• Clinical science

Precancerous skin lesions

Abstract

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's 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: 70–90 years
  • 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 (usually 1 mm–2 cm)
    • Lesions of lentigo maligna grow gradually, developing color irregularities and surrounding "island-like" speckling
    • See ABCDE criteria for melanoma
  • Treatment: surgical excision with a safety margin
  • Complications: may transform into lentigo maligna melanoma

References:[1]

Actinic keratosis (AK)

  • Definition: actinic keratosis (AK) is a UV-induced precancerous skin lesion that may progress to skin cancer
  • Epidemiology: occurs especially in individuals with light skin who are over the age of 50
  • Etiology: sun exposure (e.g., from working outdoors)
  • Lesion
    • Initially: small lesion with rough surface → sandpaper-like texture
    • Later: lesions grow and become erythematous and scaly
    • Occurs on areas of sun-exposed skin
  • Prognosis: : Lesions may either regress, persist, or progress to squamous cell carcinoma (SCC).
  • Treatment
    • Single lesions; : cryotherapy with liquid nitrogen
    • Multiple lesions; : 5-fluorouracil (5-FU), imiquimod, photodynamic therapy
    • Preventive measures: sunscreen SPF 30
  • Special types

References:[2][3][4]

Leukoplakia

  • Definition: Leukoplakia (or "white plaque") refers to hyperkeratosis of the epithelium and mucous membranes
  • Etiology: tobacco smoking, alcohol consumption
  • Histology: hyperkeratosis and epithelial dysplasia
  • Lesion: persistent white plaques that usually cannot be scraped off
  • Most common site: oral cavity
  • Diagnostics: suspicious plaques should be biopsied and checked for dysplasia
  • Differential diagnosis: oral hairy leukoplakia; in immunocompromised individuals (cause: Epstein‑Barr virus)
  • Treatment
    • Smoking cessation
    • Cryotherapy, laser ablation
    • If lesions persist: surgical excision
  • Complications: may develop into squamous cell carcinoma

References:[4][5][6]

Bowen's disease and Erythroplasia of Queyrat

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

Bowen's disease

  • Definition: squamous cell carcinoma in situ (SCCIS) of the skin
  • Etiology
  • Lesions
    • Irregularly shaped and sharply defined borders
    • Erythematous and scaly
    • Lesions are usually isolated
  • Most common site: : commonly occurs on skin that is exposed to sun
  • Prognosis: May progress to invasive squamous cell carcinoma. If treated, however, the prognosis is excellent.
  • Treatment

Erythroplasia of Queyrat (= Bowen's disease of the glans penis)

  • Definition: SCCIS of the penile mucosa
  • Etiology: not very well understood yet, but is associated with:
    • Chronic irritation or infection
    • Lack of circumcision
    • HPV types 16 and 8
  • Lesion: : single or multiple sharply demarcated, nonhealing lesions; (e.g., plaques or red papules; ) that may ulcerate and bleed easily
  • Most common site: preputium, glans penis
  • Prognosis and treatment: see Bowen's disease

References:[7][8]

Bowenoid papulosis

  • 1. Tan WW. Lentigo Maligna Melanoma. In: James WD. Lentigo Maligna Melanoma. New York, NY: WebMD. http://emedicine.medscape.com/article/279839-overview#a1. Updated April 1, 2016. Accessed December 31, 2016.
  • 2. Spencer JM. Actinic Keratosis. In: James WD. Actinic Keratosis. New York, NY: WebMD. http://emedicine.medscape.com/article/1099775-overview. Updated April 7, 2016. Accessed December 31, 2016.
  • 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. James WD, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. Philadelphia, PA: Elsevier Health Sciences; 2015.
  • 5. 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.
  • 6. 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.
  • 7. Kaldas MV. Bowen Disease. In: Elston DM. Bowen Disease. New York, NY: WebMD. http://emedicine.medscape.com/article/1100113-overview#showall. Updated September 30, 2016. Accessed December 31, 2016.
  • 8. Shrivastava V. Erythroplasia of Queyrat (Bowen Disease of the Glans Penis). In: Elston DM. Erythroplasia of Queyrat (Bowen Disease of the Glans Penis). New York, NY: WebMD. http://emedicine.medscape.com/article/1100317-overview. Updated March 31, 2016. Accessed December 31, 2016.
last updated 12/07/2018
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