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Dietmar Schulz,1 Georgiana Simona Mohor,2 Caius Solovan2,3 1Sana Kliniken Leipziger Land, Klinik fur Urologie, Borna, Leipzig, Germany; 2University Clinic of Dermatology and Venereology, Timisoara, Romania; 3Department of Dermatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Abstract: Fournier gangrene (FG) is an infectious condition with fulminant evolution and is sometimes life-threatening. Here, we present the case of an immunocompromised 59-year-old male with surgical history of a pancreatic pseudocyst stented endoscopically. After unrecognized stent migration in the sigmoid without colonic perforation, he developed severe necrosis of the scrotum and perineum, which spontaneously perforated, presenting a smell suggesting moist gangrene. FG that has spread to the male genital organs presents therapeutic challenges. The purpose of our study is to present this case, typical for FG, with an educational aim both for the internal and surgical specialties, and the goal of further multidisciplinary collaboration for the optimal management of the patient with personalized treatment. Keywords: pancreatic stent, wound debridement, vacuum-assisted closure, transplanted skin, necrotizing infection

Flavia Baderca,1,2 Dana Vincze,3 Nicolae Balica,4 Caius Solovan5,61Department of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 2Service of Pathology, Emergency City Hospital, Timisoara, Romania; 3Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 4Otolaryngology Department, 5Department of Dermatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 6Department of Dermatology, Emergency City Hospital, Timisoara, RomaniaAbstract: Melanomas are malignant tumors that originate from melanocytes. They are most frequently localized in the skin, but 5% of all melanomas interest also extracutaneous sites as mucosal surfaces, parenchymatous organs, the retroperitoneum area, and the ocular ball. The purpose of this study was to investigate the epidemiologic and morphologic data of mucosal melanomas diagnosed at Emergency City Hospital (Timisoara, Romania) during a period of 12 years. The study included 17 cases of extracutaneous, extraocular melanomas, with 16 primary melanomas and one secondary melanoma. All our patients were older than 53 years and were mostly men. Most of the patients presented with localized disease; only one case had regional lymph node metastases, and another one had systemic metastases at the time of diagnosis. Regarding localization, nine of 16 melanomas were in the head and neck region, six were diagnosed in the gastrointestinal and urogenital tracts (three cases each), and one case had a rare localization (retroperitoneum). The most common histologic type was represented by epithelioid cells, and the majority of the tumors were achromic. Mucosal melanoma is a tumor associated with aging, all our patients being older than 53 years. Because of unspecific symptoms and low incidence, the diagnosis is often delayed and requires teamwork among the clinician, pathologist, radiologist, and oncologist. Different genetic fingerprints impose a correct diagnosis to offer the patient the best novel, personalized therapy.Keywords: mucosal melanoma, melanocytes, molecular classification, kit gene mutations, immunohistochemistry

Anca Chiriac,1 Liliana Foia,2 Cristina Birsan,1 Ancuta Goriuc,2 Caius Solovan3 1Department of Dermatology, Nicolina Medical Center, Iaşi, Romania; 2Surgical Department, Grigore T Popa University of Medicine and Pharmacy, Iaşi, Romania; 3Department of Dermatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania Background: The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations. Patients and methods: Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions. Results: The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement. Conclusion: These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to choose the proper therapy is mandatory for all these cases. Dermatologists and all physicians who take care of old patients must recognize the disorder in order to provide optimum care for this chronic condition. We emphasize therefore the importance of psychiatric evaluation and treatment to avoid the major risk of suicide. Skin lesions must be regarded as an alarm signal in critical cases, especially in senior people. Keywords: pathomimia, elderly, psychiatric disorders

Anca Chiriac,1 Doina Mihaila,2 Liliana Foia,3, Caius Solovan4 1Department of Dermatology, Nicolina Medical Center, 2Department of Pathology, St Maria Children's Hospital, 3Surgical Department, Grigore T Popa University of Medicine and Pharmacy, Iaşi, Romania; 4Victor Babe University of Medicine, Timişoara, Romania Abstract: Basal cell carcinoma is a malignant skin tumor with high incidence in our country, especially in rural areas, on sun-exposed skin (particularly on the face) in elderly patients. We present three cases of basal cell carcinoma with good results with cryotherapy. This report aims to outline and to prove that in some difficult situations, a simple, inexpensive, easy-to-perform procedure with no contraindications and with minimal side effects (erythema, mild pain) can be applied and resolve such cases. Keywords: basal cell carcinoma, cryotherapy

