Metástasis cutánea de carcinoma diferenciado de tiroides. A propósito de un caso / Cutaneous metastasis of differentiated thyroid carcinoma. About a case

El cáncer de tiroides (CT) así como otros tipos de tumores malignos tienen la capacidad de invadir e infiltrar otros tejidos tanto contiguos como tejidos y órganos distantes produciendo lo que se conoce como metástasis (MT). Esta es una característica propia de la mayoría de los tumores cancerígenos, y el mecanismo por el cual lo realizan se produce de distintas maneras dependiendo del tipo histológico del tumor, así como de sus particularidades de diseminación propias sea vía linfática, hematógena, nerviosa o por invasión local. Hablando particularmente del cáncer de tiroides (CT) y siendo más específicos el cáncer papilar (CPT), es la variante histológica maligna que con más prevalencia e incidencia se presenta en esta glándula, además que es el cáncer tiroideo que presenta el mejor pronostico y más alternativas de tratamiento por su patrón de crecimiento lento, y por su baja capacidad de producir metástasis (MT) a distancia, presentado se en menos del 10% de pacientes con este diagnóstico. Pese a esta baja tasa de enfermedad metastásica, esta patología ha presentado un crecimiento notable en su prevalencia llegando a triplicarse en los últimos 30 años, lo que ha originado de la misma manera un aumento en la prevalencia de casos de metástasis (MT) por esta neoplasia. Cuando se presenta enfermedad metastásica del carcinoma papilar de tiroides (CPT) se localiza con mayor frecuencia en tejido ganglionar seguido por tejido pulmonar y óseo. La diseminación de este tipo de cáncer a otros sitios es infrecuente, y a piel es aún más inusual. Por este motivo se presenta el caso de una paciente femenina de 74 años, con antecedentes de diagnóstico de carcinoma diferenciado de tiroides sometida a varias intervenciones quirúrgicas previas, la cual presenta una lesión dérmica a nivel pre esternal, cuyo estudio histopatológico post resección fue compatible con diseminación metastásica cutánea de este tipo de cáncer.

Thyroid cancer (CT) as well as other types of malignant tumors have the ability to invade and infiltrate other tissues both contiguous and distant tissues and organs producing what is known as metastasis (MT). This is a characteristic of the majority of cancerous tumors, and the mechanism by which they are carried out occurs in different ways depending on the histological type of the tumor, as well as its own dissemination characteristics, whether lymphatic, hematogenous, nervous or local invasion. Speaking particularly of thyroid cancer (CT) and being more specific papillary cancer (CPT), it is the malignant histological variant that has the most prevalence and incidence in this gland, in addition it is the thyroid cancer that has the best prognosis and more treatment alternatives due to their slow growth pattern, and due to their low capacity to produce distance metastases (MT) presented in less than 10% of patients with this diagnosis. Despite this low rate of metastatic disease, this pathology has presented a remarkable growth in its prevalence, tripling in the last 30 years, which has also caused an increase in the prevalence of metastatic cases (MT) due to this neoplasia. When there is metastatic disease of papillary thyroid carcinoma (CPT), it is most often located in lymph tissue followed by lung and bone tissue. The spread of this type of cancer to other sites is uncommon, and the skin is even more unusual. For this reason, the case of a 74-year-old female patient is presented, with a history of diagnosis of differentiated thyroid carcinoma undergoing several previous surgical interventions, which presents a dermal lesion at the pre-sternal level, whose post-resection histopathological study was compatible with metastatic skin spread of this type of cancer

