The Role of Apoptosis in the Pathogenesis of Malignant Melanoma

Malignant melanoma genesis is a very complex process that involves a sequence of pathogenetic cellular events. Mutation of various genes and numerous other cellular mechanisms play an important role in the course of malignant melanocyte alteration and their malignant transformation from naevi into melanoma. Apoptosis is an active, genetically controlled process of programmed cell death, which leads to cell destruction and cell death without involvement of surrounding cells or inflammatory response. In this process, disrupted mechanisms of cell regulation and apoptosis take place in malignant melanoma cells, thus leading to their uncontrolled proliferation and melanocyte growth. Apoptosis is a process that involves two major pathways, the intrinsic and extrinsic apoptotic pathway, which interlace at certain points and ultimately result in apoptosis. It can be said that molecular events regulating cell survival, nomal growth arrest, apoptosis and cell differentiation, contribute to the overall pathogenesis of malignant cell growth. It is presumed that in the future, understanding of molecular aberrations and cellular processes, such as cell signaling, cell cycle regulation and cell apoptosis, will be essential for better patient monitoring and rational design of effective treatment

The Role of Apoptosis in the Pathogenesis of Malignant Melanoma

Malignant melanoma genesis is a very complex process that involves a sequence of pathogenetic cellular events. Mutation of various genes and numerous other cellular mechanisms play an important role in the course of malignant melanocyte alteration and their malignant transformation from naevi into melanoma. Apoptosis is an active, genetically controlled process of programmed cell death, which leads to cell destruction and cell death without involvement of surrounding cells or inflammatory response. In this process, disrupted mechanisms of cell regulation and apoptosis take place in malignant melanoma cells, thus leading to their uncontrolled proliferation and melanocyte growth. Apoptosis is a process that involves two major pathways, the intrinsic and extrinsic apoptotic pathway, which interlace at certain points and ultimately result in apoptosis. It can be said that molecular events regulating cell survival, nomal growth arrest, apoptosis and cell differentiation, contribute to the overall pathogenesis of malignant cell growth. It is presumed that in the future, understanding of molecular aberrations and cellular processes, such as cell signaling, cell cycle regulation and cell apoptosis, will be essential for better patient monitoring and rational design of effective treatment

Actinic Reticuloid – Photosensitivity or Pseudolymphoma? – A Review

Actinic reticuloid (AR) or chronic actinic dermatitis is considered a sunlight-induced pseudolymphoma (PSL) on light exposed areas of the skin, which primarily affects elderly males. The disease is a severe, chronic photosensitive dermatosis, first described by Ive et al. in 1969. PSL is a group of non-cancerous lymphocytic skin disorders that simulate malignant lymphomas, but the changes usually spontaneously regress. The clinical appearance of Actinic reticuloid is variable, usually characterized by an eczematous, pruritic eruption, predominantly present on the head and neck, or other sun exposed areas, but can involve any area of the body. Thereby, crucial characteristic is photosensitivity, whereat action spectrum involves UVB, UVA and visible light beyond 400 nm. The disease is considered as PSL which histologically resembles lymphoma with immunohistochemical analysis of the cutaneous infiltrate revealing presence of activated T cells, numerous histiocytes, macrophages and B cells. Moreover, the development of malignant (non-cutaneous) T cell lymphoma in the course of AR has been reported. As the disease has chronic character, it requires significant changes in the patient´s lifestyle and avoidance of provoking factors such as contact allergens or sources of intense light. Thus AR should be considered in every patient who presents with persistent, unclear, erythematous skin changes on the face and neck that are related to sun exposure

Allergic Hypersensitivity Skin Reactions Following Sun Exposure

Photoallergic dermatoses are skin lesions following sun exposure, characterized by activation of immunological mechanisms, involving photosensitizers and photoallergens that can cause photosensibilization in some individuals. In this group of disorders, photoallergic contact dermatitis should be accentuated. It manifests as contact allergic dermatitis on sun-exposed skin areas, following direct contact with photoallergens during UV exposure (predominantly UVA). Under influence of light, photosensitizers get activated, followed by fusion with cutaneous proteins which renders them to complete antigens, and consequential initiation of immunological mechanisms with resulting pathological skin lesions. The most common photoallergens are: sulfonamide antibiotics, phenothiazines, and halogenated salicylanilides. Photoallergic dermatoses are comprised of several disorders, although the causative photoallergen remains unknown (e.g. solar urticaria, polymorphous light eruption and hydroa vacciniforme). Solar urticaria is a rare, acute urticarial reaction on both sun-exposed and covered skin areas, which appears soon after exposure to sun or artificial lighting. Polymorphous light eruption is a relatively common polymorphous skin eruption, which usually appears in spring. Its pathogenesis is unknown, presumably photoallergic reaction. Hydroa vacciniforme is a rare photodermatosis of unknown etiology, which usually presents in summer-time. It is characterized by vesicobullous eruptions, with residual nonesthetic varioliform scarring

