Adenosquamous Carcinoma of the Skin: A Case Report
Round 1
Reviewer 1 Report
Comments and Suggestions for Authorsi read with great interest the manuscript called Adenosquamous carcinoma of the skin should not be missed.
some flaws should be considered and corrected
1) A mini discussion about the UV related origin of adenosquamous carcinoma and a comparison with NMSC
You can use this citation:
Karampinis E, Aloizou AM, Zafiriou E, et al. Non-Melanoma Skin Cancer and Vitamin D: The "Lost Sunlight" Paradox and the Oxidative Stress Explanation. Antioxidants (Basel). 2023;12(5):1107. Published 2023 May 17. doi:10.3390/antiox12051107
2) you can compare your patient with other case reports reported
Fu JM, McCalmont T, Yu SS. Adenosquamous carcinoma of the skin: a case series. Arch Dermatol. 2009;145(10):1152-1158. doi:10.1001/archdermatol.2009.218
3) also a brief differential diagnosis of the lesion should be included
Author Response
1) A mini discussion about the UV related origin of adenosquamous carcinoma and a comparison with NMSC
You can use this citation:
Karampinis E, Aloizou AM, Zafiriou E, et al. Non-Melanoma Skin Cancer and Vitamin D: The "Lost Sunlight" Paradox and the Oxidative Stress Explanation. Antioxidants (Basel). 2023;12(5):1107. Published 2023 May 17. doi:10.3390/antiox12051107
-> see Text in red color: lines 12-19, lines 62-69, line 71
2) you can compare your patient with other case reports reported
Fu JM, McCalmont T, Yu SS. Adenosquamous carcinoma of the skin: a case series. Arch Dermatol. 2009;145(10):1152-1158. doi:10.1001/archdermatol.2009.218
-> see Text in green color: lines 76-79
3) also a brief differential diagnosis of the lesion should be included
-> see Text in blue color: lines 33-34
Reviewer 2 Report
Comments and Suggestions for Authors
This ‘letter’ is basically a case report of a rare cutaneous tumour, Adenosquamous carcinoma (ASC). This tumour is rare, therefore the case report potentially interesting, but the paper can be improved:
- The title reads somewhat awkward – the text does not clearly explain why ‘ASC should not be missed’ (aside from the known fact that this is a potentially aggressive tumour). Please revise.
- The clinical description could be more detailed: what was the (previous) ‘non-melanoma skin cancer’ on the patient’s shoulders? How long ago had it been diagnosed? Had the patient received heavy sun exposure in the past/was he an outdoor worker? was he taking any medications ? family history of skin tumours?
- The microscopic description should also be more detailed. Typically, ASC shows squamoid differentiation towards the surface (where it is connected to the epidermis) and glandular/ductal differentiation deeper. It may show atypical mitoses. Were these features present in this case? What was the thickness ?
- Additional immunohistochemical studies are needed to highlight the glandular/ductal component of the tumour (at least EMA and CEA). Consider also alcian blue staining for mucin. Representative photomicrographs should be provided. CDX-2 and TTF-1 could be used to rule out metastasis from an adenosquamous carcinoma of another origin.
- Legend of fig. 1 : the sentence ‘Skin biopsies revealed a tumor with mixed squamous and glandular differentiation’ should be deleted.
- The pathological photomicrographs should be improved as to colour density – details cannot be easily seen.
- The presentation of references should follow a uniform style.
- line 56: correct the typo (‘However; distant metastasis remains rare).
Comments on the Quality of English Language- line 56: correct the typo (‘However; distant metastasis remains rare).
Author Response
1) The title reads somewhat awkward – the text does not clearly explain why ‘ASC should not be missed’ (aside from the known fact that this is a potentially aggressive tumour). Please revise.
-> see title
2) The clinical description could be more detailed: what was the (previous) ‘non-melanoma skin cancer’ on the patient’s shoulders? How long ago had it been diagnosed? Had the patient received heavy sun exposure in the past/was he an outdoor worker? was he taking any medications ? family history of skin tumours?
-> see Text in pink color: lines 29-31
3) The microscopic description should also be more detailed. Typically, ASC shows squamoid differentiation towards the surface (where it is connected to the epidermis) and glandular/ductal differentiation deeper. It may show atypical mitoses. Were these features present in this case? What was the thickness?
-> see Text in orange color: lines 40-44
4) Additional immunohistochemical studies are needed to highlight the glandular/ductal component of the tumour (at least EMA and CEA). Consider also alcian blue staining for mucin. Representative photomicrographs should be provided. CDX-2 and TTF-1 could be used to rule out metastasis from an adenosquamous carcinoma of another origin.
-> see Text in orange color: lines 40-44
5) Legend of fig. 1: the sentence ‘Skin biopsies revealed a tumor with mixed squamous and glandular differentiation’ should be deleted.
-> done
6) The pathological photomicrographs should be improved as to colour density – details cannot be easily seen.
-> done
7) The presentation of references should follow a uniform style.
-> done
8) Correct the typo (‘However; distant metastasis remains rare).
-> see Text in brown color: line 81
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThe authors did take my suggestions into consideration and the manuscript was improved