F Grange

Centre Hospitalier Universitaire de Reims, Rheims, Champagne-Ardenne, France

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Publications (154)442.7 Total impact

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    ABSTRACT: Background The BRAF inhibitors vemurafenib and dabrafenib have shown efficacy as monotherapies in patients with previously untreated metastatic melanoma with BRAF V600E or V600K mutations. Combining dabrafenib and the MEK inhibitor trametinib, as compared with dabrafenib alone, enhanced antitumor activity in this population of patients. Methods In this open-label, phase 3 trial, we randomly assigned 704 patients with metastatic melanoma with a BRAF V600 mutation to receive either a combination of dabrafenib (150 mg twice daily) and trametinib (2 mg once daily) or vemurafenib (960 mg twice daily) orally as first-line therapy. The primary end point was overall survival. Results At the preplanned interim overall survival analysis, which was performed after 77% of the total number of expected events occurred, the overall survival rate at 12 months was 72% (95% confidence interval [CI], 67 to 77) in the combination-therapy group and 65% (95% CI, 59 to 70) in the vemurafenib group (hazard ratio for death in the combination-therapy group, 0.69; 95% CI, 0.53 to 0.89; P = 0.005). The prespecified interim stopping boundary was crossed, and the study was stopped for efficacy in July 2014. Median progression-free survival was 11.4 months in the combinationtherapy group and 7.3 months in the vemurafenib group (hazard ratio, 0.56; 95% CI, 0.46 to 0.69; P<0.001). The objective response rate was 64% in the combinationtherapy group and 51% in the vemurafenib group (P<0.001). Rates of severe adverse events and study-drug discontinuations were similar in the two groups. Cutaneous squamous-cell carcinoma and keratoacanthoma occurred in 1% of patients in the combination-therapy group and 18% of those in the vemurafenib group. Conclusions Dabrafenib plus trametinib, as compared with vemurafenib monotherapy, significantly improved overall survival in previously untreated patients with metastatic melanoma with BRAF V600E or V600K mutations, without increased overall toxicity. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT01597908.)
    New England Journal of Medicine 11/2014; · 54.42 Impact Factor
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    ABSTRACT: Background Head and neck melanomas (HNM) account for an increasing proportion of melanomas and have a poor prognosis. Few population-based studies have focused on specific characteristics of these tumors.Objectives To compare clinical and histological characteristic of HNM with those of melanomas at other sites (MOS) and identify pertinent clinico-pathological subgroups of HNM.Materials and methodsWe performed a retrospective population-based study of incident in situ and invasive melanomas during 2004-2011, using the Champagne-Ardenne regional registry and questionnaires to physicians.ResultsHNM represented 26.7% of 1,548 melanomas, corresponding to a density ratio of 3.7 between HNM and MOS. HNM occurred later than MOS (71.2 vs 58.4 years, p<0.0001), included a higher proportion of in situ cases (49.6% vs 13.5%, p<0.0001) and were mainly lentigo malignant melanomas (73% vs 2.6%, p<0.0001). Invasive HNM, however, included a higher proportion of thick (>2 mm) tumors (33.7% vs 24.1%, p=0.009; mean Breslow thickness: 2.18 vs 1.77 mm, p=0.03), and of nodular melanomas (20.1% vs 12%, p=0.007). HNM occurring in the peripheral area of the head and neck differed from those of central location by a younger age of onset (65.2 vs 72.4 years, p<0.0001), a male predominance (64.4% vs 33.8%, p<0.0001) and higher proportions of invasive (67.2% vs 42%, p<0.0001) and nodular (15.1% vs 7.5%, p=0.01) melanomas.ConclusionHNM highly differ from MOS and are clinically and histologically heterogeneous, possibly as a consequence of different patterns of sun-exposure. These data could help to improve primary and secondary prevention messages towards patients and doctors.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 10/2014; · 3.76 Impact Factor
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    ABSTRACT: The activating mutation of MYD88 L265P is a frequent feature of primary cutaneous diffuse large B-cell lymphoma, leg-type (PCLBCL-LT), reported in up to 69% of the cases. Whether patients with MYD88 mutation display specific clinical and evolutive features has not been evaluated.
