Basal-Cell Carcinoma With Matrical Differentiation: Report of a New Case in a Renal-Transplant Recipient and Literature Review.

Basal-cell carcinoma with matrical differentiation (BCC-MD) is one of the rarest pathologic variants of basal-cell carcinoma, of which 41 cases have been so far reported in detail. One of them developed in a heart-transplant recipient. We report a new case of BCC-MD occurring in a renal-transplant recipient and review the relevant literature. A 75-year-old white man who had received a renal allograft 7 years ago developed a tumor on the left temple clinically suggestive of basal-cell carcinoma. Microscopically, the tumor associated features typical of basal-cell carcinoma (basaloid lobules with peripheral palisading and clefting) and pilomatricoma (presence of shadow/ghost cells). The 2 tumor components expressed variably beta-catenin, HEA/Ber-EP4, CD10, PHLDA-1, MIB-1/Ki67, calretinin, and bcl-2. BCC-MD has no distinctive clinical features. It affects predominantly male patients with a mean age of 69 years. More than half of cases appear on the head/neck area. Some cases harbor CTNNB1 mutations. Differential diagnosis includes tumors with matrical differentiation, namely pilomatrix carcinoma. The outcome is usually favorable after surgical excision, although regional lymph node metastases developed in 2 patients.

Management of psoriatic arthritis among cutaneous psoriasis patients: from pathogenesis to therapy.

Psoriatic arthritis (PsA) is an inflammatory rheumatism belonging to spondyloarthritis family and which occurs in about 30% of patients with psoriasis. The pathogenesis entails a genetic predisposition, environmental and immunologic factors. Most of the time, cutaneous lesions precede apparition of articular manifestations and dermatologists who treat psoriatic patients have to regularly screen for early PsA, especially in patients with risk factors (notably nail psoriasis). Early detection greatly increases the chances for successful treatment and can prevent slow joint destruction. EULAR and GRAPPA have recently published PsA treatment recommendations. Pharmacological therapies for PsA begin with non-steroidal anti-inflammatory drugs, then conventional synthetic as methotrexate, and lastly biological disease-modifying anti-rheumatic drugs. There are significant metabolic comorbidities and increased cardiovascular morbidity in patients with PsA. This aspect must be taken into account in PsA management by pharmaceutical and non-pharmaceutical approach (including educational programs). Close collaboration between dermatologists, rheumatologists and primary care clinicians is recommended to provide optimum care and to prevent the occurrence of structural damages or quality of life alteration.