Publications by authors named "Bruno Labeille"

43 Publications

In vivo and ex vivo confocal microscopy for the evaluation of surgical margins of melanoma.

J Biophotonics 2020 Nov 13;13(11):e202000179. Epub 2020 Aug 13.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy.

We report the first series of melanomas (MMs) where the surgical margins were evaluated both by ex vivo confocal microscopy (EVCM) and in vivo reflectance confocal microscopy (RCM). We evaluated the surgical margins of 42 cutaneous MMs of lentigo maligna/lentigo maligna melanoma type and 2 mucosal MMs with EVCM. Cutaneous MMs also underwent RCM mapping. Imaging results were compared with histopathology. The rate of correct identification of the tumor margins (invaded or not invaded) was 97.6% for RCM (evaluations of cutaneous MMs) and 95.5% for EVCM (evaluations of both cutaneous and mucosal MMs). Our study showed that the MM extension is visible under EVCM and that the combination of in vivo RCM and EVCM can be a new strategy for the evaluation of surgical margins of MMs.
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http://dx.doi.org/10.1002/jbio.202000179DOI Listing
November 2020

Factors Associated With Short-term Relapse in Patients With Pemphigus Who Receive Rituximab as First-line Therapy: A Post Hoc Analysis of a Randomized Clinical Trial.

JAMA Dermatol 2020 05;156(5):545-552

Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France.

Importance: Rituximab and short-term corticosteroid therapy are the criterion standard treatments for patients with newly diagnosed moderate to severe pemphigus.

Objective: To examine factors associated with short-term relapse in patients with pemphigus treated with rituximab.

Design, Setting, And Participants: This post hoc analysis of a randomized clinical trial (Comparison Between Rituximab Treatment and Oral Corticosteroid Treatment in Patients With Pemphigus [RITUX 3]) conducted from January 1, 2010, to December 31, 2015, included patients from 20 dermatology departments of tertiary care centers in France from the RITUX 3 trial and 3 newly diagnosed patients treated according to the trial protocol. Data analysis was performed from February 1 to June 30, 2019.

Exposure: Patients randomly assigned to the rituximab group in the RITUX 3 trial and the 3 additional patients were treated with 1000 mg of intravenous rituximab on days 0 and 14 and 500 mg at months 12 and 18 combined with a short-term prednisone regimen.

Main Outcomes And Measures: Baseline (pretreatment) clinical and biological characteristics (Pemphigus Disease Area Index [PDAI] score, ranging from 0-250 points, with higher values indicating more severe disease) and changes in anti-desmoglein (DSG) 1 and anti-DSG3 values as measured by enzyme-linked immunosorbent assay during the 3 months after rituximab treatment were compared between patients with disease relapse and those who maintained clinical remission during the first 12 months after treatment. The positive and negative predictive values of these factors were calculated.

Results: Among 47 patients (mean [SD] age, 54.3 [17.0] years; 17 [36%] male and 30 [64%] female) included in the study, the mean (SD) baseline PDAI score for patients with relapsing disease was higher than that of the patients with nonrelapsing disease (54 [33] vs 28 [24]; P = .03). At month 3, 7 of 11 patients with relapsing disease (64%) vs 7 of 36 patients with nonrelapsing disease (19%) had persistent anti-DSG1 antibody values of 20 IU/mL or higher and/or anti-DSG3 antibody values of 130 IU/mL or higher (P = .01). A PDAI score of 45 or higher defining severe pemphigus and/or persistent anti-DSG1 antibody values of 20 IU/mL or higher and/or anti-DSG3 antibody values of 130 IU/mL or higher at month 3 provided a positive predictive value of 50% (95% CI, 27%-73%) and a negative predictive value of 94% (95% CI, 73%-100%) for the occurrence of relapse after rituximab.

Conclusions And Relevance: The findings suggest that initial PDAI score and changes in anti-DSG antibody values after the initial cycle of rituximab might help differentiate a subgroup of patients with high risk of relapse who might benefit from maintenance rituximab infusion at month 6 from a subgroup of patients with low risk of relapse who do not need early maintenance therapy.

Trial Registration: NCT00784589.
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http://dx.doi.org/10.1001/jamadermatol.2020.0290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081151PMC
May 2020

Long-term therapy of multiple basal cell carcinomas: Clinicodermoscopic score for monitoring of intermittent vismodegib treatment.

Dermatol Ther 2019 11 17;32(6):e13097. Epub 2019 Oct 17.

Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.

Vismodegib treatment of multiple basal cell carcinomas (BCCs) is limited by adverse effects and high relapse rates: intermittent regimens are therefore preferred for long-term administration. The objective of this study was to investigate clinical and dermoscopic changes in BCCs during long-term intermittent treatment and to identify those most indicative of tumor persistence/clearing. Clinical and dermoscopic images (n = 380 each) of 38 BCCs were acquired at 10 observation times (t0-t9). Biopsies were performed at baseline (t0) and after 72 weeks of treatment (t9). All images were evaluated retrospectively by experts who assessed the presence/absence of 12 clinical and 14 dermoscopic features: clinical scores (CScs) and dermoscopic scores (DScs) were then calculated.
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http://dx.doi.org/10.1111/dth.13097DOI Listing
November 2019

Ex vivo confocal microscopy for dermatofibrosarcoma protuberans.

Skin Res Technol 2019 07 12;25(4):589-591. Epub 2019 Mar 12.

Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France.

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http://dx.doi.org/10.1111/srt.12690DOI Listing
July 2019

Higher Frequency of Dipeptidyl Peptidase-4 Inhibitor Intake in Bullous Pemphigoid Patients than in the French General Population.

J Invest Dermatol 2019 04 10;139(4):835-841. Epub 2018 Dec 10.

Department of Dermatology, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Autoimmunes, Normandie University, Rouen, France.

Dipeptidyl peptidase-4 inhibitors have been suspected to induce bullous pemphigoid (BP). The objective of this study was to compare the observed frequency of gliptin intake in a large sample of 1,787 BP patients diagnosed between 2012 and 2015 in France, with the expected frequency after indirect age standardization on 225,412 individuals extracted from the database of the National Healthcare Insurance Agency. The secondary objective was to assess the clinical characteristics and the course of gliptin-associated BP, depending on whether gliptin was continued or stopped. The observed frequencies of intake of the whole gliptin class and that of vildagliptin in the BP population were higher than those in the general population after age standardization (whole gliptin class: 6.0%; 95% confidence interval = 4.9-7.1% vs. 3.6%, observed-to-expected drug intake ratio = 1.7; 95% confidence interval = 1.4-2.0; P < 0.0001; vildagliptin = 3.3%; 95% confidence interval = 2.5-4.1% vs. 0.7%, ratio = 4.4; 95% confidence interval = 3.5-5.7; P < 0.0001). The association of any gliptin+metformin was also higher than in the general population, ratio = 1.8 (95% confidence interval = 1.3-2.4; P < 0.0001). Gliptin-associated BP had no specific clinical characteristics. Gliptin was stopped in 48 (45.3%) cases. Median duration to achieve disease control, rate, and delay of relapse were not different whether gliptin was stopped or continued. This study strongly supports the association between gliptin intake, particularly vildagliptin, and the onset of BP.
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http://dx.doi.org/10.1016/j.jid.2018.10.045DOI Listing
April 2019

Large International Validation of ABSIS and PDAI Pemphigus Severity Scores.

J Invest Dermatol 2019 01 6;139(1):31-37. Epub 2018 Oct 6.

Department of Dermatology, Rouen University Hospital, and INSERM U 1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France.

The Pemphigus Disease Area Index (PDAI) and Autoimmune Bullous Skin Disorder Intensity-Score (ABSIS) scores have been proposed to provide an objective measure of pemphigus activity. These scores have been evaluated only on already treated patients mainly with mild to moderate activity. The objective was to assess the interrater reliability of ABSIS and PDAI scores and their correlation with other severity markers in a large international study. Consecutive patients with newly diagnosed pemphigus were enrolled in 31 centers. Severity scores were recorded during a 24-month period by the same two blinded investigators. Serum was collected at each visit for ELISA measurement of anti-desmoglein antibodies. The intraclass correlation coefficient (ICC) and Spearman rank correlation coefficient were calculated. A total of 116 patients with pemphigus vulgaris (n = 84) or pemphigus foliaceus (n = 32) were included. At baseline, the ABSIS and PDAI ICCs were 0.90 (95% confidence interval [CI] = 0.85-0.93), and 0.91(95% CI = 0.87-0.94), respectively. The ICCs for PDAI were higher in moderate and extensive pemphigus (ICC = 0.82, 95% CI = 0.63-0.92 and ICC = 0.80, 95% CI = 0.62-0.90, respectively) than in patients with intermediate (significant) extent (ICC = 0.50, 95% CI = 0.27-0.68). Conversely, the ICCs for ABSIS were lower in patients with moderate extent (ICC = 0.44, 95% CI = 0.004-0.74) than in those with intermediate or extensive forms, (ICC = 0.69, 95% CI = 0.51-0.81 and ICC = 0.75, 95% CI = 0.51-0.88, respectively). During patients' follow-up, the ICCs of both ABSIS and PDAI scores remained higher than 0.70. ABSIS and PDAI skin (r = 0.71 and r = 0.75) but not mucosal (r = 0.32 and r = 0.37) subscores were correlated with the evolution of anti-DSG1 and anti-DSG3 ELISA values, respectively. ABSIS and PDAI scores are robust tools to accurately assess pemphigus activity.
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http://dx.doi.org/10.1016/j.jid.2018.04.042DOI Listing
January 2019

