光线性角化病的皮肤镜特征研究进展

光线性角化病(AK)是皮肤长期暴露于日光下所引起的一种癌前病变,有发展为鳞癌的风险,皮肤镜已广泛应用于AK的诊断与鉴别诊断,其皮肤镜特征包括:基底假网状红斑、毛囊口周围白晕、毛囊口黄色角栓等,本文对AK的皮肤镜表现及鉴别诊断进行了综述.     

皮肤镜对面部光线性角化病的鉴别诊断价值评估

目的 探讨皮肤镜在面部光线性角化病鉴别诊断中的应用价值.方法 从北京大学第三医院皮肤镜数据库选取经病理确诊的面部光线性角化病皮损作为病例组,同时选取临床曾疑诊光线性角化病,但病理证实为其他疾病的面部皮损作为对照组,比较两组间各皮肤镜特征的差异,以病理为金标准,用诊断试验方法评价皮肤镜诊断面部光线性角化病的价值.结果 病例组43个皮损,对照组22个皮损.病例组中基底假网状红斑(38/43,88.37％)、毛囊口周围白晕(39/43,90.70％)、毛囊口黄色角栓(41/43,95.35％)、表面黄白色鳞屑或角化物团块(42/43,97.67％)、玫瑰花瓣征(26/43,60.47％)、毛囊口周围粗大的不规则线状血管(19/43,44.19％)、毛囊口周围细小、线状-波浪状血管(29/43,67.44％)及周边色素加深(14/43,32.56％)的出现频率显著高于对照组(均P＜0.05).在这8个皮肤镜特征中,毛囊口周围白晕、基底假网状红斑、毛囊口黄色角栓及玫瑰花瓣征单独诊断面部光线性角化病的约登指数最高,分别为0.54、0.52、0.50和0.38,表面黄白色鳞屑或角化物团块灵敏度最高(97.67％),周边色素加深特异度最高(95.45％).基底假网状红斑、毛囊口黄色角栓及毛囊口周围白晕3个特征联合诊断价值最高,其灵敏度、特异度、阳性预测值、阴性预测值分别为90.70％、81.82％、90.70％、81.82％,约登指数为0.73,与病理诊断的符合率为80.00％.结论 面部光线性角化病具有较特异的皮肤镜表现,基底假网状红斑、毛囊口周围白晕、毛囊口黄色角栓3个皮肤镜特征联合诊断价值最高.     

扁平苔藓样角化病临床及皮肤镜特征分析

目的 探讨扁平苔藓样角化病(LPLK)的临床表现及皮肤镜特征.方法 回顾性分析2017年1月至2019年9月在上海市皮肤病医院门诊就诊并行皮肤镜及皮肤组织病理检查确诊的21例扁平苔藓样角化病患者的临床及皮肤镜特征.结果 21例患者年龄(64.69±13.29)岁,男女比例为1∶2.18例皮损位于面部,3例位于小腿.10...     

Caspase-3在皮肤鳞状细胞癌及光线性角化病中的表达

目的：检测Caspase-3在皮肤鳞状细胞癌及光线性角化病组织中的表达。方法： 应用免疫组化法检测16例皮肤鳞状细胞癌皮损、27例光线性角化病皮损及24例正常皮肤组织中Caspase-3蛋白的表达。结果：Caspase-3在皮肤鳞状细胞癌、光线性角化病及正常皮肤组织的表达率分别为37.50%,51.85%,79.17%,其表达含量在皮肤鳞状细胞癌、光线性角化病、正常皮肤组织逐渐增加。结论：Caspase-3蛋白表达下调可能参与皮肤鳞状细胞癌及光线性角化病的发病过程。     

光线性角化病132例临床及组织病理分析

对132例光线性角化病进行临床及组织病理分析.男64例,女68例,平均年龄(62.26±14.10)岁,皮损发生于头面部及颈部,临床表现多为肤色或淡褐色角化性斑丘疹,上覆粘着性鳞屑,皮损周围皮肤可见萎缩、毛细血管扩张或淡黄色斑等慢性光损伤的表现.皮损绀织病理特点包括角化过度、角化不全,基底层甚至棘层不典型角质形成细胞增生,细胞排列紊乱,基底层不典型角质形成细胞呈芽蕾状伸人真皮乳头层,真皮浅层嗜碱性变,炎性细胞浸润.组织病理分型主要是肥厚型和萎缩型.     

