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Malignant melanoma is the first fatal skin cancer. Vitiligo is a leukoderma or a multifactorial depigmentation acquired but especially of autoimmune origin. We report the first Malagasy case affected by both melanoma and Vitiligo. The appearance of Vitiligo during a melanoma could testify to an immunological response against melanocytes. Despite the association of melanoma and Vitiligo, the prognosis of melanoma is still fatal.

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Although paraneoplastic hypereosinophilia has been documented in patients with colon cancer, this association is rare. The purpose of this report is to describe a case of paraneoplastic hypereosinophilia associated with colic adenocarcinoma. This case underlines the value of methodical investigation of hypereosinophilia in tropical areas where parasitic aetiologies are frequent.

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The childhood cancer survival rate is currently 75% in industrialized countries. Rates in developing countries are much lower. The Franco-African Childhood Cancer Group (French acronym, GFAOP) was founded in 2000 with aim of reducing this unfavorable situation in Africa. The GFAOP has developed two forms of action. The main form consists of organizing two- to twelve-month training sessions for physicians and nurses in France and Morocco. The other form involves assessing the feasibility of modern treatment protocols for various cancers in Africa. The first feasibility trials were carried out on nephroblastoma and Burkitt's lymphoma in 12 pilot units in North Africa, West Africa, and Madagascar. In the first study from 2001 to 2005 we treated 306 cases of Burkitt's lymphoma using French LMB protocols adapted to the African setting and achieved a survival rate of 61%. A second study started in 2005 using Endoxan alone achieved a highly satisfactory survival rate of 73% for neuroblastoma in all stages except bilateral. Altogether from 2001 to 2007 more than 1000 cases of nephroblastoma and Burkitt's lymphoma were treated in African hospitals by African doctors and nurses. No patients were transferred to Europe. The GFAOP supplied drugs when necessary and took care of most travel expenses. African and French doctors worked together on protocol design, trial management, and data analysis. These promising results show that the latest therapeutic techniques can be used to treat childhood cancer in Africa by adapting the protocol to conditions in developing countries. Sanofi-Aventis Laboratories in association with the International Union against Cancer has launched a major campaign to improve Pediatric Oncology in developing countries. Projects in four GFAOP units are being financed through this campaign. In 2006 the GFAOP began assessment of two new treatment protocols, i.e., one for acute lymphoblastic leukemia and the other for Hodgkin's disease. Two other projects are being planned, i.e., one for treatment of retinoblastoma and the other for treatment of some types of brain tumors.

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Les tumeurs des tissus mous des membres sont souvent vues au stade avance de l'evolution dans notre pays. Devant la negligence et l'ignorance des patients; la malignite ne peut etre ecartee d'emblee dans l'arbre decisionnel therapeutique et la surveillance au long cours s'avere indispensable. De ce fait; l'examen anatomopathologique a une place importante dans la prise en charge de ces tumeurs. Nos deux observations de lipomes geants de la cuisse illustrent l'apport de cet examen

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PURPOSE: Retrospective analysis of management and outcome of breast cancer in Madagascar. PATIENTS AND METHODS: From January 1996 to December 1998, 259 women with breast cancer were seen in the only department of oncology of the island, located in Antananarivo. It is equipped with a cobalt unit (unavailable in 1996). There was no uniform policy on surgery. Chemotherapy and hormonotherapy were not available for all patients. Reduced equipment enabled a minimal pre-therapeutic workshop. RESULTS: Mean age was 48.5 years. One hundred and fifty-six women were premenopausal. The majority (69%) lived less than 50 km from the department. Tumours were at an advanced stage in 67% of the cases; the mean delay for diagnosis was 9.4 months. Treatments were done with curative intent in 118 cases and with palliative intent in 64 cases. Partial surgery (89) was adequate in 40.5% of the cases; total mastectomy concerned 94 women. Axillary lymph node dissection was done in 94 cases and was positive in 76 cases. The number of involved nodes was noticed in 47 cases. Curative radiotherapy concerned 106 patients, 41 after total mastectomy and 44 after lumpectomy, and was exclusive in 21 cases. Palliative irradiation was done locally with hypofractionation for 35 patients. Chemotherapy was performed in 86 women. The 4-year survival of the 136 assessable patients was 73%. CONCLUSION: Improvement in breast cancer treatment outcome in Madagascar is the result of earlier diagnosis of the disease. Information and education of the population together with caregivers are necessary, because updating and improving technical equipment is not currently possible due to the economic problems that the country has to face.

