Clinical and Histopathologic Profile of Patients with Cutaneous Metastasis in a Tertiary Hospital in the Philippines

Round 1

Reviewer 1 Report

This paper adds to the knowledge of the clinical and histological presentation of cutaneous metastases in the Asian population and in particular, the Filipino population.

Comments: 

1) The cells in the biopsy findings described in Line 62: are these neoplastic or hyperplastic cells?

2) The description of the morphology of the primary lesions and their associated secondary changes in Table 2 can be simplified.

3) Inclusion of clinical and histological pictures would illustrative and instructive to readers.

4) Please include the cytokeratins (CK) done for patient 18 and 106 in Table 4. 

Author Response

Thank you for your valuable comments for this study. Kindly see the responses for each point raised. Spell check and few changes in sentence structure were also done.

Point 1: The cells in the biopsy findings described in Line 62: are these neoplastic or hyperplastic cells?

The cells were neoplastic. These were changed in the paper accordingly (62).

Point 2: The description of the morphology of the primary lesions and their associated secondary changes in Table 2 can be simplified.

These are noted. The primary lesions were simplified, those with combination of primary lesions were discussed in the paper instead of placed in the table. We reviewed the primary data in order to simplify the groupings for the secondary lesions.

Point 3: Inclusion of clinical and histological pictures would illustrative and instructive to readers.

The histologic photos and representative photos for each pattern are added in the paper (Figure 4 and 5). Due to the retrospective nature of the study, inclusion of available clinical photos proved challenging especially with the retrieval of consent from the patients. The ethical approval of this study only covered photos of the slides and not of the patients.

Point 4: Please include the cytokeratins (CK) done for patient 18 and 106 in Table 4. 

Thank you for this comment. The cytokeratins done were pancytokeratin or CK AE1/ AE3 for both cases.

Reviewer 2 Report

Thanks for the opportunity to review this study. Although this type of study is common in Western-Countries, it is rare in the literature based on data from Asian Country.

Comments for author File: Comments.pdf

Author Response

Thank you for your valuable comments for this study. Kindly see the responses for each point raised. Spell check and few changes in sentence structure were also done.

Point 1: Please clarify "Nodules with plaques or just plaques"? If just plaques, please remove "with" Please clarify "Indurated with vesicles /wheals? If just vesicles /wheals, please remove "with"

Table 2 was revised to simplify the primary lesions. The combinations of lesions were discussed further in text instead of incorporated in the table.

Point 2: Percentages on the figures are blurry

Thank you. Percentages are enlarged in the updated photo (Figure 3)

Point 3: consider remove "with" in table 3

These were noted. The word “with” was removed in Table 3.

Point 4: Consider deleting table 4 since it does not add any significant findings

In the opinion of the authors, Table 4 was included in order to show what the usual immunohistochemical (IHC) stains were performed in the institution. For context, the stains are costly and shouldered usually by the patient. Hence, the dermatopathologists are usually limited to 1-3 stains. This is in contrast to first-world countries were IHC panels are usually ordered. Furthermore, there are stains that are not available in the Philippines, such as SOX10, hence HMB-45 was performed more to confirm the diagnosis of melanoma.

Round 2

Reviewer 1 Report

A few suggestions and minor amendments for this manuscript.

1)    Table 2. Secondary changes instead of secondary lesions.

2)    Figure 4. Caption for E is missing.

3)    Table 4. For patient 18 and 106, change from CKAE1/AE3 to AE1/AE3

4)    Clarification for Line 404-406: p63 (if positive, rules in squamous cell carcinoma and other adnexal carcinomas, and helpful in ruling out primary cutaneous carcinoma if negative).

5)    Repetition in Line 422: These patients experience poor experience poor quality of life due to the risk for infection, bleeding, disfigurement and pain.

Author Response

Your comments are highly appreciated. Kindly see below for the revisions made in this version:

Point 1: Table 2. Secondary changes instead of secondary lesions.

“Secondary lesions” was revised to “secondary changes”. Secondary changes was also updated in the text.

Point 2: Figure 4. Caption for E is missing.

Captions were revised and updated, included caption for photo E.

Point 3: Table 4. For patient 18 and 106, change from CKAE1/AE3 to AE1/AE3

These were noted and revised in table 4.

Point 4: Clarification for Line 404-406: p63 (if positive, rules in squamous cell carcinoma and other adnexal carcinomas, and helpful in ruling out primary cutaneous carcinoma if negative).

The statement has been revised to the following: p63 (negative staining is helpful to rule out primary cutaneous carcinoma, while positive staining rules in squamous cell carcinoma and other primary adnexal carcinomas).

Point 5: Repetition in Line 422: These patients experience poorexperience poor quality of life due to the risk for infection, bleeding, disfigurement and pain.

Repetitive statement was removed.

Reviewer 2 Report

Thanks for making the appropriate changes.

Author Response

Your comments and suggestions are deeply appreciated. Thank you for this opportunity!