Stanislav Philipov

Relapsing advanced metatypical basal cell carcinomas (MTBCC) of the face: Surgical modalities

SummaryMetatypical basal cell carcinoma (MTBCC) represents a high-risk type of cutaneous tumour. We report about three different patients with relapsing advanced large MTBCC: one of the scalp and two of the cheek region. Such patients required in most of the cases a complex surgical approach to achieve a stable and complete remission.In the first presented patient a combination of flaps and grafts has been performed. We describe tailored surgical approaches. By this contrivance it is possible to treat even elderly patients with exposed bone after complete excision effectively and safe. Interdisciplinary team work is for the benefit of these patients.ZusammenfassungDas metatypische Basalzellkarzinom (MTBCC) stellt einen Hochrisikotyp der Hauttumoren dar. Wir berichten über drei unterschiedliche Patienten mit rezidivierenden, fortgeschrittenen großen MTBCC: ein Tumor am Kapillitium und zwei an der Wange. Diese Patienten benötigen in der Regel ein komplexes chirurgisches Herangehen, um eine stabile und komplette Remission zu erreichen. Wir stellen individualisierte chirurgische Verfahren vor, die herangezogen werden können. Auf diese Weise wird es möglich, auch für ältere Patienten mit exponierten Knochen nach R0-Resektion eine wirksame und sichere Therapie zu ermöglichen. Eine interdisziplinäre Zusammenarbeit dient dem Wohl der Patienten.

Antioxidant response and biocompatibility of curcumin-loaded triblock copolymeric micelles

Abstract To evaluate the safety profile of cationic micelles, based on triblock copolymer poly(dimethylaminoethyl methacrylate)–poly(e-caprolactone)–poly(dimethylaminoethyl methacrylate) (PDMAEMA9– PCL70–PDMAEMA9), the effects of empty (PM) and curcumin loaded micelles (PM-Curc) on nonenzyme induced lipid peroxidation (LPO) in vitro, hemolytic activity and morphological changes in some organs after repeated intraperitoneal administration in vivo were studied. To induce LPO, rat liver microsomes were incubated with a solution of iron sulfate and ascorbinic acid (Fe2+/AA). The effect of empty PM (40 and 100 μg/ml), PM-Curc and free curcumin (both at 3.48 and 8.7 μg curcumin/ml) was assessed at 20 min incubation time. In the non-enzyme induced LPO model, the investigated substances at all concentrations significantly decreased the formation of malondialdehyde (MDA), compared to the Fe2+/AA induced LPO group. According to the results it can be concluded that curcumin alone and loaded in PM, exert significant antioxidant activity. In the biocompatibility safety studies, the mean hemolytic index for polymeric carrier was less than 2%, indicating it was non-hemolytic. The general appearance of the organ tissues from Wistar rats, treated in vivo with curcumin loaded PM was similar to that of controls, thus showing no apparent toxicity after repeated 14-days treatment.

Subungual Squamous Cell Carcinoma Associated with Long Standing Onychomycosis: Aggressive Surgical Approach with a Favourable Outcome

BACKGROUND Tumours of the nail bed are rare. Squamous cell carcinoma is the most frequent among them. Chronic infection, chemical or physical trauma/microtrauma, genetic disorders such as congenital ectodermal dysplasia, radiation, tar, arsenic or exposure to minerals, sun exposure, immunosuppression, and previous HPV infection have all been discussed as etiologic factors. The diagnosis is often delayed because of the variety of clinical manifestations, often resembling benign or common infectious processes. Rapidly growing ulcerative lesions should also be considered as potential malignancy. Furthermore, a lack of antifungal or antibacterial treatment response is the most indicative symptom, always requiring subungual biopsy. Early diagnosis is of great importance for therapeutic effectiveness. CASE PRESENTATION We present a case of subungual squamous cell carcinoma, associated with long-lasting onychomycosis in a 76-year-old female patient, treated with amputation of the distal phalanx and the distal part of the proximal phalanx. CONCLUSION Although there are no available data in the literature to confirm or reject the contribution of the chronic nail infection to the malignant process, we emphasise the importance of this co-existence regarding the possible disguising of the malignant process. An early biopsy of a chronic persistent nail lesion may be preventive and beneficial regarding avoiding more aggressive treatments and achieving a favourable prognosis.

Efficient tissue ablation using a laser tunable in the water absorption band at 3 microns with little collateral damage

Lasers can significantly advance medical diagnostics and treatment. At high power, they are typically used as cutting tools during surgery. For lasers that are used as knifes, radiation wavelengths in the far ultraviolet and in the near infrared spectral regions are favored because tissue has high contents of collagen and water. Collagen has an absorption peak around 190 nm, while water is in the near infrared around 3,000 nm. Changing the wavelength across the absorption peak will result in significant differences in laser tissue interactions. Tunable lasers in the infrared that could optimize the laser tissue interaction for ablation and/or coagulation are not available until now besides the Free Electron Laser (FEL). Here we demonstrate efficient tissue ablation using a table-top mid-IR laser tunable between 3,000 to 3,500 nm. A detailed study of the ablation has been conducted in different tissues. Little collateral thermal damage has been found at a distance above 10-20 microns from the ablated surface. Furthermore, little mechanical damage could be seen in conventional histology and by examination of birefringent activity of the samples using a pair of cross polarizing filters.

