FirstRanker Logo

FirstRanker.com - FirstRanker's Choice is a hub of Question Papers & Study Materials for B-Tech, B.E, M-Tech, MCA, M.Sc, MBBS, BDS, MBA, B.Sc, Degree, B.Sc Nursing, B-Pharmacy, D-Pharmacy, MD, Medical, Dental, Engineering students. All services of FirstRanker.com are FREE

📱

Get the MBBS Question Bank Android App

Access previous years' papers, solved question papers, notes, and more on the go!

Install From Play Store

Download MBBS Venereology and Leprosy Presentations 2 Pre Cancerous Lesions of The Skin Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Venereology and Leprosy 2 Pre Cancerous Lesions of The Skin PPT-Powerpoint Presentations and lecture notes

This post was last modified on 08 April 2022


Pre- Cancerous Lesions of

the Skin & Mucosa

--- Content provided by FirstRanker.com ---

ACTINIC KERATOSES

Aka solar keratosis, or senile keratosis
Precursor lesions of cutaneous squamous cel carcinoma

--- Content provided by FirstRanker.com ---

(SCC).

Consists of proliferations of atypical epidermal

keratinocytes ,that may progress to invasive SCC

--- Content provided by FirstRanker.com ---


The overal risk of progression to invasive SCC is (5 -10)%.


ACTINIC KERATOSES

--- Content provided by FirstRanker.com ---


Risk factors

cumulative UV radiation exposure (most important)- outdoor

--- Content provided by FirstRanker.com ---

work/hobby

fair skin, red or blond hair, blue eyes (Fitzpatrick type 1).
age,
immunosuppression,

--- Content provided by FirstRanker.com ---

prior history of non-melanoma skin cancer.
certain genetic syndromes, namely albinism, xeroderma

pigmentosum,

--- Content provided by FirstRanker.com ---

ACTINIC KERATOSES

Site: sun-exposed areas,

balding scalp, head, neck, forearms,

--- Content provided by FirstRanker.com ---


dorsal hands, dorsal legs in women

asymptomatic, pruritus, burning or

--- Content provided by FirstRanker.com ---

stinging pain, bleeding.

2- to 6-mm, erythematous, flat, rough,

gritty or scaly papule

--- Content provided by FirstRanker.com ---


more easily felt than seen.
against a background of

photodamaged skin

--- Content provided by FirstRanker.com ---

ACTINIC KERATOSES

A punch biopsy with depth upto mid-reticular dermis
Common indications for a biopsy
1. Rapidly enlarging lesions,

--- Content provided by FirstRanker.com ---

2. bleeding or ulceration,
3. Evidence of inflammation,
4. strong induration,
5. lesions extending beyond 1 cm of size,
6. resistance to treatment.

--- Content provided by FirstRanker.com ---


ACTINIC KERATOSES

DD

--- Content provided by FirstRanker.com ---

seborrheic keratosis, arsenical keratosis
melanocytic nevi, Senile lentigo,
cutaneous lupus erythematosus

Established AKs chronic course

--- Content provided by FirstRanker.com ---

lesions persist, spontaneously regress, or progress to invasive SCCs.
Spontaneous resolution range from 20% to 30%
limiting sun exposure, use of sunscreen promote regression.


--- Content provided by FirstRanker.com ---

PROGRESSION TO INVASIVE SCC

each AK : potential to progress into SCC (5-10% in reality)
Direct cancerous invasive transformation of basaloid atypical keratinocytes

--- Content provided by FirstRanker.com ---

is the most common mechanism of disease progression

In situ SCC

AK I

--- Content provided by FirstRanker.com ---


basal,

AK II

--- Content provided by FirstRanker.com ---

AK III

suprabasal

lower two-thirds

--- Content provided by FirstRanker.com ---


> two-thirds

SCC

--- Content provided by FirstRanker.com ---

ACTINIC KERATOSES

Treatment

treat entire actinically

--- Content provided by FirstRanker.com ---


damaged areas


PREVENTION of AK

--- Content provided by FirstRanker.com ---


SUNSCREENS : Broad-spectrum against UVB and UVA, minimum SPF 30
RETINOIDS:

Systemic retinoids in preventing nonmelanoma skin cancer, Ak

--- Content provided by FirstRanker.com ---

only effective while taking them; limited by systemic toxicities

Oral nicotinamide: doubtful


--- Content provided by FirstRanker.com ---

BOWEN DISEASE

squamous cel carcinoma (SCC) in situ.
Progress to Bowen carcinoma (invasive SCC) - 5% of

--- Content provided by FirstRanker.com ---

cases.

