Basal cell carcinoma arising in outdoor workers versus indoor workers: a retrospective study.

Basal cell carcinoma (BCC) is the most prevalent malignancy in white individuals and continues to be a serious health problem. Individuals who have sustained exposure to UV radiation are at the highest risk for developing BCC. The aim of this study was to compare the features of BCC in outdoor workers (OWs) with a history of occupational exposure to UV radiation versus indoor workers (IWs). We found that OWs are more likely to develop nodular BCC with no increased risk for superficial BCC. The age of onset of BCC was older in OWs than in IWs. Truncal BCC was more common in IWs, which may suggest other etiological factors are involved in BCC such as genetic predisposition.

Smoothelin and WT-1 expression in glomus tumors and glomuvenous malformations.

BACKGROUND: Smoothelin is a specific marker for smooth muscle cells with contractile capacity which has not been widely studied in glomus lesions. In the same way, the expression for Wilms tumor 1 (WT1) has only been studied occasionally in the endothelial cells of glomovenous malformations and in the glomus cells of glomus tumours. OBJECTIVE: We studied the significance of immunohistochemical expression of smoothelin and WT1 in 25 glomus lesions. METHODS: We assessed 9 cases of solid glomus tumors (SGT), 8 cases of glomus tumors with vascular ectasia (VEGT), 2 cases of glomangiomyomas (GMM) and 6 cases of glomuvenous malformation (GM). Immunohistochemistry was performed, evaluating the expression of WT1, smoothelin, smooth muscle actin (SMA), smooth muscle myosin (SMM), h-caldesmon and desmin. RESULTS: Glomic cells showed cytoplasmic positivity for smoothelin, and WT1 expression was present in all studied cases. SGT showed WT1 positivity in all endothelia. However, in regarding VEGT and GMM, WT1 endothelial expression was positive in some areas, but not in others. GM did not show endothelial cell positivity for WT1. CONCLUSIONS: Smoothelin expression in glomic cells indicates that they are contractile smooth muscle cells, and thus its role in routine diagnosis should be considered. The absence of WT1 expression in the endothelium of the vascular structures of the GM is a differential characteristic between SGT, VEGT and GMM.

Primary cutaneous and subcutaneous leiomyosarcomas: evolution and prognostic factors.

Cutaneous and subcutaneous leiomyosarcomas (LMS) are uncommon neoplasms. We reviewed the MEDLINE database to assess their rates of recurrence and metastasis, mortality and recommended follow-up period. Other prognostic factors were also studied. This review included 112 subcutaneous LMS and 313 cutaneous LMS. In subcutaneous LMS, we observed that rates of recurrence, metastasis and mortality were 36.63%, 43.23% and 37.82%, respectively, after a median follow-up period of 4.40 years, while in cutaneous LMS those figures were 24.40%, 4.22% and 3.33%, respectively, after a median follow-up period of 3.45 years. Although subcutaneous and cutaneous LMS show similar morphologic features, the latter show less tendency to recur and metastasize; in certain cases they both may be the cause of death. For these reasons we suggest avoiding the term "atypical intradermal smooth muscle neoplasm". Location, size and histologic grade are essential prognostic factors for superficial LMS. Recurrence after incomplete excision can be avoided when performed with a surgical margin of at least 1 cm. Follow-up should be at least five years.

Basal cell carcinoma: analysis of factors associated with incomplete excision at a referral hospital in southern Spain.

Basal cell carcinoma (BCC) is the most prevalent malignancy, with excision as the best therapeutic approach. Incomplete excision of nonmelanoma skin cancer is a clinical indicator of the surgical technique performed. This retrospective study of 292 patients with BCC assessed the rate of incomplete excision in a tertiary referral hospital in southern Spain and its relationship with tumor location as well as histologic and surgical features.

Factors related to delay in the diagnosis of basal cell carcinoma.