Dermoscopy for the Diagnosis of Conjunctival Lesions.

Dermatol Clin 2018 Oct 16;36(4):439-449. Epub 2018 Aug 16.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Viale Bracci 16, Siena 53100, Italy.

This article describes the present literature on dermoscopy of conjunctiva and shows the results of a dermoscopy study of 147 conjunctival tumors. Melanomas were characterized by a heavy pigmentation, irregular dots, and a higher prevalence of gray color compared with nevi. Squamous cell carcinomas had peculiar hairpin and glomerular vessels. Primary acquired melanoses were characterized by regularly distributed light brown dots. A large part of nevi had small cysts.
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http://dx.doi.org/10.1016/j.det.2018.05.011DOI Listing
October 2018

Ex vivo confocal microscopy: an emerging technique in dermatology.

Dermatol Pract Concept 2018 Apr 30;8(2):109-119. Epub 2018 Apr 30.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy.

This review aims to give an overview of the current available applications of ex vivo confocal microscopy (EVCM) in dermatology. EVCM is a relatively new imaging technique that allows microscopic examination of freshly excised unfixed tissue. It enables a rapid examination of the skin sample directly in the surgery room and thus represents an alternative to the intraoperative micrographic control of the surgical margins of cutaneous tumors by standard microscopic examination on cryopreserved sections during Mohs surgery. Although this technique has mainly been developed for the margin's control of basal cell carcinoma, many other skin tumors have been studied, including melanoma. Use of EVCM is continuing to evolve, and many possible applications are under investigation, such as the study of nails and hair diseases and the diagnosis of skin infections.
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http://dx.doi.org/10.5826/dpc.0802a08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955077PMC
April 2018

Treatment of Psychiatric Disorders and Skin-Restricted Lupus Remission: A Longitudinal Study.

JAMA Dermatol 2017 12;153(12):1331-1332

Service de Dermatologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.

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http://dx.doi.org/10.1001/jamadermatol.2017.3590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817441PMC
December 2017

Prevalence of actinic keratosis in a French cohort of elderly people: the PROOF study.

G Ital Dermatol Venereol 2017 10;152(5):537-540

Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France.

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http://dx.doi.org/10.23736/S0392-0488.16.05353-0DOI Listing
October 2017

Mutations in ACTRT1 and its enhancer RNA elements lead to aberrant activation of Hedgehog signaling in inherited and sporadic basal cell carcinomas.

Nat Med 2017 Oct 4;23(10):1226-1233. Epub 2017 Sep 4.

Paris Descartes University, Sorbonne Paris Cité, Paris, France.

Basal cell carcinoma (BCC), the most common human cancer, results from aberrant activation of the Hedgehog signaling pathway. Although most cases of BCC are sporadic, some forms are inherited, such as Bazex-Dupré-Christol syndrome (BDCS)-a cancer-prone genodermatosis with an X-linked, dominant inheritance pattern. We have identified mutations in the ACTRT1 gene, which encodes actin-related protein T1 (ARP-T1), in two of the six families with BDCS that were examined in this study. High-throughput sequencing in the four remaining families identified germline mutations in noncoding sequences surrounding ACTRT1. These mutations were located in transcribed sequences encoding enhancer RNAs (eRNAs) and were shown to impair enhancer activity and ACTRT1 expression. ARP-T1 was found to directly bind to the GLI1 promoter, thus inhibiting GLI1 expression, and loss of ARP-T1 led to activation of the Hedgehog pathway in individuals with BDCS. Moreover, exogenous expression of ACTRT1 reduced the in vitro and in vivo proliferation rates of cell lines with aberrant activation of the Hedgehog signaling pathway. In summary, our study identifies a disease mechanism in BCC involving mutations in regulatory noncoding elements and uncovers the tumor-suppressor properties of ACTRT1.
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http://dx.doi.org/10.1038/nm.4368DOI Listing
October 2017

Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Eyelid Margin and Conjunctival Tumors.

