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BACKGROUND: To evaluate the presence of myofibroblasts (MFs) in the development of lip carcinogenesis, through the correlation of clinical, histomorphometric and immunohistochemical parameters, in actinic cheilitis (ACs) and lower lip squamous cell carcinomas (LLSCCs). METHODS: Samples of ACs, LLSCCs, and control group (CG) were prepared by tissue microarray (TMA) for immunohistochemical TGF-ß, α-SMA, and Ki-67 and histochemical hematoxylin and eosin, picrosirius red, and verhoeff van gieson reactions. Clinical and microscopic data were associated using the Mann-Whitney, Kruskal-Wallis/Dunn, and Spearman correlation tests (SPSS, p < 0.05). RESULTS: ACs showed higher number of α-SMA+ MFs when compared to CG (p = 0.034), and these cells were associated with the vertical expansion of solar elastosis (SE) itself (p = 0.027). Areas of SE had lower deposits of collagen (p < 0.001), immunostaining for TGF-ß (p < 0.001), and higher density of elastic fibers (p < 0.05) when compared to areas without SE. A positive correlation was observed between high-risk epithelial dysplasia (ED) and the proximity of SE to the dysplastic epithelium (p = 0.027). LLSCCs showed a higher number of α-SMA+ MFs about CG (p = 0.034), as well as a reduction in the deposition of total collagen (p = 0.009) in relation to ACs and CG. There was also a negative correlation between the amount of α-SMA+ cells and the accumulation of total collagen (p = 0.041). Collagen and elastic density loss was higher in larger tumors (p = 0.045) with nodal invasion (p = 0.047). CONCLUSIONS: Our findings show the possible role of MFs, collagen fibers, and elastosis areas in the lip carcinogenesis process.
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Carcinoma de Células Escamosas , Queilite , Matriz Extracelular , Neoplasias Labiais , Miofibroblastos , Humanos , Queilite/patologia , Queilite/metabolismo , Neoplasias Labiais/patologia , Neoplasias Labiais/metabolismo , Miofibroblastos/patologia , Carcinoma de Células Escamosas/patologia , Masculino , Feminino , Pessoa de Meia-Idade , Matriz Extracelular/patologia , Idoso , Fator de Crescimento Transformador beta , Adulto , Actinas , Imuno-Histoquímica , Antígeno Ki-67 , Colágeno , Tecido Elástico/patologiaRESUMO
PURPOSE: Actinic conjunctivitis (AC), along with cheilitis (AChe), is part of the clinical spectrum of actinic prurigo (AP), a rare photo dermatosis that affects high-risk populations. We analyzed the clinical manifestations and onset of actinic conjunctivitis (AC), and its relationship with prurigo (AP) in a susceptible population. METHODS: This prospective observational cohort study was performed on Indigenous populations from the highlands of Chiapas, Mexico. Thorough dermatological and ophthalmological examinations were performed in patients attending a primary health care center. The clinical features, labor and environmental factors, onset timing, and clinical staging of AC and AP were analyzed. RESULTS: Of the 2913 patients studied, 54 patients (108 eyes) (1.8%) had AC, and 14 patients (25.9%) had AP. The mean age at diagnosis was 36.18 ± 18.52 years (6-70 years). The mean residential altitude was 1884 ± 434.2 m above sea level. Mean self-reported sun exposure was 5.14 ± 3.1 h a day (0.5-12 h). A total of 90.7% reported exposure to biomass fuels during cooking, and 50% to farm animals. AC was the sole manifestation in 70% of the cases. All patients had nasal and temporal photo-exposed conjunctiva. Among the eyes, 12.9% were classified as stage-1, 64.8% as stage-2, and 22.2% stage-3. A total of 83.3% of the patients had hyperpigmented lesions, and 35.1% had evaporative dry eye disease. CONCLUSIONS: AC may be the initial or sole manifestation of AP. Most AC cases (87%) were initially observed at the advanced stages of the disease. Although solar exposure was not associated with late AC stages, a positive association was found with farm animal exposure. Evaporative dry eye associated with meibomian gland dysfunction has not been previously reported in patients with AC.
