Annular pigmented actinic keratosis mimicking lentigo maligna melanoma in a 75-year-old female: An unusual presentation

Pigmented actinic keratosis (PAK) is an uncommon variant of actinic keratosis that can mimic different pigmented lesions, which may be benign or malignant. The diagnosis of PAK is often challenging because of overlapping features with lentigo maligna melanoma (LMM). Clinically, lesions of both conditions almost look similar; the diagnoses must be established histologically and with the help of immunostaining whenever needed. The distinction between a large PAK and LMM is important because their prognosis and management differ. We present a 75-year-old female with annular brown-to-black-colored maculo-plaque on forehead having clinical suspicious of melanocytic malignancy; which was diagnosed with a PAK on biopsy with help of histopathology and confirmed with Melan A/MART‑1 immunostaining.

Efectividad del Heberferon en pacientes con queratosis actínica asociada a carcinoma basocelular

Las queratosis actínicas son neoformaciones dermatológicas planas oexofísticas, presentes mayormente en zonas fotoexpuestas, de evolución crónica y generalmente asintomáticas, siendo la expresión más temprana del carcinoma espinocelular, producidas por la exposición solar crónica en personas fundamentalmente de piel clara. Se realizó un estudio longitudinal prospectivo de intervención terapéutica. El universo estuvo constituido por 130 pacientes y la muestra por 116 pacientes diagnosticados con queratosis actínica que concomitaron con carcinoma basocelular que asistieron a la consulta de oncodermatología del Hospital Provincial Docente "Carlos Manuel de Céspedes" de Bayamo, en el período comprendido de enero 2019 a diciembre 2020; con el objetivo de evaluar la efectividad del tratamiento con HeberFERON® en la queratosis actínica asociada a carcinoma basocelular. Para valorar la asociación entre las variables se empleó el test de Chi Cuadrado de Mantel. Fue frecuente en el estudio el sexo masculino, las edades comprendidas entre 61 y 80 años, el fototipo cutáneo II de la clasificación de Fitzpatrick, que presentaron más de 20 lesiones de queratosis actínica, de localización frecuente en los antebrazos. El HeberFERON fue efectivo y se logró respuesta favorable al tratamiento desde el punto de vista clínico y por dermatoscopia. Los efectos adversos frecuentes tras la administración del HeberFERON® fueron la fiebre, seguido de malestar general y el dolor en el sitio de la inyección.

Actinic keratoses are flat dermatological neoformations or oexofistic, present mostly in photoexposed areas, of chronic evolution and generally asymptomatic, being the earliest expression of squamous cell carcinoma, produced by chronic sun exposure in people mainly fair-skinned. A prospective longitudinal study of therapeutic intervention was conducted. The universe consisted of 130 patients and the sample consisted of 116 patients diagnosed with actinic con queratosis who concomitated with basal cell carcinoma who attended the oncodermatology consultation of the "Carlos Manuel de Céspedes" Provincial Teaching Hospital of Bayamo, in the period from January 2019 to December 2020; with the objective of evaluating the effectiveness of treatment with HeberFERON® in actinic keratosis associated with basal cell carcinoma. To assess the association between the variables, the Mantel Chi-Square test was used. The male sex, ages between 61 and 80 years, cutaneous phototype II of the Fitzpatrick classification, which presented more than 20 lesions of actinic keratosis, of frequent location in the forearms, were frequent in the study. HeberFERON was effective and a favorable response to treatment was achieved from the clinical point of view and by dermoscopy. Common side effects following administration of HeberFERON® were fever, followed by malaise and pain at the injection site.

