An Overview of Bcl-2 Expression in Histopathological Variants of Basal Cell Carcinoma, Squamous Cell Carcinoma, Actinic Keratosis and Seborrheic Keratosis

The Bcl-2 protein has been shown to suppress cell death and protects cell against apoptosis induced by different death-inducing signals. In this study the authors have analyzed imunohistochemically the expression of Bcl-2 protein in the histopathological variants of the most common malignant tumors of the skin – basal cell carcinoma (BCC) and squamous cell tumor (SCC), as well as in the precancerous lesion actinic keratosis (AK) and in benign tumor seborrheic keratosis (SK). Bcl-2 expression in solid, adenoid and cystic variants of BCC exhibited immunoreactivity of tumor stroma with more intense staining among peripheral palisading cells. Morphoeic variant demonstrated reduced amount of Bcl-2 expression. Among SCC in all samples, tumor tissue lack to express Bcl-2 positivity. In cases of hypertrophic and atrophic variants of AK, Bcl-2 expression was confined to basal cell layer, as well as in one case of hypertrophic variant in suprabasal cells. In three histological variants of SK expresseion of Bcl-2 protein was in areas of basaloid proliferation, while in areas of squamous differentiation was negative. In clonal variant immunostaining was positive among cells in characteristic »nests« Distribution of Bcl-2 protein expression in solid, adenoid and cystic variant of BCC showed that peripheral proliferating cells are protected against apoptosis what permits tumor growth. In morpheaform variant reduced amount of Bcl-2 expression indicated that this variant of BCC has increased cell proliferation, and in practice shows tendency for recurrence and difficulties to eradicate. Bcl-2 expression supports the observation that tumor cells are derived from basal keratinocytes. In SCC, lack of Bcl-2 expression indicates that origin of tumor cells is from more differentiated suprabasal keratinocytes. In AK results suggest that immunoreactivity is regulated with respect of the keratinocyte’s differentiation status, but not closely correlate with proliferative rate

Modern Approach to Topical Treatment of Aging Skin

The main processes involved in skin aging are intrinsic and extrinsic. Apart from them, so called stochastic aging connotes cell damage caused by metabolic processes, free radicals and cosmic irradiation. The clinical expression of intrinsic aging include smooth, dry, and thinned skin with accentuated expression lines. It is inevitable and time dependent. Extrinsically aged skin shows signs of photodamage which include appearance of wrinkles, pigmented lesions, actinic keratoses and patchy hypopigmentations. Therapeutic modalities imply photoprotection with sunscreens that prevent sunburns and block ultraviolet irradiation. Other modalities include use of retinoids which regulate gene transcription with subsequent cellular differentiation and proliferation. The topical and peroral administration of »network antioxidants» such as vitamin E and C, coenzyme Q10, alpha-lipoic acid and glutathione, enhance antiaging effect. The other antioxidants such as green tea, dehydroepiandrosterone, melatonin, selenium and resveratrol, have also antiaging and anti-inflammatory effects. Topical bleaching agents such as hydroquinone, kojic acid and azelaic acid can reduce signs of aging. Studies confirm the efficacy of these topical agents in combination with superficial and/or medium depth or deep peeling agents for photodamaged skin treatment. Indications for type of chemical peels according to various clinical diagnosis are done, as well as advantages and disadvantages of differetn types of chemical peels

Modern Approach to Topical Treatment of Aging Skin

The main processes involved in skin aging are intrinsic and extrinsic. Apart from them, so called stochastic aging connotes cell damage caused by metabolic processes, free radicals and cosmic irradiation. The clinical expression of intrinsic aging include smooth, dry, and thinned skin with accentuated expression lines. It is inevitable and time dependent. Extrinsically aged skin shows signs of photodamage which include appearance of wrinkles, pigmented lesions, actinic keratoses and patchy hypopigmentations. Therapeutic modalities imply photoprotection with sunscreens that prevent sunburns and block ultraviolet irradiation. Other modalities include use of retinoids which regulate gene transcription with subsequent cellular differentiation and proliferation. The topical and peroral administration of »network antioxidants» such as vitamin E and C, coenzyme Q10, alpha-lipoic acid and glutathione, enhance antiaging effect. The other antioxidants such as green tea, dehydroepiandrosterone, melatonin, selenium and resveratrol, have also antiaging and anti-inflammatory effects. Topical bleaching agents such as hydroquinone, kojic acid and azelaic acid can reduce signs of aging. Studies confirm the efficacy of these topical agents in combination with superficial and/or medium depth or deep peeling agents for photodamaged skin treatment. Indications for type of chemical peels according to various clinical diagnosis are done, as well as advantages and disadvantages of differetn types of chemical peels

Aplasia Cutis Congenita in a Newborn Child Associated with Two Fetus Papyraceous

Aplasia cutis congenita (ACC) is a rare inborn lesion, presenting with absence of skin. The etiology is unknown and is probably not attributable to a single cause but to a combination of genetic factors. Multiple causes have been suggested for ACC: syndromes and teratogens, intrauterine infection – varicella zoster virus, herpes simplex virus – fetal exposure to cocaine, heroin, alcohol, or antithyroid drugs. The most common site is the scalp. We report a case with multiple lesions on the trunk, resembling an instance with ACC group 5. This form of ACC occurs in association with the in utero death of a twin or more (in this case triple) fetus. Histological findings are available in very few reports. Therapy options depend on the characteristics of the lesion, but conservative treatment is usually chosen.</p

Fractionated Illumination Improves the Outcome in the Treatment of Precancerous Lesions with Photodynamic Therapy

