Cryotherapy for Common Premalignant and Malignant Skin Disorders

Cryotherapy, also known as cryosurgery or cryoablation, is a common dermatological treatment that is an expanded area from benign to malignant lesions. The system has been designed as a localized freezing cold that causes the destruction of cell integrity. The treatment has been also used for all ages, which is not required to have a condition of wellness. It is convenient, fast, and easy to apply in clinics, and there is no need for anesthesia. Additionally, multiple lesions are also cured in the same sessions. After the treatment, recovery period has not taken much longer and also has simple adverse effects, which are tolerable. Lastly, cryotherapy has gained excellent cosmetic results. It is highly effective for actinic keratosis and is the treatment of choice for most old patients who show poor cooperation and recurrent multiple lesions. Additionally, due to increasing premalignant lesions all over the world associated with increasing age, it is a considerable choice for lentigo maligna and Bowen’s disease. In non-melanoma skin cancers, it is also the most important option in patients who do not undergo surgery and when other options are not appropriate. In this chapter, the use of cryotherapy for premalignant and malignant cutaneous disorders has been mainly focused

The spectrum of dermatological disorders found in patients with sarcoidosis presenting to the dermatology outpatient clinic at the Chris Hani Baragwanath Academic Hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine (Dermatology). Johannesburg 2017.Backgrounds There is a paucity of studies on cutaneous sarcoidosis in the South African setting, with the last study published 18 years ago. More studies are needed to explore these gaps to inform referral policy and guidelines for early diagnosis and management of cutaneous sarcoidosis in the country. Objectives The study focuses on the patterns of cutaneous sarcoidosis, demographic features, and histological associations with the clinical patterns of skin sarcoidosisfound in patients with sarcoidosis presenting to the dermatology outpatient clinic at the Chris Hani Baragwanath Academic hospital. In addition, the pattern, chronicity and severity of the cutaneous manifestations were described. Furthermore, the co-existence of HIV/AIDS and sarcoidosis was also examined. Methods A retrospective descriptive studythat spans from 1991 to 2015, was carried out which included cases that had a definitive diagnosis of sarcoidosis. One hundred case records of patients with cutaneous sarcoidosis that attended the Dermatology Outpatient Clinic, from the study site in Soweto, in the south of Johannesburg, were collected and transferred to a collection data sheet. Results In this predominantly Black African population, women above 45 years old (70%), were most commonly affected. Papules (68.8%) and plaques (27.1%) were the most frequent skin findings in Black Africans. The most frequent extra-cutaneous organ affected was the lung (53%). Subcutaneous lesions were found to be significantly associated (p-value <0. 012) with Scadding stage 0 and stage 4 lung involvement. On histology 70% of the cases had clean granulomas, frequently associated with papules clinically. HIV seropositive and sarcoidosis cases demonstrated an inversely proportional association with the CD4 count, with disease progression noted with CD4 increments after initiation of therapy. Conclusion The variations in the patterns of presentation revealed in this study can improve our knowledge of cutaneous patterns of sarcoidosis in this study population and assist with the development of prompt diagnosis and early treatment intervention.LG201

Differential diagnosis of skin ulcers in a Mycobacterium ulcerans endemic area : data from a prospective study in Cameroon

Background Clinical diagnosis of Buruli ulcer (BU) due to Mycobacterium ulcerans can be challenging. We aimed to specify the differential diagnosis of skin lesions in a BU endemic area. Method We conducted a prospective diagnostic study in Akonolinga, Cameroon. Patients presenting with a skin ulcer suspect of BU were included. M. ulcerans was detected using swabs for Ziehl-Neelsen staining, PCR and culture. Skin punch biopsies were taken and reviewed by two histopathologists. Photographs of the lesions were taken and independently reviewed by two dermatologists. Final diagnosis was based on consensus, combining the results of laboratory tests and expert opinion. Results/Discussion Between October 2011 and December 2013, 327 patients with ulcerative lesions were included. Median age was 37 years (0 to 87), 65% were males, and 19% HIV-positive. BU was considered the final diagnosis for 27% of the lesions, 85% of which had at least one positive laboratory test. Differential diagnoses were vascular lesions (22%), bacterial infections (21%), post-traumatic (8%), fistulated osteomyelitis (6%), neoplasia (5%), inflammatory lesions (3%), hemopathies and other systemic diseases (2%) and others (2%). The proportion of BU was similar between HIV-positive and HIV-negative patients (27.0% vs. 26.5%; p = 0.940). Half of children below 15 years of age were diagnosed with BU, compared to 26.8% and 13.9% among individuals 15 to 44 years of age and above, respectively (chi2 p< 0.001). Children had more superficial bacterial infections (24.3%) and osteomyelitis (11.4%). Conclusion We described differential diagnosis of skin lesions in a BU endemic area, stratifying results by age and HIV-status

Predicting Incomplete Basal Cell Carcinoma Excisions - a Large Multidisciplinary Retrospective Analysis in a Tertiary Center

