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Carr RA, Wiggins J, Slater DN. Follicular (Infundibular-Tricholemmal) Squamous Cell Carcinoma: A New WHO Entity. Clinicopathological Features in 103 Cases, Including Follow-Up and Implications for Patient Management. Am J Dermatopathol 2024; 46:416-432. [PMID: 38648027 DOI: 10.1097/dad.0000000000002713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
AIMS Cutaneous follicular (infundibular-tricholemmal) squamous cell carcinoma (FSCC) is a new World Health Organization entity. We present the largest series of published cases, summarizing clinical data, diagnostic criteria, differential diagnosis, and implications for patient management. METHODS Cases were identified from 2004 to 2011. Inclusion criteria included discrete attachment(s) of the tumor to the overlying epidermis via follicular infundibula, tricholemmal keratinization, and cellular pleomorphism. Keratoacanthoma and lesions with adjacent bowenoid epidermal dysplasia were excluded. RESULTS One hundred three cases of FSCC identified. 48.5% demonstrated completely circumscript borders ( in situ for practical purposes), 12.6% uncertain for invasion (overwhelmingly pushing borders), and only 38.8% as clearly invasive. Follicular mucin in acantholytic spaces within tumor epithelium was a distinctive finding in 57.2% of cases. Clinical data indicated predominance in elderly (median 78.5 years) men (70.4%), with preferential head and neck location (81.6%). Many were clinically suspected as squamous cell carcinoma (48.5%). However, a significant minority were clinically diagnosed as basal cell carcinoma (40.8%). This may reflect that FSCC commonly presented as a papule or nodule (51.3%). By contrast, keratoacanthoma was less frequently suggested (17.2%) and still fewer lesions were suspected to be actinic keratosis/Bowen's disease (13.6%). Follow-up in 82 cases (median 26.5 months, range 3-144) identified 5 (6.1%) local recurrences. There was no instance of metastasis in the subgroup of lesions with completely circumscript borders. Three of 45 (6.7%) patients, with follow-up, considered to have tumors with invasive pushing, and/or infiltrative borders developed lymph node metastases. CONCLUSIONS FSCC is identified as a common skin cancer, incorporating historical entities, such as infundibular carcinoma and tricholemmal carcinoma, with readily identifiable histologic features. Correct diagnosis has implications for patient management; a significant subgroup of lesions show completely circumscript borders that are considered in situ for practical purposes.
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Affiliation(s)
- Richard A Carr
- Department of Cellular Pathology, Warwick Hospital, Warwick, United Kingdom; and
| | - James Wiggins
- Department of Cellular Pathology, Warwick Hospital, Warwick, United Kingdom; and
| | - David N Slater
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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2
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Torre-Castro J, Ríos-Viñuela E, Balaguer-Franch I, Díaz de Lezcano I, Aguado-García Á, Nájera L, Suárez D, Requena L. Perineural Infiltration: A Comprehensive Review of Diagnostic, Prognostic, and Therapeutic Implications. Am J Dermatopathol 2024; 46:271-286. [PMID: 38457673 DOI: 10.1097/dad.0000000000002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Perineural infiltration refers to a neoplastic cell involvement in, around, and through the nerves. It is considered as one of the neoplastic dissemination pathways. Thus, its identification is crucial to establish the prognosis of some malignant skin neoplasms, such as squamous cell carcinoma, and explains the locally aggressive behavior of cutaneous neoplasms, such as microcystic adnexal carcinoma. We have conducted a review of malignant and benign skin tumors in which perineural infiltration has been described, and we also discuss some histopathological findings that may simulate perineural infiltration.
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Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Elisa Ríos-Viñuela
- Department of Dermatology, Instituto Valenciano de Oncología, Escuela de Doctorado Universidad Católica de Valencia, Valencia, Spain
| | | | | | | | - Laura Nájera
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Dolores Suárez
- Department of Pathology, Puerta de Hierro University Hospital, Universidad Autónoma, Majadahonda, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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López Sanz P, Fernández-Parrado M, Escario Travesedo E. [Translated article] Differentiating Keratoacanthoma From Squamous Cell Carcinoma: Are We Losing the Battle or Our Bearings? - Comment on "Intralesional Methotrexate for Keratoacanthomas: A Case Series". ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T328-T329. [PMID: 38224736 DOI: 10.1016/j.ad.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/08/2023] [Indexed: 01/17/2024] Open
Affiliation(s)
- P López Sanz
- Servicio de Dermatología, Hospital General Universitario de Albacete, Albacete, Spain.
| | - M Fernández-Parrado
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, Spain
| | - E Escario Travesedo
- Servicio de Dermatología, Hospital General Universitario de Albacete, Albacete, Spain
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4
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López Sanz P, Fernández-Parrado M, Escario Travesedo E. Differentiating Keratoacanthoma From Squamous Cell Carcinoma: Are We Losing the Battle or Our Bearings? - Comment on "Intralesional Methotrexate for Keratoacanthomas: A Case Series". ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:328-329. [PMID: 37716500 DOI: 10.1016/j.ad.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/08/2023] [Indexed: 09/18/2023] Open
Affiliation(s)
- P López Sanz
- Servicio de Dermatología, Hospital General Universitario de Albacete, Albacete, España.
| | - M Fernández-Parrado
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, España
| | - E Escario Travesedo
- Servicio de Dermatología, Hospital General Universitario de Albacete, Albacete, España
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5
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Hameed M, Creedon M, Kesavan P, Soliman SB. A 67-year-old woman with right thumb swelling and pain. Skeletal Radiol 2024; 53:407-408. [PMID: 37783857 DOI: 10.1007/s00256-023-04472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/25/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Mujtaba Hameed
- Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Mary Creedon
- Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Preethi Kesavan
- Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
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6
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Carr RA, Mesiano D, Heffron C, Radonic T, Wiggins J, Tso S, Agrawal R, Cheung E, Slater DN, Nichols L, Craig P. Aberrant p16, p53 and Ki-67 immunohistochemistry staining patterns can distinguish solitary keratoacanthoma from cutaneous squamous cell carcinoma. Pathology 2023; 55:772-784. [PMID: 37573161 DOI: 10.1016/j.pathol.2023.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 08/14/2023]
Abstract
Keratoacanthoma (KA) is widely considered a benign, usually self-resolving, neoplasm distinct from cutaneous squamous cell carcinoma (cSCC), while some consider KA to be indistinguishable from cSCC. Published studies indicate utility for p16, p53, Ki-67 immunostaining and elastic van Gieson (EVG) in the assessment of KA and cSCC. We compared clinical features and staining patterns for p16, p53, Ki-67 and EVG in fully excised KA, cSCC with KA-like features (cSCC-KAL) and other cSCC (cSCC-OTHER). Significant differences between KA, cSCC-KAL and cSCC-OTHER were found for head and neck location (20%, 86%, 84%), and duration <5 months (95%, 63%, 36%). KA shows both a mosaic pattern for p16 (>25-90% of neoplasm area) and peripheral graded pattern for p53 (up to 50% moderate and strong nuclear staining) in 92% compared with 0% of cSCC-KAL and 0% of cSCC-OTHER. In contrast, a highly aberrant pattern (usually null) for one or both p16 and p53, was present in 0% of KA, 83.8% of cSCC-KAL and 90.9% of cSCC-OTHER. Abnormal distribution of Ki-67 beyond the peripheral 1-3 cells was uncommon in KA (4.2%) and common in cSCC-KAL (67.6%) and cSCC-OTHER (88.4%). Moderate to striking entrapment of elastic and collagen fibres was present in the majority of KA (84%), cSCC-KAL (81%) and cSCC-OTHER (65%). KA are clinically distinct neoplasms typically of short duration occurring preferentially outside the head and neck and generally lacking aberrations of p16, p53 and Ki-67, compared with cSCC that have high rates of aberrant or highly aberrant p16, p53 and Ki-67, but EVG lacked specificity.
