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Wilson–Jones angiosarcoma is one of cutaneous angiosarcomas, which is a rare aggressive tumor of blood vessels of the skin. In this case report, we present a 72-year-old female who developed multiple episodes of facial edema of 2-year duration along with partial hair loss of the scalp. Investigations, including a skin biopsy, were diagnostic of scalp angiosarcoma.

Jacek Calik,1 Monika Migdal,1 Tomasz Zawada,2 Torsten Bove2 1Old Town Clinic, Wrocław, Poland; 2TOOsonix A/S, Hoersholm, DenmarkCorrespondence: Torsten BoveTOOsonix A/S, Agern Alle 1, Hoersholm, DK-2970, Denmark, Tel +45- 2059 2999, Email torsten.bove@toosonix.comPurpose: High intensity focused ultrasound operating at 20 MHz has been demonstrated as a safe and efficient treatment modality for a range of dermatological indications. The method is potentially also applicable to removal of seborrheic keratosis.Patients and Methods: A total of 54 seborrheic keratoses in 11 volunteer subjects (8 women and 3 men, average age 51.5 ± 13.2 years) were treated in a single session with a medical 20 MHz high intensity focused ultrasound device developed for dermatological conditions. Handpieces with nominal focal depths of 0.8 mm below the skin surface were used to administer acoustic energy of 0.99– 1.2 J/dose. An integrated dermoscope in the handpiece was used to monitor the treatment in real-time. Treatment efficacy and side-effects were assessed directly after treatment and at follow-up 4– 15 weeks after treatment.Results: The treatment showed positive results in 96.3% of the cases. About 68.5% of the cases were classified as complete response and 27.8% of the cases as partial response. Two cases (3.7%) did not respond to treatment and were classified as stable condition. No subjects experienced worsening of their condition, and no treatment received the classification of progressive condition. Side effects were primarily redness in the treatment area due to superficial telangiectasia, mild scarring, and persisting and slow-healing lichen planus-like keratosis. No adverse events were observed.Conclusion: HIFU is concluded to be a safe and efficient skin treatment for seborrheic keratoses. It has advantages over conventional treatments that can lead to pain during treatment and scarring after healing.Keywords: seborrheic warts, solar lentigo, skin tumor, HIFU, dermoscopy, dermatology

Eccrine spiradenoma is a rare, benign, adnexal skin tumor of the sweat gland. It is frequently solitary and presents as a small lesion in the dermal or the subcutaneous fat layer. Eccrine spiradenomas rarely progress to malignant transformation but they can relapse. Due to its rarity, there have been few reports about the sonographic appearances of eccrine spiradenoma. Sonographic findings were reported in a relapsing case of an eccrine spiradenoma, located in the deep dermal layers and hypodermis of the preauricular region in a middle-aged man. Ultrasound was very useful to suspect the relapse. Histology was correlated with the sonography and discussed the previously reported imaging findings of eccrine spiradenoma and other sweat gland tumors.

Mast cell tumors (MCTs) are the most common skin tumor of the dog, and accurately predicting their clinical behavior is critical in directing patient therapy, as they range from benign lesions to a fatal systemic disease. Grading is useful for prognosis, but it cannot predict the behavior of all MCTs. We hypothesized that biomarker immunolabeling in tumor tissues would correlate with patient morbidity and mortality. A clinically annotated tissue microarray (TMA) of primary, recurrent, and metastatic (to lymph node) canine dermal and subcutaneous MCTs was created. Some dogs whose MCTs were included in the TMA did not receive adjunctive treatment after surgical excision of the MCT, whereas others were treated with one or a combination of chemotherapy, radiation, or oral toceranib. Immunohistochemistry for beclin-1, an autophagy protein, was performed followed by digital image analysis. Beclin-1 immunolabeling was higher in recurrent tumors (mean H-score 110.8) than primary MCTs (mean H-score 73.5), and highest in lymph node metastases (mean H-score 138.5) with a significant difference in means ( P < .001). While beclin-1 level was not prognostic, it was strongly predictive for survival after adjunctive treatment; dogs with high beclin-1-expressing tumors showed poorer survival compared to those with low beclin-1-expressing tumors (HR = 5.7, P = .02), especially in Kiupel high-grade tumors (HR = 16.3, P = .01). Beclin-1 immunolabeling was the only significant predictive factor by multivariable analysis ( P = .04). These findings may improve our ability to predict the response to adjunctive therapy. Importantly, these data suggest that autophagy inhibitors may be useful in improving response to treatment for dogs with high-grade MCTs.

Dermatofibroma (DF) is a mesenchymal tumor of the dermis, but its exact differentiation lineage is still uncertain. A progenitor cell that may be able to differentiate into fibroblastic, myofibroblastic, or fibrohistiocytic cells has been hypothesized. Some authors have also proposed the possibility of a monocytic-histiocytic origin. We stained 47 consecutive dermatofibromas with CD64, CD34, CD14, CD163, and CD68 to test which marker is more reliable for the diagnosis and to gain insight into their histogenesis. From the 35 cases stained with the whole immunohistochemical panel, all were positive for CD64, mostly showing a strong and diffuse pattern. Regarding all the other staining, CD14 was strongly positive in 77% of the lesions and CD163 in 20%. The CD68 stain was intense and diffuse only in 20% of the cases. All lesions were negative for CD34, but two of them showed patchy and weak staining. DFs were immunohistochemically stained positively with a set of macrophage/monocyte/histiocyte lineage markers such as CD14, CD68, CD163, and CD64. This finding favors an active pro-inflammatory immature monocyte-lineage cell as the more suitable origin for DF. CD64 seems to be more sensitive than other markers to confirm the diagnosis.

