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Tanja Tirnanić, Dimitrije Brašanac and Lidija Kandolf Sekulović

Abstract

The term “nevi of special sites” refers to melanocytic nevi of specific anatomic locations including the breast, axillae, umbilicus, genitalia, flexural areas, acral surfaces, ear, scalp and the conjunctiva. Nevi from these anatomic sites display sometimes dermoscopic and histological features of melanoma, resulting in unnecessarily high rates of excisions and re-excisions. Some authors have categorized nevi excised in the axillary, breast, umbilical and perineal areas as the nevi of the milk line. Two patients, a 32-year-old female and 23-year-old male with breast and periumbilical pigmented lesions, presented to our Department during 2017. Dermoscopy revealed features that were highly specific for melanoma. Excisional biopsies were done and histopathology revealed benign nevi with present site-related atypia. Irregular blotches, non-uniform radial streaks, blue-gray veil, and regression are the most specific features of melanoma of the breast and flexural areas. Excision is always recommended in pigmented lesions on the breast and flexural areas, which exhibit these features. However, larger studies are needed to define specific criteria required to distinguish special-site nevi from melanoma.

Open access

Tanja Tirnanić, Kristina Kostić, Lidija Kandolf Sekulović and Radoš Zečević

Abstract

Chronic urticaria is defined as daily or intermittent appearance of hives for more than 6 weeks. Patients with more severe forms of the disease have increased needs for immune modifying agents for disease control, and among these cyclosporine is the mainstay of treatment. Material and Methods: This retrospective study included patients treated for chronic urticaria from 2009 - 2016 at the Department of Dermatology of the Military Medical Academy. Results: There were 145 treated patients, of whom 20 (13.8%) were resistant to at least two lines of treatment (maximum dose of antihistamine monotherapy, combination of antihistamines, addition of dapsone and short courses of corticosteroids). The patients were treated with cyclosporine (6 males and 14 females; average age 40.05 years). Median duration of treatment was 6 months (range: 2 - 17). In 9 (45%) patients, cyclosporine treatment led to a complete response, in 3 (15%) occasional urticarial plaques developed in spite of treatment, while in 2 (10%) urticaria was resistant to cyclosporine treatment, with continuous disease activity. During the follow-up period, 20% of patients experienced adverse effects. Conclusion: In conclusion, 13.8% of patients were resistant to first-line standard treatment. In these patients, cyclosporine can be regarded as a safe and effective treatment modality, with relatively short course of treatment, but 10% of patients can be regarded as treatment resistant and around 20% experience adverse effects, pointing to the need for further treatment options, including omalizumab.

Open access

Milena Micković, Miroslav Dinić, Tanja Tirnanić, Olga Radić Tasić, Tatjana Terzić, Lidija Kandolf Sekulović and Aleksandar Mikić

Abstract

Primary cutaneous CD4-positive small- to medium-sized pleomorphic T-cell lymphoma is a provisional entity in the 2005 WHO-EORTC classification for cutaneous lymphomas. It is a rare condition and, in most cases, it has a favorable clinical course and prognosis. Primary cutaneous CD4-positive small/medium pleomorphic T-cell lymphoma (PCSM-TCL) is defined as a cutaneous T-cell lymphoma with predominantly small- to medium-sized CD4-positive pleomorphic T-cells without a history of patches and plaques typical of mycosis fungoides. PCSM-TCL usually presents as a solitary plaque or tumor on the head, neck, trunk or upper extremities and it is considered to have indolent clinical behavior. Histologically, it is characterized by a dense infiltration of small/medium-sized pleomorphic T-cells that involves the entire dermal thickness, often with nodular extension into the hypodermis. Using immunohistochemical staining, the majority of the reported cases proved to be CD3, CD4 positive and CD8, CD30 negative. However, due to the rarity and heterogeneity of the PCSM-TCL, precise clinicopathologic characteristics of PCSM-TCL have not been well characterized and the optimal treatment for this group of lymphomas is yet to be defined. Dermatologists and pathologists should be aware of this entity in order to avoid unnecessary aggressive treatments.

Here we present a 30-year-old man with a solitary lesion on the scalp with histopathological features corresponding to PCSM-TCL. After surgical excision, the patient has been disease-free so far, with no additional therapy used to the present day with regular checkups.