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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.

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.

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.

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.

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 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.

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.

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

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.

The prevalence of skin diseases has increased dramatically in recent decades, and they are now considered major chronic diseases globally. People suffer from a broad spectrum of skin diseases, whereas skin tumors are potentially aggressive and life-threatening. However, the severity of skin tumors can be managed (by treatment) if diagnosed early. Health practitioners usually apply manual or computer vision-based tools for skin tumor diagnosis, which may cause misinterpretation of the disease and lead to a longer analysis time. However, cutting-edge technologies such as deep learning using the federated machine learning approach have enabled health practitioners (dermatologists) in diagnosing the type and severity level of skin diseases. Therefore, this study proposes an adaptive federated machine learning-based skin disease model (using an adaptive ensemble convolutional neural network as the core classifier) in a step toward an intelligent dermoscopy device for dermatologists. The proposed federated machine learning-based architecture consists of intelligent local edges (dermoscopy) and a global point (server). The proposed architecture can diagnose the type of disease and continuously improve its accuracy. Experiments were carried out in a simulated environment using the International Skin Imaging Collaboration (ISIC) 2019 dataset (dermoscopy images) to test and validate the model’s classification accuracy and adaptability. In the future, this study may lead to the development of a federated machine learning-based (hardware) dermoscopy device to assist dermatologists in skin tumor diagnosis.

Background: Systemic photoprotection (i.e., administration of substances such as nicotinamide, carotenoids, and vitamin D) may be important to reduce photocarcinogenesis or to support long-term protection against UV irradiation. Clinical trials showed that oral nicotinamide is effective in reducing the onset of new nonmelanoma skin cancers (NMSCs), while other oral photoprotectors failed to achieve the reduction of new melanoma or NMSC formation in humans. The aim of this study was to summarize the current state of knowledge of systemic photoprotection and to evaluate the knowledge and attitude of dermatologists regarding these treatments. Methods: The survey was conducted on a sample of dermatologists recruited according to a snowball sampling procedure. The questionnaire consisted of a first part asking for characteristics of the participant and a second part with 12 specific questions on their knowledge about systemic photoprotection, particularly their knowledge of astaxanthin, β-carotene, nicotinamide, and vitamin D3. Results: One hundred eight dermatologists answered the survey. Most of them (85.2%) stated that oral photoprotectors have a role in the prevention of skin cancer, and responses mainly mentioned nicotinamide. More than half of them (54.6%) had prescribed all the considered oral photoprotectors, but the majority of them had prescribed nicotinamide, mainly for 2 to 3 months during summer, almost invariably (n = 106) associated with topical photoprotectors. Most dermatologists (&gt, 80%) were aware of scientific publications demonstrating an effect of systemic photoprotectors on NMSC. Conclusions: Most Italian dermatologists have positive views on oral photoprotection in skin cancer and are aware of the demonstrated potential of nicotinamide in the prevention of NMSCs.

High-frequency ultrasonography (HF-USG) is a non-invasive and in vivo method of visualization of the skin and upper part of subcutaneous tissue based on ultrasounds above 20 MHz. Although initially HF-USG was introduced to measure skin thickness, it currently gained widespread acceptance in dermato-oncology, primarily when used to determine skin tumor margins. Moreover, its application in different dermatology fields is known, particularly as a rapidly evolving method in the objective evaluation of the severity of various chronic skin diseases. Among different specialties, teledermatology belongs to leading and continually developing areas of successful telemedicine applications. Various skin conditions are visible to the human eye, which makes them particularly suitable for telemedicine. However, HF-USG enables specialists to look into deeper skin layers, thus extending diagnostic options. On the other hand, teledermatology creates the possibility of sending images for consultation and facilitates the therapeutic decision as HF-USG can be used in an asynchronous store and forward manner. It seems that HF-USG and teledermatology may be regarded as a truly matched pair. The aim of this work is to present current applications of 20-MHz ultrasonography in dermatology, including skin neoplasms and chronic skin diseases. Moreover, the authors aimed to analyze the possibilities of HF-USG use as a valuable tool in teledermatology, especially in diagnosing and monitoring patients suffering from long-lasting skin conditions.

