Lymphomas are malignant tumors deriving from the proliferation of cells setting up the immune system. As these cells normally circulate with the blood in the whole organism, lymphomas are generalized tumors from their appearance. However, exceptions do exist leading the Authors of the European Organization for Research and Treatment of Cancer (EORTC) to say that morphologically identical lymphomas, when arising in different organs, are clonal proliferations of distinct lymphocyte subpopulations, which are in some way related to the organ where the lymphoma arose (45). Lymphomas are much less frequent in children as compared with adults. However, some Authors (5) established that 1/6,000 children under the age of 15 develops lymphoma. According to these Authors, the frequency of lymphomas follows only that of leukemias and brain tumors. (...)
During the Congress of the European Academy of Dermatology and Vene-reology, which was held in Geneva, from 11 to 15 October, 2000, many communications and posters were devoted to antimycotic treatment. Here these reports are summarized, giving particular emphasis to the problems of the pediatric age. We will essentially talk of the treatment of dermatophytoses, namely of the mycoses caused by the genus Dermatophytes. Then we well mention the treatment of pityriasis versicolor, candidiasis and sporotrichosis. Anyway, we will start with a review of the main systemic and topical therapeutical agents.
The number and distribution of melanocytic nevi at the age of ten were investigated in 244 students. The latter were chosen at random in 15 classes of the primary school of Bari (Italy). Besides the age and sex, in these subjects were investigated the presence of ephelides, nonmelanocytic nevi, the total number of melanocytic nevi, the number of such lesions for each site -head, trunk, upper and lower limbs- and the site of the largest nevus. Ephelides were found in 49 subjects (19%). Among the nonmelanocytic nevi, hyperpigmented nevus was the most frequent (19 cases -8%-). 66% of students showed a total number of melanocytic nevi higher than 10. This percentage was 72 in subjects with ephelides. The highest concentration of melanocytic nevi was on the head, whereas the lowest was on the lower limbs. No difference was shown between sexes with regard to the number and distribution of melanocytic nevi.
Pediatric dermatology is prevalently a medical discipline. Therefore, with regard to the pain, the most frequent problem is how visiting the child without causing a trauma to him/her, to his/her family, to the other children, who stay in the waiting room, and, finally to the physician. In this case we are dealing with a psychological problem, which can be overcome in most cases, if the physician knows the child world and its fears, namely if the physician works daily with children. However, in some situations physicians should face the problem of the pain, namely of that unpleasant sensation, connected with actual or potential tissue damage and influenced by personal experiences of the first years of life (21). This subjective component is different in the various subjects and thus is responsible for a different, visible or audible, behavior reaction, to the tissue damage. The latter in Paediatric Dermatology is usually related to the skin laceration and to the stimulation of its nervous pain receptors. (...).
Nevus depigmentosus (ND) was first reported by Lesser in 1884 (13). Present at birth or from the first years, ND is a nevus malformation persisting indefinitely. Although not yet clarified from a pathogenetic point of view, ND is well defined from a clinical point of view and characterized by a decreased pigmentation as compared with the healthy surrounding skin. Its pigmentation is decreased, but not lacking, as shown by its color, which is less light as compared with the color of vitiligo and piebaldism, and by the possibility of getting tanned.
Eruptive angioma (EA) is a benign proliferation of angiopoietic tissue rapidly growing in a few weeks till causing erosion of the epidermis and bleeding. In the past its most frequent synonym was pyogenic granuloma, whereas the most recent term of “lobular capillary hemangioma” was proposed by Mills et Al. (17). Since 1982, starting from the report of Mulliken and Glowacki (18) there were some attempts of classification of lesions, which in the past had been all included in the chapter of angioma. These attempts are laudable because they try to introduce pathological and functional criteria, in contrast with the previous classification using exclusively clinical criteria. In a new classification (24) all the previously known angiomatous lesions are classified into the categories as follows: hamartomas, malformations, dilatations of preexisting vessels, and proliferations, the latter being in turn subdivided in hyperplasias, benign neoplasms and malignant neoplasms. Unfortunately, the borders between the various entities, for instance between hyperplasia and benign neoplasm or even between benign and malignant neoplasm (23) are not always well defined as it would be necessary for a classification, because nature does not jump.(...).
The diagnosis of allergic contact dermatitis to topical corticosteroids is often difficult owing to the overlapping between the clinical features of allergic contact dermatitis and many dermatoses. Allergic contact dermatitis can be suspected when a dermatosis duly treated with topical corticosteroids fails to improve or even worsens. In a series of 6,285 patients tested from January 1997 to May 2001, according to the SIDAPA (former GIRDCA) standard series, supplemented with tixocortole pevalate, budesonide and hydrocortisone 17-butyrrate, 65 (1.03%) showed sensitization to one or more topical corticosteroids. These data underline the importance of introducing molecules, which are “markers” of sensitization to topical corticosteroids, in patch test standard series. Patients suffering from allergic contact dermatitis to topical corticosteroids can be treated with low-sensitizing corticosteroids such as betametasone and other compounds classified in the “C” Coopman class.
The rarity of prepubertal melanoma prevents a statistical evaluation of data and a comparison with the data of melanoma in adults. We tried to fill this gap by reviewing 289 cases published in the relevant literature of the last century. Although taking into account their understandable lacunas, these data allowed us to do some considerations. The distribution of cases per year in the first 12 years is uniform. The female is slightly more frequently -54.7%- affected by malignant melanoma as compared with the male even at this prepubertal age. The site distribution in the two sexes is different as compared with adults. In females the trunk is more frequently affected -41.56%- than in males -30.71%-. Moreover, the lower limb is almost equally affected in females -25.32%- and in males -26.77%-. The head is more significantly -27.76%- affected in the prepubertal age as compared with adults -16.63%-. The most important favoring factor at this age -present in one third of the cases- is congenital melanocytic nevus, especially the giant type. The number of died children is significantly affected by the presence of a giant congenital melanocytic nevus -70.15%-, whereas it is not influenced by the age and the sex -37.40% in males and 39.24% in females-. The number of died children is also influenced by the presence of adenopathy -63.40% versus 6.17% in cases without adenopathy-.
Epidemiological data regarding 1,504 cases of primary malignant melanoma of the skin removed and diagnosed in Bari from 1975 to 2000 are reported. Particularly, besides the total number of cases, figures per year, sex, age and site of the primary tumor are reported. The prevalence of melanoma is increasing even in Bari of about 10% per year. Females (55%) are affected slightly more frequently than males. With regard to the age, the most affected five-year period is between 56 and 60, with 75% of cases included between 36 and 75 years. Three cases of prepubertal melanoma with a prevalence of 0.2% of the cases are reported. Particular attention was paid to the different distribution per site according to the sex. Once confirmed the more frequent involvement of the lower limb in females and of the trunk in males, we subdivided in age groups the cases of melanoma. We showed that this different localization in the two sexes starts after 30 years and persists after 60 years. As the more frequent localization on the lower limb in the female lacks in the 16-30 age group and on the other hand is present in the over sixty age group, the involvement of this site is probably not exclusively related to sex-linked hormonal factors.
Malignant metastasising tumors of the pregnant woman usually do not metastasise to the fetus. Although melanoma is not the most frequent malignant tumor in pregnancy, the cases of fetal metastatic melanoma are more frequent as compared with all the other malignant tumors. Five cases of the relevant literature are reviewed and the pathogenetic mechanisms of this exceptional experiment of the nature are discussed.