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Objective: To show and report two new cases of urological cutaneous metastasis., Methods: We describe two skin metastases cases. The first patient corresponds to a renal tumor and the other to a urothelial tumor., Results: 52-year-old female with stage IV renal tumor,which is treated with Sunitinib. 34 months later, she refers ajaw angle skin ulcer, considered metastasis.75-year-old male with stage IV mixed urothelial carcinoma,which is treated with cystoprostatectomy and adjuvantchemotherapy. 9 months later, he showed 5 skin lesionsin his thorax. A core biopsy was diagnostic of urothelialcutaneous metastases., Conclusions: Genitourinary skin metastasis are rareand have poor prognosis. The largest incidence is in renaltumors, followed by bladder and prostate malignancies.

Introduction: Both primary and metastatic cases of mucosal melanoma in urogenital localization are rare tumors. Only 4-5% of all primary melanomas do not arise from the skin. Extracutaneous melanomas have a complex clinical presentation, but these aggressive tumors have a poor prognosis., Materials and Method: In our department, we found 7 patients with malignant melanoma of the genitourinary tract in the past few years. The 7 cases were: primary amelanotic melanoma of the female urethra, a primary melanoma of the bladder, two primary melanomas of the penis, a metastatic melanoma of the urethra and another to the testis and a metastatic melanoma of the bladder with melanuria. We retrospectively analyzed the available data to describe the presentation, management, and clinical outcome of the patients., Results: In the three inoperative cases, palliative, urologic surgical procedures and systemic antitumor therapy were performed. Two of the four primary urogenital tumors were localized to the penis. In one case, local recurrence developed after surgical treatment, but with a radical, repeated surgery, the patient has been asymptomatic for a year and a half. In the other, neglected case, the penis melanoma spread through the urethra and the inguinal lymph nodes two years after radical surgery and inguinal block dissection. In the female primary urethral melanoma case, the first histological study reported a primary mesenchymal tumor, and the recurrent tumor that occurred one and a half years later showed melanoma diagnosis. Radical surgery performed because of urethral involvement resulted in a 5-year asymptomatic state, followed by local recurrence and distant metastasis. In the fourth case of a primary bladder melanoma, the rapid progression of the disease and the BRAF positivity of the tumor suggested that not the firstly diagnosed bladder melanoma was the primary tumor., Conclusion: The occurrence of urinary tract melanoma is very rare and its discovery happens often in a disseminated state, so the expected prognosis of the cases is also poor. The most important factors for increasing therapeutic efficacy are early diagnosis and radical surgical intervention. Tumors appearing in different localizations require different urological surgical approaches. The literature recommendations for treatment are not uniform. Their prognosis is worse compared to the cutaneous melanoma, which may be due to clinical and pathological diagnostic difficulties. The latest targeted and immunotherapeutic agents can significantly improve the survival of metastatic patients. Orv Hetil. 2019; 160(10): 378-385.

Pigmented Bowen disease (pBD) is an uncommon variant of squamous cell carcinoma in situ. Sometimes it can show clinical and dermoscopic features that are seen in other pigmented lesions of the skin and mucosa, making the diagnosis difficult. We report six cases of pBD occurring on the anogenital area, and discuss the importance of dermoscopy for improving the diagnostic accuracy in pBD., (© 2018 British Association of Dermatologists.)

Assessment of the immune response to tumors is growing in importance as the prognostic implications of this response are increasingly recognized, and as immunotherapies are evaluated and implemented in different tumor types. However, many different approaches can be used to assess and describe the immune response, which limits efforts at implementation as a routine clinical biomarker. In part 1 of this review, we have proposed a standardized methodology to assess tumor-infiltrating lymphocytes (TILs) in solid tumors, based on the International Immuno-Oncology Biomarkers Working Group guidelines for invasive breast carcinoma. In part 2 of this review, we discuss the available evidence for the prognostic and predictive value of TILs in common solid tumors, including carcinomas of the lung, gastrointestinal tract, genitourinary system, gynecologic system, and head and neck, as well as primary brain tumors, mesothelioma and melanoma. The particularities and different emphases in TIL assessment in different tumor types are discussed. The standardized methodology we propose can be adapted to different tumor types and may be used as a standard against which other approaches can be compared. Standardization of TIL assessment will help clinicians, researchers and pathologists to conclusively evaluate the utility of this simple biomarker in the current era of immunotherapy.