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Affiliation(s)
- Richard A Carr
- Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK.
| | - Domenico Mesiano
- Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Cynthia Heffron
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, Netherlands
| | - James Wiggins
- Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Simon Tso
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Rishi Agrawal
- Histopathology Department, New Cross Hospital, Wolverhampton, UK
| | - Elaine Cheung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong
| | | | - Linda Nichols
- Department of Statistics, University of Warwick, Coventry, UK
| | - Paul Craig
- Department of Histopathology, Cheltenham General Hospital, Gloucestershire, UK
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7
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Beyond Nicotinamide Metabolism: Potential Role of Nicotinamide N-Methyltransferase as a Biomarker in Skin Cancers. Cancers (Basel) 2021; 13:cancers13194943. [PMID: 34638427 PMCID: PMC8508019 DOI: 10.3390/cancers13194943] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 02/01/2023] Open
Abstract
Skin cancers (SC) collectively represent the most common type of malignancy in white populations. SC includes two main forms: malignant melanoma and non-melanoma skin cancer (NMSC). NMSC includes different subtypes, namely, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Merkel cell carcinoma (MCC), and keratoacanthoma (KA), together with the two pre-neoplastic conditions Bowen disease (BD) and actinic keratosis (AK). Both malignant melanoma and NMSC are showing an increasing incidence rate worldwide, thus representing an important challenge for health care systems, also because, with some exceptions, SC are generally characterized by an aggressive behavior and are often diagnosed late. Thus, identifying new biomarkers suitable for diagnosis, as well as for prognosis and targeted therapy is mandatory. Nicotinamide N-methyltransferase (NNMT) is an enzyme that is emerging as a crucial player in the progression of several malignancies, while its substrate, nicotinamide, is known to exert chemopreventive effects. Since there is increasing evidence regarding the involvement of this enzyme in the malignant behavior of SC, the current review aims to summarize the state of the art as concerns NNMT role in SC and to support future studies focused on exploring the diagnostic and prognostic potential of NNMT in skin malignancies and its suitability for targeted therapy.
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8
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Tisack A, Fotouhi A, Fidai C, Friedman BJ, Ozog D, Veenstra J. A clinical and biological review of keratoacanthoma. Br J Dermatol 2021; 185:487-498. [PMID: 33864244 DOI: 10.1111/bjd.20389] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 01/08/2023]
Abstract
Keratoacanthoma (KA) is a common skin tumour that remains controversial regarding classification, epidemiology, diagnosis, prognosis and management. Classically, a KA manifests as a rapidly growing, well-differentiated, squamoid lesion with a predilection for sun-exposed sites in elderly people and a tendency to spontaneously regress. Historically, KAs have been considered a variant of cutaneous squamous cell carcinoma (cSCC) and are often reported as KA-type cSCC. However, the penchant for regression has led many to categorize KAs as biologically benign tumours with distinct pathophysiological mechanisms from malignant cSCC. The clinical and histopathological similarities between KA and cSCC, particularly the well-differentiated variant of cSCC, have made definitive differentiation difficult or impossible in many cases. The ambiguity between entities has led to the general recommendation for surgical excision of KAs to ensure a potentially malignant cSCC is not left untreated. This current standard creates unnecessary surgical morbidity and financial strain for patients, especially the at-risk elderly population. There have been no reports of death from a definitive KA to date, while cSCC has an approximate mortality rate of 1·5%. Reliably distinguishing cSCC from KA would shift management strategies for KAs towards less-invasive treatment modalities, prevent unnecessary surgical morbidity, and likely reduce associated healthcare costs. Herein, we review the pathophysiology and clinical characteristics of KA, and conclude on the balance of current evidence that KA is a benign lesion and distinct from cSCC.
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Affiliation(s)
- A Tisack
- Wayne State University School of Medicine, Detroit, MI, USA
| | - A Fotouhi
- Wayne State University School of Medicine, Detroit, MI, USA
| | - C Fidai
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - B J Friedman
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - D Ozog
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - J Veenstra
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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9
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Vîlcea AM, Stoica LE, Georgescu CV, Popescu FC, Ciurea RN, Vîlcea ID, Mirea CS. Clinical, histopathological and immunohistochemical study of keratoacanthoma. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2021; 62:445-456. [PMID: 35024732 PMCID: PMC8848269 DOI: 10.47162/rjme.62.2.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Keratoacanthoma (KA) is an epithelial tumor of the skin, classically considered as having a malignant transformation risk of 15%; however, many authors and the new World Health Organization (WHO) Classification of skin tumors consider KA as an incipient variant of the cutaneous squamous cell carcinoma (SCC). The aims of the study were to assess the clinical, histopathological (HP) and immunohistochemical (IHC) aspects of the KA and the role of these factors in malignancy occurrence. The studied group comprises 194 patients diagnosed with KA or malignant KA, hospitalized in the Clinic of Dermatology, Emergency County Hospital, Craiova, Romania, between 2006 and 2019. There were 83 males and 111 females, aged 34 to 90 years, 57.21% of the patients being from the rural environment. The histopathology diagnosed 51 KAs and 143 malignant KAs (SCCs). Clinical diagnosis had a limited value in detecting the absence or presence of malignancy in the KA lesion, due to a low accuracy (36.08% and 29.89%, respectively) and specificity (23.07% and 27.02%, respectively); therefore, the HP exam of the surgical excision specimen has a paramount importance in establishing the diagnosis. IHC analysis revealed that the immunostainings for apoptosis-associated proteins and keratinocyte proliferative activity [p53, B-cell lymphoma-2 (Bcl-2), Ki-67 and proliferating cell nuclear antigen (PCNA)] provide some arguments to differentiate between KA and SCC in the studied cases. The correlation of clinical, HP and IHC data lead to an accurate diagnosis of KA; moreover, the clinical, HP and IHC data sustain the idea that KA is a particular form of well-differentiated SCC, which require an active therapeutic attitude.
