Clinicopathological evaluation of nonmelanoma skin cancer

Statical Association between Clinical and Histopathological Parameters for Keratinocyte Carcinomas

The most common tumor of the western world is comprised of forms of non-melanoma skin cancers, previously known as keratinocyte carcinomas (KCs) The purpose of this study was to determine de incidence of non-melanoma skin tumors and the relationship between histopathological risk factors in patients with skin cancers. The study was composed from 332 cases of skin malignancies for which clinical and histopathological aggressivity factors were statistically analyzed through comparison tests and also stored digitally. For basal cell carcinoma (BCC) statistical analysis indicated significant relationships between pT category and gender, tumor size, ulceration, depth of invasion and positive resection limits. For squamous cell carcinoma (SCC) statistical analysis indicated significant relationships between pT category and tumor size, depth of invasion and positive resection limits. Clinical and histological analysis of certain characteristics of the above-mentioned skin cancers is an essential step in documenting and improving both prognosis and therapy standards.

Incidence of melanoma and nonmelanoma skin cancers in Indian and the global regions

Background

Incidence of common types of skin cancers in India is not reported and its comparison with global load would be helpful statistics.

Aim

The aim of this study is to summarize and report recent skin cancer incidence in India and to compare it with the incidence globally.

Materials and Methods

Age-specific rates and age-adjusted rates (AARs) of the incidence of skin cancer for all ages (0-75 years) were collected from India and the world, respectively, from the National Cancer Registry Programme and GLOBOCAN 2018.

Results

The AAR per 100,000 of melanoma of the skin was highest in the North region of India for both males and females with 1.62 and with 1.21, respectively. The incidence of nonmelanoma of the skin or other skin cancers for males was highest in the East region with 6.2 and for females in Northeast with 3.49. Among nonmelanoma, northeast region showed the maximum incidence for both male (75.6) and female (43.6) sexes. Globally, AAR of melanoma of skin for males was highest in the Western Pacific region with 36.9 and for the females; AAR was highest in the European region with 31.7. The incidence of nonmelanoma of the skin or other skin cancers for males was highest in the Western pacific region with 225.4 and 68.6 for females.

Conclusion

Summary of the incidence rates of melanoma and nonmelanoma skin cancers which shows that though there are regional variations of incidence in India is lower than that of in the West.

Clinical Spectrum of Cutaneous Malignancies in Central India: A Retrospective Study

Introduction:

Cutaneous malignancies account for 1%–2% of all the diagnosed cancers in India. Nonmelanoma skin cancers (NMSCs) include basal cell carcinomas (BCC) and squamous cell carcinomas (SCC). Others include melanoma, cutaneous lymphomas, and sarcomas. Exposure to ultraviolet (UV) rays is the most important risk factor associated with skin malignancies, although various other factors are also implicated.

Aims and Objectives:

The aims of this work were to study clinical spectrum with age and sex distribution of cutaneous malignancies and metastasis; to study clinicopathological variants of each type of cutaneous malignancies; and to study the risk factors associated with cutaneous malignancies.

Patients and Methods:

It was a retrospective analysis of clinically and biopsy proven cases of cutaneous malignancies from January 1, 2016 to January 31, 2018. Medical records of patients were assessed with respect to demographic information, clinical examination, dermoscopy, and histopathology. Statistical analysis was done using mean, proportion, and percentage.

Results:

Sixty-six cases with cutaneous malignancies were recruited. There was female preponderance. The most common age group affected was 60–70 years. BCC was the most common malignancy (41%) followed by SCC (30%), malignant melanoma (9%), and cutaneous T-cell lymphoma (1.5%). Head and neck was the most common site involved. The most common clinical type of both BCC and SCC was the nodular type. Acral lentiginous was the most frequent subtype of melanoma reported. The most common predisposing for NMSCs was prolonged sun exposure (46%).

Conclusion:

This study highlights an increasing trend of NMSCs with female preponderance. Head and neck is the most common site involved. Increased risk of NMSCs is seen with increased sun exposure and predisposed genetic conditions. T-cell lymphoma was common than B-cell type. The most common internal malignancy to cause cutaneous metastasis was breast carcinoma.