Background: In extramammary Paget disease (EMPD), Paget cells are sometimes detected outside the clinical border (subclinical extension). However, the spreading pattern of Paget cells in subclinical extension remains unclear. In addition, the macroscopic appearances of lesions accompanied by subclinical extension are totally unknown., Objectives: To characterize the spreading pattern of Paget cells as well as the macroscopic appearance of lesions of EMPD with subclinical extension., Methods: Nineteen patients with primary anogenital EMPD underwent mapping biopsies and excisional surgeries; biopsy samples were then taken at the periphery of well-demarcated lesions. Samples were transparentized and subjected to whole-mount immunostaining with anticytokeratin 7 antibody to label Paget cells. The histological border was evaluated in three dimensions by two-photon microscopy. The shape and location of the histological border were compared with those of the clinical border., Results: In 21 samples taken at the lesion where subclinical extension was not shown by mapping biopsy, the shape and location of the histological border were almost identical to those of the clinical border. However, two samples exhibited small foci of Paget cells outside the clinical border, showing subclinically extended satellite lesions. In the two samples taken at the lesions where subclinical extension was shown by mapping biopsy, a continuous arrangement of Paget cells extending beyond the clinical border was identified. Subclinically extended Paget cells were detected solely outside hypopigmented patches with erythema., Conclusions: In EMPD, at least two patterns of subclinical extension exist: continuous and satellite lesions. Subclinical extension might exist preferentially outside hypopigmented patches with erythema., (© 2016 British Association of Dermatologists.)

Importance: Outlier physician practices in health care can represent a significant burden to patients and the health system., Objective: To study outlier physician practices in Mohs micrographic surgery (MMS) and the associated factors., Design, Setting, and Participants: This retrospective analysis of publicly available Medicare Part B claims data from January 2012 to December 2014 includes all physicians who received Medicare payments for MMS from any practice performing MMS on the head and neck, genitalia, hands, and feet region of Medicare Part B patients., Main Outcomes and Measures: Characteristics of outlier physicians, defined as those whose mean number of stages for MMS was 2 standard deviations greater than the mean number for all physicians billing MMS. Logistic regression was used to study the physician characteristics associated with outlier status., Results: Our analysis included 2305 individual billing physicians performing MMS. The mean number of stages per MMS case for all physicians practicing from January 2012 to December 2014 was 1.74, the median was 1.69, and the range was 1.09 to 4.11. Overall, 137 physicians who perform Mohs surgery were greater than 2 standard deviations above the mean (2 standard deviations above the mean = 2.41 stages per case) in at least 1 of the 3 examined years, and 49 physicians (35.8%) were persistent high outliers in all 3 years. Persistent high outlier status was associated with performing Mohs surgery in a solo practice (odds ratio, 2.35; 95% CI, 1.25-4.35). Volume of cases per year, practice experience, and geographic location were not associated with persistent high outlier status., Conclusions and Relevance: Marked variation exists in the number of stages per case for MMS for head and neck, genitalia, hands, and feet skin cancers, which may represent an additional financial burden and unnecessary surgery on individual patients. Providing feedback to physicians may reduce unwarranted variation on this metric of quality.

