Malignant Melanomas of the Skin Arising on the Feet.

BACKGROUND: Cutaneous melanoma frequently develops on the lower limbs, but rarely on the feet, in people with light skin. By contrast, the feet are one of the most frequently affected sites in people with dark skin. This study assessed the prevalence and clinico-pathological findings of biopsy-proven skin melanomas that were diagnosed over 11 years. MATERIALS AND METHODS: The study group comprised 217 primary melanomas from 210 patients. RESULTS: Eight (3.7%) melanomas were located on the feet. These were all invasive and obtained from 8 patients (5 females and 3 males) aged 56-85 years (mean age 72 years). In general, the lesions were large (mean diameter 3.5cm) and had a high Breslow index (mean thickness 5.6mm). They were all ulcerated, and some invaded deep into the subcutaneous tissue. Histologic analyses demonstrated that three tumors exhibited features of acral lentiginous melanoma, two were nodular melanomas, and one was a superficial spreading melanoma. Two cases could not be histologically classified. CONCLUSION: Although skin melanomas arising on the feet are relatively rare in our ethnicity, they are usually bioptically diagnosed at an advanced stage. Such melanomas may initially imitate other pathologic entities. Therefore, this location should not be overlooked during the medical workup, and melanoma should be suspected when patients present with non-healing defects or local pigmented changes on the soles of the feet or toes. Key words: malignant melanoma - anatomic distribution - foot The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 9. 2. 2018 Accepted: 16. 5. 2018.

Investigation of P120catenin Expression in Human Basal Cell Carcinoma of the Skin.

BACKGROUND: P120(ctn) is a specific membranous adhesion protein, that maintains the stability of intercellular junctions. An altered expression of p120(ctn), either reduced in the cell membrane or increase in the cytoplasm, plays a crucial role in carcinogenesis. No research has analysed the expression of p120(ctn) in basal cell carcinoma (BCC) of the skin so far. Therefore, we immunohistochemically studied p120(ctn) in a set of cutaneous BCCs in order to determine, whether there is difference in the expression pattern related to the histologic subtypes and tumor growth characteristics. MATERIAL AND METHODS: The study group consisted of 38 BCCs cathegorized into low-risk (non-infiltrative) subroup (8 superficial and 12 nodular subtypes) and high-risk (infiltrative) subgroup (10 nodular-infiltrative and 8 infiltrative subtypes). Specific monoclonal antibody against p120(ctn) was used for staining. RESULTS: Overall, there were 12 cases (31.6%) with normal preserved and 26 cases (68.4%) with abnormal p120(ctn) expression. In superficial, nodular, nodular-infiltrative and infiltrative subtypes, abnormal p120(ctn) immunoreactivity was found in 37.5% (3/8), 41.7% (5/12), 100% (10/10) and 100% (8/8), respectively. We have confirmed a strong correlation between the expression of p120(ctn) and both given, non-infiltrative and infiltrative BCC growth phenotypes. In the latter subgroup, almost all lesions showed diffusely reduced membranous staining, of which five also manifested an aberrant immunoreactivity in the cytoplasm. This cytoplasmic positivity occurred solely at the invasive front of the infiltrative tumor formations. CONCLUSION: Our results showed that decreased membranous expression of p120(ctn) was a frequent event in human cutaneous BCC and it was associated with infiltrative growth phenotype. Considering that nearly half of the BCCs with non-infiltrative growth pattern also exhibited reduced membranous expression, aberrant cytoplasmic immunoreactivity of p120(ctn), which was found exclusively in the high-risk BCC variants, can more reliably reflect and predict biological behaviour and malignant potential.

Non-melanoma Skin Cancer - a Clinicopathological Study of Patients with Basal Cell Carcinoma and Squamous Cell Carcinoma.

BACKGROUND: Non-melanoma skin cancer (NMSC) is the most common malignancy in Caucasians. It mainly includes two major keratinocyte tumors - basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The objective of the study was to analyze and compare the clinicopathological differences between patients with BCC and SCC of the skin. MATERIAL AND METHODS: A cohort of 541 patients with a total of 719 BCCs, and 126 patients with a total of 162 SCCs were retrospectively analyzed. RESULTS: While there was virtually the same proportion of men (49.91%) and women (50.09%) in BCC patients, SCCs occurred more frequently in men (68.2%) than in women (31.8%). The mean age of the individuals with BCC and SCC was 70.8 and 78.2 years, resp. The number of BCCs rises from 50 years of age and this increase showed a linear trend up to 80 years, subsequently followed by decline. SCC lesions occur more rapidly from 70 years of age followed by a sharp increase that exhibited an exponential relationship. BCCs and SCCs occurred predominantly on the head and neck region, comprising a total of 69.8% and 81.4% of the cases, resp. However, BCC lesions were seen more often on the face and SCC lesions were diagnosed more frequently on the extra-facial parts of the head. Further, BCCs occurred more frequently on the trunk, and particularly on the back, compared to SCCs. CONCLUSION: Although BCC and SCC are covered under common term NMSC, they manifest several clinicopathological differences. Despite sharing common etiologic determinants, at least from the onco-epidemiologic perspective, they should be considered separately.Key words: non-melanoma skin cancer - basal cell carcinoma - squamous cell carcinoma.

Basal cell carcinoma of the skin with mixed histomorphology: a comparative study.

