Clinical and Experimental Dermatology最新文献

In the UK, few (12%) anal squamous cell carcinomas (aSCCs) are diagnosed early at stage 1 (T1N0M0). The Homerton Anogenital Neoplasia Service (HANS) is a highly specialized tertiary centre where high-resolution anoscopy (HRA) is performed to diagnose and treat anal intraepithelial neoplasia (AIN), a precursor to cancer. In some cases, aSCC (here defined as anal canal cancers and perianal cancers up to 5 cm from the anal verge) is found on referral for AIN; in others, aSCC may develop during management of AIN. We reviewed aSCC diagnoses at our specialist unit to establish whether HRA offers added value in the early detection of aSCC in a high-risk cohort. A cross-sectional analysis was performed of all primary aSCC diagnoses at HANS between January 2016 and June 2021. Patient records and histopathology and radiology reports were reviewed to define anal cancer stage per TNM classification (AJCC version 8). The results were compared with national anal cancer data published by the Office for National Statistics (AJCC version 8). Fifty-three aSCC diagnoses were made at HANS; 35 (66%) were stage 1 (14 prevalent, 21 incident), 11 (21%) stage 2 (9 prevalent, 2 incident) and 6 (11%) stage 3 (5 prevalent, 1 incident). None were stage 4, and one cancer was unstageable due to further management at another unit. By comparison, 5836 aSCCs were diagnosed in the UK between 2013 and 2017. Of these, 12.0% were stage 1, 22.8% stage 2, 33.0% stage 3 and 8.5% stage 4; 23.8% were unknown or unstageable. There was a statistically significant difference in the proportion of early (i.e. stage 1) HRA-detected cancers between HANS and national statistics (P < 0.001). Our results suggest that surveillance and examination within an HRA programme may lead to the detection of aSCC at an earlier stage, allowing for less morbid treatment and potentially lower mortality.

Background: Dermoscopy is a valuable tool in the diagnosis of various skin conditions. It increases sensitivity and specificity in skin cancer diagnosis, as well as in infectious, inflammatory and hair diseases. However, mastering the intricacies of dermoscopy can be challenging. In this context, innovative educational methods are sought, including game-based learning (GBL) strategies.

Objectives: To describe current perceptions, knowledge and use of GBL strategies in dermoscopy education, and identify strengths and challenges to enhance their use.

Methods: A web-based cross-sectional survey with 25 questions was distributed to members of the International Dermoscopy Society -between October 2022 and April 2023. Responses were collected and analysed using frequency analysis and graphical representation.

Results: In total, 801 responses were received. Of these, 46.6% of respondents were unfamiliar with gamification and serious games. Among those acquainted with these concepts, 56.3% reported using GBL strategies for education. Younger participants were more likely to use GBL strategies (P = 0.02). Participants familiar with GBL believed it enhanced medical education (78.5%) but should not entirely replace traditional teaching methods (96.0%). For dermoscopy education specifically, 22.1% of respondents had used GBL strategies, with Kahoot! (35.5%) and YOUdermoscopy (24.1%) being the most commonly used platforms. Respondents found gaming strategies to be fun (95.5%), motivating (91.0%) and valuable for e-learning (94.4%).

Conclusions: Results from this survey demonstrate a favourable perception of GBL strategies in dermatology education, including dermoscopy. While there are ongoing challenges in validation, GBL strategies are promising and valuable tools that can aid the learning and teaching experience. Addressing implementation barriers and validating existing games could optimize the impact of GBL on dermatology education.

Cutaneous lupus erythematosus (CLE) is a complex autoimmune disease often characterized by a multitude of skin findings. CLE is generally classified into three main categories: acute CLE, subacute CLE and chronic CLE. The current therapeutic guidelines for CLE include counselling patients on general measures and medication regimens. Treatment options include optimized photoprotection, avoidance of environmental triggers, corticosteroids, topical and systemic immunomodulators, and antimalarials. To date, no biologic medications (i.e. monoclonal antibodies, mAbs) are approved for CLE. The first mAb for the treatment of both systemic lupus erythematosus (SLE) and active lupus nephritis was belimumab, and was approved for these diseases in 2011 and 2020, respectively. Belimumab is a specific inhibitor of B-lymphocyte stimulator. Anifrolumab, a type I interferon receptor antagonist, was approved in 2021 for SLE. Other mAbs with different targets, including a novel biologic that inhibits blood dendritic cell antigen 2, are currently under investigation for CLE. This review will describe the general treatment landscape for CLE. Selected studies related to these various mAbs will be discussed, as well as their safety profiles and efficacies demonstrated in clinical trials. Biologic medications can potentially augment the number of treatment options for patients living with CLE.

