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PubMed1990

[Histologic aspects of seborrheic keratosis].

The histopathological aspects of seborrheic keratosis have been studied in order to establish a basis to their classification upon structural morphology and cytology. The 210 seborrheic keratosis studied could be classified in several patterns among which we must point out the three most important ones: hyperkeratotic, adenoid and acanthotic. This last one can offer two very different images: uniform acanthotic (this one including at the same time, a variant of "small basal cells") and reticular acanthotic. Special mention has to be made as well to the activated and pure forms which, though being the result of evolutive accidental phenomena, no doubt they have very particular and distinctive histopathological aspects. Further, other variants are discussed such a clonal and acantholytic seborrheic keratosis, as well as the significance of inverted follicular keratosis and of melanoacanthoma.

Dermatitis, Seborrheic↗
PubMed1994

Clinical findings, cutaneous pathology, and response to therapy in 21 patients with keratosis pilaris atrophicans.

BACKGROUND: Keratosis pilaris atrophicans defines a group of cutaneous disorders characterized by follicular hyperkeratosis and scarring. X-linked dominant inheritance has recently been reported in a Dutch family with a form of keratosis pilaris atrophicans defined as keratosis follicularis spinulosa decalvans, with males more severely affected and having corneal involvement. The clinical manifestations observed in different families by others and ourselves did not follow that pattern, suggesting genetic heterogeneity. We report our experience with 21 unrelated individuals. RESULTS: There were 15 male and six female patients whose onset of the skin disease was in early childhood but with scalp involvement occurring in the teen years. The cutaneous lesions consisted of follicular papules with scalp involvement present in eight individuals. Half the women had scalp involvement, and one female and one male had eye changes. Familial involvement was observed in three patients and was compatible with dominant inheritance. Histopathologic examination revealed hyperkeratosis of the upper follicle with an inflammatory response that resulted in follicular destruction. Response to therapy including keratolytics, antibiotics, corticosteroids and retinoids was limited. CONCLUSIONS: Our findings support the hypothesis that there is genetic and clinical heterogeneity among the disorders represented by the term keratosis pilaris atrophicans. The cause of these diseases may be a disorder of the keratinocyte, which is responsible for inducing both the hyperkeratosis and inflammatory changes.

Adolescent↗
PubMed1995

Actinic keratosis and dysplasia of the conjunctiva: a clinicopathological study of 45 cases.

OBJECTIVE: To characterize precancerous conjunctival intraepithelial tumours on file at the Armed Forces Institute of Pathology (AFIP). DESIGN: Chart review. SETTING: Registry of Ophthalmic Pathology of the AFIP. NUMBERS: Forty-five patients with intraepithelial neoplastic lesions of the conjunctiva followed for at least 2 years. MAIN OUTCOME MEASURES: Extent; papillomatous pattern; degree of parakeratosis, hyperkeratosis and atypia; and amount of solar elastosis. RESULTS: Based on their histologic appearance, 24 cases were classified as actinic keratosis and 21 cases as dysplasia. Clinically, lesions classified as actinic keratosis tended to be focal and leukoplakic, whereas those classified as dysplasia tended to be diffuse and gelatinous. Two of the lesions classified as actinic keratosis recurred, compared with 13 of the lesions classified as dysplasia. In one patient with dysplasia locally invasive squamous cell carcinoma developed after numerous recurrences, requiring orbital exenteration. The degree of atypia was not correlated with recurrence in either group. CONCLUSIONS: Most intraepithelial neoplastic lesions of the conjunctiva can be readily diagnosed by the ophthalmic pathologist as either actinic keratosis or dysplasia.

Carcinoma in Situ↗
PubMed1999

Loss-of-function mutations in the cathepsin C gene result in periodontal disease and palmoplantar keratosis.

Papillon-Lefèvre syndrome, or keratosis palmoplantaris with periodontopathia (PLS, MIM 245000), is an autosomal recessive disorder that is mainly ascertained by dentists because of the severe periodontitis that afflicts patients. Both the deciduous and permanent dentitions are affected, resulting in premature tooth loss. Palmoplantar keratosis, varying from mild psoriasiform scaly skin to overt hyperkeratosis, typically develops within the first three years of life. Keratosis also affects other sites such as elbows and knees. Most PLS patients display both periodontitis and hyperkeratosis. Some patients have only palmoplantar keratosis or periodontitis, and in rare individuals the periodontitis is mild and of late onset. The PLS locus has been mapped to chromosome 11q14-q21 (refs 7, 8, 9). Using homozygosity mapping in eight small consanguineous families, we have narrowed the candidate region to a 1.2-cM interval between D11S4082 and D11S931. The gene (CTSC) encoding the lysosomal protease cathepsin C (or dipeptidyl aminopeptidase I) lies within this interval. We defined the genomic structure of CTSC and found mutations in all eight families. In two of these families we used a functional assay to demonstrate an almost total loss of cathepsin C activity in PLS patients and reduced activity in obligate carriers.

