Publications by authors named "Frédéric Cambazard"

56 Publications

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

J Biophotonics 2020 11 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

Efficacy and safety of oral alitretinoin as treatment for chronic hand eczema in France: a real-life open-label study.

Eur J Dermatol 2019 Feb;29(1):59-66

Hôpital Henri Mondor, Dermatologie, Créteil, France.

Background: Chronic hand eczema is an inflammatory dermatosis that results in a significant psychological and socio-economic burden. Alitretinoin (AL) is indicated in adults with severe chronic hand eczema (sCHE) unresponsive to potent topical corticosteroids.

Objectives: To assess AL effectiveness and safety in patients with sCHE under real-life conditions based on a prospective observational study in France (2010-2014).

Materials & Methods: Clinical severity was assessed using Physician Global Assessment (PGA) and Modified Total Lesion Symptom Score (mTLSS) and quality of life by Skindex and visual analogue scales. Patients were treated with AL for 12-24 weeks and followed for 24 months. Responders were patients with clear/almost clear skin based on PGA at the end of treatment and the primary outcome was remission (clear, almost clear, or mild skin) at one and two years after treatment.

Results: A total of 394 patients with severe or moderate PGA were included in the study by 109 dermatologists. AL treatment duration was 5.4 ± 4.1 months (mean ± SD) and 112/274 patients evaluated at the end of treatment were responders. Of the 112 responders, 41/51 evaluable patients were in remission after one year and 36/46 after two years. At the end of treatment, Skindex improved from 48.8 ± 18.1% to 27.1 ± 23.2%. Among the 112 responders, 68/84 did not relapse (mTLSS increased >75% from baseline). The most common adverse events were headache (24%) and dyslipidaemia (4%).

Conclusions: This study supports a positive benefit/risk profile for AL for sCHE patients unresponsive to topical corticosteroids.
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http://dx.doi.org/10.1684/ejd.2018.3484DOI Listing
February 2019

Acne mechanica in a child with a motor tic.

G Ital Dermatol Venereol 2020 Aug 20;155(4):514-515. Epub 2018 Sep 20.

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

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http://dx.doi.org/10.23736/S0392-0488.18.06063-7DOI Listing
August 2020

Role of Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Fabry Disease: A Case Report.

Diseases 2018 Jun 27;6(3). Epub 2018 Jun 27.

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

Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by the deficient activity of the lysosomal enzyme α-galactosidase that leads to a systemic accumulation of globotriaosylceramide. Handheld in vivo reflectance confocal microscopy (HH-RCM) is a useful modern technique in diagnosis and follow-ups of many skin diseases. This noninvasive device provides high-resolution and high-contrast real-time images to study both the skin and the ocular surface structures that can help clinicians to confirm the diagnosis of FD. HH-RCM could be helpful even for the follow-ups of these patients, enabling us to monitor the effect of enzyme replacement therapy on corneal cells and keratinocytes.
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http://dx.doi.org/10.3390/diseases6030055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164009PMC
June 2018

Greater improvement in quality of life outcomes in patients using fixed-combination calcipotriol plus betamethasone dipropionate aerosol foam versus gel: results from the PSO-ABLE study.

Eur J Dermatol 2018 Jun;28(3):356-363

Paul Sabatier University and Larrey Hospital, Toulouse, France.

Background: Health-related quality of life (HRQoL) measures provide patient-centred evaluations of response to treatment. In the 12-week, Phase III PSO-ABLE study, fixed-combination calcipotriol 50 μg/g as hydrate (Cal) plus betamethasone 0.5 mg/g as dipropionate (BD) aerosol foam was significantly more effective for the treatment of psoriasis than Cal/BD gel.

Objective: To compare HRQoL in mild-severe psoriasis vulgaris patients (involving 2-30% body surface area) over 12 weeks of treatment with Cal/BD foam or gel.

