Clinicopathological Study of 307 Patients with Lichen Planus Actinicus and Pigmentosus Referred to Razi Skin Hospital from 2016 to 2021

Introduction: The two less-known subtypes of lichen planus (LP) are lichen planus actinicus (LPA) and lichen planus pigmentosus (LPP), with the highest prevalence in the Middle East. Objectives: We aimed to evaluate the clinicopathological profile of these patients. Methods: 307 cases including 184 LPA and 123 LPP patients were recruited from the registered pathology reports of Razi Skin Hospital of Tehran from April 2016 to March 2021. The clinical features and pathological reports were extracted and analyzed. Results: Among 307 patients, 117 (63.9%) in the LPA group and 88 (71.5%) in the LPP group were women. Duration of disease ranged from 1 month to 20 years and 1 month to 12 years in the LPA and LPP groups, respectively. Face (159 patients), limbs (68), and neck (23) were the most frequent sites of involvement in LPA patients, whereas face (60 patients), limbs (47), and trunk (42) were more commonly involved in the LPP patients. Pruritus and oral mucosal lesions were found with similar frequency in both groups. Pathological evaluation showed vacuolar degeneration of basal layer (100%), lymphocytes infiltration (97.3%), and melanin incontinence (58.2%) as the most frequent findings in LPA and vacuolar degeneration of basal layer (100%), lymphocytes infiltration (100%), and melanin incontinence (52/8%) as the most frequent findings in LPP cases.Conclusion: LPA and LPP were both more prevalent among women.  Face was the most common site of involvement in both LPA and LPP. Vacuolar degeneration, lymphocyte infiltration, melanin incontinence, and hyperkeratosis were more common histological findings in this study

Evaluation of squamous cell carcinoma antigen 1 expression in oral squamous cell carcinoma (tumor cells and peritumoral T-lymphocytes) and verrucous carcinoma and comparison with normal oral mucosa

Background: Squamous cell carcinoma antigen (SCCA) is used as a prognostic marker for recurrence of squamous cell carcinoma in various sites, including head and neck. Studies suggest that its high serum levels are correlated to some clinical features, such as nodal metastasis. However, it is still unknown if high SCCA in patients with SCCA tissue expression in tumor cells are related to peripheral T-lymphocytes. Therefore, we did this study to evaluate SCCA expression in squamous cell carcinoma and verrucous carcinoma and to compare it with normal oral mucosa, also investigating the correlation between serum-based and tissue-based antigen levels. Methodology: In this study, the immunohistochemistry (IHC) technique was used to determine the SCCA1 expression pattern in 81 specimens divided into 3 groups, including oral squamous cell carcinoma, verrucous carcinoma, and normal oral mucosa. Serum-based and tissue-based antigen levels of 20 oral squamous cell carcinoma cases were compared by the western blot assay. SCCA expression was also evaluated and compared in both tumor cells and peripheral T-lymphocytes by the immunofluorescence assay. Results: Our results showed that the SCCA levels in SCC specimens were significantly lower than in verrucous carcinoma and normal and hyperplastic oral mucosa specimens. We found no correlation between the IHC expression of SCCA and serum levels. SCCA was well expressed in both tumor cells and peripheral T-lymphocytes. Conclusion: Decreasing SCCA in SCC specimens suggested that SCC tumor cells may affect more than the serum levels of SCCA in some patients. In addition, expression of SCCA in peripheral T-lymphocytes showed that both tumor cells and T-lymphocytes may cause serum SCCA.&nbsp

