Malignant Skin Tumors Research Articles

DARIER-FERRAND DERMATOFIBROSARCOMA OF THE FACE: TWO CASES REPORT

Darier-Ferrand dermatofibrosarcoma or dermatofibrosarcoma protuberans (DFSP) is a cutaneous mesenchymal tumor of intermediate malignancy. It is a rare but not exceptional tumor, accounting for 0.1% of malignant skin tumors. Histological examination is essential for diagnosis. Wide surgical excision is the standard treatment. We report two cases of Darier-Ferrand dermatofibrosarcoma of the face. A wide local excision is the gold-standard treatment, with negative margins of 3–5 cm from the tumor edge including the skin, the subcutaneous tissue, and the underlying fascia. However, this is a mutilating surgery, especially for cervicofacial lesions which is the case for our two patients For cervico-facial localizations,some authors advise the Mohs micrographic surgery for its low recurrence rates described. Target adjuvant therapy with imatinib has been shown to reduce tumor size and improve surgical resectability and can be proposed as an option for our patients. However, its unavailability and high-cost limit its use in our context. A combination of conservative excision and adjuvant radiotherapy was reported to reduce the rate of local recurrence and should be also considered by practicians. To improve prognosis, early, codified, multidisciplinary management is essential for this pathology.

Multispectral Raman Differentiation of Malignant Skin Neoplasms In Vitro: Search for Specific Biomarkers and Optimal Wavelengths.

Confocal scanning Raman and photoluminescence (PL) microspectroscopy is a structure-sensitive optical method that allows the non-invasive analysis of biomarkers in the skin tissue. We used it to perform in vitro diagnostics of different malignant skin neoplasms at several excitation wavelengths (532, 785 and 1064 nm). Distinct spectral differences were noticed in the Raman spectra of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), compared with healthy skin. Our analysis of Raman/PL spectra at the different excitation wavelengths enabled us to propose two novel wavelength-independent spectral criteria (intensity ratios for 1302 cm-1 and 1445 cm-1 bands, 1745 cm-1 and 1445 cm-1 bands), related to the different vibrational "fingerprints" of cell membrane lipids as biomarkers, which was confirmed by the multivariate curve resolution (MCR) technique. These criteria allowed us to differentiate healthy skin from BCC and SCC with sensitivity and specificity higher than 95%, demonstrating high clinical importance in the differential diagnostics of skin tumors.

Downregulated BIRC5 inhibits proliferation and metastasis of melanoma through the β-catenin/HIF-1α/VEGF/MMPs pathway.

Melanoma is a malignant skin tumor caused by melanocytes and associated with high mortality rates. This study aims to investigate the specific mechanism of ZWZ-3 in melanoma proliferation and metastasis. RNA sequencing was performed to identify the effect of ZWZ-3 on gene expression. siRNA was used to inhibit BIRC5 gene expression in the B16F10 cell line. A zebrafish tumor model was used to assess the therapeutic effect of ZWZ-3 in vivo. Mechanistic insights into the inhibition of tumor metastasis by ZWZ-3 were obtained through analysis of tumor tissue sections in mice. Our findings demonstrated that ZWZ-3 suppressed melanoma cell proliferation and migration. We performed RNA sequencing in melanoma cells after the treatment with ZWZ-3 and found that Birc5, which is closely associated with tumor metastasis, was significantly down-regulated. Bioinformatics analysis and the immuno-histochemical results of tissue chips for melanoma further confirmed the high expression of BIRC5 in melanoma and its effect on disease progression. Moreover, Birc5 knock-down significantly inhibited melanoma cell proliferation and metastasis, which was correlated with the β-catenin/HIF-1α/VEGF/MMPs pathway. Additionally, ZWZ-3 significantly inhibited tumor growth in the zebrafish tumor model without any evident side effects. Histological and immuno-histochemical analyses revealed that ZWZ-3 inhibited tumor cell metastasis by down-regulating HIF-1α, VEGF, and MMP9. Our findings revealed that ZWZ-3 could downregulate BIRC5 and inhibit melanoma proliferation and metastasis through the β-catenin/HIF-1α/VEGF/MMPs pathway. Therefore, BIRC5 represents a promising therapeutic target for the treatment of melanoma.

