The skin is often introduced as the largest organ of the human body which - being uniquely exposed to external stress - faces several types of challenges, from physical, chemical, biological, and immunological origin. Therefore, the skin is also a site where inflammation, oxidative stress and cellular damage occurs regularly. Heme oxygenase (HO), primarily functioning in the catabolism of heme, is a very important cytoprotective enzyme that has antioxidant, anti-inflammatory and anti-apoptotic properties. Given the need for an enzyme with such a combination of attributes in the skin, it is not surprising that HO is involved in physiological processes as well as pathological conditions of the skin. In the recent decade, a huge effort was undertaken to identify treatments that modify HO-activity for the treatment of inflammatory or malignant skin diseases. In this review, we highlight the role of HO in the skin in physiological conditions as well as in relevant dermatological diseases such as atopic dermatitis, psoriasis and melanoma.

Introduction Follicular lymphoma (FL) is an indolent, yet heterogeneous, B-cell lymphoproliferative disorder. Although most FL patients respond well to treatment, few with specific traits have a poor prognosis; the latter are difficult to define. Patients and methods We retrospectively analyzed data from 143 FL patients treated at the University of Debrecen since 2009 and investigated prognostic factors that may influence the survival of FL patients. Results A maximum standardized uptake value (SUVmax) cut-off of 9.85 at the staging positron emission tomography/computed tomography (PET/CT) (p = 0.0001, hazard ratio [HR]: 0.2535, 95% confidence interval [CI]: 0.1118–0.4878) and a lymphocyte/monocyte (Ly/Mo) ratio of 3.41 (p = 0.0027, HR: 2.997, 95% CI: 1.463–6.142), drawn at diagnosis, significantly predicted FL patients’ progression-free survival (PFS). A staging SUVmax >9.85 with Ly/Mo <3.41 could delineate a high-risk group of FL patients (p<0.0001, HR: 0.0957, 95% CI: 0.03416–0.2685). Similarly, a significant difference was shown with an SUVmax cut-off of 3.15 at the interim PET/CT (p<0.0001, HR: 0.1614, 95% CI: 0.06684–0.3897). A staging SUVmax >9.85 in conjunction with interim SUVmax >3.15 predicted poor prognosis (p<0.0001, HR: 0.1037, 95% CI: 0.03811–0.2824). The PFS difference was translated into overall survival (OS) advantage (p = 0.0506, HR: 0.1187, 95% CI: 0.01401–1.005). Conclusion Biological prognostic factors, such as the Ly/Mo ratio, may improve the prognostic assessment of staging PET/CT. The survival advantage observed in PFS is translated into OS when determined using a combination of staging and interim SUVmax. We recommend investigating additional biological prognostic factors while highlighting the role of PET/CT in FL.

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ÖSSZEFOGLALÁS A BRAFV600E/K génmutáció a melanoma kialakulásá-ban és progressziójában is fontos pathogenetikai tényező. Az esetek felében kimutatható a tumor metasztázisban és hatásának ellensúlyozására kifejlesztett célzott molekulá- Kulcsszavak: áttétes melanoma -BRAF inhibitor -MEK inhibitor -gyógyszer mellékhatás SUMMARY An important pathogenic factor in both the development and progression of melanoma is the V600E/K mutation of BRAF, which can be found in half of metastatic tumors. It is unsurprising therefore that molecular inhibitors targeting its effect are able to offer significantly higher progression free and overall survival as compared to conventional chemotherapy in the majority of patients diagnosed with metastatic melanoma. Moreover, the combination of BRAF-and MEK inhibitor therapy has greatly improved the prognosis of patients with confirmed mutations in distant metastases, showing that optimal use of new therapeutic agents by broadening clinical expertise is an effective way of expanding the inventory of anti-melanoma agents. The management of potential adverse events related to new treatments is also improved by their widespread use and the consequent enhancement of practical knowledge related to the new agents, ultimately leading to the improvement of quality of life of patients. Key words: metastatic melanoma -BRAF inhibitor -MEK inhibitor -drug adverse eventA melanoma pathofiziológiájáról szerzett, az elmúlt év-tizedben robbanásszerűen felhalmozódott ismereteink és a modern biotechnológia lehetővé tették új típusú onkoterá-piák megjelenését, mint amilyenek a célzott molekuláris inhibitorok vagy a biológiai terápiák, és ezzel megváltoztatták a metasztatikus betegek túlélési esélyeit és átírták a korábbi kezelési irányvonalakat (1-3). A melanoma kialakulásában és progressziójában kulcsszerepet játszó génmutációk komplex módon, az intracelluláris jelátviteli folyamatok kö-zötti egyensúly megbomlását okozva vezetnek megnöve-kedett sejttúléléséhez, kórosan fokozott sejtproliferációhoz. Az egyik legfontosabb pathogenetikai lépés a MAPK (Mitogén Aktivált Protein-Kináz)-útvonal aktivitásának fokozódása (4), ami igen gyakran, a melanomás eseteknek a 160 Levelező szerző: Dr. Szabó Imre Lőrinc