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Todo MC, Gonçalves de Carvalho JA, Ferreira da Silveira E Freitas JB, Grecca LS, Chahud F, Velasco E Cruz AA. Orbital invasion of a conjunctival atypical fibroxanthoma in a patient with systemic diffuse large B-cell lymphoma. Orbit 2024:1-4. [PMID: 38796753 DOI: 10.1080/01676830.2024.2350041] [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: 02/22/2024] [Accepted: 04/25/2024] [Indexed: 05/28/2024]
Abstract
An 88-year-old male patient presented with a large mass on the left lateral bulbar conjunctiva. The tumor appeared two months after the resection of a conjunctival atypical fibroxanthoma (AFX) performed by a cornea specialist. Magnetic resonance imaging of the orbits showed deep orbital invasion along the lateral rectus muscle. The mass and the entire conjunctival sac were totally excised with lid-sparing orbital exenteration. Histopathological analysis confirmed that the mass was an extension of the AFX. Two weeks after surgery, large B-cell lymphoma was diagnosed in the oropharynx. Chemotherapy was initiated, and after seven months of follow-up, there was no recurrence of the AFX. The authors believe that this is the first report of orbital invasion by AFX.
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Affiliation(s)
- Márcia Cristina Todo
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Julie Anne Gonçalves de Carvalho
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Luís Sérgio Grecca
- Department of Ophthalmology, Hospital D'olhos, São José do Rio Preto, Brazil
| | - Fernando Chahud
- Department of Pathology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Antônio Augusto Velasco E Cruz
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Ørholt M, Abebe K, Rasmussen LE, Aaberg FL, Lindskov LJ, Schmidt G, Wagenblast AL, Petersen MM, Loya AC, Daugaard S, Herly M, Jensen DH, Vester-Glowinski P. Atypical fibroxanthoma and pleomorphic dermal sarcoma: Local recurrence and metastasis in a nationwide population-based cohort of 1118 patients. J Am Acad Dermatol 2023; 89:1177-1184. [PMID: 37634740 DOI: 10.1016/j.jaad.2023.08.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The prognosis of patients with atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) remains uncertain and no standardized follow-up programs have been established. OBJECTIVE To recommend a standardized follow-up program of patients with AFX and PDS based on nationwide long-term estimates of local recurrence and metastasis. METHODS All patients with AFX and PDS in Denmark between 2002 and 2022 were included. Danish National Registries were used to estimate the risks of local recurrence and metastasis for AFX and PDS. RESULTS The 5-year risk of local recurrence was 10% for AFX and 17% for PDS. The 5-year risk of metastasis was 0.8% for AFX and 16% for PDS. PDS metastasized within 3 years in >90% of the patients with the lungs as the primary metastasis site (50%). Invasion beyond the subcutis, perineural/intravascular infiltration, and increasing age significantly increased the risk of PDS relapse. LIMITATIONS Risk of misclassification and lack of detailed surgical information. CONCLUSION The follow-up of patients with AFX can be limited to clinical visits for 4 years. Patients with PDS should be followed with clinical visits and PET/CT twice a year for the first 3 years and once a year for a minimum of 1 year.
