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Marsidi N, Ottevanger R, Demir YE, van Beugen S, Goeman JJ, Genders RE. Patient-reported outcome measurements in facial skin surgery and a comparison between Mohs micrographic surgery and conventional excisions. J Eur Acad Dermatol Venereol 2024. [PMID: 38644735 DOI: 10.1111/jdv.20025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/28/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Knowledge of the psychosocial impact of facial skin surgery on patients can help improve counselling strategies. OBJECTIVES The objective was to measure the psychological impact of facial skin cancer surgery on patients over a 1-year period. Secondary objective was to measure the difference between Mohs micrographic surgery (MMS) and conventional excision (CE) on these parameters. METHODS This observational survey study was conducted between March 2019 and July 2020. Patients who had facial skin surgery using MMS or CE were selected. Five surveys were conducted on four timepoints (preoperative, 1 week, 3 months and 1 year post-operative) measuring the quality of life, perceived stigmatization, body image, satisfaction with facial appearance and psychosocial distress. RESULTS A total of 228 patients (MMS 154 patients, CE 74 patients) were included for the analysis. Scores for quality of life did not significantly change, in the year after surgery (PCS-12 mean 50.5, SD 9.3 and MCS-12 50.6, SD 9.4); however, stigmatization (F (3, 235,39) 7,26, p < 0.01, d = -0.07), body image concerns (F (3, 198,28) = 3.75, p < 0.01, d = -0.14), satisfaction with facial appearance (F (3, 205,18) = 10.74, p < 0.01, d = 0.43) and psychosocial distress (F (3, 208,69) = 9.26, p < 0.01, d = -0.15) did change over time. The use of MMS or CE did not significantly affect outcome scores after 1 year. CONCLUSION Patients receiving facial skin cancer surgery exhibited low scores for perceived stigmatization and body image concerns. Their quality of life was not statistically influenced by facial surgery, and their satisfaction with their facial appearance and psychosocial distress even improved after 1 year. The results suggest that the surgical treatment type (MMS or CE) does not influence the outcome. The overall results can help in counselling strategies to improve expectations for patients receiving facial surgery.
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Affiliation(s)
- N Marsidi
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Dermatology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - R Ottevanger
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y E Demir
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - S van Beugen
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - J J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Dermatology, Roosevelt Kliniek, Leiden, The Netherlands
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2
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Eggermont C, Nené LEH, Koekelkoren FHJ, van der Toorn YR, Snetselaar LD, Kroah-Hartman M, Genders RE, Kelleners-Smeets NWJ, Hollestein LM, van Kester MS, Wakkee M. The impact of routine ultrasonography on nodal metastasis in head and neck cutaneous squamous cell carcinoma: A retrospective multicentre cohort study. J Eur Acad Dermatol Venereol 2023; 37:e1136-e1140. [PMID: 37114343 DOI: 10.1111/jdv.19150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Affiliation(s)
- C Eggermont
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - L E H Nené
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F H J Koekelkoren
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Y R van der Toorn
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - L D Snetselaar
- Department of Dermatology, Comprehensive Cancer Center, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Kroah-Hartman
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - N W J Kelleners-Smeets
- Department of Dermatology, Comprehensive Cancer Center, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L M Hollestein
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - M S van Kester
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - M Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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3
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de Jong E, Quint KD, El Ghalbzouri A, Verdijk RM, Goeman JJ, Heidt S, Claas FHJ, de Fijter JW, Genders RE, Vermeer MH, Bouwes Bavinck JN. HLA expression as a risk factor for metastases of cutaneous squamous-cell carcinoma in organ- transplant recipients. Hum Immunol 2023; 84:208-213. [PMID: 36621381 DOI: 10.1016/j.humimm.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Solid organ-transplant recipients (SOTR) have an increased risk of cutaneous squamous-cell carcinoma (cSCC), metastasis and death from cSCC. In immunocompetent patients with mucosal SCC, downregulation of HLA class I is associated with poor prognosis. Since the degree of HLA expression on tumor cells could play a role in immunogenicity and pathophysiology of cSCC metastasis, we hypothesized that decreased HLA expression is associated with an increased risk of metastasis. METHODS We compared HLA expression between primary metastasized cSCCs, their metastases, and non-metastasized cSCCs from the same patients. Samples were stained for HLA-A, HLA-B/-C and quantified by calculating the difference in immunoreactivity score (IRS) of the primary cSCC compared with all non-metastasized cSCCs. RESULTS The mean IRS score for HLA-B/C expression was 2.07 point higher in metastasized compared to non-metastasized cSCCs (p = 0.065, 95 % CI -0.18-4.32). 83.3 % of the primary metastasized cSCCs had an IRS score of 4 or higher, compared to 42.9 % in non-metastasized cSCCs. Moderately to poorly differentiated cSCCs had more HLA class I expression compared to well-differentiated cSCCs. CONCLUSION Contrary to immunocompetent patients, HLA-B/C expression tends to be upregulated in metastasized cSCC compared to non-metastasized cSCC in SOTR, suggesting that different tumor escape mechanisms play a role in SOTR compared to immunocompetent patients.