Introduction Malignant melanoma is an aggressive skin tumor with a good prognosis when treated in an early tumor stage, but has a poor prognosis with distant metastases. The incidence of malignant melanoma has increased continuously over the last decades, with little change in mortality. One explanation for this is that melanomas are increasingly detected in early stages, especially after the establishment of statutory skin cancer screening in 2008, which allows a free skin examination every 2 years for people older than 35 years. Methods In this study incidence and mortality of malignant melanoma were correlated with the dermatologist density in Bavarian administrative regions. In addition, the incidence data were compared before and after the introduction of statutory skin cancer screening. Results There was a significant correlation between the incidence of malignant melanoma and dermatologist density (r = 0.258, p = 0.044), but no correlation between mortality and dermatologist density (r = 0.201, p = 0.121). Similarly, the increase of malignant melanoma incidence following the introduction of statutory skin cancer screening in 2008 was independent of dermatologist density (r = 0.021, p = 0.873). Conclusion The dermatologist density in Bavaria correlates positively with the incidence of malignant melanoma. Despite an increased incidence, mortality was not elevated in the respective administrative regions.

Background Teledermatology was raised as a potential answer to increase access and decrease delay for skin cancer management. However, its influence on non-melanoma skin cancer (NMSC) care pathway has never been studied. Objectives To compare conventional care pathway to teledermatology (TD) in NMSC care pathways using a process modelling approach. Patients and methods A period study including three groups was conducted in a department of dermatology. During the first period from January till February 2013 a NMSC care pathway was mapped for a group a prior TD integration. During the second period from September 2016 till October 2018, the NMSC care pathway was determined for patients managed by a conventional care process and after TD diagnosis. Patients characteristics, type of tumors and processes were compared using time as a key performance indicator. Mean were reported with their ± SD. Linear regression was performed using time between multidisciplinary consultation and surgery as outcome adjusted on sex, age and cancer type. Results During the first period (prior to TD) 89 NMSC patients were managed (mean age = 76 yr old ± 13) during the second period, 36 patients NMSC were managed after TD, mean age of 89 years old ± 6 and 954 patients in a conventional process, mean age of 78 years old ±12. In comparison between the two periods patient’s age, sex and cancer distribution significantly differed while the rate of surgery was not significantly different (p = 0.967). Linear multivariate regression using time between multidisciplinary consultation and surgery as outcome adjusted on sex age and cancer type displayed that during the second period patients in the TD group spent 17.6 days more [0.98,34.25] while patient in the conventional care process group had 9.8 days [1.85,17.74] more than patient in the study period 1, (p = 0.04, p = 0.02) without significant difference for age and sex (p = 0.29, p = 0.51). Patients with a SCC had a decreased time between multidisciplinary consultation and surgery of −12.97 days [−17.43, −8.5], p Conclusion Interestingly, patients managed by TD were significantly older than those managed using a conventional care pathway. Unexpectedly their total time spent in the process was not shorter. The results of this analysis illustrated the interest of using process modelling approach to assess the impact of a healthcare innovation integration and to further rethink coordination and care pathways for NSMC post TD.

Equine sarcoid is the most common skin tumor of horses. Clinically, it occurs as a locally invasive, fibroblastic, wart-like lesion of equine skin, which has 6 clinical classes: occult, verrucose, nodular, fibroblastic, mixed, and malignant. Sarcoids may be single but multiple lesions are more frequent. The typical histological feature is increased density of dermal fibroblasts which form interlacing bundles and whorls within the dermis. Lesions are mostly persistent, resist therapy, and tend to recur following treatment. In general, sarcoids are not fatal but their location, size, and progression to the more aggressive form may lead to the withdrawal of a horse from use and serious infringement of their welfare leading to the loss of valuable animals. Bovine papillomavirus (BPV) type 1 and less commonly type 2 contribute to the development of equine sarcoid. The viral genome and proteins are detected in a high percentage of cases. Furthermore, viral oncoprotein activity leads to changes in the fibroblastic tissue similar to changes seen in other types of tumors. Equine sarcoids are characterized by a loss of tumor suppressor activity and changes allowing abnormal formation of the affected tissue, as well as y immune defense abnormalities that weaken the host’s immune response. This impaired immune response to BPV infection appears to be crucial for the development of lesions that do not spontaneously regress, as occurs in BPV-infected cows.