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Affiliation(s)
- Mathias Ørholt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Kiya Abebe
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise E Rasmussen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik L Aaberg
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lærke J Lindskov
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne Lene Wagenblast
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael M Petersen
- Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anand C Loya
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Daugaard
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - David Hebbelstrup Jensen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Shaker N, Phelps R, Niedt G, Patel A, Wu D, Aung PP, Prieto V, Church A, Pradhan D. Cutaneous Atypical Fibroxanthoma With Osteoclast-Like Giant Cell: A Rare but Diagnostic Pitfall. Am J Dermatopathol 2023; 45:704-707. [PMID: 37708369 DOI: 10.1097/dad.0000000000002508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Atypical fibroxanthoma (AFX) is a dermal-based, low-grade neoplasm with no specific lineage of differentiation. The occurrence of AFX with osteoclast-like giant cells is exceptionally rare. Less than 20 cases have been reported in the literature. CASE PRESENTATION A 77-year-old man with a medical history of multiple basal and squamous cell carcinomas of the skin, presented with a progressively growing erythematous nodule on the sun-damaged right central parietal scalp. A shave biopsy showed a dermal spindle cell proliferation accompanied by numerous osteoclast-like multinucleated giant cells and predominant atypical mitotic figures. The immunohistochemical staining showed a diffuse positive staining for CD68 and SMA, patchy staining for CD10, and negative staining for SOX-10, pan-cytokeratin, CK5/6, S100, CD34, and desmin. The tumor was completely excised with negative margins. A subsequent follow-up over a period of 13 months showed no recurrence. CONCLUSION Distinguishing AFX with osteoclast-like giant cells from both malignant and benign skin lesions with osteoclast-like giant cells is crucial. Although AFX tumors display worrisome malignant histologic features, most cases have a favorable prognosis with a local recurrence rate below 5% and exceedingly rare metastasis.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Robert Phelps
- Departments of Dermatology and Dermatopathology, Mount Sinai Medical Center, New York, NY
| | - George Niedt
- Departments of Dermatology and Dermatopathology, Mount Sinai Medical Center, New York, NY
| | - Ankush Patel
- Department of Pathology, Mayo Clinic, Rochester, MN
| | - Douglas Wu
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Phyu P Aung
- Department of Dermatopathology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Victor Prieto
- Department Chair, Department of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and
| | - Ann Church
- Department of Dermatopathology, The University of Nebraska Medical Center, Omaha, NE
| | - Dinesh Pradhan
- Department of Dermatopathology, The University of Nebraska Medical Center, Omaha, NE
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4
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Wood BA. Cutaneous Sarcoma-Like Tumor: A Proposal for Terminological Rationalization. Am J Dermatopathol 2023; 45:665-666. [PMID: 37506271 DOI: 10.1097/dad.0000000000002510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Affiliation(s)
- Benjamin A Wood
- Anatomical Pathology, PathWest Laboratory Medicine, J Block, QEII Medical Centre, Nedlands, Perth, Western Australia, Australia
- The University of Western Australia, Nedlands, Western Australia, Australia; and
- Clinipath Pathology and franklin.ai, Osborne Park, Perth, Western Australia, Australia
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McClure E, Carr MJ, Patel A, Hussnain Naqvi SM, Kim Y, Harrington M, Cruse W, Gonzalez RJ, Sondak VK, Sarnaik AA, Messina JL, Zager JS. Atypical Fibroxanthoma: Outcomes from a Large Single Institution Series. Cancer Control 2023; 30:10732748231155699. [PMID: 36764930 PMCID: PMC9926370 DOI: 10.1177/10732748231155699] [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] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Atypical fibroxanthomas (AFX) are rare malignant cutaneous neoplasms. Unfortunately, limited clinicopathologic and outcomes data on this cancer exists. OBJECTIVE We report the clinical, pathologic, and treatment characteristics, as well as oncologic outcomes in this single-institution retrospective analysis. METHODS This retrospective cohort study compiled clinical, pathologic, treatment, and outcome data for all patients with AFX on definitive excision diagnosed, evaluated, and treated primarily by surgical resection at a single institution between 2000-2020. Descriptive statistics evaluated clinical and pathologic characteristics. Kaplan-Meier method and Cox proportional-hazards models were used to evaluate overall survival and recurrence-free survival. RESULTS 78 patients with AFX were identified. The majority were elderly, immunocompetent, Caucasian men. 85% of tumors were located on the head and neck. 63% of patients were correctly diagnosed only after complete resection of the index lesion. The median surgical margin was 1.0 cm. Overall, only 1.3% (1/78) of patients developed a local recurrence (RFS). No patients died of disease. CONCLUSION This study suggests that resection margins of 1 cm achieve excellent local control with close to 99% RFS and 100% disease-specific survival.
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Affiliation(s)
- Erin McClure
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael J Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of General Surgery, University of Louisville, Louisville, KY, USA
| | - Ayushi Patel
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Syed Mahrukh Hussnain Naqvi
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Youngchul Kim
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael Harrington
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Plastic Surgery, University of South Florida, Tampa, FL, USA
| | - Wayne Cruse
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Plastic Surgery, University of South Florida, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Ricardo J Gonzalez
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA,Department of Sarcoma, University of South Florida, Tampa, FL, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Amod A Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Jane L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA,Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA,Jonathan S Zager, Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 N. McKinley Drive, Tampa, FL 33612-9416, USA.
