Skin cancer is the most commonly diagnosed cancer in populations of predominantly Caucasian origins. As the main cause of skin cancer is excessive sun exposure among a sun-sensitive population, most skin cancers are theoretically avoidable, and prevention is an important topic for public health purposes. The development of skin cancer may be limited by effective primary prevention campaigns, causing people to protect themselves from the sun. In order to be effective, the right people need to become aware of the risks and benefits; they also need to be convinced that they can take effective protective measures. Secondary skin cancer prevention aims to avoid skin cancer morbidity and mortality and is, therefore, mainly aimed at early detection of cutaneous melanomas. Around the world, elderly men are the worst off in terms of melanoma mortality statistics and would be an important target group for secondary prevention. Several prevention initiatives have been developed, including awareness campaigns and voluntary skin cancer screening days. So far, few of these initiatives have proven to be successful in changing population behavior and/or skin cancer related mortality. Most of these initiatives appealed more to (young) women rather than the elderly males who would benefit most. In this review, various aspects of primary and secondary skin cancer prevention are discussed, including the results of some of the primary and secondary prevention initiatives.

Keratoacanthomas represent approximately 1% of skin malignancies treated in a Mohs practice in Houston, TX. The authors compared the age of onset, sex, location and month of prevalence of keratoacanthomas between Houston, TX and Minneapolis, MN. An earlier age of presentation was observed in men in Houston (65.9 years) versus in women (71.3 years) or in men and women in Minneapolis (71 years). There was a predominance of facial tumors in Texas males compared to females and tumors seen in Minneapolis. The tumors occurred more frequently during the winter months in Houston, TX versus June, November and December in Minneapolis, MN.

Objectives: A number of investigations have already been carried out to assess the effect of photodynamic therapy (PDT) on primary basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) lesions, but lack of investigations on recurrent lesions or lesions with treatment failure, prompted the authors to carry out this study. The aim of the present study was to evaluate the efficacy of photodynamic therapy on recurrent BCC and SCC lesions on head and neck skin.

Patients and Methods: A total of 30 patients, including 16 men and 14 women, were selected from patients with recurrent SCC and BCC who referred to Iran university ENT research center Rasool-e-Akram Hospital, Tehran-Iran, met the criteria and entered the study. This is a longitudinal study of 30 patients with 43 histologically verified head and neck skin tumors, candidate for photodynamic therapy.

Results: To cite the results obtained in this study, it is worth mention that five cases expressed disagreement with this treatment modality after the first session of illumination; the treatment was stopped because of pain or burning. In a three-month evaluation, complete treatment response rates were obtained in 72% of patients (18 cases); in SCC cases it was 71.4% (10 cases) and in BCC it was 72.7% (eight cases). The final result of complete response rate in three years of follow up, demonstrated that 16 (64%) patients out of 25 were disease-free from recurrent BCC and SCC (Table 1). In BCC cases the final three-year response rate was seven (63.6%) and in SCC cases it was nine (64.2%). Hence, there was no statistical difference between SCC and BCC cases to treatment (P=0.34).

Discussion: The obtained data from the current study is supportive of the recommended treatment method of PDT as an effective, tolerable and less invasive treatment in patients with recurrent BCC and SCC carcinomas, particularly when cosmetic effects are an important consideration. However, more research is needed to establish this.

Dermoscopy has clearly had a profound impact on the clinical diagnosis of pigmented lesions. It has been shown not only to be useful in the early diagnosis of melanomas but also, more recently, for the diagnosis of nonpigmented cutaneous malignancies. In this article, the authors will briefly explore the evolution of the use of this diagnostic technique along with how dermoscopy may be best utilized with future technologies.

This study compared the safety and efficacy of a non-prescription topical hemostatic powder (THP) containing a hydrophilic polymer and a potassium-based salt (group 1) to a sterile, compressed surgical sponge (group 2) for second intention healing (SIH) in 24 subjects following Mohs micrographic surgery (MMS) for the removal of non-melanoma skin cancers of the head and neck with a final defect size of 0.5 mm–2.0 cm. At least 50% of the subjects were receiving ongoing anti-coagulants. Hemostasis, rate of healing, wound size, global assessments of healing and application-site reactions were assessed. Time to hemostasis was measured at the time of surgery. Group 1 achieved hemostasis at a median of 52.5 seconds after the first stage of MMS versus 60 seconds in group 2. By week 12, wound size was reduced by a median of 182 mm2 in group 1 and 161.5 mm2 in group 2. A case series of subjects treated with THP following 4-mm punch biopsies is also discussed.

