Erythroplasia of Queyrat (Bowen’s dis. of glans penis)
10% 6-17% 5-11% SCC 30%
Seborrheic keratosis One or more sharply defined, light brown to black, slightly raised lesions (as if stuck on surface) with soft velvety or finely verrucous surface. It occurs on trunk, face or extremities. Treatment 1. Removal with a small sharp curette. 2. Freezing. 3. TCA. 4. Cauterization.
Seborrheic Keratosis (Cont’d) Keratoacanthoma (KA): rapidly growing, self healing, epidermal tumor that has a striking resemblance, both clinically & histologically to SCC.
Solitary KA: firm, skin-colored to pink, dome-shaped nodule with a horn filled crater in its center. It usually involutes spontaneously in less than 6 ms with slightly depressed scar.
Epidermal nevi They are circumscribed hamartomatous lesions composed only of keratinocytes. They present usually at birth or shortly later. I) Localized type“Nevus Unius Lateris” II) Systematized type“Ichthyosis hystrix”
Epidermal nevus is a general term referring to birthmarks which originate from skin structures
“Nevus verrucous” is keratinocytes
“Nevus sebaceous” from sebaceous glands
“Nevus comedomicus” from hair follicles
“Nevus syringocystadenoma” from sweat glands
Cutaneous cysts Epidermal cysts(the most common type)
Traumatic implantation of epidermis into the dermis.
The wall of the cyst is composed of true epidermis, i.e. squamous, granular & horn cells. The cyst is filled with horny material arranged in laminated layers.
Primarymilia: arise spontaneously on face.
In association with many dermatoses, e.g. BP, DEB, PCT, LSA.
After trauma, e.g. dermabrasion.
Steatocystoma multiplex Sites
Sternal region, axillae and scrotal area.
Actinic keratosis (AK) “Solar keratosis”
Most common premalignant skin lesion in elderly persons (≥40 yrs), fair complexion, with excessive sun exposure, > in men.
Sun-exposed areas as face, dorsa of hands & bald portions of the scalp in men.
Multiple erythematous, ill-defined macules or papules, often covered by adherent scales with little or no infiltration. Marked hyperkeratosis may be seen.
Actinic keratosis (Cont’d)
SCC may develop in one or more of the lesions of AK in about 20% of the patients, usually after a long latent period, e.g. 10 years.
SCC arising in AK or de-novo in sun-damaged skin very rarely metastasize (0.5%), but in actinic cheilitis, the incidence is 11%.
Actinic keratosis (Cont’d) Histopathology
SCC in situ.
Morphologically,anaplastic cells are present. However, biologically, the lesions are still benign. Invasion into the dermis, if present at all, is limited to the most superficial portion.
Genodermatoses: e.g. xeroderma pig., albinism, porokeratosis & dysk. congenita have a high incidence of SCC & other cut. malignancies.
Immunosuppression: 2ry to immunosuppressive drugs, HIV inf., lymphomas or organ transplants.
SCC (Cont’d) Clinically
Solitary, firm, slowly enlarging nodule with indurated base.
Shallow ulcer with raised everted edge, indurated base.
Verrucous or fungoid lesions.
The more malignant the tumor, the greater is the number of atypical squamous cells & the less the number of differentiated cells (horn pearls).
SCC (Cont’d) Grading system
Grade 1 (less malignant): more than 75% of the cells are differentiated, i.e. several horn pearls with relatively slight atypicality.
Grade 2, more than 50%.
Grade 3, more than 25%.
Grade 4, less than 25% are differentiated (more malignant).
The degree of atypicality of the tumor cells & the depth of penetration are important factors in grading.
Curettage & electrodessication.
CO2 laser ablation.
Intralesional & topical 5-fluorouracil.
Excisional: with a safety margin.
Paget’s disease of the breast
Exclusively in women.
Age: 55 years.
It occurs unilaterally on the areola & nipple as a sharply defined, slightly infiltrated area of erythema showing scaling, oozing & crusting. Ulceration or retraction of the nipple may be found.
It is commonly associated with intraductal carcinoma of the breast.
Paget’s disease of the breast (Cont’d) Origin of Paget cells
The glandular origin was supported by immuno-histochemical studies, e.g. carcinoembryogenic antigen is found in Paget cells which is found also in normal apocrine & eccrine glands but not in keratinocytes or melanocytes.
Modified radical mastectomy.
Extramammary Paget’s disease
Occurs commonly in the anogenital region, e.g. vulva, perianal area, scrotum or axillae, i.e. areas in which apocrine glands occur.
In 20% of cases, it is 2ry to extension of an adenocarcinoma, either of the rectum to the perianal region, of the cervix to the vulva, or of the urinary bladder to the urethra & glans penis.
Extramammary Paget’s disease (Cont’d) Clinically
There is slowly enlarging, erythematous patch with oozing & crusting, with sharp but irregular border & in contrast to mammary type, itching is common.
Tumors of epidermal appendages Trichoepithelioma
Numerous, rounded, skin-colored, firm nodules located mainly in the nasolabial folds, forehead & upper lip.
Tumors of epidermal appendages (Cont’d) Nevus sebaceous of Jadassohn (Organoid nevus)
At or soon after birth, solitary, linear or round yellow-brown, hairless, slightly elevated plaque usually located on the scalp or face.
In puberty, verrucous or nodular.
Later in life, some lesions may develop various types of appendage tumors, e.g. syringocystadenoma papilliferum, BCC.
Three phases of N. sebaceus Tumor phase Adults usually Exact % unknown Probably <5% Infant phase Flat, smooth Decreased hair Pubertal phase Grows when oil glands expand – papular Orange peel surface
An adenoma of intraepidermal eccrine ducts.
More in females.
In lower lids, cheeks, axillae, abdomen and vulva.
Small, skin-colored or slightly yellow, soft papules.
Eruptive hidradenoma or syringoma: the lesions arise in large numbers in successive crops on the anterior trunk of young persons.
Basal cell carcinoma “BCC”
BCC is the most common malignancy in humans.
Although rarely metastatic, it is capable of significant local destruction & disfigurement.