Flavia Persechino

Congenital Glioblastoma multiforme and eruptive disseminated Spitz nevi

BackgroundGlioblastoma multiforme (GBM) is the deadliest malignant primary brain tumor in adults. GBM develops primarily in the cerebral hemispheres but can develop in other parts of the central nervous system. Its congenital variant is a very rare disease with few cases described in literature.Case presentationWe describe the case of a patient with congenital GBM who developed eruptive disseminated Spitz nevi (EDSN) after chemotherapy. Few cases of EDSN have been described in literature and this rare clinical variant, which occurs predominantly in adults, is characterized by multiple Spitz nevi in the trunk, buttocks, elbows and knees. There is no satisfactory treatment for EDSN and the best therapeutic choice is considered the clinical observation of melanocytic lesions.ConclusionWe recommend a close follow-up of these patients with clinical observation, dermoscopy and reflectance confocal microscopy (RCM). However, we suggest a surgical excision of the lesions suspected of being malignant.

Dermoscopic features of squamous cell carcinoma on the lips

DEAR EDITOR, Cutaneous squamous cell carcinoma (SCC) is the second most common cutaneous malignancy after basal cell carcinoma, and typically occurs in older, fair-skinned individuals. The head and neck region is the most commonly affected area, accounting for approximately 65% of all SCCs in lighter-skinned individuals. In particular, SCC of the lip represents 20% of all oral carcinomas, with the lip being one of the most high-risk anatomical sites. Recent literature suggests that dermoscopy improves early diagnosis of skin cancer compared with the naked eye alone. However, while the dermoscopic criteria for SCC have been well described, little is currently known about dermoscopic features of lip SCC. The aim of our study is to describe the clinical and dermoscopic criteria of lip SCC. In this retrospective observational study, data on histopathologically diagnosed lip SCC were collected between 2011 and 2016. For each collected lesion, patient data, clinical images and high-resolution digital dermoscopic images were recorded. Dermoscopic images had been captured with a DermLite FOTO system (3Gen, Dana Point, CA, U.S.A.) at a magnification of 9 10. Two experienced observers (E.B. and F.P.) evaluated clinical and dermoscopic images for the presence of predefined criteria. In total 22 histopathologically confirmed lip SCCs were collected in this study. The median age of the patients was 75 years, and the majority were male (86%). Most cases of lip SCC were located on the lower lip (91%), and more than two-thirds of the tumours were flat (68%), while only one-third were exophytic (32%). Based on the clinical images, white–yellow and red colours were seen almost equally (41% and 45%, respectively), and white colour alone was found only in 14% of tumours. The colours were usually combined (95% of cases). Ulceration was present in almost all cases (91%) (Fig. 1a, b). Table 1 shows the results of the dermoscopic analysis. Regarding vascular pattern, the majority of lip SCCs presented a polymorphous pattern (68%), with nonfocused small-sized vessels located both peripherally and throughout the lesion (Fig. 1b).

Dermoscopy of syringocystadenoma papilliferum

Syringocystadenoma papilliferum is a benign adnexal neoplasm frequently seen in association with other adnexal tumours. We report the dermoscopic features of three cases of syringocystadenoma papilliferum developing in naevus sebaceus. Clinically the lesions were characterised by exophytic papillary structures. Dermoscopically, polymorphous vessels were the prevalent feature.

Seborrheic keratoses mimicking melanoma unveiled by in vivo reflectance confocal microscopy

Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non‐invasive tool, which allows an in vivo imaging of the skin. The study objectives were to evaluate the agreement between RCM classification and histological diagnoses, and the reliability of well‐known RCM criteria for SebK in the identification of SebK with atypical dermoscopy presentation.

Identifying the factors that influence surgeon's compliance with excisional margins of non-melanoma skin cancer

The rising incidence of Non Melanoma Skin Cancers (NMSC) leads to a high number of surgical procedures worldwide. The strict compliance with international guidelines with regard to excisional margins may help decrease the number of re-excision procedures and reduce the risk of NMSC recurrence. The aim of this study was to investigate the prevalence of excisional margins as recommended by the European Academy of Dermatology and Venereology (EADV) and the European Dermatology Forum (EDF) guidelines, and the factors (demographic or clinical) that influence surgeons’ compliance with these guidelines.This was a prevalence study looking at surgical excisions of NMSCs performed over a period of 2 years (2011–2012). A sample size of 1669 patients was considered. Definition of excisional margins recommended by the international guidelines (EADV and EDF) were used as point of reference for the analysis. Tumor and histologic specimen size were calculated ex vivo by 5 different pathologists. The size of skin specimens was measured with a major axis and a minor axis. The same was done for the tumor present on the skin specimens. The differences between the major and minor axes of surgical specimen and tumor were calculated. These differences were subsequently divided by two, hypothesizing that the lesion had the same distance from the margins of the surgical specimen. The differences obtained were named “Delta”, the formulas applied being the following:Delta major = (major axis specimen—major axis tumor)/2; Delta minor = (minor axis specimen—minor axis tumor)/2.Results show a significant statistical difference, associated with factors such as: age of the patient, anatomical localization of the tumor, histological diagnosis, and surgeons’ experience.The identification of these factors sheds light on clinicians’ practice and decision-making regarding excisional margins. Hopefully a higher level of adherence to the guidelines can be achieved in the future.