Spectrum of Paediatric Dermatoses in a Private Medical College

Introduction: Dermatoses in children puts a huge burden on the parents as well as their development. Severity of these dermatoses vary from location to location. Environment plays an important role, especially in children and presentation of these dermatoses maybe quite different than those in adults.
 Methods: This is a six months prospective study. All children who presented to the Paediatrics / Dermatology OPD with any skin ailment were included. Diagnosis was done clinically, investigations if required were done. Based on age, cases were divided into six groups. Skin disorders were categorized into 17 groups. The demographic data and other clinical details were recorded on a pre-designed performa.
 Results: 206 children were included in our study. Males were 136 (66.01%) and females were 70 (33.98%) with M:F ratio 1.94:1. The spectrum of skin diseases were infections and exanthems (40.29%), eczematous diseases (19.41%), disorders of sebaceous and sweat glands (13.10%), papulosquamous diseases (6.31%), hypersensitivity syndromes (5.82%), disorders of pigmentation (5.33%), disorders of hair and nail (3.39%), cutaneous tumor and tumor syndromes (1.94%), vascular disorders (1.45%), disorders of cornification (0.97%), photo-dermatoses(0.97%), histiocytosis and malignant skin tumors (0.48%), and miscellaneous (0.48%). Dermatoses according to age were neonatal (0.97%), infant (4.36%), toddlers (9.70%), preschool (18.44%), school-age-children (30.58%), and adolescents (35.92%).
 Conclusions: Skin infections and infestations being the majority explains the status of developing countries like India. This study can help identify (or diagnosing) and treating common dermatological conditions in children and this would also sensitize our fellow paediatricians to this common but often neglected aspect of childcare.

Immediate reconstruction of nasal alar defects after malignant skin tumor excision without mohs surgery

Objectives: The National Comprehensive Cancer Network guidelines state that any nasal region with squamous or basal cell skin cancer is at high risk. Although Mohs surgery is the gold-standard procedure for many types of skin cancer, it is not applicable worldwide. A mean of 1.7 Mohs surgery stage is performed in cases of tumors. Nasal obstruction is a problem with Mohs surgery. In this study, we aimed to investigate nasal alar region nonmelanoma malignant skin tumor excision using immediate reconstruction without Mohs surgery. Methods: Ten patients underwent reconstruction surgery between 2018 and 2022. The inclusion criterion were ulcerated lesions in the nasal alar region measuring less than 1 cm in diameter, the lesions which were suspected either as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) on dermatoscopic examination, the patients who had intact nasal mucosa during anterior rhinoscopy. Results: The mean follow-up duration was 26 months. No patient required re-operation because of an excisional biopsy result that involved border proximity. We observed no serious complications or long-term recurrences. Conclusion: We recommend our algorithm for patients for whom Mohs surgery is not applicable.

Incidence and the risk of occurrence of benign and malignant canine skin tumours in Poland - a five-year retrospective study.

The aim of the study was to compile data on the frequency and distribution of canine skin tumours and determine the risk of these being malignant as opposed to benign. This determination proceeded from tumour histogenesis and gave consideration to the dog's breed, sex, age and the anatomical location of tumours. This retrospective five-year epidemiological study included 3,139 canine skin tumours collected in Poland. A univariable logistic regression analysis was performed to determine the odds ratios (ORs) with 95% confidence intervals (CIs). Microscopic analysis showed a significant predominance of benign tumours (65.02%) as well as mesenchymal and melanocytic tumours (59.57%). The most frequently diagnosed were mast cell tumours, accounting for 13.79% of all skin tumours, and other common tumour types were lipomas (6.40%), haemangiopericytomas (5.96%) and malignant melanomas (4.65%). The risk of malignant versus benign tumours was 1.212 times higher in the female than in the male dogs. A higher risk of development of malignant epithelial tumours was found in boxers (OR 4.091), German shepherds (OR 4.085) and flat-coated retrievers (OR 43.596). A higher risk of development of malignant mesenchymal tumours was found in golden retrievers (OR 4.693), boxers (OR 2.342), bulldogs (OR 3.469) and Maltese (OR 2.757). The results may serve as a reference point for further studies of the complex biology of canine skin tumours.