Genitourinary cancers are associated with a range of cutaneous syndromes, which can reflect direct metastatic spread, non-metastatic manifestations of malignancy or the consequences of treatment. More than 220,000 new cases of prostate cancer occur each year in the United States, and thus the associations with cutaneous involvement are quite well documented-rare metastatic spread, vasculitic and hemorrhagic syndromes. Cancers of the bladder and kidney may be associated with direct cutaneous metastases, vasculitic syndromes, hereditary leiomyomatosis, and other familial syndromes. Testicular cancer occasionally metastasizes to the skin but more commonly is associated with the dysplastic nevus (multiple atypical nevus) syndrome. A structured approach to history-taking, examination, and investigation is essential for optimal management, especially when these syndromes precede the diagnosis of a known malignancy. A brief review of the more common iatrogenic cutaneous complications is provided, and includes Raynaud's phenomenon, purpura, rash, hand-foot syndrome, the consequences of marrow failure, and bleomycin-induced pigmentation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Aim: Inguinal lymphadenectomy (IL) is the standard treatment for inguinal lymph node (LN) metastases from genitourinary neoplasm and other cutaneous malignancies. Video endoscopic inguinal lymphadenectomy (VEIL) is emerging as a new modality for treating inguinal LN metastasis, with the aim of reducing post-operative complications. However, the safety and effectiveness of this new approach is still unclear., Method: A systematic literature review was performed. Patient characteristics, selection criteria, intra-operative data, number of excised LNs and post-operative outcomes were extracted and described for each study., Results: Ten series that encompassed data of 236 procedures performed in 168 patients were reviewed. The conversion to traditional IL rates ranged between 0 and 7.7%. Median/mean operation time varied between 60 and 245 min. Wound-related complications and lymphatic collection/seroma ranged between 0 and 13.3% and 4 and 38.4%, respectively. The median/mean number of excised inguinal LNs ranged between 7 and 16. Although only four studies reported a follow-up time longer then 2 years, local recurrence rate was up to 6.6%., Conclusions: VEIL is safe and feasible for experienced surgeons with advanced laparoscopic skills and familiarity with groin anatomy. The post-operative morbidity appears lower compared to the open procedure, mainly for wound/skin related complications. The number of harvested LN and the regional recurrence rate is comparable to that of conventional groin dissection. Before VEIL technique can be considered suitable for routine clinical practice, comparable oncological outcomes and lower post-operative morbidity should be assessed in a randomized controlled trial., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

A subset of patients with melanoma present in rare and unique clinical circumstances requiring specific considerations with respect to diagnostic and therapeutic interventions. Herein, we present our review of patients with: (1) primary mucosal melanoma of the head and neck, gastrointestinal, and genitourinary tracts; (2) primary melanoma of the eye; (3) desmoplastic melanoma; (4) subungual melanoma; (5) melanoma in special populations: children, nonwhites, as well as a discussion of familial melanoma.

Cutaneous metastases occur in about 10% of patients with cancer, occasionally presenting as the initial sign of internal malignancy. Most often cutaneous metastases are an indicator of advanced cancer and are associated with a poor prognosis. The scrotum is a rare site of cutaneous metastasis, and metastatic tumor to the scrotum can be mistaken for other skin lesions. We reviewed the published literature regarding patients who developed cutaneous metastasis to the scrotum. We summarized the clinical characteristics of these men, including primary tumor sites, age at diagnosis, treatment regimens, interval between diagnosis of primary tumor and subsequent metastasis, and outcomes. We extensively searched the PubMed medical database for papers on visceral malignancies with metastasis to the scrotum. We limited our definition to solid organ tumors; thus lymphomas, sarcomas, and melanomas of the scrotum were excluded. We identified 29 patients who developed scrotal metastases from visceral cancers. The colon/rectum (34%), prostate (28%), and lung (14%) were the most frequent sites of tumor origin. The prognosis for these patients is poor: mean patient survival was only four months after diagnosis of metastatic skin lesions. Cutaneous metastasis to the scrotum is a rare manifestation of internal malignancies that most often represents an advanced and/or progressive cancer associated with a poor prognosis. Treatment is often unsuccessful, and the mean patient survival following scrotal metastasis is <4 months., (© 2013 The International Society of Dermatology.)

Claudins are the main sealing proteins of the intercellular tight junctions and play an important role in cancer cell progression and dissemination. This study examined and compared the expression of claudin-1 by immunohistochemistry in 60 squamous cell carcinomas of different tissue types and normal 33 controls, arranged in 2 tissue microarray slides. A score was generated to classify claudin-1 expression into negative, low, medium, and high. Most squamous cell carcinomas (91.67%) showed positive membranous staining. Medium to high claudin-1 expression was prevalent in carcinomas from the head-neck, skin, and genitourinary regions and was less frequent in other locations. An inverse correlation was noted between claudin-1 expression and tumor grade in tumors of the genitourinary and breast-gynecologic regions. Of the normal organs, significant claudin-1 expression was present mainly in the skin whereas other epithelial tissues had only minimal to low expression levels. Claudin-1 expression in squamous cell carcinoma varies in organ-specific manner reflecting influence of local factors and different mechanisms of claudin-1 expression. Knowledge of this fact is important in planning biologic therapy targeting claudin-1.

