Non-melanoma Skin Cancers in Uranium Miners – Clinical Cases

Introduction. Using sources of ionizing radiation in various spheres of human life became an integral part of the existence of modern society and the necessary condition for further scientific and technological progress. However, along with the obvious benefits, this increases the radiation burden and number of malignant neoplasms and the related reduction in life expectancy. The various health risks associated with uranium exposure are well known, mainly it concerns the lung cancer, but recently there has been a hypothesis that if uranium is photoactivated by ultraviolet radiation, it may be more dangerous for the skin. This idea is confirmed by statistics on countries with high levels of solar radiation and uranium deposits, which are being actively developed, such as Australia, Kazakhstan, Canada, Russia, etc. The following article provides a brief overview of the literature and presents 2 cases of basal cell carcinoma in the miners of the uranium mine. The aim of the study. To analyze the overview of the accessible literature and the description of two clinical cases of non-melanoma skin cancers in uranium miners from the own practice. Materials and methods. The content analysis, method of systemic comparative analysis, bibliosemantic method of studying of actual scientific researches concerning the practice of non-invasive methods of evaluation were used. The search for sources was carried out in the scientific meteorological databases: PubMed-NCBI, Medline, CochraneLibrary, EMBASE, ResearchGate by keywords: “uranium miners”, “non-melanoma skin cancer”, “UV”, “dermatoscopy”. Digital dermoscopic images were captured using dermatoscope (DermLite DL3 dermatoscope) mounted on a digital camera (Galaxy S-4 Samsung Corporation). Ultrasound gel was also used for immersion dermatoscopy. All images were evaluated using the algorithm of H. Kittler. Conclusions. The overview of the modern literature and clinical cases from our own practice suggest that uranium mining and processing are associated with a wide range of potential adverse human health risks and skin malignancy in this processes in not less important than of respiratory tract, especially since this risk is exacerbated by the exposure to ultraviolet light. The risk of non-melanoma skin cancers in this group requires careful clinical and dermatoscopy monitoring and in the case of suspicious lesions special tests like histology from of the skin biopsy, immunohistochemical stains and/or electron microscopy. The future study of statistical data on skin cancers from similar regions is of no less interest

S. Spitz nevus – Clinical, Dermatoscopic and Histological Features Correlation – Cases Report

Introduction. S. Spitz nevus is a benign melanocytic neoplasm composed from spindled or epitheloid new melanocytes mostly appearing in the pediatric age and described previously as juvenile melanoma. In accordance with the literature the majority of cases are observed in the first two decades of life mainly in fair-skinned persons representing about 1.0 % of all childhood melanocytic nevi. The S. Spitz nevus was first described in 1948 by Sophie Spitz as benign juvenile melanoma with good prognosis but histological resemblance with melanoma and bears her name. It may mimic melanoma at clinical, derma­toscopic and histopathological levels being today the subject of discussion and one of the most difficult questions among the pigmented lesions both for dermatologists and morphologists. As a result, there are contradictions regarding the appropriate therapy and prognosis. The aim of the study. To describe the correlations between the clinical, dermatoscopic and pathomorphological features of S. Spitz nevi in three clinical cases. Materials and methods. The content analysis, bibliosemantic method of studying the actual scientific researches concerning non-invasive methods of S. Spitz nevus evaluation were used. The study was carried out in the following scientific databases: PubMed-NCBI, Medline, Cochranel Library, EMBASE, ReseachGate by keywords: S. Spitz nevus, dermatoscopy, correlation with morphological examination. Three clinical cases were described. Digital dermatoscopic images were captured using Dermatoscope (DermLite DL3) mounted on the digital camera Galaxy S-4 Samsung Corporation) using the ultrasound gel for imersion dermatoscopy. All images were evaluated in accordance with algorithm of H. Kittler. Results. Dermatoscopy is the appropriate and helpful method for diagnosing S. Spitz nevus, but together with this the histopathological and immunohistochemical examinations are still needed to rule out malignancy, especially for uncommon or atypical dermatoscopic patterns. S. Spitz nevus clinically is presented as a solitary, pink, red or brown papule most commonly located on the face or extremities and characterized by an initially rapid growth. The other clinical characteristic feature is size, thus they are usually less than 1.0 cm in diameter, larger size is considered as abnormal. They may be pigmented when colours ranging from tan to dark brown or even black, but typically they are from pink to red because of limited melanin content and increased vascularity. Clinically the most often features are symmetry, smooth, dome-shaped and hairless surface, and well-demarcated borders. Both genders are equally affected. However, because of few specific clinical features, it is often difficult to make a correct diagnosis of S. Spitz nevus with naked eyes, sometimes it is clinically mistaken with other skin tumors such as hemangioma, verruca vulgaris, dermatofibroma, etc. Dermatoscopy became very helpful in S. Spitz nevus diagnosis accuracy and its most typical variants determining. The management of S. Spitz nevus is still controversial. According to dermatoscopic morphology of S. Spitz nevi and management guidelines by 2017 British Association of Dermatologists, surgical excision should be reserved for suspicious lesions in children at 12 years of age and older and for all suspicious neoplasm with an atypical pattern when malignant melanoma cannot be excluded in children of all ages. Clinical and dermatoscopic follow-up should be continued until these neoplasms maintain the typical features of common nevi or disappear. In this report we discuss 3 different cases of S. Spitz nevi. The patients were at the age of 7 to 11 years old, had unremarkable medical histories and rapid growth of elements in the last period. Conclusions. There are many contradictions in the diagnosis and management of S. Spitz nevus due to its peculiar clinical, dermatoscopic and histomorphological features. Dermatoscopy has emerged as an important tool in the evaluation of patients with such lesions, but it is still necessary to perform a biopsy or excision for cases with suspicious clinical manifestations or atypical dermatoscopic patterns. As well the short-term follow-up is helpful and should be continued until these neoplasms maintain the typical features of common nevi or disappear

