BACKGROUND: Mohs Micrographic Surgery (MMS) is the microscopically-controlled excision of skin cancer. Although there have been several international studies on MMS for nonmelanoma skin cancer (NMSC) including 1 from Korea, there have been no reports yet on MMS in the Philippines. This is the first study on MMS for NMSC in the Philippines.
OBJECTIVE: To describe the clinical and histopathologic profile of all patients who underwent MMS at the Dermatology Center, St. Luke's Medical Center, from March 2003- March 2008.
METHODS: A retrospective study was conducted on all MMS cases done at the Mohs Surgery Unit of the Dermatology Center in St. Luke's Medical Center from March 2003- March 2008. Demographic and clinicohistologic profile of all cases were reviewed. Three to five-year recurrence rate was reported.
RESULTS: A total of 75 cases were reviewed and included in the study. The mean age of the study population was 61.29 years old and 90 percent belong to the >40 age group. The male:female ratio was 3:1. There were almost equal number of Filipino and Caucasian patients. Most patients permanently reside in the Philippines, with a small percentage coming from nearby countries like Guam. One-fifth of the study population were retired military men. The most common tumor was basal cell carcinoma (BCC), primary cases outnumbering recurrent ones. The nose was the most common area affected with BCC, while the cheek was the most common site of squamous cell carcinoma (SCC). Majority of tumors done were d" 2 cm. The most common post-operative defect size incurred was also d" 2 cm. The most common primary indication for doing MMS was the location of the tumor. Most NMSCs were cleared after 2-3 stages. Local flaps were the most commonly used type of repair, followed by primary closure. Based on 3- to 5-year surveillance of cases done from 2003-2005, there has been no recurrence yet as of March 2008.
CONCLUSION: The clinicohistopathologic profile of patients who underwent MMS in the Dermatology Center of St. Luke's Medical Center has similarities and differences with existing local and international literature. MMS, as offered by the first Mohs Surgery Unit in the country, caters mostly to the older age group with a predominance of the male population. The number of Filipino and Caucasian patients who underwent the procedure was almost equal. BCC is still the most common tumor treated in the Center with the face as the most common location. Most tumors were immediately cleared after few MMS stages. Success rate of the procedure in the Unit is very high, based on 3 to 5- year surveillance for recurrence.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatology ; Mohs Surgery ; Neoplasm Recurrence, Local ; Skin Neoplasms

BACKGROUND: Mohs Micrographic Surgery (MMS) is the microscopically-controlled excision of skin cancer. Although there have been several international studies on MMS for nonmelanoma skin cancer (NMSC) including 1 from Korea, there have been no reports yet on MMS in the Philippines. This is the first study on MMS for NMSC in the Philippines.
OBJECTIVE: To describe the clinical and histopathologic profile of all patients who underwent MMS at the Dermatology Center, St. Luke's Medical Center, from March 2003- March 2008.
METHODS: A retrospective study was conducted on all MMS cases done at the Mohs Surgery Unit of the Dermatology Center in St. Luke's Medical Center from March 2003- March 2008. Demographic and clinicohistologic profile of all cases were reviewed. Three to five-year recurrence rate was reported.
RESULTS: A total of 75 cases were reviewed and included in the study. The mean age of the study population was 61.29 years old and 90 percent belong to the >40 age group. The male:female ratio was 3:1. There were almost equal number of Filipino and Caucasian patients. Most patients permanently reside in the Philippines, with a small percentage coming from nearby countries like Guam. One-fifth of the study population were retired military men. The most common tumor was basal cell carcinoma (BCC), primary cases outnumbering recurrent ones. The nose was the most common area affected with BCC, while the cheek was the most common site of squamous cell carcinoma (SCC). Majority of tumors done were d" 2 cm. The most common post-operative defect size incurred was also d" 2 cm. The most common primary indication for doing MMS was the location of the tumor. Most NMSCs were cleared after 2-3 stages. Local flaps were the most commonly used type of repair, followed by primary closure. Based on 3- to 5-year surveillance of cases done from 2003-2005, there has been no recurrence yet as of March 2008.
CONCLUSION: The clinicohistopathologic profile of patients who underwent MMS in the Dermatology Center of St. Luke's Medical Center has similarities and differences with existing local and international literature. MMS, as offered by the first Mohs Surgery Unit in the country, caters mostly to the older age group with a predominance of the male population. The number of Filipino and Caucasian patients who underwent the procedure was almost equal. BCC is still the most common tumor treated in the Center with the face as the most common location. Most tumors were immediately cleared after few MMS stages. Success rate of the procedure in the Unit is very high, based on 3 to 5- year surveillance for recurrence.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Dermatology ; Mohs Surgery ; Neoplasm Recurrence, Local ; Skin Neoplasms

