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Introduction Cutaneous T-cell lymphomas (CTCLs) are a diverse group of non-Hodgkin's lymphomas with malignant T lymphocytes infiltrating the skin. Mycosis fungoides (MF) and Sezary syndrome (SS) belong to the group of CTCLs, among others. In previous studies it was suggested that primary cancers more often occur in patients with cutaneous lymphoma. Aim To analyse the incidence of other malignancies in CTCL patients. Material and methods The evaluation of the coexistence of primary malignant neoplasms in CTCL patients was conducted by analysis of the patients' database, with diagnosis of mycosis fungoides and Sezary syndrome, treated in the Dermatological Department of the Medical University of Gdansk between 2010 and 2018. Results Among CTCL patients, 177 were diagnosed with MF/SS (stage MFIA 37.61%, MFIB 30.77%, MFIIA 0.85%, MFIIB 11.11%, MFIII 8.55% MFIV 4.27%; SS 6.84%). The group was characterized by a male-to-female ratio of 1.21 : 1. 16.94% of MF/SS patients had one co-existing cancer, while 1.13% of patients had 2 co-existing cancers; the most common were basal cell carcinoma, lymphomatoid papulosis, lung cancer, and B-cell lymphoma. The obtained data highlight that MF/SS is associated with increased risk of cancer. Conclusions Our study suggests that special attention should be paid to careful examination of CTCL patients - what force to perform solid clinical examination, the X-ray chest examination, abdomen USG, mammography, and others, even in early stages of MF/SS. Clinicians should be aware of the coexistence of other neoplasms such as lung, skin, and breast cancer.

Introduction Staphylococcus aureus causes a diverse array of diseases, ranging from relatively harmless localized skin infections to life-threatening systemic conditions. It secretes toxins directly associated with particular disease symptoms. Aim To determine the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) colonization among patients with atopic dermatitis and to assess the antimicrobial susceptibility to conventional antibiotics and selected antimicrobial peptides among toxin-producing strains and nonproducing strains. Material and methods One hundred patients with atopic dermatitis and 50 healthy people were microbiologically assessed for the carriage of S. aureus. Antimicrobial susceptibility tests were performed using the broth microdilution method for conventional antibiotics and antimicrobial peptides (CAMEL, Citropin 1.1, LL-37, Temporin A). Detection of genes lukS/lukF-PV, tst, sea-sed, eta and etb by multiplex PCR was performed. Results Staphylococcus aureus strains were isolated from the majority of patients, from either the skin (75%) or the anterior nares (73%). Among the conventional antibiotics tested, the highest rates of resistance were observed for ampicillin, daptomycin, lincomycin and erythromycin. Antimicrobial peptides did not show significant diversity in activity. Among MSSA strains greater differentiation of secreted toxins was observed (sec, eta, pvl, tsst, etb, seb), while in the group of MRSA strains secretion of 3 toxins (pvl, eta, seb) was noted. Conclusions Antimicrobial resistance continues to evolve. It is important to monitor S. aureus infections. The profile of toxins produced by S. aureus strains is an important consideration in the selection of an antimicrobial agent to treat infections.

Introduction : Daptomycin is a cyclic lipopeptide that is bactericidal against Staphylococcus aureus , including methicillin-resistant S. aureus (MRSA), vancomycin-intermediate S. aureus (VISA) and vancomycin-resistant S. aureus (VRSA) strains. Daptomycin exerts its antimicrobial effect by a calcium-dependent interaction with the cytoplasmic membrane resulting in depolarization, ion loss and rapid cell death. Unfortunately, loss of daptomycin susceptibility in S. aureus in the clinical setting has been noted. Aim : To evaluate the susceptibility profile to daptomycin among S. aureus strains isloted from patients with atopic dermatitis (AD). Another point was to correlate the results obtained by broth microdilution method and Etest, which is commonly applied in clinical setting. Material and methods : One hundred patients with the diagnosis of atopic dermatitis were microbiologically assessed for the carriage of S. aureus . Antimicrobial susceptibility tests were performed using broth-microdilution (BMD) and Etests for daptomycin. Results : Staphylococcus aureus strains were isolated from the majority of our patients, either from the skin (73%) or the anterior nares (75%). Six of the 100 nasal swabs (6%) and 5 of the 100 skin swabs (5%) were positive for methicillin-resistant Staphylococcus aureus (MRSA). A total of 81 of 148 (54.7%) daptomycin non-susceptible isolates of S. aureus were identified by BMD. Only 19 of 81 were also classified as non-susceptible by Etest. Conclusions : Clinicians and microbiologists should be aware of the possibility of the emergence of daptomycin non-susceptibility (or increase in minimal inhibitory concentration) during prolonged therapy and closely monitor the susceptibility of persisting isolates that might be recovered during therapy.

