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A rapidly spreading plaque of seborrheic keratosis developed following liquid nitrogen treatment and involuted quietly after a dermatitis developed; polymerase chain reaction of the tissue did not demonstrate papillomavirus DNA. Seborrheic keratoses can both develop and involute from more than one cause.
A selective inflammatory reaction involving actinic keratosis may occur in patients receiving systemic 5-fluorouracil as part of a chemotherapeutic protocol. This may be effectively treated with topical 5-fluorouracil.
BACKGROUND: Reactive oxygen species and lipid peroxides have been implicated in the pathogenesis of a variety of diseases, particularly cancer. There may be an inverse correlation between lipid peroxidation and antioxidant defense mechanisms. The aim of this study was to investigate whether certain plasma antioxidants (ascorbic acid, alpha-tocopherol, total thiol groups, ceruloplasmin, urate, albumin and erythrocyte glutathione) are altered in actinic keratosis (AK) and basal cell carcinoma (BCC). METHODS: Plasma samples and red blood cells (RBC) of 13 patients with AK, 12 with BCC and 16 healthy controls were investigated. RESULTS: Data analysis indicates significant decrease of ascorbic acid (P < 0.001), alpha-tocopherol (P < 0.05 and P < 0.001), total thiol groups (P < 0.001), ceruloplasmin (P < 0.001 and P < 0.05), and RBC glutathione (P < 0.05) values in both AK and BCC groups compared to controls. Comparison of AK and BCC groups evidenced a significant decrease of alpha-tocopherol and RBC glutathione (P < 0.05) in BCC patient. CONCLUSION: Plasma antioxidants are decreased in the AK and BCC, probably due to the long exposure to UV irradiation which is one of the most important factors in the etiology of AK and BCC and alpha-tocopherol and RBC glutathione (P < 0.05) are most altered in BCC.
An 81-year-old woman presented with a round erythematous macule with keratotic scales on her left hand. The skin specimen histologically showed hypergranulosis and apoptotic keratinocytes in the epidermis with lichenoid infiltration of lymphocytes. Parakeratosis seen in the hyperkeratotic cornified layer indicated lichen planus-like keratosis, as distinguished from lichen planus. Direct immunofluorescence study revealed the linear deposition of IgM in the basement membrane zone; IgG, IgA and C3 were not detected.
Inverted follicular keratosis (IFK) is a benign skin lesion that typically presents as an asymptomatic, solitary nodule on the face of middle-aged and older individuals. IFK may mimic malignant lesions, especially squamous cell carcinoma (SCC), both clinically and pathologically. We report a 35-year-old male patient who had an exophytic nodule with papillary surface on his right nasal ala of 3 months' duration. The nodule was solitary, flesh colored, 5 mm in diameter and tended to bleed. The patient received shave excision with cautery under the clinical impression of pyogenic granuloma. Pathologically, diagnostic confusion existed between IFK and SCC. Squamous eddy formation and lack of epithelial dysplasia were suggestive of IFK. The tissue was investigated for the presence of human papillomavirus (HPV) DNA sequences by polymerase chain reaction (PCR) and negative result was obtained. This patient healed satisfactorily after removal of the lesion and no visible recurrence occurred during the following 10 months. The possibility of histologically confusing IFK with SCC, leading to unwarranted disfiguring treatments of a benign lesion, is emphasized.
Seborrheic keratoses are superficial epithelial lesions. They are usually pigmented and often warty, but sometimes they appear as smooth papules. These lesions frequently occur on the face during middle and old age. We report an unusual case of a large seborrheic keratosis of the auricle. We also emphasize the importance of the differential diagnosis, and we discuss the treatment strategy for these usually benign but disfiguring tumors.
A 25-year-old-male patient had one keratinized tumor on the inferior right eyelid, first observed 5 months before. Its size had been increasing for the last three weeks. The visual function was normal. Clinical examination disclosed a papillomatous lesion on the cutaneous middle part of the eyelid. A surgical excision was performed under local anesthesia. The histopathological study found a papillomatous epidermal proliferation with both structural and cytological atypias, concluding with a precancerous keratosis of the eyelid.
A 46-year-old female patient had a tumor of the free margin area of the superior right eyelid, appearing as the fourth recurrence of a primary lesion, occurring 24 years before. The lesion was covered with a thick layer of keratin, giving it a grayish and black color. Excision was performed without involving the free margin. Histopathology disclosed that the tumor was a seborrheic keratosis, which was not completely removed. As the lesion was benign, no further surgery was performed but regular examination was recommended to the patient.
New therapeutic options would benefit patients with actinic keratosis (AK), a precancerous condition that is a significant health concern. The efficacy and safety of a microsphere-based formulation of 0.5% fluorouracil cream were evaluated in a randomized, double-blind, multicenter, parallel-group study. Patients (N= 177) were randomized to receive 0.5% fluorouracil or vehicle once daily for 1, 2, or 4 weeks. Efficacy was assessed by lesion counts and clearance. Safety was evaluated by monitoring adverse events, including facial irritation. Significant improvements were seen from baseline to posttreatment follow-up in all efficacy variables for all fluorouracil regimens compared with vehicle. Patients treated for one week experienced significant improvements compared with vehicle, although efficacy increased with increasing treatment duration. Most patients experienced mild to moderate facial irritation of predictable onset and duration. Once-daily administration of 0.5% fluorouracil cream for 1, 2, or 4 weeks is safe and effective for the treatment of AKs.