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Vasilyev NV, Vtorushin SV, Maltseva AA, Sannikova AV. [Atypical fibroxanthoma]. Arkh Patol 2023; 85:65-72. [PMID: 37814853 DOI: 10.17116/patol20238505165] [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: 10/11/2023]
Abstract
Atypical fibroxanthoma (AFX) is a rare skin tumor characterized by a combination of a «malignant» morphological features and non-aggressive clinical course. Diagnosing AFX is challenging due to histological «diversity» and heterogeneous immunophenotype. The presented review describes the history and evolution of AFX as a nosological form of cancer, its histogenetic origin, pathogenesis and biological potential. The clinical, morphological, immunohistochemical, molecular cytogenetic characteristics and histological subtypes of the tumor as well as differential diagnosis have been presented in detail.
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Affiliation(s)
- N V Vasilyev
- Cancer Research Institute of Tomsk National Research Medical Center, Tomsk, Russia
| | - S V Vtorushin
- Cancer Research Institute of Tomsk National Research Medical Center, Tomsk, Russia
- Siberian State Medical University, Tomsk, Russia
| | - A A Maltseva
- Cancer Research Institute of Tomsk National Research Medical Center, Tomsk, Russia
| | - A V Sannikova
- City Clinical Hospital No 3 named after B.I. Alperovich, Tomsk, Russia
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7
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Ørholt M, Aaberg FL, Abebe K, Walsh S, Roenigk RK, Venzo A, Schmidt G, Klyver H, Jensen DH, Herly M, Vester‐Glowinski PV. Risk factors for local atypical fibroxanthoma recurrence and progression to pleomorphic dermal sarcoma: A meta-analysis of individualized participant data. J Surg Oncol 2022; 126:555-562. [PMID: 35441377 PMCID: PMC9544245 DOI: 10.1002/jso.26898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/14/2022] [Accepted: 04/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Risk factors for local atypical fibroxanthoma (AFX) recurrence and progression to pleomorphic dermal sarcoma (PDS) have not previously been identified. OBJECTIVE To identify risk factors and provide follow-up suggestions for local AFX recurrence and progression to PDS. METHODS AND MATERIALS A literature search was performed in the PubMed, EMBASE, and Cochrane databases. The PRISMA and MOOSE guidelines were followed. The risks of local AFX recurrence and progression to PDS were presented as Kaplan-Meier plots and risk factors were presented as hazard ratios (HRs) calculated with univariate and multivariate Cox regression. RESULTS Five hundred and ninety-eight patients with AFX from 14 studies were included. Age >74 years and male sex significantly increased the risk of local recurrence (HR: 7.31 [95% confidence interval [CI]: 1.78-30.0], p < 0.01 and HR: 2.89 [95% CI: 1.04-8.01], p < 0.05, respectively). There was no difference when comparing wide local excision and Mohs' micrographic surgery (p = 0.89). The risks of local AFX recurrence and progression to PDS after 2 years were <1%. CONCLUSION A more intensive follow-up regimen could be considered in patients >74 years old and males due to the higher risk of local AFX recurrence.
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Affiliation(s)
- Mathias Ørholt
- Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Frederik L. Aaberg
- Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Kiya Abebe
- Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - S. Walsh
- Department of Oral and Maxillofacial SurgeryUniversity Hospitals Sussex: St Richard's HospitalChichesterWest SussexUK
| | - Randall K. Roenigk
- Department of Dermatology and Division of Dermatologic SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Alessandro Venzo
- Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Helle Klyver
- Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - David H. Jensen
- Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Peter V. Vester‐Glowinski
- Department of Plastic Surgery and Burns TreatmentCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
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8
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Sim JY, Lee DH, Jang B, Suh MJ. Atypical Fibroxanthoma Resected without Auricular Deformity in an Elderly Patient: A Case Study. EAR, NOSE & THROAT JOURNAL 2022:1455613221084072. [PMID: 35387526 DOI: 10.1177/01455613221084072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Atypical fibroxanthoma (AFX) is a dermal spindle-cell cutaneous malignancy, which is a relatively benign type of skin cancer that occurs in the elderly with sun-damaged skin. This is a case study of a rapidly enlarged left auricular mass lesion in an elderly patient who was diagnosed with AFX based on histopathological and immunohistochemical findings, and then treated by complete excision to prevent recurrence or metastasis. There was no recurrence during the 1-year follow-up. For otolaryngologists or plastic surgeons, recognizing the clinical and pathologic characteristics of AFX is important for accurate diagnosis and treatment.
