Ophelia E. Dadzie

Adverse cutaneous reactions to soft tissue fillers – a review of the histological features

The enhanced use of exogenous substances for cosmetic and reconstructive procedures is paralleled by an increase in reports of cutaneous adverse reactions to several of these agents. Recognition of the histological features of these reactions is of importance to both dermatologists and dermatopathologists but is not always easy for several reasons. First, cost‐related issues are resulting in an increasing number of these procedures being performed overseas. Thus, patients are often unsure about the exact product used. Compounding this is the fact that practitioners who perform these procedures are not forthright in divulging this information, given that improper substances may be admixed in the filler injected. Furthermore, cutaneous reactions may occur at sites distant from injected sites, secondary to migration of the filler substance and a lapse of months to years may occur prior to the development of a cutaneous reaction. Thus, a causal relationship between the procedure and the reaction is often not made. We present an overview of the histological features of adverse reactions to currently available soft tissue fillers, both in the United States and overseas, in an attempt to enhance awareness of the diversity of these reactions.

Laser Capture Microdissection: Methods and Applications

Laser microdissection is a nonmolecular, minimally disruptive method to obtain cytologically and/or phenotypically defined cells or groups of cells from heterogeneous tissues. It is a versatile technology and allows the preparation of homogenous isolates of specific subpopulations of cells from which RNA/DNA or protein can be extracted for RT-polymerase chain reaction (PCR), quantitative PCR, Western blot analyses, and mass spectrophotometry.

Incidental Microscopic Foci of Nevic Aggregates in Skin

Microscopic foci of nevic aggregates have been described in normal lymph nodes, where they may pose diagnostic challenges to pathologists. In the course of our practice, we have observed a similar phenomenon in cutaneous tissue. For this reason, we performed a retrospective study of cutaneous excisions over a 1-year period to better characterize this observation. We reviewed 2482 pathology reports of cutaneous excisions, of which 0.8% were associated with such microscopic foci of incidental nevic aggregates. Incidental nevic aggregates were typically dermal in nature and found commonly in excisions from the head and neck region. They were clinically unapparent, with a maximum mean horizontal and vertical diameter of 0.86 mm (0.3-1.5 mm) by 0.46 mm (0.1-1.3 mm). The nevic aggregates were separate and located in normal skin, away from any associated tumors or scar tissue. Although their etiology remains unknown, we hypothesize a derivation from dermal melanocytes, in keeping with the Hochsteigerung theory of nevogenesis. The purpose of this study is to draw attention to the existence of incidental cutaneous nevic aggregates, thereby alerting pathologists and dermatopathologists to their potential as a diagnostic pitfall, especially in the setting of concurrent primary cutaneous malignant melanoma or melanoma in situ.

Skin cancer, photoprotection, and skin of color

To the Editor:We readwith interest the article byAgbai and colleagues about skin cancers in ‘‘skin of color,’’ and commend them for bringing attention to this increasingly relevant issue. However, we are concerned about several aspects of this article, especially recommendations on photoprotection in ‘‘people of color’’ (POC). These are effectively public health messages and hence must be subjected to the same scrutiny dictated by other public health policies. Agbai and colleagues discuss skin cancers in POC, but their article is geared exclusively toward American audiences of physicians and patients. It is important that this relatively narrow context be appreciated by the wider readership of this journal and that recommendations of the authors not be generalized to all POC. Agbai and colleagues also discuss the racial categories of ‘‘whites,’’ ‘‘blacks,’’ ‘‘Hispanics,’’ and ‘‘Asians’’ as they existed in late 19th and early 20th century America. The many problems with the use of these categories in biomedical studies are beyond the scope of this article, but highly relevant here is that they are all socially rather than biologically defined groups. Americans who self-identify as ‘‘white’’ or ‘‘black’’ are highly genetically admixed and the authors’ ‘‘Asian’’ category comprises both East and SouthAsians. ThismakesPOCahighlyphenotypically and genotypically diverse category, which includes a high percentage of lightly pigmented people. Yet the main constitutional characteristic related to a high risk of UV-induced skin cancer is a low level of melanin skin pigmentation, which depends on the expression of various genes, including MC1R. Therefore, either Agbai and colleagues consider that a darker skin pigmentation defines POC, in which case they cannot rationally support the need for photoprotective measures for preventing skin cancer in POC, or they consider that POC forms a totally heterogeneous group in relation to skin pigmentation, in which case any global recommendation directed toward preventing UV-induced skin cancer in POC would therefore be irrelevant. Finally, in recommending use of sunscreen, concealing clothing, and vitamin D supplementation in POC, Agbai and colleagues are again geared toward American audiences, who can purchase these commodities cheaply and have access to some health care and public health information. However, recommendations for POC in most of the world would need to take into account peoples’ socioeconomic status and access to medical care. Furthermore, would it be realistic to advocate daily sunscreen use in most dark-skinned people living in sub-Saharan African countries? Based on the issues we have raised, we call upon Agbai and colleagues to revise their ‘‘one size fits all’’ recommendations on photoprotection in POC, which are not scientifically valid, and at worst may serve to discredit the dermatologic community, as questions become raised about potential conflicts of interests and the level of influence of the cosmetic industry within our specialty.