Dermatomyositis (DM) is a rare syndrome which belongs to the group of idiopathic inflammatory myopathies (IIM). The diagnosis of DM in adults is an indication for diagnostic evaluation towards malignancy. The exacerbation of clinical symptoms or laboratory markers of DM may indicate the relapse of neoplasm, therefore close follow-up visits of patients are obligatory. We present the case of a woman with a two-month history of progressive muscle weakness, dysphagia and oedemo-erythematous skin lesions limited to the face and trunk. The patient was diagnosed with DM associated with the relapse of cervical cancer.

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.

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by clonal proliferation of dendritic cells, which comprises a wide range of clinical presentations. The term LCH is used to include a spectrum of disorders previously termed: histiocytosis X, eosinophilic granuloma, Hand-Schuller-Christian disease, Letterer-Siwe disease and Hashimoto-Pritzker disease. The etiology of the lesion is still elusive, and the question of whether LCH is a reactive or neoplastic disorder remains unanswered [1]. The LCH mainly affects children under 10 years of age, but can occur at any age. The estimated incidence in adults is about 1–2 cases per million and is lower than that in children [2]. The LCH may affect any organ, but the most common locations include bone [3–6], mucous membranes [7], skin [8], lymph nodes, lung [9], pituitary [10] and liver [11]. The clinical course and prognosis of LCH is diverse ranging from a spontaneously regressing single lesion to a life-threatening multisystem disease with rapid progression and death. This disorder may involve single or multiple organs and has an unpredictable course. Diagnosis of LCH is difficult and may be delayed due to its rarity and wide clinical manifestation.

Introduction. Plasma cell mucositis (PCM) is a rare condition consisting of plasma cell infiltrate of the mucous membranes that usually involves the genital epithelium. Less frequently lesions are present in the mouth or upper respiratory tract. The etiology of PCM remains unknown. The lesions may occur in the unchanged epithelium (idiopathic, isolated PCM), on the base of inflammatory skin diseases (lichen planus, lichen sclerosus) or cancer (squamous cell carcinoma). Objective. To present a case and draw attention to PCM as a differential diagnosis of lesions within the oral mucous membrane. Case report. We present a patient with painful erosions and erythematous patches located within the mucous membrane of the palate and cheeks lasting more than 5 months. The diagnosis was based on clinical and histopathological examination. Conclusions. The course of PCM includes periods of exacerbations and remissions. Treatment with antibiotics, antifungal agents, local and systemic corticosteroids, isotretinoin or destructive methods usually provides symptomatic relief but does not lead to lesions regression.

