Association between teat-end hyperkeratosis and mastitis in dairy cows: A systematic review.

A systematic review was conducted to elucidate the role of teat-end hyperkeratosis (THK) as a risk factor for clinical mastitis (CM) or subclinical mastitis (SCM). Scientific papers on the subject were identified by means of a database search. All types of peer-reviewed analytical studies, observational or experimental and published in English, could be included in the review, regardless of publication year. Of 152 identified records, 18 articles were selected, of which 8 were prospective cohort studies, 9 were cross-sectional, and 1 was a hybrid case-control study. Internal validity of studies was assessed using a score system ranging from 0 to 6, based on design, risk of bias, and statistical methods. The most frequent study limitation was improper use of statistical methods to avoid confounding of associations between THK and CM or SCM. The 3 studies that used CM as outcome (all with high validity scores) showed positive associations with THK (especially severe), although the magnitude and statistical significance of the estimates differed among them. Most studies that used SCM as the primary outcome (based on microbiological examination of milk) reported that only severe THK was associated with SCM. Two studies with high validity scores reported moderate to strong associations between severe THK and incidence or prevalence of Staphylococcus aureus intramammary infection. Two studies with high validity scores reported that only severe THK was associated with the risk of somatic cell count (SCC) ≥200,000 cells/mL and increased mean SCC, respectively. Although 4 cross-sectional studies reported positive associations between THK and SCC, these associations were possibly spurious because confounding factors, such as parity, were not considered in the analyses. Results of the reviewed studies suggest that severe THK is a risk factor for both CM and SCM, as defined by microbiological examination of milk, SCC thresholds, or mean SCC. The effect of severe THK on both contagious (especially Staphylococcus aureus) and environmental CM or SCM emphasizes the importance of teat health for mastitis control. Four studies demonstrated that quarters with mild THK had lower prevalence of intramammary infection or lower mean SCC than quarters with no THK, suggesting that development of mild THK, as a physiological response to milking, can have a protective effect. Dairy consultants should focus on monitoring and minimizing occurrence of severe THK to prevent CM and SCM.

Oral keratosis of unknown significance shares genomic overlap with oral dysplasia.

OBJECTIVES: To identify molecular characteristics of keratosis of unknown significance and to nominate pathways of molecular progression to oral cancer. Our work could provide a rationale for monitoring and treating these lesions definitively. METHODS: Patients with oral leukoplakia were eligible for our prospective observational study. We correlated alterations in cancer-associated genes with clinical and histopathologic variables (keratosis of unknown significance vs. moderate-to-severe dysplasia) and compared these alterations to a previously molecularly characterized oral cancer population. RESULTS: Of 20 enrolled patients, 13 (65%) had evidence of keratosis of unknown significance, while seven (35%) had dysplasia. Nine patients (45%) developed oral cancer (4/13 with keratosis of unknown significance, 5/7 with dysplasia). At a median follow-up of 67 (range 22-144) months, median overall survival was significantly shorter for patients with dysplasia (hazard ratio 0.11, p = .02). KMT2C and TP53 alterations were most frequent (75% and 35%, respectively). There were molecular similarities between keratosis of unknown significance and dysplasia patients, with no significant differences in mutational frequency among genes with ≥15% rate of alteration. CONCLUSIONS: Among patients with leukoplakia, both patients with keratosis of unknown significance and patients with dysplasia developed oral cancer. Molecular alterations between these two groups were similar at this sample size.

Acquired digital fibrokeratoma: review of its clinical and dermoscopic features and differential diagnosis.

Acquired digital fibrokeratoma (ADFK) is a rare, benign, fibrous tumor that most often occurs on fingers. It may resemble a rudimentary supernumerary digit and is often misdiagnosed as another common benign condition, such as common wart. It is typically asymptomatic and occurs as a solitary nodule less than 1 cm in diameter. Oftentimes ADFK shares clinical and/or histologic resemblance with other benign and malignant cutaneous conditions so it is crucial that careful examination is undertaken. In this article, we will discuss the clinical presentation, epidemiology, etiology, dermoscopic and histologic findings, management, and differential diagnoses for ADFK, with the hope that this review will facilitate timely diagnosis and management for this distinct condition.

