Although the imputability of TNF blockers in paradoxical HS is still debatable, further research and observation are needed to confirm and distinguish patients with genetic and clinical predisposition in the onset or exacerbation of HS during anti-TNF treatment.

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BackgroundSince the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of SLNB for melanoma.MethodsA single center observational cohort of 203 melanoma patients with a primary cutaneous melanoma (tumour thickness > 1 mm) and without clinical evidence of metastasis was investigated from 2002 to 2009. Head and neck melanoma were excluded. SLN was identified following preoperative lymphoscintigraphy and intraoperative gamma probe interrogation.ResultsThe SLN identification rate was 97%. The SLN was tumor positive in 44 patients (22%). Positive SLN was significantly associated with primary tumor thickness and microscopic ulceration. The median follow-up was 39.5 (5–97) months. Disease progression was significantly more frequent in SLN positive patients (32% vs 13%, p = 0.002). Five-year DFS and OS of the entire cohort were 79.6% and 84.6%, respectively, with a statistical significant difference between SLN positive (58.7% and 69.7%) and SLN negative (85% and 90.3%) patients (p = 0.0006 and p = 0.0096 respectively). Postoperative complications after SLNB were observed in 12% of patients.ConclusionOur data confirm previous studies and support the clinical usefulness of SLNB as a reliable and accurate staging method in patients with cutaneous melanoma. However, the benefit of additional CLND in patients with positive SLN remains to be demonstrated.

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abnormality in DCS. Although the function of the CLE is still unclear, a role as a necessary scaffold for the lamellar bilayer organization is likely (Uchida and Holleran, 2008). Thus, CLE deficiency, coupled with disorganization of extracellular lamellar bilayers, likely merge to provoke the barrier abnormality in NLSDI (see Supplementary Figure S2 online). Finally, to overcome this metabolic disadvantage in forming the epidermal permeability barrier, epidermal proliferation likely increases, which in turn results in hyperkeratosis, phenotypic features common to virtually all of the ichthyoses (Demerjian et al., 2006; Akiyama et al., 2008), that is, 'A compromised permeability barrier 'drives' the hyperproliferative epidermis in NLSDI and other ichthyoses' (Elias et al., 2008).