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Barthelmann S, Butsch F, Lang BM, Stege H, Großmann B, Schepler H, Grabbe S. Seborrheic keratosis. J Dtsch Dermatol Ges 2023; 21:265-277. [PMID: 36892019 DOI: 10.1111/ddg.14984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/04/2022] [Indexed: 03/10/2023]
Abstract
Seborrheic keratosis (SK) is the most common benign epidermal tumor in clinical dermatological practice. This review summarizes current knowledge about the clinical and histological appearance, epidemiology, pathogenesis, and treatment of SK. There are different subtypes of SK based on clinical presentation and histologic findings. Several factors, including age, genetic predisposition, and possibly also exposure to ultraviolet radiation, are thought to contribute to the development of SK. The lesions can occur on all areas of the body except for the palms and soles, but the most common sites are the face and upper trunk. The diagnosis is usually made clinically, and in some cases by dermatoscopy or histology. Many patients prefer to have the lesions removed for cosmetic reasons although there is no medical indication. Treatment options include surgical therapy, laser therapy, electrocautery, cryotherapy, and topical drug therapy, which is currently in development. Treatment should be individualized depending on the clinical picture and patient preference.
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Affiliation(s)
| | | | | | | | | | - Hadrian Schepler
- Skin clinic, Mainz University Hospital
- MVZ Dermatology Clinic, Koblenz
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2
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Barthelmann S, Butsch F, Lang BM, Stege H, Großmann B, Schepler H, Grabbe S. Seborrhoische Keratosen. J Dtsch Dermatol Ges 2023; 21:265-278. [PMID: 36929560 DOI: 10.1111/ddg.14984_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/04/2022] [Indexed: 03/18/2023]
Affiliation(s)
| | | | | | - Henner Stege
- Hautklinik und Poliklinik, Universitätsmedizin Mainz
| | | | - Hadrian Schepler
- Hautklinik und Poliklinik, Universitätsmedizin Mainz
- MVZ Fokus Haut, Emil-Schüller-Str., Koblenz
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Kondo M, Matsushima Y, Nakanishi T, Iida S, Habe K, Yamanaka K. Seborrheic Keratosis Caused by Human Papillomavirus Type 20 Ameliorated by Zinc Oxide Ointment. Clin Pract 2023; 13:367-371. [PMID: 36961058 PMCID: PMC10037649 DOI: 10.3390/clinpract13020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
A 91-year-old woman visited our department with scattered small nodule lesions and multiple pules or plaques with a stuck-on appearance. The lesions were intractable and resistant to several treatments. Immunodeficiency was excluded by examinations including a CT scan, white blood cell (WBC) counts, natural killer and neutrophil function assays, and IgG titers against human papillomavirus (HPV) 20. HPV20 was identified using the PCR method. The finding of the skin biopsy showed an irritated type of feature of seborrheic keratosis. Additionally, immunohistochemical staining of the lesion revealed that both TNF-α and IFN-ɤ were produced at the skin lesions. The patient's serum zinc level was slightly low. We noticed that zinc deficiency has been reported to decrease the cytotoxic activity of natural killer cells, which play an important role in eliminating virus-infected cells and tumor cells. Finally, zinc oxide ointment was found to improve the lesions dramatically. HPV20 causes tumors only in immunodeficient patients or in patients with epidermodysplasia verruciformis (EV). In EV, EVER1- or EVER2-encoding membrane proteins, of which are related to zinc transport protein-1 expressed on the membrane of the endoplasmic reticulum, were mutated, leading to increased susceptibility to various viral and bacterial infections due to the decreased intracellular zinc concentration. We speculated that the reduction in local zinc concentration was ameliorated by using zinc oxide ointment, resulting in the recovery from HPV20 infection.