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Affiliation(s)
- Estella de Jong
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Abdoelwaheb El Ghalbzouri
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Robert M Verdijk
- Department of Pathology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Pathology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Sebastiaan Heidt
- Department of Immunology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Frans H J Claas
- Department of Immunology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Johan W de Fijter
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Roel E Genders
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Jan Nico Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
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4
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Marsidi N, Ottevanger R, Bouwes Bavinck JN, Krekel-Taminiau NMA, Goeman JJ, Genders RE. Risk factors for incomplete excision of cutaneous squamous cell carcinoma: a large cohort study. J Eur Acad Dermatol Venereol 2022; 36:1229-1234. [PMID: 35342992 PMCID: PMC9545629 DOI: 10.1111/jdv.18101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
Background The standard treatment for cutaneous squamous cell carcinoma (cSCC) is surgical excision. Failure to radically remove a cSCC is a risk for recurrence, progression and metastasis. Objectives This study investigates several risk factors for incomplete excision of cSCC. Methods All consecutive patients in a single institution treated with wide local excision for primary cSCC over a 10‐year period were included in this study. Risk factors such as: gender, age, immunosuppression, tumour size, location, differentiation grade, tumour depth, perineural and lymphovascular invasion (PNI and LVI) were extracted from the database. Univariable and (if applicable) multivariable logistic regression analysis were used to identify risk factors (P < 0.05). Generalized estimating equations (GEEs) were used for multiple tumours within the same patients. Results A total of 566 patients with 1159 cSCC were identified. Univariable and multivariable logistic regression analysis showed that depth beyond the dermis (OR: 5.7 95% CI: 3.1–10.5) was the only risk factor for incomplete excision of cSCC. Immunosuppression was only a risk factor in the deep plane (OR: 2.5, 95% CI: 1.3–4.6). Conclusion Tumour depth beyond the dermis is the most important risk factor for incomplete excision of cSCC. Immunosuppression is a risk factor in the deep plane but its relevance is uncertain. Immunosuppression is not consistently included in the current cSCC staging systems, but care should be taken when treating these patients.
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Affiliation(s)
- N Marsidi
- Department of dermatology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of dermatology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - R Ottevanger
- Department of dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J N Bouwes Bavinck
- Department of dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - N M A Krekel-Taminiau
- Department of plastic surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Department of plastic surgery, Alrijne hospital, Leiden, The Netherlands
| | - J J Goeman
- Department of biomedical data sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - R E Genders
- Department of dermatology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of dermatology, Roosevelt Clinic, Leiden, The Netherlands
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5
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Scheepens KMJ, Marsidi N, Genders RE, Horeman-Franse T. The Compressiometer: Toward a New Skin Tensiometer for Research and Surgical Planning. IEEE J Transl Eng Health Med 2022; 10:2500109. [PMID: 34938614 PMCID: PMC8682962 DOI: 10.1109/jtehm.2021.3133485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/15/2021] [Accepted: 12/03/2021] [Indexed: 12/01/2022]
Abstract
After surgery, around 35% of patients experience problems of excessive scarring, causing disfiguring and impaired function. An incision placed in the wrong direction causes unnecessary skin tension on the wound, resulting in increased collagen disposition and potentially hypertrophic scars. Currently, skin tension lines are used for incision planning. However, these lines are not universal and are a static representation of the skin tension that is in fact under influence of muscle action. By designing a new skin force measurement device the authors intend to make research on dynamic skin characteristics possible and to objectify incision planning and excision closure planning. The device applies a known compressive force to the skin in standardized directions and measures the displacement of the skin. This allows users to measure the skin reaction force in response to compression and to determine the optimal incision line or best wound closure direction. The device has an accuracy of 96% and a sensitivity of < 0.01 mm. It is compact, works non-invasively and standardizes measurement directions and is therefore an improvement over previously designed skin tensiometers.
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Affiliation(s)
- Karlijn M J Scheepens
- MechanicalMaritime and Materials Engineering DepartmentTU Delft Delft 2628 CD The Netherlands
- Leiden University Medical Centre 2333 ZA Leiden The Netherlands
| | - Nick Marsidi
- Leiden University Medical Centre 2333 ZA Leiden The Netherlands
- Ziekenhuisgroep Twente 7555 DL Hengelo The Netherlands
| | - Roel E Genders
- Leiden University Medical Centre 2333 ZA Leiden The Netherlands
| | - Tim Horeman-Franse
- Sustainable Surgery and Translational Technology, MechanicalMaritime and Materials Engineering DepartmentTU Delft 2628 CN Delft The Netherlands
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6
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de Jong E, Lammerts MUPA, Genders RE, Bouwes Bavinck JN. Update of advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2021; 36 Suppl 1:6-10. [PMID: 34855246 PMCID: PMC9299882 DOI: 10.1111/jdv.17728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022]
Abstract
The incidence of cutaneous squamous cell carcinoma (cSCC) is rapidly increasing. A growing part of this patient group is formed by immunocompromised patients, for example organ-transplant recipients (OTR). Although over 90% of the cSCC show a relatively harmless clinical behaviour, there is also a chance of developing advanced cSCC and metastases. Locally advanced cSCC are defined as cSCC that have locally advanced progression and are no longer amenable to surgery or radiation therapy. Better understanding of the clinical behaviour of cSCC is essential to discriminate between low- and high-risk cSCC. Staging systems are important and have recently been improved. Genetic characterisation of SCC will likely become an important tool to help distinguish low and high-risk cSCC with an increased potential to metastasise in the near future. Available treatments for high-risk and advanced cSCC include surgery, radiotherapy, chemotherapy and targeted therapy with epidermal growth factor receptors inhibitors. Anti-PD-1 antibodies show promising results with response rates of up to 50% in both locally advanced and metastatic cSCC but, in its present form, is not suitable for OTR.
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Affiliation(s)
- E de Jong
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M U P A Lammerts
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
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7
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Massey PR, Schmults CD, Li SJ, Arron ST, Asgari MM, Bavinck JNB, Billingsley E, Blalock TW, Blasdale K, Carroll BT, Carucci JA, Chong AH, Christensen SR, Chung CL, DeSimone JA, Ducroux E, Escutia-Muñoz B, Ferrándiz-Pulido C, Fox MC, Genders RE, Geusau A, Gjersvik P, Hanlon AM, Harken EBO, Hofbauer GF, Hopkins RS, Leitenberger JJ, Loss MJ, Del Marmol V, Mascaró JM, Myers SA, Nguyen BT, Oliveira WRP, Otley CC, Proby CM, Rácz E, Ruiz-Salas V, Samie FH, Seçkin D, Shah SN, Shin TM, Shumack SP, Soon SL, Stasko T, Zavattaro E, Zeitouni NC, Zwald FO, Harwood CA, Jambusaria-Pahlajani A. Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement. JAMA Dermatol 2021; 157:1219-1226. [PMID: 34468690 PMCID: PMC9937447 DOI: 10.1001/jamadermatol.2021.3180] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.
