Clinicopathological study of skin tumours

Background: Skin cancers are relatively uncommon malignancies worldwide, but the incidence of skin cancers has progressively increased over the last few decades. The distinction between benign and malignant neoplasm are more difficult to define when they appear in skin than when found elsewhere and histopathological examination is frequently required to establish a definitive diagnosis. Diagnosis of any skin tumours can be done by correlating clinical features and histological features. The aim and objective were to study age-sex wise distribution, clinical presentation and histopathological spectrum of various skin tumours.Methods: This is a retrospective study of three years conducted in the Department of Pathology, Government Medical College, Aurangabad, India from December 2015 to December 2018. Specimens received from Department of Dermatology were fixed in formalin and after adequately processing the sections were stained routinely with H and E stain and properly evaluated for histopathological examination. This study includes tumors of epidermis along with melanogenic tumors and skin appendageal tumors. The data collected was tabulated, analysed and compared to other similar studies.Results: The study consists of 130 cases. The ratio of male to female was 1.24:1. Head and neck region (48.46%) was the most common site observed where skin lesions were present followed by extremities (37.69%). Most of the malignant tumours were presented with non-healing ulcers (30.76%) and Noduloulcerative lesions (20.33%). Out of 130 cases, 83 (63.84%) were benign whereas 47 (36.15%) were malignant tumour. According to WHO classification, keratinocytic tumour 55 (42.30%) was the most common tumour type in the present study. Skin adnexal tumours and melanocytic tumours were observed in 54 (41.53%) and 21 (16.15%) respectively.Conclusions: The skin is a complex organ. Because of complexity of skin, a wide range of diseases can develop from the skin. The majority of benign neoplasms are from skin adnexal group whereas most common malignant neoplasm were from keratinocytic group. Skin adnexal tumors can occur anywhere in the body, however head and neck region constitute the most common site. Skin adnexal tumours are clinically often misdiagnosed, so histopathological examination remains gold standard for their correct diagnosis and for their differentiation between benign and malignant neoplasm.

Keratinocytic Vascular Endothelial Growth Factor as a Novel Biomarker for Pathological Skin Condition

Skin is an emerging target tissue in pharmaceutical and cosmetic science. Safety assessment for dermal toxicity is a critical step for development of topically applicable pharmaceutical agents and ingredients in cosmetics. Urgent needs exist to set up toxicity testing methods for dermal safety, and identification of novel biomarkers for pathological cutaneous alteration is highly required. Here we will discuss if vascular endothelial growth factor (VEGF) has a potential as a biomarker for dermal impairment. Experimental and clinical evidences for induction of keratinocytic VEGF under pathological conditions will be reviewed.

CD44 Standard and Variants Expression in Keratinocytic Tumor / 대한피부과학회지

BACKGROUND: The CD44 antigen is a widely distributed cell surface glycoprotein implicated in multiple physiological cellular functions including cell-cell adhesion, cell-substrate interaction and cell activation. In the skin, CD44 is normally expressed in epidermal keratinocytes and hair follicular, sebaceous and eccrine epithelial cells. The precise functions of CD44 are not yet clearly understood, though they appear to be involved in the mechanism of tumor invasion and metastasis. OBJECTIVE: The purpose of this study is to investigate the immunohistochemical expression of the CD44 molecule in the epidermal keratinocytic tumors with different biologic behaviors, such as squamous cell carcinoma(SCC),basal cell epithelioma(BCE), actinic keratosis(AK), bowen's disease, keratoacanthoma(KA), trichoepithelioma. METHODS: Routine paraffin sections of formalin-fixed 33 tissues (15 SCC, 23 BCE, 9 AK, 7 KA, 7 bowen's disease, 5 trichoepithelioma, 2 psoriasis, 2 lichen planus) were labeled with anti-CD44 monoclonal antibody using avidin-biotin- peroxidase complex. Normal skin served as the negative control. RESULTS: The results are as follows. 1. In SCC and KA, peripheral parts of the lesion were prominently stained. CD44v6 showed the strongest expression, followed by CD44s and CD44v4/5. The horn cyst and the keratin region of the horn pearl were not stained. The degree of staining was weaker in KA compared to SCC. 2. The degree of staining was weaker in BCC and TEE compared to SCC. The staining was more prominent at the center of the lesion than in the peripheral region. In TEE, stronger staining was found at the center or in the squamous epithelial region. 3. Among the seven cases of Bowen's disease, 4 cases were diffusely stained with all three CD44 types. In the other three cases, local staining with the standard type and diffuse staining with CD44v4/5 and CD44v6 were seen. 4. In AK, the early lesion showed decreased expression of CD44 in all three types. However, those with mature lesion and progression to SCC showed increased degree of staining in all three types of CD44. CONCLUSION: These results suggest that expression of CD44 in these keratinocytic tumors is not related to malignant transformation and metastasis, but instead may be related tumor differentiation.

