Photographic scale for the characterization of actinic keratosis through reflectance confocal microscopy: a quantitative approach to cellular transformation.

Background: Actinic keratosis (AK) is a highly prevalent pre-cancerous skin lesion that often leads to cutaneous squamous cell carcinoma. There are different stages of evolution of the disease and several features that characterize keratosis. This study aimed to develop a qualitative and quantitative visual diagnostic tool to facilitate the identification of the characteristics and severity of the main cellular attributes of AK and to show its applicability in evaluating the evolution or treatment through image analysis. Methods: Literature research on the main scientific databases and in the institute's database was carried out to gather all the different levels of cellular transformation. To validate the scale, a preliminary characterization study was carried out with 21 subjects who had clinically diagnosed AK lesions to classify the attributes in each skin layer and test the accuracy of the diagnosis of the scale. Afterward, and to show the possibility of a follow-up with a topical treatment, the subjects were divided into two treatment groups, receiving either a cream formulation containing retinoic acid, or a placebo formula. The evaluation was carried out through confocal reflectance microscopy and a digital camera with dermoscopic quality before and after 90 days of treatment. Results: A table detailing the 18 attributes of AK, and a photographic scale containing RCM images graded by scores established for each characteristic and the frequency of spreading were developed. The results of the validation presented good repeatability, correlation with clinical evaluation, and capacity for differentiating treatments demonstrated by the significant improvement after topical treatment by the reduction of the score for 10 out of the 18 attributes. The preliminary study, evaluated by the detailed transformation scale highlights important differences in the subclinical approach that allows a deeper evaluation of the aspects of the lesion's re-incidence even after fully treated skin sites. Conclusion: This study brings an innovative method based on RCM, to assist in the quantification of cell transformation level, provide early diagnosis, and deliver a powerful treatment evaluation tool to provide smoother treatment, as well as prevent re-incidence in the cases.

Efectividad del Heberferon en pacientes con queratosis actínica asociada a carcinoma basocelular

Las queratosis actínicas son neoformaciones dermatológicas planas oexofísticas, presentes mayormente en zonas fotoexpuestas, de evolución crónica y generalmente asintomáticas, siendo la expresión más temprana del carcinoma espinocelular, producidas por la exposición solar crónica en personas fundamentalmente de piel clara. Se realizó un estudio longitudinal prospectivo de intervención terapéutica. El universo estuvo constituido por 130 pacientes y la muestra por 116 pacientes diagnosticados con queratosis actínica que concomitaron con carcinoma basocelular que asistieron a la consulta de oncodermatología del Hospital Provincial Docente "Carlos Manuel de Céspedes" de Bayamo, en el período comprendido de enero 2019 a diciembre 2020; con el objetivo de evaluar la efectividad del tratamiento con HeberFERON® en la queratosis actínica asociada a carcinoma basocelular. Para valorar la asociación entre las variables se empleó el test de Chi Cuadrado de Mantel. Fue frecuente en el estudio el sexo masculino, las edades comprendidas entre 61 y 80 años, el fototipo cutáneo II de la clasificación de Fitzpatrick, que presentaron más de 20 lesiones de queratosis actínica, de localización frecuente en los antebrazos. El HeberFERON fue efectivo y se logró respuesta favorable al tratamiento desde el punto de vista clínico y por dermatoscopia. Los efectos adversos frecuentes tras la administración del HeberFERON® fueron la fiebre, seguido de malestar general y el dolor en el sitio de la inyección.

Actinic keratoses are flat dermatological neoformations or oexofistic, present mostly in photoexposed areas, of chronic evolution and generally asymptomatic, being the earliest expression of squamous cell carcinoma, produced by chronic sun exposure in people mainly fair-skinned. A prospective longitudinal study of therapeutic intervention was conducted. The universe consisted of 130 patients and the sample consisted of 116 patients diagnosed with actinic con queratosis who concomitated with basal cell carcinoma who attended the oncodermatology consultation of the "Carlos Manuel de Céspedes" Provincial Teaching Hospital of Bayamo, in the period from January 2019 to December 2020; with the objective of evaluating the effectiveness of treatment with HeberFERON® in actinic keratosis associated with basal cell carcinoma. To assess the association between the variables, the Mantel Chi-Square test was used. The male sex, ages between 61 and 80 years, cutaneous phototype II of the Fitzpatrick classification, which presented more than 20 lesions of actinic keratosis, of frequent location in the forearms, were frequent in the study. HeberFERON was effective and a favorable response to treatment was achieved from the clinical point of view and by dermoscopy. Common side effects following administration of HeberFERON® were fever, followed by malaise and pain at the injection site.

