Frequency and features of malignant tumors clinically mimicking cutaneous cysts: A retrospective chart review.

BACKGROUND: Many cutaneous lesions are clinically suspected as "cyst"; however, following histopathological examination, are found to be more significant lesions. Here, we examine the frequency and features of malignancies with cutaneous cysts in the clinical differential. METHODS: A retrospective study of surgical pathology specimens at the James A. Haley Veterans' Hospital from January 2018 to December 2022 was conducted. Cutaneous specimens containing the clinical diagnosis of "cyst" were included. The clinicopathological features were summarized. RESULTS: Premalignant or malignant neoplasms accounted for 4.5% of all specimens submitted with cysts in the clinical differential. Most cyst-mimicking cancers were basal cell carcinoma (BCC) or squamous cell carcinoma (SCC); however, cancers with poorer prognoses, such as Merkel cell carcinoma and melanoma, also clinically masqueraded as cysts. The BCCs were predominately nodular, and the SCCs were largely well-differentiated and invasive. Many exhibited clinical signs and symptoms compatible with benign cysts, such as central punctum, pain, and rapid growth. Identified risk factors included history of prior non-melanoma skin cancer diagnosis, previous excision, and immunosuppression. CONCLUSIONS: Many lesions clinically concerning cutaneous cysts were found to be malignancies following histopathological review. Accordingly, following biopsy all cyst-like lesions should be examined microscopically, especially in certain clinical contexts in which the incidence of skin cancer is increased.

Breast Cancer: 20-Year Comparative Mortality and Survival Analysis by Age, Sex, Race/Ethnicity, Stage, Grade, Disease Duration, Selected ICD-O-3 Oncophenotypes, and Cohort Entry Time-Period.

Breast cancer remains the most common non-cutaneous malignancy in women in both Europe and the United States and the second leading cause of cancer-related deaths. In this breast cancer mortality and survival study, a US retrospective population-based analysis of 656,501 microscopically confirmed breast cancer cases, 1975-2019, data is derived from the NCI Surveillance Epidemiology & End Results Program, SEER*Stat 8.4.0.1.

Outcome after treatment for sebaceous carcinoma: A multicenter study.

BACKGROUND: Sebaceous carcinoma (SC) is a rare malignant tumour whereby, comprehensive long-term data are scarce. This study aimed to assess the outcome of patients treated with resection for SC. METHODS: Patients treated at four tertiary centres were included. Cumulative incidence curves were calculated for recurrences. RESULTS: A total of 100 patients (57 males, 57%) were included with 103 SCs. The median age was 72 (range, 15-95) years with a median follow-up of 52 (interquartile range [IQR], 24-93) months. Most SCs were located (peri)ocular (49.5%). Of all SCs, 17 locally recurred (16.5%) with a median time to recurrence of 19 (IQR, 8-29) months. The cumulative incidence probability for recurrence was statistically higher for (peri)ocular tumours (p = 0.005), and for positive resection margins (p = 0.001). Two patients presented with lymph node metastases and additional seven patients (8.7%) developed lymph node metastases during follow-up with a median time to metastases of 8 (IQR, 0.5-28) months. Three patients had concurrent in-transit metastases and one patient also developed liver and bone metastases during follow-up. CONCLUSION: SC is a rare, yet locally aggressive tumour. Positive resection margins and (peri)ocular SCs are more frequently associated with local recurrence. SC infrequently presents with locoregional or distant metastases.

The Intersection of Law and Medicine in Full Skin Examination in Screening for Cutaneous Malignancy.

Full skin examination (FSE) is a vital practice in the diagnosis of cutaneous malignancy. Precisely what the FSE entails, however, with respect to concealed site examination (CSE), in particular sensitive sites including the anogenital region, breasts, scalp and oral mucosa, remains poorly elucidated. While the incidence of skin cancer at these sites is low, it carries a poor prognosis. A standardised approach is proposed to FSE with respect to inclusion of CSE to provide: an optimised and uniform approach to patient care, guidance to clinicians performing FSE routinely, and in doing so to protect them medico legally. This article analyses the medico-legal issues pertinent to this issue.

