Quick detection of nonmelanoma skin cancer by histopathology: feasibility and diagnostic accuracy of immediate cutaneous diagnosis

Background: Dermoscopy, diagnostic cytology, confocal microscopy are used to improve diagnostic accuracy. Frozen section techniques have been used to control margins but not for diagnosis. Objectives: We used a new frozen section technique called immediate cutaneous diagnosis for nonmelanoma skin cancer, assessing its feasibility and accuracy in obtaining a result within 15 minutes and recording limitations. Methods and Materials: An observational, prospective clinical study was designed. Biological samples were divided into two: one half was included in paraffin, following the standard procedure, and immediate cutaneous diagnosis was applied in the other. Fresh tissue was examined by frozen sections with perpendicular slides and staining with toluidine blue. Two hundred and sixty patients were enrolled. Results: Immediate cutaneous diagnosis-toluidine blue had a sensitivity of 98.7% (95%CI: 93.0-100%) and a specificity of 92.6% (95%CI: 87.4-96.1%) in detecting nonmelanoma skin cancer. Inter-rater agreement between two dermatopathologists using Cohen's kappa was 0.796 (P<0.0001) in a subsample of 101 cases. Immediate cutaneous diagnosis-toluidine blue had a sensitivity for squamous epithelial lesions of 78.3% (95%CI: 63.689.1%) and a specificity of 98.4% (95%CI: 95.5-99.7%)

Adalimumab-related alopecia in a patient affected by psoriasis

Alopecia induced by biological therapy is a rare side effect of this type of drugs. A total of 23 patients of psoriasiform eruptions with severe scalp involvement that induced alopecia during anti-tumor necrosis factor (anti-TNF) treatment of non-dermatological conditions have been previously reported. We present a 50-year-old man affected by plaque psoriasis that developed psoriasiform patches with alopecia over his scalp 10 months after initiating treatment with adalimumab. Punch biopsy of the alopecic area on the scalp revealed psoriasiform epidermal changes and alopecia areata-like dermal changes. Along with these findings, there was a dermal inflammatory infiltrate made up of eosinophils and plasma cells. In conclusion, scalp psoriasiform lesions with alopecia in patients treated with anti-TNF agents have been rarely reported. We describe a patient with anti-TNF therapy-related alopecia affected by psoriasis. Our patient has a peculiar histology with features of psoriasis and alopecia areata in addition to eosinophils and plasma cells. This entity may respond to topical treatment. However in patients of severe scalp involvement anti-TNF suspension should be considered

Adalimumab-related alopecia in a patient affected by psoriasis

Alopecia induced by biological therapy is a rare side effect of this type of drugs. A total of 23 patients of psoriasiform eruptions with severe scalp involvement that induced alopecia during anti-tumor necrosis factor (anti-TNF) treatment of non-dermatological conditions have been previously reported. We present a 50-year-old man affected by plaque psoriasis that developed psoriasiform patches with alopecia over his scalp 10 months after initiating treatment with adalimumab. Punch biopsy of the alopecic area on the scalp revealed psoriasiform epidermal changes and alopecia areata-like dermal changes. Along with these findings, there was a dermal inflammatory infiltrate made up of eosinophils and plasma cells. In conclusion, scalp psoriasiform lesions with alopecia in patients treated with anti-TNF agents have been rarely reported. We describe a patient with anti-TNF therapy-related alopecia affected by psoriasis. Our patient has a peculiar histology with features of psoriasis and alopecia areata in addition to eosinophils and plasma cells. This entity may respond to topical treatment. However in patients of severe scalp involvement anti-TNF suspension should be considered