Activated Cdc42‐associated kinase 1 (ACK1), a widely expressed nonreceptor tyrosine kinase, is often amplified in cancer and has been shown to interact with Cell division cycle 42 (Cdc42), Epidermal growth factor receptor (EGFR), and several other cancer‐relevant molecules, suggesting a possible role for ACK1 in development and tumor formation. To directly address this scenario, we generated mice lacking a functional ACK1 gene (ACK1 ko) using CRISPR genome editing. ACK1 ko mice developed normally, displayed no obvious defect in tissue maintenance, and were fertile. Primary ACK1‐null keratinocytes showed normal phosphorylation of EGFR, but a tendency toward reduced activation of AKT serine/threonine kinase 1 (Akt) and Mitogen‐activated protein kinase 1 (Erk). DMBA/TPA‐induced skin tumor formation did not reveal significant differences between ACK1 ko and control mice. Deletion of the ACK1 gene in the breast cancer cell lines MDA‐MB‐231, 67NR, MCF7, 4T1, and T47D caused no differences in growth. Furthermore, EGF‐induced phosphorylation kinetics of Erk, Akt, and p130Cas were not detectably altered in T47D cells by the loss of ACK1. Finally, loss of ACK1 in MDA‐MB‐231 and T47D breast cancer cells had a very limited or no effect on directed cell migration. These data do not support a major role for ACK1 in Cdc42 and EGFR signaling, development, or tumor formation., Mice with a ko of the Cdc42 effector Activated Cdc42‐associated kinase 1 (ACK1) showed normal development and normal chemically induced skin tumor formation. ACK1 ko in breast cancer cell lines did not impair proliferation or EGF signaling. These data suggest that ACK1 contrary to the expectations is lacking a major role in development or tumor formation.

Secretory carcinoma of the skin is an extremely rare adnexal tumor, histopathologically identical to homologous lesions in the salivary glands and breast tissue. Although this tumor was previously reported as indolent, we report a case of secretory carcinoma of the skin with metastases and recurrence. The patient, a 31-year-old women, had a subcutaneous mass in the right axilla. The resected specimen contained a circumscribed mass, with proliferating tumor cells that exhibited prominent nucleoli. They exhibited glandular and papillary growth patterns and there were amphophilic secretions in the glands. Immunohistochemically, the tumor cells were positive for mammaglobin and S100. The tumor was surrounded by sweat glands and there was no mammary glandular tissue, suggesting that it was derived from axillary sweat glands. Accordingly, we made a diagnosis of secretory carcinoma of the skin. Four years after the operation, there were metastases in both lungs. The resected specimen revealed a tumor identical to that of the original skin tumor. Next-generation sequencing-based multiplex gene assay performed on the metastatic tissue revealed an ETV6-NTRK3 fusion gene. This is a rare case report of secretory carcinoma of the skin with lymph node metastases and recurrence in both lungs.

Recent advances in artificial intelligence, particularly in the field of deep learning, have enabled researchers to create compelling algorithms for medical image analysis. Histological slides of basal cell carcinomas (BCCs), the most frequent skin tumor, are accessed by pathologists on a daily basis and are therefore well suited for automated prescreening by neural networks for the identification of cancerous regions and swift tumor classification. In this proof-of-concept study, we implemented an accurate and intuitively interpretable artificial neural network (ANN) for the detection of BCCs in histological whole-slide images (WSIs). Furthermore, we identified and compared differences in the diagnostic histological features and recognition patterns relevant for machine learning algorithms vs. expert pathologists. An attention-ANN was trained with WSIs of BCCs to identify tumor regions (n = 820). The diagnosis-relevant regions used by the ANN were compared to regions of interest for pathologists, detected by eye-tracking techniques. This ANN accurately identified BCC tumor regions on images of histologic slides (area under the ROC curve: 0.993, 95% CI: 0.990–0.995; sensitivity: 0.965, 95% CI: 0.951–0.979; specificity: 0.910, 95% CI: 0.859–0.960). The ANN implicitly calculated a weight matrix, indicating the regions of a histological image that are important for the prediction of the network. Interestingly, compared to pathologists’ eye-tracking results, machine learning algorithms rely on significantly different recognition patterns for tumor identification (p

Darier-Ferrand dermatofibrosarcoma is a rare but not exceptional malignant mesenchymal skin tumor, representing 0.1 % of malignant skin tumors. It is characterized by high recurrence, slow growth and low metastatic potential. Although several clinical cases of an unusual variant of Darier-Ferrand dermatofibrosarcoma have been reported in the literature, localization on the palmar face of the hand is not common. We report a case of Darier and Ferrand dermatofibrosarcoma at the level of the fourth commissure of the palm of the left hand in a 43- year-old young Malagasy adult treated by a large surgical excision with a healthy margin of two centimeters associated with adjuvant chemotherapy with Imatinib.

Skin tumor acts as a premier factor for high death rate throughout the world. To segment the skin tumor the radiologists find it impotent. Various research works find it to be an ineffective manife...

Skin cancers are relatively uncommon malignancies worldwide, but the incidence of skin cancers has progressively increased over the last few decades. The distinction between benign and malignant neoplasm are more difficult to define when they appear in skin than when found elsewhere and histopathological examination is frequently required to establish a definitive diagnosis. The present study was the incidence of various benign and malignant tumours of skin and its adnexa. Histopathological examination remains the gold standard in diagnosing most skin tumours. Thus diagnosis of any skin tumor can be done by correlating clinical features and histological features, which in turn can be supported by histochemistry, immunohistochemistry and electron microscopy. Most of the skin tumours were Nodular lesions (34.3%), followed by papular lesions (28.4%) and by ulcerated lesions (9.8%). Malignant tumours commonly presented as ulcerated lesions. Head and neck region was the most common site of occurrence followed by extremities and trunk. Keratinocytic (31.4%) tumours were the commonest group among all skin tumours.

