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Felsenreich DM, Gachabayov M, Ritter E, Bergamaschi R. En-bloc excision of sacral squamous cell carcinoma with immediate reconstruction. Updates Surg 2024; 76:1099-1103. [PMID: 38691330 DOI: 10.1007/s13304-024-01861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
Sacral squamous cell carcinoma is an uncommon condition that may arise in scars following burns or in chronic wounds, such as an untreated pilonidal cyst. The aim of the present technical note is to describe a surgical technique aimed at minimizing local recurrence rates by en-bloc resection as well as providing immediate plastic reconstruction: 1. right-sided extended vertical rectus abdominis myo-cutaneous (VRAM) flap; 2. abdomino-perineal excision of the rectum with end colostomy; 3. en-bloc excision of the mass inclusive of gluteus maximus muscles and distal sacrectomy; 4. sacrectomy defect covered with VRAM flap; 5. bilateral gluteal defects covered with single-layer dermal substitute of bovine collagen and elastin hydrolysate followed by immediate split-thickness skin grafting from bilateral thigh donor sites, and negative pressure wound therapy dressings. This approach resulted in a favorable outcome at 2-year follow-up in a male patient presenting with a large locally advanced sacral squamous cell carcinoma involving the external anal sphincter muscle.
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Affiliation(s)
- Daniel Moritz Felsenreich
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Mahir Gachabayov
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Edmond Ritter
- Section of Plastic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Roberto Bergamaschi
- Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
- Department of Surgery, New York City Health Hospitals, Jacobi Medical Center, Suite 610, 1400 Pelham Parkway South, New York, NY, 10461, USA.
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2
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Ma E, Ge S, Rush WL, Allbritton J. Malignant melanoma arising in a burn scar. Arch Dermatol Res 2024; 316:146. [PMID: 38696005 DOI: 10.1007/s00403-024-02861-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/01/2024] [Accepted: 04/07/2024] [Indexed: 06/05/2024]
Abstract
Secondary malignancies are rare but devastating complications of longstanding burn scars. Squamous cell carcinoma is the most common, followed by basal cell carcinoma and melanomas. There are fewer than 50 total reported cases of malignant melanomas arising in burn scars. We report a case of malignant melanoma arising within a longstanding burn scar confirmed by histology, FISH, and PRAME staining to further characterize melanomas arising in burn scars and to illustrate the diagnostic challenges they present.
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Affiliation(s)
- Emily Ma
- University of Maryland School of Medicine, Baltimore Maryland, USA
| | - Shealinna Ge
- Department of Dermatology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Walter L Rush
- Joint Pathology Center, 606 Stephen Sitter Avenue, Silver Spring, MD, 20910, USA
| | - Jill Allbritton
- Joint Pathology Center, 606 Stephen Sitter Avenue, Silver Spring, MD, 20910, USA.
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3
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Buruiană A, Gheban BA, Gheban-Roșca IA, Georgiu C, Crișan D, Crișan M. The Tumor Stroma of Squamous Cell Carcinoma: A Complex Environment That Fuels Cancer Progression. Cancers (Basel) 2024; 16:1727. [PMID: 38730679 PMCID: PMC11083853 DOI: 10.3390/cancers16091727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
The tumor microenvironment (TME), a complex assembly of cellular and extracellular matrix (ECM) components, plays a crucial role in driving tumor progression, shaping treatment responses, and influencing metastasis. This narrative review focuses on the cutaneous squamous cell carcinoma (cSCC) tumor stroma, highlighting its key constituents and their dynamic contributions. We examine how significant changes within the cSCC ECM-specifically, alterations in fibronectin, hyaluronic acid, laminins, proteoglycans, and collagens-promote cancer progression, metastasis, and drug resistance. The cellular composition of the cSCC TME is also explored, detailing the intricate interplay of cancer-associated fibroblasts (CAFs), mesenchymal stem cells (MSCs), endothelial cells, pericytes, adipocytes, and various immune cell populations. These diverse players modulate tumor development, angiogenesis, and immune responses. Finally, we emphasize the TME's potential as a therapeutic target. Emerging strategies discussed in this review include harnessing the immune system (adoptive cell transfer, checkpoint blockade), hindering tumor angiogenesis, disrupting CAF activity, and manipulating ECM components. These approaches underscore the vital role that deciphering TME interactions plays in advancing cSCC therapy. Further research illuminating these complex relationships will uncover new avenues for developing more effective treatments for cSCC.
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Affiliation(s)
- Alexandra Buruiană
- Department of Pathology, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.B.); (C.G.); (D.C.)
| | - Bogdan-Alexandru Gheban
- Department of Histology, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Emergency Clinical County Hospital, 400347 Cluj-Napoca, Romania
| | - Ioana-Andreea Gheban-Roșca
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania;
| | - Carmen Georgiu
- Department of Pathology, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.B.); (C.G.); (D.C.)
| | - Doința Crișan
- Department of Pathology, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.B.); (C.G.); (D.C.)
| | - Maria Crișan
- Department of Histology, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
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4
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Fang L, Simman R, Workman L, Ayoub S, Bratton C. Malignant wound aetiology, diagnosis and management: a case series and literature review. J Wound Care 2024; 33:102-117. [PMID: 38329829 DOI: 10.12968/jowc.2024.33.2.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Malignant wounds develop when neoplastic cells invade the skin either locally or by lymphatic and haematogenous spread. They can present as hard-to-heal wounds and underlying causes include: primary skin cancer; metastasis of extracutaneous primary malignancy; malignant transformation of a hard-to-heal wound; iatrogenic injury; and cutaneous forms of cancers of non-skin origin. High clinical suspicion for a malignant wound should be confirmed with skin biopsy. The aim of this case series is to highlight a combination of both clinically clear cutaneous malignancies and not-so-obvious wounds caused by malignancy. METHOD This case series examines patients with malignant wounds of varying aetiology and appearance. For each case, we explain the pathophysiology, atypical features, diagnostic approach and treatment. We also discuss types of wound biopsy and general wound management principles. RESULTS Among the 11 cases analysed using descriptive statistics, median wound duration before presentation at our clinic was one year, while median age at presentation was 65 years. Our case series included the following diagnoses: cutaneous metastasis of invasive ductal carcinoma of the breast (n=2); cutaneous metastasis of colorectal adenocarcinoma (n=1); Marjolin's ulcer (n=1), basal cell carcinoma (BCC) (n=2), primary cutaneous squamous cell carcinoma (SCC) (n=1), metastatic malignant melanoma (n=1), cutaneous T-cell lymphoma (n=1), cutaneous angiosarcoma (n=1), Kaposi sarcoma (n=1) and recurrent tonsillar SCC with osteoradionecrosis (n=1); one case had both BCC and SCC. CONCLUSION Punch and excisional biopsies were the most frequently used diagnostic techniques. Local wound therapy addressed bleeding, malodour, exudate, pain and infection. However, wound healing is usually achieved once the underlying malignancy is treated. In advanced or metastatic disease, palliative wound care aims to prevent exacerbation of existing wounds and focuses on patient comfort.
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Affiliation(s)
- Lauren Fang
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
| | - Richard Simman
- University of Toledo, College of Medicine and Life Science, Department of Surgery, Toledo, Ohio, US
- Jobst Vascular Institute, ProMedica Health Network, Wound Care Program, Toledo, Ohio, US
| | - Lauren Workman
- Jobst Vascular Institute, ProMedica Health Network, Wound Care Program, Toledo, Ohio, US
| | - Samar Ayoub
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
| | - Camille Bratton
- University of Toledo, College of Medicine and Life Science, Toledo, Ohio, US
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5
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Soria Rivas A, Bea-Ardebol S, Vida Navas E, Muñoz-Arrones ÓM, Cabañas-Montero LJ, Mena-Mateos A, López-Campos F, Corral Moreno S, Pérez-Muñoz I, González Lizan F, Sanz Pascual M, Serrano Domingo JJ. Treatment of metastatic squamous cell carcinoma arising in sacrococcygeal pilonidal sinus: a case report series. Front Med (Lausanne) 2023; 10:1248894. [PMID: 37780565 PMCID: PMC10534040 DOI: 10.3389/fmed.2023.1248894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
Background Squamous cell carcinoma (SCC) arising in a sacrococcygeal pilonidal sinus is rare, with cases of metastatic disease being even rarer. Among published cases, almost none have reported on systemic treatment. Objective This disease has a poorer prognosis than other forms of cutaneous SCC; therefore, our objective is to shed some light on the treatment of metastatic disease. Methods We present a series of nine cases treated at a single center, four of whom received systemic treatment. Additionally, other previously reported cases of metastatic disease are included in an attempt to draw stronger conclusions. Results Four patients were treated under several treatment regimens, with a median progression-free survival of only 2 months and two instances of partial response (18%). The best result was achieved with cemiplimab. Across all the cases, there was a trend toward a benefit of the use of systemic treatment (HR 0.41, 95% CI 0.15-1.12, p = 0.083; median overall survival 13 vs. 8 months). Limitations Limitations include the significant lack of information on previously published cases and the extremely heterogeneous nature of the existing information. Conclusion The initial systemic treatment should be an anti-PD-1, as with other SCCs. After progression on anti-PD-1, there is no strong evidence to support the recommendation of a specific treatment or sequence: options include cetuximab and/or chemotherapy (platinum, paclitaxel, 5-fluorouracyl).