As ceratoses actínicas são neoformações dermatológicas planas ou oexofísticas, presentes principalmente em áreas fotoexpostas, de evolução crônica e geralmente assintomáticas, sendo a expressão mais precoce do carcinoma espinocelular, produzido pela exposição solar crônica em pessoas principalmente de pele clara. Foi realizado um estudo longitudinal prospectivo de intervenção terapêutica. O universo foi composto por 130 pacientes e a amostra por 116 pacientes diagnosticados com conqueratose actínica que se concomitaram com carcinoma basocelular e que compareceram à consulta de oncodermatologia do Hospital Universitário Provincial "Carlos Manuel de Céspedes" de Bayamo, no período de janeiro de 2019 a dezembro de 2020; com o objetivo de avaliar a eficácia do tratamento com HeberFERON® na queratose actínica associada ao carcinoma basocelular. Para avaliar a associação entre as variáveis, foi utilizado o teste Qui-Quadrado de Mantel. O sexo masculino, com idades entre 61 e 80 anos, o fototipo cutâneo II da classificação de Fitzpatrick, que apresentou mais de 20 lesões de queratose actínica, de localização frequente nos antebraços, foram frequentes no estudo. O HeberFERON foi eficaz e uma resposta favorável ao tratamento foi alcançada do ponto de vista clínico e por dermatoscopia. Os efeitos secundários frequentes após a administração de HeberFERON® foram febre, seguida de mal-estar e dor no local da injeção.

Efficacy of sunscreen with photolyase or regular sunscreen associated with topical antioxidants in treating advanced photodamage and cutaneous field cancerization: a randomized clinical trial

Abstract Background Several treatments are available for skin with advanced photodamage, which is characterized by the presence of actinic keratoses (AK). Objectives Evaluate the efficacy of using sunscreen with photolyase compared to regular sunscreen, as well as to compare the combination of a topical formulation of antioxidants versus placebo in the treatment of advanced photodamage. Methods This was a randomized, double-blind, factorial clinical trial. Participants with AKs on their forearms were randomized to apply regular sunscreen (SC) or sunscreen with photolyase (SC+P) on both forearms during the day. One of the forearms in each group was randomized again to receive topical antioxidants (AOx), and the other forearm received a placebo cream (both for night application). The four groups were SC/AOx, SC/placebo, SC+P/AOx, and SC+P/placebo. The duration of treatment was 8 weeks. Primary outcomes were total AK clearance, decrease in Forearm Photoaging Scale (FPS), and AK severity scores. Secondary outcomes were reduction in AK count, partial clearance rate, and safety. Results Forty participants (80 forearms) were included. All groups showed significant improvement in outcomes at week eight. There were no significant differences between SC and SC+P for either outcome. AOx led to a significant reduction in AK count (22%; p < 0.05). Partial clearance was obtained in 18 (47.4%) forearms treated with AOx and in 9 (23.7%) treated with placebo (p < 0.05). All groups reduced the FPS score, without significant differences among them. Conclusions There is no difference in the treatment of advanced photodamage skin when comparing the use of sunscreen with photolyase and regular sunscreen, and topical antioxidants were more efficient in reducing AK count than placebo. Study limitations Short interval of follow-up and absence of re-evaluation in the absence of treatment were limitations of the present study.

Efficacy of sunscreen with photolyase or regular sunscreen associated with topical antioxidants in treating advanced photodamage and cutaneous field cancerization: a randomized clinical trial.