Aggressive Periodontitis↗
PubMed2000

Utility of step sections: demonstration of additional pathological findings in biopsy samples initially diagnosed as actinic keratosis.

OBJECTIVES: To discover additional diagnostic findings on step sections of biopsy samples showing features of actinic keratosis on the initial section and to correlate such findings with clinical and histological variables. DESIGN: Prospective study comparing initial histological findings with those noted on deeper tissue levels. SETTING: University-based dermatopathology practice. PATIENTS: Fifty-seven patients (36 men and 21 women) with biopsy samples from 69 skin lesions. MAIN OUTCOME MEASURES: Identification of additional pathological diagnoses in step sections and correlation with clinical diagnosis, size and location of lesion, history of skin cancer or immunosuppression, size and handling of specimen, and presence of ulceration on the initial level. RESULTS: Additional diagnostic findings were present on step sections in 23 specimens (33%), including 9 (13%) with squamous cell carcinoma in situ, 3 (4%) with basal cell carcinoma, and 2 (3%) with invasive squamous cell carcinoma. Three variables were significantly correlated with the discovery of cancer on step sections: (1) ulceration on the first level, (2) clinical diagnosis of skin cancer, and (3) history of skin cancer diagnosed by biopsy examination. The latter 2 variables were also correlated with the discovery of any additional finding, whether benign or malignant, on step sections. CONCLUSIONS: In biopsy samples initially diagnostic of actinic keratosis, examination of step sections contributes clinically important information. Step sections are particularly useful when a clinical diagnosis of skin cancer is present. The results of this study confirm the pathogenetic importance of actinic keratosis as a precursor to fully evolved malignant neoplasia and suggest that such lesions merit thorough histological study.

Adult↗
PubMedDate not supplied

Laryngeal keratosis and subsequent carcinoma.

The frequency with which carcinoma develops in laryngeal keratoses is a controversial subject. A study of 92 cases of laryngeal keratosis with a minimum of five years' follow-up resulted in identification of three patients (3.26%) who developed laryngeal carcinoma. A reviews of the literature reveals that, in series of keratoses defined by stringent pathologic criteria, subsequent laryngeal carcinoma develops in 3.33%-4.31%. These findings support a low but predictable frequency of conversion to malignancy in laryngeal keratosis. A grading system for keratosis is presented and discussed with reference to clinicopathologic correlation.

Carcinoma, Squamous Cell↗
PubMed1980

Keratosis obturans and external auditory canal cholesteatoma.

Keratosis obturans and external auditory canal cholesteatoma (EACC) have previously been considered to represent the same disease process. However, review of the literature and our cases reveal these to be two different clinical and pathological processes. Keratosis obturans presents as hearing loss and usually acute, severe pain secondary to the accumulation of large plugs of desquamated keratin in the ear canal. External auditory canal cholesteatoma presents as otorrhea with a chronic, dull pain secondary to an invasion of squamous tissue into a localized area of periosteitis in the canal wall. The treatment previously recommended for both of these conditions has been conservative debridement of the external canal and application of topical medication. While this remains the treatment of choice for keratosis obturans, surgery may be required to eradicate EACC.

Adult↗
PubMed1978

DNA-repair after UV-irradiation in skin fibroblasts from patients with actinic keratosis.

Autoradiographic counting technique was utilized to measure the ultraviolet-induced unscheduled DNA synthesis of skin fibroblasts from 12 patients with chronic actinic keratosis and from 12 healthy donors of about the same age. In order to reveal a possible regional difference of DNA repair between the parts of the body ordinarily exposed and those parts unexposed to sunlight, two cell strains were used for each examined subject; one developed from the forehead skin and the other from the abdominal or axillary skin. Unscheduled DNA synthesis appeared depressed in actinic keratosis patients, as compared with controls. In all examined subjects however cell strains from exposed skin showed a DNA repair more active than cell strains from unexposed skin. These findings show that skin cancer may be promoted in actinic keratosis patients by a defect of DNA repair. The exalted DNA repair of chronically sun exposed skin is probably the consequence of a defensive process caused by enzymatic induction.