Bioengineered ethosomes encapsulating AgNPs and Tasar silk sericin proteins for non melanoma skin carcinoma (NMSC) as an alternative therapeutics

Rising cases of Non melanoma skin carcinoma (NMSC) and escalating levels of ultraviolet radiations have underlined a profound correlation with the elevating levels of environmental detoriation and increasing health issues. However, the availability of therapeutics has not aided in controlling the recurrence rates of skin carcinoma. Frequent administration of therapeutics with higher chances of facial deformity escalates the patient's treatment expenses. Thus, this study initiates a low cost effective and biodegradable therapy by exploring four formulations with combinations of silver nanoparticles (AgNPs), sericin (isolated from cocoons of Antherea mylitta) and chitosan. Subsequently, various ethosomal formulations were evaluated as a platform for transdermal delivery vehicle for efficient skin intervention therapeutics. Characterization using UV visible spectroscopy, Dynamic light scattering, Fourier Infrared spectroscopy, X-ray dispersion, Transmission electron microscopy, Fluorescence assisted cell sorting and in vitro studies were done and it was inferenced that equal combination of AgNPs and sericin facilitated to combat the morphological and cellular deformation of the epidermoid A431skin carcinoma cells. The overproduction of superoxide (O^2.) and nitric oxide (NO) radicals consequently depolarized the mitochondrial membrane potential triggering apoptosis and necrosis. The in vivo experiments exhibited the stimulation of IgM secretion with T cell-mediated immune response. Therefore, this study proposes a novel approach for treatment of NMSC using biocompatible formulations delivered through ethosomes.

A Clinicopathological Study of Skin Tumors from a Tertiary Care Centre in North India

BACKGROUND

There is a huge spectrum of skin tumors which can be confused clinically with malignancies, particularly when they are pigmented or inflamed, and histopathological examination of a biopsy specimen is required to establish a definitive diagnosis and to facilitate appropriate intervention and follow up.

AIM

To evaluate all skin tumors and categorize them according to their origin.

METHODS

The present study was conducted over a period of 4 years (July 1, 2013 to June 31, 2017) comprising of 1.5 years prospective and 2.5 years retrospective analysis in the departments of Dermatology and Pathology, at a tertiary hospital in North India. All specimens of skin tumors were analyzed grossly and microscopically. Immunohistochemistry was done wherever possible.

RESULTS

A total of 232 skin tumors were seen; of which 123 cases were benign (53.0%) and 109 cases were malignant (47.0%). The mean age of patients with benign and malignant skin tumors was 40.3 ± 19.9 and 60.8 ± 14.8 years, respectively. The most common site was face (n = 106; 45.7%) followed by limbs (n = 44; 19.0%). The male:female ratio of benign and malignant tumors was 1.01:1 and 1.31:1, respectively. Among the benign tumors, keratinocytic tumors were the commonest (n = 57; 46.3%) followed by the melanocytic tumors (n = 37; 30.1%) and appendageal tumors (n = 29; 23.6%). The most common malignant skin tumors were the keratinocytic tumors (n = 87; 79.8%) followed by 12 cases (11%) of hematolymphoid tumors and five cases (4.6%) each of melanocytic and appendageal tumors.

LIMITATIONS

The lack of clinical and dermatoscopic correlation and inclusion of retrospective data are the limitations of this study.

CONCLUSIONS

Skin tumors affect people of all ages. The benign tumors are seen in the younger age group as compared to malignant tumors. Face is the most common site and keratinocytic tumors are the most common skin tumors in both benign and malignant categories.

Clinicopathological correlation of malignant skin tumors: A retrospective study of 5 years

OBJECTIVE

Skin cancers are relatively uncommon malignancies worldwide, but there is a progressive increase in the incidence over the last few decades.

METHODS

We have studied the clinical and histopathological features of malignant skin tumors received in the department of pathology of our tertiary care institute over a period of 3 years and 8 months. A detailed analysis of clinical, gross, and microscopic findings was performed, followed by clinicopathological correlation.

RESULTS

One hundred and one specimens of skin tumors were received during this period, of which 37 (36.27%) were malignant tumors. Keratinocytic tumors were most common (81.08%) followed by appendageal tumors (10.81%). Squamous cell carcinoma (SCC) was the most frequent malignancy followed by basal cell carcinoma (BCC). Malignant melanoma, hidradenocarcinoma, malignant proliferating trichilemmal tumor (MPTT), sebaceous carcinoma, and fibrosarcomatous dermatofibrosarcoma were also observed. Variants such as hybrid verrucous SCC, basosquamous carcinoma, infiltrating BCC, and MPTT with spindle SCC were also found. Malignant skin tumors were most frequent in the seventh decade (40.54%). Males and females were almost equally affected. Overall, head and neck region was the most common site for malignant skin tumors.

