1
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Burstein SE, Maibach H. Actinic keratosis metrics. Arch Dermatol Res 2024; 316:543. [PMID: 39162820 DOI: 10.1007/s00403-024-03305-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 07/20/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
Actinic keratosis (AK) is a common precancerous skin condition predominantly affecting older males with fair skin and significant UV exposure. The clinical significance of AK is related to its potential for malignant transformation and progression to squamous cell carcinoma (SCC). Accurate diagnosis of AK is essential for adequate treatment, evaluation of therapeutic efficacy, and mitigating the risk of developing SCC. However, clinician variability due to the subjective nature of current diagnostic tools presents significant challenges to achieving consistent and reliable AK diagnoses. Thus, there is no universally accepted standard for measuring AK.This review evaluates current methods for evaluating and diagnosing AK, focusing on clinician variability through inter- and intraobserver agreement. Eight peer-reviewed studies investigating the reliability of various approaches for AK evaluation show substantial variability in interobserver or intraobserver agreement, with most methods demonstrating only slight to moderate reliability. Some suggest that consensus discussions and simplified rating scales can modestly improve diagnostic reliability. However, remaining variability and the lack of a universally accepted standard for measuring AK underscore the need for more robust and standardized diagnostic and evaluation methods.The review emphasizes the need for improved diagnostic tools and standardized methods to enhance the accuracy and reliability of AK assessments. It also proposes applying a novel examination approach using 1,3-dihydroxyacetone (DHA) staining which may improve the visualization and identification of AK lesions. Advancements in these areas have significant potential, promising better clinical practices and patient outcomes in AK management.
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Affiliation(s)
- Sarah E Burstein
- Brody School of Medicine, East Carolina University, Greenville, NC, USA.
| | - Howard Maibach
- University of California San Francisco, San Francisco, CA, USA
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2
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Malvehy J, Stratigos AJ, Bagot M, Stockfleth E, Ezzedine K, Delarue A. Actinic keratosis: Current challenges and unanswered questions. J Eur Acad Dermatol Venereol 2024; 38 Suppl 5:3-11. [PMID: 38923589 DOI: 10.1111/jdv.19559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/29/2023] [Indexed: 06/28/2024]
Abstract
Actinic keratoses (AK) are common skin lesions associated with chronic exposure to sun. They are believed to be precursors of malignancy as they potentially may progress to invasive squamous cell carcinomas. The goal of current therapies is to reduce the number of AK and to prevent future cancer development. This review aims at providing an overview of the hallmarks of AK and skin field cancerization. We discuss epidemiology trends, risk factors and the state of the art and evidence of the current treatments. We review key figures of AK prevalence from different countries with regard to skin cancer risk and the associated economic burden of AK. We discuss the mutational status in AK lesions and the difficulties encountered by clinicians in evaluating AK visible and invisible lesions, referring to the concept of field cancerization. Based on a systematic literature review, we further evaluate the available treatment options. The presence of subclinical skin alterations in the periphery of visible AK lesions has gained a particular attention as those non-visible lesions are known to contain the same genetic changes as those found in the AK lesions themselves, prompting the concept of 'field cancerization'. Therefore, AK treatment guidelines now recognize the importance of treating the field in patients with AK. A recent systematic literature review and network meta-analysis showed that 5-FU interventions were associated with the best efficacy and a satisfactory acceptability profile compared with other field-directed therapies used in the treatment of AK. Although AK are considered quite common, they lack an accurate descriptive definition and conclusive epidemiologic data. Limited public awareness is a barrier to early and effective treatment, including prevention strategies. While different treatment options are available, there is still a limited understanding of long-term outcomes of treatment as measured by recurrence of cancer prevention.
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Affiliation(s)
- Josep Malvehy
- Hospital Clinic de Barcelona, IDIBAPS, and Spain & Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Universitat de Barcelona, Barcelona, Spain
| | | | - Martine Bagot
- Department of Dermatology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, and Human Immunology, Pathophysiology and Immunotherapy, Institut National de la Santé et de la Recherche Médicale U976, Université de Paris, Paris, France
| | - Eggert Stockfleth
- Department of Dermatology, Ruhr University of Bochum, Bochum, Germany
| | - Khaled Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, EA EpiDermE, UPEC-Université Paris-Est Créteil, Créteil, France
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3
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Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, Berking C, Arenberger P, Bylaite-Bučinskiene M, Del Marmol V, Dirschka T, Dreno B, Forsea AM, Harwood CA, Hauschild A, Heerfordt IM, Kauffman R, Kelleners-Smeets N, Lallas A, Lebbe C, Leiter U, Longo C, Mijušković Ž, Pellacani G, Puig S, Saiag P, Šitum M, Stockfleth E, Salavastru C, Stratigos A, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes). J Eur Acad Dermatol Venereol 2024; 38:1024-1047. [PMID: 38451047 DOI: 10.1111/jdv.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.
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Affiliation(s)
- Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endrocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - Matilda Bylaite-Bučinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany
- CentroDerm Clinic, Wuppertal, Germany
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Ida Marie Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Roland Kauffman
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP, Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Caterina Longo
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Željko Mijušković
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Susana Puig
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mirna Šitum
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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Thamm JR, Welzel J, Schuh S. Diagnosis and therapy of actinic keratosis. J Dtsch Dermatol Ges 2024; 22:675-690. [PMID: 38456369 DOI: 10.1111/ddg.15288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/28/2023] [Indexed: 03/09/2024]
Abstract
Actinic keratosis (AK) is considered a chronic and recurring in situ skin neoplasia, with a possible transformation into invasive squamous cell carcinoma (SCC). Among others, predominant risk factors for development of AK are UV-light exposure and immunosuppression. Basal epidermal keratinocyte atypia (AK I) and proliferation (PRO score) seem to drive malignant transformation, rather than clinical appearance of AK (Olsen I-III). Due to the invasiveness of punch biopsy, those histological criteria are not regularly assessed. Non-invasive imaging techniques, such as optical coherence tomography (OCT), reflectance confocal microscopy (RCM) and line-field confocal OCT (LC-OCT) are helpful to distinguish complex cases of AK, Bowen's disease, and SCC. Moreover, LC-OCT can visualize the epidermis and the papillary dermis at cellular resolution, allowing real-time PRO score assessment. The decision-making for implementation of therapy is still based on clinical risk factors, ranging from lesion- to field-targeted and ablative to non-ablative regimens, but in approximately 85% of the cases a recurrence of AK can be observed after a 1-year follow-up. The possible beneficial use of imaging techniques for a non-invasive follow-up of AK to detect recurrence or invasive progression early on should be subject to critical evaluation in further studies.
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Affiliation(s)
- Janis Raphael Thamm
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Schuh
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
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5
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Thamm JR, Welzel J, Schuh S. Diagnose und Therapie aktinischer Keratosen. J Dtsch Dermatol Ges 2024; 22:675-691. [PMID: 38730534 DOI: 10.1111/ddg.15288_g] [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: 01/31/2023] [Accepted: 09/28/2023] [Indexed: 05/13/2024]
Abstract
Actinic keratosis (AK) is considered a chronic and recurring in situ skin neoplasia, with a possible transformation into invasive squamous cell carcinoma (SCC). Among others, predominant risk factors for development of AK are UV-light exposure and immunosuppression. Basal epidermal keratinocyte atypia (AK I) and proliferation (PRO Score) seem to drive malignant turnover, rather than clinical appearance of AK (Olsen I-III). Due to the invasiveness of punch biopsy, those histological criteria are not regularly assessed. Non-invasive imaging techniques, such as optical coherence tomography (OCT), reflectance confocal microscopy (RCM) and line-field confocal OCT (LC-OCT) are helpful to distinguish complex cases of AK, Bowen's disease and SCC. Moreover, LC-OCT can visualize the epidermis and the papillary dermis at cellular resolution, allowing real-time PRO Score assessment. The decision-making for implementation of therapy is still based on clinical risk factors, ranging from lesion- to field-targeted and ablative to non-ablative regimes, but in approximately 85% of the cases a recurrence of AK can be observed after a 1-year follow-up. The possible beneficial use of imaging techniques for a non-invasive follow-up of AK to detect recurrence or invasive progression early on should be subject to critical evaluation in further studies.
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Affiliation(s)
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg
| | - Sandra Schuh
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg
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Artosi F, Costanza G, Di Prete M, Garofalo V, Lozzi F, Dika E, Cosio T, Diluvio L, Shumak RG, Lambiase S, Di Raimondo C, Campa S, Piscitelli P, Miani A, Bianchi L, Campione E. Epidemiological and clinical analysis of exposure-related factors in non-melanoma skin cancer: A retrospective cohort study. ENVIRONMENTAL RESEARCH 2024; 247:118117. [PMID: 38218521 DOI: 10.1016/j.envres.2024.118117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The incidence of non-melanoma skin cancers (NMSCs) increased over last decades, probably due to environmental concerns or to the increase of frail patients with age related comorbidities. Currently, the relationship of increasing global skin cancer rates with increased ultraviolet radiations (UVRs) resulting from stratospheric ozone depletion, global warming, and air pollution from fossil-fuel combustion. AIMS We conducted a retrospective epidemiological study including 546 NMSC patients managed at the Dermatology Unit of the Tor Vergata Hospital to highlight different trends of sun exposure or different comorbidities. METHODS Descriptive and inferential statistical analyses were performed to evidence differences between continous variable and Spearman rank test for dicotomical variables. Charlson Comorbidity Index was calculated to obtain the 10-years survival rate in order to identify the mean comorbidity burden of our patients. RESULTS Considering patients with comorbidities (73.81%), actinic keratoses (AKs) was the most frequent lesion. In patients with a history of previous melanoma, basal cell carcinoma (BCC) was predominant (ANOVA test, p < 0.05) with a statistically significant correlation (rho = 0.453; p < 0.01). Squamous cell carcinoma (SCC) showed a higher rate in arterial hypertension patients, followed by the chronic heart failure and hematologic neoplasms (60%, 29.7% and 32.1%, respectively) groups. Men were more affected than women, representing 61.54% of patients. Chronic sun exposure is directly correlated with SCC rho = 0.561; p < 0.01), whereas BCC correlated with a history of sunburns (rho = 0.312; p < 0.05). CONCLUSIONS History of photo-exposition had an important role on NMSC development especially for work or recreational reasons. Sex, age, and presence of comorbidities influenced different NMSC types. BCC was more frequent in younger patients, associated with melanoma and sunburns. The presence of SCC is associated with older patients and the hypertension group. AKs were diagnosed predominantly in oldest men, with a chronic sun-exposure history, and hematologic neoplasms group.
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Affiliation(s)
- Fabio Artosi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Gaetana Costanza
- Unit of Virology, Department of Experimental Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
| | - Monia Di Prete
- Dermatopathology Laboratory, Istituti Fisioterapici Ospitalieri, Istituto San Gallicano, via Fermo Ognibene 23, 00144, Rome, Italy.
| | - Virginia Garofalo
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy
| | - Flavia Lozzi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Emi Dika
- Dermatology, IRCCS Policlinico Sant'Orsola, via Massarenti 9, 40138, Bologna, Italy.
| | - Terenzio Cosio
- PhD Course Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
| | - Laura Diluvio
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Ruslana Gaeta Shumak
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Sara Lambiase
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Cosimo Di Raimondo
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Serena Campa
- Italian Society of Environmental Medicine, SIMA, Italy.
| | - Prisco Piscitelli
- Italian Society of Environmental Medicine, SIMA, Italy; University of Salento, Lecce, Italy.
| | - Alessandro Miani
- Italian Society of Environmental Medicine, SIMA, Italy; Department of Environmental Sciences and Policies, University of Milan, Milan, Italy.
| | - Luca Bianchi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
| | - Elena Campione
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy, via Montpellier 1, 00133, Rome, Italy.
