Premalignant lesions of skin
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This document summarizes several premalignant lesions of the skin. It discusses actinic keratosis, which are rough, scaly patches that occur in sun-exposed skin and have a 20% risk of developing into squamous cell carcinoma. Cutaneous horns, keratoacanthomas, Bowen's disease, extra mammary Paget's disease, giant congenital pigmented nevi, dysplastic nevi, oral leukoplakia, and Marjolin's ulcer are also outlined. Treatment options vary depending on the specific lesion but may include photodynamic therapy, cryosurgery, topical medications, and surgical excision. Complete removal of some lesions like giant congenital pigmented nevi is difficult
Premalignant lesions of skin
- 1. PREMALIGNANT LESIONS OF SKIN Chairpersons: Dr. S.Chakraborty Dr. J. Podder Speaker: Dr.Raju Mitra
- 2. Actinic Keratosis • Also known as Solar Keratosis • These are areas of dyskeratosis and cellular atypia, with subepidermal inflammation, but a normal dermo-epidermal junction. • Usually appear as thick , scaly or crusty area that often feel dry or rough- may felt before they ware seen • Lesion commonly ranges between 2-6mm in size but can grow to be a few cm in diameter • Use to appear on sun-exposed areas of the skin and more than one lesion • Diagnosis is suspected clinically and confirmed by microscopically
- 4. Actinic Keratosis • Upto 20% Go on to form Squamous Cell Carcinoma • Different therapeutic options are available • Preventative- sunscreen and sun protective clothing • Photodynamic therapy, freezing, tissue scraping • Topical anti-tumor medication, NSAID • Cryosurgery, curettage and desiccation , Laser surgery
- 5. Cutaneous Horn • Cutaneous accumulation of keratin • Hight greater than base diameter • 10% case have underline SCC • Excession of the lesion and biopsy of the base to rule out malignancy is the treatment of choice
- 6. Keratoacanthoma • Cup shaped growth • Central crater is filled with a plug of keratin • Usually found on the face of elderly male • Associated with papilloma virus infecting hair follicle, smoking, carcinogen exposure • Can grow 1 to 3 cm over 6 weeks and then typically resolve spontaneously within 6 months • May convert to anaplastic squamous cell carcinoma
- 7. Keratoacanthoma • Removal of central keratin plug may speed resolution • Excession is recommended
- 8. Bowen’s Disease • Slowly enlarging, erythematous, scaly patch or plaque • May occur anywhere as the mucocutaneous surface of the body • 3-11% can progress to SSC • On the glance penis it is called Erythropoiesisss of Queyrat
- 9. Bowen’s Disease • Management: • Medical – 5 fluorouracil or imiquimod application • Surgical- Excession with 4mm clear margin
- 10. Extra mammary Paget’s Disease • It is a form of intra epidermal adenocarcinoma • May occur in cutaneous site which are rich in apocrine glands such as – axilla, genital or perianal region • Early skin changes are subtle and may mimic an eczematous lession • Approximately 25% is associated with an underlying in situ or invasive neoplasm • Surgical excision is the treatment of choice
- 11. Giant Congenital Pigmented naevus
- 12. Giant Congenital Pigmented naevus • It is a haematoma of naevo-melanocytes that has a tendency to dermatomal distribution • Naevus cells are distributed variably from the epidermis throughout all layers and into the subdermal fat and muscle • 3-5% lifetime risk of developing Malignant Melanoma is quoted • Retroperitonial or intra cranial melanosis is associated with GCPN presenting before the age of 3 or in 3rd decade • A multidisciplinary management approach is advocated for these birthmarks,
- 13. Giant Congenital Pigmented naevus • initial investigations directed towards discovering neurocutaneous melanosis, as leptomeningeal involvement may necessitate a shunt to avoid raised intracranial pressure. • Removal of GCPN can be considered for both aesthetic and oncological reasons but the evidence to support complete excision to avoid developing MM is poor. • Various possibilities for partial or complete removal exist such as perinatal curettage, dermabrasion, laser resurfacing and surgical excision with reconstruction using a split-skin graft- none is completely successful.
- 14. Dysplastic Naevi • Dysplastic naevi are irregular proliferations of atypical melanocytes at the basal layer of the epidermis. • They have variegated pigmentation with irregular borders, measuring more than 5 mm in size. • Dysplastic naevi can have a familial inheritance and carry a 5–10% risk of forming superficial spreading melanoma.
- 15. ORAL LEUKOPLAKIA
- 16. ORAL LEUKOPLAKIA • Defined as a white patch or plaque that will not rub off and that cannot be characterized clinically or histologically as any specific disease • Chemical irritation through tobacco or mechanical irritation through dental stumps or ill-fitting dentures plays a role. • Any leukoplakia that is growing or altering its appearance requires a repeat biopsy • Leukoplakias on the buccal mucosa were found to be benign in 96% of the cases; whereas on the floor of the mouth, only 32% of the leukoplakias were benign, 31% showed a carcinoma in situ, and 37% an invasive carcinoma
- 17. Marjolin's ulcer • An aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatized chronically inflamed, or scarred skin • Histologically the tumour is a well-diffrentiated squamous cell carcinoma. This carcinoma is aggressive in nature, spreads locally and is associated with a poor prognosis • 40% occur on the lower limb and the malignant change is usually painless • This malignant change of the wound happens a long time after initial trauma, usually 10–25 years later. • Its edge is everted and not always raised.
- 18. Marjolin's ulcer
- 19. Marjolin's ulcer • Commonly present in the context of chronic wounds including burn injuries , venous ulcers, ulcers from osteomyelitis and post radiotherapy scars • Slow growth, painlessness (as the ulcer is usually not associated with nerve tissue), and absence of lymphatic spread due to local destruction of lymphatic channels
Editor's Notes
- #3: Cutenious Horn