Mammary and extramammary Paget's disease Kanitakis, J
Journal of the European Academy of Dermatology and Venereology,
20/May , Letnik:
21, Številka:
5
Journal Article
Recenzirano
Paget's disease is an intra‐epidermal adenocarcinoma seen over the nipple/areola (mammary Paget's disease) or in extramammary body zones, such as the anogenital and perineal skin and the axilla. ...Mammary and extramammary Paget's disease share many common clinicopathological features but also show several differences, namely, with regard to pathogenesis and association with underlying malignancies. Indeed, mammary Paget's disease is as a rule associated with an underlying breast carcinoma whereas association of extramammary Paget's disease with underlying (skin or visceral) malignancies occurs much less frequently. We review here the main clinicopathological and therapeutic features of mammary and extramammary Paget's disease.
Skin cancers are the most frequent malignancies in organ transplant recipients (OTR), with 95% being nonmelanoma skin cancers (NMSC), especially squamous (SCC) and basal cell carcinomas. Most OTR ...with a first SCC subsequently develop multiple NMSC within 5 years, highlighting the concept of ‘field cancerization’, and are also at high risk for noncutaneous cancers. In order to reduce the tumor burden in these patients, their management requires an interdisciplinary approach including revision of immunosuppression, new dermatological treatments and adequate education about photoprotection in specialized dermatology clinics for OTR. Whereas surgery remains the gold‐standard therapy for NMSC, noninvasive methods have shown promising results to treat superficial keratoses and subclinical lesions on large body areas. Although the threshold of skin cancer necessitating revision of immunosuppression is debated, this measure should be envisaged at the occurrence of the first SCC, or in case of multiple non‐SCC NMSC. While the role of immunosuppressants in the occurrence of NMSC is widely recognized, the best immunosuppressive strategies remain to be defined. Presently, randomized prospective studies assess the burden of new skin tumors, as well as graft and patient survival, in patients with one or several NMSC after the introduction of mTOR (mammalian target of rapamycin) inhibitors.
Improvements in prevention and management of post‐transplant skin cancers requires an interdisciplinary approach, including revision of immunosuppression, new dermatological treatments, and education about photoprotection.
Ten years after the first face transplantation, we report the partial loss of this graft. After two episodes of acute rejection (AR) occurred and completely reversed in the first posttransplantation ...year, at 90 months posttransplantation the patient developed de novo class II donor‐specific antibodies, without clinical signs of AR. Some months later, she developed several skin rejection episodes treated with steroid pulses. Despite rapid clinical improvement, some months later the sentinel skin graft underwent necrosis. Microscopic examination showed intimal thickening, thrombosis of the pedicle vessel, and C4d deposits on the endothelium of some dermal vessels of the facial graft. Flow magnetic resonance imaging of the facial graft showed a decrease of the distal right facial artery flow. Three steroid pulses of 500 mg each, followed by intravenous immunoglobulins (2 g/kg), five sessions of plasmapheresis, and three cycles of bortezomib 1.3 mg/m2, were administered. Despite rescue therapy with eculizumab, necrosis of the lips and the perioral area occurred, which led to surgical removal of the lower lip, labial commissures, and part of the right cheek in May 2015. In January 2016, the patient underwent conventional facial reconstruction because during the retransplantation evaluation a small‐cell lung carcinoma was discovered, causing the patient's death in April 2016.
The authors report the partial graft loss of the first face transplantation performed in 2005, after humoral rejection. See the editorial from Krezdorn and Pomahac on page 1703.
Cutaneous squamous cell carcinoma (cSCC) is the second most common non‐melanoma skin cancer. Histology represents the gold standard to confirm the diagnosis of cSCC and is mandatory to determine ...important findings for tumour grading, such as tumour thickness, depth of invasion, degree of differentiation and histological subtype, perineural and vascular invasion, and assessing tumour margins. In daily clinical practice, the combination of clinical and histological features should be considered when grading the tumours and treating the patients, accordingly. This article aims to provide a structured overview of the most common histological findings of in situ and invasive cSCCs, namely those relevant to their severity, and should facilitate the understanding and evaluation of these results.
Adnexal tumours of the skin are benign, more rarely malignant, primary skin tumours that originate from, or differentiate towards, hair follicles, sebaceous and sweat glands. Although they are ...usually encountered as single, sporadic tumours, they may occasionally be multiple, hereditary; in that case, they may herald complex genetic syndromes that comprise visceral cancers. Dermatologists should be aware of these adnexal skin tumours, the diagnosis of which may contribute to an early detection of a cancer‐prone syndrome with a potentially lethal outcome. The main tumours falling into this category and their associated syndromes are reviewed here.
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