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Jacobsen K, Ortner VK, Wenande E, Sahu A, Paasch U, Haedersdal M. Line-field confocal optical coherence tomography in dermato-oncology: A literature review towards harmonized histopathology-integrated terminology. Exp Dermatol 2024; 33:e15057. [PMID: 38623958 DOI: 10.1111/exd.15057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 04/17/2024]
Abstract
Non-invasive diagnostics like line-field confocal optical coherence tomography (LC-OCT) are being implemented in dermato-oncology. However, unification of terminology in LC-OCT is lacking. By reviewing the LC-OCT literature in the field of dermato-oncology, this study aimed to develop a unified terminological glossary integrated with traditional histopathology. A PRISMA-guided literature-search was conducted for English-language publications on LC-OCT of actinic keratosis (AK), keratinocyte carcinoma (KC), and malignant melanoma (MM). Study characteristics and terminology were compiled. To harmonize LC-OCT terminology and integrate with histopathology, synonymous terms for image features of AK, KC, and MM were merged by two authors, organized by skin layer and lesion-type. A subset of key LC-OCT image-markers with histopathological correlates that in combination were typical of AK, squamous cell carcinoma in situ (SCCis), invasive squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and MM in traditional histopathology, were selected from the glossary by an experienced dermatopathologist. Seventeen observational studies of AK (7 studies), KC (13 studies), MM (7 studies) utilizing LC-OCT were included, with 117 terms describing either AK, KC, or MM. These were merged to produce 45 merged-terms (61.5% reduction); 5 assigned to the stratum corneum (SC), 23 to the viable epidermis, 2 to dermo-epidermal junction (DEJ) and 15 to the dermis. For each lesion, mandatory key image-markers were a well-defined DEJ and presence of mild/moderate but not severe epidermal dysplasia for AK, severe epidermal dysplasia and well-defined DEJ for SCCis, interrupted DEJ and/or dermal broad infiltrative strands for invasive SCC, dermal lobules connected and/or unconnected to the epidermis for BCC, as well as single atypical melanocytes and/or nest of atypical melanocytes in the epidermis or dermis for MM. This review compiles evidence on LC-OCT in dermato-oncology, providing a harmonized histopathology-integrated terminology and key image-markers for each lesion. Further evaluation is required to determine the clinical value of these findings.
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Affiliation(s)
- Kevin Jacobsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Aditi Sahu
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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Naldi L, Cassalia F. Actinic keratosis epidemiology: the good, the bad and the ugly. Br J Dermatol 2024; 190:457-458. [PMID: 37877439 DOI: 10.1093/bjd/ljad395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Luigi Naldi
- Department of Dermatology, Ospedale San Bortolo, Vicenza, Italy
- Centro Studi GISED, Bergamo, Italy
| | - Fortunato Cassalia
- Centro Studi GISED, Bergamo, Italy
- Department of Dermatology, University of Padua, Padova, Italy
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9
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Soare C, Cozma EC, Celarel AM, Rosca AM, Lupu M, Voiculescu VM. Digitally Enhanced Methods for the Diagnosis and Monitoring of Treatment Responses in Actinic Keratoses: A New Avenue in Personalized Skin Care. Cancers (Basel) 2024; 16:484. [PMID: 38339236 PMCID: PMC10854727 DOI: 10.3390/cancers16030484] [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: 12/03/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Non-melanocytic skin cancers represent an important public health problem due to the increasing incidence and the important local destructive potential. Thus, the early diagnosis and treatment of precancerous lesions (actinic keratoses) is a priority for the dermatologist. In recent years, non-invasive skin imaging methods have seen an important development, moving from simple observational methods used in clinical research, to true diagnostic and treatment methods that make the dermatologist's life easier. Given the frequency of these precancerous lesions, their location on photo-exposed areas, as well as the long treatment periods, with variable, imprecise end-points, the need to use non-invasive imaging devices is increasingly evident to complete the clinical observations in the diagnosis and treatment of these lesions, with the aim of increasing accuracy and decreasing the adverse effects due to long treatment duration. This is the first review that brings together all skin imaging methods (dermoscopy, reflectance confocal microscopy, ultrasonography, dermoscopy-guided high frequency ultrasonography, and optical coherence tomography) used in the evaluation of actinic keratoses and their response to different treatment regimens.
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Affiliation(s)
- Cristina Soare
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Elena Codruta Cozma
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Celarel
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Rosca
- Department of Dermatology, University Military Hospital “Dr. Carol Davila”, 010825 Bucharest, Romania;
| | - Mihai Lupu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Vlad Mihai Voiculescu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
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10
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Zou DD, Sun YZ, Li XJ, Wu WJ, Xu D, He YT, Qi J, Tu Y, Tang Y, Tu YH, Wang XL, Li X, Lu FY, Huang L, Long H, He L, Li X. Single-cell sequencing highlights heterogeneity and malignant progression in actinic keratosis and cutaneous squamous cell carcinoma. eLife 2023; 12:e85270. [PMID: 38099574 PMCID: PMC10783873 DOI: 10.7554/elife.85270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most frequent of the keratinocyte-derived malignancies with actinic keratosis (AK) as a precancerous lesion. To comprehensively delineate the underlying mechanisms for the whole progression from normal skin to AK to invasive cSCC, we performed single-cell RNA sequencing (scRNA-seq) to acquire the transcriptomes of 138,982 cells from 13 samples of six patients including AK, squamous cell carcinoma in situ (SCCIS), cSCC, and their matched normal tissues, covering comprehensive clinical courses of cSCC. We identified diverse cell types, including important subtypes with different gene expression profiles and functions in major keratinocytes. In SCCIS, we discovered the malignant subtypes of basal cells with differential proliferative and migration potential. Differentially expressed genes (DEGs) analysis screened out multiple key driver genes including transcription factors along AK to cSCC progression. Immunohistochemistry (IHC)/immunofluorescence (IF) experiments and single-cell ATAC sequencing (scATAC-seq) data verified the expression changes of these genes. The functional experiments confirmed the important roles of these genes in regulating cell proliferation, apoptosis, migration, and invasion in cSCC tumor. Furthermore, we comprehensively described the tumor microenvironment (TME) landscape and potential keratinocyte-TME crosstalk in cSCC providing theoretical basis for immunotherapy. Together, our findings provide a valuable resource for deciphering the progression from AK to cSCC and identifying potential targets for anticancer treatment of cSCC.
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Affiliation(s)
- Dan-Dan Zou
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
- Department of Dermatology, The Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, KunmingYunnanChina
| | - Ya-Zhou Sun
- Clinical Big Data Research Center, The Seventh Affiliated Hospital of Sun Yat-sen UniversityShenzhen, GuangdongChina
- School of Medical, Shenzhen Campus of Sun Yat-sen UniversityShenzhen, GuangdongChina
| | - Xin-Jie Li
- School of Medical, Shenzhen Campus of Sun Yat-sen UniversityShenzhen, GuangdongChina
| | - Wen-Juan Wu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Dan Xu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Yu-Tong He
- School of Medical, Shenzhen Campus of Sun Yat-sen UniversityShenzhen, GuangdongChina
| | - Jue Qi
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Ying Tu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Yang Tang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Yun-Hua Tu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Xiao-Li Wang
- Department of Dermatology, Changzheng Hospital, Naval Medical UniversityShanghaiChina
| | - Xing Li
- Department of Dermatology, People's Hospital of Chuxiong Yi Autonomous Prefecture, ChuxiongYunnanChina
| | - Feng-Yan Lu
- Department of Dermatology, Qujing Affiliated Hospital of Kunming Medical University, The First People’s Hospital of QujingYunnanChina
| | - Ling Huang
- Department of Dermatology, First Affiliated Hospital of Dali University, DaliYunnanChina
| | - Heng Long
- Wenshan Zhuang and Miao Autonomous Prefecture Dermatology Clinic, Wenshan Zhuang and Miao Autonomous Prefecture Specialist Hospital of Dermatology, WenshanYunnanChina
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Xin Li
- School of Medical, Shenzhen Campus of Sun Yat-sen UniversityShenzhen, GuangdongChina
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen UniversityGuangdongChina
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11
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Campione E, Rivieccio A, Gaeta Shumak R, Costanza G, Cosio T, Lambiase S, Garofalo V, Artosi F, Lozzi F, Freni C, Romeo A, Dika E, Falconi M, Bianchi L. Preliminary Evidence of Efficacy, Safety, and Treatment Satisfaction with Tirbanibulin 1% Ointment: A Clinical Perspective on Actinic Keratoses. Pharmaceuticals (Basel) 2023; 16:1686. [PMID: 38139813 PMCID: PMC10748142 DOI: 10.3390/ph16121686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Actinic keratosis is a common precancerous skin lesion that can progress into invasive squamous cell carcinomas. Many topical treatments for actinic keratoses often have poor tolerability and prolonged duration. Tirbanibulin is a novel synthetic drug with potent antitumor and antiproliferative activities. METHODS We conducted a single-center, prospective and observational study using tirbanibulin ointment on a 25 cm2 area for 5 consecutive days on 30 participants with AKs on the face or scalp. They were followed for at least 57 days to assess the safety profile and efficacy of the drug as well as treatment satisfaction. We evaluated six signs of local skin reaction (LSR): erythema, scaling, crusting, swelling, blisters/pustules, and erosions/ulcerations, grading the severity as mild, moderate, or severe. The effectiveness was evaluated both clinically and dermoscopically. The treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). RESULTS On day 57, 70% of the patients showed a complete clinical and dermoscopic response. The highest scores obtained from the TSQM 1.4 were more evident in the convenience and side effects domains. Most LSRs, including erythema (83.3%), scaling (30%), and swelling (3.3%), occurred on day 8 but resolved spontaneously. CONCLUSION Tirbanibulin is a viable therapeutic option with a short regimen treatment and good tolerability, which favors therapy adherence.
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Affiliation(s)
- Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Antonia Rivieccio
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Ruslana Gaeta Shumak
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Gaetana Costanza
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Terenzio Cosio
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Sara Lambiase
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Virginia Garofalo
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Fabio Artosi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Flavia Lozzi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Claudia Freni
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy; (C.F.); (A.R.); (M.F.)
| | - Alice Romeo
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy; (C.F.); (A.R.); (M.F.)
| | - Emi Dika
- Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, DIMEC, University of Bologna, 40126 Bologna, Italy;
| | - Mattia Falconi
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy; (C.F.); (A.R.); (M.F.)
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
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12
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Daxenberger F, Deußing M, Eijkenboom Q, Gust C, Thamm J, Hartmann D, French LE, Welzel J, Schuh S, Sattler EC. Innovation in Actinic Keratosis Assessment: Artificial Intelligence-Based Approach to LC-OCT PRO Score Evaluation. Cancers (Basel) 2023; 15:4457. [PMID: 37760425 PMCID: PMC10527366 DOI: 10.3390/cancers15184457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Actinic keratosis (AK) is a common skin cancer in situ that can progress to invasive SCC. Line-field confocal optical coherence tomography (LC-OCT) has emerged as a non-invasive imaging technique that can aid in diagnosis. Recently, machine-learning algorithms have been developed that can automatically assess the PRO score of AKs based on the dermo-epidermal junction's (DEJ's) protrusion on LC-OCT images. A dataset of 19.898 LC-OCT images from 80 histologically confirmed AK lesions was used to test the performance of a previous validated artificial intelligence (AI)-based LC-OCT assessment algorithm. AI-based PRO score assessment was compared to the imaging experts' visual score. Additionally, undulation of the DEJ, the number of protrusions detected within the image, and the maximum depth of the protrusions were computed. Our results show that AI-automated PRO grading is highly comparable to the visual score, with an agreement of 71.3% for the lesions evaluated. Furthermore, this AI-based assessment was significantly faster than the regular visual PRO score assessment. The results confirm our previous findings of the pilot study in a larger cohort that the AI-based grading of LC-OCT images is a reliable and fast tool to optimize the efficiency of visual PRO score grading. This technology has the potential to improve the accuracy and speed of AK diagnosis and may lead to better clinical outcomes for patients.
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Affiliation(s)
- Fabia Daxenberger
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Maximilian Deußing
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Quirine Eijkenboom
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Janis Thamm
- Department of Dermatology and Allergology, University Hospital, University of Augsburg, 86179 Augsburg, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
| | - Lars E. French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
- Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital, University of Augsburg, 86179 Augsburg, Germany
| | - Sandra Schuh
- Department of Dermatology and Allergology, University Hospital, University of Augsburg, 86179 Augsburg, Germany
| | - Elke C. Sattler
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany (E.C.S.)