Prognostic factors for metastasis in cutaneous melanoma

Abstract: Background: Melanoma is a malignant neoplasia that shows high mortality when diagnosed in advanced stages. Early identification of high-risk patients for the development of melanoma metastases is the main strategy to reduce mortality. Objective: To assess the influence of eight epidemiological and histopathologic features on the development of metastases in patients diagnosed with primary cutaneous melanoma. Methods: Our historical cohort comprised patients with invasive primary cutaneous melanoma seen between 1995 and 2012 at a public university hospital and a private oncologic surgery institution in Southeastern Brazil. The following variables were analyzed: gender, age, family history of melanoma, site of the primary tumor, clinical and histologic subtype, Breslow thickness, histologic ulceration and the mitotic index. Kaplan-Meier univariate test and multivariate Cox proportional hazard analysis were used to assess factors associated with disease-free survival. Results: Five hundred and fourteen patients were enrolled. The univariate analysis identified the following significant risk factors: gender, age, site of the tumor, clinical and histologic subtype, Breslow thickness, histologic ulceration and mitotic index. Multivariate analysis included 244 patients and detected four significant prognostic factors: male gender, nodular clinical and histologic subtype, Breslow thickness > 4mm, and histologic ulceration. The mitotic index was not included in this analysis. Study limitations: Small number of patients in multivariate analysis. Conclusions: The following prognostic factors to the development of melanoma metastasis were identified in the study: male gender, nodular histologic subtype, Breslow thickness > 4mm and ulceration.

Dermatological conditions seen in renal transplant recipients in a Singapore tertiary hospital

<p><b>INTRODUCTION</b>Lifelong immunosuppression after renal transplant exerts effects on the recipients' skin, including skin infections, skin cancers and drug-induced skin disorders. Our study aimed to determine the epidemiology of skin conditions among renal transplant recipients in the largest tertiary hospital in Singapore.</p><p><b>METHODS</b>We reviewed the medical records of kidney transplant recipients at Singapore General Hospital, Singapore, between 1 January 2003 and 31 December 2013. Among these patients, the clinical data of patients who sought skin consultations with either dermatologists or plastic surgeons within the hospital was captured.</p><p><b>RESULTS</b>A total of 178 patients were included in our study. There were 88 (45.6%) skin infections, 23 (11.9%) drug-induced skin conditions, 9 (4.7%) skin cancers and 73 (37.8%) other skin conditions. Skin infection was the predominant reason for consultation, with viral warts (15%, n = 29) being the most common. Of the nine cases in our cohort with skin cancer, there were three cases of basal cell carcinoma, three cases of Bowen's disease, two cases of extramammary Paget's disease and one case of squamous cell carcinoma. Drug-induced skin conditions, mainly attributable to long-term steroids and cyclosporin use, were represented by acne (9.3%, n = 18) and sebaceous hyperplasia (2.6%, n = 5).</p><p><b>CONCLUSION</b>Our study demonstrated the spectrum of skin conditions that can be expected after renal transplantation. We wish to highlight the importance of careful dermatological screening and long-term follow-up for these patients, in order to reduce post-transplant skin complications.</p>

Low-dose systemic retinoids in preventing subsequent non-melanoma skin cancers (NMSC) in patients with history of NMSC: A systematic review

BACKGROUND: Non-melanoma skin cancers (NMSC) consists of  basal-cell carcinomas (BCC) and squamous-cell carcinomas (SCC).Certain populations are predisposed to develop  NMSC,  including  patients  with  previous  history  of  NMSC.Systemic  retinoids  have  shown  promising  results  in chemoprevention of recurrence of NMSC in other high-risk populations (xeroderma pigmentosum and renal-transplant patients).We  assessed  the  efficacy  and  safety  of  low-dose  systemic  retinoids  compared  with  placebo,  as  a  chemopreventive agent for NMSC in patients with previous NMSC.METHODOLOGY: Electronic  databases  were  systematically searched for this study. Participants in the studies selected must have had a biopsy-proven NMSC, over 18 years of age, with  no  exclusion  of  other  demographic  characteristics. All  types  of  systemic  retinoids  were  included  with  no restriction on dosage. Two authors independently performed standardized  eligibility  assessment  and  data-extraction.Differences in opinion were resolved by consensus with the third author. Statistical analysis was done using the Review Manager 5 software.RESULTS: Eleven full-text studies were assessed for eligibility out of 178 studies found. Five studies were excluded because of the different population, while the two articles used topical retinoids. Four articles were included. The interventions were 10.0 mg isotretinoin, 25,000IU retinol and 25.0 mg acitretin,compared with placebo. Meta-analysis produced RR of 0.94 (95% CI, 0.89-1.00), with moderate heterogeneity (34%) due to the difference in interventions used. There are significantly more  adverse  events  in  the  retinoids  group,  especially  in the  incidence  of  mucocutaneous  adverse  events,  and deranged lipid profile and liver enzymes.CONCLUSION: There is insufficient evidence to support the use of low-dose systemic retinoids as chemoprevention for patients with previous NMSC. Furthermore, adverse events may limit their use. Topical preparations with less side-effects may be investigated.

