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/hobbyfair 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 KERATOSESSite: 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 KERATOSESA 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 keratosismelanocytic 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 SCCeach 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 progressionIn situ SCC
AK I
--- Content provided by FirstRanker.com ---
basal,
AK II
--- Content provided by FirstRanker.com ---
AK IIIsuprabasal
lower two-thirds
--- Content provided by FirstRanker.com ---
> two-thirds
SCC
--- Content provided by FirstRanker.com ---
ACTINIC KERATOSESTreatment
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 toxicitiesOral nicotinamide: doubtful
--- Content provided by FirstRanker.com ---
BOWEN DISEASEsquamous 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 DISEASESlow 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 DiseaseTreatment of Bowen Disease
--- Content provided by FirstRanker.com ---
Surgical &Destructive therapiesTopical 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. ElectrosurgeryNonsurgical Ablative
5. Cryosurgery
--- Content provided by FirstRanker.com ---
Therapies
1. Photodynamic(PDT)
2. Laser ablation
--- Content provided by FirstRanker.com ---
3. Chemoablation :TCA4. Radiation therapy
ARSENICAL KERATOSES
--- Content provided by FirstRanker.com ---
result from chronic exposure to arsenicpotential 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 PAPULOSISBP 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-agedsexual 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 ---
Topical1. curettage with or without
1. Tretinoin,
--- Content provided by FirstRanker.com ---
electrosurgery
2. 5-FU,
--- Content provided by FirstRanker.com ---
2. CO2-laser3. 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 EVER2High local susceptibility to infection with HPV, commonly types
5 and 8.
--- Content provided by FirstRanker.com ---
Factors contributing to pathogenesis1. 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 thatresemble 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 CAVITYLEUKOPLAKIA
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 ---
chewing2. 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 lesionlesion
8. Oral white sponge nevus
--- Content provided by FirstRanker.com ---
2. Candida-associated
9. Oral hairy leukoplakia
--- Content provided by FirstRanker.com ---
lesion10.Verrucous carcinoma
3. Leukoedema
--- Content provided by FirstRanker.com ---
11.Squamous cel
4. Lichen planus
--- Content provided by FirstRanker.com ---
carcinoma5. 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 ---
ERYTHROPLAKIAa 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 celcarcinoma
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 fromthe surrounding pink
mucosa,
--- Content provided by FirstRanker.com ---
surface is smooth and
homogeneous in color
--- Content provided by FirstRanker.com ---
ERYTHROPLAKIA - DDErythematous candidiasis
Chronic al ergic contact
--- Content provided by FirstRanker.com ---
Atrophic lichen planus
dermatitis
--- Content provided by FirstRanker.com ---
Lupus erythematosusChronic mechanical trauma
Pemphigus
--- Content provided by FirstRanker.com ---
Thermal or mechanical injury
Cicatricial pemphigoid
--- Content provided by FirstRanker.com ---
Squamous cel carcinomaKaposi sarcoma
? High potential for malignant transformation : early treatment.
--- Content provided by FirstRanker.com ---
? Surgery or excision with CO2- laser: treatment of choice
THANK YOU