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RATIONALE: Burkitt lymphoma (LB), a frequent, very progressive cancer with multiple factors, can be cured. However, the mortality rate remains high in Madagascar. OBJECTIVE: To analyse the epidemiological aspects of LB as well as related socio-economical issues in order to improve successful treatment of the disease. METHODS: Retrospective study of files for children aged under 15 years, hospitalised for LB in the Antananarivo oncology unit from October 1985 to June 2000. The inclusion criteria were anatomo-pathological, clinical and/or X-ray results. Studied parameters included age, sex, ethnic group, medical history, and the distance covered by the child before his/her hospitalisation. FINDINGS: The 77 cases of LB represented 16% of all children aged under 15 years seen in the hospital. The characteristics of the cases corresponded to those of African endemic LB. Most of the children with LB came from areas with endemic malaria, the Eastern and the Centre of Madagascar. All of them belonged to underprivileged families. Early medical advice was sought but distance from services delayed treatment. Various units referred the children, but especially oral surgeons (stomatologists) and ORL physicians. CONCLUSION: A strategy to ensure rapid treatment for children suffering from LB should be developed, from their region of origin up until treatment. This should involve parents as well as all members of the medical staff in charge of these children.

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RATIONALE: Burkitt Lymphoma (LB), a very progressive malignant lymphoma, can now be cured by chemotherapy. However, protocols used currently by developed countries are costly and can cause problems of tolerance for underprivileged children. OBJECTIVE: To develop a protocol of care for Malagasy children suffering from LB. METHODS: A retrospective study of the files of children aged under 15 aged years, hospitalised for LB with anatomo-pathological evidence, in the Antananarivo Oncology Unit from October 1985 to June 2000. Clinical characteristics, (paraclinical) investigations, treatment and responses to treatment were studied. FINDINGS: 40 medical records included a LB anatomo-pathological evidence. The mean age of children was 7.5 years, with a sex ratio in favour of males. All children were underweight. Maxillo-facial tumours prevailed. Other locations for tumours had also been observed, both unique or immediately multiple. Patients seem to have arrived at the hospital in the early stages of the disease, but lack of investigation probably introduced biases to the evaluation of these stages. Chemotherapy, even though incomplete due to its cost, remained the main means of treatment. Generally speaking, an immediate, favourable response was obtained, but the toxicity of chemotherapy, especially haematological toxicity, contributed to malnutrition. Overall results indicated an immediate mortality rate of 22.5%, but there was loss of follow-up for many patients. CONCLUSION: A specific protocol of LB care in Madagascar appears to be possible. Such a protocol should be based on experience with treatments, and should take into account disease characteristics, the response of Malagasy children to the treatment, as well as the country's economic state.

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INTRODUCTION: Age is the major risk factor for the majority of patients with cancer. More than 50% of cancers occurs after the age of 60. Cancer in the elderly is therefore a public health issue at stake. However, in daily clinical practice the elderly presenting cancer are not listened to with great interest and treatment is often not proper or suboptimal. CURRENT KNOWLEDGE AND KEY POINTS: Diagnosis in the elderly is established at a more advanced stage of cancer than in younger people; diagnostic workup is reduced and suboptimal treatments are implemented. Therefore, barriers exist that prevent the elderly from accessing the healthcare system as easily as their younger counterpart. Misconceptions about cancer also lead them to delay their first visit. As well, although treatment with curative intent and without major side-effect is feasible, physicians have misconceptions regarding therapeutic possibilities. Due to the heterogeneity of the so-called "ageing population", difficulties are related to patients' selection. FUTURE PROSPECTS AND PROJECTS: Decision in oncology for the elderly must walk a fine line in attempting to deliver the best treatment under the best conditions. Age per se must not be the only criterion for medical decision. Providing accurate information adapted to the elderly, with large circulation among healthcare professionals, should lead to the same quality of care as that in young people. Comprehensive multimodal geriatric assessments should help to further differentiate patients who may benefit from curative treatment from those for whom only palliative treatment is necessary.

