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Basal cell carcinoma (BCC) is the most common cancer found in humans. It has several clinical appearances, among which nodular and superficial types are the most common forms. Nodular BCC appears mostly in head and neck regions, while its occurrence in lower legs is extremely rare. A case is presented of a 94-year-old patient diagnosed with multiple recurrent BCCs of lower legs with concomitant longstanding venous insufficiency and severe hypostatic alterations of the surrounding skin. Treatment of multiple BCCs of lower legs was a challenge because of its rarity, therapeutic resistance, and patient comorbidity. All available therapeutic modalities for non-melanoma skin cancer were applied. Epidermal malignant tumors in lower legs were treated with surgery, photodynamic therapy with aminolevulinic acid (ALA-PDT), cryotherapy, and chemotherapy with 5-fluorouracil (5-FU). Because of the extensiveness of tumors and chronic venous insufficiency, surgery and radiotherapy were not considered as favorable therapeutic modalities for the treatment of tumors on the extensor aspects of lower legs, consequently other non-surgical modalities were applied. In this case, topical therapy with 5-FU proved to be superior to ALA-PDT and cryotherapy in the treatment of nodular BCCs of lower legs.

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The aim of the study was to investigate the squamous cell carcinoma (SCC) incidence in Croatia in the 2003-2005 period. The cases of SCC were retrospectively studied. Data were collected from University Department of Dermatology and Venereology, Zagreb University Hospital Center and National Cancer Registry. In the study period, there were 1,860 cases of SCC (934 men and 926 women). The crude incidence rate for the Croatian population of 100,000 was 14.6 for men and 13.4 for women. The age-standardized incidence rate (adjusted for the world standard population) was 8.9 for men and 5.2 for women. The head was almost exclusive localization of SCC in both sexes. The highest SCC incidence was recorded in Zadar County. These results will serve for the SCC trend monitoring in Croatia and Europe in the forthcoming years.

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This study presents the incidence of major nonmelanoma skin cancers (major NMSCs), other nonmelanoma skin cancers (other NMSCs) and malignant melanoma (MM) in Croatia. The skin cancers recorded between 1 January 2003 and 31 December 2005 were retrospectively analyzed. Until 2003, the incidence of major NMSCs and other NMSCs was not estimated in Croatia. Incident cases of NMSCs were identified by the use of a questionnaire distributed to dermatology departments in Croatia and then collected at the University Department of Dermatology and Venereology, Zagreb University Hospital Center, and from the records kept at the National Cancer Registry. Incident cases of MM were extracted from the National Cancer Registry. During the 3-year period, 9,479 cases of major NMSCs are recorded, 4,622 (49%) in male and 4,857 (51%) in female patients. The crude incidence rate was 72.1/100,000 for males and 70.3/100,000 for females. Basal cell carcinoma (BCC) was the most common major NMSC in both sexes. In the total number of major NMSCs, there were 7,244 cases of BCC. Squamous cell carcinoma (SCC) was the second most common major NMSC. There were 1,860 SCC cases. The crude incidence rate was 54.9/100,000 for BCC in males, 53.9/100,000 in females, and 14.6/100,000 for SCC in male and 13.4/100,000 in female patients. Other NMSCs were registered in 119 cases (53% male and 47% female). The crude incidence rate was 0.9/100,000 for male and 0.8/100,000 for female patients. MM was registered in 1,427 cases (48% male and 52% female.) The crude incidence rate was 10.7/100,000 for males and females. These results will serve as reference for studying the patterns of descriptive epidemiology of major NMSCs, other NMSCs and MM in Croatia and Europe in the forthcoming years.

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The genetic background of psoriasis is clearly demonstrated by the familial occurrence, data from epidemiological studies, twin studies, and results of genome-wide scan investigations. In the last years, molecular genetics analyses have permitted new insights into psoriasis. A number of studies indicate the likely genomic location of psoriasis susceptibility genes and suggest their possible identity and function. According to current concepts, psoriasis is caused by the interplay of multiple genes and different trigger factors, and the disease is classified in the group of genetically "complex" diseases. The first associated locus (PSORS1) resides within the HLA region (6p21.3). Strong association of HLA-Cw6 allele at this locus was first reported in Finnish population over 26 years ago. However, the exact location of PSORS1 gene remains controversial due to extensive linkage disequilibrium across the region. Two genes lying within this interval have been intensively studied with respect to their role in psoriasis susceptibility: HCR and corneodesmosin (CDSN). The precise location of PSORS 1 is under intense screening. Other candidate loci identified by genetic linkage research include PSORS 2 (17q25), PSORS 3 (4q34), PSORS 4 (1q21), PSORS 5 (3q21), PSORS 6 (19p13), PSORS 7 (1p32), PSORS 8 (16q) and PSORS 9 (4q31). Despite a large body of new data, the extent of genetic heterogeneity and the role of environmental triggers and modifier genes have not yet been clarified. The isolation of novel susceptibility genes will provide an insight into the precise pathways that control the disease. Such pathways will also reveal additional candidate genes that can be tested for molecular alterations resulting in the disease.