Promjene na sluznici usne šupljine kod bolesnika s lihen planusom

Forty patients with lichen planus admitted to University Department of Dermatology and Venereology, Sestre milosrdnice University Hospital in Zagreb during the 2004-2006 period were assigned to this retrospective study. In these 40 patients (27 female and 13 male), lichen planus was diagnosed on the basis of clinical presentation, laboratory findings and histopathologic analysis. The results obtained indicated an increased prevalence of lichen planus in middle-aged patients (40% of patients were aged 40-60), with a significant female predominance (67.5% vs. 32.5%). The majority of patients with lichen planus presented with both cutaneous and oral lesions (62.5%), one third of cases had only cutaneous lesions (35%), and only one patient had isolated oral lesions (2.5%). The initial symptoms in patients with lichen planus usually manifested on the skin (82.5%), in oral cavity (5%), or both simultaneously. Oral lesions usually developed on buccal mucosa (88.5%) in the form of Wickham.s striae. All patients were administered topical therapy (corticosteroids, keratolytics), while 55% of patients were given both systemic and topical therapy (corticosteroids, retinoids). Phototherapy was used in 27.5% of patients. The management of patients with oral lichen planus lesions requires multidisciplinary approach including dermatologists and oral pathologists, general practitioners, as well as ENT specialists, internal medicine specialists, and others.Ovo retrospektivno istraživanje obuhvatilo je bolesnike hospitalizirane zbog lihen planusa u Klinici za dermatovenerologiju KB "Sestre milosrdnice" u Zagrebu u razdoblju od siječnja 2004. do kraja 2006. godine. Obuhvaćeno je 40 bolesnika (27 žena i 13 muškaraca) koji su bolovali od lihen planusa, a dijagnoza je postavljena na temelju kliničko-laboratorijskih pretraga te patohistološkog nalaza. Prema našim rezultatima lihen se najčešće javljao u dobi od 40. do 60. godine (45%), češće kod žena (67,5%) nego kod muškaraca (32,5%). Većina bolesnika je istodobno imala promjene na koži i sluznici (62,5%), kod oko trećine bolesnika promjene su bile isključivo na koži (35%), dok je samo jedan bolesnik imao promjene isključivo na sluznici usne šupljine (2,5%). Bolest je najčešće započinjala na koži (82,5%), zatim na sluznici usne šupljine (5%), dok je istodobni početak pojave promjena na sluznici usne šupljine i koži zabilježen u 12,5% bolesnika. Promjene usne šupljine najčešće su bile lokalizirane na bukalnoj sluznici (88,5%), uglavnom u obliku Wickhamovih strija (65,4%). Kod svih bolesnika se primijenila lokalna terapija (kortikosteroidi, keratolitici), dok je 55% bolesnika uz lokalnu primilo i sistemsku terapiju (kortikosteroidi, retinoidi). Kod 27,5% bolesnika je provedena fototerapija. S obzirom na to da se promjene kod lihen planusa često javljaju na sluznici usne šupljine potreban je multidisciplinski pristup koji uključuje suradnju specijalista dermatovenerologa, oralnog patologa, liječnika obiteljske medicine, ORL, internista i drugih

Lasik ultratankog poklopca (Sub-Bowman Keratomileusis) ili fotorefraktivna keratektomija