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Affiliation(s)
- Makoto Kondo
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan
| | - Yoshiaki Matsushima
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan
| | - Takehisa Nakanishi
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan
| | - Shohei Iida
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan
| | - Koji Habe
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Japan
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Bartley B, Cho WC, Rady PL, Dai J, Curry JL, Milbourne A, Tyring SK, Torres-Cabala CA. Condyloma and coincidental epidermodysplasia verruciformis acanthoma positive for human papillomavirus-14 and -21. J Cutan Pathol 2023; 50:47-50. [PMID: 36039682 DOI: 10.1111/cup.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/19/2022] [Accepted: 08/28/2022] [Indexed: 01/03/2023]
Abstract
Epidermodysplasia verruciformis (EDV) is a rare genodermatosis that predisposes individuals to persistent infection with β-human papillomavirus (HPV) genotypes. The term EDV acanthoma may be applied to lesions with incidental findings of EDV-defining histopathological features without clinical signs of EDV. We report a case of HPV-14- and -21-positive EDV acanthoma arising in association with condyloma in a female patient with a history of low-grade squamous intraepithelial lesion of the cervix positive for high-risk HPV (non-16/18), chronic kidney disease, and systemic lupus erythematosus. The patient had no family or personal history of EDV, but the patient was on immunosuppressive therapy with mycophenolate mofetil and prednisone. A biopsy specimen from one of the perianal lesions revealed histopathologic changes consistent with EDV in the setting of condyloma. Molecular testing showed HPV-14 and -21, which supported the coexistence of condyloma with EDV acanthoma.
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Affiliation(s)
- Brooke Bartley
- Department of Dermatology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter L Rady
- Department of Dermatology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Julia Dai
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrea Milbourne
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen K Tyring
- Department of Dermatology, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Nellessen T, Aoki R, Kammerbauer C, Clanner-Engelshofen BM, French LE, Reinholz M. Relationship between α-genus human papillomavirus and non-genital seborrheic keratosis: Report of new cases and updated review. J Cosmet Dermatol 2023; 22:306-310. [PMID: 35066969 DOI: 10.1111/jocd.14759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Seborrheic keratoses (SK) are the most common acquired benign tumor that affects middle-aged or older adults with great cosmetic concern. Clinical and histopathological similarities of SK and common warts have been addressed by investigating the possible presence of human papillomavirus (HPV) DNA in SK. Previous studies suggested the association between α-genus HPV and SK located on genital skin, whereas the causal relationship between α-HPV and non-genital SK remains controversial. AIM This study aimed to clarify the pathogenic involvement of α-HPV in the development of non-genital SK. METHODS We analyzed α-HPV DNA prevalence and HPV genotypes using a PCR-based microarray on 51 skin samples presenting with histologically confirmed SK without any malignant changes. Correlation between the histological subtype of SK and their HPV DNA-positive reactivity was also evaluated. RESULTS Of 51 non-genital SK, two (3.9%) skin samples were positive for α-HPV DNA; high-risk HPV 31 and low-risk HPV 42 were found. Evaluation of HPV prevalence in different histological types of SK showed that both HPV-positive cases were acanthotic type; 14.3% of acanthotic SK lesions were positive, while all of the other types were negative for α-HPV. CONCLUSIONS This study demonstrates that α-HPV positivity is very rare in common non-genital SK. The rare α-HPV-positive SK lesions histologically belonged to the acanthotic type, implying a potential impact of HPV infection on epidermal hyperproliferation. Although a possible association cannot be excluded, our findings suggest that α-HPV is not a major causative factor for non-genital SK.
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Affiliation(s)
- Tobias Nellessen
- The Department of Dermatology and Allergology, University Hospital of Munich LMU, Munich, Germany
| | - Rui Aoki
- The Department of Dermatology and Allergology, University Hospital of Munich LMU, Munich, Germany
| | - Claudia Kammerbauer
- The Department of Dermatology and Allergology, University Hospital of Munich LMU, Munich, Germany
| | | | - Lars E French
- The Department of Dermatology and Allergology, University Hospital of Munich LMU, Munich, Germany
| | - Markus Reinholz
- The Department of Dermatology and Allergology, University Hospital of Munich LMU, Munich, Germany
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Sun MD, Halpern AC. Advances in the Etiology, Detection, and Clinical Management of Seborrheic Keratoses. Dermatology 2021; 238:205-217. [PMID: 34311463 DOI: 10.1159/000517070] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022] Open
Abstract
Seborrheic keratoses (SKs) are ubiquitous, generally benign skin tumors that exhibit high clinical variability. While age is a known risk factor, the precise roles of UV exposure and immune abnormalities are currently unclear. The underlying mechanisms of this benign disorder are paradoxically driven by oncogenic mutations and may have profound implications for our understanding of the malignant state. Advances in molecular pathogenesis suggest that inhibition of Akt and APP, as well as existing treatments for skin cancer, may have therapeutic potential in SK. Dermoscopic criteria have also become increasingly important to the accurate detection of SK, and other noninvasive diagnostic methods, such as reflectance confocal microscopy and optical coherence tomography, are rapidly developing. Given their ability to mimic malignant tumors, SK cases are often used to train artificial intelligence-based algorithms in the computerized detection of skin disease. These technologies are becoming increasingly accurate and have the potential to significantly augment clinical practice. Current treatment options for SK cause discomfort and can lead to adverse post-treatment effects, especially in skin of color. In light of the discontinuation of ESKATA in late 2019, promising alternatives, such as nitric-zinc and trichloroacetic acid topicals, should be further developed. There is also a need for larger, head-to-head trials of emerging laser therapies to ensure that future treatment standards address diverse patient needs.
