Melanocytic tumors express connexin 43 but not 26: immunohistochemical analysis with potential significance in melanocytic oncogenesis.

Connexins (Cx) are structural proteins that form gap junctions, which are vital to cell-cell communication and help to regulate cell division. The purpose of this study was to evaluate if there are diagnostically important differences in immunostaining for connexins 43 (Cx43) and 26 (Cx26) in melanoma compared with nevi. Formalin-fixed paraffin-embedded sections of 34 histologically well-characterized melanocytic lesions, 17 primary malignant melanomas (MM), and 17 nevi were stained with a polyclonal antibody to Cx43 and a polyclonal antibody to Cx26. Immunoreactivity in tumor cells was evaluated semiquantitatively based on extent (1%-100%) and intensity (0-3) of reactivity. A score of 0-300 was generated by the product of the extent and intensity readings in each case. Significantly higher Cx43 immunoreactivity was detected in MM (mean intensity score = 253.5; 95% confidence interval, 227.9-279.2; P = 0.002) compared with nevi (mean intensity score = 152.4; 95% confidence interval, 104.9-199.8). In contrast, Cx26 immunoreactivity was less than 5% or entirely absent in all melanocytic tumors (n = 34). The significantly higher Cx43 staining in MM when compared with nevi suggests an oncogenic role for this protein in melanocytic tumor progression. Consequently, the evaluation of immunohistochemical staining for Cx43 in conjunction with other ancillary stains and tumor histology may be helpful in distinguishing MM from nevi, although positive Cx26 reactivity suggests that a cutaneous neoplasm is of nonmelanocytic origin.

Human papillomavirus-related genital disease in the immunocompromised host: Part I.

Human papillomavirus (HPV) is responsible for common condyloma acuminata and a number of premalignant and malignant anogenital lesions. These conditions are of particular concern in immunocompromised individuals who have higher risk of malignant transformation and are more difficult to treat. This is part I of a two-part review that will highlight the cutaneous features of condyloma acuminata and vaginal, vulvar, penile, and anal intraepithelial neoplasias, with an emphasis on presentation of these HPV-mediated diseases in the immunocompromised host. Counseling patients about these conditions requires a thorough understanding of the epidemiology, natural history of HPV, transmission and infectivity, risk of malignancy, and the role of the host immune response in clearing HPV lesions. Part II will provide an updated review of available treatments, with a focus on recent advances and the challenges faced in successfully treating HPV lesions in immunocompromised patients.

Human papillomavirus-related genital disease in the immunocompromised host: Part II.

Human papillomavirus is responsible for common condyloma acuminata and a number of premalignant and malignant anogenital lesions. The immunocompromised population is at particular risk because of a higher incidence of malignant transformation. Lesions in this population may prove refractory to standard treatment. This is part II of a two-part review that will discuss the treatment of condyloma acuminata and vaginal, vulvar, penile, and anal intraepithelial neoplasias. This article will provide an updated review of available treatments, with a focus on recent advances and the challenges faced in successfully treating human papillomavirus lesions in the immunocompromised host.

Genitogluteal porokeratosis involving the scrotum: an unusual presentation of an uncommon disease.

Porokeratosis represents a heterogeneous group of keratinization disorders typified by the presence of annular plaques with distinct, raised borders that include cornoid lamellae. Histopathologically, a cornoid lamella is a column of parakeratotic scale overlying an epidermal invagination that displays nearby dyskeratotic keratinocytes and loss of the granular layer. Porokeratosis ptychotropica constitutes a rare variant that classically presents as a plaque in the gluteal cleft that mimics a dermatitis and microscopically contains numerous cornoid lamellae. We report a 28 year-old man with a two-month history of scrotal burning and itching associated with the development of multiple thin red plaques with distinct elevated borders and a pebbled appearance. Histopathological examination revealed psoriasiform acanthosis and multiple cornoid lamellae, which is consistent with a diagnosis of porokeratosis ptychotropica. Our patient's presentation may represent a distinct variant with clinical features of verrucous porokeratosis and histopathological features of porokeratosis ptychotropica which may suggest that the finding of multiple cornoid lamellae is not unique to porokeratosis ptychotropica.

