Estimation of oral leukoplakia treatment records in the research of the Department of Maxillofacial and Oral Surgery, Medical University of Gdansk.

INTRODUCTION: Oral leukoplakia (OL) is the most common potentially malignant lesion of the oral cavity. AIM: The purpose of the study was clinical and epidemiological analysis of patients with OL diagnosed and treated in the Department of Maxillofacial and Oral Surgery, Medical University of Gdansk, comparison of effectiveness of treatment methods, defining whether van der Waal level of OL influences treatment effectiveness, correlation between localization of OL and treatment effectiveness, and defining the optimal OL therapeutic method. MATERIAL AND METHODS: Among 55 911 patients diagnosed and treated in the Department in the years 1999-2009, 204 people with OL were selected (104 women, 100 men, average age: 58.1 years). Treatment and observation period of 6 months was completed by 178 (87.25%) patients. Seventy-four patients were treated with cream containing 0.05% tretinoin. Sixty-three patients underwent cryosurgery, and 41 surgery. Control visits were made in week 2, 4, 6 and 8 and 6 months after completed treatment. RESULTS: Three hundred and twenty lesions of OL were diagnosed. According to van der Waal classification, the largest group of patients was classified into stage I and II. The percentage of totally cured patients was 90.07%. There were no statistic differences in effectiveness between surgical and cryosurgical treatment. CONCLUSIONS: Evaluation of OL treatment methods depends on localization of the lesions and its stage of progression. The effectiveness of treatment with locally applied tretinoin is smaller in comparison to surgery and cryosurgery. It allows to reduce the number and size of OL lesions, what makes it possible to reduce the number of ablative procedures.

An enhanced risk of basal cell carcinoma is associated with particular polymorphisms in the VDR and MTHFR genes.

BACKGROUND: Vitamin D and folate are influenced by ultraviolet radiation (UVR), and both are implicated in skin carcinogenesis. Polymorphisms in the genes involved in the metabolism of these two compounds may alter the risk of basal cell carcinoma (BCC). OBJECTIVE: To assess the frequency of four polymorphisms in the gene encoding the vitamin D receptor (VDR) (FokI, BsmI, TaqI and ApaI) and two in the gene encoding methylenetetrahydrofolate reductase (MTHFR) (677C/T and 1286A/C) in 142 patients of Polish origin with BCC and the same number of controls. The expression of VDR and MTHFR proteins in the skin, and the vitamin D status of a subset of patients and controls were also measured. PATIENTS/METHODS: The polymorphisms were assayed by PCR-RFLP, the VDR and MTHFR proteins by immunoblotting and vitamin D status as 25-hydroxyvitamin D (25(OH)D) level in the serum by RIA. RESULTS: The presence of the TT genotype in the FokI VDR polymorphism resulted in a >10-fold higher risk of BCC development. The CT genotype in 677C/T MTHFR polymorphism and CC genotype in 1286A/C MTHFR polymorphism also significantly increased the risk of BCC development. The expression of the VDR and MTHFR proteins was significantly higher in BCCs of the patients than in the healthy skin of the controls. The median serum level of 25(OH)D was significantly higher in the control group compared with the patients with BCC. CONCLUSIONS: Certain VDR and MTHFR gene polymorphisms increase the risk of BCC development in individuals of Polish origin.

Tobacco smoking alters the number of oral epithelial cells with apoptotic features.

Tobacco smoking is a global problem associated with the occurrence of many systemic diseases and tumors. Oral cavity tumors are common tobacco-related cancers, and of all the anatomical structures that are exposed to the effects of smoking, the oral cavity remains the least-explored area. Changes that occur in the biology of oral epithelial keratinocytes under the influence of the components of tobacco smoke often go unnoticed, if they are asymptomatic. The proper functioning of the oral epithelium is determined by the proliferation and differentiation of the cells in keratinization - the process of programmed cell death, which extends through to the mechanisms of apoptosis. Due to incomplete knowledge of the impact of tobacco smoke on the biology of keratinocytes, an evaluation of the cell cycle was conducted and the apoptosis of oral epithelial keratinocytes was analyzed. The study involved 77 patients divided into four groups according to their intensity of smoking, ranging from 0 to 27 pack-years. There were no differences in the cell count between nonsmokers and smokers in the proper cell-cycle phases. The percentage of proliferating cells in the oral epithelium is about 11%. A reduction in the number of early-apoptotic cells (caspase positive/propidium iodide negative) and an increase in the number of late-apoptotic cells (caspase positive/annexin V positive/propidium iodide positive) were observed to occur with increasing pack-years. The present study demonstrates that smoking does not affect the oral keratinocyte cell cycle, but does modify the number of cells with early and late apoptotic features. An intensification of the impact of tobacco smoke components on the biology of the oral keratinocytes is clearly noticeable at approximately 6 pack-years. This indicates that the biology of the first organ exposed to tobacco smoke - the oral epithelium - is altered by tobacco smoking.

