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Malignant melanoma is the most severe skin cancer with a rising incidence rate. Several noninvasive image techniques and computer‐aided diagnosis systems have been developed to help find melanoma in its early stages. However, most previous research utilized dermoscopic images to build a diagnosis model, and only a few used prospective datasets. This study develops and evaluates a convolutional neural network (CNN) for melanoma identification and risk prediction using optical coherence tomography (OCT) imaging of mice skin. Longitudinal tests are performed on four animal models: melanoma mice, dysplastic nevus mice, and their respective controls. The CNN classifies melanoma and healthy tissues with high sensitivity (0.99) and specificity (0.98) and also assigns a risk score to each image based on the probability of melanoma presence, which may facilitate early diagnosis and management of melanoma in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Basal cell carcinoma (BCC), the most common skin cancer in humans, requires early detection. Dermoscopy enhances diagnostic accuracy through a noninvasive approach. Pigmented BCC (pBCC) is characterized by distinctive dermoscopic features, including the presence of pigmented globules or nests. While dermoscopic features of large pBCC (size >6 mm) have been extensively studied, limited data are available on small pBCC (size ≤6 mm) and its relationship with tumor progression. Methods: Dermoscopic images of histologically proven pBCCs were collected between 2014 and 2022 at Hualien Tzu Chi Hospital. Each image was analyzed for patterns of pigmentation, vasculature, and epidermal and dermal structures. Statistical analysis was performed to compare the differences according to the size and the trend during tumor progression. Results: In total, 135 pBCCs (48 small and 87 large) were included. Pigment structures were present in all cases. Short fine telangiectasia and small erosions constituted over 85% of the cases, showing no significant distinction between small and large pBCCs, nor any specific pattern correlating with tumor enlargement. The number of arborizing vessels, ulcerations, and shiny white structures showed an increasing trend associated with size progression. Arborizing vessels appeared when tumor size exceeded 6 mm. Conclusions: This study provides a dynamic interpretation of the dermoscopic features of pBCC according to size enlargement. Short fine telangiectasia and small erosions are highly important features for the early diagnosis of small pBCCs. Arborizing vessels, ulceration, and shiny white structures are more frequent in large pBCCs, and they increase in association with tumor progression. [ABSTRACT FROM AUTHOR]

Disseminated herpes zoster (DHZ), resulting from the reactivation of the varicella-zoster virus (VZV), typically occurs in immunocompromised persons. To date, only four cases of DHZ following mRNA, viral vector, or inactivated COVID-19 vaccinations have been reported in immunocompetent patients. Herein, we present the first case of DHZ following the protein subunit COVID-19 vaccination (case 1, 64 years old) and a case of DHZ following mRNA COVID-19 vaccination (case 2, 67 years old) in elderly, immunocompetent male patients. Both cases were generally healthy, without a remarkable underlying disease and without a history of immunosuppressant use. Case 1 developed DHZ (left C3–5 predominant) 1 month after receiving the third dose of the SARS-CoV-2 spike protein vaccine (MVC-COV1901). Case 2 developed DHZ (right V1–3 predominant) 7 days after receiving the second dose of the mRNA-1273 SARS-CoV-2 vaccine. Through skin examination, Tzanck smears, and dermoscopy, the diagnosis of COVID-19 vaccination-related DHZ was established in both cases. Oral famciclovir (250 mg, three times/day for 7 days) was administered, and both cases achieved total remission of skin lesions without visceral involvement or severe post-herpetic neuralgia. Our cases demonstrate that DHZ, as a rare cutaneous adverse event in immunocompetent patients, can be secondary not only to mRNA COVID-19 vaccination but also to the protein subunit COVID-19 vaccination. It is speculated that the spike protein of SARS-CoV-2 could be the common trigger for the reactivation of VZV among different types of vaccinations. [ABSTRACT FROM AUTHOR]