Low-dose systemic retinoids in preventing subsequent non-melanoma skin cancers (NMSC) in patients with history of NMSC: A systematic review

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Non-melanoma skin cancers (NMSC) consists of  basal-cell carcinomas (BCC) and squamous-cell carcinomas (SCC).Certain populations are predisposed to develop  NMSC,  including  patients  with  previous  history  of  NMSC.Systemic  retinoids  have  shown  promising  results  in chemoprevention of recurrence of NMSC in other high-risk populations (xeroderma pigmentosum and renal-transplant patients).We  assessed  the  efficacy  and  safety  of  low-dose  systemic  retinoids  compared  with  placebo,  as  a  chemopreventive agent for NMSC in patients with previous NMSC.<br /><strong>METHODOLOGY:</strong> Electronic  databases  were  systematically searched for this study. Participants in the studies selected must have had a biopsy-proven NMSC, over 18 years of age, with  no  exclusion  of  other  demographic  characteristics. All  types  of  systemic  retinoids  were  included  with  no restriction on dosage. Two authors independently performed standardized  eligibility  assessment  and  data-extraction.Differences in opinion were resolved by consensus with the third author. Statistical analysis was done using the Review Manager 5 software.<br /><strong>RESULTS:</strong> Eleven full-text studies were assessed for eligibility out of 178 studies found. Five studies were excluded because of the different population, while the two articles used topical retinoids. Four articles were included. The interventions were 10.0 mg isotretinoin, 25,000IU retinol and 25.0 mg acitretin,compared with placebo. Meta-analysis produced RR of 0.94 (95% CI, 0.89-1.00), with moderate heterogeneity (34%) due to the difference in interventions used. There are significantly more  adverse  events  in  the  retinoids  group,  especially  in the  incidence  of  mucocutaneous  adverse  events,  and deranged lipid profile and liver enzymes.<br /><strong>CONCLUSION:</strong> There is insufficient evidence to support the use of low-dose systemic retinoids as chemoprevention for patients with previous NMSC. Furthermore, adverse events may limit their use. Topical preparations with less side-effects may be investigated.</p>

Low-dose systemic retinoids in preventing subsequent non-melanoma skin cancers (NMSC) in patients with history of NMSC: A systematic review

