In-transit metastasis of cutaneous squamous cell carcinoma: report of two cases.

Transit metastases include metastatic foci of the skin and subcutaneous tissue located between the tumor and the nearest regional lymph node. Although transit metastases have been described for malignant melanoma, some cases of transit metastases have also been reported among primary cutaneous non-melanoma cancers. Treatment of patients with in-transit squamous cell carcinoma (SCC) is a multimodal approach for advanced staging imaging and therapy, including Mohs micrographic surgery, adjuvant radiation, and possibly sentinel lymph node biopsy and immunotherapy or chemotherapy. Here we report two cases of in-transit metastasis with primary cutaneous SCC.

Isolated hair loss on the eyebrow: five cases with trichoscopic features.

Alopecia areta (AA) and trichotillomania (TTM) are common causes for hair loss on the eyebrows. Yellow dots, vellus hairs, anisotrichosis, empty follicular openings, and black dots were observed in the present study's patients with AA. Split hairs, question mark hairs, broken hairs, flame hairs, black dots, hairs with different lengths, and hemorrhagic areas were found in the patients with TTM. Trichoscopy is a very useful and helpful technic in distinguishing AA and TTM on the eyebrows.

Evaluation of the Demographic and Clinical Features of Patients With Digital Myxoid Pseudocysts and Their Response to Treatment.

BACKGROUND: Digital myxoid pseudocysts (DMPs) are the most common benign degenerative lesions of the nail unit. There is currently no consensus regarding first-line treatments for DMPs. OBJECTIVE: To evaluate demographic and clinical features and treatment methods of DMP and examine recurrence rates and factors that may affect recurrence. METHODS AND MATERIALS: All patients in the authors' clinic who were diagnosed with DMP between 2013 and 2020 were included. Treatment methods were categorized as surgical excision (SE), drainage and compression (DC), simple drainage (SD), and no treatment. Responses and recurrence rates after different treatment methods were investigated. RESULTS: Fifty-one lesions from 48 patients were included. Thirty-two lesions were treated with SE, 11 with DC, and 1 with SD, while 7 lesions were left untreated. The initial complete response rate after SE was significantly higher than that after DC. No statistically significant difference was found between the recurrence rates of the 2 treatment methods. Using intra-articular methylene blue during SE did not seem to affect recurrence rates. CONCLUSION: Drainage and compression seems to be a safe and effective first-line treatment option for DMPs located on the proximal nail fold and distal interphalangeal joint. SE is more favorable as a second-line treatment.

The role of dermoscopy in the diagnosis of subungual glomus tumors.

BACKGROUND AND OBJECTIVES: The dermoscopic features of glomus tumors have only been described in a few case reports. The aim of this research was to define the clinical and dermoscopic features of subungual glomus tumors. METHODS: Thirty-two patients with subungual glomus tumors were evaluated retrospectively. RESULTS: On the photographs, longitudinal erythronychia, longitudinal leukonychia, punctate leukonychia, splinter hemorrhage, isolated capillaries, distal notching, distal subungual hyperkeratosis, onycholysis, and onychoschizia were found. There was no statistical difference between the rates of detection of these findings by evaluation from clinical photographs alone and from both clinical and dermoscopic photographs. While ramified vessels with bluish spots could be detected in only five of 26 cases with bluish spots in their clinical photographs, these ramified vessels were seen in 14 cases in bluish spots in dermoscopic photographs (P = 0.004). Compared to clinical examination, dermoscopy was able to detect blue spots in three more cases. Lesion duration was higher in the cases with ramified vessels (P = 0.018). CONCLUSIONS: Dermoscopy seems to contribute to the clinical examination in displaying only ramified vessels located in bluish spots and in determining the localization of the subungual tumors. The presence of ramified vessel in the bluish spots is strongly related to lesion duration.

Histopathological changes of parotid and larynx in hypothyroid rats: experimental study.