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Affiliation(s)
- Ainara Soria Rivas
- Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Sonia Bea-Ardebol
- Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Elena Vida Navas
- Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | | | | | | | | | - Israel Pérez-Muñoz
- Orthopedics and Orthopedic Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Fausto González Lizan
- Orthopedics and Orthopedic Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - María Sanz Pascual
- Orthopedics and Orthopedic Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
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6
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Abstract
Thermal injuries are one of the most common injuries in both civilian and combat scenarios. The importance of clinical determination of burn and frostbite injuries and treatment involves understanding the pathophysiology and mechanisms of these injuries while continually reviewing literature and studying new treatment modalities. This present review examines the (1) epidemiology, (2) etiology, (3) pathophysiology and classification, and (4) treatment of thermal injuries occurring to the foot. In addition to the paucity of new literature and studies on thermal injury, this is the first review, to the best of our knowledge, to examine the management of thermal injuries occurring to the foot.
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Affiliation(s)
- John M Tarazi
- Donald and Barbara Zucker, School of Medicine at Hofstra/Northwell, 500 Hofstra boulevard, Hempstead, NY 11549, USA; Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, 270 Park Avenue, Huntington, NY 11743, USA.
| | - Adam D Bitterman
- Donald and Barbara Zucker, School of Medicine at Hofstra/Northwell, 500 Hofstra boulevard, Hempstead, NY 11549, USA; Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, 270 Park Avenue, Huntington, NY 11743, USA
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7
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Asghari Dilmani S, Koç S, Çakır D, Gümüşderelioğlu M. Organomodified nanoclay with boron compounds is improving structural and antibacterial properties of nanofibrous matrices. Eur J Pharm Biopharm 2023; 184:125-138. [PMID: 36708972 DOI: 10.1016/j.ejpb.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
In this study, nanofibrous polymeric matrices were successfully developed with nanoclay, montmorillonite (MMT) and various boron (B) compounds, which were known to have positive effects on the wound healing with elevated antibacterial properties. For this purpose, MMT was modified with quaternary ammonium salt, trimethyl octadecyl ammonium bromide (TMOD), and boron compounds, boron nitride (BN), zinc borate (ZB), or phenylboronic acid (PBA) were adsorbed on organomodified MMT (OMMT). Then, poly (lactic acid) (PLA) based nanofibrous PLA-OMMT/B composites were fabricated via electrospinning. Modification of MMT nanoparticles with TMOD occurred through ion-exchange reaction and led to better homogenous fibrous structures which exhibited dramatic inhibition for gram-positive bacteria. Moreover, composites with ZB and PBA demonstrated both bacteriostatic and bactericidal effects for gram-positive and gram-negative bacteria. The chemical structures of the matrices were evaluated through ATR-FTIR and supported the intercalated composite formation. The thermal and mechanical stabilities of PLA matrices were also enhanced after OMMT and B incorporation. The lowest breaking strain value was recorded for PLA-OMMT/PBA composite compared to other B composites. The 100% and 50% extracts of the PLA-OMMT matrices showed modest cytotoxic effect on the human dermal fibroblasts (NHDF) on the second day culture that probably originated from TMOD. These results demonstrated that PLA-OMMT/B matrices, especially PBA including matrices, can be used as replaceable wound dressings that have limited interaction with cells but exhibit antibacterial activity and support the early stages of wound healing both morphologically and chemically.
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Affiliation(s)
- Sara Asghari Dilmani
- Graduate School of Science and Engineering, Hacettepe University, Beytepe, Ankara, Turkey; Bioengineering Department, Hacettepe University, Beytepe, Ankara, Turkey
| | - Sena Koç
- Graduate School of Science and Engineering, Hacettepe University, Beytepe, Ankara, Turkey; Chemical Engineering Department, Hacettepe University, Beytepe, Ankara, Turkey
| | - Demet Çakır
- Graduate School of Science and Engineering, Hacettepe University, Beytepe, Ankara, Turkey; Chemical Engineering Department, Hacettepe University, Beytepe, Ankara, Turkey
| | - Menemşe Gümüşderelioğlu
- Bioengineering Department, Hacettepe University, Beytepe, Ankara, Turkey; Chemical Engineering Department, Hacettepe University, Beytepe, Ankara, Turkey.
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8
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Toledo B, Picon-Ruiz M, Marchal JA, Perán M. Dual Role of Fibroblasts Educated by Tumour in Cancer Behavior and Therapeutic Perspectives. Int J Mol Sci 2022; 23:15576. [PMID: 36555218 PMCID: PMC9778751 DOI: 10.3390/ijms232415576] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/25/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
Tumours are complex systems with dynamic interactions between tumour cells, non-tumour cells, and extracellular components that comprise the tumour microenvironment (TME). The majority of TME's cells are cancer-associated fibroblasts (CAFs), which are crucial in extracellular matrix (ECM) construction, tumour metabolism, immunology, adaptive chemoresistance, and tumour cell motility. CAF subtypes have been identified based on the expression of protein markers. CAFs may act as promoters or suppressors in tumour cells depending on a variety of factors, including cancer stage. Indeed, CAFs have been shown to promote tumour growth, survival and spread, and secretome changes, but they can also slow tumourigenesis at an early stage through mechanisms that are still poorly understood. Stromal-cancer interactions are governed by a variety of soluble factors that determine the outcome of the tumourigenic process. Cancer cells release factors that enhance the ability of fibroblasts to secrete multiple tumour-promoting chemokines, acting on malignant cells to promote proliferation, migration, and invasion. This crosstalk between CAFs and tumour cells has given new prominence to the stromal cells, from being considered as mere physical support to becoming key players in the tumour process. Here, we focus on the concept of cancer as a non-healing wound and the relevance of chronic inflammation to tumour initiation. In addition, we review CAFs heterogeneous origins and markers together with the potential therapeutic implications of CAFs "re-education" and/or targeting tumour progression inhibition.
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Affiliation(s)
- Belén Toledo
- Department of Health Sciences, University of Jaén, E-23071 Jaén, Spain
| | - Manuel Picon-Ruiz
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, E-18100 Granada, Spain
- Instituto de Investigación Sanitaria ibs. GRANADA, Hospitales Universitarios de Granada-Universidad de Granada, E-18071 Granada, Spain
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, E-18016 Granada, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, E-18016 Granada, Spain
| | - Juan Antonio Marchal
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, E-18100 Granada, Spain
- Instituto de Investigación Sanitaria ibs. GRANADA, Hospitales Universitarios de Granada-Universidad de Granada, E-18071 Granada, Spain
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, E-18016 Granada, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, E-18016 Granada, Spain
| | - Macarena Perán
- Department of Health Sciences, University of Jaén, E-23071 Jaén, Spain
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, E-18100 Granada, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, E-18016 Granada, Spain
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9
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Management of Squamous Cell Carcinoma in Chronic Osteomyelitis: Our Experience, Review of the Literature and Role of MRI in Differential Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12092062. [PMID: 36140464 PMCID: PMC9497713 DOI: 10.3390/diagnostics12092062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The authors describe a series of patients with chronic osteomyelitis associated with squamous cell carcinoma, whilst analyzing its incidence in chronic osteomyelitis, surgical options for treatment and focusing on the role of MRI in differential diagnosis. Methods. The authors reviewed 73 cases of chronic osteomyelitis (CO) treated in their department between 1995 and 2019. Six of these patients (8.2%) had a malignant degeneration in squamous cell carcinoma (SCC). All cases with malignancy were evaluated with preoperative gadolinium-enhanced MRI. Results. In this series, the authors observed an incidence rate of 8.2% (6 cases out of 73); all patients were male with a mean age of 63.5 years. The mean time between the occurrence of chronic osteomyelitis and the diagnosis of squamous cell carcinoma was 36 years (range: 21–66). The treatment consisted of amputation in five patients and limb salvage with vascularized fibula autograft in one case. Conclusions. MRI played a key role in the differential diagnosis between infected and tumoral tissue, and was found to be crucial during follow-up. Amputation is the treatment of choice in extended tumoral involvement of bone and soft tissue.
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10
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Immunotherapy for the Treatment of Squamous Cell Carcinoma: Potential Benefits and Challenges. Int J Mol Sci 2022; 23:ijms23158530. [PMID: 35955666 PMCID: PMC9368833 DOI: 10.3390/ijms23158530] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023] Open
Abstract
Melanoma and nonmelanoma skin cancers (NMSCs) are recognized as among the most common neoplasms, mostly in white people, with an increasing incidence rate. Among the NMSCs, squamous cell carcinoma (SCC) is the most prevalent malignancy known to affect people with a fair complexion who are exposed to extreme ultraviolet radiation (UVR), have a hereditary predisposition, or are immunosuppressed. There are several extrinsic and intrinsic determinants that contribute to the pathophysiology of the SCC. The therapeutic modalities depend on the SCC stages, from actinic keratosis to late-stage multiple metastases. Standard treatments include surgical excision, radiotherapy, and chemotherapy. As SCC represents a favorable tumor microenvironment with high tumor mutational burden, infiltration of immune cells, and expression of immune checkpoints, the SCC tumors are highly responsive to immunotherapies. Until now, there are three checkpoint inhibitors, cemiplimab, pembrolizumab, and nivolumab, that are approved for the treatment of advanced, recurrent, or metastatic SCC patients in the United States. Immunotherapy possesses significant therapeutic benefits for patients with metastatic or locally advanced tumors not eligible for surgery or radiotherapy to avoid the potential toxicity caused by the chemotherapies. Despite the high tolerability and efficiency, the existence of some challenges has been revealed such as, resistance to immunotherapy, less availability of the biomarkers, and difficulty in appropriate patient selection. This review aims to accumulate evidence regarding the genetic alterations related to SCC, the factors that contribute to the potential benefits of immunotherapy, and the challenges to follow this treatment regime.
