Cutaneous carcinogenic risk evaluation in 375 patients treated with narrowband-UVB phototherapy: A 15-year experience from our Institute.

BACKGROUND: Narrowband-ultraviolet B (NB-UVB) is widely used for the treatment of several dermatological diseases. A cutaneous carcinogenic effect has been hypothesized, but not proved. METHODS: We retrospectively reviewed the data of patients treated with NB-UVB between January 1998 and December 2013 at the Dermatology Unit of our University Hospital, to evaluate the cutaneous carcinogenic risk of NB-UVB. RESULTS: In all, 375 patients were included, each receiving a mean follow-up of 6.9 years. Vitiligo and psoriasis were the most common diseases. In total, 19 non-melanoma skin cancers (NMSCs) were diagnosed in eight patients, after a mean latency of 5.2 years after the first radiation. No malignant melanoma (MM) was observed. The incidence rates of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were 620.2/100 ̇000 p/y and 116.3/100 ̇000 p/y. NMSCs were more frequent in patients affected by psoriasis (P = .0232), with older age at the first radiation (mean = 68.8 years, P = .0001). CONCLUSION: Despite the small number of patients and limited follow-up, our data suggest that NB-UVB may trigger cutaneous carcinogenesis, mainly in patients at risk for NMSCs, increasing their personal risk for single and multiple neoplasms, usually superficial BCCs. MM risk does not seem to be enhanced.

Congenital nevus comedonicus complicated by a hidradenitis suppurativa-like lesion: Report of a childhood case.

Nevus comedonicus is a rare, benign hamartoma of the pilosebaceous unit that may be isolated or part of the nevus comedonicus syndrome. Although rare in children, complication by hidradenitis suppurativa-like lesions has been described. We present a report of a 9-year-old girl in whom surgical excision was curative, with a review of the relevant literature.

Chlorhexidine-Induced Chemical Burns in Very Low Birth Weight Infants.

Skin disinfection with chlorhexidine gluconate has not been standardized in preterm infants. We present 5 cases of chemical burns that occurred within the first 2 days of life in very low birth weight neonates after skin disinfection with aqueous and alcohol-based chlorhexidine solutions.

Videodermoscopy and Curettage: The Value of Simple Procedures During Mohs Surgery.

BACKGROUND: Mohs surgery (MS) is regarded as one of the most efficient surgical procedures for the treatment of skin tumors. OBJECTIVES: Delineating tumor margins accurately is important in limiting broad excisions during conventional surgery and in reducing the number of stages during Mohs procedure. METHODS: This study aimed to evaluate the role of 2 simple procedures, curettage and videodermoscopy (VDS), in determining margins during MS for the treatment of basal cell carcinoma (BCC) of the head and neck. RESULTS: The use of both procedures offered a good intraoperative margin definition and consequently small surgical defects in 197 patients affected by BCC. Recurrences in basal cell cancers, which included both primary and recurrent lesions, occurred less frequently than in the institution's previous experience, appearing in only 8 of 197 cases (approx. 4%). CONCLUSION: In the authors' experience, both VDS and curettage were found advantageous in delineating tumor margins while treating BCC with MS.

Safety and Efficacy of Phototherapy in the Management of Eczema.

Atopic Dermatitis (AD), a common skin disease, can occur in patients of all age, gender and ethnicity. It is an inflammatory affection, characterized by chronic and highly debilitating behavior. First-line interventions against AD include environmental measures and topical emollients, corticosteroids or calcineurin inhibitors. When these measures are not sufficient, phototherapy represents an efficient second-line option of treatment; it can be administered on its own, or in the most severe cases combined with systemic medicaments such as corticosteroids.Different types of light therapy, including photochemotherapy, have been tested in the past and in recent years for AD: in particular, ultraviolet A1 (UVA1) and narrow band ultraviolet B (NB-UVB) have been reported in the literature as the most effective resources, respectively for acute and chronic AD. However, to date, no guidelines have been realized concerning the use of phototherapy for AD, as no light form has been defined superior to the others. The most reliable protocols and dosimetry are standardized within the American Academy of Dermatology (AAD) psoriasis guidelines.In adults and children over 12 years (8 years for NB-UVB) phototherapy is recommended with strength B and level of evidence II (excluding home phototherapy, which is recommended with strength C and level of evidence III). It is usually safe and well tolerated; however its short- and long-term adverse effects are the same as those observed when light therapy is performed for other pathologic conditions. Erythema and photodamage are in particular quite frequent; moreover it has not been clarified whether UV radiation may induce neoplastic cellular transformation. For all these reasons, the use of phototherapy must be chosen only after a comprehensive and careful evaluation of the patient's features and compliance, as well as of the limitations of the procedure due to costs and availability.

