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Rooker A, Ouwerkerk W, Bekkenk MW, Luiten RM, Bakker WJ. The Risk of Keratinocyte Cancer in Vitiligo and the Potential Mechanisms Involved. J Invest Dermatol 2024; 144:234-242. [PMID: 37791932 DOI: 10.1016/j.jid.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 10/05/2023]
Abstract
Although light skin types are associated with increased skin cancer risk, a lower incidence of both melanoma and nonmelanoma skin cancer (NMSC) has been reported in patients with vitiligo. We performed a systematic review and meta-analysis on the NMSC risk in patients with vitiligo, indicating a reduced relative risk ratio of NMSC in vitiligo. Furthermore, we propose a series of hypotheses on the underlying mechanisms, including both immune-mediated and nonimmune-mediated pathways. This study reveals insights into the relationship between vitiligo and keratinocyte cancer and can also be used to better inform patients with vitiligo.
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Affiliation(s)
- Alex Rooker
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Wouter Ouwerkerk
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands; VU University of Amsterdam, Amsterdam, The Netherlands
| | - Rosalie M Luiten
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands.
| | - Walbert J Bakker
- Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
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2
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Sirka CS, Sethy M, Rout AN. Actinic keratoses and squamous cell carcinoma limited to photo-exposed skin in vitiligo vulgaris in pigmented skin type. BMJ Case Rep 2024; 17:e255306. [PMID: 38286583 PMCID: PMC10826530 DOI: 10.1136/bcr-2023-255306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Vitiligo skin has a lesser number of photoprotective melanocytes-theoretically, there is a higher risk of development of non-melanoma skin cancers in such patients. But most studies in Caucasian patients have shown decreased incidence of non-melanoma skin cancers in patients with vitiligo. In Indian patients, there is a paucity of literature on such adverse events. We report a case of actinic keratoses, cutaneous horn with dysplasia and squamous cell carcinoma developing exclusively over photo-exposed vitiligo lesions in an Indian woman in her 60s (housewife, Fitzpatrick skin type V and average daily photo-exposure time 2-4 hours) of long-standing vitiligo vulgaris without any history of phototherapy. The photoprotected lesional skin was completely normal with no clinically appreciable enlarged regional lymph nodes. Shave and elliptical excision of the suspicious lesions were done, and histopathology showed various degrees of malignant transformation in various lesions. The patient was started on topical imiquimod for the lesions of actinic keratoses and was referred for staging and wide excision of squamous cell carcinoma lesion. We report this case for its rarity and to emphasise the fact that there is a need for counselling for lifestyle modification in patients with vitiligo as the use of sunscreens is often not practised by Indian patients due to financial constraints and physical measures such as using full sleeves, high-collared dresses and scarves should be encouraged.
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Affiliation(s)
- Chandra Sekhar Sirka
- Dermatology and Venereology, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Orissa, India
| | - Madhusmita Sethy
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Arpita Nibedita Rout
- Dermatology and Venereology, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Orissa, India
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3
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Rashid S, Molotkov I, Klebanov N, Shaughnessy M, Daly MJ, Artomov M, Tsao H. Mendelian Randomization Analysis reveals Inverse Genetic Risks between Skin Cancers and Vitiligo. JID INNOVATIONS 2023; 3:100217. [PMID: 38034848 PMCID: PMC10685305 DOI: 10.1016/j.xjidi.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 12/02/2023] Open
Abstract
Several observational studies have demonstrated a consistent pattern of decreased melanoma risk among patients with vitiligo. More recently, this finding has been supported by a suggested genetic relationship between the two entities, with certain variants significantly associated with an increased risk of melanoma, basal cell carcinoma, and squamous cell carcinoma but a decreased risk of vitiligo. We compared 48 associated variants from a recently published GWAS and identified three variants-located in the TYR, MC1R-DEF8, and RALY-EIF2S2-ASIP-AHCY-ITCH loci- that correlated with an increased risk for melanoma, basal cell carcinoma, and squamous cell carcinoma and a decreased risk for vitiligo. We then used results of skin cancers and vitiligo GWAS to compare the shared genetic properties between these two traits through an unbiased Mendelian randomization analysis. Our results suggest that the inverse genetic relationship between common skin cancers and vitiligo is broader than previously reported owing to the influence of shared genome-wide significant associations.
