Comparison of the IHC Expression of p16, p53, and MIB-1 in Extragenital Skin Bowenoid Lesions With High- and Low- Chronic Sun Damage

BACKGROUND

Bowen disease and bowenoid actinic keratosis are difficult to distinguish due to overlapping histopathology. This study evaluates the role of p16, p53, and MIB-1 staining patterns in differentiating high-chronic sun damage (H-CSD) and low-chronic sun damage bowenoid lesions.

METHODS

Sixty extragenital in situ squamous cell carcinomas were included. Lesions with elastosis were considered H-CSD. P16, p53, and MIB-1 staining patterns were classified as block, gradient, or focal.

RESULTS

Seventy-two percent of lesions were H-CSD. Full-thickness dysplasia was observed in all lesions, and basal layer involvement in 97%. P16 staining was positive in 80%, matching areas of higher atypia, with block pattern more frequent in H-CSD (58% vs. 47%, P = 0.047). P53 was positive in 47%, with block pattern more common in H-CSD (40% vs. 18%, P = 0.02). MIB-1 was positive in all cases. P16 and MIB-1 patterns coincided in 75%, independently of sun exposure.

CONCLUSIONS

P16 and p53 expression may be less frequent in bowenoid lesions than previously described. Histopathological features like basal layer and adnexal or follicular involvement may not differentiate H-CSD from low-chronic sun damage lesions or Bowen disease from bowenoid actinic keratosis. Variations in p16, p53, and MIB-1 staining could indicate different dysplasia pathways, although further studies are needed to clarify their prognostic significance.

Tumour budding as a risk factor for lymph node metastases in cutaneous squamous cell carcinoma: a systematic review and meta-analysis

BACKGROUND

Current staging systems have limitations in stratifying high-risk cutaneous squamous cell carcinoma (cSCC). Tumour budding (TB) has emerged as a potential prognostic factor in various cancers.

OBJECTIVES

To evaluate the prognostic significance of TB in predicting lymph node metastases (NM) in cSCC.

METHODS

A comprehensive search of the PubMed, Web of Science, Embase and Cochrane databases was conducted. Studies investigating the association of TB using a 5-bud cutoff and NM in cSCC were included. A meta-analysis was performed using odds ratios (OR) to evaluate the association between TB and NM.

RESULTS

Six retrospective studies comprising 793 patients with cSCC were included. The random-effects analysis showed a significant association between high TB (≥ 5 buds) and NM (OR = 13.29, 95% confidence interval 5.55-31.86).

DISCUSSION

TB is a promising histopathological feature for predicting NM in cSCC. The results show a strong association between high TB and NM, supporting its utility as a risk factor for NM in cSCC. Its inclusion in clinical practice and cSCC staging might be helpful in the stratification of patients with high-risk cases and to guide optimal management strategies for each patient. However, further investigation is needed to determine standardized reporting guidelines for TB in cSCC.

Breslow density ability to predict melanoma survival: should it be used in clinical practice?

BACKGROUND

Breslow density (BD) is an estimation of melanoma volume, which has emerged as a novel histopathological prognostic biomarker.

OBJECTIVES

To evaluate the role of BD as a predictor of patients' survival and assess its prognostic value in relation to overall survival (OS), disease-free survival (DFS), melanoma-specific survival (MSS) and metastasis-free survival (MFS).

METHODS

A retrospective observational study in a cohort of 107 patients with invasive melanoma was conducted. Kaplan-Meier and Log-rank tests were used for 10-year survival analysis. The ability of BD and Breslow thickness (BT) to predict survival was assessed using receiver operating characteristic curves.

RESULTS

The average follow-up was 115 months, excluding deaths. People with BD ≥ 65% showed lower survival rates compared with the BD < 65% group (log-rank test P < 0.001). Area under the curve (AUC) of BD ≥ 65% was higher than BTs for all studied survival rates except for MSS, in which absolute BD showed the highest value.

CONCLUSIONS

BD is proposed as a simple, valuable and inexpensive histopathological feature that could provide additional valuable information to that available from melanoma staging, as it has proved to have a statistically significant prognostic value in relation to survival in patients with melanoma and comparable 10-year survival prediction ability with that of BT.

Reconstruction of plantar surgical defects with synthetic dermal matrix and split-thickness skin grafts: A case series and functional podiatry outcomes

Reconstruction of surgical defects after wide local excision of acral melanoma on the sole should allow patients to walk and bear weight. Moreover, certain options such as local transposition flaps can compromise follow-up. We present a case series of surgical defects on weight-bearing areas of the sole reconstructed using a synthetic dermal matrix and a split-thickness skin graft. This approach prevents surrounding tissue displacement and results in good functional outcomes assessed by baropodometry and computer-based podoscopy.