Basal Cell Carcinoma Arises from Interfollicular Layer of Epidermis.

BACKGROUND: BCC is currently the most common type of skin cancer in humans. Although having a low-grade malignancy and metastatic potential, BCC is locally aggressive and destructive. Despite numerous studies, the origin of BCC, whether arising from the follicular or interfollicular layer, remains controversial. OBJECTIVES: This study aims to evaluate whether BCC arises from the follicular or interfollicular layer by using immunohistochemical staining. METHODS: Twenty-three specimens of superficial and nodular BCC at its very early stage were examined. The samples were immunohistochemically stained using BerEP4 antibody. The stained specimens were then examined and scored by 2 independent observers. RESULTS: BerEP4 was found to be strongly positive in all BCC lesions, including a very early lesions budding off the basal layer of the epidermis. CONCLUSION: This study confirmed that the origin site of BCC is basal layer of epidermis. This finding suggests that BCC arises from the interfollicular epidermis.

A critical review of melanoma pathology reports for patients referred to the Western Australian Melanoma Advisory Service.

AIM: To assess concordance between the histopathological reports of referring pathologists and those of pathologists reviewing the cases for the Western Australia Melanoma Advisory Service. METHODS: A retrospective review of 721 pathology reports from 2000 to 2009 was conducted. Histological features including Breslow thickness, Clark level, tumour type and clinicopathological staging [American Joint Committee on Cancer (AJCC)] were compared. Further analysis was undertaken for 169 cases to compare mitotic rate, excision margins, regression, growth phase, vascular invasion, neurotropism, tumour infiltrating lymphocytes, microsatellites and predominant cell type. RESULTS: Referring pathologists consistently reported Breslow thickness, Clark level and excision margins. Reporting of other parameters including ulceration, mitotic rate and vascular invasion, however, was variable. There was almost perfect concordance (kappa = 0.81-1.00) for tumour thickness, ulceration, microsatellites and growth phase; substantial concordance (κ = 0.61-0.80) for Clark level, mitotic rate, completeness of excision and neurotropism; moderate concordance (κ = 0.41-0.60) for vascular invasion, regression, predominant cell type and histological type; and only slight concordance (κ = 0-0.2) for tumour infiltrating lymphocytes. There was a high level of agreement for diagnosis of lesions as melanoma versus benign (97.3%). Overall concordance for pathological tumour staging was substantial (81.9%, κ = 0.79). Lowest concordance was found for stage 1b (91.3%, κ = 0.62). CONCLUSION: Overall concordance in clinicopathological stage was high due to consistency of reporting of tumour thickness and ulceration. Lower concordance was found for pathological substages due to discrepancies in Clark level, highlighting its limited reliability as a prognostic indicator and supporting the revision of its use in the latest AJCC melanoma staging protocol.

Atypical fibroxanthoma: a histological and immunohistochemical review of 171 cases.

The clinical and histological features of 171 atypical fibroxanthomas (AFX) from a single institution in Western Australia are outlined. This area experiences high levels of solar radiation, and all assessable biopsies showed solar elastosis. Patients were aged between 41 and 97 years (median age 74), with 76% of tumors occurring in men (male to female ratio approximately 3 to 1). Most tumors were small, with a median diameter of 10 mm and a range of 4-35 mm. Only 5% exceeded 20 mm in diameter. Most AFX were well-circumscribed dermal lesions, with limited invasion of subcutis in a minority. Histological variants identified included keloidal (n = 8), clear cell (n = 3), and granular cell (n = 3), plaque like (n = 4), and myxoid (n = 1). Bland cytological appearances (spindle cell nonpleomorphic AFX) were noted in 5 tumors, with osteoclast-like giant cells in 2. Features suggesting regression were present in 22 cases. Two cases recurred locally, none metastasized. No tumors expressed melanocytic or epithelial markers. Seventy-four percent of cases expressed smooth muscle actin, typically strongly and diffusely. No AFX stained with desmin. Only 1 of 50 cases was CD117 positive. In conclusion, AFX may show a wide range of histological appearances, and a panel of immunohistochemical markers is essential to make the correct diagnosis. Histological mimics, such as poorly differentiated squamous cell carcinoma, must be carefully excluded. Specific diagnosis is important because there seems to be a very low risk of recurrence or metastasis despite the frequently alarming histology.

Inhibition of established subcutaneous murine tumour growth with topical Melaleuca alternifolia (tea tree) oil.

PURPOSE: Systemic toxicity coupled with long treatment regimes of approved topical chemotherapeutic agents such as imiquimod and 5-fluorouracil (5-FU) are limiting. There is now more focus on the potential use of topical terpene agents as skin cancer treatments. Here, we show for the first time that topical Melaleuca alternifolia (tea tree) oil (TTO), abundant in terpenes, has in vivo antitumour activity. METHOD: Topical TTO formulations applied to immunocompetent tumour-bearing mice were assessed for antitumour efficacy by monitoring tumour growth and by histological analysis following treatment. RESULTS: Four, daily, topical treatments of 10% TTO/DMSO regressed subcutaneous AE17 mesotheliomas in mice for a period of 10 days and significantly retarded the growth of subcutaneous B16-F10 melanomas. The antitumour effect of topical 10% TTO/DMSO was accompanied by skin irritation similar to other topical chemotherapeutic agents, but unlike other approved topical agents, quickly and completely resolved. Furthermore, we show that topical 10% TTO/DMSO caused an influx of neutrophils and other immune effector cells in the treated area, with no evidence of systemic toxicity. CONCLUSION: TTO combined with an effective carrier significantly inhibited the growth of aggressive, subcutaneous, chemo-resistant tumours in immunocompetent mice. Taken together, these findings highlight the potential of topical TTO as an alternative topical antitumour treatment.

