Немеланоцитарные новообразования кожи | Dermatology in Russia - The National Server of Dermatology

Human papillomavirus–related genital disease in the immunocompromised host: Part I

Fri, 01 Jun 2012 00:00:00 +0400

Human papillomavirus (HPV) is responsible for common condyloma acuminata and a number of premalignant and malignant anogenital lesions. These conditions are of particular concern in immunocompromised individuals who have higher risk of malignant transformation and are more difficult to treat. This is part I of a two-part review that will highlight the cutaneous features of condyloma acuminata and vaginal, vulvar, penile, and anal intraepithelial neoplasias, with an emphasis on presentation of these HPV-mediated diseases in the immunocompromised host. Counseling patients about these conditions requires a thorough understanding of the epidemiology, natural history of HPV, transmission and infectivity, risk of malignancy, and the role of the host immune response in clearing HPV lesions. Part II will provide an updated review of available treatments, with a focus on recent advances and the challenges faced in successfully treating HPV lesions in immunocompromised patients.

Blastic plasmacytoid dendritic cell neoplasm in a child

Fri, 01 Jun 2012 00:00:00 +0400

To the Editor: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) has been described as a distinct clinicopathologic entity in the last World Health Organization classification of tumors of hematopoietic and lymphoid tissue. It is a very rare neoplasm, even more infrequent in children than in adults, with an aggressive clinical course and a poor outcome (mean survival: 12-14 months). Herein we report a case of BPDCN in a 15-year-old boy and discuss treatment options.

Pemphigus foliaceus clearance status postmyomectomy for an enlarged infarcted subserous uterine fibroid

Fri, 01 Jun 2012 00:00:00 +0400

To the Editor: Pemphigus foliaceus is a well-defined clinical disease that has been linked to thymic neoplasmsm; however, most cases are idiopathic in origin. The purpose of this letter is to describe a novel observation of an association between pemphigus foliaceus and uterine fibroids.

Onychopapilloma presenting as longitudinal melanonychia

Fri, 01 Jun 2012 00:00:00 +0400

To the Editor: Onychopapilloma is a benign neoplasm of the distal matrix and the nail bed. It typically presents with longitudinal erythronychia with hemorrhagic lines. One case of onychopapilloma causing longitudinal leukonychia has also been published.

Human papillomavirus–related genital disease in the immunocompromised host: Part II

Fri, 01 Jun 2012 00:00:00 +0400

Human papillomavirus is responsible for common condyloma acuminata and a number of premalignant and malignant anogenital lesions. The immunocompromised population is at particular risk because of a higher incidence of malignant transformation. Lesions in this population may prove refractory to standard treatment. This is part II of a two-part review that will discuss the treatment of condyloma acuminata and vaginal, vulvar, penile, and anal intraepithelial neoplasias. This article will provide an updated review of available treatments, with a focus on recent advances and the challenges faced in successfully treating human papillomavirus lesions in the immunocompromised host.

The cutaneous lymphoid proliferations: A comprehensive textbook of lymphocytic infiltrates of the skin

Fri, 01 Jun 2012 00:00:00 +0400

Magro et al have succeeded in filling a vacuum in our libraries. This is the first truly comprehensive book on the subject of lymphoid-rich infiltrates of the skin covering the entire spectrum of cutaneous pathology from benign dermatoses to malignant lymphomas, including a section on cutaneous lymphoid dyscrasias, a theme Magro has pioneered and written about extensively.

Inflammatory myofibroblastic tumor of the tongue: Report of an unusual case in a teenage patient.

Wed, 30 May 2012 03:00:27 +0400

Dermatol Online J. 2012; 18(5): 6
Lourenço SV, Boggio P, Simonsen Nico MM

Inflammatory myofibroblastic tumor is a rare and distinctive lesion composed of myofibroblastic cells accompanied by an inflammatory infiltration of plasma cells, lymphocytes, and eosinophils that mainly affects viscera and soft tissues of children and young adults. It clinically manifests as a mass with rapid development that may occur at almost any site of the body, but predominantly in the lungs or the upper respiratory tract. It rarely arises in the oral cavity with approximately 15 cases reported in that location. We describe a case of an inflammatory myofibroblastic tumor of the tongue, confirmed by both histopathologic and immunohistochemical analysis, occurring in a 14-year-old boy that spontaneously regressed after the surgical procedures for its diagnosis. Because of some aggressive clinical, histological, and radiological features, this lesion may be confused with a malignant tumor. Therefore, its correct recognition is important to avoid unnecessary extensive and radical therapeutic approaches.

Localized blanching erythema in a patient with vulvar carcinoma.

Wed, 30 May 2012 03:00:27 +0400

Dermatol Online J. 2012; 18(5): 8
Hau J, Diaz L, Paravar T, Chon S

Mammary-like carcinoma arising in the vulva is a rare type of vulvar malignancy. Cutaneous metastasis of vulvar carcinoma is uncommon and the majority of cases have been reported in patients with squamous cell carcinoma of the vulva. We describe a 69-year-old woman with mammary-like carcinoma of the vulva with cutaneous metastasis presenting as asymptomatic localized blanching erythema.

Muir-Torre Syndrome / Turcot Syndrome overlap? A patient with sebaceous carcinoma, colon cancer, and a malignant astrocytoma.

Wed, 30 May 2012 03:00:27 +0400

Dermatol Online J. 2012; 18(5): 3
Kleinerman R, Marino J, Loucas E

The Muir-Torre Syndrome is characterized by the clinical constellation of sebaceous neoplasms, keratoacanthomas, and internal malignancies caused by a defect in DNA mismatch repair. Another mismatch repair defect causes Turcot syndrome, which manifests with colorectal and central nervous system neoplasms. We wish to report a case in which the manifestations of both syndromes were observed in the same patient. We further discuss the possible genetic basis for this overlap.

Island pedicle flaps for medial canthus repair

Fri, 25 May 2012 13:17:54 +0400

Summary

Background The medial canthus is a frequent site for skin cancer and reconstruction after Mohs surgery can prove to be challenging. In the literature various reconstruction methods are recommended for these cases. Flap reconstructions are mostly transposition flaps from the glabella, skin with different properties from that in the canthal region, hence mostly requiring correction in a second stage.

Objectives To ascertain the utility of a different reconstruction method, applying island pedicle flaps for medial canthal lesions and obviating the necessity for second-stage corrections.

Methods A review was undertaken of the medical records and photographs of patients who had a pedicle island flap reconstruction for medial canthal defects after Mohs surgery. There were four different possibilities: a pedicle island flap from the cheek, the back of the nose or the glabella or a combination of these flaps.

Results Sixteen patients were reconstructed by pedicle island flaps for defects of the medial canthal area. A follow-up for all patients after 1 year indicated that all patients showed good to excellent results. No cases of web deformation and ectropion were found.