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Affiliation(s)
- Jae-Yeop Sim
- Department of Otorhinolaryngology, 91577Jeju National University College of Medicine, Jeju-do, Korea
| | - Dong Hui Lee
- Department of Pathology, 37984Jeju National University College of Medicine, Jeju-do, Korea
| | - Bogun Jang
- Department of Pathology, 37984Jeju National University College of Medicine, Jeju-do, Korea
| | - Michelle J Suh
- Department of Otorhinolaryngology, 91577Jeju National University College of Medicine, Jeju-do, Korea
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9
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Jibbe A, Worley B, Miller CH, Alam M. Surgical excision margins for fibrohistiocytic tumors, including atypical fibroxanthoma and undifferentiated pleomorphic sarcoma: A probability model based on a systematic review. J Am Acad Dermatol 2021; 87:833-840. [PMID: 34587553 DOI: 10.1016/j.jaad.2021.09.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mohs micrographic surgery or wide local excision is the treatment of choice for fibrohistiocytic tumors with metastatic potential, including atypical fibroxanthoma (AFX) and cutaneous undifferentiated pleomorphic sarcoma (cUPS). Since margin clearance is the strongest predictor of clinical recurrence, improved recommendations for appropriate surgical margins help delineate uniform excision margins when intraoperative margin assessment is not available. OBJECTIVE To determine appropriate surgical wide local excision margins for AFX and cUPS. METHODS Literature search (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to March 2020) to detect case-level data. Estimation of margins required using a mathematical model based on extracted cases without recurrences. RESULTS Probabilistic modeling based on 100 cases extracted from 37 studies showed peripheral clearance margin (ie, wide local excision margin) calculated to clear 95% of all tumors was 2 cm for AFX and 3 cm for cUPS. AFX tumors 1 cm or less required a margin of 1 cm. LIMITATIONS Data were extracted from published cases. CONCLUSIONS Atypical fibroxanthoma removed with at least a 2-cm peripheral excision margin is less likely to recur. Smaller tumors 1 cm or less can be treated with a more conservative margin. Margin-control surgical techniques are recommended to ensure complete removal while minimizing surgical morbidity.
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Affiliation(s)
- Atieh Jibbe
- Division of Dermatology, Department of Internal Medicine, University of Kansas, Kansas City, Kansas
| | - Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Florida Dermatology and Skin Cancer Centers, Lake Wales, Florida
| | - Corinne H Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otoloaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Li ZX, Huang ZN, Luo H, Yang XB, Wang YL, Chen JX, Ma XK, Xu F, Wang TT, Lin L. High BTBD7 expression positive is correlated with SLUG-predicted poor prognosis in hormone receptor-negative breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1252. [PMID: 34532389 PMCID: PMC8421947 DOI: 10.21037/atm-21-3409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hormone receptor-negative breast cancer (HRNBC), which includes triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2 (HER-2) overexpressing breast cancer, is prone to metastasis and has a poor prognosis. BTB/POZ domain-containing protein 7 (Btbd7) is thought to regulate SLUG and the epithelial-mesenchymal transition (EMT) process. However, the role of Btbd7 in HRNBC is unclear. METHODS Expression of BTBD7 and SLUG in HRNBC tumor tissue and normal adjacent tissue (NAT) as well as breast cancer cells were characterized by immunohistochemistry and immunofluorescence. MDA-MA-231 cells was transfected with BTBD7 siRNA and detected by qRT-PCR and western blot. Expression levels of Slug and EMT related proteins were detected western blot analysis. cell invasion assays were used to analyse cell invasion ability of MDA-MA-231. GO and KEGG analyses was used to analysis the gene function. RESULTS The total positive rate of BTBD7 expression in HRNBC tumor tissue was 66.7%, which was higher than that in NAT (52.1%) and benign breast lesion tissues (20%). Co-expression of SLUG and BTBD7 proteins could be found in HRNBC tissue and MDA-MA-231 cells. BTBD7 silencing significantly up-regulated the epithelial marker E-cadherin, down-regulated the mesenchymal markers α-SMA and SLUG and suppressed the invasion abilities of MDA-MA-231 cells. GO and KEGG analyses based on 322 DEGs showed that BTBD7 may be associated with generic transcription in breast cancer. CONCLUSIONS The study data indicated that BTBD7 was inversely associated with SLUG expression. Higher BTBD7 was associated with poor clinicopathologic features and prognosis in HRNBC patients. BTBD7 silencing inhibited EMT through regulation of SLUG expression. BTBD7 might act as a potential molecular target for gene therapy in HRNBC patients.
