A bstract Juvenile ossifying fibromas constitute a group of heterogenous, rare, benign fibro-osseous lesions that affect the craniofacial skeleton including the jawbones. These tumors are distinguished due to their predilection for affecting younger age groups, non-specificity and also, overlapping clinico-radiologic presentation, and their potential, locally aggressive behavior. The authors report two distinct cases of aggressive juvenile ossifying fibroma of the mandible in pediatric patients who were referred for evaluation of their large expansile growths in the mandible. A brief overview of the varied clinical presentations, histopathological appearances, radiological features and management, and reconstructive options is discussed at length in the present case series.

Recessive Dystrophic Epidermolysis Bullosa (RDEB) is a severe type of epidermolysis bullosa resulting from mutations in COL7A1 gene. Patients experience various degrees of blistering following minor trauma which can over time lead to fibrosis, limb contractures and an increased risk of developing squamous cell carcinoma. The aim was to assess if repeated infusions of allogeneic umbilical cord derived mesenchymal stromal cells (UC-MSCs), CORDStromTM, were safe and could benefit children with RDEB. This was a prospective, double-blinded, randomised, placebo-controlled crossover trial with an internal dose de-escalation trial (for safety) conducted at the two National Paediatric UK EB centres in RDEB children aged >6months and <16years. Participants received IV infusions of 2-3 × 106 cells/kg of UC-MSCs or placebo at day 0 and 14 days later with a 9-month wash out period between the opposite. Main outcomes were change in disease severity as measured by the Epidermolysis Bullosa Disease Activity and Scarring index (EBDASI) and the Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (ISCOREB), wound clinical appearance, pain, itch, and quality of life at 3-months from infusion. Results will be discussed at the meeting. This is the largest study worldwide in children with RDEB. Administering cell therapy early and at regular intervals has the potential to reduce inflammation, effectively modulate disease activity, and lead to clinically meaningful and sustained improvements in disease progression and quality of life. An open-label study is planned and will help us further evaluate the long-term safety and outcomes of CORDStromTM infusions in children with RDEB.

Melanoma in situ (MIS) represents the earliest stage of melanoma, strictly confined to the epidermis. At this stage, it may closely resemble benign melanocytic lesions such as Clark’s nevus, lentiginous junctional nevus, or solar lentigo. Because clinical appearance is often subtle, dermoscopy is essential for improving diagnostic accuracy by revealing early malignant clues, including asymmetry, gray dots or areas, and an atypical pigment network. Objective — to analyze the dermoscopic and histopathologic characteristics of MIS and to emphasize the diagnostic relevance of gray structures as well as the value of dermoscopic-histopathologic correlation for early melanoma detection. Materials and methods. Four patients (two women, two men, all over 45 years, Fitzpatrick skin types I—II) with small flat pigmented lesions (3—6 mm) located on the nose, lower leg, upper back, and back were examined. Each lesion underwent detailed clinical and dermoscopic evaluation using Kittler’s analytic method. All lesions were then completely excised, and histopathologic assessment was performed to confirm the diagnosis and correlate microscopic findings with dermoscopic structures. Results and discussion. All cases demonstrated dermoscopic asymmetry, multicomponent patterns, gray dots or clods, and an atypical pigment network. These features were consistent across the series. Histopathology confirmed an intraepidermal proliferation of atypical melanocytes without dermal invasion. Dermoscopic patterns showed clear correspondence with microscopic structures, supporting the reliability of these features in identifying MIS. Conclusions. Recognition of gray structures, network atypia, and overall asymmetry plays a central role in detecting melanoma in situ at an early stage. Consistent correlation between dermoscopic findings and histopathology enhances diagnostic confidence and supports timely excision, helping prevent progression to invasive melanoma.

A Retrospective Observational Study on Oral Leukoplakia Patients Adhering to the Mediterranean Diet From Southern Italy

Biliary atresia (BA) is a congenital anomaly often found in neonates, with an incidence reaching 1:5500 per birth. BA is frequently associated with cytomegalovirus (CMV) infection in the patient, which causes a clinical appearance different from other types of BA. BA is usually treated by Kasai procedure, with cholangitis being the most common complication of this procedure. CMV infection is found to affect post-operative survival and bilirubin levels. However, it remains unclear whether the infection may affect the incidence of cholangitis in BA patients post-Kasai procedure. This retrospective study used the medical records of 33 BA patients who underwent the Kasai procedure in Dr. Sardjito Hospital between 2017 and 2021. Among 33 patients, 17 (51.5%) were infected with CMV, and 12 (36.4%) developed cholangitis. The frequency of cholangitis following the Kasai procedure is not significantly influenced by the CMV infection (p=0.615). Interestingly, the incidence of cholangitis is significantly associated with the pre-operative gamma-glutamyl transferase (GGT) levels (p=0.026). Furthermore, preoperative ALP appears to have a protective effect against cholangitis, with these associations nearly reaching a significant level (p=0.093). CMV infection is unlikely to impact the incidence of cholangitis after the Kasai procedure in BA patients. Notably, the pre-operative GGT level might affect the incidence of cholangitis following the Kasai procedure, thereby increasing their risk.