BACKGROUND: Non-melanoma skin cancers (NMSC) consists of  basal-cell carcinomas (BCC) and squamous-cell carcinomas (SCC).Certain populations are predisposed to develop  NMSC,  including  patients  with  previous  history  of  NMSC.Systemic  retinoids  have  shown  promising  results  in chemoprevention of recurrence of NMSC in other high-risk populations (xeroderma pigmentosum and renal-transplant patients).We  assessed  the  efficacy  and  safety  of  low-dose  systemic  retinoids  compared  with  placebo,  as  a  chemopreventive agent for NMSC in patients with previous NMSC.METHODOLOGY: Electronic  databases  were  systematically searched for this study. Participants in the studies selected must have had a biopsy-proven NMSC, over 18 years of age, with  no  exclusion  of  other  demographic  characteristics. All  types  of  systemic  retinoids  were  included  with  no restriction on dosage. Two authors independently performed standardized  eligibility  assessment  and  data-extraction.Differences in opinion were resolved by consensus with the third author. Statistical analysis was done using the Review Manager 5 software.RESULTS: Eleven full-text studies were assessed for eligibility out of 178 studies found. Five studies were excluded because of the different population, while the two articles used topical retinoids. Four articles were included. The interventions were 10.0 mg isotretinoin, 25,000IU retinol and 25.0 mg acitretin,compared with placebo. Meta-analysis produced RR of 0.94 (95% CI, 0.89-1.00), with moderate heterogeneity (34%) due to the difference in interventions used. There are significantly more  adverse  events  in  the  retinoids  group,  especially  in the  incidence  of  mucocutaneous  adverse  events,  and deranged lipid profile and liver enzymes.CONCLUSION: There is insufficient evidence to support the use of low-dose systemic retinoids as chemoprevention for patients with previous NMSC. Furthermore, adverse events may limit their use. Topical preparations with less side-effects may be investigated.

Occupational skin cancer: Systematic review / Câncer de pele ocupacional: revisão sistemática

SUMMARY Objective: To analyze the epidemiological profile, risk factors in the workplace environment and prevention methods for professionals at risk of skin cancer. Method: A systematic review of articles on occupational skin cancer, published in the Lilacs, Scielo, Medline and Cochrane Library from January 1st, 2008, to December 31st, 2013, was performed. The search included the following terms: “neoplasias cutâneas” (DeCS), “exposição ocupacional” (DeCS), “epidemiologia” (DeCS) as well as the keyword “prevenção”, and their equivalents in English. Results: After analyzing the titles and summaries of articles, the search strategy resulted in 83 references, of which 22 articles met the eligibility criteria. Discussion: We found that sun exposure is the main occupational risk factor for skin cancer, causing outdoor workers to be the most vulnerable to developing occupational skin cancer. Professionals with low levels of education and European descent are at increased risk of developing this cancer. Conclusion: Outdoor workers are more vulnerable to developing occupational skin cancer, estimating that professionals with low level of education and European descent are at increased risk of developing this cancer. Therefore, companies need to invest more in the health of workers by providing protective equipment and thus preventing occupational skin cancer.

RESUMO Objetivo: analisar o perfil epidemiológico, os fatores de risco no ambiente de trabalho e os métodos de prevenção dos profissionais de risco para câncer de pele. Método: foi realizada uma revisão sistemática de artigos sobre o câncer de pele ocupacional, publicados entre 1 de janeiro de 2008 e 31 de dezembro de 2013, nas bases de dados Lilacs, Scielo, Medline e Biblioteca Cochrane. A pesquisa baseou-se na intersecção dos seguintes termos: “neoplasias cutâneas” (DeCS), “exposição ocupacional” (DeCS), “epidemiologia” (DeCS) e a palavra-chave “prevenção” e seus equivalentes em inglês. Resultados: após a análise dos títulos e resumos dos artigos, a estratégia de busca resultou em 83 referências, das quais 22 artigos preencheram os critérios de elegibilidade. Discussão: a exposição solar é o principal fator de risco ocupacional para câncer de pele e os trabalhadores ao ar livre são os mais vulneráveis a desenvolvê-lo. Aqueles com baixo nível de escolaridade e ascendência europeia apresentam maior risco de desenvolver a neoplasia. Conclusão: os trabalhadores ao ar livre são mais vulneráveis a desenvolver câncer de pele ocupacional. Os profissionais com baixo nível de escolaridade e ascendência europeia apresentam maior risco de desenvolver a neoplasia. São necessários mais investimentos das empresas na saúde dos trabalhadores por meio de fornecimento de equipamentos de proteção, a fim de prevenir o câncer de pele ocupacional.