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Affiliation(s)
- Paul R. Massey
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D. Schmults
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah T. Arron
- Sarah Arron MD, A Professional Corporation, San Mateo, California
| | - Maryam M. Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston,Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | | | | | - Travis W. Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Katie Blasdale
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Bryan T. Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - John A. Carucci
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Alvin H. Chong
- Skin Health Institute, Victoria, Australia,Department of Medicine (Dermatology), St Vincent’s Hospital Clinical School, The University of Melbourne, Victoria, Australia
| | - Sean R. Christensen
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Christina Lee Chung
- Montgomery Dermatology, King of Prussia, Pennsylvania,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | - Emilie Ducroux
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | | | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matthew C. Fox
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin
| | - Roel E. Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Petter Gjersvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Allison M. Hanlon
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee
| | | | | | - R. Samuel Hopkins
- Department of Dermatology, Oregon Health and Science University, Portland
| | | | - Manisha J. Loss
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Veronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - José M. Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sarah A. Myers
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Bichchau T. Nguyen
- Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts,Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Walmar R. P. Oliveira
- Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clark C. Otley
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Charlotte M. Proby
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Emőke Rácz
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Veronica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Faramarz H. Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Deniz Seçkin
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Syed N. Shah
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Thuzar M. Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | - Seaver L. Soon
- Scripps Green Hospital, Private Practice (The Skin Clinic MD), San Diego, California
| | - Thomas Stasko
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Elisa Zavattaro
- Dermatology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Nathalie C. Zeitouni
- Medical Dermatology Specialists, Phoenix, Arizona,Division of Dermatology, University of Arizona College of Medicine, Phoenix
| | - Fiona O’Reilly Zwald
- Piedmont Healthcare, Atlanta, Georgia,O’Reilly Comprehensive Dermatology Inc, Atlanta, Georgia,Mount Vernon Medical Center, Atlanta, Georgia
| | - Catherine A. Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, United Kingdom,The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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8
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Leeman A, de Cuba EMV, Jaspars LH, Quint KD, Genders RE. A Low-Grade Trichoblastic Carcinoma Treated with Mohs Micrographic Surgery. Case Rep Dermatol 2021; 13:129-133. [PMID: 33790756 PMCID: PMC7989768 DOI: 10.1159/000512871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/07/2020] [Indexed: 11/19/2022] Open
Abstract
Trichoblastomas are rare dermal neoplasms usually found on the scalp and face. Histology shows a proliferation of small basaloid cells arranged in cords or fields surrounded by cellular stroma. Trichoblastomas are usually not aggressive, but trichoblastic carcinomas arising from preexisting trichoblastomas have been described and have been linked to basal cell carcinoma. We found a tumor with features of trichoblastoma with presence of Merkel cells, but with a deeply infiltrative growth pattern into the fat and muscle tissue, without significant architectural or cellular atypia. Tumors with similar growth patterns were previously described as deeply invasive trichoblastic neoplasms. It appears to be a new entity that has been described before but has not been fully characterized: low-grade trichoblastic carcinoma. This malignancy seems to show only locally aggressive growth. Radical excision was accomplished with Mohs micrographic surgery.
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Affiliation(s)
- Annemiek Leeman
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lies H Jaspars
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Dermatology, Roosevelt Clinic, Leiden, The Netherlands
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9
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Marsidi N, Vermeulen SAM, Horeman T, Genders RE. Measuring Forces in Suture Techniques for Wound Closure. J Surg Res 2020; 255:135-143. [PMID: 32543379 DOI: 10.1016/j.jss.2020.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/27/2020] [Accepted: 05/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The use of sutures remains the first choice for wound closure. However, incorrect use of a suture technique can lead to impaired healing. Many techniques are described for high-tension wounds, but not much is known about their mechanical properties. Complications of excessive tension include dehiscence, infection, and ischemic necrosis and could be prevented. This study aimed to compare forces in five techniques (single, horizontal mattress, vertical mattress, pulley, and modified pulley suture) in a standardized wound tension model. MATERIALS AND METHODS A standardized neoprene wound model was developed on the ForceTRAP system (MediShield B.V., Delft, The Netherlands) to mimic a 5 Newton (N) wound. Five different suture techniques were each repeated 10 times by a student, resident dermatology, and dermsurgeon. The pulling force of the suture's first throw was measured with the Hook-in-Force sensor (Technical University Delft, The Netherlands). Changes in wound tension were measured by the ForceTRAP system. The ForceTRAP is a platform measuring forces from 0 to 20 N in three dimensions with an accuracy of 0.1 N. The Hook-in-Force is a force sensor measuring 0-15 N with an accuracy of 0.5 N. Maximum and mean forces were calculated for each suture technique and operator. RESULTS Mean maximum pulling force: 5.69 N (standard deviation [SD], 0.88) single, 7.25 N (SD, 1.33) vertical mattress, 8.11 N (SD, 1.00) horizontal mattress, 3.46 N (SD, 0.61) pulley, and 4.52 N (SD, 0.67) modified pulley suture. The mean force increase on the skin (substitute) ranged between 0.80 N (pulley) and 0.96 N (vertical mattress). CONCLUSIONS The pulley suture requires less pulling force compared with other techniques. The mechanical properties of sutures should be taken in consideration when choosing a technique to close wounds.
