Federica Veronese

Basal cell carcinoma of the head region: therapeutical results of 350 lesions treated with Mohs micrographic surgery

Background  Basal cell carcinoma (BCC) is a non‐melanocytic skin tumour with a high risk of recurrence after incomplete treatment, especially the aggressive subtypes (basosquamous, micronodular and morphea BCC). The percentage of recurrence also depends on the anatomical site of the tumour. Nose–cheek fold, paranasal fold, retroauricular fold and internal canthus are considered to be critical sites.

Wide local excision vs. Mohs Tübingen technique in the treatment of dermatofibrosarcoma protuberans: a two‐centre retrospective study and literature review

Dermatofibrosarcoma protuberans (DFSP) is a rare, low‐grade mesenchymal skin tumour, characterized by slow infiltrative growth and common local recurrence, with infrequent distant metastases.

An unusual cutaneous infection caused by Mycobacterium marinum

Introduction. Mycobacterium marinum is a non-tubercular mycobacterium residing in fresh or salt water (in tropical or temperate areas); it is a fish and human pathogen, and in immunocompromised patients can cause severe cutaneous and subcutaneous infections. Case presentation. A 46-year-old white man who underwent immunosuppressive therapy was admitted to our department in May 2016 for skin lesions previously diagnosed as ‘unusual erysipelas’. We rejected the hypothesis of erysipelas, due to the clinical features, and our diagnostic hypotheses were oriented towards sporotrichosis, atypical mycobacteriosis, cutaneous tuberculosis and cutaneous sarcoidosis. Histological examination performed after a skin biopsy was compatible with a diagnosis of sporotrichosis. However, PCR performed on fresh tissue demonstrated the presence of M. marinum. Conclusion. The case reported is interesting for the unusual clinical localization and modality of infection. The patient became infected by contact with contaminated remains or in the sea, in a geographical area not endemic for M. marinum. The previous state of immunosuppression favoured infection; however, the presence of M. marinum in this area suggests a possible tropicalization of the water of the Mediterranean Sea. To our knowledge, this case is the only one reported in the literature with this modality of infection and in that geographical area.

Anti-oxidative effects of 17 β-estradiol and genistein in human skin fibroblasts and keratinocytes

BACKGROUND Estrogens and phytoestrogens can hinder the aging process through mechanisms related to estrogen receptors (ERs), guanine nucleotide-binding protein-coupled receptor (GPER30), mitochondria function and nitric oxide (NO) release. Up to date, however, the above issues are a matter of debate. OBJECTIVE To examine the effects elicited by 17 β-estradiol and genistein against peroxidation in human keratinocytes/fibroblasts and evaluate the role played by ERs, GPER30, mitochondria and NO. METHODS Human fibroblasts/keratinocytes, either subjected to peroxidation or not, were exposed to 17 β-estradiol/genistein in the absence or presence of the NO synthase (NOS) inhibitor, the ERs and GPER30 blockers, fulvestrant and G15, the phosphatidyl-inositol-3-kinase (PI3K-Akt), the p38 mitogen-activated protein (MAP) kinase and the extracellular signal-regulated kinases (ERK) 1/2 inhibitors. Specific kits were used for cell viability, NO, ROS and glutathione (GSH) detection and mitochondrial membrane potential measurement. Western Blot analysis was performed for kinases expression/activation detection. RESULTS In physiological and peroxidative conditions, 17 β-estradiol/genistein respectively increased and reduced NO release by fibroblasts/keratinocytes. Moreover, both agents prevented the ROS release and the fall of cell viability and mitochondrial membrane potential, while increasing GSH levels and the proliferation rate. Fulvestrant and G15 counteracted all above responses. Also, the NOS, and the kinases blockers reduced the protection exerted by 17 β-estradiol/genistein on cell viability/mitochondria function. The involvement of PI3K-Akt and p38-MAPK was confirmed by Western blot. CONCLUSION 17 β-estradiol/genistein protected fibroblasts/keratinocytes against peroxidation by modulating oxidant/antioxidant system and mitochondria membrane potential, through mechanisms related to ERs and GPER30 and kinases activation.

A female newborn with papulovesicular lesions

A female newborn of Pakistani origin presented at birth with papulovesicular lesions with a surrounding erythematous base on the trunk and all four limbs. The baby was born at term after an uneventful pregnancy and vaginal delivery. She had a weight of 3,400 grams and an APGAR score of 9 at the 1 st and 5 th minute. Her parents were not blood-related. The mother was 26 years of age, healthy and without a history of abortion; her three-year-old fi rstborn female was in good health. A female newborn with papulovesicular lesions Case for Diagnosis

Deep penetrating nevus of the plantar surface: report of a case with dermatoscopic features

