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Background Methods Results Conclusions While electrochemotherapy (ECT) is increasingly utilized as a highly effective method in the treatment of tumors in the head and neck region, there is significantly less data available for eyelid‐periocular skin tumors. Our group reported the first extensive case series of eyelid‐periocular basal cell carcinoma (BCC) patients with short‐term follow‐up treatment with ECT. The present study aims to report our long‐term results of eyelid‐periocular BCC cases treated with ECT.The treatments were performed according to the ESOPE (European Standard Operating Procedures on Electrochemotherapy) guidelines using the Cliniporator™ device. All patients received bleomycin‐based ECT, administered intratumorally or intravenously. Tumor response was evaluated using the RECIST 1.1 criteria.The results of 19 patients treated with ECT are presented. Four patients had locally advanced primary tumors, while 15 patients had recurrent tumors. Bleomycin was administered intratumorally in four patients and intravenously in 15 patients. The overall response was 100%, while the complete response rate proved to be 95%. In three cases (15.8%), recurrence was observed during the mean follow‐up period of 78.9 months.ECT can effectively treat locally advanced or recurrent BCC in the eyelid‐periocular skin region. Excellent tumor control can be achieved with good functional and cosmetic results without systemic adverse events with long interval follow‐up. [ABSTRACT FROM AUTHOR]

Background: Adnexal tumors of the skin are rare neoplasms that encompass a wide range of dermatologic entities. Here, we investigated the pattern of adnexal tumors of the skin in the All African Leprosy and Tuberculosis Rehabilitation and Training Center (ALERT) hospital retrospectively. Methods: A hospital‐based retrospective study was conducted at ALERT from histopathology records in the Armauer Hansen Research Institute (AHRI) pathology laboratory of patients diagnosed with any of the skin adnexal tumors during the time period January 2017 to December 2021. A structured data extraction sheet was used. Data entry was done using EpiData 4.6.0.6. Data were analyzed using SPSS version 25. Result: A total of 146 skin adnexal tumors were identified making the magnitude 2.8% of total biopsies. The 3rd decade of life was found to be the most common age group. Male‐to‐female ratio was 1 : 1.05. Majority of the tumors were benign (82.2%) and had sweat gland differentiation at 48.6%. Poroma (10.9%) was the most frequent tumor, whereas porocarcinoma (6.8%) made up the most frequent malignant tumor. The most common site was the head and neck region (48.6%). Only 21.2% of the tumors were correctly identified clinically. Conclusion: The magnitude of skin adnexal tumors is found to be slightly higher than other similar studies which could be because it was carried out in the largest dermatologic center in the country. The most common skin adnexal tumors identified, their localizations, and lines of differentiation are all in line with other studies. Histopathologic examination is mandatory for the accurate diagnosis of these tumors. [ABSTRACT FROM AUTHOR]

It is well known that adnexal skin tumors can simulate other cutaneous neoplasia and that various types of benign and malignant skin tumors can develop or modify during pregnancy. Here, we report a case of trichoblastoma mimicking a keratoacanthoma arising in a nevus sebaceous during pregnancy. Given its unique clinical and dermoscopic features, this case highlights the pivotal role of clinicopathological correlation in the diagnosis of adnexal tumors with an atypical clinical presentation. [ABSTRACT FROM AUTHOR]

The article discusses a case of epidermolytic epidermal nevus on the genitalia caused by a mosaic KRT10 mutation in a 17-year-old male. The patient presented with verrucous skin lesions over the foreskin, shaft, scrotum, and perineum, with histopathologic features consistent with epidermolytic hyperkeratosis. The mutation was found to be somatic and not present in the germline DNA, indicating a de novo occurrence. The article highlights the importance of genetic testing in cases of epidermal nevi with features of epidermolytic hyperkeratosis for accurate diagnosis and counseling on potential transmission risks. [Extracted from the article]

This article discusses a case study of a 32-year-old female who presented with cobblestone-like plaques on her lower extremity, resembling elephantiasis. The patient had previously undergone dermatoplasty for suspected elephantiasis, but the current lesions were found to be eccrine syringofibroadenoma (ESFA), a rare cutaneous adnexal neoplasm. The histopathological examination revealed anastomosing epithelial strands extending from the epidermis into the dermis, with ductal differentiation. The authors suggest that the ESFA in this case may be reactive to the scars, chronic inflammation, and lymphedema. The recommended treatment is complete excision, but unfortunately, the patient was lost to follow-up. The article also discusses the potential risk factors for skin tumors, such as cutaneous trauma and the role of cicatrization and chronic inflammation in tumorigenesis. [Extracted from the article]

The tumors categorized according to their origin were more frequently related to the sweat gland (184 tumors, 45%), followed by the hair follicle and the sebaceous gland (139 tumors [34%] and 85 tumors [21%], respectively) (Fig. Follicular CAT are often diagnosed clinically; however, eccrine and sebaceous gland tumors are often diagnosed by the histopathological findings.3,4 The low frequency of malignant CAT is reported in all consulted studies, rendering 2.3-3.3% of skin adnexal tumors1,2; we reported a prevalence of 3.5%. The skin adnexa are complex units derived from the ectoderm, structured by specific cells including several intricate functions and the site of origin of diverse tumors.1 Most of these neoplasms are benign, although malignant growths can also arise but are unusually seen in clinical settings.2 Most cutaneous adnexal tumors (CAT) have similar morphology, and this is probably due to the common origin of skin adnexa1,3; therefore, the final diagnosis often depends on the histopathological study. [Extracted from the article]

