Solar Elastosis Research Articles

The correlation between severity of melasma with facial wrinkles in Yogyakarta, Indonesia.

Melasma is a common disfiguring condition involving acquired hyperpigmentation especially on the face, for which the pathogenesis is still uncertain, however histopathological studies showed that there is not only hyperpigmentation in the epidermis, but also solar elastosis or photo-aging due to abnormality of dermal extracellular matrix which contributes to clinical wrinkles. This study aimed to examine a link between the severity of melasma and facial wrinkles as a manifestation of photoaging in a tropical area. This study was an observational study with crosssectional design, conducted in Yogyakarta, Indonesia involving 51 patients with melasma aged 30-50 years who had fulfilled the inclusion and exclusion criteria. The melasma severity was measured clinically with the modified Melasma Severity Index (mMASI), and objectively with the Melanin Index (MI) and Erythema Index (EI) assessed with Mexameter Courage Khazaka. The wrinkle severity was measured clinically by scoring from forehead horizontal lines, crow’s feet, glabellar and nasolabial lines, and total scores were obtained from all of them. The correlation analysis was done statistically with Spearman’s rank tests. The results showed a weak positive but not significant correlation between the mMASI score and total facial wrinkle score (r: 0.165), and a weak positive non-significant correlation between EI and total facial wrinkle score (r: 0.06). There were significant positive moderate correlations between MI and total facial wrinkle score (r: 0.441), due to significant positive moderate correlations between MI and glabella wrinkle (r: 0.392), and between MI and nasolabial wrinkle (r: 0.339). In conclusion, a positive moderate correlation was found between MI and total facial wrinkle score, especially relating to glabellar and nasolabial wrinkles. However, there was no correlation between mMASI score and total facial wrinkle score.

ACTINIC CHEILITIS IN PATIENT WITH SCLERODERMA

Scleroderma is an unusual mucocutaneous disease, characterized by the diffuse deposition of dense collagen in several anatomic sites. We report a case of a 69-year-old male patient, a construction worker with dark-colored skin, referred for diagnosis of a whitish, rough, rigid, and asymptomatic plaque on the lower lip, with unknown evolution time. At physical examination, hyperpigmented cutaneous lesions were also observed in the lower limbs. Based on diagnostic hypothesis of scleroderma and actinic cheilitis (AC), patient was submitted to incisional biopsy of the labial lesion. Histopathological analysis revealed hyperkeratinized stratified squamous epithelium with mild dysplasia and significant hyalinization of connective tissue, with zones of basophilic degeneration of the thick collagen fibers (solar elastosis). Microscopic findings were compatible with scleroderma associated with AC. Patient was instructed in sun protection care and referred to a dermatologist for scleroderma management. This report illustrates the contribution of the dentist in the diagnosis of systemic diseases. Scleroderma is an unusual mucocutaneous disease, characterized by the diffuse deposition of dense collagen in several anatomic sites. We report a case of a 69-year-old male patient, a construction worker with dark-colored skin, referred for diagnosis of a whitish, rough, rigid, and asymptomatic plaque on the lower lip, with unknown evolution time. At physical examination, hyperpigmented cutaneous lesions were also observed in the lower limbs. Based on diagnostic hypothesis of scleroderma and actinic cheilitis (AC), patient was submitted to incisional biopsy of the labial lesion. Histopathological analysis revealed hyperkeratinized stratified squamous epithelium with mild dysplasia and significant hyalinization of connective tissue, with zones of basophilic degeneration of the thick collagen fibers (solar elastosis). Microscopic findings were compatible with scleroderma associated with AC. Patient was instructed in sun protection care and referred to a dermatologist for scleroderma management. This report illustrates the contribution of the dentist in the diagnosis of systemic diseases.

