Dermoscopy of Chronic Radiation-Induced Dermatitis in Patients with Head and Neck Cancers Treated with Radiotherapy.

Radiotherapy (RT) is an integral part of many cancer treatment protocols. Chronic radiation-induced dermatitis (CRD) is a cutaneous toxicity that occurs in one-third of all patients treated with this method. CRD is usually observed several months after completion of treatment. Typical symptoms of CRD are telangiectasia, skin discoloration, atrophy, thickening, and cutaneous fibrosis. There are currently no data in the literature on the evaluation of the dermoscopic features of CRD. The aim of this prospective study was the identification of clinical and dermoscopic features in a group of 32 patients with head and neck cancer (HNC) in whom CRD developed after RT. CRD was assessed at 3, 6, and 12 months after RT in 16, 10, and 10 patients, respectively. CRD was assessed at one time point and two time points in 28 and 4 patients, respectively. The control included skin areas of the same patient not exposed to RT. The dataset consisted of 36 clinical and 216 dermoscopic photos. Clinical evaluation was performed according to the RTOG/EORTC radiation-induced dermatitis scale. The highest score was grade 2 observed in 21 patients. Clinical observations revealed the presence of slight and patchy atrophy, pigmentation change, moderate telangiectasias, and some and total hair loss. Dotted vessels, clustered vessel distribution, white patchy scale, perifollicular white color, white structureless areas, brown dots and globules, and white lines were the most frequently noted features in dermoscopy. Three independent risk factors for chronic toxicity, such as age, gender, and surgery before RT, were identified. The dermoscopic features that had been shown in our study reflect the biological reaction of the skin towards radiation and may be used for the parametrization of CRD regarding its intensity and any other clinical consequences in the future.

Type 1 diabetes - What's new in prevention and therapeutic strategies?

Type 1 diabetes (T1D) is an autoimmune disorder, and insulin deficiency is the result of b-cell dysfunction. Treatment of type 1 diabetes requires constant parenteral insulin administration, which can be very burdensome for the patient. Meticulous use of insulin therapy does not protect the patient against complications. Hence, the search for other methods of treatment as well as ways of preventing the onset of diabetes has been ongoing for a long time. The main obstacle in the implementation of the prevention task is the need to identify people at risk of developing diabetes before the start of autoimmunity. It seems that primary prevention is still unrealistic at the moment, because we do not know all the factors leading to the activation of autoimmunity processes. Research on the use of late secondary prevention in people who develop glucose tolerance disorders or in the early period after the onset of type 1 diabetes are at the most advanced stage. Gene therapy is another attempt at an alternative treatment and prevention of type 1 diabetes and still requires further research. Recent years have brought a lot of information about the nature of type 1 diabetes and the mechanisms leading to its development. However, it has not yet been established what factors decide about the initiation of autoimmunity and what determines the dynamics of these processes.

Dermoscopy of acute radiation-induced dermatitis in patients with head and neck cancers treated with radiotherapy.

Head and neck cancer (HNC) was the seventh most common cancer in the world in 2018. Treatment of a patient may include surgery, radiotherapy (RT), chemotherapy, targeted therapy, immunotherapy, or a combination of these methods. Ionizing radiation used during RT covers relatively large volumes of healthy tissue surrounding the tumor. The acute form of radiation-induced dermatitis (ARD) are skin lesions that appear usually within 90 days of the start of RT. This is a prospective study which compares 2244 dermoscopy images and 374 clinical photographs of irradiated skin and healthy skin of 26 patients at on average 15 time points. Dermoscopy pictures were evaluated independently by 2 blinded physicians. Vessels in reticular distribution, white, yellow or brown scale in a patchy distribution, perifollicular pigmentation and follicular plugs arranged in rosettes were most often observed. For these dermoscopic features, agreement with macroscopic features was observed. Two independent predictors of severe acute toxicity were identified: gender and concurrent chemotherapy. Knowledge of dermoscopic features could help in the early assessment of acute toxicity and the immediate implementation of appropriate therapeutic strategies. This may increase the tolerance of RT in these groups of patients.

High dose rate brachytherapy in nonmelanoma skin cancer-Systematic review.

Nonmelanoma skin cancers (NMSCs) are the most common malignancies worldwide. Millions of new cases every year present challenge to healthcare systems. Recent years brought numerous new data concerning high dose rate (HDR) brachytherapy (BT) as treatment option for NMSCs. International guidelines do not recognize BT as a method of choice given lack of randomized trials, however many prospective and retrospective studies show promising results. Aim of the study was to present the efficacy of HDR BT, with analysis of its safety and adverse effects based on review of the English published medical full-text papers. Literature review of 13 articles published between 1999 and 2021 was performed. Pubmed and Google Scholar databases were searched on October 2021 using keywords: ([Basal cell carcinoma] OR [squamous cell carcinoma] OR [non-melanoma skin cancer]) AND (HDR brachytherapy). Fourteen full-text English articles with follow up over 1 year and study group over 50 patients were included into analysis. In analyzed material, 2403 patients received HDR BT. Local control varied between 71% and 99%.Dominant reported cosmetic effect was good or very good. Results were cross-referenced with recent meta-analyses comparing BT to surgical excision, Mohs microsurgery and external beam radiotherapy. Radiodermitis is the main adverse effect of radiation treatment during and after radiotherapy. HDR BT emerges as potentially noninferior treatment method providing very good reported cosmetic outcomes.

Skin metastases in the clinical and dermoscopic aspects.

According to the literature, skin metastases affect 0.7%-10.4% of patients with malignant neoplasms of internal organs and may be 1 presentation of systemic spread of the cancer. Skin metastases may be the first sign of relapse after treatment and about 30% of cases of skin metastases are diagnosed before the diagnosis of internal organ cancer. Cutaneous metastases most often come from breast cancer and melanoma. They can present synchronous or metachronous. Adequate vigilance, combined with knowledge of the clinical picture and epidemiology, can contribute to accurate diagnosis and treatment. Clinically, skin metastases occur in the form of atypical solitary, painless nodules, or tumors. Lumps or infiltrating foci do not show clinical features that help in making a diagnosis. Skin changes are more accessible during physical examination, and it is easier to do a biopsy and provide histological assessment. Dermoscopy, a useful initial tool for the assessment of skin metastases, can lead to a rapid accurate diagnosis and treatment. Ultimately, the diagnosis of a metastatic malignancy is confirmed by histopathological examination.

ß-cell self-destruction and extremely complicated and still unknown etiopathogenesis of type 1 diabetes.

Type 1 diabetes is based on apoptosis, which leads to b-cell death. Factors triggering apoptosis processes are very diverse and currently not fully explained. The main role is attributed to genetic and environmental factors. Genetic studies have shown that the inherited propensity for type 1 diabetes is multi-genetic. Environmental factors modify the response to their own antigens, but are probably not necessary to start the autoaggression process. The effect of b-cell destruction is confirmed by the appearance of autoantibodies in the blood. The paper presents a review of the available literature regarding the self-destruction of pancreatic b-cells. The aim of the study was to draw attention to the extremely complicated and still unknown etiopathogenesis of type 1 diabetes by reviewing current literature related to the above topic. The goal is to acquire the knowledge necessary to develop and implement causal treatment for diabetes. At the moment, unfortunately, we do not have safe, innovative therapy methods in the field of diabetes prevention. Intensive research on the etiopathogenesis of type 1 diabetes is an extremely important field of medical research.