A Retrospective Study of Demographic, Clinical, and Histopathological Profiles of Cutaneous Tumors

Introduction: The baseline data of primary malignant cutaneous soft tissue tumors in this environment had been determined. It is important that as the years roll by, data collection and analyses are indispensable to determine the current trend of this tumor on one hand and compare it with the baseline data from previous studies on the other hand. The aim of this study is therefore to determine the frequency and the histopathological types of primary malignant cutaneous soft tissue tumors at the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. Methodology: This was a retrospective study of all primary malignant cutaneous soft tissue tumors that were histologically diagnosed from 1st of January 2004 to 31st of December 2013 in the Department of Morbid Anatomy, UBTH. Data were obtained from departmental archives. Data analysis was done using the SPSS statistical package version 16 (V.16.0). Results: A total of 187 malignant cutaneous tumors were diagnosed over the study period, and 87 (46.52%) of these cases were primary malignant cutaneous soft tissue tumors. Their mean age was in the fourth decade of life. Females were slightly more affected with a male:female ratio of 1:1.2. The histopathological types were angiosarcomas (2.3%), dermatofibrosarcoma protuberance (10.3%), and Kaposi's sarcoma (87.4%) in increasing order of frequency. Conclusion: The earlier determined reference point data of primary cutaneous soft tissue tumors in our environment were updated to include cutaneous angiosarcoma, thus bringing this rare tumor to the attention of both the pathologist and dermatologist. An increase in the frequency of dermatofibrosarcoma protuberance and Kaposi's sarcoma was also noted.

The rising incidence and mortality associated with cutaneous malignant tumours highlight the importance of early diagnosis of these tumors. In clinical practice, these tumors are often misdiagnosed as benign skin lesions such as melanocytic nevi (MN) and seborrheic keratosis (SK) because of their similar morphologic features. The incidence and clinicopathological subtypes of cutaneous malignancies in East Asia populations significantly differ from those in fair-skinned groups. However, studies on misdiagnoses in Eastern countries are lacking. Therefore, this study focused on the clinical and pathological features of cutaneous malignant tumors misdiagnosed as MN or SK in a Chinese population. A total of 4592 samples clinically diagnosed as MN (n = 3503) or SK (n = 1089) from July 2014 to June 2022 were collected and evaluated retrospectively. The clinical and pathological data were analyzed to identify associated factors. Pathological assessments showed that 2.5% (86/3503) of the specimens clinically diagnosed as MN were malignancies, predominantly basal cell carcinoma (BCC, 84.9%, 73/86), followed by malignant melanoma (MM, 8.1%, 7/86) and squamous cell carcinoma (SCC, 7.0%, 6/86). Similarly, 5.7% (62/1089) of the specimens clinically diagnosed as SK were malignant tumors, of which BCC (50.0%, 31/62) was the most common, followed by SCC (41.9%, 26/62) and MM (8.1%, 5/62). In both types of specimens, advanced age and facial lesions were risk factors for malignancy misdiagnosis. The malignancy rate, mean age, and proportion of SCC in the specimens clinically diagnosed as SK were higher than those in the specimens clinically diagnosed as MN. Dermoscopy significantly reduced the rate of misdiagnosis of these tumors as MN or SK. In China, cutaneous malignant tumors misdiagnosed as MN or SK are not uncommon in clinical practice, and active introduction of noninvasive diagnostic techniques is essential to distinguish them.

Background: Melasma is a common hypermelanotic condition that can be frustrating to patients, thus appropriate diagnosis and management of melasma is required. Purpose: To evaluate patient’s profile, diagnosis, and management of melasma. Methods: Retrospective study of new patient in Cosmetic Division, Dermatology and Venereology Outpatient Clinic Dr. Soetomo General Hospital, Surabaya from January 2011 until December 2013. Result: Total new patient of melasma in Cosmetic Division, Dermatology and Venereology Outpatient Clinic, Dr. Soetomo General Hospital, Surabaya from January 2011 until December 2013 (3 years) is 869 patients. Conclusion: Appropriate diagnosis, treatment, and education is needed to manage melasma because of the chronicity and progressivity of this disease.

