Squamous cell carcinoma of the skin differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(6 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Squamous_cell_carcinoma_of_the_skin]]
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Squamous_cell_carcinoma_of_the_skin]]
{{CMG}}; '''Associate Editor(s)-in-Chief:''' [[User:Aditya Govindavarjhulla|Aditya Govindavarjhulla, M.B.B.S.]] [mailto:agovi@wikidoc.org], [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:ravitheja.g@gmail.com]
{{CMG}}; {{AE}} {{RAK}}{{Homa}}
 
== Overview ==
== Overview ==
Squamous cell carcinoma should be differentiated from [[melanoma]] and [[basal cell carcinoma]]. It accounts for 20% of all non-melanomatous tumors, and is fairly invasive contrary to its counterpart, [[basal cell carcinoma]]. [[Squamous cell carcinoma]] typically presents as a non-healing ulcer or growth on a sun exposed area of the skin.
Squamous cell carcinoma should be differentiated from [[melanoma]] and [[basal cell carcinoma]]. It accounts for 20% of all non-melanomatous tumors and is fairly invasive contrary to its counterpart, [[basal cell carcinoma]]. [[Squamous cell carcinoma]] typically presents as a non-healing ulcer or growth on a sun-exposed area of the skin.


== Differentiating Squamous cell carcinoma from other Diseases ==
== Differentiating Squamous cell carcinoma from other Diseases ==
A few conditions that mimic [[Squamous cell carcinoma]] include the following:
A few conditions that mimic Squamous cell carcinoma of the skin include the following:
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
Line 25: Line 26:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Squamous cell carcinoma in situ of skin|'''SCC in situ (Bowen's disease''')]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Squamous cell carcinoma in situ of skin|'''SCC in situ (Bowen's disease''')]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Patch
*[[Patched|Patch]]
* [[Plaque]]
*[[Plaque]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Erythematous]]
*[[Erythematous]]
* Skin colored
* Skin colored
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 39: Line 40:
* In black individuals: [[Leg|legs]], [[anus]], and areas of [[chronic inflammation]]
* In black individuals: [[Leg|legs]], [[anus]], and areas of [[chronic inflammation]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Presence of dotted and/or glomerular [[vessels]]
* Presence of dotted and/or [[glomerular]] [[vessels]]
* White to yellowish surface scales
* White to yellowish [[Surface area|surface]] scales
* Red-yellowish background  
* Red-yellowish [[background]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Keratinocyte|Keratinocytic]] [[dysplasia]] of the [[epidermis]]  
*[[Keratinocyte|Keratinocytic]] [[dysplasia]] of the [[epidermis]]
* No infiltration into [[dermis]]
* No [[Infiltration (medical)|infiltration]] into [[dermis]]
 
*[[Pleomorphism|Pleomorphic]] [[Keratinocyte|keratinocytes]]
* [[Pleomorphism|Pleomorphic]] [[Keratinocyte|keratinocytes]]
* Hyperchromatic [[nuclei]]
* Hyperchromatic [[nuclei]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Slow growth over the years
* Slow [[growth]] over the years
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Invasive squamous cell carcinoma'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Invasive squamous cell carcinoma'''
Line 70: Line 70:
* White circles
* White circles
* White structureless areas
* White structureless areas
* Masses of [[keratin]]
*[[Mass|Masses]] of [[keratin]]
* Hairpin and linear-irregular [[vessels]]
*[[Hairpin]] and linear-irregular [[vessels]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Keratinocyte|Keratinocytic]] [[dysplasia]] of the [[epidermis]]  
* [[Keratinocyte|Keratinocytic]] [[dysplasia]] of the [[epidermis]]  
* No infiltration into [[dermis]]
* No [[Infiltration (medical)|infiltration]] into [[dermis]]


* [[Pleomorphism|Pleomorphic]] [[Keratinocyte|keratinocytes]]
* [[Pleomorphism|Pleomorphic]] [[Keratinocyte|keratinocytes]]
* Hyperchromatic [[nuclei]]
* Hyperchromatic [[nuclei]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* May be painful or [[Itch|pruritic]]
* May be [[painful]] or [[Itch|pruritic]]
|-
|-
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Keratoacanthoma]]'''<ref name="pmid26853179">{{cite journal| author=Kwiek B, Schwartz RA| title=Keratoacanthoma (KA): An update and review. | journal=J Am Acad Dermatol | year= 2016 | volume= 74 | issue= 6 | pages= 1220-33 | pmid=26853179 | doi=10.1016/j.jaad.2015.11.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26853179  }}</ref>
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Keratoacanthoma]]'''<ref name="pmid26853179">{{cite journal| author=Kwiek B, Schwartz RA| title=Keratoacanthoma (KA): An update and review. | journal=J Am Acad Dermatol | year= 2016 | volume= 74 | issue= 6 | pages= 1220-33 | pmid=26853179 | doi=10.1016/j.jaad.2015.11.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26853179  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Macule
*[[Macule]]
* Papule
*[[Papule]]
* May have telangiectasias
* May have [[telangiectasias]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Skin-colored
*[[Skin]]-colored
* Mildly erythematous
* Mildly [[erythematous]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Prominent keratinous core in the center of the nodule
* Prominent [[keratinous]] [[Core (anatomy)|core]] in the center of the [[nodule]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* 1 to 2.5 cm
* 1 to 2.5 cm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Sun-exposed areas
* Sun-exposed areas
* Face, neck, hands, and arms
*[[Face]], [[neck]], [[hands]], and [[Arm|arms]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* White circles
* White circles
* Keratin
*[[Keratin]]
* Blood spots
*[[Blood]] spots
* White structureless zones
* White structureless zones
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Well-[[Cellular differentiation|differentiated]] [[squamous epithelium]]  
* Well-[[Cellular differentiation|differentiated]] [[squamous epithelium]]  
* Central [[keratin]] core
* Central [[keratin]] core
* Epidermal hyperplasia + large [[eosinophilic]] [[Keratinocyte|keratinocytes]]
*[[Epidermal]] [[hyperplasia]] + large [[eosinophilic]] [[Keratinocyte|keratinocytes]]


