Dermatoscopic patterns of cutaneous metastases: A multicentre cross-sectional study of the International Dermoscopy Society.

BACKGROUND: The detection of cutaneous metastases (CMs) from various primary tumours represents a diagnostic challenge. OBJECTIVES: Our aim was to evaluate the general characteristics and dermatoscopic features of CMs from different primary tumours. METHODS: Retrospective, multicentre, descriptive, cross-sectional study of biopsy-proven CMs. RESULTS: We included 583 patients (247 females, median age: 64 years, 25%-75% percentiles: 54-74 years) with 632 CMs, of which 52.2% (n = 330) were local, and 26.7% (n = 169) were distant. The most common primary tumours were melanomas (n = 474) and breast cancer (n = 59). Most non-melanoma CMs were non-pigmented (n = 151, 95.6%). Of 169 distant metastases, 54 (32.0%) appeared on the head and neck region. On dermatoscopy, pigmented melanoma metastases were frequently structureless blue (63.6%, n = 201), while amelanotic metastases were typified by linear serpentine vessels and a white structureless pattern. No significant difference was found between amelanotic melanoma metastases and CMs of other primary tumours. CONCLUSIONS: The head and neck area is a common site for distant CMs. Our study confirms that most pigmented melanoma metastasis are structureless blue on dermatoscopy and may mimic blue nevi. Amelanotic metastases are typified by linear serpentine vessels and a white structureless pattern, regardless of the primary tumour.

Simultaneous melanomas in the setting of multiple primary melanomas.

It is estimated that about 1-13% of melanoma patients will develop multiple primary melanomas. Although the occurrence of subsequent tumors has been described during the last few years, the development of simultaneous melanomas has not yet been extensively studied. We reviewed our registries to identify patients with multiple primary melanomas. We studied epidemiological, clinical, and histological characteristics of patients who were diagnosed with simultaneous melanomas and compared them with those of patients who developed non-synchronous multiple primary melanomas. As simultaneous were defined subsequent melanomas that were diagnosed either at the same visit or within a time-period of maximum of 1 month. Between 2000 and 2020, 2500 patients were diagnosed with melanoma at Andreas Syggros Hospital. 86 (3.4%) patients presented multiple primary melanomas and among them, 35 (40.7%) developed simultaneous melanomas. Patients with simultaneous melanomas developed more frequently more than 2 tumors. First tumors of patients with non-synchronous melanomas were significantly thicker than second tumors while those of patients with simultaneous melanomas did not differ significantly. Slight differences in the tumor localization, staging and histologic type were observed between the two groups. However significant differences were ascertained between first and second tumors in both groups. Simultaneous melanomas occupy an important proportion of multiple primary melanomas, affecting a non-negligible number of patients. Slight differences between simultaneous and non-synchronous multiple primary melanomas seem to define a distinct subcategory of multiple primary melanomas.

Contact allergy caused by acrylates in nail cosmetics: A pilot study from Greece.

BACKGROUND: The growing popularity of nail techniques based on acrylates has led to a higher frequency of sensitization in both nail technicians and users. OBJECTIVES: The study aimed to assess cases of allergic contact dermatitis (ACD) caused by acrylates in individuals with occupational or non-occupational exposure to nail techniques. METHODS: A preliminary study was conducted on 30 patients with ACD caused by acrylates in nail techniques, who were patch tested from September 2022 to March 2023 at the First Department of Dermatology and Venereology of Andreas Syggros Hospital, Athens, Greece. RESULTS: Thirty female patients with ACD to acrylates were documented (15 users and 15 nail technicians and users). The most common allergens were: 2-hydroxyethyl methacrylate (HEMA), 2-hydroxypropyl methacrylate (HPMA) and ethyleneglycol dimethacrylate (EGDMA), which tested positive in all 30 patients (100.0%). Twenty patients (66.7%) had been exposed to dental procedures involving acrylates, before the onset of ACD. Nail technicians exhibited extensive skin lesions, 40.0% experienced ACD within the first year of work and 13.3% during their professional practice. Three of them (20.0%) had to discontinue their work. CONCLUSION: Acrylates have been identified as potent allergens, necessitating the implementation of safety measures for the use of these chemicals in nail techniques.

