Journal of Skin Cancer The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Mycosis Fungoides in Iranian Population: An Epidemiological and Clinicopathological Study Wed, 28 Jan 2015 13:45:30 +0000 Background. Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. Extensive studies on Iranian MF patients are absent. The present study aimed to produce updated clinical information on Iranian MF patients. Methods. This was a retrospective, descriptive, single-center study, including all cases of MF seen in the Department of Dermatology, University Hospital of Isfahan, Iran, between 2003 and 2013. Data systematically recorded for each patient included clinical, biological, histological, and molecular findings. Results. Eighty-six patients with clinical and histologic diagnosis of MF were included in the study. Thirty-nine patients (45.3%) were male. Female predominance was observed in patients (male : female ratio is 1 : 1.2). Patients were between 7 and 84 years of age (median: 41). The interval from disease onset to diagnosis ranged from 0 to 55 years (median: 1 year). Eighteen cases (20.9%) had unusual variants of MF. The most common types included hypopigmented and poikilodermatous MF. Childhood cases of MF constituted 5.8% (5/86) of all patients. The early stages were seen in 82 cases (95.34%). Conclusion. The major differences in epidemiologic characteristics of MF in Iran are the lack of male predominance and the lower age of patients at the time of diagnosis. Farahnaz Fatemi Naeini, Bahareh Abtahi-Naeini, Hamidreza Sadeghiyan, Mohammad Ali Nilforoushzadeh, Jamshid Najafian, and Mohsen Pourazizi Copyright © 2015 Farahnaz Fatemi Naeini et al. All rights reserved. Dual S-100-AE1/3 Immunohistochemistry to Detect Perineural Invasion in Nonmelanoma Skin Cancers Sun, 18 Jan 2015 08:12:49 +0000 Background. Perineural invasion (PNI) is an adverse prognostic histologic finding and increases the risk of local recurrence and metastasis. Objective. We aimed to determine if dual immunohistochemical (IHC) staining with S-100 and AE1/3 would increase the detection of PNI on nonmelanoma skin cancers (NMSCs). Methods. We collected 45 specimens of NMSCs in which there was clinical suspicion for PNI. Two dermatopathologists independently reviewed the tumors for the unequivocal presence of PNI. Results. Unequivocal PNI was present on 10 of the 45 tumors by H&E staining and on 15 of the 45 tumors by IHC staining. Large nerves (>0.1 mm) were involved in 3 of 10 H&E-stained cases and 3 of 15 IHC-stained cases, with 2 of the 4 cases demonstrating large nerve involvement with both staining methods. Of the 8 cases of PNI detected only on IHC, 7 were small nerves (≤0.1 mm). Limitations. All cases were selected because they were clinically suspicious for PNI, and this may be considered selection bias. Conclusions. PNI detection may be increased using dual S-100 and AE1/3 staining, but the majority of additional cases detected were small nerves. The clinical significance, given the small size of the involved nerves, is unclear. Alma C. Berlingeri-Ramos, Claire J. Detweiler, Richard F. Wagner Jr., and Brent C. Kelly Copyright © 2015 Alma C. Berlingeri-Ramos et al. All rights reserved. Risk of Second Cancers in Merkel Cell Carcinoma: A Meta-Analysis of Population Based Cohort Studies Wed, 10 Dec 2014 09:55:21 +0000 The risk of second cancers in Merkel cell carcinoma (MCC) remains uncertain since risk estimates vary worldwide. The global MCC population is growing and there is a demand for better knowledge of prognosis of this disease. The Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE search engines were searched for the relevant literature between January 1999 and September 2014 by use of explicit search criteria. The main outcome was second malignancies associated with MCC patients measured by standardized incidence ratios (SIRs) or other estimates of risks. Five papers fulfilled the inclusion criteria and reported SIRs of second cancer in MCC which varied from 1.07 to 2.80. Performing meta-analysis using random effects model revealed that there was an increased risk for second malignancies due to MCC (SIR, 1.52; 95% CI, 1.10–2.11). There was a significant increase in risk for malignant melanoma (SIR, 3.09; 95% CI, 2.02–4.73) as compared to all common second malignancies among the studies. Updated knowledge about risk of second malignancies in MCC will help in better assessment of the disease prognosis and will help in optimizing the medical and surgical treatment, radiotherapy, follow-up, and surveillance procedures. Anshul Saxena, Muni Rubens, Venkataraghavan Ramamoorthy, and Hafiz Khan Copyright © 2014 Anshul Saxena et al. All rights reserved. Validity and Stability of the Decisional Balance for Sun Protection Inventory Sun, 07 Dec 2014 07:29:12 +0000 The 8-item Decisional Balance for sun protection inventory (SunDB) assesses the relative importance of the perceived advantages (Pros) and disadvantages (Cons) of sun protective behaviors. This study examined the psychometric properties of the SunDB measure, including invariance of the measurement model, in a population-based sample of adults. Confirmatory factor analyses supported the theoretically based 2-factor (Pros, Cons) model, with high internal consistencies for each subscale (). Multiple-sample CFA established that this factor pattern was invariant across multiple population subgroups, including gender, racial identity, age, education level, and stage of change subgroups. Multivariate analysis by stage of change replicated expected patterns for SunDB (Pros , Cons ). These results demonstrate the internal and external validity and measurement stability of the SunDB instrument in adults, supporting its use in research and intervention. Hui-Qing Yin, Joseph S. Rossi, Colleen A. Redding, Andrea L. Paiva, Steven F. Babbin, and Wayne F. Velicer Copyright © 2014 Hui-Qing Yin et al. All rights reserved. The Experience of Melanoma Follow-Up Care: An Online Survey of Patients