Skin cancer knowledge and attitudes in the region of Fez, Morocco: a cross-sectional study.

BACKGROUND: The prevalence of skin cancers is constantly increasing in Morocco, and they have gradually become more aggressive due to a significant delay in the diagnosis. Our aim was to assess the levels of awareness and the influencing factors related to skin cancer knowledge in Morocco. METHODS: This cross-sectional study was carried out in Morocco through the medium of a validated questionnaire, which contained several items - demographics, skin cancer knowledge and attitudes towards skin cancer patients- during a period of 1 year (2014). RESULTS: Out of the 700 participants enrolled in the study, 17.9% had never heard of skin cancer, 32.5% had a low score of skin cancer knowledge, 66.7% had a moderate score, and only 0.85% had a high score of skin cancer knowledge. Further, 15.1% of the participants were under the assumption that this cancer is contagious. The sun was the most incriminated risk factor in skin cancer occurrence by 74.3% of the participants, and 57.9% of them believed that prevention is important through using various means of photoprotection. After univariate and multivariate analysis, the influencing factors related to the skin cancer knowledge in Morocco were: the socioeconomic status (P = 0.003, OR = 7. 3) and the educational level (p < 0.001, OR = 20. 9). CONCLUSIONS: Due to the lack of knowledge or the underestimation of skin cancer in our study population, efforts are needed to promote skin cancer surveillance behaviors in Morocco.

EPIMAG: International Cross-Sectional Epidemiological Psoriasis Study in the Maghreb.

BACKGROUND: Psoriasis is a common skin disorder that is characterized by red plaques covered with silvery scales and is associated with considerable psychosocial impact. It has been described in several studies worldwide, but specific data from the Maghreb (Algeria, Morocco and Tunisia) are unavailable. OBJECTIVES: To characterize the frequency of new psoriasis cases and to describe the epidemiological and clinical profile of psoriasis in the Maghreb. METHODS: A psoriasis working group for the Maghreb initiated the EPIMAG international multicentre cross-sectional observational epidemiological study coupled with a 2-week psoriasis screening study via medical consultation. Data were collected via questionnaires. RESULTS: The total analysis population included 373 pre-existing and 326 new psoriasis cases, described by 261 participating investigators. The frequency of new psoriasis cases was 10.26/1,000 in Algeria, 15.04/1,000 in Morocco and 13.26/1,000 in Tunisia, and thus 12.08/1,000 in the Maghreb. In all 699 psoriasis subjects, the mean age was 46 years, the mean BMI was 26.6, and 55.7% of subjects were men. Two thirds of the subjects had never smoked, and 85.0% had never consumed alcohol. Half had brown skin, and 28.6% had a family history of psoriasis. Three quarters had localized psoriasis, 85.8% had plaque psoriasis, coupled with pruritus in over 70.0% of cases. Flares or outbreaks were most often triggered by stress (79.4%) and change of season (43.1%). The majority of subjects used topical therapy, and the investigators considered overall treatment efficacy to be partial in over half of the cases. Among patients with pre-existing psoriasis, secondary analyses showed that 73.2% had severe psoriasis, and that quality of life was severely affected in 40.1% of cases. The mean number of missing school or work days over 6 months was 3.2 (±12.1) days. CONCLUSIONS: Our study provides novel information relative to psoriasis epidemiology and characterization in the Maghreb and highlights the need to improve psoriasis screening and management in the region. The data will help optimize psoriasis management, to ensure appropriate national health care policies.

Cutaneous Squamous Cell Carcinoma: Clinico-Dermoscopic and Histological Correlation: About 72 Cases.

