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Diagnostics
Special Issues
Diagnosis, Treatment and Prognosis of Melanocytic and Non-melanocytic Skin Cancers
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Diagnosis, Treatment and Prognosis of Melanocytic and Non-melanocytic Skin Cancers

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 May 2024) | Viewed by 11507

Special Issue Editor

Prof. Dr. Ovidiu Simion Cotoi

E-Mail Website
Guest Editor
1. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mures, 540139 Targu Mures, Romania
2. Pathology Department, Mures Clinical County Hospital, 540142 Targu Mures, Romania
Interests: dermatopathology; melanoma; tumor markers; immunohistochemistry; molecular pathology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Melanoma and non-melanocytic cancers are hot topics in the skin pathology field. Melanoma is one of the most aggressive tumors known and it is becoming more common, affecting people at increasingly younger ages.

Non-melanocytic cancers cover tumors such as basal cell carcinoma, squamous cell carcinoma and basosquamos carcinomas. These cancers present an increased incidence and are the most common skin tumors diagnosed in practice, frequently affecting elderly patients.

Both types of cancers are characterised by the presence of malignant neoplastic cells in the epidermis, dermis and subcutaneous tissue. While basal cell carcinoma does not present risks for metastasis, melanoma and squamous cell carcinoma can disseminate. SCC metastasis is rare, but this type of tumor is locally aggressive and patients diagnosed with melanoma present a high risk of metastasis and mortality. Patients with melanoma metastases have an average survival period of about 8 months from the moment of the appearance of secondary determinations, statistics which demand constant updates regarding the therapeutic options of these individuals.

The aim of this Special Issue is to describe the current state of research on melanocytic and non-melanocytic cancers. The information will include the current diagnostic options, new methods required for analyzing the histologic aspect of the tumors, new prognostic markers that can help to develop new therapies, pathophysiological mechanisms and current principles of treatment. Contributions with original research articles, reviews and case report series are welcome.

Prof. Dr. Ovidiu Simion Cotoi
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • melanoma
  • non-melanocytic
  • pathophysiology
  • management
  • skin cancer
  • treatment
  • immunohistochemistry
  • targeted therapy
  • surgery

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Published Papers (5 papers)

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14 pages, 753 KiB  
Article
Clinical Implications of Metabolic Syndrome in Psoriasis Management
by Maria-Lorena Mustata, Carmen-Daniela Neagoe, Mihaela Ionescu, Maria-Cristina Predoi, Ana-Maria Mitran and Simona-Laura Ianosi
Diagnostics 2024, 14(16), 1774; https://doi.org/10.3390/diagnostics14161774 - 14 Aug 2024
Viewed by 670
Abstract
Psoriasis is an increasingly common chronic immune-mediated skin disease recognized for its systemic effects that extend beyond the skin and include various cardiovascular diseases, neurological diseases, type 2 diabetes, and metabolic syndrome. This study aimed to explore the complex relationship between psoriasis and [...] Read more.
Psoriasis is an increasingly common chronic immune-mediated skin disease recognized for its systemic effects that extend beyond the skin and include various cardiovascular diseases, neurological diseases, type 2 diabetes, and metabolic syndrome. This study aimed to explore the complex relationship between psoriasis and metabolic syndrome by analyzing clinical, biochemical, and immunological parameters in patients with psoriasis alone and in patients combining psoriasis and metabolic syndrome. A total of 150 patients were enrolled, 76 with psoriasis only (PSO) and 74 with psoriasis and metabolic syndrome (PSO–MS). Data collected included anthropometric measurements, blood tests, and inflammatory markers. Statistical analysis was performed using the independent t-test, Mann–Whitney U test, Kruskal–Wallis test, and chi-square test to compare the two groups. Patients in the PSO–MS group had a significantly higher body weight, abdominal circumference, BMI, and inflammatory markers compared to patients with PSO. In addition, increased levels of IL-17A, cholesterol, triglycerides, and glucose were observed in the PSO–MS group. This study highlights the increased metabolic risk and exacerbated systemic inflammation associated with the coexistence of psoriasis and metabolic syndrome. These findings demonstrate the need for a comprehensive therapeutic approach and early intervention to manage metabolic complications in patients with psoriasis and metabolic syndrome. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Melanocytic and Non-melanocytic Skin Cancers)
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Figure 1