JAMA Ophthalmol 2017 08;135(8):845-851

Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France.

Importance: The clinical diagnosis of conjunctival and eyelid margin tumors is challenging, and new noninvasive imaging techniques could be valuable in this field.

Objective: To assess the diagnostic accuracy of handheld in vivo reflectance confocal microscopy (IVCM) for the diagnosis of eyelid margin and conjunctival tumors.

Design: A prospective observational study was conducted at University Hospital of Saint-Etienne from January 2, 2011, to December 31, 2016 (inclusion of patients until December 31, 2015, and follow-up until December 31, 2016). A total of 278 consecutive patients with eyelid margin or conjunctival lesions were included. Conjunctival lesions were diagnosed with a conventional clinical examination using a slitlamp and by handheld IVCM. Final diagnoses were established by histopathologic examination for 155 neoformations suspicious for being malignant through clinical and/or IVCM examination that were excised and on follow-up of 12 months or longer for the remaining 140 lesions.

Main Outcomes And Measures: Sensitivity, specificity, and positive and negative predictive values for malignant tumors of the conjunctiva and eyelid margin were calculated using clinical examination with slitlamp and handheld IVCM.

Results: In the 278 patients (136 [48.9%] females; mean [SD] age, 59 [21] years), a total of 166 eyelid margin and 129 conjunctival lesions were included in the analysis. Of the 155 excised neoformations with a histopathologic diagnosis, IVCM showed higher sensitivity compared with clinical examination conducted with the slitlamp for malignant tumors of the eyelid margin (98% vs 92%) and conjunctiva (100% vs 88%). The specificity for malignant eyelid margin tumors was higher for IVCM than for slitlamp examination (74% vs 46%), but slightly less for malignant conjunctival tumors (78% vs 88%). Analysis of all neoformations (155 excised and 140 in follow-up) confirmed these differences in the diagnostic accuracy of the clinical examination and IVCM. The presence of hyperreflective Langerhans cells mimicking malignant melanocytes was the main cause for misdiagnosis of malignant conjunctival tumors with IVCM.

Conclusions And Relevance: Handheld IVCM could be a useful tool for the identification of malignant conjunctival tumors. Further studies are required to confirm the usefulness of this device and identify possible features that can differentiate Langerhans cells from malignant melanocytes to prevent the misdiagnosis of melanoma using IVCM.
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http://dx.doi.org/10.1001/jamaophthalmol.2017.2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710297PMC
August 2017

High Prevalence of Personality Disorders in Skin-restricted Lupus Patients.

Acta Derm Venereol 2017 Aug;97(8):941-946

Service de Psychiatrie de l'Adulte A et Psychologie médicale, Pôle de Psychiatrie, CHU Clermont-Ferrand; Université d'Auvergne, FR-63003 Clermont-Ferrand, France.

Psychiatric and personality disorders have been extensively documented in patients with systemic lupus erythematosus (SLE). However, the prevalence of personality disorders in skin-restricted lupus (SRL) patients remains unknown. The aim of this study was to assess the prevalence of personality disorders in SRL outpatients and to examine the associated factors. We evaluated 60 SRL outpatients and 118 controls matched for sex, age and education level. On the basis of the Personality Diagnostic Questionnaire 4+, 38% of patients vs 20% of controls fulfilled the criteria for at least one personality disorder (OR 2.2 [95% CI 1.01-4.6], p = 0.048). Only one patient with a personality disorder had specialised mental health care. Late lupus onset and more frequent past treatments by thalidomide were associated factors. This study evidences a high prevalence of personality disorders in SRL patients and shows that most SRL patients with personality disorder do not receive specialised mental health care.
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http://dx.doi.org/10.2340/00015555-2691DOI Listing
August 2017

First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial.

Lancet 2017 May 22;389(10083):2031-2040. Epub 2017 Mar 22.

Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France.

Background: High doses of corticosteroids are considered the standard treatment for pemphigus. Because long-term corticosteroid treatment can cause severe and even life-threatening side-effects in patients with this disease, we assessed whether first-line use of rituximab as adjuvant therapy could improve the proportion of patients achieving complete remission off-therapy, compared with corticosteroid treatment alone, while decreasing treatment side-effects of corticosteroids.

