Non-invasive diagnostic techniques in the diagnosis of squamous cell carcinoma

Diagnostic accuracy of high-frequency ultrasound for cutaneous neoplasms: a narrative review of the literature

High-frequency ultrasound has been used to visualize depth and vascularization of cutaneous neoplasms, but little has been synthesized as a review for a robust level of evidence about the diagnostic accuracy of high-frequency ultrasound in dermatology. A narrative review of the PubMed database was performed to establish the correlation between ultrasound findings and histopathologic/dermoscopic findings for cutaneous neoplasms. Articles were divided into the following four categories: melanocytic, keratinocytic/epidermal, appendageal, and soft tissue/neural neoplasms. Review of the literature revealed that ultrasound findings and histopathology findings were strongly correlated regarding the depth of a cutaneous neoplasm. Morphological characteristics were correlated primarily in soft tissue/neural neoplasms. Overall, there is a paucity of literature on the correlation between high-frequency ultrasound and histopathology of cutaneous neoplasms. Further studies are needed to investigate this correlation in various dermatologic conditions.

Human buccal epithelial cells as a model system for molecular analysis of DNA, RNA and protein

We report use of human buccal epithelial cells as an easy model system for isolation and molecular analysis of genomic DNA, RNA, and protein to study any gene of interest by Polymerase Chain Reaction (PCR), RNA expression by Reverse Transcription-PCR (RT-PCR), protein-profiling, and expression by western blot as well as DNA-methylation by Msp I/Hpa II-restriction digestion. We used simple methods to isolate genomic DNA, RNA and protein from human buccal cells collected by oral swab and cultured them in-vitro. The microscopic observation of haematoxylin and eosin (EA-50) stained cells, genomic PCR of house-keeping genes (GAPDH and β-actin), RT-PCR of GAPDH and β-actin mRNAs and whole cell protein-profiling by Sodium Dodecyl Sulphate-Polyacrylamide Gel Electrophoresis (SDS-PAGE) were carried out. Expression of β-actin protein in supernatant and pellet fractions of the cells was determined by western blot analysis. MTT-assay was carried out to assess the cell viability and cell growth. Green Fluorescence Protein (GFP)-DNA was expressed in these cells by transient transfection. DNA-methylation in the genome was analyzed by Msp I/ Hpa II restriction digestion and agarose gel electrophoresis. Thus these methods can be used for molecular analysis of DNA, RNA and protein from the human buccal epithelial cells for studying and monitoring health, disease, population genetics/genomics and epidemiology under different conditions.

Shedding new light on actinic keratoses and squamous cell carcinoma in situ

ABSTRACT

Cutaneous squamous cell carcinoma can arise from various premalignant lesions such as actinic keratosis, Bowen disease, and premalignant genital squamous cell lesions. Identification and treatment can prevent malignant transformation and death. This article describes the causes, epidemiology, and characteristics of suspicious premalignant squamous cell lesions so that clinicians can identify these lesions and refer patients for specialist treatment as appropriate.

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

INTRODUCTION

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, accounting for 20% of malignant skin tumors. Dermoscopy is a very useful tool for diagnosing cSCC, and its findings are confirmed through histopathological studies.

OBJECTIVES

to describe the different dermoscopic structures of invasive cSCC and investigate their association with the clinical form and histopathological grade of differentiation.

METHODS

We conducted a cross-sectional study, collecting all patients diagnosed with squamous cell carcinoma over a period of 5 years. The study population was divided into two groups based on histological differentiation (well-differentiated and non-well-differentiated) and clinical form ( nodulo-ulcerative and nodular). Various dermoscopic parameters were compared between these groups.

RESULTS

Out of 72 invasive cSCC, 81.9% were well-differentiated, while 18.1% were non-well-differentiated. The clinical form of cSCC was nodulo-ulcerative in 83.3% of cases and nodular in 16.7%. Well-differentiated tumors showed dotted, glomerular and hairpin vessels, along with a predominant white pattern characterized by centrally distributed keratin as well as white circles, and whitish perivascular halo (P < 0.05). The distribution of these white structures was radial in nodulo-ulcerarive lesions, whereas in nodular lesions, their distribution, as well as that of keratin, was more diffuse (P < 0.05). Non-well-differentiated tumors showed a combined white-red pattern with the predominance of arborizing vessels (P < 0.05).

