Eosinophilic pustular folliculitis of infancy: A rare diagnosis in children.

Remember EPFI as a differential diagnosis in children with a rash on the scalp and no effect of antibiotic treatment.

The Danish Nonmelanoma Skin Cancer Dermatology Database.

AIM OF DATABASE: The Danish Nonmelanoma Skin Cancer Dermatology Database was established in 2008. The aim of this database was to collect data on nonmelanoma skin cancer (NMSC) treatment and improve its treatment in Denmark. NMSC is the most common malignancy in the western countries and represents a significant challenge in terms of public health management and health care costs. However, high-quality epidemiological and treatment data on NMSC are sparse. STUDY POPULATION: The NMSC database includes patients with the following skin tumors: basal cell carcinoma (BCC), squamous cell carcinoma, Bowen's disease, and keratoacanthoma diagnosed by the participating office-based dermatologists in Denmark. MAIN VARIABLES: Clinical and histological diagnoses, BCC subtype, localization, size, skin cancer history, skin phototype, and evidence of metastases and treatment modality are the main variables in the NMSC database. Information on recurrence, cosmetic results, and complications are registered at two follow-up visits at 3 months (between 0 and 6 months) and 12 months (between 6 and 15 months) after treatment. DESCRIPTIVE DATA: In 2014, 11,522 patients with 17,575 tumors were registered in the database. Of tumors with a histological diagnosis, 13,571 were BCCs, 840 squamous cell carcinomas, 504 Bowen's disease, and 173 keratoakanthomas. CONCLUSION: The NMSC database encompasses detailed information on the type of tumor, a variety of prognostic factors, treatment modalities, and outcomes after treatment. The database has revealed that overall, the quality of care of NMSC in Danish dermatological clinics is high, and the database provides the necessary data for continuous quality assurance.

Use of sildenafil or other phosphodiesterase inhibitors and risk of melanoma.

BACKGROUND: Phosphodiesterase 5A inhibitors (PDEIs), a common treatment for erectile dysfunction, were recently linked to an increased risk of melanoma. METHODS: We conducted two parallel case-control studies, using the Danish Nationwide Health Registries (DNHR) and the Kaiser Permanente Northern California (KPNC) electronic health records. Identifying men with histologically verified melanoma (cases) matched on birth year to 10 cancer-free controls, we estimated odds ratios (OR) for melanoma associated with high use of PDEIs (⩾100 tablets filled), adjusting for available confounders. RESULTS: We identified 7045 DNHR and 2972 KPNC cases with invasive melanoma. The adjusted OR for invasive melanoma associated with high PDEI use was 1.22 (95% confidence interval (CI), 0.99-1.49) in DNHR and 0.95 (95% CI, 0.78-1.14) in KPNC. Odds ratios were highest for localised invasive melanoma in DNHR (OR, 1.21) and melanoma in situ in KPNC (OR, 1.15), and lowest for non-localised disease in both populations (ORs 0.75 and 0.61, respectively). The increased ORs were slightly attenuated upon adjustment for markers of health-care utilisation. CONCLUSIONS: We found little evidence for a causal association between PDEI use and risk of melanoma. The marginally increased risk of early stage disease likely resulted from more frequent health-care contacts among PDEI users.

The incidence of metastatic basal cell carcinoma (mBCC) in Denmark, 1997-2010.

