Skin Tumors

Summary
Introduction: Historical or neglected tumors are giant tumors with a diameter of more than 5 cm and having a long-term evolution.
Objective: Identification of the existence of these tumors, the social context and psychological factors associated with delay in diagnosis.
Patients and method: 14 patients diagnosed with historical malignant tumors in a period of 8 years in the dermatology office SC Dermamed SRL from Brasov were studied.
Results: Of the 14 patients diagnosed with historical malignant tumors, nine patients were men (64.28%) and five women (35.72%) with a mean age of 76.43 years, the vast majority of patients being retired. As environment of origin eight patients came from rural areas (57.14%) and six were from urban areas (42.86%). Basal cell carcinoma was the most frequent tumor (n=7) followed by squamous cell carcinoma (n=3), B-cell or T-cell lymphoma (n=2), melanoma (n=1) and verrucous carcinoma (n=1). The mean duration of evolution of the tumors until the time of the first consultation was 5.6 years. The average tumor size was 7 cm (from 5.5 cm to 13 cm). The reason that lead the patient to come to consultation was bleeding (n=4), increasing the volume of the tumor (n=3), ulceration (n=4), visualization of bony structures (n=1) and family influence (n=2). Treatment consisted of surgical excision of the tumor
Rezumat
Introducere: Tumorile istorice sau neglijate sunt tumori gigante, cu diametrul de peste 5 cm, ºi care au o evoluþie de lungã duratã. Obiectiv: Identificarea existenþei acestor tumori, contextul social ºi factorii psihologici asociaþi întârzierii diagnosticului.
Pacienþi ºi metodã: Au fost studiaþi 14 pacienþi care au fost diagnosticaþi cu tumori maligne istorice într-o perioadã de 8 ani în cabinetul de dermatologie Dermamed SRL din Braºov.
Rezultate: Dintre cei 14 pacienþi 9 erau bãrbaþi (64,28%) ºi 5 femei (35,72%), având o vârstã medie de 76,43 ani, marea majoritate fiind pensionari. Ca ºi mediu de provenienþã 8 pacienþi proveneau din mediul rural (57,14%) iar 6 din mediul urban (42,86%). Carcinomul bazocelular a fost tumora cel mai frecvent întâlnitã (n=7) urmatã de carcinomul scuamocelular (n=3), limfomul malign de tip T sau B (n=2), melanomul (n=1) ºi carcinomul verucos (n=1). Durata medie de evoluþie a tumorilor pânã în momentul primei consultaþii a fost de 5,6 ani. Talia medie a tumorilor a fost de 7 cm (de la 5,5 cm la 13 cm). Motivul care a determinat pacientul sã se prezinte la consultaþie a fost hemoragia, creºterea de volum a tumorii, ulcerarea, evidenþierea structurilor osoase ºi influenþa familiei. Tratamentul a constat în cele mai multe cazuri în excizia chirurgicalã a tumorii combinatã sau nu.

Nevus Spitz is a benign melanocytic proliferation, first described in 1948 by Sophie Spitz as a childhood melanoma. Initially, it was described as an erythematous papule or node, but further studies of the Spitz nevus proved that in 71-92% cases it is a pigmented formation. This pigmentation is often quite intense due to the rapid growth of the formation, which leads to the need for differential diagnosis with skin melanoma. After all, dermatoscopy can be used for this purpose and, when applying this research method, typically a pattern of an exploding star formed by streaks of linear pigmentation and symmetrically located pigment globules placed in the peripheral zone can be revealed. In case of non-pigmented Spitz nevus, spot vessels and reticular depigmentation are visualized. Both pigmented and non-pigmented forms of Spitz nevus in the process of evolution can regress partially or completely. Several clinical cases of different types of spitzoids, both typical and atypical, based on the non-clinical, dermatoscopic and histological diversity of the Spitz nevi, have been demonstrated in the article. Their macroscopic and dermatoscopic features as well as probable signs of dynamic changes are indicated in order to facilitate their recognition by other specialists.

The theoretical bases and practical aspects of the algorithm «Prediction without pigment» in dermatoscopic diagnostics
application are considered in the article. The method was developed by a team of authors from around the world as a
complement to the method of the dermatoscopic image analysis «Chaos and Clues». The «Prediction without pigment»
method is an opportunity to streamline differential diagnosis of non-pigmented formations and entities with unproven
pigmentation by melanin. Dermatoscopice valuation in this case is difficult, but under standing that there are someuseful
tips formed the basis for the development of this technique. The formations being analyzed should not be brown or gray.
Black, purpleorblue, ifpresent, shouldbeduetoblood, notmelanin. The so-called «Red Flags» help in choosing the
algorithm — it is the presence of additional features or specific circumstances that characterize the formation as suspicious,
and therefore require the use of algorithmic evaluation. These features can be subjective (presented by a concerned patient),
or objectively visible macroscopically (clinically visible structure defect, ulcer, superficial keratin on the volumetric
formation) or during dermatoscopic evaluation (polarized specific white lines).