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Öğe Adequacy of surgical margins, re-excision, and evaluation of factors associated with recurrence: a retrospective study of 769 basal cell carcinomas(Elsevier Science Inc, 2023) Urun, Yildiz Gursel; Can, Nuray; Bagis, Merve; Solak, Sezgi Sarikaya; Urun, MustafaBackground: Achieving adequate surgical margins and preventing recurrence are important in the treatment of basal cell carcinoma (BCC). Objectives: The objectives of this study were to evaluate the adequacy of surgical margins and the re-excision rates in patients with primary BCC who underwent standard surgical treatment using our proposed algorithm and to define the risk factors in patients with recurrent BCC. Methods: The medical records of patients who were histopathologically diagnosed with BCC were reviewed. An algorithm created based on previous literature was used to determine the distribution of optimal surgical margins adequacy and re-excision rates. Results: Statistically significant differences were observed between the cases with and without recurrence in age at diagnosis (p = 0.004), tumor size (p = 0.023), tumor location in the H zone of the face (p = 0.005), and aggressive histopathological subtype (p = 0.000). When the tumors were evaluated for adequacy of deep and lateral surgical margins and re-excision rates, higher rates of adequate excision (457 cases, 68.0%) and re-excision (43 cases, 33.9%) were noted for tumors in the H or M zone. Study limitations: Inadequate follow-up of newly diagnosed patients in terms of recurrence and metastasis and the retrospective application of our proposed algorithm are the limitations of the present study. Conclusions: Our results showed that if BCC was detected at an early age and at an early stage, recurrence was lower. The H and M zones were the regions with the highest rates of optimal surgical outcomes. (c) 2023 Sociedade Brasileira de Dermatologia. Published by Elsevier Espan & SIM;a, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Öğe Association between Localized Scleroderma Cutaneous Assessment Tool and clinicopathologic characteristics in patients with morphea(Galenos Publ House, 2022) Urun, Yildiz Gursel; Keskin, Elif UsturaliBackground and Design: Morphea is also known as localized scleroderma. It is a rare autoimmune skin disease characterized by inflammation and sclerosis in the dermis and sometimes in the subcutaneous tissue. Laboratory findings, imaging, and histopathological features facilitate diagnosis and provide sufficient information about disease severity. Clinicopathologic correlations and severity factors in morphea are poorly described. Thus, this study aimed to review the clinical and histopathological features and treatment responses of patients with morphea and compare these features with disease activity and damage scores to identify new tools for assessing disease severity other than clinical findings. The applicability of the Localized Scleroderma Cutaneous Assessment Tool in clinical practice was also evaluated.Materials and Methods: This study reviewed data of 41 patients who had a histopathologically confirmed diagnosis of morphea and had been followed up regularly for at least 6 months. The modified Localized Scleroderma Skin Severity Index (mLoSSI), Localized Scleroderma Skin Damage Index (LoSDI), Physician Global Assessment-Activity (PGA-A), and Physician Global Assessment-Damage (PGA-D) were calculated at baseline and final treatment.Results: Among morphea subtypes, superficial morphea had significantly more sclerosis in the papillary dermis and plaque-type morphea had significantly more sclerosis in the reticular dermis (p<0.05). When positive antinuclear antibody (ANA) and high levels of thyroid autoantibodies were compared with mLoSSI, LoSDI, PGA-A, and PGA-D scores at baseline, no significant correlation was found. Comparison of the subgroups according to the initial mLoSSI and LoSDI scores revealed no significant histopathological differences between the groups.Conclusion: Although the mLoSSI, LoSDI, PGA-A, and PGA-D scores can be successfully used for the follow-up and treatment of patients with morphea, no correlation was found between positive ANA, high levels of thyroid autoantibodies, and histopathological features.