in Australia Wed, 19 Nov 2014 00:00:00 +0000 Investigating patients’ reports on the quality and consistency of melanoma follow-up care in Australia would assist in evaluating if this care is effective and meeting patients’ needs. The objective of this study was to obtain and explore the patients’ account of the technical and interpersonal aspects of melanoma follow-up care received. An online survey was conducted to acquire details of patients’ experience. Participants were patients treated in Australia for primary melanoma. Qualitative and quantitative data about patient perceptions of the nature and quality of their follow-up care were collected, including provision of melanoma specific information, psychosocial support, and imaging tests received. Inconsistencies were reported in the provision and quality of care received. Patient satisfaction was generally low and provision of reassurance from health professionals was construed as an essential element of quality of care. “Gaps” in follow-up care for melanoma patients were identified, particularly provision of adequate psychosocial support and patient education. Focus on strategies for greater consistency in the provision of support, information, and investigations received, may generate a cost dividend which could be reinvested in preventive and supportive care and benefit patient well-being. Janine Mitchell, Peta Callaghan, Jackie Street, Susan Neuhaus, and Taryn Bessen Copyright © 2014 Janine Mitchell et al. All rights reserved. Sun Protection Beliefs among Hispanics in the US Sun, 09 Nov 2014 14:04:57 +0000 Purpose. We reviewed the literature on sun protection beliefs in Hispanics living in the United States to explore what challenges are faced by area of research. Method. A review of PubMED, PsycINFO, and CINAHL databases was performed. Studies were published in peer-reviewed journals (in all years available) and written in English. The search terms used were [“skin cancer” OR “sun protection”] AND [“Latino” OR “Hispanic”] AND “beliefs.” Eligible papers were included in the final analysis after meeting the following inclusion criteria: (1) the records had to quantitatively examine and report sun protection beliefs in Hispanics, (2) the number of Hispanic participants in the sample had to be clearly specified, and (3) studies reporting differences in sun protection beliefs between Hispanics and other racial and ethnic groups were included in the review. Results. Of the 92 articles identified, 11 met inclusion criteria and addressed sun protection beliefs regarding skin cancer seriousness and susceptibility, and benefits and barriers of sun protection and skin cancer risk behaviors. Characteristics of studies and results were examined. Conclusion. There is insufficient evidence to determine a pattern of sun protection beliefs among Hispanics in the United States. More quality studies are needed which focus on sun protection beliefs in Hispanics. Marimer Santiago-Rivas, Chang Wang, and Lina Jandorf Copyright © 2014 Marimer Santiago-Rivas et al. All rights reserved. A Study of Basal Cell Carcinoma in South Asians for Risk Factor and Clinicopathological Characterization: A Hospital Based Study Mon, 03 Nov 2014 07:55:57 +0000 Objectives. Although the incidence of skin cancers in India (part of South Asia) is low, the absolute number of cases may be significant due to large population. The existing literature on BCC in India is scant. So, this study was done focusing on its epidemiology, risk factors, and clinicopathological aspects. Methods. A hospital based cross-sectional study was conducted in Punjab, North India, from 2011 to 2013. History, examination and histopathological confirmation were done in all the patients visiting skin department with suspected lesions. Results. Out of 36 confirmed cases, 63.9% were females with mean ± SD age being years. Mean duration of disease was 4.7 years. Though there was statistically significant higher sun exposure in males compared to females ( value being 0.000), BCC was commoner in females, explainable by intermittent sun exposure (during household work in the open kitchens) in women. Majority of patients (88.9%) had a single lesion. Head and neck region was involved in 97.2% of cases, with nose being the commonest site (50%) with nodular/noduloulcerative morphology in 77.8% of cases. Pigmentation was evident in 22.2% of cases clinically. Nodular variety was the commonest histopathological variant (77.8%). Conclusions. This study highlights a paradoxically increasing trend of BCC with female preponderance, preferential involvement of nose, and higher percentage of pigmentation in Indians. Sumir Kumar, Bharat Bhushan Mahajan, Sandeep Kaur, Ashish Yadav, Navtej Singh, and Amarbir Singh Copyright © 2014 Sumir Kumar et al. All rights reserved. Evaluation of the Definitions of “High-Risk” Cutaneous Squamous Cell Carcinoma Using the American Joint Committee on Cancer Staging Criteria and National Comprehensive Cancer Network Guidelines Wed, 17 Sep 2014 00:00:00 +0000 Recent guidelines from the American Joint Committee on Cancer (AJCC) and National Comprehensive Cancer Network (NCCN) have been proposed for the assessment of “high-risk” cutaneous squamous cell carcinomas (cSCCs). Though different in perspective, both guidelines share the common goals of trying to identify “high-risk” cSCCs and improving patient outcomes. Thus, in theory, both definitions should identify a similar proportion of “high-risk” tumors. We sought to evaluate the AJCC and NCCN definitions of “high-risk” cSCCs and to assess their concordance. Methods. A retrospective review of head and neck cSCCs seen by an academic dermatology department from July 2010 to November 2011 was performed. Results. By AJCC criteria, most tumors (%) were of Stage 1; 46 tumors (13.9%) were of Stage 2. Almost all were of Stage 2 due to size alone (≥2 cm); one tumor was “upstaged” due to “high-risk features.” Using the NCCN taxonomy, 231 (87%) of tumors were “high-risk.” Discussion. This analysis demonstrates discordance between AJCC and NCCN definitions of “high-risk” cSCC. Few cSCCs are of Stage 2 by AJCC criteria, while most are “high-risk” by the NCCN guidelines. While the current guidelines represent significant progress, further studies are needed to generate a unified definition of “high-risk” cSCC to optimize management. Melinda B. Chu, Jordan B. Slutsky, Maulik M. Dhandha, Brandon T. Beal, Eric S. Armbrecht, Ronald J. Walker, Mark A. Varvares, and Scott W. Fosko Copyright © 2014 Melinda B. Chu et al. All rights reserved. Six Years of Experience in Photodynamic Therapy for Basal Cell Carcinoma: Results and Fluorescence Diagnosis from 191 Lesions Sun, 14 Sep 2014 06:21:36 +0000 Background. Photodynamic therapy (PDT) has become a therapeutic option for basal cell carcinoma (BCC) in the last decade. Objectives. To study the results and predictors of BCC response to treatment with PDT and to evaluate fluorescence diagnosis of BCC. Methods. A descriptive, retrospective, and observational study was carried out. Patients with biopsy-confirmed BCC who were treated with methyl aminolevulinate and red light according to standard treatment protocols (2 sessions separated by 2 weeks, 630 nm, 37 J/cm2, 8 minutes, Aktilite) were selected. Response was scored as clinically complete and incomplete and the patients were followed up every three months. Results. Data from 191 BCC in 181 patients with a mean age of 69.55 years and a mean follow-up period of 34.4 months were collected. The overall response was 74% of the BCC treated, with the best response in superficial BCC with a 95% of complete response. The regression analysis revealed that the superficial histological type was the primary factor predictive of a complete response. Conclusions. In the treatment of BCC with PDT, the most significant factor for predicting response is the histological type. M. Fernández-Guarino, A. Harto, B. Pérez-García, A. Royuela, and P. Jaén Copyright © 2014 M. Fernández-Guarino et al. All rights reserved. A Clinicopathological and Immunohistochemical Correlation in Cutaneous Metastases from Internal Malignancies: A Five-Year Study Mon, 25 Aug 2014 10:43:40 +0000 Cutaneous metastases from internal malignancies are uncommon and occur in 0.6%–10.4% of all patients with cancer. In most cases, cutaneous metastases develop after the initial diagnosis of the primary internal malignancy and late in the course of the disease. Skin tumors are infrequent in Asian population and cutaneous metastases are quite rare. Cutaneous metastases carry a poor prognosis with average survival of few months. In the present five-year study 1924 malignant tumors were screened which included only nine cases of cutaneous metastatic deposits. A wide range of site and clinical presentations including nodules, plaques, and ulcers was noted. Histopathological findings were significant and corresponded with the primary internal malignancy. Cutaneous metastases from breast carcinoma (44.4%) were the most common finding followed by non-Hodgkin lymphoma and renal cell carcinoma (22.2% each) and carcinoma cervix (11.1%). The aim of our study is to classify the cutaneous metastases and to evaluate their clinicopathologic and immunohistochemical correlation with the primary tumor. Sarita Nibhoria, Kanwardeep Kaur Tiwana, Manmeet Kaur, and Sumir Kumar Copyright © 2014 Sarita Nibhoria et al. All rights reserved. Decrease in Self-Reported Tanning Frequency among Utah Teens following the Passage of Utah Senate Bill 41: An Analysis of the Effects of Youth-Access Restriction Laws on Tanning Behaviors Wed, 20 Aug 2014 11:24:19 +0000 Introduction. Adolescent use of indoor tanning facilities is associated with an increased risk in later development of melanoma skin cancers. States that have imposed age restrictions on access to indoor tanning generally show lower self-reported rates of indoor tanning than states with no restrictions, but currently no studies have assessed indoor tanning use before and after such restrictions. Methods. In 2013, we compared self-reported indoor tanning data collected in the Prevention Needs Assessment (PNA) survey in 2011 to PNA 2013 data. We also assessed predictors of continued tanning after passage of the bill. Results. Prior to the passage of Senate Bill 41, 12% of students reported at least one incident of indoor tanning in the past 12 months. After passage, only 7% of students reported indoor tanning in the past 12 months (P < 0.0001). Students who continued indoor tanning were more likely to be older and female and to engage in other risk behaviors, including smoking and alcohol use. Lower parental education levels were also associated with continued tanning. Conclusion. Indoor tanning restrictions showed beneficial impact on tanning rates in adolescents in Utah. Stricter restrictions may show even greater impact than restrictions that allow for parental waivers. Stronger enforcement of bans is needed to further reduce youth access. Rebecca G. Simmons, Kristi Smith, Meghan Balough, and Michael Friedrichs Copyright © 2014 Rebecca G. Simmons et al. All rights reserved. Melanocyte and Melanoma Cell Activation by Calprotectin Tue, 12 Aug 2014 11:52:40 +0000 Calprotectin, a heterodimer of S100A8 and S100A9, is a proinflammatory cytokine released from ultraviolet radiation-exposed keratinocytes. Calprotectin binds to Toll-like receptor 4, the receptor for advanced glycation end-products, and extracellular matrix metalloproteinase inducer on target cells to stimulate migration. Melanocytes and melanoma cells produce little if any calprotectin, but they do express receptors for the cytokine. Thus, keratinocyte-derived calprotectin has the potential to activate melanocytes and melanoma cells within the epidermis in a paracrine manner. We examined the ability of calprotectin to stimulate proliferation and migration in normal human melanocytes and melanoma cells in vitro. We first showed, by immunofluorescence and quantitative