As ceratoses actínicas são neoformações dermatológicas planas ou oexofísticas, presentes principalmente em áreas fotoexpostas, de evolução crônica e geralmente assintomáticas, sendo a expressão mais precoce do carcinoma espinocelular, produzido pela exposição solar crônica em pessoas principalmente de pele clara. Foi realizado um estudo longitudinal prospectivo de intervenção terapêutica. O universo foi composto por 130 pacientes e a amostra por 116 pacientes diagnosticados com conqueratose actínica que se concomitaram com carcinoma basocelular e que compareceram à consulta de oncodermatologia do Hospital Universitário Provincial "Carlos Manuel de Céspedes" de Bayamo, no período de janeiro de 2019 a dezembro de 2020; com o objetivo de avaliar a eficácia do tratamento com HeberFERON® na queratose actínica associada ao carcinoma basocelular. Para avaliar a associação entre as variáveis, foi utilizado o teste Qui-Quadrado de Mantel. O sexo masculino, com idades entre 61 e 80 anos, o fototipo cutâneo II da classificação de Fitzpatrick, que apresentou mais de 20 lesões de queratose actínica, de localização frequente nos antebraços, foram frequentes no estudo. O HeberFERON foi eficaz e uma resposta favorável ao tratamento foi alcançada do ponto de vista clínico e por dermatoscopia. Os efeitos secundários frequentes após a administração de HeberFERON® foram febre, seguida de mal-estar e dor no local da injeção.

Efficacy of sunscreen with photolyase or regular sunscreen associated with topical antioxidants in treating advanced photodamage and cutaneous field cancerization: a randomized clinical trial

Abstract Background Several treatments are available for skin with advanced photodamage, which is characterized by the presence of actinic keratoses (AK). Objectives Evaluate the efficacy of using sunscreen with photolyase compared to regular sunscreen, as well as to compare the combination of a topical formulation of antioxidants versus placebo in the treatment of advanced photodamage. Methods This was a randomized, double-blind, factorial clinical trial. Participants with AKs on their forearms were randomized to apply regular sunscreen (SC) or sunscreen with photolyase (SC+P) on both forearms during the day. One of the forearms in each group was randomized again to receive topical antioxidants (AOx), and the other forearm received a placebo cream (both for night application). The four groups were SC/AOx, SC/placebo, SC+P/AOx, and SC+P/placebo. The duration of treatment was 8 weeks. Primary outcomes were total AK clearance, decrease in Forearm Photoaging Scale (FPS), and AK severity scores. Secondary outcomes were reduction in AK count, partial clearance rate, and safety. Results Forty participants (80 forearms) were included. All groups showed significant improvement in outcomes at week eight. There were no significant differences between SC and SC+P for either outcome. AOx led to a significant reduction in AK count (22%; p < 0.05). Partial clearance was obtained in 18 (47.4%) forearms treated with AOx and in 9 (23.7%) treated with placebo (p < 0.05). All groups reduced the FPS score, without significant differences among them. Conclusions There is no difference in the treatment of advanced photodamage skin when comparing the use of sunscreen with photolyase and regular sunscreen, and topical antioxidants were more efficient in reducing AK count than placebo. Study limitations Short interval of follow-up and absence of re-evaluation in the absence of treatment were limitations of the present study.

Prevalence of Actinic Keratosis on a Facial Aesthetic Unit / 대한피부과학회지

No abstract available.

Gene Expression Patterns of Cutaneous Squamous Cell Carcinoma and Actinic Keratosis: Biomarkers Screening for Skin Disease Diagnosis

BACKGROUND: Actinic keratosis (AK) was an intraepidermal tumor which caused by ultraviolet irradiation-induced skin damage. OBJECTIVE: The aim was to screen biomarkers for development of skin disease by comparing the gene expression profiles between cutaneous squamous cell carcinoma (CSCC) and AK. METHODS: GSE45216 with 30 cutaneous squamous cell carcinoma patients and 10 actinic keratosis patients were downloaded and significance analysis of microarrays was processed to screen differently expressed genes (DEGs). Fisher's exact test was processed for DEGs enrichment. Pathway relationship network systematically reflected the signal conduction and synergism between enriched pathways based on Kyoto Encyclopedia of Genes and Genomes database. Gene co-expression network was constructed according to gene expression data. Quantitative real-time-PCR was used to verify screened biomarkers. RESULTS: Total 410 DEGs were screened and enriched into various functions, such as signal transduction and negative regulation of apoptotic process. They also participated into cytokine-cytokine receptor interaction and focal adhesion. The pathway relationship network was constructed with 27 nodes. Hub nodes with higher degree of this network were mitogen-activated protein kinase signaling pathway and apoptosis. The gene co-expression network was constructed with 39 nodes. Thereinto, hub node was ELOVL fatty acid elongase. The expression levels of ELOVL4 and HPGD were significantly higher in CSCC samples than that in AK samples, while the expression levels of INHBA and LAMC2 in CSCC samples were significantly lower than that in AK samples. CONCLUSION: These screened genes, including ELOVL4, HPGD, INHBA and LAMC2, played important roles in transformation from AK to CSCC.