INTRODUCTION: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, accounting for 20% of malignant skin tumors. Dermoscopy is a very useful tool for diagnosing cSCC, and its findings are confirmed through histopathological studies. OBJECTIVES: to describe the different dermoscopic structures of invasive cSCC and investigate their association with the clinical form and histopathological grade of differentiation. METHODS: We conducted a cross-sectional study, collecting all patients diagnosed with squamous cell carcinoma over a period of 5 years. The study population was divided into two groups based on histological differentiation (well-differentiated and non-well-differentiated) and clinical form ( nodulo-ulcerative and nodular). Various dermoscopic parameters were compared between these groups. RESULTS: Out of 72 invasive cSCC, 81.9% were well-differentiated, while 18.1% were non-well-differentiated. The clinical form of cSCC was nodulo-ulcerative in 83.3% of cases and nodular in 16.7%. Well-differentiated tumors showed dotted, glomerular and hairpin vessels, along with a predominant white pattern characterized by centrally distributed keratin as well as white circles, and whitish perivascular halo (P < 0.05). The distribution of these white structures was radial in nodulo-ulcerarive lesions, whereas in nodular lesions, their distribution, as well as that of keratin, was more diffuse (P < 0.05). Non-well-differentiated tumors showed a combined white-red pattern with the predominance of arborizing vessels (P < 0.05). CONCLUSIONS: Our results show the reliability of dermoscopy as a tool for distinguishing between well- and poorly differentiated cSCC. This distinction is characterized by an increase in predominantly arborizing vessels and a corresponding decrease in white structures as the tumor progresses from a well-differentiated to a poorly differentiated state. Additionally, the nodulo-ulcerative form exhibits a central distribution of keratin, while the nodular form displays a diffuse distribution.

Malignant Melanocytic Matricoma: A Rare Skin Tumor That Can Clinically Mimic Melanoma.

Malignant melanocytic matricoma (MMM) is an extremely rare skin malignant neoplasm composed of epithelial cells with matrical differentiation and dendritic melanocytes. We found only 11 cases reported in the literature to date according to the databases consulted (PubMed/Medline, Scopus, and Web of Science). Here, we report a case of MMM in an 86-year-old woman. A histological examination showed a dermal tumor with a deep infiltrative pattern, without an epidermal connection. On immunohistochemical staining, tumor cells were positive for cytokeratin AE1/AE3, p63, and beta-catenin (nuclear and cytoplasmic staining) and negative for HMB45, Melan-A, S-100 protein, and androgen receptor. Melanic antibodies highlighted scattered dendritic melanocytes in tumor sheets. The findings did not support the diagnosis of melanoma, poorly differentiated sebaceous carcinoma, and basal cell carcinoma, but supported the diagnosis of MMM.

Clinical and Dermoscopic Approaches to Diagnosis of Frontal Fibrosing Alopecia: Results From a Multicenter Study of the International Dermoscopy Society.

INTRODUCTION: Frontal fibrosing alopecia (FFA) is a form of primary lymphocytic scarring alopecia characterized by a progressive recession of the fronto-temporal hairline. Although the clinical presentation of FFA is very typical, biopsy for histopathological examination is still recommended to confirm the diagnosis. Currently, a growing number of skin and mucosal inflammatory diseases are diagnosed with modern noninvasive techniques such as dermoscopy without the necessity of a biopsy. OBJECTIVES: The International Dermoscopy Society (IDS) aimed to test the ability of its members to diagnose classic FFA through clinical and dermoscopic parameters and to compare acquired data to the largest cohort studies published since 1994. METHODS: This is an observational, cross-sectional study describing patient demographics, clinical presentation and diagnostic tools used in a sample of FFA patients collected by IDS members. A literature search was then performed using Pubmed to review studies reporting more than 100 cases. RESULTS: IDS members submitted 188 cases demonstrating a predominant female population (98.4%). In 71.8% of the cases, the clinical presentation and the trichoscopic findings allowed for the diagnosis. Out of 24 revised studies, 13 showed that clinical and trichoscopic features were decisive for the diagnosis in almost all cases. CONCLUSIONS: Demographic and clinical data of our cohort were mostly comparable to previous reported data on FFA. The relevant role of the clinical and trichoscopic features in diagnosing FFA was confirmed by our study and the reviewed literature. Trichoscopy could be considered a worldwide-acknowledged non-invasive technique for the diagnosis of FFA.