RT-PCR, that the melanocytic cells employed expressed a calprotectin receptor, the receptor for advanced end-products. We then demonstrated that calprotectin significantly enhanced proliferation, migration, and Matrigel invasion in both normal human melanocytes and melanoma cells. Thus, calprotectin is one of the numerous paracrine factors released by ultraviolet radiation-exposed keratinocytes that may promote melanomagenesis and is a potential target for melanoma prevention or therapy. Stephanie H. Shirley, Kristine von Maltzan, Paige O. Robbins, and Donna F. Kusewitt Copyright © 2014 Stephanie H. Shirley et al. All rights reserved. Locally Advanced and Unresectable Cutaneous Squamous Cell Carcinoma: Outcomes of Concurrent Cetuximab and Radiotherapy Mon, 21 Jul 2014 00:00:00 +0000 Background. Advanced age and immune dysfunction are risk factors for cutaneous squamous cell carcinoma (cSCC) and often render patients with locally-advanced disease medically inoperable or surgically unresectable, but potentially curable with radiotherapy. Concurrent chemotherapy and radiotherapy may not be well tolerated in this population, but another systemic therapy may improve disease control. Objective. Determine the tolerance and efficacy of concurrent cetuximab and radiotherapy (CRT) for patients with locally advanced and unresectable cSCC. Methods. Retrospective analysis of 12 patients treated with CRT for locally advanced and unresectable cSCC. Results. Patients were elderly and 75% had moderate-to-severe comorbidities, while 42% had immune dysfunction. Grades 3-4 adverse events were noted in 83% of patients; 67% required hospital admission for adverse events. Complete and partial response was noted in 36% and 27% (response rate, 64%). Stable and progressive disease was noted in 3 and 1 patients, respectively (disease control rate, 91%). Median progression-free and overall survival were 6.4 and 8.0 months, respectively. Limitations. Retrospective small-cohort, single-institution analysis. Conclusion. Patients selected for CRT were elderly, with comorbidities and immune dysfunction, but treatment responses were observed. Patients selected for this treatment approach have a poor prognosis with limited capacity for therapy; more effective treatment is needed. Robert M. Samstein, Alan L. Ho, Nancy Y. Lee, and Christopher A. Barker Copyright © 2014 Robert M. Samstein et al. All rights reserved. The Influence of the Coexpression of CD4 and CD8 in Cutaneous Lesions on Prognosis of Mycosis Fungoides: A Preliminary Study Sun, 20 Jul 2014 07:03:54 +0000 Background. Although techniques of immunophenotyping have been successful in characterizing the cells in the cutaneous infiltrates of mycosis fungoides little evidence suggests that variations in the phenotypic characterization correlate with prognosis. Objectives. In a preliminary prospective, single-centre, study we correlated the T-cell phenotype in cutaneous biopsies with the progression of the disease to determine whether the coexpression of CD4 and CD8 has an impact on prognosis. Methods. Skin biopsy specimens from 30 newly diagnosed patients were stained with immunoperoxidase techniques to determine their phenotypic characteristics. After a median followup of 42 months patients were divided into two groups with stable and progressive disease. Results. Eighteen patients had the conventional CD4+CD8− T-cell phenotype. Ten patients showed the coexpression of CD4 and CD8 and had a slightly lower rate of progressive disease. Conclusions. The coexpression of CD4 and CD8 in cutaneous lesions is not rare and is associated with a slightly lower rate of progressive disease. Since double positive CD4/CD8 phenotype is rarely reported in mycosis fungoides the presence on conventional immunophenotyping of both CD may be due to a “mixture” of neoplastic cells and inflammatory CD8+ tumor infiltrating lymphocytes. Immunohistochemical study combined with confocal microscopy could clarify this issue. Sergio Umberto De Marchi, Giuseppe Stinco, Enzo Errichetti, Serena Bonin, Nicola di Meo, and Giusto Trevisan Copyright © 2014 Sergio Umberto De Marchi et al. All rights reserved. Saphenous Vein Sparing Superficial Inguinal Dissection in Lower Extremity Melanoma Sun, 13 Jul 2014 12:06:26 +0000 Aim. The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative morbidity. The permanent lymphedema is the most devastating long-term complication leading to a significant decrease in the patient’s quality of life. In this study we present our experience with modified, saphenous vein sparing, inguinal lymph node dissections for patients with melanoma of the lower extremity. Methods. Twenty one patients (10 women, 11 men) who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity were included in this study. The effects of saphenous vein sparing on postoperative complications were evaluated. Results. We have observed the decreased rate of long-term lymphedema in patients undergoing inguinal lymphadenectomy for the lower extremity melanoma. Conclusion. The inguinal lymphadenectomy with saphenous vein preservation in lower extremity melanoma patients seems to be an oncologically safe procedure and it may offer reduced long-term morbidity. Muhammed Beşir Öztürk, Arzu Akan, Özay Özkaya, Onur Egemen, Ali Rıza Öreroğlu, Turgut Kayadibi, and Mithat Akan Copyright © 2014 Muhammed Beşir Öztürk et al. All rights reserved. Prognostic Value of Melanoma Inhibitory Activity Protein in Localized Cutaneous Malignant Melanoma Sun, 22 Jun 2014 12:31:15 +0000 Background. Cutaneous malignant melanoma (CMM) is a heterogeneous disease, acknowledged for its lack of predictability regarding clinical evolution. In order to appreciate a patient’s individual prognosis, an attempt is made to find new tumor markers that parallel the disease progression. Objective. To identify if melanoma inhibitory activity (MIA) protein could represent a tool for selecting high risk early stages melanoma patients. Method. Between 2008 and 2013, 155 patients with CMM were treated in our clinic. 