Extra-Anogenital Giant Cutaneous Squamous Cell Carcinomas.

Extra-anogenital giant cSCCs are rare but have worse outcomes compared to smaller tumors. Prompted by limited data, the authors conducted a retrospective study to gather more information about giant cSCCs to optimize clinical care. We identified seven cases of giant cSCCs from a review of cSCC cases treated in the Unit of Dermatosurgery between 2016 and 2022. Most patients were male (85.71%) with a mean age of 80.29 ± 12.22 years. UV radiation was the most common risk factor (five cases) followed by smoking (three cases) and hidradenitis suppurativa (one case). Most giant cases were located in the head area (71.4%) and the diameter of lesions ranged from 6 to 18 cm. All patients corresponded to tumor stage T3, and 42.86% of patients had lymph node metastases. Surgical excision was the treatment of choice in most cases (85.71%), while a combination of cemiplimab and RP1 was used in some cases due to the ineffectiveness of treatment or contraindications to other therapies. The authors emphasize the importance of early detection and prevention of modifiable risk factors, such as UV radiation, and a multidisciplinary approach to treatment. Other therapies, including immunotherapy, may become increasingly important.

The Pathophysiology and Treatment of Pyoderma Gangrenosum-Current Options and New Perspectives.

Pyoderma gangrenosum (PG) is an uncommon inflammatory dermatological disorder characterized by painful ulcers that quickly spread peripherally. The pathophysiology of PG is not fully understood; however, it is most commonly considered a disease in the spectrum of neutrophilic dermatoses. The treatment of PG remains challenging due to the lack of generally accepted therapeutic guidelines. Existing therapeutic methods focus on limiting inflammation through the use of immunosuppressive and immunomodulatory therapies. Recently, several reports have indicated the successful use of biologic drugs and small molecules administered for coexisting diseases, resulting in ulcer healing. In this review, we summarize the discoveries regarding the pathophysiology of PG and present treatment options to raise awareness and improve the management of this rare entity.

Erythroderma: A Retrospective Study of 212 Patients Hospitalized in a Tertiary Center in Lower Silesia, Poland.

Erythroderma is a condition characterized by erythema affecting at least 90% of the skin surface area. It can be caused by various underlying conditions. Due to nonspecific clinical and laboratory findings, determining the cause may pose a challenge. In the retrospective study, we identified 212 patients hospitalized for erythroderma in the Department of Dermatology, Venereology, and Allergology at Wroclaw Medical University between January 2012 and March 2022. Clinical, laboratory, and histopathological features, as well as the management of patients, were studied. The median age of adults was 61 years (IQR = 47-68). The most common causes of erythroderma were psoriasis (n = 49, 24.01%), followed by atopic dermatitis (AD) (n = 27, 13.23%), and cutaneous T-cell lymphomas (CTCL) (n = 27, 13.23%). Despite laboratory tests and histopathological examination, the etiology of erythroderma remained undetermined in 39 cases (19.12%). In 70.59% of patients, it was the first episode of erythroderma, while 29.41% experienced a recurrent episode. Regardless of the etiology of erythroderma, patients were most frequently treated with systemic antihistamines (146 cases, 71.57%) and systemic steroids (132 cases, 64.71%). Patients with idiopathic erythroderma constitute the greatest diagnostic and therapeutic challenge, requiring particularly thorough evaluation.

Skin Cancer Risk, Sun-Protection Knowledge and Behavior in Athletes-A Narrative Review.

Outdoor sports are associated with increased exposure to ultraviolet radiation, which may result in sunburn, solar damage, and skin cancers. Water and winter sports create additional adverse conditions, such as washing away sunscreen by water and reflection of UV rays by the water and snow. Sweating-increased skin photosensitivity and activity-induced immunosuppression are associated with a greater risk of developing skin cancers. In this review, we focus on a group of athletes and sports participants and analyze 62 articles concerning sun exposure during outdoor sports, the risk of developing skin cancer, and knowledge and behavior regarding photoprotection methods. Various practices have been linked to an increased risk of developing basal cell carcinoma (BCC), squamous cell carcinoma (SCC), malignant melanoma (MM), or UV-induced skin damage. Water sports and mountaineering increase the risk of BCC. Surfing and swimming are risk factors for SCC. Melanoma is more common in swimmers, surfers, and marathon runners. Photoprotection behaviors can reduce potential skin damage and skin cancers. Athletes' knowledge about the risk of malignant lesions was satisfactory, but despite the risks, outdoor sports participants seem not to protect themselves from the sun adequately.

