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EPITHELIAL PRECANCEROUS SKIN LESIONS BY DR. MAHESH MATHUR MD.DVD,DCP

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

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EPITHELIAL PRECANCEROUS SKIN LESIONS BY DR. MAHESH MATHUR MD.DVD,DCP

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  1. EPITHELIAL PRECANCEROUS SKIN LESIONSBYDR. MAHESH MATHUR MD.DVD,DCP

  2. 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

  3. DIFFERENTIATION& ANAPLASIA • PLEOMORPHISM • ABNORMAL NUCLEAR MORPHOLOGY • MITOSIS • LOSS OF POLARITY • LOSS OF UNIFORMITY OF THE INDIVIDUAL CELLS AS WELL AS LOSS OF ACHITECTURAL ORIENTATION

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

  5. 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

  6. PATHOGENESIS • SUNLIGHT EXPOSURE • UV-INDUCED MUTATION IN • TUMOR-SUPPRESSOR GENE p53

  7. PATHOGENISIS

  8. 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

  9. ACTINIC KERATOSIS

  10. ACINIC KERATOSIS

  11. ACTINIC CHILITIS

  12. 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.

  13. ARENICAL KERATOSIS

  14. 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

  15. RADIATION KERATOSIS

  16. 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

  17. 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

  18. BOWNE’S DISEASE

  19. PATHOLOGY • FULL THICKNES CELLULAR ATYPIA • BASEMENT MEMBRANE REMAINS INTACT • HYPERKERATOSIS • PARAKERATOSIS • ACNTHOSIS • COMPLETE DISORGANIZATION OF EPIDERMAL ARCHITECTURE • WIND BLOWN APPEARANCE • LOSS OF MATURATION & POLARITY

  20. HISTOPATHOLOGY

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

  22. 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

  23. 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

  24. 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

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

  26. GIANT MELANOCYTIC NEVUS

  27. 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 %

  28. ATYPICAL MELANOCYTIC NEVUS

  29. ATYPICAL MELANOCYTIC NEVUS

  30. HISTOPATHOLOGY

  31. THANK YOU…

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