Clinical and Dermoscopic Features of Lichenoid Keratosis: A Retrospective Case Study.

BACKGROUND: Lichenoid keratosis is a benign cutaneous lesion exhibiting many clinical faces and different dermoscopic features. OBJECTIVE: This study aims to determine the pattern of different clinical subtypes of lichenoid keratosis and to establish whether there is any correlation between the clinical variants of lichenoid keratosis and their dermoscopic appearance. METHODS: We retrospectively analyzed the medical records and clinical database of patients who had received a histological diagnosis of lichenoid keratosis. Based on the literature review and the clinical-dermoscopic features of lichenoid keratosis, we divided the lesions into 6 clinical subtypes to evaluate potential correlations between clinical and dermoscopic features in all subtypes. RESULTS: Fifty-one lesions were included in this clinical study. Preoperatively, only 1.9% of cases were clinically diagnosed as lichenoid keratosis, and the most common misdiagnosis was basal cell carcinoma (52.9%). We identified 6 subtypes of lichenoid keratosis and their corresponding dermoscopic features and clues. CONCLUSION: Since lichenoid keratosis has no pathognomonic dermoscopic clues and it is commonly misdiagnosed as malignant skin neoplasms, such as basal cell carcinoma and melanoma, improving the knowledge of both clinical and dermoscopic variability of lichenoid keratosis may help dermatologists to reduce unnecessary surgery and to reduce health care spending.

Hyperkeratotic hand eczema compared to other subgroups of hand eczema - a retrospective study with a follow-up questionnaire.

BACKGROUND: Only a few clinical trials on hand eczema have included further classification into subtypes, and there is a need for studies evaluating the present classifications. OBJECTIVES: To examine differences in demographic factors, lifestyle factors and severity between subgroups of hand eczema patients, with a focus on hyperkeratotic hand eczema. METHODS: This was a retrospective study including hand eczema patients referred to the outpatient dermatological clinic, Bispebjerg Hospital, between January 2013 and July 2014. The study comprises information on subdiagnoses, treatment and foot eczema from patient files, as well as a follow-up questionnaire. RESULTS: A total of 120 patients were included, 10 of whom were diagnosed with hyperkeratotic hand eczema. A significantly higher proportion of the patients with hyperkeratotic hand eczema were male (p = 0.002) and received systemic or ultraviolet (UV) treatment (p = 0.026). The frequency of tobacco smoking was significantly higher in patients with hyperkeratotic hand eczema (p = 0.016), as well as in the other subgroups combined (p = 0.049), than in the background population. CONCLUSIONS: Studies evaluating the subdiagnoses of hand eczema are needed, to further validate the classification system, and to provide more detailed information about demographic factors, severity and possible risk factors for different subgroups of hand eczema.

Duplicated Enhancer Region Increases Expression of CTSB and Segregates with Keratolytic Winter Erythema in South African and Norwegian Families.

Keratolytic winter erythema (KWE) is a rare autosomal-dominant skin disorder characterized by recurrent episodes of palmoplantar erythema and epidermal peeling. KWE was previously mapped to 8p23.1-p22 (KWE critical region) in South African families. Using targeted resequencing of the KWE critical region in five South African families and SNP array and whole-genome sequencing in two Norwegian families, we identified two overlapping tandem duplications of 7.67 kb (South Africans) and 15.93 kb (Norwegians). The duplications segregated with the disease and were located upstream of CTSB, a gene encoding cathepsin B, a cysteine protease involved in keratinocyte homeostasis. Included in the 2.62 kb overlapping region of these duplications is an enhancer element that is active in epidermal keratinocytes. The activity of this enhancer correlated with CTSB expression in normal differentiating keratinocytes and other cell lines, but not with FDFT1 or NEIL2 expression. Gene expression (qPCR) analysis and immunohistochemistry of the palmar epidermis demonstrated significantly increased expression of CTSB, as well as stronger staining of cathepsin B in the stratum granulosum of affected individuals than in that of control individuals. Analysis of higher-order chromatin structure data and RNA polymerase II ChIA-PET data from MCF-7 cells did not suggest remote effects of the enhancer. In conclusion, KWE in South African and Norwegian families is caused by tandem duplications in a non-coding genomic region containing an active enhancer element for CTSB, resulting in upregulation of this gene in affected individuals.

