Use of Dermatoscopy in Lesions Suspicious for Melanoma: Two Case Reports

Abstract is missing (Short communication)

Basal cell carcinoma and rosacea: coincidence or relationship?

Introduction

The relationship between rosacea and basal cell carcinoma (BCC) is still not known. Almost all reports questioning the relation between BCC and rosacea are focused on rhinophyma.

Aim

To examine the possible connection of BCC and rosacea.

Material and methods

110 patients with BCC located on the face treated surgically in the Dermatosurgery Unit in 2020-2021 were included in the study. A trained dermatologist assessed the presence or absence of concomitant rosacea and assessed its severity according to the Investigator's Global Assessment (IGA).

Results

Fifty-one (46.4%) subjects with BCC and concomitant clinically diagnosed rosacea were found. In our group 35.5% of women had BCC located on the cheeks, while in men most cancers were located on the nose (55%, n = 11), however this difference has not reached statistical significance.

Conclusions

The incidence of rosacea in our population was undoubtedly higher, comparing to the normative population. Both rosacea and BCC share the same risk factors - UV exposure, the potential association should not be neglected.

Diagnosis of the Pneumatic Wheel Condition Based on Vibration Analysis of the Sprung Mass in the Vehicle Self-Diagnostics System

This paper presents a method for the multi-criteria classification of data in terms of identifying pneumatic wheel imbalance on the basis of vehicle body vibrations in normal operation conditions. The paper uses an expert system based on search graphs that apply source features of objects and distances from points in the space of classified objects (the metric used). Rules generated for data obtained from tests performed under stationary and road conditions using a chassis dynamometer were used to develop the expert system. The recorded linear acceleration signals of the vehicle body were analyzed in the frequency domain for which the power spectral density was determined. The power field values for selected harmonics of the spectrum consistent with the angular velocity of the wheel were adopted for further analysis. In the developed expert system, the Kamada-Kawai model was used to arrange the nodes of the decision tree graph. Based on the developed database containing learning and testing data for each vehicle speed and wheel balance condition, the probability of the wheel imbalance condition was determined. As a result of the analysis, it was determined that the highest probability of identifying wheel imbalance equal to almost 100% was obtained in the vehicle speed range of 50 km/h to 70 km/h. This is known as the pre-resonance range in relation to the eigenfrequency of the wheel vibrations. As the vehicle speed increases, the accuracy of the data classification for identifying wheel imbalance in relation to the learning data decreases to 50% for the speed of 90 km/h.

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.

Serum Concentration and Skin Expression of S100A7 (Psoriasin) in Patients Suffering from Hidradenitis Suppurativa

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. An important role of innate immune dysregulation in the pathogenesis of HS has been highlighted. S100A7 (psoriasin) is an innate, antimicrobial protein that exerts proinflammatory and chemotactic action.

OBJECTIVES

The objective of the study was to investigate serum concentrations of S100A7 in individuals with HS as compared to healthy controls. Further, we evaluated the expression of S100A7 in lesional HS skin as compared to perilesional (clinically uninvolved) HS skin and normal skin.

METHODS

Serum concentrations of S100A7 were evaluated with a commercially available ELISA kit. The expression of S100A7 in the skin was assessed using qRT-PCR and immunofluorescence staining.

RESULTS

We found increased expression of S100A7 in lesional HS skin as compared to perilesional HS skin (p = 0.0017). The expression of S100A7 in lesional HS skin was positively associated with serum C-reactive protein concentration and the severity of disease according to Hurley staging. The serum concentration of S100A7 in individuals with HS was decreased as compared to healthy controls and patients with psoriasis.

CONCLUSIONS

Upregulated in lesional HS skin, S100A7 may enhance the inflammatory process and contribute to the HS pathogenesis.

Assessment of gait stability and preferred walking speed in virtual reality

PURPOSE

Analysis of human gait as well as diagnosis of human locomotion organ should always be conducted with velocity of gait equal to Preferred Walking Speed (PWS). The literature review shows that the PWS value is not the same in real and virtual environment. The aim of this study was to determine PWS values in both environments and to specify values of parameters used in equations enabling PWS calculations on the basis of lower limb length.

METHODS

Research-related tests involved 40 subjects walking on the treadmill and wearing HMD goggles. The spatial scenery made participants feel like during a walk in the park. The tests included measurements of displacements of the COP, allowing for the calculation of the Lyapunov exponent and Floquet Multiplier. Both coefficients were used to identify stability at various gait velocities.