Methods: We did a prospective, multicentre, parallel-group, open-label, randomised trial in 25 dermatology hospital departments in France (Ritux 3). Eligible participants were patients with newly diagnosed pemphigus aged 18-80 years being treated for the first time (not at the time of a relapse). We randomly assigned participants (1:1) to receive either oral prednisone alone, 1·0 or 1·5 mg/kg per day tapered over 12 or 18 months (prednisone alone group), or 1000 mg of intravenous rituximab on days 0 and 14, and 500 mg at months 12 and 18, combined with a short-term prednisone regimen, 0·5 or 1·0 mg/kg per day tapered over 3 or 6 months (rituximab plus short-term prednisone group). Follow-up was for 3 years (study visits were scheduled weekly during the first month of the study, then monthly until month 24, then an additional visit at month 36). Treatment was assigned through central computer-generated randomisation, with stratification according to disease-severity (severe or moderate, based on Harman's criteria). The primary endpoint was the proportion of patients who achieved complete remission off-therapy at month 24 (intention-to-treat analysis). This study is registered with ClinicalTrials.gov, number NCT00784589.

Findings: Between May 10, 2010, and Dec 7, 2012, we enrolled 91 patients and randomly assigned 90 to treatment (90 were analysed; 1 patient withdrew consent before the random assignment). At month 24, 41 (89%) of 46 patients assigned to rituximab plus short-term prednisone were in complete remission off-therapy versus 15 (34%) of 44 assigned to prednisone alone (absolute difference 55 percentage points, 95% CI 38·4-71·7; p<0·0001. This difference corresponded to a relative risk of success of 2·61 (95% CI 1·71-3·99, p<0·0001), corresponding to 1·82 patients (95% CI 1·39-2·60) who would need to be treated with rituximab plus prednisone (rather than prednisone alone) for one additional success. No patient died during the study. More severe adverse events of grade 3-4 were reported in the prednisone-alone group (53 events in 29 patients; mean 1·20 [SD 1·25]) than in the rituximab plus prednisone group (27 events in 16 patients; mean 0·59 [1·15]; p=0·0021). The most common of these events in both groups were diabetes and endocrine disorder (11 [21%] with prednisone alone vs six [22%] with rituximab plus prednisone), myopathy (ten [19%] vs three [11%]), and bone disorders (five [9%] vs five [19%]).

Interpretation: Data from our trial suggest that first-line use of rituximab plus short-term prednisone for patients with pemphigus is more effective than using prednisone alone, with fewer adverse events.

Funding: French Ministry of Health, French Society of Dermatology, Roche.
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http://dx.doi.org/10.1016/S0140-6736(17)30070-3DOI Listing
May 2017

Two intermittent vismodegib dosing regimens in patients with multiple basal-cell carcinomas (MIKIE): a randomised, regimen-controlled, double-blind, phase 2 trial.

Lancet Oncol 2017 03 8;18(3):404-412. Epub 2017 Feb 8.

Klinik für Dermatologie, Venereologie und Allergologie, Universitätsklinikum Essen, Essen, Germany.

Background: Vismodegib, a first-in-class Hedgehog-pathway inhibitor, is approved for use in adults with advanced basal-cell carcinoma. Patients with multiple basal-cell carcinomas, including those with basal-cell nevus (Gorlin) syndrome, need extended treatment. We assessed the safety and activity of two long-term intermittent vismodegib dosing regimens in patients with multiple basal-cell carcinomas.

Methods: In this randomised, regimen-controlled, double-blind, phase 2 trial, we enrolled adult patients with multiple basal-cell carcinomas, including those with basal-cell nevus syndrome, who had one or more histopathologically confirmed and at least six clinically evident basal-cell carcinomas. From a centralised randomisation schedule accessed via an interactive voice or web-based response system, patients were randomly assigned (1:1) to treatment group A (150 mg oral vismodegib per day for 12 weeks, then three rounds of 8 weeks of placebo daily followed by 12 weeks of 150 mg vismodegib daily) or treatment group B (150 mg oral vismodegib per day for 24 weeks, then three rounds of 8 weeks of placebo daily followed by 8 weeks of 150 mg vismodegib daily). Treatment assignment was stratified by diagnosis of basal-cell nevus syndrome, geographical region, and immunosuppression status. The primary endpoint was percentage reduction from baseline in the number of clinically evident basal-cell carcinomas at week 73. The primary analysis was by intention to treat. The safety population included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT01815840, and the study is ongoing.

