Epidemiology of pyoderma gangrenosum: Results from an Italian prospective multicentre study.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by painful, necrotic ulcerations. PG is described as a rare disease: the world-wide incidence is estimated to be around 3 to 10 cases per million population per year. These estimations are based mostly on case reports and retrospective case series; there are no prospective, multicentre studies on the matter. The apparent rarity of PG is in contrast with our clinical perception as dermatologists: in our opinion, PG is not so uncommon. Therefore, we decide to investigate the epidemiology of PG in the Italian population and confirm our clinical suspicions that it is not an orphan disease. We enrolled all patients diagnosed with PG in 8 Italian Dermatological Departments from 1st October 2014 to 1st November 2015, and we recorded their features. Our data, collected from 64 patients, are in accordance with those of the published literature regarding the epidemiology and features of PG. In an Italian population of roughly 8 million inhabitants of 7 provinces, we found an incidence of 5.17 new cases per million population per year. Unlike our predictions before the study, we confirmed the world-wide incidence of PG. To our knowledge, this is the first observational, multicentre study on PG. We hope that it provides a stimulus for further researches on PG and for the creation of an Italian register.

Glycaemic index, glycaemic load and risk of cutaneous melanoma in a population-based, case-control study.

Glycaemic index (GI) and glycaemic load (GL) are indicators of dietary carbohydrate quantity and quality and have been associated with increased risk of certain cancers and type 2 diabetes. Insulin resistance has been associated with increased melanoma risk. However, GI and GL have not been investigated for melanoma. We present the first study to examine the possible association of GI and GL with melanoma risk. We carried out a population-based, case-control study involving 380 incident cases of cutaneous melanoma and 719 age- and sex-matched controls in a northern Italian region. Dietary GI and GL were computed for each subject using data from a self-administered, semi-quantitative food frequency questionnaire. We computed the odds ratio (OR) for melanoma according to quintiles of distribution of GL and GL among controls. A direct association between melanoma risk and GL emerged in females (OR 2·38; 95 % CI 1·25, 4·52 for the highest v. the lowest quintile of GL score, P for trend 0·070) but not in males. The association in females persisted in the multivariable analysis after adjusting for several potential confounders. There was no evidence of an association between GI and melanoma risk. GL might be associated with melanoma risk in females.

Protective effects of Polypodium leucotomos extract against UVB-induced damage in a model of reconstructed human epidermis.

BACKGROUND: Polypodium leucotomos (PL) exerts potent antioxidant, photo-protective, and immune-modulatory activities. A reconstructed human epidermis (RHE) (Episkin) is a suitable model for the evaluation of acute UV-induced cell damage. No data regarding the photo-protective action of PL in this model are available. PURPOSE: We evaluated the effects of PL on the prevention of UVB-induced cell damage assessing sunburn cells, CPD formation, p53, Ki-67, p21 expression, and epidermal growth factor (EGF) production. MATERIALS & METHODS: RHE was incubated in standard conditions. PL was topically applied at the concentration of 2 mg/cm2 , immediately before UVB exposition. UVB exposition (300 mJ/cm2 ) was performed using a dedicated UVB lamp. Irradiated samples without PL and non-irradiated samples were used as positive and negative controls. Expression of p53, p21, and Ki-67 was evaluated with immune-histochemical methods. CPD were measured using a monoclonal antibody. RESULTS: PL significantly reduced sunburned cells (-80%) in comparison with positive control. PL significantly prevented the increase in EGF production at tested times. PL significantly reduced the p53 (-80%), p21 (-84%), and Ki-67 (-48%) positive cells. Finally, PL prevented the formation of CPD (0% vs. 20% positive cells). CONCLUSION: In this model, PL has shown to prevent UVB cell damage, the upregulation of proliferating proteins, and fully blocking the formation of CPD.

Videodermoscopy and Curettage: The Value of Simple Procedures During Mohs Surgery.