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Affiliation(s)
- Alina Maria Vîlcea
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, Romania; e-mail:
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10
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Claeson M, Pandeya N, Dusingize JC, Thompson BS, Green AC, Neale RE, Olsen CM, Whiteman DC. Assessment of Incidence Rate and Risk Factors for Keratoacanthoma Among Residents of Queensland, Australia. JAMA Dermatol 2021; 156:1324-1332. [PMID: 33026421 DOI: 10.1001/jamadermatol.2020.4097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Keratoacanthoma (KA) is a common and generally benign keratinocyte skin tumor. Reports of the incidence rates of KA are scant. In addition, the risk factors for KA are not well understood, although associations with UV radiation exposure and older age have been described. Objective To investigate the incidence rate of KA and the risk factors for developing KA. Design, Setting, and Participants The study included data from 40 438 of 193 344 randomly selected residents of Queensland, Australia, who participated in the QSkin Sun and Health (QSkin) prospective population-based cohort study. All participants completed a baseline survey between 2010 and 2011 and were ages 40 to 69 years at baseline. Histopathologic reports of KA were prospectively collected until June 30, 2014, through data linkage with pathologic records. Cox proportional hazards models were used to identify risk factors associated with KA while controlling for potential confounding variables. Data were analyzed from January 2 to April 8, 2020. Exposures Demographic characteristics, phenotypes, UV radiation exposure, medical history, and lifestyle. Results Among 40 438 participants (mean [SD] age, 56 [8] years; 18 240 men [45.1%]), 596 individuals (mean [SD] age, 62 [6] years; 349 men [58.6%]) developed 776 KA tumors during a median follow-up period of 3.0 years (interquartile range, 2.8-3.3 years). The person-based age-standardized incidence rate for KA in the age-restricted cohort was 409 individuals per 100 000 person-years (based on the 2001 Australian population). Risk factors after adjustment for potential confounders were older age (age ≥60 years vs age <50 years; hazard ratio [HR], 6.38; 95% CI, 4.65-8.75), male sex (HR, 1.56; 95% CI, 1.33-1.84), fair skin (vs olive, dark, or black skin; HR, 3.42; 95% CI, 1.66-7.04), inability to tan (vs ability to tan deeply; HR, 1.69; 95% CI, 1.19-2.40), previous excisions of keratinocyte cancers (ever had an excision vs never had an excision; HR, 6.28; 95% CI, 5.03-7.83), current smoking (vs never smoking, HR, 2.02; 95% CI, 1.59-2.57), and high alcohol use (≥14 alcoholic drinks per week vs no alcoholic drinks per week; HR, 1.42; 95% CI, 1.09-1.86). Conclusions and Relevance This is, to date, the first large prospective population-based study to report the incidence rate and risk factors for KA. The high person-based incidence rate (409 individuals per 100 000 person-years) highlights the substantial burden of KA in Queensland, Australia. Furthermore, the study's findings suggest that older age (≥60 years), male sex, UV radiation-sensitive phenotypes, indications of high sun exposure (eg, previous keratinocyte cancer excisions), smoking, and high alcohol use are independent risk factors for the development of KA.
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Affiliation(s)
- Magdalena Claeson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Dermatology Research Centre, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nirmala Pandeya
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jean-Claude Dusingize
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Bridie S Thompson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Adele C Green
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Cancer Research UK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rachel E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Catherine M Olsen
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Nagarajan P. Differentiating keratoacanthoma from squamous cell carcinoma-In quest of the holy grail. J Cutan Pathol 2020; 47:418-420. [PMID: 31893469 DOI: 10.1111/cup.13640] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 12/15/2022]
Abstract
To distinguish keratoacanthomas from squamous cell carcinomas remains a diagnostic challenge in dermatopathology. Several immunohistochemical and cytogenetic markers have been evaluated; however, so far there has been no unequivocal evidence supporting practical application of any of these markers. Recent studies have evaluated the composition of tumor-associated immune infiltrate, in particular the number and distribution of CD123-positive plasmacytoid dendritic cells in making this distinction; but these cells also do not appear to be a consistent biomarker in distinguishing keratoacanthoma from squamous cell carcinoma.
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Pica Alfieri E, Sisti A, Nisi G, Brandi C, Grimaldi L, D'Aniello C. A giant keratoacanthoma of the cheek. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:580-582. [PMID: 31910189 PMCID: PMC7233768 DOI: 10.23750/abm.v90i4.7409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/21/2018] [Indexed: 11/23/2022]
Abstract
Keratoacanthoma (KA) is a cutaneous tumor arising on sun-exposed skin and characterized by self-limiting growth and involution. We reported a case of a 92-year-old man presented a 4.5x3.5 cm nodular lesion with a central keratin-filled crater on his left cheek. We performed surgical excision and histopathological examination revealed a keratoacanthoma with perineural invasion. A close follow-up was carried out. (www.actabiomedica.it).
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Affiliation(s)
- Edoardo Pica Alfieri
- Division of Plastic and Reconstructive Surgery; Department of Medicine, Surgery and Neuroscience; University Hospital "Santa Maria alle Scotte", Siena, Italy; University of Siena.
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13
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Sartini D, Pompei V, Lucarini G, Rubini C, Molinelli E, Brisigotti V, Salvolini E, Campanati A, Offidani A, Emanuelli M. Differential expression of nicotinamide N-methyltransferase in cutaneous keratoacanthoma and squamous cell carcinoma: an immunohistochemical study. J Eur Acad Dermatol Venereol 2019; 34:e121-e123. [PMID: 31705831 DOI: 10.1111/jdv.16048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- D Sartini
- Department of Clinical Sciences, Marche Polytechnic University, Ancona, Italy
| | - V Pompei
- Department of Clinical Sciences, Marche Polytechnic University, Ancona, Italy
| | - G Lucarini
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - C Rubini
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - E Molinelli
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - V Brisigotti
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - E Salvolini
- Department of Clinical Sciences, Marche Polytechnic University, Ancona, Italy
| | - A Campanati
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - A Offidani
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - M Emanuelli
- Department of Clinical Sciences, Marche Polytechnic University, Ancona, Italy.,New York-Marche Structural Biology Center (NY-MaSBiC), Marche Polytechnic University, Ancona, Italy
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14
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Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report. J Contemp Brachytherapy 2019; 11:449-457. [PMID: 31749854 PMCID: PMC6854861 DOI: 10.5114/jcb.2019.88138] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/25/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose Alpha particle treatments could enhance the probability of an immune response, which can lead to abscopal effects (AE). We report a case of a patient affected by multiple cutaneous squamous cell carcinoma (cSCC). After the treatment with diffusing alpha emitters radiation therapy (DaRT) of one lesion, an AE was observed on at least two distant ones. Material and methods We investigated a case of a 65-year-old female patient with multiple synchronous lesions of the skin of lower limbs confirmed by a biopsy. Patient was enrolled in a clinical trial N.CTP-SCC-00 (NCT03015883), with the objective to assess effectiveness of DaRT technique. DaRT is based on the insertion of locally 224Ra-loaded seeds in a clinical target volume (CTV). Treatment plan with positron emission tomography/computed tomography (PET/CT) was used to entirely cover the CTV. Follow-up and biopsy evaluations were employed to outline the patient outcome. Results We performed seeds implantation according to the Paris system. At 28th day, an evident lesion shrinkage with a persistent minimal area of hyperkeratosis was noted. 76 days after implantation, a complete remission of the treated lesion was observed and an evident reduction of the area with two more distant lesion, which could be associated to an immune-mediated response. One year after the treatment, a complete remission of treated lesion was observed as well as spontaneous regression of untreated distant ones. Conclusions In this study, we reported evidences of an AE in cSCC stimulated by radiation and possibly mediated by immune system. In the next DaRT treatments, our intent is to monitor T-lymphocytes variations in peripheral blood in order to demonstrate indirect activation of the immune system mediated by radiation also in patients with solitary lesions, in which, by definition, an AE cannot be observed.
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Sivridis E, Koukourakis IM, Arelaki S, Balaska K, Karpouzis A, Giatromanolaki A. Patterns of LC3A Autophagy Protein Expression in Keratoacanthomas. Head Neck Pathol 2019; 14:150-155. [PMID: 30977096 PMCID: PMC7021871 DOI: 10.1007/s12105-019-01033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Abstract
To investigate the expression patterns of autophagy marker light chain protein 3 (LC3A) in keratoacanthoma (KA). KAs are generally regarded as benign but malignant behavior, including rare metastases, may occur. 85 KAs were assessed for the LC3A autophagic protein by immunohistochemistry. Diffuse cytoplasmic staining and a "stone-like structure" (SLS) characterized positive expression. Thirty-four out of 85 KAs (40%) had diffuse cytoplasmic LC3A immunostaining (percentage of positive cells ranging from 5 to 60%). In contrast, only 4 of the 85 KAs (4.7%) expressed SLSs. Only one SLS was detected per histologic section of each tumor. The p53 oncoprotein was encountered in all cases with expression ranging from 1 to 90% of cells (median 30%). The Ki-67 index was expressed in 63 cases (74% of cases; range 1-50% of cells; median value 5%). Neither of these two parameters nor diffuse cytoplasmic LC3A staining was significantly correlated with SLS expression or lack thereof. Expression of SLSs, a hallmark of malignancy, was found in 4.7% of KAs. Further study is necessary to determine whether this fraction represents the exceptional cases that harbor latent malignant potential.
