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Background and Objectives: Previous work has demonstrated that hydrochlorothiazide (HCTZ) is a risk factor for squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) due to pro-photocarcinogenic effects. Atypical fibroxanthoma (AFX) and pleomorphic sarcoma (PDS), both ultraviolet-induced cancers, display a rare but rising cutaneous tumor entity. This study aimed to evaluate if the use of HCTZ is higher in patients with AFX/PDS than in patients with SCC/BCC and subsequently may be a risk factor for AFX/PDS-development., Patients and Methods: In a retrospective study of four German skin cancer centers, AFX/PDS cases and SCC/BCC controls were sex and age matched (1:3) over a time-period of 7 years (2013-2019) to evaluate the use of HCTZ, immunosuppressive medication, second malignancies, and presence of diabetes mellitus., Results: Overall, 146 AFX/PDS and 438 controls (SCC/BCC) were included in the study. The use of HCTZ was significantly higher in patients with AFX/PDS (44.5%) compared to patients with SCC/BCC (25.3%). Additionally, the presence of diabetes mellitus was significantly higher in AFX/PDS patients., Conclusions: This study demonstrates a significantly higher use of HCTZ in patients with AFX/PDS compared to SCC/BCC. This result suggests that HCTZ may be a risk factor for AFX/PDS. Additionally, diabetes mellitus or its comorbidities may be associated with an increased risk for AFX/PDS., (© 2024 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by Wiley‐VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.)

Background: Institutes of dermatopathology are faced with considerable challenges including a continuously rising numbers of submitted specimens and a shortage of specialized health care practitioners. Basal cell carcinoma (BCC) is one of the most common tumors in the fair-skinned western population and represents a major part of samples submitted for histological evaluation. Digitalizing glass slides has enabled the application of artificial intelligence (AI)-based procedures. To date, these methods have found only limited application in routine diagnostics. The aim of this study was to establish an AI-based model for automated BCC detection., Patients and Methods: In three dermatopathological centers, daily routine practice BCC cases were digitalized. The diagnosis was made both conventionally by analog microscope and digitally through an AI-supported algorithm based on a U-Net architecture neural network., Results: In routine practice, the model achieved a sensitivity of 98.23% (center 1) and a specificity of 98.51%. The model generalized successfully without additional training to samples from the other centers, achieving similarly high accuracies in BCC detection (sensitivities of 97.67% and 98.57% and specificities of 96.77% and 98.73% in centers 2 and 3, respectively). In addition, automated AI-based basal cell carcinoma subtyping and tumor thickness measurement were established., Conclusions: AI-based methods can detect BCC with high accuracy in a routine clinical setting and significantly support dermatopathological work., (© 2023 Deutsche Dermatologische Gesellschaft (DDG).)

Background and Objectives: In recent years, considerable insight has been gained into the pathogenesis, diagnosis and treatment of cutaneous sarcomas, including atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). Both entities have shown increasing incidence rates in the last decade. This study was initiated to evaluate how these new insights impact the number of diagnoses of AFX/PDS compared to other cutaneous sarcoma entities., Patients and Methods: In a retrospective study of four German skin cancer centers, all histopathological reports of cutaneous sarcomas (AFX, PDS, dermatofibrosarcoma protuberans, cutaneous leiomyosarcoma, angiosarcoma, and Kaposi sarcoma) confirmed by board-certified dermatopathologists were analyzed during a time-period of seven years (2013-2019). Additionally, utilization of immunohistochemical markers (including pan-cytokeratin, S100, desmin, CD34, CD10, procollagen-1, CD99, CD14, and CD68) as an adjunct to diagnose AFX/PDS was recorded., Results: Overall, 255 cutaneous sarcomas were included in the present study. The diagnosis of a cutaneous sarcoma has consequently risen from 2013 to 2019 (from 16 to 52 annual cases). The results of AFX/PDS revealed 4.6 times more diagnoses in 2019 than in 2013. Atypical fibroxanthoma represented the most common subtype, displaying 49.3 % of all diagnosed cutaneous sarcomas. Additionally, the increase of AFX/PDS was linked to the use of immunohistochemistry, with specific immunohistochemical markers used in 57.1 % of cases in 2013 compared to 100 % in 2019., Conclusions: This retrospective study of four German skin cancer centers demonstrates a substantial rise of AFX/PDS, possibly due to recently established diagnostic and terminology standards. This rise is probably linked to increased utilization of specific immunohistochemical markers. Atypical fibroxanthoma/PDS may be more common than previously thought and seems to represent the most frequent cutaneous sarcoma subtype., (© 2022 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

