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Pigmented Bowen's disease
P2304
P2306
GUIDELINES OF CARE FOR ACTINIC KERATOSIS Aditya Gupta, MD, PhD, Division of Dermatology, Department of Medicine, Sunnybrook and Women’s College Health Sciences Centre (Sunnybrook site) and the University of Toronto, ON, Canada, and Mediprobe Research Inc., London, ON, Canada; Valerie A. Davey, MS, Mediprobe Research Inc., London, ON, Canada
METASTATIC BASALOID SQUAMOUS CELL CARCINOMA Kelly Burkert, MD, Steven Deliduka, MD, John Walsh, MD, Mayo Clinic Jacksonville, Jacksonville, FL, United States A 63-year-old woman presented for evaluation of a 3-week history of asymptomatic nodules of the scalp. She had a known history of anal basaloid squamous cell carcinomas with metastasis to the right perirectal space. Physical examination revealed two firm pink intradermal nodules measuring 4 3 4 mm and another nodule measuring 3 3 4 mm on the left anterior scalp. A punch biopsy of the larger nodule revealed a deep intradermal basaloid squamous cell carcinoma without epidermal involvement. These findings were consistent with metastatic basaloid squamous cell carcinoma. Two weeks later, the patient developed new nodules on the right angle of the jaw and mid forehead. Radiographic studies demonstrated innumerable metastatic lesions involving the lung and liver.
Actinic keratosis (AK) is a major health concern in North America, affecting almost 1 in 6 people in the United States. with more than 1 million new cases reported annually. The conventional clinical AK presentation shows discrete, hyperkeratotic lesions located on sun-exposed areas of the skin that may develop into squamous cell carcinoma. Various methods of treatment have been developed, including cryotherapy, curettage with desiccation, topical therapies, chemical peeling, laser surgery, and photodynamic therapy. The existing evidence for use of the various treatment methods for AK is varied, and there are often concerns regarding adverse events and cosmetic outcomes. Some procedures are best for a few lesions, whereas other strategies are beneficial for more widespread actinic damage. Practice guidelines are increasingly being developed worldwide in many areas of medicine. Producing guidelines of care for AK will benefit those practitioners providing treatment to people with this disease. Since the management of AK changes over time, because of advances in medical research and technology, persistent revision is necessary for enhancing health care provision by educating physicians on the optimal current treatment approaches. The purpose of the present study was to develop a set of clinical practice guidelines based on current evidence from randomized controlled trials (RCTs) for the management of AK in Canada, thereby promoting sustained provision of quality care.
Anal carcinomas are relatively rare, accounting for only 1% to 4% of colorectal malignancies. A small subset of these tumors demonstrating basaloid features has been described as basaloid squamous cell carcinoma, cloacogenic carcinoma, or transitional cell carcinoma. To our knowledge, only two other reports of cutaneous meatstasis of anal basaloid squamous cell carcinoma have been published to date. Histopathologically, metastatic basaloid squamous cell carcinoma may mimic basal cell carcinoma. Therefore, though rare, clinicians and dermatopathologists should be aware of this tumor so as not to confuse it with the more common basal cell carcinoma of the skin. Nothing to disclose.
Dr. Gupta has been an investigator for 3M Pharmaceuticals. 100% supported by 3M Pharmaceuticals
P2305 LYMPHANGITIS CARCINOMATOSA: A STUDY OF 110 CASES Carlos Serra-Guille´n, MD, Onofre Sanmartı´n, MD, Alberto Alfaro-Rubio, MD, Josefa Herrero, MD, Instituto Valenciano de Oncologı´a, Valencia, Spain Introduction: Cutaneous metastases of any type of cancer usually appear as subcutaneous nodules in any site. An infrequent type of these metastases is that of the lymphangitis carcinomatosa group. They clinically appear as erythematous plaques ranging in color from pale pink to deep red, which can be quite extensive and are warm to the touch. In oncological patients, these lesions can be simply identified clinically as being lymphangitis carcinomatosa. However, in a nononcological patient, a differential diagnosis may prove difficult because these lesions are identical to those produced by multiple causes, such as erysipelas, early inflammatory plaque morphea, or mycosis fungoides, among others. From a histological point of view, invasion of the dermal lymphatic vessels by groups of neoplastic cells is observed. These cells are similar to those of the primary tumor and form solid nests or isolated groups of cells localized within the lymphatic vessels and lined with normal endothelium. We provide an epidemiological, clinical, and histological review of this rare form of cutaneous metastasis presenting in an oncology hospital. Material and methods: A retrospective analysis was made of all histology reports in our oncology hospital from 1994 to 2004. All cases of cutaneous lymphangitis carcinomatosa diagnosed by histology were studied. Our aim was to determine clinical forms of presentation and histological patterns of lymphangitis carcinomatosa and to relate them to the primary tumor. Thus we also sought to establish the frequency of this unusual form of cutaneous metastasis in relation to those original tumors diagnosed during the same period in this oncology hospital.