Background: The COVID‐19 pandemic required the setting of a national lockdown in Italy from March 9, 2020, until May 18, 2020; therefore, most of the non‐COVID‐19 activities were postponed. As a consequence, many follow‐up visits in patients with previously excised skin cancers were delayed. The aim of this retrospective real‐life case–control study is demonstrating that delay in follow‐up led to an increased incidence of advanced melanoma and keratinocyte cancers on the total of surgically excised skin cancers. Methods: The incidence of excised advanced melanoma and keratinocyte cancers in our dermato‐surgery division in the period May 18 to November 18, 2020, was compared to the same time span of 2019. All data were collected from the electronic database of our department. Odds ratio with 95% confidence interval was used to assess the risk of excised advanced skin cancers in 2020 compared to 2019. Results: From May to November 2019, we performed 265 surgical excisions, while during the pandemic in 2020, we completed 280 surgeries. The number of advanced skin cancers excised between May 18 and November 18, 2020, was significantly higher compared with the same period in 2019 (54 vs. 22, OR: 2.64; 95% CI: 1.56–4.47; P = 0.0003). Significant differences were also observed regarding the number of surgically removed advanced BCCs (OR 2.15; 95% CI 1.14–4.07; P = 0.0187) and advanced SCCs (OR 4.60; 95% CI 1.31–16.18; P = 0.0175). Conclusion: These results confirm that delay in follow‐up and, consequently, postponed surgical excisions are related to an increased incidence of advanced skin tumors, resulting in poorer prognosis lifelong. Follow‐up visits should be carried on even during COVID‐19 pandemic, avoiding significant delays as much as possible. [ABSTRACT FROM AUTHOR]

A biopsy of the nodule was taken which showed groups of basaloid cells with neighboring eosinophilic ghost cells (Figure 2). The histopathology of the punch biopsied nodule showed eosinophilic ghost cells, a key indicator of pilomatricoma, adjacent to aggregated basaloid cells within granulomatous infiltrate (hematoxylin-eosin ×20) gl Discussion Pilomatricomas are rare benign skin tumors which originate in the matrix cells of hair follicles. Pilomatricoma, also known as pilomatrixoma, is a neoplasm derived from the germ cells of the hair matrix.[1] Pilomatricoma usually presents as a 0.5-3 cm lesion, often on the superficial skin of the head and neck region.[2] The typical clinical presentation of a pilomatricoma consists of a solitary, painless, well-circumscribed, flesh-colored or red/blue pigmented nodule on hair-bearing skin.[[1], [3]] When the lesion is >5 cm in diameter, it is classified as a giant pilomatricoma which accounts for <10% of all cases.[3] Pilomatricoma commonly presents in the second and seventh decade, which suggests a bimodal pattern of occurrence, and is most often treated by surgical excision.[[3]] Herein, we report a case of giant pilomatricoma that uniquely presented on the right buttock of a 44-year-old Hispanic female. [Extracted from the article]

Background: Depth of tissue injury in electrosurgery depends on generator power, electrode size, speed of electrode movement on tissue, and current delivery method. We sought to evaluate the depth of tissue injury associated with different methods of electrocoagulation in an effort to make electrocoagulation more reproducible. Methods: A knife‐shaped electrode was used to apply an electrosurgical current to the surface of a piece of bovine liver. Different electrosurgical methods were performed. Cross sections of the liver were then studied for tissue effect. Results: Fulguration provided only superficial coagulation. Contact electrocoagulation and electrodesiccation using the flat side of the electrode provided significantly deeper levels of coagulation and were associated with less smoke than fulguration. Desiccation provided the deepest tissue effect. Conclusions: Electrofulguration can be used for superficial tissue destruction. For deeper coagulation, a relatively larger electrode can be used in contact mode. Slower movement of the electrode on tissue in contact mode is associated with desiccation and the deepest level of tissue destruction. [ABSTRACT FROM AUTHOR]

We consider that nonavalent HPV vaccine can be an alternative to conventional destructive treatments, mainly in cases such as multiple warts, sensitive locations, and uncooperative patients. Dear Editor, Anogenital warts, or condyloma acuminata, are benign skin neoplasms caused by the human papillomavirus (HPV). [Extracted from the article]

Keywords: basal; carcinoma; cell; collision; keratosis; neoplasm; seborrheic; skin; trichoblastoma; tumor EN basal carcinoma cell collision keratosis neoplasm seborrheic skin trichoblastoma tumor e242 e243 2 03/17/23 20230401 NES 230401 We read with interest the excellent correspondence describing the first reported case of a collision tumor of melanotrichoblastoma and seborrheic keratosis by Mizuta et al.[1] We recently published an extensive review of collision tumors associated with BCC; in our paper, we suggested the descriptive term "multiple skin neoplasms at one site" (MUSK IN A NEST) to replace "collision tumors." In addition, we proposed a new terminology and classification for these unique neoplasms.[2] Cutaneous collision tumors are multiple skin neoplasms at one site. [Extracted from the article]

The authors conducted an interesting retrospective study on 141 cases of mucoepidermoid carcinoma of the skin providing valuable information in the epidemiology of primary mucoepidermoid carcinoma of the skin. It is well known, and also well noted by the authors in the manuscript, that primary mucoepidermoid carcinoma of the skin is an exceptional neoplasm. Cutaneous carcinosarcomas can be broadly classified into two distinct groups: epidermal carcinosarcoma, those showing squamous cell carcinoma or basal cell carcinoma, and adnexal carcinosarcoma. [Extracted from the article]

