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Watanabe Y, Shido K, Niihori T, Niizuma H, Katata Y, Iizuka C, Oba D, Moriya K, Saito-Nanjo Y, Onuma M, Rikiishi T, Sasahara Y, Watanabe M, Aiba S, Saito R, Sonoda Y, Tominaga T, Aoki Y, Kure S. Somatic BRAF c.1799T>A p.V600E Mosaicism syndrome characterized by a linear syringocystadenoma papilliferum, anaplastic astrocytoma, and ocular abnormalities. Am J Med Genet A 2015; 170A:189-94. [DOI: 10.1002/ajmg.a.37376] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/30/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Yuko Watanabe
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Kosuke Shido
- Department of Dermatology; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Tetsuya Niihori
- Department of Medical Genetics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Hidetaka Niizuma
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yu Katata
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Chie Iizuka
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Daiju Oba
- Department of Medical Genetics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Kunihiko Moriya
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yuka Saito-Nanjo
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Masaei Onuma
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Takeshi Rikiishi
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yoji Sasahara
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Mika Watanabe
- Department of Pathology; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Setsuya Aiba
- Department of Dermatology; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Ryuta Saito
- Department of Neurosurgery; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Teiji Tominaga
- Department of Neurosurgery; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Yoko Aoki
- Department of Medical Genetics; Tohoku University School of Medicine; Sendai Miyagi Japan
| | - Shigeo Kure
- Department of Pediatrics; Tohoku University School of Medicine; Sendai Miyagi Japan
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Patel P, Malik K, Khachemoune A. Sebaceus and Becker's Nevus: Overview of Their Presentation, Pathogenesis, Associations, and Treatment. Am J Clin Dermatol 2015; 16:197-204. [PMID: 25782676 DOI: 10.1007/s40257-015-0123-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nevus sebaceus (NS) and Becker's nevus (BN) are two variants of epidermal nevi. NS clinically presents as a yellowish-orange, hairless plaque on the scalp, face, or neck, while BN presents as a tan-to-brown hyperpigmented, sometimes hypertrichotic, plaque typically on the chest and shoulder. Histologically, NS displays mature or nearly mature sebaceus glands as well as acanthosis and fibroplasia of the papillary dermis. BN shows variable papillomatosis, acanthosis, and hyperkeratosis, with hyperpigmentation of the basal/suprabasal layer. While the genetic basis of NS is thought to be due to post-zygotic mutations in the Harvey rat sarcoma viral oncogene homolog (HRAS)/Kristen rat sarcoma viral oncogene homolog (KRAS) genes, the genetic basis of BN is relatively unknown and is implicated with paradominant inheritance. In some patients, NS and BN can each be associated with additional cutaneous and extra-cutaneous anomalies, ranging from benign or malignant tumors to multiple organ irregularities. Due to the wide range of possible associations, treatment for NS and BN is devised on a case-by-case basis. In this article, we review the features, etiology, and diagnosis/management of NS and BN, with a focus on associations. We also report a patient who concomitantly presents with both lesions.
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Affiliation(s)
- Parth Patel
- Albert Einstein College of Medicine, Bronx, NY, USA
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Luo S, Tsao H. Epidermal, sebaceous, and melanocytic nevoid proliferations are spectrums of mosaic RASopathies. J Invest Dermatol 2015; 134:2493-2496. [PMID: 25219651 DOI: 10.1038/jid.2014.244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Growing evidence demonstrates that various nevoid proliferations such as keratinocytic epidermal nevi and nevus sebaceous result from somatic mosaicism. Many of the mutations identified have been within the RAF/RAS/MAPK pathway, hence supporting the previously introduced term "mosaic RASopathy" for these nevi. In this issue, Kinsler et al. were among the first to characterize certain pigmented melanocytic nevi that may also fit this paradigm. To better frame these findings, we provide a summary of the analogous genotypic profiles for epidermal and melanocytic nevi from recent studies.