Etiologic factors include
1. UV radiation,
2. arsenic,

--- Content provided by FirstRanker.com ---

3. previous therapy with psoralen and UVA radiation (PUVA),
4. immunosuppression,
5. exposure to ionizing radiation,
6. infection with HPV(16, 18, 31, 34, 35, 54, 58, 61, 62, and 73)

--- Content provided by FirstRanker.com ---

BOWEN DISEASE

Slow growing, usually

asymptomatic.

--- Content provided by FirstRanker.com ---


erythematous plaques with

irregular, clearly demarcated

--- Content provided by FirstRanker.com ---

borders.

Surface scaly, crusted,

hyperkeratotic. measure up to

--- Content provided by FirstRanker.com ---


several centimeters.


Bowen Disease

--- Content provided by FirstRanker.com ---


Clinical variants

pigmented, intertriginous,

--- Content provided by FirstRanker.com ---

periungual, and subungual BD.

HPE

full-thickness epidermal atypia with

--- Content provided by FirstRanker.com ---


large, round cells and possible

adnexal involvement.

--- Content provided by FirstRanker.com ---

Differential Diagnosis of Bowen Disease


Treatment of Bowen Disease

--- Content provided by FirstRanker.com ---

Surgical &Destructive therapies

Topical Therapies

1. Excision

--- Content provided by FirstRanker.com ---


1. 5-Fluorouracil

2. Mohs micrographic surgery
3. Curettage with or without

--- Content provided by FirstRanker.com ---

4. Electrosurgery

Nonsurgical Ablative

5. Cryosurgery

--- Content provided by FirstRanker.com ---


Therapies

1. Photodynamic(PDT)
2. Laser ablation

--- Content provided by FirstRanker.com ---

3. Chemoablation :TCA
4. Radiation therapy

ARSENICAL KERATOSES

--- Content provided by FirstRanker.com ---

result from chronic exposure to arsenic
potential to become squamous cell carcinoma (SCC)
punctuate, keratotic, yellow papules overlying pressure points
Palms and soles.

--- Content provided by FirstRanker.com ---


HPV ASSOCIATED EPITHELIAL

PRECANCEROUS LESIONS

--- Content provided by FirstRanker.com ---

BOWENOID PAPULOSIS

BP is a precancerous

condition of the genitalia

--- Content provided by FirstRanker.com ---


infection with high-risk

HPV, (16, 18, and 33)

--- Content provided by FirstRanker.com ---

young to middle-aged

sexual y active, M>F

multiple red to brownish

--- Content provided by FirstRanker.com ---


flat papules on the penis

or vulva.
BOWENOID PAPULOSIS

--- Content provided by FirstRanker.com ---


location

on the glans penis, prepuce, and penis in males,
around the labia minora and majora in females.

--- Content provided by FirstRanker.com ---


BP : transitional state between genital warts and in situ SCC.
Benign, clinical course: spontaneous regression, persistence, rarely

transformation into BD and invasive SCC (1% to 2.6%).

--- Content provided by FirstRanker.com ---


DD
lichen planus, condylomata acuminata, erythroplasia, mol uscum

contagiosum, and seborrheic keratoses.

--- Content provided by FirstRanker.com ---


Treatment of Bowenoid Papulosis

Local destructive

--- Content provided by FirstRanker.com ---

Topical

1. curettage with or without

1. Tretinoin,

--- Content provided by FirstRanker.com ---


electrosurgery

2. 5-FU,

--- Content provided by FirstRanker.com ---

2. CO2-laser

3. Cidofovir

3. neodymium:YAG laser,

--- Content provided by FirstRanker.com ---


4. Imiquimod

4. cryosurgery
5. excision.

--- Content provided by FirstRanker.com ---


HPV-specific vaccination for types 6, 11, 16, and 18 in prevention: ?
EPIDERMODYSPLASIA VERRUCIFORMIS

inherited skin condition

--- Content provided by FirstRanker.com ---

Loss-of-function mutations of the genes EVER1 and EVER2
High local susceptibility to infection with HPV, commonly types

5 and 8.