Abstract: Background: Epidermodysplasia verruciformis (EV) is a rare genodermatosis that causes disseminated eruptions of hypo‐ or hyperpigmented macules and wart‐like papules that can coalesce and scale. It is uniquely characterized by an increased susceptibility to specific human papillomavirus (HPV) genotypes. Classically, EV is associated with mutations of the EVER1/TMC6 and EVER2/TMC8 genes. The term “acquired” epidermodysplasia verruciformis was coined to describe an EV‐like syndrome that can develop in patients with a compromised immune system. Recent discoveries of other genes implicated in EV, including RHOH, MST‐1, and CORO1A, have complicated the classification of EV and EV‐like syndromes. Methods: We review the available data on epidermodysplasia verruciformis in the literature in order to propose a new classification system to encompass current and future developments on EV and EV‐like syndromes. Results: We propose classifying EV into: (1) classic genetic EV, (2) non‐classic genetic EV, and (3) acquired EV. Conclusion: The proposed categorization scheme provides a simple and logical way to organize the different cases of EV that have been described in the literature. This system organizes EV by its cause, allowing for a better understanding of the disease and helps differentiate EV from other causes of generalized verrucosis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Sensitivity and specificity of ex vivo dermatoscopy (EVD) for malignancy detection of skin tumors is unknown. We sought to assess whether the use of EVD could be a useful adjunct to histopathological diagnosis of pigmented skin tumors, including cases where complete clinical information is inadequate or missing. Materials and methods: EVD was performed on 195 excised, formalin‐fixed pigmented skin tumors. Results: Of 183 eligible lesions, 104 (56.8%) were melanocytic and 79 (43.2%) nonmelanocytic. Overall, 54 (29.5%) were malignant: 10 melanomas, 39 basal cell carcinomas, and five squamous cell carcinomas. Ex vivo images were devoid of red color. The following colors were seen: light and dark brown, grey, blue, black, and white. All structures typical for pigmented melanocytic and nonmelanocytic lesions were observed. In malignant nonmelanocytic lesions, diagnostic accuracy and sensitivity for malignant/benign decision was not better when combining visual assessment and EVD but diagnostic specificity improved by 3.0%. For melanoma, combined diagnostics improved diagnostic accuracy, sensitivity, and specificity for 9.6, 30.0, and 7.5%, respectively. Conclusion: For dermatopathologists, EVD offers increased specificity for all categories of tumors and increased diagnostic accuracy, sensitivity, and specificity for melanoma. With EVD view, the dermatopathologist can instantly find areas of interest, thus minimizing the possibility for missing a malignant lesion. [ABSTRACT FROM AUTHOR]

Abstract: Background: Mal de Meleda (MDM) is a rare inherited autosomal recessive genodermatosis characterized by palmoplantar keratoderma (PPK) with transgrediens and caused by mutations in the SLURP1 gene. Uncommonly, cutaneous tumors have been found at PPK sites in MDM patients. Objective: To study a Middle Eastern family with MDM with both PPK and skin tumors. Methods: We studied a Middle Eastern (Palestinian) family with clinical features of MDM and cutaneous tumors. Histopathological analysis was performed on biopsies from skin lesions found in the affected individuals. Direct sequencing of SLURP1 was performed in MDM affected members. In silico analysis of publicly available datasets was used to survey SLURP1 mRNA levels in normal and malignant tissues. Statistical analysis was performed in the R statistical language. Results: Affected members from the Middle Eastern family displayed severe forms of PPK consistent with MDM. Histopathological analysis of the skin lesions revealed that the examined affected members exhibited skin squamous cell carcinomas (SCCs) and melanoma. Sequence analysis revealed homozygous SLURP1 mutations (c.82delT) in the affected members. Following analysis of various publicly available expression datasets, SLURP1 mRNA levels were found to be markedly elevated in tissues of epithelial lineage, relative to tissues of other lineages, and significantly suppressed in malignant tumors of epithelial lineage relative to normal or their premalignant counterparts. There was significant decrease in SLURP‐1 expression in melanomas versus melanocytic nevi as well as a highly significant decrease in SLURP‐1 expression in metastatic melanomas as compared to primary melanoma. Conclusion: Our study underscores cases of Middle Eastern MDM with SLURP1 mutations and skin malignancies at PPK sites. Our findings also highlight a plausible epithelial lineage‐specific tumor suppressor role for the SLURP1 gene, as well as a role in the development and metastasis of melanoma and thus a potential molecular signature for melanoma. [ABSTRACT FROM AUTHOR]

Background Clinically, pilomatricoma offers potential for a wide spectrum of differential diagnoses. It typically occurs in pediatric patients with the head being the most common location. A second peak of clinical presentation occurs in adults at age 50-65 years, suggesting a bimodal pattern of occurrence. Objective To investigate the clinical and epidemiological features of pilomatricoma in adults over 20 years old, as it is a common and frequently misdiagnosed tumor. Methods This was a retrospective study of pilomatricomas surgically removed at a tertiary hospital between January 1994 and December 2014. A search of the all-pathological database of patients aged over 20 years old with a pathological diagnosis of pilomatricoma was carried out. Results The clinical preoperative diagnosis of pilomatricoma was made in 34.0% of cases. Tumor location showed a predilection to the head and neck. Of the reported concomitant neoplasm, a majority had accompanying skin tumors. Conclusion We conclude that clinical features in adults were similar to those of children. This study outlines clinical presentations that should help to guide differential diagnoses. Additionally, because of similarities between the distribution and depth of vellus hair follicles and pilomatricomas, it is probable that vellus hair bulbs may be the origin of this tumor. [ABSTRACT FROM AUTHOR]

The article presents the case studies of multiple patients reflecting the difference between dermoscopic port wine stain and angioma serpiginosum. Dermoscopic patterns of PWS include linear red vessels and globules with deeper and superficial vasculature in the dermis. Dermoscopy of AS revealed red lacunae of variable sizes that are demarcated and round to oval in shape.

The article discusses a study which examines the features of keratoacanthoma in human skin, through the process of sonography. The study outlines the comparison of a keratoacanthoma in human skin with squamous cell carcinoma (SCC), based on its ultrasound characteristics and tumor characteristics. The study also mentions the effectiveness of supplement surgical therapy with medical therapy sucha as intralesional injection of methotrexate for treatment of keratoacanthoma.

