Seb K to Lichenoid keratosis

Dermoscopic pattern of intermediate stage in seborrhoeic keratosis regressing to lichenoid keratosis: report of 24 casesP. Zaballos, S. Blazquez**Pathology, Hospital de Sant Pau i Santa Tecla, 43004 Tarragona, Spain, S. Puig††Melanoma Unit, Dermatology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain, E. Salsench, J. Rodero, J.M. Vives and J. Malvehy††Melanoma Unit, Dermatology Department, Hospital Clinic, IDIBAPS, Barcelona, SpainDepartments of Dermatology and *Pathology, Hospital de Sant Pau i Santa Tecla, 43004 Tarragona, Spain
†Melanoma Unit, Dermatology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
Pedro Zaballos Diego.
E-mail: PZaballos@aedv.es
Conflicts of interest
None declared.

Summary

Background Lichenoid keratosis (LK) is a well-described entity which has been proposed to represent an immunological or regressive response to pre-existing epidermal lesions such as solar lentigines or seborrhoeic keratoses.

Objectives To evaluate the dermoscopic criteria of a series of cases of LK with remaining areas of seborrhoeic keratosis which were both dermoscopically and histologically diagnosed.

Methods Pigmented lesions with dermoscopic areas of seborrhoeic keratosis and LK in the same tumour were consecutively diagnosed and prospectively included in the study. All pigmented lesions were examined and registered using DermLite Foto equipment (3Gen, LLC, Dana Point, CA, U.S.A.), at 10-fold magnification, at the Dermatology Department of Hospital de Sant Pau i Santa Tecla (Tarragona, Spain), between 1 January 2003 and 31 December 2005.

Results In total, 24 cases of lesions with dermoscopic areas of seborrhoeic keratosis and LK were collected. In four lesions (17%), the clinical differential diagnosis without dermoscopy included malignant melanoma and in seven lesions (29%), basal cell carcinoma. The diagnosis of LK was clinically considered without dermoscopy in only six cases (25%). A granular pattern was observed to be distributed throughout the LK areas of the lesions. This pattern consisted of the presence of brownish-grey, bluish-grey or whitish-grey coarse granules that formed, in 11 cases (46%), globules and/or short lines. In one lesion, located on the face, these short lines produced annular or rhomboid structures as seen in lentigo maligna melanoma.

Conclusions Dermoscopy is a useful tool which assists in the correct clinical recognition of LK, which may also potentially illuminate the pathogenesis of these tumours, showing the intermediate stage of regressing epidermal lesions in an LK.

Papilloma virus and Actinic Keratoses

This study was interesting looking at the potentiation of the developement of actinic keratoses in patients who had associated papilloma virus. Can the study on SCC incidence be far behind? IMCC

Sun-Related Factors, Betapapillomavirus, and Actinic Keratoses
A Prospective Study

Penelope McBride, MBBS, MPhil; Rachel Neale, BVSc, PhD; Nirmala Pandeya, BSc, MMedSc; Adèle Green, MBBS, PhD


Arch Dermatol. 2007;143:862-868.

Objective To examine prospectively the relationship among sun exposure, Betapapillomavirus, and development of actinic keratoses.

Design Prospective, community-based cohort study.

Setting Township of Nambour in Southeast Queensland, Australia.

Participants A total of 291 randomly selected adults aged 36 to 86 years with the presence or absence of Betapapillomavirus DNA in eyebrow hair follicle cells known at baseline in August 1996 and with subsequently documented sun exposure histories.

Main Outcome Measures Prevalence of actinic keratoses in March 2003 after 7 years of follow-up.

Results Beyond the known determinants of multiple actinic keratoses, namely, advanced age, male sex, fair skin, and lifetime occupational sun exposure, Betapapillomavirus infection was associated with having more than 10 actinic keratoses (odds ratio, 1.8; 95% confidence interval, 0.7-4.4). However, Betapapillomavirus positivity led to a significant 13-fold increase in the risk of actinic keratoses among those 60 years or older, a nearly 6-fold increase in risk when combined with fair skin color, and a doubling in risk of actinic keratoses when combined with high sun exposure, recent or cumulative, compared with those who had neither Betapapillomavirus infection nor the respective risk factor of interest.

Conclusions Although the presence of Betapapillomavirus DNA in eyebrow hair follicle cells had only a small independent association with actinic keratoses, Betapapillomavirus infection in combination with key risk factors increased the risk of actinic keratoses, which is consistent with a potentiation by Betapapillomavirus of the effect of established causal factors.

Diagnosing Melanoma in Qld.

This study up to the end of 2003 indicates the rising importance of skin cancer clinics in early diagnosis of melanoma in Queensland. That role has probably massively increased since then. Does anyone know if the thickness at diagnosis of melanoma in rural Qld is markedly different from the cities? IMCC

Clinical pathways to diagnose melanoma: a population-based study.

ORIGINAL ARTICLES

Melanoma Research. 17(4):243-249, August 2007.
Baade, Peter D.; Youl, Philippa H.; English, Dallas R.; Mark Elwood, J.; Aitken, Joanne F.
Abstract:
To better understand the clinical diagnostic process for invasive melanoma in Queensland. Descriptive population-based study of Queensland residents (n=3772) aged 20-75 years diagnosed with invasive melanoma between January 2000 and December 2003. Information was obtained via telephone interview combined with pathology data from the Queensland Cancer Registry. About 85% of melanoma patients diagnosed in Queensland saw a general practitioner at least once during the process, most of these for the initial consultation. Almost one-fifth of patients (18.1%) saw a skin clinic doctor sometime through the diagnosis pathway; this proportion increased significantly over the study period (P<0.001). The most common pathway for diagnosing melanoma was an initial consultation by a general practitioner followed by referral to a surgeon for a definitive diagnosis. People living in southeast Queensland were more likely to see a dermatologist compared with those living in more rural or remote areas (14.7 versus 6.8%), more likely to see a skin clinic doctor (21.8 versus 7.2%), or a surgeon (54.9 versus 49.3%) at least once during the diagnostic process, and less likely to see a general practitioner (76.8 versus 90.2%). This descriptive study has demonstrated the complexity and diversity of clinical diagnostic pathways for melanoma in Queensland, highlighting the important role of general practitioners and the emerging role of primary care skin clinics. Although this system has resulted in a very favourable thickness distribution for diagnosed melanomas, access issues for people living in rural and remote areas of Queensland need to be addressed.

Subungual melanoma

Thumb subungual melanoma: Is amputation necessary?
Sukh S. Rayatt, a, , Anne L. Danceya and Paul M. Davisona
aDepartment of Plastic and Reconstructive Surgery, University Hospital of North Staffordshire, Stoke City Hospital, Stoke-on-Trent ST4 6QG, UK
Summary

Subungual melanoma is uncommon. Traditional teaching advocates amputation of the affected digit. Recent studies have shown that more distal levels of amputations do not compromise survival or recurrence rates. When the thumb is involved, functional and aesthetic loss can be substantial. We present a new conservative, digit-sparing approach in the treatment of subungual melanoma of the thumb. Four informed patients were recruited to undergo the new treatment. Local excision with 1 cm margins down to and including the periosteum was carried out. Reconstruction was with a local flap. There has been one recurrence and no deaths with a minimum of 6 years follow up. In selected cases, conservative management of subungual melanoma allows preservation of length and minimises disability.