Background: Malassezia folliculitis (MF) is a chronic infection of the pilosebaceous follicles caused by a skin fungus Malassezia sp. most often in teenagers who marked the onset of itchy erythematous perifolicular papules and pustules, especially in the upper body area and rarely on the face. The clinical appearance must be distinguished from acne vulgaris which has a similar clinical picture, so often have the wrong diagnosis that will affect the prognosis of the disease. Objective: To evaluate the profile of MF in Dermatology and Venereology Outpatient Clinic Dr. Soetomo General Hospital. Methods: A cross-sectional, observational, descriptive study, total samplingin three months of forty-five new patients with acne vulgaris appearance visiting Dermatology and Venereology Outpatient Clinic Dr. Soetomo General Hospital according to inclusion and exclusion criteria. Diagnosis based on history, clinical examination, Wood's lamp and KOH 20%. Malassezia sp. identification using Mycobiotic culture that is added to the olive oil. Results: Forty five patients with a clinical appearance of acne vulgaris in the upper body and slightly exposed on the face area, the new MF patients showed a total of 36 patients (80%) and the remaining 9 patients (20%) were diagnosed with acne vulgaris. Conclusions:Thirty six MF patients with the highest age range 15-24 years, anamnesis obtained itching is moderate grade, predilection in the area of the upper body, and Wood's Lamp examination produces greenish yellow color, KOH 20% examination obtained spores, whereas culture is not required for the diagnosis of MF Key words: Malassezia sp., Malassezia folliculitis, acne vulgaris, Wood's lamp, KOH 20%.

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Type 1 leprosy reaction is a delayed hypersensitivity reaction caused by the increased response of cellular-mediated immunity to the Mycobacterium leprae antigen on the skin and nerves with a reversal result. The clinical manifestation includes inflammation which can cause skin and nerve lesions, swell, to permanent disabilities. Purpose: To describe the demographic and clinical profile of type 1 leprosy reaction at the Leprosy Division of the Dermatology and Venerology Outpatient Clinic of Dr. Soetomo General Academic Hospital in 2017–2019. Methods: This was a descriptive study. We used secondary data from the medical records of leprosy patients at the Leprosy Division of Dermatology and Venereology outpatient clinic, Dr. Soetomo General Academic Hospital Surabaya, from January 2017 to December 2019. Result: Out of 364 patients, 65 (17.9%) had type 1 reactions. They were mostly in productive age at 35–55 years old (56.9%). The patients were predominantly male (75.4%), with normal nutritional status (98.5%) and negative bacterial index (72.3%). The most common types of leprosy were BB (Borderline) with 61.6% and BL (Borderline Lepromatous) with 20.8%. All patients took WHO (World Health Organization) MDT (Multi Drug Therapy) MB (Multi-Bacillary). Conclusion: The profile of type 1 leprosy reaction at the Leprosy Division of Dermatology and Venerology Outpatient Clinic of Dr. Soetomo General Academic Hospital in 2017–2019 shows an average data as follows: age 35–55 years, male, normal nutritional status, negative bacterial index, leprosy type BB.

Squamous cell carcinoma (SCC) is the most common skin cancer diagnosed in solid organ transplant recipients (OTRs) and confers significant mortality. The development of SCC in the genital region is elevated in nonwhite OTRs. Viral induction, specifically human papillomavirus (HPV), is hypothesized to play a role in the pathophysiology of these lesions. To assess the prevalence and types of genital lesions observed in OTRs. This retrospective review included 496 OTRs who underwent full skin examination from November 1, 2011, to April 28, 2017, at an academic referral center. The review was divided into 2 distinct periods before a change in clinical management that took effect on February 1, 2016 (era 1) and after that change (era 2). Patient awareness of genital lesions was assessed. All lesions clinically suggestive of malignant tumors were biopsied and underwent HPV polymerase chain reaction typing. Number and types of genital lesions, proportion of malignant tumors positive for HPV, and patients cognizant of genital lesions. Of the total 496 OTRs, 376 OTRs were evaluated during era 1 (mean [SD] age, 60 years; age range, 32-94 years; 45 [65.2%] male; 164 [43.6%] white) and 120 OTRs were evaluated during era 2 of the study (mean age, 56 years; age range, 22-79 years; 76 [63.3%] male; 30 [25.0%] white). Overall, 111 of the 120 OTRs (92.5%) denied the presence of genital lesions during the history-taking portion of the medical examination. Genital lesions were found in 53 OTRs (44.2%), cutaneous malignant tumors (basal cell carcinoma and SCC in situ) in 6 (5.0%), genital SCC in situ in 3 (4.2%), and condyloma in 29 (24.2%). Eight of the 12 SCC in situ lesions (66.7%) were positive for high-risk HPV. Seven tested positive for HPV-16 and HPV-18, and 1 tested positive for high-risk HPV DNA but could not be further specified. Genital lesions in OTRs are common, but awareness is low. All OTRs should undergo thorough inspection of genital skin as a part of routine posttransplant skin examinations. Patients with darker skin types are disproportionately affected by cutaneous genital malignant tumors and should undergo a targeted program of early detection, prevention, and awareness focused on the risk of genital skin cancer after transplant. High-risk HPV subtypes are associated with genital SCC in OTRs. Additional studies are warranted to identify significant risk factors for HPV infection and to assess the utility of pretransplant HPV vaccination in the prevention of cutaneous genital malignant tumors.