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Conjuntivite , Transtornos de Fotossensibilidade , Prurigo , Dermatopatias Genéticas , Animais , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , México/epidemiologia , Prurigo/complicações , Prurigo/epidemiologia , Prurigo/patologia , Estudos Prospectivos , Povos IndígenasRESUMO
Introdução:as desordens orais potencialmente malignas (DOPMs) são condições que podem preceder o aparecimento do câncer em cavidade bucal. Objetivo: descrever os principais aspectos clínicos, histológicos e tratamento da leucoplasia, eritroplasia, queilite actínica e líquen plano oral. Metodologia: trata-se de uma revisão da literatura atual, em que foram consultados artigos nas bases do MEDLINE/PUBMED e Biblioteca Virtual em Saúde, publicados nos últimos 10 anos. Os descritores foram localizados usando o vocabulário controlado do MeSH, sendo eles: Leukoplakia; Erythroplakia, Actinic cheilitis, Oral lichen planus, Diagnosis, Therapeutics. Resultados: asapresentações clínicas das DOPMs são diversas. A leucoplasia é a mais comum e deve ser distinguida da leucoplasia verrucosa proliferativa que tem uma apresentação clínica generalizada e uma tendência à recorrência após a excisão; a eritroplasia, embora rara, tem maior chance de malignização. A queilite actínica acomete com frequência o lábio inferior, tem forte relação com exposição solar e pode progredir para o carcinoma escamocelular labial; o líquen plano oral tem uma variedade de apresentações clínicas, sendo a forma reticular a mais comum. O tipo erosivo, atrófico ou bolhoso é acompanhado de sintomatologia dolorosa variável. A biópsia é essencial para confirmar a suspeita clínica das DOPMs e o encaminhamento oportuno para um especialista é indicado. Conclusão: as DOPMs podem ser encontradas durante o exame bucal, possibilitando assim, o diagnóstico precoce, e o correto encaminhamento a um especialista e a intervenção adequada, podendo reduzir a taxa de progressão dessas condições para câncer.
Introduction: Oral Potentially Malignant Disorders (OPMDs) are conditions that may precede the onset of cancer in the oral cavity. Objective: To describe the main clinical features, histological aspects and treatment of leukoplakia, erythroplakia, actinic cheilitis and oral lichen planus. Methodology: this is a review of the current literature, in which articles in the databases of MEDLINE/PUBMED and the Virtual Health Library, published in the last 10 years, were consulted. The descriptors were located using the MeSH controlled vocabulary, namely: Leukoplakia; Erythroplakia, Actinic cheilitis, Oral lichen planus, Diagnosis, Therapeutics. Results:the clinical presentations of OPMDs are diverse. Leukoplakia is the most common and must be distinguished from proliferative verrucous leukoplakia which has a generalized clinical presentation and a tendency to reoccur after excision; erythroplakia, although rare, has a greater chance of becoming malignant. Actinic cheilitis frequently affects the lower lip, is strongly related to sun exposure and can progress to labial squamous cell carcinoma; oral lichen planus has a variety of clinical presentations, with the reticular form being the most common. The erosive, atrophic or bullous type is accompanied by different levels of pain. Biopsy is essential to confirm the clinical suspicion of OPMDs and timely referral to a specialist is indicated. Conclusion: OPMDs can be found during oral examination, thus enabling early diagnosis, correct referral to a specialist and appropriate intervention, which may reduce the rate of progression of these conditions to cancer.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias Bucais , Queilite , Líquen Plano Bucal , Eritroplasia , LeucoplasiaRESUMO
BACKGROUND: This systematic review aimed to conduct a complete investigation of the demographic aspects, clinicopathological features, degrees of epithelial dysplasia, and malignant transformation rate of actinic cheilitis. METHODS: The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the International Prospective Register of Systematic Reviews (CRD42020201254). A search without year and language restrictions was performed using PubMed/MEDLINE, Embase, Virtual Health Library, Scopus, Web of Science, and gray literature. Studies that provided information on patients with actinic cheilitis were included, excluding those with general information on other diseases or other types of cheilitis. Risk of bias was explored using the Joanna Briggs Institute tool. Narrative and quantitative data syntheses were performed using meta-analyses and subgroup analyses. Association tests were also performed. RESULTS: Thirteen studies (728 patients) were included. The most prevalent clinical signs were dryness (99%), blurred demarcation between the lip vermilion and skin (82%), scaling (69%), and atrophy (69%). Regarding epithelial dysplasia, a prevalence of mild dysplasia (34.2%), followed by moderate (27.5%), and severe (14.9%). The malignant transformation rate was 14%. Crusts, ulcerations, and erythematous areas were associated with lip carcinoma (p < 0.001), and scaling was associated with actinic cheilitis (p < 0.001). CONCLUSIONS: This study revealed several features of actinic cheilitis, providing an overview of the disease. It is suggested that new studies help develop policy guides for the standardization of clinical criteria, enabling more rigorous and homogeneous analysis of actinic cheilitis.
