Relationship between leukocytes and tumor cells in pre-cancerous and cancerous lesions of the lip: a possible expression of immune reaction

Up-regulation of cyclooxygenase 2 and matrix metalloproteinases-2 and -9 in cutaneous squamous cell carcinoma: active role of inflammation and tissue remodeling in carcinogenesis

Background

Tissue inflammation and remodeling have been extensively studied in various tumors in relation with their invasiveness and metastasis.

Objective

The purpose of this study was to investigate the change in tissue inflammation and remodeling markers in cutaneous squamous cell carcinoma (SCC).

Methods

Expression levels of cyclooxygenase-2 (COX-2) as an inflammatory marker and matrix metalloproteinases-2 and -9 (MMPs 2/9) as remodeling markers were studied in mouse and human SCCs. Western blot analysis and RT-PCR for COX-2 and MMPs 2/9 were performed with skin samples from SCC patients and chronic ultraviolet B (UVB)-induced SCC from hairless mice.

Results

mRNA and protein levels of COX-2 and MMPs 2/9 were up-regulated with the higher sensitivity for MMP-9 in mouse SCCs, which were induced by chronic UVB irradiation. Consistently, COX-2 and MMPs 2/9 were up-regulated with the higher sensitivity for MMP-9 in human SCCs.

Conclusion

COX-2 and MMPs 2/9 are up-regulated in well-differentiated cutanous SCC. Our findings indicate that inflammatory and tissue remodeling processes are actively induced during carcinogenesis of cutaneous SCC.

Premalignant and early squamous cell carcinoma

Actinic keratosis (AK) is a common sun-induced precancerous neoplasm confined to the epidermis. The AK is the initial manifestation of a continuum of clinical and histologic abnormalities that progresses to invasive squamous cell carcinoma (SCC). Bowen's disease, also known as squamous cell carcinoma in situ, represents early SCC confined to the epidermis. More than half of all SCCs contain p53 tumor suppressor gene mutations. Like SCCs, the vast majority of AKs and Bowen's disease lesions are asymptomatic. Each AK and suspicious lesion should be treated before it progresses to invasive SCC. Destructive modalities, such as cryosurgery using liquid nitrogen and electrodesiccation and curettage, usually performed by a dermatologist, are the mainstays of therapy.

The actinic keratosis. A perspective and update

BACKGROUND

Actinic keratosis (AK) is a common sun-induced precancerous neoplasm confined to the epidermis. It is the initial manifestation of a continuum of clinical and histologic abnormalities that progresses to invasive squamous cell carcinoma (SCC), a disorder that accounts for thousands of preventable deaths in America each year.

OBJECTIVE

The purpose of this work is to describe the actinic keratosis.

METHODS

This effort was performed by a literature review and analysis.

RESULTS

Like SCCs, the vast majority of AKs are asymptomatic. Although some actinic keratoses may become clinically inapparent, possibly either due to immune rejection or simply having their external surface unknowingly scraped off, an untreated AK represents a potentially curable fatal cancer.

CONCLUSIONS

Each AK should be treated before it progresses to invasive squamous cell carcinoma. Destructive modalities such as cryosurgery using liquid nitrogen and electrodesiccation and curettage are the mainstays of therapy. Each case must be individualized.

LEARNING OBJECTIVES

After studying this article, participant should be able to: 1. Understand the concept of an actinic keratosis. 2. Learn how to recognize its clinical manifestations. 3. Be aware of the danger it poses as an easily curable papulonodule that may become a fatal cancer.

Premalignant keratinocytic neoplasms

Premalignant keratinocytic keratoses are common, especially in pale-complected persons in whom they appear most often as an actinic keratosis. Although the actinic keratosis has a very low malignant potential, arsenic, tar, thermal, scar, reactional, and radiation keratoses may be more clinically aggressive. This article discusses these premalignant keratinocytic neoplasms.

Squamous cell carcinoma developing within lichen planus of the penis. Treatment with Mohs micrographic surgery

BACKGROUND

Lichen planus is a common disease, with a low malignant potential. There are several case reports in the literature of squamous cell carcinoma (SCC) developing in cutaneous lichen planuse. However, SCC developing in penile lichen planus is extremely rare.

OBJECTIVE

To report a case of SCC developing within penile lichen planus, to discuss treatment with Mohs micrographic surgery, and to review the literature.

METHOD

The diagnosis of lichen planus and SCC were made by biopsy of the lesion.

RESULTS

We present the first case in the English literature of SCC developing within lichen planus of the penis. The lesion was treated with Mohs surgery and the patient's penis is functional and free of tumor 2 years postoperatively.

CONCLUSION

Squamous cell carcinoma may develop within lichen planus. Treatment-resistant longstanding cases of lichen planus should be biopsied. Mohs micrographic surgery is a precise treatment for penile SCC, it avoids penectomy, and preserves normal function.

Aggressive squamous cell carcinoma of the skin after chronic lymphocytic leukemia

We report two cases of squamous cell carcinoma (SCC) of the skin subsequent to chronic lymphocytic leukemia (CLL). Both cases had an unusually aggressive course for a nonmelanoma skin malignancy with extensive metastases in both, resulting in death in one patient. A literature review supports the likelihood of an increased incidence of SCC in patients with CLL. Though the mechanism is unknown, immunosuppression may play a central role. We urge patients with CLL to avoid exposure to direct sun. Any questionable skin lesion should be biopsied early, and completely excised if it is a tumor. The patient should also be examined thoroughly for metastatic disease via subsequent follow-up visits.

Phenotypic identification of mononuclear cells in oral premalignant lesions and cancer by monoclonal antibodies

To explore the nature and importance of mononuclear cells of different phenotypes in oral premalignant lesions and oral cancer, we studied biopsy specimens from 21 oral red and/or white lesions (6 hyperkeratosis, 3 mild dysplasia, 4 severe dysplasia and 8 squamous cell carcinoma), using monoclonal antibodies and avidin-biotin-peroxidase complex staining. Peripheral blood samples (PB) from 4 normal subjects and 5 reactive lymph nodes (LN) were used as controls for the technique. T11-positive cells were the predominant phenotype (74-78%) in all cases examined. The T4/T8 ratio in severe dysplasia was significantly lower than that in mild dysplasia (p less than or equal to 0.05). These observations support the hypothesis of a role for cellular immune responses in oral premalignant lesions and oral cancer. The predominance of T cells may represent the local expression of immunity against antigens (viral or other). The decreased T4/T8 ratio observed in severe dysplasia may represent a transitory stage of local immunosuppression, which may be of critical importance for the progression into carcinoma. Phenotypic variations in mononuclear cell infiltrates in these conditions could be diagnostic value.

Immunology and oral cancer

This paper summarises the evidence for the involvement of the immune response in the development of neoplasia, discusses the immunological abnormalities found in patients with head and neck carcinoma, and outlines recent attempts at treatment of patients with head and neck carcinoma by modulation of the immune response (immunotherapy).

Transformation of oral lichen planus to squamous cell carcinoma: a literature review and report of case

We have presented a case of malignant transformation of oral lichen planus along with a review of the literature and a brief description of the disease. We have attempted to indicate that within defined terms, oral lichen planus should be considered a pre-malignant lesion in which incidence of transformation approaches that of clinical oral leukoplakia, yet is clearly distinctive from that disease with regard to age and sex distribution. The erosive form of oral lichen planus most often precedes carcinomatous change. A protocol is described for documentation and periodic follow-up procedures for such patients to possibly intercept a developing malignancy.