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Affiliation(s)
- Efthimios Sivridis
- Departments of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Ioannis M. Koukourakis
- Departments of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Stella Arelaki
- Departments of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Kostantina Balaska
- Departments of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Antonios Karpouzis
- Departments of Dermatology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Departments of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
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Mascitti H, De Masson A, Brunet-Possenti F, Bouaziz JD, Laly P, Mourad N, Garrigues JM, Laurent-Roussel S, Cavelier-Balloy B, Moulonguet I, Leschi C, Mourah S, Bagot M, Lebbé C, Basset-Seguin N. Successful Treatment of Generalized Eruptive Keratoacanthoma of Grzybowski with Acitretin. Dermatol Ther (Heidelb) 2019; 9:383-388. [PMID: 30790235 PMCID: PMC6522604 DOI: 10.1007/s13555-019-0287-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Keratoacanthomas (KA) are common cutaneous skin tumors originating from the hair follicles. Unlike squamous cell carcinoma, KA can regress spontaneously and have a benign evolution. Solitary KA is the most common form but familial multiple KA (Ferguson–Smith type), genetically predisposed KA (such as in xeroderma pigmentosum, or Muir–Torre syndrome), or sporadic multiple eruptive KA (Grzybowski type) have been described. Generalized eruptive KA of Grzybowski (GEKA) is a rare condition (around 40 reported cases). The pathophysiology is still unclear. Human papillomavirus (HPV) has been detected in sporadic KA but the presence of HPV39 has never been reported, to our knowledge, in GEKA. Case Report GEKA in an 80-year-old woman was successfully treated with acitretin (0.5 mg/kg/day) combined with surgical removal of the largest lesions. Treatment was well tolerated and led to decreased pruritus and tumor regression within 6 months. The presence of HPV39 was detected in a lesion by polymerase chain reaction and Sanger sequencing. No genetic alteration was found, in particular in the genes usually altered in squamous cell carcinoma (including NOTCH1, NOTCH2, CDKN2A, TP53). Conclusion We report a case of GEKA associated with the presence of HPV39 and the successful use of acitretin combined with surgical removal of the larger lesions.
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Affiliation(s)
- Hélène Mascitti
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Adèle De Masson
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Florence Brunet-Possenti
- INSERM UMR-1137, IAME, Department of Virology, Bichat Hospital, University of Paris 7 Paris Diderot, Paris, France
| | - Jean-David Bouaziz
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Pauline Laly
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Nadim Mourad
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | | | - Sara Laurent-Roussel
- Department of Pathology, Saint-Louis Hospital, AP-HP, University of Paris 7 Paris Diderot, Paris, France
| | - Bénédicte Cavelier-Balloy
- Department of Pathology, Saint-Louis Hospital, AP-HP, University of Paris 7 Paris Diderot, Paris, France
| | - Isabelle Moulonguet
- Department of Pathology, Saint-Louis Hospital, AP-HP, University of Paris 7 Paris Diderot, Paris, France
| | - Cristina Leschi
- AP-HP, Saint-Louis Hospital, Department of Pharmacogenomics, INSERM UMR-S 976, University of Paris 7 Paris Diderot, Paris, France
| | - Samia Mourah
- AP-HP, Saint-Louis Hospital, Department of Pharmacogenomics, INSERM UMR-S 976, University of Paris 7 Paris Diderot, Paris, France
| | - Martine Bagot
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Céleste Lebbé
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France
| | - Nicole Basset-Seguin
- Department of Dermatology, Saint-Louis Hospital, AP-HP, INSERM U976, University of Paris 7 Paris Diderot, Paris, France.
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Takai T. Advances in histopathological diagnosis of keratoacanthoma. J Dermatol 2017; 44:304-314. [DOI: 10.1111/1346-8138.13696] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 10/11/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Toshihiro Takai
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
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Feldmeyer L, Szeverényi I, Mandallaz M, Lane EB, Hohl D. Late-Onset Multiple Self-Healing Squamous Epithelioma Ferguson-Smith Recurrence Induced by Radiotherapy. Case Rep Dermatol 2017; 8:344-349. [PMID: 28101021 PMCID: PMC5216202 DOI: 10.1159/000447481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/07/2016] [Indexed: 12/27/2022] Open
Abstract
We report the case of a woman in her 60s with confirmed multiple self-healing squamous epitheliomas (MSSE) Ferguson-Smith. After recurrences following surgery and radiotherapy, the patient was successfully treated with minimal surgical intervention combined with intralesional injections of triamcinolone acetate. The histological comparison between mature and regressed keratoacanthomas (KA) revealed an increased inflammatory infiltrate with numerous plasmacytoid dendritic cells in the regressed KA in comparison to the mature one, speaking in favor of an inflammation-mediated regression process. Corticosteroids injection in MSSE may have paradoxical effects with action on the proliferation phase rather than the inflammatory regression phase of the KA. Our case confirms previous reports showing that radiotherapy may exacerbate MSSE and should be avoided. Intralesional triamcinolone acetate injection is a safe and easy to use method also effective for multiple lesions. Our case underlines the difference between squamous cell carcinoma and KA, responding differently to therapies like imiquimod or radiotherapy.
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Affiliation(s)
- Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - E Birgit Lane
- Institute of Medical Biology, ASTAR, Singapore, Singapore
| | - Daniel Hohl
- Department of Dermatology and Venereology, Hôpital de Beaumont, Lausanne University Hospital Centre, Lausanne, Switzerland
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van de Glind G, Rebel H, van Kempen M, Tensen K, de Gruijl F. Fractionation of a tumor-initiating UV dose introduces DNA damage-retaining cells in hairless mouse skin and renders subsequent TPA-promoted tumors non-regressing. Oncotarget 2016; 7:8067-77. [PMID: 26797757 PMCID: PMC4884976 DOI: 10.18632/oncotarget.6932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/07/2016] [Indexed: 12/26/2022] Open
Abstract
Sunburns and especially sub-sunburn chronic UV exposure are associated with increased risk of squamous cell carcinomas (SCCs). Here we focus on a possible difference in tumor initiation from a single severe-sunburn dose (on day 1, 21 hairless mice) and from an equal dose fractionated into very low sub-sunburn doses not causing any (growth-promoting) epidermal hyperplasia (40 days daily exposure, n=20). From day 47 all mice received 12-O-Tetradecanoylphorbol-13-acetate (TPA) applications (2x/wk) for 20 weeks to promote tumor development within the lifetime of the animals. After the sub-sunburn regimen sparse DNA damage-retaining basal cells (quiescent stem cells, QSCs) remained in the non-hyperplastic epidermis. These cells were forced to divide by TPA. After discontinuation of TPA tumors regressed and disappeared in the ‘sunburn group’ but persisted and grew in the ‘sub-sunburn group’ (0.06 vs 2.50 SCCs and precursors ≥4mm/mouse after 280 days, p=0.03). As the tumors carried no mutations in p53, H/K/N-Ras and Notch1/2, these ‘usual suspects' were not involved in the UV-driven tumor initiation. Although we could not selectively eliminate QSCs (unknown phenotype) to establish causality, our data suggest that forcing specifically DNA damage-retaining QSCs to divide – with high mutagenic risk - gives rise to persisting (mainly ‘in situ’) skin carcinomas.