Introduction: Skin diseases in elderly are often not recorded and are not complained of by elderly patients, but the more we let it become a problem in decreasing the quality of life of elderly patients, it can be seen in the current global situation that the biggest problem in elderly is degenerative diseases, with increasing age the function Physiological human and health changes will decrease due to degenerative processes (aging) which will have an impact on changes in humans, not only physical changes, but also cognitive, emotional, social and sexual changes and it is predicted that by 2050 around (75%) elderly who suffer from this degenerative disease will not suffer from this disease can work and have to stay at home. Objective To know the profile of skin disease in the elderly population who visited the Dermatology and Venereology Outpatient clinic Dr. Soetomo General Academic Surabaya period of 2019-2020. Methods This study is a retrospective descriptive study based on medical records at the Dermatology and Venereology Outpatient clinic Dr. Soetomo General Academic Surabaya, data collection was carried out in July 2021 - November 2021. In this study an evaluation of the profile of elderly patients with outpatient status was carried out by noting gender, age, domicile, chief complaint, comorbidities, fluorescence, diagnosis, examination of vital signs, therapy, and response to therapy. Results Based on the incidence in elderly patients at the Dermatology and Venereology Outpatient clinic Dr. Soetomo General Academic Surabaya for the 2019-2020 period. 299 patients were found the most were men (51.51%), the age group 66-74 years (58.86%), the most domiciled in Surabaya (82.27%), the most common chief complaint was itching (60.87%) , the most frequent diagnosis was xerosis cutis (29.10%) and the most common lesion was erythematous macules (46.25%). Conclusion : The most common disease on the elderlys skin is in the form of xerosis cutis which requires special management to prevent a decreases in the quality of life of individuals.

Parkinsonism is characterized by bradykinesia with rigidity and/or resting tremor, in addition to non-motor symptoms, which include dermatological manifestations. The objective of this study is to evaluate the main dermatoses in patients with parkinsonism found at the Philanthropic Association of Curitiba - PR. A cross-sectional descriptive study was carried out with the application of a questionnaire and dermatological evaluation of the patients. The sample consisted of 386 patients and was composed mainly by men (55.4%), between 60-74 years old (51.6%), with complete primary education (45.3%), disease diagnosis time between 5-10 years (35%) and in use of medication (96.6%). The most prevalent dermatoses were pigmented nevus (36.3%), warts (25.1%), actinic keratosis (22%), seborrheic keratosis (21.5%), seborrheic dermatitis (20.5%), and rosacea (19.2%). Among the 13 cases (3.4%) of malignant cutaneous neoplasms confirmed by biopsy, 2 were melanomas. Regarding patients' sex, there was a higher prevalence of inflammatory dermatoses (OR 1.64, 95% CI 1.08-2.51, p = 0.025) and benign cutaneous neoplasms (OR 1.77, 95% CI 1.16-2.69, p = 0.01) in men. As to age, patients aged between 60-74 years had more pre-malignant skin lesions (OR 2.60, 95% CI 1.05-6.44, p <0.001) and seborrheic keratosis (OR 2.52, 95% CI 1.02-6.25, p = 0.001) and, in those older than 75 years, actinic keratosis was more frequent (OR 5.43, 95% CI 2.17-13.6, p <0.001). The results of the study show that it is fundamental to dermatologically evaluate and monitor these patients, aiming at diagnosis and early treatment of lesions, especially of skin cancer.