Background: Recent studies analyzed the impact of Merkel cell polyomavirus (MCPyV) on the prognosis of Merkel cell carcinoma (MCC) patients. No data on specific morphological clinical differences of MCPyV+ or MCPyV- are currently available neither on the possible prognostic implication of different clinical presentation of MCC.

Objectives: 1) to describe clinicopathological characteristics of MCC patients and the prevalence of MCPyV infection in an Italian cohort of patients; 2) to define possible differences in clinicopathological and prognostic features among MCPyV+ and MCPyV- MCCs.

Methods: Retrospective, multicenter, cohort study conducted in two Italian tertiary referral centers. MCPyV presence was detected by immunohistochemistry (IHC) and PCR with two different primers amplifying VP1 (VP1-PCR) and LT viral region (LT-PCR). Clinicopathological features were compared between MCPyV+ and MCPyV- tumors and between red exophytic nodules and subcutaneous cyst-like MCCs.

Results: 62 MCCs were included, presenting as red exophytic nodules (69.3%) or with a subcutaneous cyst-like appearance (19.3%); MCPyV was detected in 40.3% of cases by IHC, 56.4% by VP1-PCR and 79% by LT-PCR. No correlation was found between clinical morphology and viral status. Mortality rate was 40.8% for MCPyV- and 23.1% for MCPyV+ (p-value 0.239) and 69.8% for red nodules and 25% for cyst-like lesions (p-value 0.005). By multivariable analysis, age at diagnosis, ki67 and treatment with surgery/radiotherapy remained the only factors significantly affecting the OS.

Conclusions: This study highlights the potential impact of clinical morphology of MCCs on prognosis. Subcutaneous cyst-like morphology may provide a survival benefit to the patients, regardless the presence of MCPyV.

Background: One in five sebaceous tumour (ST) patients may have Lynch syndrome (LS), a hereditary cancer predisposition. LS patients benefit from cancer surveillance and prevention programmes and immunotherapy. Whilst universal tumour mismatch repair (MMR) deficiency testing is recommended in colorectal and endometrial cancers to screen for LS, there is no consensus screening strategy for ST, leading to low testing rates and inequity of care.

Objectives: To assess a low cost and scalable, sequencing-based, microsatellite instability (MSI) assay, previously shown to enhance LS screening of colorectal cancers, for MMR deficiency detection in ST against the current clinical standard of immunohistochemistry (IHC).

Methods: One-hundred-and-seven consecutive ST cases were identified from a single pathology department. MMR protein IHC staining was interpreted by a consultant histopathologist. MSI analysis used amplicon-sequencing of 14 microsatellites and a naïve Bayesian classifier to calculate sample MSI score.

Results: Loss of MMR protein expression was observed in 49/104 ST with interpretable IHC (47.1%; 95% CI: 37.3-57.2%). MMR deficiency was less frequent in carcinoma than adenoma and sebaceoma (P = 4.74x10-3). The majority of MMR deficient ST had concurrent loss of MSH2 and MSH6 expression. The MSI score achieved a receiver operator characteristic area under curve of 0.944 relative to IHC. Lower MSI scores were associated with MSH6 deficiency.

Conclusions: These data support MSI testing as an adjunct or alternative to MMR IHC in ST. Integration of ST into established LS screening pathways using this high throughput methodology could increase testing and reduce costs.

Hidradenitis suppurativa (HS) patients treated with tumor necrosis factor (TNF) inhibitors are at an increased risk for tuberculosis (TB) reactivation, necessitating baseline latent TB infection (LTBI) screening. However, evidence regarding the value of periodic LTBI screening in this population is limited. In this single-center retrospective chart review, we investigated the LTBI rate in HS patients treated with adalimumab or infliximab. The cohort included 92 patients with an average treatment duration of 37.4 months and a median Interferon-Gamma Release Assay (IGRA) number of 3. The cumulative observation time was 286 person-years. Our investigation found no positive LTBI results in HS patients on TNF inhibitors, challenging clinicians to reconsider the utility of serial screening for such patients who are otherwise at low risk for TB. Further research is essential for the development of evidence-based guidelines to optimize patient care and healthcare resource allocation.