Human papillomavirus (HPV) infection has been suggested as a potential risk factor for Bowen's disease. Here, we report a case of a 40-year-old man with Bowen's disease on the finger showing a discontinuous skip lesion, in which HPV-34 was detected. Our case is a reminder that the possibility of multiple lesions must be considered when Bowen's disease occurs on the finger.
This case report describes a 17-year-old male patient with frog spawnlike vesicles around the urethra.
Lymphatic Abnormalities , Urethra , Female , Humans , Lymphatic Abnormalities/diagnosis , Lymphatic Abnormalities/drug therapy , Immunosuppressive Agents , Vulva , Sirolimus/therapeutic use
Basal cell carcinoma is the most common type of skin cancer, and surgical excision with clear margins is the standard of care. Surgical margins are determined based on risk factors (high or low risk) for recurrence according to the National Comprehensive Cancer Network and Japanese basal cell carcinoma guidelines. The clarity of the clinical tumor border (well-defined or poorly defined) is considered a risk factor, and significant discrepancies in the judgment of clinical tumor borders among dermato-oncologists may occur. Therefore, we analyzed the dermato-oncologists' concordance in judging the clinical tumor border of basal cell carcinoma. Forty-seven dermato-oncologists (experts: 37; young trainees: 10) participated in this study. The datasets of clinical and dermoscopic photographs of 79 Japanese cases of head and neck basal cell carcinoma were used to determine the concordance in the judgment of clinical tumor border. The probability of the border that was selected more often was used to calculate the rater agreement rate for each dataset. Correct judgment was defined as a more frequently selected border, and the concordance rate of clarity of clinical tumor border for each dermato-oncologist was calculated based on the definition of the correct judgment. A median concordance rate of 85% or higher for all dermato-oncologists was predefined as an acceptable rate for clinical use. Of the 79 datasets, rater agreement rates were 80-100%, 60-79%, and 51-59% for 55, 19, and five datasets, respectively. The median concordance rate for all dermato-oncologists was 86% (interquartile range: 82-89%). There was no significant difference in the concordance rate between the experts and the trainees (median, 87% vs. 85.5%; p = 0.58). The concordance rates of dermato-oncologists for all datasets were relatively high and acceptable for clinical use.
Carcinoma, Basal Cell , Head and Neck Neoplasms , Skin Neoplasms , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Humans , Japan , Judgment , Margins of Excision , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Skin Neoplasms/surgery
Low-grade neuroendocrine carcinoma of the skin (LGNECS) was proposed in 2017 as a new primary cutaneous neoplasm with neuroendocrine differentiation; however, it is not yet well known due to its rarity. Herein, we perform a detailed clinicopathologic analysis of 13 cases as well as panel DNA sequencing in three cases. The study included 12 males and 1 female with a median age of 71 (43-85) years. All lesions occurred on the ventral trunk. The mean tumor size was 2.2 (0.8-11.0) cm. The histopathology resembled that of well-differentiated neuroendocrine tumors (NETs) in other organs, but intraepidermal pagetoid spreading was seen in 8 (61.5%) cases and stromal mucin deposits in 4 (30.8%). Immunoreactivity for CK7, CK19, EMA, BerEP4, CEA, chromogranin A, synaptophysin, INSM1, GCDFP15, GATA3, ER, and bcl-2 were present in varying degrees in all tested cases. PTEN c.165-1G>A splice site mutation was detected by panel sequencing in one case, and GATA3 P409fs*99 and SETD2 R1708fs*4 in another case. Lymph node metastasis was seen significantly in cases with tumor size >2.0 cm [8/8 (100%) vs. 1/5 (20%)]. All three cases with size >3.0 cm were in unresectable advanced-stage [3/3 (100%) vs. 1/10 (10%)], and two of the three patients succumbed to the disease. The two cases of death revealed mild nuclear atypia (mitosis: 1/10 HPFs) and moderate nuclear atypia (2/10 HPFs). Thus, tumor size would be a better prognostic factor than nuclear atypia, mitotic count, and Ki67 index, unlike in NETs. These clinicopathologic and immunohistochemical features would represent the characteristics as skin adnexal tumors with apocrine/eccrine differentiation rather than NETs; therefore, we rename it as sweat-gland carcinoma with neuroendocrine differentiation (SCAND).
Carcinoma, Neuroendocrine/pathology , Carcinoma/pathology , Sweat Gland Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Carcinoma/genetics , Carcinoma/mortality , Carcinoma, Neuroendocrine/genetics , Carcinoma, Neuroendocrine/mortality , Female , Humans , Immunohistochemistry , Lymphatic Metastasis/pathology , Male , Middle Aged , Sweat Gland Neoplasms/genetics , Sweat Gland Neoplasms/mortality
Autoimmune polyendocrine syndrome (APS) is one of the life-threatening immune-related adverse events (irAEs). We firstly report a case of APS induced by adjuvant nivolumab therapy. Clinicians should be aware of the potential risks of developing severe irAEs when applying adjuvant immunotherapy.
