Risk Factors and Clinicopathological Features for Developing a Subsequent Primary Cutaneous Squamous and Basal Cell Carcinomas

Simple Summary

Patients with basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) often develop new keratinocyte carcinoma (KC), but information is limited on the frequency and timing of these subsequent tumors. This information is crucial to guide follow-up care. Given the significant clinical differences of the characteristic feature of individual skin cancer, estimation of the risk of a subsequent tumor should be estimating separately. The aim of our retrospective study was to assess risk factors for a subsequent skin cancer development. We demonstrated that patients with multiple tumors must be followed up carefully and for a long time. Moreover, we indicated the connection between the BCC subtype and increased risk for further KC development. BCC subtypes with an aggressive growth pattern predispose not only to increased risk for the recurrence but also are expected to be at an increased risk for a subsequent tumor. The non-invasive diagnosis, monitoring and follow up should be more comprehensive for those patients compared to low-risk BCC.

Abstract

Background: Patients with diagnosed keratinocyte carcinomas (KCs) have an increased risk of subsequent skin cancers development. Current studies indicate that patients with subsequent tumors should be followed up regularly. However, none of the studies indicate the connection between the specific subtypes and an increased risk for further KCs development. The study assesses the differences in the risk of developing a subsequent skin cancer after a previous diagnosis of KC, especially considering individual types of skin malignances, and identifies potential factors associated with an increased risk of new cutaneous tumor describing non-invasive diagnosis and monitoring. Methods: Pathology and medical records were examined to identify the characteristics of patients with multiple KCs diagnosed between 1999 and 2019. Results: The study group comprised 13,913 KCs occurring in 10,083 patients. Multiple KCs were observed in 2300 patients (22.8%). The analysis showed aggressive subtypes, multiple tumors, and male sex as significant prognostic factors. Conclusions: The most crucial risk factors for developing subsequent KC are being of a male gender, an aggressive tumor subtype, and previous history of multiple skin cancers. Basal cell carcinoma subtypes, such as infiltrative basosquamous, with aggressive growth patterns predispose not only to increased risk for the recurrence but are also expected to be at higher risk of subsequent KCs.

Characterisation of Selected Materials in Medical Applications

Tissue engineering is an interdisciplinary field of science that has developed very intensively in recent years. The first part of this review describes materials with medical and dental applications from the following groups: metals, polymers, ceramics, and composites. Both positive and negative sides of their application are presented from the point of view of medical application and mechanical properties. A variety of techniques for the manufacture of biomedical components are presented in this review. The main focus of this work is on additive manufacturing and 3D printing, as these modern techniques have been evaluated to be the best methods for the manufacture of medical and dental devices. The second part presents devices for skull bone reconstruction. The materials from which they are made and the possibilities offered by 3D printing in this field are also described. The last part concerns dental transitional implants (scaffolds) for guided bone regeneration, focusing on polylactide–hydroxyapatite nanocomposite due to its unique properties. This section summarises the current knowledge of scaffolds, focusing on the material, mechanical and biological requirements, the effects of these devices on the human body, and their great potential for applications.

Oral Surgical and Haematological Management in a Female Patient with Turner Syndrome and Moderate Haemophilia A: Clinical Observation and Case Report

Introduction:

Turner syndrome patients are at higher risk of having X-linked recessive disorders that could have serious clinical implications. Somatic abnormalities that may coexist with coagulation disorders determine the medical procedure approaches.

Case Report:

We report a 29-year-old female showing dysmorphia, distinctive physical features, and coagulation disorder, referred for maxillofacial surgery. Based on clinical symptoms, the patient was diagnosed with Turner Syndrome, and haemophilia A. Karyotyping confirmed classical monosomy X in all analysed blood cells. Molecular studies revealed hemizygous point mutation c.5096A>G (p.Tyr1699Cys) in Factor VIII gene, in exon 14. This missense mutation disturbs the interaction of Factor VIII with the von Willebrand factor, causing moderate haemophilia in the proband. The article presents the clinical history and preparation of our patient for oral surgical and dental surgery treatment.