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Affiliation(s)
- Sarem Rashid
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ivan Molotkov
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Nikolai Klebanov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Shaughnessy
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark J. Daly
- Analytic & Translational Genetics Unit (ATGU), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute, Cambridge, Massachusetts, USA
- Institute for Molecular Medicine Finland, Helsinki, Finland
| | - Mykyta Artomov
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Analytic & Translational Genetics Unit (ATGU), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute, Cambridge, Massachusetts, USA
| | - Hensin Tsao
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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4
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Ferguson J, Eleftheriadou V, Nesnas J. Risk of Melanoma and Nonmelanoma Skin Cancer in People with Vitiligo: United Kingdom Population-Based Cohort Study. J Invest Dermatol 2023; 143:2204-2210. [PMID: 37146674 DOI: 10.1016/j.jid.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 05/07/2023]
Abstract
Although genetic studies have found an inverse relationship between vitiligo and skin cancer, epidemiological evidence is conflicting. We investigated the risk of skin cancer in adults with vitiligo using United Kingdom electronic primary care records from the Optimum Patient Care Research Database 2010-2020. Vitiligo cases were age, sex, and general practitioner practice matched to population controls without vitiligo. Incidence of melanoma, nonmelanoma skin cancers (squamous cell carcinoma and basal cell carcinoma), and actinic keratoses was compared between vitiligo cases and controls using Cox regression. A total of 15,156 vitiligo cases were matched to 60,615 controls. Vitiligo was associated with a 38% reduced risk of new-onset skin cancer (adjusted hazard ratio [aHR] = 0.62, 95% confidence interval [CI] = 0.52-0.75, P < 0.001) and skin cancer subtypes; melanoma (aHR = 0.39, 95% CI = 0.23-0.65, P < 0.001), squamous cell carcinoma (aHR = 0.67, 95% CI = 0.49-0.90, P < 0.01), basal cell carcinoma (aHR = 0.65, 95% CI = 0.51-0.83, P < 0.001). There was no significant association for actinic keratosis (aHR = 0.88, 95% CI = 0.77-1.01). People with vitiligo have a markedly reduced incidence of melanoma and nonmelanoma skin cancer. Given concerns that some treatments, such as phototherapy, may increase skin cancer risk, this finding provides reassurance to people with vitiligo and clinicians managing the condition.
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Affiliation(s)
- John Ferguson
- St John's Institute of Dermatology, Guys Hospital, London, United Kingdom
| | - Viktoria Eleftheriadou
- Department of Dermatology, Walsall Manor Hospital, Walsall Healthcare NHS Trust, Birmingham, United Kingdom
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Gupta I, Shankrit S, Narta K, Ghazi M, Grover R, Pandey R, Kar HK, Menon SM, Gupta A, Yenamandra VK, Singh A, Mukerji M, Mukhopadhyay A, Rani R, Gokhale RS, Dash D, Natarajan VT. Whole-Exome Sequencing of Vitiligo Lesions Indicates Lower Burden of Somatic Variations: Implications in Risk for Nonmelanoma Skin Cancers. J Invest Dermatol 2022; 143:1111-1114.e8. [PMID: 36535361 DOI: 10.1016/j.jid.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/27/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Iti Gupta
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Shambhavi Shankrit
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Kiran Narta
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Madeeha Ghazi
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Ritika Grover
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Rajesh Pandey
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Hemanta Kumar Kar
- Department of Dermatology, PGIMER Dr. Ram Manohar Lohia Hospital, New Delhi, India; Department of Dermatology, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha
| | - Shruti M Menon
- Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Aayush Gupta
- Department of Dermatology, Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Vamsi K Yenamandra
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Archana Singh
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Mitali Mukerji
- Department of Bioscience and Bioengineering, Indian Institute of Technology, Jodhpur, Rajasthan, India
| | - Arijit Mukhopadhyay
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India; Translational Medicine Unit, Biomedical Research Centre, University of Salford, Manchester, United Kingdom
| | - Rajni Rani
- National Institute of Immunology, New Delhi, India
| | - Rajesh S Gokhale
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; National Institute of Immunology, New Delhi, India
| | - Debasis Dash
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Vivek T Natarajan
- Council for Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.
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Alanazi Y, Shadid A, Almalki ST, Bakhribah H. Skeletal Mets From Squamous Cell Carcinoma of the Lower Limb: A Case Report. Cureus 2022; 14:e27155. [PMID: 36004016 PMCID: PMC9392849 DOI: 10.7759/cureus.27155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer worldwide and one of the most capable of metastasis. The bone is a common metastatic site of cancers, which is a major cause of morbidity, with an estimated 350,000 people dying yearly from bone metastases. However, bone metastasis from an SCC in the lower limb is rarely reported in the literature and the role of systemic chemotherapy is not well established. We report a case of a 72-year-old gentleman with an SCC metastasis of the bone. This patient received six cycles of platinum-based chemotherapy with no surgical or radiation intervention.