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Les cancers de l'enfant sont actuellement gueris dans 75des cas; dans les pays developpes. Dans les pays en developpement; les resultats sont beaucoup moins bons. Le Groupe Franco-Africain d'Oncologie Pediatrique (GFAOP) s'est constitue en 2000 avec pour objectif de redresser cette situation defavorable enAfrique. Les actions du GFAOP comprennent; d'une part la formation des medecins et des infirmieres avant tout par des stages en France et au Maroc; d'autre part des essais de traitement par des protocoles adaptes des lymphomes de Burkitt et des nephro- blastomes dans douze unites pilotes situees en Afrique du Nord; Afrique de l'Ouest et a Madagascar. Dans une premiere etude 2001-2005; 61des lymphomes de Burkitt ont gueri. Une seconde etude a commence en 2005 avec un traitement a base d'Endoxan seul. Pour les nephroblastomes; le taux de guerison; 73; est tres satisfaisant. Plus de 1000 cas de nephroblastome et de lymphome de Burkitt ont deja ete traites dans ces conditions de 2001 a 2007; tous en Afrique; dans les hopitaux africains; par desmedecins et des infirmieres africains. Ces resultats encourageants permettent de conclure a la faisabilite du traitement des cancers de l'enfant en Afrique; grace a des traitementsmodernes; adaptes de protocoles utilises dans les pays developpes. Le laboratoire Sanofi-Aventis; associe a l'Union Internationale Contre le Cancer; a lance une grande entreprise d'aide a l'Oncologie Pediatrique dans les pays en voie de developpement.Quatre projets d'unites du GFAOP sont ainsi finances. Le GFAOP a lance en 2006 deux nouveaux protocoles : le traitement des leucemies aigues lymphoblastiques et celui de la maladie de Hodgkin. Deux autres projets sont en preparation : le traitement des retinoblastomes et celui de certaines tumeurs cerebrales

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Les cancers de l'enfant sont actuellement gueris dans 75des cas; dans les pays developpes. Dans les pays en developpement; les resultats sont beaucoup moins bons. Le Groupe Franco-Africain d'Oncologie Pediatrique (GFAOP) s'est constitue en 2000 avec pour objectif de redresser cette situation defavorable enAfrique. Les actions duGFAOP comprennent; d'une part la formation des medecins et des infirmieres avant tout par des stages en France et au Maroc; d'autre part des essais de traitement par des protocoles adaptes des lymphomes de Burkitt et des nephroblastomes dans douze unites pilotes situees enAfrique du Nord;Afrique de l'Ouest et a Madagascar. Dans une premiere etude 2001-2005; 61des lymphomes de Burkitt ont gueri. Une seconde etude a commence en 2005 avec un traitement a base d'Endoxan seul. Pour les nephroblastomes; le taux de guerison; 73; est tres satisfaisant. Plus de 1000 cas de nephroblastome et de lymphome de Burkitt ont deja ete traites dans ces conditions de 2001 a 2007; tous enAfrique; dans les hopitaux africains; par desmedecins et des infirmieres africains. Ces resultats encourageants permettent de conclure a la faisabilite du traitement des cancers de l'enfant en Afrique; grace a des traitementsmodernes; adaptes de protocoles utilises dans les pays developpes. Le laboratoire Sanofi-Aventis; associe a l'Union Internationale Contre le Cancer; a lance une grande entreprise d'aide a l'Oncologie Pediatrique dans les pays en voie de developpement.Quatre projets d'unites du GFAOP sont ainsi finances. Le GFAOP a lance en 2006 deux nouveaux protocoles : le traitement des leucemies aigues lymphoblastiques et celui de lamaladie de Hodgkin. Deux autres projets sont en preparation : le traitement des retinoblastomes et celui de certaines tumeurs cerebrales

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