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Affiliation(s)
- Nick Marsidi
- Department of Dermatology, Leiden University Medical Center, Leiden, ZA, the Netherlands.
| | - Sofieke A M Vermeulen
- Department of Dermatology, Leiden University Medical Center, Leiden, ZA, the Netherlands
| | - Tim Horeman
- Department of Biomechanical Engineering, Technical University Delft, Delft, the Netherlands
| | - Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, ZA, the Netherlands
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10
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Nguyen AL, Cleven AHG, Genders RE. Multiple pleomorphic dermal sarcomas with metastases in an immunosuppressed patient. Dermatol Ther 2020; 33:e13441. [PMID: 32307811 DOI: 10.1111/dth.13441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Anh Ly Nguyen
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjen H G Cleven
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Ottevanger R, Weijns ME, Genders RE. A novel simple biopsy-site identification tool. J Am Acad Dermatol 2020; 84:e73-e74. [PMID: 32222453 DOI: 10.1016/j.jaad.2020.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Rosanne Ottevanger
- Department of Dermatology, Leiden University Medical Centre, Leiden, Netherlands.
| | - Marieke E Weijns
- Department of Dermatology, Leiden University Medical Centre, Leiden, Netherlands
| | - Roel E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, Netherlands; Department of Dermatology, Roosevelt Clinic, Leiden, Netherlands
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12
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Genders RE, Marsidi N, Michi M, Henny EP, Goeman JJ, van Kester MS. Incomplete Excision of Cutaneous Squamous Cell Carcinoma; Systematic Review of the Literature. Acta Derm Venereol 2020; 100:adv00084. [PMID: 32128598 PMCID: PMC9128936 DOI: 10.2340/00015555-3441] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The treatment of choice for cutaneous squamous cell carcinoma is complete surgical excision. Incomplete excision of cutaneous squamous cell carcinoma has an increased risk of local recurrence, deep subclinical progression, and metastasis. This study aimed to investigate the proportion and risk factors of incomplete excised cutaneous squamous cell carcinoma. A systematic review of the literature was performed. Incomplete excision rates for cutaneous squamous cell carcinoma ranged from 0.4% to 35.7%. The pooled incomplete excision risk estimate was 13% (95% confidence interval 9-17%). Risk factors noted in more than one study for incomplete excision included tumor depth and size, type of operator, head and neck localization, and former incomplete excision. We found an overall incomplete excision rate of 13% for cutaneous squamous cell carcinoma. Risk factors should be taken into account in the management of cutaneous squamous cell carcinoma surgical treatment.
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Affiliation(s)
- Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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13
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Ottevanger R, Weijns ME, Genders RE. Intranasal hemostatic pressure technique. J Am Acad Dermatol 2019; 84:e233-e234. [PMID: 31809824 DOI: 10.1016/j.jaad.2019.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Rosanne Ottevanger
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Marieke E Weijns
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Roel E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Dermatology, Roosevelt Clinic, Leiden, The Netherlands
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14
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Lanz J, Bouwes Bavinck JN, Westhuis M, Quint KD, Harwood CA, Nasir S, Van-de-Velde V, Proby CM, Ferrándiz C, Genders RE, Del Marmol V, Forchetti G, Hafner J, Vital DG, Hofbauer GFL. Aggressive Squamous Cell Carcinoma in Organ Transplant Recipients. JAMA Dermatol 2019; 155:66-71. [PMID: 30516812 DOI: 10.1001/jamadermatol.2018.4406] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Squamous cell carcinoma (SCC) is the most frequent malignant neoplasm found in solid organ transplant recipients and is associated with a more aggressive disease course and higher risk of metastasis and death than in the general population. Objectives To report the clinicopathologic features of and identify factors associated with aggressive SCC in solid organ transplant recipients. Methods This retrospective multicentric case series included 51 patients who underwent solid organ transplantation and were found to have aggressive SCC, defined by nodal or distant metastasis or death by local progression of primary SCC. Standard questionnaires were completed by the researchers between July 18, 2005, and January 1, 2015. Data were analyzed between February 22, 2016, and July 12, 2016. Results Of the 51 participants, 43 were men and 8 were women, with a median age of 51 years (range, 19-71 years) at time of transplantation and 62 years (range, 36-77 years) at time of diagnosis of aggressive SCC. The distribution of aggressive SCC was preferentially on the face (34 [67%]) and scalp (6 [12%]), followed by the upper extremities (6 [12%]). A total of 21 tumors (41%) were poorly differentiated, with a median tumor diameter of 18.0 mm (range, 4.0-64.0 mm) and median tumor depth of 6.2 mm (range, 1.0-20.0 mm). Perineural invasion was present in 20 patients (39%), while 23 (45%) showed a local recurrence. The 5-year overall survival rate was 23%, while 5-year disease-specific survival was 30.5%. Conclusions and Relevance Results of this case series suggest that anatomical site, differentiation, tumor diameter, tumor depth, and perineural invasion are important risk factors in aggressive SCC in solid organ transplant recipients.
