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Background: Cutaneous squamous cell carcinoma is a significant cause of morbidity for immunosuppressed patients such as organ transplant recipients; however, histological parameters which predict the likelihood of tumor progression are typically based on general population studies in which immunosuppressed patients represent only a small fraction of cases. Objectives: To determine the histological parameters which have independent prognostic value for cutaneous squamous cell carcinoma arising in renal transplant recipients. Methods: Case-control study incorporating a retrospective blinded histological review of 70 archived specimens of cutaneous squamous cell carcinoma diagnosed in renal transplant recipients, comprising 10 cases where the tumor had progressed and 60 controls. Results: Progression was significantly associated with head and neck location, size, depth, poor histological grade, perineural invasion (including small caliber perineural invasion), lymphovascular invasion, and a desmoplastic growth pattern. Limitations: The retrospective nature and the low number of cases compared to controls. Conclusion: In immunosuppressed patients both small caliber perineural invasion and a desmoplastic growth pattern may also have prognostic significance in addition to other histological parameters already recognized in formal staging schemes.

Epithelioid hemangioma (EHE) is a rarely malignant tumor originating from the vascular endothelium. Morphological manifestations and immunohistochemical staining results are key to diagnosing EHE. Herein, we present a case of cutaneous involment in a recurrence of EHE. A 75-year-old woman presented with a month-long history of persistent erythematous plaque and pain in the left shoulder. Skin biopsy specimen revealed epithelioid tumor cells containing abundant eosinophilic cytoplasm. Immunohistochemical staining confirmed a recurrence of EHE involving the skin. Subsequently, recombinant human endostatin was administered. At the 10-day follow-up, the cutaneous plaque had improved, and the pain had resolved. When presenting as a local painful erythematous plaque, the possibility of skin involvement in a malignant tumor should be considered. Early diagnosis and early systemic therapy have an important impact on the overall survival of patients with EHE.

Background: Current health behavior recommendations for skin cancer prevention, treatment, and survivorship are the same for survivors of other cancers; they include eating a healthy diet, being physically active, maintaining a healthy weight, and minimizing ultraviolet (U.V.) exposure. Few interventions exist to support health behaviors beyond U.V. exposure. We adapted Harvest for Health, a home-based mentored gardening intervention for cancer survivors, for implementation in Arizona as a community-based intervention. Methods: Stakeholder-informed adaptations for Harvest for Health Together Arizona (H4H2-AZ) included updating intervention materials to be relevant to the arid desert environment, emphasizing the importance of sun safety in cancer survivorship, and shifting from a home-based to a community-based delivery model. Participants will be enrolled in cohorts aligned with growing seasons (e.g., spring, monsoon, fall) and matched to an individual 30 ft2 community garden plot for two growing seasons (6 months). Original intervention components retained are: 1) Master Gardeners deliver the intervention providing one-to-one mentorship and 2) gardening materials and supplies provided. This pilot six-month single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer as primary outcomes. Secondary outcomes are to explore the effects on cancer preventive health behaviors and health-related quality of life. Discussion: This pilot single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer. If successful, the intervention could be widely implemented throughout existing Master Gardener programs and community garden networks for survivors of other cancers. Trial registration: ClinicalTrials.gov identifier: NCT05648604. Trial registered on December 13, 2022.

Background: A World Health Organization (WHO) and International Labour Organization (ILO) systematic review reported sufficient evidence for higher risk of non-melanoma skin cancer (NMSC) amongst people occupationally exposed to solar ultraviolet radiation (UVR). This article presents WHO/ILO Joint Estimates of global, regional, national and subnational occupational exposures to UVR for 195 countries/areas and the global, regional and national attributable burdens of NMSC for 183 countries, by sex and age group, for the years 2000, 2010 and 2019. Methods: We calculated population-attributable fractions (PAFs) from estimates of the population occupationally exposed to UVR and the risk ratio for NMSC from the WHO/ILO systematic review. Occupational exposure to UVR was modelled via proxy of occupation with outdoor work, using 166 million observations from 763 cross-sectional surveys for 96 countries/areas. Attributable NMSC burden was estimated by applying the PAFs to WHO’s estimates of the total NMSC burden. Measures of inequality were calculated. Results: Globally in 2019, 1.6 billion workers (95 % uncertainty range [UR] 1.6–1.6) were occupationally exposed to UVR, or 28.4 % (UR 27.9–28.8) of the working-age population. The PAFs were 29.0 % (UR 24.7–35.0) for NMSC deaths and 30.4 % (UR 29.0–31.7) for disability-adjusted life years (DALYs). Attributable NMSC burdens were 18,960 deaths (UR 18,180–19,740) and 0.5 million DALYs (UR 0.4–0.5). Men and older age groups carried larger burden. Over 2000–2019, attributable deaths and DALYs almost doubled. Conclusions: WHO and the ILO estimate that occupational exposure to UVR is common and causes substantial, inequitable and growing attributable burden of NMSC. Governments must protect outdoor workers from hazardous exposure to UVR and attributable NMSC burden and inequalities.