Analysis of the association between Janus kinase inhibitors and malignant skin tumors using the Food and Drug Administration Adverse Event Reporting System.

Malignant skin tumors areadverse events of concern regardingJanus kinase (JAK) inhibitors. This study aimed to evaluate the association between JAK inhibitors and adverse events of malignant skin tumors, and to characterize the main features. Data (2012-2021) were collected using the US Food and Drug Administration Adverse Event Reporting System (FAERS). Adverse event cases of JAK inhibitors as the primary suspected drug were extracted for further analysis. Disproportionality analysis evaluated the association between JAK inhibitors and malignant skin tumor events by estimating the reporting odds ratio (ROR) and the information component (IC) with 95% confidence intervals (95% CI). A total of 142,673 cases with JAK inhibitors as a primary suspected drug were collected, including 1400 malignant skin tumor events. Ruxolitinib, upadacitinib, tofacitinib, and baricitinib were included in the disproportionality analysis. Three JAK inhibitors were associated with malignant skin tumor events, namely ruxolitinib (ROR 5.40, 95% CI 5.03-5.81; IC 2.39, 95% CI 2.14-2.62), upadacitinib (ROR 4.79, 95% CI 4.03-5.71; IC 2.24, 95% CI 1.62-2.77), and tofacitinib (ROR 1.67, 95% CI 1.53-1.83; IC 0.73, 95% CI 0.43-1.02). The median time to onset time was 378.5 days. We found association between malignant skin tumors and ruxolitinib, upadacitinib, and tofacitinib. More attention should be paid to these events when prescribing JAK inhibitors in clinical practice.

Squamous cell carcinoma of the skin after cardiac transplantation: a clinical case

Background. Solid organ transplantation recipients have a high risk of non-melanoma skin tumors. Patients after heart transplantation are prone to a higher incidence of malignant skin tumors due to intensive immunosuppressive therapy. The most common histological type is squamous cell carcinoma, followed by basal cell carcinoma. These tumors have a more aggressive clinical course, including the frequency of recurrence and metastasis, and a tendency to multifocal lesions.
 Materials and methods. We present a clinical case of primary multiple squamous cell carcinoma with metastatic lesions of regional lymph nodes in a patient after heart transplantation.
 Results. A 67-year-old patient underwent an orthotopic heart transplant in September 2018 for ischemic cardiomyopathy. Subsequently, triple immunosuppressive therapy was administered, including tacrolimus combined with mycophenolate mofetil and prednisolone. In May 2022, a solid tumor with ulceration occurred on the skin of the right scapular region. After some time, similar tumors appeared on the skin of the temporal region on the left, the posterior surface of the auricle and the parietal region on the left. The patient later found a solid, painless tumor on the left jaw angle. As a part of the examination in the oncology dispensary, a biopsy of the scapular skin tumor, scrapings from tumors, and aspiration biopsy of the submandibular lymph nodes were performed. Histological and cytological studies of all neoplasms showed squamous cell keratinizing cancer with metastases to the submandibular lymph nodes. Additional examination methods showed no signs of progression. The diagnosis was made: primary multiple synchronous skin cancer: right scapular area, stage III, cT3N0M0; left parietal area, stage II, cT2N0M0; occipital area, stage I, cT1N0M0; left auricle, stage IV, cT1N2M0. Considering the localization of tumors, surgical treatment was performed, including of excision of tumors in the scapular and parietal regions. Radiation therapy was performed on lymph nodes with metastases. After 6 months, a tumor recurrence was detected in the irradiation area.
 Conclusion. After heart transplantation, squamous cell carcinoma of the skin is common. Usually, it affects the scalp and neck with metastases to the regional lymph nodes and is prone to recurrence. The primary treatment method is surgical and radiation therapy.