    JAMA dermatology. 07/2014;
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    ABSTRACT: Background: Recently, a consensus Bullous Pemphigoid Disease Area Index (BPDAI) was proposed to measure therapeutic outcomes in bullous pemphigoid (BP). Objective: To compare BPDAI with other clinical parameters of disease activity at baseline and to describe the variations of BPDAI during the initial phase of treatment. Methods: Thirty BP patients were included and followed for 1 year. BPDAI was assessed at baseline and on days 30, 90 and 360 by the same investigator. Concomitantly, the number of daily new blisters, the skin surface area of erythematous/eczematous/urticarial plaques and blisters/erosions, total lesion area (TLA), pruritus score and mucosal involvement were recorded. Results: At baseline, BPDAI was 46.7 ± 25 (mean ± SD); it was well correlated with erythematous/eczematous/urticarial skin surface (r = 0.63), TLA (r = 0.83), number of daily new blisters (r = 0.7; p ≤ 0.0002) and anti-BP180 autoantibodies (r = 0.49; p = 0.006), but not with anti-BP230 autoantibodies. For the 8 patients with severe BP at baseline, the mean BPDAI was 76.5, versus 35.9 for moderate BP (p = 0.0007). A value of 56 was proposed as a cut-off value for severe BP. BPDAI decreased to 11.9 ± 8.7, 10.7 ± 12.7 and 2.5 ± 4.1 on days 30, 90 and 360, respectively. Conclusion: BPDAI rapidly decreased during the early treatment stage of BP with variations almost totally conditioned by the skin activity component. © 2014 S. Karger AG, Basel.
    Dermatology (Basel, Switzerland). 07/2014;
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    ABSTRACT: Background Identification of differences in melanoma location between genders could lead to sex-adapted preventive measures.Objective To compare precise melanoma location and side in men and women.Method Location of 1542 incident melanomas diagnosed during 2004-2011 in the French Champagne-Ardenne region (1.3 million inhabitants) was recorded using a regional registry and questionnaires to physicians. Men and women were compared for frequency of tumors on the head and neck; trunk; upper limb; lower limb; hand and foot. For each location, more precise sub-locations were recorded. The laterality (right versus left) was studied for head/neck and limb tumors.ResultsMelanomas predominated on the lower limb in women (32.2% vs 9.3% in men, p<0.001), on the trunk in men (41.8% vs 14.9%, p<0.001), while the proportion of upper limb and head/neck tumors was similar in both genders. Hand and foot melanomas predominated in women (10.3% vs 6.3%, p=0.005), with a sex-related distribution between sub-locations. Within the head and neck location, 75.1% of tumors in women were located in the central area, versus 53.7% in the peripheral area in men (p<0.001). Head/neck melanomas were more frequently right-sided in women and left-sided in men (p=0.04), the left/right ratio reaching 1.58 in men vs 0.61 in women for peripheral tumors (p<0.01). No difference in laterality was observed for other locations.Conclusions Sex differences in occupational and leisure-time UV-exposure, clothing (including shoes), hairstyle, and side and photo-exposure in cars could explain these results. General preventive messages could be completed by sex-specific advices for melanoma prevention.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 04/2014; · 3.76 Impact Factor
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    ABSTRACT: IMPORTANCE Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT), occurs in elderly patients and has been considered as a lymphoma with a poor prognosis, with estimated 5-year specific survival rates of approximately 50%. The hypothesis of an improvement in prognosis over time has not been studied. OBJECTIVES To evaluate this hypothesis in a large series of patients and investigate factors associated with prognosis as well as improvement in the prognosis. DESIGN, SETTING, AND PARTICIPANTS A retrospective multicenter study was conducted including dermatology departments belonging to the French Study Group on Cutaneous Lymphoma. Participants were 115 patients with PCDLBCL-LT diagnosed between 1988 and 2003 (period 1) or between 2004 and 2010 (period 2). MAIN OUTCOMES AND MEASURES Age, sex, period of diagnosis, number of skin lesions, tumor stage, tumor location (leg vs nonleg), lactate dehydrogenase level, type of therapy (with or without a combination of rituximab and polychemotherapy [PCT]), and outcome were recorded. Baseline characteristics and outcome were compared according to period of diagnosis and type of therapy. Prognosis factors were identified by univariate and multivariate survival analyses. RESULTS The mean age of the patients was 76.9 years, and 47% of the patients were older than 80 years. The 3- and 5-year specific survival rates