process. Some combined treatments possibly increase the median overall survival.

Introduction: When using adequate wavelength illumination and high resolution recordings, Caucasian skin color appears uneven. The patterns of faint mosaic melanoderma (FMM) are diverse and possibly related to the risk of skin cancer development., Areas Covered: The current peer-reviewed publications about objective methods quantifying FMM are revisited. The images from the Visioscan® and Visioface® Quick devices are computerized in order to record the ultraviolet light-enhanced visualization (ULEV) and the color-enhanced visualization (CEV) of the skin. Previously published data regarding the FMM are gathered in 20 odd Caucasian women. Seven FMM patterns are distinguished. They appear expressed differently according to body regions, but the mean gray level appears more uniform., Expert Opinion: The combination of larger subclinical melanotic macules and ivory spots during early adulthood is apparently associated with an increased risk for non-melanoma skin cancers.

For the media and the public at large, malignant melanoma is the most dreadful cancer of the skin. This statement is obvious. However, some nuances merit to be considered. The clinical presentations, histopathology and molecular genetics point to the fact that malignant melanoma is not a single monolithic pathological condition. Different types of melanomas are distinguished based on distinct origins and contrasted prognoses. The management and information for the patient should be handled individually.

Cutaneous malignant melanoma represents one of the most dramatic skin cancers because its incidence is steadily growing in White populations. Of note, its metastatic risk and mortality dramatically increase when the primary neoplasm reaches about one millimeter thick. It is believed that angiogenesis and lymphangiogenesis associated with cutaneous melanoma potentially influence the neoplastic progression of the primary tumor and its metastases. In some instances, both the intratumoral and peritumoral microvasculature are correlated to booming of the tumoral growth fraction. In addition, the vascular network serves as a migration path for the intravascular and perivascular neoplastic spread. Hence, the quantification of the microvasculature might help establishing a prognostic factor of evolution. Among the available methods, spectral analysis of immunohistochemical sections highlighting vessels helps defining the microvasculature distribution. The benefit of using spectral analysis is discussed and the modalities of application of this analytical method are scrutinized., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Introduction: For a decade or so, artificial sources of restricted light wavelengths, particularly sunbeds, have progressively gained popularity among adolescents and young adults. Warnings were raised focusing on the risk of accelerated photoaging and photocarcinogenesis. The ULEV (ultraviolet light-enhanced visualization) method is a convenient noninvasive way identifying subtle pigmentary changes presenting as a mottled subclinical melanoderma (MSM). Of note, rare spotty amelanotic macules presenting as skin ivory spots (SIS) was reported on any part of the body., Subjects and Method: This work is the first attempt at evaluating the changes in the MSM and SIS spots developed on the skin of 33 phototype III young women designated as avid users involved in frequent exposures to sunshine and sunbeds for lifestyle purposes for a duration of at least 120 months., Results: MSM was markedly heterogeneous and was distinctly obvious in the majority of adepts of frequent natural and artificial photoexposures. SIS was particularly developed in subjects presenting with severe MSM patterns., Discussion: MSM and SIS are more severe in subjects frequently exposed to sunbeds and sun exposures. These signs possibly represent a risk marker for field photocarcinogenesis.

Treating a patient with cutaneous malignant melanoma relies on the recognition of a clever stratification of the distinct stages of the disease. The histoprognostic criteria were recently revisited. In addition, translational research fueled the development of new treatments with at last increased efficacy in the metastatic stage. Such therapeutic advance improves the median overall survival for a few months. Some combined treatments could possibly boost the beneficial effects.

Introduction: Basal and squamous cell carcinomas are the most common non-melanoma skin cancers (NMSC) in humans. Their prevalence is higher in immunocompromized patients. Results of some animal experiments have indicated that TNF acts both as a tumour promotor and an inductor of apoptosis., Areas Covered: Peer-reviewed articles about human skin cancers possibly related to TNF antagonists. The occurrence and growth kinetics of NMSC are possibly increased in some patients under TNF antagonist therapy. Other issues of such biological treatment suggested include the activation of other distinct skin malignancies, including malignant melanoma. Benign melanocytic tumours appear to be boosted as well. At present, most of the reported findings only represent anecdotal case reports. The influence of cumulative co-factors must not be neglected, particularly the effect of other therapies administered to the patients. The occurrence of antibodies to some TNF antagonists may decrease both the treatment efficacy and the risk of skin cancer progression., Expert Opinion: More research needs to be performed in order to firmly establish and understand the risk of anti-TNF biologicals in the area of human skin cancers. At present, NMSC progression appears to be boosted on areas of skin field cancerization. Benign melanocytic naevi may develop as well.