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13
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Levra Levron C, Watanabe M, Proserpio V, Piacenti G, Lauria A, Kaltenbach S, Tamburrini A, Nohara T, Anselmi F, Duval C, Elettrico L, Donna D, Conti L, Baev D, Natsuga K, Hagai T, Oliviero S, Donati G. Tissue memory relies on stem cell priming in distal undamaged areas. Nat Cell Biol 2023; 25:740-753. [PMID: 37081165 DOI: 10.1038/s41556-023-01120-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/28/2023] [Indexed: 04/22/2023]
Abstract
Epithelial cells that participated in wound repair elicit a more efficient response to future injuries, which is believed to be locally restricted. Here we show that cell adaptation resulting from a localized tissue damage has a wide spatial impact at a scale not previously appreciated. We demonstrate that a specific stem cell population, distant from the original injury, originates long-lasting wound memory progenitors residing in their own niche. Notably, these distal memory cells have not taken part in the first healing but become intrinsically pre-activated through priming. This cell state, maintained at the chromatin and transcriptional level, leads to an enhanced wound repair that is partially recapitulated through epigenetic perturbation. Importantly wound memory has long-term harmful consequences, exacerbating tumourigenesis. Overall, we show that sub-organ-scale adaptation to injury relies on spatially organized memory-dedicated progenitors, characterized by an actionable cell state that establishes an epigenetic field cancerization and predisposes to tumour onset.
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Affiliation(s)
- Chiara Levra Levron
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
| | - Mika Watanabe
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
| | - Valentina Proserpio
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
- Italian Institute for Genomic Medicine, Candiolo (TO), Italy
| | - Gabriele Piacenti
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
| | - Andrea Lauria
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
- Italian Institute for Genomic Medicine, Candiolo (TO), Italy
| | - Stefan Kaltenbach
- Shmunis School of Biomedicine and Cancer Research, George S Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Annalaura Tamburrini
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
- Italian Institute for Genomic Medicine, Candiolo (TO), Italy
| | - Takuma Nohara
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Francesca Anselmi
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
| | - Carlotta Duval
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
| | - Luca Elettrico
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
| | - Daniela Donna
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
| | - Laura Conti
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy
| | - Denis Baev
- Italian Institute for Genomic Medicine, Candiolo (TO), Italy
| | - Ken Natsuga
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tzachi Hagai
- Shmunis School of Biomedicine and Cancer Research, George S Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Salvatore Oliviero
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy
- Italian Institute for Genomic Medicine, Candiolo (TO), Italy
| | - Giacomo Donati
- Department of Life Sciences and Systems Biology, University of Turin, Torino, Italy.
- Molecular Biotechnology Center 'Guido Tarone', University of Turin, Torino, Italy.
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14
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Baskaran D, Nagamani Y, Merugula S, Premnath SP. MSRFNet for skin lesion segmentation and deep learning with hybrid optimization for skin cancer detection. THE IMAGING SCIENCE JOURNAL 2023. [DOI: 10.1080/13682199.2023.2187518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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15
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Dubois-Pot-Schneider H, Khairallah G, Brzenczek C, Plénat F, Marchal F, Amouroux M. Transcriptomic Study on Human Skin Samples: Identification of Two Subclasses of Actinic Keratoses. Int J Mol Sci 2023; 24:ijms24065937. [PMID: 36983009 PMCID: PMC10058209 DOI: 10.3390/ijms24065937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Actinic keratoses (AKs) are sun-damaged skin areas that affect 20% of the European adult population and more than 50% of people aged 70 years and over. There are currently no clinical or histological features allowing us to identify to which clinical class (i.e., regression or progression) an AK belongs. A transcriptomic approach seems to be a robust tool for AK characterization, but there is a need for additional studies, including more patients and elucidating the molecular signature of an AK. In this context, the present study, including the largest number of patients to date, is the first aiming at identifying biological features to objectively distinguish different AK signatures. We highlight two distinct molecular profiles: AKs featuring a molecular profile similar to squamous cell carcinomas (SCCs), which are called "lesional AKs" (AK_Ls), and AKs featuring a molecular profile similar to normal skin tissue, which are called "non-lesional AKs" (AK_NLs). The molecular profiles of both AK subclasses were studied, and 316 differentially expressed genes (DEGs) were identified between the two classes. The 103 upregulated genes in AK_L were related to the inflammatory response. Interestingly, downregulated genes were associated with keratinization. Finally, based on a connectivity map approach, our data highlight that the VEGF pathway could be a promising therapeutic target for high-risk lesions.
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Affiliation(s)
| | - Grégoire Khairallah
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
- Department of Plastic, Aesthetic and Reconstructive Surgery, Metz-Thionville Regional Hospital, 57530 Ars-Laquenexy, France
| | | | | | - Frédéric Marchal
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
- Département de Chirurgie, Institut de Cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
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16
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FGFR2c Upregulation Contributes to Cancer-Associated Fibroblast Program Activation and to Enhanced Autophagy in Actinic Keratosis-Derived Dermal Fibroblasts: A Possible Role in Precancerous Cell/Stromal Cell Crosstalk. BIOLOGY 2023; 12:biology12030463. [PMID: 36979155 PMCID: PMC10045898 DOI: 10.3390/biology12030463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
Actinic keratosis (AK) is a preneoplastic skin disorder which can rapidly progress to cutaneous squamous cell carcinomas (SCCs). In light of our previous findings, indicating a possible oncogenic role of the mesenchymal isoform of FGFR2 (FGFR2c) aberrantly expressed in AK keratinocytes, we analyzed the possible tumor-promoting role of this receptor in the stromal AK counterpart in this work. Molecular analysis showed that, particularly in early AK lesions, FGFR2c dermal upregulation is accompanied by the downregulation of the cancer-associated fibroblasts (CAF) transcription repressor CSL, the upregulation of the CAF activator ULK3, and the consequent CAF gene induction. Immunofluorescence and molecular analysis, coupled with silencing approaches by siRNA, applied on primary cultures of KIN I-derived fibroblasts, indicated that FGFR2c upregulation contribute to CAF signature and the increased autophagy in response to FGF2. Magnetic bead-based multiplex assay, combined with FGFR2 signaling shut-off approaches, indicated that, especially in response to FGF2, IL-6 secretion could depend on FGFR2c high expression and signaling, suggesting the possible establishment of FGFR2c-dependent secretory autophagy, contributing to tumor-promoting factor release. Overall, our results identified FGFR2c as a signaling molecule involved in controlling precancerous/stromal cell oncogenic crosstalk, pointing to this receptor as a possible early molecular marker predictive for AK’s rapid malignant progression.
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17
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Falkenberg C, Dirschka T, Gilbert G, Stockfleth E, Homey B, Schmitz L. Basal Proliferation and Acantholysis May Represent Histological High-Risk Factors for Progression into Invasive Squamous Cell Carcinoma: A Comparison Study in Solid Organ Transplant Recipients and Matched Immunocompetent Patients. Cancers (Basel) 2023; 15:cancers15061765. [PMID: 36980650 PMCID: PMC10046608 DOI: 10.3390/cancers15061765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Histological risk factors of AKs cannot be directly determined. Recent studies indicate that AKs restricted to the lower third of the epidermis (AK I), with marked basal proliferation (PRO III) and acantholysis, are associated with an increased risk of progression to invasive squamous cell carcinoma (iSCC). To confirm the aforementioned histological risk factors, this study compared AKs from solid organ transplant recipients (sOTRs), known to carry an up to 250-fold higher risk for progression into iSCC, to a matched immunocompetent control group (ICG). In total, 111 AKs from 43 sOTRs showed more AKs (n = 54, 48.7%) graded as AK I compared to 35 AKs (31.5%) in the ICG (p = 0.009). In line with these findings, 89 AKs (80.2%) from sOTRs showed pronounced basal proliferation (PRO III) compared to 37 AKs (33.3%) in the ICG (p < 0.0001). Acantholysis was more frequent in sOTRs than the ICG (59.5% vs. 32.4%, p < 0.0001) and more frequently associated with advanced basal proliferation (p < 0.0001). In conclusion, this study showed that acantholytic AKs graded as AK I and PRO III are predominantly found in a population at high risk of iSCC. Thus, AKs with marked basal proliferation and acantholysis should be assumed to be histological high-risk factors for the progression into iSCC.
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Affiliation(s)
- Conrad Falkenberg
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- CentroDerm Clinic, Heinz-Fangman-Straße 57, 42287 Wuppertal, Germany
| | - Georgia Gilbert
- Edinburgh Medical School, The University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University, 44780 Bochum, Germany
| | - Bernhard Homey
- Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Lutz Schmitz
- CentroDerm Clinic, Heinz-Fangman-Straße 57, 42287 Wuppertal, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University, 44780 Bochum, Germany
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18
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Campione E, Di Prete M, Di Raimondo C, Costanza G, Palumbo V, Garofalo V, Mazzilli S, Franceschini C, Dika E, Bianchi L, Orlandi A. Topical Treatment of Actinic Keratosis and Metalloproteinase Expression: A Clinico-Pathological Retrospective Study. Int J Mol Sci 2022; 23:ijms231911351. [PMID: 36232651 PMCID: PMC9569516 DOI: 10.3390/ijms231911351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Actinic keratosis is an intraepithelial proliferation of atypical keratinocytes that could progress into invasive squamous cell carcinoma. Most evidence suggests an important role of the dermal matrix metalloproteinases in the progression of atypical skin epithelial lesions. We evaluated the clinical efficacy of three different therapeutic modalities (a medical device containing 0.8% piroxicam cream and 50+ sunscreen, photodynamic therapy, and ingenol mebutate gel) to treat suspicious actinic keratoses, which were biopsied for histopathological examination and then analyzed for the expression of matrix metalloproteinases by immunohistochemistry. Clinical, dermoscopic, and reflectance confocal microscopy evaluations revealed a gradual decrease in all standard scores validated for actinic keratosis assessment at the end of the treatments. From a histopathological point of view, we documented the substantial restoration of normal skin architecture, while the immunohistochemical evaluation of matrix metalloproteinases showed a reduction in expression in the treated skin lesions compared to the baseline. As actinic keratoses are considered the precursors of squamous cell carcinoma, their treatment is crucial to prevent the development of a more aggressive disease. Our study monitored the evolution of actinic keratoses subjected to three different topical therapies, with the value of correlating clinical and histopathological findings. Moreover, as the matrix metalloproteinases are largely recognized factors involved in the pathogenesis and evolution of actinic keratosis to squamous cell carcinoma, the demonstration by immunohistochemistry of a reduction in their expression after the treatments adds new valuable concern to the field.
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Affiliation(s)
- Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence:
| | - Monia Di Prete
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cosimo Di Raimondo
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Gaetana Costanza
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Vincenzo Palumbo
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Virginia Garofalo
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Sara Mazzilli
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Chiara Franceschini
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Emi Dika
- Division of Dermatology, Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
- Division of Dermatology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
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Mpourazanis G, Konschake W, Vogiatzis R, Papalexis P, Georgakopoulou VE, Ntritsos G, Sklapani P, Trakas N. The Role and Effectiveness of Photodynamic Therapy on Patients With Actinic Keratosis: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e26390. [PMID: 35911353 PMCID: PMC9332024 DOI: 10.7759/cureus.26390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/05/2022] Open
Abstract
Actinic keratoses (AKs) are the most common neoplastic lesions and are recognized as a precursor to squamous cell skin cancer. Photodynamic therapy (PDT) is a therapeutic option for multiple AKs in line with field cancerization. The aim of this study was to assess the effectiveness of PDT on patients with AKs using a meta-analysis, in order to evaluate the possible superiority of one treatment over the others. For this purpose, the PubMed, MEDLINE, Scopus, OVID, Science Direct, British Journal of Dermatology, Research Gate, and Embase databases were searched in March 2022. The search terms used were 'photodynamic therapy' and 'actinic keratosis'. We utilized the random-effects meta-analysis model to compare methyl aminolevulinate PDT (MAL-PDT) and the combination of a nanoscale-lipid vesicle formulation with the prodrug 5-aminolevulinic acid (BF-200 ALA) on a complete response (CR) of the lesions. Our meta-analysis indicated that the comparison of BF-200 ALA versus MAL-PDT showed marginally higher CRs than MAL-PDT.