Background Adnexal skin tumors are diagnostically challenging with few known molecular signatures. Recently, however, YAP1-MAML2 and YAP1-NUTM1 fusions were identified in poroid adnexal skin tumors. Methods Herein, we subjected eight poroid adnexal skin tumors (three poromas and five porocarcinomas) to fusion gene analysis by whole transcriptome sequencing and next-generation DNA sequencing analysis. Results YAP1 fusions were identified in six cases. YAP1-NUTM1 fusions were identified in two poromas and three porocarcinomas. A single case of porocarcinoma harbored a YAP1-MAML2 fusion. Two cases were negative for gene fusion. All cases that harbored YAP1-NUTM1 fusions showed nuclear protein in testis (NUT) expression by immunohistochemistry, with NUT being negative in the YAP1-MAML2-positive case. In this case series, we provide a detailed histopathologic description of six YAP1-fused poroid skin tumors, which we show harbor reproducible histopathologic features, to include broad, bulbous tumor tongues with admixtures of basaloid, poroid cells punctuated by squamatized cuticles and ductules, with uniform tumor nuclei featuring frequent grooves and pseudonuclear inclusions. Conclusions Awareness of the characteristic histopathologic features of YAP1-fused poroid adnexal skin tumor is a step toward a more reproducible classification of adnexal skin tumors as well as a step toward targeted therapy for metastatic and/or unresectable examples of this poroid group of neoplasms.

espanolEl numero de diagnosticos de tumores de piel no melanoma es mayor que el numero de diagnosticos del resto de tumores juntos, por lo que conocerlos es fundamental para la practica clinica diaria. Ademas, su incidencia esta creciendo debido sobre todo al aumento de la esperanza de vida y la consiguiente acumulacion de exposicion solar. Los mas habituales son las neoplasias queratinociticas (carcinoma basocelular y espinocelular) y mucho menos frecuentes los linfomas cutaneos, carcinoma de celulas de Merkel, sarcoma de Kaposi, angiosarcomas, enfermedad de Paget e histiocitoma maligno. Repasaremos las caracteristicas principales de los dos tipos mas frecuentes, ya que se trata de tumores potencialmente curables en los estadios iniciales, por lo que su diagnostico y tratamiento temprano resulta fundamental. EnglishThe number of nonmelanoma skin tumor diagnoses is greater than the number of diagnoses of other tumors combined. Therefore, knowledge of this entity is fundamental to daily clinical practice. In addition, its incidence is increasing, mostly due to the increase in life expectancy and resulting accumulation of sun exposure. The most common tumors are keratinocytic neoplasms (basal cell and squamous cell carcinoma). Much less common are skin lymphomas, Merkel cell carcinoma, Kaposi sarcoma, angiosarcomas, Paget's disease, and malignant fibrous histiocytoma. We review the main characteristics of the two most common types, as they are tumors which are potentially curable in their initial stages and as such, early diagnosis and treatment are key.

Das Auftreten multipler gutartiger Hauttumoren ist verdachtig auf ein hereditares Tumorsyndrom. Genetische Untersuchungen klaren oft die molekularen Grundlagen und ermoglichen eine nosologische Einordnung. Im vorliegenden Fall einer kutanen Polypose wurde eine Variante in APC detektiert, gleichzeitig fehlten jedoch Symptome einer adenomatosen Polypose des Kolons.

Merkel cell carcinoma (MCC) is a neuroendocrine skin tumor with an unpredictable evolution and high metastatic potential. It usually occurs in the elderly people with long-term sun exposure or weak immune systems. The avidity of MCCs for 18F-flourodeoxyglucose justifies the use of positron emission tomography for its staging.

Introduction: Merkel cell carcinoma (MCC) is an aggressive skin tumor of neuroendocrine origin that derives from Merkel cells and occurs predominantly on the head or neck of elderly individuals at an average age of 69 years old. Its main risk factors are immunosuppression and ultraviolet exposure. The diagnosis is established on the histological aspect and completed by immunohistochemistry. Case Report: We report the case of a 65-year-old female patient, with no particular antecedents, who had right axillary swelling. Thoracic computed tomography (CT) showed a large right axillary mass of irregular contours, lobulated, heterogeneously enhanced after CP injection with central hypodense zone of necrosis. The confrontation of the morphological aspect and the results of the immunohistochemistry carried out made it possible to retain the diagnosis of Merkel cell carcinoma. Conclusion: Merkel cell carcinoma is a very aggressive cancer of the elderly. In case of doubt, a biopsy for histological confirmation should be performed. The therapy is usually based on a radical surgery followed by adjuvant radiotherapy.

Cancer is one of the most catastrophic human genetic diseases. Experimental animal cancer models are essential for gaining insights into the complex interactions of different cells and genes in tumor initiation, promotion, and progression. Mouse models have been extensively used to analyze the genetic basis of cancer susceptibility. They have led to the identification of multiple loci that confer, either alone or in specific combinations, an increased susceptibility to cancer, some of which have direct translatability to human cancer. Additionally, wild-derived inbred mouse strains are an advantageous reservoir of novel genetic polymorphisms of cancer susceptibility genes, because of the evolutionary divergence between wild and classical inbred strains. Here, we review mapped Stmm (skin tumor modifier of MSM) loci using a Japanese wild-derived inbred mouse strain, MSM/Ms, and describe recent advances in our knowledge of the genes responsible for Stmm loci in the 7,12-dimethylbenz(a)anthracene (DMBA)/12-O-tetradecanoylphorbol-13-acetate (TPA) two-stage skin carcinogenesis model.

A 46-year-old woman presented with facial pain and discomfort. Diagnosis of subcutaneous dirofilariasis was reached after several months from symptom onset. Dirofilariasis should be suspected, also in non-endemic areas, in patients with a migrating subcutaneous nodule. Plastic surgery is preferred, as the face is often involved.

Phenformin is a drug in the biguanide class that was previously used to treat type 2 diabetes. We have reported the anti-tumor activities of phenformin to enhance the efficacy of BRAF-MEK-ERK pathway inhibition and to inhibit myeloid-derived suppressor cells in various melanoma models. Here we demonstrate that phenformin suppresses tumor growth and promotes keratinocyte differentiation in the DMBA/TPA two stage skin carcinogenesis mouse model. Moreover, phenformin enhances the suspension-induced differentiation of mouse and human keratinocytes. Mechanistically, phenformin induces the nuclear translocation of NFATc1 in keratinocytes in an AMPK-dependent manner. Pharmacological or genetic inhibition of calcineurin/NFAT signaling reverses the effects of phenformin on keratinocyte differentiation. Taken together, our study reveals an anti-tumor activity of phenformin to promote keratinocyte differentiation that warrants future translational efforts to repurpose phenformin for the treatment of cutaneous squamous cell carcinomas.