improved between period 1 and period 2, from 55% to 74% and from 46% to 66%, respectively (P = .01). Patients had similar baseline characteristics during both periods, but rituximab-PCT regimens were administered to 88.5% of the patients in period 2 vs 16.7% in period 1 (P < .001). The 3- and 5-year specific survival rates were 80% and 74%, respectively, in patients who received a rituximab-PCT regimen compared with 48% and 38% in those who received less-intensive therapies. No significant difference was observed between both groups in age and baseline prognostic factors. In multivariate analysis, treatment without rituximab-PCT was the only adverse prognostic factor (odds ratio, 4.6 [95% CI, 2.4-9.1]; P < .001), whereas the number of skin lesions (P = .06) and location on the leg (P = .07) had only borderline significance. CONCLUSIONS AND RELEVANCE A major improvement in the survival of patients with PCDLBCL-LT has occurred over time in France, mainly as a result of the use of intensive rituximab-PCT regimens in most patients, including very elderly ones. Until further prospective clinical trials are conducted, such regimens should be considered as the standard of care in these patients.
    JAMA dermatology. 03/2014;
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    ABSTRACT: Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are the two main subtypes of auto-immune pemphigus, each having different clinical, histological and immunopathological features. We report the case of a patient initially with typical PV who relapsed within 2years, presenting clinically, histologically and immunologically typical PF. A 47-year old man presented in March 2008 with clinically, histologically and serologically typical PV and treated with systemic corticosteroids alone (prednisone: 1mg/kg per day) then combined with a cycle of rituximab, which resulted in complete remission. After discontinuation of therapy (duration: 26months), he relapsed 6 months later with PF presenting clinical, histological and serological characteristics typical of this condition. This is a rare case of complete transition from PV to PF in clinical, histological and serological terms, and the first case occurring after initial treatment with rituximab.
    Annales de Dermatologie et de Vénéréologie 12/2013; 140(12):788-92. · 0.60 Impact Factor
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    ABSTRACT: IMPORTANCE Although predisposing factors for bullous pemphigoid (BP) have been recently established, no clinical or immunologic factors have yet been identified to predict disease outcome. OBJECTIVE To identify risk factors for BP relapse during the first year of treatment. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective study of 120 consecutive patients with newly diagnosed BP in 8 French dermatology departments. Baseline and 6 follow-up visits were planned to record disease activity and collect blood samples for measurement of serum anti-BP180 and anti-BP230 levels by means of enzyme-linked immunosorbent assay (ELISA). MAIN OUTCOMES AND MEASURES The end point was clinical relapse within the first year of therapy. Associations of clinical and immunologic (including serum levels of anti-BP180 and anti-BP230 autoantibodies) parameters with clinical relapse were assessed using univariate and multivariate analyses. RESULTS During the 1-year follow-up, 35 patients (29.2%) experienced relapse, whereas anti-BP180 and anti-BP230 ELISA results were similar at baseline between patients who did and did not experience relapse. Factors at baseline independently associated with relapse were extensive disease at inclusion (hazard ratio [HR], 2.37 [95% CI, 1.2-4.8]) and an associated dementia (HR, 2.09 [95% CI, 1.0-4.2]). Use of superpotent topical corticosteroids alone (by 100 patients [83.3%]) induced a dramatic, early decrease in serum levels of anti-BP180 and anti-BP230 autoantibodies. Mean early decreases in autoantibody levels between baseline and day 60 were lower in patients with relapse compared with patients with ongoing remission (-10.0% and -45.2%, respectively, for anti-BP180 levels [P < .001] and -11.8% and -35.4%, respectively, for anti-BP230 levels [P = .046]). A higher serum level of anti-BP180 at day 150, with a cutoff of 23 U/mL, provided 84.2% sensitivity, 44.8% specificity, 33.3% positive predictive value, and 89.7% negative predictive value for the occurrence of relapses between days 150 and 360. CONCLUSIONS AND RELEVANCE The pronounced decrease in the level of anti-BP180 autoantibodies and, to a lesser extent, those directed against BP230 confirmed the use of superpotent topical corticosteroids alone as a reference BP treatment. Furthermore, our study suggests that neurological diseases play a major role in BP, not only as a predisposing but also as a prognostic factor.