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Carcinoma in Situ , Queilite , Neoplasias Labiais , Humanos , Queilite/epidemiologia , Queilite/patologia , Neoplasias Labiais/patologia , Pele/patologia , Transformação Celular Neoplásica/patologiaRESUMO
Abstract Lip squamous cell carcinoma (LSCC) accounts for 12% of all head and neck cancers. It is caused by chronic exposure to ultraviolet light solar radiation and related to previous actinic cheilitis (AC). This study aimed to investigate the immunostaining of the putative cancer stem cells (CSC) markers ALDH1 and CD44 in AC (n=30) and LSCC (n=20). ALDH1 positivity was found to be statistically higher in LSCC than in AC lesions (p=0.0045), whilst CD44 expression was statistically higher in AC than in LSCC lesions (p=0.0155). ALDH1+ cells in AC lesions were associated with specific clinical features: a younger age (<60 years old), the female gender, white skin, not smoking or consuming alcohol, and a fast evolution, and not associated with the chronic exposure to UV radiation (p<0.0001). CD44 positivity was associated with patients who were male, feoderm, smoked, consumed alcohol, underwent occupational exposure to UV-radiation, and demonstrated lesions with log-time evolution (p<0.0001). ALDH1 + cells were associated with mild dysplasia using a system from the World Health Organization (WHO), and with a low risk of malignant transformation, according to the binary system (p<0.0001). CD44+ cells were also associated with moderated dysplasia, according to the WHO system. In LSCC, ALDH1 + cells were positively associated with patients who were older (≥ 60 years old), smokers, and with those who consumed alcohol (p<0.0001). CD44 + cells in LSCC were associated with older (≥ 60 years old) patients as well, but also with female patients, white skin, non-smokers, and individuals who did not consume alcohol (p<0.0001), all of whom showed distinct patterns in pre- and malignant lesions of both markers. Additionally, in LSCC, both ALDH1 and CD44 staining were associated with smaller tumor sizes (T1/T2; p<0.0001). In summary, although both ALDH1 and CD44 were associated with the presence of dysplasia in AC lesions, the present findings suggest that ALDH1 and CD44 may be activated by different etiopathogenic pathways, predominantly in distinct steps of oral carcinogenesis. CD44 would thus be more significantly related to the potentially malignant lesion, while ALDH1 would be closely linked to malignancy.
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OBJECTIVE: To determine whether sun protection is associated with lower occurrence of actinic cheilitis in adults living in a city from southern Brazil. MATERIALS AND METHODS: A multi-stage proportional sample of 404 individuals 18 years and older was obtained. Interviews and clinical examinations were conducted in participants' households. Four categories of self-reported use of sun protection were determined. Multivariable Poisson regression was used to assess the associations. RESULTS: Prevalence of actinic cheilitis was 47.1%. In the first main-effects multivariable model, AC was significantly associated with sex, age, skin colour and duration of sun exposure, but not with sun protection. However, the association between sun protection and actinic cheilitis was modified by the time of sun exposure. Among those exposed ≥4 hr/day to sun, individuals using physical protection or physical + chemical protection were 33% (prevalence ratio = 0.67, 95% confidence interval [CI] 0.47-0.94, p = .02) and 36% (PR = 0.64, 95% CI 0.47-0.94, p = .02), respectively, less likely to have actinic cheilitis than those who did not use any sun protection, adjusting for sex, age and skin colour. CONCLUSIONS: Physical and chemical sun protection were associated with lower occurrence of actinic cheilitis in individuals with greater exposure to sun.
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Queilite , Adulto , Queilite/epidemiologia , Queilite/prevenção & controle , Estudos Transversais , Humanos , Prevalência , Fatores de ProteçãoRESUMO
Dentre as doenças mais letais em todo o Brasil, o câncer encontra-se como um dos principais, podendo se desenvolver em diversas áreas. Com relação ao câncer bucal, ele é considerado um dos mais prevalentes. Podendo ser justificado em decorrência do estilo de vida adotado por muitos, como tabagismo, alcoolismo, má alimentação e exposição excessiva ao sol. Produzindo um aumento no número de casos de forma progressiva. Em grande parte dos casos de câncer bucal, há o aparecimento de lesões potencialmente malignas, destacando-se a leucoplasia, eritroplasia e queilite actínica. A queilite actínica, decorrente do excesso de radiação ultravioleta, é uma lesão potencialmente maligna, altamente prevalente em pessoas que estão propensas a esta exposição sendo frequente em áreas cuja atividade econômica está pautada na agricultura, que requer exposição à radiação solar, como o noroeste do Paraná. Portanto, é essencial que todos os profissionais de saúde saibam reconhecer este como sendo um fator causador do câncer bucal e fiquem atentos às mudanças que ocorrem previamente à malignização, principalmente, lesões em lábios, onde a queilite manifesta-se. Logo, é importante que os profissionais saibam reconhecê-la precocemente, devendo ser vislumbrado já durante a universidade. Sendo assim, o objetivo do presente trabalho é avaliar o conhecimento de acadêmicos de diferentes áreas da saúde, sobre sinais e sintomas da queilite actínica, que é uma das lesões cancerizáveis mais importantes e prevalentes... (AU)