Conclusions This flap is not mentioned in textbooks in reference to the reconstruction of canthal lesions and its value for this particular location is probably underestimated.

High and sustained efficacy after two sessions of topical 5-aminolaevulinic acid photodynamic therapy for basal cell carcinoma: a prospective, clinical and histological 10-year follow-up study

Fri, 25 May 2012 13:17:54 +0400

Summary

Background Prolonged follow-up data on topical photodynamic therapy (PDT) in basal cell carcinoma (BCC) are necessary for a full evaluation of its effect and for comparison with conventional treatment methods.

Objectives To assess 10-year long-term PDT efficacy in primary and recurrent BCC and to evaluate clinical and histopathological factors which may be associated with treatment failure.

Methods We performed a longitudinal study on 60 histologically verified BCCs in 44 patients treated with curettage and one or two sessions of dimethylsulphoxide (DMSO)-supported topical 5-aminolaevulinic acid (ALA)-based PDT. Treated lesions were investigated by clinical and histopathological examination at regular intervals. The main outcomes were 10-year lesion complete response rate using a time-to-event analysis, histological treatment failure and cosmesis.

Results Overall complete response rate for all lesions was 75% (95% confidence interval 64–87%); 60% after one and 87% after two treatment sessions. The response rate was 78% for primary lesions; 63% after one and 90% after two sessions. The cosmetic outcome was rated as good or excellent in 91–100% of evaluated cases. Treatment failure was documented in 15 (25%) of 60 lesions; clinical investigation identified 14 of them. All failures were noted within 3 years of treatment. Male gender, recurrent tumour and one treatment session were factors significantly associated with treatment failure. The only lesion larger than 2·0 cm relapsed.

Conclusions Two sessions of DMSO-supported topical ALA-PDT and curettage can provide long-term effective treatment results with favourable cosmetic outcome in primary, small BCC.

Signet-ring cell gastric adenocarcinoma metastasizing into a primary cutaneous squamous cell carcinoma of the scalp

Wed, 23 May 2012 13:47:00 +0400

Signet-ring cell gastric adenocarcinoma metastasizing into a primary cutaneous squamous cell carcinoma of the scalp

Wed, 23 May 2012 13:47:00 +0400

Langerhans cell sarcoma in a patient with hairy cell leukemia: common clonal origin indicated by identical immunoglobulin gene rearrangements

Wed, 23 May 2012 13:47:00 +0400

Histiocytic/dendritic cell sarcomas are rare tumors, a few of which have been reported in association with B-cell lymphoma/leukemia. Isolated reports have documented identical immunoglobulin gene rearrangements suggesting a common clonal origin for both the sarcoma and the B-cell neoplasm from individual patients. We report a case of a 75-year-old male with hairy cell leukemia who subsequently developed Langerhans cell sarcoma 1 year after his primary diagnosis of leukemia. The bone marrow biopsy containing hairy cell leukemia and skin biopsies of Langerhans cell sarcoma were evaluated by routine histology, immunohistochemistry, flow cytometric immunophenotyping and PCR-based gene rearrangement studies of the immunoglobulin heavy chain and kappa genes. The hairy cell leukemia showed characteristic morphologic, immunohistochemical and flow cytometric features. The Langerhans cell sarcoma showed pleomorphic cytology, a high mitotic rate and characteristic immunohistochemical staining for Langerin, S100 and CD1a. There was no evidence of B-cell differentiation or a background B-cell infiltrate based on the absence of immunoreactivity with antibodies to multiple B-cell markers. Identical immunoglobulin gene rearrangements were identified in both the hairy cell leukemia and Langerhans cell sarcoma specimens. Despite the phenotypic dissimilarity of the two neoplasms, identical immunoglobulin gene rearrangements indicate a common origin.

Furmanczyk PS, Lisle AE, Caldwell RB, Kraemer KG, Mercer SE, George E, Argenyi ZB. Langerhans cell sarcoma in a patient with hairy cell leukemia: common clonal origin indicated by identical immunoglobulin gene rearrangements.

Successful Treatment of Multiple Basaliomas with Bleomycin-based Electrochemotherapy: A Case Series of Three Patients with Gorlin-Goltz Syndrome.

Wed, 23 May 2012 03:00:16 +0400

Acta Derm Venereol. 2012 May 8;
Kis E, Baltás E, Kinyó A, Varga E, Nagy N, Gyulai R, Kemény L, Oláh J

Gorlin-Goltz syndrome is a rare multisystemic disease, characterized by numerous basal cell carcinomas. The ideal approach for patients with the syndrome would be a treatment with a high cure rate, minimal scarring, short healing time and mild side-effects. Electrochemo-therapy is a novel therapeutic option that ablates tumours with electrical current and simultaneously administered anticancer drugs. Three patients with Gorlin-Goltz syndrome were treated with electrochemotherapy using intravenous bleomycin. Clinical response was obtained in 98 (99%) of the lesions, 86 (87%) of them showed complete response. In 2 tumours, regression was confirmed with histological examination. Long-term cosmetic results were excellent. We consider electrochemotherapy to be an additional tool in the therapeutic armamentarium for Gorlin-Goltz syndrome, and suggest using it as early as possible in selected patients to avoid disfiguring scarring.

Manual microdissection technique in a case of subcutaneous panniculitis-like T-cell lymphoma: a case report and review

Tue, 22 May 2012 14:41:59 +0400

Demonstration of T-cell receptor gene monoclonality often plays an important role in the diagnosis of T-cell lymphoma. When a test to detect monoclonality is performed on whole tissue sections, the presence of a reactive lymphocyte population may reduce sensitivity. This may be especially true for early or borderline cases of lymphoma. Microdissection techniques may be utilized to more readily identify a clonal population of lymphocytes. Subcutaneous panniculitis-like T-cell lymphoma represents a cutaneous lymphoid neoplasm whose clinical course may vary from an indolent, waxing and waning course to an aggressive course resulting in death. We report the first case of a microdissection technique used to facilitate diagnosing a case of subcutaneous panniculitis-like T-cell lympoma.

Hoffman D, Chaffins M, Cankovic M, Maeda K, Meehan S. Manual microdissection technique in a case of subcutaneous panniculitis-like T-cell lymphoma: a case report and review.