OBJECTIVE: The use of current surgical techniques in the management of skin cancers that are not amenable to other treatment options has become the cornerstone of dermatological surgical intervention. Among the many benign lesions and malignant lesions, such as squamous cell carcinomas, melanomas, and Merkel cell carcinomas, the tumors that are commonly excised surgically are the basal cell carcinomas (BCC). Although the majority of BCC lesions spread locally and are rarely metastatic, these lesions may recur, especially, if the excised tissue consists of positive surgical margins. As BCC lesions are more common on the head, face, and neck regions, inadvertent positive margin excisions to help avoid major disfigurement of the regions may contribute to their recurrence. Trichoepithelioma (TE) is a benign tumor that bears a close resemblance to BCC, and therefore, clinicians encounter difficulty in differentiating between TE and BCC lesions. Clinicians have to rely on histopathology and immune-histochemical markers to rule out TE. This differentiation is crucial to make a definitive diagnosis of BCC and subsequently, employ a more aggressive surgical excision approach to treat this invasive tumor as compared with TE. Our focus in this article is to highlight only the surgical excision management of local and or locally invasive BCCs and report the success rate of our hospital's Derma-to-venereology clinic (DVC) in Timisoara, Romania. This article highlights the role of an appropriate wide local lesion excision (5 mm) withfurther surgical interventions, be it for corrective or esthetic reasons. PATIENTS AND METHODS: This is a retrospective study that summarizes the evaluation of 120 lesions from 106 patients who were treated for BCCs at DVC (University Hospital), using a wide surgical excision method. Following the Romanian Society of Dermatologists guidelines, local non-aggressive BCC lesions were excised with margins of 5 mm and up to 1 cm for the aggressive sclerosing subtype. RESULTS: The results of the audit of a sample of 120 lesions from 106 patients demonstrated that none of the surgically treated patients had recurrences and only 23 (19.16%) had positive surgical margin lesions. Out of these, 17 (73.91%) lesions underwent second surgical excision, while only three (13.04%) showed the presence of a residual tumor. The evaluation results may encourage dermatologists worldwide to make appropriately sized excision, especially in regions other than the head and neck, to avoid positive surgical margins and eliminate the need for consequent surgery. CONCLUSIONS: For a better post-surgical prognosis of BCC, the authors recommend the practice of a wide margin excision (5 mm) during the primary surgery to avoid secondary surgery, especially if the tissue in the region is not sparse and chances of causing major disfigurement are minimal. As our findings suggest, only a few cases have the presence of residual tumor in the second surgery, hence authors also advocate the necessity to inform the patients about the merits of a second surgery, clearly mentioning the possibility of the absence of tumor even in the presence of positive margin. [ABSTRACT FROM AUTHOR]

The photo-induced cutaneous lesions are produced by reactive oxygen species (ROS). Ultraviolet radiation (UVR) is a major exogenous factor inducing ROS which modulate cutaneous lesions in psoriasis patients. UVR activates the oxidative metabolism and production of ROS. We developed an in vitro model based on this finding. Was investigated the production of ROS in neutrophyls by nitrobluetetrazolium (NBT) test. Heparinized venous blood was taken from 20 patients with psoriasis. It was divided in two series of samples that were irradiated for 3, and 5 min. The UVR exposure was performed at room temperature, on multiwall plates with a 1 cm layer thickness, in a dark room by means of an 80 W biological quartz lamp placed at a distance of 20 cm from the sample. In each series the pre-irradiation state served as the control. The phagocytic capacity was estimated by nitrobluetetrazolium reduction test that indirectly indicated the activation of oxidative metabolism and ROS production during phagocytosis. To evaluate the test, the NBT phagocytosis index was used. In psoriasis patients, the phagocytic capacity of leukocytes was reduced in basal conditions. The NBT tests increased to 8.8±3.8%, and to 7.53±4.68% over the initial value (4.25±3.02%), correlated with the time of blood UVR exposure. The high enhancing of the NBT tests showed the strong effect on granulocytes oxidative metabolism induced by UVR and the production of great quantities of ROS. In the skin of psoriasis patients there is an infiltrate with leukocytes which can produce ROS after UVR exposure and also can modulate the local inflammation. The obtained results showed an increase of ROS production in leukocytes. In vitro data can indirectly explain the modifications of lesions after UVR skin contact, in psoriasis patients. [ABSTRACT FROM AUTHOR]

The article describes the case of an 8-year-old boy who presented with a common wart in his third left finger which was treated with topical 5 percent potassium hydroxide (KOH) solution.