Öğe A case of extragenital linear lichen sclerosus along the lines of Blaschko responding to methotrexate(Dermatovenerological Soc Slovenia, 2020) Urun, Mustafa; Urun, Yildiz Gursel; Solak, Sezgi SarikayaLichen sclerosus, a rare, chronic, inflammatory, mucocutaneous disorder of the genital and extragenital skin, is usually asymptomatic and affects both sexes. The exact cause of lichen sclerosus is unknown. Extragenital lichen sclerosus may be localized or disseminated. Linear extragenital lichen sclerosus following the lines of Blaschko is an exceptionally rare form. A 66-year-old female patient presented with a sclerotic plaque extending from the dorsum of the right hand toward the elbow. The lesion first appeared on the right hand but spread toward the elbow within 1 year. The histological findings were consistent with a diagnosis of lichen sclerosus. We therefore diagnosed extragenital linear lichen sclerosus and achieved a good response with methotrexate.Öğe A case of perianal bowenoid papulosis: dermoscopic features and a review of previous cases(Dermatovenerological Soc Slovenia, 2021) Urun, Yildiz Gursel; Urun, Mustafa; Ficicioglu, SezinBowenoid papulosis is an uncommon precancerous condition of the genitalia caused by oncogenic human papillomavirus types. It is seen in young, sexually active adults and histologically resembles Bowen's disease. Dermoscopy is useful in the diagnosis of both pigmented and non-pigmented skin lesions, but dermoscopic diagnostic accuracy criteria have not yet developed in diseases such as bowenoid papulosis and Bowen's disease. This case report analyzes the dermoscopic findings of bowenoid papulosis in the literature with the aim of increasing the frequency of use of dermoscopy in the diagnosis of bowenoid papulosis in clinical practice.Öğe Clinical, Dermoscopic and Histopathological Evaluation of Basal Cell Carcinoma(Mattioli 1885, 2023) Urun, Yildiz Gursel; Ficicioglu, Sezin; Urun, Mustafa; Can, NurayIntroduction: Dermoscopy aids in identifying histopathological subtypes and the presence of clinically undetectable pigmentation in basal cell carcinoma (BCC). Objectives: To investigate the dermoscopic features of BCC subtypes and better understand nonclassical dermoscopic patterns. Methods: Clinical and histopathological findings were recorded by a dermatologist who was blinded to the dermoscopic images. Dermoscopic images were interpreted by two independent dermatologists blinded to the patients' clinical and histopathologic diagnosis. Agreement between the two evaluators and with histopathological findings was evaluated using Cohen's kappa coefficient analysis. Results: The study included a total of 96 BBC patients with 6 histopathologic variants: nodular (n=48, 50%), infiltrative (n=14, 14.6%), mixed (n=11, 11.5%), superficial (n=10, 10.4%), basosquamous (n=10, 10.4%), and micronodular (n=3, 3.1%). Clinical and dermoscopic diagnosis of pigmented BCC showed high agreement with histopathological diagnosis. The most common dermoscopic findings according to subtype were as follows: nodular BCC: shiny white-red structureless background (85.4%), white structureless areas (75%), and arborizing vessels (70.7%); infiltrative BCC: shiny white-red structureless background (92.9%), white structureless areas (78.6%), arborizing vessels (71.4%); mixed BCC: shiny white-red structureless background (72.7%), white structureless areas (54.4%), and short fine telangiectasias (54.4%); superficial BCC: shiny white-red structureless background (100%), short fine telangiectasias (70%); basosquamous BCC: shiny white-red structureless background (100%), white structureless areas (80%), keratin masses (80%); micronodular BCC: short fine telangiectasias (100%).Öğe Dermoscopic Characteristics of Cutaneous Lupus Erythematosus According to Subtype, Lesion Location, Lesion Duration, and CLASI Score(Mattioli 1885, 2024) Urun, Yildiz Gursel; Urun, Mustafa; Danisman, Mehmet SerifIntroduction: Dermoscopic findings are used to diagnose and evaluate disease activity in patients with cutaneous lupus erythematosus (CLE). Objectives: This study aimed to characterize the dermoscopic features of discoid LE (DLE) and LE tumidus (LET) by lesion duration and CLE Disease Area and Severity Index (CLASI) scores and to examine the dermoscopic findings of lesions in different locations in DLE patients. Methods: Dermoscopic findings (follicular features, perifollicular surface, interfollicular features, and vessel pattern) were assessed and lesion duration (<= 12 and >12 months) and CLASI scores (grouped as mild or moderate) were calculated. DLE lesion locations were categorized as, non-scalp, scalp and lip. Results: Forty-eight dermoscopic images from 35 DLE and 4 LET patients were analyzed. The most common dermoscopic findings in non-scalp DLE were follicular keratotic plugs (82.8%) and