Methods: HRQoL was assessed using: Dermatology Life Quality Index (DLQI), EuroQoL-5D-5L-PSO (EQ-5D), and Psoriasis QoL (PQoL-12) questionnaires (baseline, Weeks 4, 8 and 12); DLQI score of 0/1 (range: 0-30) and weighted EQ-5D utility index score of 1 (range: 0-1) indicates there is no impact on a patient's QoL and perfect health, respectively. Itch, itch-related sleep loss, and work impairment were also assessed.

Results: In total, 463 patients were randomized to the study (Cal/BD foam, n = 185; Cal/BD gel, n = 188; foam vehicle, n = 47; gel vehicle, n = 43). Significantly more Cal/BD foam patients achieved DLQI scores of 0/1 at Weeks 4 (45.7% vs 32.4%; p = 0.013) and 12 (60.5% vs 44.1%; p = 0.003) than Cal/BD gel patients. Cal/BD foam significantly improved EQ-5D utility index (0.09 vs 0.03; p<0.001) and PQoL-12 scores (-2.23 vs -2.07; p = 0.029) from baseline to Week 4 versus Cal/BD gel. Itch, itch-related sleep loss, and work impairment improved more with Cal/BD foam than gel.

Conclusion: Cal/BD foam demonstrated greater HRQoL improvement in patients with psoriasis than Cal/BD gel over 12 weeks of treatment.
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http://dx.doi.org/10.1684/ejd.2018.3302DOI Listing
June 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

Methotrexate Versus Cyclosporine in Adults with Moderate-to-Severe Atopic Dermatitis: A Phase III Randomized Noninferiority Trial.

J Allergy Clin Immunol Pract 2018 Mar - Apr;6(2):562-569.e3. Epub 2017 Sep 28.

Department of Allergology and Immunology, Clinical Research Unit, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, Université Lyon 1, France; Université Lyon 1, Centre International de Recherche en Infectiologie, Inserm U1111, Lyon, France.

Background: Methotrexate is currently used to treat atopic dermatitis but has never been assessed versus cyclosporine in adults.

Objective: This study evaluated the efficacy and safety of methotrexate versus cyclosporine in patients with moderate-to-severe atopic dermatitis.

Methods: Patients were randomized to receive either oral methotrexate (15 mg/wk) or cyclosporine (2.5 mg/kg/d) for 8 weeks. The primary end point was a patient achieving 50% improvement in the SCORing Atopic Dermatitis index (SCORAD 50) at week 8. When the primary end point was not achieved, methotrexate was increased to 25 mg and cyclosporine to 5 mg during the next 16 weeks. The secondary end points were a patient achieving a 50% reduction in the Eczema Area Severity Intensity index (EASI 50) and SCORAD 50 at each visit (ClinicalTrials.gov no. NCT00809172).

Results: A total of 97 patients received methotrexate 15 mg (n = 50) or cyclosporine 2.5 mg (n = 47). Regarding the primary end point at week 8, methotrexate was inferior to cyclosporine because the proportion of patients with SCORAD 50 was 8% (4 of 50) in the methotrexate arm versus 42% (18 of 43) in the cyclosporine arm. The difference in percentages for the 2 treatment groups (2-sided 90% CI) was -34% (-48% to -20%). At week 8, methotrexate and cyclosporine dosages were increased in 56% and 49% of the patients, respectively. Regarding EASI 50, the noninferiority end point was reached at week 20 in 92% (22 of 24) of patients in the methotrexate arm and 87% (26 of 30) of patients in the cyclosporine arm. The treatment-related adverse events were more frequent with cyclosporine (P < .0001).

Conclusions: Methotrexate 15 mg/wk was inferior to cyclosporine 2.5 mg/kg/d at week 8. Increasing the doses of methotrexate to 25 mg/wk induced a significant improvement versus cyclosporine at week 20.
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http://dx.doi.org/10.1016/j.jaip.2017.07.007DOI Listing
November 2019

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

Adjuvant treatment with the bacterial lysate (OM-85) improves management of atopic dermatitis: A randomized study.

PLoS One 2017 23;12(3):e0161555. Epub 2017 Mar 23.

Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Department of Dermatology, Paris, France.

