Concordance between a Mohs surgeon and a dermatopathologist in evaluating Mohs cryosections.

BACKGROUND: Mohs micrographic surgery is the gold standard treatment for high-risk non-melanoma skin cancers. The success of Mohs relies on accurate histopathologic evaluation. Due to law restrictions in some European countries, Mohs surgeons are not permitted to report on histopathology; therefore, a pathologist evaluates the frozen sections. OBJECTIVE: To retrospectively assess the concordance between the certified Mohs surgeon and the pathologist in evaluating the Mohs slides that were intraoperatively evaluated by the pathologist. MATERIALS AND METHODS: Frozen section slides of a total of 237 Mohs cases between 2013 and 2020 were examined by the blinded Mohs surgeon, and the tumours were marked on copy maps. The copy maps and the original maps were compared, and the non-concordant cases were re-evaluated together by the Mohs surgeon and the dermatopathologist. The concordance rate was calculated, and the inter-rater agreement was statistically analysed using Cohen's Kappa coefficient. RESULTS: We report a high concordance rate (97.9%) and inter-rater agreement (0.96) between Mohs surgeon and dermatopathologist in evaluating Mohs slides. CONCLUSION: As a newly settled centre, our results are in alignment with experienced centres where the Mohs surgeon evaluates the slides herself and performs the surgery.

Comparison of adrenocortical steroidogenesis in women with post-adolescent severe acne and polycystic ovary syndrome.

BACKGROUND: Increased adrenocortical production appears to be associated with acne and hirsutism in acne and polycystic ovary syndrome (PCOS). However, the aetiological role of androgens in the pathogenesis of acne per se is far from being clear. OBJECTIVE: We aimed to evaluate adrenocortical function in women with post-adolescent severe acne in comparison with patients with PCOS and healthy women. METHODS: The study included 32 women with post-adolescent severe acne, 32 women with PCOS and 32 age and body mass index (BMI)-matched healthy controls (age 17-34 years, BMI: 20.8 ± 1.9 kg/m²). Women with acne did not have hirsutism or ovulatory dysfunction whereas all PCOS patients had androgen excess and ovulatory dysfunction. Measurements included basal testosterone (T), sex hormone-binding globulin (SHBG) and dehydroepiandrosterone sulphate (DHEAS) levels and serum 17-hydroxyprogesterone (17-OHP), androstenedione (A4), DHEA and cortisol levels in response to corticotropin (ACTH) stimulation. RESULTS: T, free androgen index, DHEAS levels, basal and AUC (area under the curve) values for A4 were significantly higher in PCOS than women with acne and controls (P < 0.05 for all), whereas three groups did not differ for basal or AUC values of DHEA and cortisol. Women with PCOS and those with severe acne had significantly and similarly higher AUC values of 17-OHP compared to controls (P < 0.05). CONCLUSION: Women with isolated post-adolescent severe acne do not have increased levels of adrenal androgens basally or in response to ACTH. However, these women have similar secretion pattern of 17-OHP with PCOS patients suggesting increased enzymatic activity in this pathway.

Correlation between the dermatoscopic and histopathological features of pigmented basal cell carcinoma.

BACKGROUND: Dermatoscopy has a great value in the diagnosis of pigmented basal cell carcinoma (BCC), which is a clinical variant of BCC. The precise definitions of histopathological correlates of dermatoscopic features observed in pigmented BCC have not been established yet. OBJECTIVE: The present study aimed to investigate the correlation between the dermatoscopic features of pigmented BCC and their histopathological counterparts to provide clear histopathological definitions of each dermatoscopic feature. METHODS: In this case series that comprised a methodological component, after the orientation of dermatoscopic features was determined by placing sutures in the lesions, the histopathological counterparts of each were examined and definitions were made accordingly. RESULTS: Although the most common histopathological subtype of BCC is the solid type, the most common histopathological subtype observed in the pigmented BCC lesions in the present study was the superficial multifocal type (72.5%). Blue-whitish veil was observed in 57.5% (n=23) of the lesions, a percentage higher than that reported in the literature. In addition to confirming the previously histopathologically defined dermatoscopic features of pigmented BCC, we identified three histopathologically undefined features of pigmented BCC that are spoke-wheel areas, large blue-grey ovoid nests and multiple blue-grey globules. CONCLUSION: Dermatoscopy facilitates prediction of the corresponding histopathological findings in pigmented BCC, based on specific dermatoscopic features.