84 of them were classified into stages I and II, according to TNM 2009. MIA serum concentration was measured in all patients and 50 healthy donors. A cut-off value of 9.4 ng/ml was established using the ROC curve. Results. All patients were followed up by periodic investigations every 6 months. We have noticed that 66% of patients with MIA serum values at diagnosis greater than 9.4 ng/mL have relapsed, while only 5% of patients with MIA serum concentration below the estimated threshold, recurred during the follow-up period . The death risk was 12 times higher in pathological MIA group of patients . Conclusions. Our data suggest that MIA is an independent prognostic factor for patients with localized CMM. Angela Sandru, Eugenia Panaitescu, Silviu Voinea, Madalina Bolovan, Adina Stanciu, Sabin Cinca, and Alexandru Blidaru Copyright © 2014 Angela Sandru et al. All rights reserved. Assessing the Current Market of Sunscreen: A Cross-Sectional Study of Sunscreen Availability in Three Metropolitan Counties in the United States Thu, 15 May 2014 11:04:52 +0000 Sunscreen use is recommended for the prevention of sunburn and skin cancer. Little is known regarding sunscreen availability in high versus low income communities. We analyzed sunscreen availability in three large metropolitan counties to determine the relationship between availability and community demographics. We included sun care products in all pharmacies and supermarkets open as of July 2013 in representative high and low income zip codes in Cook County, Illinois, Miami-Dade County, Florida, and San Diego County, California. We recorded the percentage of tanning oil, sunscreens with a sun protection factor (SPF) < 15, SPF > 15, physical sunscreens, spray sunscreens, mean price per ounce (PPO), and mean SPF. Of the total products assessed, 11.0% were tanning oils, with physical sunscreens accounting for only 3.4% of the available sunscreens and 46.2% of sunscreens being spray-on. A comparison between higher and lower income zip codes demonstrated a significantly increased percentage of sunscreens with SPF < 15 in high income zip codes. Lower income zip codes had higher percentages of sunscreens with SPF > 15 and higher PPO, even when taking into account SPF. Further studies of sunscreen usage patterns in different populations must take into account sunscreen availability and price, as these significantly differ based on the community demographic. Kyle T. Amber, Romi Bloom, Patrick Staropoli, Sonam Dhiman, and Shasa Hu Copyright © 2014 Kyle T. Amber et al. All rights reserved. Squamous Cell Carcinomas of the Skin Explore Angiogenesis-Independent Mechanisms of Tumour Vascularization Tue, 06 May 2014 16:06:38 +0000 Aims. To evaluate the vascularization in basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of the skin. Methods. We performed CD31 (i.e., panendothelial marker) and CD105 (i.e., proliferating endothelium marker) immunostaining on samples of 70 SCCs and 70 BCCs of the skin. We evaluated the relative blood vessel area using the Chalkley counting method in each histologic subtype of these tumours. We calculated the degree of proliferation of blood vessel endothelium dividing CD105-Chalkley score by CD31-Chalkley score. Results. We found significantly higher peritumoral and intratumoral blood vessel area in SCC when compared to BCC (both with CD31 and CD105). Chalkley counts differed significantly between groups with different BCC histologic subtypes and SCC with different grade of differentiation. Surprisingly, the degree of proliferation of blood vessel endothelium was higher in BCC when compared to SCC. Conclusions. While SCC exhibited significantly higher intratumoral and peritumoral blood vessel areas compared to BCC, the relatively low rate of proliferating endothelium in this tumour type suggests the existence of endothelial-sprouting-independent mechanisms of vascularization in SCC. Ievgenia Pastushenko, Tamara Gracia-Cazaña, Sandra Vicente-Arregui, Gert G. Van den Eynden, Mariano Ara, Peter B. Vermeulen, Franciso José Carapeto, and Steven J. Van Laere Copyright © 2014 Ievgenia Pastushenko et al. All rights reserved. Melanoma Development and Progression Are Associated with Rad6 Upregulation and β-Catenin Relocation to the Cell Membrane Tue, 06 May 2014 12:20:29 +0000 We have previously demonstrated that Rad6 and β-catenin enhance each other's expression through a positive feedback loop to promote breast cancer development/progression. While β-catenin has been implicated in melanoma pathogenesis, Rad6 function has not been investigated. Here, we examined the relationship between Rad6 and β-catenin in melanoma development and progression. Eighty-eight cutaneous tumors, 30 nevi, 29 primary melanoma, and 29 metastatic melanomas, were immunostained with anti-β-catenin and anti-Rad6 antibodies. Strong expression of Rad6 was observed in only 27% of nevi as compared to 100% of primary and 96% of metastatic melanomas. β-Catenin was strongly expressed in 97% of primary and 93% of metastatic melanomas, and unlike Rad6, in 93% of nevi. None of the tumors expressed nuclear β-catenin. β-Catenin was exclusively localized on the cell membrane of 55% of primary, 62% of metastatic melanomas, and only 10% of nevi. Cytoplasmic β-catenin was detected in 90% of nevi, 17% of primary, and 8% of metastatic melanoma, whereas 28% of primary and 30% of metastatic melanomas exhibited β-catenin at both locations. These data suggest that melanoma development and progression are associated with Rad6 upregulation and membranous redistribution of β-catenin and that β-catenin and Rad6 play independent roles in melanoma development. Karli Rosner, Darius R. Mehregan, Evangelia Kirou, Judith Abrams, Seongho Kim, Michelle Campbell, Jillian Frieder, Kelsey Lawrence, Brittany Haynes, and Malathy P. V. Shekhar Copyright © 2014 Karli Rosner et al. All rights reserved. Treatment Patterns in Patients with Metastatic Melanoma: A