Background: Environmental factors play a major role on atopic dermatitis (AD) which shows a constant rise in prevalence in western countries over the last decades. The Hygiene Hypothesis suggesting an inverse relationship between incidence of infections and the increase in atopic diseases in these countries, is one of the working hypothesis proposed to explain this trend.

Objective: This study tested the efficacy and safety of oral administration of the bacterial lysate OM-85 (Broncho-Vaxom®, Broncho-Munal®, Ommunal®, Paxoral®, Vaxoral®), in the treatment of established AD in children.

Methods: Children aged 6 months to 7 years, with confirmed AD diagnosis, were randomized in a double-blind, placebo-controlled trial to receive, in addition to conventional treatment with emollients and topical corticosteroids, 3.5mg of the bacterial extract OM-85 or placebo daily for 9 months. The primary end-point was the difference between groups in the occurrence of new flares (NF) during the study period, evaluated by Hazard Ratio (HR) derived from conditional Cox proportional hazard regression models accounting for repeated events.

Results: Among the 179 randomized children, 170 were analysed, 88 in the OM-85 and 82 in the placebo group. As expected most children in both treatment groups experienced at least 1 NF during the study period (75 (85%) patients in the OM-85 group and 72 (88%) in the placebo group). Patients treated with OM-85 as adjuvant therapy had significantly fewer and delayed NFs (HR of repeated flares = 0.80; 95% confidence interval (CI): 0.67-0.96), also when potential confounding factors, as family history of atopy and corticosteroids use, were taken into account (HR = 0.82; 95% CI: 0.69-0.98). No major side effect was reported, with comparable and good tolerability for OM-85 and placebo.

Conclusions: Results show an adjuvant therapeutic effect of a well standardized bacterial lysate OM-85 on established AD.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161555PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363804PMC
August 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

A randomized, controlled trial of oral propranolol in infantile hemangioma.

N Engl J Med 2015 Feb;372(8):735-46

The authors' affiliations are listed in the Appendix.

Background: Oral propranolol has been used to treat complicated infantile hemangiomas, although data from randomized, controlled trials to inform its use are limited.

Methods: We performed a multicenter, randomized, double-blind, adaptive, phase 2-3 trial assessing the efficacy and safety of a pediatric-specific oral propranolol solution in infants 1 to 5 months of age with proliferating infantile hemangioma requiring systemic therapy. Infants were randomly assigned to receive placebo or one of four propranolol regimens (1 or 3 mg of propranolol base per kilogram of body weight per day for 3 or 6 months). A preplanned interim analysis was conducted to identify the regimen to study for the final efficacy analysis. The primary end point was success (complete or nearly complete resolution of the target hemangioma) or failure of trial treatment at week 24, as assessed by independent, centralized, blinded evaluations of standardized photographs.

Results: Of 460 infants who underwent randomization, 456 received treatment. On the basis of an interim analysis of the first 188 patients who completed 24 weeks of trial treatment, the regimen of 3 mg of propranolol per kilogram per day for 6 months was selected for the final efficacy analysis. The frequency of successful treatment was higher with this regimen than with placebo (60% vs. 4%, P<0.001). A total of 88% of patients who received the selected propranolol regimen showed improvement by week 5, versus 5% of patients who received placebo. A total of 10% of patients in whom treatment with propranolol was successful required systemic retreatment during follow-up. Known adverse events associated with propranolol (hypoglycemia, hypotension, bradycardia, and bronchospasm) occurred infrequently, with no significant difference in frequency between the placebo group and the groups receiving propranolol.

Conclusions: This trial showed that propranolol was effective at a dose of 3 mg per kilogram per day for 6 months in the treatment of infantile hemangioma. (Funded by Pierre Fabre Dermatologie; ClinicalTrials.gov number, NCT01056341.).
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http://dx.doi.org/10.1056/NEJMoa1404710DOI Listing
February 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

Generalized lymphedema associated with neurologic signs (GLANS) syndrome: a new entity?

J Am Acad Dermatol 2015 Feb 4;72(2):333-9. Epub 2014 Dec 4.