The article describes a case of a 36-year-old patient with a history of skin-colored nodule and subcutaneous tumor, and who was diagnosed with clear cell sarcoma. The diagnosis was confirmed after performing skin incisional biopsy, histopathological analysis and immunohistochemistry. A discussion on the algorithm approach in verifying soft tissue tumor diagnosis, consisting of cytogenetic, hematoxyling-eosin stain and liver enzyme assessment, is offered.

Background Pemphigus vulgaris is an autoimmune disease of the skin and mucous membrane. Renal transplantation is a common procedure in Iraq, and these patients required prolonged use of immunosuppressive drugs. Objective To study the frequency of skin tumors and infections in patients with pemphigus vulgaris compared with renal transplant recipients and normal controls. Patients and methods One hundred kidney transplant recipients, their ages ranged from 14 to 70 (46.65 ± 4.74) years, and 50 patients with pemphigus vulgaris, their ages ranged from 22 to 70 (43.32 ± 3.46) years, were studied in Baghdad Hospital from June 2009 to August 2010. Patients were treated with immunosuppressive drugs for 0.5-25 years. Patients were examined for tumors and infections and compared with the general population as controls (100 individuals). Results In renal transplant recipients, the following infections were observed: herpetic, 25 patients (25%); bacterial, 11 (11%); and fungal, 22 (22%). These infections appeared early in the course of immunosuppression. Benign tumors increased, most importantly viral warts in 40 (40%) and actinic keratosis, 14 (14%). The malignant tumors were basal cell carcinomas in 4 (4%), squamous cell carcinomas 2 (2%), and Kaposi's sarcoma 3 (3%). These malignancies usually appeared late in the course of immunosuppression. Patients with pemphigus vulgaris showed no important skin infections or tumors. Healthy controls showed no infections apart from herpetic infections in 7 (7%) and viral warts in 9 (9%). No tumors were seen. Conclusions Pemphigus vulgaris in prolonged immunosuppression is immunoprotective against skin infections and skin tumors while kidney transplant recipients are not protective. [ABSTRACT FROM AUTHOR]

Background Cutaneous metastasis is the result of malignant cell spread from primary malignancy to the skin. This is not uncommon, and rates reported in the literature are as high as 10.4%. To the best of our knowledge, there are no studies assessing the epidemiologic, clinical, and histopathological features of cutaneous metastasis in our region. Objective To assess the clinical and histopathological findings of all patients diagnosed with cutaneous metastasis at the American University of Beirut - Medical Center (AUB-MC) and to compare our findings with those published in the literature. Methods Retrospective clinical and histopathologic evaluation of all cases diagnosed as cutaneous metastasis at AUB-MC between 1992 and 2010. Results A total of 72 patients (50 females and 22 males) were identified. The mean age at diagnosis was 55.2 years. The most common primary cancer was breast cancer in women and laryngeal cancer in men. The most common clinical presentation was a single nodule in 27% of cases followed by multiple nodules in 23%. Cutaneous metastasis lesions were asymptomatic in the majority. The chest was the most commonly affected site. On microscopy, the majority of metastatic cases were adenocarcinomas (74%). Conclusion This is, to our knowledge, the first study characterizing the epidemiological, clinical, and histopathological features of cutaneous metastasis in the Lebanese population. The clinical and histopathological features observed were in concordance with the published literature, with minor differences. [ABSTRACT FROM AUTHOR]

Background The Tzanck smear is a simple, easily applicable, rapid, and inexpensive test for the diagnosis of erosive vesiculobullous, tumoral, and granulomatous diseases. The diagnostic accuracy of the Tzanck smear is known, but its diagnostic reliability has been evaluated only in herpetic infections and basal cell carcinoma. Objectives The aim of this study was to evaluate the diagnostic reliability of the Tzanck smear in erosive vesiculobullous, tumoral, and granulomatous diseases. Methods Patients evaluated by Tzanck smear at Başkent University Faculty of Medicine, Department of Dermatology, between February 2009 and July 2010, were included. Three dermatologists were involved in the study. Dermatologist A performed a clinical dermatologic examination, took the smear material, made a clinical diagnosis, and compared the clinical and cytological diagnoses. Dermatologists B and C evaluated the smears. Agreement between the latter two dermatologists on the cytological diagnoses was determined. Results In 500 patients, a total of 272 (54%) erosive vesiculobullous, 190 (38%) tumoral, and 38 (8%) granulomatous lesions were diagnosed. The diagnostic reliability of the Tzanck smear was reasonably substantial (κ = 0.59) for all types of lesions, substantial for erosive vesiculobullous (κ = 0.79) and granulomatous (κ = 0.68) lesions, and moderate (κ = 0.50) for tumoral lesions. Conclusions The Tzanck smear may be used for the evaluation of erosive vesiculobullous and granulomatous lesions with brief training. However, the evaluation of tumoral lesions by Tzanck smear requires more experience. [ABSTRACT FROM AUTHOR]

