Clinical and Histopathologic Profile of Patients with Cutaneous Metastasis in a Tertiary Hospital in the Philippines.

INTRODUCTION: Cutaneous metastases represent 2% of skin tumors, with an overall incidence of 5.3%. Although rare, clinical presentations of cutaneous metastasis vary and can be mistaken for benign and malignant skin conditions. METHODOLOGY: This was a descriptive, retrospective review of all patients diagnosed with cutaneous metastasis seen at the Department of Dermatology from January 2013 to December 2019. Clinical and histopathologic data from the patients were collated from medical records, and slides were retrieved for review. RESULTS: A total of 115 patients were included and 122 slides reviewed. There were more female than males, the mean age was 52.3 ± 14.0 years of age. The most common primary cancer was the breast, and accordingly, the most common location was anterior chest. Among the 122 slides reviewed from 104 patients, the most common histologic type was adenocarcinoma (72.1%), and showed the infiltrative pattern (26.2%). Other histologic types seen were melanoma (13.1%), leukemic infiltrates (11.5%), squamous origin (2.5%), and epithelioid sarcoma (0.8%). Lymphovascular invasion and dermal sclerosis were observed. Immunohistochemical stains were performed in only 13.9% of the cases. There was a high concurrence of the clinical with the histopathologic diagnosis (95.6%). CONCLUSION: Although rare, patients with cutaneous metastasis may present in dermatology clinics. Knowledge of clinical features and low threshold for doing biopsies may prove useful for these patients. Similarly, dermatopathologists should be able to recognize histologic features of cutaneous metastasis morphologically. Histologic features may be subtle and may be reminiscent of benign inflammatory conditions, hence judicious use of immunohistochemical staining is recommended.

The great mimic: A six-year retrospective study on mycosis fungoides and the use of histologic criteria to define adequacy of treatment

BACKGROUND: Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. Diagnosis relies on clinicopathological correlation. OBJECTIVE: To describe the clinicodemographic characteristics of patients with MF and to identify histologic criteria that will signify adequate treatment. METHODS: Registries from years 2004 to 2009 were searched for biopsy-proven MF. Charts were retrieved and clinicodemographic data gathered. Pre- and post-treatment biopsy slides were reviewed by a dermatopathologist blinded to the patients's treatment status. Pre-selected histologic criteria were evaluated for each slide. Pearson's chi-square and Fisher's exact test were used to analyze for statistical significance of each criteria. RESULTS: There were 34 biopsy-proven MF from years 2004 to 2009. Male-to-female ratio was 1:1.8. Mean age at initial diagnosis was 46.7 years (13-81). Among the 16 patients with fully retrievable records, the most common presentation was that of hypopigmented patches. Age ? 60 years seemed to have significant association with relapse (P=0.02). Epidermotropism of ? 5 (P=0.03), absent to focal lymphocyte tagging (P=0.04), and dropping of haloed lymphocytes from >10 to ? 10 (P=0.01) somehow differentiated treated from untreated MF. CONCLUSIONS: The hypopigmented variant of MF may be more common in Asian countries. Age ? 60 years old may be associated with higher risk of relapse. Grading epidermotropism, lymphocyte tagging and haloed lymphocytes may be helpful in determining adequacy of treatment of MF. However, given the small sample size of the present study, future larger studies are needed to confirm these findings.

Topical cashew nut extract (DeBCC©) for the treatment of basal cell carcinoma: A randomized double-blind, vehicle-controlled trial

OBJECTIVES: This study aimed to evaluate the efficacy and safety of cashew nut extract (DeBCC©) cream compared with a vehicle cream in the treatment of basal cell carcinomas (BCC), mainly by comparing each group's composite clearance rate, defined by the absence of histopathologic evidence of BCC at the target lesion site. METHODS: A randomized double-blind vehicle-controlled trial was conducted on nineteen patients, who underwent eight weekly topical treatment application sessions of either vehicle or experimental drug. Six weeks post-treatment, they underwent surgical excision of their lesions. A dermatopathologist examined these specimens. Clinical and histopathologic clearances were evaluated. RESULTS: The clinical clearance rate (67%) of DeBCC was significantly higher compared to vehicle (p=0.003), while the composite clearance rate (33%) was not (p>0.005). The pre-test probability of clinical clearance in concordance with histopathologic clearance (15.79%) suggests that clinical resolution of a BCC lesion may not equate to histopathologic clerance. CONCLUSION: This study showed a modest clinical clerance rate but a low composite clerance rate for DeBCC cream. Further studies with bigger sample size that are limited to less aggressive BCC subtypes are needed to strongly establish the efficacy and safety of topical cashew nut extract for BCC treatment.

Scleredema diabeticorum: A case report

Scleredema is an uncommon condition of unknown etiology that is characterized by dermal mucinosis and mild sclerosis. It is a symmetrical, diffuse, non-pitting induration of the skin commonly associated with an antecedent febrile illness, diabetes mellitus or paraproteinemia.This is the case of an obese, middle-aged adult female with type 2 diabetes mellitus on oral hypoglycemic medication, who presented with an ill-defined, diffuse erythema and non-pitting induration of the skin on the posterior neck and upper back. It has been estimated that as many as 2.5%-14% of diabetic patients have scleredema. This subset of patients may be under-reported as a consequence of subtle onset and under- recognition. Even lithe prognosis of scleredemadiabeticorum is usually benign, it is important that this condition is recognized since it may have systemic involvement that can lead to complications.