Lines under the eyes: a large prospective case series of linear basal cell carcinomas.

Basal cell carcinomas (BCC) are the most common form of cancer globally. Linear BCCs are an unusual variant which are generally defined by having a length three times longer than the width and exhibiting relatively straight edges. In this report, we describe the largest global cohort (n = 31) with this rare subtype. Within this cohort, 22 were in the periocular region, 27 underwent Mohs micrographic surgery and 12 involved oculoplastic reconstruction. These results suggest that, whilst this subtype is relatively rare, it may be more prevalent than previously thought. Dermatologists and other specialities managing skin cancer, particularly ophthalmologists, should, therefore, be aware of this subtype, as it is often more aggressive than other BCC subtypes, often requiring multi-disciplinary management.

Current Concepts in the Surgical Management of Non-melanoma Skin Cancers.

The surgical management of non-melanoma skin cancers has seen some significant changes over the past 20 years, as a result of developments in three equally important and overlapping specialties that deal with this specific pathology: plastic and reconstructive surgery, surgical oncology and dermatological surgery. Better understanding of vascular and particularly microvascular anatomy, coupled with technological advances in operating microscopes, microsurgical instrumentation and preoperative planning via advanced imaging, allows functional and aesthetic restoration of any radical oncological skin and soft-tissue surgery defect from head to toe. As reconstruction has practically lost its technical boundaries, resectional surgery can be executed without compromising on surgical margins, thus reducing rates of local recurrences and metastatic spread. The increasing use of Mohs surgery and its several advantages for difficult high-risk non-melanoma skin cancer in facial sites especially, offers optimal cure rates while reducing functional impairment and optimising cosmetic outcomes. Advances in preoperative planning utilising computed tomography and magnetic resonance imaging scans can help to predict the degree of resectability and tailor further treatments, including radiotherapy, accordingly. From the reconstructive point of view, these techniques provide a roadmap to select the best blood supply for the transplanted flap, thereby reducing complications and increasing success rates. The focus of skin cancer surgery has therefore shifted from pure cancer clearance and flap survival, to a high degree of functional and aesthetic reconstruction.

Does fasting during Ramadan affect the use of topical dermatological treatment by Muslim patients in the UK?

BACKGROUND: Ritual fasting during the Muslim religious festival of Ramadan is one of the 'Five Pillars' of Islam, and is widely observed by Muslims. Previous studies have highlighted compliance issues in patients prescribed oral medications during this period. Aim. To assess whether fasting during Ramadan influence the use of topical treatments for skin disease in Muslim patients. METHODS: This was a prospective, anonymous, questionnaire survey undertaken in a dermatology centre in a tertiary hospital in the UK. Patients were asked if they would use topical treatment while fasting, and whether they would consider this a breach of their fast. RESULTS: We found that more than one-third of the people interviewed would not use topical treatment while fasting, and around the same number (> 30%) would also consider this a breach of their fast. Although the majority of these patients thought that using steroid-based topical products was not acceptable, a significant proportion extended this opinion to use of any cream or emollient, and even to light therapy. Gender, age, or educational level were not useful predictors of patient opinion, but there was a significant association with birthplace and likelihood of using topical treatment during Ramadan; patients born outside the UK were significantly (P < 0.01) less likely than those born in the UK to use topical treatment in the fasting period. CONCLUSIONS: Our study indicates that fasting may be a significant and a hitherto unrecognised cause of non-compliance with topical treatment in Muslim patients in the UK, with potential health, quality and cost implications. Ritual fasting during Ramadan is widely observed by Muslims. Previous studies have highlighted compliance issues in patients prescribed oral medications during this period, and it seems this extends to use of topical treatments for skin disease.

Nuclear beta-catenin in basal cell carcinoma correlates with increased proliferation.

BACKGROUND: Virtually all BCCs have deregulation of the Hedgehog (Hh) signalling pathway and a proportion show nuclear beta-catenin accumulation. The latter is thought to be due to Hh pathway-directed Wnt expression but this has not been tested. An alternative cause of nuclear beta-catenin accumulation is gene mutation, which stabilizes the protein. Theoretically, reduced E-cadherin expression could also be important because it can sequester beta-catenin at the cell membrane. In turn, nuclear beta-catenin can increase expression of MYC and cyclin D1, thus potentially altering proliferation. OBJECTIVES: To assess whether nuclear beta-catenin occurs in BCC, and to look at potential causes and consequences. METHODS: Nuclear beta-catenin was assessed by immunohistochemistry, and its causes by analysis of E-cadherin expression, beta-catenin exon 3 mutation and WNT5A expression. Its consequences were assessed by analysing proliferation. RESULTS: We found nuclear beta-catenin in 20 of 86 paraffin-embedded sections of BCCs using immunohistochemistry. BCCs showed increased WNT5A relative to the surrounding skin. No mutations in exon 3 of the beta-catenin gene were found in 10 cases. There was no association between beta-catenin localization and E-cadherin expression. Tumours with nuclear beta-catenin had significantly higher proliferation (P < 0.01). CONCLUSIONS: The absence of beta-catenin gene mutations indicate that the Hh pathway-directed Wnt signalling remains the most likely cause of nuclear beta-catenin accumulation in BCC. Additionally, the correlation with increased proliferation is the first evidence that nuclear beta-catenin may have a biological effect. However, a causal link between Hh pathway deregulation, Wnt ligand overexpression, nuclear beta-catenin accumulation and increased proliferation remains to be confirmed.