Biopsy type does not affect the number of stages during Mohs micrographic surgery: a retrospective study.

Mohs micrographic surgery (MMS) is the treatment of choice for high-risk basal cell carcinoma (BCC). However, there are no evidence-based recommendations regarding which biopsy type is more appropriate to obtain tumour samples prior to MMS. Shave or punch biopsies are performed depending on the clinical characteristics of the tumour, surgeon experience and local protocols. However, biopsy type might result in difficult histopathological interpretation and influence the practical implementation of MMS. We performed a retrospective study on 208 consecutive BCCs treated with MMS. Of the 208 BCC biopsies, 42 (20.2%) were obtained by the shave method and 166 (79.8%) via punch. Those obtained with the shave technique had a mean of 1.64 stages vs. 1.69 stages with the punch technique (P = 0.130). These findings suggest biopsy type does not affect Mohs surgery performance. The biopsy type of choice is the one deemed adequate for each specific case to obtain a diagnosis and tumour subtyping.

[Prevalence of nasal colonization by methicillin-resistant Staphylococcus aureus in medical students in Chile: comparison between pre-clinical and clinical environment]. / Prevalencia de colonización nasal por Staphylococcus aureus meticilino resistente en estudiantes de medicina de la Pontificia Universidad Católica de Chile: comparación entre estudiantes no expuestos a la clínica (pre-clínicos) y clínicos.

OBJECTIVES: The primary objective of this study was to determine the prevalence of nasal colonization of methicillin resistant Staphylococcus aureus (MRSA) in medical students in pre-clinical versus clinical courses at the Pontificia Universidad Católica de Chile and to describe the epidemiological, clinical and molecular pattern of the MRSA strains obtained. METHOD: A cross-sectional descriptive study was carried out on 299 undergraduate and graduate medical students from the Pontificia Universidad Católica de Chile, 44 first-year students and 29 second-year students, corresponding to students of courses without regular clinical exposure and 26 sixth-year students, 58 seventh-year and 142 residents, who are daily exposed to hospital environments. RESULTS: A carriage of 0% (0/73) was found in students not exposed to the clinic (pre-clinical courses) and 0.9% (2/226) in students of clinical courses, a difference that was not statistically significant (p-value 0.42). CONCLUSIONS: The MRSA nasal carriage found in our medical students was low, finding positive samples only in students with clinical exposure. This prevalence is similar to the one reported in other studies in Chile with similar characteristics.

Clinical and dermoscopic evaluation of melanocytic nevi changes during diode laser hair removal: A prospective study.

BACKGROUND: Laser hair removal (LHR) is a common practice with increasing use worldwide. Clinical and dermoscopic changes in melanocytic nevi after LHR have been reported but prospective studies are lacking. OBJECTIVE: To describe dermoscopic changes of melanocytic nevi at different time points after LHR. METHODS: Prospective study in a cohort of female patients undergoing diode LHR. Dermoscopic follow-up of at least three nevi on the legs that underwent hair removal. We included three nonexposed nevi on the arms as controls. Two blinded investigators analyzed dermoscopic images, according to variables selected based on the available literature. RESULTS: Thirty-four patients were included with a total of 148 nevi on the legs and 112 nevi on the arms (controls). 47.9% (71/148) of the nevi on the legs had evidence of dermoscopic changes at the sixth hair removal session, compared to 9.8% (11/112) on controls (p < 0.001). The most frequent change was "bleaching" (41.9%, 62/148). Also, we observed "irregular hyperpigmented areas," and "regression structures" in 5.4% (8/148) and 4.7% (7/148) of the cases at the sixth session, respectively. Neither of these structures were observed in the controls (p < 0.05). LIMITATIONS: Only females were included; we did not perform histopathological evaluation nor reflectance confocal microscopy of changing nevi. CONCLUSION: Melanocytic nevi frequently change after diode LHR. The changes cannot always distinguish between LHR induced and melanoma, so we advise avoiding nevi during laser therapies with melanin targets.

[Rapid implementation of tele-dermatology during COVID-19 pandemic in an academic dermatology department]. / Rápida implementación de teledermatología durante la pandemia por COVID-19: lecciones aprendidas de un departamento académico de Dermatología.