OBJECTIVES: In this study, we aimed to investigate the laryngeal and parotid histopathological alterations in rats with experimentally induced postnatal hypothyroidism. MATERIALS AND METHODS: 200-300 g weighed Wistar albino rats were included in this study. The rats were randomly divided into four groups: group 1 is control and the other groups are experimental groups. Food and water were supplied ad libitum in group 1, no medication was administered. Propylthiouracil (PTU) was administered intraperitoneally for 15 days in group 2; for 30 days in group 3, for 45 days in group 4. The larynx and parotid glands of the rats were removed and intracardiac blood samples were collected for thyroid-stimulating hormone (TSH) analysis under anesthesia (ketamine hydrochloride, 100 mg/kg) 24 h after the last PTU injection. The same procedures were done for the control group at day 46. Histopathological evaluation was done for all the specimens. RESULTS: While submucosal vascular dilatation was significantly higher in the experiment groups (p < 0.05), there was not a significant difference in lamina propria edema, inflammation, goblet cell loss, cilia loss between the groups in larynx specimens. In parotid gland specimens, serous asinus atrophy, stromal connective tissue increase were significantly higher in experiment groups (p < 0.05). In addition, there was a significant difference in nuclear morphology between control and experimental groups (p < 0.05). CONCLUSION: The results of the study showed that hypothyroidism may have effect on inflammatory procedure by causing vascular dilation in larynx and serous asinus atrophy nucleus changes, connective tissue increase in stroma in parotid gland.

Integrated Cadaveric Nail Surgery Course Improves Self-Assessed Knowledge and Competency of Dermatologists.

INTRODUCTION: Dermatologists see many patients with nail disorders requiring surgical interventions. However, nail surgery is often found to be difficult by dermatologists. The aim of this study was to evaluate the effectiveness of an integrated nail surgery course. METHODS: A nail surgery course model, combining anatomy, pathology, and dermatology with theoretical lectures and hands-on training on fresh-frozen cadaver, was designed for dermatologists. Before and after the course, the participants were asked to complete a questionnaire in which they assessed their knowledge and competence levels. RESULTS: Twenty-eight dermatologists completed the questionnaires. The majority of the dermatologists (79.6%) had limited nail surgery experience, previously. The most commonly cited reasons for lack of knowledge or low or moderate theoretical and/or practical level of knowledge of nail surgery were not having received theoretical and practical education during dermatology residency. The median scores of self-assessed knowledge and competency improved significantly after the course (p < 0.001). The majority (82.1%) of the participants were "quite" or "very" well satisfied. CONCLUSION: An integrative nail surgery course model seems beneficial and encouraging for dermatologists. Organizing this type of nail surgery course, especially in medical schools using fresh-frozen cadavers, may significantly improve dermatologists' knowledge and skills.

The effects of 4-aminopyridine and methylprednisolone on recovery of the facial nerve crush injury.

OBJECTIVE: 4-Aminopyridine (4-AP) is a potassium channel blocker that enhances nerve excitability. In this study, rat models that have facial nerve crush injury (FNCI) were grouped and treated with methylprednisolone (MP), 4-AP, and a combination of these two drugs. Electrophysiologic and histopathologic outcomes of these groups will be compared with a control group. MATERIALS AND METHODS: Thirty healthy male Wistar rats (mean weight of 265 g) were used in this study. The rats were randomly divided into five groups with six subjects in each: Group 1 (sham group), Group 2 (control group), Group 3 (MP group), Group 4 (4-aminopyridine group), and Group 5 (4-AP + MP group). All groups except the sham group underwent crush injury to the right facial nerve. Electrophysiologic and histologic recovery was recorded three weeks postoperatively. RESULTS: The 4-AP group and the combined group had a more significant recovery at Nerve Excitability Thresholds (NET) at the end of three weeks. The methylprednisolone group and the control group had a minimal recovery of NET. Histologically, when compared with the control group, the combined group was the only group that had significant recovery at all three of axonal degeneration, axon diameter, and myelin thickness. CONCLUSION: In this experimental study, we demonstrated that a combination treatment of 4-AP and MP is more effective in the recovery of peripheric FNCI than in the no-treatment control group and in the 4-AP- or MP-alone groups. Moreover, our results suggested that 4-AP can be a potent alternative to MP in the treatment of the FNCI. LEVEL OF EVIDENCE: N/A.

A case of adult-onset longitudinal melanonychia due to nail matrix compound nevus.