Investigative Landscape in Advanced Non-Melanoma Skin Cancers.

OPINION STATEMENT: Advanced non-melanoma skin cancers have been challenging to treat due to limited treatment options. Treatment paradigm has shifted with the approval of immunotherapeutic agents cemiplimab and pembrolizumab which have been a key development and have changed the landscape of advanced or metastatic squamous cell skin cancers. Hedgehog inhibitors, vismodegib and sonidegib, remain upfront options for advanced or metastatic basal cell carcinomas. Current clinical trials are continuing to evaluate the use of immune checkpoint inhibitors and hedgehog pathway inhibitors. There is further need for ongoing research and development of new therapies in both malignancies.

Immunotherapy for skin cancer.

Among all tumor types, skin cancers are profoundly sensitive to immunotherapy. Indeed, the recently reported response rates for anti-PD-1 (anti-programmed-death 1) therapy for cutaneous malignant melanomas (MM), Merkel cell carcinomas, basal cell carcinomas, cutaneous squamous cell carcinomas and Kaposi sarcomas are all above 40%. This unique immunogenicity renders skin cancers as a paradigm for tumor-immune interactions and is driven by high mutational burdens, over-expressed tumor antigens and/or viral antigens. However, despite the clear demonstration of immunologic cure of skin cancer in some patients, most tumors develop either early (primary) or late (adaptive) resistance to immunotherapy. Resistance mechanisms are complex, and include contributions of tumor cell-intrinsic, T cell and microenvironment factors that have been recently further elucidated with the advent of single-cell technologies. This review will focus on the exciting progress with immunotherapy for skin cancers to date, and also our current understanding of the mechanisms of resistance to immunotherapy.

Anticancer therapies associated with secondary cutaneous malignancies: A review of the literature.

Recent advancements in anticancer therapy have produced an array of highly specialized therapeutics that prolong disease-free survival, improve tolerability of treatment, and individualize care. With improved treatments and longer survival, treatment-related toxicities are gaining importance. Dermatologic toxicities are common, with therapy-induced secondary cutaneous malignancies of the most frequent and serious for targeted therapies, immunotherapy, and radiotherapy. Often, these eruptive malignant lesions can be treatment limiting and detrimental to quality of life. As such, dermatologists play an important role in multidisciplinary oncologic care teams for surveillance and management of secondary cutaneous malignancies. Proactive dermatologic supervision yields early diagnosis and treatment of secondary cutaneous malignancies, which limits therapy discontinuation and thus optimizes treatment through both therapeutic achievement and overall well-being.

Custom surgical management of invasive malignant tumors of the scalp.

BACKGROUND: There is no universal management protocol concerning invasive malignant tumors of the scalp with bone and dura mater invasion. The aims of this study were to report and discuss our experience in the management of these forms of tumors. METHODS: We retrospectively reviewed all consecutive patients of microsurgical scalp reconstruction performed after resection of invasive cutaneous malignancies of the scalp, calvarium, and dura mater from 2017 to 2019, at Pitié-Salpêtrière University Hospital (Paris, France). RESULTS: Five patients met inclusion criteria. There were three squamous cell carcinomas and two sarcomas. Mean age at surgery was 63.6 years. The sex ratio male/female was 4. Two received radiation prior to resection and two patients had a history of prior scalp tumor surgery. All the patients underwent craniectomy and the mean cranial defect size was 41 cm2. Cranioplasty was performed in one patient. Soft tissue coverage was provided by free tissue transfer of latissimus dorsi muscle in all patients. In four patients, split thickness skin graft was performed in a second surgical stage few weeks later. There were no intraoperative complications and no complications into the donor site for the tissue transfer or the skin graft. Two patients had flap necrosis that healed after a new free flap of latissimus dorsi. CONCLUSIONS: Wide resection with craniectomy and reconstruction with microvascular free tissue transfer provides safe and reliable treatment of recalcitrant invasive scalp skin cancers. The surgical management of these complex patients is a challenge that must be conducted by trained, experienced, and multidisciplinary teams.

