[Chinese guildeline on diagnosis and treatment of basal cell carcinoma (2023 edition)].

Basal cell carcinoma (BCC) is the most common skin malignancy, with a higher prevalence in Caucasians than in East Asians. Although there is a lack of epidemiological data in China, it is generally believed that the incidence of BCC in China is increasing due to the aging population. A variety of risk factors are related to the occurrence of BCC, among which ultraviolet rays and gene mutations play a major role, especially the abnormal activation of Hedgehog (Hh) signaling pathway, which is considered to be the most important pathogenesis of BCC. The clinical manifestations of BCC are highly specific, and most experienced doctors can make a preliminary diagnosis by clinical manifestations. Dermoscopy and other imaging methods can greatly improve the accuracy of diagnosis, but there are still some atypical or rare types of BCC that need further confirmation through histopathological examination. This guideline is initiated by the National Clinical Research Center for Skin and Immune Diseases (based on Peking University First Hospital). It has invited a panel of experts consisting of 24 senior dermatologists specializing in dermatologic surgery from the Dermatologic Surgery Group of the Chinese Medical Doctor Association of Dermatology, the Dermatologic Surgery Group of the Dermatology & Venereology Committee, Chinese Association of Integration Medicine, and the Dermatologic Surgery and Cosmetic Branch of Clina Leprosy Association. In addition, experts from the Burn and Plastic Surgery (Maxillofacial), Ophthalmology, Otolaryngology, Head and Neck Surgery, Radiation Therapy, and Pathology were also invited to participate. This panel forms the "Chinese Guideline for the Diagnosis and Treatment of Basal Cell Carcinoma" expert group. Based on the latest domestic and international research findings, the guideline was developed through four rounds of discussions by the expert group and revised to provide valuable references for clinical healthcare providers in the diagnosis and treatment of BCC.

Five-year pattern of adnexal tumors of the skin in Ethiopia.

BACKGROUND: Adnexal tumors of the skin are rare neoplasms that encompass a wide range of dermatologic entities. Here, we investigated the pattern of adnexal tumors of the skin in the All African Leprosy and Tuberculosis Rehabilitation and Training Center (ALERT) hospital retrospectively. METHODS: A hospital-based retrospective study was conducted at ALERT from histopathology records in the Armauer Hansen Research Institute (AHRI) pathology laboratory of patients diagnosed with any of the skin adnexal tumors during the time period January 2017 to December 2021. A structured data extraction sheet was used. Data entry was done using EpiData 4.6.0.6. Data were analyzed using SPSS version 25. RESULT: A total of 146 skin adnexal tumors were identified making the magnitude 2.8% of total biopsies. The 3rd decade of life was found to be the most common age group. Male-to-female ratio was 1 : 1.05. Majority of the tumors were benign (82.2%) and had sweat gland differentiation at 48.6%. Poroma (10.9%) was the most frequent tumor, whereas porocarcinoma (6.8%) made up the most frequent malignant tumor. The most common site was the head and neck region (48.6%). Only 21.2% of the tumors were correctly identified clinically. CONCLUSION: The magnitude of skin adnexal tumors is found to be slightly higher than other similar studies which could be because it was carried out in the largest dermatologic center in the country. The most common skin adnexal tumors identified, their localizations, and lines of differentiation are all in line with other studies. Histopathologic examination is mandatory for the accurate diagnosis of these tumors.

Follicular mycosis fungoides: Clinicohistopathologic features and outcomes in a series of 12 Chinese cases.