BACKGROUND: Several treatments are available for skin with advanced photodamage, which is characterized by the presence of actinic keratoses (AK). OBJECTIVES: Evaluate the efficacy of using sunscreen with photolyase compared to regular sunscreen, as well as to compare the combination of a topical formulation of antioxidants versus placebo in the treatment of advanced photodamage. METHODS: This was a randomized, double-blind, factorial clinical trial. Participants with AKs on their forearms were randomized to apply regular sunscreen (SC) or sunscreen with photolyase (SC+P) on both forearms during the day. One of the forearms in each group was randomized again to receive topical antioxidants (AOx), and the other forearm received a placebo cream (both for night application). The four groups were SC/AOx, SC/placebo, SC+P/AOx, and SC+P/placebo. The duration of treatment was 8 weeks. Primary outcomes were total AK clearance, decrease in Forearm Photoaging Scale (FPS), and AK severity scores. Secondary outcomes were reduction in AK count, partial clearance rate, and safety. RESULTS: Forty participants (80 forearms) were included. All groups showed significant improvement in outcomes at week eight. There were no significant differences between SC and SC+P for either outcome. AOx led to a significant reduction in AK count (22%; p < 0.05). Partial clearance was obtained in 18 (47.4%) forearms treated with AOx and in 9 (23.7%) treated with placebo (p < 0.05). All groups reduced the FPS score, without significant differences among them. CONCLUSIONS: There is no difference in the treatment of advanced photodamage skin when comparing the use of sunscreen with photolyase and regular sunscreen, and topical antioxidants were more efficient in reducing AK count than placebo. STUDY LIMITATIONS: Short interval of follow-up and absence of re-evaluation in the absence of treatment were limitations of the present study.

Clinical, histopathological and immunohistochemical evaluation of daylight photodynamic therapy in the treatment of field cancerization: a study of 30 cases.

BACKGROUND: Actinic keratosis (AK) are pre-malignant lesions, precursors of squamous cell carcinoma (SCC). Normal skin adjacent to AK, may present initial mutations with potential risk for new neoplasms, currently known today as field cancerization (FC). OBJECTIVES: To evaluate the effectiveness of daylight photodynamic therapy (PDT) with methyl amino levulinate (MAL) based on clinical evaluation, histological examination and immunohistochemical expression of p53 and Ki67. MATERIAL AND METHODS: Thirty patients, over 35 years old, phototypes between I and III, presenting non-hypertrophic AK on the face or scalp. Two biopsies with 2 mm punch of the lesion and adjacent skin before and 60 days after daylight PDT were performed. Results: Improvement was seen in lesion thickness and Ki67. 19 (63.33%) lesions had atypia improvement with a p-value <.05, showing efficacy in treatment. After daylight PDT, 22 (73.33%) patients showed satisfactory esthetic improvement. CONCLUSION: The study shows that PDT has cellular and molecular effects that support its indication in the control of carcinogenesis, as it decreases atypia and controls the expression of Ki67, reducing the proliferation of atypical cells. However, its indication following this study is still mainly aimed at clinical improvement of the skin, at this moment, probably due to the sample size.

A 12-month follow-up split-scalp study comparing calcipotriol-assisted MAL-PDT with conventional MAL-PDT for the treatment of actinic keratosis: a randomized controlled trial.

To enhance the efficacy of photodynamic therapy (PDT) for actinic keratosis (AKs), physical and chemical pre-treatments, such as calcipotriol (CAL) have been suggested. To compare the long-term 12-month efficacy and safety between methylaminolevulinate (MAL)-PDT and prior application of topical CAL versus conventional MAL-PDT for AKs of the scalp. Twenty patients with multiple AKs on the scalp were randomized to receive conventional PDT on one side of the scalp and CAL-assisted PDT, in which CAL was applied daily for 15 days beforehand, on the other side. Patients were evaluated for AK clearance at three, six and 12 months thereafter. All 20 patients completed the study. At three months, overall AK clearance was 92.07% and 82.04% for CAL-PDT and conventional PDT, respectively (p < 0.001). Similar results were found at six and 12 months: 92.07% and 81.69% (p < 0.001), and 90.69% and 77.46% (p < 0.001) for CAL-PDT and conventional PDT, respectively. Grade I AKs showed a similar response rate for both sides (p = 0.055) at three months and significant differences were obtained at six (p = 0.001) and 12 months (p < 0.001) for CAL-PDT and conventional PDT. Grade II AKs showed greater improvement on the CAL-PDT side (89.55% vs 62.90%) (p < 0.001) at three months. No difference was found at six and 12 months. CAL-PDT proved to be safe and more effective than conventional PDT for the treatment of AKs on the scalp after 12 months. CAL pre-treatment may have enhanced the efficacy of PDT for AK treatment, however, larger trials are needed to corroborate our findings.

