Adenosquamous Carcinoma of the Skin: A Case Report

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

i 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 Authors

The authors did take my suggestions into consideration and the manuscript was improved