The rpZDIII vaccine triggers vertical protection on newborn mice against zika virus infection.

Background: Radiotherapy is an essential treatment in reducing the risk of breast cancer but can cause side effects such as acute radiodermatitis. This condition is the result of ionizing radiation damaging deoxyribonucleic acid (DNA) through reactive oxygen species (ROS) and inducing inflammatory responses, which lead to variable degrees of skin damage. Hyaluronic acid (HA) plays a role in triggering cell proliferation and keratinocyte differentiation while inhibiting lipid peroxidation caused by oxidative stress. Purpose: This study aims to determine the effectiveness of hyaluronic acid in reducing the degree of acute radiodermatitis using the Radiation Therapy Oncology Group (RTOG) score in breast cancer patients undergoing radiotherapy. Methods: This study was a double-blind randomized controlled trial. The samples were from patients diagnosed with breast cancer receiving radiotherapy. The treatment group received 0.2% HA cream, while the control group received a placebo The clinical appearance was evaluated weekly from the beginning of radiotherapy until two weeks post-radiotherapy using the RTOG score. Result: A total of 41 subjects were divided into two groups. RTOG score evaluation with intention-to-treat analysis and per-protocol analysis at weeks 3, 4, and 5 showed that the hyaluronic acid cream group experienced delayed onset of acute radiodermatitis compared to the placebo group. The log-rank test showed a significant difference in effectiveness between 0.2% HA cream compared to base cream in reducing the degree of acute radiodermatitis (p=0.035). Conclusion: The use of 0.2% HA cream was effective in reducing the severity of acute radiodermatitis in breast cancer patients undergoing radiotherapy.

Keratoconus (KC) is a progressive corneal disorder characterized by thinning of the cornea and conical protrusion leading to distorted vision and blindness. The disease often marks in adolescence and progresses until the mid-40s, with varying degrees of severity. Global prevalence shows regional variation, with higher rates in Asian populations and strong associations with systemic conditions such as Down syndrome. The current study investigates the underlying pathological mechanism with a focus on biomarkers, including Prolactin-Induced Protein (PIP), Matrix Metalloproteinases (MMPs), Interleukins, and genetic markers as LOX and FOXO1. While the clinical appearance may be highly variable with relevant distorted vision, the pathophysiology remains poorly understood. Generally, it affects teenagers, young adults, and has been related to pathological factors like oxidative stress, environmental influences, hormonal changes, and eye rubbing. Although with the progress of diagnostic modalities from corneal topography and tomography to tear-based assays and artificial intelligence, it is still a challenge to diagnose it early. The involvement of systemic and local inflammatory responses in KC is now an area of increasing interest, implying that targeting these pathways will provide new treatment options. Besides, progress in tear-based diagnostics offers promising paths for non-invasive monitoring of disease progression. Clarifying the biochemical and genetic profile of keratoconus may help to focus on better diagnosis. The present review will increase our insights into keratoconus pathophysiology and encourage new diagnostic and therapeutic strategies that can eventually enhance patient outcomes.

Background/Objective: The effectiveness of blue-light phototherapy (PT) is mainly dependent on the total dose of light (time under PT and amount of skin exposed) received by infants. The primary aim of this study was the development of a novel, flexible, and stretchable device to provide continuous PT treatment, avoiding temporary interruptions that are often observed in practice, such as during breastfeeding, for example. This study evaluated the biocompatibility of a novel, low-cost blanket equipped with light-emitting diode (LED) lamps designed to maintain therapeutic efficacy while facilitating uninterrupted skin-to-skin contact. Methods: Fourteen New Zealand White rabbits, weighing approximately 2.9 kg and aged 4 months, were randomly assigned to an experimental group (TG, n = 7) or a control group (CG, n = 7). The TG received phototherapy directly on the skin (irradiance: 19.3 [13.0–22.0] µW/cm−2/nm−1) during two 12 h sessions over consecutive days, while the CG remained under identical conditions with the device turned off. Biochemical, hematological, dermatological, and histological parameters, as well as rectal and skin temperatures, were assessed. Results: The results showed no differences in clinical appearance or histological analysis of skin tissue between the groups. Blood analysis indicated a reduction in absolute monocyte counts in the TG compared to the CG (p = 0.049), though levels remained within normal ranges. Skin temperature was consistently higher in the TG, except during the initial measurement. Rectal temperatures were similar on the first day but lower in the TG on the second day (mean 40.3 ± 0.21 °C vs. 40.7 ± 0.32 °C; p = 0.039). Conclusions: Temperature levels remained within physiological limits for both groups throughout the study. The device demonstrated biocompatibility and caused no adverse dermatological, hematological, or biochemical effects.

