Research progress on malignant tumor after lung transplantation / 器官移植

Lung transplantation has become the most effective treatment of end-stage lung diseases. Along with persistent optimization of lung transplantation technique and perioperative management, the short-term clinical efficacy after lung transplantation has been significantly improved, whereas the long-term clinical prognosis remains unoptimistic. Besides chronic lung allograft dysfunction, postoperative malignant tumors also threaten the long-term survival of the recipients. Common malignant tumors following lung transplantation include nonmelanoma skin cancer, posttransplant lymphoproliferative disease and lung cancer. After solid organ transplantation, a large majority of the recipients require lifelong immunosuppressive therapy. The intensity of immunosuppressive therapy for the lung transplant recipients is generally higher than other organ transplant recipients. Immunosuppression is the main factor which leads to the impairment of anti-tumor immune monitoring function and promotes the incidence and development of malignant tumors. In this article, the risk factors, prevention and treatment of the most common malignant tumors after lung transplantation were reviewed, aiming to provide reference for comprehensive diagnosis and treatment of malignant tumors following lung transplantation.

Epidemiology and biology of cutaneous human papillomavirus

Cutaneous human papillomaviruses (HPVs) include β- and γ-HPVs, in addition to a small fraction of α-HPVs. β-HPVs were first isolated from patients with the rare genetic disorder Epidermodysplasia verruciformis, and they are associated with the development of nonmelanoma skin cancer at sun-exposed skin sites in these individuals. Organ transplant recipients also have greater susceptibility to β-HPV infection of the skin and an increased risk of developing nonmelanoma skin cancer. In both immunosuppressed and immunocompromised individuals, cutaneous HPVs are ubiquitously disseminated throughout healthy skin and may be an intrinsic part of the commensal flora. Functional analysis of E6 and E7 proteins of specific cutaneous HPVs has provided a mechanistic comprehension of how these viruses may induce carcinogenesis. Nevertheless, additional research is crucial to better understand the pathological implications of the broad distribution of these HPVs.

Squamous Cell Carcinoma Associated with Arsenic Keratosis in a Psoriasis Patient Treated with Ustekinumab: A Case Report / 대한피부과학회지

A 53-year-old Korean woman with known history of psoriasis and treatment with ustekinumab over 16 months, presented with a nontender erythematous plaque with oozing noted on her left sole. Histopathologic examination of the lesion confirmed squamous cell carcinoma (SCC). Although use of ustekinumab was considered a possible risk factor for the development of SCC, administration of ustekinumab was continued per her request following an operation for removal of the SCC. And 19 months later, newly developed multiple hyperkeratotic papules on her soles were diagnosed as arsenic keratosis based on her past history of consumption of Chinese traditional herbal medicine. I concluded that SCC in this patient was not caused by ustekinumab, but was associated with arsenic keratosis. This case emphasizes that screening for risk factors associated with skin malignancies, such as exposure to arsenic or presence of arsenic keratosis, should be performed prior to using biologics in Korean psoriasis patients.

Lesiones cervicofaciales precancerosas y cánceres cutáneos no melanomas del paciente geronte / Premalignant cervicofacial lesions and nonmelanoma skin cancer in elderly patient

Introducción: el envejecimiento poblacional constituye el principal problema demográfico actual y perspectivo de la población cubana. El cáncer de piel, así como las lesiones premalignas de este órgano protector son cada vez más frecuentes en los adultos mayores. Objetivo: determinar el comportamiento clínico-epidemiológico del cáncer de piel y las lesiones premalignas en los gerontes de un área de salud. Método: se realizó un estudio descriptivo, analítico, de corte transversal en los pacientes gerontes del consultorio No. 3 del policlínico Adrián Sansaric del municipio Artemisa, en el período comprendido entre marzo y noviembre de 2011. El universo estuvo constituido por 481 adultos mayores y la muestra quedó conformada por 100 pacientes, aquellos que presentaron alguna lesión premaligna y/o maligna en la región cervicofacial. Resultados: la lesión premaligna más frecuente fue la queratosis senil con 95 por ciento y como lesión maligna, el carcinoma basocelular con 12 por ciento. Los principales factores asociados a estas fueron el color de la piel blanca, los pacientes de 80 años y más, la exposición al sol y las ocupaciones de riesgo, estas dos últimas presentes en los pacientes con carcinoma basocelular, se encontró significación estadística entre el tipo de lesión con el color de la piel blanca (X2= 6,7 con p═ 0,03). Las lesiones premalignas aparecieron en la región geniana en el 75,0 por ciento y en la frontal en el 62,5 por ciento, mientras que las lesiones malignas se presentaron en la región nasal en 50 por ciento de los casos. Conclusiones: se encontró una elevada prevalencia de lesiones premalignas y malignas en la piel de la región cervicofacial en los adultos mayores de 65 años, lo que atenta contra una longevidad satisfactoria y la estética de estos(AU)