Apocrine adenomyoepithelioma – a rare but distinctive primary sweat gland neoplasm

Tue, 22 May 2012 14:35:34 +0400

Adenomyoepithelioma is a rare, microscopically distinctive tumor of the skin. This article explores an example that presented in the inguinal area in a 29-year-old woman, mimicking adenopathy. Histopathologically, the tumor included two different areas: a cystic area consisting of tubules and glands in hyalinized stroma and a solid area showing marked myoepithelial proliferation. The diagnosis of adenomyoepithelioma was confirmed by the presence of a biphasic immunoprofile, with expression of cytokeratins and epithelial membrane antigen in the glandular epithelium and with expression of vimentin and smooth muscle actin in the myoepithelial cells. An interesting novel finding was the expression of claudin-10 by myoepithelial cells, which to date has not been reported in the literature. The absence of metaplastic changes in the tumor stroma is crucial in the differential diagnosis with apocrine mixed tumor. Given that soft tissue adenomyoepithelioma is a benign tumor believed to originate from conventional sweat glands, its classification as a cutaneous myoepithelial neoplasm seems reasonable.

Sabater Marco V. Apocrine adenomyoepithelioma – a rare but distinctive primary sweat gland neoplasm.

Overall treatment success after treatment of primary superficial basal cell carcinoma: a systematic review and meta-analysis of randomized and non-randomized trials.

Mon, 21 May 2012 17:19:54 +0400

Abstract

Background: Several non-invasive treatment modalities are available for superficial basal cell carcinoma (sBCC).

Objectives: This systematic review has the aim to determine residue, recurrence and tumour- free survival probabilities of patients with primary sBCC treated with the currently most frequently used therapies.

Methods: Pubmed (January 1946 - October 2010), EMBASE (January 1989 – October 2010), Cochrane databases (January 1993 - October 2010) and reference lists were searched without date restriction. Inclusion criteria were studies that included primary, histologically proven sBCCs, had to report on residue and/or recurrence probabilities after treatment and had to have a minimum follow-up period of 12 weeks. Both randomized and non-randomized studies were included. Primary and secondary outcomes were probability of complete response and tumour-free survival, respectively. Two independent reviewers selected 36 studies (14 randomized and 22 non-randomized) and extracted residue, cumulative recurrence and tumour-free survival probabilities.

Results: Pooled estimates of percentages of sBCC with complete response at 12 weeks posttreatment derived from 28 studies were 86.2% (95% CI 82-90%) and 79.0% (95% CI 71-87%) for imiquimod and photodynamic therapy, respectively. With respect to tumour-free survival at one year, pooled estimates derived from 23 studies were 87.3% for imiquimod (95% CI 84-91%) and 84.0% for PDT (95% CI 78-90%). Only a small number of studies reported on results of sBCC treatment with 5-fluorouracil (2), surgical excision (1) and cryotherapy (2).

Conclusions: Pooled estimates from randomized and non-randomized studies showed similar tumour-free survival at one year for imiquimod and PDT. The PDT tumour-free survival was higher in studies with repeated treatments. However, these results were largely derived from non-randomized studies and randomized studies with head-to-head comparison of imiquimod and PDT are lacking. There is a need for head-to-head comparison studies between PDT, imiquimod and other treatments with long-term follow-up to enable better recommendations for optimal sBCC treatment.

Psoriasiform Eruption and Oral Ulcerations as Adverse Effects of Topical 5% Imiquimod Treatment in Children: A Report of Four Cases

Mon, 21 May 2012 16:51:28 +0400

Abstract: Imiquimod 5% cream is a topical immune-response modifier indicated in the treatment of multiple cutaneous conditions including actinic keratoses, superficial basal cell carcinoma, and condylomata acuminata. In children, it has been approved only for ages 12 and older in the treatment of external genital and perianal warts. It has also been used off label for a variety of pediatric skin disorders, including molluscum contagiosum (MC), trichoepitheliomas, verrucae plana, and verrucae vulgaris. Local and systemic adverse reactions have been reported, with the most frequently reported events being application site reactions including itching, burning, erythema, and erosion. Although these local reactions are well known, other rare local and systemic reactions can occur. There have been multiple case reports in adults of rare adverse cutaneous reactions occurring with imiquimod, but few have been reported in children. We present four cases of rare adverse cutaneous reactions. In all cases, the children were being treated with imiquimod 5% cream for verrucae or MC. Two of these patients developed a localized psoriasiform eruption, and two developed mucosal ulcerations.

Imiquimod 5% cream as pretreatment of Mohs micrographic surgery for nodular basal cell carcinoma in the face: a prospective randomized controlled study

Mon, 21 May 2012 15:58:46 +0400

Summary

Background Imiquimod 5% cream can reduce or clear superficial and small nodular basal cell carcinoma (BCC). It could be used as a pretreatment of Mohs micrographic surgery (MMS) to decrease defect size.

Objectives To study if a pretreatment with imiquimod 5% cream decreases defect size after MMS. In addition, to study the effect on the number of Mohs stages and reconstruction time.

Methods Seventy patients aged >18 years with a primary nodular BCC in the face were included. The imiquimod group used imiquimod 5% cream for 4 weeks, before MMS. The control group was treated with MMS only. Tumour and defect sizes were measured. We noted the number of Mohs stages, reconstruction time and side-effects.

Results The median percentage increase in area from tumour size at baseline to the post-MMS defect for the imiquimod group was significantly less compared with the control group, 50% vs. 147% (P < 0·001). A tendency towards fewer Mohs stages in the imiquimod group was observed and the reconstruction time was significantly shorter in this group (P = 0·01).

Conclusions Imiquimod 5% cream as pretreatment of MMS significantly reduced the tumour size in primary nodular BCC and reduced the surgical defect size. Further research is necessary to investigate cost-effectiveness.

Human papillomavirus type 73 associated with multiple cutaneous squamous cell carcinomas in an immunosuppressed patient

Mon, 21 May 2012 13:46:38 +0400

Mohs micrographic surgery for verrucous carcinoma of the anogenital area: report of two cases

Mon, 21 May 2012 13:46:38 +0400

Abstract

Background Verrucous carcinoma (VC) of the anogenital area is an uncommon variant of squamous cell carcinoma (SCC). Its treatment is not standardized, but surgical excision must be performed if possible. The traditional approach does not distinguish between conventional SCC and VC, despite the extremely low metastatic potential of VC. Accordingly, most patients reported in the literature have been treated with radical surgery, including regional lymphadenectomy.

Methods We report two cases in order to describe the oncologic, functional, and esthetic results achieved by Mohs micrographic surgery (MMS) in the treatment of this disease.

Results Good functional and esthetic results were achieved in both patients. No local or nodal relapses were detected during the respective 12- and 27-month follow-ups.

Conclusions Early recognition of VC and the proper evaluation of deep biopsies will avoid misdiagnosis as SCC and may prevent the occurrence of unnecessary disfiguring interventions. The MMS technique may be considered as a surgical approach in genitoanal VC, although further research is required to confirm this.

Solid Organ Transplant Recipients Presenting for Mohs Micrographic Surgery: A Retrospective Case–Control Study

Tue, 15 May 2012 17:17:46 +0400

Background

Solid organ transplant recipients (SOTR) have a high risk of cutaneous malignancy. Mohs micrographic surgery (MMS) is recommended for the treatment of skin cancers in this group. The characteristics of the tumors in SOTR presenting for MMS are not well documented.