Co-existence of Two Types of Porokeratosis with Malignant Transformation / 대한피부과학회지

The rate of malignant transformation in porokeratosis (PK) lesions is approximately 7.5%, and linear PK demonstrates the highest rate of malignancy. An 83-year-old woman presented with a rapidly enlarging mass on her left arm. Variably sized erythematous scaly patches were scattered across the left half of her trunk and arm. Additionally, generalized variably sized brownish annular patches with a hyperkeratotic outer ring were observed on her face, trunk and bilateral arms. A skin biopsy was performed on 3 lesions-a yellowish to erythematous appearing mass, an erythematous scaly patch, and a brownish annular patch. Histopathological evaluation of these 3 lesions revealed squamous cell carcinoma, actinic keratosis, and PK, respectively. The final diagnosis was disseminated superficial PK with linear PK on the left side of the body, and actinic keratosis and squamous cell carcinoma confined to the linear PK lesions. We report a case which represents the progressive and stepwise malignant transformation of PK into squamous cell carcinoma.

Various Skin Tumors Originating from Disseminated Superficial Actinic Porokeratosis / 대한피부과학회지

Disseminated superficial actinic porokeratosis (DSAP) is a rare keratinization disorder. It is histopathologically characterized by the presence of coronoid lamellae and clinically by lesions showing central atrophy with elevated borders. Squamous cell carcinoma originating in the classical Mibelli subtype of porokeratosis is well-documented; however, few reports have described squamous cell carcinoma in DSAP lesions. We report the case of a 76-year-old woman with DSAP who developed Bowen's disease, actinic keratosis, and keratoacanthoma on her face.

Prevalences of Actinic Skin Lesions and Comparison of Single and Multiple Lesions in Patients with Actinic Keratosis: A Retrospective Study of 61 Patients / 대한피부과학회지

BACKGROUND: Photoaged skin is characterized by actinic skin lesions such as wrinkling, elastosis, and premalignant and malignant lesions. Actinic keratosis (AK) is one of the most common precancerous lesions, and multiple actinic keratosis lesions are one of the risk factors for skin cancer. Few studies have investigated the prevalences of actinic skin lesions and compared the characteristics of the lesions and the patients with sinle and multiple AK lesions. OBJECTIVE: The aim of this study was to evaluate the prevalences of actinic skin lesions and to compare characteristics between single and multiple lesions in Korean patients with AK. METHODS: We retrospectively reviewed the medical records and biopsy specimens of 61 patients. RESULTS: Frequencies of deep wrinkle, solar elastosis, cutis rhomboidalis nuchae, and senile purpura were higher in the multiple lesions group. The ratio of males to females was 1:3.43 and the mean age was 79 years in the multiple lesions group, both of which were higher than those in the single lesion group (1:1.14, 72 years). The mean duration was longer in the multiple lesions group. Sun protective behavior was more frequent in the single lesion group, and the occupation of farmer was more common in the multiple lesions group. There was no statistically significant clinicopathological difference between the two groups. CONCLUSION: This study may improve our understanding of the characteristics of actinic keratosis with both single and multiple lesions.

Multiple Actinic Keratoses Induced by Phototherapy in a Korean Psoriatic Patient / 대한피부과학회지

No abstract available.

