Clinical and dermatoscopic diagnosis of early amelanotic melanoma

Amelanotic cutaneous melanoma (ACM) often defies clinical diagnosis because of the lack of pigmentation. In an attempt to find diagnostic clues, we retrospectively studied the clinical features of 15 thin (< 1 mm thick or Clark level I) ACM lesions. The clinical features of early ACMs are identified and illustrated to enable early diagnosis and cure of these lesions. The typical early lesion presents as an asymmetric macula, which may be uniformly pinkish or reddish or, more often, has faint light pigmentation (tan, brown or grey) at the periphery; it has borders that may be well- or ill-defined. In our study, these features suggested the correct clinical diagnosis in only a minority (40%) of cases. Nine cases in this series were also subjected to dermatoscopy. By this technique we identified, as constant feature, the presence of small red dots, evenly distributed or grouped on a whitish or pink-red background. Our results show the importance of dermatoscopy in the evaluation of equivocal pink or reddish lesions. Red dots seen with this technique can be an important sign for the diagnosis of thin ACM. Since this sign does not appear to be pathognomonic, the presence of an associated pigmentary network can be decisive in the differential diagnosis.     

Outcome of biliopancreatic diversion in subjects with Prader-Willi Syndrome

Background: In Prader-Willi Syndrome (PWS), mental retardation and compulsive hyperphagia cause early obesity, the co-morbidities of which lead to short life-expectancy, with death usually occurring in their 20s. Long-term weight loss is mandatory to lengthen the survival; therefore, the lack of compliance in voluntary food restriction requires a surgical malabsorptive approach. Methods: 15 PWS subjects were submitted to biliopancreatic diversion (BPD) and followed (100%) for a mean period of 8.5 (4-13) years. BPD consists of a distal gastrectomy with a long Roux-en-Y reconstruction which, by delaying the meeting between food and biliopancreatic juices, causes an intestinal malabsorption. Indication for BPD was BMI >40 or >35 with metabolic complications. Preoperative mean age was 21±5 years, mean weight 127±26 kg, and mean Body Mass Index (BMI, kg/m²) 53±10. According to Holm's criteria, all of the subjects had a total score ≥8. IQ assessment was performed in each subject, with a mean score of 72±10. An arbitrary lifestyle score was given to each subject. Results: No perioperative complications were observed. Percent excess weight loss (%EWL) was 59±15 at 2 years and 56±16 at 3 years, and then progressive regain occurred; at 5 years %EWL was 46±22 and at 10 years 40±27. Spearman rank test failed to demonstrate any correlation between weight loss at 5 years and patient data, except with lifestyle score (Spearman r=0.8548, p<.0001). Current mean age is 31±7 years. Conclusion: BPD has to be considered for its value in prolonging and qualitatively improving the PWS patient's life.