A 55 year-old women presented with lesions simulating cysts of the scalp. The dermatopathological examination revealed a metastasis of a breast adenocarcinoma. At the diagnosis disclosure, the patient recognized having concealed for 7 years a neoplastic wound replacing one of her breasts. About this case report, we report the astonishing clinical diversity of skin metastases of breast adenocarcinomas.

Malignant melanoma (MM) micrometastases are basically seen in three locations inside the peritumoral dermis. They are localized (i) inside the interstitial sector of the dermal stroma; (ii) abutted to the external surface of the microvasculature; and (iii) more rarely present inside vascular channels. Single-cell and paucicellular micrometastases may be disclosed using immunohistochemistry even in the absence of larger microsatellites, which represent micronodular nests of metastatic cells. The presence of microsatellites is frequently tied to markers of MM aggressiveness including thickness and the Ki-67 index. Micrometastases may be present in the same conditions, but even as early as thin MM showing a small growth fraction. Microsatellites as well as micrometastases appear to predict locoregional extension and decreased relapse-free interval, but not distant metastasis and overall survival. These considerations have implications for patient care since patients with microsatellites and micrometastases are now included in the clinical stage III category of the disease. Their implication as a prognostic factor is not fully dependent on or linked to other markers of MM aggressiveness.

Malignant melanoma developed after 60 years of age is not a rare neoplasm. It is mainly but not exclusively represented by the lentigo maligna (LM) and the invasive melanoma developed on LM (LMM). Men are more often affected, and chronic sun exposure is the main cause. The diagnosis relies on the clinical, dermoscopic and dermatopathologic examinations. Surgical excision is recommended but alternative treatments are possible in case of contra-indication.

Immunosuppressive therapy associated with organ transplant leads to an increased risk to develop skin cancers. In such circumstances, squamous cell carcinomas and basal cell carcinomas represent the most frequent tumors. Other neoplasms include malignant melanoma, Merkel cell carcinoma and Kaposi disease. Histopathology is primordial in the establishment of the diagnosis. In addition, bioengineering devices and skin imaging methods are useful in establishing the risk of cancers and for detecting incipient tumoral lesions.

The occurrence of the vast majority of skin cancers depends on the environment, in particular on exposure to ultraviolet light radiations. Several modalities of primary and secondary prevention are possible. The first modality relies on proper covering or remaining hidden under shadow. Textiles exhibit some photoprotective function the efficacy of which depends on their nature and diverse modulating factors. Sun protection cream, some food habits, the intake of non steroidal anti-inflammatory drugs, and that of specific food complements are supposed to be beneficial at various levels.

In a manichean ideal, one expects unreservedly a clear-cut distinction between benign melanocytic neoplasms and the malignant ones. Such a distinction is commonly established by a clinico-pathologic confrontation for the majority of neoplasms. However, the boundaries may be blurred and uncertain for some lesions. We present an exploratory clinicopathologic algorithm of the border area between seemingly benign and seemingly malignant melanocytic neoplasms. The concept of a group of neoplasms called skin melanocytomas shed some light on such quandaries where the risk of misdiagnosis is quite high.

Primary cutaneous lymphomas are distinguished by singular clinical, histological and prognostic features that are not shared by other lymphomas originating from the lymphoid tissues. This review is an update of the current concepts about the biology, diagnosis and treatment of mycosis fungoides, the most frequent entity among the primary cutaneous T cell lymphomas. It is currently established that mycosis fungoides originates from T lymphocytes normally homing the dermis. Such a situation implies that treatments at least in the initial stages of the disease, should primarily target the skin without searching for an impact on internal lymphoid tissues.

Merkel cell carcinoma is a skin malignancy showing an increasing trend of incidence in the white population. Its viral origin due to the MC polyomavirus is likely. The diagnosis relies on the histological and targeted immunopathological examinations. Histoprognostic criteria remain to be defined. An assessment using medical imaging is important to establish. Treatments rely on surgery and radiotherapy. Chemotherapy is mandatory at the metastatic stage. Some biotherapies are potentially active.