O impacto de ações assistenciais na percepção da qualidade do Sistema Único de Saúde (SUS), Brasil: um estudo transversal / The impact of care actions on the perception of the quality of the Single Health System (SUS), Brazil: a cross-sectional study

INTRODUÇÃO: O tumor de pele não melanoma é o câncer mais frequente no Brasil. A ressecção cirúrgica é um dos pilares do manejo e ações assistenciais como mutirões de cirurgias são formas de reduzir o tempo de espera por tratamento. MÉTODOS: Nesse trabalho, conduziu-se um estudo transversal com 40 pacientes, 20 deles participantes de mutirão e 20 controles. Coletaram-se dados epidemiológicos, além de nove perguntas relacionadas à qualidade do Sistema Único de Saúde (SUS). RESULTADOS: Observou-se diferença significativa entre as respostas relacionadas ao tempo de espera por cirurgias no SUS (p < 0,05). CONCLUSÃO: Pode-se verificar melhora na impressão dos pacientes em relação ao SUS quando incluídos em ações assistenciais.

INTRODUCTION: Non-melanoma skin cancer is the most prevalent cancer in Brazil. Surgical resection is one of the pillars of management, and care actions, such as surgical task forces, are one way to reduce treatment waiting time. METHODS: In this research, we conducted a cross-sectional study with 40 patients; 20 of whom were treated by a surgical task force and 20 were controls. Epidemiological data were collected in addition to answers to nine questions related to the quality of the Single Health System (SUS in Portuguese). RESULTS: A significant difference was observed in responses related to the waiting time for surgery in the SUS (p < 0.05). CONCLUSION: One can observe an improvement in the perception of patients, with regard to the SUS, when included in care actions.

Recent Trends (1991-2010) of Metastatic Skin Cancers in Korea

The incidence of overall cancer has increased over time. The incidence of top-ranking cancers has changed in the 1990s and the 2000s. However, few studies have evaluated the trends in metastatic skin cancers during this period. We evaluated the recent trends in incidence, peak age and location of metastatic skin cancers from 1991 to 2010. This 20-yr survey was divided into two decades to determine the trends by comparing the statistics. Out of 694,466 outpatients (1991-2010), 174 (0.025%) were diagnosed with metastatic skin cancer. The incidence of metastatic skin cancer increased significantly from 20.64 per 100,000 outpatients in the 1990s to 28.70 per 100,000 outpatients in the 2000s (P = 0.030). The peak age of skin metastasis shifted from the 40s to the 50s in women, and from the 50s to the 60s in men. The percentage of metastatic skin cancers originating from intra-abdominal organs increased from 10% in the 1990s to 23.1% in the 2000s (P = 0.027). The percentage of metastatic skin cancers located on the abdomen increased from 7.1% in the 1990s to 15.4% in the 2000s (P = 0.011). The higher proportion of metastatic skin cancers located on the abdomen may be related to the increase in skin metastases from intra-abdominal organs.

Expression of the c-Met Proteins in Malignant Skin Cancers

BACKGROUND: The expression of c-Met is substantially elevated in most malignant human cancers. We therefore searched for c-Met expression and compared the expression level among malignant skin cancers. OBJECTIVE: The aim of this study was to determine the c-Met expression pattern and the protein expression level in selected malignant cutaneous tumors. METHODS: G361 cells (malignant melanoma cell line) and A431 cells (squamous cell carcinoma cell line) were cultured and analyzed, using immunoprecipitation and Western blot analysis, for expression of c-Met. Additionally, 16 separate specimens of malignant melanomas (MMs), 16 squamous cell carcinomas (SCCs), 16 basal cell carcinomas (BCCs) and 16 normal tissues were analyzed for the expression of c-Met using immunohistochemical studies. RESULTS: Based on cultured cell immunoprecipitation and Western blot analysis, both A431 cells and G361 cells expressed c-Met, however, c-Met was expressed substantially more in G361 cells. Immunohistochemical examination of c-Met showed that it was over-expressed in all malignant skin cancers. In addition, c-Met expression was more increased in MM compared to other cancers. CONCLUSION: In our study, c-Met is involved in malignant skin cancer development and the level of its expression is thought to be related to the degree of malignancy in melanoma cancers.