HYPERKERATOSIS ASSOCIATED WITH ACTINIC CHEILITIS: A CASE REPORT

Actinic cheilitis (AC) is an inflammatory lower lip condition with high potential for malignant transformation, associated to sunlight ultraviolet-rays chronic exposure. It is reported a case of a male patient, 51 years old, feoderm, smoker and drinker, and chronic solar exposure, with a habit of nibbling the lips and a complaint of a lesion diagnosed by his dental clinician. Extraoral examination of the left side of lower lip it was observed a white plaque surrounded by erythematous areas associated. An incisional biopsy was performed and the histopathological sections revealed fragments of mucosa coated with squamous epithelium with hyperkeratosis without dysplasia, mild chronic inflammatory infiltrate, and a band of amorphous, acellular, basophilic change known as solar elastosis in lamina propria confirming clinical diagnosis of AC. This case illustrates the importance of AC-patient follow-up, and emphasizes the patient’s encouragement of changing depletory habits to not develop malignant lesion in AC. Actinic cheilitis (AC) is an inflammatory lower lip condition with high potential for malignant transformation, associated to sunlight ultraviolet-rays chronic exposure. It is reported a case of a male patient, 51 years old, feoderm, smoker and drinker, and chronic solar exposure, with a habit of nibbling the lips and a complaint of a lesion diagnosed by his dental clinician. Extraoral examination of the left side of lower lip it was observed a white plaque surrounded by erythematous areas associated. An incisional biopsy was performed and the histopathological sections revealed fragments of mucosa coated with squamous epithelium with hyperkeratosis without dysplasia, mild chronic inflammatory infiltrate, and a band of amorphous, acellular, basophilic change known as solar elastosis in lamina propria confirming clinical diagnosis of AC. This case illustrates the importance of AC-patient follow-up, and emphasizes the patient’s encouragement of changing depletory habits to not develop malignant lesion in AC.

CHARACTERIZATION OF ACTINIC CHEILITIS AS A POTENTIALLY MALIGNANT ORAL DISORDER

Actinic cheilitis (AC) is caused by chronic exposure to ultraviolet (UV) radiation, affecting mainly the lip of white people aged 50 or older, with loss of mucocutaneous delimitation. The question remains whether AC has the potential for malignancy. Currently, it is still not considered a potentially malignant oral disorder (PMOD) due to the lack of studies with a consistent sample. Objective: To characterize AC as a PMOD by studying the index of malignant transformation and clinicopathological correlation. Study design: A total of 182 clinical files of patients with AC were evaluated. Parametric and nonparametric statistical tests were used with a significance level of 5%. Results: AC affects mainly the lower lip of white men over 50 years of age who suffer from chronic exposure to the sun. We found that the probability of malignancy may be high mainly when it is associated with smoking. The percentual of malignant transformation was 28.02%. Microscopic analysis revealed that cellular atypia, inflammatory infiltrate, and solar elastosis are common features. In this study, a close relationship was found between the intensity of the inflammatory process and the degree of epithelial dysplasia in AC. Conclusion: AC is a potentially malignant disorder with high malignancy rate, even higher than some classic PMOD cases.

Photoaging Skin Therapy with PRP and ADSC: A Comparative Study.

Background Stem cells from adipose tissue (ADSCs) and platelet-rich plasma (PRP) are innovative modalities that arise due to their regenerative potential. Objective The aim of this study was to characterize possible histological changes induced by PRP and ADSC therapies in photoaged skin. Methods A prospective randomized study involving 20 healthy individuals, showing skin aging. They underwent two therapeutic protocols (protocol 1: PRP; protocol 2: ADSCs). Biopsies were obtained before and after treatment (4 months). Results PRP protocol showed unwanted changes in the reticular dermis, mainly due to the deposition of a horizontal layer of collagen (fibrosis) and elastic fibers tightly linked. Structural analyses revealed infiltration of mononuclear cells and depot of fibrotic material in the reticular dermis. The ADSC protocol leads to neoelastogenesis with increase of tropoelastin and fibrillin. There was an improvement of solar elastosis inducing an increment of macrophage polarization and matrix proteinases. These last effects are probably related to the increase of elastinolysis and the remodeling of the dermis. Conclusions The PRP promoted an inflammatory process with an increase of reticular dermis thickness with a fibrotic aspect. On the other hand, ADSC therapy is a promising modality with an important antiaging effect on photoaged human skin.

Codelivery of hydrophilic and hydrophobic drugs in a microneedle patch for the treatment of skin pigmentation

When overexposed to ultraviolet B (UVB) irradiation, skin can cause a series of abnormal reactions, such as excessive pigmentation and solar elastosis. In order to better treat the skin after overexposed to UVB, we designed a dissolving microneedles (MNs) loading hydrophilic ascorbic acid and hydrophobic vitamin A palmitate to achieve codelivery. Here, we confirmed that MNs had enough mechanical strength to insert the skin and two drugs were delivered subcutaneously in sequence in vitro. In white guinea pigs, surface observation and histological observation results confirmed that two drugs by MNs transdermal delivery were better than topical administration in the treatment of UVB-damaged skin. The MNs provide a method of loading different drugs into the needles and advance the development of transdermal drug delivery.

