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Cigarette smoking in men may be a risk factor for increased severity of psoriasis of the extremities
Author(s) -
Gupta M.A.,
Gupta A.K.,
Watteel G.N.
Publication year - 1996
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.1996.tb03909.x
Subject(s) - psoriasis , medicine , risk factor , cigarette smoking , dermatology
When reviewed in 3 weeks she was complaining of considerable irritation of the vulval area. Examination showed unchanged appearance of the cervix and two lightly pigmented nodular lesions on the right lahia minora and one of these was ulcerated. She was admitted and had an amputation of the cervix and an excision biopsy of the lesions from the vulva. Macroscopic examination of the excised cervix showed a 0-8-cm pigmented nodule at the junction of vagina and cervix. This was the lesion initially biopsied. Microscopic examination showed an invasive tumour having features of a malignant melanoma. Cells were mixed spindle and epithelioid with a high mitotic rate. Tumour was invading the subepithelial tissue with a depth of 2-8 mm. There was a malignant junctional component suggesting that this was the primary origin for this tumour. Both the lesions removed from the vulva showed features of malignant melanoma. The ulcerated one had a malignant junctional component suggesting a second primary which is unusual. The second lesion showed no junctional activity and was thought to be a metastatic deposit from one of the primary melanomas. She was subsequently seen by the Dermatology Department. Examination of the skin and mucosa showed several benign pigmented lesions but no suspicious areas. Metastases of malignant melanoma can involve the cervix uteri but a primary melanoma at this site is very rare. A worldwide search shows 27 previously reported cases. Primary melanomas are distinguished from secondaries by the presence of junctional activity. This case has the unusual features of two primary melanomas presenting at the same time. In a series of 1250 patients reported by Pack et al..^ only 16 (1-3%) had multiple primaries presenting synchronously. Multiple malignant melanomas of the genital tract are even rarer. We could only find one other case^ of a 71-year-old female with multiple primary melanomas of vulva, cervix and vagina. Prognosis for patients with cervical melanoma is generally poor. Most patients succumb to the disease within 3 years of the diagnosis. Only two patients are reported to have lived longer than that. Both died of metastatic disease at 13 and 14 years. ̂ Due to the small number of cases there is no established treatment protocol. Most investigators recommend radical hysterectomy and possible node dissection. Both radiotherapy and chemotherapy have been tried but so far there is no documented survival benefit from any treatment method used alone or in combination.