Day 2 :
- Track 2: Diagnostic Techniques in Dermatology
Track 6: Dermatology: Therapies and Advances
Track 7: Alternative Medicine Solutions
Location: Aspin I
Maria M Tsoukas
University of Chicago, USA
New York University, USA
Brown University, USA
Time : 09:50-10:10
George Kroumpouzos, MD, PhD, FAAD, is Clinical Associate Professor of Dermatology at the Alpert Medical School of Brown University and former Instructor at the Department of Dermatology, Harvard Medical School. He is certified by both American and European Boards of Dermatology. Dr. Kroumpouzos’ expertise is in the fields of obstetric/gynecologic dermatology, adverse drug reactions, connective tissue disease, complex medical dermatology, and disorders of pigmentation. He is an editorial board member in three peer-reviewed dermatologic journals, and has published more than 50 peer-reviewed publications and book chapters. Dr. Kroumpouzos has delivered numerous lectures in the US and internationally. He has been the recipient of several scholarships and awards, including awards by the International Union against Cancer and the Dean’s Teaching award at Alpert Medical School of Brown University.
Pigmentary changes, such as melasma and hyperpigmentation, are reported in more than 90% of pregnant patients. Treatment of melasma and hyperpigmentation in pregnancy is not recommended as these pigmentary changes may improve or resolve postpartum. When therapeutic intervention is indicated postpartum, topical medications such as hydroquinone, topical retinoids, and kojic acid, should be tried first. Chemical peels and device-based therapies, including laser and intense pulsed light, are indicated when topical medications fail. Chemical peels that have been successful in randomized control trials (RCTs) include glycolic 20-70%, salicylic 20-30%, trichloroacetic 20%, and amino fruit 20-60% acids as well as Jessner’s solution. Ablative lasers, such as carbon dioxide and erbium, have been successful in RCTs but carry the risks of postinflammatory hyper- or hypopigmentation. Q-switched lasers, such as alexandrite and Nd:yag, have been also effective in RCTs and carry less risk of dyspigmentation. Fractionated lasers have been effective, especially when combined with a tyrosinase inhibitor. Intense pulse light therapy can be successful but carries the risks of dyspigmentation, blistering and scarring. Dermabrasion and microdermabrasion have been used with some success, but have not been evaluated in RCTs. Outcomes are better when the above procedures are combined with hydroquinone and/or other topical medications. The presenter will include his own experience with chemical peels and device-based procedures. Clinical cases will be presented in an interactive way.
University of Chicago, USA
Time : 10:10-10:30
Maria M Tsoukas clinical and research interests are focused on skin cancer in healthy and immunosuppressed transplant patients surveillance therapy and prevention, skin photodynamic therapy, skin cancer genomics and virus HPV induced tumor development minimally invasive and latest laser technology in dermatologic care like facial rejuvenation, laser assisted hair removal, laser therapy for skin vascular malformations, aesthetic skin surgery for aging face hand and body: Botox latest filler products and techniques facial contouring sclerotherapy and procedural dermatology in medicine and cosmetic procedures like Laser Skin Surgery for scleroderma patients.
Several therapeutic modalities have been applied topically, for the treatment of actinic keratosis as well as superficial nonmelanoma skin cancers. This session will explore the indications and significance of these field modalities in topical "chemo-prevention", in elderly as well as high risk patients under chronic immunosuppression, with emphasis on skin photodynamic therapy. Algorithms for monitoring actinic keratosis and non-melanoma skin cancers are reviewed. The concept of applying sequential PDT, as well as PDT in combination with other topical field therapies is explored. Evidence supports that sequential PDT may impact actinic keratosis recurrence and consequently non-melanoma skin cancer incidence. Moreover, preliminary data indicates that combination of PTD with other established topical field therapies, may improve PDT efficacy in eradicating precancerous and malignant non-melanoma skin lesions, comparing to outcomes when each therapy has been used as single modality. The value of current field therapies as mono-therapies and in combination in medical and aesthetic dermatology is reviewed.
