Premalignant lesions of the skin Flashcards
What is acantholysis
loss of intercellular connections between keratinocytes
What is acanthosis
increase in s. gervinatum due to larger population of epidermal cells
WHat is hyperkeratosis
Increase in the stratum corneum
What are premalignant lesions of BCC?
- Nevus sebaceous of jadassohn
- Nevus sebaceous LINEAR
- Porokeratosis
- Arsenic keratosis
What are precancerous conditions with increased risk of BCC development?
BCC BXGG - ARM
B - Bazec
XP
Gorlins
Gardners
Albinism
Radiodermatitis
Muir-Torres
What are premalingant lesions of SCC
Premalignant
- Porokeratosis
- Leukoplakia
- AK
- Arsenic keratosis
- Cutaneous horn
SCC Insitu
- Bowen’s
- Paget’s
- Erythroplasia de Quarat
- Erythroplasia
- Epithelioma (intraepithelial)
- Epidermoid Ca (subungal)
What are precancerous conditions with risk of developing SCC?
SCC X MAR
XP
Muir Torre
Albinism
Radiodermatitis
What are premalignant lesions for MM?
Cellular Blue Nevus
GCMN
Dysplastic nevus
Lentigo Maligna
What are precancerous conditions with risk of developing MM
XP
FAMM
What is arsenic keratosis
- Punctate keratosis caused by arsenic exposure 5-30yrs later
- Exposure is
- Occupational
- pesticide, mining, carpentry
- Therapeutic
- fowlers solution
- Occupational
- SCC>BCC
- Treatment - chelate arsenic, excise SCC/BCC
*
What is nevus of JADASSOHN?
- Congenital nevus on face/scalp/forehead containing overgrowth of entire dermis. Salmon oily plaque with smooth papillomatous area->verucous with age
- Incidence of conversion to BCC>SCC <1%
- Treatment - excise if neoplastic changes
What is porokeratosis
- Atrophic annular plaque with ridgelike pigmented border called cornoid lamella (hyperkeratotic)- sharp margins and outward growth
- OCcurs in linear*, disseminated, punctate, Mibeli (classic)*
- DDX: lichen planus/sclerosis, AK, Verucca Vulgaris
- risk of transformation 10% SCC>BCC. Greatest for *
- Treatment
- medical : 5-FU, imiquimod
- Surgical excision
What is Actinic Keratosis
- Hyperkeratotic lesion on erythematous plaque with background solar damage
- RFs
- sunexposure
- age, men, fair skin
- hx of AK
- Includes cutaneous horn, actinic chelitis
- Path: hyperkeratosis, acanthosis, parakeratosis
- Transformation
- 10% over 10yr =>SCC
- 0.5% metastasis with actinic chelitis
- Treatment
- Medical: 5-Fu, Imiquimod, PDT
- Surgical: cryotherapy (mainstay), dermabrasion, excision
What is a cutaneous horn
Hyperkeratotic projection overlying
- AK
- SK
- SCC
- Verruca vulgaris
- molluscum contagiosum
Tx: excision w 2-3mm margin for diagnosis of underlying histopatho
What is leukoplakia
Squamous proliferation of white plaque on oral mucosal surface. Due to epithelal hyperplasia and surface hyperkeratosis.