A case of adult-onset longitudinal melanonychia caused by a compound nevus is described. Longitudinal melanonychias are mainly caused by melanocytic activation (hypermelanosis), lentigo (benign melanocytic hyperplasia), nevus, and melanoma. Nevi are more commonly seen in children than adults; however, melanocytic activation, atypical melanocytic proliferation, and melanoma are more frequent in adults. The majority of nail matrix nevi causing longitudinal melanonychia first appear in childhood and are junctional. Rarely, compound nevi are reported to cause longitudinal melanonychia in childhood.

A Controlled Study to Examine the Effect of Topical Sucralfate on Radiofrequency-induced Burn Wounds in Rats

Several preclinical studies have shown topical sucralfate facilitates wound repair. PURPOSE: This study aimed to evaluate the effect of 10% topical sucralfate on healing radiofrequency-induced burn wounds in rats. METHODS: Twenty (20) male rats were divided into 2 equal groups. Using radiofrequency, 4 full-thickness, 1 cm in diameter round burns were created on the backs of the rats that then were randomized to receive twice-daily treatment for 30 days with 10% sucralfate or neutral cream. Biopsies were taken on days 4, 7, 14, and 21 to analyze fibrin-leukocyte crut, edema density, epidermal-dermal cell infiltration, amount of fibroblast and collagen fibers, amount of elastic fibers, neovascularization-angiogenesis, and reepithelialization-granulation tissue. Data were collected to a spreadsheet and entered into statistical software for analysis. Histopathological features were classified as categorical variables and compared using the χ2 test and Fisher's exact test. When χ2 was used, Yates' correction for continuity was performed. All reported P values were 2-tailed; P less than .05 was considered statistically significant. RESULTS: On day 4, improvement in edema density (P = .034), epidermal detachment (P = .020), epidermal-dermal cell infiltration (P = .007), and polymorphonuclear leukocyte infiltration (P = .021) were statistically more significant in the sucralfate than control group. On day 7, epidermal-dermal cell infiltration (P = .007) and elastic fibers P = .050) were statistically more significant in the sucralfate group. On day 14, angiogenesis (P = .029), reepithelialization (P = .035), and granulation tissue (P = .003) were statistically more significant in the sucralfate group. By the end of the study (day 30), angiogenesis (P = .010), reepithelialization (P <.001), fibroblast density (P = .016), granulation tissue (P = .035), and collagen density (P = .002) were significantly improved in the sucralfate group versus the control group. CONCLUSION: In a rat wound model, 10% topical sucralfate was found to histopathologically facilitate the healing process compared to the control group. Controlled clinical studies are needed to elucidate the effect of this treatment in human wounds.

Telangiectatic Carcinoma - Like Lymphangioma Circumscriptum. A Rare Form of Cutaneous Metastasis of Breast Carcinoma: Case Report.

INTRODUCTION: The Breast cancer is the most common malignancy in middle-aged women and that causes skin metastasis. Skin metastasis in internal cancer cases is a very rare condition and may be difficult to diagnose and have poor prognostic marker. Cutaneous metastasis of breast carcinoma is mostly seen as direct invasion and/or local infiltration. However, in addition to the well-known types, cutaneous metastases may mimic many benign skin lesions and therefore may be difficult to diagnose. CASE REPORT: In this article we present a 36-year-old woman with telangiectatic carcinoma-like lymphangioma circumscriptum, a rare form of cutaneous metastasis skin metastases. It can be the first sign of internal malignancies, so early diagnosis is very important at this stage. CONCLUSION: Therefore, solitary lesions or benign dermatoses seen in the skin and not associated with specific disease should be considered as tumor metastasis especially in female patients with a history of breast cancer and differential diagnosis must be made.

A new immunohistochemical marker, insulinoma-associated protein 1 (INSM1), for Merkel cell carcinoma: Evaluation of 24 cases.

Merkel cell carcinoma (MCC) is an uncommon primary neuroendocrine carcinoma of the skin. Nowadays, pathologists are required to perform immunohistochemistry to demonstrate neuroendocrine and epithelial differentiation for diagnosis of MCC. Insulinoma-associated protein 1 (INSM1) is a zinc-finger transcription factor expressed in tissues undergoing terminal neuroendocrine differentiation, and INSM1 immunohistochemistry is a well-validated nuclear marker of neuroendocrine differentiation. We evaluated 24 cases of MCC for the expression of INSM1 and compared it with frequently used neuroendocrine markers, Chromogranin A, Synaptophysin, and CD56. INSM1 was positive in all cases, and its expression was stronger, more extensive, clean and homogeneous compared to other markers. As a consequence, INSM1 can be used to serve as a solitary marker for neuroendocrine differentiation due to high sensitivity and specificity in MCC cases.