Background: MF, the most common variant of cutaneous T-cell lymphoma (CTCL) is a disease in which T-cell lymphocytes become malignant, resulting in highly symptomatic, disfiguring skin lesions even in the earliest stages. Standard therapy for MF includes both local and systemic treatments that have shown efficacy, but some have considerable side effects. The recent understanding of the pathogenesis and signaling pathways promoting MF suggest that a focus on the development of targeted therapies could provide important advances for more effective treatment. The signal transducer and activator of transcription protein3 (STAT3) is an oncogenic transcription factor that drives invasion, angiogenesis, and immune suppression in many tumors. It has been identified as one of the key regulators of MF. STAT3 activation via phosphorylation of tyrosine 705 (p-STAT3) leads to increased proliferation and survival of tumor cells as well as suppression of the immune response. WP1220 is a synthetic analogue of caffeic acid benzyl ester (CABE) that potently inhibits p-STAT3 and effectively inhibits growth of CTCL cell lines in vitro. Methods: This is the first clinical evaluation of WP1220, a p-STAT3 inhibitor in MF. This Phase 1b study was designed to demonstrate the safety and efficacy of topical treatment with a 10% (w/w) WP1220 ointment in adults with Stage I, II or III MF. Topical WP1220 is not absorbed and has no systemic effects. Patients were required to have histopathologic confirmation of the diagnosis of MF and have at least 2 lesions or more up to a maximum total skin area of ≤40cm2.Lesions were selected on the basis of progression despite at least one prior therapy, which could have been either systemic or topical. No concomitant topical therapies on index lesions to which WP1220 was applied was allowed. Patients were trained to apply ointment 2X daily for 3 months on these index lesions, which were evaluated on Days 7, 28, 56 and 84 using the same procedures/assessor throughout the study. The primary endpoint was absolute change from baseline CAILS (Composite Assessment of Index Lesion Severity) scores of the index lesions up to Day 84, with a follow up 1 month later (Day 112). Secondary objectives included monitoring of adverse events (AE) via patient diaries, and photographic documentation validated by independent dermatologic consultation. Biopsies from treated sites were obtained at baseline and at the end of the study to assess histopathology, as well as to perform exploratory evaluations of changes in STAT3 phosphorylation and pathway activation. Results: There were 6 patients screened, and 5 patients enrolled between March and July 2019. Three are evaluable for both safety and efficacy after completing 3 months of treatment, with 2 ongoing and evaluable for safety. The only AE reported potentially related to study drug in one of the five patients was a mild contact dermatitis not requiring treatment. CAILS scores on index lesions were significantly decreased in the first 3 patients, who were stages IA, IB, and IIB, respectively, at entry. A composite score was obtained for all treated lesions for each patient, and percent changes were calculated from baseline to Day 84. There was a median reduction of 70.8% (range 62.1%-76.2%) for the 3 patients. Improvement was noted as early as 7 days after initiation of treatment, and maintenance of improvement was also shown at follow up (1 month after discontinuation, as per protocol). The fourth patient has also shown an initial reduction in the composite CAILS score after 56 days (26.7%), and is continuing on treatment. Independent dermatologic review based on photographic documentation, which will be provided, is in progress, as are evaluations of the biopsy samples for histopathology and status of p-STAT3 in treated lesions. Conclusions: WP1220, an inhibitor of p-STAT3, has shown demonstrable safety and significant efficacy after at least 3 months of topical treatment in 3 patients with progressive MF, with a continuing trend towards improvement in additional patients currently in treatment. This is the first demonstration that inhibition of the STAT3 activation pathway with topical therapy has impacted the course of this disease. The trial is continuing, and updated and more comprehensive data from this study as well as assessment of STAT3 phosphorylation in treated lesions will be reported. Disclosures Klemp: Moleculin Biotech, Inc.: Employment, Equity Ownership. Silberman:Trovagene: Consultancy; Moleculin Biotech: Employment. Priebe:Moleculin Biotech, Inc.: Consultancy, Equity Ownership, Research Funding.

