pathology
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Clinical features •2nd commonest malignant skin tumor after BCC (1:4) •Etiology includes UVB, HPV, ionizing radiation, scarring e.g., burns, syndromic e.g., xeroderma pigmentosum, albinism, Rothmund-Thompson syndrome & epidermolysis bullosa, immunosuppression, PUVA, chronic infections e.g., tuberculosis, arsenic & coal tar derivatives •Type I and II skin •M=F •Generally middle aged or elderly but may arise in at risk children •Sun-exposed skin most often affected- face, neck,…
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Epidermolytic hperkeratosis is a feature of a number of conditions including epidermolytic ichthyosis, annular epidermolytic ichthyosis & epidermolytic epidermal nevus. These are associated with mutations in KRT1 or KRT10. Superficial epidermolytic ichthyosis is associated with a mutation in KRT2. Epidermolytic hyperkeratosis may be encountered as an acquired lesion (epidermolytic acanthoma ) whichmay be associated with…
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This blog prepared by myself and Antonina Kalmykova is based on the review that we wrote for Pathology Outlines. I am indebted to Antonina & her technical staff for the innumerable histology cases that were scanned for me. These cases form the basis for the histology and will not be individually acknowledged unless the photogrpahs…
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Clinical features •Exceedingly rare variant •Elderly patients •M>>F •Sun-damaged skin of head & neck •Often rapidly growing, ulcerated, often large exophytic, nodular tumor . 5-year survival-70% Histological features •Tp53, CDKN2A & PIK3CA mutations variable detected •Biphasic tumor •Possible epithelial to mesenchymal transition •Overexpression of YAP may be at least in part responsible for this phenotype •Admixture of squamous carcinoma & pleomorphic spindled cell, osteoid, chondroid, MFH-like +/-…
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Verrucuous carcinoma may arise in the skin, the oral cavity and the genitalia. In this blog only cutaneous tumors are described. Oral & genital tumors will be discussed in separate blogs. Clinical features •Predilection for middle-aged males but either sex may be affected at any age including exceptionally in children •Sole of the foot, wrists, fingers…
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Lichenoid keratosis (lichen planus, lichen planus-like keratosis): the older literature sometimes uses the term “solitary lichen planus”, this is confusing as lichenoid keratosis is quite different from lichen planus. Clinical features •Fairly common, erythematous or brown, scaly macule or plaque with a predilection for the chest & upper extremities •Sometimes pruritic •Generally solitary •F>M •Caucasians++ •Wide…
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Clinical features •Essentially, a clinical diagnosis •Presents as an erythematous scaly or crusted plaque clinically mimicking psoriasis & presenting on the head, neck & extremities; often affecting sun-exposed surfaces •Anogenital Bowen’s disease is discussed in a seperate blog •Single or multiple lesions, often many cm in diameter •Middle-aged or elderly •No significant sex predilection •Pigmented variant •Immunosuppression related cases •5% develop invasive tumor with significant…
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Variants of keratoacanthoma •Solitary •Multiple •Giant (>3.0 cm diameter) •Agglomerate keratoacanthoma (aggregation of multiple lesions) •Keratoacanthoma centrifugum marginatum- large expansile lesion many cm in diameter •Subungual keratoacanthoma . Oral keratoacanthoma •Association with Muir-Torre syndrome •Arising in a nevus sebaceus •Fergusson-Smith syndrome; familial, autosomal dominant associated with a male predominance and development of innumerable lesions •Grzybowski syndrome characterized by development of very large numbers of…
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Clinical features •This variant shows a predilection for the head & neck of the elderly; less often on the limbs, genitalia & elsewhere •Sometimes arises in an acantholytic actinic keratosis •Presents as a frequently ulcerated nodule or plaque •Intraoral variant •Although previously thought to represent an aggressive variant of SCC with high recurrence and metastasis rate, this is has largely been disproven Histological…
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Clinical features •Common, often multiple, dry, scaly erythematous or yellow brown lesions (up to 1.0 cm diameter) on sun-damaged skin of the middle-aged or elderly Caucasians •Face, neck, forearms & hands •M>F •Fair complexion with a tendency to sunburn •Associated keratin horn •Pigmented variant •Represent a strong indicator of risk of developing SCC (up to…