Epidemiology of malignant cutaneous granular cell tumors: A US population-based cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) database.

BACKGROUND: Malignant cutaneous granular cell tumors (mcGCTs) are rare and associated with substantial morbidity and mortality. The literature includes single-institution studies. OBJECTIVE: To examine the incidence, secondary malignancies, treatment, overall survival, and disease-specific survival (DSS) of patients with mcGCT. METHODS: A population-based cohort analysis was conducted in the Surveillance, Epidemiology, and End Results database from 1973 to 2013 for patients with a diagnosis of mcGCT. Risk-adjusted associations between overall survival/DSS and patient characteristics and treatment modalities were assessed by Cox proportional hazard regression. Quantile regression was used to determine median survival times. RESULTS: The 5-year DSS rate was 62.8%. Patients demonstrated an increased risk for renal and pancreatic cancers. In risk-adjusted models, male sex (hazard ratio [HR], 0.21; 95% confidence interval [CI], 0.06-0.82; P = .02), advanced cancer stage (HR, 2.29; 95% CI, 1.40-3.72; P < .01), and surgical resection (HR, 0.06; 95% CI, 0.01-0.59; P = .02) predicted DSS. Median survival time in years increased for males (1.39), earlier stage (0.60), and surgical intervention (5.34). LIMITATIONS: Absent or incorrect reporting in retrospective Surveillance, Epidemiology, and End Results data is possible. The database is more likely to include academic centers. Some subanalyses may be underpowered because of the limited sample size for a rare cancer. CONCLUSIONS: Our study presents an in-depth assessment of factors that identify high-risk patients. Residency in a nonmetro area, black race, female sex, and no surgical resection were each associated with poorer DSS.

Potential cutaneous carcinogenic risk of exposure to UV nail lamp: A review.

The increased use of ultraviolet (UV) nail lamps in recent years has generated safety concerns of this device. A UV nail lamp is a source of artificial UVA radiation, often used to dry, harden, and cure the nails at home and in the salon. UVA radiation is known to be mutagenic and can cause damage to the DNA, resulting in cutaneous malignancy. Currently, there are only a few studies that have evaluated UV nail lamp irradiation and its potential carcinogenic risk. We review the literature on UV nail lamps, its safety, effect on nails and hands, and the potential role in increasing the risk of cutaneous malignancy. Based on available data, the carcinogenic risk is low; nonetheless, the use of a broad spectrum sunscreen with SPF >30 before UV nail lamp exposure is recommended.

Adverse effects of voriconazole: Over a decade of use.

Voriconazole use has increased since the drug's introduction in 2002, and new and unique adverse effects are emerging as patients undergo prolonged therapy. Most concerning is the increased risk of cutaneous malignancies, primarily squamous cell carcinoma (SCC); this risk is duration dependent and the associated malignancies tend to be more aggressive and multifocal. Voriconazole is also associated with phototoxicity (which may be a precursor to malignancy), periostitis, hallucinations and encephalopathy, peripheral neuropathy, alopecia, nail changes, hyponatremia, and other adverse effects. Some toxicities (neuropsychiatric and gastrointestinal including hepatic) are seen in clear association with supratherapeutic serum voriconazole levels; thus, careful monitoring of voriconazole levels is a critical component of safe drug use. Guidelines for screening for adverse effects after long-term voriconazole use may be beneficial and need to be established.

Incidental melanomas detected in veterans referred to dermatology.