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20
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Romero MP, Posso V, Ureña V, Inada N, Bagnato V, Cabrera F. Clinical and histopathologycal study of actinic keratosis treatment with photodynamic therapy VS 5-fluorouracil in face cancerization field. Photodiagnosis Photodyn Ther 2022; 39:102967. [PMID: 35716996 DOI: 10.1016/j.pdpdt.2022.102967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
Actinic keratosis (AK) is one of the most frequent pathologies in clinical practice. The prevalence varies according to the area of incidence and age. Approximately 10% of the prevalence of AK occurs at 30 years of age and rises to 80% at 70 years of life. This study conducted a split-face analysis based on Photodynamic Therapy (MALA-PDT) and 5-fluorouracil (5-FU) treatments in patients with AK. Clinical and histopathological studies evaluated each treatment's efficiency and side effects. Six patients were recruited between 50 and 70 years of age for this. MALA-PDT was applied on the right side of the face. A biodistribution time of 2 hours, a dose of light of 36 J / cm2 (20 min irradiation), a spot for photoirradiation with a total area of 100 cm2, and a wavelength of 635 nm were used. (LINCE equipment MMOPTICS-Brazil). By fluorescence diagnosis, clinical and subclinical AK lesions were evidenced in the area called the "cancerization field." Two cycles of MALA-PDT were performed on each patient, and 5-FU was applied twice daily for 15 days. A 2-month follow-up post-MALA-PDT and post-5-FU was carried out. The treatment based on 5-Flu and MALA-PDT clinically shows the same response, but MALA-PDT is less aggressive than 5-FU. The treatment of AK based on MALA-PDT is a practical, cheap, and easy-to-use technique.
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Affiliation(s)
| | - Verónica Posso
- Servicio de Anatomía Patológica. Hospital Carlos Andrade Marín. Quito, Ecuador.
| | - Valeria Ureña
- Postgrado de Dermatología. Facultad de Medicina Eugenio Espejo, Universidad UTE. Quito, Ecuador.
| | - Natalia Inada
- Instituto de Física. Universidade de São Paulo. São Carlos SP-Brasil.
| | - Vanderlei Bagnato
- Instituto de Física. Universidade de São Paulo. São Carlos SP-Brasil.
| | - Franklin Cabrera
- Servicio de Dermatología. Hospital Carlos Andrade Marín. Quito, Ecuador.
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21
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Baker C, James A, Supranowicz M, Spelman L, Shumack S, Cole J, Weightman W, Sinclair R, Foley P. Method of Assessing Skin Cancerization and Keratoses TM (MASCK™): development and photographic validation in multiple anatomical sites of a novel assessment tool intended for clinical evaluation of patients with extensive skin field cancerization. Clin Exp Dermatol 2022; 47:1144-1153. [PMID: 35150158 PMCID: PMC9313559 DOI: 10.1111/ced.15136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A range of 'field-directed' treatments is available for the management of extensive skin field cancerization (ESFC), but to date, the only validated objective quantitative tools are limited to assessment of actinic keratoses (AKs) affecting the head. AIMS To develop a versatile quantitative instrument for objective clinical assessment of ESFC and perform initial internal validation across multiple anatomical zones. METHODS The study comprised instrument development, pilot testing and instrument refinement and two rounds of reliability and inter-rater validation testing. The study was noninterventional and used a convenience sample of de-identified patient photographs selected based on preset criteria. An expert panel developed the instrument and scoring system via a modified Delphi voting process. A sample of 16 healthcare professionals from multiple specialties undertook the pilot testing, and a panel of seven dermatologists were involved in validation testing. Validation was determined by assessment of overall inter-rater agreement using Gwet chance-corrected agreement coefficients (ACs). RESULTS The instrument produced, called the Method for Assessing Skin Cancer and Keratoses™ (MASCK™), comprises the Skin Field Cancerization Index (SFCIndex), derived from area of skin involvement and AKs (number and thickness), a global assessment score and a cancer-in-zone score, and uses Likert scales for quantitative scoring. The SFCIndex is a composite score comprising the number and thickness of AKs multiplied by area of skin involvement. ACs for the SFCIndex components, the overall SFCIndex score and the global assessment score were > 0.80 (rated 'almost perfect') while the AC for the cancer-in-zone metric was lower (0.33, rated 'fair'). Internal consistency was demonstrated via positive correlation between the overall SFCIndex score and the global assessment score. CONCLUSIONS Our study found near-perfect agreement in inter-rater reliability when using MASCK to assess the severity of ESFC in multiple anatomical sites. Further validation of this novel instrument is planned to specifically assess its reliability, utility and feasibility in clinical practice.
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Affiliation(s)
- Christopher Baker
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia
| | - Amelia James
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia
| | | | | | - Stephen Shumack
- Sydney Medical SchoolUniversity of SydneySydneyNSWAustralia,Department of DermatologyRoyal North Shore HospitalSydneyNSWAustralia
| | - Judith Cole
- Department of DermatologySt John of God HospitalSubiacoWAAustralia
| | - Warren Weightman
- Department of Dermatology Queen Elizabeth HospitalWoodvilleSAAustralia
| | | | - Peter Foley
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia,Probity Medical ResearchSkin Health InstituteMelbourneVic.Australia
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22
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Ratkaj I, Mušković M, Malatesti N. Targeting Microenvironment of Melanoma and Head and Neck Cancers
in Photodynamic Therapy. Curr Med Chem 2022; 29:3261-3299. [DOI: 10.2174/0929867328666210709113032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
Background:
Photodynamic therapy (PDT), in comparison to other skin cancers,
is still far less effective for melanoma, due to the strong absorbance and the role of
melanin in cytoprotection. The tumour microenvironment (TME) has a significant role in
tumour progression, and the hypoxic TME is one of the main reasons for melanoma progression
to metastasis and its resistance to PDT. Hypoxia is also a feature of solid tumours
in the head and neck region that indicates negative prognosis.
Objective:
The aim of this study was to individuate and describe systematically the main
strategies in targeting the TME, especially hypoxia, in PDT against melanoma and head
and neck cancers (HNC), and assess the current success in their application.
Methods:
PubMed was used for searching, in MEDLINE and other databases, for the
most recent publications on PDT against melanoma and HNC in combination with the
TME targeting and hypoxia.
Results:
In PDT for melanoma and HNC, it is very important to control hypoxia levels,
and amongst the different approaches, oxygen self-supply systems are often applied. Vascular
targeting is promising, but to improve it, optimal drug-light interval, and formulation
to increase the accumulation of the photosensitiser in the tumour vasculature, have to
be established. On the other side, the use of angiogenesis inhibitors, such as those interfering
with VEGF signalling, is somewhat less successful than expected and needs to be
further investigated.
Conclusion:
The combination of PDT with immunotherapy by using multifunctional nanoparticles
continues to develop and seems to be the most promising for achieving a
complete and lasting antitumour effect.
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Affiliation(s)
- Ivana Ratkaj
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
| | - Martina Mušković
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
| | - Nela Malatesti
- Department of Biotechnology, University of Rijeka, Rijeka, Croatia
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23
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Garofalo V, Geraci F, Di Prete M, Lanna C, Lozzi F, Cosio T, Lambiase S, Gaeta Schumak R, Di Raimondo C, Diluvio L, Bianchi L, Campione E. Early clinical response to 5-fluorouracil 0.5% and salicylic acid 10% topical solution in the treatment of actinic keratoses of the head: an observational study. J DERMATOL TREAT 2022; 33:2664-2669. [PMID: 35435128 DOI: 10.1080/09546634.2022.2067817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Actinic keratosis is one of the most common dermatological disorders. A new topical solution, constituted by 0.5% 5-fluorouracil and 10% salicylic acid (Actikerall, Almirall) has been introduced in the treatment pipeline of non-hyperkeratotic actinic keratoses of the head and neck. PATIENTS AND METHODS We analyzed in an observational prospective clinical study the short-term treatment effectiveness of 5-fluorouracil and salicylic acid on face and scalp actinic keratoses of grade 1 and 2 of forty patients. Efficacy assessment was performed by clinical dermatological examination, collecting color photographs, calculating AKASI score, and by means of dermoscopy for each target lesion at every visit. RESULTS AKASI score decreased from an initial score of 3.3 to a final score of 0.9. At week 4, we were able to record a complete clearance of 50% of the treated lesions and a partial clearance of 28%. At the end of 12 weeks, 84% of the total lesions showed complete clearance, while 8% had partial clearance. CONCLUSIONS 5-fluorouracil and salicylic acid topical solution is effective in the treatment of mild to moderate actinic keratoses. In the future, further studies are needed to evaluate the chance of adjusting drug dosage according to patients' and actinic keratoses features.
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Affiliation(s)
- Virginia Garofalo
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Francesco Geraci
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Monia Di Prete
- Anatomic Pathology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy.,Anatomic Pathology, Santa Maria di Ca' Foncello Hospital, 31100 Treviso, Italy
| | - Caterina Lanna
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Flavia Lozzi
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Terenzio Cosio
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Sara Lambiase
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Ruslana Gaeta Schumak
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Cosimo Di Raimondo
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Laura Diluvio
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Elena Campione
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
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Spontaneous regression rates of actinic keratosis: a systematic review and pooled analysis of randomized controlled trials. Sci Rep 2022; 12:5884. [PMID: 35393452 PMCID: PMC8990007 DOI: 10.1038/s41598-022-09722-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 12/01/2022] Open
Abstract
Actinic keratosis (AK) are precancerous lesions of the skin which may progress to invasive squamous cell carcinoma. However, single lesions may also persist or even regress and heal spontaneously. Until now, evidence on the natural course of AK including spontaneous regression is limited. We aimed to synthesize regression rates of AK. We performed a systematic literature research in Medline, Embase, and CENTRAL for eligible trials until 3rd March 2020. Spontaneous regression rates were pooled using a random-effects model to calculate pooled proportions of participant-specific and lesion-specific complete clearance rates reported for the placebo arms of randomized controlled trials. Subgroup analyses were performed to dissect differences according to the type of placebo, immunocompetence of the participants, and localization of the lesions. Data from 38 records was included. The pooled participant-specific clearance rate was 8% (95% CI 6–10%, I2 = 71%) while the lesion-specific clearance rate was 23% (95% CI 16–31%, I2 = 97%). The highest participant- and lesion-specific clearance rates were achieved 12 weeks after the end of treatment (12% and 33%, respectively). Subgroup analysis revealed participant- as well as lesion-specific clearance rates of 0% for organ transplant recipients (OTR). We conclude that only a few participants achieve complete regression of their AK without any active treatment. Besides, the results underline that lesion clearance without active treatment is unlikely in OTR. Thus, early and consequent treatment of AK is recommended. Special attention should be paid when treating AK of OTR.
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25
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Juszczak AM, Wöelfle U, Končić MZ, Tomczyk M. Skin cancer, including related pathways and therapy and the role of luteolin derivatives as potential therapeutics. Med Res Rev 2022; 42:1423-1462. [PMID: 35187675 PMCID: PMC9303584 DOI: 10.1002/med.21880] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/16/2021] [Accepted: 01/23/2022] [Indexed: 12/12/2022]
Abstract
Cutaneous malignant melanoma is the fastest growing and the most aggressive form of skin cancer that is diagnosed. However, its incidence is relatively scarce compared to the highest mortality rate of all skin cancers. The much more common skin cancers include nonmelanoma malignant skin cancers. Moreover, over the past several decades, the frequency of all skin cancers has increased much more dynamically than that of almost any other type of cancer. Among the available therapeutic options for skin cancers, chemotherapy used immediately after the surgical intervention has been an essential element. Unfortunately, the main problem with conventional chemopreventive regimens involves the lack of response to treatment and the associated side effects. Hence, there is a need for much more effective anticancer drugs. Correspondingly, the targeted alternatives have involved phytochemicals, which are safer chemotherapeutic agents and exhibit competitive anticancer activity with high therapeutic efficacy. Among polyphenolic compounds, some flavonoids and their derivatives, which are mostly found in medicinal plants, have been demonstrated to influence the modulation of signaling pathways at each stage of the carcinogenesis process, which is also important in the context of skin cancers. Hence, this review focuses on an exhaustive overview of the therapeutic effects of luteolin and its derivatives in the treatment and prevention of skin cancers. The bioavailability and structure–activity relationships of luteolin derivatives are also discussed. This review is the first such complete account of all of the scientific reports concerning this particular group of natural compounds that target a specific area of neoplastic diseases.
