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The hedgehog pathway inhibitor vismodegib provides a new treatment option for metastasized and locally advanced basal cell carcinoma for which surgical excision or radiotherapy is contraindicated. However, adverse events frequently lead to discontinuation of therapy and development of tumor resistance is quite common. In the future, combination therapy could reduce the occurrence of tumor resistance.

To date, there is no consensus on the treatment of actinic keratosis (AK). Current national and international guidelines state no clear recommendations for the best choice of therapy. To determine the most effective treatment in terms of lesion reduction, costs and patient satisfaction topical treatment with 0.015% ingenol mebutate gel, 5% 5-fluorouracil cream, 5% imiquimod cream and photodynamic therapy were compared in a prospective randomized controlled multi-centre study. Patients older than 18 years with a Fitzpatrick skintype I-IV, with 5 AK’s Olsen class I-III in an area of minimal 25 cm2 and maximal 100 cm2 , localized in the head and neck area were included in the study. In total 624 were included in the Dermatology departments of the Maastricht University Medical Centre, Catharina hospital Eindhoven, Zuyderland Medical Centre Heerlen and VieCuri Medical Centre Venlo/Venray. Primary outcome measure is treatment success, defined as the proportion of participants with ≥ 75% reduction of the number of AK lesions in the treatment area at 12 months post final treatment compared to baseline. Secondary outcome is treatment success at 3 months post final treatment, cost-effectiveness, side effects, patient satisfaction, cosmetic outcome and treatment compliance.

Basal cell nevus syndrome is an autosomal dominant disorder. The most common underlying genetic cause is a mutation in de PTCH1 gene. Mutations in PTCH2 or SUFU gene are less common. In this case a 28 years old patient with basal cell nevus syndrome with a SUFU mutation is described. Patients with a SUFU mutation have an increased risk of developing a medulloblastoma at childhood. Due to the long-term side effects of radiation therapy, regular neurological assesment is recommended. Dermatologic examination was recommended yearly or every six months after developing the first basal cell carcinoma. Odontogenic keratocysts have not been described previously in patients with a SUFU mutation. For this reason, annual screening for jaw cysts is not indicated.

Keratoacanthoma is a common cutaneous tumor, of which the benign or malignant potential remains controversial. Keratoacanthoma is often considered as a benign skin tumor, because metastases rarely occur. However, metastases of a keratoacanthoma are reported in literature. Furthermore, development of squamous cell carcinoma in keratoacanthoma is also reported. Besides this, it can histopathologically be difficult or even impossible to distinguish between a well differentiated squamous cell carcinoma and keratoacanthoma. These factors lead to complex therapeutical decisions, that can have large implications for the patient. In this report we present a case of an incompletely excised moderately differentiated squamous cell carcinoma of the left cheek (infraorbital), which was initially diagnosed as keratoacanthoma at the referring hospital. The patient was referred to our multidisciplinary head and neck team. It was decided to perform a re-resection, using a so-called ‘Slow Mohs’-procedure. This re-resection appeared to be incomplete and showed extensive perineural growth. This perineural growth extended along the infraorbital/maxillary nerve via the foramen rotundum, into the sinus cavernosus. This made radical surgical resection impossible. It was decided to treat the patient with adjuvant radiotherapy. This case emphasizes not only the controversy surrounding the benign or malignant nature of a keratoacanthoma and the implications for the patient, but also the importance of an adequate multidisciplinary approach in such complex cases.

Introduction To date, the diagnosis and subtype of basal cell carcinoma (BCC) is verified by histopathology by means of a skin biopsy. However, non-invasive diagnostic strategies such as optical coherence tomography (OCT) enable detailed examination of skin tissue architecture and may be used to identify BCC. In this study, the diagnostic accuracy and level of confidence in detection and subtyping of BCC by OCT was evaluated. Materials & methods In this prospective observational study, OCT imaging was used for all lesions suspected for non-melanoma skin cancer or pre-malignancy that were biopsied to confirm the diagnosis at our outpatient Dermatology clinic. Decisions on treatment were guided by clinical examination and biopsy conform standard care. The OCT images were assessed by two investigators, blinded to the histological diagnosis. Diagnostic accuracy and certainty of clinical diagnosis alone was compared to the diagnostic accuracy and certainty of the combination of clinical diagnosis and OCT imaging, using histopathological diagnosis of the biopsy specimen as the gold standard. Aim of the study The aim of the study is to investigate the diagnostic value of OCT in addition to clinical examination for the detection and subtyping of BCC. Diagnostic parameters such as the sensitivity, specificity, positive- and negative predictive value were evaluated.