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Basal cell carcinoma is the most common type of skin cancer, and surgical excision with clear margins is the standard of care. Surgical margins are determined based on risk factors (high or low risk) for recurrence according to the National Comprehensive Cancer Network and Japanese basal cell carcinoma guidelines. The clarity of the clinical tumor border (well-defined or poorly defined) is considered a risk factor, and significant discrepancies in the judgment of clinical tumor borders among dermato-oncologists may occur. Therefore, we analyzed the dermato-oncologists' concordance in judging the clinical tumor border of basal cell carcinoma. Forty-seven dermato-oncologists (experts: 37; young trainees: 10) participated in this study. The datasets of clinical and dermoscopic photographs of 79 Japanese cases of head and neck basal cell carcinoma were used to determine the concordance in the judgment of clinical tumor border. The probability of the border that was selected more often was used to calculate the rater agreement rate for each dataset. Correct judgment was defined as a more frequently selected border, and the concordance rate of clarity of clinical tumor border for each dermato-oncologist was calculated based on the definition of the correct judgment. A median concordance rate of 85% or higher for all dermato-oncologists was predefined as an acceptable rate for clinical use. Of the 79 datasets, rater agreement rates were 80-100%, 60-79%, and 51-59% for 55, 19, and five datasets, respectively. The median concordance rate for all dermato-oncologists was 86% (interquartile range: 82-89%). There was no significant difference in the concordance rate between the experts and the trainees (median, 87% vs. 85.5%; p = 0.58). The concordance rates of dermato-oncologists for all datasets were relatively high and acceptable for clinical use.

Basal cell carcinoma (BCC) is the most common skin cancer. While Mohs micrographic surgery is commonly accepted for BCC treatment, surgical excision with free margins is widely considered the best treatment modality for BCCs in Japan. However, little is known about the predictors of the invasion levels of BCCs.To investigate the optimization of deep surgical margins by identifying factors significantly influencing the invasion levels of facial BCCs.The tumor invasion level was defined as the deepest part of a tumor. Tumor thickness was measured from the top of the granular layer to the deepest extension of the tumor or from the ulcer base overlying the deepest point of invasion in ulcerated lesions. Factors independently associated with tumor thickness and invasion level were identified by multivariate analysis. Six variables were tested: age, sex, anatomical region (nose, orbit, others), histologic pattern (aggressive, non-aggressive), presence of pigmentation, and diameter.We included 718 cases of facial BCCs involving 705 Japanese patients. The most frequent anatomical region and histologic pattern were the nose and nodular pattern, respectively. Only tumor diameter showed a correlation with tumor thickness (β = 0.377, P0.001). Tumor diameter (AOR = 71.189, 95 % CI: 11.420-430.931, P = 0.01) and the following anatomical regions showed correlations with the invasion level: nose/others: AOR=2.769, 95 % CI: 1.235-6.493, P = 0.01; orbit/others: AOR=6.369, 95 % CI: 2.728-15.429, P0.001; orbit/nose: AOR=2.300, 95 % CI: 1.056-4.984, P = 0.04.This study serves as a guide for optimizing deep surgical margins and planning surgery for facial BCCs considering independently associated factors.

This case report describes a 17-year-old male patient with frog spawn–like vesicles around the urethra.

is missing (Short communication)

Psoriatic arthritis (PsA) is an inflammatory disease occurring in 5-30% of patients with psoriasis [1]. Since interleukin (IL)-17 promotes the production of inflammatory cytokines, such as IL-1 and tumour necrosis factor (TNF)-alpha, it is thought to act as a key cytokine in the pathogenesis of PsA. Secukinumab is a monoclonal human IgG1 antibody that can fully neutralise IL-17A and is thereby effective in the treatment of psoriasis and PsA. Several adverse events (such as nasopharyngitis) [2], but [...]

Mucous membrane pemphigoid (MMP)-like epidermolysis bullosa acquisita (EBA) is a severe and intractable phenotypic variant of EBA [1, 2]. We report a case of oral-predominant MMP-like EBA (oral EBA) successfully treated with intravenous immunoglobulins (IVIg).A man in his seventies developed oral pain and blistering. The aphthae and blisters were localized in the oral cavity, lips, tongue, and flexor sides of the wrists (figure 1A-C). No other mucous lesions were observed. Fibroscopic examination [...]

Chilblain lupus erythematosus (CHLE) is an acral erythema with cutaneous lesion of lupus erythematosus (LE) that is exacerbated during the winter (1). LE/lichen planus (LP) overlap syndrome is a rare cutaneous disorder characterized by mixed histological features of LE and LP at the same lesion (2). Although both CHLE and LE/LP overlap syndrome are immune mediated diseases (3), there is no indication that the same lymphocyte subset induces two distinct cutaneous lesions. This article is protected by copyright. All rights reserved.