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Affiliation(s)
- Aleksandra M. Juszczak
- Department of Pharmacognosy, Faculty of Pharmacy with the Division of Laboratory Medicine Medical University of Białystok Białystok Poland
| | - Ute Wöelfle
- Department of Dermatology and Venereology, Research Center Skinitial, Medical Center, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Marijana Zovko Končić
- Department of Pharmacognosy, Faculty of Pharmacy and Biochemistry University of Zagreb Zagreb Croatia
| | - Michał Tomczyk
- Department of Pharmacognosy, Faculty of Pharmacy with the Division of Laboratory Medicine Medical University of Białystok Białystok Poland
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Exposome and Skin. Part 2. The Influential Role of the Exposome, Beyond UVR, in Actinic Keratosis, Bowen's Disease and Squamous Cell Carcinoma: A Proposal. Dermatol Ther (Heidelb) 2022; 12:361-380. [PMID: 35112326 PMCID: PMC8850498 DOI: 10.1007/s13555-021-00644-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
Actinic keratosis (AK) is the main risk factor for the development of cutaneous invasive squamous cell carcinoma (SCC). It represents the first sign of severe chronic ultraviolet radiation exposure, which has a clear significant effect. Nevertheless, the skin is exposed to many other exposome factors which should be thoroughly considered. Our aim was to assess the impact of exposome factors other than ultraviolet radiation (UVR) on the etiopathology of AK and Bowen's disease (BD) and progression of AK to SCC and to design tailored prevention strategies. We performed an exhaustive literature search in September 2021 through PubMed on the impact of exposome factors other than UVR on AK, BD and SCC. We conducted several parallel searches combining terms of the following topics: AK, BD, SCC and microbiome, hormones, nutrition, alcohol, tobacco, viral infections, chemical contaminants and air pollution. Notably, skin microbiome studies have shown how Staphylococcus aureus infections are associated with AK and AK-to-SCC progression by the production of chronic inflammation. Nutritional studies have demonstrated how a caloric restriction in fat intake, oral nicotinamide and moderate consumption of wine significantly reduce the number of premalignant keratoses and SCC. Regarding lifestyle factors, both alcohol and smoking are associated with the development of SCC in a dose-dependent manner. Relevant environmental factors are viral infections and chemical contaminants. Human papillomavirus infections induce deregulation of cellular proliferation and are associated with AK, BD and SCC. In addition to outdoor jobs, occupations such as industrial processing and farming also increase the risk of developing keratoses and SCC. The exposome of AK will undoubtedly help the understanding of its etiopathology and possible progression to SCC and will serve as a basis to design tailored prevention strategies.
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Pazzini JM, Moreira SH, Cassino P, Maronezi M, Zangirolami M, Gomés JLA, Bertolo PH, Rocha MDCP, Fiebi SP, Kajiura C, Bernardes FJ, Bustamante C, Nardi ABD. Skin graft associated with platelet-rich plasma in correcting extensive injuries resulting from the resection of skin cancer chemically induced in rats. Acta Cir Bras 2022; 36:e361203. [PMID: 35019065 PMCID: PMC8734959 DOI: 10.1590/acb361203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/10/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate whether using platelet-rich plasma (PRP) in the graft recipient
bed after the resection of a neoplasia can influence its recurrence because
this product stimulates angiogenesis, mitogenesis and chemotaxis. Methods: A study with 30 rats Wistar (Rattus norvegicus albinus),
which were separated into group A (induction of carcinogenesis, PRP in the
postoperative period) and group B (induction of carcinogenesis, absence of
PRP in the postoperative period), with 15 animals in each. Carcinogenesis
was induced on the skin of the animals’ chest by the topical application of
0.5% dimethylbenzantracene (DMBA) diluted in acetone. After surgical
resection of the induced neoplasia, PRP was used to stimulate angiogenesis
before surgical wound synthesis. Data on the control and experimental groups
and macroscopic and microscopic variables were evaluated using analysis of
variance and the Tukey’s test (5%). Results: It was possible to determine that the use of PRP is good in reconstructive
surgeries, but it is contraindicated in patients during tumor resection, as
it can cause changes in the surgical bed, in addition to stimulating
recurrences and metastases. Conclusions: PRP may interact with tumour cells that were in the recipient site of the
surgical wound during the resection of a neoplasia, and a local recurrence
process can be triggered by applying this product.
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Zha X, Li Y, Wang J, Xiao W, Liu J. Risk factors for actinic keratoses: A systematic review and meta-analysis. Indian J Dermatol 2022; 67:92. [PMID: 35656236 PMCID: PMC9154173 DOI: 10.4103/ijd.ijd_859_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To integrate evidence and assess the risk factors associated with actinic keratosis (AK). Methods Unrestricted searches were conducted on five electronic databases, with an end-date parameter of September 2021. We summarized the study characteristics and pooled the results from individual studies by using a random-effects model. The risk of bias was estimated using the Cochrane Risk of Bias Tool, and the quality of evidence was estimated according to the Newcastle-Ottawa Scale. Results Sixteen studies were included in final analysis, and we assessed the AK risk among a variety of risk factors. Overall, the male sex (odds ratio (OR): 2.51; 95% confidence interval (CI): 1.94-3.25; P < 0.01), age >45 years (OR = 7.65, 95% CI: 2.95-19.86; P < 0.01), light Fitzpatrick skin phototype (OR = 2.32, 95% CI: 1.74-3.10; P < 0.01), light hair color (OR = 2.17, 95% CI: 1.40-3.36; P < 0.01), light eye color (OR = 1.67, 95% CI: 1.03-2.70; P = 0.04), freckles on face/arms (OR = 1.88, 95% CI: 1.37-2.58; P < 0.01), suffered positive history of other types of non-melanoma skin cancer (OR = 4.46, 95% CI: 2.71-7.33; P < 0.01), sunburns in childhood (OR = 2.33, 95% CI: 1.47-3.70; P < 0.01) and adulthood (OR = 1.50, 95% CI: 1.12-2.00; P < 0.01), severe sunburn (OR = 1.94, 95% CI: 1.62-2.31; P < 0.01), and chronic occupational and/or recreational sun exposure (OR = 3.22, 95% CI: 2.16-4.81; P < 0.01) increased the risk of AK. Moreover, sunscreen use (OR = 0.51, 95% CI: 0.34-0.77; P < 0.01) and history of atopy reduced the risk of AK. Sensitivity analysis yielded consistent results. The included studies showed a high risk of bias. Conclusion We confirm several well-known AK risk factors and their quantitative data, and summarized the uncommon risk factors and protective factors. Our results may inform on the design and implementation of AK screening and educational programs.
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29
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Cinotti E, Tognetti L, Cartocci A, Lamberti A, Gherbassi S, Orte Cano C, Lenoir C, Dejonckheere G, Diet G, Fontaine M, Miyamoto M, Perez‐Anker J, Solmi V, Malvehy J, del Marmol V, Perrot JL, Rubegni P, Suppa M. Line-field confocal optical coherence tomography for actinic keratosis and squamous cell carcinoma: a descriptive study. Clin Exp Dermatol 2021; 46:1530-1541. [PMID: 34115900 PMCID: PMC9293459 DOI: 10.1111/ced.14801] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early and accurate diagnosis of cutaneous squamous cell carcinomas (SCCs) and actinic keratoses (AK) is fundamental to reduce their associated morbidity and to select the correct treatment. Line-field confocal optical coherence tomography (LC-OCT) is a new imaging device that can characterize healthy skin and basal cell carcinoma, but no large studies on keratinocyte cell tumours have yet been published. AIM To identify and describe LC-OCT criteria associated with SCC and AK, and to compare LC-OCT findings in these tumours. METHODS A retrospective observational multicentre study was conducted. Lesions were imaged with the LC-OCT device before surgery and examined histologically. LC-OCT criteria for AK/SCC were identified and their presence was evaluated in all study lesions. Univariate and multivariate analyses were performed to compare AK and SCCs, and to investigate differences between in situ and invasive tumours. RESULTS In total, 158 patients with 50 AK and 108 SCCs (62 in situ and 46 invasive) were included. Cytological and architectural alterations were found in most lesions, and differences were found between AK and SCCs. Although the visualization of the dermoepidermal junction (DEJ) was often hampered by hyperkeratosis and acanthosis, an outlined DEJ without broad strands was observed in almost all AK and almost all in situ SCCs, but in only three invasive SCCs (P < 0.001) when the DEJ was detectable. CONCLUSION Our results suggest that LC-OCT can help clinicians in the identification of AK and SCC and their differentiation, providing a real-time and noninvasive examination. Further studies are needed to confirm our data.
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Affiliation(s)
- E. Cinotti
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - L. Tognetti
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - A. Cartocci
- Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - A. Lamberti
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - S. Gherbassi
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - C. Orte Cano
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - C. Lenoir
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - G. Dejonckheere
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - G. Diet
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - M. Fontaine
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - M. Miyamoto
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - J. Perez‐Anker
- Melanoma UnitHospital Clinic BarcelonaUniversity of BarcelonaBarcelonaSpain
- CIBER de Enfermedades RarasInstituto de Salud Carlos IIIBarcelonaSpain
| | - V. Solmi
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - J. Malvehy
- Melanoma UnitHospital Clinic BarcelonaUniversity of BarcelonaBarcelonaSpain
- CIBER de Enfermedades RarasInstituto de Salud Carlos IIIBarcelonaSpain
| | - V. del Marmol
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - J. L. Perrot
- Department of DermatologyUniversity Hospital of Saint‐EtienneSaint‐EtienneFrance
| | - P. Rubegni
- Dermatology UnitDepartment of MedicalSurgical and Neurological SciencesUniversity of SienaSienaItaly
| | - M. Suppa
- Department of DermatologyHôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
- Department of DermatologyInstitut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
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Xu D, Sun JF, Qi RQ, Zhang W, Dong LD, Liu TY, Zheng S, Niu RX, Zhang J, Cui TT, He L, Chen HD. A multicenter retrospective analysis of the clinical and pathological characteristics of 1188 cases of actinic keratosis in different ultraviolet radiation intensity areas of China. J Cosmet Dermatol 2021; 21:2879-2888. [PMID: 34719097 DOI: 10.1111/jocd.14479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Actinic keratosis (AK) is a precancerous disease, caused by ultraviolet radiation (UV). OBJECTIVE To analyze the clinical and pathological characteristics of AK in four areas with different ultraviolet radiation intensities. METHODS 1188 diagnosed AK patients, from January 2000 to July 2015, in dermatology department of four hospitals were collected. The UV intensity of hospital located cities from high to low is Kunming, Yinchuan, Shenyang and Nanjing. The information comes from medical records, and the pathological types and Keratinocyte Intraepithelial Neoplasia (KIN) grades were checked by two experienced pathologists. All information was conducted a retrospective multicenter research. RESULTS The patients were mainly middle-aged and elderly female, which was in direct contrast to the majority of men in European. The age of onset in Kunming group was lower than that in Yinchuan Group (p = 0.013) and Nanjing Group (p < 0.01). The course of disease in Kunming group was significantly shorter than that in Nanjing Group (p < 0.001). The lesions were almost located in the exposed area. The proportion of unexposed areas in Shenyang group was significantly higher than that in other groups (p < 0.001). There were statistical differences in pathological morphological classification among the four groups. These differences were not affected by age and gender. The number of KIN III grade patients in Shenyang group was significantly higher than that in other three groups (p < 0.05). CONCLUSION The Asian patients were mainly female. The clinical characteristics of AK are closely related to UV intensity, and environmental pollution, lifestyle, religious beliefs and other factors are also related.