Findings: Between April 30, 2013, and April 9, 2014, 229 patients were randomly assigned treatment, 116 in treatment group A and 113 in treatment group B. The mean number of basal-cell carcinoma lesions at week 73 was reduced from baseline by 62·7% (95% CI 53·0-72·3) in treatment group A and 54·0% (43·6-64·4) in treatment group B. 216 (95%) of 227 patients included in the safety analysis had at least one treatment-emergent adverse event deemed to be related to study treatment (107 [94%] of 114 in treatment group A and 109 [97%] of 113 in treatment group B). The most common grade 3 or worse treatment-related adverse events were muscle spasms (four [4%] patients in treatment group A vs 12 [11%] in treatment group B), increased blood creatine phosphokinase (one [1%] vs four [4%]), and hypophosphataemia (zero vs three [3%]). Serious treatment-emergent events were noted in 22 (19%) patients in treatment group A and 19 (17%) patients in treatment group B. Four (2%) patients died from adverse events; one (pulmonary embolism in treatment group A) was possibly related to treatment.

Interpretation: Both intermittent dosing schedules of vismodegib seemed to show good activity in long-term regimens in patients with multiple basal-cell carcinomas. Further study is warranted.

Funding: F Hoffmann-La Roche.
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http://dx.doi.org/10.1016/S1470-2045(17)30072-4DOI Listing
March 2017

Dermoscopy, reflectance confocal microscopy, and high-definition optical coherence tomography in the diagnosis of generalized argyria.

J Am Acad Dermatol 2017 Feb;76(2S1):S66-S68

Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France.

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http://dx.doi.org/10.1016/j.jaad.2016.07.057DOI Listing
February 2017

'En face' ex vivo reflectance confocal microscopy to help the surgery of basal cell carcinoma of the eyelid.

Clin Exp Ophthalmol 2017 Jul 31;45(5):442-447. Epub 2017 Jan 31.

Department of Dermatology, University Hospital of St-Etienne, Saint Etienne, France.

Background: Ex vivo confocal microscopy is a recent imaging technique for the perioperative control of skin tumour margins. Up to date, it has been used in the fluorescence mode and with vertical sections of the specimen margins. The aim of this study was to evaluate its use in the reflectance mode and with a horizontal ('en face') scanning of the surgical specimen in a series of basal cell carcinoma of the eyelid.

Design: Prospective consecutive cohort study was performed at the University Hospital of Saint-Etienne, France.

Participants: Forty-one patients with 42 basal cell carcinoma of the eyelid participated in this study.

Methods: Basal cell carcinomas were excised with a 2-mm-wide clinically safe margin. The surgical specimens were analysed under ex vivo confocal microscopy in the reflectance mode and with an en face scanning in order to control at a microscopic level if the margins were free from tumour invasion. Histopathogical examination was later performed in order to compare the results.

Main Outcome Measures: Sensitivity and specificity of ex vivo confocal microscopy for the presence of tumour-free margins.

Results: Ex vivo confocal microscopy results were consistent with histopathology in all cases (tumour-free margins in 40 out of 42 samples; sensitivity and specificity of 100%).

Conclusions: Ex vivo confocal microscopy in the reflectance mode with an 'en face' scanning can control tumour margins of eyelid basal cell carcinomas and optimize their surgical management. This procedure has the advantage on the fluorescent mode of not needing any contrast agent to examine the samples.
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http://dx.doi.org/10.1111/ceo.12904DOI Listing
July 2017

Skin tumours and skin aging in 209 French elderly people: the PROOF study.

Eur J Dermatol 2016 Oct;26(5):470-476

Department of Dermatology, University Hospital of Saint Etienne, Cedex 2, 42055 Saint Etienne, France.