Retracted: Application of Free Skin Flap Transplantation in Skin Malignant Tumor Resection.

[This retracts the article DOI: 10.1155/2022/7510330.].

Annular skin tumors and lymphoproliferative diseases

Determining the shape of a skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape.

A comprehensive identification of potential molecular targets and small drugs candidate for melanoma cancer using bioinformatics and network-based screening approach

Melanoma is the third most common malignant skin tumor and has increased in morbidity and mortality over the previous decade due to its rapid spread into the bloodstream or lymphatic system. This study used integrated bioinformatics and network-based methodologies to reliably identify molecular targets and small molecular medicines that may be more successful for Melanoma diagnosis, prognosis and treatment. The statistical LIMMA approach utilized for bioinformatics analysis in this study found 246 common differentially expressed genes (cDEGs) between case and control samples from two microarray gene-expression datasets (GSE130244 and GSE15605). Protein–protein interaction network study revealed 15 cDEGs (PTK2, STAT1, PNO1, CXCR4, WASL, FN1, RUNX2, SOCS3, ITGA4, GNG2, CDK6, BRAF, AGO2, GTF2H1 and AR) to be critical in the development of melanoma (KGs). According to regulatory network analysis, the most important transcriptional and post-transcriptional regulators of DEGs and hub-DEGs are ten transcription factors and three miRNAs. We discovered the pathogenetic mechanisms of MC by studying DEGs’ biological processes, molecular function, cellular components and KEGG pathways. We used molecular docking and dynamics modeling to select the four most expressed genes responsible for melanoma malignancy to identify therapeutic candidates. Then, utilizing the Connectivity Map (CMap) database, we analyzed the top 4-hub-DEGs-guided repurposable drugs. We validated four melanoma cancer drugs (Fisetin, Epicatechin Gallate, 1237586-97-8 and PF 431396) using molecular dynamics simulation with their target proteins. As a result, the results of this study may provide resources to researchers and medical professionals for the wet-lab validation of MC diagnosis, prognosis and treatments. Communicated by Ramaswamy H. Sarma

Killing three birds with one stone: Tumor-membrane-decorated Prussian blue nanovaccines for synergistic management of skin tumors, radiation dermatitis and wounds

Unhealed wounds following the resection of malignant skin tumors, featuring incomplete tumor tissue resection, full-thickness cutaneous defects, wound infection and radiation dermatitis, represent the main causes of prolonged recovery time, poor prognosis, and elevated tumor recurrence. Herein, a tumor cell membrane-decorated Prussian blue (PB) nanovaccine, referred to as PBVac, was fabricated via camouflage of PB nanozymes with the tumor cell membrane as tumor antigens and CpG oligodeoxynucleotides (ODNs) as adjuvants. Reinforcement by the tumor cell membrane substantially enhanced the tumor targeting potential of PBVac, achieving tumor-selective targeting and therapeutic efficacy. The bioactivity of PB nanozymes conferred PBVac with remarkable photothermal activity, antibacterial and antioxidant effects, curing wounds and radiation dermatitis by stimulating angiogenesis, antioxidation and anti-infection. The enhanced antitumor immunity of PBVac conferred by improved antigenicity was also assessed in a tumor challenge assay. PBVac could provide tumor antigens and molecular adjuvants for the priming of an efficient adaptive immune response, suppressing tumor growth. The combined merits of PBVac (photothermal, antibacterial and antioxidant capacities, and tumor membrane antigen) make it a novel nanoplatform that could be utilized as a safe and efficient therapeutic for synergistic management of skin tumors, radiation dermatitis and wounds.

