Precancerous Skin Lesions

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Precancerous skin lesions are various dermatological growths that have a higher risk of developing into skin cancer. Surgical excision is usually the recommended treatment to prevent malignant transformation. Below are some of the precancerous skin lesion in detail.

Precancerous Skin Lesions In The Article:

Actinic keratosis (AK)​1​:

Right hand of a patient with Actinic keratosis.  Source: “SolarAcanthosis” by James Heilman, MD, Wikimedia Commons, licensed under CC BY-SA 4.0.
Image Credits: Wikipedia CC

Actinic keratosis (AK) is the most common precancer that develops on skin that has been damaged by UV radiation from the sun or indoor tanning. Another name for the condition is solar keratosis. Long-term exposure to ultraviolet (UV) radiation causes AKs. If you already have an AK, this suggests you’re more prone to get more actinic keratoses (plural) in the future. AKs can develop into squamous cell carcinoma (SCC), a common and sometimes invasive form of skin cancer, so you’re at a higher risk of developing skin cancer if you have them​1​.

In appearance AKs are small dry, scaly or crusty patches of skin. They are sometimes elevated and can be red, light or dark tan, white, pink, flesh-toned, or a combination of colors. Sun-exposed parts of the face, lips, ears, scalp, shoulders, neck, and backs of hands and forearms are frequent places for these precancerous lesions. Surgical removal, cryotherapy, and topical anticancer agents such as 5-FU and bleomycin are the main treatments​2​. To prevent AKs, apply sunscreen(>SPF 30) before going out in the Sun.

Bowen’s disease:

Image Source: IMPP

Bowen’s disease is a squamous cell carcinoma in situ. In appearance they are round or oval, flatly elevated, relatively sharply edged, infiltrative plaque of several centimeters in diameter, ranging from brown to reddish brown. Bowen’s disease can be caused by UV exposure and the human papillomavirus. Arsenic consumption is highly associated with multiple Bowen’s disease. Therefore , taking a history of preexisting conditions like mass arsenic poisoning or chronic pesticide poisoning, as well as treatments like arsenic antisyphilitic therapy, are important​2​. Surgical removal is the first-line treatment, and pharmacotherapy (e.g., 5-FU, imiquimod) and Photodynamic therapy are also used in the treatment​2,3​.

Erythroplasia of Queyrat:

Erythroplasia of Queyrat is Bowen’s disease on the mucous membranes and at the mucocutaneous junction. These red plaques with a velvety surface appear, mainly on the penis. It can also affect the female genitalia and the mouth. Queyrat’s erythroplasia often progresses to SCC. These precancerous skin lesions may ulcerate and bleed easily.

Leukoplakia​2,4​:

The lesion of leukoplakia, notice the white lesion on the right cheek.
Image Credits: Michael Gaither, Wikipedia CC

The World Health Organization defines leukoplakia as a white oral mucosa lesion that cannot be scraped off and cannot be attributed to another definable lesion. The oral cavity and lips are the most commonly affected areas. The skin lesions of Leukoplakia can be benign and malignant. Slightly infiltrative, smooth-surfaced, keratinous, verrucous, papillary, and/or erosive leukoplakia develops as a precancerous lesion. Keratinous proliferation causes the epidermis to thicken.

There is a high risk of cancer when an erythroplasia-like lesion forms. Men over 50, especially smokers, are the most commonly affected. To determine if the lesion is cancerous or benign, a skin biopsy is required. If there is a malignancy, the appropriate treatment should be given. If the lesion is benign, investigation should be made for the underlying disease. When leukoplakia is precancerous, surgical removal, laser ablation (A procedure that uses a laser of specific wavelength to heat and destroy abnormal tissue.), laser therapy, or cryotherapy are done for treatment. Also it is important to stop smoking.

Eccrine porocarcinoma​5​:

Image Source: DermNet

Eccrine porocarcinoma is a rare type of skin cancer that affects the eccrine glands, which are a type of sweat gland. Eccrine sweat glands are present in the skin, with the highest density on the palms, soles, face and scalp. Eccrine porocarcinoma is a slow-growing tumour that is more common in those over 60 years old and affects both men and women equally. It has the ability to spread to the body’s internal organs. The condition’s cause is unknown. But, being immunosuppressed (having a disease or drug that causes weakened defenses against some infections and cancers) has been associated to an increased risk of developing eccrine porocarcinoma.

In appearance it has a moist and shiny surface and appears as a dome-shaped nodule or lump within the skin. Its color is frequently described as pink or red. commonly occurs on the legs, but may also occur on the body, head and neck. Because Eccrine porocarcinoma is a rare malignancy, it can be difficult to diagnose sometimes. A skin biopsy of the affected area is frequently used to make a diagnosis. A tiny sample of tissue is removed and examined under a microscope. If eccrine porocarcinoma is diagnosed early and surgically excised completely, the cure rate is 70-80%.

Surgical removal under local anaesthesia is the most common treatment. Mohs’ micrographic surgery, a highly specialized surgical method for removing skin cancer, may be recommended for some patients. Treatments like as radiotherapy and chemotherapy may be considered in the 20% to 30% of people whose tumour has spread to other organs in the body.

Lentigo maligna (LM)​3​:

Image Credits: Wikipedia CC

They are precancerous skin lesions with with intraepithelial proliferation of dysplastic melanocytes.. The peak incidence occurs between the ages of 70 and 79. It occurs as a result of UV radiation exposure. Lentigo maligna have a deeply colored macule appearance. Color irregularities, surrounding “island-like” speckling, irregular borders and varying size gradual growth. Surgical excision is the most common treatment method.

Sources:

  1. 1.
  2. 2.
    Hiroshi S. Shimizu’s Textbook of Dermatology. Hokkaido University Press; 2007.
  3. 3.
  4. 4.
    Dr Delwyn Dyall-Smith. Carcinoma in situ of oral cavity. dermnetnz.org. https://www.dermnetnz.org/topics/carcinoma-in-situ-of-oral-cavity/
  5. 5.
    BRITISH ASSOCIATION OF DERMATOLOGISTS. ECCRINE POROCARCINOMA. bad.org.uk. Published 2013. Accessed 2021. https://www.bad.org.uk/shared/get-file.ashx

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