CONCLUSIONS

Our results show the reliability of dermoscopy as a tool for distinguishing between well- and poorly differentiated cSCC. This distinction is characterized by an increase in predominantly arborizing vessels and a corresponding decrease in white structures as the tumor progresses from a well-differentiated to a poorly differentiated state. Additionally, the nodulo-ulcerative form exhibits a central distribution of keratin, while the nodular form displays a diffuse distribution.

Clinical Signs for Differential Diagnosis of Eyelid Tumours

This article aims to present the differential diagnostics of benign and malignant eyelid tumours. The most common malignant eyelid tumour is basal cell carcinoma, followed by squamous cell carcinoma. The common signs of malignity are loss of lashes, ulceration, and infiltration of the lesion. Often the clinical appearance is various and therefore only a histological analysis gives the proper diagnosis. For most tumours, surgical resection is the gold standard of therapy. The reconstruction of the defects should be performed by an experienced oculoplastic surgeon. In malignant tumours that require large safety margins, the defect can be easily very large, and the reconstruction must then be performed with advanced ophthalmic plastic reconstruction techniques.

Revisiting laminin and extracellular matrix remodeling in metastatic squamous cell carcinoma: What have we learned after more than four decades of research?

Patients with squamous cell carcinoma (SCC) have significantly lower survival upon the development of distant metastases. The extracellular matrix (ECM) is a consistent yet dynamic influence on the metastatic capacity of SCCs. The ECM encompasses a milieu of structural proteins, signaling molecules, and enzymes. Just over 40 years ago, the fibrous ECM glycoprotein laminin was identified. Roughly four decades of research have revealed a pivotal role of laminins in metastasis. However, trends in ECM alterations in some cancers have been applied broadly to all metastatic diseases, despite evidence that these characteristics vary by tumor type. We will summarize how laminins influence the SCC metastatic process exclusively. Enhanced laminin protein deposition occurs at the invasive edge of SCC tumors, which correlates with elevated levels of laminin-binding β1 integrins on SCC cells, increased MMP-3 presence, worse prognosis, and lymphatic dissemination. Although these findings are significant, gaps in knowledge of the formation of a premetastatic niche, the processes of intra- and extravasation, and the contributions of the ECM to SCC metastatic cell dormancy persist. Bridging these gaps requires novel in vitro systems and animal models that reproduce tumor-stromal interactions and spontaneous metastasis seen in the clinic. These advances will allow accurate assessment of laminins to predict responders to transforming growth factor-β inhibitors and immunotherapy, as well as potential combinatorial therapies with the standard of care. Such clinical interventions may drastically improve quality of life and patient survival by explicitly targeting SCC metastasis.

Update on Management Recommendations for Advanced Cutaneous Squamous Cell Carcinoma

Simple Summary

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, which predominantly occurs on the head and neck. Early detection and treatment of primary tumours is crucial to limit progression and local invasion of deep tissues. While high-risk markers of poor prognosis have been identified, factors predicting regional control or survival remain uncertain. Therefore, diagnosis and management of cSCC should be performed individually, considering patient’s clinicopathological profile and the best available treatment options. Surgical excision, radiotherapy, and/or systemic treatments can be selected depending on patient’s status and tumour stage. Considering that a more comprehensive assessment will be provided by a multidisciplinary team, we aimed to generate a practical document that may assist oncologists and dermatologists on the prognosis, diagnosis, management, and follow-up of patients with advanced cSCC.

