Benign Epidermal Tumors Research Articles

Correlation Among Serum Calcidiol, Sun Index, and Vitamin D Intake in Individuals With Seborrheic Keratoses Living in Coastal Area.

Seborrheic keratoses (SK) are benign epidermal tumors with high sun exposure as a major risk factor. Vitamin D deficiency is also thought to play a role in its pathogenesis. There has been no data regarding SK, calcidiol level, vitamin D intake, and sun index (SI) among people living in coastal areas in Indonesia. To assess the correlation between 1) serum calcidiol levels with SI and vitamin D intake and 2) lesion size with SI and serum calcidiol level among SK patients living in a coastal area. This is a cross-sectional study. We performed interviews using the sun index questionnaire and semiquantitative food frequency questionnaire for vitamin D; physical examination; dermoscopy to determine the largest SK lesion size; and measurement of serum calcidiol levels in participants with SK living in Cilincing District, North Jakarta. Spearman correlation test was used to assess the relationship between variables. Thirty-nine participants with SK aged 19-59 years were analyzed. The median of the SK largest diameter, SI, serum calcidiol, and vitamin D intake was 2 (1-10) mm, 3.95 (1.1-23.52), 14.3 (5.25-35.30) ng/ml, and 4.3 (0.1-30.1) mcg/day, respectively. SI and vitamin D intake were not significantly correlated with calcidiol levels. Similarly, SI and calcidiol levels were not significantly correlated with the largest SK lesion size. We found low calcidiol levels and vitamin D intake in this coastal population. The SI and vitamin D intake had no correlations with calcidiol levels. Furthermore, calcidiol levels and SI had no correlations with the lesion largest diameter.

Giant clear cell acanthoma: a case report and a review of the literature

Clear cell acanthoma (CCA) is an uncommon benign epidermal tumor of unknown origin and etiology. It is often solitary, and the presence of multiple CCAs in the same individual is rare. Typically, it presents as a slowly growing plaque or nodule located on the legs with a peripheral scaling collarette. Diagnosis is primarily based on clinical and histopathological findings, with dermoscopy enhancing diagnostic accuracy. The differential diagnosis includes various skin tumors and inflammatory dermatoses. The preferred treatment is surgical excision, as these lesions do not regress spontaneously. We describe a case of a large CCA on the right thigh associated with multiple small nodular lesions scattered across the legs.

Hypertrophic Lichen Planus: An Up-to-Date Review and Differential Diagnosis.

Hypertrophic lichen planus (HLP) is a variant of lichen planus that can be difficult to diagnose based on histopathologic features alone. Thus, patient clinical history and clinicopathologic correlation are essential considerations to make the correct diagnosis. To discuss the clinical and histologic presentation of HLP and provide a thorough review of commonly encountered mimickers in the differential diagnosis. Data were derived from a literature review, personal clinical and research experiences, and a review of cases in the archives of a tertiary care referral center. In general, HLP involves the lower extremities and is characterized by thickened, scaly nodules and plaques that are often pruritic and chronic in nature. HLP affects both males and females and is most common in adults 50 to 75 years of age. Unlike conventional lichen planus, HLP tends to have eosinophils and classically displays a lymphocytic infiltrate most concentrated around the tips of rete ridges. The differential diagnosis for HLP is broad and encompasses numerous entities in many different categories, including premalignant and malignant neoplasms, reactive squamoproliferative tumors, benign epidermal neoplasms, connective tissue disease, autoimmune bullous disease, infection, and drug-related reactions. Therefore, a high index of suspicion must be maintained to avoid a misdiagnosis and potential inappropriate treatments.