[Erysipelas associated with recurrent squamous cell carcinoma of the labium majus after radiochemotherapy]. / Érysipèle sur carcinome épidermoïde récidivant de la grande lèvre après radio-chimiothérapie.

The erysipelas is a bacterial infection most frequently due to (85% of cases) streptococcus ß-hemolytic of group A (SGA), resulting in non-necrotizing dermo-hypodermitis. Many factors may play a role in its occurrence such as general factors: diabetes, immunosuppression, chemotherapy, radiotherapy as well as locoregional ports of entry such as leg ulcer, an insect bite, intertrigo. The occurrence of erysipelas associated with recurrent squamous cell carcinoma after radiochemotherapy is exceptional, requiring early treatment of dermo-hypodermitis as well as suitable and multidisciplinary management of the carcinoma. The mechanism of the occurrence of erysipelas after radiotherapy coincides with its pathophysiology. Indeed, this therapeutic component, which is very used to treat squamous cell carcinoma, alters lymphatic drainage resulting, very gradually, in lymph fibrosis thus weakening the defense mechanism. Its association with alteration of cellular immunity, also favored by radiotherapy and chemotherapy, can cause the occurrence of erysipelas in these patients. We report the case of a 50-year old female patient with a 1-year history of squamous cell carcinoma of the right labium majus treatment with radiochemotherapy with remission. Eight months later, the patient had recurrence. Evolution was marked by the appearance of a painful hot erythematous plaque on the right thigh suggesting erysipelas, confirmed by laboratory tests which showed an infection. The patient was put on antibiotic therapy with good improvement and then referred to the Department of Oncology for recurrence management.

[The role of the micrographic surgery in the management of basal cell carcinoma: experience in the Department of Dermatology, at the Hassan II University Hospital, Fes, Morocco]. / L'intérêt de la chirurgie micrographique dans la prise en charge du carcinome basocellulaire: expérience du service de dermatologie CHU Hassan II de Fès, Maroc.

Mohs micrographic surgery (MMS) is a technique allowing for intraoperative histologic assessment of surgical margin of malignant tumors. This study aims to highlight the role of MMS in the achievement of radical healing of basal cell carcinoma (BCC) in our patients. We conducted a study of 29 patients with basal cell carcinoma of the face over a period of 5 years. The median age of patients was 45.8 years (12-80). The sex-ratio M/F was 1.23. One-stage surgical procedure was sufficient to obtain complete resection in 51% of cases. Three-stage surgical procedure was needed in 14% of the cases. The mean duration of one-stage surgical procedure was 1 hour. No complications were reported in the postoperative period and sequelae were simple. The aesthetic and functional result was satisfactory. No recurrence was noted. BCC accounts for approximately 80% of all skin cancers. The decision to use MMS to treat BCC is based on three variables: the seat and the size of the tumor, its histological appearance with the identification of resection margin and its recurrent nature. MMS is currently the most effective method in the treatment of BCC and allows maximum healthy tissue preservation. It is a safe and repeatable surgical procedure based on team work and adapted to the treatment of patients with BCC who are at high risk of recidivism. The aesthetic and functional results are satisfactory. Recurrence rate at 5 years is 10 times lower than with the other methods.

[Unexpected positive outcome following rituximab treatment in a patient with pemphigus vegetans resistant to conventional therapies: a case report]. / Evolution spectaculaire d'un pemphigus végétant réfractaire aux thérapies conventionnelles sous Rituximab: à propos d'un cas.