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Weng YC, Ho HJ, Chang YL, Chang YT, Wu CY, Chen YJ. Reduced risk of skin cancer and internal malignancies in vitiligo patients: a retrospective population-based cohort study in Taiwan. Sci Rep 2021; 11:20195. [PMID: 34642421 PMCID: PMC8511292 DOI: 10.1038/s41598-021-99786-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
The relationship between cancer and vitiligo has been explored but with inconsistent results. To examine the long-term cancer risk in vitiligo patients, we conducted a retrospective nationwide cohort study. From the National Health Insurance Research Database of Taiwan, a total of 13,824 vitiligo patients were identified and matched with 55,296 reference subjects without vitiligo by age, gender, and propensity score estimated by major comorbidities from 1997 to 2013. Demographic characteristics and comorbidities were compared between these two groups. Incidence rate ratios and hazard ratios (HRs) were calculated to examine cancer risks. The 16-year incidence rates of overall cancers were 621.06 (566.56–675.55) and 726.99 (697.24–756.74) per 100,000 person-years in the vitiligo and reference groups. Patients with vitiligo showed a significantly decreased risk of overall cancers [adjusted HR, 0.85; 95% confidence interval (CI), 0.77 to 0.93, p < 0.001] compared with reference subjects without vitiligo after adjusting for age, sex, comorbidities, and treatments. The risks of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were significantly reduced (adjusted HR 0.21, 95% CI 0.11–0.38, p < 0.001), as well as internal malignancies (adjusted HR 0.89, 95% CI 0.81–0.99, p = 0.026). The results were consistent across different subgroups of patients, including male gender, ages more than 40 years, and those receiving long-term systemic disease-modifying antirheumatic drugs and phototherapies. Information related to phenotype, disease duration, vitiligo lesion sites, family history of vitiligo or cancer, occupation, and personal lifestyle was not included in the database. Vitiligo is associated with reduced risks of BCC and SCC, as well as internal malignancies.
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Affiliation(s)
- Yu-Ching Weng
- Department of Dermatology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Taichung, 407, Taiwan
| | - Hsiu J Ho
- Institute of Biomedical Informatics, Institute of Public Health, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei, 11221, Taiwan
| | - Yi-Ling Chang
- Department of Dermatology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Taichung, 407, Taiwan
| | - Yun-Ting Chang
- Faculty of Medicine and Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Ying Wu
- Institute of Biomedical Informatics, Institute of Public Health, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei, 11221, Taiwan. .,Faculty of Medicine and Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Translational Research and Center of Excellence for Cancer Research, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Public Health, China Medical University, Taichung, Taiwan. .,National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan.
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Taichung, 407, Taiwan. .,Faculty of Medicine and Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Abstract
Background Vitiligo is a depigmentation disorder associated with genetic loss of melanocytes and decreased melanin synthesis. The current literature is conflicting in regard to vitiligo patients' risk of cutaneous malignant melanoma and keratinocyte cancer. Objective To investigate the risk of cutaneous malignant melanoma and keratinocyte cancer in vitiligo patients. Methods We conducted a population-based study, including 2,339 subjects with a first-time vitiligo diagnosis between 1994 and 2017 and 23,293 age- and sex-matched (1:10) controls. To address surveillance bias, we included 12,380 subjects with a first-time diagnosis of lichen planus. Results Age was the only significant factor for cutaneous malignant melanoma in comparison of vitiligo with controls and lichen planus (hazard ratio 1.04, 95% confidence interval [CI] 1.03-1.05; and hazard ratio 1.02, 95% CI 1.01-1.04, respectively). Similarly, age was a significant factor for keratinocyte cancer in comparison of vitiligo with controls and lichen planus (hazard ratio 1.07, 95% CI 1.06-1.07; and hazard ratio 1.06, 95% CI 1.05-1.07). Male sex was an additional factor for keratinocyte cancer in comparison of vitiligo with lichen planus (hazard ratio 1.38; 95% CI 1.09-1.75). Phototherapy did not increase the risk of receiving a diagnosis of cutaneous malignant melanoma or keratinocyte cancer in the vitiligo cohort. Conclusion We observed no significant difference in cutaneous malignant melanoma or keratinocyte cancer risk among vitiligo subjects. Phototherapy use was not associated with a higher skin cancer risk in vitiligo compared with other skin diseases.