RESULTS

The analysis revealed that the PWS in relation to gait on the treadmill with VR was lower than the PWS without VR. The final stage of research involved the determination of new values of coefficients of the formula enabling the identification of the velocity of comfort of gait in VR.

CONCLUSIONS

Obtained results proved that PWS in real and virtual environment are different. The lower values were obtained for measurements in VR. On the basis of these results, value of the "a" coefficient, used in PWS calculations on the basis of lower limb length, was re-determined. The new value makes it possible to assess PWS for gait conducted on treadmill in virtual environment, what can be very important in gait evaluation.

The assessment of the kinematics of the rescuer in continuous chest compression during a 10-min simulation of cardiopulmonary resuscitation

BACKGROUND

In pursuit of improvement in cardiopulmonary resuscitation (CPR), new technologies for the measurement and assessment of CPR quality are implemented. In our study, we assessed the kinematics of the rescuer during continuous chest compression (CCC-CPR). The proper performance of the procedure is a survival predictor for patients with cardiac arrest (CA). The purpose of the study was a prospective assessment of the kinematics of the rescuer's body with consideration given to the depth and rate of chest compression (CC) as the indicator of properly performed CC maneuver by professional and non-professional rescuers during a simulation of a 10-min CCC using a manikin.

METHODS

Forty participants were enrolled in the study. CCC-CPR was performed in accordance with the 2015 AHA guidelines on a manikin positioned on the floor. Kinematic data on the movement were obtained from the measuring system (X-sens MVN Biomech) transmitting information from 17 inertial sensors. Measurement data were imported to the author's program RKO-Kinemat written in the Matlab and C # environments. Two groups of results were distinguished: Group I-results of CC with the depth of ≥ 40 mm and Group 2-CC results with the depth of < 40 mm.

RESULTS

The multiple regression model demonstrated that the path length, left knee flexion angle, and left elbow flexion angle were the essential elements of the rescuer's kinematics that facilitated achieving and maintaining the normal depth of CC.

CONCLUSIONS

We believe that raising the rescuer's hips by moving the center of the rescuer's body over the point of sternal compression increases the value of the CC force vector, thereby increasing the depth of CC. In addition, we observed that, during an effective CC, the rescuer was unable to maintain arms straight and, in consequence, a slight elbow flexion was observed. It, however, did not influence the quality of the maneuver.

The Standard Deviation of Differential Index as an innovation diagnostic tool based on kinematic parameters for objective assessment of a upper limb motion pathology

PURPOSE

Indexing methods are very popular in terms of determining the degree of disability associated with motor dysfunctions. Currently, indexing methods dedicated to the upper limbs are not very popular, probably due to difficulties in their interpretation. This work presents the calculation algorithm of new SDDI index and the attempt is made to determine the level of physical dysfunction along with description of its kind, based on the interpretation of the calculation results of SDDI and PULMI indices.

METHODS

23 healthy people (10 women and 13 men), which constituted a reference group, and a group of 3 people with mobility impairments participated in the tests. In order to examine possibilities of the utilization of the SDDI index the participants had to repetitively perform two selected rehabilitation movements of upper extremities. During the tests the kinematic value was registered using inertial motion analysis system MVN BIOMECH.

RESULTS

The results of the test were collected in waveforms of 9 anatomical angles in 4 joints of upper extremities. Then, SDDI and PULMI indices were calculated for each person with mobility impairments. Next, the analysis was performed to check which abnormalities in upper extremity motion can influence the value of both indexes and interpretation of those indexes was shown.

CONCLUSION

Joint analysis of the both indices provides information on whether the patient has correctly performed the set sequence of movement and enables the determination of possible irregularities in the performance of movement given.

The Upper Limb Motion Deviation Index: A new comprehensive index of upper limb motion pathology

PURPOSE

The aim of the research was to formulate a new index enabling assessment of the overall pathology of the upper limb movement. It defines the difference between the pathological movement and a normal movement pattern.

METHODS

Methodology of determining the index is based on a mathematical algorithm for calculating the Gait Deviation Index which is based on advanced methods of image comparison. To calculate the ULMDI index, one must divide the analyzed movement into cycles appropriate to the nature of the movement (similarly in gait it is the gait cycle) and then determine kinematic quantities (courses of joint angles).

RESULTS

A group of 23 healthy people (10 women: k1-k10 and 13 men: m1-m13) as the reference group and a group of 3 persons with mobility impairments (p1-p3) took part in the research. Time values of the angles of the joints on both upper limbs were registered and then ULMDI indexes were calculated.