New York University, USA
Time : 10:30-10:50
Miroslav Blumenberg is an Associate Professor in the R.O. Perelman Department of Dermatology and Department of Biochemistry and Molecular Pharmacology, NYU Langone Medical Center. He has completed his Ph.D. at the Massachusetts Institute of Technology and postdoctoral studies at Stanford University. He has published more than 100 papers in refereed journals, serves on editorial boards of BMC Genomics, Acta Dermatovenerologica APA and World Journal of Biological Chemistry and holds3 patents. Dr. Blumenberg pioneered the use of DNA microarrays in skin biology.
One of the challenges of OMICS research is the integration of new data into the preexisting, and then re-interpretation of the integrated data. We used readily available meta-analysis computational methods to integrate new data on the transcriptomic effects of EGF in primary human epidermal keratinocytes with the preexisting transcriptomics data in keratinocytes. We separately addressed the consequences of adding EGF to keratinocyte cultures and its reverse, blocking the EGFR kinase with Tyrphostin AG1478. We first starved primary human epidermal keratinocytes for 24 hrs and next treated them with EGF. Then, we compared the genes expressed in the treated and control cultures in parallel, using Affymetrix microarrays. We find that the addition of EGF promotes keratinocyte proliferation, attachment and motility and, surprisingly, induces DUSPs, the phosphatases that attenuate the EGF signal. Using metaanalysis, we identified overlapping effects of EGF with those of IL-1 and IFNg, both activators of keratinocyte in wound healing and inflammation. We also identified and characterized the genes and pathways which are suppressed by EGF but are induced by agents promoting epidermal differentiation, such as Ephrins and JNK inhibitors. EGFR activation is important in many malignancies, including cutaneous SCC, lung, colon and other cancers, and targeting the EGFR is currently used to treat such cancers. However, a significant drawback to EGFR targeted therapies is the skin toxicity side effect. This toxicity usually presents as hair and nails abnormalities, papular or pustular folliculitis and pruritic dry skin. These limit the usefulness of EGFR targeting therapies. Surprisingly, the transcriptional effects of EGFR inhibition have not been extensively explored in epidermal keratinocytes. Therefore, we treated primary human epidermal keratinocytes with Tyrphostin AG1478, a specific inhibitor of the EGFR kinase, and compared the treated and control cultures using Affymetrix microarrays. The observed changes were integrated with the preexisting data on transcriptional profiling in epidermal keratinocytes. We find that the inhibition of EGFR suppresses the transcription of genes linked to keratinocyte proliferation, attachment and motility. Interestingly, inhibiting EGFR promotes apoptosis by both induction of proapoptotic and suppression of antiapoptotic genes. Certain transcriptional effects of EGFR inhibition counter the transcriptional effects of retinoids. Surprisingly, EGFR inhibition strongly and specifically induces expression of markers of epidermal differentiation. Overall, our work defines the yin-yang of EGF signaling in human epidermis, namely both the changes responding to activation of the EGF receptor, and its inhibition. Moreover, this work can serve as a paradigm for integration and analysis of new omics data with the large bodies of data in public repositories.
Yale University, USA
Time : 11:05-11:25
Rossitza Lazova, MD has completed a residency in Anatomic and Clinical Pathology and a fellowship in Dermatopathology with Dr. A. Bernard Ackerman. She is an Associate Professor of Dermatology and Pathology and Director of the Dermatopathology Fellowship at Yale University. Dr. Lazova has published more than 60 papers in reputed journals and is an author of a textbook titled Atlas of Practical Mohs Histopathology. She has established the Yale Spitzoid Neoplasm Repository and is an internationally recognized expert in the field of Spitzoid melanocytic neoplasms. She has pioneered the use of Mass Spectrometry in the diagnosis of difficult melanocytic lesions.