Pemphigus vegetans is a rare form of pemphigus. It accounts for only 2%. There is a broad range of effective options available to treat this disease: topical and/or oral corticosteroids as first-line treatment, immunosuppressants such as Azathioprine, Cyclosporine, Methotrexate, Cyclophosphamide and Mycophenolate mofetil to reduce the side effects of steroids. Some patients are resistant to all these treatments. Rituximab has revolutionized the treatment of pemphigus, pemphigus vegetans in particular. We here report the case of a 42-year old female patient, admitted with pemphigus vegetans confirmed by histology. She initially received corticosteroid therapy associated with immunosuppressive therapy without improvement. Then she was treated with Rituximab and had an unexpected positive outcome.

Idiopathic harlequin syndrome: a case report and literature review.

Harlequin's syndrome is a rare dysautonomic syndrome of the face characterized by sweating with flush of one side and anhidrosis of the contralateral side. Mostly idiopathic although several secondary cases have been reported in the literature, the purpose of the treatment is mainly aesthetic and functional. We report the case of a patient having harlequin syndrome in its idiopathic form with a literature review.

Dermoscopic Findings and Their Therapeutic Implications in Trichostasis Spinulosa: A Retrospective Study of 306 Patients.

BACKGROUND: Data about the contribution and the implications of dermoscopy in trichostasis spinulosa (TS) are lacking in the literature. OBJECTIVE: To describe dermoscopic features of TS in a large sample of patients and to correlate dermoscopy with clinical characteristics of the patients and therapeutic responses to medical treatments. METHODS: A descriptive study was conducted (from October 2015 to June 2016) at the Department of Dermatology of Fez in Morocco. Dermoscopic signs were divided into signs of hair retention (SHR) and follicular keratosis (FK). RESULTS: SHR was severe in 8.8% and minimal in 40.5% of all cases. Vellus hairs were observed in 81.6% of all cases and hair tufts were described in 48.7%. Dermoscopic blackhead-like structures (DBH) were found in 53.9% of all cases. FK was observed as orange-yellowish keratotic plugs in 92.7% of all cases. Therapeutic demand was significantly related to female gender (p = 0.002) and recurrences after medical treatment (p = 0.004). Complete improvement after medical treatment was only described in patients with DBH and minimal SHR (p = 0.001). CONCLUSION: Dermoscopy not only increases the accuracy of the clinical diagnosis in TS, but a new description of dermoscopic classification has also been proposed leading to therapeutic implications.

The rainbow pattern in dermoscopy: A zoom on nonkaposi sarcoma skin diseases.

The rainbow pattern is currently a subject of debate, it is considered the specific dermoscopic pattern of Kaposi sarcoma. We present in this research correspondence a review of 700 dermoscopic figures of different biopsy-proven skin diseases in our department of dermatology of the Hospital Hassan II of Fez. All the lesions were localized to the limbs except for one lesion of atrophic scar that was localized on the left shoulder. RP was observed in four raised lesions: one case of hypertrophic scar, one case of angiokeratoma, one case of stasis dermatitis and one case of pseudo-Kaposi. These results indicate that the RP may be observed in non-kaposi sarcoma, with new observations of RP in pseudo-Kaposi and angiokeratoma.

[The superficial circumscribed lymphangioma of the tongue]. / Le lymphangiome circonscrit superficiel de la langue.

Superficial circumscribed lymphangiomas are predominantly benign lesions occuring in the cervicofacial area. These malformations of the lymphatic vessels are frequently diagnosed in children. We report the clinical case of lymphangioma of the tongue that occurred in an old man. The differential diagnosis was made primarily with Kaposi's disease, circumscribed angiokeratoma and metastases of a solid tumor. The patient had a biopsy that confirmed the diagnosis. The decision was abstention and supervision since the patient was not embarrassed.

Painful tumors in a patient with neurofibromatosis type 1: a case report.