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11
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Marjanovic J, Ramirez HA, Jozic I, Stone RC, Wikramanayake TC, Head CR, Abdo Abujamra B, Ojeh N, Kirsner RS, Lev-Tov H, Pastar I, Tomic-Canic M. Dichotomous role of miR193b-3p in diabetic foot ulcers maintains inhibition of healing and suppression of tumor formation. Sci Transl Med 2022; 14:eabg8397. [PMID: 35544594 PMCID: PMC9707408 DOI: 10.1126/scitranslmed.abg8397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Despite the hyperproliferative environment marked by activation of β-catenin and overexpression of c-myc, the epidermis surrounding chronic diabetic foot ulcers (DFUs) is clinically hypertrophic and nonmigratory yet does not undergo malignant transformation. We identified miR193b-3p as a master regulator that contributes to this unique cellular phenotype. We determined that induction of tumor suppressor miR193b-3p is a unique feature of DFUs that is not found in venous leg ulcers, acute wounds, or cutaneous squamous cell carcinoma (SCC). Genomic analyses of DFUs identified suppression of the miR193b-3p target gene network that orchestrates cell motility. Inhibition of migration and wound closure was further confirmed by overexpression of miR193b-3p in human organotypic and murine in vivo wound models, whereas miR193b-3p knockdown accelerated wound reepithelialization in human ex vivo and diabetic murine wounds in vivo. The dominant negative effect of miR193b-3p on keratinocyte migration was maintained in the presence of promigratory miR31-5p and miR15b-5p, which were also overexpressed in DFUs. miR193b-3p mediated antimigratory activity by disrupting stress fiber formation and by decreasing activity of GTPase RhoA. Conversely, miR193b-3p targets that typically participate in malignant transformation were found to be differentially regulated between DFUs and SCC, including the proto-oncogenes KRAS (Kirsten rat sarcoma viral proto-oncogene) and KIT (KIT proto-oncogene). Although miR193b-3p acts as a tumor suppressor contributing to low tumor incidence in DFUs, it also acts as a master inhibitor of cellular migration and epithelialization in DFUs. Thus, miR193b-3p may represent a target for wound healing induction, cancer therapeutics, and diagnostics.
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Affiliation(s)
- Jelena Marjanovic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Horacio A Ramirez
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ivan Jozic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Rivka C Stone
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Tongyu C Wikramanayake
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Cheyanne R Head
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Beatriz Abdo Abujamra
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Nkemcho Ojeh
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.,Faculty of Medical Sciences, The University of the West Indies, Bridgetown BB11000, Barbados
| | - Robert S Kirsner
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Hadar Lev-Tov
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Irena Pastar
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
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12
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Squamous cell carcinoma complicating chronic osteomyelitis: A systematic review and case series. Surgeon 2021; 20:e322-e337. [PMID: 34969605 DOI: 10.1016/j.surge.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Squamous cell carcinoma (SCC) is a rare but serious complication of chronic osteomyelitis. This study aimed to determine an optimum approach to diagnosis and management. METHODS A systematic review was performed using Medline, Embase, CINAHL and Web of Science, from 1999-present. Additional cases, meeting the eligibility criteria, were added from our hospital database. Patient demographics (age, gender, co-morbidities), osteomyelitis diagnosis (location, duration), diagnosis of SCC (method, imaging, extent of disease) and management (amputation versus wide local excision versus palliation) as well as outcome at one and five years were collected. RESULTS Nineteen studies involving 106 patients met strict inclusion criteria. All published studies were case reports or case series. Chronic osteomyelitis had been present for a mean of 31 years (range 3-67) prior to SCC diagnosis. SCC was most commonly treated by amputation (81%). A poorer outcome occurred in those with metastatic disease (p = 0.006 at one year; p = 0.032 at five years), an incidental diagnosis at surgery for osteomyelitis (p = 0.052; p = 0.021) and SCC after pelvic osteomyelitis (p < 0.001; p = 0.002). CONCLUSIONS SCC should be suspected in all cases of chronic osteomyelitis with skin changes, particularly if the duration of sinus drainage exceeds 3 years. Histological biopsy for malignancy should be taken in all suspected cases, as well as routinely during excision of osteomyelitis when chronic skin changes are present. Staging computed tomography (CT) scanning is recommended to guide adjunctive therapy. Amputation, where possible, may be considered as the definitive surgical management, after discussion with the patient.
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Gajarawala SN, Pelkowski JN, Pettit PD, Lewis GK. Marjolin's Ulcer: Mesh-Related Vaginal Cutaneous Fistula With Superimposed Osteomyelitis and Neoplastic Transformation. Cureus 2021; 13:e16476. [PMID: 34430092 PMCID: PMC8372679 DOI: 10.7759/cureus.16476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/05/2022] Open
Abstract
Marjolin's ulcer is a rare, often aggressive squamous cell malignancy identified in previously injured areas or those affected by chronic inflammation. It often develops in deep wounds that are slow to heal or allowed to heal by secondary intention. Few reports and small case series about Marjolin's ulcer have been published. We present a unique case with well-differentiated keratinized squamous cell carcinoma arising from a mesh-related vaginocutaneous fistula with superimposed osteomyelitis. The risk of cancerous transformation leading to Marjolin's ulcer in non-healing traumatic wounds is 8.1% and 2.6% in a fistula associated with purulent-inflammatory bone diseases. Approximately 1.7% of chronic cutaneous ulcers undergo neoplastic transformation, with a disposition to squamous cell carcinoma. Women experiencing mesh complications may require multiple procedures to address these issues and, therefore, should have them addressed in a timely manner to allow for the best patient outcome. Treatment optimization on a whole should incorporate the goals outlined by the American Urogynecologic Society and the International Urogynecological Association. These include the use of relevant evidence to help guide the management of mesh complications as well as identifying the gaps in currently available evidence, developing a treatment algorithm to be used for shared decision making, and identifying provider and healthcare facility characteristics that may optimize treatment outcomes specific to mesh complications.
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Affiliation(s)
| | | | - Paul D Pettit
- Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, USA
| | - Gregory K Lewis
- Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, USA
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14
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Malignant Tumours Presenting as Chronic Leg or Foot Ulcers. J Clin Med 2021; 10:jcm10112251. [PMID: 34067425 PMCID: PMC8196993 DOI: 10.3390/jcm10112251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 01/18/2023] Open
Abstract
Our purpose was to collect data on the incidence of malignant skin tumours presenting as chronic leg or foot ulcers in a tertiary centre, and to analyse the frequency and type of initial clinical misdiagnoses in these cases. A retrospective chart review of cases with melanoma or other malignant neoplasms of the skin of the lower extremity treated in a tertiary centre during January 2010 until February 2020 was conducted to identify cases that presented as chronic ulcers. Out of 673 cases, 26 (3.9%) were identified with a total of 27 malignant tumours presenting as chronic ulcers of the lower leg or foot. Therefrom, seven were diagnosed as melanoma, eight as squamous cell carcinoma, and twelve as basal cell carcinoma. The mean interval until diagnosis for all tumour types was 44.4 months (median 24 months). A delay in correct treatment occurred in 12 out of 26 cases (46%) as a result of misdiagnosis with subsequent treatment as chronic leg or foot ulcers of a different etiology. Misdiagnoses were venous ulcer, traumatic wound, mixed arterial and venous ulcer, arterial ulcer, and ulcer of an unknown origin. Malignant ulcers presenting as chronic ulcers are rare, but often lead to misdiagnosis.
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Enhanced performance of gelatin 5-fluorouracil-containing nanoparticles against squamous cell carcinoma in simulated chronic wounds conditions. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 124:112073. [PMID: 33947565 DOI: 10.1016/j.msec.2021.112073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/17/2022]
Abstract
Chronic wounds are considered a silent epidemic affecting a significant fraction of the World population. Their treatment supposes a large fraction of the public spending on the health of developed countries. In chronic wounds secondary to burns, trauma, UV light radiation, and diabetes, among others, the development of squamous cell carcinoma (SCC) has been reported. If detected early, 95% of SCC are most comfortable to be treated and cured; however, 5% of advanced SCC is more dangerous and challenging to treat. It has been reported that the pH value within the wound-milieu influences indirectly and directly all biochemical reactions taking place in this process of healing. Differences in pH values between normal skin and chronic cutaneous wounds could be considered in designing and developing stimuli-responsive nanomaterials. In this work, the anticancer drug 5-fluorouracil (5-FU) inclusion on gelatin-based NPs for SCC treatment has been projected. The present work goal is to prepare and characterize physicochemical and biological properties of new therapeutic-containing NPs for the sustainable delivery of 5-FU under simulated chronic wound conditions. In vitro experiments have been performed to assess the biocompatible character of these gelatin-based NPs in terms of their hemolytic and cytotoxicity properties. Due to hyperglycemia impact on both the chronicity of the wounds and chemotherapy efficacy, cellular responses have been determined under euglycemic and hyperglycemic conditions. In vitro cytotoxicity studies have reported good selective toxicity against the A431 cell line, demonstrating that gelatin-based NPs are promising dual-responsive delivery systems to SCC targeting under simulated chronic wound conditions.