Hailey-Hailey Disease: Case Series and Review of Systemic Medications

Introduction: Hailey-Hailey disease (HHD) is a rare inherited blistering skin disorder characterized by a chronic relapsing course. While it doesn't pose a serious threat to the patient's health, the quality of life can change. Unfortunately, there is currently no standard treatment for this condition. Objective: In this observational retrospective cohort study, our aim was to discover the demographic characteristics and treatment strategies for managing Hailey-Hailey disease. Methods: In this retrospective cohort study, we documented the demographic, clinical, and histopathological characteristics beside various treatment employed options of patients diagnosed with HHD at Razi Hospital over the past 14 years. Results: A total of 32 patients with HHD were enrolled in the study (15 male and 17 female). The mean age of patients was 50.41 ± 13.15 (22-77) years. The average age of disease onset was 37.31 ± 11.88 (15-60) years. Among the participants, 16 individuals (50%) affirm a positive family history of some kind of pemphigoid blisters. The most common site of disease activity was the inguinal area, observed in 14 patients (33.33%). Histopathological examination discovered the existence of suprabasal acantholysis in all of the specimens. Worthily, direct immunofluorescence analysis showed negative results in all skin biopsies. All patients received topical steroids and either topical or systemic antimicrobial agents. In cases of flares, systemic steroids were the most popular and favorable treatment choice during flares. Conclusion: Indeed, Hailey-Hailey disease, characterized by its chronic inflammatory and rare nature with a relapsing and remitting course, poses a significant challenge for dermatologists. The treatment of HHD has been less than satisfactory and it often presents a challenge and could be misdiagnosed. Among the available treatment options, topical steroids and antimicrobial agents are the most commonly administered therapies

BMI1 and TWIST1 Downregulated mRNA Expression in Basal Cell Carcinoma

Background: BMI1, TWIST1 and SNAI2/SLUG have been implicated in aggressive behavior of squamous cell carcinoma (SCC) and melanoma and BMI1 expression could identify subtypes of Merkel cell carcinoma (MCC). However, BMI1, TWIST1 and SNAI2 expression levels in basal cell carcinomas (BCCs) have not been elucidated. We hypothesized BCC could be a good model system to decipher mechanisms which inhibit processes that drive tumor metastasis. The aim of this study was to examine the mRNA expression level of BMI1, TWIST1, and SNAI2 in BCCs. Materials and Methods: Thirty-five fresh non-metastatic BCC tissue samples and seven fresh normal skin tissue samples were evaluated by real-time RT-PCR. Results: BMI1 and TWIST1 demonstrated marked down-regulation (p< 0.00l, p= 0.00l respectively), but SNAI2 showed no significant change (p=0.12). Conclusions: Previous literature has clearly demonstrated a positive association between BMI1 and TWIST1 expression and metastatic BCC, aggressive SCC and melanoma. Here, we demonstrated a negative association between BMI1 and TWIST1 mRNA expression level and BCC

Tracing human papillomavirus in skin and mucosal squamous cell carcinoma: a histopathological retrospective survey

Objective: The annual incidence of squamous cell carcinoma (SCC) has been increasing worldwide. The causative role of human papillomavirus (HPV) in SCC development of cutaneous has been controversial in the literature. In this study, we aimed to assess the presence of the histopathological features of HPV in SCC samples. Materials and Methods: This retrospective study was conducted at a tertiary referral skin center in 2020. Specimens of patients with a definite SCC diagnosis were evaluated for histopathological features of HPV, including koilocytosis, hyperkeratosis, acanthosis, hypergranulosis, parakeratosis, solar elastosis, papillomatosis, as well as the grade of the tumor. All the samples were re-evaluated by two dermatopathologists independently. Results: a total of 331 (male:female ratio= 3.9:1) cases of SCC were analyzed. The mean age was 68.1, with a 15.1 standard deviation. Most lesions were located on the face (40.5%), followed by the scalp (22.7%) and extremities (20.8%). Koilocytes were detected in 50 (15.1%) of lesions. The koilocytosis proportion was significantly higher in lesions on nails (38.1%, P-value= 0.007), oral cavity (36.8%, P-value= 0.014), and genitalia lesions (60.0%, P-value= 0.026). Although SCCs in-situ were found in 6.6% of our specimens, the highest koilocytosis proportion (64.7%) was detected in in-situ tumors, which was significantly more than other grades (P-value< 0.001). Conclusions: The histopathological features of HPV and in specific koilocytes can be frequently seen in SCC pathology. This association is more prominent in nail, oral, and genital lesions and is significantly higher in well-differentiated SCC

High expression of Talin-1 is associated with tumor progression and recurrence in melanoma skin cancer patients.