Malignant mesothelioma presenting as a lip tumor: report of two cases with one unrecognized by 166 pathologists.

Malignant mesothelioma is a relatively uncommon malignancy, but continues to increase in incidence in many countries around the world, including Australia.

Molecular markers of circulating melanoma cells.

Of all skin cancers, cutaneous malignant melanoma (CMM) is the most aggressive and the life expectancy of patients with lymphatic or systemic metastases is dramatically reduced. Understandably therefore, scientists and clinicians have focused on improving diagnostic and prognostic techniques. Of these, perhaps the most promising are multimarker real-time RT-PCR and microarray for detection of circulating CMM cells in peripheral blood. While the optimal set of markers is still to be identified that can accurately assess disease severity and progression at all clinical stages of the disease, recent progress has been dramatic. Here we provide an exhaustive review of recent studies in which a variety of markers are assessed. Moreover, the efficacy of the markers relative to clinical stage is discussed in light of experimental findings. From these studies, it is apparent that researchers are now much closer to defining a set of markers of circulating cells that can be utilized in routine diagnostic tests.

A clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia.

BACKGROUND: Nonmelanoma skin cancer (NMSC) comprises a heterogeneous group of cancers. A comprehensive review of NMSC mortality has not been performed previously in this region. OBJECTIVE: We sought to document the population affected by lethal NMSC, the types of tumors involved, and their histopathologic features. METHODS: Death certificates of all patients who died from NMSC were examined. Histology of the primary lesion was reviewed in cases when the primary lesion was identified and sections were available. RESULTS: A total of 120 NMSC deaths occurred, including 89 caused by squamous cell carcinoma, 22 by Merkel cell carcinoma, and 9 others. The median age at death was 79 years, unless the patients were immune deficient (68 years). When the primary lesion was identified (n = 45), the median survival after diagnosis was 17 months; 75% of patients died within 3 years. Lethal neoplasms were deeply invasive and infiltrated into the reticular dermis and beyond. Three squamous cell carcinomas were reclassified as adenosquamous carcinoma. CONCLUSION: Lethal NMSC occurs in the elderly and consists mainly of 3 types of deeply invasive cancers.

Toward the discrimination of early melanoma from common and dysplastic nevus using fiber optic diffuse reflectance spectroscopy.

We describe a study of the discrimination of early melanoma from common and dysplastic nevus using fiber optic diffuse reflectance spectroscopy. Diffuse reflectance spectra in the wavelength range 550 to 1000 nm are obtained using 400-microm core multimode fibers arranged in a six-illumination-around-one-collection geometry with a single fiber-fiber spacing of 470 microm. Spectra are collected at specific locations on 120 pigmented lesions selected by clinicians as possible melanoma, including 64 histopathologically diagnosed as melanoma. These locations are carried through to the histopathological diagnosis, permitting a spatially localized comparison with the corresponding spectrum. The variations in spectra between groups of lesions with different diagnoses are examined and reduced to features suitable for discriminant analysis. A classifier distinguishing between benign and malignant lesions performs with sensitivity/specificity of between 6469% and 7278%. Classifiers between pairs of the group common nevus, dysplastic nevus, in situ melanoma, and invasive melanoma show better or similar performance than the benign/malignant classifier, and analysis provides evidence that different spectral features are needed for each pair of groups. This indicates that multiple discriminant systems are likely to be required to distinguish between melanoma and similar lesions.

Grover's disease: 34 years on.

Grover's disease is an entity reported worldwide and recognized as a common disease since Grover first described it in 1970. Its cause remains obscure, but hospitalized, febrile and sun-damaged patients are particularly prone. It is frequently associated with some other skin diseases, including eczemas, psoriasis and solar keratoses. Acantholysis is the universal histological finding in all the varying clinical presentations. Treatment in the past has been ad hoc, but topical therapy, acitretin and phototherapy can suppress symptoms.

Inverted follicular keratosis simulating malignant melanoma.

A 93-year-old woman was noted to have a single pigmented lesion on the posterior aspect of her neck. Clinical examination revealed a 12 x 8-mm flat lesion, with an irregular border and variegated pigmentation. Dermatoscopic examination revealed a lesion with multiple colours, featureless areas and black dots, suggestive of malignant melanoma. With a presumed clinical diagnosis of malignant melanoma, an elliptical excision was performed, with a 1-cm margin. However, histological examination revealed the unexpected diagnosis of pigmented inverted follicular keratosis.

Two cases of eosinophilic pustular folliculitis associated with parasitic infestations.

Two patients presented with papular eruptions that could not be diagnosed clinically. Biopsies of these lesions showed eosinophilic pustular folliculitis (EPF). Both cases were subsequently found to have infestations: one as a result of cutaneous larva migrans was successfully treated with ivermectin and the other caused by scabies mites was successfully treated with topical pyrethrin. The two cases of EPF presented emphasize the need for careful clinicopathological correlation to determine the cause.