Based on molecular evidence that melanomas with unknown primary (MUPs) arise from the skin, we hypothesised that sites of MUPs are disproportionately on trunk and lower limbs, sites that are not readily visible to patients and clinicians. We tested this hypothesis by inferring the anatomic site of origin of MUPs from the corresponding known cutaneous sites of melanoma patients with known primary tumours (MKPs). We analysed data from three separate cohorts of patients from Brisbane, Australia (n = 236); Manchester, UK (n = 51) and Padova, Italy (n = 33), respectively, who first presented with stage III melanoma with lymph node metastases. We matched two MKP patients to each MUP patient based on lymph node dissection (LND) site, age and sex, and imputed cutaneous sites of origin of MUPs from their two matched MKPs for study countries, giving two possible sites for each MUP per centre. Overall, results showed that MUP patients were predominantly male, and trunk was the most likely origin, comprising around a third to a half of MUPs across the three cohorts. The remaining MUP inferred sites varied by country. In the Australian cohort, the legs accounted for a third of imputed sites of MUPs, while in the UK and Italian cohorts, the most frequent site was the arms followed by the legs. Our findings suggest the need for regular and thorough skin examination on trunk and limbs, especially in males, to improve early detection of cutaneous melanoma and reduce the risk of metastatic disease at the time of presentation. © 2022 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

Keratoacanthoma (KA) is a low grade, rapidly growing skin tumor which is thought to originate from the pilosebaceous unit from hyperkeratosis of the infundibulum and are often thought to originate on hair bearing skin or sun exposed surfaces. There are very scarce reports demonstrating they may occur in other areas such as mucous membranes or soles of the feet. We present a rare case of palmar KA in a 65-year-old female with no known antecedent history. Surgical excision was performed with complete removal of the tumor. Following surgical excision, the pathology of the irregularly elevated 0.7 x 0.2 cm lesion revealed a keratoacanthoma. The patient remained without evidence of recurrence at one year follow-up. We believe there is only one other report of isolated palmar KA to date in the literature. We review relevant literature on hand KA.

Primary cribriform carcinoma of the skin is an indolent, rare, adnexal tumor. Although its malignant potential remains uncertain, no recurrence or metastasis has been reported. A 33-year-old man presented with a solitary, erythematous, subcutaneous nodule on the right knee. The clinical impression was epidermal cyst, and the resected tumor demonstrated a well-circumscribed mass in the dermis and subcutis. The tumor was composed of two regions: a solid component and a cribriform component. The solid component (90%) showed multiple solid nests of epithelial cells. Individual cells had large, oval-to-round, hyperchromatic, pleomorphic nuclei with a nuclear groove. The cribriform component (10%) showed similar neoplastic cells with many prominent lumina. Some lumina had an eosinophilic substance that exhibited a positive periodic acid-Schiff reaction. No recurrence or metastasis was observed within a follow-up period of eight months after excision. In conclusion, we report the first case of primary cribriform carcinoma of the skin in Korea.

Primary gastric melanoma is an extremely rare disease. Melanoma of upper gastrointestinal tract usually occurs as metastasis from a primary skin tumor in 1 to 4 % of cases. The paper describes a case report of primary gastric melanoma in a female patient who received complex therapy at the State Healthcare Institution Ulyanovsk Regional Clinical Oncology Dispensary.

Background. Diagnoses of Skin diseases are frequently delayed in China due to lack of dermatologists. A deep learning-based diagnosis supporting system can facilitate pre-screening patients to prioritize dermatologists’ efforts. We aimed to evaluate the classification sensitivity and specificity of deep learning models to classify skin tumors and psoriasis for Chinese population with a modest number of dermoscopic images. Methods. We developed a convolutional neural network (CNN) based on two datasets from a consecutive series of patients who underwent the dermoscopy in the clinic of the Department of Dermatology, Peking Union Medical College Hospital, between 2016 and 2018, prospectively. In order to evaluate the feasibility of the algorithm, we used two datasets. Dataset I consisted of 7192 dermoscopic images for a multi-class model to differentiate three most common skin tumors and other diseases. Dataset II consisted of 3115 dermoscopic images for a two-class model to classify psoriasis from other inflammatory diseases. We compared the performance of CNN with 164 dermatologists in a reader study with 130 dermoscopic images. The experts’ consensus was used as the reference standard except for the cases of basal cell carcinoma (BCC), which were all confirmed by histopathology. Results. The accuracies of multi-class and two-class models were 81.49% ± 0.88% and 77.02% ± 1.81%, respectively. In the reader study, for the multi-class tasks, the diagnosis sensitivity and specificity of 164 dermatologists were 0.770 and 0.962 for BCC, 0.807 and 0.897 for melanocytic nevus, 0.624 and 0.976 for seborrheic keratosis, 0.939 and 0.875 for the “others” group, respectively; the diagnosis sensitivity and specificity of multi-class CNN were 0.800 and 1.000 for BCC, 0.800 and 0.840 for melanocytic nevus, 0.850 and 0.940 for seborrheic keratosis, 0.750 and 0.940 for the “others” group, respectively. For the two-class tasks, the sensitivity and specificity of dermatologists and CNN for classifying psoriasis were 0.872 and 0.838, 1.000 and 0.605, respectively. Both the dermatologists and CNN achieved at least moderate consistency with the reference standard, and there was no significant difference in Kappa coefficients between them (P > 0.05). Conclusions. The performance of CNN developed with relatively modest number of dermoscopic images of skin tumors and psoriasis for Chinese population is comparable with 164 dermatologists. These two models could be used for screening in patients suspected with skin tumors and psoriasis respectively in primary care hospital.