No abstract details for the moment.

No abstract details for the moment.

No abstract details for the moment.

Background: Combination products in which the individual components have different mechanisms of antimicrobial action have been shown in many disease states to provide the most effective therapy.
Methods: This 16-week, two-center, investigator-blinded, randomized, parallel-group study evaluated the antimicrobial efficacy of clindamycin phosphate 1%/benzoyl peroxide 5% gel (BPO/C) as compared to a clindamycin phosphate 1.2%/tretinoin 0.025% gel (T/C) over 16 weeks in the treatment of moderate to moderately severe acne.
Results: While subjects in both arms experienced reductions in total Propionibacterium acnes (P. acnes) counts, the BPO/C arm produced greater reductions throughout the study. Furthermore, overall reductions in the number of clindamycin-resistant and erythromycin- resistant P. acnes occurred only in BPO/C treated subjects.
Conclusion: These data suggest that clindamycin phosphate 1%/benzoyl peroxide 5% gel reduces P. acnes counts and mitigates the emergence of antimicrobial resistance.

A case series of Merkel cell carcinoma (MCC) is reported here and illustrates some of the current controversies in clinical management of this disease. From 1988–2007, 145 cases (74 men and 71 women) were analyzed. These were combined with other cases in the literature, hence the total number of patients was 433. Nodal metastases occurred clinically at presentation in 9/105 (9%) patients with primary tumor size <1 cm. The rate of nodal metastases is too high to obviate sentinel node biopsies even for these small tumors. For the 87 patients with intermediate tumor size (>1–<2 cm), nodal metastases occurred clinically in 11 of 87 patients (13%) at presentation and 23 of 87 patients (26%) during follow-up. Distant metastases occurred in 20 of 87 patients (23%) only at follow-up. The risks of nodal and distant failures for tumors of intermediate sizes were sufficient to be classified as high-risk for clinical study purposes.

In Asian patients, ablative laser therapies are seldom used to treat burn scars due to posttreatment dyschromia, especially when nonfacial areas are treated. The non-ablative 1550-nm erbium-doped fractional photothermolysis system, although effective, requires multiple treatment sessions. In the authors hands, a 34-year-old Korean woman achieved improved atrophy, contracture, texture and color of a burn scar on her chest after two treatments spaced six weeks apart with an ablative 10,600 nm CO2 fractional laser system (Ultrapulse® EncoreTM Laser, Lumenis Inc., Santa Clara, CA).

Nevoid basal cell carcinoma syndrome (NBCCS) is a genetic disorder characterized by multiple basal cell carcinomas (BCCs) in addition to skeletal abnormalities and other neoplasms. Difficulty lies in treating the large number of BCCs that develop in these patients. The authors report a case of a patient with NBCCS treated successfully with photodynamic therapy (PDT) using 20% 5-aminolevulinc acid and blue light. The authors also review the literature and summarize past case reports and series using PDT to treat patient with NBCCS. Based on their experience and the reports of others, the authors assert that PDT should become the first-line therapy in the treatment of multiple BCCs in patients with NBCCS.

The incidence of malignant melanoma has reached more than 62,000 people this past year alone. Much is unknown about the genetic predisposition of this cancer. The authors present a 62-year-old woman with a history of Charcot-Marie-Tooth disease (CMTD), diagnosed at age five, who has also developed multiple primary cutaneous malignant melanomas since 2003. The patient presented to the authors’ clinic with a pigmented lesion on the left thigh, which was increasing in size and changing color. The patient was diagnosed with malignant melanoma in situ on biopsy. As both CMTD and malignant melanoma are neural crest derived disorders, this may suggest a shared underlying genetic defect. A gene locus of particular interest is 1p36, both previously recognized in the proposed pathogenesis of CMTD and malignant melanoma (MM).

Subungual melanoma is a relatively rare variant of melanoma, accounting for 0.7–3.5% of all melanoma cases in the Caucasian population. Curiously, it occurs in 8–33% of cases in black, Asian, Native American and Hispanic populations, which generally face a substantially lower risk of melanoma. Herein the authors report the case of a 69-year-old Hispanic female with a subungual melanoma of the acral lentiginous type that directly invaded the periosteum, cortex and medulla of the distal phalanx. In addition, we review published reports of acral lentiginous melanoma with osseous invasion and discuss the evidence, on a molecular level, for this entity’s aggressive pattern of invasion. The review of cases is limited to those found through the PubMed search engine.