The Role of Myositis-Specific and Myositis-Associated Autoantibodies and the Activation of Type I Interferon Pathway in the Generation of Clinical Phenotypes of Inflammatory Myopathies.

Idiopathic inflammatory myopathies (IIMs) are a group of heterogeneous autoimmune diseases with a prevalence of 20 cases per 100000 of population. Despite their diversity, IMMs are characterised by several common clinical features such as muscle inflammation, proximal muscle weakness, abnormal electromyography and/or muscle biopsy. Over the last years, it has been increasingly recognised that an array of autoantibodies known as myositis-specific antibodies (MSAs) and myositis-associated antibodies (MAAs) are associated with distinct clinical phenotypes and diverse prognosis. Although the exact underlying mechanism of IIMs is not fully understood, accumulating data suggest that the activation of type I interferon pathway plays a central role in disease development. Previous studies have reported the upregulation of type I interferon (IFN) induced genes in peripheral blood and muscle biopsies derived from myositis patients. Given the heterogeneity of inflammatory myopathies along with the central role of type I IFN pathway in disease pathogenesis, the aim of the current study is to elucidate the link between distinct clinical phenotypes of inflammatory myopathies with the presence of serum MSAs or MAAs, as well as with type I IFN activation.

Octenidine Versus Dispase Gels for Wound Healing After Cryosurgery Treatment in Patients with Basal Cell Carcinoma.

For a specific group of patients with basal cell carcinoma (small, low risk), cryosurgery could be the suggested treatment, which results in the formation of an ulcer in the lesion area. The proteolytic enzymes' contribution to the wound healing is an ongoing research goal. Preclinical animal experiments in the Laboratory of the Pharmaceutical Technology Department of the National and Kapodistrian University of Athens have showed that a dose of 5 U/mL of dispase gel after the formation of tissue rashes, significantly promoted wound healing. Herein, a feasibility study in 16 patients enrolled by the First Department of Dermatology of Andreas Syggros Hospital was designed: 5 U/mL of dispase gel (once every 3 days) versus a drug reference containing octenidine (daily administration). The evaluation of the healing effect, safety, and tolerance was done on days 1 (cryosurgery), 2, 7, 21, and 60. The study end point was considered either the ulcer complete healing or the eighth week since treatment initiation. Wound healing was faster with dispase gel and hemoglobin reduced rapidly after the seventh day. Yet, hydration was higher in the control group. Our non-parametric analysis provides evidence that the dispase gel shows faster healing compared to the reference drug, in humans, meriting further investigation in larger human sample sizes before massive production of the product.

A Retrospective Analysis to Investigate Contact Sensitization in Greek Population Using Classic and Machine Learning Techniques.

Allergic contact dermatitis (ACD) is an inflammatory reaction affecting all age groups and both sexes. ACD is characterized by a delayed-type hypersensitivity reaction IV caused by skin contact with haptens. Chronic exposure typically leads to a decrease in erythema accompanied by lichenification (thickening and hardening of the skin) and persistent itching. The current study aims to investigate the patterns of contact sensitization in the Greek population using patch test data analysis. Patch test data from 240 patients (120 Males/120 Females) with allergic contact dermatitis were collected at the Laboratory for Patch Testing, National Reference Center for Occupational Dermatoses "Andreas Syggros" Hospital in Athens Greece. The contact allergic reactions were caused by ethylenediamine dihydrochloride 1%, thimerosal 0.5%, and methyldibromo-glutaronitrile 0.1% from the European baseline series of allergens; information was also collected for ICDRG evaluation, an extended MOAHLFA index and patient-reported outcomes (daily routine questionnaire). The chi-square test for independence and Spearman's rank were used to evaluate the association and correlation, respectively, between patient characteristics and ACD-related factors. Multiple correspondence analysis (MCA), which is a data analysis approach, was used to find and depict underlying structures in the data collection for nominal categorical data. Statistically significant associations were found between the following pairs of characteristics: eczema triggers and gender and eczema triggers and hand dermatitis. The results from MCA showed that there is correlation between allergic contact dermatitis onset, allergens, and demographic variables.