Spitzoid neoplasms are melanocytic lesions that include a spectrum ranging from completely benign "‘classic"’ Spitz nevi to malignant melanomas that show "‘Spitzoid"’ features. The gold standard for diagnosing Spitz nevus (SN) and differentiating it from Spitzoid malignant melanoma (SMM) is histopathologic examination applying well established criteria. However, there are melanocytic lesions that show conflicting histopathologic criteria and the distinction between a benign SN and SMM may be extremely difficult. We performed Imaging Mass Spectrometry analysis on formalin-fixed, paraffin embedded (FFPE) tissue samples to identify differences on proteomic level between SN and SMM. The diagnosis of SN and SMM was based on histopathologic criteria, clinical features, and follow-up data. The melanocytic component from 114 cases of SN and SMM from the Yale Spitzoid Neoplasm Repository were analyzed. After obtaining mass spectra from each sample, classification models were built using a training set of biopsies from 26 SN and 25 SMM. The classification algorithms developed on the training data set were validated on another set of 30 samples from SN and 33 from SMM. We found proteomic differences between the melanocytic components of SN and SMM and identified 5 peptides that were differentially expressed in the 2 groups. From these data, 29 of 30 SN and 26 of 29 SMM were recognized correctly in the validation set. This method correctly classified SN with 97% sensitivity and 90% specificity in the validation cohort. Imaging Mass Spectrometry analysis can reliably differentiate benign nevi from malignant melanomas in FFPE tissue based on proteomic differences.
Gaurang Joshi, is a B.A.M.S. Gold Medalist, Gujarat Ayurved University, M.D. (Alternative Medicine), International Ayurveda Consultant, Expert Ayurveda Skin Specialist,Director-Atharva Multispeciality Ayurveda Hospital,Panchakarma And Skin Care Hospital, Rajkot, President-International Psoriasis Foundation,Organizing Secretary-International Conference on Ayurved and CAM, Rajayucon 2013. He has published more than 12 papers in national and international conferences on Dermatology and Oncology research; he was invited by University of Indonesia, Department of Pharmaceuticals Sciences as a Guest Speaker in International Symposium September 2011.
Psoriasis is universal in occurrence which affects about 125 million people worldwide. Psoriasis occurs when the immune system mistakes the skin cells as a pathogen, and sends out faulty signals that speed up the growth cycle of skin cells. This ayurvedic combined modality of the treatment has improved local control in many clinical situations & its most profound impact has definitely been on improving the quality of life. It is hoped that a better understanding of the clinical use of poly herbal formulation will provide a sound scientific basis for the improved care of patients with psoriasis, a study was has been done on poly herbal formulation which was a combination of few herbal drugs. It was thought to known that this formulation has better effect as compared to existing synthetic drugs. Despite recent innovations a considerable number of patients with psoriasis cannot be successfully treated by current therapies, the avail synthetic drugs have tons of drawbacks or side effects, poly herbal formulation devoid of any adverse effects. Which was the most advantageous to all the patients, this study had assess the safety and efficacy of a poly herbal formulation compared to placebo and existing drug in patients that have moderate to severe, chronic psoriasis. Ayurveda life style, diet and stress management with its detoxification treatment (panchakarma) had proved to be an innovative and promising future for the management of psoriasis.
Xianling Cong, M.D is an Associate Professor of Dermatology in the third hospital of Jilin University, Changchun, China. She got her medical degree in Jilin University, and completed her post dcotoral research in the Sidney Kimmel Cancer in San Diego in U.S. With 20 years of clinical experience in dermatology, she is specialized in the diagnosis of Sporotrichosis.
