Metatypical basal cell carcinoma: a clinical review.

BACKGROUND: Metatypical cell carcinoma can be considered as a new entity of skin cancer, being an intermediate typology between basal cell carcinomas and squamous cell carcinomas. The behaviour of the metatypical cell carcinoma lies between these two varieties of skin cancer. It is difficult to perform a differential diagnosis based on morphological and clinical features - therefore it is only possible by accurate histology. METHODS: The authors have retrospectively analysed clinical records of 240 patients who were affected by metatypical skin cancer and who were treated by surgery, radiotherapy and chemotherapy. RESULTS: MTC affected more males than females (62.5% vs 37.5%) than males. The most affected site was the cervicofacial area, 71.7%; then the trunk, 10%; the limbs, 9.6%; the scalp 3.7%; and other regions 5%. A recurrence occurred in 24 cases (10%), mainly in head and neck area. CONCLUSION: In this manuscript, the authors have emphasised the importance of conducting a differential diagnosis, and the importance of the specific treatment for metatypical skin cancer, even though more clinical studies and long-term follow-ups are required before establishing specific guidelines.

An open-label tolerability and efficacy study of an aluminum sesquichlorohydrate topical foam in axillary and palmar primary hyperhidrosis.

Primary hyperidrosis (PH) is a disorder characterized by excessive eccrine sweat gland production that primarily involves the axillae as well as palms and soles. Common first-line topical treatment for PH consists of aluminum salts (AS) that act by physically blocking eccrine sweat gland ducts. However, primary irritant contact dermatitis is a common side effect of AS treatment. Recently, a new low-residue, thermophobic foam formulation containing 20% aluminum sesquichlorohydrate has been developed (Nidrox, Mipharm S.p.A.). To evaluate the local tolerability and efficacy of 20% aluminum sesquichlorohydrate foam in the treatment of axillary and palmar PH. Twenty subjects affected by PH were enrolled in a multicenter, open-label study. Local tolerability was evaluated by physicians assessing itching, burning, and skin irritation using a four-point score (from 0: no symptoms to 3: severe symptoms). Skin irritation was quantified with a visual score. Efficacy was assessed by means of Minor test score using a four-point score (range 0-3). The foam was applied to clean dry skin, every night during the first 2 weeks and three times a week during the following 2 weeks. Clinical evaluations were performed at baseline, at day 14 and at day 28. Patients were monitored throughout the study for adverse events. All 20 subjects completed the study. The foam induced a significant reduction of the Minor score in comparison with baseline values (p = 0.0002) both at day 14 and at day 28. At the end of the 4-week treatment period, the foam reduced eccrine sweating by 61% (Minor score: 3.3 vs. 8.5). No skin irritation was observed during the trial except for one subject who experienced a mild and transient itching sensation. No other side effects were reported during the study. This new foam appears to be an effective and well-tolerated topical treatment in reducing sweating in patients with axillary and palmar PH.

Moderate acne vulgaris: efficacy, tolerance and compliance of oral azithromycin thrice weekly for.

The aim of the study was to investigate the efficacy, safety and compliance of 500 mg azithromycin thrice weekly for 12 weeks in moderate inflammatory acne vulgaris. An open-label, noncomparative study was carried out for 12 weeks at Department of Dermatology and Plastic Surgery, La Sapienza University in Rome. Fifty-seven patients (20 male and 37 female) between 13 and 41 years of age, affected by moderate papulopustular and nodular acne vulgaris, were enrolled in the study. Azithromycin 500 mg was administered orally thrice weekly for 12 weeks. Patients were examined at baseline, 4 weeks, 8 weeks and 12 weeks (completion of treatment), evaluating both clinical (Global Acne Grading System, GAGS) and quality of life (Acne Quality of Life Questionnaire, AQoL) improvements. Forty-six patients completed the study and showed significant improvement. Six patients interrupted their treatment, while five patients did not complete the study for unknown reasons. Side effects (diarrhea and abdominal pain) were recorded in eight patients. Azithromycin, 500 mg thrice weekly for 12 weeks, is a safe and effective treatment for moderate acne vulgaris with excellent patient compliance.

Giant fibrolipoma in the leg--a case report.