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Baykal Selçuk L, Katkat E, Aksu Arıca D, Yaylı S, Bahadır S. Sun-protection habits and knowledge of patients with vitiligo. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Bellei B, Picardo M. Premature cell senescence in human skin: Dual face in chronic acquired pigmentary disorders. Ageing Res Rev 2020; 57:100981. [PMID: 31733332 DOI: 10.1016/j.arr.2019.100981] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 01/10/2023]
Abstract
Although senescence was originally described as an in vitro acquired cellular characteristic, it was recently recognized that senescence is physiologically and pathologically involved in aging and age-related diseases in vivo. The definition of cellular senescence has expanded to include the growth arrest caused by various cellular stresses, including DNA damage, inadequate mitochondria function, activated oncogene or tumor suppressor genes and oxidative stress. While senescence in normal aging involves various tissues over time and contributes to a decline in tissue function even with healthy aging, disease-induced premature senescence may be restricted to one or a few organs triggering a prolonged and more intense rate of accumulation of senescent cells than in normal aging. Organ-specific high senescence rate could lead to chronic diseases, especially in post-mitotic rich tissue. Recently, two opposite acquired pathological conditions related to skin pigmentation were described to be associated with premature senescence: vitiligo and melasma. In both cases, it was demonstrated that pathological dysfunctions are not restricted to melanocytes, the cell type responsible for melanin production and transport to surrounding keratinocytes. Similar to physiological melanogenesis, dermal and epidermal cells contribute directly and indirectly to deregulate skin pigmentation as a result of complex intercellular communication. Thus, despite senescence usually being reported as a uniform phenotype sharing the expression of characteristic markers, skin senescence involving mainly the dermal compartment and its paracrine function could be associated with the disappearance of melanocytes in vitiligo lesions and with the exacerbated activity of melanocytes in the hyperpigmentation spots of melasma. This suggests that the difference may arise in melanocyte intrinsic differences and/or in highly defined microenvironment peculiarities poorly explored at the current state of the art. A similar dualistic phenotype has been attributed to intratumoral stromal cells as cancer-associated fibroblasts presenting a senescent-like phenotype which influence the behavior of neoplastic cells in either a tumor-promoting or tumor-inhibiting manner. Here, we present a framework dissecting senescent-related molecular alterations shared by vitiligo and melasma patients and we also discuss disease-specific differences representing new challenges for treatment.
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Affiliation(s)
- Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center for Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Fiszon‐Cerqueira L, Ramos‐e‐Silva M, Guerreiro FB, Cistaro‐Serrano M, Carneiro AHC, Gomes MK. Giant basal cell carcinoma associated with vitiligo. Clin Case Rep 2019; 7:1782-1786. [PMID: 31534749 PMCID: PMC6745442 DOI: 10.1002/ccr3.2359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/11/2022] Open
Abstract
We report a woman with two giant Basal cell carcinomas (BCCs) on the back, the largest with 12 cm in diameter, inside a vitiligo plaque. They were metatypical subtype BCC associated with a nodular subtype area. Thinking of BCC in vitiligo lesion is extremely important. Giant BCC and vitiligo are rare association.
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Affiliation(s)
- Luiza Fiszon‐Cerqueira
- Sector of Dermatology and Post Graduation Course in Dermatology – University Hospital and School of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Marcia Ramos‐e‐Silva
- Sector of Dermatology and Post Graduation Course in Dermatology – University Hospital and School of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Flávio Bacelar Guerreiro
- Sector of Dermatology and Post Graduation Course in Dermatology – University Hospital and School of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Marcela Cistaro‐Serrano
- Sector of Dermatology and Post Graduation Course in Dermatology – University Hospital and School of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Ana Helena Correia Carneiro
- Department of Pathology – University Hospital and School of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Maria Kátia Gomes
- Sector of Dermatology and Post Graduation Course in Dermatology – University Hospital and School of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
- Department of Family Medicine – University Hospital and School of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
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Cancer Risks in Vitiligo Patients: A Nationwide Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091847. [PMID: 30150564 PMCID: PMC6164767 DOI: 10.3390/ijerph15091847] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/19/2018] [Accepted: 08/25/2018] [Indexed: 02/08/2023]
Abstract
Vitiligo is an autoimmune disease characterized by destruction of melanocytes and associated with other autoimmune disease. Whether the dysregulation of immune system enhances oncogenesis or not remains obscure. Until now, no nationwide population-based study has been conducted regarding this. As such, this paper aims to clarify cancer risk in vitiligo patients. A retrospective nationwide population-based cohort study between 2000 and 2010 was performed based on data from the National Health Insurance Research Database of Taiwan. Standardized incidence ratios (SIRs) of cancers were analyzed. Among the 12,391 vitiligo patients (5364 males and 7027 females) and 48,531.09 person-years of observation, a total of 345 cancers were identified. Significantly increased SIRs were observed for prostate cancer in male patients, thyroid cancer and breast cancer in female patients and bladder cancers in both male and female patients. Unfortunately, the low incidence rate of certain cancers limited the power of our statistical analyses. This study demonstrated the patterns of malignancies in vitiligo patients of Taiwan. Compared with the general population, male patients had higher risks of prostate cancer and female patients had higher risks of thyroid cancer and breast cancer. The risks of bladder cancer were also increased in both male and female patients.