Figure 1
<p>Distribution of patients according to the therapy type and study group.</p> Full article ">Figure 2
<p>Distribution of patients according to the therapy type and gender.</p> Full article ">
22 pages, 2039 KiB  
Article
Can Artificial Intelligence “Hold” a Dermoscope?—The Evaluation of an Artificial Intelligence Chatbot to Translate the Dermoscopic Language
by Emmanouil Karampinis, Olga Toli, Konstantina-Eirini Georgopoulou, Elli Kampra, Christina Spyridonidou, Angeliki-Victoria Roussaki Schulze and Efterpi Zafiriou
Diagnostics 2024, 14(11), 1165; https://doi.org/10.3390/diagnostics14111165 - 31 May 2024
Cited by 6 | Viewed by 937
Abstract
This survey represents the first endeavor to assess the clarity of the dermoscopic language by a chatbot, unveiling insights into the interplay between dermatologists and AI systems within the complexity of the dermoscopic language. Given the complex, descriptive, and metaphorical aspects of the [...] Read more.
This survey represents the first endeavor to assess the clarity of the dermoscopic language by a chatbot, unveiling insights into the interplay between dermatologists and AI systems within the complexity of the dermoscopic language. Given the complex, descriptive, and metaphorical aspects of the dermoscopic language, subjective interpretations often emerge. The survey evaluated the completeness and diagnostic efficacy of chatbot-generated reports, focusing on their role in facilitating accurate diagnoses and educational opportunities for novice dermatologists. A total of 30 participants were presented with hypothetical dermoscopic descriptions of skin lesions, including dermoscopic descriptions of skin cancers such as BCC, SCC, and melanoma, skin cancer mimickers such as actinic and seborrheic keratosis, dermatofibroma, and atypical nevus, and inflammatory dermatosis such as psoriasis and alopecia areata. Each description was accompanied by specific clinical information, and the participants were tasked with assessing the differential diagnosis list generated by the AI chatbot in its initial response. In each scenario, the chatbot generated an extensive list of potential differential diagnoses, exhibiting lower performance in cases of SCC and inflammatory dermatoses, albeit without statistical significance, suggesting that the participants were equally satisfied with the responses provided. Scores decreased notably when practical descriptions of dermoscopic signs were provided. Answers to BCC scenario scores in the diagnosis category (2.9 ± 0.4) were higher than those with SCC (2.6 ± 0.66, p = 0.005) and inflammatory dermatoses (2.6 ± 0.67, p = 0). Similarly, in the teaching tool usefulness category, BCC-based chatbot differential diagnosis received higher scores (2.9 ± 0.4) compared to SCC (2.6 ± 0.67, p = 0.001) and inflammatory dermatoses (2.4 ± 0.81, p = 0). The abovementioned results underscore dermatologists’ familiarity with BCC dermoscopic images while highlighting the challenges associated with interpreting rigorous dermoscopic images. Moreover, by incorporating patient characteristics such as age, phototype, or immune state, the differential diagnosis list in each case was customized to include lesion types appropriate for each category, illustrating the AI’s flexibility in evaluating diagnoses and highlighting its value as a resource for dermatologists. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Melanocytic and Non-melanocytic Skin Cancers)
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Figure 1

