Proliferative actinic keratosis: An invasive squamous cell carcinoma or not?

Actinic keratoses have variants that differ clinically and pathologically. Proliferative actinic keratoses (PAK) are known to be resistant against standard therapies and to create a tendency for the development of invasive squamous cell carcinoma (SCC). This study retrospectively reviewed the medical records of 50 patients with 51 PAK lesions. Fifty patients (40 male, 10 female) with a mean age of 68.5 were included in the study. Thirty-two (63%) PAK lesions were clinically selected for total excision but only 27 of them could be totally excised. Among the excised lesions, 13 were reported to be PAK, 13 were SCC, and 1 was keratoacanthoma. There was no significant difference between the PAK and SCC groups. Overall, the groups with excised and unexcised lesions were statistically similar with respect to age, sex, lesion duration, localization, size, and surface features, but induration was more common in the SCC group. The mean follow-up time was 19.7 and 17.0 months in the PAK and SCC group, respectively. In conclusion, 25% (13/51) of lesions diagnosed as PAK were invasive SCC, which is of clinical and histopathological significance. Our results suggest that the definition of PAK should be histopathologically revised and that total excisional biopsy instead of punch biopsy should be considered, especially for lesions with a proliferative appearance. </p

Epidemiology of pemphigus in Turkey: One-year prospective study of 220 cases

Pemphigus is a group of rare and life-threatening autoimmune blistering diseases of the skin and mucous membranes. Although they occur worldwide, their incidence shows wide geographical variation, and prospective data on the epidemiology of pemphigus are very limited. Objective of this work is to evaluate the incidence and epidemiological and clinical features of patients with pemphigus in Turkey. All patients newly diagnosed with pemphigus between June 2013 and June 2014 were prospectively enrolled in 33 dermatology departments in 20 different provinces from all seven regions of Turkey. Disease parameters including demography and clinical findings were recorded. A total of 220 patients were diagnosed with pemphigus during the 1-year period, with an annual incidence of 4.7 per million people in Turkey. Patients were predominantly women, with a male to female ratio of 1:1.41. The mean age at onset was 48.9 years. Pemphigus vulgaris (PV) was the commonest clinical subtype (n=192; 87.3%), followed by pemphigus foliaceus (n=21; 9.6%). The most common clinical subtype of PV was the mucocutaneous type (n=83; 43.2%). The mean Pemphigus Disease Area Index was 28.14±22.21 (mean ± Standard Deviation).  The incidence rate of pemphigus in Turkey is similar to the countries of South-East Europe, higher than those reported for the Central and Northern European countries and lower than the countries around the Mediterranean Sea and Iran. Pemphigus is more frequent in middle-aged people and is more common in women. The most frequent subtype was PV, with a 9-fold higher incidence than pemphigus foliaceus.   </p

Association between biophysical properties and anxiety in patients with sensitive skin

Background: Sensitive skin (SS) is a syndrome in which neurosensory disorders accompany epidermal barrier dysfunction. However, it is not yet clear how high anxiety levels affect the biophysical parameters of the skin in patients with SS

Palisaded Encapsulated (Solitary Circumscribed) Neuroma: A Review of 30 Cases

Background. Solitary circumscribed neuroma (SCN), also known as palisaded encapsulated neuroma (PEN), is a benign neural tumor. It may be mistaken as either schwannoma or neurofibroma in pathology practice. In this study, we aimed to define clinicopathologic and immunohistochemical features and discuss its differential diagnosis. Materials and Methods. The histopathological features of 30 cases of SCN/PEN were reviewed. The presence of intralesional axons, Schwann, and perineural cell distributions were investigated by performing neuronal immunomarkers. Results. Twelve cases were females, and 18 cases were males. The mean age was 48 years. Lesions were mostly located on the face (27/30). Histologically, 18 had a lobular pattern, 9 were plexiform, 2 fungating, and 1 multilobular. Although the majority of cases were well circumscribed, capsular integrity was at least focally disrupted (73%). Verocay body was noted only in 6 cases (20%). One case showed excessive hyperkeratosis, forming a keratin horn. Adipocytic change was detected in another case. The lesions consisted of S100-positive Schwann cell proliferation and were partially surrounded by perineural cells highlighted by EMA or Claudin-1. The amount of intralesional axons revealed by neurofilament immunostaining was variable. Conclusion. SCN/PEN is a relatively common lesion, and usually seen as an asymptomatic papule on the face of elderly patients. A circumscribed lesion composed of bundles of bland-looking spindle cells thought to be of neural origin is seen in the dermis. Pathologists should be aware of the existence of plexiform and multilobular PEN/SCN variants, to avoid misdiagnosis of plexiform neurofibroma or schwannoma

Intravascular/Intralymphatic Histiocytosis: A Report of 3 Cases

Intravascular/intralymphatic histiocytosis (IV/ILH) is a rare, reactive cutaneous condition, with uncertain pathogenesis. It may be associated with various inflammatory and neoplastic diseases. Although the clinical presentation is various, the biopsies reveal dilated vessels, mostly lymphatics, containing aggregates of histiocytes within their lumina. We described 3 cases of IV/ILH with different clinical presentations. In the first case, the patient presented with lymphedema in the genital region without any underlying disease. However, the second and third cases had reticular erythematous skin lesions. The second case had common variable immunodeficiency disease, rheumatoid arthritis, inflammatory bowel disease, and a history of a lymphoproliferative lesion. The third case had metal prostheses at both his right and left knees. In all these 3 cases, histopathologic and immunohistochemical findings were similar to each other and to those cases reported in the literature. In addition, the third case was admixed with reactive angioendotheliomatosis. In the second case, the endothelium of the ectatic vessels expressed CD31 and CD34, but not D2-40/podoplanin, pointing out that these vessels were blood vessels rather than lymphatics, differing from the other 2 cases. In conclusion, we believe, the most convincing statement about IV/ILH is that it is not a distinct clinicopathologic entity, but a histopathologic feature found as a part of a constellation of inflammatory changes or many other conditions

Solitary noninfiltrating angiolipoma on the finger, an unusual localization.