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Abstract
This article gives a general overview of pressure ulcers, with a focus on secondary care. Pressure ulcers are damage to the skin or underlying tissue as a result of pressure, friction or shearing forces. They place a significant physical, psychological and financial burden on patients and healthcare systems which will be explored. This review also covers risk assessment, classification and management of pressure ulcers in the inpatient setting.
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Affiliation(s)
- John Headlam
- Department of Care of the Elderly, St James University Hospital, Leeds, UK
| | - Amy Illsley
- Department of Care of the Elderly, Bradford Royal Infirmary, Bradford, UK
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Abstract
GENERAL PURPOSE To provide a comprehensive review of Marjolin ulcer (MU) to assist clinicians in understanding the epidemiology, etiology, pathogenesis, diagnosis, and treatment of MU. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Describe the epidemiology, pathogenesis, and clinical manifestations of MU.2. Summarize the diagnostic and treatment approaches for patients who have an MU. ABSTRACT This article aims to provide a comprehensive review of Marjolin ulcer (MU) to assist clinicians in understanding the epidemiology, etiology, pathogenesis, diagnosis, and treatment of MU. Marjolin ulcer presents with clear signs and symptoms of malignant degeneration in chronic wounds. It can be prevented by raising awareness and educating wound care providers appropriately about its signs and symptoms.
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Janowska A, Romanelli M, Oranges T, Davini G, Iannone M, Dini V. Prognostic Indicators of Wound Healing in Atypical Wounds: A Case Series. INT J LOW EXTR WOUND 2020; 21:529-534. [PMID: 33174491 DOI: 10.1177/1534734620970292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Healing rate is the most accurate method to predict healing; however, there are no data in atypical ulcers. We retrospectively analyzed clinical features, associated comorbidities, and therapies of 159 patients with atypical ulcers. In a subgroup of 59 patients, we analyzed the areas, perimeters, and the healing rate (mm/d) as prognostic indicators of wound healing. Atypical ulcers were more frequent among women (n = 98) with an average age of 76 years. Confirmed by biopsy, the etiologies were as follows: inflammatory diseases (38%), neoplastic ulcers (29%), vasculitis (21%), drug-induced ulcers (7%), and infectious ulcers (4%). Systemic therapies were applied based on the different etiologies. Wound bed preparation principles guided the local treatment. The average reduction of the area during the observation interval was 36%, while the average reduction in the perimeter was 41%. Overall, 51 ulcers showed a reduction in wound size and 8 ulcers showed an increase. Neoplastic ulcers were the group with the fastest healing rate, with an average speed of 0.24 mm/d. The slowest healing occurred in the inflammatory group with an average healing rate of 0.032 mm/d. The initial area and perimeters influenced wound healing; however, ulcer etiology and comorbidities significantly altered the healing rate.
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Affiliation(s)
| | | | - Teresa Oranges
- University of Pisa, Pisa, Italy.,Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
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19
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Piipponen M, Nissinen L, Kähäri VM. Long non-coding RNAs in cutaneous biology and keratinocyte carcinomas. Cell Mol Life Sci 2020; 77:4601-4614. [PMID: 32462404 PMCID: PMC7599158 DOI: 10.1007/s00018-020-03554-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/29/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
Long non-coding RNAs (lncRNAs) are a largely uncharacterized group of non-coding RNAs with diverse regulatory roles in various biological processes. Recent observations have elucidated the functional roles of lncRNAs in cutaneous biology, e.g. in proliferation and differentiation of epidermal keratinocytes and in cutaneous wound repair. Furthermore, the role of lncRNAs in keratinocyte-derived skin cancers is emerging, especially in cutaneous squamous cell carcinoma (cSCC), which presents a significant burden to health care services worldwide and causes high mortality as metastatic disease. Elucidation of the functions of keratinocyte-specific lncRNAs will improve understanding of the molecular pathogenesis of epidermal disorders and skin cancers and can be exploited in development of new diagnostic and therapeutic applications for keratinocyte carcinomas. In this review, we summarize the current evidence of functionally important lncRNAs in cutaneous biology and in keratinocyte carcinomas.
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Affiliation(s)
- Minna Piipponen
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, 20520, Turku, Finland
- Cancer Research Laboratory, Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Turku, Finland
| | - Liisa Nissinen
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, 20520, Turku, Finland
- Cancer Research Laboratory, Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Turku, Finland
| | - Veli-Matti Kähäri
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, 20520, Turku, Finland.
- Cancer Research Laboratory, Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Turku, Finland.
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Chiriac AE, Betiu M, Brzezinski P, Di Martino Ortiz B, Chiriac A, Foia L, Azoicai D. Malignant Degeneration of Scars. Cancer Manag Res 2020; 12:10297-10302. [PMID: 33116884 PMCID: PMC7585506 DOI: 10.2147/cmar.s274470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022] Open
Abstract
”Marjolin’s ulcer” is known as malignant degeneration of ancient burn scars, but both words can induce misdiagnosis. Malignant degeneration of scarring tissue can occur and can vary in its clinical, histological manifestations and its pre-existing skin lesions. We present several cases to substantiate our observations. ”Marjolin’s ulcer” is not synonym to an ulceration appeared on an old burn scar, transformed into squamous cell carcinoma.
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Affiliation(s)
- Anca E Chiriac
- Department of Epidemiology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iași, Romania
| | - Mircea Betiu
- Department of Dermatovenereology, Faculty of Medicine, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Kishinev, Republic of Moldova
| | - Piotr Brzezinski
- Department of Physiology and Cosmetology, Institute of Biology and Environmental Protection, Pomeranian Academy, Slupsk, Poland.,Department of Dermatology, Provincial Specialist Hospital in Slupsk, Ustka, Poland, Military Support Unit, Ustka, Poland
| | - Beatriz Di Martino Ortiz
- Dermatology Department, Clinicas Hospital, Faculty of Medical Sciences, National University of Ausunción-Paraguay
| | - Anca Chiriac
- Department of Dermatology, Nicolina Medical Center, Iasi, Romania.,Department of Dermatophysiology, "Apollonia" University, Iasi, Romania.,"P.poni" Insitute of Macromolecular Chemistry, Romanian Academy, Iasi, Romania
| | - Liliana Foia
- Department of Surgery, Faculty of Dentistry, "Grigore T. Popa" University of Medicine and Pharmacy, Iași, Romania
| | - Doina Azoicai
- Department of Epidemiology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iași, Romania
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Jiang N, Li SY, Zhang P, Yu B. Clinical characteristics, treatment, and prognosis of squamous cell carcinoma arising from extremity chronic osteomyelitis: a synthesis analysis of one hundred and seventy six reported cases. INTERNATIONAL ORTHOPAEDICS 2020; 44:2457-2471. [PMID: 32705317 DOI: 10.1007/s00264-020-04737-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Squamous cell carcinoma (SCC) arising from extremity chronic osteomyelitis (COM) has not been well-understood due to its low prevalence. This study aimed to synthesize the cases recently published to clarify their clinical characteristics, treatment, and prognosis. METHODS PubMed, Embase, and Cochrane Library databases were searched for English literature reporting cases diagnosed of SCC originating from extremity COM between January 1, 1990, and September 30, 2019. The National Institutes of Health (NIH) assessment tool was used to evaluate the quality of reports included, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to summarize the quality of available evidence. The data synthesized for analysis were clinical features, treatment strategy, and incidences of local recurrence, metastasis, all-cause, and SCC-related deaths. In addition, potential factors that might have influenced treatment efficacy and prognosis of SCC were also investigated. RESULTS Included for this analysis were 60 studies of 176 patients (a male-to-female ratio of 6.7). COM mostly occurred following trauma (73%), the tibia was the most frequent site (61%), and a sinus tract was the most common symptom (61%). The mean duration from COM to SCC was 27 years. Positive rate of pathogen culture was 90%, with 73% being polymicrobial. Limb amputation was performed in 80.5% of the patients. Incidences of local recurrence, metastasis after treatment, all-cause, and SCC-related mortalities were 16.7%, 12%, 31.1%, and 12.6%, respectively. Patients with local lymphadenopathy at diagnosis had significantly higher risks of local recurrence (P = 0.01), SCC-related (P = 0.02), and all-cause deaths (P = 0.01) than those without. Patients with moderately-to-poorly differentiated SCC types had significantly higher risks of local recurrence (P = 0.01) and all-cause death (P = 0.02) than those with a well-differentiated type. CONCLUSIONS SCC arising from extremity COM favoured males and the tibia. Although limb amputation was the mainstay of treatment, the overall incidences of local recurrence, metastasis, and SCC-related death exceeded 10%. Patients with local lymphadenopathy at diagnosis of SCC and those with moderately-to-poorly differentiated SCC types should be followed up closely. TRIAL REGISTRATION CRD42020154221.
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Affiliation(s)
- Nan Jiang
- Division of Orthopaedics & Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, People's Republic of China
| | - Su-Yi Li
- Department of Health Management Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Ping Zhang
- Division of Orthopaedics & Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, People's Republic of China
| | - Bin Yu
- Division of Orthopaedics & Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515, People's Republic of China.