BACKGROUND: There is often a delay between the clinical emergence of a basal cell carcinoma (BCC) and the point in time at which the patient presents for definitive diagnosis and treatment. Previously published studies on delays regarding skin cancer have focused on melanoma rather than BCC. We conducted a study aimed at identifying factors associated with the detection of BCC and reasons for the delay in diagnosis. METHOD: A monocentric study was performed. Patients with a primary BCC diagnosed in 2010 were included in the study. They were asked about factors concerning BCC awareness and detection, tumor characteristics, previous history of nonmelanoma cutaneous cancer, family history of nonmelanoma cutaneous cancer, and the presence of comorbidities. Data were analyzed using SPSS software. RESULTS: The mean diagnostic delay for BCC in our hospital setting was estimated at 19.79 ± 14.71 months. Delayed diagnosis was significantly associated with patients over 65 years, those without a previous history of BCC, those without a family history of BCC, those with BCC located elsewhere than the head or neck, and those with lesions not associated with itching or bleeding. CONCLUSION: This study revealed considerable delay in the diagnosis of BCC. The main reason for delay in the diagnosis seems to be the initial decision of the patient to seek medical advice. These data suggest a need for greater information for the general public on the symptoms and signs that should prompt suspicion of a BCC.

MT1 melatonin receptor expression in Warthin's tumor.

We contribute the first immunohistochemical study of MT1 melatonin receptor in Warthin's tumor and normal parotid gland. All 14 Warthin's tumors studied showed intense cytoplasmic positivity for MT1 receptor in all cylindrical epithelial cells lining spaces and a less intense positivity in basal cells. The lymphoid component accompanying the tumor was always negative for MT1 receptor. The parotid structure surrounding the tumor showed intense cytoplasmic positivity in all cells lining excretory ducts (lobar and lobulillar), with a lesser and focal positivity in cells of the acinar component. The biological activity of MT1 receptor in epithelial cells lining parotid excretory ducts may resemble its activity in Warthin's tumor cells. Hence, we propose Warthin's tumor as a useful positive control in immunohistochemical studies of MT1 melatonin receptor.

MTNR1A receptor expression in normal and pathological human salivary glands.

AIM: To analyze and compare the expression of MTNR1A receptor in normal and pathological major and minor salivary glands. MATERIALS AND METHODS: Twenty samples of major and minor salivary glands and 10 with Warthin's tumor were studied. Expression of the MTNR1A receptor (goat polyclonal antibody raised against a peptide mapping at the N-terminus of MEL-1A R of human origin) was analyzed. RESULTS: The excretory ducts of major salivary glands demonstrated intense intracytoplasmic positivity but scant cytoplasmic membrane positivity for MTNR1A. The studied Warthin's tumors showed intense cytoplasmic positivity for MT1 receptor in all cylindrical epithelial cells lining spaces and a less intense positivity in basal cells. The lymphoid component accompanying the tumor was negative for MT1 receptor. CONCLUSION: Intense intracytoplasmic positivity for the MTNR1A receptor in the excretory ducts of human major and minor salivary glands and Warthin's tumor was found. The intense expression of MTNR1A receptors observed in this study in the excretory ducts of major and minor salivary glands may be related to salivary regulation.

Alcohol intake and risk of aggressive histological basal cell carcinoma: a case-control study.

BACKGROUND: Aggressive basal cell carcinomas (BCC) are not rare. These subtypes of skin cancer are characterized by an infiltrative behavior and rapid progression. Often, management may be difficult. Recent evidence suggests that minimal UV exposure in combination with other behavioral and/or environmental factors may lead to higher incidence of BCC and, therefore, more risk of aggressive subtypes of this malignancy. Alcohol is a very commonly consumed beverage in Western societies, especially in association with outdoors activities. OBJECTIVE: To investigate a possible relationship between alcohol intake and aggressive histological variants of BCC. MATERIALS AND METHOD: We designed a prospective study. Patients who underwent surgery for BCC in our hospital were interviewed to collect data regarding alcohol intake. The specimens were reviewed by a pathologist and classified into aggressive and non-aggressive subtypes. Statistical analysis was performed using SPSS software. RESULTS: 136 patients were included. Of participants with aggressive BCCs, 10 (26.3%) were abstainers, 4 (10.4%) had light consumption, 18 (47.5%) moderate consumption and 6 (15.8%) heavy consumption, while among participants with non-aggressive BCCs, 57 (58.2%) were abstainers, 29 (29.5%) had light consumption, 10 (10.2%) moderate consumption and 2 (2.1%) heavy consumption. In the multivariate analysis we found a positive significant association between alcohol consumption and the presence of aggressive BBCs. CONCLUSIONS: According to our results, alcohol intake may be linked with a higher incidence of aggressive subtypes of BCC.

