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Three lesions showing squamous cell carcinoma in situ (Bowen's disease) within seborrheic keratosis are reported: 2 were located symmetrically on the legs of one of the patients, with a lesion recurring after surgery. Nests of atypical cells were seen in the transitional zone between the 2 components of the third lesion.
Thirty-eight solar keratoses from 32 patients were studied for expression of mutant p53 protein by an immunohistochemical technique. Twenty-eight of the 38 solar keratoses (73.7%) showed positive and variable nuclear labelling, whereas 10 specimens were immunonegative. The nuclear immunopositivity which was seen in all variants was mostly diffuse in distribution. The adjacent "normal" epidermis of 8 keratoses showed positive mutant p53 labelling. Eight of the keratoses were associated with invasive squamous cell carcinoma of which only two were immunopositive. Cytoplasmic labelling was never a feature. The study demonstrates that mutant p53 protein is commonly expressed in all variants of solar keratosis and that its expression correlates with atypical keratinocyte proliferation. It is proposed that the demonstration of mutant p53 in the adjacent normal epidermis may be a potential marker of early neoplastic transformation.
The histological features of 234 conjunctival biopsies from Africans in Malawi have been re-examined. The appearances of solar keratosis, pinguecula, and pterygium are presented as part of a continuous spectrum of the same pathological process and aetiology, which may lead to carcinomatous change. The results are discussed with regard to the specific geographical distribution of such lesions found by other workers, with particular emphasis on ultraviolet radiation as the main aetiological factor.
BACKGROUND: Overexpression of p53 protein has frequently been demonstrated in human epithelial neoplasms including squamous cell carcinoma (SCC) and solar keratosis (SK). SK is a precursor lesion of SCC. In SCC of the skin, we have already reported that overexpression of p53 protein is associated with the proliferative activity, which is indicated by the percentage of Ki-67-positive cells. In SK, however, the significance of p53 overexpression is still unclear. OBJECTIVE: The aim of the present study was to clarify the relationship between p53 overexpression and proliferative activity, and between p53 overexpression and histological degree of malignancy in SK. METHODS: Sixty-eight cases of SK were divided into four grades according to the proportion of atypical cells in the epidermis (in grade I, up to 25% of the epidermal cells are atypical, in grade II 25-50%, in grade III 50-75%, in grade IV more than 75%) and were immunohistochemically analyzed for the expression of p53 protein and Ki-67 antigen. RESULTS: p53 overexpression was detected in 58 out of the 68 cases of SK. The percentage of p53-protein-positive cells (DO-7 index) ranged from 0 to 78.8 (mean +/- SD = 20.6 +/- 21.6). Mean DO-7 indices were 7.9 in grade I, 26.7 in grade II and 38.3 in grade III. The differences in mean DO-7 index between grades I and II and between grades I and III were statistically significant (p < 0.001). The percentage of Ki-67-antigen-positive cells (MIB-1 index) ranged from 0.8 to 38.2 (mean +/- SD = 10.5 +/- 9.0). Mean MIB-1 indices were 5.9 in grade I, 10.7 in grade II and 20.5 in grade III. The differences in the mean MIB-1 index between grades I and II and between grades II and III were statistically significant (p < 0.01). Cases with higher DO-7 indices tended to show higher MIB-1 indices, and the relation was statistically significant [y = 0.272x + 4.8; correlation coefficient r = 0.59 > r (n - 2, 0.01) = 0.31]. CONCLUSION: Overexpression of p53 protein was related to cell proliferation as well as histological degree of malignancy in SK. Dysfunction of p53 protein might be implicated in skin carcinogenesis.
BACKGROUND: In a previous study we have found that young patients with insulin-dependent diabetes mellitus had a higher prevalence of keratosis pilaris (KP) than healthy controls, with a high correlation with body mass index (BMI) and ichthyosiform skin changes of the legs. OBJECTIVES: To investigate whether BMI, dry scaly legs and atopic conditions could be associated with KP in a healthy population of adolescents. METHODS: A total of 202 Jewish adolescents chosen at random among students undergoing a routine medical examination at school participated in the study. The patients filled in a questionnaire for data on ethnic origin, the presence or history of allergic rhinitis, asthma or atopic dermatitis, the presence of thyroid disease, diabetes or dry skin. A similar questionnaire was sent to the family physician for verification. A general inspection of the skin was made for the presence of KP; the lower legs were also examined for dry scaly skin and ichthyosiform skin changes. RESULTS: KP was present in 33 examinees (16%). Factors significantly associated with were dry scaly skin (p < 0.001, odds ratio, OR = 31.3, with 95% confidence interval, CI, 6.4-153.7), BMI >25 (p < 0.001, OR = 4.9, with 95% CI 2.2-11.2) and atopy (p = 0.001, OR = 4.5, with 95% CI 1.8-11.1). CONCLUSION: It therefore appears that KP is associated with multiple factors, including high BMI, leg skin dryness and atopic conditions.