Ocorrência de neoplasias cutâneas em cães com dermatite actínica em um Hospital Veterinário Escola (HCV - UFRGS) / Occurrence of cutaneous neoplasia in dogs with actinic dermatitis in a Veterinary Medical Teaching Hospital - UFRGS, Brazil

Background: Actinic dermatitis is an environmental skin disease resulting from excessive exposure to ultraviolet light irradiated by thesun. This phototoxic reaction affects dogs and cats, particularly with short hair and lightly pigmented skin, exposed to sun light. Primarylesions are typical from a sunburn and chronic exposure, and may induce to a premalignant lesion known as actinic keratosis, whichmay develop to neoplasms. The aim of the present study was to describe a retrospective study of actinic dermatitis and the occurrenceof cutaneous neoplasia in dogs presented to a Veterinary Medical Teaching Hospital (HCV/UFRGS) in Porto Alegre, Rio Grande doSul, Brazil in a period of 10 years.Materials, Methods & Results: A retrospective review of medical records from January 2009 to December 2019 was performed toidentify dogs with actinic dermatitis. Twenty-eight dogs were diagnosed based on a history of sun exposure and skin lesions includingerythema, scaling, comedones, thickened skin, hyperpigmentation, ulceration and/or secondary infections on poorly pigmented skin. Inaddition, in twelve dogs (42.8%) the disease was also confirmed by histopathology. Cutaneous lesions locations were previously definedas head, limbs, neck and trunk. The head was subdivided in chin, ears, face, lips and nasal plane; the limbs in pelvic and thoracic; andthe trunk, in abdomen, dorsal pelvis, perianal and thorax. All 28 dogs diagnosed with actinic dermatitis in the study had been chronically exposed to solar radiation and had light skin and coat. Dogs were between 3 and 20 years old, mean 7.6 years and median 7 years,mostly female dogs (64.3%) and neutered or spayed (64.3%). The most affected breeds were American Pitbull Terrier (35.7%) andBoxers (28.5%). Other breeds were Bull Terrier, Dalmatian, Dogo Argentino and Scottish Terrier...(AU)

Contemporary management of actinic keratosis.

Actinic keratosis (AK) is a skin lesion characterized by itraepithelial keratinocyte dysplasia and molecular alterations shared with normal chronically sun-damaged skin and squamous cell carcinoma (SCC). AK can undergo spontaneous regression, stable existence, or malignant transformation to cutaneous SCC with progression rates to SCC ranging from 0% to 0.5% per lesion-year and AK spontaneous regression of 15-63%. As AK is a potential precursor of invasive SCC, it is commonly treated to mitigate the risk of malignant progression, including metastasis and death. There is a myriad of available spots (e.g. cryotherapy) and field (e.g. 5-fluorouracil, imiquimod photodynamic therapy) treatments for AK. Recently published randomized clinical trials have helped bridge the gap on AK management. In this viewpoint, we sought to summarize the most up-to-date evidence in the management of AK.

Skin field cancerisation: A systematic review of the literature regarding its treatment.

INTRODUCTION: Skin neoplasms are the most frequent malignant lesions, increasing patient's morbidity when associated with skin field cancerisation. There is a need to understand the current therapies, both clinical and surgical. METHODS: A systematic review was performed according to the PRISMA guideline, registered in PROSPERO: CRD42018114826, including studies from 2012 to 2019. RESULTS: Seven hundred and eighty-two studies were found, of which 21 were included. Of these, 8 primary studies were randomised controlled trials: fractional CO2 laser-assisted photodynamic therapy (PDT) vs. PDT (no significance), daylight PDT vs. PDT (no significance, daylight PDT had less adverse effects), trichloroacetic acid peel vs. 5-aminolaevulinic acid PDT (clinical improvement of aminolaevulinic acid PDT), 5-Fluorouracil 0.5%/Salicylic Acid 10% vs. vehicle (clinical improvement of 5-Fluorouracil 0.5%/Salicylic Acid 10%), photolyase vs. sun filters (no significance), sunscreens vs. sunscreens plus DNA repair enzymes (DNA Repair Enzymes was more effective in reducing field cancerisation). Only one systematic review was included in which there was effectiveness of daylight PDT in the treatment of actinic keratoses. The other 12 included studies had a lower level of evidence including surgical studies. CONCLUSION: Clinical studies are more relevant in the treatment of the field cancerisation. There is a lack of surgical studies.