* Dermal inflammatory infiltrate
*[[Dermal]] [[inflammatory]] [[Infiltration (medical)|infiltrate]]
| style="background: #F5F5F5; padding: 5px;" |
* Rapid [[growth]] (within weeks)
|-
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''Dermatofibroma'''<ref name="LeeLee2015">{{cite journal|last1=Lee|first1=MiWoo|last2=Lee|first2=WooJin|last3=Jung|first3=JoonMin|last4=Won|first4=ChongHyun|last5=Chang|first5=SungEun|last6=Choi|first6=JeeHo|last7=Moon|first7=KeeChan|title=Clinical and histological patterns of dermatofibroma without gross skin surface change: A comparative study with conventional dermatofibroma|journal=Indian Journal of Dermatology, Venereology, and Leprology|volume=81|issue=3|year=2015|pages=263|issn=0378-6323|doi=10.4103/0378-6323.154795}}</ref><ref name="MentzelWiesner2012">{{cite journal|last1=Mentzel|first1=Thomas|last2=Wiesner|first2=Thomas|last3=Cerroni|first3=Lorenzo|last4=Hantschke|first4=Markus|last5=Kutzner|first5=Heinz|last6=Rütten|first6=Arno|last7=Häberle|first7=Michael|last8=Bisceglia|first8=Michele|last9=Chibon|first9=Frederic|last10=Coindre|first10=Jean-Michel|title=Malignant dermatofibroma: clinicopathological, immunohistochemical, and molecular analysis of seven cases|journal=Modern Pathology|volume=26|issue=2|year=2012|pages=256–267|issn=0893-3952|doi=10.1038/modpathol.2012.157}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*[[Nodule]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Hyperpigmentation|Hyperpigmented]]
| style="background: #F5F5F5; padding: 5px;" |
*Firm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Rapid growth (within weeks)
*0.3- 1 cm
| style="background: #F5F5F5; padding: 5px;" |
*Mostly seen in [[extremities]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*Localized [[nodular]] [[proliferation]] of [[spindle]]-shaped [[fibrous]] [[Cells (biology)|cells]] in a [[mixture]] of [[Histiocyte|histocytoid]] [[Cells (biology)|cells]] inside the [[dermis]]
* Spiculated margin of cells
* “Storiform” [[pattern]]
*[[Collagen]] bundles
* "Grenz zone"
*[[Epidermal]] [[hyperplasia]]
| style="background: #F5F5F5; padding: 5px;" |
* Slow [[growth]] over the years
!
|-
|-
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[dermatofibrosarcoma protuberans]]'''<ref name="BernardPoulalhon2013">{{cite journal|last1=Bernard|first1=J.|last2=Poulalhon|first2=N.|last3=Argenziano|first3=G.|last4=Debarbieux|first4=S.|last5=Dalle|first5=S.|last6=Thomas|first6=L.|title=Dermoscopy of dermatofibrosarcoma protuberans: a study of 15 cases|journal=British Journal of Dermatology|volume=169|issue=1|year=2013|pages=85–90|issn=00070963|doi=10.1111/bjd.12318}}</ref><ref name="AcostaVélez2017">{{cite journal|last1=Acosta|first1=Alvaro E.|last2=Vélez|first2=Catalina Santa|title=Dermatofibrosarcoma Protuberans|journal=Current Treatment Options in Oncology|volume=18|issue=9|year=2017|issn=1527-2729|doi=10.1007/s11864-017-0498-5}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*[[Patched|Patch]]
*[[Plaque]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Skin]]-[[Color|colored]], [[Violet (plant)|violet]] or [[Red-Al|reddish]]-[[brown]]
| style="background: #F5F5F5; padding: 5px;" |
*Firm
| style="background: #F5F5F5; padding: 5px;" |
*1-5 cm
| style="background: #F5F5F5; padding: 5px;" |
*Mostly seen in [[trunk]]
| style="background: #F5F5F5; padding: 5px;" |
*Presence of [[vessels]]
*[[Pigmentation|pigmented]] network
*pinkish [[background]]
| style="background: #F5F5F5; padding: 5px;" |
*Highly [[cellular]] with [[Cells (biology)|cells]] having following [[Characteristic function (probability theory)|characteristics]]:
** Monomorphic
** Thin
** [[Spindle cells|Spindly]]
** Scant [[eosinophilic]] [[cytoplasm]]
** Hyperchromatic [[nuclei]] (resembling [[neurofibroma]])
| style="background: #F5F5F5; padding: 5px;" |
!
|-
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Kaposi sarcoma]]'''<ref name="CesarmanDamania2019">{{cite journal|last1=Cesarman|first1=Ethel|last2=Damania|first2=Blossom|last3=Krown|first3=Susan E.|last4=Martin|first4=Jeffrey|last5=Bower|first5=Mark|last6=Whitby|first6=Denise|title=Kaposi sarcoma|journal=Nature Reviews Disease Primers|volume=5|issue=1|year=2019|issn=2056-676X|doi=10.1038/s41572-019-0060-9}}</ref><ref name="HuKe2009">{{cite journal|last1=Hu|first1=S C-S|last2=Ke|first2=C-L K|last3=Lee|first3=C-H|last4=Wu|first4=C-S|last5=Chen|first5=G-S|last6=Cheng|first6=S-T|title=Dermoscopy of Kaposi's sarcoma: Areas exhibiting the multicoloured ‘rainbow pattern’|journal=Journal of the European Academy of Dermatology and Venereology|volume=23|issue=10|year=2009|pages=1128–1132|issn=09269959|doi=10.1111/j.1468-3083.2009.03239.x}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*[[Macule]]
*[[Patched|Patch]]
| style="background: #F5F5F5; padding: 5px;" |
* Red/violaceous
| style="background: #F5F5F5; padding: 5px;" |
*Smooth
| style="background: #F5F5F5; padding: 5px;" |
*[[Variable]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Mucus membrane]]
| style="background: #F5F5F5; padding: 5px;" |
* Rainbow pattern
* scaly [[Surface area|surface]]
* Small brown globules
| style="background: #F5F5F5; padding: 5px;" |
*[[Spindle cells]] with minimal [[nuclear]] [[atypia]]
* Excessive [[vascular]] [[proliferation]]
* Abundant [[Red blood cell|red blood cells]]
*[[RBC]] and [[hemosiderin]] [[extravasation]]
* Abundant [[Lymphocyte|lymphocytes]] and [[monocytes]]
* Premonitory sign
* Intracytoplasmic [[PAS stain|PAS]] +ve [[hyaline]] globules
| style="background: #F5F5F5; padding: 5px;" |
* Kaposi's sarcoma is commonly associated with [[AIDS|acquired immune deficiency syndrome]] ([[AIDS]])
|-
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Merkel cell carcinoma]]'''<ref name="pmid19638070">{{cite journal| author=Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE| title=Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. | journal=J Cutan Pathol | year= 2010 | volume= 37 | issue= 1 | pages= 20-7 | pmid=19638070 | doi=10.1111/j.1600-0560.2009.01370.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19638070  }}</ref>
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Merkel cell carcinoma]]'''<ref name="pmid19638070">{{cite journal| author=Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE| title=Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. | journal=J Cutan Pathol | year= 2010 | volume= 37 | issue= 1 | pages= 20-7 | pmid=19638070 | doi=10.1111/j.1600-0560.2009.01370.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19638070  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 130: Line 207:
* Milky red areas
* Milky red areas
* Linear
* Linear
* Irregular vessels
* Irregular [[vessels]]
* Polymorphous [[vessels]]
*[[Polymorphic|Polymorphous]] [[vessels]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Uniform [[cells]] with large [[basophilic]] [[nuclei]]
* Uniform [[cells]] with large [[basophilic]] [[nuclei]]
* Single-cell [[necrosis]]
* Single-cell [[necrosis]]
* Frequent [[mitoses]]
* Frequent [[mitoses]]
* Lymphovascular invasion
* Lymphovascular [[Invasive (medical)|invasion]]
* Perineural invasion
*[[Perineurium|Perineural]] [[invasion]]
* [[Epidermal]] involvement via [[pagetoid]] spread
* [[Epidermal]] involvement via [[pagetoid]] spread
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Older individuals with light skin tones
* Older individuals with light [[skin]] tones
* Rapidly growing
* Rapidly [[Growth|growing]]
|-
|-
| rowspan="3" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Basal cell carcinoma]]'''<ref name="pmid22759209">{{cite journal| author=Wolberink EA, Pasch MC, Zeiler M, van Erp PE, Gerritsen MJ| title=High discordance between punch biopsy and excision in establishing basal cell carcinoma subtype: analysis of 500 cases. | journal=J Eur Acad Dermatol Venereol | year= 2013 | volume= 27 | issue= 8 | pages= 985-9 | pmid=22759209 | doi=10.1111/j.1468-3083.2012.04628.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22759209  }}</ref>
| rowspan="3" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Basal cell carcinoma]]'''<ref name="pmid22759209">{{cite journal| author=Wolberink EA, Pasch MC, Zeiler M, van Erp PE, Gerritsen MJ| title=High discordance between punch biopsy and excision in establishing basal cell carcinoma subtype: analysis of 500 cases. | journal=J Eur Acad Dermatol Venereol | year= 2013 | volume= 27 | issue= 8 | pages= 985-9 | pmid=22759209 | doi=10.1111/j.1468-3083.2012.04628.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22759209  }}</ref>
Line 150: Line 227:
* Flesh-colored
* Flesh-colored
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Small bump
* Small [[Bumps on skin|bump]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Variable
* Variable
Line 159: Line 236:
* Loosely arranged blue-gray dots
* Loosely arranged blue-gray dots
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Nest-like infiltration with basaloid [[cells]]
* Nest-like [[Infiltration (medical)|infiltration]] with [[Basal cell|basaloid]] [[cells]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* May have a "rolled" border
* May have a "rolled" [[Borderline|border]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Superficial basal cell carcinoma '''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Superficial basal cell carcinoma '''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Patch
*[[Patched|Patch]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Erythematous]]
* [[Erythematous]]
Line 177: Line 254:
* [[Trunk]]
* [[Trunk]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Superficial fine [[Telangiectasias|telangiectasia]]
*[[Superficial]] fine [[Telangiectasias|telangiectasia]]
* Shiny white to red, translucent or opaque structureless areas
* Shiny white to red, [[translucent]] or opaque structureless areas
* Multiple small erosions
* Multiple small erosions
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 189: Line 266:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Sclerosing basal cell carcinoma (morpheaform)'''<ref name="pmid8959949">{{cite journal| author=Wrone DA, Swetter SM, Egbert BM, Smoller BR, Khavari PA| title=Increased proportion of aggressive-growth basal cell carcinoma in the Veterans Affairs population of Palo Alto, California. | journal=J Am Acad Dermatol | year= 1996 | volume= 35 | issue= 6 | pages= 907-10 | pmid=8959949 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8959949  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Sclerosing basal cell carcinoma (morpheaform)'''<ref name="pmid8959949">{{cite journal| author=Wrone DA, Swetter SM, Egbert BM, Smoller BR, Khavari PA| title=Increased proportion of aggressive-growth basal cell carcinoma in the Veterans Affairs population of Palo Alto, California. | journal=J Am Acad Dermatol | year= 1996 | volume= 35 | issue= 6 | pages= 907-10 | pmid=8959949 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8959949  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Papule
*[[Papule]]


* Plaque
*[[Plaque]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Flesh-colored
* Flesh-colored
Line 198: Line 275:
* Firm  
* Firm  
* [[Induration|Indurated]]  
* [[Induration|Indurated]]  
* Indistinct borders
* Indistinct [[Borderline|borders]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Variable
* Variable
Line 204: Line 281:
* Sun-exposed areas
* Sun-exposed areas
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Whitish backround
* Whitish [[background]]
* Few fine arborizing [[vessels]]
* Few fine arborizing [[vessels]]
* Multiple brown dots
* Multiple brown dots
Line 224: Line 301:
* Firm
* Firm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Few millimeters to several centimeters
* Variable
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Extensor surfaces of the arms and legs and on the trunk
*[[Extensor]] [[Surface area|surfaces]] of the [[Arm|arms]] and [[Leg|legs]] and on the [[trunk]]


