Editor’s Choice November 2012

Koebner phenomenon and vitiligo

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In this retrospective observational cohort study, 700 patients with vitiligo were evaluated using a new assessment method for Koebner phenomenon (KP). KP1 was positive in 34·1% of the patients, 66·3% were KP2A positive and 15·1% were classified as KP2B. The body surface area was significantly (< 0·001) higher in the presence of any KP subtype and more disease activity was found in KP1-positive and KP2B-positive patients. An ­earlier age at onset and elevated risk of ­further ­depigmentation despite ­treatment were observed in all KP-positive groups. The new assessment method for KP, taking into account both history and clinical examination, seems to be a useful and valuable tool for assessing KP in daily practice. Results support the hypothesis that KP may function as a clinical parameter to assess and predict the clinical profile and course of vitiligo.

van Geel N, Speeckaert R, De Wolf J et al. Clinical significance of Koebner phenomenon in vitiligo. Br J Dermatol 2012; 167: 1017–24.

doi: 10.1111/j.1365-2133.2012.11158.x

Cutaneous manifestations of dabrafenib (GSK2118436)

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In this study, a cohort of patients enrolled in the phase I/II trials of dabrafenib was followed for the development of cutaneous side-effects. Thirty-eight patients (93%) developed new skin lesions while receiving dabrafenib. The most frequent cutaneous lesions observed were of keratinocytic origin and included verrucal keratoses (49%), squamous cell carcinoma (SCC) (20%), Grover disease (27%), seborrhoeic keratoses (34%), plantar hyperkeratosis (22%), hyperkeratotic actinic keratoses (10%) and verruca vulgaris (5%). Most SCCs appeared between weeks 6 and 24 following commencement of therapy on both sun-damaged and non-sun-damaged skin. HPV (human papillomavirus) was negative in 15 of the 16 tissues studied and p16 expression was higher in SCCs compared with verrucal keratoses. Patients need careful monitoring for the development of SCCs during treatment with dabrafenib in particular between weeks 6 and 24 of treatment.

Anforth RM, Blumetti TCMP, Kefford RF et al. Cutaneous manifestations of dabrafenib (GSK2118436): a selective inhibitor of mutant BRAF in patients with metastatic melanoma. Br J Dermatol 2012; 167: 1153–60.

doi: 10.1111/j.1365-2133.2012.11155.x

Ro/SS-A antibody as a poss­ible marker for ­malignancy

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Consecutive patients (= 303) with Ro/SS-A antibody positivity were collected over 11 years and were retrospectively analysed. Fifty (16·5%) patients were diagnosed with malignancies; 33 (66%) of these patients had systemic lupus erythematosus or cutaneous lupus erythematosus (CLE). Ro/SS-A antibody was strongly associated with malignancy, particularly melanoma, T-cell lymphoma, non-Hodgkin lymphoma and breast carcinoma. Logistic regression modelling revealed that Ro/SS-A antibody-positive patients aged 55 years or older, presenting with fever, anaemia and CLE, have a greater probability of developing malignancy and are considered high-risk patients, compared with Ro/SS-A antibody-positive patients with none of the mentioned clinical criteria.

Böckle BC, Stanarevic G, Ratzinger G, Sepp NT. Analysis of 303 Ro/SS-A antibody-positive patients: is this antibody a possible marker for malignancy? Br J Dermatol 2012; 167: 1067–75.

doi: 10.1111/j.1365-2133.2012.11161.x

Prognosis of PCBCL­subtypes

During the period 1987–2009, consecutive patients with primary cutaneous B-cell lymphomas (PCBCL) were identified from the Nottingham Lymphoma Registry. The 5- and 10-year lymphoma-specific survival for patients with marginal zone lymphoma was 100%. The only patient with intravascular large B-cell lymphoma died from widespread disease in spite of chemotherapy. The 4-year lymphoma-specific survival for follicle centre cell lymphoma was 90%. Patients with the other subtypes had the following 5-year lymphoma-specific survival rates: diffuse large B cell, leg type, 61% and diffuse large B cell, other, 40%. PCBCL is a rare disease and the authors stress the importance of diagnosis by a pathologist with an interest in cutaneous lymphoma and that the treating clinician appreciates the different prognosis of the subtypes.

Bessell EM, Humber CE, O’Connor S et al. Primary cutaneous B-cell lymphoma in Nottinghamshire U.K.: prognosis of subtypes defined in the WHO-EORTC classification. Br J Dermatol 2012; 167: 1118–23.

doi: 10.1111/j.1365-2133.2012.11122.x