Queilitis actínica: aspectos histológicos, clínicos y epidemiológicos / Actinic cheilitis: histological, clinical and epidemiological characteristics

Introducción: la destrucción de la capa de ozono ha provocado un aumento en la incidencia de lesiones de la piel, a la que se suma la queilitis actínica. Objetivo: describir los aspectos histológicos, clínicos y epidemiológicos de la queilitis actínica a partir de la literatura reciente. Métodos: se revisaron las bases electrónicas PubMed, SciELO y Google Scholar con los términos claves en inglés y español: queilitis, queratosis, actínica, solar. Se incluyeron artículos originales, de revisión, reportes de casos, tesis y libros de la especialidad publicados preferentemente en el período 2005-2014. Resultados: La queilitis actínica es un trastorno potencialmente maligno inducido por la exposición solar y caracterizado por alteraciones micro y macroestructurales del labio. Factores de riesgo que interaccionan con la exposición solar son el fototipo (piel clara), hábito tabáquico, sexo (hombres), edad y ocupación (aire libre). Entre las alteraciones histológicas se encuentran la displasia epitelial y la elastosis solar; sin embargo, la severidad de estas no correlacionan con la gravedad clínica. Los pacientes con queilitis actínica presentan alteraciones de color, descamación, ulceraciones, difuminación del bermellón, entre otras. En muchas ocasiones la consulta y el diagnóstico son tardíos; se realizan cuando el cuadro ha evolucionado a cáncer. El diagnóstico es principalmente clínico, sumado a la biopsia de las lesiones con presentaciones moderadas y severas. Actualmente la terapia incluye métodos quirúrgicos y farmacológicos, y métodos innovadores como la fototerapia. Sin duda, la estrategia de prevención más importante es aumentar el uso de protectores solares, especialmente en la población de alto riesgo ocupacional. Conclusiones: la queilitis actínica es una patología relevante para los países sudamericanos, debido a que los factores de riesgo están presentes diariamente en las actividades de millones de trabajadores de nuestra región, por eso es necesario potenciar la investigación que permita mejorar la prevención, tratamiento y rehabilitación de esta patología(AU)

Introduction: depletion of the ozone layer has brought about an increase in the incidence of skin lesions, including actinic cheilitis. Objective: describe the histological, clinical and epidemiological characteristics of actinic cheilitis based on a review of recent literature. Methods: a search was conducted in the databases PubMed, SciELO and Google Scholar using the descriptors cheilitis, keratosis, actinic, solar, and their counterparts in Spanish. The search included original papers, review papers, case reports, theses and books about the specialty preferably published from 2005 to 2014. Results: actinic cheilitis is a potentially malignant condition induced by sun exposure and characterized by micro- and macrostructural alterations of the lip. The risk factors interacting with sun exposure are the skin phototype (light skin), smoking, gender (male), age and occupation (outdoor jobs). Histological alterations include epithelial dysplasia and solar elastosis, though their severity does not correlate with the degree of clinical seriousness. Patients with actinic cheilitis present color alterations, desquamation, ulceration and blurring of the vermillion border, among other signs and symptoms. On many occasions patients do not seek care during the early stages of the disease. As a result, diagnosis is made when the condition has already evolved into cancer. The diagnosis is basically clinic, with the support of the biopsy of lesions with moderate to severe characteristics. Current therapy includes surgery and medication, as well as innovative techniques like phototherapy. The most important strategy is no doubt the use of sunscreens, especially by the population at high occupational risk. Conclusions: actinic cheilitis is a condition relevant to South American countries, since its risk factors are present in the daily activities of millions of workers from our region. It is therefore necessary to foster research aimed at improving its prevention, treatment and rehabilitation(AU)

Clinical Features of Cutaneous Premalignant Lesions in Busan City and the Eastern Gyeongnam Province, Korea: A Retrospective Review of 1,292 Cases over 19 Years (1995~2013)