Integrated Safety Analysis on Skin Cancers among Patients with Psoriasis Receiving Ixekizumab in Clinical Trials.

INTRODUCTION: Limited data exist on skin cancer risk in patients with psoriasis using biologics. Here, we report treatment-emergent adverse events (TEAEs) of skin cancer in patients treated with ixekizumab from psoriasis clinical trials. METHODS: Integrated safety databases from 17 clinical trials of adults with moderate-to-severe psoriasis treated with ≥ 1 dose of ixekizumab for ≤ 5 years were used to analyze exposure-adjusted incidence rates (IRs) per 100 patient-years of exposure (PYE) and clinically characterize dermatologist-adjudicated skin cancer TEAEs. RESULTS: Of 6892 patients, 58 presented with ≥ 1 skin cancer TEAE (IR 0.3) with IRs remaining stable with longer ixekizumab exposure. Non-melanoma skin cancer (NMSC) was the most common event (IR 0.3) affecting 55 patients; of those, 44 had basal cell carcinoma (IR 0.2) and 16 had squamous cell carcinoma (IR 0.1). Two treatment-emergent melanoma events were identified; neither were classified as serious AEs. CONCLUSIONS: Incidence of skin neoplasms in patients with psoriasis treated with ixekizumab for ≤ 5 years was low, and among those events, NMSC was most common. Limitations included that longer exposure may be required to confirm risk of skin cancer and that the study exclusion criteria of several studies, which excluded patients with skin cancer events within 5 years prior to baseline, might limit interpretation of skin cancer risk in this cohort. These findings support the safety profile of ixekizumab for patients requiring long-term psoriasis control.

Simultaneous Multiple-Stages Mpox Genital Lesions on the Same Site in a Traveler to Greece: A Case Report.

A 47-year-old Caucasian traveller from an mpox (formerly monkeypox and also best suited abbreviated MPX)-endemic country was referred for a skin rash, of recent onset, confined to the genital area. The rash consisted of erythematous umbilicated papules, vesicles and pustules with a characteristic white ring. The lesions were observed simultaneously at different stages of progression on the same anatomical site, a clinical presentation that is not encountered frequently. The patient was febrile, fatigued and had blood-tinged cough. The clinical suspicion of mpox was raised, and the initial real-time PCR identified a non-variola orthopox virus, which was confirmed at the National Reference Laboratory to belong to the West African clade.

Self-Esteem, Depression, Anxiety and Quality of Life in Patients with Melasma Living in a Sunny Mediterranean Area: Results from a Prospective Cross-Sectional Study.

INTRODUCTION: Melasma is a common acquired disorder of hyperpigmentation and has a significant effect on quality of life. The aim of this prospective cross-sectional study was to assess the effect of melasma on depression, social anxiety and self-esteem in the Greek population. METHODS: The study included a total of 254 participants: 127 patients with melasma and an equal sample of healthy controls. Both participant groups completed the following psychometric measures: the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression and Rosenberg's Self-esteem Scale (RSES) for self-esteem. Furthermore, in patients with melasma, quality of life was assessed using Melasma Quality of Life (MELASQoL). RESULTS: Melasma patients (7.47 ± 4.53) presented statistically significantly higher anxiety compared to healthy controls (6.06 ± 3.59, p = 0.006), while no differences emerged with regard to depression or self-esteem. It is important to note that the difference regarding anxiety remained significant (b = 1.25, p = 0.003) even after adjusting for age, depression and self-esteem. A higher disease severity (MASI) correlated statistically significantly with longer disease duration (r = 0.24, p < 0.001), higher depression (r = 0.28, p = 0.002), and a more impaired health-related quality of life (MelasQol; r = 0.29, p < 0.001). Notably, a more impaired health-related quality of life was also correlated with higher depression (r = 0.19, p = 0.027) and lower self-esteem (r = - 0.31, p < 0.001). CONCLUSION: The results of this study highlight the importance of evaluating quality of life, anxiety and depression in patients with melasma. The therapeutic approach should not be based solely on clinical findings; it should also include an evaluation of the patient's psychological aspects. Dermatologists can further improve their patient care by being supportive or requesting psychological intervention when needed, resulting in better compliance with treatment and an improved social and psychological status.