Figure 1
<p>(<b>A</b>) Dermoscopy of a BCC lesion including arborizing vessels, ulceration, shiny white-red structureless areas, and short white streaks (example used in <a href="#diagnostics-14-01165-t001" class="html-table">Table 1</a>). (<b>B</b>) Dermoscopy image of seborrheic keratosis with fissures and ridges giving cerebriform appearance (example used in questions regarding dermoscopic features of benign lesions). (<b>C</b>) Peripheral delicate pigment network and central white patch in case of dermatofibroma (used as a question to the chatbot). (<b>D</b>) Dermoscopy image of psoriasis lesion with distributed dotted vessels in a reddish pink background and white scale. (<b>E</b>) Yellow and black dots and at least one broken hair in a case of alopecia areata (example posed to the chatbot in the category of inflammatory dermatoses). (<b>F</b>) Dermoscopy image indicating an atypical nevus with an atypical pigment network, asymmetry in structure or color, brown dots, and irregular dots and globules. This image was posed as a scenario to the chatbot, and the differential diagnosis was assessed.</p> Full article ">Figure 2
<p>Pie charts showing the percentage of participants who agreed, neither agreed nor disagreed, and disagreed regarding the completeness of the chatbot’s differential diagnosis based on the dermoscopic description for each category of skin lesions.</p> Full article ">Figure 3
<p>Pie charts illustrating the proportions of participants who agreed, neither agreed nor disagreed, and disagreed regarding the “helpful to diagnosis” category of the chatbot’s differential diagnosis based on the dermoscopic description for each skin lesion.</p> Full article ">Figure 4
<p>Pie charts showing the proportions of participants who agreed, neither agreed nor disagreed, and disagreed regarding how useful the chatbot’s differential diagnosis teaching tool can be based on the dermoscopic description for each skin lesion.</p> Full article ">
12 pages, 2576 KiB  
Article
Sun-Exposed versus Sun-Protected Cutaneous Basal Cell Carcinoma: Clinico-Pathological Profile and p16 Immunostaining
by Abdulkarim Hasan, Ahmad M. Kandil, Hasan S. Al-Ghamdi, Mohammad A. Alghamdi, Mohamed Nasr, Suhaib Alsayed Naeem, Wagih M. Abd-Elhay, Osama Khalil E. Mohamed, Hany Sabry A. Ibrahim, Eman Mohamed Ahmed, Ahmed Elsayed M. Abdrabo and Shimaa Abdelraouf Elgohary
Diagnostics 2023, 13(7), 1271; https://doi.org/10.3390/diagnostics13071271 - 28 Mar 2023
Cited by 6 | Viewed by 2195
Abstract
Introduction: Although widespread, BCC is still relatively poorly understood in regards to pathogenesis and prognosis, particularly the lesions formed on anatomical sites away from sun exposure. With the aim of deepening our understanding of the pathogenesis and clinico-pathological correlations of BCCs, we conducted [...] Read more.
Introduction: Although widespread, BCC is still relatively poorly understood in regards to pathogenesis and prognosis, particularly the lesions formed on anatomical sites away from sun exposure. With the aim of deepening our understanding of the pathogenesis and clinico-pathological correlations of BCCs, we conducted this study. Methods: Tissue blocks and data of 52 Egyptian patients diagnosed with BCC were retrieved for clinical information and inclusion criteria, then re-examined histologically; p16 immunostaining was carried out and evaluated for analysis and comparison between the two groups, i.e., sun-exposed and sun-protected. Results: Sex, age, clinical suspicion, tumor size, recurrence status, and histologic variants did not show a significant difference between the sun-protected and sun-exposed groups; however, the mean ages recorded were 67.2 vs. 62.7 for the sun-protected and sun-exposed groups, respectively. A total of 52% of BCCs were positive for p16. The sun-protected lesions showed p16 positivity in 61% of cases, whereas 49% of the sun-exposed lesions were positive with no significant difference. There was a significant difference in p16 expression between the recurrent and non-recurrent lesions. Conclusions: A significant difference was seen in the case of cancer recurrence, where all the recurrent BCCs in this study demonstrated negative p16 immunostaining of the primary lesions; however, the positively stained cases in total were 52% of BCCs. The mean patient age of the sun-protected group was much higher than in previous peer studies. We assume that the biological, prognostic, and clinical aspects of p16 protein expression in BCCs are still far from being clearly understood. Further studies are highly recommended, with more focus on its role in the pathogenesis and the prognostic factors. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Melanocytic and Non-melanocytic Skin Cancers)
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Figure 1