Among the most lethal diseases in Brazil, cancer is one of the main and can develop in several areas. Re garding oral cancer, it is considered one of the most prevalent. It can be justified due to the lifestyle adopt ed by many, such as smoking, alcoholism, poor diet and excessive sun exposure. Producing an increase in the number of cases in a progressive way. In most cases of oral cancer, there is the appearance of poten tially malignant lesions, highlighting the leukoplakia and actinic cheilitis. Actinic cheilitis, resulting from excess ultraviolet radiation, is a potentially malignant lesion, highly prevalent in people who are prone to this exposure being frequent in areas whose economic activity is based on agriculture, which requires exposure to solar radiation, such as the northwest Paraná. Therefore, it is essential that all health professionals know how to recognize this as a factor causing oral cancer and be aware of the changes that occur prior to malignancy, especially lip lesions, where cheilitis manifests. Therefore, it is important that profes sionals know how to recognize it early, and should be glimpsed already during the university. Therefore, the objective of this work is to evaluate the knowledge of scholars from different health areas about signs and symptoms of actinic cheilitis which is one of the most important and prevalent cancerizable lesions... (AU)
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Neoplasias Bucais , Queilite , Estudantes de Odontologia , Conhecimentos, Atitudes e Prática em Saúde , Radiação Solar , Estilo de VidaRESUMO
BACKGROUND: To analyse the clinical and histological characteristics from a series of oral leukoplakias, leukoerythroplakias, erythroplakias and actinic cheilitis diagnosed in a 14-year period. METHODS: The files were reviewed and all cases diagnosed as leukoplakia, leukoerythroplakia, erythroplakia and actinic cheilitis were selected. Clinical information was obtained from the biopsy submission forms, and histological review was performed in all cases. RESULTS: Final sample included 953 lesions, mostly affecting females (534, 56%), and 87.5% of the patients were 41 to 80 years old. The most commonly affected regions were the lower lip (20.1%), tongue (18.1%) and buccal mucosa (16.9%). Leukoplakias, actinic cheilitis, leukoerythroplakias and erythroplakias represented, respectively, 74.6%, 15.2%, 9.3% and 0.8% of the sample. Most cases presented no dysplasia (42.1%) or mild dysplasia (33.5%). Lesions in the tongue, floor of mouth and lower lip, as well as lesions that presented hyperparakeratosis, showed higher frequencies of moderate dysplasia and severe dysplasia/carcinoma in situ. The most common histological criteria were the increase in number and size of nucleoli, loss of polarity of the basal cells and variations in cellular size and shape. Classification by the binary system showed that 7% were high-risk lesions. CONCLUSION: All histological criteria for classification of oral epithelial dysplasia recommended by the World Health Organization showed increased frequency as grading increased. Additional criteria seem to be useful in grading oral epithelial dysplasia, such as the presence of normal and abnormal superficial mitotic figures and endophytic epithelial proliferation.
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Carcinoma in Situ , Queilite , Eritroplasia , Lesões Pré-Cancerosas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Leucoplasia Oral , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: This study aimed to analyze the expression of miR-181b, miR-21, miR-31, and miR-345 in actinic cheilitis with and without epithelial dysplasia and lower lip squamous cell carcinomas, and to verify if the deregulated expression of these miRNAs would be indicative of malignant transformation. MATERIALS AND METHODS: The sample was selected from formalin-fixed paraffin-embedded tissues of 19 actinic cheilitis without epithelial dysplasia, 32 actinic cheilitis with epithelial dysplasia, 42 lower lip squamous cell carcinomas, and 10 nonaltered oral mucosa of the lip. The microRNA (miR, miRNA) expression was quantified by real-time RT-PCR and the expression of the selected miRNAs among the groups of actinic cheilitis and lower lip cancer was compared by chi-square. RESULTS: A higher expression of miR-181b, miR-31, and miR-345 was found in actinic cheilitis without epithelial dysplasia in comparison to that in actinic cheilitis with epithelial dysplasia and with lower lip cancer. There were no differences in miR-21 expression between actinic cheilitis and lower lip cancer. Hierarchical clustering analysis showed a tendency for a downregulation of miR-181b, miR-21, miR-31, and miR-345 in most patients with lower lip cancers. CONCLUSIONS: The upregulation of miR-181b, miR-31, and miR-345 expression in actinic cheilitis without epithelial dysplasia and the decrease in the expression of these miRNAs in actinic cheilitis with epithelial dysplasia and in lower lip cancer are potential biomarkers of malignant progression. CLINICAL RELEVANCE: This miRNA signature can help to identify actinic cheilitis with potential to progress to lip cancer.