Melanocytic nevi can have a wide range of histologic appearances. Within the spectrum of nevi, there exists a group that presents in certain anatomic locations with histologically worrisome features but nonetheless benign behavior. This group of nevi has been broadly categorized as nevi of special sites. The anatomic locations affected by this group include the embryonic milkline (breast, axillae, umbilicus, genitalia), flexural areas, acral surfaces, ear, and scalp. Nevi in these locations may be mistaken for melanomas because of their histologic appearance, resulting in inappropriate overtreatment of patients. In this article, the authors review the histologic features of these special site nevi and discuss the criteria that help distinguish them from melanoma., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Although skin cancers on the eyelids, lips, genitalia, and the nail unit are infrequent, some skin cancers can have higher recurrence rates in these anatomic locations. Intrinsic to Mohs micrographic surgery (MMS) is maximal tissue preservation and high cure rates, making it a worthwhile procedure for these sensitive anatomic areas to ameliorate any functional or aesthetic compromise. The Mohs surgeon can provide a great service to patients by being aware of the anatomy, specialized instruments, unique histology, and potential complications when performing MMS on these areas., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Melanocytic lesions of the genital area are rare. They arise mainly in the vulva, although they can also occur less frequently in the perineum, mons pubis and male genitalia and represent 10-12% of pigmented lesions of White women. These pigmented lesions include melanocytic nevi, lentigines, melanocytic nevi with architectural disorder and atypia of melanocytes (dysplastic nevi) and melanomas with microscopic features similar to those seen elsewhere on the body. There is a small subset of benign nevi named atypical melanocytic nevi of the genital type (AMNGT) that occur in young women, with distinctive histologic features in some cases overlapping morphologically with those of melanoma. Thus, it is important to distinguish AMNGT from melanomas in terms of prognosis and treatment. We retrieved 58 cases of genital pigmented lesions diagnosed at our hospital from 1986 to 2008 to evaluate their clinicopathologic features with especial consideration to those cases with atypical features. Thirty-two cases (55%) were common nevi, 10 (17%) lentigines, 6 (10%) melanomas, 3 (5%) dysplastic nevi and 1 blue nevus. Six cases (10%) corresponded to AMNGT and were taken from women with a median age of 21 years. All cases showed symmetry, and the melanocytic proliferation was well demarcated at the lateral margins. The junctional component was very prominent and formed by round or fusiform nests with common retraction artifact and/or cellular dyshesion or as a single cell proliferation with mild (33%) to moderate (67%) cytologic atypia, focal pagetoid spread (17%) and a benign-appearing dermal component (83%) with maturation and dense eosinophilic fibrosis in the superficial dermis. Neither nuclear atypia of melanocytes in the superficial dermis nor dermal mitoses were observed. AMNGT were excised, and no recurrences were recorded in the follow up (median 10.5 years). Therefore, it seems that there is no evidence that AMNGT are precursors of dysplastic nevi or melanomas.

Background: Specificity protein 1 (Sp1) is a transcription factor and shown to be a sequence-specific DNA-binding protein that activate a broad and diverse spectrum of mammalian gene, such as vascular endothelial growth factor (VEGF) gene. But the expression of Sp1 and VEGF has not previously been investigated in extramammary Paget's disease (EMPD)., Methods: To investigate the expression of Sp1 and VEGF proteins in EMPD and to assess their relationships and potential contribution to malignant transduction of EMPD, paraffin-embedded EMPD specimens (35 tissue samples from 33 patients with primary EMPD, including two samples of metastatic lymph nodes from two patients) were subjected to immunohistochemical staining for Sp1 and VEGF., Results: All of the 35 EMPD specimens, including all of six invasive EMPD and two metastatic lymph node specimens, showed strong nuclear positive staining for Sp1 and strong cytoplasmic positive staining for VEGF. The expression levels (% positive cells) of Sp1 and VEGF in EMPD were significantly higher than those of normal skin (NS). There was a significantly high correlation between expression levels of Sp1 and VEGF in EMPD., Conclusions: The present study reveals that the concordant over-expression of Sp1 and VEGF may play a pivotal role in the tumorigenesis and further malignant transduction of EMPD.