* Upper back, abdomen, and sacrum
* Upper [[back]], [[abdomen]], and [[sacrum]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* White "starburst pattern" surrounding red/brown/yellow crusts  
* White "starburst pattern" surrounding red/brown/yellow crusts  
* Erosions  
*[[Erosion (dental)|Erosions]]
* Hyperkeratosis
*[[Hyperkeratosis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Thick and compact orthohyperkeratosis
* Thick and compact orthohyperkeratosis
* Irregular epidermal hyperplasia
* Irregular [[epidermal]] [[hyperplasia]]
* Focal parakeratosis with irregular acanthosis
* Focal parakeratosis with irregular [[Acanthosis nigricans|acanthosis]]
* Nonspecific dermal infiltrate containing WBCs
* Nonspecific [[dermal]] [[Infiltration (medical)|infiltrate]] containing [[WBC|WBCs]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Nodules range in number from few to hundreds
*[[Nodule (medicine)|Nodules]] range in number from few to hundreds
* Worsened by heat, sweating, or irritation from clothing  
* Worsened by [[heat]], [[sweating]], or [[irritation]] from clothing
|-
|-
| rowspan="6" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Melanoma]]'''<ref name="pmid201377432">{{cite journal| author=Witt C, Krengel S| title=Clinical and epidemiological aspects of subtypes of melanocytic nevi (Flat nevi, Miescher nevi, Unna nevi). | journal=Dermatol Online J | year= 2010 | volume= 16 | issue= 1 | pages= 1 | pmid=20137743 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20137743  }}</ref>
| rowspan="6" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Melanoma]]'''<ref name="pmid201377432">{{cite journal| author=Witt C, Krengel S| title=Clinical and epidemiological aspects of subtypes of melanocytic nevi (Flat nevi, Miescher nevi, Unna nevi). | journal=Dermatol Online J | year= 2010 | volume= 16 | issue= 1 | pages= 1 | pmid=20137743 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20137743  }}</ref>
Line 253: Line 330:
* Around 1 cm
* Around 1 cm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Sun-damaged skin of the head or neck
* Sun-damaged [[skin]] of the [[head]] or [[neck]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Asymmetric, pigmented follicular openings
* Asymmetric, [[Pigmented lesions|pigmented]] follicular openings
* Gray angulated lines
* Gray angulated lines
* Gray areas, dots, and globules
* Gray areas, dots, and globules
Line 261: Line 338:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* '''↑''' atypical [[spindle]] shaped [[melanocytes]]  
* '''↑''' atypical [[spindle]] shaped [[melanocytes]]  
* Arranged in single cells or in small nests along the [[Epidermal junctions|dermal-epidermal junction]]
* Arranged in single [[Cells (biology)|cells]] or in small nests along the [[Epidermal junctions|dermal-epidermal junction]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Darkening of pigmentation, sharpening of borders, or emergence of nodular areas are signs of progression to [[lentigo maligna melanoma]]
* Darkening of [[pigmentation]], sharpening of borders, or emergence of [[nodular]] areas are [[signs]] of progression to [[lentigo maligna melanoma]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Lentigo maligna melanoma]]'''<ref name="pmid302665592">{{cite journal| author=Connolly KL, Giordano C, Dusza S, Busam KJ, Nehal K| title=Follicular involvement is frequent in lentigo maligna: Implications for treatment. | journal=J Am Acad Dermatol | year= 2019 | volume= 80 | issue= 2 | pages= 532-537 | pmid=30266559 | doi=10.1016/j.jaad.2018.07.071 | pmc=6333487 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30266559  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Lentigo maligna melanoma]]'''<ref name="pmid302665592">{{cite journal| author=Connolly KL, Giordano C, Dusza S, Busam KJ, Nehal K| title=Follicular involvement is frequent in lentigo maligna: Implications for treatment. | journal=J Am Acad Dermatol | year= 2019 | volume= 80 | issue= 2 | pages= 532-537 | pmid=30266559 | doi=10.1016/j.jaad.2018.07.071 | pmc=6333487 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30266559  }}</ref>
Line 271: Line 348:
* Brown/tan
* Brown/tan
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Freckle-like
*[[Freckle]]-like
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Variable
* Variable
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Chronically sun-damaged areas
*[[Chronic|Chronically]] sun-damaged [[Area|areas]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Asymmetric, pigmented follicular openings
* Asymmetric, [[Pigmented lesions|pigmented]] follicular openings
* Gray angulated lines
* Gray angulated lines
* Gray areas, dots, and globules
* Gray areas, dots, and globules
Line 292: Line 369:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Macule]]
* [[Macule]]
* Plaque with irregular borders
*[[Plaque]] with irregular [[Borderline|borders]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Variably pigmented (red, blue, black, gray, and white)
* Variably [[Pigmented lesions|pigmented]] (red, blue, black, gray, and white)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Thin
* Thin
Line 301: Line 378:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Anywhere but usually:
* Anywhere but usually:
** Back (men and women)
**[[Back]] ([[men]] and [[women]])
** Lower extremities (women)
** Lower [[extremities]] ([[women]])
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Asymmetry of shape
* Asymmetry of shape
Line 310: Line 387:
* Asymmetric
* Asymmetric
* Poorly circumscribed
* Poorly circumscribed
* Lack cellular maturation
* Lack [[cellular]] [[maturation]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Lateral (radial) growth before vertical (invasive) growth
*[[Lateral]] (radial) [[growth]] before [[Vertical direction|vertical]] ([[invasive]]) [[growth]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Nodular melanoma]]'''<ref name="pmid12734496">{{cite journal| author=Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F et al.| title=Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. | journal=J Am Acad Dermatol | year= 2003 | volume= 48 | issue= 5 | pages= 679-93 | pmid=12734496 | doi=10.1067/mjd.2003.281 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12734496  }}</ref><ref name="MenziesMoloney2013">{{cite journal|last1=Menzies|first1=Scott W.|last2=Moloney|first2=Fergal J.|last3=Byth|first3=Karen|last4=Avramidis|first4=Michelle|last5=Argenziano|first5=Giuseppe|last6=Zalaudek|first6=Iris|last7=Braun|first7=Ralph P.|last8=Malvehy|first8=Josep|last9=Puig|first9=Susana|last10=Rabinovitz|first10=Harold S.|last11=Oliviero|first11=Margaret|last12=Cabo|first12=Horacio|last13=Bono|first13=Riccardo|last14=Pizzichetta|first14=Maria A.|last15=Claeson|first15=Magdalena|last16=Gaffney|first16=Daniel C.|last17=Soyer|first17=H. Peter|last18=Stanganelli|first18=Ignazio|last19=Scolyer|first19=Richard A.|last20=Guitera|first20=Pascale|last21=Kelly|first21=John|last22=McCurdy|first22=Olivia|last23=Llambrich|first23=Alex|last24=Marghoob|first24=Ashfaq A.|last25=Zaballos|first25=Pedro|last26=Kirchesch|first26=Herbert M.|last27=Piccolo|first27=Domenico|last28=Bowling|first28=Jonathan|last29=Thomas|first29=Luc|last30=Terstappen|first30=Karin|last31=Tanaka|first31=Masaru|last32=Pellacani|first32=Giovanni|last33=Pagnanelli|first33=Gianluca|last34=Ghigliotti|first34=Giovanni|last35=Ortega|first35=Blanca Carlos|last36=Crafter|first36=Greg|last37=Ortiz|first37=Ana María Perusquía|last38=Tromme|first38=Isabelle|last39=Karaarslan|first39=Isil Kilinc|last40=Ozdemir|first40=Fezal|last41=Tam|first41=Anthony|last42=Landi|first42=Christian|last43=Norton|first43=Peter|last44=Kaçar|first44=Nida|last45=Rudnicka|first45=Lidia|last46=Slowinska|first46=Monika|last47=Simionescu|first47=Olga|last48=Di Stefani|first48=Alessandro|last49=Coates|first49=Elliot|last50=Kreusch|first50=Juergen|title=Dermoscopic Evaluation of Nodular Melanoma|journal=JAMA Dermatology|volume=149|issue=6|year=2013|pages=699|issn=2168-6068|doi=10.1001/jamadermatol.2013.2466}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Nodular melanoma]]'''<ref name="pmid12734496">{{cite journal| author=Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F et al.| title=Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. | journal=J Am Acad Dermatol | year= 2003 | volume= 48 | issue= 5 | pages= 679-93 | pmid=12734496 | doi=10.1067/mjd.2003.281 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12734496  }}</ref><ref name="MenziesMoloney2013">{{cite journal|last1=Menzies|first1=Scott W.|last2=Moloney|first2=Fergal J.|last3=Byth|first3=Karen|last4=Avramidis|first4=Michelle|last5=Argenziano|first5=Giuseppe|last6=Zalaudek|first6=Iris|last7=Braun|first7=Ralph P.|last8=Malvehy|first8=Josep|last9=Puig|first9=Susana|last10=Rabinovitz|first10=Harold S.|last11=Oliviero|first11=Margaret|last12=Cabo|first12=Horacio|last13=Bono|first13=Riccardo|last14=Pizzichetta|first14=Maria A.|last15=Claeson|first15=Magdalena|last16=Gaffney|first16=Daniel C.|last17=Soyer|first17=H. Peter|last18=Stanganelli|first18=Ignazio|last19=Scolyer|first19=Richard A.|last20=Guitera|first20=Pascale|last21=Kelly|first21=John|last22=McCurdy|first22=Olivia|last23=Llambrich|first23=Alex|last24=Marghoob|first24=Ashfaq A.|last25=Zaballos|first25=Pedro|last26=Kirchesch|first26=Herbert M.|last27=Piccolo|first27=Domenico|last28=Bowling|first28=Jonathan|last29=Thomas|first29=Luc|last30=Terstappen|first30=Karin|last31=Tanaka|first31=Masaru|last32=Pellacani|first32=Giovanni|last33=Pagnanelli|first33=Gianluca|last34=Ghigliotti|first34=Giovanni|last35=Ortega|first35=Blanca Carlos|last36=Crafter|first36=Greg|last37=Ortiz|first37=Ana María Perusquía|last38=Tromme|first38=Isabelle|last39=Karaarslan|first39=Isil Kilinc|last40=Ozdemir|first40=Fezal|last41=Tam|first41=Anthony|last42=Landi|first42=Christian|last43=Norton|first43=Peter|last44=Kaçar|first44=Nida|last45=Rudnicka|first45=Lidia|last46=Slowinska|first46=Monika|last47=Simionescu|first47=Olga|last48=Di Stefani|first48=Alessandro|last49=Coates|first49=Elliot|last50=Kreusch|first50=Juergen|title=Dermoscopic Evaluation of Nodular Melanoma|journal=JAMA Dermatology|volume=149|issue=6|year=2013|pages=699|issn=2168-6068|doi=10.1001/jamadermatol.2013.2466}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Polypoid [[nodule]]
*[[Polyploidy|Polypoid]] [[nodule]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Dark color
* Dark color
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Lump
*[[Lump]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* 6mm to > 1 cm
* 6mm to > 1 cm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Trunk
*[[Trunk]]
* Head
*[[Head]]
* Neck
*[[Neck]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Pigment network or pseudonetwork
*[[Pigment]] network or pseudonetwork
* Aggregated brown or black globules  
* Aggregated brown or black globules  
* Blue pigmentation within lesion
* Blue [[pigmentation]] within [[lesion]]
* Small dotted or comma [[vessels]]
* Small dotted or comma [[vessels]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Cells [[proliferate]] downwards through the skin
*[[Cells (biology)|Cells]] [[proliferate]] downwards through the [[skin]]