This eruption, which was described in 1955 by Gianotti and again by Crosti and Gianotti in 1957, was initially termed papular acrodermatitis of childhood and later better known as Gianotti-Crosti syndrome. It is a self-healing childhood exanthem, usually associated with viral infections. Here is reported a child who developed this syndrome following group A streptococci angina. [ABSTRACT FROM AUTHOR]

Background and Objectives: Mycosis fungoides (MF) and large plaque parapsoriasis (LPP) evolution provide intriguing data and are the cause of numerous debates. The diagnosis of MF and LPP is associated with confusion and imprecise definition. Copy number alterations (CNAs) may play an essential role in the genesis of cancer out of genes expression dysregulation. Objectives: Due to the heterogeneity of MF and LPP and the scarcity of the cases, there are an exceedingly small number of studies that have identified molecular changes in these pathologies. We aim to identify and compare DNA copy number alterations and gene expression changes between MF and LPP to highlight the similarities and the differences between these pathologies. Materials and Methods: The patients were prospectively selected from University Clinic of Dermatology and Venereology Timișoara, Romania. From fresh frozen skin biopsies, we extracted DNA using single nucleotide polymorphism (SNP) data. The use of SNP array for copy number profiling is a promising approach for genome-wide analysis. Results: After reviewing each group, we observed that the histograms generated for chromosome 1-22 were remarkably similar and had a lot of CNAs in common, but also significant differences were seen. Conclusions: This study took a step forward in finding out the differences and similarities between MF and LPP, for a more specific and implicitly correct approach of the case. The similarity between these two pathologies in terms of CNAs is striking, emphasizing once again the difficulty of approaching and differentiating them.

MicroRNAs (miRNAs) have been proven to regulate the development and progression of cancer through various mechanisms. The aim of the present study was to compare miRNA expression between primary melanomas from different sites. We analyzed the expression of 84 miRNAs in 27 primary melanoma and 5 nevus formalin-fixed paraffin-embedded (FFPE) samples using the Human Cancer PathwayFinder miScript miRNA PCR Array. The FFPE samples were obtained from the archives of the Municipal Clinical Emergency Hospital of Timisoara and included 10 cutaneous melanomas, 10 uveal melanomas, 7 mucosal melanomas, and 5 cutaneous nevi. Out of 84 miRNAs, 11 miRNAs showed altered expression in all types of melanoma compared with the nevi. Among these, miR-155-5p, miR-9-5p, miR-142-5p, miR-19a-3p, miR-134-5p, and miR-301a-3p were upregulated, while miR-205-5p, miR-203a-3p, miR-27b-3p, miR-218-5p, and miR-23b-3p were downregulated. The highest similarity in miRNA expression pattern was found between uveal and mucosal melanoma groups, i.e., 15 miRNAs had altered expression in both groups. Overall, we identified several miRNAs with significantly altered expression in primary melanomas, including those reported for the first time in this type of cancer. Among them, mir-9-5p, mir-203a-3p, mir-19a-3p, mir-27b-3p, and mir-218-5p showed altered expression in all three melanoma types vs. nevi. Further research should explore the potential of these miRNAs in melanoma.

Lymphangioma circumscriptum (LC) is a rare, benign condition, predominantly characterized by the malformation of lymphatic skin vessels. Its onset may be congenital or due to secondary causes such as radiotherapy, infections, or surgical procedures. We present the case of a 55-year-old patient with a pathologic history of squamous cell carcinoma of the penis followed by radical penectomy. Due to metastasis to the locoregional lymph nodes, the entire affected area was subsequently treated with radiation therapy, receiving a total dose of 55.8 Gray. Eight years after this treatment, translucent vesicles filled with a clear liquid appeared on the scrotum. Histopathology confirmed the diagnosis of LC and therapy with CO2 laser was applied, resulting in a favorable outcome. LC of the scrotum may present a long-term radiotherapy-induced complication of this site. Our clinical experience showed that the CO2 laser was the therapy of choice as the vesicles entirely disappeared and healed as white scar-like lesions.