Background: Avidin-biotin-horseradish peroxidase enzyme complex, enzyme-linked immunosorbent assay (ABCELISA) is widely used in detecting the soluble bacterial, viral antigen and antibody, but the reports of detecting mycotic antigens were few. We used the method to detect Sporothrix schenckii pathogen of sporotrichosis in smear. Aim: To provide a rapid diagnostic method for sporotrichosis. Methods: 20 cases of sporotrichosis-in doubt we scraped pus or tissue fluid from the skin lesion and perform ABCELISA by reagent vectastatin ABC kit, rabbit anti Sporothrix schenckii serum. Results: 18 of 20 cases were diagnosed as sporotrichosis. 14 of 18 cases were positive (77.8%) by ABC-ELISA stain, 5 of 18 cases were positive (27.7%) by Gram stain. Conclusion: ABC-ELISA is new fashioned biological amplification technique. Due to its sensitivity this method is 77.8% in smear, the specificity is 100%. Only three hours is needed, so this method can be used to detect Sporothrix schenckii rapidly.
Cairo University, Egypt
Title: A randomized, controlled, double-blind study evaluating photodynamic white hair removal using topical Liposomal Rose Bengal
Time : 12:25-12:45
Maha Fadel is a Professor of Pharmaceutical Technology at National Institute of Laser Enhanced Sciences, Cairo University and Head of the Pharmaceutical Technology Unit, Drug delivery laboratory. Medical Laser Applications Dpt. PhD in Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Egypt
Laser hair removal of blond and white hair is acomplicated task with often unsatisfactory results as a result of lack of laser-absorbing chromophore. In the present study, we investigated if repetitive sessions of photodynamic therapy (PDT) using Topicall application of liposomal rose bengal (RB) hydrogel followed by intense pulsed light (IPL) exposure enables removal of white and gray hair. Liposomal RB in hydrogel was prepared and pharmaceutically characterized. Fifteen adult females, skin phenotypes III-IV were entered into the study. They were determined to have white terminal hair. Unwanted facial hair was treated for three sessions at 4-6 week intervals using intense pulsed light (IPL). At each treatment: the treatment area was pre-treated with topical liposomal rose RB gel. While a control group of another 15 patients applied Placebo gel before IPL treatment. Hair regrowth was measured 4 weeks after each treatment and additionally 6months after the last treatment by counting the number of terminal hair compared with baseline pretreatment values. Rate of hair regrowth, complications and treatment outcomes were documented. Mean regrowth in the liposomal RB group was 63% after 3 treatment cycles. Six months after therapy, average terminal hair count compared with baseline pretreatment showed 40% reduction, and no recorded side effects. Also significant difference was seen compared with the control group, the clinical outcome was promising. As a conclusions photodynamic therapy using liposomal RB hydrogel in combination with IPL treatment showed significant efficacy in the treatment of white hair compared with a control group.
Minia University, Egypt
Time : 13:45-14:05
Background: Phototherapies are the most commonly used modalities in the treatment of vitiligo. Oral PUVA is the classical treatment and the NB-UVB is recently introduced without shorter erythemogenic wavelengths. Aims: This study designed to compare the effects of PUVA and NB-UVB clinically and immuno-pathogically in managing non segmental vitiligo. Patients/Methods: Thirty vitiligo patients, divided randomly into two groups treated either by oral PUVA or by narrow band UVB. After 4 months evaluation was done clinically and immuno-pathologically Results: One patient (3.3%) failed to respond to therapy in PUVA group of patients while 29 patients (93.3%) improved. Excellent repigmentation was achieved in 6.7% in PUVA group and 66.6% in NB-UVB group; good repigmentation was achieved in 60% in PUVA and 20% in NB-UVB while 26.7% in PUVA and 13.3% in NB-UVB showed mild repigmentation. The colour matching was excellent in NB-UVB patients. Recurrence and activation of vitiligo were in low percentage in PUVA treated cases. Microscopic examination revealed that dermal lympho-histiocytic infiltrate and the interface changes were more in biopsies from vitiliginous lesions treated with NB-UVB than with PUVA. Conclusions: The present study demonstrated that NB-UVB provides statistically significant better results than oral PUVA in managing non segmental vitiligo. Although NB-UVB therapy gives a rapid effect, yet the observation of decreasing recurrence and development of new lesions of vitiligo were significant with PUVA. It was also observed that PUVA has better immuno-modulatory effect on vitiligo than NB-UVB and will give better response on a longer period of time.