We report the case of a 56-year-old Italian woman who was referred to our department with a solitary and symmetrical blue maculopapular lesion, 5 mm in diameter, located on the plantar surface of the left foot (Figure 1 a). The patient reported that the lesion had appeared three months earlier and had, since then, not shown any apparent change or growth. Dermatoscopy of the lesion showed a homogenous, brown-blue pattern with a distinctly hypopigmented area at the center, surrounded by a peripheral light brown halo (Figure 1 b). Since on the basis of both clinical and dermatoscopic features, malignant melanoma could not be completely excluded, the lesion was excised. Histology revealed a symmetrical and circumscribed dermal proliferation of typical nevus cells. These were arranged in loose fascicles, interspersed with melanophages, and showed a wedge-shaped growth pattern: the base towards the epidermis and the tip towards the reticular dermis and subcutis. There was a subtle junctional component, as evidenced by nests of typical melanocytes. The lesion was highly cellular and made up of predominantly round cells; mitoses and cellular atypia were absent (Figure 1 c). Based in these fi ndings, a diagnosis of deep penetrating nevus (DPN) was made. The patient did not require any further treatments, and – after four years – she remains otherwise healthy. DPN is a rare, benign melanocytic tumor fi rst described by Seab et al. in 1989 [ 1 ] . The most frequent clinical presentation is that of a deeply pigmented (brown to black) papule, less than 1 cm in diameter, primarily located on the face, neck, trunk, and proximal extremities. Deep penetrating nevus usually affects young adults, especially women under the age of 50 [ 2 ] . Although more than 300 cases of DPN have been published so far, none of the lesions was located on the palms or soles [ 1, 2 ] . Histopathological evaluation is essential for the correct diagnosis, particularly with regard to differentiation from malignant melanoma, but also from other melanocytic lesions. There is still controversy as to whether DPN represents a distinct clinical entity or simply a variant of blue nevus; in addition, DPN has also frequently been found in association with other nevi, thus forming a combined nevus. With respect to this issue, Barnhill et al. recently published a consensus paper on benign melanocytic lesions. Here, they concluded that, unless DPN shared histological features with other nevi, it could be regarded as a distinct entity in most cases [ 3 ] . Histopathologically, DPN is a wedge-shaped deeply pigmented dermal and, rarely, subcutaneous lesion, with its base parallel to the epidermis and a subtle junctional component consisting of small round nests of typical melanocytes. In particular, unlike blue nevi [ 4 ] , nevus cells may have a round contour, and are interspersed with scarce melanophages; moreover, compared to other benign melanocytic lesions, nevus cellularity is usually high in DPN. At higher magnifi cation, nevus cells show pleomorphic nuclei with nuclear pseudoinclusions; mitotic activity is low or absent. Lesional cell nests tend to surround adnexal structures. When present, the infl ammatory infi ltrate is primarily composed of lymphoid elements [ 1, 5, 6 ] . Unlike DPN, malignant melanoma is characterized by an asymmetrical and poorly circumscribed proliferation of atypical melanocytes with destructive growth in the dermis, frequent infi ltration into the subcutis, and more pronounced cytologic atypia with frequent mitoses.One case of a malignant variant of DPN with lymph node metastasis was reported by Graham in 1996; in that case, however, there was no unequivocal differentiation from melanoma [ 7 ] .

Tief penetrierender Nävus an der Fußsohle: Fallbericht und dermatoskopische Merkmale.

Literatur 1 Riddel C, Rashid R, Thomas V. Ungual and periungual human papillomavirus-associated squamous cell carcinoma: a review. J Am Acad Dermatol 2011; 64: 1147–53. 2 Delaporte E, N’guyen-Mailfer C, Janin A et al. Keratoderma with scleroatrophy of the extremities or sclerotylosis (Huriez syndrome): a reappraisal. Br J Dermatol 1995; 133: 409–16. 3 Schiller S, Seebode C, Hennies HC et al. Palmoplantar keratoderma (PPK): acquired and genetic causes of a not so rare disease. J Dtsch Dermatol Ges 2014; 12: 781–8. 4 Stevens HP, Kelsell DP, Bryant SP et al. Linkage of an American pedigree with palmoplantar keratoderma and malignancy (palmoplantar ectodermal dysplasia type III) to 17q24: literature survey and proposed updated classification of the keratodermas. Arch Dermatol 1996; 132: 640–51. 5 Tourlaki A, Bentivogli M, Boneschi V, Brambilla L. Genetically proven Mal de Meleda complicated by Bowen’s disease of the sole. Eur J Dermatol 2011; 21: 292–4. 6 Yoshizaki Y, Kanki H, Ueda T et al. A further case of plantar squamous cell carcinoma arising in Olmsted syndrome. Br J Dermatol 2001; 145: 685–6. 7 Rogoziński TT, Schwartz RA, Towpik E. Verrucous carcinoma in Unna-Thost hyperkeratosis of the palms and soles. J Am Acad Dermatol 1994; 31: 1061–2. 8 Affleck AG, Leach IH, Littlewood SM. Carcinoma cuniculatum arising in focal plantar keratoderma. Dermatol Surg 2007; 33: 745–8. 9 Ayman T, Yerebakan O, Yilmaz E. Mal de Meleda: a review of Turkish reports. J Dermatol 2000; 27: 664–8. 10 Wajid M, Kurban M, Shimomura Y, Christiano AM. Mutations in the SLURP-1 gene underlie Mal de Meleda in three Paskistani families. J Dermatol Sci 2009; 56: 27–32.

Inflammatory Cutaneous Diseases in Renal Transplant Recipients

Kidney transplant recipients frequently suffer from skin infections and malignancies, possibly due to the effects of long-term immunosuppressive therapy. While the relationships between immunosuppression and these pathological conditions have been widely investigated, little is known about the relative incidence and characteristics of inflammatory skin diseases in this type of patient. In this study, we analyze the incidence of a number of inflammatory cutaneous diseases in a cohort of patients who underwent kidney transplantation. Although our study shows a relatively low incidence of these pathologies in transplanted patients—in agreement with the general action of immunosuppressant therapies in reducing inflammation—we scored a different efficacy of the various immunosuppressive regimens on inflammatory and autoimmune skin diseases. This information can be key for designing immunosuppressive regimens and devising accurate follow-up protocols.