A case of multiple atypical nevi with co-localized Basal cell carcinomas on the scalp: insight into the pathogenesis.

The authors report a case of a 29-year-old female with multiple lesions on the scalp containing an atypical nevus and a co-localized basal cell carcinoma (BCC) in the same specimen. This is the first description of such a case in the literature. The peculiar co-existence of these 2 neoplasms in the same specimen in multiple skin lesions raises the possibility of an unknown mutation(s) that increases the risk of developing both conditions; and this case illustrates that the signaling pathways mediating the development of atypical nevi may interact with those associated with BCCs. Additionally, crosstalk between melanocytes and basal keratinocytes, which are both located in the basal layer of the epidermis, may contribute to the development of these coexisting neoplasms.

Impact of a dermatology wiki website on dermatology education.

BACKGROUND: The Dermatology Education Wiki (dermwiki) website serves as a resource platform for medical students and residents. The readily accessible interface provides dermatology articles, survival guides, didactic lectures, and links to faculty talks as well as research opportunities. OBJECTIVE: To assess medical student and resident satisfaction with the dermwiki website. METHODS: Fourth-year medical students taking a dermatology elective were provided with a temporary password to access relevant dermwiki information. A satisfaction survey was created to assess whether medical students found the website helpful. Second- and third-year dermatology residents were also surveyed to compare satisfaction scores prior to and after the introduction of the dermwiki website. End-of-rotation medical student exam scores were tabulated and compared to the average scores from years prior to the development of the dermwiki website. RESULTS: Medical students rated the dermatology elective with the dermwiki website higher than rotations without a wiki (8.12 vs 7.31). Students planning to go into dermatology were more satisfied with the dermwiki website, reported accessing the website more frequently (11 times vs 9.5 times), and reported more time spent studying (12.2 hours vs 6.7 hours) than students not going into dermatology. End-of-rotation medical student exam scores did not differ from those prior to the development of the demwiki website. Ten second- and third-year dermatology residents unanimously stated that they were more satisfied with the program after the institution of the dermwiki website. CONCLUSIONS: Overall, addition of the dermwiki website to the dermatology elective curriculum has improved medical student and resident satisfaction scores. The improvement is greater among students planning to enter the field of dermatology. This study serves as a model for the incorporation of internet-based interactive tools to transform and supplement the learning environment.

Collodion baby: an update with a focus on practical management.

Collodion baby is an uncommon clinical presentation of several genetic conditions, primarily disorders of cornification. The severely compromised epidermal barrier presents the greatest challenge during the newborn period and advances in neonatal care have significantly improved the prognosis. This review summarizes the clinical characteristics, complications, outcomes, and differential diagnosis of the collodion baby. A practical approach to management based on the literature and clinical experience is presented.

Hidradenitis suppurativa: surgical and other management techniques.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, recurrent, painful, debilitating, and emotionally distressing disease. OBJECTIVE: This article aims to provide a comprehensive review of HS, with a focus on surgical and procedural therapies for this devastating disease. MATERIALS AND METHODS: By searching PubMed using the keyword "hidradenitis suppurativa," this author identified 718 articles on this disease, among which surgical and other procedural treatments for HS represent the most common topic. This literature was reviewed. RESULTS: Management of this devastating disease comprises medical, surgical, and other procedural therapies. Medical management can be successful in controlling mild diseases, but recurrences are frequent. Surgery is considered the only curative therapy for HS. CONCLUSION: More randomized controlled trials are needed to clarify the relative efficacy of various treatment modalities; however, surgical and procedural treatments can be more successful than medical treatments, especially for patients with severe diseases.

Melanoma in situ treated successfully using imiquimod after nonclearance with surgery: review of the literature.

BACKGROUND: The standard of care for melanoma in situ (MIS) is surgical removal by surgical excision with a 5-mm margin or Mohs micrographic surgery, but as more and more MIS is diagnosed in the head and neck region, surgeries may not be an option for patients when the lesions are large or less well defined. In addition, when negative margins cannot be achieved without grossly disfiguring the patient or when patients have medical comorbidities that preclude a surgical option, other treatment modalities may be considered. Recently, topical treatment with an immunomodulator, imiquimod, has been proposed as an alternative treatment for MIS. OBJECTIVE: We report a case of MIS successfully treated with topical imiquimod cream. In addition, because there has not been any comprehensive review of the use of topical imiquimod on melanoma and MIS, we conducted an extensive literature search and reviewed the topic in detail. MATERIALS AND METHODS: Using the keywords "imiquimod," "melanoma," "melanoma-in-situ," and "lentigo maligna," we searched the literature using PubMed in an attempt to find all relevant articles on the use of imiquimod on MIS or melanoma. RESULTS: There were 46 reports involving 264 patients on the use of imiquimod on MIS or lentigo maligna. Twenty-three reports were published on the use of imiquimod on metastatic melanoma involving 55 patients, and two articles were on melanoma, with two patients in total. In addition, there were two articles on the use of imiquimod on dysplastic or atypical nevi with a total of 13 subjects. CONCLUSION: Imiquimod appears to be beneficial in the treatment of MIS and melanoma metastases when surgical options are not feasible. Imiquimod should not be used for removal of dysplastic or atypical nevi. The treatment regimens varied from study to study, and there are no randomized controlled trials in the literature. More studies are needed to develop a reliable and reproducible treatment regimen, to fully elucidate the role of imiquimod in the treatment of MIS and melanoma, and to determine the prognostic predictors for favorable responses to imiquimod.