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In women with psoriasis, the course of the disease during conception, pregnancy and delivery generally does not differ from other individuals involved. In psoriasis patients, pre-pregnancy period offers time to learn about the hereditary nature of the disease, the effect of hormonal changes and acceptable treatments during pregnancy. In the majority of patients, psoriasis improved during pregnancy and worsened six weeks after delivery. Women should tell their dermatologist early if they plan to become pregnant and the treatment during pregnancy should be considered carefully. This article provides a short review of the most important literature data on therapeutic options for psoriasis in pregnancy.

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Although non-melanoma skin cancers are the most predominant malignancies in the Caucasian population and hemophilia A is one of the most frequent hereditary bleeding disorders, medical literature data about the management of non-melanoma skin cancers in patients with hemophilia are surprisingly scarce. In this case report we describe the treatment of a patient with multiple recurrent non-melanoma skin cancers and severe hemophilia A. The management of such patients could be very challenging, with possible significant bleeding complications, and requires a multidisciplinary approach.

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The aim of the study was to investigate the antiproliferative, antiangiogenic and apoptotic effect of photochemotherapy (PUVA) in psoriatic patients, and to compare it with a control group of psoriatics treated with local corticosteroid therapy. The study included 60 psoriasis patients, 30 of them allocated to PUVA therapy and local corticosteroid each. Immunohistochemical methods of staining with Ki-67, F-8 and bcl-2 antibodies were used to determine proliferative keratinocyte count, to visualize the number of blood vessels in the dermis, and to determine the number of cells exhibiting expression of the antiapoptotic oncoprotein bcl-2, respectively. In all study patients, the values of Ki-67, F-8, bcl-2 and PUVA score were recorded pre- and at six weeks post-therapeutically. Study results showed a statistically significant decrease in the epidermal proliferative keratinocyte count and dermal number of blood vessels after both therapeutic modalities (p < 0.001 both). The value of bcl-2 showed a statistically significant increase in the group of patients treated with PUVA therapy (p = 0.001) and an increase in the control group, demonstrating enhanced keratinocyte apoptosis after treatment. Accordingly, study results demonstrated the antiproliferative, antiangiogenic and apoptotic effect of both PUVA and local corticosteroids. These very mechanisms appear to play a key role in the action of most antipsoriatic therapies.

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Milker's nodule (noduli mulgentium) is a benign viral skin disease caused by parapoxvirus, a poxvirus that is endemic in cattle. The virus is usually transmitted to cattle handlers from infected cows. We present a case of a 25-year-old housewife who milked cows on her family farm and developed itchy, purplish red nodules on her fingers and hands, and lymphangiitis of the right arm. Two weeks before, several cows on her family farm were treated by a veterinarian under the diagnosis of pseudocowpox. She was treated with orally administered amoxicillin with clavulanic acid 2 g for 10 days, with complete resolution of lymphangiitis. The nodules resolved in several weeks.

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Narrow-band UVB has been reported to be efficacious in patients with vitiligo. The epidermis of patients with vitiligo showed reduction in the levels of catalase, in association with high levels of hydrogen peroxidase (H2O2) that is toxic for melanocytes. Based on these findings, we studied the efficacy and safety of a topical gel containing catalase and superoxide dismutase (Vitix) in combination with narrow-band UVB. The study included 22 patients of which 19 completed the 6-month study period. Patients applied the gel containing catalase and superoxide dismutase twice a day and received narrow-band UVB 3 times per week. Two different dermatologists evaluated the grade of repigmentation by photograph comparison. At the end of therapy, more than 50% of overall repigmentation was noticed in 11 of 19 (57.9%) patients. More than 75% repigmentation was recorded in three (15.79%), 26%-50% repigmentation in six (31.58%) patients and 1%-25% repigmentation in one (5.26%) patient, whereas one (5.26%) of 19 patients showed no repigmentation at all. The best response was achieved on the face and neck, with more than 50% repigmentation observed in 11 of 14 (78.6%) patients. Development of new lesions was not observed. Adverse events were mild and transient. The study showed that the combination therapy of narrow-band UVB and gel containing catalase and dismutase is a therapeutic option that could be considered in the management of vitiligo. Further evaluation of this combination in multicenter, double-blind, placebo-controlled studies should be undertaken.

