"Your Skin Tells You" Campaign for Keratinocyte Cancers: When Individuals' Selection Makes the Difference.

BACKGROUND: Prevention campaigns for skin cancers have focused primarily on melanoma, and over time there has been increasing awareness of the need to select the population to be screened to maximize program effectiveness. OBJECTIVES: The objective of the study was to report the results of a free dermatological initiative, as part of an awareness campaign dedicated to keratinocyte cancers, targeting individuals pre-selected through a short questionnaire. METHODS: One day of dermatological consultations was held at 15 dermato-oncology referral centers during May 22-June 30, 2021. For selection, individuals answered a telephone interview consisting of 7 yes/no questions on risk factors. Demographics, clinical characteristics of suspicious tumors, and histopathologic diagnosis of excised lesions were collected. Suspicion rate, detection rate, and positive predictive values (PPVs) for any skin cancer, basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and melanoma were calculated. RESULTS: A total of 320 individuals (56.9% males; 43.1% females) with a median age of 69.6 (range 21-91) years qualified for the screening initiative. Overall, skin cancers and precancerous lesions were diagnosed in 65.9% of the patients. Suspicion rate was 28.7% for any skin cancer (92/320), 22.8% for BCC (73/320), 4.7% for cSCC (15/320), and 1.2% for melanoma (4/320). Detection rate was 23.4% for any skin cancer (PPV 93.7%), 18.1% for BCC (PPV 95.1%), 4.4% for cSCC (PPV 93.3%), and 0.9% for melanoma (PPV 75%). CONCLUSIONS: Selection of individuals at high risk is a cost-effective approach for early detection campaigns for keratinocyte cancers.

Advanced Cutaneous Squamous Cell Carcinoma: Italian Multicentric Retrospective Analysis of Patient Profiles and Therapeutic Approaches.

BACKGROUND: Advanced cutaneous squamous cell carcinoma (aCSCC) represents an area of unmet clinical need, with no standardized treatments until the recent approval of immune checkpoint inhibitors (ICIs). OBJECTIVES: The aim of the study was to describe clinical characteristics and therapeutic strategies of a real-life Italian cohort of aCSCC patients managed at the beginning of cemiplimab approval as compassionate use in Italy. METHODS: A multicenter retrospective study was performed by 10 Italian centers in the period January 1, 2018-May 31, 2020. Patients aged ≥18 years and diagnosed with aCSCC (locally aCSCC and metastatic CSCC) were eligible for the study. Analysis of patients' characteristics and treatment strategies was performed. RESULTS: 239 patients were initially recruited in the study: 19 patients were excluded due to incomplete data collection, yielding a final cohort of 220 patients, of which 191 and 220 were included for patients' clinical characteristics and therapeutic intervention analysis, respectively. Median age at the time of diagnosis was 81 years (range: 72-86); nodal metastases were detected in 64/220 (29%) patients, and distant metastatic spread was reported in 33/220 (15%) patients. Most of our patients referred chronic occupational and/or recreational sun exposure, experienced ≥1 sunburn during their lifetime, never wore hats or used photoprotective filters, and presented with signs of cumulative sun damage (solar lentigines and/or actinic keratosis). Majority of our cohort received at least one intervention directed to the primary tumor (n = 212, 96.3%); surgery and radiotherapy were the most common therapeutic choices. Immunotherapy was administered to a small number of patients as compassionate use, especially in the metastatic setting. CONCLUSIONS: Our study outlines the complex and heterogeneous clinical and therapeutic landscape of aCSCC patients at the beginning of ICI era, highlighting the need of a standardized care for this fragile and high-need patient population.

Basal cell carcinoma of the eyelid margin: Dermoscopic clues in a case series.

Basal cell carcinoma (BCC) can sometimes affect the eyelids and in particular the eyelid margin, where it can often be misdiagnosed, mimicking other benign, more common diseases. Dermoscopy may provide additional diagnostic criteria for an earlier diagnosis of eyelid margin BCC, although the dermoscopic features of BCC affecting this anatomical site have seldom been reported. We highlight the peculiar presence of linear vessels perpendicular to the eyelid margin in BCCs of the eyelid margin. Our article represents the first report of these dermoscopic findings in a series of BCCs of the eyelid margin.

Homogeneous blue lumps of the nipple-areola complex in pubertal girls.

Retroareolar cysts are benign breast lesions caused by the obstruction and consequent dilatation of Montgomery tubercles. Herein, we report two cases of premenarchal girls who developed retroareolar cysts. Their course and differential diagnosis are discussed.

Combined CO2 laser and photodynamic therapy enhances the efficacy of treatment of basal cell carcinomas.

BACKGROUND AND OBJECTIVES: In selected cases, conventional photodynamic therapy (C-PDT) is a valid alternative to surgery for the treatment of basal cell carcinoma (BCC). However, it is limited to superficial BCCs. Pretreatment of BCCs with ablative lasers may enhance its efficacy. We evaluated the C-PDT and CO2 laser combination therapy for the treatment of superficial and nodular BCCs. PATIENTS AND METHODS: In this prospective, interventional, monocentric study, patients affected by BCC were treated with CO2 laser therapy, using a continuous superpulsed CO2 laser for nodular BCCs and a fractional CO2 laser for superficial BCCs. All patients were subsequently treated with photodynamic therapy using methyl aminolevulinate cream and an Aktilite CL128® (Galderma) lamp. RESULTS: 32 patients (20 males, 12 females) aged from 45 to 96 years (with a total of 181 BCCs) were treated using a CO2 laser combined with C-PDT. A 100 % cure rate was achieved at three months, with no signs of relapse in 97.2 % of the cases during the mean follow-up period (10.7 months, range 4 to 18 months). We observed mild adverse reactions and good aesthetic results. CONCLUSIONS: We recommend this combination therapy in selected cases, based on its high efficacy, good aesthetic results and few side effects.

