Background: The elastotic changes of the dermis are thought to be the primary indicator of the cumulative sun exposure of the dermis. The changes of elastotic material have been evaluated by several previous methods, but these did not quantitatively measure the amount of elastic tissue. Objective: The purpose of this study was to quantify dermal elastosis and to assess the significance of sun exposure in the pathogenesis of nonmelanomatous skin tumors such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and Bowen’s disease (BD). Methods: Ninety-nine sections from biopsy specimens of histopathologically proven BCC, SCC and BD were stained with Verhoeff-van Gieson stains. We studied the amount of elastotic material adjacent to the tumor by image analysis. Results: There was a 3- to 4-fold increase in the amount of elastotic material in BCC and SCC compared to the sun-exposed skin of normal controls (p < 0.0001). The amount of elastotic material was increased 1.3 times in BD as compared with the nonexposed skins of normal controls (p < 0.01). Conclusion: We demonstrated a quantitative relationship between cumulative solar exposure and skin cancer such as SCC, BCC and BD.

This study supported the findings of hyperkeratosis and dilatation of superficial dermal blood vessels in EFFC. The pigmentation of the basal layer and the percent area of the inner spaces of the superficial dermal blood vessels may reflect the clinical severity more than the other parameters. Although follicular plugging is a characteristic clinical feature of EFFC, enlargement of hair follicles and hair shafts were not characteristic pathologic changes EFFC in our study.

The visual grading method was neither objective nor reproducible. On the other hand, the image analysis system can be used as an objective method of measuring the involved surface area of patients with psoriasis. Therefore, the image analysis system can be used as a standard for the assessment of the involved area of patients with psoriasis.

The severity of psoriasis has been traditionally assessed by measures, such as the psoriasis area and severity index (PASI), the psoriasis severity scores, and the lesional severity scores. As a result, even experienced dermatologists show variations when attempting to determine the severity of psoriasis. Therefore, a better non-invasive and objective measurement of clinical signs is needed. In this study, an instrument, a so-called 'stereoimage optical topometer' (SOT), based on a new concept of 'stereoimaging' was used to measure the three-dimensional skin surface. The aim of this study was to compare the results obtained by the SOT with the visual score of psoriasis lesion. Thirty psoriatic patients were enrolled in this study. Initially, the severity of the infiltration and the scale of 134 psoriatic lesions were assessed by using a visual scoring system (0: none, 1: mild, 2: moderate, 3: severe, and 4: very severe), as scored by five dermatologists. The SOT was then used to quantify the severity of each psoriatic lesion using four three-dimensional SOT parameters (Sa, SL, SA, and SV). Secondly, the involved skin-surface area in the psoriasis cases was scored by the naked eye by the five dermatologists and by image analysis. Statistically significant differences were observed between grades 0, 1, 2, and 3 in terms of the severity measurements of the individual psoriatic lesions by SOT when using the parameters Sa, SL, SA, and SV. Therefore, it was concluded that there is a strong correlation between the results measured by visual scoring and by SOT in psoriasis.

These data indicate that morphologic study of skin surface contours are useful in evaluating of AD severity. If we would combine methods to evaluate the physiologic changes and those such as SOT to measure the morphological changes of skin surface, we could evaluate more objectively and quantitatively the severity of AD.