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The prevalence of nail psoriasis varies considerably among different studies, ranging from 10% to 55%. In psoriatic arthritis, its prevalence is as high as 85%. In spite of the high prevalence of the disease, considerable functional, psychical and cosmetic discomforts for the affected patients, and recent advances in the management of skin psoriasis, an efficacious and longlasting treatment for psoriatic nails remains elusive. A 51-year-old male patient with skin psoriasis and severe psoriatic lesions of all his finger nails and toe nails is presented. Some nail plates were up to 30 times thicker than normal. The patient received radiotherapy with soft x-rays in a total dose of 13.5 Gy administered in nine fractionated doses of 1.5 Gy (43 kV, 25 mA, 0.6 mm aluminum filter) at one-week and two-week intervals. Upon therapy completion, the appearance of nail plates gradually improved to normalize completely at 12 months of therapy. Almost three years of therapy completion, the patient is free from both disease relapse and radiotherapy sequels. Considering the high therapeutic efficacy and longlasting remission achieved, this type of radiotherapy should be used in the treatment of severe psoriatic nail lesions with massive nail plate thickening, to alleviate psychical and functional difficulties associated with the disease.

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Photodynamic detection (PDD) of skin tumours is based on the visualization of a fluorophores, with the ability to accumulate in tumour tissue, by the use of fluorescence imaging. Of particular importance is the application of δ-5-aminolaevulinic acid (ALA) that, through the process of biosynthesis causes formation of the protoporphyrin IX (PpIX). The PpIX has the ability of selective fluorescence after basal cell carcinoma (BCC) has been treated with ALA. Higher concentration of PpIX in tumour tissue compared to surrounding normal skin is the basis for PDD. Our contribution in this preliminary study is application of the independent component analysis (ICA) to extract the BCC spatial map, by processing fluorescent RGB image acquired under excitation with 405nm light. Comparative performance analysis with other two widely used image processing methods: ratio imaging and optimal threshold based imaging, reveals that ICA produces BCC spatial map that is most consistent in term of diagnostic quality by both visual assessment and calculation of the BCC demarcation line. We believe this represents a solid basis for the design of a compact and low-cost multi-spectral fluorescence imaging system, capable for real time calculation of the skin tumour demarcation.

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Solar lentigines are benign, brownish lesions that occur on light exposed skin surfaces from age 30 onwards, as a sign of photoaging. As they are of cosmetic importance to many patients, different therapeutic modalities have been tried to remove these unwanted spots. The recent development of short-pulsed, pigment-specific lasers has enabled physicians to selectively destroy the pigment within the solar lentigo lesions with significant clinical improvement, low risk of adverse effects, and high patient acceptance. Therefore this therapeutic option is superior to traditional treatment modalities and represents the treatment of choice in the management of solar lentigines. A case is reported of the successful use of Q-switched ruby laser in the treatment of solar lentigo on the face.

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Reports on clinical and histologic follicular alterations in patients previously diagnosed with mycosis fungoides (MF) or at the time of MF diagnosis are rare. The clinical and histologic criteria to distinguish MF associated with follicular mucinosis from follicular MF are a matter of debate. A patient is described with advanced clinical and histologic alterations predominated by follicular lesions and presence of mucin. In the early stage of the disease, folliculotropism was clinically and histologically present but less pronounced than epidermotropism and classic plaque-like lesions. The patient died four years after the diagnosis. As the term 'folliculotropic' describes a particular histopathologic finding, we consider it correct to use the term "folliculotropic MF" to denote atypical lymphocyte folliculotropism in the absence or presence of mild epidermotropism, presence of mucin, or no evidence for intrafollicular mucin. Folliculotropic MF seems to represent a specific clinicopathologic entity which may have a poorer prognosis than classic MF.

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Psoriasis is a common disease in children and adolescents. Because of the chronic course of the disease, appropriate choice of therapy in particular stage of the disease, so-called rotation therapy, is of paramount importance. This article provides a review of therapeutic options for childhood psoriasis. Local therapy for psoriasis in children consists of corticosteroid preparations, calcipotriol, tars and dithranol, local retinoids, and local immunomodulators. Phototherapy (narrow band UVB, photochemotherapy PUVA baths) is now a part of psoriasis therapy in children. Systemic therapy retinoids (acitretin) methotrexate, cyclosporine is only used in severe forms of the disease such as erythrodermic, pustular and arthritic psoriasis. All these therapeutic options can be used as monotherapy or in various combinations.

