rss_2.0Serbian Journal of Dermatology and Venereology FeedSciendo RSS Feed for Serbian Journal of Dermatology and Venereology Journal of Dermatology and Venereology Feed Maligna as an Initial Presentation of Underlying HIV Infection in a Homosexual Man<abstract><title style='display:none'>Abstract</title><p> Lues maligna is a rare ulcerative form of secondary syphilis. This clinical entity is predominantly found in patients living with HIV or AIDS. We report a case of a 32-year-old homosexual man with diffuse non-pruritic, papular skin lesions, ulcerated nodules and plaques disseminated on the face, trunk and extremities. The rash was followed by fever, malaise and joint pains. Serological tests for syphilis were positive. The patient was treated with intramuscular penicillin and the lesions resolved completely. Lues maligna was an initial presentation of underlying HIV infection. The HIV seropositivity was confirmed by Western blot analysis. Due to the increased number of syphilis cases and frequent HIV co-infection in Serbia, dermatologists must be able to recognize this condition based on clinical characteristics and risk factors and to diagnose and treat it promptly.</p></abstract>ARTICLEtrue Larva Migrans – Report of 2 new Cases Locally Acquired in Serbia<abstract><title style='display:none'>Abstract</title><p> Cutaneous larva migrans (CLM) is a parasitic skin disease caused by the accidental percutaneous penetration and subsequent intraepidermal migration of larvae of various nematode parasites of the hookworm family. The hookworms responsible for CLM are spread worldwide, but the infection occurs mostly in tropical and subtropical climates. Nowadays, because of ever increasing foreign travel, the disease is no longer confined to these areas. Moreover, a significant increase of autochthonous cases in southern Europe has been observed in recent years. We report two new patients from Serbia who acquired CLM, none of them having traveled abroad. As the recommendations for the treatment of CLM are not uniform, two different treatment modalities were applied in these patients, both with an excellent response.</p></abstract>ARTICLEtrue Cell Carcinoma Arising from Linear Porokeratosis - a case report and review of the literature<abstract><title style='display:none'>Abstract</title><p> Porokeratosis belongs to a group of disorders of keratinization that are characterized by the histopathological feature of the cornoid lamella, a column of tightly fitted parakeratotic cells. The etiology of porokeratosis is still unclear. Different variants of porokeratosis (PK) have been subsequently recognized, each with its own specific properties in terms of morphology, distribution and clinical course. Linear porokeratosis is one of the variants of porokeratosis, a rare disorder of keratinization that may develop into several epidermal malignancies, squamous cell carcinoma being the most frequent among all of them. Thus, a clinical surveillance for malignancy is an imperative. We present a case of a 54-year-old man with non-healing ulcer of the lower leg caused by squamous cell carcinoma arising on long-standing linear porokeratosis. The treatment included wide excision of tumor with the reconstruction of the area. Acitretin was prescribed for linear porokeratosis treatment. The follow-up of our patient so far has shown that he does not have new malignant lesions after surgical excision.</p></abstract>ARTICLEtrue OF THE MONTH Nevi with Site-Related Atypia<abstract><title style='display:none'>Abstract</title><p> The term “nevi of special sites” refers to melanocytic nevi of specific anatomic locations including the breast, axillae, umbilicus, genitalia, flexural areas, acral surfaces, ear, scalp and the conjunctiva. Nevi from these anatomic sites display sometimes dermoscopic and histological features of melanoma, resulting in unnecessarily high rates of excisions and re-excisions. Some authors have categorized nevi excised in the axillary, breast, umbilical and perineal areas as the nevi of the milk line. Two patients, a 32-year-old female and 23-year-old male with breast and periumbilical pigmented lesions, presented to our Department during 2017. Dermoscopy revealed features that were highly specific for melanoma. Excisional biopsies were done and histopathology revealed benign nevi with present site-related atypia. Irregular blotches, non-uniform radial streaks, blue-gray veil, and regression are the most specific features of melanoma of the breast and flexural areas. Excision is always recommended in pigmented lesions on the breast and flexural areas, which exhibit these features. However, larger studies are needed to define specific criteria required to distinguish special-site nevi from melanoma.