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Affiliation(s)
- Zi-Xiong Li
- Department of Rheumatology, The First Affiliated Hospital, Shantou University Medical College, Shantou, China
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Breast Cancer, Shantou University Medical College, Shantou, China
| | - Ze-Nan Huang
- Department of Thyroid and Breast Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui Luo
- Anesthesia and Operation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiong-Bin Yang
- Department of Rheumatology, The First Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Yu-Lin Wang
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Jie-Xin Chen
- Department of Endocrinology, First Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Xiao-Kai Ma
- The first affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Feng Xu
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Tian-Tian Wang
- Department of Medical Oncology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ling Lin
- Department of Rheumatology, The First Affiliated Hospital, Shantou University Medical College, Shantou, China
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Iglesias-Pena N, Martínez-Campayo N, López-Solache L. Relation Between Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: Histopathologic Features and Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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12
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What is the ulcerated pink nodule on this patient's scalp? JAAPA 2021; 33:55-56. [PMID: 32740118 DOI: 10.1097/01.jaa.0000684144.71148.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Iglesias-Pena N, Martínez-Campayo N, López-Solache L. Relation Between Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: Histopathologic Features and Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:392-405. [PMID: 33301761 DOI: 10.1016/j.ad.2020.11.018] [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: 10/28/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022] Open
Abstract
The relation between atypical fibroxanthoma and pleomorphic dermal sarcoma has led to confusion and debate in the literature. Both tumors present on sun-exposed skin, typically on the head and neck, in patients of advanced age. Both are comprised of a variable mix of histiocytoid, spindle, epithelioid, and/or giant multinucleated cells with pleomorphic nuclei. No immunohistochemical diagnostic techniques have emerged to distinguish these tumors. Diagnosis is by exclusion. Histologically, atypical fibroxanthoma is seen as a well-circumscribed dermal nodule but there will be no evidence of extensive subcutaneous invasion, tumor necrosis, or lymphovascular or perineural invasion. Therefore, if any of the aforementioned features is present, the diagnosis would be pleomorphic dermal sarcoma. This narrative review of the literature aims to identify the distinguishing and overlapping histopathologic features of these 2 tumors as they have been described in case series.
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Affiliation(s)
- N Iglesias-Pena
- Servicio de Dermatología, Hospital Universitario Lucus Augusti, Lugo, España.
| | - N Martínez-Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - L López-Solache
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario A Coruña, A Coruña, España
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Cesinaro AM, Gallo G, Tramontozzi S, Migaldi M. Atypical fibroxanthoma and pleomorphic dermal sarcoma: A reappraisal. J Cutan Pathol 2020; 48:207-210. [PMID: 32583897 DOI: 10.1111/cup.13787] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) share clinical, pathological, immunohistochemical and molecular features, though PDS is associated with a more aggressive behavior. METHODS We reviewed 71 tumors fulfilling criteria for AFX and PDS to further stratify their biological potential. RESULTS Lesions were mainly located on the scalps of elderly men, and were often ulcerated. One case was necrotic, one showed vascular invasion, and one showed perineural invasion. Fifty-one tumors were limited to reticular dermis (71.8%), 20 invaded subcutaneous tissue, focally in 13 cases (18.3%), and diffusely in seven (9.9%). Subcutaneous invasion was present significantly more often in tumors showing predominantly spindle compared to pleomorphic/mixed cell morphology (P = 0.02). At a follow-up of 17-125 months, 4 cases recurred locally, 4, 6, 10 and 13 months after surgery; no metastases were observed. Three tumors were composed of spindle cells, and one of clear cells. Three cases had margins focally involved, while the fourth case had clear margins. CONCLUSION Depth of invasion and state of margins are criteria predicting prognosis in AFX/PDS; in addition, spindle cell morphology seems to be related to a more infiltrative pattern of growth and to aggressiveness. Grouping these tumors on a morphologic base could help to clarify their different biological behavior.