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Affiliation(s)
- Mary D Sun
- Icahn School of Medicine at Mount Sinai, New York, New York, USA,
| | - Allan C Halpern
- Dermatology Service, Memorial Sloan Kettering, New York, New York, USA
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Nivolumab induced inflammation of seborrheic keratoses: a novel cutaneous manifestation in a metastatic melanoma patient. Melanoma Res 2019; 28:475-477. [PMID: 29965880 DOI: 10.1097/cmr.0000000000000477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immune checkpoint inhibitors targeting the programmed cell death (PD)-1 receptor have dramatically changed the landscape of metastatic melanoma treatment. Nevertheless, these immuno-modulatory agents have associated side effects, including dermatologic manifestations. To this end, we report a patient with metastatic melanoma that was treated with a PD-1 inhibitor, and subsequently developed inflammation of existing seborrheic keratosis lesions and new verrucous keratoses, a cutaneous side effect that has not been previously reported to our knowledge. The etiology of seborrheic and verrucous keratoses is not well understood, although their physical and histopathologic similarities to chronic viral-derived lesions, such as human papilloma virus, suggest a potential viral association. Chronic viral infections are known to result in T-cell tolerance because of persistent antigen stimulation. PD-1 inhibition is able to reinvigorate exhausted T cells, which are accordingly able to decrease viral load. Thus, the inflammatory reaction, seen in our patient, may be the result of PD-1 inhibition reactivating virally driven T lymphocytes.
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Bakke JR, McMurray SL, Peck ASH, Fisher KR, Tyring SK, Rady PL, Patel TS, Jones A. Seborrheic keratosis-like lesions localized to tattoo. JAAD Case Rep 2019; 5:274-276. [PMID: 30891479 PMCID: PMC6403172 DOI: 10.1016/j.jdcr.2019.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Joshua R Bakke
- University of Tennessee Health Science Center, Kaplan-Amonette Department of Dermatology, Memphis, Tennessee
| | - Stacy L McMurray
- University of Tennessee Health Science Center, Kaplan-Amonette Department of Dermatology, Memphis, Tennessee
| | - Aurora S H Peck
- University of Tennessee Health Science Center, Kaplan-Amonette Department of Dermatology, Memphis, Tennessee
| | - Kristopher R Fisher
- University of Tennessee Health Science Center, Kaplan-Amonette Department of Dermatology, Memphis, Tennessee
| | - Stephen K Tyring
- University of Texas Health Science Center at Houston, Department of Dermatology, Laboratory for Molecular Studies in Mucocutaneous Diseases, Houston, Texas
| | - Peter L Rady
- University of Texas Health Science Center at Houston, Department of Dermatology, Laboratory for Molecular Studies in Mucocutaneous Diseases, Houston, Texas
| | - Tejesh S Patel
- University of Tennessee Health Science Center, Kaplan-Amonette Department of Dermatology, Memphis, Tennessee
| | - Allison Jones
- University of Tennessee Health Science Center, Kaplan-Amonette Department of Dermatology, Memphis, Tennessee
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Seborrheic Keratosis With Prominent Clear Cell Changes-A Rare But Important Diagnostic Variant. Am J Dermatopathol 2017; 40:209-211. [PMID: 28937426 DOI: 10.1097/dad.0000000000000992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Seborrheic keratoses, although exceedingly common, occasionally have morphologic similarities to other lesions that complicate a typically straightforward diagnosis. The authors present a case of a 69-year-old man with a left shoulder lesion that displayed characteristic clinical and microscopic features of seborrheic keratosis on biopsy. However, diffuse and prominent clear cells were also noted. These stained strongly with Periodic acid-Schiff and were diastase sensitive, suggestive of glycogen accumulation and possible trichilemmal differentiation. This case is presented to demonstrate a unique and striking example of clear cell change within a seborrheic keratosis and to briefly review the published literature on this finding, which is rarely reported and demands close examination to exclude more aggressive neoplasms.