International Cancer Foundation, India
Time : 14:05-14:25
Bhavna Joshi (M.D. Ayurvedic Oncology Gold Medalist, Gujarat Ayurved University) is a Consultant Cancer Physician and Director of Atharva Multispeciality Ayurveda Hospital, Cancer Research Center, Rajkot and President-International Cancer Foundation. She has published more than 10 papers in national and international conferences on oncology research i.e. ASCO-PAN Asia conference at New Delhi. Poster presentation at GCRI-Ahmedabad in AROI National conference, International conference on cancer at NCI- National Cancer Institute, Betehesda, USA
Skin Cancer is of two type basal cell carcinoma and melanoma. Basal Cell Carcinoma is curable and can be easily treated, but Melanoma is a challenging skin cancer disease and hard to cure, but however if skin cancer is diagnosed in early stages it can be cured fairly. Ayurvedic medicines and other herbal treatment are one of the best sources to help cure and manage skin cancer disease. A healthy and nutrient rich diet plan helps in overcoming skin cancer disease. Leafy green vegetables, cancer-fighting cruciferous vegetables, and beta carotene rich sweet potatoes and carrots should be consumed regularly, if not daily. Ayurvedic cancer treatment may also compatible with Western medicine. In a study conducted by the Atharva Ayurveda Research center, ayurvedic solutions are actually helpful in controlling the side effects and problems associated with chemotherapy cancer treatment and are helpful in reducing the toxicity of cytotoxic chemotherapy for breast and gastrointestinal cancers. Hence, the inclusion of ayurvedic healing to cancer treatment can provide a synergistic effect in cancer management. In this modern age cancer remains a great threat to society and ayurvedic wisdom can significantly help patients cope with cancer and can be used as an adjunct to alleviate symptoms associated with conventional therapies, such as nausea, pain, or fatigue
China Medical University Hospital, Taiwan
Title: The nature reconstitued smile by facial rejuvenation with lipocontoured ubperiosteal midface and endoscpic forehead lifts in the oriental patients
Time : 14:25-14:45
Dr. Sophia Chia-Ning Chang is the Chief of the Department of Plastic Surgery, China Medical University Hospital, Taiwan. He was working for long time on the Functional and aesthetic approach to adult unoperated mobius syndrome, Orthognathic surgery followed by bilateral free gracilis muscle transfers.
Objective: The modified surgical techniques of the subperiosteal midface and endoscopic forehead lifts with
lipocontouring were presented with clinical outcome in 30 consecutive oriental patients.
Design: Prospective cohort of 30 consecutive adult female patients who underwent rejuventation procedures, but without accompanying upper eyelid surgery in a medical center. All patients underwent bilateral infracilliary and intraoral incisions for midface subperiosteal undermining with zygomatic major and minor muscles lifted and fixed to left lateral orbital rim. The endoscopic-assisted subperiosteal forehead lift was performed through three small scalp incisions, with bilateral lateral canthal ligments sutured and fixed to the skull bone. Lipocontouring was performed to surmount glabella, supraorbital rims, the cheeks and bilateral temporal hallowing. Objective and subjective criteria were recorded and photodocumented during the postoperative period at 1 week and 1, 3, 6 and 24 months. The erythema, tenderness, and pain were recorded with a visual analog scale.
Results: All 30 patients completed the 24-month postoperative follow-up. Twenty eight patients had significant improvements in their aesthetic outcome. The enigmatic smile was constituted because the oral angles were elevated to a natural position. The most common objective symptom of forehead and malar numbness diminished before postoperative 3 months. One patient had a deviation towards left when she pursed her mouth. There were no major complications of infection, extrusion, skin irregularities, or screws protrusion.