Conclusion:

Turner syndrome patients require special attention due to the higher probability of congenital haemorrhagic diathesis. Maxillofacial surgery interventions in Turner syndrome and congenital haemorrhagic diathesis patients require individual patient preparation preventing post-extraction bleeding and ensuring proper local haemostasis.

Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study

Background

Patients using antiplatelet drugs following infarctions, acute coronary syndrome or stroke pose a significant clinical problem if it is necessary to perform surgery, including dental surgery, since they are at risk of prolonged or secondary post-extraction bleeding. Discontinuation of this therapy is associated with a high risk of serious thromboembolic complications. The purpose of this study was to assess the effectiveness of TachoSil fibrin-collagen patches in stopping and preventing of secondary post-extraction bleeding in patients undergoing chronic antiplatelet therapy.

Methods

The study was conducted through retrospective examination of the medical records of 153 patients using chronic antiplatelet therapy and those qualified for tooth extraction. The largest group comprised 74 patients using aspirin and clopidogrel as dual platelet antiaggregation therapy; in this group 75 tooth extractions were carried out. In all of the patients TachoSil fibrin-collagen patches and stiches were applied to the wounds resulting from tooth removal.

Results

Following tooth extraction, primary bleeding was stopped in all the patients and their wounds closed via coagulation within 20–30 min. In eight cases, accounting for 4.9% of the patients, secondary bleeding occurred and was successfully stopped only by applying a pressure dressing soaked in tranexamic acid. Secondary bleeding occurred in three patients on the second day and in five patients on the third day following tooth removal.

Conclusion

Topical application of TachoSil patches following tooth removal in patients using single or dual antiplatelet therapy effectively stopped bleeding and prevented secondary bleeding after tooth extraction.

Surgical management of double lip: A case report

BACKGROUND

Double lip is a rare developmental anomaly that mainly affects the upper lip. It is characterised by the presence of excess hyperplastic tissue that gives an illusion of double organ. It may occur independently or as a component of a set of defects, mainly in Ascher's syndrome, which presentes with blepharochalasis, non-toxic thyroid enlargement and double upper lip. The aim of this article is the presentation of a case report.

CASE REPORT

The case of a 15-year-old patient with double lip treated surgically for cosmetic reasons is reported. Surgical excision under general anaesthesia was performed, without any complications neither during the surgery nor postoperatively, with no recurrence at the 2-year follow-up. Histopathological analysis showed normal oral mucosa with numerous hypertrophic mucosal glands, capillaries, and lymphocytic and plasmocytic infiltration.

CONCLUSION

Due to the lack of unambiguous, clear recommendations and comparative studies in the literature, the choice of the incision depends on the experience and preferences of the operator. Regular follow-ups after the surgery are crucial; though recurrences are observed rarely, long-term, regular follow-ups are suggested due to the risk of developing additional symptoms characteristic for Ascher's syndrome.

Calcifying Epithelial Odontogenic Tumour. Review of the literature and own experience

The present paper discusses the case of a patient who was surgically treated for a rare calcifying epithelial odontogenic tumour (Pindborg tumour) at the Department of Maxillofacial Surgery, F. Chopin Clinical Voivodeship Hospital in Rzeszow. Calcifying Epithelial Odontogenic Tumour (CEOT) is a benign odontogenic tumour arising from the remnants of the dental lamina epithelium. The first three cases of this tumour were recognized by the Danish pathologist J.J. Pindborg in 1955. Since then Calcifying Epithelial Odontogenic Tumour has been commonly referred to as the Pindborg tumour. This type of neoplasm is relatively rare, since it occurs in approximately 0.4% of all odontogenic tumour cases. Due to a fairly common tendency of recurrence, estimated to be approximately 14% of all cases, the preferred o choice of treatment is radical surgical procedure and postoperative follow-up. Appropriate clinical and histopathological diagnosis is very important before applying the most suitable surgical treatment. Based on the case reviewed and the available literature, we can confirm the suitability of the therapeutic procedure course aligned with contemporary views, guidelines and established standards.