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Kuwahara M, Yurugi S, Ando J, Takeuchi M, Miyata R, Harada M, Masuda Y, Kanagawa S. Squamous cell carcinoma developed in a chronic radiation-induced chest wall ulcer that is difficult to undergo thorough preoperative histological examination. Int J Surg Case Rep 2020; 72:467-470. [PMID: 32698267 PMCID: PMC7317167 DOI: 10.1016/j.ijscr.2020.05.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022] Open
Abstract
Squamous cell carcinoma (SCC) arose in a large chronic radiation-induced thoracic ulcer which exposing the lung and pericardium after flap surgery. Preoperative histopathological examination point indicated Inflammation. But after flap surgery, squamous cell carcinoma was diagnosed from a fistula at the margin of the flap. We should have asked a thoracic/cardiac surgeon to conduct a biopsy at the pericardium during the debridement operation before flap covering. It is necessary to consider the best method for performing the most thorough histological examination possible, even in areas where histological examinations are difficult, as all ulcers can contain tumors.
Introduction We report a case in which squamous cell carcinoma (SCC) developed in a large chronic radiation-induced thoracic ulcer after flap surgery in areas where preoperative histological examinations are difficult. Presentation of case The patient was a 75-year-old female. She had undergone resection and radiotherapy for left breast cancer 15 years earlier. Six years ago, the ulcer expanded from the subclavian to xiphoid levels, exposing the lung and pericardium. A histopathological examination, which avoided the lung and pericardium, was performed. Inflammation was diagnosed. We reconstructed the chest wall with a pedicled rectus abdominis flap. Eighteen months later, three verrucous tissue-lined fistulas formed. A histological examination revealed well-differentiated SCC. Six months later, the patient died of massive bleeding from a fistula. Discussion It is unclear exactly when the SCC occurred. As three fistulas formed at the margins of the flap around the pericardium, we suspect that the cancer developed within or near the pericardial region. We need to reflect on the lack of a thorough biopsy. As no pericardial biopsy was performed, we should have asked a thoracic/cardiac surgeon to conduct a biopsy during the debridement operation. If the tumor had been localized to the pericardium, it could have been removed. Conclusion It is necessary to consider the best method for performing the most thorough histological examination possible, even in areas where histological examinations are difficult, as all ulcers can contain tumors.
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Affiliation(s)
- Masamitsu Kuwahara
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan.
| | - Satoshi Yurugi
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
| | - Junji Ando
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
| | - Mika Takeuchi
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
| | - Riyo Miyata
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
| | - Masayuki Harada
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
| | - Yasumitsu Masuda
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
| | - Saori Kanagawa
- Division of Plastic Surgery, Nara Medical University Hospital, 840 Shijocho, Kashihara, Nara 634-8522, Japan
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Allepot K, Curings P, Viard R, Vincent PL, Voulliaume D. [Diagnostic pitfall: Early arising, multiple and recurrent Marjolin's ulcer. About 8 patients (16 tumors) and literature review]. ANN CHIR PLAST ESTH 2020; 66:151-158. [PMID: 32665065 DOI: 10.1016/j.anplas.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Marjolin's ulcer (MU) is a large entity representing skin cancers resulting from the transformation of chronic wounds of a heterogeneous nature. Burn scars are the most at risk of degeneration, in particular because there are the sites of important skin tension. Atypical forms are not uncommon. The objective of this study is to present these exceptions which are underestimated. MATERIALS AND METHODS All patients with UM in our centre between January 2011 and February 2019 have been included permitting to report the initial pathology, the location, the latency time, the histology and the management carried out. RESULTS Eight patients were treated in our center for MU, they developed 16 skin cancers. Fourteen were squamous cell carcinomas (SCC). The shortest latency period was 2 months. The youngest patient was 22 years old when she was diagnosed with MU. Three patients had at least 2 synchronous SCC. One patient had a recurrence after a split-thickness skin grafting on artificial dermis and 2 patients had second locations. CONCLUSION Atypic forms are not rare. MU is commonly recurrent, multiple, early arising and may appear in young people. The treatment of chronic wounds cannot be dissociated from the treatment of contractures, otherwise the wound will inevitably reappear.
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Affiliation(s)
- K Allepot
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France.
| | - P Curings
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - R Viard
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - P-L Vincent
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - D Voulliaume
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
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Peng L, Luo Y, Huang X, Li Z. Carcinogenesis and precancerosis transformation of chronic osteomyelitis: 6 cases report and literature review. Med Hypotheses 2020; 140:109643. [PMID: 32163794 DOI: 10.1016/j.mehy.2020.109643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Malignant transformation is a rare and late complication of chronic osteomyelitis. This study presented the results of six cases of carcinogenesis and precancerosis transformations arising from chronic osteomyelitis. METHODS Patients who were diagnosed as chronic osteomyelitis and treated in our division were retrospectively retrieved from electronic case system of our hospital. A total of six cases of chronic osteomyelitis patients, confirming with pathological results were included. Not only the characteristics and causes of chronic osteomyelitis, but also time from diagnosis to malignancy, histological types, therapeutic choices and results of treatment were fully incorporated to further study this disease. RESULTS All 6 cases with chronic osteomyelitis included in the study were male, with average age of 55.67 year-old (ranging from 48 to 66). The average time from onset of osteomyelitis to carcinomatous change was 31 years (ranging from 9 to 50). Two thirds of patients had explicit infection source of trauma, whereas the rest cases had no obvious culprits before osteomyelitis emerging. All 3 patients diagnosed as carcinoma were performed with proximal limb amputation, but therapy strategies varied in the remaining 3 patients in precancerosis stage. After amputation, 1 patient had carcinoma relapsed at the lower portion of his femur. CONCLUSION Although carcinomatous degeneration exists as a rare complication in chronic osteomyelitis, some suspicious conditions such as failure treatment of refractory ulcer and bulking of cauliflower-like mass should be taken cautiously. Early diagnosis and proximal amputation are essential for prognosis and clinical results.
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Affiliation(s)
- Lin Peng
- Department of Bone and Joint, Hospital Affiliated to Southwest Medical University, Lu Zhou City, Si Chuan Province 646000, PR China
| | - Yuhao Luo
- Department of Medical Oncology, Hospital Affiliated to Southwest Medical University, Lu Zhou City, Si Chuan Province 646000, PR China
| | - Xianrong Huang
- Traditional Chinese Medicine Hospital of Yuechi County, Yuechi County, Sichuan Province 638300, PR China
| | - Zhong Li
- Department of Bone and Joint, Hospital Affiliated to Southwest Medical University, Lu Zhou City, Si Chuan Province 646000, PR China.
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Nicoara M, Bain K, Patel R, Jaikaran O, Hingorani A, Asher E. Malignant Transformation of Nonhealing Ulcer-Basal Cell Carcinoma. Ann Vasc Surg 2020; 70:565.e7-565.e10. [PMID: 32035267 DOI: 10.1016/j.avsg.2020.01.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/09/2020] [Accepted: 01/26/2020] [Indexed: 11/17/2022]
Abstract
We discuss the rare case of a 72-year-old female with a history of a nonhealing lower extremity ulcer that was biopsied, revealing malignant transformation to basal cell carcinoma (BCC). Although BCC is the most common malignancy worldwide, malignant transformation of nonhealing wounds is more often associated with squamous cell carcinoma. Current literature estimates the rate of BCC arising from venous stasis ulcer to occur between 1.5 and 15%. When diagnosed early, BCC can have cure rates of up to 95%. However, metastatic BCC has a median survival of roughly 8 months. We believe it is important to raise awareness of this rare, but often curable, clinical diagnosis to improve long-term outcomes.
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Affiliation(s)
- Michael Nicoara
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY.
| | - Kevin Bain
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
| | - Ronak Patel
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
| | - Omkaar Jaikaran
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
| | - Anil Hingorani
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
| | - Enrico Asher
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
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Guzmán-Herrera A, Mao Y. Polarity during tissue repair, a multiscale problem. Curr Opin Cell Biol 2020; 62:31-36. [PMID: 31514044 PMCID: PMC7036748 DOI: 10.1016/j.ceb.2019.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022]
Abstract
Tissue repair is essential for all organisms, as it protects the integrity and function of tissues and prevents infections and diseases. It takes place at multiple scales, from macroscopic to microscopic levels. Most mechanisms driving tissue repair rely on the correct polarisation of collective cell behaviours, such as migration and proliferation, and polarisation of cytoskeletal and junctional components. Furthermore, re-establishment and maintenance of cell polarity are fundamental for a tissue to be fully repaired and for withstanding mechanical stress during homeostasis and repair. Recent evidence highlights an important role for the interplay between cell polarity and tissue mechanics that are critical in tissue repair.
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Affiliation(s)
- Alejandra Guzmán-Herrera
- MRC Laboratory for Molecular Cell Biology, University College London, London WC1E 6BT, UK; Institute for the Physics of Living Systems, University College London, London, UK
| | - Yanlan Mao
- MRC Laboratory for Molecular Cell Biology, University College London, London WC1E 6BT, UK; Institute for the Physics of Living Systems, University College London, London, UK; College of Information and Control, Nanjing University of Information Science and Technology, Nanjing, Jiangsu 210044, People's Republic of China.
