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Takayama E, Takai T, Fujimoto M, Yoshioka A. Bowen disease with sebaceous differentiation arising from clonal seborrheic keratosis. J Dermatol 2024. [PMID: 38444094 DOI: 10.1111/1346-8138.17180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/20/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
We present a rare case of clonal seborrheic keratosis (SK) with focal Bowen disease (BD) (squamous cell carcinoma in situ) accompanied by sebaceous differentiation. An 89-year-old woman presented with a pale reddish-brown plaque on the left buttock. Histopathological examination of the excisional specimen revealed hyperkeratosis, acanthosis, and intraepidermal epithelioma. In some areas of the tumor, we observed proliferation of basaloid keratinocytes within the intraepidermal nests and pseudohorn cysts. This area was diagnosed as clonal SK. However, in other areas, the tumor cells within the intraepidermal nests showed nuclear pleomorphism, abnormal mitoses, dyskeratotic cells, and clumping cells, consistent with BD with a nested/clonal pattern (clonal BD). The SK and BD areas were contiguous with the transitional zone. Some nests within the BD area contained vacuolated cells with bubbly cytoplasm and scalloped nuclei, suggestive of sebaceous differentiation. Therefore, we made the diagnosis of clonal BD with sebaceous differentiation arising from clonal SK. All areas contained intraepidermal nests, which revealed that the lesions were not the result of accidental collision, but that the neoplastic cells in the intraepidermal nests of the SK transformed into BD and underwent sebaceous differentiation.
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Affiliation(s)
- Eriko Takayama
- Department of Dermatology, Konan Medical Center, Kobe, Japan
| | - Toshihiro Takai
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Akiko Yoshioka
- Department of Dermatology, Konan Medical Center, Kobe, Japan
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Goto K, Ogawa K, Hishima T, Oishi N, Tomita O, Tsuyuki T, Oda T, Iwahashi Y, Inaba Y, Honma K. Seborrheic Keratosis With Malignant Transformation (Invasive or Noninvasive Squamous Cell Carcinoma Arising in Seborrheic Keratosis): A Clinicopathologic and Immunohistochemical Study of 11 Cases. Am J Dermatopathol 2022; 44:891-899. [PMID: 36395445 DOI: 10.1097/dad.0000000000002245] [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: 11/26/2022]
Abstract
ABSTRACT Seborrheic keratosis is a common benign neoplasm composed of basaloid keratinocytes. However, little is known about the malignant transformation of the tumor. Eleven cases of seborrheic keratosis with malignant transformation were analyzed. The 11 patients included 5 male patients and 6 female patients with a median age of 75 years at diagnosis (68-90 years). The tumors arose at various sites from the scalp (n = 3) to the lower leg (n = 2). The median tumor size was 12 (10-32) and 40 (20-75) mm in 7 noninvasive and 4 invasive cases, respectively. One patient exhibited in-transit skin metastasis. Histopathology of the malignant components resembled porocarcinoma or inverted follicular keratosis. Bowenoid and pagetoid spreading was frequently observed. The malignant components expressed cytokeratin 5/6 (100%) and GATA3 (73%), but not cytokeratin 7 (0%), cytokeratin 19 (9%), BerEP4 (0%), c-kit (0%), and NUT (0%). No significant immunoreactivity of YAP1 was observed in any of the cases. Mutant-type immunostaining of p53 and PTEN was observed in 91% and 82% of the cases, respectively. An increase in p16 expression was seen in 6 (86%) of the 7 cases with noninvasive carcinoma, although a loss of p16 immunoexpression was seen in the invasive carcinoma component in 3 (75%) of the 4 cases. This study demonstrated that seborrheic keratosis can undergo malignant transformation, particularly in large-sized lesions in elderly patients. Malignant components mimic porocarcinoma or inverted follicular keratosis. Malignant transformation induced by TP53 and PTEN mutations and tumor invasion by CDKN2A inactivating mutations are suggested in this study.