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Affiliation(s)
- Su Luo
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Wellman Center for Photomedicine and MGH Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Kim SW, Song JS, Kang MS, Sin JB, Ki CS, Jeon GW. Identification of somatic KRAS mutation in a Korean baby with nevus sebaceus syndrome. Ann Lab Med 2015; 35:178-80. [PMID: 25553307 PMCID: PMC4272958 DOI: 10.3343/alm.2015.35.1.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/10/2014] [Accepted: 10/25/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sung Woo Kim
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ju Sun Song
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Seon Kang
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong Beom Sin
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Abstract
The term epidermal nevus syndrome (ENS) has been used to describe the association of epidermal hamartomas and extracutaneous abnormalities. Although many continue to use the term "ENS," it is now understood that this is not one disease, but rather a heterogeneous group with distinct genetic profiles defined by a common cutaneous phenotype: the presence of epidermal and adnexal hamartomas that are associated with other organ system involvement. One commonality is that epidermal nevi often follow the lines of Blaschko and it appears the more widespread the cutaneous manifestations, the greater the risk for extracutaneous manifestations. The majority of the extracutaneous manifestations involve the brain, eye, and skeletal systems. The CNS involvement is wide ranging and involves both clinical manifestations such as intellectual disability and seizures, as well as structural anomalies. Several subsets of ENS with characteristic features have been delineated including the nevus sebaceus syndrome, Proteus syndrome, CHILD syndrome, Becker's nevus syndrome, nevus comedonicus syndrome, and phakomatosis pigmentokeratotica. Advances in molecular biology have revealed that the manifestations of ENS are due to genomic mosaicism. It is likely that the varied clinical manifestations of ENS are due in great part to the functional effects of specific genetic defects. Optimal management of the patient with ENS involves an interdisciplinary approach given the potential for multisystem involvement. Of note, epidermal nevi have been associated with both benign and malignant neoplasms, and thus ongoing clinical follow-up is required.
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Affiliation(s)
- Sarah Asch
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey L Sugarman
- Departments of Dermatology and Community and Family Medicine, University of California San Francisco, Santa Rosa, CA, USA.
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Phenotype/genotype correlations in epidermal nevus syndrome as a neurocristopathy. HANDBOOK OF CLINICAL NEUROLOGY 2015; 132:9-25. [DOI: 10.1016/b978-0-444-62702-5.00002-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Tsai JH, Huang WC, Jhuang JY, Jeng YM, Cheng ML, Chiu HY, Kuo KT, Liau JY. Frequent activating HRAS mutations in trichilemmoma. Br J Dermatol 2014; 171:1073-7. [PMID: 24890286 DOI: 10.1111/bjd.13143] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Trichilemmoma is a benign follicular epithelial tumour exhibiting outer root sheath differentiation. It is associated with Cowden syndrome and naevus sebaceus (NS), but the pathogenesis of sporadic tumours is poorly understood. Recently, NS was found to be caused by postzygotic HRAS or KRAS mutations. OBJECTIVES We sought to determine whether NS-related and NS-unrelated trichilemmomas harbour RAS mutations. METHODS Formalin-fixed and paraffin-embedded blocks of 12 NS-related and 15 NS-unrelated trichilemmomas from 26 individuals were retrieved and analysed to determine the presence of mutations in exons 1 and 2 of the HRAS, KRAS and NRAS genes by polymerase chain reaction and direct sequencing. Mutational hotspots of the FGFR3 and PIK3CA genes were also analysed for NS-unrelated cases. RESULTS Among the 27 cases, mutually exclusive HRAS c.37G>C and c.182A>G mutations were observed in 17 and three tumours, respectively. Of the 12 NS-related tumours, 11 (92%) harboured the HRAS c.37G>C substitution. Of the 15 sporadic tumours, nine (60%) harboured HRAS mutations, including six c.37G>C and three c.182A>G. An HRAS c.182A>G mutation was observed only in sporadic tumours. No mutations were observed in the other genes that were tested. CONCLUSIONS The high frequency of HRAS activating mutations, including the c.182A>G substitution, which was rather rare in NS, suggests that most trichilemmomas are authentic neoplasms.
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Affiliation(s)
- J-H Tsai
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Fate and plasticity of the epidermis in response to congenital activation of BRAF. J Invest Dermatol 2014; 135:481-9. [PMID: 25202828 PMCID: PMC4289449 DOI: 10.1038/jid.2014.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/07/2014] [Accepted: 08/19/2014] [Indexed: 01/22/2023]
Abstract
Determining the developmental consequences of activated RAS and its downstream effectors is critical to understanding several congenital conditions caused by either germline or somatic mutations of the RAS pathway. Here we demonstrate that embryonic activation of BRAF in mouse ectoderm triggers both craniofacial and skin defects, including hyperproliferation, loss of spinous and granular keratinocyte differentiation, and cleft palate. RNA-sequencing reveals that despite an apparent block in spinous and granular differentiation, the epidermis continues to mature, expressing >80% of EDC genes and forming a hydrophobic barrier, both characteristic of later stages in epidermal development. Spinous and granular differentiation can be restored by pharmacologic inhibition of MEK or BRAF; however, in tissue recombination studies, phenotypic reversion was found to be non-cell autonomous and required dermal tissue to be present. These studies indicate that early activation of the RAF signaling pathway in the ectoderm has specific effects on progressive differentiation of the epidermis, which may be amendable to treatment using existing pharmacologic inhibitors.
