Cutaneous squamous cell carcinoma (CSCC) is the second most frequent cancer in humans, and is now responsible for as many deaths as melanoma. Immunotherapy has changed the therapeutic landscape of advanced CSCC after the FDA approval of anti-PD1 molecules for the treatment of locally advanced and metastatic CSCC. However, roughly 50% of patients will not respond to this systemic treatment and even those who do respond can develop resistance over time. The etiologies of primary and secondary resistance to immunotherapy involve changes in the neoplastic cells and the tumor microenvironment. Indirect modulation of immune system activation with new therapies, such as vaccines, oncolytic viruses, and new immunotherapeutic agents, and direct modulation of tumor immunogenicity using other systemic treatments or radiotherapy are now under evaluation in combined regimens. The identification of predictors of response is an important area of research. In this review, we focus on the features associated with the response to immunotherapy, and the evaluation of combination treatments and new molecules, a more thorough knowledge of which is likely to improve the survival of patients with advanced CSCC.
BACKGROUND: Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. METHODOLOGY/PRINCIPAL FINDINGS: From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. CONCLUSIONS/SIGNIFICANCE: Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control.
Community Health Services , Scabies/diagnosis , Scabies/epidemiology , Acaricides/therapeutic use , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Malawi/epidemiology , Male , Rural Population , Scabies/drug therapy , Young Adult
Se denomina leucemia cutánea aleucémica a la invasión cutánea por células leucémicas en ausencia de afectación de sangre periférica y/o médula ósea. Aunque se desconocen los mecanismos patogénicos de esta enfermedad, está ampliamente aceptado su pronóstico grave. En la mayoría de los casos publicados se describe la expresión completa del proceso hematológico (con mayor frecuencia leucemias agudas monocíticas o granulocíticas) en los 10-14 meses posteriores al inicio del cuadro cutáneo, así como una supervivencia media de unos 22 meses. Presentamos el caso de un paciente varón de 77 años con leucemia cutánea aleucémica que inició la enfermedad en forma de múltiples lesiones papulonodulares eritematovioláceas en tronco y cabeza, con ausencia de afectación de sangre periférica y alteraciones incipientes en médula ósea. El estudio inmunohistoquímico, tanto de las lesiones cutáneas como de médula ósea, demostró la invasión de ambos tejidos por células tumorales pertenecientes a la estirpe monocitohistiocitaria. El paciente presentó una desaparición espontánea de las lesiones cutáneas, así como una ausencia de progresión del cuadro hematológico en los 9 meses posteriores al diagnóstico, a pesar de no haberse sometido a ningún tratamiento. Destacamos la baja incidencia de asociación entre síndromes mielodisplásicos y leucemias cutáneas aleucémicas, así como la sorprendente resolución espontánea de las lesiones cutáneas en nuestro caso (AU)
Aged , Male , Humans , Leukemia/complications , Leukemia/diagnosis , Leukemia/epidemiology , Leukemia, Monocytic, Acute/complications , Leukemia, Monocytic, Acute/diagnosis , Immunohistochemistry/methods , Myelodysplastic Syndromes/complications , Myelodysplastic Syndromes/diagnosis , Leukemic Infiltration/diagnosis , Lumpy Skin Disease/complications , Lumpy Skin Disease/diagnosis , Skin Diseases/diagnosis , Tomography, Emission-Computed/methods , Skin Manifestations , Drug Therapy/methods , Drug Therapy/trends