Cutaneous lymphomas (CLs) represent a group of lymphoproliferative disorders that can be difficult to diagnose in the early stage because they could mimic many benign inflammatory dermatoses (chronic eczema, bullous dermatosis, idiopathic erythroderma, psoriasis, lymphadenitis). Primary cutaneous B-cell lymphomas are a unique and controversial group of skin lymphomas characterised by the absence of extracutaneous manifestations at diagnosis. We present the case of a 60-year-old man with 7-month history of a growing inguinal mass/tumour, which was misdiagnosed as inguinal chronic lymphadenitis. Recognition of the correct entity, primary cutaneous diffuse large B-cell lymphoma leg type, led to an appropriate therapeutic strategy, knowing that these types of tumours behave more aggressively than other types of primary cutaneous B-cell lymphomas. The patient was discharged with rituximab + chemotherapy indication and favourable outcome. The aim of the presentation is to describe these common skin manifestations, however seen in a primary cutaneous B-cell lymphoma, which underlines the necessity of rigorous monitoring/long-term follow-up as well as exhaustive histopathological analysis for the diagnosis., (© 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Background: DNA copy number profiles from microarray and sequencing experiments sometimes contain wave artefacts which may be introduced during sample preparation and cannot be removed completely by existing preprocessing methods. Besides, large derivative log ratio spread (DLRS) of the probes correlating with poor DNA quality is sometimes observed in genome screening experiments and may lead to unreliable copy number profiles. Depending on the extent of these artefacts and the resulting misidentification of copy number alterations/variations (CNA/CNV), it may be desirable to exclude such samples from analyses or to adapt the downstream data analysis strategy accordingly., Results: Here, we propose a method to distinguish reliable genomic copy number profiles from those containing heavy wave artefacts and/or large DLRS. We define four features that adequately summarize the copy number profiles for reliability assessment, and train a classifier on a dataset of 1522 copy number profiles from various microarray platforms. The method can be applied to predict the reliability of copy number profiles irrespective of the underlying microarray platform and may be adapted for those sequencing platforms from which copy number estimates could be computed as a piecewise constant signal. Further details can be found at https://github.com/baudisgroup/CNARA ., Conclusions: We have developed a method for the assessment of genomic copy number profiling data, and suggest to apply the method in addition to and after other state-of-the-art noise correction and quality control procedures. CNARA could be instrumental in improving the assessment of data used for genomic data mining experiments and support the reliable functional attribution of copy number aberrations especially in cancer research.

Objectives: Genital infection with human papillomavirus (HPV) has become one of the most frequently viral sexually transmitted diseases. The infection may remain asymptomatic, may take the form of external genital warts and may give raise to cervical cancers. The aim of this study was to assess the frequency of the patients with genital warts addressing to five tertiary referral dermato-venereological units in Romania (where patients from several counties are referred) and to compare the results with the out-patient data reported by all Romanian hospitals., Material and Methods: Data regarding patients with external genital warts who addressed to the hospital emergency rooms, in five tertiary referral dermato-venerological units in Romania (Bucharest, Timisoara, Craiova, Constanta, Târgu-Mures) were collected for the year 2012. For comparison there have been used data collected by the National School of Public Health, Management and Professional Development, during the same year., Outcomes: Data reported at national level in 2012 included 952 patients (731 women and 221 men) with 26 males under 20 years of age and 251 female patients in the age group 0-20 years. In the overall population (males and females combined) the total number of genital warts cases registered at the hospital emergency rooms in the five centers, in the year 2012, was 266 patients (119 men and 147 women) with 4 girls under 14 years of age and 6 male patients in the age group 0-14 years., Conclusions: The high prevalence of the infection with HPV, the costs of treatment and the psychological impact prove that prevention of the disease is the most important step for decreasing the incidence of this disease. General measures for patients awareness regarding the disease and its complications need to be completed with the recommendation for vaccination. A closer monitoring of patients would provide information for a strategic national approach leading to a better outcome.

A 67 year-old man was diagnosed 10 years ago with severe plaque psoriasis and was hospitalized for re-evaluation of therapy. He was treated previously with topical corticosteroids, methotrexate, and phototherapy. As part of the assessment protocol for initiation of biological treatment, a tuberculin skin test was done, which was positive without signs of active tuberculosis. Isoniazid therapy was started with marked improvement of psoriatic lesions before biologic treatment could be initiated.

Nail bracing is a safe, simple, and inexpensive treatment option that avoids surgery, requires no anesthetic, requires no recovery period, allows wearing the existing shoes, offers immediate relief from pain, and allows the practice of daily activities. Braces can be used for prolonged periods of times. If recurrence occurs, reapplication of bracing is usually required.

