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[NAME],  MD  Quantum Biophysical Semeiotics Laboratory |  |  | The article is fascinating, but I,d like to emphasise some interesting new aspects, which plays a central bedside diagnostic role. Authors admit generally that although the evidence is insufficient to make a recommendation because of the lack of evidence on benefits and harms of screening, many advocate whole-body screening as the best modality for skin cancer, including melanoma, early detection. Epidemiological data have shown that although the incidence of skin cancer, e.g. melanoma, is increasing, primarily because of an increase in early-stage lesions, the mortality from melanoma has not changed substantially. I’d like emphasize that screening is not identical to Primary Prevention, since the screening is aiming to ascertain the presence of a malignancy, even in oncogenesis initial stage. Physicians all around the world have to take into accounts that both Oncological Terrain and INHERITED Oncological Real Risk in biological systems, including skin, conditio sine qua non of malignancy, do really exist, as I’ve referred to in earlier papers (1-10). At this point, I suggest an easy and reliable quantum-biophysical- semeiotic manoeuvre, easy to perform, that proved to be efficacious in rapid detecting Skin Cancer Inherited Real Risk, as well as overt Cancer (10). In health, lying down in supine position and psycho- physically relaxed, “intense” pinching of leg skin does not “simultaneously” brings about gastric aspecific reflex (= in the stomach, both fundus and body dilate, while antral-pyloric region contracts: See www.semeioticabiofisica.it, Technical Page, N° 1) (9). On the contrary, in case of skin cancer inherited real risk (e.g., melanoma) and obviously in presence of overt skin cancer, even in very initial stage, under identical experimental condition, skin “intense” pinching causes “simultaneously” gastric aspecific reflex, followed by tonic Gastric Contraction, typical sign of a disorder, oncological in nature, after a latency time of 5 sec. or more, and respectively 2 sec. The intensity of both stomach dilation and contraction is directly related to the severity of underlying disorder (10). Immediately thereafter, doctor will ascertain the precise location of disorder, with the aid of a large number of quantistic-biophysical-semeiotic signs, as described formerly (1- 10) For further information about Quantum Biophysical Semeiotics, See Bibliography in above-cited website.   References. 1) U.S. Preventive Services Task Force Screening for Skin Cancer: U.S. Preventive Services Task Force Recommendation Statement. [NAME], 3 February 2009, Volume 150 Issue 3, Pages 188-193.   2) [NAME]. Overloking Oncological Terrain and oncological Real Risk, no paper is up-dated! 18 January 2008, Annals of Internal Medicine http://www.annals.org/cgi/eletters/147/11/775   3) [NAME] and Cancer: a clinical view-point. The Oncological Terrain. BioMed Central Informatics, 2004. http://www.biomedcentral.com/1471-2105/5/21/comments#10454   4) [NAME], Stagnaro-Neri M., Oncological Terrain, conditio sine qua non of Oncogenesis, 2004: http://www.gutjnl.com/cgi/eletters?lookup=by_date&days=60   5) [NAME]. [NAME] and Oncological Terrain. 2006. http://www.wjso.com/content/4/1/74/comments#247528   6) [NAME]. A new way in the war against breast cancer, fortunately Breast Cancer Res 2005,. http://breast-cancer research.com/content/7/2/R210/comments   7) [NAME]. Without Oncological Terrain oncogenesis is not possible. CMAJ. 23 March 2007 http://www.cmaj.ca/cgi/eletters/176/5/646   8) Simone Caramel, [NAME]. The Role of Mitochondria and mit-DNA in Oncogenesis, 16 July, 2010. http://www.quantumbiosystems.org/admin/files/QBS%202%281%29%20250-281.pdf   9) [NAME] [NAME] alla [NAME]. [NAME]. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm 10) [NAME]. [NAME]: Diagnosi Clinica di Melanoma a partire dal suo [NAME]. www.fcenews.it, 23 luglio 2008, http://www.fcenews.it/index.php?option=comcontent&task=view&id=1599&Itemid=45    Conflict of Interest: None declared |  | NR |  |  | 147 | 7 | 783