Background: Cancer is a leading cause of death globally and the second cause of death in developed countries. Having a rising incidence, skin cancer is the most prevalent cancer in Iran. Long-term UV radiations, particularly during childhood and adolescence, is a major cause of skin cancers. The Theory of Planned Behavior as the most precise indicator of behavior, contains motivational factors affecting behavior. This theory has been successful in predicting factors related to chronic diseases, especially cancer. As this model was successful in assessing sun-protective behaviors in previous studies, this study was designed to figure out how a theory-based educational intervention can affect the skin cancer prevention practices of Iranian female high school students. Methods: This experimental investigation was carried out 2019–2020 using multistage cluster sampling method on 400 female high school students in Fasa, Fars, Iran. A questionnaire consisting of demographic data and a questionnaire including the components of the Theory of Planned Behavior was used to assess skin cancer preventative behaviors of both the trial and control groups of the study. An educational program based on the Theory of Planned Behavior was held for the experimental group for eight weeks regarding skin cancer preventive behaviors. The two groups completed questionnaires three months following the intervention for a second time. Results: The study's findings revealed that prior to the intervention, there was no considerable distinction between the two study groups with regard to knowledge, attitude, subjective norms, perceived behavioral control, behavioral intentions, and skin cancer prevention behaviors; yet, three months later, the experimental group demonstrated increases in each of the mentioned variables with a significant difference. In contrast, the control group showed no discernible difference. Conclusions: The findings of this investigation highlighted the success of the Theory of Planned Behavior for designing educational interventions aimed at encouraging skin cancer prevention in a population of female high school students.

Donor-transmitted malignancy is a rare and often fatal complication of organ transplantation. We report a case of a 55-year old male kidney transplant recipient who was diagnosed with stage-IV donor-transmitted melanoma 5 months after transplantation with metastases in the liver, spleen, lung, and brain. Immunosuppression was discontinued, and encorafenib and binimetinib, inhibitors of a serine/threonine B-Raf proto-oncogene (BRAF) and mitogen-activated protein kinase kinase (MEK) respectively, were started. Severe rejection ensued and necessitated the start of hemodialysis as well as urgent graft nephrectomy. However, the tumor progressed and BRAF/MEK inhibition was replaced by immune-checkpoint inhibition with ipilimumab and nivolumab. When this also failed to slow disease progression and seizures occurred, therapy with encorafenib and binimetinib was reinstated. Afterwards, most of the metastases remained stable. The patient has now survived for more than 4 years in good general health, which is an exceptionally long survival with donor-transmitted, metastasized melanoma., Competing Interests: Declaration of competing interest The authors have no conflicts of interest regarding this manuscript., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Pathogenic LZTR1 variants cause schwannomatosis and dominant/recessive Noonan syndrome (NS). We aim to establish an association between heterozygous loss-of-function LZTR1 alleles and isolated multiple café-au-lait macules (CaLMs)., Methods: A total of 849 unrelated participants with multiple CaLMs, lacking pathogenic/likely pathogenic NF1 and SPRED1 variants, underwent RASopathy gene panel sequencing. Data on 125 individuals with heterozygous LZTR1 variants were collected for characterizing their clinical features and the associated molecular spectrum. In vitro functional assessment was performed on a representative panel of missense variants and small in-frame deletions., Results: Analysis revealed heterozygous LZTR1 variants in 6.0% (51/849) of participants, exceeding the general population prevalence. LZTR1-related CaLMs varied in number, displayed sharp or irregular borders, and were generally isolated but occasionally associated with features recurring in RASopathies. In 2 families, CaLMs and schwannomas co-occurred. The molecular spectrum mainly consisted of truncating variants, indicating loss-of-function. These variants substantially overlapped with those occurring in schwannomatosis and recessive NS. Functional characterization showed accelerated protein degradation or mislocalization, and failure to downregulate mitogen-activated protein kinase signaling., Conclusion: Our findings expand the phenotypic variability associated with LZTR1 variants, which, in addition to conferring susceptibility to schwannomatosis and causing dominant and recessive NS, occur in individuals with isolated multiple CaLMs., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (Copyright © 2024 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)