Retrospective Analysis Mon, 05 May 2014 00:00:00 +0000 Objective. To describe treatment patterns and factors influencing treatment in a real-world setting of US patients with metastatic melanoma (MM). Methods. This was a retrospective claims-based study among patients with MM diagnosed between 2005 and 2010 identified from MarketScan databases. Results. Of 2546 MM patients, 66.8% received surgery, 44.7% received radiation, 38.7% received systemic therapies, and 17.7% received all modalities. Patients with lung, brain, liver, or bone metastases were less likely to undergo surgery (all ); patients with lung (), brain (), or liver metastases () were more likely to receive systemic therapies; patients with brain () or bone metastases () were more likely to receive radiation therapy. Oncologists were more likely to recommend systemic therapy () or radiation (), while dermatologists were more likely to recommend surgery (). Monotherapy was the dominant systemic therapy (82.4% patients as first-line). Conclusions. Only 39% of MM patients received systemic therapies, perhaps reflecting efficacy and safety limitations of conventional systemic therapies for MM. Among those receiving systemic therapy, monotherapy was the most common approach. Sites of metastases and physician speciality influenced treatment patterns. This study serves as a baseline against which future treatment pattern studies, following approval of new agents, can be compared. Zhongyun Zhao, Song Wang, and Beth L. Barber Copyright © 2014 Zhongyun Zhao et al. All rights reserved. Basal Cell Carcinoma of the Head and Neck Region: A Retrospective Analysis of Completely Excised 331 Cases Thu, 17 Apr 2014 07:30:33 +0000 The aim of the study is to analyze all completely excised BCCs in the head and neck region with regard to age, sex, personal and familial history, skin type, tumor localization and size, histopathological subtype of tumor, reconstruction method, and recurrence rates. Incompletely excised BCCs were not included in this study since incomplete excision is the most important preventable risk factor for recurrence. In 320 patients, 331 lesions were retrospectively evaluated by dividing into the following 8 subunits: scalp, frontotemporal, orbital, nose, cheek, auricula, perioral, and chin-neck area. Most of the patients were in 60–70 age group (34.7%). The nose (32.3%) was the most common site of presentation. Clinically, all lesions and, histopathologically, most of the lesions (42.2%) presented were of the nodular type. All cases of recurrence after complete excision (, 2.7%) were located in the median parts of the head and neck region and were mainly diagnosed histopathologically as sclerotic and micronodular. Even though completely excised, head and neck region BCCs, especially which are more prone to recurrence due to anatomical and histopathological properties, should be more closely monitored in order to decrease morbidity and health care costs. Duriye Deniz Demirseren, Candemir Ceran, Berrak Aksam, Mustafa Erol Demirseren, and Ahmet Metin Copyright © 2014 Duriye Deniz Demirseren et al. All rights reserved. Skin Cancer Knowledge, Attitudes, and Behaviors in Collegiate Athletes Mon, 24 Mar 2014 14:24:19 +0000 Outdoor athletes represent an important group at risk for skin cancer because they are routinely exposed to high levels of ultraviolet radiation. The purpose of this study was to assess current skin cancer knowledge, attitudes, and behaviors among collegiate athletes. A modified version of the Melanoma Risk Behavior Survey was completed by 343 athletes attending a Southern University in the USA, generating an 87% response rate. Survey results demonstrated that the majority of the athletes do not limit their sun exposure and reported low levels of sun protective behaviors. In addition, athletes lacked knowledge about skin cancer and sun protection. Eighty-three percent of the athletes stated that tanning beds improve one’s overall health. Race was significantly associated with skin cancer knowledge, whereas, gender was found to be significantly associated with knowledge, attitudes, and behaviors towards skin cancer. Additionally, there was a significant relationship between knowledge and behavior, but not between attitude and behavior. This study highlights the need to educate athletes about the hazards of tanning to minimize UV exposure and promote sun protection habits. Moreover, athletes should be educated on the dangers of indoor tanning facilities and encouraged to avoid these facilities. Courtney Hobbs, Vinayak K. Nahar, M. Allison Ford, Martha A. Bass, and Robert T. Brodell Copyright © 2014 Courtney Hobbs et al. All rights reserved. Kaposi’s Sarcoma-Associated Herpesvirus Subversion of the Anti-Inflammatory Response in Human Skin Cells Reveals Correlates of Latency and Disease Pathogenesis Mon, 17 Feb 2014 10:00:43 +0000 KSHV is the etiologic agent for Kaposi’s sarcoma (KS), a neoplasm that manifests most aggressively as multifocal lesions on parts of human skin with a propensity for inflammatory reactivity. However, mechanisms that control evolution of KS from a benign hyperplasia to the histologically complex cutaneous lesion remain unknown. In this study, we found that KSHV induces proteomic and morphological changes in melanocytes and melanoma-derived cell lines, accompanied by deregulation of the endogenous anti-inflammatory responses anchored by the MC1-R/α-MSH signaling axis. We also identified two skin-derived cell lines that displayed differences in ability to support long-term KSHV infection and mapped this dichotomy to differences in (a) NF-κB activation status, (b) processing and expression of KSHV latency-associated nuclear antigen isoforms putatively associated with the viral lytic cycle, and (c) susceptibility to virus-induced changes in expression of key anti-inflammatory response genes that antagonize NF-κB, including MC1-R, POMC, TRP-1, and xCT. Viral subversion of molecules that control the balance between latency