epithelial precancerous skin lesions by dr. mahesh mathur md.dvd,dcp
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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…
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