Because cutaneous basal cell carcinoma (BCC) is such a common malignancy, its unusual histologic manifestations are important. We identified a variant of BCC in which thickened basement membranes surround aggregations of neoplastic epithelial cells. Thickened basement membranes of similar appearance have previously been observed in benign cutaneous adnexal neoplasms, in basaloid monomorphic adenomas of the salivary gland and in other benign conditions, such as folliculocentric basaloid proliferation. We identified nine BCCs that otherwise met standard criteria, but which also had thick basement membranes surrounding some of the aggregations, and examined them by routine and histochemical staining. The cases included BCC with nodular, micronodular, and infiltrating patterns. Two neoplasms were composed largely of clear cells, suggesting, together with the thickened membranes, outer root sheath differentiation. CD34, which labels keratinocytes of the outer root sheath, marked only the epithelial cells of one of these cases. The thickened membranes were stained by periodic-acid Schiff with and without diastase (PAS-D) and by antibodies to type IV collagen and laminin, with slightly different staining patterns. Intraepithelial droplets within aggregations stained with PAS-D and type IV collagen antibodies. Thickened basement membranes therefore can occur in most of the common growth patterns of BCC. The absence of CD34 staining of epithelial cells in most cases makes it problematic at this time to prove that the thickened membranes indicate trichilemmal differentiation. BCC with thick basement membranes can closely mimic benign neoplasms, such as cylindroma and trichilemmoma, from which they can be distinguished in routinely stained sections. The presence of a continuous thick basement membrane around aggregates of epithelial cells does not in and of itself distinguish between benign and malignant cutaneous epithelial neoplasms.

Granular cell tumor is rare and accounts for approximately 0.5 % of all soft tissue tumors. The malignant granular cell tumor, especially cutaneous malignant granular cell tumor is extremely rare. The present case is the first patient of primary cutaneous malignant granular cell tumor reported from China in English. A review of the literature is performed, and the presentation, position, pathological diagnosis, treatment and prognosis of the patients with cutaneous malignant granular cell tumor of the reported cases before is analysed.

Introduction: In geriatrics, there are changes in structure and function results in histopathological, physiological and clinical skin changes. The conditions can cause morbidity and decreases the quality of life of patients. This study was the first study that provide the characteristics of geriatric skin disorders in Dr. Mohammad Hoesin Hospital Palembang.&#x0D; Methods: This study was descriptive observational with cross-sectional design using total sampling method performed among patients in Geriatric Outpatient Clinic, Dermatology and Venereology Outpatient Clinic and geriatric inpatient room in Dr. Mohammad Hoesin Hospital on July-September 2019.&#x0D; Results: Physiological skin changes in geriatrics include xerosis cutis (13,95%), seborrheic keratosis (13,17%), guttate hypomelanosis (8,5%), senile lentigen (6,97%), freckle (2,32%), periorbital hyperpigmentation (1,55%), senile purpura (0,77%) and poikiloderma civatte (0,77%). The most skin disorder found were lichen simplex chronicus (11,1%), pressure ulcers (9,25%), senile pruritus (8,32%), asteatotic dermatitis (6.47%) and candidiasis (3,7%). The most common comorbid condition were diabetes mellitus in 16 patients (22,5%), CVD in 7 patients (9,9%), hypertension in 6 patients (8,5%), AKI in 6 patients (8,5 %), and HHD in 4 patients (5,6%). Diabetes mellitus was significantly associated with xerosis cutis (p = 0,0007), senile pruritus (p = 0,015), and guttate hypomelanosis (p = 0,016).&#x0D; Conclusion: The most physiological skin changes found in geriatric patients in Dr. Mohammad Hoesin Hospital were xerosis cutis, seborrheic keratosis, and guttate hypomelanosis, while skin disorder were lichen simplex chronicus, pressure ulcer, and senile pruritus. Diabetes mellitus was significantly associated with skin disorders.

