Cutaneous Metastatic Disease: Case Series in a Tropical Setting

Background: Cutaneous metastasis is valuable though with infrequent occurrence in clinical practice. It is of esteem value in diagnosis as well as treatment of cancer due to the ease of accessibility for clinical examination and biopsy. Case Series: This is a presentation of 5 consecutive patients with histologic diagnosis of cutaneous metastatic malignancies at the University of Calabar Teaching Hospital, (UCTH), Calabar, Nigeria from 2010 to 2013. They were studied in an attempt to evaluate the clinical significance of cutaneous metastatic nodules/disease in a tropical setting. This was compared with total cutaneous malignancies and total malignancies seen over the same period. Conclusion: The spectrum in the reported cases ranged from localised and barely noticeable nodules to generalised nodules. Clinicians are urged to show renewed interest in cutaneous nodules in view of the estimable value by subjecting such for histological evaluation.

Up-regulation of Human Leukocyte Antigen G Expression in Primary Cutaneous Malignant Melanoma Associated with Host-vs-tumor Immune Response

Human leukocyte antigen G （HLA-G） is one of the molecules implicated in immunotolerance. To investigate the role of HLA-G in primary cutaneous malignant melanoma （CMM）, a series of 47 skin melanocytic lesions were immunohistochemically evaluated. The correlation between HLA-G expression and CMM clinicohistopahtological data and Bcl-2 expression was also analyzed. HLA-G expression was detected in a variety of cell types. No significant difference in HLA-G expression was observed between malignant and non-malignant melanocytic lesions. HLA-G expression was significantly correlated with the inflammatory infiltration and Bcl-2 expression, whereas no significant correlation with ulceration, tumor thickness, clinical stage, histopathological subtypes were observed. HLA-G expression may be the result of host immune reaction in tumor microenvironment rather than a malignant feature of CMM.

Surgical outcomes for cutaneous squamous cell carcinoma of the auricle

Background:Cutaneous squamous cell carcinoma (CSCC) on the auricle is believed to carry a higher risk of metastatic spread.The rates of lymphatic metastasis reported in the literature have varied widely.There are no established prognostic criteria to determine which of these tumors are higher risk and warrant prophylactic treatment of the associated lymphatic basins.Objective:To retrospectively evaluate outcomes after surgical treatment of auricular CSCC in our department,examining excision completeness,tumor recurrence,and lymphatic metastasis.Secondarily,to identify factors associated with lymphatic metastasis.Methods:One hundred and thirty‐eight consecutive cases of auricular SCC were excised from 126 patients in our department over a 7‐year period (January 2012–December 2018).Data were retrospectively collected on patient characteristics,tumor histology,surgical procedures,and follow‐up.Results:Incomplete initial excision occurred in 17 cases (12.32%).Six patients (4.76%) had a local recurrence.Lymphatic metastasis occurred in eight patients (6.35%),on average within 10.25 months after primary excision.Six patients with metastasis died during follow‐up,with a mean survival of 10.2 months.Older age was associated with lymphatic metastasis (P = 0.0267).Other factors,including tumor recurrence,size,grade,cartilage invasion,and positive margins,were evaluated and not significantly associated with metastasis.Conclusion:In this study,the metastatic rate of auricular SCC was 6.35%,which is within the previously reported ranges.No histological prognostic factors were identified in this study,which may be due to our limited sample size.In the absence of established prognostic criteria,decisions regarding prophylactic treatment should be made on an individual basis with multidisciplinary support.

Recent advancements in the diagnosis and treatment of acral melanoma

Acral melanoma(AM)is the most common histologic subtype of melanoma in dark-skinned patients and is associated with a worse prognosis and a high mortality rate,largely due to the inconspicuous nature of early-stage lesions,which can lead to late diagnosis.Because of the overlapping clinical and histopathological features of AM with other forms of cutaneous melanomas,early detection of AM requires a multidisciplinary approach that integrates various diagnostic modalities,including clinical examination,dermoscopy,histopathology,molecular testing,radiological imaging,and blood tests.While surgery is the preferred method of treatment for AM,other therapeutic options may be employed based on the stage and underlying etiology of the disease.Immune checkpoint inhibitors,molecular targeted therapy,radiotherapy,chemotherapy,and oncolytic virotherapy represent promising advanced treatment options for AM.In this review,we provide an overview of the latest advancements in diagnostic and therapeutic methods for AM,highlighting the importance of early detection and the prompt,individualized management of this challenging disease.

EXPRESSION OF PROLIFERATING CELL NUCLEAR ANTIGEN IN CUTANEOUS MALIGNANT LYMPHOMAS AND LYMPHOID INFILTRATES

Paraffin-embedded tissue of skin biopsy specimens taken retrospectively from 24 patients with cutaneous malignant lymphomas (CML) and 8 patients with cutaneous lymphoid infiltrates (CLI) and other dennatoses were studied retrospectively with PCIO immunostaining. The results show a statistical significant difference among PCIO indices for cutaneous genuine histiocytic lymphoma (CGHL), cutaneous germinal center cell-derived lymphomas (CGCCL), cutaneous peripheral T-cell lymphomas (CPTL), non-mycosis fungoides (MF) and Sezary's syndrome (SS), and MF when compared with those for CLI. There is a linear relationship between PCIO index and square root of PCIO density, both of which seem to have a parallel relationship to the severity of malignancy in CML. The nuclear volume of the positive tumor cell or lymphocyte with PCIO immunostaining may be also useful in differentiating CML from CLI.

Lymph node metastasis from non-melanoma skin cancer

The management of non-melanoma skin cancers metastatic to the neck is challenging due to variability in biological behavior and patterns of regional lymphatic spread.Metastatic non-melanoma skin cancers to the parotid and neck often behave aggressively,with a high incidence of local recurrence after treatment and reduced five-year survival outcomes.Patterns of lymphatic spread are different from those seen in mucosal squamous cell carcinoma,with higher prevalence of disease in the parotid and superficial lymphatics.These factors require that treatment is individualized to achieve optimal outcomes.Traditionally,the management of non-melanoma skin cancers metastatic to lymph nodes has involved surgical excision followed by adjuvant radiation therapy.However,novel systemic therapies are showing promising results and their role in the management of these cancers is evolving.

Partial auricular reconstruction surgery for facial skin cancer

Auricular defects resulting from excision of cutaneous malignancies pose a challenge to the reconstructive surgeon due to the complex anatomy,convexities,and concavities of the ear.A surgeon must be familiar with analyzing defects of the ear and understand the variety of reconstructive options available with the goals of restoring function,re-establishing anatomic units,and achieving aesthetic balance.This review summarizes current methods for reconstruction of partial auricular defects resulting from neoplasm.A brief overview of ear anatomy and aesthetic relationships is also provided.Techniques for the reconstruction are classified by anatomic region:upper-third,middle-third,and lower-third defects.