Dermoscopic features of Bowen’s disease in Asians

Background Previously, dermoscopic features of Bowen’s disease (BD) were extensively investigated in two studies, but there were some discrepancies. The dispute necessitated a further study concerning the dermoscopic features of BD. Objective To describe the dermoscopic features of BD in Asians and to assess dermoscopy as a post‐treatment monitoring tool of BD. Materials and methods Dermoscopic examinations of histopathologically diagnosed 26 BD lesions were performed to evaluate for the presence of various dermoscopic features. In addition, the correlating changes of dermoscopic features and histopathological results before and after treatments were assessed in five patients with BD. Results Dermoscopically, 10 lesions were pigmented and 16 lesions were non‐pigmented. The most frequent dermoscopic findings of BD were vascular structures (96%) and a scaly surface (96%). Among vascular structure, glomerular vessels were most frequently observed (77%). The other vascular structures in our study were linear irregular vessels, dotted vessels, polymorphous/atypical vessels and arborizing vessels. Among five patients who had been treated with either photodynamic therapy or 5% imiquimod cream, four patients revealed disappearance of dermoscopic vascular structures, but one patient showed remaining vascular structures after treatment. Skin biopsy from treated lesions disclosed clearance of BD in four patients who had no vascular structures but remaining BD in the patient whose dermoscopic finding displayed no disappearance of vascular structures. Conclusions Vascular structures, especially glomerular vessels plus a scaly surface, were common dermoscopic findings of BD in Asians. In addition, existence of dermoscopic vascular structures after treatment appears to be associated with residual disease.     

Vascular patterns in basal cell carcinoma

Background Dermoscopy has been proved to increase the diagnostic accuracy of basal cell carcinoma (BCC). Objective To characterize the type and frequency of vascular patterns in superficial and nodular BCCs. Methods We retrospectively analysed the dermoscopic images of 504 histopathologically proven BCCs. Results The most common vascular pattern was represented by arborizing vessels (306/504; 60.7%), which were significantly more frequent in nodular BCCs (nBCCs) compared with superficial BCCs (sBCCs), and in pigmented sBCCs vs. non‐pigmented sBCCs (P < 0.0001). Short fine telangectasias (SFTs) were found in 33.1% (167/504) of cases and were significantly more frequent in sBCCs compared with nBCCs (P < 0.0001). Hairpin vessels were detected in 52/504 (10.3%) BCCs. Minor vascular patterns included glomerular vessels (41/504; 8.1%), dotted (21/504; 4.2%), comma vessels (5/504; 1.0%) and polymorphous pattern (9/504; 1.8%). Conclusions Arborizing vessels are prototypic of nBCCs, whereas SFTs are characteristics of sBCCs. Differential diagnosis with squamous cell carcinoma or melanoma is mandatory when a polymorphous pattern is detected.     

Livin和Smac在鲍恩病及皮肤鳞状细胞癌中的表达

目的：确定Livin和Smac在鲍恩病（BD）及皮肤鳞状细胞癌（SCC）中的表达和意义.方法：应用免疫组化SP法检测35例BD和32例SCC中Livin和Smac的表达,分析二者表达的相关性.结果：Livin表达：BD组高于BD癌旁组织（P〈0.001）;BD癌旁组织高于正常对照组（P〈0.05）.SCC组高于SCC癌旁组织（P〈0.001）;SCC癌旁组织高于正常对照组（P〈0.05）.SCC组高于BD组（P〈0.05）.Smac表达：BD组低于BD癌旁组织（P〈0.01）;BD癌旁组织低于正常对照组（P〈0.05）;SCC组低于SCC癌旁组织（P〈0.001）;SCC癌旁组织低于正常对照组（P〈0.05）;SCC组低于BD组（P〈0.05）.Livin和Smac在BD中表达无相关性（P〉0.05）,在SCC中表达呈负相关（P〈0.05）.结论：Livin的过表达和Smac的低表达可能在BD和SCC的发生、发展中起一定作用.     