white scales (69%). In scalp DLE (n=9), the most common findings were absent follicular openings (77.8%), white structureless areas (77.8%), and perifollicular scaling (66.7%). All LET patients had pink-white background and linear vessels. Follicular plugs, peripheral pigmentation, and polymorphous vessels were lower in patients with mild CLASI activity than moderate activity (P = 0.036, 0.039, and 0.019, respectively). Fibrotic white dots, honeycomb pigment pattern, and blue-gray dots/globules were lower in those with mild CLASI damage scores than moderate damage (P = 0.010, 0.010, and 0.020, respectively). Peripheral pigmentation was more common in patients with lesion duration <= 12 months, while blue-gray dots/globules were more common with lesion durations >12 months. Conclusions: Certain dermoscopic features may facilitate the differential diagnosis of DLE and LET.Öğe Evaluation of skin lesions of lupus with Turkish revised cutaneous lupus erythematosus disease area and severity index(Deri Zuhrevi Hastaliklar Dernegi, 2014) Urun, Yildiz Gursel; Donmez, Salim; Arican, Ozer; Pamuk, Omer NunriBackground and Design: The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is used to evaluate the cutaneous manifestations in patients with lupus erythematosus (LE). In recent years, the Revised Cutaneous Lupus Erythematosus Disease Area and Severity Index (RCLASI) which provides more objective assessment has been developed, but the number of studies utilizing RCLASI are limited. The aim of this study was to increase the clinical use of the RCLASI by translating this scale into Turkish and to evaluate the effects of factors, which affect CLASI, on RCLASI. Materials and Methods: The scale was translated into Turkish by using proper international translation steps. Ninety-three LE patients who were admitted to Trakya University Faculty of Medicine were included in this study. Socio-demographic and clinical characteristics of the patients were recorded. Cutaneous manifestations were calculated using RCLASI. Two scores were obtained: activity and damage scores. The relationship of the scores with patient age, gender, duration of illness, facial involvement, subtypes of LE, and antinuclear antibody, Anti-Ro/SS-A antibody and Anti-La/SS-B antibody positivities were evaluated. Results: The mean activity and damage scores were 2.59 +/- 2.88 and 0.81 +/- 1.88, respectively. When activity and damage scores were compared between the age groups, there was no statistically significant difference. The damage scores were significantly higher in male patients than in female patients. The activity scores were statistically significantly higher in patients with disease duration of more than three years and facial involvement. There was no statistically significant difference between the subtypes of LE and the activity and damage scores. RCLASI damage scores were statistically significantly higher in Anti-La/SS-B antibody positive patients. Conclusion: RCLASI is an appropriate scoring system to evaluate the cutaneous manifestations in patients with LE. The scores obtained from this scale may vary depending on gender, disease duration and presence of facial involvement.Öğe High prevalence of high-risk cutaneous squamous cell carcinoma in the thrace region of Turkey(Wolters Kluwer Medknow Publications, 2020) Solak, Sezgi Sarikaya; Yondem, Haydar; Urun, Yildiz Gursel; Cezik, Mert; Can, NurayBackground: The characteristics of cutaneous squamous cell carcinoma (cSCC) may show differences according to the geographic distribution and ethnicity. Although most cSCCs are treated with surgical excision or other local interventions, high-risk cSCCs may have poor outcome. In the present study, we aimed to evaluate the clinicopathological characteristics and determine the high-risk features of cSCCs in the Thrace region of Turkey where the information on cSCCs is scarce. Methods: We retrospectively investigated the biopsy-proven cSCCs diagnosed between the years 2014 and 2018, in a tertiary university hospital and evaluated the high-risk features. Results: A total of 211 cSCCs were included. Men with cSCC were significantly younger than women with cSCC (P <.001). Almost one-half of the tumors (n = 103) were located on the lower lip. Patients with a cSCC on the lower lip were younger than those with a cSCC on the other sites. All patients with a cSCC on the ears were men. Twenty-eight percent of patients had tumor size more than 20 mm and 28% had tumor thickness more than 6 mm. Immunosuppression was present in 7.6% of patients. A total of 177 (83.9%) patients had high-risk cSCC. The local recurrence rate was 6.2%, and the metastasis rate was 5.2%. Conclusions: The Thrace region has significant number of cSCC, and high-risk features are very frequent. Clinicians should carefully evaluate the cSCCs in terms of high-risk features.