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Erfurt-Berge C, Bültemann A, Gerber V, Motzkus M, Rembe JD, Dissemond J. [Importance of biopsy in the diagnostic assessment of chronic wounds-position paper of the Initiative Chronische Wunden (ICW) e. V.]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:163-169. [PMID: 38038746 PMCID: PMC10824797 DOI: 10.1007/s00105-023-05259-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
Diagnostic assessment of chronic wounds is essential for the initiation of causal therapeutic treatment. For diagnostic classification of the wound genesis, it may be necessary to take a tissue sample for histological and/or microbiological processing. If there is clinical suspicion of a specific cause of the wound such as a neoplasm, an inflammatory dermatosis or a pathogen-induced wound, a tissue sample for further diagnosis is required immediately. If the ulceration does not respond sufficiently to adequate causal therapy, a tissue sample for further evaluation is recommended after 12 weeks. The choice of the correct sampling technique, further storage, transport and processing are just as decisive for a reliable result as the specific question for the diagnostic laboratory.
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Affiliation(s)
- C Erfurt-Berge
- Hautklinik, Uniklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland.
| | - A Bültemann
- Klinik für Gefäß- und Viszeralchirurgie, Asklepios Klinikum Harburg, Hamburg, Deutschland
| | - V Gerber
- Initiative Chronische Wunden (ICW) e. V., Quedlinburg, Deutschland
| | - M Motzkus
- ZentralesWundmanagement, Evangelisches Krankenhaus Mülheim, Mülheim/Ruhr, Deutschland
| | - J-D Rembe
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Essen, Deutschland
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Ju T, Hernandez L, Mohsin N, Labib A, Frech F, Nouri K. Evaluation of risk in chronic cutaneous inflammatory conditions for malignant transformation. J Eur Acad Dermatol Venereol 2023; 37:231-242. [PMID: 36251409 DOI: 10.1111/jdv.18663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/06/2022] [Indexed: 01/18/2023]
Abstract
Skin carcinomas are the most common form of cancer, and every year thousands of people die from skin cancer-related malignancies. Chronic inflammation is linked to the development and progression of cancer in multiple organ systems - about 20% of all human cancers are a result of chronic inflammation - skin included. While acute inflammation under normal circumstances is a mechanism for host defence and tissue regeneration following insult by trauma or infection by pathogens, over the long term it can drive oncogenic transformation of epithelial cells and promote cancer development, growth and metastasis. Therefore, inflammatory conditions may put individuals at a higher risk to developing skin malignancies. Many skin conditions are characterized by chronic inflammatory processes. These conditions may be particularly susceptible to malignant transformation and predispose patients to develop skin malignancies. As more pathophysiology of chronic inflammatory skin conditions is unveiled, we find that many of these conditions are characterized by immune dysregulation and signalling that result in chronic activation and upregulation of pro-inflammatory chemokines and cytokines, leading to downstream processes that further exacerbate inflammatory processes and cause abnormal cell growth and apoptosis. Here, we review the major chronic cutaneous inflammatory diseases that may have an increased risk of skin malignancies, including atopic dermatitis, psoriasis, discoid lupus erythematosus, lichen planus, hidradenitis suppurativa, prurigo nodularis, lichen sclerosus, systemic sclerosis and morphea, chronic leg ulcers, seborrheic keratoses and basal cell carcinoma. We evaluate the evidence for increased incidence and prevalence, the risk factors associated, the populations at heightened risk and the best management practices.
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Affiliation(s)
- Teresa Ju
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Loren Hernandez
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Noreen Mohsin
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Angelina Labib
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Fabio Frech
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Keyvan Nouri
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
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Soutou B, Senet P, Lionnet F, Habibi A, Aractingi S. Sickle cell disease induces resistance to cutaneous carcinogenesis. Orphanet J Rare Dis 2020; 15:66. [PMID: 32143660 PMCID: PMC7060573 DOI: 10.1186/s13023-020-1341-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background While skin carcinomas are reported in chronic ulcers and in patients treated with hydroxyurea (HU) for myeloproliferative neoplasms, no skin carcinoma has been reported in patients with sickle cell disease (SCD), presenting chronic skin ulcers or treated with HU. The objective was to estimate the risk of cutaneous malignant transformation in SCD patients with prolonged leg ulcers or under HU therapy. Results In this cross-sectional study, the cohort consisted of 1543 patients. In the first series, 29 patients presented a total of 53 ulcers lasting more than two years. The median age was 35 ± 8.4 years old. The median duration for a single ulcer was 9.2 ± 7 years. None of the examined ulcers showed any suspicious area of malignant transformation. In the second series, 187 patients treated with HU for more than two years were identified. The median age was 31.3 ± 9.9 years old. The median duration of treatment with HU was 6 ± 3.2 years. No skin carcinoma or actinic keratosis was recorded. Conclusions This study showed that skin carcinogenesis did not occur in our series of SCD patients exposed to transforming events such as long term HU treatment or prolonged leg ulcers.