Conclusions: Our techniques help in effective forehead and midface lifts. Temporary numbness over the forehead and malar area can be expected during the early postoperative period
Muna S. Elburki is a Ph.D. student in the Dept. of Oral Biology and Pathology, Stony Brook Medicine, State University of New York at Stony Brook. She received her master's degree in Periodontics in 2004 from the University of Manchester, United Kingdom, and she has held a faculty position at the School of Dental Medicine (after receiving her DDS degree) in Benghazi, Libya. Her research focuses on "novel Chemically-Modified-Curcumins as MMP inhibitors: a potential therapeutic in diabetes associated connective tissue breakdown"
Objective: To determine the effect of a novel chemically-modified-curcumin (CMC 2.24, phenylaminocarbonylcurcumin)
on accelerated aging of collagen in skin of type I diabetic rats.
Methods: As described by us previously, adult male rats (n=10) rats were rendered type I diabetic by streptozotocin injection. Half were orally administered CMC 2.24 (30mg/kg, 1/day); the other diabetics (n=5) and the non-diabeticcontrols (n=5) were administered vehicle alone. After 3 weeks, all rats were sacrificed, skin dissected, weighed, thickness measured, and skin samples were extracted (4°C) to generate salt-soluble, acetic-acid-soluble, and insoluble fractions (hydrolysates of each were analyzed for hydroxyproline). Other samples were analyzed for the Matrix Metalloproteinases, MMP-2 & MMP-8, by gelatin zymography & western blot, respectively.
Results: As expected, diabetes reduced skin thickness (atrophy) associated with increased levels/activity of collagenolytic enzymes (MMP-2 & 8) and decreased levels of newly synthesized (salt-soluble, un-crosslinked) collagen. Oral administration of CMC 2.24, although it did not reduce the elevated blood glucose levels in the diabetics, did “normalize” the measures of collagen synthesis and degradation. There were no adverse effects associated with CMC 2.24 treatment.
Conclusions: CMC 2.24 appeared to reduce collagen-destructive-proteinases (MMP-2 & 8) and increase newly synthesized collagen in skin even in the presence of persistent hyperglycemia in diabetic rats, an animal model of accelerated connective tissue aging. The same compound is currently being tested, and showing evidence of efficacy, as a topical agent in skin lesions.
Qiao Li, Ph.D. is a Research Assistant Professor at the University of Michigan and has long been involved in research on tumor immunology and cancer immunotherapy. He has published extensively in preclinical studies and in clinical trials utilizing various immune strategies, such as T cells, B cells, and dendritic cells as well as targeting of cancer stem cells.
Background: So far, the majority of the stem cell studies have been confined to human tumors in immunosuppressed
hosts which are not suitable for immunologic evaluation.
Aim: To identify cancer stem cell (CSC)-enriched populations in a murine melanoma tumor in syngeneic immunocompetent host, and in human melanoma cells.
Methods: Isolation of stem cell-enriched populations from melanoma using ALDEFLUOR/ALDH as a marker.
Results: A very small percentage (<5%) of ALDEFLUOR+/ALDHhigh cells exist in D5 murine melanoma tumors. Sorted and as few as 500 ALDEFLUOR+/ALDHhigh cells could form tumors in the syngeneic hosts, while equal and much larger numbers of ALDEFLUOR-/ALDHlow cells could not. The stem cell nature of the ALDELFUOR+/ALDHhigh cells was confirmed by their ability to form spheres in culture and to self-renew in-vivo. More recently, we detected ALDEFLUOR+/ALDHhigh cells from two cell lines established from human melanoma. These ALDEFLUOR+/ALDHhigh cells formed tumor when injected into SCID mice. However, equal number of ALDEFLUOR-/ALDHlow cells did not, demonstrating significantly distinct tumorigenicity of the two populations. Conclusion: We have identified CSC-enriched populations in a syngeneic immunocompetent murine model (D5), as well as from two cell lines established from human melanoma. These allow us to evaluate CSC-induced antitumor immunity by selectively targeting melanoma cancer stem cells.