Keratosis lichenoides chronica (KLC) is a rare chronic dermatosis characterized by lichenoid hyperkeratotic papules arranged in a linear and reticular pattern, and seborrheic-dermatitis-like lesions on the face. Less frequently, palmoplantar keratoderma, nail dystrophies, mucosal as well as eye lesions are present. KLC affects adults and very few cases have been reported in childhood. Although infrequently, KLC has been associated with systemic diseases, including chronic infectious diseases, kidney disorders and lymphoma. Here we report the case of an adult KLC patient with skin, nail and mucosal involvement, and onset in the first year of life who developed a leg panniculitis and a mantle cell lymphoma. Following chemotherapy for the lymphoma, panniculitis resolved completely, and skin and mucosal KLC lesions ameliorated.
BACKGROUND AND OBJECTIVE: We describe a familial disorder featuring hystrix-like keratosis, thickened nails and plantar hyperkeratosis. The index patient, a 10-year-old girl, suffered also from joint laxity and had long fingers, while in her mother only the typical skin lesions were observed. METHODS AND RESULTS: Histologic examination of the spiny hyperkeratoses in the index patient showed parakeratosis with marked cornoid lamella. On electron microscopy the keratinocytes exhibited intracellular vacuolization and aggregated tonofilaments, but no concentric shell formation. CONCLUSION: The striking skin lesions present in the 2 cases can be distinguished from other forms of hystrix-like hyperkeratoses such as nevus corniculatus or multiple digitate hyperkeratoses and hence may represent a new autosomal dominant genodermatosis.
An unusual severe case of keratosis lichenoides chronica is presented. In addition to the typical lichenoid reticulated lesions, the patient had a prominent erythematosquamous involvement of the face and lips. Sclerodactylia was present and represented a yet undescribed manifestation of the disease.
In 1895, Kaposi used the term 'lichen ruber acuminatus verrucosus et reticularis' to describe the case of a 27-year-old woman with a linear, warty lichenoid eruption. We have reviewed the literature and found 50 cases, of which only 40 had common features reminiscent of the original description of Kaposi. These 'authentic' cases of keratosis lichenoides chronica (KLC) showed strong clinical and histological similarity, a uniformity indicating that KLC is an entity and is distinct from lichen planus. KLC may be associated with internal diseases such as glomerulonephritis and lymphoproliferative disorders.
Keratosis lichenoides chronica (KLC) is a rare chronic disorder of keratinization characterized by lichenoid hyperkeratotic papules arranged in a linear pattern, erythematosquamous plaques and seborrhea-like dermatitis on the face. Adults between 20 and 50 years of age are usually affected, but the disease is very uncommon in childhood. Our purpose was to study the clinical and histopathologic findings and course of KLC in one pediatric case. Detailed clinical data were studied. Two punch biopsies were performed and histopathologic features were compared with those of other reported cases of KLC. In our patient, a 4-year-old boy, the clinical features of the lesions did not deviate notably from those of other cases of KLC. The histologic pattern of the papules was typical of KLC, while that of the erythematosquamous plaques showed some dyskeratotic keratinocytes. The histologic pattern of the erythematosquamous lesions is peculiar in our case, whereas only a nonspecific pattern is reported in the literature. The papular and erythematosquamous lesions showed similar histopathologic features suggesting that they could be different degrees of evolution of the same lesion.
Keratosis lichenoides chronica (KLC) is a disorder of keratinization with a chronic progressive course. The nosology of this disorder has been discussed in relation to lichen planus. In this communication a classical case of KLC is presented; however, the lesions involuted spontaneously. The present observation challenges the common belief that KLC has a chronic progressive course.