Leiomyomas are rare, benign neoplasms that arise from smooth muscles. The condition was first reported in 1854 by Rudolf Virchow [1, 2]. According to the site of origin we can distinguish piloleiomyoma (deriving from the arrector pili muscles of hair follicles), genital leiomyoma (originating from the tunica dartos of the scrotum, and mammary muscles of nipples), and angioleiomyoma (arising from smooth muscles of blood vessels) [3]. The most common locations include the uterus (about 95% of cases) and the skin, which accounts for 75% of extra-uterine leiomyomas [4]. According to Malhotra, the average age of onset is 38.9 years for solitary leiomyomas and 43.8 years for multiple lesions [5]. Herein we report a 41-year-old man with multiple, painful, well-demarcated, oval, red papules localized within the region of the left scapula. The lesions had appeared progressively over the past 6 months. They measured 5 mm to 20 mm and were increasing in size and number (Figure 1). The intensity of the pain was aggravated by pressure and exposure to low temperature. The level of pain was preventing him from sleeping, sitting and participating in normal everyday activities. Family history of similar lesions and physical examination were unremarkable. Based on the clinical picture we assumed multiple leiomyoma. The final diagnosis of leiomyoma was based on histopathological examination of the lesional tissue. It revealed a well-demarcated lobulated tumor located in the reticular dermis. It consisted of bundles of smooth muscle fibers. Tumor cells had eosinophilic cytoplasm and blunt-ended vesicular nuclei. There was no cytologic atypia or mitotic activity (Figure 2). Routine hematological, urine and ultrasound examination of the abdomen did not reveal any abnormalities. Figure 1 A – Multiple cutaneous leiomyomas within the region of the left scapula at initial presentation. B – The clinical appearance 1 month after the initial lesions were treated. C – The clinical appearance 6 months postoperative Figure 2 The histopathological examination of the lesional tissue revealed a well-demarcated lobulated tumor located in the reticular dermis. It consisted of bundles of smooth muscle fibers. Tumor cells had eosinophilic cytoplasm and blunt-ended vesicular nuclei. ... Because of the huge number of leiomyomas, surgical removal was impossible. Treatment with carbon dioxide laser ablation was performed under local anesthesia with 2% lignocaine. We used the following settings: total power output – 10 W, spot size – 1 mm. We performed four procedures with monthly intervals and no side effects had been reported. During a 6-month follow up, the patient was completely asymptomatic and occurrence of new leiomyomas had not been noticed (Figures 1 B, ​,C).C). Although the cosmetic outcome was not perfect, the resolution of pain seemed to be more important. Cutaneous leiomyomas are benign tumors of smooth muscle bundles [4]. Piloleiomyomas are the most common type of leiomyomas. They may be either solitary or multiple. Solitary cutaneous piloleiomyomas are usually asymptomatic and larger in size. Multiple piloleiomyomas occur more often and can be inherited as an autosomal-dominant trait with variable penetrance, or they can occur spontaneously. The pathogenesis of leiomyomas remains obscure. Multiple cutaneous leiomyomas may occur in conjunction with uterine leiomyomas, also known as multiple cutaneous and uterine leiomyomatosis (MCUL), familial leiomyomatosis cutis et uteri, Reed syndrome, or multiple leiomyomatosis [2]. Some patients with Reed syndrome also were found to have aggressive forms of renal cell carcinoma, which is known as hereditary leiomyomatosis and renal cell cancer (HLRCC) [6]. In the case of our patient, the family history of similar lesions was unremarkable. Piloleiomyomas usually present as small, red-brown, firm papules. Individual lesions range in size from few millimeters to 1 cm and are fixed to the skin [7]. They are freely movable over underlying deeper structures. The most common location includes the trunk and extensor surfaces of upper extremities, however, involvement of the face, breast and scrotum have also been described [5, 8]. Various distribution patterns have been reported: symmetrical, Blaschkoid, diffuse (disseminated), and segmental (zosteriform) [2, 5, 9–11]. Piloleiomyomas can be asymptomatic or very painful. Approximately 50% to 72% of patients complain of pain [5, 7]. They tend to occur more frequently in diffuse and segmental forms [2]. The origin of pain is not fully understood. It may be spontaneous or secondary to local pressure by the tumor on cutaneous nerves [3]. Other authors have suggested that it is due to muscle contraction mediated via a-adrenergic receptors [12]. The diagnosis of pilar leiomyoma may be suspected clinically, but the final diagnosis is based on the histopathological examination of lesional tissue. It shows proliferation of smooth muscle bundles which are described as cigar-shaped. The cells have eosinophilic cytoplasm and elongated nuclei with blunt ends. They stain positively for markers of smooth muscle differentiation (desmin and actin) [5, 9, 13, 14]. In the case of solitary leiomyomas, the first line of therapy is surgical excision of tumor. Due to numerous lesions and frequent recurrences after surgical removal of multiple leiomyomas, we decided to avoid surgical procedures. Various medications have been used with diverse response to alleviate pain connected with cutaneous leiomyomas. These include calcium channel blockers [3, 10, 11], α-adrenergic blocking agents [15], anticonvulsants [3], serotonin reuptake inhibitors, and topical 9% hyoscine hydrobromide, hyoscine butyl bromide. There is a single report of carbon dioxide laser ablation with significant improvement [4]. The carbon dioxide laser is the most versatile laser used in the treatment of cutaneous lesions. It is unique in that it can be used for resurfacing as well as excisional and even incisional procedures. The localized tissue destruction produced by carbon dioxide laser may make this technique superior to other destructive methods and allows the scarring to be limited. As in the case described by Christenson et al. [4], we observed resolution of pain in all treated lesions. Although the cosmetic outcome was not perfect, the resolution of pain seemed to be more important. The follow up period is required to assess the long-term results. Multiple leiomyomas can arise in hundreds and because of that, surgical procedures are not a viable option. Carbon dioxide laser ablation may be one of the therapeutic options in the case of multiple and painful leiomyomas.