Background: The early detection of Non-Melanoma Skin Cancer (NMSC) is essential to ensure patients receive the most effective treatment. Diagnostic screening tools for NMSC are crucial due to high confusion rates with other types of skin lesions, such as Actinic Keratosis. Nevertheless, current means of diagnosing and screening patients rely on either visual criteria, that are often conditioned by subjectivity and experience, or highly invasive, slow, and costly methods, such as histological diagnoses. From this, the objectives of the present study are to test if classification accuracies improve in the Near-Infrared region of the electromagnetic spectrum, as opposed to previous research in shorter wavelengths., Methods: This study utilizes near-infrared hyperspectral imaging, within the range of 900.6 and 1454.8 nm. Images were captured for a total of 125 patients, including 66 patients with Basal Cell Carcinoma, 42 with cutaneous Squamous Cell Carcinoma, and 17 with Actinic Keratosis, to differentiate between healthy and unhealthy skin lesions. A combination of hybrid convolutional neural networks (for feature extraction) and support vector machine algorithms (as a final activation layer) was employed for analysis. In addition, we test whether transfer learning is feasible from networks trained on shorter wavelengths of the electromagnetic spectrum., Results: The implemented method achieved a general accuracy of over 80 %, with some tasks reaching over 90 %. F1 scores were also found to generally be over the optimal threshold of 0.8. The best results were obtained when detecting Actinic Keratosis, however differentiation between the two types of malignant lesions was often noted to be more difficult. These results demonstrate the potential of near-infrared hyperspectral imaging combined with advanced machine learning techniques in distinguishing NMSC from other skin lesions. Transfer learning was unsuccessful in improving the training of these algorithms., Conclusions: We have shown that the Near-Infrared region of the electromagnetic spectrum is highly useful for the identification and study of non-melanoma type skin lesions. While the results are promising, further research is required to develop more robust algorithms that can minimize the impact of noise in these datasets before clinical application is feasible., Competing Interests: Declaration of competing interest The corresponding author has no conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: Regional metastases of cutaneous head and neck squamous cell carcinoma occur in approximately 5 % of cases, being the most important prognostic factor in survival, currently with no distinction between parotid and neck metastasis. Objective: The purpose of this study was to evaluate the prognostic features among patients with head and neck cutaneous squamous cell carcinoma exhibiting regional metastasis. Methods: A retrospective analysis of patients with cutaneous squamous cell carcinoma who underwent parotidectomy and/or neck dissection from 2011 to 2018 at a single institution tertiary center was performed. Patient demographics, clinical, surgical and pathological information, adjuvant treatments, and outcome at last follow-up were collected. Outcomes included disease recurrence and death due to the disease. Prognostic value of clinic pathological features associated with disease-specific survival was obtained. Results: Thirty-eight cases of head and neck cutaneous squamous cell carcinoma with parotid and/or neck metastasis were identified. Overall, 18 (47.3 %) patients showed parotid metastasis alone, 12 (31.5 %) exhibited neck metastasis alone and 8 (21.0 %) had both. A primary tumor in the parotid zone (Hazard Ratio ‒ HR = 5.53; p = 0.02) was associated with improved disease-specific survival. Poorer disease-specific survival was observed in patients with higher primary tumor diameter (HR = 1.54; p = 0.002), higher depth of invasion (HR = 2.89; p = 0.02), invasion beyond the subcutaneous fat (HR = 5.05; p = 0.002), neck metastasis at first presentation (HR = 8.74; p < 0.001), number of positive lymph nodes (HR = 1.25; p = 0.004), and higher TNM stages (HR = 7.13; p = 0.009). Patients presenting with isolated parotid metastasis during all follow-ups had better disease-specific survival than those with neck metastasis or both (HR = 3.12; p = 0.02). Conclusion: Head and neck cutaneous squamous cell carcinoma with parotid lymph node metastasis demonstrated better outcomes than cases with neck metastasis.

Introduction: Since the first report of a platysma transverse myocutaneous flap in 1977, few articles about this flap design have been added to the literature. Objective: Our aim is to describe our department’s experience with platysma transverse myocutaneous flap. Methods: A retrospective review of all patients undergoing platysma transverse myocutaneous flap reconstruction between 2011 and 2019. Results: There were 16 men and 5 women in this series. The mean patients’ age was 72.7 years old. In eight cases, we had wound complications, including four wound infections, one hematoma and three distal flap ischemia problems. Distal flap ischemia occurred only in cases that advanced beyond the midline and with length-to-width ratio equal to or over three to one. Neck dissection was performed in two of these three cases with ischemic complications. Conclusion: Several factors may influence platysma transverse myocutaneous flap survival. Usually a long and narrow flap, especially crossing the neck midline and associated with neck dissection are more prone to poor outcomes.

Resumo: O cancro cutâneo não melanoma é a neoplasia mais prevalente na população caucasiana e a sua incidência está a crescer. Nos últimos anos, um conjunto de estudos sugeriu que a terapêutica anti‐hipertensora poderá aumentar o risco destes tumores, salientando‐se a hidroclorotiazida, pelas suas propriedades fotossensibilizadoras. A crescente evidência disponível levou a Infarmed (Autoridade Nacional do Medicamento e Produtos de Saúde) a realizar um alerta dirigido aos profissionais de saúde para o risco de cancro cutâneo não melanoma com a exposição dos doentes a doses cumulativas deste fármaco. Contudo, os resultados dos estudos têm‐se revelado heterogéneos e, por vezes, contraditórios. A elevada incidência de cancro cutâneo não melanoma e o grande número de indivíduos a cumprir terapêutica crónica com hidroclorotiazida poderão ter importantes repercussões em termos de saúde pública. Neste artigo, os autores propuseram‐se a reunir e analisar a evidência científica disponível, tendo concluído uma possível associação entre a toma de hidroclorotiazida e o risco de cancro cutâneo não melanoma, não esquecendo, no entanto, algumas limitações dos trabalhos existentes na literatura. O reforço de medidas educacionais para a adoção de estratégias preventivas face à exposição solar, a monitorização regular da pele e avaliação individual do benefício da terapêutica com hidroclorotiazida são importantes, em particular na presença de antecedentes pessoais de tumores de pele. Abstract: Non‐melanoma skin cancer is the most prevalent malignancy in fair‐skinned people and its incidence is increasing. Recently, studies have suggested that antihypertensive drugs may increase the risk of these tumors, particularly hydrochlorothiazide, due to its photosensitizing properties. The Portuguese National Authority for Medicines and Health Products, INFARMED, has issued an alert to healthcare professionals concerning the increased risk of non‐melanoma skin cancer in patients exposed to cumulative doses of this drug. However, study results have been heterogeneous and sometimes conflicting. The high incidence of non‐melanoma skin cancer and the large number of patients under chronic hydrochlorothiazide therapy may thus have important public health consequences. In this article, the authors review the published evidence and conclude that there may be an association between hydrochlorothiazide use and the risk of non‐melanoma skin cancer, but also point out some limitations of the studies in the literature. It is important to promote preventive strategies against sun exposure, regular skin examinations, and individual assessment of the benefits of hydrochlorothiazide use, particularly in patients with previous skin cancer.