Skin Cancer Associated With Chronic Leg Ulcers in the Population of Olmsted County, Minnesota

Malignant skin tumors in the setting of chronic leg ulcers (CLUs) are often underdiagnosed which may contribute to treatment delay and poor outcomes. The aims of our study were to determine the incidence and clinical characteristics of skin cancers in leg ulcers in the Olmsted County population from 1995 to 2020. We used the Rochester Epidemiology Project (a collaboration between health care providers) infrastructure to describe this epidemiology, allowing “population-based” research. Electronic medical records of adult patients with International Classification of Diseases diagnosis codes for leg ulcers and skin cancers on the legs were queried. Thirty-seven individuals with skin cancers in nonhealing ulcers were identified. The cumulative incidence of skin cancer over the 25-year period was 37:7864 (0.47%). The overall incidence rate was 470 per 100,000 patients. Eleven (29.7%) men and 26 (70.3%) women were identified with mean age of 77 years. History of venous insufficiency was present in 30 (81.1%) patients and diabetes in 13 (35.1%) patients. Clinical characteristics of CLU with skin cancer included abnormal granulation tissue in 36 (94.7%) and irregular borders in 35 (94.6%) cases. Skin cancers among CLUs included 17 (41.5%) basal cell carcinomas, 17 (41.5%) squamous cell carcinomas, 2 (4.9%) melanomas, 2 (4.9%) porocarcinomas, 1 (2.4%) basosquamous cell carcinoma, and 1 (2.4%) eccrine adenocarcinoma. The apparent association between chronic wounds and subsequent biopsy-proven skin cancer of the same site was primarily observed in elderly patients; malignant transformation of wounds favored basal cell carcinoma and squamous cell carcinoma. This retrospective cohort study further characterizes the association between skin cancers and chronic leg wounds.

Model for End-Stage Liver Disease Correlates with Disease Relapse and Death of Patients with Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a highly malignant skin tumor that occurs mainly in elderly and/or immunosuppressed patients. MCC prognosis has been significantly improved by the introduction of immune checkpoint inhibitor treatment. Recently, blood-based biomarkers have been investigated that can potentially predict the outcome of MCC patients. In this context, parameters of liver scores have not yet been investigated. We retrospectively recruited 47 MCC patients with available relevant laboratory data at primary diagnosis. At this time, we investigated blood-based scores as follows: model for end-stage liver disease (MELD), aspartate aminotransferase/platelet count ratio index (APRI), and the alanine transaminase/aspartate aminotransferase ratio (De Ritis ratio). MCC relapse was negatively correlated with the De Ritis score (r = −0.3, p = 0.024) and positively correlated with the MELD score (r = 0.3, p = 0.035). Moreover, MCC-specific death positively correlated with CCI score (r = 0.4, p = 0.01) and MELD score (r = 0.4, p = 0.003). In multivariable analysis, the MELD score remained in the regression model as significant independent predictor for MCC relapse (hazard ratio: 1.16 (95% CI 1.04 to 1.29; p = 0.008) and MCC-specific death (hazard ratio: 1.2 (95% CI 1.04 to 1.3; p = 0.009). We observed for the first time that the MELD score appears to independently predict both MCC relapse and MCC-specific death. These results should be further investigated in larger prospective studies.