Birt-Hogg-Dube is a rare syndrome which is sporadic or hereditary with a dominant autosomal transmission. Various organs, in particular the skin, can be affected. In the presently reported case, skin was covered by hundreds of small molluscoid papules corresponding to trichodiscomas, fibrofolliculomas and skin tags.

Cutaneous leiomyosarcoma is a soft tissue neoplasm exhibiting an aggressive local behavior and a potential for distant metastases. It is rare during childhood and diagnosis can be challenging both clinically and histologically. Surgical excision with wide lateral and deep margins is the treatment of choice, whereas radiotherapy and chemotherapy are contraindicated. Long-term follow-up is necessary as recurrences are not infrequent.

Skin weathering and photoaging of the balding scalp have not attracted much investigative attention so far. However, the concept of field cancerization, in particular actinic field carcinogenesis, is likely applicable to this part of the body. The aim of the study was to finetune the epidermal actinic changes present on hairlessness scalp. The ultraviolet light-enhanced visualization (ULEV) method was used to assess a series of 50 healthy men older than 50 years with documented baldness for over 15 years. They were scrutenized looking for altered epidermal structures corresponding to photoaging-associated changes. Attention was focused on the faint mosaic melanoderma (FMM) and atypical scaliness. Observations were made on the scalp and forehead. FMM was recognized in each case. It presented either as a single manifestation of photoaging or it was associated with an unusual pattern of discrete rimmed scaliness. In this latter case histology and morphometry disclosed keratinocyte dysplasia. A similar scaly pattern was not seen on the forehead. Subtle skin surface changes were disclosed on long-standing sunexposed balding scalps. The scaly aspect was distinct from dandruff, seborrheic dermatitis or any other common inflammatory scalp dermatosis. The presently described changes had not previously been described during early balding. It is suggested that the presently described condition may be associated with or indicative for actinic field carcinogenesis and incipient keratinocyte dysplasia.

The incidence of skin cancers is still on the rise despite information provided to the public and to cancer screening initiatives. We designed a 3D movie with the support of all Belgian university departments of dermatology. Looking at the impact of ultraviolet light in cells was the objective of this presentation. Several themes of actuality were addressed including genotoxicity of light, the primary prevention of skin cancers, the field actinodermatosis and cancerogenesis, the skin cancer epidemiology, the duality of skin melanomas with contrasted prognoses, and the recognition of melanoma stem cells.

Background: Radiodermatitis in its acute and chronic presentations represents a set of specific adverse effects resulting from ionizing radiations. Skin-field cancerization is another condition associated to or independent of clinically recognizable radiodermatitis. This condition leads to the risk of later occurrence of skin malignancies., Method: Review of the current and most pertinent peer-reviewed publications with the addition of personal perspectives., Result/conclusion: The presence of field cancerization encompasses subclinical changes, precursors of malignant alterations, as well as single or multiple primary neoplasms and local neoplastic recurrences. These tumours commonly require repeated treatments over time and cause significant morbidity. In general, specific tumour-directed treatments using ablative or destructive techniques require regular follow-up and screening for disclosing any further neoplasm. Another strategy corresponding to field-directed treatment targets a larger area of irradiated skin to reduce the risk of developing second neoplasms and local recurrences. Imiquimod is an immune response modifier of the imidazoquinoline class. It is the archetype drug used to control skin-field carcinogenesis. Cryotherapy, topical 5-fluorouracil, diclofenac and conventional photodynamic therapy are supposed to bring effects differing by their indications, healing rates and remission rates. The possibility of inducting a radiation recall dermatitis by some of these therapeutic modalities has not been thoroughly evaluated, and at present cannot be ruled out with confidence.

A series of skin cancers are more frequent or show a worse course and outcome in HIV-treated patients. The leading neoplasms correspond to basal and squamous cell carcinomas, some primary cutaneous lymphomas and malignant melanomas. In these patients, early diagnosis and radical treatment on sight should be considered.

The scientific information about melanoma is on the rise. It has a direct impact on the diagnostic acuteness and on the therapeutic management. The most recent aspects of the utmost importance are presented. The concept of the duality between fast-growing (high malignancy) and slow-growing (reduced malignancy) melanoma is stressed. A new international multicentric approach using adjuvant therapy for stage III melanomas involves the clinical oncology department of the CHU of Liège. It concerns a targeted immunotherapy directed to the Mage A3 protein.

