Colchicine for treatment of relapsing polychondritis

This report describes the effectiveness of oral colchicine, 0.6 mg twice daily, in abating three attacks of chondritis in two patients who fulfilled the diagnostic criteria for relapsing polychondritis (RP). Chondritis of the pinnae of the ears was utilized as a therapeutic guideline toward improvement. Collagen antibodies and urinary mucopolysaccharides were negative during flares and after improvement; antinuclear antibodies (ANA) and anti-deoxyribonucleic acid (DNA) were present in one patient. Both patients experienced a continued chondritis for at least 10 days before colchicine was started. Marked improvement was observed in 4 days, and complete resolution occurred after 7 days' treatment with colchicine. These observations indicate that the effectiveness of colchicine, as a relatively safer medicine, should be evaluated further in the treatment of RP.     

Successful treatment of relapsing polychondritis with mycophenolate mofetil

We report a 50 year old man who presented to our clinic with a 5 year history of intermittent bilateral ear pain and underwent 2 biopsies which revealed nonspecific findings. A diagnosis of relapsing polychondritis was made based on positive serum antibodies to type II collagen and a wedge biopsy which revealed areas of cartilage necrosis and focal areas of perichondral inflammation with lymphocytes and histiocytes. He was successfully treated with a prednisone taper and mycophenolate mofetil 3 g per day (increased from the initial dose of 2 g per day). During his last clinic follow up, 17 months after beginning mycophenolate mofetil, our patient had no subjective symptoms and objectively had no inflammation or pain to palpation. He was continued on prednisone 5 mg daily and mycophenolate mofetil 3 g per day.     

Local surgical treatment of cutaneous squamous cell carcinoma: deficits and controversies in the literature

The prognostic impact of primary excision in the treatment of cutaneous squamous cell carcinoma depends on certain tumor characteristics (risk factors), the surgical approach chosen and the subsequent histological examination. For the development of the AWMF (Association of Scientific Medical Societies in Germany) guidelines for squamous cell carcinoma, the most conclusive guidelines available were evaluated using the DELBI tool (German Instrument for the Methodological Appraisal of Guidelines). These were the Scottish and Canadian guidelines as well as the joint guidelines published by EDF, EADO and EORTC. The primary literature on the aforementioned topics that was used for these guidelines included 49 studies and 9 reviews. None of the studies had a prospective, randomized design; 19 studies contained prospective data; 30 studies provided retrospective data. Overall, the results were heterogeneous. Not only were there discrepancies in terms of the validity of the various risk factors for locoregional disease progression – such as dedifferentiation, desmoplasia and perineural invasion – but also with respect to tumor thickness and surgical consequences. Differences were also found regarding the histological processing method used. In general, there are two such methods: conventional histology (bread loaf technique) and complete histological assessment of excision margins. The latter was found to be associated both with low recurrence rates and low metastatic rates, possibly due to the fact that patients treated with the latter method had lower‐risk tumors. Publications on bread loaf histology lacked precise information as to how the tissue was actually processed. Likewise, there was a lack of usable data in terms of the surgical margins used in the primary excision. Conclusion : The current literature is inconsistent and insufficient with regard to the various prognostic factors and the surgical approach to cutaneous squamous cell carcinoma.     

Relationship of treatment delay with surgical defect size from keratinocyte carcinoma (basal cell carcinoma and squamous cell carcinoma of the skin)

Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24%). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size (R(2) = 0.39) and were used as control variables. Self-reported delay between initial physician examination and MMS predicted defect size (p = 0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3-3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7-8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5-18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5-83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5-15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.     

Comparison of treatment modalities for squamous cell carcinoma

Numerous treatment modalities exist for cutaneous SCC. Having a variety of modalities in our armamentarium is useful, but they should be selected carefully based on certain key clinical and histologic prognostic factors. The histologic parameters should be provided to you by your dermatopathologist and can direct the clinician to better tailor treatment to specific neoplasms and thus produce more predictable outcomes. By incorporating the available prognostic factors in the literature, we can develop a reproducible schema or algorithmic approach to the treatment of cutaneous SCC to provide the highest cure rates possible while minimizing the morbidity for our patients (see Table 1).     

