• Clinical science

Precancerous skin lesions

Summary

Precancerous skin lesions refer to various dermatological growths that are at an increased risk of developing into skin cancer. Typical precancerous skin lesions include lentigo maligna, which may develop into malignant melanoma, and actinic keratosis, which may develop into squamous cell carcinoma. There is also a risk of leukoplakia – presenting in the oral cavity as white plaques – progressing to squamous cell carcinoma. Bowen disease and erythroplasia of Queyrat are less common types of precancerous skin lesions and are often associated with the human papillomavirus (HPV). To prevent malignant transformation, surgical excision is usually the treatment of choice.

Lentigo maligna (LM)

  • Definition: precancerous lesion with intraepithelial proliferation of dysplastic melanocytes
  • Epidemiology: peak incidence between 70 and 79 years of age [1]
  • Etiology: : exposure to UV light
  • Lesion
    • Mostly found in areas exposed to sun (e.g., face, neck)
    • Darkly pigmented macule
    • Irregular borders and varying size
    • Gradual growth, color irregularities, surrounding "island-like" speckling
    • See “ABCDE criteria.”
  • Pathology: clusters of spindled, atypical melanocytes
  • Treatment: surgical excision with a safety margin
  • Complications: may transform into lentigo maligna melanoma

Actinic keratosis (AK)

Leukoplakia

Bowen disease and Erythroplasia of Queyrat

Although Bowen disease affects the skin and erythroplasia of Queyrat affects the mucous membrane, the precancerous lesions are histopathologically identical.

Bowen disease

Erythroplasia of Queyrat (Bowen disease of the glans penis)

  • Definition: squamous cell carcinoma in situ (SCCIS) of the penile mucosa
  • Etiology
    • Chronic irritation or infection
    • Lack of circumcision
    • HPV types 16 and 18
  • Lesion
    • Most commonly preputium and glans penis affected
    • Single or multiple sharply demarcated, nonhealing lesions (e.g., plaques, red papules)
    • May ulcerate and bleed easily
  • Treatment and prognosis: see Bowen disease

Bowenoid papulosis

  • 1. Mirzoyev SA, Knudson RM, Reed KB, et al. Incidence of lentigo maligna in Olmsted County, Minnesota, 1970 to 2007. J Am Acad Dermatol. 2013; 70(3): pp. 443–448. doi: 10.1016/j.jaad.2013.11.008.
  • 2. James WD, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. Philadelphia, PA: Elsevier Health Sciences; 2015.
  • 3. Werner RN, Stockfleth E, Conolly SM et al. . Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis – International League of Dermatological Societies in cooperation with the European Dermatology Forum. J Eur Acad Dermatol Venereol. 2015; 29: pp. 2069–2079. doi: 10.1111/jdv.13180.
  • 4. Bishop JA. Leukoplakia and Erythroplakia - Premalignant Squamous Lesions of the Oral Cavity . In: Anton R. Leukoplakia and Erythroplakia - Premalignant Squamous Lesions of the Oral Cavity . New York, NY: WebMD. http://emedicine.medscape.com/article/1840467-overview#a1. Updated January 13, 2014. Accessed December 31, 2016.
  • 5. Dyall-Smith D. Carcinoma in situ of oral cavity. http://www.dermnetnz.org/topics/carcinoma-in-situ-of-oral-cavity/. Updated January 1, 2009. Accessed December 31, 2016.
last updated 11/23/2020
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