    JAMA dermatology (Chicago, Ill.). 11/2013;
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    ABSTRACT: Primary cutaneous large B-cell lymphoma, leg type has been individualized from nodal diffuse large B-cell lymphoma. The objective of this study was to screen primary cutaneous large B-cell lymphoma, leg type for genetic alterations recently described in nodal diffuse large B-cell lymphoma. Skin biopsies from 23 patients were analyzed for IRF4, BCL2, BCL6, and MYC expression. FISH testing was performed for BCL2, BCL6, MYC with separation probes and for CDKN2A and PRDM1/BLIMP1 deletion. Multiple sequential FISH analyses with up to six probes were performed to define samples with multiple cytogenetic alterations. MYD88 mutations were studied by Sanger sequencing. All cases but one displayed at least one genetic alteration (96%). Nine patients exhibited a single genetic mutation and 12 combined several alterations (52%). We observed a split for BCL2, BCL6, or MYC in 1/23, 6/23, and 3/23 of cases, respectively. No double-hit lymphoma was observed. CDKN2A deletion was detected by FISH in only 5/23 cases. BLIMP1 and/or 6q deletion was observed at a higher rate in 10/20 of cases. No correlation between rearrangement and immunohistochemical expression was found for BCL2 or MYC. FISH tracking of sequential hybridizations showed that several alterations were carried by the same nuclei. The p.L265P MYD88 mutation was found in 11/18 (61%) of cases. Contrary to most cutaneous lymphomas that rarely harbor primary genetic alteration of their nodal histological equivalent, primary cutaneous large B-cell lymphoma, leg type seems to be a 'cutaneous counterpart' of activated B-cell-like diffuse large B-cell lymphoma with a similar cytogenetic profile and a high rate of MYD88 oncogenic L265P mutation. This also suggests a common lymphomagenesis with NF-κB activation, strong IRF4 expression and terminal B-cell differentiation blockage. Our data support the use of therapies targeting NF-κB, as most patients displayed disease progression and resistance to conventional therapies.Modern Pathology advance online publication, 13 September 2013; doi:10.1038/modpathol.2013.156.
    Modern Pathology 09/2013; · 5.25 Impact Factor
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    ABSTRACT: IMPORTANCE Life expectancy is increasing in most developed countries, and elderly people have the highest incidence of melanoma. OBJECTIVE To identify characteristics of melanoma and its management in the elderly compared with younger patients. DESIGN, SETTING, AND PARTICIPANTS Retrospective population-based study of incident cases of primary melanoma in 1621 patients with stage I or II melanoma in 2004 and 2008. Questionnaires administered to physicians and a survey of cancer registries and pathology laboratories were used to obtain data. The study was conducted in 5 regions in northeastern France. MAIN OUTCOMES AND MEASURES Characteristics of patients and tumors, circumstances of diagnosis, and further management in older patients (≥70 years, 487 patients [30.0%]) compared with younger ones (<70 years, 1134 [70.0%]). RESULTS Older patients had more frequent melanomas of the head and neck (29.4% vs 8.7%; P < .001) and of the nodular, lentigo maligna, or acral lentiginous histologic subtypes. They had thicker and more frequently ulcerated tumors, categorized as T3 or T4 in 36.7% of cases vs 20.1% in younger patients. Diagnosis of melanoma occurred more frequently in a general practice setting and less frequently in direct consultation with a dermatologist or regular screening for skin cancer. Time to definitive excision was longer in older patients, and 16.8% of them compared with 5.0% of the younger population had insufficient excision margins (P < .001). A sentinel lymph node biopsy was performed in 23.3% of the older patients with melanoma thicker than 1 mm vs 41.4% in the younger patients (P < .001). Adjuvant therapy was less frequently started in older patients and was prematurely stopped in a higher proportion of that population. CONCLUSIONS AND RELEVANCE Age-related variations are observed at every step of melanoma management. The most important concerns are access of elderly people to settings for early diagnosis and excision with appropriate margins.