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Affiliation(s)
| | - Heggert Rebel
- Department of Dermatology, LUMC, Leiden, 2333RC, The Netherlands
| | | | - Kees Tensen
- Department of Dermatology, LUMC, Leiden, 2333RC, The Netherlands
| | - Frank de Gruijl
- Department of Dermatology, LUMC, Leiden, 2333RC, The Netherlands
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20
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Ogita A, Ansai SI, Misago N, Anan T, Fukumoto T, Saeki H. Histopathological diagnosis of epithelial crateriform tumors: Keratoacanthoma and other epithelial crateriform tumors. J Dermatol 2016; 43:1321-1331. [DOI: 10.1111/1346-8138.13390] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Azusa Ogita
- Division of Dermatology; Nippon Medical School Musashi Kosugi Hospital; Kawasaki Japan
| | - Shin-ichi Ansai
- Division of Dermatology; Nippon Medical School Musashi Kosugi Hospital; Kawasaki Japan
| | | | - Takashi Anan
- Sapporo Dermatopathology Institute; Sapporo Japan
| | | | - Hidehisa Saeki
- Department of Dermatology; Nippon Medical School; Tokyo Japan
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21
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Cutaneous Side Effects of BRAF Inhibitors in Advanced Melanoma: Review of the Literature. Dermatol Res Pract 2016; 2016:5361569. [PMID: 27042173 PMCID: PMC4794559 DOI: 10.1155/2016/5361569] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/07/2016] [Accepted: 02/15/2016] [Indexed: 01/08/2023] Open
Abstract
The incidence of melanoma has recently been increasing. BRAF mutations have been found in 40–60% of melanomas. The increased activity of BRAF V600E leads to the activation of downstream signaling through the mitogen-activated protein kinase (MAPK) pathway, which plays a key role as a regulator of cell growth, differentiation, and survival. The use of BRAF inhibitors in metastatic melanoma with BRAF mutation ensures clinical improvement of the disease. Vemurafenib and dabrafenib are two selective BRAF inhibitors approved by the Food and Drug Administration (FDA). Both drugs are well tolerated and successfully used in clinical practice. However, some adverse reactions have been reported in patients in the course of treatment. Cutaneous side effects are the most common adverse events among them with a broad spectrum. Both the case reports and several original clinical trials reported cutaneous reactions during the treatment with BRAF inhibitors. In this review, the common cutaneous side effects of BRAF inhibitors in the treatment of metastatic melanoma with BRAF V600E mutation were reviewed.
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22
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Bedir R, Güçer H, Şehitoğlu İ, Yurdakul C, Bağcı P, Üstüner P. The Role of p16, p21, p27, p53 and Ki-67 Expression in the Differential Diagnosis of Cutaneous Squamous Cell Carcinomas and Keratoacanthomas: An Immunohistochemical Study. Balkan Med J 2016; 33:121-7. [PMID: 27403379 DOI: 10.5152/balkanmedj.2016.16442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/01/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Distinguishing squamous cell carcinoma (SCC) from keratoacanthoma (KA) by histopathological features may not be sufficient for a differential diagnosis, as KAs may, in some cases, imitate well-differentiated SCCs. AIMS In this study, we investigated whether the expression of the p16, p21, p27, p53 genes and a Ki-67 proliferation index are useful in distinguishing between these two tumors. STUDY DESIGN Cross-sectional study. METHODS Immunohistochemistry was used to investigate the expression of the p16, p21, p27, p53 genes and the Ki-67 proliferation index was investigated in well-differentiated SCC with KA-like features (n=40) and KA (n=30). RESULTS The results of all of the examined markers, except for p27 (p16, p21, p53, and Ki-67) were found to be significantly different between the SCC and KA samples (p<0.05). CONCLUSION In well-differentiated SCC with KA-like features and KA cases where the differential diagnosis is difficult from a histopathological perspective, the use of p16, p21, p53 expression and a Ki-67 proliferation index can be useful for the differential diagnosis of SCCs and KAs.
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Affiliation(s)
- Recep Bedir
- Department of Pathology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Hasan Güçer
- Department of Pathology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - İbrahim Şehitoğlu
- Department of Pathology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Cüneyt Yurdakul
- Department of Pathology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Pelin Bağcı
- Department of Pathology, Marmara University School of Medicine, İstanbul, Turkey
| | - Pelin Üstüner
- Clinic of Dermatology, Rize State Hospital, Rize, Turkey
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23
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Kwiek B, Schwartz RA. Keratoacanthoma (KA): An update and review. J Am Acad Dermatol 2016; 74:1220-33. [PMID: 26853179 DOI: 10.1016/j.jaad.2015.11.033] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 11/03/2015] [Accepted: 11/12/2015] [Indexed: 02/03/2023]
Abstract
Keratoacanthoma (KA) is a common but underreported tumor of the skin. Two striking features of KA are its clinical behavior with spontaneous regression after rapid growth and its nosological position on the border between benignity and malignancy. We review current knowledge on the clinical, histopathological, and dermoscopic features of KA to ensure a proper diagnosis and describe its variants, including different types of multiple KAs. We highlight current concepts of KA ethiopathogenesis with special emphasis on the genetic background of multiple familial KA, the role of Wnt signaling pathway, and induction of KA by BRAF inhibitors and procedures of esthetic dermatology. Finally, treatment strategies are presented with surgical excision as a first option, followed by other modalities, including intralesional chemotherapy, topical and systemic agents, lasers, cryotherapy, and photodynamic therapy.
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Affiliation(s)
- Bartlomiej Kwiek
- Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland.
| | - Robert A Schwartz
- Dermatology and Pathology, Rutgers University New Jersey Medical School, and Rutgers University School of Public Affairs and Administration, Newark, New Jersey
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24
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Gleich T, Chiticariu E, Huber M, Hohl D. Keratoacanthoma: a distinct entity? Exp Dermatol 2015; 25:85-91. [DOI: 10.1111/exd.12880] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Tobias Gleich
- Service of Dermatology; University Hospital Center and University of Lausanne; Lausanne Switzerland
| | - Elena Chiticariu
- Service of Dermatology; University Hospital Center and University of Lausanne; Lausanne Switzerland
| | - Marcel Huber
- Service of Dermatology; University Hospital Center and University of Lausanne; Lausanne Switzerland
| | - Daniel Hohl
- Service of Dermatology; University Hospital Center and University of Lausanne; Lausanne Switzerland
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25
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Ra SH, Su A, Li X, Zhou J, Cochran AJ, Kulkarni RP, Binder SW. Keratoacanthoma and squamous cell carcinoma are distinct from a molecular perspective. Mod Pathol 2015; 28:799-806. [PMID: 25676557 DOI: 10.1038/modpathol.2015.5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/06/2014] [Accepted: 12/09/2014] [Indexed: 12/23/2022]
Abstract
Keratoacanthoma is a controversial entity. Some consider keratoacanthoma as a variant of squamous cell carcinoma, whereas others see it as a distinct self-resolving squamoproliferative lesion. Our objective is to examine the relationship of keratoacanthoma with squamous cell carcinoma and normal skin by using DNA microarrays. DNA microarray studies were performed on formalin-fixed and paraffin-embedded blocks from ten cases of actinic keratoacanthoma utilizing the U133plus2.0 array. These results were compared with our previously developed microarray database of ten squamous cell carcinoma and ten normal skin samples. Keratoacanthoma demonstrated 1449 differentially expressed genes in comparison with squamous cell carcinoma (>5-fold change: P<0.01) with 908 genes upregulated and 541 genes downregulated. Keratoacanthoma showed 2435 differentially expressed genes in comparison with normal skin (>5-fold change: P<0.01) with 1085 genes upregulated and 1350 genes downregulated. The most upregulated genes, comparing keratoacanthoma with normal skin included MALAT1, S100A8, CDR1, TPM4, and CALM1. The most downregulated genes included SCGB2A2, DCD, THRSP, ADIPOQ, adiponectin, and ADH1B. The molecular biological pathway analysis comparing keratoacanthoma with normal skin showed that cellular development, cellular growth and proliferation, cell death/apoptosis, and cell cycle pathways are prominently involved in the pathogenesis of keratoacanthoma. The most enriched canonical pathways were clathrin-mediated endocytosis signaling, molecular mechanisms of cancer and integrin signaling. The distinctive gene expression profile of keratoacanthoma reveals that it is molecularly distinct from squamous cell carcinoma. The molecular pathways and genes differentially expressed in comparing keratoacanthoma with normal skin suggest that keratoacanthoma is a neoplasm that can regress due to upregulation of the cell death/apoptosis pathway.
