Dermoscopy of skin metastases in advanced cancer-systemic (visceral, hematologic) and cutaneous.

Introduction: Skin metastases arise in 10% of cancer patients, but standardized dermoscopy diagnostic criteria for skin metastases remain poor. This study's objective was to analyze the dermoscopy features of skin metastases from advanced systemic and cutaneous cancers. Methods: A retrospective study on 715 dermoscopy images of skin metastases from 33 patients with various primary cancers (breast, ovary, melanoma, non-melanoma skin cancer, and chronic leukemia) attending two academic centers between 2013 and 2023 was performed. Four independent observers blindly analyzed patterns, colors, vessels, and elementary lesions for each metastasis (30 parameters in total). Results: The structureless white pattern was the most prominent indicator of cutaneous metastasis (81.26%, p < 0.001). Regardless of the primary tumor, colors pink, red, white, and tan were identified. Elementary lesions were infrequent, except for melanoma metastases that displayed dots (13.23%) and globules (11.11%). Breast cancer metastases presented: blue (41.48%) and red (34.32%) colors, irregular vessels (13.58%), and a blue-naevus pattern (22.22%). Melanoma metastases displayed: a blue-naevus pattern (61.38%), a blue color (85.71%), and a structureless-blue combination pattern (79.37%). Non-melanoma skin cancer metastases were characterized by vascular (42.11%) and angioma-like (31.58%) patterns, pink (57.89%) and red (57.89%) colors, irregular (57.89%), thin hairpin (47.37%), comma (47, 37%), and thick hairpin (26, 32%) vessels and a red, white and irregular vessels combination pattern (52, 63%). A pink structureless combination pattern was frequent (61.05%) in chronic leukemia metastases. Ovarian cancer metastases displayed a white and tan structureless combination pattern (100%) and frequently had dotted vessels (42.85%). Conclusion: Papules and nodules with a white structureless pattern suggest skin metastases, regardless of the primary tumor. A blue structureless lesion is indicative of melanoma metastasis and a vascular pattern with irregular vessels indicates a non-melanoma skin cancer metastasis. Dermoscopy stands as a reliable non-invasive diagnostic method for suspected cutaneous metastases in patients with a known cancer history.

Paraneoplastic Pemphigus Mimicking Pemphigus Vulgaris Associated With Castleman Disease.

Paraneoplastic pemphigus (PNP) is a rare bullous disease with a polymorphic presentation. Diagnosis can be difficult because it can mimic other bullous diseases, while the underlying neoplasm may be completely asymptomatic. We present the case of a 19-year-old female with a four-year history of exclusively oral bullous lesions, mimicking pemphigus vulgaris, before the diagnosis of a retroperitoneal Castleman disease. While PNP is a severe and sometimes deadly condition, our patient had a mild and long evolution on minimal treatment, with complete resolution after tumor excision. Practitioners should be aware of PNP in young patients presenting with bullous disease and should conduct prompt systemic investigations in refractory or long-evolving cases, even when PNP diagnostic criteria are not fully met.

A Conservative Combined Laser Cryoimmunotherapy Treatment vs. Surgical Excision for Basal Cell Carcinoma.

Surgical excision is the standard treatment for basal cell carcinoma (BCC), but it can be challenging in elderly patients and patients with comorbidities. The non-surgical guidelines procedures are usually regarded as monotherapy options. This quasi-experimental, non-randomized, comparative effectiveness study aims to evaluate the efficacy of a combined, conservative, non-surgical BCC treatment, and compare it to standard surgical excision. Patients with primary, non-ulcerated, histopathologically confirmed BCCs were divided into a conservative treatment (129 patients) and a standard surgery subgroup (50 patients). The conservative treatment consisted of ablative CO2 laser, cryosurgery, topical occlusive 5-fluorouracil, and imiquimod. The follow-up examinations were performed 3 months after remission, then every 3 to 6 months, and were extended with telephone follow-ups. Cosmetic-self assessment was recorded during a telephone follow-up. Subjects from the conservative subgroup presented a clearance rate of 99.11%, and a recurrence rate of 0.98%. No recurrences were recorded in the surgical group, nor during the telephone follow-up. There were no differences regarding adverse events (p > 0.05). A superior self-assessment cosmetic outcome was obtained using the conservative method (p < 0.001). This conservative treatment is suitable for elders and patients with comorbidities, is not inferior to surgery in terms of clearance, relapses, or local adverse events, and displays superior cosmetic outcomes.