Introduction: Surgical treatment of basal cell carcinomas is often performed by physicians with different surgical backgrounds. Collecting data from different surgical departments would better reflect their real-life surgical management.Objectives: To identify the rate, recurrence risk, and predictive factors accordingly to their relative contribution for an incomplete basal cell carcinoma excision in a large multidisciplinary real-life settingMethods: Retrospective cohort study of 2305 surgically treated lesions in different departments of a tertiary center.Results: There was a rate of incomplete excisions (15%) and a recurrence rate (35.5% vs. 6.8% in incomplete vs. complete excisions (p < .001)). A third of incompletely excised basal cell carcinoma (BCC) will recur over time. Stratified by relevancy, high-risk histological subtypes (micronodular (OR 5.10 - p < .001) and morpheaform (OR 5.42 - p < .001), smaller specimen sizes ( <0.5 cm or 0.5-1 cm, OR 3.99 and 2.49, respectively, p < .001) high-risk locations (OR 3.06 on the nose, OR 2.77 on the eyelids, p < .001), and recurrent BCCs (OR 1.72, p < .001). are the best predictors of an incomplete excision.Conclusions: Acknowledging the rate, recurrence risk and predictive factors for incomplete excisions may be beneficial for optimal preoperative planning and to prevent unwarranted re-interventions, morbidity, and healthcare costs.info:eu-repo/semantics/publishedVersio

Skin manifestations in patients with coronavirus disease 2019

Purpose of review: Coronavirus disease 2019 (COVID-19) is a well established respiratory tract illness. Recent studies in adults and children have shown an increasing number of patients reporting polymorphic cutaneous manifestations during COVID-19, including different types of rashes, from maculopapular, vascular, vesicular to atypical forms. Recent findings: Although pathogenesis of skin manifestations is still not fully understood, it has been proposed that cutaneous involvement during COVID-19 may be the results of the activation of the immune response against severe acute respiratory syndrome coronavirus-2, the reactivation or co-infection of herpesviruses or drug hypersensitivity. Summary: According to available literature, skin manifestations in patients with COVID-19 may be categorized on the basis of their clinical presentations as follows: erythematous rashes, lesions of vascular origin, vesicular rash, urticarial rash and acute generalized exanthematous pustulosis (AGEP), erythema multiforme and other polymorphic erythema/atypical reactions. Prompt recognition of these cutaneous manifestations represents a crucial point to facilitate diagnosis and management of COVID-19 patients

Sarcoidosis Cutánea : Correlacion Clinico-Patologica

Sarcoidosis is a multi-system disease that may involve any organ or system. Cutaneous manifestations occur in 25-30% of patients.La sarcoïdosi és una malaltia multisistèmica que pot afectar qualsevol òrgan o sistema. Les manifestacions cutànies es produeixen en el 25-30% dels pacients

What is the frequency of floor of the mouth lesions? A descritive study of 4,016 cases

The aim of this study was to investigate the frequency of oral lesions in the floor of the mouth from representative oral pathology centres in Latin America. This study was conducted on biopsies obtained from January of 1978 to December of 2018 at nine Latin America oral and maxillofacial pathology centres. Gender, age and histopathological diagnosis were evaluated. Data were analysed using descriptive methods. Chi-square test was used for pairwise comparisons. From 114,893 samples, 4,016 lesions (3.49%) occurred in the floor of the mouth. Brazil showed 3,777 cases (94%), Mexico 182 cases (4.5%) and Argentina 57 cases (1.4%). Benign lesions represented 65.1% (2,617 cases), followed by 34.9% (1,404 cases) of malignant disorders. Lesions of epithelial origin were more frequent (1,964 cases; 48.9%), followed by salivary glands (1,245 cases; 31%) and soft tissue lesions (475 cases; 11.7%). The most common histological subtypes were oral squamous cell carcinoma (1,347 cases; 33.5%), ranula (724 cases; 18%), oral leukoplakia (476 cases; 11.8%) and inflammatory fibrous hyperplasia (239 cases; 5.9%). The lesion affected males in 2,129 cases and females in 1,897 cases. In the current study, lesions in the floor of the mouth represented 3.49% of biopsies submitted to oral pathology services and oral squamous cell carcinoma, ranula and leukoplakia were the most common lesions

CLINICO - HISTOPATHOLOGICAL SPECTRUM OF CUTANEOUS VASCULITIS: A RETROSPECTIVE STUDY OF 62 CASES

Context:&nbsp;Cutaneous Vasculitis is the inflammation of vessel walls which leads to hemorrhagic or ischemic events. The histopathological classification of cutaneous vasculitis depends on the vessel size and the dominant immune cell mediating the inflammation. Object: We studied the etiological factors and clinico-pathological spectrum of patients with cutaneous vasculitis at a tertiary referral centre of north India.&nbsp;Design: Skin biopsies of all patients with clinically suspected cutaneous vasculitis presenting over 5 years, between 2009-2014 were reviewed. Cutaneous vasculitis was classified on the basis of etiology (primary or secondary), on the basis of size of vessel wall as well as on the dominant inflammatory cell infiltrating the vessels.&nbsp;Results: Over 5 years, 62 / 103 patients evaluated for vasculitic syndromes had histologically proven vasculitis. Clinically, vasculitis was primary (77.4%) or secondary (22.5%) to drugs, infections, underlying connective tissue diseases and malignancy. Neutrophilic (n=30), lymphocytic (n=18), eosinophilic (n=10), and granulomatous (n=4) vasculitis were the major histopathological groups. Small vessel involvement was seen in 97% cases.&nbsp;Conclusion: Skin biopsy remains the gold standard for diagnosing cutaneous vasculitis. Small vessel vasculitis was the most common type of cutaneous vasculitis with the dominant cell type being neutrophilic. Eosinophilic infiltrate was exclusively associated with primary vasculitis. KEYWORDS:&nbsp;Cutaneous vasculitis; Small vessel vasculitis; Skin biopsy