Skin cancer risk from the use of immunosuppressive medications used to treat inflammatory conditions is not well understood, though studies clearly establish an exaggerated risk of skin cancer in solid organ transplant recipients (SOTRs) receiving these medications. The authors report a patient with Behcet’s disease treated with combination immunosuppressive therapy and common variable immunodeficiency developing multiple squamous cell carcinomas (SCCs) of the skin, necessitating adjustment of her immunosuppressive regimen. As more patients are treated with immunosuppressive medications for chronic inflammatory diseases, clinicians must be aware of the possible increased risk of skin cancers associated with these medications. Skin cancer risk assessment, screening for sub-clinical malignancies and frequent skin exams of high risk patients may represent strategies to improve the safety of these medications.

Background: Malignant proliferating trichilemmal tumor (MPTT) is a rare neoplasm originating in the outer sheath of a hair follicle that often presents as a slowly enlarging, painful, subcutaneous scalp nodule. The authors describe a case of malignant proliferating trichilemmal tumor (MPTT) in an elderly 65-year-old Asian male who presented with a 5.5 x 5.0 cm mass on the posterior scalp.

Methods: The authors present a unique dual approach to treatment of MPTT in both the excision and wound revision phases. First, Mohs micrographic surgery is utilized for more discrete removal of malignant tissue, as opposed to wide excision. Then, a novel device called DermaClose® RC is used in wound revision, a device that has proven to be more effective in promoting wound closure than traditional suturing.

Results: Mohs micrographic surgery was used to excise the tumor in three stages. The resulting irregular wound measured 6.3 x 5.6 cm, and was repaired with the device. Following the application of the device, the wound reduced in size to 1.5–1.0 cm. Postoperatively, the patient had no evidence of recurrent disease at seven months.

Conclusion: Use of the DermaClose RC tissue expander following a Mohs surgical procedure provides an effective functional and cosmetic alternative to a skin graft which creates a donor site wound and creates a more complicated, time consuming procedure. The dual approach discussed here–of Mohs micrographic surgery performed in tandem with wound revision via the tissue expanding device is one that may yield promising benefits but warrants further evaluation.

Background: Methyl aminolevulinic acid photodynamic therapy (MAL-PDT) has antitumor activity and may promote wound healing. Superficial and nodular basal cell carcinomas (BCCs) have been successfully treated with MAL-PDT in prior reports. In vitro and animal studies have shown more rapid re-epithelialization and decreased myofibroblast response after treatment thus suggesting that PDT may play a possible role in promotion of wound healing.

Objectives: To describe a novel case of a large multifocal BCC treated with postoperative PDT that showed results of tumor clearance and rapid re-epithelialization and to review the relevant literature.

Case Report: A patient presented for Mohs micrographic surgery (MMS) after recent biopsy revealed recurrent BCC. Mohs micrographic surgery was performed, where after six stages were taken, approximately 50% of the peripheral margins of the tumor remained positive for superficial BCC. Given the large size of the wound defect (12.5 cm x 9 cm) and superficial nature of the persistent tumor, the authors opted to treat the patient with adjuvant MAL-PDT in lieu of pursuing additional stages with MMS. The patient returned the following day for adjuvant therapy with MAL-PDT. Two consecutive treatments one week apart were given as an adjunctive treatment course for persistent BCC. At follow-up four weeks after the PDT treatment, the defect had fully reepithelialized. In the authors’ clinical practice, an untreated wound of this size typically heals in 10–12 weeks. The patient has been seen in six months of follow-up to date. Review of the literature relevant to use of MAL-PDT in treatment of basal cell carcinoma and literature describing effects of PDT on wound healing was performed.

Conclusion: MAL-PDT may be an effective adjuvant tool against large multifocal BCCs for which surgery has not resulted in clearance. Treatment with PDT resulted in rapid re-epithelialization of the surgical wound in this case. This observation is supported by prior in vitro studies and in vivo animal experiments demonstrating more rapid re-epithelialization of wounds and decreased scarring response after PDT.

Sorafenib is a multikinase inhibitor that blocks tumor cell proliferation and angiogenesis and is used for the treatment of advanced renal cell carcinoma, unresectable hepatocellular carcinoma, and other solid tumors. Various dermatologic side effects have been reported, most notably a hand-foot-skin reaction (HFSR). This is a case of a sorafenib-induced psoriasiform eruption in a patient with metastatic thyroid carcinoma. This patient also developed cutaneous squamous cell carcinoma and HFSR in association with sorafenib. To the authors’ knowledge, a psoriasiform eruption due to sorafenib has not been reported in the literature and has important therapeutic implications.