{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:21:42Z","timestamp":1760059302565,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Radiodermitis is an inflammatory or dystrophic skin process caused by the direct action of ionizing radiation. The primary objective was to study two clinical cases. The secondary objective was to propose the foundations of an intelligent system for decision support in complex cases of radiodermitis diagnosis that can operate even in the case of a low amount of available clinical data that can be used for training. Methods: The first case is a female patient, aged 74 years, with squamous cell carcinoma on a chronic radiodermitis site, which appeared after 20 years of local radiotherapy treatment for mammary adenocarcinoma. Dermatologic examination revealed five round-oval nodules between 2 and 8 cm in diameter. They were pink colored with lilac edges, hard and infiltrated on palpation, adherent to the subcutaneous tissue, painless, and located above and lateral on the right chest and the upper region of the right hypochondrium. The second case concerns a 60-year-old patient with verrucous squamous cell carcinoma appearing on a chronic radiodermatitis 40 years after local radio-therapeutic treatment with Chaoul rays for a deep right temporal region mycosis. There are presented artificial intelligence (AI) challenges regarding the application of advanced hybrid models in decision support for diagnosis of difficult radiodermitis cases, in that intelligent computing must be made in the context of very little available data, and collaboration between physicians is necessary. Results: Both cases were confirmed by histology as squamos cell carcinomas. In the AI research, the adaptation of the IntMediSys intelligent system was proposed for solving complex cases of radiodermitis. The proposal integrates different AI technologies, which include agents, intelligent computing, and blackboard systems. Conclusions: The presented first cases confirm the presence of a squamous cell carcinoma that appeared on chronic radiodermitis after a long latency. The foundations of a highly complex collaboration and decision support system that can assist physicians in the radiodermitis diagnostics establishment that opens the path for further development are presented.<\/jats:p>","DOI":"10.3390\/jcm14113921","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T06:21:51Z","timestamp":1748931711000},"page":"3921","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Reports and Artificial Intelligence Challenges on Squamous Cell Carcinoma Developed on Chronic Radiodermitis"],"prefix":"10.3390","volume":"14","author":[{"given":"Gyula L\u00e1szl\u00f3","family":"Fekete","sequence":"first","affiliation":[{"name":"Department of Dermatology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"CMI Dermamed Private Medical Office, 540530 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6254-9291","authenticated-orcid":false,"given":"Laszlo Barna","family":"Iantovics","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00falia Edit","family":"Fekete","sequence":"additional","affiliation":[{"name":"National Institute of Public Health, Regional Center for Public Health, 540142 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e1szl\u00f3","family":"Fekete","sequence":"additional","affiliation":[{"name":"Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e6058","DOI":"10.1002\/ccr3.6058","article-title":"Radio-induced simultaneous development of squamous cell carcinoma and undifferentiated pleomorphic sarcoma of scalp","volume":"10","author":"Malakoutikhah","year":"2022","journal-title":"Clin. Case Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1177\/12034754221100192","article-title":"Squamous Cell Carcinoma Arising From Chronic Radiodermatitis","volume":"26","author":"Yu","year":"2022","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"318","DOI":"10.2307\/3578117","article-title":"Radiation-induced skin carcinomas of the head and neck","volume":"125","author":"Ron","year":"1991","journal-title":"Radiat. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4616","DOI":"10.1016\/j.jaad.2005.08.054","article-title":"Radiation dermatitis: Clinical presentation, pathophysiology, and treatment 2006","volume":"54","author":"Hymes","year":"2006","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1111\/j.1365-2230.2006.02218.x","article-title":"Radiation-induced cutaneous carcinoma of the head and neck: Is there an early role for p53 mutations?","volume":"31","author":"Franchi","year":"2006","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.exphem.2007.01.017","article-title":"Radiation-induced alterations in cytokine production by skin cells","volume":"35","author":"Muller","year":"2007","journal-title":"Exp. Hematol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2307\/3578641","article-title":"Increased expression of the epidermal growth factor receptor in human epidermal keratinocytes after exposure to ionizing radiation","volume":"136","author":"Peter","year":"1993","journal-title":"Radiat. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1093\/annonc\/mdm400","article-title":"Consensus guidelines for the management of radiation dermatitis and coexisting acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck","volume":"19","author":"Bernier","year":"2008","journal-title":"Ann. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.hoc.2006.01.017","article-title":"Sarcoma and skin radiation oncology","volume":"20","author":"Nedea","year":"2006","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.canrad.2003.12.003","article-title":"Radio-induced malignancies of the scalp about 98 patients with 150 lesions and literature review","volume":"8","author":"Maalej","year":"2004","journal-title":"Cancer Radiother."},{"key":"ref_11","first-page":"692","article-title":"Artificial intelligence-empowered cellular morphometric risk score improves prognostic stratification of cutaneous squamous cell carcinoma","volume":"49","author":"Mao","year":"2023","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1001\/jamadermatol.2013.2139","article-title":"Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: A 10-year, single-institution cohort study","volume":"149","author":"Schmults","year":"2013","journal-title":"JAMA Dermatol."},{"key":"ref_13","first-page":"903","article-title":"Next Generation Hybrid Intelligent Medical Diagnosis Systems, 24th International Conference","volume":"Volume 10636","author":"Liu","year":"2017","journal-title":"Neural Information Processing (ICONIP 2017), Guangzhou, China, November 14\u201318, 2017, Proceedings, Part III"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Knuutila, J.S., Riihil\u00e4, P., Karlsson, A., Tukiainen, M., Talve, L., Nissinen, L., and K\u00e4h\u00e4ri, V.M. (2022). Identification of metastatic primary cutaneous squamous cell carcinoma utilizing artificial intelligence analysis of whole slide images. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-13696-y"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Brorsen, L.F., McKenzie, J.S., Tullin, M.F., Bendtsen, K.M.S., Pinto, F.E., Jensen, H.E., Haedersdal, M., Takats, Z., Janfelt, C., and Lerche, C.M. (2024). Cutaneous squamous cell carcinoma characterized by MALDI mass spectrometry imaging in combination with machine learning. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-62023-0"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1001\/jamaoto.2019.0981","article-title":"Development and Assessment of a Machine Learning Model to Help Predict Survival Among Patients With Oral Squamous Cell Carcinoma","volume":"145","author":"Karadaghy","year":"2019","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102060","DOI":"10.1016\/j.artmed.2021.102060","article-title":"Machine learning in oral squamous cell carcinoma: Current status, clinical concerns and prospects for future\u2014A systematic review","volume":"115","author":"Alabi","year":"2021","journal-title":"Artif. Intell. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Iantovics, L.B., and En\u0103chescu, C. (2022). Method for Data Quality Assessment of Synthetic Industrial Data. Sensors, 22.","DOI":"10.3390\/s22041608"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Zhang, K., Ye, B., Wu, L., Ni, S., Li, Y., Wang, Q., Zhang, P., and Wang, D. (2023). Machine learning?based prediction of survival prognosis in esophageal squamous cell carcinoma. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-40780-8"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Joon, H.K., Thalor, A., and Gupta, D. (2023). Machine learning analysis of lung squamous cell carcinoma gene expression datasets reveals novel prognostic signatures. Comput. Biol. Med., 165.","DOI":"10.1016\/j.compbiomed.2023.107430"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"102150","DOI":"10.1016\/j.eclinm.2023.102150","article-title":"Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: Development and validation of a clinico-pathological model","volume":"63","author":"Pacheco","year":"2023","journal-title":"eClinicalMedicine"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Li, Z., Koban, K.C., Schenck, T.L., Giunta, R.E., Li, Q., and Sun, Y. (2022). Artificial Intelligence in Dermatology Image Analysis: Current Developments and Future Trends. J. Clin. Med., 11.","DOI":"10.3390\/jcm11226826"},{"key":"ref_23","unstructured":"Kang, S., Amagai, M., Bruckner, A.L., Enk, A.H., Margolis, D.J., McMichael, A.J., and Orringer, J.S. (2019). Fitzpatrick\u2019s Dermatology, 9e, McGraw-Hill Education."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lallas, A., Apalla, Z., Lazaridou, E., and Ioannides, D. (2019). Dermatoscopy A\u2013Z, CRC Press. [1st ed.].","DOI":"10.1201\/9780429243240"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/SAP.0000000000000110","article-title":"The effect of differentiation grade of cutaneous squamous cell carcinoma on excision margins, local recurrence, metastasis, and patient survival: A retrospective follow-up study","volume":"75","author":"Brinkman","year":"2015","journal-title":"Ann. Plast. Surg."