Ocorrência de neoplasias cutâneas em cães com dermatite actínica em um Hospital Veterinário Escola (HCV - UFRGS) / Occurrence of cutaneous neoplasia in dogs with actinic dermatitis in a Veterinary Medical Teaching Hospital - UFRGS, Brazil

Background: Actinic dermatitis is an environmental skin disease resulting from excessive exposure to ultraviolet light irradiated by thesun. This phototoxic reaction affects dogs and cats, particularly with short hair and lightly pigmented skin, exposed to sun light. Primarylesions are typical from a sunburn and chronic exposure, and may induce to a premalignant lesion known as actinic keratosis, whichmay develop to neoplasms. The aim of the present study was to describe a retrospective study of actinic dermatitis and the occurrenceof cutaneous neoplasia in dogs presented to a Veterinary Medical Teaching Hospital (HCV/UFRGS) in Porto Alegre, Rio Grande doSul, Brazil in a period of 10 years.Materials, Methods & Results: A retrospective review of medical records from January 2009 to December 2019 was performed toidentify dogs with actinic dermatitis. Twenty-eight dogs were diagnosed based on a history of sun exposure and skin lesions includingerythema, scaling, comedones, thickened skin, hyperpigmentation, ulceration and/or secondary infections on poorly pigmented skin. Inaddition, in twelve dogs (42.8%) the disease was also confirmed by histopathology. Cutaneous lesions locations were previously definedas head, limbs, neck and trunk. The head was subdivided in chin, ears, face, lips and nasal plane; the limbs in pelvic and thoracic; andthe trunk, in abdomen, dorsal pelvis, perianal and thorax. All 28 dogs diagnosed with actinic dermatitis in the study had been chronically exposed to solar radiation and had light skin and coat. Dogs were between 3 and 20 years old, mean 7.6 years and median 7 years,mostly female dogs (64.3%) and neutered or spayed (64.3%). The most affected breeds were American Pitbull Terrier (35.7%) andBoxers (28.5%). Other breeds were Bull Terrier, Dalmatian, Dogo Argentino and Scottish Terrier...

Diagnostic Accuracy of Dermoscopy of Actinic Keratosis: A Systematic Review.

INTRODUCTION: Dermoscopy is a tool that aids clinicians in the diagnosis of actinic keratosis; however, few diagnostic accuracy studies have determined its sensitivity and specificity for this diagnosis. OBJECTIVE: Determine the diagnostic accuracy of dermoscopy on actinic keratosis. METHODS: A systematic review was conducted on EMBASE, PubMed, Scopus and the Cochrane Central Registry of Controlled Trials from inception to August 2019. RESULTS: We screened 485 titles and abstracts. Two studies comprising 219 actinic keratoses were eligible for qualitative analysis. The number and heterogeneity of included studies limited a quantitative analysis. CONCLUSIONS: Studies that focus specifically on the diagnostic accuracy of dermoscopy for actinic keratosis are lacking.

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.

Field cancerization treatment using topical photodynamic therapy: A comparison between two aminolevulinate derivatives.

The objective of this study was to evaluate and compare the clinical response to PDT (Photodynamic Therapy) in field cancerization using two aminolevulinate derivatives. Forty patients with multiple actinic keratosis (AK) on forearms and hands scattered received two sessions of ALA and MAL-PDT at 630 nm (36 J/cm2). The AK clearance rate was 72 % for both drugs with a significant decrease in AK observed clinically (p < 00,001). Clinical improvement in field cancerization using two aminolevulinate derivatives in PDT is proven with no significant difference in the efficacy of drugs.

Laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound with short incubation time for field cancerization treatment: A left-right comparison.

BACKGROUND: Laser-assisted MAL-PDT has been reported to increase the effectiveness of conventional PDT. Nonetheless, clinical effects of this association when reducing MAL incubation time is poorly discussed. Furthermore, the association of acoustic pressure wave ultrasound with laser-assisted MAL-PDT with short incubation time for field cancerization had not been reported before. OBJECTIVES: To compare clinical effects of ablative fractional laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound (IMPACT US) with 1-hour incubation time and conventional MAL-PDT for skin field cancerization on the forearms, as well as the impact on safety and tolerability. METHODS: Fifteen patients with 638 AK (grade I-III) with field cancerized-skin on the forearms were enrolled in this left-right trial. Two protocols were randomly chosen. One side was treated with conventional MAL-PDT, whereas the other with laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound with 1-hour incubation time. Actinic keratoses were quantitively measured, and the other signs of sun-damaged skin, like pigmentation and texture, in field cancerized skin were qualitatively evaluated before and after six months. Side effects were assessed subjectively during the procedure and one week after. RESULTS: All patients completed the study. At six months after treatment, both protocols reduced the number of AK (72%; CO2 + PDT, and 65%; MAL-PDT). The difference between these two protocols was not statistically significant (p = 0.77). The improvement of pigmentation and texture of field cancerized skin was more significant on the side treated with laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound. Both protocols were well tolerated and without significant difference in adverse events. CONCLUSION: Laser-assisted MAL-PDT using CO2 laser and acoustic pressure wave ultrasound with short incubation time of 1 h was as effective as conventional MAL-PDT for field-cancerized skin with actinic keratosis in forearms with better cosmetic outcome.