</p></abstract>ARTICLEtrue Tank Granuloma – a Case Report<abstract><title style='display:none'>Abstract</title><p> Swimming-pool granuloma and fish tank granuloma refer to the infections caused by Mycobacterium marinum. After having been discovered in salt water fish in Philadelphia Aquarium and described in 1926, this skin infection was first reported in humans in 1951. It developed in people who had swum in contaminated swimming pools. M. marinum is a non-tuberculous, atypical mycobacterium, which is found on plants, soil and fish in freshwater and salt water worldwide. Humans become infected usually after trauma and contact with an aquatic environment. Infection is limited to the skin and usually occurs in healthy individuals, but in immunocompromised patients the infection may disseminate or spread to the subcutis and bone. The lesions usually appear as solitary nodules or plaques that may lead to suppurative ulcers after 2-3 weeks of incubation. Occasionally, there may be sporotrichoid spread along lymphatics. Its diagnosis is frequently delayed, probably because the infection is very rare and a history of aquatic exposure, which is present in the majority of cases, is often overlooked. Common misdiagnoses include fungal and parasitic infection, cellulitis, verrucous tuberculosis of the skin, gout, rheumatoid arthritis, a foreign body and a skin tumour. We present a case of a 39-year-old Caucasian male with a 12-month history of a single erythematous tender nodule on the right dorsal aspect of the right hand. Histopathological examination revealed longstanding suppurated granulomatous inflammation. The infection was not responsive to several courses of antibiotics until we introduced doxycycline capsules as monotherapy which led to complete remission after 5 months.</p></abstract>ARTICLEtrue Case of the Month<abstract><title style='display:none'>Abstract</title><p>Mammary Paget's disease is a rare intraepithelial carcinoma of the nipple/areola complex often associated with ductal breast carcinoma. We report a case of a 55-year-old female patient with a classical form of mammary Paget's disease associated ductal ipsilateral breast carcinoma. Dermoscopy of Paget's disease revealed a whitish-pink area with polymorphous vessels organized in irregular nests separated by pale streak-like structures, with peripheral light brown diffuse pigmentation. Dermoscopic features described in this case are in agreement with rare previous reports and may contribute to better differentiation of mammary Paget's disease from clinically similar lesions.</p></abstract>ARTICLEtrue Congenita - Can a Specific Phenotype be a Clue to a Genetic Defect? - a Case Report and Literature Review<abstract><title style='display:none'>Abstract</title><p>Pachyonychia congenita (PC) is a rare inherited disorder of keratinization characterized by hypertrophic nail dystrophy, painful palmoplantar blisters, cysts, follicular hyperkeratosis and oral leukokeratosis. These pathological clinical features are resulting from mutations in keratin proteins including KRT6A, KRT6B, KRT6C, KRT16, and KRT17. We present a 6-year-old girl with hypertrophic nail dystrophy, follicular hyperkeratosis, circumscribed plantar keratoderma and oral leukokeratosis. The features were consistent with the diagnosis of PC. The patient has been registered in the International Pachyonychia Congenita Research Registry (IPCRR) and is waiting for a detailed genetic analysis. The IPCRR has contributed to publication of numerous papers which emphasized the importance of the mutation type affecting various clinical presentations of PC. Based on recent data, a new classification system has been developed for PC, and it is gradually replacing the earlier classifications. It is based almost exclusively on the mutated genes. In this report we have raised the hypothesis that distinctive clinical features may be highly suggestive of a specific keratin mutation.</p></abstract>ARTICLEtrue Systemic Mastocytosis – a Case Report<abstract><title style='display:none'>Abstract</title><p>Indolent systemic mastocytosis is a benign form of systemic mastocytosis characterized by an abnormal proliferation of mast cells either in the bone marrow or in numerous tissues. Case Report: A 27-year-old female patient was admitted to our department due to urticaria which started a month ago. Before the skin changes appeared, our patient suffered from a toothache, so she took various painkillers (nimesulide, ibuprofen, acetylsalicylic acid, paracetamol). During skin examination, individual hyperpigmented macules on the trunk and lower limbs were observed as incidental findings. The patient reported having them for the last two years. Darier's sign was positive. Following the examination, she was admitted due to suspected urticaria pigmentosa. Laboratory Findings: erythrocyte sedimentation rate: 9 mm/h; complete