A Patient with Multiple Keratinocytic Cancers (MKC): Uncommon Presentation in a Bulgarian Patient

Keratinocyte skin cancers, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common cancer occurring in people with fair skin, worldwide. Despite all known triggers, several suggested contributors are still investigated. We will focus our attention on the personal history of previous cancers and radiation exposure as occupational risk factors, as in the presented case. We report a patient, with multiple BCCs, and subsequent occurrence of a SCC on photo-exposed area of the face, as we want to emphasize the importance of strict following up of these patients, regarding the risk for developing new tumors in short periods of time, no matter if the triggering exposure factor is known from the history, or not. Although keratinocytes tumours are associated with the low mortality rate, we focus the attention on the fact, that the history of non-melanoma skin cancer is associated with increased mortality.

Melanoma in situ (MIS) in a patient with atypical mole syndrome (AMS): with aggressiveness to success?

Dear editors, Malignant melanoma is an extremely aggressive tumor, which is responsible for approximately 80% of the mortality caused by cutaneous tumors in general [1]. The lowest invasive variant of melanoma is the socalled melanoma in situ (MIS), accounting for approximately 27% of all melanomas [2]. This noninvasive lesion is in fact a precursor to invasive disease, which highlights the obligation for their careful and regular follow-up [2]. We present a case of a 52-year-old white male patient, presenting to the dermatologic unit for surgical

Subungual Exostosis in a Young Soccer Player

BACKGROUND: Subungual exostosis is a relatively uncommon, benign osteocartilaginous tumor of the distal phalanx of the toes or fingers in young adults, considered as a rare variant of osteochondroma. Differential diagnoses include subungual verruca (viral wart), pyogenic granuloma, osteochondroma, amelanotic subungual melanoma and glomus tumour. Misdiagnosis and total onychodystrophy frequently occur as a result of late treatment or inadequate treatment strategy. Dermoscopy could be a useful technique, involved in the diagnostic process, although X-ray examination and histopathology are mandatory for the diagnosis. CASE REPORT: We report a rare case of subungual exostosis of the great toe associated with repeated trauma of the nail bed. The lack of radiographic and histopathological examination could lead to misdiagnosis and inadequate treatment. Although completely benign, subungual exostosis should be considered in differential diagnosis of nail bed tumors in young adults, in order to avoid associated complications and unneeded aggressive surgical interventions. CONCLUSION: Complete excision of the lesion and delicate separation from the underlying nail bed structures results in total resolve of the problem, by providing the lowest risk of recurrences.

Mid-IR Laser Tissue Ablation with Little Collateral Damage Using a Laser Tunable in the Water Absorption Peak

A comprehensive experimental study of mid-IR laser tissue ablation within the water absorption peak is presented. A novel all-solid-state table-top sub-ns mid-IR laser designed for efficient tissue ablation have been used for observation of wavelength-dependent effects on the ablation of hard and soft tissue.

Anorectal malignant melanoma in a hemorrhoidal nodule: a diagnostic and therapeutic problem

SummaryAnorectal malignant melanoma (ARMM) is an extremely rare condition, often misdiagnosed and mistreated until development of metastatic disease. Clinical presentation mimicking hemorrhoids is a well-known pitfall. We present a male patient with hemorrhoidal nodules who was referred to the policlinic of dermatology for management of anal pruritus. A dark macule was detected over one of the hemorrhoidal nodules histologically verified as melanoma. Subsequent CT and PET/CT showed lymph nodes involvement and the patient underwent wide local excision (WSE) followed by abdominoperineal resection (APR). The rarity of ARMM does not allow for establishment of a validated staging system, placebo-controlled treatment trials and management guidelines adoption. The current treatment for the condition is surgical excision, using different techniques according to the stage of the disease and depth of invasion. The prognosis and overall survival are poor, but recent genetic studies give promising results for molecular targeting. Awareness for this disease is indispensable, as early recognition could result in improved survival and quality of life.ZusammenfassungDas anorektale maligne Melanom (ARMM) ist ein sehr seltener Tumor, der häufig fehldiagnostiziert und -behandelt wird bis es zur Metastasierung kommt. Das klinische Mimikry von Hämorrhoiden ist eine solche recht gut bekannte Situation. Wir berichten über einen männlichen Patienten mit einem Hämorrhoidalknoten, der ab die Poliklinik für Dermatologie mit der Diagnose eines Pruritus ani überwiesen wurde. Bei der klinischen Untersuchung fand sich eine dunkle Makel auf einem der Hämorrhoidalknoten, der sich histologisch als Melanom herausstellte. Nachfolgende CT- und PET/CT-Diagnostik zeigte einen Lymphknotenbefall. Der Patient wurde mit einer ausgedehnten Lokalresektion und nachfolgend mit abdominoperinealer Resektion behandelt. Die Seltenheit des ARMM ist Ursache dafür, dass noch kein validiertes Staging-System, plazebo-kontrollierte Therapiestudien und Therapieleitlinien etabliert wurden. Die derzeitige Behandlung besteht in der chirurgischen Exzision – je nach Stadium der Erkrankung und Invasionstiefe des Tumor mit verschiedenen Techniken. Die Prognose ist ernst und die Gesamtüberlebensrate gering. Allerdings geben neue genetische Untersuchungen Anlass zur Hoffnung bezüglich zielgerichteter Therapieansätze. Die Kenntnis des ARMM ist unverzichtbar, denn nur eine frühzeitige Diagnosestellung kann die Überlebensrate sowie die Lebensqualität der Patienten verbessern.