[NAME],  MD  Hospital Universitario de Gran Canaria,,  [NAME], [NAME], Pilar de la Rosa-del Rey, [NAME]. |  |  | Sir, we read with great interest the online article of [NAME] al. titled Epidermodysplasia verruciformis in human immunodeficiency virus-infected (EV-HIV) patients.1 The authors concluded that "acquired EV-HIV should be considered (..) as a generalized immunodeficiency state associated with low or high-risk mucosal HPV infection and lymphoproliferative disorders". We would like to highlight this conclusion reporting the first case of EV-HIV and fatal HPV-induced anorectal squamous cell carcinoma (SCC) association reported up to now.   Case report. A 43 year-old, HIV-positive homosexual man with AIDS C3 stage, CD4+ cells count of 517 cel/uL and under highly active antiretroviral therapy (HAART), was sent to us in april, 2009 for years of asymptomatic and progressive cutaneous and perianal lesions. He noted also perianal induration, serosanguineous discharge, tenesmus and pain during defecation, symptoms that started insidiously nine months before and progressed up to the time of consultation.   Exploration showed generalized skin lesions that distally were flat papular confluent skin-colored papules. On trunk, lesions were oval confluent maculae with light desquamation. Koebnerization was evident. Papular fibroma-like lesions seated on a suppurative fistulized perianal mass were also seen. A biopsy of cutaneous lesions was consistent with verrucciform epidermodysplasia and a biopsy of perianal lesions was compatible with condyloma showing high dysplasia. An intraanal biopsy of the mass showed an SCC. Image studies disclosed hepatic and peritoneal metastasis. Treatment of skin lesions with cryotherapy and immunomodulators were of no aid. SCC was treated with surgical and radiation palliative measures. Finally, He died 10 months after diagnosis from complications of metastatic disease of anorrectal SCC. We conducted PCR studies to determine the presence of HPV in paraffin embedded specimens that disclosed the presence of HPV-5 in EV lesions and HPV-59 in both high grade dysplastic condylomas and epidermoid anal carcinoma.   As EV-HIV,1 HPV induced mucosal carcinoma, notably anal carcinoma, as result of chronic HPV infection is an emerging problem in HIV populations.2 In immunocompetent patients, a lengthy period from HPV infection is necessary for development of neoplasia but in HIV patients this incubation period is shortened (2). [NAME], the diagnosis of anal SCC often fairly quickly followed the diagnosis of HIV disease.3 However, introduction of HAART therapy has changed the natural evolution of HPV infection in HIV patients and now a substantial delay from the time of diagnosis of HIV disease to diagnosis of anal SCC, which averages 10 years or more, is observed.3 In spite of this, HAART does not restore the defective immune response against HPV in HIV patients including EV-HIV and high grade dysplastic condylomas.1,2 Therefore, we must be prepared for a significant increase of this type of patient in the near future and encourage, as suggested by [NAME] for clinical follow-ups with detailed mucosal, oral, genital and anal examinations in EV-HIV patients.   References   1. [NAME], Laude H, Carlotti A, [NAME], Deleuze J, [NAME], et [NAME]. [NAME] verrucciformis in human immunodeficiency virus- infected patients. [NAME]   2. [NAME], Potthoff A, Brockmeyer NH, Gambichler T, [NAME], St?cker M, et al. Anal carcinoma in human immunodeficiency virus-positive men: results of a prospective study from Germany.[NAME]. 2010;162:1269- 77.   3. Nagle D. Anal squamous cell carcinoma in the HIV-positive patient. [NAME].    Conflict of Interest: None declared |  | P |  |  | 147 | 5 | 590
[NAME],  MSc  University of Montreal |  |  | I read with interest this important case series report. I just want to call attention of the authors that reference number 20 in their article is not the one they quote in the discussion section. Their reference 20 (RAVE study by [NAME] et al.) compares abacavir versus tenofovir. The correct reference is: [NAME] al. [NAME] outcomes in a randomized trial of nucleoside, nonnucleoside and protease inhibitor-sparing regimens for initial HIV treatment. AIDS, 2009;23: 1109-1118 Hoping this correction will me made [NAME], MSc, MD student, [NAME], University of Montreal, Montreal, QC., Canada   Conflict of Interest: None declared |  | NR |  |  | 146 | 11 | 1279