Malignant melanoma is the skin tumor that causes most deaths in Germany. At an early stage, melanoma is well treatable, so early detection is essential. However, the skin cancer screening program in Germany has been criticized because although melanomas have been diagnosed more frequently since introduction of the program, the mortality from malignant melanoma has not decreased. This indicates that the observed increase in melanoma diagnoses be due to overdiagnosis, i.e. to the detection of lesions that would never have created serious health problems for the patients. One of the reasons is the challenging distinction between some benign and malignant lesions. In addition, there may be lesions that are biologically equivocal, and other lesions that are classified as malignant according to current criteria, but that grow so slowly that they would never have posed a threat to patient's life. So far, these "indolent" melanomas cannot be identified reliably due to a lack of biomarkers. Moreover, the likelihood that an in-situ melanoma will progress to an invasive tumor still cannot be determined with any certainty. When benign lesions are diagnosed as melanoma, the consequences are unnecessary psychological and physical stress for the affected patients and incurred therapy costs. Vice versa, underdiagnoses in the sense of overlooked melanomas can adversely affect patients' prognoses and may necessitate more intense therapies. Novel diagnostic options could reduce the number of over- and underdiagnoses and contribute to more objective diagnoses in borderline cases. One strategy that has yielded promising results in pilot studies is the use of artificial intelligence-based diagnostic tools. However, these applications still await translation into clinical and pathological routine.

BACKGROUND: Youzhi artificial intelligence (AI) software is the AI-assisted decision-making system for diagnosing skin tumors. The high diagnostic accuracy of Youzhi AI software was previously validated in specific datasets. The objective of this study was to compare the performance of diagnostic capacity between Youzhi AI software and dermatologists in real-world clinical settings. METHODS: A total of 106 patients who underwent skin tumor resection in the Dermatology Department of China-Japan Friendship Hospital from July 2017 to June 2019 and were confirmed as skin tumors by pathological biopsy were selected. Dermoscopy and clinical images of 106 patients were diagnosed by Youzhi AI software and dermatologists at different dermoscopy diagnostic levels. The primary outcome was to compare the diagnostic accuracy of the Youzhi AI software with that of dermatologists and that measured in the laboratory using specific data sets. The secondary results included the sensitivity, specificity, positive predictive value, negative predictive value, F-measure, and Matthews correlation coefficient of Youzhi AI software in the real-world. RESULTS: The diagnostic accuracy of Youzhi AI software in real-world clinical settings was lower than that of the laboratory data (P 

Background/Objectives: Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare skin tumor. The head and neck (H&N) is the most common anatomical location. Due to limited published cases, its clinical course and management are not well understood. Methods: The National Cancer Database (NCDB) was queried for all cases of H&N PCACC diagnosed from 2004 to 2016. Kaplan–Meier (KM) and Cox proportional hazards models were used to determine clinicopathological and treatment factors associated with survival outcomes. Results: A total of 201 cases were analyzed. The average age of diagnosis was 57.7 years (± SD 15.8). There was a female predilection (57.7%; P Conclusion: This study represents the largest cohort of H&N PCACC studied to date and provides important clinicopathologic information for this rare tumor. Additionally, our results emphasize the importance of health insurance as an independent predictor of survival in PCACC.

The current paradigm holds that the inhibition of Rho guanosine nucleotide exchange factors (GEFs), the enzymes that stimulate Rho GTPases, can be a valuable therapeutic strategy to treat Rho-dependent tumors. However, formal validation of this idea using in vivo models is still missing. In this context, it is worth remembering that many Rho GEFs can mediate both catalysis-dependent and independent responses, thus raising the possibility that the inhibition of their catalytic activities might not be sufficient per se to block tumorigenic processes. On the other hand, the inhibition of these enzymes can trigger collateral side effects that could preclude the practical implementation of anti-GEF therapies. To address those issues, we have generated mouse models to mimic the effect of the systemic application of an inhibitor for the catalytic activity of the Rho GEF Vav2 at the organismal level. Our results indicate that lowering the catalytic activity of Vav2 below specific thresholds is sufficient to block skin tumor initiation, promotion, and progression. They also reveal that the negative side effects typically induced by the loss of Vav2 can be bypassed depending on the overall level of Vav2 inhibition achieved in vivo. These data underscore the pros and cons of anti-Rho GEF therapies for cancer treatment. They also support the idea that Vav2 could represent a viable drug target., XRB is supported by grants from Worldwide Cancer Research (14-1248), the Castilla-León Government (CSI252P18, CLC-2017-01), the Spanish Ministry of Science and Innovation (MSI) (RTI2018-096481-B-I00), and the Spanish Association against Cancer (GC16173472GARC). XRB’s institution is supported by the Programa de Apoyo a Planes Estratégicos de Investigación de Estructuras de Investigación de Excelencia of the Castilla-León autonomous government (CLC-2017-01). SF, SR-F, and LFL-M contracts have been supported by funding from the MSI (SF, BES-2010-031386; SR-F, BES-2013-063573), the Spanish Ministry of Universities (LFL-M, FPU13/02923), and the CLC-2017-01 grant (SR-F and LFL-M). JR-V has been supported by the CIBERONC and, currently, by the Spanish Association against Cancer. Both Spanish and Castilla-León government-associated funding is partially supported by the European Regional Development Fund.

The present study was conducted to estimate the incidence, clinical findings, cytological and histopathological characteristics of spontaneously occurring skin neoplasms in dogs. A total of 40 grossly suspected cases of cutaneous and subcutaneous tumors were gathered during the period from July 2016 to August 2018 from male and female dogs in Baghdad city. Dogs with skin neoplasia revealed various clinical signs, and their ages were older than 5 years to 15 years. German shepherd 30% followed by Terrier dogs 25% were more influenced than other breeds. Concerning tumor features, the majority of neoplasms had solitary lesion 70%, regular shapes 65% with black color 55%. The tumors frequently occurred on fore-limbs and abdomen, and 80% of them lasted for 1-6 months. Cytological examination was valuable for initial evaluation of benign and malignant tumors. Its results were confirmed by the histopathology, in which the majority of neoplasms sized more than 5 cm and grade I. Nine different types of skin neoplasms were recognized, while 65% of them were malignant, the others were benign. Squamous cell carcinoma and adenocarcinomas were the most common comprising 35% and 25%, respectively.