Introduction: The risk of locoregional and distant recurrence of stage IIB/IIC cutaneous melanoma is high, and limited evidence exists on the clinical benefit of adjuvant immunotherapy (aIMT). This is the first retrospective study to evaluate the utilization and survival benefit of adjuvant immunotherapy (aIMT) for high-risk stage II cutaneous melanoma. Methods: The National Cancer Database (NCDB) was queried for stage IIB/IIC melanoma patients who underwent resection and sentinel lymph node biopsy. Chi-square tests and multivariable logistic regression examined associations between utilization of aIMT and socioeconomic and clinical characteristics. Propensity score weighted Cox proportional hazards model assessed impact of aIMT on overall survival. Results: Of the 8,549 patients with pathologic stage IIB/IIC melanoma, 344 (4.02%) patients received aIMT. Patients with pT4b disease or positive surgical margins were more likely to receive aIMT than patients with pT3b disease or negative margins (OR=3.10, OR=2.71, respectively, all P

BLZ-100 (tozuleristide) is an intraoperative fluorescent imaging agent that selectively detects malignant tissue and can be used in real time to guide tumor resection. The purpose of this study was to assess the safety, tolerability, and pharmacokinetics of BLZ-100 and to explore the pharmacodynamics of fluorescence imaging of skin tumors. In this first-in-human study, BLZ-100 was administered intravenously to 21 adult patients 2 days before excising known or suspected skin cancers. Doses were 1, 3, 6, 12, and 18 mg, with 3–6 patients/cohort. Fluorescence imaging was conducted before and up to 48 h after dosing. BLZ-100 was well tolerated. There were no serious adverse events, deaths, or discontinuations due to adverse events, and no maximum tolerated dose (MTD) was identified. Headache (n = 2) and nausea (n = 2) were the only BLZ-100 treatment-related adverse events reported for >1 patient. Median time to maximal serum concentration was

Syringoid eccrine carcinoma (SEC) is a rare, malignant, adnexal, and locally aggressive tumor. Due to their low incidence and non-specific clinical manifestation, these tumors are often misdiagnosed, even in the presence of specific histological findings. The involvement of the ear is exceptionally rare. Here we present the case of a male patient who arrived at our clinic with a non-painful nodular lesion that had developed over the course of month, located in the right external auditory canal (EAC) and post auricular area. Magnetic Resonance (MRI) and computed tomography (CT) were carried out, through which cervical lymph nodes, mastoid bone invasion, and right jugular thrombosis were identified. A type 3 lateral temporal bone resection was performed with posterior adjuvant radiotherapy and the pathology of the resected tissue was reported as a SEC compromising the EAC with infiltration to the tympanic membrane, middle ear, and parotid gland, and involvement of the sternocleidomastoid and temporal muscles, without lymphovascular invasion. At follow up, no tumor recurrence was identified. To our knowledge this is the first case of SEC with invasion of the ear reported in Latin America.