Introduction: Basal cell nevus syndrome is not a common disorder. It has an estimated prevalence of 1 in 57,000-164,000 persons.1,2 It presents as a spectrum of phenotypic abnormalities that include developmental anomalies and postnatal tumors, particularly basal cell carcinomas. More than 100 clinical abnormalities have been reported in patients with basal cell nevus syndrome. The most typical features include: (1) basal cell carcinomas; (2) palmar and/or plantar pits; and (3) odontogenic cysts of the jaw. Early diagnosis of basal cell nevus syndrome is imperative to prevent developmental delay and increased risk for physical impairment. Case report: This case involves a 48-year-old Filipino male who showed multiplewell-defined hyperpigmented gray-black papules and nodules on the scalp, face, trunk, and back. Pertinent family history revealed three family members with multiple biopsy-proven basal cell carcinomas. On physical examination, the patient was noted to have frontal bossing and multiple palmar and plantar pits. Dermoscopy and skin punch biopsy of multiple sites were consistent with basal cell carcinoma, both superficial and nodular subtypes. Additional work-up included a panoramic x-ray of the jaw, which revealed a solitary odontogenic cyst on the left. A plain cranial MRI was also done, revealing thickened and hypointense falx cerebri suggestive of calcifications. Conclusion: Based on the presence of multiple biopsy-proven basal cell carcinomas, multiple palmar and plantar pits, and the solitary odontogenic cyst, the patient was diagnosed with basal cell nevus syndrome. Other findings that aid in the diagnosis are the presence of frontal bossing and calcifications of the falx cerebriin the patient.

Original article: Kroemer S, Frühauf J, Campbell T, Massone C, Schwantzer G, Soyer H, Hofmann-Wellenhof R. Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic image tele-evaluation using cellular phones. Br J Dermatol. 2011;164(5):973-979. Aim: The original article aimed to evaluate the diagnostic accuracy of clinical and dermoscopic image tele-evaluation for mobile skin tumor screening. Setting and population: The tumors examined in the study were selected prospectively from an outpatient clinic in Graz, Austria in a duration of 3 months. They are from men or women with benign and/or malignant skin tumors of either melanocytic or non-melanocytic origin. A total of 104 tumors from 80 patients using a mobile phone camera were gathered. The lesions were from the head and neck area, trunk, legs and feet and genital area. Study examination: A board-certified dermatologist with clinical expertise in teledermatology and dermoscopy reviewed the clinical and dermoscopic pictures with clinical information separately. The results from the review of the pictures were compared with those obtained by face-to-face examination and the gold standard face-to-face examination plus histopathology. Outcome: Tumors were classified under four categories: benign non-melanocytic, benign melanocytic, malignant non-melanocytic and malignant melanocytic. The table (Table 1) below shows the final diagnoses of the skin tumors examined per category. Results: Among these 104 lesions, 25 (24%) benign non-melanocytic, 15 (14%) benign melanocytic, 58 (56%) malignant non-melanocytic and six (6%) malignant melanocytic lesions were identified. Clinical and dermoscopic tele-evaluations showed high sensitivity and specificity. For malignant non-melanocytic tumors, sensitivity for both clinical and dermoscopic lesions is 97%; specificity for clinical and dermoscopic lesions are 91& and 94%, respectively. For classifying malignant melanocytic lesions, sensitivity for both clinical and dermoscopic lesions is 100% while specificity is 98% and 97%, respectively Conclusion: Clinical image tele-evaluation might be the method of choice for mobile tumor screening. Both clinical image tele-evaluation and teledermoscopy achieved excellent and equally high concordance rates with the gold standard.
dermatology ;

