Cytokeratin 10-negative nested pattern enables sure distinction of clonal seborrheic keratosis from pagetoid Bowen's disease

Background: The histopathologic pattern of clonal seborrheic keratosis (SK) is quite similar to the nested pattern of pagetoid Bowen's disease [squamous cell carcinoma in situ (SCCIS)], and differentiation between the two can be challenging, especially when only small pieces are available for interpretation. Methods: Eleven examples of clonal SK and 13 examples of pagetoid SCCIS were examined histopathologically (tabulating necrotic keratinocytes, suprabasal mitoses, infiltrate, parakeratosis housing plump nuclei, crowding of nuclei) and immunohistochemically (using Ki‐67, bcl‐2, cytokeratin 7 and cytokeratin 10). Sensitivity, specificity, p‐values (Fisher's exact test, two‐tailed) and positive/negative likelihood ratios (+LR/?LR) were calculated. Results: Significant differences were seen with regard to crowding (p = 0.0009) and mitoses (p = 0.0006); however, only complete absence of necrotic keratinocytes or of crowding appeared to be diagnostically convincing for a diagnosis of clonal SK (?LR < 0.01). Significant differences were also seen with bcl‐2 (p = 0.0005) and cytokeratin 10 antibodies (p < 0.00001). Both markers displayed a typical nested pattern in clonal SK, nests being bcl‐2‐positive and cytokeratin 10‐negative. Cytokeratin 10‐negative nests were the most convincing criterion for differentiation between clonal SK and pagetoid SCCIS (+LR > 10, ?LR < 0.01). Conclusions: The most reliable marker to distinguish clonal SK from pagetoid SCCIS is cytokeratin 10 when it spares nests. Other criteria that assist in the differential diagnosis are bcl‐2 expression, absence of crowding and of mitoses. Böer‐Auer A, Jones M, Lyasnichaya OV. Cytokeratin 10‐negative nested pattern enables sure distinction of clonal seborrheic keratosis from pagetoid Bowen's disease.     

Expression of p53 and p16 in actinic keratosis,bowenoid actinic keratosis and Bowen's disease

Introduction Bowen's disease (BD) and bowenoid actinic keratosis (bAK) have traditionally been differentiated according to the presence or absence of dysplasia in the follicular epithelium. p16 has been suggested to be a useful tool to make the differential diagnosis between BD and AK and as a marker of bad prognosis. Materials Five biopsies of BD, five of AK and five of bAK where stained for p53 and p16. Results All lesions showed positive immunostaining of p53, affecting to the lower two thirdss of the epidermis in BD and bAK, and only the basal layer in non‐bAK. All the BD and bAK cases were positive for p16, showing a similar immunostaining pattern, whereas no staining was observed in non‐bAK. Discussion and conclusion These findings suggest a common pathogenic mechanism for BD and bAK. bAK might have worse prognosis than AK. p16 might not be useful as a tool for differential diagnosis between AK and BD because bAK and BD show an extremely similar immunohistochemical pattern.     

A comparison of dermoscopic features among lentigo senilis/initial seborrheic keratosis, seborrheic keratosis, lentigo maligna and lentigo maligna melanoma on the face

Clinical differentiation of facial lentigo senilis/initial seborrheic keratosis (LS/ISK), seborrheic keratosis (SK), lentigo maligna (LM), and lentigo maligna melanoma (LMM) can be difficult. Dermoscopy improves the diagnoses in pigmented skin lesions (PSLs), but it is not helpful for the sun-exposed face because of the flat rete ridges without network-derived features. Therefore, development of new diagnostic criteria for this particular localization is a current issue of dermatology. In this retrospective study, dermoscopic slides of facial pigmented skin lesions of 66 patients referred to two clinics in Turkey were evaluated. Our aim was to determine the reliability of dermoscopy in the differentiation of these entities. The facial PSLs of 66 patients (34 males and 32 females) (median age: 58.2) were photographed with a Dermaphot (Heine, Hersching, Germany) over a five year period from November of 1995 to May of 2000. All of the dermoscopic slides were analysed according to 27 dermoscopic criteria developed by Schiffner et al. This data set contained 22 histologically proven malignant (14 LM, 8 early LMM) and 44 benign (18 SK, 26 LS/ISK) PSLs. In general, asymmetric pigmented follicular openings, dark streaks, slate-gray streaks, dark globules, slate-gray globules, dark dots, dark rhomboidal structures, light brown rhomboidal structures, dark homogeneous areas and dark pseudonetworks were statistically significant for malignant growth. On the other hand, milia-like cysts, pseudofollicular openings, cerebriform structures, light brown globules, light brown dots, light brown homogeneous areas, yellow opaque homogeneous areas, and light brown pseudonetworks were statistically significant for benign growth. This research emphasizes that dermoscopic features on the face differ from criteria used in other locations of the body. Analysis of the data suggests that dermoscopy can be used in the differentiation of LS/ISK, SK, LM and LMM from each other.     

