Merkel cell carcinoma (MCC) is a rare skin tumour of neuroendocrine origin with aggressive behaviour. The aims of this study were to investigate the association of p63 + MCC with clinicopathological features and to estimate survival through a systematic review and meta-analysis. A comprehensive search of PubMed, Embase, Scopus and Virtual Health Library following the PRISMA guidelines was conducted on September 2017. DerSimonian and Lard random-effects models were used to calculate survivalweighted means and their corresponding 95% confidence intervals (CI) among studies. Five studies met our inclusion criteria after screening 77 citations and 36 full-text articles. The included studies enrolled 413 patients with MCC. We observed that p63 + MCC was significantly associated with mortality with OR 2.92 (95% CI [1.66-5.13]). The summary hazard ratio of multivariate analysis was 1.99 (95% CI [1.32-3.01]). The only clinicopathological feature associated with p63 + MCC with statistical significance was the Merkel cell polyomavirus (MCPyV) status. The presence of MCPyV was associated as a protective factor for the expression of p63 (OR 0.25, 95% CI [0.08-0.73]). These results support that p63 + MCC evaluated by immunohistochemistry has a poor outcome. Therefore, we suggest p63 to be performed when staging MCC.

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia commonly seen in African American individuals. 1 It classically affects the vertex scalp, although 1 study 2 suggests that it may manifest as patchy hair loss beyond the vertex. In that study, the histopathologic, dermatoscopic, and clinical findings were crucial in diagnosis. However, another study 3 reported histopathologic changes in the vertex scalp consistent with CCCA even without clinically visible hair loss. Our study explored dermatoscopic and histopathologic findings in areas of the scalp without clinically active disease, specifically beyond the vertex scalp. We also assessed the reliability of dermatoscopy, which may serve as a less invasive diagnostic tool than biopsy, for the diagnosis of CCCA in the context of subclinical disease.

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Lipomatous metaplasia of the upper dermis is a rare phenomenon scarcely described in the literature which has always been identified in the context of inflammatory or neoplastic processes. Microscopically, it should be distinguished from pseudolipomatosis cutis, dermal lipoma, nevus lipomatosus, and focal dermal hypoplasia (Goltz syndrome). This is the first report of the histologic and ultrasound evaluation of a patient with extensive involvement and the description of the coincidental finding of an anomalous nonseptate subcutaneous tissue.

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