Figure 1
<p>A bar chart demonstrating the anatomical distribution of the total studied cases.</p> Full article ">Figure 2
<p>A histopathology picture of basal cell carcinoma showing dermal basaloid malignant nodular masses in the dermis with peripheral palisading and cleft seen area (H&amp;E, 200×), (<b>A</b>): Myxoid stroma appears. (<b>B</b>) The cleft is obvious around the tumor.</p> Full article ">Figure 3
<p>Immunohistochemical staining of p16 marker in a case of BCC showing: (<b>A</b>) strong positivity (200×); (<b>B</b>) moderate positivity in (400×).</p> Full article ">Figure 4
<p>Negative immunostaining of p16 in two cases of BCC. (<b>A</b>) A case from a sun-exposed area (200×); (<b>B</b>) a case from a sun-protected area (400×).</p> Full article ">
13 pages, 2863 KiB  
Article
The Importance of Immunohistochemistry in the Evaluation of Tumor Depth of Primary Cutaneous Melanoma
by Anca Maria Pop, Monica Monea, Peter Olah, Raluca Moraru and Ovidiu Simion Cotoi
Diagnostics 2023, 13(6), 1020; https://doi.org/10.3390/diagnostics13061020 - 7 Mar 2023
Cited by 3 | Viewed by 4967
Abstract
Primary cutaneous melanoma (PCM) is the most aggressive skin malignancy, with an increasing incidence and significant mortality. Tumoral invasion, expressed as Breslow thickness, is routinely assessed on hematoxylin and eosin (HE), although this stain may sometimes underestimate the tumoral depth. The aim of [...] Read more.
Primary cutaneous melanoma (PCM) is the most aggressive skin malignancy, with an increasing incidence and significant mortality. Tumoral invasion, expressed as Breslow thickness, is routinely assessed on hematoxylin and eosin (HE), although this stain may sometimes underestimate the tumoral depth. The aim of this study was to compare the efficiency of the immunohistochemical (IHC) markers S-100, SOX10, Melan-A, and HMB-45 with HE for the evaluation of the Breslow thickness and staging of PCM. This retrospective study included 46 cases of PCM diagnosed between 2015 and 2022; for each case, the Breslow thickness using HE, S-100, SOX10, Melan-A, and HMB-45 was measured and the appropriate T category was recorded. The highest values of the Breslow thickness were observed for S-100. However, S-100, SOX10, and Melan-A provided statistically significant higher values of the Breslow thickness compared to HE, but no difference was noted between HMB-45 and HE. S-100 was most frequently involved in increasing the T category (26.1%), the majority of cases being upstaged from T1a to T1b. The IHC markers S-100, SOX10, and Melan-A contributed to better evaluation of the melanoma invasion, especially in thin melanomas, but their impact on staging and consecutive treatment remains to be confirmed by future studies. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Melanocytic and Non-melanocytic Skin Cancers)
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Figure 1

Figure 1
<p>Flow chart illustrating the case selection for the study.</p> Full article ">Figure 2
<p>(<b>a</b>) Nodular melanoma, stage pT1a, in a 65-year-old male patient. The tumor is in the vertical growth phase; pagetoid spread and non-brisk TILs can be observed. The value of the Breslow thickness measured on HE was &lt;0.8 mm; Clark level of invasion II. (HE, ×5). (<b>b</b>) The value of the Breslow thickness measured on S-100 was 1.0 mm, upstaging the tumor to pT1b. (S-100, ×5); (<b>c</b>) The value of the Breslow thickness measured on SOX10 was 1.0 mm. (SOX10, ×5). (<b>d</b>) The value of the Breslow thickness measured on HMB-45 was 0.9 mm. (HMB-45, ×5). (<b>e</b>) The value of the Breslow thickness measured on Melan-A was 0.9 mm. (Melan-A, ×5). Isolated tumor cells suggesting invasion are highlighted with black arrows (case from the archive of the County Clinical Hospital Mureș).</p> Full article ">Figure 2 Cont.
<p>(<b>a</b>) Nodular melanoma, stage pT1a, in a 65-year-old male patient. The tumor is in the vertical growth phase; pagetoid spread and non-brisk TILs can be observed. The value of the Breslow thickness measured on HE was &lt;0.8 mm; Clark level of invasion II. (HE, ×5). (<b>b</b>) The value of the Breslow thickness measured on S-100 was 1.0 mm, upstaging the tumor to pT1b. (S-100, ×5); (<b>c</b>) The value of the Breslow thickness measured on SOX10 was 1.0 mm. (SOX10, ×5). (<b>d</b>) The value of the Breslow thickness measured on HMB-45 was 0.9 mm. (HMB-45, ×5). (<b>e</b>) The value of the Breslow thickness measured on Melan-A was 0.9 mm. (Melan-A, ×5). Isolated tumor cells suggesting invasion are highlighted with black arrows (case from the archive of the County Clinical Hospital Mureș).</p> Full article ">