Intraepidermal benign sebaceous neoplasm: apocrine poroma (hidroacanthoma simplex type) with extensive sebaceous differentiation with sebaceoma‐like features

We herein report a patient who clinically presented with a yellowish, flat plaque that histopathologically showed a benign lesion mainly composed of intraepidermal basaloid nests with sebaceous differentiation. This lesion was considered to be fundamentally apocrine poroma (hidroacanthoma simplex type) with sebaceous differentiation. Nests composed of typical poroid cells were seen, and the results of immunostaining for lumican supported this diagnosis and excluded the possibility of clonal seborrheic keratosis. The sebaceous differentiation in apocrine poromas mostly occurs in Pinkus type lesions, and is usually seen in only part of the lesions, as solitary, mature sebocytes within the poroma nests. However, our apocrine poroma case was unique not only in that sebaceous differentiation occurred in the hidroacanthoma simplex type, but also in that it was observed extensively (approximately 60% of the nests). We therefore called this lesion an ‘intraepidermal benign sebaceous neoplasm’. Although it may be hard to differentiate sebaceous germinative cells (seen in sebaceoma) from poroid cells, in this case, some poroma nests could be judged to neighbor or contain the sebaceoma‐like areas. Therefore, the presented apocrine poroma was considered to have some features of (intraepidermal and dermal) sebaceoma.     

Arsenic keratosis and pigmentation accompanied by multiple Bowen's disease and genitourinary cancer in a psoriasis patient

We report a case of arsenic keratosis and pigmentation accompained by multiple Bowen's disease and genitourinary cancer in a 64-year-old man. He was a psoriasis patient with a history of herbal medication for about thirty years. He showed multiple hyperkeratotic plaques on the bilateral palms, soles, and multiple, brownish, scaly, elevated papules on the back in addition to diffuse hyperpigmentation. Biopsy confirmed arsenic keratosis and Bowen's disease. Transitional cell carcinoma was also detected on his ureter and bladder during follow-up. The skin lesions were treated with topical 5-fluorouracil, etretinate, and excision with improvement.     

日光性雀斑样痣、脂溢性角化病及扁平苔藓样角化病皮肤镜特征专家共识

【摘要】 日光性雀斑样痣、脂溢性角化病及扁平苔藓样角化病是常见的良性表皮增生性疾病,其皮肤镜特征对于明确诊断、与其他皮肤肿瘤相鉴别、避免不必要的活检和手术以及动态监测皮损变化等都有一定帮助。本共识对这3种疾病的皮肤镜特征进行了总结。日光性雀斑样痣的皮肤镜特征主要为皮损边界清晰、虫蚀状边缘、模糊的色素网、指纹模式、棕色均质模式、假性网络。脂溢性角化病的皮肤镜特征主要为皮损边界清晰、粟粒样囊肿、粉刺样开口、脑回状模式、发夹样血管、摇晃试验中皮损整体移动。扁平苔藓样角化病的皮肤镜特征主要为胡椒粉样或颗粒模式以及周围可见日光性雀斑样痣、脂溢性角化病或光线性角化病的皮肤镜特征。     

