Stromal α-Smooth Muscle Actin Positivity Is Associated With High-Risk Basal Cell Carcinomas.

ABSTRACT: The presence of myofibroblast differentiation has been proposed as an invading mechanism in basal cell carcinomas. However, small studies regarding α-smooth muscle actin positivity have led to conflicting results. This review of 100 cases examines the association between α-smooth muscle actin positivity on immunohistochemical studies and the clinical and histopathological characteristics of the tumor, including tumor size, thickness, subtype, topography, ulceration, 5-year recurrence rate, and age at diagnosis.

Dermoscopic Aspects of Cutaneous Adverse Drug Reactions.

BACKGROUND: Little is known about the dermoscopic evaluation of cutaneous adverse drug reactions (CADRs). OBJECTIVES: To evaluate the dermoscopic patterns of CADRs and identify those associated with severe cutaneous adverse reactions to drugs (SCARDs). PATIENTS AND METHODS: Patients included in this study from May 2015 to April 2016 had presented with CADRs. CADR presentation and classification were based on standard criteria. SCARDs included Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), overlap SJS/TEN, drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). The dermoscopic features of CADRs were described and compared according to the severity of the reactions. RESULTS: Sixty-nine patients were included. Sixteen patients (23.2%) presented SCARDs. The main dermoscopic findings in SJS, overlap SJS/TEN and TEN were black dots or necrotic areas (100%). Erosion [respectively, 4/6 (66.7%), 3/3 (100%) and 1/1 (100%)], necrotic borders [respectively, 4/6 (66.7%), 3/3 (100%) and 1/1, (100%)] and epidermal detachment [respectively, 5/6 (83.3%); 2/3 (66.7%) and 1/1 (100%)] were also common among these reactions. Erythema and purpuric dots were the main dermoscopic findings [respectively, 5/6 (83.3%) and 4/6 (66.7%)] in DRESS. In non-severe reactions, the most prevalent structures were erythema and purpura in exanthema [respectively, 31/33 (93.9%) and 24/33 (72.7%)] and erythema and vascular structures in urticarial reactions [respectively, 6/6 (100%) and 3/6 (50%)]. Black dots or necrotic areas, epidermal detachment, necrotic borders and erosion were highly associated with SCARDs (P < 0.001). CONCLUSIONS: Dermoscopy improves clinical recognition of SCARDs.