Immunohistochemical Findings of p53, PCNA, and bcl-2 in the Tumor and Epidermis Overlying and Adjacent to Non-melanoma Skin Cancers / 대한피부과학회지

BACKGROUND: In both normal tissue development and malignant cell growth, the maintenance of cell numbers reflects a balance between cell proliferation and cell death. Excessive growth may result from uncontrolled cellular proliferation or limited cell death. The growth process of squa mous cell carcinorna(SCC) has recently been reported to differ from that of basal cell carcinoma (BCC). Several reports have suggested that the normal-appearing, overlying epidermis might be a proliferative and be a precursor lesion of BCC. SCCs occur in burn scars, chronic ulcers, and chronic sinus but the najority of SCCs are actinic in origin. It is possible to develop subsequent. skin cancer from the normal-appearing epidermis adjacent to SCC due to chronic sun-exposure. OBJECTIVE: The purpose of this study was to investigate growth dynamics of non-melanorna skin cancers and characteristics, including the carcinogenic property, of the normal appearing epidermis overlying and acljacent to non rnelanoma skin cancers. METHODS: We compared expressions for p53, PCNA, bcl 2, and TGF-alpha in 21 BCCs and 8 SCCs by irnmunohistochi.mical staining with a labelled strept,avidin biotin complex(LSAB) method. RESULTS: The results were as follows. 1) Expressions for p53 and PCNA within the tumor remarkably increased and the distribution pattern of expression for p53 was not always consistent with that for PCNA. 2) An expression the bcl-2 was increased in half of the BCCs, but not in all of the SCCs. 3) The epidermis overlying the BCC showed increased expressions for p53, PCNA, and TGF-alpha. 4) The epidermis adjacent to the SCC showed increased expressions for p53, and PCNA in a few of cases. CONCLUSION: We suggest that a neoplastic transformatiqn in BCC is caused by extended cell survival rather than increased cell proliferation, but in SCC it is caused by other mechanisms, and that the proliferativ activity in the epiderrnis overlying BCC is different from the normal epidermis and maybe repr'sents carcinogenic activity of the epidermis.

A Clinical Observation of Primary Epithelial Skin Cancers / 대한피부과학회지

BACKGROUND: The incidence of primary epithelial skin cancers is rising steadily, but little is khown of the clinical features of primary epithelial skin cancers, and limited data are available in Korea. OBJECTIVE: Our purpose was to analyze the clinical characteristics of primary epithelial skin cancers. METHODS: A retrospective analysis was conducted of 106 cases of primary epithelial skin cancers observed between 1989 and 1995. RESULTS: 1. Basal cell curcinoma(BCC), 41 cases, was the most common skin cancer. The numbers of cases of squamosis cell carcinoma(SCC) and Bowens disease(BD) were 33 and 24, respectively. There were 3 cases of mixed type(BCC + SCC), 2 cases of Pagers disease and 3 cases of extramammary Pgets disease. 2. The average age at ciragnosis and the mean duration of disease were as follows . BCC(65.5 years old 4.34 years), SCC(70.2 years old-1.63 years), BD(59.3 years old-2.85 years) 3. The face was the most common anatomic site for BCC(93%) and SCC(70%), but the trunk was the most common site for BD. 4. The most common c inical type of BCC was the noduloulcerative type(65% ) and the solid type was t.he most frequert histologic type of BCC. 5. In histologic grading of SCC, grade I and II lesions occupied in 88% of total cases. The numbers of special variants of SCC were as follows aenoid(4), spindle cell(1), verrucous(2) CONCLUSIONS : 1. The average age of patient with primary epithelial skin cancers was older thar: in earlier reports in Korea, and was closer to the recent, reports in western count.ries. 2. The number of cases of BD was much higher than that reported previously. This emphasizeci the importance of tissue examination for the pigmented lesions of the skin, especially on the trunk and extremities.