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G A Krekels

Publications and source records attributed to G A Krekels.

5 recordsLinked to original sources
PubMed2006

Histopathological characteristics of metastasizing squamous cell carcinoma of the skin and lips.

AIMS: The reported incidence of metastasis from squamous cell carcinoma (SCC) of the skin and lip varies between 0.5% and 16%. Clinical and histopathological criteria have been proposed to identify tumours that may have an increased risk of metastasis. The aim of this study was to define such high-risk tumours, especially since the incidence of SCC of the skin is increasing. METHODS AND RESULTS: Histopathological features of metastasized skin and lip tumours and a matched group of non-metastasizing tumours were reassessed. Characteristics studied were: tumour width, excision margins, histological subtype, Clark level, Breslow depth, tumour differentiation, inflammation, perineural and angio-invasive growth, ulceration and desmoplasia. Data were statistically analysed separately for skin and labial lesions. Desmoplasia, Clark level, Breslow depth, maximum diameter, angio-invasion, grading, perineural invasion, plasma cells and eosinophilic inflammatory response proved to be statistically significantly related to metastasis of skin tumours. Breslow depth, plasma cells and grading appeared to be statistically significantly related to metastasis of SCC of the lips. CONCLUSIONS: A typical metastatic SCC showed: a tumour width of at least 15 mm, a vertical tumour thickness (=Breslow) of at least 2 mm, less differentiation, presence of desmoplasia and an inflammatory response with eosinophils and plasma cells.

Aged↗
PubMed2000

[Diagnostic image (13). Erythropoietic protoporphyria].

In a five-year-old girl with photosensitivity (burning skin sensation after a sun bath) and purpura on the nose and the sides of the fingers erythropoietic protoporphyria was diagnosed, an autosomal dominant disease.

Child, Preschool↗
PubMed1997

[Mohs' method of micrographic surgery as treatment for recurrent basal cell carcinoma].

OBJECTIVE: Evaluation of Mohs' micrographic surgery as treatment for recurrent basal cell carcinoma of the skin. DESIGN: Retrospective. SETTING: University Hospital Maastricht, the Netherlands. METHOD: In the period April 1992 to December 1995, 91 recurrent basal cell carcinomas (88 patients) were treated by Mohs' micrographic surgery. Medical records were analysed retrospectively with respect to different aspects. RESULTS: The mean age of the patients was 69 years. The recurrent basal cell carcinomas, with an mean diameter of 19.7 mm, were mainly localized on the nose and forehead. There were equal numbers of solid and morphea-like types of basal cell carcinomas. Most of these tumours had been treated by means of surgical excision in the past. The last treatment had taken place 3 years previously on average. Reconstruction was performed by means of primary closure, a graft or a flap. The mean follow-up period after Mohs' micrographic surgery was 12 months, in which one tumour recurred. CONCLUSION: Mohs' micrographic surgery is a surgical technique which provides the best prospect of total tumour removal together with maximal functional and cosmetic preservation. Mohs' micrographic surgery is of particular value for the treatment of recurrent basal cell carcinomas.

Adult↗
PubMedDate not supplied

Actinic keratosis: how to differentiate the good from the bad ones?

Our objective was to obtain practical clinical parameters to indicate those actinic keratoses (AK) that are at risk of becoming invasive. A systematic review of the literature, with focus on randomized trials, retrospective studies and reviews was undertaken. The main outcome measure was the rates and clinical features of AK that transformed into SCC. This study reviewed randomized and retrospective studies and reviews of AK and their risk of becoming SCC. We reviewed a total of 875 studies and identified 62 useful prospective, retrospective studies and reviews. Finally 15 studies covering percentage and/or clinical parameters of malignant transformation were found to be useful: a total of 9 reviews, 4 randomized controlled trials and 2 retrospective studies. Only 1 study (meta-analysis) examined the percentage of malignant transformation and found a rate between 0.025% and 20% per year/per lesion. Clinical parameters found were: induration (3 studies), bleeding (3 studies), enlargement in diameter (3 studies), erythema (2 studies) and ulceration (2 studies). Other minor clinical criteria were pain, palpability, hyperkeratoses, pruritic lesions and pigmentation. The amount of quality research on the most common premalignant lesion in humans is disappointing. The only longitudinal study looking at the incidence of malignant transformation of AK to SCC dates from 1988. Besides the known risk factors (skin type, photodamage, immunosuppression etc), based on this review we found clinical features that provide a practical guide to practitioners in the treatment of AK. Although not prospectively studied, clinical parameters indicating those AK with an increased risk of malignancy are IDRBEU. I (Induration /Inflammation), D (Diameter > 1 cm), R (Rapid Enlargement), B (Bleeding), E (Erythema) and U (Ulceration). In future prospective studies, these parameters should be included.

Diagnosis, Differential↗