Porocarcinoma is a very rare malignant tumor arising from the duct of eccrine sweat glands. Its prognosis is variable. We report on a patient who developed lymph node and multiple distant metastases, and who died of this malignancy only 6 months after the initial diagnosis.

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Objective: To examine the effects of topical therapy with Mahonia aquifolium on the expression of pathogenetically relevant molecules in psoriatic skin by immunohistochemistry. Study Design: Prospective-randomized, half-side comparison study with subsequent immunohistochemical assessment of biopsies. Methods: The study areas were treated with Mahonia aquifolium ointment 3( daily and with dithranol in rising concentrations 1( daily, respectively. Biopsies of lesional skin from the test areas were carried out in 49 patients a) prior to therapy and b) 4 weeks after the start of therapy. Immunohistochemical stainings were performed with the following monoclonal antibodies: anti-ICAM-1, -CD3, -HLA-DR, -keratin 6, -keratin 16, -Ki-67. Evaluation of staining was made by two independent examiners using established semiquantitative scores. Results: Marked staining with all of the cited monoclonal antibodies was observed in the lesional skin prior to therapy. After 4 weeks of therapy there was a marked reduction in the expressions of ICAM-1, CD 3, HLA-DR and keratin 6 and 16. There were significantly greater reductions of ICAM-1, CD3, and HLA-DR at sites treated with dithranol. The expression of Ki-67 was not reduced by either therapy. Conclusions: These results indicate efficacy of Mahonia aquifolium and dithranol in psoriatic skin both on cellular cutaneous immune mechanisms and on the hyperproliferation of keratinocytes. The effect of dithranol appears to be more potent than that of Mahonia aquifolium.

Previous in vitro studies have shown CD44 isoforms containing the alternatively spliced exon v3 (CD44v3) to be modified with heparan sulphate (HS) and to bind HS-binding basic fibroblast growth factor (bFGF). Here, we demonstrate that exogenously added bFGF is also bound in vivo by CD44v3-positive keratinocytes in normal skin and by tumour cells in basal cell carcinoma and squamous cell carcinoma (SCC), two skin cancers of keratinocyte origin. bFGF binding and CD44v3 expression were colocalized in cultured human normal keratinocytes (HNK) and on the SCC cell line A431. By contrast, benign or malignant tumours of melanocyte origin failed to express CD44v3 and bound no bFGF. The bFGF binding to normal or transformed keratinocytes in vivo and in vitro was dependent on HS modification, as it was completely eliminated by pretreatment with heparitinase or by blocking with free heparin, whereas chondroitinase had no effect. In addition, specific removal of CD44v3 by antibody-induced shedding also diminished bFGF binding to keratinocytes. Furthermore, bFGF stimulated the proliferation of CD44v3-positive HNK and A431 in a dose-dependent fashion. This bFGF effect was again completely abolished by heparitinase or free heparin, but not by chondroitinase. In aggregate, our results suggest that a function of HS-modified CD44 isoforms such as CD44v3 in skin is to present the HS-binding growth factor bFGF, thereby stimulating the proliferation of normal or transformed keratinocytes.

Background: Several studies indicate that the prognosis of malignant melanoma (MM) can be improved if tumor progression, e.g. local recurrences and lymph node metastases, is detected at an early stage. Thus, instructed self-examination by the patients is recommended in aftercare. Although clinical experience shows that many patients do not sufficiently perform self-examination, no studies have so far focused on self-examination behavior. Objective: 1) To assess the self-examination behavior of patients with MM in aftercare, 2) to investigate factors that could explain the self-examination behavior. Methods: Cross-sectional study on 324 patients with MM in aftercare. Validated questionnaires evaluating the disease-related strain, coping with illness, and behavior and attitudes towards self-examination were handed to the patients. Results: 62% of the patients consider self-examination important. However, the operation site and pigmented lesions are inspected on a regular basis by only 29.6% of the patients, the lymph nodes are regularly self-examined by 9.9% of the patients. 73.2% of the patients claim that they have not been instructed by the physicians how to perform self-examinations. Patients who had been instructed in self-examinations rated the importance of self-examinations significantly higher. In this group, the frequency of self-examinations correlated with prognostic markers such as tumor depth and Clark level. By contrast, in the group of patients who had not been instructed, the frequency of self-examinations correlated with psychosocial strain. Conclusions: Although self-examinations in the aftercare are of considerable importance, most patients are not instructed and are not used to performing self-examinations. Patients who had been instructed show a more adequate and reasonable self-examination behavior.