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Genetische Grundlagen seborrhoischer Keratosen und epidermaler Nävi. DER PATHOLOGE 2014; 35:413-23. [DOI: 10.1007/s00292-014-1928-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Al-Rohil RN, Leung D, Andrew Carlson J. Congenital vulnerability of cutaneous segments arising from skin mosaicism: A genetic basis for locus minoris resistentiae. Clin Dermatol 2014; 32:577-91. [DOI: 10.1016/j.clindermatol.2014.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Sebaceous tumors are epithelial tumors with a differentiation towards sebaceous adnexal structures of the skin. They imitate the epithelial cells of mature sebaceous glands, sebaceous ducts, immature (embryonic) sebaceous structures or sebaceous glands that are not stimulated by hormones (mantle structures). This article explains the classification of sebaceous tumors on the basis of the normal histology of sebaceous glands. Clinical and histopathological criteria are given for the most important sebaceous tumors. The differential diagnosis of sebaceoma, sebaceous adenoma and various types of sebaceous carcinoma is emphasized. The importance of a specific diagnosis of adnexal tumors is demonstrated by tumor-associated syndromes with involvement of other organs (e.g., Muir-Torre syndrome and Birt-Hogg-Dubé syndrome). Furthermore, conceptional controversies, problems in differential diagnosis and the impact of immunohistochemical staining in the assessment of sebaceous tumors are considered.
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Kadam P, Rand J, Rady P, Tyring S, Stehlik J, Sedivcova M, Kazakov DV, Ray K, Hill J, Agag R, Carlson JA. Adolescent Onset of Localized Papillomatosis, Lymphedema, and Multiple Beta-Papillomavirus Infection: Epidermal Nevus, Segmental Lymphedema Praecox, or Verrucosis? A Case Report and Case Series of Epidermal Nevi. Dermatopathology (Basel) 2014; 1:55-69. [PMID: 27047923 PMCID: PMC4772932 DOI: 10.1159/000367967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Herein, we report the case of a 12-year-old female who noted the recent onset of an oval, circumscribed, 10-cm papillomatous plaque affecting the thigh and vulva that showed histologic signs of lymphedema without evidence of secondary lymphedema. The sequencing of genes associated with a delayed onset of lymphedema or epidermal nevi (EN) - GATA2 and GJC2, and HRAS and KRAS, respectively - showed wild-type alleles. Polymerase chain reaction for human papillomavirus (HPV) DNA demonstrated infections with 15 HPV genotypes. Evidence of productive HPV infection, HPV capsid expression, and cytopathic changes was detected. At the 6-month follow-up, no evidence of recurrence was found after complete excision. The analysis of a consecutive series of 91 EN excision specimens revealed that 76% exhibited histologic evidence of lymphostasis. Notably, multiple acrochordon-like EN, which most closely resembled this case, showed similar signs of localized lymphedema. The late onset and evidence of lymphedema favors the diagnosis of congenital unisegmental lymphedema. However, the clinical findings and epidermal changes point to the diagnosis of EN. Moreover, localized verrucosis also accurately describes this patient's cutaneous findings. Based on the above evidence, we postulate that an abnormal development of lymphatics may play a primary role in the pathogenesis of some types of EN and facilitate productive HPV infection.