Melanoma is a complex and highly aggressive skin tumor with increasing incidence worldwide. In this chapter, this malignant cancer is addressed, gathering information about epidemiology, mitochondrial role in the disease, clinical presentation, and therapeutic management. In the search for novel and more effective therapies against melanoma, pharmacologically active natural products have been explored, with several drugs reaching the market. In vitro and in vivo studies of natural compounds with potential antimelanoma activity are highlighted. Despite their promising potential, some of them can display unfavorable physicochemical and pharmacokinetic features that compromise their clinic translation. Over the last years, there have been advances in nanotechnology applied to cancer treatment that have overcome many of these limitations, providing versatile and effective tools for the successful in vivo delivery of natural molecules, namely lipid-based, polymeric, and metallic nanosystems. These nanocarriers allow not only the modulation of pharmacokinetic and pharmacodynamic profiles of the compounds, but also the increase of their stability and circulation time, resulting in greater therapeutic efficacy and less toxicity. Overall, this chapter focuses on nanoformulated natural-based compounds as an alternative therapeutic approach against melanoma, describing the most representative works from 2008 to 2020.

Objective It is challenging to repair postoperative defect caused by skin tumor resection on the maxillofacial, which not only affects appearance but also impairs functions. To better repair skin defect on the maxillofacial, the application value of V-Y vascular myocutaneous flap was introduced in our study. Methods Between June 2011 and December 2018, 16 patients with maxillofacial skin tumors who received extensive resection were enrolled in our study. The defect on the maxillofacial was repaired by V-Y vascular myocutaneous flap. The follow-up period lasted for 12 to 24 months. Results All 16 cases of myocutaneous flaps survived with 1 case of partial venous congestion and 1 case of partial distal necrosis. No recurrence occurred during follow-up. The color and texture of myocutaneous flaps like those of the surrounding skin. Conclusion Featured with better freeness, larger repair range and aesthetic effect of "kite" flaps, V-Y vascular myocutaneous flap can repair the superior border of zygomatic arch pedicled with facial artery and repair 1.5 cm above the superior border of zygomatic arch pedicled with transverse facial artery for elderly patients in Asia.

A keloid scar is a benign skin tumor and we aimed to assess the Quality of Life (QoL) of black Africans with keloid scars based on the Dermatology Life Quality Index (DLQI). We conducted a cross-sectional descriptive study in the department of dermatology of the teaching hospital of Treichville in Ivory Coast. We recruited 132 patients with keloid and 3612 dermatoses without keloid: The prevalence was 3.50% (132/3753). We included 120 patients aged from 16 to 63 years old, the sex ratio was 0.46 (38/82) and the mean age was 34.20 years. Keloid scars were mostly secondary to skin trauma in 30.00 % and infection in 21.67%. The commonest site was the ear in 29.17 %. We reported Keloid with pain in 53.33% and pruritus in 95.00%. We observed psychological impact in 65.83%. The DLQI scores were moderate and high in 61.66 %. QoL was impacted significantly when keloid was associated with pain (p=0.046), pruritus (p=0.81) and functional disorders (p=0.29). The DLQI score could be a valuable tool to assess QoL in black African patients with keloid, for better treatment option.

Graphical abstract, Background and objectives Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma. Material and methods Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points. Results Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter > 4 cm or thickness > 6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (> 6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five- and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months. Conclusions In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect to see to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays.

Carcinosarcomas are composed of epithelial and mesenchymal elements and primarily present within visceral organs. Despite being potentially aggressive, they are a rare diagnosis in the skin, and few manifestations have been reported to date. In this report, we describe two separate cases of carcinosarcoma presenting as nonhealing scalp wounds. Patient A: a 57-year-old male with a nonhealing skin lesion of ten years successfully treated with wide-local excision and local ortichochea flap reconstruction. Patient B: a 75-year-old female that presented with a painless, slow-growing hemorrhagic mass of 7 years invading the skull and dura ultimately requiring craniectomy and free-tissue transfer with anterolateral thigh flap. Cutaneous carcinosarcomas have more favorable outcomes due to low metastatic rates likely due to earlier detection, but delayed presentation can be fatal. Histopathological analysis is critical for determining diagnosis and prognosis. Adequate reconstruction after wide base excision varies and follows the reconstructive ladder/elevator ranging from primary closure up through free-tissue transfer. With cutaneous manifestations of carcinosarcoma seldom reported in the literature, it is our hope that reporting unusual instances such as this will raise awareness and allow for earlier diagnoses, treatments, and reconstructions.