A smartphone-based application for an early skin disease prognosis: Towards a lean healthcare system via computer-based vision

Malignancy is the tendency of a medical condition to progressively become fatal and generally refers to the presence of cancerous cells that can spread, invade, and destroy tissues. In the United States, a new cancer diagnosis is given every 30 s, and the rates of diagnosis are not indicating any slowdown. The number of cancer cases is projected to increase by 35% over the next decade. Increasing cancer cases have attracted researchers to find new approaches for their identification and characterization. Skin diseases are a significant healthcare burden, affecting millions of people globally. The early detection and diagnosis of skin diseases are essential to prevent adverse health consequences, including the development of malignant skin tumors. Dermoscopy-based diagnosis of skin diseases is a time-consuming process, particularly in resource-limited healthcare settings. Recent advancements in computer vision algorithms have led to the development of several smartphone-based applications for early skin disease prognosis. In this paper, we have utilized a set of 16 distinctive convolutional neural network models, based on deep learning, to process over 45,000 high-quality images from the HAM10000 dataset, encompassing seven categories of skin diseases. Our models were able to effectively identify and classify skin diseases using lesion images as input. Dermoscopy-based diagnosis of skin diseases is a time-consuming process, particularly in resource-limited healthcare settings. Our proposed application for early skin disease detection aims to prevent unintended health consequences, which can result in wastage of operating hours, resources, and, in some cases, compromised patient health. We have benchmarked our models against one another to evaluate their effectiveness and efficiency, using performance measures such as accuracy, precision, sensitivity, specificity, F-score, and G-Mean. Our results demonstrate that most deployed models achieve an accuracy of up to 99%.

Transdermal treatment for malignant melanoma by aptamer-modified tetrahedral framework nucleic acid delivery of vemurafenib

Melanoma is one of the most malignant skin tumors, whose high invasion is generally associated with BRAF gene mutation. Although new chemotherapeutic drugs, such as vemurafenib, have been developed to inhibit the growth of melanoma, these drugs are usually administered intravenously or orally, resulting in toxic side effects on major tissues and organs. Tetrahedral framework nucleic acids (tFNAs) are a novel type of DNA nanostructures with excellent biocompatibility and versatility which have been proven to penetrate through skin barrier with ease. In this study, we prepared tFNAs with vemurafenib and connected DNA aptamer AS1411 at the apex of tFNAs (AS1411-tFNAs/vemurafenib). On one hand, AS1411-tFNAs/vemurafenib could kill melanoma cells by blocking the mutated BRAF gene in vitro. Compared with free vemurafenib, AS1411-tFNAs/vemurafenib had no obvious toxicity to normal cells. On the other hand, AS1411-tFNAs could transfer vemurafenib to cross through the skin barrier and permeate into tumor tissues. In vivo, transdermal delivery of AS1411-tFNAs/vemurafenib could inhibit the growth of human A375 melanoma, whose inhibiting effect was stronger than intravenous administration of vemurafenib. These results demonstrated the application prospects of tFNAs combined with chemotherapeutic drugs in skin tumors.

Prognostic Analysis of Patients With Extramammary Paget Disease Treated With Conservative Excision.

Extramammary Paget disease (EMPD) is a malignant skin tumor with a relatively good prognosis. The standard treatment is wide local resection or Mohs micrographic surgery. However, conservative excision may be a better option when radical wide local excision is difficult to perform due to the patients' mental or physical condition. There have been no studies on the prognosis of patients with EMPD who underwent conservative excision. To compare the prognosis of conservative excision cases to wide excision cases of EMPD. The authors retrospectively analyzed the clinical data of 69 cases of EMPD without metastases to lymph nodes or organs (11 cases treated with conservative excision, 58 cases treated with wide local excision) who underwent resection of the primary tumor from 2002 to 2022 in the Department of Dermatology at Hokkaido University Hospital. The log-rank test showed no significant differences in overall survival or metastasis-free survival between the wide excision group and the conservative excision group, although conservative surgery was often chosen in elderly patients or patients with lower performance status. This study suggests that conservative surgery should be considered as a treatment option for EMPD.

Cutaneous malignancies in patients with Parkinson's disease at a dermato-oncological university centre in Hungary.