BACKGROUND: Mohs surgery (MS) is regarded as one of the most efficient surgical procedures for the treatment of skin tumors. OBJECTIVES: Delineating tumor margins accurately is important in limiting broad excisions during conventional surgery and in reducing the number of stages during Mohs procedure. METHODS: This study aimed to evaluate the role of 2 simple procedures, curettage and videodermoscopy (VDS), in determining margins during MS for the treatment of basal cell carcinoma (BCC) of the head and neck. RESULTS: The use of both procedures offered a good intraoperative margin definition and consequently small surgical defects in 197 patients affected by BCC. Recurrences in basal cell cancers, which included both primary and recurrent lesions, occurred less frequently than in the institution's previous experience, appearing in only 8 of 197 cases (approx. 4%). CONCLUSION: In the authors' experience, both VDS and curettage were found advantageous in delineating tumor margins while treating BCC with MS.

Spitz Nevi and Other Spitzoid Neoplasms in Children: Overview of Incidence Data and Diagnostic Criteria.

Spitz nevi are benign melanocytic neoplasms characterized by epithelioid or spindle melanocytes or both. In some rare cases their presentation overlaps with the clinical and histopathologic features of malignant melanoma, so a differential diagnosis can be difficult to make. Intermediate forms between Spitz nevi and malignant melanoma, with unpredictable behavior, have been called atypical Spitz tumors. A literature search was performed to review the clinical, dermoscopic, genetic, and histopathologic aspects of spitzoid tumors. Spitz nevi mainly occur in children, with no predilection for sex, and in young women. Common sites are the head and lower arms, where Spitz nevi present as pink nodules or hyperpigmented plaques. Spitzoid lesions may have diverse dermoscopic patterns: vascular, starburst, globular, atypical, reticular, negative homogeneous, or targetoid. The management of spitzoid lesions can be invasive or conservative; surgical excision is usually reserved for those with doubtful features, whereas clinical and dermoscopic follow-up is preferred for typical pediatric Spitz nevi. The role of sentinel lymph node biopsy in atypical Spitz tumors is debated. Immunohistochemistry and new molecular techniques such as comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization offer new diagnostic perspectives, investigating genetic alterations that are specific for malignant melanoma or for Spitz nevi.

Spitznävi: unterschiedliche klinische, dermatoskopische und histopathologische Merkmale in der Kindheit.

HINTERGRUND UND ZIELE: Die Charakterisierung der klinischen Merkmale und des biologischen Potenzials von Spitznävi hat in den letzten Jahrzehnten breites Interesse gefunden. Das Ziel dieser Arbeit ist die Beschreibung der klinischen und dermatoskopischen Merkmale von Spitznävi sowie des klinischen Ergebnisses nach chirurgischer Exzision von Spitznävi in drei pädiatrischen Altersgruppen. PATIENTEN UND METHODEN: Restrospektive Studie zur Analyse von klinischen Merkmalen, videodermatoskopischen Bildern, histopathologischen Diagnosen und Behandlungsergebnissen. Der Grad der Pigmentierung wurde sowohl klinisch als auch histopathologisch beurteilt. ERGEBNISSE: Bei 71 Patienten wurden 72 spitzoide Neoplasien entfernt. Videodermatologische Bilder lagen für 41 Patienten vor. Das Muster der Pigmentierung korrelierte signifikant mit dem Alter der Patienten: Hyperpigmentierte Läsionen waren bei Vorschulkindern selten, bei Patienten von 7 bis 12 Jahren und ab 13 Jahren dagegen häufiger. Eine histopathologische Diagnose von atypischen Spitznävi wurde selten durchgeführt. Keiner der Patienten, bei denen ursprünglich ein atypischer Spitznävus diagnostiziert worden war, entwickelte ein Lokalrezidiv oder Metastasen während der anschließenden Nachbeobachtung. SCHLUSSFOLGERUNGEN: Pigmentierte Spitznävi traten im Alter ab 13 Jahren häufiger auf. Die Studie bestätigt andere Berichte über die Altersverteilung von Pigmentierungsmustern und hebt die geringe Anzahl atypischer Spitznävi bei pädiatrischen Patienten hervor sowie das Ausbleiben von Rezidiven bei der langfristigen Nachbeobachtung.

Spitz nevi: diverse clinical, dermatoscopic and histopathological features in childhood.

