The efficacy of long-term psoralen plus ultraviolet A and low-dose interferon-a combination therapy in mycosis fungoides: A literature review.

BACKGROUND/PURPOSE: Interferon (IFN)-a is often used in combination with psoralen plus ultraviolet A (PUVA) in patients with mycosis fungoides (MF) refractory to skin-targeted therapies in early or advanced stages. The main objective is to evaluate the effectiveness of combined PUVA and low-dose IFN-α-2a therapy in patients with early- and advanced-stage MF. METHODS: Sixty-eight patients who received a combination of PUVA twice or thrice a week and INF-a 3 MU thrice a week for at least 3 months were reviewed retrospectively. The treatment response was evaluated as complete remission (CR), partial remission, stable disease, or progression. RESULTS: At the initiation, the majority of patients (66.2%) had early-stage disease. In 27.9% of cases, this was the initial treatment administered following the diagnosis of MF. The median duration of combination therapy was 11 months. Complete remission was achieved in 45.6% of the patients with an overall response rate of 60.3%. The mean duration of response was 5 months. Complete remission was statistically significantly higher in early-stage patients (p < .05). No statistically significant correlation was observed between CR and gender, histopathological features, or laboratory parameters. In patients with CR, 80% experienced relapse, significantly higher in early-stage patients (p < .05). However, there was no significant difference in disease-free survival between early and advanced stages (p > .05). CONCLUSIONS: The study results indicated that PUVA + low-dose INF-a combination therapy was more effective in the early stage than in the advanced stage. Additionally, there was a high relapse rate after the cessation of treatment in patients who achieved CR.

Dermatoscopic profiling of inverted follicular keratosis in different skin phenotypes.

BACKGROUND: Inverted follicular keratosis (IFK) is a rare benign tumour of the follicular infundibulum. Owing to its similarity to other benign and malignant cutaneous lesions, it poses a diagnostic challenge. There is limited information on the dermatoscopic characteristics of IFK and the majority of cases have been reported in patients with lighter skin types. OBJECTIVES: To describe the prevalent dermatoscopic features of IFK, especially in patients with skin of colour. METHODS: We retrospectively analysed 35 histopathologically verified cases of IFK from a single university hospital in Turkey. RESULTS: With respect to the Fitzpatrick skin phototype, 2 (6%), 12 (34%), 16 (46%) and 5 (14%) patients had Fitzpatrick skin phototypes II, III, IV and V, respectively. Clinically, the majority of IFKs were hypopigmented or nonpigmented (83%). Pink-white structureless areas (54%), ulceration (54%), a central keratin mass (43%) and blood spots on keratin mass (43%) were the most frequent dermatoscopic findings. Pigmented structures were observed as blue-grey structureless areas in 12 lesions and as blue-grey clods in 5, primarily in Fitzpatrick phototype IV and V skin. The incidence of a pink, structureless area and blood spots on ulceration was found to be statistically significantly higher in individuals with fairer skin types, while a greater prevalence of blue-grey coloration was observed in those with skin of colour (P < 0.05). CONCLUSIONS: Although our study found some distinguishing dermatoscopic findings in IFK, diagnosis is generally confirmed by histopathology, as the clinical appearance and dermatoscopic findings may not be sufficient to differentiate it from other tumours, especially squamous cell carcinoma or keratoacanthoma. The dermatoscopic characteristics of dark skin are comparable to those of pale skin; however, hyperpigmentation can be more noticeable in skin of colour.

A Comprehensive Study on Aberrant CD20-Positive Mycosis Fungoides: Clinical and Prognostic Insights.

BACKGROUND: As the majority of T-cell lymphomas lack CD20 expression, cases of mycosis fungoides (MF) exhibiting aberrant CD20 expression are exceedingly uncommon. OBJECTIVES: We aim to comprehensively evaluate the clinical, histopathological, and prognostic features of 7 patients diagnosed with CD20-positive MF. METHODS: This retrospective study examines seven cases of MF with aberrant CD20 expression. The study provides details of demographics, clinical features, histopathology and treatment outcomes. Key time points include initial diagnosis of MF, detection of CD20 expression and follow-up, with a mean follow-up of 46 months. RESULTS: Aberrant CD20-positive MF was diagnosed at an average age of 58.6 years, approximately 5.6 years after first MF diagnosis. Following CD20 detection, patients presented with advanced disease stages, requiring treatments such as chemotherapy, brentuximab vedotin, and allogeneic hematopoietic stem cell transplantation. Four patients died from lymphoma, with an average survival time of 52 months. CONCLUSIONS: Aberrant CD20 expression in MF is rare but indicates a progressive course associated with poor prognosis. This often requires systemic chemotherapy and, in certain instances, allogeneic hematopoietic stem cell transplantation. This study provides important insights into the clinical attributes, disease progression, and treatment options for MF patients with aberrant CD20 expression. Further research is necessary to validate the effectiveness of emerging therapies and enhance our understanding of the underlying mechanisms and prognostic determinants specific to this unique MF subgroup.