* Dermal growth in isolation or in association with an [[epidermal]] component
*[[Dermal]] [[growth]] in isolation or in association with an [[epidermal]] component
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Two-thirds arise in normal skin, the rest in existing moles
* Two-thirds arise in normal [[skin]], the rest in existing [[moles]]
* Rapidly enlarging
* Rapidly enlarging
|-
|-
Line 343: Line 420:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Macule]]
* [[Macule]]
* Patch
*[[Patched|Patch]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Dark brown to black
* Dark brown to black
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Raised areas
* Raised [[Area|areas]]
* [[Ulceration]]
* [[Ulceration]]
* [[Bleeding]]
* [[Bleeding]]
Line 353: Line 430:
* Variable
* Variable
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Palmar
*[[Palmar]]
* Plantar
*[[Plantar]]
* Subungual
* Subungual
* Mucosal surfaces
*[[Mucosal]] surfaces
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Parallel-ridge pattern
* Parallel-ridge [[pattern]]
* Irregular diffuse pigmentation
* Irregular [[diffuse]] [[pigmentation]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Asymmetric proliferation of single melanocytes at dermoepidermal junction
* Asymmetric [[proliferation]] of single [[melanocytes]] at dermoepidermal junction
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Most common among dark skinned individuals
* Most common among dark [[Skin|skinned]] individuals
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Amelanotic melanoma]]'''<ref name="pmid23197217">{{cite journal| author=Steglich RB, Meotti CD, Ferreira MS, Lovatto L, de Carvalho AV, de Castro CG| title=Dermoscopic clues in the diagnosis of amelanotic and hypomelanotic malignant melanoma. | journal=An Bras Dermatol | year= 2012 | volume= 87 | issue= 6 | pages= 920-3 | pmid=23197217 | doi= | pmc=3699915 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23197217  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Amelanotic melanoma]]'''<ref name="pmid23197217">{{cite journal| author=Steglich RB, Meotti CD, Ferreira MS, Lovatto L, de Carvalho AV, de Castro CG| title=Dermoscopic clues in the diagnosis of amelanotic and hypomelanotic malignant melanoma. | journal=An Bras Dermatol | year= 2012 | volume= 87 | issue= 6 | pages= 920-3 | pmid=23197217 | doi= | pmc=3699915 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23197217  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Patch
*[[Patched|Patch]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Skin color
*[[Skin]] color
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Slightly elevated borders
* Slightly elevated [[Borderline|borders]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Around 6 mm
* Around 6 mm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Sun-exposed areas
* Sun-exposed [[Area|areas]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* No [[melanin]] pigmentation
* No [[melanin]] [[pigmentation]]