Photodynamic therapy (PDT) is a noninvasive therapy for non-melanoma skin cancer. The aim of this study was comparison of efficacy between fractioned versus single dose illumination in photodynamic therapy (PDT) of actinic keratosis (AK) and Bowen’s disease (BD). Fifty-one patients (36 AK and 15 BD) were treated with PDT. They were randomly arranged in two treatment groups. Group one included 26 patients (20 AK and 6 BD) that, after five hours of incubation with 20% 5-ALA, were treated with a single illumination of 100 Jcm–2 at fluence rate of 30 mWcm–2. Group two included 25 patients (16 AK and 9 BD) that, after 16 hours of incubation with 20% 5-ALA, were treated with two light fractions (50 plus 50 Jcm–2) at same fluence rate with dark interval of two hours between fractions. Twenty-four weeks later, a treated area was incubated for four hours again with 5-ALA in order to detect occult areas of abnormal skin with possible remaining tumor tissue. In case of fluorescence, histological examination was performed. In the group one, fluorescence at the end of the session was absent in 19 (73%) or very weak in 7 (27%). Residual tumor was found in 15 (75%) AK and in 4 (66.6%) BD. In the group two, fluorescence at the end of second session was more intense; in one patient (4%) was absent, very weak in 5 (20%) and weak in 19 (76%) of patients. In this group histology revealed remaining tumor tissue in only 2 (12.5%) AK and 2 (22.2%) BD. Among the patients in the first group, the remaining tumor tissue was significantly bigger (p=0.005). The treatment response with clearing of tumor tissue was significantly higher in fractionated illumination than in a single dose illumination group. Fractionated illumination scheme with 16 hours of incubation separated by two hours dark interval significantly improves the therapeutic outcome in tumor eradication

De Novo NEMO Gene Deletion (D4–10) – A Cause of Incontinentia Pigmenti in a Female Infant: A Case Report

Incontinentia pigmenti (IP) is a rare, inherited, multisystem genodermatosis. It is transmitted as an X-linked dominant trait. The disorder is a consequence of mutations in the NEMO gene (Xq28) that completely abolish expression of the NF-kappaB essential modulator. Here we present a female infant of healthy nonconsanguinous, young parents with a clinically evident first phase of IP. PCR analysis of patient’s peripheral blood lymphocytes DNA was done for detection of NEMO D4–10 deletion. Skin changes present at birth appertain to first inflammatory stage. However, a pathohistological feature of the skin biopsy showed second phase of disease. Genetic testing of diseased child revealed D4–10 in NEMO gene. However, the assumption that the female child has familial IP was rejected as PCR performed on the mother’s leukocytes did not record the presence of the same mutation. Moreover, the existence of a healthy male infant of the same mother as well as the lack of any phenotypic signs of the disease in other family members additionally support that IP was not inherited, but it was a consequence of de novo NEMO gene mutation. In conclusion, here we describe a Croatian female with clinical IP phenotype having de novo genomic rearrangements in the NEMO gene

Descriptive Epidemiology of Cutaneous Squamous Cell Carcinoma in Croatia

The aim of the study was to investigate the squamous cell carcinoma (SCC) incidence in Croatia in the 2003–2005 period. The cases of SCC were retrospectively studied. Data were collected from University Department of Dermatology and Venereology, Zagreb University Hospital Center and National Cancer Registry. In the study period, there were 1,860 cases of SCC (934 men and 926 women). The crude incidence rate for the Croatian population of 100,000 was 14.6 for men and 13.4 for women. The age-standardized incidence rate (adjusted for the world standard population) was 8.9 for men and 5.2 for women. The head was almost exclusive localization of SCC in both sexes. The highest SCC incidence was recorded in Zadar County. These results will serve for the SCC trend monitoring in Croatia and Europe in the forthcoming years

INCIDENTALNI NALAZ ČVORA NA VRATU KOŽNOG MALIGNOG MELANOMA NAKON 34 GODINE LATENCIJE

The authors report a case of a 64-year-old man who had nodal recurrence of melanoma 34 years after the primary diagnosis of a cutaneous melanoma on his back. Neck ultrasound confirmed an oval anechogenic/hypoechogenic lobular lesion (1.6x1.7 cm) in the right supraclavicular fossa. Fine-needle aspiration revealed sparse population of the poorly preserved malignant cells and bare malignant nuclei with prominent nucleoli. Extirpation of the lymph node was done and the histopathologic diagnosis confirmed metastatic melanoma. The man was referred to positron emission tomography/ computed tomography, dermatologist, ophthalmologist and gastroenterologist for further management to exclude other potential sites of new primary melanoma. It is one of the longest disease-free latency periods between the primary melanoma diagnosis and recurrence reported to date. This article suggests melanoma to be a disease with a potentially lifelong risk of recurrence, however, late recurrences are very rare. The clinicians and patients must be vigilant and aware of the risk of late recurrences.Prikazujemo slučaj 64-godišnjeg muškarca koji je imao metastazu melanoma u limfnom čvoru 34 godine nakon postavljene dijagnoze kožnog melanoma na leđima. Na ultrazvuku je ponađena ovalna anehogena/hipoehogena lobularna lezija (1,6x1,7 cm) u desnoj supraklavikularnoj regiji. Citološka punkcija je ukazivala na slabo diferencirane maligne stanice. Učinjena je ekstirpacija limfnog čvora i patohistološki nalaz je potvrdio metastatski melanom. Daljnjom obradom (pozitronska emisijska tomografi ja, pregled dermatologa, oftalmologa i i gastroenterologa) nije pronađeno novo sijelo primarnog melanoma. To je jedno od najdužih razdoblja između primarnog melanoma i povratka bolesti opisano do danas. Ovaj prikaz pokazuje da se metastaze melanoma mogu javiti tijekom cijelog života. Liječnici i bolesnici moraju biti svjesni rizika kasnih metastaza