Abstract

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, the incidence of which has risen over the last years. Although cSCC rarely metastasizes, early detection and treatment of primary tumours are critical to limit progression and local invasion. Several prognostic factors related to patients’ clinicopathologic profile and tumour features have been identified as high-risk markers and included in the stratification scales, but their association with regional control or survival is uncertain. Therefore, decision-making on the diagnosis and management of cSCC should be made based on each individual patient’s characteristics. Recent advances in non-invasive imaging techniques and molecular testing have enhanced clinical diagnostic accuracy. Surgical excision is the mainstay of local treatment, whereas radiotherapy (RT) is recommended for patients with inoperable disease or in specific circumstances. Novel systemic treatments including immunotherapies and targeted therapies have changed the therapeutic landscape for cSCC. The anti-PD-1 agent cemiplimab is currently the only FDA/EMA-approved first-line therapy for patients with locally advanced or metastatic cSCC who are not candidates for curative surgery or RT. Given the likelihood of recurrence and the increased risk of developing multiple cSCC, close follow-up should be performed during the first years of treatment and continued long-term surveillance is warranted.

Usefulness of Dermoscopy to Provide Accurate Assessment of Skin Cancers

Seborrheic keratosis (SK) is the most common benign tumour of epidermal origin. In most cases, it is simple to recognize in the clinical examination. However, sometimes SK can be a problematic lesion. We present the cases of two patients with seborrheic keratosis in whom we diagnosed the skin cancer through dermoscopic and histopathological examinations. The article aims to draw attention to the need for dermoscopic examinations to be included for an accurate assessment of the nevi not only by dermatologists but also not-specialized doctors. We would like to underline that many skin cancers share the similar features of malignancy, and competence and capability to interpret the dermoscopic pictures correctly are important for early recognition of malignant lesion. Very often malignant skin cancers can be hidden among benign lesions like seborrheic keratosis or they can be imitators of benign lesions. Amongst all cases of imposing SK, basal cell carcinoma, squamous cell carcinoma, melanoma is the most important differential diagnosis, of which their dermoscopic features will be discussed in this article.

High-frequency ultrasound in clinical dermatology: a review

Background

Ultrasound was first introduced in clinical dermatology in 1979. Since that time, ultrasound technology has continued to develop along with its popularity and utility.

Main text summary

Today, high-frequency ultrasound (HFUS), or ultrasound using a frequency of at least 10 megahertz (MHz), allows for high-resolution imaging of the skin from the stratum corneum to the deep fascia. This non-invasive and easy-to-interpret tool allows physicians to assess skin findings in real-time, enabling enhanced diagnostic, management, and surgical capabilities. In this review, we discuss how HFUS fits into the landscape of skin imaging. We provide a brief history of its introduction to dermatology, explain key principles of ultrasonography, and review its use in characterizing normal skin, common neoplasms of the skin, dermatologic diseases and cosmetic dermatology.

Conclusion

As frequency advancements in ultrasonography continue, the broad applications of this imaging modality will continue to grow. HFUS is a fast, safe and readily available tool that can aid in diagnosing, monitoring and treating dermatologic conditions by providing more objective assessment measures.

High-frequency ultrasound in the diagnosis of the spectrum of cutaneous squamous cell carcinoma: Noninvasively distinguishing actinic keratosis, Bowen's Disease, and invasive squamous cell carcinoma

OBJECTIVE

To evaluate high-frequency ultrasound (HFUS) features for diagnosing cutaneous squamous cell carcinoma (cSCC) as a spectrum of progressively advanced malignancies, including precursor actinic keratosis (AK), Bowen's disease (BD), and invasive squamous cell carcinoma (iSCC).

METHOD

In this retrospective study, 160 skin lesions diagnosed histopathologically (54 AK, 54 BD, and 52 iSCC) in 160 patients were included. The HFUS features of AK, BD, and iSCC were analyzed. The obtained data were evaluated using univariate and forward multivariate logistic regression analyses.

RESULTS

The most significant HFUS features in AK were regular surface (odds ratio [OR], 8.42) and irregular basal border (OR, 6.36). The most significant HFUS features in BD were crumpled surface (OR, 19.62) and layer involvement confined to the epidermis (OR, 3.96). The most significant HFUS features in iSCC were concave surface (OR, 27.06), stratum corneum (SC) detachment (OR, 14.41), irregular basal border (OR, 4.01), and convex surface (OR, 3.73). The characteristics of surface features, basal border, and layer involvement could be valuable HFUS clues in the discrimination of AK, BD, and iSCC.