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Affiliation(s)
- Dan Xu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian-Fang Sun
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Rui-Qun Qi
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
| | - Wei Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Ling-Di Dong
- Department of Dermatology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Tong-Yun Liu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Song Zheng
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
| | - Rui-Xian Niu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Juan Zhang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ting-Ting Cui
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hong-Duo Chen
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
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How to Assess the Efficacy of Interventions for Actinic Keratosis? A Review with a Focus on Long-Term Results. J Clin Med 2021; 10:jcm10204736. [PMID: 34682859 PMCID: PMC8538594 DOI: 10.3390/jcm10204736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Actinic keratoses (AK) are common lesions of the skin caused by cumulative sun exposure. Since AK may progress to invasive cutaneous squamous cell carcinoma (cSCC), guidelines uniformly recommend early and consequent treatment. A variety of interventions are available; however, most randomized controlled trials, meta-analyses, and guidelines focus on outcomes that are usually evaluated 8–12 weeks after the end of treatment. Importantly, these assessments can capture the short-term, transient outcomes, but do not allow any conclusions about long-term results to be drawn and do not reflect the probability of transition towards cSCC. Until now, few studies have assessed the long-term results of interventions for AK. Indeed, finding the most appropriate end-point and adjunct time point for determining the long-term results of interventions for AK remains a challenge. Here, we provide an overview of the different ways of measuring the efficacy of AK treatments, such as using recurrence rates or sustained clearance rates, and discuss methodological aspects. Furthermore, we highlight the importance of evidence from post-marketing surveillance trials for the detection of efficacy values and safety signals. Additionally, we emphasize that a follow-up period of 12 months might not be sufficient to reflect the long-term results and stress the urgent need for a longer follow-up period and regular risk-stratified surveillance.
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Guidelines of care for the management of actinic keratosis. J Am Acad Dermatol 2021; 85:e209-e233. [PMID: 33820677 DOI: 10.1016/j.jaad.2021.02.082] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. OBJECTIVE This analysis examined the literature related to the management of AK to provide evidence-based recommendations for treatment. Grading, histologic classification, natural history, risk of progression, and dermatologic surveillance of AKs are also discussed. METHODS A multidisciplinary Work Group conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus. RESULTS Analysis of the evidence resulted in 18 recommendations. LIMITATIONS This analysis is based on the best available evidence at the time it was conducted. The pragmatic decision to limit the literature review to English language randomized trials may have excluded data published in other languages or limited identification of relevant long-term follow-up data. CONCLUSIONS Strong recommendations are made for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are made for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.
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Spandau DF, Chen R, Wargo JJ, Rohan CA, Southern D, Zhang A, Loesch M, Weyerbacher J, Tholpady SS, Lewis DA, Kuhar M, Tsai KY, Castellanos AJ, Kemp MG, Markey M, Cates E, Williams AR, Knisely C, Bashir S, Gabbard R, Hoopes R, Travers JB. Randomized controlled trial of fractionated laser resurfacing on aged skin as prophylaxis against actinic neoplasia. J Clin Invest 2021; 131:e150972. [PMID: 34428179 PMCID: PMC8483749 DOI: 10.1172/jci150972] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/18/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUNDThe loss of insulin-like growth factor 1 (IGF-1) expression in senescent dermal fibroblasts during aging is associated with an increased risk of nonmelanoma skin cancer (NMSC). We tested how IGF-1 signaling can influence photocarcinogenesis during chronic UVB exposure to determine if fractionated laser resurfacing (FLR) of aged skin, which upregulates dermal IGF-1 levels, can prevent the occurrence of actinic keratosis (AK) and NMSC.METHODSA human skin/immunodeficient mouse xenografting model was used to test the effects of a small molecule inhibitor of the IGF-1 receptor on chronic UVB radiation. Subsequently, the durability of FLR treatment was tested on a cohort of human participants aged 65 years and older. Finally, 48 individuals aged 60 years and older with considerable actinic damage were enrolled in a prospective randomized clinical trial in which they underwent a single unilateral FLR treatment of one lower arm. Numbers of AKs/NMSCs were recorded on both extremities for up to 36 months in blinded fashion.RESULTSXenografting studies revealed that chronic UVB treatment with a topical IGF-1R inhibitor resulted in a procarcinogenic response. A single FLR treatment was durable in restoring appropriate UVB response in geriatric skin for at least 2 years. FLR resulted in sustained reduction in numbers of AKs and decreased numbers of NMSCs in the treated arm (2 NMSCs) versus the untreated arm (24 NMSCs).CONCLUSIONThe elimination of senescent fibroblasts via FLR reduced the procarcinogenic UVB response of aged skin. Thus, wounding therapies are a potentially effective prophylaxis for managing high-risk populations.TRIAL REGISTRATIONClinicalTrials.gov (NCT03906253).FUNDINGNational Institutes of Health, Veterans Administration.
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Affiliation(s)
- Dan F. Spandau
- Department of Biochemistry and Molecular Biology and
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Roy Chen
- Department of Pharmacology & Toxicology and
| | - Jeffrey J. Wargo
- Department of Dermatology, Boonshoft School of Medicine at Wright State University, Dayton, Ohio, USA
| | - Craig A. Rohan
- Department of Pharmacology & Toxicology and
- Department of Dermatology, Boonshoft School of Medicine at Wright State University, Dayton, Ohio, USA
| | - David Southern
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Angela Zhang
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mathew Loesch
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan Weyerbacher
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sunil S. Tholpady
- Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
- Department of Surgery and
| | - Davina A. Lewis
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Matthew Kuhar
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kenneth Y. Tsai
- Departments of Anatomic Pathology and Tumor Biology, Moffit Cancer Center, Tampa, Florida, USA
| | | | | | - Michael Markey
- Department of Dermatology, Boonshoft School of Medicine at Wright State University, Dayton, Ohio, USA
| | | | | | | | | | | | | | - Jeffrey B. Travers
- Department of Pharmacology & Toxicology and
- Department of Biochemistry and Molecular Biology, Boonshoft School of Medicine at Wright State University, Dayton, Ohio, USA
- Dayton Veterans Administration Medical Center, Dayton, Ohio, USA
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34
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Pinto D, Trink A, Giuliani G, Rinaldi F. Protective effects of sunscreen (50+) and octatrienoic acid 0.1% in actinic keratosis and UV damages. J Investig Med 2021; 70:92-98. [PMID: 34531252 PMCID: PMC8717479 DOI: 10.1136/jim-2021-001972] [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] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
Actinic keratosis is a form of dysplastic epidermal lesion resulting from chronic and excessive UV exposure with a certain risk of becoming cancerous. Current guidelines advocated the use of sunscreens to prevent photodamage. An efficient photoprotection must involve both primary protective factors such as UV filters and secondary factors (eg, antioxidants) able to disrupt the photochemical and genetic cascade triggered by UVs. An in vitro model of human skin (Phenion FT) was used to assess the photoprotective potential of a sunscreen containing inorganic sun-filters (50+ SPF) and 0.1% octatrienoic acid (KERA’+) after UVA (10 J/cm2) and UVB (25 mJ/cm2) by means of evaluation of the number of sunburn cells (SBCs) and apoptotic keratinocytes. Also resulting alterations in the gene expression of markers involved in apoptosis (Tumor protein 53), inflammation/immunosuppression (IL-6 and IL-8), oxidative stress (oxidative stress response enzyme heme oxygenase 1), remodeling (metalloproteinase 1) and cell-cell adhesion (E-cadherin) were investigated. Gene expression was investigated using quantitative real-time PCR. This work demonstrated that the sunscreen preparations under study (with and without 0.1% octatrienoic acid, respectively) can be distinguished about their ability to prevent UVs-induced damage. Synergism between the inorganic filters and 0.1% octatrienoic acid was found (KERA’+) on all end points analyzed and this effect was found to be statistically significant (p<0.05). Our data revealed that topical application of a sunscreen containing inorganic filters (50+SPF) and 0.1% octatrienoic acid can protect from SBC formation, reduce the number of apoptotic keratinocytes and protect from the main molecular alterations caused by UV radiations.
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Affiliation(s)
| | - Anna Trink
- Human Microbiome Advanced Project, Milan, Italy
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35
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Steeb T, Wessely A, Petzold A, Brinker TJ, Schmitz L, Leiter U, Garbe C, Schöffski O, Berking C, Heppt MV. Evaluation of Long-term Clearance Rates of Interventions for Actinic Keratosis: A Systematic Review and Network Meta-analysis. JAMA Dermatol 2021; 157:1066-1077. [PMID: 34347015 DOI: 10.1001/jamadermatol.2021.2779] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Multiple interventions are available for the treatment of actinic keratosis (AK). However, most randomized clinical trials and meta-analyses focus on short-term efficacy outcomes. Objective To investigate and synthesize the long-term efficacy (≥12 months) of interventions for AK from parallel-arm randomized clinical trials. Data Sources Searches in MEDLINE, Embase, and Central were conducted from inception until April 6, 2020. The reference lists of the included studies and pertinent trial registers were hand searched. The study was completed February 27, 2021. Study Selection Two reviewers screened the titles and abstracts of 2741 records. Finally, 17 published reports (original studies and follow-up reports) referring to 15 independent randomized clinical trials with an overall sample size of 4252 patients were included. Data Extraction and Synthesis Two reviewers independently extracted data on study, patient, and intervention characteristics. Network meta-analysis (NMA) of each outcome was conducted with a frequentist approach. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidance for NMA was used to assess the certainty of evidence. The revised Cochrane risk-of-bias tool for randomized clinical trials was used to evaluate the methodologic quality. Main Outcomes and Measures Participant complete clearance, participant partial clearance, and lesion-specific clearance were the outcomes, with each assessed at least 12 months after the end of treatment. Results Data from 15 independent randomized clinical trials including 4252 patients were extracted and synthesized. Ten studies were included in an NMA for the outcome of participant complete clearance, with photodynamic therapy with aminolevulinate (ALA-PDT) showing the most favorable risk ratio (RR) compared with placebo (RR, 8.06; 95% CI, 2.07-31.37; GRADE, moderate), followed by imiquimod, 5% (RR, 5.98; 95% CI, 2.26-15.84; GRADE, very low), photodynamic therapy with methyl aminolevulinate (MAL-PDT) (RR, 5.95; 95% CI, 1.21-29.41; GRADE, low), and cryosurgery (RR, 4.67; 95% CI, 1.36-16.66; GRADE, very low). Similarly, ALA-PDT had the highest RR in the NMA for lesion-specific clearance (RR, 5.08; 95% CI, 2.49-10.33; GRADE, moderate). No NMA was possible for participant partial clearance owing to poor reporting of this outcome. Conclusions and Relevance This systematic review and network meta-analysis found that therapy including ALA-PDT, imiquimod, 5%, MAL-PDT, and cryosurgery was associated with significant long-term efficacy in the NMA. This study provides data for a possible use in an evidence-based framework for selecting interventions with sustained lesion clearance.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Anne Petzold
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lutz Schmitz
- Department of Dermatology, Ruhr-University, Bochum, Germany.,Institute of Dermatopathology, MVZ Corius DermPathBonn, Bonn, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Oliver Schöffski
- School of Business, Economics and Society, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Nürnberg, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
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Sartini D, Campagna R, Lucarini G, Pompei V, Salvolini E, Mattioli-Belmonte M, Molinelli E, Brisigotti V, Campanati A, Bacchetti T, Ferretti G, Offidani A, Emanuelli M. Differential immunohistochemical expression of paraoxonase-2 in actinic keratosis and squamous cell carcinoma. Hum Cell 2021; 34:1929-1931. [PMID: 34302630 DOI: 10.1007/s13577-021-00581-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Davide Sartini
- Department of Clinical Sciences, Marche Polytechnic University, Ancona, Italy
| | - Roberto Campagna
- Department of Clinical Sciences, Marche Polytechnic University, Ancona, Italy
| | - Guendalina Lucarini
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Veronica Pompei
- Department of Clinical Sciences, Marche Polytechnic University, Ancona, Italy
| | - Eleonora Salvolini
- Department of Clinical Sciences, Marche Polytechnic University, Ancona, Italy.
| | | | - Elisa Molinelli
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Valerio Brisigotti
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Anna Campanati
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Tiziana Bacchetti
- Department of Life and Environmental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Gianna Ferretti
- Department of Clinical Sciences, Marche Polytechnic University, Ancona, Italy
| | - Annamaria Offidani
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Monica 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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37
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Van der Weyden L, O'Dell N, Avenant A, Pazzi P, Koeppel KN. Successful treatment of early cutaneous squamous cell carcinoma with hypofractionated radiation therapy in an African lion (Panthera leo). J S Afr Vet Assoc 2021; 92:e1-e6. [PMID: 34212735 PMCID: PMC8252176 DOI: 10.4102/jsava.v92i0.2134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/09/2022] Open
Abstract
Cutaneous squamous cell carcinoma (SCC) is a slow growing but locally invasive neoplasm, most commonly caused by prolonged exposure to ultraviolet (UV) radiation. Whilst SCC accounts for 15% of skin tumours in domesticated cats, cutaneous SCC in non-domesticated felids (apart from captive snow leopards) appears to be uncommon, with only three reports in the literature to date. In this report, a captive African lion (Panthera leo) presented with two ulcerative lesions on the nasal planum. Histopathology of the lesions revealed epidermal keratinocyte dysplasia and neoplastic basal- and supra-basal epithelial cells with dyskeratosis and evidence of basement membrane breaching and dermal invasion, consistent with a diagnosis of SCC. There was also evidence of laminar fibrosis and inflammation of the subjacent dermis suggesting that the SCC most likely resulted from UV-induced neoplastic transformation of the epidermal squamous epithelium following actinic keratosis. The lion was treated with hypofractionated radiation therapy and remained in remission until his death (euthanised 17 months later because of age-related chronic renal failure). This is the first report of cutaneous SCC in a lion with evidence of actinic damage and resolution after radiation therapy.