Clinico-epidemiological study cf skin lyarts among patientsattending Tikrit teaching hospital

Back ground : Warts are benign epidermal neoplasms that are caused by human papilloma virus (HPVs). Warts are transmitted by touch; it may occur on adjacent toes ("kissing lesions"), or at sites of trauma at the hands, in periungual regions as a result of nail biting, and on plantar . surface. There are different clinical types as Common warts (Verruca vulgaris) begin as smooth, flesh-coloured papules and evolve into dome-shaped, gray-brown, hyperkeratotic growths with black dots on the surface ( thrombosed capillaries).The hands are the most commonly involved areas, but they may be found on any skin surface. Patients and methods: One hundred and twenty four (124) patients with warts were encountered in the outpatient clinic of dermatology at Tikrit Teaching Hospital from October 2008 to May 2009.Patients were examined by dermatologists and medical history was taken using special questionnaire. Results: from 124 patients , 68 (54.8%) were males. Preschool and primary school children were the most age group affected (41 %). Most frequent of wart cases were from urban (62%). The hands was the most frequent site in the body affected (24%). The most frequent wart type was a common wart (54.8%). Regarding the associated diseases atopic dermatitis was the most frequent (12%). Conclusion: The most frequent wart type was a common wart (54.8%)and The hands was the most frequent site in the body affected(24%).

Clonal-pattern Seborrheic Keratosis: Risk of Recurrence and Progression to Carcinoma.

Seborrheic keratosis is a benign epidermal tumor. Seborrheic keratosis with clonal pattern (CPSK) displays histologic features distinct from other subtypes of SK (non-CPSK). We sought to quantitatively assess the risk of recurrence and progression to squamous cell carcinoma (SCC), either in situ or invasive, of incompletely excised CPSKs. We studied all 244 cases from 238 patients of "seborrheic keratosis, clonal pattern" diagnosed in our institution over a 10-year period (2008-2018). Demographic, clinical, pathologic, and follow-up data were gleaned from electronic health records. Following glass slide review, CPSK lesions were divided into 2 groups: CPSK with cytologic atypia and CPSK without cytologic atypia. For comparison, 107 non-CPSKs were studied as controls. The minimum follow-up period was 2 years (median=4y). All lesions were incompletely excised. Eighteen of 244 CPSKs (7.4%) recurred at or adjacent to the site of initial partial removal compared with 1.9% of non-CPSKs. Five of the 18 (28%) recurrent CPSKs recurred as CPSK, 11 (61%) as SCC in situ, and 3 (17%) as invasive SCC. The mean time to recurrence was 3.1 years. Two non-CPSKs recurred as non-CPSKs. Overall CPSKs were more likely to recur than non-CPSKs ( P =0.04). CPSKs with atypia were more likely to recur than CPSKs without atypia ( P =0.03). The upgrade rate to SCC at least in situ of all recurrent CPSK lesions with atypia was 78%. Our results suggest that pathologists should report the presence of clonal pattern when observed in seborrheic keratoses, indicate the presence of atypia, and provide lesional margin assessment.

Role of dermoscopy in diagnosing and differentiating seborrheic keratoses

Background Seborrheic keratosis is one of the most common benign epidermal tumors seen in elderly individuals. It has slow growth and presents with a varied degree of pigmentation in skin color closely resembling many other pigmented dermatoses. Dermoscopy, a noninvasive technique, could increase the accuracy of diagnosis and can differentiate it from various closest mimickers and malignancies. Aim This study aims to describe the various dermoscopic features of seborrheic keratosis in a series of cases. Patients and methods A hospital-based, descriptive study was conducted over 12 months from January 2018 to December 2018 in the Department of Dermatology, a tertiary-care center. A total of 100 patients were selected and evaluated in a prestructured proforma concerning age, sex, site of lesion, number and duration, and associated comorbidities. The lesion is observed on dermoscopy, and the dermoscopic patterns were then documented and analyzed. Result Among a total of 100 (32%) cases, the most common age group was between 41 and 50 years with females (52%) outnumbering males (48%). The most common site was the face (38%), and the common morphology was plaque (60%). Sign of Leser-Trélat was observed in five patients of which three were associated with malignancy that includes two lymphomas and one breast carcinoma. The color on dermoscopy was predominant dark brown (43%) and brownish-black (32%). The common element was clod (39%) and combined clod and dots (18%). More than three colors and more than two elements in a single lesion were observed in 15 and 11% of cases, respectively. The dermoscopic clues of seborrheic keratosis with highest to lowest prevalence were cerebriform pattern (76%), sharp demarcation (64%), comedone-like opening (56%), milia-like cyst (54%), mica-like scales (52%), moth-eaten border (46%), jelly sign (40%), fingerprint-like pattern (40%), fat fingers (36%), peripheral globules/network (34%), coral-like structure (26%), papillary structures (26%), irregular globules (12%), irregular opaque brown pigmentation (12%), and yellow-orange areas (3%). The flat seborrheic keratosis predominantly showed an irregular network-like structure, fat fingers, milia-like cyst, and accentuation of two adjacent perifollicular pigmentations forming a double ring-like structure (16%). The raised lesions predominantly showed fissures/ridges (cerebriform pattern), exophytic papillary structures, opaque pigmentation, and a mica-like pattern. Ten lesions were misinterpreted as seborrheic keratosis clinically and on dermoscopy were verruca vulgaris (2/10, 20%), melanocytic nevus (3/10, 30%), and basal cell carcinoma (5/10, 50%), which were confirmed on histopathology. Conclusion The study emphasizes the use of dermoscopy in seborrheic keratosis to improve the clinical accuracy of diagnosis and also to differentiate from its common mimickers.