Background: Adherence to self-management interventions is critical in both clinical settings and trials to ensure maximal effectiveness. This study reports how the Behaviour Change Wheel may be used to assess barriers to self-management behaviours and develop strategies to maximise adherence in a trial setting (the MEL-SELF trial of patient-led melanoma surveillance)., Methods: The Behaviour Change Wheel was applied by (i) using the Capability, Opportunity, Motivation-Behaviour (COMB) model informed by empirical and review data to identify adherence barriers, (ii) mapping identified barriers to corresponding intervention functions, and (iii) identifying appropriate behaviour change techniques and developing potential solutions using the APEASE (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects and safety, Equity) criteria., Results: The target adherence behaviour was defined as conducting a thorough skin self-examination and submitting images for teledermatology review. Key barriers identified included: non-engaged skin check partners, inadequate planning, time constraints, low self-efficacy, and technological difficulties. Participants' motivation was positively influenced by perceived health benefits and negatively impacted by emotional states such as anxiety and depression. We identified the following feasible interventions to support adherence: education, training, environmental restructuring, enablement, persuasion, and incentivisation. Proposed solutions included action planning, calendar scheduling, alternative dermatoscopes, optimised communication, educational resources in various formats to boost self-efficacy and motivation and optimised reminders (which will be evaluated in a Study Within A Trial (SWAT))., Conclusion: The Behaviour Change Wheel may be used to improve adherence in clinical trials by identifying barriers to self-management behaviours and guiding development of targeted strategies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Aims: With the development of novel therapies for advanced malignant melanoma (MM), biomarkers that can accurately reflect the progression of MM are needed. Serum levels of melanin-related indole metabolites such as 5-hydroxy-6-methoxyindole-2-carboxylic acid (5H6MI2C) and 6-hydroxy-5-methoxyindole-2-carboxylic acid (6H5MI2C) are potential biomarkers for MM. Here, we describe the development of a mass spectrometry (MS)-based assay to determine serum levels of 5H6MI2C and 6H5MI2C., Materials and Methods: We developed a stable isotope dilution-selective reaction monitoring-MS protocol using liquid chromatography tandem mass spectrometry (LC-MS/MS) to measure human serum 5H6MI2C and 6H5MI2C levels. Analytical evaluations of the method were performed and the method was applied to serum samples from MM patients (n = 81)., Results: The method established in this study showed high reproducibility and linearity. This novel method also found that serum 6H5MI2C levels were significantly elevated in patients with metastatic MM compared to those with non-metastatic MM. Unfortunately, 5H6MI2C did not show a comparable significant difference., Conclusion: We successfully established measurement methods for serum 5H6MI2C and 6H5MI2C levels using LC-MS/MS. Serum 6H5MI2C levels offer a potential marker for MM., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘Tomohiro Nakayama belongs to an endowment division, supported with a grant from JEOL Ltd. since June 2020. There are no other conflicts of interest to declare.’., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Abstract: Patients with Sézary syndrome (SS), a leukemic variant of cutaneous T-cell lymphoma (CTCL), are prone to Staphylococcus aureus infections and have a poor prognosis due to treatment resistance. Here, we report that S aureus and staphylococcal enterotoxins (SE) induce drug resistance in malignant T cells against therapeutics commonly used in CTCL. Supernatant from patient-derived, SE-producing S aureus and recombinant SE significantly inhibit cell death induced by histone deacetylase (HDAC) inhibitor romidepsin in primary malignant T cells from patients with SS. Bacterial killing by engineered, bacteriophage-derived, S aureus-specific endolysin (XZ.700) abrogates the effect of S aureus supernatant. Similarly, mutations in major histocompatibility complex (MHC) class II binding sites of SE type A (SEA) and anti-SEA antibody block induction of resistance. Importantly, SE also triggers resistance to other HDAC inhibitors (vorinostat and resminostat) and chemotherapeutic drugs (doxorubicin and etoposide). Multimodal single-cell sequencing indicates T-cell receptor (TCR), NF-κB, and JAK/STAT signaling pathways (previously associated with drug resistance) as putative mediators of SE-induced drug resistance. In support, inhibition of TCR-signaling and Protein kinase C (upstream of NF-κB) counteracts SE-induced rescue from drug-induced cell death. Inversely, SE cannot rescue from cell death induced by the proteasome/NF-κB inhibitor bortezomib. Inhibition of JAK/STAT only blocks rescue in patients whose malignant T-cell survival is dependent on SE-induced cytokines, suggesting 2 distinct ways SE can induce drug resistance. In conclusion, we show that S aureus enterotoxins induce drug resistance in primary malignant T cells. These findings suggest that S aureus enterotoxins cause clinical treatment resistance in patients with SS, and antibacterial measures may improve the outcome of cancer-directed therapy in patients harboring S aureus., (© 2024 American Society of Hematology. Published by Elsevier Inc. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Unclear cystic masses in the pelvis in male patients are a rare situation and could be of benign or malignant origin. The underlying diseases demand for specific diagnostic and therapeutic approaches. We present a case series of 3 male patients with different clinical symptoms (perineal pain, urinary retention and a large scrotal cyst) related to cystic lesions in the pelvic region. On all patients initial histopathological workup was unclear. All patients underwent surgery with complete resection of the tumor which revealed a broad spectrum of histopathological findings: unusual form of cystic adenocarcinoma of the prostate, malignant transformation of a dysontogenetic cyst, and finally a very rare diagnosis of a malignant tumor of the Cowper gland. This case series and literature review provide clues for a possible diagnostic and therapeutic approach in the case of unclear pelvic cystic masses and could support urologists during the therapy selection in the future., Competing Interests: Disclosure The authors declare no financial interest, (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Actinic keratoses (AK) are one of the most frequent reasons for consultations in dermatology. Ultraviolet-induced fluorescence dermatoscopy (UVFD) is a new method that allows the assessment of lesions in a spectrum of light that originates from the fluorochromes emitting UV-excited luminescence. The aim of this study was to assess the UVFD features of AKs before PDT and their intensity in field cancerization and single lesions., Methods: This retrospective study was conducted from June to November 2023. Lesions were assessed with the Olsen scale clinically and dermatoscopically (DermLite DL5, 10x magnification) and photographed. UVFD fluorescence was categorized as 'none', 'weak', 'moderate', and 'intense'. A 1-mm thick layer of 10 % 5-ALA gel was applied to single lesions or cancerization field (depending on the patient) and covered with an occlusive dressing for 3 h. Prior the application of 10 % 5-ALA gel, the lesions were degreased with an alcoholic solution. The occlusion was removed, and the field was cleaned with a 0,9 % saline solution. Afterward, each lesion was photographed in polarized light and UVFD mode., Results: A total of 194 dermatoscopic images were analyzed, 111 corresponded to field cancerization and 81 to single AKs. Overall, weak fluorescence was noticed in 22 of them (11,3 %), moderate in 107 (55,15 %), and intense in 65 (33,5 %). Amongst field cancerization (111 images), weak fluorescence was seen in 11 (9.9 %), moderate in 68 (61,26 %), and intense in 32 (28,82 %). In single lesions (81 images), weak fluorescence was detected in 11 (13,2 %), moderate in 39 (46,99 %), and intense in 33 (28.83 %) of the lesions. Slightly more intense fluorescence was noticed in higher Olsen grade (p = 0.04)., Conclusions: UVFD can enhance our efficacy of pre-procedural examination and might arise as a useful device to predict the therapeutic effect of PDT., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Childhood panniculitides are not common. Histopathological diagnostic approach is vital to differentiate this group of pathologies that commonly present with inflammation of the subcutaneous adipose tissue. Pediatric subcutaneous panniculitis-like T-cell lymphomas are rare. Treatment modalities include observation, surgical excision, radiotherapy, immunosuppression, and chemotherapy. The case of an 18-month female who presented with a flank mass that was diagnosed as a subcutaneous panniculitis-like T-cell lymphoma and successfully managed with intensity-reduced, dual agent immunosuppression is described.