BACKGROUND: Early detection of melanoma is integral to preventing morbidity and mortality. OBJECTIVE: We sought to characterize and compare incidental versus consult melanomas detected in veterans referred to the Minneapolis, MN, Department of Veterans Affairs Medical Center dermatology clinic. METHODS: We retrospectively reviewed charts of all dermatology consults between January 2004 and March 2012. RESULTS: Of the 28,405 consults sent during the study period, 17,174 met inclusion criteria. There were 231 melanomas identified in 221 patients. In all, 144 melanomas were identified on the consult and 87 melanomas were discovered incidentally. The incidental melanoma detection rate was 0.5% (84/17,174). Consult melanomas were more likely to be invasive than incidental melanomas (relative risk 1.51, 95% confidence interval 1.23-1.86, P < .0001) and less likely to have a Breslow depth of less than 1.00 mm (relative risk 0.73, 95% confidence interval 0.61-0.88, P = .0036). Incidental melanomas were smaller than consult melanomas (mean diameter 0.98 vs 1.3 cm, respectively) and thinner (mean Breslow depth 0.64 vs 1.74 mm). Consult melanomas were more likely to be detected on the head/neck (relative risk 1.25, 95% confidence interval 1.03-1.52, P = .0295). LIMITATIONS: Nondiverse patient population is a limitation. CONCLUSION: Melanomas detected during an in-person skin examination by a dermatologist were more likely to be detected at an earlier stage of disease.

Tanning bed and nail lamp use and the risk of cutaneous malignancy: a review of the literature.

Malignant melanoma (MM) and non-melanoma skin cancer (NMSC) are increasingly common and both can be fatal. In 2009 the World Health Organization (WHO) classified the whole ultraviolet spectrum and tanning beds as carcinogenic to humans, placing them in the same category as asbestos and tobacco. Despite this, the trend for indoor tanning continues. A growing body of evidence has now associated indoor tanning with an increased risk of MM and NMSC. As a result, there has been an upsurge in regulations in the tanning industry ranging from age restrictions to complete bans on commercial tanning. This article examines the evidence and strengthens the case for a complete ban of a recognised modifiable risk factor for cutaneous malignancy.

NovoSorb® biodegradable temporising matrix (BTM) in the reconstruction of cutaneous malignancies in a major cancer centre: a case series.

BACKGROUND: Non-graftable or composite defect reconstruction represents a major challenge to the reconstructive surgeon, with many wounds requiring local flap or free microvascular tissue transfer approaches. The recent advent of synthetic skin substitutes such as Biodegradable Temporizing Matrix (BTM) have revolutionized the management of complex defects including those caused by burns, trauma and infection, with low-morbidity and low-complexity surgery. However, limited data exist supporting their use in cancer reconstruction in Australia. METHODS: We performed a prospective cohort study of patients undergoing cancer resection and reconstruction with BTM between February 2021 and February 2023 in our institution. Reported outcomes included matrix integration, infection, and return to theatre. RESULTS: Twelve patients underwent reconstruction of primary or secondary defects following cancer resection during this period. Eight patients were male, four female, mean age at surgery was 70 years. Pathology resected included squamous cell carcinoma (SCC) and melanoma of the head and neck, sarcoma resection of the lower limb, and osteoradionecrosis (ORN) of the scalp. T-stage of primary tumours ranged from T2 to T4 and one in-transit metastasis of melanoma. Four patients were treated with radiotherapy, two of whom received postoperative radiotherapy (PORT) and two who received neoadjuvant radiotherapy, three additional patients had an intervention to a previously irradiated wound bed for recurrence or ORN. Overall matrix integration was 83% (10/12), with a 50% integration rate (2/4) observed in the post-radiotherapy group, requiring return to theatre for alternative reconstructive approaches. CONCLUSION: We report our experience with a synthetic dermal matrix (BTM) in cancer reconstruction, the largest cohort of this type in the Australian literature. BTM represents an exciting reconstructive tool for the cancer reconstructive surgeon, with a high rate of success and low morbidity.

Sepsis Associated With Aggressive Cutaneous Angiosarcoma.

Cutaneous angiosarcoma is an aggressive tumor most commonly presenting on the head and neck. In this case report, we describe the presentation of sepsis secondary to an aggressive and rapidly expanding wound, located in a sun-protected area on the body, in a patient with multiple concurrent comorbidities. Treatment was tailored toward targeting the causative organisms, as well as identifying the histologic morphology of the pathologic legion. Histopathology and immunohistochemistry were used to confirm the diagnosis of cutaneous angiosarcoma, and the patient-centered decision surrounding palliative chemotherapy is outlined.

