Periungual Bowen's Disease in a 4‐Year‐Old Girl

Bowen's disease (BD), or cutaneous squamous cell carcinoma (SCC) in situ, is rare in children. BD usually occurs in Caucasian adults on sun‐exposed areas and may progress to invasive cutaneous SCC. Most cases of periungual BD have been linked to human papillomavirus infection. We report an immunocompetent child with periungual BD.     

High‐risk human papillomavirus in a child with digital pigmented Bowen's disease: Case report and dermoscopic findings

Squamous cell carcinoma in situ, also known as Bowen's disease (BD), is a skin malignancy most commonly seen in middle‐aged and elderly adults. Pediatric BD is rare and can be a diagnostic challenge for physicians. Digital BD has largely been associated with human papilloma virus. We report an immunocompetent 11‐year‐old girl with periungual pigmented BD induced by high‐risk human papilloma virus.     

Focus of tricholemmal differentiation (tricholemmal carcinoma) within Bowen's disease/carcinoma

Bowen's disease (BD)/carcinoma is a type of squamous cell carcinoma of the skin, however, the possibility of adnexal differentiation (the development of sebaceous carcinoma or porocarcinoma) occurring in BD/carcinoma has been suggested. We herein describe a case of BD with superficial invasive carcinoma, which showed a clear cell focus, demonstrating tricholemmal differentiation. This clear cell focus showed the following findings: primarily composed of clear cells, somewhat columnar clear cells aligned in a palisade along a discernible basement membrane, tricholemmal keratinization and glycogen contained within the cells. In addition, the immunohistochemical profile in this clear cell focus, namely, negative staining for cytokeratin (CK)1 and positive staining for CK17 and calretinin in the inner cells of the neoplastic lobule, corresponded to that of the outer root sheath cells. This case suggested that adnexal differentiation can rarely occur within true BD/carcinoma, although adnexal carcinomas are commonly associated with a simple bowenoid change.     

Eccrine porocarcinoma and Bowen's disease arising in a seborrhoeic keratosis

An association between seborrhoeic keratosis (SK) and malignant tumours is considered to be rare. We observed a case of eccrine porocarcinoma and Bowen's disease (BD) occurring synchronously, forming one lesion in a SK on the abdomen. It is controversial whether malignant neoplasms arising in SK occur only by chance or if pre-existing SK plays a role in pathogenesis. This case suggests an implication of pre-existing SK in the subsequent development of both BD and eccrine porocarcinoma.     

Porocarcinoma with areas of mucinous differentiation suggesting multilineage differentiation

Porocarcinoma is an infrequent malignant adnexal carcinoma, with some histopathological variants described, such as the clear cell, the sarcomatoid or the pigmented porocarcinoma. We report an invasive porocarcinoma showing areas of tumor cells floating in prominent dermal mucin, simulating mucinous carcinoma, that we consider a new histopathological variant of porocarcinoma. We report a 74‐year‐old male with previous history of multiple basal cell carcinomas that presented a nodule on his left temple. Histopathologic study showed a large ulcerated multilobular tumor composed of thickened cords of cells emanating from a hyperplastic epidermis and showing a mixed infiltrative and pushing pattern in the dermis. Poroid differentiation was observed in most of the neoplasm, both in intraepidermal and dermal invasive component. Within the neoplasm a prominent area where these small nests with clear formation of ducts were floating in mucinous pools with few septa intermingled was observed, simulating a primary cutaneous mucinous carcinoma. Cytology, immunohistochemistry and the presence of both neoplastic areas as closely related and with multiple points of connectivity favors the consideration of a composite tumor in this peculiar case. Other differentials are discussed.     

Eccrine porocarcinoma arising within an area of Bowen disease

Summary Very little is known about the aetiology of eccrine porocarcinoma (EP), a rare malignant sweat-gland tumour. Most reported cases have arisen de novo, or from a benign eccrine poroma. We report an unusual case, in which eccrine porocarcinoma arose at the exact site of pre-existing Bowen disease (BD).     