The aim of this study was to compare two different refractive surgery approaches in correction of myopia with or without astigmatism. In patients where one eye underwent sub- Bowman keratomileusis (SBK) and the other eye photorefractive keratectomy (PRK), the objective and subjective results were retrospectively compared during the six-month follow-up. Eighty four patients (168 eyes) were involved in this retrospective contralateral study. The mean preoperative spherical refraction was -3.88 diopters (D) and the mean cylinder was -0.82 D for all eyes. Each patient underwent SBK on one eye and PRK on the contralateral eye. The eyes in the PRK group underwent mechanical epithelial removal, which was followed by laser treatment. Mitomycin C 0.02% was used for 15 seconds if ablation was deeper than 50 microns. In the SBK group, the intended 100-μm corneal flap was created with IntraLase femtosecond laser. All eyes underwent customized wavefront guided laser ablation using a VI SX Star S4 IR excimer laser. Preoperative and postoperative outcome measures included best spectacle-corrected visual acuity, uncorrected visual acuity, corneal topography, contrast visual acuity, and anterior optical coherence tomography imaging. Patients were asked to complete subjective satisfaction questionnaires at each visit. Through the first 3 months of follow up, the SBK eyes demonstrated clinically and statistically better visual results than PRK eyes, between 3 and 6 months the results in the two groups began to equalize, and after 6 months of follow up there were no clinical and statistical differences between the SBK and PRK groups. SBK seems to be more practical for the patient with less pain, faster visual recovery, fewer medications, and overall superior experience.Cilj ove studije bio je tijekom šestomjesečnog praćenja bolesnika usporediti subjektivne i objektivne rezultate korekcije miopije s astigmatizmom očiju ili bez njega podvrgnutih dvama različitim zahvatima: refrakcijskoj kirurgiji ultratankog poklopca (sub-Bowman keratomileusis, SBK) ili fotorefraktivnoj keratektomiji (photorefractive keratectomy, PRK). Osamdeset četiri bolesnika (168 očiju) su bila uključena u ovu retrospektivnu studiju. Prosječna kratkovidnost bila je -3,88 sfernih dioptrija s prosječnim astigmatizmom od -0,82 cilindrične dioptrije. U svakog bolesnika je primijenjen SBK na jednom oku i PRK na drugom oku. Rožnični epitel je mehanički uklonjen na očima iz skupine PRK, nakon čega je učinjen laserski zahvat. Zatim je apliciran mitomicin C 0,02% (vrijeme ekspozicije 15 sekunda) ako je ablacija bila dublja od 50 mikrona. Kod očiju iz skupine SBK formiran je ultratanki poklopac od 100 mikrona pomoću IntraLase femtosekundnog lasera. Laserska korekcija je u oba slučaja izvršena metodom wavefront CustomVue laserom VI SX Star S4. Prijeoperacijska i poslijeoperacijska izlazna mjerenja uključivala su određivanje vidne oštrine (nekorigirane i najbolje korigirane), rožničnu topografiju, aberometriju, test kontrastne osjetljivosti i optičku koherentnu tomografiju prednjega očnog segmenta. Bolesnici su na svakom kontrolnom pregledu ispunjavali upitnik o subjektivnoj procjeni rezultata. Klinički i statistički su značajno bolji rezultati bili u skupini očiju operiranih metodom SBK i to poslijeoperacijski do trećeg mjeseca. Od trećeg do šestog mjeseca su se rezultati počeli izjednačavati te nakon 6 mjeseci praćenja više nije bilo statistički i klinički značajnih razlika između dviju skupina očiju. Metoda SBK je objektivno i subjektivno bolja metoda u odnosu na PRK, te bolesniku omogućuje brži oporavak uz manje nuspojava

Actinic Reticuloid – Photosensitivity or Pseudolymphoma? – A Review

Actinic reticuloid (AR) or chronic actinic dermatitis is considered a sunlight-induced pseudolymphoma (PSL) on light exposed areas of the skin, which primarily affects elderly males. The disease is a severe, chronic photosensitive dermatosis, first described by Ive et al. in 1969. PSL is a group of non-cancerous lymphocytic skin disorders that simulate malignant lymphomas, but the changes usually spontaneously regress. The clinical appearance of Actinic reticuloid is variable, usually characterized by an eczematous, pruritic eruption, predominantly present on the head and neck, or other sun exposed areas, but can involve any area of the body. Thereby, crucial characteristic is photosensitivity, whereat action spectrum involves UVB, UVA and visible light beyond 400 nm. The disease is considered as PSL which histologically resembles lymphoma with immunohistochemical analysis of the cutaneous infiltrate revealing presence of activated T cells, numerous histiocytes, macrophages and B cells. Moreover, the development of malignant (non-cutaneous) T cell lymphoma in the course of AR has been reported. As the disease has chronic character, it requires significant changes in the patient´s lifestyle and avoidance of provoking factors such as contact allergens or sources of intense light. Thus AR should be considered in every patient who presents with persistent, unclear, erythematous skin changes on the face and neck that are related to sun exposure

The ABCD grading system in assessment of corneal cross-linking effect in keratoconus with different cone locations

Purpose The aim of this study was to analyse the postoperative corneal cross-linking results of corneal parameters and the ABCD grading system, depending on the cone location. Methods Thirty eyes of 25 patients with keratoconus (KC), who received the corneal cross-linking (CXL) treatment, were included in this study. The exclusion criteria were: patients under 18 years of age, corneal pachymetry less than 400 μm, corneal scarring, history of ocular trauma, history of ocular surgery, and corneal pathology other than KC. Patients were examined at the baseline visit, and followed-up at three, six, and twelve months after the CXL. All patients underwent visual acuity and Scheimpflug tomography at all visits. Progression parameters, keratometries, and ABCD grading were compared between the visits. Patients were classified into two groups: central and paracentral cones group (within the central 5 mm corneal zone) and peripheral cones group (outside the central 5 mm corneal zone), based on X-Y coordinates of maximal keratometry (Kmax). Results Parameter A remained relatively stable throughout the follow-up period in both groups. Parameter B and parameter C showed a significant increase in both groups postoperatively. Parameter D showed stability at the 6-month post-CXL visit in the peripheral KC group, while the central and paracentral KC group showed improvement at the 12-month post-CXL visit. Conclusion There was no significant difference in the postoperative response between different cone locations in the ABCD grading system, when classifying according to the Kmax, except an earlier recovery of the parameter D in peripherally located cones