High prevalence of Gammapapillomaviruses (Gamma-PVs) in pre-malignant cutaneous lesions of immunocompetent individuals using a new broad-spectrum primer system, and identification of HPV210, a novel Gamma-PV type.

Genus Gammapapillomavirus (Gamma-PV) is the most diverse and largest clade within the Papillomaviridae family. A novel set of degenerate primers targeting the E1 gene was designed and further used in combination with the well-known CUT PCR assay to assess HPV prevalence and genus distribution in a variety of cutaneous samples from 448 immunocompetent individuals. General HPV, Gamma-PV and mixed infections prevalence were significantly higher in actinic keratosis with respect to benign and malignant neoplasms, respectively (p = 0.0047, p = 0.0172, p = 0.00001). Gamma-PVs were significantly more common in actinic keratosis biopsies than Beta- and Alpha-PVs (p = 0.002). The full-length genome sequence of a novel putative Gamma-PV type was amplified by 'hanging droplet' long-range PCR and cloned. The novel virus, designated HPV210, clustered within species Gamma-12. This study provides an additional tool enabling detection of HPV infections in skin and adds new insights about possible early roles of Gamma-PVs in the development of cutaneous malignant lesions.

PDT and emerging therapies for Actinic Keratosis-A resource letter.

Aktinic Keratosis is common and if left untreated may develop into life threatening squamous cell carcinoma. Therefore early intervention is the standard of care. While many treatments are available PDT continues to move to the for - front for this indication (Brito et al., 2016 [31]). Topical PS is commercially available that are able to reliably ablate these lesions. Innovative protocols including sunlight, large volume LED arrays and maneuvers to improve treatment parameters and cosmesis continue to make this a worldwide treatment of choice for AK.

Opening a Window into Living Tissue: Histopathologic Features of Confocal Microscopic Findings in Skin Tumors.

The knowledge of histopathology and in vivo reflectance confocal microscopy correlation has several potential applications. Reflectance confocal microscopy can be performed in all skin tumors, and in this article, the most common histopathologic features of confocal microscopic findings in melanocytic skin tumors and nonmelanocytic skin tumors are described.

Queilitis actínica: aspectos histológicos, clínicos y epidemiológicos / Actinic cheilitis: histological, clinical and epidemiological characteristics

Introducción: la destrucción de la capa de ozono ha provocado un aumento en la incidencia de lesiones de la piel, a la que se suma la queilitis actínica. Objetivo: describir los aspectos histológicos, clínicos y epidemiológicos de la queilitis actínica a partir de la literatura reciente. Métodos: se revisaron las bases electrónicas PubMed, SciELO y Google Scholar con los términos claves en inglés y español: queilitis, queratosis, actínica, solar. Se incluyeron artículos originales, de revisión, reportes de casos, tesis y libros de la especialidad publicados preferentemente en el período 2005-2014. Resultados: La queilitis actínica es un trastorno potencialmente maligno inducido por la exposición solar y caracterizado por alteraciones micro y macroestructurales del labio. Factores de riesgo que interaccionan con la exposición solar son el fototipo (piel clara), hábito tabáquico, sexo (hombres), edad y ocupación (aire libre). Entre las alteraciones histológicas se encuentran la displasia epitelial y la elastosis solar; sin embargo, la severidad de estas no correlacionan con la gravedad clínica. Los pacientes con queilitis actínica presentan alteraciones de color, descamación, ulceraciones, difuminación del bermellón, entre otras. En muchas ocasiones la consulta y el diagnóstico son tardíos; se realizan cuando el cuadro ha evolucionado a cáncer. El diagnóstico es principalmente clínico, sumado a la biopsia de las lesiones con presentaciones moderadas y severas. Actualmente la terapia incluye métodos quirúrgicos y farmacológicos, y métodos innovadores como la fototerapia. Sin duda, la estrategia de prevención más importante es aumentar el uso de protectores solares, especialmente en la población de alto riesgo ocupacional. Conclusiones: la queilitis actínica es una patología relevante para los países sudamericanos, debido a que los factores de riesgo están presentes diariamente en las actividades de millones de trabajadores de nuestra región, por eso es necesario potenciar la investigación que permita mejorar la prevención, tratamiento y rehabilitación de esta patología(AU)