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Affiliation(s)
- Joana Lanz
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Marlies Westhuis
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen D Quint
- Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Shaaira Nasir
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Vanessa Van-de-Velde
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, London, United Kingdom.,London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charlotte M Proby
- Division of Cancer Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Carlos Ferrándiz
- Department of Dermatology, Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roel E Genders
- Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - Véronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Forchetti
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jürg Hafner
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Domenic G Vital
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
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15
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Affiliation(s)
- Nick Marsidi
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Roel E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Dermatology, Roosevelt Clinic, Leiden
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16
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Genders RE, Weijns ME, Dekkers OM, Plasmeijer EI. Metastasis of cutaneous squamous cell carcinoma in organ transplant recipients and the immunocompetent population: is there a difference? a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2019; 33:828-841. [PMID: 30793804 DOI: 10.1111/jdv.15396] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/14/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Organ transplant recipients (OTR) have a higher risk of developing cutaneous squamous cell carcinoma (cSCC) compared to the immunocompetent population. Immunosuppression is often stated as a risk factor for metastasis. However, evidence for this is scarce. OBJECTIVES To investigate the cSCC metastasis risk in OTR and the immunocompetent population by systematically reviewing the literature. METHODS A systematic review of the literature was performed up to January 2018 using: Medline; Embase; Web of Science and ISI Science Citation Index. Studies assessing cSCC metastasis risk in ORT or immunocompetent cohorts were considered. A pooled risk estimate for metastasis was calculated for the immunocompetent population and OTR separately. RESULTS The pooled metastasis risk estimate for OTR was, respectively, 7.3% (95% CI 6.2-8.4) for cSCC on total body, and 11.0% (95% CI 7.7-14.8) for cSCC of the head neck area. For the immunocompetent population reported risk estimate analysis showed a pooled metastatic risk of 3.1% (95% CI 2.8-3.4) in total body cSCC and of 8.5% (95% CI 7.3-9.8) in cSCC of the head and neck area. Pooled risk estimate per single cSCC in OTR was 1.3% (95% CI 1.0-1.7) in total body cSCC and 4.0% (95% CI 2.7-5.5) in cSCC of the head and neck area. In the immunocompetent population, these pooled risk estimates were, respectively, 2.4% (95% CI 2.1-2.6) and 6.7% (95% CI 5.7-7.8). CONCLUSIONS Organ transplant recipients show a higher overall risk of cSCC metastasis compared to the immunocompetent population. Metastasis risks per single cSCC were substantially lower in both groups. However, due to heterogeneity and differences between studies, comparisons are difficult. Comprehensive follow-up studies with defined cohorts are necessary to adequately asses the risk for cSCC metastasis.
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Affiliation(s)
- R E Genders
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - M E Weijns
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - O M Dekkers
- Department of clinical epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - E I Plasmeijer
- Department of dermatology, Leiden University Medical Centre, Leiden, the Netherlands
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17
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van Loenen D, Genders RE. Use of surgical scrub sponge for auricular dressing. J Am Acad Dermatol 2018; 82:e9-e10. [PMID: 30590073 DOI: 10.1016/j.jaad.2018.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/01/2018] [Accepted: 12/18/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Daphne van Loenen
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Dermatology, Roosevelt Kliniek, Leiden, The Netherlands
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18
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Genders RE, Osinga JAJ, Tromp EE, O'Rourke P, Bouwes Bavinck JN, Plasmeijer EI. Metastasis Risk of Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients and Immunocompetent Patients. Acta Derm Venereol 2018; 98:551-555. [PMID: 29405246 DOI: 10.2340/00015555-2901] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Organ transplant recipients (OTRs) have a high incidence of cutaneous squamous cell carcinoma (cSCC), and immunosuppression has been reported to be an important risk factor for metastasis. The aim of this study was to identify the metastasis risk over a 10-year period for 593 patients with cSCC, of whom 134 were OTR and 459 were immunocompetent. Metastasis incidence rate was 1,046 (95% confidence interval (95% CI) 524-2,096) per 100,000 person years in OTR and 656 (95% CI; 388-1,107) in immunocompetent patients, yielding an incidence rate ratio of 1.6 (95% CI 0.67-3.81). In OTRs head/neck location, older age at transplantation and older age at diagnosis of first cSCC were associated with metastatic risk, and 7 out of 8 metastasized tumours were smaller than 2 cm. In immunocompetent patients tumour size and tumour depth were associated with metastasis. In conclusion, we were not able to demonstrate an increased incidence rate of metastasis in OTRs compared with immunocompetent patients. However, OTRs and immunocompetent patients differed with regard to risk factors for metastasis.
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Affiliation(s)
- Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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19
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Bouwes Bavinck JN, Feltkamp MCW, Green AC, Fiocco M, Euvrard S, Harwood CA, Nasir S, Thomson J, Proby CM, Naldi L, Diphoorn JCD, Venturuzzo A, Tessari G, Nindl I, Sampogna F, Abeni D, Neale RE, Goeman JJ, Quint KD, Halk AB, Sneek C, Genders RE, de Koning MNC, Quint WGV, Wieland U, Weissenborn S, Waterboer T, Pawlita M, Pfister H. Human papillomavirus and posttransplantation cutaneous squamous cell carcinoma: A multicenter, prospective cohort study. Am J Transplant 2018; 18:1220-1230. [PMID: 29024374 PMCID: PMC5947129 DOI: 10.1111/ajt.14537] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/20/2017] [Accepted: 10/03/2017] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients (OTRs) have a 100-fold increased risk of cutaneous squamous cell carcinoma (cSCC). We prospectively evaluated the association between β genus human papillomaviruses (βPV) and keratinocyte carcinoma in OTRs. Two OTR cohorts without cSCC were assembled: cohort 1 was transplanted in 2003-2006 (n = 274) and cohort 2 was transplanted in 1986-2002 (n = 352). Participants were followed until death or cessation of follow-up in 2016. βPV infection was assessed in eyebrow hair by using polymerase chain reaction-based methods. βPV IgG seroresponses were determined with multiplex serology. A competing risk model with delayed entry was used to estimate cumulative incidence of histologically proven cSCC and the effect of βPV by using a multivariable Cox regression model. Results are reported as adjusted hazard ratios (HRs). OTRs with 5 or more different βPV types in eyebrow hair had 1.7 times the risk of cSCC vs OTRs with 0 to 4 different types (HR 1.7, 95% confidence interval 1.1-2.6). A similar risk was seen with high βPV loads (HR 1.8, 95% confidence interval 1.2-2.8). No significant associations were seen between serum antibodies and cSCC or between βPV and basal cell carcinoma. The diversity and load of βPV types in eyebrow hair are associated with cSCC risk in OTRs, providing evidence that βPV is associated with cSCC carcinogenesis and may present a target for future preventive strategies.