* Dotted [[vessels]]
* Dotted [[vessels]]
* Linear irregular vessels  
* Linear irregular [[vessels]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
Line 392: Line 469:
* [[Hypopigmentation|Hypopigmented]]
* [[Hypopigmentation|Hypopigmented]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Smooth surface
* Smooth [[Surface area|surface]]
* Terminal hairs  often present
* Terminal [[hairs]] often present
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* 1 cm to > 20 cm
* 1 cm to > 20 cm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Sun-exposed areas above the [[waist]]
* Sun-exposed [[Area|areas]] above the [[waist]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Comma-shaped or curved vessels
* Comma-shaped or curved [[vessels]]
* Structureless light brown background  
* Structureless light brown [[background]]
* Residual brown thick circles around the [[hair follicles]]
* Residual brown thick circles around the [[hair follicles]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Multinucleated [[melanocytes]]
*[[Multinucleated]] [[melanocytes]]
* [[Melanocyte|Melanocytes]] diffusely infiltrate [[dermis]]
* [[Melanocyte|Melanocytes]] diffusely [[Infiltration (medical)|infiltrate]] [[dermis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Also called Miescher [[nevus]]
* Also called Miescher [[nevus]]
Line 419: Line 496:
* Variable
* Variable
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Head and neck,  
*[[Head]] and [[neck]],
* Dorsal aspect of the distal extremities
*[[Dorsal]] aspect of the [[distal]] [[extremities]]
* Sacral area
*[[Sacral]] [[area]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Structureless blue pigmentation
* Structureless blue [[pigmentation]]
* Structureless blue and white or blue and brown on some occasions
* Structureless blue and white or blue and brown on some occasions
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Proliferation of dendritic, dermal, melanin-producing melanocytes
*[[Proliferation]] of [[Dendritic cell|dendritic]], [[dermal]], [[melanin]]-producing [[melanocytes]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Also called Mongolian spots
* Also called [[Mongolian spot|Mongolian spots]]
|-
|-
| rowspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''Spitz nevus'''<ref name="pmid22082838">{{cite journal| author=Luo S, Sepehr A, Tsao H| title=Spitz nevi and other Spitzoid lesions part I. Background and diagnoses. | journal=J Am Acad Dermatol | year= 2011 | volume= 65 | issue= 6 | pages= 1073-84 | pmid=22082838 | doi=10.1016/j.jaad.2011.04.040 | pmc=3217183 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22082838  }}</ref><ref name="pmid21494025">{{cite journal| author=Argenziano G, Agozzino M, Bonifazi E, Broganelli P, Brunetti B, Ferrara G et al.| title=Natural evolution of Spitz nevi. | journal=Dermatology | year= 2011 | volume= 222 | issue= 3 | pages= 256-60 | pmid=21494025 | doi=10.1159/000326109 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21494025  }}</ref>
| rowspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''Spitz nevus'''<ref name="pmid22082838">{{cite journal| author=Luo S, Sepehr A, Tsao H| title=Spitz nevi and other Spitzoid lesions part I. Background and diagnoses. | journal=J Am Acad Dermatol | year= 2011 | volume= 65 | issue= 6 | pages= 1073-84 | pmid=22082838 | doi=10.1016/j.jaad.2011.04.040 | pmc=3217183 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22082838  }}</ref><ref name="pmid21494025">{{cite journal| author=Argenziano G, Agozzino M, Bonifazi E, Broganelli P, Brunetti B, Ferrara G et al.| title=Natural evolution of Spitz nevi. | journal=Dermatology | year= 2011 | volume= 222 | issue= 3 | pages= 256-60 | pmid=21494025 | doi=10.1159/000326109 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21494025  }}</ref>
Line 441: Line 518:
* < 1 cm
* < 1 cm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Cheek
*[[Cheek]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Coiled vessels
* Coiled [[vessels]]
* White network over a pink to reddish background
* White network over a pink to reddish [[background]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* In children and adolescents
* In [[children]] and [[Adolescent|adolescents]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Reed-like Spitz'''<ref name="pmid27222770">{{cite journal| author=Pedrosa AF, Lopes JM, Azevedo F, Mota A| title=Spitz/Reed nevi: a review of clinical-dermatoscopic and histological correlation. | journal=Dermatol Pract Concept | year= 2016 | volume= 6 | issue= 2 | pages= 37-41 | pmid=27222770 | doi=10.5826/dpc.0602a07 | pmc=4866625 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27222770  }}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Reed-like Spitz'''<ref name="pmid27222770">{{cite journal| author=Pedrosa AF, Lopes JM, Azevedo F, Mota A| title=Spitz/Reed nevi: a review of clinical-dermatoscopic and histological correlation. | journal=Dermatol Pract Concept | year= 2016 | volume= 6 | issue= 2 | pages= 37-41 | pmid=27222770 | doi=10.5826/dpc.0602a07 | pmc=4866625 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27222770  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Papule
*[[Papule]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Heavily [[Pigmented lesions|pigmented]]
* Heavily [[Pigmented lesions|pigmented]]
Line 459: Line 536:
* < 1 cm
* < 1 cm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Head and neck
*[[Head]] and [[neck]]
* Upper and lower extremities
* Upper and lower [[extremities]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Structureless black to gray center
* Structureless black to gray center
Line 468: Line 545:
* Globules
* Globules
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Enlarged spindle [[melanocytes]] with polyangular form
* Enlarged [[spindle]] [[melanocytes]] with polyangular form
* "Ground glass" cytoplasm
* "Ground glass" [[cytoplasm]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Most commonly develops in children, adolescents, and young adults.
* Most commonly develops in [[children]], [[Adolescent|adolescents]], and young [[Adult|adults]].
|-
|-
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Solar lentigo]]'''<ref name="pmid21175756">{{cite journal| author=Tanaka M, Sawada M, Kobayashi K| title=Key points in dermoscopic differentiation between lentigo maligna and solar lentigo. | journal=J Dermatol | year= 2011 | volume= 38 | issue= 1 | pages= 53-8 | pmid=21175756 | doi=10.1111/j.1346-8138.2010.01132.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21175756  }}</ref>
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''[[Solar lentigo]]'''<ref name="pmid21175756">{{cite journal| author=Tanaka M, Sawada M, Kobayashi K| title=Key points in dermoscopic differentiation between lentigo maligna and solar lentigo. | journal=J Dermatol | year= 2011 | volume= 38 | issue= 1 | pages= 53-8 | pmid=21175756 | doi=10.1111/j.1346-8138.2010.01132.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21175756  }}</ref>
Line 483: Line 560:
* Around 5mm
* Around 5mm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Sun-exposed areas
* Sun-exposed [[Area|areas]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Faint pigmented fingerprint structures
* Faint [[Pigment|pigmented]] [[fingerprint]] structures
* Structureless pattern
* Structureless [[pattern]]
* Light brown pseudonetwork with well-defined borders and a "moth-eaten" edge  
* Light brown pseudonetwork with well-defined [[Borderline|borders]] and a "moth-eaten" edge
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* '''↑''' [[melanin]] deposition in [[Keratinocyte|keratinocytes]]  
* '''↑''' [[melanin]] deposition in [[Keratinocyte|keratinocytes]]  
Line 498: Line 575:
* [[Papule]]
* [[Papule]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Skin-colored to brownish  
*[[Skin]]-colored to brownish
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Umbilicated
*[[Umbilicated lesions|Umbilicated]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* 2 - 6 mm
* 2 - 6 mm
Line 511: Line 588:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Usually in middle-aged or older patients
* Usually in middle-aged or older [[patients]]
|-
|-
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''Lichen planus-like keratosis'''<ref name="pmid16148406">{{cite journal| author=Morgan MB, Stevens GL, Switlyk S| title=Benign lichenoid keratosis: a clinical and pathologic reappraisal of 1040 cases. | journal=Am J Dermatopathol | year= 2005 | volume= 27 | issue= 5 | pages= 387-92 | pmid=16148406 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148406  }}</ref>
| colspan="2" style="background: #C0C0C0; padding: 5px; text-align: center;" |'''Lichen planus-like keratosis'''<ref name="pmid16148406">{{cite journal| author=Morgan MB, Stevens GL, Switlyk S| title=Benign lichenoid keratosis: a clinical and pathologic reappraisal of 1040 cases. | journal=Am J Dermatopathol | year= 2005 | volume= 27 | issue= 5 | pages= 387-92 | pmid=16148406 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16148406  }}</ref>
Line 527: Line 604:
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Shows a coarse or fine, gray to blue, granular [[pigmentation]]
* Shows a coarse or fine, gray to blue, granular [[pigmentation]]
* Diffuse brownish gray [[granules]]
*[[Diffuse]] brownish gray [[granules]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Hypergranulosis]]
* [[Hypergranulosis]]
* [[Epidermal]] [[hyperplasia]]
* [[Epidermal]] [[hyperplasia]]
* Superficial bandlike  infiltrate
*[[Superficial]] bandlike  [[Infiltration (medical)|infiltrate]]
* Melanophages
* Melanophages
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Appearance depends on stage of evolution
* Appearance depends on stage of evolution
|}
|}
Squamous cell carcinoma of the mouth must be differentiated from other mouth lesions such as oral candidiasis and aphthous ulcer
<div style="width: 70%;">
<small><small>
{| class="wikitable"
!Disease
!Presentation
!Risk Factors
!Diagnosis
!Affected Organ Systems
!Important features
!Picture
|-
! colspan="3" |Diseases predominantly affecting the oral cavity
!
!
!
!
|-
|[[Oral candidiasis|Oral Candidiasis]]
|
* [[Dysphagia]] or [[odynophagia]]
* White patches on the mouth and tongue
|
*[[Newborn]] babies
*Denture users
*Poorly controlled [[diabetes]]
*As a side effect of medication, most commonly having taken [[antibiotic]]s. Inhaled [[corticosteroids]] for the treatment of lung conditions (e.g, [[asthma]] or [[COPD]]) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
*People with poor [[nutrition]], specifically [[vitamin A]], [[Iron deficiency anemia|iron]] and [[Folate deficiency|folate deficiencies]].
*People with an [[immune deficiency]] (e.g. as a result of [[AIDS]]/[[HIV]] or [[chemotherapy]] treatment).
*Women undergoing hormonal changes, like [[pregnancy]] or those on [[birth control pills]].
*[[Organ transplantation]] patients
|
* Clinical diagnosis
* Confirmatory tests rarely needed
|'''Localized candidiasis'''
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]]
* [[Candida vulvovaginitis]]
* [[Chronic mucocutaneous candidiasis]]
'''Invasive candidasis'''
* [[Candidiasis|Candidaemia]]
* [[Endocarditis|Candida endocarditis]]
* [[Osteoarthritis|Candida osteoarticular disease]]
|
* [[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]].
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]]
|-
|[[Herpes simplex|Herpes simplex oral lesions]]
|
* [[Fever]] 
* [[Sore throat]]
* Painful [[ulcer]]s
|
* Stress
* Recent [[URTI]]