BACKGROUND: The day after COVID-19 quarantine started, we initiated patient care through Tele-dermatology. AIM: To report the experience of the implementation of Telemedicine in dermatology and to assess its impact on the number of dermatological visits compared with the pre-pandemic period. MATERIAL AND METHODS: The study was conducted between March 27th, 2020, and April 30th, 2020. All patients submitted clinical images of their skin condition via secure email before the telemedicine visit. All telemedicine visits were conducted using the Zoom video conferencing platform. Patient demographics and medical history were recorded. If the dermatologist was unable to reach a diagnosis, the patient was sent for an in-person visit, skin biopsy, or additional laboratory workup. RESULTS: We recorded 1,357 Tele dermatology visits from 1,222 patients aged 29 ± 18 years (38% males). Visits increased from 104 to 298 from the first to the last week, corresponding to 17% of the patient volume seen before the pandemic (1,709 in-person patients/week). A preliminary diagnosis was made in 95% of cases. Ninety percent of patients sent photos. Fifty eight percent of cases were chronic diseases, and were classified as inflammatory in 68%, infectious in 15%, neoplastic/tumoral in 7%, or other conditions in 11%. Less than 1% of these visits were COVID-19 related. CONCLUSIONS: In this prospective study of Tele-dermatology lasting five weeks, a preliminary diagnosis could be made in approximately 95% of cases and in the first five weeks of implementation, a volume of consultations equivalent to 17% of those made in the pre-pandemic period was carried out. Therefore, Tele-dermatology can be implemented quickly and successfully in practices when healthcare access is limited.

Syndecan-1 modulates the invasive potential of endometrioma via TGF-ß signalling in a subgroup of women with endometriosis.

STUDY QUESTION: What is the physiological role of transforming growth factor-beta (TGF-ß1) and syndecans (SDC1, SDC4) in endometriotic cells in women with endometriosis? SUMMARY ANSWER: We observed an abnormal, pro-invasive phenotype in a subgroup of samples with ovarian endometriosis, which was reversed by combining gene silencing of SDC1 with the TGF-ß1 treatment. WHAT IS KNOWN ALREADY: Women with endometriosis express high levels of TGF-ß1 and the proteoglycan co-receptors SDC1 and SDC4 within endometriotic cysts. However, how SDC1 and SDC4 expression is regulated by TGF-ß1 and the physiological significance of the high expression in endometriotic cysts remains unknown as does the potential role in disease severity. STUDY DESIGN, SIZE, DURATION: We utilized a pre-validated panel of stem- and cancer cell-associated markers on endometriotic tissue (n = 15) to stratify subgroups of women with endometriosis. Furthermore, CD90+CD73+CD105+ (SC+) endometriotic stromal cells from these patient subgroups were explored for their invasive behaviour in vitro by transient gene inhibition of SDC1 or SDC4, both in the presence or absence of TGF-ß1 treatment. PARTICIPANTS/MATERIALS, SETTING, METHODS: Endometriotic cyst biopsies (n = 15) were obtained from women diagnosed with ovarian endometriosis (ASRM Stage III-IV). Gene expression variability was assessed on tissue samples by applying gene clustering tools for the dataset generated from the pre-validated panel of markers. Three-dimensional (3D) spheroids from endometriotic SC+ were treated in vitro with increasing doses of TGF-ß1 or the TGFBRI/II inhibitor Ly2109761 and assessed for SDC1, SDC4 expression and in vitro 3D-spheroid invasion. Transcriptomic signatures from the invaded 3D spheroids were evaluated upon combining transient gene silencing of SDC1 or SDC4, both in presence or absence of TGF-ß1 treatment. Furthermore, nanoscale changes on the surface of endometriotic cells were analysed after treatment with TGF-ß1 or TGFBRI/II inhibitor using atomic force microscopy. MAIN RESULTS AND THE ROLE OF CHANCE: Gene clustering analysis revealed that endometriotic tissues displayed variability in their gene expression patterns; a small subgroup of samples (2/15, Endo-hi) exhibited high levels of SDC1, SDC4 and molecules involved in TGF-ß signalling (TGF-ß1, ESR1, CTNNB1, SNAI1, BMI1). The remaining endometriotic samples (Endo-lo) showed a uniform, low gene expression profile. Three-dimensional spheroids derived from Endo-hi SC+ but not Endo-lo SC+ samples showed an aberrant expression of SDC1 and exhibited enhanced 3D-spheroid invasion in vitro, upon rhTGF-ß1 treatment. However, this abnormal, pro-invasive response of Endo-hi SC+ was reversed upon gene silencing of SDC1 with the TGF-ß1 treatment. Interestingly, transcriptomic signatures of 3D spheroids silenced for SDC1 and consecutively treated with TGF-ß1, showed a down-regulation of cancer-associated pathways such as WNT and GPCR signalling. LARGE SCALE DATA: Transcriptomic data were deposited in NCBI's Gene Expression Omnibus (GEO) and could be retrieved using GEO series accession number: GSE135122. LIMITATIONS, REASONS FOR CAUTION: It is estimated that about 2.5% of endometriosis patients have a potential risk for developing ovarian cancer later in life. It is possible that the pro-oncogenic molecular changes observed in this cohort of endometriotic samples may not correlate with clinical occurrence of ovarian cancer later in life, thus a validation will be required. WIDER IMPLICATIONS OF THE FINDINGS: This study emphasizes the importance of interactions between syndecans and TGF-ß1 in the pathophysiology of endometriosis. We believe that this knowledge could be important in order to better understand endometriosis-associated complications such as ovarian cancer or infertility. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by Cancerfonden (CAN 2016/696), Radiumhemmets Forskningsfonder (Project no. 154143 and 184033), EU MSCA-RISE-2015 project MOMENDO (691058), Estonian Ministry of Education and Research (IUT34-16), Enterprise Estonia (EU48695) and Karolinska Institute. Authors do not have any conflict of interest.