Background: Psoriasis is a chronic skin condition that can decrease the level of self-esteem, leading to self-devaluation, emotional distress, irrational beliefs and discomfort in everyday life. In this study, we aimed to provide a deeper understanding of lifestyle satisfaction and to identify the nature and magnitude of irrational beliefs in patients with psoriasis., Material and Methods: A two-year case-control study was carried out between 2010 and 2012. The study enrolled 100 consecutive patients with psoriasis vulgaris, admitted to a dermatology clinic and 101 healthy volunteers with similar demographic characteristics, willing to subject themselves to the testing. A series of standardized questionnaires were used, including: The Anamnestic Questionnaire, The General Attitudes and Beliefs Scale - Short version, The Rosenberg Self-Esteem Scale, The Self-Efficacy Scale and The Unconditional Self-Acceptance Questionnaire., Results: The tests revealed a strong correlation between the presence of the disease and the decrease of subject's satisfaction regarding: body satisfaction, sexual satisfaction, social satisfaction, family satisfaction, professional satisfaction and satisfaction concerning their own health condition; p<0.01. There were highly significant differences with a large effect regarding the level of irrational beliefs between the two groups of subjects (p<0.01; f > 0.35)., Conclusion: The focus on psychological impacts of the disease provides important data for a holistic approach to patients with psoriasis. Effective cooperation between all the parties involved (physicians, family and social network) is necessary to improve the patient's psychological status.

The metal alloys used in dental practice are the subject of numerous discussions referring to the effect they have on oral cavity tissues. Numerous scientists established that the organic molecules did not exert a significant influence on the degradation of metallic implants. The aim of this study was to test the cytotoxic potential of the most used dental alloys, the Ni-Cr alloy and the Co-Cr alloy. The tests were made on cell culture of pure cell line dermal fibroblasts and of those obtained from skin biopsies, for both, dental alloys and their eluates. The results were compared with control samples. At seven days after inoculation, we observed the relative similarity between the Ni-Cr alloy and the Co-Cr alloy, where the cells did not detach from the plate and they grow to the edge of the material. In case of the eluates, there were no fragments detached, the cells having a relatively high confluence. Therefore, the cytotoxic effects of the two alloys are similar, even if there are speculations in the literature according to which Ni-Cr alloys would have a more pronounced effect. In conclusion, our study revealed non-cytotoxicity of these two dental alloys, and we believe so they can be used successfully in dental practice.

Introduction: The era of biologic therapies has provided new options for the treatment of chronic plaque psoriasis. However, safety concerns have led to intensive screening and monitoring of patients receiving anti-tumor necrosis factor alpha (anti-TNF-alpha) agents., Methods: The authors describe the cases of three patients with moderate to severe psoriasis treated with anti-TNF agents, with challenging diagnostic and treatment aspects regarding tuberculosis (TB) infection, a serious adverse event associated with this type of treatment. The cases are discussed in the context of a comprehensive literature review describing the risk of TB associated with the use of TNF inhibitors. A critical review of the clinical trials that have tested the safety of these agents is also presented., Results: One patient, who tested negatively for latent TB infection (LTBI) during screening, developed active TB under adalimumab therapy. For two other patients the diagnosis and management of LTBI in relation to anti-TNF therapy represented a challenge. Although clinical trials involving the use of anti-TNF therapy for psoriasis haven't demonstrated a high TB incidence, active TB is continuously reported in association with this treatment., Conclusions: Findings from clinical practice and the scientific literature indicate that anti-TNF therapies are associated with an increased risk of TB, and close monitoring of patients is needed.

Introduction: Pyoderma gangrenosum (PG) is a rare sterile neutrophilic dermatosis characterized by painful recurrent ulcerations. It is frequently associated with inflammatory bowel disease, rheumatoid arthritis, or malignancies. PG is a diagnosis of exclusion, and it is based on clinical presentation, histology, history of an underlying disease, and exclusion of other causes of ulceration., Case Report: The authors report a 62-year-old male who developed a nonhealing ulcer at the site of incision following nephrectomy for renal cell carcinoma. Past medical history included chronic lymphocytic leukemia treated with rituximab. Histology of the skin lesion showed a phlegmonous nonspecific inflammation without being able to differentiate between a necrotizing wound infection and PG. The patient's condition was initially diagnosed as an infectious process and treated accordingly. After unsuccessful results with systemic antibiotics, high-dose corticosteroids induced prompt healing of the wound. On these bases, the diagnosis of postoperative PG within chronic lymphocytic leukemia and renal cell carcinoma was made., Conclusion: Faced with postoperative necrotizing ulceration resistant to correctly administered antibiotics, PG must be considered. In such condition, the diagnosis must not be guided primarily by histology and early advice of a dermatologist is recommended.