Objective

To describe the characteristics of tumors in SOTR presenting to a single institution over an 11-year period and compare them with tumors of non-SOTR who have also undergone MMS.

Methods

A database query captured patients with a current organ transplant who underwent MMS. These patients (cases) were matched to controls who also underwent MMS. Statistical models were used to identify tumor and operative characteristics significantly associated with SOTR compared with matching controls.

Results

Ninety-two SOTR underwent MMS for 432 skin cancers; 163 controls had 269 skin cancers. Squamous cell carcinoma (SCC) was the most common tumor in SOTR, with a reversal of the usual ratio of basal cell carcinoma to SCC. Mean tumor and defect sizes were similar in SOTR and controls. Cardiac transplants were the predominant transplant.

Conclusions

SOTR referred for MMS have disproportionately more and different types of skin cancers than controls.

CD147 expression in advanced cutaneous squamous cell carcinoma

Fri, 11 May 2012 13:10:41 +0400

Background: CD147 is upregulated in multiple cancer types, but its expression in advanced cutaneous squamous cell carcinoma (SCC) is unknown. Our purpose was to evaluate the expression patterns of CD147 and related monocarboxylate transporters (MCT1, MCT4) to determine their correlation with survival.

Methods: This is a retrospective cohort study of patients with advanced stage cutaneous SCC of the head and neck who presented to a tertiary care center between 1998 and 2006 (n=50). CD147, MCT1 and MCT4 expression levels were assessed using immunofluorescence analysis of archived tumor samples and correlated with survival and clinicopathologic characteristics.

Results: The majority of patients (92%, n = 46) were diagnosed with stage III disease, with 46% (n = 23) having positive regional lymph node metastasis and 8% (n = 4) with distant metastasis. Primary malignancies had an overexpression of CD147 (78%; n = 35), MCT1 (23%; n = 10) and MCT4 (47%; n = 20). In addition, there was a significant relationship between the overexpression of CD147 and node positive disease (p = 0.048). Two- and five-year survival rates were 69 and 61%, respectively. There was a trend toward decreased survival in patients with overexpression of CD147 (p = 0.17), MCT1 (p = 0.11) and MCT4 (p = 0.15).

Conclusion: CD147 may represent a biomarker or potential therapeutic target in advanced cutaneous SCC.

Sweeny L. Dean NR, Frederick JW, Scott Magnuson J, Carroll WR, Desmond RA, Rosenthal EL. CD147 expression in advanced cutaneous squamous cell carcinoma.

Alcohol intake and risk of aggressive histological basal cell carcinoma : a case-control study.

Thu, 10 May 2012 03:00:34 +0400

Eur J Dermatol. 2012 Apr 19;
Husein-Elahmed H, Aneiros-Fernandez J, Gutierrez-Salmerón MT, Botella-Lopez M, Aneiros-Cachaza J, Naranjo-Sintes R

Background: Aggressive basal cell carcinomas (BCC) are not rare. These subtypes of skin cancer are characterized by an infiltrative behavior and rapid progression. Often, management may be difficult. Recent evidence suggests that minimal UV exposure in combination with other behavioral and/or environmental factors may lead to higher incidence of BCC and, therefore, more risk of aggressive subtypes of this malignancy. Alcohol is a very commonly consumed beverage in Western societies, especially in association with outdoors activities. Objective: To investigate a possible relationship between alcohol intake and aggressive histological variants of BCC. Materials and Method: We designed a prospective study. Patients who underwent surgery for BCC in our hospital were interviewed to collect data regarding alcohol intake. The specimens were reviewed by a pathologist and classified into aggressive and non-aggressive subtypes. Statistical analysis was performed using SPSS software. Results: 136 patients were included. Of participants with aggressive BCCs, 10 (26.3%) were abstainers, 4 (10.4%) had light consumption, 18 (47.5%) moderate consumption and 6 (15.8%) heavy consumption, while among participants with non-aggressive BCCs, 57 (58.2%) were abstainers, 29 (29.5%) had light consumption, 10 (10.2%) moderate consumption and 2 (2.1%) heavy consumption. In the multivariate analysis we found a positive significant association between alcohol consumption and the presence of aggressive BBCs. Conclusions: According to our results, alcohol intake may be linked with a higher incidence of aggressive subtypes of BCC.

Cutaneous Cryptococcosis Mimicking Basal Cell Carcinoma in a Patient with Sézary Syndrome.

Sun, 06 May 2012 03:00:10 +0400

Acta Derm Venereol. 2012 Mar 20;
Töröcsik D, Gergely L, Veres I, Remenyik E, Bégány A

Abstract is missing (Letter).

Adamantinoid Basal Cell Carcinoma: A Predictor of More-Aggressive Clinical Behavior

Wed, 02 May 2012 17:40:38 +0400

Background

Identifying histopathologic subtypes of basal cell carcinoma (BCC) associated with an aggressive clinical course helps the surgeon to anticipate the size of the postexcision defect and complexity of repair. During Mohs micrographic surgery (MMS), we have observed that BCC with adamantinoid histopathologic features tend to be clinically more aggressive.

Objective

To characterize the subtype of BCC with adamantinoid histopathologic features and determine whether it is clinically more aggressive than other BCCs.

Methods and Materials

A chart review was conducted of consecutive cases of MMS performed at Stanford University Medical Center for BCC from June 2002 through March 2004. Cases had been prospectively categorized as adamantinoid BCC if they met histopathologic criteria, including uniform clear areas around the individual tumor cells within tumor islands. We retrospectively compared adamantinoid and control cases in terms of patient age, sex, tumor location, number of Mohs stages required, area of post-Mohs defect, and type of repair.

Results

Four hundred eighty-nine cases of MMS for BCC were reviewed. Forty-four (9%) were adamantinoid BCC. Patients with adamantinoid BCC did not differ statistically from the control group in terms of sex (23% vs 32% female, p = .20) but tended to be older (median age 73 vs 66, p = .04; mean age 70 vs 65 years, p = .05). The distribution of cases on the head and neck differed significantly between the adamantinoid and control groups (p = .02), with more adamantinoid cases located on the nose and ears. Adamantinoid BCC required more stages for clear histologic margins (median 3.00 vs 2.00, p < .001; mean 3.68 vs 2.34, p < .001) and had larger post-Mohs defects (median 3.00 vs 1.68 cm², p < .001; mean 4.24 vs 2.78 cm², p = .02). Only 4.5% of adamantinoid BCC cases were able to heal by second intention, with 20.4% requiring complex primary closure. Staged flaps were performed in 13.6% of individuals with adamantinoid BCC.