[Understanding current therapies in metastatic melanoma]. / Entendiendo las terapias actuales en melanoma metastásico.

Cutaneous melanoma is a highly aggressive tumor developing from melanocytes, its incidence is increasing, and prognosis in advanced stages is daunting. New therapies have been approved during the recent years with unprecedented results, including inhibitors of MAPK/ERK pathway and immune checkpoint blockade (anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) as ipilimumab, anti-programmed cell death protein 1 (PD-L1) as pembrolizumab and anti-programmed cell death protein 1 ligand (PD-L1), among many others). The aim of this paper is to review currently available metastatic melanoma therapies focusing mainly on new therapies that have demonstrated effectiveness, after several decades of little progress in the treatment of this disease.

High-risk cutaneous squamous cell carcinoma and the emerging role of sentinel lymph node biopsy: A literature review.

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer in the world. A minority of patients will be given a diagnosis of a high-risk cSCC (HRcSCC) and a proportion of these will have a poor outcome. HRcSCC is characterized by an increase in aggressiveness manifested as locoregional recurrence, and occasionally death. The utility of sentinel lymph node biopsy in this group of patients is unclear without high-level evidence or clear-cut recommendations. If clinicians accept a cutoff threshold of 10% risk of harboring occult nodal metastasis, then a selected group of patients with HRcSCC may benefit from sentinel lymph node biopsy. We performed a review of the currently available evidence, in the form of systematic reviews, meta-analysis, trials, and case series and analyzed the features that define a HRcSCC and the feasibility of performing sentinel lymph node biopsy in this group of patients.

Diffuse melanosis cutis in the setting of BRAF(V600E) mutant melanoma and treatment with targeted therapies.

Diffuse melanosis cutis (DMC) is a rare presentation of metastatic melanoma associated with a particularly guarded prognosis. We report a case of a 35-year-old man with BRAF(V600E) metastatic melanoma treated with dabrafenib (as well as ipilimumab and whole brain radiotherapy), who is alive, 25 months after the onset of his DMC. This is significantly longer than the reported mean survival of 4 months, highlighting the importance of BRAF mutation testing and the promising survival advantage of using targeted therapies compared with conventional chemotherapeutic regimens.

Cutaneous embolism of an atrial myxoma.

Cardiac myxoma often presents with heterogeneous symptoms and signs and represents a challenging diagnosis. The cutaneous manifestations, if present, are often transient and non-specific and the clinician must possess a high degree of suspicion to secure the diagnosis. We present the case of a 36-year-old woman with a 6-month history of intermittent, painful, violaceous, non-blanching macules on the thumb and fingertips of the left hand and right ankle. A cutaneous embolic phenomenon was suspected and an urgent echocardiogram demonstrated an atrial mass, with subsequent histopathology confirming the clinical suspicion of atrial myxoma. Early diagnosis and excision of the tumour avoided serious complications.

Acneiform eruptions: a common cutaneous toxicity of the MEK inhibitor trametinib.

BACKGROUND: The MEK inhibitor trametinib is currently undergoing clinical trials as the treatment of metastatic melanoma both alone and in combination with the BRAF inhibitor dabrafenib. One of the most frequent side-effects associated with its use as a single agent is the development of acneiform eruptions. These eruptions seem to be reduced when dosed in combination with dabrafenib. OBJECTIVES: To investigate the prevalence of acneiform eruptions in patients taking the MEK inhibitor trametinib, both alone and in combination with dabrafenib. METHODS: All patients enrolled in the trametinib alone (n = 13) or trametinib and dabrafenib combination (n = 30) clinical trials at a single site underwent a retrospective file review. The development and management of acne or acneiform eruptions was noted. RESULTS: In total, 77% of the trametinib group developed an acneiform eruption on the trial, while only 10% developed acneiform lesions in the combination trial. The patients were treated with oral doxycycline, topical antibiotics or topical antiseptic washes, with a good response. However the condition recurred if these treatments were ceased and the patient was still on trametinib therapy. CONCLUSIONS: The MEK inhibitor trametinib is associated with the development of acneiform eruptions. When combined with dabrafenib the frequency of this side-effect is reduced.