The management and treatment of hyperkeratosis.

Rebecca Elwell, Macmillan Lymphoedema Advanced Nurse Practitioner, Royal Stoke University Hospital, discusses recommendations on management of this skin problem, which may co-occur with chronic oedema.

Symmetrical acrokeratoderma: a case series in Indian patients.

Symmetrical acrokeratoderma is a recently described dermatosis in young adult males of Chinese descent. In this report, we describe a series of five cases of symmetrical acrokeratoderma from India. All 5 patients had asymptomatic, brownish-black plaques distributed symmetrically over dorsum of hand and feet with variable involvement of wrist, flexural surface of forearm, elbow, ankles, shin and knee joint. Palms and soles were characteristically spared. Typically whitish maceration of the lesions was seen after immersing in water. The disease showed exacerbation in hot and humid climate with spontaneous resolution in winter. Histopathological examination showed basket weave hyperkeratosis, irregular acanthosis and mild peri-vascular lymphomononuclear infiltrate. Loosening of the stratum corneum was seen in post-immersion biopsy specimens. Acitretin appeared to provide symptomatic improvement in the short term without any long-term effect on the natural disease course. The genetic and environmental factors involved in disease causation needs to be elucidated in future. TRIAL REGISTRATION: The study was not registered in a trial registry since it was a retrospective analysis of the clinical records and not an interventional/observational study.

Ramps and hybrid effects on keel bone and foot pad disorders in modified aviaries for laying hens.

Non-cage systems provide laying hens with considerable space allowance, perches and access to litter, thereby offering opportunities for natural species-specific behaviors. Conversely, these typical characteristics of non-cage systems also increase the risk of keel bone and foot pad disorders. The aim of this study was twofold: 1) to investigate if providing ramps between perches (housing factor) reduces keel bone and foot pad disorders and 2) to test for genetic predisposition by comparing 2 different layer hybrids. In a 2 × 2 design, 16 pens were equipped either with or without ramps between perches and nest boxes (8 pens/treatment), and housed with either 25 ISA Brown or Dekalb White birds per pen (in total 200 birds/hybrid). Keel bone injuries and foot health were repeatedly measured via palpation and visual assessment between 17 and 52 wk of age and daily egg production was recorded. The relationships between the dependent response variables (keel bone and footpad disorders, egg production) and independent factors (age, ramps, hybrid) were analyzed using generalized linear mixed models and corrected for repeated measures. Ramps reduced keel bone fractures (F1,950 = 45.80, P < 0.001), foot pad hyperkeratosis (F1,889 = 10.40, P = 0.001), foot pad dermatitis (F1,792 = 20.48, P < 0.001) and bumble foot (F1,395 = 8.52, P < 0.001) compared to pens without ramps. ISA Brown birds sustained more keel bone fractures (F1,950 = 33.26, P < 0.001), had more foot pad hyperkeratosis (F1,889 = 44.69, P < 0.001) and laid more floor eggs (F1,1883 = 438.80, P < 0.001), but had fewer keel bone deviations (F1,1473 = 6.73, P < 0.001), fewer cases of foot pad dermatitis (F1,792 = 19.84, P < 0.001) and no bumble foot as compared to Dekalb White birds. Age, housing and hybrid showed several interaction effects. Providing ramps proved to be very effective in both reducing keel bone and foot pad problems in non-cage systems. Keel bone and foot pad disorders are related to genetic predisposition. These results indicate that adaptation of the housing systems and hybrid selection may be effective measures in improving laying hen welfare.