Introduction Exacerbation of atopic dermatitis can be associated with bacterial infection. The skin of patients is colonized with Staphylococcus aureus in 90% of cases. An attempt has been made to demonstrate that eradication significantly reduces the severity of the disease. Studies indicate the efficacy of topical antibiotics, topical corticosteroids and calcineurin inhibitors. Due to increasing resistance to drugs and the defective antimicrobial peptide profile, decolonization is virtually impossible. Aim To determine the prevalence of S. aureus colonization among patients with atopic dermatitis and to assess antimicrobial susceptibility of isolated strains to antibiotics, especially fusidic acid and mupirocin. Material and methods One hundred patients with atopic dermatitis and 50 healthy subjects were microbiologically assessed for the carriage of S. aureus. Antimicrobial susceptibility tests were performed using the broth-microdilution method for antibiotics: ampicillin, ciprofloxacin, daptomycin, erythromycin, fusidic acid, linezolid, lincomycin, mupirocin, tetracycline and vancomycin. Results Staphylococcus aureus strains were isolated from the majority of our patients, either from the skin (71%) or the anterior nares (67%). In the present study, 10% of isolations represented methicillin-resistant S. aureus (MRSA). Antibiotics exhibited diverse activities against clinical isolates of S. aureus. Among those tested, the highest rates of resistance were shown for ampicillin – 58.5%, lincomycin – 37.5% and erythromycin – 31.0%. Enhanced resistance levels were expressed to mupirocin (17.5%) and fusidic acid (15.5%). Conclusions According to the increasing rate of resistance and quick recolonization after discontinuation of the treatment, chronic use of topical antibiotics is not recommended and should be limited to exacerbation of atopic dermatitis with clinical signs of bacterial infection.

Abscesses related to drug use are the most common cutaneous manifestations among injection drug users, often occurring when the veins become less accessible. In these cases, other techniques may be used to administer drugs, such as skin popping (subcutaneous injection) or muscle popping (intramuscular injection). The main risk factors for abscess formation include skin popping, use of unsterilized needles, and injection of speedball (a mixture of cocaine and heroin). We present a case of recurrent abscesses accompanied by fever, hypersomnia alternating with insomnia, diaphoresis, fatigue, recent weight loss, and agitation following subcutaneous injection of a tramadol, opipramol, and clonazepam mixture. Differential diagnoses included pyoderma gangrenosum on the basis of hepatitis C virus, skin lesions connected with human immunodeficiency virus infection, vasculitis, endocarditis, and serotonin syndrome. The patient was treated with oral antibiotics, surgical incision, and drainage of the abscesses, with consequent improvement.

Interstitial granulomatous dermatitis (IGD) is a distinct histopathological pattern with a diverse clinical appearance which can be associated with autoimmune systemic diseases or, rarely, with drug-related adverse reactions. The IGD is a rare entity, first described in 1993 by Ackerman, which belongs to a group of non-infectious cutaneous granulomas [1]. The disease affects mostly women, at the mean age of onset at 58 years [2]. The precise etiopathogenesis remains unknown, but the underlying inflammatory process of the dermis and granulomatous infiltrate can be involved in the development of the disease. One hypothesis suggests that the depositions of immune complexes in the dermal vessels may be the trigger, which is then followed by complement and neutrophil activation and damage of dermal collagen, which in response gives rise to a granulomatous infiltrate [3]. We present a case of IGD that seems to be a distinct entity with variable clinical manifestations, which can be easily differentiated from other granulomatous skin diseases on the basis of histopathological examination. Although the disease occurs more frequently in adults, we present a case of IGD in a child.

Introduction: Leukoplakia is the most common potentially malignant condition of the oral cavity. Aim: Epidemiological and clinical analysis of patients with oral leukoplakia (OL) diagnosed and treated in the Department of Maxillofacial and Oral Surgery, Medical University of Gdansk. Material and methods: The study was retrospective and prospective. Among 55 911 patients diagnosed and treated in the Department in 1999–2009, 204 people with OL were selected. The material includes 104 women and 100 men with an average age of 58.1. Most of the patients were in the age group of 50–70 years, average age was 58.1. Results: The most common concomitant disease was diabetes. More than 88% of the patients declared occurrence of OL predisposing development factors (50.49% – cigarette smoking). Three hundred and twenty foci of OL were found among patients. Homogeneous OL dominated (72.05%). Multifocal OL was diagnosed in 58.3% of patients. The most common location of lesions was buccal mucosa (52.2%). Cancers developed on the basis of OL in 7 patients (3.43%). The percentage of malignant transformation was 12.19% for untreated patients and 1.41% for treated patients. The floor of the oral cavity was proven to be the location of the highest risk of oral squamous cell carcinoma. Patients with diabetes may be more likely to develop OL. The risk of malignant transformation is relatively high. In our material it was equal to 3.43%. Conclusions: Cigarette smoking is the most important factor, which can influence the effectiveness of treatment.