BACKGROUND: Few data exist on the occurrence of metastatic basal cell carcinoma (mBCC). OBJECTIVE: To identify all cases of mBCC in Denmark over a 14-year period. METHODS: We searched the Danish National Patient Registry covering all Danish hospitals, the Danish Cancer Registry, the National Pathology Registry and the Causes of Death Registry during the period 1997 to 2010 for potential cases of mBCC registered according to the International classification of diseases ICD-10 and the International Systemized Nomenclature of Medicine (SNOMED). RESULTS: We identified 126,627 patients with a history of primary basal cell carcinoma (BCC) in the registries during the 14-year study period. Using case identifications from the four registries, a total of 170 potential mBCC cases were identified. However, after a pathology review, only five cases could be confirmed, of which three were basosquamous carcinomas. The 14-year cumulative incidence proportion of mBCC was 0.0039% (95% CI 0.0016-0.0083) among individuals with a history of previous BCC (n = 126,627) and 0.0001% (95% CI 0.0000-0.0002) in the general population. CONCLUSION: MBCC is a rare disease and only a small proportion of potential cases identified in automated clinical databases or registries can be confirmed by pathology and medical record review.

[Marked effect of botulinum toxin A for severe toe digital ulcers in a patient with systemic sclerosis]. / Eklatant effekt af botulinumtoksin A til svære digitale sår hos en patient med systemisk sklerose.

In this case we describe a successful combined treatment with local anaesthetics and botulinum toxin A. A 61-year-old man with systemic sclerosis of limited type presented treatment refractory digital ulcers on his toes with a poor response to conventional treatment. A combined treatment as above-mentioned prevented a threatening amputation and improved quality of life, reduction of pain and healing of wounds. Using botulinum toxin A combined with local anaesthetics to severe toe digital ulcers in patients with systemic sclerosis may be a solution, when other treatments have been ineffective and amputation seems to be the last option.

Quality of life in non-melanoma skin cancer--the skin cancer quality of life (SCQoL) questionnaire.

BACKGROUND: Disease-specific quality of life (QoL) questionnaires are increasingly used to provide patient-reported out-come measures in both malignant and non-malignant disease. OBJECTIVE: To create, validate and test the psychometrics of the Skin Cancer Quality of Life (SCQoL), which was designed to measure health-related QoL in patients with non-melanoma skin cancer affecting any area and undergoing any therapy. METHODS AND MATERIALS: The SCQoL was developed in a stepwise approach. Three pilot studies (testing content and face validity) and psychometric testing (scale structure, reliability, domains and known-groups validity, concurrent and convergent validity) were conducted. Rasch analyses were performed on the final questionnaire. RESULTS: The initial 10-item questionnaire was reduced to 9 items following interviews and inter-item correlations. The nine item scale was confirmed by Item Response Theory (IRT) and internal consistency. Differential Item Functioning (DIF) was found for a single item, but the effect was small. CONCLUSION: The final 9-item SCQoL is unidimensional and consists of 3 domains covering function, emotions and control. Furthermore there is one single global item. The total score range from 0 to 27. Higher score denote a greater impairment of the QoL.

[Silica exposure and the risk of systemic sclerosis]. / Kvartseksponering øger risikoen for systemisk sklerodermi.

The aetiology of systemic sclerosis (Ssc) is unknown, but there is evidence of environmental factors playing a part in disease development in a number of cases. By examining a group of male patients with Ssc we found significant exposure to silica in 26% (6/23) of the patients compared to 2,1% in the general working population in Denmark. In the article we review the association between silica and Ssc and suggest how to question and refer patients with SSc who are suspected to have been exposed to silica.

Completeness of TNM cancer staging for melanoma in the Danish Cancer Registry, 2004-2009.