CONCLUSIONS

It has been shown that the developed ULMDI index allows to detect the deviations from the accepted norm in the performance of movements. The results showed that both the description of the motor dysfunction of examined person based on the diagnosis of the physician, a detailed analysis of kinematic waveforms received during the tests and the calculated values provide a coherent picture of the state of a human movement. The index analysis is less time-consuming for the doctor, and the comparison of the results at various stages of therapy gives an objective picture of the rehabilitation progress.

Influence of changing frequency and various sceneries on stabilometric parameters and on the effect of adaptation in an immersive 3D virtual environment

PURPOSE

The aim of the study was to examine the influence of different types of virtual sceneries and frequencies of movement of visual disturbances on stabilometric values as well as whether individual sceneries and changing frequency can minimize effect of adaptation of tested person to applied disturbances.

METHODS

There were 23 healthy participants. A person has been standing on a Zebris stabilometric platform. Virtual 3D environment was displayed by means of HMD Oculus Rift system. An open (a meadow) and closed (a room) sceneries were used. The sceneries moved along the sagittal axis and rotated around horizontal axis. The measurement lasted 30 seconds and in the middle of it frequency of translational movement was changed from 0.7 Hz to 1.4 Hz or from 1.4 Hz to 0.7 Hz.

RESULTS

The data were reported as medians of COP velocity and ellipse area. Visual disturbances caused the increase of these values in comparison with the tests conducted with open eyes. Results divided into periods (the first and the second 15 seconds) showed that in the first half of the test values were higher compared to the second half. The comparison of values obtained for open and closed scenery showed that higher values were recorded for open scenery.

CONCLUSIONS

The comparison of both types of sceneries on the basis of COP velocity and ellipse area showed that open scenery had a greater impact on the measured stabilometric values. It was found out as well that people got accustomed to the applied disturbances, but this effect was lower in the open scenery.

Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: Implications for treatment with anti-IL-17 agents

BACKGROUND

Biologics seem to offer a promising nonsurgical approach in hidradenitis suppurativa (HS), especially in disease with highly pronounced inflammation. Recent studies revealed increased expression of a broad range of cytokines in lesional HS skin, including interleukin (IL)-17.

OBJECTIVE

This study was undertaken to determine IL-17 serum levels in this group of patients.

METHODS

Our study was conducted on a group of 86 patients between 16 and 72 years of age with HS. A total of 86 matched healthy volunteers constituted the control group. Enzyme-linked immunosorbent assay kits were used to quantify IL-17 serum concentration.

RESULTS

The mean IL-17 serum level of patients with HS was 3.68 ± 2.08 pg/mL, which was significantly elevated (P < .0001) compared with that found in healthy volunteers (2.5 ± 1.11 pg/mL). Moreover, there was a tendency toward higher serum concentrations of IL-17 in patients with more advanced disease (P = .005). Disease duration; patient sex, age, and body mass index; and smoking habits were not determining factors for IL-17 serum concentration.

LIMITATIONS

Hospital-based study population was a limitation, as was a lack of posttreatment assessment.

CONCLUSION

In light of our findings and literature on increased expression of IL-17 in HS lesions, evaluating the clinical effectiveness of using anti-IL-17 agents in the treatment of patients with HS is justified.

Surgical Procedures in Hidradenitis Suppurativa

Hidradenitis suppurativa is difficult to treat owing to its complex pathomechanism; beside the extensive inflammation with abscesses and inflammatory nodules, there is also an architectural loss with sinus tract formation and in severe cases with extensive scarring. Therefore, surgery is mandatory in moderate and severe HS.

SOX18 Expression in Non-melanoma Skin Cancer

BACKGROUND/AIM

SRY-related HMG box protein 18 (SOX18) is a transcription factor involved in a range of physiological processes, including differentiation of endothelial cells during new vessel formation. Numerous studies are being conducted to determine its role in carcinogenesis.

MATERIALS AND METHODS

Thirty-five cases of squamous cell carcinoma (SCC), 61 cases of basal cell carcinoma (BCC), 15 cases of actinic keratosis (AK) and 15 normal skin (NS) cases were examined in the study. Expression of SOX18 was investigated with immunohistochemistry and light optic microscopy. The obtained results were subjected to statistical analysis including available clinicopathological data.

RESULTS

Nuclear expression of SOX18 was shown in vascular endothelial cells, basal layer cells of NS epidermis, as well as in AK, BCC and SCC cancer cells. Expression of SOX18 in SCC, BCC and AK cells was significantly higher than in NS (p<0.01, p<0.001 and p<0.01, respectively). Additionally, higher expression of SOX18 in BCC than in SCC cells (p<0.001) was observed.

