Two very different disorders such as gangrene of the buttock and hemangioma can affect the buttock of the newborn with very similar clinical features, namely an ischemic patch followed by an ulcer with sharply defined borders.
Gangrene of the buttock is a typical disorder of the newborn, due to an artery occlusion in the territory of the hypogastric artery and favored by “inspissatio sanguinis”, vasomotory instability and catheterization of the umbilical vessels. It starts with a white patch that rapidly undergoes necrosis. Later on, the segregation of the latter gives raise to an ulcer.
Hemangioma can be preceded by a white ischemic patch, sometimes with central telangiectases. When localized on the buttock, hemangioma can ulcerate, due to soaking of the disposable diaper and rubbing characteristic of the site.
Nevus is a circumscribed area of the skin, usually consisting of an excess of cutaneous cells. Nevus is usually present at birth or from the first periods of life and persists throughout life in most cases. The definition is uncertain due to numerous factors, the first being the discrepancy between the common meaning of nevus, which exclusively regards the melanocytic nevus, and the dermatological use of the word nevus, including all types of nevi, besides melanocytic nevus. We are now considering the other factors responsible for the uncertain definition of nevus, analysing its definition. (...)
Definition. Congenital melanocytic nevus is a mole consisting of epidermal melanocytes and nevus cells, present at birth. The melanocyte derives from the neural crest, reaches the epidermis during the fetal life and here persists throughout life, particularly in the basal layer. By routine staining, melanocytes are characterized by a light, perinuclear halo. By special staining, its cytoplasmatic prolongations or dendrites get visible. Through its dendrites, melanocytes transfer to the surrounding cells -keratinocytes- their product, namely melanin. The melanocytic nevus probably arises form a post-mutational clonal proliferation (9). Initially, techae of melanocytes are present at the dermal-epidermal junction, then going down into the dermis and loosing the contact with the epidermis. The lack of contact with the epidermis is probably responsible for morphological and functional changes such as disappearance of dendrites and stopped production of melanin, leading to the transformation of the melanocyte in nevus cell. (...)
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.
In the previous issue, which was devoted to prepubertal melanoma, the congenital melanocytic nevus was treated due to its close relationship with this tumor. In this issue we face the complex chapter of melanocytic nevi. The cells which produce these nevi are the melanocytes and the nevus cells. According to some Authors this distinction is not necessarily well-founded since the nevus cells probably derive from melanocytes. We maintain that this distinction is useful not only for didactic purposes and classification, but also because the two cell types, independently of their origin, are significantly different morphologically and functionally. Apart from melanocytes and nevus cells, we shall discuss melanophages. (...)
The treatment of dermatophytoses should be associated to the identification of the source of the infection. The latter can be helped by the identification of the responsible mycotic agent thanks to the mycological culture. A systemic treatment is indicated when the lesions affect more than 10% of the skin surface and are far each other, when areas close to terminal hairs are affected and finally in immunocompromised subjects. The topical treatment is based upon the new antimycotic agents, particularly imidazoles. In case of intense inflammation, a topical corticosteroid cream, possibly associated to an antimycotic agent, is initially indicated. The treatment of tinea corporis, tinea inguinalis with a mention to diaper rash, tinea pedis and finally pityriasis versicolor is discussed.
The literature on the superficial folliculitis of the buttocks and thighs has especially highlighted the acute forms caused by Pseudomonas aeruginosa (2, 3, 4) or methicillin-susceptible Staphylococcus (1). In both cases we are dealing with acute, non recurrent episodes; the former are most frequently linked to the popular water plays in the US and are due to water pollution with Pseudomonas aeruginosa, thus more often interesting many subjects involved in the game. On the other hand, our cases affected single children with chronic-recurrent course. In our case the role of infectious factors is questionable: the isolation of Pseudomonas aeruginosa and Staphylococcus aureus is frequent; however, being these bacteria commensal of the skin, it is difficult to envisage their pathogenic role. Moreover, since the course of this disorder is chronic-recurrent with subintrant crops, it is not easy to assess the therapeutic significance of antibiotics, unless, as in our case, recurrences intervene precisely during the administration of antibiotics. Our cases intervene in the age of primary school in single subjects; they are not epidemic; they do not occur as single acute episodes, but instead are chronic-recurrent for months or years; they are not accompanied by itching, but when deeper, folliculitis can make sitting position painful; the bacteriological examination can be positive for Pseudomonas aeruginosa or Staphylococcus aureus; however, antibiotics are not effective; our cases affect immunocompetent individuals; hyperhidrosis seems an important pathogenic factor; there may be follicular keratosis; in parents you may find minimal folliculitis of the buttocks.