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Affiliation(s)
| | - Mariet C. W. Feltkamp
- Department of Medical MicrobiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Adele C. Green
- QIMR Berghofer Medical Research InstituteBrisbaneAustralia
| | - Marta Fiocco
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenThe Netherlands,Institute of MathematicsLeiden UniversityLeidenThe Netherlands
| | - Sylvie Euvrard
- Department of DermatologyEdouard Herriot HospitalHospices Civils de LyonLyonFrance
| | - Catherine A. Harwood
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonUK
| | - Shaaira Nasir
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonUK
| | - Jason Thomson
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonUK
| | - Charlotte M. Proby
- Division of Cancer ResearchUniversity of DundeeNinewells Hospital and Medical SchoolDundeeUK
| | - Luigi Naldi
- Department of DermatologyAzienda Ospedaliera papa Giovanni XXIII, and GISED Study CenterBergamoItaly
| | - Janouk C. D. Diphoorn
- Department of DermatologyAzienda Ospedaliera papa Giovanni XXIII, and GISED Study CenterBergamoItaly
| | - Anna Venturuzzo
- Department of DermatologyAzienda Ospedaliera papa Giovanni XXIII, and GISED Study CenterBergamoItaly
| | - Gianpaolo Tessari
- Department of MedicineSection of DermatologyUniversity of Veronac/o Ospedale Civile MaggioreVeronaItaly
| | - Ingo Nindl
- Department of DermatologyUniversity Hospital CharitéSkin Cancer Center CharitéBerlinGermany
| | | | | | | | - Jelle J. Goeman
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenThe Netherlands
| | - Koen D. Quint
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - Anne B. Halk
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - Carmen Sneek
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - Roel E. Genders
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | | | | | - Ulrike Wieland
- Institute of VirologyUniversity of CologneCologneGermany
| | | | - Tim Waterboer
- German Cancer Research Center (DKFZ)HeidelbergGermany
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20
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Genders RE, van Kester MS. Novel uses of bilateral advancement flaps for tip defects on the nose: Part II. J Am Acad Dermatol 2017; 78:e93-e94. [PMID: 28989108 DOI: 10.1016/j.jaad.2017.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Dermatology, Roosevelt Clinic, Leiden, The Netherlands
| | - Marloes S van Kester
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
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21
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van der Kolk T, Dillingh MR, Rijneveld R, Klaassen ES, de Koning MNC, Kouwenhoven STP, Genders RE, Bouwes Bavinck JN, Feiss G, Rissmann R, Burggraaf J. Topical ionic contra-viral therapy comprised of digoxin and furosemide as a potential novel treatment approach for common warts. J Eur Acad Dermatol Venereol 2017; 31:2088-2090. [PMID: 28833595 PMCID: PMC5763383 DOI: 10.1111/jdv.14527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
Background DNA viruses such as HPV rely on K+ influx for replication. Both digoxin and furosemide inhibit the K+ influx by interacting with cell membrane ion co‐transporters (Na+/K+‐ATPase and Na+‐K+‐2Cl− co‐transporter‐1, respectively). We therefore hypothesized that these two compounds in a topical formulation may be valuable in the treatment of HPV‐induced warts. This new approach is called Ionic Contra‐Viral Therapy (ICVT). Objective To evaluate systemic exposure, safety and tolerability of ICVT with a combination of furosemide and digoxin after repeated topical application in subjects with common warts. Furthermore, we aimed to evaluate pharmacodynamics effects of ICVT. Methods Twelve healthy subjects with at least four common warts on their hands were included in the study and treated with a fixed dose of 980 mg topical gel containing 0.125% (w/w) digoxin and 0.125% (w/w) furosemide for 7 consecutive days on their lower back to assess safety and systemic exposure. Two warts were treated with 10 mg each and two served as negative controls to obtain preliminary evidence of treatment effect. Results ICVT was well tolerated topically, and there was no evidence of systemic exposure of digoxin or furosemide. There were no clinical relevant safety findings and no serious adverse events (SAEs). A rapid and statistically significant reduction in diameter, height and volume of the warts was already observed at day 14. Conclusion ICVT was found to be safe for administration to humans and 7 days of active treatment showed a statistical significant wart reduction compared to untreated control lesions, clearly indicating pharmacological activity.
