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{{SK}} Pilomatrixoma; Calcifying Epithelioma of Malherbe; Epithelioma cuniculatum; Carcinoma cuniculatum; Superficial epithelioma
{{SK}} Pilomatrixoma; Calcifying Epithelioma of Malherbe; Epithelioma cuniculatum; Carcinoma cuniculatum; Superficial epithelioma
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Epithelioma is an [[tumor|abnormal growth]] of the [[epithelium]], which is the layer of tissue that covers the surfaces of organs and other structures of the body.  
Epithelioma is an [[tumor|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==
==Historical Perspective==
*Epithelioma cuniculatum was first discovered by Aird et al in 1954.<ref name="pmid13219306">{{cite journal| author=AIRD I, JOHNSON HD, LENNOX B, STANSFELD AG| title=Epithelioma cuniculatum: a variety of squamous carcinoma peculiar to the foot. | journal=Br J Surg | year= 1954 | volume= 42 | issue= 173 | pages= 245-50 | pmid=13219306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13219306  }} </ref>
*Epithelioma cuniculatum was first discovered by Aird et al. in 1954.<ref name="pmid13219306">{{cite journal| author=AIRD I, JOHNSON HD, LENNOX B, STANSFELD AG| title=Epithelioma cuniculatum: a variety of squamous carcinoma peculiar to the foot. | journal=Br J Surg | year= 1954 | volume= 42 | issue= 173 | pages= 245-50 | pmid=13219306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13219306  }} </ref>
* Epithelioma cuniculatum is derived from the words epitheliomameans "tumor of the epithelium"and cuniculate refers to crypt-like spaces seen on histology that resemble rabbit burrows.
* 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==
==Classification==
*Epithelioma may be classified according to nature of tumor into 2 subtypes:
*The term epithelioma is usually considered for skin tumors originating from the epithelial origin also known as carcinoma cutis<ref>{{cite journal|doi=10.1158/ajc.1939.179}}</ref>. However, epithelial tumors can arise from any epithelial lining of the organs including [[Ovarian cancer|ovarian]], [[Uterine cancer|uterine]], glands, [[prostate]], [[Thyroid cancer|thyroid]], [[Lacrimal gland tumor (patient information)|lacrimal gland]] among others
:* [[Benign growths]]  
*Epithelioma may be classified according to nature of tumor into 2 sub-types:
:* [[Carcinoma|Malignant carcinomas]]
**[[Benign tumor|Benign growths]]
* Other variants of epithelioma according to the specific type of epithelial cells that are affected include [[basal cell carcinoma]] and [[squamous cell carcinoma]].
**[[Carcinoma|Malignant carcinomas]]
***[[Basal cell carcinoma]]
***[[Squamous cell carcinoma]]
***Mixed or squamo-basal
* [[Basal cell carcinoma|Basal]] and the [[Squamous cell carcinoma|squamous cell carcinomas]] are the most common types of epithelioma's
==Pathophysiology==
==Pathophysiology==
*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
*On gross pathology, bulky [[exophytic]] mass are characteristic findings of epithelioma. However there is a variance in the presentation of epithelioma
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
*Clinical picture can range anywhere from superficial to deep, simple papillary to nodular appearance, fungoid, ulcerated, or cauliflower shaped
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*On microscopic histopathological analysis, endophytic and exophytic growth pattern, [[histiocytes]], [[eosinophils]], [[plasma cells]], [[hyperchromasia]], and [[mitoses]] are characteristic findings of epithelioma.
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
==Causes==
==Causes==
* Epithelioma may be caused by either trauma, chronic irritation,and HPV infection
*Epithelioma of the skin may be caused by<ref name="pmid181473622">{{cite journal| author=RATTNER H, RODIN H| title=Epithelioma. | journal=Q Bull Northwest Univ Med Sch | year= 1949 | volume= 23 | issue= 3 | pages= 370-4 | pmid=18147362 | doi= | pmc=3802892 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18147362  }}</ref>;
==Differentiating [disease name] from other Diseases==
**[[trauma]]
*[Disease name] must be differentiated from other diseases that cause
**Chronic irritation
[clinical feature 1], [clinical feature 2], and [clinical feature 3],
**[[HPV]] infection
such as:
**Prolonged sun exposure
:*[Differential dx1]
**Occupational exposure to tar<ref name="pmid132194092">{{cite journal| author=ALEXANDER JO, MACROSSON KI| title=Epithelioma due to tar ointment. | journal=Br Med J | year= 1955 | volume= 1 | issue= 4908 | pages= 287 | pmid=13219409 | doi= | pmc=2060973 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13219409  }}</ref> and certain oils
:*[Differential dx2]
**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;
:*[Differential dx3]
***[[Senile Keratosis]]
==Epidemiology and Demographics==
***[[Leukoplakia]]
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
***[[Radiation dermatitis]]
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
***[[Xeroderma]]
***[[Cutaneous horns]]
***Old scars
***Chronic ulceration
***[[Wart|Warts]]
***[[Sebaceous cyst]]<nowiki/>s
***[[Pigmented nevi]]
***[[Psoriasis|Psoriatic]] or [[Eczema|eczematous]] lesions
***[[SLE]] skin lesions
***<nowiki/>[[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<ref name="pmid2312827">{{cite journal| author=Chuang TY, Popescu A, Su WP, Chute CG| title=Basal cell carcinoma. A population-based incidence study in Rochester, Minnesota. | journal=J Am Acad Dermatol | year= 1990 | volume= 22 | issue= 3 | pages= 413-7 | pmid=2312827 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2312827  }}</ref>==
===Age===
===Age===
*Patients of all age groups may develop [disease name].
*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.
*[Disease name] is more commonly observed among patients aged [ag range] years old.
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
===Gender===
===Gender===
*[Disease name] affects men and women equally.
*Males are more commonly affected with epithelioma as compared to females.
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
===Race===
===Race===
*There is no racial predilection for [disease name].
*Epithelioma is seen more commonly in Caucasians.
*[Disease name] usually affects individuals of the [race 1] race.
*Not common in dark skinned people
*[Race 2] individuals are less likely to develop [disease name].
==Risk Factors==
==Risk Factors==
*Common risk factors in the development of epithelioma are trauma, chronic irritation, and HPV infection.
*Common risk factors in the development of epithelioma are trauma, chronic irritation, and [[Human papillomavirus|HPV i]]<nowiki/>nfection, prolonged sun exposure as well as occupational exposure to tar<ref name="pmid132194092" /> and certain oils. An additional risk factor is the presence of benign skin conditions called pre-cancerous dermatosus which include [[warts]],[[dermatitis]], [[leukoplakia]], [[eczema]]<nowiki/>tous or psoriatic liesions, [[sebborhic keratosis]], [[SLE]] skin lesions, nevi and cutaneous horns.
 
==Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
===Prognosis===
===Prognosis===
The prognosis varies dramatically, depending on the type and stage at the time of treatment. However, the most common epitheliomas are very easily treated and rarely result in death.
*The prognosis of the epithelioma is variable, depending on the type, location, extent and stage at the time of diagnosis and hence treatment.
== Diagnosis ==
*However, most of the epitheliomas can be treated easily and the prognosis is good
===Diagnostic Criteria===
==Diagnosis==
*The diagnosis of [disease name] is made when at least [number] of the
===Symptoms===
following [number] diagnostic criteria are met:
*Epithelioma of the skin can present in any form, usually easy to diagnose. Some of the presentations may include:
:*[criterion 1]
**New mole/growing mole/mole changing color
:*[criterion 2]
**New or growing warty lesion
:*[criterion 3]
**Painless swelling
:*[criterion 4]
**Indurated or ulcerated lesion
=== Symptoms ===
**Chronic scar that starts bleeding or changing
*[Disease name] is usually asymptomatic.
* Epithelial tumors of the organs can present in any way ranging from swelling or mass to symptoms related to involved organ system
*Symptoms of [disease name] may include the following:
===Physical Examination===
:*[symptom 1]
*Physical examination for epithelioma of the skin may be remarkable for:
:*[symptom 2]
**Non tender swelling
:*[symptom 3]
**Hard, waxy nodules with pearly borders
:*[symptom 4]
**Ulceration or Induration
:*[symptom 5]
===Laboratory Findings===
:*[symptom 6]
*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.
=== Physical Examination ===
===Other Diagnostic Studies===
*Patients with [disease name] usually appear [general appearance].
*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.
*Physical examination may be remarkable for:
:*[finding 1]
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]
=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].
*A [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].
*[Imaging study 1] is the imaging modality of choice for [disease name].
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
==Treatment==
==Treatment==
Treatment usually involves surgically removing the tumor and affected tissue.
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<ref name="pmid6823454">{{cite journal| author=Browder JP, Tomsick RS| title=Basal cell epithelioma. Types, treatment methods, and prognosis. | journal=Postgrad Med | year= 1983 | volume= 73 | issue= 2 | pages= 161-8 | pmid=6823454 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6823454  }}</ref><ref name="pmid85061712">{{cite journal| author=Hacker SM, Browder JF, Ramos-Caro FA| title=Basal cell carcinoma. Choosing the best method of treatment for a particular lesion. | journal=Postgrad Med | year= 1993 | volume= 93 | issue= 8 | pages= 101-4, 106-8, 111 | pmid=8506171 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8506171  }}</ref>
=== Medical Therapy ===
*Surgical excision
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*Irraditation
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*Electrocauterisation
*[Medical therapy 1] acts by [mechanism of action1].
*Combination Therapy- Surgery plus electrocauteristaion plus irradiation
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
**Involves curreting the lesion under local anesthesia followed by cauterization of the base by the chemical method(zinc chloride or nitrate) followed by irradiation
=== Surgery ===
*Combination therapy - Surgery plus radiation (usually used in case of advanced tumors with metastasis or infilltration)
*Surgery is the mainstay of therapy for [disease name].
Some other treatment options include:
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
* Cryosurgery
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
* Podophyllin
=== Prevention ===
* Treatment with tissue extract
*There are no primary preventive measures available for [disease name].
* Chemosurgery - usually for recurrent basal cell epitheliomas
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
*Once diagnosed and successfully treated, patients with [disease name] are followedup every [duration]. Followup testing includes [test 1], [test 2], and [test 3].
*  
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 16:31, 7 January 2019

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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

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

Differentiating Epithelioma from other Diseases

  • Epithelioma must be differentiated from other diseases that cause skin masses, such as:

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

  1. ↑ 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.
  2. ↑ . doi:10.1158/ajc.1939.179. Missing or empty |title= (help)
  3. ↑ RATTNER H, RODIN H (1949). "Epithelioma". Q Bull Northwest Univ Med Sch. 23 (3): 370–4. PMC 3802892. PMID 18147362.
  4. ↑ 4.0 4.1 ALEXANDER JO, MACROSSON KI (1955). "Epithelioma due to tar ointment". Br Med J. 1 (4908): 287. PMC 2060973. PMID 13219409.
  5. ↑ 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.
  6. ↑ Browder JP, Tomsick RS (1983). "Basal cell epithelioma. Types, treatment methods, and prognosis". Postgrad Med. 73 (2): 161–8. PMID 6823454.
  7. ↑ 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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