P2307
Conclusions: Although lymphangitis carcinomatosa is rarely encountered in neoplastic processes, all other forms of erythematous plaques in oncology patients must be discarded. A diagnosis of cutaneous lymphangitis carcinomatosa was made in 110 cases from 1994 to 2004. Breast tumor was the primary tumor that most commonly metastasized to the skin in this peculiar way, in more than 90% of cases. The majority of cutaneous lesions consisted of erythematous plaques. Few cases showed authentic lymphangitis carcinomatosa cuirasse, which occupied large cutaneous areas. Dermal vessel infiltration was histologically demonstrated and, occasionally, subcutaneously, by neoplastic cells similar to the primary tumor.
PIGMENTED BOWEN’S DISEASE Liborka Kos, MD, Ethan Nydorf, MD, Henry Ford Hospital, Detroit, MI, United States Pigmented Bowen’s disease is an unusual presentation of this common neoplasm. It is encountered more often in dark-skinned individuals. We describe a 63-year-old African American woman with an enlarging, sharply circumscribed, dark brown patch on her lower extremity, which had been diagnosed as a seborrheic keratosis 3 years earlier. Histopathology showed increased pigment within the epidermis and full-thickness epithelial dysplasia consistent with pigmented Bowen’s disease. This variant of Bowen’s disease can mimic a seborrheic keratosis or a melanoma. It should be considered in dark-skinned patients with solitary, darkly hyperpigmented lesions.
Nothing to disclose.
Nothing to disclose.
P148
J AM ACAD DERMATOL
MARCH 2005
P2306
GUIDELINES OF CARE FOR ACTINIC KERATOSIS Aditya Gupta, MD, PhD, Division of Dermatology, Department of Medicine, Sunnybrook and Women’s College Health Sciences Centre (Sunnybrook site) and the University of Toronto, ON, Canada, and Mediprobe Research Inc., London, ON, Canada; Valerie A. Davey, MS, Mediprobe Research Inc., London, ON, Canada
METASTATIC BASALOID SQUAMOUS CELL CARCINOMA Kelly Burkert, MD, Steven Deliduka, MD, John Walsh, MD, Mayo Clinic Jacksonville, Jacksonville, FL, United States A 63-year-old woman presented for evaluation of a 3-week history of asymptomatic nodules of the scalp. She had a known history of anal basaloid squamous cell carcinomas with metastasis to the right perirectal space. Physical examination revealed two firm pink intradermal nodules measuring 4 3 4 mm and another nodule measuring 3 3 4 mm on the left anterior scalp. A punch biopsy of the larger nodule revealed a deep intradermal basaloid squamous cell carcinoma without epidermal involvement. These findings were consistent with metastatic basaloid squamous cell carcinoma. Two weeks later, the patient developed new nodules on the right angle of the jaw and mid forehead. Radiographic studies demonstrated innumerable metastatic lesions involving the lung and liver.
Actinic keratosis (AK) is a major health concern in North America, affecting almost 1 in 6 people in the United States. with more than 1 million new cases reported annually. The conventional clinical AK presentation shows discrete, hyperkeratotic lesions located on sun-exposed areas of the skin that may develop into squamous cell carcinoma. Various methods of treatment have been developed, including cryotherapy, curettage with desiccation, topical therapies, chemical peeling, laser surgery, and photodynamic therapy. The existing evidence for use of the various treatment methods for AK is varied, and there are often concerns regarding adverse events and cosmetic outcomes. Some procedures are best for a few lesions, whereas other strategies are beneficial for more widespread actinic damage. Practice guidelines are increasingly being developed worldwide in many areas of medicine. Producing guidelines of care for AK will benefit those practitioners providing treatment to people with this disease. Since the management of AK changes over time, because of advances in medical research and technology, persistent revision is necessary for enhancing health care provision by educating physicians on the optimal current treatment approaches. The purpose of the present study was to develop a set of clinical practice guidelines based on current evidence from randomized controlled trials (RCTs) for the management of AK in Canada, thereby promoting sustained provision of quality care.