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18 pages, 4545 KiB  
Case Report
Diagnostic and Therapeutic Particularities of Symptomatic Melanoma Brain Metastases from Case Report to Literature Review
by Adelaida Avino, Daniela-Elena Ion, Daniela-Elena Gheoca-Mutu, Abdalah Abu-Baker, Andrada-Elena Țigăran, Teodora Peligrad, Cristian-Sorin Hariga, Andra-Elena Balcangiu-Stroescu, Cristian-Radu Jecan, Adrian Tudor and Laura Răducu
Diagnostics 2024, 14(7), 688; https://doi.org/10.3390/diagnostics14070688 - 25 Mar 2024
Cited by 2 | Viewed by 1580
Abstract
The recent introduction of immunotherapy and targeted therapy has substantially enriched the therapeutic landscape of metastatic melanoma. However, cerebral metastases remain unrelenting entities with atypical metabolic and genetic profiles compared to extracranial metastases, requiring combined approaches with local ablative treatment to alleviate symptoms, [...] Read more.
The recent introduction of immunotherapy and targeted therapy has substantially enriched the therapeutic landscape of metastatic melanoma. However, cerebral metastases remain unrelenting entities with atypical metabolic and genetic profiles compared to extracranial metastases, requiring combined approaches with local ablative treatment to alleviate symptoms, prevent recurrence and restore patients’ biological and psychological resources for fighting malignancy. This paper aims to provide the latest scientific evidence about the rationale and timing of treatment, emphasizing the complementary roles of surgery, radiotherapy, and systemic therapy in eradicating brain metastases, with a special focus on the distinct response of intracranial and extracranial disease, which are regarded as separate molecular entities. To illustrate the complexity of designing individualized therapeutic schemes, we report a case of delayed BRAF-mutant diagnosis, an aggressive forearm melanoma, in a presumed psychiatric patient whose symptoms were caused by cerebral melanoma metastases. The decision to administer molecularly targeted therapy was dictated by the urgency of diminishing the tumor burden for symptom control, due to potentially life-threatening complications caused by the flourishing of extracranial disease in locations rarely reported in living patients, further proving the necessity of multidisciplinary management. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Melanocytic and Non-melanocytic Skin Cancers)
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Figure 1

Figure 1
<p>(<b>a</b>) Ulcerated, polypoid melanoma of the left forearm. (<b>b</b>) Excisional defect coverage—fully integrated graft at 1 month after surgery.</p> Full article ">Figure 2
<p>(<b>a</b>) Right fronto-insular and left frontal lobe brain lesions with adjacent vasogenic edema. (<b>b</b>) Right parasagittal and left frontal lobe brain lesions. Scale bar: 12.5 mm.</p> Full article ">Figure 3
<p>Biliary duct metastases: (<b>a</b>) Polypoid gallbladder metastasis on initial CT. (<b>b</b>) Dilation of cholecyst (containing multiple enlarged polypoid lesions) and extrahepatic bile ducts secondary to distal common bile duct obstruction though iodophilic melanoma metastasis (arrow). Scale bar: 12.5 mm.</p> Full article ">Figure 4
<p>Exophytic nodular melanoma: expansive growth pattern with absence of maturation with increasing dermal depth. The tumor cells are enlarged, atypical even at this magnification, and have abundant amphophilic cytoplasm and prominent nucleoli (black arrow) (Haematoxylin and Eosin, ×40).</p> Full article ">Figure 5
<p>Proliferation of melanoma cells arranged in nests (black arrow) at the level of the papillary dermis and in sheets at the deeper levels (white arrow). Non-brisk tumor-infiltrating lymphocytes are noted (encircled area) (Haematoxylin and Eosin, ×20).</p> Full article ">Figure 6
<p>SOX 10, a sensitive and specific marker of malignant melanoma, is strongly expressed in all tumor cells (black arrow), confirming the melanocytic lineage (SOX10, ×10).</p> Full article ">Figure 7
<p>(<b>a</b>) Postoperative aspect of left frontal lobe MBM and irradiated parasagittal MBM; edema and shift of anterior midline structures. (<b>b</b>) Right fronto-insular MBM enlargement and development of cystic appearance; subacute hematoma in the left temporo-parietal region. Scale bar: 12.5 mm.</p> Full article ">
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