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Genome Sequence of Human Papillomavirus Type 20, Strain HPV-20/Lancaster/2015. GENOME ANNOUNCEMENTS 2017; 5:5/31/e00712-17. [PMID: 28774975 PMCID: PMC5543637 DOI: 10.1128/genomea.00712-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The genome sequence of human papillomavirus type 20 (HPV-20; family Papillomaviridae, genus Betapapillomavirus, species Betapapillomavirus 1, type 20) was assembled by deep sequencing from nasopharyngeal swabs. The assembled genome is 0.37% divergent over its full length from the single complete genome of HPV-20 in GenBank (U31778). We named the strain HPV-20/Lancaster/2015.
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Genome Sequence of Human Papillomavirus 23 Strain HPV-23/Lancaster/2015. GENOME ANNOUNCEMENTS 2017; 5:5/20/e00257-17. [PMID: 28522701 PMCID: PMC5477316 DOI: 10.1128/genomea.00257-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The genome of human papillomavirus type 23 (HPV-23; family Papillomaviridae, genus Betapapillomavirus, species Betapapillomavirus 2, type 23) was assembled by deep sequencing from nasopharyngeal swabs. The assembled genome is 2.7% divergent over its full length from the single complete genome of HPV-23 in GenBank (accession no. U31781). We named the strain HPV-23/Lancaster/2015.
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12
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Tin SS, Wiwanitkit V. Human Papillomavirus Deoxyribonucleic Acid in Non-Genital Benign Papillomatous Skin Lesion. Indian J Dermatol 2015; 60:425. [PMID: 26288460 PMCID: PMC4533591 DOI: 10.4103/0019-5154.160553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sim Sai Tin
- Medical Center Unit, Shantou Medical Center, Shantou, China. E-mail:
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Abstract
Nearly 200 distinct human papilloma viruses (HPVs) have now been recognized, and each is associated with a specific set of clinical lesions. They are associated with a spectrum of diseases, from benign verrucae vulgares and condylomata acuminata to the malignancies of the cervix, vulva, anus, and penis. Disease associated with HPV can be divided into skin and mucosal lesion of the genital and extragenital regions. The relationship between HPV and nonmelanoma skin cancer (NMSC) is important clinically, because NMSC is the most common form of malignancy among fair-skinned populations. HPVs have also been detected in skin tags, lichen sclerosus, seborrheic keratoses, actinic keratoses, epidermal cysts, psoriatic plaques, and plucked hairs, but cutaneous HPV can be found on healthy skin.
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Affiliation(s)
- Suzana Ljubojevic
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia.
| | - Mihael Skerlev
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
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Boyd AS, Su PF, Shyr Y, Tang YW. Squamous cell carcinomasin situarising in seborrheic keratoses: an association with concomitant immunosuppression? Int J Dermatol 2014; 53:1346-50. [DOI: 10.1111/ijd.12086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Alan S. Boyd
- Department of Medicine (Dermatology); Vanderbilt University; Nashville TN USA
- Department of Pathology; Vanderbilt University; Nashville TN USA
| | - Pei F. Su
- Department of Biostatistics; Vanderbilt University; Nashville TN USA
| | - Yu Shyr
- Department of Biostatistics; Vanderbilt University; Nashville TN USA
| | - Yi W. Tang
- Department of Clinical Microbiology Service; Memorial Sloan-Kettering Cancer Center; New York NY USA
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Meibodi NT, Nahidi Y, Meshkat Z, Esmaili H, Gharib M, Gholoobi A. No Evidence of Human Papillomaviruses in Non-genital Seborrheic Keratosis. Indian J Dermatol 2013; 58:326. [PMID: 23919020 PMCID: PMC3726897 DOI: 10.4103/0019-5154.113949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Seborrheic keratosis (SK) is a benign epidermal tumor of unknown etiology. Because of its wart-like morphology, Human papillomaviruses (HPVs) have been suggested as a possible causative agent. Viral involvement, however, has not been confirmed yet despite research and the association between HPVs and seborrheic keratosis has not been studied among Iranian population by PCR. OBJECTIVES The aim of this case-control study was to evaluate the presence of HPVs DNA in non-genital SK by PCR. MATERIALS AND METHODS Fifty biopsy specimens obtained from patients with non-genital SK and 50 controls were analyzed using polymerase chain reaction (PCR). RESULTS No HPVs DNA was detected by PCR within the tissue extracts from paraffin-embedded SK samples, while one of the controls was HPVs DNA positive. The age range of the patients was 20 to 82 yrs (mean = 52). Twenty-eight patients (56%) were males and 22 patients (44%) were females. The most common anatomic site was the face. Histopathologic changes due to viral infection such as koilocytosis (10%), dyskeratosis (66%), mitosis (28%), and parakeratosis (88%) were evident within the lesions. The most common histologic type was acanthotic type. CONCLUSION Our results showed that there is no association between HPVs and seborrheic keratosis in investigated subjects.
