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Pre-malignant skin conditions (Bowen's disease (Diagnosis (History …
Pre-malignant
skin conditions
Actinic (solar)
keratosis
Clinical presentation
Erythematous background with scaly, rough patches
May be thick/warty
Sun exposed areas - face, chest, back of hands
Diagnosis
History
PC/HPC: chronic, growing over time
PMH: skin conditions, skin cancers
DH: medications, allergies
FH: skin cancers
SH: sun exposure, smoking, alcohol
Examination
Erythematous, poorly defined lesion, with scaly, rough patches
Sun exposed area
Investigations
Biopsy - dysplastic lesion
Risk factors
Fair skin
Older age
Sunny exposure
Management
Medical
Topical chemotherapy
Indication: widespread keratoses
E.g. 5-FU, imiquimod
MOA: 5-FU kills dysplastic cells with high turnover,
imiquimod stimulates immune response to abnormal cells
Photodynamic therapy
MOA: skin sensitising agent (porphyrin) plus UV light causes highly metabolically active cells to take up the porphyrin which destroys the cells (toxic metabolites)
Surgical
Cryotherapy
MOA: liquid nitrogen freezes the lesion
Curettage and cautery
MOA: scrape away the lesion and cauterise the base
to reduce bleeding and destroy residual cells
Excision
Indication: large keratoses
MOA: physical removal of lesion plus small area around it
Conservative
Information, advice, support
Sun protection (hats, sunscreen, moisturisers)
Pathophysiology
Sun exposure, pre-malignant changes
Bowen's
disease
Clinical presetation
Well defined, erythematous, scaly patches
Non-tender, often on lower legs or hands
Diagnosis
History
PC/HPC: chronic, growing over time
PMH: skin conditions, skin cancers
DH: medications, allergies
FH: skin cancers
SH: sun exposure, smoking, alcohol
Examination
Well-defined, erythematous, scaly lesion
Legs or hands
Investigations
Biopsy - dysplastic lesion
Epidemiology
Elderly
F>M
Management
Per solar keratoses
Pathophysiology
Oil and HPV exposure
Dysplasia in the skin
Risk factors
HPV
Sun exposure
Older age
Fair skin
