Atypical fibroxanthoma is a controversial entity with a disputed histogenesis. It has recently been suggested that most atypical fibroxanthoma are actually variants of squamous cell carcinoma. We reviewed 100 purported cases of atypical fibroxanthoma received over 4 years to perform clinical follow up and immunohistochemical markers. In particular, we focused on the detection of any recurrence or metastasis. Ten cases were subsequently excluded on the basis of either incorrect coding, or insufficient or absent paraffin blocks on file. A further case was interpreted as a malignant fibrous histiocytoma. Additional new markers, such as CD10 and CD99, were employed in a proportion of cases. Our cases were typical of the usual clinical presentation of atypical fibroxanthoma on the skin of the sun-damaged elderly. We found no cases of recurrent or metastatic atypical fibroxanthoma. Two patients developed a second primary atypical fibroxanthoma. CD10 proved to be a useful marker for atypical fibroxanthoma when used on 20 cases in the present study, as was CD99 in seven cases. The only case demonstrating positive staining for keratin also stained for CD10. It had dual features of atypical fibroxanthoma and squamous cell carcinoma. However, as the majority of atypical fibroxanthoma had no adjacent solar keratosis, our data suggest it is unlikely that atypical fibroxanthoma is a variant of squamous cell carcinoma.

A large series of 211 Spitz nevi is reviewed. 30% of the lesions were from patients 20 years of age and over. The trunk and lower extremity were most commonly involved. There were no significant histologic differences between cases from adults and children. Features which may help in differentiating atypical Spitz nevi from malignant melanoma include the presence of some nevus cell maturity at the base, an absence of atypical mitoses, no significant upward epidermal spread and the nuclear chromatin pattern.

The etiology of Crohn's disease is still unknown. The most likely hypotesis is the alteration of the intestinal immune system with abnormal response to environmental factors and/or intrinsic factors in genetically predisposed individuals, with tissue destruction, chronic inflammation and fibrosis. There are many factors that could contribute to the onset of the disease, modulate clinical manifestations and influence the occurence of complications also post-operative: cigarette smoking is often associated with a more aggressive disease. The pathophysiological mechanism of this association is not yet clear. Crohn's disease is difficult to cure and even on the basis of this evidence, the therapeutic approach to patient can not be other than multidisciplinary. The most common complications of Crohn's disease are represented by stenosis, fistulas and abscesses that generally need a surgical therapy, despite drug treatment, newly with biological drugs have proved effective. Neoplastic degeneration is a terrible and feared complication in the long term. Although there is a substantial evidence that patients with ulcerative colitis are at increased risk of developing colorectal cancer, the prevalence of cancer in patients with Crohn's disease is also not so well defined even if it's now accepted that the risk of colorectal cancer is equivalent in both conditions. From a review of the literature it can be assumed that the number of cancer cases of large and small intestine associated with inflammatory bowel disease has increased both in patients with ulcerative colitis as well as in patients with Crohn's disease. The rectum, interested only in a small percentage of cases by Crohn's disease, does not seem to be subject to this consideration. Beside it the risk of developing extraintestinal tumors and lymphomas in patients with Crohn's disease appears to have increased in relation to the general population, but, at present, evidences to establish secure real causal link between these disorders are still lacking. The role of immunosuppressive therapies, often carried out on patients with Crohn's disease, also remains unclear. Cancer is often preceded by dysplasia in both patients with ulcerative colitis and in patients with Crohn's disease affection. Young patients who have severe Crohn's disease of long standing, with extensive colonic involvement may benefit from endoscopic surveillance for cancer, especially those affecting the large intestine. We're waiting for good screening methods more sensitive, less invasive and less costly in terms of economic cost and discomfort for the patient. An attitude of alertness may be stated as good: the onset of new symptoms in a patient with up till now stable disease should always be investigated.

Spontaneous regression of some cutaneous tumours is well recognized, and is thought to result from an immunological response to the tumour. Regression has previously been noted in basal cell carcinomas, but no studies defining the role of the immune response in the regression of this malignancy have been performed. We have examined 45 primary basal cell carcinomas (BCCs) (20 nodular, 25 superficial) and identified the cellular phenotypes and activation states of the cells infiltrating primary regressing and non-regressing BCCs, by immunocytochemistry. We have found a significantly increased number of CD3+ and CD4+ T cells infiltrating regressing compared with non-regressing tumours, and the expression of interleukin-2 receptor (an early activation marker for T cells) was also increased. There were no significant differences in class II major histocompatibility complex (MHC), CD1, or macrophage antigen expression in these groups. These findings suggest that activated CD4+ cytokine-secreting cells are important in the regression of BCCs.

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Because it is not possible to monitor skin cancer accurately using routine methods, special surveys have been undertaken in Nambour, a typical subtropical community in Queensland, Australia. Estimates of incidence reported here are based on skin cancers medically treated between 1985 and 1992 and new cases diagnosed by dermatologists in two examination clinics in 1986 and 1992. Among men and women aged 18-69 years in 1986, age-adjusted incidence rates of basal cell carcinoma were 2,074 and 1,579 per 100,000 per year, respectively-the highest incidence rates of a specific cancer ever reported. Squamous cell carcinoma occurred at half the rate of basal cell carcinoma among men and at about one third the rate among women. Although as expected, fair skin, a history of repeated sunburns, and nonmalignant solar skin damage diagnosed by dermatologists were strongly associated with both types of skin cancer, outdoor occupation was not. Significant self-selection was observed among outdoor workers, whereby people with fair or medium complexions and a tendency to sunburn were systematically underrepresented among those in long-term outdoor occupations although they accounted for more than 80 percent of the community study sample. The mitigating effect of this selection bias may partly explain the paradox of the lack of quantitative evidence of a causal link between sun exposure and skin cancer in humans.

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