The possible correlation between melanoma and Parkinson's disease (PD) has been intensively studied. In this work, we aimed to assess the coincidence of skin malignancies and PD at a dermato-oncological university centre in Central-Eastern Europe, Hungary. From 2004 to 2017, a retrospective analysis of the centre's database was performed based on International Statistical Classification of Diseases-10 codes. Out of the patients who visited the clinic during the study period, 20,658 were treated for malignant skin tumours. Over the 14 years, 205 dermatological patients had PD simultaneously, 111 (54%) of whom had at least one type of skin malignancy: melanoma (n=22), basal cell carcinoma (BCC) (n=82), or squamous cell carcinoma (SCC) (n=36) (in some patients, multiple skin tumours were identified). Compared to the age- and sex-matched control group, patients with PD had a significantly lower risk for basal cell carcinoma (OR, 0.65; 95% CI, 0.47-0.89, p=0.0076) and for all skin tumours (OR, 0.74; 95% CI, 0.56-0.98, p=0.0392) but not for melanoma. We found a decreased risk of all skin tumours and basal cell carcinoma and an unchanged risk of melanoma among patients with PD. However, it should be kept in mind that some large-scale meta-analyses suggest a higher incidence of melanoma after a diagnosis of PD, indicating the importance of skin examination in this vulnerable population.

Cancer per Economic Activity at Brazil’s Southeast Region: Benefits Granted by the Brazilian Social Security System

Introduction: Despite the economic importance of the Region, there are still few studies in the literature about occupational cancer in Brazil’s Southeast Region. Objective: Compare the distribution of cancer-related benefits granted by the Brazilian Social Security System (RGPS) by economic activity of the insured individual, between 2008 and 2014, at Brazil’s Southeast Region. Method: The proportions of cancer-related accidental (work-related) and social security (general) benefits granted, according to the economic activity of the insured individual (bank cashier, salesperson, transport and freight worker, railway worker, industrial worker, sailor, public servant, rural worker, and blank) were calculated. Results: Cancer represented 3.07% (271,086) of the benefits granted for all causes. Commercial and rural activities showed the largest proportions of cancer-related benefits granted in all States. For both activities, breast and prostate cancers were the main locations that justified the approval of social security benefits, and other malignant skin neoplasms were the main locations for accidental benefits. Conclusion: The disproportionality between the number of cancer-related social security and accidental benefits granted suggests an error in many benefits, disfavoring accidental benefits. The improvement of the anamneses of the worker by the medical expert, with the use of additional documents, can aid the establishment of the causal link between the professional activity and the cancer developed, granting accidental benefits when this link exists. Moreover, surveillance strategies to boost the implementation of actions to prevent occupational cancer are still necessary at that Region.

Primary multiple malignant skin tumors: melanoma and basal cell carcinoma

The incidence of skin melanoma in the world is growing every year. Despite advances in diagnostics, the identification of the primary focus of melanoma in some cases is still difficult. The natural course sometimes manifests only with the appearance of melanoma metastases, which can mimic other diseases. Patient S., 52 years old, was admitted to the FCBRN of FMBA of Russia with complaints on periodic systemic dizziness, headaches of a pressing nature, episodes of speech impairment over the past three months. According to the brain MRI-scan results, a volumetric formation of the left frontal lobe was revealed. Upon examination, two non-pigmented lesions were found on the skin of the scalp and forehead. Due to the presence of focal neurological symptoms, it was decided to remove the brain tumor using neurophysiological monitoring and the scalp skin lesion, with histological verification. Morphological diagnosis of the removed brain tumor was a metastasis of amelanotic epithelioid melanoma. The skin lesion was basal cell carcinoma. Thus, the patient had primarily multiple malignant tumors: metastatic melanoma and basal cell carcinoma. The primary focus of melanoma could not be identified by available noninvasive research methods. The patient was referred to an oncologist to decide on the tactics of further examination and treatment. To date, the patient has been treated according to the scheme sh0876 1 line 1 course of pembrolizumab 400 mg IV, cycle 42 days.