Introduction: Basal cell nevus syndrome (BCNS) (Gorlin-Goltz syndrome or Nevoid basal cell carcinoma syndrome) is a rare inherited multisystem and tumor-predisposing disorder caused by the patched tumor suppressor gene mutations and suppressor of fused gene. Its diagnosis follows a set of criteria based on specific cutaneous features and radiologic findings. Although an autosomal dominant disorder with a high degree of penetrance, BCNS has variable expression making its diagnosis difficult. The limited epidemiologic data among Asians especially in the Philippines hamper early detection or cause frequent misdiagnosis of the condition. Case report: A 56-year-old Filipino female with Fitzpatrick skin type V presented with early onset multiple basal cell carcinomas and bilateral palmoplantar pits. Radiologic investigation reveals odontogenic keratocyst, calcification of the falx cerebri, bridging of the sella turcica, bifid/splayed ribs and vertebral anomalies. The patient exhibits coarse facial features and bilateral cataracts. Cranial computed tomography scan shows cerebrocerebellar atrophy with ventricular dilatation. Management included wide excision of the nodular basal cell carcinomas (BCC), application of 5-flourouracil cream on the superficial BCC and electrodessication and curettage of the smaller lesions. Oral acitretin was also prescribed. Conclusion This is a case that highlights the approach to diagnosis, clinical features and management of BCNS in a Filipino patient. Since various phenotypic presentations may exist among dark-skinned individuals, early diagnosis poses a challenge among physicians. Epidemiologic and prevalence studies among Filipinos may be done to aid in the diagnosis and early management of this rare genodermatosis.
Basal Cell Nevus Syndrome ; Carcinoma, Basal Cell

BACKGROUND

Seborrheic keratosis is a common benign skin tumor treated with invasive methods like electrodessication, cryotherapy, or surgery. Topical therapy with trichloroacetic acid (TCA) may be a cheaper, non-invasive alternative with less complications. While TCA has been studied for other skin conditions, more research is needed on its use for seborrheic keratosis.

OBJECTIVE

To compare the safety and efficacy of one time application of 80% TCA peel to 65% TCA peel in the clearance of raised seborrheic keratosis in Filipino patients.

METHODOLOGY

One hundred one patients were randomized to either 80% or 65% TCA groups. Each participant underwent one session of treatment and was followed up after a month. Pre- and post-test size and thickness of lesions were compared between groups.

RESULTS

Based on Physician’s Lesion Assessment (PLA), both concentrations of TCA achieved high treatment success (TCA80: 66.7%, TCA65: 68%, p-value 0.89). A similar trend was observed based on Subject’s Self-Assessment (TCA80: 74%, TCA65: 74.5%, p-value 0.95). Similar reductions in lesion size and thickness were observed in both concentrations. In terms of safety, pain, pruritus, and erythema were mostly observed during and immediately after treatment, with little to no adverse events observed after 1 month in both groups.

CONCLUSION

One time application of either 80% or 65% TCA is effective in decreasing the size and thickness of seborrheic keratosis with little to no complications 1 month post- treatment. Both concentrations were safe, causing minimal and non-persistent pain, pruritus, and erythema immediately after application.