BACKGROUND: The global prevalence of premalignant lesions has been continuously increasing in recent years, but there has been little research regarding the distribution and incidence of cutaneous premalignant lesions in Korean populations. OBJECTIVE: We conducted this retrospective study to analyze recent trends in the incidence and clinical patterns of cutaneous premalignant lesions in the Korean population. METHODS: We reviewed 1,292 cases (3,651 lesions) of patients with cutaneous premalignant lesions, including actinic keratosis (AK) and Bowen's disease (BD), from the Department of Dermatology at Dong-A University Hospital (January 1995 to December 2013). RESULTS: The average cutaneous premalignant lesion annual incidence was 1.82%, and the incidence continuously increased from 0.70% to 4.25% over the study period. The most common cutaneous premalignant lesion was AK (75.85%), followed by BD (24.15%). The mean age of onset was 68.76 years (men, 70.89 years; women, 65.56 years), and the male:female ratio of patients was 1:1.52. Major skin cancers, including squamous cell carcinoma (SCC, 8.90%), basal cell carcinoma (BCC, 6.42%), and malignant melanoma (MM, 0.70%), were detected in 15.79% of patients with cutaneous premalignant lesions. Three patients (0.23%) were previously diagnosed with both SCC and BCC. In addition, 59.13% of patients had a single lesion, while 40.87% had multiple lesions. Patient age, history of previous skin cancers, and occupation-related exposure to ultraviolet radiation were more common in patients with multiple lesions. CONCLUSION: Cutaneous premalignant lesion incidence has gradually increased in the Korean population.

Potential Role of S100A8 in Cutaneous Squamous Cell Carcinoma Differentiation

BACKGROUND: S100A8 is differentially expressed in various cell types and is associated with a number of malignant disorders. S100A8 may affect tumor biology. However, its role in cutaneous squamous cell carcinoma (SCC) is not well established. OBJECTIVE: This study aims to investigate the relationship between S100A8 and cutaneous SCC development. METHODS: We performed immunohistochemical staining to detect S100A8 expression in facial skin specimens of premalignant actinic keratosis (AK), malignant SCC, and normal tissues. In addition, we utilized postconfluence and high calcium-induced differentiation in a culture system model. Furthermore, we constructed a recombinant adenovirus expressing GFP-tagged S100A8 to investigate the role of S100A8 in SCC cell differentiation. RESULTS: S100A8 was significantly overexpressed in human cutaneous SCC compared to that in normal and AK tissues. S100A8 was gradually upregulated in SCC cells in a post-confluence-induced differentiation model. Overexpression of S100A8 in SCC cells induced by adenoviral transduction led to increased expression levels of differentiation markers, such as loricrin, involucrin, and filaggrin. S100A8 overexpression also increased loricrin and involucrin luciferase activity. CONCLUSION: S100A8 regulates cutaneous SCC differentiation and induces well-differentiated SCC formation in skin.

Unilateral Favre-Racouchot Syndrome with Multiple Ultraviolet Light-induced Skin Conditions / 대한피부과학회지

No abstract available.

Una puesta al día en el tratamiento de las queratosis actínicas / An update on the treatment of actinic keratosis

Las queratosis actínicas son una de las causas más frecuentes de consultas dermatológicas. Están consideradas como lesiones premalignas que pueden evolucionar a carcinoma espinocelular invasor. Constituyen un marcador de fotodaño y actualmente se consideran como modelo de cancerización de campo. Existen diversos tipos de tratamientos que se clasifican en terapias dirigidas a la remoción de la lesión (crioterapia y / o quirúrgicos) y terapias dirigidas al campo de cancerización que incluyen: inmunomoduladores tópicos (imiquimod y diclofenaco), agentes quimioterapéuticos (5-Fluorouracilo y retinoides), Ingenol mebutato, dermoabrasión, peelings químicos, láser, terapia fotodinámica y terapias combinadas entre otras. El principal objetivo de esta revisión es realizar una actualización de las terapias dirigidas al campo de cancerización de las queratosis actínicas con sus respectivas indicaciones, ventajas y desventajas.

Actinic keratosis are one of the most common causes of dermatological consultation. Considered as premalignant lesions that can progress to invasive squamous cell carcinoma. Constitute a marker of photodamage and actually considered as a model of field cancerization. There are several types of treatments classified as therapies targeting the removal of the lesion (cryotherapy and / or surgery) and targeted therapies of field cancerization that include topical immunomodulators (imiquimod and diclofenac), chemotherapeutic agents (5-fluorouracil, and retinoids), ingenol mebutate, dermabrasion, chemical peels, laser, photodynamic therapy and combination therapies among others. The main objective of this review is to update therapies of field cancerization for actinic keratosis with their respective indications, advantages and disadvantages.

