Clinicopathological evaluation of intralesional methotrexate in different subtypes of basal cell carcinoma.

Basal cell carcinoma (BCC) is the most common malignant skin tumor. While slowly growing, it can cause major skin disfigurement. Therefore, novel cosmetically acceptable treatment options, other than surgery require investigation. The aim of the study was to evaluate efficacy and safety of intralesional methotrexate (MTX) as a convenient modality for BCC treatment clinically and pathologicaly. A total of 20 patients with BCC of any clinical variant underwent intralesional MTX injection at a maximum 1 mL of 25 mg/mL MTX per session. Histopathological assessments were performed before and 1 month after treatment. Forty percent of patients showed >50% clinical improvement after 1-4 sessions. Intralesional MTX is a suitable and safe treatment modality for BCC and may be used as an adjuvant to surgery.

Post COVID-19 Head and Neck Mucormycosis: MR Imaging Spectrum and Staging.

OBJECTIVE: To develop a systematic approach for magnetic resonance imaging (MRI) analysis, imaging spectrum, and classification system for the staging of post-COVID-19 head and neck mucormycosis. METHOD: The study included 63 post-COVID-19 patients with pathologically proven mucormycosis who underwent head and neck MR imaging. Three independent radiologists assessed the imaging spectrum of mucormycosis, MRI characteristics of sino-nasal mucormycosis, and extra-sinus extension, and submitted a final staging using a systematic approach and a proposed categorization system. A consensus reading was considered the reference imaging standard. The kappa statistics were used to assess the categorization system's diagnostic reliability. RESULTS: The overall interreader agreement of the MR staging system was very good (k-score = 0.817). MR imaging spectrum involved localized sino-nasal mucormycosis (n = 7 patients, 11.1%), sino-nasal mucormycosis with maxillo-facial soft tissue extension (n = 28 patients, 44.5 %), sino-nasal mucormycosis with maxillo-facial bony extension (n = 7 patients, 11.1%), sino-naso-orbital mucormycosis (n = 13 patients, 20.6%), and sino-nasal mucormycosis with cranium or intracranial extension (n = 8 patients, 12.7%). Extra-sinus extension to the orbit and brain did not have significant association with involvement of the posterior ethmoid/sphenoid sinuses and maxillo-facial regions (p > 0.05). MRI-based staging involved four stages: stage 1 (n = 7, 11.1%); stage 2 (n = 35, 55.6%), and stage 3 (n = 13, 20.6%), and stage 4 (n = 8, 12.7%). Involvement of the bone and MR-based staging were significant predictors of patients' mortality p = 0.012 and 0.033, respectively. CONCLUSION: This study used a diagnostic-reliable staging method to define the imaging spectrum of post-COVID-19 head and neck mucormycosis and identify risk variables for extra-sinus extension.

A combined approach of subcision with either cross-linked hyaluronic acid or threads in the treatment of atrophic acne scars.

BACKGROUND: Acne scars are one of the most common cosmetic concerns causing psychosocial distress. OBJECTIVE: To evaluate the efficacy of subcision versus its combination with either cross-linked hyaluronic acid (HA) or poly-l-lactic acid (PLLA) threads in the treatment of atrophic post-acne scars. METHODS: Forty patients of both genders with atrophic acne scars were subjected to subcision 1 month apart for 3 sessions. After the last session of subcision, the patients were reclassified randomly into 2 equal groups each received either HA or threads in one side of the face leaving the other side that underwent subcision before as a control. Clinical assessment was carried out by the physicians and patients. Photographs and skin biopsies were obtained. Follow-up was 6 months. RESULTS: A significant clinical improvement was achieved in 67.3% of patients after subcision alone compared to 94.1%, 82.4% of subcision combined with HA or threads, respectively. Patients' satisfaction was higher in the combined groups compared to subcision alone (p < 0.0001). Side effects were tolerable and transient. CONCLUSION: Subcision combined with HA or threads could offer a higher significant clinical improvement of acne scars than subcision alone.

Squamous Cell Carcinoma Antigen in Psoriasis: An Immunohistochemical Study.

BACKGROUND: Squamous cell carcinoma antigens (SCCA1, SCCA2) are members of the ovalbumin serpin family that have been described as biomarkers of squamous cell carcinomas. Different studies to date have stated the involvement of SCCA in the pathogenesis of certain immunological diseases, such as asthma and atopic dermatitis. OBJECTIVE: We sought to assess the expression of SCCA2 in the skin of patients with chronic plaque psoriasis and to detect its correlation with the clinical severity of psoriasis and with the density of inflammatory infiltrates in the skin lesions. METHODS: Skin biopsies were taken from 24 patients with psoriasis vulgaris and 24 healthy controls by 5-mm punches. Tissues were stained with hematoxylin and eosin to confirm the diagnosis and to assess the grade of inflammation. The expression level of SCCA2 in the skin was assessed by immunohistochemical analysis. RESULTS: The tissue SCCA2 level was significantly higher in psoriatic patients than controls and correlated positively with the severity of psoriasis. In addition, the dermal SCCA2 expression correlated positively with the density of dermal inflammatory infiltrates. CONCLUSION: SCCA2 could be a useful marker of the clinical severity and the grade of inflammation of psoriasis.