Observations on surgical reconstructive management following the excision of malignant neoplasms of the eyelid and periocular area

BACKGROUND

The surgical treatment of malignant neoplasms of the eyelid and the periocular area, due to the complex structure of the eye protective apparatus, remains a difficult surgical problem. The aim is to reconstruct the missing tissue as precisely as possible, both from a functional and esthetic point of view. Postoperative disorders of eyelid function may considerably disturb both the functioning and the quality of life of the patients.

OBJECTIVES

The aim of the study was to evaluate 262 patients who had underwent operations related to malignant neoplasms of the eyelid and the periocular area, and to demonstrate which reconstruction methods for post-resection defects were the most advantageous in terms of functions and esthetics.

MATERIAL AND METHODS

The study was based on an analysis of the medical records of 262 patients. The analysis included the reconstruction techniques used, the patient's age, the sizes and locations of the primary skin cancer, any healing complications, and the distant esthetic and functional outcomes.

RESULTS

Various types of flap procedures were the most frequently used techniques in the studied group of patients (66.8%). Single flaps were used in 83 patients, multiple flaps in 89 patients and complex flaps with a cartilage graft in 3 patients. Free skin grafts were used in 52 patients and were associated with complications in the form of partial necrosis. Complications during postoperative wound healing were observed in 18.3% of the patients. In 12 patients, the complications were associated with a local infection, in 15 patients with partial, marginal necrosis and in 8 patients partial wound breakdown after the transfer of the flap occurred.

CONCLUSIONS

The most frequently used mechanisms for correction and reconstruction of the deficits following the excision of the eyelid skin and periorbital malignancies included various flaps used in a total of 175 patients (66.8%).

Clinical-pathological characteristics of patients treated for cancers of the eyelid skin and periocular areas

BACKGROUND

Malignant cancers of the eyelid skin and the periocular area comprise 5-10% of facial skin malignant cancers. Basal cell carcinomas (BCCs) dominate, comprising approx. 80-90% of cancers of this area of the face. Considerably less often, in 9-14% of cases, squamous cell carcinomas (SCCs) are observed.

OBJECTIVES

The aim of this study is to provide an epidemiological-clinical assessment of patients treated over the period 2006-2015 for primary malignant cancers of the eyelid skin considering histological diagnosis and clinical staging.

MATERIAL AND METHODS

This study was based on an analysis of the medical records of 262 patients. Demographic data, age, sex, size and location of lesions, histological types, and clinical staging were assessed.

RESULTS

In the analyzed group of 262 patients, most were over the age of 60 years. Primary cancers were most frequently located in the area of the medial canthus of the eye and in the lower eyelid skin. They were mainly lesions of 6-10 mm and 16-20 mm with histologically diagnosed basal cell carcinoma of nodular and cystic types.

CONCLUSIONS

The most represented group was that of patients aged 60-70 years with primary cancers located in the medial canthus of the eye (47.3%) and in the lower eyelid. Basal cell carcinoma was diagnosed, mainly nodular and cystic types.

Awareness of Polish undergraduate and graduate students regarding the impact of viral infections and high-risk sexual behaviors on the occurrence of oral cancer

With every passing year, more and more studies and observations demonstrate growing incidence of oral cancer, a decrease in patients' age, and an increasing number of epidemiological factors. The aim of the study was to determine the level of awareness among undergraduate and graduate university students regarding the incidence of oral cancer linked with viral infections and high-risk sexual behavior, including oral sex. Self-administered questionnaire-based survey was carried out among 196 Polish students aged 19 to 25 years. It was found that the young adults understood the meaning of human papillomavirus (HPV), but associated it only with the squamous cell carcinoma of the cervix. A total of 43.4% did not realize that there was any correlation between HPV infection and the development of oral cancer. The students who were aware of this correlation constituted 40.3% of the total. The majority of the participants, that is, 82 subjects (41.8%), did not associate the occurrence of malignant neoplasms of the oral cavity with oral sex. The study group did not present adequate awareness of the fact that occurrence of oral cancer may be associated with high-risk sexual behaviors. Knowledge of oral cancer was not significantly related to the level of university education (P < .005).