[Frequency of oral squamous cell carcinoma and oral epithelial dysplasia in oral and oropharyngeal mucosa in Chile]. / Frecuencia de displasia epitelial y carcinoma escamoso en mucosa oral y orofaríngea en Chile, entre los años 1990 y 2009.

BACKGROUND: Oral cancer in Chile corresponds approximately to 1.6% of all cancer cases. There are few studies about oral epithelial dysplasia and oral squamous cell carcinoma in the Chilean population. AIM: To determine the frequency of hyperkeratosis, mild, moderate and severe oral epithelial dysplasia, in situ carcinoma and squamous cell carcinoma of the oral and oropharyngeal mucosa in a registry of the Oral Pathology Reference Institute of the Faculty of Dentistry, Universidad de Chile, in a ten years period. MATERIAL AND METHODS: Review of clinical records and pathological plates of 389 patients, obtained between 1990 and 2009. Cases were selected according to their pathological diagnosis, including hyperkeratosis, oral epithelial dysplasia, in situ carcinoma, squamous cell carcinoma and verrucous carcinoma. RESULTS: Forty four percent of cases were squamous cell carcinoma, followed by hyperkeratosis in 37% and mild epithelial dysplasia in 11%. Squamous cell carcinoma was more common in men aged over 50 years. Most of the potentially malignant disorders presented clinically as leukoplakia and squamous cell carcinoma were clinically recognized as cancer. CONCLUSIONS: In this study, men aged over 50 years are the highest risk group for oral cancer. Early diagnosis is deficient since most of these lesions were diagnosed when squamous cell carcinoma became invasive. Leukoplakia diagnosis is mostly associated with hyperkeratosis and epithelial dysplasia, therefore biopsy of these lesions is mandatory to improve early diagnosis.

Nail alterations during pregnancy: a clinical study.

During pregnancy, cutaneous and appendageal alterations manifest and may cause concern in the subject. The nails may be affected by pregnancy. This study investigated the frequency and nature of nail changes occurring during pregnancy in 312 healthy, 18-40-year-old pregnant women in gestation weeks 16-40. After a routine obstetric examination at the obstetrics and gynecology clinic at the study institution, all subjects submitted to an examination of all fingernails and toenails. Only nail alterations that had developed during pregnancy were recorded. Any nail changes that had occurred before the start of gestation were not considered. Data were presented as percentages. The Shapiro-Wilk and chi-squared tests were used to make categorical comparisons. A P-value of < 0.05 was considered to indicate statistical significance. No nail pathologies were detected in 116 (37.2%) of the 312 subjects. The most commonly found nail change was leukonychia (24.4%). Ingrown toenail (9.0%) and onychoschizia (9.0%) represented the second most common nail changes. Rapid nail growth and subungual hyperkeratosis were observed in 6.7% and 4.2%, respectively, of subjects. When the alterations were evaluated according to gestational age, the most common nail pathology was leukonychia at both 14-28 weeks (16.3%) and 29-42 weeks (27.4%) of pregnancy. Leukonychia, onychoschizia, onycholysis, and brittle nail pathologies were frequently observed at 29-42 weeks of pregnancy (P = 0.047). A large proportion of nail changes that occur during pregnancy are benign and do not require treatment. However, these changes may cause significant cosmetic stress in women.

Papular acantholytic dyskeratosis of the vulva associated with familial Hailey-Hailey disease.