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Affiliation(s)
- Seong H Ra
- 1] San Diego Pathology Medical Group, San Diego, CA, USA [2] Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Albert Su
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Xinmin Li
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jaime Zhou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alistair J Cochran
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Rajan P Kulkarni
- Department of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Scott W Binder
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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26
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Misago N, Inoue T, Nagase K, Tsuruta N, Tara-Hashimoto A, Kimura H, Takahara K, Narita T, Narisawa Y. Crater/ulcerated form of infundibular squamous cell carcinoma: A possible distinct entity as a malignant (or high-grade) counterpart to keratoacanthoma. J Dermatol 2015; 42:667-73. [PMID: 25854192 DOI: 10.1111/1346-8138.12871] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 02/20/2015] [Indexed: 11/30/2022]
Abstract
Follicular squamous cell carcinoma (SCC) with infundibular differentiation includes the common and crater forms of infundibular SCC. We previously considered the crater/ulcerated infundibular SCC to be a progressive condition of the common form and histopathologically studied an additional five cases of the crater/ulcerated infundibular SCC, the results of which suggested the following characteristic histopathological features and possible developmental process in this type of SCC: (i) a considerable number of continuous hyperplastic follicular infundibula, which may develop at the beginning of the disease; (ii) hyperplastic infundibula exhibiting an abrupt or gradual transition to the SCC component, which frequently change relative to the neoplastic infundibular canal; and (iii) the presence of multiple sites of branching of the neoplastic infundibular canals and/or complete involvement of large cysts in the neoplastic process over the center of the lesion, resulting in ulceration. Based on these histopathological findings, we considered that crater/ulcerated infundibular SCC involve a considerable number of continuous follicular infundibula from the start, although some cases may develop from the common form. We also emphasize the possible aggressive biological behavior of the crater/ulcerated form. Keratoacanthoma (KA) is a unique, benign or borderline malignant neoplasm exhibiting follicular (infundibular/isthmic) differentiation characterized by the involvement of continuous follicular infundibula in multiples. From this standpoint, we consider that crater/ulcerated infundibular SCC is possibly related to KA in terms of histogenesis and is a malignant (or high-grade) counterpart of KA.
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Affiliation(s)
- Noriyuki Misago
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takuya Inoue
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kotaro Nagase
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Noriko Tsuruta
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Akiko Tara-Hashimoto
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiromi Kimura
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kanako Takahara
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomomi Narita
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yutaka Narisawa
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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27
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Takai T, Misago N, Murata Y. Natural course of keratoacanthoma and related lesions after partial biopsy: Clinical analysis of 66 lesions. J Dermatol 2015; 42:353-62. [DOI: 10.1111/1346-8138.12784] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Toshihiro Takai
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
| | - Noriyuki Misago
- Division of Dermatology; Department of Internal Medicine; Saga University; Saga Japan
| | - Yozo Murata
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
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28
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Aktinische Keratose, Morbus Bowen, Keratoakanthom und Plattenepithelkarzinom der Haut. DER PATHOLOGE 2015; 36:16-29. [DOI: 10.1007/s00292-014-2063-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Carr RA, Taibjee SM, Turnbull N, Attili S. Follicular squamous cell carcinoma is an under-recognised common skin tumour. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mpdhp.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Abstract
Recently we described skin tumors driven by skin-specific expression of Zmiz1 and here we define keratoacanthoma pathobiology in this mouse model. Similar to human keratoacanthoma development, we were able to segregate murine keratoacanthomas into three developmental phases: growth, maturation, and regression. These tumors had areas with cellular atypia, high mitotic rate, and minor local invasion in the growth phase, but with development they transitioned to maturation and regression phases with evidence of resolution. The early aggressive appearance could easily be misdiagnosed as a malignant change if the natural pathobiology was not well-defined in the model. To corroborate these findings in the Zmiz1 model, we examined squamous skin tumors from another tumor study in aging mice, and these tumors followed a similar biological progression. Lastly, we were able to evaluate the utility of the model to assess immune cell infiltration (F4/80, B220 Granzyme B, CD3 cells, arginase-1) in the regression phase; however, because inflammation was present at all phases of development, a more comprehensive approach will be needed in future investigations. Our study of keratoacanthomas in selected murine models suggests that these squamous tumors can appear histologically aggressive during early development, but with time will enter a regression phase indicating a benign biology. Importantly, studies of squamous skin tumor models should be cautious in tumor diagnosis as the early growth distinction between malignant versus benign based solely on histopathology may not be easily discerned without longitudinal studies to confirm the tumor pathobiology.
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Carr RA, Houghton JP. Histopathologists’ approach to keratoacanthoma: a multisite survey of regional variation in Great Britain and Ireland. J Clin Pathol 2014; 67:637-8. [DOI: 10.1136/jclinpath-2014-202255] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Misago N, Takai T, Murata Y, Nagase K, Narisawa Y. Cases with a spontaneous regression of an infiltrating non-crateriform keratoacanthoma and squamous cell carcinoma with a keratoacanthoma-like component. J Dermatol 2014; 41:430-4. [DOI: 10.1111/1346-8138.12454] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Noriyuki Misago
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Toshihiro Takai
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
| | - Yozo Murata
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
| | - Kotaro Nagase
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | - Yutaka Narisawa
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
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Abstract
An 83-year-old man presented with a 1-month history of a rapidly enlarging conjunctival mass. On examination, slit lamp biomicroscopy revealed a leukoplakic tumour at the temporal limbus. The lesion was excised with cryotherapy application to the limbus and conjunctival margins. Histopathology revealed a keratoacanthoma (KA). KA typically occurs on sun-exposed areas of the skin. Conjunctival KA is very rare, and differentiation between conventional squamous cell carcinoma (SCCA) and KA can be challenging. The present case highlights the indication for excisional surgery in patients with conjunctival KA using the no touch technique, cryotherapy, amniotic membrane and the histopathological differentiation between KA and SCCA.