BACKGROUND: Talin-1 as a component of multi-protein adhesion complexes plays a role in tumor formation and migration in various malignancies. This study investigated Talin-1 in protein levels as a potential prognosis biomarker in skin tumors. METHODS: Talin-1 was evaluated in 106 skin cancer (33 melanomas and 73 non-melanomas skin cancer (NMSC)) and 11 normal skin formalin-fixed paraffin-embedded (FFPE) tissue samples using immunohistochemical technique on tissue microarrays (TMAs). The association between the expression of Talin-1 and clinicopathological parameters, as well as survival outcomes, were assessed. RESULTS: Our findings from data minings through bioinformatics tools indicated dysregulation of Talin-1 in mRNA levels for skin cancer samples. In addition, there was a statistically significant difference in Talin-1 expression in terms of intensity of staining, percentage of positive tumor cells, and H-score in melanoma tissues compared to NMSC (P = 0.001, P \u3c 0.001, and P \u3c 0.001, respectively). Moreover, high cytoplasmic expression of Talin-1 was found to be associated with significantly advanced stages (P = 0.024), lymphovascular invasion (P = 0.023), and recurrence (P = 0.006) in melanoma cancer tissues. Our results on NMSC showed a statistically significant association between high intensity of staining and the poor differentiation (P = 0.044). No significant associations were observed between Talin-1 expression levels and survival outcomes of melanoma and NMSC patients. CONCLUSION: Our observations showed that higher expression of Talin1 in protein level may be significantly associated with more aggressive tumor behavior and advanced disease in patients with skin cancer. However, further studies are required to find the mechanism of action of Talin-1 in skin cancers

Whole Transcriptome-Based Skin Virome Profiling in Typical Epidermodysplasia Verruciformis Reveals α-, β-, and γ-HPV Infections

HPVs are DNA viruses include approximately 450 types that are classified into 5 genera (α-, β-, γ-, μ-, and ν-HPV). The γ- and β-HPVs are present in low copy numbers in healthy individuals; however, in patients with an inborn error of immunity, certain species of β-HPVs can cause epidermodysplasia verruciformis (EV), manifesting as recalcitrant cutaneous warts and skin cancer. EV presents as either typical or atypical. Manifestations of typical EV are limited to the skin and are caused by abnormal keratinocyte-intrinsic immunity to β-HPVs due to pathogenic sequence variants in TMC6, TMC8, or CIB1. We applied a transcriptome-based computational pipeline, VirPy, to RNA extracted from normal-appearing skin and wart samples of patients with typical EV to explore the viral and human genetic determinants. In 26 patients, 9 distinct biallelic mutations were detected in TMC6, TMC8, and CIB1, 7 of which are previously unreported to our knowledge. Additionally, 20 different HPV species, including 3 α-HPVs, 16 β-HPVs, and 1 γ-HPV, were detected, 8 of which are reported here for the first time to our knowledge in patients with EV (β-HPV-37, -47, -80, -151, and -159; α-HPV-2 and -57; and γ-HPV-128). This study expands the TMC6, TMC8, and CIB1 sequence variant spectrum and implicates new HPV subtypes in the pathogenesis of typical EV

Cutaneous Lymphadenoma: A Case of Recurrence after Shave Excision

Cutaneous lymphadenoma (CL) is a rare skin tumor supposedly derived from the pilosebaceous unit. Since its description in 1987, fewer than 60 cases have been documented. Herein we report a case of CL presenting as a small nodule on the forehead of a young female. The lesion recurred two years after shave excision of a similar lesion. The histopathological examination revealed interconnected islands, sheets, and trabeculae consisting of two distinct types of cells within a sclerotic stroma, a peripheral rim of palisading basophilic cells, and central epithelial cells with eosinophilic to clear cytoplasm. A dense infiltration with prominent lymphocytes and few plasma cells dominated the stroma and permeated the epithelial nests. This case represents the recurrence of this type of skin tumor after shave excision and thus highlights the importance of complete margin-free excision of such lesions

Reactivation of Cutaneous Leishmaniasis after Renal Transplantation: A Case Report

A 45-year-old man with reactivation of previously existing and subsiding cutaneous leishmaniasis on his wrist and lower leg (shin) after renal transplantation was admitted to our dermatology service on March 2008. He presented to us with two huge tumoral and cauliflower-like lesions. Skin smear and histopathology of skin showed leishman bodies and confirmed the diagnosis. After renal transplantation, he received cyclosporine plus prednisolone to induce immunosuppression and reduce the probability of transplant rejection. After immunosuppressive therapy, reactivation of cutaneous leishmaniasis with the above presentation took place. The patient responded to 800 mg/day intravenous sodium stibogluconate for 3 weeks plus local cryotherapy. Systemic plus local therapy along with reducing the doses of immunosuppressive drugs led to improvement of lesions. Reactivation of leishmaniasis after immunosuppression has been rarely reported