A Red Nodule on the Cheek - a Case Report

Abstract Introduction: Merkel cell carcinoma (MCC) is a rare, very aggressive neuroectodermal tumor of the skin typically located on sun-exposed areas and frequently found in Caucasian men between 70 and 80 years of age. Case Report: We present a case of a 86-year-old woman who was referred to our Skin Cancer Unit with a red and well defined nodule located on her left commissure of the mouth, that grew during a couple of months and was completely asymptomatic. Dermoscopic examination revealed a reddish background with linear and arborizing irregular vessels, some out of focus vessels and whitish areas. The lesion was excised, histological examination showed that the tumor was hypercellular and composed of round epithelial elements with large nuclei and scant cytoplasm suggestive of MCC. Immunohistochemical stains confirmed a diffuse positivity with cytokeratin (CK) 2 chromogranin, and synaptophysin; CK7 and thyroid transcription factor-1(TTF-1) were negative. Sentinel lymph node biopsy was done, resulting negative for neoplastic cells, and computed tomography (CT) of the chest, abdomen and pelvis showed no distant metastasis. Adjuvant radiotherapy on the tumor site and on homolateral neck lymph nodes was also done. Conclusion: Merkel cell carcinoma presents as an asymptomatic, rapidly growing nonpigmented nodule without specific characteristics. Dermoscopic features may help to distinguish MCC from other similar tumors: linear irregular vessels, milky pink areas, architectural disorders and structureless areas, even if not specific, when present are strongly suggestive of MCC. Wide excision with 2 cm margins with adjuvant radiotherapy is the treatment of choice in high-risk primary tumors, while sentinel lymph node biopsy and computed tomography scans are necessary for early diagnosis of metastatic disease

Can we improve melanoma detection methods?

N

Image Gallery: Brain? no, melanoma

N

Occurrence of Paraleucilla magna Klautau et al., 2004 (porifera : Calcarea) in Malta

The calcareous sponge Paraleucilla magna, first recorded from the Mediterranean in 2001 (southern Tyrrhenian, southern Adriatic and northwest Ionian coasts of Italy), is recorded from Malta (Central Mediterranean) where it was found forming part of the fouling community on small, surface marker-buoys around a fish-farm in Marsaxlokk Bay.peer-reviewe

Broadening the List of Basal Cell Carcinoma Mimickers: Dermoscopic Features of Trichoadenoma

N/

What is New in Melanoma Genetics and Treatment?

New therapies for advanced melanoma have led to major advances, which, for the first time, showed improved survival for patients with this very challenging neoplasm. These new treatments are based on gene-targeted therapies or stimulation of immune responses. However, these treatments are not without challenges in terms of resistance and toxicity. Physicians should be aware of these side effects as prompt treatment may save lives. Melanoma genetics is also unravelling new genetic risk factors involving telomere genes as well as new gene pathways at the somatic level which may soon become therapeutic targets. It is also shedding new light onto the pathology of this tumour with links to neural diseases and longevity

Fibroepithelioma of Pinkus: Solitary tumor or sign of a complex gastrointestinal syndrome

Fibroepithelioma of Pinkus (FEP), which is considered to be an uncommon variant of basal cell carcinoma, has been described in association with other systemic diseases. However, no specific studies are currently available on this subject. The aim of our study was to evaluate the clinical and morphological characteristics of FEP and investigate whether this rare tumor is a single entity or seen in the context of a more complex syndrome. We retrospectively analyzed 49 cases of FEP diagnosed and excised in a single academic institution from 1995 to 2011. The tumors were mainly located on the trunk (77.55%), followed by the lower extremities (12.20%) and the head and neck (10.20%). In 9 of the 49 cases (18%), FEP was associated with gastrointestinal tumors. The abovementioned cases are presented in an attempt to make clinicians more aware of a possible association between FEP and gastrointestinal cancer. Although a possible underlying common genetic background between FEP and gastrointestinal tumors was not provided, our study suggests that patients with FEP should be screened for the occurrence of gastrointestinal tumors

Aquaculture and Restoration: Perspectives from Mediterranean Sea Experiences

In this paper, the different possibilities and innovations related to sustainable aquaculture in the Mediterranean area are discussed, while different maricultural methods, and the role of Integrated Multi-Trophic Aquaculture (IMTA) in supporting the exploitation of the ocean’s resources, are also reviewed. IMTA, and mariculture in general, when carefully planned, can be suitable for environmental restoration and conservation purposes. Aquaculture, especially mariculture, is a sector that is progressively increasing in parallel with the increase in human needs; however, several problems still affect its development, mainly in relation to the choice of suitable sites, fodder production, and the impact on the surrounding environment. A current challenge that requires suitable solutions is the implementation of IMTA. Unfortunately, some criticisms still affect this approach, mostly concerning the commercialization of new products such as invertebrates and seaweeds, notwithstanding their environmentally friendly character. Regarding the location of a suitable site, mariculture plans are currently displaced from inshore to offshore, with the aim of reducing the competition for space with other human activities carried out within coastal waters. Moreover, in open water, waste loading does not appear to be a problem, but high-energy waters increase maintenance costs. Some suggestions are given for developing sustainable mariculture in the Mediterranean area, where IMTA is in its infancy and where the scarce nutrients that characterize offshore waters are not suitable for the farming of both filter feeder invertebrates and macroalgae. From the perspective of coupling mariculture activity with restoration ecology, the practices suggested in this review concern the implementation of inshore IMTA, creating artificially controlled gardens, as well as offshore mussel farming coupled with artificial reefs, while also hypothesizing the possibility of the use of artificially eutrophized areas

Reflectance Confocal Microscopy as an Aid to Dermoscopy to Improve Diagnosis on Equivocal Lesions: Evaluation of Three Bluish Nodules

Nodular lesions can be difficult to diagnose under dermoscopy alone, since they often lack specific diagnostic features. Confocal microscopy can be used as an aid to dermoscopy, to increase the diagnostic accuracy on equivocal skin lesions. We report three cases of bluish nodular lesions, difficult to diagnose under dermoscopy alone. Confocal features were very useful in these cases to lead us to the correct diagnosis, recognizing benign versus malignant entities. Histopathology is also reported, with high correspondence compared to the confocal imaging