Basal cell carcinoma and melanocytic nevus in the same lesion.

We report a case of basal cell carcinoma and intradermal melanocytic nevus in the same lesion. A review of the literature indicates that the simultaneous occurrence of two or more neoplasms in one specimen is a relatively infrequent finding. The pathogenesis of simultaneously occurring neoplasms remains the subject of speculation. Based on currently available evidence, we believe that the coexistence of lesions in this particular patient is most likely coincidental.     

Simultaneous occurrence of junctional nevus and seborrheic keratosis

A 45-year-old man presented with a pigmented lesion on his face. A clinical diagnosis of melanocytic nevus was made and the lesion was excised. Histopathologic examination showed a reticular seborrheic keratosis associated with a junctional nevus. We discuss the relation of nevocellular nevi with epidermal and adnexal tumors.     

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。     

Lipid profile in actinic keratosis and basal cell carcinoma

BACKGROUND: The lipid content of the skin and its changes are important in the pathogenesis of many disorders affecting the skin, particularly actinic keratosis (AK) and basal cell carcinoma (BCC). METHODS: Cholesterol, phospholipid, triglyceride, and total lipid levels were studied in paired lesional (AK and BCC) and nonlesional intact skin of 13 patients with AK and 12 patients with BCC. Serum concentrations of the same lipid fractions studied in the skin were investigated in AK and BCC patients and in 11 healthy, age-matched controls. RESULTS: Levels of all lipid fractions were increased in both AK and BCC skin. When AK and BCC skin were compared with each other, a significant increase in phospholipids (p < 0.02) and total lipids (p < 0.01) was found in BCC. Serum cholesterol (p < 0.001), phospholipid (p < 0.001), triglyceride (p < 0.05), and total lipid (p < 0.001) concentrations of AK patients were significantly higher than those of the control group. When BCC and controls were compared, a significant increase in phospholipids and total lipids (p < 0.001) was seen. Serum cholesterol in BCC patients was significantly lower (p < 0.001) and serum phospholipid levels were significantly higher (p < 0.05) than those in the AK group. CONCLUSIONS: An increase in the metabolically active serum phospholipid fraction is reflected in elevated neoplastic tissue phospholipid. This produces altered proportions between lipid fractions in tumorous areas and may result in changes in the intact nature of the cellular membrane, spread, and malignant proliferation.     

皮肤镜在脂溢性角化、日光性角化和基底细胞癌诊断中的应用

目的:探讨皮肤镜在脂溢性角化、日光性角化及基底细胞癌中的诊断价值。方法:收集临床上拟诊为脂溢性角化(108例)、日光性角化(46例)和基底细胞癌(71例)的病例,以病理学检查为“金标准”,研究皮肤镜诊断三种疾病的敏感性、特异度及一致性。结果:与病理诊断比较:①A、B两位医生使用皮肤镜诊断脂溢性角化的一致率分别为93.52%、93.52%,灵敏度为94.67%、93.33%,特异度为90.91%、93.94%,误诊率为9.09%、6.06%,漏诊率为5.33%、6.67%,Youden指数为85.58%、87.27%,Kappa值为0.8484、0.8511。②A、B两位医生使用皮肤镜诊断日光性角化的一致率分别为89.13%、89.13%,灵敏度为88.89%、85.19%,特异度为89.47%、94.74%,误诊率为10.53%、5.26%,漏诊率为11.11%、14.81%,Youden指数为78.36%、79.93%,Kappa值为0.7776、0.7809。③A、B两位医生使用皮肤镜诊断基底细胞癌的一致率分别为91.55%、91.55%,灵敏度为89.74%、92.31%,特异度为93.75%、90.63%,误诊率为6.25%、9.37%,漏诊率为10.26%、7.69%,Youden指数为83.49%、74.84%,Kappa值为0.8304、0.8293。结论:皮肤镜诊断脂溢性角化、日光性角化和基底细胞癌灵敏度、特异度均较好,值得临床推广应用。     

