Precancerous or malignant skin diseases


Precancerous or malignant skin diseases

Introduction

Precancerous or premalignant skin diseases there are some skin condition in which under certain circumstances can be changed or transformed into skin cancer such as squamous cell carcinoma , basal cell carcinoma and malignant melanoma if they left without any treatment
These skin condition include the following
  • Keratocanthoma
  • Bowen,s disease
  • Solar or senile keratosis
  •  Chronic radiodermatitis
  • Xeroderma pigmentosa
  • Carcinogens agents
  • Leukoplakia
  • Chronic scars Marjolin,s ulcer
  • Lupus vulgaris or Tuberculosis of skin T.B of skin
  • Moles or naevi
Each disease will be discussed separately as follow

  • Others names adenoma sebaceum ,molluscum pseudocarcinomatosum or molluscum sebaceum
  • It is means overgrowth of hair follicle cells with producing central plug of keratin with subsequent regression
  • May be self limiting benign tumor or neoplasm or may due to an unusual response to infection
  • Certain causes unknown
  • Common in  male adults
  • It take from 2-4 weeks to grow and from 2-3 months to regress normally single lesion
  • Common site on the face
  • Appear as hard separated central core then the lump collapses leaving a deep indrawn scar
  • May mistake for squamous cell carcinoma  but it differs from it by it is has slow rate of growth does not have a central dead core and gradually become an ulcer
  • Rare under change to squamous cell carcinoma
  • Treatment by surgical removal or excision to confirm the diagnosis and prevent depressed scar formation and its changes to malignancy
Bowen,s disease
  • Pre-malignant intra-epidermal carcinoma or carcinoma in situ
  • Slow growing lesion and common in old age
  • May look like as eczema
  • Can occur on any part of the body especially the trunk
  •  Appear as thickened brown or pink colour with well defined plaque
  • Appear also as flat papular clusters covered with crusts
  • Causes may be associated with sun damage ,arsenic exposure,viral infection such as human paplilloma virus and immune-suppression such as AIDS 
  • Can be changed into squamous cell carcinoma
  • Appear under microscope as full thickness dysplasia of the epidermis
  • Erythroplasia of Queyrat is bowen,s disease of the glans of the pens or prepuce in male and also same in  female
  • Treatment by surgical removal or excision with safety margin about 0.5 cm or cryotherapy  cauterization or diathermy coagulation
  • Exposure to sun is the important predisposing factor
  • Resulting from solar damage to the skin and hyperkeratosis of the skin
  • Common found in old weather-beaten man eg farmers  on the backs of fingers and hands, face and helix of the ears and in fair- skinned
  • Skin appear as yellow, grey, or has brown crusty patches from which arise prodtruding plaques of horny skin and have dry hard scale
  • Common changes to squamous cell carcinoma if not treated
  • Appear under microscope as hyperkeratosis and epidermal dysplasia
  • Can develop tethering ,fixity, or regional enlarged are worrying features
  • Treatment Surgical removal,shaving,cryotherapy or topical or local appilcation of 5- fluorouracil chemotherapy drug
Chronic radiodermatitis
  • Result from prolonged exposure of skin to ionized irradiation which result in  varying degree of skin damage after several months to several years irradiation known as carcinogens which can causes damage DNA cells and transformed it into cancer cells
  • Common in those handling radioactive materials or delivering X rays
  • Usually affects face and hands
  • Skin appear as chronic inflammation from prolonged irradiation irritation and the skin appear as atrophic indurated plaques with yellowish or whitish colour with telangiectasia ,radionecrosis and ulceration can occur especially in moist areas
  • Can be changes to squamous cell carcinoma and basal cell carcinoma
Xeroderma pigmentosa
  •  Xeroderma mean skin dryness  and change in the color (pigment) of the skin pigmentosum
  • Also called XP disease
  • Causes it is an autosomal recessive genetic disorders of DNA repair
  • The patient have no any ability to repair damage caused by ultraviolet rays of the sun
  • Rare disease which characterized by an extreme abnormal sensitivity to sunlight
  • Common site affection are the eye and any areas of the skin exposed to the sun
  • The symptoms and signs appear commonly during infancy or early childhood
  • Many children develop a severe sunburn on exposure to sunlight even for just few minutes causing redness and blistering which may  persist for weeks
  • The child develop freckling in the skin exposed areas to the sun such as in the arms ,face and eyelids and lips the skin become scaly and dry with irregular dark spot on the skin
  •    Can be changed to malignancy or skin cancer such as squamous cell carcinoma at early age during childhood especially in those does not protect from the sun
  • Most people develop multiple skin cancer during their life which can develop in the lips , tongue,face,eyelids and also on the scalp
  • The eyes become so sensitive to the ultraviolet of the sun may become painful irritated with blood shot with clouding in front of the cornea and corneal ulceration the patient can not see clear and the eyelashes fall out and the eyelids become atrophic and thin and may turn abnormally inside called entropion or turn outside called ectropion which associated with impair vision field
  • Some patient may develop progressive neurological disorders such as hearing loss inability to walking difficulty in swallowing which called dysphagia difficulty in speech and fits or seizures
  • Poor prognosis few patient may survive up to their adolescence
  • Treatment by surgical removal with grafting and protective measures against sunlight eg sun - screen ointments
Carcinogenic agents
These are substance when become in contact with skin for prolonged period can develop skin cancer these substance acts as carcinogens which can produce DNA  damage of the normal cells and transformed it into cancer cells such as exposure to pitch,tar and soot  for more see here