A Report of a Keratoacanthoma-Type Cutaneous Squamous Cell Carcinoma Arising Within a Multicolored Ink Tattoo.

Keratoacanthoma (KA) is a common, low-grade, rapidly growing cutaneous squamous cell carcinoma that presents as an enlarging crateriform nodule, which may spontaneously involute but rarely metastasizes. Immunosuppression, ultraviolet light, viral infection, surgical procedures, and trauma are associated with their development. Overall, tattoo-induced squamous cell neoplasms are infrequently described in the literature. Carcinogenesis is hypothesized to result from trauma caused by the tattooing procedure or a foreign body reaction to the pigment. However, the pathogenesis has not been clearly defined. While most commonly associated with red ink, to date, very few cases of KA forming within black, blue, or multicolored ink tattoos are reported. Herein, we describe a case of KA arising within areas of blue and black pigment in a decorative ink tattoo.

Variability of Leser-Trélat Sign Secondary to Melanoma In Situ.

Leser-Trélat sign (LTS) is characterized as an eruptive display of multiple seborrheic keratoses (SKs) in association with malignancy. This case highlights the variable presentation of LTS secondary to melanoma. To our knowledge, this LTS pattern is the first case where the sign manifests as a subtle pattern secondary to melanoma. This stands in contrast to the five documented cases in the literature of LTS-melanoma, which exhibited distinctive and eruptive patterns. A 64-year-old Caucasian female presented for a wellness examination. No personal history of skin cancer was noted. Patient displayed an onset proliferation of SKs with an irregular, sub-centimeter macular nevus over her right lateral mid back. A 6mm punch biopsy was significant for melanoma in situ, arising within a lentiginous compound dysplastic nevus, focally abutting one peripheral tissue edge. A re-excision with a minimum of 5mm margins was completed and the specimen was negative for residual in situ melanoma. Because of the rare occurrence of this delicate pattern at the site of the melanoma, this presentation adds to the knowledge surrounding this diagnosis. This case emphasizes the importance of maintaining vigilance regarding skin manifestations associated with disease and highlights the critical importance of observation and identification of subtle physical exam findings.

A Unique Case of Late Presentation Giant Lower Extremity Malignant Melanoma.

This case describes a unique presentation of a rare malignancy: giant melanoma. Due to the accessibility of healthcare in the United States, it is unusual for melanomas to grow to massive sizes without clinical intervention. In fact, an in-depth literature review elicited only a handful of similar cases. Giant malignant melanomas are typically defined by a cutoff size of no less than 10 cm in diameter. They often present with distant metastases and are highly invasive. Due to limited yet highly variable presentations, there is no standardized approach to treating this class of melanomas. We present a case with unique features not previously documented in similar cases that was ultimately treated with a novel approach.

From diagnosis to intervention: a review of telemedicine's role in skin cancer care.

Skin cancer treatment is a core aspect of dermatology that relies on accurate diagnosis and timely interventions. Teledermatology has emerged as a valuable asset across various stages of skin cancer care including triage, diagnosis, management, and surgical consultation. With the integration of traditional dermoscopy and store-and-forward technology, teledermatology facilitates the swift sharing of high-resolution images of suspicious skin lesions with consulting dermatologists all-over. Both live video conference and store-and-forward formats have played a pivotal role in bridging the care access gap between geographically isolated patients and dermatology providers. Notably, teledermatology demonstrates diagnostic accuracy rates that are often comparable to those achieved through traditional face-to-face consultations, underscoring its robust clinical utility. Technological advancements like artificial intelligence and reflectance confocal microscopy continue to enhance image quality and hold potential for increasing the diagnostic accuracy of virtual dermatologic care. While teledermatology serves as a valuable clinical tool for all patient populations including pediatric patients, it is not intended to fully replace in-person procedures like Mohs surgery and other necessary interventions. Nevertheless, its role in facilitating the evaluation of skin malignancies is gaining recognition within the dermatologic community and fostering high approval rates from patients due to its practicality and ability to provide timely access to specialized care.