SGK1在日光性角化病、基底细胞癌及鳞状细胞癌中的表达

目的：检测SGK1在日光性角化病（AK）、基底细胞癌（BCC）及鳞状细胞癌（SCC）中的表达。方法：采用免疫组化SABC法检测SGK1在25例正常皮肤(NS)、25例AK、28例BCC、28例皮肤鳞状细胞癌标本中的表达。结果：NS、AK、BCC和SCC标本中,SGK1阳性细胞率分别为（40.03±14.42）%,（36.63±14.28）%,（52.82±18.73）%和（52.58±20.13）%。BCC组和SCC组分别与NS组比较,差异均有统计学意义（Ps<0.05）。各组SGK1染色阳性细胞率>50%的标本分别为6例（24%）,3例（12%）,16例（57.14%）和14例（50%）,BCC组和SCC组分别与NS组比较,差异均有统计学意义（Ps<0.05）。结论：SGK1的高表达可能与基底细胞癌及鳞状细胞癌的发病有关。     

Lamin expression in normal human skin,actinic keratosis,squamous cell carcinoma and basal cell carcinoma

BACKGROUND: Aberrant expression patterns of nuclear lamins have been described in various types of cancer depending on the subtype of cancer, its aggressiveness, proliferative capacity and degree of differentiation. In general, the expression of A-type lamins (lamins A and C) has been correlated with a non-proliferating, differentiated state of cells and tissues. OBJECTIVES: To establish and compare the expression patterns of lamins in normal human skin, actinic keratosis (AK), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). METHODS: Expression patterns of the individual lamin subtypes were studied immunohistochemically. The proliferation capacity of the tumour cells was detected using a specific antibody to Ki-67, and was related to the A-type lamin expression patterns. RESULTS: In normal skin, lamin A was expressed in the suprabasal cell compartment of the epidermis, whereas the basal cells were mostly unstained. BCCs and SCCs stained positive in most cells, while the epidermis overlying BCC and SCC and the epidermis in AK stained homogeneously and strongly in the basal cells in addition to the suprabasal cells. Lamin C was expressed in some basal cells of normal epidermis while the suprabasal cells stained strongly positive. Both BCCs and SCCs stained strongly positive for lamin C, with the difference that in BCC the staining was predominantly present in nucleolar structures with occasional staining of the nuclear envelope. The epidermis overlying SCC showed strong positivity in the lamina of virtually all cells. The expression of lamin C in the basal cells of AK resembled the expression pattern seen in the epidermis overlying BCC, i.e. a nucleolar staining next to nuclear envelope staining. Lamin B1 and B2 were found in virtually all cells in normal epidermis, AK, BCC, SCC and the epidermis overlying cancer. The percentage of Ki-67-expressing cells was highest in BCC (45%), and gradually decreased via epidermis overlying BCC, AK, SCC, and epidermis overlying SCC, to normal skin (11%). Simultaneous expression of A-type lamins and Ki-67 occurred in approximately 50% of the proliferating (Ki-67 positive) cells in BCC and SCC. CONCLUSIONS: Significant changes occur in the expression patterns of A-type lamins in both premalignant and malignant lesions of the skin. The profound overlap of lamin A and Ki-67 staining patterns indicates that the proliferating tumour cells may obtain a certain degree of differentiation. Finally, lamin A expression in the basal cell layer of the apparently normal epidermis overlying BCC may suggest its involvement in the primary process.     

埃兹蛋白在皮肤鳞状细胞癌、基底细胞上皮瘤、脂溢性角化病中的表达及临床意义

目的 探讨埃兹蛋白（ezrin）在脂溢性角化病、基底细胞上皮瘤、皮肤鳞状细胞癌中的表达及其与临床病理参数之间的相关性。方法 采用免疫组化法（SP法）检测36例皮肤鳞状细胞癌、27例基底细胞上皮瘤和20例脂溢性角化病、10例正常人皮肤中埃兹蛋白表达水平。结果 埃兹蛋白在正常人皮肤、脂溢性角化病、基底细胞上皮瘤、皮肤鳞状细胞癌中的阳性率分别为20.0%,25.0%,66.7％和91.3%,除脂溢性角化病组外,各肿瘤组与正常人对照组比较,阳性率差异均有统计学意义（H = 40.061,P < 0.01）。埃兹蛋白表达水平与皮肤肿瘤良恶性、与皮肤鳞状细胞癌的病理分级及肿瘤有无淋巴结转移均呈正相关（r分别为0.87,0.80,0.89）。COX回归显示,埃兹蛋白表达水平是皮肤鳞状细胞癌预后的独立影响因素之一。结论 脂溢性角化病、基底细胞上皮瘤、皮肤鳞状细胞癌组织中埃兹蛋白阳性表达水平与皮肤肿瘤的良恶性、皮肤鳞状细胞癌病理分级及有无淋巴结转移有关。     