CONCLUSION

The vast diversity of skin tumors produces difficulty in diagnosis. Any lesion, for which the diagnosis is uncertain, based on the history and clinical examination, should be biopsied for histopathological examination to rule out malignancy.

A dosimetric study of electron beam therapy vs. high-dose-rate mould brachytherapy in adjuvant treatment of non-melanoma skin carcinomas of the head and neck region

Purpose

Radiation for superficial tumours of the head and neck region can be given either by brachytherapy or electrons. Brachytherapy (BT), due to rapid dose fall-off and minor set-up errors, should be superior to external beam radiotherapy (EBRT) for treatment of lesions in difficult locations such as the nose and earlobe. The present study is a dosimetric comparison of computed tomography (CT)-based mould brachytherapy treatment plans with 3D conformal electron beam therapy in the treatment of non-melanoma skin cancers (NMSC).

Material and methods

From December 2017 to November 2018 10 patients with NMSC of the head and neck region (forehead, nose, cheek) who underwent adjuvant radiation with HDR brachytherapy (BT) with a surface mould individual applicator were enrolled for analysis. We evaluated dose coverage by minimal dose to 90% of planning target volume (PTV, D₉₀), volumes of PTV receiving 90-150% of prescribed dose (PD) (VPTV_90-150), conformal index for 90% and 100% of PD (COIN₉₀, COIN₁₀₀), dose homogeneity index (DHI), dose nonuniformity ratio (DNR), and exposure of organs at risk (OARs) (eyes, lens, underlying bone and skin). Prospectively, we created CT-based treatment plans for electron beam therapy. We compared conformity (COIN₉₀, COIN₁₀₀), dose coverage of PTV (D₉₀, VPTV₉₀, VPTV₁₀₀), volumes of body receiving 10-90% of PD (V₁₀-V₉₀), doses to OARs (D_0.1cc and D_2cc) of BT and electron plans.

Results

We obtained mean BT-DHI 0.81, BT-DNR 0.608, Electron-DHI 1.25. We observed no significant differences in VPTV_90,100 and D₉₀ between BT and electron beam. Mean BT-VPTV_125,150 were significantly higher than Electron-VPTV_100,125. COIN₉₀ was superior for BT plans.

Conclusions

CT-based surface mould brachytherapy results in better conformity of superficial lesions on small, irregular surfaces such as the nose and inner canthus than electrons with a slightly higher skin dose.

Interplay Between the Immunohistochemical Expression of P53 and the Proliferation Index in the Keratinocyte Tumors of the Skin

P53 is important for cell cycle regulation, and its overexpression is seen in malignant tumors. We examined correlation between p53 expression and cell proliferation, and its role in the pathogenesis of keratinocyte skin tumors. We used biopsies from patients with squamous cell carcinoma, actinic keratosis and keratoacanthoma. We examined crosssections stained with HE and using anti-cytokeratin, antip53 and anti-Ki67 antibodies.

Expression of p53 is found in 87, 85% of SCC, in 83. 3% of AK and 13. 4% KA. The high index of p53 expression was higher in SCC and AK compared to KA. We also observed a positive correlation between the expression of p53 and localization of the tumors. The largest proportion of subjects with AK and SCC has a high index of p53 expression on photoexposed region. We also observed that p53 expression correlates with age whereby in AK p53 expression increases with age. The high index of proliferation is most frequent in SCC and KA. Also at AK we found a strong correlation between a moderate proliferation index and tumor localization in photoexposed region. Between the proliferation index and p53 expression we observed a significant positive correlation only in SCC.

Proliferation index and the expression of p53 are useful for the differentiation of precursor keratinocyte lesions and skin carcinoma. High p53 expression has been associated with the aging and significantly correlates with the exposure to UV radiation in SCC and AK. High expression of p53 in AK and SCC supports the importance of this oncoprotein in carcinogenesis of the skin.