800 Dermoscopic findings and histopathological correlation in large cell acanthoma

Large cell acanthoma (LCA) is a benign epidermal tumor that presents with pigmented hyperkeratotic patch with well-demarcated boundaries in sun-exposed areas. Since various epidermal pigmented tumors present overlapping clinical and histopathological features, additional methods to differentiate them would be of great clinical significance. Although there are numerous data on the dermoscopic findings of other comparable epidermal pigmented tumors, there is a lack of data on the dermoscopic features of LCA.

Human papillomavirus genotype distribution of genital keratotic lesions.

Genital keratotic lesions include bowenoid papulosis (BP), which histologically resembles squamous cell carcinoma in situ containing high-risk HPV, condyloma acuminatum (CA) that is a genital wart containing mostly low-risk HPV, and genital seborrheic keratosis (GSK), which is a benign epidermal tumour lacking a clear etiologic relationship with HPV. This study compared HPV genotype distributions among BP, CA and GSK and revealed that BP and GSK were related to high-risk HPV whereas CA was related to low-risk HPV. It is plausible that GSK is a distinct epidermal tumour often related to high-risk HPV rather than merely a senescent form of CA considering the overall discrepancy in the frequency distribution of HPV genotypes along with histopathological differences, and the detection of high-risk HPV in GSK alerts physicians to consider more active treatment and continued follow-ups.

Genç Bir Erkekte Greft Bölgesinde Seboreik Keratoz

Seborrheic keratosis are common, benign epidermal tumours that present as asymptomatic, pigmented papules with a stuckon appearance. Stucco keratosis is a type of seborrheic keraosis which has a scaly verrucous surface and can be scrapped off by scratching. Seborrheic keratosis is usually associated with advancing age and ultraviolet light exposure. Herein, we describe a case of stucco keratosis present only over the full thickness skin graft site in a young male. The tumours developed soon after skin grafting was done for a defect produced after a road traffic accident. Skin grafts are associated with skin barrier dysfunction and lymphatic compromise which may produce immunocompromised cutaneous districts and lead to seborrheic keratosis.

Pigmented seborrheic keratosis: The importance of histopathological evaluation distinguishing from melanoma

Seborrheic keratosis is a common benign epidermal tumor of the skin. Pigmented seborrheic keratosis is a relatively rare variant of the entity. Here it has been reported a rapidly growing cutaneous hairy hemorrhagic lesion exhibiting discoloration including pinkish, light and dark brownish, black areas with irregular border in an adult man.

Effectiveness of a cosmetic device containing a combination of alpha- and beta-hydroxy acids, urea, and thuja for the treatment of seborrheic keratoses.

