Basal cell carcinoma: differences according to anatomic location and clinical-pathological subtypes.

AIM: Basal cell carcinoma (BCC) is the most common skin malignant neoplasm in humans. Its localization and its clinical-pathological aspects are fundamental for the treatment and the outcome of these tumors. We wanted to verify if different clinical-pathological subtypes of BCC may be present with different frequencies on single skin areas. METHODS: Three hundred six patients affected by BCC seen in Sant'Andrea Hospital, U.O.C. Dermatology, NESMOS Department, Faculty of Medicine, University of Rome "Sapienza", from January 2008 to December 2010, were retrospectively included in this study. Findings from all patients were tabulated and analyzed to characterize the clinical-pathological aspects of BCC according to their anatomic localization. We considered the following clinical subtypes of BCC, nodular, superficial, sclerodermiform, pearly and ulcerative. RESULTS: One hundred ninety-seven out of 306 patients (64.4%) were localized on the head, 6 (1.9%) on the neck, 73 patients (23.9%) on the trunk, 2 (0.6%) on the perineum, 4 (1.3%) on upper limbs and 24 (7.9%) on legs. On the head BCC were mostly nodular (44.7%). On the trunk they were mostly superficial (34.3%). BCC on legs were ulcerative in all the 24 patients. CONCLUSION: Our data confirm that BCC may have different clinical-pathological aspects on single skin areas. Interestingly in our casistic BCC on the legs were present in an uncommon high percentage. They presented as ulcerative lesions and this fact leads to conclude that in every patient presenting a chronic ulcer on the leg with difficulty to be cured a biopsy is mandatory to put in evidence the possible presence of BCC and consequently to perform the correct surgical treatment to obtain a complete response for the patient.

Occurrence of salivary gland tumours in two patients treated with biological agents.

We report two cases of salivary gland tumors arising in two psoriatic patients treated with an anti- TNF-alpha agent. A clear causal relationship could not be established, but the exceptional onset of a bilateral Warthin's tumor in one of these patients should be emphasized.

A case of lichen amyloidosus treated with acitretin.

Lichen amyloidosus is a cutaneous dermatosis clinically characterized by an hyperkeratotic brownish-grey papular eruption located on trunk and extremities, associated to severe pruritus. Histologically it is characterized by amyloid deposits in the papillary derma. Amyloid is an amorphous substance, probably derived by apoptotic keratinocites and other protein such as Apolipoprotein E. The exact pathogenesis of this deposition is not yet understood but some factors can act as favourable agents, such as pruritus. In fact this dermatosis is often associated to intensely pruritic conditions. Its treatment is very difficult but is important, because patients refer a bad quality of life. In literature have been described a lot of therapeutic options, often unefficacious. We describe herein the case of a 39-year old patient affected by Lichen amyloidosis, treated with acitretin a good improvement of cutaneous lesions and a complete resolution of pruritus after only three weeks of treatment. At actual follow-up of eight months the results are maintained.