Actinic keratoses (AKs) are commonly believed to be premalignant precursors to cutaneous squamous cell carcinoma (SCC). Using comparative genomic hybridization, Ashton et al identified chromosomal copy number changes in SCC that were strikingly similar to those in AK, suggesting a clonal precursor-product relationship. The SCCs sustained allelic loss at 18q that is rare in AKs, suggesting a role in progression from AK to SCC. The similarity of the AK and SCC profiles is striking and consistent with a progression model in which AKs must acquire additional mutations to progress to SCC.
Mycosis fungoides (MF) and Sézary syndrome (SS) are extranodal non-Hodgkin lymphomas of T-cell origin with primary cutaneous involvement. In this single-center, retrospective analysis, Kim et al update the clinical characteristics and long-term outcome of a large cohort of patients with MF and SS, identifying clinical factors predictive of survival and disease progression. In patients with MF and SS, the most important clinical predictive factors for survival include patient age, T classification, and the presence of extracutaneous disease. The significant disease-specific survival differences between different clinical stages validate the usefulness of the current (National Cancer Institute) MF clinical staging system and demonstrate that increasing tumor burden leads to a decrease in expected survival.
Although emotional stress has long been a suspected trigger for acne vulgaris exacerbations, no more than anecdotal evidence exists to support this concept. In this prospective cohort study, Chiu et al examine the possible role of stress in acne by evaluating changes in acne severity among college students during nonexamination periods and examination periods. Students experienced worsening of their acne during examination periods, and changes in acne severity were highly correlated with increasing stress. Proposed mechanisms include stress-induced elevations of glucocorticoids, adrenal androgens, corticotropin-releasing hormone, and neuroactive substances.
In this retrospective chart review of 205 patients diagnosed with facial infantile hemangioma, Waner et al mapped the sites of these common tumors of infancy and correlated these with growth patterns, clinical complications, and proximity to structural and developmental landmarks. Two distinct patterns were observed: a more common focal type with a tumorlike appearance, and a less common diffuse type with a plaquelike appearance. The diffuse lesions were more likely to be complicated by ulceration or airway obstruction and showed a strikingly segmental distribution pattern. Focal hemangiomas, in contrast, showed a predilection for regions of embryologic fusion. Knowledge of these patterns may help predict the risk of clinically significant complications.
Lentigo maligna, the in situ phase of lentigo maligna melanoma, is often located on the head, where surgical treatment options present formidable risks. In cases of lentigo maligna where surgical treatment is not a viable option or where the patient offers informed refusal of surgical therapy, topical imiquimod may represent a valuable therapeutic alternative, as this case report demonstrates.
Lentigo maligna involving the left cheek and the eyelids of a 90-year-old woman.
This Month in Archives of Dermatology. Arch Dermatol. 2003;139(7):841. doi:10.1001/archderm.139.7.841