* Female sex
|
* Physical examination
* [[Viral culture]]
* [[Tzanck smear]]
|
* Orofacial Infection
* [[Herpes simplex anogenital infection|Anogenital Infection]]
* [[Herpes simplex ocular infection|Ocular Infection]]
* [[Herpes simplex encephalitis|Herpes Encephalitis]]
* [[Herpes simplex neonatorum|Neonatal Herpes]]
* [[Herpetic whitlow|Herpetic Whitlow]]
* [[Herpes gladiatorum|Herpes Gladiatorum]]
|
* The symptoms of primary [[HSV]] infection generally resolve within two weeks
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]]
|-
|[[Aphthous ulcer|Aphthous ulcers]]
|
* Painful, red spot or bump that develops into an open [[ulcer]]
|
* Being a female
* Between the ages of 10-40
* Family history of [[Aphthous ulcer|aphthous ulcers]]
|
* Physical examination
* Diagnosis of exclusion
|
* Oral cavity
|
* Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the under surface of the tongue|By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]]
|-
|[[Squamous cell carcinoma]]
|
*Non healing [[ulcer]], [[nodule]], indurated plaque or mass
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]]
|
* Chronic sun or [[Ultraviolet|UV exposure]]
* Fair [[skin]]
* [[Elderly]] age (>45 yrs)
* [[Male sex]]
* [[Smoking]]
|
*[[Physical exam]]
*[[Biopsy]]
|
*[[Oral Cavity]]
**Floor of [[mouth]]
**Lateral [[tongue]]
*[[Throat]]
*[[Esophagus]]
|
*[[Malignant]]
*Can spread to [[TMJ]]
*Some times associated with [[leukoplakia]]
|[[File:PLoS oral cancer.png|thumb|400x400px|Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]]
|-
|[[Leukoplakia]]
|
*White leathery spots on the [[mucous membranes]] of the [[tongue]] and inside of the [[mouth]]
*Lateral borders of [[tongue]]
|
*Atypical [[Tobacco]] use
*Chronic [[irritation]]
*[[Immunodeficiency]]
*[[Bloodroot]] ([[Sanguinarine|sanguinaria]])
|
*[[Physical exam]]
*Diagnosis of exclusion
*[[Biopsy]]
|
*[[Vulva|Vulvar]] lesions occur independent of oral lesions
|
*Associated with [[HIV]]
*Persistant white spots
*[[Benign]] but can progress to [[carcinoma]] after almost 10 years
*Oral proliferative [[Leukoplakia|verrucous leukoplakia]] is an aggressive sub type with multiple lesions and higher conversion to [[warts]] or [[carcinoma]]<ref>{{Cite journal
| author = [[Ann M. Gillenwater]], [[Nadarajah Vigneswaran]], [[Hanadi Fatani]], [[Pierre Saintigny]] & [[Adel K. El-Naggar]]
| title = Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!
| journal = [[Advances in anatomic pathology]]
| volume = 20
| issue = 6
| pages = 416–423
| year = 2013
| month = November
| doi = 10.1097/PAP.0b013e3182a92df1
| pmid = 24113312
}}</ref>
|[[File:Oral hairy leukoplakia (EBV, in HIV)a.jpg|thumb|400x300px|Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087]]
|-
|[[Melanoma]]
|
*A lesion with [[ABCD]]
**[[Asymmetry]]
**Border irregularity
**Color variation
**[[Diamete]]r changes
*[[Bleeding]] from the lesion
|
*[[Ultraviolet|UV radiations]]
*[[Genetic predisposition]]
*[[Old age]]
*[[Male gender]]
*Family or personal history of [[melanoma]]
*Multiple benign or atypical [[Nevus|nevi]]
|
*[[ABCD]] characteristics
*[[Bleeding]] or [[ulceration]] may show [[malignancy]]
*Serum [[LDH]] may be elevated in case of [[malignancy]]
*[[Biopsy]]
|
*Can [[metastasize]]
*All [[UV radiation]] or sun exposed areas can be effected independently
*1-2 to hundreds of [[granules]]
|
*[[Neural crest cell]] derivative
*Development begins with disruption of [[nevus]] growth control
*Progression involves [[MAPK/ERK pathway]]
*[[RAS|N-RAS]] or [[BRAF]] [[oncogene]] also involved
|[[File:Palate malign melanoma 01.jpg|thumb|400x400px|Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811]]
|-
|[[Fordyce spots]]
|
*Rice-like [[granules]] or [[spots]]
*Small, [[painless]], [[raised]], [[pale]], red or white
*1 to 3 mm in [[diameter]]
|
*Greasy skin types
*Some [[Rheumatic|rheumatic disorders]]
*[[Hereditary nonpolyposis colorectal cancer]]
**Lower [[gingiva]] (gums)
**[[Vestibular system|Vestibular mucosa]]
|
*[[Physical exam]]
*Small [[keratin]]-filled [[pseudocysts]]
*May be seen on [[incidental]] [[mucosal]] [[biopsy]]
**[[Biopsy]] not done for them primarily
|
*[[Oral cavity]]
**[[Vermillion border|Vermilion border]] of the lips
**[[Oral mucosa]] of the upper lip
*[[Buccal mucosa]] in the commissural region often bilaterally
*[[Genitals]]
|
*[[Benign neoplasms]] with [[sebaceous]] features
*Visible [[sebaceous glands]]
*No surrounding [[mucosal]] change
*Several adjacent [[glands]] may coalesce into a larger cauliflower-like cluster
|[[File:Fospot.jpg|thumb|400x400px|Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899]]
|-
|[[Burning mouth syndrome]]
|
*Burning or [[tingling]] on the [[lips]], [[tongue]], or entire [[mouth]]
|
*[[Nutritional deficiencies]]
*Chronic [[anxiety]] or [[depression]]
*[[Diabetes type 2]]
*[[Menopause]]
*[[Oral thrush]] or [[dry mouth]], or damaged [[nerves]] transmitting taste
*[[Female gender ]]
*[[Menopause]]
|
*[[Presentation]]
*[[Physical exam]]
|
*[[Oral cavity]]
|
*Pain typically is low in the morning and builds up over the day
*Low dosages of [[benzodiazepines]], [[tricyclic antidepressants]] or [[anticonvulsants]] may be effective
|
|-
|[[Torus palatinus]]
|
*Bony growth on midline of the [[hard palate]]
*[[Nodular]] mass covered with normal [[mucosa]]
|
*[[Genetic predisposition]]
**[[Autosomal dominant]]
|
*[[Physical exam]]
*Types
**[[Torus palatinus|Flat tori]]
**[[Torus palatinus|Spindle tori]]
**[[Torus palatinus|Nodular tori]]
**[[Torus palatinus|Lobular tori]]
|
*[[Hard palate]]
|
*More common in [[Asian]] and Inuit populations
*Twice more common in [[females]]
*Repeated [[trauma]] can cause [[bleeding]]
*[[Surgery]] may be required in symptomatic
|[[File:06-06-06palataltoria.jpg|thumb|Torus palatinus|400x400px|Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591]]
|-
| colspan="4" |'''Diseases involving oral cavity and other organ systems'''
|
|
|
|-
|[[Behçet's disease|Behcet's disease]]
|
*Painful [[mouth sores]]
*[[Acne]] like skin lesions
*Headache, [[fever]], poor [[balance]], [[disorientation]]
*[[Abdominal pain]], [[diarrhea]] or [[bleeding]]
*[[Uveitis]]
*Joint [[swelling]] and joint [[pain]]
*Genital [[sores]] wit [[pain]] and [[scaring]]
*[[Aneurysms]]
|
*Over active [[immune system]]
|
*[[Physical examination]]
|
*[[Mouth]]
*[[Genitals]]
*[[GIT]]
*[[Eye]]
*[[Joints]]
*[[Skin]]
*[[Vascular system]]
*[[Brain]]
|
*[[Outbreaks]] of exaggerated [[inflammation]]
*Affects smaller [[blood vessels]]
|[[File:Behcets disease.jpg|thumb|400x400px|Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021]]
|-
|[[Crohn's disease]]
|
*Chronic, episodic [[diarrhea]] or [[constipation]]
*[[Abdominal pain]]
*[[Vomiting]]
*[[Weight loss]] or [[weight gain]]
|
*[[Smoking]]
*[[Whites]] and [[European]] [[Jews]]
*[[Hormonal contraception]]
*Diets high in microparticles, sweet, fatty or refined foods
*Industrialized country
|
*Typical [[history]] and [[symptoms]]
*[[Skip lesions]] on [[biopsy]]
*[[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies (ASCA)]]
*[[Anti-neutrophil cytoplasmic antibodies]] ([[ANCA]])
|
*[[Eyes]]
*[[Joints]]
*[[Skin]]
|
*May lead to
**[[Obstruction]]s
**[[Abscess]]es
**Free [[perforation]]
**[[Hemorrhage]]
|
|-
|[[Agranulocytosis]]
|
*[[Fever]] or [[chills]]
*Frequent [[infections]]
*Unusual [[redness]], [[pain]], or [[swelling]] around a wound
*Mouth [[ulcers]]
*[[Abdominal pain]]
*[[Burning sensation when urinating]]
*[[Sore throat]]
|
*[[Medications]]<ref name="PMID17142169">{{cite journal |author=Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. |title=Idiosyncratic drug-induced agranulocytosis: Update of an old disorder. |journal=Eur J Intern Med. |volume=17|issue=8 |pages=529-35 |year=2006|pmid 17142169|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17142169}}</ref>
*[[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]]
*[[Hematological malignancy|Hematologic malignancies]]
*[[Autoimmune disorders]]
|
*[[Neutropenia]] <100 cells per micro litre
*[[Eosinopenia]]
*[[Basopenia]]
|
*[[Oral cavity]]
*[[Skin]]
*[[GIT]]
*[[Urinary system]]
*[[Conjunctiva]]
|
*[[Immunocompromised|Immunocompromization]]
*Types
**[[Drug-induced]]
**[[Malignant]]
**[[Autoimmune]]
|
|-
|[[Syphilis]]<ref>title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"</ref>
|
*[[Chancre]]
*Regional [[lymphadenopathy]]
|
*[[Multiple sexual partners]]
*Illicit [[drug use]]
*[[Unprotected sex]]
*[[Homosexual men|Men who have sex with men]]
*Residence in highly prevalent areas
*[[Human Immunodeficiency Virus (HIV)|HIV]] infection
*Presence of other [[STI]]s
*Previous history of [[Sexually transmitted disease|STIs]]
*[[Intravenous drug use]]
|
*[[Darkfield microscope|Darkfield microscopy]]
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]])
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]])
|
*[[Oral cavity]]
*[[Penis]]
*[[Cervix]]
*[[Labia]]
*[[Anal canal]]
*[[Rectum ]]
*[[CNS]]
*[[Cardiovascular|CVS]]
|
*[[Primary syphilis]]
**[[Chancre]]
*[[Secondary syphilis]]
**[[Condyloma latum|Condylomata lata]]
*[[Latent syphilis]]
**[[Asymptomatic]]
*[[Tertiary syphilis]]
**[[Gumma|Gummas]]
**[[Neurosyphilis]]
|[[File:Hutchinson teeth congenital syphilis PHIL 2385.rsh.jpg|thumb|400x400px|oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349]]
|-
|[[Coxsackie virus]]
|
*[[Fever]]
*[[Sores]] in the [[mouth]]
*[[Rash]] with [[blisters]]
*[[Aches]]
|
*[[Pregnancy]]
*[[immunodeficiency]]
|
*[[History]] and [[Physical exam]]
*[[Swabbing|Throat swabs]]
*Swabs from the lesion
*[[Tzanck test]]
|
*[[Oral cavity]]
*[[Skin]]
|
*Symptomatic treatment
|[[File:Hand foot mouth disease 07a.jpg|thumb|400x400px|Hand-foot-and-mouth disease - adapted from atlasdermatologico.com<ref name="urlDermatology Atlas">{{cite web |url=http://www.atlasdermatologico.com.br/ |title=Dermatology Atlas |format= |work= |accessdate=}}</ref>]]
|-
|[[Chickenpox|Chicken pox]]
|
*[[Conjunctival]] symptoms
*[[Catarrhal]] symptoms
*Characteristic [[spots]] on the trunk appearing in two or three waves
*[[Itching]]
|
*[[Pregnancy]]
*[[Premature infants]] born to susceptible mothers
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh =1000 grams
*[[Immunocompromised]]
|
*[[History]] and [[physical exam]]
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[Maculopapular|maculopapular lesions]])
|
*[[Oral cavity]]
*[[Skin]]
|
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]]
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]]
*[[Prednisolone]] is [[contraindicated]]
|[[File:Herpangina2016.jpg|thumb|400x400px|Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565]]
|-
|[[Measles]]
|
*[[Fever]]
*[[Rash]]
*[[Cough]]
*[[Coryza]] (runny nose)
*[[Conjunctivitis]] (pink eye)
*[[Malaise]]
*[[Koplick spots]] in mouth
|
*Unvaccinated individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778  }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400  }} </ref>
*Crowded and/or unsanitary conditions
*Traveling to less developed and developing countries
*Immunocompromized
*Winter and [[spring]] seasons
*Born after 1956 and never fully vaccinated
*Health care workers
|
*[[History]] and [[examination]]
*[[PCR]] for [[Measles]]-specific [[IgM|IgM antibody]]
*[[PCR]] for [[Measles]] [[RNA]]
|
*[[Oral cavity]]
*[[Skin]]
*[[Respiratory tract]]
*[[Eyes]]
*[[Throat]]
|
*Caused by [[Morbillivirus]]
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]]
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[Virus|virus particles]]
|[[File:Koplik spots, measles 6111 lores.jpg|thumb|400x400px|Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483]]
|}</small></small>
</div>