A Clinicopathologic Study of Clear Cell Actinic Keratosis / 대한피부과학회지

BACKGROUND: Clear cells are defined as cells that contain abundant, clear, lightly eosinophilic cytoplasm. On rare occasions, clear cell changes have been observed in actinic keratosis (AK). OBJECTIVE: We aimed to evaluate the cytoplasmic contents of clear cells and the clinicohistopathological features of clear cell AK. METHODS: From 456 cases of histopathologically confirmed AK, we selected 30 cases (6.6%) with greater than 10% of clear cells in the epidermis. We collected the demographic data and clinical features for all specimens. In addition, the specimens were divided into five histopathologic types: hypertrophic, atrophic, Bowenoid, acantholytic, and pigmented. Clear cell distribution was classified into 3 categories: upper, middle, and lower areas of the epidermis. Periodic acid-Schiff (PAS), PAS diastase (d-PAS), and alcian blue staining were carried out, and immunoperoxidase stainings were performed for S-100, HMB45, and cardio embryonic antigen (CEA) to evaluate the origin of the clear cytoplasm. RESULTS: The cheek was the most common site of involvement. The most frequent lesion color was erythematous (66.7%). Scale and telangiectasia were found in the majority of patients (90% and 66.7%, respectively). The most common histopathological type was Bowenoid, found in 21 cases. This was followed by hypertrophic in 7 cases and pigmented in 2 cases. Seventeen specimens (56.7%) stained positive for PAS and negative for d-PAS. All of the PAS-positive specimens were Bowenoid AK. All specimens stained negative for alcian blue and immunoperoxidase staining results were negative for S-100, HMB 45 and CEA. CONCLUSION: We conclude that clear cells in AK most likely originate due to an accumulation of glycogen or due to hydropic degeneration. The presence of glycogen in clear cells may induce adnexal differentiation to an atypical keratinocyte in AK.

Oral acetylsalicylic acid and prevalence of actinic keratosis / Ácido acetilsalicílico oral e prevalência de queratoses actínicas

Objective: To investigate the influence of a regular oral use of acetylsalicylic acid in the prevalence of actinic keratosis. Methods: A case-control study with dermatologic outpatients above 50 years of age assessed between 2009 and 2011. Cases were defined as those who had been under regular use of oral acetylsalicylic acid for more than six consecutive months. The assessment focused on: age, sex, skin-type, tobacco smoking, use of medication, occurrence of individual or family skin cancer, and sunscreen and sun exposure habits. Actinic keratoses were counted in the medial region of the face and upper limbs. Counts were adjusted by co-variables based on a generalized linear model. Results: A total of 74 cases and 216 controls were assessed. The median time of acetylsalicylic acid use was 36 months. Cases differed from controls as to the highest age, highest prevalence of use of angiotensin-converting enzyme inhibitors and fewer keratosis on the face and on the upper limbs (p<0.05). The multivariate model showed that the use of acetylsalicylic acid was associated to lower counts of face actinic keratosis and upper-limb erythematous actinic keratosis (p<0.05), regardless of other risk factors. Conclusion: The regular use of oral acetylsalicylic acid for more than six months was associated to a lower prevalence of actinic keratosis, especially facial and erythematous ones. .