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Tardío JC, Bancalari E, Moreno A, Martín-Fragueiro LM. Genital seborrheic keratoses are human papillomavirus-related lesions. A linear array genotyping test study. APMIS 2012; 120:477-83. [PMID: 22583360 DOI: 10.1111/j.1600-0463.2011.02853.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Controversy exists about the meaning of human papillomavirus (HPV) detection in seborrheic keratosis (SK). To clarify the pathogenic contributing role of HPV in the development of genital SK, we have studied 40 genital SKs, 20 extragenital SKs, and 20 non-SK genital lesions by polymerase chain reaction for HPV, using a Linear Array Genotyping test that detects 37 genital HPV types. Twenty-eight of the 40 genital SK specimens (70%) were positive for HPV. Twenty-seven of the 28 positive cases (96%) contained HPV6, one of them associated to HPV18 and HPV35 (4%), and the remaining lesion (4%) harbored HPV55. However, HPV was detected in only 2/20 extragenital SK samples (10%) and in 1/20 non-SK genital lesions (5%). Our results support a pathogenic relationship between HPV and genital SK by showing: 1) a high rate of virus detection in these lesions, with a strong predilection for HPV6, and 2) scarcity of genital HPV types in most of the remaining non-SK cutaneous genital lesions and in the extragenital SKs. HPV cannot be found in a minority of genital SKs using highly sensitive techniques, and therefore, other presently unknown factors may also be implied in the pathogenesis of these lesions.
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Affiliation(s)
- Juan C Tardío
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
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Seo EY, Lee DH, Lee Y, Cho KH, Eun HC, Chung JH. Microarray analysis reveals increased expression of ΔNp63α in seborrhoeic keratosis. Br J Dermatol 2012; 166:337-42. [PMID: 21967648 DOI: 10.1111/j.1365-2133.2011.10665.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Seborrhoeic keratoses (SKs) are very common benign epidermal lesions without malignant potential. Ultraviolet radiation, old age and viruses are well-known risk factors for disease development. However, the pathomechanisms of SK are not fully understood. OBJECTIVES To detect and characterize the genes that are involved in the pathogenesis of SK. METHODS We performed a gene expression study using paired lesional and nonlesional skin samples from patients with SK. RESULTS We identified and validated 19 differentially expressed genes in SK. Of these 19 genes, we focused on p63 transcription factor, which plays a pivotal role in epidermal development by regulating its transcriptional programme. We found by immunofluorescence that the expression of ΔNp63α, the most abundantly expressed p63 isoform, was significantly increased in SK as compared with normal skin. Moreover, siRNA-mediated knockdown of ΔNp63 led to the downregulation of 11 genes, including a member of the tensin family TNS4. Chromatin immunoprecipitation assay revealed that TNS4 was a target gene of p63. CONCLUSIONS We identified upregulated genes in SK using genome-wide cDNA microarray and elucidated the functional contribution of p63 to the disease transcriptome by gene-silencing assay. Taken together, these data may provide a novel insight into the molecular basis of these benign skin lesions.