BACKGROUND: The purpose of this study was to investigate the completeness of TNM (Tumor, Node, Metastasis) staging of melanoma in the Danish Cancer Registry (DCR). METHODS: We identified 8762 patients with a first primary diagnosis of melanoma from the DCR between 2004 and 2009. We obtained information on level of comorbidity, defined according to the Charlson Comorbidity Index, through the Danish National Patient Register. We computed the completeness of TNM staging overall and by each stage component. Analyses were stratified by gender, age, year of diagnosis, and level of comorbidity. We designed an algorithm that categorized melanoma stage as localized, regional, distant, or unknown. Owing to knowledge on clinical coding practice, we allowed for categorization of tumors with certain missing stage components. RESULTS: The overall completeness of the TNM staging was 78.4% (95% confidence interval [CI] 77.5-79.3). Completeness varied little by gender and year of diagnosis. However, completeness decreased from 83.5% (95% CI 81.7-85.3) in patients aged 0-39 years to 68.7% (95% CI 65.7-71.6%) in patients 80 years or older, and from 80.3% (95% CI 79.4-81.3) among patients with a low level of comorbidity to 67.4% (95% CI 63.1-71.4) among patients with a high level of comorbidity. Using the algorithm, 87.3% of cases could be assigned to one of the defined stage categories. CONCLUSION: The overall completeness of the TNM registration for melanoma was fairly high but varied with age and level of comorbidity. Thus, data on TNM stage should be used with caution in epidemiological and other research.

Nonsteroidal anti-inflammatory drugs and the risk of skin cancer: a population-based case-control study.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) may prevent the development of cancer by inhibiting cyclooxygenase (COX) enzymes, which are involved in carcinogenesis. Therefore, the authors of this report examined the association between NSAID use and the risk of squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and malignant melanoma (MM). METHODS: From 1991 through 2009, all incident cases of SCC (n = 1974), BCC (n = 13,316), and MM (n = 3242) in northern Denmark were identified. Approximately 10 population controls (n = 178,655) were matched to each case by age, gender, and county of residence. The use of aspirin, other nonselective NSAIDs, or selective COX-2 inhibitors was ascertained through a prescription database. Conditional logistic regression analyses adjusted for potential confounders were used to compute odds ratios as estimates of incidence rate ratios (IRRs). RESULTS: For NSAIDs overall, ever use (>2 prescriptions) compared with nonuse (≤2 prescriptions) was associated with a decreased risk of SCC (IRR, 0.85; 95% confidence interval [CI], 0.76-0.94) and MM (IRR, 0.87; 95% CI, 0.80-0.95), especially for long-term use (≥7 years) and high-intensity use (>25% prescription coverage during the total duration of use). NSAID use was not associated with a reduced risk of BCC overall (IRR, 0.97; 95% CI, 0.93-1.01), but the risk of BCC at sites other than the head and neck was reduced in association with long-term use (IRR, 0.85; 95% CI, 0.76-0.95) and high-intensity use (IRR, 0.79; 95% CI, 0.69-0.91). All estimates of reduced risk were driven primarily by the use of nonselective NSAIDs and older COX-2 inhibitors (diclofenac, etodolac, and meloxicam). CONCLUSIONS: The current results indicated that NSAID use may decrease the risk of SCC and MM.

Mortality in cancer patients with a history of cutaneous squamous cell carcinoma--a nationwide population-based cohort study.

BACKGROUND: Cutaneous squamous cell carcinoma (SCC) is associated with underlying immunosuppression, so it may be a prognostic marker in patients with subsequent cancer. We therefore conducted a nationwide population-based Danish cohort study to evaluate whether a history of cutaneuos SCC has prognostic impact in patients with one of the following index cancers: non-Hodgkin's lymphoma (NHL), or cancer of the lung, colon, rectum, breast, or prostate. METHODS: We used Danish medical databases, which cover the entire Danish population of 5.6 million inhabitants and linked them using the unique personal identification number assigned to all Danish residents. From 1982 through 2003, we identified 745 index cancer patients with and 79,143 without previous cutaneous SCC. Using Cox proportional hazards regression, we calculated adjusted mortality rate ratios (MRRs) with 95% confidence intervals (CIs). RESULTS: Overall, previous SCC was associated with an increased mortality of cancer (MRR 1.13, 95% CI: 1.04-1.23). When examining index cancers separately, increased MRRs were found for cancer of the lung (MRR 1.23, 95% CI: 1.05-1.43), colon (MRR 1.13, 95% CI: 0.92-1.40), rectum (MRR 1.29, 95% CI: 1.00-1.67), breast (MRR 1.09, 95% CI: 0.82-1.43), and NHL (MRR 1.09, 95% CI: 0.81-1.47), but not for prostate cancer (MRR 0.99, 95% CI: 0.83-1.18). CONCLUSIONS: Our results suggest that previous cutaneous SCC is associated with poor prognosis of some cancers. This finding stresses the importance of adherence to the existing recommendations of screening, diagnosis, and treatment of cancer in patients with a history of SCC.