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 16:52, 27 August 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2] Homa Najafi, M.D.[3]

Overview

Squamous cell carcinoma should be differentiated from melanoma and basal cell carcinoma. It accounts for 20% of all non-melanomatous tumors and is fairly invasive contrary to its counterpart, basal cell carcinoma. Squamous cell carcinoma typically presents as a non-healing ulcer or growth on a sun-exposed area of the skin.

Differentiating Squamous cell carcinoma from other Diseases

A few conditions that mimic Squamous cell carcinoma of the skin include the following:

Diseases Skin examination Diagnosis Additional findings
Type Color Texture Size Distribution Dermoscopic Findings Histopathology
Cutaneous squamous cell carcinoma[1] SCC in situ (Bowen's disease)
  • Scaly
  • Variable
  • Fair-skinned individuals: sun-exposed areas
Invasive squamous cell carcinoma
  • Skin colored
  • 0.5 to 1.5 cm
  • Fair-skinned individuals: sun-exposed areas
  • In black individuals: legs, anus, and areas of chronic inflammation
Keratoacanthoma[2]
  • 1 to 2.5 cm
Dermatofibroma[3][4]
  • Firm
  • 0.3- 1 cm
dermatofibrosarcoma protuberans[5][6]
  • Firm
  • 1-5 cm
Kaposi sarcoma[7][8]
  • Red/violaceous
  • Smooth
  • Rainbow pattern
  • scaly surface
  • Small brown globules
Merkel cell carcinoma[9]
  • Shiny
  • Flesh-colored or bluish-red
  • Firm
  • < 1 cm
  • Sun-exposed areas
  • Older individuals with light skin tones
  • Rapidly growing
Basal cell carcinoma[10] Nodular basal cell carcinoma
  • Flesh-colored
  • Variable
  • Focused, bright red, and branching arborizing vessels
  • Loosely arranged blue-gray dots
Superficial basal cell carcinoma
  • Scaly
  • 1 to > 10 cm
  • Sun-exposed areas
  • Head (cheek and nose)
  • Trunk
  • Large, hyperchromatic, oval nuclei
  • Minimal cytoplasm
  • Small basaloid nodules
Sclerosing basal cell carcinoma (morpheaform)[11]
  • Variable
  • Sun-exposed areas
Prurigo nodules[12][13]
  • Firm
  • Variable
Melanoma[14] Melanoma in situ (Lentigo Maligna)[15]
  • Variable (from light to dark brown, black, pink, red, or white)
  • Smooth
  • Around 1 cm
  • Asymmetric, pigmented follicular openings
  • Gray angulated lines
  • Gray areas, dots, and globules
  • Circle within a circle
Lentigo maligna melanoma[16]
  • Brown/tan
  • Variable
  • Asymmetric, pigmented follicular openings
  • Gray angulated lines
  • Gray areas, dots, and globules
  • Circle within a circle
  • Usually in older individuals
Superficial spreading melanoma[17]
  • Variably pigmented (red, blue, black, gray, and white)
  • Thin
  • 1 mm to > 1 cm
  • Asymmetry of shape
  • > 2 colors
  • Asymmetry of structures
Nodular melanoma[18][19]
  • Dark color
  • 6mm to > 1 cm
  • Two-thirds arise in normal skin, the rest in existing moles
  • Rapidly enlarging
Acral lentiginous melanoma[20]
  • Dark brown to black
  • Variable
  • Most common among dark skinned individuals
Amelanotic melanoma[21]
  • Around 6 mm
Common nevus[22][23]
  • 1 cm to > 20 cm
  • Also called Miescher nevus
Blue nevus[24]
  • Blue
  • Smooth
  • Variable
  • Structureless blue pigmentation
  • Structureless blue and white or blue and brown on some occasions
Spitz nevus[25][26] Nonpigmented Spitz nevus
  • Pink
  • Smooth
  • < 1 cm
Reed-like Spitz[27]
  • Smooth
  • < 1 cm
Solar lentigo[28]
  • Multiple spots
  • Brown
  • Smooth
  • Around 5mm
  • Associated with UV exposure and skin aging
Sebaceous hyperplasia[29]
  • Skin-colored to brownish
  • 2 - 6 mm
  • Structureless yellow to whitish center surrounded by short linear "crown vessels"
  • Usually in middle-aged or older patients
Lichen planus-like keratosis[30]
  • Gray to brown
  • Prominent
  • Variable
  • Appearance depends on stage of evolution