CD44 Standard and Variants Expression in Keratinocytic Tumor / 대한피부과학회지

BACKGROUND: The CD44 antigen is a widely distributed cell surface glycoprotein implicated in multiple physiological cellular functions including cell-cell adhesion, cell-substrate interaction and cell activation. In the skin, CD44 is normally expressed in epidermal keratinocytes and hair follicular, sebaceous and eccrine epithelial cells. The precise functions of CD44 are not yet clearly understood, though they appear to be involved in the mechanism of tumor invasion and metastasis. OBJECTIVE: The purpose of this study is to investigate the immunohistochemical expression of the CD44 molecule in the epidermal keratinocytic tumors with different biologic behaviors, such as squamous cell carcinoma(SCC),basal cell epithelioma(BCE), actinic keratosis(AK), bowen's disease, keratoacanthoma(KA), trichoepithelioma. METHODS: Routine paraffin sections of formalin-fixed 33 tissues (15 SCC, 23 BCE, 9 AK, 7 KA, 7 bowen's disease, 5 trichoepithelioma, 2 psoriasis, 2 lichen planus) were labeled with anti-CD44 monoclonal antibody using avidin-biotin- peroxidase complex. Normal skin served as the negative control. RESULTS: The results are as follows. 1. In SCC and KA, peripheral parts of the lesion were prominently stained. CD44v6 showed the strongest expression, followed by CD44s and CD44v4/5. The horn cyst and the keratin region of the horn pearl were not stained. The degree of staining was weaker in KA compared to SCC. 2. The degree of staining was weaker in BCC and TEE compared to SCC. The staining was more prominent at the center of the lesion than in the peripheral region. In TEE, stronger staining was found at the center or in the squamous epithelial region. 3. Among the seven cases of Bowen's disease, 4 cases were diffusely stained with all three CD44 types. In the other three cases, local staining with the standard type and diffuse staining with CD44v4/5 and CD44v6 were seen. 4. In AK, the early lesion showed decreased expression of CD44 in all three types. However, those with mature lesion and progression to SCC showed increased degree of staining in all three types of CD44. CONCLUSION: These results suggest that expression of CD44 in these keratinocytic tumors is not related to malignant transformation and metastasis, but instead may be related tumor differentiation.

bcl - 2 Expression in Basal Cell Carcinoma , Squamous Cell Carcinoma , Keratoacanthoma , and Trichoepithelioma / 대한피부과학회지

BACKGROUND: The bcl-2, gene is a newly described oncogene involved in tumorigenesis by blocking apoptosis, or programmed cell death and overexpression of bcl-2 protein has been reported in several malignant tumors such as lymphoma, breast cancer, and lung cancer. Though keratinocyte-derived skiri tumors are one of the most common human tumors the detailed molecular mechanism of the keratinocytic tumors is not clear. Also, the differentiation between basal cell carcinoma(BCC) and trichoepithelioma(TE) is sometirnes difficult clinically and histologically. OBJECTIVE: The purpose of this study is to examine whether there is difference in staining pattern of bcl-2 protein in BCC, TE, squamous cell carcinoma(SCC), and keratoacanthoma(KA). We also evaluated the diagnostic value of expression pattern of bcl-2 protein in distinguishing BCC and TE. METHODS: Routine paraffin sections of formalin-fixed forty-four tissues (19 BCC, 9 SCC, 10squamous cell carcinoma in situ : 5 actinic keratosis [AK] and 5 Bowen disease [BD], 5 keratoacanthoma, and 6 (TE) were labeled with anti-bcl-2 monoclonal antibody using a avidin-biotin peroxidase complex. Normal skin for bcl-2 protein served as negative controls. RESULTS: The results were as follows. l. In normal skin, bcl- 2 positivity was observed in the epidermal basal layer, the basal layer of follicular infundibuium, the mesenchymal cells of the follicular papillae, and the eccrine glands. 2. All cases of BCC and TE showed a positive cytoplasmic staining for bcl-2 proein, but all cases of SCC, AK, BD, and KA were negative. 3. In staining pattern, of bcl-2 protein, BCC showed diffuse staining throughout the tumor lobules. In TE, the basaloid cells lining the periphery of each tumor nests and the papillary mesenchymal bodies stained strongly. CONCLUSION: This study shows that BCC express bcl-2 protein, whereas SCC are negative. Our results indicate that proteon from apoptosis mediated by bcl-2 protein may be involved in the neoplastic growth mechanism of BCC. In addition, the ohserved findings in expression pattern of bcl-2 protein in BCC and TE may be of a diagnostic help in distinguishing the borderline cases.