Locoregional cutaneous metastases of melanoma (LCMM) represent a therapeutic challenge. Many treatment options are available with varying results. The combination of cryotherapy and imiquimod, two treatments with a possible synergistic effect, has not yet been described for treating this disease. In this paper, we aimed to show the response of LCMM to cryotherapy combined with topical imiquimod 5%. A retrospective review of 20 patients diagnosed with LCMM and treated with cryotherapy combined with topical imiquimod 5% between November 2000 and May 2014 at three institutions was performed. The locoregional cutaneous response was evaluated. After a mean of five sessions, 13 patients (65%) responded to treatment, eight (40%) of these completely and five (25%) partially. Systemic disease progressed in 16 (80%) patients. Cryotherapy followed by topical imiquimod 5% is simple to apply, has minimal adverse effects and provides response rates similar to other, more complex treatment options.

Background: Treatment of oral erosive lichen planus is considered a therapeutic challenge. Various systemic and topical agents aimed at controlling the symptoms, rather than curing the lesions, have been used with varying results. Objective: To evaluate the response to treatment with antimalarial drugs in patients with oral erosive lichen planus. Methods: Eight patients diagnosed with oral erosive lichen planus were treated with antimalarial agents. The first clinical evaluation was made after a month of treatment and then every 2-3 months. Baseline ophthalmologic examinations were performed, and laboratory values were monitored before and during treatment. Results: All studied patients who had previously been resistant to other treatments responded favorably. Pain relief and reduced erythema and erosions were observed after of a mean of 2.4 months. Conclusion: Antimalarials may be useful for the treatment of oral erosive lichen planus. They are easily administered and affordable, with few adverse effects.

Dear Editor, Various cutaneous adverse effects have been described with the use of vascular endothelial growth factor (VEGF) inhibitors; among them, are ulcerative lesions located on striae distensae. 1,2 We report a case of ulcerations that were exclusively localized on the abdominal wound scar of a patient treated with aflibercept.A 63-year-old man was treated with surgical resection and chemotherapy with aflibercept for a metastatic colorectal cancer. One month after starting chemotherapy treatment (and 9 months after surgery), he rapidly developed focal skin necrosis on an abdominal wound scar ( Fig. 1a,b); the lesions did not improve despite local wound care using non-stick dressings. A skin biopsy showed epidermal hyperplasia and dermal fibrosis. Vascular proliferation in the upper dermis and a mild inflammatory infiltrate composed of lymphocytes, eosinophils and neutrophils between vessels were observed. In the deep dermis, there was a focus of fibrinoid necrosis of collagen not related to vascular structures (Fig. 1c,d). Treatment was discontinued 13 months later because the patient developed several infections, which did not allow him to complete the therapeutic regimen. The ulcerations healed spontaneously a month after stopping the drug. Therapy was reintroduced 5 months later, resulting in the recurrence and extension of necrotic areas that remained limited to the scar.Angiogenesis is an essential process for growth, invasion and metastasis in many solid tumors. Inhibition of this pathway has emerged as an important target in cancer drug development. Aflibercept acts as a soluble trap to the VEGF and is thus a potent angiogenesis inhibitor. It is a fusion protein (a) (c) (b) (d) Figure 1. (a,b) Ulcerations strictly localized on abdominal wound scar. (a) Periumbilical and (b) hypogastrium. (c,d) Histological examination of the lesion. Epidermal hyperplasia and dermal fibrosis. Vascular proliferation in the (c) upper dermis and (d) fibrinoid necrosis of collagen not related to vascular structures in the deep dermis (hematoxylin-eosin, original magnifications: [c] 940; [d] 9200).

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