blood count, urine, blood glucose, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, urea, creatinine, and uric acid were within normal ranges. Electrolytes: sodium, potassium, chlorine clearance, total calcium and calcium ionized, osteocalcin, and crosslaps were within normal ranges as well. Fibrinogen: 5.57 g/l; 5-Hydroxyindoleacetic acid: 49.8 umol/dU (10.4 - 31.2). Bone densitometry, chest x-ray and upper abdomen ultrasound findings were normal. The suspected clinical diagnosis of urticaria pigmentosa was confirmed by skin biopsy. Histopathological examination of the bone marrow showed moderately increased cellularity (60 - 70%). All three types of blood cells were slightly multiplied. Focal infiltrations were found in the perivascular area, consisting of elongated, oval cells with abundant eosinophilic granular cytoplasm. The nuclei were regular, oval shaped with finely granular chromatin and inconspicuous nucleoli. No nuclear atypia was found. These cells are highly CD117-positive. This finding strongly indicated bone marrow infiltration in systemic mastocytosis. The diagnosis was based on ‘major’ and ‘minor’ diagnostic criteria. The recommended therapy included H1 and H2 antagonists and topical corticosteroids. Conclusion: Regular follow-up was recommended in order to prevent complications and malignant alterations.</p></abstract>ARTICLEtrue Cutaneous Mastocytosis in a Child - a Case Report<abstract><title style='display:none'>Abstract</title><p>Mastocytosis refers to a group of diseases characterized by a clonal proliferation and accumulation of mast cells in one or more tissues/organs with different clinical presentations. In children, limited cutaneous forms of mastocytosis are rather frequent, while systemic mastocytosis is rare. The diagnosis of cutaneous mastocytosis is based on clinical findings and histopathology. We present a patient who developed skin lesions at the age of 18 months. Clinical findings, confirmed by histopathology, were consistent with diffuse cutaneous mastocytosis. The follow-up period was 7 years. The treatment included oral antihistamines in combination with mast cell stabilizers, mild topical steroids and avoidance of friction. During the follow-up period, there were no signs of systemic involvement, and the quality of life was preserved, despite the large surface of affected skin. This case report should increase the awareness and knowledge of clinicians about this rare form of cutaneous mastocytosis in the pediatric population.</p></abstract>ARTICLEtrue Manifestations in HIV Infected Libyan Patients<abstract><title style='display:none'>Abstract</title><p>Cutaneous manifestations of human immunodeficiency virus (HIV) disease may result from HIV infection itself, or from opportunistic disorders secondary to the declined immunocompetence due to the disease. A total of 220 HIV positive patients, treated in the Benghazi Center of Infectious Diseases and Immunology over a period of 14 years (January 2003 to November 2016), were included in a retrospective study. The patients' age ranged from 7 to 46 years. The study was conducted by reviewing the patients' records using the management information system (MIS). Statistical analysis of the data was carried out by the t-test and Chi square test. Among the studied patients, 119 (54.1%) were males and 101 (45.9%) were females, and most of them (78.6%) were 10 – 19 years of age. The predominant mode of transmission was parenteral transmission, in 95% of patients, and positive family history was observed in 12% of patients. Among the total number of visits to dermatologists, 93% of patients had a single disease. Of the total number of skin diseases diagnosed during the visits, parasitic infestations were seen in 92 patients (21.0%), eczematous and related disorders in 78 patients (17.8%), viral infections in 71 patients (16.2%), bacterial infections in 41 patients (9.3%), and fungal infections in 35 patients (7.9%). Dermatophyte infections were the most common fungal infections recorded in 19 patients (4.3%), followed by Candida infection in 11 patients (2.5%). Warts were found in 5.9% of viral infections, followed by herpes zoster (4.1%). HIV positive patients should be examined for skin disorders, because early diagnosis and management of such problems improves the quality of life in these patients.