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Queilite , Neoplasias Labiais , MicroRNAs , Biomarcadores , Queilite/genética , Humanos , Lábio , Neoplasias Labiais/genética , MicroRNAs/genéticaRESUMO
INTRODUCTION: Actinic cheilitis (AC) is part of a spectral disease of keratinocyte carcinomas considered by some authors an early stage of in situ squamous cell carcinoma. Treatment options for AC can be lesion and field-directed therapies. Ingenol mebutate (IM) induces rapid and direct cell death and immune responses being able to destruct dysplastic cells. MATERIALS AND METHODS: This study enrolled patients with AC to receive IM gel 0.015% for self-application on the lower lip for 3 consecutive days. A biopsy was performed before and after treatment for histopathological and immunohistochemical evaluation. Local skin reactions (LSR) were evaluated. The level of significance considered was 5%. RESULTS: Fourteen patients were enrolled. All LSR had a complete resolution for up to 2 weeks. The most common adverse events were burning sensation, angular cheilitis, and pain. There was an improvement of more than 80% in patients' subjective evaluation. There was no statistically significant histopathological response since all patients remained with mild dysplasia. No reduction in the P53 expression was observed in the current study. CONCLUSIONS: Despite being a safe therapeutic method, the absence of histopathological or immunohistochemical response suggests that clinical improvement may not be accompanied by histopathological cure for AC treated with IM.
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Queilite , Diterpenos , Ceratose Actínica , Queilite/tratamento farmacológico , Diterpenos/uso terapêutico , Genes p53 , Humanos , Ceratose Actínica/tratamento farmacológico , Resultado do Tratamento , Proteína Supressora de Tumor p53RESUMO
Cheilitis Glandularis (CG) is a chronic inflammatory disorder with no specific etiology that affects the minor salivary glands of the lips. The main characteristic of this condition consists of the exit of thick saliva or mucopurulent secretion through the dilated ducts present in the vermilion border of the lip, associated to varying degrees of macrocheilia. In this article we report the case of a male patient, leucoderma, 48 years old, that exhibited actinic cheilitis and glandular cheilitis. We emphasized the clinical management, diagnosis criteria and treatment, taking into consideration that GC is a rare condition and makes a differential diagnosis with other entities that may occur on lips. Although a diagnosis of CG is not difficult, its treatment is a challenge, considering the unknown etiology that hinders the development of more specific and effective treatments.
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Queilite , Sialadenite , Humanos , Masculino , Pessoa de Meia-Idade , Glândulas Salivares MenoresRESUMO
To compare two grading systems of epithelial dysplasia-World Health Organization (WHO) and binary system (BS) -in actinic cheilitis (AC). Seventy cases diagnosed as AC in an Oral Pathology Laboratory from Brazil in the last 12 years were retrospectively retrieved, including the demographic data of each patient. All conventionally stained slides were reviewed, and epithelial dysplasia was evaluated by two independent observers using both WHO and BS grading systems. Data correlation was performed using kappa and chi-square tests (p < 0.05). Most patients were white men with a mean age of 57 years old and history of chronic exposure to sunlight. Most of the lesions were clinically described as whitish plaques with irregular surface located in the lower lip semi-mucosa. Most cases were microscopically graded as severe epithelial dysplasia and low-risk by both observers. The interobserver and intraobserver agreement between systems was slight. All reddish lesions were graded as severe epithelial dysplasia, showing an equal distribution between low and high-risk grading. Most ulcerated lesions showed severe epithelial dysplasia but was graded as low-risk of malignant transformation. Statistical significance was observed among the presence of "irregular stratification", severe epithelial dysplasia and high-risk lesions (p < 0.05) likewise among the presence of "loss of polarity of basal cells" and "drop-shaped ridges" (p < 0.05) with high-risk lesions. The absence of "increased mitotic figures", "dyskeratosis" and "keratin pearls" (p < 0.05) were strongly correlated to low-risk lesions. The presence of "hyperchromasia" was statistically significant with severe epithelial dysplasia (p < 0.05) as well the absence of "atypical mitotic figures" with low-risk lesions (p < 0.05). Although there was slight agreement between microscopic grading systems, microscopic analysis indicated that architectural epithelial changes individually may be the more reliable criteria to indicate the risk of malignant transformation in AC in both grading systems.