Aged↗
PubMedDate not supplied

The development of actinic keratosis into invasive squamous cell carcinoma: evidence and evolving classification schemes.

Actinic keratosis is an incipient form of cutaneous squamous cell carcinoma. Consequently, actinic keratoses must be treated expeditiously to forestall their downward growth. Several classification schemes have been proposed to better categorize actinic keratoses, and to guide their diagnosis and treatment. Among these approaches is the "keratinocyte intraepithelial neoplasia" (KIN) system developed by Cockerell; Goldberg's concept of the "proliferative actinic keratosis" (PAK), and Berhane's emphasis on the "inflamed actinic keratosis" (IAK). In the future, disparate classification schemes may be unified into a single pragmatic approach which accurately reflects the biological process whereby actinic keratoses devolve into invasive squamous cell carcinoma.

Carcinoma, Squamous Cell↗
PubMed2006

Seborrheic keratosis with basal clear cells: a distinctive microscopic mimic of melanoma in situ.

BACKGROUND: We observed seborrheic keratoses with many basilar clear cells, creating a microscopic pattern that mimicked a seborrheic keratosis involved by melanoma in situ. OBJECTIVE: We sought to report a series of these seborrheic keratoses and the immunohistochemical stains used to reach a proper diagnosis. METHODS: We reviewed 9 cases of seborrheic keratosis that had a distinctive pattern of basal clear cells with ample cytoplasm. All cases were evaluated by conventional microscopy, and Melan-A, S-100, and high molecular weight keratin 903 immunostains. RESULTS: The basal clear cells failed to react with Melan-A and S-100 protein antisera. In contrast, these cells labeled with an antikeratin antibody in all cases. In all, 7/9 (78%) showed immunopositivity only at the peripheries of cells, creating a pattern that could be mistaken for a negative stain if not examined at high magnification. LIMITATIONS: This is a retrospective review of cases limited to a large referral dermatopathology service. CONCLUSIONS: We describe a previously uncharacterized pattern of seborrheic keratosis that can microscopically mimic melanoma in situ. Careful conventional microscopy coupled with a panel of immunostains can allow the proper diagnosis to be reached.

Aged↗
PubMed1999

Immunohistochemical study of the inflammatory infiltrate associated with feline cutaneous squamous cell carcinomas and precancerous lesions (actinic keratosis).

The distribution of T lymphocytes (CD3+), B lymphocytes (CD79+), immunoglobulin-containing plasma cells (IgG, IgM and IgA), macrophages (Mac387+) and MHC Class II antigen was analysed in the inflammatory infiltrate associated with cutaneous squamous cell carcinomas (SCC) from 23 cats. Peri-tumoural skin (12 cases) and precancerous lesions of actinic keratosis (nine cases) were also evaluated for the expression of MHC Class II. The results revealed that an abundant inflammatory infiltrate was associated with the majority of SCC. This infiltrate was composed mainly of CD3+ T lymphocytes, B cells (CD79+) and IgG-bearing plasma cells, and the intensity of infiltration increased with the degree of invasiveness of the tumour. The number of CD3+ T cells and CD79+ cells was significantly increased in well-differentiated SCC compared with moderately differentiated tumours, whereas the number of IgM+, IgA+ plasma cells and Mac387+ macrophages was low or moderate and did not change significantly with histologic grade or invasiveness. MHC Class II antigen was expressed by infiltrating lymphocytes and macrophages, and by fibroblasts. A variable number of neoplastic cells (10% to 80%) in 10 SCC, and keratinocytes of basal layers in seven of nine cases of actinic keratosis also expressed MHC Class II, whereas keratinocytes of normal skin were always negative for this antigen. These results suggest that CD3+ T lymphocytes, CD79+ B cells and IgG-bearing plasma cells may participate in down-regulation of tumour growth, since these cell types were particularly numerous in well-differentiated and mildly invasive SCC, as well as in actinic keratosis. The expression of MHC Class II by neoplastic cells could enhance this local anti-tumour immune response.

Animals↗
PubMed2001

Association analysis of somatostatin receptor (SSTR1 and SSTR2) polymorphisms in breast cancer and solar keratosis.