</p></abstract>ARTICLEtrue Case of the Month Combined Nevus - a Case Report<abstract><title style='display:none'>Abstract</title><p> Combined nevi are melanocytic lesions composed of two or more distinct types of melanocytic populations within the same lesion. Different types of combined nevi may form bizarrely shaped, multicolored skin lesions, making them one of the greatest melanoma mimickers. We report a 48-year-old female patient with suspicious skin lesion in the left lumbar region. Clinically, there was an oval, slightly asymmetrical lesion measuring 6 x 4 mm, showing multiple colors and shades of brown and black. A dermoscopic examination revealed a brown-bluish coloration in the right part of the lesion, while a fine pigment network with perifollicular halo was found in the left part of the lesion, suggesting the diagnosis of a combined nevus. Histological examination showed a poorly circumscribed proliferation of dendritic melanocytes in the superficial and deep dermis and proliferation of melanocytes in the dermoepidermal junction. A surgical excision of the tumor was performed, in order to confirm the dermoscopic findings. In conclusion, dermoscopy is useful in differentiating combined nevi from other melanocytic lesions.</p></abstract>ARTICLEtrue Cutaneous Diffuse Large B-Cell Lymphoma – a Case Report<abstract><title style='display:none'>Abstract</title><p> In 2005, the World Health Organization - European Organization for Research and Treatment of Cancer (WHOEORTC) classified cutaneous B-cell lymphomas into 4 categories: primary cutaneous marginal zone B-cell lymphoma (PCMZL), primary cutaneous follicle center lymphoma (PCFCL), primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT), and primary cutaneous diffuse large B-cell lymphoma, other (PCDLBCL-O). The absence of evident extra-cutaneous disease is a necessary condition for the diagnosis of primary cutaneous B-cell lymphomas, because they have a completely different clinical behavior and prognosis from their nodal counterparts. PCDLBCL-O basically represents a morphological variation, lacking the typical features of PCDLBCLLT, neither confirming the definition of PCFCCL, but on the clinical ground, its behavior seems at least to partially overlap the indolent course of PCFCCL. In fact, the present WHO lymphoma classification from 2008 overcame the previous WHO-EORTC classification, including at least a part of PCDLBCL-O within the spectrum of PCFCCL. However, owing to the rarity and heterogeneity of the PCDLBCL-O, the precise clinicopathological characteristics have not been well characterized and the optimal treatment for this group of lymphomas is yet to be defined. Nevertheless, dermatologists and pathologists should be aware of this entity in order to avoid unnecessary aggressive treatment. We present a case of a 46-year-old Caucasian male with one large round-shaped tumor and a few scattered nodules localized on the back. The histopathological features of the lesion corresponded to PCDLBCL-O. The patient follow-up showed that he was disease-free three months after surgical excision of the lesions and adjuvant local radiotherapy. No additional therapy was introduced, including chemotherapy with rituximab, cyclophosphamide, doxorubicin hydrochloride, oncovin, prednisolone (R-CHOP).</p></abstract>ARTICLEtrue Notification for Gonorrhea and Syphilis in Belgrade<abstract><title style='display:none'>Abstract</title><p> “Contact tracing” or “partner notification” refers to clinicians’ efforts to identify sex partners of infected persons to ensure their medical evaluation and treatment. For many years partner notification has been a cornerstone in the management of patients diagnosed with sexually transmitted infections (STIs) and it is the essential component in the control of these infections. Clinicians’ efforts to ensure the treatment of a patient’s sex partners can reduce the risk for re-infection and potentially diminish transmission of STIs. Partner notification includes three different approaches for notifying the sexual partners of the person infected with a STI: provider referral, patient referral, and contract referral. The aim of our study was to evaluate the efficacy of partner notification among syphilis and gonorrhea cases registered at the City Institute for Skin and Venereal Diseases in Belgrade in 2016, and its contribution to prevention and control of these diseases. A retrospective chart review of patients with gonorrhea and early syphilis registered in 2016 was undertaken. We analyzed data about the possible source of infection as well as sexual orientation, provided on the official form for notification of syphilis and gonorrhea. The study included 112 male patients, 67 with gonorrhea and 45 with syphilis. Out of three modalities of partner notification offered to patients, only patient notification of sexual partner/s was accepted. Although all patients accepted this type of partner notification, index patients with gonorrhea notified only 17 partners (25.4%) and index patients with syphilis also notified 17 partners (37.8%). The effectiveness of partner notification for gonorrhea and syphilis cases was only 30.4%, and its contribution to prevention and control of these diseases was lower than we expected. National guidelines offering standardized protocols for partner notification service provision can improve this process, as a novel approach with non-traditional method of partner notification such as patient-delivered partner therapy.