Objetivo: Queratoses actínicas são proliferações atípicas de queratinócitos com potencial para se transformarem em carcinoma invasivo. Estudos clínicos e laboratoriais têm observado um efeito preventivo de anti-inflamatórios não hormonais no desenvolvimento de diversas neoplasias. Neste estudo, investigamos a influência do uso regular do ácido acetilsalicílico na prevalência de queratoses actínicas. Métodos: Estudo caso-controle com pacientes dermatológicos acima de 50 anos de idade, avaliados entre 2009 e 2011. Os casos foram definidos como aqueles que estavam sob uso regular de ácido acetilsalicílico por via oral por mais de seis meses consecutivos. Avaliou-se idade, sexo, fototipo, tabagismo, uso de medicamentos, ocorrência de câncer de pele no indivíduo ou na família, hábitos de proteção e exposição solar. As queratoses actínicas foram contadas nos membros superiores e região medial da face. As contagens foram ajustadas pelas covariáveis em um modelo linear generalizado. Resultados: Um total de 74 casos e 216 controles foi avaliado. O tempo médio de uso de ácido acetilsalicílico foi de 36 meses. Casos diferiam dos controles quanto a idade mais elevada, maior prevalência de uso de inibidores da enzima conversora da angiotensina e menos queratoses na face e membros superiores (p <0,05). O modelo multivariado mostrou que o uso do ácido acetilsalicílico esteve associado a contagens mais baixas de queratoses actínicas na face de queratoses não hipertróficas nos membros superiores (p <0,05). Conclusão: O uso regular do ácido acetilsalicílico por via oral por mais de seis meses esteve associado a uma menor prevalência de queratose actínica, especialmente faciais e eritematosas. .

Characterization of Actinic Keratosis by Dermoscopy in Koreans / 대한피부과학회지

BACKGROUND: Dermoscopy is a real-time, noninvasive technique that increases the diagnostic accuracy of clinical evaluation by the dermatologist. Characterization of facial actinic keratosis via dermoscopy is valuable in guiding the dermatologist in the differential diagnosis of facial skin lesions. To our knowledge, dermoscopic evaluation of actinic keratosis has not yet been reported in Korean literature. OBJECTIVE: The purpose of this study was to investigate the dermoscopic features of facial actinic keratosis in Koreans. METHODS: We examined 60 patients with facial actinic keratosis using dermoscopy. We determined the frequency of specific features revealed by dermoscopy across the Korean patient population and compared our results with those of other published studies. RESULTS: A total of 67 facial actinic keratoses were observed in 60 patients. The common features of non-pigmented actinic keratoses revealed by dermoscopy were a red pseudo-network (66%), white-to-yellow surface scales (48.9%), linear wavy vessels (38.3%), and targetoid hair follicles (42.6%). The common features of pigmented actinic keratoses revealed by dermoscopy were slate-grey dots (55%) and globules (30%), annular-granular pattern (35%), a brown-to-gray pseudo-network (40%), and targetoid hair follicles (30%). The frequency of specific features revealed by dermoscopy across the analyzed patient population was not significantly different from that reported in other studies, except for rhomboidal structures (5%), which was lower in Koreans than in other populations (35.8%, p<0.05). The frequency of dermoscopic features was different according to histopathologic subtypes (hypertrophic, atrophic, bowenoid, acantholytic actinic keratosis). CONCLUSION: Dermoscopy revealed specific features of facial actinic keratosis that can be utilized to evaluate and diagnose facial skin lesions.

Basal Cell Carcinoma Arising from the Scar of Laser Ablation for a Pre-Existing Actinic Keratosis / 대한피부과학회지

No abstract available.

Effect of ultraviolet radiation on the exp ression of p53, matrix metalloproteinase-2 and-9 in actinic keratosis lesions and normal human skin / 中华皮肤科杂志