Background Skin metastases can be defined as the spread of a tumor from its site of primary origin to the skin. Skin metastasis may be the first sign of advanced cancer or an indicator of cancer recurrence. Objectives To review patient data of 401 skin metastases available from our institution and compare this information to previously published studies. Methods Patient data from the Cancer Registry at RPCI database was reviewed for skin metastasis using vendor software. We included all cases of carcinoma, melanoma, sarcomas, and hematologic malignancies entered during a 25-year period from January 4, 1985, to March 1, 2010. Data identifying the relationship of tumor incidence, morphology, and skin metastasis was reviewed. A total of 401 patients who had skin metastases at the time of cancer diagnosis or had skin metastases as a recurrent site were included in this study. Extensive literature review was conducted using PubMed for articles relating to skin metastases and its clinical presentation and histological features. Results Breast cancer was the most common cancer to metastasize to the skin (32.7% of all skin metastases seen) followed by bronchus and lung (13.2%), skin (melanoma; 9.5%), lymph nodes (7.5%), oral cavity/pharynx/larynx (6.2%), blood and bone marrow (5.5%), and colorectal (4.2%). The most common histological types of tumors were identified as adenocarcinoma (infiltrating ductal carcinoma [22.7%]), lobular carcinoma (4.7%), and non-adenocarcinoma (squamous cell carcinoma [12.2%] and malignant melanoma [5.2%]). Conclusions This is the largest review of skin metastases in the United States in the past 25 years. We found the primary cancers that metastasize to the skin have changed in frequency from previous studies. Our data are helpful in indicating which cancers have the strongest predilection for skin metastasis. Identification of these cancers can help both the clinician and patient detect early signs of metastases, which may allow for earlier diagnosis, implementation of therapy, and possible prolonged survival. [ABSTRACT FROM AUTHOR]

The article discusses a case report of alveolar rhabdomyosarcoma arising in a congenital melanocytic nevus (CMN) in a 21-year-old male. A biopsy was conducted and shows a malignant round cell tumor. The patient was advised to undergo palliative therapy, but he chose to go to his native place and died within a month. Rhabdomyosarcoma in the skin may develop within a CMN as an extension from the deep tissue tumor or by metastatic spread.

Birt- Hogg- Dubé syndrome ( BHDS) is an autosomal dominant genodermatosis characterized by the presence of three skin tumors (fibrofolliculomas, trichodiscomas, and acrochordons), together with an increased risk for other tumors, especially renal tumors, caused by a mutation in folliculin, an oncogene suppressor protein. The association of this syndrome with melanoma is very unusual. We report the case of a 54-year-old man with a history of melanoma who had multiple white facial papules. His son also presented similar facial lesions. Histopathologic study showed fibrofolliculomas. These clinical and histopathologic features suggested the diagnosis of BHDS. Genetic study revealed a novel heterozygous mutation p. S185P in exon 6 of the FLCN gene. To date, the association between melanoma and BHDS has rarely been described. As the pathogenic mechanism responsible for melanoma seems to be the same as that responsible for neoplasms in BHDS, the authors consider the melanoma a manifestation of BHDS. Thus, during the periodic follow-up of patients with BHDS, we recommend periodic exhaustive skin examination and excisional biopsy of any suspicious pigmented lesion. [ABSTRACT FROM AUTHOR]

Background Melanoma in South-East Europe shows varying incidence from 1.7 per 100,000 in Albania to 14.5 per 100,000 in Slovenia, but more detailed data from this region are scarce. In this study, we report epidemiological and clinicopathological characteristics of melanoma in central Serbia. Materials and methods Epidemiological data were retrieved from the Cancer Registry of Central Serbia and clinicopathological data from the hospital-based registry. Results The ASR(W) incidence rate of melanoma was 4.2/100,000 (males) and 3.9/100,000 (females), and ASR(W) mortality rates were 1.9/100,000 (males) and 1.4/100,000 (females), with recorded rising trends in both of them. Data from the hospital-based registry revealed a total of 266 patients treated from 2005 to 2010, with the median age at diagnosis of 57 (13-86) years. The most frequent histopathological subtype was superficial spreading melanoma (SSM; 63.53%), and ulceration was present in 40.6% of primary tumors. Median Breslow thickness was 3 mm (0.1-25 mm). Primary tumors with thickness of more than 4 mm were found in 31.95% of patients, and in this group statistically significant difference was found for younger age in patients with SSM (55 years vs. 61 years, P = 0.04). Conclusion Low incidence rates in central Serbia and probably other countries of South-East Europe are accompanied by a large percentage of thick tumors and a significant proportion of younger patients with thick tumors. This points to the urgent need for more effective primary and secondary prevention of melanoma in these countries. [ABSTRACT FROM AUTHOR]

Background Osteosarcoma is a common malignancy, although skin metastasis is rare. We sought to review the incidence, epidemiology, risk factors, and prognosis of osteosarcoma with skin involvement. Methods We conducted a retrospective chart review that covered 30 years and involved clinic patients younger than 18 years who had cutaneous metastases of osteosarcoma. The main outcome measure was histologic documentation of both primary tumor and metastatic lesion in the skin. Results Two patients were found to have osteosarcoma with skin involvement. No unifying factors were identified. Conclusions Although osteosarcoma is a common malignancy with frequent metastases, involvement of the skin is rare. Further studies to identify risk factors and subsequent prognosis are necessary. Nevertheless, unidentifiable skin lesions in a patient with a history of osteosarcoma should be investigated to rule out tumor metastasis, regardless of cancer status. [ABSTRACT FROM AUTHOR]

Background With increasing incidence over the last few decades, cutaneous malignant melanoma (CM) represents 3% of all skin tumors, and accounts for 75% of all deaths because of cutaneous malignancies. Little is known about the nature and epidemiology of CM in individuals with pigmented skin. Method Data were collected from the records of four public and private histopathology laboratories of Kerman city from March 20, 1994 to March 20, 2004. Skin biopsies with a diagnosis of CM were reevaluated to confirm the diagnosis of CM. The medical records of the patients were also taken into consideration. Results A total of 125 CMs were found. The male-to-female ratio was 1.08 : 1. The mean age at the time of diagnosis was 58.9 years; with a peak in the seventh decade of life. Acral-lentiginous melanoma (ALM) represented 28.8% and; nodular melanoma occurred in 20% of cases. Limbs were the site of occurrence in 44% of tumors; whereas 36% of tumors occurred in head and neck region. There was a significant correlation between age and ALM ( P = 0.007) and also between gender and melanoma types ( P = 0.024). Conclusions This study indicates that some demographic and histopathologic features of CM in this population differ from those in the literature. More studies including cohort studies are needed to fully describe the nature and survival rate of CM in this area. [ABSTRACT FROM AUTHOR]