and lytic replication represents a novel correlate of KSHV pathogenesis and tropism in skin and underscores the potential benefit of harnessing the endogenous anti-inflammatory processes as a therapeutic option for attenuating cutaneous KS and other proinflammatory outcomes of KSHV infection in high-risk individuals. Judith M. Fontana, Justin G. Mygatt, Katelyn L. Conant, Chris H. Parsons, and Johnan A. R. Kaleeba Copyright © 2014 Judith M. Fontana et al. All rights reserved. Sun-Tanning Perceptions of a New Zealand Urban Population (1994–2005/6) Mon, 10 Feb 2014 07:20:16 +0000 Background. Sun-tanning perceptions are monitored to identify changes and help refine targeting of skin cancer prevention messages. Aim. To investigate associations between perceptions of sun-tanning and demographic factors among a New Zealand urban population, 1994–2006. Methods. A telephone survey series was conducted during summer in 1994, 1997, 1999/2000, 2002/2003, and 2005/2006. Demographic and personal information (sex, age group, skin sun-sensitivity, and self-defined ethnicity) obtained from 6,195 respondents, 50.2% female, 15–69 years, was investigated in relation to six sun-tanning related statements. A total “positive perceptions of tanning” (ProTan) score was also calculated. Regression analyses modelled each component and the ProTan score against survey year and respondent characteristics. Results. Statistically significantly higher ProTan scores were found for age group (strong reverse dose-response effect), male sex, residence (highest in Auckland), ethnicity (highest among Europeans), and sun sensitivity (an -shaped association). There was no statistically significant change in total ProTan scores from baseline. Conclusions. The development, pretesting, and evaluation of messages for those groups most likely to endorse ProTan statements should be considered for the New Zealand skin cancer prevention program. To achieve and embed significant change, mass media campaigns may require greater intensity and reinforcement with sustained contextual support for settings-based behavioural change. A. I. Reeder, G. F. H. McLeod, A. R. Gray, and R. McGee Copyright © 2014 A. I. Reeder et al. All rights reserved. Histopathological Study of Skin Adnexal Tumours—Institutional Study in South India Wed, 05 Feb 2014 11:52:21 +0000 Objective. The aim of this study was correlation of skin adnexal tumors with age, sex, and location and determining its incidence in the Department of Pathology at Dr. D. Y. Patil Medical College and Hospital, Kolhapur, Maharashtra. Material and Methods. 56 cases were included in this study from Jan 2004 to June 2010 with respect to incidence of adnexal tumors, age, and sex distribution. All slides were stained with haematoxylin and eosin and then findings were corroborated with special stains like PAS and reticulin wherever required. Results. 80.36% (45/56) were benign and 19.64% (11/56) were malignant adnexal tumors. The sweat gland tumors constituted the largest group (42.86% 24/56) cases followed by the hair follicle tumors (35.71%, 20/56) of cases and sebaceous gland tumors (21.43%, 12/56) cases. Overall male : female ratio was 1.07 : 1. The commonest age group was 51–60 years and the commonest affected body part was head and neck region (64.28%, 36/56) followed by trunk (14.28%, 8/56). Clear cell hidradenoma and pilomatricoma were commonest benign tumors and sebaceous carcinoma was the only malignant tumor seen. Conclusion. The incidence of benign skin adnexal tumors was more as compared to the malignant tumors. Malignant tumors were seen in older age group, usually over 50 years of age. Ankit Sharma, Deepak G. Paricharak, Jitendra Singh Nigam, Shivani Rewri, Priyanka Bhatia Soni, Anita Omhare, and Preethi Sekar Copyright © 2014 Ankit Sharma et al. All rights reserved. Characterization of the Merkel Cell Carcinoma miRNome Mon, 03 Feb 2014 12:03:17 +0000 MicroRNAs have been implicated in various skin cancers, including melanoma, squamous cell carcinoma, and basal cell carcinoma; however, the expression of microRNAs and their role in Merkel cell carcinoma (MCC) have yet to be explored in depth. To identify microRNAs specific to MCC (MCC-miRs), next-generation sequencing (NGS) of small RNA libraries was performed on different tissue samples including MCCs, other cutaneous tumors, and normal skin. Comparison of the profiles identified several microRNAs upregulated and downregulated in MCC. For validation, their expression was measured via qRT-PCR in a larger group of MCC and in a comparison group of non-MCC cutaneous tumors and normal skin. Eight microRNAs were upregulated in MCC: miR-502-3p, miR-9, miR-7, miR-340, miR-182, miR-190b, miR-873, and miR-183. Three microRNAs were downregulated: miR-3170, miR-125b, and miR-374c. Many of these MCC-miRs, the miR-183/182/96a cistron in particular, have connections to tumorigenic pathways implicated in MCC pathogenesis. In situ hybridization confirmed that the highly expressed MCC-miR, miR-182, is localized within tumor cells. Furthermore, NGS and qRT-PCR reveal that several of these MCC-miRs are highly expressed in the patient-derived MCC cell line, MS-1. These data indicate that we have identified a set of MCC-miRs with important implications for MCC research. Matthew S. Ning, Annette S. Kim, Nripesh Prasad, Shawn E. Levy, Huiqiu Zhang, and Thomas Andl Copyright © 2014 Matthew S. Ning et al. All rights reserved. The Pink Rim Sign: Location of Pink as an Indicator of Melanoma in Dermoscopic Images Mon, 03 Feb 2014 09:06:23 +0000 Background. In dermoscopic images, multiple shades of pink have been described in melanoma without specifying location of these areas within the lesion. Objective. The purpose of this study was to determine the statistics for the presence of centrally and peripherally located pink melanoma and benign melanocytic lesions. Methods. Three observers, untrained in dermoscopy, each retrospectively analyzed 1290 dermoscopic images (296 melanomas (170 in situ and 126 invasive), 994 benign melanocytic nevi) and assessed the presence of any shade of pink in the center and periphery of the lesion. Results. Pink was located in the peripheral region in 14.5% of melanomas and 6.3% of benign melanocytic lesions, yielding an odds ratio of 2.51 (95% CI: 1.7–3.8, ). Central pink was located in 12.8% of melanomas and 21.8% of benign lesions, yielding an odds ratio of 0.462 (95% CI: 0.67, ). Pink in melanoma in situ tended to be present throughout the lesion (68% of pink lesions). Pink in invasive melanoma was present in 17% of cases, often presenting as a pink rim. Conclusions. The presence of pink in the periphery or rim of a dermoscopic melanocytic lesion image provides an indication of malignancy. We offer the “pink rim sign” as a clue to the dermoscopic diagnosis of invasive melanoma. Ryan K. Rader, Katie S. Payne, Uday Guntupalli, Harold S. Rabinovitz, Maggie C. Oliviero, Rhett J. Drugge, Joseph J. Malters, and William V. Stoecker Copyright © 2014 Ryan K. Rader et al. All rights reserved. Gene Expression Differences Predict Treatment Outcome of Merkel Cell Carcinoma Patients Thu, 30 Jan 2014 09:20:41 +0000 Due to the rarity of Merkel cell carcinoma (MCC), prospective clinical trials have not been practical. This study aimed to identify biomarkers with prognostic significance. While sixty-two patients were identified who were treated for MCC at our institution, only seventeen patients had adequate formalin-fixed paraffin-embedded archival tissue and followup to be included in the study. Patients were stratified into good, moderate, or poor prognosis. Laser capture microdissection was used to isolate tumor cells for subsequent RNA isolation and gene expression analysis with Affymetrix GeneChip Human Exon 1.0 ST arrays. Among the 191 genes demonstrating significant differential expression between prognostic groups, keratin 20 and neurofilament protein have previously been identified in studies of MCC and were significantly upregulated in tumors from patients with a poor prognosis. Immunohistochemistry further established that keratin 20 was overexpressed in the poor prognosis tumors. In addition, novel genes of interest such as phospholipase A2 group X, kinesin family member 3A, tumor protein D52, mucin 1, and KIT were upregulated in specimens from patients with poor prognosis. Our pilot study identified several gene expression differences which could be used in the future as prognostic biomarkers in MCC patients. Loren Masterson, Bryan J. Thibodeau, Laura E. Fortier, Timothy J. Geddes, Barbara L. Pruetz, Rajwant Malhotra, Richard Keidan, and George D. Wilson Copyright © 2014 Loren Masterson et al. All rights reserved. Surgical Excision with Forehead Flap as Single Modality Treatment for Basal Cell Cancer of Central Face: Single Institutional Experience of 50 Cases Tue, 28 Jan 2014 08:15:43 +0000 Basal cell carcinoma (BCC) is the most common skin cancer worldwide. The WHO has defined it as “a locally invasive, slowly spreading tumor which rarely metastasizes, arising in the epidermis or hair follicles and in which the peripheral cells usually simulate the basal cells of the epidermis.” Here we discuss the management of BCCs of central face with surgical excision and reconstruction with forehead flap as single modality treatment. Material and Methods. This is a retrospective review of 50 patients who underwent surgical excision of BCC involving the facial region followed by primary reconstruction using forehead flaps at a single institution. There were 20 males and 30 females, mean age of 59 years. Results. No recurrence at primary site was observed during the follow-up of 1–4 yrs. There was no ectropion or exposure sequela. However, epiphora was evident. Size of lesions ranged from 2 to 6 cm. Keloid formation was seen in 2 (4%) patients. Functional and cosmetic outcomes were satisfactory. Conclusion. For the face, the best reconstructive effort eventually fails in the face of tumor recurrence. The forehead flap represents one of the best methods for repair of extensive facial defects. Complete tumor extirpation, the primary event, is the key. Jagdeep Rao and Harsh Deora Copyright © 2014 Jagdeep Rao and Harsh Deora. All rights reserved. Prediction of Sentinel Node Status and Clinical Outcome in a Melanoma Centre Wed, 25 Dec 2013 08:32:06 +0000 Background. Sentinel lymph node biopsy (SLNB) is a standard procedure for patients with localized cutaneous melanoma. The National Comprehensive Cancer Network (NCCN) Melanoma Panel has reinforced the status of the sentinel lymph node (SLN) as an important prognostic factor for melanoma survival. We sought to identify predictive factors associated with a positive SLNB and overall survival in our population. Methods. We performed a retrospective chart review of 221 patients who have done a successful SLNB for melanoma between 2004 and 2010 at our department. Univariate and multivariate analyses were done. Results. The SLNB was positive in 48 patients (21.7%). Univariate analysis showed that male gender, increasing Breslow thickness, tumor type, and absence of tumor-infiltrating lymphocytes were significantly associated with a positive SLNB. Multivariate analysis confirmed that Breslow thickness and the absence of tumor-infiltrating lymphocytes are independently predictive of SLN metastasis. The 5-year survival rates were 53.1% for SLN positive patients and 88.2% for SLN negative patients. Breslow thickness and the SLN status independently predict overall survival. Conclusions. The risk factors for a positive SLNB are consistent with those found in the previous literature. In addition, the SLN status is a major determinant of survival, which highlights its importance in melanoma management. Vera Teixeira, Ricardo Vieira, Inês Coutinho, Rita Cabral, David Serra, Maria José Julião, Maria Manuel Brites, Anabela Albuquerque, João Pedroso de Lima, and Américo Figueiredo Copyright © 2013 Vera Teixeira et al. All rights reserved.