Morphological Spectrum of Basal Cell Carcinoma in Southern Karnataka

INTRODUCTION

Basal Cell Carcinoma (BCC) is the most common skin cancer worldwide, which appears over sun-exposed skin as slow-growing, locally invasive lesion that rarely metastasizes. Many phenotypic presentations are possible. BCCs are more common in males and tend to occur in older people. Majority is found on the head and neck. Many histopathological subtypes have been defined including nodular, micronodular, cystic, superficial, pigmented, adenoid, infiltrating, sclerosing, keratotic, infundibulocystic, metatypical, basosquamous and fibroepitheliomatous. Mixed patterns are common.

AIM

The aim was to study morphological spectrum of BCC in a tertiary care hospital in southern Karnataka.

MATERIALS AND METHODS

This was a retrospective analysis of 100 cases of BCCs reported in the Department of Pathology over a 9-year period from 2006 to 2014.

RESULTS

The mean age of presentation was 62 years. There was slight female preponderance (56%). The most common location was face (65%) and the most common presentation was ulceration (45%). Of the 100 BCCs, 50% were nodular, 13% infiltrating, 6% basosquamous, 4% superficial, 3% keratotic, 3% multinodular and 1% mixed.

CONCLUSION

BCC, besides being the commonest cutaneous cancer, is also known for its numerous histological patterns which are shown to have prognostic implications. This study reveals the frequency of the various histological patterns of BCC in southern Karnataka, where it has been rarely studied before.

Changing Trends of Skin Cancer: A Tertiary Care Hospital Study in Malwa Region of Punjab

INTRODUCTION

Skin cancer constitutes a small but significant proportion of patients with cancer. Although the presence of eumelanin in dark skin is protective against the development of skin cancer, it is increasingly being diagnosed in the Indian population.

AIM

To study the profile of skin cancer patients presenting to a tertiary hospital in Malwa area of Punjab, India.

MATERIALS AND METHODS

Retrospective study was done to analyse the profile of skin cancer patients who attended the institution over one year from 1(st) December 2013 to 30(th) November 2014. A comprehensive review of aetiology and related risk factors was done to correlate the environmental factors with high skin cancer prevalence in this region.

RESULTS

Skin cancer constituted (3.18%) 84 out of 2638 patients registered with cancer of all types. The age of the patients was 62±14.2 years and ranged from 27 to 92 yrs. Basal cell carcinoma (BCC) was the most common histological type(46/84, 54.76%) followed by squamous cell carcinoma (SCC) (31/84, 36.91%) and malignant melanoma (MM) (7/84, 8.33%). Male: female ratio was found to be 0.79:1. BCC showed higher female preponderance (p<0.05). Head and Neck was the commonest site involved (p<0.05). Majority (88%) of patients were from rural area. 92% of patients were directly into the profession of agriculture with history of prolonged exposure to sunlight.

CONCLUSION

Skin cancer constitutes a small but significant proportion of patients with cancers. This study highlights a paradoxically increasing trend of BCC and female preponderance. Head and neck is the most common site involved. Exposure to Ultra Violet B (UVB) radiation and higher levels of arsenic in drinking water has been reported to be associated with skin cancers. Limited studies show that levels of arsenic and pesticides were higher in the samples of drinking water in Malwa area of Punjab. Therefore a multipronged strategy to provide safe drinking water supply and discouraging the indiscriminate use of pesticides is recommended.

Nonmelanoma facial skin carcinomas: methods of treatment

AIM

The objective was to present in this study the administered treatment, reconstruction, and outcomes for lesions excised according to a prediagnosis of facial tumor, whose pathological finding was reported as nonmelanoma skin tumor.

METHODS

A total of 178 patients with full medical histories who were operated on for skin tumors in the Ear, Nose, and Throat Clinic of Ankara Oncology Education and Research Hospital between February 2010 and March 2012 were evaluated retrospectively. The test group was made up of 125 men (70%) and 53 women (30%), with a median age of 56 years (range, 29-89 years).

RESULTS

Basal cell carcinoma was diagnosed in 112 patients (63%), 45 (40%) of whom underwent flap reconstruction procedures; squamous cell carcinoma (SCC) was diagnosed in 55 patients (31%), 25 (45%) of whom underwent flap reconstruction procedures; 5 patients (3%) were diagnosed with basosquamous carcinoma, 3 (60%) of whom underwent flap reconstruction, and metatypical carcinoma was found in 6 patients (3%), and 5 (80%) underwent flap reconstruction treatment. Recurrence occurred in 10 (18%) of the 55 SCC patients. Invasion depths in the patients with recurrence were between 7 and 30 mm. In 21 (46%) of the 45 patients without recurrence, invasion depths were between 4 and 30 mm, whereas the invasion depths in the other 24 patients (53.3%) were less than 4 mm.