Background Ezrin is a cytoskeleton linker protein that is actively involved in regulating the growth and metastatic capacity of cancer cells. The purpose of the study was to assess the expression pattern of ezrin in normal skin and various epithelial neoplasms. Methods We used immunohistochemical techniques to examine the expression of ezrin in paraffin-embedded tissues of squamous cell carcinoma ( n = 23), basal cell carcinoma ( n = 10), Bowen’s disease ( n = 10), actinic keratosis ( n = 10), keratoacanthoma ( n = 9), seborrheic keratosis ( n = 5), psoriasis vulgaris ( n = 5), and normal control skin ( n = 5). Results In Bowen’s disease, actinic keratosis, keratoacanthoma, and seborrheic keratosis, ezrin was dominantly expressed in the cell membrane except for the cornified layer. In squamous cell carcinoma (SCC) specimens, the percentage of ezrin-positive cells was increased compared with Bowen’s disease, actinic keratosis, keratoacanthoma, and seborrheic keratosis. Especially in SCC samples, ezrin expression was markedly expressed in the cytoplasm. In addition, there was a correlation between the pattern of ezrin expression and tumor differentiation in SCC. Basal cell carcinoma showed intense and diffuse staining especially in the solid growth pattern. Conclusions Our findings suggest that dysregulation of ezrin may be important in the development of cutaneous epithelial malignancies and tumor grade. We suggest that the cytoplasmic localization of ezrin may be useful in the diagnosis of skin SCC. [ABSTRACT FROM AUTHOR]

Background Acral lentiginous melanoma (ALM) is a clinicopathologic subtype of cutaneous malignant melanoma. ALM is the most common type of melanoma amongst Asians, Africans, and patients with mixed ancestry. In Brazil, ALM comprises 10% of cutaneous melanoma. ALM develops on palmar, plantar, and subungual skin, and its biology is different from that of other cutaneous melanomas, where sunlight is the major known environmental determinant. Alterations and inactivation of the p16INK4 gene that encodes a specific inhibitor of cyclin-dependent kinase have been related to melanoma genesis and progression. Few studies, however, have addressed p16 expression in ALM. Methods In order to verify and compare p16 protein expression, 32 paraffin-embedded ALM specimens were subjected to a immunohistochemical technique using a monoclonal anti-p16 antibody. The tumors were classified according to thickness (up to 1.0 mm and thicker than 1.0 mm) and the presence of ulceration. Results Twenty-five (78%) ALMs displayed positive p16 protein expression: 21 of the 25 (84%) with a thickness of more than 1.0 mm, and four of the seven (57%) with a thickness of 1.0 mm or less. Thirteen of the 17 (76%) nonulcerated lesions and 12 of the 15 (80%) ulcerated lesions displayed positive p16 protein expression. Conclusion The data obtained suggest that p16 protein expression per se may not represent a marker of retinoblastoma protein (pRb) pathway disturbance in ALM tumorigenesis. [ABSTRACT FROM AUTHOR]

Background Cutaneous tuberculosis has re-emerged in the last 15 years together with the higher incidence of pulmonary tuberculosis and multidrug resistance. The choice for a single diagnostic tool among the many available today is a challenge. Our objective was to compare polymerase chain reaction (PCR) with other exams in the diagnosis of cutaneous tuberculosis and atypical mycobacteria skin infection. Methods PCR and a set of five different exams were performed in 32 patients (34 samples of paraffin-embedded tissue) evaluated for 3 years in a university hospital, considering the response to mycobacterial infection treatment as a positive case. Results PCR was the most sensitive (88%) and specific (83%) exam. Culture, immunohistochemistry and acid-fast bacilli were not in agreement with clinical response to treatment. Conclusions Although PCR is a useful tool, careful clinical exam is still the gold standard for the evaluation and treatment of cutaneous tuberculosis and mycobacteria skin infection. [ABSTRACT FROM AUTHOR]

Background Primary mucinous carcinoma of the skin (PMCS) is a rare malignant tumor deriving from the sweat glands. It is typically located on the head and is often mistaken for a metastasis from a more common primary tumor of the breast or gastrointestinal tract. We present the first population-based study of PMCS. Materials and Methods Data on PMCS was obtained from the Danish Cancer Registry, which has recorded incident cases of cancer on a nationwide basis since 1943. We extracted all patients diagnosed 1978–2003 with PMCS. Results Fifteen cases of PMCS have been registered during the study period of 26 years, seven in men and eight in women. The patient was typically in his or her 60th or 70th decennium. Seven cases were found on the scalp or neck, five on the eyelids, two on the face, and one on the trunk. Only one recurred, and apart from one regional metastasis, no distant spread or PMCS related deaths were reported. Conclusion PMCS is a rare, slow-growing tumor which rarely metastasizes and is associated with low mortality. The age-standardized incidence rate, based on data from a population-based cancer registry of high quality and validity, is less than 0.1 per million. However, the precise number may be higher, since PMCS is an indolent tumor, which may be mistaken for a benign tumor and thus not always examined histologically. [ABSTRACT FROM AUTHOR]

The author reflects on actinic keratosis (AKs). He discusses that AK are skin neoplasms and considered to be one of the most common cutaneous intraepithelial neoplastic disorders presenting chromosomal abnormalities. He added that AK are in situ intradermal squamous cell carcinomas which can develop into invasive squamous cell carcinoma. Furthermore, the author suggested that the patient should be monitored closely from AK to avoid invasive squamous cell carcinoma.