- Leukoplakia simplex - white homogenous plaque, asymptomatic
- ErythroLeukoplakia - white and red plaque - associated w pain, itch (higher risk of trasnformation)
Associated w Etoh, smoking, illfitting dentures
Transformation risk - 1-20%
Tx
- Excision WLE - no guide on margins
What is bowens disease
SCC in situ - scaly plaque qith erythematous base, hyperkeratotic plaque
RFs
- actinic damage, radiation
- genetic predisposition, HPV16
- immunosupression
- chronic wound
- arsenic, petroleum byproduct
Trasnformation: 5% AND 1/3 will metastasize
Treatment
- MEdical - imiquimod (not 5-FU cuz need to penetrate to adnexal structure), Rtx, PDT
- Surgical - 5mm excision or mohs
What is Bowen Papulosis
GENITAL Bowens - BP is the trasnformation from genital warts to SCC. Associated with HPV16, 18, 31, 33
- pigmented papules/nodules in genitals with flat/verrucous surface
- Transformation 3%
Tx
- MEdical - 5-FU, imiquimod
- Surgical - excision, ED
What is Pagets disease
Intraepidermal extension of adenocarcinoma from secretory gland. Eryhtemtous scaly plaque wiht irregular borders
- Mammary - indicates Ductal CA. Nipple discahrge on breast with scaly itchy plaque. <50% ass. with breast mass
- Extra-Mammary - found in genital regions. Thick scaly plaque with itchiness. USually from 1’ cells of genital egion but may be 2’ to visceral cancer or adnexal AdenoCa
Tx
- Mamary pagets: AS IDC: excsiion with mastectomy/lumpectomy, +/- rdx, chemo, SLNB
- EMPD: WLE, work up for underlying malingnancy
What is erythroplasia of Queyrat
SCC in situ from mucocutaneous epitheliium of
- penile glans, vulva
- oral mucosa
Associated with HPV16,18, poor hygiene, smoking, immunosuppresoin
Transformation 10-30%
Tx
- MEdical - 5-FU imiquimod, PDT, laser NdYAG
- Surgical - excision
What is erythroplakia
Chronic red oral mucosal patch - 95% of oral cancers begin as erythroplakia
- RFs:
- tobacco 2-4x risk of oral ca
- tobacco +alvohol 15x risk of oral ca
- Transfomration 50% - considered as SCC requiring excision
What is the pathology for SCC in situ
- acanthosis
- thick rete ridges
- hyperkeratosis
- parakeratosis
What is epiermoid carcinoma (subungal)?
Bowens disease of nail bed => verucous lesion, onycholysis
Predisposing Rfs
- HPV16
- chronis paronychia
- smoking
- radiation, sun
Transformation - 20%
Tx - surgical excision w rim of normal tissue
if into bone, its invasive SCC and requires en bloc bone excision w possible DIP amp
What is epithelioma (intraepidermal)
Scaly lesion with intraepidermal collection of atypical keratinocytes
Tx - excision
What is XP
AR Genetic defect cuasing poor DNA mismatch repair, resulting in high skin cancer susceptibility with UV irradiation
- most common in japanese
Clinical features
- Skin - freckles, dry skin. Dx of AK then BCC/SCC/melanoma with time
- Eyes: photosensitivity keratitis - may lead ot blindness
- Neuro: SNdefects, progressive xonal degen - may lead to deafness
- Oral - may have leuko/erythro/SCC on tongue and oral cavity
Diagnosis
- prenatal CVS, FHx, clinical findings, DNA repair test
Prognosis
- 1000x increase riskof BCC SCC melanoma <20
Tx
- protection
- 5-FU, cryotherapy for precursors AK, high dose retinoids
- Surgical - EDC, excision
What is radiodermatitis
Chronic radiation keratosis in area of previous radiation
SCC lag time up to 20yrs, high risk of metastasis if SCC develops
Stages
erythema, epilation
dry/moist desquaamtion
dermal fibrosis and telangiectasia
What is gorlins syndrome
AD familial cancer syndrome wtih predisposition to BCC developedment ealry in life
Mutated of PTCH1 TSG
Clinical features
- BCC nodular>superficial
- high forehead, falx cerebri calcification, dysgeneration of corpus callosum
- bifid ribs, vetebral skeletal abnoralities
- palmar plantar pits
Tx
- avoid ionizin radiation (CT)
- Medical: 5-FU, imiquimod, Vismodegib (for BCC mets/slow progression)
- Surgical:reserved b/c so many lesions -excision mohs EDC
What is albinism
AR with absent or reduced melanin synthesis resulting in hypopigmented hair, skin ,eye
Normal # melanocytes, defective prod of melanin
SCC inevitable>BCC>melnoma
What is muir torre
AD condition with 1 sebaceous Ca and one visceral malingnancy
Most typical cutaneous tumor:
sebaceousCa/adenoma, KA
Most typical visceral tumor:
Colorectal then urogenital
What is 5-FU
Effudex - inhibits pyrimidine synthesis
Indication: AK, superficial BCC
App: topical bid x6wk
ContraI: pregnancy
S/E- blistering, erosion
What is Imiuimod
aldara - Immunomodulator of Tcalls
Uses: AK sup BCC
App; daily q6wk
How r retinoids used for premalignant skin lesions
decrease cohesivenss of hyperproliferative ketinocytes
Use: acne
off label - AK BCC