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13
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Zhang XT, Ma XH, Jin WW, Chen SS, Xu HT. Concurrence of Multiple Cutaneous Malignancies on Sun-exposed Vitiligo Skin of a Patient: A Case Report and Review of the Literature. Indian J Dermatol 2018; 63:346-348. [PMID: 30078882 PMCID: PMC6052745 DOI: 10.4103/ijd.ijd_140_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There are very few published studies in the literature examining the association between vitiligo and skin cancers and only some anecdotal reports about phototherapy-associated nonmelanoma skin carcinoma (NMSC) in patients with vitiligo. Herein, we report a case of an 84-year-old male with widespread vitiligo with concurrent onset of two primary cutaneous malignancies in sun-exposed vitiligo skin. The association between vitiligo and NMSC deserves further assessment. Chronic sun damage might be a possible causative factor for the development of NMSC in the vitiligo patient.
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Affiliation(s)
- Xiao Ting Zhang
- The Second Affiliated Hospital And Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xin Hua Ma
- The Second Affiliated Hospital And Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Wan Wan Jin
- The Second Affiliated Hospital And Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Shi Sheng Chen
- The Second Affiliated Hospital And Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Hai Ting Xu
- The Second Affiliated Hospital And Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
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14
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McDonald PB, Zapata L, Rodrigues M. Sunscreen habits and skin cancer rates in patients with vitiligo in Australia. Australas J Dermatol 2018; 59:346-348. [PMID: 29485683 DOI: 10.1111/ajd.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Priska Bb McDonald
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Dermatology, St George's Hospital, London, UK
| | - Lucio Zapata
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michelle Rodrigues
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.,The Skin and Cancer Foundation Inc., Melbourne, Victoria, Australia
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Mohammad TF, Silpa-Archa N, Griffith JL, Lim HW, Hamzavi IH. Home phototherapy in vitiligo. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017. [DOI: 10.1111/phpp.12321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Narumol Silpa-Archa
- Department of Dermatology; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok Thailand
| | | | - Henry W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
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Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE. Current and emerging treatments for vitiligo. J Am Acad Dermatol 2017; 77:17-29. [DOI: 10.1016/j.jaad.2016.11.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 01/28/2023]
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Mohammad TF, Al-Jamal M, Hamzavi IH, Harris JE, Leone G, Cabrera R, Lim HW, Pandya AG, Esmat SM. The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo. J Am Acad Dermatol 2017; 76:879-888. [PMID: 28216034 DOI: 10.1016/j.jaad.2016.12.041] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/09/2016] [Accepted: 12/23/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Treatment of vitiligo with narrowband ultraviolet B light (NBUVB) is an important component of the current standard of care. However, there are no consistent guidelines regarding the dosing and administration of NBUVB in vitiligo, reflected by varied treatment practices around the world. OBJECTIVE To create phototherapy recommendations to facilitate clinical management and identify areas requiring future research. METHODS The Vitiligo Working Group (VWG) Phototherapy Committee addressed 19 questions regarding the administration of phototherapy over 3 conference calls. Members of the Photomedicine Society and a group of phototherapy experts were surveyed regarding their phototherapy practices. RESULTS Based on comparison and analysis of survey results, expert opinion, and discussion held during conference calls, expert recommendations for the administration of NBUVB phototherapy in vitiligo were created. LIMITATIONS There were several areas that required further research before final recommendations could be made. In addition, no standardized methodology was used during literature review and to assess the strength of evidence during the development of these recommendations. CONCLUSION This set of expert recommendations by the VWG is based on the prescribing practices of phototherapy experts from around the world to create a unified, broadly applicable set of recommendations on the use of NBUVB in vitiligo.