The presence of somatostatin receptors (SSTR1-5) in tumour cells indicates a potential for somatostatin to bind and suppress growth, as well as allowing for therapeutic treatment with somatostatin analogues. The genes for SSTR1 and SSTR2 have been shown to contain dinucleotide repeat polymorphisms. We have performed association studies on breast cancer and solar keratosis populations to determine whether these genes play a role in the development of these conditions. Results showed that there was no significant difference between SSTR1 and SSTR2 polymorphism frequencies in the tested breast cancer population (P = 0.59 and P = 0.54, respectively) nor the solar keratosis population (P = 0.10 and P = 0.883, respectively) as compared to unaffected populations. Hence, these studies do not support a role for these receptor genes in either breast cancer or solar keratosis lesions.

Alleles↗
PubMed2000

Prevalence of solar damage and actinic keratosis in a Merseyside population.

This study examines the prevalence of sun-related damage to the skin in a caucasian population in north-west England. The importance of constitutional factors (complexion, skin type and age) as well as environmental and occupational exposures for the development of actinic keratosis (AK) and skin cancers was assessed in people over 40 years of age attending outpatient clinics (non-dermatology) at four centres in north-west England (Mersey region). Nine hundred and sixty-eight volunteers (531 men and 437 women) were recruited. The overall prevalence of AK was 15.4% in men and 5.9% in women. The prevalence was strongly related to age in both sexes, being 34.1% and 18.2%, respectively, in men and women aged 70 years and above, and was most strongly related to two objective signs of sun exposure, namely degree of solar elastosis and presence of solar lentigines. The prevalence of AK was higher in subjects with red hair and freckles, particularly women. There was no evidence of an increased prevalence of AK in relation to any occupation. There was a high prevalence of seborrhoeic keratosis and viral warts in both sexes, which was age-related in the case of seborrhoeic keratosis. Ten cases of basal cell carcinoma, eight cases of Bowen's disease and one case of malignant melanoma were identified. This study shows that the sun exposure received in 'normal' life in England is sufficient to cause potentially malignant skin damage in a significant proportion of the population.

Adult↗
PubMed2002

Treatment of arsenical keratosis and Bowen's disease with acitretin.

BACKGROUND: Long-term exposure to arsenic is associated with the development of arsenical keratosis, Bowen's disease, squamous cell carcinoma, and basal cell carcinoma. The efficacy of acitretin therapy was examined in two patients with cutaneous arsenical neoplasms. METHODS: Lipid profile, hematological and liver function tests were performed regularly during the therapy at monthly intervals. RESULTS: After the third month of treatment, improvement of lesions of arsenical keratosis and Bowen's disease were observed in both patients. For the first patient who received 1 mg/kg daily acitretin for 10 months nearly total clearing was obtained at the end of therapy. The second patient discontinued the treatment after a period of 5 months because of symptomatic side-effects. During therapy no new lesions and no laboratory side-effects were observed in either patient. CONCLUSIONS: Although these results need to be confirmed by larger, long-term trials, it appears that acitretin is effective in the treatment of Bowen's disease related with arsenic, as well as arsenical keratosis.

Acitretin↗
PubMed2000

Keratosis lichenoides chronica: report of a case developing after erythroderma.

A 66-year-old male presented with keratosis lichenoides chronica after a presumed drug-induced erythroderma. After resolution of the erythroderma, slightly scaly erythematous and violaceous papules in a reticular arrangement over the trunk and limbs developed in association with hoarseness, palmoplantar keratoderma, onycholysis and subungual keratosis. Histology from a lichenoid lesion showed pseudo-epitheliomatous hyperplasia, hyperorthokeratosis, parakeratosis, dyskeratosis, neutrophil exocytosis and focal vacuolar degeneration of the basal layer of the epidermis. There was a band-like chronic inflammatory infiltrate in the upper dermis. The skin improved with prednisone 40 mg/day for 15 days, leaving atrophic hypopigmented scars. A diagnosis of keratosis lichenoides chronica was made.

Aged↗
PubMed2003

Pigmented squamous cell carcinoma of the cheek skin probably arising from solar keratosis.