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。     

Dermoscopic pattern of intermediate stage in seborrhoeic keratosis regressing to lichenoid keratosis: report of 24 cases

BACKGROUND: Lichenoid keratosis (LK) is a well-described entity which has been proposed to represent an immunological or regressive response to pre-existing epidermal lesions such as solar lentigines or seborrhoeic keratoses. OBJECTIVES: To evaluate the dermoscopic criteria of a series of cases of LK with remaining areas of seborrhoeic keratosis which were both dermoscopically and histologically diagnosed. METHODS: Pigmented lesions with dermoscopic areas of seborrhoeic keratosis and LK in the same tumour were consecutively diagnosed and prospectively included in the study. All pigmented lesions were examined and registered using DermLite Foto equipment (3Gen, LLC, Dana Point, CA, U.S.A.), at 10-fold magnification, at the Dermatology Department of Hospital de Sant Pau i Santa Tecla (Tarragona, Spain), between 1 January 2003 and 31 December 2005. RESULTS: In total, 24 cases of lesions with dermoscopic areas of seborrhoeic keratosis and LK were collected. In four lesions (17%), the clinical differential diagnosis without dermoscopy included malignant melanoma and in seven lesions (29%), basal cell carcinoma. The diagnosis of LK was clinically considered without dermoscopy in only six cases (25%). A granular pattern was observed to be distributed throughout the LK areas of the lesions. This pattern consisted of the presence of brownish-grey, bluish-grey or whitish-grey coarse granules that formed, in 11 cases (46%), globules and/or short lines. In one lesion, located on the face, these short lines produced annular or rhomboid structures as seen in lentigo maligna melanoma. CONCLUSIONS: Dermoscopy is a useful tool which assists in the correct clinical recognition of LK, which may also potentially illuminate the pathogenesis of these tumours, showing the intermediate stage of regressing epidermal lesions in an LK.     

Clinical clues for differential diagnosis between verruca plana and verruca plana‐like seborrheic keratosis

Sometimes the clinical differentiation between verruca plana (VP) and VP‐like seborrheic keratosis (SK) could be challenged. However, there have been no studies on this issue to date. The aim of this study was to elucidate clinical and dermoscopic differences between these two diseases, and also to suggest a diagnostic algorithm of VP and VP‐like SK without skin biopsy. The patients who had lesions clinically considered as VP or VP‐like SK were the target of our study. We took clinical and dermoscopic photos with informed consent and conducted a questionnaire. All patients had their diagnoses confirmed by biopsy. Thirty‐three patients were enrolled in our study. Seventeen patients were finally diagnosed with VP (51.5%) and 16 patients with VP‐like SK (48.5%). In clinical findings, VP‐like SK showed significantly more scattered distribution than VP (P = 0.039), which exhibited more clustered or grouped distribution (P = 0.039). In dermoscopic findings, brain‐like appearance was more commonly observed in VP‐like SK (P = 0.003) whereas VP showed more red dots or globular vessels (P = 0.017) and even‐colored light brown to yellow patch (P < 0.001). Sex, onset age, the size of each lesion, location, color and shape showed no significant differences between them (P > 0.05). Based on our results, we suggest a diagnostic algorithm using Koebner's phenomenon, dermoscopic findings, distribution of each lesion and biopsy for multiple VP‐like lesions in adults, and we think it will be a very useful diagnostic tool in daily clinical dermatological practice.     

NB-UVB治疗儿童白癜风诱发脂溢性角化病一例

UVB治疗白癜风的不良反应主要有局部出现轻度瘙痒、红斑、光毒反应,儿童白癜风在接受NB-UVB治疗后,皮损区域出现脂溢性角化样的改变既往尚未报道.本文报道一例13岁右下肢屈侧白癜风女性患者,予31次NB-UVB照射治疗后局部出现褐色斑丘疹,组织病理学特点符合脂溢性角化病改变.     