Actinic Keratosis (AK) arises from sun-damaged skin and is the first clinical manifestation in the multistep process of skin carcinogenesis to invasive squamous cell carcinoma. Thus, it is an ideal target for chemopreventive efforts. Noninvasive measures of AK severity are needed to assess the efficacy of chemoprevention agents. We performed a pilot study on 20 participants to investigate the OCT appearance of sun-protected skin of the upper inner arm as well as sun-damaged skin and early AKs of the dorsal forearms, and to determine if features or quantitative measures in Optical Coherence Tomography (OCT) images could be used to reliably differentiate between these categories. OCT images of upper inner arm (normal appearing skin) showed skin layers and features (stratum corneum, epidermis, dermis, blood vessels) seen in previous studies; additionally in this participant group the subcutaneous fat layer was usually identified. Sun-damaged skin was characterized by increased signal in the epidermis and rapid attenuation of light. AKs were diverse in appearance but frequently characterized by high surface reflection, the presence of a low-signal band in the stratum corneum, and heterogeneous appearance in the epidermis/dermis. Significant differences were found between skin categories using measures of stratum corneum and epidermal/dermal depths and intensities. The presence of a dark band in the stratum corneum was 79% sensitive and 100% specific for AK. This study indicates that OCT holds promise as a useful technique for identifying and characterizing AKs and monitoring their response to chemoprevention agents.
Topical application of 5-fluorouracil (5-FU) is one of the most effective clinical strategies available to treat actinic keratosis (AK). During treatment, an apparent toxic skin reaction occurs before dermal quiescence ensues. We report a case of a typical flare of AK in a woman treated with capecitabine for advanced breast cancer.
Three cases of keratosis obturans, which were studied by tomography of the petrous temporal bone, are described. The widening of the deep bony part of the external auditory canal by pressure erosion of an impacted benign slowly-growing mass is the key radiological finding. Erosion was so severe as to involve the facial nerve canal in one and the temporo-madibular joint in two cases. The theories of causation are reviewed. Tomography using elliptical tube movement was valuable in diagnosis, pre- and post-operative management.
The vocal cord fine surface structure was examined by scanning electron microscopy (SEM), and the observations related to the light-microscopical (LM) findings after embedding and cutting. The SEM micrographs were assessed using a rating system based on 7 parameters. The proportion of "normal" and "abnormal" SEM areas varied within the respective histologic groups. There was, however, a significant difference between the SEM ratings in the group with hyperplasia-keratosis, with or without mild dysplasia, compared to the groups with severe dysplasia-carcinoma in situ and invasive squamous cell carcinoma. In the small number of cases with moderate dysplasia and juvenile laryngeal papilloma, the SEM ratings displayed pronounced disparity.
Seborrheic keratosis (SK) is a benign epidermal tumor of unknown etiology. Because of its wart-like morphology, human papillomavirus (HPV) has been suggested as a possible causative agent. Viral involvement, however, has not been confirmed yet despite extensive research. The aim of this study was to evaluate the presence of HPV 6/11, 31, 33 DNA in nongenital SK. We analyzed 40 biopsy specimens taken from patients with nongenital SK using in situ polymerase chain reaction (PCR) and PCR with tissue extracts. The SK specimens (n=40), analyzed by in situ PCR, were negative for all HPV probes tested (types 6/11, 31, 33). Control slides (condyloma acuminatum, n=3) were positive for type 6/11, 31, and 33 HPV probes tested. Melasma samples (n=4), the negative controls, were consistently negative. No HPV DNA band was detected by PCR with the tissue extracts from paraffin-embedded SK samples, while condyloma acuminatum, the positive controls, showed DNA bands of the correct molecular weights. Our results show that HPV type 6/11, 31, and 33 cannot be recognized as causative agents for nongenital SK, which is in contrast to the previous studies. Further studies are required to reveal the presence of other types (more than 90) of HPV DNA.
Two cases of borderline-tuberculoid leprosy which developed keratosis spinulosa over the anaesthetic areas alone during type I lepra reactions are described. Both patients only developed spiny papules during the period of reaction and subsided with control of the reaction. The probable mechanism of this peculiar phenomenon might be due to the generation of epidermal growth factors by local T cell activation during the type I lepra reaction.
The authors studied 40 V-osteotomies of the lesser metatarsal performed for chronic intractable plantar keratosis. They discuss the effectiveness of the V-osteotomy for this deformity as well as other findings such as whether or not fixation of the osteotomy yields a better result (i.e., a lower incidence of complications). The results show that the V-osteotomy had limited effectiveness for this condition and resulted in a high complication rate.