Lipomas are the most common benign tumors of the mesenchyme; they are composed of mature lipocytes. Benign fatty tumours can arise in any location in which fat is present. Most patients affected by such tumours are in their fifth or sixth decade of life. Only rarely are children affected. Lipomas may be single or multiple. Multiple lipomas are more common in women; many are seen in a familial setting. For a lipoma to be referred to as "giant", the lesion should be at least 10 cm in diameter or weigh a minimum of 1000 g. When very close to vital structures, giant lipomas may, on account of their excessive size, cause functional limitations, such as lymphedema, pain or nerve compression syndromes. Owing to the peculiarity of this condition and the difficulties encountered in its diagnosis and treatment, a case of a giant fibrolipoma in the leg is reported. A 48-year-old woman presented with an enlarging, soft, noduled mass on the right ankle and in the lower third of the right leg and heel; it was decided to remove the mass with all the overlying epidermis and to repair the resulting lesion first with fibroblast culture and subsequently with a meshed dermo-epidermal graft. One year after surgery, both the local and the general condition of the patient were good and there were no signs of recurrence.

Ultrastructural study of autologous cultivated conjunctival epithelium.

BACKGROUND AND OBJECTIVE: This report is one of the first in the literature on the attempted cultivation and clinical application of human conjunctival epithelium. The authors investigated the possibility of restoring severely damaged ocular surface with autologous cultivated conjunctival epithelium. PATIENTS AND METHODS: The conjunctival cells needed for the experiment were harvested from six patients with oculopalpebral diseases. Confluent epithelial sheets were developed from each biopsy specimen. The new epithelium was then implanted on the patients' or donors' eye surface. RESULTS: The histologic examination showed a pluristratified squamous non-keratinized epithelium lying on a basement membrane and with a lamina propria of well-vascularized connective tissue. Normal ultrastructural characteristics were evident on electron microscopy. CONCLUSION: The cultivation of autologous conjunctival cells may be a good option for rapid and safe repair of large single or bilateral conjunctival defects, as an alternative to heterotopic or allogenic grafts.

Association of penile lichen sclerosus and oncogenic human papillomavirus infection.

BACKGROUND: Data on the prevalence of human papillomavirus (HPV) infection in patients with penile lichen sclerosus (LS) are scant and controversial. AIM: To investigate the prevalence of HPV infections in patients with penile LS. METHODS: HPV infection was assessed by polymerase chain reaction (PCR) in paraffin-embedded penile biopsies obtained from the glans or inner foreskin of 46 adult patients with penile LS, and in brush cytology smears of penile healthy mucosa from an equal number of randomly selected control males matched for age. Statistical evaluation was performed using conditional logistic regression analysis. RESULTS: PCR disclosed the presence of HPV infection in 17.4% of LS patients (HPV 16, six cases; HPV 18, one case; HPV 45, one case). Amongst the controls, HPV infection occurred in 8.7% of patients (HPV 16, two cases; HPV 53, one case; HPV 70, one case). Statistical regression analysis confirmed that the rate of HPV infection was higher amongst patients with genital LS than amongst healthy controls [odds ratio (OR), 2.55; 95% confidence interval (CI), 0.73-8.89]. CONCLUSIONS: Infection with oncogenic "high-risk" HPV types in patients with genital LS may enhance the risk of penile cancer arising on LS.

Giant meta-typical carcinoma: an unusual tumor.

Meta-typical carcinoma (MTC) or basosquamous carcinoma is a remarkable malignancy with features of both basal and squamous cell carcinoma. It is typically located on the back and face, often with clinical features of basal cell carcinoma but tending to be more aggressive with enhanced prospects of lymph node or distant metastases. Our report describes a huge neglected MTC of the back of ten-year duration, a giant ulcero-vegetative tumor measuring 20 x 25 cm. Histologic examination of specimens from the margins and periphery revealed aspects of both basal and squamous cell carcinoma, while the ulcerated center showed sclerotic tissue without tumor. Radical excision and reconstruction by grafts were performed. No metastases were observed after two years. There are many controversies surrounding the histologic definition and biologic behavior of MTC, including its metastasizing potential. The MTC we describe exhibited benign biologic behavior. This may have been related to an intense inflammatory host response with elimination of neoplastic tissue and consequent local sclerosis evident in the central tumor-free portion. This central tumor regression is to our knowledge a unique finding in MTC.

Penile cancer.

