The exact incidence of cutaneous squamous cell carcinoma (CSCC) or nonmelanoma skin cancer is unknown, and it is believed that the rate of occurrence is increasing with the growing elderly population and sun exposure, and it is more prevalent in males than in females. In this article, we describe the case of an 81-year-old woman who presented with a lesion on the right upper eyebrow. The patient had been consulting a dermatologist and undergoing treatment for three months. However, the lesion did not show any signs of improvement, and the dermatologist speculated that it might be a common wound that was healing slowly because of her diabetes. Imaging revealed an ulcerating skin lesion on the right upper eyebrow without connection to the deeper structures. Surgical intervention was chosen with the patient\'s consent. This rare case of CSCC on a woman\'s eyebrow showed that skin cancer can occur in unusual locations and in people without risk factors.

We present a case of a 49-year-old man with a giant basal cell carcinoma of the back, with metastases in the lungs, liver, mediastinum and both adrenal glands. Neoadjuvant vismodegib was administered, after which wide local resection of the tumour was performed. There have been no signs of local recurrence.

BACKGROUND: Renal transplantation is the most common organ transplantation procedure in Indonesia. Renal transplant recipients (RTRs) were found to carry 3-to-5-time higher risk of cancer compared to the normal population. Around 40% of cancers in RTR patients were non-melanoma skin cancer (NMSC). It was found to be correlated with several risk factors. The study aimed to determine the prognostic factors for NMSC in RTRs with Indonesian skin colors.
METHODS: The article search was conducted on three different journal databases, which were Cochrane, PubMed, and Embase. Relevant articles were appraised using critical appraisal guidelines from The Centre for Evidence-Based Medicine (CEBM), University of Oxford.
RESULTS: Four articles were selected for appraisal. Incidence of NMSC on RTRs in these studies were 25,2% (CI 24,67%-32,47%), 6,67% (CI 2,87%-10,47%), 23,67% (CI 19,38%-27,96%) and 28,57% (CI 24,67%-32,47%). Prognostic factors correlated with the incidence of NMSC on RTRs were age, sun exposure, history of sunburn, existing chronic actinic lesion, lentigo solaris, precancerous lesion including actinic keratoses, and consumption of cyclosporine and tacrolimus during maintenance therapy.
CONCLUSIONS: Combination of age, environmental factors, sun exposure-related skin lesion, and immunosuppressant therapy are the main prognostic factors of NMSC on RTRs.

The development and approval of ruxolitinib, the first JAK1/2 inhibitor indicated to treat myelofibrosis, has improved patient outcomes, with higher spleen and symptoms responses, improved quality of life, and overall survival. Despite this, several unmet needs remain, including the absence of resistance criteria, suboptimal response, the timing of allogeneic transplant, and the management of patients in case of intolerance. Here, we report the results of the second survey led by the \"MPN Lab\" collaboration, which aimed to report physicians\' perspectives on these topics. As in our first survey, physicians were selected throughout Italy, and we included those with extensive experience in treating myeloproliferative neoplasms and those with less experience representing clinical practice in the real world. The results presented here, summarized using descriptive analyses, highlight the need for a clear definition of response to ruxolitinib as well as recommendations to guide the management of ruxolitinib under specific conditions including anemia, thrombocytopenia, infections, and non-melanoma skin cancers.

UNASSIGNED: The recent addition of immunotherapy as a treatment modality to surgery and radiation has vastly improved disease control for patients with keratinocyte-derived carcinomas (KCs) that are incurable with local therapies alone. With the advent of immune checkpoint inhibitors (ICPis) in non-melanoma skin cancers comes diagnostic and therapeutic challenges when considering treatment strategies for patients presenting with clinical perineural invasion (cPNI) of locally advanced KC of the head and neck.
UNASSIGNED: We report four cases that convey the diagnostic and therapeutic complexity of managing patients with neuropathic symptoms from cutaneous neurotropic carcinomas of the head and neck. We also discuss an updated review regarding immunotherapies and perineural invasion within KC management.
UNASSIGNED: Patients presenting with symptoms suspicious for cPNI warrant an expanded diagnostic evaluation to correlate neurological findings with neurotropic spread of disease. While nerve biopsies can be precarious in sensitive areas, a history of skin cancer and clinical presentation suggestive of neurotropism may be enough to pursue timely management in the form of surgery, radiation, and/or systemic therapy given each patient\'s individual priorities, comorbidities, and prognosis. When adding ICPi as a treatment modality for patients with disease not amenable to local therapies, the potential for immune-related adverse events must be considered. A multi-disciplinary review and approach to the management of patients with KC and cPNI is essential for obtaining optimal patient outcomes.

Psoriasis is a systemic inflammatory cutaneous disease that affects approximately 2% of the world\'s population. Systemic treatments and biologic treatment therapies are a powerful option for patients with moderate to severe psoriasis. Some studies from the literature indicate an overall small, but increased, risk of neoplasia in patients with psoriasis treated with phototherapy or systemic medication. The relationship between psoriasis and malignancy is not very well established; there are few studies with conflicting results. We present the case of a 31-year-old male patient, diagnosed with psoriasis, who was deemed eligible for systemic therapy. Treatment with methotrexate was initiated, but without a satisfactory outcome. Given the patient\'s resistant disease involving 15% of his body surface, his desire to have a clear skin, besides his being naïve to biologic therapy, he was proposed to start treatment with secukinumab 300 mg monthly. The patient experienced complete clearance of lesions and was followed-up on the basis of clinical and biological parameters. There are limited data concerning the relationship between melanocytic lesions, psoriasis and melanoma. Immunologic pathways implicated in psoriasis induce a reduction in the number of melanocytic nevi. Nevertheless, little is known concerning the association of melanocytic nevi with psoriasis. Thorough skin examination, meaning clinical and dermoscopic evaluation of melanocytic lesions, must be encouraged in patients treated with systemic therapies such as biologic agents.