CONCLUSION

SOX18 may play a role in the development of BCC and SCC. Further studies with the use of additional markers tested at the mRNA and protein level are necessary for better explanation of SOX18 function in cancer transformation.

Expression of SATB1, MTI/II and Ki-67 in Mycosis Fungoides

BACKGROUND/AIM

A genome organizer protein, special AT-rich sequence binding protein 1, (SATB1), was recently shown to play an important role in the development and spread of various malignancies. Metallothioneins I and II (MTI/II) are multifunctional proteins involved, among others, in cell proliferation and apoptosis resistance in tumors. The role and relevance of these factors in mycosis fungoides (MF), the most common primary cutaneous T-cell lymphoma, is not fully understood. The aim of the present analysis was to evaluate the expression and potential correlation of SATB1, MTI/II and Ki-67 with clinicopathological data in MF.

MATERIALS AND METHODS

We performed immunohistochemical analysis for SATB1, MTI/II and Ki-67 on 90 cases of MF and 19 controls (chronic benign dermatoses). The expression of SATB1 and Ki-67 was analyzed in cancer cell nuclei, whereas nuclear and cytoplasmic expressions of MTI/II were scored separately (nMT, cMT; respectively).

RESULTS

We recorded a significantly higher expression of SATB1 and cMT in MF compared to the control group (p<0.002, p=0.04, respectively, Student's t-test). We also noted significant differences in the mean (±SD) expression of nMT and cMT in advanced MF compared to early MF, (1.4±1.3 vs. 0.9±0.9, 4.1±3.8 vs. 2.5±2.9, respectively; p=0.04 for both). Similarly, Ki-67 expression was significantly higher in advanced MF (p<0.01). The expression of SATB1, cMT and Ki-67 was significantly higher in more infiltrating skin lesions (p<0.001, p=0.08 and p<0.001, respectively). Regarding extracutaneous involvement, a higher expression of SATB1, nMT, cMT and Ki-67 was found in patients with clinical or histological involvement of lymph nodes (N1-3 vs. N0) (p<0.001, p=0.002, p<0.001 and p=0.1, respectively). A marked correlation was observed between SATB1 and Ki-67 (Spearman correlation test: r=0.53, p<0.001). No associations between SATB1, nMT and cMT expression and demographic data nor overall survival were found.

CONCLUSION

Our study provides data on the differences in the expression of SATB1 and cMT regarding differential diagnosis of MF and tumor-node-metastasis-blood staging. Additionally, our report documented significantly different expression levels of MTI/II and Ki-67 according to the advancement of the disease. In view of these data, the role of studied factors in the development of this type of cutaneous T-cell lymphoma is postulated. Our results indicate that both SATB1 and MTI/II may be of diagnostic value, but our study revealed no prognostic significance; however, given the small number of reports focusing on this topic, further studies are required.

The influence of frequency of visual disorders on stabilographic parameters

PURPOSE

Defining the influence of parameters of visual disorders on ability of balancing turns out to be an important process in effective diagnostics. Current diagnostic methods relating mainly to determination of the coefficient of BRUTM (Balance Rehabilitation Unit Trade Mark) depend on lots of tests carried out in a disturbed environment created by Virtual Reality Technology. The aim of this study is to determine the effect of the frequency of visual disturbances on stabilographic values in the virtual reality environment.

METHODS

The study was carried out involving one research group in Virtual Cave. There were induced visual disturbances with different frequencies and with the change of frequency during measuring the position of the center of pressure (COP) in the test. Before each test the reference test was performed. All tests were performed with disorders in two different sceneries: closed and open scenery. All measurements were carried out on an immobile Zebris platform which enables determination of feet pressure distribution. From the measured values of the position of the COP Short Time Fourier Transform (STFT) was calculated.

RESULTS

The results of calculation are shown in graphs. Their analysis showed that changing the parameters of disorder frequency in world created using Virtual Reality Technology affects stabilographic parameters. The intensity of these changes is also affected by applied research scenery.

CONCLUSIONS

Conditions have been set out to carry out similar studies in order to obtain reliable results. The study is the first step in a project to develop a system for diagnosis and rehabilitation of human movement using Virtual Reality Technology.