Stanford University, USA
Title: Conversion from tacrolimus/mycophenolic acid to tacrolimus/leflunomide to treat cutaneous warts in a series of four pediatric renal allograft recipients
Time : 15:45-16:05
Lieuko Nguyen completed her pediatric nephrology training at Stanford University in Palo, Alto, California and is currently a Paediatric Academic Multi-Organ Transplant Clinical Fellow at the Hospital for Sick Children in Toronto.
The challenge of immunosuppression in pediatric renal transplantation is to balance preventing rejection while avoiding infectious complications. A dermatological complication of immunosuppression is viral warts, which cause significant disfigurement and increase the risk of skin malignancy. We present three pediatric and adolescent renal allograft recipients with multiple, recalcitrant verrucae vulgares lesions and one patient with molluscum contagiosum who were switched from mycophenolate mofetil to leflunomide. Teriflunomide metabolite levels were carefully maintained between 50,000 and 100,000ng/mL to balance its immunosuppressive and antiviral properties. No adverse events requiring discontinuation of leflunomide were encountered. Switching from mycophenolate mofetil to leflunomide successfully cleared verruca vulgaris and molluscum lesions in all four renal transplant patients. The ability to minimize and even resolve warts can improve quality of life by reducing risk of skin malignancies and emotional distress in solid organ transplant patients. Leflunomide is a potential therapeutic option for post transplantation patients with skin warts because it serves both as an adjunct to the immunosuppressive regimen and an antiviral agent.
Federal University of Maranhao, Brazil
Time : 16:05-16:25
Dimitre Luz Felipe da Silva is a medical student at Federal University of Maranhao, Brazil. In june 2012, he received a scholarship from the Brazilian government through the program Science Without Borders, studying at Cal. State Fullerton during the summer, where he received the prize Dean’s list, and then, studying at Loyola University Chicago, where he is involved with the project “Psoriasis patient education study”. Back in Brazil, he is heading the project “Social impact caused in patients with acne”. He was president of the Dermatology League and received a scholarship for the project “Reconstructive Surgery in patients with skin cancer”.
Introduction: Basal Cell Carcinoma (BCC) is the less aggressive type of skin tumor. It consists of cells which resemble
epidermis basal cells, and metastases are described as exceptions. However, it can invade and destroy adjacent tissues,
including bones. It is the most common cutaneous malignancy, with 65% of the total. It usually occurs after 40 years old,
with sun exposure and fair skin as related factors, being rare in African-Americans. BCC is generally located on sunexposed
areas, like face (nose, ears and neck) and less commonly in trunk and extremities. The most frequent skin cancer
in blacks is Squamous Cell Carcinoma, followed by BCC. There are different histologic patterns in BCC and the main
characteristic is the presence of palisade basaloid cells masses arranged peripherally. The diagnosis is clinical and must be
confirmed histologically. The choice for therapeutic procedures depends on the location, size and depth of the lesion.
Case Reports: Case 1: A 53-years-old male, black, husbandman, presenting plaque lesion with pearly and pigmented edges on the nasal dorsum (Figure 1). Wide resection was made with safety margin, followed by reconstruction with a graft of frontal region (Figure 2). Case 2: A 57-years-old male, black, husbandman, presenting nodular-ulcerated lesion with pearly and pigmented edges on the right nasal ala (Figure 3). The resection with a wide safety margin was made, followed by reconstruction with graft of right genian region, bent at its end to reconstructing the inner portion of the nostril after two weeks (Figure 4). The diagnosis was confirmed through histopathology, which showed clear surgical margins
Discussion: Skin cancer affects mainly Caucasian people. It is rare in blacks, because the higher melanin content and dispersion pattern of melanosomes protect against the carcinogenic effects of sunlight. These cases are rare, but confirmed that ultraviolet radiation is an important risk factor for skin cancer, especially BCC. These two patients were over 40 years old; group most affected by skin cancer, and was submitted to prolonged sun exposure. Surgical resection was curative in both cases, since it was accomplished with good safety margin.
Coffee Break 16:25-16:40 @ Pine
17:30-18:30 Cocktails sponsored by Journal of Anaplastology @ Pine