EPITHELIAL PRECANCEROUS SKIN LESIONS

BY

DR. MAHESH MATHUR MD.DVD,DCP

DIFENATION

PRECANCEROUS SKIN LESIONS ARE ONE THAT HAS STRONG POTENTIAL TO TRANSFORM INTO MALIGNANCY- CHARECTERISED -

CLINICALLY- BY HAVING POTENTIAL TO BECOMES INVASIVE CARCINOMAS

HISTOPATHOLOGIACLLY - SHOWS CELLULAR ATYPIA CONFINED TO EPIDERMIS

DIFFERENTIATION& ANAPLASIA

PLEOMORPHISM ABNORMAL NUCLEAR MORPHOLOGY MITOSIS LOSS OF POLARITY LOSS OF UNIFORMITY OF THE

INDIVIDUAL CELLS AS WELL AS LOSS OF ACHITECTURAL ORIENTATION

PRECANCEROUS SKIN LESION ACTINIC KERATOSIS ARSENICAL KERATOSIS CHRONIC RADIATION KERATOSIS BOWEN’S DISEASE ERYTHROPLASIA OF QUEYRAT ERYTHROPLAKIA LEUKOPLAKIA

ACTINIC KERATOSIS

AGE >60 - 80% CHNCES OF DEVELOPMENT M>F PHENOTYPE OF FAIR SKIN WHICH BURN &

FRECKLES EAISLY AND RERELY TAN BLUE OR LIGHT COLOURED EYES & BLOND

HAIR IMMUNOSUPPRESSION GENETIC SYNDROMES - XERODERMA PIGMENTOSUM & ALBINISM

PATHOGENESIS

SUNLIGHT EXPOSURE UV-INDUCED MUTATION IN TUMOR-SUPPRESSOR GENE p53

PATHOGENISIS

CLINICAL PICTURE

IN ELDERLY PATIENT 80% OF LESIONS FOUND ON CHRONICALLY

SUN EXPOSED SITES – HEAD,NECK,FORARMS & DORSA OF HAND

ERYTHEMATOUS, FLAT,SCALY,YELLOW COLOURED PAPULES

HYPERTROPHIC - CUTANEOUS HORN ACTINIC CHEILITES

ACTINIC KERATOSIS

ACINIC KERATOSIS

ACTINIC CHILITIS

ARSENICAL KERATOSIS

CHRONIC ARSENISM – TRIVALENT ARSENIC EXPOSURE

PREEXISTING LIVER DISEASE CLINICALLY – PIN POINT PAPULES AT PALMS &

SOLES ELEVATED ERYTHEMATOUS PLAQUES ON NON

PHOTO DAMAGE AREA OF SKIN, MULTIPLE LESIONS AT TRUNK

UNDERLYING SYSTEMIC MALIGNANCY BECOME INVASIVE TO CAUSE SCC.

ARENICAL KERATOSIS

CHRONIC RADIATION KERATOSIS OCCURS AFTER CHRONIC EXPOSURE TO

RADIATION X’RAY THEREPY MEDICAL PERSONNELS, DENTISTS NUCLEAR ACCIDENTS PAPULES,PLAQUES AT PALMS, FINGERS &

MUCOSA SCC & BCC MAY DEVELOPES WITH OTHER

MALIGNANCY

RADIATION KERATOSIS

BOWEN’S DISEASE 1912

SQUAMOUS CELL CARCINOMA IN SITU AFFECTS BOTH SKIN & MUCOUS MEMBRANES -

HAVING POTENTIAL TO PROGRESS INTO INVASIVE CARCINOMA

AGE >60 RARELY BEFORE 30 YEARS OF AGE CAN OCCUR AT ANY BODY PARTS – SUN OR NON SUN

EXPOSED AREAS OF BODY SUN EXPOSURE, ARSENIC EXPOSURE IONIZING RADIATION, IMMUNOSUPPRESSION INFECTION WITH HPV-16 SPECIALLY ANOGENITAL BOWEN’S

DISEASE

CLINICAL PICTURE

DISCRETE SLOWLY ENLARGING PINK TO ERYTHEMATOUS THIN PLAQUE WITH WELL

DEMARCATED,IRREGULAR BORDERS OVER LINING SCALES OR CRUST HYPERKERATOTIC VERRUCOUS LESIONS 5% OF BD PROGRESS TO INVASIVE SCC

BOWNE’S DISEASE

PATHOLOGY FULL THICKNES CELLULAR ATYPIA BASEMENT MEMBRANE REMAINS INTACT HYPERKERATOSIS PARAKERATOSIS ACNTHOSIS COMPLETE DISORGANIZATION OF

EPIDERMAL ARCHITECTURE WIND BLOWN APPEARANCE LOSS OF MATURATION & POLARITY

HISTOPATHOLOGY

TREATMENT

SURGICAL EXCISION - 95% CRYOSURGERY - 90 % CURETTAGE - 65% 5 FU TOPICAL CHEMOTHERAPY – 66% IMIQUIMOD 5% CREAM - 93% LASER - 89 T0 100% PHOTO DYNAMIC THERAPY

ERYTHROPLASIA OF QUEYRAT EQ- IS CARCINOMA IN SITU AFFECTING

THE MUCOSAL SURFACES OF PENIS IN UNCIRCUMCISED MALES

AGE 20 TO 80 YEARS UNCIRCUMCISED POOR HYGIENE SMEGMA HSV INFECTION HPV-16 & 18 INFECTION

CLINICAL PICTURE GLISTENING RED VELVETY PLAQU ON GLANS PENIS,PREPUCE OR

URETHRA USUALLY SOLITARY PLAQUE LOCALISED PAIN OR PRURITUS DIFFICULTY IN RETRACTING FORE BLEEDING OR CRUSTING MAY BE THERE AT THE

LESION ENLARGE SLOWLY & PERSIST FOR SEVERAL YEARS 33% OF CASES PROGRESS TO INVASIVE SCC

LEUKOPLAKIA IT IS FIXED PREDIMINANTLY WHITE LESION OF MUCOSA ORAL & ANOGENITAL MUCOSAL SURFACES ALCOHOL & TOBACCO USE AGE >50 TO 70 YEARS 5 TO 25% RISK OF BECOMING INVASIVE CLINICALLY - ASYMPTOMATIC ASYMMETRIC WHITE PLAQUE AT FLOOR OF MOUTH LATERAL & VENETRAL TOUNGE SOFE PLATE DIAGNOSIS BY BIOPSY SURGICAL EXCISION OF THE LESION

MULTIPLE PIGMENTED NEVUS >50 IN NUMBER _> 2 mm SIZE 64 TIMES INCREASE RISK

GIANT MELANOCYTIC NEVUS

DYSPLASTIC NEVUS

MELANOMA IN SITU MACULAR FRACKELS LIKE LESIONS WITH

IRREGULAR SHAPE WITH DIFFERENT SHADES OF COLOUR

ELDERLY PATIENT OCCURS ON SUN EXPOSED AREA OF SKIN

ENLARGING RADIALLY FEW TO MANY IN NUMBERS

LIFE TIME RISK OF DEVELOPMENT OF MELANOMA IS 4.7 %

ATYPICAL MELANOCYTIC NEVUS

ATYPICAL MELANOCYTIC NEVUS

HISTOPATHOLOGY

THANK YOU…THANK YOU…