References

  1. ↑ Petter G, Haustein UF (2000). "Histologic subtyping and malignancy assessment of cutaneous squamous cell carcinoma". Dermatol Surg. 26 (6): 521–30. PMID 10848931.
  2. ↑ Kwiek B, Schwartz RA (2016). "Keratoacanthoma (KA): An update and review". J Am Acad Dermatol. 74 (6): 1220–33. doi:10.1016/j.jaad.2015.11.033. PMID 26853179.
  3. ↑ Lee, MiWoo; Lee, WooJin; Jung, JoonMin; Won, ChongHyun; Chang, SungEun; Choi, JeeHo; Moon, KeeChan (2015). "Clinical and histological patterns of dermatofibroma without gross skin surface change: A comparative study with conventional dermatofibroma". Indian Journal of Dermatology, Venereology, and Leprology. 81 (3): 263. doi:10.4103/0378-6323.154795. ISSN 0378-6323.
  4. ↑ Mentzel, Thomas; Wiesner, Thomas; Cerroni, Lorenzo; Hantschke, Markus; Kutzner, Heinz; Rütten, Arno; Häberle, Michael; Bisceglia, Michele; Chibon, Frederic; Coindre, Jean-Michel (2012). "Malignant dermatofibroma: clinicopathological, immunohistochemical, and molecular analysis of seven cases". Modern Pathology. 26 (2): 256–267. doi:10.1038/modpathol.2012.157. ISSN 0893-3952.
  5. ↑ Bernard, J.; Poulalhon, N.; Argenziano, G.; Debarbieux, S.; Dalle, S.; Thomas, L. (2013). "Dermoscopy of dermatofibrosarcoma protuberans: a study of 15 cases". British Journal of Dermatology. 169 (1): 85–90. doi:10.1111/bjd.12318. ISSN 0007-0963.
  6. ↑ Acosta, Alvaro E.; Vélez, Catalina Santa (2017). "Dermatofibrosarcoma Protuberans". Current Treatment Options in Oncology. 18 (9). doi:10.1007/s11864-017-0498-5. ISSN 1527-2729.
  7. ↑ Cesarman, Ethel; Damania, Blossom; Krown, Susan E.; Martin, Jeffrey; Bower, Mark; Whitby, Denise (2019). "Kaposi sarcoma". Nature Reviews Disease Primers. 5 (1). doi:10.1038/s41572-019-0060-9. ISSN 2056-676X.
  8. ↑ Hu, S C-S; Ke, C-L K; Lee, C-H; Wu, C-S; Chen, G-S; Cheng, S-T (2009). "Dermoscopy of Kaposi's sarcoma: Areas exhibiting the multicoloured 'rainbow pattern'". Journal of the European Academy of Dermatology and Venereology. 23 (10): 1128–1132. doi:10.1111/j.1468-3083.2009.03239.x. ISSN 0926-9959.
  9. ↑ Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE (2010). "Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study". J Cutan Pathol. 37 (1): 20–7. doi:10.1111/j.1600-0560.2009.01370.x. PMID 19638070.
  10. ↑ Wolberink EA, Pasch MC, Zeiler M, van Erp PE, Gerritsen MJ (2013). "High discordance between punch biopsy and excision in establishing basal cell carcinoma subtype: analysis of 500 cases". J Eur Acad Dermatol Venereol. 27 (8): 985–9. doi:10.1111/j.1468-3083.2012.04628.x. PMID 22759209.
  11. ↑ Wrone DA, Swetter SM, Egbert BM, Smoller BR, Khavari PA (1996). "Increased proportion of aggressive-growth basal cell carcinoma in the Veterans Affairs population of Palo Alto, California". J Am Acad Dermatol. 35 (6): 907–10. PMID 8959949.
  12. ↑ Errichetti E, Piccirillo A, Stinco G (2015). "Dermoscopy of prurigo nodularis". J Dermatol. 42 (6): 632–4. doi:10.1111/1346-8138.12844. PMID 25808786.
  13. ↑ Weigelt N, Metze D, Ständer S (2010). "Prurigo nodularis: systematic analysis of 58 histological criteria in 136 patients". J Cutan Pathol. 37 (5): 578–86. doi:10.1111/j.1600-0560.2009.01484.x. PMID 20002240.
  14. ↑ Witt C, Krengel S (2010). "Clinical and epidemiological aspects of subtypes of melanocytic nevi (Flat nevi, Miescher nevi, Unna nevi)". Dermatol Online J. 16 (1): 1. PMID 20137743.
  15. ↑ Connolly KL, Giordano C, Dusza S, Busam KJ, Nehal K (2019). "Follicular involvement is frequent in lentigo maligna: Implications for treatment". J Am Acad Dermatol. 80 (2): 532–537. doi:10.1016/j.jaad.2018.07.071. PMC 6333487. PMID 30266559.
  16. ↑ Connolly KL, Giordano C, Dusza S, Busam KJ, Nehal K (2019). "Follicular involvement is frequent in lentigo maligna: Implications for treatment". J Am Acad Dermatol. 80 (2): 532–537. doi:10.1016/j.jaad.2018.07.071. PMC 6333487. PMID 30266559.
  17. ↑ Argenziano G, Ferrara G, Francione S, Di Nola K, Martino A, Zalaudek I (2009). "Dermoscopy--the ultimate tool for melanoma diagnosis". Semin Cutan Med Surg. 28 (3): 142–8. doi:10.1016/j.sder.2009.06.001. PMID 19782937.
  18. ↑ Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F; et al. (2003). "Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet". J Am Acad Dermatol. 48 (5): 679–93. doi:10.1067/mjd.2003.281. PMID 12734496.
  19. ↑ Menzies, Scott W.; Moloney, Fergal J.; Byth, Karen; Avramidis, Michelle; Argenziano, Giuseppe; Zalaudek, Iris; Braun, Ralph P.; Malvehy, Josep; Puig, Susana; Rabinovitz, Harold S.; Oliviero, Margaret; Cabo, Horacio; Bono, Riccardo; Pizzichetta, Maria A.; Claeson, Magdalena; Gaffney, Daniel C.; Soyer, H. Peter; Stanganelli, Ignazio; Scolyer, Richard A.; Guitera, Pascale; Kelly, John; McCurdy, Olivia; Llambrich, Alex; Marghoob, Ashfaq A.; Zaballos, Pedro; Kirchesch, Herbert M.; Piccolo, Domenico; Bowling, Jonathan; Thomas, Luc; Terstappen, Karin; Tanaka, Masaru; Pellacani, Giovanni; Pagnanelli, Gianluca; Ghigliotti, Giovanni; Ortega, Blanca Carlos; Crafter, Greg; Ortiz, Ana María Perusquía; Tromme, Isabelle; Karaarslan, Isil Kilinc; Ozdemir, Fezal; Tam, Anthony; Landi, Christian; Norton, Peter; Kaçar, Nida; Rudnicka, Lidia; Slowinska, Monika; Simionescu, Olga; Di Stefani, Alessandro; Coates, Elliot; Kreusch, Juergen (2013). "Dermoscopic Evaluation of Nodular Melanoma". JAMA Dermatology. 149 (6): 699. doi:10.1001/jamadermatol.2013.2466. ISSN 2168-6068.
  20. ↑ Phan A, Dalle S, Touzet S, Ronger-Savlé S, Balme B, Thomas L (2010). "Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population". Br J Dermatol. 162 (4): 765–71. doi:10.1111/j.1365-2133.2009.09594.x. PMID 19922528.
  21. ↑ Steglich RB, Meotti CD, Ferreira MS, Lovatto L, de Carvalho AV, de Castro CG (2012). "Dermoscopic clues in the diagnosis of amelanotic and hypomelanotic malignant melanoma". An Bras Dermatol. 87 (6): 920–3. PMC 3699915. PMID 23197217.
  22. ↑ Witt C, Krengel S (2010). "Clinical and epidemiological aspects of subtypes of melanocytic nevi (Flat nevi, Miescher nevi, Unna nevi)". Dermatol Online J. 16 (1): 1. PMID 20137743.
  23. ↑ Bauer J, Garbe C (2003). "Acquired melanocytic nevi as risk factor for melanoma development. A comprehensive review of epidemiological data". Pigment Cell Res. 16 (3): 297–306. PMID 12753404.
  24. ↑ Granter SR, McKee PH, Calonje E, Mihm MC, Busam K (2001). "Melanoma associated with blue nevus and melanoma mimicking cellular blue nevus: a clinicopathologic study of 10 cases on the spectrum of so-called 'malignant blue nevus'". Am J Surg Pathol. 25 (3): 316–23. PMID 11224601.
  25. ↑ Luo S, Sepehr A, Tsao H (2011). "Spitz nevi and other Spitzoid lesions part I. Background and diagnoses". J Am Acad Dermatol. 65 (6): 1073–84. doi:10.1016/j.jaad.2011.04.040. PMC 3217183. PMID 22082838.
  26. ↑ Argenziano G, Agozzino M, Bonifazi E, Broganelli P, Brunetti B, Ferrara G; et al. (2011). "Natural evolution of Spitz nevi". Dermatology. 222 (3): 256–60. doi:10.1159/000326109. PMID 21494025.
  27. ↑ Pedrosa AF, Lopes JM, Azevedo F, Mota A (2016). "Spitz/Reed nevi: a review of clinical-dermatoscopic and histological correlation". Dermatol Pract Concept. 6 (2): 37–41. doi:10.5826/dpc.0602a07. PMC 4866625. PMID 27222770.
  28. ↑ Tanaka M, Sawada M, Kobayashi K (2011). "Key points in dermoscopic differentiation between lentigo maligna and solar lentigo". J Dermatol. 38 (1): 53–8. doi:10.1111/j.1346-8138.2010.01132.x. PMID 21175756.
  29. ↑ Sato T, Tanaka M (2014). "Linear sebaceous hyperplasia on the chest". Dermatol Pract Concept. 4 (1): 93–5. doi:10.5826/dpc.0401a16. PMC 3919849. PMID 24520522.
  30. ↑ Morgan MB, Stevens GL, Switlyk S (2005). "Benign lichenoid keratosis: a clinical and pathologic reappraisal of 1040 cases". Am J Dermatopathol. 27 (5): 387–92. PMID 16148406.
Retrieved from "https://www.wikidoc.org/index.php?title=Squamous_cell_carcinoma_of_the_skin_differential_diagnosis&oldid=1580828"