Seborrheic keratosis is a benign epidermal tumor of cosmetic concern-as it progressively increases in size, thickness, and pigmentation-on which topical treatments are poorly effective. Considering its keratotic component, effective products may include active principles with keratolytic action. Evaluate the efficacy and tolerability of a topical cosmetic product with urea and hydroxy acids, in the treatment of seborrheic keratoses. Twenty patients were enrolled in an observational, prospective, open-label study. The topical device was applied on seborrheic keratoses twice daily for 30days. We evaluated the progression of the treatment by clinical examination-using Daily Life Quality Index-and epiluminescence microscopy at baseline and day 30. After 30days of treatment, we documented a significant reduction in seborrheic keratosis thickness and number, which was confirmed also by epiluminescence microscopy. On day 30, global Daily Life Quality Index improved by 99.95%. The tolerability of the cosmetic device was considered excellent, according to 19/20 subjects (95%). The results of our study showed the efficacy and tolerability of this cosmetic device. Its active compounds favor gradual removal of seborrheic keratoses, even in case of pigmented variants. This non-invasive treatment represents an alternative to surgical procedures, mainly for fragile patients and delicate skin areas. It is possible to speculate its usefulness in the topical treatment of circumscribed hyperkeratosis, palmoplantar keratoderma, and thick psoriatic plaques.

The Correlation between Human papillomavirus and Increased Expression of p53 in Seborrheic Keratosis

Background: Seborrheic keratosis is a benign epidermal skin tumor caused by sun exposure, virus, and genetic factor. Human papillomavirus (HPV) infection presumed to have an important role in seborrheic keratosis. Protein p53 is a protein produced by tumor suppressor gene. There has been no research that correlates of HPV with p53 increase in seborrheic keratosis. Purpose: To prove the correlation between HPV and increased p53 expression in seborrheic keratosis. Methods: This study is an analytic cross-sectional comparative study. Samples were taken using a consecutive sampling method. There were 22 seborrheic keratosis patients recruited as the research sample. HPV were detected using the polymerase chain reaction (PCR), and p53 expression were detected using the immunohistochemistry examination. Result: The mean age of seborrheic keratosis patients in this study was 54.36±10.09 years, and they were predominantly males (54.5%). HPV were found in 86.4% of the seborrheic keratosis patients. The P53 expression (+) were 77.3%, (++) were 13.6%, and (+++) were 9.1%. All of the seborrheic keratosis with increased p53 expression had positive HPV results, but with no significant results (p=0.600). Conclusion: There were no correlation between HPV with increased p53 expression in seborrheic keratosis patients.

Therapeutic and diagnostic considerations in multiple eruptive clear cell acanthoma

Clear cell acanthoma represent a benign solitary epidermal tumor of the clear glycogen containing epithelial cells, which is quite common in dermatologic practice. The etiology of this tumor formation is not known exactly at the moment. Clinically, the lesion appears as a single reddish papule or papule-nodule and the characteristic of this lesion is represented by a peripheral scaling collarette. Although solitary lesions represent the most common form of presentation of the acanthoma with clear cells, less than thirtieth cases of multiple clear cell acanthoma, from two up to four hundred lesions, have been described in the medical literature to date. The diagnosis based on clinical features frequently needs to be supported using a dermoscopy exam and, in most cases, a histopathology exam is required. The treatment consists is complete removal (standard surgical excision, cryotherapy, electrofulguration alone, carbon dioxide laser or shave removal or curettage followed by electrofulguration). For the cases with multiple lesions, cryotherapy, or topical 5- fluorouracil are preferred. We present the case of a 62-year-old male patient, presented to our Dermatology Department for multiple asymptomatic rounded papules and multiple exophytic nodular tumor formations (approximate fifteen), on the lower extremities, which had occurred approximately two years previously and gradually increased in number.

Seasonal emergence of benign epidermal tumor in farm-reared adult grass carp (Ctenopharyngodon idella) caused by lymphocystis disease virus at Uttarakhand, India