Hintergrund Und Ziele: In den letzten Jahren konnten umfassende Erkenntnisse über die Pathogenese, Diagnostik und Behandlung von kutanen Sarkomen, insbesondere des atypischen Fibroxanthoms (AFX) und pleomorphen dermalen Sarkoms (PDS) gesammelt werden. Beide Entitäten zeigten innerhalb der letzten Dekade steigende Inzidenzraten. Die vorliegende Studie diente der Untersuchung, welchen Einfluss die neuen Erkenntnisse auf die Fallzahlen von AFX/PDS im Vergleich zu anderen Sarkom-Entitäten haben., Patienten Und Methodik: Diese retrospektive Studie wurde an vier deutschen Hauttumorzentren durchgeführt und alle von zertifizierten Dermatopathologen bestätigten histopathologischen Befunde von kutanen Sarkomen (AFX, PDS, Dermatofibrosarcoma protuberans, kutanes Leiomyosarkom, Angiosarkom und Kaposi-Sarkom) in einem Zeitraum von sieben Jahren (2013-2019) evaluiert. Zusätzlich wurde der Einsatz von immunhistochemischen Markern als diagnostische Hilfe (Panzytokeratin, S100, Desmin, CD34, CD10, Prokollagen-1, CD99, CD14 und CD68) erfasst., Ergebnisse: Insgesamt konnten 255 kutane Sarkome in die vorliegende Studie eingeschlossen werden. Die Zahl der kutanen Sarkome nahm kontinuierlich von 2013 bis 2019 zu (von 16 auf 52 Fälle im Jahr). Die Diagnose eines AFX/PDS konnte in 2019 4,6-mal häufiger als in 2013 gestellt werden. Das AFX stellte mit 49,3 % aller kutanen Sarkome den häufigsten Sarkom-Subtypen dar. Zusätzlich war der Anstieg von AFX/PDS mit dem Einsatz von Immunhistochemie assoziiert. Der Einsatz von spezifischen Immunhistochemischen Markern stieg von 57,1 % im Jahr 2013 auf 100 % in 2019., Schlussfolgerungen: Diese retrospektive Studie von vier deutschen Hauttumorzentren demonstriert eine substanzielle Zunahme von AFX/PDS, wahrscheinlich infolge kürzlich etablierter beziehungsweise verbesserter diagnostischer und terminologischer Standards. Dieser Anstieg ist vermutlich mit dem vermehrten Einsatz von bestimmten immunhistochemischen Markern assoziiert. AFX/PDS treten wahrscheinlich häufiger auf als bisher vermutet und repräsentieren möglicherweise den häufigsten kutanen Sarkom-Subtyp., (© 2022 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

The present CME article highlights fundamental aspects with respect to the histopathology of the most common skin tumors (epidermal, adnexal, melanocytic, and mesenchymal), their laboratory workup, as well as the importance of supplementary immunohistochemical and molecular studies. The information provided is meant to assist experienced clinicians in choosing the correct biopsy technique and in interpreting dermatopathology reports, and to provide dermatology residents with a better understanding of dermatopathology. Similar to inflammatory dermatoses, the diagnosis of skin tumors, too, requires the close cooperation between clinicians and dermatopathologists. The diagnostic quality and the resultant therapeutic approach can be significantly improved if this collaboration is based on the same dermatological understanding., (© 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