Basal cell carcinoma (BCC) of the skin exhibits a very heterogeneous histomorphology, on the basis of which it is classified into several subtypes and variants. In many cases, however, a definite categorization remains difficult, because BCC may consist of more than one histopathological subtype. There are limited data exploring the characteristics of these mixed BCCs, since they have not been specifically analysed. The aim of this study was to estimate the prevalence of BCCs with mixed histomorphology observed in a set of primary BCCs and to compare their clinicopathological features with a single type BCC subgroup. A total of 911 histologically proven primary BCCs from 697 patients were investigated. Prevalence of single and mixed type BCCs was 64.9 % and 35.1 %, respectively. In mixed type BCC subgroup, a very heterogeneous histomorphology was found comprising a mixture of two to four different subtypes in various proportions. The most frequent combinations included nodular-infiltrative, superficial-nodular, nodular-trichoepithelial and nodular-micronodular subtype. Comparative analysis of the two given subgroups showed that mixed type BCCs were significantly more frequently localized on the extrafacial regions of the head (30.0 % vs. 20.0 %, p = 0.02) and less often on the face (37.2 % vs. 45.2 %, p = 0.03). There were not convincing differences in the occurrence of single vs mixed type BCCs in other parts of the body. Histologically, mixed type BCCs exhibited an aggressive-growth pattern more frequently (64.6 % vs. 13.0 %, p < 0.0001). Positive surgical margins were significantly more common in mixed type BCC subgroup (17.8 % vs. 12.6 %, p = 0.02). Cutaneous BCCs with mixed histomorphology represented about one third of the cases. It is a common finding in routine pathological practice, probably suggestive of evolution and phenotypic transformation of the cancer. Since mixed type BCCs are frequently composed of aggressive histological subtypes, regardless the personal habits in description or terminology among pathologists, the presence of aggressive-growth component in tumor tissue should always be mentioned in final biopsy report.

Immunohistochemical Expression of Calponin in Cutaneous Basal Cell Carcinoma.

Calponin is an actin filament-associated protein significantly involved in the regulation of the cellular motility. Some data have indicated that overproduction of calponin in basal cell carcinoma (BCC) of the skin may be responsible for local tumor invasiveness and more aggressive biological behavior. We studied the immunohistochemical expression of calponin in a set of cutaneous BCCs, in order to clarify whether the presence of calponin in cancer cells may be a predictor of invasive tumor growth. The study group consisted of 37 primary BCCs categorized into a non-infiltrative subgroup (5 superficial, 16 nodular subtypes) and infiltrative subgroup (9 nodular-infiltrative, 7 infiltrative subtypes). A specific monoclonal antibody against calponin was used for staining. Expression of calponin in tumor tissue was found in 72.9% (27/37) of the cases, though staining intensity was relatively weak. In superficial, nodular, nodular-infiltrative, and infiltrative BCC subtypes, calponin positivity was found in 80% (4/5), 75% (12/16), 66.7% (6/9), and 71.5% (5/7), respectively. We did not confirm a significant correlation between expression of calponin and given, non-infiltrative, and infiltrative BCC subgroups. Furthermore, we found seven BCCs (18.9%) with striking immunoreactivity for calponin in adjacent peritumorous stroma. There was a significant association between stromal immunoreactivity for calponin and tumor growth histomorphology being positive only in BCCs with infiltrative growth features. Our study has shown that neoplastic cells in cutaneous BCC commonly produce calponin regardless of histological subtype. Expression of calponin in tumor tissue was not associated with the aggressive tumor phenotype. However, since some BCCs with infiltrative growth patterns strongly expressed calponin in peritumorous stroma, this finding could more reliably reflect the biological behavior of cancer and should be better explained in the future.

Recurrent basal cell carcinoma: a clinicopathological study and evaluation of histomorphological findings in primary and recurrent lesions.

BACKGROUND: Basal cell carcinoma (BCC) of the skin is now the most common malignancy in the human population. One of the most negative features of this disease is frequent tumor recurrence. Unfortunately, all of the traditional diagnostic criteria have failed to definitively predict which patients should be considered at high risk of recurrence. OBJECTIVE: The aim of this study was to evaluate the prevalence, topographical localization, and histomorphological features of recurrent BCCs. METHODS: Biopsy samples and clinical data from 30 consecutive patients (15 women and 15 men) with 31 recurrent BCCs diagnosed from January 2007 to September 2010 were analyzed retrospectively. The mean age of the individuals at the time of diagnosis of recurrence was 68.2 years (range 32 to 97 years). Histological types and other pathological findings of original and relapsing BCCs, as well as the time between them, were able to be compared in 24 cases. RESULTS: Recurrent carcinomas represented 4.9% of all diagnosed cases during the observed period. Recurrence time varied from 4 to 105 months with a mean time of 31.2 months. The majority of recurrences occurred within 3 years after the primary treatment. The topographic localization of tumors was as follows: auricles (n = 5), cheeks (n = 4), medial canthus (n = 4), periauricular regions (n = 3), temporal areas (n = 3), paranasal regions (n = 3), nose (n = 3), forehead (n = 1), lower eyelid (n = 1), mandible (n = 1), chin (n = 1), neck (n = 1), and back (n = 1). Histologically, 50% of primary and 54.8% of recurrent BCCs demonstrated at least partial aggressive-growth features. Comparing primary and corresponding relapsing BCCs, 50% of them showed an identical type, in 16.7% the recurrent tumor had developed a more aggressive histological picture, and in 20.8% the histomorphology had became more benign. Of all primary tumors previously removed by total extirpation, 54.5% were resected completely and 45.5% incompletely. CONCLUSIONS: BCC recurrences may vary considerably with respect to various tumor- and host- -related factors, and so it is impossible to predict them precisely. Although aggressive histological types and positive excision margins are considered the strongest predictors, we demonstrated that half of the primary cancers had shown an indolent character, and that more than half of them had appeared to be completely resected. We can conclude that all patients that have had BCCs removed should be re-examined regularly even after microscopically adequate excisions, or lesions with an indolent histomorphology. Careful monitoring must be undertaken for at least 3 years; however, the most appropriate course is a lifetime of regular follow-up.