Management of Bladder Cancer Patients with Clinical Evidence of Lymph Node Invasion (cN+).

The purpose of this review is to present the current knowledge about the diagnostic and treatment options for bladder cancer (BCa) patients with clinically positive lymph nodes (cN+). This review shows compaction of CT and MRI performance in preoperative prediction of lymph node invasion (LNI) in BCa patients, along with other diagnostic methods. Most scientific societies do not distinguish cN+ patients in their guidelines; recommendations concern muscle-invasive bladder cancer (MIBC) and differ between associations. The curative treatment that provides the best long-term survival in cN+ patients is a multimodal approach, with a combination of neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) with extended pelvic lymph node dissection (ePLND). The role of adjuvant chemotherapy (AC) remains uncertain; however, emerging evidence indicates comparable outcomes to NAC. Therefore, in cN+ patients who have not received NAC, AC should be implemented. The response to ChT is a crucial prognostic factor for cN+ patients. Recent studies demonstrated the growing importance of immunotherapy, especially in ChT-ineligible patients. Moreover, immunotherapy can be suitable as adjuvant therapy in selected cases. In cN+ patients, the extended template of PLND should be utilized, with the total resected node count being less important than the template. This review is intended to draw special attention to cN+ BCa patients, as the oncological outcomes are significantly worse for this group.

The Skin Microbiome in Cutaneous T-Cell Lymphomas (CTCL)-A Narrative Review.

In recent years, numerous studies have shown a significant role of the skin microbiome in the development and exacerbation of skin diseases. Cutaneous T-cell lymphomas (CTCL) are a group of malignancies primary involving skin, with unclear pathogenesis and etiology. As external triggers appear to contribute to chronic skin inflammation and the malignant transformation of T-cells, some microorganisms or dysbiosis may be involved in these processes. Recently, studies analyzing the skin microbiome composition and diversity have been willingly conducted in CTCL patients. In this review, we summarize currently available data on the skin microbiome in CTLC. We refer to a healthy skin microbiome and the contribution of microorganisms in the pathogenesis and progression of other skin diseases, focusing on atopic dermatitis and its similarities to CTCL. Moreover, we present information about the possible role of identified microorganisms in CTCL development and progression. Additionally, we summarize information about the involvement of Staphylococcus aureus in CTCL pathogenesis. This article also presents therapeutic options used in CTCL and discusses how they may influence the microbiome.

Photoprotection among young children: assessment of mothers' awareness and health behaviours.

Introduction: Due to the increasing incidence of skin cancer in the last decades a wide promotion of proper sun protection is needed. Mothers and their children commonly spending time outdoors are particularly vulnerable to the harmful effects of sunlight. Aim: To assess health awareness and behaviours connected to sun protection in the group of mothers of children under 6 years of age. Material and methods: An online survey containing 23 questions (19 closed and 4 open) was carried out between July and August 2019. One hundred and seven women (mean age: 30.7 ±4.3years) participated in the study. The mean age of children was 1.9 ±1.6years (range: 0-6 years). Results: One hundred and five (98.1%) mothers declared using sunscreen. Of them, 36 women used sunscreen only in summer, while 14 women applied sunscreen all year. Mothers of younger children used sunscreen all year round significantly more often (p = 0.041) compared to mothers of older children. Mothers of children under the age of 1 used sunscreen when staying in the shade more often (p = 0.025) than mothers of older children. Only 14 (13.3%) women declared applying sunscreen on their children during cloudy weather. Conclusions: A good photoprotection awareness of mothers, especially with respect to the youngest children was observed. However, a need for further education regarding certain photoprotection aspects (proper application and damaging effect of UVA) is necessary.

Chitinase-3-like Protein 1 (YKL-40): A New Biomarker of Inflammation in Pyoderma Gangrenosum.

Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis with unclear aetiopathology, considered as an autoinflammatory disease, associated with other immune-mediated disorders. Chitinase-3-like protein 1 (YKL-40) is an inflammatory biomarker secreted by a wide variety of cells, including neutrophils. To evaluate YKL-40 serum level in relation to clinicopathological data, 48 patients with PG and 40 healthy controls were enrolled in the study. Skin lesions were measured to calculate the affected area. Inflammatory parameters (C-reactive protein, white blood cell count with neutrophils) were determined from blood samples. YKL-40 and IL-6 levels were measured in serum by enzyme-linked immunosorbent assay. YKL-40 serum level was significantly higher in patients with PG than in controls (58.4 vs 36.4 ng/ml, respectively; p < 0.00001). The positive correlation between YKL-40 level and IL-6 level was observed (r=0.48, p = 0.0006) along with a trend towards significance of relationship between YKL-40 level and C-reactive protein (r=0.28, p = 0.052). YKL-40 can be considered a valuable biomarker of inflammation in PG.

What factors affect the length of hospitalization in patients with erysipelas? A 10-year retrospective study of patients hospitalized in Lower Silesia, Poland.

BACKGROUND: Erysipelas is an acute skin infection caused by group A and G streptococci. This infection is associated with many comorbidities and often requires hospitalization. OBJECTIVES: The aim of this study was to identify the factors related to the length of hospitalization in patients with erysipelas. MATERIAL AND METHODS: This retrospective study included 153 admissions of 135 patients (63 women and 72 men) hospitalized due to erysipelas from January 2010 to December 2019. Clinical symptoms, test results, comorbidities, and antibiotic treatments were taken into consideration as factors affecting the length of hospital stay. RESULTS: The median length of hospitalization was 10 days (interquartile range (IQR) = 7-14). Women spent less time in the ward, but the difference was not significant. Features such as tinea pedis (15.5 days, IQR = 13.5-20; p = 0.002), anemia (11 days, IQR = 9-15; p = 0.02), chills (12 days, IQR = 9-15; p = 0.03), elevated serum C-reactive protein (CRP) level over 100 mg/L (11 days, IQR = 8-17; p = 0.02), and leukocytosis (11 days, IQR = 8-15, p = 0.005) were identified as prolonged hospitalization factors. Moreover, patients with erysipelas localized to the legs (p = 0.01) and with a gangrenous variant of erysipelas (p = 0.03) were hospitalized longer. The first-choice antibiotic was not significant in terms of prolonged hospitalization. Patients treated with clindamycin during hospitalization, regardless of whether it was a first-line or subsequent antibiotic, stayed in the ward significantly longer (p = 0.005). CONCLUSION: Patients suffering from erysipelas with the features identified above, have a higher risk of a prolonged stay in the hospital. Significantly increased inflammatory factors, anemia and tinea pedis contributed to prolonged hospitalization.

Sun protection among university students in Poland: a survey of awareness and attitudes.

AIM: The aim of the study was to evaluate students' awareness and attitudes related to skin protection against UVR and to check the hypothesis whether medical students differ from other faculty students in terms of health-promoting behaviour in photoprotection. MATERIAL AND METHODS: Internet-based survey containing 24 questions about students' knowledge and attitudes associated with sun exposure and photoprotection was carried out between March and May 2019. Two hundred and forty-three questionnaires were subject to statistical analysis. RESULTS: Out of 243, 149 (60.9%) respondents studied medicine and 95 (39.1%) were students of other faculties. 235 (96.7%) declared using sunscreen. 46 (18.9%) students applied it all year round and 116 (47.7%) only in the summer. Medical students chose more willingly products with SPF > 30 (p = 0.002). A hundred and fifty-nine (65.4%) students used sunscreen once when outdoors and 76 (31.3%) applied products more than once. Additional sun protective methods included wearing sunglasses (82.7%), hats or caps (62.1%) and avoiding sunlight around noon (46.5%). Students of the medical faculty avoided sun exposure statistically more frequently (p = 0.042) than students of other faculties. 28.4% had dermoscopy performed in the past. Medical students underwent dermoscopy examination statistically more frequently (p = 0.001) than students of other faculties. CONCLUSIONS: Medical students, probably due to their education, show increased pro-health attitudes associated with photoprotection. This indicates that they may be involved in creation and promotion of education activities to general public.