Öğe Methylation status, mRNA and protein expression of the SMAD4 gene in patients with non-melanocytic skin cancers(Springer, 2023) Urun, Yildiz Gursel; Budak, Metin; Keskin, Elif UsturaliBackground SMAD4 is a potent tumor suppressor. SMAD4 loss increases genomic instability and plays a critical role in the DNA damage response that leads to skin cancer development. We aimed to investigate SMAD4 methylation effects on mRNA and protein expression of SMAD4 in cancer and healthy tissues from patients with basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and basosquamous skin cancer (BSC). Methods and results The study included 17 BCC, 24 cSCC and nine BSC patients. DNA and RNA were isolated from cancerous and healthy tissues following punch biopsy. Methylation-specific polymerase chain reaction ( PCR) and real-time quantitative PCR methods were used to examine SMAD4 promoter methylation and SMAD4 mRNA levels, respectively. The percentage and intensity of staining of the SMAD4 protein were determined by immunohistochemistry. The percentage of SMAD4 methylation was increased in the patients with BCC (p = 0.007), cSCC (p = 0.004), and BSC (p = 0.018) compared to the healthy tissue. SMAD4 mRNA expression was decreased in the patients with BCC (p.0.001), cSCC (p.0.001), and BSC (p = 0.008). The staining characteristic of SMAD4 protein was negative in the cancer tissues of the patients with cSCC (p = 0.00). Lower SMAD4 mRNA levels were observed in the poorly differentiated cSCC patients ( p = 0.001). The staining characteristics of the SMAD4 protein were related to age and chronic sun exposure. Conclusions Hypermethylation of SMAD4 and reduced SMAD4 mRNA expression were found to play a role in the pathogenesis of BCC, cSCC, and BSC. A decrease in SMAD4 protein expression level was observed only in cSCC patients. This suggests that epigenetic alterations to the SMAD4 gene are associated with cSCC.Öğe A Study of FoxO1, mTOR, miR-21, miR-29b, and miR-98 Expression Levels Regarding Metabolic Syndrome in Acne Vulgaris Patients(Springernature, 2024) Akdag, Nazan; Atli, Engin; Zhuri, Drenushe; Guler, Hazal Sezginer; Urun, Yildiz GurselBackground: Acne vulgaris (AV) is an inflammatory skin disease caused by the mechanistic target of rapamycin complex 1 (mTORC1). forkhead box protein (Fox) O1 is known to regulate the relationship between the mTORC1 signaling pathway and insulin resistance (IR). Increased mTORC1 signaling is known to predispose one to diseases such as insulin resistance (IR), obesity, and diabetes mellitus. One of the major components of mTORC1 is mTOR. FoxO1 and mTOR play key roles in the onset and progression of metabolic syndrome (MetS). In this study, we aimed to elucidate the relationship between AV and MetS through FoxO1 and mTOR signaling pathways and microRNAs (miRs) associated with these signaling pathways. Methods: We examined 20 AV patients without MetS, 16 AV patients with MetS, and 20 healthy controls. The demographic characteristics of the patients, MetS parameters, clinical severity of AV (Global Acne Grading System, GAGS), and the homeostasis model assessment (HOMA) values were compared between the groups. In addition, the expression levels of FoxO1 and mTOR genes, along with the expression levels of miR-21, miR-29b, and miR-98, were assessed in skin biopsy samples from all groups using real-time polymerase chain reaction methods. FoxO1, mTOR, and miRNA expression levels were recorded as fold change. Results: The mean age of patients with AV without MetS was statistically lower. In AV patients with MetS, those with moderate GAGS scores had statistically significantly higher HOMA values than those with mild GAGS scores. FoxO1 expression was significantly lower in AV patients compared to controls. The mTOR expression levels of AV patients with MetS were significantly higher than the other two groups. The expression levels of miR-21 and miR-29b were significantly increased in the group of AV patients with MetS compared to the group of AV patients without MetS. Conclusions: These results suggested that the mTOR pathway may play an important role in explaining the relationship between AV and MetS in acne pathogenesis. They also suggested that miR-21 and miR-29b play a role in the inflammatory process of AV.