BACKGROUND: Locally advanced basal cell cancer is a rare and challenging clinical problem. Historically, these patients were treated with aggressive surgery or radiotherapy. Most sporadic basal cell carcinomas have somatic mutations in the hedgehog pathway. Oral hedgehog inhibitors induce rapid and often complete clinical responses in locally advanced basal cell tumors. Unfortunately, these responses are usually transient. We hypothesized that treatment failure represents persistence of drug resistant cells that could be eradicated by addition of localized radiotherapy.
METHODS: We performed a retrospective review of our patients with locally advanced basal cell cancer treated with sonidegib or vismodegib induction therapy who were treated with added superficial radiotherapy at the time of maximal response.
RESULTS: Twelve patients met inclusion criteria. All patients achieved a complete response following hedgehog inhibitor therapy with addition of radiotherapy. Progression-free survival at 40 months was 89%, with a median follow-up of 40 months. Relapses occurred in only 2 of 12 patients (16.6%). Nine patients experienced grade I-II toxicity from hedgehog inhibitor induction therapy (taste changes [3], weight loss [3], muscle cramps [3]). Eight patients experienced mild radiotherapy-induced skin toxicity during concurrent therapy. No patients had to discontinue treatment.
CONCLUSIONS: Induction therapy with hedgehog inhibitors followed by addition of concurrent radiation therapy resulted in an extremely high clinical response rate with relatively minor and reversible toxicity. This gave a high rate of progression-free survival and a low disease-specific progression rate. Further prospective evaluation of this treatment approach is needed to confirm the apparent clinical activity.
CONCLUSIONS: Locally advanced basal cell cancers are challenging to treat. Previously, aggressive surgical resection or radiotherapy represented the best treatment options. Most basal cell cancers have somatic mutations in the hedgehog pathway. Oral inhibitors of this pathway produce rapid but transient clinical responses. This study reports 12 patients treated with hedgehog inhibitor induction therapy to near-maximal response. Addition of concurrent involved field radiotherapy resulted in a very high complete response rate with minimal toxicity. There was prolonged progression-free survival in 90% of patients. This study identified a novel treatment approach for patients with advanced basal cell carcinoma.

We present the case of a 60-year-old man with unresectable cutaneous squamous cell carcinoma (cSCC) of the sternal area, which was not amenable to radiation therapy. The treatment history of this patient is remarkable as the disease had progressed through all lines of conventional therapy established in the literature. We decided to initiate treatment with epidermal growth factor receptor (EGFR) inhibitor cetuximab and we reassessed the patient after 12 weeks with a whole-body CT scan, documenting stability in the size and radiologic features of the disease. Cetuximab, like all current treatments for advanced cSCC, is administered off-label and proved effective in preventing further progression of disease in our patient.

BACKGROUND: Sun exposure is critical for vitamin D synthesis and is a major risk factor for the development of non-melanoma skin cancer (NMSC). NMSC is the most common type of cancer in Brazil and coexists with a very high prevalence of vitamin D deficiency.
OBJECTIVE: The present study aimed to assess serum 25-hydroxyvitamin D (25[OH]D) concentration in patients with a recent diagnosis of NMSC.
METHODS: The serum 25(OH)D concentration of patients with a histological diagnosis of NMSC, made between September 2016 and September 2017, was measured by chemiluminescence up to 60 days after diagnosis and compared to healthy individuals without NMSC matched by age, sex, BMI, and skin phototype.
RESULTS: Forty-one patients with NMSC and 200 healthy controls were evaluated. Most of the patients were men (56.1%) and most had basal cell carcinoma (90.2%). Patients were 67 years old on average (21-87 years) with skin Phototype 2 or 3 (80.6%). Mean serum 25(OH)D concentration in NMSC patients was significantly higher than in healthy controls (p < 0.001). Most of the patients with NMSC (65.9%) had vitamin D deficiency (25[OH]D <30 ng/mL). No association was identified between histological type, time from diagnosis, or a previous history of skin neoplasm and 25(OH)D measurements.
CONCLUSIONS: Patients with recently diagnosed NMSC had significantly higher serum levels of 25(OH)D when compared to healthy controls. On the other hand, most of the NMSC patients were still considered to have vitamin D insufficiency.

The reconstruction of complex wounds in patients with comorbidities in the lower extremities is a challenging problem for surgeons. Skin grafting is frequently used to cover large skin defects, but it has several limits, including unwanted outcomes resulting from scars, poor elasticity and limitations in joint movement due to contractures. Locoregional flaps, particularly in the lower limbs, have limited application due to the size of the defect. Tissue engineering of the skin has offered major improvements in the coverage of large defects. Dermal matrix can be applied in order to generate a new dermis that allows good re-epithelialisation or skin grafting at a later stage. The reconstruction of large lower limb defects is more complicated in the case of chronic wounds showing no tendency to heal due to chronic infection. For all surgeons, it is very important to prevent the formation of a biofilm or manage it when it is already established before undertaking surgical procedures that involve a dermal matrix. We report our reconstruction strategy of chronic infected neoplastic ulcers of the lower extremities with a dermal matrix and our postoperative dressing protocol.