Dermatoscopic patterns of cutaneous metastases: A multicentre cross-sectional study of the International Dermoscopy Society.

BACKGROUND: The detection of cutaneous metastases (CMs) from various primary tumours represents a diagnostic challenge. OBJECTIVES: Our aim was to evaluate the general characteristics and dermatoscopic features of CMs from different primary tumours. METHODS: Retrospective, multicentre, descriptive, cross-sectional study of biopsy-proven CMs. RESULTS: We included 583 patients (247 females, median age: 64 years, 25%-75% percentiles: 54-74 years) with 632 CMs, of which 52.2% (n = 330) were local, and 26.7% (n = 169) were distant. The most common primary tumours were melanomas (n = 474) and breast cancer (n = 59). Most non-melanoma CMs were non-pigmented (n = 151, 95.6%). Of 169 distant metastases, 54 (32.0%) appeared on the head and neck region. On dermatoscopy, pigmented melanoma metastases were frequently structureless blue (63.6%, n = 201), while amelanotic metastases were typified by linear serpentine vessels and a white structureless pattern. No significant difference was found between amelanotic melanoma metastases and CMs of other primary tumours. CONCLUSIONS: The head and neck area is a common site for distant CMs. Our study confirms that most pigmented melanoma metastasis are structureless blue on dermatoscopy and may mimic blue nevi. Amelanotic metastases are typified by linear serpentine vessels and a white structureless pattern, regardless of the primary tumour.

Postauricular linear basal cell carcinomas related to medical mask cords: a possible association.

Linear basal cell carcinoma (BCC) is a distinct clinical morphological variant of BCC. Although it has been speculated that trauma and the Koebner phenomenon may be linked to linear BCC, the pathophysiology has not yet been shown. Herein, 5 cases of BCC were presented that developed in the postauricular region as a result of trauma caused by the cords of the medical face masks worn during the COVID-19 pandemic.

Efficacy of Long-Pulsed Nd:YAG Laser for Classic Kaposi's Sarcoma: A Dermoscopic Study.

INTRODUCTION: Classic Kaposi's sarcoma (CKS) is a chronic and indolent skin tumor. Because CKS has a low mortality rate but can have a significant impact on quality of life, it is important to choose safe, long-term treatments with minimal side effects. OBJECTIVES: The aim was to assess the efficacy of long-pulsed Nd:YAG laser therapy in treating CKS based on clinical and dermoscopic observations. METHODS: Forty-two nodular lesions from three CKS patients (stage 4) were treated using a long-pulsed Nd:YAG laser with a spot size ranging from 3 to 7 mm, a fluence of 200-250 j/cm2, and a pulse duration lasting between 10 and 20 milliseconds in one or two sessions. Patients were photographed clinically and dermoscopically before the procedure, immediately after the procedure, and at 1, 6, and 12 months after the procedure. RESULTS: All participants displayed significant clinical and dermoscopic improvements, and all lesions healed within 2-3 weeks, resulting in only minor atrophic scars. No instance of recurrence was found among any of the patients during the 1-year follow-up. CONCLUSIONS: Nd:YAG laser therapy may prove to be an effective therapeutic alternative for both early and advanced-stage CKS, specifically in instances of stubborn cutaneous lesions or patients receiving systemic therapy. The treatment results in quick improvement, typically within 2-3 weeks, and is well tolerated. Nd:YAG laser therapy could provide potential benefits for HIV-positive patients as it is free from immunosuppression, easy to apply to recurring lesions, and demonstrates overall effectiveness and safety.

"String of pearls pattern": report of three cases of non clear-cell acanthoma

Abstract The coiled and dotted vessels in a serpiginous arrangement or "string of pearls" is considered a classical vascular pattern associated with clear cell acanthoma. We present three cases of epidermal tumors different from clear cell acanthoma that have the same "string of pearls" vascular pattern. Even though most authors keep considering the "string of pearls" vascular pattern an almost pathognomonic sign of clear-cell acanthoma, the cases presented here suggest that some other epidermal tumors can also show this pattern.