    JAMA dermatology (Chicago, Ill.). 08/2013;
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    ABSTRACT: No strategy for improving early diagnosis of melanoma has been evaluated so far on a population-basis in France. To evaluate the efficacy of a general practitioner (GP) awareness and training campaign in a pilot French geographic region (Champagne-Ardenne), including 1.34 million inhabitants, 1241 GPs, 56 dermatologists and a population-based melanoma registry. All GPs received repeated awareness postal mailings in 2008 and 398 (32.1%) attended training sessions organized by 27 dermatologists. The pre- (2005-2007) and post-campaign (2009-2011) periods were compared for: primary endpoint: the world-standardized incidence of very thick melanomas (VTM) (Breslow thickness ≥ 3 mm); secondary endpoints: the mean Breslow thickness; the proportions of VTM and of thin (< 1 mm) melanomas among invasive cases; and the ratio of in situ/all melanoma cases. Similar measures were performed in the control area of Doubs/Belfort territory (655,000 ha), where no similar campaign was carried out. The incidence of VTM decreased from 1.07 to 0.71/100,000 habitants/year (p=0.01), the mean Breslow thickness from 1.95 mm to 1.68 mm (p=0.06) and the proportion of VTM from 19.2% to 12.8% (p=0.01). The proportion of thin and in-situ melanomas increased from 50.9% to 57.4% (p=0.05) and from 20.1% to 28.2% (p=0.001), respectively. No significant variation was observed in Doubs/Belfort territory . These results strongly support the efficacy of such a campaign targeting GPs and provide a rationale for a larger public-health campaign in France, including training of GPs by dermatologists and encouraging patients to ask their GP for a systematic skin examination. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 08/2013; · 3.76 Impact Factor
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    ABSTRACT: BACKGROUND: Genital and anorectal mucosal melanomas (GAMM) are rare, compared to cutaneous melanoma (CM). Many epidemiological and genetic studies have been carried out in CM. In contrast, the genetic and environmental risk factors for GAMM have been poorly documented up to now. OBJECTIVE: The aim of the study was to compare the distribution of pigmentation and nevus phenotypes, sun exposure and family history of melanoma between GAMM and CM patients. METHODS: For that purpose, we compared two series of 81 GAMM and 293 CM patients. RESULTS: GAMM and CM patients did not show significant differences for phenotypic risk factors. However, GAMM patients tend to display red hair (10.8% vs 5.5%, P = 0.08) and a poor tanning ability (22.2% vs 13.3%, P = 0.06) at a higher frequency than CM patients.A family history of melanoma was significantly more frequent in the GAMM than in the CM series (18.2% vs 7.5%, P = 0.005). Apart from the GAMM index case, affected relatives had CM except in one family. The frequency of multiple primary melanomas (MPM) was similar in GAMM and CM series (6.5% vs 5.3%, P=0.43). All GAMM patients with MPM had only one GAMM primary while the other primary was cutanaeous. No CDKN2A germline mutation was detected in GAMM patients. CONCLUSIONS: This study shows that GAMM and CM may occur in the same patient and GAMM may develop in a familial setting. The association of both GAMM and CM in patients and families suggests shared genetic factors by these two types of melanoma. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 05/2013; · 3.76 Impact Factor
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    ABSTRACT: INTRODUCTION: Blastic plasmacytoid Dentritic Cell Neoplasm (BPDCN) is, as defined in the new 2008 World health Organized (WHO) classification of tumors of hematopoietic and lymphoid tissue, a rare disease characterized by malignant proliferation of a contingent blastic plasmacytoid dendritic cell. This rare entity is mostly revealed and diagnosed on cutaneous spreading associated d'emblée or not with a leukaemic component .The prognosis is very poor. We herein studied a large cohort of 90 patients with BPDCN and try to define additional clues to coin earlier the correct diagnosis and manage such patients accordingly. MATERIALS AND METHOD: We retrospectively reviewed BPDCN cases registered in the French Study Group on Cutaneous Lymphoma (GFELC) database from November 1995 to January 