播散性浅表性光线性汗孔角化病1例

患者男,52岁,藏族.双下肢角化性丘疹2年余,加重1年,于2008年5月至我院就诊.2年前患者无明显诱因于双下肢伸侧出现散在对称性浅褐色丘疹,约米粒大小,无自觉症状,未诊治.近1年皮损增多,累及双下肢屈侧和双七肢.伴瘙痒,皮损夏重冬轻.23年前曾因肝包虫病行手术治疗,半个月前诊断脑包虫病,可疑肺部包虫病.否认家族中有类似疾病患者.     

93例光线性角化病和62例鲍恩病临床病理回顾性分析

对2014年1月1日至2018年12月31日我院皮肤科门诊临床诊断为光线性角化病(AK)和鲍恩病患者的临床和病理资料进行回顾性分析。结果示组织病理确诊AK和鲍恩病分别为93例和62例,临床诊断与组织病理报告均AK和鲍恩病患者分别为50例和29例,诊断符合率分别为54%和50%。AK与鲍恩病在临床诊断上易误诊为脂溢性角化病（21例）和基底细胞癌（11例）。AK好发部位为头面部（94%）,鲍恩病则好发于躯干（52%）。     

棘层松解型光线性角化病1例

报告1例棘层松解型光线性角化病.患者男,80岁,因左颞部皮肤斑块伴疼痛1年余就诊.皮肤组织病理检查示:表皮增生,角化过度,棘层松解,基底层不典型细胞向真皮上部生长.免疫组化检查示:CK(+)、P63(+),ki67约20%(+).诊断为棘层松解型光线性角化病.     

光线性角化病皮损的细胞DNA含量流式细胞分析

光线性角化病的病理组织学特征为不同程度的表皮细胞的非典型增生。为了更加客观地反映该病的这一特征，应用流式细胞技术定量分析了２７例光线性角化病皮损细胞的ＤＮＡ含量及细胞增殖活性。结果：光线性角化病细胞的增殖指数（ＰＩ）同于正常人皮肤的ＰＩ值（Ｐ〈０．０５），８例非典型增生严重的光线性角化病细胞的ＤＮＡ指数（ＤＩ）高于其余１９例光线性角化病的ＤＩ值（Ｐ〈０．０５）。提示：光线性角化病皮损细胞增殖活跃，     

光线性角化病皮损细胞Bcl—2基因表达产物的定量分析

Ｂｃｌ－２蛋白是Ｂｃｌ－２基因的表达产物，可抑制细胞凋亡，在某些恶性肿瘤细胞出现过度表达。为探讨Ｂｃｌ－２蛋白与光线性角化病（ＡＫ）的关系，作者用流式细胞免疫荧光技术，检测了２７例ＡＫ。结果显示：２７例ＡＫ及正常对照的Ｂｃｌ－２蛋白相对含量ＦＩ（ＦｌｕｏｒｅｓｃｅｎｃｅＩｎｄｅｘ）分别为１．１５０±０．１８８和０．９９６±０．０６５（Ｘ－±Ｓ），０．０５＜Ｐ＜０．０１。但其中８例不典型增生严重ＡＫ的ＦＩ为１．３３５±０．０１７６（Ｘ－±Ｓ），与正常对照相比Ｐ＜０．０２。提示该病的Ｂｃｌ－２蛋白有增高的倾向。     

Dermoscopy of facial nonpigmented actinic keratosis

BACKGROUND: The accuracy of clinical diagnosis of nonpigmented, facial actinic keratosis (AK) is often suboptimal, even for experienced clinicians. OBJECTIVES: To investigate the dermoscopic features of nonpigmented AK located on the head/neck that may assist the clinical diagnosis. METHODS: Forty-one nonpigmented AKs on facial sites were examined by dermoscopy for any consistent underlying features. Lesions were gathered from skin cancer centres in Australia, Austria, Italy and the U.S.A. All cases were diagnosed histopathologically. RESULTS: Four essential dermoscopic features were observed in facial AK: (i) erythema, revealing a marked pink-to-red 'pseudonetwork' surrounding the hair follicles (95%); (ii) white-to-yellow surface scale (85%); (iii) fine, linear-wavy vessels surrounding the hair follicles (81%); and (vi) hair follicle openings filled with yellowish keratotic plugs (66%) and/or surrounded by a white halo (100%). These features combined, in 95% of cases, to produce a peculiar 'strawberry' appearance. CONCLUSIONS: A dermoscopic model of 'strawberry' pattern is presented, which may prove helpful in the in vivo diagnosis of nonpigmented, facial AK. A limitation of this study is the lack of testing of the specificity of the described dermoscopic criteria in differentiating nonpigmented AKs from other nonpigmented skin lesions at this site.     