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Janowska A, Dini V, Oranges T, Iannone M, Loggini B, Romanelli M. Atypical Ulcers: Diagnosis and Management. Clin Interv Aging 2019; 14:2137-2143. [PMID: 31849457 PMCID: PMC6911347 DOI: 10.2147/cia.s231896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/16/2019] [Indexed: 01/22/2023] Open
Abstract
Atypical ulcers show atypical clinical features, histology, localization, and resistance to standard therapies. The persistence of a chronic ulcer despite treatment with standard therapies requires a more specific diagnostic investigation. Diagnosis involves obtaining the history and performing clinical examination and additional tests. A skin biopsy is frequently used to confirm unclear diagnosis. In difficult cases, microbiological and immunohistochemical examinations, laboratory blood tests, or instrumental tests should be evaluated. The treatment of atypical wounds is characterized by local systemic therapy and pain control. Our results highlight the need for early diagnosis, and standardized and targeted management by a multidisciplinary wound healing center.
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Affiliation(s)
- Agata Janowska
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Department of Dermatology, University of Pisa, Pisa, Italy.,Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Dörr S, Lucke-Paulig L, Vollmer C, Lobmann R. Malignant Transformation in Diabetic Foot Ulcers-Case Reports and Review of the Literature. Geriatrics (Basel) 2019; 4:geriatrics4040062. [PMID: 31703431 PMCID: PMC6961039 DOI: 10.3390/geriatrics4040062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 01/13/2023] Open
Abstract
An imbalance of regeneration and destruction of the extracellular matrix due to a plethora of chemo- and cytokines, elevated matrix metalloproteinases, bacterial contamination and repetitive painless tissue damage can lead the chronicity of a wound, especially in diabetic foot ulcers (DFU). Along general lines, wound healing and cancer development are similar. Therefore chronic wounds prepare a breeding ground for cancer development. Several characteristics such as increase in size, verrucous everted margins and contact bleeding are suspicious for malignant growth in a chronic wound. While previously the term Marjolin's ulcer was attributed to a malignant tumor in (burn) scars, it is nowadays used for every malignant tumor in chronic wounds. Furthermore, chronic ulcers in diabetic feet are susceptible for malignant transformation. We describe two cases of squamous cell carcinoma in patients with DFU-a 71 year-old woman and a 67 year old man. Both received total tumor excision and split-skin grafts with good short-time results.
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Affiliation(s)
- Stefan Dörr
- Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, 70374 Bad Cannstatt, 24 Prießnitzweg, Germany;
- Correspondence: (S.D.); (R.L.); Tel.: +49-711-278-44887 (S.D.)
| | - Lara Lucke-Paulig
- Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, 70374 Bad Cannstatt, 24 Prießnitzweg, Germany;
| | - Christian Vollmer
- Department of Orthopedics and Trauma Surgery, Stuttgart General Hospital, 70374 Bad Cannstatt, 24 Prießnitzweg, Germany;
| | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, 70374 Bad Cannstatt, 24 Prießnitzweg, Germany;
- Correspondence: (S.D.); (R.L.); Tel.: +49-711-278-44887 (S.D.)
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29
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Dong W, Nie LJ, Wu MJ, Xie T, Liu YK, Tang JJ, Dong JY, Qing C, Lu SL. WoundCareLog APP - A new application to record wound diagnosis and healing. Chin J Traumatol 2019; 22:296-299. [PMID: 31481277 PMCID: PMC6823661 DOI: 10.1016/j.cjtee.2019.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 02/04/2023] Open
Abstract
The incidence of chronic wounds has been increasing over the past 20 years. However, the standardized diagnosis and treatment practice of chronic refractory wounds have not been established. In addition, the properties of the wound are characterized by morphology and thus correct description of the wound in medical history collection plays a vital role, which directly affects the definitive diagnosis. To develop more accurate format of clinical history record which can correctly reflect a patient's course and treatment progress, and to standardize the medical history record of chronic refractory wounds, at the national or regional level, we designed the WoundCareLog APP. It acts as a recording and communication tool for wound healing specialists at all levels of medical institutions in China. The WoundCareLog APP is fully compatible to meet the criteria and requirements of conventional medical records by embedding 9 modules. In addition, the demands for morphological description of wounds in wound healing diagnosis and treatment have been fulfilled by enroll of digital imaging technology to overcome the inadequacies of traditional medical history records.
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Affiliation(s)
- Wei Dong
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Lan-Jun Nie
- Department of Plastic and Reconstructive Surgery, 2nd Affiliated Hospital, Nanjing Medical University, Nanjing, 210003, China
| | - Min-Jie Wu
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Ting Xie
- Wound Healing Center at Emergency Department, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200023, China
| | - Ying-Kai Liu
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Jia-Jun Tang
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Jiao-Yun Dong
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Chun Qing
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Shu-Liang Lu
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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Goodarzi G, Maniati M, Qujeq D. The role of microRNAs in the healing of diabetic ulcers. Int Wound J 2019; 16:621-633. [PMID: 30821119 PMCID: PMC7949391 DOI: 10.1111/iwj.13070] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022] Open
Abstract
MicroRNAs (miRNAs) are small protected molecules with a length of 18 to 25 nucleotides. Many studies have recently been conducted on miRNAs, illustrating their role in regulating many biological, physiological, and pathological activities, such as maintaining cellular signalling and regulating cellular pathways. The main role of miRNAs is to regulate the expression of genes after translation, which can lead to the destruction or suppression of translation by binding to mRNAs. As any change in the regulation of miRNAs is associated with several physiological abnormalities, such as type 2 diabetes and its complications, these molecules can be used for therapeutic purposes or as biomarkers for the diagnosis of diseases such as diabetes and its complications. In this review article, we will discuss important findings about the miRNAs and the role of these molecules in different phases of the wound-healing process of chronic wounds, especially diabetic ulcer.
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Affiliation(s)
- Golnaz Goodarzi
- Department of Medical Biochemistry and Biotechnology, School of MedicineNorth Khorasan University of Medical SciencesBojnurdIran
| | - Mahmood Maniati
- School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Durdi Qujeq
- Cellular and Molecular Biology Research Center (CMBRC), Health Research InstituteBabol University of Medical SciencesBabolIran
- Dental Materials Research Center, Institute of HealthBabol University of Medical SciencesBabolIran
- Cancer Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
- Department of Clinical Biochemistry, School of MedicineBabol University of Medical SciencesBabolIran
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Abstract
Dhoti is traditional Indian dresses worn by males in the Indian subcontinent to cover the lower parts of the body. The term Dhoti cancer was first used by Khanolkar and Suryabhai in 1945. It is a type of waistline SCC reported in Indian males wearing dhoti. Only a handful of cases are reported in English literature. This case is remarkable due to its rare site of presentation, simultaneous presence of carcinoma and suspicious acanthosis on both side of waist in the same patient. Any hypo pigmented patch and acanthosis on the waist area in a dhoti clad man should be viewed with suspicion and continuous surveillance is needed thereof.
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Affiliation(s)
- Manojit Midya
- Department of Burns, Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepti Sukheeja
- Department of Pathology and Blood Bank, Government Medical College, Kota, Rajasthan, India
| | - Jagdeep Rao
- Department of Burns, Plastic and Reconstructive Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Gautam Prakash
- Department of Burns, Plastic and Reconstructive Surgery, SMS Medical College, Jaipur, Rajasthan, India
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Powell HB, Googe PB, Sayed CJ. Squamous cell carcinoma arising in a chronic perineal wound in a patient with long-standing cutaneous Crohn's disease. JAAD Case Rep 2018; 4:346-348. [PMID: 29693066 PMCID: PMC5911976 DOI: 10.1016/j.jdcr.2017.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Helen B Powell
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Paul B Googe
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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miRNA delivery for skin wound healing. Adv Drug Deliv Rev 2018; 129:308-318. [PMID: 29273517 DOI: 10.1016/j.addr.2017.12.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/24/2017] [Accepted: 12/16/2017] [Indexed: 12/13/2022]
Abstract
The wound healing has remained a worldwide challenge as one of significant public health problems. Pathological scars and chronic wounds caused by injury, aging or diabetes lead to impaired tissue repair and regeneration. Due to the unique biological wound environment, the wound healing is a highly complicated process, efficient and targeted treatments are still lacking. Hence, research-driven to discover more efficient therapeutics is a highly urgent demand. Recently, the research results have revealed that microRNA (miRNA) is a promising tool in therapeutic and diagnostic fields because miRNA is an essential regulator in cellular physiology and pathology. Therefore, new technologies for wound healing based on miRNA have been developed and miRNA delivery has become a significant research topic in the field of gene delivery.
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Abstract
Cutaneous squamous cell carcinoma (cSCC) is a malignant neoplasm of the skin characterized by an aberrant proliferation of keratinocytes. Cutaneous SCC is the second most common malignancy globally, and usually arises in the chronically sun-damaged skin of elderly white individuals. From a pathologist's perspective, it is important to differentiate cSCC from the benign and reactive squamoproliferative lesions and identify the high-risk features associated with aggressive tumor behavior. In this article, we provide an up-to-date overview of cSCC along with its precursor lesions and important histologic variants, with a particular emphasis on the histopathologic features and molecular pathogenesis.