Keywords: CD1a; hair follicle; pseudolymphoma EN CD1a hair follicle pseudolymphoma 327 330 4 03/24/22 20220401 NES 220401 INTRODUCTION Pseudolymphomatous folliculitis (PLF) is a variant of cutaneous pseudolymphoma. Dermoscopy showed multiple follicular ostia and surface telangiectasia. gl HISTOPATHOLOGY Incisional skin biopsy revealed diffuse and dense lymphocytic infiltration from superficial to deep dermis. Histopathologically, PLF lesions show dense lymphocytic infiltrate throughout the entire dermis and may extend into the subcutaneous fat. [Extracted from the article]

Melanocytic nevi, dysplastic nevi, and melanoma are all derived from the pigment-producing cells, namely melanocytes. Concerning the clinical spectrum, cutaneous melanoma is the most aggressive skin cancer with a low survival rate, while nevi are the most common benign lesions in the general population, and dysplastic nevi place in between nevi and melanoma. Ultraviolet (UV) radiation is a well-recognized extrinsic risk factor for all three. BRAFV600E is a well-recognized driver mutation that activates the RAS-BRAF-mitogen-activated protein kinase (MAPK) signaling pathway among 40%–60% of melanoma cases. Interestingly, BRAFV600E mutation is detected even more in acquired nevi, approximately 80%. However, in nevi, several tumor suppressors such as p53 and phosphatase and tensin homolog (PTEN) are intact, and senescence factors, including p15INK4b, p16INK4a, p19, and senescence-associated acidic β-galactosidase, are expressed, leading to cell senescence and cell cycle arrest. Although loss of p53 function is rarely found in melanoma, decreased or loss of PTEN with an activated PI3k/Akt signaling pathway is common in nevi, which may abolish senescence status and allow further progression into dysplastic nevi or melanoma. At present, mouse models closely resembling human nevi are used for investigating these phenomena. Melanocortin 1 receptor deficiency, an intrinsic risk factor for melanomagenesis, is related to the production of procarcinogenic pheomelanin and the inhibition of PTEN function. Immune response escape via programmed cell death-1/programmed cell death ligand-1 interaction plays further roles in monitoring the spectrum. Here, we review the current literature on the molecular and immune mechanisms involving the transition from benign nevi to malignant melanoma. [ABSTRACT FROM AUTHOR]

Women with abnormal uterine bleeding (AUB) have been reported to develop chronic spontaneous urticaria (CSU). Nevertheless, whether or not AUB women have an increased risk of CSU has not been examined in large‐scale epidemiologic studies. This study aimed to investigate the risk of CSU among reproductive‐aged women with AUB. A total of 79 595 patients and 79 107 propensity‐score matched controls were recruited from Taiwan's National Health Insurance Research Database to conduct a nationwide cohort study. The Cox proportional‐hazard regression model was applied to examine the adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for CSU in relation to AUB. We found that women with AUB had a higher risk for CSU (aHR = 1.83; 95% CI, 1.76–1.90) than women without AUB. Subgroup analyses revealed that AUB with an abnormal bleeding frequency (aHR = 1.70; 95% CI, 1.60–1.79), irregular bleeding (aHR = 1.80; 95% CI, 1.71–1.89), and intermenstrual bleeding (aHR = 1.65; 95% CI, 1.49–1.83) were associated with an increased risk of CSU compared with those without abnormalities. The Kaplan–Meier analysis revealed that the cumulative incidence of developing CSU was consistently higher in the AUB cohort than in the non‐AUB cohort during the entire follow‐up period (log‐rank test, p < 0.001). In conclusion, reproductive‐aged women with AUB were found to have a higher risk of developing CSU. This study emphasizes the importance of enquiring CSU patients about menstrual problems in clinical practice. Further consultation with obstetrician‐gynecologists may be beneficial. [ABSTRACT FROM AUTHOR]