In diesem CME-Artikel werden histopathologische Grundkenntnisse der häufigsten Hauttumoren (epidermal, adnexiell, melanozytär, mesenchymal), deren labortechnische Aufarbeitung sowie der Stellenwert immunhistochemischer und molekularer Zusatzuntersuchungen zusammengefasst. Dies soll dem erfahrenen Kliniker bei der Wahl der richtigen Entnahmetechnik und der Interpretation der histopathologischen Befundberichte behilflich sein und in dermatologischer Weiterbildung befindlichen Ärzten ein besseres Verständnis der Dermatohistologie vermitteln. Ähnlich wie bei den entzündlichen Dermatosen sind auch in der Diagnostik von Hauttumoren Kliniker und Dermatohistopathologen aufeinander angewiesen und können die Qualität der Diagnostik und der daraus resultierenden therapeutischen Verständnisbasis deutlich verbessern., (© 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Die Dermatohistologie ist von unverzichtbarem Stellenwert in der Diagnostik entzündlicher und neoplastischer Hautveränderungen. Zur richtigen Einordnung und Interpretation der histologischen Befunde, der Durchführung klinisch-pathologischer Korrelationen (insbesondere bei entzündlichen Hauterkrankungen) sowie für die Wahl der richtigen Exzisionsmethode sind grundlegende Kenntnisse in der Dermatohistologie für den praktisch tätigen Dermatologen wertvoll und steigern die diagnostische Qualität. In diesem Artikel wird die Vorgehensweise des Dermatopathologen in der Diagnostik entzündlicher Dermatosen beschrieben. Anhand wichtiger histologischer Grundmuster werden die Grundprinzipien der dermatohistologischen Diagnostik erläutert. Ein folgender zweiter Teil wird die histologischen Charakteristika der häufigsten Hauttumoren darstellen., (© 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Dermatopathology is an indispensable tool in the diagnostic workup of inflammatory and neoplastic lesions. For the dermatologist in everyday clinical practice, basic knowledge of dermatopathology is highly valuable, as it allows for proper classification and interpretation of histological findings, as well as their correlation with the clinical picture (especially in case of inflammatory skin diseases). Such basic understanding is also important with regard to selecting the appropriate biopsy technique, thus increasing the overall diagnostic quality. The present article describes the diagnostic approaches taken by dermatopathologists in the histological workup of inflammatory skin diseases. The basic principles of this workup are highlighted on the basis of key histological patterns. Published in an upcoming issue, the second part of this article will address the histological characteristics of the most common skin tumors., (© 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Introduction: Pyoderma gangrenosum (PG) is a rare neutrophilic, ulcerative skin disease of largely unknown pathophysiology., Material and Methods: In this study, potentially relevant cofactors and comorbidities in patients with PG from three dermatological wound care centers in Germany were evaluated., Results: Of the 121 patients assessed, women (66.9 %) were more frequently affected than men. Patient age ranged from 18 to 96 years (mean 59.8). Wound size varied from 1-600 cm² (mean 65.6 cm²), and the pain intensity was predominantly very high (VAS 1-10, mean 7). The lower legs were most commonly (71.9 %) affected. Overall, 12 (9.9 %) patients had inflammatory bowel disease (ulcerative colitis, 5.8 %; Crohn's disease, 4.1 %), 14.1 % exhibited rheumatic comorbidities. Neoplasms were found in 20.6 % of patients, with 6.6 % classified as hematological and 14.0 % as solid neoplasms. With respect to criteria for the metabolic syndrome, obesity was found in 69.4 %, arterial hypertension in 57.9 %, and diabetes mellitus in 33.9 % of patients., Conclusions: The present data analysis confirms the association of PG with metabolic syndrome and neoplasms. In the future, these aspects should be included in the targeted diagnostic workup of patients with PG and subsequently treated in a timely fashion., (© 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Einleitung: Das Pyoderma gangraenosum (PG) ist eine seltene, inflammatorische destruktiv-ulzerierende neutrophile Erkrankung mit weitgehend unklarer Pathophysiologie., Material Und Methodik: In dieser Studie wurden die potenziell relevanten Kofaktoren und Begleiterkrankungen von Patienten mit PG aus drei dermatologischen Wundzentren in Deutschland differenziert ausgewertet., Ergebnisse: Von den insgesamt 121 analysierten Patienten waren Frauen (66,9 %) häufiger betroffen als Männer. Das Alter der Patienten war 18-96 Jahre (Mittelwert [MW]: 59,8); die Wunden hatten eine Größe von 1-600 cm² (MW: 65,6 cm²) und waren überwiegend sehr schmerzhaft (VAS 1-10, MW: 7). Die Unterschenkel waren am häufigsten (71,9 %) betroffen. Bei 12 (9,9 %) Patienten bestanden chronisch entzündliche Darmerkrankungen (5,8 % Colitis ulcerosa; 4,1 % Morbus Crohn), bei 14,1 % der Patienten wurde eine Begleiterkrankung aus dem rheumatischen Formenkreis beschrieben. Neoplasien bestanden bei 20,6 % der Patienten, von denen 6,6 % als hämatologische und 14,1 % als solide Neoplasien klassifiziert wurden. Aus dem Kreis des metabolischen Syndroms wurde bei 69,4 % Patienten eine Adipositas, bei 57,9 % eine arterielle Hypertonie und bei 33,9 % ein Diabetes mellitus diagnostiziert., Schlussfolgerungen: Diese Datenanalyse bestätigt Assoziationen des PG mit dem metabolischen Syndrom und mit Neoplasien, die zukünftig frühzeitig bei einer zielgerichteten Diagnostik der Patienten beachtet und behandelt werden sollten., (© 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Most fungal infections of the skin are caused by dermatophytes, both in Germany and globally. Tinea pedis is the most frequent fungal infection in Western industrial countries. Tinea pedis frequently leads to tinea unguium, while in the elderly, both may then spread causing tinea corporis. A variety of body sites may be affected, including tinea glutealis, tinea faciei and tinea capitis. The latter rarely occurs in adults, but is the most frequent fungal infection in childhood. Following antifungal treatment of tinea unguium and also tinea capitis a dermatophytid or hyperergic reaction to dermatophyte antigens may occur. Yeast infections affect the mucous membranes both of the gastro-intestinal system and the genital tract as candidiasis mostly due to Candida albicans. Cutaneous candidiasis affects predominantely the intertriginous regions such as groins and the inframammary area, but also the intertriginous space of fingers and toes. In contrast, pityriasis versicolor is a superficial epidermal fungal infection primarily on the the trunk. Mold infections are rare in dermatology; they play a role nearly exclusively in nondermatophyte-mold (NDM) onychomycosis. The diagnosis of dermatomycoses comprises the microscopic detection of fungi using the potassium hydroxide preparation or alternatively the fluorescence optical Blankophor preparation together with culture. The histological fungal detection with PAS staining possesses a high sensitivity, and it should play a more important role in particular for diagnosis of onychomycosis. Molecular biological methods, based on the amplification of fungal DNA with use of specific primers for the distinct causative agents are on the rise. With PCR, such as dermatophyte-PCR-ELISA, fungi can be detected directly in clinical material in a highly specific and sensitive manner without prior culture. Today, molecular methods, such as Matrix Assisted Laser Desorption/Ionization Time-Of-Flight Mass Spectrometry (MALDI TOF MS) as culture confirmation assay, complete the conventional mycological diagnostics., (© 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)