复发性多软骨炎12例临床分析

目的 总结复发性多软骨炎（RP）的临床特点。方法分析12例RP患者（男5例,女7例,发病年龄27～78岁）的临床表现和治疗。结果耳廓红肿、疼痛,鼻梁塌陷,多发关节痛是主要症状。亦有的以喘息、咳嗽为首发症状。软骨活体检查,支气管镜检,胸部CT有助于诊断。治疗包括免疫抑制剂（环磷酰胺）、糖皮质激素（强的松）、中药、气道内支架置入。12例患者病情均缓解。结论耳、鼻软骨症状,多发关节痛是主要症状。恰当治疗后疾病可获缓解。     

Case of probable spontaneous regression of Merkel cell carcinoma combined with squamous cell carcinoma without surgical intervention

Merkel cell carcinoma (MCC) is a rare but more lethal cutaneous cancer than melanoma. However, spontaneous regression of a number of MCC has been reported, although the cause of this regression remains unclear. In most cases, MCC regresses after a surgical procedure, for example, biopsy. Herein, we report a case of Merkel cell polyomavirus‐negative MCC coincident with squamous cell carcinoma (SCC) that underwent true spontaneous regression without biopsy. One month after the patient's first visit, clinical examination revealed that the tumor had not grown, but its surface showed changes in texture and color. Histopathologically, the excised specimen was indicative of MCC coincident with SCC and showed extensive necrosis in the upper portion of the tumor, numerous caspase‐3‐positive apoptotic cells, an accumulation of CD68‐positive foam cells and vascular invasion. These findings suggested that the tumor had regressed. We hypothesize that extensive coagulative necrosis resulting from an insufficient local blood supply triggered the shedding of some products or components of MCC and SCC, which in turn induced antitumor immunity against both lesions.     

Oral squamous cell carcinoma during long-term treatment with hydroxyurea

Hydroxyurea (HU) is commonly used for the treatment of chronic myelogenous leukaemia, polycythemia vera and essential thrombocythaemia. Patients receiving HU present a number of side-effects including skin/mucosa changes and tumours. Mucocutaneous abnormalities include xerosis, ichthyosiform lesions, dark brown pigmentation of skin folds and nails, malleolar ulcers, oral mucositis and oral ulcers. Cutaneous squamous/basal cell carcinomas have also often been reported following long-term administration of HU. HU-induced carcinogenesis is due to both the mutagenic potential of this agent and to an impairment of DNA repair mechanisms after damage by external factors such as ultraviolet radiation. Oral cancer following long-term treatment with HU has been reported only once, in a patient with concomitant multiple skin tumours. We present the unique case of a patient with polycythemia vera who developed oral cancer after 15 years of HU therapy.     

Pseudovascular squamous cell carcinoma

The adenoid form of squamous cell carcinoma is a neoplasm that is characterized by the fact that it presents a pseudoglandular pattern in the histological study. The biological phenomenon that explains this histological pattern is acantholysis; when the latter is massive, the tumor may even mimic a vascular proliferation, and is known as pseudovascular squamous cell carcinoma. This tumor has the clinical characteristics of a squamous cell carcinoma, but histologically, it may mimic an angiosarcoma. Most cases of pseudovascular squamous cell carcinoma of the skin have a poor prognosis.     

Pigmented squamous cell carcinoma

Although dendritic, melanin-containing melanocytes can be seen in a variety of epithelial neoplasms, only 0.01% to 7% of all squamous cell carcinomas (SCC) are pigmented. Furthermore, most reported cases have occurred in the oral and ocular mucosa, with relatively few cases reported to originate in the skin. Herein we report a case of a 61-year-old Caucasian male who presented with a large blue-black nodule on his left cheek, clinically suspicious for a melanoma; however, histological evaluation revealed an acantholytic pigmented squamous cell carcinoma. Previous cases are reviewed and the clinical and histological differential diagnoses are discussed.     

Pigmented squamous cell carcinoma

Pigmented squamous cell carcinomas have been reported in the oral and ocular mucosae, but rarely in the skin. We present a case of pigmented squamous cell carcinoma of the forehead and review the current English literature. Pigmented squamous cell carcinoma can be confused with pigmented basal cell carcinomas and melanoma, especially those melanomas associated with pseudoepitheliomatous hyperplasia and should be included in the differential diagnosis of atypical pigmented lesions.