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Affiliation(s)
- Patrick Oellers
- Bascom Palmer Eye Institute, University of Miami, , Miami, Florida, USA
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Shah K, Kazlouskaya V, Lal K, Molina D, Elston DM. Perforating elastic fibers (‘elastic fiber trapping’) in the differentiation of keratoacanthoma, conventional squamous cell carcinoma and pseudocarcinomatous epithelial hyperplasia. J Cutan Pathol 2013; 41:108-12. [DOI: 10.1111/cup.12247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/25/2013] [Accepted: 08/24/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Kabeer Shah
- Rocky Vista University College of Osteopathic Medicine; Parker CO USA
| | | | - Karan Lal
- New York College of Osteopathic Medicine; New York NY USA
| | - David Molina
- Department of Pathology; Memorial Sloan Kettering Cancer Center; New York NY USA
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Mandalà M, Massi D, De Giorgi V. Cutaneous toxicities of BRAF inhibitors: Clinical and pathological challenges and call to action. Crit Rev Oncol Hematol 2013; 88:318-37. [DOI: 10.1016/j.critrevonc.2013.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 05/28/2013] [Accepted: 06/04/2013] [Indexed: 01/07/2023] Open
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36
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A cutaneous horn – benign or malignant? J Craniomaxillofac Surg 2013; 41:144-6. [DOI: 10.1016/j.jcms.2012.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 06/05/2012] [Accepted: 06/06/2012] [Indexed: 11/17/2022] Open
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Ectopic expression of Zmiz1 induces cutaneous squamous cell malignancies in a mouse model of cancer. J Invest Dermatol 2013; 133:1863-9. [PMID: 23426136 PMCID: PMC3672356 DOI: 10.1038/jid.2013.77] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Cutaneous squamous cell carcinoma (SCC) is the second most common form of cancer in the human population, yet the underlying genetic mechanisms contributing to the disease are not well understood. We recently identified Zmiz1 as a candidate oncogene in non-melanoma skin cancer through a transposon mutagenesis screen. Here we show that transposon-induced mutations in Zmiz1 drive expression of a truncated transcript that is similar to an alternative endogenous ZMIZ1 transcript found to be overexpressed in human SCCs relative to normal skin. We also describe an original mouse model of invasive keratoacanthoma driven by skin-specific expression of the truncated Zmiz1 transcript. Unlike most mouse models, Zmiz1-induced skin tumors develop rapidly and in the absence of promoting agents such as phorbol esters. Additionally, we found that the alternative Zmiz1 isoform has greater protein stability than its full-length counterpart. Finally, we provide evidence that ZMIZ1 is overexpressed in a significant percentage of human breast, ovarian, and colon cancers in addition to human SCCs, suggesting ZMIZ1 may play a broader role in epithelial cancers.
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Misago N, Inoue T, Koba S, Narisawa Y. Keratoacanthoma and other types of squamous cell carcinoma with crateriform architecture: Classification and identification. J Dermatol 2013; 40:443-52. [DOI: 10.1111/1346-8138.12104] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 01/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Noriyuki Misago
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga; Japan
| | - Takuya Inoue
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga; Japan
| | - Shinichi Koba
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga; Japan
| | - Yutaka Narisawa
- Division of Dermatology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga; Japan
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Ferreira SA, Vasconcelos JLA, Silva RCWC, Cavalcanti CLB, Bezerra CL, Rêgo MJBM, Beltrão EIC. Expression patterns of α2,3-sialyltransferase I and α2,6-sialyltransferase I in human cutaneous epithelial lesions. Eur J Histochem 2013; 57:e7. [PMID: 23549466 PMCID: PMC3683614 DOI: 10.4081/ejh.2013.e7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/06/2012] [Accepted: 11/12/2012] [Indexed: 11/22/2022] Open
Abstract
Skin tumors have become one of the most common cancers in the world and their carcinogenesis is frequently associated with altered glycosylation patterns. The aberrant sialylation, a type of glycosylation, can mediate pathophysiological key events during various stages of tumor progression, including invasion and metastasis. Sialyltransferases play a key role in a variety of biological processes, including cell-cell communication, cell-matrix interaction, adhesion, and protein targeting. In this study, it was evaluated the expression of ST3Gal I and ST6Gal I in cutaneous epithelial lesions that include actinic keratosis (n=15), keratoacanthoma (n=9), squamous cell carcinoma (n=22) and basal cell carcinoma (n=28) in order to evaluate if sialyltransferases expression is different in premalignant and in malignant tumors. The expression of ST3Gal I was observed in actinic keratosis (53%), keratoacanthoma (78%), squamous cell carcinoma (73%) and basal cell carcinoma (32%) with statistic differences between basal cell carcinoma and keratoacanthoma (P=0.0239) and basal cell carcinoma and squamous cell carcinoma (P=0.0096); for ST6Gal I, cytoplasmic expression was noted in actinic keratosis (40%), heterogeneous and cytoplasmic expression was noted in keratoacanthoma (67%), squamous cell carcinoma (41%) and basal cell carcinoma (7%) with statistic differences between basal cell carcinoma and squamous cell carcinoma (P=0.0061) and basal cell carcinoma and keratoacanthoma (P=0.0008). In summary, our results showed that the high expression of ST3Gal I and ST6Gal I, in skin tumors, is associated with tumors with greater potential for invasion and metastasis, as in the case of squamous cell carcinoma, and this may be related to their behavior.
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Affiliation(s)
- S A Ferreira
- Laboratório de Imunopatologia Keizo Asami (LIKA), Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, Brazil.
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Soddu S, Di Felice E, Cabras S, Castellanos ME, Atzori L, Faa G, Pilloni L. IMP-3 expression in keratoacanthomas and squamous cell carcinomas of the skin: an immunohistochemical study. Eur J Histochem 2013; 57:e6. [PMID: 23549465 PMCID: PMC3683613 DOI: 10.4081/ejh.2013.e6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/23/2012] [Accepted: 10/24/2012] [Indexed: 11/23/2022] Open
Abstract
The protein insulin-like growth factor II mRNA binding protein 3 (IMP-3) is an important factor for cell migration and adhesion in malignancies. Recent studies have shown a remarkable overexpression of IMP-3 in different human malignant neoplasms and also revealed it as an important prognostic marker in some tumor entities. The purpose of this study is to compare IMP-3 immunostaining in cutaneous squamous cell tumors and determine whether IMP-3 can aid in the differential diagnosis of these lesions. To our knowledge, IMP-3 expression has not been investigated in skin squamous cell proliferations thus far. Immunohi-stochemical staining for IMP-3 was performed on slides organized by samples from 67 patients, 34 with keratoacanthoma (KA) and 33 with primary cutaneous squamous cell carcinoma (SCC) (16 invasive and 17 in situ). Seventyfour percent of KAs (25/34) were negative for IMP-3 staining, while 57% of SCCs (19/33) were positive for IMP-3 staining. The percentage of IMP-3 positive cells increased significantly in the invasive SCC group (P=0.0111), and particularly in the SCC in situ group (P=0.0021) with respect to the KA group. IMP-3 intensity staining was significantly higher in invasive SCCs (P=0.0213), and particularly in SCCs in situ (P=0.008) with respect to KA. Our data show that IMP-3 expression is different in keratoacanthoma with respect to squamous cell carcinoma. IMP-3 assessment and staining pattern, together with a careful histological study, can be useful in the differential diagnosis between KA e SCC.
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Affiliation(s)
- S Soddu
- Department of Surgical Sciences, Division of Pathology, University of Cagliari, Italy.
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41
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Li J, Wang K, Gao F, Jensen TD, Li ST, DeAngelis PM, Kølvraa S, Proby C, Forslund O, Bolund L, Clausen OPF. Array Comparative Genomic Hybridization of Keratoacanthomas and Squamous Cell Carcinomas: Different Patterns of Genetic Aberrations Suggest Two Distinct Entities. J Invest Dermatol 2012; 132:2060-6. [DOI: 10.1038/jid.2012.104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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42
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Alain J. Management of Keratoacanthoma. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-012-0010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Aubut N, Alain J, Claveau J. Intralesional Methotrexate Treatment for Keratoacanthoma Tumors: A Retrospective Case Series. J Cutan Med Surg 2012; 16:212-7. [DOI: 10.1177/120347541201600316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Intralesional methotrexate (IL-MTX) is an effective treatment for keratoacanthoma. Objective: We sought to determine the response rates and adverse events in KA treated with intralesional methotrexate. Methods: All cases of KA treated with intralesional methotrexate at our institutions from 2001 to 2009 were systematically reviewed. Results: Forty-six cases of KA treated with IL-MTX were identified. A complete resolution was achieved in 74% of patients, requiring an average of 1.8 injection sessions, for a mean total dose of 10 mg. Adverse events did not occur. Limitations: The follow-up period was short, and there was no histologic confirmation of the initial diagnosis. Conclusion: IL-MTX is an effective and well-tolerated alternative to surgery for the treatment of KA.