The efficacy and safety of a new 0.5% fluorouracil topical cream were compared with vehicle control for the treatment of actinic keratosis (AK). Active treatment applied once daily for 1, 2, or 4 weeks was more effective than vehicle control in achieving reduction from baseline in lesion counts and lesion clearance. Active treatment also resulted in significantly better global assessments of overall improvement. Treatment was effective regardless of the number of baseline lesions. Although longer treatment duration correlated with greater efficacy, treatment for 1, 2, or 4 weeks was effective. This new microsphere-based fluorouracil formulation was generally well tolerated; adverse events were primarily limited to facial irritation that resolved quickly after treatment. This new treatment provides a safe alternative to the topical fluorouracil formulations currently available for the 1-, 2-, or 4-week treatment of AK.
Epidermodysplasia verruciformis (EV) is a rare genodermatosis characterized by disseminated infection by human papillomavirus (HPV) and malignant transformation of the lesions in about half of the patients. Two phenotypes of EV have been described according to their propensity to develop malignant tumors. The benign form of EV presents a singular type of lesions comprised of flat warts widely disseminated. The malignant form of EV is highly polymorphic and presents as malignant skin tumors, predominantly basal and squamous cell carcinomas, on sun-exposed sites. The seborrheic keratosis-like (SK) lesions in patients of EV have been reported to be associated with the malignant phenotype. In this work, we documented the behavior of SK-like lesions in nine patients with EV, through clinical observations as well as histological and immunohistochemical findings. We suggest that the HPV infection may promote the occurrence of SK-like lesions in EV patients. Despite the fact that we did not observe any malignant transformation of these lesions in our series of patients, this possibility was not completely excluded.
Pemphigus Foliaceus (PF) is an antibody-mediated autoimmune disease. IgG directed against desmoglein-1 induces acantholysis in the superficial epidermis, leading to the classic presentation of crusted erosions in a seborrheic distribution. We report a case of a 51-year-old African-American man with an 8-year history of PF, who developed multiple hyperpigmented, 'stuck-on' appearing verrucous papules and plaques on the back, chest, and neck. Skin biopsy and direct immunofluorescence from the seborrheic keratosis-like lesions was consistent with pemphigus foliaceus. The patient was treated by adding oral gold (auranofin) to his regimen of prednisone and discontinuing hydroxychloroquine. After six months of follow-up his erosions healed. This is the first report of treating pemphigus foliaceus with oral gold.
Clinical findings were studied in 50 patients with 53 lesions of solar keratosis encountered during the 15 year period from 1977 to 1991. The majority of these cases were evident in the over-sixty age group (average 62.2 years). A greater proportion were females. Most lesions were observed on the face; especially on the cheek, and from the outer eyelid to the temple. The erythematous type (desquamative-keratotic) lesion was the most evident. With the exceptions of the years 1979 and 1991, no remarkable increase in the number of patients was noted during the 15 year period.
We examined histopathologic data from 50 patients with 53 lesions of solar keratosis encountered over the past 15 years (1977 to 1991). The epidermis showed acanthosis, uneven epidermal dyeing properties, disorderly arrangement of the basal cells, atypia of the nucleus, mitotic figures and hyperpigmentation of the basal layers. The dermis showed actinic elastosis, cell infiltration mainly consisting of the lymphoid cells, and incontinentia pigmenti histologica. Among histologic types, the hypertrophic type was the primary example.
Lectin binding patterns in psoriasis, lichen planus and seborrheic keratosis lesions were studied using 14 different biotinyl lectins and avidin-horseradish peroxidase. Compared with normal epidermis, there were significant quantitative and qualitative differences, some of which were characteristic.
Leukoplakia simplex lesions affecting the oral mucous membrane of cheeks and the floor of the mouth were characterized from the clinical, histological, electron-microscopical and stereological point of view. An integration of the various observations suggested that a combination of atrophic and metaplastic processes give rise to this type of leukoplakia-lesion which imitates epidermal structures and, therefore, could be defined as a metaplastic keratosis. Possible pathogenetic mechanisms are formulated which might be responsible for and cause this type of oral mucous membrane lesion.
Seborrheic keratosis can simulate a malignant melanoma and should form the differential diagnosis of a malignant melanoma. Histopathology is confirmatory.
Imiquimod 5% cream has been available since 1997 for the treatment of genital warts. Health Canada has expanded the indication to include actinic keratosis (AK). There are no trials comparing imiquimod 5% cream to standard AK therapy; placebo-controlled trials have shown an increased lesion clearance rate of 30% to 55% eight weeks post-treatment. Side effects include local skin reactions that can be severe and require discontinuation of treatment in 2% to 4% of patients. Imiquimod has shown a great potential for use in unapproved indications.