Objective To estimate the effect of different doses of ultraviolet (UV) radiation on the proliferation of and apoptosis in kertatinocytes,as well as on the expression of p53,matrix metalloproteinase-2 (MMP2) and-9 (MMP9) in actinic keratosis (AK) lesions and normal human skin.Methods Tissue specimens were obtained from the lesions of 20 patients with AK and sun-exposed normal skin of 20 healthy human subjects,and subjected to an air-exposed culture.Each of the specimens was divided into 4 areas to remain untreated (control area) or be irradiated with UV of 5,10 and 20 J/cm2 (irradiated areas) for 4 consecutive days.After another 24-hour culture,the tissue cultures were collected followed by the evaluation of apoptosis in and proliferation of keratinocytes by using terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and Ki-67 staining,and determination of mRNA and protein expressions of p53,MMP2 and MMP9 by using real time PCR and immunohistochemistry respectively.Results A statistical increase was observed in the percentage of apoptotic cells in the normal skin irradiated with UV of 10 and 20 J/cm2 (46.8％ ± 2.1％ and 56.7％± 2.4％,both P ＜ 0.05) and in the AK lesions irradiated with UV of 20 J/cm2 (43.5％ ± 1.5％,P ＜ 0.05)compared with the corresponding unirradiated tissues.The normal skin showed a higher percentage of apoptotic cells than the lesional skin after irradiation with UV of 10 and 20 J/cm2 (both P ＜ 0.05).The percentage of Ki67-positive cells was significantly decreased in the normal skin after irradiation with UV of 20 J/cm2 (3.34％ ±0.76％,P ＜ 0.05),but experienced no statistical changes in the lesional skin after different doses of UV irradiation (all P ＞ 0.05).There was a statistical elevation in the expression of p53 mRNA (5 J/cm2:1.106 ± 0.025,10 J/cm2: 1.259 ± 0.045,20 J/cm2:1.425 ± 0.053,all P ＜ 0.05) and protein(10 J/cm2:0.1169 ± 0.0032,20 J/cm2:0.1454 ± 0.0047,both P＜ 0.05) in the normal skin,but a statistical reduction in the expression of p53 mRNA(10 J/cm2.0.611 ± 0.050,20 J/cm2:0.578 ± 0.070,both P ＜ 0.05) and protein (20 J/cm2:0.0404 ± 0.0027,P＜ 0.05) in the lesional skin after irradiation compared with the corresponding unirradiated skin tissues.Further more,a statistical increment was observed in MMP2 mRNA and protein expression in normal skin irradiated with UV of 10 J/cm2 (1.086 ± 0.013,0.0843 ± 0.0024,respectively,both P ＜ 0.05) and 20 J/cm2 (1.417 ± 0.036,0.1236 ±0.0042,respectively,both P ＜ 0.05) and in lesional skin irradiated with UV of 20 J/cm2 (1.296 ± 0.028,0.0744± 0.0032,respectively,both P ＜ 0.05),as well as in MMP9 mRNA and protein expression in normal skin irradiated with UV of 20 J/cm2 (1.395 ± 0.026,0.3065 ± 0.0162,respectively,both P ＜ 0.05) and in lesional skin irradiated with UV of 10 J/cm2 (1.298 ± 0.035,0.0992 ± 0.0053,respectively,both P ＜ 0.05) and 20 J/cm2(1.286 ± 0.032,0.1010 ± 0.0063,respectively,both P ＜ 0.05) compared with the corresponding unirradiated tissues.Conclusion Ultraviolet may accelerate the progression of AK by down-regulating p53 expression but up-regulating MMP2 and MMP9 expression.

Photodynamic Therapy with Ablative Carbon Dioxide Fractional Laser in Treatment of Actinic Keratosis

BACKGROUND: Recently, photodynamic therapy (PDT) has been shown to be an effective first-line treatment for actinic keratosis (AK). However, a major limitation of PDT is the long incubation time required to allow penetration of the photosensitizer. OBJECTIVE: The aim of this study was to assess if pretreatment with an ablative carbon dioxide (CO2) fractional laser can reduce the incubation time of the photosensitizer. METHODS: Initially, 29 patients with a total of 34 AK lesions were treated with an ablative CO2 fractional laser at Ajou University Hospital between January and December 2010. Immediately after the laser treatment, topical 20% 5-aminolevulinic acid or methyl-aminolevulinate was applied to the AK lesions and incubated for 70 to 90 minutes. Then, the treated areas were illuminated with a red light source. Improvement was clinically or histologically assessed eight weeks after the treatment. RESULTS: In spite of the short incubation time, 24 lesions (70.6%) showed a complete response (CR) within three sessions of PDT (10 lesions a clinical CR and 14 lesions a clinical/histological CR). There were no significant side effects associated with the combination of ablative CO2 fractional laser and PDT. CONCLUSION: Ablative CO2 fractional laser may be considered an additional treatment option for reducing the incubation time of the photosensitizer in PDT.