Conclusion

Adamantinoid BCC is an aggressive histopathologic subtype in terms of number of stages for clear margins and size of post-Mohs defect. It may also require more-complex repairs. Recognition of this aggressive variant may benefit future patients by facilitating prediction of the clinical extent of tumors.

The absence of Brm exacerbates photocarcinogenesis

Wed, 02 May 2012 10:25:31 +0400

ABSTRACT

Brm is an ATPase subunit of the SWI/SNF chromatin-remodeling complex. Previously we identified a novel hotspot mutation in Brm in human skin cancer, which is caused by exposure to ultraviolet radiation (UVR). As SWI/SNF is involved in DNA repair, we investigated whether Brm-/- mice had enhanced photocarcinogenesis. P53+/- and Brm-/-p53+/- mice were also examined as the p53 tumor suppressor gene is mutated early during human skin carcinogenesis. Mice were exposed to a low dose irradiation protocol that caused few skin tumors in wild-type mice. Brm-/- mice with both p53 alleles intact had an increased incidence of skin and ocular tumors compared to Brm+/+p53+/+ controls. Brm loss in p53+/- mice did not further enhance skin or ocular cancer incidence beyond the increased photocarcinogenesis in p53+/- mice. However, the skin tumors that arose early in Brm-/-p53+/- mice had a higher growth rate. Brm-/- did not prevent UVR-induced apoptotic sunburn cell formation, which is a protective response. Unexpectedly, Brm-/- inhibited UVR-induced immunosuppression, which would be predicted to reduce rather than enhance photocarcinogenesis. In conclusion, the absence of Brm increased skin and ocular photocarcinogenesis. Even when one allele of p53 is lost, Brm has additional tumor suppressing capability.

Squamous cell carcinoma and junctional epidermolysis bullosa

Tue, 01 May 2012 00:00:00 +0400

To the Editor: In the October issue, Yuen and Jonkman, based on 7 patients, reiterate an important observation reported in 1990–that squamous cell carcinomas (SCCs) may arise in non-Herlitz junctional epidermolysis bullosa (JEB-H) skin. Citing data from the National Epidermolysis Bullosa (EB) Registry (NEBR), they correctly state that EB SCCs tend to arise in areas of chronic nonhealing wounds or scars, consistent with what occurs in chronic nonhealing skin wounds in patients without EB. Several inaccurate conclusions, however, have been drawn.

Reply

Tue, 01 May 2012 00:00:00 +0400

To the Editor: In a commentary to our original research article, “Risk of squamous cell carcinoma (SCC) in junctional epidermolysis bullosa (JEB), non-Herlitz type (JEB-nH): Report of 7 cases and a review of the literature,” Dr Fine raises some concerns about possible inaccurate conclusions that we have made in the comparison with his previously published results on the National Epidermolysis Bullosa (EB) Registry (NEBR) in the United States.

Overexpression of RNA helicase p68 protein in cutaneous squamous cell carcinoma

Mon, 30 Apr 2012 15:10:32 +0400

Summary

Background. RNA helicase p68 is a prototypic DEAD-box RNA helicase. Recent studies indicate that p68 plays important role in cancer development and progression. However, the role of p68 protein expression in cutaneous squamous cell carcinoma (SCC) remains unknown.

Aim. To elucidate the expression of p68 protein in cutaneous SCC.

Methods. The level of p68 protein was examined by double immunofluorescent staining in 24 samples of human cutaneous SCC tissue specimens and their adjacent tissues and in 6 normal foreskin samples to compare the expression of p68 with that of Ki-67.

Results. Overexpression of p68 protein was seen in all 24 SCC cases (100%), whereas very low expression of p68 was detected in normal foreskin. Moreover, p68 protein expression was higher in cases of cutaneous SCC with metastasis than in cases without metastasis. Additionally, p68 had a similar expression pattern to that of Ki-67.

Conclusion. The high frequency of p68 expression in cutaneous SCC indicates that p68 might be involved in the development and progression of cutaneous SCC.

Activation of mitochondrial apoptosis pathways in cutaneous SCC cells by diclofenac/HA is related to upregulation of Bad as well as downregulation of Mcl-1 and Bcl-w

Mon, 30 Apr 2012 10:25:19 +0400

Abstract

Actinic keratosis (AK) is characterized by high prevalence and the risk to proceed to squamous cell carcinoma (SCC). Cyclooxygenase-2 (COX-2)-mediated prostaglandin E2 (PGE₂) synthesis has been reported in AK and SCC, and the COX inhibitor diclofenac in hyaluronic acid (diclofenac/HA) was approved for AK therapy. Its mode of action, however, remained to be unravelled. In the present study, diclofenac resulted in reduced PGE₂ levels in apoptosis-sensitive cutaneous SCC cell lines (SCL-II, SCC-12, SCC-13) whereas no PGE₂ and no COX-2 expression was detectable in a SCC cell line resistant to apoptosis induction (SCL-I). Activation of mitochondrial apoptosis pathways was evident in SCC cells due to loss of the mitochondrial membrane potential and release of the mitochondrial factors cytochrome c and AIF. Characteristic proapoptotic changes at the level of Bcl-2 proteins occurred in sensitive cells, as upregulation of Bad and downregulation of Mcl-1 and Bcl-w. In contrast, Bad was already high, and Mcl-1 and Bcl-w were already low in resistant SCL-I, even without treatment, which may be explained by the lack of PGE₂. An antiapoptotic downregulation of proapoptotic Bcl-2 proteins Noxa and Puma was however also seen in SCL-I, suggesting here pathways independent of COX-2. The regulations of Mcl-1 and Bad were also reproduced in SCC cells by the more selective COX-2 inhibitor celecoxib, thus further underlining the specific role of COX-2. The findings illuminate the mode of action of diclofenac/HA in SCC cells as well as principles of their resistance, which may allow further adaptation and improvement of the new therapy.

Active skin immunoreactions lead to significant epidermal Langerhans cells reduction in facial malignant and premalignant skin tumours

Sat, 28 Apr 2012 11:01:00 +0400

Morphology of basal cell carcinoma in high definition optical coherence tomography: en-face and slice imaging mode, and comparison with histology

Sat, 28 Apr 2012 11:00:26 +0400

Abstract

Background Optical coherence tomography (OCT) allows real-time, in vivo examination of basal cell carcinoma (BCC). A new high definition OCT with high lateral and axial resolution in a horizontal (en-face) and vertical (slice) imaging mode offers additional information in the diagnosis of BCC and may potentially replace invasive diagnostic biopsies.

Objectives To define the characteristic morphologic features of BCC by using high definition optical coherence tomography (HD-OCT) compared to conventional histology.

Methods A total of 22 BCCs were examined preoperatively by HD-OCT in the en-face and slice imaging mode and characteristic features were evaluated in comparison to the histopathological findings.

