Surgical Outcomes of More Than 1300 Cases of Mohs Micrographic Surgeries from a Private Mohs Clinic in Romania.

Background: Basal cell carcinoma (BCC) and Squamous cell carcinoma (SCC) are the most frequent skin cancers with a continuous increasing incidence and a cause of economic impact. Mohs micrographic surgery (MMS) is known as the gold-standard of treatment of non-melanoma skin cancer. Methods: The files of the patients treated with MMS were analysed during a 6 year period (2014-2019) and demographic information was extracted in addition to the information on tumor histology, localization of tumors, number of stages required for a complete removal of the tumors, and the evolution of the patients. We also analysed the information regarding the number and type of reconstructions performed. Results: Over the course of 6 years, 1,356 cutaneous tumors were treated in our clinic by means of MMS. BCC represented 80.5%, SCC 17.6%, and other tumors such as melanoma in situ, DFSP, Extramammary Paget's Disease - being 1.9% of the number of other treated tumors. During the period under review, only 4 cases of post-Mohs Micrographic Surgery recurrence have been recorded, with a cure rate of over 99.7%. Conclusions: Mohs micrographic surgery is an efficient treatment method in removing cutaneous carcinoma as well as tumors with special indications with a low recurrence rate therefore reducing the need of successive surgical interventions.

Modified Mohs Micrographic Surgery in Lentigo Maligna Treatment: A Series of Six Cases.

The surgical approach to lentigo maligna is a challenge to dermatologists, given its clinical and histopathological particularities. Staged excision with paraffin-embedded, permanent sections for histopathological evaluation of surgical margins is an effective treatment of lentigo maligna because it enables complete excision of the tumor, at the same time preserving maximum amount of healthy tissue. We report a case series of 6 patients diagnosed with lentigo maligna who underwent this procedure in our Institution and we describe the procedure we used. Complete excision of the tumors was achieved with one to three levels, with margins of excision ranging from 2 to 8 mm. There were no local recurrences at the median follow-up of 16 months, obtaining 100% cure rate with this technique. These are comparable with the margins and number of levels of excision described in previous case series reported in the literature. The technique described herein for the treatment of lentigo maligna provides excellent cure rates for this type of cutaneous malignancy notorious for its challenging management.

Biosimilars: An Update on Clinical Trials (Review of Published and Ongoing Studies).

Biosimilars represent a new trend in the treatment of many immune-mediated inflammatory diseases. Regulatory requirements for approval of biosimilars are different from those of originators and rely mostly on the evidence generated from bioequivalence studies and in particular from RCTs. Our goal in this review was to search for relevant studies from randomized controlled trials on the biosimilars adalimumab, etanercept, infliximab and ustekinumab compared with their reference medication (publication in Medline) and ongoing studies in clinical trial registries. For infliximab biosimilars, we found data on patients with ankylosing spondylitis rheumatoid arthritis indicating no clinically relevant differences regarding efficacy and safety, as well as data on inflammatory bowel diseases and psoriasis. In addition, three registered studies of adalimumab biosimilars and just one study of an etanercept biosimilar were being carried out in patients with psoriasis. Ongoing studies on adalimumab, etanercept, and infliximab biosimilars in patients with rheumatoid arthritis were also identified. The conclusion seems to be that there are only 4 clinical trials on psoriasis (3 for the adalimumab biosimilar and 1 for etanercept biosimilar) and 1 clinical trial for Pso, CD, UC, RA, and AS (with the Infliximab biosimilar). Thus, the real and unique advantage of biosimilars is the low price derived from the special design studies despite the high technology used in fabrication process. Although not all ongoing biosimilar trials may have been registered, the present situation in terms of registered trials is quite unsatisfactory and provision of further clinical data and inclusion of patients in patient registries will be crucial.

Paradoxical reactions induced by tumor necrosis factor-alpha antagonists: A literature review based on 46 cases.

Anti-tumor necrosis factor (TNFα) agents have acquired a prominent place in the treatment options for inflammatory disorders. Among the side effects of these agents are the so-called paradoxical reactions which have increasingly been reported in recent years. A review of literature was carried out using Medline (PubMed) database from January 2010 to December 2014 to collect all published articles on cases of anti-TNFα-induced psoriasis and psoriatic arthritis. Published articles were identified, reviewed and the relevant data extracted. A total of 22 studies (46 patients) fulfilled the inclusion criteria and were selected for analysis. Of the 46 patients, 45 (97.8%) developed psoriasis and 1 (2.1%) psoriatic arthritis. The mean age of patients was 47 years; three (6.5%) patients had a past history of psoriasis. Infliximab caused cutaneous reactions in the most number, 26 (56.5%) cases. Thirty seven (80.4%). patients developed primary plaque-type psoriasis. Women accounted for 86.9% of patients. There was complete resolution of psoriasis in 12 (26%) patients despite differences in the therapeutic approach. Cessation of the incriminated drug led to resolution of cutaneous lesions in 5 (10.8%), switching to another TNFα antagonist led to resolution in 6 (13%) and one (2.1%) patient improved despite continuation of the drug. As for the lone case of psoriatic arthritis, drug withdrawal did not result in improvement; only switching to another anti-TNFα agent helped. Since our sample was small, it was not adequately powered to draw any firm conclusions. However, in this analysis, we found that paradoxical reactions occurred predominantly in adult women, there were only isolated cases with a personal history of psoriasis, infliximab was responsible for most cases of these reactions and the most prevalent form was plaque-type psoriasis. The decision whether to continue or discontinue the triggering anti-TNFα agent should be individualized as results are highly variable.

Epidemiological aspects of genital warts in romania - a 2012 retrospective survey.

OBJECTIVES: Genital infection with human papillomavirus (HPV) has become one of the most frequently viral sexually transmitted diseases. The infection may remain asymptomatic, may take the form of external genital warts and may give raise to cervical cancers. The aim of this study was to assess the frequency of the patients with genital warts addressing to five tertiary referral dermato-venereological units in Romania (where patients from several counties are referred) and to compare the results with the out-patient data reported by all Romanian hospitals. MATERIAL AND METHODS: Data regarding patients with external genital warts who addressed to the hospital emergency rooms, in five tertiary referral dermato-venerological units in Romania (Bucharest, Timisoara, Craiova, Constanta, Târgu-Mures) were collected for the year 2012. For comparison there have been used data collected by the National School of Public Health, Management and Professional Development, during the same year. OUTCOMES: Data reported at national level in 2012 included 952 patients (731 women and 221 men) with 26 males under 20 years of age and 251 female patients in the age group 0-20 years. In the overall population (males and females combined) the total number of genital warts cases registered at the hospital emergency rooms in the five centers, in the year 2012, was 266 patients (119 men and 147 women) with 4 girls under 14 years of age and 6 male patients in the age group 0-14 years. CONCLUSIONS: The high prevalence of the infection with HPV, the costs of treatment and the psychological impact prove that prevention of the disease is the most important step for decreasing the incidence of this disease. General measures for patients awareness regarding the disease and its complications need to be completed with the recommendation for vaccination. A closer monitoring of patients would provide information for a strategic national approach leading to a better outcome.