Papular acantholytic dyskeratosis (PAD) of the vulva is a rare, chronic disorder first described in 1984. It presents in young women as white to skin-coloured smooth papules over the vulva, which are persistent but asymptomatic. Histologically, there is hyperkeratosis and focal parakeratosis with acantholytic and dyskeratotic cells forming corps ronds and grains, placing PAD within Ackerman's spectrum of focal acantholytic dyskeratoses with Hailey-Hailey disease (HHD) and Darier disease. There have been 17 previous reports of PAD of the vulva, to our knowledge. Only one demonstrated a familial pattern, and none of the cases was associated with a family history of HHD. This is the first report of PAD and HHD in a single family, suggesting that PAD and HHD lie on a spectrum of disease and are genetically linked.

Frecuencia de displasia epitelial y carcinoma escamoso en mucosa oral y orofaríngea en Chile, entre los años 1990 y 2009 / Frequency of oral squamous cell carcinoma and oral epithelial dysplasia in oral and oropharyngeal mucosa in Chile

Background: Oral cancer in Chile corresponds approximately to 1.6% of all cancer cases. There are few studies about oral epithelial dysplasia and oral squamous cell carcinoma in the Chilean population. Aim: To determine the frequency of hyperkeratosis, mild, moderate and severe oral epithelial dysplasia, in situ carcinoma and squamous cell carcinoma of the oral and oropharyngeal mucosa in a registry of the Oral Pathology Reference Institute of the Faculty of Dentistry, Universidad de Chile, in a ten years period. Material and Methods: Review of clinical records and pathological plates of 389 patients, obtained between 1990 and 2009. Cases were selected according to their pathological diagnosis, including hyperkeratosis, oral epithelial dysplasia, in situ carcinoma, squamous cell carcinoma and verrucous carcinoma. Results: Forty four percent of cases were squamous cell carcinoma, followed by hyperkeratosis in 37% and mild epithelial dysplasia in 11%. Squamous cell carcinoma was more common in men aged over 50 years. Most of the potentially malignant disorders presented clinically as leukoplakia and squamous cell carcinoma were clinically recognized as cancer. Conclusions: In this study, men aged over 50 years are the highest risk group for oral cancer. Early diagnosis is deficient since most of these lesions were diagnosed when squamous cell carcinoma became invasive. Leukoplakia diagnosis is mostly associated with hyperkeratosis and epithelial dysplasia, therefore biopsy of these lesions is mandatory to improve early diagnosis.

Incidence of trichostasis spinulosa at a single institution in Yemen.

BACKGROUND: Trichostasis spinulosa (TS) is a common, underdiagnosed cosmetic skin condition. OBJECTIVES: The main objectives of this study were to determine the occurrence of TS relative to age and gender, to analyze its cutaneous distribution, and to investigate any possible familial basis for this condition, its impact on patients, and the types and efficacy of previous treatments. METHODS: All patients presenting to the outpatient dermatology clinic at the study institution and their relatives were examined for the presence of TS and were questioned about family history and previous treatment. Photographs and biopsies of suspected cases of TS were obtained. RESULTS: Of 2400 patients seen between August and December 2013, 286 patients were diagnosed with TS (135 males, 151 females; prevalence: 11.9%). Women presented more frequently than men with complaints of TS (6.3 vs. 4.2%), and more women had received prior treatment for TS (10.5 vs. 2.8%). The most commonly affected sites were the face (100%), interscapular area (10.5%), and arms (3.1%). Lesions involved the nasal alae in 96.2%, the nasal tip in 90.9%, the chin in 55.9%, and the cheeks in 52.4% of patients. Only 15.7% of patients had forehead lesions, and only 4.5% had perioral lesions. Among the 38 previously treated patients, 65.8% reported temporary improvement. CONCLUSIONS: Trichostasis spinulosa is a common condition that predominantly affects the face in patients of all ages. Additional studies employing larger cohorts from multiple centers will be required to determine the prevalence of TS in the general population.

Prevalence of oesophageal epidermoid metaplasia in 1048 consecutive patients and 58 patients with squamous neoplasms.