Results The following features were found in the en-face mode of HD-OCT: lobulated nodules (20/22), peripheral rimming (17/22), epidermal disarray (21/22), dilated vessels (11/22) and variably refractile stroma (19/22). In the slice imaging mode the following characteristics were found: grey/dark oval structures (18/22), peripheral rimming (13/22), destruction of layering (22/22), dilated vessels (7/22) and peritumoural bright stroma (11/22). In the en-face mode the lobulated structure of the BCC was more distinct than in the slice mode compared to histology.

Conclusion HD-OCT with a horizontal and vertical imaging mode offers additional information in the diagnosis of BCC compared to conventional OCT imaging and enhances the feasibility of non-invasive diagnostics of BCC.

Expression of microRNAs in basal cell carcinoma

Fri, 27 Apr 2012 19:34:59 +0400

Abstract

Background: Perturbations in the expression profiles of microRNAs (miRNAs) have been reported for a variety of different cancers. Differentially expressed miRNAs have not been systematically evaluated in basal cell carcinoma (BCC) of the skin.

Methods: Patients with BCC (n=7) were included in this study. Punch biopsies were harvested from the tumor center (lesional, n=7) and from adjacent non-lesional skin (intraindividual control, n=7). Microarray-based miRNA expression profiles were obtained on an Agilent platform using miRBase 16 screening for 1205 Homo sapiens (hsa)-miRNA candidates. To validate the microarray data, the expression of seven dysregulated miRNAs was measured by TaqMan quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR).

Results: We identified sixteen significantly up-regulated (hsa-miR-17, miR-18a, hsa-miR-18b, hsa-miR-19b, hsa-miR-19b-1*, hsa-miR-93, hsa-miR-106b, hsa-miR-125a-5p, hsa-miR-130a, hsa-miR-181c, hsa-miR-181c*, hsa-miR-181d, hsa-miR-182, hsa-miR-455-3p, hsa-miR-455-5p and hsa-miR-542-5p) and ten significantly down-regulated (hsa-miR-29c, hsa-miR-29c*, hsa-miR-139-5p, hsa-miR-140-3p, hsa-miR-145, hsa-miR-378, hsa-miR-572, hsa-miR-638, hsa-miR-2861 and hsa-miR-3196) miRNAs in BCC compared with non-lesional skin. Data mining revealed connections to many tumor-promoting pathways, such as the Hedgehog and the MAPK/ERK signaling cascades.

Conclusions: This study identified several miRNA candidates that may play a role in the molecular pathogenesis of BCC.

Multiple eruptive keratoacanthomas associated with myelodysplastic syndrome

Tue, 24 Apr 2012 11:56:09 +0400

Mucoepidermoid carcinoma of the parotid presenting as periauricular cystic nodules: a series of four cases

Tue, 24 Apr 2012 10:38:23 +0400

Mucoepidermoid carcinoma is a relatively common neoplasm of the major and minor salivary glands that can secondarily involve skin. In the vicinity of the ear lobe, mimicry of a benign cyst, both clinically and histopathologically is a diagnostic pitfall to avoid. The clinical manifestations, diagnostic histopathology, and clinical course of mucoepidermoid carcinoma of the parotid gland presenting as a clinically benign periauricular cystic nodule in four patients ranging in age from 11 to 63 years, are analyzed in the present report. Illustrating the challenge of accurate diagnosis, three of the four cases were initially misinterpreted on biopsy as benign cystic lesions. Multiple biopsies displayed foamy histiocytes around mucinous extravasations into dermis that mimicked ruptured epithelial cysts in two cases before malignancy was ascertained. This series demonstrates the need to include parotid tumor in the differential diagnosis of odd periauricular cyst-like expansions and adenosquamous proliferations. Mucoepidermoid carcinoma in particular can explain indolent, infra-auricular ‘mucinous cysts'. Familiarity with this syndrome should arouse suspicion of parotid carcinoma when a ‘cyst’ or nodule is located near the earlobe. Delay in diagnosis results in larger surgical procedures than are otherwise necessary.

Lehmer LM, Ragsdale BD, Crawford RI, Bukachevsky R, Hannah LA. Mucoepidermoid carcinoma of the parotid presenting as periauricular cystic nodules: a series of four cases.

Combined intraepidermal neuroendocrine (Merkel cell) and squamous cell carcinoma in situ with CM2B4 negativity and p53 overexpression*

Tue, 24 Apr 2012 10:38:18 +0400

Primary cutaneous neuroendocrine carcinoma, also known as Merkel cell carcinoma (MCC), usually presents as a dermal and/or subcutaneous tumor. Rarely, it is confined to the epidermis or adnexal epithelium [MCC in situ (MCCIS)]. Little is known about the spectrum of features and biology of MCCIS. Herein, we report a case of MCCIS arising on the cheek of a 77-year-old Caucasian male, which was associated with squamous cell carcinoma in situ. The tumor cells of both the neuroendocrine and squamous components prominently involved adnexal structures but did not invade the dermis. The tumor cells with neuroendocrine features were immunoreactive for cytokeratin-20, chromogranin and synaptophysin. They also expressed p53 but were non-reactive with the monoclonal antibody CM2B4. Lack of labeling for CM2B4 is in keeping with prior observations of combined squamous and MCC. Our findings support the concept of a distinct subtype of virus-independent cutaneous neuroendocrine carcinoma that differs from conventional MCC. The observed overexpression of p53 suggests that the development of this tumor type may be related to chronic ultraviolet damage.

Tan BH, Busam KJ, Pulitzer MP. Combined intraepidermal neuroendocrine (Merkel cell) and squamous cell carcinoma in situ with CM2B4 negativity and p53 overexpression.

Recurrence rates and patient assessed outcomes of 0.5% 5-fluorouracil in combination with salicylic acid treating actinic keratoses.

Tue, 24 Apr 2012 03:00:41 +0400

Eur J Dermatol. 2012 Apr 11;
Stockfleth E, Zwingers T, Willers C

Background: Actinic keratoses (AK) have been classified as early in situ squamous cell carcinomas and should be treated. Objectives: To evaluate the clinical benefit of 5-fluorouracil 0.5%/salicylic acid 10.0% (5-FU/SA) versus 3% diclofenac/hyaluronic acid (HA) for the treatment of AK and report patients' assessments of efficacy, tolerability and practicability. Methods: Randomised, placebo-controlled, double-blind, parallel-group, multicentre trial. Patients received topical 0.5% 5-FU/SA once daily, its vehicle or diclofenac/HA twice daily for maximum of 12 weeks. Lesion recurrence rates were evaluated at 6 and 12 months after end of treatment (EOT). Patients' assessments were evaluated at 6 weeks, EOT, post-treatment (PT) visit, 6 and 12 months. Results: At 12 months 85.8% of lesions did not recur in the 5-FU/SA group compared to 79.8% (p=0.04419) in the vehicle and 81.0% (p=0.02476) in the diclofenac/HA groups. At PT visit 93.2% patients (n=163/175) in the 5-FU/SA group rated clinical improvement as "very good" or "good" compared to vehicle (66.7%, n=62/93, p<0.0001) and diclofenac/HA (81.6%, n=142/174, p<0.0001). Local side effects (inflammation and burning) were more common with 0.5% FU/SA but in general did not lead to discontinuation of therapy. Overall, patients were satisfied with the therapy. At 12 months, there were no differences in practicability and handling between treatments. Conclusions: Topical 0.5% 5-FU/SA demonstrated superior sustained clinical efficacy versus diclofenac/HA with acceptable tolerability. Patient satisfaction was high.