2012. Ninety patients were studied. Demographic data, clinical presentation, initial staging, and outcome were recorded. RESULTS: The studied group contained 62 male and 28 female patients (sex ratio 2.2). Age ranged from 8 to 103 years at the time of diagnosis (mean age: 67.2 years).Three major different clinical presentations were identified: Sixty six patients (73.2%) presented with nodular lesions only, 11 patients with "bruise-like» patches (12.2%).The remaining 13 ones showed disseminated lesions (patches and nodules). Mucosal lesions were seen in five patients (5.6%) The median survival in patients with BPDCN was at 12 months . CONCLUSIONS: We here distinct three different clinical presentation of BPDCN. Nodular pattern is actually a more common feature than the originally reported "bruise-like" pattern. Despite the fact that BPDCN may initially appear as a localized skin tumor an aggressive management including allogenic bone marrow transplantation should be considered d'emblée since it is so far the only one option associated with long term survival. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 05/2013; · 3.76 Impact Factor
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    ABSTRACT: Herein, we report the first case of kaposiform haemangioendothelioma (KHE) associated with acute B-lymphoblastic leukemia (B-ALL). A five-month-old infant presented a plaque of angiomatous appearance on the forearm that had increased in volume since birth, as well as pallor and cutaneous haematomas. Kasabach-Merritt syndrome (KMS) was evoked despite hepatomegaly and considerable splenomegaly. Laboratory tests revealed severe anaemia and thrombocytopenia as well as major hyperleukocytosis with 90% blasts. Skin biopsy revealed vast vascular lobules containing cohesive fusiform endothelial cells not expressing Glut1, bound up in a dense infiltrate of B-lymphoblast cells. It was in fact KHE associated with B-ALL confirmed by the myelogram. The child was treated with the INTERFANT 2006 protocol followed by allograft of haematopoietic stem cells, which resulted in complete haematological remission. At the same time, almost total regression of KHE was noted. In this infant, KHE had an inflammatory appearance and was associated with thrombocytopenia, evocative of KMS. Analysis of blood and marrow samples resulted in a diagnosis of B-ALL. Histopathological examination of the angioma revealed a typical appearance of KHE associated with dense lymphoblastic proliferation. This appearance could have resulted either from passive contamination by circulating blast cells or from active recruitment of tumor cells at the KHE site. HK mimicking KMS may reveal B-ALL.
    Annales de Dermatologie et de Vénéréologie 03/2013; 140(3):209-14. · 0.60 Impact Factor
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    ABSTRACT: Background Herein, we report the first case of kaposiform haemangioendothelioma (KHE) associated with acute B-lymphoblastic leukemia (B-ALL). Patients and methods A five-month-old infant presented a plaque of angiomatous appearance on the forearm that had increased in volume since birth, as well as pallor and cutaneous haematomas. Kasabach-Merritt syndrome (KMS) was evoked despite hepatomegaly and considerable splenomegaly. Laboratory tests revealed severe anaemia and thrombocytopenia as well as major hyperleukocytosis with 90% blasts. Skin biopsy revealed vast vascular lobules containing cohesive fusiform endothelial cells not expressing Glut1, bound up in a dense infiltrate of B-lymphoblast cells. It was in fact KHE associated with B-ALL confirmed by the myelogram. The child was treated with the INTERFANT 2006 protocol followed by allograft of haematopoietic stem cells, which resulted in complete haematological remission. At the same time, almost total regression of KHE was noted. Discussion In this infant, KHE had an inflammatory appearance and was associated with thrombocytopenia, evocative of KMS. Analysis of blood and marrow samples resulted in a diagnosis of B-ALL. Histopathological examination of the angioma revealed a typical appearance of KHE associated with dense lymphoblastic proliferation. This appearance could have resulted either from passive contamination by circulating blast cells or from active recruitment of tumor cells at the KHE site. Conclusion HK mimicking KMS may reveal B-ALL.
