Epithelioma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]Ammu Susheela, M.D. [3]

Synonyms and keywords: Pilomatrixoma; Calcifying Epithelioma of Malherbe; Epithelioma cuniculatum; Carcinoma cuniculatum; Superficial epithelioma

Overview

Epithelioma is an abnormal growth of the epithelium, which is the layer of tissue that covers the surfaces of organs and other structures of the body.

Historical Perspective

• Epithelioma cuniculatum was first discovered by Aird et al. in 1954.
• Epithelioma cuniculatum is derived from the words epithelioma, meaning "tumor of the epithelium," and cuniculate, referring to crypt-like spaces seen on histology that resemble rabbit burrows.

Classification

• The term epithelioma is usually considered for skin tumors originating from the epithelial origin also known as carcinoma cutis. However, epithelial tumors can arise from any epithelial lining of the organs including ovarian, uterine, glands, prostate, thyroid, lacrimal gland among others
• Epithelioma may be classified according to nature of tumor into 2 sub-types:
  • Benign growths
  • Malignant carcinomas
    • Basal cell carcinoma
    • Squamous cell carcinoma
    • Mixed or squamo-basal

Pathophysiology

• On gross pathology, bulky exophytic mass are characteristic findings of epithelioma. However there is a variance in the presentation of epithelioma
• Clinical picture can range anywhere from superficial to deep, simple papillary to nodular appearance, fungoid, ulcerated, or cauliflower shaped
• On microscopic histopathological analysis, endophytic and exophytic growth pattern, histiocytes, eosinophils, plasma cells, hyperchromasia, and mitoses are characteristic findings of epithelioma.

Causes

• Epithelioma of the skin may be caused by;
  • trauma
  • Chronic irritation
  • HPV infection
  • Prolonged sun exposure
  • Occupational exposure to tar and certain oils
  • Pre-cancerous dermatosus - these are the benign skin lesions that develop as a result of trauma or any other condition that may serve as a base for development of epithelial skin cancers. examples include;
    • Senile Keratosis
    • Leukoplakia
    • Radiation dermatitis
    • Xeroderma
    • Cutaneous horns
    • Old scars
    • Chronic ulceration
    • Warts
    • Sebaceous cysts
    • Pigmented nevi
    • Psoriatic or eczematous lesions
    • SLE skin lesions
    • Lupus vulgaris

Differentiating Epithelioma from other Diseases

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

• Seborrheic keratosis with sebaceous differentiation
• Sebaceous hyperplasia
• Sebaceous adenoma
• Sebaceous carcinoma

Epidemiology and Demographics

Age

• Epithelioma is more commonly observed among older patients above 50 years of age.

Gender

• Males are more commonly affected with epithelioma than females.

Race

• Epithelioma usually affects individuals of the Caucasian race.

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 and certain oils. An additional risk factor is the presence of benign skin conditions called re-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 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.

Diagnosis

Symptoms

• Symptoms of epithelioma may include the following:

• Painless swelling

Physical Examination

• Physical examination may be remarkable for:

• Nontender swelling

Laboratory Findings

• There are no specific laboratory findings associated with epithelioma.

Other Diagnostic Studies

• Epithelioma may also be diagnosed using biopsy.

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. Some common treatment methods include

• Surgical excision
• Irraditation
• Electrocauterisation
• Combination therapy - Surgery plus radiation (usually used in case of advanced tumors with metastasis or infliltration)

References

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