P-cadherin expression in Merkel cell carcinomas is associated with prolonged recurrence-free survival

Mon, 23 Apr 2012 16:06:52 +0400

Summary

Background Merkel cell carcinoma (MCC) is a highly aggressive skin cancer, associated with advanced age, immunosuppression and Merkel cell polyomavirus (MCV) infections. As development and progression of cancer can be promoted by changes in cell adhesion proteins, we have previously analysed homo- and heterotypic cell–cell contacts of normal Merkel cells and MCCs and obtained indications for cadherin switching.

Objectives To examine the prevalence and prognostic relevance of E-, N- and P-cadherin in MCCs.

Methods Paraffin-embedded MCC samples (n = 148) from 106 different patients were analysed by double-label immunostaining and immunofluorescence microscopy. MCV status was determined by real-time polymerase chain reaction. The cadherin repertoire and MCV status were correlated to clinical data, including tumour stage and recurrence-free survival.

Results Ninety-one per cent of all MCC were positive for N-cadherin whereas only 61·6% and 70·3% expressed E- and P-cadherin, respectively. P-cadherin was significantly more frequent in primary tumours than in lymph node metastases (81·9% vs. 40·9%, P = 0·0002). Patients with P-cadherin-positive primary tumours were in earlier tumour stages at initial diagnosis (P = 0·0046). Both in log-rank tests (P = 0·0474) and in multiple Cox regression analysis including age, sex, immunosuppression, stage at initial diagnosis and MCV status (hazard ratio 0·193, P = 0·0373), patients with P-cadherin-positive primary MCCs had significantly prolonged recurrence-free survival (mean 25·2 vs. 10·6 months; median 9·0 vs. 4·0 months). MCV DNA was detected in 78·2% of all MCC, more frequently in P-cadherin-positive MCC (P = 0·0008).

Conclusion P-cadherin expression in MCCs predicts prolonged recurrence-free survival and may therefore indicate favourable prognosis.

Metastatic basal cell carcinoma of the posterior neck: case report and review of the literature

Fri, 20 Apr 2012 11:58:52 +0400

Although primary basal cell carcinoma (BCC) represents an extremely common malignancy, metastases derived from BCC are exceedingly rare. The prognosis for metastatic BCC is poor, and little consensus exists regarding predictive factors or optimal treatment strategies. Here, we present the case of a 63-year-old man with BCC of the neck who subsequently developed multiple metastases to subcutaneous tissue, lymph nodes, and the parotid gland. Risk factors and clinical features of metastatic BCC are reviewed, as is the relationship of histopathologic subtype to metastatic behavior. Current chemotherapeutic and targeted therapies also are discussed in the context of recent advances in molecular biology.

Gropper AB, Girouard SD, Hojman LP, Huang SJ, Qian X, Murphy GF, Vleugels RA. Metastatic basal cell carcinoma of the posterior neck: case report and review of the literature.

Disseminated discoid lupus erythematosus leading to squamous cell carcinoma

Fri, 20 Apr 2012 00:00:00 +0400

M Ramesh Bhat, Manjunath Hulmani, Sukumar Dandakeri, Srinath M Kambil, Rohan Gatti

Indian Journal of Dermatology 2012 57(2):158-161

Limits of fine-needle aspiration cytology in diagnosing pilomatrixoma: A series of 25 cases with clinico-pathologic correlations

Fri, 20 Apr 2012 00:00:00 +0400

A Ieni, P Todaro, AM Bonanno, F Catalano, A Catalano, Giovanni Tuccari

Indian Journal of Dermatology 2012 57(2):152-155

Background: Pilomatrixoma (PMX) is a benign, quite uncommon, skin neoplasm, which is frequently misdiagnosed by clinicians. Aim: We have analyzed 25 PMX to determine the agreement between clinical diagnosis, preoperative FNA characteristics, and corresponding histopathological specimens; moreover, reliable cytologic criteria for PMX and the differential diagnosis to avoid cytological pitfalls have been emphasized. Materials and Methods: By fine-needle aspiration (FNA) cytology a series of consecutive cases of PMX collected during last 5 years were studied. Smears were stained by Papanicolau and May-Grünwald-Giemsa. Results: Patients affected by PMX were 11 males, 14 females (ratio 1:1.27); the mean age was 32.72 years with age range 3-78 years, being 72% (18/25) of patients 40 years or less. PMX was mainly distributed in the head-neck region (52%), scalp (16%), upper/lower arms (28%), and chest (4%). The observed diagnostic cytological features were represented by clusters of basaloid epithelial cells, shadow or ghost cells, inflammatory background, calcification, and giant cells. Unfortunately, not all these morphological aspects were always disclosed in smears, thus making the cytological preoperative diagnosis questionable and problematic. Conclusions: The experience of a well-trained cytopathologist should distinguish the relevant FNA features in terms of smear background, architecture, and cell morphology. The most dangerous mistake in FNA diagnosis of PMX regards a diagnosis of primary malignant or metastatic cutaneous lesions.

Solitary cylindroma with malignant transformation

Fri, 20 Apr 2012 00:00:00 +0400

Cherry Bansal, Mayanka Batra, Nirupma Lal, AN Srivastava

Indian Journal of Dermatology 2012 57(2):141-143

A 59-year-old woman presented with a history of rapidly progressive recurrent tumor of 6.5 cm diameter of the scalp. Histopathological examination revealed a case of malignant cylindroma. There has been no recurrence or metastases and the patient is disease free at the end of 15 months postoperatively. Malignant transformation occurs less often in solitary form of cylindroma, but once transformed, tumors behave aggressively with extensive local infiltrative growth or metastases. The case is reported to document a rare case of malignant cylindroma arising in a patient with solitary cylindroma on the parieto-temporal region.