Few studies have evaluated the prevalence of skin tumours in the geriatric population and none have analysed different skin aging parameters for whole-body skin in this population. To evaluate the prevalence of skin tumours and global skin aging in a French cohort of elderly people. In total, 209 subjects, 105 women and 104 men (mean age: 77.5; range: 74-81 years), were enrolled from the PROOF (PROgnostic indicator OF cardiovascular and cerebrovascular events) cohort. SCINEXA (SCore for INtrinsic and EXtrinsic skin Aging) was used to assess the degree of skin aging and the prevalence of skin tumours. Some additional cutaneous parameters were also studied. Skin aging in women and men was compared. Mean global SCINEXA was 24.3 (SD: 4.7; range: 8.2-35.3). Solar elastosis and lax appearance were more severe in women (t test; p<0.0001), whereas pseudoscars (t test; p = 0.0312) and coarse wrinkles (t test; p = 0.0479) were more severe in men. Erythrosis coli (chi-square test; p <0.0001) was more frequent in men, whereas varicous veins (chi-square test; p = 0.0026) and eyelid xanthomas (chi-square test; p = 0.0282) were more frequent in women. Twelve patients presented with cutaneous carcinomas and two patients had early melanomas. This research describes in detail the main indices of skin aging in an old population and the differences related to gender. Moreover, it highlights the utility of systematic screening of old patients by dermatologists in order to diagnose skin cancers early.
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http://dx.doi.org/10.1684/ejd.2016.2838DOI Listing
October 2016

Confocal Microscopy for Special Sites and Special Uses.

Dermatol Clin 2016 Oct;34(4):477-485

Dermatology Department, University Hospital of Saint-Etienne, Cedex 2, Saint-Etienne, 42055, France.

This article describes the use of confocal microscopy for special sites and unconventional applications. These new applications have been made possible thanks to the introduction on the market of a hand-held camera. Special sites discussed include mucosa, nails, and palms and soles. Special uses discussed include infections and infestations; tumor mapping; understanding clinical, dermoscopic, and histology features; videos and ex vivo confocal microscopy.
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http://dx.doi.org/10.1016/j.det.2016.05.010DOI Listing
October 2016

The venous-arterial difference in CO should be interpreted with caution in case of respiratory alkalosis in healthy volunteers.

J Clin Monit Comput 2017 Aug 10;31(4):701-707. Epub 2016 Jun 10.

Service de Physiologie Clinique et de l'Exercice, Centre Hospitalier Universitaire de Saint Etienne, 42055, Saint Etienne, France.

The venous-arterial difference in CO (ΔCO) has been proposed as an index of the adequacy of tissue perfusion in shock states. We hypothesized that the variation in PaCO (hyper- or hypocapnia) could impact ΔCO, partly through microcirculation adaptations. Fifteen healthy males volunteered to participate. For hypocapnia condition (hCO), the subjects were asked to hyperventilate, while they were asked to breathe a gas mixture containing 8 % CO for hypercapnia condition (HCO). The 2 conditions were randomly assigned. Blood gases were measured at baseline before each condition, and after 5-7 min of either hCO or HCO condition. Microcirculation was assessed by the muscle reoxygenation slope measured with near infrared spectroscopy following a vascular occlusion test and by skin circulation with in vivo reflectance confocal microscopy. ΔCO was significantly increased with hCO while it tended to decrease with HCO (non-significant). HCO induced a moderate increase of the resaturation slope of NIRS oxygenation. Skin microcirculatory blood flow significantly dropped with hCO, while it remained unchanged with hypercapnia. Our results warrant cautious interpretation of ΔCO as an indicator of tissue perfusion during respiratory alkalosis.
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http://dx.doi.org/10.1007/s10877-016-9897-6DOI Listing
August 2017

Neutrophil dermatosis of the dorsal hands with multiple myeloma.

Joint Bone Spine 2016 Mar 6;83(2):227. Epub 2015 Oct 6.

Department of Rheumatology, CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex, France; Inserm 1059/LBTO, Université Jean-Monet, Université de Lyon, 42270 Saint-Étienne, France. Electronic address:

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http://dx.doi.org/10.1016/j.jbspin.2015.03.011DOI Listing
March 2016

Sensitivity of handheld reflectance confocal microscopy for the diagnosis of basal cell carcinoma: A series of 344 histologically proven lesions.

J Am Acad Dermatol 2015 Aug;73(2):319-20

Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France.

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http://dx.doi.org/10.1016/j.jaad.2015.04.048DOI Listing
August 2015

Dermoscopy and confocal microscopy for in vivo detection and characterization of Dermanyssus gallinae mite.

J Am Acad Dermatol 2015 Jul;73(1):e15-6

Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France.

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http://dx.doi.org/10.1016/j.jaad.2015.03.022DOI Listing
July 2015

Ex vivo confocal microscopy imaging to identify tumor tissue on freshly removed brain sample.