Sunscreen is a popular form of sun protection and when applied sufficiently (2 mg/cm2) has been shown to block the harmful molecular effects of ultraviolet radiation (UV). This field study tested the effectiveness of UV detection stickers to improve sunscreen use. During a rugby league two-day sporting event (28–29 February 2020) in Queensland, Australia interested players 14–18 years old were provided with access to free sunscreen on DAY-1 and during the subsequent day (DAY-2) were provided with a free UV detection sticker and access to sunscreen. On DAY-2, one UV detection sticker was handed out to 550 attendees. The sunscreen bottles were weighted periodically by research staff throughout both event days. Primary outcomes were sunscreen usage. Overall, 868 g of sunscreen was used across both DAY-1 and DAY-2, with 19% (167 g) of sunscreen used on DAY-1 and 81% (701 g) of sunscreen used on DAY-2. This resulted in a >3-fold improvement in sunscreen use on DAY-2 when the UV detection stickers were provided. We found UV detection stickers may improve use of sunscreen in adolescents during sporting events in high UV environments.

Background: NA OBJECTIVE: Evaluate the safety and feasibility of platelet-rich plasma (PRP) in the treatment of giant congenital melanocytic nevi (GCMN) in children with human acellular dermal matrix (HADM) transplantation., Patients and Methods: A total of 22 children with GCMN were included in the study. They were divided into an experimental and a control group. The experimental group used the method of HADM with Razor Autologous Skin Graft combined with PRP to repair skin and soft tissue defects after giant nevus resection (Group A, n = 11). The control group was treated with HADM with Razor Autologous Skin Graft (Group B, n = 11) only. To compare the survival rate of skin grafts, we used the Vancouver Scar Scale (VSS) for the postoperative skin graft area and the Patient and Observer Scar Assessment Scale (POSAS) to compare the two groups of patients., Results: There was no statistically significant difference in age, gender, location of giant nevi, and pathological classification between Group A and Group (P > 0.05). The survival rate of skin grafting and the VSS and POSAS scores of scar tissue in group A were superior to those of group B (P < 0.05)., Conclusions: PRP has improved the survival rate of composite skin grafting in children with GCMN, and long-term satisfactory prognosis of scar healing. Therefore, we consider this treatment method a valuable contribution to clinical practice., Competing Interests: Declaration of Competing Interest Authors report no conflict of interest., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Adolescents with the rare birthmarks congenital melanocytic naevi (CMN) experience physical and psychosocial challenges, many of which stem from looking different from the 'norm'. However, some adjust and have positive experiences. Understanding the lived experiences of adolescents who have adjusted to CMN can provide a holistic picture of adjustment and inform the development of support and interventions for others with the condition. Open, participant-driven photo-elicitation interviews were conducted with four White females (15-17 years) who self-identified as having adjusted to CMN. Participants chose five photographs which were used to guide the interviews (47-80 min). Interpretative phenomenological analysis (IPA) was used to analyse the transcribed interview data. Three superordinate themes were identified: 'Accepting My 'True' Self' (1), 'I am Not Alone in This' (2), and 'Developing as a Person' (3). The themes related to accepting CMN as part of their identity, developing a positive body image (e.g., body appreciation, broad conceptualisations of beauty, body image flexibility), feeling supported and accepted by family, friends, and others with CMN, and developing adaptive coping skills. Findings suggest positive body image may be important for adjustment and can be determined by an individual. The benefits of using photo-elicitation within appearance research are discussed., Competing Interests: Declaration of Competing Interest In accordance with Body Image policy, the authors declare that they have no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Skin cancer diagnosis often relies on image segmentation as a crucial aid, and a high-performance segmentation can lower misdiagnosis risks. Part of the medical devices often have limited computing power for deploying image segmentation algorithms. However, existing high-performance algorithms for image segmentation primarily rely on computationally intensive large models, making it challenging to meet the lightweight deployment requirement of medical devices. State-of-the-art lightweight models are not able to capture both local and global feature information of lesion edges due to their model structures, result in pixel loss of lesion edge. To tackle this problem, we propose LeaNet, a novel U-shaped network for high-performance yet lightweight skin cancer image segmentation. Specifically, LeaNet employs multiple attention blocks in a lightweight symmetric U-shaped design. Each blocks contains a dilated efficient channel attention (DECA) module for global and local contour information and an inverted external attention (IEA) module