High-throughput screening and clinical importance of autophagy-associated genes in basal cell carcinoma.

Autophagy is a type II programmed cell death mechanism that plays a critical role in preserving cellular homeostasis through the regulation of protein, lipid, and organelle quality control. It has become gradually evident that autophagy plays a fundamental role in the initiation and progression of various types of human cancers. Nevertheless, its significance in non-melanoma skin cancers, particularly in basal cell carcinoma, has not been well documented and remains largely elusive. In this study, we aimed to illuminate the role of autophagy-associated signaling signatures during development and progression of basal cell carcinoma. For the study, a total of 72 autophagy-related genes were screened using a high-throughput qPCR approach integrating Fluidigm 96.96 Dynamic Array™ integrated fluidic circuits (IFC) and BioMark™ HD Real-Time PCR system, which enabled efficient and precise analysis of gene expression patterns. Results were analyzed using Fluidigm's Real-Time PCR Analysis software and 2-ΔΔCt formula was used for the calculation of expression changes. Notably, expression levels of INS, TMEM74 and IFNA2 genes were identified to be prominently altered in BCC comparted to adjacent healthy tissues. However, only IFNA2 expression showed statistically significant change in BCC. Consequently, these findings suggest that IFNA2 might play significant role in the regulation of autophagy in BCC development and progression and can be therapeutically targeted.

A New Surgical Technique for Closure of Pilonidal Sinus Defects: Triangular Closure Technique.

BACKGROUND We present a clinical experience with a new local flap procedure, namely the triangular closure technique, for reconstruction of sacrococcygeal skin defects resulting from excision of the pilonidal sinus. MATERIAL AND METHODS In this technique, the defect is surgically converted to a triangle in shape. Then, the triangular defect is closed by transposition of 2 skin flaps designed in an unequal z-plasty manner. Over 6 years, this technique has been used for closure of defects of chronic pilonidal sinus disease in 27 patients (6 females, 21 males). The size of the defect ranged between 3.5 cm and 12 cm in dimension. RESULTS A tension-free defect closure was obtained in all patients. All flaps except one healed with no complications. A mean follow-up of 3.62±1.77 months revealed aesthetically and functionally acceptable results with the obliteration of the natal cleft in all patients. No recurrence was observed in the follow-up period. CONCLUSIONS The triangular closure technique was found to be a useful technique for the treatment of pilonidal sinus with favorable results regarding the time before return to work.

Is hemoglobin A1c level effective in predicting the prognosis of Fournier gangrene?

OBJECTIVES: To evaluate the effect of immune failure and/or diabetes mellitus (DM) association on the mortality and morbidity of the Fournier's Gangrene (FG), and interrelatedly, the usability of HbA1c level in the prediction of prognosis. MATERIALS AND METHODS: The data of 38 patients with the diagnosis of FG were investigated retrospectively. The patients were divided into two groups as patients with DM (Group 1, n = 18) and non-diabetics (Group 2, n = 20). The patients in group 1 were also divided into two subgroups as patients with HbA1c value ≥7 (Group 1a) and HbA1c value <7 (Group 1b). RESULTS: The mean age of all 38 male patients was 66.3 ± 6.4 years. The initial symptoms were scrotal rash and swelling (n = 20, 52.6%), high fever (>38°C) (n = 22, 57.8%), purulent discharge from genital or perineal areas (n = 13, 34.2%), skin bruises (n = 11, 28.9%) and general state disorder in five patients that were admitted from day care center (13.1%). DM, as the most often comorbid disease, was detected in 18 patients (47.3%). Six patients (15.7%) were deceased during the follow-up period. CONCLUSION: In the present study, the researchers determined that diabetic patients with HbA1c level of 7 or higher had worse prognosis, and increased mortality.

The expression levels of the sirtuins in patients with BCC.

Basal cell carcinoma (BCC) is the most common tumor in humans. Reduced expression of sirtuins interferes with DNA repair, which may cause mutations and genomic instability, and eventually leads to tumor development. In the present study, we investigate the expression levels of SIRT genes in non-tumoral and tumor tissues of patients with BCC. A total of 27 patients (16 males, 11 females) with BCC were included in the study; the mean age was 65.40 ± 10.74 years and mean follow-up was 2.5 ± 0.5 years. There were multiple synchronous lesions in six patients, and the remaining 21 patients had a single lesion. Tumor and non-tumoral tissue samples were collected from all patients, and mRNA expression levels of SIRT1-7 (Sirt1.1, Sirt1.2, Sirt2, Sirt3, Sirt4, Sirt5, Sirt6, and Sirt7) were examined by real-time PCR. The results showed that expressions of SIRT1.1, SIRT1.2, SIRT4, SIRT5, SIRT6, and SIRT7 mRNAs were unchanged in tumor tissues of BCC patients compared with non-tumoral tissue samples. Importantly, the expressions of SIRT2 and SIRT3 mRNAs were significantly reduced in tumor tissue samples from BCC patients compared with non-tumoral tissues (P = 0.02 and P = 0.03, respectively). In light of the previous reports that have demonstrated a link between SIRT proteins and cancer, our findings suggest that SIRT2 and SIRT3 may plan important roles in BCC pathogenesis and could be candidate prognostic biomarkers for BCC.

Is it really necessary to make wide excisions for basal cell carcinoma treatment?

Basal cell carcinoma (BCC) is the common malignancy at the skin arising from the cells of the basal layer of the epithelium or from the external root sheath of the hair follicle. It usually occurs at sites with the greatest concentration of pilosebaceous follicles, and it is directly related to sun exposure. Metastasis is rare, but it recurs if it is inadequately treated. For preventive recurrence, BCC is often excised with wide skin margins. It leads to sacrifice of healthy tissue and causes morbidity problems. In our study, we make a treatment plan of excising the primary BCC with its natural tumor margin. Incomplete excision rates were compared between the patient group in which the excisions were performed according to the previously mentioned literature knowledge and the patient group in which excisions were made along the visible outer margins of erythema or induration area surrounding the tumor. In conclusion, there was no statistically significant difference between these 2 groups. This treatment modality is suitable for the excision of BCC, and it eliminates the need for the sacrifice of healthy tissue. This technique also offers the successful functional and aesthetic outcome.Therefore, unnecessary tissue sacrifice can be prevented with this method of treatment. We think our method is the new horizon to ongoing debate of safe excision concept of BCC.

Z plasty closure of lower lip defects after tumor excision.

Reconstruction of the defects of the lower lip should provide a sensate, functional, and aesthetic lip structure. Defects of the lower lip, up to 30% of the total width, can be closed primarily, which gives a better result than any known flap operation unless the contracture of the linear scar tissue distorts the anatomic landmarks. Taking this possibility into consideration and to prevent scar contracture, we have performed Z plasty to the skin component while closing the resultant central defects of the lower lip after tumor excision. This modification improved our cosmetic results.

Two extreme conditions of xeroderma pigmentosum.

Two atypical cases of xeroderma pigmentosum are reported. One of these cases with lung metastasis of squamous cell carcinoma in the first decade of life and the other with late onset disease (XP) in fifth decade of life. Lung metastasis of squamous cell carcinoma in first decade of life in patients with xeroderma pigmentosum has never been reported in the literature to our knowledge. Late onset of the disease in fifth decade is also a rare condition. Clinicians should be more alert for the internal organ metastases to improve the survival of the patients and should never forget that xeroderma pigmentosum has got a wide range of clinical presentation.