Introduction: aging is currently the main demographic problem for Cuban population. The frequency of skin cancer and other premalignant lesions in this protective organ has increased in recent years, especially in elderly patients. Objective: to determine clinical and epidemiological behavior of the aforementioned lesions in elderly patients. Method: an observational and descriptive cross-sectional study was conducted in 2011, between March and November, with patients from the area of the Adrian Sansaric polyclinic in the municipality of Artemisa. A sample of 100 patients showing premalignant and/or malignant lesions in the cervicofacial region was selected from an initial population of 481 elderly patients. Results: the most frequent premalignant and malignant lesions were senile keratosis (95 percent) and the basal cell carcinoma (12 percent), respectively. Skin colour, age, sun exposure and occupational risk were the main factors associated with these lesions. Patients aged 80 or more, with white skin, increased sun exposure and occupational risk were the most susceptible. Premalignant lesions were located in the genian (75 percent) and frontal (62.5 percent) regions while the malignant lesions were more frequent in the nasal region (50 percent). Conclusions: premalignant and malignant lesions in the skin show a high prevalence among elderly patients which significantly threaten their longevity and aesthetics(AU)

Manifestaciones cutáneas en pacientes con Enfermedad de Parkinson en una población chilena / Cutaneous manifestations in patients with Parkinson's disease In a Chilean population

IINTRODUCCIÓN: Las alteraciones cutáneas asociadas a la Enfermedad de Parkinson (EP) constituyen un área poco estudiada. OBJETIVOS: Describir las alteraciones cutáneas de un grupo de pacientes con EP y su asociación a parámetros cutáneos funcionales (sebo y humedad). PACIENTES Y MÉTODOS: Estudio observacional descriptivo prospectivo de pacientes con EP evaluados entre los meses de febrero y octubre del 2010. RESULTADOS: Se observó dermatitis seborreica (DS) en un 9,58 por ciento, no correlacionándose con seborrea (p=0,415), tiempo de evolución (p=0,338) ni severidad de la EP (p=0,787). Además, se observó un 6.84 por ciento de cáncer de piel no melanoma. La sebometría se asoció de forma inversa con la edad y mayores dosis de L-dopa. La higrometría no se asoció con tiempo de evolución, severidad de la EP ni fluctuaciones motoras. CONCLUSIONES: Los pacientes con EP evaluados tienen una mayor frecuencia de cáncer de piel no melanoma y DS, sin embargo, se necesitan más estudios para determinar su real asociación.

INTRODUCTION: Skin disorders associated with Parkinson’s disease (PD) are a poorly studied area. OBJECTIVES: To describe skin changes in a group of PD patients and its association with cutaneous functional parameters (sebum and humidity). PATIENTS AND METHODS: Descriptive prospective observational study of PD patients evaluated between February and October 2010. RESULTS: Seborrheic dermatitis (SD) was observed in 9.58 percent and not correlated with seborrhea (p = 0.415), duration (p = 0.338) and severity of PD (p = 0.787). In addition, a 6.84 percent of non-melanoma skin cancer was observed. Sebometry was inversely associated with age and higher doses of L-dopa. Humidity was not associated with time of evolution, severity of PD or motor fluctuations. CONCLUSIONS: The evaluated patients with PD have a higher frequency of non-melanoma skin cancer and SD. However, more studies are needed to establish their real association.