BACKGROUND AND OBJECTIVES: The characterization of clinical features and biological potential of Spitz nevi has attracted a lot of interest in past decades. The aim of our paper was to describe the clinical, dermatoscopic features as well as the clinical outcome of surgically excised Spitz nevi in three different pediatric age groups. PATIENTS AND METHODS: A retrospective study analyzing clinical features, videodermatoscopic images, histopathological diagnosis and patient outcome. The level of pigmentation was evaluated both clinically and histopathologically. RESULTS: 72 spitzoid neoplasms were excised from 71 pediatric patients. Videodermatoscopic images were available for 41 patients. The distribution of pigmentation significantly correlated with patient age: hyperpigmented lesions were rather rare in preschool children, becoming more frequent in patients aged 7 to 12 years and older than 13 years. The histopathological diagnosis of atypical Spitz nevus was uncommon. None of the patients originally diagnosed with atypical Spitz nevi developed local recurrence or metastases during subsequent follow-up. CONCLUSIONS: Pigmented Spitz nevi were more common after 13 years of age. The study confirms other reports regarding the distribution of pigmentation patterns, and underlines the low number of atypical Spitz nevi in pediatric patients as well as their low recurrence rate during long-term follow-up.

The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute.

INTRODUCTION AND OBJECTIVES: Nail apparatus melanoma (NAM) is an uncommon tumor, especially in Caucasians. The prognosis of patients affected by NAM was analyzed and correlated with the histopathological criteria and the surgical management of the tumors. MATERIALS AND METHODS: We collected data regarding NAM referred to the Skin Cancer Unit of the Dermatology Department of the University of Bologna, from 1992 to January 2012. RESULTS: Out of 1,327 melanoma cases diagnosed between 1992 and 2012, 42 patients were affected by NAM (2.93%). All the patients were Caucasian. Two deceased patients with insufficient medical records and 1 woman with a personal history of breast cancer were excluded. Thirty-nine cases entered this study: 24 were women (67%) and 15 men (33%). The mean age at diagnosis of NAM was 57.3 years (range 29-88 years). Statistical analyses showed that prognosis was significantly correlated with the Breslow thickness (≥/<2 mm; p = 0.02), regression (p < 0.0001) and ulceration (p = 0.04). Regarding surgical management, Kaplan-Meier's test pointed out that performing functional surgery compared to disarticulation did not correlate with a better prognosis of patients (p = 0.08). CONCLUSIONS: In our experience, the surgical management (disarticulation with respect to functional surgical excision) did not influence the prognosis of NAM patients. The latter was affected by the histopathological characteristics (Breslow thickness, regression and mitoses) and location (fingers vs. foot).

Diet Quality and Risk of Melanoma in an Italian Population.

BACKGROUND: Some results from laboratory and epidemiologic studies suggest that diet may influence the risk of melanoma, but convincing evidence for a role of single nutrients or food items is lacking. Diet quality, which considers the combined effect of multiple food items, may be superior for examining this relation. OBJECTIVE: We sought to assess whether diet quality, evaluated with the use of 4 different dietary indexes, is associated with melanoma risk. METHODS: In this population-based case-control study, we analyzed the relation between 4 diet quality indexes, the Healthy Eating Index 2010 (HEI-2010), Dietary Approaches to Stop Hypertension (DASH) index, Greek Mediterranean Index (GMI), and Italian Mediterranean Index (IMI), and melanoma risk in a northern Italian community, with the use of data from 380 cases and 719 matched controls who completed a semiquantitative food frequency questionnaire. RESULTS: In the overall sample, we found an inverse association between disease risk and the HEI-2010 and DASH index, but not the Mediterranean indexes, adjusting for potential confounders (skin phototype, body mass index, energy intake, sunburn history, skin sun reaction, and education). However, in sex stratified analyses, the association appeared only in women (P-trend: 0.10 and 0.04 for the HEI-2010 and DASH index, respectively). The inverse relations were stronger in women younger than age 50 y than in older women, for whom the GMI and IMI scores also showed an inverse association with disease risk (P-trend: 0.05 and 0.02, respectively). CONCLUSIONS: These results suggest that diet quality may play a role in cutaneous melanoma etiology among women.

Mohs Surgery for Squamous Cell Carcinoma of the Nail Unit: 10 Years of Experience.

