| go to our full topic on Merkel cell carcinoma (MCC) MCC is a rare, aggressive cutaneous neuroendocrine neoplasm that primarily affects white adults. Incidence increases with age and is highest among those >85 years of age.[5]Paulson KG, Park SY, Vandeven NA, et al. Merkel cell carcinoma: current US incidence and projected increases based on changing demographics. J Am Acad Dermatol. 2018 Mar;78(3):457-63.e2.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5815902
http://www.ncbi.nlm.nih.gov/pubmed/29102486?tool=bestpractice.com
Two distinct etiologies are recognized: exposure to ultraviolet radiation and oncogenic transformation by Merkel cell polyomavirus. Diagnosis is confirmed with skin biopsy and histopathologic evaluation including immunohistochemistry. Occult metastasis is common, and sentinel lymph node biopsy and imaging are important tools for staging the disease. |
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| go to our full topic on Basal cell carcinoma The most common malignancy of the skin in fair-skinned adults in the US, Australia, and Europe.[6]Trakatelli M, Morton C, Nagore E, et al. Update of the European guidelines for basal cell carcinoma management. Eur J Dermatol. 2014 May-Jun;24(3):312-29.
http://www.ncbi.nlm.nih.gov/pubmed/24723647?tool=bestpractice.com
It typically presents as pearly papules and/or plaques; nonhealing scabs; small crusts and nonhealing wounds; plaques, nodules, and tumors with rolled borders; or papules with associated telangiectasias.[7]Lear W, Dahlke E, Murray CA. Basal cell carcinoma: review of epidemiology, pathogenesis, and associated risk factors. J Cutan Med Surg. 2007 Jan-Feb;11(1):19-30.
http://www.ncbi.nlm.nih.gov/pubmed/17274935?tool=bestpractice.com
[8]Raasch BA, Buettner PG, Garbe C. Basal cell carcinoma: histological classification and body-site distribution. Br J Dermatol. 2006 Aug;155(2):401-7.
http://www.ncbi.nlm.nih.gov/pubmed/16882181?tool=bestpractice.com
[Figure caption and citation for the preceding image starts]: Nodular basal cell carcinoma on the cheek, on background of diffuse solar damage with marked solar elastosisFrom the collection of Dr Robert A. Schwartz [Citation ends]. Strong risk factors include UV radiation, sun exposure, x-ray exposure, arsenic exposure, xeroderma pegmentosum, nevoid basal cell carcinoma (Gorlin-Goltz) syndrome, and history of transplantation. Metastases and advanced lesions are uncommon. |
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| go to our full topic on Squamous cell carcinoma Ranges from in situ tumors (Bowen disease) to invasive tumors and metastatic disease. Patients commonly present with a new or englarging lesion that they are concerned about, which may be tender or itchy, or a nonhealing wound originally caused by some trauma. In situ tumors are typically thin, flesh-colored to erythematous, scaly plaques, while invasive squamous cell carcinoma (SCC) may present as an exophytic tumor or ulcer.[Figure caption and citation for the preceding image starts]: Squamous cell carcinoma on the ear with surrounding actinic damageFrom the collection of Dr Jessica M. Sheehan and Dr Keyoumars Soltani [Citation ends]. Tumors may be friable and bleed easily and are located mostly on sun-exposed areas of skin, such as the head and neck (84%) and extensor upper extremities (13%).[9]Rundel RD. Promotional effects of ultraviolet radiation on human basal and squamous cell carcinoma. Photochem Photobiol. 1983 Nov;38(5):569-75.
http://www.ncbi.nlm.nih.gov/pubmed/6647566?tool=bestpractice.com
Cumulative UV exposure and immunosuppression are major risk factors. |
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| go to our full topic on Melanoma A malignant tumor arising from pigment-producing melanocytes found in the skin, eye, and central nervous system. Several variants exist. Typically presents as a deeply pigmented skin lesion that is new or changing in size, shape, or color.[10]Radhi JM. Malignant melanoma arising from nevi, p53, p16, and Bcl-2: expression in benign nevus versus malignant components. J Cutan Med Surg. 1999 Oct;3(6):293-7.
http://www.ncbi.nlm.nih.gov/pubmed/10575157?tool=bestpractice.com
[11]Nestle FO, Kerl H. Melanoma. In: Bolognia JL, Jorizzo Jl, Rapini RP, eds. Dermatology, 2nd ed. Philadelphia, PA: Elsevier; 2007:1745-69.[Figure caption and citation for the preceding image starts]: Superficial spreading malignant melanomaFrom the collection of Dr Hobart W. Walling [Citation ends]. Unlike basal cell carcinoma and squamous cell carcinoma, melanoma is most common at body sites that have received intense, intermittent sun/UV exposure.[12]Gilchrest BA, Eller MS, Geller AC, et al. The pathogenesis of melanoma induced by ultraviolet radiation. N Engl J Med. 1999 Apr 29;340(17):1341-8.
http://www.ncbi.nlm.nih.gov/pubmed/10219070?tool=bestpractice.com
Lesions are more common on the trunk in men and on the legs and feet in women.[13]Stanienda-Sokół K, Salwowska N, Sławińska M, et al. Primary locations of malignant melanoma lesions depending on patients’ gender and age. Asian Pac J Cancer Prev. 2017 Nov 26;18(11):3081-3086.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773794
http://www.ncbi.nlm.nih.gov/pubmed/29172282?tool=bestpractice.com
Tanning beds and sun lamps have been positively correlated with melanoma.[14]Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol. 2014 May;70(5):847-57.e1-18.