Cáncer de piel no melanoma e inmunosupresión / Non-melanoma skin cancer and inmunosuppressive therapy

El cáncer de piel no melanoma es la neoplasia más frecuente en el ser humano, sin embargo su incidencia es aún mayor en individuos trasplantados usuarios de inmunosupresión prolongada, representado en ellos el 95 por ciento de los cánceres de piel, con un comportamiento más agresivo y mayor probabilidad de recidiva. A diferencia de la población general, en la cual el cáncer basocelular es el más común, en estos pacientes el carcinoma de células escamosas es el más habitual. El papel del tratamiento inmunosupresor en la génesis del cáncer de piel no melanoma es vastamente reconocido. Los cánceres de piel resultan tanto de una disminución de la actividad inmunológica, como de los efectos oncogénicos directos vinculados a algunos inmunosupresores. La carga tumoral específica parece estar vinculada con el tipo, dosis y duración de la inmunosupresión. En este artículo presentamos una revisión sistemática actualizada de la literatura acerca de esta interesante entidad patológica, con especial énfasis en la epidemiología, factores de riesgo, patogénesis y terapia.

Clinicohistopathologic profile of patients who underwent Mohs micrographic surgery at the Dermatology Center of St. Luke's Medical Center from 2003-2008

BACKGROUND: Mohs Micrographic Surgery (MMS) is the microscopically-controlled excision of skin cancer. Although there have been several international studies on MMS for nonmelanoma skin cancer (NMSC) including 1 from Korea, there have been no reports yet on MMS in the Philippines. This is the first study on MMS for NMSC in the Philippines.OBJECTIVE: To describe the clinical and histopathologic profile of all patients who underwent MMS at the Dermatology Center, St. Luke's Medical Center, from March 2003- March 2008.METHODS: A retrospective study was conducted on all MMS cases done at the Mohs Surgery Unit of the Dermatology Center in St. Luke's Medical Center from March 2003- March 2008. Demographic and clinicohistologic profile of all cases were reviewed. Three to five-year recurrence rate was reported.RESULTS: A total of 75 cases were reviewed and included in the study. The mean age of the study population was 61.29 years old and 90 percent belong to the >40 age group. The male:female ratio was 3:1. There were almost equal number of Filipino and Caucasian patients. Most patients permanently reside in the Philippines, with a small percentage coming from nearby countries like Guam. One-fifth of the study population were retired military men. The most common tumor was basal cell carcinoma (BCC), primary cases outnumbering recurrent ones. The nose was the most common area affected with BCC, while the cheek was the most common site of squamous cell carcinoma (SCC). Majority of tumors done were d" 2 cm. The most common post-operative defect size incurred was also d" 2 cm. The most common primary indication for doing MMS was the location of the tumor. Most NMSCs were cleared after 2-3 stages. Local flaps were the most commonly used type of repair, followed by primary closure. Based on 3- to 5-year surveillance of cases done from 2003-2005, there has been no recurrence yet as of March 2008.CONCLUSION: The clinicohistopathologic profile of patients who underwent MMS in the Dermatology Center of St. Luke's Medical Center has similarities and differences with existing local and international literature. MMS, as offered by the first Mohs Surgery Unit in the country, caters mostly to the older age group with a predominance of the male population. The number of Filipino and Caucasian patients who underwent the procedure was almost equal. BCC is still the most common tumor treated in the Center with the face as the most common location. Most tumors were immediately cleared after few MMS stages. Success rate of the procedure in the Unit is very high, based on 3 to 5- year surveillance for recurrence.