to improve information correlation between data samples. Additionally, LeaNet uses an attention bridge (AB) module to connect the left and right sides of the U-shaped architecture, thereby enhancing the model's multi-level feature extraction capability. We tested our model on ISIC2017 and ISIC2018 datasets. Compared with large models like ResUNet, LeaNet improved the ACC, SEN, and SPEC metrics by 1.09 %, 2.58 %, and 1.6 %, respectively, while reducing the model's parameter number and computational complexity by 570x and 1182x. Compared with lightweight models like MALUNet, LeaNet achieved improvements of 2.07 %, 4.26 %, and 3.11 % in ACC, SEN, and SPEC, respectively, reducing the parameter number and computational complexity by 1.54x and 1.04x., Competing Interests: Declaration of competing interest All authors disclosed no relevant relationships., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The risk of cancer among relatives of patients with either myelodysplastic neoplasia (MDS), acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) has not been thoroughly examined., Methods: We linked the Danish Civil Registration System with the Danish Cancer Registry, the Danish National Acute Leukemia Registry, and the Danish Myelodysplastic Syndrome Database to estimate the relative risk of cancer among relatives of patients with MDS/AML/ALL. We used standardized incidence ratios (SIRs), i.e., the ratio of observed to expected number of cancers among the relatives as a measure of relative risk., Results: We identified 13010 first-degree (FDR) and 22051 second-degree (SDR) relatives of 8386 patients with MDS/ALL/AML. Disregarding basal cell carcinoma (BCC), the relative risk for cancer overall was increased in both FDR (SIR=1.3; 95% confidence interval (CI) 1.1-1.4) and SDR (SIR=1.5; 95% CI 1.2-1.8). SIRs among FDRs were statistically significantly increased for malignant melanoma, BCC and for the combined groups of cancers of the male genital organs, urinary tract, and MDS/AML/ALL. Among SDRs, SIRs were statistically significantly increased for malignant melanoma, BCC, and cancers in the digestive organs and peritoneum., Conclusions: We observed an increased risk of cancer among FDR and SDR of patients with MDS/AML/ALL., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The objective of this study was to analyze, in a randomized controlled multicenter trial, whether a xenogeneic collagen matrix (XCM) could be used to cover skin defects. Patients with the need for skin excisions were recruited and randomized to treatment with a skin graft after a period of granulation or to treatment with an XCM. The results were evaluated by two independent observers on the Patient and Observer Scar Assessment Scale. On this scale, scars are ranked from 1 to 10 in six different categories. Results range from 6 to 60, with lower scores representing scars closer to normal skin. The results 6 months after reconstruction were used as primary endpoint and compared in a non-inferiority approach. A total of 39 wounds in the head and neck region were analyzed. The mean results were 16.55 (standard deviation 6.8) for XCM and 16.83 (standard deviation 8.21) in the control group. The result of the XCM was not significantly inferior to the result of the skin graft (p = 0.91). Within the limitations of the study, it seems that the use of xenogeneic collagen matrices is a viable alternative to other approaches in small skin defects, and therefore should be taken into account whenever the reduction of patient morbidity to a minimum is the priority. TRIAL REGISTRATION: This trial was registered in the German Clinical Trials Register under registration identification number DRKS00010930 and can be found under the following URLs: https://www.drks.de/drks&#95;web/navigate.do?navigationId=trial.HTML&TRIAL&#95;ID=DRKS00010930. https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00010930., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Competing Interests: Conflict of interest Niels Ødum has received consulting honoraria from Micreos Pharmeceuticals, and Almirall. Emmanuella Guenova has received consulting fees, payment or honoraria from Helsinn, KIOWA Kirin, Mallinckrodt Pharmaceuticals, Novartis, Recordati Rare Diseases, Sanofi, and Takeda.

Purpose: The aim of this research was to adapt the Sun Protection Behavior Scale (SPBS) to Turkish and to perform validity and reliability analyses. Methods: The scale was administered to a total of 900 adolescents, the retest to 91 adolescents. The construct validity of the scale was evaluated using exploratory (EFA) and confirmatory factor analysis (CFA). The EFA and CFA were applied to sample groups of 449 and 451 people, respectively. Results: The Cronbach alpha coefficients for the Turkish form of the SPBS (α = .74) and its sunscreen (α = .88) and hat use (α = .70) subscales were found to be ≥.70 while the sun avoidance subscale was calculated to be .67. The item-total score correlation between the scale and its subscales was ≥.26 and the test-retest correlations were found to be ≥.51. The CFA results verified the 8-item, 3-factor Turkish version of the SPBS. The confirmatory factor loadings for the scale were .45–.80 for sun avoidance, .72–.93 for sunscreen use, and .66–.83 for hat use. In particular, SPBS and sunscreen use (p