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38
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Ruini C, Schuh S, Gust C, Hartmann D, French LE, Sattler EC, Welzel J. In-Vivo LC-OCT Evaluation of the Downward Proliferation Pattern of Keratinocytes in Actinic Keratosis in Comparison with Histology: First Impressions from a Pilot Study. Cancers (Basel) 2021; 13:2856. [PMID: 34201052 PMCID: PMC8228287 DOI: 10.3390/cancers13122856] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
It is known that actinic keratoses (AKs) can progress to invasive squamous cell carcinoma (SCC). The histological PRO grading of AKs is based on the growth pattern of basal keratinocytes and relates to their progression risk. AKs can be non-invasively characterized by line-field confocal optical coherence tomography (LC-OCT). The aim of the study was to define criteria for an LC-OCT grading of AKs based on the PRO classification and to correlate it with its histological counterpart. To evaluate the interobserver agreement for the LC-OCT PRO classification, fifty AKs were imaged by LC-OCT and biopsied for histopathology. PRO histological grading was assessed by an expert consensus, while two evaluator groups separately performed LC-OCT grading on vertical sections. The agreement between LC-OCT and histological PRO grading was 75% for all lesions (weighted kappa 0.66, 95% CI 0.48-0.83, p ≤ 0.001) and 85.4% when comparing the subgroups PRO I vs. PRO II/III (weighted kappa 0.64, 95% CI 0.40-0.88, p ≤ 0.001). The interobserver agreement for LC-OCT was 90% (Cohen's kappa 0.84, 95% CI 0.71-0.91, p ≤ 0.001). In this pilot study, we demonstrated that LC-OCT is potentially able to classify AKs based on the basal growth pattern of keratinocytes, in-vivo reproducing the PRO classification, with strong interobserver agreement and a good correlation with histopathology.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Sandra Schuh
- Department of Dermatology and Allergy, University Hospital, 86156 Augsburg, Germany;
| | - Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Lars Einar French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Elke Christina Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Julia Welzel
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
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Holzscheck N, Falckenhayn C, Söhle J, Kristof B, Siegner R, Werner A, Schössow J, Jürgens C, Völzke H, Wenck H, Winnefeld M, Grönniger E, Kaderali L. Modeling transcriptomic age using knowledge-primed artificial neural networks. NPJ Aging Mech Dis 2021; 7:15. [PMID: 34075044 PMCID: PMC8169742 DOI: 10.1038/s41514-021-00068-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 04/26/2021] [Indexed: 02/04/2023] Open
Abstract
The development of 'age clocks', machine learning models predicting age from biological data, has been a major milestone in the search for reliable markers of biological age and has since become an invaluable tool in aging research. However, beyond their unquestionable utility, current clocks offer little insight into the molecular biological processes driving aging, and their inner workings often remain non-transparent. Here we propose a new type of age clock, one that couples predictivity with interpretability of the underlying biology, achieved through the incorporation of prior knowledge into the model design. The clock, an artificial neural network constructed according to well-described biological pathways, allows the prediction of age from gene expression data of skin tissue with high accuracy, while at the same time capturing and revealing aging states of the pathways driving the prediction. The model recapitulates known associations of aging gene knockdowns in simulation experiments and demonstrates its utility in deciphering the main pathways by which accelerated aging conditions such as Hutchinson-Gilford progeria syndrome, as well as pro-longevity interventions like caloric restriction, exert their effects.
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Affiliation(s)
- Nicholas Holzscheck
- Front End Innovation, Beiersdorf AG, Hamburg, Germany.
- Institute for Bioinformatics, University Medicine Greifswald, Greifswald, Germany.
| | | | - Jörn Söhle
- Front End Innovation, Beiersdorf AG, Hamburg, Germany
| | - Boris Kristof
- Front End Innovation, Beiersdorf AG, Hamburg, Germany
| | - Ralf Siegner
- Front End Innovation, Beiersdorf AG, Hamburg, Germany
| | - André Werner
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Janka Schössow
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Clemens Jürgens
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Horst Wenck
- Front End Innovation, Beiersdorf AG, Hamburg, Germany
| | | | | | - Lars Kaderali
- Institute for Bioinformatics, University Medicine Greifswald, Greifswald, Germany.
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Tanaka R, Tanese K, Zhu Y, Fujio Y, Konohana I, Kurihara Y. Follicular extension of atypical keratinocytes predicts the resistance of actinic keratosis to topical imiquimod treatment: A single-center retrospective analysis. J Dermatol 2021; 48:1262-1267. [PMID: 33896047 DOI: 10.1111/1346-8138.15914] [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: 02/14/2021] [Revised: 03/17/2021] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
Topical imiquimod therapy has been widely used for actinic keratosis (AK). However, some cases are refractory to treatment. Therefore, an indicator that can predict its efficacy is desired. Herein, we retrospectively analyzed 52 AK lesions treated with imiquimod to investigate the characteristics of refractory lesions. Imiquimod was applied in a cycle of three times weekly for 4 weeks, followed by a 4-week break. This treatment cycle was repeated up to three times and treatment responses were evaluated. As a result, a complete response (CR) was observed in 78.8% (41/52) of lesions. Next, treatment response of lesions was correlated with clinicopathological characteristics including clinical morphology and thickness, pathological morphology and thickness, and presence of follicular extension (FE). Of these, lesions with FE were significantly less responsive to imiquimod treatment; while 92.6% of AK lesions without FE achieved a CR, only 64.0% of AK lesions with FE achieved a CR (p = 0.029). Logistic regression analysis revealed that FE was the sole significant predictor of its efficacy (p = 0.019). These results suggest that preliminary histological evaluation of FE may be useful to predict the efficacy of imiquimod for AK.
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Affiliation(s)
- Ryo Tanaka
- Department of Dermatology, Hiratsuka City Hospital, Hiratsuka, Japan.,Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Keiji Tanese
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yingyao Zhu
- Department of Dermatology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Yumi Fujio
- Department of Dermatology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Izumi Konohana
- Department of Dermatology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Yuichi Kurihara
- Department of Dermatology, Hiratsuka City Hospital, Hiratsuka, Japan
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Heerfordt IM, Poulsen T, Wulf HC. Actinic keratoses contiguous with squamous cell carcinomas are mostly non-hyperkeratotic and with severe dysplasia. J Clin Pathol 2021; 75:560-563. [PMID: 33863749 DOI: 10.1136/jclinpath-2021-207497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/03/2022]
Abstract
AIMS Actinic keratosis (AK) is a precursor of cutaneous squamous cell carcinoma (SCC). No validated parameters can predict which AKs will progress into SCCs, but especially thick AKs are under suspicion. The clinical and histopathological thickness of AKs is strongly correlated. This study aimed to investigate the thicknesses and degree of dysplasia of AKs contiguous with SCCs assuming these AKs represent the AKs that have undergone malignant transformation. METHODS Files of the Pathology Department, Hospital of Southern Jutland, Denmark, were reviewed. 111 cases met the inclusion criteria: a skin biopsy containing an invasive SCC. All SCCs merged with an AK at the edge. Degree of dysplasia, epidermal thickness and stratum corneum thicknesses of AKs were measured. RESULTS All AKs showed severe dysplasia. Most AKs had a stratum corneum thickness under 0.1 mm and an epidermal thickness under 0.5 mm, corresponding to clinically thin and non-hyperkeratotic AKs. CONCLUSIONS Our result suggests malignant progression potential of AKs regardless of thickness.
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Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Thomas Poulsen
- Department of Pathology, Hospital of Southern Jutland, Soenderborg, Denmark
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Persechino F, Ranieri D, Guttieri L, Nanni M, Torrisi MR, Belleudi F. Expression Profile of Fibroblast Growth Factor Receptors, Keratinocyte Differentiation Markers, and Epithelial Mesenchymal Transition-Related Genes in Actinic Keratosis: A Possible Predictive Factor for Malignant Progression? BIOLOGY 2021; 10:biology10040331. [PMID: 33920760 PMCID: PMC8071104 DOI: 10.3390/biology10040331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
Abstract
Simple Summary In this work, we checked the modulation of Fibroblast Growth Factor Receptors (FGFRs) along with differentiation-related and epithelial-to-mesenchymal transition (EMT)-related markers to identify expression profiles that could be predictive for actinic keratosis (AK) progression through the “differentiated” pathway. We found that the downregulation of the analyzed differentiation markers, but not the modulation of the EMT-related markers, correlated with the canonical progression of AK. In addition, the observed modulation of FGFR2 mesenchymal/epithelial isoforms compatible with FGFR2 isoform switch, as well as the upregulation of FGFR4 suggested their correlation with early steps of AK pathogenesis. In contrast, the increase of mesenchymal FGFR3c isoform expression appeared to suggest that this event correlated with late steps of AK progression. In addition, the strong modulation of filaggrin (FIL), Snail1, as well as of FGFR2c, FGFR4, and their ligand Fibroblast Growth Factor 2 (FGF2), observed in some of the keratinocytic intraepithelial neoplasia grade I (KIN I) samples, may indicate that they could be molecular markers predictive for those KIN I lesions destined to a direct progression to squamous cell carcinoma (SCC) through the “differentiated” pathway. Abstract Actinic keratosis (AK) is the ultra violet (UV)-induced preneoplastic skin lesion clinically classified in low (KIN I), intermediate (KIN II), and high (KIN III) grade lesions. In this work we analyzed the expression of Fibroblast Growth Factor Receptors (FGFRs), as well as of keratinocyte differentiation and epithelial-to-mesenchymal transition (EMT)-related markers in differentially graded AK lesions, in order to identify specific expression profiles that could be predictive for direct progression of some KIN I lesions towards squamous cell carcinoma (SCC). Our molecular analysis showed that the keratinocyte differentiation markers keratin 1 (K1), desmoglein-1 (DSG1), and filaggrin (FIL) were progressively downregulated in KIN I, II, and III lesions, while the modulation of epithelial/mesenchymal markers and the induction of the transcription factors Snail1 and Zinc finger E-box-binding homeobox 1 (ZEB1) compatible with pathological EMT, even if observable, did not appear to correlate with AK progression. Concerning FGFRs, a modulation of epithelial isoform of FGFR2 (FGFR2b) and the mesenchymal FGFR2c isoform compatible with an FGFR2 isoform switch, as well as FGFR4 upregulation were observed starting from KIN I lesions, suggesting that they could be events involved in early steps of AK pathogenesis. In contrast, the increase of FGFR3c expression, mainly appreciable in KIN II and KIN III lesions, suggested a correlation with AK late progression. Interestingly, the strong modulation of FIL, Snail1, as well as of FGFR2c, FGFR4, and of their ligand FGF2, observed in some of the KIN I samples, may indicate that they could be molecular markers predictive for those low graded lesions destined to a direct progression to SCC. In conclusion, our data point on the identification of molecular markers predictive for AK rapid progression through the “differentiated” pathway. Our results also represent an important step that, in future, will help to clarify the molecular mechanisms underlying FGFR signaling deregulation in epithelial tissues during the switch from the pre-neoplastic to the oncogenic malignant phenotype.