BACKGROUND: Squamous cell carcinoma (SCC) is the most frequent malignant tumor of the nail unit. OBJECTIVE: The aim of this study was to review the long-term outcome of patients affected by SCC of the nail who underwent Mohs surgery. MATERIALS AND METHODS: Patients affected by nail SCC were enrolled, including cases where x-ray examination had revealed bone changes. The tumor was completely excised and the defect filled with a skin substitute based on hyaluronic acid where bone involvement was not observed. Where Mohs sections indicated bone involvement, the distal phalanx was disarticulated and the remaining end of the digit repaired using a volar/plantar flap. Follow-up was performed every 6 months for 5 years. RESULTS: Mohs technique was performed in 43 cases. Microinvasive SCC was diagnosed in 5 cases, in situ SCC in 7 cases, and invasive SCC in 45 patients. Recurrences were observed in 2 patients (3.5%). Disarticulation was performed in both of them, and no further tumor recurrences were observed in 4 to 5 years of follow-up. CONCLUSION: Mohs surgery provides the highest cure rate for the treatment of nail SCC. It allows the evaluation of periosteal invasion and therefore bone invasion to be reliably distinguished from inflammation or compression. This technique reduces the number of unnecessary amputations, a critical consideration for patient's quality of life.

Virologic and genetic evaluation of vemurafenib-induced skin cancers.

We describe the occurrence of a giant squamous cell carcinoma in a patient receiving vemurafenib for the treatment of late melanoma mestastases. Although the development of keratoacanthomas and squamous cell carcinomas (SCC) has been described during vemurafenib therapy, most of the reported cases are treated with surgical excision. In the present case, SCC regressed after drug withdrawal.

Vascular leg ulcers: histopathologic study of 293 patients.

Vascular leg ulcers remain a challenge for the modern health care, and a systematic pathological study on this kind of lesions has not been reported so far. A total of 293 consecutive white patients with chronic leg ulcers (present for a minimum of 6 months and up to several years) referred to the Wound Care Unit (Dermatology, University of Bologna) between March 2008 and June 2011. Thirty-four patients affected by other than vascular ulcers, neoplastic or inflammatory conditions, were excluded. The remaining 259 patients affected by vascular leg ulcers were enrolled in this study. Assessment of the patients general health, skin biopsy, and vascular Doppler of the lower limbs were performed to determine the etiology and to formulate an appropriate management plan, whereas 2 punch biopsies of 3 mm were performed on the border and on the bed of each ulcer. Doppler evaluation showed the presence of vascular hemodynamic impairment in 259 patients. Of these, 181 (69.9%) patients were affected by venous insufficiency, 58 (22.4%) by venous and arterial insufficiency, and 20 (7.7%) by arterial insufficiency. Histopathologic features revealed significant differences, thus, reflecting the clinicopathologic correlation with the underlying hemodynamic impairments. In conclusion, histopathologic and hemodynamic data correlation could provide the basis for future analysis of leg ulcers pathogenesis and may improve treatment protocols. We should underline that this observational study represents a single-institute experience and that larger series are needed to confirm our observations.

Frequency of malignant neoplasms in 257 chronic leg ulcers.

BACKGROUND: Chronic leg ulcers are one of the most common medical conditions and are a substantial source of morbidity. OBJECTIVES: To investigate the prevalence of skin cancer mimicking leg ulcers. PATIENTS AND METHODS: This observational study included all patients with a clinical diagnosis of chronic leg ulcers (CLU) admitted to the Wound Care Unit, Division of Dermatology, University of Bologna, between March 2008 and February 2011. Patients' general health was assessed, and skin biopsy and vascular Doppler of the lower limbs were performed. RESULTS: Two hundred fifty-seven patients ages 45 to 98 with CLU were included. Skin biopsies were performed in all patients. Pathologic results showed that 10 patients had ulcerative lesions of neoplastic origin. Surgical excision was performed in all patients with neoplasms. After at least 1 year of follow-up, no recurrences were observed. DISCUSSION AND CONCLUSION: Our findings highlight the important role of systematic biopsies in diagnosing ulcerated tumors of the lower legs and indicate a high prevalence of large ulcerated basal cell carcinomas.

Two synchronous periungual BCC treated with Mohs surgery. Nail polish related?

Basal cell carcinoma (BCC), the most frequent malignant skin tumor observed in Caucasian adults, especially males, occurs mainly in sun-exposed areas of the body. BCC in the periungual tissues, such as proximal nail fold, nail matrix, nail bed and hyponychium, is rarely reported. We report a patient with two synchronous BCC of the periungual tissue localized in the IV and V fingernail, effectively treated with Mohs micrographic surgery.