Dermatoscopic features of pigmented and non-pigmented basal cell carcinoma

Basal cell carcinoma (BCC) is one of the most common malignant tumors, which accounts for about 75% of all skin cancers, its early diagnosis is crucial for proper treatment. In recent years, an increasingly important role in the early and differential diagnosis of skin tumors plays dermatoscopy, making possible to improve the diagnosis of pigmented and nonpigmented skin lesions, especially in the early stages of development. The aim of this work is to study the dermatoscopic criteria for pigmented and nonpigmented BCC using the algorithm of H. Kittler. Were studied 78 cases of different clinical types of BCC, diagnosis was based on clinical and dermatoscopic picture with further confirmation by cytology. The obtained data show that for pigmented BCC are characteristic five major signs of dermatoscopy - lines, dots, clods, circles and pseudopodia, whereas for non-pigmented form - pattern of blood vessels and, as an additional feature, structureless areas. Further studies are needed to evaluate specific dermoscopic hallmarks regarding different categories of BCC and sensitivity of these dermatoscopic features

Phages in Treatment of Some Deep Purulent Skin Infections

Introduction. The questions of treatment of chronic skin purulent infections are extremely important due to their wide spread, severe clinical course of some nosological forms, development of resistance to the traditional means, and growth of undesirable side effects of antibiotic therapy. Chronic suppurative skin diseases connected with skin appendages are disorders of common occurrence and a major constituent of pyodermas. They still remain a problem due to their chronic character and difficulty of treatment, as well as its large impact on patients’ quality of life. Due to the chronic course of the disease, treatment is long lasting, and often ineffective because of resistance to antibiotics therefore it is desirable to provide the treatment with effective alternatives to commonly used antibiotics to reduce the resistance and obtain a highly specific agent which is able to destroy bacteria effectively. In the same time across the world a growing number of scientists are noting the promising positive results of phage therapy and its advantages, especially in the treatment of chronic cases. The aim of this communication, which is a continuation of previously presented research, is to report the data and results of treatment of some common chronic suppurative skin disease with phages. Materials and methods. In the present investigation were included 87 males aged 18 to 56 with chronic folliculites (n=52), syccosis (n=30) and folliculitis et perifolliculitis capitis abscendens et suffodiens, Hoffmann (n=5), in all cases was approved prevalence of staphylococcal flora and all of them were treated before with antibiotics, but unsuccessfully. The treatment was provided with pyophages produced by Giorgi Eliava Institute (Tbilisi, Georgia) which include Staphylococcus aureus, Streptococcus (different cultures), Escherichia coli (different serotypes), Psedomonas aeruginosa, Proteus vulgaris, mirabilis. Taking into consideration deep locations for treatment was chosen mesotherapy technique – phage solution was injected by dermal nappage, papula and point by point technique in all damaged areas. In each case the frequency of procedures was usually once in 3-4 days until healing, the process took about one month. In patients with folliculitis full recovery was achieved in all cases, but they were still under observation up to 2 months in order to avoid relapses. In the cases of folliculitis et perifolliculitis capitis abscendens et suffodiens Hoffmann treatment was started with М. Jessner’s peeling followed by intralesional injections into buggy nodules and sinus tracts and dermal nappage, papula and point by point technique in all damaged areas. Patients were treated within three weeks once in three days with following break of 7 days, after the course was repeated. In all 5 cases the final results were positive. The cosmetic defect in the form of a fibroid growth was still present, but after the course of treatment the laboratory data confirmed the absence of pathogenic flora in correlation with marked clinical improvement. Conclusions. Рhage therapy has a long history and phages potential for treating infectious diseases has been pursued since their discovery, but still there are many important questions that must be decided before their wide therapeutic use in different clinical fields. Their benefits are undeniable, this therapy may replace or augment the conventional antibiotic therapy, help eliminate antibiotic resistance of bacterial strains and they give a real chance for patients suffering from chronic infections caused by antibiotic-resistant bacteria. The experience in phage therapy may become very important with the rapidly-increasing spread of antibiotic-resistance bacterial infections which are difficult to treat now. There is a need to develop phage therapy of purulent skin diseases, but more research is needed to understand the bacteria-bacteriophage interactions in the skin community to obtain comprehensive knowledge on different pathogenic flora

Silk route to the acceptance and re-implementation of bacteriophage therapy.

This multidisciplinary expert panel opinion on bacteriophage therapy has been written in the context of a society that is confronted with an ever-increasing number of antibiotic resistant bacteria. To avoid the return to a pre-antibiotic era, alternative treatments are urgently needed. The authors aim to contribute to the opinion formation of relevant stakeholders on how to potentially develop an infrastructure and legislation that paves the way for the acceptance and re-implementation of bacteriophage therapy