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Bazaliński D, Przybek-Mita J, Barańska B, Więch P. Marjolin's ulcer in chronic wounds - review of available literature. Contemp Oncol (Pozn) 2017; 21:197-202. [PMID: 29180925 PMCID: PMC5701580 DOI: 10.5114/wo.2017.70109] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
Marjolin's ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and areas affected by inflammations. Its incidence is estimated to range from 1% to 2% of all burn scars. It most frequently takes the form of squamous cell carcinoma which sometimes is diagnosed during examination of lesions developing in scars and hard-to-heal chronic wounds (pressure sores, leg ulcers). Therapeutic management of Marjolin's ulcer requires well-designed treatment plan to ensure optimal medical care and good quality of life for the patient. The high risk of metastases and damage to the structure of vitally important organs determines the need for early diagnosis and prompt surgical intervention with supplementary therapy. The purpose of the study was to examine etiopathogenesis of Marjolin's ulcer and principles of its treatment. The authors focused on the aspect of malignant degeneration in chronic wounds (leg ulcers, pressure sores) as a very rare, aggressive form of Marjolin's ulcer. A review of the available literature on the issue of Marjolin ulcers was conducted using the key words; Marjolin ulcers, pressure sore, chronic wound. Malignant degeneration in chronic wounds is a very rare aggressive form of Marjolin ulcer. Increased oncological alertness should be displayed by nursing and medical personnel taking care of patients with chronic wounds.
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Affiliation(s)
- Dariusz Bazaliński
- 1Institute of Nursing and Health Sciences, Medical Faculty, University of Rzeszow, Rzeszów, Poland
- Podkarpackie Oncology Centre Specialist Hospital, Brzozów, Poland
| | | | - Beata Barańska
- Podkarpackie Oncology Centre Specialist Hospital, Brzozów, Poland
| | - Paweł Więch
- 1Institute of Nursing and Health Sciences, Medical Faculty, University of Rzeszow, Rzeszów, Poland
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38
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Mostaço-Guidolin L, Rosin NL, Hackett TL. Imaging Collagen in Scar Tissue: Developments in Second Harmonic Generation Microscopy for Biomedical Applications. Int J Mol Sci 2017; 18:E1772. [PMID: 28809791 PMCID: PMC5578161 DOI: 10.3390/ijms18081772] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 01/13/2023] Open
Abstract
The ability to respond to injury with tissue repair is a fundamental property of all multicellular organisms. The extracellular matrix (ECM), composed of fibrillar collagens as well as a number of other components is dis-regulated during repair in many organs. In many tissues, scaring results when the balance is lost between ECM synthesis and degradation. Investigating what disrupts this balance and what effect this can have on tissue function remains an active area of research. Recent advances in the imaging of fibrillar collagen using second harmonic generation (SHG) imaging have proven useful in enhancing our understanding of the supramolecular changes that occur during scar formation and disease progression. Here, we review the physical properties of SHG, and the current nonlinear optical microscopy imaging (NLOM) systems that are used for SHG imaging. We provide an extensive review of studies that have used SHG in skin, lung, cardiovascular, tendon and ligaments, and eye tissue to understand alterations in fibrillar collagens in scar tissue. Lastly, we review the current methods of image analysis that are used to extract important information about the role of fibrillar collagens in scar formation.
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Affiliation(s)
- Leila Mostaço-Guidolin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
| | - Nicole L Rosin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
| | - Tillie-Louise Hackett
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
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Abstract
Introduction Carcinomatous degeneration is a rare and late complication developing decades after the diagnosis of chronic osteomyelitis. Objectives To present the results from a retrospective study of six cases of squamous cell carcinoma arising from chronic osteomyelitis. Methods Six cases of chronic osteomyelitis related to cutaneous squamous cell carcinoma were identified. The cause and characteristics of the osteomyelitis were analyzed, as well as time up to malignancy, the suspicion signs for malignancy, the localization and histological type of the cancer, and the type and result of the treatment. Results The mean time between osteomyelitis onset and the diagnosis of malignant degeneration was 49.17 years (range: 32–65). The carcinoma resulted from tibia osteomyelitis in five cases and from femur osteomyelitis in one. The pathological examination indicated cutaneous squamous cell carcinoma in all cases. All the patients were staged as N0M0, except for one, whose lomboaortic lymph nodes were affected. The treatment consisted of amputation proximal to the tumor in all patients. No patient presented signs of local recurrence and only one had carcinoma metastasis. Conclusion Early diagnosis and proximal amputation are essential for prognosis and final results in carcinomatous degeneration secondary to chronic osteomyelitis.
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Abstract
In 1828, Jean Nicholas Marjolin, a French surgeon, first described the findings of a neoplastic development arising from a burn scar, now more commonly referred to as a Marjolin's ulcer. A Marjolin's ulcer describes malignant degeneration in any chronic wound. The majority of cases arises in burn scars and are often latent for decades. Marjolin ulcers have been widely identified in post-war time injuries. These ulcers may arise in almost any anatomical location. We report a case of an 82-year-old male that presented with a painful fluctuating mass on the right arm localized to the site of an old grenade blast injury he sustained many years earlier. While the presentation of these cases may be variable, the significance of proper management of the wounds is essential to optimal patient outcomes. An aggressive course and poor prognosis is associated with Marjolin's ulcers that degenerate into squamous cell carcinoma. Early detection and aggressive treatment/management with wide local excision and prompt coverage yield the best results when treating patients with Marjolin's ulcers.
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Affiliation(s)
- Susan E Wozniak
- Department of General Surgery, Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Stephanie Zuo
- Department of General Surgery, Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Kamran Khan
- Department of General Surgery, Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - JoAnn Coleman
- Department of General Surgery, Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
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Caruso G, Gerace E, Lorusso V, Cultrera R, Moretti L, Massari L. Squamous cell carcinoma in chronic osteomyelitis: a case report and review of the literature. J Med Case Rep 2016; 10:215. [PMID: 27491284 PMCID: PMC4973539 DOI: 10.1186/s13256-016-1002-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 07/06/2016] [Indexed: 01/24/2023] Open
Abstract
Background Chronic osteomyelitis is a challenging problem, and malignant transformation is a rare occurrence. We report a case of a patient with squamous cell carcinoma arising from an osteomyelitic hotbed and discuss through a literature review the etiopathogenesis, diagnosis, and treatment of this lesion. Case presentation A 69-year-old Italian man had sustained an exposed tibial fracture 40 years ago during a road accident, for which he had undergone various surgical osteosynthesis treatments with multiple antibiotic therapies. He presented to our hospital because of recurrence of a fistula at the proximal third of the anterior region of the tibia. For 2 months, we treated the lesion with antibiotics, and local medication with curettage. We saw no evidence of lesion improvement, and we advised the patient to undergo a knee amputation, which he refused. The alternative we chose was a surgical toilet of the osteomyelitic hotbed and used bioglass as a bone substitute. After 2 months of follow-up, we noticed a fulminating, budding formation in the area of the surgical wound that turned out to be a squamous cell carcinoma on biopsy. The patient again refused the amputation and underwent a wide-margin surgical debridement. After 2 months, the carcinoma recurred, and an above-the-knee amputation was performed. Conclusions Our experience with this case indicates that amputation is the most appropriate treatment for squamous carcinoma occurring in patients with chronic osteomyelitis. To avoid risks of lymphonodular and organ metastasization, this radical surgical procedure should not be delayed. Early diagnosis and timely therapy can prevent amputation only in selected cases. Surgeons who treat osteomyelitis and chronic wounds should be aware of the risk of tumor degeneration. Squamous cell carcinoma associated with chronic osteomyelitis has a low-grade malignancy, but implications of lymphonodular involvement and organ metastasis should not be excluded.
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Affiliation(s)
- Gaetano Caruso
- Orthopaedic and Traumatology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Emanuele Gerace
- Orthopaedic and Traumatology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Vincenzo Lorusso
- Orthopaedic and Traumatology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Rosario Cultrera
- Infectious Diseases Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Loredana Moretti
- Plastic and Reconstructive Surgery, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Leo Massari
- Orthopaedic and Traumatology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
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43
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The neglected role of copper ions in wound healing. J Inorg Biochem 2016; 161:1-8. [DOI: 10.1016/j.jinorgbio.2016.02.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/19/2016] [Accepted: 02/10/2016] [Indexed: 12/30/2022]
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Reich-Schupke S, Doerler M, Wollina U, Dissemond J, Horn T, Strölin A, Erfurt-Berge C, Stücker M. [Squamous cell carcinomas in chronic venous leg ulcers. Data of the German Marjolin Registry and review]. J Dtsch Dermatol Ges 2016; 13:1006-14. [PMID: 26408462 DOI: 10.1111/ddg.40_12649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Stefanie Reich-Schupke
- Abteilung für Dermatologie, Venerologie und Allergologie der, Ruhr-Universität Bochum, Deutschland.,Artemed - Diagnose- und Therapiezentrum für Venen und Haut, Dermatologie & Gefäßchirurgie, Bad Oeynhausen, Deutschland
| | - Martin Doerler
- Abteilung für Dermatologie, Venerologie und Allergologie der, Ruhr-Universität Bochum, Deutschland
| | - Uwe Wollina
- Klinik für Dermatologie und Allergologie, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Dresden-Friedrichstadt, Dresden, Deutschland
| | - Joachim Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie, Universität Essen, Deutschland
| | - Thomas Horn
- Klinik für Dermatologie, Venerologie und Allergologie, Krefeld, Deutschland
| | - Anke Strölin
- Klinik für Dermatologie, Venerologie und Allergologie, Eberhard-Karls-Universität, Tübingen, Deutschland
| | - Cornelia Erfurt-Berge
- Klinik für Dermatologie, Venerologie und Allergologie, Universität Erlangen, Deutschland
| | - Markus Stücker
- Abteilung für Dermatologie, Venerologie und Allergologie der, Ruhr-Universität Bochum, Deutschland
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Reich-Schupke S, Doerler M, Wollina U, Dissemond J, Horn T, Strölin A, Erfurt-Berge C, Stücker M. Squamous cell carcinomas in chronic venous leg ulcers. Data of the German Marjolin Registry and review. J Dtsch Dermatol Ges 2016; 13:1006-13. [PMID: 26408463 DOI: 10.1111/ddg.12649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Secondary squamous cell carcinoma (SCC) is a rare complication of chronic venous leg ulcers. So far, little is known about its pathophysiology and clinical behavior. Initiated by the working group "Wound Healing" (AGW) of the German Society of Dermatology (DDG), it is the objective of the current Marjolin registry to collect cases of SCC arising in venous ulcers, in order to evaluate diagnostic characteristics. PATIENTS AND METHODS All members of the AGW received questionnaires inquiring about basic patient data, ulcer characteristics, and therapy conducted. RESULTS From 2010 to 2013, 30 patients (20 women, 10 men) from six tertiary wound care centers were registered. Mean age was 76.17 years. The average duration of venous leg ulcers prior to SCC diagnosis was 15.93 years. Suspicious wound characteristics primarily included: pain (n = 3), therapy resistance (n = 27), and fetor (n = 12) as well as clinical appearance (n = 10) with atypical morphology, nodular wound bed, and hypergranulation. CONCLUSIONS Atypical morphology or changes in appearance as well as therapy resistance despite optimal care (6-12 weeks) should prompt physicians to take spindle-shaped, if necessary multiple and serial, biopsies. Primary risk factors for malignant transformation include patient age and ulcer duration.