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Affiliation(s)
| | - Mohammed Al-Jamal
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - John E Harris
- Department of Dermatology, The University of Massachusetts Medical School, Worcester, Massachusetts
| | - Giovanni Leone
- Department of Dermatology, The San Gallicano Institute, Rome, Italy
| | - Raúl Cabrera
- Department of Dermatology, The Clinica Alemana de Santiago de Chile, Santiago, Chile
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samia M Esmat
- Department of Dermatology, Cairo University, Kasr Al Aini Hospital, Cairo, Egypt
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Igari S, Hiraiwa T, Kikuchi N, Hanami Y, Satoh M, Yamamoto T. Non-pigmented basal cell carcinoma occurring within a widespread vitiliginous lesion. J Dermatol 2016; 44:e99-e100. [PMID: 27882590 DOI: 10.1111/1346-8138.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shohei Igari
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Tomoko Hiraiwa
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Nobuyuki Kikuchi
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Yuka Hanami
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Masataka Satoh
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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Consensus for Nonmelanoma Skin Cancer Treatment, Part II: Squamous Cell Carcinoma, Including a Cost Analysis of Treatment Methods. Dermatol Surg 2016; 41:1214-40. [PMID: 26445288 DOI: 10.1097/dss.0000000000000478] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in the United States. Cutaneous squamous cell carcinoma has an estimated incidence of more than 700,000 new cases per year and a 5% risk of metastasis. OBJECTIVE To provide clinicians with guidelines for the management of cSCC based on evidence from a comprehensive literature review and consensus among the authors. MATERIALS AND METHODS The authors conducted an extensive review of the medical literature on treatment methods for cSCC, taking into consideration cure rates, recurrence and metastatic rates, aesthetic and functional outcomes, and cost effectiveness of the procedures. RESULTS Surgical treatments provide the best outcomes for cSCC. Mohs micrographic surgery is a cost-effective procedure that affords the highest cure rate, maximal tissue preservation, and superior cosmetic outcomes. Nonsurgical methods may be used as a primary treatment for low-risk squamous cell carcinomas, but the cure rates are lower. CONCLUSION The cure rate remains the most important consideration in choosing the treatment method, but additional factors, such as the patient's general medical condition, psychosocial circumstances, the location of the tumor and cost effectiveness of the therapy should be considered. Mohs micrographic surgery remains the preferred treatment for high-risk tumors and tumors located in cosmetically sensitive areas.
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Madigan LM, Al-Jamal M, Hamzavi I. Exploring the gaps in the evidence-based application of narrowband UVB for the treatment of vitiligo. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:66-80. [DOI: 10.1111/phpp.12228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Iltefat Hamzavi
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
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Paradisi A, Tabolli S, Didona B, Sobrino L, Russo N, Abeni D. Markedly reduced incidence of melanoma and nonmelanoma skin cancer in a nonconcurrent cohort of 10,040 patients with vitiligo. J Am Acad Dermatol 2014; 71:1110-6. [DOI: 10.1016/j.jaad.2014.07.050] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 01/25/2023]
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Tarlé RG, Nascimento LMD, Mira MT, Castro CCSD. Vitiligo--part 1. An Bras Dermatol 2014; 89:461-70. [PMID: 24937821 PMCID: PMC4056705 DOI: 10.1590/abd1806-4841.20142573] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/25/2013] [Indexed: 12/27/2022] Open
Abstract
Vitiligo is a chronic stigmatizing disease, already known for millennia, which
mainly affects melanocytes from epidermis basal layer, leading to the
development of hypochromic and achromic patches. Its estimated prevalence is
0.5% worldwide. The involvement of genetic factors controlling susceptibility to
vitiligo has been studied over the last decades, and results of previous studies
present vitiligo as a complex, multifactorial and polygenic disease. In this
context, a few genes, including DDR1, XBP1 and NLRP1 have been
consistently and functionally associated with the disease. Notwithstanding,
environmental factors that precipitate or maintain the disease are yet to be
described. The pathogenesis of vitiligo has not been totally clarified until now
and many theories have been proposed. Of these, the autoimmune hypothesis is now
the most cited and studied among experts. Dysfunction in metabolic pathways,
which could lead to production of toxic metabolites causing damage to
melanocytes, has also been investigated. Melanocytes adhesion deficit in
patients with vitiligo is mainly speculated by the appearance of Köebner
phenomenon, recently, new genes and proteins involved in this deficit have been
found.