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Affiliation(s)
- Nicolas Aubut
- Department of Dermatology, Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec City, QC
| | - Jimmy Alain
- Centre Dermatologique du Québec Métropolitain, Quebec City, QC
| | - Joël Claveau
- Clinique Dermatologique Joël Claveau, Quebec City, QC
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Corbalán-Vélez R, Martínez-Barba E, López-Poveda MJ, Vidal-Abarca Gutiérrez I, Ruíz-Maciá JA, Oviedo-Ramirez I, Martínez-Menchón T. [The value of laminin-322 staining in distinguishing between keratoacanthoma, keratoacanthoma with areas of squamous cell carcinoma, and crateriform squamous cell carcinoma]. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:308-16. [PMID: 22176864 DOI: 10.1016/j.ad.2011.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 07/26/2011] [Accepted: 09/15/2011] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Keratoacanthoma is a fast-growing crateriform skin tumor. Approximately 25% of such tumors undergo malignant transformation and develop areas of squamous cell carcinoma (SCC). The presence of laminin-322 has been associated with progression to invasive forms of SCC. The aim of this study was to determine whether or not immunohistochemical staining for laminin-322 would be of value in distinguishing between keratoacanthomas, keratoacanthomas with areas of squamous cell carcinoma, and SCCs. MATERIAL AND METHODS Seventy-four lesions were selected from the pathology archives of our hospital and divided into 4 groups: 20 keratoacanthomas without SCC, 20 keratoacanthomas with areas of squamous cell carcinoma, 20 invasive SCCs (8 with crateriform morphology) unrelated to keratoacanthoma, and 14 problem lesions (keratoacanthomas with areas suggestive of SCC). All 74 lesions were stained for laminin-322. RESULTS Laminin-322 staining was strongly positive both in areas of SCC in keratoacanthomas with malignant transformation and in invasive SCCs (mostly at the invasive front of the SCC). However, in benign keratoacanthomas, it was only weakly positive and furthermore it was confined to isolated cells or small groups of cells. The 14 problem lesions were reexamined after laminin-322 staining and 8 were diagnosed as keratoacanthomas with incipient SCC and 6 as keratoacanthomas without SCC. CONCLUSIONS Laminin-322 staining is different in keratoacanthomas and SCCs and would thus be a useful test for differentiating keratoacanthomas from both invasive SCCs and keratoacanthomas with areas of squamous cell carcinoma. It would also be of value in diagnosing keratoacanthomas with areas suggestive of SCC or with incipient SCC.
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Affiliation(s)
- R Corbalán-Vélez
- Servicio de Dermatología, Hospital Universitario, Virgen de la Arrixaca, Murcia, España.
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Corbalán-Vélez R, Martínez-Barba E, López-Poveda M, Vidal-Abarca Gutiérrez I, Ruíz-Maciá J, Oviedo-Ramirez I, Martínez-Menchón T. The Value of Laminin-322 Staining in Distinguishing Between Keratoacanthoma, Keratoacanthoma With Areas of Squamous Cell Carcinoma, and Crateriform Squamous Cell Carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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46
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Martorell-Calatayud A, Requena C, Nagore E, Sanmartín O, Serra-Guillén C, Botella-Estrada R, Sanz-Motilva V, Llombart B, Alcañiz-Moscardo A, Guillén-Barona C. Intralesional Infusion of Methotrexate as Neoadjuvant Therapy Improves the Cosmetic and Functional Results of Surgery to Treat Keratoacanthoma: Results of a Randomized Trial. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
PURPOSE To review characteristics of patients who develop premalignant and malignant skin lesions while on sorafenib therapy and discuss implications for subsequent treatment of their primary malignancies. BACKGROUND Sorafenib is a newly developed multitargeted protein kinase inhibitor reported to induce a variety of adverse cutaneous effects, rarely including actinic keratoses, keratocanthomas, and squamous cell carcinomas (SCCs). METHODS Published reports of individuals who have developed cutaneous lesions demonstrating atypia of the epidermis are reviewed. In addition, a 77-year-old man who developed not only an SCC but also verrucas within one month of taking sorafenib monotherapy for metastatic adenocarcinoma of the lung is described. RESULTS Cutaneous lesions develop most commonly in Caucasian men older than 40 years without previous histories of skin cancer, within two weeks to three years of starting sorafenib therapy. Currently there is no definitive explanation for the relationship between sorafenib and cutaneous neoplasms. Management typically involves treatment of skin lesions with cryotherapy or excision with at least a brief discontinuation of sorafenib. In patients whose primary malignancies were responding well, sorafenib therapy was continued with close follow-up. CONCLUSIONS The possibility of rapidly developing actinic keratoses, keratocanthomas, verrucas, and SCC during treatment with sorafenib, warrants close dermatologic follow-up and a lower threshold for biopsy and treatment of suspicious cutaneous lesions. Development of a sorafenib-induced SCC is not an absolute contraindication for continued use of sorafenib therapy; however, the drug should be briefly discontinued until lesions are treated.
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[Intralesional infusion of methotrexate as neoadjuvant therapy improves the cosmetic and functional results of surgery to treat keratoacanthoma: results of a randomized trial]. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:605-15. [PMID: 21742301 DOI: 10.1016/j.ad.2011.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 03/09/2011] [Accepted: 03/14/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Keratoacanthoma is currently considered to be an in situ squamous cell carcinoma that mainly affects patients over 70 years of age. The tumor has a good prognosis and, in some cases, can resolve spontaneously. Treatment involves simple excision. However, since the tumors generally occur on the face or extremities and display rapid growth, aggressive surgery may be required and the cosmetic results may be poor. OBJECTIVE The primary study objective was assessment of the efficacy of presurgical intralesional methotrexate infiltration to reduce the size of the tumor and the corresponding surgical defect. MATERIAL AND METHODS A prospective, randomized study was undertaken in patients with a diagnosis of keratoacanthoma of at least 1.5 cm who were seen in our service between January 2009 and January 2010. Two groups were established: one receiving a single infiltration of methotrexate prior to surgery and another that did not receive methotrexate. RESULTS Of the 25 patients included in the study, 10 received neoadjuvant intralesional methotrexate (group A) and 15 underwent surgery without prior infiltration of methotrexate (group B). The patients in group A displayed a reduction of between 50% and 80% in the size of the lesion prior to surgery. No complications were observed either in relation to methotrexate infusion or surgery. In group B, only 1 patient had a slight reduction in the dimensions of the lesion prior to surgery. In the remaining cases, the lesions remained similar (4 cases, 26%) or had increased in size (10 cases, 66%) at the time of surgery. Five patients in this group required hospital admission following surgery. CONCLUSIONS Neoadjuvant intralesional methotrexate is well tolerated and reduces the need for aggressive surgery in elderly patients with keratoacanthoma measuring more than 1.5 cm on the face or extremities.
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Skyrlas A, Hantschke M, Passa V, Gaitanis G, Malamou-Mitsi V, Bassukas ID. Expression of apoptosis-inducing factor (AIF) in keratoacanthomas and squamous cell carcinomas of the skin. Exp Dermatol 2011; 20:674-6. [DOI: 10.1111/j.1600-0625.2011.01249.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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