[The extensive phlegmon of the neck leading to severe complications - a case report]

Purulent infection of the neck is a serious condition, which can occur at any age and regardless of any factors. It often leads to the serious complications, including death. A case report. The authors present a case of a 56-year-old patient who reported to the emergency department because of the severe neck pain, fever and progressive weakness. Physical examination revealed an extensive inflammation involving skin and subcutaneous tissue surrounding suboccipital area and neck. Palpation of the thyroid gland showed tumor of the left lobe. Due to deteriorating condition, it was decided to admit the patient to the hospital, along with urgent surgery. It was necessary to perform a repeated removal of the necrotic tissues of the nuchal area. Diabetes mellitus type II was diagnosed during hospitalisation. Long and laborious extensive wound care enabled to perform a skin graft and full recovery. The patient was discharged in good general and local condition in the 11th week of the hospitalization.

Bacteriology of hidradenitis suppurativa - which antibiotics are the treatment of choice?

The bacterial superinfection in hidradenitis suppurativa (HS), although it does not initiate the disease itself, seems to be one of the major contributors to an inflammatory vicious circle. Antibiotic therapy is therefore commonly prescribed in HS. This study was undertaken to evaluate the prescription of systemic antibiotics in the light of bacteriological cultures and antibiograms. The study was conducted on a group of 69 patients with HS. The huge majority (n=62) of the patients were treated with antibiotics. The antibiotics were prescribed 132 times and taken for a mean period of 9.9 ± 8.9 weeks. The most commonly used antibiotic was doxycycline (16.7%). The majority of the patients had a polymicrobial flora with up to 5 species, predominantly staphylococci and bacteria of intestinal flora. The highest effectiveness against isolates was observed for carbapanems, penicillins with β-lactamase inhibitors and fluoroquinolones - 8.5%, 11.9%, and 11.9% of resistant strains, respectively. In daily practice penicillins with β-lactamase inhibitors or fluoroquinolones could serve as first-line therapy of HS.

Polymorphisms in nucleotide excision repair genes and basal cell carcinoma of the skin

BACKGROUND

Mutations in nucleotide excision repair (NER) genes are the cause of xeroderma pigmentosum, a genetic syndrome with proneness to basal cell carcinoma (BCC) of the skin. Single nucleotide polymorphisms (SNPs) may affect the effectiveness of DNA repair and hence influence individual susceptibility to a variety of neoplasms. The aim of this study was to find associations between SNPs in selected NER genes and sporadic BCC development.

MATERIALS AND METHODS

The study group consisted of 100 patients with histopathologically confirmed BCCs and the control group of 100 elderly individuals with no personal history of any cancer. DNA isolated from peripheral blood lymphocytes was genotyped for seven SNPs in five different NER genes. Statistical analyses for associations were performed.

RESULTS

A weak association between XPD exon 6 silent C/A polymorphism and BCC development risk was found when comparing single polymorphisms between the two groups. When considering sex and SNPs, men with the A-allele in XPC intron 11 C/A have been found to have a decreased risk of BCC.

CONCLUSIONS

There is no consistency in association studies between SNPs and BCC susceptibility. SNPs in NER genes seem to have an insignificant influence on the risk of developing BCC of the skin.

Carbon materials as new nanovehicles in hot-melt drug deposition

The application of commercially available carbon materials (nanotubes and porous carbons) for the preparation of drug delivery systems is studied. We used two types of carbon nanotubes (CNT) and two activated carbons as potential materials in so-called hot-melt drug deposition (HMDD). The materials were first studied using Raman spectroscopy. Paracetamol was chosen as a model drug. The performed thermal analysis, kinetics, and adsorption-desorption studies revealed that nanoaggregates are formed between carbon nanotubes. In contrast, in pores of activated carbon we do not observe this process and the drug adsorption phenomenon mechanism is simply the filling of small pores. The formation of nanoaggregates was confirmed by the results of GCMC (grand canonical Monte Carlo) simulations and the study of the surface area on nitrogen adsorption-desorption isotherms. The application of carbon nanotubes in HMDD offers the possibility of controlling the rate of drug delivery. Performed MTT tests of nanotubes and drug-loaded nanotubes show that the observed decrease in cell viability number is caused by the influence of the cytostatic properties of nanotubes-they inhibit the proliferation of cells. The carbon nanotubes studied in this paper are essentially nontoxic.

Interdisciplinary treatment of BCC located on the nose - review of literature

Skin cancers are a large group of all diagnosed face cancers. Surgical treatment of tumours with a margin of healthy tissue around the face is a challenge for dermatology, oral and maxillofacial surgery, plastic surgery and reconstructive prosthetics. The location of cancer in an exposed location has significant effects on the psyche of the patients. Removal of a part or all of the nose and multi-stage reconstruction requires the cooperation of many professionals throughout the treatment period. This paper describes the procedure of treatment from diagnosis to definitive surgery. The aim of this article is intended to present the method of interdisciplinary cure of basal cell carcinoma located on the wing of the nose.