Large nested melanoma: a clinicopathological, morphometric and cytogenetic study of 12 cases

A group of melanomas characterised by predominant growth as large nests within the epidermis has been described. These cases present a diagnostic challenge, as many traditional architectural criteria for the recognition of melanoma are absent. We report the clinical, histological, immunohistochemical, morphometric and cytogenetic features of a series of 12 cases of large nested melanoma. In this series, large nested melanoma accounted for 0.2% of cases of melanoma. The majority occurred on the trunk of middle aged patients with absent or minimal solar elastosis and 42% were associated with a component of benign intradermal melanocytic naevus, speaking to classification of these melanomas as falling within the spectrum of lesions developing in skin with low cumulative sun damage. In 67% of cases invasive melanoma was present. Criteria such as asymmetry, variation in nest size and intraepidermal nests with an underlying rim of junctional keratinocytes appear to be highly specific, and are strongly predictive of typical cytogenetic abnormalities of melanoma, which were identified in 92% of cases. Conversely, in addition to features which are definitionally absent or limited, features such as solar elastosis and cytological atypia do not appear to be particularly helpful in recognition of this variant.

Histopathological features of photodamage and mast cell infiltrate in actinic cheilitis with different grades of epithelial dysplasia.

Actinic cheilitis is induced by chronic exposure to ultraviolet radiation and shows solar elastosis, a feature that has been associated with mast cell infiltrates. This study aimed to investigate the area of solar elastosis, collagen loss, and mast cell infiltrates in a series of actinic cheilitis. We evaluated the epithelial dysplasia in 52 cases of actinic cheilitis and the solar elastosis with Weigert's resorcin-fuchsin. Collagen loss was evaluated with Picrosirius red, analyzed under polarized microscopy, and scored from 1 to 3. Elastosis proportionate area (EPA) was calculated with image software. Mast cells were highlighted with toluidine blue stain. EPA varied from 2% to 45%, with a mean of 17.1% in the cases, with no differences among epithelial dysplasia degrees. Most cases presented collagen loss scores of 2 or 3, and higher loss of type I collagen was associated with older age. Mast cell density was higher in severe epithelial dysplasia (P = 0.002) and in high-risk cases (P = 0.01). Actinic cheilitis presented variable EPA and marked loss of type I collagen; however, these features were not associated with the degrees of epithelial dysplasia. Besides, mast cell density increased with epithelial dysplasia worsening and this was not associated with elastosis area or collagen loss.

Morphological Analysis of Dermatoporosis by in vivo Reflectance Confocal Microscopy and Ultrasonography

Background: Dermatoporosis is defined as a chronic cutaneous fragility and insufficiency syndrome. It results from chronological aging, long-term and unprotected sun exposure, genetic factors, or the chronic use of topical and systemic corticosteroids. There is currently a lack of noninvasive tools for the evaluation and quantification of dermatoporosis. Objectives: The aim of this study was to define the dermal-epidermal modifications which characterize dermatoporosis using noninvasive methods such as in vivo reflectance confocal microscopy (RCM) and ultrasound (US). Subjects and Methods: Seventeen patients with stage I dermatoporosis and 14 healthy volunteers were included in the study. The posterior surface of the right forearm was analyzed in all subjects, and stellate pseudoscars and senile purpura in patients with dermatoporosis were analyzed when possible. We used a commercially available reflectance confocal microscope and measured different histometric parameters (thickness of the epidermis and its different layers, cellular architecture, aspect of the dermal-epidermal junction and the dermis). We also used a commercially available US skin system to define the dermal-epidermal thickness (DET) in all subjects. Results: The DET measured with the US skin system was significantly different between the two groups: mean value 1.19 mm (volunteers group) versus 0.81 mm (patient group). The significant differences measured with RCM were (1) epidermal thickness, (2) number of dermal papillae, and (3) thickness of solar elastosis. Stellate pseudoscars are also characterized by a modified dermis, with a linear organization of the collagen bundles. Conclusion: US and in vivo RCM are useful tools for the diagnosis of dermatoporosis. Dermal-epidermal atrophy, reduction of dermal papillae/area, and the thickness of dermal elastosis seem to be the major histometric parameters which characterize dermatoporosis.