Epidemiological studies have found that high citrus fruit consumption was associated with higher risk of skin cancer. Citrus fruits and some vegetables contain furocoumarins, which may interact with ultraviolet radiation to induce skin cancer. We aimed to determine the effects of two furocoumarins, including 8-methoxypsoralen (8-MOP) and 6',7'-dihydroxybergamottin (DHB), on UVA-induced DNA damage in human epidermal melanocytes, the origin of melanoma. Our hypothesis was that these dietary furocoumarins increase UVA-induced DNA damage in melanocytes, compared to cells exposed to UV alone. We incubated melanocytes with 8-MOP or DHB, followed by exposure to physiological doses of UVA radiation. We used Western blots to quantify the UVA-induced DNA damage measured by the fraction of phosphorylated histone variant H2AX (γH2AX), which is a marker of DNA damage, relative to total H2AX (γH2AX/H2AX) in the presence or absence of furocoumarins. To quantify the UVA-induced change in γH2AX/H2AX, we calculated the UVA:Control ratio as the ratio of γH2AX/H2AX in UVA-exposed cells to that in cells without UVA (control). The mean UVA:Control ratios were borderline significantly higher for cells treated with 8-MOP and significantly higher for cells treated with DHB, compared to that of untreated cells. This study suggests that furocoumarins (particularly 8-MOP and DHB) enhance UVA-induced DNA damage in melanocytes, which is a potential novel mechanism for citrus and furocoumarins to elevate the risk of skin cancer., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Eunyoung Cho reports financial support was provided by Legorreta Cancer Center at Brown University., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Evidence indicates that a melanoma prevention program using personalized genomic risk provision and genetic counseling can affect prevention behaviors, including reducing sunburns in adults with no melanoma history. This analysis evaluated its longer-term cost-effectiveness from an Australian health system perspective., Methods: The primary outcome was incremental cost effectiveness ratio (ICER) of genomic risk provision (intervention) compared with standard prevention advice. A decision-analytic Markov model was developed using randomized trial data to simulate lifetime cost-effectiveness. All costs were presented in 2018/19 Australian dollars (AUD). The intervention effect on reduced sunburns was stratified by sex and traditional risk, which was calculated through a validated prediction model. Deterministic and probabilistic sensitivity analyses were undertaken for robustness checks., Results: The per participant cost of intervention was AUD$189. Genomic risk provision targeting high-traditional risk individuals produced an ICER of AUD$35,254 (per quality-adjusted life year gained); sensitivity analyses indicated the intervention would be cost-effective in more than 50% of scenarios. When the intervention was extended to low-traditional risk groups, the ICER was AUD$43,746 with a 45% probability of being cost-effective., Conclusion: Genomic risk provision targeted to high-traditional melanoma risk individuals is likely a cost-effective strategy for reducing sunburns and will likely prevent future melanomas and keratinocyte carcinomas., Competing Interests: Conflict of Interest Alexander M. Menzies has served on advisory boards for BMS, MSD, Novartis, Roche, Pierre-Fabre, and QBiotics., (Copyright © 2023 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)

Accurate and automatic segmentation of medical images is a key step in clinical diagnosis and analysis. Currently, the successful application of Transformers' model in the field of computer vision, researchers have begun to gradually explore the application of Transformers in medical segmentation of images, especially in combination with convolutional neural networks with coding-decoding structure, which have achieved remarkable results in the field of medical segmentation. However, most studies have combined Transformers with CNNs at a single scale or processed only the highest-level semantic feature information, ignoring the rich location information in the lower-level semantic feature information. At the same time, for problems such as blurred structural boundaries and heterogeneous textures in images, most existing methods usually simply connect contour information to capture the boundaries of the target. However, these methods cannot capture the precise outline of the target and ignore the potential relationship between the boundary and the region. In this paper, we propose the TGDAUNet, which consists of a dual-branch backbone network of CNNs and Transformers and a parallel attention mechanism, to achieve accurate segmentation of lesions in medical images. Firstly, high-level semantic feature information of the CNN backbone branches is fused at multiple scales, and the high-level and low-level feature information complement each other's location and spatial information. We further use the polarised self-attentive (PSA) module to reduce the impact of redundant information caused by multiple scales, to better couple with the feature information extracted from the Transformers backbone branch, and to establish global contextual long-range dependencies at multiple scales. In addition, we have designed the Reverse Graph-reasoned Fusion (RGF) module and the Feature Aggregation (FA) module to jointly guide the global context. The FA module aggregates high-level semantic feature information to generate an original global predictive segmentation map. The RGF module captures non-significant features of the boundaries in the original or secondary global prediction segmentation graph through a reverse attention mechanism, establishing a graph reasoning module to explore the potential semantic relationships between boundaries and regions, further refining the target boundaries. Finally, to validate the effectiveness of our proposed method, we compare our proposed method with the current popular methods in the CVC-ClinicDB, Kvasir-SEG, ETIS, CVC-ColonDB, CVC-300,datasets as well as the skin cancer segmentation datasets ISIC-2016 and ISIC-2017. The large number of experimental results show that our method outperforms the currently popular methods. Source code is released at https://github.com/sd-spf/TGDAUNet., Competing Interests: Declaration of competing interest All authors have seen and approved manuscript being submitted. They warrant that the article is the authors’ original work, has not received prior publication and is not under consideration for publication elsewhere. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. No potential competing interests exist. There is no an undisclosed relationship that may pose a competing interest. There is no an undisclosed funding source that may pose a competing interest. Moreover, I, corresponding author, have full access and responsibility for the accuracy of data analysis, manuscript preparation and decision to submit the manuscript for publication., (Copyright © 2023 Elsevier Ltd. All rights reserved.)