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Affiliation(s)
- E Y Seo
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Jongno-gu, Seoul 110-744, Korea
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Escutia B, Ledesma E, Serra-Guillen C, Gimeno C, Vilata J, Guillén C, Nagore E. Detection of human papilloma virus in normal skin and in superficial and nodular basal cell carcinomas in immunocompetent subjects. J Eur Acad Dermatol Venereol 2010; 25:832-8. [DOI: 10.1111/j.1468-3083.2010.03875.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Lally A, Casabonne D, Waterboer T, Imko-Walczuk B, Michael KM, Pawlita M, Newton R, Wojnarowska F. Association of seborrhoeic warts with skin cancer in renal transplant recipients. J Eur Acad Dermatol Venereol 2010; 24:302-7. [DOI: 10.1111/j.1468-3083.2009.03412.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Noiles K, Vender R. Are all seborrheic keratoses benign? Review of the typical lesion and its variants. J Cutan Med Surg 2009; 12:203-10. [PMID: 18845088 DOI: 10.2310/7750.2008.07096] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Seborrheic keratosis (SK) is one of the more common benign epidermal neoplasms seen in adult and middle-aged patients. OBJECTIVE As little is written in the literature about the variants of SK, this article aims to categorize and discuss the different subtypes and their important associations. METHODS An in-depth literature search using OVID Medline and PubMed was conducted to classify the various subtypes of SK. Clinical variants were photographed and used to help document the subtypes. The pathology is described for each. RESULTS Six subtypes of SK were identified: dermatosis papulosa nigra, stucco keratosis, inverted follicular keratosis, large cell acanthoma, lichenoid keratosis, and flat seborrheic keratosis. Although the etiology and pathogenesis of SKs are still largely debatable, several underlying mechanisms and contributing factors have been identified. All subtypes represent benign lesions, and treatment is usually done for cosmetic reasons. Several of the subtypes may act as cutaneous markers for internal malignancy and should be monitored closely for any atypical changes. CONCLUSION Although all subtypes of SK are benign, their association with other malignant lesions and ability to serve as cutaneous markers of internal malignancy emphasize the importance of correctly identifying all variants.
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Affiliation(s)
- Kristin Noiles
- Micheal G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S 1P3, Canada.
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Incidental epidermodysplasia verruciformis human papillomavirus infection (EV acanthoma): evidence for ‘field cancerization’ and a putative cofactor in seborrheic keratosis. J Cutan Pathol 2008; 35:1151-5. [DOI: 10.1111/j.1600-0560.2007.00920.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Carlson JA, Cribier B, Nuovo G, Rohwedder A. Epidermodysplasia verruciformis-associated and genital-mucosal high-risk human papillomavirus DNA are prevalent in nevus sebaceus of Jadassohn. J Am Acad Dermatol 2008; 59:279-94. [PMID: 18638629 DOI: 10.1016/j.jaad.2008.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 02/17/2008] [Accepted: 03/10/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND The hamartoma nevus sebaceus (NS) presents at birth or early childhood as a yellowish plaque characterized histologically by variable acanthosis, papillomatosis, sebaceus hyperplasia, and proliferations of adnexal structures. Clinically apparent human papillomavirus (HPV) infection is also recognized by acanthosis and papillomatosis. OBJECTIVE We sought to determine the prevalence and physical state of HPV DNA in NS. METHODS DNA was retrieved from 44 formalin-fixed, paraffin-embedded samples of NS (22 with secondary tumors [eg, trichoblastoma, verruca, syringocystadenoma papilliferum] and two epidermal nevi [EN]). Nested polymerase chain reaction with multiple degenerate consensus and type-specific primers and direct sequencing of polymerase chain reaction products was performed. For selected cases, in situ hybridization using probes specific for HPV 5 and 8 and for high-risk genital-mucosal HPV types was performed. RESULTS HPV DNA was detected in 82% of NS and both EN, and consisted of genital-mucosal HPV types in 52% (HPV 6, 16, and 33) and a diverse variety of epidermodysplasia verruciformis-associated HPV types in 61%, including well-known epidermodysplasia verruciformis HPV types (5, 8, 15, 20, 22, 24, 36, 37, 38, and 80) and putatively novel epidermodysplasia verruciformis HPV types (DL285, DL287, DL436, and alb-1, -2, -3, -5, -6, -7, -8, -10, -11, -12, and -13). HPV coinfection was frequent, found in 48% (two HPV genotypes in 35% and 3 in 13%). Of NS and EN, 42% had HPV genotypes associated with cancer (ie, HPV 5, 8, 16, 20, 33, and 38); the two most commonly identified HPV types where HPV 16 (39%) and HPV 38 (18%). No differences were detected comparing frequency of HPV DNA detected with respect to age or presence of a secondary tumor. Histologically, all NS and EN showed HPV-associated cytopathic effects (ie, perinuclear halos, altered keratohyaline granules). By in situ hybridization, 64% (18/28) were positive, showing a low-intensity, punctate nuclear signal in epidermal and adnexal keratinocytes, indicating viral integration and low viral genome copy number. LIMITATIONS Absence of adjacent, uninvolved normal-appearing skin control samples. CONCLUSION HPV DNA is prevalent in NS, and HPV 16, the most frequently detected genotype, appears to be integrated into the host genome. Whether HPV represents a commensal infection caused by localized cutaneous predisposition, or is an essential factor in the pathogenesis of NS is unknown. The high frequency of oncogenic HPV types implicates maternal transmission of HPV and infection of an ectodermal stem cell leading to an epigenetic mosaic and altered skin development manifested along Blaschko's lines.