CONCLUSIONS

Metastatic lymph node involvement localized to the auricular, infra-auricular, and postauricular was present in the pathological specimens of all patients with lesions who had selective neck dissection I to IV included into their treatment. The depth of invasion of SCCs was found to be statistically significant in terms of recurrences.

Profile of skin biopsies and patterns of skin cancer in a tertiary care center of Western Nepal

BACKGROUND

Skin biopsy is the method to assist clinicians to make definite dermatological diagnosis which further helps in holistic management. Skin cancers are relatively rare clinical diagnosis in developing countries like Nepal, but the prevalence is on rise.

OBJECTIVES

To investigate the profile of skin biopsies and frequencies and pattern of skin cancers in a tertiary care centre of Western Nepal.

MATERIALS AND METHODS

The materials consisted of 434 biopsies (1.37%) out of 31,450 OPD visits performed in the Department of Dermatology, Manipal Teaching Hospital, Pokhara, Nepal, during the period of Dec 2011-Nov 2014. Data were collected and analyzed using SPSS-16 with reference to incidence, age, sex, race and clinical and histopathological features.

RESULTS

The commonest disorders observed in biopsies were papulosquamous lesions, skin tuberculosis of different types, benign skin tumors, leprosy, collagen and fungal diseases. Viral diseases were rarely seen, probably due to straight forward clinical diagnosis. Dermatological malignancies accounted for 55/434 (12.67%) of biopsies. Skin disorders in general were commoner in females 280/434 (64%), including malignancies 32/55(58.2%). Mean age of patients with skin cancer was 54.5 years. Facilities for proper laboratory investigation of dermatological disorders will improve the quality of life.

CONCLUSIONS

The most prevalent lesion in skin biopsies was papulosquamous disorders followed by skin tuberculosis of different types. Dermatological malignancy constituted 55/434 (12.67%) cases. The prevalence of skin malignancy is on rise in Nepalese society probably due to increase in life expectancy and better diagnostic services.

Comparative studies to evaluate relative in vitro potency of luteolin in inducing cell cycle arrest and apoptosis in HaCaT and A375 cells

Luteolin is a naturally occurring flavonoid present in many plants with diverse applications in pharmacology. Despite several studies elucidating its significant anti-cancer activity against various cancer cells, the mechanism of action in skin cancer is not well addressed. Hence, we investigated the effects of luteolin in HaCaT (human immortalized keratinocytes) and A375 (human melanoma) cells. The radical scavenging abilities of luteolin were determined spectrophotometrically, prior to a cytotoxic study (XTT assay). Inhibitory effects were assessed by colony formation assay. Further, the capability of luteolin to induce cell cycle arrest and apoptosis were demonstrated by flow cytometry and cellular DNA fragmentation ELISA, respectively. The results revealed that luteolin possesses considerable cytotoxicity against both HaCaT and A375 cells with IC50 values of 37.1 μM and 115.1 μM, respectively. Luteolin also inhibited colony formation and induced apoptosis in a dose and time-dependent manner by disturbing cellular integrity as evident from morphological evaluation by Wright- Giemsa staining. Accumulation of cells in G2/M (0.83-8.14%) phase for HaCaT cells and G0/G1 (60.4-72.6%) phase for A375 cells after 24 h treatment indicated cell cycle arresting potential of this flavonoid. These data suggest that luteolin inhibits cell proliferation and promotes cell cycle arrest and apoptosis in skin cancer cells with possible involvement of programmed cell death, providing a substantial basis for it to be developed into a potent chemopreventive template for skin cancer.

Advanced basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin malignancy worldwide. Ultraviolet light exposure is the best known exogenous factor in BCC development. This is also the target for primary prevention. Advanced BCC include locally advanced tumors and metastatic tumors. Prognosis is worse compared to stage I and II BCCs. Mohs or micrographically controlled surgery is the gold standard of treatment. In patients with tumors that cannot be completely removed radiotherapy was the only alternative in the past. More recently new drugs for targeted therapy of signaling pathways like sonic hedgehog or epidermal growth factor receptor became available. More small molecules are under investigation. Since the complete response rates are limited, future research has to evaluate their combination with surgery.