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Skin Cancer and Desquamation Disorders Keratoderma/ Keratosis

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Skin Cancer and Desquamation Disorders Keratoderma/ Keratosis Skin Cancer and Desquamation Disorders Keratoderma/ Keratosis • Definition: a growth of keratin on the skin or mucous membranes stemming from keratinocytes • Types • Punctate Or Palmar plantar keratodermas is on the palms of hands and soles of feet • Actinic keratosis is premalignant caused by cumulative exposure to the sun. may progress slowly to squamous cell CA or a cutaneous horn • Actinic cheilitis is actinic dermatosis of the lip • Seborrheic keratosis is a benign plaque beige to brown in color with a velvety, warty surface • Treatment • Liquid nitrogen or electrodessication and curettage • 5-fluorouracil • Palmarplant Keratodermas can be treated with topical keratolytics Basal cell cancer • Definition:non melanocytic skin cancer arising from basal cells • Types • Nodular: translucent or pearly papule or nodule • Ulcerating: ulcer with a rolled border and covered with a crust • Sclerosing: White sclerotic patch with ill defined borders • Superficial: erythematous, slightly scaly, thick plaques with pearly border slow growing • Pigmented: thick, hard area of variegated pigmentation. • Diagnosis: via biopsy • Treatment: excision, 5-fluorouracil, radiation therapy, Mohs’ surgery, or imiquimod topical Cutaneous Squamous cell carcinoma • Definition: skin cancer that begins in squamous cells of the skin • Clinical presentation • Asymptomatic • Sharply demarcated, scaling, or hyperkeratotic macule, papule or plaque. • May have erythema, scaling, erosions, and crusts • typically present as non-healing ulcer in suns exposed areas • Diagnosis: biopsy • Treatment: Excision, Mohs surgery, radiation therapy, electrodessication and curettage, in high risk cases oral 5-FU may be used. Melanoma • Definition: aggressive form of skin cancer that frequently metastasizes, caused by the malignant transformation of melanocytes • Clinical presentation • Can occur anywhere on the body including eyes and mucous membranes of the genitalia, anus, oral cavity, or nails. • Black or dark brown lesions that may have blue, pink or red component. • Irregular borders with an outward spreading of pigment • Lesions changes size over a relatively short period of time • Lesions can be macular or nodular and include 4 types • Lentigo maligna, superficial spreading (most common), nodular, acral lentiginous (palms, soles, nail beds) • Characterized by ABCDE. Asymmetry, Borders (irregular), Colour variations, Diameter> 6 mm, Elevated Surface • Diagnosis: biopsy and staging workup • Treatment • Surgery, radiation therapy, chemotherapy depending on the stage. Desquamation • Stevens Johnson Syndrome • Toxic epidermal necrolysis • Erythema multiforme Urticaria Clinical presentation • Hives or wheals that are raised with red areas on the skin or mucous membranes caused by the release of histamines, bradykinin, and other vasoactive substances from mast cells and basophils. • Results in small blood vessels to leak and cause intradermal edema. • Wheals may be size of pencil eraser or a large dinner plate and may coalesce into even larger areas. • Lesions are pruritic and may sting or burn. • Acute urticaria • Usually an allergic reaction from food or drugs • Usually self limiting lasting a few minutes to hours • Eliminate allergy exposure, antihistamines, epinephrine if severe • Chronic Urticaria • Cause is often idiopathic but exacerbated by stress • typical antihistamine or H2 blockers( ranitidine) or sometimes both. • Steroids if needed • Physical urticaria • Caused by a reaction to heat or cold, water, exercise or sun exposure • Benadryl, ranitidine or other H1 blocker and avoid exposure if possible Erythema multiforme (EM) • Definition: Acute Self-limiting type IV hypersensitivity reaction typically associated with certain medications, infections and other triggers • Clinical presentation • Lesions start as macules and become papular • Vesicles and bullae form in the center of the papules • Lesions can be localized to the hands and feet or be generalized • Mucosal lesions (hallmark of EM) are painful and erode • Fever, malaise, weakness • Diagnosis: clinical, biopsy will confirm • Treatment • Avoid/stop trigger • Systemic steroids for severely ill patients • Supportive care Stevens Johnson Syndrome (SJS) Toxic Epidermal Necrolysis(TEN) • Definition • A mucocutaneous blistering reaction most often caused by a severe drug reaction. • Usually associated with sulfonamides, aminopenicillins, quinolones, cephalosporins, tetracyclines, phenobarbital, carbamazepine, phenytoin, valproic acid, oxicam, allopurinol, corticosteroids • SJS is a severe form of erythema multiforme • TEN is a severe form of SJS • life threatening and risks include secondary infection, fluid loss, electrolyte imbalance, kidney failure • Clinical presentation • Fever, photophobia, sore throat, mucosal inflammation, sore mouth • Cutaneous lesions tend to be more concentrated on the trunk at first and are painful and sting • Lesions progress to diffuse erythema, morbilliform lesions, necrotic epidermis, wrinkled surfaces, sheet like loss of epidermis, and raised, flaccid blisters (Nikolsky’s sign) • TEN has a higher fever and more severe epidermal separation and loss • Regrowth of skin takes weeks SJS and TEN • Diagnosis • Biopsy is diagnostic • Treatment • Stop causative agent • Extensive necrosis should be treated in a burn unit • Wound dressings • Replace fluids and electrolytes aggressively • Treat infections- be careful as antibiotics are the likely cause • Corticosteroids.
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