Green tea polyphenol epigallocatechin-3-gallate suppresses melanoma growth by inhibiting inflammasome and IL-1ß secretion.

Epigallocatechin-3-gallate (EGCG), the major polyphenolic component of green tea, has been demonstrated to possess anti-inflammatory, antioxidant, anti-mutagenic and anti-carcinogenic properties. The anti-melanoma effect of EGCG has been previously suggested, but no clear mechanism of action has been established. In this study, we demonstrated that EGCG inhibits melanoma cell growth at physiological doses (0.1-1 µM). In the search for mechanisms of EGCG-mediated melanoma cell suppression, we found that NF-κB was inhibited, and that reduced NF-κB activity was associated with decreased IL-1ß secretion from melanoma cells. Since inflammasomes are involved in IL-1ß secretion, we investigated whether IL-1ß suppression was mediated by inflammasomes, and found that EGCG treatment led to downregulation of the inflammasome component, NLRP1, and reduced caspase-1 activation. Furthermore, silencing the expression of NLRP1 abolished EGCG-induced inhibition of tumor cell proliferation both in vitro and in vivo, suggesting a key role of inflammasomes in EGCG efficacy. This paper provides a novel mechanism for EGCG-induced melanoma inhibition: inflammasome downregulation→decreased IL-1ß secretion→decreased NF-κB activities→decreased cell growth. In addition, it suggests inflammasomes and IL-1ß could be potential targets for future melanoma therapeutics.

Inflammasomes as molecular mediators of inflammation and cancer: potential role in melanoma.

The inflammasome is a multi-protein complex that mediates immune responses to microbial, host, and environmental signals. When active, inflammasomes regulate caspase-1 activation and IL-1ß secretion. There is a strong link between inflammation and cancer, and IL-1ß is one of the major molecules involved in both of these disease processes. Here we review the role of inflammasomes in regulating IL-1ß secretion, and the impact of this pathway on cancer pathogenesis, with a focus on melanoma. This represents an exciting new area of research, and could potentially result in new targets for melanoma therapeutics in the future.

Granulomatous reaction to silicone injection.

The use of liquid injectable silicone for soft tissue augmentation is controversial. Proponents of its use consider it safe when highly purified medical-grade product is employed appropriately by well-trained and experienced physicians, whereas opponents believe complications from silicone injections are inherently inevitable and unpredictable and that they outweigh the benefits. One of the feared complications is granuloma formation. In this article, the authors report two cases of granulomatous nodules from silicone injections and present the histological features. These cases highlight the need for continued vigilance among clinicians about this complication and the importance not only of careful selection of filler products, but also of patients knowing the credentials of their injection practitioners.

Side population cells from human melanoma tumors reveal diverse mechanisms for chemoresistance.

Side population (SP) cells are identified as cells capable of excluding the fluorescent Hoechst dye and anticancer drugs, and it represents hematopoietic stem cells and chemoresistant cells from several solid tumors. In this study, we confirmed the presence of SP cells in tumors from melanoma patients. Melanoma SP cells overexpressed ATP-binding-cassette (ABC) transporters, ABCB1 and ABCB5. We generated a direct in vivo xenograft model, and demonstrated that SP cells were resistant to paclitaxel, a substrate of ABCB1, both in vitro and in vivo. However, melanoma SP cells were also resistant to temozolomide, which is not a substrate for ABC transporters, through IL-8 upregulation. In addition, gene profiling studies identified three signaling pathways (NF-κB, α6-ß4-integrin, and IL-1) as differentially upregulated in melanoma SP cells, and there was a significant increase of PCDHB11 and decrease of FUK and TBX2 in these cells. Therefore, we provide evidence that SP is an enriched source of chemoresistant cells in human melanomas, and suggest that the selected genes and signaling pathways of SP cells may be a potential target for effective melanoma therapies. To our knowledge, this is a previously unreported study to isolate SP cells from melanoma patients and to investigate the gene expression profiling of these cells.