Ultraviolet radiation (UVR) can have a beneficial biologic impact on skin, but it is also the most significant environmental risk factor for skin cancer development. Photocarcinogenesis comprises a complex interplay between the carcinogenic UVR, skin, and the immune system. UVB is absorbed by the superficial skin layers and is mainly responsible for direct DNA damage, which, if unrepaired, can lead to mutations in key cancer genes. UVA is less carcinogenic, penetrates deeper in the dermis, and mainly causes indirect oxidative damage to cellular DNA, proteins, and lipids, via photosensitized reactions. UVR not only induces mutagenesis, altering proliferation and differentiation of skin cells, but also has several immunosuppressive effects that compromise tumor immunosurveillance by impairing antigen presentation, inducing suppressive cells, and modulating the cytokine environment. This review focuses upon molecular and cellular effects of UVR, regarding its role in skin cancer development.

Phototherapy is a valuable therapeutic tool in Dermatology, but there may be drawbacks. Acute and long-term adverse effects, of variable severity, include skin erythema, xerosis, pruritus, blistering, altered pigmentation, photoaging, and photocarcinogenesis. Despite concerns over the carcinogenic potential of ultraviolet radiation, most studies have not found an increased risk of non-melanoma or melanoma skin cancer in patients treated with ultraviolet B (broadband and narrowband) and ultraviolet A1 phototherapy. These are therefore considered reasonably safe treatment modalities concerning the development of skin neoplasms, although caution and further investigation are warranted. Photoprotective measures, such as avoidance of concurrent sunlight exposure and covering skin areas not afflicted with disease, or more modern strategies, including phytochemical antioxidants and exogenous DNA repair enzymes, can minimize the hazards of phototherapy. Patients submitted to phototherapeutic regimens should undergo complete, careful dermatologic examination regularly and lifelong.

Our results highlight the relevance of testing men who have sex with men for Neisseria gonorrhoeae at extragenital sites, regardless of the existence of local complaints. The implementation of adequate screening programmes in Portugal should be considered. We also reinforce the need to raise awareness in the population regarding the adoption of prophylactic measures against transmission of sexually transmitted infections during anal and/or oral sexual exposure.

No abstract

The authors present the case of a woman in the seventh decade of life with medical history of: left nephrectomy for renal tuberculosis and non-Hodgkin’s lymphoma treated with chemotherapy (QT) and radiotherapy. She presented with a 2-month history of non-tender, left inguinal lymph node enlargement. Positron Emission Tomography (PET)—CT —scanshowed hypermetabolic inguinal and retroperitoneal lymphadenopathies, no primary tumour. On the second dermatological examination a pink, 2 cm plaque on the anterior left knee was noted. The histopathological analysis revealed Merkel cell carcinoma. The patient underwent two lines of systemic QT, with life-threatening toxicities limiting treatment. Followed overwhelming disease progression with lymphoedema and numerous skin metastases in the left lower limb. The patient received palliative care until death. The rare incidence of such neoplasia and its uncommon clinical presentation justifies reporting this case and highlights the importance of multidisciplinary teams in the management of cancer patients.

A woman in her 60s presented with a 1-year history of progressively numerous seborrheic keratoses and velvety, gray-brown plaques on the face, neck, axillae, and perineum, causing bothersome ptosis and ectropion (Figure). She also reported a sensation of dry mouth and palms, but denied constitutional, gastrointestinal, genitourinary, and respiratory symptoms. Dermatologic examination confirmed the diagnosis of acanthosis nigricans (AN) and was also remarkable for palmar discoloration with accentuated dermatoglyphs, consistent with "tripe palms." The patient had a known medical history of obesity, type 2 diabetes, hypertension and dyslipidemia, but her metabolic disorders alone could not explain such a florid clinical picture. As such, an occult neoplasm was suspected. A thorough laboratory, imaging, and endoscopic workup revealed an enlarged uterus with uterine masses. Further gynecologic examination revealed a 6-cm solid tumor of the cervix consistent with invasive endocervical adenocarcinoma which was confirmed by histopathologic analysis.Acanthosis nigricans is clinically characterized by symmetric, hyperpigmented, velvety or verrucous plaques in intertriginous areas. It is a cutaneous manifestation of internal disease, most often associated with benign conditions (80%), such as obesity, insulin resistance, and diabetes. Less frequently it represents a paraneoplastic dermatosis, called acanthosis nigricans maligna (ANM), which is in most cases associated with abdominal malignant tumors, especially adenocarcinomas, like gastric cancer. 1 This form of AN typically has a rapid onset and extensive skin involvement, and generally affects adults older than 40 years. It can be accompanied by other cutaneous paraneoplastic manifestations, including tripe palms, so called owing to the resemblance of velvety palmar skin to the stomach lining of ruminants, and the "sign of Leser-Trélat", corresponding to the abrupt appearance of multiple seborrheic keratoses. 1,2 Acanthosis nigricans maligna can present concurrently or following tumor detection, but may also precede the diagnosis and serve as an important clinical clue. 1 Its presence should therefore prompt a thorough workup for malignant abnormality, comprising physical examination and comprehensive complementary investigation, including endoscopic and/or imaging methods.Because ANM skin findings usually improve with treatment of the underlying tumor and worsen with disease recurrence or progression, dermatologic examination is crucial for follow-up. 3 This case is a reminder of how the recognition of particular skin findings can lead to the diagnosis of internal malignant tumors. 3 It also represents a rare clinical observation because, to our knowledge, only a few cases of ANM in association with gynecologic tumors-including ovarian, endometrial, and cervical cancershave been reported. [2][3][4]

No abstract

No abstract