Cutaneous melanoma metastases: Clinical and dermoscopic findings.

BACKGROUND: About 2%-20% of melanoma patients will develop cutaneous melanoma metastases (CMM). Their clinical diagnosis still remains challenging because of the variation of clinical and dermoscopic characteristics. Until today, few studies exist concerning the dermoscopic image of CMM but no one has focused on its possible association with clinicopathological melanoma characteristics. METHODS: Between 2002 and 2019, 42 patients diagnosed with melanoma at Andreas Syggros Hospital developed CMM. We studied the dermoscopic presentation of these metastases and its possible association with the clinical and histologic characteristics of the underlying melanoma. RESULTS: There were 20 male and 22 female patients with a mean age of 64.02 years. Nineteen patients developed satellites and 23 in transit metastases. Mean Breslow index was estimated at 2.93 mm and ulceration was observed in half of the tumours (50%). Almost half of the patients developed cutaneous metastases on the lower limbs (45.24%). We identified 5 dermoscopic patterns of CMM: saccular, amelanotic, homogenous, vascular and polymorphic. Homogenous (30.95%) and amelanotic (28.57%) were the most common patterns. Homogenous pattern was the most common in satellite metastases while amelanotic was mostly observed in in-transit metastases. Homogenous pattern was more frequent among superficial spreading melanomas. Patients with thin (<1 mm) and medium depth (1-2 mm) melanomas mostly developed metastases with saccular pattern. Vascular pattern was only present in metastases of tumours with Breslow index 2-4 mm. Homogenous and amelanotic were the only patterns found in tumours with Breslow index >4 mm. CONCLUSIONS: We observed that vascular structures were more frequent in metastases of deeper tumours while nevus-like structures were more common in metastases of thinner tumours. CMM occasionally may constitute the first clinical sign of melanoma disease. Therefore, it is important for clinicians to recognize their dermoscopic patterns which seem to be associated with some of the clinical and histological characteristics of cutaneous melanomas.

Artificial Intelligence in Dermatology: Challenges and Perspectives.

Artificial intelligence (AI) based on machine learning and convolutional neuron networks (CNN) is rapidly becoming a realistic prospect in dermatology. Non-melanoma skin cancer is the most common cancer worldwide and melanoma is one of the deadliest forms of cancer. Dermoscopy has improved physicians' diagnostic accuracy for skin cancer recognition but unfortunately it remains comparatively low. AI could provide invaluable aid in the early evaluation and diagnosis of skin cancer. In the last decade, there has been a breakthrough in new research and publications in the field of AI. Studies have shown that CNN algorithms can classify skin lesions from dermoscopic images with superior or at least equivalent performance compared to clinicians. Even though AI algorithms have shown very promising results for the diagnosis of skin cancer in reader studies, their generalizability and applicability in everyday clinical practice remain elusive. Herein we attempted to summarize the potential pitfalls and challenges of AI that were underlined in reader studies and pinpoint strategies to overcome limitations in future studies. Finally, we tried to analyze the advantages and opportunities that lay ahead for a better future for dermatology and patients, with the potential use of AI in our practices.

Artificial intelligence (AI) is the development of computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, and translation between languages. The research on the use of AI in dermatology includes the ability of a machine to correctly classify a skin lesion. Skin cancer is the most common cancer worldwide and melanoma is the deadliest form of skin cancer. All skin cancers have a better prognosis when detected early in their development, hence their early detection is of paramount importance. Dermatologists use a dermatoscope­a specialized magnifying lens to improve their diagnostic capacity. However, even with the use of the dermatoscope, their ability to recognize skin cancer is far from perfect. AI has the ability to learn from dermoscopic images and subsequently provide an image-based diagnosis. Several studies compared the performance of machines and humans in classifying skin lesions from these images and showed that machines can classify skin lesions as good (and sometimes better) than humans. However, the application of AI in everyday clinical practice remains a challenge. In this article, we attempt to summarize the limitations and challenges that researchers found in their studies, and we provide strategies to improve the design of future studies. Finally, we describe the advantages and opportunities that could lay ahead for a better future for dermatology and patients.