},{"key":"ref_26","unstructured":"Bolognia, J.L., Jorizzo, J.J., Schaffer, J.V., Callen, J.P., Cerroni, L., Heymann, W.R., Hruza, G.J., Mancini, A.J., McGrath, J., and Patterson, J.W. (2012). Dermatology, Elsevier. [4th ed.]."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/ijd.12553","article-title":"Squamous cell carcinoma of the skin: Epidemiology, classification, management, and novel trends","volume":"54","author":"Kallini","year":"2014","journal-title":"Int. J. Dermatol."},{"key":"ref_28","first-page":"114","article-title":"Steatocystoma multiplex generalisata partially suppurativa\u2014Case report","volume":"18","author":"Fekete","year":"2010","journal-title":"Acta Dermatovenerol. Croat."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1001\/archdermatol.2010.19","article-title":"Incidence estimate of nonmelanoma skin cancer in the UnitedStates, 2006","volume":"146","author":"Rogers","year":"2010","journal-title":"Arch. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s11373-006-9092-8","article-title":"Arsenic carcinogenesis in the skin","volume":"13","author":"Yu","year":"2006","journal-title":"J. Biomed. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/S0190-9622(89)70072-4","article-title":"Skin cancer in patients with chronic radiation dermatitis","volume":"20","author":"Davis","year":"1989","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1056\/NEJMra022137","article-title":"Skin cancers after organ transplantation","volume":"348","author":"Euvrard","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"85","DOI":"10.5306\/wjco.v4.i4.85","article-title":"Squamous cell carcinoma of the skin: Emerging need for novel biomarkers","volume":"4","author":"Kivisaari","year":"2013","journal-title":"World J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1001\/archderm.136.8.1007","article-title":"Therapeutic ionizing radiation and the incidence of basal cell carcinoma and squamous cell carcinoma","volume":"136","author":"Lichter","year":"2000","journal-title":"Arch. Dermatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1667\/0033-7587(2002)157[0410:SCAXRT]2.0.CO;2","article-title":"Skin cancer after X-ray treatment for scalp ringworm","volume":"157","author":"Shore","year":"2002","journal-title":"Radiat. Res."},{"key":"ref_36","first-page":"593","article-title":"Agent-Based Medical Diagnosis Systems","volume":"27","author":"Iantovics","year":"2008","journal-title":"Comput. Inform."},{"key":"ref_37","first-page":"e64115","article-title":"Artificial Intelligent Agent Architecture and Clinical Decision-Making in the Healthcare Sector","volume":"16","author":"Huang","year":"2024","journal-title":"Cureus J. Med. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"102922","DOI":"10.1016\/j.ijhcs.2022.102922","article-title":"Modeling adoption of intelligent agents in medical imaging","volume":"168","author":"Calisto","year":"2022","journal-title":"Int. J. Hum. Comput. Stud."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"102285","DOI":"10.1016\/j.artmed.2022.102285","article-title":"BreastScreening-AI: Evaluating medical intelligent agents for human-AI interactions","volume":"127","author":"Calisto","year":"2022","journal-title":"Artif. Intell. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1145\/356810.356816","article-title":"The Hearsay-II Speech-Understanding System: Integrating Knowledge to Resolve Uncertainty","volume":"12","author":"Erman","year":"1980","journal-title":"ACM Comput. Surveys."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/0004-3702(85)90063-3","article-title":"A blackboard architecture for control","volume":"26","year":"1985","journal-title":"Artif. Intell."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"263","DOI":"10.24846\/v19i3y201006","article-title":"On Investigating the Cognitive Complexity of Designing the Group Decision Process","volume":"19","author":"Zamfirescu","year":"2010","journal-title":"Stud. Inform. Control"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1109\/TC.1980.1675516","article-title":"The Contract Net Protocol: High-Level Communication and Control in a Distributed Problem Solver","volume":"C-29","author":"Smith","year":"1980","journal-title":"IEEE Trans. Comput."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Goktas, P., and Grzybowski, A. (2024). Assessing the Impact of ChatGPT in Dermatology: A Comprehensive Rapid Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195909"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3921\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:46:31Z","timestamp":1760031991000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":44,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113921"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113921","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,6,3]]}}}