AIMS: Oesophageal epidermoid metaplasia is defined by a dense granular layer with overlying hyperorthokeratosis, resembling the epidermis of skin. A possible association between epidermoid metaplasia, squamous dysplasia and squamous cell carcinoma has been proposed. The aim of this study was to compare the prevalence of epidermoid metaplasia in patients with oesophageal squamous neoplasms with that in a control cohort. METHODS AND RESULTS: Medical records and slides from 1048 consecutive oesophageal biopsies and resections for any indication and 58 patients with oesophageal squamous neoplasms were reviewed. Two cases (0.19%) of epidermoid metaplasia were identified in the 1048-patient control group. The prevalence of epidermoid metaplasia was significantly higher (P < 0.05) in the 58 patients with oesophageal squamous neoplasms, two of whom (3.5%) had concurrent epidermoid metaplasia (odds ratio 18.1, 95% confidence interval 2.5-131). One case was associated with a verrucous carcinoma and the other with a well-differentiated, superficial (pT1), exophytic squamous cell carcinoma. No patients had epidermoid metaplasia in a biopsy prior to the diagnosis of squamous neoplasia. CONCLUSIONS: The increased prevalence of epidermoid metaplasia observed in patients with squamous neoplasms provides some additional support for the proposed association. The hypothesis that epidermoid metaplasia is a precursor to squamous neoplasms remains unproven.

Lichen planopilaris epidemiology: a retrospective study of 80 cases.

BACKGROUND: Lichen planopilaris is a frequent presentation of primary cicatricial alopecia. Scalp distribution characterizes the main clinical presentations: classic lichen planopilaris, frontal fibrosing alopecia and Graham-Little Piccardi-Lassueur Syndrome (GLPLS). OBJECTIVE: Description of the clinical, dermoscopic and histopathological findings of Lichen planopilaris in public and private practices. METHOD: A retrospective observational study was performed by reviewing medical records of patients with lichen planopilaris. RESULTS: Eighty patients were included, 73 (91,25%) were female. Prototype II was seen in 53 (66,25%) patients. Classic lichen planopilaris was seen in 62,5% of the cases. Frontal fibrosing alopecia was seen in 31% of the patients and only one patient presented Graham-Little Piccardi-Lassueur Syndrome (GLPLS). Scalp lesions were scattered throughout the scalp in 47 (58,75%) of the patients, while 24 (30%) presented mainly central scalp lesions, 29 (36,25%) presented marginal lesions and only 4 (5%) patents had vertex lesions. CONCLUSIONS: Clinical presentation of Lichen planopilaris varies. To recognize the heterogeneity of the clinical appearance in lichen planopilaris is important for differential diagnosis.

Lichen planopilaris epidemiology: a retrospective study of 80 cases

AbstractBACKGROUND:Lichen planopilaris is a frequent presentation of primary cicatricial alopecia. Scalp distribution characterizes the main clinical presentations: classic lichen planopilaris, frontal fibrosing alopecia and Graham-Little Piccardi-Lassueur Syndrome (GLPLS).OBJECTIVE:Description of the clinical, dermoscopic and histopathological findings of Lichen planopilaris in public and private practices.METHOD:A retrospective observational study was performed by reviewing medical records of patients with lichen planopilaris.RESULTS:Eighty patients were included, 73 (91,25%) were female. Prototype II was seen in 53 (66,25%) patients. Classic lichen planopilaris was seen in 62,5% of the cases. Frontal fibrosing alopecia was seen in 31% of the patients and only one patient presented Graham-Little Piccardi-Lassueur Syndrome (GLPLS). Scalp lesions were scattered throughout the scalp in 47 (58,75%) of the patients, while 24 (30%) presented mainly central scalp lesions, 29 (36,25%) presented marginal lesions and only 4 (5%) patents had vertex lesions.CONCLUSIONS:Clinical presentation of Lichen planopilaris varies. To recognize the heterogeneity of the clinical appearance in lichen planopilaris is important for differential diagnosis.

Seroprevalence of trichodysplasia spinulosa-associated polyomavirus in Japan.