</p></abstract>ARTICLEtrue a Rare Variant of Lipidized Dermatofibroma from Nonlipidized Dermatofibromas in a Patient with Hypothyroidism and Alopecia Areata<abstract><title style='display:none'>Abstract</title><p> Introduction. Lipidized dermatofibromas represent rare and often underrecognized variants of dermatofibromas. Histologically, dermatofibromas are composed of fibroblast-like spindle cells, foam cells, giant cells, siderophages, lymphocytes, capillaries, collagen fibers, and hyaline dermal collagen fibers. Lipidized dermatofibromas are characterized by numerous foam cells, Touton giant cells, and hyalinized wiry collagen in the stroma. Case report. We present a case of a 31-year-old woman with a history of hypothyroidism and alopecia areata, presenting with an enlarging 8 mm, firm erythematous nodule on her upper-mid back. Biopsy examination showed a cellular proliferation of spindle cells with peripheral collagen trapping and cholesterol clefts with associated foam cells and sclerosis, staining weakly positive for Factor XIIIa and negative for CD34. The diagnosis of a benign lipidized dermatofibroma was rendered. Conclusion. Lipidized dermatofibromas are rare histologic variants of dermatofibromas, biologically indolent, and should be distinguished from other cutaneous foamy histiocytic lesions, particularly xanthomas, which may alter patient management.</p></abstract>ARTICLEtrue Laterothoracic Exanthem – Asymmetric Periflexural Exanthem of Childhood – a Case Report and Literature Review<abstract><title style='display:none'>Abstract</title><p> Unilateral laterothoracic exanthem (ULE), or asymmetric periflexural exanthem of childhood (APEC), is an uncommon skin eruption that usually occurs in childhood, with unilateral distribution and self limiting course. The etiology of ULE is unknown, but viral cause is suspected. We report a case of ULE in a 4-year-old girl, that was associated with parvo virus B19 infection, and a brief selected literature review. The patient presented with unilateral maculopapular rash on the left side of the body which was asymptomatic and resolved spontaneously within 5 weeks. The clinical diagnosis of ULE may be precise, ruling out a broad spectrum of differential diagnosis, and prevent unnecessary examinations, whereas the patient is informed about the benign self-limiting nature of ULE.</p></abstract>ARTICLEtrue Pediatric Case of Disseminated Lichen Sclerosus – a Case Report<abstract><title style='display:none'>Abstract</title><p>Lichen sclerosus (LS) is an uncommon chronic inflammatory skin disorder with a predilection for the anogenital area, characterized by porcelain white papules, plaques and atrophic patches. We report a prepubertal, 12-year-old girl who presented with chronic, disseminated pearly, flat-topped papules, plaques and atrophic patches located on the trunk, limbs and in the anogenital area, consistent with LS based on clinical and histologic findings. Potent and ultrapotent topical corticosteroids should be considered as first-line treatment. The ultraviolet A1 (UVA1) and calcipotriol for extragenital lesions, as well as calcineurin inhibitors for anogenital lesions, are other treatment options for pediatric LS.</p></abstract>ARTICLEtrue Pemphigus in a Child – a Case Report<abstract><title style='display:none'>Abstract</title><p>IgA pemphigus (IGAP) is a rare autoimmune bullous disease characterized by IgA deposits on keratinocyte cell surfaces. The IGAP is classified into: 1) subcorneal pustular dermatosis (SPD) type, and 2) intraepidermal neutrophilic (IEN) IgA dermatosis type. So far, only 9 children with IGAP have been described in the literature, of whom only 3 with SPD type. We report a 3-year-old boy with SPD type of IGAP. Clinically, he presented with pruritic vesicles, pustules and erosions on the face, trunk, groin area, and extremities. Histopathology showed subcorneal pustules containing a few acantholytic cells. Direct immunofluorescence (DIF) test of Tzanck smear showed intercellular IgA deposits on the surface of the groups of epidermal cells. Oral dapsone and prednisone induced remission after two weeks; the treatment was discontinued 11 months later, and complete remission was achieved during 19 months without any treatment. Direct immunofluorescence of Tzanck smear is a simple, sensitive, rapid and non-aggressive test, very suitable for the diagnosis of IGAP in children.