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Queilite/patologia , Adulto , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Estudos RetrospectivosRESUMO
BACKGROUND: Actinic cheilitis is induced by chronic exposure to ultraviolet radiation and shows solar elastosis, a feature that has been associated with mast cell infiltrates. This study aimed to investigate the area of solar elastosis, collagen loss, and mast cell infiltrates in a series of actinic cheilitis. METHODS: We evaluated the epithelial dysplasia in 52 cases of actinic cheilitis and the solar elastosis with Weigert's resorcin-fuchsin. Collagen loss was evaluated with Picrosirius red, analyzed under polarized microscopy, and scored from 1 to 3. Elastosis proportionate area (EPA) was calculated with image software. Mast cells were highlighted with toluidine blue stain. RESULTS: EPA varied from 2% to 45%, with a mean of 17.1% in the cases, with no differences among epithelial dysplasia degrees. Most cases presented collagen loss scores of 2 or 3, and higher loss of type I collagen was associated with older age. Mast cell density was higher in severe epithelial dysplasia (P = 0.002) and in high-risk cases (P = 0.01). CONCLUSION: Actinic cheilitis presented variable EPA and marked loss of type I collagen; however, these features were not associated with the degrees of epithelial dysplasia. Besides, mast cell density increased with epithelial dysplasia worsening and this was not associated with elastosis area or collagen loss.
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Queilite/patologia , Tecido Elástico/patologia , Células Epiteliais/patologia , Mastócitos/patologia , Adolescente , Adulto , Idoso , Criança , Colágeno Tipo I/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Luz Solar/efeitos adversos , Adulto JovemRESUMO
Data on the occurrence and clinicopathological characteristics of actinic cheilitis (AC) and lip squamous cell carcinoma (LSCC) are well studied; however, they are based on studies limited to a single centre. Herein, we described the frequency of AC and LSCC submitted to microscopic examination from representative geographic regions of Brazil. A retrospective multicentre study was performed on biopsies obtained from 1953 to 2018 at 10 Brazilian oral and maxillofacial pathology centres. A total of 198,709 biopsy specimens were surveyed. Sociodemographic data and clinicopathologic characteristics were analysed. A total of 2017 cases of ACs (1.0%) and 850 cases of LSCCs (0.4%) were recorded. A strong fair-skinned (> 87%) male (> 70%) predilection was observed in both conditions. The mean age was 54.8 ± 18.7 for individuals with AC and 57.8 ± 19.0 for individuals with LSCC. The most commonly affected site was the lower lip (> 90%). This is a large multicentre study of AC and LSCC from Brazil. The frequency and clinicopathological features of AC and LSCC were similar to those described worldwide. This study provides robust and representative epidemiological data of these conditions for the scientific community.
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Queilite/patologia , Neoplasias Labiais/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Queilite/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Neoplasias Labiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: Actinic cheilitis is a potentially malignant disorder caused by excessive sun exposure. It affects the lower lip of individuals, mostly those with light skin color. Different treatments have been proposed for AC; however, no consensus has been reached on the best option available. MATERIALS AND METHODS: The present study describes the results of a computer-based systematic search conducted on electronic databases to identify the best therapies. RESULTS: A total of 29 journal articles were selected, and the results were divided according to the type of treatment employed: laser therapy, chemotherapy agents, surgical treatment, and application of anti-inflammatory agents. Clinically, photodynamic therapy showed positive results, with improvement in up to 100% of the patients; however, histopathological improvement varied greatly, from 16 to 100%. Among the chemotherapeutic agents assessed, imiquimod showed the best results: clinical improvement in 80 to 100% of the patients, and histopathological improvement in 73 to 100%. Regarding studies describing surgical approaches, the main focus was the search for the best technique, rather than the cure of AC. Finally, studies employing anti-inflammatory agents are sparse and have small samples, thus providing limited results. CONCLUSION: The scientific evidence available on the treatment of AC is scarce and heterogeneous, photodynamic therapy, and imiquimod application are promising. CLINICAL RELEVANCE: The study of the treatments for AC in the form of a systematic review allows us to evaluate the results against the different treatments. Being a potentially malignant lesion, it is important to seek evidence about the best results found.
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Queilite/terapia , Terapia a Laser , Fotoquimioterapia , Humanos , Lábio/patologiaRESUMO
OBJECTIVE: The aim of this systematic review was to compare outcomes between surgical and non-surgical treatment of actinic cheilitis (AC). MATERIALS AND METHODS: A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline were performed. A search of PubMed/MEDLINE, Web of Science, and Cochrane Library databases was conducted. Articles were selected based on the inclusion criteria: randomized clinical trials, prospective/retrospective studies, and case series with at least 10 patients, with a minimum follow-up period of 6 months. A weighted remission rate (RER) and recurrence rate (RR) with a 95% confidence interval was performed. Data analysis was performed using a comprehensive meta-analysis software. RESULTS: A total of 283 ACs in 10 studies were included. About 2.5% surgically treated cases underwent malignant transformation. The weighted remission rate was higher for surgical (92.8%) compared to non-surgical treatment (65.9%). The recurrence rate was lower for surgical (8.4%) compared to non-surgical treatment (19.2%). CONCLUSION: In this systematic review, the surgical treatment was more favorable than non-surgical for AC. Meanwhile, further studies are needed that should maximize methodological standardization and have greater rigor of the data collection process.