Treatment of chronic infected post-oncological wounds with a dermal matrix: two case studies

The reconstruction of complex wounds in patients with comorbidities in the lower extremities is a challenging problem for surgeons. Skin grafting is frequently used to cover large skin defects, but it has several limits, including unwanted outcomes resulting from scars, poor elasticity and limitations in joint movement due to contractures. Locoregional flaps, particularly in the lower limbs, have limited application due to the size of the defect. Tissue engineering of the skin has offered major improvements in the coverage of large defects. Dermal matrix can be applied in order to generate a new dermis that allows good re-epithelialisation or skin grafting at a later stage. The reconstruction of large lower limb defects is more complicated in the case of chronic wounds showing no tendency to heal due to chronic infection. For all surgeons, it is very important to prevent the formation of a biofilm or manage it when it is already established before undertaking surgical procedures that involve a dermal matrix. We report our reconstruction strategy of chronic infected neoplastic ulcers of the lower extremities with a dermal matrix and our postoperative dressing protocol.

Improving mandibular contour: A pilot study for indication of PPLA traction thread use

ABSTRACT Background: The request for less-aggressive procedures to improve mandibular contour is increasing. Several kinds of threads have been used for this purpose. Nevertheless, PLLA (poly-L-Lactic acid) traction thread procedure has not been previously described. Aim: To investigate the role of PLLA traction threads in improving mandibular contour. Methods: Twenty women were enrolled in the study. They were differentially classified for skin laxity. Patients were treated in a single session with two PLLA traction threads per side. Specific post-procedure instructions were given to patients, and complications occurred after the procedures were estimated. A Fisher’s t-test was performed to identify criteria related to longevity of results. Results: We found longevity of results to be associated with younger age (p = 0.001), absence of severe skin laxity of jawline and neck (p = 0.001), and aesthetic satisfaction (p = 0.024). Edema, swelling, and temporary skin contour irregularities were found in most cases (N = 16; 80%), whereas paresthesia resolving without sequelae in 2–4 weeks was found in two cases (10%). Conclusions: Our results show that selected patients, younger than 51 and showing a mild-moderate degree of skin laxity of jawline and neck angle represent ideal candidates for PLLA traction thread treatment. Further studies will be performed to confirm our results.

Folliculotropism in pigmented facial macules: Differential diagnosis with Reflectance confocal microscopy

Pigmented facial macules are common on sun damage skin. The diagnosis of early stage lentigo maligna (LM) and lentigo maligna melanoma (LMM) is challenging. Reflectance confocal microscopy (RCM) has been proven to increase diagnostic accuracy of facial lesions. A total of 154 pigmented facial macules, retrospectively collected, were evaluated for the presence of already‐described RCM features and new parameters depicting aspects of the follicle. Melanocytic nests, roundish pagetoid cells, follicular infiltration, bulgings from the follicles and many bright dendrites and infiltration of the hair follicle (ie, folliculotropism) were found to be indicative of LM/LMM compared to non‐melanocytic skin neoplasms (NMSNs), with an overall sensitivity of 96% and specificity of 83%. Concerning NMSNs, solar lentigo and lichen planus‐like keratosis resulted better distinguishable from LM/LMM because usually lacking malignant features and presenting characteristic diagnostic parameters, such as epidermal cobblestone pattern and polycyclic papillary contours. On the other hand, distinction of pigmented actinic keratosis (PAK) resulted more difficult, and needing evaluation of hair follicle infiltration and bulging structures, due to the frequent observation of few bright dendrites in the epidermis, but predominantly not infiltrating the hair follicle (estimated specificity for PAK 53%). A detailed evaluation of the components of the folliculotropism may help to improve the diagnostic accuracy. The classification of the type, distribution and amount of cells, and the presence of bulging around the follicles seem to represent important tools for the differentiation between PAK and LM/LMM at RCM analysis.

Reflectance confocal microscopy features of regression in congenital naevus: case report.

A 26 year old male patient, phototype II, presented with a recently change aspect of an old lesion on the upper trunk. Clinically, the lesion appeared as a papule of 0.6 cm x 0.4 cm in diameter, with unevenly distributed bluish pigmentation, and irregular borders, defined as an ugly duckling. (Fig. 1). This article is protected by copyright. All rights reserved.

Plasticity of immune system vs. memory therapy IST

BACKGROUND Pharmacotherapy and immunotherapy are the main treatments for allergic diseases to inhalants. OBJECTIVE This study investigates whether to repeat short cycles of immunotherapy after 3 or 5 years the from interruption of the first therapeutic cycle, lasting 3-4 years, to maintain immune memory in individuals subjected to IST. METHODS AND RESULTS We have compared two groups, one of 452 patients who, after the first treatment for 3-4 years of IST, performed a cycle of four months after three and 10 years from the suspension, and a second group of 126 individuals who have performed only the IST treatment for 3-4 years. The best results were obtained in the first group. CONCLUSIONS These results are due to the immune systems plasticity, a very important concept in clinical practice.