--- Content provided by FirstRanker.com ---

Factors contributing to pathogenesis
1. host genetic background
2. HPV infection,
3. UV exposure
4. immunosuppression

--- Content provided by FirstRanker.com ---


EPIDERMODYSPLASIA VERRUCIFORMIS

develop skin lesions early in life
clinical presentation

--- Content provided by FirstRanker.com ---

1. numerous thin, pink, flat-topped papules and plaques that

resemble verrucae planae ; knees, elbows, and trunk.

2. widespread scaly, erythematous, or hypopigmented macules

--- Content provided by FirstRanker.com ---


and flat papules resemble tinea versicolor

High risk to develop AK, BD, invasive SCC in future
Sun avoidance, sun-protective measures, regular fol ow up,

--- Content provided by FirstRanker.com ---


screening of family members

topical 5% imiquimod cream and retinoids ? mixed results

--- Content provided by FirstRanker.com ---


EPIDERMODYSPLASIA VERRUCIFORMIS

POTENTIALLY MALIGNANT DISORDERS

--- Content provided by FirstRanker.com ---

OF THE ORAL CAVITY

LEUKOPLAKIA
white lesion of the oral mucosa that cannot be rubbed off or characterized

--- Content provided by FirstRanker.com ---

by any other definable lesion or known disease.

most common potentially malignant lesion of the oral mucosa
potential to become oral SCC is 0.2% to 3.4%.
LEUKOPLAKIA

--- Content provided by FirstRanker.com ---


Etiologic factors for leukoplakia
1. Chronic chemotoxic exposure,
Tobacco is the strongest risk factor: either as smoke or by

--- Content provided by FirstRanker.com ---

chewing
2. mechanical trauma with poor oral hygiene
il -fitting prosthesis, chronic cheek biting,
3. HPV (16 and 18)
4. alcohol consumption

--- Content provided by FirstRanker.com ---


Differential Diagnosis of Oral Leukoplakia

1. Tobacco-associated

--- Content provided by FirstRanker.com ---

7. Frictional lesion

lesion

8. Oral white sponge nevus

--- Content provided by FirstRanker.com ---


2. Candida-associated

9. Oral hairy leukoplakia

--- Content provided by FirstRanker.com ---

lesion

10.Verrucous carcinoma

3. Leukoedema

--- Content provided by FirstRanker.com ---


11.Squamous cel

4. Lichen planus

--- Content provided by FirstRanker.com ---

carcinoma

5. Lupus erythematosus
6. Habitual cheek biting
LEUKOPLAKIA treatment

--- Content provided by FirstRanker.com ---


OMMISSION
1. consumption of tobacco products, alcohol, bethel nuts,
2. chronic mechanical trauma

--- Content provided by FirstRanker.com ---

Surgical excision is the first treatment of choice.
recurrence after surgical excision : cryotherapy or CO2-laser

the patient should be followed closely

--- Content provided by FirstRanker.com ---

ERYTHROPLAKIA

a red macule or patch on a mucosal surface that cannot

be categorized as any other known disease entity caused

--- Content provided by FirstRanker.com ---


by inflammatory, vascular, or traumatic factors.

commonly seen with leukoplakia
least common of al oral potential y malignant lesions

--- Content provided by FirstRanker.com ---

greatest potential to become oral squamous cel

carcinoma

Males

--- Content provided by FirstRanker.com ---

Risk factors tobacco products, alcohol consumption.


ERYTHROPLAKIA

--- Content provided by FirstRanker.com ---

asymptomatic,
solitary, erythematous

macule or patch.

--- Content provided by FirstRanker.com ---

sharply demarcated from

the surrounding pink

mucosa,

--- Content provided by FirstRanker.com ---


surface is smooth and

homogeneous in color

--- Content provided by FirstRanker.com ---

ERYTHROPLAKIA - DD

Erythematous candidiasis

Chronic al ergic contact

--- Content provided by FirstRanker.com ---


Atrophic lichen planus

dermatitis

--- Content provided by FirstRanker.com ---

Lupus erythematosus

Chronic mechanical trauma

Pemphigus

--- Content provided by FirstRanker.com ---


Thermal or mechanical injury

Cicatricial pemphigoid

--- Content provided by FirstRanker.com ---

Squamous cel carcinoma

Kaposi sarcoma

? High potential for malignant transformation : early treatment.

--- Content provided by FirstRanker.com ---


? Surgery or excision with CO2- laser: treatment of choice
THANK YOU