Introduction: depletion of the ozone layer has brought about an increase in the incidence of skin lesions, including actinic cheilitis. Objective: describe the histological, clinical and epidemiological characteristics of actinic cheilitis based on a review of recent literature. Methods: a search was conducted in the databases PubMed, SciELO and Google Scholar using the descriptors cheilitis, keratosis, actinic, solar, and their counterparts in Spanish. The search included original papers, review papers, case reports, theses and books about the specialty preferably published from 2005 to 2014. Results: actinic cheilitis is a potentially malignant condition induced by sun exposure and characterized by micro- and macrostructural alterations of the lip. The risk factors interacting with sun exposure are the skin phototype (light skin), smoking, gender (male), age and occupation (outdoor jobs). Histological alterations include epithelial dysplasia and solar elastosis, though their severity does not correlate with the degree of clinical seriousness. Patients with actinic cheilitis present color alterations, desquamation, ulceration and blurring of the vermillion border, among other signs and symptoms. On many occasions patients do not seek care during the early stages of the disease. As a result, diagnosis is made when the condition has already evolved into cancer. The diagnosis is basically clinic, with the support of the biopsy of lesions with moderate to severe characteristics. Current therapy includes surgery and medication, as well as innovative techniques like phototherapy. The most important strategy is no doubt the use of sunscreens, especially by the population at high occupational risk. Conclusions: actinic cheilitis is a condition relevant to South American countries, since its risk factors are present in the daily activities of millions of workers from our region. It is therefore necessary to foster research aimed at improving its prevention, treatment and rehabilitation(AU)

Increasing demonstration of angiogenic markers in skin neoplastic lesions.

BACKGROUND: Skin cancer represents the most common worldwide malignancy. Angiogenesis is an important factor in tumor growth and metastasis. Given these facts, the purpose of the current study was to compare the levels of angiogenic proteins in the context of the most common malignant and premalignant skin lesions. METHODS: Immunohistochemistry of CD31, HIF1A, VEGFR1 and VEGFR2 was performed in basal cell carcinoma (BCC), actinic keratosis (AK) and squamous cell carcinoma of the skin (SCCS). RESULTS: SCCS presented with increased levels of HIF1A, VEGFR1 and VEGFR2 in comparison to AK. In addition, SCCS also demonstrated increased levels of HIF1A to BCCLR or BCCHR. BCC presented with more vessels than AK. However, no correlation was observed among CD31, HIF1A, VEGFR1 and VEGFR2. CONCLUSIONS: SCCS presented with higher levels of HIF1A, VEGFR1 and VEGFR2, while BCC demonstrated an increased number of vessels in relation to AK. These data suggest that antiangiogenic therapy might be useful for skin cancer treatment.

Protein expression of MMP-2 and MT1-MMP in actinic keratosis, squamous cell carcinoma of the skin, and basal cell carcinoma.

Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are 2 skin neoplasms with distinct potentials to invasion and metastasis. Actinic keratosis (AK) is a precursor lesion of SCC. Immunohistochemistry was performed to evaluate the expression of MMP-2 and MT1-MMP in samples of BCC (n = 29), SCC (n = 12), and AK (n = 13). The ratio of positive cells to total cells was used to quantify the staining. Statistical significance was considered under the level P < .05. We found a higher expression of MMP-2 in tumor stroma and parenchyma of SCC as compared to BCC. The expression of this protein was also similar between SCC and its precursor actinic keratosis, and it was higher in the stroma of high-risk BCC when compared to low-risk BCC. MT1-MMP, which is an activator of MMP-2, was similarly expressed in all groups. Our results suggest that MMP-2 expression may contribute to the distinct invasive patterns seen in SCC and BCC.