Diabetes Mellitus, Type 1 , Polyendocrinopathies, Autoimmune , Thyroid Diseases , Adrenocorticotropic Hormone/adverse effects , Adrenocorticotropic Hormone/deficiency , Diabetes Mellitus, Type 1/chemically induced , Diabetes Mellitus, Type 1/drug therapy , Endocrine System Diseases , Genetic Diseases, Inborn , Humans , Hypoglycemia , Nivolumab/adverse effects , Polyendocrinopathies, Autoimmune/chemically induced , Thyroid Diseases/chemically induced
BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer. While Mohs micrographic surgery is commonly accepted for BCC treatment, surgical excision with free margins is widely considered the best treatment modality for BCCs in Japan. However, little is known about the predictors of the invasion levels of BCCs. OBJECTIVE: To investigate the optimization of deep surgical margins by identifying factors significantly influencing the invasion levels of facial BCCs. METHODS: The tumor invasion level was defined as the deepest part of a tumor. Tumor thickness was measured from the top of the granular layer to the deepest extension of the tumor or from the ulcer base overlying the deepest point of invasion in ulcerated lesions. Factors independently associated with tumor thickness and invasion level were identified by multivariate analysis. Six variables were tested: age, sex, anatomical region (nose, orbit, others), histologic pattern (aggressive, non-aggressive), presence of pigmentation, and diameter. RESULTS: We included 718 cases of facial BCCs involving 705 Japanese patients. The most frequent anatomical region and histologic pattern were the nose and nodular pattern, respectively. Only tumor diameter showed a correlation with tumor thickness (ß = 0.377, P < 0.001). Tumor diameter (AOR = 71.189, 95 % CI: 11.420-430.931, P = 0.01) and the following anatomical regions showed correlations with the invasion level: nose/others: AOR=2.769, 95 % CI: 1.235-6.493, P = 0.01; orbit/others: AOR=6.369, 95 % CI: 2.728-15.429, P < 0.001; orbit/nose: AOR=2.300, 95 % CI: 1.056-4.984, P = 0.04. CONCLUSIONS: This study serves as a guide for optimizing deep surgical margins and planning surgery for facial BCCs considering independently associated factors.
Carcinoma, Basal Cell/surgery , Dermatologic Surgical Procedures/methods , Facial Neoplasms/surgery , Margins of Excision , Skin Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Carcinoma, Basal Cell/diagnosis , Carcinoma, Basal Cell/pathology , Dermatologic Surgical Procedures/statistics & numerical data , Face , Facial Neoplasms/diagnosis , Facial Neoplasms/pathology , Female , Humans , Japan , Male , Middle Aged , Neoplasm Invasiveness , Patient Care Planning , Prognosis , Retrospective Studies , Skin/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Tumor Burden , Young Adult
Adenocarcinoma of Lung/therapy , Brain Neoplasms/radiotherapy , Chemoradiotherapy/adverse effects , Lichen Planus/etiology , Lung Neoplasms/therapy , Nivolumab/adverse effects , Adenocarcinoma of Lung/secondary , Aged , Brain Neoplasms/secondary , Female , Humans , Lichen Planus/pathology , Lung Neoplasms/pathology , Radiotherapy/adverse effects
Fibroma/diagnosis , Muscle, Skeletal/pathology , Soft Tissue Neoplasms/diagnosis , Subcutaneous Tissue/pathology , Aged, 80 and over , Biopsy , Female , Fibroma/pathology , Fibroma/surgery , Humans , Magnetic Resonance Imaging , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/surgery , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/surgery , Subcutaneous Tissue/diagnostic imaging , Subcutaneous Tissue/surgery , Thigh , Tomography, X-Ray Computed
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Etretinate/therapeutic use , Plant Extracts/therapeutic use , Skin Neoplasms/drug therapy , Administration, Oral , Aged, 80 and over , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/pathology , Female , Humans , Lip/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Treatment Outcome
Hemorrhage/chemically induced , Nail Diseases/chemically induced , Nails/pathology , Sleep Aids, Pharmaceutical/adverse effects , Zolpidem/adverse effects , Adult , Drug Substitution , Female , Hemorrhage/diagnosis , Hemorrhage/pathology , Humans , Nail Diseases/diagnosis , Nail Diseases/pathology , Sleep Aids, Pharmaceutical/administration & dosage , Sleep Initiation and Maintenance Disorders/drug therapy , Triazoles/administration & dosage , Young Adult , Zolpidem/administration & dosage
Collagen Type VII/genetics , Epidermolysis Bullosa Dystrophica/genetics , Collagen Type VII/ultrastructure , DNA Mutational Analysis , Epidermolysis Bullosa Dystrophica/diagnosis , Epidermolysis Bullosa Dystrophica/pathology , Homozygote , Humans , Infant , Male , Microscopy, Electron , Mutation , Severity of Illness Index , Skin/pathology , Skin/ultrastructure
Bandages , Epidermolysis Bullosa Simplex/drug therapy , Epidermolysis Bullosa Simplex/genetics , Keratin-5/genetics , Silicones/therapeutic use , Adult , Apgar Score , Blister , Epidermolysis Bullosa Simplex/diagnosis , Epidermolysis Bullosa Simplex/mortality , Female , Follow-Up Studies , Gestational Age , Humans , Infant , Infant, Newborn , Japan , Mutation , Pedigree , Treatment Outcome
Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Melanoma/pathology , Nivolumab/pharmacology , Skin Neoplasms/pathology , Aged , Disease Progression , Humans , Lymph Node Excision , Lymph Nodes/cytology , Lymph Nodes/drug effects , Lymphatic Metastasis/diagnostic imaging , Melanoma/diagnostic imaging , Melanoma/secondary , Melanoma/therapy , Necrosis/chemically induced , Nivolumab/therapeutic use , Sentinel Lymph Node Biopsy , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/therapy , Tomography, X-Ray Computed
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Lung Neoplasms/therapy , Melanoma/therapy , Skin Neoplasms/pathology , Aged, 80 and over , Chemoradiotherapy/methods , Drug Administration Schedule , Humans , Ipilimumab/administration & dosage , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Male , Melanoma/diagnostic imaging , Melanoma/secondary , Nivolumab/administration & dosage , Tomography, X-Ray Computed , Treatment Outcome