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Affiliation(s)
- Pooja Kadam
- Department of Pathology, Albany Medical College, Albany, N.Y., USA
| | - Janne Rand
- Department of Pathology, Albany Medical College, Albany, N.Y., USA
| | - Peter Rady
- Department of Dermatology, University of Texas Health Science Center, Houston, Tex., USA
- Department of Microbiology/Medical Genetics, University of Texas Health Science Center, Houston, Tex., USA
- Department of Internal Medicine, University of Texas Health Science Center, Houston, Tex., USA
| | - Stephen Tyring
- Department of Dermatology, University of Texas Health Science Center, Houston, Tex., USA
- Department of Microbiology/Medical Genetics, University of Texas Health Science Center, Houston, Tex., USA
- Department of Internal Medicine, University of Texas Health Science Center, Houston, Tex., USA
| | - Jan Stehlik
- Department of Pathology, Medical Faculty in Pilsen, Charles University, Pilsen, Czech Republic
| | - Monica Sedivcova
- Department of Pathology, Medical Faculty in Pilsen, Charles University, Pilsen, Czech Republic
| | - Dmitry V. Kazakov
- Department of Pathology, Medical Faculty in Pilsen, Charles University, Pilsen, Czech Republic
| | - Kathy Ray
- Department of Capital District Dermatology, Glenmont, N.Y., USA
| | - Jerome Hill
- Department of Capital District Dermatology, Glenmont, N.Y., USA
| | - Richard Agag
- Department of Plastic Surgery, Albany Medical College, Albany, N.Y., USA
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Sarin KY, McNiff JM, Kwok S, Kim J, Khavari PA. Activating HRAS mutation in nevus spilus. J Invest Dermatol 2014; 134:1766-1768. [PMID: 24390138 DOI: 10.1038/jid.2014.6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.
| | - Jennifer M McNiff
- Department of Dermatology, Yale Medical School, New Haven, Connecticut, USA
| | - Shirley Kwok
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Jinah Kim
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA; Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Paul A Khavari
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA; Dermatology Service, VA Palo Alto Health Care System, Palo Alto, California, USA
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Aslam A, Salam A, Griffiths CEM, McGrath JA. Naevus sebaceus: a mosaic RASopathy. Clin Exp Dermatol 2013; 39:1-6. [DOI: 10.1111/ced.12209] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 11/27/2022]
Affiliation(s)
- A. Aslam
- Dermatology Centre; Salford Royal NHS Foundation Trust; Stott Lane University of Manchester Manchester UK
| | - A. Salam
- St John's Institute of Dermatology; King's College London (Guy's Campus); London UK
| | - C. E. M. Griffiths
- Dermatology Centre; Salford Royal NHS Foundation Trust; Stott Lane University of Manchester Manchester UK
| | - J. A. McGrath
- St John's Institute of Dermatology; King's College London (Guy's Campus); London UK
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Lim YH, Ovejero D, Sugarman JS, Deklotz CMC, Maruri A, Eichenfield LF, Kelley PK, Jüppner H, Gottschalk M, Tifft CJ, Gafni RI, Boyce AM, Cowen EW, Bhattacharyya N, Guthrie LC, Gahl WA, Golas G, Loring EC, Overton JD, Mane SM, Lifton RP, Levy ML, Collins MT, Choate KA. Multilineage somatic activating mutations in HRAS and NRAS cause mosaic cutaneous and skeletal lesions, elevated FGF23 and hypophosphatemia. Hum Mol Genet 2013; 23:397-407. [PMID: 24006476 DOI: 10.1093/hmg/ddt429] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pathologically elevated serum levels of fibroblast growth factor-23 (FGF23), a bone-derived hormone that regulates phosphorus homeostasis, result in renal phosphate wasting and lead to rickets or osteomalacia. Rarely, elevated serum FGF23 levels are found in association with mosaic cutaneous disorders that affect large proportions of the skin and appear in patterns corresponding to the migration of ectodermal progenitors. The cause and source of elevated serum FGF23 is unknown. In those conditions, such as epidermal and large congenital melanocytic nevi, skin lesions are variably associated with other abnormalities in the eye, brain and vasculature. The wide distribution of involved tissues and the appearance of multiple segmental skin and bone lesions suggest that these conditions result from early embryonic somatic mutations. We report five such cases with elevated serum FGF23 and bone lesions, four with large epidermal nevi and one with a giant congenital melanocytic nevus. Exome sequencing of blood and affected skin tissue identified somatic activating mutations of HRAS or NRAS in each case without recurrent secondary mutation, and we further found that the same mutation is present in dysplastic bone. Our finding of somatic activating RAS mutation in bone, the endogenous source of FGF23, provides the first evidence that elevated serum FGF23 levels, hypophosphatemia and osteomalacia are associated with pathologic Ras activation and may provide insight in the heretofore limited understanding of the regulation of FGF23.
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Abstract
The recent discovery that nevus sebaceus is a mosaic RASopathy represents a major breakthrough in research on epidermal nevi. In this issue, both Levinsohn et al. and Sun et al. confirm this advancement with results obtained through whole-exome sequencing. Further molecular studies will almost certainly show that sebaceous and keratinocytic nevi are different disorders, although there is some clinical overlap.
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Affiliation(s)
- Rudolf Happle
- Department of Dermatology, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany.
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