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Affiliation(s)
- Boutros Soutou
- Faculté de médecine, Université Saint-Joseph, Beirut, 16-6830, Lebanon.
| | - Patricia Senet
- Department of Dermatology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - François Lionnet
- Department of Internal Medicine, Center for sickle cell disease, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anoosha Habibi
- Centre de référence des syndromes drépanocytaires majeurs, Unité des Maladies génétiques du globule rouge, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Sélim Aractingi
- Faculté de médecine Paris 5 Descartes. Service de Dermatologie, Hôpital Cochin Tarnier, Paris. Equipe Cellules souches foetales, Inserm UMR S 938, Paris, France
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Gil T, Pistunovich Y, Kulikovsky M, Elmalah I, Krausz Y, Mettanes I, Lavi I, Har-Shai Y. A prospective case-control study of non-healing wounds of the lower limbs - the value of biopsies for ulcerating carcinoma. J Eur Acad Dermatol Venereol 2014; 29:337-345. [PMID: 24854481 DOI: 10.1111/jdv.12550] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 04/14/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND In some leg ulcer patients there is cancer that is responsible for lack of healing of such a wound. AIM This study was aimed at prospective analysis of histopathology of non-healing wounds (NHWs) in the patient presenting with high and low suspicion for ulcerating carcinoma. MATERIAL AND METHODS Forty patients with NHWs were enrolled and had been prospectively divided into two groups: 25 patients with high suspicion for ulcerating carcinoma according to their medical history and physical examination, and the second group of 15 patients without suspicion for malignancy (control group). All NHWs were photographed and underwent biopsies. RESULTS In the control group biopsies did not reveal cancers. On the contrary, in 10 patients (40%) from high suspicion group biopsies revealed cancers: seven basal cell carcinomas (BCCs), one - malignant melanoma, one - Bowen's disease and one - squamous cell carcinomas. Histopathology of six of seven BCCs suggested that non-healing benign wound might have preceded malignancy. We found that leg ulcers which were small (wound area less than 3 cm(2) ), longstanding (duration 24 ≤ weeks), presenting with granulation tissue covering ≥75% of the wound area, with a dull pink appearance of the granulation tissue, or an atypical clinical presentation, can actually be an ulcerating carcinoma. Dull pink granulation tissue or an atypical clinical presentation of ulceration, as a single clinical finding, suggested an underlying malignancy with a statistical significance (71.5% vs. 0%; P = 0.001 and 27.8% vs. 0%; P = 0.0049 respectively). CONCLUSIONS Prevalence of malignancy, primarily: BCCs in NHWs, may be higher than expected and clinical features suggestive of such a nature of ulcer are an indication for diagnostic biopsy.
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Affiliation(s)
- T Gil
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel.,The Department of Plastic Surgery, Linn Medical Center, Haifa, Israel.,The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Y Pistunovich
- The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - M Kulikovsky
- The Department of Plastic Surgery, Linn Medical Center, Haifa, Israel
| | - I Elmalah
- The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,The Department of Pathology, Haemek Medical Center, Afula, Israel
| | - Y Krausz
- The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,The Department of Pathology, Haemek Medical Center, Afula, Israel
| | - I Mettanes
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel.,The Department of Plastic Surgery, Linn Medical Center, Haifa, Israel.,The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - I Lavi
- The Biostatistics Consultation Unit, Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Y Har-Shai
- The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel.,The Department of Plastic Surgery, Linn Medical Center, Haifa, Israel.,The Bruce Rapapport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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