Purpose: The BRAF mutation is common in melanomas, but variation in rates across melanoma subtypes points to a complex interplay between BRAF activation and other factors (eg, sun exposure). Nevi also harbor the BRAF mutation. A description of mutation distribution in nevi could provide insight into the significance of this event in melanocytic tumorigenesis., Experimental Design: One hundred thirty-five nevi from 116 patients were evaluated for the T-->A mutation at nucleotide 1799. The nevi were inclusive of congenital (n = 34) and acquired (n = 101) nevi, dysplastic (n = 11) and nondysplastic (n = 124) nevi, and anogenital (n = 24) and common cutaneous (n = 111) nevi., Results: The overall mutation rate was 81%. The rate varied only slightly by anatomic site: BRAF mutations were detected in 21 of 21 (100%) nevi of the head and neck, 62 of 76 (82%) nevi of the trunk, 8 of 14 (62%) nevi of the extremities, and 18 of 24 (75%) anogenital nevi. For acquired nevi, there was no association between BRAF mutations and sun exposure as inferred from anatomic site. There were no significant differences in the mutation rates between congenital and acquired nevi (76% versus 81%; P = 0.5)., Conclusions: The BRAF mutation is uniformly distributed in various types of nevi. Its presence in congenital and anogenital nevi points to mechanisms of induction other than sun exposure. Its ubiquitous presence suggests that it poses no significant threat of malignant transformation, raising doubts about its relevance in melanoma development and its suitability as a target of directed therapy in patients with melanoma.

Objectives: To review the world literature for reports of cutaneous metastases from primary genitourinary malignancies and compare them with our experience during a 10-year period. Cutaneous metastases from primary visceral malignancies are uncommon manifestations of advanced disease. Among patients with urologic malignancies, the incidence and appearance of cutaneous metastases are not well established and recognition is poor among practicing urologists., Methods: A Medline search and manual bibliographic review was performed to identify peer-reviewed reports pertaining to cutaneous metastases from all visceral malignancies. A comparative review of all pertinent cases arising from primary urologic malignancies was performed. A comprehensive search of our institution's tumor registry was performed to identify all analytic cases of urologic malignancy diagnosed, treated, and followed up between 1990 and 2000. Clinical and pathologic data were collated., Results: We identified 2,369 reported cases of cutaneous metastases arising from 81,618 primary solid visceral malignancies, for an overall incidence of 2.9%. Dermatologic spread from primary urologic malignancies of the kidney, bladder, prostate, or testes was noted in 116 (1.3%) of 10,417. The incidence of cutaneous metastases from the kidney, bladder, prostate, and testes was 3.4%, 0.84%, 0.36%, and 0.4%, respectively. Overall, 436 cases of cutaneous metastases from urologic organs were identified in the English-language literature. We identified nine additional cases of pathologically confirmed cutaneous metastatic urologic tumors at our institution in the past 10 years. The most common presentation was an infiltrated plaque or nodules. Most cases displayed clinical features that mimicked common skin disorders. The median disease-specific survival was less than 6 months from the presentation of cutaneous metastasis., Conclusions: Cutaneous metastases from urologic tumors are uncommon and occur in 1% of patients with advanced disease. Urologic skin metastases are most common from renal tumors, followed by those of the bladder and then prostate. Their clinical appearance may mimic other common dermatologic disorders affecting patients with advanced malignancies. Definitive diagnosis requires an index of suspicion and skin biopsy. Cutaneous metastases from urologic malignancies are associated with a poor prognosis.