CONCLUSION

High-frequency ultrasound is valuable for the differentiation of AK, BD, and iSCC, which may allow dynamic and noninvasive monitoring in the spectrum of cSCC.

Dermatoscopic findings and dermatopathological correlates in clinical variants of actinic keratosis, Bowen's disease, keratoacanthoma, and squamous cell carcinoma

Non-melanoma skin cancer (NMSC), predominantly squamous cell carcinoma (SCC) and basal cell carcinoma, is increasing worldwide. Dermatoscopy, which is one of the non-invasive diagnostic techniques, is important for early diagnosis of NMSC. In this study we aimed to determine dermatoscopic features of keratinocyte derived tumors including actinic keratosis (AK), Bowen's disease (BD), keratoacanthoma (KA), and SCC and correlate the dermatoscopic findings with pathology. A total of 242 lesions from 169 patients were included in the study and dermatoscopic and dermatopathological findings of the lesions were retrospectively studied. Revised pattern analysis was used for the dermatoscopic evaluation. Among 242 lesions, 145 were clinically flat (86 AK, 30 BD, and 29 SCC). Presence of vessels, ulceration, fiber sign, keratin mass, and blood spots decreased the probability of a lesion being AK. When the differential diagnosis was considered between KA and SCC vs AK and BD; vessel presence, ulceration, fiber sign, blood spots, white structureless, keratin, and centred vessels favored the diagnosis of KA and SCC. Our results may contribute to the determination of the lesions to be biopsied in patients with multiple AK on chronically sun damaged skin. In non-pigmented lesions when a final diagnosis cannot be established, knowledge of dermatopathologic and dermatoscopic correlation may significantly assist interpretation of dermatoscopic patterns and clues.

Clinical value of high-resolution dynamic contrast-enhanced (DCE) MRI in diagnosis of cutaneous squamous cell carcinoma

BACKGROUND

While uncomplicated cases of skin squamous cell carcinoma (cSCC) can be treated with surgery topical therapy alone, more objective and non-invasive examination methods are needed to guide clinicians to make more detailed biopsy and surgical plans for lesions with atypical or subcutaneous growth. High-resolution magnetic resonance imaging (HR-MRI) is a novel skin imaging method.

MATERIALS AND METHODS

Prospective collection of 19 patients with clinically suspected cSCC. All patients underwent high-resolution DCE-MRI using a 70-mm microscopy coil before operation. The imaging features and results of surgical pathology were recorded. K^trans , K_ep , V_e values, and the time-signal curve (TIC) types were determined using DCE images.

RESULTS

16 cases of cSCC, 3 cases of acanthoma. The subcutaneous invasion of all lesions was clearly displayed, of which 8 lesions invaded the subcutaneous fat layer, 5 invaded the muscle layer, 1 invaded the periosteum, 2 invaded the cap fascia, and the layer of all lesions invasion judged by HR-MR imaging was consistent with the postoperative pathology. The main manifestations of cSCC were ill-defined margin, obvious inhomogeneous enhancement, higher perfusion parameters value and type-III TIC, while acanthoma showed well-defined and type-I TIC. Some imaging findings (such as boundary, enhancement) and DCE perfusion parameters of the two groups overlap.

CONCLUSION

High-resolution DCE-MRI can fully and directly display the subcutaneous invasion of cSCC, and more work needs to be done to prove its value. Next, we will expand the sample size, and further explore its value in the differential diagnosis and prognosis evaluation of cSCC from acanthoma or other skin tumors.

Squamous Cell Carcinoma: An Update on Diagnosis and Treatment

Squamous cell carcinoma (SCC) accounts for most nonmelanoma skin cancer-related metastatic disease and deaths. Histopathology and correct surgical excision remain the gold standard for the diagnosis and treatment of SCC; however, new diagnostic imaging techniques such as dermoscopy and reflectance confocal microscopy have increased the diagnostic accuracy in terms of early recognition, better differential diagnosis, more precise selection of areas to biopsy, and noninvasive monitoring of treatments. The therapeutic intervention in patients with severe actinic damage and multiple in situ/low-risk SCC, and the development of innovative treatments such as epidermal growth factor receptor inhibitors and immune checkpoint inhibitors for locally advanced and metastatic SCC, are improving considerably the approach to the disease. This review summarizes the up-to-date knowledge in the field of detection, treatment, and monitoring of cutaneous SCC.