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Sharquie KE, Noaimi AA, Al-Jobori AA. Skin tumors and skin infections in kidney transplant recipients vs. patients with pemphigus vulgaris. Int J Dermatol 2013; 53:288-93. [DOI: 10.1111/j.1365-4632.2012.05708.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Khalifa E. Sharquie
- Chairman of Scientific Council of Dermatology & Venereology; Iraqi Board for Medical Specializations; Baghdad Iraq
| | - Adil A. Noaimi
- Department of Dermatology & Venereology; College of Medicine; University of Baghdad; Baghdad Iraq
| | - Ali A. Al-Jobori
- Department of Dermatology & Venereology; Baghdad Teaching Hospital; Baghdad Iraq
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Teulings H, Overkamp M, Ceylan E, Nieuweboer-Krobotova L, Bos J, Nijsten T, Wolkerstorfer A, Luiten R, van der Veen J. Decreased risk of melanoma and nonmelanoma skin cancer in patients with vitiligo: a survey among 1307 patients and their partners. Br J Dermatol 2012; 168:162-71. [DOI: 10.1111/bjd.12111] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dhawan AK, Verma P, Singal A, Sharma S. Squamous cell carcinoma complicating vitiligo in an Indian man. J Cutan Aesthet Surg 2012; 5:36-7. [PMID: 22557854 PMCID: PMC3339127 DOI: 10.4103/0974-2077.94340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An elderly man, a known case of generalized vitiligo of long duration, presented to us with an ulcerated exophytic growth arising from the vitiliginous skin. The histopathological study confirmed the clinical suspicion of squamous cell carcinoma. Cutaneous neoplasia arising from the vitiliginous skin is a rare situation. Lack of melanin leaves the skin vulnerable to ultraviolet radiation damage, which may predispose to cutaneous neoplasia. Therefore, the importance of photoprotection has been stressed upon through this illustration.
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Affiliation(s)
- Amit Kumar Dhawan
- Department of Dermatology and STD, University College of Medical Sciences (University of Delhi) and Associated Guru Teg Bahadur Hospital, Dilshad Garden, Shahdara, New Delhi, India
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Jadotte YT, Schwartz RA. Solar cheilosis: An ominous precursor. J Am Acad Dermatol 2012; 66:173-84; quiz 185-6. [DOI: 10.1016/j.jaad.2011.09.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 08/30/2011] [Accepted: 09/03/2011] [Indexed: 12/31/2022]
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Park KK, Murase JE, Koo J. Long-term prognosis of vitiligo patients on narrowband UVB phototherapy. J Am Acad Dermatol 2012; 66:326-7. [DOI: 10.1016/j.jaad.2011.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/04/2011] [Indexed: 11/15/2022]
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Syed ZU, Hamzavi IH. Role of phototherapy in patients with skin of color. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2011; 30:184-9. [PMID: 22123415 DOI: 10.1016/j.sder.2011.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/16/2011] [Accepted: 08/16/2011] [Indexed: 11/30/2022]
Abstract
Phototherapy has proven to be one of the most versatile and effective treatment options for a variety of inflammatory and pigmentary skin diseases. However, the use of these treatment modalities in patients of color requires some special considerations. The modality chosen, the dosing of the treatment and duration of treatment are all issues to be considered for patients of color treated with ultraviolet phototherapy. In addition, there are some diseases which are more commonly seen in patients of color. These diseases may have better treatment outcomes using newer phototherapeutic options such as the long pulsed Nd:YAG laser or UVA1. As our population in the United States becomes more diverse it would behoove all dermatologists to acquaint themselves with the special circumstances of treating ethnic patients with phototherapy.
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Affiliation(s)
- Zain U Syed
- Department of Dermatology, Mulitcultural Dermatology Center, Henry Ford Hospital, Detroit, MI, USA
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Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: A comprehensive overview. J Am Acad Dermatol 2011; 65:473-491. [DOI: 10.1016/j.jaad.2010.11.061] [Citation(s) in RCA: 384] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/23/2010] [Accepted: 11/05/2010] [Indexed: 12/20/2022]
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Abstract
Vitiligo is a disorder that causes the destruction of melanocytes. It has three important factors underlying this destruction. The depigmented skin has many aberrant functions such as a muted response to contact allergens, a phenomenon also seen in mice that depigment. The white skin of those with vitiligo does not form non-melanoma skin cancers although the white skin of albinos, which has a similar color as vitiligo, is highly susceptible to skin cancer.
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Affiliation(s)
- James J Nordlund
- Department of Dermatology, Wright State Boonshoft School of Medicine, Dayton, Ohio, USA.