Anal carcinomas are relatively rare, accounting for only 1% to 4% of colorectal malignancies. A small subset of these tumors demonstrating basaloid features has been described as basaloid squamous cell carcinoma, cloacogenic carcinoma, or transitional cell carcinoma. To our knowledge, only two other reports of cutaneous meatstasis of anal basaloid squamous cell carcinoma have been published to date. Histopathologically, metastatic basaloid squamous cell carcinoma may mimic basal cell carcinoma. Therefore, though rare, clinicians and dermatopathologists should be aware of this tumor so as not to confuse it with the more common basal cell carcinoma of the skin. Nothing to disclose.
Dr. Gupta has been an investigator for 3M Pharmaceuticals. 100% supported by 3M Pharmaceuticals
P2305 LYMPHANGITIS CARCINOMATOSA: A STUDY OF 110 CASES Carlos Serra-Guille´n, MD, Onofre Sanmartı´n, MD, Alberto Alfaro-Rubio, MD, Josefa Herrero, MD, Instituto Valenciano de Oncologı´a, Valencia, Spain Introduction: Cutaneous metastases of any type of cancer usually appear as subcutaneous nodules in any site. An infrequent type of these metastases is that of the lymphangitis carcinomatosa group. They clinically appear as erythematous plaques ranging in color from pale pink to deep red, which can be quite extensive and are warm to the touch. In oncological patients, these lesions can be simply identified clinically as being lymphangitis carcinomatosa. However, in a nononcological patient, a differential diagnosis may prove difficult because these lesions are identical to those produced by multiple causes, such as erysipelas, early inflammatory plaque morphea, or mycosis fungoides, among others. From a histological point of view, invasion of the dermal lymphatic vessels by groups of neoplastic cells is observed. These cells are similar to those of the primary tumor and form solid nests or isolated groups of cells localized within the lymphatic vessels and lined with normal endothelium. We provide an epidemiological, clinical, and histological review of this rare form of cutaneous metastasis presenting in an oncology hospital. Material and methods: A retrospective analysis was made of all histology reports in our oncology hospital from 1994 to 2004. All cases of cutaneous lymphangitis carcinomatosa diagnosed by histology were studied. Our aim was to determine clinical forms of presentation and histological patterns of lymphangitis carcinomatosa and to relate them to the primary tumor. Thus we also sought to establish the frequency of this unusual form of cutaneous metastasis in relation to those original tumors diagnosed during the same period in this oncology hospital.
P2307
Conclusions: Although lymphangitis carcinomatosa is rarely encountered in neoplastic processes, all other forms of erythematous plaques in oncology patients must be discarded. A diagnosis of cutaneous lymphangitis carcinomatosa was made in 110 cases from 1994 to 2004. Breast tumor was the primary tumor that most commonly metastasized to the skin in this peculiar way, in more than 90% of cases. The majority of cutaneous lesions consisted of erythematous plaques. Few cases showed authentic lymphangitis carcinomatosa cuirasse, which occupied large cutaneous areas. Dermal vessel infiltration was histologically demonstrated and, occasionally, subcutaneously, by neoplastic cells similar to the primary tumor.
PIGMENTED BOWEN’S DISEASE Liborka Kos, MD, Ethan Nydorf, MD, Henry Ford Hospital, Detroit, MI, United States Pigmented Bowen’s disease is an unusual presentation of this common neoplasm. It is encountered more often in dark-skinned individuals. We describe a 63-year-old African American woman with an enlarging, sharply circumscribed, dark brown patch on her lower extremity, which had been diagnosed as a seborrheic keratosis 3 years earlier. Histopathology showed increased pigment within the epidermis and full-thickness epithelial dysplasia consistent with pigmented Bowen’s disease. This variant of Bowen’s disease can mimic a seborrheic keratosis or a melanoma. It should be considered in dark-skinned patients with solitary, darkly hyperpigmented lesions.
Nothing to disclose.
Nothing to disclose.
P148
J AM ACAD DERMATOL
MARCH 2005