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Introduction: Oral leukoplakia (OL) is the most common potentially malignant lesion of the oral cavity. Aim: The purpose of the study was clinical and epidemiological analysis of patients with OL diagnosed and treated in the Department of Maxillofacial and Oral Surgery, Medical University of Gdansk, comparison of effectiveness of treatment methods, defining whether van der Waal level of OL influences treatment effectiveness, correlation between localization of OL and treatment effectiveness, and defining the optimal OL therapeutic method. Material and methods: Among 55 911 patients diagnosed and treated in the Department in the years 1999-2009, 204 people with OL were selected (104 women, 100 men, average age: 58.1 years). Treatment and observation period of 6 months was completed by 178 (87.25%) patients. Seventy-four patients were treated with cream containing 0.05% tretinoin. Sixty-three patients underwent cryosurgery, and 41 surgery. Control visits were made in week 2, 4, 6 and 8 and 6 months after completed treatment. Results: Three hundred and twenty lesions of OL were diagnosed. According to van der Waal classification, the largest group of patients was classified into stage I and II. The percentage of totally cured patients was 90.07%. There were no statistic differences in effectiveness between surgical and cryosurgical treatment. Conclusions: Evaluation of OL treatment methods depends on localization of the lesions and its stage of pro- gression. The effectiveness of treatment with locally applied tretinoin is smaller in comparison to surgery and cryosurgery. It allows to reduce the number and size of OL lesions, what makes it possible to reduce the number of ablative procedures.

In recent years we can observe a dynamic increase in skin cancers in whose pathogenesis exposure to ultraviolet radiation (UVR) plays an important role. Actinic keratosis (AK) is a common skin disease, characterized by hyperkeratotic lesions located on skin damaged by UVR (photodamaged skin) or senile skin, most frequently present in people of Caucasian origin. The most frequent risk factors for AK development are: elderly age, male sex, cumulative UVR dose, low skin phototype, living in equatorial regions and long-lasting administration of immunosuppressive agents. In various papers on pathogenesis of AK it was revealed that it is an initial form of lesions leading in consequence to development of skin cancers, especially squamous cell carcinoma (SCC). To date there clinical features of AK predisposing to development of SCC are not known, however, inflammation, diameter over 1 cm, rapid enlargement, bleeding and ulceration are considered as risk factors. AK may spontaneously regress, remain stay stable for many years or progress to SCC. This new concept on pathogenesis of AK caused a new approach to its treatment, with a special emphasis on field of cancerisation, with the use of 5-fluorouracil, imiquimod, photodynamic therapy and ingenol mebutate. In the article we present current knowledge on the pathogenesis of actinic keratosis, a review of therapeutic options and principle rules of prophylaxis.

Extranodal natural killer (NK)/T-cell lymphoma, nasal type, is a rare type of non-Hodgkin's lymphoma with similar presentation to various benign inflammatory diseases. Adequate biopsy is required for a diagnosis because this lymphoma frequently coexists with large amount of necrosis and inflammation. In this study, a case of a 49-year-old woman presenting with a 3-week history of right maxillary alveolar ridge pain with a subsequent diagnosis of periodontitis is described. The patient's clinical condition deteriorated over a period of 6 weeks. Computed tomography delineated involvement of the right maxillary sinus, posterior part of the right pharynx and right nasal cavity. Immunohistopathology initially revealed Wegener's granulomatosis, followed by extranodal nasal-type NK/T-cell lymphoma. Severe refractory periodontitis in a background of Wegener's granulomatosis may be the initial presentation of extranodal NK/T-cell lymphoma, nasal type. In addition to careful examination, radiographic and laboratory testing, multiple large biopsies should be taken for immunohistochemical analysis to obtain an appropriate diagnosis.

The number of newly diagnosed cases of lymphomas of the head and neck region has been continually increasing over the recent years. The symptoms of these lymphomas are commonly similar to benign inflammatory diseases and thus frequently lead to clinical misdiagnoses. Many consultations, including dermatological one, and repeated tissue biopsies are often necessary because of the coexistence of necrosis and inflammation in the tumors. Biopsies should be deep enough – punch biopsies are not recommended. The classification of lymphomas has undergone dramatic changes with the increasing understanding and progress in immunohistochemistry and molecular biology. We describe five patients with lymphomas of oral and nasal cavities: 2 derived from B-cells, 2 from T-cells, and 1 from NK/T-cells. The initial presentation of these diseases often suggests an inflammatory process, such as an odontogenic inflammation, sinusitis or benign inflammatory process.

Introduction: The incidence of non-melanoma skin cancer (NMSC) and melanoma is increasing rapidly in the Euro pean population. There are only a few reports about cutaneous malignancy in the elderly population. Aim: Epidemiological, clinical, histopathological and surgical treatment result analysis of skin cancers in patients over 75 years old. Material and methods: A group of 254 patients over 75 years old operated on during 2002-2006 in the Department of Dermatology, Venerology and Allergology of the Medical University of Gdansk was included in the study. Sex ratio F/M was 1.2. The average age was 81.1 years old. Results: Patients over 75 years old comprised 40% of all operated patients because of malignancy in the analyzed period. Non-melanoma skin cancer were diagnosed in 92.5% of cases, melanoma in 5.9%. Basal cell carcinoma (BCC) was the most common malignancy, diagnosed in 72% of the patients. The incidence of squamous cell carcinoma (SCC) was statistically significantly higher compared to the general population (20.5% vs. 10.9%; p = 0.0002). BCC/SCC ratio was 3.5. In 39 patients (16.6%) multiple NMSC were observed. Exposure to UV radiation was the most com mon (52%) risk factor of cutaneous malignancy. The local recurrence rate of NMSC was 5.51%. Conclusions: The incidence of skin cancers in the northern Polish population over 75 years old is increasing. The clin ical and histopathological profile of skin cancer in the elderly differs from the general population. Surgical treatment is safe and effective management in these cases.