Multiple‐digit periungual Bowen's disease: a novel treatment approach with radiotherapy

Multiple periungual Bowen disease [BD; also known as squamous cell carcinoma (SCC) in situ] is rare. The pathogenesis of the disease is linked to human papilloma virus, and in some instances to chronic immunosuppression. The usual management of periungual BD is by local excision, Mohs micrographic surgery or distal phalanx amputation. Our patient was offered radiotherapy in the hope of maximizing residual function and minimizing morbidity from treatment. A good response was seen at 2 months post‐radiotherapy, but this was followed by relapses at 4 and 6 months post‐radiotherapy. Persistent anonychia resulted in improved access to the involved skin, making topical therapy possible. Radiotherapy can be a valuable management approach for periungual SCC/BD in locations where amputation could result in substantial disability.     

Serum galectin‐3 levels in patients with Behçet’s disease: association with disease activity over a long‐term follow‐up

Background There is a need for a laboratory marker that correlates with the clinical activity of Behçet’s disease (BD). Objective We aimed to investigate whether serum galectin‐3 (Gal‐3) levels were affected during the course of the disease with regard to disease activity. Methods A total of 131 subjects were involved in the study as follows: Group 1: BD active (n = 39); Group 2: BD inactive (n = 31); Group 3: Disease controls with leucocytoclastic vasculitis confirmed with a skin biopsy (n = 22); and Group 4: Healthy control subjects (n = 39). The BD patients were followed regularly and samples were taken in their active and inactive periods of the disease over a 2‐year period. Results Serum Gal‐3 levels were significantly higher in active BD patients (mean 2.38) than inactive BD patients (mean 0.63; P < 0.0001) and the healthy control subjects (mean 0.75; P < 0.0001). There was no significant difference between the leucocytoclastic vasculitis and active BD patients (P = 0.093). Serum Gal‐3 levels were positively correlated with clinical activity scores of active BD patients (r = 0.66, P < 0.0001). In addition, the Gal‐3 levels were significantly higher in the active disease period when compared with the inactive period during the follow‐up. There were no significant differences between the two inactive periods of the disease among the same patients. Further analyses revealed that patients with vascular involvement had significantly higher Gal‐3 levels than the other active BD patients (mean 7.57; P = 0.007). Limitations The limitation of the study is the small number of patients with vascular involvement in the active BD patient group. Conclusion Gal‐3 levels are correlated with the activity of Behçet’s disease especially with the vascular involvement.     

Periungual Bowen's Disease in a 12‐Year‐Old Boy Treated with Photodynamic Therapy

Bowen's disease (BD) usually occurs on sun‐exposed areas in elderly patients. BD rarely occurs in childhood and lesions of the nail unit and periungual area are likely associated with human papillomavirus infection. Herein, we report a case of BD presenting on the periungual area in a 12‐year‐old boy which was successfully treated with two sessions of photodynamic therapy.     

A carcinoma with features of porocarcinoma, dermal ductular carcinoma, and squamous cell carcinoma in situ

We report the case of a 69-year-old Japanese woman with an extraordinary carcinoma on her back. The tumor had three different histologic components including porocarcinoma, dermal ductular carcinoma, and an area resembling squamous cell carcinoma in situ (SCCIS). Sweat gland tumors (SGTs) are known to have a wide spectrum of pathologic appearances and variable grades of differentiation. This report expands the spectrum of reported combinations.     

An unknown mass: the differential diagnosis of digit tumors

There is little discussion of tumors arising in the digits in the dermatology literature. The patient with an undifferentiated mass of the finger is frequently encountered in the clinic, and variances in presentation of common and uncommon entities pose a challenge that may prompt further investigation for proper diagnosis and treatment. In this review, the authors illustrate the approach and work‐up of an unknown digit mass of a 45‐year‐old female patient. They go on to discuss the presentation and treatment of common tumor lesions of the finger likely to be encountered in the dermatologist's clinic including: ganglion cyst/mucous cyst, giant‐cell tumor, verruca vulgaris, epidermal inclusion cyst, poroma, porocarcinoma, squamous cell carcinoma, basal cell carcinoma, melanoma, infantile digital fibromatosis, acquired digital fibrokeratoma, Koenen's tumor, schwannoma, cutaneous neurofibroma, pyogenic granuloma, hemangioma, glomus tumor, epithelioid sarcoma, and metastatic disease.     