[HPV infection might play a role in the development of non-melanoma skin cancer in immunocompetent individuals]. / HPV-infektion spiller måske en rolle for udvikling af nonmelanom hudkræft hos immunkompetente personer.

Human papillomavirus (HPV) is necessary for the development of cervical cancer and is also involved in vulvar, anus, penis and head and neck cancer. Little is known about the role of HPV infection in non-melanoma skin cancer (NMSC). Through a systematic review of the literature, we studied the HPV prevalence in immunocompetent individuals in relation to NMSC. We found that HPV, including multiple HPV types, tended to be more prevalent in NMSC, especially in squamous cell carcinoma (SCC) compared to basal cell carcinoma and healthy skin, indicating a potential link between HPV and SCC in immunocompetent individuals.

[Evaluation of the learning outcome in clinical rotations]. / Evaluering af læringsudbytte ved fokuserede ophold.

This article examines the learning outcome and obtainment of skills in clinical rotations. The survey involved junior doctors (JDs) and consultants responsible for education (CREs). The questionnaires covered different subjects rated on a scale. The response rate was 61% for JDs and 73% for CREs. The results show that a majority of both JDs and CREs find that the JDs obtain the skills described in the statement of aims, that the skills cannot be obtained otherwise and that the learning outcome is satisfactory compared to the use of resources.

Does hormone replacement therapy and use of oral contraceptives increase the risk of non-melanoma skin cancer?

OBJECTIVE: We aimed to examine whether use of hormone replacement therapy (HRT) and oral contraceptives (OC) affect the risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in women. METHODS: Using data from 29,875 women enrolled in the prospective "Diet, Cancer, and Health" study between 1993 and 1997, women with available information on HRT and OC use at baseline were identified. Statistical analyses were based on the Cox's proportional hazards model. RESULTS: The mean age at enrollment in the study was 56.7 years, whereas the mean age at the end of follow-up was 67.5 years. 1,175 cases of BCC and 76 cases of SCC were identified in the cohort during follow-up through 2007. The BCC incidence rate ratio was 1.15 (95% CI: 1.07-1.37) for ever users of HRT at baseline compared to never users, whereas risk of BCC was unaffected by duration of HRT use. Ever use of HRT was not associated with SCC risk but a significantly increased risk of 1.35 (95% CI: 1.05-1.72) associated with every 5 years of HRT use was observed. No convincing associations between OC use and BCC or SCC risk were observed. CONCLUSION: The findings indicated that HRT but not OC may increase the risk of NMSC. However, further studies are warranted as risk estimates for SCC had relatively low precision due to a limited number of SCC cases.

Hip fracture history and risk of nonmelanoma skin cancer: a Danish population-based study.

BACKGROUND: Vitamin D deficiency is associated with osteoporotic fractures, such as hip fracture. Sun exposure, the natural source of vitamin D, is the main risk factor for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In this study, we examined the association between a history of hip fracture and risk of BCC and SCC. METHODS: We conducted a population-based case-controlled study using data on BCC and SCC cases registered in the Danish Cancer Registry from 1990-2005. For each case, we selected five population controls matched by age and gender. We used conditional logistic regression to compute odds ratios (OR) and 95% confidence intervals (CI), while adjusting for chronic diseases and socioeconomic status. RESULTS: A history of hip fracture was associated with a decreased risk of BCC (OR 0.90, 95% CI 0.85-0.94), which was most pronounced in cases of tumors on the trunk, extremities, or at multiple sites. We found no association for SCC (OR 1.07, 95% CI 0.98-1.17). CONCLUSION: Our study showed an inverse association between history of hip fracture and risk of BCC, but not of SCC. Sun exposure, resulting in vitamin D synthesis, may explain the link between the two diseases.