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

Summary 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.     

No evidence of human papillomavirus DNA in actinic keratosis

Human papillomaviruses (HPVs) are involved in premalignant and malignant skin diseases as well as in a variety of benign cutaneous and mucosal lesions. Actinic keratosis (AK) is a common premalignant disease. Its association with HPV infection has recently been evaluated in a few studies, but the results are contradictory. For further assessment of the role of HPVs in AK, a series of 100 paraffin-embedded biopsy specimens taken from subjects with AK were studied for the presence of HPV types 1, 2, 3, 4, 5, 7, 12, 15, 26, 36, 37 and 59 DNA using in situ hybridization (ISH) under high stringency conditions (Tm -10°C). All specimens were definitely negative for all biotinylated HPV DNA probes tested. One-fifth of the specimens were studied using the polymerase chain reaction (PCR) with general primers to confirm the negative results. All cases were also negative in the PCR. Our results suggest that HPVs are not directly involved in the aetiology of AK.     

Use of dermoscopy in the diagnosis of temporal triangular alopecia

Temporal triangular alopecia, also referred as congenital triangular alopecia, is an uncommon dermatosis of unknown etiology. It is characterized by a non-scarring, circumscribed alopecia often located unilaterally in the frontotemporal region. It usually emerges at ages 2-9 years. Alopecia areata is the main differential diagnosis, especially in atypical cases. Dermoscopy is a noninvasive procedure that helps distinguish temporal triangular alopecia from aloepecia areata. Such procedure prevents invasive diagnostic methods as well as ineffective treatments.     

Dermoscopic features of actinic keratosis

Actinic keratosis (AK) is a keratinocytic neoplasm that typically develops on sun‐damaged skin of elderly individuals. Only a few reports so far have described the dermoscopic diagnostic features of AK, mainly focusing on facial non‐pigmented AKs. A typical feature of facial non‐pigmented AK is a composite pattern named “strawberry pattern”, characterized by a background erythema/red pseudonetwork consisting of unfocused, large vessels located between the hair follicles, associated with prominent follicular openings surrounded by a white halo. Dermoscopic characteristics of pigmented AK on the face include multiple slate‐gray to dark‐brown dots and globules around the follicular ostia, annular‐granular pattern and brown to gray pseudonetwork. Recognizing specific dermoscopic features of AK can be useful in guiding the clinician in the differential diagnosis of AK with melanocytic skin lesions such as LM and non‐melanocytic lesions. Histopathologic examination should be performed whenever clinical and/or dermoscopic differential diagnosis is inconclusive.     

皮肤镜诊断黑素细胞痣、脂溢性角化和日光性角化与组织病理诊断的一致性

目的：评价皮肤镜诊断黑素细胞痣、脂溢性角化、日光性角化的准确度。方法：收集临床怀疑为黑素细胞痣、脂溢性角化和日光性角化的病例,由两位医生参照目前皮肤镜诊断标准对该三种皮肤肿瘤进行盲法独立诊断,并与组织病理结果相对照。结果：与组织病理诊断比较,(1)A、B两位医生使用皮肤镜诊断黑素细胞痣一致率（89.3%、91.2%）、灵敏度（94%、95.2%）、特异度（84.2%、86.8%）、误诊率（15.8%、13.2%）、漏诊率（6%、4.8%）。(2)A、B两位医生使用皮肤镜诊断脂溢性角化一致率（88%、91.7%）、灵敏度（91.7%、95.8%）、特异度（83.6%、86.9%）、误诊率（16.4%、13.5%）、漏诊率（8.3%、4.2%）;(3)A、B两位医生使用皮肤镜诊断日光性角化一致率（84.1%、86.4%）、灵敏度（87.5%、87.5%）、特异度（17.9%、12.5%）、误诊率（82.1%、85.7%）、漏诊率（17.9%、14.3%）。结论：皮肤镜诊断黑素细胞痣、脂溢性角化和日光性角化的结果与病理诊断结果均有较好的一致性。