Spitz Nevi and Other Spitzoid Neoplasms in Children: Overview of Incidence Data and Diagnostic Criteria.

Spitz nevi are benign melanocytic neoplasms characterized by epithelioid or spindle melanocytes or both. In some rare cases their presentation overlaps with the clinical and histopathologic features of malignant melanoma, so a differential diagnosis can be difficult to make. Intermediate forms between Spitz nevi and malignant melanoma, with unpredictable behavior, have been called atypical Spitz tumors. A literature search was performed to review the clinical, dermoscopic, genetic, and histopathologic aspects of spitzoid tumors. Spitz nevi mainly occur in children, with no predilection for sex, and in young women. Common sites are the head and lower arms, where Spitz nevi present as pink nodules or hyperpigmented plaques. Spitzoid lesions may have diverse dermoscopic patterns: vascular, starburst, globular, atypical, reticular, negative homogeneous, or targetoid. The management of spitzoid lesions can be invasive or conservative; surgical excision is usually reserved for those with doubtful features, whereas clinical and dermoscopic follow-up is preferred for typical pediatric Spitz nevi. The role of sentinel lymph node biopsy in atypical Spitz tumors is debated. Immunohistochemistry and new molecular techniques such as comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization offer new diagnostic perspectives, investigating genetic alterations that are specific for malignant melanoma or for Spitz nevi.

Spitznävi: unterschiedliche klinische, dermatoskopische und histopathologische Merkmale in der Kindheit.

HINTERGRUND UND ZIELE: Die Charakterisierung der klinischen Merkmale und des biologischen Potenzials von Spitznävi hat in den letzten Jahrzehnten breites Interesse gefunden. Das Ziel dieser Arbeit ist die Beschreibung der klinischen und dermatoskopischen Merkmale von Spitznävi sowie des klinischen Ergebnisses nach chirurgischer Exzision von Spitznävi in drei pädiatrischen Altersgruppen. PATIENTEN UND METHODEN: Restrospektive Studie zur Analyse von klinischen Merkmalen, videodermatoskopischen Bildern, histopathologischen Diagnosen und Behandlungsergebnissen. Der Grad der Pigmentierung wurde sowohl klinisch als auch histopathologisch beurteilt. ERGEBNISSE: Bei 71 Patienten wurden 72 spitzoide Neoplasien entfernt. Videodermatologische Bilder lagen für 41 Patienten vor. Das Muster der Pigmentierung korrelierte signifikant mit dem Alter der Patienten: Hyperpigmentierte Läsionen waren bei Vorschulkindern selten, bei Patienten von 7 bis 12 Jahren und ab 13 Jahren dagegen häufiger. Eine histopathologische Diagnose von atypischen Spitznävi wurde selten durchgeführt. Keiner der Patienten, bei denen ursprünglich ein atypischer Spitznävus diagnostiziert worden war, entwickelte ein Lokalrezidiv oder Metastasen während der anschließenden Nachbeobachtung. SCHLUSSFOLGERUNGEN: Pigmentierte Spitznävi traten im Alter ab 13 Jahren häufiger auf. Die Studie bestätigt andere Berichte über die Altersverteilung von Pigmentierungsmustern und hebt die geringe Anzahl atypischer Spitznävi bei pädiatrischen Patienten hervor sowie das Ausbleiben von Rezidiven bei der langfristigen Nachbeobachtung.

Spitz nevi: diverse clinical, dermatoscopic and histopathological features in childhood.

BACKGROUND AND OBJECTIVES: The characterization of clinical features and biological potential of Spitz nevi has attracted a lot of interest in past decades. The aim of our paper was to describe the clinical, dermatoscopic features as well as the clinical outcome of surgically excised Spitz nevi in three different pediatric age groups. PATIENTS AND METHODS: A retrospective study analyzing clinical features, videodermatoscopic images, histopathological diagnosis and patient outcome. The level of pigmentation was evaluated both clinically and histopathologically. RESULTS: 72 spitzoid neoplasms were excised from 71 pediatric patients. Videodermatoscopic images were available for 41 patients. The distribution of pigmentation significantly correlated with patient age: hyperpigmented lesions were rather rare in preschool children, becoming more frequent in patients aged 7 to 12 years and older than 13 years. The histopathological diagnosis of atypical Spitz nevus was uncommon. None of the patients originally diagnosed with atypical Spitz nevi developed local recurrence or metastases during subsequent follow-up. CONCLUSIONS: Pigmented Spitz nevi were more common after 13 years of age. The study confirms other reports regarding the distribution of pigmentation patterns, and underlines the low number of atypical Spitz nevi in pediatric patients as well as their low recurrence rate during long-term follow-up.