From 2017‐2019, during the winter months (November–January), epidermal papilloma like benign tumor was observed in farm-reared adult grass carp, Ctenopharyngodon idella at the northern part of India. An investigation was undertaken to establish the causative agent of this epizootiology. Based on the clinical signs and ineffectiveness of antibiotics to control this disease, viral infection was suspected. A primer was designed to PCR amplify the partial DNA polymerase gene of lymphocystis disease virus (LCDV) from the tumor of moribund grass carp, which yielded 460 bp amplicon. After sequencing this 460 bp amplicon, the viral agent from the tumor of grass carp was identified as lymphocystis disease virus and given strain designation LRI-18 (Genbank accession number-MK347473). Phylogenetic analysis based on the nucleotide sequence of DNA polymerase gene of LCDV revealed the close association of LCDV LRI-18 to LCDV strain from Israel with 99.0% and 96.5% nucleotide and amino acid sequence identity, respectively. LCDV LRI-18 form single (type A; 0.5–2.0 μm) or multiple (type B; 0.5–2.0 μm) intracytoplasmic inclusion bodies on lymphocystis and erythrocyte cells of infected grass carp. Transmission Electron Microscopy (TEM) of blood revealed the presence of enveloped icosahedral virions of approximately 280 nm in diameter with electron dense core and an outer capsid. Histopathological study of various organs of LCDV infected grass carp revealed extensive hypertrophy and fusion of secondary gill lamellae, focal hemorrhage in the eye, pyknotic nuclei in the liver, inflammation in the myocardium, fused villi of intestine and degeneration of the glomeruli in the kidney. Experimental infection by a dip to grass carp fingerlings (average body weight 4.4 ± 0.9 g) using 0.45 μm filtered LCDV crude suspension did not reproduce the disease, and also no mortality were observed. This is the first report of the occurrence of lymphocystis disease in grass carp in India.

Evaluation of Topical Photo-Enhancer Assisted Intense Pulsed Light versus Methylene Blue Assisted Intense Pulsed Light for Treatment of Seborrheic Keratosis

Abstract Background seborrheic keratosis is one of the most common benign epidermal tumors that affects both sexes equally, and usually arises in individuals older than 50 years. It presents as sharply demarcated, slightly raised brownish patches or plaques, usually on sun-exposed surfaces of the skin. The clinical presentation can be quite variable and includes clinical variants, such as stucco keratosis and dermatosis papulosa nigra. Aim of the Work to evaluate the efficacy and safety of topical carbon gel photo-enhancer assisted intense pulsed light versus methylene blue assisted intense pulsed light photodynamic therapy for treatment of Seborrheic Keratosis. Patients and Methods this is a comparative prospective study that included thirty patients of skin types III to V Fitzpatrick class having multiple Seborrheic Keratosis lesions with no sex or age predilection. They were randomly recruited from Dermatology out-patient clinic of Ain –Shams University Hospitals, during period from June 2017 till March 2018. The study was approved by Research Ethical Committee of Ain Shams University and fulfilled all the ethical aspects required for human research. Results this denoted that the methylene blue-mediated photodynamic therapy (MB-PDT) (liposomal-loaded methylene blue gel 10%).and topical carbon gel photo-enhancer assisted intense pulsed light). could be effective in treating patients with Sks. Our findings denote the efficacy of them in curing multiple Sk lesions. The efficacy of methylene blue-mediated photodynamic therapy (MB-PDT) (liposomal-loaded methylene blue gel 10%). Conclusion that Intense Light Pulse using liposomal-loaded MB and Topical carbon suspension-assisted IPL treatment could be a good option for patients with indistinct pigmented or thick melanogenesic lesions. Adverse reactions to this treatment were minimal and the results acceptable, though appropriate lesions need to be chosen care- fully.

Hydrogen Peroxide Use for Chemical Destruction in Seborrheic Keratosis: A Review

Seborrheic Keratosis (SK) is a common, benign epidermal tumor as observed by dermatologists. Removal is rarely indicated, and usually requested by patients for cosmetic preference. The most common method of removal is cryotherapy, but other topical treatments exist. Topical Hydrogen Peroxide has been recognized as an effective topical treatment. Safety concerns and maximum efficiency of peroxides have been a topic of study in a variety of dermatological conditions. This article aims to review the chemical composition of hydrogen peroxide (H202) in treating SK, methods to increase its effectiveness as a topical dermatological product, and explore the promising new FDA approved treatment.

Recent advances in managing and understanding seborrheic keratosis.