Considering wider variance in MED and polypharmacy, MED test prior to NBUVB phototherapy is recommended for patients over 65 years old. The NBUVB 24-h MED in the control group is within the 24-hour MED range reported for normal Asian populations.4 Previous studies suggested initiating a lower NBUVB dose with subsequently slower increase in dosage among the elderly than in the general population.1,3 For evaluating the reliability of 24-hour MED among the elderly, all patients were treated with the NBUVB phototherapy protocols based on their 24-h MEDs ranging from 2 weeks to 3 months. Keywords: geriatric dermatology; minimal erythema dose; narrowband UVB; phototherapy EN geriatric dermatology minimal erythema dose narrowband UVB phototherapy 173 175 3 03/23/22 20220301 NES 220301 INTRODUCTION Phototherapy for elderly patients, defined as individuals aged 65 years old or older, has become an emerging issue with aging on the rise.1The initial dose of narrowband ultraviolet B (NBUVB, 311nm) phototherapy, a widely utilized treatment modality in Taiwan, is determined by the minimal erythema dose (MED). The MED test was performed on the patient subjects' backs, in areas without skin lesions, with twelve different NBUVB doses (100-800 mJ/cm SP 2 sp ) using Neolux SP ® sp (Daavlin, Bryan, Ohio) as the light source. [Extracted from the article]

Background: The incidence, histological subtypes, and tumor behaviors of cutaneous malignant melanoma are quite different in Asian and Western countries. Objectives: Our purpose was to define the epidemiology, tumor behaviors, and possible prognostic predictors of cutaneous melanomas based on an Eastern Taiwanese population. Methods: We conducted a retrospective study to collect cases of cutaneous melanoma at Buddhist Tzu-Chi General Hospital, Hualien, Taiwan, from May 1, 2003, to August 31, 2017. We analyzed mean age at onset, gender, primary tumor locations, histological subtypes, Breslow's thickness, Clark's level, ulceration, lymph nodes, and distant metastatic status. Univariate and multivariate analyses for survival were performed by means of Cox proportional hazard model. Survival curves were plotted by Kaplan–Meier method. Results: A total of 56 cases of cutaneous melanoma were recorded. The male-to-female ratio was 3.67:1. The median survival was 2.82 years (0.63–5.00 years). Acral melanoma (AM) accounts for 69.6% of cases, and feet are the most common location (62.5%). Acral lentiginous melanoma (ALM) is the most common histological type (44.6%), followed by nodular melanoma (33.9%). Poor prognostic factors include older age (≧65 years), male gender, Breslow's thickness >4 mm, distant metastasis, and head-and-neck location. Conclusion: AM is the most common location, and ALM is the most common histological type of cutaneous melanoma in Eastern Taiwan. Melanoma in Eastern Taiwan tends to be delay diagnosed with advanced stage and thicker tumors than Western Taiwan. Prudent palm and sole examinations, improved medical accessibility, and more public educational programs may help encourage the early detection of melanoma. [ABSTRACT FROM AUTHOR]