http://www.ncbi.nlm.nih.gov/pubmed/24629998?tool=bestpractice.com
The likelihood of metastatic disease as a complication is high, and in young adults melanoma is a common cause of cancer-related death.[15]Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020 Jan;70(1):7-30.
http://www.ncbi.nlm.nih.gov/pubmed/31912902?tool=bestpractice.com
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| go to our full topic on Kaposi sarcoma A low-grade vasoformative neoplasm associated with human herpesvirus-8 (HHV-8, also known as Kaposi sarcoma-associated herpesvirus [KSHV]) infection.[16]Chang Y, Cesarman E, Pessin MS, et al. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma. Science. 1994 Dec 16;266(5192):1865-9.
http://www.ncbi.nlm.nih.gov/pubmed/7997879?tool=bestpractice.com
Lesions frequently involve mucocutaneous sites, but may become more extensive to involve the lymph nodes and visceral organs. Skin lesions evolve from an early patch, to a plaque, and later to ulcerating tumor nodules. [Figure caption and citation for the preceding image starts]: Kaposi sarcoma cutaneous purple-brown plaque on the footFrom the collection of Dr Bruce J. Dezube [Citation ends]. There are four main subtypes: classic (sporadic); endemic (observed in sub-Saharan Africa); epidemic (AIDS-related); iatrogenic (transplant-related). Among people who are HIV positive, early initiation of antiretroviral therapy (ART) is likely to be the most effective measure for the prevention of Kaposi sarcoma.[17]National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: Human herpesvirus-8 disease. 2018 [internet publication].
https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/human-herpesvirus?view=full
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| go to our full topic on Cutaneous T-cell lymphoma Heterogeneous group of uncommon disorders characterized by clonal accumulation of T lymphocytes primarily or exclusively in the skin. Mycosis fungoides and its leukemic variant, Sézary syndrome, are the most common subtypes.[18]Olsen EA, Whittaker S, Kim YH, et al. Clinical end points and response criteria in mycosis fungoides and Sézary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer. J Clin Oncol. 2011 May 16;29(18):2598-607.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3422534
http://www.ncbi.nlm.nih.gov/pubmed/21576639?tool=bestpractice.com
Establishing a diagnosis is often difficult, as the disease can manifest in a number of different ways, including flat patches, raised plaques, large tumors, and/or marked erythroderma (intense and widespread reddening of the skin).[Figure caption and citation for the preceding image starts]: Cutaneous T-cell lymphoma: extensive patch diseaseFrom the collection of the Christie NHS Foundation Trust, Manchester, UK; used with permission [Citation ends]. Diagnosis is based on clinical findings, skin biopsy (specimens should be sent for histology, immunophenotyping, and molecular studies), and laboratory blood tests, and usually requires specialist expertise.[18]Olsen EA, Whittaker S, Kim YH, et al. Clinical end points and response criteria in mycosis fungoides and Sézary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer. J Clin Oncol. 2011 May 16;29(18):2598-607.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3422534
http://www.ncbi.nlm.nih.gov/pubmed/21576639?tool=bestpractice.com
[19]Kempf W, Pfaltz K, Vermeer MH, et al. EORTC, ISCL, and USCLC consensus recommendations for the treatment of primary cutaneous CD30-positive lymphoproliferative disorders: lymphomatoid papulosis and primary cutaneous anaplastic large-cell lymphoma. Blood. 2011 Aug 12;118(15):4024-35.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204726
http://www.ncbi.nlm.nih.gov/pubmed/21841159?tool=bestpractice.com
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| go to our full topic on Actinic keratosis Lesions are skin-colored, yellowish, or erythematous, ill-defined, irregularly shaped, small, scaly macules or plaques localized in sun-exposed areas of the body (e.g., forehead, lower lip, dorsum of the hands, forearms, bald areas of the scalp, and ears).[Figure caption and citation for the preceding image starts]: Regular actinic keratosisFrom the collection of the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine [Citation ends]. Typically, they occur in middle-aged or older men with light-colored skin and a history of chronic sun exposure. It has the potential to progress into an invasive squamous cell carcinoma (SCC). The risk of progression to SCC has been calculated to be between 0.025% and 16% per year.[20]Marks R, Rennie G, Selwood TS. Malignant transformation of solar keratoses to squamous cell carcinoma. Lancet. 1988 Apr 9;1(8589):795-7.
http://www.ncbi.nlm.nih.gov/pubmed/2895318?tool=bestpractice.com
[21]Glogau RG. The risk of progression to invasive disease. J Am Acad Dermatol. 2000 Jan;42(1 Pt 2):23-4.
http://www.ncbi.nlm.nih.gov/pubmed/10607353?tool=bestpractice.com
Although diagnosed clinically, a biopsy may help to rule out SCC. |
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| go to our full topic on Sunburn Sunburn is an acute inflammatory reaction of the skin induced by overexposure to UV radiation. Skin findings include erythema and edema, with or without vesiculation, followed by desquamation. Symptoms include pain and/or pruritus. Acute sunburn is a self-limited condition and typically requires only supportive care. Primary prevention via sun avoidance, physical protection, and the appropriate use of sunscreen is key to managing the condition, as cellular damage caused by UV radiation is irreversible and may with time increase the risk of skin cancer. |
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