Jacek Calik,1 Monika Migdal,1 Tomasz Zawada,2 Torsten Bove2 1Old Town Clinic, Wroc&lstrok;aw, Poland; 2TOOsonix A/S, Hoersholm, DenmarkCorrespondence: Torsten BoveTOOsonix A/S, Agern Alle 1, Hoersholm, DK-2970, Denmark, Tel +45- 2059 2999, Email torsten.bove@toosonix.comPurpose: High intensity focused ultrasound operating at 20 MHz has been demonstrated as a safe and efficient treatment modality for a range of dermatological indications. The method is potentially also applicable to removal of seborrheic keratosis.Patients and Methods: A total of 54 seborrheic keratoses in 11 volunteer subjects (8 women and 3 men, average age 51.5 ± 13.2 years) were treated in a single session with a medical 20 MHz high intensity focused ultrasound device developed for dermatological conditions. Handpieces with nominal focal depths of 0.8 mm below the skin surface were used to administer acoustic energy of 0.99– 1.2 J/dose. An integrated dermoscope in the handpiece was used to monitor the treatment in real-time. Treatment efficacy and side-effects were assessed directly after treatment and at follow-up 4– 15 weeks after treatment.Results: The treatment showed positive results in 96.3% of the cases. About 68.5% of the cases were classified as complete response and 27.8% of the cases as partial response. Two cases (3.7%) did not respond to treatment and were classified as stable condition. No subjects experienced worsening of their condition, and no treatment received the classification of progressive condition. Side effects were primarily redness in the treatment area due to superficial telangiectasia, mild scarring, and persisting and slow-healing lichen planus-like keratosis. No adverse events were observed.Conclusion: HIFU is concluded to be a safe and efficient skin treatment for seborrheic keratoses. It has advantages over conventional treatments that can lead to pain during treatment and scarring after healing.Keywords: seborrheic warts, solar lentigo, skin tumor, HIFU, dermoscopy, dermatology

Actinic keratosis (AK) is a carcinoma in situ that may progress into an invasive squamous cell carcinoma and, previously, it has been considered as a pre-cancerous lesion. Its prevalence is increasing, and it has been estimated worldwide to range between 1% and 44% of the adult population. The main risk factors for AK are advanced age, fair skin phototype and cumulative sun exposure. Treatment of AK consists of lesion-directed treatment to target single lesions (i.e., cryotherapy, curettage, electrocoagulation, and laser therapy) or field therapy to treat multiple AKs (i.e., photodynamic therapy (PDT), 5- Fluorouracil (5-FU), diclofenac sodium (DIC), imiquimod (IMQ), ingenol mebutate (Ing Meb)). The choice of therapy depends on the number and localization of AKs, patient’s condition, and the patient's tolerability and compliance. In this survey we provided data from one hundred and ten Italian dermatologists regarding knowledge and attitude towards different therapeutic approaches specific for AK. In our study, we observed that the most frequent treatments for AK are cryotherapy and PDT while surgery and laser therapy are the less frequently utilized. The most frequent topical therapies utilized are DIC and IMQ 3.75% cream compared to IMQ 5% cream, Ing Meb, and 5-FU. Choice the correct treatment for AK can be challenging but the adherence to therapy plays a key role to obtain good results. Considering the high and progressive increase in incidence of AK, it is crucial to improve the knowledge of different therapeutic approaches among dermatologists.

Background Dermatofibrosarcoma protuberans (DFSP) is an invasive skin tumor traditionally associated with very high recurrence rates when treated with conventional surgery (CS). Objective To calculate the minimum margin that would have been required to achieve complete tumor clearance with hypothetical CS. To analyze DFSP characteristics and Mohs micrographic surgery (MMS) effectiveness in treatment of this tumor. Materials and methods Minimum margin was calculated by measuring the largest distance from the visible edge of the tumor to the edge of the surgical defect. Tumor variables (age, sex, size, time since onset, and location) were correlated with surgical variables (number of stages and minimum margin). Results We studied 222 cases of DFSP treated with MMS. A mean of 1.47 MMS stages and a mean minimum margin of 1.23 cm were required to achieve tumor clearance. Tumors on the head and neck required significantly more stages and a significantly wider margin. Tumor size was positively correlated with time to diagnosis, age, and number of MMS stages. Conclusion Tumors located on the head and neck have greater subclinical extension. Tumor size was also a predictor of surgical difficulty, but time to diagnosis was not.

Pilomatricomas are rare skin tumors related to hair follicles. They typically present in children, and the most common locations are head and neck. Pilomatricomas are usually painless; however, they can cause cosmetic problems. Treatment is decided on an individual basis and involves local excision. However, caution should be taken if the lesion is malignant, as resection with safe margins (0.5-1.0 cm) is determinant of the overall outcome. Radiotherapy is indicated in cases of residual tumor tissue or recurrence. The role of chemotherapy in pilomatricomas is still undetermined. We report a 55-year-old female with multiple lumps on her shoulder and back. The sonographic features of these lesions were typically consistent with pilomatricomas. The patient decided to opt for excision due to cosmetic reasons and the histopathology features were suggestive of pilomatricoma.

Nevus is a benign melanocytic neoplasm and the most common type of skin tumor. It may occur anywhere on the skin, but it is rare in the external auditory canal (EAC). We present a case of melanocytic nevus in the EAC with keratin accumulation. In microscopic surgery, the mass was excised completely, and the wax and keratin material medial portion of the EAC behind the mass was removed. In this patient, a melanocytic nevus in the EAC caused symptoms of hearing loss and wax and keratin buildup. For melanocytic nevus in the EAC, excision and pathologic confirmation should be performed if there are symptoms or when malignant transformation is suspected.

Seborrhoeic keratosis is a common benign skin tumor and can have a variable presentation. Irritated seborrhoeic keratosis can clinically mimic cutaneous malignancy and often warrant biopsy. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET-CT) can give false-positive results in many cutaneous pathologies. We present an interesting case of irritated seborrhoeic keratosis masquerading as skin cancer, clinically as well as on18F-FDG PET-CT.

Cutaneous malignant melanoma is a rapidly progressing skin tumor accounting for most deaths from skin malignancies. Four morphological variants (nodular, superficial spreading, lentigo maligna, and acral lentiginous) are described in the literature. Here we are reporting malignant melanoma in a 35-year-old male who presented with depigmented plaques with few hyperpigmented areas and extensive overlying scaling. The patient progressed to the nodular stage within 2 weeks and succumbed to death during chemotherapy. We are reporting such rare presentation of malignant melanoma to create awareness among dermatologists to avoid misdiagnosis and delayed treatment which can lead to rapid progression and fatal outcome.