Imaging findings of Bowen's disease: A comparison between ultrasound biomicroscopy and conventional high-frequency ultrasound

OBJECTIVES

To compare the imaging findings of Bowen's disease (BD) between ultrasound biomicroscopy (UBM) and conventional high-frequency ultrasound (HFUS).

METHODS

A total of 29 pathologically proven BD lesions in 28 patients were retrospectively enrolled in the study, and all were after surgery. All the lesions were imaged with both UBM and HFUS. The imaging features on HFUS and UBM were analyzed and compared. The diagnostic results of ultrasound for BD were referenced with pathology results.

RESULTS

All the 29 (100%) BD lesions appeared hypoechogenicity, solid component, and superficial hyperechoic layer (ie, keratinization) on both UBM and HFUS. The typical imaging feature of BD lesions, that was, infiltration depth confined to the epidermis, was visualized in 25 (86.2%, 25/29) lesions on UBM whereas 15 (51.7%, 15/29) on HFUS (P = .002). A "wave sign," which corresponds to the surface keratinization of BD lesion, was visualized in 17 (58.6%, 17/29) of BD lesions on UBM whereas 6 (20.7%, 6/29) on HFUS (P = .001). UBM and HFUS correctly diagnosed 25 (86.2%, 25/29) and 15 (51.7%, 15/29) BD lesions, respectively (P = .002).

CONCLUSIONS

Bowen's disease has some typical imaging features on US. The "wave sign" of the superficial hyperechoic layer and the clear borderline between the tumor in epidermis and the slightly hyperechoic dermis layer are better depicted by UBM in comparison with HFUS, which leads to a more accurate diagnosis of BD. UBM has potential to be used as a diagnostic tool for characterization of BD on account of its high resolution.

Stimulation of collagen and elastin production in-vivo using 1,540 nm Er:Glass laser: assessment of safety and efficacy

Introduction: Induction of collagen and elastin remodeling in the human skin can be achieved by non-ablative fractional laser (NAFXL) and ablative fractional laser (AFXL). Our objective was to compare the safety, efficacy, tolerability, and ability to induce collagen and elastin remodeling of NAFXL versus AFXL in a series of treatments over time.Materials and Methods: In this prospective, proof of principle, single-case study, the safety, tolerability and efficacy of the laser systems were assessed via histopathology and clinical evaluations including photographs. Optical biopsies by means of multiphoton tomography (MPT) were used to evaluate the induction of collagen and elastin remodeling.Results: Treatments by both NAFXL and AFXL were well tolerated. The NAFXL system was found to be less painful and resulted in a shorter down- and healing times. MPT findings showed the superior capability of the AFXL procedure to induce collagen; on the other hand, elastin induction was more pronounced after NAFXL treatments.Conclusions: While NAFXL is as effective and safe as the traditional AFXL, it is better tolerated and has a shorter downtime. Serial optical biopsies over time over time can be a useful tool to assess the induction of collagen and elastin remodeling in the human skin.

The usefulness of high-frequency ultrasonography in the preoperative evaluation of vulvar cancer - a case series

Vulvar cancer is a malignancy of female lower genital tract with incidence of 1:100,000 in Poland. The most common types of vulvar cancers are squamous cell carcinoma and basal cell carcinoma. This study was approved by the board of the Clinical Unit of Obstetrics, Women’s Disease and Gynecological Oncology, United District Hospital, Collegium Medicum University of Nicolaus Copernicus in Toruń, Poland. This is a tertiary reference center. We analyzed cases of postmenopausal women diagnosed with vulvar cancer referred to our clinic for surgery. The aim of the study was to compare 48 MHz ultrasound images of vulvar cancer with histological images and assess the utility of high-frequency ultrasonography images in preoperative assessment. We examined 3 cases of squamous cell carcinoma and 1 case of basal cell carcinoma using 48 MHz DermaView high-frequency mechanical probe. We described typical ultrasonographic features of vulvar carcinoma, such as echogenicity, depth of infiltration, as well as we discussed limitations of this transducer. The 48 MHz frequency exhibits a promising value for the preoperative assessment of vulvar carcinoma. High-frequency ultrasonography can provide some important information, such as morphology, boundary, internal echo, and thus help choose adequate surgical approach.