Lasers or light sources for treating port-wine stains.

BACKGROUND: Port-wine stains are birthmarks caused by malformations of blood vessels in the skin. Port-wine stains manifest themselves in infancy as a flat, red mark and do not regress spontaneously but may, if untreated, become darker and thicker in adult life. The profusion of various lasers and light sources makes it difficult to decide which equipment is the best for treating port-wine stains. OBJECTIVES: To study participant satisfaction, clinical efficacy, and adverse effects of the treatment of port-wine stains by lasers and light sources. SEARCH METHODS: We searched the following databases up to April 2010: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE (from 2005), EMBASE (from 2007), LILACS (Latin American and Caribbean Health Science Information database, from 1982), and reference lists of articles. We also searched online trials registries for ongoing trials and contacted trial authors where appropriate. SELECTION CRITERIA: Randomised clinical trials (RCTs) of lasers or light sources for the treatment of port-wine stains. DATA COLLECTION AND ANALYSIS: Our outcomes of interest were participant satisfaction, reduction in redness of the port-wine stain as determined by clinical evaluation, and short- and long-term adverse effects of the treatments. Three authors independently extracted data and assessed trial quality. MAIN RESULTS: We included 5 RCTs involving a total of 103 participants; all of the trials used a within-participant design. The interventions and outcomes were too varied to be combined statistically. All trials used the pulsed dye laser for comparisons.None of the studies focused on participant satisfaction, which was one of our primary outcomes, but participant preference was evaluated in three of five studies. Participants preferred the pulsed dye laser to intense pulsed light based on the clinical effect. They marginally preferred the Neodymium:YAG (yttrium-aluminium-garnet) (Nd:YAG) laser to the pulsed dye laser due to shorter lasting purpura, and pulsed dye laser in conjunction with cooling was preferred to treatment with pulsed dye laser alone.All trials examined short-term efficacy of less than six months after treatments with the pulsed dye laser, intense pulsed light, and Nd:YAG laser. The pulsed dye laser was evaluated in all five trials. Depending upon the setting of the pulsed dye laser, this resulted in more than 25% reduction in redness. This was after 1 to 3 treatments for up to 4 to 6 months postoperatively in 50% to 100% of the participants. There was only one study each of intense pulsed light and Nd:YAG laser.Two trials had no occurrence of long-term adverse effects, i.e. six months after treatment. Three trials reported pigmentary alterations in 3% to 24% of the participants, with the highest percentage occurring in Chinese participants with darker skin types. In one study one participant experienced scarring of the skin caused by a too-high dose of the laser used. Short-term side-effects included pain, crusting, and blistering in the first two weeks after treatment. AUTHORS' CONCLUSIONS: The pulsed dye laser leads to clinically relevant clearance of port-wine stains. A limited number of RCTs evaluated the efficacy from intense pulsed light and other laser types. High-quality RCTs are needed to assess individual efficacy from different lasers and light sources, as well as participant satisfaction.

[Presentation of atypical bullous pyoderma gangrenosum]. / Præsentation af atypisk bulløs pyoderma gangraenosum.

Pyoderma gangrenosum (PG) is a rare, ulcerative skin disease. Atypical PG is characterized by rapidly evolving painful vesicles and enlarging bullae. Minor trauma or surgery is considered the cause in 25-50% of PG lesions. PG often mimics necrotizing infection and may therefore be inadequately treated. We present a patient with rapidly progressing bullous PG. The lesions were initially treated surgically, which led to exacerbation of the ulcers. A decision of surgery should be preceded by bacterial culture and microscopy and in case of uncertain diagnosis also by histopathologic examination.