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Queilite/terapia , Recidiva Local de Neoplasia , Biópsia , Queilite/patologia , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Abstract The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Labiais/imunologia , Antígenos HLA-DR/imunologia , Queilite/imunologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/imunologia , Neoplasias Labiais/patologia , Neoplasias Labiais/secundário , Queilite/patologia , Gradação de Tumores , Carcinogênese/imunologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/secundário , Inflamação/patologia , Metástase Linfática/patologia , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
A queilite actínica (QA) é uma lesão potencialmente maligna que ocorre principalmente em homens leucodermas com histórico de exposição crônica ao sol. Atualmente, não é possível predizer quais os casos de QA progredirão para o Carcinoma de células escamosas (CCE), portanto alguns marcadores biomoleculares têm sido alvo de pesquisas. A ß-catenina é uma proteína multifuncional que está envolvida nos processos de adesão célula-célula. A alteração do complexo caderina-catenina tem sido demonstrada no CCE e correlacionada com a invasão tumoral, metástase e com pior prognóstico dos pacientes. O REGγ é um ativador de proteassoma que pode promover a degradação de múltiplas proteínas incluindo p53 e MDM2. Estudos mostram que o REGγ está superexpresso em numerosos tipos de câncer, sugerindo que a superexpressão do REGγ está envolvida na progressão do câncer. O objetivo deste estudo foi analisar a expressão imuno- histoquímica da ß-catenina e do REGγ em casos de QA e Carcinoma de células escamosas de lábio inferior (CCELI), comparando os achados imunohistoquímicos com os dados clínicopatológicos, afim de averiguar se há uma correlação com a progressão tumoral e se as mesmas atuam de forma sinérgica nesse processo. A imunoexpressão de ß-catenina e REGγ foi analisada semi-quantativamente em 30 casos de QA e 30 casos de CCELI de acordo com os escores: 0 (sem marcação); 1 (1-25% de células positivas); 2 (26-50% de células positivas); 3 (51-75% de células positivas); 4 (> 75% células positivas). Para a análise estatística, foram realizados os testes de Mann-Whitney e de Spearman (p < 0,05). Tantos as QAs quanto os CCELIs expressaram a proteína ß-catenina, sendo evidenciado um aumento da expressão citoplasmática e nuclear nos casos de Displasias moderadas e severas. Nos CCELIs a imunoexpressão de ß-catenina membranar foi maior nos casos de baixo grau de malignidade. Tantos as QAs quanto os CCELIs expressaram a proteína REG-γ porém não verificamos significância estatística entre a sua expressão e o grau displasia epitelial, bem como, entre a imunoexpressão do REG-γ e os parâmetros clinicopatológicos analisados nos CCELIs. Os resultados do presente estudo sugerem que a superexpressão de REG-γ e a redução na expressão membranar de ß-catenina podem ser eventos importantes na carcinogênese labial. No entanto, acreditamos que esta proteína esteja envolvida no processo da carcinogênese oral. Nesse processo, correlacionando a expressão imuno-histoquímica da ß-catenina com a expressão do REG-γ, não resultados estatisticamente significativos, sugerimos então que a expressão de ßcatenina pode não ser influenciada diretamente pelos níveis de expressão de REGγ (AU).
Actinic cheilitis (QA) is a potentially malignant lesion that occurs mainly in men with light skin and a history of chronic sun exposure. Currently, it is not possible to predict which cases of QA will progress to Squamous Cell Carcinoma (SCC), so some biomolecular markers have been researched. Β-catenin is a multifunctional protein that is involved in cell-cell adhesion processes. The alteration of the cadherin-catenin complex has been demonstrated in SCC and correlated with tumor invasion, metastasis and worse prognosis of patients. REGγ is a proteasome activator that can promote the degradation of multiple proteins including p53 and MDM2. Studies show that REGγ is overexpressed in numerous cancers, suggesting that REGγ overexpression is involved in cancer progression. The aim of this study was to analyze the immunohistochemical expression of ß-catenin and REGγ in cases of QA and lower lip squamous cell carcinoma (CCELI), comparing the immunohistochemical findings with the clinical and pathological data, in order to verify if there is any a correlation with tumor progression and whether they act synergistically in this process. Β-catenin and REGγ immunoexpression was analyzed semi-quantitatively in 30 cases of QA and 30 cases of CCELI according to the scores: 0 (no labeling); 1 (1-25% positive cells); 2 (26-50% positive cells); 3 (51-75% positive cells); 4 (> 75% positive cells). For statistical analysis, Mann-Whitney and Spearman tests were performed (p <0.05). Both QAs and CCELIs expressed the ß-catenin protein, showing an increase in cytoplasmic and nuclear expression in cases of moderate and severe dysplasias. In CCELIs, membrane ß-catenin immunoexpression was higher in cases of low grade malignancy. Both QAs and CCELIs expressed the REG-γ protein but no statistical significance between its expression and the degree of epithelial dysplasia was found, as well as between the immunoexpression of REG-γ and the clinicopathological parameters analyzed in the CCELIs. The results of the present study suggest that REG-γ overexpression and reduction in membrane expression of ß-catenin may be important events in lip carcinogenesis. However, we believe that this protein is involved in the process of oral carcinogenesis. In this process, correlating the immunohistochemical expression of ß-catenin with the expression of REG-γ, as we did not obtain statistically significant results, we suggest that ß-catenin expression may not be directly influenced by the levels of REGγ expression (AU).