Dermoscopic follow‐up of therapeutic response in mantle cell lymphoma with secondary involvement of the scalp

The scalp is a potential location for both benign and malignant tumors. Lymphoproliferative diseases can involve the skin as a primary or secondary manifestation. Dermoscopy is a noninvasive diagnostic tool for rapid diagnosis, screening, and follow‐up of the majority of skin tumors. Mantle cell lymphoma (MCL), a rare type of aggressive systemic lymphoma, usually occurs as a generalized lymphadenopathy, commonly with infiltration of the bone marrow, spleen, gastrointestinal tract, and Waldeyer's ring. In rare cases, it can also involve other structures, such as the lungs, central nervous system, liver, or skin. We report the case of a 74‐year‐old male patient suffering from MCL since 2015. Complete remission was obtained after R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) treatment. During maintenance therapy with rituximab, a solitary tumor occurred on the scalp. Dermoscopy of the lesion suggested relapse because of the presence of multiple chaotically distributed short linear vessels with multiple red dots within the hair follicles. Histological examination confirmed the diagnosis of MCL. After second‐line therapy with rituximab and bendamustine (R‐B), the tumor of the scalp completely disappeared and dermoscopy showed no abnormalities.     

High‐risk human papillomavirus in a child with digital pigmented Bowen's disease: Case report and dermoscopic findings

Squamous cell carcinoma in situ, also known as Bowen's disease (BD), is a skin malignancy most commonly seen in middle‐aged and elderly adults. Pediatric BD is rare and can be a diagnostic challenge for physicians. Digital BD has largely been associated with human papilloma virus. We report an immunocompetent 11‐year‐old girl with periungual pigmented BD induced by high‐risk human papilloma virus.     

Automatic detection of basal cell carcinoma using telangiectasia analysis in dermoscopy skin lesion images

Background: Telangiectasia, dilated blood vessels near the surface of the skin of small, varying diameter, are critical dermoscopy structures used in the detection of basal cell carcinoma (BCC). Distinguishing these vessels from other telangiectasia, that are commonly found in sun‐damaged skin, is challenging. Methods: Image analysis techniques are investigated to find vessels structures in BCC automatically. The primary screen for vessels uses an optimized local color drop technique. A noise filter is developed to eliminate false‐positive structures, primarily bubbles, hair, and blotch and ulcer edges. From the telangiectasia mask containing candidate vessel‐like structures, shape, size and normalized count features are computed to facilitate the discrimination of benign skin lesions from BCCs with telangiectasia. Results: Experimental results yielded a diagnostic accuracy as high as 96.7% using a neural network classifier for a data set of 59 BCCs and 152 benign lesions for skin lesion discrimination based on features computed from the telangiectasia masks. Conclusion: In current clinical practice, it is possible to find smaller BCCs by dermoscopy than by clinical inspection. Although almost all of these small BCCs have telangiectasia, they can be short and thin. Normalization of lengths and areas helps to detect these smaller BCCs.     

Exosomes in chronic inflammatory skin diseases and skin tumors

Exosomes are membrane vesicles of endocytic origin that can mediate communication between cells and the transport of cellular components such as microRNAs, mRNAs, proteins and DNA. Recently, exosomes have been under investigation for their significant roles in both healthy physiology and disease states. Herein, we review the role of exosomes in chronic inflammatory skin diseases and skin tumors, especially focusing on systemic lupus erythematosus, psoriasis, atopic dermatitis, bullous pemphigoid and melanoma. Moreover, we emphasize the involvement of changes in exosome cargo in the regulation of these diseases.     

尖锐湿疣、鲍恩样丘疹病、Bowen病及外阴鳞状细胞癌皮损中端粒酶的表达

目的 探讨端粒酶在正常组织、良性增殖性疾病及恶性肿瘤中的表达情况及其临床意义。方法 采用免疫组化方法检测皮损中端粒酶逆转录酶(hTERT)蛋白的表达情况,并对所有鲍恩样丘疹病和Bowen病病例进行组织病理分析。结果 正常人对照组、尖锐湿疣组及外阴鳞状细胞癌组中任两组间hTERT表达强度差异均有统计学意义,其阳性率依次增高。鲍恩样丘疹病组较尖锐湿疣组hTERT表达强度高,两组差异有统计学意义;虽与Bowen病组比较差异无统计学意义,但较外阴鳞状细胞癌组表达强度低,差异有统计学意义。组织病理上,Bowen病比鲍恩样丘疹病细胞异形性更明显。结论 端粒酶在正常组织、良性增殖性疾病及恶性肿瘤中的表达强度呈梯度升高,提示端粒酶激活在细胞增生及永生化中均发挥重要作用。     