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Affiliation(s)
| | - M R Dillingh
- Centre for Human Drug Research, Leiden, The Netherlands
| | - R Rijneveld
- Centre for Human Drug Research, Leiden, The Netherlands
| | - E S Klaassen
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | - S T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G Feiss
- Cutanea Life Science, Wayne, PA, USA
| | - R Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands
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22
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Kouwenhoven STP, van Kester MS, Genders RE. The wingman flap: Bilateral closure of a supra-tip defect of the nose. J Am Acad Dermatol 2017; 76:e57-e58. [PMID: 28089014 DOI: 10.1016/j.jaad.2016.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/01/2016] [Accepted: 08/19/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Stijn T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Dermatology, Roosevelt Clinic, Leiden, The Netherlands
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23
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Genders RE, Beck S, Bouwes Bavinck JN, van den Munckhof HAM, Kouwenhoven STP, de Koning MNC, de Gruijl FR, Jenkins D, Willemze R, Quint KD. p16 immunostaining in keratinocytic neoplasia in organ transplant recipients: Bowen's disease shows a characteristic pattern. J Cutan Pathol 2016; 44:28-33. [PMID: 27717097 DOI: 10.1111/cup.12840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/30/2016] [Accepted: 09/30/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND For selecting therapy, it is important to distinguish different types of keratinocytic neoplasia. It is sometimes difficult to make histopathologic diagnosis, especially in organ transplant recipients (OTR) who develop numerous lesions. METHODS To investigate p16 immunostaining in different types of keratinocytic neoplasia in OTR, we studied 59 actinic keratoses (AK), 51 Bowen' s disease (BD), 63 squamous cell carcinomas (SCC), 16 benign keratotic lesions (BKL) from 31 OTR patients and 25 controls (eczema and psoriasis). Tissue sections were stained for H&E and p16. We scored intensity, proportion and distribution of p16 positive lesional cells. RESULTS In 19% of AK, 92% of BD, 35% of SCC and 12% of BKL more than 15% of lesional cells were p16-positive. In 16% of AK, 80% of BD, 18% of SCC and 13% of BKL strong p16 staining was observed. BKL, AK and SCC showed focal and patchy staining, BD showed diffuse pattern with strong staining of all atypical cells. Sparing of the basal layer was predominantly seen in BD. No control specimen showed p16-overexpression. CONCLUSIONS p16 immunostaining shows a characteristic pattern in BD, but not in AK, SCC and BKL. It appears useful in recognizing BD, but not in differentiating between other keratinocytic neoplasia.
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Affiliation(s)
- Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | - Samuel Beck
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | | | | | - Stijn T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Frank R de Gruijl
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - David Jenkins
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
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Abstract
The current case report describes a 35-year-old man who presented with unilateral scrotal angiomas. The presence of unilateral scrotal angiomas was associated with an underlying varicocele on the ipsilateral side due to increased venous pressure. In case of unilateral scrotal angiomas further examination for underlying pathology is necessary.
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Affiliation(s)
- Elise E Tromp
- a 1 Department of Dermatology Leiden University Medical Centre , Leiden, The Netherlands.,b 2 Alrijne Hospital , Leiden, The Netherlands
| | - Stijn T P Kouwenhoven
- a 1 Department of Dermatology Leiden University Medical Centre , Leiden, The Netherlands
| | - Koen D Quint
- a 1 Department of Dermatology Leiden University Medical Centre , Leiden, The Netherlands.,c 3 DDL Diagnostic Laboratory , Rijswijk, The Netherlands
| | | | - Roel E Genders
- a 1 Department of Dermatology Leiden University Medical Centre , Leiden, The Netherlands.,d 4 Roosevelt Clinics , Leiden, The Netherlands
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Quint KD, Genders RE, de Koning MNC, Borgogna C, Gariglio M, Bouwes Bavinck JN, Doorbar J, Feltkamp MC. Human Beta-papillomavirus infection and keratinocyte carcinomas. J Pathol 2015; 235:342-54. [PMID: 25131163 DOI: 10.1002/path.4425] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/04/2014] [Accepted: 08/11/2014] [Indexed: 12/15/2022]
Abstract
Although the role of oncogenic human Alpha-papillomaviruses (HPVs) in the development of mucosal carcinomas at different body sites (eg cervix, anus, oropharynx) is fully recognized, a role for HPV in keratinocyte carcinomas (KCs; basal and squamous cell carcinomas) of the skin is not yet clear. KCs are the most common cancers in Caucasians, with the major risk factor being ultraviolet (UV) light exposure. A possible role for Beta-HPV types (BetaPV) in the development of KC was suggested several decades ago, supported by a number of epidemiological studies. Our current review summarizes the recent molecular and histopathological evidence in support of a causal association between BetaPV and the development of KC, and outlines the suspected synergistic effect of viral gene expression with UV radiation and immune suppression. Further insights into the molecular pathways and protein interactions used by BetaPV and the host cell is likely to extend our understanding of the role of BetaPV in KC.
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Affiliation(s)
- Koen D Quint
- Department of Dermatology, Leiden University Medical Centre, The Netherlands; DDL Diagnostic Laboratory, Rijswijk, The Netherlands
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Bouwes Bavinck JN, Harwood CA, Genders RE, Wisgerhof HC, Plasmeijer EI, Mitchell L, Olasz EB, Mosel DD, Pokorney MS, Serra AL, Feldmeyer L, Baumann Conzett K, Piaserico S, Belloni Fortina A, Jahn K, Geusau A, Gerritsen MJP, Seckin D, Gulec AT, Cetkovska P, Ricar J, Imko-Walczuk B, Proby CM, Hofbauer GFL. Pain identifies squamous cell carcinoma in organ transplant recipients: the SCOPE-ITSCC PAIN study. Am J Transplant 2014; 14:668-76. [PMID: 24730051 DOI: 10.1111/ajt.12587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients (OTR) are at high risk for cutaneous squamous cell carcinomas (SCC). We aimed to define clinically meaningful patient-reported warning signals predicting the presence of invasive SCC.Patient-reported signs and symptoms of 812 consecutively biopsied skin lesions from 410 OTR were determined by questionnaire and physical examination and related to the subsequent biopsy-proven diagnoses. Receiver-operating characteristic (ROC) curve analyses were used as a measure of distinction between the predictive values of patient-reported warning signals and the occurrence of SCC. Pain was an independent predictive patient-reported warning signal for a biopsy-proven invasive SCC. The odds ratio from the fully adjusted model predicting SCC was 4.4(95% confidence interval: 2.4–8.2). Higher scores on the visual analog scale (VAS) for pain were associated witha greater likelihood for the presence of SCC compared to none or mild pain. The for scores on the VAS from 1to 3, 4 to 6 and 7 to 10 were 4.9 (2.2–10.5), 2.3 (0.96–5.5)and 16.5 (3.6–75.8), respectively. Pain is the most powerful patient-reported warning signal for invasive cutaneous SCC in OTR. Empowerment of patients by education could accelerate diagnosis and treatment of cutaneous SCC.