Nodular hidradenoma is a rare benign adnexal tumor. It is most frequently encountered in the head and neck region, trunk, and extremities. This tumor exhibits a high recurrence rate, and an association with malignancy.Many names have been used to describe this pathology.We report the case of a nodular hidradenoma in a 30-year-old moroccan woman who presented with a 2-year history of a swelling in her right preauricular region. Histological examination revealed the typical appearance of a nodular hidradenoma. The tumor was excised and one year after the initial presentation, there was no sign of recurrence. We emphasize the importance of wide surgical excision with appropriate margins to prevent local recurrence. A close follow up of the patients is recommended., Highlights • Nodular hidradenoma is a rare benign adnexal tumor. Itis most frequently encountered in the head and neck region, trunk, and extremities. • This tumor exhibit a high recurrence rate, and an association with malignancy. • We emphasize the importance of wide surgical excision with appropriate margins to prevent local recurrence. A close follow up of the patients is recommended.

BackgroundTrichilemmal carcinoma (TC) is a rare malignancy of cutaneous adnexal carcinoma, with only 136 cases reported in the literature to date. It usually has an indolent course and benign clinical evolution, and only four cases with regional and distant metastasis have been reported. Tumor cells present with the characteristics of trichilemmal differentiation on both histological and immunohistological examination.Case PresentationWe report a case of TC on the scalp with an aggressive course and metastasis to the ipsilateral neck. Moreover, the lesions presented with two distinct histological morphologies.ConclusionDespite an indolent course and benign clinical evolution, TC has the potential for local invasion and recurrence, which implies that accurate early diagnosis and careful follow-up are very important for these patients. More than one specimen should be obtained for histopathological examinations when the lesion is very large and characterized by different morphologies.

Halo nevi, known as leukoderma acquisitum centrifugum, Sutton nevus, leukopigmentary nevus, perinevoid vitiligo, or perinevoid leukoderma, together with vitiligo and melanoma-associated hypopigmentation, belong to the group of dermatoses designated as immunological leukodermas. The etiology and pathogenesis of halo nevi has not been fully elucidated. There are several mechanisms through which a lymphocytic infiltrate can induce tumoral regression. In this review, we aimed to update the knowledge about Sutton nevi starting with the clinical appearance and dermoscopic features, continuing with information regarding conventional microscopy, immunohistochemistry, and the immunological mechanisms responsible for the occurrence of halo nevi. We also included in the article original unpublished results when discussing dermoscopic, pathologic and immunohistochemical results in halo nevi. Sutton nevi are valuable models for studying antitumor reactions that the human body can generate. The slow and effective mechanism against a melanocytic skin tumor can teach us important lessons about both autoimmune diseases and anticancer defenses.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare reactive angio-proliferative lesion. ALHE was initially classified as the late stage of Kimura’s disease (KD), although studies later showed that they were two separate clinical entities. Diagnosing ALHE remains a clinical challenge. Here, we report a case of ALHE in a young man and review current literature with an emphasis on how to distinguish ALHE particularly from KD. A 26-year-old man presented with a subcutaneous nodule in right infra-auricular area. Recurrence had occurred after three surgical excisions. Neither enlargement of salivary glands nor lymph nodes were found. Hematological examinations and renal function were normal. The mass was removed surgically. Microscopic examination showed proliferation of vascular channels with accompanying mixed inflammatory infiltrate consisting of lymphocytes, plasma cells, and eosinophils. Based on clinical data and histopathological examination, the patient was diagnosed with ALHE. Several clinical features differ between ALHE and KD, such as gender predilection, hypereosinophilia, IgE levels, and renal involvement. However, clinical features can overlap, so definitive diagnosis relies on histopathological examination. The most important hallmark of ALHE is vascular proliferation with epithelioid endothelial cells. Distinguishing ALHE from KD is important due to the lack of systemic manifestations in ALHE. However, ALHE can be easily mistaken for other diseases due to its rarity. Careful microscopic examination is very important to distinguish ALHE from KD and other mimicking lesions.

The diagnosis of pilomatricoma, the most common matrical tumor, is generally straightforward; however, it exhibits diverse histology associated with various morphological stages and several clinical variants, and matrical differentiation can occur in various neoplastic diseases. A 56-year-old man was admitted to our hospital to resect an 11.0-cm skin tumor on his right shoulder. Because of its large size and surface irregularities, including multiple erosions and ulcers, cutaneous malignancies were clinically suspected. Histologically, the tumor formed numerous nodules with marked matrical differentiation in the superficial to deep dermis. Although the tumor was macroscopically asymmetrical and irregular, each nodule was microscopically round-shaped and consisted of basaloid cells without marked atypia, atypical mitoses, or lymphovascular invasion. Immunohistochemically, the tumor cells were positive for beta-catenin, LEF-1, and PHLDA-1, consistent with their pilomatrical differentiation. We diagnosed the case as a giant pilomatrical tumor with uncertain malignant potential, considering its "contradictory" features, namely, the worrisome histoarchitecture, such as the asymmetrical silhouette, but bland-looking cytological appearance. Unlike typical pilomatrical tumors, this tumor contained numerous epidermal components with features similar to those of the dermal components, resulting in a unique macroscopic and histological appearance. Our case broadens the known histological diversity of pilomatrical tumors.

Merkel cell carcinoma is a rare neuroendocrine skin tumor with a poor prognosis. Metastasis is frequent and is seen in the first few years after diagnosis. This report describes a case of renal metastasis from Merkel cell carcinoma which is an unusual clinical presentation.

Multiple primary tumors are uncommon in patients with squamous cell esophageal cancer. Conventional imaging methods have limitations in detecting those tumors. Although 18-F-fluoro-deoxyglucose-positron emission tomography scanner increases the detection of multiple synchronous tumors in patients with other malignancies, its contribution in patients with squamous cell esophageal cancer has not been assessed as it is not systematically performed. The detection of synchronous skin squamous cell tumors in patients with squamous cell esophageal cancer presents a challenge for making diagnostic and therapeutic decisions. A metastatic tumor leads to palliative management, whereas the diagnosis of a primary skin tumor requires curative treatment of both squamous cell tumors. Pathological evaluation appears crucial in the decision.