Long-term skin quality and scar formation after enzymatic debridement of deep-dermal burn wounds: A follow-up comparative study of Suprathel® and Jelonet®.

Decreasing wound healing complications is important for total joint arthroplasty. 2-Octyl cyanoacrylate with polymer mesh tape (2OPMT) is a skin closure system that works by combining a liquid adhesive with a polymer mesh to form a waterproof microbial barrier over surgical wounds. However, allergic contact dermatitis (ACD) has been a reported complication of 2OPMT use, with an incidence ranging from 0.5% to 2.5%. We sought to report our results of 2OPMT with primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) and determine the incidence of ACD. We conducted a single-institution, single-surgeon retrospective cohort study of 185 TKA and 154 THA patients who underwent procedures at a tertiary referral institution from October 2021 to November 2023. Overall incidence of ACD associated with 2OPMT was 3.8% (13/339). Incidence of ACD in TKA was 3.8% (7/185) and in THA it was 3.9% (6/154). All skin reactions were recognized at the first postoperative visit and treated with a combination of topical and/or oral steroids and oral antihistamines. All ACD reactions resolved by the second postoperative visit, and none of these patients developed a surgical site infection or a periprosthetic joint infection. We found an ACD incidence of 3.8% with 2OPMT use in TKA and THA. This is similar to other studies reporting on ACD in TKA and THA. While it can be treated with routine use of steroids, antihistamines, and antibiotics, ACD is uncomfortable for patients and presents them with a concerning clinical appearance that requires additional treatment. Level III: retrospective cohort study.

Lip epidermization is a phenomenon little reported in the literature. Earlier believed to be due to lip hyperkeratosis without associated parakeratosis or cellular atypia, it is now thought to be caused by the presence of ectopic sebaceous glands called Fordyce’s spots. There are currently no guidelines on standard treatment for this condition, and the effects of various treatment modalities on the lip lesions are unknown. We report the clinical, dermoscopic, and histopathological findings of a case of lip epidermization and document the response to ablative CO2 laser treatment on the clinical and dermoscopic appearance of lip lesions.

Optimizing establishment of high need pediatric Acute Myeloid Leukemia (AML) patient derived xenograft (PDX) models

Phylogenetic reconstruction reveals early divergence and late expansion of focal lesions in multiple myeloma

Abstract Introduction/Objective Oral lymphangioma is an uncommon benign proliferation of lymphatic vessels lesion, most frequently seen in the tongue and floor of the mouth. Its clinical presentation can closely resemble other exophytic lesions, particularly squamous papilloma, leading to diagnostic pitfalls. The clinical resemblance of lymphangiomas to squamous papilloma’s often leads to misdiagnosis and delaying appropriate management. Methods/Case Report This report highlights the diagnostic challenges of lymphangioma that had a clinical appearance of an HPV-associated squamous papilloma. The patient is a 3-year-old boy with a 1-year history of multiple papillomatous tongue lesions arising on the center of the ventral surface, and which began shortly after frenulectomy at 18 months of age at the surgical site. An excisional biopsy showed a tan-pink and papillomatous lesion. Microscopically, the lesion displayed multiple dilated thin-walled lymphatic vessels abutting a hyperplastic and papillomatous squamous epithelium, consistent with a lymphangioma. Results NA Conclusion A review of relevant literature reveals several similar presentations, reinforcing the potential for misclassification based on clinical appearance alone. Pathologists and clinicians must maintain a high index of suspicion for lymphangioma in exophytic oral lesions to ensure appropriate treatment and prevent recurrence. This case highlights the importance of histological and immunochemical evaluation to distinguish lymphangiomas from other papillomatous lesions.

Current concepts: Common variable immunodeficiency.

To report a case of secondary unilateral multiple evanescent white dot syndrome after blunt trauma to the eye. Observational case report of one patient. A 25-year-old man initially presented after being hit in the left eye with a football, with visual acuity of 20/50, traumatic iritis, commotio retinae, vitreous hemorrhage, and a large pigment epithelial detachment in the superior macula. He was lost to follow-up for 2 years before presenting with a sudden decrease in vision. On examination, best-corrected visual acuity was counting fingers, and clinical examination demonstrated fibrosis in the superior macula, small white lesions around the optic disk and throughout the posterior pole and ellipsoid zone disruption on optical coherence tomography. Given the clinical appearance, a diagnosis of multiple evanescent white dot syndrome was made and the decision was made to observe. Two months later, without treatment, best-corrected visual acuity improved to 20/20, and there was resolution of the white lesions in the posterior pole as well as improved continuity of the ellipsoid zone on optical coherence tomography. The authors describe a case of multiple evanescent white dot syndrome 2 years after blunt trauma to the eye; a far longer latency than previously reported cases of multiple evanescent white dot syndrome secondary to blunt trauma.