Carcinoma and eccrine syringofibroadenoma: a report of five cases

BACKGROUND: In the literature, there are some reports of cases interpreted as carcinomatous transformation in eccrine syringofibroadenoma (ESFA). RESULTS: We have studied five cases with a histological mixture of ESFA and carcinoma. The carcinoma had a partial squamous cell cytology in all cases. In two of them, there was partial poroma and porocarcinoma picture. However, the squamous cell parts had some features of porocarcinoma such as retiform configuration and funnel-like cavities with luminal carcinoembryonic antigen (CEA) positivity. Also, there was strong epithelial membrane antigen (EMA) positivity. Therefore, we interpret the cases as porocarcinomas with extensive squamous metaplasia. One case had a life-long precursor lesion with a histologic picture interpreted as ESFA, with progressing cytologic atypia. Another case had ectodermal dysplasia, a condition known to predispose to ESFA and a precursor lesion of long-standing, probably benign ESFA. In these two cases, we interpret the carcinoma as a secondary development in a benign ESFA. Three cases were otherwise healthy people with precursor lesions of 10-, 5-, and 2-year duration. We do not know for certain if the ESFA preceded the carcinoma in these cases but we think that it probably did. CONCLUSIONS: We recommend that diagnosed ESFA shall be completely excised or followed, in view of the risk of developing carcinoma.     

Efficacy of photodynamic therapy with topical 5‐aminolevulinic acid using intense pulsed light for Bowen’s disease

Photodynamic therapy (PDT) with topical 5‐aminolevulinic acid (ALA) is reported to be an effective and safe treatment for superficial non‐melanoma skin cancers. We have developed an photodynamic therapy with topical δ‐aminolevulinic acid (ALA‐PDT) protocol using intense pulsed light (IPL) for treating Bowen’s disease (BD). Three patients diagnosed with BD by skin biopsy were recruited in this study. They received IPL treatment after 3 h of occlusive dressing with application of ALA. This protocol was repeated every 2 weeks for a total of five sessions. The treated areas did not show any signs of BD for more than 1 year; therefore, it appeared that the affected areas showed improvement in all the patients. No patients withdrew from the study because of side‐effects. ALA‐PDT with IPL as a light source is well tolerated by patients and is beneficial for treating BD.     

High‐risk cutaneous squamous cell carcinoma in a Japanese allogeneic bone marrow transplant recipient on long‐term voriconazole

Cutaneous squamous cell carcinomas arise as secondary cancers in hematopoietic stem cell transplant survivors. They have been documented primarily in Western cohorts and relatively little is known about their occurrence in Asian hematopoietic stem cell transplant recipients, with no reports of squamous cell carcinomas with high‐risk features in Asian patients. We describe a case of a cutaneous squamous cell carcinoma with high‐risk features on the scalp of a Japanese bone marrow transplant recipient approximately 6.5 years post‐transplant, who was on long‐term voriconazole. The history of a photodistributed erythema followed by the appearance of multiple actinic keratoses and solar lentigines, together with the rarity of cutaneous squamous cell carcinomas in Asian hematopoietic stem cell transplant cohorts revealed in our literature review, suggest that voriconazole use contributed to the development of high‐risk squamous cell carcinoma in our patient.     

Serum GDF‐15 level in Behçet's disease: relationships between disease activity and clinical parameters

Growth differentiation factor‐15 (GDF‐15), a member of the transforming growth factor‐β superfamily of cytokines, plays an important role in cell growth, signal transduction, and apoptosis regulation. The aim of this study was to evaluate serum GDF‐15 levels and their relationships with disease‐related variables in patients with Behçet's disease (BD). Forty‐six patients diagnosed with BD and 30 demographically matched healthy control subjects participated in the study. GDF‐15 levels were measured in blood samples from patients and controls. The Behçet's Disease Current Activity Form (BDCAF) was used to evaluate the disease activity of BD. There were no significant differences between the two groups in C‐reactive protein (CRP) level, mean erythrocyte sedimentation rate (ESR), age, body mass index, and mean GDF‐15 levels (P > 0.05). Serum GDF‐15 levels were positively correlated with findings for peripheral arthritis and CRP, and with BDCAF erythema nodosum, BDCAF arthralgia, and BDCAF arthritis scores. Patients with BD were divided into two groups according to the presence of peripheral arthritis; nine subjects (20%) were positive for peripheral arthritis. Serum ESR, CRP, white blood cell counts, and GDF‐15 levels were significantly higher in the group that was positive for peripheral arthritis (P < 0.05). GDF‐15 may play a role in the progression and pathway of Behçet's joint involvement and erythema nodosum that is independent of classic inflammatory response measures.     