</p></abstract>ARTICLEtrue Vegetans – a Case Report<abstract><title style='display:none'>Abstract</title><p>Pyoderma vegetans (PV) or blastomycosis-like pyoderma (BLP) is a chronic inflammatory disease, by some authors considered a rare variety of pyoderma gangrenosum (PG), and others describe it as a distinct entity. It commonly presents with verrucous plaques with multiple pustules. The etiology of this disease is unknown, but it has been connected with staphylococcal and streptococcal infections, inflammatory bowel disease, hematological diseases, primary immunodeficiency, alcoholism, and nutritional deficit. Here we present a 66-year-old, otherwise healthy female, with a 2-year-long history of well-defined, vegetative livid plaques with multiple pustules on the dorsal side of both hands. Histopathological analysis of the skin biopsy of the hand showed chronic inflammation and micro-abscesses, ruptured follicular cysts and follicular pseudoepitheliomatous hyperplasia. Treatment with anti-tuberculosis drugs and antibiotics showed to be ineffective, as well as the treatment with systemic corticosteroids, dapsone and cyclosporine. Itraconazole was given for its immunomodulatory effects and findings of Penicillium species in one of the swabs, which led to partial regression of lesions. Since the treatment did not lead to complete resolution, acitretin was indicated 3 months later, but the patient was lost to follow-up.</p></abstract>ARTICLEtrue Red Nodule on the Cheek - a Case Report<abstract><title style='display:none'>Abstract</title><p>Introduction: Merkel cell carcinoma (MCC) is a rare, very aggressive neuroectodermal tumor of the skin typically located on sun-exposed areas and frequently found in Caucasian men between 70 and 80 years of age.</p><p>Case Report: We present a case of a 86-year-old woman who was referred to our Skin Cancer Unit with a red and well defined nodule located on her left commissure of the mouth, that grew during a couple of months and was completely asymptomatic. Dermoscopic examination revealed a reddish background with linear and arborizing irregular vessels, some out of focus vessels and whitish areas. The lesion was excised, histological examination showed that the tumor was hypercellular and composed of round epithelial elements with large nuclei and scant cytoplasm suggestive of MCC. Immunohistochemical stains confirmed a diffuse positivity with cytokeratin (CK) 2 chromogranin, and synaptophysin; CK7 and thyroid transcription factor-1(TTF-1) were negative. Sentinel lymph node biopsy was done, resulting negative for neoplastic cells, and computed tomography (CT) of the chest, abdomen and pelvis showed no distant metastasis. Adjuvant radiotherapy on the tumor site and on homolateral neck lymph nodes was also done.</p><p>Conclusion: Merkel cell carcinoma presents as an asymptomatic, rapidly growing nonpigmented nodule without specific characteristics. Dermoscopic features may help to distinguish MCC from other similar tumors: linear irregular vessels, milky pink areas, architectural disorders and structureless areas, even if not specific, when present are strongly suggestive of MCC. Wide excision with 2 cm margins with adjuvant radiotherapy is the treatment of choice in high-risk primary tumors, while sentinel lymph node biopsy and computed tomography scans are necessary for early diagnosis of metastatic disease.</p></abstract>ARTICLEtrue Use Among Belgrade High School Students<abstract><title style='display:none'>Abstract</title><p>Introduction: The incidence of melanoma has been increasing worldwide. Ultraviolet (UV) radiation from the sun and sunbeds are the major risk factors for the development of melanoma and non-melanoma skin cancers. Excessive UV exposure during childhood and adolescence increases the probablity of skin cancer in adulthood. The objective of this study was to analyze the exposure to artificial UV radiation using sunbeds among Belgrade high school students.</p><p>Material and Methods: The study was conducted using a questionnaire among 549 3<sup>rd</sup> and 4<sup>th</sup> grade students in 4 Belgrade high schools. The questionnaire included 10 questions on the sunbed use, attitudes, and general knowledge about effects of UV radiation from sunbeds. Statistical analysis assessed the frequency rate and relative frequency as methods of descriptive statistics.</p><p>Results: A total of 39% of participants had used a sunbed at least once, and 38% plan on using it in the future. When asked at what age they first used a sunbed, 45.66% of high school students stated that it was at the age of 13 or 14. Most adolescents have used a sunbed less than 5 times (38%), whereas 8% of them used it over 30 times.</p><p>Conclusion: The awareness of the risks associated with UV exposure in sunbeds is not at a satisfying level among Belgrade high school students. Educational and legislative measures are necessary to protect this highly sensitive population and prevent malignant consequences.</p></abstract>ARTICLEtrue