青年面部多发性脂溢性角化病35例临床分析

青年面部多发性脂溢性角化病临床易误诊为扁平疣,本文对35例青年面部脂溢性角化病患者临床资料进行分析,临床特征总结如下:(1)扁平丘疹大小、形态均匀对称;(2)常伴有皮赘;(3)面部皮疹多分布于颊部、颞部、额角及颧部等;(4)无扁平疣自身接种现象。     

Smad7在脂溢性角化病、日光性角化病及基底细胞癌中的表达

目的： 检测Smad7在脂溢性角化病、日光性角化病以及基底细胞癌中的表达。方法：对脂溢性角化病、日光性角化病及基底细胞癌标本（各30例）和30例正常标本进行免疫组化染色。结果：23例脂溢性角化病标本、23例日光性角化病标本和28例基底细胞癌标本中Smad7染色阳性,阳性细胞率分别为（31.0±23.0）%,（32.7±26.3）%和（62.6±32.1）%,均显著高于正常组织的（6.7±5.0%）。结论： Samd7可能与脂溢性角化病、日光性角化病以及基底细胞癌的发病有关。     

Relationship between dermoscopy and pathology in a case of clonal‐type pigmented Bowen's disease: Observation with vertical‐view dermoscopy

Pigmented Bowen's disease (pBD) is a subtype of Bowen's disease, which presents clinically as a well‐circumscribed, hyperpigmented plaque. Its clinical manifestations are not fully characterized, and differential diagnoses include various pigmented skin lesions. Dermoscopy could be useful for the diagnosis, although nothing has been reported on the dermoscopic features of clonal‐type pBD. We herein report a first case of clonal‐type pBD on the sole and its dermoscopic features. Dermoscopy showed brown to blue‐gray dots/globules and focally anastomosing lines on the non‐weight‐bearing area, while the weight‐bearing area had a brown to blue‐gray fibrillar‐like pattern. To investigate the relationship between dermoscopy and histopathology, we focused on the melanin distribution in the horny layer of the epidermis, and used vertical dermoscopy observation. We investigated the relationship between dermoscopy and pathology by melanin depth estimation using a color lightness value.     

鲍温病的皮肤镜特征分析

分析2018年8月至2019年12月我院门诊行皮肤镜检查并经组织病理学确诊的28例鲍温病患者的皮肤镜特征。最常见的皮肤镜表现为无结构区（20处，71.43%）和局灶性、线状分布的肾小球样血管（19处，67.86%），其他表现依次为结痂（14处，50%），鳞屑（10处，35.71%），点、球状血管（7处，25%）棕，放射性条纹及色素性点、球状结构共存（6处，21.43%），肾小球样血管与点、球样血管共存（2处，7.14%），毛囊角栓（1处，3.57%）。     

Dermoscopic features of actinic keratosis and follow up with dermoscopy: A pilot study

Actinic keratosis (AK) is a common precursor of sun‐related squamous cell carcinoma. AK is difficult to be differentiated from other malignancies with the naked eyes. Dermoscopic features of AK were previously described in some studies, but not extensively investigated. We investigated the dermoscopic features of AK in Asians and assessed dermoscopy as a post‐treatment monitoring tool of AK. We retrospectively examined 34 AK lesions which had been diagnosed by histology. The changes of dermoscopic features and histopathological findings were assessed in all these lesions before and after treatment. Before treatment, 18 lesions were pigmented and 16 lesions were non‐pigmented AK dermoscopically. The frequent dermoscopic features of AK were keratin/scales (79.4%), red pseudonetwork (73.5%), targetoid‐like appearance (55.9%), rosette sign (38.2%) and absent fissures/ridges, crypts and milia‐like cysts. All the lesions had been treated with either photodynamic therapy, cryotherapy or 5% imiquimod cream. After treatment, dermoscopic features of 33 AK lesions were decreased or disappeared, and skin biopsies confirmed that atypical keratinocytes disappeared. One lesion showed accentuated and new dermoscopic features after treatment, and skin biopsy also showed progressing squamous cell carcinoma. In conclusion, scales, red pseudonetwork, targetoid‐like appearance and rosette sign were common dermoscopic findings of AK in Asians. In most cases, the treatment response correlated with the changes in dermoscopic features. These findings suggest that dermoscopy is a useful tool to monitor AK.     

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%）。