MALATTIE BOLLOSE AUTOIMMUNI E NEOPLASIE: STUDIO RETROSPETTIVO SU UNA CASISTICA ULTRATRENTENNALE CON CRITICA DELLA LETTERATURA

The relationship between cancer and autoimmune bullous skin diseases (ABSDs) is still unclear, despite the introduction of immunofluorescence techniques and an unprovement in statistical analysis. This study was designed te evaluate the presence of cancer-associated ABSDs in a sample of 17,677 patients admitted to the Milan Dermatologic Department in the period 1961-1994. The data of 299 patients affected by ABSDs (28 with associated neoplasia) had to be divided into two groups - 'before' and 'after the introduction of the immunofluorescence techniques' - because the Milan School used to classify bullous pemphigoid and dermatitis herpetiformis together as a single entity (so-called 'Duhring-Brocq disease'), according to the French unifying conception. Notwithstanding this dissertion, these results can be numerically superimposed on those presented by other groups. However, although the bullous pemphigoid-cancer link is currently denied on a statistical basis, every clinician has experienced cases of ABSD undoubtedly related to neoplasia which promptly resolved after tumour ablation. For instance, recently the authors observed 4 such cases during a period of 20 months. Moreover, a link between bullous pemphigoid and some types of neoplasia cannot be excluded. In fact, this retrospective study underlines the association between bullous pemphigoid and carcinoma of the large intestine. In regard to pemphigus, the problem has progressively been solved and the existence of a new distinctive entity called paraneoplastic pemphigus is currently recognized. Some of its aspects could account for 'atypical' definition that the authors found in the Milan files. For these reasons it is unethical to omit a thorough search for neoplasia at least in suspect cases (age, extension and/or 'bursts' of the ABSD, laboratory clues, etc.), especially as recently introduced immunoblotting techniques and statistical analysis could open up new prospects in the association ABSDs-specific types of cancer.