Lupus erythematosus tumidus (LET) with autoimmune thyroid dysfunction (AITD) as the first presentation of systemic lupus erythematosus: A case report and review of the literature

IntroductionLupus erythematosus tumidus (LET) is a rare cutaneous manifestation especially as a first presentation of systemic lupus erythematosus (SLE). Autoimmune thyroid dysfunction (AITD) may be associated with SLE but rarely at initial presentation, and its diagnosis may be delayed. Case reportA 29 year old male presented to Tishreen Hospital in Damascus with a three-year history of recurrent cellulitis-like lesions on the face, and more recently, he developed similar lesions on the trunk and the chest, in addition to the development of peripheral and scrotal edema, constipation, xeroderma, hair loss, musculoskeletal pain and depression. Laboratory investigations revealed: leukopenia, anaemia, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Immunological tests identified the positive anti-nuclear antibody (ANA), anti-double stranded DNA (anti-dsDNA), anti Ro/SSA, anti La/SSB antibodies. Additionally, there was consumed complement C3, elevated thyroid stimulating hormone (TSH), thyroid hormones decreased free T3 and T4 and anti-thyroid peroxidase (anti-TPO) antibody was positive. Skin biopsy from the cheek plaque suggested the presence of LET and revealed slight hyperkeratosis; actinic elastosis, telangiectasia and edema of the papillary dermis; deep dermis perivascular and periadnexal inflammatory infiltrates with karyorrhexis of the lymphocytes and dermis edema between strands of collagen. The patient fulfilled the SLE classification criteria and consequently, methylprednisolone, azathioprine, hydroxychloroquine, levothyroxine were introduced with dramatic improvement. ConclusionLET is a rare cutaneous lupus-specific lesion that may be associated with SLE. AITD, hypothyroidism in particular, could be an initial presentation of SLE. Increased awareness and early diagnosis of such clinical presentations may improve patient outcomes.

The 2018 World Health Organization Classification of Cutaneous, Mucosal, and Uveal Melanoma: Detailed Analysis of 9 Distinct Subtypes Defined by Their Evolutionary Pathway.

There have been major advances in the understanding of melanoma since the last revision of the World Health Organization (WHO) classification in 2006. To discuss development of the 9 distinct types of melanoma and distinguishing them by their epidemiology, clinical and histologic morphology, and genomic characteristics. Each melanoma subtype is placed at the end of an evolutionary pathway that is rooted in its respective precursor, wherever appropriate and feasible, based on currently known data. Each precursor has a variable risk of progression culminating in its fully evolved, invasive melanoma. This review is based on the "Melanocytic Tumours" section of the 4th edition of the WHO Classification of Skin Tumours, published in 2018. Melanomas were divided into those etiologically related to sun exposure and those that are not, as determined by their mutational signatures, anatomic site, and epidemiology. Melanomas on the sun-exposed skin were further divided by the histopathologic degree of cumulative solar damage (CSD) of the surrounding skin, into low and high CSD, on the basis of degree of associated solar elastosis. Low-CSD melanomas include superficial spreading melanomas and high-CSD melanomas incorporate lentigo maligna and desmoplastic melanomas. The "nonsolar" category includes acral melanomas, some melanomas in congenital nevi, melanomas in blue nevi, Spitz melanomas, mucosal melanomas, and uveal melanomas. The general term melanocytoma is proposed to encompass "intermediate" tumors that have an increased (though still low) probability of disease progression to melanoma.

Photoaging: a Review of Current Literature

Photoaging, also known as extrinsic aging, consists of premature skin changes secondary to damage caused by chronic sun exposure. This review highlights epidemiology, pathogenesis, clinical, and pathological features of photoaging. UV radiation is the central driver of photoaging. However, there is growing evidence that other environmental factors—including ambient air pollution and visible/infrared light—also play a key role. Furthermore, newer research suggests that skin phototype, ethnicity, and sex can all differentially mediate the process of photoaging. UV radiation is the primary cause of photoaging, an extrinsic aging of the skin. This process can be exacerbated by other factors including air pollution, visible/infrared light, and endocrine factors. Clinically, decreased skin elasticity (solar elastosis) with wrinkle formation is a characteristic feature. However, differences in the features and timing of presentation may vary by skin phototype, ethnicity, and sex. Prevention through minimizing solar irradiation is key.

