No abstract

Basal cell carcinoma (BCC) is the most common variety of non-melanoma skin cancer. Treatment modalities include cryotherapy, topical imiquimod 5% cream, photodynamic therapy, electrodessication and curettage, classic surgical excision, Mohs surgery, and radiotherapy. Surgical treatments are regarded as the most effective, but, in some cases, may produce poor cosmetic outcomes. Delineating tumor margins as much as possible is important in order to limit broad surgical excisions. Preoperative curettage is a surgical technique proposed to delineate BCC margins. Reported data on curettage utility are controversial. Some authors report that curettage better delineates the tumor, decreasing relapsing rates, whereas others consider it as a nonspecific procedure that may damage the surrounding healthy tissue and falsely increase the final defect size. We studied the pathologic features of curetted material and the main surgical specimens of 55 BCC treated with preoperative curettage. According to BCC subtype, preoperative curettage may lead to a complete or almost complete tumor removal. Preoperative curettage might be helpful in delineating BCC margins, especially in nodular and superficial BCC. No evidence of unspecific removal of tumor's surrounding healthy tissue was observed in our specimens.

Anecdotal reports have shown that tumour necrosis factor (TNF)-α inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti-TNF-α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re-evaluated. In patients non-responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week(-1) for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti-TNF-α therapy is seldom reported, it is not likely to be rare, but rather under-reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.