Diagnosis and management of premalignant skin lesions

THE DIAGNOSIS and appropriate management of premalignant skin lesions are important because these lesions have a serious potential. Salient features of specific conditions are provided. The most common premalignant lesion in whites is actinic keratosis, and a high percentage of these keratoses exhibit mutation of the p53 tumor suppressor gene. A significant proportion of any group chronically exposed to arsenic develops keratoses, and although many agricultural products contain arsenic, few patients are aware of that fact. Although progression of leukoplakia to squamous cell carcinoma is uncommon, its occurrence is important because this carcinoma metastasizes more frequently than cutaneous squamous carcinoma. Dysplastic nevi are precursors of cutaneous melanoma and occur clinically as sporadic cases or in a familial setting. Sebaceous nevi are congenital tumors usually seen on the scalp or face. Because of their unsightly appearance and risk of malignant change, they are generally excised during childhood. The incidence of skin cancer continues to increase, and all physidans should be aware of the importance of recognizing premalignant skin and mucosal lesions.