Mohs Surgery for Squamous Cell Carcinoma of the Nail Unit: 10 Years of Experience.

BACKGROUND: Squamous cell carcinoma (SCC) is the most frequent malignant tumor of the nail unit. OBJECTIVE: The aim of this study was to review the long-term outcome of patients affected by SCC of the nail who underwent Mohs surgery. MATERIALS AND METHODS: Patients affected by nail SCC were enrolled, including cases where x-ray examination had revealed bone changes. The tumor was completely excised and the defect filled with a skin substitute based on hyaluronic acid where bone involvement was not observed. Where Mohs sections indicated bone involvement, the distal phalanx was disarticulated and the remaining end of the digit repaired using a volar/plantar flap. Follow-up was performed every 6 months for 5 years. RESULTS: Mohs technique was performed in 43 cases. Microinvasive SCC was diagnosed in 5 cases, in situ SCC in 7 cases, and invasive SCC in 45 patients. Recurrences were observed in 2 patients (3.5%). Disarticulation was performed in both of them, and no further tumor recurrences were observed in 4 to 5 years of follow-up. CONCLUSION: Mohs surgery provides the highest cure rate for the treatment of nail SCC. It allows the evaluation of periosteal invasion and therefore bone invasion to be reliably distinguished from inflammation or compression. This technique reduces the number of unnecessary amputations, a critical consideration for patient's quality of life.

Virologic and genetic evaluation of vemurafenib-induced skin cancers.

We describe the occurrence of a giant squamous cell carcinoma in a patient receiving vemurafenib for the treatment of late melanoma mestastases. Although the development of keratoacanthomas and squamous cell carcinomas (SCC) has been described during vemurafenib therapy, most of the reported cases are treated with surgical excision. In the present case, SCC regressed after drug withdrawal.

Association of miR-146a-5p and miR-21-5p with Prognostic Features in Melanomas.

BACKGROUND: Cutaneous melanoma (CM) is one of the most lethal tumors among skin cancers and its incidence is rising worldwide. Recent data support the role of microRNAs (miRNAs) in melanoma carcinogenesis and their potential use as disease biomarkers. METHODS: We quantified the expression of miR-146a-5p and miR-21-5p in 170 formalin-fixed paraffin embedded (FFPE) samples of CM, namely 116 superficial spreading melanoma (SSM), 26 nodular melanoma (NM), and 28 lentigo maligna melanoma (LMM). We correlated miRNA expression with specific histopathologic features including Breslow thickness (BT), histological subtype, ulceration and regression status, and mitotic index. RESULTS: miR-146a-5p and miR-21-5p were significantly higher in NM compared to SSM and LMM. The positive correlation between miR-146a-5p and miR-21-5p expression and BT was confirmed for both miRNAs in SSM. Considering the ulceration status, we assessed that individual miR-21-5p expression was significantly higher in ulcerated CMs. The increased combined expression of the two miRNAs was strongly associated with ulceration (p = 0.0093) and higher mitotic rate (≥1/mm2) (p = 0.0005). We demonstrated that the combination of two-miRNA expression and prognostic features (BT and ulceration) can better differentiate cutaneous melanoma prognostic groups, considering overall survival and time-to-relapse clinical outcomes. Specifically, miRNA expression can further stratify prognostic groups among patients with BT ≥ 0.8 mm but without ulceration. Our findings provide further insights into the characterization of CM with specific prognostic features. The graphical abstract was created with BioRender.com.

Frequency of malignant neoplasms in 257 chronic leg ulcers.

BACKGROUND: Chronic leg ulcers are one of the most common medical conditions and are a substantial source of morbidity. OBJECTIVES: To investigate the prevalence of skin cancer mimicking leg ulcers. PATIENTS AND METHODS: This observational study included all patients with a clinical diagnosis of chronic leg ulcers (CLU) admitted to the Wound Care Unit, Division of Dermatology, University of Bologna, between March 2008 and February 2011. Patients' general health was assessed, and skin biopsy and vascular Doppler of the lower limbs were performed. RESULTS: Two hundred fifty-seven patients ages 45 to 98 with CLU were included. Skin biopsies were performed in all patients. Pathologic results showed that 10 patients had ulcerative lesions of neoplastic origin. Surgical excision was performed in all patients with neoplasms. After at least 1 year of follow-up, no recurrences were observed. DISCUSSION AND CONCLUSION: Our findings highlight the important role of systematic biopsies in diagnosing ulcerated tumors of the lower legs and indicate a high prevalence of large ulcerated basal cell carcinomas.

Two synchronous periungual BCC treated with Mohs surgery. Nail polish related?

Basal cell carcinoma (BCC), the most frequent malignant skin tumor observed in Caucasian adults, especially males, occurs mainly in sun-exposed areas of the body. BCC in the periungual tissues, such as proximal nail fold, nail matrix, nail bed and hyponychium, is rarely reported. We report a patient with two synchronous BCC of the periungual tissue localized in the IV and V fingernail, effectively treated with Mohs micrographic surgery.