Epithelioma
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]Ammu Susheela, M.D. [3]
Synonyms and keywords: Pilomatrixoma; Calcifying Epithelioma of Malherbe; Epithelioma cuniculatum; Carcinoma cuniculatum; Superficial epithelioma
Overview
Epithelioma is an abnormal growth of the epithelium, which is the layer of tissue that covers the surfaces of organs and other structures of the body.
Historical Perspective
- Epithelioma cuniculatum was first discovered by Aird et al. in 1954.[1]
- Epithelioma cuniculatum is derived from the words epithelioma, meaning "tumor of the epithelium," and cuniculate, referring to crypt-like spaces seen on histology that resemble rabbit burrows.
Classification
- The term epithelioma is usually considered for skin tumors originating from the epithelial origin also known as carcinoma cutis[2]. However, epithelial tumors can arise from any epithelial lining of the organs including ovarian, uterine, glands, prostate, thyroid, lacrimal gland among others
- Epithelioma may be classified according to nature of tumor into 2 sub-types:
- Benign growths
- Malignant carcinomas
- Basal cell carcinoma
- Squamous cell carcinoma
- Mixed or squamo-basal
- Basal and the squamous cell carcinomas are the most common types of epithelioma's
Pathophysiology
- On gross pathology, bulky exophytic mass are characteristic findings of epithelioma. However there is a variance in the presentation of epithelioma
- Clinical picture can range anywhere from superficial to deep, simple papillary to nodular appearance, fungoid, ulcerated, or cauliflower shaped
- On microscopic histopathological analysis, endophytic and exophytic growth pattern, histiocytes, eosinophils, plasma cells, hyperchromasia, and mitoses are characteristic findings of epithelioma.
Causes
- Epithelioma of the skin may be caused by[3];
- trauma
- Chronic irritation
- HPV infection
- Prolonged sun exposure
- Occupational exposure to tar[4] and certain oils
- Pre-cancerous dermatosus - these are the benign skin lesions that develop as a result of trauma or any other condition that may serve as a base for development of epithelial skin cancers. examples include;
- Senile Keratosis
- Leukoplakia
- Radiation dermatitis
- Xeroderma
- Cutaneous horns
- Old scars
- Chronic ulceration
- Warts
- Sebaceous cysts
- Pigmented nevi
- Psoriatic or eczematous lesions
- SLE skin lesions
- Lupus vulgaris
Differentiating Epithelioma from other Diseases
- Epithelioma must be differentiated from other diseases that cause skin masses, such as:
- Seborrheic keratosis with sebaceous differentiation
- Sebaceous hyperplasia
- Sebaceous adenoma
- Sebaceous carcinoma
Epidemiology and Demographics[5]
Age
- Epithelioma is more commonly seen in older patients more than 50 years of age. Incidence in age 55 to 75 is 100 times higher as compared to 20 years old.
Gender
- Males are more commonly affected with epithelioma as compared to females.
Race
- Epithelioma is seen more commonly in Caucasians.
- Not common in dark skinned people
Risk Factors
- Common risk factors in the development of epithelioma are trauma, chronic irritation, and HPV infection, prolonged sun exposure as well as occupational exposure to tar[4] and certain oils. An additional risk factor is the presence of benign skin conditions called pre-cancerous dermatosus which include warts,dermatitis, leukoplakia, eczematous or psoriatic liesions, sebborhic keratosis, SLE skin lesions, nevi and cutaneous horns.
Natural History, Complications and Prognosis
Prognosis
- The prognosis of the epithelioma is variable, depending on the type, location, extent and stage at the time of diagnosis and hence treatment.
- However, most of the epitheliomas can be treated easily and the prognosis is good
Diagnosis
Symptoms
- Epithelioma of the skin can present in any form, usually easy to diagnose. Some of the presentations may include:
- New mole/growing mole/mole changing color
- New or growing warty lesion
- Painless swelling
- Indurated or ulcerated lesion
- Chronic scar that starts bleeding or changing
- Epithelial tumors of the organs can present in any way ranging from swelling or mass to symptoms related to involved organ system
Physical Examination
- Physical examination for epithelioma of the skin may be remarkable for:
- Non tender swelling
- Hard, waxy nodules with pearly borders
- Ulceration or Induration
Laboratory Findings
- There are no specific laboratory findings associated with epithelioma. However tests can be performed to rule out other causes of skin lesions like syphilis, lupus vulgaris, allergies etc.
Other Diagnostic Studies
- Any suspicious skin lesion should be biopsied. Histopathology is the most accurate way of diagnosing a skin condition or identifying or ruling out a malignancy of the skin.
Treatment
There is no single method of treatment since treatment procedure and extent depends upon the location and extent as well as the stage of the tumor along with the age and the sex of the patient. Some common treatment methods include[6][7]
- Surgical excision
- Irraditation
- Electrocauterisation
- Combination Therapy- Surgery plus electrocauteristaion plus irradiation
- Involves curreting the lesion under local anesthesia followed by cauterization of the base by the chemical method(zinc chloride or nitrate) followed by irradiation
- Combination therapy - Surgery plus radiation (usually used in case of advanced tumors with metastasis or infilltration)
Some other treatment options include:
- Cryosurgery
- Podophyllin
- Treatment with tissue extract
- Chemosurgery - usually for recurrent basal cell epitheliomas
References
- ↑ AIRD I, JOHNSON HD, LENNOX B, STANSFELD AG (1954). "Epithelioma cuniculatum: a variety of squamous carcinoma peculiar to the foot". Br J Surg. 42 (173): 245–50. PMID 13219306.
- ↑ . doi:10.1158/ajc.1939.179. Missing or empty
|title=(help) - ↑ RATTNER H, RODIN H (1949). "Epithelioma". Q Bull Northwest Univ Med Sch. 23 (3): 370–4. PMC 3802892. PMID 18147362.
- ↑ 4.0 4.1 ALEXANDER JO, MACROSSON KI (1955). "Epithelioma due to tar ointment". Br Med J. 1 (4908): 287. PMC 2060973. PMID 13219409.
- ↑ Chuang TY, Popescu A, Su WP, Chute CG (1990). "Basal cell carcinoma. A population-based incidence study in Rochester, Minnesota". J Am Acad Dermatol. 22 (3): 413–7. PMID 2312827.
- ↑ Browder JP, Tomsick RS (1983). "Basal cell epithelioma. Types, treatment methods, and prognosis". Postgrad Med. 73 (2): 161–8. PMID 6823454.
- ↑ Hacker SM, Browder JF, Ramos-Caro FA (1993). "Basal cell carcinoma. Choosing the best method of treatment for a particular lesion". Postgrad Med. 93 (8): 101–4, 106–8, 111. PMID 8506171.
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