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Labiais/patologia , Carcinoma de Células Escamosas/patologia , Queilite/patologia , beta Catenina , Carcinogênese/patologia , Imuno-Histoquímica/métodos , Estatísticas não ParamétricasRESUMO
RESUMEN La queilitis actínica (QA) es un desorden potencialmente maligno del labio inducido por la exposición crónica a la luz ultravioleta, que afecta principalmente al bermellón del labio inferior de personas adultas y de piel clara. Si no es tratada en forma oportuna puede transformarse en un carcinoma de células escamosas del labio. Histológicamente la QA presenta una serie de alteraciones a nivel epitelial que van desde hiperplasia a displasia; en el tejido conectivo se presentan distintos grados de elastosis actínica acompañada por infiltrado inflamatorio. El objetivo de este trabajo es presentar tres casos de pacientes con QA y analizar sus características clínicas e histopatológicas.
ABSTRACT Actinic cheilitis (AC) is a potentially malignant lip disorder induced by chronic exposure to ultraviolet light, which mainly affects the vermilion of the lower lip of adults and fair skin. If it is not treated in a timely manner it can become a squamous cell carcinoma of the lip. Histologically, AC presents a series of alterations at the epithelial level ranging from hyperplasia to dysplasia; Connective tissue presents different degrees of actinic elastosis accompanied by inflammatory infiltrate. The objective of this work is to present three cases of patients with AC and analyze their clinical and histopathological characteristics.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Carcinoma de Células Escamosas , Queilite/diagnóstico , Ceratose Actínica/tratamento farmacológicoRESUMO
Resumen La matriz extracelular (MEC) juega un papel importante en la regulación de los eventos biológicos, tales como, el desarrollo de la migración celular, proliferación y diferenciación. La exposición crónica a la luz ultravioleta (UV) provoca elastosis (en distintos grados), que corresponde a una degeneración basófila de la MEC. La queilitis actínica (QA) es una lesión potencialmente maligna del labio inducida por la exposición regular y prolongada a la luz UV, que afecta principalmente al bermellón del labio inferior. Las lesiones de QA tienen un estroma complejo, se observa siempre la presencia de elastosis, infiltrado inflamatorio crónico de distinta intensidad y la aparición de vasos sanguíneos telangiectásicos. Dentro de este infiltrado inflamatorio se ha descrito un aumento significativo de mastocitos (MCs), localizados especialmente alrededor de las zonas de elastosis y en la zona subepitelial. Se ha propuesto que la elastosis actínica se produce tanto por procesos degenerativos como de síntesis anormal de fibras elásticas por parte de fibroblastos con daño solar, lo que va acompañado de cambios morfológicos del colágeno. A pesar de que el fibroblasto tendría un rol preponderante en la formación de la elastosis actínica, diversos estudios sugieren que otros tipos celulares como el MC también contribuirían en forma significativa al daño actínico de la MEC. El propósito de esta revisión es analizar las características de la elastosis en la QA.
Abstract The extracellular matrix (ECM) plays an important role in the regulation of biological events, such as cell migration, proliferation and differentiation. Chronic exposure to ultraviolet (UV) light causes elastosis (to varying degrees), which corresponds to a basophilic degeneration of the ECM. Actinic cheilitis (AC) is a potentially malignant lip lesion induced by regular and prolonged exposure to UV light, which mainly affects the vermilion. AC lesions have a complex stroma characterized by the presence of elastosis, chronic inflammatory infiltrate of different intensity and the appearance of telangiectatic blood vessels. Within this inflammatory infiltrate a significant increase of mast cells (MCs) has been described, located especially around areas of elastosis and at the subepithelial zone. It has been proposed that actinic elastosis is produced both, by degenerative processes and by abnormal synthesis of elastic fibers by photodamaged fibroblasts, which is accompanied by morphological changes in collagen. Although the fibroblast would play a major role in actinic elastosis formation, several studies suggest that other cell types such as MCs also contribute significantly to actinic ECM damage. The purpose of this review is to discuss the characteristics of elastosis in AC.