We report a rare case of pigmented squamous cell carcinoma (SCC) of the cheek skin probably arising from solar keratosis. An 80-year-old man was referred to our clinic because of a black skin nodule in the right cheek. The nodular lesion was 1 cm in diameter, dome-shaped, hard, sharply demarcated, partially erosive and telangiectatic at the border. The lesion was completely excised under the clinical diagnosis of probable seborrheic keratosis. Microscopically, cutaneous horn and mildly atypical squamous epithelia suggestive of previous solar keratosis were present in the surface of the lesion. The lesion consisted of atypical squamous cells with keratinization and intercellular bridges, and it was regarded as SCC. The SCC cells were seen to invade lightly into the upper dermis, where lymphocytic infiltrations and melanophages were noted. Characteristically, heavy deposition of melanin pigment was recognized in the SCC cells as well as in proliferated dendritic and pigment blockade melanocytes that were scattered or colonized within the SCC cell nests. Masson-Fontana stain revealed numerous melanin granules in the SCC cells, as well as in dendritic and pigment blockade melanocytes. Immunohistochemically, the SCC cells were positive for cytokeratins and epithelial membrane antigen, and negative for S-100 protein and HMB45 antigen. Dendritic and pigment blockade melanocytes were negative for cytokeratins, epithelial membrane antigen, and HMB45 antigen, but positive for S-100 protein. The present case suggests that SCC cells of the skin may induce proliferation of melanocytes. The differential diagnosis and the histogenesis of pigmented SCC of the skin are discussed.

Aged↗
PubMed2002

Seborrhoeic keratosis or occult malignant neoplasm of the skin?

BACKGROUND: Seborrhoeic keratosis is generally considered to be a benign lesion of the skin. OBSERVATION: We present the case of a 68-year-old male who presented with clinically typical seborrhoeic keratosis that later histological examination showed partially covered an occult basal cell carcinoma. OBJECTIVE: To have an indication of what percentage of clinically apparent seborrhoeic keratoses may be associated with some form of histologically proven skin malignancy. METHODS: We carried out a retrospective analysis of approximately 23,000 histopathological examinations done on specimens from dermatological lesions. RESULTS: Fifty-nine (11.9%) clinically apparent seborrhoeic keratoses were later histologically diagnosed as basal cell carcinomas, 17 (3.4%) as squamous cell carcinomas, and five (1.01%) as malignant melanomas. CONCLUSIONS: Although the association of seborrhoeic keratosis and skin malignancy appears to be relatively uncommon, the possibility of such an association cannot be ruled out.

Aged↗
PubMed2000

Lichenoid keratosis: a clinicopathologic study of 17 patients.

BACKGROUND: Lichenoid keratosis (LK) is a rather frequent skin lesion that has some histologic features similar to lichen planus (LP). The clinical and histopathologic characteristics of LK and differential tools from LP are not yet fully established. OBJECTIVE: The purpose of this study was to investigate the clinical and histopathologic characteristics of LK. METHODS: A clinical survey was done with 17 patients diagnosed as having LK. We reevaluated biopsy materials of 17 patients diagnosed during the past 10 years at Asan Medical Center, Seoul, Korea. We performed an immunohistochemical staining in 17 cases of LK and 7 cases of LP using 5 antibodies for CD3, CD4, CD8, CD20, and cutaneous lymphocyte-associated antigen (CLA). Standard streptavidin-biotin peroxidase method using the monoclonal antibodies with 3-amino-9-ethyl-carbazole was used. RESULTS: The male/female ratio was 1:1.1. The mean age at diagnosis was 54.9 years. The face was the most commonly affected site, followed by the arm and forearm, dorsum of hand, chest, trunk, abdomen, and leg. The lesions were predominantly solitary (76.5%); 1 patient had 4 lesions; 3 patients (17.6%) had numerous lesions. The lesions ranged in size from 0.4 to 2.0 cm. Histopathologically, all the cases showed characteristic lichenoid infiltrates of lymphocytes, occasional parakeratosis, and apoptotic bodies in the epidermis without nuclear atypia of keratinocytes. LK could be reclassified into 3 patterns by means of histopathologic findings: LP-like (11/17), seborrheic keratosis-like (3/17), and lupus erythematosus-like (3/17). Immunohistochemical studies revealed that infiltrated epidermal and dermal lymphocytes in LK consisted mainly of CD8(+) T cells and partly CD20(+) B cells. In LP, epidermal lymphocytes were mainly CD8(+) T cells and dermal lymphocytes were CD4(+) or CD8(+) T cells. Interestingly, CLA was strongly expressed in LP but not expressed in LK. CONCLUSION: We reclassified LK as follows: LP-like LK, seborrheic keratosis-like LK, and lupus erythematosus-like LK. Immunohistochemical stains for CLA as well as CD4 and CD8 may be valuable tools in the differential diagnosis between LK and LP.

Adult↗