Acquired reactive perforating collagenosis (ARPC) is a rare condition caused by transepidermal elimination of collagen, elastin fibers and keratin. To date, the pathogenesis of ARPC remains unknown. Different hypotheses were proposed, including superficial microtrauma due to pruritus and subsequent scratching, diabetes-induced microangiopathy, epidermal and dermal abnormalities in metabolic disorders, dermal microdeposits in patients with chronic renal failure and vasculopathy underlying chronic venous insufficiency and hypertension. In the past two decades, oral allopurinol had been found to be effective in treating ARPC. We report a case of a 36-year-old pregnant woman with itchy skin lesions on the trunk and four limbs since 36 weeks of her gestation. Initially, she was prescribed with oral antihistamine and topical steroid but did not respond well. Skin biopsy was performed and was compatible with ARPC. Normal renal and liver function tests were noted, and the HLA-B5801 test was negative. We treated the patient with allopurinol. Significant improvement was noticed at 1-month follow-up. To the best of our knowledge, this is the first case successfully treating ARPC induced by pregnancy with allopurinol. On careful follow-up of laboratory data and HLA-B5801 test screening, allopurinol may be another effective treatment option for ARPC patients after pregnancy. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory skin disorder that affects ~2%–3% of the worldwide population. Inappropriate and excessive activation of endosomal Toll-like receptors 7, 8, and 9 (TLRs 7–9) at the psoriatic site has been shown to play a pathogenic role in the onset of psoriasis. Macrophage is a major inflammatory cell type that can be differentiated into phenotypes M1 and M2. M1 macrophages produce proinflammatory cytokines, and M2 macrophages produce anti-inflammatory cytokines. The balance between these two types of macrophages determines the progression of various inflammatory diseases; however, whether macrophage polarization plays a role in psoriatic inflammation activated by endosomal TLRs has not been investigated. In this study, we investigated the function and mechanism of macrophages related to the pathogenic role of TLRs 7–9 in the progression of psoriasis. Analysis of clinical data in database revealed significantly increased expression of macrophage markers and inflammatory cytokines in psoriatic tissues over those in normal tissues. In animal studies, depletion of macrophages in mice ameliorated imiquimod, a TLR 7 agonist-induced psoriatic response. Imiquimod induced expression of genes and cytokines that are signature of M1 macrophage in the psoriatic lesions. In addition, treatment with this TLR 7 agonist shifted macrophages in the psoriatic lesions to a higher M1/M2 ratio. Both of the exogenous and endogenous TLR 7–9 ligands activated M1 macrophage polarization. M1 macrophages expressed higher levels of proinflammatory cytokines and TLRs 7–9 than M2 macrophages. These results suggest that by rendering macrophages into a more inflammatory status and capable of response to their ligands in the psoriatic sites, TLR 7–9 activation drives them to participate in endosomal TLR-activated psoriatic inflammation, resulting in an amplified inflammatory response. Our results also suggest that blocking M1 macrophage polarization could be a strategy which enables inhibition of psoriatic inflammation activated by these TLRs. [ABSTRACT FROM AUTHOR]

A 56-year-old woman presented with multiple blisters on the rim of painful erythematous annular lesions over the trunk and four extremities, accompanied with fever and arthralgia on both ankles and feet. Laboratory studies showed neutrophilia and elevated C-reactive protein level. Skin biopsy revealed exuberant edema of the papillary dermis, extensive neutrophil infiltration, and hemophagocytosis within the dermis. Her symptoms and skin lesions resolved 3 days after initiation of systemic corticosteroids. To the best of our knowledge, this is the first case report of cutaneous hemophagocytosis without additional symptoms of hemophagocytic syndrome in patients with Sweet's syndrome. [ABSTRACT FROM AUTHOR]

• Photodynamic therapy provides a safe and effective strategy for treating large Bowen's disease lesions. • Photodynamic therapy may enhance topical imiquimod therapeutic effects. • Optical coherence tomography provides a useful and noninvasive diagnosis of early Bowen's disease recurrence. Bowen's disease, a form of skin cancer, is an intraepithelial carcinoma involving keratinocytes. It is associated with a risk of developing invasive squamous cell carcinoma in 3-5% of cases. Ultraviolet exposure, arsenic, human papillomavirus infection, immunosuppression, and genetic factors have been reported to be the causes. Clinically, it presents as symptomless and slowly growing, well-demarcated, irregular erythematous patches or plaques with scaly or crusted surfaces. Surgical excision remains common; however, for large (>20 mm) or multiple Bowen's disease lesions, alternative therapies need to be considered. Here, we present a case of extremely large Bowen's disease lesions in the lower extremities successfully treated with combination therapy using topical aminolevulinic acid-based photodynamic therapy followed by topical 5% imiquimod cream. Optical coherence tomography revealed disorganized and uneven nuclei of keratinocytes in the recurrent lesions, which became relatively small and uniform upon resolution. We demonstrated that photodynamic therapy provides a generally safe and effective strategy for treating large Bowen's disease lesions and optical coherence tomography provides a useful and noninvasive diagnosis of early Bowen's disease recurrence. [ABSTRACT FROM AUTHOR]