UNLABELLED: Penile cancer, while relatively rare in the western world, remains a disease with severe morbidity and mortality, not to mention significant psychological ramifications. Furthermore, the disease is observed with dramatically increased incidence in other parts of the world. A review of the literature has shown that the overwhelming majority of penile cancers are in situ or invasive squamous cell carcinomas, including a well-differentiated variant, verrucous carcinoma. Important predisposing factors are lack of circumcision, human papillomavirus infections, and penile lichen sclerosus, although other factors have occasionally been reported as well. Prevention, careful monitoring of patients at risk, and early diagnosis are essential to reduce the incidence of penile carcinoma and to provide a definitive cure. Public health measures, such as prophylactic use of circumcision, have proved successful but are controversial. Also, no standard therapeutic guidelines as to the best treatment strategy according to different stages, including efficacy of conservative nonsurgical modalities and indications for lymph nodal dissection, are available so far. It is common opinion that penile cancer is an emerging problem that deserves further investigations, and physicians, especially dermatologists, should be aware of this issue. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be familiar with penile carcinoma, its risk factors, its clinical and histologic presentation, and the treatments currently available for its management.

An increase in basal cell carcinoma among the young: an epidemiological study in a middle-south Italian population.

During the last 20 years, an increasing incidence of basal cell carcinoma (BCC) has been demonstrated by several studies. A ten-year retrospective analysis on 7,266 cases of primary BCC of the Department of Dermatology and Plastic Surgery of the University of Rome La Sapienza and the Department of Dermatology of the University of Naples "Federico If' is reported. Among a population aged over 35 years, BCC cases increased from 618 in 1994 up to 749 cases in 2003, while among the younger population (<35 years), BCC cases increased from 30 in 1994 to 47 cases in 2003. Anatomic site distribution of BCC among people aged <35 years was: head and neck=51.54%, trunk=41.40%, limbs=5.91%, others= 1.12%. On histological examination aggressive-growth BBC was recorded in 48 out of 355 cases (13.52%) among people aged <35 years and in 841 out of 6,755 cases (12.45%) among patients >35 years. In conclusion, an increasing incidence of basal cell carcinoma among young people over the past 20 years was reported. No significant difference in tumour aggressiveness between the young and the elderly patients was observed.

Penile lichen sclerosus: Correlation between histopathologic features and risk of cancer.

The relationship between penile lichen sclerosus (LS) and cancer development has not been clearly assessed so far. In order to define these histological features of LS that may indicate or precede a malignant degeneration, 104 biopsy specimens from 86 patients with LS of the glans (90.5%) and from 9 patients with a penile malignancy (7 squamous cell carcinomas, 1 in situ carcinoma, and 1 verrucous carcinoma) arising on LS (9.5%) were reviewed. Three different histopathologic LS patterns were identified: pattern 1 with a prominent lichenoid inflammatory infiltrate in the dermis (9%), pattern 2 characterized by a band-like infiltrate separated from the epidermis by a band of dermal sclerosis (44%), and pattern 3 showing prominent sclerosis with minimal or absent inflammatory infiltrate (9%). These patterns have previously been described in vulvar LS, and have been considered typical of early, mature, and late LS, respectively. In our study, we also found a fourth pattern in 38% of cases, with overlapping features between the first and third pattern, occasionally showing areas of epidermal thickening, with loss of the normal keratinocyte cytoarchitectural differentiation, mitoses and apoptotic cells. In our opinion, the histological features observed in this last pattern may be interpreted as areas of disease reactivation within a chronic stage. Furthermore, 7 out of 9 cases of penile cancer from our series (78%) were associated with this pattern, suggesting that it may correlate with a malignant degeneration.

Cutaneous implantation metastasis of cholangiocarcinoma after percutaneous transhepatic biliary drainage.