Background Follicular mycosis fungoides is a distinct variant of mycosis fungoides with a broad clinical spectrum. Recently, many studies have indicated that follicular mycosis fungoides should be divided into different subtypes with disparate prognoses. Objective To define the clinicohistopathologic features and outcomes of follicular mycosis fungoides and to identify risk factors that may be related to the prognosis of Chinese patients with follicular mycosis fungoides. Materials and methods We conducted a single-centre retrospective study and reviewed the clinical, histopathologic and immunophenotypic data of 12 patients diagnosed with follicular mycosis fungoides between 2009 and 2020 in the Department of Dermatology of West China Hospital of Sichuan university. Results A total of 12 patients (seven males and five females) with a mean age of 30 ± 14 years (age range 16-55 years) were included. Scalp and face were the most common involved sites (100%). Follicular papules, acneiform lesions, plaques, and nodules, were the main clinical presentations. Histopathological findings were consistent with the classic manifestations of follicular mycosis fungoides, including folliculotropism, perifollicular and intrafollicular lymphocytic infiltrates and mucinous degeneration. Interferon α-1b was the most common treatment. Four patients died of follicular mycosis fungoides in three years. Notably, immunohistochemical analysis revealed a decreased number of CD20+ cells in the deceased patients. Limitations This is a retrospective evaluation with a small number of cases; further prospective studies are warranted to support our inferences. Conclusion Our patients were much younger than in previous studies. The observed difference in this cohort may be explained by race, in addition to the limited number of cases. A decreased number of B cells might be associated with a poor prognosis, and more studies are necessary to discover the role of B cells in follicular mycosis fungoides as well as in mycosis fungoides.

The association between skin cancer and HIV infection.

Background People affected by Human Immunodeficiency Virus (HIV), are burdened by a higher risk of developing malignancies including non-melanoma skin cancer (NMSC) and melanoma skin cancer. Objective To evaluate the association of HIV with melanoma and NMSC at a University Hospital. Methods This is a cross-sectional retrospective study of HIV-infected and a matched comparison group, analyzing the associations between skin cancer and HIV infection. Results Compared to the HIV-uninfected, HIV-infected had 80% association with skin cancer (CI 95%: 1.3-2.4, P = 0.001) The risk was 45-fold higher by patients" age (CI 95%: 3.3-15.9: P = 0.001). When adjusted for patient age, sex and race, the risk was 6.4 fold ligher of having cancer if compared to the others (CI 95%: 49-84, P = 0.001). Melanoma was not found in HIV-infected. Conclusion With this study, we have demonstrated that HIV-infected patients have an increased risk of BCC and SCC. Preventive dermatologic management is pivotal in the care of immunosuppressed patients. These patients must undergo the dermatological examination annually and should receive extensive counseling regarding sun avoidance, use of sunscreens,and sun-protective clothing.

The role of mobile teledermoscopy in skin cancer triage and management during the COVID-19 pandemic.

The unprecedented onset of the COVID-19 crisis poses a significant challenge to all fields of medicine, including dermatology. Since the start of the coronavirus outbreak, a stark decline in new skin cancer diagnoses has been reported by countries worldwide. One of the greatest challenges during the pandemic has been the reduced access to face-to-face dermatologic evaluation and non-urgent procedures, such as biopsies or surgical excisions. Teledermatology is a well-integrated alternative when face-to-face dermatological assistance is not available. Teledermoscopy, an extension of teledermatology, comprises consulting dermoscopic images to improve the remote assessment of pigmented and non-pigmented lesions when direct visualisation of lesions is difficult. One of teledermoscopy's greatest strengths may be its utility as a triage and monitoring tool, which is critical in the early detection of skin cancer, as it can reduce the number of unnecessary referrals, wait times, and the cost of providing and receiving dermatological care. Mobile teledermoscopy may act as a communication tool between medical practitioners and patients. By using their smartphone (mobile phone) patients can monitor a suspicious skin lesion identified by their medical practitioner, or alternatively self-detect concerning lesions and forward valuable dermoscopic images for remote medical evaluation. Several mobile applications that allow users to photograph suspicious lesions with their smartphones and have them evaluated using artificial intelligence technology have recently emerged. With the growing popularity of mobile apps and consumer-involved healthcare, this will likely be a key component of skin cancer screening in the years to come. However, most of these applications apply artificial intelligence technology to assess clinical images rather than dermoscopic images, which may lead to lower diagnostic accuracy. Incorporating the direct-to-consumer mobile dermoscopy model in combination with mole-scanning artificial intelligence as a mobile app may be the future of skin cancer detection.

Risk of skin cancer in kidney, liver and heart recipients: A nationwide population-based study in Taiwan.