The utility of high-frequency ultrasonography in preoperative assessment of vulvar Paget's disease - a case report

Paget’s disease of the vulva is a rare skin cancer accounting for less than 1% of all vulvar neoplasias. Surgery is the first treatment of choice. Unfortunately, it is insufficient in many cases, which require further treatment, and the risk of recurrence is high. We present a case of an 85-year-old woman who underwent surgery due to Paget’s disease of the vulva. A preoperative skin imaging using a high-frequency 48 MHz mechanical probe was used to assess the lesion margins. Typical high-frequency ultrasonographic features of vulvar Paget’s disease were identified and analyzed. This is the first report of high-frequency ultrasonography imaging of vulvar Paget’s disease.

Optical coherence tomography imaging of oral mucosa bullous diseases: a preliminary study

OBJECTIVES

Optical coherence tomography (OCT) is a non-invasive technique based on optical imaging with a micrometre resolution. The purpose of this study is to investigate the potential role of OCT in evaluating oral mucosa bullous diseases.

METHODS

two patients with bullous pemphigoid (BP) and one patient with pemphigus vulgaris (PV) were examined and images of their oral lesions were performed using OCT.

RESULTS

In OCT images, the BP blister has a clearly different morphology from the PV one compared to the blistering level.

CONCLUSION

This exploratory study suggests that the OCT is able to distinguish epithelial and subepithelial layer in vivo images of healthy oral mucosa from those with bullous diseases, assisting the clinicians in differential diagnosis.The presented data are in accordance with the scientific literature, although a wider pool of cases is needed to increase statistical power. Histological examination and immunofluorescence methods remain the gold standard for the diagnosis of oral bullous diseases. In this context, the OCT can provide the clinician with a valuable aid both as an additional diagnostic tool and in the follow up of the disease.

Measurement of Oral Epithelial Thickness by Optical Coherence Tomography

Optical coherence tomography (OCT) is a real-time, in-situ, non-invasive imaging device that is able to perform a cross-sectional evaluation of tissue microstructure based on the specific intensity of back-scattered and reflected light. The aim of the present study was to define normal values of epithelial thickness within the oral cavity. OCT measurements of epithelial thickness were performed in 28 healthy patients at six different locations within the oral cavity. Image analysis was performed using Image J 1.52 software. The healthy epithelium has a mean thickness of 335.59 ± 150.73 µm. According to its location within the oral cavity, the epithelium showed highest values in the region of the buccal mucosa (659.79 µm) and the thinnest one was observed in the mouth’s floor (100.07 µm). OCT has been shown to be useful for the evaluation of oral mucosa in vivo and in real time. Our study provides reference values for the epithelial thickness of multiple sites within the oral cavity. Knowledge of the thickness values of healthy mucosa is, therefore, of fundamental importance.

Clinical utility of ingenol mebutate in the management of actinic keratosis: perspectives from clinical practice

Actinic keratoses (AKs) are epidermal cutaneous neoplasia observed predominantly in middle-aged and older subjects with mainly photo type I and photo type II on sun-exposed surfaces as a result of DNA damage. AKs have historically been characterized as being "precancerous"; however, now it is considered by many authors a carcinoma in situ that can persist or progress to invasive squamous cell carcinoma (SCC) with metastatic potential. Despite the advances in the recognition of typical clinic, dermoscopic and histologic patterns, currently it is not yet possible to predict which AKs will progress to SCC. For this reason, early diagnosis and effective therapy are recommended based on cost/risk/benefit analysis. Current treatment consists of lesion-directed or field-directed therapies or a combination of both. Among the topical field therapies, ingenol mebutate stands out for its therapeutic efficacy, both as directed lesion therapy and as field directed therapy. The aim of this review is to demonstrate the utility of ingenol mebutate in the management of AK in daily clinical practice and to highlight data from real world in order to confirm evidence from pivotal studies. In order to explore clinical data from real world, PubMed searches were performed with the search terms "clinical data ingenol mebutate" and "real world ingenol mebutate". The hits were examined for relevant articles using defaults criteria. The timeframe for the sample search started from the first publication on this topic in 2008 up to now. A total of 23 articles were found using the keywords specified above. The overview points out a low number of real-life studies on the effectiveness and tolerability of this novel treatment due to short period of clinical experience for its recent approval. Further real-life studies are required in order to better identify the efficacy, safety and adherence of the drug on a larger population.