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Syed ZU, Hamzavi IH. Photomedicine and phototherapy considerations for patients with skin of color. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:10-6. [DOI: 10.1111/j.1600-0781.2010.00554.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reddy IS, Swarnalatha G, Swain M. Asymptomatic papules and plaque in a patient with generalized vitiligo. Indian J Dermatol 2011; 56:341-2. [PMID: 21772607 PMCID: PMC3132923 DOI: 10.4103/0019-5154.82506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Leung J, Dowling L, Obadan I, Davis J, Bonis PA, Kaplan MM, Casey D, Viveiros K. Risk of non-melanoma skin cancer in autoimmune hepatitis. Dig Dis Sci 2010; 55:3218-23. [PMID: 20165977 DOI: 10.1007/s10620-010-1145-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 01/26/2010] [Indexed: 12/09/2022]
Abstract
BACKGROUND Most patients with autoimmune hepatitis (AIH) require long-term immunosuppressive therapy (IS). While it is well established that solid organ transplant recipients have a high risk of developing non-melanoma skin cancer (NMSC) as a result of immunosuppression, little is known about the risk of NMSC associated with IS in patients with AIH. OBJECTIVES The aim of this study is to determine the incidence and risk factors for NMSC in patients on IS for AIH. METHODS We reviewed the medical records of all patients with AIH seen at a tertiary care medical center between 1998 and 2008. We compared the incidence of NMSC to an age- and sex-matched control population and analyzed risk factors for NMSC. RESULTS A total of forty-five patients with AIH were identified. Twenty NMSC lesions were found in eight patients. Compared to the age and sex-matched general population, the risk of SCC and BCC were increased as quantified by elevated standardized incidence ratios (28.5 and 5.0, respectively). Patients who developed NMSC were on average 24 years older (78.4 vs. 54.2 years old, p < 0.0001) and had AIH diagnosed at a more advanced age (66.0 vs. 45.4 years old, p = 0.0003). CONCLUSION The risk of NMSC is significantly increased in patients with AIH on immunosuppression. Independent risk factors include current age and age at diagnosis of AIH.
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Affiliation(s)
- John Leung
- Division of Gastroenterology, Tufts Medical Center, 800 Washington Street, Boston, MA, USA.
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Rustemeyer J, Günther L, Deichert L. A rare association: basal cell carcinoma in a vitiliginous macula. Oral Maxillofac Surg 2010; 15:175-7. [PMID: 20623309 PMCID: PMC3157603 DOI: 10.1007/s10006-010-0240-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 06/28/2010] [Indexed: 11/22/2022]
Abstract
Background Today, no proven significant association was detected between sun-exposed vitiliginous patches and non-melanotic skin cancers. In fact, the occurrence of a basal cell carcinoma (BCC) in vitiliginous patches seems to be extremely rare. Case report We present a case of a 33-year-old female patient suffering from BCC in a vitiliginous patch on the cheek. This is the first report of the occurrence of a sclerodermiform type of BCC in a vitiliginous macula. Conclusion Our case report challenges the long-standing belief that the occurrence of BCC in vitiligo is nearly impossible. However, even if this association is apparently fortuitous, our report contributes to the awareness of the risk of BCC in young patients with vitiligo.
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Affiliation(s)
- Jan Rustemeyer
- Department of Oral and Maxillofacial Surgery, Klinikum Bremen-Mitte, School of Medicine of the University of Göttingen, Bremen, Germany.
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Abstract
The ultraviolet (UV) light spectrum has long been known to induce biologic effect on the skin. For a large number of cutaneous disorders, phototherapy and photochemotherapy are effective therapeutic options with excellent safety profiles and well-documented side effects. Despite their ease of administration and benefits, phototherapeutic treatment modalities require appropriate space for the equipment, trained staff, and patient education prior to initiating treatment. However, when the initial barriers to treatment can be overcome, UV therapy can offer patients significant relief from their cutaneous disease. Furthermore, UVB-based phototherapy can produce significant alteration to vitamin D levels. With the recent research implicating association of low vitamin D levels with a variety of health conditions, whether patients receiving phototherapy or, more specifically, those getting vitamin D supplement may be protected from these diseases remains to be established.
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Affiliation(s)
- Robert J Sage
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan 48202, USA
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Nordlund JJ. Nonmelanoma skin cancer in vitiligo patients. J Am Acad Dermatol 2009; 61:1080-1. [DOI: 10.1016/j.jaad.2009.06.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 06/24/2009] [Accepted: 06/26/2009] [Indexed: 11/27/2022]
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