Malignant adnexal tumors: diagnostic and therapeutic challenges in Calabar, Nigeria

Thu, 19 Apr 2012 22:20:52 +0400

Potential association of single nucleotide polymorphisms in pigmentation genes with the development of basal cell carcinoma

Thu, 19 Apr 2012 06:55:41 +0400

Abstract

The risk of developing skin cancers is dependent on a combination of environmental factors and personal genetic predispositions. Basal cell carcinoma (BCC) has been associated with single nucleotide polymorphisms in several pigmentation genes; however, there is still controversy concerning the mechanism by which these variants may increase the risk of BCC. The pathway may lead to pigmentation alone, but evidence for their independent influence is growing. Using a single base extension protocol, candidate polymorphisms within 11 known pigment-related genes were studied for their association with BCC in a population sample consisting of 164 patients and 707 controls. The significance of variation within the MC1R gene was confirmed and, in addition, position rs12203592 within the IRF4 gene was shown to be associated with BCC. These associations remained significant after adjustment for skin color. Gene–gene interactions were found to influence susceptibility to BCC. Among interacting genes are the two above-mentioned loci with main effect on BCC risk and additionally KITLG, TYRP1, ASIP and TYR. The obtained results indicate that polymorphism at MC1R and IRF4 constitute pigmentation-independent risk factor in the development of BCC. Moreover, susceptibility to BCC may be influenced by epistatic effects between pigmentation genes.

A tan in a test tube –in vitro models for investigating ultraviolet radiation–induced damage in skin

Tue, 17 Apr 2012 07:24:38 +0400

Abstract: Presently, global rates of skin cancers induced by ultraviolet radiation (UVR) exposure are on the rise. In view of this, current knowledge gaps in the biology of photocarcinogenesis and skin cancer progression urgently need to be addressed. One factor that has limited skin cancer research has been the need for a reproducible and physiologically-relevant model able to represent the complexity of human skin. This review outlines the main currently-used in vitro models of UVR-induced skin damage. This includes the use of conventional two-dimensional cell culture techniques and the major animal models that have been employed in photobiology and photocarcinogenesis research. Additionally, the progression towards the use of cultured skin explants and tissue-engineered skin constructs, and their utility as models of native skin’s responses to UVR are described. The inherent advantages and disadvantages of these in vitro systems are also discussed.

siRNA-mediated knock-down of COX-2 in melanocytes suppresses melanogenesis

Tue, 17 Apr 2012 07:21:52 +0400

Abstract: Cyclooxygenase-2 (COX-2) is an enzyme induced in response to multiple mitogenic and inflammatory stimuli, including UV light. UV-induced COX-2 expression induces production of prostaglandin E2 (PGE2) in keratinocytes, which mediates inflammation and cell proliferation. Until recently, studies regarding COX-2 and PGE2 in the skin have focused on keratinocytes and skin cancer and the effect of PGs produced by keratinocytes on melanocytes. However, the effects of COX-2 itself or COX-2 inhibitors on melanogenesis are not well known. Therefore, to establish the role of COX-2 in melanogenesis, we investigated the effects of knock-down of COX-2 in melanocytes on melanin production and the expression of melanogenic molecules through silencing of COX-2 expression with COX-2 short interfering RNA (siRNA). COX-2 knock-down in melanocytes decreased the expressions of tyrosinase, TRP-1, TRP-2, gp100 and MITF and also reduced tyrosinase enzyme activity. Furthermore, COX-2 siRNA-transfected melanocytes showed markedly reduced alpha-melanocyte stimulating hormone (α-MSH)-induced melanin production. In addition, α-MSH-induced COX-2 expression in both scrambled siRNA-transfected and COX-2 siRNA-transfected melanocytes was greater than α-MSH-untreated cells. Our results suggest that COX-2 might be a candidate target for the development of anti-melanogenic agents and α-MSH-induced pigmentation could be closely associated with COX-2 expression. COX-2 inhibitors might therefore be of particular use in whitening cosmetics for hyperpigmentation disorders such as melasma, postinflammatory hyperpigmentation and solar lentigo.

A Cross-sectional Study Examining the Correlation Between Sunless Tanning Product Use and Tanning Beliefs and Behaviors [Study]

Mon, 16 Apr 2012 23:50:43 +0400

Objectives To establish the effect of sunless tanning products on tanning behaviors and to determine characteristics of sunless tanning product users.

Design A cross-sectional survey study conducted between May 30, 2007, and December 4, 2007.

Setting The Emory University campus and surrounding locations in Atlanta, Georgia.

Participants Four hundred fifteen community and university-affiliated women.

Main Outcome Measures Self-reported use of sunless tanning products and UV radiation tanning methods.

Results Forty-eight percent of participants had used sunless tanning products, 70.6% had tanned in the sun, and 26.0% had used tanning beds at least once in the past year. Most participants (92.7%) believed that tanned skin is more attractive than untanned skin, and 79.2% reported feeling better about themselves when tan. Many sunless tanning product users reported decreased frequency of tanning in the sun (36.8%) or in tanning beds (38%) because of product use. Frequent users were more likely to have decreased their UV radiation exposure. Lighter complexion, frequent use of UV radiation tanning methods, feeling better about oneself when tan, and having a history of skin cancer were independently associated with sunless tanning product use.

Conclusions The desire for tanned skin remains strong despite growing awareness of the dangers of UV radiation exposure. In some women, sunless tanning product use is associated with decreased UV radiation tanning frequency, especially in women who use them repeatedly. Improvements in the appearance of sunless tanning product tans may allow wider acceptance by the public and further decreases in UV radiation tanning practices.

Pronounced Allelic Imbalance at D9S162 in Skin Squamous Cell Carcinoma of Organ Transplant Recipients [Study]

Mon, 16 Apr 2012 23:40:56 +0400

Objective To evaluate chromosomal instability at 9p21-22 with p16 protein expression in organ transplant recipients (OTRs) compared with immunocompetent patients with squamous cell carcinoma (SCC).

Design In a select population of intraepithelial and subsequent invasive SCC from the same anatomic region of the same patient at different times, we assessed loss of heterozygosity at 3 microsatellites—IFNA, D9S162, and D9S925—in the course of carcinogenesis in OTRs and immunocompetent patients.

Setting Department of Dermatology, University Hospital Zurich.

Patients Immunocompetent patients and OTRs with SCC on sun-damaged skin.

Main Outcome Measure Chromosomal allelic balance in SCC of OTRs and immunocompetent patients.

Results Reduced allelic balance at IFNA, D9S162, and D9S925 in intraepithelial forms of SCC and similar allelic imbalance in invasive forms of SCC were found. Allelic balance at D9S162 was reduced for SCC in OTRs compared with SCC in immunocompetent patients. The study revealed broadly reduced allelic balance at 9p21-22 in all cutaneous SCCs, and OTRs presented a further reduced allelic balance for D9S162, suggesting a common trait for SCC in OTRs. Actinic keratosis and Bowen disease differed in allelic balance at D9S162, suggesting substantial differences in their carcinogenesis.

Conclusion Reduced allelic balance around locus D9S162 is a genomic correlate for enhanced carcinogenesis in OTRs.