Dermoscopy of skin metastases in advanced cancer-systemic (visceral, hematologic) and cutaneous.

Introduction: Skin metastases arise in 10% of cancer patients, but standardized dermoscopy diagnostic criteria for skin metastases remain poor. This study's objective was to analyze the dermoscopy features of skin metastases from advanced systemic and cutaneous cancers. Methods: A retrospective study on 715 dermoscopy images of skin metastases from 33 patients with various primary cancers (breast, ovary, melanoma, non-melanoma skin cancer, and chronic leukemia) attending two academic centers between 2013 and 2023 was performed. Four independent observers blindly analyzed patterns, colors, vessels, and elementary lesions for each metastasis (30 parameters in total). Results: The structureless white pattern was the most prominent indicator of cutaneous metastasis (81.26%, p < 0.001). Regardless of the primary tumor, colors pink, red, white, and tan were identified. Elementary lesions were infrequent, except for melanoma metastases that displayed dots (13.23%) and globules (11.11%). Breast cancer metastases presented: blue (41.48%) and red (34.32%) colors, irregular vessels (13.58%), and a blue-naevus pattern (22.22%). Melanoma metastases displayed: a blue-naevus pattern (61.38%), a blue color (85.71%), and a structureless-blue combination pattern (79.37%). Non-melanoma skin cancer metastases were characterized by vascular (42.11%) and angioma-like (31.58%) patterns, pink (57.89%) and red (57.89%) colors, irregular (57.89%), thin hairpin (47.37%), comma (47, 37%), and thick hairpin (26, 32%) vessels and a red, white and irregular vessels combination pattern (52, 63%). A pink structureless combination pattern was frequent (61.05%) in chronic leukemia metastases. Ovarian cancer metastases displayed a white and tan structureless combination pattern (100%) and frequently had dotted vessels (42.85%). Conclusion: Papules and nodules with a white structureless pattern suggest skin metastases, regardless of the primary tumor. A blue structureless lesion is indicative of melanoma metastasis and a vascular pattern with irregular vessels indicates a non-melanoma skin cancer metastasis. Dermoscopy stands as a reliable non-invasive diagnostic method for suspected cutaneous metastases in patients with a known cancer history.

Basal cell carcinoma-a clinical indicator of immunosuppression.

Background: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are skin-derived carcinomas. The literature strongly connects SCC with acquired immunosuppression. Current data regarding BCC's association with immunosuppressive comorbidities are vague. The primary objective of this study was to establish the correlations between BCC and immunosuppressive comorbidities of patients. Materials and methods: We conducted a retrospective cohort study on 275 patients with a histopathological proven diagnosis of BCC from October 2019 to October 2023. Demographic data, BCC characteristics, and patients' comorbidities were analyzed. Comorbidities were classified as non-immunosuppressant and immunosuppressant (primary and secondary immunodeficiencies). Results: We recorded 292 BCCs from 275 patients (142 females, 133 males), with equally distributed skin phototypes. 66.44% of the BCCs were detected in patients with various comorbidities (p < 0.001), of which 81.44% had immunosuppressive comorbidities (p < 0.001). All the immunosuppressive comorbidities were secondary and included diabetes mellitus (47.55%), history of solid or hematogenous cancer in the last 5 years (26.57%), chronic kidney disease (8.39%), chronic infections (9.09%), and antirheumatic immunosuppressive therapies (8.39%) (p < 0.001). BCC patients with immunosuppressive comorbidities did not develop larger BCCs (p = 0.2577) or more aggressive subtypes (p = 0.4269) and BCC did not arise earlier in their life (p < 0.001). BCC on the nasal pyramid was frequent in cancer history patients (p = 0.008). The ulcerated form of BCC is more confined to patients with chronic kidney disease (p = 0.006). Multiple BCCs are more frequent in patients with secondary immunodeficiencies (p = 0.027). Conclusion: BCC represents a clinical indicator of secondary immunodeficiency. Further research should establish if cancer screening campaigns may be beneficial in BCC patients.

Inverse problem for parameters identification in a modified SIRD epidemic model using ensemble neural networks.

In this paper, we propose a parameter identification methodology of the SIRD model, an extension of the classical SIR model, that considers the deceased as a separate category. In addition, our model includes one parameter which is the ratio between the real total number of infected and the number of infected that were documented in the official statistics. Due to many factors, like governmental decisions, several variants circulating, opening and closing of schools, the typical assumption that the parameters of the model stay constant for long periods of time is not realistic. Thus our objective is to create a method which works for short periods of time. In this scope, we approach the estimation relying on the previous 7 days of data and then use the identified parameters to make predictions. To perform the estimation of the parameters we propose the average of an ensemble of neural networks. Each neural network is constructed based on a database built by solving the SIRD for 7 days, with random parameters. In this way, the networks learn the parameters from the solution of the SIRD model. Lastly we use the ensemble to get estimates of the parameters from the real data of Covid19 in Romania and then we illustrate the predictions for different periods of time, from 10 up to 45 days, for the number of deaths. The main goal was to apply this approach on the analysis of COVID-19 evolution in Romania, but this was also exemplified on other countries like Hungary, Czech Republic and Poland with similar results. The results are backed by a theorem which guarantees that we can recover the parameters of the model from the reported data. We believe this methodology can be used as a general tool for dealing with short term predictions of infectious diseases or in other compartmental models.

A regime switch analysis on Covid-19 in Romania.

In this paper we propose a three stages analysis of the evolution of Covid19 in Romania. There are two main issues when it comes to pandemic prediction. The first one is the fact that the numbers reported of infected and recovered are unreliable, however the number of deaths is more accurate. The second issue is that there were many factors which affected the evolution of the pandemic. In this paper we propose an analysis in three stages. The first stage is based on the classical SIR model which we do using a neural network. This provides a first set of daily parameters. In the second stage we propose a refinement of the SIR model in which we separate the deceased into a distinct category. By using the first estimate and a grid search, we give a daily estimation of the parameters. The third stage is used to define a notion of turning points (local extremes) for the parameters. We call a regime the time between these points. We outline a general way based on time varying parameters of SIRD to make predictions.

A Conservative Combined Laser Cryoimmunotherapy Treatment vs. Surgical Excision for Basal Cell Carcinoma.

Surgical excision is the standard treatment for basal cell carcinoma (BCC), but it can be challenging in elderly patients and patients with comorbidities. The non-surgical guidelines procedures are usually regarded as monotherapy options. This quasi-experimental, non-randomized, comparative effectiveness study aims to evaluate the efficacy of a combined, conservative, non-surgical BCC treatment, and compare it to standard surgical excision. Patients with primary, non-ulcerated, histopathologically confirmed BCCs were divided into a conservative treatment (129 patients) and a standard surgery subgroup (50 patients). The conservative treatment consisted of ablative CO2 laser, cryosurgery, topical occlusive 5-fluorouracil, and imiquimod. The follow-up examinations were performed 3 months after remission, then every 3 to 6 months, and were extended with telephone follow-ups. Cosmetic-self assessment was recorded during a telephone follow-up. Subjects from the conservative subgroup presented a clearance rate of 99.11%, and a recurrence rate of 0.98%. No recurrences were recorded in the surgical group, nor during the telephone follow-up. There were no differences regarding adverse events (p > 0.05). A superior self-assessment cosmetic outcome was obtained using the conservative method (p < 0.001). This conservative treatment is suitable for elders and patients with comorbidities, is not inferior to surgery in terms of clearance, relapses, or local adverse events, and displays superior cosmetic outcomes.