Mortality in Danish patients with nonmelanoma skin cancer, 1978-2001

Background  Nonmelanoma skin cancer (NMSC) is a growing public health problem among Caucasians, thus mortality data that may provide insight into the clinical course and foster our understanding of NMSC are important.
Objectives  We examined total and cause-specific mortality among patients with NMSC registered in the Danish Cancer Registry from 1978 to 2001.
Methods  A total of 82 837 patients with basal cell carcinoma (BCC) and 13 453 patients with squamous cell carcinoma (SCC) were followed through the National Death Registry for specific causes of death. Standardized mortality ratios (SMRs) were computed based on mortality rates in the general population.
Results  Among patients with BCC, we found a slightly reduced total mortality [SMR 0·97, 95% confidence interval (CI) 0·96–0·98] with decreased SMRs seen for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD) and diabetes mellitus. The SMR for suicide was increased. Among patients with SCC, we found an increased total mortality (SMR 1·30, 95% CI 1·26–1·33) due primarily to excess deaths from cancers, COPD, CVD and infectious diseases.
Conclusions  We found markedly different mortality patterns among patients with BCC and those with SCC, suggesting important differences in the clinical course of these patients.     

Increased expression of an epidermal stem cell marker, cytokeratin 19, in cutaneous squamous cell carcinoma

Background Cytokeratin 19 (CK19) has been considered to be a putative marker for epidermal stem cells in the hair follicle bulge. Cumulative reports have shown that epidermal stem cells play an important role in skin carcinogenesis. However, to date there has been no report on the clinical alteration of the stem cells in squamous cell carcinoma (SCC). Objectives To investigate alteration of the stem cells and proliferating cells and to assess their relationship and potential contribution to SCC. Methods Thirty paraffin‐embedded neoplastic skin lesions, consisting of 10 cases each of actinic keratosis (AK), Bowen disease (BD) and SCC, were examined immunohistologically for CK19 and Ki‐67. Results Positive reactivity for CK19 was seen in 30% of AK, 50% of BD and 80% of SCC lesions. There was significantly higher expression levels of CK19 in SCC than in AK and BD (P < 0·05). In addition, BD lesions harboured a significantly higher number of CK19‐positive cells than did AK lesions (P < 0·05). There were significant differences in Ki‐67 labelling indices between AK and BD and between AK and SCC (P < 0·001), but not between BD and SCC (P > 0·05). Furthermore, a serial section comparison study showed that there was a minor population of cells co‐expressing CK19 and Ki‐67 in a subset of the tumour cells of SCC samples. The percentage of CK19+ cells significantly correlated with that of Ki67+ cells in all examined neoplastic skin lesions. Conclusions These results suggest that CK19 expression may be associated with the retention of stem cell characteristics or a state that is uncommitted to terminal squamous differentiation.     

Characteristics of skin cancers among adult patients in an urban Malaysian population

There has been a rising incidence of skin cancers among Asians in recent years. We present a retrospective analysis of 106 skin cancers and analysed the demography, clinical subtypes of skin cancers and surgical techniques used for skin cancer treatment. In our population, skin cancers were most frequently basal cell carcinomas and diagnosed among ethnic Chinese patients.     

Tratamiento de la enfermedad de Bowen con imiquimod 5% crema

Imiquimod is an immune modifier that has been shown to be effective for some skin cancer and precancer such as solar keratoses, basal cell carcinoma and Bowen's disease. It has been proved to have antiviral and antitumor properties in animal models. The biological pathway is closely related with the release of some cytokines, mainly interferon (INF)-α and tumoral necrosis factor (TNF)-α.A trial with imiquimod 5% cream, twice daily, three times a week, during 8 weeks was undertaken in 5 patients with biopsy-proven Bowen's disease. One patient had undergone a renal transplantation and was on chronic immunosupressive chemotherapy for 8 years. Lesions were located on the legs, hands and face. After treatment all lesions had cleared up, and in three patients clearance was histologically confirmed with a posttreatment biopsy. All patients complained of mild erythema and itching, but the treatment was well tolerated. Within follow-up periods of 3 to 11 months after treatment none has shown evidence of recurrence.Even though this is a short series of patients, we believe that imiquimod 5% cream is an effective and safe treatment for Bowen's disease at a shorter term than previously advised. Since Bowen's lesions were not fully excised at the end of the treatment, only a longer follow up of our patients will confirm their clearance.     

银屑病伴发多发Bowen病及鳞状细胞癌1例

患者女,50岁。周身反复出现鳞屑性红斑伴瘙痒30年,右臀出现菜花状肿物1年。有银屑病病史30年,予UVA照射治疗70余次。手术切除右臀肿物,组织病理示鳞状细胞癌和Bowen病。诊断:银屑病;鳞状细胞癌;Bowen病(多发)。