Dermoscopic features and differential diagnosis of sebaceous carcinoma

Sebaceous carcinoma is a rare malignant skin neoplasm arising from sebaceous glands. Its clinical diagnosis is difficult and reports of dermoscopic findings have been limited. This study aims to analyze its dermoscopic features and differential diagnosis in dermoscopic examination. The study included patients diagnosed with histologically proven sebaceous carcinomas as well as diagnosed cases of sebaceous hyperplasia, sebaceoma, squamous cell carcinoma and basal cell carcinoma for comparison of dermoscopic findings. The dermoscopic criterion of presence of sebaceous carcinoma was scored only if the two evaluators reached a consensus. Fifteen cases of histologically diagnosed sebaceous carcinoma were included in our study. All cases were extraocular sebaceous carcinoma. A total of 60 (15 basal cell carcinomas, 15 squamous cell carcinomas, 15 sebaceous hyperplasias and 15 sebaceomas) cases were collected for comparing dermoscopic features with sebaceous carcinoma. In dermoscopic analysis of sebaceous carcinoma, the majority of tumors (66.67%) presented polymorphic vessel pattern. Other features included whitish-pink areas (80%), yellowish structures (73.33%) and yellowish structureless areas (60%). Yellowish structures in sebaceous carcinomas are the main dermoscopic findings to differentiate squamous cell and basal cell carcinomas (P < 0.001), whereas purplish globules, shiny white blotches and strands and whitish-pink area distinguish sebaceous carcinomas from other sebaceous tumors (P < 0.05).     

Dermoscopic features distinctive for extraocular sebaceous carcinoma

We examined dermoscopic features of three cases of extraocular sebaceous carcinoma and reviewed the literatures. The yellowish structures, polymorphous vessels and ulceration were common findings in our cases and all cases of the previous reports. The appearance of whitish‐pink areas has not been described previously. Our results suggested that the combination of four dermoscopic features, whitish‐pink areas, yellowish structures, polymorphous vessels and ulceration might be distinctive in extraocular sebaceous carcinoma.     

Two histopathologic patterns of well-differentiated extraocular sebaceous carcinoma

Background: No previous reports on the variation in the histopathological patterns of well‐differentiated sebaceous carcinoma are yet to be published. Methods: We reviewed the histopathology of six examples of well‐differentiated extraocular sebaceous carcinoma. Results: Two distinct histopathological patterns of sebaceous carcinoma, namely a secretory pattern (N = 2) and a non‐secretory pattern (N = 4), were defined. The secretory pattern is typified by sebaceous lobular architecture with focal holocrine secretion, whereas the non‐secretory pattern lacks this organoid quality. Both carcinomas with the secretory pattern showed low‐grade cytological atypia, whereas the four carcinomas with the non‐secretory pattern included three lesions with high‐grade cytological atypia. A sebaceous adenoma‐like area was seen in both secretory pattern carcinomas, whereas a focus of intraepithelial sebaceous carcinoma (sebaceous carcinoma in situ) was seen in two of the non‐secretory pattern carcinomas. Conclusions: The clinicopathological significance of the two histopathological patterns remains unclear, because the number of reported cases is limited. It is possible that these two histopathological patterns of carcinoma have different histogenetic and prognostic implications, but no definitive conclusions can be made until further studies of a larger number of cases can be completed. Misago N, Toda S, Narisawa Y. Two histopathologic patterns of well‐differentiated extraocular sebaceous carcinoma.     

眼周皮脂腺癌

报告1例眼周皮脂腺癌.患者女,86岁.右眼内眦部肿物6周,无自觉症状.皮肤科检查可见右眼内眦及上、下眼睑内侧有2个直径约2.4cm的半球形暗红色肿物,并相互融合,边界清楚,表面光滑,触痛明显.经皮损组织病理检查确诊为眼周皮脂腺癌.     

Dermoscopic features of small size pigmented basal cell carcinomas

Dermoscopic images of histologically proven pigmented basal cell carcinomas (BCC) were retrospectively assessed to compare the dermoscopic features of BCC of 3 mm or less in diameter (n = 6) with BCC of 4–6 mm in diameter (n = 11). All lesions lacked the presence of a pigment network. BCC with a diameter of 3 mm or less had fewer positive dermoscopic features compared with the 4–6 mm in diameter BCC. Multiple blue‐gray globules and large blue‐gray ovoid nests were frequently present. Dermoscopy is a useful tool for early diagnosis of pigmented BCC, even when they are small.     