Introduction:Malignant cutaneous epithelial tumors comprise various skin malignancies originating from the cutaneous epithelium, including cutaneous squamous cell carcinoma, basal cell carcinoma, and malignant cutaneous adnexal tumors. Treatment options are limited, as the rarity of these tumors, especially among Asians, renders well-controlled clinical trials extremely challenging to conduct. Thus, we designed a clinical trial to evaluate the efficacy and safety of the anti-programmed cell death-1 (PD-1) monoclonal antibody nivolumab in patients with metastatic cutaneous squamous cell carcinomas and other rare metastatic cutaneous epithelial tumors.Methods and analysis:This is an open-label, single-arm, multicenter, phase 2 clinical trial involving patients with metastatic malignant cutaneous epithelial tumors. Nivolumab (480 mg) will be administered intravenously every 4 weeks for a maximum of 26 doses. The primary outcome of the study will be the response rate based on response evaluation criteria in solid tumors, version 1.1. Assuming a null hypothesis of a response rate ≤5% and an alternative hypothesis of a 25% response rate, a minimum of 26 patients are required to achieve a 5% two-sided type I error and 80% power based on the exact binomial distribution. Finally, a target cohort size of 30 patients was determined as some patient dropout will be expected.Discussion:This is the first phase 2 clinical trial evaluating the efficacy and safety of the PD-1 inhibitor nivolumab in Asian patients with metastatic malignant cutaneous epithelial tumors. The findings of the study will contribute to the development of novel treatment approaches for patients with rare cutaneous malignancies, which remains an unmet clinical need.Trial registration:Registry number: jRCT 2031190048

Topical application of Photofrin® for photodynamic diagnosis of malignant cutaneous neoplasms

Background: Psoriasis is a complex, chronic disease with increasing global incidence. Studies on the effectiveness of psoriasis therapy in Indonesia are limited. This study aimed to evaluate the patient’s clinical improvement with moderate-to-severe psoriasis vulgaris using the Psoriasis Area and Severity Index with ≥75% score reduction (PASI75).&#x0D; Methods: This is a retrospective study involving patients diagnosed with psoriasis vulgaris who visited the Dermatology and Venereology Outpatient Clinic in Dr. Soetomo General Hospital between January 2016 and December 2018. The electronic medical record obtained data on demographic characteristics, the number of visits, psoriasis at initial (PASI) score before and after treatment, type and dose of treatment, and comorbidities. Data were analyzed using SPSS version 23 for Windows.&#x0D; Results: Overall, 54 patients with psoriasis vulgaris were included. Almost all subjects were adults (≥18 years old) and presented with severe PASI (PASI score &gt; 10) (96.3%). The majority of the subjects (64.8%) successfully achieved PASI75. Most subjects received methotrexate (72.2%); the most frequent dosage was 15 mg/week (61.5%). A significant association was found between methotrexate treatment and a larger improvement in PASI scores (p=0.001).&#x0D; Conclusion: moderate-to-severe psoriasis therapy in terms of PASI75 achieved a satisfactory success rate of 64.8%, and the improvement of PASI score was significantly better in patients who received methotrexate. Further studies in Indonesia are needed to explore the effectiveness of psoriasis therapy and its factors.

Abstract: Xeroderma pigmentosum is an autosomal recessive genetic disease that accompanied by abnormalities in deletion and repair of DNA due to enzymatic damage by ultraviolet radiation. It is described by photo hypersensitivity of areas exposed to sun radiation, changes in the skin pigmentation, cutaneous premature aging and increased risk of developing cutaneous and ocular malignant tumors early in life. Most common types of malignant cutaneous tumors detected are basal cell and squamous cell carcinoma and less commonly malignant melanoma. It is very frequent in certain areas of the world, most markedly Middle East, like Egypt and North Africa with positive consanguinity. In patients with Xeroderma pigmentosum prior to the age of 20 years, the risk of developing skin cancer is several thousand times greater. In patients with XP for non-melanoma skin cancers, the median age of onset is eight years relative to the non-XP population with a median age of onset of sixty years. This research study presents two siblings; 18-years-old sister and 16-years-old brother; from relative parents that had xeroderma pigmentosum with development of different malignant skin tumors. Treatment protocol was surgical excision of the malignant tumor with adequate safety margin and removal of enlarged lymph nodes. Reconstruction options were directed mainly to flap surgery. Postoperative follow up reveled no recurrence.