Cutaneous metastases may accompany up to 3 to 10% of all malignancies. They are usually identified after diagnosing the primary neoplasm. However, their disclosure can be synchronous, or the metastasis may be the initial finding qualified as "precocious". The identification of the primary neoplasm sometimes proves to be difficult. Gender of the patient, the aspect and distribution of the metastases, as well as the histological and immunohistological examinations help establishing the diagnosis. The prognosis of the metastatic disease is often poor.

The histological assessment of atypical melanocytic neoplasms is mandatory to ensure proper diagnosis and treatment. However, for some atypical lesions, expert pathologists report only moderate concordance in the diagnosis. In addition, certain atypical neoplasms have been coined differently in the literature. These designations include among others atypical and metastasizing Spitz tumor, malignant Spitz naevus, borderline and intermediate melanocytic tumor, and melanocytic tumor of uncertain malignant potential (MELTUMP) or Spitzoid melanocytic tumor of uncertain malignant potential (STUMP). These neoplasms are grouped here under the heading melanocytoma. Such melanocytic lesions have a benign outcome but exhibit an atypical and worrisome aspect. Rare individual cases of melanocytomas can progress to locoregional disease (agminate melanocytomas), and even beyond. At times, the distinction between melanocytoma and melanoma is difficult and may even be impossible. However, multipronged immunohistochemistry can help define malignancy risk stratification and therapeutic guidelines.

The neurocristopathies encompass genetic disorders targeting some structures originating from the neural crest development. Hence, skin is affected by some clinical manifestations of these disorders. This review covers the main aspects found in neurofibromatosis, tuberous sclerosis, incontinentia pigmenti, neurocutaneous melanoblastosis, basal cell naevomatosis and the epidermal naevus syndrome.

Background: In Westernized populations, the number of diagnosed cases of primary cutaneous cancers, particularly malignant melanomas and basal cell carcinomas (BCC), has been previously shown to fluctuate during specific periods of the year., Objective and Method: The aim of the present 6-year study was to explore the seasonality if any in skin cancer detection in Wallonia (south-east Belgium)., Results: For both malignant melanomas and BCC late spring/early summer and mid-autumn were the periods of highest diagnosis prevalence irrespective of gender. The amplitude of this bimodal evolution remained within the range of 2 standard deviations around the monthly means. Similar seasonal variations were also found in non-neoplastic controls consisting of laboratory samplings of onychomycoses and non-infectious onychodystrophies., Conclusion: There is reason to believe that this timing and rhythm is unrelated to any specific cancer chronomics. Rather, the present findings suggest unspecific seasonality in diagnosing skin disorders including malignancies. A variable patient awareness of changing aspects of the skin according to seasons probably represents the major influence of the described space-time clustering of skin cancer diagnosis., (Copyright 2008 S. Karger AG, Basel.)

Actinic keratoses (AKs) and their derived squamous cell carcinomas are distinctive lesions forming a continuum in a multi-step carcinogenesis process. They are typically found on chronically sun exposed skin. AKs merit to be recognized as such and to be distinguished from squamous cell carcinomas both conceptually and for therapeutic implications. The histological differences between these lesions are well defined and should not be blurred. A brief review is presented about the biological features responsible for AKs and the clinicopathologically distinctive aspects of these lesions. In addition, recent findings are presented about pharmacotherapy using anti-epidermal growth factor receptors, imidazoquinolines, diclofenac-hyaluronan, and methyl aminolevulinate photodynamic therapy.

Drug-induced immunosuppression is the necessary corollary of organ transplantation. This situation is responsible for an increased risk of both infection and neoplasia. Cutaneous carcinomas are the most frequent malignancies developing after organ transplantation. The usual squamous to basal cell carcinoma ratio is increased and reversed compared to the general population. Carcinomas primarily result from the combination of cumulative sun exposure, fair skin phototype and effects of immunosuppressive drugs. These treatments impair the systemic immunosurveillance and may exert a direct carcinogenic effect. The severity of these carcinomas is due to their multiplicity and to the occurrence of more aggressive lesions. Prevention relies on a strict adherence to sun protection after transplantation, and on refined immunosuppressive strategies. The treatment of the neoplastic lesions is based on their early and complete excision with histological control of the nature of the neoplasm, the safety surgical margins, and the determination of prognostic factors.