Human ; Keratosis, Seborrheic ; Trichloroacetic Acid

Porocarcinoma is a rare, cutaneous adnexal malignancy usually seen in elderly patients. We present three females with varying lesions located at the head region with a history of a sudden increase in growth. Histologically, all were composed of nests of basaloid cells showing atypia, mitotic figures and eccrine-differentiated ductal elements. One patient underwent excision (0.5 cm margin) and was recurrence-free one-month post-op. This series also brings a brief review of the current literature on porocarcinoma.
Eccrine Porocarcinoma

Background: Seborrheic keratosis is a benign skin tumor removed through electrodessication, cryotherapy, or surgery. Alternative options may be beneficial to patients with contraindications to standard treatment, or those who prefer a non-invasive approach. Objectives: To determine the effectiveness and safety of topical medications on seborrheic keratosis in the clearance of lesions, compared to placebo or standard therapy. Methods: Studies involving seborrheic keratosis treated with any topical medication, compared to cryotherapy, electrodessication or placebo were obtained from MEDLINE, HERDIN, and Cochrane electronic databases from 1990 to June 2018. Results: The search strategy yielded sixty articles. Nine publications (two randomized controlled trials, two non-randomized controlled trials, three cohort studies, two case reports) covering twelve medications (hydrogen peroxide, tacalcitol, calcipotriol, maxacalcitol, ammonium lactate, tazarotene, imiquimod, trichloroacetic acid, urea, nitric-zinc oxide, potassium dobesilate, 5-fluorouracil) were identified. The analysis showed that hydrogen peroxide 40% presented the highest level of evidence and was significantly more effective in the clearance of lesions compared to placebo. Conclusion Most of the treatments reviewed resulted in good to excellent lesion clearance, with a few well-tolerated minor adverse events. Topical therapy is a viable option; however, the level of evidence is low. Standard invasive therapy remains to be the more acceptable modality.
Keratosis, Seborrheic ; Systematic Review

BACKGROUND: Non-melanoma skin cancers (NMSC) consists of  basal-cell carcinomas (BCC) and squamous-cell carcinomas (SCC).Certain populations are predisposed to develop  NMSC,  including  patients  with  previous  history  of  NMSC.Systemic  retinoids  have  shown  promising  results  in chemoprevention of recurrence of NMSC in other high-risk populations (xeroderma pigmentosum and renal-transplant patients).We  assessed  the  efficacy  and  safety  of  low-dose  systemic  retinoids  compared  with  placebo,  as  a  chemopreventive agent for NMSC in patients with previous NMSC.
METHODOLOGY: Electronic  databases  were  systematically searched for this study. Participants in the studies selected must have had a biopsy-proven NMSC, over 18 years of age, with  no  exclusion  of  other  demographic  characteristics. All  types  of  systemic  retinoids  were  included  with  no restriction on dosage. Two authors independently performed standardized  eligibility  assessment  and  data-extraction.Differences in opinion were resolved by consensus with the third author. Statistical analysis was done using the Review Manager 5 software.
RESULTS: Eleven full-text studies were assessed for eligibility out of 178 studies found. Five studies were excluded because of the different population, while the two articles used topical retinoids. Four articles were included. The interventions were 10.0 mg isotretinoin, 25,000IU retinol and 25.0 mg acitretin,compared with placebo. Meta-analysis produced RR of 0.94 (95% CI, 0.89-1.00), with moderate heterogeneity (34%) due to the difference in interventions used. There are significantly more  adverse  events  in  the  retinoids  group,  especially  in the  incidence  of  mucocutaneous  adverse  events,  and deranged lipid profile and liver enzymes.
CONCLUSION: There is insufficient evidence to support the use of low-dose systemic retinoids as chemoprevention for patients with previous NMSC. Furthermore, adverse events may limit their use. Topical preparations with less side-effects may be investigated.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Vitamin A ; Acitretin ; Xeroderma Pigmentosum ; Isotretinoin ; Incidence ; Kidney Transplantation ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Chemoprevention ; Biopsy ; Lipids ; Liver