J Neurooncol 2015 Sep 2;124(2):157-64. Epub 2015 Jun 2.

Service d'Anatomie et Cytologie Pathologiques - CHU de Saint Étienne, Hôpital Nord, 42055, Saint Étienne. Cedex2, France.

Confocal microscopy is a technique able to realize "optic sections" of a tissue with increasing applications. We wondered if we could apply an ex vivo confocal microscope designed for dermatological purpose in a routine use for the most frequent brain tumors. The aim of this work was to identify tumor tissue and its histopathological hallmarks, and to assess grading criteria used in neuropathological practice without tissue loss on freshly removed brain tissue. Seven infiltrating gliomas, nine meningiomas and three metastases of carcinomas were included. We compared imaging results obtained with the confocal microscope to frozen sections, smears and tissue sections of formalin-fixed tissue. Our results show that ex vivo confocal microscopy imaging can be applied to brain tumors in order to quickly identify tumor tissue without tissue loss. It can differentiate tumors and can assess most of grading criteria. Confocal microscopy could represent a new tool to identify tumor tissue on freshly removed sample and could help in selecting areas for biobanking of tumor tissue.
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http://dx.doi.org/10.1007/s11060-015-1832-zDOI Listing
September 2015

The role of in vivo confocal microscopy in the diagnosis of eyelid margin tumors: reply from the authors.

J Am Acad Dermatol 2015 May;72(5):e123

Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France.

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http://dx.doi.org/10.1016/j.jaad.2015.01.013DOI Listing
May 2015

In vivo confocal microscopy of pine processionary caterpillar hair-induced keratitis.

Cornea 2015 Mar;34(3):350-2

*Department of Ophthalmology, University Hospital, Saint-Etienne, France; †Corneal Graft Biology, Engineering and Imaging Laboratory, EA2521, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France; ‡Department of Dermatology, University Hospital, Saint-Etienne, France; and §Institut Universitaire de France, Paris, France.

Purpose: Multimodal imaging of processionary caterpillar hair-induced keratitis with anterior segment optical coherence tomography and in vivo confocal microscopy.

Methods: Case report.

Results: A 25-year-old woman presented with acute keratitis induced by multiple tiny processionary caterpillar hairs. She initially experienced severe pain and moderate vision loss, which gradually improved within a few weeks. Diagnosis was confirmed by in vivo confocal microscopy showing a pathognomonic image strictly comparable with ex vivo microscopy photography.

Conclusions: To the best of our knowledge, this is the first case of corneal in vivo confocal imaging of a caterpillar hair with confirmation by ex vivo microscopy.
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http://dx.doi.org/10.1097/ICO.0000000000000360DOI Listing
March 2015

A dermoscopic clue for scurvy.

J Am Acad Dermatol 2015 Jan;72(1 Suppl):S37-8

Department of Dermatology, University Hospital of St-Etienne, 42055 Saint-Etienne Cedex 2, France.

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http://dx.doi.org/10.1016/j.jaad.2014.05.061DOI Listing
January 2015

Handheld reflectance confocal microscopy for the diagnosis of conjunctival tumors.

Am J Ophthalmol 2015 Feb 5;159(2):324-33.e1. Epub 2014 Nov 5.

Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France.

Purpose: To evaluate whether the handheld in vivo reflectance confocal microscopy that has been recently developed for the study of skin tumors is suitable for the diagnosis of conjunctival tumors.

Design: Prospective study, observational case series.

Methods: We prospectively evaluated the reflectance confocal microscopy features of 53 conjunctival lesions clinically suspicious for tumors of 46 patients referred to the University Hospital of Saint-Etienne (France) by using the handheld device. Twenty-three lesions were excised (3 nevi, 10 melanomas, 5 squamous cell carcinoma, 2 lymphomas, and 3 pinguecula/pterygium) while the other 30, presenting no reflectance confocal microscopy malignant features, were under follow-up for at least 1 year. Clinical reflectance confocal microscopy and histologic diagnosis were compared.

Results: In vivo reflectance confocal microscopy diagnosis was in agreement with the histologic diagnosis in all cases and none of the lesions that were not excised show any clinical progression under follow-up.

Conclusion: In vivo reflectance confocal microscopy with a handheld dermatology-dedicated microscope can play a role in the noninvasive diagnosis of conjunctival lesions. Further studies should be performed to better define the diagnostic ability of this technique.
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http://dx.doi.org/10.1016/j.ajo.2014.10.031DOI Listing
February 2015