Effect of non-steroidal anti-inflammatory drugs on the histology of basal cell carcinomas.

BACKGROUND: Aggressive histology is not rare in BCC. Large studies from referral centers report incidences of aggressive histology BCC ranging from 2.5- 44%. These aggressive BCC are characterized by subclinical extension, invasive behavior, local recurrence and challenging treatment. OBJECTIVES: To examine the association between non-steroidal anti-inflammatory drug (NSAID) use and the different histological subtypes of basal cell carcinoma (BCC). METHODS: The design was a nested case-control study. The two population-based cohorts were of patients with a primary BCC diagnosis during January and May 2010 (n=136) and NSAID use in the 15 years prior to baseline. All the lesions were excised and analyzed to determinate the histological subtype of BCC as aggressive or non-aggressive. Odds ratios (ORs) and 95% confidence intervals (CIs), using conditional logistic regression, were calculated with the SPSS software to estimate the association of aggressive histological subtypes of BCC and use of NSAID. We controlled the potential confounding factors. RESULTS: The rate of non-aggressive BCC associated with exposure to NSAID was increased (OD: 0.34; 95% CI: 0.14-0.84) after adjusting for covariants. LIMITATIONS: our sample is small. We collected data regarding use of NSAID over a wide time ranges, so that we are unable to propose when the potential benefits of NSAID on the histology of BCC would happen. CONCLUSION: According to our data, NSAID exposure is associated with a decreased risk of aggressive BCC.

Hemangiopericytoma-like dermatofibroma with mast cells.

We report an unusual case of hemangiopericytoma-like dermatofibroma in the right shoulder of an 82-year-old patient with a well-defined nodular growth located in the dermis. Microscopic study revealed a band of haphazardly arranged cells with a vascular component of gaping, simple, endothelial-lined vascular structures with intervening postcapillary venules and capillary-sized slit-like "staghorn" vascular channels filled with erythrocytes; abundant mast cells were also observed. The neoplasm cells were positive for CD68 and Factor XIIIA and negative for CD34. Few data have been published on the presence of abundant mast cells (tryptase and CD117 positive) in these neoplasm. The differential diagnosis of this entity should consider other spindle cell neoplasm, including hemangiopericytoma/solitary fibrous tumor, dermatofibrosarcoma protuberans, myopericytoma, angioleiomyoma, amelanotic melanoma, pecoma, and benign and malignant peripheral nerve tumors. We present an infrequent case of dermatofibroma with a vascular pattern resembling hemangiopericytoma and the presence of abundant mast cells, which may be responsible for this vascular component.

A new perspective in Oral health: potential importance and actions of melatonin receptors MT1, MT2, MT3, and RZR/ROR in the oral cavity.

BACKGROUND: Melatonin is involved in many physiological processes in mammals, amongst others; it is implicated in sleep-wake regulation. It has antioxidant and anti-inflammatory properties. It also acts as an immunomodulator, stimulates bone metabolism and inhibits various tumours. Additionally an abnormal melatonin rhythm may contribute to depression and insomnia. The mechanisms of action of melatonin include the involvement of membrane receptors (MT1, MT2), cytosolic binding sites (MT3 and calmodulin), and nuclear receptors of the RZR/ROR family. Melatonin also has receptor-independent activity and can directly scavenge free radicals. The current review addresses the functions of melatonin in the oral cavity in relation to its receptors. METHODS: An extensive search was conducted on the following scientific databases Pub Med, Science Direct, ISI Web of Knowledge and Cochrane database in order to review all pertinent literature. RESULTS: Melatonin from the blood into the saliva may play an important role in suppressing oral diseases. It may have beneficial effects in periodontal disease, herpes and oral cancer, amongst others. CONCLUSIONS: Melatonin contributes to protecting of oral cavity from tissue damage due to its action of different receptors. From the reviewed literature it is concluded that experimental evidence suggests that melatonin can be useful in treating several common diseases of the oral cavity. Specific studies are necessary to extend the therapeutic possibilities of melatonin to other oral diseases.