Neuroendocrine differentiation of a metastatic basal cell carcinoma in a patient with basal cell nevus syndrome

A 48 year-old white male with basal cell nevus syndrome presented with a metastatic basal cell carcinoma with neuroendocrine features. The tumor manifested aggressive behavior, having deep local invasion and metastases to para-aortic lymph nodes and bone. Neuroendocrine differentiation has rarely been associated with basal cell carcinoma. The histologic, immunohistochemical, and electron microscopic studies of this rare tumor are described.     

皮脂腺痣并发多发性基底细胞癌1例

报道1例皮脂腺痣患者并发10余个肿瘤,经病理组织学检查,诊断为皮脂腺痣及基底细胞癌.皮脂腺痣并发多发性基底细胞癌国内外尚未见报道.     

Comparison of proteinase activities in squamous cell carcinoma, basal cell epithelioma, and seborrheic keratosis

The correlation between proteinase activities and invasive and metastatic potentials was investigated by comparing three different kinds of tumors. Extracts from tumor homogenate of 11 squamous cell carcinoma (SCC), 5 basal cell epithelioma (BCE), and 8 seborrheic keratosis (SK) were prepared in order to examine the activity of acid phosphatase and proteinases such as cathepsin B and D, type I and IV collagenase, and plasminogen activator (PA). There was no difference observed between acid phosphatase and cathepsin D activities among the three tumors. Cathepsin B and PA activities were slightly elevated in SCC. Type I collagenase activity of SCC was 9-fold higher than that of SK (p less than 0.01), and type IV collagenase was 3-fold higher per tissue DNA (p less than 0.05). Type I and IV collagenase of BCE were elevated per tissue protein but not elevated per tissue DNA. Correlation was found between the level of cell differentiation in SCC and the activities of cathepsin B, PA, and type I collagenase. Poorly differentiated SCC exhibited a tendency to have higher proteinase activities. Proteinases that showed high activities in malignant tumor homogenate may be related to the degradation of the surrounding cell matrix in addition to intracellular metabolism. Type I and IV collagenase, in cooperation with cathepsin B and PA, might play a major role in invading the dermal stroma and basement membrane.     

Lichenoid keratosis is frequently misdiagnosed as basal cell carcinoma

Lichenoid keratosis (LK), also known as benign lichenoid keratosis or lichen planus‐like keratosis, is a solitary, pink to red‐brown scaly plaque representing a host immunological response to a variety of precursor lesions. LK is often misdiagnosed as a dermatological malignancy owing to its clinical resemblance to basal cell carcinoma (BCC) or Bowen disease. We performed a retrospective analysis of the pathology records of a series of LK lesions with reference to the demographic features and accuracy of clinical diagnosis. The pathology records from 2008 to 2009 of 263 consecutive patients with a histological diagnosis of LK from a specialized skin laboratory were retrieved. Data relating to clinical diagnosis, age, sex, anatomical location, time of year of presentation and any coexistent pathological lesions adjacent to the LK were recorded. Mean age at presentation was 64 years (range 34–96), and 58% of patients were female. The most common anatomical site was the chest/anterior torso, followed by the back and legs. The most common coexisting lesion was solar keratosis at 14%, followed by seborrhoeic keratosis (SK) at 7.8%. The correct clinical diagnosis of LK was made in 29.5% of cases. The most common clinical diagnosis was BCC (47%), while SK was the preferred diagnosis in 18%. A clinical diagnosis was not given in 5.5% of cases. In conclusion, it appears that LK is frequently misdiagnosed, with misdiagnosis occurring in > 70% of cases in this study.