Primary spindle cell sarcoma is a rare neoplasm with great heterogeneity in clinicopathologic presentation and morphological features. This previous study showed that a superficial, cutaneous, primary site of spindle cell sarcoma was associated with both better overall survival (OS) and disease-specific survival (DSS) than an internal site.[2] Due to the paucity of epidemiological data on this disease, we specifically interrogated outcomes of patients with primary spindle cell sarcoma of the skin. Given that spindle cell sarcoma is a morphologic description of an undifferentiated neoplasm, modern immunohistochemical and molecular tests applied to cases diagnosed in earlier years may have allowed more accurate subclassification. [Extracted from the article]

Granular cell tumor is an uncommon benign tumor, most often found in the skin and subcutaneous tissue, although it may occur at any anatomical site. Multiple cutaneous lesions are rare, particularly in childhood. An association between multiple cutaneous granular cell tumors and systemic defects has been suggested. We report a case of a 9-year-old boy with multiple cutaneous granular cell tumors and growth retardation, and review the literature. [ABSTRACT FROM AUTHOR]

The article presents a report regarding the role of human papillomaviruses (HPV) in cutaneous oncogenesis. It is reported that the relationship between cutaneous tumors and papillomaviruses (PV) was first established in cottontail rabbits, and there after species-specific PVs were found and identified in many animals. It is informed that the biologic and pathogenic properties of these viruses may differ within phylogenetic groups. It is suggested that the viral DNA could be replicated in normal activated keratinocytes and this can contaminate the epidermis on top of cutaneous tumors.

Discusses cutaneous sarcoidosis, a type of chronic idiopathic disorder. Characteristics of cutaneous sarcoidosis; Risk of systemic involvement associated with the morphologic expression of cutaneous sarcoidosis; Options for treating cutaneous sarcoidosis.

Background Human T-cell lymphotrophic virus type 1 (HTLV-1)-induced lymphoproliferative disease occurs in approximately 3–5% of people in endemic areas who have been HTLV-1 positive for decades. Lymphoproliferative disease may present as four subtypes, including an acute adult T-cell leukemia/lymphoma (ATLL), an aggressive HTLV-1 lymphoma, chronic ATLL, and smoldering ATLL. Materials and methods A 72-year-old HTLV-1+ Haitian woman presented with a 2-year history of a cutaneous eruption localized to the right arm. The eruption had evolved into multinodular lesions over the past 6–7 months. Peripheral blood and cutaneous biopsy specimens were evaluated. Immunohistochemical studies for lymphoid markers were performed on the cutaneous biopsy material, and polymerase chain reaction (PCR) and Southern blot assay were evaluated for the presence and integration of HTLV-1 within the genome. Results The biopsy specimen showed a pleomorphic T-cell infiltrate with epidermotrophism, and an immunohistochemical phenotype showing CD3+, CD4+, CD8−, CD25, CD30−, HLDA-DR+ cells. PCR and Southern blot assay evaluation showed a single clonal integration of HTLV-1 provirus within a monoclonal tumor cell population. The patient had no abnormal lymphoid forms on peripheral smear at presentation, and no evidence of other organ involvement. Conclusions Smoldering HTLV-1-induced lymphoma is uncommon even in endemic areas. In previously reported cases, the smoldering variant was accompanied by abnormal forms in the peripheral blood and/or by other signs of systemic disease. This case illustrates that smoldering disease may be localized to the skin with no detected morphologic abnormalities on peripheral smear. [ABSTRACT FROM AUTHOR]

A 50-year-old Hispanic woman presented to the medical walk-in clinic of a local community hospital complaining of shoulder pain. The problem had begun 9 months previously, and first manifested as dull right shoulder pain that developed after she carried a bag of groceries up one flight of stairs. A diagnosis of “muscle strain” and “arthritis” was made for which nonnarcotic analgesics were prescribed. The pain persisted, and 2 months later she was re-evaluated and diagnosed with degenerative joint disease. An orthopedics consultation was sought for further evaluation. During this examination, she pointed out to the physician that she had a “lump in her shoulder,” but she was informed that this was of no consequence and that her complaints were due to arthritis. Roentgenograms of the right shoulder and thoracic spine were performed and determined to be within normal limits. Once again she attempted to control the pain with nonsteroidal anti-inflammatory agents to no avail. Because the pain had become unbearable, she sought relief at the medical walk-in clinic. Physical examination was remarkable for a solitary, skin-colored, firm, deeply-seated tumor measuring 3×4 cm located over the right posterior of the deltoid. The mass was exquisitely tender to palpation and was fixed to the underlying muscle. There was a full range of motion as well as good muscle strength of the shoulder, but movement of the arm in any direction was painful. The patient subsequently underwent a deep, partial excisional biopsy of the lesion, and a firm white tumor mass of about 3 × 3 cm in size was dissected away from the deltoid muscle. Although the majority of the tumor was excised, visible portions of the lesion were not removed because they were present deep within the bulk of the muscle. Histopathologic examination revealed a large, deeply-seated poorly-circumscribed fibrous proliferation containing areas in which there were numerous... [ABSTRACT FROM AUTHOR]

Describes a patient with malignant nodular hidradenoma. Incidence of sweat gland carcinoma among all malignant epithelial neoplasms of the skin; Histopathology of the tumor lobules; Clues in diagnosing malignant tumors.