A Study of Reconstruction Methods for 186 Cases after Complete Excision ofNonmelanoma Skin Cancers / 대한피부과학회지

BACKGROUND: Skin cancer is divided into two categories, melanoma and nonmelanoma skin cancer, by its malignant potential. The former is prone to be metastatic and it often requires regional lymph node dissection and chemotherapy, while the latter is rarely metastatic with no need for such further treatment. We report here on the reconstruction methods after surgical removal of skin cancers, with excluding melanoma. OBJECTIVE: Our purpose was to analyze the reconstruction methods according to the location and size of the lesions after surgical removal of nonmelanoma skin cancers and we report on the clinical findings. METHODS: We analyzed 186 cases of nonmelanoma skin cancers that were treated Between January, 2000 and December, 2006 at the Department of Dermatology, Chonbuk University Hospital. The cases were analyzed according to the reconstruction methods for the defects after surgery, the gender ratio, the age range, the lesion site and the lesion size. RESULTS: The mean age of onset was 67.7 years old. The ratio of men to women was 1:1.02. The most common nonmelanoma skin cancer was basal cell carcinoma (66.7%), followed by squamous cell carcinoma (22.1%), and Bowen's disease (4.3%). The most common site of all the nonmelanoma skin cancers was the face (68.8%), followed by the trunk (7.5%) and scalp (6.5%). The most common reconstruction method was local flap (40.3%), followed by primary closure (38.7%), skin graft (18.8%) and secondary intention (2.2%). In terms of location, the most commonly used method was local flap for the face (50.0%) and primary closure for the trunk (53.3%), scalp (83.3%) and the upper (44.4%) and lower extremities (63.6%). According to the lesions' size, the most common method was flap for tumor between 10 mm and 30 mm in diameter (95.1%), primary closure for tumor less than 10 mm in diameter (66.7%) and graft for tumor greater than 30 mm in diameter (66.7%). CONCLUSION: We offer this data for the reconstruction methods of nonmelanoma skin cancers and their clinical findings in Korea.

Clinicohistopathologic profile of patients who underwent Mohs micrographic surgery at the Dermatology Center of St. Luke's Medical Center from 2003-2008

BACKGROUND: Mohs Micrographic Surgery (MMS) is the microscopically-controlled excision of skin cancer. Although there have been several international studies on MMS for nonmelanoma skin cancer (NMSC) including 1 from Korea, there have been no reports yet on MMS in the Philippines. This is the first study on MMS for NMSC in the Philippines.OBJECTIVE: To describe the clinical and histopathologic profile of all patients who underwent MMS at the Dermatology Center, St. Luke's Medical Center, from March 2003- March 2008.METHODS: A retrospective study was conducted on all MMS cases done at the Mohs Surgery Unit of the Dermatology Center in St. Luke's Medical Center from March 2003- March 2008. Demographic and clinicohistologic profile of all cases were reviewed. Three to five-year recurrence rate was reported.RESULTS: A total of 75 cases were reviewed and included in the study. The mean age of the study population was 61.29 years old and 90 percent belong to the >40 age group. The male:female ratio was 3:1. There were almost equal number of Filipino and Caucasian patients. Most patients permanently reside in the Philippines, with a small percentage coming from nearby countries like Guam. One-fifth of the study population were retired military men. The most common tumor was basal cell carcinoma (BCC), primary cases outnumbering recurrent ones. The nose was the most common area affected with BCC, while the cheek was the most common site of squamous cell carcinoma (SCC). Majority of tumors done were d" 2 cm. The most common post-operative defect size incurred was also d" 2 cm. The most common primary indication for doing MMS was the location of the tumor. Most NMSCs were cleared after 2-3 stages. Local flaps were the most commonly used type of repair, followed by primary closure. Based on 3- to 5-year surveillance of cases done from 2003-2005, there has been no recurrence yet as of March 2008.CONCLUSION: The clinicohistopathologic profile of patients who underwent MMS in the Dermatology Center of St. Luke's Medical Center has similarities and differences with existing local and international literature. MMS, as offered by the first Mohs Surgery Unit in the country, caters mostly to the older age group with a predominance of the male population. The number of Filipino and Caucasian patients who underwent the procedure was almost equal. BCC is still the most common tumor treated in the Center with the face as the most common location. Most tumors were immediately cleared after few MMS stages. Success rate of the procedure in the Unit is very high, based on 3 to 5- year surveillance for recurrence.