Natural killer/T-cell lymphoma, nasal type, masquerading as recalcitrant periodontitis in a patient with a diagnosis of Wegener's granulomatosis.

Extranodal natural killer (NK)/T-cell lymphoma, nasal type, is a rare type of non-Hodgkin's lymphoma with similar presentation to various benign inflammatory diseases. Adequate biopsy is required for a diagnosis because this lymphoma frequently coexists with large amount of necrosis and inflammation. In this study, a case of a 49-year-old woman presenting with a 3-week history of right maxillary alveolar ridge pain with a subsequent diagnosis of periodontitis is described. The patient's clinical condition deteriorated over a period of 6 weeks. Computed tomography delineated involvement of the right maxillary sinus, posterior part of the right pharynx and right nasal cavity. Immunohistopathology initially revealed Wegener's granulomatosis, followed by extranodal nasal-type NK/T-cell lymphoma. Severe refractory periodontitis in a background of Wegener's granulomatosis may be the initial presentation of extranodal NK/T-cell lymphoma, nasal type. In addition to careful examination, radiographic and laboratory testing, multiple large biopsies should be taken for immunohistochemical analysis to obtain an appropriate diagnosis.

Childhood nail alterations in Polish population.

The epidemiology and nature of childhood nail apparatus pathology is not well known. The aim of our study was to investigate the frequency and nature of nail alterations in Polish pediatric patients. Among 1588 patients diagnosed and treated at our clinic due to nail alterations, 82 (5.16%) patients under age 16 were selected. The most frequent (36.59%) diagnosis were variants of normal nails, which were observed in 30 patients. The most common pathology were viral warts (19.51%). Differences in the distribution of onychomycosis and viral warts in children and adults were statistically significant. Onychomycosis was more common in adults (60.39% vs. 9.76%), whereas viral warts were more common in children (19.51% vs. 5.86%; P<0.0001). Melanonychia was diagnosed in one (1.22%) case. Benign and malignant tumors were not observed. In conclusion, distribution of nail apparatus pathology in children is different comparing with adults. In the group of children under 6 years of age, there were mainly variants of normal nails, whereas in older children viral infection and acquired structural disorders were recorded. The risk of nail apparatus malignancy in childhood seems to be extremely low.

Normal variants in patients consulted in the Dermatology Clinic for lesions of the male external genitalia.

INTRODUCTION: So far there have been no papers analyzing the incidence of 'non-pathological' lesions or normal variants on the male external genitalia. Subsequently, the number of patients consulted due to the presence of such lesions remains unknown. The aim of the study was to estimate the incidence of normal variants in patients who were consulted due to lesions on the skin or mucosa of the male external genitalia. MATERIAL AND METHODS: The study group consisted of 400 males, aged 3-91, who were consulted due to lesions on the genitalia in the Department of Dermatology, Venereology and Allergology of the Medical University of Gdansk. RESULTS: The most common lesions were hyperpigmentation of the median raphe of the penis and scrotum (85.6%), pearly penile papules (24%), and prominent veins (24%). Sebaceous hyperplasia or ectopic sebaceous glands were revealed in 9% of patients, respectively. Melanocytic nevi were diagnosed with similar frequency (9.5%), whereas skin tags more rarely (7%). Other 'non-pathological' lesions were diagnosed in a considerably lower number of patients. In 32 patients (8% of all patients) the reason of admission to the Clinic was just the presence of some 'non-pathological' lesions. Pearly penile papules were found to be the most common condition, occurring in 78.1% patients. CONCLUSIONS: Normal variants represent a substantial percentage of generally asymptomatic lesions and the only indication for their removal is cosmetic discomfort or venerophobia.