Background. Dermatofibrosarcoma protuberans (DFSP) is an uncommon malignant tumor of the skin, the diagnosis of which can be difficult not only clinically but also histologically. The tumor has a low metastatic potential, but tends to recur locally if removal is incomplete. Methods. We reviewed the clinical and histologic features of 19 cases of DFSP, seen at the Department of Dermatology (14 cases) and Department of Surgery (5 cases) at the Hull Royal Infirmary between 1975 and 1992. Results. There were only 19 cases of DFSP diagnosed from a population of 500,000 over a period of 17 years. None of the cases were diagnosed clinically prior to histologic diagnosis. The highest incidence was in the 4th decade of age. The most frequent site was on the head and neck. None of the lesions metastasized but there were a total of eight incidents of local recurrence in five patients. Histologically all the cases showed presence of storiform-pattern spindle- shaped cells and new collagen formation. Conclusions. Dermatofibrosarcoma protuberans is a soft tissue tumor that is often not recognized clinically due to its rarity and variable appearance. Local recurrence is frequent. A wide surgical excision is the treatment of choice. [ABSTRACT FROM AUTHOR]

The article presents information on Molluscum contagiosum. It is a cutaneous skin neoplasm, caused by a DNA virus from the poxvirus family. Although worldwide in its distribution, Molluscum contagiosum has been most frequently encountered as an easily treated disease of childhood and has rarely been a cause of serious morbidity. Molluscum contagiosum virus is an unclassified poxvirus which has not yet been grown in tissue culture cells nor in an animal model. The ultrastructure of the molluscum virus is analogous to vaccinia virus, the prototypical poxvirus. The mature virion contains an inner and outer membrane that surrounds a dumbbell-shaped nucleus. Two lateral bodies lie between the membranes and the structure is surrounded by an envelope. The genome, like that of all poxviruses, is a single, linear molecule of double-stranded DNA.

Eight patients with skin tumor lesions composed of dense, predominantly plasma cell in filtrates were studied. Primary cutaneous plasmacytoma can be reactive (polyclonal) or neoplastic (monoclonal). In four of the patients skin lesions were associated with multiple myeloma. Specific skin lesions usually consisted of reddish or purple nodules located on the trunk. In one case the cutaneous lesions developed at the site of previous herpes zoster. Histologically, the cutaneous plasmacytic infiltrate was mainly diffuse and monomorphous. Most of the plasma cells were mature, but in some cases immature immunoblasts and mitoses were observed. Serum immunoelectrophoresis findings correlated with the mono-clonality or polyclonality of the plasmacytoma. Presence or absence of systemic involvement cannot he predicted from the appearance of clinical lesions or from maturity of plasma cell infiltration in the skin. [ABSTRACT FROM AUTHOR]

Congenital smooth-muscle hamartomas are rare, benign tumors of the skin. Since their original description in 1969, 16 case reports have appeared in the literature, with 7 cases reported within the last year. We describe the 17th patient with this lesion and have included a review of the literature. In addition, we describe three morphologic types of smooth muscle cells—the pale cells, dark cells, and intermediate cells—found on electron microscopy, and the features that support our belief that these may reflect different stages of maturity of the smooth-muscle cells. In addition to the smooth muscle, bundles of nerve fibers (both unmyelinated and myelinated) appear to be an intrinsic part of the lesion, as are the prominent vellus hairs. Congenital smooth muscle hamartoma thus appears to be an organoid nevus. [ABSTRACT FROM AUTHOR]

IntraepitheliaI epithelioma (lEE) is a distinct histologic expression of a variety of epithelial processes. The most common intraepidermal tumors giving rise to this histologic pattern are seborrheic keratosis and actinic keratosis, although several others were seen in our series. We report a total of 33 cases of lEE seen during a 10-year period and a review of the literature. [ABSTRACT FROM AUTHOR]

ABSTRACT: Pigmented follicular cysts are newly described cutaneous cysts with characteristic histology. They are usually single pigmented lesions occurring in men between 20 and 63 years of age that often are mistaken for nevi. The eighth case of this newly described cyst is presented; a brief review of epithelial cysts and how they differ from pigmented follicular cysts also is reported [ABSTRACT FROM AUTHOR]

Considerable progress recently has been made in the systemic chemotherapy of disseminated skin neoplasms. Several agents are particularly useful In this regard: the nitrosoureas, methotrexate, actinomycin D, and dacarbazine. This paper reviews their pharmacologic disposition in man. The nitrosoureas have short plasma half-lives; however, they are extensively degraded to metabolites that persist in the body, and are only slowly excreted. Highly soluble in lipids, the nitrosoureas penetrate significantly into the central nervous system. Actinomycin D is only minimally metabolized in vivo; its elimination from the plasma shows a prolonged slow phase with a half-life of 36 hours; but its excretion is even slower than expected, about 30% in a week. A potent inhibitor of dihydrofolate reductase, methotrexate exhibits a multiphasic plasma disappearance, and accumulates in tissues with high dihydrofolate reductase activities. At the normal therapeutic dosages, methotrexate is eliminated by the kidneys as the unchanged drug; appropriate dosage modifications are mandatory if renal function is compromised. Dacarbazine has a relatively short plasma half-life, and is rapidly excreted partly as the unchanged drug; it undergoes extensive bio-transformation in the body. Like other anti-tumor agents, these drugs may cause gastrointestinal toxicities and myelosuppression; in addition, each drug can have its own individual organ toxicity. [ABSTRACT FROM AUTHOR]

With biopsies from 101 cutaneous lymphoma patients, enzymecytochemical and immunologic features of the lesions were outlined. Their histo- and cytomorphology and Kiel classification were defined. [ABSTRACT FROM AUTHOR]

The article presents a case study of 12-year-old male patient with asymptomatic subcutaneous mass in the groin region. Magnetic resonance imaging (MRI) showed presence of dermatofibrosarcoma protuberans (DFSP). It adds that immunohistochemical analysis has revealed positive signs of CD34 antigen in the neoplastic cells.

The article presents a case study of a 46-year-old Chinese woman who suffers from slightly painful and pale blue nodes on her forearm for 30 years, on her face and scalp for 10 years and her 25-year-old nephew has similar lesion on the face. The patients were diagnosed with Brooke-Spiegler syndrome (BSS) and trichoepithelioma, respectively. Mutations in the CYLD gene were considered as the cause of the syndrome.