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Affiliation(s)
- J Andrew Carlson
- Department of Pathology, Division of Dermatopathology, Albany Medical College, Albany, New York 12208, USA.
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Segura S, Carrera C, Ferrando J, Mascaró JM, Palou J, Malvehy J, Puig S. Dermoscopy in Epidermodysplasia Verruciformis. Dermatol Surg 2008; 32:103-6. [PMID: 16393609 DOI: 10.1111/1524-4725.2006.32018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidermodysplasia verruciformis (EV) is a rare autosomal recessive genodermatosis characterized by an impairment of cellular immunity. It clinically manifests as widespread, long-lasting, pityriasis versicolor-like macules and flat, wart-like papules, usually occurring in early childhood. There is a risk of development of multiple skin cancers in the third decade, primarily in sun-exposed skin. EV-associated human papillomaviruses have been implicated in a number of cutaneous lesions in non-EV populations, such as seborrheic keratoses or psoriasis. They have also been implicated in the development of nonmelanoma skin cancer, especially in immunosuppressed patients. Patients affected with EV are not able to eliminate oncogenic viruses within lesions, leading to a malignant transformation. OBJECTIVE To describe the dermoscopic characteristics of EV cutaneous tumors by performing histopathologic correlation. METHODS AND MATERIALS Cutaneous lesions and tumors from two patients affected by EV were included. Clinical and dermoscopic images were obtained and excision with ulterior histopathology was performed in all suspicious tumors and characteristic lesions. RESULTS Dermoscopy and histology of pityiriasis versicolor-like macules, wart-like papules, seborrheic keratosis-like tumors, psoriasis-like plaques, collision tumors, and Bowen in situ carcinoma are described. CONCLUSIONS Dermoscopy in EV tumors correlated with histopathologic findings and improved the differential diagnosis of tumors in this disease.
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Affiliation(s)
- Sonia Segura
- Department of Dermatology, Hospital Clinic, IDIBAPS, University of Barcelona, 170 Villaroel, 08036 Barcelona, Spain
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Lin MT, Rohwedder A, Mysliborski J, Leopold K, Wilson VL, Carlson JA. ‘HPV vulvitis’ revisited: frequent and persistent detection of novel epidermodysplasia verruciformis-associated HPV genotypes. J Cutan Pathol 2008; 35:259-72. [DOI: 10.1111/j.1600-0560.2007.00805.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Forslund O, Iftner T, Andersson K, Lindelof B, Hradil E, Nordin P, Stenquist B, Kirnbauer R, Dillner J, de Villiers EM. Cutaneous human papillomaviruses found in sun-exposed skin: Beta-papillomavirus species 2 predominates in squamous cell carcinoma. J Infect Dis 2007; 196:876-83. [PMID: 17703418 PMCID: PMC3795387 DOI: 10.1086/521031] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 04/03/2007] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A spectrum of cutaneous human papillomaviruses (HPVs) is detectable in nonmelanoma skin cancers, as well as in healthy skin, but the significance that the presence of these types of HPV DNA has for the pathogenesis of skin cancer remains unclear. METHODS We studied 349 nonimmunosuppressed patients with skin lesions (82 with squamous cell carcinomas, 126 with basal cell carcinomas, 49 with actinic keratoses, and 92 with benign lesions). After superficial skin had been removed by tape, paired biopsy samples--from the lesion and from healthy skin from the same patient--were tested for HPV DNA. Risk factors for HPV DNA were analyzed in multivariate models. RESULTS Overall, 12% of healthy skin samples were positive for HPV DNA, compared with 26% of benign lesions, 22% of actinic keratoses, 18% of basal cell carcinomas, and 26% of squamous cell carcinomas. HPV DNA was associated with sites extensively exposed to the sun, both for the lesions (odds ratio [OR], 4.45 [95% confidence interval {CI}, 2.44-8.11]) and for the healthy skin samples (OR, 3.65 [95% CI 1.79-7.44]). HPV types of Beta-papillomavirus species 2 predominate in squamous cell carcinomas (OR, 4.40 [95% CI, 1.92-10.06]), whereas HPV types of Beta-papillomavirus species 1 are primarily found in benign lesions (OR, 3.47 [95% CI, 1.72-6.99]). CONCLUSIONS Cutaneous HPV types are primarily detected at sites extensively exposed to the sun. HPV types of Beta-papillomavirus species 2, but not of species 1, are associated with squamous cell carcinoma.
