[A tumor can hide another one].
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Antigens, CD34↗
Biomedical subjects
F Champeau
Publications and source records attributed to F Champeau.
[Malignant melanoma].
Malignant melanoma is the most serious skin tumor and its incidence is doubling every ten years. Ultraviolet rays represent the main environmental cause of melanoma. Among the constitutional factors identified, two clinicopathological forms of naevus are considered to be important epidemiological precursors: acquired dysplastic naevi and congenital giant naevi. Four clinical and histological types are distinguished: SSM (Superficial Spreading Melanoma), NM (Nodular Melanoma), LMM (Lentigo Maligna Melanoma), arising from Dubreuilh melanosis, ALM (Acral Lentiginous Melanoma). Thickness constitutes the essential prognostic factor. Clinical examination is the only recommended standard assessment. Chest x-ray is useful, and acts as a reference for subsequent follow-up. Other complementary investigations are requested as a function of clinical signs. Treatment is exclusively surgical. The lateral resection margins are 0.5 cm for melanoma in situ, 1 cm for melanomas less than 1 mm thick, 2 cm for melanomas between 1 and 4 mm thick, and 3 cm for melanomas thicker than 4 mm. Chemotherapy is mainly used in the treatment of metastatic melanoma. There is no indication for radiotherapy apart from palliative treatment of nonsurgical metastases. New therapies such as immunotherapy and gene therapy are under investigation.
Adult↗
[Cutaneous and subcutaneous sarcomas].
Cutaneous sarcomas are uncommon tumors presenting many histological types. The diagnosis is based on pathological, immunohistochemical and sometimes ultrastructural studies. The development of cytogenetic and molecular analysis may constitute an additional aid to the diagnosis and classification. Prognosis and therapeutic strategies are established on the basis of various criteria using different types of staging and grading, but these classifications have not yet been standardized. The rarity of cutaneous sarcoma, and the diversity of clinical presentations account for the difficulties of management, which requires a multidisciplinary approach.
Adolescent↗
[Merkel cell carcinoma].
Merkel cell carcinoma (MCC) is a malignant cutaneous neuroendocrine tumor which may be difficult to diagnose. It mostly occurs in old patients and the commonest sites are the skin of the head and neck and the extremities. MCC appears as a solitary violaceous dome-shaped nodule or indurated plaque. Histopathologic diagnosis may be difficult and three main patterns have been described. With immunohistochemistry studies, MCC express both epithelial (cytokeratins, EMA) and neuroendocrine (NSE, chromogranin, ...) markers. The tumor develops an aggressive course not unlike an aggressive melanoma. Local recurrence and regional lymph node metastases occur in 40 to 75% of cases. Long-term prognosis is unfavorable (3-year survival rate is 55%). Wide surgical excision associated with radiotherapy is the treatment of choice, regional lymph node metastases should be treated by lymph node excision and radiotherapy; chemotherapy should be used in systemic disease.
Adolescent↗
[Iatrogenic extravasations of cytotoxic or hyperosmolar aqueous solutions. Value of surgical emergency by aspiration and lavage].
Iatrogenic extravasations are characterized by their unpredictable course, the possible repercussions of functional, cosmetic and psychological sequelae, and the absence of a therapeutic consensus. The authors present the protocol used in Hôpital Saint-Louis, based on a synthesis of current procedures, consisting of emergency conservative surgical aspiration and lavage, performed in a context of close collaboration with oncolosits, intensive care physicians and radiologists. From 1994 to March 1997, fifteen patients were operated following extravasation during seven chemotherapeutic protocols, three radiographic examinations with injection of contrast agents and five resuscitation procedures. This simple protocol, applied systematically, achieved cure without cutaneous or functional sequelae in all patients. Aspiration-lavage during the first twelve hours therefore constitutes the treatment of choice of iatrogenic extravasation with cytotoxic or hyperosmolar aqueous solutions.
Aged↗