Circadian cortisol profiles and hair cortisol concentration in patients with psoriasis: associations with anxiety, depressive symptomatology and disease severity

Background: There is evidence that stress and psoriasis interact bidirectionally. Specifically, stress is not only induced by psoriasis, but it is also considered a precipitating factor for onset or exacerbation of the disease. Neuroendocrine alterations of the stress system have been implicated in this association. Objectives: To assess the diurnal rhythm of the hypothalamic-pituitary-adrenal (HPA) axis and hair cortisol levels in patients with psoriasis compared to healthy controls, and further explore whether suggested alterations in HPA axis activity are related to anthropometric, psychological, and disease activity/severity indices. Materials & Methods: We assessed stress levels quantified by questionnaires, psoriasis severity, and stress system activity based on HPA axis biomarkers. The sample comprised 18 adult patients with exacerbation of non-pustular psoriasis compared to 18 healthy controls (18-65 years old). In particular, salivary cortisol diurnal profiles and hair cortisol concentration were evaluated in both groups. Five distinct salivary samples were collected during a day of rest and 3-cm hair segments were cut. Results: A higher prevalence of self-reported anxiety, stress, and depressive symptoms was reported among psoriatic patients compared to healthy controls. Also, blunted salivary cortisol diurnal rhythm in psoriatic patients and a positive correlation of salivary cortisol concentration with state anxiety and psoriasis severity were revealed. No associations were shown between hair cortisol concentrations and disease presence/severity. Conclusion: We provide preliminary evidence that psoriasis patients may demonstrate a hypofunctional HPA axis, while our findings also suggest a complex interaction between HPA axis activity, psychosocial status and pathophysiological processes in psoriasis.

Ulvan-Based Nanofibrous Patches Enhance Wound Healing of Skin Trauma Resulting from Cryosurgical Treatment of Keloids.

Keloids are skin fibroproliferative disorders, resulting from abnormal healing of deep cutaneous injuries. Cryosurgery, the most common treatment for keloids, causes skin traumas. Even though the clinical practice of cryosurgery has increased, effective wound healing therapy is still lacking. In this investigation, nonwoven nanofibrous patches composed of ulvan, a marine sulfated polysaccharide exhibiting anti-inflammatory and antioxidant activities, and polyethylene oxide (PEO) were fabricated through electrospinning and characterized. Their wound healing efficacy on skin traumas resulting from cryosurgical treatment of keloids was clinically tested and evaluated in comparison to a reference product. Twenty-four volunteer patients undergoing cryosurgery as a treatment of keloids were selected to apply either the ulvan/PEO patch or the reference product for 21 days. The ulvan/PEO patch, 21 days after cryosurgery, showed significant wound healing, elimination of skin inflammation, restoration of biophysical parameters similar to normal values and significant decrease in haemoglobin concentration, skin texture and volume, while no discomfort or adverse reaction was observed. In contrast, the reference product showed inferior performance in all evaluated parameters. The designed ulvan/PEO patch represents the first wound dressing to effectively heal skin trauma after cryosurgical treatment of keloids.

The role of dual-specificity phosphatase 3 in melanocytic oncogenesis.

Dual-specificity phosphatase 3 (DUSP3), also known as Vaccinia H1-related phosphatase, is a protein tyrosine phosphatase that typically performs its major role in the regulation of multiple cellular functions through the dephosphorylation of its diverse and constantly expanding range of substrates. Many of the substrates described so far as well as alterations in the expression or the activity of DUSP3 itself are associated with the development and progression of various types of neoplasms, indicating that DUSP3 may be an important player in oncogenesis and a promising therapeutic target. This review focuses exclusively on DUSP3's contribution to either benign or malignant melanocytic oncogenesis, as many of the established culprit pathways and mechanisms constitute DUSP3's regulatory targets, attempting to synthesize the current knowledge on the matter. The spectrum of the DUSP3 interactions analysed in this review covers substrates implicated in cellular growth, cell cycle, proliferation, survival, apoptosis, genomic stability/repair, adhesion and migration of tumor melanocytes. Furthermore, the speculations raised, based on the evidence to date, may be considered a fundament for potential research regarding the oncogenesis, evolution, management and therapeutics of melanocytic tumors.