Learning from mistakes: errors in approaches to melanoma and the urgent need for updated national guidelines.

BACKGROUND: The tracking and identification of errors in the detection and follow-up of melanoma are important because there is huge potential to increase awareness about the most vulnerable aspects of diagnosis and treatment, and to improve both from the perspective of healthcare economics. The present study was designed to identify where errors occur and to propose a minimum set of rules for the routine guidance of any specialist in melanoma management. METHODS: This report describes the evaluation of a unique series of 33 cases in which errors applying to many steps in the diagnosis and treatment of melanoma were detected. Cases were collected at two centers in Romania, one public and one private, as part of a process of obtaining patient-requested second opinions. RESULTS: A total of 166 errors were identified across the 33 patients, most of which were treatment errors. The errors fell into six categories: clinical diagnostic errors (36 errors among 30 patients); primary surgical errors (31 errors among 16 patients); pathology errors (24 errors among 17 patients); sentinel lymph node biopsy errors (13 errors among 13 patients); staging errors (17 errors among 13 patients); and treatment or management errors (45 errors among 33 patients). CONCLUSIONS: Based on the present results, we propose that in countries lacking national guidelines, clinicians should adhere to international evidence-based guidelines for the diagnosis and treatment of melanoma.

IRIS COLOUR CLASSIFICATION SCALES--THEN AND NOW.

Eye colour is one of the most obvious phenotypic traits of an individual. Since the first documented classification scale developed in 1843, there have been numerous attempts to classify the iris colour. In the past centuries, iris colour classification scales has had various colour categories and mostly relied on comparison of an individual's eye with painted glass eyes. Once photography techniques were refined, standard iris photographs replaced painted eyes, but this did not solve the problem of painted/ printed colour variability in time. Early clinical scales were easy to use, but lacked objectivity and were not standardised or statistically tested for reproducibility. The era of automated iris colour classification systems came with the technological development. Spectrophotometry, digital analysis of high-resolution iris images, hyper spectral analysis of the human real iris and the dedicated iris colour analysis software, all accomplished an objective, accurate iris colour classification, but are quite expensive and limited in use to research environment. Iris colour classification systems evolved continuously due to their use in a wide range of studies, especially in the fields of anthropology, epidemiology and genetics. Despite the wide range of the existing scales, up until present there has been no generally accepted iris colour classification scale.

Improving Melanoma Path Reports: the Importance of Histopathological Parameters in Diagnosis of Cutaneous Melanoma.

BACKGROUND: Despite the fact that melanoma is an easy approachable tumor for diagnosis, the incidence of this skin cancer is still increasing. Histopathological assessment of melanocytic tumors is the gold standard in melanoma diagnosis and represents a problematic aspect of dermatology and pathology. Over the past decades many efforts have been made in determining histological characteristics influencing the prognosis and survival of patients with clinically localized primary melanoma. Some of these parameters also proved to be essential for tumor staging and choosing adequate clinical management. OBJECTIVE: We present a retrospective study of 21 melanoma cases with histopathological errors or incomplete path reports, with the intention to raise awareness about the importance of an accurate diagnosis for the management of these cases and for patient prognosis. METHODS: We retrospectively reviewed data from pathology reports and discharge medical records from 21 patients diagnosed with melanoma between 2006 and 2014 and treated in other hospitals that presented in our clinic for second opinion. All slides were reviewed by an authorized dermatopathologist and the new path report was compared with the other ones, presented by the patients. RESULTS: The majority of the path reports were incomplete, with absent (35.7%) or wrong (35.7%) tumor thickness, making impossible to stage the tumor. Absence of histopathological diagnosis was noticed in 3 cases and a wrong diagnosis was determined in 3 patients. Other missing parameters were ulceration status, mitotic rate, microsatellitosis and surgical margins evaluation. missing or incorrect determined in half of the cases. CONCLUSIONS: This study presents the fact that there is a lack of relevant information in the path reports of melanoma cases, making impossible to stage and treat this patients, with adverse clinical impact. We want to emphasize the importance of a standardized histopathological evaluation of melanocytic tumors, consistent with the generally accepted standards, leading to improved healthcare quality and reduced medico legal risks associated with melanoma.