Bowen’s disease (skin), erythroplasia of Queyrat (glans penis), leukoplakia (mucous epithelia).
3.3.2 Carcinoma in situ
Synonyms
Epidemiology
Incidence 15/100,000/year in persons with white skin.
Definition
Carcinoma in situ (intraepidermal and intraepithelial carcinoma).
Aetiology & Pathogenesis
UV exposure, immunosuppression, HPV, tobacco, betel nut.
Signs & Symptoms
Circumscribed erythematous (sometimes scaly) patch or plaque, persistent whitish mucosal lesions.
Localisation
Sun-exposed skin, genitalia, buccal mucosa.
Classification
Grade 1 to 3 according to progression and involvement by histology.
Laboratory & other workups
None
Dermatopathology
Orthohyperkeratosis (pink) alternating with parakeratosis (blue). Abnormal keratinocytes. Pseudopod-like proliferation of the epidermis. Solar elastosis in the upper dermis.
Complications
Transition to invasive cutaneous or mucosal squamous cell carcinoma.
Diagnosis
Diagnosis relies on clinical picture and histology.
Differential diagnosis
Depending on localisation (lips, buccal or genital mucosa): superficial basal cell carcinoma, bowenoid papulosis, extramammary Paget’s disease. Confirmation by histology.
Prevention & Therapy
Depends on localisation and histological type. For example: excision, cryosurgery, photodynamic therapy, radiotherapy, 5-fluorouracil or imiquimod cream.
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