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Affiliation(s)
- Anna Maria Cesinaro
- Department of Anatomic Pathology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Graziana Gallo
- Department of Anatomic Pathology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Sabrina Tramontozzi
- Department of Anatomic Pathology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.,Visiting fellow from the Department of Anatomic Pathology, University "Alma Mater" of Bologna, Bologna, Italy
| | - Mario Migaldi
- Department of Anatomic Pathology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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16
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Bitel A, Schönlebe J, Krönert C, Wollina U. Atypical fibroxanthoma: An analysis of 105 tumors. Dermatol Ther 2020; 33:e13962. [PMID: 32618393 DOI: 10.1111/dth.13962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
Atypical fibroxanthoma (AFX) is a rare, low-grade dermal sarcoma. We analyzed our files from January 2001 to January 2020 for AFX. Clinical parameters, histopathology, treatment and outcome have been investigated. We identified 87 patients (mean age of 80.0 ± 8.4 years) with 105 confirmed tumors. Of these patients 86.2% were males. The most common clinical presentation was nodular (93.3%). The majority of AFX was located on the head with a mean tumor diameter of 15.0 mm ± 3.5 mm. All tumors showed a dermal localization, in 46.4% with a focal infiltration of the deeper layers. Second skin cancer was reported in 62.1% of patients. Collision tumors were seen in six patients. Treatment was surgical with three-dimensional margin control. Relapses were noted in 11.4% of tumors with a mean delay of 11.7 ± 17.3 months. Focally deeper infiltration of AFX was a risk factor (P = .014). None of the purely dermal AFX relapsed. No metastasis was observed. AFX is a rare mesenchymal tumor of elderly patients. Treatment of choice is the complete surgical excision. Due to the high rate of other skin malignancies among patients with AFX, a regular follow-up is recommended.
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Affiliation(s)
- Alena Bitel
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Jacqueline Schönlebe
- Institute of Pathology "Georg Schmorl", Städtisches Klinikum Dresden, Dresden, Germany
| | - Claudia Krönert
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
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17
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Rosenfeld D, Alam M, Van Tine B, Council ML. Atypical fibroxanthoma: A malignant tumor of the skin and soft tissue. J Am Acad Dermatol 2020; 83:e429-e430. [PMID: 32679278 DOI: 10.1016/j.jaad.2020.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/18/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022]
Affiliation(s)
- David Rosenfeld
- Division of Dermatology, Department of Medicine, Loyola University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Brian Van Tine
- Division of Oncology, Department of Medicine, Washington University in St. Louis, St Louis, Missouri
| | - M Laurin Council
- Division of Dermatology, Department of Medicine, Washington University in St. Louis, St Louis, Missouri.
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18
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Greif CS, Nijhawan RI. Cells to Surgery Quiz: June 2020. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Aramin H, Zaleski M, Prieto VG, Aung PP. Skin and superficial soft tissue neoplasms with multinucleated giant cells: Clinical, histologic, phenotypic, and molecular differentiating features. Ann Diagn Pathol 2019; 42:18-32. [DOI: 10.1016/j.anndiagpath.2019.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022]
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20
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Craig PJ. An Overview of Uncommon Cutaneous Malignancies, Including Skin Appendageal (Adnexal) Tumours and Sarcomas. Clin Oncol (R Coll Radiol) 2019; 31:769-778. [PMID: 31466845 DOI: 10.1016/j.clon.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/07/2019] [Accepted: 07/23/2019] [Indexed: 01/25/2023]
Abstract
A standardised classification of malignant skin appendageal (adnexal) tumours and sarcomas is required for improved patient management and prognosis. This has been hindered by considerable morphological variation both within and between tumour types, the use of many synonyms for the same tumour types and variation in classification between pathologists. This update uses the improved classification in the 2018 WHO classification of skin tumours as the basis to discuss malignant skin appendageal tumours, sarcomas and cutaneous metastases that regularly present to skin cancer clinicians, multidisciplinary skin cancer teams and tumour boards, with current evidence for management, where appropriate.
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Affiliation(s)
- P J Craig
- Gloucestershire Cellular Pathology Laboratory, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK.
