Cutaneous squamous cell carcinoma (SCC) is an increasingly prevalent and potentially fatal disease with considerable implications if not recognized early and treated promptly. Several disease features contribute to a higher risk profile and adverse outcomes in affected patients. Given the clinical observation that elderly males from rural communities often present with large SCCs of the scalp, we sought to investigate and describe features of disease and sociodemographic factors from a cohort of patients with scalp SCCs. Histology reports of scalp primary SCCs were retrospectively assessed. Disease and demographic features were recorded. Descriptive statistics were generated, and statistical analyses (Fisher’s exact, Mann–Whitney U and Spearman’s rank test) were utilized to examine relationships between high-risk disease features and sociodemographic features. Ninety-three occurrences of scalp SCC in 61 patients were assessed. The average age at presentation was 78.81 years. Males were predominantly affected at a 14:1 ratio. Half of all tumours were greater than 2 cm (47/93 (50.54%)). The geographical distance from treatment was significantly associated with larger tumours at presentation. (rs = .34 P = 0.002). Recurrence and metastasis rates were determined amongst 188 patients with a primary scalp SCC, and low rates were observed (2.66% and 2.13%, respectively). Elderly males are inordinately affected by scalp SCC compared to females. Those living further from care exhibited larger tumours at presentation. Data from this study characterize features of SCC of the scalp and provide evidence to suggest that rural isolation may act as a mediator of high-risk presentation and larger tumour size.

A retrospective cohort study of cutaneous squamous cell carcinoma of the scalp: features of disease and influence of sociodemographic factors on outcomes.

Neutrophil-rich, noncollagenous 16A domain-negative bullous pemphigoid associated with psoriasis

Direct immunofluorescence is a vital diagnostic test for assessing vesiculobullous disorders, vasculitides, and connective tissue diseases. It is a robust and valuable technique that offers essential diagnostic information for many critical dermatoses. Dermatopathologists depend heavily on the data obtained from direct immunofluorescence evaluation to confirm final diagnoses. Selecting the most appropriate biopsy site is necessary for maximizing diagnostic accuracy, and the best site may vary depending on the clinical differential diagnosis. Inaccurate biopsy site selection can significantly impact the accuracy of the results. To optimize the use of direct immunofluorescence studies, this review provides helpful guidelines and some practical tips for selecting the best biopsy site.

Direct Immunofluorescence of Skin and Oral Mucosa: Guidelines for Selecting the Optimum Biopsy Site

Amaç: Direkt immünfloresan ve histopatolojik inceleme yapılan cilt/mukoza biyopsilerinin immünfloresan sonuçlarını, histomorfolojik bulgularını, ön tanılarıyla uyumunu karşılaştırmak ve immünfloresan incelemenin diagnostik rolünü değerlendirmek amaçlanmıştır.
Hastalar ve Yöntem: 01 Ocak 2019 – 31 Aralık 2019 tarihleri arasında patoloji laboratuvarına gönderilen toplam 207 hastanın biyopsileri değerlendirildi. Ön tanılara göre gruplar oluşturuldu, histolojik ve direkt immünfloresan bulgular kaydedildi. SPSS programında Kappa istatistikleri ve McNemar testi kullanıldı. P<0.05 istatistiksel olarak anlamlı kabul edildi.
Bulgular: Direkt immünfloresan sonuçları 115 hastada negatif, 91 hastada pozitifti ve bir hastada değerlendirme yapılamamıştı. Büllöz pemfigoidli 44 hastanın 19’unda (%43,2), pemfiguslu 18 hastanın 10’unda (%55,6), lupus eritematozuslu 26/51 (%50,9), liken planuslu 10/15 (%66,7), Henoch Shönlein purpuralı 6/6 (%100), diğer vaskülitler için 37/62 (%59,7) hastada histopatolojik uyum izlenmiştir. Direkt immünfloresan pozitifliği büllöz pemfigoid için 19/19, pemfigus için 10/10, lupus eritematozus için 11/26, liken planus için 2/10, Henoch Shönlein purpurası için 6/6, diğer vaskülitler için 28/37 olguda saptanmıştır (κ = 0.021).
Sonuç: İmmün aracılı dermatolojik hastalıkların tanısında ve vezikülobüllöz hastalıkların ayırıcı tanısında direkt immünfloresan inceleme, klinik ve histolojik bulgulara önemli ölçüde destek olmaktadır.

An Overview of The Results of Direct Immunofluorescence in Mucocutaneous Biopsies: Single Center Experience

Bullous pemphigoid (BP) is the most common autoimmune blistering disorder of the skin It is typified by tense blisters with a subepidermal split and mixed dermal inflammatory infiltrate on histology Biopsy of the perilesional skin for direct immunofluorescence (DIF) has become the gold standard in the diagnosis of BP Currently there is a pervasive clinical opinion that the lower extremity is a site with a high false-negative rate (FNR) for DIF in the diagnosis of BP This notion is primarily based on 2 early studies from the 1980s without more recent confirmatory studies To readdress this question regarding the lower extremities, a retrospective study from 2012 to 2018 was performed in our institution that evaluated the FNR of DIF by an anatomical site in the diagnosis of BP Cases of BP were identified using standard criteria (clinical and histological data reviewed in cases with negative DIF), and overall, 79 patients were included in the study A total of 4 false-negative DIF biopsies were verified Two negative DIF were from the lower extremity yielding a FNR of 10% compared with 4% on the trunk and 3% from the upper extremity, with no statistically significant difference by anatomical sites Our study fails to demonstrate a high FNR of DIF from the lower extremity in the diagnosis of BP

False-Negative Rate of Direct Immunofluorescence on Lower Extremities in Bullous Pemphigoid.

Background/aim Keratinocyte carcinoma (KC) is a marker of increased risk of other cancer types. To assess if this association exhibits a dose-response relationship, a case-control study was carried out. Patients and methods This was a clinic-based study of cases with KC plus another type of cancer matched by age, race (all Caucasian), sex and histologic type to controls with KC only (n=48 matched pairs). Results Compared with the KC only group, those with KC plus another cancer had a mean number of lesions that were 43%, 35%, and 41% greater for basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and total KC, respectively. The odds ratio (OR) of developing another type of cancer increased from 1.0 to 1.09 (95% confidence interval (CI)=0.23-5.13) to 2.12 (95%CI=0.50-9.08) according to whether the patient had zero, one, or ≥two BCC lesions; for SCC, the corresponding ORs were 1.0, 1.24 (95%CI=0.48-3.24), and 1.39 (95%CI=0.29-6.61). Conclusion A dose-response relationship seems to exist between the number of skin lesions and the risk of another type of cancer, but the lack of statistical significance weakens this evidence.

Keratinocyte Carcinoma and Risk for Another Type of Cancer: Assessment of a Dose-response Relationship.

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False-Negative Rate of Direct Immunofluorescence on Lower Extremities in Bullous Pemphigoid.

Keratinocyte Carcinoma and Risk for Another Type of Cancer: Assessment of a Dose-response Relationship.