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Affiliation(s)
- Ola Forslund
- Department of Medical Microbiology, Malmo University Hospital, Lund University, Malmo, Sweden.
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Tobler K, Favrot C, Nespeca G, Ackermann M. Detection of the prototype of a potential novel genus in the family Papillomaviridae in association with canine epidermodysplasia verruciformis. J Gen Virol 2006; 87:3551-3557. [PMID: 17098970 DOI: 10.1099/vir.0.82305-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Epidermodysplasia verruciformis (EV) is a rare human genetic predisposition to develop flat warts, some of which subsequently undergo cancer transformation. Some human papillomaviruses (HPVs), i.e. HPV 5 and 8, have been associated with cancer development as a sequela of EV. As similar diseases have been observed in dogs, it was hypothesized that unknown canine papillomaviruses (CPVs) may exist and that they may be present in cases of canine EV. Consequently, DNA was extracted from a malignant lesion of a dog with EV and circular DNA was amplified by multiple-primed rolling-circle amplification (RCA). Indeed, sequence determination and analysis of the RCA-amplified and cloned DNA from a malignant canine EV lesion resulted in the detection and primary description of a third CPV (CPV3). Typical papillomavirus genes were identified, with deduced amino acid similarities ranging from 20 to 57 % for E1, E2, E6, E7, L1 and L2, respectively. According to the sequence of the L1 gene, which is used for papillomavirus classification, the new isolate meets the majority of criteria needed to declare detection of a novel genus among the papillomaviruses. Thus, CPV3 may represent the prototype of this novel genus. As the novel virus was found in a dog in association with lesions reminiscent of human EV, it should be interesting to test in the future whether this condition can be reproduced in experimental animals. If such were the case, a new model for EV could be established.
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Affiliation(s)
- Kurt Tobler
- Institute for Virology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, CH-8057 Zurich, Switzerland
| | - Claude Favrot
- Clinic for Small Animal Internal Medicine, Dermatology Unit, University of Zurich, Winterthurerstrasse 266a, CH-8057 Zurich, Switzerland
| | - Gilles Nespeca
- Clinic for Small Animal Internal Medicine, Dermatology Unit, University of Zurich, Winterthurerstrasse 266a, CH-8057 Zurich, Switzerland
| | - Mathias Ackermann
- Institute for Virology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, CH-8057 Zurich, Switzerland
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Coates CM, Boehm AP, Leonheart EE, Vlahovic TC. Malignant transformation of plantar verrucae. Adv Skin Wound Care 2006; 19:384-5. [PMID: 16943705 DOI: 10.1097/00129334-200609000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Claire M Coates
- Temple University School of Podiatric Medicine, Philadelphia, PA, USA
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Hazard K, Eliasson L, Dillner J, Forslund O. Subtype HPV38b[FA125] demonstrates heterogeneity of human papillomavirus type 38. Int J Cancer 2006; 119:1073-7. [PMID: 16557595 DOI: 10.1002/ijc.21920] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The human papillomaviruses (HPVs) exist as more than 100 distinct types. While variants of HPV are common, only few HPV subtypes have been reported. HPV type 38 has been proposed to be associated with nonmelanoma skin cancer (NMSC), with reported prevalences of up to 55%. A subtype of HPV38 was cloned, completely sequenced and found to have a 96% sequence similarity to prototype HPV38 in the L1 open reading frame. The presence of prototype HPV38 and HPV38b[FA125] was examined in paired biopsies of tape-stripped skin lesions and healthy skin from 269 immunocompetent patients by real-time PCR. Prototype HPV38 and HPV38b[FA125] were present in seven (3%) and five (2%) lesions, respectively, in viral loads ranging from one copy per 150 cells to one copy per 70,000 cells. In summary, we found that HPV38 is heterogeneous and is one of so far only few HPVs that contain subtypes. The heterogeneity needs to be considered in studies of the biology of this virus.
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Affiliation(s)
- Kristina Hazard
- Department of Laboratory Medicine, Division of Medical Microbiology, Lund University, University Hospital, Malmö, Sweden
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