Spitz melanoma is a distinct subset of spitzoid melanoma.

Melanomas that have histopathologic features that overlap with those of Spitz nevus are referred to as spitzoid melanomas. However, the diagnostic concept is used inconsistently and genomic analyses suggest it is a heterogeneous category. Spitz tumors, the spectrum of melanocytic neoplasms extending from Spitz nevi to their malignant counterpart Spitz melanoma, are defined in the 2018 WHO classification of skin tumors by the presence of specific genetic alterations such a kinase fusions or HRAS mutations. It is unclear what fraction of ‘spitzoid melanomas’ defined solely by their histopathologic features belong to the category of Spitz melanoma or to other melanoma subtypes. We assembled a cohort of 25 spitzoid melanomas diagnosed at a single institution over an eight-year period and performed high coverage DNA sequencing of 480 cancer related genes. Transcriptome wide RNA sequencing was performed for select cases. Only 9 cases (36%) had genetic alterations characteristic of Spitz melanoma, including HRAS mutation or fusion involving BRAF, ALK, NTRK1, or MAP3K8. The remaining cases were divided into those with a MAPK activating mutation and those without. Both Spitz melanoma and spitzoid melanomas in which a MAPK activating mutation could not be identified tended to occur in younger patients on skin with little solar elastosis, infrequently harbored TERT promoter mutations, and had a lower burden of pathogenic mutations than spitzoid melanomas with non-Spitz MAPK activating mutations. The MAPK activating mutations identified affected non-V600 residues of BRAF as well as NRAS, MAP2K1/2, NF1 and KIT while BRAF V600 mutations, the most common mutations in melanomas of the WHO low-CSD category, were entirely absent.While the ‘spitzoid melanomas’ comprising our cohort were enriched for bona fide Spitz melanomas, the majority of melanomas fell outside of the genetically defined category of Spitz melanomas, indicating that histomorphology is an unreliable predictor of Spitz lineage.

Exploratory Study of Epidermis, Basement Membrane Zone, Upper Dermis Alterations and Wnt Pathway Activation in Melasma Compared to Adjacent and Retroauricular Skin.

BackgroundMelasma is a chronic acquired focal hypermelanosis which pathogenesis has not been fully elucidated. Classical pathophysiologic studies have analysed the affected and perilesional areas, but little is known about the status of sun-protected skin, which is subjected to the same endogenous and genetic factors.ObjectiveTo assess the histological characteristics of melasma compared to adjacent and retroauricular skin.MethodsSkin samples were collected from 10 female from: melasma, perilesional area and retroauricular. The samples were stained (haematoxylin-eosin, periodic acid-Schiff, Fontana-Masson, picrosirius red, toluidine blue and Verhoeff), immunolabelled for CD34 and Wnt1. The data from the skin sites were analysed simultaneously by a multivariate model.ResultsMelasma skin exhibited noteworthy stratum corneum compaction, greater collagen heterogeneity, solar elastosis, higher number of mast cells, basement membrane zone (BMZ) damage, Wnt1 expression, pendulum melanocytes, higher cellularity and vascular proliferation at the superficial dermis. Stratum corneum compaction, collagen heterogeneity and BMZ abnormalities were variables associated to melasma that not follow a continuum through retroauricular to adjacent skin. Mast cell count was the variable that disclosed correlation with the most other abnormalities as well as had the greater contribution in the multivariate model.ConclusionIn addition to melanocyte hyperactivity, melasma skin exhibits alterations in the epidermal barrier, upper dermis and BMZ, which differ from the adjacent sun-exposed skin and retroauricular skin, indicating a distinct phenotype, rather than a mere extension of photoageing or intrinsic ageing. Mast cells appear to play a central role in the physiopathology of melasma.

A SYNCHRONOUS PARACOCCIDIOIDOMYCOSIS AND SQUAMOUS CELL CARCINOMA: A CASE REPORT

A 51-year-old white man presented with a 3-month history of oral pain. He was edentulous and his intraoral examination revealed a mulberrylike granulomatous lesion on the right superior alveolar ridge and 2 adjacent ulcerations on the right upper lip. Biopsies of the oral lesions were performed revealing a granulomatous inflammatory response positive for Paraccocidioides brasiliensis. Systemic investigation showed pulmonary involvement. He was treated with itraconazole. A synchronous actinic cheilitis was detected. After 12 months of follow-up, a persistent white, rough, scaly area developed on the left vermilion lower lip and an incisional biopsy was performed. Histopathologic analysis demonstrated solar elastosis and superficially invasive squamous cell carcinoma. The patient was referred to a head and neck surgeon and vermilionectomy was the treatment employed. No recurrence was observed after a 7-month follow-up. This case report emphasizes the importance of global clinical evaluation and patient follow-up aiming at early oral lesion diagnosis.