University François Rabelais, Tours, France; Department of Dermatology, Centre Hospitalier Régional Universitaire, Tours, France; Inserm U930, Tours, France. Electronic address:

Background: Primary lymphedema in children, especially generalized disease with facial involvement, is rare.

Objective: We sought to report 3 childhood cases of lymphedema with associated neurologic findings and to provide a pathophysiologic explanation for this association.

Methods: Clinical observations, electroencephalography, and neuroimaging studies were evaluated. Microcomparative genomic hybridization was performed in 1 case.

Results: The 3 children had primary lymphedema of all 4 limbs and the face. This was confirmed by lymphoscintigraphy, which showed hypoplasia of vessels and hypofixation of lymph nodes. They had nonspecific neurologic disorders and electroencephalography abnormalities, without intellectual deficit. Neuroimaging revealed normal findings. Microcomparative genomic hybridization in 1 patient revealed no cytogenetic anomaly. The outcome was fatal in 1 case with development of visceral lymphedema and coma.

Limitations: Genetic studies were performed in only 1 case.

Conclusion: These observations suggest that neurologic assessment and electroencephalography are indicated for patients with lymphedema of the limbs and face to identify this syndrome.
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http://dx.doi.org/10.1016/j.jaad.2014.10.033DOI Listing
February 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

The role of in vivo confocal microscopy in the diagnosis of eyelid margin tumors: 47 cases.

J Am Acad Dermatol 2014 Nov 3;71(5):912-918.e2. Epub 2014 Jul 3.

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

Background: Handheld in vivo reflectance confocal microscopy (IVCM) is a new imaging method that allows noninvasive diagnosis of cutaneous tumors but to date it has not been used in the study of eyelid tumors.

Objective: We sought to evaluate the suitability of IVCM for eyelid margin tumors.

Methods: We prospectively evaluated the IVCM features of 47 eyelid margin lesions, clinically suspicious of malignancy; 35 of these were excised whereas the other 12, with no IVCM malignant features, were followed up for at least 1 year. Clinical, IVCM, and histologic diagnoses were compared.

Results: IVCM showed sensitivity and specificity of 100% and 69.2%, respectively, for malignancy (basal cell carcinoma, squamous cell carcinoma, and melanoma). The follow-up of the 12 nonexcised lesions did not show any clinical progression.

Limitations: The lesions showing neither clinical nor IVCM features for malignancies were not biopsied in view of the potential functional and aesthetic consequences of eyelid margin surgery.

Conclusion: Used with a handheld dermatology-specific microscope, IVCM can play a role in the noninvasive diagnosis of eyelid margin lesions. Further studies are needed to better define diagnostic criteria of eyelid tumors and improve the specificity of this technique.
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http://dx.doi.org/10.1016/j.jaad.2014.05.060DOI Listing
November 2014

In vivo reflectance confocal microscopy to optimize the spaghetti technique for defining surgical margins of lentigo maligna.

Dermatol Surg 2014 Mar 21;40(3):247-56. Epub 2014 Jan 21.

Department of Maxillofacial and Plastic Surgery, University Hospital of Saint Étienne, Saint-Étienne, France; Faculty of Medicine, University of Saint-Étienne, Saint-Étienne, France.

Background: Lentigo maligna (LM) is a therapeutic challenge for surgeons because of its location in aesthetic areas and the difficulty in determining margins.

Objective: To investigate a new procedure combining the "spaghetti" technique described by Gaudy-Marqueste and colleagues in 2011 with in vivo reflectance confocal microscopy (RCM) to define the margins of LM more accurately and allow strict histologic control.

Methods And Materials: Thirty-three consecutive patients with LM of the head underwent a RCM-guided delineation of the margins followed by the "spaghetti" technique.

Results: The excision of the first "spaghetti" in a tumor-free area was obtained in 28 of 33 patients. In the other five cases, persistence of LM foci was found in <5% of the length of spaghetti. The average number of pieces of "spaghetti" was 1.2 (range 1-3). Definitive histologic examination of the lesion showed a minimum average margin of 2.7 mm. Follow-up in 27 patients after an average of 10 months (range 4-25 months) did not show any recurrence.