Percutaneous transhepatic biliary decompression is a preoperative surgical adjunct in patients with obstructive jaundice that has been in use since 1973. It is recommended that this procedure be adopted for both palliative treatment in unresectable patients and as a preoperative means of lowering serum bilirubin in patients with potentially resectable malignancies of the pancreas or biliary tract. Metastatic tumor seeding along the transhepatic biliary catheter is an unusual complication resulting from this procedure but there have been a few cases reported in the literature. Below is a report on a 59-year-old woman in whom the percutaneous transhepatic catheter drainage of the biliary tree, performed before surgical resection of a cholangiocarcinoma, caused cutaneous tumor implantation at the catheter site 3 months later. The clinical aspect was morphea-like and histopathologic examination revealed typical features of a dermal metastasis of adenocarcinoma. Immunohistochemistry revealed cytoplasmic positivity for cytokeratin 7-19, specific for the biliary tract epithelium. A review of the literature available led us to conclude that port-site metastasis in patients with obstructive jaundice treated with percutaneous transhepatic biliary decompression was an unusual but possible complication. In fact, many catheter-tract metastatic deposits in the liver parenchyma, detected at autopsy or on operation, are mistakenly identified as hematogenous or lymphatic metastasis and are not attributed to a catheter-related process. We also report on this case because of the atypical morphea-like aspect of the skin metastasis.

Efficacy of a new aluminium salt thermophobic foam in the treatment of axillary and palmar primary hyperhidrosis: a pilot exploratory trial.

BACKGROUND: Primary or idiopathic hyperhidrosis (PH) is a disorder of excessive eccrine sweating glands that mainly affects the axillae and the palms. The treatment options for PH involve a range of topical or systemic medication and/or surgical invasive techniques. The common topical treatments are aluminium salts which act by blocking the duct of the eccrine gland or by atrophying the secretory cells. Recently, a new low-residue thermophobic foam formulation (VersaFoam, Mipharm Spa, Milan, Italy), containing 20% of an aluminium salt (sesquichlorhydrate), has been developed. The foam is easy to apply especially in hairy body sites. OBJECTIVE: to evaluate the efficacy and the tolerability of the new aluminium salt foam in the treatment of axillary and palmar PH. PATIENTS AND METHODS: Twenty patients were enrolled in a single-centre, open-label follow-up study. The Minor test score (range 0-3) and the Dermatology Life Quality Index (DLQI), were used to evaluate the amount of sweating and the impact on quality of life. The foam was applied to dry, clean skin, every night during the first week of treatment, and three times a week during the second week of treatment. Evaluation of the results was performed at baseline and at 7 and 15 days after treatment. Patients were monitored throughout the study for adverse events. RESULTS: All of the 20 enrolled patients completed the study. The foam resulted in a significant reduction of the Minor score in comparison with baseline values in both the axillary (p = 0.0002) and palm regions (p = 0.0047). By the end of treatment (day 15) the foam had reduced the amount of sweating in the axillae and palm regions by 50% (Minor score: 4.1 vs. 8.1) and 53% (Minor score: 4.0 vs. 8.5), respectively. Use of the foam showed a positive impact in the DLQI for patients with axillary but not palm hyperhidrosis. No side effects were reported during the study duration by the patients. CONCLUSION: The new foam has been shown to be an effective topical treatment in reducing sweating in patients with axillary and palm PH. This formulation is well tolerated in the short term. Further studies are warranted to evaluate the efficacy and safety in the medium and long term.

Association of palmoplantar keratoderma, cutaneous squamous cell carcinoma, dental anomalies, and hypogenitalism in four siblings with 46,XX karyotype: a new syndrome.

The association of palmoplantar keratoderma (PPK) with the development of cutaneous squamous cell carcinomas (SCCs), dental anomalies, severe hypogenitalism with hypospadias, abnormal development of gonads with ambiguous external genitalia, gynecomastia, altered plasma sex hormones levels, and hypertriglyceridemia has not, to our knowledge, been reported previously. We describe it in 4 brothers with 46,XX karyotype, whereas the 5 sisters of their consanguineous parents were unaffected. This family may represent a new syndrome. The PPK was of the classical nonepidermolytic histologic type. The proband also had a laryngeal carcinoma diagnosed in his early forties and nodular testicular hyperplasia of Leydig cells.

Cystic lymphangioma of the upper extremity: US and MRI correlation (2004:11b).

The authors described a very rare case of the cystic lymphangioma (CL) of the left upper extremity in a 12-year-old patient. The diagnosis was made by US and MRI and confirmed by histological examination of the resected specimen.

99mTc-interleukin-2 scintigraphy as a potential tool for evaluating tumor-infiltrating lymphocytes in melanoma lesions: a validation study.