Atypical presentation of cutaneous angiosarcoma: review of the literature.

Cutaneous angiosarcoma (CAS) is an aggressive tumour of vascular or lymphatic origin. Although relatively rare, it needs to be recognized and treated early. CAS typically arises on the head or neck as a bruise or raised purplish-red papule or plaque. However, it can sometimes resemble a benign skin lesion, leading to delay in diagnosis and consequent poor patient outcome. CAS may be mistaken for inflammatory, autoimmune or infectious disease, or for a benign skin tumour or post-traumatic lesion. We analyse the atypical clinical forms of this aggressive tumour and review the literature.

Patient characteristics, treatment patterns and disease outcomes in patients with psoriatic arthritis followed in a combined Dermatology-Rheumatology clinic: a retrospective real-world study.

The aim of this study was to assess the patient characteristics, treatment patterns and disease outcomes in patients with psoriatic arthritis (PsA) referred to a combined Dermatology-Rheumatology (Derm-Rheum) Clinic. This was a retrospective study of patients seen in a combined Derm-Rheum Clinic (February 2018 to June 2020) in a Tertiary University Hospital. Consecutive patients with suspicious musculoskeletal symptoms or a known diagnosis of PsA referred to the Derm-Rheum Clinic were examined and followed simultaneously by experienced dermatologists and rheumatologists. Among 151 patients with psoriasis (PSO) with suspicious musculoskeletal complaints, 129 (85%) with a final diagnosis of PsA were included (56% females, mean age: 55 years, median disease duration: 14.2 years). In 62% of these patients (n = 94), PsA was diagnosed for the 1st time. At initial evaluation, 95% had peripheral arthritis, 45% nail involvement, 23% axial involvement, 12% enthesitis and 6% dactylitis with a median DAPSA and PASI scores of 20.5 and 1.6, respectively. 31% of the patients were not receiving any systemic treatment, 45% were on biologics, 29% on non-biologics and 10% on targeted synthetic agents (apremilast). At last visit (median interval time: 15 months), only 8% did not receive any systemic therapy (p < 0.001 compared to 1st visit), 62% were on biologics (p = 0.009 compared to 1st visit), 46% on non-biologics (p = 0.01 compared to 1st visit) and 10% remained on apremilast. The median DAPSA and PASI scores decreased significantly to 5.3 and 0, respectively. In conclusion, about 2/3 of patients with PSO and musculoskeletal complaints referred to a combined Derm-Rheum Clinic were diagnosed for the 1st time with PsA. During follow-up, the percentage of PsA patients on systemic therapies significantly increased with major improvement of disease activity indices. These data emphasize the value of combined Derm-Rheum Clinics for earlier referral, diagnosis, and more effective treatment of PsA patients.

Occupational contact allergy of construction workers in Greece: Trends during 2009-2018.

BACKGROUND: Recent trends in the sensitization of construction workers show a decrease in potassium dichromate and an increase in epoxy resin sensitization. OBJECTIVES: To present the trends of occupational contact allergy of construction workers in Greece from 2009 to 2018. METHODS: We retrospectively reviewed the files of patients with eczema patch tested in our Contact Dermatitis Clinic who were construction workers. RESULTS: A total of 191 construction workers initially reported contact dermatitis. Of these, 138 had occupation-relevant allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD). All patients were men. After being patch tested, 98 (71.0%) were diagnosed with ACD and 40 with ICD. Median duration of occupation till onset of ACD was 2 years (interquartile range [IQR] 0.8-7). The hands were the most common location for ACD (73.5%), followed by the trunk (39.8%), the legs (38.8%), and the face (11.2%). Of the patients, 74.6% had lesions affecting multiple body sites. Potassium dichromate (67%) was the most frequent allergen, followed by thiuram mix (37.4%) and cobalt chloride (31.8%). Sensitization to epoxy resins was lower (12.1%). CONCLUSION: The sensitization pattern of Greek construction workers does not follow the trends in Central or Northern Europe, rather sharing attributes with less industrialized countries.