BACKGROUND: Herein, we report an unusual case of multifocal glomus tumors in the same hand in a patient suffering from neurofibromatosis type 1. CASE PRESENTATION: The patient was a 37-year-old Moroccan woman, suffering from neurofibromatosis type 1, with intense pain in the fingers, successfully treated with the excision of the tumors. Histology of the lesions confirmed the diagnosis of glomus tumor. CONCLUSION: We present this case to support the association between glomus tumors and neurofibromatosis type 1. Thus, we strongly recommend that one should suspect a glomus tumor in patients with neurofibromatosis type 1 if such patients have symptoms from finger pulp or nails.

A prospective study of tinea capitis in children: making the diagnosis easier with a dermoscope.

INTRODUCTION: Tinea capitis is a scalp infection caused by different fungi. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. The association of clinical and dermatoscopic findings in suspected cases of tinea capitis may help the identification of the etiological agent, facilitating precocious, specific treatment. MATERIALS AND METHOD: We report a prospective descriptive analytical study of 34 children with tinea capitis. We performed a trichoscopic examination of all patients; only six children were able to have the mycological culture. RESULTS: Trichoscopy was abnormal in all 34 patients; it showed hair shaft abnormalities and, in some cases, scalp disorders too. We found that the comma and corkscrew appearance was found in microsporic tinea capitis, V-shaped hair was mainly seen in inflammatory tinea capitis, scales and follicular keratosis in non-inflammatory tinea capitis, and crusts and follicular pustules in inflammatory tinea capitis. Finally, erythema was seen in trichophytic and inflammatory tinea capitis. CONCLUSION: We propose a classification of trichoscopic signs of tinea capitis. This classification will enable rapid diagnosis and prediction of the type of fungus before mycological culture, thus a faster and more adapted management. Our study shows the importance of trichoscopy in the diagnosis and monitoring of tinea capitis. We suggest further prospective studies with a larger number of patients with tinea capitis, having performed mycological culture, to confirm this classification.

A painless glomus tumor: a case report.

BACKGROUND: Glomus tumor is a benign and vascular hamartoma that originates from the neuromyoarterial cells of the normal glomus apparatus in the reticular dermis. The etiology of glomus tumors is unknown. It usually presents as a small, slightly raised, bluish or pinkish-red, painful nodule of the fingertips and the pulp. we report an atypical case of a patient of painless glomus tumor. CASE PRESENTATION: Our patient, a 60-year-old Moroccan man, had a 2.5 cm purplish painless soft tumor, covered with melliciric and hemorrhagic crusts, involving the first phalanx of his right index finger. This tumor was compressing his nail plate. No bony lesions were identified by radiographic studies, but magnetic resonance imaging was suggestive of glomus tumor. Surgical excision was performed with directed healing. CONCLUSIONS: The diagnosis of a glomus tumor is an eventuality even in the absence of pain.

Rare tumor in unusual location - glomus tumor of the finger pulp (clinical and dermoscopic features): a case report.

BACKGROUND: Glomus tumors are rare, benign, vascular neoplasms arising from the glomus body. Although they can develop in any part of the body, they commonly do so in the upper extremities, most frequently subungual areas. They can be either solitary or multiple. Most typically they present as a small, round, bluish nodule visible through the nail plate with a classic triad of symptoms: hypersensitivity to cold, heightened pinprick sensitivity, and paroxysmal pain. Several tests can help in diagnosing these tumors with multiple imaging tools such as X-ray, magnetic resonance imaging, and ultrasonography. However, only histology can confirm the diagnosis. Complete surgical excision of the tumor is the only effective treatment to achieve pain relief and low recurrence rate. CASE PRESENTATION: We report here a rare case of a 54-year-old Moroccan Berber woman presenting with a 10-year history of a glomus tumor at an unusual site. Dermoscopy and histology were helpful to confirm the diagnosis. CONCLUSIONS: We aim to discuss clinical, dermoscopical aspects of this tumor and surgical modalities. We also emphasize the importance of keeping this tumor in mind among the possibilities of differential diagnosis of painful digital nodules.