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Affiliation(s)
- Keisuke Goto
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
- Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
- Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto, Japan
- Department of Clinical Laboratory and Diagnostic Pathology, Osaka National Hospital, Osaka, Japan
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Kohei Ogawa
- Department of Dermatology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | | | - Ozumi Tomita
- Dermatology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | | | - Takao Oda
- Dermatology, Kainan Hospital, Yatomi, Japan ; and
| | | | - Yutaka Inaba
- Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Keiichiro Honma
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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Oka M, Yamamoto Y, Fujii M. Transformation of Seborrheic Keratosis into Bowenoid Actinic Keratosis via Three Steps of Histological Change in a Patient with Rheumatoid Arthritis Treated with Multiple Immunosuppressants. Case Rep Dermatol 2020; 12:19-24. [PMID: 32110205 PMCID: PMC7036593 DOI: 10.1159/000505530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022] Open
Abstract
We report a case of seborrheic keratosis (SK) that transformed into bowenoid actinic keratosis (AK) via three steps of histological change in a 77-year-old woman. The patient presented with a multiple-year history of a brownish lesion on the right cheek. She reported that some months earlier she had noted a pinkish lesion developing within the brownish lesion. She had also been treated with several immunosuppressants for rheumatoid arthritis for many years. Physical examination revealed a nodule measuring 13 × 12 mm on the lateral side of the right upper cheek. The lesion comprised three regions: a brownish hyperkeratotic region in the upper portion; a pinkish region in the lower portion; and a slightly dented, band-like region between the other two regions. Histopathologically, the specimen consisted of four zones: SK comprising basaloid cells; SK composed of squamoid cells; atrophic AK; and bowenoid AK. The zones of SK with basaloid cells and squamoid cells clinically corresponded to the brownish hyperkeratotic region. Atrophic and bowenoid AK zones corresponded to the dented, band-like region and pinkish region, respectively. Collectively, the nodular skin lesion was diagnosed as SK associated with atrophic and bowenoid AK within the SK lesion. The present case suggests that bowenoid AK developed from SK by malignant transformation via three steps of histological change. The facts that our patient had received treatment with several immunosuppressants and that no other AK lesions were evident around the AK support the notion that in this case, bowenoid AK developed from SK by malignant transformation.
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Affiliation(s)
- Masahiro Oka
- Department of Dermatology, Kita-Harima Medical Center, Ono City, Japan
| | - Yuki Yamamoto
- Department of Pathology, Kita-Harima Medical Center, Ono City, Japan
| | - Miki Fujii
- Department of Plastic and Reconstructive Surgery, Kita-Harima Medical Center, Ono City, Japan
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Ameliorative effects of snake (Deinagkistrodon acutus) oil and its main fatty acids against UVB-induced skin photodamage in mice. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2019; 197:111538. [PMID: 31247385 DOI: 10.1016/j.jphotobiol.2019.111538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 12/15/2022]
Abstract
The effects of topically administered snake (Deinagkistrodon acutus) oil and its main fatty acid components on skin photodamage were explored. Epidermal thickness, mice body weight, antioxidant enzymes (superoxide dismutase, glutathione peroxidase, catalase), inflammatory cytokines (tumor necrosis factor alpha and interleukin-6), skin histology, collagen content, and metalloproteinase-1 indicators were analyzed. The results show that topical application of both snake oil and its main fatty acids recovered ultraviolet B (UVB) irradiation induced antioxidant enzymes depletion, prevented metalloproteinase-1. Snake oil and its main fatty acids suppressed dermal infiltration of inflammatory cells and reduced inflammatory cytokines levels. Notably, there was no significant difference in the antioxidant activity but a significant difference in the anti-inflammatory activity between fatty acids and snake oil under the same dose. Finally, snake oil and its main fatty acids inhibited UVB-induced histological damage such as epidermal thickening, collagen fiber and elastic fiber destruction. Our study demonstrated for the first time in KM mice that snake oil exhibited prominent photoprotection activity by protecting the activity of antioxidant enzymes and inhibiting inflammatory factors, as well as reducing the generation of MMP-1. What's more, the main fatty acids in snake oil play an important role in preventing photo-damage especially in protecting antioxidant enzyme activity.