Expression of metallothionein I/II and Ki-67 antigen in various histological types of basal cell carcinoma

Basal cell carcinoma (BCC) is the most frequent skin cancer, with many different histological subtypes. Recent studies have investigated the expression of proliferative markers, but little is known about the expression of metallothioneins (MT) in different histological subtypes of this cancer and their impact on proliferation intensity in BCC. In this study, we examined MT-I/II expression by immunohistochemistry in 58 different histological subtypes of BCC (38 nodular, six adenoid, eight infiltrative, and six metatypic cases) and correlated its expression with tumor size and Ki-67 proliferation rate. Statistical analysis revealed no significant differences in the expression of studied markers in regard to the histological subtype. A positive correlation between MT and Ki-67 expression was observed for all the studied cases (r = 0.26; p = 0.049), but was even stronger in the metatypic subtype of BCC (r = 0.85; p = 0.033). MT and Ki-67 expression did not correlate with tumor size. In conclusion, it seems that metallothioneins may have an impact on the proliferation rate of BCC,but further studies are required to determine whether MT may be a risk factor of recurrences.

Secondary intention healing in skin surgery: our own experience and expanded indications in hidradenitis suppurativa, rhinophyma and non-melanoma skin cancers

BACKGROUND

There are many situations in integument surgery in which secondary intention healing (SIH) may bring results comparable or even superior to those obtained with primary intention healing.

OBJECTIVE

To present our own methods of employing SIH in surgical treatment of different skin lesions. Moreover, to delineate the extended indications for SIH as a first-line method of wound treatment.

METHODS

Between 1999 and 2009, we conducted 236 operations followed by SIH in the group of 195 patients. Two independent investigators and the patients carried out post-operative assessment (at 12 months) of both cosmetic and functional results of operations (data for 142 patients). Moreover, at 3 and 12 months, patients were asked for self-evaluation of the outcomes of surgical procedures using the visual analogue scale (VAS).

RESULTS

The most frequent indications for SIH were defects after the excision of non-melanoma skin cancers and hidradenitis suppurativa lesions. Depending on localization, the mean extent of the post-operative wounds prepared for SIH ranged from 0.8to 85.7 cm(2). The healing lasted 2-12 weeks. The most important factor was the size of the wound (r = 0.59; P < 0.001). The assessment at 12 months revealed that cosmetic/functional outcomes were evaluated as 'good' or 'excellent' in 89/83% and 72/70% cases, according to patients and physicians respectively. VAS showed that evaluation scores at 3 months post-surgery were significantly lower than at 12 months (P < 0.0001).

CONCLUSION

SIH is a safe and efficient form of treatment for various post-operative skin defects. In certain areas of the body, SIH shows favourable cosmetic and functional effects. In these cases, it may even be regarded as the method of choice.

Role of base-excision repair in the treatment of childhood acute lymphoblastic leukaemia with 6-mercaptopurine and high doses of methotrexate

Methotrexate (MTX) and 6-mercaptopurine (6MP) are the most commonly used drugs in the therapy of childhood acute lymphoblastic leukaemia (ALL). The main genotoxic effect of MTX resulting from inhibition of thymidylate synthase is mis-incorporation of uracil into DNA, which is considered essential for the effectiveness of the Protocol M in ALL IC BFM 2002/EURO LB 2002 regimens. In this study, we investigated the level of basal and induced DNA damage as well as the effectiveness of DNA repair in lymphocytes of children with ALL at four time-points during therapy with MTX and 6MP. To assess DNA damage and the efficacy of DNA repair we used the modified alkaline comet assay with uracil DNA glycosylase (Udg) and endonuclease III (EndoIII). In addition, we examined the induction of apoptosis in the lymphocytes of the patients during treatment. Finally, we compared the activity of base-excision repair (BER), involved in removal of both uracil and oxidized bases from DNA in lymphocytes of children with ALL and lymphocytes of healthy children. BER efficiency was estimated in an in vitro assay with cellular extracts and plasmid substrates of heteroduplex DNA with an AP-site. Our results indicate that there is a significant decrease in the efficacy of DNA repair associated with an increased level of uracil in DNA and induction of apoptosis during therapy. Moreover, it was found that the BER capacity was decreased in the lymphocytes of ALL patients in contrast to that in lymphocytes of healthy children. Thus, we suggest that an impairment of the BER pathway may play a role in the pathogenesis and therapy of childhood ALL.