Reflectance confocal microscopy features of thin versus thick melanomas

BACKGROUND

In-vivo reflectance confocal microscopy (RCM) plays an increasingly important role in differential diagnosis of melanoma. The aim of the study was to assess typical confocal features of thin (≤1 mm according to Breslow index) versus thick (>1mm) melanomas.

METHODS

Thirty patients with histopathologically confirmed cutaneous melanoma were included in the study. RCM was performed with Vivascope equipment prior to excision. Fifteen melanomas were thin (Breslow thickness ≤1 mm) and 15 were thick (Breslow thickness >1 mm).

RESULTS

In the RCM examination, the following features were more frequently observed in thin compared to thick melanomas: edged papillae (26.7% vs. 0%, P=0.032) and areas with honeycomb or cobblestone pattern (33.3% vs. 6.7%, P=0.068). Both features are present in benign melanocytic lesions, so in melanoma are good prognostic factors. The group of thick melanomas compared to the group of thin melanomas in the RCM images presented with greater frequency of roundish cells (100% vs. 40%, P=0.001), non-edged papillae (100% vs. 60%, P=0.006), numerous pagetoid cells (73.3% vs. 33.3%, P=0.028), numerous atypical cells at dermal-epidermal junction (53.3% vs. 20%, P=0.058) and epidermal disarray (93.3% vs. 66.7%, P=0.068).

CONCLUSIONS

Non-invasive imaging methods helps in deepening of knowledge about the evolution and biology of melanoma. The most characteristic features for thin melanomas in confocal examination are: fragments of cobblestone or honeycomb pattern and edged papillae (as good prognostic factors). The features of thick melanomas in RCM examination are: roundish cells, non-edged papillae, numerous pagetoid cells at dermal-epidermal junction and epidermal disarray.

Raman spectral post-processing for oral tissue discrimination - a step for an automatized diagnostic system

Most oral injuries are diagnosed by histopathological analysis of a biopsy, which is an invasive procedure and does not give immediate results. On the other hand, Raman spectroscopy is a real time and minimally invasive analytical tool with potential for the diagnosis of diseases. The potential for diagnostics can be improved by data post-processing. Hence, this study aims to evaluate the performance of preprocessing steps and multivariate analysis methods for the classification of normal tissues and pathological oral lesion spectra. A total of 80 spectra acquired from normal and abnormal tissues using optical fiber Raman-based spectroscopy (OFRS) were subjected to PCA preprocessing in the z-scored data set, and the KNN (K-nearest neighbors), J48 (unpruned C4.5 decision tree), RBF (radial basis function), RF (random forest), and MLP (multilayer perceptron) classifiers at WEKA software (Waikato environment for knowledge analysis), after area normalization or maximum intensity normalization. Our results suggest the best classification was achieved by using maximum intensity normalization followed by MLP. Based on these results, software for automated analysis can be generated and validated using larger data sets. This would aid quick comprehension of spectroscopic data and easy diagnosis by medical practitioners in clinical settings.