Introduction. So far there have been no papers analyzing the incidence of ‘non-pathological’ lesions or normal variants on the male external genitalia. Subsequently, the number of patients consulted due to the presence of such lesions remains unknown. The aim of the study was to estimate the incidence of normal variants in patients who were consulted due to lesions on the skin or mucosa of the male external genitalia. Material and methods. The study group consisted of 400 males, aged 3-91, who were consulted due to lesions on the genitalia in the Department of Dermatology, Venereology and Allergology of the Medical University of Gdansk. results. The most common lesions were hyperpigmentation of the median raphe of the penis and scrotum (85.6%), pearly penile papules (24%), and prominent veins (24%). Sebaceous hyperplasia or ectopic sebaceous glands were revealed in 9% of patients, respectively. Melanocytic nevi were diagnosed with similar frequency (9.5%), whereas skin tags more rarely (7%). Other ‘nonpathological’ lesions were diagnosed in a considerably lower number of patients. In 32 patients (8% of all patients) the reason of admission to the Clinic was just the presence of some ‘non-pathological’ lesions. Pearly penile papules were found to be the most common condition, occurring in 78.1% patients. Conclusions. Normal variants represent a substantial percentage of generally asymptomatic lesions and the only indication for their removal is cosmetic discomfort or venerophobia.

Background: Vitamin D and folate are influenced by ultraviolet radiation (UVR), and both are implicated in skin carcinogenesis. Polymorphisms in the genes involved in the metabolism of these two compounds may alter the risk of basal cell carcinoma (BCC). Objective: To assess the frequency of four polymorphisms in the gene encoding the vitamin D receptor (VDR) (FokI, BsmI, TaqI and ApaI) and two in the gene encoding methylenetetrahydrofolate reductase (MTHFR) (677C/T and 1286A/C) in 142 patients of Polish origin with BCC and the same number of controls. The expression of VDR and MTHFR proteins in the skin, and the vitamin D status of a subset of patients and controls were also measured. Patients/Methods: The polymorphisms were assayed by PCR-RFLP, the VDR and MTHFR proteins by immunoblotting and vitamin D status as 25-hydroxyvitamin D (25(OH)D) level in the serum by RIA. Results: The presence of the TT genotype in the FokI VDR polymorphism resulted in a >10-fold higher risk of BCC development. The CT genotype in 677C/T MTHFR polymorphism and CC genotype in 1286A/C MTHFR polymorphism also significantly increased the risk of BCC development. The expression of the VDR and MTHFR proteins was significantly higher in BCCs of the patients than in the healthy skin of the controls. The median serum level of 25(OH)D was significantly higher in the control group compared with the patients with BCC. Conclusions: Certain VDR and MTHFR gene polymorphisms increase the risk of BCC development in individuals of Polish origin.

Background. Advanced, histologically aggressive basal cell carcinomas (BCCs) of eyelids are difficult to eradicate. Objective. To describe a case of BCC of both eyelids and lateral canthus and the reconstruction procedures used. Methods. A two-stage reconstruction procedure was used. First, only mobilization of the forniceal conjunctiva and the musculocutaneous flap technique were used. The because of shortage and insufficiency of the upper eyelid the flap/graft technique was performed. A conchal complex cartilage-perichondrial graft was selected. Results. The described procedure resulted in a very good functional and aesthetic outcome.

Intestinal ischemia/reperfusion (I/R) injury remains associated with high morbidity and mortality. The protective efficacy of the following endothelin (ET) receptor blockers: BQ-123 (ET A receptor), BQ-788 (ET B ); tezosentan (dual ET blocker) was tested against the inhibition of gastrointestinal (GI) motility induced by intestinal I/R. Intestinal Evans blue transit was measured in untreated (UN) rats and animals subjected to skin incision (SI), I/R (1 h superior mesenteric artery clamping followed by 2–24 h reperfusion) or sham operation (SO). Surgical procedures were conducted under diethyl ether anesthesia. Anesthesia and SI did not affect the GI transit compared to UN rats. In contrast both SO and I/R significantly reduced GI motility, the latter evident at 2–24 h of reperfusion. Tezosentan (1–10 mg/kg), BQ-123 and BQ-788 (0.1–1 mg/kg) protected against I/R-induced inhibition of intestinal motility in a time- and dose-dependent manner at the early and late stages of reperfusion. Furthermore tezosentan alleviated the I/R-induced decrease in the contractile response of the longitudinal jejunal smooth muscle strips to carbachol in vitro . The serum ET(1–21) level was increased at 2 h but not 24 h of reperfusion compared to SO animals and ET(1–21) was higher in tezosentan pretreated rats.