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Affiliation(s)
- Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
| | - Danilo Ranieri
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
| | - Luisa Guttieri
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
| | - Monica Nanni
- Tissue Biology Research Unit, Department of Surgery, University Children’s Hospital, CH–8032 Zurich, Switzerland;
| | - Maria Rosaria Torrisi
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
- S. Andrea University Hospital, 00100 Rome, Italy
| | - Francesca Belleudi
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
- Correspondence:
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Zhang Y, Tan L, Huang J, Tang Z, Tong X, Gao L, Zeng J. In vivo reflectance confocal microscopy for monitoring actinic keratosis treated with 5-aminolevulinic acid photodynamic therapy. Skin Res Technol 2021; 27:871-879. [PMID: 33847402 DOI: 10.1111/srt.13036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Actinic keratosis (AK) occurs frequently in sun-exposed skin while its diagnosis and treatment were still in exploration. MATERIALS AND METHODS Thirty two patients with facial AK lesions were selected and examined with reflective confocal microscopy (RCM) firstly, followed by biopsy at the same site. RCM was used to observe AK lesions before 5-aminolevulinic acid photodynamic therapy (ALA-PDT) treatment, after the first treatment, after 4 treatments, and at 1 and 6 months follow-up. Retrospective analysis of RCM images was performed. RESULTS Thirty two AK cases showed initial RCM microscopic features including disorderly arranged epidermal cells (100%), atypical keratinocytes (100%), and blurry border between the epidermis and dermis (100%). 4 patients quitted trail. After treatments, 24 cases showed basically regular arrangement of epidermal cells, absent atypical keratinocytes, and clear border between epidermis and dermis, while 4 cases improved little. At 1 and 6 months follow-up, 23 cases remained relapse-free while 1 case developed recurrent symptoms. Effective rate of 4 ALA-PDT treatments for AK was 100%; recurrence and cure rates were 4.2% and 82.1%, respectively. CONCLUSION ALA-PDT is effective to treat AK, while RCM can be recommended for in vivo evaluating and monitoring the effect of ALA-PDT on AK.
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Affiliation(s)
- Yuezhong Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lina Tan
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jian Huang
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhen Tang
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoliang Tong
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lihua Gao
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinrong Zeng
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
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Philipp-Dormston WG, Aschoff R, von Braunmühl T, Eigentler T, Haalck T, Thoms KM. [Decision criteria and patient characteristics for patient-oriented treatment of field cancerization : Standardized algorithm for personalized treatment concepts]. Hautarzt 2021; 72:314-320. [PMID: 33263779 PMCID: PMC8016782 DOI: 10.1007/s00105-020-04731-y] [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] [Indexed: 11/30/2022]
Abstract
Hintergrund Aktinische Keratosen (AK) zeichnen sich durch einen chronischen Verlauf aus, und häufig ist ein ganzes Hautareal betroffen (Feldkanzerisierung). Die patientenindividuelle Abwägung therapiespezifischer Vor- und Nachteile einer feldgerichteten Therapie ist herausfordernd. Fragestellung Ziel der vorliegenden Arbeit war die Entwicklung und Evaluierung patientenorientierter Entscheidungskriterien, die sich für die pragmatische Einordnung einer AK-Feldtherapie im Behandlungsalltag bei Patienten mit besonderer Prädisposition zur Feldkanzerisierung eignen (Patiententyp 1 bis 3). Material und Methoden Die Entwicklung der Entscheidungskriterien und der Patiententypologie erfolgte im Rahmen eines nominalen bzw. strukturierten Multi-level-Gruppenprozesses. Anhand der patientenrelevanten Entscheidungskriterien, der verfügbaren Evidenz aus klinischen Studien und entlang der Patiententypologie wurde ein Bewertungsalgorithmus etabliert, und feldgerichtete AK-Therapieoptionen wurden systematisch evaluiert. Ergebnisse Als patientenrelevante Kriterien für die Therapieentscheidung wurden u. a. Effektivität, Sicherheit, Praktikabilität der Therapie, Adhärenz, Kosmetik, Patientenpräferenz und Komorbiditäten identifiziert und näher spezifiziert. In Bezug auf diese Entscheidungskriterien und Patiententypen, bei denen eine Feldtherapie vorrangig indiziert ist, erfüllte die photodynamische Therapie mit Tageslicht das therapiebezogene Anforderungsprofil in besonderem Maße. Schlussfolgerung Die Definition von patientenrelevanten und therapiebezogenen Entscheidungskriterien in der AK-Feldtherapie erlaubt eine strukturierte und gleichzeitig praxisorientierte Herangehensweise, um spezifische Therapieoptionen einzuordnen und individuelle Therapieentscheidungen herzuleiten.
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Affiliation(s)
- W G Philipp-Dormston
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland. .,Hautzentrum Köln, Klinik Links vom Rhein, Schillingsrotter Str. 39-41, 50996, Köln, Deutschland.
| | - R Aschoff
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - T von Braunmühl
- Praxis für Dermatologie und Allergologie im Isarklinikum München, München, Deutschland
| | - T Eigentler
- Zentrum für Dermatologische Onkologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Haalck
- Fachbereich Dermatologie, Ambulanzzentrum des UKE GmbH - Medizinisches Versorgungszentrum (MVZ) des Universitätsklinikums Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - K-M Thoms
- Hautkrebszentrum der UMG/Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen (UMG), Göttingen, Deutschland
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Conforti C, Giuffrida R, Dianzani C, Guarneri F, Marangi GF, Neagu N, Persichetti P, Zalaudek I, di Meo N. Effectiveness and tolerability of treatment for isolated actinic keratoses: A retrospective comparison between cryotherapy, CO 2 laser and 5-fluorouracil 0.5%/salicylic acid 10. Dermatol Ther 2021; 34:e14846. [PMID: 33528869 DOI: 10.1111/dth.14846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
Actinic keratoses (AK) have been described as either intraepithelial keratinocytic dysplasia that can evolve into invasive squamous cell carcinoma (SCC) or as in situ SCC that can progress into an invasive form. A retrospective study was conducted to compare outcomes of three different topical therapies for patients with single AK (<4): cryotherapy, CO2 laser and 5-fluorouracil 0.5%/salicylic acid 10%. We included 72 patients who presented at the Dermatology Clinic of Maggiore Hospital of Trieste between 1 November 2019 and 31 January 2020 for the treatment of AKs. All treatments led to a significant reduction in the average diameter of AK. Pain felt by patients was significantly lower after 5-FU 0.5%/SA 10%. Side effects appeared similarly distributed among the three groups, with erythema and crusts being the most frequent. Aesthetic outcomes were highest in the 5-FU 5%/SA 10% group, as evaluated by both the patient and the operator. Cryotherapy, CO2 laser and 5-FU 5%/SA 10% were all effective, with no significant efficacy differences among them. Additionally, 5-FU 5%/SA 10% was proved to have the best aesthetic result and to cause the least pain, while necessitating long-term administration. This should be taken into account for patients with low pain tolerance and low treatment adherence. Cryotherapy and CO2 laser have the advantage of requiring a single session, which might be more suitable for uncooperative patients.
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Caterina Dianzani
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Guarneri
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | | | - Nicoleta Neagu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
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Ho YH, Pan Y, Sun CK, Liao YH. Presence of intralesional melanocytes as a histopathological feature of actinic keratosis based on in vivo harmonic generation microscopy in Asians. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 37:20-27. [PMID: 33476066 DOI: 10.1111/phpp.12595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/04/2020] [Accepted: 07/16/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Most patients with actinic keratosis (AK) present with more than one lesion. Although histopathological examination is the gold standard for diagnosing this condition, performing an invasive skin biopsy for each AK is impractical. Thus, this study aimed to identify AK's morphological characteristics based on harmonic generation microscopy (HGM). Moreover, the correlation between features observed using HGM and histopathological grading of AK was examined. METHODS Lesions of seven patients were examined using HGM (n = 1, ex vivo and n = 6, in vivo), and histopathological examinations of the biopsy specimens were also performed. The features of each AK, based on HGM, were assessed and compared with corresponding standard histopathological findings. RESULTS Using the histopathological findings as a standard reference, HGM's accuracy in detecting features of AK lesions, such as hyperkeratosis, epidermal thinning, abnormal architecture, and atypical honeycomb pattern, was 100%. Approximately five (72%) patients had similar histopathological grades. Moreover, based on HGM, except for one patient with grade 1 AK, six (85.71%) patients had lesions with intraepidermal dendritic cell-like cells, representing melanocytes. CONCLUSION Harmonic generation microscopy can be used in vivo to provide critical diagnostic information with a resolution comparable to histopathological examination. In addition, intralesional melanocytes in AK, which may be correlated with disease severity, can be specifically enhanced using HGM.
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Affiliation(s)
- Yi-Hsin Ho
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi Pan
- Graduate Institute of Photonics and Optoelectronics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chi-Kuang Sun
- Graduate Institute of Photonics and Optoelectronics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan.,Molecular Imaging Center and Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Bhat Y, Dar U, Zeerak S. Clinico-dermoscopic diagnosis of skin cancers in skin of color: An update. INDIAN JOURNAL OF DERMATOPATHOLOGY AND DIAGNOSTIC DERMATOLOGY 2021. [DOI: 10.4103/ijdpdd.ijdpdd_8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Invasive squamous cell carcinomas and precursor lesions on UV-exposed epithelia demonstrate concordant genomic complexity in driver genes. Mod Pathol 2020; 33:2280-2294. [PMID: 32461624 PMCID: PMC7934000 DOI: 10.1038/s41379-020-0571-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022]
Abstract
Although squamous cell carcinomas (SCC) are the most frequent human solid tumor at many anatomic sites, the driving molecular alterations underlying their progression from precursor lesions are poorly understood, especially in the context of photodamage. Therefore, we used high-depth, targeted next-generation sequencing (NGS) of RNA and DNA from routine tissue samples to characterize the progression of both well- (cutaneous) and poorly (ocular) studied SCCs. We assessed 56 formalin-fixed paraffin-embedded (FFPE) cutaneous lesions (n = 8 actinic keratosis, n = 30 carcinoma in situ [CIS], n = 18 invasive) and 43 FFPE ocular surface lesions (n = 2 conjunctival/corneal intraepithelial neoplasia, n = 20 CIS, n = 21 invasive), from institutions in the US and Brazil. An additional seven cases of advanced cutaneous SCC were profiled by hybrid capture-based NGS of >1500 genes. The cutaneous and ocular squamous neoplasms displayed a predominance of UV-signature mutations. Precursor lesions had highly similar somatic genomic landscapes to SCCs, including chromosomal gains of 3q involving SOX2, and highly recurrent mutations and/or loss of heterozygosity events affecting tumor suppressors TP53 and CDKN2A. Additionally, we identify a novel molecular subclass of CIS with RB1 mutations. Among TP53 wild-type tumors, human papillomavirus transcript was detected in one matched pair of cutaneous CIS and SCC. Amplicon-based whole-transcriptome sequencing of select 20 cutaneous lesions demonstrated significant upregulation of pro-invasion genes in cutaneous SCCs relative to precursors, including MMP1, MMP3, MMP9, LAMC2, LGALS1, and TNFRSF12A. Together, ocular and cutaneous squamous neoplasms demonstrate similar alterations, supporting a common model for neoplasia in UV-exposed epithelia. Treatment modalities useful for cutaneous SCC may also be effective in ocular SCC given the genetic similarity between these tumor types. Importantly, in both systems, precursor lesions possess the full complement of major genetic changes seen in SCC, supporting non-genetic drivers of invasiveness.
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Zhang G, Cao Z, Wang P, Zhu L, Zhang L, Zho Z, Shi L, Wang X. Comparison of efficacy, adverse effects and costs between 20 % ALA-PDT and 10 % ALA-PDT for the treatment of actinic keratosis in Chinese patients. Photodiagnosis Photodyn Ther 2020; 31:101605. [DOI: 10.1016/j.pdpdt.2019.101605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 01/10/2023]
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50
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Yoon J, Kim YC. Daylight photodynamic therapy with ablative carbon dioxide fractional laser for treating actinic keratosis in Asians: A case series. Photodiagnosis Photodyn Ther 2020; 31:101905. [DOI: 10.1016/j.pdpdt.2020.101905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
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