The effect of wool hydrolysates on squamous cell carcinoma cells in vitro. Possible implications for cancer treatment

Squamous cell carcinoma of the skin is the second most common cutaneous malignancy. Despite various available treatment methods and advances in noninvasive diagnostic techniques, the incidence of metastatic cutaneous squamous cell carcinoma is rising. Deficiency in effective preventive or treatment methods of transformed keratinocytes leads to necessity of searching for new anticancer agents. The present study aims to evaluate the possibility of using wool hydrolysates as such agents. Commercially available compounds such as 5-fluorouracil, ingenol mebutate, diclofenac sodium salt were also used in this study. The process of wool degradation was based on chemical pre-activation and enzymatic digestion of wool. The effect of mentioned compounds on cell viability of squamous carcinoma cell line and healthy keratinocytes was evaluated. The obtained data show a significantly stronger effect of selected wool hydrolysates compared to commercial compounds (p<0.05) on viability of cells. The wool hydrolysates decreased squamous cell carcinoma cells viability by up to 67% comparing to untreated cells. These results indicate bioactive properties of wool hydrolysates, which affect the viability of squamous carcinoma cells and decrease their number. We hypothesize that these agents may be used topically for treatment of transformed keratinocytes in actinic keratosis and invasive squamous skin cancer in humans.

Photoacoustic and Fluorescence Imaging of Cutaneous Squamous Cell Carcinoma in Living Subjects Using a Probe Targeting Integrin αvβ6

Cutaneous squamous cell carcinoma (cSCC) is the second most common non-melanoma skin cancer worldwide. Today, cSCC is diagnosed by visual inspection followed by invasive skin biopsy. There is a need to develop non-invasive diagnostic tools to achieve early and accurate detection. Photoacoustic imaging (PAI) possesses high ultrasonic resolution and strong optical contrast at new depths (<1-5 cm). Together with exogenous contrast agents, PAI has found promising use in various tumors in living subjects. The expression of integrin α_vβ₆ is significantly up-regulated in cSCC. We fabricated an anti-integrin α_vβ₆ antibody and labeled it with indocyanine green (ICG) to form an ICG-α_vβ₆ antibody. The results showed that the ICG-α_vβ₆ antibody probe could be used to detect cSCC with high specificity (3-fold over the control by PAI) and deep penetration (approximately 1 cm) by PAI. This suggests that the ICG-α_vβ₆ antibody is a promising probe targeting the integrin α_vβ₆ for detection of cSCC tumors by PAI and fluorescence imaging. It may find clinical application in the early diagnosis of cSCC as well as in intraoperative navigation.

From Normal Skin to Squamous Cell Carcinoma: A Quest for Novel Biomarkers

Squamous cells carcinoma (SCC) is the second most frequent of the keratinocyte-derived malignancies after basal cell carcinoma and is associated with a significant psychosocial and economic burden for both the patient himself and society. Reported risk factors for the malignant transformation of keratinocytes and development of SCC include ultraviolet light exposure, followed by chronic scarring and inflammation, exposure to chemical compounds (arsenic, insecticides, and pesticides), and immune-suppression. Despite various available treatment methods and recent advances in noninvasive or minimal invasive diagnostic techniques, the risk recurrence and metastasis are far from being negligible, even in patients with negative histological margins and lymph nodes. Analyzing normal, dysplastic, and malignant keratinocyte proteome holds special promise for novel biomarker discovery in SCC that could be used in the future for early detection, risk assessment, tumor monitoring, and development of targeted therapeutic strategies.

Gene Expression and Proteome Analysis as Sources of Biomarkers in Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the world's leading skin cancer in terms of frequency at the moment and its incidence continues to rise each year, leading to profound negative psychosocial and economic consequences. UV exposure is the most important environmental factor in the development of BCC in genetically predisposed individuals, this being reflected by the anatomical distribution of lesions mainly on sun-exposed skin areas. Early diagnosis and prompt management are of crucial importance in order to prevent local tissue destruction and subsequent disfigurement. Although various noninvasive or minimal invasive techniques have demonstrated their utility in increasing diagnostic accuracy of BCC and progress has been made in its treatment options, recurrent, aggressive, and metastatic variants of BCC still pose significant challenge for the healthcare system. Analysis of gene expression and proteomic profiling of tumor cells and of tumoral microenvironment in various tissues strongly suggests that certain molecules involved in skin cancer pathogenic pathways might represent novel predictive and prognostic biomarkers in BCC.