[Merkel cell carcinoma of the facial skin. Cases presentation and general rules of treatment]

Merkel cell carcinoma is an aggressive, malignant, neuroendocrine tumor of the skin. The aim of the study is to present the clinical pictures, methods and results of treatment of MCC in the Clinic of Maxillofacial Surgery in Rzeszow in years 2003-2010. Changes were located on the skin of the face of four patients. All patients were treated surgically, the primary change was removed. Recurrence after surgical treatment was observed in all patients. The observations confirmed the data from the literature about the incidence of MCC over 75 years of age, aggressiveness and difficulties in treatment of this disease.

Leiomyosarcoma in the mandible: A rare case report

Leiomyosarcoma (LMS) is a malignancy which very rarely occurs in maxillofacial location, and the course of the disease is not very characteristic.In this case report, we present a 58-year-old female patient with a painless tumor of the left angle of the mandible causing slight asymmetry of the face. She also reported that she observed deterioration in fitting of the lower denture in the oral cavity for several months, which she had used successfully for 5 years.On the basis of clinical tests, histopatological examination, and imaging (CT, MRI, ultrasound, pantomography), the patient was diagnosed with primary malignant leiomyosarcoma (LMS) of the mandibular corpus and ramus on the left side. The patient received combined surgical and oncological treatment. The first stage was a surgery, and then adjuvant radiotherapy was applied on the site of the resected tumor-a total dose of 60 Gy in 35 fractions. The patient's postoperative course was uneventful. She also underwent adjuvant therapy well. In the period of 3-year follow-up, no signs of recurrence were observed.The findings may extend our knowledge and experiences in the treatment of leiomvosarcoma in the craniofacial area.

[The rare case of osteonecrosis of the jaws in a patient treated with bisphosphonates for osteoporosis]

Bisphosphonates are used primarily in patients with bone metastases and osteoporosis One of the local complications, less well-known to doctors, associated with the use of bisphosphonates is osteonecrosis of the jaw (Biophosphatate Related osteonecrosis of the jaw--BRONJ). It affects approximately 1-10% of patients and may cause diagnostic difficulties because of its similarity to a primary focus in the bone. This issue can be encountered by the doctors of various specialties who use bisphosphonates. The purpose of this study is to present a case of the patient with BRONJ symptoms following the administration of bisphosphonate therapy, which can occur in the doctors practice. Concluding, maintaining good health of the oral cavity before starting the therapy reduces the incidence of BROKJ. Before starting bisphosphonate therapy, all patients should be referred to dental consultation to assess the potential foci of infection in the mouth.

Mucoceles of minor salivary glands in children. Own clinical observations

INTRODUCTION

Mucoceles are benign lesions associated with the pathology of the oral mucosa of minor salivary glands. Two types of cysts are distinguished depending on their pathogenesis. Most often they occur as a result of mechanical trauma and mucus extravasation into tissues or obstruction of the gland ducts.

AIM

The aim of the study was to present our own experiences regarding mucoceles of minor salivary glands in the oral cavity taking into account how frequently the individual types of cysts occur in children.

MATERIAL AND METHODS

The research was carried out based on medical files from the years 2005-2015. These were: medical case records, operating books and the medical registry of patients treated at the Clinic of Maxillofacial Surgery, Frederic Chopin Clinical Regional Hospital in Rzeszow. In that period 64 children and teenagers, 28 girls and 36 boys were treated. What was considered was the age and gender of the patients, the reason for their appointment with a doctor, the location, size and histopathological type of the cysts, as well as the course and results of the diagnostic and therapeutic process.

RESULTS

In the group analyzed, the reasons for referral to the Clinic were: in 25 patients accidental ascertainment of a non-symptomatic tumor in the oral cavity during examination by a dentist, pediatrician or laryngologist which had not caused any discomfort to the children; in 13 patients concern had been raised by a gradually increasing tumor; in 18 cases there was an increased tissue tension surrounding the tumor, while in 3 children red oedema was observed in the oral cavity (suspicion of abscess). The most frequent mucocele location was the lower lip (34 children). The most frequent size was 2.1-3 cm (28 children). The most frequent histological type was MEP. All the patients were treated at the Clinic in the one-day surgery mode, with good outcome.