Surgical treatment of hidradenitis suppurativa: experiences and recommendations

OBJECTIVE

To describe our own surgical techniques of wound closure in pubic and armpit areas in the treatment of hidradenitis suppurativa (HS) and to analyze surgical procedures performed with regard to complications, tolerance, and factors influencing recurrence rate.

METHODS

Between 1999 and 2009, 118 operations were performed on 57 patients with HS. Surgical procedures included local excision of involved tissue and different methods of wound closure, including those of our own design such as the "star-like" technique and "pubic flaps." Treatment tolerance was evaluated 3 months after surgery, and efficacy was evaluated after 24 months.

RESULTS

Forty-four (77.2%) patients showed good tolerance of the operation and during the postoperative period, whereas only one individual (1.8%) reported unsatisfactory tolerance. Of all patients, 51 (89.5%) expressed willingness to undergo additional surgery in the event of lesion recurrence. During the 2-year follow-up period, complete recovery was observed in 34 (59.7%) patients, partial recovery in 18 (31.6%), and no improvement in five (8.8%). Factors influencing recurrence rate were number of skin areas affected by HS lesions and disease duration.

CONCLUSION

Surgical treatment of HS is effective and well tolerated. In selected cases, our own techniques of surgical wound closure accelerated healing and improved results.

Psychophysical aspects of hidradenitis suppurativa

Hidradenitis suppurativa is a recurrent, debilitating suppurative skin disease. The symptoms are much more than just physical, but studies of its impact on patients' psychological state and related quality of life are very limited. The current study was conducted with a group of 54 patients, aged 16-65 years, who had an active, but stable, course of hidradenitis suppurativa. The aim of the study was to determine the influence of hidradenitis suppurativa on a broad spectrum of psychophysical factors. Assessment was carried out using several questionnaires, which revealed the following mean scores: Dermatology Life Quality Index (DLQI) (12.67 +/- 7.7), Beck Depression Inventory-Short Form (BDI-SF) (5.87 +/- 4.68), Evers et al. "6-Item Scale" (3.87 +/- 3.65), EQ-5D (0.66 +/- 0.23 (health index) and 56.78 +/- 18.84 (VAS)), Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F) (32.06 +/- 11.01) and Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) (56.44 +/- 15.17%). The results highlight the important impact of hidradenitis suppurativa on a wide spectrum of psychophysical aspects and impairment of related quality of life among patients. Our findings indicate that advancement of the disease seems to be the most important factor negatively influencing patients' well-being (p < 0.01). It is noteworthy that an anogenital location appears to impair the hidradenitis suppurativa patients' quality of life most of all (p < 0.05), but the occurrence of lesions on uncovered skin plays a crucial role in the stigmatization level (p < 0.05).

Increased serum tumour necrosis factor-alpha in hidradenitis suppurativa patients: is there a basis for treatment with anti-tumour necrosis factor-alpha agents?

Hidradenitis suppurativa (HS) is a recurrent, debilitating suppurative skin disease. Nowadays the major challenge is the choice of optimal treatment. Many conservative therapies seem to have only a supportive character and do not prevent progression of the disease. Early surgical intervention with complete excision of the involved areas is still considered to be the most efficient therapy, but anti-tumour necrosis factor (TNF)-alpha agents may offer a possible non-surgical treatment. The aim of this study was to determine the serum concentration of TNF-alpha and its probable alterations during the disease process in patients with HS. Analysis of TNF-alpha serum concentration in 54 individuals with HS revealed significantly higher levels than in the sera of healthy controls (p = 0.006). To the best of our knowledge, this is the first report of increased TNF-alpha serum concentration in patients with HS.

Amelanotic malignant melanoma in an acral location

We present the case of a 74-year-old white female admitted to the Department of Dermatology because of a tumor in the IV-V interdigital area of her right foot. A crimson, dome-shaped tumor with a granular, spongy surface (diameter 4 cm) had developed over a period of about 3 months. The biopsy, stained with H and E, revealed an anaplastic malignant tumor. Additional immunochemical staining with Melan A allowed us to make the final diagnosis: amelanotic malignant melanoma (MM). The melanoma was removed by amputation of digits IV and V, with partial removal of the metatarsal bones (Clark degree 5, Breslow thickness 9 mm). Sentinel node biopsy was done using Tc99; it revealed no neoplastic alteration. The patient is still under oncological observation.