Background Previous population-based studies in western countries had revealed increased skin cancer risk among transplant recipients compared to the general population. However, population-based studies in Asia on skin cancer among recipients of different transplanted organs were lacking in the literature. Aims This study aims to estimate skin cancer risk among recipients in Taiwan, examine the association between each specific type of skin cancer and each type of transplanted organ, and compare skin cancer risk between different immunosuppressive regimens. Methods This population-based retrospective cohort study identified 7550 patients with heart, lung, kidney or liver transplantation and 30,200 controls matched for gender, age and comorbidity index from the National Health Insurance Research Database in Taiwan between 2000 and 2015. Using multivariable Cox proportional hazard models, we estimated the hazard ratios and 95% confidence intervals for the correlation of skin cancer with organ transplantation as well as immunosuppressive regimen. Results Organ transplant recipients in Taiwan had an increased risk of skin cancer with adjusted hazard ratios of 4.327 (95% confidence intervals 2.740-6.837, P < 0.001), with the greatest risk, observed among heart recipients (adjusted hazard ratios 6.348, 95% confidence intervals 3.080-13.088, P < 0.001). The risk of non-melanoma skin cancer and melanoma was 4.473 (95% confidence intervals 2.568-7.783, P < 0.001) and 3.324 (95% confidence intervals 1.300-8.172, P < 0.001), respectively. When comparing immunosuppressants, those with calcineurin inhibitors carried the highest risk of skin cancer (adjusted hazard ratios 4.789, 95% confidence intervals 3.033-7.569, P < 0.001), followed by those with antimetabolites (adjusted hazard ratios 4.771, 95% confidence intervals 3.025-7.541, P < 0.001). Limitations We could not evaluate confounding behavioural risk factors of skin cancers that were not documented in the database, nor could we recognize patients' compliance with immunosuppressants. Conclusion Organ recipients have a greater risk of skin cancer. Clinicians should inform recipients of the importance of photoprotection and regular dermatologic follow-up.

Dermoscopic features of basal cell carcinoma in skin of color: A retrospective cross-sectional study from Puducherry, South India.

BACKGROUND: Dermoscopy is useful in the diagnosis of basal cell carcinoma (BCC). However, most descriptions of the dermoscopic features of BCCs are in Caucasians (skin types I-III) and there is a paucity of data in dark-skinned Indian patients. AIMS: The aim of this study was to describe the various dermoscopic features of BCC in dark-skinned patients from South India and correlate these with the histopathologic subtypes. METHODS: A retrospective observational study of biopsy-proven cases of BCC was conducted at a tertiary care center in South India using nonpolarized contact dermoscopy. RESULTS: Sixty BCCs in 35 patients predominantly of skin phototypes IV or V were studied. These included 32 nodular, 27 superficial and 1 infiltrative type of BCC. The most common dermoscopic features noted were maple leaf-like areas (61.7%), blue-white veils (53.4%), ulceration (48.4%) and short fine telangiectases (46.7%). Ulceration, blue-white veils and arborizing vessels were significantly associated with nodular BCCs, while maple leaf-like areas, red-white structureless areas, multiple small erosions and spoke wheel areas were noted with superficial BCCs. LIMITATIONS: The limitations of this study include its retrospective nature, the use of only nonpolarized light for examination, the lack of other histopathological variants of BCC as well as the lack of a comparison group. CONCLUSION: We report a dermoscopic study of BCC in dark-skinned patients from Puducherry, South India. The blue-white veil was observed in half of the patients and was significantly associated with nodular BCCs. The addition of the blue-white veil to the diagnostic criteria for pigmented BCC could improve the diagnostic accuracy of dermoscopy in Indian patients.

Onychomatricoma on the fourth toenail: A rare tumor in a rare localization.

Onychomatricoma is a rare benign tumor of the nail matrix, characterized by finger-like projections that invade the nail plate. The fingernails of Caucasian women are most commonly affected. Because this tumor can easily mimic other more prevalent ungual diseases, it is crucial to be acquainted with its characteristic clinical and histopathologic features. The authors present a case of a 40-year-old man with an onychomatrichoma in the fourth left toenail, which was initially misdiagnosed and treated as onychomycosis.