Nevus lipomatosis cutaneous superficialis (NLCS) is a rare hamartoma of mature adipose tissue. There are two main clinical variants: one with multiple lesions that are usually presented in a segmental distribution, and another variant with a solitary papule or nodule. However, rare cases have also been published to describe other clinical presentations, such as giant NLCS, NLCS with multiple open comedones, and NLCS with ulcerations and necrosis. One report has described increased hair growth over the nevus. The present report describes a case of a child with NLCS with an unusual presentation of overlying hypertrichosis.

Background: Basal cell carcinoma (BCC) is a malignant, slow growing, and locally invasive skin tumor. Advanced and neglected BCC may invade adjacent structures. The 5-year recurrence rates of facial BCCs are 4.1% after excision and 2.5% after Mohs Micrographic Surgery (MMS) . The number of BCC cases invading the bones of the head and neck region is limited. Case Illustration: A 75-year-old male complained of bleeding and ulcer enlargement on the right cheek expanding to the right nasal ala for 1 month. The patient had a history of an enlarged and painful lenticular nodule with a hyperpigmented spot that appeared 10 years ago on the right cheek and was diagnosed as BCC. The patient was treated with a wide excision having a negative pathological margin 3 years ago. He noticed that the similar lesion reappeared at the same location 2.5 years ago. Post-operative histopathological results showed nodular infiltrative BCC and maxillary bone invasion. Discussion: Based on history taking, physical examination, and diagnostic evaluation, the diagnosis of the patient was recurrent nodular infiltrative BCC. The final histopathology confirmed that tumor cells invaded the maxillary bone. After considering the treatment options, the patient opted to proceed with radiotherapy. Conclusion: Recurrent nodular BCC with invasion to the maxillary bone is a rare and interesting case. Among 140 BCC cases that we treated with MMS in our hospital from June 2014 to September 2019 , this case is the first recurrent BCC with maxillary bone invasion. Keywords: basal cell carcinoma, skin tumor, MMS, bone invasion

The prevalence of liver and skin tumors in brown bullhead ( Ameiurus nebulosus) from the Anacostia River (Washington, DC) and nearby areas was determined in 2014, 2015, and 2016. The objectives were to (1) compare tumor prevalence across space and time; (2) analyze the 1992–2016 Chesapeake Bay Tumor Database to identify reference locations and test age, length, weight, and sex as covariates; and (3) explore whether changes in bullhead exposure to contaminants can explain the observed trends. With logistic regression, we reported large statistically significant decreases in liver tumor probabilities in bullheads from the Anacostia CSX Bridge (ANAC) area between 1996 and 2001 (merged: female, 77.8%; male, 48.6%), 2009 to 2011 (female, 42.5%; male, 16.6%), and 2014 to 2016 (female, 18.0%; male, 5.7%). Skin tumors decreased by a factor of six in both females and males. Polycyclic aromatic compounds (PAC) initiate liver neoplasms and polychlorinated biphenyls (PCBs) and DDT compounds are promoters. The causes of skin tumors in bullhead are uncertain. Biomarker and tissue data show decreases in PAC-DNA adducts and PCB and DDT contamination in ANAC bullheads. It is likely that the decreased liver tumor prevalence is associated with decreased exposure to these contaminants.

Skin cancer is one of the dangerous form of cancer spreading vigorously among humans, so its early detection is very important for further treatment. Theoretical study on skin tumor detection using long-pulsed infrared thermal wave testing technology (LP-ITWTT) has been carried out. The working principle of LP-ITWTT was described. The 3-D thermal model for skin tumor using LP-ITWTT was established and calculated. The effect of tumor geometry size including radius, depth and thickness to the measurement parameter Cmax is studied, and the influence law has been got, which can provide a theoretical basis for the diagnosis of skin tumors using LP-ITWTT.

Background Melanoma is a lethal skin malignancy with a high risk of metastasis, which prompts a need for research on treatment targets and prognostic factors. Recent studies show that the presence of neuroblastoma RAS viral oncogene homolog (NRAS) mutation can influence cell growth in melanomas. The NRAS mutation, which stimulates the mitogen‐activated protein kinase (MAPK) signaling pathway, is associated with a lower survival rate. However, evidence from Indonesia population is still very rare. Further understanding of the role of NRAS mutations in Indonesian melanoma cases will be crucial in developing new management strategies for melanoma patients with NRAS mutations. Aims To explore the frequency of NRAS mutations and their clinicopathological associations in patients with primary nodular cutaneous melanoma in Central Java and Yogyakarta, Indonesia. Methods and results Fifty‐one paraffin‐embedded tissue samples were collected from primary nodular skin melanoma cases between 2011 and 2019 from the two largest referral hospitals in Yogyakarta and Central Java, Indonesia. The NRAS mutation status was evaluated using qualitative real‐time polymerase chain reaction (qRT‐PCR). The association of NRAS mutation was analyzed with the following: age, gender, location, lymph node metastasis, ulceration, mitotic index, tumor‐infiltrating lymphocytes (TILs), necrosis, tumor thickness, lymphovascular invasion (LVI), and tumor size. NRAS mutations were detected in 10 (19.6%) samples and predominantly observed (60%) in exon 2 (G12). These mutations were significantly correlated with lymph node metastases (p = .000); however, they were not associated with other variables analyzed in this study. Conclusions The prevalence of NRAS mutations in primary nodular cutaneous melanoma cases from Indonesia is consistent with previous studies and is significantly associated with increased lymph node metastases. However, the predominant mutation detected in exon 2 (G12) is different from previous studies conducted in other countries. This suggests that melanoma cases in Javanese people have different characteristics from other ethnicities.

This review presents some methods applied to micro-FTIR imaging for classification of human skin tumors. It is a collection of the pre-processing pipeline and machine learning classification models. The aim of this review is to update and summarize the current methods which are applied in our skin tumor research.