UNLABELLED: Cutaneous melanoma is often characterized by the presence of tumor-infiltrating lymphocytes (TILs). The degree of such infiltration and cell activation are considered significant prognostic factors reflecting the host's immune response to the tumor; thus, patients with peritumoral infiltration may have a better prognosis and may also achieve a better response to interleukin-2 (IL2) immunotherapy. There is evidence that the expression of cluster designation (CD) 25 antigen (IL2 receptor [IL2R]) is a good marker of activity of T lymphocytes against melanoma cells. The aim of this study was to evaluate in vivo the binding of 99mTc-IL2 to lymphocytes infiltrating cutaneous melanoma and to determine whether such uptake correlates with immunologic and histologic data, thus providing useful prognostic information for IL2 therapy in patients with advanced disease. METHODS: Thirty patients with cutaneous lesions suspected of being melanoma were studied. Planar gamma-camera images over known tumor sites were acquired 1 h after the injection of 111-185 MBq of 99mTc-IL2. Tumor uptake of 99mTc-IL2 was measured as a target-to-background (T/B) radioactivity ratio. All patients underwent surgery, and histologic evaluation of the resected lesion was performed. The percentage of different peripheral blood lymphocyte subsets (CD3, CD4, CD8, CD16, CD25) and the percentage of IL2R-positive tumor cells on histologic sections were also measured. RESULTS: At final histology, 21 lesions were found to be melanoma and 9 were classified as benign. In 15 of 21 (71%) melanomas and 2 of 9 (22%) benign cutaneous lesions, we found uptake of 99mTc-IL2. The calculated T/B ratios correlated significantly with the number of IL2R-positive TILs. CONCLUSION: 99mTc-IL2 scintigraphy provides a means of in vivo measurement of the extent of tumor infiltration of IL2R-positive cells, thereby providing valuable prognostic information for selection of patients who may benefit from IL2 immunotherapy.

Human papillomavirus-32-positive extragenital Bowenoid papulosis (BP) in a HIV patient with typical genital BP localization.

OBJECTIVES: Bowenoid papulosis (BP) is characterized by multiple maculopapular lesions of the genitalia; extragenital localization is rarely found. Human papillomavirus (HPV) type 16 has been found in most cases of BP, but the other HPV genotypes associated with BP had been poorly characterized. GOAL: We describe an extragenital BP with concomitant genital involvement in an HIV-positive woman. STUDY: Several HPV gene-specific amplifications and sequencing were performed on DNA extracted from biopsy samples. RESULTS: The presence of HPV-16 DNA in anogenital and HPV-32 DNA in lip lesions was demonstrated in the absence of any other HPV type and with no coinfection. Semiquantitative polymerase chain reaction analysis revealed that HPV-16 and -32 DNA sequences are in the episomal state. CONCLUSIONS: This is the first report of BP associated with HPV-32 (the causative agent of a benign hyperplasia) and a rare case of BP associated with 2 HPV types in the same patient. The immune depression could have modified the normal benign progression of the extragenital lesions.

Invasive penile carcinoma: a review.

BACKGROUND: Penile carcinoma is an invasive epithelial tumor that may arise from penile skin or mucosa. OBJECTIVE: To review the pathogenesis and the clinical and histopathologic features of invasive penile carcinomas, with emphasis on current guidelines for their diagnosis and treatment. METHODS: Information available from the authors' clinical experience, review articles, case reports, clinical trials, and in vitro research studies identified from a computerized literature search on MEDLINE database and from Meetings' Abstract Books, including those from non-English literature, was considered. RESULTS: Penile cancer may develop de novo or in association with underlying factors. Conditions predisposing to the development of penile cancer are delineated. The diagnosis should be suspected by clinical findings and must be confirmed histologically. Imaging techniques may be useful for staging and planning therapy. Therapeutic options include excisional surgery, laser destruction, cryosurgery, radiotherapy, immunotherapy, and chemotherapy. CONCLUSIONS: Although there are no current guidelines for the treatment of penile carcinoma, surgical ablation probably represents the best option, as conservative treatments still deserve cautious evaluation because of the relatively small number of treated patients and the lack of good-quality comparative data. Regarding indications for lymph nodal dissection in patients showing no inguinal node enlargement, sentinel node mapping with targeted lymph node dissection is recommended for those with deeply invasive, high-grade tumors, whereas a watchful waiting may be advised for those with superficially invasive, low-grade tumors.