Human papillomaviruses (HPV) infect exclusively the basal cells of the skin and of mucosal epithelia adjacent to the skin such as the mouth, the upper respiratory tract, the lower genital tract and the anal canal. HPV does not lead to a viremia. Basically there are three different types of HPV infection: Clinically visible lesions, subclinical HPV infections and latent HPV infections. Distinct HPV types induce morphologically and prognostically different clinical pictures. The most common HPV associated benign tumor of the skin is the common wart. Infections of the urogenitoanal tract with specific HPV-types are recognised as the most frequent sexually transmitted viral infections. So-called "high-risk" HPV-types (HPV16, 18 and others) are regarded by the world health organisation as important risk-factors for the development of genital cancer (mainly cervical cancer), anal cancer and upper respiratory tract cancer in both genders. Antiviral substances with a specific anti-HPV effect are so far unknown. Conventional therapies of benign skin warts and of mucosal warts are mainly nonspecific. They comprise tissue-destroying therapies such as electrocautery, cryotherapy and laser. In addition cytotoxic substances such as podophyllotoxin and systemic therapy with retinoids are in use. Systemically and topically administered immunotherapies represent a new approach for treatment. Both interferons and particularly the recently developed imiquimod, an interferon-alpha and cytokine-inductor lead to better results and are better tolerated then conventional therapies. HPV-specific vaccines have been developed in the last 5 years and will be used in future for prevention and treatment of benign and malignant HPV-associated tumors of the genitoanal tract in both sexes.

We report a case of arsenic keratosis and pigmentation accompained by multiple Bowen's disease and genitourinary cancer in a 64-year-old man. He was a psoriasis patient with a history of herbal medication for about thirty years. He showed multiple hyperkeratotic plaques on the bilateral palms, soles, and multiple, brownish, scaly, elevated papules on the back in addition to diffuse hyperpigmentation. Biopsy confirmed arsenic keratosis and Bowen's disease. Transitional cell carcinoma was also detected on his ureter and bladder during follow-up. The skin lesions were treated with topical 5-fluorouracil, etretinate, and excision with improvement.

In the early 1990s, the first reports appeared indicating a disturbingly high incidence (20%) of port site metastases following laparoscopic procedures for visceral and gynecological malignancies. At the same time, animal experiments were performed to investigate the phenomenon of port site metastases. The results were independently and repeatedly verified by different groups. In view of these distressing facts, a controversial, at times emotional discussion arose that evolved at least in part without strict regard to the available data. In the recent past, reports on increased incidence of port site metastases after laparoscopic interventions have completely vanished from the literature. Figures on incidence reported by various authors range between 0.5% and 1.3% and thus are comparable to the rate for surgical wound metastases (0.8-1.6%) as known from open conventional methods. Prospective studies have even shown that the survival rate in comparison to conventional techniques is 20% better, at least for laparoscopically treated stage I-III colorectal carcinomas. At present the discussion on the phenomenon of port site metastases can be considered closed. Port site metastases are thus no longer a fact, but also not fiction, since this phenomenon does occur in a small percentage of patients after laparoscopy just as after open surgery.

The relative frequencies of cutaneous metastases are similar to those of the primary cancers; breast, colon, and melanoma are the most frequent in women and lung, colon, and melanoma are the most common in men. Cutaneous metastases represent an opportunity to detect a potentially treatable cancer before other evidence of it is present, to modify therapy as appropriate to the tumor stage, or possibly to use the cutaneous lesion as a source of easily accessible tumor cells for specific therapy. Cutaneous metastatic disease as the first sign of internal cancer is most commonly seen with cancer of the lung, kidney, and ovary.

Keratin 20 is a recently identified keratin protein distributed particularly in the epithelial cells of the gastrointestinal tract. In this study, keratin 20 was immunohistochemically evaluated in 788 epithelial tumors of different organs. Keratin 20 was consistently present in colonic adenocarcinomas and their metastases in lymph nodes, liver, lung, and ovaries; most primary and metastatic colon carcinomas showed high numbers of positive cells independent of their level of differentiation. Adenocarcinomas of the upper gastrointestinal tract, pancreas, and cholangiocarcinomas showed variable reactivity. Hepatocellular carcinomas and carcinoid tumors often showed focal reactivity limited to scattered tumor cells. In contrast, keratin 20 was virtually absent in primary adenocarcinomas of lung, ovaries, and endometrium. Notable exceptions among ovarian tumors were the mucinous neoplasms that showed variable, sometimes significant keratin 20 reactivity. Transitional cell carcinomas irrespective of grade were usually positive, whereas most prostatic and renal adenocarcinomas were negative or showed only single positive cells. Typically negative were squamous cell carcinomas of all organs and carcinomas of the breast. Merkel cell carcinomas of the skin showed consistent reactivity, whereas small cell carcinomas of the lung were negative. On the basis of these observations, keratin 20 seems to be a suitable adjunct marker to evaluate the primary origin of carcinomas in specific contexts, especially to separate adenocarcinomas of gastrointestinal versus nongastrointestinal origin.