Frontiers in sebaceous gland biology and pathology

Abstract:  The development of experimental models for the in vitro study of human sebaceous gland turned down the theory of a phylogenetic relict and led to the identification of several, unknown or disregarded functions of this organ. Such functions are the production of foetal vernix caseosa, the influence of three-dimensional organization of the skin surface lipids and the integrity of skin barrier and the influence on follicular differentiation. In addition, the sebaceous gland contributes to the transport of fat-soluble antioxidants from and to the skin surface, the natural photoprotection, the pro- and antiinflammatory skin properties and to the innate antimicrobial activity of the skin. It is mainly responsible for skin's independent endocrine function, the hormonally induced skin ageing process, the steroidogenic function of the skin as well as its thermoregulatory and repelling properties and for selective control of the hormonal and xenobiotical actions of the skin. Interestingly, sebocytes, at least in vitro , preserve characteristics of stem-like cells despite their programming for terminal differentiation. This review reports on various sebaceous gland functions, which are currently under investigation, including its role on the hypothalamus–pituitary–adrenal-like axis of the skin, the impact of acetylcholine on sebocyte biology, the activity of ectopeptidases as new targets to regulate sebocyte function, the effects of vitamin D on human sebocytes, the expression of retinoid metabolizing cytochrome P450 enzymes and the possible role of sebum as vehicle of fragrances. These multiple homeostatic functions award the sebaceous gland the role 'brain of the skin' and the most important cutaneous endocrine gland.     

儿童脑回状皮脂腺痣14例临床分析

目的 探讨脑回状皮脂腺痣的临床表现、病理特征及手术时机.方法 回顾2014年6月至2019年12月北京儿童医院皮肤科诊治的14例脑回状皮脂腺痣患儿的临床特点、组织病理学特征以及手术治疗时机.结果 14例患儿中男10例,女4例,出生即有皮损,单发且位于头面部,外观与脑回结构相似,平均直径4.79 cm.所有患儿系统检查均...     

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.     

71例基底细胞癌皮肤镜下特征分析

目的：明确基底细胞癌在皮肤镜下的特征,为临床皮肤镜鉴别色素性皮损提供参考。方法：分析71例（71 lesions)经组织病理确诊为基底细胞癌的皮损皮肤镜图像。结果：最主要的皮肤镜指征按出现频率由高到低分别为：蓝灰色卵圆形巢（78.9%）、血管模式（74.6%）、多发性蓝灰色小球（60.6%）、溃疡（57.7%）、叶状结构（21.1%）。单纯临床诊断符合率为55%,加用皮肤镜后临床准断符合率为95%,提高了40%。结论：皮肤镜可提高临床诊断基底细胞癌的符合率。     

Deletions of BRCA1/2 and p53 R248W gain-of-function mutation suggest impaired homologous recombination repair in fragile histidine triad-negative sebaceous gland carcinomas

Background Sebaceous gland carcinomas represent rare malignancies of the skin and some 60% of them demonstrate high‐grade microsatellite instability on the background of a defective mismatch repair system. However, a significant fraction of periocular sebaceous gland carcinomas exhibits microsatellite stability associated with a frequent loss of the candidate tumour suppressor fragile histidine triad (FHIT). Objectives We hypothesized that in those sebaceous gland carcinomas with microsatellite stability and loss of FHIT, effector molecules participating in homologous recombination repair (HRR), such as BRCA1/2, could be somatically inactivated. Methods A pilot series of 10 paraffin‐embedded sebaceous gland carcinoma specimens with a defined FHIT status was studied for loss of heterozygosity (LOH) events in the genes BRCA1, BRCA2, FHIT and WWOX. We sequenced the coding exons 5–8 of the p53 gene. Results Sebaceous gland carcinomas with FHIT negativity displayed LOH and biallelic deletions of the BRCA1 gene in five of 10 (50%) of the sebaceous gland carcinoma specimens analysed. Tumour‐specific genomic losses close to BRCA2 were also uncovered. A homozygous p53 R248W gain‐of‐function mutation as the result of a CGG to TGG transition was identified in one of seven sebaceous gland carcinomas. It has been demonstrated previously that p53 R248W mutants inactivate ATM‐directed HRR. This particular sebaceous gland carcinoma presented with concomitant genomic deletions at the BRCA1 and BRCA2 loci, and also at the constitutively fragile sites FRA3B/FHIT and FRA16D/WWOX. Conclusions Our study demonstrates for the first time that microsatellite‐stable FHIT‐negative sebaceous gland carcinomas accumulate mutations that target central components of the HRR network. This observation will prompt investigations in synthetic lethality of BRCA‐deficient sebaceous gland carcinomas by therapeutic poly(ADP‐ribose) polymerase inhibitors.     