    Annales de Dermatologie et de Vénéréologie 03/2013; 140(3):209–214. · 0.60 Impact Factor
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    ABSTRACT: Head and neck melanomas (HNMs) are frequent and have a poorer prognosis than melanomas at other sites. Photoprotection in these locations is difficult. In this population-based study of 279 HNMs diagnosed in a French region between 2004 and 2009, major differences were found between genders. A clearcut, sex-related distribution was found between a "peripheral" area (scalp, forehead, temples, ears, and neck) and a "central" one (other parts of the face), with 56.7% of HNMs being located in the peripheral area in men and 79.3% in the central area in women (P<0.0001). Moreover, HNMs located in the peripheral area occurred on the left side in 57.6% of men and on the right side in 73.1% of women (P=0.009). Peripheral HNMs differed from central HNMs by a higher proportion of invasive tumors, nodular or superficial spreading melanomas, and a lower proportion of lentigo maligna melanomas (LMMs). We hypothesized that this differential distribution between men and women could be explained mostly by a major role of long-term photoprotection by hair and sun exposure in a car. Important public health messages could result from these observations, such as the role of hairstyles in melanoma prevention and the importance of reducing sun exposure in a car, particularly in professional drivers.Journal of Investigative Dermatology advance online publication, 7 February 2013; doi:10.1038/jid.2012.405.
    Journal of Investigative Dermatology 02/2013; · 6.19 Impact Factor
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    ABSTRACT: End-of-life care is becoming a daily concern of French dermatology departments. The aim of this single-centre retrospective study was to assess changes in mortality and end-of-life care in a university dermatology department over a 14-year period. The medical records of all patients dying in our dermatology department from 1996 to 2009 were studied retrospectively. A descriptive analysis was performed together with a comparison between the two periods demarcated by the institution of the French National Cancer Plan at the end of 2002. The number of patients dying in the department rose by 33% from 108 for period 1 (1996-2002) to 144 for period 2 (2003-2009). The majority of patients presented metastatic melanoma, with doubling of numbers between the two periods. During period 2, 40 % of patients were managed in collaboration with the mobile palliative care team. This study shows an increase in the number of deaths in a French university hospital dermatology department over the 14-year period in question, ascribable mainly to an increase in the number of patients receiving end-of-life care for metastatic melanoma. Significant changes were noted in the management of these patients with an increase in palliative care procedures.
    Annales de Dermatologie et de Vénéréologie 02/2013; 140(2):91-6. · 0.60 Impact Factor
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    ABSTRACT: Background Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are the two main subtypes of auto-immune pemphigus, each having different clinical, histological and immunopathological features. We report the case of a patient initially with typical PV who relapsed within 2 years, presenting clinically, histologically and immunologically typical PF. Patients and methods A 47-year old man presented in March 2008 with clinically, histologically and serologically typical PV and treated with systemic corticosteroids alone (prednisone: 1 mg/kg per day) then combined with a cycle of rituximab, which resulted in complete remission. After discontinuation of therapy (duration: 26 months), he relapsed 6 months later with PF presenting clinical, histological and serological characteristics typical of this condition. Discussion This is a rare case of complete transition from PV to PF in clinical, histological and serological terms, and the first case occurring after initial treatment with rituximab.