Leukoplakia
  • Leukoplakia means white patches it is also called leukokeratosis or idiopathic keratosis or idiopathic white patches
  • Appears as adherent white patches on the mucous membrane of the oral cavity and lips also can occur in other mucous membrane such as gastrointestinal tract , urinary tracts and genitals
  • Leukoplakia may confused with other lesion causes white patches  in the mouth such as oral candidiasis or fungal infection and lichen planus
  • Common occur in smoking and chewing tobacco but other causes may unknown
  • Precancerous or malignant lesion which can be changed into squamous cell carcinoma eg cancer lips or esophagus
  • Patient may complaining from nothing or from pain or discomfort and presence of white or grey patches
  • Treatment by surgical removal , electrocautery and cryotherapy
Chronic scar or marjolin,s ulcer
  • The name is applied to malignant change in a scar ,ulcer or sinus such as chronic varicose ulcer , an unhealed burn, the sinus of chronic esteomyelitis and chronic wounds
  • It has the following criteria slow rate of growth because the lesion is relatively avascular  has no pain or painless ulcer because the tissue does not contain cutaneous nerves secondary metastases do not occur in the regional lymph nodes because the lymphatic vessels have been destroyed but if the ulcer invades normal tissue surrounding the scar then the ulcer take rapid rate of growth and become painful and can give lymphatic metasese
  • Common change to malignancy such as squamous cell carcinoma later may develop to basal cell carcinoma
  • Treatment by  wide surgical removal with safety margin about 1 cm or radiotherapy
Lupus vulgaris
  • Also called tuberculosis of the skin or T.B of the skin
  • Caused by mycobacterium tuberculosis which it is the micro-organism of TB
  • Has the following criteria painful cutaneous lesion with nodular appearance common seen in the face around the nose,lips ,cheeks,ears and neck may develop into disfiguring skin ulcer and deformity , lesion may persist for many years
  • Has progressive and persistent form of skin T.B
  • Appear as small reddish or brownish small nodules with gelatinous consistency called apple -jelly nodules
  • Can be changed into malignancy or skin cancer such as squamous cell carcinoma
  • Treatment by anti-tubercolsis drugs such as rifampicin , isoniazid,pyrazinamide,streptomycin and ethambutol
Moles or navei
  • Common precancerous skin lesion
  • Mainly junctional naevus and compound naevs can change or transformed into skin cancer
  • Junctional naevus appear as tiny dark points they are not raised above the skin the melanocytes lie in the deeper layers of the epidermis
  • Compound naevus the melanocytes are present in both the dermis and epidermis
  • They can changed into malignant melanoma
  • There are warring criteria with moles which if present so it is need for immediate investigations and deal with it to exclude the malignant changes these criteria are
The mole become increased in size
The mole become change in its colour either increased or decreased in pigmentation
The mole become have fissuring and ulceration
The mole become painful and itching
The mole become indurated and bleeding
There is spread of pigment as sattelite nodules around it due to lymphatic permeation
 
 

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