Dermoscopic features of idiopathic facial aseptic granuloma

Idiopathic facial aseptic granuloma is a recently described condition with defined clinical features, natural history, and underlying histopathologic findings. Several reports have recently described the potential diagnostic usefulness of ultrasound findings in idiopathic facial aseptic granuloma. We describe herein the dermoscopic features of idiopathic facial aseptic granuloma.     

Primary cutaneous carcinosarcoma: Dermoscopic and immunohistochemical features

A 73-year-old man presented a 9-month history of an enlarging nodule on his right temple. Dermoscopy revealed a non-pigmented lesion with ulceration, fibrosis and pale globules. An excisional biopsy was carried out and histology showed a biphasic tumour with a basal cell carcinoma like epithelial component and a dermal undifferentiated sarcoma, with pleomorphic spindle cells and numerous osteoclast-like giant cells. Based on immunohistochemistry findings, a diagnosis of primary cutaneous carcinosarcoma was made and the patient underwent wide local excision.     

Sebaceous carcinoma in Western Australia: A registry-based study of site-related outcomes

Sebaceous carcinoma is a rare cutaneous malignancy which is typically regarded as relatively aggressive and has traditionally been subdivided into periorbital or extraorbital tumours. We conducted a retrospective review of all cases of sebaceous carcinoma reported to the Western Australian Cancer Registry between 1987 and May 2019. The incidence of sebaceous carcinoma in Western Australia has increased over the last three decades, with extraorbital tumours being much more common than periorbital tumours. Very few sebaceous carcinomas have led directly to the death of patients; however, adverse outcomes were more likely with periorbital tumours, in particular local recurrence and the need for major surgical intervention.     

Presenile diffuse familial sebaceous hyperplasia successfully treated with low‐dose isotretinoin: A report of two cases and review of the published work

Presenile diffuse familial sebaceous hyperplasia (PDFSH) presents as extensive yellowish papules with central umbilication on the face without involvement of periorificial regions and occurs in adolescents or young adults with a positive family history. Thirteen cases of PDFSH have been reported in the English‐language published work, 10 of which responded to oral isotretinoin from 0.5 to 1 mg/kg per day but recurrences were often observed. Herein, we report two cases of PDFSH, which were successfully managed without recurrence with prolonged low‐dose isotretinoin (0.2 mg/kg per day, a cumulative dose of 41 and 64 mg/kg, respectively). Treatment protocols among different published works were reviewed to verify the efficacy of isotretinoin.     

Dermoscopic features of digital mucous cysts: A study of 23 cases

Digital mucous cysts (DMC) are common benign myxoid cysts typically located on the fingers and toes. Recently, dermoscopic patterns of DMC were reported. However, only a small number of cases were described in the published work; therefore, information on this topic is scarce in the published work. We investigated dermoscopic patterns of histopathologically diagnosed DMC. In total, 23 cases were enrolled in this study. Polarized dermoscopy revealed vascular patterns in 13 cases (56.5%), with arborizing vascular patterns, dotted vessels, linear vessels and polymorphous vessels in eight (34.8%), three (13.0%), one (4.3%) and one (4.3%) case, respectively. Red‐purple lacunas, ulceration, nail dystrophy and white shiny structures were detected in five (21.7%), two (8.7%), seven (30.4%) and six cases (26.1%), respectively. We report the largest case series regarding dermoscopic features of DMC to date. Dermoscopy can be used as a helpful adjuvant and non‐invasive tool in the diagnosis of DMC.