Background: It is a common observation that superficial freezing of normal skin and skin tumors may create a transient superficial whitening effect. In this respect, cryoscopy refers to the direct observation by dermoscopy, with or without digital recording, of the visual alterations of the frozen tissues., Aims: To define the optimal method of cryoscopy and to describe the cryoscopy patterns of normal skin and selected skin lesions., Materials and Methods: The influence of (a) different cryogenic sources [solid carbon dioxide (-78.5 degrees C), liquid nitrogen (N(2), -196 degrees C), and a mixture of dimethyl ether and propane (-57 degrees C)], (b) various application methods (spraying, cotton chill tips, copper plate), and (c) freezing time was assessed with regard to clinical feasability, visualization quality, and persistance time of the whitening effect. Cryoscopy patterns of normal skin, callosities and of histologically proven seborrheic keratoses, verrucous hamartomas, molluscum contagiosum, keratoacanthomas, viral warts, condylomas, actinic keratoses, dermatofibromas, skin tags, basal cell carcinomas, angiomas, and melanocytic naevi were assessed., Results: The cryoscopy images of skin highlighted the skin lines. They appeared similar regardless of the freezing source and the application method. The aspects differed according to the nature of the lesions. The cotton chill tip method provided a longer whitening period compared with the other cold sources, both in normal and lesional skin. Hence, it represented the most convenient way for performing digital recording cryoscopy. On normal skin, cryoapplication was limited to about 1.5 s due to pain, resulting in whitening times ranging from 6 to 9 s, which was too short for easy digital recording. On all studied skin tumors, a 10-s N(2) freezing time was not experienced as painful, and blanching time persisted for 20-34 s, allowing easy digital recording. The whitening time was longer with increasing freezing time on both normal and lesional skin. Every single examined normal skin site and all the skin lesions showed a strong whitening effect, except heavily cornified structures, including some keratoses, callosities, and viral warts. Increased contrast of the skin surface texture was observed in almost every studied lesion., Conclusion: The N(2) cotton chill tip technique appeared to be the most convenient technique for cryoscopy and provided longer whitening periods compared with the other freezing sources. Pain prevented its use on normal skin, but a series of exophytic skin lesions was conveniently accessible to cryoscopy. The differences in whitening periods of various epidermal components resulted in increased visual contrast, creating typical cryoscopy images for the different exophytic skin tumors. Cryoscopy represents a novel in vivo skin imaging technique that is rapid, non-invasive, cost-effective, and easily performed. It shows both investigative and diagnostic potentials. It is remarkable that cryoscopy pictures closely resemble those yielded by skin capacitance imaging.

Distinguishing complete removal of a skin cancer and its partial destruction is frequently requested by the clinicians and their patients. The information is awaited from the laboratory, but it is not always correctly interpreted by the information-seekers. The factors influencing this assessment include the combination of the nature of the antineoplastic therapy, the sampling modality of the area to be examined, and the quality of the dermatopathology procedure. In addition, the possibility of neoplastic regression linked to scarring or, conversely, the existence of a possible field cancerisation should be taken into consideration.

Cutaneous verrucous carcinoma is a low-grade and well-differentiated variant of squamous cell carcinoma. This rare neoplasm follows a seemingly indolent progression and exhibits a low metastatic potential. Photodynamic therapy relies on the selective intratumoral cell accumulation and photoactivation of a photosensitizer, leading to the generation of phototoxic compounds responsible for necrosis and apoptosis of the target cells. An 82-year-old man presenting with a large long-standing verrucous carcinoma on the leg was treated successfully by 6 photodynamic therapy sessions administered at weekly intervals using methyl-aminolevulinate and 57-J/cm(2) irradiations at 634-nm wavelength. The use of methyl-aminolevulinate-photodynamic therapy for treating cutaneous verrucous carcinoma had not been reported so far. It may represent a convenient therapeutic alternative in this setting.