CHARACTERIZATION OF BASAL CELL CARCINOMAS IN THE ORAL PATHOLOGY SERVICE OF THE UNIVERSITY OF TALCA. A CASE SERIES

Basal cell carcinoma (BCC) is the most frequent malignant neoplasm that affects the skin of the maxillofacial territory. Histopathologic records of the Pathology and Oral Medicine Service of the University of Talca show an increase in the frequency of BCC from 2007, with 6 cases registered to date. Average age of patients is 56 years, mostly women, with predominance of an ulcerated clinical presentation without healing. A total of 5 of the cases affected high-risk anatomic areas. All cases were submitted to excisional biopsy. Microscopically, 100% presented invasion to the connective tissue with well-differentiated cells, 50% of the cases contained melanin pigmentation, and only 1 showed solar elastosis. A total of 50% of the cases had a different presumptive diagnosis at clinical examination; however, 100% were confirmed as BCC by histopathologic analysis. To date, patients maintained at least a 2-year control period with no recurrence.

Exogenous Ochronosis as an Elastotic Disease: A Light-Microscopic Approach.

Exogenous ochronosis (EO) is a deposition disease associated with application of hydroquinone-containing preparations. Characteristic ochronotic bodies (OBs) arise from endogenous connective tissues, most often reported as collagen. We highlight a significant role for elastic fibers as a precursor tissue. To evaluate elastic tissue pathology in EO, specifically as it relates a precursor role in ochronotic body formation. In this retrospective observational study, a literature review using PubMed/MEDLINE database was conducted to ascertain the most commonly ascribed precursor connective tissue. Eleven histopathologic cases of EO were identified. Patient demographics and clinical characteristics were recorded. Slides were reviewed for the presence and grade of solar elastosis (SE), the relationship of OBs to elastotic material, the presence of elastotic fibers transitioning to OBs, and positivity of bodies with Verhoeff-van Gieson elastic tissue stain. Elastic fibers are uncommonly reported as the major precursor tissue of OBs. SE was uniformly present in our cases, and the majority demonstrated heavy/high-grade elastosis. Elastotic fibers transitioning to OBs were observed in all cases, and the bodies demonstrated Verhoeff-van Gieson positivity. Small sample size. Ochronotic body formation is associated with SE, and bodies appear to arise from damaged elastic fibers.

Actinic cheilitis: Morphometric parameters and its relationship with the degree of epithelial dysplasia

Actinic cheilitis (AC) is a potentially malignant lesion caused by chronic sun exposure. This study aimed to evaluate the relationship between the degree of epithelial dysplasia and morphometric findings in AC. Sixty-eight slides of AC cases were selected and classified according to the grade of epithelial dysplasia, following morphologic criteria of World Health Organization. For morphometric analysis, the slides were scanned and images were analyzed using Pannoramic Viewer software. We obtained vertical measurements of the parameters: thicknesses of the keratin layer, lamina propria and zone of solar elastosis in three selected fields. Thirty-seven (54.4%) of the analyzed cases were classified as none/mild dysplasia and 31 (45.6%) as moderate/severe epithelial dysplasia. Cases with a moderate/severe dysplasia exhibited a thicker layer of keratin (median = 0.055 mm) than none/mild dysplasia (median = 0.045 mm) (p = 0.033). No significant differences in the thicknesses of lamina propria and zone of solar elastosis were observed according to the grade of epithelial dysplasia. A positive significant correlation between keratin layer and lamina propria thicknesses was found (p = 0.019). Based on our findings, rigorous clinical follow-up should be recommended for patients whose histopathological examination shows a greater thickness of the keratin layer.