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Pemphigus vulgaris is an organ-specific autoimmune mucocutaneous disorder. In the majority of cases, the disease manifests initially with oral lesions, and may be limited to a single site for months before spreading. A 78-year-old woman with yellowish crusted areas on her left preauricular region and close to the medial angle of her right eye is presented. Although she described an episode of erosions on her lower lip, the involvement of mucosal surfaces was not noticed on examination. Before she presented to our Department, she was misdiagnosed as an actinic cheilitis and malignant skin tumor. Histopathologic examination and direct immunofluorescence confirmed the diagnosis of pemphigus vulgaris. Immunoblotting of epidermal extracts detected IgG antibodies against desmoglein 3 but not desmoglein 1, which was also confirmed by ELISA test. The patient responded favorably to systemic corticosteroid therapy combined with adjuvant immunosuppressive therapy, with complete clearance of the lesions.

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A brief overview of some metastatic carcinomas of the skin is given. The basic principles of the metastatic process, the distribution of metastases and clinical features of the most common metastatic carcinomas of the skin are presented, along with an account of our own data based on the records of Dermatohistology Registry of the University Department of Dermatology and Venereology, Zagreb University Hospital Center, for the 1994-2004 period and presentation of 22 cases of cutaneous metastases from this eleven-year period.

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The development of effective treatment modalities for vitiligo is dependent on an understanding of the events leading to depigmentation. However, the exact pathogenesis of vitiligo is still mostly unknown. Abnormalities in both humoral and cell-mediated immunity have been documented in vitiligo patients and they present a basis for using immunomodulating agents, such as corticosteroids and macrolide immunomodulators, in the treatment of vitiligo. Macrolide immunomodulators, such as tacrolimus and pimecrolimus, which can be used topically, are known as topical immunomodulators (TIMs). TIMs inhibit the action of calcineurin, and consequently inhibit T-cell activation and the production of various cytokines; this is considered the working mechanism of action of TIMs in vitiligo. Several small studies and case reports on the use of TIMs in vitiligo have been published so far. Tacrolimus achieves better results on the face and neck than on other body areas. Particular advantages of TIMs are safety in treating these areas because of lack of skin atrophy and good tolerability. The incidence of application site adverse events in vitiligo seems to be lower than in the treatment of atopic dermatitis. On the face and neck, TIMs may become a useful tool in the treatment of adults and children with vitiligo despite possibly lower efficacy than topical corticosteroids. Further, larger, controlled clinical studies are warranted to determine the definite role of TIMs as monotherapy or in combination with other modalities in the treatment of vitiligo.

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The most frequent consideration in the clinical and histologic differential diagnosis of keratoacanthoma is squamous cell carcinoma. In the present study, cytokeratin 10 expression and proliferation rate as measured by Ki-67 expression were compared between 50 clinically and histologically diagnosed keratoacanthomas and 50 squamous cell carcinomas. Tissue sections from the skin were immunohistochemically stained with anti-cytokeratin 10 and anti-Ki-67 monoclonal antibodies. The distribution of cytokeratin 10 expression and proliferative cell count were analyzed. Study results showed higher cytokeratin 10 expression in keratoacanthomas than in squamous cell carcinomas and different distribution of staining in the two entities. The analysis of cytokeratin 10 expression showed a much wider range of values and statistically higher median (p<0.001) in keratoacanthomas than in squamous cell carcinomas. Additionally, the proliferation index of keratinocytes as measured by Ki-67 expression was significantly higher in squamous cell carcinomas than in keratoacanthomas (p<0.01). These results may prove helpful in histologic differentiation of these disorders.

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Hereditary benign telangiectasia is a very uncommon disorder characterized by generalized telangiectasias and angiomatous lesions of the skin. The diagnosis should be suspected in patients with such cutaneous signs, positive family history, no associated bleeding problems, and no mucosal involvement. We present a 74-year-old woman with typical clinical features of hereditary benign telangiectasia.

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There is considerable epidemiologic evidence that genetic component plays a key role in the pathogenesis of psoriasis. The disease is multifactorial in origin and shows polygeneic inheritance. In the last decade, there have been significant advances in our understanding of the genetic basis of this common disease. Susceptibility gene characterization and knowledge of the immune basis of psoriasis have better defined the disease pathways involved in the pathogenesis of psoriasis. A number of genetic loci have been identified by genome wide-linkage scans. In particular, the importance of PSORS 1 linkage characterization is emphasized, as this information will help develop more specific diagnostic and prognostic tools.

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