Abstract Introduction Dermatomyositis rashes in Afro-Caribbean individuals can present differently in comparison to individuals with lighter skin tones. Dyschromia, changes in skin colour, can be the presenting feature of dermatomyositis rashes in Afro-Caribbean cohorts. We present a case of an Afro-Caribbean patient who presented with dyschromia. Case description A 45-year-old Afro-Caribbean woman presented with three year history of progressive skin hyperpigmentation affecting her face, forehead, neck and subsequently upper limbs, torso and lower limbs. She is an accountant who does not smoke, drink nor use illicit drugs. She described a preceding itching sensation followed by a burning sensation of her hyperpigmented skin. She denies photosensitivity. She was reviewed by dermatology in the private sector. The first skin biopsy in 2022 showed lichen planus pigmentosus (LPP). When the skin hyperpigmentation progressed, a second skin biopsy in 2024 demonstrated post-inflammation hyperpigmentation. She did not respond to topical calcineurin inhibitor. She has strongly positive ANA. ENA, dsDNA and complements, however, are normal. There are no features to suggest systemic sclerosis, especially Raynaud’s phenomenon. When she was first reviewed by rheumatology, she had dyschromia with hyperpigmentation in pathognomonic locations (images 1-3). She reported a six month history of progressive proximal weakness without bulbar or respiratory involvement. CK was elevated at 1610 U/L with MMT8 score of 133/150. She was found to have strongly positive Mi-2 antibodies. Electromyography was consistent with inflammatory myopathy with fibrillation potentials. MRI demonstrated oedema affecting adductor muscles, gluteal muscles and, to a milder degree, anterior thigh muscles. Muscle biopsy was consistent with inflammatory myositis in the pattern of dermatomyositis with upregulation of HLA Class 1. CT scan of chest, abdomen and pelvis did not show interstitial lung disease but revealed a breast lesion which upon further investigations was benign. She responded well to corticosteroid therapy and was promptly commenced on dual treatment of mycophenolate mofetil and hydroxychloroquine. Her skin is improving with less itching and less dyschromia. MMT8 score improved to 148/150. Discussion Classical dermatomyositis rashes are widely known violaceous heliotrope rashes, Gottron’s papules, V and shawl signs. In an Afro-Caribbean cohort, dermatomyositis rashes can be atypical, leading to delayed or missed diagnoses as described in this case. In African descendants, facial oedema is generally predominant and Gottron’s papules are often hypochromic. In others, the papules, V and shawl signs can appear darker with varying shades of pigmentation. Nailfold abnormalities can be subtle and easier to miss. Dyschromia is the prominent cutaneous features in a case series of 14 myositis patients of black individuals. Skin biopsies in dermatomyositis typically show a combination of vacuolar interface dermatitis, increased dermal mucin and perivascular inflammation. They may also show dyskeratosis and superficial dermal vascular dilatation. None of these were present in the skin biopsies for our patient but the absence clearly does not exclude dermatomyositis. LPP is a chronic disease characterised by hyperpigmented lichenoid lesions in intertriginous and sun-exposed skin of unknown aetiology. LPP and dermatomyositis are distinct diseases but cases of overlap syndrome have been documented, such as in our patient. Key learning points • Dermatomyositis rashes in an Afro-Caribbean cohort can manifest in an atypical pattern and potentially lead to delayed or missed diagnoses alongside increased morbidity and mortality. • The rashes may appear lighter in colour but, in other cases, they can appear darker with varying shades of pigmentation. • Dyschromia can be the prominent feature. • LPP and dermatomyositis are distinct diseases but cases of overlap syndrome have been documented. • Knowledge of clinical appearances of dermatomyositis rashes in darker skin is essential in reducing racial disparity in practice and facilitating early diagnosis and management.

Darier and Ferrand’s dermatofibrosarcoma (DFSP) is a rare cutaneous mesenchymal tumor characterized by a high potential for local recurrence and a low risk of metastasis. We report an unusual case of DFSP located on the scalp of a 63-year-old female patient with a history of hypertension. The lesion, which had been evolving for six years, presented with a polymorphic clinical appearance, mimicking benign tumors. The diagnosis was confirmed by histopathological examination, and a wide surgical excision with safety margins was performed. This case highlights the importance of heightened vigilance regarding atypical skin lesions, particularly in rare locations such as the scalp, and the need for a multidisciplinary approach to optimize therapeutic outcomes.

Comparison between clinical and punch biopsy diagnosis of suspected head and neck skin cancer.