CONCLUSIONS

Mucocele ascertainment in children's oral cavity could be made accidentally in routine pediatric examination, therefore it is necessary to extend pediatricians' knowledge about small salivary gland mucoceles. The most frequent type of MEP could be related to different types of trauma in the oral mucose.

Multiple, supernumerary retained teeth in the course of cleido-cranial dysplasia. A case report

Cleido-cranial dysplasia, often referred to as Scheuthauer-Marie-Sainton syndrome, is an autosomal dominant disorder of the musculo-skeletal system. Patients with cleido-cranial dysplasia are characterized by short stature, frequent varus or valgus hip, kyphoscoliosis, underdevelopment of the scapulas and the sternum, incorrect number of ribs. The most characteristic feature is unilateral or bilateral, partial or total underdevelopment of clavicles. Mental development is not affected in this syndrome. Malocclusion, occlusal irregularities, multiple supernumerary teeth, impacted teeth, and persistent milk teeth are found in the stomatognathic system. Teeth often have abnormal anatomy. Gothic palate, cleft hard and soft palate are diagnosed. The aim of this paper is to present a case of a 12-year-old boy diagnosed with irregularities in the masticatory system involving an additional number of retained teeth. The boy was referred by an orthodontist for surgical and orthodontic team therapy. The case presented confirms the observations of other authors that only the multi-specialty collaboration of a pediatrician, a geneticist, an orthopedist, an orthodontist, a maxillofacial surgeon, an implant prosthetic surgeon and a physiotherapist can provide proper diagnosis and treatment.

Effect of light-harvesting complex II on ion transport across model lipid membranes

The effect of the incorporation of the major light-harvesting complex of photosystem II (LHCII) to planar bilayer lipid membranes (BLMs) formed from soybean asolectin and unilamellar small liposomes formed from egg-yolk phosphatidylcholine on ion transport across the lipid bilayer has been studied. The specific conductivity of the BLM rises from 5.2 +/- 0.8 x 10(-9) up to 510 x 10(-9) O(-1) cm(-2) upon the incorporation of LHCII. The conductivity of the membrane with LHCII depends upon the ionic strength of the bathing solution and is higher by a factor of five when the KCl concentration increases from 0.02 to 0.22 M. Such a strong effect has not been observed in the same system without LHCII. The liposome model is also applied to analyse the effect of LHCII on the bilayer permeability to protons. Unilamellar liposomes with a diameter less than 50 nm have been prepared, containing (trapped inside) Neutral Red, a pigment sensitive to proton concentration. A gradient of protons on the membrane is generated by the acidification of the liposome suspension and spectral changes of Neutral Red are recorded in time, reflecting the penetration of protons into the internal space of liposomes. Two components of proton permeation across liposome membranes are observed: a fast one (proceeding within seconds) and a slow one (operating on the time scale of minutes). The rate of both components of proton transport across LHCII-containing membranes is higher than for liposomes alone. The enhancement effect of LHCII on the ion transport across the lipid membrane is discussed in terms of aggregation of the pigment-protein complexes. The possible physiological importance of such an effect in controlling ion permeability across the thylakoid membrane is discussed.

[Primary management of facial skeleton injuries in patients treated at the maxillofacial surgery ward]

This study aimed at discussing 278 patients with facial skull fractures and injuries, being managed at the Maxillofacial Surgery Ward of the Voivodeship Specialist Hospital in Rzeszów within 1991-1998. There have been 201 male, 65 female and 12 paediatric patients, aged between 6 and 67 years. The majority of injures in 161 (57.9%) patients required simultaneous treatment of fractures and soft tissue lesions. 68 (24.6%) patients have had closed injuries and face wounds. In 49 (17.6%) patients reposition and immobilisation of fractures have been necessary. In most cases injures have been dressed at emergency room. Fractures of facial skull, coexisting with face injures and wounds, often required specialist treatment provided by the maxillofacial surgeon, laryngologist and ophthalmologist, combining reposition and immobilisation of fracture with the wire, Nichrominox plates and Champy miniplates, followed by wound dressing, according to the commonly approved rules of the primary medical care.