Radio‐guided surgery: advantages of a new portable γ‐camera (Sentinella®) for intraoperative real time imaging and detection of sentinel lymph nodes in cutaneous malignancies

Background The histological status of the sentinel lymph node (SLN) is one of the most relevant prognostic factors for the overall survival of patients with cutaneous malignancies, independent of tumour depth of the primary tumour. Objectives Our study seeks to evaluate the reliability and medical benefit of SLN excision (SLNE) performed with a portable γ‐camera for intraoperative real time imaging of SLN. Methods Therefore our study compares the visualization of SLN performed with preoperative lymphoscintigraphy and preoperative SPECT/CT with the intraoperative real time imaging of SLN performed with a new portable γ‐camera (Sentinella^®) in 60 patients who were treated with a SLNE for early stage melanoma (n = 38), high risk cutaneous squamous cell carcinoma (n = 16), Merkel cell carcinoma (n = 4), sebaceous gland carcinoma (n = 1), and sweat glands carcinoma or porocarcinoma (n = 1). Results Sixty patients were enrolled in this study. The portable γ‐camera visualized all 126 preoperatively identified SLN. 23 additional SLN (15.4%) in 15 patients were only identified using the portable γ‐camera. Two of these additional SLN showed metastatic involvement. Conclusion The portable γ‐camera is an innovative imaging technique, reliable and providing additional information in the detection of SLN. Therefore SLNE with intraoperative γ‐camera use is an attractive option to improve the detection of SLN in cutaneous malignancies and could help to reduce false negative SLN results.     

Dermatoscopic features of cutaneous atypical fibroxanthoma: three cases

Atypical fibroxanthoma (AFX) is an uncommon, low‐grade, malignant, spindle‐cell tumour of fibrohistiocytic histogenesis, which can mimic other malignant skin tumours, such as basal and squamous cell carcinoma (CC), melanoma, and Merkel cell carcinoma (MCC). Three cases of AFX were examined by dermatoscopy, which revealed white areas and an atypical polymorphous vascular pattern characterized by the concurrence of different structures: linear, dotted, hairpin, arborescent and highly tortuous vessels, irregularly distributed over the surface. Seborrhoeic elements and photoageing may be accompanying features depending on the anatomical location of the AFX. AFX may be added to the list of slightly pigmented, reddish, malignant cutaneous tumours, such as SCC, MCC, amelanotic/hypomelanotic melanoma and eccrine porocarcinoma, which display prominent and chaotic dermatoscopic neoangiogenetic features in more advanced stages of proliferation.     

Intravesicular taxane‐induced dermatotoxicity in a 78‐year‐old man with urothelial carcinoma and primary cutaneous anaplastic large cell lymphoma

Patients treated with intravesical bacillus Calmette‐Guérin therapy for urothelial carcinoma often become refractory and experience recurrent disease, thus necessitating alternative intravesical treatment modalities if the patient is to be spared the morbidities associated with radical cystectomy. Intravesical treatment with taxane‐based chemotherapy, such as docetaxel, has gained traction in urologic oncology, proving to be an effective salvage therapy in such patients. Systemic taxane‐based chemotherapeutic regimens have long been used in several advanced malignancies, and their systemic side‐effects and associated histologic correlates have been extensively documented. In contrast to adverse effects associated with systemic administration, intravesical taxane administration has thus far proven to be well‐tolerated, with little to no systemic absorption. To our knowledge, features of taxane‐induced systemic effects have not been reported in this setting. Herein, we report a case of a patient with recurrent urothelial carcinoma treated with intravesical docetaxel, along with primary cutaneous anaplastic large cell lymphoma, who developed characteristic dermatotoxic histologic findings associated with intravenous taxane administration. As such histopathologic findings often represent close mimickers of neoplastic and infectious etiologies, knowledge of the potential for systemic manifestations of taxane therapy in patients treated topically may prevent potentially costly diagnostic pitfalls.