Background: Most previous studies have found that cutaneous metastases occur infrequently and are rarely present at the time the cancer is initially diagnosed., Objective: We studied patients with metastatic cancer to determine the overall frequency of skin metastases, the frequency that these were the first sign of extranodal disease, and the clinical and histologic features of the cutaneous lesions., Methods: A 10-year period of tumor registry files was searched for patients with metastatic carcinoma and melanoma. For patients with skin metastases, medical records and pathology reports were also examined., Results: Of 4020 patients with metastatic disease, 420 (10%) had cutaneous metastases; in 306 of them the skin metastases were the first sign of extranodal metastatic Breast cancer and melanoma were the most common. Nodules were the most frequent clinical presentation, although inflammatory, cicatricial, and bullous lesions were also noted. Incisional metastases were common. Histologic findings most frequently revealed adenocarcinoma that was sometimes suggestive of the site of origin. After recognition of skin metastases, mean patient survival ranged from 1 to 34 months depending on tumor type., Conclusion: Cutaneous metastases are not uncommon and frequently are the first sign of extranodal metastatic disease, particularly in patients with melanoma, breast cancer, or mucosal cancers of the head and neck.

Three epithelial neoplastic lesions, perineal Bowenoid papulosis, uterine cervical carcinoma, and bladder transitional cell carcinoma, which occurred in a mildly immunosuppressed patient who had aplastic anemia were studied for human papillomavirus (HPV) infection. In the Bowenoid papulosis, HPV type 16 DNA was identified by polymerase chain reaction (PCR) and by in situ hybridization (ISH). In contrast, in the uterine cervical carcinoma, HPV 16 was not detected, although possibly another unidentified type of HPV in the lesion was suggested by the ISH findings. In the bladder transitional cell carcinoma, neither papillomavirus genus-specific (PGS) antigen nor HPV DNA was found.

Two hundred two patients with malignant melanoma underwent computed tomography (CT) scanning of the abdomen and pelvis. The frequency of metastases in the abdomen and pelvis was correlated with the site, level, and thickness of the primary tumor. The sites of the primary tumors were the trunk (70 patients), the lower extremities (37 patients), the upper extremities (33 patients), the head and neck (29 patients), the eye (nine patients), and the genitourinary tract (six patients). In 18 patients, the primary site could not be identified. In 96 patients, the level and thickness of the primary tumor, based on Clark and Breslow classifications, were correlated with the presence and extent of metastases. CT showed metastases in 122 patients (60%). The head and neck were the most common primary sites associated with metastases (79%), followed by the eye (77%) and genitourinary tract (67%). Thick lesions had the highest frequency of metastases (84%), compared with intermediate (50%) and thin (46%) lesions. Tumors classified as Clark level V had the highest frequency of metastases (87%).

The majority of findings in relation to warts have been passed on from one textbook to the other since the end of the last century. More recent studies have been carried out with the electron microscope. But information is lacking as to histology, histochemistry, examination with the phase-contrast microscope, with the interference microscope, microradiography and other new techniques. Warts are a proliferation of the epidermis caused by a virus, and we know that the culprit acts in the epidermis itself. Warts are acanthomas, and a transition to malignancy is possible in predisposed persons. It is most remarkable that in the malignant tumors of epidermodysplasia verruciformis, no virus could be found. As the demonstration of viruses with the electron microscope and other techniques cannot be made as a matter of routine, we have to search for a simpler method with the light microscope. With the application of more elaborate procedures, new information about epidermal proliferation will certainly be obtained.