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Moreno-Ramírez D, Raya-Maldonado J, Morales-Conde M, Ojeda-Vila T, Martín-Gutiérrez FJ, Ruíz-de-Casas A, Fernández-Orland A, Jm HE, Ferrándiz L. Increasing Frequency of Seborrheic Keratosis Diagnoses as a Favorable Consequence of Teledermatology-Based Skin Cancer Screening: A Cross-sectional Study of 34,553 Patients. Am J Clin Dermatol 2017; 18:681-685. [PMID: 28397109 DOI: 10.1007/s40257-017-0283-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Screening of skin cancer by teledermatology (TD) has improved the early detection of skin cancer by enhancing access to skin cancer clinics. OBJECTIVE We sought to analyze how TD-based skin cancer screening has changed the frequency of consultations for benign lesions. PATIENTS AND METHODS A cross-sectional study including teleconsultations received during a 7-year period was conducted to analyze and compare the trendlines of each lesion type over the study period. Trendlines were analyzed using a linear regression model with the R-squared (R 2) test for goodness of fit. RESULTS A total of 34,553 teleconsultations were included in the study. Seborrheic keratoses, followed by benign melanocytic lesions, were the most frequent lesions diagnosed. The pick-up rate for malignant lesions was 1:8.6 teleconsultations. Seborrheic keratoses and precancerous lesions showed a positive trendline with good fit to the linear model (R 2 = 0.8 and R 2 = 0.8, respectively). Tis-T1 malignant melanoma (in situ melanoma or melanoma with a Breslow thickness <1 mm) showed an increasing trendline with moderate-to-low fit to the model (R 2 = 0.4). CONCLUSIONS TD-based screening of skin cancer is associated with an increasing rate of consultations involving seborrheic keratoses, which can be considered a consequence of improved access to dermatologists resulting from TD implementation.
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Affiliation(s)
- David Moreno-Ramírez
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain.
| | - Jesús Raya-Maldonado
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Macarena Morales-Conde
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Teresa Ojeda-Vila
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Francisco J Martín-Gutiérrez
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Andrés Ruíz-de-Casas
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Almudena Fernández-Orland
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | | | - Lara Ferrándiz
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
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Conic RZ, Napekoski K, Schuetz H, Piliang M, Bergfeld W, Atanaskova Mesinkovska N. The role of immunosuppression in squamous cell carcinomas arising in seborrheic keratosis. J Am Acad Dermatol 2017; 76:1146-1150. [PMID: 28162852 DOI: 10.1016/j.jaad.2016.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Seborrheic keratoses (SK) are common skin neoplasms considered to be benign. Reports of associated squamous cell carcinoma arising within seborrheic keratosis (SCC-SK) have been described. OBJECTIVE To describe the histopathologic characteristics of SCC-SK and identify predisposing factors in formation of these rare lesions. METHODS There were 162 cases of SCC-SK in a span of a decade (2003-2014). All of the histopathologic specimens and medical records were reviewed. Data from these patients were compared to a control group with seborrheic keratosis who were matched by age, sex, and location of lesion from the same time period (n = 162). RESULTS SCC-SK has the classic histopathologic features of SK, such as hyperkeratosis, parakeratosis, papillomatosis, and pseudohorn cysts. The areas of squamous cell carcinoma were characterized by areas of squamous dysplasia (100%), hypogranulosis (79.6%), squamous eddies (79.6%), solar elastosis (80.9%), and brown pigmentation (59.9%). Patients with a history of immunosuppression had an increased risk for developing SCC-SK (19% vs 3%; P < .01), particularly when inhibition was transplant-associated (10% vs 0%; P < .01). LIMITATIONS This was a single center, retrospective study. CONCLUSION SCC-SK occurs more often in elderly men with a history of immunosuppression associated with organ transplants.
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Affiliation(s)
- Ruzica Z Conic
- Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio; Department of Dermatology, Case Western Reserve University, Cleveland, Ohio.
| | - Karl Napekoski
- Department of Pathology, Edward Hospital, Naperville, Illinois
| | - Heidi Schuetz
- Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio
| | - Melissa Piliang
- Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio
| | - Wilma Bergfeld
- Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio
| | - Natasha Atanaskova Mesinkovska
- Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio; Department of Dermatology and Dermatopathology, University of California Irvine, Irvine, California
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