Conclusion: This procedure allows accurate definition of the surgical margins of LM, with a low rate of multiple excisions, sparing tissue in functional and aesthetic areas. These results should be confirmed on the basis of a larger series with longer follow-up.
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http://dx.doi.org/10.1111/dsu.12432DOI Listing
March 2014

Yellow globules in balloon cell naevus.

Australas J Dermatol 2013 Nov 29;54(4):268-70. Epub 2012 Nov 29.

Dermatology, Hôpital Nord, Saint Etienne Cedex 2, France.

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http://dx.doi.org/10.1111/ajd.12006DOI Listing
November 2013

Anal melanosis diagnosed by reflectance confocal microscopy.

Australas J Dermatol 2014 Nov 5;55(4):286-8. Epub 2013 Sep 5.

Dermatology Department, University Hôpital of Saint Etienne, Saint Etienne, France.

Until now, in vivo reflectance-mode confocal microscopy (IVCM) has been applied only to pigmented lesions of the vulvar and oral mucosa, but not to anal mucosa lesions. We present the first case in which IVCM has been used to diagnose anal melanosis. Clinical and dermoscopic features were of concern while IVCM found the draped pattern already described for genital melanosis. IVCM adds information to the clinical and dermatoscopic examination and allows skin biopsies to be avoided. Further studies are needed to define the IVCM features of anal melanosis and to compare the performance of IVCM with the findings of histological examinations.
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http://dx.doi.org/10.1111/ajd.12096DOI Listing
November 2014

Laser photodynamic treatment for in situ squamous cell carcinoma of the glans monitored by reflectance confocal microscopy.

Australas J Dermatol 2014 Feb 8;55(1):72-4. Epub 2013 May 8.

Department of Dermatology, University Hôpital of Saint Etienne, Saint Etienne, France.

While mutilating surgery can be avoided with non-surgical treatment of in situ squamous cell carcinoma (SCC) of the penis, such as photodynamic therapy (PDT), this procedure is not followed by histological evaluation to verify the total removal of the lesion, leading to possible recurrence. We present the first case of in situ penile SCC treated with laser PDT, where the efficacy of the treatment was monitored by reflectance confocal microscopy (RCM) using a handheld camera. In the future RCM may be regarded as a complementary technique to assess the efficacy of non-surgical treatment of mucous membrane cancers.
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http://dx.doi.org/10.1111/ajd.12052DOI Listing
February 2014

Optical diagnosis of a metabolic disease: cystinosis.

J Biomed Opt 2013 Apr;18(4):046013

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

Nephropathic cystinosis (NC) is a rare autosomal recessive storage disease characterized by the lysosomal accumulation of cystine crystals throughout the body, particularly in blood cells, the cornea, skin, kidneys, the central nervous system, and the muscles. The skin and the cornea are the most accessible sites to explore, and in vivo reflectance confocal microscopy (IVCM) helps identify crystals in both but does not provide any information to help define their composition. Raman spectroscopy (RS) allows cystine to be easily recognized thanks to its characteristic signature with a band at 499 cm⁻¹. Two dermatology confocal microscopes were used to visualize crystals in both the skin and the ocular surface of a cystinosis patient, and an ex vivo Raman examination of a skin biopsy and of the cornea was performed and removed during a corneal graft to confirm the cystine composition of the crystals. Recently, RS has been performed in vivo and coupled with IVCM. In the future, it is suggested that crystals in NC and other deposits in storage diseases could be identified with this noninvasive in vivo technique that combines IVCM to recognize the deposits and RS to confirm their chemical nature.
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http://dx.doi.org/10.1117/1.JBO.18.4.046013DOI Listing
April 2013

Characterization of cutaneous foreign bodies by Raman spectroscopy.

Skin Res Technol 2013 Nov 22;19(4):508-9. Epub 2013 Mar 22.

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

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http://dx.doi.org/10.1111/srt.12065DOI Listing
November 2013