Seborrheic keratosis (SK) is a common benign epidermal tumor with predominance in adult patients. Whereas common SKs are more frequent in Caucasians, dermatosis papulosa nigra is more prevalent in patients with a Fitzpatrick skin type of at least 3. There seems to be a link between extrinsic skin aging and the occurrence of SK. Mutations of fibroblast growth factor receptor 3 and other signaling molecules are a frequent finding in SK lesions. However, this does not translate into any malignant potential. Viral infections are particularly common in genital lesions, although their pathogenetic relevance for SK is questionable. Different histologic and clinical subtypes have been identified. The great variability of SKs raises some difficulties in diagnosis. Dermoscopy is the preferred non-invasive diagnostic method, in particular to differentiate pigmented SKs from other pigment tumors, including cutaneous melanoma. Eruptive SKs can be a paraneoplastic condition known as the Leser–Trélat sign. New targeted cancer treatments can cause a pseudo-Leser–Trélat sign. The treatment in practice is mainly minor surgery, including cryosurgery, shave excisions, and laser-assisted removal. The medical approaches have only limited effects. Recently, two formulations for topical therapy have been evaluated: a product with 40% hydrogen peroxide (HP40) and an aqueous nitric–zinc complex. Based on clinical trials, HP40 seems to be a promising alternative to surgery, in particular for facial lesions.

Clarion and Crystal-Clear Cell Acanthoma Reviewed

Clear cell acanthoma was portrayed primarily by Degos [1]. Clear cell acanthoma is also referred to as Degos’ acanthoma or pale cell acanthoma and is cogitated as an asymptomatic, benign epidermal tumor devoid of gender predilection.

Pale (Clear) Cell Acanthoma of the Palate

Clear cell acanthoma (CCA), also known as pale cell acanthoma, represents a rare benign epidermal tumor with strong predilection for the lower extremities of middle-aged individuals and no frank gender preference. The etiology of CCA is poorly understood, although a localized psoriasiform reaction is favored. Herein, we report on the clinicopathologic and immunohistochemical features, and HPV status of an apparent example of oral CCA. A 58-year-old female presented with a well-circumscribed, asymptomatic, exophytic, sessile and erythematous nodule of the right hard palate, measuring 0.7cm in greatest dimension. Microscopically, the lesion featured parakeratosis and acanthosis with neutrophilic microabscesses and broad elongated rete pegs. In areas, spinous epithelial cells exhibited pale or clear cytoplasm without nuclear pleomorphism, mitoses or cytologic atypia. The supporting connective tissue revealed mild chronic inflammation with few scattered neutrophils and numerous capillary vessels. PAS histochemical stain with and without diastase disclosed the presence of cytoplasmic glycogen in the pale cells. The majority of glycogen-rich epithelial cells stained strongly for EMA and were negative for D2-40. Ki-67 immunostaining was confined only to the basal cell layer of the epithelium. A diagnosis of CCA was rendered. The lesion was negative for human papillomavirus (HPV) infection, as assessed by HPV-DNA PCR using the MY09/11 primers for the L1 conserved region, thus HPV infection does not appear to contribute to the pathogenesis of oral CCA. In conclusion, we report an intraoral example of CCA in order to raise awareness about this entity.

Extragenital cutaneous warts - clinical presentation, diagnosis and treatment.

Extragenital cutaneous warts are benign epidermal tumors caused by human papillomaviruses (HPVs) and a frequent reason for patients to consult a dermatologist. Depending on wart type and site involved, the clinical presentation is highly varied. Given that warts represent a self-limiting condition, a wait-and-see approach may be justified. However, treatment is always indicated if the lesions become painful or give rise to psychological discomfort. Factors to be considered in this context include subjective disease burden, patient age, site affected, as well as the number and duration of lesions. Destructive treatment methods involve chemical or physical removal of diseased tissue. Nondestructive methods consist of antimitotic and antiviral agents aimed at inhibiting viral proliferation in keratinocytes. Some of the various immunotherapies available not only have localized but also systemic effects and are thus able to induce remission of warts located at any distance from the injection site. Especially patients with warts at multiple sites benefit from this form of treatment. Intralesional immunotherapy using the mumps-measles-rubella (MMR) vaccine is a particularly promising option for the treatment of recalcitrant warts in adult patients. For children, on the other hand, HPV vaccination is a novel and promising approach, even though it has not been approved for the treatment of cutaneous warts. At present, there is no universally effective treatment available. Moreover, many frequently employed therapies are currently not supported by conclusive clinical trials.