Use of mobile telemedicine for cervical cancer screening.

Visual inspection of the cervix with application of 4% acetic acid (VIA) is an inexpensive alternative to cytology-based screening in areas where resources are limited, such as in many developing countries. We have examined the diagnostic agreement between off-site (remote) expert diagnosis using photographs of the cervix (photographic inspection with acetic acid, PIA) and in-person VIA. The images for remote evaluation were taken with a mobile phone and transmitted by MMS. The study population consisted of 95 HIV-positive women in Gaborone, Botswana. An expert gynaecologist made a definitive positive or negative reading on the PIA results of 64 out of the 95 women whose PIA images were also read by the nurse midwives. The remaining 31 PIA images were deemed insufficient in quality for a reading by the expert gynaecologist. The positive nurse PIA readings were concordant with the positive expert PIA readings in 82% of cases, and the negative PIA readings between the two groups were fully concordant in 89% of cases. These results suggest that mobile telemedicine may be useful to improve access of women in remote areas to cervical cancer screening utilizing the VIA 'see-and-treat' method.

Digital squamous cell carcinoma and association with diverse high-risk human papillomavirus types.

Digital squamous cell carcinoma (SCC) presents a diagnostic challenge because of its relatively rare occurrence and mimicry of benign conditions. Although low-risk human papillomavirus (HPV) subtypes are commonly associated with benign digital verrucae, digital SCC can be associated with high-risk, oncogenic HPV subtypes. We report 7 patients, including 4 HIV-positive patients, who presented with 10 lesions of digital SCC in situ. Six of 10 lesions were typed for HPV by immunostain or polymerase chain reaction. Multiple high-risk oncogenic subtypes were found, including HPV-16, -33, -51, and -73. The majority of reports linking HPV and digital SCCs have implicated the HPV-16 subtype. This case series highlights the diversity of oncogenic HPV types that may be associated with digital SCCs. Because the high rate of recurrence of digital SCCs may be a result of persistence of oncogenic HPV at the margins of resection, aggressive treatment of individual lesions and of genital reservoirs for HPV on patients and their sexual partners is warranted.

Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma.

Cutaneous T-cell lymphomas most commonly have a CD4(+) memory T-cell phenotype with relatively indolent course, but may in rare cases present with a CD8(+) cytotoxic phenotype exhibiting strikingly more aggressive clinical behavior. We present two cases of the clinically aggressive subtype of primary cutaneous epidermotropic CD8(+) cutaneous T-cell lymphoma and review the current literature, clinical behavior, and recommendations for treatment distinct from that of more common CD4(+) variants of cutaneous T-cell lymphoma.

Dermatologic manifestations of HPV in HIV-infected individuals.

Dermatologic human papillomavirus (HPV) infection in HIV patients manifests as both anogenital and nongenital skin disease. Anogenital HPV-related disease includes benign condyloma acuminata, the most common cutaneous manifestation of genital HPV infection; intermediate malignancy or premalignant conditions including giant condyloma acuminata (also called Buschke-Loewenstein tumor), anal intraepithelial neoplasia, penile intraepithelial neoplasia, and vaginal or vulvar intraepithelial neoplasia; and frankly malignant disease including Bowen's disease and invasive anal, penile, or vulvar carcinoma. Cutaneous HPV-related disease in nongenital skin is also increased in HIV-positive patients, in the form of benign common warts, epidermodysplasia verruciformis-like skin lesions, and nonmelanoma skin cancers. This review and update addresses the above listed dermatologic manifestations of HPV disease in HIV-infected individuals, with an emphasis on new findings and published data from 2006 to 2008.