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Houtman CJK, Genders RE, von dem Borne PA, Vermeer MH. [Skin disorders associated with monoclonal gammopathies]. Ned Tijdschr Geneeskd 2014; 158:A6717. [PMID: 24780569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A monoclonal gammopathy is a condition in which a monoclonal immunoglobulin (M-protein, formerly known as paraprotein) produced by a clonal proliferation of plasma cells is present in the blood. The spectrum of monoclonal gammopathies includes monoclonal gammopathy of uncertain significance (MGUS), multiple myeloma, Waldenström disease, plasmacytoma and primary amyloidosis. Various skin diseases are associated with monoclonal gammopathies. These are often rare skin diseases which are not easily recognised. This association is important to be known, in order to screen these patients for M-proteins and if necessary refer them to a haematologist. We present a 62-year-old male with cryoglobulinaemia and MGUS, a 64-year-old male with lichen myxoedematosus and MGUS and a 74-year-old male with necrobiotic xanthogranuloma and probably MGUS.
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Genders RE, Spitaels D, Jansen CL, van den Akker TW, Quint KD. A misleading urethral smear with polymorphonuclear leucocytes and intracellular diplococci; case report of urethritis caused by Neisseria meningitidis. J Med Microbiol 2013; 62:1905-1906. [PMID: 24000224 DOI: 10.1099/jmm.0.059378-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The primary pathogens found in men with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Rapid diagnosis of N. gonorrhoeae infection can be made based on a Gram- or methylene blue-stained urethral smear. We describe a case of a man with purulent penile discharge, in which microscopic examination led to the presumptive diagnosis of gonorrhoea. A nucleic acid amplification test was negative for N. gonorrhoeae but positive for C. trachomatis. Culture showed Gram-negative diplococci which were identified as Neisseria meningitidis. N. meningitidis can be sporadically pathogenic in the genito-urinary tract and mimicks gonococcal urethritis, and appears identical by microscopy. When a gonococcal urethritis is suspected based on clinical signs and microscopic examination, but investigatory tests cannot confirm the diagnosis, a N. meningitidis infection should be considered.
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Affiliation(s)
- R E Genders
- Department of Dermatology, Roosevelt Clinic, Leiden, The Netherlands.,Municipal Health Services of The Hague, Sexually Transmitted Disease Clinic, The Hague, The Netherlands.,Department of Dermatology, LUMC, Leiden, The Netherlands
| | - D Spitaels
- Municipal Health Services of The Hague, Sexually Transmitted Disease Clinic, The Hague, The Netherlands
| | - C L Jansen
- Department of Medical Microbiology, Medical Center Haaglanden Westeinde Hospital, The Hague, The Netherlands
| | - Th W van den Akker
- Department of Dermatology, Medical Center Haaglanden Westeinde Hospital, The Hague, The Netherlands
| | - K D Quint
- Department of Dermatology, LUMC, Leiden, The Netherlands
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Genders RE, Quint KD, van Leeuwen RL. [A woman with a "bruise" on the face]. Ned Tijdschr Geneeskd 2013; 157:A5456. [PMID: 23343735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 95-year-old woman presented with a progressive purple blue asymptomatic tumorous plaque on her forehead, extending as a macula to the upper face, possibly arisen after a fall. Histology showed atypical epitheloid cells with vascular-lumen formation. The patient was diagnosed with cutaneous angiosarcoma. She was treated palliatively with radiotherapy.
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Affiliation(s)
- Roel E Genders
- Leids Universitair Medisch Centrum, afd. Dermatologie, Leiden, the Netherlands.
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Quint KD, Genders RE, Vermeer MH. A Delayed Granulomatous Reaction to a Cosmetic Tattoo of the Eyebrows: A Report of Total Regression After Intralesional Corticosteroid Injections. Dermatol Surg 2012; 38:951-3. [DOI: 10.1111/j.1524-4725.2012.02360.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 12/10/2011] [Accepted: 12/12/2011] [Indexed: 12/01/2022]
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Genders RE, Kouwenberg PP, Bleichrodt RP. Abdominal wall repair with human acellular dermal autograft. Surg Tech Dev 2011. [DOI: 10.4081/std.2012.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Repair of abdominal wall defects in the presence of contamination or infection is a significant problem. The loss of tissue warrants enforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive surgery. This paper presents a review of available literature of placement of an acellular human dermis to repair an abdominal fascia defect, in contaminated as well as in non-contaminated surgical fields. It is illustrated with a case report that describes the successful reconstruction of an infected abdominal wall defect with a human acellular dermis allograft. A systematic literature review was undertaken with searches performed in the Pubmed and Cochrane databases for the period up till March 2009, using the search terms Alloderm [Substance Name], Hernia [Mesh] and the key words acellular dermis, acellular dermal matrix, human acellular dermal allograft and abdominal wall defect. To assess methodological quality, each article was subjected to a modification of the methodological index for non-randomized studies (MINORS) according to Slim et al. Two items from the original index were not included because none of the studies selected had an unbiased assessment of the study end points and in none of the studies was a prospective calculation of the study size performed. Seventeen studies were included in the review. Data were extracted regarding study design, number of patients, surgical technique, followup period, contaminated or non-contaminated area of the fascia defect, mortality and morbidity (hemorrhage, seroma, wound dehiscence, infection) of the operative procedure, the longterm results (removal of the graft, reherniation and bulging) and level of evidencey. A total of 169 short-term complications and 151 longterm complications occurred after 643 surgical procedures reconstructing both contaminated and clean abdominal wall defects by implantation of an HADA. Human acellular dermal allograft seems to be a good alternative for autologous repair of contaminated or infected abdominal wall defects.
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Affiliation(s)
- Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands.
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Affiliation(s)
- Roel E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands.
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