XPD Common Variants and their Association with Melanoma and Breast Cancer Risk

There are suggestions in the literature that common variants in the XPD gene may be associated with an altered risk of melanoma and breast cancer. To establish if the XPD common variants Asp312Asn and Lys751Gln are associated with an increased melanoma or breast cancer risk we performed an association study based on genotyping 426 unselected patients with malignant melanoma (MM) and 1830 consecutive breast cancer cases and compared the results to 1262 geographically matched newborns, 621 adults from the region of Szczecin (unselected for age and cancer family history), 421 healthy adults age- and sex-matched with the melanoma cases and 511 healthy controls matched with the breast cancer patients from the region of Szczecin. Additionally we examined the prevalence of three additional XPD variants, Gly156Gly, Leu485Pro and Arg112His amongst the 421 unselected melanoma patients. All of the variants when evaluated singularly were found not to be associated either with melanoma or breast cancer risk in younger or older patients. A modest association was observed with breast cancer risk when the Lys751Gln_CC/Asp312Asn_AA genotype (OR=1.5, p<0.05) segregated together. Individuals harboring the Lys751Gln_CC/Gly156Gly_CC genotype were significantly over-represented among late-onset melanoma cases (OR=1.7, p<0.05). The results of analyses of linkage disequilibrium and haplotype frequency support the thesis that a combination of at least two SNPs (Lys751Gln_CC/Gly156Gly_CC or Lys751Gln_CC/Asp312Asn_AA) inherited as a haplotype was associated with disease. These two pairs of SNPs could therefore be regarded as a single hereditary unit that would have a very small probability of being disrupted by recombination. Additional studies are required to determine whether these particular changes can be associated with an increased risk of other malignancies at different sites of origin.

Surgical treatment of axillary hyperhidrosis with liposuction equipment: risks and benefits

Axillary hyperhidrosis poses a serious problem to the affected patients. So far, the conservative measures employed seem to be disappointing, operations with axillary skin excision, undermining and/or skin reconstruction may cause secondary functional and cosmetic problems, whereas botulinum A toxin injections need to be repeated frequently. The aim of this study was to establish the safety, efficacy, and durability of subdermal (subcorial) suction sweat gland curettage in the treatment of axillary hyperhidrosis. So far, the method seems to be devoid of possible risks and drawbacks. In the last 4.5 years, 15 patients with axillary hyperhidrosis were operated on with the use of liposuction tools. First operations were performed in general anesthesia, then in tumescent anesthesia. The procedure of suction curettage was performed with the use of 3- to 4-mm wide liposuction cannulas. The patients were closely monitored during early stages of the healing process; then they were evaluated at 1 and 3 months, and finally at 1-4 years of the operation, when they were asked to assess the effects of the operation. Four patients had recurrence of the disease within 3 months; three of them were reoperated on, with good result. At 1-4 years of the operation, all our responders (ten of 15 patients) stated that the disease had completely subsided. The following complications were observed during the process of healing: hematomas, transient skin unevenness, and partial skin flap necrosis. In conclusion, subdermal suction curettage seems to be superior to botulinum A toxin injections by the effect durability, and to the surgical methods with skin excision and undermining by the probably lower complication rates.

Basal Cell Carcinoma on the Eyelids: Own Experience

BACKGROUND

Basal cell carcinoma (BCC) is the most common skin malignancy. Eyelids constitute a special location of BCC because of the proximity of the eyeball.

OBJECTIVE

This study was undertaken to evaluate the incidence of BCC located on the eyelids, to examine the clinical and histologic types of BCCs in this location, and to present some reconstructive techniques used in the treatment of BCC in palpebral region.

METHODS

There were 330 patients with BCC retrospectively included in the study. The comparison was performed between clinical and histologic features of BCCs located on eyelids and in other locations.

RESULTS AND CONCLUSIONS

Approximately 16% of all tumors were located on the eyelids. The majority of tumors were situated on the lower eyelid. Noduloulcerative clinical type was observed in 96.3% of tumors. This type was significantly more frequently found on eyelids than on trunk and extremities (p<0.00001). The histologic nodular type was the most common found on eyelids. It was significantly more common on eyelids than on trunk and extremities (p=0.002). The superficial type was significantly less frequently found on the eyelids (p<0.00001). The infiltrative type was significantly more seldom observed on the eyelids compared with other locations of head and neck region (p=0.048). Some technical aspects of reconstructive surgery of the eyelids are presented.

Brooke-Spiegler syndrome

The Brooke-Spiegler syndrome is an autosomal dominant one characterized by cylindromas, trichoepitheliomas and occasionally spiradenomas. Within a given family, some members may have cylindromas whereas others may have trichoepitheliomas or both. We describe the coexistence of trichoepithelioma papulosum multiplex (also known as epithelioma adenoides cysticum of Brooke) and cylindromas in a 30-year-old man, and discuss the relationship between these two autosomal dominant syndromes.