Dermatological and Epidemiological Profiles of Patients with Albinism in São Paulo, Brazil, between 2010 and 2017: A Cross-Sectional Study

Introduction: Oculocutaneous albinism is an autosomal recessive disease caused by complete absence of or decrease in melanin biosynthesis in melanocytes. Due to the reduction or absence of melanin, albinos are highly susceptible to the harmful effects of ultraviolet radiation and are at greater risk of actinic damage and skin cancer. There are no epidemiological data on the incidence of albinism in Brazil. Objective: To analyze the clinical and epidemiological profile of patients with albinism treated by the Pró-Albino Program of the Dermatology Clinic of Santa Casa de Misericórdia from its beginning in 2010 until 2017. Methods: In this cross-sectional study, the records of all consecutive albino patients admitted to the service in the study period were reviewed. Sociodemographic data, family history, and dermatological clinical data were collected. Results: Between March 2010 and April 2017, 191 patients were admitted, of whom 109 were female (57.07%) and the age range was 0–92 years, with >30% under the age of 18 years. Consanguinity among the parents was confirmed by 26% of the patients. Unprotected sun exposure was reported by 109 (57.07%), and 138 (72.25%) had a history of sunburn. Of the 146 records with information, 38 had skin cancer (26%), with a mean age of 47.4 (p < 0.0001); the youngest patient diagnosed with a cutaneous tumor was 23 years old. The prevalence of actinic damage was high. There was information on solar elastosis and actinic keratosis in 148 medical records, of which 96 (64.8%) patients had elastosis and 75 (50.67%) keratoses. Elastosis, keratosis, and skin cancer were significantly associated with age, unprotected sun exposure, and sunburn (p < 0.05). Of the 37 (26% of the sample of 146) patients with a previous or current history of skin cancer, it was possible to identify the histological type in 29 (13 men and 16 women); of these, 18 (62%) were basal cell carcinomas (BCC), 15 (51%) were squamous cell carcinomas (SCC), and 2 (7%) were melanomas. Of these, 4 cases (14%) presented the 2 types of carcinoma (BCC and SCC), and the 2 that had a diagnosis of melanoma also had BCC. Some patients had multiple ulcerated tumors. The tumor site was preferentially in the head and neck (43%), trunk (37%) and limbs (20%). Conclusions: Albinos represent a risk group for skin cancer and other actinic lesions. These lesions were found to be prevalent in the albinos seen by the program and probably reflect the characteristics found in the Brazilian albino population. Access to health care, especially through multidisciplinary programs that enable the diagnosis and early treatment of these lesions, health education, and the use of photoprotective measures can reduce morbidity and mortality and improve the quality of life of patients with this rare genetic condition.

The clinicopathological features and HPV detection of conjunctival actinic keratosis

Objective: To describe the clinicopathological features of conjunctival actinic keratosis (AK) and relation to the infection of human papillomavirus (HPV). Method: Retrospective case series study. Eighteen cases (18 eyes) of conjunctival AK were obtained in Tianjin Eye Hospital and Institute (2005-2018). The clinical and histopathological features were studied. HPV was detected by a modified general primer HPV polymerase chain reaction (PCR) system in all formalin-fixed, paraffin-embedded specimens. Results: The male to female ratio was 5∶1. The mean age at diagnosis was 60 years (range: 43-79 years). Sixteen cases were located in the nasal interpalpebral region, and two cases were located in the temporal interpalpebral region. All cases were located in corneal limbus, and the mean distance of corneal invasion was 2 mm (range, 1-4 mm). The mean diameter was 4.6 mm (range, 2.0-8.0 mm). Clinically, most lesions (16 cases) appeared as a white or milky, flat plaque with clear borderline and conjunctival hyperemia; a few lesions (2 cases) showed a brown-black mass, partially white. Pathologically, conjunctival AK was a proliferation of epithelium with prominent parakeratosis or hyperkeratosis, stratum spinosm thickening and basal cell proliferation. Many AKs show solar elastosis and a mild inflammatory infiltrate of lymphocytes and plasma cells in the stroma. Most lesions (15 cases) were hypertrophic type, two cases were pigmented type, and one case was acantholytic type. HPV was negative in 18 cases. All case were removed by complete surgical excision. The rage of follow-up period was 1.0-10.4 years, ten cases were recorded, and no case recurred after surgical excision. Conclusions: Conjunctival AK is epithelial precancerous lesion that occurs in the keratoconjunctival margin. HPV infection might not be a causative factor in conjunctival AK. (Chin J Ophthalmol, 2019, 55: 531-535).