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Affiliation(s)
- Stefanie Reich-Schupke
- Department of Dermatology, Venereology and Allergology, Vein centre - Dermatology & Vascular Surgery, Ruhr-University Bochum, Germany.,Artemed - Vein competence centre, Dermatology & Vascular Surgery, Bad Oeynhausen, Germany
| | - Martin Doerler
- Department of Dermatology, Venereology and Allergology, Vein centre - Dermatology & Vascular Surgery, Ruhr-University Bochum, Germany
| | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching -Hospital Dresden-Friedrichstadt, -Dresden, Germany
| | - Joachim Dissemond
- Clinic for Dermatology, -Venereology and Allergology, -University Essen, Germany
| | - Thomas Horn
- Clinic for Dermatology, Venereology and Allergology, Krefeld, Germany
| | - Anke Strölin
- Clinic for Dermatology, Venereology and Allergology, University Tübingen, Germany
| | | | - Markus Stücker
- Department of Dermatology, Venereology and Allergology, Vein centre - Dermatology & Vascular Surgery, Ruhr-University Bochum, Germany
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Kapp S, Santamaria N. Chronic wounds should be one of Australia's National Health Priority Areas. AUST HEALTH REV 2016; 39:600-602. [PMID: 26072695 DOI: 10.1071/ah14230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/26/2015] [Indexed: 11/23/2022]
Abstract
Chronic wounds are a poorly recognised chronic disease that cause pain and suffering and cost the Australian healthcare system A $2.85 billion dollars per annum. Unlike the highly profiled and relatively well-funded chronic diseases that comprise the Australian National Health Priority Areas, chronic wounds remain a largely hidden and poorly supported problem in the Australian community. This perspective article proposes that one approach to generate action to reduce the burden of chronic wounds is to better articulate the relationship between chronic wounds and the Australian National Health Priority Areas, and to establish a profile of chronic wounds as a chronic disease of national significance in its own right. This approach has the potential to raise awareness of the significance of chronic wounds and garner support from the public, healthcare sector, research funders and policy makers to improve the outcomes for people who are living with or at risk of developing this condition and to potentially reduce expenditure in this area.
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Affiliation(s)
- Suzanne Kapp
- The University of Melbourne, School of Health Sciences, Department of Nursing, Alan Gilbert Building, 161 Barry Street, Carlton, Vic. 3053, Australia. Email
| | - Nick Santamaria
- The University of Melbourne, School of Health Sciences, Department of Nursing, Alan Gilbert Building, 161 Barry Street, Carlton, Vic. 3053, Australia. Email
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Shaked Y. Balancing efficacy of and host immune responses to cancer therapy: the yin and yang effects. Nat Rev Clin Oncol 2016; 13:611-26. [PMID: 27118493 DOI: 10.1038/nrclinonc.2016.57] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Local and systemic treatments for cancer include surgery, radiation, chemotherapy, hormonal therapy, molecularly targeted therapies, antiangiogenic therapy, and immunotherapy. Many of these therapies can be curative in patients with early stage disease, but much less frequently is this the case when they are used to treat advanced-stage metastatic disease. In the latter setting, innate and/or acquired resistance are among the reasons for reduced responsiveness or nonresponsiveness to therapy, or for tumour relapse after an initial response. Most studies of resistance or reduced responsiveness focus on 'driver' genetic (or epigenetic) changes in the tumour-cell population. Several studies have highlighted the contribution of therapy-induced physiological changes in host tissues and cells that can reduce or even nullify the desired antitumour effects of therapy. These unwanted host effects can promote tumour-cell proliferation (repopulation) and even malignant aggressiveness. These effects occur as a result of systemic release of numerous cytokines, and mobilization of various host accessory cells, which can invade the treated tumour microenvironment. In short, the desired tumour-targeting effects of therapy (the 'yin') can be offset by a reactive host response (the 'yang'); proactively preventing or actively suppressing the latter represents a possible new approach to improving the efficacy of both local and systemic cancer therapies.
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Affiliation(s)
- Yuval Shaked
- Department of Cell Biology and Cancer Science, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 1 Efron St. Bat Galim, Haifa 31096, Israel
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Khan K, Giannone AL, Mehrabi E, Khan A, Giannone RE. Marjolin's Ulcer Complicating a Pressure Sore: The Clock is Ticking. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:111-4. [PMID: 26898816 PMCID: PMC4763807 DOI: 10.12659/ajcr.896352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Malignant degeneration in any chronic wound is termed a Marjolin's ulcer (MU). The overall metastatic rate of MU is approximately 27.5%. However, the prognosis of MU specific to pressure sores is poor, with a reported metastatic rate of 61%. This is due to insidious, asymptomatic malignant degeneration, a lack of healthcare provider awareness, and, ultimately, delayed management. CASE REPORT An 85-year-old white male was noted by his wound-care nurse to have a rapidly developing growth on his lower back over a period of 4 months. There was history of a non-healing, progressive pressure ulcer of the lower back for the past 10 years. On examination, there was a 4 × 4 cm pressure ulcer of the lower back, with a superimposed 1.5 × 2 cm growth in the superior region. There was an absence of palpable regional lymphadenopathy. Punch biopsy revealed squamous cell carcinoma consistent with Marjolin's ulcer. The ulcer underwent excision with wide margins, and a skin graft was placed. Due to the prompt recognition of an abnormality by the patient's wound-care nurse, metastasis was not evident on imaging. There are no signs of recurrence at 1-year follow-up. CONCLUSIONS Marjolin's ulcer has a rapid progression from local disease to widespread metastasis. Therefore, it is essential that wound-care providers are aware of the clinical signs and symptoms of malignant degeneration in chronic wounds.
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Affiliation(s)
- Kamran Khan
- Department of General Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | | | - Erfan Mehrabi
- Department of Pediatrics, Harbor Hospital, Baltimore, MD, USA
| | - Ayda Khan
- Department of Biology, Hofstra University, Hempstead, NY, USA
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Akhtar MA, Saxena DK, Chikhlikar AA, Bangde AP, Rangwala M. Dhoti cancer: a waistline skin cancer with review of literature. World J Surg Oncol 2015; 13:281. [PMID: 26391587 PMCID: PMC4578415 DOI: 10.1186/s12957-015-0698-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/09/2015] [Indexed: 11/23/2022] Open
Abstract
Skin cancers account for less than 1 % of all malignancies in India. Squamous cell carcinomas occurring over the waistline due to tying of cotton cloth called dhoti in males and sarees in females are predominantly seen in traditional Indian population. On wearing of these clothes for years, there is a constant irritation which produces depigmentation, glazing of the skin, acanthosis, scar formation, and later on malignant transformation. Presenting a case of a 65-year-old male with 7 × 5 cm ulceroproliferative growth over the right waistline with a history of prolonged use of dhoti. Wide local excision of the growth with 2-cm margin and primary closure of wound by mobilizing the skin was carried out. Histopathology showed well-differentiated squamous cell carcinoma. The patient is clinically disease free after postoperative follow-up of 1 year.
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Affiliation(s)
- Murtaza A Akhtar
- Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre, Lata Mangeshkar Hospital, Digdoh hills, Hingna Road, Nagpur, 440019, India.
| | - Divish K Saxena
- Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre, Lata Mangeshkar Hospital, Digdoh hills, Hingna Road, Nagpur, 440019, India.
| | - Akanksha A Chikhlikar
- Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre, Lata Mangeshkar Hospital, Digdoh hills, Hingna Road, Nagpur, 440019, India.
| | - Akshay P Bangde
- Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre, Lata Mangeshkar Hospital, Digdoh hills, Hingna Road, Nagpur, 440019, India.
| | - Murtuza Rangwala
- Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre, Lata Mangeshkar Hospital, Digdoh hills, Hingna Road, Nagpur, 440019, India.
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