20 - 110 - EPITHELIAL PRECANCEROUS LESIONS Flashcards
Precursor lesions of cutaneous squamous cell carcinoma (SCC).
ACTINIC KERATOSES
most important etiologic factor in the development of actinic keratoses
Long-term and cumulative ultraviolet (UV) radiation exposure
Risk factors of Actinic keratoses
fair skin, age, cumulative UV radiation exposure, immunosuppression, prior history of non-melanoma skin cancer
Actinic Keratoses
Multiple scaly and erythematous plaques on the dorsal hands of a 71-year-old male patient with a history of significant ultraviolet exposure. The lesions were grade II to grade III actinic keratoses.
They typically develop on sun-exposed areas, such as the balding scalp, head, neck, forearms, dorsal hands, and in women, additionally the dorsal legs (Fig. 110-1).
Mild actinic keratoses on the face of a fairskinned woman (grade I). The lesions appear as erythematous patches with a rough texture on palpation. Note other signs of actinic skin damage such as perioral wrinkling and the presence of solar lentigines.
Field cancerization. There are several ill-defined erythematous and scaly plaques, crusts, and ulcerations affecting a large area (“field”) of the balding scalp. Further alterations, such as mottled hypopigmentation and hyperpigmentation, are present and indicate actinic damage.
Alongside clinically detectable AKs, multiple subclinical lesions may be present (Fig. 110-3). This concept is known as field cancerization and is crucial for the therapeutic approach.
A, Multiple well-defined hypertrophic actinic keratoses on the decollete of a middle-aged female. B, A higher magnification reveals the rough and hyperkeratotic texture of some lesions.
main clues to the transition of AK to SCC
induration, inflammation, pain, and ulceration
type of hypertrophic AK that presents with a conical hypertrophic protuberance emanating from a skin-colored to erythematous papular base
Cutaneous horn, also known as cornu cutaneum, refers to a reaction pattern and not a particular lesion.
A, Cutaneous horn of the ear. Only biopsy will confirm whether this is an actinic keratosis or a squamous cell carcinoma. B, Cutaneous horn of the cheek.
represents confluent AKs on the lips, most often the lower lip
Actinic cheilitis
Persons with this condition have red, scaly, chapped lips, and at times erosions or fissures may be present (Fig. 110-6). The vermilion border of the lip is often indistinct, and focal hyperkeratosis and leukoplakia also may be seen. Individuals with this condition often complain of persistent dryness and cracking of the lips.
Classification of Actinic Keratosis
Olsen classification
Grade 1 includes lesions that are mild, slightly palpable, and are better seen than felt
Grade 2 represents lesions that are moderately thick and easily seen and felt.
Grade 3 lesions are severe, very thick and/or obvious AKs
Roewert-Huber classification (scheme for grading AK severity)
type AK I, atypical keratinocytes are restricted to the lower third of the epidermis and are only found within the basal and suprabasal layers.
type AK II, atypical keratinocytes are found within the lower two-thirds of the epidermis, alternating with zones of normal epidermis. In the upper papillary dermis buds of keratinocytes can be found
type AK III, atypical keratinocytes extend to the lower two-thirds of the full thickness of the epidermis. They can also involve the epithelia of the hair follicle, infundibula, and acrosyringium.
most important contributing factors for the formation of AKs.
Fair skin and exposure to UV radiation
single most effective means of decreasing the risk of AKs
Minimizing UV radiation
squamous cell carcinoma (SCC) in situ
Bowen disease (BD)
Bowenoid papulosis is a precancerous condition of the genitalia caused by infection with high-risk HPV, most commonly with types
16, 18 and 33
Epidermodysplasia verruciformis (EV) is an inherited skin condition with a high local susceptibility to infection with human papillomavirus (HPV), most commonly with HPV types ________
types 5 and 8
Anal intraepithelial neoplasia (AIN) is associated with high-grade human papillomavirus (HPV) types, most commonly with types _________________
types 16, 18, 31, and 33
clinical term that refers to a predominantly white lesion of the oral mucosa that cannot be rubbed off or characterized by any other definable lesion or known disease
LEUKOPLAKIA
most common potential malignant lesion of the oral mucosa, with the potential to become oral SCC
LEUKOPLAKIA
markers for increased risk for additional oral or upper aerodigestive tract malignancies.
Leukoplakia and erythroplakia
strongest risk factor for the development of leukoplakia
Tobacco
In leukoplakia, if causative agents, such as tobacco or mechanical irritation, are detected, it is recommended to eliminate these factors for a period of
2 to 6 weeks
clinical term used to describe a red macule or patch on a mucosal surface that cannot be categorized as any other known disease entity caused by inflammatory, vascular, or traumatic factors
Erythroplakia (or erythroplasia)
Of all potentially malignant lesions in the oral cavity, _______ is considered to be the most dangerous and carries the greatest risk of progressing to or harboring invasive carcinoma.
erythroplakia
Precancerous lesions that result from long-term exposure to infrared radiation; can progress to squamous cell carcinoma (SCC).
THERMAL KERATOSES
Precursor lesion of thermal keratoses
Erythema ab igne
Precancerous lesions resulting from prolonged exposure to tar.
HYDROCARBON KERATOSES
Dermoscopy findings of AK
**Nonpigmented lesions **
- scales that appear as whitish or yellowish crystalline structures and a reddish pseudonetwork with erythema and wavy configuration of telangiectasias between enlarged hair follicles.
- The follicles may show a perifollicular halo, resulting in a “strawberry pattern.”
- Hyperkeratotic AK lesions on the face may have prominent keratotic plugs within the hair follicles (targetoid-like pattern).
- The **rosette sign **consists of white dots localized inside the follicular openings, which may reflect alternating orthokeratosis and parakeratosis.
**Pigmented lesions **
- brown dots and globules surrounding the follicular openings
Lesion tartgeted therapies for AK
Topical treatment options for AK
histologic findings of bowen disease
- full-thickness epidermal atypia with loss of the stratified epidermal architecture that is clearly demarcated from the surrounding physiologic structures
- Abnormal mitoses, acanthosis, and hyperkeratosis
- parakeratosis is usually present.
- The degree of cytologic atypia may be variable.
- Typical are hyperchromatic, pleomorphic, and enlarged nuclei