Skin contains various hormonal receptors, particularly those for estrogens, progesterone and androgens. Steroid hormones of oral contraceptives affect the skin, in particular the control of the cell cycle, DNA replication, apoptosis and other cellular functions. Some estrogen-responsive pathways have the potential to promote tumor development. The question of whether oral contraceptives increase the risk for the development of skin cancer, particularly melanoma, remains an area of concern. There is some evidence that steroid hormones present in oral contraceptives do not significantly increase the risk of developing skin cancer when estrogen exposure is not excessive.

Cutaneous melanoma is a cancer affecting an ever growing proportion of young adults. Currently, the best approach for a prolonged remission or cure relies on early detection of the primary neoplasm and of its first possible metastases. Some therapies can bring much hope at this stage of the disease. The early detection of lymph node metastases is therefore essential in the global management strategy. The excision and the microscopic examination of the sentinel lymph node are important in this evaluation. Echography of the draining lymph nodes is a non invasive procedure which may also prove to be informative. PET-scan brings additional information, particularly when the dissemination risk is beyond the first group of lymph nodes.

Primary lymphomas of the skin exhibit singular clinical, histological and prognostic features that are not shared by lymphomas originating from the lymphoid tissues. This review is an update of the current concepts about the diagnosis and treatment of mycosis fungoides, the most frequent entity among the primary cutaneous lymphomas.

Basal cell carcinomas (BCC) are the most common malignant neoplasms in humans. Clinical misdiagnoses are not uncommon. These cancers are classified according to their histological and clinical characteristics which exhibit distinct malignant behaviours. It is important to be aware of the different clinical presentations both for the accurate diagnosis and tumour management. We report the case of a 78-year-old man, who presented an unusual pedunculated and pigmented BCC. This combined aspect is rarely encountered.

In Wallonia, the incidence of cutaneous melanoma has steadily increased over the past decades. Hopefully, the early diagnosis made at the premetastatic stage has benefited from great advances both in the clinical and laboratory fields. Thanks to the "Groupement Oncologique Universitaire Wallonie-Liège" (GOUWL) organization, some efforts are currently made in order to better frame and normalize the management of cancer patients. Some medical staffs involved in prospective clinical research bring by their own experience further practical insights for the benefit to the patients. In this field, Belgium is not destituted. We report a brief review of the contribution of the Mosan Study Group of Pigmentary Tumors (GMETP) at the University Hospital of Liège.

Photodynamic therapy (PDT) and topical imiquimod immunotherapy (TII) are two recently introduced treatment modalities for certain types of basal cell carcinomas (BCC). We present a review of the relevant literature and report our own findings regarding the efficacy and tolerance of PDT and TII in the treatment of BCCs. According to published studies, the cure rates range from 75-95% for PDT and 42-100% for TII, depending on treatment modalities and BCC type. In our observations, 13 patients with nodular or superficial BCCs were treated by PDT using two courses of 3-hour topical application of methyl aminolevulinate, followed by 8 minutes illumination (lambda = 634 nm, e = 37J/cm2). Biopsies were taken before and one month after PDT. Side effects including pain and crusting were assessed. Eight patients with superficial BCC were treated by TII using 3 monthly courses each consisting of 3 weekly applications for 3 weeks followed by one week out of treatment. Biopsies were taken before and after 3 months of TII. Adverse reactions including erythema, oozing, ulceration, and crusting were recorded. Clinico-histological cure was obtained in 12/13 PDT cases as assessed after 1 month, and in 6/8 TII cases after 3 months. Minimal pain during illumination and crust formation were observed in 7/13 and 3/13 PDT cases, respectively. Variable erythema, oozing, ulceration, and crusting were observed in all TII-treated lesions. It is concluded that PDT represents an active and well tolerated alternative treatment for both nodular and superficial BCCs. TII also shows activity, although the tolerance may be poor and cure needs a longer time to be obtained. The final cosmetic appearance was fine following both PDT and TII procedures. Both PDT and TII may leave intact neoplastic aggregates inside the skin. They cannot be clinically perceived, leading to unexpected recurrences. It is stressed that the currently available efficacy information about PDT and TII deals with short term follow-up periods. A 5-year follow-up must be awaited before drawing firm conclusions.

Lentigo maligna is a special form of in situ cutaneous melanoma that develops on the face of sun worshipers. The topic immunostimulator imiquimod can destroy the neoplasm before it expresses its invasive potential. A strict clinical follow-up of the treated zone must be observed at least 5 years to detect any early sign of recurrence.