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Archives of Dermatology
To quantitatively examine the epidermal and dermal cellular and molecular changes that occur after photodynamic therapy of photodamaged human skin.
Serial in vivo biochemical and immunohistochemical analyses after photodynamic therapy using topical 5-aminolevulinic acid (5-ALA) and pulsed-dye laser treatment.
Academic referral center, Department of Dermatology, University of Michigan, Ann Arbor.
A volunteer sample of 25 adults, 54 to 83 years old, with clinically apparent photodamage of the forearm skin.
Three-hour application of 5-ALA followed by pulsed-dye laser therapy using non–purpura-inducing settings to focal areas of photodamaged forearms and serial biopsy specimens taken at baseline and various times after treatment.
Immunohistochemical analysis was used to assess levels of markers of epidermal proliferation (Ki67), epidermal injury (cytokeratin 16), and photodamage (p53), as well as various markers of dermal collagen production (including prolyl 4-hydroxylase and heat shock protein 47, and type I procollagen). Real-time reverse transcriptase–polymerase chain reaction technology was used to quantify type I and type III collagen. Type I procollagen protein was quantified with enzyme-linked immunosorbent assay.
Epidermal proliferation was stimulated as demonstrated by increases in Ki67 (more than a 5-fold increase; P < .05) and epidermal thickness (more than a 1.4-fold increase; P < .05). Epidermal injury was produced with increased cytokeratin 16 levels demonstrated (to nearly 70-fold of baseline levels; P < .05). Upregulation of collagen production was demonstrated with increases in procollagen I messenger RNA (2.65-fold; P < .05), procollagen III messenger RNA (3.32-fold; P < .05), and procollagen I protein (2.42-fold; P < .05) levels detected. The baseline epidermal p53 level correlated with cytokeratin 16 levels at acute time points, and the latter were found to correlate with peak collagen production.
Photodynamic therapy with the specific treatment regimen employed produces statistically significant quantitative cutaneous molecular changes (eg, production of types I and III collagen) that are associated with improved appearance of the skin. Baseline epidermal p53 immunostaining levels may be predictive of dermal responses to this therapy. Comparison with historical data using pulsed-dye laser therapy alone suggests that use of the photosensitizer may enhance dermal remodeling. The quantitative in vivo molecular data presented herein are in keeping with an evolving model to potentially predict the efficacy of new techniques for the treatment of photoaging.
Orringer JS, Hammerberg C, Hamilton T, et al
To characterize nodular melanoma (NM) using dermoscopy, in vivo reflectance-mode confocal microscopy, and histopathologic analysis.
Consecutive pure NMs and superficial spreading melanomas (SSMs) with nodular or blue areas were studied using dermoscopy and confocal microscopy, and a correlation with histopathologic findings was performed.
Ten NMs, 10 SSMs with a nodular area, and 10 SSMs with a blue palpable but not yet nodular area.
Confocal differences withinthe nodular component between pure NMs and SSMs with a nodular area, hypothesizing different biological behaviors.
Whereas NMs had predominantly nonspecific global dermoscopic patterns, SSMs exhibited a multicomponent pattern and higher dermoscopic scores. Globules, blue-white veil, atypical vessels, and structureless areas were frequent in NMs and in nodular areas from SSMs. At confocal microscopy, NMs exhibited few pagetoid cells within a typical epidermal architecture in the superficial layers in most cases, differing from SSMs frequently characterized by epidermal disarrangement and pagetoid infiltration. At the dermoepidermal junction, dermal papillae were rarely seen in nodular areas both from NMs and from SSMs, frequently substituted by nonaggregated atypical cells distributed in sheetlike structures. In the upper dermis, all groups exhibited plump bright cells, dense dishomogeneous cell clusters, and atypical nucleated cells, whereas cerebriform clusters were characteristic of NMs.
Distinctive dermoscopic and confocal features seen in NMs compared with SSMs are helpful in making the diagnosis and suggest different biological behavior.
Segura S, Pellacani G, Puig S, et al
To examine the significance of eccentric hyperpigmentation (EH), central hyperpigmentation (CH), multifocal hyper/hypopigmentation (MH/HP), and the multicomponent pattern (MCP) in melanocytic lesions lacking specific dermoscopic features of melanoma.
A total of 3367 benign and malignant melanocytic lesions (n = 341 melanomas, excluding lentigo maligna and lentigo maligna melanoma) were examined to identify those lesions lacking specific dermoscopic features of melanoma but having any of the global patterns of EH, CH, MH/HP, and MCP.
Dermoscopic images were collected from lesions excised or undergoing sequential digital monitoring from the Sydney Melanoma Diagnostic Centre, a tertiary referral institution located in Sydney, Australia.
The odds ratio (OR) for melanoma of EH, CH, MH/HP, and MCP.
While EH (OR, 3.3; 95% confidence interval [CI], 2.5-4.6) and MCP (OR, 15.4; 95% CI, 11.9-19.9) were significant predictors of melanoma when total melanomas vs nevi were analyzed, there was no significant difference between the frequency of any of the global patterns in melanomas vs benign nevi lacking specific dermoscopic features of melanoma.
Based on our study results and previous prevalence data on these global patterns in benign nevi, we do not believe that lesions with EH or MCP require closer observation than other benign nevi lacking specific dermoscopic features of melanoma.
Arevalo A, Altamura D, Avramidis M, Blum A, Menzies S
To conduct an assessment of levels of UV radiation (UVR) exposure and the range of sun protection behaviors of beachgoers at a popular vacation destination.
Participants completed the sun habits survey prior to entry to the beach and completed an exit survey on leaving regarding their sun protection practices while at the beach. Ambient UVR was monitored using polysulfone dosimeters.
A popular beach for vacationers in Honolulu, Hawaii.
Sun protection practices and UVR.
Participants spent an average of 3 hours at the beach and received an estimated UVR dose of 10.4 standard erythemal doses. Latent class analysis identified 3 homogeneous classes with distinct characteristics and sun protection behaviors. Those in class 1 (unconcerned and at low risk) were at least risk of skin cancer, intended to tan, and used the least amount of sun protection. Those in class 2 (tan seekers) had the second highest risk of skin cancer, had the highest proportion of women, became sunburned easily, intended to tan, had used tanning beds in past 30 days, and had the highest proportion of sunscreen coverage and the least clothing coverage. Those in class 3 (concerned and protected) had the highest skin cancer risk, the highest proportion of clothing coverage and shade use, and were more likely to be residents of Hawaii.
Beachgoers were exposed to 5 times the UVR dose required to result in erythema among unprotected fair-skinned populations. Latent class analysis was effective in identifying subgroups of beachgoers who would benefit from targeted, population-based interventions aimed at reducing skin cancer risks while enjoying outdoor leisure-time activities.
O’Riordan DL, Steffen AD, Lunde KB, Gies P
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2009;11(5):354–355. doi:https://doi.org/10.1001/archfacial.11.5.354
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