Summary Background Actinic keratoses (AKs) are common premalignant skin lesions triggered by excessive ultraviolet exposure. The majority of AKs regress or persist, but some progress to squamous cell carcinomas. Biomarkers associated with their persistence, progression and regression have not been characterized. Objectives We performed skin biopsies in patients with extensive actinic damage to identify biomarkers that correlate with clinical progression and regression of AKs. Methods This was an observational study of a cohort of patients with extensive actinic damage. AKs were mapped on a clear plastic template in 26 patients at months 3, 6, 9 and 11. Biopsies were taken from randomly selected, predetermined AKs and were evaluated for p53, E‐cadherin, Snail, Slug and Twist. The study is registered at Clinicaltrials.gov: NCT00027976. Results p53 exhibited greater expression in clinically apparent AKs (histological score 2·89 ± 1·45) than in regressed AKs (0·75 ± 0·96); P < 0·01. There was also significantly less membrane E‐cadherin, the lack of which is a marker of epithelial–mesenchymal transition, in clinically apparent AKs (1·89 ± 1·81) than in sun‐exposed skin (3·07 ± 1·75); P < 0·005. The E‐cadherin transcription repressors Snail, Slug and Twist were increased in AKs compared with sun‐exposed skin. A limitation of the study is that measurement of histological biomarkers was not a primary end point. In addition, patients were allowed to apply sunscreens. Conclusions At the molecular level, loss of E‐cadherin and an increase in p53 are linked to the dynamic interplay between the persistence, progression and regression of AKs. What's already known about this topic? Actinic keratoses (AKs) are common dysplastic epidermal lesions that result from chronic and excessive ultraviolet exposure. Biomarkers associated with progression and regression of AK have not been characterized. What does this study add? Decreased E‐cadherin and increased p53, Snail, Slug and Twist (E‐cadherin transcription factors) were associated with progression from AK to nonmelanoma skin cancer. What is the translational message? Strategies targeting these molecules may be effective in reversing rising skin cancer rates. E‐cadherin, p53, Snail, Slug and Twist are potential biomarkers that may be used to assess the efficacy of existing chemopreventive agents.

Chromoblastomycosis is a chronic cutaneous fungal infection commonly caused by Fonsacea and Cladophialophora spp. Dermoscopy is a non-invasive, real-time diagnostic tool for rapid bedside diagnosis of various inflammatory and non-inflammatory disorders and can be an excellent modality for evaluation of cutaneous mycosis, for which it shows characteristic brown dots, crust, scales and yellow orange structures.

A 70-year-old woman presented with generalized reticulate pigmentation, scarring alopecia, and few discrete, violaceous plaques over the trunk and forearm. Dermoscopic evaluation of the reticulate plaque showed reticulate hyperpigmentation with multiple telangiectasias, and skin biopsy showed lichenoid interface dermatitis with marked pigment incontinence. Thus, a final diagnosis of poikiloderma due to lichen planus pigmentosus was considered.

Insulated IL-RFA seems to be safe and effective in selectively targeting deep-seated cutaneous lesions.

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