An Uncommon Coexistence of Sarcoidosis and Cutaneous Leukocytoclastic Vasculitis in an Adult.

The skin is the second most commonly involved organ after pulmonary system in sarcoidosis, a multisystemic granulomatous disease. Cutaneous small-vessel vasculitis (leukocytoclastic vasculitis [LCV]) is a disorder characterized by neutrophilic inflammation of small blood vessels. Although the skin is the organ where LCV is seen most frequently, extracutaneous involvements are also seen. Herein, we present a coexistence of sarcoidosis and cutaneous LCV, which is an uncommon condition in adult.

Progesterone receptor expression in fibromuscular dysplasia: A report of two unusual cases.

Fibromuscular dysplasia is rarely biopsied. Progesterone receptor expression in myofibroblastic cells is useful for the histopathological evaluation in difficult-to-diagnose cases. Herein, we report two unusual cases of fibromuscular dysplasia in which progesterone receptor expression was shown in vessel sections.

Melanocytic Lesions of the Nail Unit.

Melanocytic lesions of the nail unit are traditionally classified as follows: melanocytic activation, lentigo, nevi, and melanoma. Undoubtedly, melanoma is the most important malignant tumor of the nail unit. Differentiating nail unit melanoma from other melanocytic lesions is often difficult both clinically and histopathologically. This article will first describe the histology of the nail unit, followed by a brief summary of clinical and histopathological features as well as differential diagnosis of melanocytic lesions of the nail unit.

Early effects of irradiation on laryngeal mucosa in a gastroesophageal reflux model: an experimental study.

OBJECTIVE: The aim of this study was to evaluate the early histopathological changes of gastroesophageal reflux and irradiation on laryngeal mucosa in rats. STUDY DESIGN: Animal study. SETTING: Experimental animal laboratory, tertiary referral center. SUBJECT AND METHOD: Twenty-four adult female Wistar Albino rats were grouped as: control (n = 6), reflux and irradiation (n = 10), and irradiation (n = 8). Rats were operated to create a reflux model 30 days before irradiation. Ionizing radiation was administered in a single fraction of a 20 Gy to the larynx. Laryngeal tissue samples were taken at the 4th day of irradiation and all specimens underwent histopathological examination. RESULTS: Edema and vascular dilation in lamina propria were higher in the reflux and irradiation, and irradiation groups than control group. Inflammation was higher in the reflux and irradiation group than the control group. Inflammation in squamous epithelium was higher in the reflux and irradiation and irradiation groups compared to the control group. Inflammation in the squamous epithelium of the irradiation group was higher than the reflux and irradiation group. In the respiratory tract epithelium, inflammation was higher in the reflux and irradiation group; additionally, a significant loss of cilia was present in the reflux and irradiation and irradiation groups while pseudostratification was higher in the reflux and irradiation group. CONCLUSION: Ionizing radiation-induced inflammation may increase on previously inflammated area due to gastroesophageal reflux. Therefore, it may be helpful to investigate and treat the reflux in laryngeal cancer patients that will receive ionizing radiation.

A Rare Syndrome Resembling Scleroderma: Huriez Syndrome.

Huriez syndrome, also referred to as "sclerotylosis," is a rare autosomal dominant genodermatosis characterized by the triad of congenital scleroatrophy of the distal extremities, palmoplantar keratoderma, and hypoplastic nails. The development of aggressive squamous cell carcinoma (SCC) arising in the scleroatrophic area is also a distinctive feature of the syndrome. Early diagnosis is important due to the early onset, mostly in the third to fourth decades of life, and aggressive progress of SCC, which occurs in around 15% of affected individuals. Our patient had palmoplantar keratoderma, scleroatrophy of the hands, and hypoplastic nails. Her mother and father had a second-degree blood relation. Two of her siblings had similar complaints and findings. She showed no sign of actinic keratosis or SCC, and was called for regular follow-ups. With this case, we want to emphasize that Huriez syndrome is a rare genodermatosis, mimicking scleroderma-like acrosclerosis, and early diagnosis is critical for recognizing and preventing the development of SCC.