BACKGROUND: Trichodysplasia spinulosa-associated polyomavirus (TSV) was identified in, and shown to be the probable cause of, trichodysplasia spinulosa, a rare skin disease. To date, serological analyses have revealed that TSV infection is common among adults in the general population of Europe and Australia. However, there have been no reports of TSV in Asia. OBJECTIVE: To study the prevalence of TSV infection in Japan. STUDY DESIGN: TSV-VP1 expressed in a recombinant baculovirus expression system in an insect cell line, Tn5, self-assembled into virus-like particles. Overall, 1000 serum samples were examined by enzyme-linked immunosorbent assays using virus-like particles of TSV as antigen. Participants ranged in age from 0 to 94 years. RESULTS: Overall, 629 of 1000 serum samples (62.9%) were positive for anti-TSV antibodies. The seropositive rate increased with age and the seroprevalence of TSV significantly increased from 17.1% (25/146) in children aged from 0 to 4 years to 78.7% (472/600) in adults aged over 20 years (odds ratio = 0.056, 95% confidence interval = 0.035-0.900, P = 0.000, Chi-squared test). TSV seropositivity was not different between sera obtained in 1980 and 2012, and was not associated with sex. Competitive assay demonstrated that TSV antibodies did not cross-react with BK virus or Merkel cell polyomavirus. CONCLUSIONS: These results provide evidence that TSV circulates widely in the Japanese population, with primary exposure occurring mainly at early childhood, similar to that previously reported in other countries.

Incidental lesions found in veterans referred to dermatology: the value of a dermatologic examination.

BACKGROUND: Few studies have evaluated the detection of incidental skin cancers. OBJECTIVE: We sought to evaluate the rate of incidental cutaneous malignancies in routine dermatology consults. METHODS: This was a retrospective chart review of all dermatology consults at the Minneapolis Department of Veterans Affairs Medical Center over 8.25 years. Inclusion criteria included an in-person clinic visit within 18 months of the initial consult date. Patients with an in-person skin examination by a dermatologist in the 18 months before consult date were excluded. RESULTS: Of 28,405 consults sent during the study period, 17,174 met inclusion criteria. In all, 2257 (13.1%) patients had 1 or more biopsied incidental lesions. Half (50.3%; n = 1674) of the 3328 biopsied incidental lesions were malignant, which included 1187 patients. The per-person detection rate for an incidental malignant lesion was 6.9% (1187/17,174). There were 87 incidental melanomas identified in 84 patients. The per-person detection rate for an incidental melanoma was 0.5% (84/17,174). The most frequent anatomical location for biopsied incidental malignancies was the head and neck (53.9%). Incidental melanomas were most frequently located on the back (33.3%). LIMITATIONS: Nondiverse patient population and conservative detection rate estimates are limitations. CONCLUSION: An in-person skin examination by a trained dermatologist is important for detection of skin malignancies. This may have implications for teledermatology.

Keratosis of unknown significance and leukoplakia: a preliminary study.

OBJECTIVE: The objectives were to (1) determine the frequency of specific diagnoses in a series of white lesions, and (2) describe the nature of keratotic lesions that are neither reactive nor dysplastic. STUDY DESIGN: White lesions were analyzed and diagnosed as reactive keratoses, dysplastic/malignant, or keratoses of unknown significance (KUS). RESULTS: Of the 1251 specimens that were evaluated, 703 met criteria for inclusion, and approximately 75% were reactive, 10% dysplastic/malignant, and 14% KUS. Excluding reactive keratoses, 43% were dysplastic/malignant and 57% were KUS. CONCLUSIONS: Reactive keratoses were the most common white lesions followed by lichen planus. Dysplastic/malignant lesions constituted almost 50% of all true leukoplakias. KUS constituted the remaining cases and do not show typical reactive histopathology as well as clear dysplasia. They may represent evolving or devolving reactive keratoses but may also represent the very earliest dysplasia phenotype. Clinical findings may be helpful in differentiating the two.