    Annales de Dermatologie et de Vénéréologie 01/2013; 140(12):788–792. · 0.60 Impact Factor
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    ABSTRACT: The role of trauma in the physiopathology of malignant melanoma remains controversial. We report a case of acral melanoma in which a characterized trauma seems implicated in tumour progression; we performed a review of the literature. A 73-year-old male consulted for a lesion of his right big toe. Physical examination revealed a dystrophic and hyperkeratotic nail destroyed by a growing lesion. Histological study showed an ulcerated superficial spreading melanoma with a Breslow thickness of 4mm. He had previously had this same toe broken, leaving gradually worsening dystrophy of the nail; the toe was injured again spontaneously and by partial removal of the nail tablet. A number of cases of "post-traumatic" melanomas have been reported. This hypothesis, though widely admitted for other tumours, remains debated for melanomas mainly because of possible recall bias. In this patient, there was a clear continuum of the lesion as well as topographic correspondence between the initial trauma, the remaining dystrophy and the appearance of the melanoma. Case-control studies have identified trauma as an independent risk factor for acral melanoma with a high relative risk; such risk is multiplied for repeated trauma, suggesting a "dose-effect" relationship. Trauma could act as the promotional stage of melanoma mediated by cytokines released during wound healing or it could cause direct activation of micro-vascular tumour cell transport. Our observation and literature research provide convincing arguments for a role of trauma in the development of acral melanomas. Dermatologists must pay attention to any unusual changes in an old scar.
    Annales de Dermatologie et de Vénéréologie 11/2012; 139(11):727-31. · 0.60 Impact Factor
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    ABSTRACT: OBJECTIVE To identify clinical and sociodemographic factors associated with very thick melanoma (VTM) (Breslow thickness, ≥3 mm) in France. DESIGN Retrospective, population-based, case-case study using a survey of cancer registries and questionnaires to practitioners. SETTING Five regions covering 19.2% of the French territory and 8.2 million inhabitants. CASES Cases included all incident melanomas with a Breslow thickness of 3 mm or greater (ie, VTM), diagnosed between January 1 and December 31, 2008, in residents of the study area (Alsace, Bourgogne, Champagne-Ardenne, Franche-Comté, and Lorraine, France), and a randomly selected sample of melanomas thinner than 3 mm. MAIN OUTCOME MEASURES Circumstances of diagnosis, clinical and pathological characteristics of melanomas, and sociodemographic characteristics of patients (age, sex, residence, home and family life conditions, educational level, and smoking habits). RESULTS Among 898 melanomas, 149 (16.6%) were VTMs. Very thick melanomas were more often diagnosed in a general-practice setting than thinner melanomas. The rate of immediate clinical recognition by dermatologists was lower for VTMs than for thinner melanomas. In a multivariate logistic regression analysis, factors associated with VTM were the nodular and acrolentiginous types; the head and neck and lower limb locations; older age; male sex; and being single, separated, divorced, or widowed. When only factors related to patients were taken into account, older age, male sex, and living alone were independent risk factors for VTM. The most significant risk was observed for patients living alone. CONCLUSIONS Intrinsic factors related to the tumor and sociodemographic characteristics of patients contribute to the occurrence of VTM. These factors should be better targeted in future secondary prevention programs.
    Archives of dermatology 09/2012; · 4.76 Impact Factor

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2k Citations
442.70 Total Impact Points

Institutions

  • 2005–2014
    • Centre Hospitalier Universitaire de Reims
      • Service de Dermatologie
      Rheims, Champagne-Ardenne, France
    • Hôpital Universitaire Robert Debré
      Lutetia Parisorum, Île-de-France, France
  • 2005–2013
    • Université de Reims Champagne-Ardenne
      • Laboratoire SiRMa
      Rheims, Champagne-Ardenne, France
  • 2010
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France
  • 2008
    • Centre Hospitalier Régional d'Orléans
      Orléans, Centre, France
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 1997–2005
    • Hopitaux Civils De Colmar
      Kolmar, Alsace, France
  • 2000
    • University of Bordeaux
      Burdeos, Aquitaine, France
  • 1992–1995
    • Institut de Cancérologie Gustave Roussy
      • Department of Radiotherapy
      Île-de-France, France