Melatonin and cancer: current knowledge and its application to oral cavity tumours.

BACKGROUND: Melatonin (MLT) is a molecule secreted by the pineal gland in cyclical periods. In mammals, MLT is involved in physiological processes, such as sleep/wake regulation in the circadian cycle. It has antioxidant and anti-inflammatory properties, functions as an immunomodulator, and stimulates bone metabolism. MLT is also involved in tumour processes in breast, prostate, liver, and bone cancers, among others, and in oral cavity tumours like epidermoid carcinoma. We are gradually increasing our knowledge of the underlying mechanism of MLT action in the aforementioned tumour processes, in which MT1, MT2, MT3, and RZR receptors appear to play a highly important role. These receptors belong to a large family of G-protein-coupled transmembrane receptors, some of which have been linked to melatonin's anticancer action, to tumour growth, and to prognosis. The objective of this article is to provide a clear review of research into the range of MLT functions, focusing specifically on MT receptors. We aim to contribute interesting, new approaches to research into oral cavity tumours. METHODS: An extensive review of the research literature was conducted using PubMed, Science Direct, ISI Web of Knowledge, and the Cochrane base. RESULTS: This study highlights the growing importance of MLT in the prognosis and treatment of certain tumours, including epidermoid carcinoma in the oral cavity. Moreover, it opens up a highly original, encouraging line of research in the field of tumours. CONCLUSIONS: MLT contributes to protecting the oral cavity from tissue damage caused by receptor action. Experimental evidence suggests that it may be useful in the treatment and prognosis of tumour processes in the oral cavity.

Acantholytic-like malignant melanoma: an unusual morphologic variant.

We report the case of a primary cutaneous melanoma with acantholytic-like changes in a 61-year-old man. Clinical and immunohistochemic features were similar to those of other superficial spreading with vertical growth melanomas. Histologically, intraepidermal and suprabasal bullous spaces were filled by isolated tumor cells, simulating acantholytic blisters. These findings could be explained by the presence of inflammation-related extracellular fluid. Two other cases with suprabasal discohesive atypical melanocytes have recently been described. We report the first case of malignant melanoma with an intense and diffuse pattern of dyscohesion, resembling acantholysis. Recognition of this histologic pattern in malignant melanoma is important to avoid a misdiagnosis.

Myositis ossificans circumscripta without history of trauma.

UNLABELLED: Myositis ossificans circumscripta is a form of heterotopic ossification that is benign in nature associated to a trauma, but may appear clinically and radiologically as a malignant neoplasm. We describe a rare case of calcifying of myositis ossificans not associated to trauma in a 35-year-old woman with a mass in her upper third and external of right thigh. We discuss some of the difficulties of diagnosis and histological evolution of the lesion. KEYWORDS: Myositis ossificans; Thigh; Differential diagnosis; Nontraumatic.

Cutaneous granular cell tumor of the breast: a clinical diagnostic pitfall.

UNLABELLED: We report the clinical-morphological study of a granular cell tumor in dermal/hypodermal junction and subcutaneous fat left breast of an 83-year-old woman with a family history of breast carcinoma. Mammography study showed a spiculated lesion in the lower inner quadrant with suspicion of malignancy. The results of fine needle puncture-aspiration were inconclusive. Subsequent tumorectomy revealed a poorly-defined indurated lesion of 1.1 x 0.7 cm. The histopathology study showed a proliferation of cells with ample and granular cytoplasm that were positive for S100, CD 68 and inhibin and negative for hormonal receptors. We present a benign lesion that clinically reproduces a breast carcinoma. KEYWORDS: Granular cell tumor; Breast; Differential diagnosis; Cutaneous.