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21
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Ecchymotic Nodule on the Scalp: Answer. Am J Dermatopathol 2019; 41:612-613. [PMID: 31335419 DOI: 10.1097/dad.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Iglesias‐Pena N, López‐Solache L, Martínez‐Campayo N, Meilán‐Sánchez I, Yebra‐Pimentel MT, Balboa‐Barreiro V, Paradela S, Fonseca E. Incidence rate and clinicopathological features of 62 atypical fibroxanthomas in a North‐Western Spanish population. Australas J Dermatol 2019; 61:e22-e27. [DOI: 10.1111/ajd.13102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | - Laura López‐Solache
- Pathology Department Complejo Hospitalario Universitario A CoruñaA Coruña Spain
| | | | - Iago Meilán‐Sánchez
- Dermatology DepartmentComplejo Hospitalario Universitario A Coruña A Coruña Spain
| | | | | | - Sabela Paradela
- Dermatology DepartmentComplejo Hospitalario Universitario A Coruña A Coruña Spain
| | - Eduardo Fonseca
- Dermatology DepartmentComplejo Hospitalario Universitario A Coruña A Coruña Spain
- Instituto de Investigación Biomédica de A Coruña (INIBIC) A Coruña Spain
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23
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Phan K, Onggo J. Time to recurrence after surgical excision of atypical fibroxanthoma‐updated systematic review and meta‐analysis. Australas J Dermatol 2019; 60:e220-e222. [DOI: 10.1111/ajd.13010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Kevin Phan
- Department of Dermatology Liverpool Hospital Sydney New South WalesAustralia
| | - James Onggo
- Department of Medicine Monash University Melbourne Victoria Australia
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24
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Ting SW, Yang SJ, Lee YY. Atypical fibroxanthoma in a young female patient with systemic lupus erythematosus: A case report and literature review. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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Lai K, Harwood CA, Purdie KJ, Proby CM, Leigh IM, Ravi N, Mully TW, Brooks L, Sandoval PM, Rosenblum MD, Arron ST. Genomic analysis of atypical fibroxanthoma. PLoS One 2017; 12:e0188272. [PMID: 29141020 PMCID: PMC5687749 DOI: 10.1371/journal.pone.0188272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022] Open
Abstract
Atypical fibroxanthoma (AFX), is a rare type of skin cancer affecting older individuals with sun damaged skin. Since there is limited genomic information about AFX, our study seeks to improve the understanding of AFX through whole-exome and RNA sequencing of 8 matched tumor-normal samples. AFX is a highly mutated malignancy with recurrent mutations in a number of genes, including COL11A1, ERBB4, CSMD3, and FAT1. The majority of mutations identified were UV signature (C>T in dipyrimidines). We observed deletion of chromosomal segments on chr9p and chr13q, including tumor suppressor genes such as KANK1 and CDKN2A, but no gene fusions were found. Gene expression profiling revealed several biological pathways that are upregulated in AFX, including tumor associated macrophage response, GPCR signaling, and epithelial to mesenchymal transition (EMT). To further investigate the presence of EMT in AFX, we conducted a gene expression meta-analysis that incorporated RNA-seq data from dermal fibroblasts and keratinocytes. Ours is the first study to employ high throughput sequencing for molecular profiling of AFX. These data provide valuable insights to inform models of carcinogenesis and additional research towards tumor-directed therapy.
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Affiliation(s)
- Kevin Lai
- Department of Dermatology, University of California, San Francisco, California, United States of America
| | - Catherine A. Harwood
- Center for Cutaneous Research and Cell Biology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Karin J. Purdie
- Center for Cutaneous Research and Cell Biology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charlotte M. Proby
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Irene M. Leigh
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Namita Ravi
- Department of Dermatology, University of California, San Francisco, California, United States of America
| | - Thaddeus W. Mully
- Department of Dermatology, University of California, San Francisco, California, United States of America
| | - Lionel Brooks
- Department of Dermatology, University of California, San Francisco, California, United States of America
| | - Priscilla M. Sandoval
- Department of Dermatology, University of California, San Francisco, California, United States of America
| | - Michael D. Rosenblum
- Department of Dermatology, University of California, San Francisco, California, United States of America
| | - Sarah T. Arron
- Department of Dermatology, University of California, San Francisco, California, United States of America
- Veterans Administration Medical Center, San Francisco, California, United States of America
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