Angiolipoma, a subtype of lipoma, is a benign adypocytic soft tissue tumor composed of mature adipose tissue and small vascular proliferations. This entity makes up 5–17% of all lipomas. The diagnosis is made by clinical and pathological examination, ultrasonography, and/or magnetic resonance imaging (MRI). It is generally an encapsulated tumor (noninfiltrative), but rarely has an infiltrative form. Angiolipoma mostly occurs on the trunk and extremities with male predominance. The forearm is the most frequent location for angiolipomas. It is very rarely seen on the fingers. Herein, we report a patient with solitary noninfiltrating angiolipoma on a finger. The patient was treated with surgical excision and no recurrence has been noted over one year of observation

Evaluation of quality of life in female patients with melasma

Melasma is an acquired pigmentation disease occurs on the face and neck, sun-exposed areas. It significantly affects the quality of life of the patients. The objective of this study was to evaluate the quality of life in patients with melasma. A prospective cross-sectional study was conducted on 49 female patients diagnosed with melasma between November 2016 and March 2017 in a tertiary referral hospital dermatology outpatient clinic. The patients were evaluated according to age, marital status, education level, Fitzpatrick skin type, puberty age, the duration of disease, family history, medical comorbidities. Disease severity were measured with the melasma area and severity index (MASI). The patients were evaluated according to quality of life scales: Turkish version of the melasma quality-of-life questionnaire (MelasQoL-TR), Dermatology Life Quality Index (DLQI), Turkish version of Skindex 16. The correlation between the severity of the disease and the qualities of life of the patients were evaluated. Fourty-nine female patients with the mean age of 36.8 ± 7.8 enrolled in the study. Fitzpatrick skin type III (49.6%) and IV (49.0%) were the most common skin phototypes. The mean disease duration was 56.7 ± 49.0 months. The mean MASI score was 16.3 ± 8.7. The mean MeLaSQoL-TR score, DLQI score and Skindex 16 score were 34.4 ± 13.0, 15.1 ± 7.6, 34,7 ± 16,9 respectively. Significant positive correlation was found between MASI score and MelasQoL-TR, DLQI and Skindex 16 scores (p &#706; 0.05). When the scores of emotion and function of Skindex 16 were evaluated separately, there was a significant positive correlation between MASI score and these scores (p &#706; 0.05). However no significant correlation was observed between MASI score and Skindex 16 symptom score (p &#707; 0.05). There was a significant correlation between these three different life quality scales. Age and education level were not significantly related with quality of life scales in our study. In this study, all scale scores were high in patients with melasma, and were correlated with severity of the disease. Melasma has a significant emotional and functional impact on quality of life in female patients. [Med-Science 2020; 9(2.000): 347-51

Proliferative actinic keratosis: An invasive squamous cell carcinoma or not?

Actinic keratoses have variants that differ clinically and pathologically. Proliferative actinic keratoses (PAK) are known to be resistant against standard therapies and to create a tendency for the development of invasive squamous cell carcinoma (SCC). This study retrospectively reviewed the medical records of 50 patients with 51 PAK lesions. Fifty patients (40 male, 10 female) with a mean age of 68.5 were included in the study. Thirty-two (63%) PAK lesions were clinically selected for total excision but only 27 of them could be totally excised. Among the excised lesions, 13 were reported to be PAK, 13 were SCC, and 1 was keratoacanthoma. There was no significant difference between the PAK and SCC groups. Overall, the groups with excised and unexcised lesions were statistically similar with respect to age, sex, lesion duration, localization, size, and surface features, but induration was more common in the SCC group. The mean follow-up time was 19.7 and 17.0 months in the PAK and SCC group, respectively. In conclusion, 25% (13/51) of lesions diagnosed as PAK were invasive SCC, which is of clinical and histopathological significance. Our results suggest that the definition of PAK should be histopathologically revised and that total excisional biopsy instead of punch biopsy should be considered, especially for lesions with a proliferative appearance. </p

In vivo reflectance confocal microscopy terminology in the Turkish language

In vivo reflectance confocal microscopy (RCM) is a diagnostic method to examine a skin lesion at the cellular level in vivo without biopsy. It provides non-invasive, high resolution imaging for diagnosis and follow-up of malignant, benign skin tumors and inflammatory dermatologic diseases, and its use is spreading worldwide. Standard terminology which has been used in RCM was described earlier in the English language. This study aimed to propose a Turkish terminology for RCM to allow Turkish-speaking dermatologists to communicate in a homogeneous language and familiarize themselves with the terminology of this new diagnostic technic. Six Turkish-speaking dermatologists with RCM experience participated in the study. RCM terminology used in English was determined and translated into Turkish. Turkish terms and their definitions were reviewed by each participant and the consensus was provided in the group. Finally, philology department examined the last version of the terms and the study was finalized. The terms, definitions and the translations of the terms have been identified, and the Turkish RCM terminology has been created and shown. Turkish RCM terminology will provide Turkish-speaking dermatologists to describe their findings in a homogenous language